In March nine KIS sophomores and juniors traveled to Williamson, West Virginia with Global Public Service Academies (GPSA) to learn about the region and rural healthcare. Students prepared for the trip beginning in October, meeting weekly for medical lectures and discussion and practicing basic health screenings such as taking blood pressure. Because Williamson’s health profile includes high rates of obesity, diabetes, heart disease and COPD, the group concentrated on understanding the causes or risk factors for those health issues, and learned what treatment or prevention measures are available. This was our first partnership with GPSA so as knowledgeable as our group was about medical concerns, and as excited as we were to shadow healthcare workers and learn about the town’s culture, we were a little nervous too.
We began at Duke University where we met Brittany Ploss, a biomedical engineer and assistant director of GPSA. She opened a conversation about global public health, sharing her experience working with hospitals in Uganda. What does it take, she wondered, to provide neurosurgery when the electricity might blink off, or the equipment is shared between departments, or patients’ families provide post-operative care? Though most students on the trip are considering a career in medicine, Brittany widened the idea of what that career might include. “I thought it was interesting that Brittany enjoyed working with the machines and procedures. That’s a form of medical care too,” said Sanghee. The conversation continued with GPSA founder Dr. Robert Malkin, a professor at the Global Health Institute at Duke.
With Dr. Malkin, we discussed transparency in public health and the necessity of sharing resources with developing countries. Though West Virginia is part of a wealthy nation, the region is underserved medically and residents rely on publicly funded health programs and volunteer medical professionals. He asked each of us what we hoped to glean from our time in Williamson: what challenges did we expect, and what strengths did we bring? “We hoped that, as students, we’d be a welcoming presence,” Tony said, “Our main goal was to reach out to people and encourage them to be more open to healthcare services.”
On our drive from North Carolina we stopped in Madison, West Virginia to visit the coal mining museum. There we met Tim and Peggy who walked us through the history of mining and its modernization. For generations, mining was a good occupation but dangerous. But as mining technology and safety improves, fewer workers are needed in the mines. Tim, a retired miner, traced the connection between the decline of mining and the region’s present struggle to keep its young population. With few jobs available, many college age men and women move to another state for work. Our group was beginning to understand the challenges of the region, to consider how mining and shifts in population and unemployment could affect public health needs.
That afternoon we arrived in Williamson, a small town in Mingo county in the southwestern part of the state, bordering Kentucky. For decades the county thrived on its coal production and at its peak, Williamson’s population was over ten thousand. Today about three thousand people live in the town. In 1977 the Tug River flooded the downtown, and flooded again in 1984. In 1991 the Army Corps of Engineers designed and built a flood wall to protect the town from future devastation, but by then many families had moved away. The town is built up into the surrounding hills, houses one next to another, streets and paths steep, and there are empty or abandoned houses on most blocks. Williamson’s economy suffered again in 2015 when new EPA regulations cut into the profitability of coal mining and now the region reckons what should come after coal. Miners still live in Mingo county but the jobs are few.
GPSA partners with local community members to support student visits so during our week there, we enjoyed traditional southern meals cooked by a local woman. “I missed rice but I loved the banana pudding,” said Lynn. “I like the beef stew and oyster crackers,” said Tony. We had one more day to explore the area before beginning home healthcare visits and clinic observations so we spent a morning at Breaks Interstate Park where rail tracks thread through the canyon floor. Most rail yards we passed had cars heaped with coal and at crossing in town you might pick up a small piece of coal. That afternoon we visited the Appalshop, a collective arts workshop in Kentucky, and watched a documentary about the long effort in the 1980s to build the Mud Creek Clinic to provide better local aid and healthcare than mining companies offered. Again, we were challenged to consider what it takes to provide public healthcare.
At Appalshop we also listened to local musicians play bluegrass. The sounds of the Appalachian region are its story. The language of the region is rich – a dialect with phrases drawn from Old English, an accent that can drawl or lilt – and the music richer still, making art of any gathering of fiddlers and banjo players.
