Artie Equihua ’20

Artie Equihua ’20 — When I was around three or four years old, I told my grandfather I wanted to be a scientist. This statement did not evoke the greatest response considering he probably wanted (and still wants) me to pursue a career in professional sports. However, my fascination with science and deep desire to help those who feel hopeless has crafted my current dream of becoming a physician. However, even a kid who has dreamed of working in healthcare for his entire life can become overwhelmed by the negativity associated with it. Most recently, I had a discussion with a primary care physician working out of North Carolina. In our conversation he mentioned he had always wanted to be a doctor because of his love for science and his ability to utilize it in order to help people, but the current system was not allowing him to care for his patients to the extent he wanted to. Shortly after this comment he looked at me and said, “Healthcare is going to hell. What is it you want to do, again? Primary care? Pick something else.”

This encounter with the primary care physician had truly shook me. How could someone with such similar aspirations become so depressed and resentful toward healthcare? I tried to formulate a response that would somehow change the subject, and I ended up blurting out what his statement had made me feel. I started with the story involving my grandpa. I explained how I had identical interests and why I wanted to become a physician, but I did not say I agreed with his current perspective. Instead, I explained that I often, too, feel very cynical about the industry that I hope to someday find a career in; however, there is so much innovation and change already occurring that it keeps me hopeful.

Unfortunately, I could tell that he had not changed his position on the matter. Perhaps, he believes me to be naive, but I can live with that. Fortunately for me, with each new daunting flaw that I hear about in healthcare, I am exposed to the innovative work of twice as many people who are dedicating their lives to solving current healthcare issues on all levels. With so much innovation and optimism radiating from individuals at Volunteers in Medicine, HealthLINC, NCHICA, DHIT, Duke, UNC, and many other organizations, it is hard not to feel hopeful for the future.

This summer Equihua is participating along with Nathan Gray in a Global Health Initiative internship with Wabash alumnus Dr. Todd Rowland (www.bridge2medical.com). This is his second blog post in the series of posts on exploring the world of health care and those trying to revolutionize it. The G. Michael Dill Fund makes this internship possible.

Nathan Gray ’20, Dr.Todd Rowland ’85, Dr.Raj Haddawi, Arthur Equihua ’20. Dr. Haddawi helped found the Monroe County Volunteers in Medicine (VIM) Clinic in Bloomington in 2007, raising nearly $1 million in donations from the local community and engaging 200+ physicians in a volunteer effort. He now lives in Chapel Hill and was happy to meet with the students.

Nathan Gray ’20 — This summer I am fortunate to participate in a Global Health Initiative internship with Wabash alumnus Dr. Todd Rowland (www.bridge2medical.com) with my fellow intern Artie Equihua. This is the first of a series of blog posts where I share my experiences and observations about the healthcare field. I would like to thank the G. Michael Dill Fund for making this valuable opportunity possible.

During my week in Bloomington, I had the pleasure to shadow many of the staff at HealthLINC, a health information exchange, and at the Volunteers In Medicine (VIM) Clinic of Monroe County which provides care for the medically underserved. As I learned, in a healthcare system as fragmented as ours, a patient can quickly rack up a laundry list of medical care providers, and the failure of providers to coordinate their care can be deadly. Medical errors may result in as many as 251,000 deaths in the U.S. each year, making it the third leading cause of death in the country.1 Coordinating care and patient medical records across providers is critical to challenging this unacceptable statistic.

Health information exchanges, like HealthLINC, are playing an essential role in this battle by developing tools that aggregate a patient’s data into more complete and accessible records for all the providers using the tool. Sitting-in on a staff meeting and a conference call with their software developer provided Artie and I a unique peek into how these tools are developed, and my time at the VIM Clinic, which uses HealthLINC’s tools, demonstrated their important use.

