The three-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 the Medical University of South Carolina.
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, 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.
Dr. Ray Greenberg, 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.”
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, Tina 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-5th 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 far more convenient for the patients.
A virtual doctor isn’t a doctor
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 more doctors to work in rural or poor communities if it dramatically increased the amount of Medicaid reimbursement they receive if they work in rural or poor communities.
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 the 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 Tina Brown over 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.
Over 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 necessary 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 kids she otherwise would have to send home, forcing parents to leave work and take their child to a doctor.
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. Some don’t even have transportation.
“It’s real,” she said. “With this we treat children right here. This is a good deal for everybody.”
Reach Doug Pardue at 937-5558
Nurse Lynn Floyd logs into the virtual doctor system holding on to the Bluetooth stethoscope that she uses to let the doctor hear what she hears despite being miles away at Williamsburg County Magnet School of the Arts Elementary Monday February 25, 2103. (Grace Beahm/postandcourier.com)×
Mary Peavy (left) listens as Dr. Wade Lamb asks her mother Edith Rice how she is feeling during a visit to his Lake City office Feb. 25.×
Nurse practitioner Gay Douglas. (Grace Beahm/postandcourier.com)×
Dr. James McElligott from MUSC works to help children living in rural areas get doctors treatment virtually Monday February 25, 2103. (Grace Beahm/postandcourier.com)×
Dr. James McElligott from MUSC talks with school nurse Tina Brown at Hemingway Elementary about the virtual doctor system.×