Howard Lincoln of White Mountain, Alaska, doesn't always hear it when people knock on his door. He's 82 and he still has a little shrapnel in his jaw from a mortar shell that nearly killed him in the Korean War 60 years ago.
"We heard it whistling, but I was the third one in line running toward the bunker," he recalls.
Wounds to his face, arm and hip laid him up in a Tokyo hospital for quite a while. But he recovered, came home to Alaska in 1955 and says he never applied for Veterans Administration (now the Department of Veterans Affairs) benefits.
The nearest VA hospital was hundreds of miles — and at least two plane rides — away. White Mountain, along the Fish River, is still pretty remote. It's a day's journey by snowmobile or dog sled to Nome or a short flight if the weather allows. But the distance to health care just got a lot shorter — virtually.
"Travel is a big burden on a veteran who may be older, not feeling well," says Susan Yeager, who directs the VA health care system for the state, "and just the sheer expense of travel. That can be a barrier to care, and that's part of what telemedecine is about."
"Telemedicine" happens over a secure computer connection between the big VA hospital in Anchorage and hundreds of small clinics across Alaska. Each clinic has a cart — picture your old desktop computer with retractable cables that connect it to everything in a doctor's little black bag — a stethoscope, an otoscope to look in ears, high-resolution cameras and an ultrasound.
Saving Time, Money And Travel
Brian Laufer, chief health officer at the Anchorage VA hospital, recalls a recent case where he showed a patient's skin lesion to the head of dermatology at the VA in Seattle, a thousand miles away.
It could have taken weeks and maybe a plane ride to get a specialist to look at the lesion in person. Instead the specialist asked — over the video link — for an immediate biopsy.
"Turned out to be a melanoma. Within three weeks it was fully excised and had surgery here and had a cure because the melanoma was caught very early," said Laufer.
Quick action like that can save lives — and lots of money on travel. The VA estimates it has saved more than 800,000 miles of travel that patients didn't have to make since the program was set up.
Vets with post-traumatic stress disorder can sit in group therapy by video. Therapists say that can be more discreet for veterans in tiny towns where everyone knows everybody's business.
Last year the VA made the distance to get care even shorter by joining with the Indian Health Service, which already has hundreds of clinics around rural Alaska and six other states. Vets, whether they are Native Americans or not, can now use the Native clinic system and the VA will pay for it.
That means vets like Howard Lincoln in White Mountain can get care near home. For Lincoln, it's just a short walk to the village clinic, or a snowmobile ride when the snow is too deep.
Aging Veterans From Vietnam And Korea
Vets from the Korean and Vietnam eras make up the large majority of those seeking care these days, as they reach an age where health complaints are common. Lincoln's sister Willa Ashenfleter helped him get signed up with the VA — and not a moment too soon. Lincoln had two minor strokes last year. Now he's monitoring his health more closely.
"There's a machine by his table that he takes his blood pressure around 8:30 every morning," says Ashenfelter, adding that the information can be beamed directly to the VA.
At 82, he's still fiercely independent, Ashenfleter says. Her brother worked hard to recover and stay active even after his strokes, she adds.
"Couple times he's been on his roof ... working on his stovepipe ... and when we tell him he shouldn't be up there, he isn't happy," she says.
Howard Lincoln was back up on his roof last winter. His sister says he doesn't like people telling him where he should or shouldn't go.
DAVID GREENE, HOST:
Yesterday on the program we heard how difficult it can be to reach or even find U.S. veterans. NPR's Quil Lawrence took us to a remote town in rural Alaska. It was just one extreme example, though truth be told many vets live in hard-to-reach places. Today we're looking at how to get them health care without making them travel hundreds of miles to a hospital. It's a problem technology is helping to solve. Quil Lawrence has today's report from a snowy village just south of the Arctic Circle.
(SOUNDBITE OF KNOCKING)
QUIL LAWRENCE, BYLINE: Howard Lincoln of White Mountain doesn't always hear it when people knock on his door. He's 82.
