When Ruby Evans Moss called on Dr. Marlo Paul this spring, the schoolteacher had nowhere to turn. Her husband, Adolphus Moss, a deacon and office employee who farmed in his spare time, was hospitalized with COVID-19.

Moss was told to quarantine at home despite feeling ill because her rural hospital had run out of tests and PPE. Her primary care doctor’s office was shuttered and the nearest city hospital was a 70-mile drive from her tiny Alabama Black Belt community of Bellamy.

Within days, Moss tested positive for COVID-19 at a mobile testing unit, as did her two sisters, a cousin, her best friend’s husband, and a co-worker. A few days later, her husband passed away.

“It was happening so fast,” said Moss. “So many of our family members, friends, and neighbors getting sick.”

As the virus engulfed her community, Moss was visited by Dr. Paul and her husband Anthony, a retired plant biologist. The couple, who run a medicinal herb farm and wellness center in the region, drove 50 miles from their farm in Sawyerville to check on Moss. Dr. Paul, who is the only Black female doctor within three neighboring counties, took Moss’s vitals and offered health tips, then the Pauls gave her a generous supply of an herbal supplement they produced on their farm. They also provided the supplement to several of Moss’ family members and the doctor phoned her daily to offer support and monitor symptoms—all without charging her a penny.

Dr. Marlo Paul gives Ruby Evans Moss a virtual hug during a recent home visit.

In recent months, COVID-19 has battered the rural South, disproportionately affecting African Americans like Moss and her friends and family, and stretching already thin health care resources. The Pauls have aimed to fill the gap, making approximately 200 home wellness visits thus far to those ill with the virus in a region saddled with some of the worst COVID-19 infection rates. They don’t charge for the visits, the herbs, or the after-care calls. And, so far, all the patients they’ve served have survived, the couple said.

“They were there for me mentally and physically,” Moss told Civil Eats. “It was just a blessing that God sent these people.”

Disparities Lead to Climbing COVID-19 Cases

The Pauls’ 116-acre farm lies on a gentle slope surrounded by woods in Hale County, the heart of Alabama’s Black Belt. While the land is bucolic, life in the region is harsh. The Black Belt, known historically for its rich black soil, cotton production, and predominantly African American population, continues to be defined by the legacy of slavery. With some of the highest poverty rates in the nation, the region’s residents face unemployment or under-employment and meager access to education and medical care—conditions ripe for the coronavirus to spread unfettered.

Most of the farmland in the Black Belt is still owned by white people, while African Americans are employed in marginal jobs in housekeeping, trucking, manufacturing, food processing, and agriculture.

While rural communities are remote and isolated—often a good thing when it comes to fighting coronavirus—many Black Belt residents are essential frontline workers who commute to nearby cities, where they’ve been exposed.

While the rural communities are remote and isolated—often a good thing when it comes to fighting coronavirus—many Black Belt residents are essential frontline workers who commute to nearby cities, where they’ve been exposed. And because most people in the area live in cramped trailers or mobile homes—often in multi-generational families—the virus has spread quickly among relatives.

Thirty-seven percent of Alabama’s COVID-19 cases and nearly half of its COVID-19 deaths have taken place among the state’s Black residents, despite the fact that they make up only a quarter of the state’s population.

Alabama, which like other Southern states reopened early (including bars and dine-in restaurants), has seen a spike in cases since Memorial Day. As of last week, cases have continued to climb, hospitalizations were at an all-time high, and ICU beds at an all-time low. More than 1,000 people in the state have died.

“The numbers of positive cases rose very slowly in our area because there wasn’t adequate testing,” said Pamela Madzima, Alabama state coordinator at the Federation of Southern Cooperatives, which represents Black farming cooperatives. “As testing expanded, the numbers [in the Black Belt] quickly doubled and tripled. We’re still seeing high numbers . . . even though the state has opened up.”

Before the pandemic, Black rural residents grappled with high rates of chronic health conditions such diabetes, hypertension, asthma, and high blood pressure. Now, many of those same conditions have put them at increased risk of severe illness from COVID-19.

“What COVID-19 did was really reveal the underlying health problems of people in our Black Belt counties and exposed the great health disparities between Black and white,” said John Zippert, chair of Greene County Hospital System board of directors. Those disparities exist partly because about 40 percent of the population is uninsured, Zippert said, because lawmakers in Alabama—like other Southern states—chose not to expand Medicaid under the Affordable Care Act.

“What COVID-19 did was really reveal the underlying health problems of people in our Black Belt counties and exposed the great health disparities between Black and white.”

