Hazard Perry County Kentucky by MikeJenny


									Hazard, Perry County,

Hazard Family Health Services, one offour major health           HAZARD, COMMERCIAL HUB OF
care systems serving the eastern Kentucky coalfields, began      THE EASTERN Kentucky coalfields,
in 1972 as an outreach program aimed at reducing the high        isn't a place you'd particularly
infant mortality rate in that part of Appalachia. Today, the     choose to visit. This is Appalachia, a
                                                                 land of bleak beauty, its fortunes
system includes adult and pediatric clinics adjacent to the      linked to the mineral wealth it con-
Appalachian Regional Hospital in Hazard, Ky., and family         tains.
care clinics in three small towns within a 30-mile radius of        But the bustling town of 8,000,
Hazard. The four facilities serve about 25,000 patients a        named for naval hero Oliver Hazard
year. Outreach remains an important function. Nurses and         Perry, in many ways defies the im-
social workers still canvas the hollows in jeeps, visiting 300   age of a rural backwater. With the
to 400 infants regularly.                                        resurgence of the coal industry, peo-
                                                                 ple are moving in, not out. The town
  At first, Family Health Services had only one National         has a modern shopping center with
Health Service Corps physician, a pediatrician who arrived       A & P and K-Mart stores, a net-
in 1976. Two years later, the staff included three doctors, a    work-affiliated TV station, a com-
physician's assistant, and a nurse practitioner who were         munity theater and concert series,
members of the Corps.                                            and rush-hour traffic jams. "There's
  In eastern Kentucky, as in many other rural areas, attract-    a lot of money around here," people
                                                                 are fond of telling visitors. "A man
ing and keeping physicians is an ongoing battle. Through         can easily make $10 an hour in the
their work with organizations such as Family Health Ser-         mines."
vices and the historic Frontier Nursing Service in Hyden,
Ky., Corps members help bring quality health care to the          Phyllis E. Lehmann is a Washington-based
mountains.                                                       freelance writer specializing in health issues.
                                                                                        July-August 1979 25
   Yet, the other Appalachia is not       -   Eastern Kentucky Health Ser-
far from Main Street. Still clinging      vices Corporation, with two clinics
to the hillsides up and down the          in Hindman, some 20 miles north of
hollows are the sagging shacks and        Hazard. The clinics were founded 6
junk cars that inspired the nation to     years ago and are still operated by
declare war on rural poverty more         Dr. Grady Stumbo and Benny
than a decade ago. For many moun-         Bailey, sons of local coal miners,
tain people, the war is far from won.     who recently won a Rockefeller
Despite the new wealth, coal and          Public Service Award for their work
dole remain the chief means of            in bringing health care to rural Ken-
livelihood. And to a considerable ex-     tucky.
tent, eastern Kentucky still must de-
                                            National Health Service Corps
pend on outsiders for many things,
                                          members have served at one time or
including health care.
                                          another at all of these sites.
   As recently as the early 1970s,
most medical care in the area was
provided by a few overworked pri-         Family Health Services                   Although infant mortality rates have
                                                                                   dropped significantly, child and maternal
vate physicians. Now, thanks to a         The fastest growing of the four          nutrition are still below par
network of clinics and outreach           organizations is Family Health Ser-
programs, some health care is             vices (FHS). It was launched as an       deaths per 1,000 live births in 1971
available to the poorest and most         infant care project in 1972 by Dr.       to 5.2 per 1,000 in 1975. In 1970,
isolated families. In addition to the     Greg Culley, a pediatrician now          half the children entering school
private practitioners, there are four     with the University of Louisville        had received no immunizations and
major health care providers serving       Medical School, and Les Rogers, a        had never had a medical examina-
approximately 120,000 people in an        social worker and currently director     tion. Almost 40 percent of children
8-county area:                            of FHS, to help reduce high infant       under 2 years who were admitted to
                                          mortality rates in Perry and sur-        the hospital had significant iron
-   Hazard Family Health Services,        rounding counties. Funding came          deficiency anemia. Five years later,
a system of four primary care clinics     initially from Appalachian Regional      about 90 percent of all 2-year-olds in
and an outreach program for               Hospitals, Inc., a nonprofit chain of    the area were immunized, and the
mothers and children, associated           10 hospitals in Kentucky, Virginia,     rate of anemia had dropped to 12
with the Appalachian Regional             and West Virginia built during the       percent.
