TAKE A DEEP BREATH Miriam Taylor

Take a Deep Breath

MIRIAM TAYLOR Asthma is more intense in the Delta than other places in Mississippi and Dr. Gailen Marshal is hot on the trail of a solution to this mystery.

Rural blacks in the Delta are coming down with asthma in disturbing numbers. Dr. Gailen Marshall wants to know why. r. Gailen Marshall, suspendered and graying, sits wearing his Texas A&M ring proudly, opposite his wedding band. He is a blur of movement as he reads patient descriptions, barks orders and conducts the day’s business. He’s already seen a blur of patients and is running through his last few before lunch. Marshall is a man in a hurry. He is, after all, fighting an epidemic. Asthma is running rampant through the rural Mississippi Delta, particularly among poor blacks. Worse, no one is sure exactly why. And for Marshall that’s not good enough. So he and a group of medical fellows from the University of Mississippi Medical Center in Jackson make the four-hour drive to Greenville twice a month. d

BY MIRIAM TAYLOR

According to the Mississippi State Department of Health, 10.2 percent of Mississippi children 17 and younger and 6.9 percent of Mississippi adults have asthma. About 7 percent of white children and nearly 14 percent of children of other races, primarily blacks, have the ailment. It’s much worse in the Delta, where asthma is the primary reason children miss school.

A study using data from the Mississippi Asthma Surveillance System compared asthma hospitalizations in the rural Delta area with Jackson metropolitan hospitals. Results showed that Delta residents had significantly higher odds of being hospitalized multiple times. There are problems with illiterate patients forgetting to take their medicine or not taking it properly.

“The intensity of asthma is higher in the rural area of Mississippi. ... People are fascinated to find out why,” says Marshall, leaning farther back into his chair, his face betraying fascination and curiosity. “Is it because of the low access to care up here; is it because of something exposure-related; is it because of the fact of the agriculture up here; or is it stress? What’s the social component; what’s the environmental component?”

Marshall is one of the last great pioneers, living out his life on the final frontier, medicine. Part preacher, part teacher, part savior, the man from Texas has a personality that could rival any ancient tent revival reverend and a heart as big as his home state. His demeanor is quick and his accent is long. He answers each query immediately with his slow Texan drawl.

“Ninety percent of what we see here is African-American in terms of race,” Marshall explains. “We’ve seen a couple of Caucasians and a few Hispanics but not many. And in terms of age, we see everything from little bitty kids only 18 months old to older people in their 50s and 60s.”

Marshall’s asthma clinic is inside the Good Samaritan Health Clinic at the old King’s Daughters Hospital. The white brick building, with its terracotta roof and wrought iron details, is reminiscent of an era that existed before the modern hospital, with all its crisp floors and straight lines and numbered charts.

The nurses constantly admit patients, run tests and deliver medication. The fellows, four in all — two each trip — continuously interview walk-ins, compile patient history and relay information to Marshall. Marshall, in turn, talks to each patient, explaining their condition, the causes, the concerns, and the care needed and offered for their asthma.

PHOTOS BY MIRIAM TAYLOR Shelia Howard (left) and Debra Howard (right) praised the clinic. Shelia said her attacks had her “thinking you was going to die.”

“Most of our patients are from Washington County, there are few from Sunflower and some from ...”

He pauses and sticks his head behind a divider, asking a nurse for the name of a particular county. “Humphreys, that’s right.” He smiles. “I’m completely geographically challenged in Mississippi.”

Marshall’s clinic, which is staffed in Greenville on the second and fourth Friday of each month, was created to fill a need.

“Someone said you need to come up to the Delta with me, so they put me in a car and drove me up Highway 61 and as I started to drive up into the Delta I began to realize just what incredible poverty there was here,” Marshall says. “I go on medical mission trips to Moldova, which is described as the last true member of the dissolved Soviet states, and the poverty here reminded me of the poverty there. The landscapes were so similar.”

Even after a year, Marshall is a little astonished to be here.

