VASHON ISLAND, Wash. — Bharat Mankad had been wheezing for a few days. It wasn’t an emergency, but the coughing was getting worse.

Mankad’s son wanted quick help for his 77-year-old father, but with no urgent care or hospital on the island, he had few options. He remembered hearing about a new type of medical team recently. He dug up the phone number.

So, rather than endure a ferry ride and a long trip, Mankad had his appointment in his son’s front yard, under the shade of a monkey puzzle tree.

“It can be complicated to get off-island,” his son, Kedar, said later. “Having a service like this in a rural place is quite helpful.”

Modern mobile urgent care, with the feeling of an old-fashioned house call, has arrived on Vashon Island, a community of about 11,000 in southern Puget Sound in between the coasts of Seattle and Tacoma. A team is following the footsteps of a similar experiment born in Mason County three years ago.

The idea of treating such a wide range of patients at home, free of charge, is still somewhat new to Washington state, but as the U.S. healthcare system becomes increasingly fractured, more communities nationwide have turned to “mobile integrated health,” especially in medical deserts.

These mobile health teams can differ widely, but have one common goal: to provide urgent medical care and social services in the most accessible and affordable way possible.

On Vashon, the superintendent of the public hospital district had been trying to bring more medical care to the island for several years. After the 2024 election, Tim Johnson’s plans became more urgent.

“The two questions I wake up with every day are: What is the Trump administration going to do next, and what can I do about it?” he said. “We decided not to wait.”

In 2019, when Vashon’s then-community clinic needed a funding boost, island residents voted to create a public hospital district and introduce a property tax.

After the district stopped needing to support the island’s primary care clinic, now run by the federally-funded Sea Mar, Johnson began talking with the Vashon fire department about how to prioritize expanding urgent care. The changing political climate, and fears about federal healthcare funding, kicked the planning into overdrive.

Now, property owners across the island are helping fund a physician assistant, a nurse practitioner, two registered nurses and two social workers, who see patients five days a week at the fire station or wherever they are on the island. Taxes cost about $330 per year for the owner of a $780,000 home, roughly the median value on the island.

Without the team, most serious or emergency care — ranging from a bad cut to a heart attack — often requires an off-island trip. Many residents buy additional health insurance for possible helicopter transports.

A locally owned pharmacy, natural medicine center and at-home healthcare startup cover other lower-level medical needs.

“I’d probably be broke without mobile integrated health,” said David Mish, 66, who called for help in January, after his former provider fell out of his insurance network. He had just been diagnosed with a prostate condition and needed a catheter, but his new provider was overwhelmed with patients.

Mish, who grew up in the tight-knit island community, turned to Vashon’s mobile health team. Over eight months, the providers helped him through 11 catheter changes.

“It was a nightmare,” the part-time bartender said, later adding, “These guys were here for me every time.”

It takes an island

Tyler Young grew up in a town of about 400 people south of Spokane. Now co-owner and lead pharmacist at Vashon Pharmacy, Young says this foundation was key in his career at the only pharmacy on the island, where, as he says, “you get to know everybody and their dog.”

After more than a decade on Vashon, Young says he sees two main healthcare gaps: urgent care and retaining primary providers.

“Once you get past 5 or 6 o'clock, there’s not much available to you other than 911,” he said, “People don’t want to call 911 for a sore throat or an earache.”

Historically, the island relied on longtime primary care providers with heavy patient loads, according to Young. “Those folks aren’t growing on trees,” he said.

Now, keeping primary providers is difficult on Vashon.

The community already looked to organizations like the pharmacy to step up and address gaps in coverage, but the COVID-19 pandemic pushed Young and his staff to lead the vaccination charge and increase care options for islanders in new ways.

The pharmacy and local healthcare organizations helped the community reach some of the highest COVID vaccination rates in the state at one point, Young said. Although Vashon is known for its history of low vaccine rates, in recent years, uptake has improved.

Each service the pharmacy provides, from adjusting medication to investigating side effects for chronic diseases, can save patients a four-hour round trip off the island and at least $25 to $30 in ferry fares, Young said.