The dedication of the VIM staff to their mission and the empathy with which they treated everyone who came into the clinic was an astounding sight. In my time at the clinic, I was inspired by an approach to medical care that was truly focused on improving patient outcomes of wellness—not only through clinical treatment but also by tackling the behavioral and social determinants of health whether that be overcoming language barriers, lifestyle counseling, or accessing social services. In carrying out their work, the VIM staff make effective use of digital health tools to the betterment of their patients.

Finally, a visit to the Critical Access hospital in Paoli, Indiana exposed me to the challenges for rural populations to access medical care. Critical Access is a designation given by the government to hospitals which serve rural populations and meet a number of other requirements. Critical Access hospitals, and especially their 24/7 emergency departments, are often an essential provider of care to these communities. Rural populations have greater difficulty accessing affordable medical care than their urban counterparts due to the limited supply of rural healthcare providers and other obstacles like transportation. It seems many now rely on the emergency departments of these hospitals as their primary care providers. This causes financial strain on the hospitals, is non-ideal for long term patient care, and if proper information systems are not in place, larger hospitals to which patients are transferred, may lack access to their patients’ complete medical records.

My experiences highlighted how various groups are working to reduce disparities in access and quality of care for the medically underserved and the important role that coordinated care plays in improving patient outcomes. In the coming weeks, I look forward to gaining a better understanding of the different actors involved in our healthcare system and how they are responding to changes in the industry of healthcare in innovative and patient-centered ways. A special thanks to Kathy Church from HealthLINC, the VIM Clinic staff especially Ed Hinds, and Sonya Zeller from IU Health Paoli for their time and effort in making this week so valuable.

1.         Anderson, JG; Abrahamson, K. “Your Health Care May Kill You: Medical Errors” Stud Health Technol Inform. 2017

Artie Equihua ’20 — This summer I am fortunate to participate in a Global Health Initiative internship with Wabash alumnus Dr. Todd Rowland (www.bridge2medical.com) with my fellow intern Nathan Gray.  This is the first of series of blog posts where I provide an update to the larger community. I would like to thank the G. Michael Dill Fund for making this internship possible.

This past week I had the privilege of observing a health information exchange called HealthLINC, in addition to, medical and business professionals at the Volunteers in Medicine (VIM) Clinic in Bloomington, Indiana. From observing these two organizations, I was able to see how the integration of technology affected the organization of the clinic and level of care provided to patients.

A common trend I had observed while I was at the VIM clinic was the large number of prescribed medications each patient was taking from multiple physicians. As it turns out, one third of Medicare spending is on patients which have five or more chronic conditions and see an average of fourteen different physicians annually (1). On top of that, those with 5 or more chronic conditions are prescribed an average of 50 prescriptions a year (2). Thus, if a patient is prescribed medications from multiple different doctors, do all of the doctors communicate? How do they keep track of every medication prescribed to the patient? Unfortunately, the answer to the first question is most likely no. These are the questions that are currently being answered by innovative healthcare technology known as digital health. Luckily for the VIM clinic, HealthLINC provides a digital health software system called Med Management which enables physicians and other medical staff to input and track each drug prescribed to their patients, instead of relying on the patient to recite their entire medical list. Thus, the increased efficiency created by the integration of technology systems such as med management, enabled more personalized care than before.

Overall, my experiences with Volunteers in Medicine and HealthLINC has been both insightful and thought provoking. In just a week, I have established a much better sense of what a functional clinic needs in order to sustain its level of care and office efficiency. Yet, the knowledge gained from my experiences has only exposed more dimensions of the healthcare industry that I still need to explore.

Sources:

CBO Budget Options, Volume 1: Health Care. December 2008.
U.S. Department of Health and Human Services (2010). Multiple Chronic Conditions – A Strategic Framework: Optimum Health and Quality of Life for Individuals with Multiple Chronic Conditions. Washington, D.C. December, 2010.

