JACKSON, Miss. — Four days before Christmas, Chiquikta Fountain watched as a growing line of cars stretched down a mile of road in the Mississippi Delta.
From her vantage point, it seemed like every resident in the rural town of Shaw was en route to the holiday meal giveaway at Delta Hands for Hope, a nonprofit she runs to support the area’s children.
The Dec. 21 event was meant to be a cheerful affair, despite the desperate need. Hams had been purchased from a mom-and-pop grocery store. There were bags of freshly picked greens, potatoes and onions for sides. With schools on winter break, volunteers tucked cereal and cases of orange juice into bags to help tide over families with children into the new year.
There were only 140 meals to distribute in the town of roughly 1,700. The meals were meant for a group of families and senior citizens who have relied heavily on the nonprofit for weekly assistance. But word spread quickly and it soon became clear that the food on hand wouldn’t be enough.
As supplies dwindled, the group began passing out the remnants. Produce for one person, a few boxes of cereal for another.
“To have to turn these families away,” Fountain said, “I can’t even describe what it felt like to you to do that.”
Before the pandemic, Bolivar County knew hunger. Almost 40 percent of its residents live in poverty. In areas like Shaw, trying to make ends meet has become even more fraught as the county struggles with the highest Covid-19 infection rate in the Mississippi Delta.
Weekly case counts in December have surpassed the peak of the county’s summer surge, when so many fell ill that the county coroner asked the board of supervisors to purchase an extra refrigerator for fear he would run out of space to store the dead.
That the recent surge has so far claimed fewer lives compared to previous peaks has left little room for comfort. Cases in the county quadrupled in the weeks after Thanksgiving.
Statewide, hospitalizations for patients with the virus spiked, plummeting the number of available intensive care unit beds in the state’s rural areas and larger cities alike. By the third week of December, Bolivar Medical Center in Cleveland, the county’s only hospital, ran out of ICU beds, a situation that could recur as cases rise.
L. Nicole Stringfellow, who leads the Mississippi Delta office of Together for Hope, a nonprofit that assists the country’s poorest rural communities, has heard concerns about people with pneumonia showing up at hospitals only to be sent home with instructions to monitor their symptoms.
Caitlyn Thompson, a spokeswoman for Bolivar Medical Center, acknowledged that the hospital had seen an increase in patients, but said its admitting and triage practices had not changed.
The Covid-19 crisis has compounded existing health care challenges in Bolivar County: Almost 1 in 6 residents are uninsured and more likely to put off treatment as a result, and there is a shortage of medical providers.
Unlike major cities where people can access public transportation, residents without cars in rural areas like Shaw have few options for getting to medical appointments. Almost 1 in 8 households in Bolivar County lack a car, making carpooling for errands common.
Nurse practitioner Nora Gough-Davis owns Shaw Family Medical, a clinic that offers home coronavirus testing for patients without the means to come into town. Some patients feared exposing their loved ones to the virus if they asked for a ride.
Several times a week, Tracy Hall, a nurse at Shaw Family Medical, dons a surgical gown, mask, face shield and gloves and enters a home. Sometimes, she sees a patient lying on a couch, barely able to move as she swabs.
Every morning, her husband gives her the same goodbye.
"Babe, be safe."
On the way to work, she says a prayer in her car. On occasion, patients have asked her to pray that their tests come back negative.
She understands their fears. In Bolivar County, the fallout from the virus has been particularly pernicious. Three out of every 1,000 residents in the area have died from Covid-19. Only a handful of communities in Mississippi — several of them, like Bolivar, predominantly Black and in the Delta — have lost more.
Before Mississippi’s state health officer uttered the words “hot spot,” before the local hospital ran out of ICU beds, health outcomes for Black residents in Bolivar County were already troubling.
The consequences of a shortage of health care providers in the Mississippi Delta have been evident for decades. Shorter lives. Higher rates of amputations. Stringfellow said political leaders haven’t paid enough attention to these disparities. The pandemic, she said, makes it harder to look away.
