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With Higher Risks Of Relapse During COVID-19, Appalachians Are Finding New Ways To Support Recovery

At 8:15 every weekday morning, the Clarksburg Mission’s staff circles up their chairs to share gratitude. It’s generally thankfulness for something that happened within the past 24 hours, big or small– help from dorm residents in moving furniture, a kind word from a colleague, a new day.

Desi Underwood, who serves as the mission’s ministry coordinator, said that in the past four weeks, as the cloud of COVID-19 has drawn nearer to her Appalachian community, spirits remain high; appreciation, deep. She said that throughout the mission, those with the resources to do so are pulling together impressively.

Desi Underwood is the ministry coordinator at the Clarksburg Mission, located in Clarksburg, West Virginia, where she’s continuing to provide programming for the 50 people who are now on lockdown in the emergency shelter to avoid the spread of COVID-19. Photo:

But not everyone within the walls of the Clarksburg, West Virginia, facility has the resources. The mission offers emergency shelter to up to 50 people a night in its Welcome Room. It has a dorm for men and another for women and children, each of which can house about 20. A large majority of those for whom the mission is a temporary or midterm home have experienced addiction; many also grapple with mental health issues.

COVID-19 is a formidable challenge to those across the spectrum of addiction– those in recovery and those still actively using– and to those who provide them with care.

Melissa Carter has traversed that spectrum. Her Martinsburg, West Virginia, youth was nightmarish. She suffered sexual and emotional abuse; repeated rejection and displacement. She’s been jailed and imprisoned multiple times, rehabbed and relapsed many more.

She eventually made her way to the Clarksburg Mission’s sober-living housing, some 300 miles west of her hometown. It was there that, at 38, she was thrown her first birthday party. Carter has been drug-free for two years. She’s now serving multiple roles at the mission, including as a recovery coach.

“Stress is a big trigger,” Carter said of those in recovery. Today, stress abounds.

As of Tuesday, no one at the mission had tested positive for COVID-19. But everyone there is bracing for the near inevitable.

They began preparing four weeks ago with hand-washing and social-distancing instructions.

“And then it just got more and more intense,” said Lou Ortenzio, the mission’s executive director, “and we realized we should probably lock down as a facility.”

Lou Ortenzio’s name is known in many circles in the tight knit community of Clarksburg, West Virginia. Shown here in 2019, Ortenzio was once a prominent doctor in the area and struggled with substance abuse issues of his own, but now serves as the executive director of the Mission where he leads programs and support systems for others in recovery.

Many residents, Ortenzio said, “have come through, found amazing strength, have stepped up and are volunteering and cooperating in new ways,” cooking, cleaning, comforting.

But it’s a fragile equilibrium. Like caregivers and advocates everywhere, the Clarksburg Mission team fears what the COVID-19 crisis will mean for those along the edge of addiction.

Sharing Vital Information

Measures are being taken across the country to help people in recovery get the care they require.

On March 16, the federal Substance Abuse and Mental Health Administration relaxed its restrictions on the number of doses of methadone clinics can dispense to patients. Methadone is used in medication-assisted treatment for opioid addiction.

In the past, most people enrolled in an opioid-treatment program would have to visit a clinic daily to receive their dose. After proving stable, they might be allowed to take a few home with them. Now, a person considered stable can take 28 doses home; those not yet deemed fully stable but a good risk can be given 14 doses.

The Centers for Medicare & Medicaid loosened restrictions on services its beneficiaries can receive through telehealth, using computers or smartphones. Health care providers now are able to offer more addiction-treatment services via telehealth. And providers can now initiate medication-assisted treatment, or MAT, via telehealth.

Cabin Creek Health Systems, based in Dawes, West Virginia, 20 miles south of Charleston, serves more than 100 people in its MAT program. Cabin Creek is now using telehealth to reach those patients.

“We tend to have strong relationships with the patients in that program,” said Executive Director Craig Robinson. “They know and trust us, and that carries over into being willing to try the new technologies.”

Narcotics Anonymous chapters throughout Appalachia are convening meetings on Zoom, and Narcotics Anonymous World Services has a webpage with listings for virtual meetings all over the world.

“It’s been really cool to see the recovery communities come together so strongly,” said Dan McCawley, a peer-recovery coach with West Virginia Peers in Morgantown who is himself in long-term recovery. “I’m going to more meetings now than I did before because it only takes me 30 seconds to join in. I’ve been to meetings in Ireland, California, New York, North Carolina, Virginia. It’s cool to feel a sense of unity worldwide, that the recovery community is still there for one another. ”

Telehealth is not, however, always a viable option.

Hillary Brown is director of the Steady Collective, which offers harm-reduction services, referrals to care and education for those using drugs and in recovery in Asheville, North Carolina. The Steady Collective serves a great many people who are homeless, and, Brown said, “virtual isn’t accessible for our folks. Most of our folks don’t have phones or any access to internet.”

The Steady Collective is now providing its syringe-exchange services from a mobile unit. But Brown is plenty concerned about the other essential services her clients are losing access to: food, housing, public restrooms and medical care. (The North Carolina Harm Reduction Coalition has petitioned municipalities to reopen public restrooms and deploy portable latrines and to refrain from clearing encampments.)

Brown and her colleagues are distributing masks made by a local kid (“Great fabric. They’ve been a big hit.”) and hand sanitizer provided by the state. They have an herbalist riding along with them a couple of times a week talking with people about how to manage withdrawal symptoms using herbal formulas.

A lot of the folks the Steady Collective is serving are not getting much information around COVID-19, Brown said. “They don’t have access to televisions or to social media, and so they’re not getting a lot of updates about this. So we’ve had to do a lot of education, giving folks materials and saying, like, ‘You know, this is a serious thing.’”

