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Keshee Dozier-Smith abrupt through the basement aperture of the crumbling Uniontown Municipal Building. She abandoned the lectern at the advanced of the allowance breadth she was appointed to accord a talk, branch instead for the folding tables at the aback breadth her advisers were ambience out the food.

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She abutting them, rolling up her leopard-print sleeves afore aperture containers of bloom and craven fingers.

Uniontown burghal workers trickled in, all of them men, all dressed for amore and alfresco work. It was a arctic December afternoon.

Tall alike in her flat, belted boots, Dozier-Smith has the no-nonsense, seen-it-all address of a aerial academy principal. She’s a affiliated mother of four.

And at 34, she’s the CEO of Rural Bloom Medical Program, a accumulation of South Alabama association bloom clinics that serve some of the state’s atomic and best rural counties.

After the army at the Uniontown Municipal Architecture anchored their plates of aliment and alternate to their folding chairs, Dozier-Smith strode to the lectern. She faced her babyish audience.

“How abounding of you go to the doctor anniversary year to get your anniversary exam?” she asked. Nobody aloft a hand.

Rural Health’s advantage breadth is a five-county swath of the Alabama Atramentous Belt – Perry, Marengo, Dallas, Wilcox and Monroe counties. A arena already Alabama’s agronomical and bread-and-butter engine, it’s the cradle of the Civil Rights movement and the birthplace of Harper Lee.

Today it’s affluent in ancestry but poor in bread-and-butter opportunities. Added than a division of the citizenry in best of the Atramentous Belt lives in poverty. The boilerplate domiciliary assets is far beneath the accompaniment average.

It’s additionally federally appointed as medically underserved, which agency it has too few primary affliction doctors, aerial babyish mortality, aerial poverty.

But in the four years aback Dozier-Smith took over at Rural Health, the aggregation has opened three new clinics – in Monroeville, Demopolis and Thomaston – for a absolute of eight clinics beyond bristles counties. She’s about to barrage a adaptable assemblage to biking to babyish communities and accommodate primary care.

Her ancestors has alleged the Atramentous Belt home for generations. In rural, underserved places, it can booty locals like Dozier-Smith with abysmal association ties to accept and ample in the gaps in healthcare, gaps that accept commonly larboard rural Alabama with poor outcomes for women and bound medical options for all residents.

“In rural communities, if bodies don’t apperceive you, they don’t assurance you and will not abutment you,” she said. “You appetite to be arrive in; you don’t appetite to appear in and set up boutique and apprehend bodies to appear to you.”

* * *

A few blocks from the Uniontown Municipal Building, accomplished the Piggly Wiggly and the mostly shuttered storefronts of Water Street, a babyish brick architecture sits beside a accessible apartment development.

It’s the Uniontown Bloom Center, a dispensary managed by Rural Bloom that offers dentistry and primary care. Aback Dozier-Smith was a kid, it’s breadth she went to the doctor. He’s still there, in fact.

Dozier-Smith grew up actuality in the 1990s, in a ancestors of educators, “where you could not breach subject-verb agreement,” she brand to say. Her ancestors could be begin at the Aboriginal Colored Missionary Baptist Abbey about any time the doors were open. Her grandfathering operated a babyish abundance in boondocks and generally delivered vegetables he grew on his acreage to the elderly. He already endemic about 2,000 acreage in Uniontown. He’s the one who donated the acreage breadth the accessible apartment circuitous and dispensary now sit.

As a child, Dozier-Smith watched her mother and grandmother disturbing to accomplish ends accommodated as teachers, while aggravating to be, in her words, “beacons of achievement in the community.” The boilerplate domiciliary assets in Uniontown today is about $18,000 a year, beneath than bisected the accompaniment average.

Uniontown, Ala. – Keshee Dozier-Smith, 34, stands in a doctor’s appointment at Uniontown Bloom Center, breadth she accustomed medical affliction as a child. As the Arch Executive Administrator of Rural Bloom Medical Program, Dozier-Smith now oversees the operation of the clinic. (Photo by Bob Miller)

Dozier-Smith knew she capital article different, alike as a kid. She capital to go into business.

Vera Davis aboriginal met Dozier-Smith at the abbey aback she was 6 or 7.

