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”.

Caryl Carpenter talks about the origins of the Tennessee Primary Care Association

Caryl Carpenter, former administrator of the Mountain People’s Health Councils (MPHC) of East Tennessee, talks about formation of the Tennessee Primary Care Association. Recorded on May 17, 2017, as a part of a panel discussion at a reunion of the… Continued

Bill Dow on Healthcare Policy, 1973

A clip from Appalachian Genesis, courtesy of Appalshop Film Archives (Whitesburg, Ky.). Continued

On the resourcefulness, work ethic, and generosity of people and communities in the mountains

Margaret Ecker describes what impressed her most about people and communities in the mountains, highlighting Byrd Duncan’s role in establishing and maintaining the Briceville Clinic. She also mentions J.W. Bradley and Marie Cirillo. Rosie Hammond reflects on other characteristics, such… Continued

On institutional benefit of student-led Coalition energy and notoriety

Margaret Ecker and Bob Hartmann discuss how the university seemed to be feeding off of and trying to control Coalition energy and notoriety in the effort to recruit foundation dollars. He shares the story of his trip escorting Sir George… Continued

Tom John on the Student Health Coalition and community self-determination

Tom John, M.D. comments on his work with the Student Health Coalition (SHC) in 1971. He shares that one of the most powerful takeaways from this learning experience was an introduction to and participation in the development of community health… Continued

On healthcare education and mentoring

Art Van Zee discusses the value of healthcare education and mentoring. He expresses gratitude for the nurturing and supportive environment both his parents cultivated for him as a child; for Sister Beth Davies’ mentorship in the field of addiction-related healthcare… Continued

Caryl Carpenter on community leader Odes McKamey

Caryl Carpenter, former administrator of the Mountain People’s Health Councils (MPHC) of East Tennessee, shares a story about community leader Odes McKamey of Stoney Fork, Tenn. MPHC was founded in 1974 as a coalition of three rural health clinics in… Continued

The community worker’s role in supporting health fairs

Dick Burr delves into more detail about the community worker’s role with the Student Health Coalition, namely as it relates to the operation and success of health fairs.   Full footage of Dick Burr’s interview from March 25th, 2021. 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

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 in Smithville ,Tenn., 1970

Bill Dow

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

Byrd Duncan

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

Dana Ellis

Dana worked West Tennessee health fairs in the summers of 1973 and 1974 while a student in the School of Nursing at Vanderbilt. She served as co-director of the Student Health Coalition alongside George Smith who was in medical school… 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 “Legacy”.