Rolling Health Care to Where It’s Needed Most: Harvard’s Dr. Nancy Oriol on her Family Van Mobile Health Clinic

Dr. Nancy Oriol

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Margaret Flinter: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter , a show where we speak to the top thought leaders
in health innovation , health policy , care delivery and the great minds
who are shaping the health ca re of the future.

This week Mark and Margaret speak with Dr. Nancy Oriol , Faculty
Dean for Community Engagement in Medical Education at the
Harvard Medical School . Founder of The Family Van , a mobile medical
clinic that provides free health screenings for Boston’s underserved
communities , which she founded in 1992, she’ll talk about the power
of this upstream health intervention and how it ’ s improving health
outcomes saving money and saving lives.

Lori Robertson also checks in, Managing Editor of FactCheck. org , she
look s at misstatements s poken about health policy in the public
domain, separating the fake from the facts, and we end with a bright
idea that’s improving health and well - being in everyday lives.

If you have comments please e - mail us at [email protected] or
find u s on Facebook , Twitter, or wherever you listen to Podcast . You
can also hear us by asking Alexa to play the program Conversations on
Health Care .

Now stay tuned for our interview with Dr. Nancy Oriol her e on
Conversati ons on Health Care.

Mark Masselli : We lcome to Conversations on Health Care , I am Mark Masselli .

Margaret Flinter: And I am Marga ret Flinte r .

Mark Masselli : We’re speaking today with Dr. Nancy Oriol , Faculty Associate Dean for
Commu nity Engagement in Medical Education , lecturer on Global
Health and Social Medicine in Harvard School of Medicine and
Founder of The Family Van , a mobile medical clinic , which provides
free health screenings in Boston’ s most economically challenged
neighbo rhoods.

She earned the Dr. Louis W. Sullivan Award for contributions to the
delivery of quality care to black men and the Pearl Birnbaum Hurwitz
Award for Humanism in medicine. She e arned her bachelor’s degree
from Boston University and her medical degree from Harvard Medical
School .

Dr. Oriol welcome to Conversations on Health Care .

Dr. Oriol: Thank you very much for having me here.

Mark Masselli : You know and first of all , let me just say , we had the opportunity to
have you talk with us at the Weitzman Co nversation, and really,

Dr. Nancy Oriol

you're somebody that it's our hero, because you're so ahead of your
time and in the work that you've been doing . Really one of the
innovations, which I think is The Family Van, which is thi s mobile
health clinic you launched in the early ’ 90s and sounds simple, but the
reality is, when you execute at the highest level, it really is a
transformational vehicle to help people improve their health and their
outcomes. I'm wondering , if you could talk about how that Family Van
is addressin g health disparities by bringing prevention right to
patients.

Dr. Oriol: Bringing prevention right to patients is absolutely what it's about .
Thank you very much. I need to say that you're one of my heroes,
having heard about the work that you did startin g in 1972 , so speak
about being ahead of your time.

Bringing prevention right to people is critically important , but it's so
much more than just bringing prevention. It's really about bringing
relationships that build trust. It's about helping people get t he sense
that they can manage their own life, giving them the knowledge they
need to take better care of themselves, listening to people , listening
to what they want, what they need, listening to how things fit in their
lives, and not just sort of plunking down. Well, here's some preventive
service and just do it.

Margaret Flinter: Well, Dr. Oriol , I think it's safe to say that you a re decades ahead of
your time on this idea of upstream work. I think peop le get that
sometimes almost more than prevention tha t we're r eally going up
before the problems begin ; but now, that's something that both
insurers and payers and everybody in health care has bought into.

I often think of it as this is looking for the silent things, the things that
people walk around feelin g great, while their blood sugar is rising, and
their blood pressure is rising , while they may be engaging in behaviors
that put them at risk for HIV. Of course , it reduces burden on the
health system further down the road. Tell us how have these
intervent ions improved health outcomes and is th ere a tie that you've
been able to make to reducing health expenditures , because of this
upstream intervention ?

Dr. Oriol: I think if you get information to people in a way that they can use it ,
so they can manage the ir own lives, then you know, that ’s sort of
prim ary prevention, you help people take better care of themselves ;
but I don't know how many of us actually do that.

