Story by Jeff Deal

While the U.S. Congress wrestled with the question of uninsured Americans, many Appalachian residents were without health insurance in 2008 and 2009.

According to the U.S. Census Bureau’s Current Population Survey, the number of insured residents in the region ranges between one out of every five people in Georgia to one out of eight in Virginia, compared to a national average of one out of six. Growing concern regarding access to substantive health care is mounting.

To address the limited access to affordable healthcare, health professionals have united with local communities to address the shortfall of medical services within their communities at free health fairs and clinics around the region. Doctors, nurses and other providers team up with volunteers to donate their medical expertise to those lacking these critical services.

Wise, Va.,— lying in the southwestern corner of the state—hosted a 2010 Remote Area Medical Volunteer Corp “RAM” clinic in July. In just two and a half days, the confederation of volunteer community members and professionals met with more than 1,250 patients seeking treatment for ailments ranging from depression to pulmonary disease in the improvised examining rooms of the county’s fairgrounds.

Wise will once again offer this service when they hold the 11th annual health clinic July 22 – 24, 2011. Volunteers seeking to assist with the fair may submit their applications in April, 2011.

Grundy, Va.,—an hour and half northeast of Wise—is also the site of a yearly RAM clinic, taking place each October. According to RAM, his year’s Grundy clinic treated 766 patients an estimated $89,000 worth of medical care in just two days.

“Volunteering with RAM was a powerful experience that helped me decide to go to medical school,” says Patricia Feeney, a student at the Virginia College of Osteopathic Medicine in Blacksburg, Va., who volunteered at a Union, Tenn., RAM event last year. “We need more accessible and affordable long term care in Appalachia, and while we work for that, RAM gives us all a way to reach out to our neighbors and help meet immediate needs.”

Tennesseans in need of health services had opportunities to attend RAM clinics in Oneida, Knoxville, Nashville, Pigeon Forge, and Clinton; these sites will once again offer clinics during 2011.

RAM accepts all volunteers, in addition to physicians and health care professionals. RAM clinics provide eye exams, prescription eye glasses, and dental care, as well as primary care visits. For more information on the Remote Area Medical Volunteer Corp, visit: ramusa.org or call 1-877-5RAM-USA.

For a comprehensive step-by-step guide to available health insurance options by state, as well as an explanation of the health care reform legislation enacted by the U.S. Congress, visit healthcare.gov

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Clinics Around the Region

In addition to the volunteer medical clinics organized by RAM, other free and/or accessible clinics offer health care for Appalachian residents in need.

The West Virginia Association of Free Clinics offers medical services at 13 sites throughout the state (www.wvafc.org or call 304-414-5941).

Fifty-nine member clinics, spread over the state, make up The Virginia Association of Free Clinics (www.vafreeclinics.org or call 804-340-3434).

North Carolina also has an Association of Free Clinics (www.ncfreeclinics.org or call 336-251-1111).

Residents without health insurance in Kentucky may contact Health Kentucky to gain information regarding health care opportunities in their area (www.healthkentucky.org or call 1-800-633-8100).
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Community Caregivers

A number of organizations are working to combat health disparities and improve the physical and emotional well-being of people in Appalachia. From public universities to statewide nonprofits to community clinics, there are programs throughout the region that provide medical care to the uninsured, advocate for healthcare legislation and educate children about the importance of healthy behaviors.

Appalachia Community Cancer Network is an initiative funded by the National Caner Institute aimed at reducing cancer disparities in the region through community participation in education, research, and training.

