Contributed by Caryl Carpenter, November 2022.
Norma, Tenn. is one of the original three communities that came together to form Mountain People’s Health Councils (MPHC). Norma is in the southern part of Scott County, Tenn., a county that was once one of the leading coal producers in the state. Norma was at one time a prosperous community with coal mining and timbering. It had a large lumber mill, several large company stores, a clothespin factory, a high school, and a full-time doctor.
But by the early 70s, the lumber company had closed. One brick wall of the mill remained standing as a reminder of the old days. One of two company stores incorporated the town’s post office in its front corner; the other became the town’s elementary school. The high school eventually moved to Huntsville. And on top of all these changes, the only doctor in Norma was robbed and murdered (1970). Read more about Dr. Divine Truth “D.T.” Chambers’ life and death in an obituary from the Scott County News, available here.
Regardless, Norma remained as the center of several other surrounding communities – Fairview, Straight Fork, Mill Branch, Montgomery, and Smokey Junction. Each town ran into another on the main road, bringing the immediate population to slightly more than 1000.
By the time the Student Health Coalition (SHC) came to Norma in 1973, the town had one paved road down a narrow valley with many folks back in the hollows. The muddy New River flowed past the fields. There were several churches, one store, and a large coal tipple where the strip miner’s coal was loaded onto railroad cars for the trip North.
Most people in Norma and surrounding communities were either unemployed, retired, or worked in Oneida (where most of the job opportunities had moved). Some still worked at logging, a few worked on the railroad, and some worked in the few strip mining jobs or in one of the small deep mines. After their town doctor, John Chambers, passed, people in Norma had to travel 30 miles away to Oneida to see one of the five doctors there who served the entire county and much of the surrounding area.
Prior to 1973, Scott County had never had a Student Health Coalition (SHC) health fair. But several people in Norma had heard about the Coalition from people in Stoney Fork, where there had been a health fair in 1972. They expressed interest in having a health fair of their own. SHC representatives then came to visit several individuals in Norma and some of the smaller surrounding communities. Because there was a great deal of community interest, the SHC decided to hold a health fair in Norma. Before that decision was made, however, there had been no large community meeting and only basic groundwork had been done. This made the community workers’ jobs more difficult at the outset because they had to more widely disseminate information.
Shortly after the SHC community workers arrived, a community meeting was held that was attended by Kate Bradley from Petros, the site of a health fair the previous summer, and by Bob Hartmann, the Director of the SHC for East Tennessee in 1972 and 73.
Two local families were especially involved in the Norma clinic’s origins by hosting students from the Student Health Coalition during the 1973 health fair. Maynard and Mertie Adkins were among those who hosted. Another family was Virgil and Tilley Burress.
In 2019, SHC alumni Diane Lauver and Anne Thomas interviewed two of the Burress daughters – Janet and June – about their memories of the health fair. They were asked why people like Virgil and Tilley were open to having strangers stay with them. “That’s the way it was,” said both Janet and June. “People in this area are very giving.” And when it came to SHC volunteers, it worked both ways. People were trusting; they wanted the health fair and clinic for their community.
During the interview, Diane read a letter from another SHC alum, Diane Cushman, who had stayed with Virgil and Tilley during the Norma health fair:
I believe you are going to visit the Burresses from Norma (June and Janet). I stayed with their parents (Virgil and Tilley) and LOVED them both. Virgil gave me a new porch swing when I graduated from college (so sweet) and I still have it (having moved it many times over the years).
Virgil once told me he had ‘never spoken to a yankee before’, but he had figured out why he liked me in spite of that. He had looked at a map to see where Vermont was and he saw that the Green Mountains of Vermont are the northern end of the Appalachian chain, so ‘we must be the same people from the same place.’ Myself and RoseMarie Daly stayed with them. RoseMarie reminded me of another story. Somehow it came up in conversation that I spoke a little German and Virgil asked that we go down to his barn with him: He had a tractor, apparently a German brand. He said he couldn’t get it to start and ‘would I please ‘talk to it’ and convince it to start…’! He had a great sense of humor. Assuming you end up going, will you share these stories with Janet and June and send them my best? THANK YOU!
Check out the clip below to hear this letter read aloud and learn more about Virgil and Tilley, Norma, and the 1973 SHC health fair directly from Janet and June Burress themselves.
In addition to their legacy as the daughters of a family that hosted SHC students, Janet and June Burress later worked at the Norma clinic as lab assistants and outreach workers. They discuss the skills they developed on-the-job (all of which are typical of other community workers at Mountain People’s and at clinics throughout the region) in the interview clip below.
The health fairs in Norma were conducted in June and August of 1973 in the gym and cafeteria of Norma Elementary School. Janet and June Burress remembered that while there were very long lines, people didn’t mind waiting. Often whole families came to the health fair.
The SHC students saw 507 adults – 187 males and 320 females. About 50 percent of those screened had seen a physician within the previous two years. Among the women, 12 percent had given birth outside a hospital and 8 percent had experienced pregnancy complications. About 76 percent used birth control but only 12 percent had had a pap smear. The most prevalent diagnosis among the adults was heart disease.
There were 302 children screened at the Norma health fairs; 38 percent of them had a positive history of worms. The vast majority of the children had the required childhood vaccinations, ranging from 75 percent for tetanus to 84 percent for rubeola. The most prevalent diagnosis for children was dental carries (30 percent).
After the health fairs, a group of community leaders in Norma, some of whom had hosted SHC students and helped to organize the health fairs, decided to form a health council and develop a clinic. The Norma community had the advantage of having a facility available that could house the health clinic. The previous town physician, Dr. Chambers, had a vacant office that was on the Norma Road, across the road from his former residence.