“But how many protections can you really give yourself when your only option for staying inside is an apartment where 10 people are staying,” Brown asked, “or an abandoned house or camp where a lot of people are sleeping?”

Stephanie Almeada is battling a lack of access to information in her rural Western North Carolina community, where she is providing emergency tents, food and medical supplies to people who are homeless, some of whom are also in recovery.

“I have really deep concerns that because we’re working with so many folks who were already immune compromised, that we’re going to lose a lot of people,” she said. “And that’s really heartbreaking.”

Seventy miles to the southwest of Asheville in Franklin, North Carolina – a town of 3,800 in a mountainous, predominantly rural region – Stephanie Almeida provides care to those across the spectrum of addiction. She runs Full Circle Recovery Center and is the executive director of Smoky Mountain Harm Reduction.

Almeida is distributing food, medical supplies and tents for clients who are homeless. But like Brown, she recognizes the urgency of providing information. In these mountains, bandwidth is coveted; cell phone service is spotty.

“Most of the people that I talk to have no idea at all about what’s happening or ways to prevent the spread of infection,” Almeida said. “They’re cut off completely, really, from the information that’s life saving.”

What they do learn is often of little use: “They’re told, ‘If you get sick, just stay at home and call your doctor.’ Well, my folks don’t have a doctor. Cut them off from every access to life and then tell them to call your doctor? They don’t have medical insurance. They don’t have $5 to get to [the convenience store] to get gas.”

Almeida is witnessing her neighbors cycling through the stages of grief. Many are still at denial.

“‘No, this isn’t gonna bother me; I’m healthy.’ And I’m like, ‘Okay; let me show you this little infographic of how your “I’m healthy” has just exposed 100 people.’”

“Those that do get it,” she said, “are, like, ‘Holy shit.’”

“I think we know what’s coming,” Almeida said. “We can’t handle that here.”

‘Forcing People to Be Still’

Though the Clarksburg Mission isn’t taking in any new residents, it’s not turning anyone out– not unless it’s necessary for the well-being of the others. Some have chosen to leave, unable to handle the pressure of being cooped up. Some have returned to drugs. As of last week, Melissa Carter said, nine people had relapsed in the previous couple of weeks.

Melissa Carter has found a sense of home and community at the Clarksburg Mission. A former resident of its sober-living home, she now works for the facility in a number of ways, including as a recovery coach

Carter is especially concerned about those newly in recovery, a particularly fragile time. She shares the story of a guy with whom she’s been working very closely:

“He hasn’t really had too many people show him that they really care whether he’s clean or not. So I’m trying to take the time to not only help him figure out a way to get clean but to show him that he matters.” He continues to struggle.

“I’m taking the people that just relapsed and the people that are in recovery, and we’re starting back at the beginning,” Carter said, “the relapse warning signs, writing about it. We’re just going to meet each day and talk, talk about our struggles, talk about where we are and try to work the problems out.”

The Mission folks, residents and staff alike, are doing the best they can, given the dimensions, to be mindful of social distances. Chairs are set apart in the now-otherwise-empty dining hall for small recovery meetings. Daily devotions are held in the dorms.

Desi Underwood emceed a spelling bee in the Welcome Room one afternoon, with prizes for the winners. On a recent Friday night, the mission staff threw an ice cream sundae party to show their appreciation for the cooperative spirit that’s prevailed.

“We’re trying to get by as best we can,” Ortenzio, the director, said.

“I think it’s giving everyone an opportunity, almost forcing people, to be still,” Underwood said. “I think people are becoming more insightful and more aware of their struggles, and ways to deal with their struggles, and they have more opportunity to come alongside one another– to be kind and see kindness in each other.”

This story was co-published by 100 Days in Appalachia, Microsoft News and Spotlight for Poverty and Opportunity, a nonprofit, nonpartisan site featuring commentaries and original journalism about poverty and mobility. MSN News and Spotlight partnered on a package of stories and long-form videos, Poverty Next Door, late last year. Follow Spotlight on Twitter @povertynews and 100 Days at @Appalachia100

Correction 04/16/20 10 a.m.: A previous version of this story included an image that misidentified Melissa Carter. It has been replaced. We regret the error.

The High Cost Of Living Rural: A Q&A With A Journalist Covering Healthcare In Appalachia

Rural hospitals across the country are closing in large numbers, making emergency and speciality services harder and harder to come by for Americans who…

Rural hospitals across the country are closing in large numbers, making emergency and speciality services harder and harder to come by for Americans who don’t live in urban centers. One hundred and thirteen rural hospitals have closed since 2010, and about a third of the remaining, some 670, were at risk of closing in 2016.

Mason Adams, who is based in Floyd County, Virginia, detailed the impacts of those closures on rural Appalachians in his latest report for In These Times. That includes the increased travel times that many older, poorer Appalachians now face to reach the medical services they need, sometimes requiring helicopter rides in emergency situations that can cost upwards of more than $44,000, more than the average annual income in many of the communities directly effected.

Adams also details the difficulty communities face in finding adequate services after their local facilities downgrade the services they offer after consolidations in rural healthcare systems, such as trauma care and neonatal intensive care units (NICUs), all of which contribute to the growing cost of rural health care.

Adams spoke with 100 Days in Appalachia’s Kristen Uppercue about his reporting.

KU: Your report details, the challenges rural Americans, especially those that are older than 65 face when trying to access health care services. Some of the biggest challenges you write about include the impact of hospital closures. But that’s not necessarily a new issue. Outlets throughout the region have been covering this issue. Was there anything you found in your reporting for this article that was new to you or that you thought was surprising?

MA: Well, first, I agree. You’re right. A lot of these issues have been around for a little while. I’ve reported on some of them myself. What I hadn’t done before this report was to really see them stacked up in one state in one story, all these different layers from access to cost to transportation, and a lot of these stacked up and so seeing that in a complex, layered way was something new to me.

