Harvard Medical School's Family Van Short on Funds

Every Thursday morning, Calvin Miller waits for a 39-foot blue and white van to pull up on 577 Washington Street in Codman Square, Dorchester for his weekly primary care check-up.

The 30-year Dorchester resident, who is currently unemployed, first stopped by the Harvard Medical School-affiliated mobile health clinic four years ago out of curiosity.

“It was really good that I stopped, because I learned that my blood pressure was high,” Miller recalls. “But since I now come to the van, it’s started to drop.”

Founded in 1992 by current Medical School Dean for Students Nancy E. Oriol, The Family Van has been providing free health screenings at six sites in the Boston neighborhoods with the highest rates of obesity, heart disease, and diabetes. A small staff of health professionals regularly sees residents like Miller for preventative screenings ranging from blood pressure checks to confidential HIV testing and counseling.

But like many other mobile health clinics in Boston, The Family Van was forced to slash its budget by roughly 20 percent—or a little over $100,000—in 2008 and to cut back on staff and services including community health awareness events.

Faced with a shrinking donor base, The Family Van—which relies on funding from the Medical School and state and federal foundations—hopes to increase its visibility to prime for a larger fundraising push, Executive Director Jennifer L. Bennet says.

“In this kind of economy, the need [for mobile health clinics] only increases,” Bennet says. “But it is tough to be able to sustain these programs—they’re not cheap.”

‘A VERY SICK COMMUNITY’

Twenty years ago, when Oriol was treating patients at Harvard-affiliate Beth Israel Deaconess Mecical Center, she was struck by the high rates of infant mortality in Boston, which she says are symptomatic of a “very sick community” suffering from great disparaities in access to care.

Oriol recalls spending the next two years networking with “everybody and anybody who was related to healthcare in Boston.”

“Eventually, after talking to many men on the street, the barber shop, we crystallized the idea of a family van,” Oriol says.

Serving approximately 5,000 patients a year, The Family Van focuses on cost-effective prevention with free tests and counseling services in Boston’s low-income neighborhoods.

The Family Van is estimated to save the healthcare system roughly $20 million a year by treating patients who otherwise would not have regular access to primary care and saving them the cost of potentially expensive emergency room visits, Oriol explains.

Harvard researchers estimate that The Family Van returns $36 for every $1 spent on preventative care, based on a formula developed and published last year in BMC Medicine, an online peer-reviewed journal.

“Our model is focused on prevention, and in this country, we don’t fund prevention, we fund illness,” Bennet says. “That can sometimes make it difficult to have people understand the impact and the value of prevention.”

VALUE OF PREVENTION

Four days a week, The Family Van makes its rounds through Boston neighborhoods, stopping at each designated site for three hours as patients enter the blue-cushioned compartment that serves as a mobile waiting room.

Behind sliding wooden doors, the staff begin patient check-ups by taking blood pressures and patient histories. Patients who wish to discuss more sensitive health concerns such as pregnancy or HIV test results are taken to a private room in the back of the van.

“The van creates a culture of wellness,” Bennet says. “People can come in without being judged for their illness.”

Manager of Direct Service Rainelle Walker-White stresses that the staff of The Family Van strive to listen to their patients as well as treat them.

“People come in, and we share and spend as much time as we can with them,” Walker-

White says. “This isn’t a doctor’s office. We are just what this neighborhood needs.”

Despite The Family Van’s emphasis on preventative measures and healthy lifestyle choices, Bennet says that the patient population consists primarily of minorities and low-income groups who do not have easy access to healthy foods.

McDonald’s golden arches are a common sight in these neighborhoods, and Bennet says thatthe availability of cheap, fried foods likely hinders efforts to lead healthier lives.

“One of the big efforts is to access fresh fruits and vegetables,” Bennet says. “But when they don’t have a car and the neighborhood is full of fast-food restaurants, you are really fighting an uphill battle.”

THE REGULARS

Miller was so pleased with The Family Van’s efforts to help him manage his hypertension that he encouraged a good friend living in the area to come with him on his weekly visits.

“We always call one another, and we always come,” Miller says. “Sometimes he picks me up by the hospital where I’m staying. Sometimes he calls me and both of us come.”

In Dorchester’s Codman Square, the van’s visitors tend to be elderly patients diagnosed with chronic conditions, who, without The Family Van’s services, would not be able to effectively manage their multiple illnesses, Bennet says.

After over a year since Family Van had to scale back on services and staff due to funding shortages, Bennet says that The Family Van was able to hire back some of its staff to full-time positions this January.

With a reduced operating budget of roughly $480,000, The Family Van is hoping to regain solid financial footing to offer its original range of services and possibly more, Bennet says.

“We had been slowly been building up donor base, but we saw a drop in donors on a group and individual basis,” Bennet says.

While funding from the Medical School has remained constant, Bennet explains that several foundations had to temporarily limit grant awards or eliminated funding completely due to the economic downturn.

“It’s always tough to get general operating support,” Bennet says. “You have to get people to appreciate that we need those costs to get care to people.”

Ruby Hubbert, a Roxbury resident and a regular, stresses that she would be upset to see Family Van cut back on curbside visits.

“I love it. They give you birthday cards,” Hubbert says. “Don’t stop it—it’s nice to have.”

—Staff writer Barbara B. DePena can be reached at barbara.b.depena@college.harvard.edu.