Rural Health | St. Louis Public Radio

Rural Health

At a pediatric clinic in Kirksville, Mo., a young boy is waiting in an exam room to be vaccinated. A nurse explains the shots to his mother, and Lisette Chibanvunya translates.

Karolyn Schrage, executive director of the Choices Medical Services clinic in Joplin, Mo., says that pregnant women, young men and teens are part of the rapidly growing number of syphilis patients she sees. 4/18/19
Bruce Stidham | KHN

When Karolyn Schrage first heard about the “dominoes gang” in the health clinic she runs in Joplin, Missouri, she assumed it had to do with pizza.

Turns out it was a group of men in their 60s and 70s who held a standing game night — which included sex with one another. They showed up at her clinic infected with syphilis.

That has become Schrage’s new normal. Pregnant women, young men and teens are all part of the rapidly growing number of syphilis patients coming to the Choices Medical Services clinic in the rural southwestern corner of the state. She can barely keep the antibiotic treatment for syphilis, penicillin G benzathine, stocked on her shelves.

Hydrocodone is a common opioid that is prescribed for pain relief
Jonathan Ahl | St. Louis Public Radio

A study of workplace injuries in 27 states, including Missouri and Illinois, shows 68% of injured workers in very rural areas received at least one opioid prescription, while 54% of their urban counterparts received the same amount of prescription.

The study was conducted by the Workers Compensation Research Institute, an independent group that does research for insurance companies, employers and labor unions.

One of the first signs drivers see on the way into Unionville, Missouri, is this billboard advertising cardiology at Putnam County Memorial Hospital, a hospital in northern Missouri.
Bram Sable-Smith | Side Effects Public Media

Rural hospitals are more likely to close in states such as Missouri that have not expanded Medicaid.

A recent report from the pro-Affordable Care Act organization Protect Our Care analyzed 84 rural hospital closures since 2010. It found 90 percent of those hospital closures were in states that had not expanded Medicaid coverage. Missouri remains one of the 14 states that hasn’t amended its program to cover people who earn up to 138 percent above the poverty line.

At the start of the year, Missouri was sitting on $80 million. The money was set aside in case the Children’s Health Insurance Program wasn’t refunded by the federal government. In late January, Missouri was caught by surprise when CHIP was refunded.


This story was originally published February 6. It has been updated as of February 9 at 1 pm.

The Atchison-Holt Ambulance District spans two counties and 1,100 square miles in the far northwest corner of Missouri. The EMTs who drive these ambulances cover nearly 10 times more land area than their counterparts in Omaha, the nearest major city. 

An illustration of pills.
Illustration by Rici Hoffarth | St. Louis Public Radio

White residents in Missouri are dying at a higher rate than they did nearly two decades ago, according to a report from the Missouri Foundation for Health.

The increased death rate largely is occurring in the state's rural counties, especially in the Ozarks and the Bootheel region and substance abuse appears to be a major factor. For example, deaths by drug overdose have increased by nearly 600 percent in many rural counties. Poor mental health also plays a significant role, as suicides among young and middle-aged adults have increased by 30 percent since 1995. 

When the hospital closed in rural Ellington, Missouri, a town of about 1,000, the community lost its only emergency room, too. 

That was 2016. That same year, a local farmer had a heart attack.


After 20 years of selling and using meth, 38-year-old Andy Moss turned his life around. He got off drugs and got a good job. Next step: he wanted to fix his teeth, which had disintegrated, leaving nerves exposed.


Access to mental health care a challenge for rural areas

Mar 26, 2015
Jonathan Bailey | NIH

Every day, LaDonna Haley talks to patients who can’t find a psychiatrist or counselor who takes new clients in the St. Louis area. She estimates that 10 percent of those callers live in a rural county.

This article first appeared in the St. Louis Beacon, Jan. 27, 2012 - At first, it sounds like a put-down when Dr. Angela Whitesell describes Lockwood, Mo., the place where she grew up. "It's a town in the middle of nowhere," she says, "and an hour away from everything." It soon becomes clear that her tone is reverential, another way of saying she was so "emotionally connected to the land" that she felt good about deciding to return home a few years ago to establish her medical practice.

This article first appeared in the St. Louis Beacon, Aug. 17, 2009 - Lesley O'Daniel, a nurse who works in rural Missouri, shook her head as she contemplated the nation's emotional debate over health-care reform.

"The scope of the problems is almost unimaginable,'' she said. "When we as health-care people in the field sit down to discuss it among ourselves -- how we think maybe this or that could be handled -- then the questions come: 'But what do you do about this? What do you do about that?' This is so complex, and people have so many different needs that it's going to be difficult to make one set of answers. I just don't know.''

This article first appeared in the St. Louis Beacon, Aug. 14, 2009 - Every Monday morning, primary health care arrives on a bus in Oran, a town of 1,264 in southeast Missouri that hasn't had a doctor for at least 15 years, or maybe 30, depending on who you ask.

From 9:30 a.m. to 3 p.m., the Southeast Health on Wheels (S.H.O.W.) Mobile sets up shop in front of City Hall with a nurse practitioner and registered nurse prepared to treat whoever walks through the door.