When Stewart-Webster Hospital closed, Richland residents lost both a critical source of medical treatment as well as dozens of jobs associated with the facility. Some see health care at the top of priorities for revitalizing Stewart County’s economy, while others say high-speed internet is the top need. (Max Blau / For The Atlanta Journal-Constitution

Georgia’s rural woes a big problem awaiting next governor

In the 1,400-person town of Richland, on the eastern edge of the county, residents say the two things they need the most are health care and high-speed internet. In a county with some of Georgia’s worst health outcomes, including infant mortality and respiratory disease, they have watched the only hospital within a 30-minute drive of Richland close its doors. And in a county where the poverty rate is triple the national average, the vast majority of residents lack access to high-speed internet, a huge hurdle for kids to study at home or parents to apply for jobs.

“The next governor will have a lot on his or her shoulders,” said David Barrett, a former paramedic who owns a medical supply company, one of the few remaining businesses open on Broad Street, which runs through the heart of downtown Richland. “Whoever it is, they’ve got to be in contact with us as much as they are with the big cities.”

In the final months of the governor’s race, candidates Stacey Abrams and Brian Kemp have zigzagged across Georgia, proposing vastly different plans to revitalize rural economies. Twenty miles east of Richland, a once bustling railroad town, the Atlanta Democrat recently unveiled her rural health plan outside a new clinic in Plains, appearing alongside the town’s most famous resident, former President Jimmy Carter. And at a recent South Georgia fundraiser, the Republican Kemp mentioned Stewart as a place where his rural broadband initiative could help erase Georgia’s digital divide.

Drive around Richland, you’ll find yard signs for Republican and Democratic candidates alike, both on well-manicured lawns and in gas stations whose pumps have run dry. (Fifty-nine percent of Stewart voters supported Hillary Clinton in 2016.) In a county whose population is now under 6,000, where the best job prospects for locals is the immigration detention center, residents wonder whether either candidate can truly turn around their fortunes. Not only do they want to fill the medical gap left by the shuttered Stewart-Webster Hospital — along with the high-paying jobs associated with the 25-bed facility — they also hope to bring broadband to more households so children can study at home and parents can apply for jobs. Local officials and community leaders, along with experts trying to help revitalize Richland, are as divided about the best way forward as the plans touted by Abrams and Kemp.

“It’s a perplexing question,” said Mac Moye, a veteran tree farmer who serves as Stewart County’s manager, regarding whether to tackle Richland’s health care or high-speed internet needs first. “Where do you start?”

A case for health care

When Stewart-Webster Hospital shuttered in 2013, Richland didn’t just lose a precious medical institution that saved untold lives. The former director of nursing, Sybil Ammons, says Richland lost a part of its identity.

“My sister was born there, my mama worked there, my sons worked there,” Ammons said. “But it wasn’t just about the health care. We lost 70 jobs. New businesses don’t want to come here without health care. People who need to go to the doctor don’t because of the ambulance bill.”

Since 2010, more than half a dozen rural hospitals have shuttered in Georgia. Democrats say the closings of hospitals such as Stewart-Webster are directly tied to Republican opposition to Medicaid expansion, which policy experts predict would pump $3 billion annually into the economy and provide insurance to 473,000 more residents statewide. Abrams hopes to make Georgia the 34th state to expand Medicaid.

“The only way rural hospitals are going to survive is through medical expansion,” said Monty Veazey, a former South Georgia lawmaker who heads the Georgia Alliance of Community Hospitals, which represents 80 not-for-profit hospitals. “We’re leaving good money on the table.”

In nearby Plains, Abrams recently touted a rural health care plan that calls for more telemedicine to connect patients with providers, and more financial assistance and training for the newer health care workers who express a desire to serve in medically underserved communities. All that starts, she has said, with expanding Medicaid.

Richland Mayor Adolph McClendon, a former hospital board member, doesn’t see Medicaid expansion as a panacea to Richland’s health care woes. He once started talks to reopen the facility. But deteriorating conditions, including a busted pipe that led to the spread of black mold, dashed those dreams. He’s now working on a $7 million proposal to open a smaller 10-bed hospital with an operating room and dialysis center. His personal donations to Kemp — three separate contributions totaling $700 — reflect who he thinks will bolster Richland’s health care.

Instead of supporting Medicaid expansion, Kemp believes that Georgia needs to offer more tax credits to rural hospitals to bolster their finances. Kemp spokesman Ryan Mahoney said the candidate wants to increase the number of doctors in rural areas by expanding residency programs and loan forgiveness programs.