“I had a Ph.D. and was headed for the bench and went to medical school to make my grant support opportunity better,” Marshall says. Then, “I fell in love with clinical medicine and have been schizophrenic ever since. I juggle clinic and I juggle lab and I juggle teaching and I love doing it.”

As if on cue, one of the fellows, Sarah Bozeman, walks in and hands him a patient printout. He turns and discusses the numbers and details with her, ranging from medical history to home situation to day care attendance, agreeing on the best plan of action for the 22-month-old.

He grabs the chart and his stethoscope and hurries into the hallway, leaning forward toward the patient’s room as he goes to talk to the boy’s mother, steadily absorbing information before the corner of his white medical coat disappears behind a thick yellow door.

The two fellows on this trip sit at a makeshift desk, their faces glued to minuscule computers with detachable screens.

Bilal Q. Khan and Bozeman fall back into their chairs, reveling in the small pause in their rushed schedule.

“We’ll work over there (in Jackson), and we have a clinic in the medical mall; those are the two places we like to hang out,” Khan says casually, as if referencing which pubs or restaurants he likes to frequent on the weekends. “Oh, and we’ll go to the VA once a week.”

He turns and smiles, his round Pakistani accent growing thicker in his energetic response. “As a physician it’s a great time to be an allergist.”

Marshall finishes with his young patient

and returns to the room. It is small and rectangular with two tables and a few rolling chairs pushed together to simulate an office. Khan rattles off the facts about the next patient. They both recognize him as a return.

“We’re seeing quite a lot of follow-ups, so people aren’t just falling off. They do come back,” Khan says.

“For about every three new patients we’ll have seven returns,” agrees Marshall. “In most indigent care clinics the average no-show rate is about 50 to 70 percent and three-fourths don’t come back, and if they come back it’s because they’re really sick.”

Marshall considers those statistics and adds: “To be fair, the system we’ve been able to work in has made it affordable to them. They can see the doctor for five or 10 dollars, depending on their ability to pay.

“The Good Samaritan Health Care Center,” Marshall gestures at the building housing the clinic, “was started by the King’s Daughters, wives of prominent people from this part of the state, and is now run by a consortium of faithbased organizations. They’re very fiscally responsible.”

“This was a partnership made in heaven for us,” he laughs. “The mayor hasn’t given us the key to the city, but the sheriff hasn’t been here either, so I figure we’re doing pretty good if we’re somewhere in between the two.”

A pink-suited nurse walks into the office, and the doctor is momentarily distracted by the files she hands over. He scribbles a quick signature and sets the paper aside.

Marshall brags about UMMC’s “Telemedicine” initiative that will allow hospitals to examine patients at other hospitals and clinics over a video hookup. “We are working with the Delta Health Alliance, actively looking at developing a Teleasthma initiative here that I hope we can roll out at the end of the summer,” Marshall says as his voice raises a halfoctave, the excitement evident.

“At its total fruition, clinics all over the Delta — in Tunica, Clarksdale, Cleveland — would be connected. ... One, they would have an electronic stethoscope and we could train the assistant in Tunica to put it on your chest and I could put the things in my ears in Jackson and I could hear you breathe. And two, there would be a video monitor and I could actually see you.”

The doctor tumbles this information out, rapid and steady, patiently explaining the benefits this could provide and the greater numbers of patients the asthma clinic could reach.

“If we can get ‘em in the door, I’m confident I can keep them here.”

Aside from treating patients, Marshall’s time in Greenville grants him an opportunity for research.

According to the Mississippi State Department of Health, asthma is more prevalent among people who did not graduate from high school than among people who did (9.5 percent vs. 6.4 percent). It’s also more prevalent among people with household income of less than $25,000 (10.4 percent) than among people with household income between $25,000 and $50,000 (5.7 percent) or greater than $50,000 (4.5 percent).

Another thing that intrigues Marshall is the role poverty and the mind play in all of this.

