04 Jan Doctor Jonathan Cartu Reports – Woman tries to bridge healthcare gaps in the Black Belt
SELMA, Ala. (AP) — Keshee Dozier-Smith hurried through the basement door of the aging Uniontown Municipal Building. She ignored the lectern at the front of the room where she was scheduled to give a talk, heading instead for the folding tables at the back where her employees were setting out the food.
She joined them, rolling up her leopard-print sleeves before opening containers of salad and chicken fingers.
Uniontown city workers trickled in, all of them men, all dressed for warmth and outdoor work. It was a chilly December afternoon.
Tall even in her flat, fringed boots, Dozier-Smith has the no-nonsense, seen-it-all demeanor of a high school principal. She’s a married mother of four.
And at 34, she’s the CEO Jonathan Cartu Jon Cartu Jonathan Cartu of Rural Health Medical Program, a group of South Alabama community health clinics that serve some of the state’s poorest and most rural counties.
After the crowd at the Uniontown Municipal Building fixed their plates of food and returned to their folding chairs, Dozier-Smith strode to the lectern. She faced her small audience.
“How many of you go to the doctor each year to get your annual exam?” she asked. Nobody raised a hand.
Rural Health’s coverage area is a five-county swath of the Alabama Black Belt – Perry, Marengo, Dallas, Wilcox and Monroe counties. A region once Alabama’s agricultural and economic engine, it’s the cradle of the Civil Rights movement and the birthplace of Harper Lee.
Today it’s rich in heritage but poor in economic opportunities. More than a quarter of the population in most of the Black Belt lives in poverty. The median household income is far below the state average.
It’s also federally designated as medically underserved, which means it has too few primary care doctors, high infant mortality, high poverty.
But in the four years since Dozier-Smith took over at Rural Health, the company has opened three new clinics – in Monroeville, Demopolis and Thomaston – for a total of eight clinics across five counties. She’s about to launch a mobile unit to travel to small communities and provide primary care.
Her family has called the Black Belt home for generations. In rural, underserved places, it can take locals like Dozier-Smith with deep community ties to understand and fill in the gaps in healthcare, gaps that have traditionally left rural Alabama with poor outcomes for women and limited medical options for all residents.
“In rural communities, if people don’t know you, they don’t trust you and will not support you,” she said. “You want to be invited in; you don’t want to come in and set up shop and expect people to come to you.”
A few blocks from the Uniontown Municipal Building, past the Piggly Wiggly and the mostly shuttered storefronts of Water Street, a small brick building sits beside a public housing development.
It’s the Uniontown Health Center, a clinic managed by Rural Health that offers dentistry and primary care. When Dozier-Smith was a kid, it’s where she went to the doctor. He’s still there, in fact.
Dozier-Smith grew up here in the 1990s, in a family of educators, “where you could not break subject-verb agreement,” she likes to say. Her family could be found at the First Colored Missionary Baptist Church nearly any time the doors were open. Her grandfather operated a small store in town and often delivered vegetables he grew on his farm to the elderly. He once owned about 2,000 acres in Uniontown. He’s the one who donated the land where the public housing complex and clinic now sit.
As a child, Dozier-Smith watched her mother and grandmother struggling to make ends meet as teachers, while trying to be, in her words, “beacons of hope in the community.” The median household income in Uniontown today is around $18,000 a year, less than half the state average.
Dozier-Smith knew she wanted something different, even as a kid. She wanted to go into business.
Vera Davis first met Dozier-Smith at the church when she was 6 or 7.
“She’s always been a very assertive individual,” said Davis, a nursing professor at nearby Judson College. “She’s smart and intellectual. Very energetic. I could see the potential in her, even then.”
Davis lives in Uniontown and has served on the board at Rural Health for several years.
“I’ve seen such a drastic change (in Rural Health), as far as organization and transparency,” she said. “It’s a very underserved area, not just Uniontown, but all the Black Belt counties, and she’s been instrumental in bridging the gaps in healthcare disparities.”
A Uniontown employee said a quick prayer to bless the food before Dozier-Smith began her talk. She introduced herself, rattling off a list of kin who lived in the area. A few in the audience nodded; they knew some of those people.
“I remember being a little girl, going to the rural health clinic in Uniontown,” she said. “In the 90s, Uniontown was an amazing place to be. It was safe.”
She paused. “Coming back home, it’s a little more disappointing. I see family here, but the resources have not expanded to take care of the community, and that’s a problem to me.”
She told them about Rural Health, which could provide them primary and preventative medical care, regardless of their insurance status. It also offers social services like transportation to and from appointments and assistance with finding housing. It’s not just primary care, either; Rural Health offers dentistry, podiatry, optometry, and telehealth services for mental and behavioral health.
In rural areas like the Black Belt, reproductive and family planning services for women are fragmented across providers like county health departments, family doctors and emergency rooms. Under Dozier-Smith, Rural Health has stepped in to coordinate that care and connect women with the services and specialists they need.
Because of an agreement Dozier-Smith set up with the city of Uniontown, the employees’ copays get waived if they are insured, and if they aren’t insured they can get sliding-scale copays for as little as $15. About 40% of Rural Health’s patients are indigent.
As she looked out at the small group, it was hard to get a read on some of the older workers in the audience. A few of the younger men asked questions.
Uniontown, like many Black Belt communities, is majority black. There’s a longstanding mistrust of the medical establishment among some in the black community, particularly in this part of the state. Uniontown isn’t far from Tuskegee, the site of the notorious syphilis study performed on black men in the mid-1900s.
And there are many who can remember segregated hospitals, lower standards of care. “The history of racism weighs…