I hadn’t gotten into too much before, I had thought about the emergency transportation side of it. I hadn’t thought about birth services so much. One of the interviews and the first person I quoted in the story had quadruplets that came three months early and she had to drive an hour to get to neonatal intensive care unit, which is where you need to go if you have a high-risk pregnancy or your babies need to stay over, as hers did for the next six to eight weeks after she gave birth. I think today with some of the changes that have been made to the hospital systems, she’d have been driving an hour and a half, which boggles my mind. But something else that came up in this was just the prevalence of these issues. You know, I kind of got started on it because I heard stories about these $44,000 helicopter bills, and I had trouble finding people who had had that experience and were willing to talk about it, I think in part because they signed nondisclosure agreements when they settled but it seemed like everybody I talked to had a story about it.

KU: I agree. That was one of the anecdotes that really stuck with me from your piece. You write that the cost of those helicopter rides are more than the average annual salary in the area you are or you were looking at.

MA: Right. Well, air ambulances are, you know, that’s the term where an emergency helicopter comes in to pick up somebody and take them to a hospital. But now there’s a number of private companies running systems like that. These are out of network services for many patients and so that out of network price is you know, people will get a bill. I spoke to one lady in Rogersville, Tennessee, who’d been transported and she received a bill for more than $44,000. I will say just to qualify that, I think it’s hard to find stories of people who’ve got stuck with that whole bill. In some cases, Medicare will more or less cover it. In other cases, there’s an insurance that people purchase. I think all of the rescue squads and public safety officials in Lee County are covered by that, for instance. And they market it to people in the area because so many folks are having to be flown out. So a lot of people have that insurance that helps cover the cost. And then I think in other cases, people end up settling with the company for maybe a few thousand dollars.

KU: So your story is centered around a nonprofit healthcare provider that bought up services in a rural community, consolidated into one organization and then downgraded those services because there really isn’t any competition in the area anymore. You write that this is a trend that we’re seeing in the region. Can you explain in a little bit more detail what exactly is happening?

MA: Essentially, in northeast Tennessee and southwestern Virginia, there were two competing health care providers, Wellmont and Mountain States. And by 2014, both of them had, just covering a rural area that is increasingly losing population and the population’s older, poorer, it tends to be, you know, sick, they’re dealing with things like black lung and not to mention chronic, you know, illnesses like diabetes and heart conditions. So, they emerged under a process called a Certificate of Public Advantage, or cooperative agreement that’s in Virginia and Tennessee. And so the resulting entity, Ballad Health, basically had all of Mountain States’ and Wellmont’s assets and some of it, you know, like I said, these had been two competing healthcare systems, so they ended up with things like two hospitals in Norton, which is a city in southwestern Virginia of about 4000 people.

And so, you know, as you’d expect, they’re looking at that larger system and looking for ways to make it more efficient. Now, some of the changes that they’ve made have really upset people who are in that coverage area. Probably the one that’s fired up people the most is they had two level-one trauma center hospitals in Kingsport and Johnson City, which are pretty close together. Kingsport, I think, is within range of more population than Johnson City. But Ballad chose to downgrade Kingsport from a level-one to a level-three trauma center, and as part of that closed the neonatal intensive care unit. They’ve essentially converted one of the hospitals in Norton into a long-term facility and they’ve moved its services to hospital and the other hospital in Norton, and then a different one in Big Stone Gap. And they’ve made changes around the edges and, you know, some people are worked up. You know, Ballad will say this makes for a more effective healthcare and they’re doing things by the book and the numbers, but at the same time, you know, the Robert Wood Johnson Foundation has done a study that found that basically hospital consolidation and these monopolies see price increases.

And so we’re still in the early years of this Ballad procedure or this Ballad entity, so there’s still a lot to learn, but a lot of people are pretty worried about it. You know, there have been protests going on in front of that Kingsport hospital that was downgraded, Holston Valley Medical Center. They’ve been, there’s protesters there who’ve been out front 24/7 continuously for more than 200 days and are involved in, you know, some battles with Ballad just not only protesting the service changes but even kind of fighting to hold their ground now Kingsport town councils looked at some ordinances that might push those protesters out and so that’s like one ongoing front with Ballad.

But, to its credit, you know Ballad is also reopening the hospital in the county that closed in 2013. The hospital there in Pennington Gap was one of two in Virginia that closed. Folks there have been really trying to reopen that hospital and, you know, this fall, six years after that hospital closed, its doors reopen, not as a full critical access hospital or even an ER but as an urgent care center and Ballad says they’re going to reopen it as a critical access hospital next year. And that’s met with some extra spots, but I think a lot of people in Lee County are glad it’s going to be reopening again that even if it’s not providing the services of a level one or even level two trauma center, it’s still, you know, a place where there’ll be an emergency room and in case of a trauma or other situation like a heart attack or stroke.

KU: We know that Appalachia is a region that’s struggling with many health issues. The rates of diabetes, of heart disease, of cancer, they’re all high here. After doing this reporting, and this might be an obvious question, but do you feel like you can say that the financial climate of rural healthcare is impacting the health of the people here?

MA: Yeah, absolutely. And I think that’s true, not just in Appalachia, but across America, especially rural America. I mean, that’s just speaking from firsthand experience, you know? I’m one of the many, many Americans who’s basically one healthcare crisis away from financial disaster. Like, we’re doing okay, but if we were to, you know, suffer an unexpected issue, you know, I think I think we’d be in financial trouble and I think a lot of people are that way, you know, and will let small things go just because they know it’s going to come with a bill, and often when they can’t afford. I mean even co-pays, you know. You can see that play out if you look at the local courts were Ballad is certainly not the only company, they’re one of many healthcare providers that will pursue patients for bills in court, you know. They go after them to enable them to chase the debt more aggressively and then they start to garnish wages. And in all the cases I checked, I could not find one case where somebody had come to court with a lawyer. Yeah, it’s, it’s, I think it’s a challenge for a lot of Americans and Appalachians.

