LIANE HANSEN, host:
In the summer of 1608, Captain John Smith left Virginia's Jamestown colony to explore. He discovered a small, windswept, uninhabited island in the middle of the Chesapeake Bay. Today, some 500 people live there. When the weather permits, watermen go out on their boats to set crab pots or to fish. In the summer, tourists arrive by ferry to see the dozens of quaint homes.
But for the year-round residents, theres no hospital, no pharmacy, and medical care arrives by air.
Ready to go?
Dr. DAVID NICHOLS: Ready to go.
HANSEN: At least once a week, Dr. David Nichols pilots his helicopter from the parking lot of his family medical practice in Whitestone, Virginia - about 25 miles across the Chesapeake Bay - to Tangier Island.
HANSEN: How often have you made this trip, in your long years as medical man?
Dr. NICHOLS: I'm working on my 31st year.
HANSEN: I imagine there are days you can't make it.
Dr. NICHOLS: Out of the 52 weeks, we probably go 51. I found you got to be reliable. People depend on you. I've had people wait with chest pains and heart attacks and hip fractures and broken bones - counting on us being there, and I would feel awful if I didn't get there.
HANSEN: Dr. Nichols volunteers his time to care for his Tangier Island patients. The cost of medical supplies and transportation are partially covered by the nonprofit Riverside Health System, based in Newport News, Virginia. There's now a full-time physician's assistant on the island: Inez Pruitt. Her family dates back to the 1800s.
She meets the helicopter at the tiny airport, and accompanies Dr. Nichols for a house call on an elderly man, Richard Lake.
Mr. RICHARD LAKE: Do I know you?
Ms. INEZ PRUITT: I think you might know me. I'm just going to get your vital signs, Rich. One-ten over 68.
Dr. NICHOLS: That's good. It's a good blood pressure. Are you dizzy at all when you get up now?
Mr. LAKE: Not at all, doc, not at all. I guess (unintelligible).
Dr. NICHOLS: And are you taking that water pill I told you to take just once a day?
Mr. LAKE: Yeah, yeah.
Dr. NICHOLS: Richard had a problem with severe edema of his legs, so much so that the skin split, and we had to treat it so it would close up. The swelling is a lot better.
Well, you know, that fluid pill that we were giving you was drying your kidneys out so we had to cut back on it.
Mr. LAKE: Well, good.
Dr. NICHOLS: This looks really good. This looks better. So, what else was going on?
Mr. LAKE: And now I feel good all around, from my head to toe.
Dr. PRUITT: You're not eating pickles again, are you?
Dr. NICHOLS: Can't have any salt.
Mr. LAKE: No. No, I could eat pickled beets and watermelon, but I hold back.
HANSEN: What would it be like if Dr. Nichols was not here?
Mr. LAKE: Oh, I don't know.
HANSEN: It'd be tough.
Mr. LAKE: Sure would. No doubt about that. Takes care of me, all right.
HANSEN: Well, listen, you take care and rest. Thank you for letting us into your home.
Mr. LAKE: You too, ma'am. You're certainly welcome any time.
HANSEN: Dr. Nichols and Inez Pruitt walk over to their base of operation on Tangier Island, the Gladstone Memorial Medical Center. The white-clapboard, one-story house was built in the 1950s and is showing its age.
Dr. NICHOLS: This is one of three exam rooms, and it has wallpaper that's falling off the walls. It has a ceiling with many of the ceiling tiles off, and we had water leaking through there for a couple of years until the town could afford to replace the roof. So we didn't use this room during the rain. If you didn't know better, you'd think this was a torture chamber.
HANSEN: A little bit. And you had had problems with the water here? I mean, you had water that had bacteria?
Dr. NICHOLS: I would not drink the water in this building. The last person I know that did it was a former partner of mine that got very sick with diarrhea -and really, it was not good stuff to drink.
HANSEN: Dr. Nichols describes himself as a country doctor. The people on Tangier Island treat him as one of their own. Outside the clinic, the mayor, James Eskridge, pulls up on his motorcycle.
Mayor JAMES ESKRIDGE (Tangier Island): This doctor here has been a lifesaver for the island. Saved quite a few lives. Really been an asset to the island. My wife's been to him - and children, through the years.
HANSEN: What do you do when you're not the mayor?
Mr. ESKRIDGE: I'm a waterman. Being the mayor doesn't pay the bills.
HANSEN: So, you get on this little yellow motorbike, and you go around and make sure that everything's OK?
Mr. ESKRIDGE: Yeah, it's the mayor-mobile.
