| EDITOR'S NOTE: Much like the Wall Street Journal, George Magazine and other outside reporters came to report on
the poverty and joblessness in Calhoun, the Boston Globe has gone to McDowell County. Most West Virginian's do not
look with favor when outsiders write about our problems, starting with the Saturday Evening Post in the 60s.
11/23/03
By John Donnelly
The Boston Globe
COALDALE, W.Va. -- The funeral home director looked approvingly at
the clearing in the forest of poplar, pine, oak, and locust trees, as a
family gathered with their heads lowered.
"They got room out here for plenty of graves," said Jim Widener,
shading his eyes from the noon sun as seven men shoveled dirt on a
casket, their shirts stained with sweat.
Only three months earlier, Widener had stood on this same spot to
bury a Culbertson. Now the family was putting another relative into
the earth. Inside the pine casket the color of rose lay the body of
Diana Culbertson Sisson, 28, of Crumpler, in northeastern McDowell
County, a few hilltops north of Coaldale.
This is the story in McDowell County, the funeral director said:
People are dying at younger ages, dying from a lack of care and, in
many cases, from a loss of hope.
For three generations, the steadiest work in McDowell County was
mining coal. As those mines have closed over the last few decades,
residents say, there seemed nothing left to build a livelihood, much
less a future, around. Today, one of the best business hereabouts is
burials, mostly those of long-out-of-work miners and their families.
The health of residents in parts of Appalachia has deteriorated so
much that a boy born in McDowell County has a life expectancy
lower than that of babies in 34 of the world's developing nations,
among them some of the most impoverished -- Tajikistan, Colombia,
the Dominican Republic, Mongolia, and Vietnam.
"It's amazing that these places exist in the United States," said
Christopher J. L. Murray, lead author of a 1998 mortality study of US
counties by Harvard School of Public Health and the Centers for
Disease Control. "These are people who have the same set of
diseases and risk factors that much of the rest of the world -- some
two to three billion poor people -- worry about."
At the Culbertson burial site, Widener said he sees common causes
behind many deaths here.
"A lot of it goes back to the quality of medical care," he said. "A lot of
them can't pay bills. Some of it is coal-related, or cancer. And the
young people, it's the lifestyles. . . . People need to take better care
of themselves."
In a series of articles this year, the Globe has reported on lives lost
needlessly in many countries around the world. More than 8 million
people die each year because of the lack of simple medical
interventions for treatable illnesses, according to the World Health
Organization.
Most of those deaths are in poor countries with few resources. But some occur in the world's
richest nation, mostly in communities like those scattered about McDowell County, left behind by
the economy, their troubles hidden from view in the folds of West Virginia's hills.
McDowell, the souther nmost county in West Virginia, is just a six-hour drive from Washington.
But men here live an average of 64.5 years -- the sixth-lowest of all counties in the United States,
according to the Harvard and CDC study. McDowell County women live a decade longer, but even
at that, they die younger than women in all but seven other US counties.
There are other American outposts of needless death, death at too young an age. The Sioux
tribes of South Dakota, whose alcohol-related accidents have plunged male life expectancy to 61
years. Or the African Americans of the Mississippi Delta region, who are plagued by high rates of
homicide, AIDS, and drug abuse. Or those living in the urban neighborhoods of Washington, D.C.,
Baltimore, St. Louis, and the Bronx, who die young even as their neighbors, in some of the
country's wealthiest neighborhoods, live the longest.
There is a common thread linking the residents of these very different places: They have almost no
economic base, or political pull.
In effect, they are a kind of ongoing social experiment in how long people can live in a state of
chronic poverty, and dispiritedness, before their bodies give way and their health falls apart.
"If you don't treat anybody or offer lifestyle interventions, life expectancy -- without high infant
mortality -- probably is in the low 60s in the United States. That's what you are seeing in those
places," said Thomas Graziano, a native West Virginian who specializes in cardiovascular
diseases at Brigham & Women's Hospital in Boston. "So it's not that they are dying young. They
are dying without interventions."