Matt Hodges ’19 — I spent this summer working at a Little Flower Clinic, a homeless clinic in Hazard Kentucky. Hazard is the county seat of Perry County, located in Southeastern Kentucky in the heart of Appalachia. Working in this setting with this population allowed me to experience the immense value of a liberal arts education in rural healthcare, and in healthcare in general. While at Little Flower I prepared health education presentations on type II diabetes and naloxone overdose intervention, engaged in community outreach, and accompanied the clinic’s case manager on her home visits to patients with chronic medical conditions. In all of these situations it felt as though Dr. Gelbman’s Sociology in Healthcare course had suddenly come alive, and seeing so vividly the real-world implications of what I learned in the classroom at Wabash stretched my critical thinking skills and left me exhausted at the end of each day.

The history and economy of Appalachia are both important in understanding its current health profile. For decades the economy of Perry County (and Southeastern Kentucky in general) was entirely dependent upon the coal industry. When the coal industry started to die, so did the economy. Now downtown Hazard resembles something along the lines of a ghost town that happens to have some people in it. Many people who worked in the coal industry lost their jobs and since many coal workers began work before they graduated high school, they don’t have the education necessary to find a new job that pays well. As a result of this, unemployment rates are through the roof and people have a hard time accessing healthcare.

In addition to this, Southeastern Kentucky has a sizeable dose of warranted medical skepticism. This region was the epicenter of the Opioid Crisis that currently raging through the United States (in fact, the heroin outbreak in Scott County Indiana was traced back to Hazard Kentucky). Many of the blue-collar workers in the area either experienced chronic pain as they aged, or required back surgery as a result of years of physically demanding work. Many doctors put their patients on liberally prescribed and poorly supervised painkiller regimens that got the patient hooked on opioids. Soon these high-powered drugs were being prescribed to almost anyone who complained of pain. A few (but not as few as you would like to think) corrupt physicians opened up methadone or suboxone treatment clinics so they could profit from not only getting their patients addicted, but also from weaning them off. This led to a physician distrust that can be felt in the community and many clinics (like Little Flower) are run instead by nurse practitioners, who are generally more trusted within the community.

A lot of the work I did involved health education regarding naloxone overdose reversal and the local Good Samaritan laws that protect individuals who try to help in the event of an opioid overdose. The wound left by opioid over-prescription is still very fresh, and a decent portion of the population still abuses pain pills (fortunately heroin has not hit the area quite as hard as it has hit some parts of Indiana yet). The local health department has also been providing great education in this area, but I discovered that active drug users weren’t likely to attend these events, but active drug users are the most likely to be the first responders to an overdose. So I set out to provide education to this demographic, and made several trips down to the local homeless shelter for that purpose. I unfortunately cannot go into detail on the life stories I heard there and still call this a blog post of reasonable length, but the impact it had on me was immense.

The other part of my experience that was the most eye-opening was accompanying our case manager Helen on her home visits. No matter how good the trust between a healthcare provider and a patient is, there is still a wall that goes up between them in a clinical setting. Visiting a patient at their home tears that wall down. It also gives valuable insight into things that might complicate their treatment plan that would have been entirely unknown otherwise. For example: it is a lot more difficult to eat diabetic-friendly meals if your oven has been broken for eight months. But the broken oven will likely never come up in a yearly checkup. Following Helen around showed me that even if a diagnosis is the same between a group of patients (hypertension, diabetes, alcoholism, etc.), no two patients are alike in their needs and have very unique social and economic situations that impact their medical care.

My liberal arts education at Wabash was instrumental in my perception of the health issues in Appalachia and their underlying causes. However, lessons I learned from the wonderful people at Little Flower could not have been taught in a classroom, and I will be forever grateful to them and to the Wabash GHI for allowing me to spend this summer in Appalachia. The experiences I had will continue to weigh on my mind as I continue along my career path as a health professional.