“She’s consistently been a actual absolute individual,” said Davis, a nursing assistant at adjacent Judson College. “She’s acute and intellectual. Actual energetic. I could see the abeyant in her, alike then.”

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Davis lives in Uniontown and has served on the lath at Rural Bloom for several years.

“I’ve apparent such a desperate change (in Rural Health), as far as alignment and transparency,” she said. “It’s a actual underserved area, not aloof Uniontown, but all the Atramentous Belt counties, and she’s been active in bridging the gaps in healthcare disparities.”

***

A Uniontown agent said a quick adoration to absolve the aliment afore Dozier-Smith began her talk. She alien herself, awkward off a account of kin who lived in the area. A few in the admirers nodded; they knew some of those people.

“I bethink actuality a little girl, activity to the rural bloom dispensary in Uniontown,” she said. “In the 90s, Uniontown was an amazing abode to be. It was safe.”

She paused. “Coming aback home, it’s a little added disappointing. I see ancestors here, but the assets accept not broadcast to booty affliction of the community, and that’s a botheration to me.”

She told them about Rural Health, which could accommodate them primary and bactericide medical care, behindhand of their allowance status. It additionally offers amusing casework like busline to and from accessories and abetment with award housing. It’s not aloof primary care, either; Rural Bloom offers dentistry, podiatry, optometry, and telehealth casework for brainy and behavioral health.

In rural areas like the Atramentous Belt, changeable and ancestors planning casework for women are burst beyond providers like canton bloom departments, ancestors doctors and emergency rooms. Under Dozier-Smith, Rural Bloom has stepped in to alike that affliction and affix women with the casework and specialists they need.

Because of an acceding Dozier-Smith set up with the burghal of Uniontown, the employees’ copays get waived if they are insured, and if they aren’t insured they can get sliding-scale copays for as little as $15. About 40 percent of Rural Health’s patients are indigent.

As she looked out at the babyish group, it was adamantine to get a apprehend on some of the beforehand workers in the audience. A few of the adolescent men asked questions.

Uniontown, like abounding Atramentous Belt communities, is majority black. There’s a longstanding apprehension of the medical enactment amid some in the atramentous community, decidedly in this allotment of the state. Uniontown isn’t far from Tuskegee, the armpit of the belled syphilis abstraction performed on atramentous men in the mid-1900s.

And there are abounding who can bethink absolute hospitals, lower standards of care. “The history of racism weighs on the association heavily,” one bounded baton told a analysis accumulation from the Kaiser Ancestors Foundation beforehand this year.

Before Rural Bloom moves into a community, Dozier-Smith spends hours at burghal lath meetings, talking with the bounded newspaper, abutting the alcove of commerce, agreeable business owners to accommodated with her.

“You absolutely do accept to absorb a acceptable bulk of time architecture those relationships and adopting that trust,” she said. “Then through chat of mouth, through bounded support, you accretion a adherent for life. That’s what I’m best absorbed in.”

Uniontown, Ala. – Keshee Dozier-Smith, 34, easily out pamphlets anecdotic a array of bloom casework to Uniontown badge admiral afterward an advisory acquisition hosted by Rural Bloom Medical Affairs in December 2019. (Photo by Bob Miller)

* * *

Ludell Bryant was the academy advice advisor at Selma Aerial Academy aback she aboriginal met Dozier-Smith in the aboriginal 2000s. Dozier-Smith, afresh a student, would appear into Bryant’s appointment attractive for academy scholarship applications.

“She was a acute girl, and she would claiming you in a minute,” Bryant recalled. “Not in a abrogating way; I got a bang out of it. Keshee was aloof one of a kind. Consistently absolved with her amateur back, with the persona of, ‘I apperceive what I want, and this is what I accept to do to get there.’”

And what the boyish Dozier-Smith capital was to go to Spelman College, the historically atramentous women’s advanced arts academy in Atlanta. Bryant afraid the big-ticket charge would accumulate the academy out of Dozier-Smith’s reach. But Spelman gave Dozier-Smith a abounding scholarship on the backbone of her association service.

After college, she went to assignment for accumulated behemothic Accenture and confused to Pittsburgh, afresh Houston. She affiliated her aerial academy sweetheart, Tavarius Smith. They had a son, Tavarius Jr. and daughter, Kahlan.

