By Susan Smallheer, Brattleboro Reformer
LONDONDERRY Dr. Roger Fox, given the season, could pass for Santa Claus in a heartbeat.
With his snowy white hair, full mustache and twinkly eyes behind round tortoiseshell glasses, only his trim modest beard might betray the cliche.
Oh, and the English accent might be a tip-off.
He's actually a Vermont country doctor, serving one of the more remote rural spots in southern Vermont.
At the Mountain Valley Health Center, Fox has for the past 45 years tended to the disappearing farmers of the West River Valley, the business elite who retired in the mountains and injured skiers and snowboarders from nearby Bromley, Magic Mountain and Stratton. He's won accolades from his patients and the community for his kindness and empathy, medical compassion and expertise.
Linda Bickford, the administrator of the Mountain Valley Health Center, described Fox as "the heart of the clinic, a community doctor, their doctor."
"Some find him gruff at times and scary," she said. "Children have mistaken him for Santa Claus but at the end of the day, when the patient has been brought into his office to be interviewed and then examined, they know they have received excellent care."
If the letters of thanks Bickford has saved are any indication, he's beloved.
"A grateful heart says thank you for your house visit this past week and although there were no immediate solutions, it certainly helped to calm and reinforce us," one patient wrote.
"Had it not been for your medical expertise and diligence in investigating my health problems, I do not know if I would be here today," wrote another.
"Dear Roger, thank you for being the honest country doctor everyone wished they had," wrote another.
Why would a doctor who lived in several different African countries and England and trained in London and Boston be content to work in a small Vermont town, where the closest hospital is 30 miles away and his patients can't always pay?
"I like country life," said Fox, who said he likes the intimacy of getting to know his patients, treating them at the clinic and tending to them at the hospital.
Fox, now 72, plans on retiring when he turns 75, and the Mountain Valley Health Center and Springfield Medical Care Systems are already looking for someone to replace him with the hope he can work with his replacement for a year before he retires .
The nearest emergency room or hospital room is more than 30 miles away in Springfield, Rutland or Bennington. The health center is a medical outpost, a mini hospital of sorts. It has its own laboratory and X-rays and hosts other specialists.
The clinic opened its doors on Jan. 5, 1976 in a converted real estate office, Fox said, , and the health center was later built on land across Route 11 from Flood Brook School. In the years that followed, other doctors joined Fox at the clinic; there are usually two physicians, sometimes three, seeing patients, along with a physician's assistant and nurses.
The health center's building was named in Fox's honor in 2015 and he dominates the two-doctor rural health center with a benevolent and knowing heart.
An internist, he's only delivered two babies in his long career one, his own daughter, and another, a Peru, Vermont, woman who went into labor far from a hospital during a big snowstorm.
"We couldn't go anywhere," Fox said of that experience.
In addition to practicing medicine, Fox is a Renaissance man of many interests and is active in his community. He's been a singer since he was 11 years old, and recently had a solo with the Springfield Community Chorus's Christmas concert. He had hoped to go to Cambridge University on a music scholarship, and is learning to play the piano in his seventh decade.
He and his wife keep chickens, and have had a small farm, with sheep and milking cows. He currently tends two flocks of chickens in separate barns at his Peru home.
In his younger years, he played polo with the West River Polo Club for more than 20 years: his polo saddles are on display in a small room off the kitchen of his home.
Inside his 1840 Peru home, where he has lived for 33 years, even in the cold, dark days of late fall, there's the musical sound of birds: lovebirds and zebra finches and what Fox calls "budgies" (Americans call them parakeets). The old farmhouse stretches to include a new addition, and the Foxes can hear the loud "jake brakes" of truck drivers descending Bromley Mountain on Route 11.
He and his first wife, a Scottish woman he met in Africa, had two sons and a daughter. She ultimately went back to Scotland, he said.
His second wife, Nancy, is a nurse practitioner, working for Harvard University in Cambridge, Massachusetts, three or four days a week. They've been married 37 years, and also have a son.
None of Fox's children live in Vermont, with the closest living outside of Boston; two live in London, and the third in San Francisco.
While his daughter initially wanted to be a pediatrician, none of the Fox children went into medicine, he said. He and his children have dual citizenship.
Living in Peru and working in Londonderry has been a perfect fit, professionally and personally, Fox said. .
"He's fabulous; he is the clinic," said Esther Fishman of Londonderry, who has known Fox for decades, and serves on the health center's council, which handles its endowment and does fund raising.
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Fox's path from the Midlands of England to southern Vermont was surprisingly smooth.
