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Caring for veterans: Medical outreach team unfazed by pandemic

The VA Palo Alto's Mobile Medical Outreach team is focusing on providing COVID-19 surveillance and testing for veterans during the pandemic.

The pandemic hasn't stopped the VA Palo Alto's Mobile Medical Outreach team, but it has temporarily changed their focus.

In normal times, this eight-person unit, led by Jean Lighthall, MD, Stanford Medicine clinical assistant professor of primary care and population health, serves patients in 10 California counties and makes 30 to 40 site visits a month in their two vans. That adds up to 400 trips a year, providing care for more than 850 veterans.

As I wrote in a Department of Medicine article, the team goes to "colleges to see younger veterans, halls for veterans of foreign wars and American Legions, libraries, senior centers, veteran resource centers, and Native American pow-wows, including the Stanford and Stockton pow-wows."

These health care professionals provide referrals to specialists, mental health care, physical therapy, orders for labs, prescriptions and vaccines for diseases, including influenza and hepatitis A.

Their goal is to ensure that veterans have the best possible access to health care; and this mission hasn't changed with the onset of the pandemic.

VA Palo Alto's Mobile Medical Outreach team
Jean Lighthall, MD, and nurse practitioner Doral Gonzales of the VA Palo Alto's Mobile Medical Outreach team in 2019

Continuing care

These days, the mobile medical outreach team is focusing on COVID-19 surveillance and testing. For surveillance, they're coordinating with VA-contracted homeless shelters, counties' public health representatives and VA social workers to test veterans in the shelters. Those who test positive are transferred to hotels set up for people in quarantine, "where they can remain safe and isolated, and receive improved medical oversight." 

The team is also involved in testing at 12 VA-contracted housing facilities. These shelters have a capacity of 400 beds to assist veterans experiencing homelessness, and can provide short-term emergency housing or transitional housing for up to two years. As Lighthall explained, the team is "working tirelessly" to ensure the safety of all residents and staff members.

Serving fellow veterans

Doral Gonzales

Doral Gonzales, a nurse practitioner who works with the unit, told me it's important to her that the mobile team continues its outreach; even as the country faces COVID-19, she has worked to serve fellow veterans.

 Gonzales retired from the army in 2012 at the rank of lieutenant colonel after a 22-year career that included deployments to Afghanistan and Iraq. 

At one point in Iraq, a rocket-propelled grenade exploded 20 feet from her, causing a traumatic brain injury, as well as post-traumatic stress disorder.

This background has made Gonzales both dedicated to veterans and able to speak their language. "I went through a lot with the VA," she told me, "so I figured I might as well work there."

Helping others connect

Gonzales decided to do outreach because "I was going to be out and about, helping veterans who had the same issues with PTSD that I did."

"Most of us, my health techs and I, are veterans, so the veterans trust us," she said. "And we have rapport with them; we connect."

During her time in the program, Gonzales has taught others how to make this connection as well. She helped to train new providers on formal and informal military jargon, improving their communication: "This made the veterans more open, trusting us with their issues," she said.

During the early stages of the pandemic, Gonzales was reassigned to the respiratory clinic at the Livermore VA, where she was responsible for much of the COVID testing and evaluation. 

Then, at the end of July, she returned to the mobile medical outreach team -- as adaptable and dedicated as ever. 

Top photo of VA Palo Alto's Mobile Medical Outreach team members Edgar Alonso Alarcon, Camellia Lau and Doral Gonzales, courtesy of Camellia Lau. Photo of Jean Lighthall and Doral Gonzales by Steve Fisch. Photo of Doral Gonzales by Rafael Gonzales.

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