A dermatology resident's approach to increase rural health care access and bring health care home

John Carl Barba II, MD, MPH, is a first-generation college student from the Village of Byesville and City of Cambridge, areas in rural Ohio that are in Appalachia. Growing up, he often had less access to health care due to Appalachia’s infrastructure deficits and longer physical distances between appointment locations. He aims to open a rural dermatology clinic and residency program in Appalachia after his residency training at The Ohio State University College of Medicine. His research focuses on the intersection of place, poverty and health disparities. He’s working on specific interventions that address barriers to care and increase access to preventive care and screenings, while pioneering a rural academic dermatology residency model in Ohio’s Appalachia region. 

During the recent Clinical Translational Science Institute annual meeting, he shared his firsthand experience of living in an area characterized by its lack of health care services. The area lacks physical offices and also lacks telehealth services because fewer people own computers or other devices, and there are fewer internet/cell towers.   

When he reviews the health statistics of his home region, he does not see numbers -- he sees the faces of friends, family, and fellow Appalachians who make up these statistics. Barba wants to bring a rural dermatology clinic to the area but also wants to help provide broader health care.

Mail-based care:

• In clinical trials, the “Patch it Up” flu vaccine program mails vaccination patches to participants, removing the need for transportation to a clinic. 
• The Evalyn Brush is a self-sampling device designed for the screening of human papillomavirus (HPV), which is the primary cause of cervical cancer. Users can collect vaginal/cervical specimens in the privacy of their own homes. Kits contain features like built-in indicators and feedback to ensure correct sample-taking, making it a valuable tool for cervical cancer prevention and early detection.  
• There is also an initiative to educate available providers on portable, pocket colposcopy wands, which they can use in-office. These perform as well as standard-of-care clinical colposcopy. 
• Mailed colorectal screening kits that do not require a doctor’s appointment. 

Creating Health Infrastructure: 

• With his mother and cousin, Dr. Barba founded the Dr. Disc Golf Initiative, which led to the creation of three disc-golf courses and a shade structure, to promote healthy living.   
• Dermatology Rural Education and Access Model (DREAM), which provides satellite dermatological care as part of a larger academic center. Inspired by the model in Mississippi connecting Jackson to Louisville, Dr. Barba hopes to create a version, based out of Ohio State, connecting Cambridge to Columbus, with a rural academic dermatology residency program in his hometown.  

Overall, these solutions can help improve health care in rural communities. Dr. Barba also hopes to inspire generations to believe that by working together, they can improve their lives.