Family nurse practitioner Tamieka Alston-Gibson

Serving the underserved

UofSC graduates help fill the gaps in rural health care



After Dr. James Gragg graduated from medical school at the University of South Carolina in 1993 and completed his residency in 1996, he practiced for two years with the National Health Service Corp at a rural health clinic in Eastover, South Carolina.

It was work that confirmed the primary care physician’s “passion for rural health care.”

He then moved to Woodruff, South Carolina, in late 1998 and has been practicing family medicine there for more than 23 years. He takes care of patients of all ages — from infants to elderly.

“It is 30 minutes-plus from our office to the nearest hospital, so we often need to handle acute problems until EMS can arrive and the patient can be transported to the hospital for emergency care,” Gragg says. “Growing up, I was only exposed to family practice doctors who handled everything in their office, so those were my expectations going into primary care. I felt as though I chose the perfect medical school for me because there was always such a strong emphasis on primary care and serving underserved areas.”

As the country marks Rural Health Day this week, the University of South Carolina works — through its School of Medicine, College of Nursing, Arnold School of Public Health and other areas — to understand and improve the delivery of health care in rural and underserved communities. For example, the medical school was recognized by U.S. News and World Report this year as the top medical program in the country for graduates who are practicing in areas where there is a shortage of health care professionals.

Access to health care in rural and underserved communities has long been an issue in South Carolina, even before the COVID-19 pandemic disrupted life around the country. Residents in those communities tend to have lower incomes, higher poverty rates and fewer people covered by insurance.

“So they're already kind of behind the eight ball,” says Kevin Bennett, a professor of family and preventive medicine at the UofSC School of Medicine and director of the South Carolina Center for Rural and Primary Healthcare. “There are places where you're still 30 minutes from a primary care provider. We have some maps on our website about travel time for primary care, obstetrics care, hospital care, those kinds of things. And it's obstetrics care that is the most alarming. About a third of the state is more than 30 to 40 minutes away from an obstetrician. And that's not what you want. You want women to be able to go see a doctor quickly and easily.”

It was very important for me to come back to my home county or the surrounding county and just give back.

Rocio Mundo, UofSC alumna, school nurse in Bamberg District 2

And the pandemic exacerbated the problem in many ways. In a rural medical practice with a smaller workforce, the move to virtual classrooms, the lack of open child care centers and the spike in quarantine numbers was responsible for forcing employees to stay home. That wreaked havoc on clinics and health care centers, many of which already had staffing shortages.

Rocio Mundo, who grew up in Allendale County, never doubted she would be a nurse in a rural part of South Carolina. She had been working as a licensed practical nurse for 11 years before returning to school at USC Salkehatchie to earn her Bachelor of Science in Nursing through the school’s Rural Nursing Initiative. Mundo, 38, graduated from the nursing program in May 2020, right at the height of the pandemic.

Now a registered nurse, she accepted a job as the lead school nurse for Bamberg District 2, covering the elementary, middle and high school.

“Growing up in a rural area, there's always been a shortage of nurses. There's always been a shortage of almost everything. The local grocery store is 25 to 30 miles way. We’re out in the middle of nowhere. So it was very important for me to come back to my home county or the surrounding county and just give back.”

She said her first year working as an RN in the school, from August 2020 until 2021 wasn’t too hectic, because students had the option of in-person or virtual school, and roughly half of 750 students in the small district chose the virtual option.

“It wasn't bad because we didn't have a full population. If we had a positive (COVID) case in the school, it was very limited in the amount of kids that actually had to be quarantined,” she says. “However, when school started back in August of this year, it was very bad. We had to close down for two weeks. We were quarantining. I think our total was up to 200 cases.”

And the cases were more serious.

“In 2020, our kids who got COVID, it was just a mild case, with cold or flu-like symptoms. Well, this year, it was bad. Nine times out of 10, the kids who got COVID at our school, they were really, really sick. We had a handful of kids who were actually hospitalized,” she says.

“It was horrible because we're such a small school district, we pretty much know all the kids and you bond with the kids. When your kids start getting sick, it breaks your heart.”

She says resources are limited in the rural area and there is not a hospital in Bamberg County, meaning there have been times when she has had to call EMS for a student and it takes about 30 minutes for an ambulance to arrive.

“I know that these kids need me. It kind of melts your heart to know how much the kids need you, to know that we’re all family.”

About a third of the state is more than 30 to 40 minutes away from an obstetrician. And that's not what you want. You want women to be able to go see a doctor quickly and easily.

Kevin Bennett,  professor of family and preventive medicine at the UofSC School of Medicine and director of the South Carolina Center for Rural and Primary Healthcare

That commitment to help those most in need is what draws many to work in rural health care.

“I think there's a strong sense of altruism there that they want to try to make an impact. Especially those who are primary care, obstetrics, pediatrics, those kinds of folks. They want to go where there's a need and where they can make a huge difference just by being there. I think that's a draw for a lot of folks. Rural places tend to have complex problem, and patients are more complex, with more than one chronic condition that’s not under control. Just trying to make an impact is a huge thing,” Bennett says.

“And I think, too, there's a lot to be said for the sense of community in a little place that you don't necessarily get in an urban place. You're seeing your patients at the grocery store and knowing that you helped intervene and make that difference. It's a lot more of an inclusive type of experience in a lot of ways.”

After more than two decades in rural health, Dr. Gragg understands both the benefits and challenges of the work.

“There are many rewards in rural health care. I have seen patients as infants who now have children of their own,” he says. “It is rewarding to see all generations of a family from great-grandparents to grandparents to parents to children. It is rewarding to see patients out in the community in a different light outside of the office.”

But rural health brings challenges as well.

“It is much more difficult to do imaging and diagnostic studies on patients, often due to transportation issues. Patients are often hesitant to travel to the nearest hospital or nearest specialist for additional testing or consultation. Many elderly patients do not have reliable transportation to go for these additional studies or consultations,” Gragg says. “We do have access to a very good transportation system through the hospital system, but it often requires at least one week to schedule and arrange.”

 I felt as though I chose the perfect medical school for me because there was always such a strong emphasis on primary care and serving underserved areas.

Dr. James Gragg, UofSC School of Medicine alumnus and family medicine physician

Gragg said those challenges were magnified during the COVID pandemic.

“Initially, we tried to limit visits to essential care to avoid exposing high risk patients to infection. After the development of the vaccine, we were able to expand care somewhat. We also attempted to do some virtual visits but in a rural community the access to technology is somewhat limited. Only about 50 percent of our patients can access their medical records through MyChart, whereas this number would probably exceed 75 percent in a nonrural practice,” he says “However, I must say that the South Carolina Office of Rural Health has made significant strides in closing this gap for patients all across the state.”

Along with doctors, nurses and health care staff, South Carolina desperately needs more nurse practitioners, especially in rural and underserved areas. The College of Nursing is using a grant from federal Health Resources and Services Administration to train more family nurse practitioners for underserved communities.

Tamieka Alston-Gibson grew up in the small town of Estill in Hampton County and earned her bachelor’s and graduate degrees in nursing from UofSC. She now has her own Family Nurse Practitioner practice, Visions Medical Health Care, near Spartanburg.

“We definitely cater to the underserved and take care of uninsured patients,” she says. “My goal is to provide equality in health care because I truly believe that health care is a human right. I try to make my community my priority and help everyone who’s willing to take my help. You have to have a heart for it.”


Banner image: Tamieka Alston-Gibson earned her bachelor’s and graduate degrees in nursing from UofSC. She now treats patients at her Family Nurse Practitioner office, Visions Medical Health Care, near Spartanburg.


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