Screening Tennessee Women From Top to Bottom

by Candi Helseth

“Mountain Tops and Bottoms,” held annually in Tennessee's Grundy County, has nothing to do with geography or altitude. Instead, the outreach event is designed to save lives by getting area women screened with mammograms and pap smears.

Nurse Practitioner (NP) Darryl Adams initiated “Mountain Tops and Bottoms: A Women's Health Event” in 2009 following the death of a patient with breast cancer. The 53-year-old woman came to see Adams because she thought she had a breast infection. Adams' examination revealed a large cancerous mass that had metastasized throughout the woman's body. The woman had never done a breast self-examination or had a mammogram.

“There is a general lack of knowledge here about available resources and preventive health benefits,” Adams said. “We have a breast and cervical services program that offers free screenings, but she didn't know about it and didn't really understand why it was important until it was too late. She might have lived if she'd used those services. It was such a tragedy.”

Grundy County (pop. 13,700) is Tennessee's third poorest county, and for the most part, preventive health care takes a back seat when patients are more concerned about buying food and paying rent. Health care resources are stretched. Adams is the sole primary care provider at the Tennessee Department of Health Primary Care Clinic in Altamont, which serves only uninsured patients. Adams also coordinates the health department's family planning and breast and cervical services. Once a month, a physician travels to Altamont to review Adams' patient charts because, by law, NPs must have physician oversight. The rest of the time she is on her own.

When Adams suggested an educational event for area women, the 10 clinic staff members were eager to help. Because there was no budget, Adams and staff members did all the grunt work, including advertising, decorating, making the food for the event, and going to local businesses to ask for donations that could be used as door prizes. The 25 women who attended the first event were deeply grateful, and requested that the event be offered annually so they could invite their mothers, daughters and friends.

Mountain Tops and Bottoms now attracts 50 to 60 women each year, many of them driving from their sparsely populated mountain homes over rough, narrow roads from as far away as 50 miles. As the enthusiasm spread, other small communities have held their own outreaches, using Adams as their keynote speaker. Core to all events is what Adams calls “my simple and girly Power Point presentation,” which outlines how to access free screenings and why self care and screenings are so important. The all-female atmosphere also gives Adams an opportunity to explain what women can expect. Some women are uncomfortable thinking a man might be looking at their breasts, others worry that screenings are painful. Once she is able to convince them to have that first screening, Adams said those worries dissipate.

“A lot of what we do at these events is just motivating and encouraging women,” she said. “We are working more now to do tracking to see if they follow up. These women come from all over the region so they aren't all patients at our clinic. That makes it harder to track.”

Women can schedule pap smears at the Altamont clinic. The Tennessee Breast and Cervical Cancer Screening Program also contracts with hospitals in area counties to provide mammograms. And women can schedule a mammogram with a mobile mammography van out of Chattanooga. If the women don't meet the criteria for free services, Adams says she can generally find a way to see that they receive free services.

Last year the Tennessee Cancer Coalition began organizing similar events with Adams traveling to those events. This year, Adams secured grant funding for event planning and implementation.

“Our community and businesses have been so generous,” Adams commented. “We don't have many businesses around us, but the ones we do have support us. One gas station doesn't even have gift certificates so they handwrite their $20 gift card on an index card for us.”

More money, in the form of a higher salary, motivated Adams to return to college in her thirties for a NP degree after having worked six years as a registered nurse in Louisiana. Following graduation, she took the Altamont job to gain primary care experience. She loved the health department's mission and thought the experience would better prepare her for moving into private practice. Six years later, Adams no longer has any intention of starting a private practice or leaving her patients.

“I absolutely fell head over heels in love with the patients I care for and with what we do here,” she said. “Our patients pay on a sliding scale based on family size and income. The majority of my patients fall within the minimum fee of $5.00. It's a beautiful program to be part of.”

According to Adams, the families living in the region are proud, good, hardworking people who are uninsured because, for the most part, they are unemployed. The mining companies that used to support families have closed. Available jobs are few and far between. Almost all of her patients have spent their entire lives in this small community, and they can't imagine starting over elsewhere.

Adams, who was honored in June as Nurse Practitioner of the Year by the National Conference for Nurse Practitioners, also received the Tennessee Practitioner of the Year award in 2011. But she says her greatest reward is the day-to-day interactions with her patients.

“Every day I'm rewarded by the absolute, genuine heartfelt gratitude of these folks I care for,” she said. “I'm in a little outpost with not much else around here, but I get to do primary care and I love what I do and I love this place. And so I stay.”

For more information on Mountain Tops and Bottoms, contact Adams at Darryl.Adams@tn.gov.

Back to: Summer 2013 Issue