From the outside looking in, the numbers looked pretty bleak for Tuskegee in the 2000 Census:• Median household income, $18,889
• Unemployment, 16.9 percent
• 35.7 percent of population below poverty line
• Nearest public hospital (not counting the VA Hospital) 17 miles awayBut Deanah Maxwell, a 26-year-old medical student, looks beyond those numbers and sees home sweet home … and a chance to make life better for those in her Macon County hometown, population 11,846.”I’ve always felt that you should do something that you love to do,” said Maxwell. “That’s how I feel about coming back here. I may not be able to earn as much as a family physician in Birmingham, but I also won’t be broke. I’ll have enough to put a roof over my head, to feed my family and myself. So, it balances out. And I’ll be doing something that I enjoy getting up and coming in to do every day. Besides, the only way to make a situation better is to come back and change the situation.”That’s why Maxwell recently spent eight weeks discovering the health issues facing Tuskegee residents and putting that knowledge to practice in the offices of Tuskegee Medical & Surgical Clinic. It was all part of her study in the Rural Medical Scholars Program (RMSP), a cooperative effort between the University of Alabama and the UA School of Medicine.Founded by Dr. John Wheat in 1996 at the UA College of Community Health Sciences, the RMSP is designed to groom young recruits such as Maxwell to return to their rural roots to help improve the health of Alabama’s rural communities. Up to 10 qualified students from rural areas are chosen each year as Rural Medical Scholars, a highly selective pre-med and medical school program based on high academic achievement, character and leadership qualities. The Alabama Farmers Federation and Alfa recognized the value of the program, and, in 2004, presented the program with a $1.8 million gift that is now accruing interest in an endowed scholarship fund for students. At the time of the presentation, Federation President Jerry A. Newby likened the program’s mission to the Federation’s own.”Almost 60 years ago, the Alabama Farmers Federation founded Alfa Insurance to help better serve rural communities,” said Newby. “By helping educate rural physicians, our company is continuing its legacy of service to farmers and rural Alabamians.”To be eligible for the program, applicants must have lived in a rural Alabama county for at least eight of their formative years and taken or registered to take the Medical School Admission Test (MCAT). If selected, the candidate is enrolled at the University of Alabama in the year prior to entry into medical school and takes a course each semester related to rural health or the practice of primary care in rural areas. He or she also participates in special seminars, community service projects and field trips intended to enrich their knowledge of what a career in rural medicine entails.Wheat says previous incentive programs and efforts that sought to plant urban-reared physicians into the unfamiliar surroundings and culture of rural areas have always failed. The reason, he says, is simple: They don’t understand rural values.”Rural kids grow up with rural values, and they value rural things … they identify with the community as ‘my people,'” said Wheat. “They have grown up where they are living way out there on the farm and if the pump breaks down, you don’t call a plumber to come in from the city to fix it — you go out there and fix it. Or, if your car is on the fritz, you have to work on it. If the house needs painting, you paint it. A rural resident has to be a jack-of-all-trades. In city living, you have a specialist in all things. But rural physicians have to be jacks-of-all-trades in order to survive out there.”We do see some urban folks make it in rural practice, but you can’t count on it as a trend,” he said. “Medicine has done that for years, and we have found that it just won’t work — less than 3 percent of medical school graduates will go into a rural practice. That’s about 40 percent of your population out there so you have to do something special to get rural doctors, and if you do something special, it works.”But the RMSP is about more than just creating doctors; it’s about creating leaders eager to become a part of the community and help address its problems.”They really want you to be a part of the community, not just have your clinic there,” said Maxwell. “They want you to raise your family there, go to church there, to be really integrated into the community. The thought is that if you pull students from the community to become doctors, they’ll have more of a sense of commitment or desire to go back to the community they know as opposed to taking someone who grew up in Birmingham or Mobile and trying to put them in Tuskegee or Selma or some other small town.”As part of her study, Maxwell spent time talking with governmental officials, educators and others in an effort to identify the health needs of the community, whose only public hospital closed in 1986. But, perhaps, her most valuable lessons came while talking with patients under the watchful eye of her preceptor, Dr. Robert Story.”A lot of the population here are on Medicare and Medicaid, and you have to have physicians willing to accept those programs,” said Maxwell. “When I was in Tuscaloosa, I was surprised at the number of places that don’t accept Medicaid. You could not practice in Tuskegee and not accept Medicare and Medicaid.”What’s more, she’s learned that sometimes it’s not always the lack of private insurance that prevents patients from seeing the doctor — sometimes, it’s distance. “We have patients who come through here who have to pay somebody to bring them from out in the county to get them here,” said Maxwell. “If they have trouble getting to the doctor from out in the county, getting to a hospital in Auburn, Montgomery or Tallassee would really seem far away.”Maxwell is picking up plenty of pointers from Story, himself a hometown product who returned to the family farm after medical school 35 years ago to build his home and practice.”One of my friends who had been in Tuskegee had moved his practice to Montgomery and tried to get me to come down and join him,” said Story. “He said, ‘Most of your patients will follow you.’ Well, I thought, the ones who could afford to would, but a lot of them could not. One of my other friends said, ‘Bob, you’re just a medical missionary.’ I thought about that and to some extent, I feel that’s what I am. I know I could make more money in Montgomery, but this is where I’m supposed to be.”For more information on the RMSP, contact Susan Guin at (205) 348-6196 or Irene Wallace at (205) 348-5892.