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Millions of Americans who live in rural areas have two choices: Travel long distances to get health care or simply go without it. But high-speed Internet now makes it possible to bring a doctor's expertise to patients in far off places, if those places are connected.

As part of its National Broadband Plan, the Federal Communications Commission has pledged $400 million a year to connect nearly 12,000 rural health care providers.

NPR's Laura Sydell has the story.

LAURA SYDELL: Redway, California is more than 200 miles north of San Francisco, a pit stop on the way for tourists heading to see the giant redwoods more than an hour up the road. The town of 1,200 has one health clinic.

Dr. WENDI JOINER (Physician, Redwoods Rural Health Center): Hi, is Michelle in? Hi, Michelle. It's Dr. Wendi Joiner is the only doctor at the Redwoods Rural Health Center.

SYDELL: Wendi Joiner is the only doctor at the Redwoods Rural Health Center.

Dr. JOINER: I can't say this sounds exactly like a migraine, per se...

SYDELL: Four thousand people from Redway and the surrounding area use this clinic, so Joiner is one busy physician.

Dr. JOINER: It's a great job. It's a special challenge. I love it, but sometimes I feel like there should be two or three of me.

(Soundbite of laughter)

SYDELL: Or at least a few experts on hand.

Dr. JOINER: It happens a lot or we're asked to do things that we're not specialists in.

SYDELL: Patients come in with skin problems, cancers, diabetes, hepatitis - all diseases that require expertise Joiner may not have. So she has to send patients to doctors in cities 100 or more miles away. That can be hard on many of them, both physically and financially.

Take Marlene McReynolds((ph), a 61-year-old retiree with diabetes, arthritis in her spine and Parkinson's disease. She now has to have surgery on her shoulder, and she will have to travel for that.

Ms. MARLENE MCREYNOLDS: I can't drive after the surgery. So I have to have somebody drive me, and it's just hard to get up there. It hurts.

SYDELL: It's the follow-up visits that really have her worried. She'll have to set aside money for gas and tolls, and she'll have to arrange for someone to drive her.

Ms. MCREYNOLDS: It's gonna come out of my food money 'cause I can't take it out of anywhere else. That's my choices. I mean, if I don't pay my property tax or my PG&E bill, then I don't have a home.

SYDELL: That's where the Federal Communications Commission's rural telemedicine plan will help, says FCC Chairman Julius Genachowski.

Mr. JULIUS GENACHOWSKI (Chairman, Federal Communications Commission): If you have rural connectivity for health care, then patients don't have to drive two or three or four hours. Instead, patients can stay back where they live, consult with a medical professional remotely.

SYDELL: The FCC has had a pilot program for several years that Genachowski says has been a success. It's helped expand the reach of the telemedicine clinic at the University of California, Davis Medical Center.

Dr. ALISON SEMRAD (Endocrinologist, University of California, Davis Medical Center): Im Dr. Alison Semrad. Are you Katherine?

Ms. LAURA MCKEWAN: No, Im Laura McKewan...

Dr. SEMRAD: You are Laura McKewan. Oh, we swapped.

SYDELL: Two afternoons a week, Dr. Alison Semrad, an endocrinologist, sits at a desk and consults with patients over a broadband video conference.

Laura McKewan is sitting in a chair in front of a camera at a clinic 300 miles away in Eureka. She has Addison's disease, a rare condition that affects the adrenal glands. She has to drive six hours to San Francisco to see an endocrinologist, so McKewan jumped at the chance to consult with Dr. Semrad.

Ms. MCKEWAN: I'm so excited. I don't think you could get a more enthusiastic patient.

(Soundbite of laughter)

SYDELL: McKewan has been suffering from serious fatigue that might be related to her condition. Her primary care doctor hasn't been able to help. But Dr. Semrad probes.

Dr. SEMRAD: Did notice that the fatigue is getting worse more recently or is this something thats kind of always been there?

Ms. MCKEWAN: It's always been there.

SYDELL: After listening for a while, Dr. Semrad offers up recommendations.

Dr. SEMRAD: One thing for Addison's disease is that we sometimes will also use a different type of steroid called hydrocortisone. And...

SYDELL: Semrad spends an hour with McKewan. When she's done, she will write up her recommendations and put them on a secure server, where McKewan's primary care doctor can get them immediately.

McKewan has been to an endocrinologist only once in the past seven years.

Ms. MCKEWAN: It may not be quite as wonderful as sitting right there, but to drive all the way, to save the expense and, you know, I think this has worked out really well.

SYDELL: Every year, the U.C. Davis Hospital serves around 3,000 patients who live in rural areas, says Dr. Tom Nesbitt, who heads the program here.

Dr. TOM NESBITT (Director, Telemedicine Clinic, University of California, Davis Medical Center): The demand would even be greater if the remote locations had equipment, bandwidth and training.

SYDELL: That's what the FCC's $400 million is intended to do. The money is already there through what's called the Universal Service Fund. Thats intended to provide telephone service to rural communities.

By transferring the money to broadband, FCC Chairman Genachowski believes he can provide a lot of savings in health care. But he still has to convince critics of government overspending.

Mr. GENACHOWSKI: One of the greatest forms of savings will come from health care spending that we don't have to make because we catch problems earlier, we can treat and diagnose remotely.

SYDELL: The FCC has been criticized by some broadband providers who don't like the competition from the government.

But many rural areas don't have broadband connections because the rough terrain and low population density make it unprofitable for commercial carriers to build out there. Genachowski says for those areas it makes sense for the federal government to step in.

Laura Sydell, NPR News, San Francisco.

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