The legacy of slavery continues to shape life circumstances for Black people in Madison Parish, Louisiana, and Jefferson County, Mississippi. On opposite sides of the Mississippi River, these Deep South communities boast a proud civil rights history. Expanding Medicaid would benefit Mississippi communities like Jefferson as studies show it has in rural Louisiana. These photos and vignettes tell the story of self reliance despite enduring structural racism.
Tourists stand around chains and shackles placed in concrete at a memorial that recognizes the enslaved people who were bought and sold at the Forks of the Road site in Natchez, Mississippi. Prior to the Civil War, the port city on the eastern banks of the Mississippi River hosted one of the country’s largest slave markets. The city sits on a bluff overlooking the Mississippi River and northern Louisiana parishes whose rolling flat land is peppered with old farms and plantations. Large, Greek revival style mansions saturate Natchez, located about 25 miles from Jefferson County. (April Simpson / The Center for Public Integrity) 
The red brick exterior of the stately Rodney Presbyterian Church, built in 1831, was scarred by a cannon during the region’s only Civil War battle. It’s at the end of a narrow road that moves between dirt, gravel and paved surfaces. The town of Rodney was once a merchant city that was a contender to become the capital of Mississippi before a sandbar disconnected it from the Mississippi River. Now, it’s a ghost town. About five families live there full time, while a small number of hunting camps fill up with regular visitors during fall and winter. The area is full of deer, hawks and wild turkey. (April Simpson / The Center for Public Integrity) 
Pastor Tracy “Rev” Collins stands on the Nolan Hill Low Water Bridge in Jefferson County. As owner of “Rev’s Country Tours,” Collins takes tourists to historic sites in Jefferson and neighboring counties, including a drive through the Nolan Hill Plantation. The property’s narrow, single lane roads first cleared by slaves were made just wide enough for wagons to pass. The 6,000-acre plantation once had a company store, school and church for sharecroppers. Collins, a former member of the county board of supervisors, says the landowner is a descendant of the original plantation owners. Both the American flag and the old Mississippi flag wave in front of his farmhouse. (Eric J. Shelton for the Center for Public Integrity) 
Agriculture continues to be an important component of the Madison Parish economy. Figures from the latest Agriculture Census show that farm operations and producers make on average per farm nearly three or four times as much as the state average. In 2019, the Parish received the 4th highest amount in farm subsidies among all parishes in Louisiana. All but 5% of Madison Parish farms are family operations. Of the 426 farm producers logged by the latest Agriculture Census, 12 are Black. (AP Photo/The News-Star, File) 
About 500 Black people make a circle turn in downtown Fayette, Mississippi, Dec. 24, 1965, during a “Black Christmas” march. The march was led by Mississippi NAACP field director Charles Evers who led a boycott of Fayette stores. Evers said it would be a “Black Christmas” in Fayette unless officials met his demands. Evers discovered Fayette when he traveled to Natchez to lead civil rights protests. He returned to lead demonstrations and register voters. (AP Photo/Jack Thornell) 
Newly inaugurated Fayette, Mississippi, Mayor Charles Evers introduces the town’s city council during festivities, July 8, 1969 in Natchez, Mississippi. From left are Howard Chambliss, Isiah Anderson, Evers, Will Turner, Ferdinand Allen and James Gales. Evers was the first African-American mayor of a mixed-race town in Mississippi since Reconstruction. His leadership served as a model for what Blacks could do in other majority-Black rural communities. (AP Photo) 
In this Feb. 19, 2014 photo, a student walks past The Chapel, one of the more iconic buildings at Alcorn State University whose campus straddles Jefferson and Claiborne counties. Founded in 1871 to educate the descendants of the formerly enslaved, it is the oldest, historically Black, public land grant institution in the country. Notable alumni include Medgar and Charles Evers. (AP Photo/Rogelio V. Solis) 
Although his given name is Marvin Muhammad, he is known as Son of Man. “That’s the name that Allah told me to speak as,” he said. “I am the Son of Man, the one that all the prophets told you was coming to judge the world.” Son of Man, 70, leads the New Nation of Islam from an unincorporated area of Jefferson County called Red Lick. The Bible teaches that Jerusalem was destroyed, but the New Nation of Islam is the fulfillment of the new Jerusalem, Son of Man said. The community maintains a tailor shop, automotive shop and other small businesses on and around Main Street in the county seat, Fayette. (Eric J. Shelton for the Center for Public Integrity) 
