Imagine having a heart attack and the nearest hospital is about an hour away.
What is your occupation?
That’s the situation some of the 46 million Americans who live in rural areas could find themselves in, where they’re more likely to die than those in urban areas because of limited access to emergency services and specialized medical care, according to the Centers for Disease Control and Prevention.
Morning Edition Wanting to see what this challenge is like firsthand, we traveled to Elberton, Georgia, the self-proclaimed “Granite Capital of the World.” The town of fewer than 5,000 people is located a few hours east of Atlanta, near the South Carolina border.
The sound of cicadas echoed as I entered Elberton Medical Center.
Office manager Brooke McDowell said they don’t get quieter at night.
The centre was formally established by the government Rural Health ClinicThat means it can make more money by treating Medicare and Medicaid recipients — about 70% of the center’s patients fit that profile.
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The clinic offers services such as primary care, gynecology, x-rays and chronic disease management. According to Dr. Dan McAvoy, who was present during the interview, the clinic has six physicians and two nurses.
“Probably the most common conditions we treat are high blood pressure, diabetes, heart disease and stroke,” McAvoy said.
Without the clinic, most people would have to travel to a city 30 to 40 miles away, McAvoy said, which he said is a barrier for some patients because they don’t have transportation.
Additionally, many rural hospitals across the country are closing. Between 2010 and 2019, 114 hospitals across the U.S. closed or reduced key services. According to health policy nonprofit KFF:The closures are concentrated in states like Georgia, which have not expanded Medicaid, the joint state and federal program that provides health insurance to low-income people.
In Georgia in particular, 18 of the 30 rural hospitals are at risk of closing due to financial problems. According to a February 2024 report: About half of rural hospitals in the U.S. are operating at a loss, according to a report by health consulting firm Chartis.
For Sylvia Chapman, 72, the clinic means medical care closer to home — and the chance to tell jokes.
“Why do melons get married?” she asked us, waiting for our guesses. “Because melons are cantaloupes.”
Chapman retired after 34 1/2 years in public service and moved to Elberton seven years ago. She’s been going to the clinic for six years and loves it here. “They let me make jokes. They tolerate me, so it’s not bad,” she said.
She has had several strokes and needs to see specialists from time to time, and the medical center helps with referrals, she likes her doctor, and she can also get care at nearby Elbert Memorial Hospital.
Where would she go without this clinic?
The journey to Athens, Georgia takes about 50 minutes, or you can head a little closer just across the state line to the town of Anderson, South Carolina.
Would she be able to avoid care if her needs were further away?
“It’s easier to come here,” she said, adding that she’ll travel further if necessary. But since she rarely drives, it’s her husband who ends up worrying: “Whenever I tell him I have an appointment, he always asks, ‘Where?'”
He was relieved to hear that they had reached the town.
“We need this place. We 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 can see this is a place we need. It’s very convenient for the locals.”
Dr. Jonathan Poon’s schedule reflects the local need: It’s only early May, but he’s already booked through July.
Poon said that’s not a good feeling because he doesn’t want to be inaccessible to patients.
“You know, we have patients who come in without appointments, and we see them,” Poon said, “but it’s never a good feeling to have to wait a month or more to get an appointment.”
Poon said it’s a matter of balance, as he wishes he could spend more time with his patients.
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“But the more time you spend with patients, the less patients you have to spend with them,” Poon said.
“We may not be able to clone ourselves, but if we can get more medical professionals with the same passion as us to help us treat patients, that would be a great start,” Poon said.
It’s a challenge the clinic will have to address sooner rather than later.
“We’re going to need more doctors in the coming years, especially as we have an aging population,” McAvoy said.
However, it is difficult to relocate doctors this way.
“You have to find people who like the small community lifestyle and enjoy the outdoors, fishing and hunting,” McAvoy said.
Poon said one of the most lacking medical services here is mental health care.
Poon said he and other doctors have noticed that mental health needs have become a bigger issue in recent years, but there are limits to what the clinic can do.
“We don’t have a really robust mental health program here,” Poon said, “so ultimately we would like to provide it ourselves, but there’s no practical way for local health care to be able to provide it directly.”
Georgia ranks 49th in access to mental health care and first in prevalence of mental illness. 2023 report from Mental Health Americais a nonprofit organization dedicated to providing resources and promoting greater access.
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In Atlanta, Kim JonesI asked him, executive director of the Georgia National Alliance on Mental Illness, why access is such an issue here.
She said federal law requires insurers to provide mental health care at the same level as physical health, something her organization found wasn’t happening in Georgia.
But it’s also something people are reluctant to talk about.
“I think there’s a common stigma around mental health that it’s something you can overcome on your own because it’s based on your own behavior and beliefs, when in fact sometimes it’s caused by physical and chemical imbalances in the brain,” Jones said.
Access is already a challenge across Georgia, but the situation is even worse in rural towns and counties, Jones said.
“Here in Georgia, we have a significant number of counties that don’t have any mental health providers at all,” she said, “so even if we were to expand telehealth, there are areas that don’t have internet coverage.”
Despite the challenges of accessing healthcare, Sylvia Chapman explains why life in this small town is so appealing.
“I don’t get stuck in city traffic,” she says. She enjoys her retirement by playing games and puzzles on her cell phone. She and her husband will celebrate their 47th wedding anniversary in late August.
She will continue to visit the clinic for health care.
She’s also keeping an eye on the November election.
As someone who has spent her life working to help Georgians access Medicaid, she knows health care is an important issue.
“People are deciding whether to buy groceries or buy medicine. This is the same problem we had in the ’70s and ’80s,” Chapman said, adding that the outcome of the vote in November will be “hugely important” in determining whether Americans will continue to face this challenge in the future.
Copyright 2024 NPR
