A survey of roughly 200 Cedar Hollow patients who missed appointments found transportation, not cost, was the biggest barrier to care. Riverside Free Clinic's answer is a mobile unit that will meet residents where they live instead.
Riverside Free Clinic will begin sending a converted van to three outlying pockets of Cedar Hollow twice a week starting next month, extending no-cost primary care to residents who live within the neighborhood the clinic already serves but who staff say rarely make it through the clinic’s front door.
“People assume that because we’re physically located in Cedar Hollow, everyone in Cedar Hollow can get to us,” said Dr. Beatriz Santos, the clinic’s medical director. “But Cedar Hollow is spread out, bus service is thin on the edges of the neighborhood, and a lot of our patients are working hourly jobs that don’t leave room for a two-hour round trip on foot or by bus for a fifteen-minute appointment.”
Three stops, twice a week
The mobile unit will rotate between a senior housing complex on the neighborhood’s northern edge, a mobile home community near the old rail spur, and a stop outside a Cedar Hollow elementary school during after-school pickup hours, timed to reach parents. Anand said the clinic chose the sites based on a survey of roughly 200 patients who had missed appointments over the past year.
- Cedar Hollow senior housing complex, Tuesday mornings
- Rail Spur mobile home community, Tuesday afternoons
- Cedar Hollow Elementary School pickup line, Thursday afternoons
“When we actually asked people why they missed appointments, transportation came up more than cost or insurance,” Anand said. “That told us the clinic being free doesn’t matter much if people can’t physically get here.”
The van, a retrofitted delivery vehicle with two exam rooms, will offer basic primary care, vaccinations and blood pressure and diabetes screening, along with referrals back to the clinic’s main Cedar Hollow location for anything requiring more equipment. It will also carry the fentanyl test strips and naloxone kits the clinic has distributed since it expanded its medication-assisted treatment hours to three days a week.
A patient’s relief
Loretta Vance, a 68-year-old resident of the senior housing complex on the mobile unit’s first stop, said she had gone more than a year without a blood pressure check after a knee injury made the walk to the clinic’s main building too difficult. “I kept meaning to ask my daughter to drive me, but she works two jobs and I didn’t want to be a burden over something that felt routine,” Vance said. “Having them come to the parking lot means I actually go.”
Council Member Gary Petrowski, who represents Cedar Hollow, said he had pushed the clinic and county officials for two years to consider a mobile option after hearing similar complaints at community meetings. “This is a neighborhood that’s had a lot of promises made to it,” Petrowski said. “A van that actually shows up twice a week is a smaller thing than a new transit line, but it’s the kind of smaller thing that people notice because it’s real and it’s now.”
Funding still year to year
The unit cost roughly $140,000 to retrofit and will run on a combination of a county health grant and private donations the clinic raised over the past year, according to Anand, who said staffing it will require redistributing existing clinic hours rather than new hires for now. She said the clinic hopes to add a fourth weekly stop, potentially in a different underserved pocket of the neighborhood, if the pilot shows strong turnout.
“We’re proving the model with the budget we have,” Anand said. “If this works the way I think it will, the case for expanding it, maybe even into parts of Lowertown, gets a lot easier to make to funders next year.”
Dr. Kwame Asare, director of the Wentworth County Department of Health, said the county views the mobile unit as a complement to its own outreach van program rather than a duplication, since Riverside’s van will focus on primary care and preventive screening while the county’s vans focus on overdose response. “Between the two programs, we’re finally reaching people at more of the actual places they are, instead of just the places we assumed they’d come to us,” Asare said.
The clinic plans to track appointment completion rates for patients reached through the mobile unit against its overall no-show rate, data Anand said will shape whether the program expands or contracts when its current funding comes up for renewal.
Logistics of a two-room clinic on wheels
Anand said outfitting the van required more regulatory review than she initially expected, including separate health department sign-off on refrigeration for vaccines and a review of how patient records would sync back to the clinic’s main system without a reliable cellular connection at some of the rural-feeling edges of Cedar Hollow. “We spent almost as much time solving the technology problem as we did deciding which neighborhoods to visit,” she said.
The clinic is staffing the van with one physician assistant and one medical assistant per shift, drawn from its existing roster rather than new hires, a staffing decision Anand said reflects budget limits more than preference. “I would love to hire dedicated mobile-unit staff,” she said. “For now we’re asking existing staff to split their week between the building and the van, which works but isn’t sustainable indefinitely if the program grows the way I expect it to.”
Petrowski said he plans to raise the mobile unit’s early results at an upcoming council committee hearing on health equity, hoping to make the case for county matching funds that could let the clinic add staff rather than stretch its current team further. “A pilot that works on the backs of staff who are already stretched thin isn’t really proof the model is sustainable,” he said. “It’s proof the need is real. The county still has to decide whether it’s going to pay for the staffing that makes it last.”