KU: So with those challenges and the challenges that you’ve reported on before, are there any solutions out there? Are there ways to make healthcare more accessible and more affordable in Appalachia?

MA: That’s a good question. A lot of folks are trying different things. There are clinics that have gone out and really made a difference, like a few people made a point to me that you know, just having a registered nurse or a nurse practitioner who can see people at a spot and help them maintain their long term chronic conditions like diabetes or heart issues, that’s, that’s super important. Ballad itself is focused on a lot of community health issues, you know, helping support Parks and Rec and things that get people outside to exercise, helping support healthy eating patterns. I certainly saw Ballad trying to engage on that level and that’s something we don’t always think about, but it does make a difference in community health.

And then you have more, I guess, more political solutions or looking at changing the healthcare…healthcare system in more fundamental ways, you know, that I talked to some people for this story that made a case that moving to a single-payer system for healthcare will take the profit motive out of it. And if you can do that, then maybe you can kind of make a more level playing field, both for providers, but also patients across the U.S. instead of into this system of winners and losers of have and have not healthcare providers that we currently have now.

KU: What can rural Appalachians who view this report, learn from you, especially those who want to push back against this divide in health care?

MA: I’m not sure they’d want to look to me to learn but I do think they can look to people in the story. There are voices in the story like Danny Cook who decided to take action against the closure of the NICU in Kingsport. Now, you know, you can argue whether or not she has been successful. Ballad still closed the NICU and downgraded the trauma center level at that hospital, but she’s certainly drawn a lot of attention to the topic, not just from me but from other reporters as well and I think probably from lawmakers. I’m sure there are a lot of elected officials who may not otherwise be thinking about this story but are thinking about it and how to handle it due to her.

I think one thing is that did come through from this is just the sturdiness of Appalachian people. I think, most everybody I talked to, had a very stoic attitude toward it, which can cut both ways, but I do think and surviving day to day, it makes a difference and it’s a quality I’ve seen in people in the mountains throughout my career.

This article was originally published by 100 Days in Appalachia.

‘The Homecomers’: Writer Sarah Smarsh’s New Podcast Explores Trend Of Rural Americans Returning Home

In 2018, Sarah Smarsh released her New York Times bestselling memoir The Heartland, exploring her childhood growing up on a farm in central Kansas. It was a national book award finalist and thrust her into the spotlight for writing about life in rural America from rural America.

Now, Smarsh is expanding her focus on life in rural Kansas to regions across the country, inviting Appalachian filmmakers, Black Belt farmers, and farmworkers from California’s Central Valley, among others, to discuss what she sees as a shift in America: the trend of young people moving from their elite urban cities back home.

It’s the focus of her new podcast “The Homecomers,” which she discussed with 100 Days in Appalachia’s Ashton Marra.

The interview below has been edited for length and clarity.

AM: Can we start first with the origin story of this podcast? Where did this idea come from?

SS: For a long time, I’ve been a podcast listener and avid consumer of all sorts of media, but podcasting, in particular, seemed like a realm of my own industry where the place I come from was woefully ignored, or at the very least, a sort of unintentional void in terms of content and message and narratives and stories and voices and ideas [being shared from there]. And as it happens, [when] I started journalism school in the late ’90s, I actually thought that I was going to go into broadcasting. That was my original intention, [but] I ended up being what we used to call a print journalist. I’m a writer, we say these days, but it was still in me to kind of hop media and do something in a different format.

So, it was kind of a confluence of personal inclinations, within the realm of storytelling, as well as what I saw as a deep need for rural America specifically. When I talk about where I come from and it being this place that seemed [overlooked] in terms of the content, I wanted to to amplify those sorts of voices in this great, new and definitely here to stay medium of the podcast.

AM: So, this season will be six episodes. Can you tell me a little bit about how you went about finding these six people for this first season of the show?

SS: So, I initially got a research fellowship at Harvard University, they’ve got this great research center called the Shorenstein Center on Media, Politics and Public Policy, and they bring in cross discipline professionals to basically spend a semester working on some sort of project that looks at the confluence of media and these sort of politics and policy realms.

I’ve, for a long time been writing about politics and the way that policy affects people and so I’m kind of in that sweet spot, and I said, ‘Yeah, I would, I would love to take you up on this fellowship,’ could I spend my time developing this podcast about what at the time I was calling working class America and ended up migrating into the more specific focus on rural. So, they gave me the space to do the development.

This was in the spring of 2018, and in that time, I actually recorded four out of the six episodes. A couple of the guests, full disclosure, I did know previously just because we’re in sort of the same wheelhouse professionally. It’s a very small space and it’s not very many people who are doing the sorts of things I’m doing.

The last two guests that I found, though, it took me a year to find someone who was the right storyteller and that just kind of clicked for the sort of conversation I wanted to have. Because these are very specific sorts of interviews. It’s not just facts and nuts and bolts and statistics, I wanted to talk to people who are in two worlds. They are from that rural disadvantaged place that they’re speaking about, but they’re also doing work that is entrenched in that place still. They didn’t leave that place, they either went and got some social capital and schooling and came back, or they’ve been there all along. So, that’s a very specific sort of American story. And then within that it had to be someone who was very learned in all the ways of research, but also willing to just open up a vein and and let let their heart pour out for the listener.

AM: At the end of each episode, you think West Jackson of the Land Institute for borrowing the term that he coined home comers, which you know, is the title of your podcast? Can you tell us what that phrase means and why you connected with it?

