- [Announcer] Support for "Georgia Rising: A Story of Rural Health" is provided by the Georgia Rural Health Innovation Center at Mercer University School of Medicine.

Dedicated to improving healthcare opportunities and outcomes for Rural Georgia communities.

(machine beeping) (machine continues beep) - Whenever we were in kindergarten, they ask you, what do you wanna be when you grow up?

And I said, "I wanna be a doctor."

And I don't know why.

Nobody in my family was really in medicine.

I think it was just innate in me that I wanted to help people and be able to love on people and give back to the community.

- Yes.

(baby whines) - Aw.

(chuckles) (baby whining) - What was our birth time?

- 08:04.

(machine beeping) (baby whining) (birds chirping) - [Justin] Yeah, I wanna talk to you a little bit about delivery plans.

We could either let you go into labor on your own.

Other option would be to induce the labor.

The earliest I can induce you is 39 weeks.

Good thing about it is we know kinda when you're going to go in.

- I'm not a fan of the element of surprise.

I'd like to being induced.

- I gotcha.

- I liked checking in and just being there, so.

- Okay.

What other questions you got for me today?

- I don't have any.

- All right.

You wanna take a look at baby real quick?

- Okay.

- Straight towards your bag.

That's his ear.

I definitely remember the first baby I delivered.

I was a third-year medical student and I believe it was her sixth or seventh baby.

I remember looking at the lady and I'm like, "She knows way more about this than I do.

I mean, she's done this six or seven times.

I've never done this."

And she definitely knew what she was doing more than I did.

It was really special to be able to, you know, deliver babies, bring it into the world, and it's definitely something that I'll never forget.

I wanted something that I could get to know my patients really well.

I wanted continuity care, long-term care.

- Patient Have this baby without a husband- - My patients come to me even before they're having babies and getting on birth control, to having babies, to raising their kids, going through menopause.

And so I get to see them throughout their life.

You know, that's what medicine used to be like.

Most patients do pretty well with the epidural.

You know, it will wear off if you get it too early sometimes.

Most patients, I recommend getting it, you know, three, four centimeters before you get into real active labor.

- And is there anything I can be doing to avoid induction?

- You know, walking is really good.

Anything that's gonna stimulate the cervix.

Bouncing on a ball sometimes can.

- We got the wrong size yoga ball.

- You got the wrong size?

- Yeah, got it.

We thought we had it and it's like, it's that tiny.

(group laughing) - It never was a question for me if I was gonna go to a metropolitan area or rural area.

I really wanted somewhere where I could see my own patients, do my own deliveries.

I wanted somewhere where we could have a farm that was not too far from the hospital.

So whenever I was on call, I could be at home.

I knew I wanted to be somewhere and to watch my kids grow up in a rural area.

I can be on the pond fishing and get a call and be here within, you know, 10, 15 minutes to deliver a baby.

(dog barking) Right, shoot over.

I coach my son's basketball team and just, you know, I see the little kids on that running around that some of them I delivered.

I see their parents and that's just fun, you know.

Not only do I get to deliver them and be a part of someone's life and one of the most meaningful times in it, I also get to watch those kids grow up with how connected our community is.

And I get that and I get to see that, and it's rewarding.

(audience applauding) (buzzer buzzing) Coffee County is a rural area in South Georgia.

Growing up here was always a tight community.

Because it is a smaller town, you know, you know most of everybody in town.

Growing up, for me, there was a lot of work on the farm and that's kinda what I did growing up.

(plastic rustling and crackling) - All right, home.

- No.

- Let's go.

(feed crashes) (person chuckles) I think that we do have a lot of unique challenges in rural areas that people in urban areas don't always have.

My patients have to drive three hours to get to a maternal fetal medicine doctor.

And that's a real challenge.

You know, if that mom has two or three kids at home and she has to decide, do I go to the specialist and take time off work, spend, you know, $4 a gallon for gas to drive three hours or do I continue to work and put food on the table for my kids?

Most of 'em are gonna choose to work and put food on the table for their kids.

That's a real challenge that we face.

We have obstacles that we have to face that are different from metropolitan areas.

In a metropolitan area, you have a call team that's there 24 hours a day, 365 days a year.

If they call a stat C-section, they can have a patient from a room to the OR in a matter of minutes.

Here, we don't always have a team in-house.

And so if it's the middle of the night, I have to call anesthesia in from home.

I have to come in from home.

I have to have my scrub tech come in from home.

And so sometimes that takes time.

I have to realize that, hey, I might can't push this patient quite as far because it's gonna take me 20 minutes to get a team in, and so my C-section rate might be a little bit higher.

Not saying that the care is worse.

I would argue that the care is probably better because I'm really in tune with that.

But it's different.

(staff chattering) (vehicles whirring) - Georgia has 159 counties.

I think we're the second most counties of any state in the nation, second only to Texas, and of course their land mass is a lot bigger than ours.

And we are the largest geographical state east of the Mississippi River.

But our population tends to be focused in the Metro Atlanta area.

And so therefore it leaves a huge landmass with scattered population throughout the rest of our state.

