Editor’s note: This article is part of a joint editorial initiative between the National Association of Community Health Centers and Direct Relief.

In South Carolina’s Lowcountry, barrier islands and rural inland communities sit just above sea level. It was here, along the nation’s southeastern coast, that residents in Beaufort County lacked indoor plumbing into the early 1970s. That changed when a rural, Black community found ways to funnel money to build a health center, created their own water company, and subsequently produced better health outcomes.

Throughout the 1960s, health conditions were dire. Hypertension was widespread, and Beaufort had the lowest life expectancy rate in the state. In 1965, an average of 62 out of 1,000 children in Beaufort “did not live to see their first birthday,” according to the New York Times. By 1969, there were at least 600 homes in Beaufort and Jasper counties without sanitary facilities. Almost 1,800 households had annual incomes below $1,000, and just under 5,000 households had annual incomes under $3,000.

At the time, Beaufort’s Levy, Limehouse, and Bellinger Hill neighborhoods were predominantly Black; home to descendants of slaves who had earned multi-acre plots of land after the Civil War. Instead of installing costly indoor plumbing, property owners dug shallow wells in their yards, just five feet below the surface. Families carried buckets of water into the house for cooking and bathing. There were outhouses for waste. They unknowingly drank water infested with Ascaris lumbricoides, or intestinal parasites. Black children were disproportionately affected and had recurring cases.

“Seventy-three percent of the Negro children had intestinal parasites, and nearly five percent of the white preschool children had intestinal parasites,” a University of South Carolina report shared at a U.S. Senate hearing.
Few could afford necessary medical care, and far fewer had enough to fix the water-related health issues at their source.

“To see a kid who is three years old, pass a worm that is two feet long, it was unbelievable,” said Roland Gardner, a community leader who spearheaded many of the reforms. “That woke me up.”

While the lack of potable water in Beaufort County was an immediate problem, government officials were preoccupied with national poverty rates and racial desegregation. So, local advocates vowed to find solutions and advocated for a federally qualified health center with affordable payment options. In the fall of 1970, the doors opened to Beaufort Jasper Hampton Comprehensive Health Services, Inc, often called ‘Comp Health.’ In turn, leaders of the health center supported a new water system and created jobs for residents, influencing better health outcomes for decades. By 1974, reports indicated that the infant mortality rate had decreased by two-thirds.
“It was almost like a miracle,” said Thomas Barnwell, the first executive director of Comp Health. “Because just, for example, solving the problem of intestinal parasites was described by the epidemiologist as an almost unsolvable situation.”

In 53 years, Comp Health has expanded to host 15 health programs at 10 locations across Beaufort, Jasper and now Hampton counties. Just three executives have led the health center since its inception in 1970: Thomas Barnwell, Roland Gardner, and Dr. Faith Polkey.

The creation of the water system and the health center has yielded massive dividends; Beaufort has been recognized as the healthiest county in South Carolina for the last 11 years, and its residents have the longest life expectancy in the state.

It all started with the desire to meet an unmet need.

“Water was basic. It was a need that many people had,” Barnwell said.

The Need for Change

Barnwell, now 88, is a descendant of families from Mitchelville, the first self-governed community of formerly enslaved people in South Carolina. He still owns acres of land on Hilton Head Island, which he intends to pass down to his sons.

In the mid-to-late 1960s, researchers visited Beaufort County and surrounding areas to document issues of health and hunger. Barnwell was working at the Economic Opportunity Commission and spent his free time driving his mother, a licensed nurse who cared for pregnant women, to her appointments. She worked alongside a white physician who identified the parasites. Hannah Barnwell told her son of the depressing health conditions during their rides around town and encouraged Thomas to help find a solution.

“She said, ‘let me tell you something, son, it’s more important to provide service to people than to make money,’” Barnwell recalled.

In 1969, Barnwell testified at a U.S. Senate hearing to advocate for the creation of a federally qualified health center in Beaufort. He told the committee that the health center’s priorities would be defined by the needs of the community, which was still lacking basic sanitation infrastructure.

“But, in the area of sanitation, and I speak of basic needs—out-houses—we have been unable to fund them, projects to construct them. It is not improbable that the cost of eight studies dating from 1936 confirming the presence of the Ascaris worm in our community would, alone, have built 600 privies vital to the blotting out of these parasites. Apparently, we can send a man to the moon, but we can’t build outhouses…We have been attempting since 1966 to bring potable water to areas where residents have to haul water in buckets, bottles, or cans. Most of them are too poor to afford pumps even if potable groundwater were available. To this date, not one drop of water has reached them”

– Thomas Barnwell, in his 1969 testimony before the U.S. Senate

Transcripts from that hearing detailed the severity of Beaufort’s poor health conditions, compared to the millions of federal dollars spent on international aid for water and waste disposal and the stark differences between white and Black communities in America. Several mentioned the “desperate need” for a health center, potable water, and a sewerage system.