“Kemp is going to work with large and small communities,” McLendon said. “Rural communities aren’t going to be left out.”

But Martha Williams, a Stewart resident, believes Abrams’ plan to focus on health care first — including Medicaid expansion — is what southwest Georgia needs most. Williams said single parents can’t always afford health care for their children. And residents who lack reliable access to transportation must rely on the county’s two ambulances to reach a hospital in Columbus, she said.

“If we don’t get health care, we’re going to starve the children (of other opportunities),” Williams said. “If you have a comfortable home for them — with food, nourishment, love and God — then they can get broadband.”

A case for boradband

Across the street from Barrett’s medical supply shop, Erik and Karin Vonk have drawn more than 10,000 annual visitors to Richland Rum, shipping bottles from its distillery to 10 foreign countries including Japan and South Africa. That is, of course, when the internet cooperates enough to stay connected with their customers, the owners say.

“The number of times that we had communication outages in Richland is frequent,” Erik Vonk said. “It’s utterly primitive. An emerging business like ours suffers.”

The Vonks want Georgia’s next governor to prioritize high-speed internet over health care. They think broadband could entice more employers to move their businesses — and jobs — to southwest Georgia. And so does Rossi Ross, the chairman of Richland’s downtown development authority. “If you’re trying to bring business into a small area,” Ross said, “broadband makes you contend for some kinds of industry, including distribution centers.”

According to an analysis by the University of Georgia’s Carl Vinson Institute of Government, only 5 percent of residents in Stewart have access to fixed broadband that runs at 25 Mbps for download and 3 Mbps for upload — considered a fast-enough speed to allow household members to simultaneously surf the web without disrupting each other’s usage. Stewart’s dearth of high-speed internet, according to UGA’s analysis, makes it one of the least connected counties in Georgia.

In responses to UGA’s recent statewide broadband survey, several Stewart residents pleaded for better connectivity.

“Please make reliable, unlimited, wireless internet access available to all rural areas,” one resident said.

“Have it available in all areas!” another said.

Kemp says broadband would be his top priority for rural Georgia. On Sept. 16, Kemp made a nod to Stewart during an Albany fundraiser in which he pledged to create an “economic development strike team” that would partner with local communities to boost broadband. By investing in broadband, he has said, cities such as Richland can become attractive to new employers, which will in turn boost the economy and lead to more health care resources.

In interviews throughout her campaign, Abrams acknowledged the importance of bringing high-speed internet to rural Georgia, calling for the state’s Transportation Department to study the expansion of broadband along rights of way.

Other needs

Some southwest Georgia leaders believe the state’s next governor should focus on even more basic needs of rural communities. Moye believes Stewart’s biggest need is affordable housing. During an event called the Stewart County Community Summit, Linda Buchanan, the president of nearby Andrews College, told Richland residents that food security is a more pressing need for low-income residents of this part of the state.

“They’re trying to feed their children,” Buchanan said. “They’re trying to provide electricity. Let’s not talk about broadband. We cannot assume that parents can log into the parent portal (for schools). There’s not a laptop on the kitchen counter.”

And while Abrams and Kemp have different plans to revitalize rural Georgia, not everyone sees health care and high-speed internet as entirely separate. Karin Vonk, for instance, says that “when you have broadband in 2018, you have health care” in the form of telemedicine — echoing a point that Abrams made about Stewart at a 2017 gubernatorial panel.

“It isn’t an either/or situation,” Abrams spokeswoman Caitlin Highland said in an email. “Although Medicaid expansion is a top priority … Abrams knows that both must be addressed to support our rural communities.”

On the other hand, Williams says that having the resources to stay healthy gives residents the chance to take advantage of broadband for school or work. The choice of which issue to prioritize, come Nov. 6, will be as important as the choice of which candidate is best suited to revitalize Richland.

“I hope that, four years from now, we haven’t missed our opportunity to take advantage of every broadband health opportunity being offered,” said Republican state Rep. Gerald Greene, a longtime teacher who has represented this swath of the state since 1983. “If we miss this golden opportunity, it’s not going to come again.”

Support real journalism. Support local journalism. Subscribe to The Atlanta Journal-Constitution today. See offers.

Your subscription to the Atlanta Journal-Constitution funds in-depth reporting and investigations that keep you informed. Thank you for supporting real journalism.