Community health workers join with medical schools to bring care closer to rural Texans

From KTTZ:

In April, the Texas Tech University Health Sciences Center and Texas A&M University Health Sciences Center hosted a tour of their latest collaboration, a clinic built in a retrofitted shipping container in rural Burton, Texas.

The partnership between the two schools began last year, with another container clinic in Fort Davis. Each of the clinics are operated by community members, with primary health services provided by Texas Tech Physicians and behavioral health by Texas A&M Health through telehealth. There’s no insurance necessary and patients pay a flat rate of $30 for telehealth services.

Across the United States, rural areas have less favorable health outcomes than more urban ones. Barriers to care, like lack of health insurance and long drives to facilities, can create further complications for rural Americans with chronic diseases and disabilities.

Dr. Cole Johnson was recently appointed as the Chief Operating Officer of TTUHSC, and for the past year, he has served as the senior vice president of the center’s Division of Rural Affairs and director of both the Institute for Telehealth and Digital Innovation and the F. Marie Hall Institute for Rural & Community Health.

He said the clinics are a great example of the ingenuity and collaboration it takes to bring healthcare solutions to rural areas.

“If you look up the Department of State Health Services data by physician licensure, there’s 40 counties in Texas, as of the 2025 data, that do not have a licensed primary care provider,” he said. “How can that be a data point and us not think about solutions to address that? And so I think that’s where this desire and really mission-driven focus comes from, is knowing that there’s a need and knowing that we have the capabilities to help address that need, and that the communities are looking for innovative solutions. So it’s a very exciting time in rural health right now.”

Johnson pointed out that most people probably don’t think of rural communities being “at the cutting edge of healthcare services,” but developing initiatives in rural care is a “core tenet” of TTUHSC and that work has taken projects far beyond the Lubbock area, where the university is based.

Johnson said TTUHSC established the model for these community-based clinics through a project in Marathon.

Marathon is a census-designated place in the Big Bend region, with a population of about 400 according to the U.S. Census Bureau.

Danielle Gallo is the board president of the Marathon Health Center. She said the original clinic in the building opened in 1995, but keeping up operations proved challenging.

“There’s really no way to financially support a traditional clinic model in a town the size of Marathon. It just doesn’t work. You can’t make money, you can’t even really break even,” she explained. “So, over and over and over again, we would just lose our contract and have to start over from scratch. The services just kept getting worse and worse over time as healthcare got more and more expensive.”

Gallo said it is also hard to retain and replace family practitioners, particularly in rural communities.

The primary medical center for the region is about 30 miles away, in Alpine, but because of the broad region it serves, it can be difficult to schedule appointments, especially for those with chronic conditions and those without insurance.

According to the U.S. Census, Marathon has a disabled population of almost 32% and an uninsured rate of almost 22%.

The disability rate for the state of Texas is about 12%, according to the Texas Workforce Investment Council, and the uninsured rate is more than 16%, according to America’s Health Rankings.

After losing yet another contract in 2017, the president of the clinic board at the time started looking into telemedicine options and reached out to Texas Tech as a collaborator.

“So we tried out all of these different things and just eventually narrowed it down to a model that worked really well for our community. I like to think of it as we beat our heads against the brick wall to create a doorway for the people who came behind us, and we’re very proud and happy to have done that,” Gallo explained.

In 2023, the clinic got a grant and Gallo was able to be in the building five days a week, something she said made a huge difference.

Today, the nonprofit clinic has two full-time employees, yoga classes, traveling practitioners, a licensed professional counselor who comes once a week, and does not charge for tests and lab orders or nurse visits.

“Texas Tech especially has been spreading that model to other communities, because it’s very scalable,” she said. “It can be as small as a janitor’s closet with internet access and a blood pressure cuff and a scale, or it can be as big as a facility like ours that has multiple exam rooms and a community room and offices, so it’s very flexible based on what the needs of the community are.”

A janitor’s closet – or a shipping container.