And that's where the challenges are and that's what rural healthcare has to try to address those challenges.

You know, we always heard the old two-Georgia scenario: the Atlanta area and the ones that were outside that metropolitan area.

We are more disproportionate in terms of a centralized population in one part of one city of our state than almost any other state in the union that you can point to.

There are very different challenges facing the rural parts of our state.

But as we try to get industry to move to more rural parts of our state, there are two questions that an employer who's gonna invest millions of dollars in capital investment in a community.

Two main questions they won't ask.

One is, can my employees get good healthcare?

And secondly, are their children gonna be able to get a good education?

It affects the overall quality of life of our state.

It is all intertwined.

- The state of Georgia defines a rural community as 50,000 or less.

I want every Rural Georgian to have access to quality primary care in their community, but sometimes we build such obstacles to access to care.

We're the stroke center of the world.

We have one of the highest stroke rates in the country and yet most of the stroke centers, I think there are four in Metropolitan Atlanta and maybe there's six in the whole state.

And you think about a life lost, a person that has a stroke at 35 'cause they never had their blood pressure checked, primarily because of the absence of care.

We were 50 outta 50 in maternal mortality.

When you look at the cost of maternal mortality in our state, the lives lost, the children who don't get the right care, because there's no pediatrician or even family medicine doc that takes care of pediatrics.

Children are the future of our state and yet there are 65 counties with no pediatrician?

It takes good doctors and good nurse practitioners and good PAs and it takes development of alliances with urban environments to the things that aren't done in Rural Georgia.

(group applauding) And there are really good people out there who deserve that care, - Put it in a cast and see what happens.

- We soon found out that not every community did need a hospital.

That sometimes a simple clinic would suffice.

And I must commend Mercer Medical School for their outreach through establishing these clinics in areas that don't have the hospitals, because by doing that, they can triage individuals and they can refer them to places that do have the hospitals that are equipped to deal with 'em.

The support system to keep a hospital going is huge and if you do not have a large-enough population base in your hospital to spread those costs out, your bottom line is gonna be awful and you're not gonna be able to succeed.

So there are challenges that vary from parts of the state to the other, but that some were consistent all across the state.

(vehicle whirring) - Twiggs is the geographic center of the state.

There's actually a sign right before you get on the highway that actually says that.

So pretty big deal.

Georgia has 159 counties and our health status score was 159 out of 159 and had been that way for quite some time.

The nearest hospital is about 30 minutes from us, and so honestly, this is the only main medical facility here.

If there was a true emergency, it's actually an issue, and we don't have an ambulance service.

And so if I have an emergency in the office, I have to wait about 30 minutes for the ambulance to get here.

Care in the hospital really should be used just for the acute sense and what's happened a lot in our society, and part of that is access to care, is we've lost the whole idea of outpatient relationship with a provider.

And I really want more people to utilize that access and can trust that the quality of care that they're going to get in little Twiggs or Jeffersonville will be the same quality that they can get in Macon or another city.

And so it's making sure that that level of care matches.

You're not stepping down by going to a clinic that's in a small community.

I mean, you actually might be stepping up, to be honest with you, because of the access of services that we do have.

It is impossible for everyone to live in Atlanta.

So we're going to see a natural dilution of people moving to rural communities.

Your healthcare should not be determined by your zip code.

If the people in the small communities are doing well, then everybody's gonna be doing well.

Just because it doesn't impact you, doesn't mean it's not important.

Everyone should be able to have their wellness and their wellbeing where they feel most comfortable.

They shouldn't have to move to an urban community just to be able to have that.

(crickets chirping) (vehicles rumbling) (door thuds) (trunk clicks) (bag clattering) (trunk thuds) - I am Angela Ammons.

I'm the CEO of Clinch Memorial Hospital and we are in Clinch County, Georgia in Homerville.

Like any town, it has its positives and some negatives.

So I think it's the second largest county per land mass in the State of Georgia.

I didn't know a lot about Clinch County.

I just thought it was a small town you bypass to get to Valdosta.

It's entrenched in tradition, football, sports, church, high level of poverty, high level of illiteracy.

Several years ago, the hospital was in some trouble.

I think a lot of people thought it's okay, the hospital can close, because we've got Valdosta and we've got Waycross.

But really when you think about it, what's 40 minutes for someone delivering a child?

What's 40 minutes when someone has a stroke, a cardiac issue?

And they don't realize how important the right access at the right time is to them.

There's a higher level of death, a higher level of uncontrolled diabetes.

People not receiving the right education as to what their diagnosis means.

It's a trickle effect and I don't think people realize that.

I think immediate response is we don't need that.

There are high poverty rate here with a lot of people, senior citizens whose food stamp reimbursement is sometimes 18 to $28 a month.

And then they have a small check they get from social security and then you're gonna have to drive 45 minutes one way to see a doctor.

What's gonna happen?

It's gonna be a negative impact to healthcare.

I believe that healthcare is just not treatment.

Is it prevention?

And can we expect people to be compliant with their medications when they're hungry?

(machine beeping) Morning.

Okay, you got it, Eli.

Thank you.

- All right.