SS: While [the show] is about rural America, that’s a vast concept, contrary to some national headlines that would reduce it to one thing or another. That’s an incredibly immense topic. So the driving theme behind this show, what I’m specifically talking about, is what I perceived– by way of some data but also just my sense as someone on the ground as a journalist and someone who travels all over the country talking to folks– is a real shift in the zeitgeist of this American tale that we’ve had for a long time of the small town or the rural kid who is encouraged to or on his or her own volition leaves home for the commercial mecca– the urban, coastal, shiny thing where wages are higher and [there’s more] prestige.

Certainly, there seems to be a shift in the other direction and some of the the numbers are starting to bear this out. And I certainly in a very qualitative way have heard conversation after conversation with with people who say to me, ‘Hey, I read your book about how you’re from this place where we’re encouraged to “get out” yet, you’re still riding, you’re still in Kansas, and you’re writing from that place about the good, bad and the ugly.’

And, and these folks say to me, ‘that’s me. I left small town, Idaho, and I ended up in New York for a couple of years and I went back because I wanted to participate in caregiving for my grandma and cost of living is way lower, and I love being in nature and I can work remotely now by way of technology.’

So, this is a shift in the American story as it relates to place and class and all sorts of other identity markers, that’s just been kind of under reported and under explored, I think. Most members in the national media are white, urban and affluent. I’m white, not urban, and not affluent and so those I have a little bit of less of a blind spot to this particular story that allowed me to see it and and seek to uncover it with these conversations.

So, homecomers is a term that Wes Jackson, who directs the the Land Institute, which is a very kind of progressive, agricultural research center seeking to develop perennial grains that would be a lot easier on our soil and our food production system. He is good buds with Wendell Berry, the great philosopher farmer down in Kentucky and they have together kind of developed a conversation and a dialogue in letters about what I am now seeing come to fruition, something I believe they sort of hoped for for some time and that they themselves were perhaps decade the decades ago, sort of pioneers.

AM: This kind of push of young people of young generations out of the rural places that they’re from to bigger cities to find success, it feels like a very Appalachian narrative to me, but is perhaps larger than that. Why is that narrative so important to you? Is it a personal statement? Did you personally feel like you had to leave your home in Kansas in order to succeed?

SS: In some ways I did. I grew up on a wheat and cattle farm about 30 miles west of Wichita. I was raised by a teenage mother and by a couple of grandparents who left school and six and ninth grade, respectively. I’m a fifth generation Kansas farm kid, I was a child in the ’80s, when we were first starting to talk about something called the farm crisis. All around me, small town businesses were shuttering and family farms were going under.

What we call “rural flight” is not a new story by any stretch of imagination. It’s been going on since the Industrial Revolution. Most counties in my home state of Kansas, for example, their population peaked around 1900 so it’s a 100 year old story. It’s just that the the destruction and the social imbalance that it has wrought is just now being tended to in national dialogue.

So, why is it so important to me? Yes, because it is my story. And it’s deeply personal to me. Growing up, I was an ambitious, a bright kid.

There are folks who come from rural and small town places who are just like, ‘this is not my jam, I have got to get to the city. And the second I get there, I’m going to be a city person. And I’m going to do that the rest of my life.’ A lot of people have that story and happily so. But for me, the getting was that I wanted to get out of a certain sort of circumstance, I wanted to get out of poverty, I wanted to get out of lack of economic and professional opportunity.

I didn’t want to get out of my place, though. I love Kansas, I love rural Kansas. I love my family. I love my community, but those two goals, unfortunately, were somewhat opposed to one another. Our current economic structure, such that it is, so I did [leave]. I was a first generation college student at the University of Kansas. And then I did go on, after a brief reporting state in Kansas City, to live in New York City for a couple of years.

And people thought I had lost my mind when I left New York in my mid 20s, to move back to Kansas. This was in 2005 so this is not a recent story for me, but people thought thought I was nuts. ‘You just now got all the connections and contacts and mover and shaker kind of friends in Manhattan where your selected industry is located, [they said].’ Meanwhile, the media industry is utterly collapsing in places like Kansas due to the digital shift and trying to reckon with those sorts of new business models.

And yet it felt right, for various reasons. I did it and I’m not going to say that the universe suddenly rewarded me for being true to myself. I was poor for most of my 20s, I took on a lot of jobs adjacent to my ongoing journalism career just to pay the bills. It was very hard road to hoe as a journalist in Kansas at that moment, but it has ended up though being a real asset for me on the national stage in that there just aren’t very many folks with a national platform who really have and currently are residing in the place that I report on and and write about.

So the story of an American homecoming, if you will, across all sorts of lines, whether it’s places like Appalachia where a coal miner’s daughter is encouraged to leave, or the Black Belt of the American South where the African American descendant of slaves is encouraged to leave, or any myriad iterations of this from coast to coast and corner to corner of this country.

The conversations that I host in The Homcomers are all over this enormous nation and what they all have in common is the idea of home and that sense of responsibility and love and place being somehow at odds with the way our current economic and class structure works. The people who are going back, or who are saying, ‘I’m not going to leave for any extended period of time,’ to my mind, they are they are heroes in sort of rectifying what has become a severe social imbalance between rural and urban America.

AM: Then do you feel like you’re seeing a shift in this narrative around home? I see so many people in my life personally who have moved away and are starting to think about coming back to West Virginia, where I’m from and also based for 100 Days, just because their families are still here, they’re getting married, they want to start families of their own, and I see them grapple with this idea of failure. ‘If I come back, I have failed.’ At a national level, as you have these conversations with people, do you see them push away and push back at that idea of ‘if I go home, I have failed?’

SS: It really gets to the heart of the American psyche, to my mind, in that our sort of foundational tale of ourselves is about individualism, it’s about the ambitious seeker striking out and making good and doing better than her parents. It’s all quite aspirational and the story that we have tracked along that aspiration has to do with an exodus from places that our classist society views as backward, undesirable, ‘why would anybody want to live there,’ you know?

