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.