But the accumulated apple started to lose its allure. Dozier-Smith yearned to assignment about she acquainted she could accomplish a difference. She and her bedmate capital to move aback to Selma to be afterpiece to family. They bought a 100-year-old bungalow abreast the centermost of Selma, not far from the Edmund Pettus Bridge. They did it because, they said, they capital a allotment of Selma history.

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They began architecture Tavarius’ trucking company. Dozier-Smith’s affairs for a nonprofit apartment didn’t assignment out. They had accession daughter, Khariyah. Dozier-Smith approved to focus on allowance at her husband’s aggregation and actuality a calm mom to three adolescent children.

But there came a point aback she acquainted like she couldn’t bend accession onesie afterwards activity crazy.

That’s aback a ancestors acquaintance showed her an ad for an accessible position as CEO of Rural Bloom Medical, a about 40-year-old accumulation of association bloom centers.

***

Earlier this year, the Georgiana Medical Center, amid two hours southeast of Uniontown in rural Butler County, became the thirteenth hospital to abutting in Alabama aback 2011. Added than bisected of those shuttered hospitals already served rural populations.

Among the rural Alabama hospitals that are still open, about 90 percent accomplish in the red.

Dozier-Smith’s Selma appointment is abutting aperture to Vaughan Regional Medical Center, now the alone hospital in a seven-county breadth that has a activity & commitment unit.

About bisected of Alabama counties don’t accept distinct OBGYN, according to the American Congress of Obstetricians and Gynecologists. That includes some counties in the Rural Bloom advantage area, like Perry and Wilcox. Obstetrical specialists are 60 afar abroad in Montgomery or Tuscaloosa or Birmingham.

The doctor curtailment agency that the kinds of casework Dozier-Smith took for accepted in Houston, breadth she had her aboriginal two babies, are about absent here, breadth she had her third and fourth babies.

“Here I collection 54 afar anniversary way to my OBGYN,” she said. “In Houston, there were all kinds of abundance and accouchement classes, referrals to wellness centers, advance to assurance up for lactation classes. To apperceive that best of those are not alike options in Selma, it’s hard.”

This spring, a accumulation of advisers from the nonprofit Kaiser Ancestors Foundation came to Dallas County, breadth Selma is located, to appraise admission to changeable bloom casework for low-income women.

The abstraction begin “severe provider shortages, accumulated with a abridgement of accessible busline and, for some, the charge to biking continued distances to see medical providers are above barriers to care.” Aerial poverty, bound affordable apartment and a curtailment of application opportunities account abounding women to accent added needs over their own bloom and ancestors planning needs, the abstraction found.

The allegation weren’t a abruptness to Dozier-Smith, who assisted with the study. About two thirds of Rural Health’s patients are women.

“Because the bactericide affliction is not there, you alpha to see preterm deliveries or stillborns or miscarriages, because you accept bodies who aren’t demography affliction of abiding illnesses, like diabetes or aerial claret pressure,” she said.

In Alabama, Medicaid covers bisected of all births. But the accompaniment chose not to aggrandize Medicaid and has one of the strictest accommodation requirements in the nation. That agency best Alabama women aren’t acceptable for Medicaid advantage until they’re already pregnant.

“So there may be no prenatal care, bearing apprenticeship or ancestors planning,” Dozier-Smith said. “And afresh you’re not acquainted of the bloom issues until it’s time to deliver.”

She’s talked with two Selma obstetricians about absolution them use amplitude at the Rural Bloom dispensary in Selma, aback it opens, to action parenting classes, Lamaze and added birth-related services. She additionally afresh assassin an obstetrician to assignment at the new Rural Bloom centermost in Monroeville. Through his office, they plan to action added bactericide affliction for abundant patients and abetment with ancestors planning.

***

Selma, Ala. – Keshee Dozier-Smith (center), 34, leads a agents affair at the Rural Bloom Medical Affairs appointment in December 2019. (Photo by Bob Miller)

Three months afterwards Dozier-Smith got the job at Rural Health, she alleged a affair with her healthcare providers to altercate new changes she had planned.

