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”.

Post-health fair formation of community councils and the origins of MPHC in Tennessee

As part of the Student Health Coalition Archive Project, Caryl Carpenter and Rick Davidson meet with James Lovett, CEO of Mountain People’s Health Councils, Inc. Their primary objective is to collect a firsthand account from Lovett and in so doing,… Continued

Bob Hartmann on Appalachian culture and rural healthcare

Bob Hartmann shares a story about one of his patients while working with Mountain People’s Health Councils (MPHC) in Norma, Tenn. The narrative speaks to the influence of Appalachian culture on rural healthcare and community medicine.   Full footage of… Continued

SHC’s patient-centered healthcare and its role in the expansion of Nurse Practitioners

Carolyn Burr discusses the Student Health Coalition’s (SHC) approach to healthcare, emphasizing their value of patient/community involvement and accountability. She describes Dr. Amos Christie’s direct influence on her own nursing career, as well as on the profession moving forward–namely as… 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

Margaret Ecker on her inspiration to pursue nursing

Margaret Ecker shares about early career pursuits and explains how the Student Health Coalition (SHC) played a prominent role in steering her toward a life of service through nursing. Recorded on June 2, 2018.   Full footage of the conversation… Continued

What drew Carolyn Burr to the Coalition

Carolyn Burr shares how she first got involved with the Student Health Coalition (SHC) and what about the organization spoke to her, framing it as an opportunity to live out her values for sociopolitical activism in a way that was… Continued

Randall Rice on the origins of his and Meryl’s work rolling out the Affordable Care Act in West TN

Randall Rice shares about his and Meryl’s involvement in assisting with open enrollment of the Affordable Care Act (ACA) in rural West Tennessee communities. Their work began in 2013, developed from a need left by the absence of major enrollment… Continued

The role of community control in structure of Stone Mountain Health Clinics

Art Van Zee discusses the impact of community agency on the success of the St. Charles Clinic and the key role local ownership plays in rural healthcare centers. Recorded March 17th, 2013.   Full footage of Art Van Zee’s interview. 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”.