Doctor’s office on wheels widens access to care

Miami Children’s Hospital’s mobile clinic, known as Health On Wheels, is like a Transformers toy.

Its arrival is preceded by the heavy noise of its engine and the high-pitch screech of its brakes. For the past 15 years, Dr.Gloria Riefkohl of the hospital’s Preventive Medicine division has been boarding the white truck with the rainbow icon to connect with some of the poorest children in South Florida.

For the dozens of children who stand in line every week, Riefkohl and Melissa Gámez, the driver and medical emergency technician, are often their only contact with healthcare, unless they get very sick and end up at a hospital’s emergency room.

The mobile clients are mostly uninsured children. The Miami Children’s Hospital Foundation covers the annual $300,000 it takes to run the mobile operation, complemented by federal and state aid programs such as the CDC’s Vaccines for Children.

“The most important service we are giving at this moment is helping low-income parents to comply with the vaccines required by the school system,” says Riefkohl. “Some of them are immigrants with no medical history.”

During the school year, the bus visits about 1,000 children in public schools like José Martí Middle in Hialeah and José de Diego Middle in Wynwood. However, budget cuts and the high price of gasoline have forced the hospital to reduce the perimeter of the mobile visits and keep the vehicle parked for a longer time at the Palmetto Bay Center, says Angela Machado-Valdés, director of operations of Miami Children’s Hospital’s Preventive Medicine division.

The Otero family, who has just arrived in Miami from Puerto Rico “seeking a better education and a better quality of life,” learned about the Miami Children’s Hospital’s service through a relative. They approached the vehicle, parked in front of the center, on a day in which the heat was suffocating.

Carlos Otero, 32, who has just started working as a truck mechanic, entered the air-conditioned vehicle and couldn't believe what he saw. “It’s incredible that there is room in here for all of this,” Otero said, looking at the two examination rooms at both ends of the truck and then stopping to watch television. Sonia Otero, 31, told Gámez that she needed to update her three children’s vaccines.

To two of her daughters, 10 and 11 years old, Gámez suggested the HPV vaccine against certain varieties of sexually transmitted papilloma virus. The vaccine, recommended to protect the girls from cervical cancer, has a cost of $5. Otero decided that that could wait and paid $90 in cash for three general checkups and the vaccines: $30 each.

“It would have cost us much more anywhere else,” Otero said.

While waiting behind the Oteros, 12-year-old Joselin Weaver, accompanied by her grandfather, pinched her arm anticipating the sting of the injection.

“I’m very scared,” said Weaver, who is getting ready for seventh grade at Richmond Heights Junior High School.

Weaver, who got her vaccine with a smile, was also a candidate for the $5 HPV vaccine, but her grandfather was not counting on that expense and decided to do it some other time.

Besides vaccination services and ear and scoliosis examinations, the mobile unit has a dual purpose: to treat immediate health problems and focus on prevention.

“We try to give parents options when they are present, but it’s difficult to know if any of them will do anything about it after they leave our truck,” Gámez said. “It can be frustrating, but in the short time we have the children inside our vehicle we do the best we can.”

This story was originally published August 14, 2011 at 2:00 AM with the headline "Doctor’s office on wheels widens access to care."