Bram Sable-Smith

Bram Sable-Smith is a native Missourian and a reporter on the KBIA Health & Wealth Desk. He’s documented mbira musicians in Zimbabwe, mining protests in Chile, and a lobstering union in Maine. His reporting from Ferguson, Missouri won a regional Edward R. Murrow award for feature reporting. Bram cut his radio chops at the Salt Institute for Documentary Studies in Portland, Maine.

Lee Ann Stuart still wears her nursing scrubs, even though the only work she’s been doing since Twin Rivers Regional Medical Center closed June 11 is to pack boxes of medical supplies to be hauled away.

“It’s strange walking those halls, and they’re empty and the lights are down,” Stuart says. She’s been a nurse at the hospital in rural Kennett, Missouri, for 22 years.

Bram Sable-Smith / Side Effects Public Media

Taja Welton is ready for her daughter to be born. She’s moved into a bigger house, one with room for a nursery. She has a closet full of pink, Minnie Mouse-themed baby clothes. Her baby bag is packed right down to the outfit she plans to bring her baby home in that reads, “The Princess Has Arrived.”

Taja Welton is ready for her daughter to be born. She’s moved into a bigger house, one with room for a nursery. She has a closet full of pink, Minnie Mouse-themed baby clothes. Her baby bag is packed right down to the outfit she plans to bring her baby home in that reads, “The Princess Has Arrived.”

“I can’t wait to put it on her,” Welton smiles. The princess even has a name: Macen.


This story was originally published February 6. It has been updated as of February 9 at 1 pm.

The Atchison-Holt Ambulance District spans two counties and 1,100 square miles in the far northwest corner of Missouri. The EMTs who drive these ambulances cover nearly 10 times more land area than their counterparts in Omaha, the nearest major city. 

When the hospital closed in rural Ellington, Missouri, a town of about 1,000, the community lost its only emergency room, too. 

That was 2016. That same year, a local farmer had a heart attack.


It’s a familiar story in rural America. Four years ago the Pemiscot County hospital, the lone public hospital in Missouri’s poorest county, nearly closed. What’s keeping it in business today has also become increasingly common in rural healthcare: relationships with a handful of local pharmacies.


When Sarah Scantling went into labor this summer, she had to drive 30 miles and across state lines.

Three years earlier, the only maternity ward where she lives in Pemiscot County, Missouri closed down. Scantling had to choose between a handful of other hospitals in the region between 20 and 70 miles away. She chose to give birth in the hospital in Dyersburg, Tennessee.


For five years now, the Missouri legislature has considered legislation to create a prescription drug monitoring database that would allow pharmacists and physicians to look at their patient's prescription history for signs of misuse of narcotics. And for five years, Missouri pharmacists like Erica Hopkins have watched those efforts fail with disappointment.


$1.25 million.

That’s the size of the bill that could have shuttered the only public hospital in rural Pemiscot County, Missouri in August 2013.