In Perry County, one of the rural Alabama counties that does not have its own hospital, healthcare challenges can take a toll.

The ratio of citizens to primary care physicians is 3,190 to one, over double the ratio for the state. Perry County also ranks 66 out of 67 for rural Alabama counties in health behaviors, having higher percentages than the state statistics for things like adult obesity, smoking, and physical inactivity.

It makes it even easier to neglect prescribed medicine and medical advice in an environment withthese challenges.

However, in Marion, Alabama, young people like Jennifer Lynn Gamble, a Project Horseshoe Farm Fellow, spend time checking in on their health partners. Making sure her assigned partner is taking proper medications is just one of Gamble’s tasks.

On a typical summer day, Gamble pulls up to the home of her partner to provide transportation to the doctor’s appointment for the day. On the way to the appointment, Gamble finds herself in conversation as her partner talks about her children and hobbies.

As they drive by the Food Valu grocery store, conversation turns in the direction of creating a healthy diet for diabetics by, for example, substituting sugary snacks or drinks for other food items.

With a lack of resources such as healthcare access, a county hospital, transportation, and lack of healthcare specialties in rural areas, Gamble is just one “outsider” who is motivated to come to Perry County to promote health and wellness.

Gamble is one of the 2019 Project Horseshoe Farm Fellows. She and other Fellows have discovered this summer that Marion is a perfect place for aspiring healthcare providers to cultivate relationships and make a difference.

Project Horseshoe Farm is a non-profit organization that serves as a post-graduate program for top recent college graduates.

Most of the Fellows plan on continuing education at various health graduate programs such as medical school or physician’s assistant school. The program originated in Greensboro, Alabama, and expanded to Marion in the summer of 2018.

The Marion site’s first year was run by two of the second-year Fellows, Timothy Huang, from Great Neck, New York, and Brooke Hess, from Mocksville, North Carolina.

Hess explained, “A health partner is like a really helpful friend, like someone who would take you to the doctor, the drugstore, go on a walk with you, coordinate your care with the doctor, and things like that.”

Huang added, “Our mission is to build on the strengths of our community, to improve the quality of life and health of vulnerable neighbors and community members, and to build citizen-service leaders of tomorrow.”

The Fellows have held true to their mission in Marion by becoming a key part of many health or education-based programs in town. The Fellows work with a wide array of already established organizations within the town such as the local clinic, Vaughan Regional Medical Center, Perry County Nursing Home, Southland Nursing Home, Marion Nutrition Center, Sowing Seeds of Hope, Francis Marion School, Mainstreet Marion, and more.

The Fellows have worked hard to create a name for themselves in Marion and are only growing. This year, the program doubled with four new Fellows working in the community.  In addition to Gamble, from Augusta, Georgia, the three 2019 Fellows in Perry County are Mary Zhou, from Irvine, California, and Zavier Carmichael and Reed Miller, both from Mobile, Alabama.

The Fellows offer a unique approach to creating more available forms of healthcare while working to highlight the assets of the community.

California native Zhou explained her decision to participate saying, “The Project Horseshoe Farm Fellowship program struck me as a once-in-a-lifetime, life-changing experience when I stumbled upon it in my school’s pre-health newsletter. The promise of deep engagement and partnership with community members, as well as the opportunity to live in a new environment sounded too great to pass up. I feel humbled and grateful for how warm and welcoming everyone in Marion has been.”

While expanding from Greensboro to Marion in Alabama’s Black Belt seemed like a logical next step for Project Horseshoe Farms, it was mostly motivated by the community itself. Hess explained that existing organizations in town reached out wanting what the Fellows had to offer.

“It couldn’t have been done without the community support,” she said.

And the need for the Fellows was clear. Alabama is the sixth poorest state in the nation, while Perry County specifically has 37.2 percent in poverty, according to Alabama Possible’s 2019 data.

Marion already has existing programs in place working toward the betterment of a town that suffers from the consequences of this high poverty rate. The Fellows commonly work with existing programs like the Marion Nutrition Center, enhancing services already in place.

For instance, the Marion Nutrition Center offers as a free service Monday through Friday to any citizen who is 60 years or older. The site serves around 68 well-balanced meals a day. The meals can either be picked up at the site or home delivery is an option.