One doctor, an beforehand man, looked beeline at her and said, “I’ve been active 10 years here, and in my experience, bodies don’t acquaint doctors what to do; it’s the added way around.”

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It bent her off-guard, but she remembers captivation his gaze.

“If you appetite to be active accession 10 years, your mindset needs to change,” she said. “You aren’t alive at a clandestine practice, you’re alive at a association bloom center.”

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Eventually, she said, they became friends.

There are 14 added association bloom centermost networks that accomplish in Alabama in accession to Rural Health. Some of them are the aforementioned age as Rural Bloom but accept advantageous coffer accounts and tens of bags of patients, Dozier-Smith said.

“My catechism was, ‘Why doesn’t Rural Bloom accept that?’” she said. “You alpha to see you’ve got to accept the agents to abutment the work. Aback you acquisition bodies who are aloof as passionate, they’re bounded and homegrown, or they’re aloof absorbed in this affectionate of accessible bloom work, that’s what helps a affairs aftermost accession 40 years.”

Dr. Meneka Johnson was a post-doctoral apprentice at the University of Alabama aback Dozier-Smith met her at a appointment and they discussed their affection for accessible health.

The afterward day, Johnson said, “She came up to me and had a accomplished plan, and a anthology abounding of ideas, and asked if I was attractive for a job.”

Johnson wasn’t, but was afflicted by Dozier-Smith’s activity and eyes for what Rural Bloom could be.

“She’s a dreamer, and you charge bodies like that to booty organizations to levels breadth they didn’t see themselves going,” said Johnson, who is now arch operating administrator at Rural Health. “We’re boilerplate abreast breadth she dreams us to be, but Rural Bloom isn’t breadth it was aback she came here.”

Dozier-Smith had her fourth babyish anon afterwards abutting Rural Bloom and generally brought her to assignment because she was still breastfeeding. Little Kallie Grace watched her mother from a playpen in the office.

A babyish arbor of high-heeled shoes sits in the bend of Dozier-Smith’s appointment and added changes of clothes still adhere on the aback of the appointment door. She’s consistently traveling, switching amid assignment and ancestors commitments. It leaves little downtime.

“I do not accept a claimed life, is what I’ll acquaint you,” she said. “With this job, and aggravating to be a abundant mom and wife, you do cede things that you would commonly do for yourself. But we try to be admiring of anniversary added in our ancestors and we try to accomplish abiding the bodies who advice us are taken affliction of. Those things appear aback to you in the end.”

Selma, Ala. – Keshee Dozier-Smith, 34, gathers her four accouchement at home afore accessory a academy anniversary program. (Photo by Bob Miller)

***

It was aphotic by the time Dozier-Smith got home to Selma.

Her daughters rushed her as anon as she opened the aperture of the house, calling “Mommy!” and jockeying to see who could be the aboriginal to appearance her the Christmas ability they’d gotten at ballet chic that afternoon. Her son Tavarius, 9, captivated aback until they were done, watching with the ability backbone of an beforehand brother who has three little sisters.

Dozier-Smith accomplished into her bag and pulled anniversary antler hats for the girls and an elf hat for her son; they were headed to an black Christmas affairs at their school. Her aunt, who was watching the kids while her bedmate was out of town, helped get them into their coats.

Dozier-Smith had been home a absolute of 15 account afore it was time to leave again. She’d afflicted into a anniversary dress aback at the office.

Her son already asked her if she was a doctor. She told him no, she was added of a ‘fixer.’

“I booty this job, actuality a mom and a wife and actuality allotment of the association that needs to progress, as a way to break the knots,” she said. “I was about admiring bodies who took affliction of me as a little girl, and that brought me aback home to be the administrator of this association program.

“Imagine all the accouchement we affliction for now, brainstorm who they’ll abound up to be.”

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Selma, Ala. – Keshee Dozier-Smith, 34, leaves the Selma-Dallas Canton YMCA afterwards a lath affair in December 2019. Dozier-Smith took her bench on the Selma-Dallas Canton YMCA Lath of Directors in September, 2019, and angle her captivation there as an befalling to animate all-embracing fettle and wellness aural the community, and aural the Rural Bloom Medical Affairs network. (Photo by Bob Miller)

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