Stories

Mobile Health Clinic Brings Care to Patients in Appalachian Mountains

The story of the Health Wagon, a nurse-driven mobile health clinic that provides care to several thousand medically underserved people in the Appalachian Mountains in Virginia, is one of great risk and greater reward.

The Health Wagon, the oldest mobile health clinic in the nation, has delivered care to people in isolated towns along winding, narrow mountain roads for nearly 40 years. It started with the selfless work of Sister Bernadette “Bernie” Kenny, a nurse practitioner and medical missionary. Since 1978 had been providing free medical care to people in rural Virginia from the back of a donated Volkswagen Beetle.

Kenny had served in Ireland and East Africa before settling in Wise County, Va., in the southwest corner of the state near the borders of Kentucky, Tennessee and North Carolina. Here, she risked travel in all kinds of weather to care for the underserved.

“Every day, somebody in need comes in my path, and it is a privilege to make a difference for them,” the 81-year-old Kenny said in a February 2020 article on GlobalSistersReport.org.

Teresa Owens Tyson, DNP, FNP-BC, FAANP, who today is President and CEO of the Health Wagon, is like Kenny in her unrelenting desire to serve people. She describes her patients as the people who built our nation on their backs.

A Team Rooted in Altruism

Paula Hill-Collins, DNP, left, and Teresa Owens Tyson, DNP

Tyson grew up in the poverty of coal mining towns in Central Appalachia and knew people in the region needed help. “It has never been about work for me,” she said.

Her grandmother was not a nurse, yet she took people with tuberculosis into her home when there was no cure for TB. “I don’t know how she didn’t catch it because it was so contagious, but I guess it was just her faith in God,” she said. “She had such compassion to do for others. My mother was like her.”

Tyson started as an RN at the Health Wagon. Through financial aid and merit-based scholarships, she advanced her education, first becoming a family nurse practitioner and ultimately achieving a Doctor of Nursing Practice degree from the University of Alabama.

Tyson and her childhood friend, Paula Hill-Collins, DNP, FNP-BC, FAANP, Clinical Director of the Health Wagon, drive care delivery for nearly 5,000 patients in the region. Together, they offer an impressive menu of services, including acute disease management, behavioral health, low-cost dentures, wound care, sports physicals, transportation assistance, lab services, and more.

The Health Wagon has three mobile units and three stationary clinics. A handful of specialty physicians volunteer and a small staff of nurses and NPs work on mobile units and in the clinics. The team works with some 40 colleges and universities, providing training for student nurses.

“We’re very proud that we’re a nurse practitioner-managed clinic, and we’re a 501(c)(3) nonprofit,” said Tyson.

A Vulnerable Population

While The Health Wagon provides old-fashioned, one-on-one care, the NP-duo relies on innovation and collaboration to get people the care they need at little to no cost.

Tyson started The Health Wagon’s telehealth program 27 years ago, providing advanced diagnostics and consults with specialists at the University of Virginia, which is about a five-hour drive away. In 2015, The Health Wagon made the first Federal Aviation Administration-approved drone delivery of medications. Recently, the nonprofit started putting telehealth carts with computers into the community, to give people easy access to care, according to Tyson.

Health Wagon patients are among the most vulnerable in the U.S., according to Tyson. “We have a high proportion of elderly and those with coexisting or other medical conditions,” she said.

Among those conditions is pulmonary fibrosis, which is an advanced form of black lung, also known as anthracosis.

Statistics describing the population they serve paint a stark picture. According to the nonprofit’s website, “adults in the Health Wagon coverage area ages 35-64 die 30% earlier than the same population in the rest of Virginia.”

“It’s a life and death critical role here in the Central Appalachian Mountains of Virginia,” Tyson said. “It’s a critical role because we’re in a health professional shortage area. We had 20,000 patient encounters in 2019. If we weren’t here taking care of this vulnerable population, who would be?”

Health Wagon as a Calling

Tyson, Collins and the staff offer a holistic approach to care, taking time to talk with patients.

“We do an awful lot of social work,” Tyson said. “We’re praying with the patients. We’re teaching them if they’ve been laid off about what the government is doing to feed people.”

The nurse practitioners don’t just do exams and order an X-ray or MRI. They call around to see where the patient can get the least expensive option. The nurses navigate medication purchasing through government and other programs. And they secure access to specialists when needed.

For the comprehensive care in a visit, patients who don’t have health insurance or have high copays or deductibles might pay as little as $15, which includes labs, according to Collins.

“At the end of the day, I’m a grant writer,” Tyson said. “I’m the fundraiser. Although we’re doing the care for free, the care is not free. It costs to have these resources that we desperately need. We work pretty much around the clock to meet the needs of the patients.”

Like Kenny, these nurses see the care they provide as a privilege and a calling.

“It’s very hard on most days,” Tyson said. “You have to have the passion, the drive, and a love for the people. Our people here in the mountains are the most wonderful people on the planet, I feel. They’re so appreciative of the care.”

Collins has worked in for-profit and nonprofit healthcare clinics but said her work with the mobile health clinic is like no other nursing job.

“It allows you to do what your calling is, what your mission is, and that’s to take care of people,” she said. “That’s the bottom line. We want to take care of patients.”


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Nursing is a moral profession. But technological advances in healthcare require that nurses expand their understanding of ethics. This course informs nurses about the Code of Ethics for Nurses, nursing ethics committees and nursing advocacy.

Nursing Ethics, Part 5: The Process of Ethical Decision Making
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The principle of well-being, doing good, and preventing harm, obliges nurses to promote the health and safety of patients. The principle of equity, or justice, requires that patients be treated fairly and equally in the decision-making process. This module will further explore these principles and discuss methods of determining decision-making ability in borderline cases.

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