A native of Warwickshire, he grew up in the British Midlands and later South Africa, thanks to his businessman father. He said in a recent interview at his office, filled with medical diplomas and mementos, that his mother, a teacher, was responsible for his decision to become a medical doctor.
"My mother was very much a country person," he said, and she greatly admired the local doctor. Her admiration led to her son's ambition to become a doctor.
He and his mother followed his father to a promotion with his company, which made industrial scales, to South Africa for three years. He was 7, and the family lived outside of Johannesburg. Fox said his father, Norman Fox, started as an office boy and worked his way up to chairman of the board, overseeing the modernization of the Avery Scale Co. "Think Texas Instruments," he said.
The life of industry was not for the son, and he returned to England for school. He attended London University, later returning to Africa for a year. He was accepted to medical school at St. George's Hospital Medical School, University College.
Fox said the British health care system, established during World War II, was too stratified for him you either were a local practitioner or a hospitalist, he said. He said he wanted to do both care for people in their home community, and continue that care if they got sick and had to go to the hospital.
So Fox headed to the United States, to Beth Israel Deaconess Hospital in Boston as a senior resident in the 1970s.
"I wanted to see what American medicine was like," he said. Beth Israel Deaconess Hospital asked him to stay.
Fox returned to Great Britain for more medical training at the Royal College of Physicians for an additional degree. He then returned to Boston and worked at a clinic that proved to be a disappointment. Looking around for a new job, he happened to see an advertisement in the New England Journal of Medicine in the summer of 1975. A small start-up clinic in Vermont was looking for a doctor to help start a new rural health clinic.
"'Forsake city life and come help start a clinic!'" he said, doing his best 45 years later to quote the advertisement.
A group of people banded together in Londonderry to raise money and start the clinic, he said.
Fox and his first wife came to Londonderry, met with the leaders of the clinic, and decided rural Vermont was just what they wanted. And he's never wanted to leave or practice medicine elsewhere.
His first impression was of "a beautiful area with a leavening of attentive, interesting people." He said there were a small number of second homeowners, who had come to the area for skiing. There were also "a lot of indigenous farmers."
They were hardscrabble farmers, he said, with a short growing season, and working with thin soils.
But it was the mix of people that convinced him to make a life in the Londonderry area.
"You'd have a counselor to a president sitting next to a farmer" in the waiting room, he said. "The clinic is very egalitarian."
In the years since he has been at the clinic, now called a health center, the numbers of people with health insurance, as well as Medicaid and Medicare, have increased..
"When I came here, not a lot of people had insurance," he said.
He said in the early days, he worked closely with the rescue squad, and he said communication was a big obstacle in the days before cell service and towers. But the squad had a portable defibrillator, which was carried in a suitcase. He remembers the first resuscitation of a man who suffered a severe heart attack; the man went on to live another 15 years, Fox said.
"We just had telephones," he said, and then radios, beepers and pagers.
Saving lives is always the goal, he said. "It's trite, but sometimes we fail and sometime everybody finally dies," he said. "The main concern is missing stuff and not keep up to date reading journals," he said.
Many days, he would drive from Londonderry to Springfield to visit patients in the hospital, and he has praise for the now-struggling hospital.
Springfield Hospital used to have weekly meetings for its medical staff, bringing in experts from Dartmouth-Hitchcock Medical Center or the University of Vermont. But financial pressures sadly stopped that, he said.
The clinic joined Springfield Medical Care Systems, the parent organization of Springfield Hospital, four years ago, and became a federally qualified health center. That designation qualifies the clinic for higher reimbursement payments from the government and from insurance companies.
"The clinic never made a profit. The insurance system is very unequal," Fox said.
Springfield Medical Care Systems sought Chapter 11 bankruptcy protection in June, and the future of the Mountain Valley Health Center "is a delicate subject," Fox said. "It's a work in progress," he said of the financial changes.
Even though the health center is under the umbrella of Springfield Hospital, it maintains an independent board or council, which raises funds for the health center and manages its separate endowment.
Fox has praise for the state's tiniest hospital, Grace Cottage Hospital in Townshend. "That's an example of what a great rural hospital should be," he said. "They've been nimble," he said, "surviving in this changing landscape." Dr. Robert Backus, now retired, and before him, Dr. Carlos Otis, were great community doctors, he said.
"I don't think medicine should be a profit-driven business," he said. "I believe in socialized medicine."
Contact Susan Smallheer at ssmallheer@reformer.com or at 802 254-2311, ext. 154.
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Dr. Fox is cosmopolitan, urbane and a Vermont country doctor through and through - The Manchester Journal