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Where Health Care Won’t Go


It was a miserable January morning in Marion, Alabama, last year, with temperatures twenty degrees below average and freezing rain that sliced sideways. But that did not dissuade the people lining up outside the Perry County Health Department. The first appeared at the door when the sun had barely risen, then a couple more arrived, and soon they came by the hundreds. Some brought their children, others showed up with cousins; there were families four generations deep. By nine o’clock, the line had lassoed around the building, with its tail pitching into the parking lot. People held umbrellas in one hand and with the other gripped handkerchiefs or scarves tightly across their mouths. Many were from the same neighborhood, and most were black. All of them had come to collect twenty dollars in exchange for getting tested for tuberculosis.

Shane Lee, Marion’s town doctor for the past quarter-century, pulled his taupe pickup truck into the parking lot. His clinic was kitty-corner to the health department, and he was having trouble finding a spot. It was Lee who had discovered the community’s first severe case of TB, a little more than a year earlier. In October 2014, a nurse practitioner tore into his office with a fresh medical mask over her mouth, frantically waving an X-ray film. The mask, a tight-fitting turquoise respirator, was unusual. And then he looked at the radiography, which showed that the patient’s lungs were nearly completely whited out. It was the worst case of tuberculosis that he had ever seen.

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is a physician and an assistant professor of medicine at Columbia University. Her article “Hashtag Prescription” was published in the June 2016 issue of Harper’s Magazine.

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