Ben Grubbs ’20 — Durban, South Africa was an experience like none other. The city rich with history and culture is more than just a typical African city. It is a city not to be fully understood unless immersed into the different lifestyle. While abroad during the month of June, I learned what real struggles were. These real struggles involved not knowing if you were going to have electricity, clean water, or even food for dinner. In a city rampant with HIV, tuberculosis, and poverty, everything in life is quickly put into perspective. Our “first world problems” are suddenly not problems at all, they are actually privileges. Durban is faced with all of these challenges and still manages to thrive off of community and family relationships. Their culture revolves around one another and building those relationships. It is so unique and not one to be found anywhere in the United States.

While culture was a daily learning experience for me, it wasn’t the only thing. My mission while abroad was to learn about the problems associated with HIV/AIDS. With over 60% of adults testing positive for HIV, it is a problem that needs to be handled. Each of the weeks while I was there, I worked in a different hospital/clinic/pharmacy in order to see the problems from all aspects. I was lucky enough to ride along with a hospice company to homes and see the problems faced by millions of Africans first hand. Many patients lived in one room, tin-walled shacks that did not have running water or electricity. They lived with family and were unable to do anything due to cancer, TB, and other common diseases. While working in a pharmacy, I was able to pack and help distribute antiretrovirals (ARV) to those in need. Since ARV’s are free to the public, it is a very busy business. In the hospitals, I saw tuberculosis secondary to HIV which is rarely seen in an American hospital. The challenges they faced daily were not having the correct medicine to treat patients, not having the technology, and also not having the funds to continue to run the hospitals. The first week while I was in South Africa, the last oncologist for public hospitals in the whole province quit, leaving millions of patients out to dry. The wait list to see an oncologist was over six months and that was just a guess on the hospitals part. My whole time abroad, they were unable to hire any more so the oncology field was nearly nonexistent.

My trip to South Africa was truly an eye opening experience that changed my outlook on healthcare and life forever. I learned more than I could imagine that I will take with me for the rest of my life. I hope to translate what I learned abroad to a more local level in Crawfordsville in order to help us achieve the goals in the healthcare field.

Jade Doty ’18 — This past summer was an incredible learning experience that I know will hold many benefits in the years to come. I cannot thank the Wabash Global Health Programs, enFocus, and the St Joseph County Health Department enough for guiding me during my internship in South Bend, Indiana. During my stint as an enFocus intern, I worked closely with the St. Joseph County Health Department in the fight against low food access in South Bend. Additionally I worked with a team of other enFocus interns on a project that consisted of raising funds for a county wide mass CPR training event that will take place in the fall of 2017 and finding the best ways to locate and catalog all Automatic External Defibrillators (AEDs) in the St. Joseph County area.

During my main project with the Health Department, I did a thorough analysis on all the census tracts in South Bend that were labeled as Food Deserts. In short, a food desert consists of an area where there is an abundance of low income residents, limited amount of food resources, and the spacing of residential living and food resources are far apart. I compiled a report of these census tracts which included the number of residents living below the poverty line, the number of SNAP (food stamp) recipients, Health statistics (such as number of residents with type 2 diabetes, high blood pressure, and high cholesterol), and the average cost of providing food for a household in a given census tract. This analysis held many interesting findings that showed that these census tracts were definitely food deserts and how poor health statistics were the results of this problem. The census tracts held a poverty percentage average of 35.6% (the national average is 14%), an average of two SNAP distributors, per census tract, and health statistics that soared above national averages. I hope that these specific findings give the city information that helps identify the problem of low food access in South Bend and helps them see a clearer way to solving this issue.

After this analysis, I conducted focus groups, researched several case studies, and found recommended next steps for the city of South Bend to take on their fight against low food access. One possible next step I found very interesting was providing a special shuttle system that would provide direct transport to several grocery stores for South Bend residents. I compiled all of these findings into a single 40-page report that I delivered to the Robin Vida, the head of the St Joseph County Health Department, and Samuel Milligan at the end of my internship.

