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by Doug Pardue
Of The Post and Courier staff
The 3-year-old
boy rushed into Tina Brown's office at
Hemmingway Elementary School complaining
that his tongue burned.
At first he
looked fairly normal. Suddenly his
tongue swelled before Brown's eyes, and
his face inflated like a balloon.
"He looked like
the man in the moon," she said.
Then his throat
began closing, threatening to cut off
his air.
Brown quickly
realized the child had slipped into
life-threatening anaphylactic shock from
an allergic reaction to a yellow jacket
sting.
Her worst fear
had materialized.
As a nurse she is
prohibited from treating such conditions
without a doctor. She generally is
limited to care for minor injuries such
as cuts, scrapes and bruises.
Most medications,
even many over-the-counter ones, can't
be given without parental permission or
a doctor's prescription.
But Brown knew
she had to do something.
She feared the
EMS stations were too far away in rural
Williamsburg County for emergency
vehicles to reach the boy in time.
Her thoughts
reeled:
Should she do
what she could to save the boy and risk
her career?
Should she do
nothing and hope it passed?
Should she let
him die?
She grabbed a
phone and made a panicked call to the
only doctor anywhere near the rural
school and begged the physician to see
the child.
He agreed and the
school rushed the boy to his office.
That was three
years ago. Now, the boy is in first
grade.
A lack of doctors
What happened
remains an all too common occurrence
throughout much of rural South Carolina
where treatable medical problems become
emergencies because doctors continue to
be scarce.
Most of these
rural counties rank among the least
healthy in the state. Poverty and lack
of access to medical care are two of the
main reasons for the poor health. That's
one of the findings in The Post and
Courier's recent series, "Forgotten
South Carolina," that investigated the
state's disparities in health, education
and economic opportunity.
Brown soon will
get the doctor she so desperately wanted
three years ago.
The doctor won't
actually be with her or even near. The
physician will be two hours away in
Charleston.
Brown's nursing
office at Hemmingway Elementary School
will house a virtual doctor computer
system from MUSC.
The machine comes with special
electronic equipment so an MUSC doctor
can listen from afar to a patient's
heart and lungs, look in ears and view
rashes and other skin ailments up close.
The need is now
James McElligott,
M.D., a 34-year-old pediatrician, heads
up the virtual doctor program. He had
long been interested in disparities in
health care. As he researched the issue,
he discovered that research wasn't what
was needed: Those living in areas needed
help now.
Ray Greenberg,
M.D., Ph.D., MUSC's president, placed
McElligott in charge, telling him money
was available to attack the problem if
he could come up with a solution that
didn't require placing the hospital's
physicians out in rural South Carolina.
McElligott's
effort is part of a larger program by
MUSC to attack health disparities across
18 counties along the state's coast and
I-95 corridor. That program, called the
Southeastern Virtual Institute for
Health Equity and Wellness, is designed
"to address the high rates of disease
occurrence, disability and mortality in
rural, low-income or minority
communities."
 Dr.
James McElligott from MUSC talks with
school nurse Tina Brown at Hemingway
Elementary about the virtual doctor
system. photo by Grace
Beahm/The Post and Courier
"The most
important thing to remember is that
telehealth is a means to solve problems
with access to health care, not as a
replacement of in-person visits. The
programs we are developing at MUSC are
intended to reach out to South
Carolinians in need of improved access,
and to finally address some of the long
standing problems with health care
disparities in our state." —Dr. James
McElligott
It was
established with a three-year, $12.7
million grant from the U.S. Department
of Defense. In addition to tele-medicine
efforts such as McElligott's, the
institute's other efforts include
programs to treat and reduce the
incidence of strokes, heart disease and
obesity. The institute also is
conducting research to see what efforts
are most successful.
The focus is to
promote healthy lifestyles and disease
prevention.
McElligott
initially thought the key medical
treatment problem for many in rural
counties was lack of access to medical
specialists. However, he soon discovered
"they didn't have access to anybody."
