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”.

Did you ever feel afraid? Rosie Hammond shares.

Rosie Hammond responds to Margaret Ecker’s inquiry about whether she ever felt afraid during her time in the mountains. She describes an experience while staying with Vada Evans in White Oak, Tenn. Follow this link for full-footage of Margaret Ecker’s… Continued

“Whites treated Whites and Blacks treated Blacks”

Sharon Roberson discusses her witness of racial segregation in rural West Tennessee healthcare (circa late 1970s), noting how said disparities severely limited access to healthcare for many in the area.   Full footage of Sharon Roberson’s 2018 oral history interview. 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

Bob Hartmann on his follow-up visits with the Bradleys in Petros, Tenn.

Bob Hartmann discusses the informal nature of community organizing characteristic of the Coalition’s work, both prior to and following summer health fairs. He shares the story of his and others’ regular visits back to communities during the academic year, highlighting… Continued

Bob Hartmann on the importance of defining health beyond the physical

Bob Hartmann explains how his and many others’ formative experience in rural healthcare and community medicine with the Center for Health Services (CHS), Student Health Coalition (SHC), and Mountain People’s Health Councils (MPHC)—both as students and young professionals—left a lasting… Continued

Nancy Raybin’s onboarding and role as Director of the St. Charles Clinic, 1974

Nancy Raybin discusses her onboarding and role as the Director of the St. Charles Clinic from 1974 to 1976, a period during which she hired Polly McClanahan as the clinic’s Nurse Practitioner (NP), recruited Art Van Zee as the clinic’s… Continued

Stephanie Park on doctor-patient relationships

Stephanie Park, a community scholar with the Center for Health Services (CHS), shares how her firsthand experience in community healthcare bolstered her education in the field and furthered her understanding of holistic community development—particularly with regard to doctor-patient relationships.  … Continued

Reflections on personal growth from SHC participation

Carolyn Burr poignantly describes the profound mutual value of getting involved with projects like the Student Health Coalition (SHC), based on reflections of her own experience and the personal growth that transpired from her participation. Follow this link for access… 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

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

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 “Legacy”.