Mississippi Today

‘These people were never given the chance to catch up’: Inside the diabetes belt of rural Mississippi

Published

2 years ago

December 20, 2023

Melvin Jones, a 64-year-old native of Cleveland, was in his 30s when he was diagnosed with diabetes. He knew he was at an increased risk because of his family history.

In 2013, at 54 years old, Jones had two toes on his right foot removed and would later lose the big toe on his left foot. He didn’t know it then, but he had peripheral artery disease, or PAD, a condition where plaque builds up in peripheral arteries – those that do not supply blood to the heart or brain – and restricts circulation. Without treatment, a patient will continue to need further amputations and will die young.

One doctor told Jones he would likely need to amputate his entire foot – but Jones, whose condition made him retire early from his job at Baxter Pharmaceuticals, was resolved not to let that happen.

“I thought ‘I don’t want that,’ and me and the doctor were through,” Jones said. “It would have changed my life. I already can’t drive my truck no more.”

But many diabetics in rural Mississippi don’t have access to the care Jones went on to receive to avoid further amputations. Diabetes and the cardiovascular problems it causes are often asymptomatic at first, or symptoms are obscure. A lack of specialists coupled with some of the lowest social determinants in the country leave regions like the Delta prone to late detection of diabetes and a high rate of amputations.

Now, Jones goes to cardiologist Dr. Foluso Fakorede’s Cleveland clinic, Cardiovascular Solutions of Central Mississippi, for regular wound care from a nurse practitioner who travels to the clinic every Thursday from Oxford.

His life is different now, but he’s thankful he can still move around and hasn’t had to undergo a major amputation, which, for legs, is characterized as any cut above the ankle joint.

Mississippi is the only state with every county represented in what is called the “diabetes belt” of the U.S., which spans an upward arc from the deep South to Appalachian states, according to the Centers for Disease Control and Prevention.

Fakorede said academic institutions should be investing in the region through medical research, but it’s not an attractive market.

“I’ll make the argument that it should be,” he said. “Because these people were never given the chance to catch up. And now we’ve left them to suffer in isolation and in pain.”

With 14.8% of its adults diagnosed with the disease, Mississippi is second only to West Virginia in prevalence.

Uncontrolled diabetes, which runs rampant in rural and underserved areas, can lead to blindness, kidney failure, high blood pressure, high cholesterol, heart attacks, strokes and gangrene.

Mississippi, one of 10 states that has not expanded Medicaid, is the fifth highest uninsured state. In Bolivar County and several other Delta counties, at least one in five residents have medical debt in collections.

About one in three diabetics over the age of 50 will develop PAD, which often goes undiagnosed and untreated in medical care deserts like the Delta.

When it is caught, doctors often have an “amputation-first” mentality, which results in the loss of limbs and early mortality – despite the fact that a procedure exists to clean out the arteries of a PAD patient and restore blood flow to extremities.

Within five years of an amputation, diabetics stand a good chance of being dead. Nationally, Black patients are four times more likely to suffer diabetes-related amputations than white patients.

“It’s a death sentence,” Fakorede said, “and it’s very often preventable.”

The procedure capable of decreasing a PAD patient’s odds of amputation by 90% is called an angiogram, an invasive diagnostic imaging test that detects arterial blockages. Revascularization is the therapeutic procedure that cleans out those arterial blockages.

Jones received five angiograms and revascularization procedures in both his legs over the course of the last two years.

The number of angiograms a diabetic patient with PAD will need depends on a number of risk factors such as age, race, hypertension, heart conditions and habits such as diet and tobacco use.

In the U.S., more than half of patients never receive an angiogram or revascularization procedure before a major amputation.

At his Delta clinic, Fakorede, the only cardiologist in Bolivar County, estimates that the number of amputees who never had an angiogram is close to 90%.

Dr. Foluso Fakorede follows up with patient Joann Moore at Cardiovascular Solutions of Central Mississippi in Cleveland, Miss., Wednesday, Nov. 29, 2023. Credit: Eric J. Shelton/Mississippi Today

Fakorede, who was born in Nigeria and spent his teenage and young adult life in New Jersey, struggled to justify moving to Mississippi and opening his own clinic. He knew nothing about the place and had never operated his own business. But when he saw how great the need was in the Delta for a procedure he was skilled at, he knew his mind was made up.

“You walk through Walmart or Kroger here,” Fakorede said, “and I promise you you’ll see someone who has had a limb taken off or a dialysis catheter around their neck.”