Hospital in Hazard.                        1950s to serve members of the              Eventually, the infant care project
- Mountain Comprehensive                                                           was expanded to include a pediatric
                                          United Mineworkers of America
Health Corporation, the pioneer           and their families. Later, the project   clinic and child development clinic
provider of family health care in         was supported by the Robert Wood         at the Hazard hospital. In 1974 it
eastern Kentucky when it began            Johnson Foundation. Over a period        began offering prenatal services. In
operations in 1971 with money from        of 5 years, teams of nurses, health      1977, Family Health Services took
the now extinct Office of Economic        aides, social workers, nutritionists,    over operation of independent
Opportunity. Mountain Comp now            and child development specialists        clinics in three small towns within a
runs four clinics in Perry, Letcher,      followed nearly 4,000 children born      30-mile radius of Hazard, and in
and Breathitt Counties.                   at the Hazard hospital. Canvassing       July 1978 began offering full family
- Frontier Nursing Service, with a        the hollows in jeeps, the health         medical services at all four facilities.
40-bed hospital, six satellite clinics,   teams visited homes, monitoring             The system now includes the
and a world-renowned school for           each infant's growth, providing          pediatric and adult clinics in
family nurse midwives located in          nutritional information, urging the      Hazard; the Homeplace Clinic in
tiny Hyden, about 20 miles south-         mother to have the child im-             Ary, formerly a 20-bed hospital and
west of Hazard. The service was           munized, and suggesting ways to          now an outpatient clinic with its
started by a Kentucky woman, Mary         stimulate the baby's development.        own laboratory, pharmacy, and X-
Breckenridge, who brought the first          The program, along with im-           ray facilities; the June Buchanan
professional midwives to the United       proved medical care in general, con-     Clinic in Hindman, which has a
 States after World War I to help         tributed to substantial gains in child    full-time dentist as well as two
reduce the risk of childbirth among       health. The infant mortality rate in      family doctors; and a small clinic in
 mountain women.                          Perry County dropped from 23              Yerkes, visited by a physician 1 day
26 Public Health Reports Supplement
                                                                                        and Children) Program. These
                                                                                        programs were started by the U.S.
                                                                                        Department of Agriculture in 1974
                                                                                        to provide iron-rich foods to
                                                                                        children under 5 years and to preg-
                                                                                        nant and lactating mothers who are
                                                                                        certified by a physician or nutri-
                                                                                        tionist as nutritional risks. Two
                                                                                        thousand people in the Hazard area
                                                                                        receive monthly vouchers good for
                                                                                        purchases of milk, eggs, cheese, fruit
                                                                                        juices, and iron-fortified cereals.
                                                                                        The program also features nutrition
                                                                                        clinics and check-ups held in
                                                                                        church basements, schools, libr-
                                                                                        aries, and clinics in some 20
                                                                                        crossroads communities - places
Homeplace Clinic in Ary has laboratory, pharmacy, and X-ray facilities                  like Busy, Mousie, Buckhorn, and
                                                                                        Pippa Passes.
a week and soon to be staffed by a               With its addition of new clinics          Les Rogers, director of Family
nurse practitioner 3 days a week.             and expansion to a full primary care      Health Services and a Hazard na-
   The Hazard and Homeplace                   system, Family Health Services has        tive, is proud that most of his ad-
clinics operate 8 hours a day, 5 days         not lost sight of its original mission.   ministrative staff are local people.
a week. Emergency care is available           In a scaled-down version of the in-       "At one point, it was all imissionary
around the clock at the Hazard                fant care project, 1 RN., 3 L.P.N.s       types who came down here and got
hospital and at the June Buchanan             and a social worker regularly visit       us mountain folk involved," he says.
