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The Surprising Rural Health-Care Legacy of the ’60s

A country road with "Good Health" written on it in block letters
Gustavo Frazao via Shutterstock

Of the many challenges for America’s rural communities, near the top of the list is access to health care. Rural clinics and hospitals are closing across the nation. When they close, it’s hard for younger families, and older residents, to stay in town—and harder to attract new businesses, or attract replacements for the doctors, nurses, and other health-care workers who may be retiring from their practices or just leaving town.

Previously we’ve reported on the realities of smaller-town and rural health care in Brownsville, Texas, and Ajo, Arizona. This is a report from the smallest city we have visited in our travels, in spectacularly beautiful though remote far Down East Maine.


Today’s health care in Eastport, Maine, traces its roots back to Lyndon Johnson’s War on Poverty and the establishment of the Office of Economic Opportunity (OEO). In this, it is like a large number of other small communities across the country. Just as today’s libraries bear the century-old imprint of Andrew Carnegie, and many of today’s post offices and other public buildings are legacies of construction and mural-painting efforts launched during the Great Depression by Franklin D. Roosevelt, today’s remaining rural clinics are, in many cases, the effects of an initiative launched 50 years ago. Along with other OEO initiatives, such as Job Corps, VISTA, and Head Start, that remain to this day, this rural-health initiative has shaped the primary health care in poor or underserved areas long since it was started.

Back in the 1960s, enter a young medical doctor and civil-rights activist with a vision. This was H. Jack Geiger, who had spent time in South Africa during medical school and had seen the positive impact that the community health-care model had in the very poor area of Pholela. Later, back in the United States, he spent time in the Mississippi Delta for the Freedom Summer project of 1964 as field coordinator for the Medical Committee for Human Rights.

When he returned to Boston, Geiger connected his observations in South Africa and the Mississippi Delta. Along with a colleague, Count Gibson, Geiger proposed to the OEO to try out what he had learned by starting two experimental, community-based health-care programs, one in Boston’s Columbia Point housing project and the other in the Mississippi Delta. Eventually, these became models for the roughly 1,400 Federally Qualified Health Centers (FQHC) that serve more than 28 million people around the U.S. today.

During our travels for American Futures and Our Towns reporting, my husband, Jim, and I visited two examples of these community-based health centers: Desert Senita Community Health Center in Ajo, Arizona, and the Rowland B. French Medical Center in Eastport, Maine.

Their FQHC designation is a godsend for rural health-care centers. It ensures that the centers will receive, among other things, enhanced reimbursements for patients covered by Medicaid and Medicare, and will offer a sliding scale for those without any coverage. It promises federal malpractice-insurance coverage for providers, extra partnerships for the centers, and more specialist care. Each center is unique in its profile, depending on the community’s needs. For example, the Rowland B. French Medical Center has providers for behavioral health counseling, podiatry, radiology, nephrology, and social support. Desert Senita has a regularly visiting cardiologist and ophthalmologist, a certified Spanish translator, and a special phone line with third-party translators for multiple languages.

The editorial and business office of the Quoddy Tides newspaper, in downtown Eastport, Maine
The editorial and business office of the Quoddy Tides newspaper, in downtown Eastport, Maine James Fallows

This is another road report on the state of local journalism, which is more and more important, and more and more imperiled.

It is important because so much of the future of American economic, cultural, and civic life is now being devised and determined at the local or state level. Educational innovation, promotion of new industries and creation of fairer opportunities, absorption of new arrivals (in growing communities) and retaining existing talent (in shrinking ones), reform of policing and prison practices, equitable housing and transportation policies, offsets to addiction and homelessness and other widespread problems, environmental sustainability—these and just about every other issue you can think of are the subjects of countless simultaneous experiments going on across the country. Voters, residents, and taxpayers need to know what is happening (or not), and what is working (or not), in their school systems, and their city councils, and their state capitals.

It is imperiled for obvious reasons. What has happened to media revenues in general has happened worst, fastest, and hardest to local publications, newspapers most of all.

This is part of the reason Deb Fallows and I have been reporting on local-journalism innovations (and successes) we’ve seen, such as the Report for America initiative I mentioned in June, and the business model behind the last family-owned daily in Mississippi, The Commercial Dispatch in Columbus (and, long before that, the former alt-weekly that has become a leading statewide news source in Vermont, Seven Days, of Burlington).

No one of these models or examples will necessarily apply in other places or circumstances. But any illustration of success is worth noticing, for tips.


This brings us to The Quoddy Tides, the twice-monthly, family-owned and -run newspaper that has a print circulation several times larger than the population of the city where it is based.

