A rural remedy to health care access

A virtual telementoring program helps the West respond to the pandemic.


In the 1990s, a New Mexico woman learned that she was suffering from hepatitis C, a viral disease that infects the liver. Though she had insurance, she did not seek treatment because of the lack of specialists in her area. When her abdominal pain intensified, however, she got on a long waitlist, hoping to be helped by Dr. Sanjeev Arora, a gastroenterologist, at his clinic in Albuquerque, New Mexico. In 2001, she and her two children travelled over 200 miles to meet with him. But by then it was too late, and six months later, the woman died. Arora was shocked that people were dying of a curable disease in the United States — and even more shocked that it kept happening. “These people were dying because the right knowledge didn’t exist at the right place at the right time,” he said. 

In 2017, Dr. Sanjeev Arora leads a virtual training session on treating hepatitis C. Project ECHO connects specialists like Arora with physicians in rural communities.
Courtesy of Project ECHO

That woman’s death was needless, yet because of Arora’s response to the tragedy, thousands of patients in communities with health-care access gaps can now get treatment. In 2003, Arora created a virtual telementoring program called Project ECHO. Unlike traditional telemedicine — where virtual appointments take place between a patient and doctor — the program connected specialists like Arora with physicians in rural areas and those working at state prisons. This enabled Arora and his team to train primary care doctors across New Mexico on how to treat individual cases of hepatitis C through weekly remote sessions that expanded his reach.

“These people were dying because the right knowledge didn’t exist at the right place at the right time.” 

Over the years, Arora adapted ECHO to treat dozens of medical issues, including opioid addiction and hantavirus outbreaks; he also developed a program for miners’ wellness, aimed at helping coal and uranium miners and workers in the nuclear weapons industry. By “democratizing knowledge,” as Arora puts it, Project ECHO grew. The model overcame barriers unique to the region, like a shortage of physicians and the great distances between rural communities and health-care services.

All the while, Arora and his team — and specialists across the West — had no idea they were building a virtual infrastructure that would later save lives when the global COVID-19 pandemic arrived.

Over the years, Arora adapted Project ECHO to treat dozens of medical issues, including opioid addiction, behavioral health conditions and hantavirus outbreaks.
Courtesy of Project ECHO

PRIOR TO COVID-19, the model was already being adapted in new ways. Project ECHO specialists in Reno, Nevada, for example, helped mental health professionals diagnose behavioral health conditions and treat patients with schizophrenia across the state. “(It’s) really about identifying those people early on and getting them to these services quickly,” Troy Jorgensen, program manager of Project ECHO Nevada, told me. In Laramie, Wyoming, Project ECHO was used to improve education outcomes for students with disabilities. “We had just two staff members who were traveling around the state year after year to provide training and technical assistance,” said Sandra Root-Elledge, executive director of the Wyoming Institute for Disabilities. Project ECHO provided a way to expand the reach of those staff members.

When the pandemic hit, Project ECHO programs pivoted to tackle new challenges. The ECHO team in Wyoming changed its curriculum to address the challenges of virtual learning, bringing in speakers who could discuss how to create a daily classroom structure at home. “We’ve got families who are now working from home, their kids are all at home, and they’re trying to balance everything that’s going on in their life,” said Wendy Warren, program manager for ECHO in education. “For students with autism, frequently it’s that change in routine, which is very difficult for them.”

“At the heart of ECHO is the idea that with this much inequity in the world, it is almost impossible for us to have peace and harmony amongst people.” 

Nevada’s Project ECHO hub, too, adapted existing programming to treat COVID-19. “We were able to shift when the pandemic happened, and everybody started working from home,” Jorgensen said. “We already knew how to use Zoom, we already were very comfortable with that and working in a virtual space.” A training on antibiotic resistance that had been led by an infectious disease expert moved to address the  transmission and treatment of COVID-19. At the onset of the crisis in Nevada, attendance for that training skyrocketed, with 100 participants Zooming in weekly from around the state. A critical care specialist joined the discussion, offering advice on techniques like how to “prone” patients, a term for turning patients onto their stomachs, a common tactic for those who are having difficulty breathing.

A model that grew out of a need in rural New Mexico is now leading trainings nationally to address urgent issues like vaccine hesitancy and the spread of COVID in nursing homes. Arora and Project ECHO are also working with the World Health Organization on a new global vaccination initiative to equitably distribute the vaccine. “Because, ultimately, what is the goal of ECHO?” Arora told me recently by Zoom. “(It’s) social justice: At the heart of ECHO is the idea that with this much inequity in the world, it is almost impossible for us to have peace and harmony amongst people.”   

Jessica Kutz is an assistant editor for High Country News. Email her at [email protected] or submit a letter to the editor

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