Clinic, which has its own emergency           300 to 400 infants. (The Hazard           "We've come a long way since
room. Known for its "walk in" ap-             hospital's home health agency cares        1972." Of the seven physicians cur-
proach to obstetrics, the June                for homebound adults.) Nurses             rently employed by FHS, two are na-
Buchanan Clinic has a modern                  usually visit babies at age 2 weeks       tives. Three others are members of
delivery room and 2 post-partum               and at 2 months to make sure all is       the National Health Service Corps,
hospital rooms where mothers and              well. A premature or low birth            and two more Corps physicians, a
babies spend 8 to 12 hours before             weight baby gets more frequent at-         husband and wife, are scheduled to
being discharged. Since birth is very         tention, and problem cases are seen       arrive soon. A family nurse practi-
much a family matter in the moun-             as often as once a week. "We had          tioner and a physician's assistant on
tains, husband and kin are en-                one 14-month-old child who                the staff also are Corps members.
couraged to join the mother and               weighed only 13 pounds," says out-
baby in the room, to bring food, and          reach supervisor Donna Creech.            Hazard's Special Qualities
generally to enjoy the occasion.              "The mother had 3 kids under age 3        Personal reasons for selecting
   "I read an article recently about          -2 of them only 8 months apart            Hazard vary among the Corps mem-
how 'rooming in' with new mothers             and she just wasn't able to take care     bers, but most cite a desire to leave
is becoming big in New York," says            of the baby."                             the city and to practice in a rural
Dr. Gene Watts, a Family Health                  Often the battle is against ig-        area where they could fulfill what
Services physician who delivered              norance. On a recent visit, the out-      one calls "the old medical school
1,500 babies in his Hindman office            reach nurses encountered an angry         cliche of helping the people." All
before moving his practice to June            father who protested what he saw as       say they were attracted to Family
Buchanan 4 years ago. "What's so              meddling in his family life. Pre-         Health Services because of its prox-
new about that? We've been doing it           viously, it had taken FHS staff 3         imity to a 150-bed hospital.
for years." Perhaps the ultimate ex-          years to convince the father to per-         For some, the area itself holds a
ample of rooming in was the time              mit surgery on his older daughter's       special fascination. "I had a real
Dr. Watts looked in on a new                  badly crossed eyes.                       curiosity about Appalachia and just
mother to find her husband lying in              In another type of outreach,           wanted to experience it as much as I
bed beside her, both of them sound            Family Health Services administers        could," says Becky Warner, a family
asleep.                                       the local WIC (Women, Infants,            nurse practitioner from Illinois who
                                                                                                          July-August 1979   27
has, been working at the Homeplace
Clinic since January 1978. "I knew,
through Vanderbilt University,
where I got my master's, that the
Corps was one, way to practice in a
rural setting."
   Others see the Corps as an oppor-
tunity to step out of an academic
medical setting for several years and
decide on the direction of their
careers. David Werner was in the se-
cond year of a, 3-year pediatric resi-
dency at the University of Virginia
when he decided it was time for a
change. "I was interested in a job
with a small, responsive organiza-
tion, where I wouldn't be bogged
down. I knew who I wanted to work                                                             :1I~i .-.
                                                                                               I           ,!'r"

for; I just had to find the right          Dr. Sandy Schneider likes the variety of practice in the NHSC offers. As an internist at
place.,"                                   Hazard Family Heafth Services, she gets consufts, works in the CCU and will soon be
                                           screening and treating coal miners who have black lung
   Leslie Grissom, who is working as
a general practitioner at Hormeplace,      Irom radiology to public relations at
wasn't sure she liked her specialty of     the Hazard hospital has proved more
internal medicine and decided to           satisfying then he expected. Besides,
fulfill her 3-year scholarship com-        easten Kentucky offered a lifestyle
mitment to the Corps after complet-        that the Schneidemrwere eager to try.
