PIDInk: The evolution of a primary care clinic

So how did a nonprofit rural primary care clinic like ours in Franklin, W.Va., begin, and how did a pediatrician get there?

The idea for the clinic came from a small group of young people living on the side of a mountain in Pendleton County, W.Va., one day in the early 1970s. We were out to found a school, The Woodlands and Whitewater Institute, now an international non-governmental organization (NGO), The Mountain Institute (www.mountain.org). The clinic idea took root after a community needs assessment revealed access to health care as a top community concern, and it has grown into what today is a community health center: Pendleton Community Care (PCC; www.pccnfc.org).

PCC consists of a central clinic in the county seat and two satellite clinics in even more rural settings, with four physicians, one nurse practitioner, two physician’s assistants, three nurses and a staff of more than 50 people.

Our clinic is located in the town of Franklin, which has a population of about 720 (2011) and is in the county of Pendleton, population 7,600, in eastern West Virginia. The county’s area is 696 square miles, and the population density is equal to that of a frontier, at 11 people per square mile. Much of the county is in a US Forest Service National Forest.

Nineteen percent of the people here are aged younger than 18 years, and 22% are aged older than 65 years. Eighty percent have graduated from high school and 12% from college; we have 826 veterans. Seventeen percent of residents live below the poverty level, yet there are no homeless, and many folks live on the land their families have farmed for a hundred years or more. As my wife said in an article she wrote 20 years ago, “Going by the demographics, our clinic is like the bumblebee: it should not be able to fly — and yet, there it goes.” We’ve now been at it for 30 years, and if I do say so, pretty successfully — delivering high-quality health care for all, on a sliding fee scale.

To deliver that care, we face many challenges and impediments — geographic, socioeconomic, meteorological. We are in the Mountain State, and transportation difficulties affect access to care. We suffer from the same economic privation and joblessness as many others across the country, sometimes keeping proud families from seeking needed health care, acute and preventive. The weather is often a factor — we certainly have our share of deep snows, high winds and heavy rains with flooding.

Although there are many challenges, there are great assets and resources. Neighbors and community members help each other when there is distress or difficulties for an individual or for a family. There are robust community services to ensure that people are warmly clothed, have enough to eat, and have decent homes with a roof and heat. And because there is no coal here to be mined, the air and water are pristine, a true benefit of mountain life.

There has always been a good tradition of physicians in the community dating well back into the early 1800s. When we arrived on the scene, this was still the case — there were two fine physicians practicing in town — however, as we had foreseen, both of those physicians retired within the first 10 years of the clinic’s existence, leaving PCC as the sole provider of health care for this county and parts of several surrounding counties.

At any rate, the clinic opened its doors in 1982. It got started without me, as I was still in medical school, having resisted my family’s — well really, my mother’s — prodding for 10 years, while running Woodlands. What our family has in its closet is not skeletons, but physicians going back nearly 200 years — and I was bucking my genetic code. Just a bit more family history and then on with the saga of a clinic in the mountains of West Virginia.

The history of medicine and our family is a bit cloudy prior to 1850. I’m pretty clear, however, about my grandfather, who migrated at the age of 4 with his family across the Chesapeake Bay in a log canoe (canoes figure prominently in the story to come so stay tuned) from the Eastern Shore of Maryland. The family settled in Baltimore on Park Avenue, and my grandfather graduated in the class of 1898 from the University of Maryland Medical School. My father followed in his academic footsteps in obstetrics, then during World War II found himself in Calcutta and then Fiji. He returned to practice with his father and their practices overlapped, as my practice overlapped with the active practice of my father: Thus, there has been a physician with our shared name practicing medicine for 114 uninterrupted years. The very fact that I just put this in writing will make my 97-year-old mother extremely happy, so thanks so much for looking at it.