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.

 

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 a complete catalogue of oral and written narratives on the website, go to “Stories”.

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

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

Was the Student Health Coalition radical? Dal Macon responds.

Dal Macon distinguishes the Student Health Coalition’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 such… Continued

The focal role of listening in community organizing

Dal Macon highlights the Student Health Coalition’s emphasis on listening as the primary agent of sustainable, lasting community change. Solidifying its importance, Dal shares how this philosophy impacted his long-term relationship-building with community members and overall connection to the communities… Continued

Dal Macon’s introduction to Bill Dow and the Student Health Coalition

Dal Macon shares his first impressions of Bill Dow and what attracted him to the Student Health Coalition’s unique approach to community organizing. He frames the SHC and its work of rural healthcare delivery as a mission of listeners responding… Continued

Margaret Ecker on her inspiration to pursue nursing

Margaret Ecker shares about early career pursuits and explains how the Student Health Coalition played a prominent role in steering her toward a life of service through nursing. Recorded June 2nd, 2018.   Full footage of the conversation between Barbara… Continued
Left to right: Marian Colette, Minnie Bommer, Tilda Kemplen, Linda Stein, Mary Elliott; Barbara Clinton, Project Director and daughter Greta in front

“Freedom from drain” and the Maternal-Infant Health Outreach Worker Project (MIHOW)

Barbara Clinton shares about the program she started as an appendage of the Student Health Coalition, known as the Maternal-Infant Health Outreach Worker Project (MIHOW). The largest and most renowned of SHC’s various outgrowths, this program sought to draw on… Continued
Vista member, Jeff Summerville (right), works alongside community volunteer on the Memphis Greenway.

The Student Environmental Health Program

Barbara Clinton delineates the incitement of Vanderbilt’s Student Environmental Health Program following discovery by SHC participants of widespread water contamination in several rural and inner city communities across Tennessee. This student-led organization attracted those from hard science disciplines to tackle… Continued

 

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”.

Tennessee Valley Authority (TVA)

The Tennessee Valley Authority provided support to the Student Health Coalition early on, beginning in 1970.  A TVA van traveled to the Coalition health fairs and included x-ray, lab facilities, and staff to run it.  Retired TVA vans eventually served… Continued

Odes and Shelby McKamey

Odes and Shelby McKamey were among the most cherished local hosts for members of the SHC when the health fair arrived in their remote mountain community of Stoney Fork, Tennessee. Later, after the Stony Fork Clinic was established, the McKameys… Continued

John Kennedy

The summer before his final year at the Vanderbilt Law School and during the summer and fall after his graduation, John Kennedy worked for the Student Health Coalition, 1971 and 1972. He provided assistance to former miners who were seeking… Continued

J. Thomas “Tom” John

I am a bit late in getting my bio in, best done in the earlier stages of pending dotage. I am originally from Laurinburg, N.C., a small farming and, then, textile community in the eastern part of the state. I… 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.   More… Continued

Carolyn Burr reflects

Interview with Carolyn Burr, recorded at a 2013 Student Health Coalition reunion in Nashville, Tennessee. In this clip, Burr reflects on how the experience of working with the Coalition shaped her values and future career in nursing.   More on… Continued

Lewis Lefkowitz

[Contributed by Richard Davidson, October 2015] Lewis Lefkowitz was born in Dallas, Texas in December, 1930. He attended the University of Texas Southwestern medical school, did an internship at Duke University and finished his internal medicine residency at the VA… 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

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”.

Notes from the road: Mountain People’s Health Councils

[Story contributed by Caryl Carpenter] On October 23rd, in 2017, a doctor, a lawyer, an archivist, and an old lady started out to make history, or more accurately, to record history – the history of Mountain People’s Health Councils (MPHC)… Continued

Connecting the dots: from SHC to ACA

In 2013, just as the Affordable Care Act 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 work of forty years ago and… Continued

1976 St. Charles Health Clinic, VA

After the 1975 health fair In St. Charles, Virginia, the local health council worked tirelessly to build a permanent clinic. By 1976, that clinic had opened to the public. And over time, it grew into a network of 12 regional… Continued