Mobile Clinics: “Health on Wheels”

posted on February 5, 2019

Lincoln Cushing, Heritage writer

 

Kaiser Foundation School of Nursing student members of Kaiser Black Student Nurses’ Association serving on mobile Foot Health Clinic, 1972

If you can’t easily get patients to a clinic, what do you do?

Take the clinic to the patients.

This year, a Kaiser Permanente grant to the Healthy Smiles Mobile Dental Foundation in Fresno, California, paid for a brand-new recreational vehicle that’s been transformed into a dental clinic on wheels, complete with exam space, X-ray machines, and dental equipment. Several hygienists and dentists work inside the clinic, cleaning children’s teeth, and filling cavities.

It’s a model that’s been researched in the medical literature — and, because of long history in mobile medicine, we know that it works.

Early innovations in mobile medicine

In the early 1970s, Kaiser Permanente undertook several projects to test the feasibility of mobile health vans to serve underrepresented communities. One was rural, one was urban.

STARPAHC mobile health unit with medical personnel, neonatal patient and mother, 1970s

The rural example was “STARPAHC” — short for Space Technology Applied to Rural Papago Advanced Health Care. Kaiser Permanente and NASA partnered with Arizona’s Papago Indian Reservation to test the practicality of the emerging field of telemedicine. The project used the real needs of a remote earth-bound population to see how technology and routines could work when providing health care for astronauts in outer space.

And in very urban Oakland, California, Kaiser Foundation School of Nursing student members of Kaiser Black Student Nurses’ Association served on a mobile Foot Health Clinic in 1972.

Our medical care keeps moving

Mobile health van, Kansas City Region, 1989

In 1988, Kaiser Permanente launched a Mobile Health Education and Screening Program in the Kansas City area. The 25-foot mobile van traveled to Kaiser Permanente medical offices as well as community organizations, local businesses, and public health fairs, where staff checked blood pressure and cholesterol levels, gave lifestyle assessment quizzes, and provided educational materials on a variety of health topics.

 

Southern California Care-A-Van, 1988

In Southern California, Kaiser Permanente had a similar program that operated out of a 38-foot Wellness Care-A-Van. It traveled as far north as Bakersfield and as far south as San Diego, reaching out to people in their communities, testing blood pressure and body fat. Frayne Rosenfield, Member Health Education administrator and Worksite Wellness Program coordinator, was enthusiastic about the service: “The van has been very well received. We see approximately 120 people a day, and the van is out 5 to 7 days a week.”

Kaiser Permanente also used the mobile van model for immunization drives in the 1990s.

Scan Van, Mid-Atlantic states, 2001

Kaiser Permanente’s 2001 Annual Report profiled a mobile bone-scan van used in the Mid-Atlantic states (complete with custom Maryland license plate “KPBONES”) to help members prevent and treat osteoporosis. It was staffed by Stephen Moki, radiology technologist and health educator, and Pat Brown, clinical assistant.

The Scan Van rotated among several Kaiser Permanente medical centers, spending 1 to 3 weeks at each facility before moving on. It proved to be a valuable outreach tool, and community organizations frequently called to request a visit from the van. Michael J. Moriarty, MD, vice president and associate medical director of Quality and Health Management, said, “I think that it helps to affirm our image as an innovator and a quality health care provider.”

Mobile health vans are in our future

In 2009, Kaiser Permanente in Hawaii celebrated the arrival of a mobile health vehicle. The 500-square-foot, 10-wheeled rolling clinic was fully wired, equipped with our electronic health record system, a digital mammography unit, and video telemedicine capability.

Hawaii Island Mobile Health Vehicle, 2009

The vehicle was designed to roam the Big Island, providing glucose and cholesterol screenings, mammograms, urinalysis, testing for sexually transmitted diseases, and vaccinations for the flu and pneumonia.

Billy Kenoi, the mayor of Hawaii County, praised the service when it was formally blessed July 2.

“I come from a 48,028 square mile island with incredible geographical and infrastructure challenges,” Kenoi said, “and the delivery of this Mobile Health Vehicle will improve not only the health care available on the island of Hawaii, but ultimately, the quality of life for our island residents.”

 

The use of mobile health vans is now integrated into our health plan, visiting urban worksites and rural communities and saving members time and travel for many of their medical needs.