ing her internship. "This has given        "There's still a missionary spirit alive
me the opportunity to see what kind        in both of us," Paul says. "But we
of practice I want," she says. "I'm        would never know if we wanted to live
really beginning to enjoy seeing kids,     - or could live - in a rural area
for instance."'                            unless we came to an isolated place"
   Site selection was more complicat-         Rural health care systems such as          Her NHSC service thas given Dr. Lesle
ed for the married physicians, who         those in the Hazard area offer Corps          Grissom, a generalpractitioner, "the
                                                                                         opportunity to see what kind of practice
als-o had to consider their spouses'       doctors the chance to practice a              I want"
careers. Two ofthe four Corps doctors      different kind of medicine than they
at Frontier Nursing Service in Hyden       would in an urban area. "This is a               Mark Buchanan, a Corps internist
were attracted to the site because their   quick way to get a glimpse of what            at the Frontier Nursing Service, has
wives wanted to attend the fimous          practice is like without working my           found simnilar satisfactions. "In cities
nurse midwife school. For Sandy            way up from junior partner," says             and suburbs, general internal
Schneider, an internist at Hazard          Sandy Schneider. "At one site I               medicine is becoming a restricted
Family Health Services, and her hus-       visited, they said, 'If you come here,        field," he says. "There's a lot of
band Paul, a hospital administrator,       in a year and a half you should have          pressure to refer people right out to a
the decision was not an easy one.          10 people in the hospital, be getting         subspecialist. Down here the nearest
They spent months and more than            referrals from other GPs, and maybe           subspecialists are in Lexington, a 2
$1,000 of their own money looking at       even get a chance to work in the cor-         1/2-hour drive, so I can exercise my
Corps sites before they decided            onary care unit' I didn't want to             skills as far as I'm able to. As the
Hazard was the best spot for tboth of      wait a year and a half for that ex-           only internist here, I do a fair
them. Sandy could practice internal        perience P'm getting consults now,            amount of primary care, but it's un-
medcine while Paul could continue          and I regularly work in the CCU."             derstood that when there's a patient
to work in a hospital. For Paul, the       As soon as respiratory therapy                with an unexplained heart sound or
switch from executive director's aide      equipment is set up in the hospital,          a hematologic abnormality in a lab
at a Pittsburgh teaching hospital to       she also will be involved in screen-          test that nobody can figure out, the
personnel manager and assistant ad-        ing and treating coal miners with             problem ends up in my office. That
ministrator in charge of everything        black lung.                                   really appeals to me."
28   PublIc Health Reports Supplement
   For general practitioner David              Having lived in the New York          nearest larige city, 118 miles away,
Coursin, a 2 1/2-year stint at Fron-        City area until age 40, Yvonne Im-       for a weekend escape. "Last winter,
tier Nursing Service has meant a            bleau is content with the quiet isola-   three of us would go to Lexington,
chance to practice "hand and eye"           tion of Hyden, population 300. For       check into a hotel with an indoor
medicine. "You don't learn that in a        some younger doctors, though,            pool, astro-turf, and sun lamps and
medical center setting," he main-           eastern Kentucky was a bit of a          just soak it up," says a New Yorker.
tains. "You learn how to order tests,       cultural shock. One doctor recalls       "I never thought I'd spend $100 on a
how to interpret diagnostic laborato-       arriving before the movingvan at the     weekend like that."
ry studies, and how to decide who is        house he had just bought at the head          Generally, the urge to get away
the best consult to handle the pa-          of a hollow. "I was sitting there with    isn't as great as anticipated. "'When
tient. In a rural area where you don't      just one chair and my plants, and I       we came, I had plans to get out at
have those things right down the            experienced 3 hours ofsheer panic."       least once a month and fly to Pitts-
hall, you have to make decisions on            Another doctor found "the only         burgh or elsewhere," says Paul
the basis of what you can see and           adjustment I had was with my              Schneider. "I haven't left yet."
