Making Things Healthy

By Harriet Swift

Vol. 2, No. 2., 1979, pp. 12-16

There's a familiar 1960s feel to the scene that recalls VISTA television spots: energetic, attractive college students bustle up and down the halls of the summer-emptied Black high school. Country people, mostly Black but a smattering of Whites, come into the building slowly, a little hesitantly. It's late morning on a sweltering July weekday in the Alabama Black Belt. Most of the people trickling into the Amelia Johnson High School in Thomaston are elderly or women with young children. They are here to have a physical examination, get their blood, eyesight, and hearing tested, have their blood pressure checked and perhaps receive some advice from a nutritionist and law student. They're participating in the health fair.

The health fair, with its retinue of 30 travelling members has already been in Thomaston once and has set up in two other rural Alabama counties for weeklong stays. Now, the health fair is back in town for a follow-up week before returning to the other towns for second visits that will end with community meetings to consider the state of health care in the area and what local folks want to do about it.

Debby Hicks, 21, one of two community organizers living in Thomaston for the summer says that almost 500 people have been through the health fair here. Hicks, an anthropology graduate student at the University of Alabama in Tuscaloosa, explains that her job is to help the community prepare for the health fair's arrival then ensure that all the necessary follow-up work is done after the "travelling" part of the fair leaves town. Follow-up can involve seeing that records are sent to area doctors, arranging for visits to specialists if some unusual medical problem has been discovered during a check-up, or assisting community work to build a clinic.

With the help of three CETA workers


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arranged through the county, Hicks and the other community organizer, Ann Wade, have visited almost every church and civic group in Marengo County telling people about the health fair, urging them to come and enlisting their support.

"This is not a do-gooder project," says Wade, 24, who hopes to go to medical school next year. "The community must ask for us to come, then they have to provide housing and food for the students. There's got to be something here for us to build on."

Health fairs have been an energetic force in rural Alabama since 1974, when a group of Alabama undergraduates, medical and nursing students began seeking "something to build on" as part of their commitment to improving rural health care. Sponsored by the Student Coalition for Community Health, a loosely-organized group based around the church-connected Wesley Foundation at the University of Alabama, the health fairs have had more spectacular successes in the past five years. One small town in North Alabama now has a doctor, clinic, and pharmacy, and other communities have established nurse-practitioner clinics and organized community improvement projects.

Not every community visited by the health fairs has found tangible results from the visit, but the coalition doesn't write off these experiences as failures. "Sometimes," observes a follow-up report written on a disappointing health fair site, "the best thing to help a community is to leave it alone."

There's a healthy lack of dogma about the coalition and its attitude toward the small communities that it visits.

"Rural places don't need anyone's charity," bristles the Rev. Jack Shelton, the mentor of many of the student leaders involved in the coalition. "It's important for our whole society for the rural community to be healthy."

Shelton, who until recently served as director of the UA Wesley Foundation is now with the university administration, working in President David Mathews' office on rural development projects. He's pleased with the evolution of the student coalition which he describes as being "not very self-conscious about its own life."

He traces the coalition's beginnings to a group of "bright, hard-working, thoughtful" students that gathered around the Wesley Foundation in the early 1970s. Reading Robert Coles' studies and after serious discussions about the South and what it meant to be a Southerner, the students eventually hooked up with a group of Vanderbilt University students in 1973. The Nashville group


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had been sponsoring health fairs in rural Tennessee since 1969, blending primary health care and community organizing in an open non-elitist manner that the Tuscaloosa group found attractive.

With seed money from the United Methodist Church, the coalition managed to win a $100,000 grant from the Robert Wood Johnson Foundation (of the Johnson & Johnson toiletry fortune) to be spread out over two years. Although the money has been handled by the university, the coalition is emphastically autonomous and totally student-run.

It's important, says Shelton, for college students to have a chance to "prove themselves."

"The coalition is a chance to build up confidence in themselves, to take a job and be responsible for seeing it through - pulling it off not in the best circumstances, not with the most expensive equipment. It's hard work and some of them can't take it."

The benefits to the students may be as important in the long run as the immediate gains in the communities. The future doctors, nurses, teachers, social workers, mathematicians, nutritionists and pillars of the community who work with the health fairs each summer attesting to its profound effect on their outlook and judgment, The "final reports" published after each summer include personal evaluations of the project by each staff member, and most of these speak poignantly of these mostly White, mostly middle class college students' reactions to living in small Alabama communities, many of them still clouded with racism, poverty and suffering.

"I've yet to see anybody come out of it unscathed," Dona Norton, an unofficial advisor to the health fairs, says cheerfully.

Asked by friends to arrange introductions between coalition organizers and officials in his home county in North Alabama during the first year of the health fairs, Norton has never had an assigned position in the health fairs, but now works with the Agricultural Marketing Project, a spin-off from the health fairs that operates under the coalition umbrella.

"This just throws 'em up against real life," he says. "There's no typical coalition student, and there's no typical health fair. One week he may be living up on Sand Mountain with a nice middle class White family with a swimming pool out back and the next week he's down in the Black Belt with some poor Black family that doesn't even have an indoor bathroom."