The site also serves as a great social area for many residents to catch up and play games like Dominoes. Many of the Fellows, like Carmichael, a second-year participant, like to join the games.

Project Horseshoe Farm Fellows have started a free weekly health clinic at the Nutrition Center at 210 Lincoln St. They measure blood pressure, blood sugar, heart rate and weight. They also take the opportunity to discuss health goals of each individual and help them track health vitals on a weekly basis. This creates opportunities to encourage healthier lifestyle choices.

Hess emphasized the Fellows’ focus for this expansion. She said, “The goal was to figure out what the community wanted and said they needed and to tailor what we could provide, what our services were to the community and to build off of the strengths of Marion.” 

Another group in Marion that works to find resources and solutions in health is Sowing Seeds of Hope (SSOH). This organization started soon after the closing of the hospital in town. Their executive director, Frances Ford, also serves on the board as the Perry County Health Care Coordinator.

SSOH is a successful faith-based, nonprofit organization that focuses on improvements in healthcare, education, housing, economic and community development. Volunteers from as far as Connecticut and Missouri come to work in Marion with this organization.

“Our whole goal is to meet the needs of the people. So, if someone comes in, we try to meet that need,” Ford said.

The Project Horseshoe Farm Fellows assist Ford with whatever tasks are needed, including administrative and organizational tasks. SSOH runs a free blood pressure clinic in partnership with Samford University, has established a dialysis center in town and offers prescription assistance among many other projects.

Ford sees many of the hardships in Marion up close every day, especially when it comes to availability and affordability of healthcare services.

She said, “We have those who are working and may be making $11 an hour, but some travel 60 miles a day for work, some traveling 100 miles a day. So, when they look through all of the costs that are associated, they are not making a lot of money. We try to identify the resources that we can use to help them because they are struggling to make ends meet.”

Ford has worked for decades to create programs and services that help. But, it’s not easy.

She explained that work in Marion, a town of 3,300 residents, is challenging. She said it is difficult for many to look beyond the day. Ford said real change in terms of health care and other needs is hard for anyone to grasp.

However, a welcoming spirit has inspired much needed work in Marion. “Our people are our greatest asset,” Ford said.

Adjusting throughout her years of service, Ford has determined the recipe for success. She often works with younger individuals at SSOH as interns or volunteers as well as the Project Horseshoe Farm Fellows. Her experience, as well as the new programs aimed at improving health care in this rural area, make a perfect combination.

Ford said, “We have to work with our young people. We have to help them to have the wisdom that we’ve acquired throughout the years. But at the same time, we need them to help us come up with creative ideas and different ways that we can do things.”

By focusing on working alongside established organizations in Marion and also starting their own initiatives, the Fellows are following Ford’s recipe exactly.

An important part of any community work is to establish trust and credibility, and the Fellows seemed to be developing that by being active even after hours at all of the local restaurants, gym, events, and the town’s walking trail.

Walking down the street on their way to Lottie’s Restaurant, the Fellows find people waving and wanting to stop for conversation. “It felt like home really, really quickly,” Huang said. The intimacy of the community is what makes the Fellows’ Health Partners Program so important and can easily be a highlight of their week.

They also appreciate Marion’s role in history, particularly during the Civil Rights movement. The Lincoln Normal School, one of the first educational institutions created for African Americans after the Civil War, now houses the Marion Nutrition Center.

Fellow Miller said, “Marion was built on a foundation that has become both uniquely historic and extensively meaningful. Its successes have created a vivid legacy that each resident holds dear and true. During my time in Marion, I genuinely hope to support the current efforts that are being channeled through the many strengths of the community to build the same amount of excitement for the future as there is pride for the past.”

Ford, with SSOH, agreed the focus should be on the future. She said, “I think that Perry County is a wonderful place to live, and there are so many opportunities. So, we need to seize the moment, grasp those opportunities to move forward. The time is now for us to do that.” 

Written by Kira Wence

Kira Wence is a University of Alabama Honors College rising senior who served as a Jean O’Connor-Snyder summer 2019 intern in Marion, Alabama. She is originally from Manassas Park, Virginia, and is studying biology and psychology. She hopes to work in the health care field in the future.