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”.

Bob Hartmann on the National Health Service Corps and its role in his development as a young doctor

Bob Hartmann shares about his return to Mountain People’s Health Councils (MPHC) after graduating from Vanderbilt medical school and explains the role of the National Health Service Corps in his education and early professional development.   Full footage of Bob… Continued

Dana Ellis: Personal reflections

In this video clip, Dana Ellis reflects on her personal experiences as a student nurse working with community leaders in rural West Tennessee back in the early 1970s and how that work affected her career and her life. Continued

Sally Kimberly on MPHC community boards

Sally Kimberly discusses the challenges of collaborating with community boards on the frontier of a practice largely unfamiliar in Appalachia at the time—community-driven, rural healthcare. Unique to her and other nurse practitioners’ experience was a widespread misunderstanding about their role. Reminiscing about these hurdles, Sally shares what it was like to be… Continued

Connecting the dots: from SHC to ACA

In 2013, just as the Affordable Care Act (ACA) was about to get rolled out, Bill Corr took time out of his busy schedule as Deputy Secretary of Health and Human Services to reflect on the resonance between the Coalition… Continued

Randall and Meryl Rice call for political change in the interest of Medicaid expansion

Randall and Meryl Rice discuss the influence of Tennessee’s political climate on Medicaid expansion and affordable healthcare in rural communities and introduce the resolution which developed in response, an initiative known as Insure Tennessee. They highlight the importance of applying… Continued

Behind the scenes: non-medical techs with the Student Health Coalition

Dal Macon explains his role as coordinator of the Student Health Coalition’s (SHC’s) non-medical techs, bringing light to its operations behind the scenes.   Full footage of interview with Dal Macon. Continued

Caryl Carpenter talks about her experiences with Mountain People’s Health Councils

Caryl Carpenter, former administrator of the Mountain People’s Health Councils (MPHC) of East Tennessee, talks about her experiences with MPHC, which was founded in 1974 as a coalition of three rural health clinics in Norma (Scott County), Petros (Morgan County)… Continued

Nurse Practitioners, in the beginning…

Community leaders recognized early on the added value nurses with expanded roles brought to the table. In this video clip, community leaders Marie Cirillo and Betty Anderson recollect their efforts to lobby for legal changes that would continue to support… 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

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

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

Diane Lauver

Contributed by Diane Lauver, February 2018 Growing up, I was close to my paternal grandparents; they lived in a pastoral valley looking at Appalachian hills in a northern state. With their 8th grade educations and practical wisdom, they taught me… Continued

Dick Couto

The following text was part of a memorial by Irwin Venick during a gathering of Coalition alumni at Vanderbilt University, May 20, 2017. Richard (Dick) Couto served as Co-Director and then Director of the Center for Health Services (CHS) from… 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”.

Betty Anderson’s introduction to SOCM

Betty Anderson shares how she first became involved with Save Our Cumberland Mountains (SOCM) and the Student Health Coalition. Included in her account is a story about how she and others responded to opposition of the rural health clinics in… Continued

Dal Macon’s community return and ongoing work post-Student Health Coalition

Dal Macon briefly shares about some of his post-Student Health Coalition (SHC) community projects, including having served on the board of Marie Cirillo’s Community Land Trust and organized outreach efforts through the Center for Health Services (CHS) at Vanderbilt University.… Continued

Barbara Clinton on the emergence of Vanderbilt’s Center for Health Services

Barbara Clinton discusses the influence of Vanderbilt’s Student Health Coalition (SHC) on various subsequent initiatives, speaking specifically to the extension of its core mission and student-led approach to several programs. She focuses on the Center for Health Services (CHS) and… Continued

Hearts of Gold

Brought to us by Margaret Ecker and others involved in its 2013 production, this special collection of insights from several Student Health Coalition (SHC) figureheads in the 1970s features Bill Dow, Bill Corr, Carolyn Burr, Dal Macon, and Marie Cirillo–among… Continued

Dr. Daniel Gabriel’s legacy in St. Charles, VA

Ron Carson discusses Dr. Daniel Gabriel, M.D. and his local legacy in African American healthcare as the only doctor who in the 1940s and 50s would see Black patients.   Full footage of Ron Carson’s tour of the African American… Continued

Challenges facing nurse practitioners

Outside the old clinic building of what used to be Douglas Community Health Center, Margaret Ecker and Jean Carney discuss the multitude of challenges facing nurse practitioners and what legislative movement’s been made to overcome adversity of such restrictive practice.… Continued

Pushback against Douglas Community Health Center

Jean Carney shares how rhetoric against the Black-run Douglas Community Health Center manifested as several false accusations and presented various legal challenges to both the clinic and associated nurse practitioners.   Full footage of Jean Carney at the old Douglas… Continued

Behind the scenes at Douglas Community Health Center

Jean Carney reminisces the early days of Douglas Community Health Center in Stanton, Tenn. Following a brief overview of the clinic’s architectural layout and functional operations, she delves into the impact of race relations on healthcare at the time.  … Continued