They focus on the prevention and early detection of cervical, lung and colorectal cancers, all of which have high incidence rates in the region. Based at the University of Kentucky, ACCN serves the northern and central Appalachian regions. www.accnweb.com

Health Kentucky works with a statewide network of volunteer health care providers, dentists, pharmacies, and pharmaceutical companies to provide free health care and medication to uninsured residents of Kentucky. Since 1984, they have provided free health care to more than 300,000 patients Visit: www.healthkentucky.org

Appalachian Regional Healthcare operates a system of hospitals in eastern Kentucky and southwestern Virginia. In 2010 they were named an Outstanding Rural Health Organization by the National Rural Health Association. www.arh.org

Healthy Appalachia Institute – part of UVa-Wise – provides policy makers, healthcare workers, educators and community members the necessary tools, resources, ideas and strategies to foster a healthy population. They provide community based research opportunities, service learning and health education. www.healthyappalachia.org

The Center for Rural Health Development Inc. provides leadership on rural health issues in West Virginia. They work with community health centers, hospitals, private physicians and dentists to improve the health of WV residents. They also work with banks to provide financing for healthcare providers strengthening rural health infrastructure. Visit: www.wvruralhealth.org

Rural Health Association of Tennessee advocates and educates on rural health issues including substance abuse, mental health, health professional education, disease prevention, oral health and emergency preparedness. Visit: www.rhat.org

An End-of-the-Decade Checkup on the Wellbeing of Our Region

Story by Parker Stevens and Jeff Deal

How much money would you take in exchange for 40 years of your life? $1 million? $1 billion? Would any sum of money be sufficient to replace the years with your family and friends, the laughter and the love we all hope to share? In Appalachia, there is an alarming trend of lower life expectancy and higher disease rate than in most other parts of the country. Poverty, lack of education, a spotty regional medical infrastructure and polluting industry are all contributors to the numbers that are stacking up against us. The real question is, how do we reverse the trend?

It’s often remarked that if you have your health, you’ve got everything. As I watched my grandmother die of bone cancer at 63 years of age, I realized just how profound, for me, this cliché is.

When you think of the ancient rolling green tree clad mountains that form the backbone of the Eastern seaboard, what do you imagine? Most find Appalachia a premiere vacation destination, a land of flora, fauna and four distinct seasons—a landscape of near indescribable loveliness, where one can relax, “get away” and “breath easy” while fishing a trout stream, swimming in a hole, hiking to a waterfall or daydreaming lazily under the lone tree of a serene mountain pasture.

It is ironic to consider the health challenges faced by many living in or near this most enchanted natural wonder.

Poverty and poor health have long plagued Appalachia. Quality of health concerns in the region have been influenced by issues of prosperity, education, physical landscape, culture, history, medical infrastructure, health insurance, occupation and daily behaviors.

The Appalachian Regional Commission (ARC) classifies one in four Appalachian counties as “high poverty.” Per capita income in Appalachia consistently falls below the national average. Impoverished residents in the region have a life expectancy equal to that of Panama and Mexico. A report released by the ARC indicates that people living in poverty and without health insurance are more likely to die prematurely, particularly from cancer or cardiovascular disease, than people with higher incomes.

Exposure to harmful substances in coal mines, chemical factories, and agriculture—common occupations in the region—can also prove damaging to the health of an individual.

A study published in the Californian Journal of Health Promotion found that, on a cultural level, there is a general sentiment of mistrust among Appalachian people with respect to health care professionals.

According to the study, some residents fear being taken advantage of or exploited by the health care system—or being unfairly, or unjustly, stereotyped. Many Appalachians are reluctant or lack the time and means to participate in preventive screenings—such as mammograms—without showing acute symptoms of an illness.

Geography also isolates Appalachian communities from urban ones, where health care resources are more abundant. According to the ARC, nearly half of all rural Appalachian counties are designated as health professional shortage areas.

Wayne Myers, founder of the University of Kentucky Center for Rural Health, says that there is a lack of municipal hospitals and community clinics in the region. “Most rural counties don’t have community health centers,” Myers says. “Only two or three Appalachian counties have academic medical centers or a teaching hospital.”

The shortage of doctors is particularly difficult for Medicaid patients, as many doctors will not accept Medicaid due to low reimbursement rates. Patients often have to travel long distances to larger cities and urban areas in order to seek treatment covered by Medicaid.