As Frayne Rosenfield said in 1988, “The van is out 5 to 7 days a week.”
That’s about as accessible as health care can get.

 

Also see: “Driver as Receptionist? Kern County union and management leaders work out innovative solution” to optimize mobile health van driver workload.

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The First Women Industrial Welders Weren’t Rosies

posted on January 23, 2019

Lincoln Cushing, Heritage writer

 

The nation is at war. A desolate stretch of waterfront is rapidly turned into a state-of-the-art shipyard, producing vessels for national defense. The huge demand for labor runs deep, and, for the first time ever, women are hired to perform electric welding on ships for the Navy.

The Kaiser Richmond shipyards, 1942? No.
Hog Island, just outside of Philadelphia, 1918.

“Sarah A. Erwin and Aina Kannisto at work at their welding machines.” The Baltimore Sun, 12/15/1918.

Although the powerful role of women on the World War II U.S. home front is well-known now as the story of “Rosie the Riveter,” the pioneering role of women 24 years earlier is all but forgotten.

Sarah A. Erwin was the first woman in the United States to be engaged in industrial ship construction. She applied for a job at the Hog Island shipyard in September 1918.

The managers put her in the electric welding department as a test of women’s abilities in this craft, where she did so well that the jobs were opened to 30 more women. The shipyard provided paid training, and the women fixed bad welds in the plate and angle shop. Erwin was followed by Anna Kenneste (or Aina Kannisto) and Mary Dunn. The women had to be between the ages of 24 and 35 and be “healthy and robust.”

The thousand-acre Hog Island yards were under the jurisdiction of the United States Shipping Board Emergency Fleet Corporation, had 50 shipways, and employed as many as 35,000 men and nearly 700 women.

Newspaper ad for women drivers at Hog Island shipyard, 10/5/1918.

Although only a handful of women worked as welders, other non-clerical positions included such jobs as drivers of “high power touring cars.” The newspaper want ads noted that, despite requiring the ability to change tires and perform engine cranking, “Women of poise and character only wanted.”

Like the World War II “Rosie the Riveter” and “Wendy the Welder” pioneers, the women welders at Hog Island were proud of their accomplishments. A November 30, 1918, article in the Pittsburgh Press quoted Kannisto as saying, “I would rather do electric welding than sell ribbons behind a counter or work in an office. The pay is better, and you have more independence. This war has driven out of the heads of many women the mistaken idea that they are only fit to look pretty and flatter their husbands.”

Alas, a generation later, on the other side of the country in the Kaiser shipyards, women would again have to blaze the same path. Yet Erwin’s contribution to the advancement of women in the workforce should not be forgotten.

Special thanks to History of Total Health reader Frank Trezza who pointed out this lost history.

 

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Steps from Rosie the Riveter, a New Ferry Service

posted on December 20, 2018

Lincoln Cushing, Heritage writer

 

Workers disembarking from Richmond ferry, Fore ‘n’ Aft, 9/24/1942

During World War II, Henry J. Kaiser’s job wasn’t just getting ships built. It also included providing the services all those workers needed — such as child care, housing, health care, and transportation. Fast forward through history, and a $20 million commuter ferry terminal is opening right next to the Rosie the Riveter World War II Home Front National Historical Park in Richmond, California, where thousands of Kaiser shipyard workers on the home front produced cargo vessels.

Those workers had ferry service, too — a few hundred yards from the new terminal, across the Richmond Inner Harbor Channel.

A news item in the shipyard newspaper Fore ‘n’ Aft on September 17, 1942, noted, “After untiring efforts by Labor-Management committees in all three yards, the trial run of the San Francisco ferries to the shipyards took place Wednesday of last week.”

The hour-long trips went from the Ferry Building in San Francisco to the slip at the parking lot along the estuary at Yard Three. Ferries arrived 15 minutes before shifts started and left 30 minutes after shifts ended. The fare was 10 cents each way, and passengers could buy food onboard.

Richmond-San Rafael ferry ad, Oakland Tribune, 7/11/1943

The service was sponsored by the U.S. Maritime Commission and run by the Wilmington Transportation Company, which operated the Los Angeles-Catalina Island ships. Pressed into duty were craft from the Key System, the enormous public transportation service of San Francisco’s East Bay, and included relics such as the side wheeler Yerba Buena. Some of the ferries carried automobiles.

