Jackson County nonprofit health provider rolls out new mobile health clinic

In February, a bright blue, 38-foot-long, custom-built mobile health clinic rolled into Jackson County. Five days a week, it provides an array of free or low-cost services in Medford and Ashland, ranging from medications and lab tests to dental exams and wound treatment. The mobile health clinic is operated by La Clinica, a nonprofit that for nearly 40 years has been helping meet the health care needs of primarily low-income residents in Jackson County.

This is La Clinica’s third mobile health clinic, and the first time it has been able to provide these services in nearly three years after an arson fire destroyed its previous mobile clinic just a few days after it began seeing patients. Roughly 160 patients have already visited the new mobile clinic during its stops at food pantries, campgrounds, apartment complexes and other sites, according to Zulma Larios, La Clinica’s field-based care manager. The patients include Latinx residents afraid of visiting hospitals and clinics because of increased federal immigration enforcement, unhoused people and formerly incarcerated adults reentering society. Larios joins us to share more details about the impact the mobile health clinic is having.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. The nonprofit La Clinica has been working to meet the health needs of low-income residents in Jackson County for nearly 40 years. One of its tools is a mobile health clinic, a 38-foot-long custom built Winnebago that just started operating in February. It’s actually the nonprofit’s third mobile clinic, a replacement for the last one, which was destroyed three years ago by arson.

Zulma Larios is La Clinica’s field-based care manager. She joins us now. It’s great to have you on Think Out Loud.

Zulma Larios: Thank you for having me, Dave.

Miller: What is the big idea behind a mobile health center?

Larios: Ever since COVID hit, I think it really started taking off. It’s been a part of health care for many, many years. Really that sense of understanding that folks are at different places in their life and they have various barriers, traumas, experiences, that sometimes prevent them from going into brick and mortar clinics. So our mobile health clinic, any mobile health clinic I think, has the goal of going to where people are at and providing access to care that they typically would not have access to.

Miller: Where does this clinic go?

Larios: It goes all over the place. This new clinic, we’re out Tuesday through Saturday. That’s one of the things that we shifted was bringing in more hours that are more accessible to our community. So we’ve added Saturdays and later days. We go to two sites a day all over Jackson County, really trying to create various access points. And throughout the month we partner with other organizations to try to go out to some of the more rural areas that really have no access to care.

We partner with locations like shelters, there’s various housing sites that we go to. We try to be present when there’s community events to make sure that folks know about us, and get to know our team and see our face – that really supports building the trust with these communities.

Miller: Is it a regular schedule, so someone knows on Wednesdays at 2 p.m., there’s a good chance that the mobile clinic is going to be here?

Larios: A little bit of yes and no. We do have a consistent schedule, for the most part, for the week. We have a couple of days that are rotational days, so we go to different sites. We’re really trying to create as much access as we can. Right now, because of just some of the things that have been going on in our country, we understand that there’s some fear for some folks. So there’s some sites that we are not marketing as widely online. We have some sites that we share with community partners and rotate more, just to create more opportunities for the community to come to places that aren’t so scheduled.

Miller: I want to hear more about that as we go, but first, can you give us a sense for the kinds of services that people can get in this Winnebago?

Larios: Pretty much anything that you could get in a clinic, you could get in this mobile health clinic. We offer basic health care. We’ve got sexual and reproductive health. We care for chronic illness, immunizations. We even have a little lab testing station where we do point of care, where we can do comprehensive metabolic panels, A1Cs, sexual transmitted infection disease testing. We get those results in minutes because oftentimes, the communities we serve, [we know] we might not see [them] tomorrow or we don’t know when the next time we will see them. So we’ve got a little lab area for that...

Miller: I have to say just to step in, as probably most people listening have experienced, if you go to a clinic to get lab tests as part of a primary care checkup, it could be a day or more before you get your results. You’re saying in this van you can get them within minutes?

Larios: Yes, with some of the machines that we have available to us, we’re able to get results right away.

Miller: What about dental care?

Larios: We also offer urgent dental care. I’m partnering with our dental clinics at La Clinica. Right now we’re able to provide about four hours a week of dental care that we hope will expand as it is utilized more and more by the community. Our mobile health clinic has one medical exam room, and then a second one that works as a medical and a dental room. So depending on what we’re offering, we can use it for either.

Miller: What are the reasons that people might seek out your mobile clinic now, as opposed to a brick and mortar clinic?

Larios: I think oftentimes the communities that we serve have had negative experiences, not just in clinics but in other offices. So there’s that trauma of going into brick and mortar clinics. There’s fear of judgment for whatever their story is. Sometimes things are a little bit structured. And depending on where someone is in their life, they might not know what they’re doing the next hour, tomorrow or next week. So having that availability of them just being able to walk in.

And then I think just some of the things going on in our nation around immigration, there’s fear for folks to come into clinics, uncertainty around processes with all the Medicaid possible data sharing, things like that that create a lot of uncertainty and fear. So that’s part of what our team does, is really supports in educating when we can. And then making sure that folks know all that is available, but also the consequences of getting care so that they can make the best decision for themselves.

Miller: Have you seen a drop in people visiting the brick and mortar clinic from either undocumented or immigrant communities in the last year-and-a-half?

Larios: I think so. I think that there is definitely fear and uncertainty that is keeping people from coming in, even when they really need care. I don’t work with the hospital systems, but just being as connected as I am to the communities, I do know that there are folks that are not going in for care until they really have no other choice. And that’s sad, because as a health care leader, I think that we know early care can change everything. And so when people wait, conditions get worse, and that impacts not just individuals but the entire family.

