Cash-strapped health care facilities work to stave off projected spike in heart disease

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• Amna Nawaz:

  In two parts tonight, heart disease and the obesity epidemic.

  No disease kills more Americans annually than heart disease. At least half of all Americans are at risk because of factors such as obesity, elevated blood pressure, high cholesterol or smoking. And that's projected to get even worse in the coming decades.

  Stephanie Sy reports from Mississippi, the state with the highest rate of heart disease, on how access to care is affecting residents in the rural Delta.

• Lee Roach, Cardiac Rehab Nurse, Greenwood Leflore Hospital:

  How does that feel, Terry? Is it hard?

• Stephanie Sy:

  In a small room tucked away at Greenwood Leflore Hospital's Physical Rehab Center, nurse Lee Roach is putting her patients through their paces.

• Lee Roach:

  Just stay close to the front. It's easier.

• Woman:

  OK.

• Lee Roach:

  You start dragging behind, you're going to be back over here in this chair.

  (LAUGHTER)

• Stephanie Sy:

  Each patient here is recovering from a serious cardiac event, like a heart attack or heart surgery. And as they go through their circuit of exercises, each patient's heart rate and blood pressure are closely monitored.

• Lee Roach:

  Exercise, though, walking will actually make it go down, so — and then got to watch the sugars that you eat.

• Stephanie Sy:

  While they're here, Roach peppers in counseling around medication and wellness.

• Lee Roach:

  Small changes made very big differences in lifestyle is what I like to say. We can change it a little bit.

• Stephanie Sy:

  Sixty-six-year-old Leslie Rounds travels here from a small rural town almost an hour away. She recently had a stent put in her heart.

• Leslie Rounds, Cardiac Rehab Patient:

  It will help me a whole lot since, you know, I have been coming.

• Stephanie Sy:

  Seventy-five-year-old James Wellborn is recovering from open heart surgery in November.

• James Wellborn, Cardiac Rehab Patient:

  You can do this three days a week without feeling different.

• Lee Roach:

  Is that the one that helps you sleep?

  Education is a big part of it, and try and make sure that, while they're here, that we get everything that they need to know to decrease the likelihood of having to come back after another cardiac event. So it's very rewarding for me to see people actually change.

• Stephanie Sy:

  It's change that's desperately needed in the Mississippi Delta, a swathe of fertile farmland bound by two rivers northwest of Jackson. The region has among the highest poverty and heart disease rates in the country.

• Dr. Daniel Edney, Mississippi State Health Officer:

  The Mississippi Delta is the canary in the coal mine.

• Stephanie Sy:

  Dr. Daniel Edney is Mississippi's top health officer and a practicing physician for more than 30 years in the state.

• Dr. Daniel Edney:

  You have to understand, in Mississippi, poverty drives most everything. And with poverty comes obesity, because there are fewer choices for healthy food, and there are fewer opportunities for exercise and increased activity.

  Obesity drives diabetes, which drives — in coordination with hypertension, drives heart disease and stroke. Overlaying all of that is access to — access to care.

• Stephanie Sy:

  Access that Edney says is made more limited by the fact that Mississippi is one of 11 states that has not expanded Medicaid, a change that has been resisted by Republican leaders in the state.

• Dr. Daniel Edney:

  It's not my role to advocate one way or the other, but I point out where the resources are. And, in 2023, part of federal funding of health care is the Affordable Care Act. It just is. And we have a very big danger in Mississippi, especially in Mississippi Delta, of hospitals closing or downgrading services.

• Stephanie Sy:

  Greenwood Leflore Hospital has been open for more than a century, but it's now on borrowed time. Hospital officials say they only have enough money to stay solvent through June.

• Dr. Abasha Thakur, Greenwood Leflore Hospital:

  No chest pain, anything like that?

• Man:

  No chest pain.

• Stephanie Sy:

  Dr. Abasha Thakur is Greenwood Leflore's only cardiologist. The hospital has closed its maternity ward and intensive care unit and has 40 percent fewer employees than it had in 2021.

• Dr. Abasha Thakur:

  And you're eating good?

• Man:

  Yes.

• Dr. Abasha Thakur:

  Not bad stuff, right?

• Man:

  No. No.

  (LAUGHTER)

• Stephanie Sy:

  In his own unit, Dr. Thakur had a nurse practitioner laid off as well.

• Dr. Abasha Thakur:

  People can get sick and can die from this kind of disease, where we can help if we can catch it early.

• Stephanie Sy:

  It's preventable?

• Dr. Abasha Thakur:

  That's right.