Moreover, Alabama’s Black Belt counties and others near them have long been the dumping grounds for various industries. Those who work in plants and factories are also in contact with pollutants and dangerous chemicals. As a result, large numbers of relatively young people in the region have bone and pancreatic cancers, heart attacks, and strokes, said Marlo Paul. And a recent Harvard study found that even a very small increase in the amount of pollution a community is exposed to over the long term can lead to a large increase in the COVID-19 death rate.

On top of those issues, access to healthcare in the Black Belt is abysmal, said Paul. At least seven rural hospitals have closed over the past decade and, of the ones that remain, 88 percent operate in the red. Many rural hospitals and clinics are unable to afford even basic necessities, including gloves, masks, or coronavirus tests, not to mention ventilators. “There are no specialists and the hospitals are not equipped to do most of what people need,” said Paul.

Due to this lack of resources, Paul said, hospitals and nursing homes there have turned away very sick COVID-19 patients. Those patients are forced to make it on their own or drive long distances to a larger hospital.

There’s also a dearth of information about the virus in the region, said Anthony Paul. “The schools, the churches, and the clinics are closed,” he said “There is no education, and the people in this area don’t understand the virus.” Some don’t have broadband or even a consistent phone signal, he added. As a result, people may not know how the virus is transmitted; rumors and conspiracy theories abound. Some believe the virus won’t hurt them and go about their lives as usual, while others wear their masks even to sleep, compromising their ability to breathe.

Growing Herbs to Thwart Disease

These socio-economic and health disparities have inspired the Pauls to work for change. And their farm has become a vehicle for much-needed healing in the region.

As a student and later biology professor at Oakwood University in Alabama, Anthony founded the National Association for the Prevention of Starvation (NAPS), a nonprofit Christian-based relief organization that worked with the Federation of Southern Cooperatives, supporting African American farmers in the Black Belt and seeing first-hand the challenges faced by residents of the rural South. “The poverty, the health disparities, and the problems faced by Black farmers really stuck in my mind,” he said.

Marlo Paul used to have a private practice in northern Alabama. On weekends, she offered free clinics in the state’s Black Belt counties. The couple eventually decided to focus full-time on helping rural Black communities. Ten years ago, they left their jobs and bought land about 40 miles south of Tuscaloosa, naming it Eden Land Farm.

At first, they grew vegetables and Anthony led local NAPS volunteers in building a wellness center on the farm and a clinic and school in a neighboring county. Marlo, who serves as NAPS’s medical director, began to work at two clinics in the state’s poorest counties. “This work brought me back to my true calling as a physician,” she recalled. “It was not to make a lot of money, but to help those who need it the most.”

As she witnessed the extent and broad range of illnesses in the Black Belt, Marlo came to realize that conventional medicine wasn’t working for most of her patients. Instead of leading them toward recovery and disease prevention, she was temporarily patching up problems. It was then that the Pauls started working with a more holistic approach to healing, including promoting lifestyle changes and growing herbs that could counter disease.

Today, the Pauls grow about 30 herbs on the farm; some start from seeds in the greenhouses and others are perennials that permanently grow on the property. Instead of using pesticides and herbicides, they keep 50 sheep, 10 cows, and 30 goats, and use the manure to fertilize the soil (the farm is not certified organic). They source drip irrigation from rainwater.

To develop their line of herbal supplements, the Pauls merged their medical and plant biology skills to search for potent plant-derived ingredients that power conventional medication. Willow bark, for example, contains salicin that the body converts into salicylic acid—a pain reliever and anti-inflammatory agent that has been modified by chemists into modern-day aspirin.

They also rely widely on plants considered medicinal around the world, with scientific research backing, including moringa oleifera, widely used in Southeast Asia to remedy diabetes, joint pain, and other maladies, hibiscus, popular with healers across the globe for its antibacterial, anti-diabetic and anti-hypertensive effects, ligustrum (privet) plants, used in Chinese medicine to prevent and cure hepatitis and chronic bronchitis, and the mimosa plant, employed in Indian Ayurvedic medicine to treat everything from diarrhea to dysentery and bleeding.

When traveling internationally on medical missions with NAPS, the Pauls have also spoken with local medicine men and women about the herbs they use. And they’ve interviewed African American elders in the Black Belt about popular plant-based remedies used there. That’s how they came across mullein (verbascum thapsus), traditionally used in the South to treat respiratory problems, aches, and arthritis. Another local discovery was osage orange, also known as maclura pomifera or the hedge apple tree, omnipresent in the Black Belt and used as an anti-inflammatory medicine. Some scientists believe the bitter plant could be an alternative cancer treatment.