That is what I love about mobile health in general, is that it provides an opportunity for folks to get the care that they need, and then be connected with someone that can walk them through getting additional care if we can’t support them with whatever it is that they need in our mobile clinic.

Miller: How do you actually address those concerns? If people are afraid to go to a clinic because of fears, say, that their information could then be turned over to the feds, what do you say and how do you get them to feel comfortable going to the mobile clinic?

Larios: I think that one of the things that we do really great in general, but really in our mobile clinic, is that we try to give the option and the decision to the patient, and really empower them to know that it is their decision. All we can really do is provide the information that we have. As we are getting updates about what is going on on the federal level, then we can share that with our patients and then they can make the decision. But also, we’ve got our sliding scale. So if someone decides, “I’m not going to apply for Medicaid right now because I have uncertainty or fear of doing this,” then they can use our sliding scale if they qualify based on their income.

We try to give options so that they can make the best decision for themselves. But again, we [say], “Here’s all the information we have for you and if you have questions, we’ll answer them.” But really, the decision is theirs. We are not pushing them or pressuring them to do what could have consequences for them.

Miller: I understand from your recent press release that another group that you’re trying to reach through this mobile clinic is people who have been involved in the criminal justice system. What does that look like?

Larios: We’ve partnered with organizations such as our local transition center here. There’s other organizations that have created hubs for those that have recently been involved in the criminal justice system. Again, it’s part of that trauma of feeling judged, of shame, of uncertainty, of re-engaging back with society. So creating a space for them to be able to take care of themselves, and hopefully help them create capacity and renewed skills to be able to engage with not just health care, but all the various things that they need to survive in life.

Miller: La Clinica, your organization, launched its first mobile health center back in 2011 and that lasted for about a dozen years. And then you had a second one, which started in May of 2023. But that was destroyed just three days later because of arson. What was that day like for the organization?

Larios: Oh gosh, it was devastating. We were very excited about this new mobile [health center]. Our first one that actually launched in February 2012 had provided so much for our community, and it just had so many repairs that needed to happen. So through a federal grant, we were able to get a new mobile health clinic that we planned for at least a year-and-a-half. It got destroyed three days after we had provided services.

It was a really sad day, but also full of hope and heart to see our team not judge the person that had done this, and understand that this is because of all of the lack of resources for mental health, substance use, that are lacking in our communities. And really not put shame or guilt on this person, but instead say, “gosh, I understand and it’s just going to drive us to continue to provide services.”

So we actually sent them home that day and said, “Go take care of yourselves. This was a hard thing.” And they all went to our community sites instead of home, to say, “We’re still here, we’re still going to provide care. How can we connect you?” Which was the best way in such a horrible experience to see how the heart is there for our team. And that is why we’re successful in what we do.

Miller: What has it been like to be back in the community with this clinic on wheels after that absence of close to three years?

Larios: It’s been beautiful. Our community partners have just welcomed us with open arms. They’ve shared the gap that they have seen. And we see it when we go and we see patients that haven’t refilled their medications for a year, that have had wounds for so long that they haven’t taken care of, patients that just have so much going on that maybe even were already established but hadn’t been able to make it into one of our clinics. So being there when they need us, in the moment, come and see us, has been so essential.

I think of dental and how hard it is to get in to see a provider right now, having that resource for our community is great. And just the navigation of our system. Sometimes it’s challenging for those of us that have some experience with our systems or have the capacity to do those things. Sometimes, even for us, it’s challenging to get appointments, to fill out all the paperwork and understand what the processes are. So I think having someone that really can walk folks through that and support them in getting in with the least barriers possible, I think is such an essential thing.

And the other thing I really appreciate about our teams is that they go beyond health care, although we see these things as healthcare too, social determinants of health. And sometimes that is the priority for patients. I think that sometimes in clinics, that is not understood. A patient might have a priority of food, housing, transportation, something with their children that unless that is addressed, they have no capacity to care for their health. So our team has community resource specialists that are community health workers that can address those things and help build some capacity, so then the patient can take care of their health.

So I think that’s a beautiful thing, that the patients can get all of these various services. They’re not going to get any less than if they were in a clinic. We’re going to provide the same quality and the same wraparound services.

Miller: What have you heard from patients who’ve gotten help through this mobile clinic in the last couple months?

Larios: I mean, so much gratitude, appreciation that we’re there for them, that we’re in all of these various locations. The comments that we get from patients are just so heartwarming: how they feel heard, they feel connected to our team. A majority of our team is bilingual, bicultural, so we’ve gotten comments of how cool it is to get care that feels culturally appropriate in their language.

That’s the cool thing about our mobile is that we do have like 30-minute appointments, but if we only have two patients today, then we’re going to utilize the whole time to spend with them and take care of all of their needs. So there’s flexibility in how we care for each individual. We always have a goal to try to get them into a primary care clinic if possible, but understanding that not everyone’s there and might not be there, and so we’ll hold them as long as we need to.

Miller: What happens if people don’t have insurance?

Larios: We won’t turn anyone away for not having insurance. We work off of a sliding scale, so depending on their income and housing status, that can be reduced all the way down to zero. But depending on their income, they might fall within a sliding scale.

Miller: Zulma, thanks very much.

Larios: Thank you so much.

Miller: Zulma Larios is a field-based care manager at the Jackson County nonprofit health care provider La Clinica. They recently debuted their new mobile health clinic. It is a large refurbished Winnebago.

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