(machine beeping) (feet clacking) Hey, Trina.

I have had to learn to stick up for myself and I think all the things that happened to me as a younger person really helped me weather, I have the thick skin that I needed to be here.

My mother is Korean.

My father met her when he was in the military and stationed in Korea.

Unfortunately my parents divorced when we were very young and I ended up living with my paternal grandparents.

So I've always felt like I have been an outsider, whether it's in my own home, school, environments, churches, and so forth, because the Rural south, how many Asian people are in Rural South Georgia?

Moving out at 15, went on later to complete a GED, and then I went on to pursue a nursing degree.

And I always had servant mentality of how can I serve people and how can I make your life better if mine's not that great today?

And I can look back now that every opportunity or every challenge that presented itself really built on whether or not I could be CEO here.

(feet clacking) Hi, Les.

- Good morning.

- Good morning.

The floors look good.

Good.

- Good.

- I was at a previous hospital and I was a nurse manager and this person worked for me and she would ask me questions about some of the hospital's challenges, which was Clinch County.

She lived in Clinch.

And she would say, well, we're having this situation.

I'm like, "Well, have you thought about this?"

And I would just relay some questions or ideas and then she would in turn relay them to her husband who sat on the board.

So he asked that I'd be considered for the CEO position.

And I said, "I think you have me confused with someone else.

I'm not a CEO.

I'm very grateful for the phone call.

And I'm flattered."

And he said, "We know.

Just come in and interview."

And I said, "Okay," and I hung up the phone and I thought, "This can't be real."

And I was like, "You know, God, if it's meant to be, I'll get it and if not, it's fine."

And they called and said I got it.

When I first started here as CEO, there was a tremendous pushback.

And I knew there was a lot of discussions about the hospital possibly closing.

I knew enough by working in previous other hospitals that what I saw was not meeting standard.

I thought, "I am a superwoman.

I'm gonna save this hospital.

Everything is gonna be great."

And the second board meeting, I said, they've hired me to be the scapegoat for the closure of this hospital.

I'm gonna let the people down in this hospital.

And then I cried until I pulled into my driveway and I said, "This is the last tear you will shed and you're not gonna let this hospital close."

I was grasping at anything to save our hospital.

(person speaking indistinctly) - [Staff Member] Oh.

Yeah.

- [Staff Member] (indistinct) Can we get... - Vernon is a musician, but he also drive trucks.

He was driving an 18 wheeler from Florida to Savannah when everything took a change.

He made it home, but when he got home and I came in like maybe 15, 20 minutes after him, he was just laying there on the floor.

So I called 911.

They examined him.

They say no stroke, no heart attack, no diabetes or anything, but he started slowly stiffening.

- Pull my arm, good, push down.

- That's when they found a very small clot on the back of the head, the brain, and that's what it was that shut him down: the speech, the swallowing, and everything, and they put him on the ventilator and all this stuff, and that's everything started.

I never heard of Swing Bed until the social worker said, well, you know we have to release him.

I said, I'm not bringing him home flat and he's not going to the nursing home.

He was ready to go to the next level, and that's when I've been introduced to the Swing Bed and that encouraged me.

And Clinch Memorial will be that place that you can come to.

- Swing Bed is a step-down rehabilitation opportunity that Medicare pays for.

You get socialization, which is important.

You get good nutrition, they take care of wounds, they change bandages.

And so going on Swing Bed for a couple of weeks sometimes means the difference in going home or going to a nursing home.

The hospitals get a reasonable reimbursement for that.

And some of these rural hospitals do a superb job.

And when you advocate for your patients, people listen.

- Swing Bed is a service line that critical access hospitals can utilize.

They can swing for rehab and then they can stay as long as the insurance approves it or if they're meeting the treatment plan.

The first year that I was here, when I started looking at the Swing Bed program, our Swing Bed revenue was 730,000 for a whole year, a year.

And then within nine months of implementing the Vent/Trac program into our Swing Bed, it was almost $6 million of revenue.

It really was our saving grace.

- I think the most important thing I can say about rural hospitals is we need them.

Now do they do everything?

No.

Should they do everything?

No, but what they do, they do as well as anybody.

Hospitals bring diagnostic ability that the physician's office doesn't have.

They serve as a tremendous resource for the community, handling trauma that eventually will be transferred.

But making sure that you have a place to stabilize a patient is important.

There's so many benefits to rural hospitals.

Do we need one in every county?

No, but we need a relatively close area.

We need to be strategic and they need to be supported in some way because if you have a cardiac arrest, every minute matters and you have to go 40 or 50 miles to get to a facility, the outcomes are not good.

By bringing that quality of care to these rural communities, you improve education, you improve economic development, you also decrease chronic disease, and catastrophic disease.

By finding it early and perhaps curing or controlling that disease, you see fewer people in very poor health.

What we need is community-based care and I think we need to just return to the basic good care with advocacy and continuity.

And that happens in rural Georgia.

(people chattering) - One of the things that I think is really important is if people don't have regular access to care, it delays their access to preventive health services and then it also increases the chances of them having more negative outcomes.

