Across the Border

The Cancer Center's Blood & Marrow Transplantation Program takes a house-call approach in rural Maine

The image of the country doctor with his black bag calling on families and patients far back in the hills or across rivers and forests in a horse-drawn buggy is one of the indelible, iconic impressions Americans carry in their heads about the medical profession.

Ken Meehan, MD, director of the Cancer Center's Blood & Marrow Transplantation Program

Ken Meehan, MD, director of the Cancer Center's Blood & Marrow Transplantation Program. "They're not just sending that patient to an unknown specialist in a far-away city, they're sending that patient to us, here, where the doctors know us."

The image, however, isn't so much about a pastoral past as it is about bringing health care to people in the context of their daily lives—bringing medicine to the place, that is, where medicine counts most: home.

It's been more than a century since doctors made house calls with a horse, but even in today's modern, ultra-high-tech health care environment, some doctors still reach out to patients and other doctors in remote regions of the country.

Blood and Marrow Transplants in Maine

Ken Meehan, MD, director of the Blood & Marrow Transplantation (BMT) Program at Norris Cotton Cancer Center, is one of them. Four times a year, he bundles into his car for a long day's drive from New Hampshire into Maine to visit with primary care physicians and oncologists there to talk about patients and the BMT program. It's one of the most important ways that Meehan uses to communicate the value and importance of the BMT program, which is the only program of its kind in northern New England, to doctors in rural areas who do not have local access to sophisticated transplantation clinics. He also is an active member of the Northern New England Clinical Oncology Society, a forum for oncologists to discuss cancer care and research in the unique northern New England environment and culture.

In return, patients with cancers of the blood in Maine and other rural New England locations—eastern upstate New York, northern Massachusetts, and Vermont—have access, through Meehan's well-developed relationships with rural hospitals, clinics, and doctors, to some of the highest quality treatment available in the U.S.—allogeneic as well as autologous transplants, for example—without having to travel farther than to Lebanon, NH.

Help and Healing at Home for Blood Cancers

"The referring doctors love to have a relationship with the Cancer Center," says Meehan, "because it broadens what they can offer their patients. When they refer a patient to us, they're not just sending that patient to an unknown specialist in a far-away city, they're sending that patient to us, here, where the doctors know us. It's familiar territory."

It's familiar for the patients, too. While Lebanon offers many amenities not available in Maine's hundreds of tiny, rural hamlets, it is still a quiet town located in a place of great natural, and quiet, beauty.

An Outreach Outpost for Marrow Transplant

One of Meehan's most important Maine stops is at the Harold Alfond Center for Cancer Care in Augusta, Maine. The Center is the most sophisticated cancer-care facility in the state—but it does not do marrow transplants. Instead, Meehan has established a close partnership with the Center, attending tumor boards and frequently seeing patients, to offer expertise and, when necessary, the procedures available in the BMT program at NCCC.

The Center was established with help from a significant grant from the late Harold Alfond, the founder of the Dexter Shoe Company in Dexter, Maine (he also created the concept of the outlet store), and it is part of MaineGeneral Health. The medical director of MaineGeneral's oncology services, Andrew Hertler, MD, is a graduate of Dartmouth College who still holds a soft spot for the Upper Valley, according to Meehan. "We had a connection right away," he says. "That helped pave the way."

Blood and Marrow Doctors, Nurses, and More

The network of relationships Meehan has established in Maine now supports a team of BMT nurses who regularly travel there to care for post-transplant BMT patients who live in Maine. While the black bags and horses may be things of the past, reaching out to patients and their doctors where it's most important—home—is not, not for the BMT program at Norris Cotton Cancer Center.

December 06, 2011