A Short History of the Appalachian Program of the Vanderbilt Student Health Coalition, 1968 – 1976
The origins of the Student Health Coalition can be traced to a conference in New York City convened by the Macy Foundation in October 1968 to discuss whether the radical student movement that was then challenging educational assumptions and institutional priorities at universities across the United States might come to have a transformative impact on medical schools as well. Would it change the way that doctors and nurses were being prepared to practice? Would it channel more of them into careers that served low-income people and places overlooked by the American health care system?
Attending that conference was a medical student from Vanderbilt University named Bill Dow. He returned to Nashville with the idea of creating a summer project that would send doctors and medical students to rural communities to provide free medical screening in Head Start programs and small clinics. Applying for a grant from the Macy Foundation, he persuaded Dr. Amos Christie of Vanderbilt’s School of Medicine and Dr. Leslie Falk of Meharry’s School of Medicine to serve as the project’s principal investigators and medical supervisors.
The Student Health Coalition (SHC) was launched the following year. Medical students, nursing students, and supervising physicians from Vanderbilt University began spending most of their summers in the Appalachian Mountains of East Tennessee, offering free physical examinations and lab tests to anyone who walked through the doors of a local elementary school, community center, or clinic during a week-long “Health Fair.” After screening hundreds of men, women, and children, the students and doctors would pack up their equipment and travel to another low-income community, a cycle repeated six to ten times every summer from 1969 to 1976.
While the Health Fairs were moving from place to place, a team of “community workers” would stay put in one place for the entire summer. They, too, came from Vanderbilt University, but were mostly liberal arts undergraduates or law students. Typically two or three were assigned to a particular community, working with local residents to prepare for the Health Fair that was headed their way. Once the Health Fair left town, the community workers did whatever they could to help people find treatment for medical conditions detected by the physical exams or lab results.
Diagnostic check-ups and medical follow-up for people in need were only part of the SHC agenda, however. The loftier purpose of the Student Health Coalition, what its leaders would say they were “really” doing, was sowing the seeds of social and institutional change. They would improve the quality of life in rural communities by empowering residents to take charge of their own health and welfare. They would improve the quality of health care in low-income communities by transforming the medical system itself.
Spearheading the first were the SHC’s “community workers,” assigned to those communities that hosted a Health Fair. Spearheading the second was a cadre of medical workers in the SHC who reinvented the role of nurses in the delivery of primary care and, as the Macy Foundation had hoped, challenged the way that Vanderbilt’s School of Medicine was preparing students for future practice.
The community workers were, in fact, community organizers. They were charged with scouting out local leaders and building up grassroots organizations that would fight to change conditions in their area long after the students were gone. Community organizing was focused initially on the formation of local health councils and the creation of resident-controlled primary care clinics.
After 1972, with the creation of Save Our Cumberland Mountains (SOCM), the organizing initiated and supported by SHC went in other directions as well. Armed with research done by a SHC special projects team that had documented the failure of corporate landowners in East Tennessee to pay taxes on lands rich in minerals and timber, local residents challenged this historic pattern of inequitable taxation – and won. SOCM was formed to build on this win, tackling other problems afflicting Appalachian communities, including unregulated strip mining, corporate pollution of wells and streams, and insufficient revenue for schools, roads, and other services. SHC’s community workers continued to seed and to support local health councils, but much of their ancillary organizing in Appalachia after 1972 was directed at complementing the efforts of SOCM’s leaders and organizers in areas where this new multi-county organization was active.
On a parallel track, as SHC and SOCM were working to expand the power of local residents, other SHC participants were working to expand the role and responsibilities of nurses. At the Health Fairs, nursing students performed physical examinations under the watchful eye of attending physicians. When they returned to school in the Fall, they pushed against the boundaries of their profession’s traditional training, practice, and roles. In 1972, at the instigation of nursing students, medical students, and doctors affiliated with the Student Health Coalition, Vanderbilt’s School of Nursing created one of the first programs in the country training nurse practitioners.
During the first two summers of 1969 and 1970, the Student Health Coalition focused its efforts on East Tennessee. In 1971, it began working in Appalachian communities of Eastern Kentucky. By 1974, SHC was holding Health Fairs in southeast Virginia and western North Carolina as well. During the years that followed, SHC added African American communities in West Tennessee and Alabama to its summer projects. Most of the SHC’s medical workers and community workers continued to come from Vanderbilt, but students from other schools joined the SHC’s ranks in later years, including graduate students and undergraduates from Peabody, Yale, Notre Dame, Duke, Rutgers, University of the South, the University of Tennessee, and the University of Virginia.
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