How do we merely make sure that patients who have limitations that may be completely beyond their control, how do we make sure they have the same access?

The pandemic was a very pivotal point for our country.

One of the things that came out of that was we realized there were a lot of people that were getting sick at the time were people who were not in care, had no access to a physician.

And so we thought, let's use this opportunity to encourage people to get connected to a primary care physician.

And so we developed an initiative that we call Live Well Twiggs, which is an opportunity for us to really get a lot of our local community resources to start working together.

We actually connected with Mercer's Rural Innovation Center.

We looked at counties that had a similar population, no hospital within 30 minutes.

And we're like, "Well, what are they doing and how come their numbers look like that?"

And we started being very strategic about those initiatives.

And so we started thinking about doing more community-related activities relating to health and really started to really promote utilization of the care that we had because we're here.

But not a lot of people knew about the services.

They didn't know that there was an OB/GYN that was here that could provide women's health services, that I had birth control options that were available, that we have a nurse practitioner.

So that's really kinda how things started to move.

(uplifting music) - We're on the brink of a transformative change.

A change that will not (indistinct) on physical wellbeing, but also nurture our emotional and mental health.

This wellness center represents a beacon of hope and progress.

It symbolizes our commitment to the health and wellness of every individual within our community.

It reassure me that I'm a part of a community that work tirelessly together, that understands the importance of nurturing both the body and the mind.

Having a wellness center open on our campus is a game changer.

It eliminates barriers to access and ensures that no students or faculty members are left behind.

(machine rumbling) - We have added a school-based clinic, which is officially open and will be starting to accept students and staff and people from the community in the fall.

Being able to take your child to a doctor is something that is dependent on the parents or the family or the caregiver.

Having that facility on site, the child does not have to miss school, the parent does not have to miss work.

And if the mental health and behavioral health component is what is needed to help that child thrive, we can now offer that.

And those services overall will be available to the teachers, the staff, the students and their parents.

So it really will become an extension of what we're doing here in our clinic.

But when you invest in a school-based clinic, you're telling everybody your health really matters.

And because your health matters, your literacy and your education matters, which means we want you to succeed.

Now our health status score is up to 112 as of this year, which is phenomenal.

I mean, you think about changes happening and how long that really takes, but, really, the pandemic pivot that we did to invest in our collaboration is really a part of that.

The other part that's happening is we're spreading our story.

And so it's good to do something, but if you don't document it, if you don't share it, then people don't realize it.

And so my hope is that our Live Well Twiggs- - which I think is, the name is just beautiful- will inspire people to do their own Live Well and then fill in the blank.

You know, what county are you in?

Where are you?

What can you do differently?

And you start small.

I mean, if we can start that during a pandemic and then it really grow to that level, just think, that collaborative leadership is a game changer.

I mean, Twiggs is like not something you hardly hear of now because we just have so many amazing things that we're doing and it really is a testament to the collaborative effort, but also a community that really wants to thrive.

And so I think we have all the things that we need to make that continue to happen.

(birds chirping) - I teach the local CNA dual enrollment program at Clinch County High School.

I've always had this idea of how can we grow our own school program for EMTs or anything like that.

We get a lot of people who come in with a CNA certificate and do they really know the ins and outs of the hospital?

Do they really know what to expect?

- The CNA course is a certified nursing assistant and it's a dual enrollment program with Coastal Pines.

So the students are high school students.

They have 24 hours worth of clinicals that they'll come do here alongside my staff.

They learn basic certified nursing assistant tasks and then once they complete this course, they will have the degree to do it and they'll actually sit for their boards.

And when they're done, they're certified nursing assistants.

And we have offered a lot of job opportunities for those individuals.

And our ultimate goal is that they'll hopefully come back and be one of our own.

- I'm saving him from a fire.

(chuckles) (dummy clattering) I leave every day at 01:20-01:30 to go to class and set up for class.

We open up with lecture.

I think we've had to go through medical terminology, diet, nutrition, the foundations of healthcare, and now we're doing the actual CNA program.

Now personal care is something that's very personal, but it's very sensitive.

And I've told you before that CNAs usually spend more time with the patient than the nurses.

Think about how independent you are.

What if you lost that independence?

Your mom had to go back to bathing, brushing your hair, picking out the clothing that you wore.

What if it's a stranger?

What if it's somebody in one of the nursing team you didn't particularly care for?

And then bust in the door and like, "Hey, I'm gonna be your CNA today."

And you're like, "No, you're not."

This is a great time for you to talk about things, to build trust, and so forth.

So even though I know you've got 16 or 18 other patients, it's very important that you don't rush it.

They are very inquisitive, they're learning a lot, and it's also opened up some other programs here in the hospital.

So we revamped our Candy Striper program and then we opened up some more internships for the high school students to come in and work in different areas of the hospital.

So they're gonna be able to have a 360 view of all the services in the hospital.

Make sure you get that pit really good.

(students chuckling) You wanna dry it and make sure it doesn't stay moist.

And watch how you hold some, 'cause some people's skin is very frail, depending on their medications, and you don't wanna tear that skin.

- I love that we can assist them in making their dreams come true, and a lot of kids don't have an opportunity outside of high school to get a college education.