“Old folks are dying off and the next generation has no knowledge of plants because they have not relied on home remedies.”

“If you don’t use it, you’re going to lose it,” said Anthony. “Old folks are dying off and the next generation has no knowledge of plants because they have not relied on home remedies.”

The herbs are picked fresh, freeze dried, and packaged on the farm. The supplements are sold online, but the Pauls also distribute them locally free of charge, said Anthony. Prior to the pandemic, the couple also hosted health seminars and ran retreats.

Their herbal supplements are not a replacement for western medicine, the couple said. But they can help support healthy outcomes, especially when coupled with lifestyle changes. The U.S. Food and Drug Administration (FDA), which regulates dietary supplements—including herbal ones—does not require that they be tested or approved prior to being sold. “Federal law does not require dietary supplements to be proven safe to FDA’s satisfaction before they are marketed,” says the agency.

The rapid spread of COVID-19 among Black Belt residents refocused the couple’s work, said Marlo, leading her to assemble an all-volunteer medical team to make house calls, including nurses, medical assistants, volunteer missionary school students, and her husband. The team drives to the homes of those impacted by the virus, many of whom live in isolated areas, with the doctor checking temperatures, oxygen saturation, and listening to patients’ lungs. They also distribute the herbal supplements to all household members. Marlo shares health tips: drink a lot of water, do moderate exercise such as walking, get adequate sleep, and avoid sugar. She also prays with the patients.

“During the pandemic, our main objective is to keep people out of the hospital,” she said. “Those who go to the hospital usually don’t make it.”

Resilience and Hope

Ruby Moss recovered at home within a few weeks of getting COVID. Since her husband’s passing, she now lives alone in a remote wooded area with few other houses around—so she’s thankful that the Pauls checked on her in person when no one else did.

“You don’t have too many doctors who do that kind of stuff,” said Moss.

Now, she’s worried for her neighbors’ health as well as their economic well-being, given that the pandemic has wiped away jobs in a region that was already economically depressed. Moss lives in Sumter County, which is two-thirds African-American and carries the distinction of being Alabama’s poorest county, with a poverty rate of 36 percent. “Our community is dying out,” she said, “but not just because of COVID. People can’t find work, schools have closed, people don’t have enough to eat. It’s just been rough living here.”

Zippert of the Greene County Hospital System said the work Marlo and Anthony Paul do is a great service to the community. “They’re providing care to people who desperately need it,” Zippert said. But the Black Belt deserves a lot more access to care to relieve its health care inequities, he added, and that can only be accomplished through systemic change, namely expanding Medicaid.

Without health insurance, tens of thousands of people in the state’s rural areas don’t see a doctor on a regular basis, can’t afford medication, and end up with chronic, advanced stages of preventable diseases such as cancer, hypertension, or asthma—all co-morbidity factors when it comes to COVID-19.

“People have these conditions because they don’t have insurance. And if they catch the coronavirus, they get sicker and are more likely to die,” Zippert said. “It’s an injustice, and for people in places like the Black Belt, where there’s historical poverty, the impact has been much worse.”

Southern states’ refusal to expand Medicaid has impacted not just individuals, but also strained the health care system, Zippert said. The Greene County Health System spends $100,000 per month on uncompensated care, destabilizing its finances. It has stayed afloat due to revenue from electronic bingo machines, but it has just two doctors and can’t afford to bring on another.

Because chances for Medicaid expansion in Alabama are small—Republican Governor Kay Ivey has refused to consider it—and COVID-19 cases in Alabama and across the South are continuing to rise, the Pauls are working to expand their home visiting service to neighboring Mississippi, where a recent spike in cases has battered local health care facilities. NAPS is also working to build a clinic in that state.

They’re also working with the Federation of Southern Cooperatives to start a telemedicine program. But it won’t be easy, given that much of the area lacks reliable, affordable broadband.

Despite the despair of rural poverty and the scarcity of medical care, Anthony said he is continuously awed by Black Belt residents. “People here have that thing called resilience,” he said. “It’s something mysterious and spiritual.”

For Marlo, who recently learned that her great-great-grandmother was a freed slave from Itta Bena, Mississippi, working in the Black Belt has turned out to be a homecoming of sorts.

“I’m serving my brothers and sisters,” she said. “It’s a very rewarding thing.”