Rural healthcare in the spotlight in Georgia director's film 'The Only Doctor'

Caption

Doctor Karen Kinsell (right) meets with a patient in the film 'The Only Doctor'.

Credit: Courtesy

A film set in southwest Georgia sheds light on how hard it can be for people in rural communities to find quality, affordable health care. The Only Doctor profiles Doctor Karen Kinsell, whose Clay County clinic is a lifeline for poor residents of one of Georgia's unhealthiest counties. And she's worried about what happens when she's gone. The film airs on GPB TV Monday, April 29 at 10 p.m. on Reel South. Director Matthew Hashiguchi spoke with GPB’s Peter Biello.

Peter Biello: How did you first learn about Doctor Karen Kinsell and what she's been doing there?

Matthew Hashiguchi: I learned of Doctor Kinsell in an article that I read. I had been researching maternal mortality health and she did an interview on maternal health in rural regions. And this was when I was trying to figure out the next film to make, which was on maternal health. And what she had discussed wasn't just maternal health but was access to everything regarding health and how that impacts outcomes. And in rural regions, it's especially bad, especially in Georgia.

Peter Biello: For this film, you had access to several of the meetings between Doctor Kinsell and her patients. I'm sure you met with many more that didn't make it to the film. How would you describe the overall health of the people in Clay County, Georgia?

Matthew Hashiguchi: Clay County I would describe as a very, very unhealthy place and has been rated as one of the unhealthiest counties in Georgia. What surprised me the most was the poor mental health that people were experiencing. And then, of course, how mental health is connected to physical health. So I would say that nearly every single person that I had spent time with or interviewed or filmed with had some sort of mental health struggle, which was then causing a physical issue or vice versa. People had physical health issues, which was then impacting their mental health, but an unbelievable amount of people were struggling with mental health problems and [had] no one to help improve those problems.

Peter Biello: Doctor Kinsell used her inheritance essentially to fund her services. She says she sought out the most underserved community she could find, and that's how she landed there. And she basically spent down her inheritance caring for these people. But how did she make ends meet while giving this care away for basically nothing?

Matthew Hashiguchi: Well, she really survived on her inheritance and use that inheritance to help support the practice. So she's in no way a replicable model in the United States for health care. When we started filming—I didn't notice when we started filming---she had she had sort of reached the end of the line and had run out of money and needed to find some sort of other option to help her stay open. And during the pandemic, there were some positives for her and medical practices during the pandemic where she was able to see more patients through tele-health. And that helped increase the number of patients that she was able to see, and then helped increase the number of reimbursements that she got from Medicaid or Medicare or private insurance. So, from what I observed, she was really scraping by every day trying to figure out .'How do I keep this place open?' And that's the storyline that we followed was, 'How is she going to keep this place open?'

Peter Biello: The film ends with a question. It's a question that you have asked during this interview. Doctor Kinsell puts it at the end: What do you do with the poor people? Meaning: What's it going to take for a for-profit health care system to start caring for people who are costly to care for?

Matthew Hashiguchi: Right. And I don't think there's any one single simple answer to this problem. And what I've learned is that it's going to take many things. And Medicaid expansion is the big talk of not just the state, but the country where it hasn't been adopted. But that doesn't solve the problem. It may help the problem. But in a place like Clay [County] and other rural regions, not just in Georgia but the United States, you can't get doctors to come to these regions. So even if we had Medicaid expansion, even if fees were lower, what's going to convince a doctor to go to the middle of nowhere to live a particular way of life that they may not want to live? They have the option of going to a city and being surrounded by museums and sporting events and parks and grocery stores. You really need someone specific who will be willing to go to a rural place, and that's part of the problem. We just can't get people to go to rural regions. Which is unfortunately leaving a huge part of our country without health care.

Peter Biello: I've been reporting for almost two decades, and the percentage of people I have met who are truly inspirational, who are actually doing something good for their community at great personal cost because they want to, because it makes them feel good—that's a very small percentage for me over my career. Maybe it's just who I happen to have run into, but I imagine for you, given the way you've portrayed her in this movie, Doctor Kinsell is one of those people for you.

Matthew Hashiguchi: You know, I think it was exhausting for me to watch her work because so much throughout the filming of this, people are asking, what does she do other than health care? Or what does she do other than being a doctor? And she really doesn't do almost anything outside of health care. She is a doctor 24 hours a day, seven days a week. She gets calls on the weekends, at night, random times, from residents and patients asking for help. And I was just sort of in awe of her willingness to do whatever it took to do what was right in her eyes. And she kind of operated by her own rules and standards and whatever the patient needed that's what she did. And that got her in trouble at points in her career where, you know, she did something for a patient and that may have gone against policy—the policy of the clinic or the hospital. And that got her in trouble. So I think something that was really interesting to me is that her goal was to help the patient and to help the person. And our health care system just is not set up to prioritize the patient. It's set up for profit, and she really went out of her way to do whatever was best for people and for their health care. So I was just really impressed that she had this mission, and she stuck to this mission, and she was knowledgeable of that. And she really didn't stray from that mission. And she really kind of stuck to her principles throughout and continues to stick to those principles.

Peter Biello: What is she doing now? Is the clinic still open?

Matthew Hashiguchi: The clinic is still open, yes. And she's kind of kind of venturing on to another stage in life where she's starting to reduce her the amount of time that she can spend at the clinic. And she's now purchasing up properties around Clay County and rehabilitating them into affordable housing for poor and low-income residents. So she still has this mission of serving the poor and serving those that are underserved. It's just in another arena. But I think she's getting ready for retirement. I think her health is struggling a bit. So that region is soon going to be facing another question of who is going to provide health care for this region.