To have this program here in Clinch County is great because they're leaving high school with a college degree that they can apply and use anywhere.

And that's amazing to me.

Miss Angela is a great person.

She loves to see you secede in anything that you do and she gives you that push to go that extra mile and to just step outta your comfort zone.

- It's a lot (speaking indistinctly).

- Oh, wow.

- Throughout my time in training, I had a lot of really, really good mentors that made me believe in myself a lot of times, and I want to do that for students.

I take students from Augusta, I take students from Mercer.

Most of the students haven't ever been in rural areas.

Most of them are from metropolitan areas, and my goal with them are to bring them down to see what challenges we have in Rural Georgia and how good things in Rural Georgia are.

Contraception discussion period.

And also let 'em be hands-on.

If they operate with me, they are right there.

They can see, they can help.

And I think that's important.

The students I take from Mercer, a lot of them are from rural areas and they have a passion to go back to rural areas.

I really want them to see what the work-life balance is, to be able to see that you can raise a family, that you can have kids, that you can make an impact and also have a very rewarding career and make a difference in a community.

(tractor clattering) - Rural Georgia has always been home for me.

When I was getting my undergraduate degree at Georgia Southern, I had an opportunity of working at a local pharmacy.

From that point, whatever line of work I went in, I knew I wanted to come home.

I just didn't know exactly what it was until I got that taste of the patient interaction at the pharmacy.

(vehicle whirring) (horn honks) I had patients that drove to get their medicine through the drive-thru on their lawnmowers.

We had farmers that were working in the fields that would park their tractors and fill their medications.

I think it was a combination of things when I decided to pursue medical school.

During the COVID Pandemic, we had a 96-year-old woman.

She had called the pharmacy to ask if somebody could come and give her her COVID-19 vaccine at her home.

I went and come to find out it was the woman who read to my elementary school class from pre-K to fifth grade.

She just unloaded all these emotions of the struggles she's had with her health.

Although I could help her with her medications, I felt limited in my ability to help her with her other health problems.

So that was, I think, the real turning point for me.

I needed to provide more for my patients in this community that I grew up in.

They needed more from me.

- She is a sweetheart.

- After that experience, I came home, talked to my wife, and I just, I explained to her, I felt there was something else in me, and I've had that feeling for a while, but it didn't hit me until that day.

I was really good friends with Dr.

Justin Peterson.

I filled a lot of his prescriptions and he was telling me about Mercer's mission, how they're wanting to get more physicians back in rural areas.

Well, for me, I knew I wanted to come back home.

This has always been home for me.

That was a no-brainer.

The more I talked with him and his experience through Mercer Medical School, I knew that's where I wanted to go after looking at all the schools and their mission and their values and what they stand for.

- If you look across the country, 4.3% of students in an MD program grew up rural.

We challenged our admissions committee to look at finding qualified individuals in rural communities who were really interested in our mission.

Now are we naive enough to think all our students will be rural?

No, but when they leave Mercer, they'll understand rural and they're much more likely to help their colleague who's out there in Rural Georgia, taking care of people who really need them when they call.

- I have a quotation that's on my foyer table that says educating the mind without educating the heart is no education at all.

Your minds have been educated.

Hopefully you have had your heart educated as well.

But people talk about poverty.

You're gonna see poverty.

As you go forward with your medical education, and as you begin to serve the people of this state, I know your heart is gonna be educated in the process.

That is what will make you all great doctors.

Congratulations to you.

- Thank you.

- Thank you.

- Great to see- - I don't think the situation about rural healthcare being a problem is unique to Georgia.

We'd always assumed that the delivery system was gonna be a state and local issue, but more and more we've realized that it takes everybody contributed, and the federal government, of course, does.

While I was governor, we had a major accounting as to how that was working out, and we found out that we had been shortchanged by the federal government for in excess of $70 million.

That was a lump sum of money that had not been built into our budget, so therefore it had not been technically spent.

And in talking with the General Assembly, they agreed that we should try to use that money to effectively generate more doctors in Rural Georgia.

And the only two medical schools that had that as their primary purpose of creating primary physicians was Morehouse Medical School in Atlanta and Mercer University in Macon.

So we divided that money and it was roughly $35 million a piece, I think.

Gave that to those two institutions to try to stimulate and support their effort to create primary physicians.

Every year, Mercer Medical School selects a group of individual incoming members of the medical school class.

They really have most of their cost of their medical expenses paid through that scholarship and they promise to go back to rural areas in our state and serve, I think, at least four years as a physician in that area.

(group applauding) - The Nathan Deal Scholars are a group of young people who are generally rural who want to go to a rural community, young doctors who want to be there and who want to see their community healthy and grow.

Those young people get opportunities to really spend time in rural areas.

They're some of our best students.

They care deeply.

- Rural health is very important.

These are patients that don't have a voice, they don't have access, they don't have enough physicians.

It is important for people in urban areas to realize that there's a big change and shift in the patient care coming from a urban environment to a rural environment, because a lot of the policies that are happening up in Atlanta are trickling down into rural areas, and sometimes it's too late, and it's behind, and so we're constantly trying to catch up and we are also constantly trying to find additional resources for our patients.

