June 21, 2023 818 PM
TERLINGUA — On Monday, Terlinguans packed the Red Pattillo Community Center to discuss plans and priorities for a new clinic in Terlingua. Big Bend Regional Hospital District (BBRHD) Executive Director J.D. Newsom, grant writer Lynette Brehm and Susan Martin of Terlingua Fire and EMS (TFEMS) were on hand to field questions and suggestions from the community.
The BBRHD announced last June that Presidio and Terlingua were the recipients of a large grant from the USDA — this week’s town hall was an important step toward realizing long-term goals. Presidio will open an after-hours clinic; Terlingua will have a part-time clinic for the first time in two decades.
Exactly what Terlingua’s clinic will look like has yet to be determined. The original USDA grant includes operational costs, but does not cover the construction of new facilities. The existing TFEMS response building is “pretty occupied,” according to Martin.
Instead, Newsom posed the idea of a mobile clinic — a service that Preventative Health Care Services already offers in Presidio County. Before the opening of a pharmacy in Marfa, prescriptions for locals were also dispensed on wheels. “In theory, you could start that tomorrow,” he said.
Martin thought it was a good place to start, especially for a community as dispersed as Terlingua — as a first responder, she’s traveled all over South Brewster County to treat community members in distress. “We can get closer to our people, so it’s not as much of a challenge to come to the doctor,” she said. “I think it fits the way we live down here.”
In addition to the new clinics, both Presidio and Terlingua will also benefit from a community paramedicine program to expand the range of services that local EMTs are able to provide. “For me, it’s the most exciting part of this project,” said Newsom. “It’s going to provide a very impactful service to some of the most vulnerable residents in Terlingua.”
Paramedics have an advanced EMT certification that expands their scope of care to provide certain medicines en route to the hospital. Community paramedicine takes that training out of the ambulance and applies to non-emergency settings — community paramedics can provide certain kinds of primary care such as collecting blood and urine samples, instructing patients on proper use of medication and conducting check-ups, like well baby visits.
The BBRHD is partnering with Texas Tech’s Health Science Center in El Paso to provide training for first responders and to collect data to help keep the program on target. The ultimate goal of the program is to reduce transports to the hospital by at least 25%, easing the pressure on a strained rural EMS system.
Martin explained that the original concept of community paramedicine was to provide follow-up care — providing a check-up after a hospital stay or an office visit so that patients don’t have to leave home to see the doctor. That model has been quickly evolving, especially within rural medicine.
She would like to see the program adapted to suit Terlingua’s unique needs — by encouraging folks to call the community paramedics directly to see if issues can be resolved at home, rather than traveling an hour or more to see a doctor. “It’s a great unknown,” she said. “But I want to bring healthcare to you guys.”
Monday’s conversation was just the tip of the iceberg. One of the main challenges in Terlingua will be determining demand — because the population fluctuates with the seasons, it can be difficult to predict when folks will need medical services. That same fluctuation also makes it difficult to provide stable jobs for the professionals who would potentially staff these services.
Another unknown is telemedicine — in the past few years, the field has exploded, particularly in terms of access to mental healthcare. Newsom had even explored the possibility of an automatic diagnostic kiosk that could dispense medicine but wasn’t sure if that would necessarily be the right fit for Terlingua — the machines had only been piloted in areas with a high population density.
Martin agreed, hoping instead to bring patients “face to face” with people they know and trust. “You can’t bring in a $300,000 robot and fix everything,” she said. “I think you could do a lot more with a lot less.”
The grant also provides funding for a social worker to help connect locals with resources — and to encourage people to ask for help. “The bigger picture to me is prevention — doing what you need to do before it’s an emergency,” Martin said. “I love the people that make up Terlingua and their independent spirit, but we all need help sometimes.”
BBRHD is shooting to start clinic services early next year — hopefully by February 1, if not sooner. Newsom was also hoping that the paramedicine program could get off the ground by August 1, dependent on TFEMS’ ability to hire new staff members. “As soon as they come on board, they’re launching,” he said.