My second project garnered some great learning experience because I had to create a business plan with a team of interns. Myself and two other interns were required to find the best practice to catalog AEDs in St. Joseph County. We believed that if we went out into the city and actually did some hard ground work in high dense areas, we would be able to produce results that would identify whether there is a lack, surplus, or moderate amount of AEDs in public spaces. These results were recorded and will be used to show a sample of the number of AEDs in public areas, which will further the county’s plan on whether to pursue cataloging more AEDs or creating a more strict AED policy for other businesses.

I enjoyed my time and learned a lot while working for enFocus and the St Joseph County Health Department. I was fortunate to work for an organization like enFocus, where the company is small enough to see the ins and outs of all their work from the top down, but still make a large impact with various projects in the St Joseph County area. While working with Robin Vida at the St Joseph County Health Department, I gained the perspective of how health departments work and how much they have the potential to benefit the cities and towns they are in. Robin was a tremendous mentor, as well as everyone at enFocus. I strongly suggest that the Wabash Global Health Program continues to keep ties with South Bend, enFocus and the various Health Systems in the St Joseph County area. I was blessed to have such a great learning experience.

Evan Hansen ’19 — Over the past eight weeks I have been working with the IUPUI Fairbanks School of Public Health. Each year the Your Life, Your Story summer camp supports up to 30 low income campers in a program, designed to reduce their risk of poor health outcomes. The 5 day camp took place from June 19-23 and it was one of the most fulfilling weeks of my life. This camp provided teens (ages 12-18) the opportunity to learn problem solving skills and develop their sense of identity and sense of self through creative outlets such as storytelling, music, art, and sports.

It has been a while since I was last at a summer camp, but I quickly felt the same enthusiasm. The three sessions I went to on a daily basis were storytelling, music, and theater. I am certainly not gifted in music or theater but I wanted to show the campers I could learn just like them.  Each camper highlighted their interests on an initial survey, and the professional storyteller was a very popular choice. In addition to the three activities there was a resilience building session led by community leaders. For about two hours each day, the resilience building involved various individual and group activities. As a mentor I was responsible for organizing events, observing the campers, and of course having a great time by participating in the games.

Our staff of ten mentors was comprised from all across the country. Since most of the campers spoke Spanish as well as English, it was very useful to have a couple mentors that were fluent in Spanish. From Colombia, Alabama, Georgia, Indiana, and North Carolina we all shared a similar passion for working in health careers. Some of us have medical school ambitions while others have recently graduated from IUPUI with degrees in public health. The interactions I had with the campers, mentors, and activity leaders affirmed my interest in physical therapy because I was able to witness the importance of serving others. The camp was a very fulfilling opportunity for myself because I was able to practice Spanish in a very active setting.

Throughout this internship I have developed my leadership, teamwork, and communication skills. Since this was the fourth year of the camp, a former mentor trained myself when I arrived back in May. With only a couple days before she was leaving for Swaziland, we had a lot to cover in a short amount of time. Over the next several weeks I attended various public health meetings with Dr. Bigatti and aided her with a couple other projects. Sitting at a desk planning events and training other mentors is all worth it for the incredible fun that awaited at Your Life, Your Story.

Pat Azar ’19 — I have spent the last seven weeks working with the Fountain & Warren County Health Department in Attica, Indiana. This internship has given me great experience in the broad world of public health. One of the main projects I worked on was giving a presentation to the medical staff at the St. Vincent Williamsport Hospital on how to properly fill out the cause-of-death portion of a death certificate. This project really helped me bridge the gap between public health and clinical health as I was tasked with explaining to the medical staff not only the proper way to fill out a death certificate but also why correctly filling them out is crucial for public health. Presenting in front of several physicians was a challenge. I was worried about how I would be received, being a twenty year old undergraduate student presenting to a room of physician who probably had patients waiting on them. They responded well to my presentation. I went through some cases and gave them time to fill out mock cause-of-death certificates and we discussed each case in detail and I explained to them how they should be thinking through each case. My nerves quickly subsided as I was able to facilitate a constructive conversation with the medical staff. Presenting in front of physicians was a success and it really boosted my confidence in my own public speaking abilities.