The term that some sociologists use to refer to people seeking a college education then being kind of siphoned away from particular areas of this country is brain drain. There is a sort of condescension inherent that the people who stay behind must be dumb.

Of course, that’s not the case at all. Some of the most brilliant people I know are people who never left, but they might have had a different set of opportunities, or lack thereof, perhaps. They had a different value set at work when they were making decisions about what to do with their lives.

So we’ve got to get more sophisticated as a country about how we appraise the the relationship between one’s location one’s merit. Our vision of the successful American, I guess, those components are also contained in the the proud residents of rural and small town spaces, but we correlate those attributes with urban America, and that has to do with money. It’s got to do with all sorts of things, but when you’ve got a popular culture continually reinforcing that narrative– not to mention political headlines that reduce those sorts of debates to red states and blue states as though the state lines separate different kinds of people. I occupy both of those places simultaneously, and I am the same person.

When I was first living in New York, and in my 20s, people would talk to me as though I were somehow different from the average Kansan. And it was because they had negative stereotypes about the average Kansan, but they liked me and so to square that sort of psychological schema, they had to envision me as sort of exceptional somehow. There are parallels to this in the ways that people configure individuals through in spite of their racist thoughts and sexist thoughts and all sorts of things.

But the shame that someone might feel about returning home, even if that’s their dream, or what’s right for them, and their family, or heck, even what’s right for their well being and their profession even, that’s not internal. That is external, it’s being put on those people. And it’s our job as a society to correct that narrative and to celebrate someone who would return or even seek to stay.

If any of us are interested in a balanced society, folks who love being in the city should be excited about the shift that I’m talking about. Because we need people in our rural lands to protect the Earth, to be what I would hope we will be eventually stewards of a Green New Deal, to diversify and create a more inclusive rural America. There’s important work to be done there that’s intertwined with urban folks outcomes as well. So, I think collectively, we need to stop. We need to cut the snobbery and start looking at the the merit and the value that is inherent in going home.

AM: So far in this conversation you’ve said words like brain drain, or shame, shame of returning to your your home rural community. It seems to me that when we talk especially about the economic structures of rural communities and the young people who have been pressured to leave them in order to find success, that what they leave behind is essentially the destruction of our rural communities. And there is a strong correlation that with the idea of a loss of hope. Do you see a connection in this kind of push away from rural communities and the demise of the rural communities that we are from?

SS: Oh, yeah, absolutely. I think that most of people who I know who have made that type of migration, it was, at its core, an economic imperative. There’s sometimes cultural matters at work. And there’s sometimes just personal sensibility. But what all of these stories have in common is, if you’re going to get by, if you’re going to be able to pay the bills, if you want to aspire to a sort of middle class life, that ain’t going on here anymore.

I want to be clear that the sort of homecoming that I’m talking about, it is not, ‘let’s sugarcoat it,’ and the conversations that I have in The Homecomers by no means do so. The sort of rural advocates and kind of small town community builders [we’re speaking with], their class background is wildly different. Some of them grew up in deep poverty, or working poverty, or in the middle class, or lower middle class, upper class, but what they all have in common is that what is now enabling them to fight for the place that they’re from and the place that they love is some semblance of economic and cultural agency.

So, that’s why for them it is, in some cases, they had no choice but to go off and get the sort of economic stability that could only be achieved somewhere else and then going back to that more disadvantaged place, they’re there to do that kind of work. I say that because there are some people who leave a place because they were run out of town as a person of color. Some people leave a place because they were mercilessly mercilessly picked on as, as a member of the LGBT q community. Some people left a place because they were poor, some people left a place because all the above, but this the sort of national homecoming trend that I’m seeing is across cultural and racial and gender lines, and what these folks have in common is they come from somewhere that has been written off in the national story as dead or dying.

The statistics often bear that out. These aren’t Pollyanna folks who are denying the numbers, but they are choosing to devote what social assets they have acquired to fight for a place that a lot of people have given up on. And it’s not for everybody, and I’m not trying to pitch this as an easy road, but what I find is, when I talk to people who are doing that sort of work, their lives are so full. They’re incredibly enriched by a sense of returning to the very spot that that made them and would often with a sense of gratitude, in spite of its dangers and shortcomings.

AM: Your podcast isn’t overtly political in that there is no mention of specific candidates or specific elections, at least up through Episode 4 which is how many have been released at the time we’re speaking.

I’m curious, did you have to make a conscious choice to not talk politics? Or did it just not naturally come up in the conversations that you are having while recording these episodes?

SS: While I do wear my politics on my sleeve as a commentator, as many journalists do, but depending on the project, I often try to aspire to a sort of objectivity that just makes a space for a dialogue rather than me making some argument. The Homecomers would definitely be in that column.

I wanted to host conversations that had to do with rural America and its struggles and its beauties at a moment when that place tends to be reduced to very simplistic political headlines. I would love to see somebody count in headline references to rural America since the 2016 election what percentage of those were a political frame. That is an important story, but it’s actually quite dehumanizing and unfair to a place to to constantly only view it through a political lens and put every human life through a political blender when most the people I know on the ground, regardless of their politics, their lives are much broader than that.

I wanted to host conversations that gave people space to talk about something other than the current administration in Washington, which for some of these people might as well be Mars in terms of the work on the ground that they’re doing. So I suppose that I had a hand in shifting and shaping where those conversations went because I didn’t ask them about politics, but I would say it’s also true that organically it just didn’t come up. I didn’t sort of ban myself from bringing it up.

[My guests] are doing important work. They’re experts in their fields. They’re also proud sons and daughters of places that they love that usually get short shrift in the media and they’ve got all sorts of things to talk about that have nothing to do with American elections.