Education improvements do provide access to jobs that raise families and communities above poverty and illness, but must develop apace with other economic opportunities—or the newly educated leave for greener pastures.

With the betterment of health care access and public campaigns encouraging healthy lifestyles, Appalachian communities can gain prosperity, good health, and well-being.

A recent study by Dr. Michael Hendryx and other researchers at the West Virginia Rural Health Research Center found that rural areas in Appalachia have more exposure to agriculture-related pollution than urban and metropolitan areas.

The study also found a significant correlation between areas with water pollution and both cancer and total death rates. In addition, sites within these rural regions that are monitored as air pollution sources “were associated with greater cancer mortality rates” for inhabitants.

In areas of Appalachia where coal is mined, the study found higher mortality rates for non-mining residents, and not simply those working in the coal mines.
The report concluded that health care professionals working in rural Appalachia will need “appropriate training and resources to diagnose and treat environmentally-instigated or mediated disease.”

Story by Jamie Goodman

Kentucky citizens attend an air permit hearing press conference for the Smith plant last February. Eastern Kentucky Power Cooperative reached a settlement with several groups and agreed to cancel plans to build the 278MW power plant. Photo by Kentuckians for the Commonwealth

Environmental groups in Kentucky are celebrating a major victory over a proposed coal-fired power plant slated for Clark County.

Eastern Kentucky Power Cooperative (EKPC) reached a settlement with environmental groups, three individual co-op members, the Kentucky attorney general and Gallatin Steel—EKPC’s largest industrial customer—agreeing to halt plans for the utility’s proposed Smith coal-fired power plant.

EKPC also agreed to commit $125,000 toward a joint effort between the involved parties to evaluate and recommend new energy efficiency and renewable energy programs.

In exchange, Kentuckians for the Commonwealth (KFTC), Kentucky Environmental Foundation and the Sierra Club agreed to drop a number of lawsuits and administrative challenges against the cooperative.

According to EKPC representatives, the decision was based on financial concerns and not environmental pressure. Estimates for the total cost of constructing the Smith plant were around $819 million, with $150 million already spent on materials.

“I believe this decision by EKPC is the right one for Kentucky,” said KFTC member Tona Barkley. “I am heartened by this new development and the commitment EKPC has made to work in a collaborative fashion with co-op members and the other parties to the agreement.”

“This new openness and more democratic method will, I believe, help bring the co-ops back to their original purpose–serving its rural members in a transparent fashion,” Barley said.

The groups involved in the settlement also agreed to not oppose the utility’s efforts to recover costs already spent on the plant, including selling turbines and other parts that were already purchased.

Story by Jillian Randel

A century ago, one in four trees in the forests of Appalachia and throughout the eastern United States was an American chestnut, providing a reliable source of food and timber for humans and animals. Now it may grow once more.

Since 1983, The American Chestnut Foundation (TACF) has been working to restore the American chestnut to its original habitat.

Scientists working with TACF have been able to cross and then backcross the American and Chinese species to develop a tree that is fifteen-sixteenths American chestnut. Characteristics of the Chinese species make the new tree resistant to blight while retaining dominant characteristics of the American species.

In 1904, the first signs of Cryphonectri parasitica, known as chestnut blight, appeared. The blight came to America through Japanese and Chinese chestnuts that were transplanted here. It spread throughout northern forests rapidly. A second pathogen called Phytophthora had also been invading southern forests. Within fifty years, the two blights had killed four billion trees.

One of the approaches employed for chestnut tree revival is planting on reclaimed mine sites, which will restore the tree to its native region and also help reforest the mine sites—remediation and re-vegetation is a federally required law for mining companies.

“While some make the claim that it is not our true American chestnut, without doing something like this, we won’t have any adult chestnuts,” said Dr. Neufeld, biology professor at Appalachian State University. “Given how important this species was in the 19th and early 20th century, I think having a fifteen-sixteenths chestnut is better than none.”

