A LONG ROAD

Medical providers and patients navigate the uneven terrain in a battle to secure access to proper health care.

In Appalachia, the rolling hills keep people and services they need at a distance. For many, daily life typically involves extended periods of travel to and from, as well as unreliable cellphone coverage. For those who do not have access to reliable transportation or may be confined by the landscape, a miniscule task can seem like a burden.

Athens County Emergency Medical Technicians (EMT) understand the impact of these situations because of the constant struggle to meet urgent medical demands of those isolated and living remotely.

RESPONDING IN
RURAL AREAS

Locating homes and finding reliable directions to accidents are major hurdles for providing necessary care that the Athens County Emergency Medical Service (EMS) first responders face on a daily basis. Rick Callebs, chief of Athens County EMS, recounted the search for a victim of a logging accident in February 2020.

While dispatch knew that the caller was located on Mountville Road, on the border of Athens and Morgan counties, the precise location was difficult to find.

The ambulance only knew the road and it is a particularly long road, the ambulance did not know which end to enter and had nothing to go on."
Rick Callebs, the chief of Athens County Medical Services (ACMS)

The accident wasn’t visible from the road. The EMTs had to choose one end of the road to begin on and travel until they could see the caller. According to Chief Callebs, this is just one example of many incidents in which locating a caller is problematic. As he describes it, the time it takes for some callers to reach dispatch and the time spent in locating the scene of the accident can be the difference between life and death.

It took 22 minutes for the EMTs to arrive at the Mountville Road location. The victim did not survive. While interviewing Callebs stated the victim may have died when the accident initially occurred.

Inside of EMS
The inside of an Athens County EMS ambulance holds a single sanitized gurney, which is used to help transfer patients to hospitals. (Photo | Meagan Deanne)

The Bureau of Workers’ Compensation is investigating as to whether or not the logging company, the employer of the victim, had provided a safe working environment.

Chief Callebs explained that inadequate cellphone coverage and unmarked roads are common issues encountered by his department when responding to emergency calls. Many regions in the county get poor or no cell service, requiring people to stand in one area of their house, or even outside of their house, in order to call 911. Many of these roads are unmarked, increasing the level of difficulty in searching for callers. According to Callebs, while county engineers are working to update signage in the area, signs are often knocked down by snow plows, may be vandalized or disappear for unknown reasons.

It’s not as simple as you find in an urban area where they just give you a street address and you can go there."

To reach a lot of these unmarked locations, EMT drivers use different forms of GPS systems, like Google Maps and Apple Maps. When these systems fail because of service issues or lack of information about the location, drivers are able to call back to a 911 operator to help locate the caller.

Common issues for which Athens EMS receives calls include shortness of breath, chest pain, lung problems, heart problems and long-term health issues. Southeast Ohio, compared to the rest of the state, experiences disproportionally high levels of some illnesses, such as cancer, heart disease and stroke, according to OhioHealth.

The combination of illness and lack of medical access has gained the attention of many health professionals in the area, who are seeking solutions that are accessible and reliable for patients. It is common for people who utilize the Mobile Health Clinic, a portable doctor’s office, to travel more than an hour to receive the care they need to survive.

PROVIDING HEALTH CARE OFF THE BEATEN PATH

David Pannell, 63, has diabetes and depends on the free care and prescriptions the unit provides. Having a free mobile health clinic available for Pannell has made it possible to be healthy, without the stress of additional bills that might not have been paid.

EMS workers at a home
David Pannell, a regular at the HCOM mobile clinic, gets his temperature taken by nurse Jessica Rutter. (Photo | Meagan Deanne)

Once a month, Panell and his wife wake up at their home in Marietta, load up their car with what they will need for the entire day, and make the half-hour drive along US-50 to Coolville. This is the closest mobile health unit location, and without it, the Pannells would have to drive an hour to Athens for a 20-minute health checkup.