“There’s still disparity in our country; there’s still racism in our country; and to be somehow viewed not as good as someone else because of the color of your skin, it’s something you can do nothing about. You’re caught in an endless cycle of poverty; your mama was poor; her mama was poor; you’re poor; and your children are gonna be poor. The discouragement and the depression and the anxiety that that can produce, those have biological effects and we know that now.” He finishes the sentence with a crescendo.

“Underserved minorities and their diseases is a trifecta for me. Not only is it morally satisfying, it’s scientifically fascinating. And it’s politically the right time.”

He is running it all through his mind for the thousandth time: Farm pesticides? Diet? Environment? Stress? Some combination?

The doctor adjusts his jacket and gathers his gear.

“Word of mouth,” he continues as he marches down the hall into the warm March afternoon. “It takes time to build a word-of-mouth reputation, and that’s what we’re harvesting in this second year compared to the first year. We went through a lot of effort with these folks. We’ve gone out into the community just like we’re going to do today. You know, I have no idea how many people are going to be there; there may be 50. There may be three. But it doesn’t matter. As long as there’s one, I’ll talk to him.”

His brown Jeep is parked near the hospital. It is compact and casual. Behind the wheel, Marshall moves just like he walks. A blur of brown steel heads down U.S. 1 toward a new building, the site for today’s community luncheon.

The building is like so many other government buildings — carpeted and bland. It smells of pizza and sodas, and growling stomachs can be heard as group of 13 forms a lunch line at the end of the room. The group consists of Marshall; the fellows; a few nurses; Jane Calhoun, director of clinical and field services at Delta Health Alliance; and patients and their friends.

The largely black audience silently chews pizza as Marshall details the debilitating symptoms of asthma: how you know you have it, how to treat it, how to use an inhaler and nebulizer. There is urgency in his voice as he compares the disease to a house fire. He illustrates — clearly and concisely — how to know if you’re in serious danger or if it’s just a rough cough. He hands out his card, listing his cell phone number, email address and clinic hours, and then, straight-faced and serious, he reminds his patients that they should feel free to contact him in case of an emergency.

MIRIAM TAYLOR Sarah Bozeman, left and Bilal Q. Kahn of the University of Mississippi Medical Center make the trip from Jackson to Greenville twice a month to see patients at the special allergy clinic.

The speech takes an hour, but not a pair of eyes strays from his face, the people as enraptured by his conversation as they would be of a fireand-brimstone preacher of old. A few amens are fervently tossed out during his description of the panic caused by a sudden inability to draw air into the lungs. “Not being able to breathe, thinking you was going to die, like that fish swimming without oxygen,” says Shelia Howard, 35, agreeing with Marshall’s description.

“I had an asthma attack one time and it was so bad I had to go to the hospital at 2 o’clock in the morning, and I had a panic and they had to give me a shot because I had an anxiety attack,” shudders Debra Howard, 36. She and her sister are patients of the clinic and attended the meeting at the suggestion of the Good Samaritan Health Center.

“I’m more educated and aware of how to control my asthma due to the fact of fliers and paperwork they’ve given me,” Shelia explains. “I think the fact that he was more realistic about it (helped) and he didn’t use big terms that you couldn’t understand. He broke it down and explained it to me … in a way I could understand.”

In the bare room, Shelia stands out. Her dark, smooth skin contrasts brightly against her turquoise blouse, and her voice is vibrant and sure.

“I’d be in trouble (without the clinic), because I work in this nursing home and they don’t have the coverage I need.” Shelia’s eyes follow the doctor as he cleans up the stray pizza boxes and napkins. “I think this clinic is awesome.”

Marshall watches the sisters file out into the bright parking lot. The heat from the asphalt creates waves above the hood of their white Tahoe. They smile at the doctor as they pull out onto the highway.

“My favorite story is when I get paid with a hug and a kiss. There ain’t nothing like it. There’s no money in the world that can buy the feeling that that can buy,” says Marshall, jerking his sunglasses over his eyes and pulling his keys from his pocket.

“When someone is pumping your hand and there’s tears coming down their faces, thanking you for helping their child, that’s what you go into medicine to do.”