As a journalist, the Remote Area Medical clinic in Wise, VA, was an event teeming with stories and lives waiting to be uncovered. But as a sociologist, it was a textbook case of yet another rural community suffering from systemic disenfranchisement. Global and national forces have trapped the communities within Southwest Virginia in the cycle of poverty. Unemployment is high, wages are low, and medical care, education, and health lag behind the rest of the Commonwealth. The area has long been neglected by political representatives, and has become the subject of misunderstood stories that feed exploitative portrayals in media and entertainment.
Within sociology, I study access disparity, asking who, what, when, where, why, and how people are able to access the systems and concepts necessary to their well-being.
Setting out to Wise to cover the clinic with my reporting partner, Sarah Kerndt, we agreed that we wanted to tell the true stories of the community. Rather than exploit the residents and put them on display, we wanted to find out what they really needed, and share it in an informative, respectful manner. Understandably, we were met with skepticism and wariness. “Are you from the media?” Once, I was even seriously asked if I was part of the “crooked” media. What we found was a major disparity gap that drove these people to the fairgrounds for those three days, and personal experiences that have made them reserved when dealing with the media.
Rural Virginia, southwestern Virginia, and even more specifically, Wise, Virginia, have been grossly misrepresented by the media. The people who live in these communities are often seen as behind the times; backwards, toothless hicks that live in hollers. They are called desperate, which they often are, but are still spun as caricatures of rural America, as if they were the characters of the “Beverly Hillbillies” still stuck in their farmland homes.
These are inaccurate portrayals of the people of southwestern Virginia.
Policymaking often forgets those of low-populated, low-income areas. Although Wise isn’t as large as a metro area, I still struggle to find the logic behind forgetting a county that’s populated by more than 38,000 people. Yes, in the grand scheme of things, it is not the largest county by land area (Pittsylvania County) or population (Fairfax County) or by wealth (Loudoun County). But, no county is worth forgetting when it comes to baseline healthcare.
What is probably the largest misconception about the region is that the residents are all hateful, ignorant, and full of racist vitriol toward people of color, especially immigrants from Central and South America. While residents did want jobs to come back, they didn’t describe the loss as an immigration issue. “It’s ridiculous because people can’t get jobs because all of the coal mines are closing and everything, and what jobs that are there are pretty much gas stations and stores,” said Melody Austin, a resident of the area. She was standing in line waiting for general medical. “Everybody’s needing jobs, can’t get jobs, so you can’t get healthcare because you can’t pay for healthcare. It’s a cycle that feeds itself.”
While a lack of funding for schools and educational programs impacts people in rural communities, I came to find that this did not mean that people did not know how to take care of themselves. Sandra Schwaner, an RN from UVA, told me a story about an eye-opening experience she had during one of her first years volunteering for RAM. “From the dental perspective, dental care down here is horrible. I used to think it was because nobody brushed their teeth. Then somebody pointed out to me, “You know we’re not all idiots down here, don’t you? I do know how to take care of my teeth, but with all the fracking and coal mining runoff…”
She said the contaminated water would collect in the wells, impacting dental health. Chewing on sediment and drinking poisonous water has taken a toll on the lives of these people.
People wonder why these folks just don’t get a better job or apply for health insurance, or even just move to a new area with better opportunities. For many, generations of their family have lived in this area. Additionally, the conditions they live in are not their fault.
“The folks that are here are mainly the folks that have fallen through the cracks of the expansion,” said RJ Briscione, regional vice president and Medicaid business development leader at Aetna. Aetna, a healthcare insurance company, was the local partner sponsor that year for RAM. “Most of the folks that you see here either don’t have or can’t get Medicaid or can’t afford other coverage.” As part of their analytics, Aetna partnered with US News and discovered that Wise has some of the worst healthcare coverage in the state. Falls Church was first on the list.
Just a few weeks before RAM, the Virginia legislature passed Medicaid expansion, granting necessary health insurance to nearly 400,000 low-income Virginians. According to the act, states are allowed to “to open their Medicaid rolls to people with incomes up to 138 percent of the federal poverty level, which is $16,643 for an individual. The federal government pledged to pay at least 90 percent of the cost, which in Virginia would amount to about $2 billion a year.” What has existed as a longstanding problem has been the lack of insurance for specialists, an often forgotten step in the role of healthcare. “A lot of the specialties and the subspecialties that you see here represented at all these different trucks…it’s really hard for people to find that kind of care,” said Briscione, gesturing to the different tents and trucks providing medical services at RAM. “We hope, in coming years, we wouldn’t see as many chronic cases here because the Medicaid expansion would help cover some of these folks.”
Chronic pain, in particular, has run rampant in southwest Virginia due to the looming yet decaying coal industry. On the drive down to Wise, you pass a behemoth of a coal plant run by Dominion. The cars leave with a thin layer of dust from the plant. “Southwest Virginia is kind of unique because we have a lot of coal mining industry workers, so we have a lot of chronic pain injury,” said Sarah Melton, professor of pharmacy practice at the Gatton College of Pharmacy at East Tennessee State University. She said this results in the abuse of opioids to treat their chronic or acute pain.
The dangerous field of coal mining leaves many with unbearable pain, work-related injuries, and black lung, which has been making a comeback since President Trump promised to bring back the coal industry. But as many have seen across the Appalachian Mountains, where many plants are located, his promise hasn’t brought back jobs. Nearly 20 percent of coal plants have closed since Trump took office, and coal consumption has fallen 2.4 percent, the lowest it’s been in 40 years.
What is hard to fully capture in this piece is how much passion the people of Wise hold. Their desire to work, to care, and to help is evident. As one woman, who wished to remain anonymous, told me, “All we want are jobs. A way of life.” Their sense of heart and pride was palpable. “The people are amazing. To a person, every single person here will [say] ‘thank you’ for volunteering. We don’t go 10, 15 minutes without somebody saying thank you even though they’ve got [to] sit and wait in the heat, which isn’t the best way to get healthcare,” said Briscione. Autumn, who drove all the way from North Carolina with her husband to seek care, was a former resident of Wise. “Everybody here would give you the shirt off their back if you needed it. [They’re] willing to help each other [and are] friendly.”
I refuse to accept the rationale that because a certain group of people voted a certain way means they shouldn’t receive the same treatment as everyone else. For many, the promises that President Trump boasted during his campaign was a sign of hope for the people of Wise. You can’t blame them for clinging to the only hope they have. Many people from Richmond barely know where Wise is located, much less that it’s a county within our Commonwealth. It is about time that people on this side of the region gave a damn about the folks on the other side of the mountains who need care. With the expansion of Medicaid and the looming elections ahead, perhaps we will see changes that are truly needed to aid those in southwestern Virginia.