Shelby Hamilton takes her three children to a primary care doctor in Seattle, which requires more planning and time, but allows them to keep the physician they had before her family moved to the island in 2019.

“We knew when we moved, that was just going to be the reality,” Hamilton said.

That’s partially why her family has called Vashon Mobile Integrated Health — known as MIH — three times so far, once for each kid, for advice on cuts and falls. She most recently took her eldest, Holden, for a visit after he tumbled from his scooter and hurt his arm.

“We’re really thankful they’re here,” she said. “They add an important layer of medical support for the community.”

Word is still spreading about the island’s mobile health team. Young said his patients are sometimes surprised, but grateful, to hear the extent of the program’s services.

“The community looks to us to supply more than just prescriptions, and the same is asked of a lot of the other organizations,” Young said. “All of us have to chip in and do some things that are a bit above the norm just to try and make it so that our patients are cared for without having to feel that burden of being out here.”

Young’s goal is for healthcare on Vashon to feel as accessible as in urban areas, with the signature community feel of the island, where “you’re a lot more like neighbors and friends than patients and providers,” he said.

‘Future of the profession’

Lilie Corroon flies around the Vashon Island fire station with a smile, answering patient phone calls, scheduling appointments, maybe pausing for a moment to pet Dottie, the office pup.

Corroon did not intend to go into healthcare. But now, she says, “I eat, sleep and breathe MIH.”

As program director, Corroon is the administrative backbone. Since Vashon Mobile Integrated Health’s official launch in 2024, Corroon has helped the team grow from one provider to six, and increase services from one day a week to five. Since starting, the team has seen more than 1,000 patients.

By next year they hope to be up to seven days a week, she said.

She’s learned a lot from the work of other programs, like in north Mason County, which has expanded to staff two mobile teams that cover the entire county.

“We wanted to become mini-Mason,” Corroon said.

These two programs are rare in Washington, according to mobile health experts, in that they’re both largely taxpayer-funded through an agreement between a local public hospital district and fire district, as well as staff medical providers with such a wide-ranging scope of practice.

On Vashon, physician assistant Paul McGown can examine patients, prescribe medication, diagnose illnesses, order tests and provide stitches, among other care to island residents.

McGown, who grew up in a small Central Massachusetts town, moved to Washington about three years ago. He later heard from a neighbor about a program that brought free healthcare to people’s doorsteps, and was curious.

While Vashon’s mobile health team isn’t the place for primary care, they do a lot of “bridge care,” McGown said, like refilling medicine or offering referrals.

“Vashon’s kind of the perfect place to be able to do something like this,” McGown said of the mobile health model, referring to the island’s isolated location and community support.

Other parts of the state, from Bellevue to Spokane, have taken similar steps in teaming up with local fire departments to provide care for conditions that are urgent but not quite life-threatening.

“For a while, it was a relatively niche area,” said Jon Ehrenfeld, who leads the Seattle Fire Department’s mobile integrated health program, which provides case management after 911 calls.

“But at this point” he said, “I would say any fire or EMS program of any size has seen the writing on the wall, that (mobile integrated health) really is the future of the profession, to an extent.”

Growing roots

Before one of Katie Burke’s first house calls of the day, the newly minted family nurse practitioner packs up the main mobile health van – affectionately referred to as “Big Red” – and heads south, to a neighborhood far from ferry access.

When she and registered nurse Ashley Soares arrive, they open a white gate, cross Kedar Mankad’s yard and introduce themselves to his father, on a visit from Arizona to see his new granddaughter.

Burke listens to Bharat Mankad’s heart with a stethoscope; Soares takes his blood pressure. At the end, Burke says she’ll look into sending a steroid inhaler prescription to Vashon Pharmacy, for the 77-year-old’s family to pick up.

“The medicine prescribed really worked,” Kedar Mankad later said. “He was better the rest of the trip.”

In July, Vashon’s fire district and public hospital district officially extended the mobile health program for another three years.

“We're hoping this is a scalable thing,” said Johnson, the hospital district superintendent. “That we can encourage other communities to join us, and maybe we'll build something from the bottom up.”

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