Reinventing Primary Health Care in Appalachia & the Rural South

The principle at the heart of the work of the Student Health Coalition (SHC) held that quality health care required the voice of the people. Students operationalized this principle by helping small rural communities to organize around access to health care.

Stepping into these communities was facilitated by the fact that most residents lived in a vacuum of services, a complete absence of accessible health care, neither private nor public. Children were not immunized. Diabetes, high blood pressure, pulmonary disease were left undiagnosed and untreated. The nearest hospital might be hours away. Roads were subject to impassible disrepair. Clinics were no where to be seen, nor were public health officials. The proposal that students and community leaders working together might change all that was radical and thrilling.

Health Fairs were at the heart of the organizing. The fairs took place in a school or community center. Student nurses and physicians conducted comprehensive free exams for anyone who showed up. Funds to support the fairs were recruited from foundations. The Tennessee Valley Association (TVA) loaned a van for the first few summers, outfitted with lab equipment and exam rooms. The exams included hematocrits, urine screens, stool culture for parasites, throat cultures, and a full physical exam. People with abnormal results got a home visit from one of the students, with assistance on followup. Most children were anemic, from poor nutrition or parasites or both. Most miners had lung disease. Many adults were found to have untreated heart disease or diabetes.

The Health Fair team moved to a new community at the end of each week. At the end of the summer, most students returned to school. A handful stayed behind, digging into long term work. The Health Fairs and the clinics that were the “fruits” of our labors uncovered dirty secrets about the adequacy of health in Appalachia and the rural South. SHC challenged and angered local health departments, physicians, county judges, and the like.

Nonetheless, many of those clinics still stand. And in some cases, they grew into networks of clinics serving whole regions with community owned and operated primary care clinics.

Related Stories:

A sampling of vignettes that illustrate activities and aspirations of the SHC in striving to reinvent primary health care in Appalachia and the rural South. For all oral and written narratives related to this theme, click here. For a complete catalogue of clips across all three themes, visit “Stories”.

The Origin Story: In the words of Bill Dow

Several years before he died, Bill Dow agreed to participate in recorded conversations about his farming philosophies, with the idea that he would use the recordings to compose a book about sustainable agriculture. He died in 2012, before the project… Continued

On the Bradley’s motivation to organize a community clinic in Petros, Tenn.

Kate Bradley frames the initiative to organize a local health council and community clinic as a direct response to the Petros health fair’s preliminary identification of needs. She details early fundraising efforts, including Pat Kalmans’ key role in securing grant… Continued

On the SHC’s energy of dissatisfaction vs Vanderbilt Med School’s sense of institutional fulfillment

Charles Scott, professor of Philosophy and early faculty supporter of the Student Health Coalition (SHC), concludes this 2019 gathering with poignant remarks about what transpired when the Vanderbilt Medical School assumed control of the SHC. The energy of dissatisfaction that… Continued

History of the St. Charles Clinic ft. Art Van Zee

Art Van Zee, an active participant in the Student Health Coalition’s work in St. Charles, Va., beginning first in 1973 with a visiting summer clinic, discusses the now more established center’s evolution and his role as a physician there. Recorded… Continued

Carolyn Burr reflects

In this clip, Burr reflects on how the experience of working with the Coalition shaped her values and future career in nursing. Recorded at a 2013 Student Health Coalition reunion in Nashville, Tenn. Continued

“Community knows best”

Margaret Ecker facilitates a discussion among Irwin Venick, Bob Hartmann, and Joe Little about the philosophies and guiding principles of the SHC. All agree a central facet of the Coalition’s approach was a collective understanding of the local community’s role… Continued

Lewis Lefkowitz on the Student Health Coalition’s key accomplishments

Lewis Lefkowitz recalls what facilitated the Student Health Coalition’s (SHC’s) success. He discusses the organization’s framework of community mobilization and agency, and furthermore highlights the leadership legacy of Kate and J.W. Bradley. Recorded on December 1, 2015.   Full footage… Continued

Was the Student Health Coalition radical? Dal Macon responds.

Dal Macon distinguishes the Student Health Coalition’s (SHC’s) activism from other “radical” movements of the time. He expounds on the context of what it meant to be “radical”, how it was generally perceived, and why SHC participants didn’t identify as… Continued

Related People:

Profiles of several individuals and organizations, among many, whose work with the Student Health Coalition was centered on reinventing primary health care in Appalachia and the rural South. A listing of all SHC profiles can be found under “People”.

Amos Christie (1902-1986)

Amos Christie received his M.D. from the University of California. In 1943, he arrived at Vanderbilt University as Chair of the Department of Pediatrics. During his time at Vanderbilt, he studied histoplasmosis, a fungal disease simulating tuberculosis, and received a… Continued

Art Van Zee

Art Van Zee, during his Internal Medicine Residency at Vanderbilt, served as a mentor for Coalition students in 1974 and 1975 when the health fairs were active in St. Charles and other southwest Virginia sites. He was very taken by… Continued

Bill Corr

Contributed by Bill Corr, September 2015 I am forever indebted to the Vanderbilt Student Health Coalition because my involvement put me on a career path that has enriched my life and given me the opportunity to serve our nation’s health… Continued

Bill Dow (1945-2012)

Bill Dow co-founded the Student Health Coalition while in medical school at Vanderbilt University, in 1969. His larger-than-life role in the SHC origin story and beyond warrants special telling, which we attempt in the essay that follows. Contributed by Margaret… Continued

Black Lung

Upon reaching East Tennessee in 1969-70, SHC community workers immediately encountered Black Lung Disease (Pneumoconiosis). For years, the SHC engaged Black Lung Disease on several levels: medical diagnosis and treatment; representation for federal benefits claims; and organizing for reform of… Continued

Byrd Duncan (1900-1986)

Contributed by John E. Davis When the newly recruited medical workers and community workers of the Student Health Coalition gathered in Nashville in June 1970, beginning a week of orientation for the SHC’s second summer in Appalachia, they were introduced… Continued

Cathy Barrow Heck and Jeff Heck

Contributed by Cathy Barrow Heck I was absolutely sold on the Appalachian Student Health Coalition upon seeing the video as a nursing student in the fall of 1973. The idea of a team of students working in partnership with rural… Continued

Chuck Darling

    Related Content: Continued

Related Outcomes:

A selection of initiatives, organizations, and other developments that grew from seeds planted or causes championed by the SHC. A complete catalogue of materials related to various outcomes of the SHC experience can be found under “Spinoffs”.