And a lot of times that means them going out of town, and that's something that I hope I see to change in my lifetime is bringing more resources to people in rural areas.

Hurt when they're- Rural healthcare providers in general, they become a beacon of hope.

Dr.

Justin Peterson is the staple of what it means to be a rural physician.

He takes time with his patients and they all trust him.

They all listen.

Through my first year of medical school, I shadowed him and saw how his interaction with patients, his bedside manners, and what challenges he goes through- him and his patients- with having limited resources in such a rural area.

From the get-go, he got me in there with patients, I was helping give vaccines.

I got to help do ultrasounds, which he taught me a lot about, and helping deliver babies.

And it was really cool to be able to experience that in my first year of medical school.

- That's a heartbeat.

So hit that PW button.

(heart beating) Do you get threes?

- He's definitely on the bigger side, so I'm getting six pounds, 14 ounces.

- So at what point do we start training for D1?

- [Doctor] I mean, now?

(person chuckles) (button clicking) (machine wails) - [Doctor] That was a good picture there.

- [Reporter] More than 800,000 people are without power right now in the state.

The most of those outages are in our southeastern counties.

Early estimates say farm and timber damage will cost Georgia's economy more than $6 billion.

The storm didn't just topple trees, it uprooted generations of hard work and family legacies.

- Clinch County has been very fortunate- I don't know how many years back- of never being directly hit.

Being in that storm and hearing that wind, seeing this ceiling just bounce up and down when it hit, over 100 miles an hour winds, the awning here where some of the cars were parked was tearing apart.

So my facilities manager and I grabbed everyone's keys and we ran out into the storm right when it was hitting, and it started pulling them away and taking 'em to the front and just soon as we moved the last car out from the awning, it came crashed into the ground.

We thought we would get a couple hours sleep here and there, but all night we were just waiting to see if the windows were gonna crash in, battling water intrusion coming in from the front windows.

We were very glad to be here inside the building because we knew it was a safe place to be.

Tony and I left probably at 05:30 that morning just to go survey some of our outlying buildings and we couldn't even get down streets.

Massive trees in the road, electrical wires swinging back and forth.

Streets were unrecognizable.

Trees had broken down into people's homes and we thought, "How long will it ever take to recover?"

And then the next day, you just go into action.

We took our nurse practitioner, she practices over in Fargo.

We took hot soup sandwiches, some medical supplies, and just bags of supplies over there, and we went door-to-door.

People were out of insulin, they were out of their blood pressure medication.

We brought all those prescriptions back, had 'em filled at our pharmacy, and we delivered them that night to make sure that they had 'em.

I finally went home maybe two or three days later and I was taking a shower and, you know, it just hit me, a voice just said, "No one knows.

No one knows what's going on at Clinch and you need to tell everyone."

So I got on Facebook and I told them and I sent out a plea for everyone, "Friends, if you hadn't been hit, I need to let you know about Clinch and we need help.

And before 15 minutes passed, I started getting phone calls and we have been blessed with people making deliveries almost every single day down to our facility.

We reached out to several grocery stores and restaurants, "Listen, electricity's down, water's down.

We know you're probably gonna have to throw this stuff away.

Why don't you let us buy this and we'll feed the community with it?"

And most of them say "No, we're gonna donate it to you."

- We are bringing a pallet of water to the Senior Citizen Center there in Homerville.

Throughout this hurricane necessarily, we've been managing all of the shipments comin' in, helping out, deliver to the community there.

Everyone in the community's definitely been grateful for the meals that we've been providing.

It definitely means a lot.

It makes us feel like we're doing our part and what we're called to do as far as helping, not only ourselves, but the community also.

You know, my truck's been crushed by a tree and things like that, but that's very minor stuff.

Any of those things could be replaced, but everyone at the house has been very blessed to be alive as well.

(people chattering) (forklift rumbling) (indicator beeping) (group clamoring) - Okay, y'all, good.

(speaking indistinctly) - I know, but your house okay.

- A lot of people still ain't got hit by (indistinct).

- Yeah, you live next to do Doreen, don't you?

- Yeah, nothing happened to mine.

Thank the Lord.

- Yeah.

- We had no lights or water till my daughter from Jacksonville came and got us, and we stayed four days there.

- I like your hair.

- Oh, thank you.

- Thank you.

See you later.

Get you some water.

(crickets and birds chirping) - Whenever it came through here, we had Category 3 winds, 125 mile per hour.

We were not expecting quite that high of winds.

I got woken up about 3:00 AM when the door blew open in the house.

Winds were blowing really, really bad and you could hear trees starting to snap.

Whenever we got up, we were pretty much trapped, because we had so many trees down, couldn't get to town, couldn't get to the hospital.

And I was on call, so that provided some challenges.

I could see out to the highway, and it was basically solid trees all the way back as far as I could see.

We didn't have any power or water.

I was covered in pine tar and sweat and everything else.

I was able to get to the hospital, had cleaned off with some baby wipes, ended up doing some deliveries, and I just washed with a bottle of water.

