Teresa Gardner serves patients with Health Wagon [Bristol Herald Courier, Va.]

Jan. 03--STRATTON, Va. -- At a nurse's station slightly larger than a tour bus bathroom, three people work, elbows entwined, but don't seem to mind the tight quarters.

Squeezing behind them to reach an even smaller patient exam room, nurse practitioner Teresa Gardner says that, of all the options in the health care field, this is where she wants to be.

Gardner is the executive director of the Health Wagon, a free mobile clinic that serves patients in the remote mountains of Southwest Virginia. For her, Gardner says, this is the mission field.

Barriers to access

Parked alongside a narrow two-lane highway that winds more than 30 miles through the mountains between the tiny towns of St. Paul and Clintwood, the clinic -- a customized Winnebago -- barely fits in the narrow parking lot of the Binns-Counts Community Center.

In the remote mountains of Southwest Virginia, this is the reality for residents who might seek medical care: long distances made even longer by the challenging terrain, especially when there's rain or snow on the two-lane roads that hug the sides of the mountains.

For some -- particularly senior citizens with little income or access to transportation -- the topography makes access to health care a practical impossibility.

For those people who already lack access because of the distance, the cost of medical care is also a seemingly insurmountable obstacle. And for a proud generation that shuns the hospital as long as they have outstanding bills, the combination can be deadly, Gardner said.

At times, she said, her tiny clinic on wheels is literally the difference between life and death.

She recalls one patient, a World War II veteran, who came bundled up in coats because his house was unheated; he was saving all his money in an effort to buy life-saving blood pressure medication that he could not afford.

Another patient, she said, was a diabetic who was out of insulin, he came to the clinic out of desperation because he lacked both money and transportation.

Huge need

For the last 12 years, the Health Wagon organization hosts a free medical care event at the Wise County Fairgrounds that gives a visual representation of just how big the need is.

The Remote Area Medical clinic operates with volunteers from all over the country. Every year it treats hundreds of patients -- and turns hundreds more away once it reaches capacity.

Each year, the health care providers who spend the weekend giving free care come away with stories of the impact they made: glasses that enable people to see, dentures that enable them to chew, cancers caught just in time for life-saving treatment.

"If you want to see a miracle," Gardner said, "come the third weekend in July in Wise County."

The rest of the year, they have the clinic-on-wheels, which Gardner said mainly gets patients through word of mouth and referrals from social service agencies.

The Health Wagon travels to eight sites in Buchanan, Dickenson, Russell and Wise counties.

"Everything is free," Gardner said. "The only cost that the patients may incur is if they have to have lab work."

Seventy-eight percent of her patients have no insurance, though the decision on whether to accept a patient is made on an individual basis. Many are women between the ages of 30 and 60, small business owners and the working poor, she said.

"We've never done any advertising," she said, "because we wouldn't be able to handle the influx of patients."

Sister Bernie

Seemingly unusual in a region saturated with Pentecostal, Baptist and independent churches, the Health Wagon was started by a Catholic nun from Massachusetts.

Her name was Sister Bernadette Kenny, but everyone called her Sister Bernie. Beginning in 1980, she dispensed health care from the back of a Volkswagen Beetle.

"God has to have placed Sister Bernie here, because she just fit right in," said Gardner of Kenny, who was known for her flaming red hair and the equally bright red Volkswagen that she drove up and down the mountains. "Sister Bernie was not your conventional Catholic nun."

Gardner came to the Health Wagon 18 years ago as the organization's first employee. A freshly graduated nurse, she learned of the job opening while giving birth at St. Mary's Hospital in Norton.

"It was like mission work, which I've always wanted to do," Gardner said, "and I never left it."

Until the hospital was sold to a for-profit health care company in the mid-2000s, it provided funding to the Health Wagon. At that point, the organization had to become independent.

Gardner, who took over in 2005, said they're constantly writing grants because, despite the positive recognition and awards the organization has received over the years, she still has to worry as much about fundraising as she does about how to provide care.

Thanks to some relatively recent grant funding, the organization is operating on a budget of more than $700,000 a year. For that sum, the Health Wagon's staff of nurse practitioners, nurses and support people treats 3,800 patients annually -- not including the 3,000 or so seen at the RAM clinic each year.

Rethinking care

While hesitant to speak about the politics of health care in the 21st century, Gardner said the reality she sees daily won't be solved by the massive health care legislation recently passed by Congress.

"With this health care reform, there are still is going to be people falling through the cracks," she said. "That's not going to be the answer."

Instead of creating a health insurance program, Gardner said, someone must look at the cost of health care -- including the use of unnecessary tests and the cost of practicing defensive medicine to avoid liability.

At the Health Wagon, they follow a different model. Unlike providers who bill by the procedure, she must rely on her diagnostic skills and generic drugs to treat as many patients as she can with the funding available.

"We have to be innovative and develop the resources to reach our patients," she said. "We're using our own assessment skills rather than ordering all the tests that these patients can't afford anyway."

Some changes that would begin to meet the health care need include free clinics in every community to bring health care to the people and elimination of the rules that restrict nurse practitioners from treating patients, Gardner said.

The rules, she said, require nurse practitioners to be supervised by a physician -- and limit the number that each physician can supervise to four.

Lifting some of those restrictions would enable more nurse practitioners to treat patients in underserved rural areas -- and would allow them to volunteer at RAM.

Moving Forward

Meanwhile, Gardner said she hopes the Health Wagon's new, 4,900-square-foot specialty clinic -- this one stationary in Wise -- will help draw more physicians to volunteer their time.

A second mobile clinic is also going into operation, with the hope of expanding services into two more counties. The organization's main office will remain in Clintwood.

For the moment, she's asking for money and prayers that her medical mission will be able to meet more of the needs in a region where the chance to receive free medical care can change people's lives.

"We've seen miracles," she said, "on a daily basis."

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