The partnership, now underway, is providing needed health resources to the rural county while UA students receive training and experience in their fields

About three years ago, Pickens County Medical Center found itself in the same situation as many rural hospitals in Alabama and across the country. What was once the rural county’s largest employer—it had more than 300 on staff at one point—the county-owned hospital in Carrollton, Alabama, faced financial challenges that had resulted in layoffs and furloughs, cuts to programs and services and concern about the hospital’s ability to pay its bills on time.

It was feared that the 56-bed medical center, which had provided inpatient, outpatient and emergency services for the county’s nearly 20,000 residents since it opened in 1979, might close.

This is a familiar plight for rural parts of the state. By 2011, Alabama rural hospitals had closed in Florala, Elba, Clanton, Hartselle, Thomasville and Roanoke. Others cut services, particularly obstetrical care.

What makes this worse is that because of the characteristics of their populations, rural areas need greater access to health care, as their citizens are typically older, sicker and poorer.

In Pickens County, nearly one-third of the population lives below the poverty line and health outcome rankings show that the county is 41st among the state’s 67 counties. Faced with the closing of the medical center and what it could mean for the community, a conversation began.

It started within Pickens County. The County Commission, in collaboration with Buddy Kirk, a retired attorney, Patti Presley-Fuller, the extension coordinator of Pickens County, and local businessman and state Rep. Alan Harper, formed a citizens committee, which came to be known as Friends of the Hospital in Pickens County. They knew action had to be taken if the hospital was to stay open.

The University of Alabama and its College of Community Health Sciences were brought into the discussion by several Pickens County physicians who are graduates of the College’s medical programs and who have served as clinical teachers for CCHS medical students and residents. After several months of brainstorming and discussions, those involved met with top UA officials in August 2014, including former UA President Dr. Judy Bonner.

“Ideas and support for a collaboration emerged from the conversations,” says Dr. Richard Streiffer, dean of CCHS. “They asked, ‘Could the rural county partner with UA to bring intellectual capital and energy from University faculty and students while simultaneously helping the county and its health care and providing real life educational experiences for students?”’

The concept of a Health Care Teaching County, allowing Pickens County to benefit from additional health services and UA students to learn from hands-on experiences, was born.

After further discussions between UA and the citizens of Pickens County, and with help from Harper, $600,000 was secured from the Alabama Legislature to initiate The University of Alabama-Pickens County Partnership.

Coordinated by CCHS, the partnership seeks to provide sustainable health care for the rural county and “real world” training for UA students in medicine, nursing, social work, psychology, health education and other disciplines. With oversight from UA faculty and in partnership with Pickens County organizations, students will gain practice from internships and other learning opportunities, while the county will gain additional and needed health resources.

The partnership seeks to provide sustainable health care for the rural county and real world training for UA students in medicine, nursing, social work, psychology, health education and other disciplines.

Pickens County Medical Center
Carrollton, Alabama

The College’s mission is to improve and promote the health of individuals and communities in Alabama and the region, and of one of the ways it seeks to do that is by engaging communities as partners, particularly in rural and underserved areas. 

Dr. David Mathews, former UA president who was instrumental in the creation of the College in the 1970s, says that CCHS was founded on the notion that communities play a role in health and that patient care should be provided in communities. Additionally, universities should take an interdisciplinary approach to improving the health of communities, he says.

“The vision was you could take a comprehensive state university and you had all of the other professions that you needed to mount an armada of health care,” says Mathews, who later served as secretary of the US Department of Health, Education and Welfare and is now the president of the Kettering Foundation.      

“You had psychologists, lawyers, business people, social work, education—there was a real potential that all of these would come together and the University would launch an armada of professional caregivers and support for these caregivers that would transform health in the state of Alabama.”

He said many of the issues facing the health of Alabama in the 1970s are still prevalent today.

“In some ways, they’re more intense because our rural communities are really taking a beating,” Mathews says. “The potential of a University-wide response is still there.”

The partnership is about more than just the Pickens County Medical Center, says Kirk, who lives in Pickens County.

It could be a long-term solution for the hospital and for Pickens County,” says Kirk. “The idea of this partnership is very, very innovative. I’m not sure if there is another one in existence in the US.”

To date, the secured funds have been used to hire a project coordinator, to provide stipends for four fellows in Pickens County and to fund eight health projects proposed by UA faculty in partnership with Pickens County organizations, which will impact the county.

“It’s been a hard battle (with the hospital’s imminent closure),” says Presley-Fuller, “But we’ve turned the corner, “We’re excited about the opportunities.”

The Coordinator

Wilamena Dailey, Coordinator
(Photo: Andrea Mabry)

Wilamena Dailey joined the College in May as coordinator of the UA-Pickens County

Partnership. Dailey, who studied health care management at UA and has worked as an event and training coordinator for Maude Whatley Health Services, Inc. in Tuscaloosa, grew up on a farm in rural Archer, Florida.

“So I have a close connection with a rural community, and I understand rural communities really well,” she says.

Her interest in understanding healthcare systems in rural areas stems from personal experiences. Her great-grandmother was diagnosed with Alzheimer’s and was cared for in a nursing home. Dailey said she saw a lot of signs of neglect in her great-grandmother’s care, like bedsores and repeated urinary tract infections. That motivated her to explore the healthcare system and see what is effective and what needs to be changed.

She says she is excited that her position will allow her to focus on the health care of a community as a whole.