Working with the public health office showed me the importance of knowing and being involved in your community in the health care world. My post graduate plans include attending medical school and practicing medicine. While working and talking with host Wabash graduate Dr. Sean Sharma and others at the St. Vincent Williamsport Hospital I learned how important being aware of the issues in your community is to practicing good medicine. Luckily, I was able to spend a lot of time in the communities of Fountain and Warren counties. I frequently visited the local parks programs in the cities and towns and along with the nurses would talk to the children about head lice. Also, for the county fairs I made a display on various pest bugs that people may come into contact with during the summer months like mosquitos, ticks, scabies, head lice, and bed bugs, and I talked with people about those issues as they visited our booth at the county fairs. The community interaction was one of my favorite aspects of this internship and public health in general.

I would like to thank the Lilly Endowment for making this opportunity possible. It was an amazing experience and the knowledge and skills I’ve taken away from the past eight weeks will surely help me in my future career.

Aaron Becker ’17 – I recently had the privilege of taking part in a medical internship for the month of June in the Philippines through Child Family Health International. CFHI is dedicated to providing community-based global health education programs, which focuses on empowering local communities. The entirety of my trip was focused on global health, the Philippines’ healthcare system, public health, and community health. For the first week of the program I had the opportunity to visit a number of different healthcare facilities in Manila, the capital of the Philippines. I was joined by two other undergraduate students, Sara and Zoe, from New York and New Jersey. We were guided by two doctors, Dr. Paolo and Dr. Joel, through places such as the Department of Health, World Health Organization, University of Saint Thomas medical school and hospital, Philippines General Hospital, University of the Philippines medical school, and even the smallest volcano in the world at Tagaytay. The time that I spent in Manila was incredibly eye opening. I was able to try all kinds of different Filipino foods, visit a number of different malls, ride in Jeepneys, see historical sites, and of course visit the different health care facilities. Perhaps the most memorable part about seeing the different healthcare facilities was the stark contrast between different wards in Philippines General Hospital. On one side of the hospital there were wards that were only for patients covered by PhilHealth, their national healthcare coverage. These had no air conditioning, heavily crowded rooms, and insanely long lines. We met one patient that had been there for five hours and was only just getting seen to have his x-ray examined to be cleared for work. Yet, in another section of the hospital, there were wards for patients who paid higher premiums for their coverage. These had air conditioning, nicer waiting rooms, shorter lines, and smaller room for greater privacy. It was shocking to see such obvious differences in provided facilities for those who were able to pay versus those who could not; especially considering that the wards were in the same hospital where those who couldn’t pay could see.

After the first week in Manila I spent the next two and a half weeks in the remote island town of Quezon, Quezon. We were guided and instructed by Dr. Jana and the group of nurses and midwives that she worked with. Our time was spent shadowing Dr. Jana and the nurses as they handled consultations, emergencies, and child births. We were able to travel throughout the island by motorcycle/tricycle with the nurses to visit smaller health stations and reach even more remote regions. A typical day consisted of shadowing the nurses from 8 AM to 5 PM at the Rural Health Unit (RHU). However, we also took trips to Barangay Health Stations (BHS) with one or two nurses to reach patients even closer to their homes. These are smaller stations that are located within every Barangay, which are smaller sections of the town. Patients presented with a variety of different health concerns but some of the most common concerns included: high blood pressure, high cholesterol, cough, cold, fever, and prenatal checkups. However, the most interesting thing that I was able to witness was a live birth. The RHU has a side building dedicated to births and caring for mothers before and after they give birth. The room itself has no air-conditioning and no windows making it the hottest room I have ever been in. Fortunately, even in the extreme heat, Dr. Jana and the nurses were able to deliver the healthy baby without any incidents. Seeing a baby birthed did not make me want to be an OBGYN, but it was certainly an amazing thing to witness.