The home city is Eastport, Maine, whose library Deb wrote about recently, and which we described in our book, Our Towns. In its heyday as a sardine-canning capital, Eastport had a population of more than 5,000. Now the canneries are gone, and the year-round population is about 1,300, and nearly everyone in town holds a combination of jobs—lobster fishing, seasonal tourist businesses, work at the commercial port or in forestry, small crafts or art studios—to make ends meet. But in this setting, The Quoddy Tides has a paid print circulation of just less than 5,000, and now has more than 50 years of continuous operation. Its editorial and business office is in a white clapboard structure that at various times was a fishing-company office and then a Christian Science church, along the bay front in Eastport’s small but architecturally distinguished downtown. It is run on a shoestring, but it has some 20 contributors and correspondents in the region, and it is full of both articles and ads, and it matters in its community.

Eastport’s downtown, from its pier. The Quoddy Tides office is the small white building to the right. (James Fallows)

Part of The QT’s circulation secret is similar to that of Seven Days, in Vermont: It is aimed at an audience, and market, beyond its immediate hometown base. In addition to news of Eastport, The QT covers that of other down-east Maine towns such as Lubec, Machias, and Calais (pronounced like callous), and adjoining maritime islands and towns in the Canadian province of New Brunswick. It also has a substantial mail circulation, reaching subscribers in 49 states who are originally from the area, or have visited, or feel some interest or connection to it. (South Dakota is the outlier. People of Sioux Falls and Rapid City, c’mon!)

Also, like The Commercial Dispatch in Mississippi, the paper’s family ownership means that it can spend its modest resources as it chooses. It is not under external-ownership pressure to meet regular profitability targets, which has sent so many small papers into cycles of cutback and decline.

But when I spoke with the husband-and-wife couple who run the paper, Edward French and Lora Whelan, they emphasized that it was the kind of journalism they provide that has allowed them to survive.


The Quoddy Tides—named for the Passamaquoddy Bay on which Eastport sits, which feeds into the Bay of Fundy—was founded by Edward’s mother, Winifred, in 1968. She and her husband, Rowland, a doctor, had moved to Eastport from Arizona in the early 1950s, and stayed there to raise their family. (“My mother was looking for someplace not quite as hot,” Edward told me in The QT’s office earlier this month. “Coastal Maine qualified.”) Rowland became a leading local doctor, with a clinic now named in his honor. One of Edward’s brothers, Hugh, also lives now in Eastport, where with his wife, Kristin McKinlay, he runs a museum and arts organization called the Tides Institute.

In the late 1960s, as the family’s children were growing, Winifred decided that the community needed a newspaper. A previous one, from the town’s sardine-canning days, had gone out of business in the 1950s. “She had no newspaper experience,” Lora said of her mother-in-law. “But she thought these communities really needed a voice. So she talked to other small newspapers and had correspondence with people all around the country about how she should set this up.” After a year of research, she launched the paper in 1968.

Lora Whelan at work (Courtesy of Lora Whelan)

Edward, then elementary-school age, grew up helping address papers for mail subscribers, and with the page layout. In those days, a fishing boat took article text across the water to a layout shop in Deer Island, Canada, and then another boat would carry the pasted-up pages back to the U.S. for printing.

Edward French at the Quoddy Tides office (Leslie Bowman / the Working Waterfront)

Then and now, the striking characteristic of the paper is its density of local news. The most recent issue, when we visited, was 40 pages long, with many dozens of purely local, information-packed news stories.

For instance, the front page (at right) had five local stories: about the Passamaquoddy Tribal Council’s effort to defend water rights; about limits on sea-urchin fishing (a quickly growing market, mainly for export to Asia); about the impact of new tax preferences, for land conservation, on local tax revenues; a crime story; and one about an academic-freedom dispute at the local Maritime College of Forest Technology. Plus, a picture of a kayaker viewing a Minke whale—of which we saw large numbers in the bay.

The Quoddy Tides’ front page of the August 9, 2019, edition (James Fallows)

In the rest of the paper you have: high-school sports. Commercial shipping schedules and tide tables. Gardening and cooking tips. Religious news. Birth and death notices. Puzzles. Local city-council roundups. A long editorial and letters-to-editors section. Everything.

“I think it’s important for newspapers not to keep cutting,” Edward told me at The QT’s office. “If you keep cutting, there’s less and less reason for people to buy the paper. If you want to keep a healthy circulation, you have to make the investment in reporters and providing the news that people can’t find anywhere else.” If there is a “secret” of the paper’s success, he said, it is “that you’re providing information that people can’t find any other place.”

The Peavey Memorial Library in Eastport, Maine
The Peavey Memorial Library in Eastport, Maine Courtesy of the Tides Institute & Museum of Art

Andrew Carnegie was the force of Gilded Age philanthropy behind the building of public libraries. Along with other recognizable names who made their fortune in the late 1800s and early 1900s—Rockefeller, Ford, Mellon, Morgan, Stanford, Harriman, Heinz—Carnegie’s influence endures today largely because of the way he gave away the vast fortune he amassed.

