The Appalachian Region includes all of West Virginia and parts of 12 other states, and is home to over 25 million people, 40 percent of whom live in rural areas (as compared with 20 percent of the U.S. population overall). The region stretches from southern New York to northern Mississippi, following the Appalachian Mountains (ARC).
The region faces huge gaps in health status, compared with the rest of the U.S. Appalachia has higher mortality rates in the nation’s seven leading cause of death (heart disease, cancer, chronic obstructive pulmonary disease (COPD), injury, stroke, diabetes, and suicide). The rate is even higher in rural areas. The Appalachian region also has a lower ratio of healthcare workers per 100,000 population the national average, as well as more prevalent health risk factors, such as obesity, smoking, and physical inactivity (Wasserman, 2017).
RAD-AID partners in Appalachia with The Health Wagon, a nonprofit organization providing healthcare services to the underserved in Southwest Virginia since 1980. Its fixed clinic is located in Wise, VA, while two mobile clinics serve the more remote areas. The Wise clinic serves over 150,000 people, more than 60 percent of whom are women. In April 2017, The Health Wagon staff completed the Radiology Readiness Survey, and in July 2017 RAD-AID International and a team from University of Virginia’s RAD-AID chapter visited The Health Wagon’s Wise Clinic to assess its operations and needs.
The Health Wagon has one computed radiography (CR) unit and one ultrasound machine. Most of the healthcare services are delivered by nurse practitioners, and radiology exams are done by non-radiology personnel. The clinic finds it difficult to find physicians and other healthcare workers to serve in Appalachia on a long-term basis. The clinic does not have radiologists to read the images; a pulmonologist, however, reads chest radiographs once or twice a month. The clinic does not have picture archiving and communication system (PACS), making it difficult for radiologist volunteers to provide teleradiology services. PACS readiness survey was completed in early 2018.
RAD-AID in the Appalachian Region
Under the leadership of program director Dr. Jenni Pierce, RAD-AID is currently working to implement PACS to expand the clinic’s radiology capabilities and to provide more opportunity for The Health Wagon to collaborate with radiologists, non-radiology specialists, universities, and hospitals for telemedicine.
Other areas of RAD-AID’s focus are providing ultrasound examinations and training nurse practitioners to use ultrasound for basic and emergency cases. To this end, RAD-AID is donating an ultrasound machine to The Health Wagon with support from The Philips Foundation.
During RAD-AID’s visit in July 2017, the team volunteered for The Health Wagon’s largest annual community outreach program, called the Remote Area Medical (RAM) event, which provided free eye, dental, and medical care for approximately 2000 patients. In April 2018, Dr. Pierce brought with her a team of radiologists, sonographers, residents, and medical students. RAD-AID provided ultrasound examinations and found a high prevalence of fatty liver cases. RAD-AID teams plan to visit The Health Wagon on a quarterly basis to provide necessary ultrasound education and evaluation. Their next trip was completed in July 2018, which coincides with 2018’s RAM event. The PACS was completely installed in January 2019. Dr. Pierce envisions advancement in telemedicine services for The Health Wagon, to better reach the underserved, a key priority of RAD-AID’s partnership and capacity building in Appalachia.