Another highlight from my time in Quezon was being a part of their first ever dengue virus school vaccination. Like malaria, dengue commonly spreads through mosquito bit, and can cause intense fevers and rashes. Dengue has just begun to emerge in the Philippines and the vaccination has only recently been developed. We went to three different schools to administer the vaccinations and ensure that each of the students received a card detailing their follow-up dates. Though the three of us were not able to actually give the vaccinations we were still able to assist the nurses in preparing them and interact with the children. This was my first real taste of having to honor medical ethics outside of the United States. Though I likely could have easily administered the vaccinations I agreed with CFHI’s stance on having us not administer them. It made me feel a bit useless at times not being able to perform the regular tasks of the nurses, but it was certainly an important lesson in ethics and humility.

The trip has transformed me in a number of ways. First, it has given me confidence in the kind of medicine that I want to practice. I am much more certain that I want to be a family physician and that I want to work in a community setting. It was incredible to see how influential Dr. Jana was on the island. Everyone recognized her as the town’s doctor and trusted her to care for them to the best of her ability. They knew that she was a part of their community and had a genuine concern for their health; that’s the kind of setting that I want to be in. Second, this trip has taught me a lot about the influence of religion. The Philippines has a majority of Catholic followers and it has a strong effect on government policy. The church had recently shown its disapproval of a healthcare bill that would have provided greater access to contraceptives and lobbied to have to bill blocked. The bill did end up passing, but the budget for the bill was slashed, making it nearly ineffective. Whether or not this decision is morally right, it is interesting to see how great an impact the Catholic church has on the Philippine’s government in comparison to the United States’ government. My religious studies at Wabash have mostly covered religion’s impact relative to America and seeing its effects on the Philippines has broadened my understanding of its impact. That leads me to my third take away: perspective. I have never had the chance to see healthcare, culture, and life in general outside of the United States until this trip and it gave me an entirely new outlook on all of them. My perspective on global issues and topics had been fairly shallow due to my lack of global experience. However, now that I have had the opportunity to live in and experience another country I feel much more prepared to consider global issues. In particular, this trip has made me consider our healthcare system, what can and should be done to improve it, while also giving me a better appreciation for the strengths that it has. My experience in the Philippines will be one that I never forget and will take with me no matter what career path I end up taking.

Anthony Douglas ’17 – In a recent New York Times article, a list of the 10 worst/hardest places to live in America was created. Out of the 10, 6 of those places were in Eastern Kentucky. If you’re a movie lover, you’ve likely seen a show or two that depicts the stereotypical rural Eastern Kentuckian as a moonshiner, drug addict, poor, hillbilly, and uncivilized person. “You better keep both eyes open,” “Be careful around them mountain folks,” “Don’t go anywhere by yourself,” “You’re going where? Oh, we will definitely pray for you.” This is just a small portion of some of the things I heard prior to my internship in Eastern Kentucky.

The road to Kentucky was a pleasant change from the flat lands of Indiana. The Appalachian Mountains are a sight for sore eyes, and make for a beautiful sunset. The first culture shock I received was the extremely narrow and windy roads that allow for “easy” transportation between hollers (or what non-Appalachians would call hollows). If visiting, don’t be surprised if you see equal amounts of ATV’s and 4-wheelers as cars, especially during the winter because it makes for efficient transportation and short cuts across the mountains. Make sure you take it easy going around the curvy roads, as veering off the road for a slight second may send you tumbling down the steep mountain hills. Appalachian Kentucky is a very special and unique place‑-one of the best things about it to me is how peaceful and simple life is in the mountains. Being from the city, I’ve realized how caught up we get in the hustle and bustle of city life, and how a lot of times we can become so self-absorbed that we don’t enjoy the simple things, like the people around us. You’d be surprised how much you learn about yourself, and life in general, when you’re able to come to a place like this. As I’m typing, I find myself outside of my room on the swing looking up at the mountains enjoying the sound of nature.

Douglas interacting with children from Eastern Kentucky.

