Mobile Women's Health Unit
A project has been developed in cooperation with the Indian Health service (IHS) and Aberdeen Area Indian Health Service to use a mobile clinic with telemedicine capabilities to provide high quality health care to women in underserved areas. The project will deliver care to American Indian/Alaska Native women living on reservation lands in the Aberdeen Area who do not have convenient access to breast and cervical cancer screening and diagnostic examinations. Living far from medical care, it is more difficult for these women to get expert diagnosis and treatment and more difficult to comply with follow-up recommendations, especially if the recommendations are not made in person at the time of the initial appointment. Our current ability to provide underserved women with better access to care is, in part, the result of the convergence of digital imaging, computer technology, and high-speed telecommunications. A customized women's health clinic has been designed to offer mammography and breast ultrasound examinations, cervical cancer screenings, and other health and education services to American Indian/Alaska Native women in the Aberdeen Area. The clinic is a mobile unit containing digital mammography and other medical equipment to provide the selected services.
About the mobile clinic:
The mobile unit has a small waiting area, a mammography suite with dressing room, digital mammography, and digital ultrasound, an examination room for PAP smears and space for obtaining blood samples for diabetes screening and satellite telecommunications to transmit the digital medical images to a center of excellence for immediate interpretation and reporting back to the mobile clinic. With this broadband link, the mobile clinic can go anywhere that is convenient for the patients in the widespread rural areas of North and South Dakota. The patients will receive diagnostic reports and follow up recommendations while they are in the mobile clinic. This innovative approach is intended to reduce the patient anxiety that comes while waiting for the results of a mammogram. Such anxiety sometimes causes patients to defer screenings until serious problems occur. Further, this approach includes immediate patient counseling and scheduling of follow up procedures. This approach should increase the relatively low compliance rate that has been common in remote and rural areas.
The Aberdeen Area Indian Health Service will operate the mobile unit, with four health care workers staffing the mobile clinic. The workflow on the mobile unit has been planned to provide care to 15-20 patients per day. The mammography examination will be followed by the other available services, which will keep patients productively occupied while the images are transmitted to and interpreted by remote radiologists. A radiology department equipped with the proper digital mammography technology will interpret the digital images and transmit the diagnostic reports to the mobile clinic while the patient is still there. With the mobile women's health clinic, we expect to see more patients, provide better care, reduce morbidity and mortality, and -over time - reduce the costs of care.
In conjunction with this approach to delivering healthcare, there will be a study to measure the effect of this approach to delivering care. The overall plan was developed from the recommendations of the Workshop on Mobile Breast Care sponsored by the National Institutes of Health and also the results of the initial testing phase of the program conducted by a team of participants working in 2001 and 2002 who were supported by the Komen Foundation. The evaluation is intended to determine the cost of health care delivery and to measure its economic viability.
This project is the first of its kind to combine telecommunications with mobile health care delivery to provide high quality, timely care to women in remote rural areas. Recent advances in telecommunications, digital imaging, and computer technology have made it possible to implement this innovative approach. The rationale for adapting these technical advances to health care includes the evidence that early detection of breast and cervical cancer can reduce the mortality of these diseases, and the demonstrated effectiveness of preventive care measures on women's health. The evaluation component of the program is intended to substantiate this rationale for delivering high quality care to women in underserved areas. We also hope to show that this approach is cost effective and can be applied to urban as well as rural areas.
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Every woman should do their part to stay healthy by being informed, looking for signs and symptoms of illness, and taking action when treatment is necessary. These women from the Aberdeen Area each have a message to share about the importance of preventive care.
Angeline Afraid of Hawk
Cheyenne River Sioux
"In 1970, I was 37 years old then. I felt a lump in my right side, so I did a breast exam. I went to Mobridge and they did surgery right away. They told me it was cancer so they removed the lump.
It used to be we kept everything quiet. Most of my relatives were like that too. We kept everything to ourselves. Now I tell people my story.
Just recently, I felt a pain again in my breast. I did not wait. Contract Health referred me to Rapid City. But the tests came back okay."
Turtle Mountain Band of Chippewa
"I was getting bigger and bigger in my stomach. I knew it wasn't right. I kept gaining weight. They referred me to a gynecologist.
I had a complete hysterectomy and my appendix taken out. A six-pound tumor was removed from the area around my stomach. That's when they found out it was cancer.
Pay attention to your body. Definitely get your exams! You have to focus just to get well, so you don't hurt yourself or delay your healing."
Madonna White Bear Azure
Three Affiliated Tribes Arikara
"My aunt is a breast cancer survivor of 23 years. She had a bilateral mastectomy involving two separate surgeries. This makes me very aware of the importance of getting yearly breast exams.
All women, not just Native American women, should obtain yearly exams for preventive screening of hypertension, diabetes, cancer and heart disease."
Betty A. Elk
Standing Rock Sioux
"I found out I had a major medical condition in 1993. I went through a lot. It was very difficult and I struggled with depression and a lot of pain. But, I found a support group and I have been doing well for about four years now.
I go for my check ups to get my Pap smears and breasts examined regularly. I feel that's real important to do. I would like to encourage the young women to do the same.
It's important to develop a lifestyle change; you can't always do what you want. I can't run or skip, but I can walk."
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Women from the Aberdeen Area are excited about the positive difference the Mobile Women's Health Unit will make in the lives of American Indian women.
Click on a picture to hear what each of them had to say.