Sarah Smarsh is the host of The Homecomers and author of “Heartland: A Memoir of Working Hard and Being Broke in the Richest Country on Earth.” She was a 2018 finalist for the National Book Award and winner of the Chicago Tribune Heartland Literary Prize.

Pallottine Sisters Find A New Legacy In Community Healthcare

When Vincent Pallotti was ordained a priest in 1818, he wrote, “I ask God to make me an untiring worker.” He set about to offer “food for the hungry…medicine and health for the sick.”

Pallotti, who lived simply, in Rome, his entire life, worked in fellowship. He established schools and shelters for women, orphanages, night schools for laborers. “Remember that the Christian life is one of action; not of speech and daydreams,” he wrote. “Let there be few words and many deeds, and let them be done well.”

In that spirit, the Pallottine Missionary Sisters were founded, in Germany, in 1888. The order flourished, its members venturing into the world to serve. The Pallottine sisters arrived in West Virginia in 1912. In 1924, they opened a 35-bed hospital in Huntington. That hospital is now St. Mary’s Medical Center, the largest medical facility in Huntington and Cabell County’s largest private employer. It was announced in May that St. Mary’s had been sold to Cabell Huntington Hospital, another of West Virginia’s largest hospitals.

An exterior of the original St. Mary’s Hospital, taken in 1924. The building previously housed the St. Edwards Preparatory School for Boys.

The number of Pallottine sisters in the U.S. today has dwindled to 20, 12 of whom are in West Virginia, 10 in Huntington. In announcing the sale of St. Mary’s, Sister Mary Grace Barile, the provincial of the Pallottine Missionary Sisters, said, “Due to the declining number of sisters in our community, we are no longer able to continue our health care ministry.”

But the Pallottine sisters aren’t relinquishing the commitment to their community. Their mission will now be advanced through the Pallottine Foundation of Huntington, a conversion foundation.

Conversion foundations are created when nonprofit health care organizations are sold to for-profit entities. They’re not a new phenomenon in Appalachia.

This conversion foundation, the Pallottine Foundation of Huntington, will provide yearly cycles of grant funding to nonprofit organizations in 20 counties in West Virginia, Kentucky and Ohio in support of health-related initiatives, not necessarily hospitals or health systems. The first recipients will be announced in the coming weeks, expected in the areas of food insecurity, mental health, substance-use disorder and tobacco-use prevention and cessation.

Fundamental to St. Vincent Pallotti’s ministry was his commitment to harnessing the gifts of those with whom he communed. He strove to empower the laity to fully realize the church’s mission – clergy and lay people of “every class, rank and condition” ministering in concert – an initiative that was about a century and a half ahead of its time.

In a sense, as the Pallottine Missionary Sisters pass ownership of St. Mary’s to Cabell Huntington and double down on their commitment to the broader community, they’ve come full circle.

“We’ve lost many, many members, but the mission is still there,” Sr. Joanne Obrochta avows. “We know why we’re here; we have a purpose, and it’s being fulfilled. Maybe differently, but even more meaningfully.”

‘Just The Place’

Sr. Joanne is a woman of quiet, impactful words. Born in the once-bustling coalmining town of Gary, West Virginia, her first calling was to nursing.

“My mother had a stroke and died when I was a junior in high school,” Sr. Joanne says, “and I think that was the beginning of my vocation.”

She wanted to attend a Catholic school, and sought counsel from her parish priest. “He said, ‘I know just the place you would probably like very much. It’s in Huntington.’ He was referring to St. Mary’s School of Nursing, within what is now St. Mary’s Medical Center.

“He said he was going there that next weekend, he had some business there, and invited me to come down and have an interview with the sisters.

“And once I got here, I thought, ‘This is for me.’ I knew right away.”

Sr. Joanne left briefly to earn degrees at Duquesne and Creighton Universities; she’s otherwise spent her life serving at St. Mary’s. “In December, I’ll be 90.”

Though she loved nursing dearly, Sr. Joanne knew “there was something over and above that I needed to do in life, and that was to become a religious sister.” Entering the Pallottine order, “I found my home. This is my home.”

The history of the Pallottine Missionary Sisters is an epic tale.

In 1912, four women left Bremerhaven, Germany, bound for they knew not where. They simply knew they were called. They booked passage on the Titanic, but were delayed due to an issue with one of the sisters’ travel documents. They later sailed past the wreckage of the ship, carnage, reportedly, strewn for miles.

Arriving in the States, they were scheduled to travel by train to upstate New York, to study English with the Sisters of St. Francis. But, once again, they were delayed at the last moment. The train on which they’d been booked crashed, killing or injuring many of the passengers.

The sisters arrived in Richwood, West Virginia, in August of 1912, a mountain community of about 3,000 people at the time. They opened a school and a hospital. In 1920, they opened another hospital in Buckhannon, St. Joseph’s, now a 51-bed facility, which the Pallottine Missionary Sisters sold to United Hospital Center in 2015.

The Pallottine sisters arrived in Huntington in 1924. On Nov. 7, they admitted the first patient to their 35-bed hospital, a charity case. The sisters were nurses, cooks and cleaners. They grew fruits and vegetables, pounded nails and stoked the coal furnace.

St. Mary’s now has nearly 400 beds, a nursing school and a teaching facility for residents and fellows associated with the Joan C. Edwards Marshall University School of Medicine. It has centers of excellence in cancer treatment, cardiac care, emergency and trauma services, neuroscience and orthopedics.

St. Mary’s Medical Center in Huntington, West Virginia.

The sale of the hospital was four years in the making. An agreement was signed with Cabell Huntington in 2014, but there were objections to the partnering of two of the state’s largest hospitals. The state legislature cleared the way for the transaction in 2016. The Vatican then gave its approval, with, Sr. Mary Grace said at the time, “the understanding that the values and mission established by the Pallottine Sisters will continue at St. Mary’s Medical Center after the transaction is complete.”