And high rates of poverty complicated
that lack of access. In many cases, the
sick didn't seek out treatment at all,
or went to emergency rooms only when it
got bad enough.
He discovered
that for many children the problem was
exacerbated by the fact that working
parents couldn't get off work to take
them to a doctor and lost wages if they
did. Many parents worked an hour away in
beach communities. Others had no
transportation of their own.
McElligott knew
about other states where forms of
virtual doctors had been used, and
decided to toy with developing one for
South Carolina thinking it might provide
the answer.
At first the
systems seemed too complicated and too
expensive — about $40,000. But that has
dropped. Now, he can purchase and
install one for about $10,000.
He decided public
schools were the natural places to put
the systems because that's where the
county's children are five days a week.
And the schools had nurses who could
consult with the virtual doctor and
administer prescribed treatment.
With the virtual doctor in her school
office, Brown will be able to diagnose
and treat students at school. That
allows her to provide better health care
in general for more than 560 pre-K
through fifth grade students in a county
ranked as the fourth least healthy in
the state.
"We could bring
the services to the patients," she said.
That is not the way medicine normally
works, but it's certainly more
convenient.
The virtual
doctor program is not without its
detractors.
Dr. Oscar
Lovelace runs a multi-service medical
office in Prosperity in rural Newberry
County. He has long been a proponent of
"medical homes," places where people
visit a regular doctor who knows them
and their history.
He was upset when
former Gov. Mark Sanford ignored
recommendations in a report from the
Governor's Health Care Task Force that
he co-chaired. One of those
recommendations called for the state to
create medical homes in rural and
underserved areas.
As a result of
Sanford's rejection of his
recommendations, Lovelace ran against
him in the 2006 Republican primary, but
was drubbed.
Despite his
political defeat, Lovelace remains
passionate about rural medicine and the
medical home concept. He believes the
state could encourage doctors to work in
rural communities if it increased the
amount of Medicaid reimbursement they
received.
To him, the
virtual doctor program for schools is
better than nothing but does not make-up
for a medical home.
"The relationship between patient and
doctor is unique," Lovelace said.
Taking virtual
statewide
So far, McElligott has set up two
virtual doctors in the school nurse
program, one at Meeting Street Academy
in Charleston, where McElligott
experimented with the system, and one in
Williamsburg County Magnet School of the
Arts.
He expects to have the system operating
for Brown during the next several weeks.
McElligott's goal
is to place them in at least one more
Williamsburg County school, probably a
high school, and five in Charleston
County schools as part of a separate
wellness program.
During the rest
of this school year and next, he plans
to gather data on the effectiveness of
the systems for treating children. If
it's successful, he hopes to expanded
virtual doctors to all underserved areas
in the state.
McElligott also
assists in an effort to provide similar
set-ups for physicians and other health
providers in areas that lack medical
specialists. That system provides rural
doctors a virtual computer link with
MUSC specialists, such as stroke
experts, to diagnose and treat patients
who could not get treatment without
traveling to Charleston or other medical
centers — a delay that could prove
deadly.
Six of those
systems are in operation, two in
Allendale County, one in Bamberg County,
two in Georgetown County and one in
southern Florence County where a nurse
practitioner uses it to enable her to
treat a wider range of illnesses.
At Williamsburg
County Magnet School of the Arts in
Kingstree, nurse Lynn Floyd said the
virtual doctor allows her to treat sick
children she otherwise would have to
send home, forcing parents to leave
work.
For many parents
in Williamsburg County, where one out of
three people lives in poverty, that's
difficult. They can't afford to lose the
pay, and they can't afford a doctor or
emergency room bill.
"It's real," she
said. "With this we treat children right
here. This is a good deal for
everybody."
Editor's
note: This article ran in
the March 11 issue of The Post and
Courier and is reprinted with
permission.
Friday,
March 15, 2013
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