In the end, Fakorede said the Delta proved to be far more similar to his hometown in Nigeria than he thought. They are regions that, for the majority of residents, reflect nothing of their country’s wealth – despite the rich resources they provide that contribute to that wealth.

“That is actually what made me stay – that similarity,” he said.

In the Delta, Fakorede explained, there are a number of socioeconomic factors that contribute to what he calls “the perfect storm” and leave people at a greater risk of chronic and life-threatening conditions.

Studies have shown that the body’s inflammatory response to chronic stressors like poverty, food deserts and unemployment – all of which pervade the Delta – can accelerate diseases like PAD.

Fakorede believes that a large part of the problem is inadequate screening measures. The United States Preventive Services Taskforce, or USPSTF, is the governing body that doctors look to for recommendations on who to screen for which conditions.

The USPSTF has not endorsed a screening for PAD, despite the fact that the five-year mortality for undiagnosed or untreated PAD patients is higher than that of breast cancer and prostate cancer, and studies have shown minorities are disproportionately affected.

“That is atrocious,” Fakorede said. “These patients have existed for decades. We know that this disease is destroying them because it’s taking them out of the workforce. It’s taking them out of their homes. They’re ending up in caskets early on.”

Meanwhile, Ozempic shortages are sweeping the nation as doctors prescribe the FDA-approved, weekly Type 2 diabetes medication to patients without diabetes for weight loss.

In Mississippi, nurse practitioner KC Arnold, director of the Ocean Springs Diabetes Center, witnesses the shortage daily.

“Every single day I’m getting a call: ‘hey, my pharmacy can’t get this,’” Arnold said. “In all my years of helping people with diabetes, this has been the biggest challenge for me to help people get what they need.”

Arnold’s facility is nurse practitioner owned and run – a rarity in Mississippi, where restrictive and expensive collaboration agreements limit the freedom with which nurse practitioners can operate.

Ozempic has a weight-loss version called Wegovy, but it isn’t covered by Medicare, so doctors will sometimes prescribe Ozempic in its place. The Mississippi Board of Nursing has guidelines that prohibit nurse practitioners from prescribing the weight loss drugs off label. But that rule doesn’t apply to doctors.

Arnold says she supports insurance companies covering a drug that addresses obesity. But until that happens, doctors shouldn’t be prescribing Ozempic to patients for weight loss.

“I can’t get the medicine for my patients with Type 2 diabetes,” she said. “Insurance needs to change to help people with weight – I’m all for that – but right now my patients with diabetes need medicine they’re not getting.”

And the drug isn’t just prescribed to people with diagnosed obesity. Chelsea Handler, a comedian and host of the 2023 Critics Choice Awards, joked that “everyone’s on Ozempic” in Hollywood.

Many insurance companies don’t cover drugs prescribed off label, but those who can afford it are paying premiums out of pocket.

“You know who ain’t getting it?” Fakorede said. “We ain’t getting it here in the Delta. There are people who are not even diabetic who are getting it in the Upper East Side in New York. Socioeconomic status matters.”

Dr. Foluso Fakorede takes a call from a professional in wound care while at Cardiovascular Solutions of Central Mississippi in Cleveland, Miss., Wednesday, Nov. 29, 2023. Credit: Eric J. Shelton/Mississippi Today

Mississippi’s alarming rate of diabetes plays a significant role in another of the state’s abysmal health statistics: leading the country in infant and maternal mortality.

Pregnancy tends to highlight the socioeconomic disparities of diabetes since some women receive Medicaid coverage for the first time during pregnancy, according to maternal-fetal specialist Dr. Sarah Novotny.

“Often, pregnancy is the first time women have access to health care insurance,” Novotny, who serves as division director of maternal-fetal medicine at University of Mississippi Medical Center, said. “So, a lot of times patients are coming into pregnancy with very poorly controlled diabetes because they didn’t have access to pre-pregnancy care.”

In pregnancy, diabetes can be separated into two categories: women who already had diabetes, whether it be Type 1 or Type 2, and then became pregnant, versus those who developed gestational diabetes during pregnancy.

Women who have preexisting diabetes and become pregnant are at risk of developing vascular problems, high blood pressure, renal problems and retinopathy. Gestational diabetes doesn’t carry the same risks for the mother. Both conditions carry increased risks such as abnormal growth and birth defects for babies.

Women who develop gestational diabetes carry a 50% risk of developing Type 2 diabetes later in life.