Norton, 29, has a degree in regional planning from Alabama and expresses the same strong agrarian sentiments as Shelton. During his student days Norton was "infuriated" with the campus insensitivity to the rest of the state.

"All these professors who come down from Indiana or somewhere, calling everything 'podunk,' dismissing everything smaller than Atlanta as not worth fooling with . . . ." he shaes his head in disbelief.

The health fairs run, in Norton's words, on "a constant series of miracles." Generally there is only a small carry-over group from one year to the next. Health fairs, on the whole exhilirating, are also exhausting and demanding, easy to burn out on. As soon as one summer's fairs are over, planning starts for the next year, more often than not with an entirely new group of students. They read the final reports, talk to old coalition workers, turn to Shelton and Norton for guidance.

"But nobody can tell you how to do it," says


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Angie Wright, a member of the three-member directorship that ran this summer's project. Wright, 22, a recent graduate of Davidson College in North Carolina, was looking for a way to combine her interest in medicine and community organizing when she heard about the health fairs.

There's a feeling that the coalition's strength comes from the constant infusion of new blood. If the health fairs seem to have the same problems with sloppy organization, uneven pacing and inadequate planning year after year, then they also have a freshness and enthusiasm that has gone out of too many other well-organized humanitarian efforts.

Shelton concedes that it was "easier' to recruit students for the projects a few years ago. "They had greater social sensitivity," he says. "They were a little more sophisticated generation of students; less dominated by the pleasure principle."

Still, every year, the coalition manages to fill its openings with music students who learn to take

EKGs, medical students who work as community organizers, geology students who learn how to test well water. It all gets out together, and somehow, it works.

There's some mumbling that the health fairs are being taken for granted, that they've taken a backseat to other coalition related projects. But no one foresees discontinuing the health fairs, at least not any time soon. Money has been a constant worry since the Johnson grant expired. In the last three years funds have come from the Methodist church, the University Student Government Association, the Chattanooga-based Lyndhurst Foundation and the Alabama governor's office. The other coalition projects also have to scramble for funds, usually drawing on the same sources.

Norton's Agricultural Marketing Project is similar to one run in Tennessee setting up "food fairs" in church and public parking lots throughout the summer. Farmers and gardeners bring produce to a market site on a regularly scheduled day and sell directly to consumers. The coalition has also undertaken a study of land ownership patterns in Alabama's Appalachian counties as part of a grant from the Appalachian Regional Council. A newly-formed Community Health Development Project, headed by two former health fair community organizers, is coordinating follow-up work in health fair communities and working toward building a network of primary health care advocates in Alabama.

The unifying idea behind the coalition's different directions is the group's broad definition of health.

"People in a community are healthy because of what they do for themselves," says Shelton.


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"The coalition has been intent on joining in a partnership with the communities that want to be self-reliant. This isn't a charity, do-gooder thing. It's just working to make things healthy. It's just working with folks."

In Thomaston, there's a palpable feeling of discouragement among the staff.

"It's too bad you couldn't visit one of the other sites," a visitor is told over and over. "The response has been so much more enthusiastic than here."

The health fairs have scored their most satisfying successes in the small, primarily White towns in the hill country of North Alabama. The health fairs have acted as a catalyst in several communities, providing a vehicle to identify and act on the dissatisfactions shared by many in the area. The coalition always works with the established lower structure, but at the same time it offers new energy and new ideas that can generate their own momentum.

The coalition has had less success in the Black Belt, where communities are often split sharply along racial lines. Previous efforts have centered in Black communities, which are desperately poor and able to marshal few resources. In Thom aston the power structure is undeniably White, while the population is perhaps slightly more Black than White. There was a pronounced hesitancy on the part of the White community to participate, although several respected authority figures sanctioned the health fair. It seems a testimony to the dedication and high goals of the students that they are unhappy with the response to the health fair in Thomaston. Several key community persons were very pleased with the health fair, one pointing out that no one can recall Whites and Blacks ever working together as equals on a mutually beneficial project before the coalition came. What will happen in the months to come is unknown, of course, but the health fair has brought a moment of cooperation and sense of purpose to Thomaston that might never have been known otherwise.

Dona Norton sees a common thread of experience in all the small communities where the health fairs have worked: "They all talk about the past, things that happened twenty years ago. And it's always traumatic, catastrophic stuff - when the school closed, when the train depot closed, when the lake came, we used to be known as the strawberry capital of the United States. The health fair is the first positive community experience that most of these folks can remember."

It's a time, he says, when the potential of the community can be revealed and mobilized. "One of the wonderful things is seeing so many good people surface," he says. "Not whittlers and fiddlers and all that goddamn craftsy stuff, just ordinary good folks. They could be on the Supreme Court, president of the United States, some of them were so wise and good, but they were born in Cedar Bluffs or Boykin or Castleberry and that's where they've stayed to live and die."

A native Alabamian, Harriet Swift is a graduate of the University of Alabama and copy editor with the Birmingham Post-Herald.