HANSEN: Your mayor-mobile?
Mr. ESKRIDGE: Yeah.
HANSEN: Well, it's swell to meet you. Thank you so much.
Mr. ESKRIDGE: Sure.
HANSEN: And good luck to your family.
Mr. ESKRIDGE: Yep. Nice talking with you.
(Soundbite of engine running)
HANSEN: Back at the clinic, Dr. Nichols describes the health problems he encounters on the island.
Dr. NICHOLS: I would say that the biggest concern has to do with their diet, arteriosclerosis, and their genetics. They have a very large preponderance of heart disease here. They also have a lipid problem here, where they have very little HDL cholesterol.
HANSEN: The good...
Dr. NICHOLS: The good one.
Dr. NICHOLS: And too much of the bad cholesterol, LDL. In fact, there are a few islanders that have a disease called Tangier's Disease, which is an extreme case of low HDL, or absent HDL - characterized by orange tonsils, yellow spleen and liver - but it's pretty rare. But that's just an extreme case of the problem here. There's so much heart disease here that, you know, you really have to be very preventatively oriented. You have to make sure people's cholesterol is correct, their blood pressure is controlled, that if they have diabetes, that that's controlled very tightly.
Even doing that the best you can, the amount of disease here is so high compared to the mainland.
HANSEN: The swampy and salted land on Tangier Island makes it nearly impossible to grow fresh fruit and vegetables. So residents eat more canned food, which tends to be high in salt. Dr. Nichols also says that genetics contribute to the high rate of disease.
Because generations of families have never left the island, many people are related to each other, by birth or by marriage. And Dr. Nichols says the islanders haven't paid much attention to preventative care.
Dr. NICHOLS: When I first came here, if it wasn't broke, don't fix it. The idea of treating blood pressure when you didn't feel anything was totally foreign. So explaining to them preventatively - you know, like, you change the oil in your boat, don't you? So you probably ought to do that with yourself.
HANSEN: The people that work here, a lot of them are watermen. There's not a lot of money for health care.
Dr. NICHOLS: Over the years, we have just kind of worked with patients. There's a lot of Medicare and Medicaid, and then there are a lot of people that just don't have the money. So, you just do the best you can. And our motive to being here is not to come home with a big profit center. It's here to help people that really need it, and this is my way of giving back and thanks for all the wonderful opportunities given to me, which a lot of people don't have, which is to be educated and to become a physician.
HANSEN: Four years ago, Dr. Nichols began the process of finding ways to finance the construction of a new medical clinic for the residents of Tangier Island.
Dr. NICHOLS: I am very fortunate to have a friend who's a patient of mine, named Jimmy Carter - not the president. And he is a real estate developer, and he and I are friends. And I said, let's go to lunch somewhere. And he said, well, yeah, let's go to Tangier.
So, we flew over to Tangier in my helicopter and he said, well, I'd like to see your clinic. So we went over to the clinic and I said to him - as I was walking there - you know, Jimmy, before I leave Tangier, I hope that one day we can have a brand-new facility that will be more state-of-the-art. He walked in, he looked around, and he said, David, you really need a new clinic.
And with his great skill and connections, we were able to raise funds for a brand-new clinic.
HANSEN: They received financial help from the government as well as private donations to cover the $1.3 million cost of the new clinic. It's at least five times the size of the old one. It's still under construction, and is scheduled to open next month.
(Soundbite of footsteps)
HANSEN: Let's step over the sawhorses and...
Dr. NICHOLS: And we're just going in the front door here.
Dr. NICHOLS: The waiting room.
HANSEN: Wow. That new paint smell.
Dr. NICHOLS: That's right, yeah. You can see it's not dark and dingy, like certain other buildings we've been in today.
(Soundbite of laughter)
Dr. NICHOLS: And there's a sense of color coordination.
HANSEN: And there's good water.
Dr. NICHOLS: Yep.
HANSEN: Clean water. This is phenomenal. You must be over the moon with this place.
Dr. NICHOLS: You can see the difference.
HANSEN: Oh, yeah - can smell the difference.
Dr. Nichols helped to establish the Tangier Island Health Foundation, a nonprofit group that is raising money to keep the new clinic operating. But there will come a time when he will decide to hang up his stethoscope for good.
Dr. NICHOLS: Don't write me off yet. But eventually, you know, it's going to come a time when I'll retire and hopefully with them in place, and with Inez and her successors, this will be an ongoing process. All I can say is, it's worked for 31 years and it ought to continue - I hope.
HANSEN: You're listening to NPR News.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.