On Monday we split into three groups to begin our healthcare rotation with Williamson Health & Wellness Center. Two home healthcare nurses, Kelly and Aleta, invited us on their rounds. Home healthcare supports the needs of chronically ill or aging people who have difficulty traveling to the clinic. Because nurses are able to routinely check patients’ vitals, symptoms and medications, concerns are addressed before they become emergencies. Kelly and Aleta develop good rapport with their patients and the families, and are often called between visits if a patient has a question. “When it comes to the medical field, I consider interaction with patients to be a key aspect. I was impressed by how Kelly and Aleta showed the excelled example of patient interaction,” Chris said, “I found myself imitating their gestures and small talk. Small talk becomes meaningful.” Patients still see a doctor as needed but Kelly and Aleta ensure each patient is well between visits. Back in Korea, our students wondered how a similar model might provide healthcare to the country’s aging population.
Students also had the opportunity to shadow doctors at Williamson Health & Wellness Center. Because the clinic accepts appointments and walk-in patients, our students were able to observe how doctors address a variety of medical concerns. Kevin said, “I was not only learning about how a clinic works, but the doctor also told me each step he took with a patient, to make sure the patient receives the proper care.” Sanghee remembers the doctors and patients were really excited to meet Korean students – we travel we learn a new culture, but also share our own culture.
The Health & Wellness Center also provides community outreach. We met with leaders and center workers to learn how the center is designed to address public health. The community garden and farmer’s market offer seasonal, affordable produce, and regular fun runs invite people of all ages to get moving. During our week in Williamson, elementary students on spring break attended a day camp organized by the center and we joined the activities for one morning. Our students played basketball and kickball with the kids, and led lessons about hand washing, dental care, and good nutrition. “It was interesting to have the diversity of age. Working with kids gave us the perspective that public health should be marketed toward people of different age groups,” said Kyle. The morning with elementary kids energized our students and now they are considering how to promote wellness at KIS too.
One of the most profound experiences during our week in Williamson was learning about the opioid epidemic. Our housing was blocks away from an infamous pill mill, a clinic that gave prescription medication without oversight, resulting in costly addiction to opioids. While some pharmacies may be closed, addiction remains an issue in Williamson and nearly every person can name someone who suffers an addiction, is in recovery, or has died from their addiction. Before visiting a twenty-eight day recovery program, our students admitted assumptions about what drug addiction looks like, or who becomes a drug addict. “Visiting the recovery center made me think about how far public health can expand to,” said Ann, “Before, I didn’t think drug problems were part of public health.” The men and women in recovery were humble and open about the devastating consequences of addiction and the struggle to live sober.
Later we visited a sober living house where residents may transfer after completing a twenty-eight day program. “I actually saw the effects of addiction, rather than thinking of drug addiction in the abstract,” said Joshua, “I was impressed by their efforts to recover. Some were in recovery to get their children back, and some were in recovery for a second or third time. I was impressed by their perseverance.” At the sober living house, men and women are supported in their sobriety for as long as one year, giving them time to decide what comes next. To share the Korean culture with residents, our students prepared kimbap, egg roll and Korean pancake. The afternoon stretched to early evening. For years we will remember the men and women we met and hope for them the very best.
Reflection is essential to the learning process. At points during our week in Williamson we were overwhelmed by the volume of information or our interactions with people in the community. So much to learn! So much to wonder! We were open during that week and each conversation, presentation, observation and practice added to our understanding of public health in rural West Virginia, even while we also connected our ideas to what know about public health in South Korea. We ended our trip with a return to Duke, to share our experiences, and in the weeks since our reflection continues. Each of us carry a different most important moment from the week in Williamson but we are all glad to be KIS’s inaugural GPSA group.
Such big thanks to our GPSA trip coordinator, Andrea, and leaders Karl and Gabriella: thank you for shepherding us through a full, wonderful week.
Article and photos by Sarah Marslender.