Managing diabetes before conception would go a long way in mitigating the state’s maternal and fetal mortality and morbidity rates, according to Novotny. But at the very least, recognizing and diagnosing diabetes during pregnancy can serve as an opportunity for previously uninsured or underinsured women to improve their quality of life.

In the last three decades, despite all the technological and medical advancements that have been made, diabetics in minority populations have seen worse outcomes.

Turning those statistics around would mean prioritizing tackling inequities in health care and recognizing places like the Delta as meccas for research, according to Fakorede.

“We need to be collaborators,” he said. “We need to be hope dealers. We need to be disruptive in terms of using our positive thinking to address some of the systemic inequities that have plagued these people and this region for decades.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

Hospitals see danger in Medicaid spending cuts

Published

18 hours ago

July 10, 2025

Staff Editor

mississippitoday.org – @MSTODAYnews – 2025-07-10 15:30:00

by Sophia Paffenroth, Mississippi Today
July 10, 2025

Mississippi hospitals could lose up to $1 billion over the next decade under the sweeping, multitrillion-dollar tax and policy bill President Donald Trump signed into law last week, according to leaders at the Mississippi Hospital Association.

The leaders say the cuts could force some already-struggling rural hospitals to reduce services or close their doors.

The law includes the largest reduction in federal health and social safety net programs in history. It passed 218-214, with all Democrats voting against the measure and all but five Republicans voting for it.

In the short term, these cuts will make health care less accessible to poor Mississippians by making the eligibility requirements for Medicaid insurance stiffer, likely increasing people’s medical debt.

In the long run, the cuts could lead to worsening chronic health conditions such as diabetes and obesity for which Mississippi already leads the nation, and making private insurance more expensive for many people, experts say.

“We’ve got about a billion dollars that are potentially hanging in the balance over the next 10 years,” Mississippi Hospital Association President Richard Roberson said Wednesday during a panel discussion at his organization’s headquarters.

Richard Roberson, Mississippi Hospital Association president and CEO, discusses the impact of what the White House calls “One Big Beautiful Bill,” Wednesday, July 9, 2025, at the Mississippi Hospital Association Conference Center in Madison.

“If folks were being honest, the entire system depends on those rural hospitals,” he said.

Mississippi’s uninsured population could increase by 160,000 people as a combined result of the new law and the expiration of Biden-era enhanced subsidies that made marketplace insurance affordable – and which Trump is not expected to renew – according to KFF, a health policy research group.

That could make things even worse for those who are left on the marketplace plans.

“Younger, healthier people are going to leave the risk pool, and that’s going to mean it’s more expensive to insure the patients that remain,” said Lucy Dagneau, senior director of state and local campaigns at the American Cancer Society.

Among the biggest changes facing Medicaid-eligible patients are stiffer eligibility requirements, including proof of work. The new law requires able-bodied adults ages 19 to 64 to work, do community service or attend an educational program at least 80 hours a month to qualify for, or keep, Medicaid coverage and federal food aid.

Opponents say qualified recipients could be stripped of benefits if they lose a job or fail to complete paperwork attesting to their time commitment.

Georgia became the case study for work requirements with a program called Pathways to Coverage, which was touted as a conservative alternative to Medicaid expansion.

Ironically, the 54-year-old mechanic chosen by Georgia Gov. Brian Kemp to be the face of the program got so fed up with the work requirements he went from praising the program on television to saying “I’m done with it” after his benefits were allegedly cancelled twice due to red tape.

Roberson sent several letters to Mississippi’s congressional members in weeks leading up to the final vote on the sweeping federal legislation, sounding the alarm on what it would mean for hospitals and patients.

Among Roberson’s chief concerns is a change in the mechanism called state directed payments, which allows states to beef up Medicaid reimbursement rates – typically the lowest among insurance payors. The new law will reduce those enhanced rates to nearly as low as the Medicare rate, costing the state at least $500 million and putting rural hospitals in a bind, Roberson told Mississippi Today.

That change will happen over 10 years starting in 2028. That, in conjunction with the new law’s one-time payment program called the Rural Health Care Fund, means if the next few years look normal, it doesn’t mean Mississippi is safe, stakeholders warn.

“We’re going to have a sort of deceiving situation in Mississippi where we look a little flush with cash with the rural fund and the state directed payments in 2027 and 2028, and then all of a sudden our state directed payments start going down and that fund ends and then we’re going to start dipping,” said Leah Rupp Smith, vice president for policy and advocacy at the Mississippi Hospital Association.

