On an ordinary day in the Summer of 2016, I was seeing patients in my office. Like every other clinic day, there was a waiting room full of folks eager to be seen -- pregnancies from 6 weeks to overdue, menopausal women fanning themselves over hot flashes, children on iPads and an assortment of others nervously awaiting a pap smear, or STD check or IUD insertion.
Those days I wore a white coat and heels, a stethoscope draped across my neck. I closed one exam room door and paused to give notes to my medical assistant. And then I took a breath, just stopped for a second, and it felt like that was the moment everything changed.
“We are going to lose access to reproductive healthcare.”
The thought flashed across my mind right then, in the most inopportune time. I was busy and folks were waiting. But it was as if a summer’s worth of news stories and political podcasts, the faces of the young women behind the closed doors, the wailing of a newborn’s cry, coalesced into that one thought and I realized, it was over. Reproductive health, access, rights, justice as we knew it, was on its way out.
I looked around my office, set my laptop down and jotted on a piece of paper -- "Funding for birth control, access to abortion, all the preventive services that go along with these things are under grave threat. And those of us in the trenches will be both challenged and accountable to our patients one day."
It took a few years for that moment’s pause to make its way into our daily lives. Little by little, the signs appeared -- justices assigned to the courts, threats to bodily autonomy in the way of LGBTQIA+ rights, Transgender rights, and then Reproductive rights.
By 2019 it was clear to me that if we did not act proactively to help protect access to reproductive health, women across the country would be left with little to no Gynecology specialty care. Hints of Labor & Delivery units closing in rural communities had started. We had the highest maternal death and illness rate in the developed world. Nothing in our political realm felt reassuring. Funding for women’s issues, reproductive issues, bodily autonomy issues was sure to get reduced or eliminated. And worse than that, we were heading towards a landscape where healthcare deserts would leave some of our most vulnerable patients absolutely absent of care.
The idea for FemForward sprouted during that time. It began as a business model and evolved into an entire model to transform the way care is provided. I knew that we needed an Ob/Gyn clinic run by a Board-Certified Ob/Gyn to provide the highest quality care. I also felt that we needed to be contracted with as many insurance companies as possible, to help make care accessible and affordable for most folks. But in addition, I wanted to add a non-profit entity, to allow us to apply for grants, to fundraise, to have enough money in a separate pot so that we never had to turn a patient away. AND, I wanted us to be mobile. Like, on wheels mobile. Like, nimble mobile. Like, in an RV mobile, with an exam room, and a bathroom and a sink. Something like that, I imagined, because I had never actually stepped foot inside of an RV.
This daydream-turned-reality began with that vision, and with a step-by-step imagining of what could be possible. We credentialed with nearly every major insurance company. Even Kaiser hopped on board to support our cause. We created a separated 501(c)3 and began fundraising. We purchased a 31-foot Forest River Forester RV and I learned to drive it, fill the gas tank, park in perfectly small spaces. We began the process of forming community partnership, advertising to patients.
Today, after 13 months, we are a full-fledged operation with locations in SE Portland, Gresham, Sandy, and Hillsboro. Our partnerships include non-profits, community-based organizations, corporate offices, universities and departments of public health. We are performing annual exams, treating menopausal symptoms and postpartum depression, helping with early pregnancy decisions and pregnancy loss, utilizing our ultrasound, doing colposcopies with biopsies for abnormal pap smears, placing IUDs and Nexplanon implants, diagnosing cancer, and also taking patients to the hospital operating room for gynecologic surgery.
The days in the RV have been the most rewarding, challenging, interesting of my career. There is a joy that returned in providing individualized care. There is an ongoing education that happens when one is in the world, based in communities, learning day-to-day how to improve and meet specific needs. And there has been a growth that continues -- a vision to expand and share and spread the model of mobile care.
We are an aspirational clinic attracting everything that we might aspire to in our lives -- compassion, professionalism, humanism, and a belief that every individual has a right to access high quality health care in a caring, affordable, accessible manner. It is what we are doing at FemForward today, and then again tomorrow. And, as I step behind the wheel to head towards our location for the day, I am admittedly humble and beyond proud to be driving the bus on this one.