For about 35 years beginning in 1883, Carnegie donated money from his steelmaking empire (which became U.S. Steel) to build nearly 1,700 libraries around the country and another 800 around other parts of the world. He was careful about his “formula” for agreeing to construct the commanding, elegant buildings, a formula whose elements remain fundamental in the basic operations and democratic spirit of public libraries today. The libraries were required, among other things, to support staff and maintenance, to gather at least some of their funding from public sources, and to be open and free to the public to use.

It has been stunning to see the physical and spiritual legacy of Carnegie libraries—large and small—as we have visited more than 50 towns around the country for our Our Towns reporting project. It has been inspiring to bear witness to how libraries have evolved from the simple idea of serving the wants and needs of the public to becoming crucial, essential public institutions of communities in this modern era.

Around the turn of the 20th century in Columbus, Ohio, an audacious city librarian named John Pugh hopped the train for New York to knock on Carnegie’s door, and—appealing to their shared Celtic background— charmed Carnegie into donating $200,000 for the construction of the imposing granite and marble main library in downtown Columbus. Today the building has been newly renovated and expanded, retaining its original main building and entry, where the words OPEN TO ALL are carved in granite over the door. From the library’s main reading room, you can look out the two-story glass windows onto the seven acres of topiary park with more than 200 different types of trees.

The Carnegie Center for the Arts in Dodge City, Kansas (Courtesy of the Carnegie Center for the Arts)

In Dodge City, Kansas, a small but distinguished group of residents, inspired by the town’s women’s club, appealed to Carnegie in 1905 for support to build their public library, as he had previously done for five other towns in Kansas. He gave them $7,500, and they agreed to ante 10 percent of that sum annually to maintain it. The town’s population grew and eventually outgrew the small library. Today it is home to the Carnegie Center for the Arts.

The view from our plane this week, headed to Maine
The view from our plane this week, headed to Maine Deborah Fallows

We were flying away from Washington D.C. again, leaving the Sturm und Drang of our hometown in early August for a point nearly as far east on the U.S. map as one can get. It is “Down East,” in the vernacular of Maine, and the town of Eastport, where residents say the sun first rises over the United States, as does the moon, which gets far too little attention.

James Fallows, banking the Steel Edition Cirrus SR-22 en route to Eastport (Deborah Fallows)

In Eastport, it is difficult to rise before the fishermen do; they are often out by dawn, returning with a catch before most of us see the sun, and then they head to the local Waco Diner, which is ready for them with bacon and coffee.

Close in to shore this morning, seagulls cry back and forth to each other. Winches lower lobster traps onto boats for setting in the bay. A few townspeople arrive at the new town pier in pickups stocked with their fishing gear. They cast their lines some six feet down from the pier to the water at high tide, and as much as 25 at low tide. The tidal difference is greatest when the moon is full, as it is now. I watched the fishermen catching mackerel, smelt, and herring for their dinner tables.

The port’s pilot boat glides silently offshore; I know a big ship is scheduled to arrive at the port this week, maybe like the Industrial Ruby, which came and went last week, loaded up with wood pulp for China. It’s a Dutch-built and -owned ship, registered in Liberia, with Russian and Ukrainian officers and a Filipino crew.

Looking at the piers of Eastport (Deborah Fallows)

Many elements in Eastport help you touch the whole world, in a hugely romantic way rather than the fearing and dark way in which many elements in our hometown touch the world. Ships heading for China; evening flights departing the east coast for early arrivals in London or maybe Paris, their lights flickering and their huge jet engines barely whispering in our ears.

Canada is right across the water; from Eastport, you see the island of Campobello, where Franklin and Eleanor Roosevelt spent summers with their family. Within a few days in August of 1921, FDR contracted a sudden series of symptoms that were finally diagnosed as polio. Eventually, he was ferried across the water to Eastport, and taken by train to New York. His dark-red house with the dark-green roof, surprisingly comfortably rambling, still stands at the top of lawns that slope down to the water. His small sailboat sits dry on the lawn. The trains have long since gone away.

Downtown Eastport this week, from its pier (James Fallows)

On land, workers are hammering at Eastport’s 1887 Masonic Block, owned by the Tides Institute, replacing the crumbling wood beams with monstrous steel ones to keep the building standing for two centuries more, at least. It’s worth the trouble to be sure that the west side of Water Street remains solid with its row of red brick buildings.

New steel beams going into the Masonic Block (Deborah Fallows)

Just uphill is the Peavey Memorial Library, which desperately needs some attention like the Masonic Block is getting so that more of Peavey’s bricks don’t crumble. Like many other public libraries, they are looking every which way to find the funds for this. There was a music festival behind the library all weekend, free but for library donations. There’s a thermometer drawn on a poster out front marking donations rising like degrees, and according to the Quoddy Tides, Eastport’s biweekly paper, a grant writer from Bangor, Maine, has been hired to seek money from outside Eastport.