feel and what lab tests you can do.         sinuses. It's too wet and damp here."         Practicing in Appalachia necessi-
Then you sweat it out. But I think          But for most of those from cities,        tates some professional adjustments
you learn something that will enable        mountain life does indeed take some       as well. The outsider, for example,
you subsequently to practice an             getting used to. Anonymity, for in-       must learn to translate a patient's
economical, sensible kind of                stance, is unheard of in a town like      description of symptoms. "Every-
medicine that is more human than            Hazard. "Something can happen in          body around here 'smothers',"
technological."                             the clinic, and 20 minutes later          reports nurse practitioner Becky
   For the most part, the National          everybody on any floor of the             Warner. "'Smothering' can mean
Health Service Corps practitioners           hospital knows about it," reports a     anything from a cold to a goiter to
at Family Health Services and Fron-          newcomer.                                chronic lung disease to dying." New
tier Nursing are young, fresh out of                                                  doctors find they must deal
training, just starting their careers.      Drawbacks                                 diplomatically with reliance on
Then there's Yvonne Imbleau, an             Petty frustrations are numerous.          home remedies and with some
obstetrician who finished medical           Corps people at one clinic complain       unusual customs. A brew known as
school 25 years ago and arrived in          that the phone lines go dead every        i"sheep dip tea" is given to babies
Hyden by way of the African bush.           time it rains - and it takes several      about a year old to make them break
Imbleau was in private practice in          days to get them fixed. There is a        out in "welps" or hives, in the belief
New Jersey until 1971 when she              movie theater in Hazard, but it took      that the hives are in the child and
decided that the malpractice in-            more than a year for "Star Wars" to       must come out. Since children are
surance situation had become in-            arrive. The fanciest bread in town is     allergic to the tea, hives do indeed
tolerable, closed the office, and went      Roman Meal, although the new,             come out, usually without complica-
to Africa. She stayed 5 years, work-        much enlarged A & P is a haven for        tions. The concoction also is taken
ing without pay at maternity                those with sophisticated palates.         for colds, which led to near tragedy
hospitals run by a mission. Return-         "We go in every day," says one doc-       for a woman who drank the arsenic-
ing home following an illness, she          tor, "and count the packs of frozen      containing pesticide known as sheep
did not want to resume a city prac-         wonton soup to see if anybody is          dip. Fortunately, most home
tice. "I like to be able to see the trees   buying it except us."                     remedies are harmless. A man who
and sky. I came to Frontier Nursing            Former city dwellers do appreci-       had cut his leg soaked the wound in
Service because there is a need here,       ate the peace and quiet, the slower      kerosene. It burned like crazy, he
too, and because I got used to work-        pace, the freedom to leave the door       told the doctor, but at least it didn't
ing with British and Irish midwives         unlocked. There is small-town             get infected.
in Africa Here, I'm the midwives'           friendliness, too, although outsiders        Are the conditions that bring peo-
back-up more than anything else,            find it difficult to break into local     ple to the doctor substantially
but I also go out to the district clinics   social circles and end up fraterniz-      different in the mountains than in
one afternoon a week. That's my             ing mostly among themselves. Din-         the city? "No," answered a doctor at
favorite. "                                 ners and parties at one another's         Frontier Nursing, "but I had a guy
   For Imbleau, a prime advantage           homes are more common than in a           last week who was bitten by a pig. I
of the Corps is being salaried. "I          city where there are more outside         also see a lot of snakebites and a fair
hate saying to a patient, 'Look, you        diversions. Occasionally Corps            number of gunshot wounds. This is
owe me so much."'                            members go to Lexington, the             still Hatfield-McCoy territory."
                                                                                                        July-August 1979 29
Recruiting Physicians
For the people of Hazard, attracting
and keeping an adequate supply of                                                                                                                   ........-

medical personnel is a continuing
preoccupation. "I've only been here
3 years," saysJack Burch, director of
a local community service organiza-
tion, "and my little boy has already
had four different pediatricians."
