- The success of telehealth has always been closely tied to the idea of bringing healthcare to those who have problems with access.
To the 700 or so residents of several islands off Maine’s Downeast region, that success is tied to a video link with an onshore clinic and the 75-foot, steel-hulled vessel that makes twice-monthly runs up and down the coast.
It’s all part of a “big jigsaw puzzle” for healthcare, says Sharon Daley, RN, a Missouri native who launched the nonprofit Maine Seacoast Mission’s telehealth program some 17 years ago and now directs the multi-faceted program out of Bar Harbor.
“Going off island is extremely expensive,” she says. “So we have to make do with what we have.”
Daley’s network begins of the Sunbeam. Equipped with a telemedicine lab that includes virtual visit technology, it sails out of Bar Harbor twice a month, each three-day journey tracing a route that might take it to Matinicus – at 21 miles out, it’s the most distant island, and only accessible at high tide, and home to about 75 full-timers – Isle au Haut and/or Frenchboro 9a few others islands are visited with less frequency). Appointments are scheduled with island residents in need of medical service, and time is left for walk-ins as well. All of these services are free.
She handles basic primary care services (there’s a phone and video link but no store-and-forward services) - physicals, flu shots, chronic health screenings for issues like diabetes and high blood pressure, strep tests, some behavioral healthcare and treatment for issues like drug interactions, even a little marriage counseling.
Any tests that Daley does have to be dropped off on the mainland when she returns. They can be sent out via the mail boat (that’s often how prescriptions are managed) or, in a pinch, flown out by plane from Matinicus.
“I am the doctor’s hands, not the doctor,” she points out. “I always tell people if you think it’s an emergency, don’t wait for me.”
But many do. The Sunbeam’s twice-monthly trips are big events on the islands, and not just because of the healthcare services.
“Telemedicine is probably about 10 percent of what I do out there,” says Daley, “but it also enables me to do everything else that I, as a nurse, can do.”
That means switching from nurse to neighbor, sitting with people, asking about their families and diet and exercise, and fitting some advice into the conversations about health and wellness. A fisherman’s complaint about an aching back, for instance, might not be about the pain he’s feeling in his back as much as it’s about a battle with depression or substance abuse.
“A lot of this is just about listening to them,” she says. “The boat is a very social place. There’s coffee, meals, games, all sorts of stuff going on.”
Back on land, Daley coordinates the mission telemedicine program from Bar Harbor, maintaining phone and video links with telemedicine clinics on Monhegan and Swan’s Island (each staffed with a nurse’s aide) and coordinating care with a network of clinics, hospitals and behavioral healthcare services on land, from Bangor to Hallowell to Camden-Rockport. The system was set up on Polycom technology with help from Ron Emerson, the company’s former global director of healthcare and a Maine native.
Through the video link, Daley can coordinate educational sessions for islanders on issues that include drug and alcohol abuse, suicide prevention, smoking cessation, Lyme disease, cardiac and other chronic disease care and domestic violence. She also conducts a lot of follow-up and home visits via phone and video.
She also has access to a network of doctors – some retired, some living on the islands or vacationing during the summers, offering their services when needed – and specialists scattered in clinics along the coast.
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“The providers I know really do not need new patients,” she says. “They have to have a desire to do this … and many of them really want to help out when they can.”
The Maine Seacoast Mission’s roots stretch back to 1905, when Angus and Alexander MacDonald, two brothers living on Mount Desert Island, launched the organization. The brothers, both Congregational ministers, bought a 26-foot sloop, christened the Hope, and began sailing to nearby islands, delivering books and whatever supplies the islanders needed.
Six boats have carried on the mission after the Hope, the last five of which have been called the Sunbeam. The latest version was built in 1995, with a reinforced hull so that it can break through the ice during its winter runs.
“We have covered basically the same footprint from Downeast Maine to the Midcoast for 110 years,” the Reverend Scott Planting, who has served as president of the Maine Seacoast Mission since 2010, told Maine Magazine in a 2016 story. “Doing basically the same thing, obviously modernized with telemedicine and state-of-the-art technology, but with the same very close connection to people, families, and communities.”
Today the organization consists of some 30 full-time employees and 80 part-timers, a wide range of services that go far beyond healthcare and a budget of about $3.6 million, met with a combination of donations, grants and an endowment.
The mission recently announced that it had put its Bar Harbor home, a 115-year-old, 13,000-square-foot waterfront mansion reportedly built by the a great-grandson of Alexander Hamilton donated to the organization in 1972, up for sale. The property, which includes 2.9 acres of land in one of Maine’s most popular tourist communities, is valued at $5.3 million.
“We want to convert this asset into services and programs for Downeast Maine,” Planting told the Bangor Daily News when the announcement was made in July.
When asked what the future holds, Daley’s sigh can be heard over the telephone. More and more people need follow-up care for chronic conditions, she says. There’s high demand for mental health care, dentistry, audiology, cardiac care, pediatric services … and veterinary care.
Not to mention the well-known New England reputation for being taciturn. A lot of people, she points out, are uncomfortable asking for help. Some go without healthcare at all, while others need to be coaxed into talking.
“The isolation people lived with has always been there,” Marty Shaw, who has worked for the Maine Seacoast Mission for 17 years, told Maine Magazine. “It didn’t take very long to discover that life on an island is not the romantic one that many people think it is. It was often hard and lonely - as life is everywhere, but islands offer fewer options for people.”
“The Sunbeam continues to be important because isolation and other difficulties that come with living on an island still exist,” says Shaw. “The programs that the Sunbeam offers make a huge difference.”
Daley dreams of a broader provider network on and off the islands, connected by a reliable telemedicine platform that can link people to care providers at any time, in any weather.
That’s one of her biggest challenges.
“Finding a way that they can do their visiting when I’m not there,” she says, describing a “wonky” broadband network all along the Maine coast – and, realistically, over much of the decidedly rural state – that acts up on occasion, especially during Maine’s harsh winters.
“You’ve got to get it to work,” she says, “so you work it out, and you do it outside the box if you have to.”