“The mobile health units are essentially doctors’ offices on wheels,” explained Sherri Oliver, the Executive Director for Community Health Programs and the Area Health Education Center.

Oliver helps run a free clinic on Ohio University’s Athens campus through the Heritage College of Osteopathic Medicine, along with two mobile health units that serve 24 counties in Southeastern and Eastern Ohio. The mobile health units treat patients who are unable to afford a visit to the doctor for free.

The mobile health units are each forty feet long with two exam rooms. Both also have a waiting room for patients to fill out paperwork before meeting with a nurse. Nurse practitioners, medical students and registered nurses all travel in the mobile health unit to surrounding counties to provide medical care through various health clinics. These units present an opportunity for the Heritage College of Osteopathic Medicine (HCOM) students to gain hands-on experience while interacting with clients to provide a much-needed service.

360 degree photo shows the interior of one of the mobile health units. (360 Photo | Shelby Miller)

Pannell has been driving to the mobile health unit for over three years, and he plans to continue for as long as he can. He believes that the truck’s services are keeping him alive.

Dave getting his temperature taken
Jessica Rutter, a nurse at the HCOM mobile clinic, takes patient David Pannell’s blood pressure. (Photo | Meagan Deanne)
Without the help of these nurses and this mobile unit, I without a doubt would be 6 feet under...this truck has saved my life."

As of April 2020, the mobile health trucks have suspended their operations because of the COVID-19 pandemic.

Reflection of mobile clinic in puddle
Ohio University’s Heritage College of Osteopathic Medicine offers free medical care through a mobile health clinic outside of the Tecumseh Theater in Shawnee. (Photo | Shelby Miller)

MEETING THE GAP

While innovative programs like the mobile health units ensure physical access to healthcare for everyone, it cannot address every need. “Sometimes we could take that medical health unit within maybe two miles of your house, [but] if you don’t have a vehicle to get to us, sometimes we’re still not totally meeting that transportation gap,” Oliver described.

In order to meet that gap, Oliver finds herself and her colleagues at the Community Health Program using grants or community donations to give people gas cards in order to help people travel to their health clinics.

“We see a lot of people who have health insurance, but their health insurance has such a high deductible that they can’t really use it,” Oliver said. “So they’ll still come to the free clinic and they’ll still seek out our services because they can’t access health care in a traditional setting.”

Abandoned building in Shawnee with mobile clinic parked beside building
The Heritage College of Osteopathic Medicine team parks its mobile health clinic in the lot of an unoccupied building in Coolville. (Photo | Meagan Deanne)

When these members of the community do not see doctors regularly, their health issues can snowball into more protracted problems and lead to more intense situations for EMS. That is when the words of Sherri Oliver and Chief Callebs can collide.

Callebs said some community members may not call an ambulance because they cannot afford it. In these cases, many individuals seek medical care from services like those that Oliver oversees.

Once they enter the health care system in an emergency situation, the costs for care are higher than the initial visit would have been because their conditions require follow-up care. More doctor visits means more traveling, making it harder for those living farther away.

COMMUNITIES CREATING RESOURCES

In non-emergent cases, Athens County residents have access to transportation through the Hocking Athens Perry Community Action (HAPCAP). HAPCAP has been working in the Tri-County (Hocking, Athens and Perry) area since the early 1960s, according to the HAPCAP website. The organization seeks to provide critical services to help individuals become self-sufficient and improve their own quality of life.

One of the five divisions of the nonprofit’s focus is transportation. In HAPCAP’s transit office, Athens and Hocking County Mobility Manager Jessie Schmitzer plays a key role in managing the services that HAPCAP offers.

“Athens On Demand Transit is a door-to-door service that services all of Athens county and services anybody for any reason,” Schmitzer said. Originally created for senior citizens and individuals with disabilities, HAPCAP expanded Athens On Demand Transit for use by anyone, for the cost of $2 one way, beginning Jan. 1, 2020.