“Clearly, these children are suffering from the chronic effects of undernutrition, parasitism, and repeated bacterial and viral infections,” said James P. Carter, a Vanderbilt University School of Medicine and Meharry Medical College professor.

After the hearing, Beaufort County received several grants, including $342,000 for a health center. Senator James Wadell appointed Barnwell as chair of the health center’s advisory board to manage federal funding. In the fall of 1970, the Comp Health building opened to serve 25,000 low-income residents of Beaufort and Jasper counties.
Barnwell hired Beaufort locals to work at the health center.

He had connections through family, his volunteer work, and previous employment at Penn Community Services and the Economic Opportunity Commission. Though he had taken courses at seven universities, he didn’t have a college degree– so he contacted those who did. He called Roland Gardner, who at the time was a graduate student at Howard University and was home in Beaufort for winter holiday.

Gardner, who later became CompHealth’s longest-tenured CEO, said Barnwell asked him to write an outline for a potential children’s behavioral health program. At the time, Black children in Beaufort were sent to special education classes under the guise of behavioral health issues, which delayed their educational development.

Barnwell shared Gardner’s report in Washington the following spring and called the grad student from the airport.

“He said he needed somebody to run the program,” Gardner told Direct Relief, laughing.

Gardner promised to return to Beaufort to temporarily work for Comp Health upon graduation. He started the behavioral health program and found that most of the children had psychological issues due to poor living conditions, not behavioral health challenges. According to Gardner, the energy that Barnwell brought to the area mobilized others to get involved.

“That’s what this was,” said Gardner. “People in a community who said, ‘Nobody is going to come help us; we have to do it ourselves.’”

Gardner became President and CEO of Comp Health in 1980 until he retired in 2022.

FUNDING POTABLE WATER IN BEAUFORT AND BEYOND

With the health center established, funding for what became the Levy Limehouse Bellinger Hill Water Company was next on the community’s list.

Federal dollars existed for rural communities, but with federal racial desegregation taking place, not all local authorities were willing to help Black residents access those dollars.

Barnwell and Thad Coleman, the first African American to sit on the Beaufort Jasper Water Sewer Authority board of directors, began to work with a national nonprofit: The National Demonstration Water Project, or NDWP. Their mission was to help low-income, rural families gain access to safe, potable water.

The organization’s board, made up of executives from health centers and housing programs across the country, met on a quarterly basis to find clean water solutions.

“It was very exciting to see that we were traveling in a route that would open doors for people around the country,” Barnwell said. “Our problem was a greater problem as we dug more into it.”

In Bonnie Lefkowitz’s book Community Health Centers: A Movement and the People Who Made it Happen, she shares that the USDA didn’t want to support “smaller, community-based systems.” Granting loans to impoverished rural communities that couldn’t meet a marginal tax requirement as a down payment was risky.

Lefkowitz says the NDWP sued the USDA’s program to receive special funding.

Retired judge and civil rights activist Olly Neal Jr. was an NDWP member who worked alongside Barnwell and Coleman. He was the founding executive director of the Lee County Cooperative Clinic in Arkansas. Neal told Direct Relief that the group had to prove that the shallow wells built across the country were “major contributors” to the health problems of children and that financial support for new cluster well systems would solve the issue.

“That was the most important thing that we did, in my opinion,” Neal said. “We got loans to low-income communities so they could be eligible (for the program).”

Ultimately, the Congressional Budget Committee approved a $200 million budget for federal loans for water systems nationwide, and Comp Health would receive $40,357. Comp Health and other NDWP members had gained momentum on what was now a national water crisis.

THE PEOPLE OF BEAUFORT

Lorraine Bond still remembers the smell of sulfur in Beaufort from the contaminated water. “If you were washing dishes and you were wearing jewelry, it would turn the jewelry, so you had to take off the jewelry in order to wash dishes,” Bond said.

Bond sits on the Board of the current regional water system in Beaufort. Her mother, Juanita White, worked on special projects for Comp Health and was an advocate for what became the Levy Limehouse Bellinger Hill water company. As a child, Bond found her mother digging along the side of the road in desperation for pipes that would lead to clean water. Neighbors who had questions about the water would call her as early as 6 a.m.

“It was weird because my mother was very feminine and a very classy dresser, and here you go see her in the ditch with mud all over,” Bond said.

Residents had a lot of questions. Most earned less than $3,000 annually and didn’t want to stop using their free, shallow well taps and pay $50 into the new water system.