When the town lost five doctors for
various reasons in the summer of
1977, the citizenry decided it was
time for an all-out recruitment
drive. "It had gotten so bad around                    ~~~~~~~~~~~~~~~   ................   ...............
here that I made sure I behaved           Diana Fortney, respiration therapist, and Dr. Schneider check equipment used to
myself," jokes Mayor Bill Gorman.         screen and treat miners with black lung
"I was afraid to have a heart attack."
   The board of governors of Family       southeastern States," she says. "Fred
liealth Services, the hospital staff,     Rivara spoke to me and said, 'The
some private physicians, and the          place you want to go is Hazard,
Perry County Jaycees assembled a          Kentucky.' He was the only one who
committee that placed ads in medi-        said anything like that. After check-
cal journals and contacted medical        ing four or five sites, I liked Hazard
schools. Contributions were               best because of the need in the area
solicited from local residents so that    and because of the enthusiasm of the
prospects and their spouses could be      doctor who was here before."
invited to Hazard for a visit. "We           Rivara also was instrumental in
rolled out the red carpet for them        David Werner's decision to come to
and showed them our area, but we          Hazard. 'Just by serendipity, some-
told them our faults as well," says       one dropped off brochures about
Betty Morton, chairman of the FHS         Hazard at the University of Virginia
Board of Governors. "We tried not         where I was in my residency. I
                                                                                                              Although the birth rate is down
to paint any false pictures." Their       called and talked to Fred Rivara and                                considerably from 17-child families,
efforts paid off. In the past year, the   we hit it right off, because we had                                 mountain women still tend to have
town has welcomed a total of 11 new       similar experiences and had the                                     babies close together. Education on how
                                                                                                              to plan families is provided at the clinics
doctors, both private practitioners       same feelings about academic
and salaried members of the               medicine. He was about to leave and
hospital staff, including the 3 Na-       needed a pediatrician to replace
tional Health Service Corps physi-        him, so here I am."
cians.                                       Changes wrought by the recruit-
   The recruitment committee              ment drive, however, have not all
agrees that the lion's share of credit    been harmonious. The sudden in-
must go to Fred Rivara, a pediatri-       flux of salaried physicians has cre-
cian who previously was Hazard's          ated an "us and them" political
only National Health Service Corps        situation within the medical com-
physician. Before moving to Seattle       munity. Although the area has a
to complete his training, Rivara and      long history of salaried physicians
his wife J'May spoke on Hazard's          first the doctors hired by the mining
behalf at National Health Service         companies and later the staff of the
Corps recruitment meetings. Their         miners' hospitals - some of the
enthusiasm proved infectious for          older private practitioners see the
people like Leslie Grissom. "I went       current trend as a threat to medicine
to a meeting in Chicago where there       as they know it. There are frequent                                 Dr. Grissom is one of five Corps
were representatives from all the         rumblings about socialized                                          members at Family Health Services
30   Public Health Reports Supplement
                                                                                        several counties, is clearly a medical
                                                                                        shortage. And, of course, the
                                                                                        Government concurs. But Beasley
                                                                                        agrees that the situation can be most
                                                                                        frustrating. "It's either feast or
                                                                                        famine," he says. "You have a
                                                                                        whopping staff, because people are
                                                                                        here for training. Then, suddenly
                                                                                        everybody leaves and goes off to In-
                                                                                        dia or North Dakota or somewhere,
                                                                                        and you have to build up all over
                                                                                           Dr. Beasley manages some
                                                                                        stability by requiring all students
Dr. Schneider discusses X-ray with patient. Hazard offered professional opportunities   who train as nurse practitioners or
to the physician and her husband Paul, a hospital administrator. And eastern Kentucky
offered a /ife style both wanted to try                                                 midwives at Frontier to devote at
                                                                                        least 1 year's service to the com-
 medicine. Even Dr. Eli Boggs, a pri-         and sees no reason why private doc-       munity after they graduate. "We ad-
vate  practitioner who serves on the          tors, who make   a great deal more        mit 24 students a year, which means
Family Health Services board and              money, should feel threatened by          that people in this small community
was active in the recruitment cam-           them.                                      have 24 new faces looking at them
paign, worries about increasing                  The upsurge in Government              each year, 24 strange people mash-
government influence in health               spending for rural health care in the      ing on their bellks and asking all
care. Some Corps members feel that           past decade has created competition        manner of personal questions. We
the resentment is directed not so            and bickering among the health             feel these students are obligated to
much at them or the other salaried           organizations as well. Lois Baker,         their main teacher - the com-
doctors as at Family Health Ser-             executive director of Mountain             munity."