Leah Rupp Smith, Mississippi Hospital Association general counsel and vice president for policy and advocacy, breaks down a timeline for what the White House calls “One Big Beautiful Bill,” during an event to discuss the impact of the law on health care in the state, Wednesday, July 9, 2025, at the Mississippi Hospital Association Conference Center in Madison.

Even with that buffer time, immediate changes are on the horizon for health care in Mississippi because of fear and uncertainty around ever-changing rules.

“Hospitals can’t budget when we have these one-off programs that start and stop and the rules change – and there’s a cost to administering a program like this,” Smith said.

Since hospitals are major employers – and they also provide a sense of safety for incoming businesses – their closure, especially in rural areas, affects not just patients but local economies and communities.

U.S. Rep. Bennie Thompson is the only Democrat in Mississippi’s congressional delegation. He voted against the bill, while the state’s two Republican senators and three Republican House members voted for it. Thompson said in a statement that the new law does not bode well for the Delta, one of the poorest regions in the U.S.

“For my district, this means closed hospitals, nursing homes, families struggling to afford groceries, and educational opportunities deferred,” Thompson said. “Republicans’ priorities are very simple: tax cuts for (the) wealthy and nothing for the people who make this country work.”

While still colloquially referred to as the One Big Beautiful Bill Act, the name was changed by Democrats invoking a maneuver that has been used by lawmakers in both chambers to oppose a bill on principle.

“Democrats are forcing Republicans to delete their farcical bill name,” Senate Democratic Leader Charles Schumer of New York said in a statement. “Nothing about this bill is beautiful — it’s a betrayal to American families and it’s undeserving of such a stupid name.”

The law is expected to add at least $3.3 trillion to the nation’s debt over the next 10 years, according to the most recent estimate from the Congressional Budget Office.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The post Hospitals see danger in Medicaid spending cuts appeared first on mississippitoday.org

Note: The following A.I. based commentary is not part of the original article, reproduced above, but is offered in the hopes that it will promote greater media literacy and critical thinking, by making any potential bias more visible to the reader –Staff Editor.

Political Bias Rating: Center-Left

This article reports on the negative impacts of a major federal tax and policy bill on Medicaid funding and rural hospitals in Mississippi. While it presents factual details and statements from stakeholders, the tone and framing emphasize the harmful consequences for vulnerable populations and health care access, aligning with concerns typically raised by center-left perspectives. The article highlights opposition by Democrats and critiques the bill’s priorities, particularly its effect on poor and rural communities, suggesting sympathy toward social safety net preservation. However, it maintains mostly factual reporting without overt partisan language, resulting in a moderate center-left bias.

Crooked Letter Sports Podcast

Podcast: The Mississippi Sports Hall of Fame Class of ’25

Published

2 days ago

July 9, 2025

Staff Editor

mississippitoday.org – @rick_cleveland – 2025-07-09 10:28:00

by Rick Cleveland and Tyler Cleveland, Mississippi Today
July 9, 2025

The MSHOF will induct eight new members on Aug 2. Rick Cleveland has covered them all and he and son Tyler talk about what makes them all special.

Stream all episodes here.

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The post Podcast: The Mississippi Sports Hall of Fame Class of '25 appeared first on mississippitoday.org

Mississippi Today

‘You’re not going to be able to do that anymore’: Jackson police chief visits food kitchen to discuss new public sleeping, panhandling laws

Published

7 days ago

July 4, 2025

Staff Editor

mississippitoday.org – @MSTODAYnews – 2025-07-04 13:00:00

by Maya Miller, Mississippi Today
July 4, 2025

Diners turned watchful eyes to the stage as Jackson Police Chief Joseph Wade took to the podium. He visited Stewpot Community Services during its daily free lunch hour Thursday to discuss new state laws, which took effect two days earlier, targeting Mississippians experiencing homelessness.

“I understand that you are going through some hard times right now. That’s why I’m here,” Wade said to the crowd. “I felt it was important to come out here and speak with you directly.”

Wade laid out the three bills that passed earlier this year: House Bill 1197, the “Safe Solicitation Act,” HB 1200, the “Real Property Owners Protection Act” and HB 1203, a bill that prohibits camping on public property.

“Sleeping and laying in public places, you’re not going to be able to do that anymore,” he said. “There’s a law that has been passed that you can’t just set up encampments on public or private properties where it’s a public nuisance, it’s a problem.”

The “Real Property Owners Protection Act,” authored by Rep. Brent Powell, R-Brandon, is a bill that expedites the process of removing squatters. The “Safe Solicitation Act,” authored by Rep. Shanda Yates, I-Jackson, requires a permit for panhandling and allows people to be charged with a misdemeanor if they violate this law. The offense is punishable by a fine not to exceed $300 and an offender could face up to six months in jail. Wade said he’s currently working with his legal department to determine the best strategy for creating and issuing permits.