What most of us do is when something is not s eeming right in our
lives, we often ask a friend, what do you think about this, and if your
friend is a knowledgeable neighbor , if your friend has more
information , knows more t han you, you will often take their advice.

Dr. Nancy Oriol

We are the knowledgeable neighbor for t he communities we serve.
People come to us the y a re -- something that concerned about
something they don't understand. W e can sort of help talk it through
with them and sometimes that's all you need to actually need
someone to sort of stand with you and support you as you're trying to
make change .

Whe n you ’re try ing to improve your life and nothing is a straight line,
everything is with their challenges. Having someone who knows your
challenges that stands with you , witnesses it with you, that makes you
be able to take better care of yourself, it empow ers you and all of that
then helps avoid the cost of poorly manage d chronic disease.

Also , there are a lot of times , when if you're not quite sure what to
do, the answer might be, well , I better go to the emergency room,
because you've just become very sca red ; but in fact, sometimes you
just need to talk it through and you don't actually need to go to the
emergency room.

Margaret Flinter: Interesting.

Mark Masselli : You know, what I really like about this model that you have is that you
saw beyond just that it's a mobile clinic in a neighborhood. You've
really started to say , we're not only trying to connect with people, but
we're trying to connect neighborhood to neighbor hood. There's this
whole mobile clinic movement across the country , but you along with
your Harvard colleague, John Brownstein, who we did have on the
show, he talked about Uber Health with us , yo u know, you really
started to say -- h ow do we bring best practices to the willing , folks
who a re running these mobile clinics? How do you start co llecting
data? Then how do yo u start telling the story about the intervention ?
Walk us through that process of how you started to connect the
network and the movement together.

Dr. Oriol: I ha ve been Executive Director of The Family Van for about 10 years,
but we were just working very hard to make ends meet and do the
work that we were doing in Boston.

I was introduced to the Mobile Health Clinics Association. I, you know,
went to California to their conference . I saw this room full of people,
all of whom were running mo bile clinics, all of whom were having
exactly the same problems we were having. They were struggling to
make ends meet. It was a group of people sharing best practices with
each other, but all of us were working so hard that we didn't really
have time to think about data.

Fast forward , you know, we started thinking about well, if we had a
way of collecting data and sharing our data with each other and
analyzing our data. One, we could understand what the mobile clinic

Dr. Nancy Oriol

sector is all about , be c ause nobody knew who we were or where we
were, we were all doing our job in our own little lo cal area.

Mobile health map was created where we put tools on the web ,
mobile clinics can use the tools , they bring the data together, we
create reports , so th at m obile clinic can know, what is their impact,
you know, using the research that we've actually worked with and Dr.
Brownstein ’s mapping program was what really got us started of
being able to localize where the mobile clinics are and then help each
one of u s prove our value and our outcomes.

Margaret Flinter: Dr. Oriol , let me sort of turn it a little bit. Obviously , the mobile clinics
are a very high touch relationship with patients and that high touch is
part of t he core of relationships in primary care, b ut they also are
often wrapped within the high tech resources that we hav e. I think all
of us across the health care continuum are looking at how technology
can be our friend, something that really amplifies our ability to care
for people and we think part icularly about remote monitoring and
telehealth , these are strategies that technology makes available to us.
What are you thinking about this in the mobile clinic movement, the
use of remote mo nitoring and tele health as strategies that might b e
helpful to your cause as well?

Dr. Oriol: I completely agree . The view of medicine as just the doctor in the
office doesn't quite work, we really need to reach out much more
than that. That , like you say, might be high touch , you reach out , you
drive the van o ut to c ommunity, or it might be using telehealth
anything that connects the patie nt to the health care system , it has to
be tailored. I mean, that's -- the whole point of mobile clinics is that
they're designed to fit their community.

Well , every community is ext remely different, a nd what the
community needs, what the people need, and the resources that are
nearby , they might be nearby they might be far awa y .

In rural areas , absolutely having -- telehealth will be an amazing
solution to many problems. I think the point is pullin g it all together
and tailoring it to the needs of the communities and the resources
that are available in a way that works for everyone.

