Q: Did you enter religious life with the idea of becoming a physician?
A: No, I really didn't. I was a teacher for many years, and I didn't think about becoming a physician until I was in the community for, well, 12, 15 years -- something like that.
Q: What sparked that?A: It came to me, actually, through prayer. I had made a 30-day retreat, and while on retreat a year or two later, I was praying one evening, and it just seemed as if the Lord wanted me to do something with my life more than I was doing. Over the next few days of retreat, it finally came into focus that that's probably what it was. A friend of mine who was a physician's assistant in the mountains of Peru had planted the seed of the idea several years before that.
Q: When you went to medical school, did you expect to be working overseas, or in the U.S.?
A: I expected to be working in Latin America, in particular in Peru. But the Shining Path guerrilla movement was very, very active in the mountains there, and they were targeting the clinic that the sisters had, and the peasants that were coming to the clinic, and the sisters themselves. It became obvious that it was better, rather than to lose life, to go ahead and move out of that area. Then there was no clinic in Peru for me to work with. The sisters that remained there went into health education and went out into the community to help teach hygiene and good health habits and so on, rather than doing actual clinical work. They set up their headquarters at the mouth of the Amazon, around the northern part of the country.
Q: And then how did you end up in Alabama?
A: I'm probably one of the only physicians recruited by their nurse practitioner. Sister Jane Kelley, who has been part of this clinic since its inception, kept calling me during medical school and then later on during residency training and saying, "Come on down and see what we have down here. We need a doctor. We need a doctor." During the third-year residency program, we were given a month to travel around and try to see what location we'd like to practice in. I came to a rural Appalachia area of Kentucky, rural Georgia, Alabama, and then went on to [the] Delta region of Mississippi. I finally decided to come back here.
Q: What did Sister Jane tell you about the conditions at that time?
A: She told me that the people were quite poor. Most of them did not have access to medical care of any kind of quality. The doctors that they had were all temporary; they would just come to pay off their [medical school] debts and then move on. And she asked if I would come to stay.
Q: Did you know immediately you wanted to be here?
A: Part of my decision was the fact that there were other Sisters of St. Joseph working right here in the area. There would be community support, and I wouldn't be out there all by myself, setting up a practice and so on.
Q: How hard is it for you to see as many as 30 patients a day?
A: Well, you go home tired but, you know, each patient has their own story to tell. Each room that you go into, there are some differences, and no two days are alike. It's not boring by any means. Sometimes it's a little fatiguing. We do a lot of walking because we try to provide medicine for people, and so we're walking back to the pharmacy all the time in between patients. But it's not too bad. Not too bad.
Q: What are the types of problems people come to see you about?
A: The most common problems that we see are associated with poor diet -- diabetes and hypertension. And then flowing from those two diseases would be renal problems, cardiac problems, strokes. We see a lot of people with back injuries, because the main employment here is the logging industry. Many of the men who come in have had a tree fall on their back, or have been in a motor vehicle accident, or have had a skidder that went wild, and they lost an arm or a hand and are disabled from that. We see a lot of people who have problems with overuse syndromes -- women who work in the sewing factories around here who have to do the same motion over and over and over again, and they get carpal tunnel syndrome. This morning we saw a woman who had difficulty with her hand. The tendon sheaths were all scarred down. She had been ironing at a cleaning establishment for 20 years, holding onto a hard iron, and it's ruined her right hand. We see a lot of injuries that come from chronic use, from hard use. But diabetes and hypertension are the two biggest that we see.
Q: You work the emergency room. You do some procedures that another doctor might send a patient to a specialist for.A: I'm on the staff of our little county hospital, and there are three of us that are active. We each take one night a week on call, which means that we see anyone who comes into the emergency room. That would be from 5:00 in the evening to 7:00 in the morning. Then we have one weekend a month, ordinarily, when we start at 5:00 on Friday and end Monday morning at 7:00. On the weekend, we may be the only doctor in the county, and so we're it. We see people who have motor vehicle accidents, people who fall out of trees, people who are in altercations and have knife wounds, fishhooks in hands, and children with upset stomachs. We see the whole range of things. If people are critically ill, mostly we will stabilize and transfer to a larger facility, because our little hospital doesn't have any intensive care. We don't have any on-staff surgeons. We don't regularly do OB work, because we don't have the insurance to do it. In order to get insurance to deliver babies, you have to have access to a C-section within 30 minutes, and we cannot. The next OB department is 40 miles away, and we can't get up there in 30 minutes. So, we all deliver babies in the emergency room, but we'd rather we didn't. You can't send somebody out if they're really ready.
Q: What are some of the other things that you do that a specialist would do in a bigger area?