The Commission proposed four ferries run between Richmond, San Francisco, and Sausalito, with almost continuous service to accommodate the staggered shifts at the Kaiser Richmond and Bechtel’s Marinship (Sausalito) yards.

The wartime ferries weren’t the first to come to Richmond; regular service between Richmond and San Rafael had operated since 1915.

Oakland Tribune, 7/2/1944

By 1943, the ferry service was overwhelmed, and thousands of workers threatened to quit because it wasn’t running on time and was making them late to work. Under Maritime Commission rules, worker pay was docked if they were 15 minutes late. Faster ferries were put in service.

Some of the transits were quite eventful. The Klamath rammed a surfaced submarine in the middle of San Francisco Bay on July 1, 1944, (minor damage, no injuries) and almost collided with an anchored — but loaded — ammunition ship in the foggy morning of September 5, 1945.

A new auto ferry pier was one of the first infrastructure projects authorized after the war ended. Construction at Castro Point, at the terminal of Standard Oil (now Chevron), commenced in early 1946, and service began March 1947. By 1951, plans were being drawn up for a Richmond-San Rafael toll bridge. When it opened in 1956, the bridge was the last across San Francisco Bay to replace a ferry service.

It’s unlikely the new generation of Richmond ferry passengers will risk hitting a submarine or an ammunition ship, but they can travel with pride knowing that commuters to the Kaiser shipyards over 70 years ago were part of a bold social experiment in child care, housing — and health care.

 

 

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Southern Comfort – Doctor Gaston and The Southeast Permanente Medical Group

posted on December 10, 2018

Guest post by Cuong Le
Permanente Medical Group historian

 

New physicians Anne and Harper Gaston, May 23, 1955

History is often a treasured story passed down through generations. The history of The Southeast Permanente Medical Group, opened in 1985 to serve the Georgia area, is one such story: It begins with a group of doctors who had a vision of building a community focused and patient-centered culture.

Georgia native J. Harper Gaston, MD, was one leader who graduated with his medical degree from Emory University and worked as an internist at Grady Hospital. After Kaiser Permanente hired Dr. Gaston in 1961, he moved to California and worked at hospitals in the cities of San Leandro and Hayward. As HMOs expanded throughout the 1970s, Kaiser Permanente saw the opportunity to develop medical group practices in other geographical regions. After much research and discussion, Atlanta was one of two selected areas for expansion during the early 1980s.

News of Dr. Gaston’s success in hospital administration, combined with his re-election as physician-in-chief at Kaiser Foundation Hospital in Hayward, convinced Kaiser Permanente leaders to approach him with plans to establish a medical group practice in Georgia. Atlanta was a growing urban capital, attracting the attention of major corporations and leaders around the world. However, the city’s lack of familiarity with HMOs before 1980 presented a challenge for Kaiser Permanente’s geographical expansion.

Dr. Gaston and Edgar T. Carlson, MD, a colleague from Kaiser Permanente’s Ohio Region, went off to open the new region. Georgia. When they arrived in Atlanta in 1984, State Insurance Commissioner Jimmy Caldwell revealed that previous agreements with existing HMOs prevented Kaiser Permanente from receiving the certificate needed to establish an HMO in Georgia for a year. Dr. Gaston turned the unexpected situation into an opportunity by spending the next year meeting with physicians and community organizations.

Doctors Gaston and Carlson reviewing clinic plans, September 29, 1985

The bonds formed between Dr. Gaston and the Georgia community became lasting partnerships when Kaiser Permanente finally received the certificate during the summer of 1985. After opening their first medical office, Dr. Gaston and a team of physicians volunteered at the Downtown Day Labor Service Center and conducted medical exams for the homeless on Friday nights. When the annual school budget ran out, they volunteered to continue hearing and vision screenings for elementary schools through the Adopt-A-School program.

Since the first Kaiser Permanente medical office opened in Atlanta more than 30 years ago, Kaiser Permanente in Georgia has grown to more than 25 offices around Atlanta and one in Athens. And the momentum continues. A recent agreement with Emory Healthcare provides Kaiser Permanente members with a fully integrated health care experience, and in the process, advances patient- and family-centered care in metro Atlanta and beyond.

 

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