UNIDENTIFIED MAN #1: All right, Howard.
HOWARD LINCOLN: OK, Ryan.
UNIDENTIFIED MAN #1: These two guys are going to talk with you.
LINCOLN: Yeah, OK.
UNIDENTIFIED MAN #1: Yeah, they're really good people.
LAWRENCE: He's skinny but spry. Lincoln jumped up to say hello when his nephew showed us in. Nice to meet you.
LINCOLN: Welcome to White Mountain. This is my home.
LAWRENCE: Out the window of his home the sun is casting long shadows on the Fish River. Sun sets at midnight this time of year.
(SOUNDBITE OF SCRAPING)
LAWRENCE: When we came in, Lincoln had been sitting at his coffee table sharpening a buck knife on a piece of flint. Knives and knickknacks fill the shelves of his double-wide, also photographs of Lincoln with famous dog sled racers. He's got his Purple Heart up on a shelf too. Do you remember when you got wounded?
LINCOLN: Yeah. It was terrible.
LAWRENCE: Did you get hit by bullets or shrapnel or...
LAWRENCE: That's maybe another reason Lincoln is hard of hearing - a screaming mortar shell in Korea 60 years ago. He's still got a little metal in his jaw and scars on his arm and hip. But he recovered, came home, and says he never applied for VA benefits. Anyhow, the nearest VA hospital was hundreds of miles and at least two plane rides away. But recently that distance got shorter - virtually.
SUSAN YEAGER: Travel is a big burden on a veteran who may be older, not feeling well.
LAWRENCE: Susan Yeager directs the VA health care system for the state.
YEAGER: And just the sheer expense of travel, that can be a barrier to care. That's part of what tele-medicine's about.
LAWRENCE: Tele-medicine happens over a secure computer connection between the big VA hospital in Anchorage and hundreds of small clinics across Alaska.
BRIAN LAUFER: So this is a global media cart.
LAWRENCE: Brian Laufer is chief health officer at the Anchorage VA hospital. Each clinic has a cart. Picture your old desktop computer with retractable cables that connect it to everything in a doctor's office.
LAUFER: There's a stethoscope, there's an otoscope to look in ears, ultrasound.
LAWRENCE: In a recent case, Laufer used a high-definition webcam to show a skin lesion to the head of dermatology at the VA in Seattle, a thousand miles away.
LAUFER: Turned out to be a melanoma. Within three weeks that melanoma was fully excised and had seen surgery here and had a cure because the melanoma was caught very, very early.
LAWRENCE: Quick action like that can save lives - and lots of money on travel. Vets with PTSD can sit in group therapy by video, which turns out to be more discreet - important in a tiny town where everyone knows everybody's business. Susan Yeager of the VA says tele-health carts are all over the state.
YEAGER: We have these carts - hundreds of them now - throughout the native clinic system.
LAWRENCE: The native clinic system - that's the key. The VA doesn't have a presence everywhere. But the Indian Health Service already does. A recent deal in Alaska and six other states allows veterans to use these clinics. And that means Howard Lincoln, the Korean War vet back in White Mountain, can get care in his home village and the VA will pay for it.
WILLA ASHENFLETER: There's a machine that's by his, his table that takes his blood pressure around 8:30 every morning.
LAWRENCE: Lincoln's sister, Willa Ashenfleter, helped him get signed up with the VA, which was a good thing, since he had two minor strokes last year. But, she says, he's worked hard to recover and stay independent - too independent maybe.
ASHENFLETER: Couple times he's been working on his roof, and when we tell him he shouldn't be up there, he isn't happy with that.
LAWRENCE: Howard Lincoln, 82 years old, was back up on his roof last winter. He doesn't like people telling him where he should or shouldn't go. Quil Lawrence, NPR News. Transcript provided by NPR, Copyright NPR.