A: We set uncomplicated fractures and put casts on, do skin biopsies, remove moles, sometimes remove cysts that are a little bit deeper than just the skin. We don't have general anaesthesia. We wouldn't be taking out an appendix or any kind of major abdominal surgery or anything like that. A lot of doctors won't do simple casting, simple fractures anymore. They go to an orthopedic doctor for that. We see children. We don't have a pediatrician on hand, so we take care of children. We do a certain amount with cardiac patients, if they're stable and don't want to be transferred to a larger facility. We will keep somebody who's had an un-acute myocardial infarction. Sometimes we also take care of stroke patients at our little hospital. We take care of some bad abscesses and have to pack wounds. One of the things we do is house calls, something that a lot of doctors don't do anymore. I also have a large number of nursing home patients -- about 35, 36 nursing home patients who are in varying states of health or illness. Nowadays, people get sent out of the hospital much faster, and many times are a lot sicker when they go back to the nursing home.
Q: Why do you have to do house calls?
A: Because people's transportation is so difficult in the country. Rural access is really a key problem -- having any kind of transportation. There's no public transportation available, and our older folks, many of them don't drive. Younger people who would maybe be able to take them are off at work during the day. In some cases, it's such a project to get the elderly dressed and into a car that it's much easier for me to come to see them.
Q: How hard is it for people to get adequate health care in an area like this?
A: I would say it's fairly difficult, really, because so many of the people that we take care of don't have health insurance. Either they do domestic work, or they work for employers who don't provide them with health care because they're small operations -- particularly our small trucking companies, who maybe have six or eight employees. Some of the smaller wood pulp manufacturing companies don't have many employees, and so they don't provide health insurance. And then a lot of our people also do farm work, and they don't have health insurance there, either. The first question when you try to refer somebody is, "What kind of health insurance do they have?" And if they don't have any, you don't get an appointment very easily.
Q: How hard is it to recruit medical personnel to an area like this?
A: It's very difficult, actually. Our little hospital has been wanting to increase our staff numbers, and they've had headhunters out there looking for people to come. And we just haven't been able to find anybody.
Q: And it's not just doctors, is it? It's medical technicians.
A: Medical technicians, lab techs, x-ray. We have a perfectly good mammography setup at the hospital, but the girl that was doing them took leave when she had her baby and didn't come back, and we don't have anybody to do it. The mammography [equipment] has been sitting there idle for close to two years. They've been advertising regularly, and we just can't get anybody in the area. Trained personnel are not common to our area. As a result, it's very difficult to fill those places.
Q: What happens if someone needs a mammogram?
A: We have to send them up the road to Selma, which from here would probably be about 50 miles; to Greenville, another 25 miles; to Monroeville, which is probably about 45 miles; or else over to Thomasville, which is about 50 miles. Selma right now is overbooked; so we'd have to wait three or four months to get an appointment there.
Q: And here in your own clinic, some equipment is lying idle.
A: That's right. We have two wonderful dental chairs that are fully equipped -- new equipment -- and no dentist. We have many, many people with terrible, terrible teeth and a lot of health problems as a result of poor dental care -- practically absent dental care. It's very common for me to look in someone's mouth and find the teeth rotted off right to the gum. You have this little black nub right down there in the gum line, which is just the root of the tooth sticking up.
Q: It's also access to prescription medicine, too.
A: Yes. It's 25 miles in either direction to the nearest drugstore. Even if patients have Medicaid, many times it takes them $20 to get into town, because whoever they ask to drive them wants remuneration. As a result, even if they only have to pay a dollar, two dollars, three dollars for their prescription, you have to add their transportation cost on to that. It's difficult. About 20 percent have Medicaid. The rest do not, and Medicare patients, for the most part, don't have any pharmacy coverage and are all on fixed incomes. That makes it very difficult for people. More than 80 percent don't have any way of getting their medicines.
Q: Why is it so hard, do you think, to recruit doctors and medical personnel here?
A: Most doctors want to be in a larger metropolitan area, where there are a lot of colleagues that they can call on for consults, for backup, for interaction of all kinds. Many times doctors' families don't want to come to a rural community, unless they've grown up in a rural area and want to go back. They're just not interested in living out in the country, where you might have three restaurants. You have to drive up to Montgomery in order to see a movie in a theater, which would be about 70 miles away. The school system in our area is not really good. The school system is not integrated, even though it's supposed to be. And the quality of education has been questioned over and over again by not just the ordinary citizens, but by the state board of education. So there are drawbacks. There's also the fact that so many people are poor and don't have insurance. As a result, the doctor's worried about being able to make it financially in an area like this.
Q: What would a doctor earn here?
A: Well, it depends. If they're in private practice, it depends on how good they are. I'm an employee of the Rural Health Medical Program, and so my salary is reasonable, based on federal guidelines. About 40 percent of our operating budget comes from a federal grant, and as a result, we're able to see patients and discount the services and have federal monies come in and subsidize us, so that we can continue to function and stay afloat.
Q: Do you think it makes any difference to the patients that you're a Catholic sister?
Q: Many people would look at you and say, "This is a happy, fulfilled woman, despite the difficult job that she's doing." What do you attribute that to?
