After topical treatments failed to heal a patient with a rare form of skin cancer, family physician John Mohs, MD, carefully evaluated the patient’s next steps.
Mohs practices at Northern Navajo Medical Center in Shiprock, N.M., a rural hospital operated by the U.S. Indian Health Services (IHS), which provides health care for American Indians living on or near their native homeland. Patients in this remote region of Navajo Nation are at higher risk for many diseases, yet specialty care is scarce. Northern Navajo Medical Center serves approximately 30 inpatients per day and approximately 600 outpatients per day, according to the IHS.
Diagnosed with cutaneous T-cell lymphoma – a form of lymphoma that affects the skin – Mohs’ patient was a good candidate for phototherapy, which exposes targeted areas of the body to ultraviolet light to reduce skin inflammation. Also known as light therapy, phototherapy has been proven to be safe, effective and affordable in treating a number of inflammatory skin conditions.
For Mohs and his patient, the challenge was access. Until recently, Mohs had neither the training nor equipment to provide phototherapy at his small dermatology clinic in Shiprock. The nearest phototherapy center was about 200 miles away, and his patient would need to go there three days per week for several months. The combination of barriers made it infeasible for the patient to obtain the specialized care he needed.
Ironically, the solution to their problem would be found more than 2,000 miles away – in the BWH Department of Dermatology.
Thanks to a clinical collaboration between BWH faculty volunteers and IHS clinicians through the Brigham and Women’s Outreach Program, Mohs developed and launched a phototherapy service for his patients in Shiprock based on guidance he received from BWH experts in the field.
He worked closely with Elizabeth Buzney, MD, director of the BWH Phototherapy Center, and Margaret Cavanaugh-Hussey, MD, MPH, director of Public Health and Community Outreach Programs in BWH Dermatology, who Mohs said both played a significant role in helping him get this new clinical service off the ground.
“I probably would not be using phototherapy without the guidance and assistance they provided. Dr. Buzney willingly shared many resources so that I wouldn’t have to reinvent the wheel,” Mohs said. “Thanks to all of this support, my patient was treated right at Northern Navajo Medical Center and is now in remission.”
Buzney was delighted she could help to expand access to this treatment – a cause she says is close to her heart.
“I felt like I did something that was so small – I shared resources and knowledge I already had – and Dr. Mohs has since been able to care for so many people as a result,” Buzney said. “As physicians, we typically treat patients one-to-one. To play a part in assisting many patients who are so far away is immensely gratifying.”
A Helping Hand
The project represents one of many collaborations established over the years between IHS clinicians and BWH faculty volunteers through the Outreach Program. Building on their latest momentum in phototherapy, Mohs and his physician assistant colleague, Toby Crooks, PA-C, visited the outpatient Dermatology clinic at 221 Longwood Ave. last month for a weeklong shadowing opportunity to observe and learn from BWH clinicians in action.
Mohs and Crooks were assigned to various specialty clinics, ranging from advanced wound care to cutaneous lymphoma – an experience that enabled them to broaden their dermatologic knowledge and strengthen relationships with experts in the field, said Cavanaugh-Hussey. In return, she added, BWH faculty had the chance to learn firsthand about the important work their IHS colleagues are doing in Shiprock.
“The BWH Outreach Program is a model for how forming meaningful relationships with primary care providers in underserved communities can dramatically increase access to high-quality specialty care,” said Cavanaugh-Hussey. “This is particularly important in dermatology, where access to care is limited in many areas of the country.”
While the Outreach Program may be best known for sending BWH faculty volunteers to Shiprock to train IHS clinicians and help care for patients, providing shadowing and observation opportunities at the Brigham are equally important to its work and mission, said Thomas Sequist, MD, MPH, medical director of the Outreach Program, a primary care physician in the Phyllis Jen Center for Primary Care, and chief quality and safety officer at Partners HealthCare. Since 2009, the program has hosted training opportunities at the Brigham for 18 IHS clinicians.
“The delivery of highly specialized, complex care is crucially needed within the IHS. However, the number of patients that require such care on a day-to-day basis is relatively low, so if we send a BWH specialist to New Mexico, it is quite likely that there will be no training opportunity with actual patients the week they are there,” Sequist said.
Mohs agreed that observing the BWH Dermatology team in person was enormously beneficial.
“We were able to see a large volume of more rare and complex conditions that we don’t see often enough to feel confident managing,” he said. “Being able to see these cases with BWH attendings and ask questions – and receive extensive answers from the experts – in real time was invaluable.”