In Boston, a mobile clinic meets health needs in the neighborhood

BOSTON — By 9 a.m. on a recent Friday morning, the bright blue, colorfully branded van was already parked on a street in the Boston neighborhood of Dorchester. And while the street was still quiet, the community health workers were waiting inside for things to soon pick up.

On that particular morning, about 10 people stopped inside the Family Van, a mobile clinic run by Harvard Medical School that provides free, basic care four days a week. There, two community health workers and a supervisor worked steadily, checking each person’s blood pressure and blood sugar, then handing them a chilled bottle of water. Outside, a third community health worker who doubles as a driver spoke with people passing by, while two summer interns staffed a table with informational health fliers.

One of the people who walked in was a familiar face: a middle-aged woman named Emily.

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“I come to check on my health because sometimes I see a doctor every four to six months,” Emily said in Cape Verdean Creole, her words translated by community health worker Simone de Oliveira. “I first saw the van many years ago. I would pass by, I would see the van. And one day I got in. Ever since, I saw what they do and I come every Friday.”

The Family Van offers a paper card with 12 fields each to jot down weekly blood pressure and sugar measurements. Emily has come back so often she’s moved on to a second sheet of paper; others have a third or a fourth.

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By coming each week, specific health workers can build a rapport with specific clients, particularly if they can speak the same language. “People who are Portuguese speakers, sometimes they come to see me,” said de Oliveira, who grew up in Brazil and speaks Brazilian Portuguese and Spanish. Other people might go to see her colleague who speaks Haitian Creole, or another community health worker who speaks Spanish.

“The people count on it, like Emily here,” de Oliveira added. “She knows that the van’s going to be here. And whenever the van’s not here, whenever we’re not here, next time we’re here, she comes and she tells like ‘You guys weren’t here, what happened to you guys?’”

For years, roving clinics like the Family Van have hit roads across the country to reach millions of people who might not otherwise have access to medical care. In rural Appalachia, a Health Wagon started 40 years ago out of a Volkswagen Beetle has recently delivered Covid-19 vaccines and treatments to thousands. A mobile pharmacy started with a Ford Fusion in 2015 was called by the Ohio governor to operate 30 Covid vaccination sites in 10 counties. Colorado’s Department of Human Services has experienced such success with roving units that prescribe medications to treat opioid use disorder that they will soon partner with the state public health department to offer rapid hepatitis testing, too.

The work of mobile clinics grew all the more important during the Covid-19 pandemic, when health care saw widespread disruptions. The Family Van still operated during this slowdown by calling people to check their wellbeing, delivering masks, and handing out gift cards. “When they say front-line workers, meaning you are front-line,” said Rainelle Walker-White, “the Family Van stayed.” Walker-White has worked with the Family Van for 28 of its 30 years.

That kind of commitment isn’t just good for the health of a community — it’s good for business, the team behind the Family Van argued in a recent report. Mobile clinics boost staff morale, and so can reduce employee burnout and turnover, they added. They improve brands and earn organizations positive recognition, too. Given the lower start-up costs of a mobile unit, these clinics are also a way for health systems to study the need in a particular area before deciding whether to build a brick-and-mortar site.

If traffic is low in one area, vehicles can simply head somewhere else. The Family Van, for example, used to stop in the Mattapan neighborhood, where they received a high patient volume, until an unaffiliated community health center opened a clinic on the same corner. Some clients still preferred the van’s services, but they moved to East Boston where they perceived a higher need.

The Family Van doesn’t just do blood pressure and blood sugar checks. Before the pandemic, when the team was working out of a larger van, they also tested and counseled people about HIV and sexually transmitted infections. In the past year, they have started educating people about mental health as well.

When needed, the community health workers will set up appointments for clients with community health centers or hospitals. And they don’t stop there — they call to make sure the client made their appointment and reschedule if not. Often, being a point of contact also means helping people navigate the complexities of the health care system, whether that’s applying for Medicaid or figuring out what to do with a big hospital bill. People will just show up with letters, said Mollie Williams, executive director of the Family Van. “We can’t necessarily solve that for them, but we can be a second pair of eyes and read it for them, help them understand what it’s saying, and then help them figure out what the next step is.”

Many mobile clinics are dedicated to providing routine care to people in far-flung areas, where health care is hard to access. That isn’t inherently a problem in Boston, where, as Williams said, “there’s a doctor on every corner.” But the Family Van is trying to combat a unique, more complicated set of barriers.

“Even for me as someone with more than adequate resources and time, an education, trying to get an appointment, get to that appointment, communicate with my doctor about what I need, follow-up on what they tell me to do, I encounter many barriers,” she said. “And when you layer on top of that financial struggles or emotional struggles or lack of social support, or the experience of racism and classism in the health care system, for our clients, it’s a much more difficult experience getting health care.”

Those challenges can be compounded when people are uninsured, or underinsured, and struggle to pay for their care. In Massachusetts, over 97.5% of residents have health insurance, compared to 92% of Americans nationally. Yet, two in five people say that they have trouble affording health care. That can lead to health issues — and higher costs — down the line.

Based on estimating their impact in decreasing unnecessary emergency trips to the hospital and increasing lifespan through preventive screening, the Family Van team has previously estimated that the mobile clinic saved close to $36 for every $1 spent on the program. Clients who visited twice had reduced blood pressure readings, which in turn lowered their heart attack and stroke risk.

The mobile clinic has another advantage: the diverse identities and backgrounds of the community health workers who staff it.

“The truth is, it’s not really helpful for me to be here,” said Williams, even though she can speak Spanish. “One of the things that makes the van a safe place is that it is run by people from the community who look like them, who speak the same language, and who meet them where they are. And as a white woman who doesn’t blend in well to, say, Upham’s Corner, and who doesn’t have the same lived experiences as the people on our van, I’m not the best one to deliver care.”

Williams said that by being able to meet people where they are — and make them comfortable — the mobile clinic can provide care in a way that can be hard to pull off in a traditional medical setting. In some cases, they’re more willing to share personal information without fear of judgment. “People don’t hold back when they come on the Family Van,” she said.

The staff also places a premium on building not just trust, but a sense of comfort, connection, and consistency with the people the mobile clinic serves.

“People love to be comfortable, like they love seeing us in the area every week,” said Thanex Louis, who works with the Family Van as a project manager at Mobile Health Map, a Harvard program that maps out the locations and services of mobile clinics throughout the country. Louis and his family had little access to health care while he was growing up in Haiti, and that experience has helped him connect with the people who step into the van. “People trust that we’re all friends,” he said.

Part of that effort to build relationships: calling people who come into the van “clients,” not “patients.”  To Williams, it’s a subtle way to signal that “our job is to meet their needs.”

Williams and the rest of the team behind the Family Van have expanded their work to support national-level initiatives as well, making the case that mobile clinics are an investment in health equity and in better outcomes. (The Family Van costs about $700,000 a year to run.) They can also alleviate problems with public transportation, Williams said.

And mobile clinics like the Family Van have the potential to show health systems what, exactly, people in their communities need.

“You can’t get more patient-centered than a van parked across from your local dollar store or your local liquor store,” Williams said. “ And I think that’s part of our secret sauce.”