When the closure of the deal was announced, Jerry Gilbert, president of Marshall University, said he believed this new “comprehensive academic medical center” would become “a destination medical center – along the lines of some of the top clinics and hospitals in the nation.”

Entering The Public-Health Sphere

As CEO of the Pallottine Foundation of Huntington, Janell Ray has come to know the sisters well.

CEO of the Pallottine Foundation Janell Ray, right, sits with Sisters Mary Grace Barile, Mary Terence Wall and Joanne Obrochta, right to left.

“You have a group of elderly sisters, and this has been their way of life for their whole life,” Ray says. “This is what they know, everything’s changing, and it’s hard for them.”

But the sisters are embracing their new reality.

Allen Smart, founder of PhilanthropywoRx, based in Winston-Salem, North Carolina, serves as a consultant to the Pallottine Foundation board. While acknowledging the sadness the sisters are experiencing with the sale, he sees this transition into the public-health sphere as an opportunity to more proactively help define “what a healthy community means.”

“The sisters said, ‘Well, okay, we can’t continue to do business the way we’ve always done it. So what can we do?,” Ray says. “What can we do to continue our ministry to the poor, to the sick?’”

From left to right, Sisters Mary Grace Barile, Mary Terence Walland Joanne Obrochta.

“Hospital work is changing,” Sr. Joanne says. “It’s changing gradually and it’s changing rapidly. It’s not just within the walls of the hospital. Through the foundation, we can also see that people are taken care of in the neighborhoods where it’s needed so badly today for so many different reasons.”

“Properly executed and listening to the right members of the community, and engaging people, the opportunities to spread their mission are really a lot greater in the foundation situation than in the hospital situation,” Smart says.

He cites, for example, the opportunity to advance services for pregnant women struggling with opioid addiction.

Sr. Mary Grace sees this next step as a means of advancing “the values of our pioneer sisters.” Her message to the new leadership: “You know what we value and what our mission is, and we expect you to carry that out. We’re turning it over to you.”

“You hand it over to the laity and let them take over,” she says. “Educate, and move on,” exactly as Vincent Pallotti would have it.

“That’s our legacy as Pallottine sisters,” adds Sr. Mary Terence Wall. “We’re few now, and there are good lay people here.”

Still Working

A few miles from St. Mary’s Medical Center is a cemetery where so many Pallottine Missionary Sisters have been laid to rest.

Sr. Terence says that when she visits, she’s drawn to the dash on the headstone that separates the dates of a sister’s birth and death. “That dash is all the things they did in life,” she observes, “and nothing’s put there.”

“There’s too much to put there,” Sr. Mary Grace offers.

“The Lord knows what was there,” Sr. Joanne affirms.

As do so many in the Huntington community. During the Great Depression, the hungry came regularly to the back of the hospital to be fed by the sisters. For years after, Sr. Joanne says, people would recall how “had it not been for the sisters with the bread line,” their families wouldn’t have survived.

When out in the community, Sr. Mary Grace says she’s often asked, “‘Is Sr. Joanne still around? Is she still working?’ She’s still working.”

As her 90th birthday approaches, Sr. Joanne arrives for a couple of hours of work three days a week. She now does pastoral ministry in oncology, pediatrics and obstetrics.

In a video chronicling the history of the Pallottine Missionary Sisters, Sr. Mary Grace notes that, “One thing Vincent always said is, ‘We’re not going to be many… We’re going to be few, but we’re going to be able to carry on the work.’”

A new chapter in this legacy commences.

This story was originally published by 100 Days in Appalachia.

Q&A: Decorated Military Pilot Reflects on Path that Led Him to Aviation Hall of Fame

On this West Virginia Morning, Joseph Turner grew up in the hills and hollers of West Virginia. He went on to attend an ROTC program at then-West Virginia State College and Institute. He was one of more than a dozen generals produced by that program. He served as a pilot on the front lines in Vietnam, and then had a lifetime career with the Army Reserves serving in Atlanta and in the Pentagon, as well as being a long-haul Delta pilot.

He was recently inducted into the West Virginia Aviation Hall of Fame. Freelance reporter Douglas Imbrogno interviewed Tuner for 100daysinappalachia.com and learned about how his aviation career, including how he was inspired as a boy by a certain Daredevil, West Virginia pilot.

Also on today’s show, When Cicero Fain started working on his Ph.D., he decided he wanted to focus on the black community in Huntington, West Virginia, his hometown. His goal was to understand what brought African Americans to town and what helped the community thrive.

In his new book titled “Black Huntington: An Appalachian Story”, Fain looks at the history and evolving culture of Huntington’s black community. Eric Douglas brings us the story.

West Virginia Morning is a production of West Virginia Public Broadcasting which is solely responsible for its content.

Support for our news bureaus comes from West Virginia University, Concord University, and Shepherd University.

LISTEN: A Discussion on Immigration and Poultry in Moorefield, W.Va.

For more than a decade, more than 100 migrant and refugee families from countries like Myanmar (formerly Burma), Vietnam, Ethiopia, Guatemala and others have come to Moorefield, West Virginia.

They’ve done so to work at Pilgrim’s Pride – a large poultry plant that is Hardy County’s biggest employer with 1,700 workers.

For the past six months, 100 Days in Appalachia reporter Anna Patrick has been working on two stories exploring Moorefield’s growing migrant and refugee population.

Her stories take a deep dive into Moorefield’s poultry industry and discusses what a typical workday is like for employees at Pilgrim’s Pride.

Her stories also include a profile of one Moorefield woman who teaches English class offered to new community members.

West Virginia Public Broadcasting spoke with Anna about her stories. See below for an extended version of the interview.

Anna’s stories called “Always Hiring” can be foundhere.

100 Days in Appalachia is a partner with West Virginia Public Broadcasting.