The Norma Health Council assumed responsibility for raising funds to renovate the office and equip it. Maynard Adkins and Virgil Burress did much of the renovation, including flooring and paneling.
The Norma Health Council hosted singing groups who performed to benefit the clinic in the elementary school gym. These included the Coffey Family and the McKameys, a couple with two young daughters who became a nationally-recognized singing group.
One year, the Norma Health Council hosted a basketball game between a team from Norma High School and a team that included Bob Hartmann and other clinic staff. Bob was the National Health Service Corps physician for Mountain People’s at the time and had been an SHC leader for several health fairs in East Tennessee. People paid a small fee to see the game and for refreshments that were served. People also bought chances to win a sheet cake that was beautifully decorated with an image of Bugs Bunny. At half time, there was a “cake walk”. People who had bought chances started to walk around the gym while music was playing. When the music stopped, the person standing in front of a pre-determined spot won the cake.
The Norma clinic was incorporated on August 6, 1973 as the Area Health Center, governed by the Norma Health Council. Those who signed the incorporation document were Raymond Jeffers (the Superintendent of Schools for Scott County who eventually became the chair of the Mountain People’s Board of Directors), Donald Jeffers, June Burress (who eventually became an outreach worker at the Area Health Center), and Maynard Adkins (one of the leaders who worked with SHC organizers).
Virgil Burress and his daughter Imogene Vann became members of the Norma Health Council. Other health council members were Maynard and Mertie Adkins, Raymond Jeffers, Betty Anderson, and Ruth Phillips.
The clinic opened in the summer of 1974. The first staff were Debbie Lay, the receptionist; Janet Burress, the clinic assistant; and June Burress Sharpe, the outreach worker.
The first Mountain People’s physician from the National Health Service Corps (NHSC) was Rick Davidson, who had been a student member of the SHC when he was a medical student at Vanderbilt. The first NHSC nurse practitioner in Norma was Sally Kimberly, a nurse midwife who had trained at the Frontier Nursing Service in Kentucky. Sally was well-accepted in Norma. Unlike the typical NHSC volunteer who left after a year or two, Sally stayed in Norma for 8 years, providing clinical stability to the practice, even as the physicians rotated through every two years. At one point the NHSC told Sally they usually didn’t let clinicians stay that long, but they apparently knew it would be hard to replace Sally. After 8 years, the NHSC finally notified Sally that her tour of duty was done.
Sally and the other nurse practitioners (NPs) who worked at Mountain People’s in the early days were pioneers, playing a role as clinicians that was unfamiliar to the communities they served. In fact, Sally was one of the nurses to take the first certification exam for family nurse practitioners in 1975.
In a 2019 interview, Sally contrasted her style of practice with that of the local physicians with which the community was familiar. The local physicians didn’t explain things to patients the way Sally was trained to do. To Sally, patient education was a critical part of her role. Check out the short clip below to hear from her directly.
When she left Norma, Sally said the only way the clinic would survive is if they could get a local nurse practitioner to work in Norma. Eventually, a local nurse practitioner named Betty Stanley who had worked at the Scott County Health Department took the position when Sally left. Like Sally, Betty was very popular with patients. She was followed by Judy Yancey, and then by Melissa Justice, both local.
At one point the clinic was closed for about a year because Mountain People’s could not find a nurse practitioner who was willing to drive along the winding Norma Road to work at the clinic. When James Lovett became the CEO of Mountain People’s, he recruited Dee Dee Sharpe to be the Norma clinic’s nurse practitioner.
Three other NHSC physicians who followed Rick Davidson also worked at Mountain People’s while Sally was the clinic’s nurse practitioner. They were Alan Miller, Bob Hartmann, and Trish Woodall. Bob and Trish had been part of the SHC while in medical school. Below, Bob narrates a story about one of his patients in Norma and reflects on the influence Appalachian culture had on rural healthcare and community medicine.
After the health fairs in Norma, Bill Dow, the student founder and leader of the SHC, worked with the health councils in Norma, Petros, and Stoney Fork to create Mountain People’s Health Councils (MPHC). MPHC was the entity that applied for federal funding through the Rural Health Initiative, Section 330 of the Public Health Service Act, and the National Health Service Corps (NHSC) for placement of one physician to circuit-ride among the three clinics, each of which was staffed by a full-time nurse practitioner.
In 2022, the Norma Clinic looks very much like it did in 1974. There is a porch that was added over the front door and an addition on the side of the building that houses space for staff and lab services. Unlike the early days of the clinic, however, there is no pharmacy in the clinic. Patients now receive written prescriptions to fill at local pharmacies.
In 2017, Rick Davidson, Irwin Venick and Caryl Carpenter visited the Norma Clinic. Rick was the first MPHC physician; Irwin worked with the SHC in East Tennessee when he was a law student at Vanderbilt; and Caryl was the second administrator at MPHC. They were joined by Biff Hollingsworth, an archivist from the Southern Historical Collection at UNC’s Wilson Special Collections Library. The trip led to much dialogue about the legacy of the Norma Clinic and, more conceptually, the importance of community-based public health in general. Check out this audio clip of a conversation between Rick and Caryl as they drove up the infamous Norma Road while en route to the clinic.
Norma is the only one of the three original Mountain People’s clinics that remains open. Norma and the other clinics now part of MPHC have had a significant impact on the people of Scott County, serving over 50 percent of the county population.
This story about the clinic in Norma draws on the Vanderbilt Center for Health Services Annual Report for 1973 and interviews with Janet Burress Chambers and June Burress Sharpe, Sally Kimberly, Bob Hartmann, and Betty Anderson.