“I'm seeing a lot of people that might have recurring appointments that they can get transportation sometimes but not all the time,” Schmitzer said. “A big reason for that is because our transportation programs are really at capacity because there's such a huge need.”

The high demand for rides through HAPCAP-managed transportation programs can be an issue for riders relying on the program as their ticket to the doctor’s office. Schmitzer said that those needing a ride should call right away in order to reserve a ride once they have scheduled their next appointment.

[Medical access] it's all encompassing. So getting to the hospital, getting to the doctor, especially if it's a recurring appointment, that makes it really difficult to find that transportation constantly,"

“So, we got together with Athens On Demand Transit and Green Cab [an Athens-based cab service] and came up with this really cool collaboration. If someone is stranded at the emergency room, then OhioHealth staff can call either Athens On Demand Transit or Green Cab, depending on the time of day, and they could go pick them up at the cost of OhioHealth and then bring them back home,” Schmitzer said.

As of March 30, 2020, following the stay-at-home order enacted in response to the COVID-19 outbreak, HAPCAP has declared that Athens On Demand Transit will only be available for essential travel and activities, which include healthcare appointments, grocery stores, pharmacy and essential work locations. Athens On Demand Transit is also eliminating all fares and no longer providing service on Saturdays.

For Athens Public Transit, only one wheelchair and five seated passengers are allowed to be on the buses at one time in order to keep passengers at least six feet apart from one another.

REACTING TO COVID-19

As the coronavirus pandemic continues to challenge communities near and far, the availability of test kits is a subject that has demanded attention from state leaders. As far as the state’s access to test kits Rep. Jay Edwards., R-Nelsonville, says Ohio is “on par per capita with other areas of the state.” While Ohio Governor Mike Dewine says, “We can use all the testing we can get.”

OhioHealth O'Bleness Hospital has begun preparations for possible COVID-19 surges by erecting emergency “triage tents” outside of the hospital’s emergency department. As of April, 2020, the tents are being prepared as a precautionary measure only since the spread of COVID-19 in the community has not yet reached a level that requires patient triage.

Two tents are set up and a third will soon accompany them. Each tent will serve a different purpose. Patients are to be evaluated in the first tent, and the second and third tents will hold patients with confirmed or possible COVID-19 cases.

Paula Peterson, of Albany Ohio, says she is doing well despite the spread of COVID-19. “I'm doing really great, and I don't see why that couldn't continue,” she said.

Peterson said she is well-isolated to begin with, so the pandemic has not changed her life much. Peterson lives in a senior housing facility with independent living. She says she now washes her hands more and disinfects her apartment once a week.

Although this time has been mostly stress-free for Peterson, she is concerned for her daughter-in-law, who was in the emergency room being tested for COVID-19 at the time of the interview. “That’s stressing me out,” she said.

Peterson has been using FaceTime to talk to her family during this time.

Despite her concern for her daughter-in-law, Peterson reiterated that she is not worried overall. “I'm really not terribly worried about it,” Peterson said. “My family has been really good about staying away since everything went to lockdown.”

Aside from her COVID-19 quarantine, Peterson manages a back injury from 2008 that requires in-home care and long-distance doctor’s appointments. Peterson had back surgery for a fractured vertebra, during which doctors discovered she also had severe scoliosis. Peterson normally uses alternative long-distance medical transportation. She feels satisfied with her two medical care services: Hopewell and PASSPORT.

Through PASSPORT, a waiver program administered through Ohio Medicaid, Peterson is assigned a nurse case manager and receives support from a home health aide two days a week.

“They've really helped me out a lot,” Peterson said. “If I've got to go even as far as Columbus to the doctors, PASSPORT will pay for it.”

Despite the help of community initiatives like HCOM, HAPCAP and local EMS services, the fight for better medical access in Southeastern Ohio continues to be an issue for many community members. The path to securing access for all remains unclear.

CREDITS

© 2020. Ohio University, School of Visual Communication