Texas A&M BUILD is a student-led nonprofit that designs and constructs Texas Aggie Medical Clinics. It has built 60 medical clinics, including the container clinics in Burton and in Fort Davis.

The Davis Mountain Clinic was the first collaboration between the two health sciences centers. It is located in Jeff Davis County, which has a population of about 1,800 people. As of 2024, more than 44% of the county’s population is 65 years or older, according to the U.S. Census Bureau.

Carol Brewer is a registered nurse, the clinic’s executive director, and its only employee.

Similar to Burton, Brewer said the closest clinic was in Alpine, about 25 miles and a drive through the mountains away. The only doctor in town is semi-retired and has practices in other nearby communities as well.

The Davis Mountain Clinic began taking patients in October 2025. The clinic is a nonprofit, funded through grants and donations.

Brewer said typically, people can get an appointment in the clinic same-day or next-day. She gets a lot of drop-ins, people coming by with general questions, making inquiries on behalf of family members, or determining if telehealth is the best fit for their issue or if they should be referred to a specialist.

She even makes home visits for people who can’t come to the clinic in person.

Brewer was working as a nurse in Dallas, but made the move to rural medicine after she fell in love with Fort Davis.

“We had some medical students come through for a tour, and I’m like, ‘If you all are looking for work-life balance, this is the place,’” she said. “The quality of life and the patient population, they’re just very appreciative.”

Over in Burton, a small city with a population of about 300 people, Mark Rosenbaum is a paramedic lieutenant at Washington County EMS and a registered nurse. He has worked in emergency medical services for about 15 years and has spent his whole career in rural areas.

He said that whether it’s 15 miles or 100 to the nearest doctor’s office, it does not make much of a difference for those who don’t have transportation.

“There have been multiple times we’re taking people to the hospital via ambulance, because that’s quite frankly the only way they can get into town to go see a physician.”

He explained that not only is getting primary care through emergency rooms not cost-efficient, it does not make for the best care experience.

“Emergency rooms are for emergencies. They don’t tackle primary diseases like hypertension and things like that,” Rosenbaum said. “A lot of these people don’t even have primary care.”

A local ministry, Burton Bridge Ministry, had been looking into ways to bring a clinic to the community for years and Rosenbaum said it joined with Washington County EMS to try to find a partner to provide the telehealth care.

“It’s not something that we can do locally,” he explained. “And we tried a couple different avenues, but then after talking with the A&M people, they put us in touch with the concept of what they’re doing with the telebehavioral at A&M and the telemedicine from Texas Tech, and they kind of stepped in and helped us finish the plan.”

Burton Bridge Ministry also has a transportation service, which will be able to bring patients in from around the region, even if they don’t have a vehicle.

The in-person services at Burton – Southern Clinic will be provided by paramedics.

“They’re the ones that are actively going out and seeing people trying to do preventive care in the community,” Rosenbaum said. “So we’ll be the hands and the kind of eyes and ears and physicians. And the eyes and the ears get replaced by the telemedicine equipment.”

Dr. Johnson with the Texas Tech University Health Sciences Center said this kind of community-based care can help improve health outcomes for a population.

“If [healthcare] is daunting to access, you kind of put it off in your mind until it becomes emergent or urgent, and not part of how you live your daily life,” he said. “Where, if healthcare is staked and anchored in your community, I think it changes the community’s perception of how they perceive and embrace healthcare as part of the fabric of the community.”

In Fort Davis, Carol Brewer is seeing those changes firsthand.

“There’s people out here that, they’ve told me, they do not know what they would have done if we hadn’t been here. Because it’s a combination of the doctor services, what they need from the physician, and then what I can provide to them in between their physician visits,” she said. “And it’s just saving them time and money and stress.”

A 2021 data brief from the National Center for Health Statistics found that in 2019 rural areas had a 20% higher death rate than urban areas, even when accounting for different age demographics.

“We’re looking at other ways we can help the community, in lifestyle management and things of that nature,” Brewer explained, “providing things that are so easy for people that live in urban areas to access, to the people in this area, is going to make for a healthier population.”

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