How a small Georgia town is feeling the rural health care crisis: NPR

Imagine you have a heart attack and the nearest hospital is almost an hour away.

What are you doing?

It’s a situation some of the 46 million Americans who live in rural areas could find themselves in, according to the Centers for Disease Control and Prevention. They are more likely to die than someone who lives in an urban area due to limited access to emergency services and specialized care.

Morning edition We wanted to see for ourselves what this challenge was like, so we visited Elberton, Georgia, which bills itself as the “Granite Capital of the World.” The city of fewer than 5,000 people is a few hours east of Atlanta, near the South Carolina border.

Cicadas chirped loudly as we entered the Elberton Medical Center.

Office manager Brooke McDowell said they don’t shut up, even at night.

The center is officially designated by the government as a rural health clinic, which means it can get more money to treat people on Medicare and Medicaid. Around 70% of the center’s patients fit this profile.

The clinic offers services such as primary care, gynecology, x-rays and chronic disease management. Dr. Dan McAvoy, who sat down with us for an interview, said the clinic has six doctors and two nurse practitioners.

“Probably the most common problems we treat are hypertension, diabetes, heart disease and stroke,” McAvoy said.

Without this clinic, he said, most people would have to travel to towns 30 or 40 miles away. This can be a barrier for some patients, McAvoy said, because they don’t have transportation.

Beyond that, many rural hospitals have closed across the country. From 2010 to 2019, 114 people closed or eliminated key services in the United States, according to KFF, a health policy nonprofit. The closures are concentrated in states like Georgia that have not expanded Medicaid, the joint state-federal program that provides health coverage to low-income people.

In Georgia specifically, 18 of its 30 rural hospitals are at risk of closing due to financial problems, according to a February 2024 report from health consulting firm Chartis. The report also finds that about half of all rural hospitals in the United States are operating in the red.

For Sylvia Chapman, 72, the clinic means access to health care close to home and the opportunity to tell jokes.

“Why do melons get married?” She asked us and waited for a guess. “Because they make cantaloupe.”

Chapman retired after 34 1/2 years in public service and moved to Elberton seven years ago. She has been a patient at the clinic for six years and loves being here. “They let me tell my jokes. They tolerate me, so it’s not bad,” she said.

She has had a few strokes and from time to time she needs to see specialists. The medical center helps her refer patients and she likes her doctor. She can also visit the nearby Elbert Memorial Hospital.

Where would she go if this clinic wasn’t here?

It takes about 50 minutes to get to Athens, Georgia, or the town of Anderson, which is slightly closer but across the border from South Carolina.

Would she ignore care if what she needed was further away?

“It’s easier to come here,” she said, adding that she would travel further if necessary. But the headache would be her husband’s because she rarely drives. “Every time I tell my husband I have a date, he asks me, ‘Where is he?’ »

He is relieved to learn that they are in town.

“You need it.” You don’t need to get rid of this place,” she said of Elberton Medical Center. “There are too many people in the waiting room, so you know it’s a necessary place. Very practical for locals. »

The local need is highlighted in Dr. Jonathan Poon’s schedule: It’s the beginning of May and it’s already full until July

It’s not a good feeling, Poon said, because he doesn’t want to be accessible to his patients.

“We’ll see, you know, our patients walk in every day without an appointment. We will integrate them,” Poon said. “But it’s just not nice to see someone call and have to wait a month or more to get an appointment.”

It’s a balance, Poon said, because he would like to be able to spend more time with patients.

“But the more time we spend with patients, the less time we can spend with them,” Poon said.

“Maybe I can’t clone myself, but if we could have more providers to help see our patients who have the same passion as us, that would be a great start,” Poon said.

This will be a challenge that the clinic will have to face as soon as possible.

“In particular, as some of us age, we will need more doctors in the coming years,” McAvoy said.

But it’s difficult to get doctors to leave this way.

“We need to find someone who loves the small community lifestyle and loves outdoor activities, like fishing and hunting,” McAvoy said.

Poon told us that one of the medical services most lacking here is mental health care.

Poon said he and other doctors here have noticed that mental health needs have become more problematic in recent years, but that the clinic is limited in what it can do.

“We just don’t really have a stable mental health program here,” Poon said. “And so we would like to, you know, ultimately offer that ourselves. But there is no real, direct, real way for rural health to deliver that.

Georgia ranked 49th for access to mental health care and first for prevalence of mental illness in the 2023 report from Mental Health America, a nonprofit organization that works to provide resources and advocates for better access.

In Atlanta, we asked Kim Jones, executive director of the National Alliance on Mental Illness for Georgia, why access is such a problem here.

She said federal law requires insurance companies to provide mental health care at the same level as they do for physical health. His organization found that this is not the case in Georgia.

But it’s also something people aren’t comfortable talking about.

“I think there’s just this general stigma that mental health is maybe more based on your behavior and your beliefs, you have to step up and get over it. On the other hand, sometimes it’s a physical and chemical imbalance in your brain,” Jones said.

With overall access in Georgia already a challenge, Jones said cities and rural counties fare even worse.

“There are a significant number of counties here in Georgia that don’t have any mental health providers,” she said. “So even when we look at expanding telehealth, we have areas that are not covered by the internet. »

Despite the difficulty in accessing health care, Sylvia Chapman tells us why this small town life appeals to her.

“I don’t have to fight traffic in metropolitan areas,” she said. She is enjoying her retirement, playing games and puzzles on her phone. She and her husband will celebrate their 47th wedding anniversary later in August.

She will continue to come to this clinic for her health care

She will also monitor the November elections.

Having spent her professional life helping Georgians obtain Medicaid, she recognizes the importance of health care as an issue.

“People decide whether to go shopping or buy medicine. And it’s the same problem we had in the ’70s and ’80s,” Chapman said, adding that how people vote in November will be “very important” in deciding whether Americans continue to meet this challenge.