Dr. Alfredo Gei at the University of Texas Medical Branch in Galveston examining his patient, Nicole Dezort, in Nacogdoches

Nicole Dezort traveled four hours from her home near Nacogdoches to Galveston when she was ready to deliver her second child. She had an uneventful Caesarean section on October 19, 2000, and returned home a few days later. On October 28, Ms. Dezort developed a fever and a rash and was rushed back to The University of Texas Medical Branch at Galveston. Soon after her arrival, she lapsed into a coma from toxic shock syndrome.

Dr. Alfredo Gei, Ms. Dezort’s surgeon, remembers, "She was so unstable and so sick, we opted as an extreme life-saving measure to remove her uterus. She began to improve after surgery, but a few days later she developed renal failure to the point that she needed continuous dialysis to clean her blood. Then septicemia and a fungus set in, which required extreme measures of ventilation in order to keep her lungs from becoming infected. She also had a tracheotomy and was multiply transfused. Then she had cardiac arrest and was brought back, but in the best of situations, we were giving her between a zero and 20 percent chance to live.

"The most amazing thing is not only did she survive all these hurdles over the course of three months," Dr. Gei observes, "but her neurologic aspect is completely intact."

On January 26, Ms. Dezort finally was able to go home. Because of the surgeries, interventions, medications and prolonged stays in bed, she requires daily physical therapy and frequent exams. But when Dr. Gei must see her, instead of traveling four hours to Galveston, Ms. Dezort, with the assistance of a certified nurse/midwife, sits in front of a computer with a camera in Nacogdoches while her doctor does the same in Galveston.

Nearly 11,000 of the almost 70,000 low-income women and children who are served each year by UTMB’s Regional Maternal & Child Health Program are pregnant women. Six thousand of them, who live in south and southeast Texas, receive care at one of UTMB’s 39 regional clinics; the other 5,000 must travel to UTMB’s Galveston hospital for more specialized care. For many of them, the trip is physically exhausting and financially challenging. Dr. Gei explains, "In addition to Ms. Dezort’s fragile physical condition, the trips to Galveston caused big disruptions in her husband’s work and in her family’s life. Now her husband won’t miss a day’s pay and her children can stay in school because we have the luxury of seeing her while she stays in Nacogdoches."

Nineteen of the 39 UTMB satellite clinics now are installing communications equipment that will give patients in rural areas the ability to receive specialized medical attention on a regular basis. Dr. Garland Anderson, professor and chairman of the Department of Obstetrics & Gynecology at UTMB, explains, "This program allows us to take all the different components of the medical center out to a large geographic area of people who primarily are working poor. One doctor can stay in front of the computer and see patients who geographically are all over Texas. Before, our only alternative was to bring them here." Now, UTMB’s telehealth technology can serve people in rural areas and in other remote places such as cruise ships, offshore oil rigs and prisons.

When it was time for Ms. Dezort’s exam, Dr. Gei instructed the clinic nurse in Nacogdoches how to manipulate the camera so he could view Ms. Dezort’s incisions. He was able to see how they were healing and could answer questions. When the nurse asked about applying a certain ointment, Dr. Gei was able to reply, "No, I wouldn’t use it quite yet. I would let it heal a little bit longer." He was able to tell his patient, "Your tracheotomy looks great, your wounds overall look great, and I’m very happy to see you walking the way you are. That tells me a lot about your strength."

Ms. Dezort was glad to hear the good news and was happy that she was spared another trip to Galveston.

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