Treating Tangier Island
Just a touch of sunshine twinkles over the Chesapeake Bay on a brisk October morning as Dr. David Kemp boards Sharon Kay III, a former crabbing boat that’s now used for tours heading to Tangier Island. Dressed in a fleece jacket and a spiffy Halloween bowtie, he steps on board, carrying his black medical bag in one hand and a small cooler in the other (to bring back a crab—two if he’s lucky). His office manager, Kimberly Clark, slips a bag of M&Ms into her purse before climbing on the boat.
Dr. Kemp, a Riverside physician, drives nearly 40 miles from his Gloucester home to Smith Point Marina in Reedsville, then makes the hour-and-a-half boat ride to Tangier. He’s been traveling to the island twice a month for five years and typically doesn’t return home until 8:30 in the evening—not an easy journey for the 73-year-old physician, but he doesn’t complain. “I’m retired Navy; I like this sort of stuff,” he says.
Most importantly, he’s carrying on a mission to provide regular healthcare to the people of Tangier—a mission that was started more than 30 years ago.
Life on the Island
Tangier, as anyone who’s visited can testify, is a modest town, and visiting is like traveling back in time. The 1.2-square-mile island is surrounded by collapsing crab shanties and boats with names like Betty Jane and Joyce Marie. A once-thriving community of watermen, Tangier is now losing 7–9 acres per year, due to rising sea levels and erosion. It’s been said that in 100 years, all that may be left of the island is the town’s water tower, which flaunts the image of a big, red crab.
The population, like the land mass, is also dwindling as young people leave for college and don’t return. Most of the island’s approximate 500 residents are friends or relatives (many with the surname Parks, Pruitt or Crockett). Everyone knows everyone, and the islanders speak in a unique English Restoration-era dialect, though some accents are stronger than others.
The only cars on the island are used for transporting goods; residents travel by bicycle or golf cart. Businesses include an airport, some restaurants (most only open during summer), a couple bed-and-breakfasts, a post office, a fire department, a history museum, a school where grades K–12 attend in the same building, a small grocery store and a brand new, 1.4 million-dollar medical clinic.
The clinic is where Dr. Kemp is heading today. Once Sharon Kay III docks, the doctor is greeted by Inez Pruitt, a 53-year-old physician assistant who was born on Tangier—in fact, inside the house right next door to the clinic. Inez greets Dr. Kemp and Kim with warm hugs; she smiles upon noticing that she and Kim are wearing matching helicopter pins on their jackets. The three pile on a golf cart and head to the clinic, where Inez has prepared a breakfast casserole.
The pristine clinic features three exam rooms, a digital X-ray machine and a lab. There’s a room set up for a dental chair, but they’re still waiting for a dentist to come to the island. Then there’s the waiting room, which as Dr. Kemp says, is “almost like a social hall.”
Prescriptions come by mail boat through a pharmacy on the Eastern Shore, so if Dr. Kemp sees a patient in the morning, they can have their prescription by the afternoon boat.
In major medical emergencies, like a heart attack, residents can be brought to a hospital in Crisfield or Salisbury, Md., via the Maryland State Police medevac helicopter, at no charge.
Health Issues on Tangier
Most residents on Tangier either work in the summer tourism industry or as a waterman, equaling a tough life—long hours, increasing regulations, an ever-rising cost of fishing supplies and fuel and declining profits.
“When you’re a waterman, you work ‘til you drop on your boat,” says Gerald Wheatley, who was mayor of Tangier for 11 months. “A lot of ’em would have pains in their chest and all that, but they’d never go to a doctor because they had to go to Crisfield (Maryland), so they’d drop dead on their boats.”
Some of the island’s older residents have significant illnesses, including diabetes, heart disease, hypertension, cardiovascular disease and hypothyroidism. “The people out here work long into their 70s,” Dr. Kemp explains. And because they work such long hours with the sun beating down on them all day, many of them have skin cancer, or as they call it, barnacles.
Due to the island’s small genetic population, there is a high incidence of a rare genetic disorder called Tangier Disease, characterized by a severe reduction in the amount of high density lipoprotein in the bloodstream.
Even with all of these health issues, for years, doctor visits to the island were inconsistent, and residents would jump at the chance to get medical attention when it was available. Outside an outdated and dilapidated building, lines would form, consisting of folks with anything from colds and cuts to broken bones and pneumonia. Leaving the island to seek medical care is no easy task; the closest healthcare facility is an hour boat ride, plus additional drive time, so islanders would avoid going to the doctor, often having their conditions escalate because of it.
The face of healthcare on Tangier changed with Dr. David B. Nichols, who visited Tangier on a family vacation with his parents and felt a connection to the place and the people. Born and raised in Winnipeg, Manitoba, Canada, he moved to Newport News for his Family Practice residency under the direction of the Medical College of Virginia at Riverside Hospital. He started his own family practice at White Stone, which he eventually joined with Riverside Health System.