vices, whose costly outreach                 Comprehensive Health Corpora-
program is unpopular with conser-            tion, sees the situation in Darwinian
vative physicians.                           terms: "It's reached the point where       Appalachia's Heafth Needs
   For all the high-sounding argu-           it's survival of the fittest and the       There is general agreement that no
menth, much of the conflict boils            strongest. The intentions of the            matter how many health practi-
down to dollars and cents. "Private          Federal Government were beautiful.         tioners are aboard at any given time,
practice of medicine is also a busi-         They were going to bring health care       there is plenty of business for all.
ness," says Donnie Spencer, a young          to the mountains of east Kentucky,         Health problems indigenous to Ap-
private physician who grew up on a           and they did. But I'm afraid that if       palachia have not been wiped out.
farm outside of Hazard. "The busi-           the trend continues, they're going to      Although infant mortality rates have
ness side of these doctors doesn't           put us all out of business, because        dropped significantly in the past
like the competition, even though on         we won't be able to meet the patient       decade, child and maternal nutrition
the medical side there will always be        quotas the Government sets for us.         still are below par. Pediatricians see
a need for more doctors."                    You can't build a half-million-dollar      a lot of children who fail to thrive
   Dr. Spencer, who is on the Family         clinic at every wide spot in the road      both physically and intellectually.
Health Services' board and a leader          just to keep some politician happy.           Although the birth rate is down
of the recruitment committee, finds          The government should have                 considerably from the days of 17-
himself in the position of                   enough sense to stop and give those        child families, mountain women
peacemaker, a bridge between the             of us they've already spent millions       still tend to have babies close
old order and the new. He chose to            on a chance to survive."                  together, which depletes the
go into private practice because, "I            Her feelings are not shared by          mothers' nutritional stores. A recent
want to be completely in control of          most others knowledgeable about            survey by the Coordinated Con-
my own practice, and I like the idea         health care in eastern Kentucky. Dr.       sumer Health Education Project in
that everybody who comes to see me           W. B. Rogers Beasley, director of          Hazard showed that 25 percent of
chooses to come of his own free              Frontier Nursing Service, points out       the pregnant women studied were
will." Yet, Spencer has a deep ap-           that the ratio of 1 physician for 5,000    anemic, almost all were protein defi-
preciation for the salaried physicians       or 6,000 people, which exists in           cient, and about half had low
                                                                                                          July-August 1979 31
calcium levels. The survey revealed         cerned about spouse abuse, but they       year. The project planners also hope
a significant deficiency of iron in in-     point out that transportation             to enlist outside experts to help edu-
fants' diets as well.                       problems and lack of anonymity            cate health professionals about
    Breast feeding, not encouraged by       would make it difficult for battered       nutrition, which gets short shrift in
physicians in the past, is generally        wives to take advantage of support        medical schools.
