Seeking Healthcare, Finding Community: An Ethnography of a Charitable Clinic in a Rural Appalachian Community

Appalachia has a long-standing association as a place of health inequalities, including the lack of access to quality healthcare for many individuals. Despite various programs to address these inequalities and the implementation of the Affordable Care Act to introduce health insurance to all, health inequalities remain in the region. Additionally, the lack of Medicaid expansion in the majority of Appalachian states has left many individuals with the inability to afford premiums or to meet deductibles, if they can afford to obtain insurance at all (Bristol Regional Medical Center, 2016). For individuals who are uninsured or underinsured, community based free and charitable clinics serve as healthcare safety nets by allowing people to obtain limited healthcare. The idea of cash-free medical treatment is not new to Appalachia for meeting individual healthcare needs and is dated as far back as 1918 in the area (Asheville Citizen, 1918). This ethnographic investigation of a rural charitable clinic in Tennessee provides insight into understanding why certain individuals fall into the “gaps” of our healthcare system by being uninsured or underinsured and how these discrepancies are addressed by such clinics. In conclusion, this study explores the role a charitable clinic plays in a rural Tennessee community as a healthcare safety-net provider. This study also provides important insight into the understanding of rural free clinics since the implementation of the Affordable Care Act and in the present politically uncertain state of our healthcare system.