Many delta hospitals complain that their emergency rooms are overrun with nonpaying patients. Dr. James Keeton, the vice chancellor for health affairs at the University of Mississippi Medical Center, says that 14 percent of the center’s patients are uninsured, or “self-pay,” and the hospital recovers only a small part of what they owe. “Now, I say to you as a businessperson: How would you like to work at an auto company and give away . . . cars before even opening your doors?”

Of the state’s population of nearly three million, 550,000 are uninsured. At the moment, Governor Bryant is claiming that the state might not accept federal money to expand Medicaid under the Affordable Care Act. But even if it does, there won’t be enough doctors to see all the Mississippians who need them; the state has 176 doctors per 100,000 people, the lowest such number in the country.

Sixty years ago, Mississippi, the country’s poorest and most racially divided state, was “the standard by which this nation’s commitment to social justice would be measured,” the historian John Dittmer wrote. Talk to those in Mississippi’s health care community, and they all whisper the same thing: It’s not rocket science; we all know what needs to be done. In short, as one Mississippian put it to me, “hand-to-hand combat” — hiring folks whose sole job is to ameliorate the problems in poor people’s lives — and a tremendous amount of money could change the situation. But the political will does not exist. So the status quo endures: generations of people who can’t afford fresh tomatoes, and who don’t understand that when a doctor says take this pill three times a day, he doesn’t mean all at once.

In May, Shirley, Shahbazi and a black pediatrician named Eva Henderson-Camara piled into Shahbazi’s car and headed to the delta to talk to two nurses at a small hospital in Belzoni, more than an hour north of Jackson. The first thing you notice on entering the delta, especially when you’re expecting to find poverty, is that you don’t see many people. The farms are vast and empty. So much of the area is bucolic and sun-dappled that it doesn’t seem poor. When I said as much to Claudia Cox about Mississippi in general, she replied sternly: “That’s because poverty in America doesn’t look like what y’all think. It used to be bare feet, now it’s Nikes. If I miss two months of work because I get sick, well, guess what? I’m in poverty. This is the new poverty.” Yet in delta towns like Louise and Midnight, the poverty is impossible to miss: desolate commercial streets in the shadow of a rotting mill, shotgun houses wilting on one side of railroad tracks, houses almost buried under possessions on the porch and in the yard.

Henderson-Camara, now 60, grew up on the plantation her grandfather owned. Children at the time worked much of the school year as part of the sharecropper system, which lasted until the ’70s, as corporations bought and mechanized the farms. (“Imagine waking up every morning and this is all you see,” Henderson-Camara said, looking out the window at the flat fields stretching to the sky. “And you think, Should I shoot myself now or later?”) Thousands of displaced workers found jobs at the Jockey factory, or the Schwinn plant, or on catfish farms, but those shut down in the early ’90s. Henderson-Camara got out by winning a scholarship for a fifth year of high school at Yale. Today she lives in Jackson and works in HealthConnect’s medical clinic.

In Belzoni, everyone sat down at a rectangular table, and the director of nursing, Dee Ann Brown, recounted the hospital’s troubles: emergency-room readmissions, obesity, inadequate insurance. Shirley then explained the role of community health workers and asked Brown if she thought that service might be helpful.

“What you are describing is home health, isn’t it?” Brown said.

Home-health agencies dispatch nurses to do clinical work in patients’ homes. But they are not obligated to take your phone calls at midnight or steer you away from eating fried food — and you have to have insurance to get their care. Often for-profit services, they are also the hedge funds of the health care community: potentially lucrative, largely unregulated, producing bad results as often as good. Sanjay Basu, a physician and policy expert at the University of California, San Francisco, says that while he has seen some remarkable and devoted home-health agencies, “if you’re in it for a buck, you could have a terrible home agency and make a ton of money.” Many towns in the delta have them — yet the delta’s problems persist. Why? Shirley offered that the hospitals need a third party trained to discern what exactly will help a patient, and that party must come from the patient’s world: talk the same, share similar fears and frustrations and life experiences.