Thomas Mitchell, Madison Parish Hospital board member, stands next to the framework of the Madison Parish Hospital’s soon-to-be new facility in Tallulah, La., Saturday, Sept. 11, 2021. Unlike the hospital in Fayette, the Tallulah hospital sits at the intersection of five truck stops, two rail systems, two highways and an interstate. Increased traffic helps rural hospitals boost patient volumes, which in turn reduces costs. Mitchell is hopeful that the new hospital will be able to lease space to specialty clinics. But it’s tough to attract doctors to a small, rural community. “In some of the small towns, doctors get out of the medical field,” Mitchell said. “They can’t make big money. That’s a local challenge.” It’s among the issues Mitchell wants to address should he win his bid for Tallulah mayor next year. (Eric J. Shelton for the Center for Public Integrity)
Dr. Mark Guidry, CEO of Outpatient Medical Center in Tallulah, Louisiana
Since the pandemic began, fewer people are seeking primary care at Outpatient Medical Center in Tallulah, a half mile from the Madison Parish Hospital. Visits to the community health center declined again when COVID resurged during the late summer and early fall. The clinic sees about 8 patients a day, down from 27 just prior to the pandemic in February 2020.
The public’s concern about the pandemic has impacted access to care, said Dr. Mark Guidry, the center’s CEO. “With COVID here, it’s been hard to fully realize the impact of the Medicaid [expansion],” Guidry said.
The center started offering telephone visits during the pandemic, but in person visits are better for some patients, Guidry said.
Guidry wants the center to return to focusing on preventative measures like smoking cessation, cervical cancer screenings and diabetes prevention. “Right now, we’re reacting to emergencies and COVID, and so that has taken a lot of emphasis away from the value-added things that keep us healthy and reduce health care costs and that’s prevention,” Guidry said.
Anthony Edwards of Fayette, Mississippi
A common problem among rural hospitals in non-Medicaid expansion states is that uninsured patients can’t afford primary care and will put off seeing a doctor until they’re facing an emergency. Those patients might look like Janell Edwards’ husband, Anthony, a tall and big 53-year old man who almost got taken down by a hangnail.
A heavy machine operator, Anthony got his thumb infected over the summer while using cleaning chemicals. He poked a hole in it for relief. The pain got worse. A nurse at the local health center treated his thumb and discovered he had sky high blood pressure. Afterwards, Anthony scheduled a physical and lab work, which he says he wouldn’t have been able to do without having health insurance.
“I promise you, it saved my life,” Anthony said. Without it, he would be drinking vinegar or using other home remedies “like everybody else do and walking around a time bomb.”
Prior to signing up for an Obamacare subsidized plan, Anthony didn’t have insurance for 20-plus years. When uninsured people show up at the emergency room and can’t pay out of pocket, the hospital is not reimbursed at a rate that covers the cost of the visit.
Dr. Ronald Wyche of Tallulah, Louisiana
Black and white patients used segregated waiting rooms at his childhood doctor’s office in Madison Parish, recalled Dr. Ronald Wyche, 72. As a young adult, Wyche asked himself, “Is there equal care for people of color, for Black people in my community?”
The experience sparked Wyche’s passion for health care equity, but so did his father’s civil rights leadership. Zelma Wyche fought for Blacks in Madison Parish and across Louisiana to resist Jim Crow laws and gain the franchise. He went on to become Tallulah police chief and mayor.
Wyche left Tallulah to pursue his education, and went on to practice medicine in New Orleans where he focused on indigent patients. He returned to Tallulah after Hurricane Katrina in 2005, and went on to work at Outpatient Medical Center, a Federally Qualified Health Center that largely serves the poor and uninsured.
Tallulah had several doctors then, but not enough patients had Medicaid and too many lacked health insurance, Wyche said. The city had lost population. Tallulah’s main street had deteriorated. Local politics could become popularity contests, he said. The area lacked the Black solidarity that fortified his upbringing. Sixteen years later, Wyche finds his father’s legacy is fading. “There are not many people left who are old enough to know what he contributed.”