Eisenhower Mobile Care
In a dimly lit parking lot near the freeway, there is a buzz that isn’t quite distinguishable from across the street. There are tables with chairs and there are small groups of men and women - some at the tables and some standing scattered about - bundled in jackets as the temperatures drop in the late days of fall.
On this Tuesday evening in November, Eisenhower Mobile Care was parked in the lot, quietly glowing in the light and welcoming those who arrived along with that night’s medical care team.
Lanched in February 2024 with the generous support of the Houston Family Foundation and guided by Eisenhower Health’s Latinos in Philanthropy Advisory Board, the mobile care unit is dedicated to providing health care to the underserved in the entire Coachella Valley. Its current focus is on addressing the significant needs of the east valley’s agricultural community, the unhoused population, and individuals without access to transportation or insurance.
In collaboration with Coachella Valley Volunteers in Medicine (CVVIM) and Eisenhower School of Graduate Medical Education (GME), the mobile care unit represents a key initiative in Eisenhower’s commitment to delivering equitable and accessible care to everyone in the Coachella Valley.
Health equity is the principle that everyone deserves a fair and just opportunity to achieve their highest level of health, regardless of their background. Beyond the challenges faced by the area’s large geriatric population, farmworkers, LGBTQ+ individuals, and the unhoused community also encounter significant barriers. These not only include limited access to health care, but also critical deficits in key social determinants of health, such as food security, housing stability, transportation, utilities and personal safety.
“At Eisenhower, we’ve implemented initiatives to address social determinants of health, starting with screening and identifying the prevalence of food insecurity among patients in the emergency department and inpatient settings. We are now expanding these efforts with our mobile care unit to help bridge the transportation gap and bring care directly to communities in need,” explains Victor Cisneros, MD, MPH, Director of Diversity, Equity, and Inclusion, and Community Health Outreach for the GME program.
Dr. Cisneros also serves as faculty for the Department of Emergency Medicine at Eisenhower Health and the Medical Education Departments at both the University of California, Riverside School of Medicine, and the California University of Science and Medicine.
In collaboration with partners such as CVIIM, F10 Love, Bridges of Hope, Overflow 9:12, and FIND Food Bank, the mobile unit provides health care screenings and hosts educational events within the community. Each Tuesday night, the unit travels directly to areas where people in need eagerly await its arrival.
As part of Eisenhower Health’’s GME program, resident physicians in family medicine, internal medicine, and emergency medicine participate in a dedicated street medicine rotation. They are joined by a multidisciplinary team that includes undergraduate and medical students, nursing students, nurses, attending physicians, and emergency medical technicians (EMTs), working together to deliver care and support to underserved populations.
The street medicine program initially began with a small group of dedicated individuals, including Brian Wexler, PhD, a licensed clinical psychologist at Eisenhower Health, and Rosa Lucas, FNP-C, both team leaders with the CVVIM Outreach Team. In 2015, Dr. Wexler was invited to join the Eisenhower Health Family Medicine Residency Program as faculty, where he worked to integrate street medicine outreach as part of the curriculum.
Dr. Wexler remains an active supporter of the program, which, on that particular night, marked its 434th Tuesday providing care and support to the community.
“We realized that in creating the street medicine outreach team, we needed a multi-disciplinary approach,” Wexler says.
Eisenhower faculty and residents, staff and volunteers at CVVIM - including the support of Executive Director Doug Morin, and volunteers from numerous disciplines are able to gain a unique experience in providing care to the unhoused, he explains.
“It’s such a unique part of their education,” Wexler says. “Many have never worked outside a clinic environment. It’s important to realize that when you’re out in the street, it is critical to be respectful and compassionate. The unhoused are one of the most marginalized groups of people in our society and they deserve as much respect and care as anyone else.”
When Dr. Cisneros joined Eisenhower, he was tasked with improving the street medicine curriculum and broached the idea of improving the experience for both medical residents and patients through a mobile care unit that would provide privacy and technology similar to what those would experience in a clinic or hospital. Thus, the work began of the mobile unit and the eventual tie-in of additional hands-on experience in the GME program or for those interested in pursuing a career in medicine.
“We bring care directly to vulnerable populations, addressing not only their health care needs but also providing educational resources and tackling substance use disorders, including the opioid epidemic,” explains Dr. Cisneros.
For many individuals in the unhoused population, pets are a vital part of their lives. The distribution of Narcan through the program has saved the lives of both humans and their pets over the past year.
“We’ve encountered patients with complex needs, such as a pregnant woman who lacked access to essential resources,” explains Dr. Cisneros. “She had no access to OB-GYN care, so we started her on prenatal vitamins, performed a bedside ultrasound to ensure her baby was healthy, and connected her with community partners offering OB-GYN continuity of care. This simple intervention profoundly impacted her health and well-being.”
Dr. Cisneros emphasizes the unique advantage of the mobile unit, which is equipped with ultrasound technology - a rare offering in Riverside County.
“Having this capability allows our team to tailor treatment plans in real-time. For example, we can determine whether a patient with a red, swollen extremity needs emergency department care for blood thinners or more aggressive treatment, or if it’s a simple skin infection that can be treated on-site. This approach has prevented unnecessary emergency department visits and hospital admissions,” he says.
He continues, “Not only does this benefit the patients by addressing their needs promptly, but it also helps the health care system by reducing emergency department wait times and preventing overcrowding with non-emergent cases.”
Dr. Wexler adds that the care and treatment provided on the street is not only reducing the impact on the emergency department, but with fewer hospital admissions, ultimately reducing the financial impact to the hospital itself.
Looking ahead, Dr. Cisneros is focused on expanding the resources and services offered by the mobile clinic. His vision includes managing chronic diseases more effectively and developing a comprehensive continuity-of-care model to better serve everyone in the community.
“The addition of the mobile care unit really adds another layer of access and service,” says Dr. Wexler.
“It’s hard not to be impressed that so many are taking the time to be available week after week. So many of the volunteers really put their heart into this work,” he adds.
Educationally speaking, the learning spans all directions, as a community pathway for students seeking a career in medicine, to senior medical staff teaching residents, to EMTs teaching from their expertise in on-the-spot treatment.
For Dr. Wexler, he encourages the team to meet the unhoused where they are, practicing and teaching respect and offering care.
“A lot of the work is making the connection with others and offering our services,” he adds. “It’s truly helping people to change their lives.”
The street medicine team will accept donations - knitted items, blankets, hygiene kits - throughout the year, especially through the winter season. For more information, contact, contact Ali Calderon at CVIIM at 760.342.4414.
To learn more about Eisenhower School of Graduate Medical Education, visit EisenhowerHealth.org/GME.