  Hey, Hope. How are you?

• Hope Cooper, Patient:

  I'm doing fine.

• Stephanie Sy:

  Fifty-year-old Hope Cooper has an elevated heart rate and a leaky heart valve. She's been seeing Dr. Thakur for almost three years.

• Hope Cooper:

  I'm not feeling well today. So if I had to drive myself somewhere else besides, I don't think I could — would have been able to make that drive.

  So we need him here at Greenwood Leflore Hospital. It's not just, oh, I want to go here. No, we need him here.

• Stephanie Sy:

  The crisis in rural health care access comes as rates of heart disease are expected to surge across the country.

  A study released last August projected that heart disease and risk factors like diabetes, hypertension and obesity would rise steeply over the next 35 years, especially among Black and Hispanic Americans, even as they decrease for whites.

  How do you even begin to prepare for that, given that you're already so busy now?

• Dr. Abasha Thakur:

  You do your best. You fight the war, the army you have. So, that's what my principle is, so that you do your best. You keep doing it, even one life at a time, one patient at a time.

• Stephanie Sy:

  And those patients come from all over the region. About 25 miles south of Greenwood Leflore is the small town of Tchula. Surrounded by farmland its population of 1,652 is more than 97 percent Black.

• Quinnie Denton, Patient:

  Tchula kind of like the graveyard where they put out people that can't work anymore.

• Stephanie Sy:

  Quinnie and Aaron Denton have lived around Tchula their whole lives. Both were born to sharecroppers who worked on the same plantations where their great-grandparents were once enslaved.

• Aaron Denton, Patient:

  When I'm coming up, you went to the doctor, you was in bad shape. You were bleeding and hurting and everything else. It wasn't no checkups.

• Stephanie Sy:

  You didn't have any preventative care?

• Aaron Denton:

  No. Grandmama go to in their kitchen and do some brewing and kept you going.

• Stephanie Sy:

  Aaron was hospitalized at Greenwood Leflore for an irregular heartbeat in 2021. And Quinnie was diagnosed with congestive heart failure there in 2020.

• Quinnie Denton:

  That hospital is very important, because not many people can make it to Jackson, to be quite frank with you, not right here in this area, because they don't have the transportation.

  So, if they close the closest thing to us down, then it's going to be back to where as — like living on the plantation out there and can't get any health care.

• Julian Miller, Tougaloo College:

  Mississippi has a history of chattel slavery, of course. These health disparities also are a result of this — these racial and economic injustices of the system that was — that was forced upon us.

• Stephanie Sy:

  Julian Miller is a professor at Tougaloo College in Jackson, a historically Black college. He is also a fifth generation Deltan with a family history of heart disease.

  Miller is helping lead a $6 million National Institutes of Health-funded study examining how access to healthy food can improve health disparities.

• Julian Miller:

  We plan over this five-year study to recruit 300 patients, to actually provide them access to locally grown fresh produce and study their health outcomes.

  Additionally, this project has the benefit of also building a sustainable food system in the Delta with the investments it's making in building production the ground. So our health would drive our economic security.

• Stephanie Sy:

  Miller hopes this is the first step in making food as important as medicine.

• Julian Miller:

  We want to be able to have a system where Medicare and Medicaid dollars are used to purchase locally grown fresh food the same way it's used to purchase prescription drugs.

• Stephanie Sy:

  But the reality today for patients in the Delta is very different.

  At Greenwood Leflore Hospital, administrators are taking action to get more funding, but it's not clear it will save the hospital.

  What is the worst-case scenario if this place has to close? And have you thought about your plans?

• Dr. Abasha Thakur:

  One patient told me that we will collect money and open a clinic for you.

• Stephanie Sy:

  A patient told you they would open a clinic for you, Doctor, so they could keep you in this community?

• Dr. Abasha Thakur:

  Yes.

• Stephanie Sy:

  That's how much you mean to them.

• Dr. Abasha Thakur:

  Yes. And I don't think she has even $100 to spare. So she said they will go and the community will collect it.

• Stephanie Sy:

  Would you stay?

• Dr. Abasha Thakur:

  I will try.

• Stephanie Sy:

  Over at the cardiac rehab center, nurse Lee Roach also keeps trying.

• Lee Roach:

  It's disheartening. My parents still live here. If the hospital closed, I just — it would just not be good. People would die.

• Stephanie Sy:

  Yes.

• Lee Roach:

  People need care.

• Stephanie Sy:

  In fact, they need it more than ever.

  For the "PBS NewsHour," I'm Stephanie Sy in Greenwood, Mississippi.