Nichols flew his airplane, then later on, his helicopter, to Tangier every Thursday (his day off) to treat patients. He would circle the island to let everyone know he was there, which earned him the nickname “Dr. Copter.”
He visited the island once a week for more than 30 years, even though he was still treating residents in an old building with outdated equipment.
During one of his visits, Dr. Nichols brought along friend and real estate developer Jimmie Carter to have lunch. “He showed me the existing clinic, and on a spur of the moment I told him I would like to work with him,” Carter says. The two formed the Tangier Island Health Foundation in 2006 to raise funds to construct a new clinic.
Five years later, the foundation had raised $1.7 million, enough to build the clinic for Tangier’s residents, who’d began to form a bond with the doctor.
“I think there was just something about the people on the island that aligned with his sensibilities,” says Carter, who is president of the foundation. “They were honest, hardworking and in need of care.”
Inez, who considers Nichols her mentor, says the doctor became intertwined with the community. “People came to trust him so much,” she remarks. “He saved so many lives.”
In August 2010, the state-of-the-art and appropriately named David B. Nichols Health Center opened its doors, and residents attended a dedication ceremony with both gratitude and grief.
Just a few months before the clinic’s opening, Dr. Nichols learned that an eye cancer he had survived six years ago had spread to his liver and that it was terminal. When he broke the news to the islanders, he assured them that there would always be a doctor that would come to Tangier—because he had gotten assurance from Riverside.
“Dr. Nichols was extremely devoted to maintaining the clinic and care on Tangier Island,” says Dr. James Lesnick, senior vice president for Riverside Health System and medical director for Riverside Medical Group. “We at Riverside feel privileged to continue that legacy.”
Dr. Nichols died in December 2010, leaving behind an inspirational promise, as well as a protégé.
Carrying on the Legacy
Now Dr. Kemp alternates traveling to the island every two weeks with another Riverside doctor from the Eastern Shore, Angelica Perry. Medical supplies, staffing at the clinic and transportation for both doctors is all provided by Riverside.
After working with Dr. Nichols at White Stone and joining him on Tangier to treat patients, Dr. Kemp says he got to liking the people very much and decided to keep coming once Dr. Nichols passed. “He’s sweet as can be,” Inez says of Dr. Kemp. “And he’s fit right in.”
On the days of the week when a doctor isn’t present on the island, the people of Tangier rely on Inez.
“Since I was a little teeny girl, I’ve always wanted to be a nurse,” Inez says. She even had goals of being a nurse in the military, but in high school, things changed, and she decided to drop out. “I got married; I fell in love,” she says. “I had my babies, and I loved it.”
Inez earned her GED and started working in a dentist’s office on Tangier in 1984. A few years later, in 1987, Dr. Nichols asked if she would work for him as a medical assistant. “Doing what?” she asked. “Whatever you’re willing to learn,” he told her.
“Over a period of time, people started thinking because I worked for Nichols I knew what I was doing.” Inez laughs. When emergencies would arise, the residents began calling on her. So she said to herself, “I better get some training.”
She commuted almost daily for the first two-and-a-half years to University of Maryland Eastern Shore (UMES) to earn her degree. Her commute included a 45-minute boat ride and a 25-minute drive, each way, sometimes waking at 4 a.m. to be on the boat by 5. Still, she knows that her dedication was necessary. “Dr. Nichols told me I had to,” she said.
She completed her family practice and clinical rotations at Dr. Nichols’ White Stone Clinic, developing a close relationship with some of the employees, including Kim. Inez received her degree in 2006, the same year that Dr. Nichols was named National Country Doctor of the Year.
Now Inez is the primary health care provider for the people of Tangier, handling minor surgeries, sewing lacerations and performing other day-to-day necessities. In 2013, she was named one of Virginia’s Women in History, after being nominated by a 10th grade class at the Tangier Combined School for her fervent dedication to the people of Tangier.
Ending the Day
It’s well after 5 now as Dr. Kemp, Inez and Kim wrap up their work at the clinic. Dr. Kemp gathers his belongings, including the small cooler that contains just one crab.
Kim reaches into her purse to grab the bag of M&Ms, and she and Inez walk down the front steps of the clinic to a cemetery several feet away, stopping at a gravestone that reads, “Tangier Island’s Beloved Doctor.”
Kim sprinkles some M&Ms into Inez’s hands, and together, they scatter them over Dr. Nichols’ grave. “He loved chocolate,” Kim says softly. The two women stand in the cemetery in silence for a few moments, then hug one another and walk back up the steps to the clinic—the clinic that Dr. Nichols had always envisioned for the people whom he loved, on the island that became his home.
Read this story in full in the August/September issue of Coastal Virginia Magazine.