Mark Masselli : We're speaking today with Dr. Nancy Oriol, Faculty Associate Dean for
Community Engageme nt in Medical Education, lecturer on Global
Health and Social Medicine in Harva rd School of Medicine and
founder of The Family Van , a mobile medical clinic , which provides
free health screenings to underserved Boston communities.

Dr. Or iol was also Directo r of obstetric anesthesia at Beth Israel
Deaconess Medical Center and you also develop tools that made
childbirth easier, including the walking epidural, you've taken your

Dr. Nancy Oriol

broad knowledge , you've applied some critical thinking to things that
you're passion ate about, talk a little bit about the passion that
motivates you as a physician , as a human being and how y ou have
framed up some of these interventions that have b ecome used all
around the world?

Dr. Oriol: The walking epidural, which is such a shame, we named it that ,
because many people say, well we ’ll be walking labor a nyway, but
with all of these, it's been about seeing problems from the
perspective of the patient.

Obstetric anesthesia, the standard of care w as, if a person wanted
pain relief for chil dbirth, the choice was to be completely numb and
weak. I didn't know very many women who want ed to be numb a nd
weak during childbirth , so it seemed to me to find a way , a better way
that would give the woman what she wanted, which was the ability to
be the re , the ability to move to just feel normal, but to not have labor
hurt as much.

I think the point is that it is always about what the patient wants.
Some people don't want to feel anything, that's great , if that's what
you want , that should be your choice ; but many people actually just
didn't want to be numb and unable to move.

When I first started doing the walking epidural, I w ould get comments
from people saying, why is it more better? I would often ask , if you
were going to have a stomach ache and I ga ve you the option of being
at home, stuck in your bed unable to move at all, in exchange for
making y our stomach ache better, would you choose that ? Generally,
no, most people don't want to be so numb and so weak , so it's about
looking at it from the patie nt's perspective and figuring out what
would I want and then creating that.

Margaret Flinter: Well , Dr. Oriol , I know that you have devoted a good bit of your time
to Harvard to the mentoring in the training of the next generation.
You're the Associate Dea n of Community Engagement in Medical
Education . You're at this incredible intersection of very talented
young people. They've made the choice for health care or for
medicine and now they're going to make the choice about where they
go for specialties and y ou kn ow, certainly primary care is often not
the first choice , but we have another one of our former guest ,
Andrew Morris - S inger was the Founder of Primary Care Progress at
Harvard.

I'm sure you've run across him over the years, but in the interest of
impr oving prevention a s a vital part of the American care system a n d
the interest of making sure that we recruit the best and the brightest
from all the disciplines tha t can serve as primary care providers to
consider that , what's your strategy for inspiring p eople to think about

Dr. Nancy Oriol

primary care or the primary care disciplines?

Dr. Oriol: I was Dean of Students at Harvard Medical School for 19 years and
Andrew was one of my students.

Margaret Flinter: Oh - ho , but you did a very good job, you inspired him .

Dr. Oriol : I watched many students go through medicine and make the ir
choices. Now remember, I'm an obstetric anesthesiologist. I chose
that field , because it spoke to my part heart and my brain , so student
have to pick what suits them.

Primary care is an amazing f ield and for many students it's absolutely
the right choice. I think primary care a s a field h as some issues that
needs to work with, and it's beginning to sort o f alter the relationships
to use team based care. I m ean, the sense of trying to be everything
to a patient is daunting ; but the beauty of having sort of the long --
longitudinal relationship of actually, you know, especially getting to
know patients and their families, that's a spectacular way of practicing
medicine.

One, I do think early exposure to health care outside of the walls of
the hospital, is important to helping students choose primary care,
but I also think that all of the advances that are happening in primary
care, I think that is also what is making it more attractive. Students
can s ee their professional lives, their academic lives, you know, and
their joy.

Mark Masselli : You know, certainly health policy looms large for whatever field that
you're in. I think right now , we are a nation in flux is we're starting to
think about the next presidential election. That's coming up. We're
certainly hearing a lot from Democratic candidates about a variety of
changes that they'd make in health policy.

I'm wondering how -- do you think our policymakers should be
addressing the issues around cover age and access? Certainly , the cost
of training is enormous , the burden that people carry, wondering
what animates your mind a s you think about policy issues?

Dr. Oriol: To be quite honest, I have to start by quoting you, and you said, the
goal is to make health care a fundamental right available to all , so that
motivates me.

