ST. JOHN, KAN. -- The Persian Gulf War made itself felt here on the frozen plains of south-central Kansas Jan. 11, five days before shooting started.
It was then that H. Sprague Taveau IV -- proud member of a military family, a decorated Vietnam War veteran and retired Army lieutenant colonel -- received his orders: Report to Fort Sill, Okla., for a minimum of one year of active duty.
Taveau, however, was more than a military man being called back to serve his country.
Until he left for Oklahoma Jan. 21, Taveau also was this town's only full-time resident physician and the pivotal figure in an experimental program in providing rural health care. Now, officials here say, the war's unintended casualties eventually could include the health-care pilot project and the struggling local hospital.
Taveau's unexpected activation is among thousands of examples of the personal and economic disruption caused by the massive gulf mobilization. The impact on local communities will vary, but few aspects of national life are more fragile and vulnerable to an unexpected jolt than the health-care system in St. John and other small towns of rural America, where an aging population is served by a dwindling number of doctors and medical facilities.
According to Brig. Gen. Ronald Blanck, chief of medical corps affairs in the Army surgeon general's office, Taveau and 53 other retired Army physicians are among about 2,000 Army doctors recalled because of the war.
Taveau, a family practitioner, was not needed in the war zone but is replacing physicians at Fort Sill who are. Blanck said the Army has received 53 applications to exempt physicians from active duty and has approved six. He said about half of the applications cite "community hardship" that would be caused by loss of the local doctor. One such pending application is from St. John.
Town officials are at pains to explain that this does not reflect opposition by them or their doctor to President Bush's decision to use military force to push Iraq out of Kuwait. In this community 60 miles south of the home town of a well-known and highly decorated World War II veteran, Senate Minority Leader Robert J. Dole (R-Kan.), they said a sense of patriotism is as much a local commodity as the wheat, cattle and oil that form the backbone of the central Kansas economy.
"Neither Sprague nor the community want to see him not serve his country," said Jim Doran, a cattleman and member of the hospital board. "He and the community are largely backing what we're doing in Saudi Arabia. He is torn between what he sees as a viable project for rural health care and serving his country. It's a real dilemma."
Another doctor in nearby Stafford has a part-time practice here, and John Hagood, St. John Hospital administrator, is scrambling to find other physicians to help temporarily.
But losing Taveau does threaten to undercut a two-year effort to save the hospital and about 40 jobs that are part of the local health-care system.
Twenty years ago, St. John Hospital was a flourishing enterprise. In the 1970s, two doctors practiced at the one-story, 34-bed facility built in 1968 and expanded in 1973.
By the 1980s, however, the combination of a declining and aging population and changes in Medicare reimbursement rules began to affect the tax-supported institution. During the decade, the town also had increasing difficulty attracting and keeping a locally based physician. At least six doctors worked here but left, said Don Knappenberger, the hospital board attorney who doubles as city attorney in this community of 1,357 people.
St. John was not alone in struggling to maintain a locally based health-care system. "It's difficult to sell a rural practice even to a physician who grew up in a rural community and then went to school in an urban area and liked it," said Melissa Hungerford, a vice president of the Kansas Hospital Association.
While the number of physicians in Kansas has been growing since 1988, last year the state listed 64 of its 105 counties as medically "un- derserved" or "critically under- served."
Stafford County, of which St. John is the seat, was not among these last year, but Hagood said state officials have told him that the loss of Taveau, coupled with the retirement next month of another doctor in the county, will push Stafford into the "critically underserved" category.
The crisis for St. John came in late 1988 when yet another doctor announced that he was leaving town, Knappenberger said. In response, town leaders turned to the Wichita-based Wesley Foundation, which is devoted to improving rural health-care services, in a final attempt to save their care system and hospital.
With more than $150,000 in grants from the foundation and more than $300,000 from a local fund-raising drive, they are turning St. John into a "rural primary-care" hospital, the first of its kind in Kansas and what officials here hope will be a national model under recently enacted federal legislation to develop such facilities.
The concept is that rural communities such as St. John no longer can afford to operate traditional "acute-care" hospitals. But they can sustain a local medical facility that combines skilled long-term nursing care, a doctor's office and clinic, a pharmacy and several "primary-care" beds for basic, noncritical hospital services.
More costly and complicated hospital services are provided through affiliation with larger hospitals in Great Bend and Wichita.
A key to the project's success was the recruitment last year of Hagood, who serves as hospital administrator and pharmacist, and Taveau, who began his practice here last March. Five months later, Iraq invaded Kuwait. Five months after that, Taveau was back in the Army.
The son of an Air Force officer, Taveau, 47, was a combat infantryman in Vietnam, where he received a battlefield commission. He later attended medical school and was an Army doctor for 10 years before retiring in 1987 after 25 years' service.
One of his sons is with the Army in Saudi Arabia, while his daughter-in-law, an Army nurse, and another son, in the Navy, await orders that could send them to war.
"I really have mixed emotions," Taveau said in voicing strong support for Operation Desert Storm but also a firm belief that a system of primary-care hospitals such as that in St. John could revitalize a rural health-care system "in critical condition in this country."
Hagood said the new St. John Primary Care Hospital probably cannot survive for a year without its doctor. "We can make it three to six months," he said. "After that, we're in serious trouble."
Special correspondent Lauren Ina in Chicago contributed to this report.