When Sewanee tapped Professors Alyssa Summers and Clint Smith to develop a lab to conduct COVID-19 testing at the beginning of the pandemic, Summers already had an eye toward the future. Since the Sewanee Molecular Diagnostic Lab’s inception, Summers has known that she wanted to expand the lab’s capability to be able to offer a range of diagnostic tests, not only to the University, but to the surrounding area as well.
“When I was initially asked if we could do this, we were investing in machines and certification processes to get the lab up and running,” Summers says. “And we were wondering what would happen to them once the COVID pandemic was less severe.” Her answer to that question was that the lab could have a public, civic-minded function and that it could work with local organizations to address health in the region. Now, through a new partnership with the Tracy City Free Medical Clinic, the lab is working to bring critical Hepatitis C testing (and eventual treatment) at no cost to at-risk patients on the Mountain.
New Tools for New Challenges
The Sewanee Molecular Diagnostics Lab’s capacity has grown beyond COVID-19 testing in just a few short years. Molecular diagnostic testing examines DNA or RNA to detect genetic markers of infections or diseases, and the applications of this type of testing are numerous and rapidly growing. Molecular diagnostics can detect common illnesses like strep throat and the flu, testing which the SMDL provides for University Health Services, as well as more complex diseases like cancer.
As director of both the Sewanee Molecular Diagnostic Lab and Sewanee’s Pre-Health program, Summers has made community outreach a priority in her work. “Alongside Sewanee’s Office of Civic Engagement, we've been working with free medical clinics in the area for quite some time to send students to them for internship and community services opportunities,” she says.
One such clinic is the Tracy City Free Medical Clinic, which was founded by Dr. Tom Phelps, C’74, in 2022. Phelps had been working with Jim Peterman on public health initiatives and volunteering for another free medical clinic in Winchester called Christians Celebrating God’s Bounty, founded by Sewanee alumnus Tom Smith, C'71. While he was happy with his work in “the valley,” which allowed him to practice medicine and develop meaningful doctor-patient relationships, he felt called to establish a practice in Grundy County, which for many years had been ranked as one of Tennessee’s least healthy counties.
But Phelps is quick to note that the success of the clinic is not due to his efforts alone. “Emily Partin at the Littell-Partin Center was the inspiration for the clinic and instrumental in helping get it off the ground,” he says. She helped Phelps write a successful grant proposal to South Cumberland Community Fund for a startup grant and helped find partners to host the clinic. The clinic has multiple Sewanee connections. Nurse practitioner Beth Sperry, a graduate of Sewanee Academy, assists Phelps at the clinic with women’s health. Bill and Carol Titus, C’91, and Sheri Lawrence, P’13, volunteer their time and resources toward crucial fundraising, grant writing, and other administrative responsibilities. Maggie White Parmley, C’22, works as a medical assistant, gaining clinical experience in preparation for study to become a physician assistant. Phelps’ wife, Marilyn, serves as the office manager.
A visit to the clinic, with space in the Littell-Partin Center donated by Volunteer Behavioral Health, strikes a nostalgic note. Walking into the center, one is greeted by metal lockers and empty trophy cases, unmistakable relics of the building’s previous life as Grundy County High School. The center opened in late 2021 after a partial renovation as a hub for social services in the community, and refurbishments continue as the center adds more services.
Resources for a Cure
Within just a few months of opening the Tracy City Free Medical Clinic, Phelps noticed a prevalence of Hepatitis C in the community. “The pathology I see is just mind-blowing,” he says. “I never even thought about Hepatitis C when I was in private practice. But here, it's just everywhere.” Phelps’ anecdotal experience is also backed by data; the Tennessee Department of Health noted in a 2021 epidemiological study that Grundy County is one of the areas of the state most highly vulnerable to a Hep C outbreak. Both Franklin and Marion counties also show increased vulnerability to an outbreak. The disease is often coincident with HIV, other sexually transmitted diseases, and substance abuse disorder in what many public health experts term a “syndemic.”
Hepatitis C is a virus that attacks the liver and, if left untreated, can lead to death. According to Phelps, this is particularly problematic because most early cases are asymptomatic, and even in cases that are not, symptoms can be very subtle. When caught early enough, the antiviral cure rate is 95% to 98%, making widespread testing efforts extremely effective in both improving the quality of life of patients and slowing the spread of the virus in the community.
