LaFAYETTE, Ala. 鈥 Charity Hodge had mixed feelings when she spotted a Facebook post announcing that her longtime primary care doctor was ready to retire after decades of serving their rural community.
鈥淚 was like, 鈥極h my gosh, no!鈥欌 Hodge recalled while sitting in an exam room on a July afternoon, waiting to see the physician, Terry Vester. 鈥淲ell, I’m happy for the retirement part, but that’s my favorite doctor, so I鈥檓 crying on the inside.鈥
Hodge, a 29-year-old customer service representative, has been seeing Vester for nine years. She had come to check in on her diabetes management and to ask for anti-nausea medication in preparation for a cruise.
LaFayette 鈥 pronounced 鈥渓uh-FAY-it鈥 by most residents 鈥 and surrounding Chambers County face of disease and chronic illness. Yet Terry Vester and her husband, Al, are the only primary care doctors in the town of 2,700 residents, surrounded by farms and other small communities.
The Vesters are in their late 60s and would like to retire soon. Terry Vester wants to spend more time with her grandson and aging parents. But she can鈥檛 imagine abandoning her patients, some of whom she has cared for since they were born.
鈥淭here are people here that still need in-town doctors,鈥 said Vester, who sometimes visits patients in their homes. 鈥淪o we want to stay here to take care of them until someone else is here to take care of them.鈥
Terry Vester鈥檚 worry 鈥 leaving her town with no doctors 鈥 is already reality across much of rural America, where but to turn to.
LaFayette, in east-central Alabama near the border with Georgia, is a 30-minute drive to the nearest sizable city, the college town of Auburn. Its lush, wooded neighborhoods include elegant, restored homes with wraparound porches and massive lawns. But the town also has formerly grand houses that have fallen into disrepair, plus mobile homes and public housing.
The town鈥檚 is much lower than the state鈥檚 and country鈥檚. Black residents 鈥 who make up 70% of the population 鈥 are than white residents. They are also more likely to attend the public high school, whose student body is and which is with a majority-white school in another community.
The Vesters have worked in LaFayette since the early 1980s and saw the local hospital close in 1988. The nearest emergency room is now in another town 20 minutes away along a rolling road. So are the nearest urgent care clinic and pediatrician鈥檚 office.
To fill that void, residents turn to the one place in LaFayette where medical professionals are always on the clock: the city fire department, staffed with full-time firefighters and emergency medics.
Fire Chief Jim Doody worked for 13 years as the fire chief at Bagram Airfield in Afghanistan. He arrived in LaFayette in 2020, just as the county was about to be hit by covid-19 outbreaks in Alabama.
Doody said most of the station鈥檚 ambulance runs are for nonemergency situations. Other calls involve urgent issues that could have been headed off if patients had better access to preventive care.
People from LaFayette regularly walk or drive themselves to the fire station to ask for help, Doody said. The station has a makeshift exam area within its small entryway, containing a bench, defibrillator machine, and cabinet filled with medical supplies.
Firefighter Tanner Hill said people often arrive with concerns about fatigue, blood sugar levels, breathing difficulties, or heart trouble. He recalled helping a man who walked into the station after getting hit by a car.
鈥淗e was just like, 鈥楬ey, I just got run over.鈥 And I was like, 鈥極h, OK, well, let me check you out.鈥 And sure enough, he got run over,鈥 Hill said.
Hill determined the man鈥檚 leg was broken and sent him by ambulance to the nearest hospital.
This de facto walk-in clinic option isn鈥檛 available in most other rural areas, where emergency medical services are often run by volunteers who aren鈥檛 posted at a station all day, Doody said. But he鈥檚 noticed fewer LaFayette residents relying on the fire department since a new telehealth service arrived in town.
Rickey Whitlow was recently driving in LaFayette when he saw a sign touting the new option.
The 61-year-old was intrigued. He parked his car and walked into a new health center that also houses an OnMed Care Station, a large booth stocked with a video screen and high-tech health monitoring equipment.
Whitlow was scheduled for his monthly diabetes checkup with physician Al Vester in a few weeks. But his feet felt like they were burning, and he needed relief now.
Whitlow stepped into the telehealth kiosk, pressed a button, and saw a nurse practitioner appear on a large vertical video screen positioned at eye level. After consulting with the provider, he left the free appointment with a prescription for a cream to relieve his foot pain.
OnMed patients use an automated blood pressure cuff and other devices to collect their vital signs, and the data is sent to the provider treating them from a distance. Patients can also hold a stethoscope to their chest to transmit the sounds of their heart and lungs. A special camera captures internal temperatures, which can be used to diagnose infections. A hand-held camera lets providers examine problems such as rashes, irritated eyes, and swollen throats. In some states, the stations can dispense medications.
OnMed, a Florida-based company, has another kiosk in rural Texas and hopes to open several dozen more in various states next year. The company wants to keep its services free for patients, with funding from universities, health systems, nonprofits, and insurance companies.
The kiosks can stay open on evenings and weekends and are much cheaper to operate than brick-and-mortar doctor鈥檚 offices, said CEO Tom Vanderheyden. They also make telehealth available to rural residents whose home internet connections are too weak for video appointments.
LaFayette鈥檚 OnMed kiosk is part of a new health center inside a building that has seen several medical facilities come and go.
The is operated by Auburn University, whose students and faculty travel there to host vaccination and diagnostic clinics, such as speech and hearing exams. They also offer health education events on topics such as healthy eating and maternal health.
The university plans to bring similar centers and OnMed kiosks to other rural Alabama towns.
Vester, the longtime primary care physician, is excited about the new health care resources in LaFayette. But she said it鈥檚 still important to have doctors in town.
鈥淵ou know everyone, or you have a connection with someone,鈥 Vester said.
Vester鈥檚 statement rang true during recent appointments as she asked about her patients鈥 lives and relatives.
鈥淒eep breath,鈥 Vester instructed as she placed a stethoscope on Hodge鈥檚 chest.鈥 鈥淎re you still at home with your mother? Is she doing good?鈥
鈥淵es, she鈥檚 doing very well,鈥 Hodge said.
Earlier that day, Vester treated a patient who had throat pain and difficultly speaking after surviving a choking incident. During the appointment, the patient mentioned an upcoming funeral.
Vester knew about the funeral. It was for a woman she once treated.
鈥淚 see her daughters and then their children, and they have children 鈥 so that鈥檚 four generations right there,鈥 Vester said. 鈥淎nd so, you sort of know the whole story, you know the context.鈥
Vester plans to reach out to Alabama medical schools to let them know she鈥檚 looking for doctors to take over for her and her husband. But she said not everyone wants to live in rural areas like LaFayette.
The doctor hopes some of the Auburn students will want to serve in LaFayette after seeing what it鈥檚 like working at the new health center. She said it鈥檚 nice to live in a small, quiet town that鈥檚 relatively close to larger cities, and to run an independent clinic rather than work for a larger health system.
Vester said the charm of LaFayette and its residents is also a selling point.
鈥淎ll they have to do is pretty much come here and spend a day and go through what we do, and I think they would enjoy it,鈥 she said.
