In the counties of northeastern North Carolina, where the base average income is 40% below that of the western counties, health care needs far outstrip medical services.  The NC Area Health Education Center (AHEC) recommends one doctor to serve 750 people, but the ratio in some NC counties is closer to 1:3750.  The North Carolina "Black Belt" is in the worst 4% of 202 health service areas in the U.S. in terms of health factors such as infant mortality and life expectancy.

The North Carolina Student Rural Health Coalition (NCSRHC) was initially founded in 1978 and for eight years provided two-week health fairs to different North Carolina communities.  The health fair model brought important medical services to poor and powerless communities, but it could not adequately redress the health care problems seen in this region.  Thus, the free clinics were founded, first in Fremont and Tillery in 1987, and the list has now expanded to include Bloomer Hill, Garysburg, Warsaw, and Shiloh. Except for the Warsaw clinic, each clinic is organized by the local Community Health Committee (CHC) in conjunction with area health schools, as follows:
 
 

Since their foundation, the clinics have provided needed medical care to over 17,000 patients, and have provided wonderful educational opportunities for over 2,000 students. In addition to supplying on-the-spot medical care, the clinics have referred many people to doctors and hospitals in their counties, enabling them to speak more confidently and effectively about their health symptoms and problems.  Furthermore, the experience of community organizing gives the people in the rural communities we serve a sense of control in their lives.

The statewide Coalition is involved in numerous activities that go beyond the monthly free clinics. These include statewide efforts in preventive medicine, new successes in our ongoing effort to provide inexpensive medical care to the members of rural communities, direct interventions in occupational health, and training programs for rural youth. Examples include:
 

• The Healthy Churches program is a statewide effort in preventive medicine in which lay members of rural churches are trained to screen for diabetes and hypertension as a way of catching these progressively damaging diseases earlier on, when treatment is more effective. Currently involving the lay members of over twenty rural churches, this project is expanding this year to include monthly educational talks at the Fremont clinic for patients diagnosed with these conditions.
 
• As the result of ten years of planning on the part of the Coalition and the Community Health Collectives, the Medications Cooperative will deliver free or discount medications to patients seen in our clinics as a way of further reducing the expense of medical care. Working through the generous donations of community physicians and pharmaceutical companies, the Medications Cooperative is based out of a pharmacy in the Bloomer Hill clinic but will provide medications to each clinic upon community request.
 
• The Coalition also runs an Occupational Health Work Group which addresses the occupational health needs of all the communities we serve. Occupational health issues are particularly important to the population served by the Coalition since many work in factories or on farms where their rights as workers have historically been abridged.
 
• Finally, one of the cornerstones of the Coalition's mission is encouraging young people from rural communities to enter the health professions in the hopes that they will return to their communities with much-needed expertise. The Pre-Health Careers Interns program involves selecting promising youth from the communities we serve and in addition to involving them in the clinics organization in a number of capacities, giving them mentoring experiences at health professions schools throughout the state.