Rural Doctor's Struggle to Care for the Poorest

By Peter Applebome

New York Times
New York, NY

January 12, 2000

"There aren't many doctors like Ronald Myers, a jazz-playing, Baptist-preaching family practitioner whose dream has always been to practice medicine in the kind of place most other doctors wouldn't even stop for a tank of gas."

(Tchula, Mississippi) - There aren't many doctors like Ronald Myers, a jazz-playing, Baptist-preaching family practitioner whose dream has always been to practice medicine in the kind of place most other doctors wouldn't even stop for a tank of gas.

But there are plenty of places like Tchula, a forlorn patch of Mississippi Delta poverty where it is hard to find a street that's not rutted, a sign that's not crooked, a paint job that's not peeling or a life that's not perched on the brink of economic ruin.

Dr. Myers's story - how hard it has been for him to get here and how hard it may be for him to stay - provides a dispiriting look at health care in rural America. The situation is worsening because the Government's program to provide doctors for the nation's neediest areas is being dismantled as health care needs continue to grow.

"Working in Tchula, Miss., is like working in a third world country," said Dr. Myers, who became Tchula's only doctor when he opened a clinic this month in an abandoned restaurant next to an empty liquor store. "The needs are that great. So how is it that here's a well-trained physician who wants to come to an area that's desperately poor, and I can't get any assistance? I can't get a loan. I'll take a tongue depressor if someone will give me one. There's a problem somewhere."

In poor rural areas, particularly in the South, regular medical care is seldom more than a distant dream. In areas like Tchula and nearby Belzoni, where Dr. Myers previously worked, infant mortality rates are three times the national average, most women receive little if any prenatal care and people usually see a doctor only when they have no choice.

"The health problems in this area are staggering," said Dr. Henry Bartee, who operated a practice here before giving it up two years ago and now practices 12 miles away in Lexington. "I would say 70 percent of the people who walk through the door are either hypertensive or they have diabetes. Many have significant heart disease and their cholesterol levels are all sky high. A lot of people have never had a Pap smear, a breast examination or a pelvic or rectal exam."

It is a common story, especially in the South. In Tennessee, the state says, more than a third of the 95 counties have no doctors who deliver babies and almost half do not have enough doctors to provide adequate basic health care. In South Carolina, all but 9 of the 47 counties have doctor shortages, and the state says it needs 225 family practitioners, obstetricians and pediatricians.

'I Feel Right Being Here'

Dr. Myers is rare in his profession, a physician who went to a good deal of trouble to practice where no one else would. A 33-year old Milwaukeean who graduated from the University of Wisconsin Medical School, an accomplished jazz pianist and an ordained Baptist minister, he said coming to the rural South was always his goal in medicine.

"I feel God put this burning desire in my heart to serve in the rural areas of the South where the need is the most," said Dr. Myers, whose new clinic office is decorated with black-history and black-pride posters and mementos from his musical career. "I feel right being here. I feel it's what I was called to do."

Tchula, about 60 miles north of Jackson, has 2,000 people, and the population of the area served by Dr. Myers's clinic is 4,500. Mayor Jessie D. Banks says 70 percent of the town is unemployed in winter, when there is no agricultural work to be found.

Dr. Myers began work in Belzoni a year and a half ago as part of his agreement with the National Health Services Corps, which pays a year's worth of medical school costs for each year the recipient agrees to serve in an underserved area.

While he served at a clinic there, he saw that the need was even greater in Tchula, 21 miles away, where there was no doctor at all. He decided to set up his own clinic in Tchula, using money he had made working overtime at emergency rooms, and to work there in the evening after spending his days at Belzoni.

The Federal Public Health Service, which oversees the program, told him he was not authorized to practice in Tchula and ordered him to stay in Belzoni. Officials told him that they did not think a medical practice could survive in Tchula and that doctors fare better when they can take advantage of existing health care organizations. Too Poor to Support a Practice? Undeterred, Dr. Myers took his fight to elected officials and the Mississippi news media, winning so much attention that the Public Health Service relented. He now operates full-time in Tchula while living in a double-wide trailer in Belzoni.

But getting permission to be in Tchula was only half the battle. To cobble together his clinic, he has had to rely on makeshift financing, advances from medical suppliers and his own wits. He has no lab equipment and does his own urinalysis under a microscope.

Dr. Bartee thinks that all this is in vain, that Tchula may be too poor to support a physician. "The patients he will be seeing will primarily be indigent, Medicare-Medicaid patients, and it's almost impossible to make a living just seeing those patients," Dr. Bartee said. "He's got to have some outside help."

Dr. Myers wonders why the Government does not encourage the doctors it brings to rural areas to stay there by helping them set up practices. But increasingly, the problem is not keeping rural doctors but getting them there in the first place.

Started in 1972, the National Health Services Corps has placed more than 13,000 doctors in the nation's most underserved communities. But its financing has been slashed from $79.5 million in the 1980 fiscal year to $7.5 million in 1990, and six doctors leave the program for every one who enters it. Now it is unclear whether the program will survive at all. Its plight reflects both the Reagan-era budget cutbacks and an assumption that turned out to be erroneous: that because there was a nationwide oversupply of doctors, large numbers would stay in the rural areas where they were placed.

Bemused Cries of "Hi, Doc"

"It was hoped that natural diffusion would take care of a lot of our needs," said Joseph Hayden, the corps's associate director. "But it didn't." Today's needs, he went on, "are just as great now as they were in 1980."

Dr. Tom Dean, a family practitioner in Wessington Springs, S.D., who is president-elect of the National Rural Health Association, said that without the health service corps there would be ''a lot of needy people who just will not get care.''

"It would be just another critical hole in the theoretical safety net that's supposed to exist but we all know it really doesn't," he said.

If the poverty is most pronounced in the rural South, the problems are national, he said. The vast distances between towns in the West can make problems particularly acute there.

Dr. Myers, who is greeted with admiring if slightly puzzled cries of "Hi, Doc," as he walks through Tchula's dilapidated business district, seems unfazed by the economic prospects here. He has already arranged for an ophthalmologist, a surgeon and a podiatrist to see patients at his Tchula Family Health Center. He doesn't expect to solve the health problems of the Mississippi Delta. But he wonders whether the statewide educational initiatives that have been hailed as the salvation of the South will mean much if no one addresses the health-care needs.

"Here you're putting all of this money into educational reforms, and you've got these sick, malnourished kids whose mothers never got any prenatal care," he said. "If they're not healthy, how are they going to be able to learn?"


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