“We’re going to navigate these legal challenges, get some interpretations, not only from our legal department, but the Attorney General’s office to ensure that we are doing it legally and lawfully, because I understand that these are citizens,” he said. “I understand that they deserve to be treated with respect, and I understand that we are going to do this without violating their constitutional rights.”

Homeless encampment located in the 1700 block of S. Gallatin Street in Jackson, Wednesday, June 2, 2025.

Wade said the Jackson Police Department is steadily fielding reports of squatters in abandoned properties and the law change gives officers new power to remove them more quickly. The added challenge? Figuring out what to do with a person’s belongings.

“These people are carrying around what they own, but we are not a repository for all of their stuff,” he said. “So, when we make that arrest, we’ve got to have a strategic plan as to what we do with their stuff.”

Wade said there needs to be a deeper conversation around the issues that lead someone to becoming homeless.

“A lot of people that we’re running across that are homeless are also suffering from medical conditions, mental health issues, and they’re also suffering from drug addiction and substance abuse. We’ve got to have a strategic approach, but we also can’t log jam our jail down in Raymond,” Wade said.

He estimates that more than 800 people are currently incarcerated at the Raymond Detention Center, and any increase could strain the system as the laws continue to be enforced.

“I think there’s layers that we have to work through, there’s hurdles that we are going to overcome, but we’ve got to make sure that we do it and make sure that my team and JPD is consistent in how we enforce these laws,” Wade said.

Diners applauded Wade after he spoke, in between bites of fried chicken, salad, corn and 4th of July-themed packaged cakes. Wade offered to answer questions, but no one asked any.

Rev. Jill Buckley, executive director of Stewpot, said that the legislation is a good tool to address issues around homelessness and community needs. She doesn’t want to see people who are homeless be criminalized, but she also wants communities to be safe.

“I support people’s right to self determine, and we can’t impose our choices on other people, but there are some cases in which that impinges on community safety, and so to the extent that anyone who is camping or panhandling or squatting and is a danger to themselves and others, of course, I fully support that kind of law. I don’t support homelessness being criminalized as such,” Buckley said.

One of the homeless in Jackson panhandles at the intersection of U.S. 80 and Gallatin Street, Wednesday, June 2, 2025.

Many of the people Wade addressed while they ate Thursday said they have housing, don’t panhandle, and shouldn’t be directly impacted by the legislation. But Marcus Willis, 42, said it would make more sense if elected officials wanted to combat the negative impacts of homelessness that they help more people secure employment.

“There ain’t enough jobs,” said Willis, who was having lunch with his girlfriend Amber Ivy.

The two live in an apartment together nearby on Capitol Street, where Ivy landed after her mother, whom Ivy had been living with, suffered a stroke and lost the property. Similarly, Willis started coming to eat at Stewpot after his grandmother, whose house he used to visit for lunch, passed away.

Willis holds odd jobs – cutting grass, home and auto repair – so the income is inconsistent, and every opportunity for stable employment he said he’s found is outside of Jackson in the suburbs. The couple doesn’t have a car.

Making rent every month usually depends on their ability to find someone to help chip in, said Ivy, who is in recovery from substance abuse. She said she’s watched problems surrounding homelessness grow over the years in Jackson. Ivy grew up near Stewpot and has lived in various neighborhoods across the city – except for the times she moved out of state when things got too rough.

“There was just moments where I just had to leave,” Ivy said. “Sometimes if you hit a slump here, there’s almost no way for you to get out of it.”

This article first appeared on Mississippi Today and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

The post 'You're not going to be able to do that anymore': Jackson police chief visits food kitchen to discuss new public sleeping, panhandling laws appeared first on mississippitoday.org

Political Bias Rating: Center-Right

This article primarily reports on new laws in Jackson, Mississippi, targeting public sleeping, panhandling, and squatting, focusing on statements by Police Chief Joseph Wade and community perspectives. The coverage presents the legislative measures—authored by Republican and independent lawmakers—with a tone that emphasizes law enforcement challenges and community safety, reflecting a conservative approach to homelessness as a public order issue. While it includes voices concerned about criminalization and the need for social support, the overall framing centers on law enforcement and property protection. The article maintains factual reporting without overt editorializing but leans slightly toward a center-right perspective by highlighting legal enforcement as a solution.