“You had to convince them to take the water,” said Emory Campbell, who was involved in the efforts. “People were reluctant, skeptical… and signing a piece of paper was a serious thing for people.”

Campbell was involved in the AmeriCorps VISTA program at the time, though he’s best known for his contributions to civil rights and preserving and sharing the cultural significance of the Gullah Geechee people on Hilton Head Island. Like Gardner, he too was encouraged by Barnwell to return to Beaufort. Campbell had an advanced degree in environmental engineering and eventually left the VISTA program to work for the State’s Health and Environmental Department, which was key in the development of the water system.

Historically, African Americans were untrusting of some government systems and signing documents that might not have truly benefited them long-term, Campbell said. VISTA participants and health center volunteers knocked on doors, attended church meetings and broadcast radio announcements to build trust and educate the community about the quality of the water that came from shallow wells.

“Our healthcare movement was tied very closely to the civil rights movement,” he said, adding that it was important for residents to hear from their friends and neighbors that the well water was contaminated. Building community-level trust and understanding encouraged people to visit Comp Health for treatment.

“We didn’t know any different, people really didn’t talk about it at that time, I guess,” Pat Walls said. “We realized that there were worms and stuff, but it’s like being Black and white. If you live away from it, you don’t really realize what you’ve got until you get something different.”

Walls had pumped water from her family’s well and carried buckets inside for cooking and cleaning. She learned of the dangerous well water conditions as an adult in the VISTA program and began working with White, while knocking on her neighbors’ doors to encourage them to join the new water program instead.

They, too, realized the issue was bigger than Beaufort. White was elected to the South Carolina House of Representatives with Walls as her campaign manager. She served for 15 years as an advocate for clean water and support for rural communities.

The more the community learned, the more they were empowered and wanted to be involved. Once there were enough residents who agreed to switch to the new water system, they named the water project after the areas it served: Levy Limehouse and Bellinger Hill Water Company. The water company’s board was composed of residents who were patients or worked at Comp Health.

The health center became the impetus for community involvement. Residents wanted to participate in the changes and to have a ‘seat at the table’ to develop policies that operated their health, water, school, and government systems.

“Everything that was done by Levy was done by the people,” Bond said.

THE FUTURE IN BEAUFORT

Beaufort’s health conditions drastically improved after Comp Health opened and clean water became accessible. Employment rates increased, and the Lowcountry became a more desirable place for people to live.

By 1989, the Levy Limehouse Bellinger Hill Water Company had reached capacity. The original cluster well system was the most efficient and economical choice for the 1970s, but not sustainable given the area’s growing population. LLBH was sold to the regional entity, Beaufort Jasper Water Sewer Authority, which paid the owners of 822 properties for their shares. Walls was chair of the board then and negotiated with lawyers to ensure property owners were paid based on the years they were connected to the system.

However, since the change in ownership, not every LLBH home was connected to BJWSA’s water and sewer lines. Many homes rely on septic tanks, and some property owners have been placed on a waitlist for sewer access—but it’s unlikely, given the low-lying area’s limited groundwater access and continued development growth. The other option is to support trucking and manufacturing companies that are trying to build in the Levy community in hopes that the company will run a new sewer line across their property. But allowing major companies to build in the area could create other issues for property owners in the rural area.

Michael Bell, the immediate past chair and current board member of BJWSA, said increasing water and sewer access in Beaufort’s Levy community is ongoing work. Bell, one of two African Americans on the BJWSA board, said that he follows in the footsteps of people like Barnwell, Coleman, and White, in ensuring that safe and potable water is available to all Beaufort residents.

Dr. Polkey, the newest President and CEO of CompHealth, says she, too, follows in the footsteps of great leadership in Beaufort County.

“That’s how we started, right?” Polkey said. “It (started) from people being in the community and being willing to go out to where the people are.”

Maintaining and building new partnerships in the community remains of high importance to Comp Health leadership. Polkey’s background is in pediatric, public health and preventative medicine, and she has spent her first year leading Comp Health through strategic planning. Originally from the Charleston area, she began working at Comp Health years ago when Gardner was still at the helm. She learned the history of the health center and the important role the community plays in its own health outcomes.

Polkey said that during the height of the coronavirus pandemic, they realized a greater need for telehealth opportunities, dental and mental health supports, and methods to address the social determinants of health.
“Keeping the community part in our community health center is of the utmost importance, like understanding the mission being central, and that is to take care of the community,” she said.

Polkey said that every community deserves the best health care, which requires advocates willing to create change to bring about better health outcomes.

“I never want us to be this corporate thing that is chasing the dollar and chasing that next patient,” she said. “We’re not here for that. We’ll take care of everybody and understand how we started and why; that’s still really important.”