considered taboo. Many mothers              groups and shelters.                          In the future, providing adequate
believe formula is both more                   Medical care in the Hazard area        medical care for eastern Kentucky
sophisticated and better for the            continues to be crisis-oriented.          will be a continuing battle for the
babies, according to Carol Golden,          Although some health education is         Government, for health practi-
director of the Consumer Health             incorporated into outreach pro-           tioners, and for the citizens of
Education Project. As early as 3            grams and WIC nutrition clinics,          Hazard who are weary of searching
weeks of age, babies start receiving        patient interest in preventive care is    for new doctors. Even with 11 new
table food that is loaded with fats         low. Warner writes a question-and-        physicians in town and ambitious
and sugars. These empty calories            answer health column for the              plans afoot for health education, the
produce many overweight, but not            Hazard newspaper; so far it has           recruiting job is far from done.
necessarily healthy, infants.               generated few inquiries. One              Hazard needs more specialists
    Adult obesity and dental                problem in a deprived area, notes         another surgeon, an orthopedist
problems also are common conse-             Carol Golden, is that people value        and upgraded facilities so it will be
quences of the local diet. Lard re-         simple pleasures like smoking and         less dependent on Lexington.
mains a staple of mountain cooking,         soft drinks. "It's hard to talk to a          Despite Hazard's hopes for
and in the new A & P tubs of lard           woman with nine kids and a hus-           stability, high turnover rates among
are stacked almost to the ceiling.          band who doesn't have a job about         Corps physicians and other health
Consumption of soft drinks is legen-        not drinking Pepsi."                      practitioners undoubtedly will con-
dary in eastern Kentucky. Repor-               A formal health education effort,      tinue. Corps members attribute this
tedly, Perry Countains drink more           planned by the Coordinated Con-           not just to a desire to leave the hills
Pepsi per capita than any other             sumer Health Education Project,           but to a general increase in mobility.
group in the nation. In the hollows,        will be aimed at the most receptive       To the mountain people, these rapid
it's not uncommon to see a Pepsi            group - pregnant women and                departures often smack of disloyalty
machine on a front porch or along           mothers of infants. The plan is to        or an inability to "stick it out."
the road, sometimes wired into a            train lay women in four counties             Still, the people of Hazard dream
house lacking indoor plumbing.              who will meet individually or in          of the time when they might have a
    Such forms of exercise as walking       small groups with their neighbors to      self-sufficient medical center staffed
and jogging are not part of the             communicate health information.           and equipped so that overworked
mountain culture. "Where am I               "Child care and transportation are        pediatricians would no longer have
going to walk?" an obese woman              such problems here that a woman is        to transport a critically ill newborn
asked her doctor. "People will think        lucky if she can get to a clinic to see   100 miles to Lexington. "I'd like to
I had a fight with my husband."            the doctor, much less come back in         see us get doctors who would move
   Mental problems are not                 the evening to attend a health             in, put their roots down, and enjoy
necessarily more prevalent here than       program," Carol Golden says.               the beauty of the mountains," says
elsewhere, but they are more likely         "Besides, these are private people        Mayor Gorman. "Possibly a third of
to go untreated. Because counseling         who resist the idea of walking into a     the population of Kentucky could
is virtually nonexistent, pill-popping      room with 20 other women and talk-        be served out of this area Right now
is the standard method for dealing          ing about what it feels like to be        a lot of people die needlessly be-
with depression and anxiety. This is        pregnant. We've got to reach them         tween here and Lexington or here
frustrating to the Corps members,          on their own ground, through a lady        and Cincinnati."
who sometimes find themselves hav-         they may have seen at church or in            In the meantime, Kentuckians
ing to practice psychotherapy.             the neighborhood who is coming             are pragmatic enough to welcome
Although families tend to be close-        around to talk as a friend and             help from wherever they can get it.
knit in some respects, individuals         helper."                                   All they ask in return is a commit-
often are unable to tell their relatives      A key feature of the proposed pro-      ment to providing quality health
their personal problems. Corps             ject will be ongoing evaluation,           care. "If you want to help the sick,"
physician Leslie Grissom and nurse         which will include following a             says Mayor Gorman, "we've got
practitioner Becky Warner are              woman from the second trimester of         plenty of sick people to go around
working with a local group con-            pregnancy through the baby's first         for everybody."
32   Public Health Reports Supplement

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