More often than not, stereotypes are unreasonably large generalizations of a group of people. The negative stereotypes that exist of Eastern Kentucky have been very inaccurate from my experience thus far. All the preconceived notions I had about this place quickly dissipated within the first few weeks of interacting with community members. Eastern Kentucky folk are about the nicest people you’ll ever meet. Everyone knows everyone, last names are repetitive because generations of family stay put due to their love for their home, and people are genuinely interested in knowing who you are and developing a relationship with you. It’s honestly one big family. Poverty exists everywhere, and although certain areas of Eastern Kentucky are poverty-stricken, I would venture to say it is not significantly more prevalent than in other areas in the country. However, the difference lies between urban and rural poverty, each of which comes with its own set of issues. For instance, in rural Eastern Kentucky those living in poverty differ from the urban impoverished based on access to clean water, safely built homes, safe transportation across the mountains, and diversity in healthy foods (beans and cornbread make up the common diet of Appalachians). Much of the poverty that exists can be linked to the mono-economy that this area is heavily dependent on: coal. As federal regulations increase, the coal industry is seeing many contractors going out of business and laying off many coal miners. This reality has been detrimental to the economy and quality of life of many rural Eastern Kentucky areas. Additionally, advanced techniques in mining like stripping (blowing the caps off the mountains to retrieve coal) pose a threat to the environment and can lead to public health issues. The topic of coal mining is a very sensitive subject in this region, especially after incidents within the last two decades of miners losing their lives in explosions.

This summer has been very informative because I’ve been able to witness these problems first-hand, and understand the societal factors that are involved due to the shadowing and volunteering opportunities I’ve had. It has also been very helpful for me to see what rural health care is like. Rural health care here in Eastern Kentucky is plagued with a lack of primary care doctors. There’s a shortage currently in general of physicians going into primary care, which is alarming because primary care doctors are often the first line of defense in terms of treating and recognizing health ailments. With the shortage of primary care physicians in this community, nurses and nurse practitioners are taking on much larger responsibilities in the clinic and hospital. Many procedures/services that you would expect to be available in the hospital like labor and delivery aren’t offered because there’s either a lack of physicians, or lack of funding to have units that cater to those needs. For certain procedures, patients must travel to Lexington, KY or other hospitals miles away.

As this past week marked the halfway point of my internship, I can’t believe how much I’ve learned and grown. In a typical week, I’ll shadow and volunteer at the Hospice of the Bluegrass in Hazard, KY, lead activities and lessons at Mountain View Elementary School about nutrition and exercise, or volunteer and participate in community engagement activities. This summer I’ve shadowed nurses and doctors, sat and talked with patients daily, worked at a local café and food pantry, collected data for community surveys, led sessions on nutrition and proper exercise, assisted in running health fairs and fundraising events, and the list goes on. My summer has been very rewarding, and has given me the space to grow spiritually, emotionally, and mentally. There has been points in this summer that have been very frustrating for me. Sometimes the feeling of wishing I could do more to help discourages me. However, I’ve come to realize that this summer experience is not about making a major impact on the community I’m serving–that’s unrealistic and naïve. This experience is about learning, gaining skills in servant leadership, and interacting with a different culture in order to effect change in my community, and future communities I find myself in. As the time approaches for me to return to Indiana, I’m very excited to take advantage of every opportunity I can to learn, and possibly spark a partnership between the Wabash Democracy and Public Discourse Initiative’s own Democracy Fellows. Through conversations with local county leaders in Eastern Kentucky, there may be an opportunity for the Fellows to come to Appalachian KY and lead conversations concerning community issues plaguing the counties.

In conclusion, I think it’s very important to keep in mind that life is very short, and can bog us down if we allow it. We must learn to appreciate the simpler things in life like kin (family) and friends, the beautiful green earth God has blessed us with, and good food. That’s the Appalachian attitude. I’ve thoroughly enjoyed my time in Eastern Kentucky, and I’m strongly considering the possibility of returning to practice medicine here one day.