Tracy "Rev" Collins poses for his portrait at Nolan Hill Low Water Bridge near Lorman, Miss., Saturday, Sept. 11, 2021. (Eric J. Shelton for the Center for Public Integrity)
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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.


Dr. Mark Guidry, CEO of Outpatient Medical Center in Tallulah, Louisiana

Dr. Mark Guidry, CEO of Outpatient Medical Center in Tallulah, Louisiana. (Courtesy of Dr. Mark Guidry)

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

Anthony Edwards (Courtesy of Anthony Edwards)

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

Dr. Ronald Wyche (Screenshot)

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.”


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April Simpson joined the Center for Public Integrity in October 2020 as a senior reporter covering racial...