However, testing and treatment for Hep C are cost-prohibitive. For an uninsured or underinsured person, a treatment course can cost around $20,000. Through strategic partnerships with Gilead Sciences and AbbVie, Phelps is able to secure curative medications for his patients who test positive, but the testing itself can be prohibitively expensive, too. The donations of medications are linked to specific people with active infections, so testing is a critical step in bringing the medicine to the community.
That’s why, in 2022, Phelps and the Tracy City Free Medical Clinic were awarded a $10,000 grant from South Cumberland Community Fund to address the acute need for testing and treatment resources for Hep C on the Plateau.
“We like to think that all our grants have a clear positive impact in the community,” says Tom Sanders, executive director of South Cumberland Community Fund. “In the case of this award, we could do the math. Our $10,000 has the potential to yield hundreds of thousands in benefit to the community through donated medicine.”
When Phelps applied for the grant, he understood that tests would cost about $450 each, which would mean about 20 people could be tested using grant funds. Through technological advances and Sheri Lawrence's work to petition the state, over the last year that cost has been reduced to $85. The Tracy City Free Clinic team has sponsored free testing for the public and for those incarcerated in Grundy County Jail, a population that is disproportionately affected by Hep C. In all, the clinic has administered 69 tests, with 39 of those producing a positive result. But the scale of the public health problem has become ever more clear and daunting. “Some people think that life expectancy in Grundy County is significantly lower than elsewhere in the state, and the presence of this virus in the community is certainly part of that picture,” Phelps says.
The problem of scale led Phelps and Carol Titus to reach out to Alyssa Summers to ascertain whether the SMDL might be able to aid in faster, more cost-effective testing for this project. “With Alyssa's help and her gracious offer to conduct these tests at cost, we will be down to around $45 per test soon, making it so that we can test and therefore treat and cure as many people as possible,” says Phelps.
Currently, the SMDL’s Hep C test is in the validation phase. “Anytime you bring a test to the public through a clinical lab, you have to make sure that the test, each time, is going to accurately represent exactly what you say it is,” Summers says. This process also involves taking samples that have been tested elsewhere and comparing the results to those from Sewanee’s lab.
Creating and validating a diagnostic test comes with significant start-up costs, which the SMDL has absorbed instead of passing on to the Tracy City Free Medical Clinic. Titus and her husband, Bill, community members who have been actively involved with the clinic from its start, contributed a gift to the SMDL to help fund these initial set-up costs. “We were thrilled to contribute to this partnership,” says Titus. While students cannot be credentialed to perform clinical tests, the lab affords them educational exposure to clinical validation and testing processes. “We are excited that students will learn about rural healthcare, testing, and treatment,” Titus says. “It’s a great learning opportunity to have a lab on campus doing this work.”
So far, the results have been successful, and the SMDL is close to completing the validation process. “We’re just waiting on a few more samples,” says Summers. “But, so far, everything has looked awesome. We're increasing our numbers for statistics, and then we're ready to send it to our medical director who will sign off, and then we can offer the test.”
Making Lasting Connections
Looking back on the early days of Sewanee’s lab, Summers notes that community collaborations always seemed inevitable. As soon as the lab was accredited and licensed, Summers reached out to local hospitals and other universities to see whether they needed help with COVID-19 testing. “For me, community was always part of it,” she says.
Just a few years later, the lab has a contract with Southern Tennessee Regional Health System, a network of hospitals in the area, and is working with local clinics to discern what kinds of tests would be most beneficial to them. “We’re a small lab,” Summers notes. “We’ll never compete with the big labs. They have the facilities, the history, and the connections to dominate the market for testing needs. Think of us like an independent bookstore versus Amazon. We can fill needs specific to our community—for University health services, the free medical clinics, local schools, and the like.”
Summers sums up her dedication to providing community outreach and her partnership with the Tracy City Free Clinic by underlining that “there are real health inequalities between urban and rural areas, and one of the ways those inequalities present is in access to precision medicine.” The SMDL seeks to rectify this for all those who live on the Mountain. Their mission statement includes a charge “to ameliorate rural health disparities while expanding educational opportunities to students and community members.”
The Sewanee Molecular Diagnostics Lab was an innovation that the University built out of necessity in the middle of a global public health crisis. Now, the lab is making a meaningful contribution to the community in the midst of another epidemiological event. If you ask him, Phelps won’t hesitate to tell you that it is his dream to eradicate Hepatitis C on the Plateau. With the help of Summers and the SMDL, that dream may soon become a reality.