Help Wanted: Alabama's Rural Healthcare Crisis

Aug 15, 2017

Advocates working to fix problems with rural health care say Alabama is ground zero nationally. Studies say Alabama has the highest infant mortality rate in the U.S. The state also leads the nation for diabetes. Alabama is also home to Gadsden which had the lowest life expectancy in the nation in 2016. Despite all this, rural hospitals in the state receive among the lowest reimbursements nationally from Medicare. That’s blamed for eighty percent of Alabama’s hospitals that are operating in the red. The Alabama Public Radio news team has spent the year investigating rural health care issues, some possible remedies, and the people whose health may be at stake. APR’s Pat Duggins starts us off with this report...

“I hurt so bad, and I just stayed in bed like, for years I stayed in bed. I couldn’t get out of bed. I couldn’t wait on myself.”

We’re sitting at the dining table with Fay. She asked us not to use her real name. During our visit, one of her favorite songs plays in the background on an old portable CD player. Fay is seventy two and following her first ever mammogram in the year 2000, she found she had breast cancer.

“And then they told me I had the worst kind. And, I said ‘cancer? What is the worst kind? It’s bad no matter how you look at it.”

It didn’t stop there.

“It metastasized to my spine. My back kept hurting and kept hurting, and I kept running to the doctor.”

For Fay, running to the doctor takes explaining. That’s because of where she lives. The nearest cancer specialist is in Tuscaloosa. That’s an hour and a half away by car and Fay didn’t have one. She scraped together six hundred dollars for a used truck. Her latest checkup meant hitting the road at 2 a.m. She says that meant fewer stop lights.

“You know the truck made it all the way down there, without me having to stop. It was making all kinds of weird noises, like the transmission was gone. It wouldn’t change gears, it wouldn’t do nothing. It would only creep along.”

And a study from the Alabama Department of Heath says Fay may be one of the lucky ones. The report shows sixteen percent of rural residents in Alabama have no transportation at all. And, Fay’s not the only one feeling the pressure of finding health care…

“People are doing without the health care that they need, because there are not facilities, and people don’t have the money," says Julia. Like Fay, she doesn’t want us to use her real name.

Fifty four of Alabama’s sixty seven counties are considered rural. That includes Julia’s hometown, which looks like a slice of middle America. Seven of these counties have no hospital at all. That includes Coosa County which doesn’t even have a doctor. In these communities, unemployment is often high and poverty is often common. Julia says rural health care is a constant worry…

“I have three kids who wear glasses, three kids who…three kids total—but, you’ve got to dental appointments every year, eye appointments every year. And, then when they’re sick.”

While Fay pays her medical bills with a combination of Medicare and Medicaid, Julia and her husband both have jobs. They get insurance from the State and where Julia’s husband works. Their concern is still how to pay for health care and where to get it.

“You’re thinking ‘well, I’m going to go local, so I don’t have to drive forty five minutes out of town, and therefore it would be less time.’ But, when there’s a limited amount of offices there, you’re spending that time waiting because the places are so packed.”

Then, there are the shortcuts to get health care… At one point, Julia’s family raised cattle. They don’t do that anymore. But when they did, they worked with a local veterinarian. Julia says if her husband needed medical help, and he didn’t want to wait in line or face co-pays…well, you know where this is going… 

“Living in rural area, and working on farms…most men are not going to take off and go to the doctor, or there’s not enough time. And so…you know…it just happens.”

Julia admits it’s not always a matter of convenience, and the choice of people seeing their vet instead of their doctor often comes down to money. “I know of local people who’ve ran up and got an x-ray at the vet clinic, to see if it really broke or not,." says Julia. "Because they don’t want the expense of hospital…what they’ve got to pay to go there.”

You may not know someone like Julia, or like Fay. You may not know anyone living in any of Alabama’s rural counties. But an incident in rural Macon County changed how medical research leads to many of the newest drugs you and your family use. In 1997, President Bill Clinton took the podium to address a period in history where the health industry worked against rural Alabamians based on their race. Twenty years later, many of these same family members of the men who were part of the Tuskegee Syphilis study gathered to remember the twentieth anniversary of Clinton’s apology for the program.

“Just being human, you’re angry,” says Felicia Chandler.

She’s referring to the treatment her grandfather suffered. He was one of the African Americans who syphilis went untreated as researchers watched how the disease progressed. Chandler say she remembers her mother’s stories of how her grandfather underwent regular spinal taps that left him unable to move for hours…

“I mean, just the effects of when they came down for so-called treatment, were just horrific.”

“What the United States’ government did was shameful,” said President Clinton. “And, I am sorry.”

The Tuskegee syphilis study ended in 1972, forty years after it began. It led to tougher regulations on medical research involving human beings. Felicia Chandler wants one thing…

“I’m hoping that, one day, that history will show…it will be written in our text books, it will be taught in our schools, about actually what happened," says Chanlder. "So, our children and grandchildren will know.”

When it comes to all of the problems with Alabama’s rural health care crisis, some people are trying to make it work. Check in is underway at the annual meeting of Alabama’s rural health association in Prattville. The association is made up of Alabama doctors, hospitals, medical schools, and advocates. But today, there’s an extra guest sitting in the discussion.

“I’m Alan Morgan. I’m Chief Executive Officer of the National Rural Health Association, which is a national non-partisan membership organization.”

Morgan’s group represents forty three states that are struggling with rural healthcare. So, what place does Alabama hold nationally?

“Well, it’s more extreme,” he says.

And when asked for specifics, Morgan has a list…

“Hypertension, obesity, diabetes…unfortunately, almost all the health disparity metrics…Alabama, unfortunately leads the country, or is in the top five when you look at states across that.”

So, has any progress been made? “Unfortunately, no," says Morgan.

But, there are ideas out there. For the next few weeks, the Alabama Public Radio news team will be examining these strategies and we’ll meet the people whose health and lives may be at stake.