We in Massachusetts are unbelievably lucky. We have, you know, well
organized health care . We've got, you know, almost universal
coverage ; but having insurance isn't the whole answer. Now access is
-- having access to care that you can utilize , because it suits you w e ll .
Care that makes you feel welcome an d helps you lead a healthier life.
Health care should be available to all , having health insurance is a
critical step. Then building a health care system that is welcoming and

Dr. Nancy Oriol

makes you feel respected and tr eated well .

Mark Masselli : Oh, that's great . Just from your perch , and you've had so many
incredible opportunities to look over the horizon of things that are
happening, anything tha t you're keeping an eye on right now , in terms
of transformations that are going on that really excite you?

Dr. Oriol: I was recently at the Gold Summit , and the Gold Humanism Medicine
is a movement that's, you know, been very active in medical schools.
At the Gold Summit, they had a leadership track and there were CEOs
from various for - profit organizations that are not the first thing you
think about in terms of health care , and they are all understanding
that it's a bout going out to the people and actuall y getting to people ,
but what was really wonderful was they were there at a humanism
and medicine conference.

Yet, if you are going to bring health care into the work you do, then
you need to do it in a humanistic way. I think , health care , as we know
it i s going to be expanded. I think the way you access h ealth care is
going to increase. I think it's just going to be more user - friendly. I
think there many people are thinking about that and building systems
to make that be so .

Margaret Flinter: Yeah , I thin k about our cities like Boston, like San Francisco, and the
increasing pushing out of low income people into the suburbs , so that
we can convert the heart of the city into the playground of the
affluent, really .

With your Family Van , you must have a front row seat at the
incredible transformations under way, as the cost of living in Boston
skyrockets . We're hearing from community health centers that
they're having to follow patients to the suburbs , because the
traditional neighborhoods are no longer the epic enters. They were of
low income neighborhoods and what are you see ing from your perch
with the Vans?

Dr. Oriol: Absolutely the same thing. I think that's one of the reasons that
mobile clinics and other entries into the health care system are going
to be a round more, I think telehealth is going to become more
important for that reason.

I think mobile clinics have a place in all of health care . W e know for a
fact that they were using them in Silicon Valley , because you know,
young people working in the diffe rent businesses weren't actually
getting up to the health care system.

We’ve invited to be part o f the inauguration of Larry Bacow at
Harvard University and so we parked the van in Harvard Yard and
people who were w alking through Harvard Yard came on the v an. I
think mobile clinics as a way of accessing health care probably have a

Dr. Nancy Oriol

roll in places more than just in economically disadvantage.

I think , as we build a more networked and creative health care
system, I think -- yes , we're going to have to be reachi ng people of all
socio economic statuses where they are in a way they’ve --

Margaret Flinter: We have been speakin g today with Dr. Nancy Oriol , Faculty Associate
Dean for Community Engagement in Medical Education , lecture r on
Global Health and Social Medic ine at the Harvard Scho ol of Medicine.

She is also the Founder of The Family Van , a mobile medical clinic,
which provides free health screenings in Boston's most economically
challenged neighborhoods. You can learn more about her work by
going to familyvan .org and go to mobilehealthmap.org .

Dr. Oriol , we want to thank you for your pioneering work in health
equity, for improving maternal health and childbirth outcomes , for
inspiring generations of he alth care providers and students , and of
course for joining us today on Conversations on Health Care .

Dr. Oriol: Thank you very much for h aving me.

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Mark Masselli : At Conversations on Health Care , we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy, Lo ri Robertson is an award winning journalist and Managing
Editor of FactCheck.org , a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. politics,
L ori , what have you got for us this week?

Lori Robertson: A headline circulating on social media misleadingly tells users that
Democrats chose to vote down a Health Record System for veterans ,
while approving the same for immigrants who cross the border
illegally.

The bill i n question did not affect veterans. The D emocratic controlled
House in late September passed a bill largely along party lines that
would create new requirements for the Department of Homeland
Security to research and recommend ways to improve the medical
screening of immigrants who cross the bord er illegally.

