Q&A: Medicine on the Move

Dr. Jonathan Kirsch ’90 directs the University of Minnesota's Mobile Health Initiative providing no-cost health care to the state's most underserved populations.

Launched in June 2020, the program brings U of M health professionals and students from multiple disciplines into communities where long-standing racial and social injustices have created barriers to care. Kirsch’s experiences working in Latin America and with migrant farmworkers in the U.S. informs his leadership for this nascent model of medicine.

Question: Mobile health care is relatively uncommon in the U.S. How did the U of M decide to launch the Mobile Health Initiative (MHI)?

Answer: The school had an interest in creating local work experiences with global populations for residents and students. Because I have provided medical services to migrant and Latin American farmworkers, I was asked to set up a program. After running it as a volunteer for six years, funding came in from Otto Bremer Trust, and we were able to purchase a mobile unit and hire a small staff.

Q: What services does MHI provide?

A: We focus mostly on preventable diseases, like kidney failure, diabetes and heart disease. We do a lot of lab tests where we screen in the field and get results right away. It’s called point-of-care testing, and if you do a lot of it, you can link patients to the care they need. For instance, we’ll screen 100 people or more in a day for diabetes. Often there’ll be 10 or 15 who are diabetic and didn’t know it. So we’ll educate 85 people on wellness and self care and link 15 to medical care to control their diabetes. A lot of our efforts are in working with people with substance use disorder, which is a rapidly growing population that includes a lot of deaths from overdoses.

Q: Can you talk about the role community partnerships play in MHI’s success?

A: It’s clear there's a lot of mistrust and anger from people who feel they’ve been left out of their own care. Engaging with communities to meet the needs of their own people goes a long way toward building trust. Our hope is that by working with community-based organizations, more patients will seek preventive care so they don’t, for instance, go on dialysis in 10 years or have a heart attack or lose a foot. In my work in the U of M medical center, I see these complications every day, and they are almost all preventable.

It's clear there's a lot of mistrust and anger from people who feel they've been left out of their own care. Engaging with communities to meet the needs of their own people goes a long way toward building trust.

Q: How does MHI serve as an educational program for U of M students?

A: In developing this program, we focused on making it very learner friendly. MHI includes undergraduates, medical students, residents and pharmacy students. Often medical care is dependent on these learners. So we want to help them have [learning] experiences because it can be life changing. That happened to me: I had experiences as a medical student that convinced me to work with underserved communities.

Q: Are other schools taking up this mobile health model?

A: There are some health systems that do it to some degree, but not many and not connected with universities. This model is in the early phases, and it’s got a lot of room to grow. Its strength allows us to be adaptable. For instance, we rapidly mobilized teams to provide screening and care linkage for over 1,200 Afghan evacuees after the government collapsed and organized it all within weeks.

Q: What excites you about the work you’re doing through MHI?

A: Seeing students and colleagues get excited about mobile health. We're used to the rigid, top-down, controlled environment of a clinic or a hospital, which is important in many cases. But what really excites me is early detection— finding preventable diseases before they become a problem. When we sit in our ivory tower and say, “All right, we're gonna wait until things get really bad. And when they do, we're here.” that model is just not very public health-oriented, and it hurts populations that have barriers—people who don't speak English or don't trust the medical system, people who don't have money or jobs where they can get off to seek care. Why do marginalized or underserved populations do worse with particular diseases? Largely, I think, it’s lack of prevention and early detection. Seeing medical students, undergraduates and residents get excited about [prevention and early detection] has been awesome. We've had students present their work all over the country, and I like to believe this will influence their career trajectories.

Do you know Blake alumni doing interesting work? Let us know at cyrus@blakeschool.org.