- [Angela] It doesn't matter what issues may have presented yesterday.

When something like this happens, everyone forgets about it.

And it's immediately, what can I do to help?

How can we help each other?

We're used to not having enough and we're having to be resourceful and trying to find ways to be resilient.

There's no color, there's no Democrat or Republican.

There is not this side of the town and that side of town.

We're just people who want to help each other out.

And I think Rural Georgia really practices that way almost daily.

So it wasn't anything for us to step up and do what we needed to do.

- I don't think you ever realize how much the community will pull together until something like this happens.

And pretty much everybody that had something was out cutting, trying to get to people.

Whenever you've got a bunch of farmers, and I always say, good old boys that, you know, come out with their chainsaws and tractors and, like, they're the ones who did the work to clear the roads.

And it's just the knowledge set to live in a rural area that you have to have to be able to kinda do a little bit of everything, really pays off in a time like this.

Yesterday was four weeks since it happened and initially it was kinda the survival mode.

Somewhat life is kinda getting back to normal, so now it's just trying to figure out how to clean up.

To be honest, it's hard to come up with a new dream.

You know, I had a dream for the farm and all that changed overnight.

Trying to pick up the pieces and figure out how to move forward.

(birds chirping) (wind swooshing) (feet clacking) - We having a boy or a girl?

- Boy.

- Okay, that one's getting baby's heart rate and then this one is gonna pick up your uterine activity.

It'll show some (indistinct).

- He's getting real excited.

- [Staff Member] Yeah?

- My husband was really good friends with Todd.

(speakers drowning out one another) - Yes, so what happened with your husband, so they... We thought she'd be fully dilated at around 12 o'clock and we're like two hours early and she's responding really well and the coming and it's really exciting.

- Okay.

(feet clacking) - Ready to push?

I think we're ready, (indistinct) all right.

Let's see what (indistinct).

- Covers off, okay?

- Okay.

- [Staff Member] Here we go.

- Hard as you can, Jess, hard, hard, hard.

You ready?

- Deep breath and, come on.

- [Staff Member] Hard, a little bit harder.

A little bit harder.

Right there.

- Seven.

- Right there.

A little bit more, a little bit more.

- He's coming.

He's coming.

Keep going.

He's coming.

- Push, push, push.

That's it, that's it, that's it.

Push, push, push.

- He's coming.

He's coming.

He's coming.

You're doing it.

Keep going, you're doing it.

- Push, push, push, push, push, push.

Push, push, push.

- Here he comes.

Here he comes - We got him.

- We've got him.

We've got him.

He's so beautiful.

- Oh my god.

- Here he is.

(baby crying) - Hey, baby.

- People in larger cities of Georgia should care deeply about people in Rural Georgia.

They should care about it because it's the right thing.

They contribute to their wellbeing when they don't even realize it.

Public health is important in Rural Georgia.

I think patients realize care close to home is better care.

It's less disruptive to their family.

It's more personal, there's more of a a relationship, and there are things that rural hospitals do better than urban hospitals.

They're accountable to the community.

Many of the rural hospitals in Southeast and Southwest Georgia, some have closed, but some have grown and do an amazing service for their community.

People value their rural hospitals and communities are stepping up and helping support those hospitals, so they'll be there.

We're a great state and we're a wealthy state, and we have good leadership, but we have got to share the resources with Rural Georgia.

They are not asking for free care and they are not asking for a handout.

They're asking for a chance.

And all we have to do is give 'em that chance and stand by and help in any way possible, and you will see a transformation, and they can do it with a little outside help.

- I would like to tell you that you are a part of a great thing here in Clinch County.

Clinch Memorial Hospital is well known throughout the state and our team has worked hard for that, and we make a huge impact on the economy here.

And we're trying to do great things.

We can't do those things without you.

We are dedicated in making sure that we can serve Clinch County in the best way that we can.

- We cannot tell you how excited we are that you are supporting your hometown hospital.

Thank you for your donation, your gifts, and I think you know that all proceeds go directly to supplies, materials that our hospital needs.

I thank you so much.

(ambient music) - When I first got in office, Georgia was still in the grips of the Great Recession.

Healthcare overall had experienced the same kind of pressures that a recession brings on.

The rural healthcare system felt that pressure tremendously.

They saw more and more of their patient service base having to be indigent care, which means they're not getting paid anything for the care they're providing, which puts a huge financial strain.

And unfortunately in the rural parts of our state, that was exacerbated.

(vehicles whirring) - I remember having two or three days cash on hand in the bank.

It takes over a million, I think $1.6 million a month to pay our bills.

So divide that by 30, and I only had three days cash on hand, and you gotta meet payroll every two weeks.

You gotta pay your vendors, you gotta make an $80,000 note payment for your building.

And we really depended on every single dollar that came in every day.

And so we started utilizing the Georgia HEART Program and getting people more aware of that.

There was just so much work to be done and it's still being done.

- You can't have a prosperous state if you do not have adequate and affordable healthcare provided to your citizens.

That was where the HEART Act came in and provided the kind of assistance that some of these hospitals desperately needed.