It could take 75 to 100 years to complete reintroduction efforts and even longer to return the American chestnut to the full extent of their natural range, but success in growing other hardwood trees on reclaimed sites provides a promising outlook for a successful reintroduction program in Appalachia.

Visit acf.org for more information.

Artist Lowell Hayes Raises Awareness of the Threatened Evergreen in A 3-D Painting Exhibition

Story by Jamie Goodman

A striking new art exhibit has captured the life and death of the great eastern hemlock, bringing the plight of this threatened tree to indoor audiences.

Internationally-renowned artist Lowell Hayes, a resident of Valle Crucis, N.C., has created eleven large-scale constructed-canvas paintings that incorporate natural materials such as bark and tree limbs for a striking 3-dimensional representation.

“The exhibition is really not about the blight. [It’s] about the life of the hemlock, rather than the death of it,” Hayes said.

“The Hemlocks! The Hemlocks!” exhibit will show in the Turchin Center for the Visual Arts at Appalachian State University from December 3 through March 19, 2011.

Across the eastern seaboard, a tiny invasive bug is wiping out the mighty hemlock tree. Known as the hemlock woolly adelgid, the pest was first noticed in 1951 near Richmond, Va., and has since decimated evergreen populations from Vermont to Georgia. Unconfirmed reports place the sap-sucking adelgid as far west as Wisconsin.

“Maybe we won’t have a time here in the South when we will be [without] hemlocks, but we already have lost about half of them,” Hayes said.
Hayes has worked on the project for over four years, during which time he experienced the loss of his mother to cancer.

“There I was immersed in the loss of the hemlocks, and [my mother] had cancer and she was not getting any better,” he said. “We knew it was only a matter of time.”

“You don’t sit around and weep with your mother [while she is dying],” he said. “You might have some tears, but when you are with your mother you are trying to contribute to her having a good life so long as she has it.”
Hayes realized he did not want to focus on the death of the hemlocks, but to appreciate the tree while it lives. “What I am painting in the representations and the interpretations of hemlocks is our being with them,” Hayes said.

Hayes, now in his 70s, has been painting the Appalachian landscape and its people for 40 years, but the bas relief hemlock canvases are considered his most evocative and focused work to date. He credits the project with encouraging him to get out in the forest and relate to nature more intimately. “There have been a lot of blessings involved,” he said. “That is a tremendous life experience, and I am very privileged, grateful to be able to do that.”

The ultimate goal of the exhibit is to connect viewers spiritually and emotionally to the plight of this magnificent tree.

“It’s one thing to read about the devastation, or even to go into the field and observe it, but it’s another… to have an artist’s take on how you feel when you are with these hemlocks,” he said. “I hope this does get a chance to [create] contact between people and hemlocks, especially between people in urban situations who don’t get into the forest very much.”

Viewing the massive paintings first-hand is a study in nature itself. Tree limbs, constructed moss and rocks, and sections of real hemlock bark loom off the canvas in realistic detail. The sheer size—the largest is 9 feet high by 19 feet long—dwarfs the viewer.

During the exhibition, the art will be complimented by a range of educational materials about the woolly adelgid and the demise of the hemlocks.

A two-story exhibition hall will also house a site-specific installation by Hayes that includes a nearly 40-foot section of a dying hemlock tree.

Hayes hopes to take the show on tour after the Turchin exhibition, and is seeking venues throughout the hemlock range, from Maine to Alabama and west to Minnesota.

“The finest thing that anyone says to me about my work is, ‘After seeing your work, I saw what you mean [out] in nature,’” he said. “I like to say, ‘This is heaven, don’t miss it while you’re here.’”

Work by Lowell Hayes has been included in a touring exhibition by the National Museum of American Art and graces numerous private and public collections, including the University of North Carolina and the Tennessee State Museum.

The Turchin Center for the Visual Arts is located at 423 W. King Street, Boone, N.C., and is open Tuesday through Saturday. Admission is free.