Rollete County Public Health Unit rolls across the county
The Rolette County Public Health District’s (RCPHD) new mobile health unit is providing modern day house calls. The 38-foot customized RV unit allows staff of RCPHD to travel across the county in a two-exam room clinic, reception area, and bathroom—on wheels. This innovation is allowing more people to get more vaccinations, providing fluoride varnish for children, and educating on preventative healthcare.
Barb Frydenlund, administrator of RCPHD, shared her excitement of this new endeavor.
“Fifteen years ago, I went to a conference and there was someone talking about their ‘health on wheels’ program. That caught my attention. We are a county with a lot of housing units, we have very little infrastructure, our schools are overflowing, and there isn’t [physical space] for us. A mobile health clinic would be amazing.”
Rolette County Public Health District
Rolette County is located in north-central North Dakota, near the Canadian border. The sparsely populated county includes the Turtle Mountain Band of Chippewa Indian Reservation.
First established in 2001, public health at the county level is relatively new to Rolette County. Merle Boucher, a then Rolette County legislator, led the way for all land in North Dakota to be covered by local public health services that same year.
“We were one of the last four counties [in the state] to get local public health,” said Frydenlund. “We are a very unique county. We have a large Native American reservation. We have a lot of health needs and very limited taxable land, and a comparably low tax levy on that land.”
When Frydenlund joined RCPHD in 2003, the office had two staff members and an annual budget slightly over $100,000. Twenty years later, RCPHD has 16 employees and a budget of just under $2 million.
“I have been blessed to have a very supportive board of health,” said Frydenlund, calling the late Wade Burgess, a UND alum, her program’s “top champion.” “He was a physical therapist and director of physical therapy at our local hospital. He was the only Rolette County Board of Health president until he passed away in 2020. He was instrumental in the development of public health in the county. Together we had a big vision and we made things happen. It helped bring our program to where it is today.”
Frydenlund also credits Dr. Duane Glasner, RCPHD health director and a retired long-term physician in the county, for much of the success of RCPHD. With Glassner’s support, she was able to dream about one day having a mobile health unit to help serve the residents of the county.
Laying the Groundwork
Frydenlund knew early that her office couldn’t afford a project like a mobile unit. Still, she always kept the idea in the back of her mind. So a few years ago she reached out to staff at the UND Center for Rural Health (CRH) to find out what resources might be available. And when she presented at various state health department meetings, she would talk about the needs of the county and the lack of funding and infrastructure available.
Brenda Weisz, the chief financial officer for the North Dakota Department of Health, listened. In October 2020, Weisz called Frydenlund and shared that the state had $300,000 in CARES Act funding they wanted to give to RCPHD to put toward a mobile health unit, if they were still interested in pursuing the project. Frydenlund quickly accepted.
“Barb contacted me early on about their needs,” added Brad Gibbens, acting director at CRH. “One thing we do to help communities is seek funding options. Unfortunately, at that time, options were limited so the CARES Act money was great timing. Access to quality health services and outcomes is a goal, so the mobile clinic idea is a great way to bring services to people when they can’t go to the service. It is very practical.”
“The Center for Rural Health has been so supportive of us,” Frydenlund continued, “and we feel so connected. For public health, you need to look at the culture of the community, being culturally competent, and knowing what the needs are. One size does not fit all. The needs are very different.”
It was the needs of the county that first attracted Frydenlund to the idea of a mobile health unit.
“This has been a 15-year professional dream that came true. Wade passed away two days before we received word we would get the funding. The mobile clinic will be dedicated to Wade. We are naming it ‘Wally,’ which was Wade’s nickname. Without his support all along, this would not be happening.”
Clinic on wheels
The mobile health unit has two slide-out wings to create a reception area; two exam rooms, with doors for privacy; a bathroom; and is accessible for people with disabilities. It was designed and built by Mission Mobile Medical, based out of North Carolina.
The mobile health unit is an extension of the clinics, located in Rolla, and a satellite clinic in Dunseith, N.D. Every supply at the clinic is in the mobile unit, which has a generator, wifi capability, and a vaccine-quality refrigerator.
The unit was delivered on August 3, 2021, and has been on the road ever since.
“It has been used primarily for vaccinations, at this point,” said Frydenlund. “We have an aggressive Health Tracks program through the North Dakota Department of Human Services, providing preventive health for newborns and individuals up to age 21 who are eligible for the North Dakota Medicaid program. That program will use this heavily. We also have one of the largest dental fluoride varnish programs for students, and this unit will be used for those visits. The uses are endless once you have it and can see what can be done.”
The biggest barrier to service for the county is transportation. Rolette County has a relatively young population, with a high poverty rate. Forty percent of children live in poverty. The unemployment rate is around 13% in the county.
“We could see we needed to do more to reach our residents,” explained Frydenlund. “Someone might have a car, but they might not have gas money, or they have a flat tire. We decided we needed to go to the people, since they could not come to us. I look at it as a full circle from when physicians used to make house calls. We are meeting the people where they are to take care of them.”
Rural mobile clinics
Previously, RCPHD had an established schedule of outreach clinics set up throughout the county, usually at a local office or wherever they could find space. Supplies would have to be packed, transported, and unpacked. When staff would go into a school, they were displacing someone from an office, or using a school library. The mobile health unit has simplified everything. A monthly schedule is shared in the local newspaper and on social media, so people know when and where they can be seen locally.
“We have been in parking lots of grocery stores, schools, housing units—anywhere we can park,” shared Frydenlund. “This has also enhanced the opportunity to provide public health education to students, when we visit schools. One of the programs we will focus on is epidemiology/immunology education in some of the schools, to help students understand vaccines, how a virus happens, mutations, and how it all links together.”
The mobile health unit is usually staffed with a registered nurse, a licensed practical nurse, and a support staff member. RCPHD has five registered nurses and one licensed practical nurse on staff. The services offered at each location depend on who is staffing the unit. When the mobile unit is scheduled to be in the community, there are certain services that are offered.
Mission and services
“At the beginning, our biggest mission was to increase immunization rates in Rolette County and to make it very accessible,” continued Frydenlund. “There was not a lot of preventative health happening. It was a foreign concept in the county that we have spent 20 years growing. Our immunization program has grown tremendously, for children and adults. We have continued to add programs to meet the needs of our county.”
Noting that public health providers do not decline services based on an inability to pay, anyone in the county can use RCPHD services. When possible, they charge a fee for service and bill third party insurance companies. Funding comes from multiple sources. Two-thirds of funding comes from grants or fee for service. Seven percent comes from state aid while 5-7% is the local mill levy.
North Dakota law limits the local mill levy to five mills for public health. In Rolette County, that amounts to $112,000 annually.