It requires an Electronic Health Record system to b e established
within 90 days. Since the House passed the bill , it h asn't moved
forward in the republican controlled Senate , but a headline circulating
on a YouTube video from an account calle d “ Top Stories Today ” offers
a grossly distorted take on what the bill does.

It says “ dems vote to enhance Medicare for illegals now , vote down
vets waiting 10 years for same service. ” The legislation didn't concern
veterans medical care. The VA currently has an Electronic Health

Dr. Nancy Oriol

Record system ; but in 2018, it awarded a contract to a health IT
company for a ne w system that can link in with the Department of
Defens ive system . The project is expected to take 10 years to
complete.

House Repub licans opposed to the democrat ’ s border legislation ,
introduced a last minute amendment to push back the Electronic
Record system implementation for im migrants until September 2027
and then cited a connection to the -- i n the works VA system.

Republicans said the amendment would make sure veterans get their
Electronic Record system first. That spawned the now viral misleading
headline that Democrats, “ vote down vets . ” That's my fact check for
this week. I'm Lori Robertson , Managing Editor at FactCheck.org .

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and i s a project of the Annenberg Public Policy
Center at the University of Pennsylvania .

If you have a fact that you'd like checked, email us at chc radio.com,
we'll have FactCheck.org ’s Lori Robertson, check it out for you here on
Conversations on Health Care .

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Margaret Flinter: Each week , Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. When Wichit a ,
Kansas nurse practitioner , Michael Wawrzewski learned of the harsh
and often fatal con ditions that expectant mothers endure in Sub -
Saharan Africa , all because they live too far from a medical clinic.

He thought there had to be a way to fill that need. B elieving that
every human being should have access to quality health care, he came
up with a solution , Clinic s in a Can , transforming shipping containers
into fully equipped mobile clinics and operating rooms that can be
shipped anywhere in the world where there is a need.

Michael Wawrzewski : When you walk in the inside, you will believe or think that you're
inside your doctor's office or inside the clinical environment for which
maybe you're in an emergency room or an ICU unit. They look exactly
the same.

Margaret Flinter: Wawrzewski learned from his early iterations that gas power ed
gen erators could be problematic in low resource areas and switch ed
all of his portable clinics to solar power, which he says was a game
changer.

Michael Wawrzewski : There's no part o f the world that does not have sunlight. Solar power
has become the cornerstone of how we r e - engineered to how we
power our clinics , so that now every piece of equipment including the

Dr. Nancy Oriol

air conditioners, we can run it o ff of 500 watts of electricity, w hich
means six solar panels on the top and eight batteries is enough to run
a clinic for 18 hours .

Margaret Flinter: Since its founding a decade ago, Clinics in a Can , ha ve been delivered
to war torn Sudan to earthquake ravaged Haiti and more recently to
S anta Rosa, California, an area decimated by the wildfires that also
destroyed the main community health center there . Santa Rosa
Community Health Center , CEO , Naomi Fuchs says , that the portable
clinic provided a lifeline for her patients. It was a godsend for her
providers.

Naomi Fuchs: These are converted shipping containers that arrived fully equipped
as a medical exam room. Th e se ha ve been an outstanding way to
respond to emergencies , to set something up very quickly.

Margaret Flinter: They’re roughly 1 20 square feet shipping container clinics are
designed to support workflow and to become a permanent fixture in
low resource areas serving as long term primary care centers as well.

Michael Wawrzewski : A containerized clinic is something that's a turnkey , it ’ s a ll built here in
the United States. We equip it with the best equipment and we ship it
as a completed project that once on the ground within 20 , 30 minutes
it ’ s ready to be used .

Margaret Flinter: Clinic in a Can , a professionally outfitted shipping container fully
equipped with medical and surgical equipment , ready for deployment
anywhere in the w orld where disaster strikes , providing quality , state -
of - the - art medical facilities in a low resource area. Now that's a bright
idea.

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Mark Masselli : You've been listening to Conversations on Health Care . I'm Mark
Masselli

Margaret Flinter: I'm Margaret Flinter .

Mark Masselli : Peace in health.

Margaret Flinter: Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at chcradio.com , iTunes, or wherever you
listen to podcasts.

If you have comments, please e - mail us at [email protected] , or
find us on Facebook or Twitter. We love hearing from you. This show
is brought to you by the Community Health Center.

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