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”.

Reflections on the level of care at SHC health fairs

Tom John and Rick Davidson retrospectively comment on the level and quality of care provided at the Student Health Coalition summer health fairs, and how theses experiences shaped their own understanding of and perspective on healthcare.   Full footage of… Continued

Barbara Clinton on the concept of psychological defensive denial and Medicaid expansion

During discussion with Randall and Meryl Rice about Medicaid expansion, Barbara Clinton comments on the role of psychological defensive denial in both the rejection of reality and voting against one’s best interest. Recorded on June 2, 2018.   Full footage… 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

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

Frances Henderson on the Center for Health Services’ approach to community development

Frances Henderson from the Service Training for Environmental Progress (STEP) discusses the relationship between environmental pollution and public health, sharing specifically about a nearby contaminated creek in Hendersonville, Tenn. which caused significant medical concerns among community members. She also shares… Continued

Art Van Zee’s message to students today

Art Van Zee discusses how the legacy of St. Charles Clinic may serve as inspiration to students today, and encourages them to harness a belief that they, too, should feel empowered to get involved in social movements. Recorded March 17th,… Continued

On the SHC’s provision of hope as fuel for systemic change to rural healthcare

Kate and J.W. Bradley share sweet reflections of the friendships made during the Student Health Coalition’s (SHC’s) community organizing efforts in rural Tennessee, and explain that the organization’s leader, Bill Dow, gave them hope to change what they’d always been… Continued

Bob Firestone and John Twiggs arrive in Jacksboro

John McArthur tells the story of his and the board’s decision to hire Bob Firestone and John Twiggs, both from the University of Minnesota, as the Jacksboro Clinic’s first two National Health Service Corps physicians. Despite cultural differences, the community… 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 is a physician at St. Charles Community Health Clinic in Lee County, in southwest Virginia.   Related Content: 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”.