She pointed out that four years ago, the State Health Department shut down one of the two state-run medical clinics in Bolivar. A steep drop in patients was cited as the reason, but Stringfellow said the health care needs in the region remain high.
“How do you catch those areas up?” she asked. “True access to health care.”
The current state of public education, economic opportunity, housing and health care in the region, all beleaguered in their respective ways, she argues, are “putting a Band-Aid on open-heart surgery.”
While the rollout of Covid-19 vaccines has brought a note of hope for many front-line workers, physical health is only one part of the battle. The mental trauma that accompanies persistent poverty in the Delta has escalated as families struggle with the fallout of the pandemic.
“It’s like working in a funhouse mirror,” said Nadia Bethley, a psychologist with the Delta Health Center, a nonprofit that provides health care to low-income patients on a sliding fee scale. “Things weren’t great before. Now, they’re distorted and worse in a lot of ways.”
She feared for her patients leading up to the first Christmas some would experience without their loved ones. She worried about those who were already isolated becoming further detached, like many others around the world affected by this pandemic. Patients who loved attending church services and socializing before and after sermons didn’t feel the same connection online.
Others have survived the virus only to feel challenged cognitively, almost like they had a stroke. Bethley said they want to know if they’ll fully recover.
“Having to sit with people and hold space for that kind of uncertainty, shrugging my shoulders, like ‘I don’t know either,’ those are the kind of things that have hit hard the most,” she said.
Many of her patients have found their livelihoods in limbo.
“Family members who were the primary breadwinners are now dying,” Bethley said. “Do you go to work and put yourself at risk, or do you become homeless or starving?”
Job security remains fragile in the community. Half of the residents make less than $30,000 per year. And although Cleveland, the county seat of Bolivar, is a university town, which brings economic activity, good jobs are scarce enough that some residents travel across state lines for work. For two years, dozens of residents have gathered daily outside the county’s Walmart, one of the few grocery stores in the area, waiting for charter buses to ferry them to Memphis, Tennessee, two hours away, to work at a FedEx hub, where some workers make upwards of $18 per hour.
The county’s unemployment rate, which climbed to double digits in the summer, has since improved, but remains higher than this time last year.
Caressa McKay, a single mother of five in Shelby, a small town in Bolivar County, was laid off from her job at a day care center in June. She’s since found another job, but she still has to skip a phone bill or an electric bill some months to make sure her children have enough to eat.
The public assistance she receives is “not enough to constantly keep food on the table,” she said. Meals dropped off by her local school district help, but with her children home all day for remote schooling, they need more food.
“They have to eat,” she said. “I have to do what I have to do.”
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Mississippi state Rep. Abe Hudson Jr., a Democrat who lives in Bolivar County, said workers have been hit hard as local businesses struggle to stay afloat.
The people who are seeking help, he said, run the gamut from middle-class professionals now stretched thin to elderly residents hesitant to enter grocery stores.
“You don’t realize the degree of need until you go out to some of these food distribution events,” Hudson said. “It’s a constant reminder of the fact that people are not getting paychecks.”
That reminder is never far from Fountain.
The nonprofit she leads, Delta Hands for Hope, previously served as a tutoring site for students and assisted with volunteer projects. Last spring, the center began operating an emergency food pantry.
But now, the food bank’s future is in question. Recently, the nonprofit went from receiving 800 boxes of fresh food twice a month to none.
The U.S. Agriculture Department’s food box program had changed its funding rules and declined to renew a contract with the farm that had been supplying Delta Hands for Hope.
Fountain’s group now uses a private grant to buy food from a corporate restaurant supplier with the goal of feeding at least 140 children and senior citizens in Shaw per week. She’s unsure if the funding will carry them past spring break.
Occasionally, she receives an alert that a church or a food bank in the region has enough to share. The group rents or borrows a truck to pick up the food.
“The biggest question is, ‘Are we going to remain an emergency food pantry?’” she asked. “What happens when those funds run out?”