What the closing of a health clinic has meant for North Carolina’s Warren County

Warren County, North Carolina has experienced decades of hardship and despair. But Mary Somerville, executive director and co-founder of the Warren Community Health Clinic, says nothing was more heartbreaking than the day she had to close the clinic. “A man was beating on the door while we were closing, trying to get his medicine,” Somerville said. “It was just really sad.”

The Warren clinic opened in 2006, serving close to 4,700 patients. In less than two years, it began feeling the strain of the economic downturn that affected big and small communities alike. The Warren clinic started losing funding from donors soon after it opened, at a time when need was growing. The Warren clinic was one of the busiest in North Carolina.

The population of Warren County is about 20,000 residents. More than half of the population is African American and the county’s poverty rate is 27.3 percent — more than 10 points higher than the overall state rate. The teen pregnancy rate is one of the highest in the state, according to the latest “Roadmap of Need” report, published by the Public School Forum of North Carolina. The latest Census numbers show 77.8 percent of residents in this, poor, vulnerable county have a high school diploma and 15.4 percent have a bachelor’s degree or higher. Across the state, 85.8 percent of residents have a high school diploma and 28.4 percent have a bachelor’s degree or higher.

Still, an even more startling fact is that Warren County ranks near the bottom of the list when it comes to the number of doctors on duty. There are 100 counties in North Carolina — Warren County ranks 98th for its number of physicians. Retired Warren County doctor Cosmos George moved to Warren County in the early 1980s, when he was recruited to help with the doctor shortage. George says that if any community needs a health clinic, it is Warren County. “The state funding is no longer available — a large source of our volunteer physicians is no longer available,” said George.

That means there is a major void when it comes to providing health care for thousands of people in Warren and nearby Vance counties. Health professionals at the Warren clinic have said they mostly served people who were fighting diabetes, high blood pressure and asthma — illnesses that can be controlled with primary care and medication, but can be deadly without treatment.

My 2017 National Fellowship project will take a closer look at the “free clinic” model and how well it is serving the residents of Warren County. (There are nearly 70 free clinics across North Carolina and close to 40 community health centers, with several locations.) I will also look at the decision North Carolina made not to expand Medicaid and how it has affected the clinic. When that decision was made under the leadership of Republican Gov. Pat McCrory, the North Carolina Justice Center reported that without the expansion of Medicaid, a half million people would be left without health care in this state. My reports will also focus on the Warren clinic’s decision to switch from a “free” model to a “community health” model, and if that change was too little, too late.

One of the most valuable parts of this project will be its focus on the voices of people who relied on the former Warren Community Health Clinic as their main source for primary health care. This project has already begun seeking out these former patients to find out where they now get their health care and if they have health care at all. The North Carolina Community Health Center Association’s health centers serve “significantly more uninsured patients than health centers nationally,” according to a 2016 report. Forty-three percent of the patients served in North Carolina community health centers are uninsured, while nationally, the figure stands at 28 percent.

Since the closing of the Warren Community Health Clinic, North Carolina has elected a new governor, Roy Cooper, a Democrat who served as the state’s attorney general for more than 15 years. No formal decisions have been made about the Medicaid expansion, but rural health care across the state is a topic of concern for this administration. There are many health policy implications and it will be interesting to see what the future holds. The Warren clinic closed with little statewide outcry or media attention.

Warren County has been called the “birthplace” of the environmental justice movement. For generations, residents, mostly African American, had to fight extremely hard to secure a healthy home and environment for its family members. Some even risked their lives. In many ways, their lives are at risk again by not having access to basic health care. I hope my reports bring enough attention to this issue that legislators, health officials and community residents take action and, maybe, even reopen the clinic.