The HEART bill is premised on the fact that some people would like to give to hospitals that are in trouble, in particular, and they may not be able to do so on the normal deductions for income tax purposes.

This way, they give the public the option of deciding and propping up the ones that are in the most need and having it distributed appropriately without having to build it in to an appropriations bill.

In other words, you eliminate one step.

Instead of having to pay your taxes into the state, then the state legislature adopt a budget that reallocates your money.

This is a allocation before it ever reaches the coffers of the state.

Now the hospitals themselves have a cap on what they can receive.

They can receive more than $4 million a year.

Otherwise you'd have a very disproportionate system and that wouldn't be what you want.

And now Governor Kemp has signed legislation that extends the program through 2029 and it has been proven to be a successful model and hopefully it'll be able to continue.

- I didn't know of the Georgia HEART Program until I became the CEO here.

So I get to say where my state tax dollars go and I can say that it can go right back to my employer and keep our hospital open.

By all means, let my state tax dollars go there.

And it can be a lifeline to save hospitals.

It really can.

There's enough for every hospital on that list to get a million dollars plus more.

We can put that money up for a rainy day, for the time when the volumes are low.

We can put that money up to recruit a new physician.

There are so many things that we could use that money for, and it really helps a lot of people just to make payroll.

But this isn't charity.

This is you paying your state tax dollar or liability to the rural hospital of your choice who are in trouble.

And it doesn't matter if you live in Clinch County, it doesn't matter if you live in Atlanta, or anywhere, you pay the state tax dollars to Georgia, you can reallocate that here.

I give every dollar that I can, and I'm really proud of our employees, because our largest donor base is our own employees, whether they're a CNA all the way up to a physician, we give back to our hospital.

This is a way that you can prevent a hospital closure.

It means that you are a part of preventing jobs from being lost, from small towns turning into ghost towns, from the access to medical care.

You say it's a long wait now, well, think about it when all the rural hospitals in the State of Georgia close and then everyone has to go to the urban hospitals.

So if you waited four hours before in the ER then, what do you think your wait time will be next time?

So you don't have to do this huge mission trip to be mission minded.

Rural healthcare is mission minded in itself.

So you can be a part of that by just being a part of the Georgia HEART Program.

- This is an opportunity for everyone to make a contribution to really level the playing field for how we pay for and access services.

We know that there are several hospitals that have closed in the past year because sustainability is an issue.

So this is an opportunity for us to really put our money where our mouth is.

And if we really do care about the places where a lot of us came from in terms of our rural communities, we should be excited about giving back, knowing that those dollars will be specifically allocated to addressing the services and needs of those communities.

We think about the economic development of our state.

A lot of our projects that are happening, a lot of the things that are drawing people to Georgia are going to require the support of our rural communities.

And so it makes perfect sense that we would mirror that momentum for how we build our economic development with how we're investing in our rural healthcare as well.

- Gosh, y'all, I could talk about it forever.

You know, I lay awake at night and worry about it, you know?

And I'm not the only person.

I'm, you know, every medical school in Georgia cares about it, I'm sure.

But I feel like Mercer is so committed and our students, like Justin, or our faculty, like Keisha, these guys are as committed as I am.

I think some of the outcomes are amazing.

It's about seeing the need and addressing the need.

And I think we're doing that.

I don't think you can have a better existence than being a small-town doctor, so I'm very biased.

♪ God ♪ ♪ How thou are ♪ - What a gift that you have given to Will and Jess.

Father, I pray for Baby Zach, that he would grow to know You, to love You, and that Jesus would be his joy and strength.

We thank you for all that You do.

And I pray this in Jesus' name, and all God's people say, amen.

- The providers that are here are not here to make a dollar.

They're here because they love the community.

They love the people, they love the lifestyle.

It's really unique to be a physician and a father sometimes.

My boys know that I have to be on call and they know that at any moment, I could get called away.

It's also really rewarding to be able to see what I do through their eyes.

They know that I have to go to the hospital and that I'll go in and deliver babies.

And I think for me, being a physician has shaped who I am.

I'm not taking care of a patient chart number.

You know, a face that I haven't ever seen, that I'm never gonna see again.

I'm taking care of my son's teacher or... You know, I'm taking care of the people that I know and that I love.

And it's impactful to me, to my patients, to my family.

("It's a Start" by Brent Cobb) ♪ Well it's springtime down around Slaughter Creek Dirt Road ♪ ♪ I bet the crawfish bite ♪ ♪ Any bait thrown in the hole ♪ ♪ Got my six string strung, this song on my heart ♪ ♪ It ain't about a thing but by God it's a start ♪ ♪ And it feels so good ♪ ♪ Being here with you ♪ ♪ Just burnin' firewood ♪ ♪ Tellin' jokes we learned from old folks ♪ ♪ Sippin' cokes with barbecue ♪ (nostalgic music) - [Announcer] Support for "Georgia Rising: A Story of Rural Health" is provided by the Georgia Rural Health Innovation Center at Mercer University School of Medicine.

Dedicated to improving healthcare opportunities and outcomes for Rural Georgia communities.