By Melissa Patrick
Kentucky Health News
PIKEVILLE, Ky. – From top to bottom of the health-care system, speakers agreed local cooperation is essential to improving health in Appalachian Kentucky. They spoke Thursday, at the first-ever preliminary sessions for the annual Shaping Our Appalachian Region Summit, held Friday in Pikeville.
Dr. Jeffrey Howard, the state health commissioner, talked briefly about some of the many health issues that plague Appalachia – including diabetes, lung disease, cancer, adverse childhood experiences – but spent most of his time talking about substance abuse.
Howard said the rate of drug-related overdoses in Appalachia is 140 percent higher than the rate outside the region, and though there will be an “unprecedented” amount of money available in the next year to fight the problem, the real solutions will need to be found at the local level.
“There is no amount of money that is going to get us out of this crisis,” Howard said. “This is a cultural crisis, especially in Appalachia. So we have to come together as a group, we have to embrace one another and really have a grass-roots effort to overcome the issue of substance abuse.”
Howard suggested that one community solution that comes at no cost would be to identify at-risk children and families to invite to dinner once a month. He said a family had done this for him growing up, allowing him to “see what a functional family looked like.”
The session opened with a video of Howard talking about how he had been raised in Eastern Kentucky by a mother and stepfather who were addicted to drugs, and in and out of recovery. He said it wasn’t until he turned 14 and moved in with his father, became involved in sports, found his faith and met the woman who is now his wife, that he was able to overcome the many obstacles that substance abuse had put in his way.
Howard lives in Louisville. He described what it felt like to “come home” in a way that likely rings true to many from the region, and also speaks to the need for local solutions.
“Every time those low, round-top mountains peak up on the horizon, I just get a feeling of tranquility, peace, happiness,” he said, adding later, “I know that every time I get that feeling, I know who I am, where I belong, that I’m home. And most importantly, I’m with the people I belong with.”
Rural health: A boots-on-the-ground perspective
In second part of the health session, a rural hospital CEO, a health department director and a federally qualified health center’s behavioral-health coordinator and therapist talked about what rural health in Kentucky is really like.
Scott Lockard, public health director of the Kentucky River Health Department District, told the group that one entity can no longer be responsible for providing health care in a community.
“We have to partner. . . . We don’t need to be competitors, we need to complement each other,” he said. “And I think we are seeing that more and more throughout our communities, throughout our systems and we’re all working together, we’re playing well in the sandbox and we’re sharing our pails and shovels better than we used to.”
Sonji Adams, the behavioral health coordinator and therapist at Mountain Comprehensive Health Corp., said she is most proud of their many programs that integrate behavioral and physical health care. For example, Adams said it takes a collaborative, integrated effort to help people with substance-use disorders be successful.
“Let’s get everybody together in the same room. Let’s share ideas. Let’s figure out a hub and spoke model so whenever they come to say I need help, we know exactly where to send them,” she said to a room full of applause. “We have to be able to meet them with community resources to get them better so that we’re making an entire community better.”
Asked for a wish list that would improve rural health, Lockard said to applause that he would wish for a “statewide smoke-free law.” And among a long list of other wishes, he said that while everyone recognizes the issues around substance use disorders are “huge,” he added that we “can’t drop the ball” on other diseases that are killing citizens, such as heart disease, cancer, smoking, and obesity.
Adams said she would wish for a model of care that moves from “sick care” to “health care” for both physical health and mental health issues. She said she would also wish for more behavioral health care providers to work in Eastern Kentucky.
Susan Starling, CEO of Mercy Health-Marcum & Wallace Hospital in Irvine, wished for policy makers in Baltimore (where her hospital’s new parent company, Bon Secours Health System, is headquartered) and Washington, D.C., to understand “what rural is” because she said they often don’t understand the importance of a hospital that only has 25 beds or how harmful a 1 percent cut to a program can be. Starling’s hospital is one of those critical-access hospitals, 27 in Kentucky, that get 1 percent more federal reimbursement in return for limiting their beds and services.
She also said she wished for a way to save rural emergency medical services, saying many of them “don’t have the money to survive.” She said her hospital often has patients in the emergency room who have to wait two days for transport because “they can’t get an EMS truck to come to our hospital and take them back to their community.”
Earlier, Starling said she wanted to make sure everyone understood how important hospitals are to rural communities. Listing her hospital’s many awards and accreditations, she said “quality health care in a small rural hospital setting” is possible. She said her hospital, in 2016, provided $1.5 million of uncompensated health care, employed over 250 people, spent $12 million on wages, supplies and services, and had a total economic output estimated at $19 million: “That’s not chump change for us in Estill County.”