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The executive director of the Fordland Clinic, Robert G. Marsh II is also a nurse practitioner, director and owner of Fordland Family Medical LLC, and a farmer to boot.

This week's profile:

Robert G. Marsh II, family nurse practitioner and geriatric nurse practitioner, director and owner of Fordland Family Medical LLC since its inception in 1996 and executive director of the nonprofit Fordland Clinic Inc. since 1998.

What brought you to this position? I had enlisted in the Coast Guard but was not to be inducted for more than a year. The short-term engineering job I was working ended a couple months early, just as an Emergency Medical Technician course started. It was to end before my Coast Guard induction date. I took this course as a way to learn good first aid.

While in the Coast Guard, I was able to assist the medical staff on ship and work in the emergency room, which led to nursing school. After graduation I worked for seven years in the emergency room at Springfield Community Hospital, then, while attending the University of Florida Graduate Program for Family Nurse Practitioners, worked for two years on a part-time job on the pediatric team in the emergency room at Shands Teaching Hospital.

Returning to Missouri, I obtained a nurse practitioner/ manager position at a family practice clinic in Branson. While there, I received a call from the owner of the building that housed the old clinic in Fordland. The physician had left and no other medical provider was interested in the practice. He knew I lived in the area and offered a first-year discounted rent to provide medical care in the Fordland area

My family and I renovated the inside of the old garage building and we started seeing patients two days a week. The need for good community wide health care was so great that I quit the Branson job and began full-time practice there within two months.

We were certified as a rural health clinic four months later and outgrew the old building and moved into our new 3800-square-foot building in 2001. The need for improving access to care, especially in rural areas, led to my organizing Fordland Clinic Inc.

Share your goal for the coming year: I have four primary goals centered around the nonprofit Fordland Clinic for this year. The dental facility, primarily for Medicaid and indigent care, is almost completed with most of the equipment installed.

My first goal is to obtain donations of dental instruments and funds to complete this facility. The second is to locate a dentist who is willing to provide screenings for children one day a month and who will supervise a dental hygienist in providing preventative care and cleaning. The third goal is to initiate a grant for funding for a full-time dentist. The last goal is to identify funding sources for mental health services for those who lack insurance.

What health issue concerns you the most? The increasing rates of preventable diseases, such as diabetes and heart disease, along with the increasing difficulty of patients without insurance to obtain the health care they need.

It used to be that I would diagnose a new patient with diabetes a few times a year: I now diagnose diabetes almost weekly in adults, and at least half a dozen times each year in children. I have many hundreds of patients taking cholesterol and high blood pressure medications - with lifestyle changes earlier on; they would not have needed these drugs.

I see a health care system that offers great care, yet people who cannot afford such care. I also see a health care "dissystem," that is, parts that conflict with each other: basic care unavailable to many, insurance company rules and governmental regulations that may have been created with the best of intent not working in real life.

Most gratifying part of your work? Seeing people make healthy changes as a result of what I have been able to teach them is quite gratifying. I endeavor to teach every patient some helpful health-promoting ideas, regardless of what they are being seen for, whether it be a school physical, a strep throat, high blood pressure, cancer or whatever the case may be.

Personal philosophy: Providing health care is a service and a privilege. I am here to assist people achieve health or solve a medical problem in any way possible, and sometimes this means helping them find other people or resources. I strongly believe in providing every patient with choices for care and then assisting them with their choices. To accomplish this I work within their support systems - their beliefs, their desires and their financial resources - in a way that is right for them on their journey to health.

Community ties: I spend some time working with sustainable agriculture systems and have had one field day at our farm to demonstrate the successes and failures of the ideas we have tried.

I work with anyone who wishes to stop smoking (at no charge if they don't have insurance).

I am a member of the Missouri Association of Rural Health Clinics, National Association of Rural Health Clinics, Advanced Practice Nurses of the Ozarks, American Academy of Nurse Practitioners, Midwest Renewal Energy Association, American Dairy Goat Association and Ozarks Mountain Region of the Sports Car Club of America.

Family life: I have been married to Melissa for 16 years and without her help could never have started the clinic or built the new building.

We have a son, Joshua, 12, and a daughter, Sativa, 14, who help with the farm and work holidays at the clinic. Daughter Heather, 27, works for a local potter, helps her husband in his cabinetry business and heads the cleaning crew at the clinic. Son John, 23, helps with construction.