Her first steps have been to orient fellows, coordinate the start-up of projects and educate the community. While she’s spending some time at UA, she will be located primarily in Pickens County.

“I’m the glue,” she says. “My role is to make sure the community is aware of the partnership and understands the partnership, and I’ll be making sure that we are headed in the right direction and that at the end of this year, funding will continue. I will be making sure that we are introducing innovative ideas into the community and providing needed resources.”

The Fellows

August Anderson, Fellow
(Photo: Andrea Mabry)

Laura Beth Brown, Fellow
(Photo: Andrea Mabry)

Courtney Rentas, Fellow
(Photo: Andrea Mabry)

Judson Russell, Fellow
(Photo: Andrea Mabry)

The partnership also sought recent UA graduates for one-year paid fellowships that provide opportunities to serve in health-related capacities in Pickens County. Four fellows joined the partnership: August Anderson, Laura Beth Hurst, Courtney Rentas and Judson Russell.

They will spend time working in Pickens County in community engagement and project development, and they will also participate in seminars on health and public policy, social determinants of health and leadership. 

“They’re so ambitious,” Dailey says.

The fellows will help implement health promoting strategies in partnership with schools in the county, for example to improve nutrition and increase physical activity and to raise awareness of health services. “For instance,” Dailey says, “they might hold up a banana and a cookie in front of a child and ask, ‘Which do you like better? Which is healthier?’” One nutrition-related project being discussed is the implementation of school-yard gardens and ultimately community gardens.

“It’ll hopefully bring together the older generation that knows how to garden and the younger generation that is learning in their schools how to garden to come together to work the community gardens.”

Dailey says the fellows will seek community input and feedback in their projects.

“Things can always change once you hear the feedback, too,” she says. “So we need to be prepared for anything.”

The partnership could be a long-term solution for the hospital and for Pickens County. The idea … is very, very innovative. I’m not sure if there is another in existence in the US.

—Buddy Kirk, Retired Attorney and Committee Member of Friends of the Hospital in Pickens County

The Projects

A portion of funding obtained for the partnership will support eight projects that address Pickens County health issues. These projects, some of which are already underway, each includes UA faculty, UA students and a Pickens County community organization or similar entity.

The partnership steering committee approved grants for the following projects:

Disseminating the Power PATH mental health preventive intervention to Pickens County Community Action Head Start Program
Dr. Caroline Boxmeyer, associate professor of Psychiatry and Behavioral Medicine at UA’s College of Community Health Sciences; Dr. Ansley Gilpin, assistant professor of Psychology at UA; Dr. Jason DeCaro, associate professor of Anthropology at UA; Pickens County Community Action Head Start Program

TelePlay: Connecting physicians, families and autism professionals to increase early autism identification in Pickens County
Dr. Lea Yerby, assistant professor of Community and Rural Medicine at UA’s College of Community Health Sciences; Dr. Angela Barber, assistant professor of Communicative Disorders and the clinical research director of UA’s Autism Spectrum Disorders Clinic; Dr. Julia Boothe, family medicine physician in Pickens County

Improving Pickens County residents’ knowledge of risk factors for cardiovascular disease and type 2 diabetes
Dr. Michele Montgomery, assistant professor at UA’s Capstone College of Nursing; Dr. Paige Johnson, assistant professor at UA’s Capstone College of Nursing; Pickens County Community Action Committee & CDC Inc.; Pickens County Board of Education; Pickens County Head Start; Diabetes Coalition

Development of a family medicine residency in Pickens County
Dr. Richard Friend, director of The University of Alabama Family Medicine Residency and associate professor and chair of the Department of Family, Internal, and Rural Medicine at UA’s College of Community Health Sciences;; Jim Marshall, CEO of Pickens County Medical Center; Deborah Tucker, CEO of Whatley Health Services

Pickens County medical-legal partnership for the elderly
Gaines B. Brake, staff attorney with the Elder Law Clinic at UA’s School of Law; Jim Marshall, CEO of Pickens County Medical Center

Improving access to cardiac rehabilitation services in Pickens County
Dr. Avani Shah, assistant professor of Social Work at UA; Dr. Jonathan Wingo, associate professor of Kinesiology at UA; Sharon Cawford Wester, RRT, Cardiopulmonary Rehab Pickens County Medical Center

Alabama Literacy Project
Dr. Carol Donovan, professor of special education and multiple abilities at UA; Jamie Chapman, superintendent of Pickens County schools

Bringing healthy food options and ease of preparation to senior adults
Jennifer Anderson, director of Osher Lifelong Learning Institute at UA; Suzanne Henson, RD, LD, dietitian and assistant professor of Family Medicine at UA’s College of Community Health Sciences; Anne Jones, Pickens County Family Center; Joe Lancaster, mayor of Carrollton, Alabama

EXPO: Exploring professional opportunities in the health care field
Dr. Richard Friend, director of The University of Alabama Family Medicine Residency and associate professor and chair of the Department of Family, Internal, and Rural Medicine at UA’s College of Community Health Sciences; Shawn McDaniel, Pickens County Board of Education

Dailey says one objective of the projects is to connect and support community members and let them know about the expansion of health-related services that will be available as a result of the partnership.

Ultimately, Dailey says she hopes people will be reintroduced to and feel positive about the hospital and health services in the county.

“I want the people of Pickens County to know that they are being heard,” Dailey says. ”I hope that seeing a light shined on their community will boost their morale and that they will feel like they’re cared for.”

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