The Legacy of James D. Bernstein: Part 2
“I was giving a talk at the University of South Carolina Family Practice Symposium on my work. A family physician in the audience stood up and said the countryside is littered with the bodies of family physicians who thought they could make a difference. Why did you? At the time, I had no answer. Since then, I’ve pondered this question, and this is what I know: Jim Bernstein, Bernie Patterson, and the entire staff at the Office of Rural Health always had my back.” — Dr. Jane McCaleb
Part one of this blog series examined Jim Bernstein’s background, early work, and the North Carolina Office of Rural Health. Here, we dive into a personal story from a physician providing health care in rural North Carolina and explore Bernstein’s nationwide impact.
Accelerating Change in Rural North Carolina
Dr. Jane McCaleb, 2020 recipient of the Jim Bernstein Community Health Career Achievement Award, was assigned to Jackson, NC, in Northampton County, for a two-year term by the National Health Service Corps. She stayed for 35 years. The Office of Rural Health recruited her, and, according to Dr. McCaleb, she largely remained due to the robust support its staff provided.
She joined the small practice in Jackson in the late 1970s when, according to her, Eastern North Carolina was still a derivative of the plantation sharecropping economy and “where grinding poverty and racism were apparent everywhere, every day, and in every way.”
The KKK was still active in the area then, and Dr. McCaleb, a white female family medicine practitioner, worked with a Black male internist to serve the rural communities with the highest maternal risk characteristics and neonatal mortality in the state. They were the first racially integrated practice outside of a university in North Carolina.
Firsthand Account from Rural Health Physician & Leader Dr. Jane McCaleb
During her Jim Bernstein Community Health Career Achievement Award acceptance speech, Dr. McCaleb shared a story that painted a clear picture of the community and conditions at the hospital when she arrived:
“At the hospital, things were changing slowly. I clearly remember a hot summer day when a 14-year-old Black girl in her first pregnancy came to my office. She had already been to the neighboring health department that morning. She was two weeks overdue, had a blood pressure of 160 over 100, and marked swelling, denoting preeclampsia. She had been certified by the OB (obstetrician) for lay midwife delivery at home because she had no money. It would have been a hot, miserable delivery and very dangerous. She was scared, and so was I.
I did not even bother to send her to the hospital. I called the rescue squad and sent my LPN (Licensed Practical Nurse), Barbara Harris, to get IV (intravenous) fluids and mag (magnesium) sulfate from the hospital, and I called ECU (Eastern Carolina University).
I stuck her in the back of an ambulance with volunteer EMTs and Barbara to run the IV and mag drip and put her on the road. I never saw her again until about 15 years later, when she came back for a visit. Everything had turned out fine, and her little boy was thriving.
Can you figure out what the trick to driving down the neonatal death rate? No great OB skill on my part, no great pediatric skill. I referred a third of all my OB patients to Greenville to deliver until I could get a team in place, our staff trained, and the hospital up to snuff. I gave a damn, and Jim knew.”
When Dr. McCaleb arrived in Northampton County, the neonatal death rate was almost 22 per thousand, nearly double the state rate of 12. After three years, the Office of Rural Health (ORH) staff recruited a pediatrician who was married to a neonatal nurse. Within four years, the team recruited two family practitioners who brought a labor and delivery nurse with them. Five years after Dr. McCaleb started, the rate had dropped from 21.8 to 7.6, below the state rate of 8.4, thanks to her dedication and support from NCORH.
At the end of her award acceptance speech, she reflected on her experience: “I was giving a talk at the University of South Carolina Family Practice Symposium on my work. A family physician in the audience stood up and said the countryside is littered with the bodies of family physicians who thought they could make a difference. Why did you? At the time, I had no answer. Since then, I’ve pondered this question, and this is what I know: Jim Bernstein, Bernie Patterson, and the entire staff at the Office of Rural Health always had my back.”
Driving National Rural Health Solutions
Beyond North Carolina, Bernstein also left a lasting impact on rural health at the national level. He served as president of the National Rural Health Association (NRHA) and advocated for legislative changes in Medicaid and Medicare, leading to more equitable reimbursement for rural health centers and hospitals.
Thanks to Bernstein and his team’s work, all 50 states now have rural health offices. The National Organization of State Offices of Rural Health (NOSORH), founded in 1995, assists these Offices in supporting the health care infrastructure for 61 million rural Americans.
Bernstein also mobilized, mentored, and inspired hundreds of rural health leaders nationwide. He and NCORH staff established a highly successful framework for working within existing policies and designing programs for sustainable, lasting change. Bernstein knew how to get things done and generously shared his knowledge, insights, and resources with fellow leaders and advocates.
After he passed away, the National Advisory Committee on Rural Health and Human Services (NACRHHS) honored him: “Rare is the leader who so many would claim as mentor and friend.” The NOSORH Educational Exchange Scholarship Program provides State Offices of Rural Health employees with resources to help them cultivate the essential and effective characteristics Bernstein embodied:
- Capacity to see and share the “big picture”
- Ability to identify and implement strategies that fulfill an inspired vision
- Understanding of rural health issues and the resources needed to address them
- Commitment to nurture and sustain relationships with stakeholders and partners
- Ability to think entrepreneurial
- Dedication to lifelong learning
- Desire to cultivate the leadership skills of others
Nancy Lane, a health care management consultant, said, “What was magic about Jim was that he could work with such a wide breadth of people. He encouraged people to tackle the impossible, all while making it look like fun.”
Our next post will dive into Bernstein’s foundation leadership and current FHLI programs and priorities.