`Used up and thrown away'
McDowell County is, in its own rough way, a place of startling beauty. Morning fog shrouds
hillsides. Dirt roads snake up to the ridgeline, then descend hell-bent into the hollows, eventually
leading to hamlets with names like Jenkinjones, Skygusty, and Cucumber.
These are the hometowns to the storytellers, coon hunters, four-wheel-drive riders, pensioners,
anti-poverty crusaders, and preachers who sustain the area's rich identity.
But the county today is only a shell of its vibrant old self. In 1960, McDowell was the third most
populous county in West Virginia, home to more than 100,000 people. The county seat, Welch,
had three movie theaters and nightly traffic jams on Main Street. Today the county's population is
down to about 25,000. There are just two stoplights, no theaters, and few businesses of any kind.
The only nighttime action on Welch's Main Street seemed, on one recent night, to be drug dealers
connecting with their customers.
By 1985, more than 100 mines had closed, the local economy had collapsed, and 35,000 jobs
vanished in less than a generation. Nature compounded the hurt: Heavy floods in 2000 and 2001
destroyed many buildings, including several dozen in Welch. On prominent lots along the Tug
River, many of the buildings remain as dismembered hulks, abandoned to kudzu, the smothering
vine that grows unchecked almost everywhere in the county. Wherever people retreat, kudzu
advances. And McDowell has been in full retreat for a generation.
"This is a society that's been used up and thrown away," said Franki Patton Rutherford, director of
Big Creek People in Action in the nearby town of Caretta, which provides maternal and infant care
to the poor. "The folks who have remained here are beginning to show the stresses and strains of
practically a whole generation without an economic future."
Many of those who try to help the poor here draw comparisons to the suffering of people in Africa
or southeast Asia. Needless death is the shared theme, but the causes of death are so different.
In McDowell, people aren't dying because they live in a country that can't afford better care.
People die here within a short drive of some of the finest hospitals in the world.
It is, in many ways, the inverse of needless death in the developing world.
"Anywhere else in the world, poor people die from starvation," said Jay Wilson, 42, director of
McDowell Mission, which provides food, clothing, education, and home repairs to the destitute. "In
America, they become overweight instead. That's what's killing people. Diabetes is running
rampant. The free foods given out are breads or other foods with high starch. People are basically
eating themselves to death."
Of West Virginia's 55 counties, McDowell County ranks first in deaths per capita, and in incidence
of diabetes, suicide, and homicide. It is second highest in heart diseases, third in chronic
pulmonary disease, and fourth in cancers. Its diabetes rate is 92 percent higher than the national
average. Infant mortality also ranks highest in the state, although, by the standards of developing
countries, the numbers are very low.
Twenty-nine percent of the county's residents are obese, compared to 17 percent nationwide,
according to state and national studies.
A funeral home director in Welch, who asked not to be named out of fear of losing business, said
the standard-size casket "just isn't big enough anymore for most people here. We often have to go
a size up." Those caskets are called "Tall and Wide," and the demand is so great that they are
often back-ordered, the director said.
Sharon Denham, an associate professor in the School of Nursing at Ohio University who has
studied health care in the Appalachian region, said one of the reasons for early deaths is the high
levels of stress endured by people living in poverty.
"What is it like to live with poverty your entire life, and worry day after day about how you are
going to feed your children?" she said. "Sometimes we need to look in the dirt or the sky for a
germ. But the stresses of a society may also be a factor."
Some people in McDowell have another name for it.
"It's like a plague," said Norma Jean Rose, an ashen-faced 64-year-old resident of Raysal, in
western McDowell County, five miles north of Virginia. Leaning on the railing of her trailer, she said
she suffers from a bad heart and has trouble breathing because of excess fluid in her lungs.
"People are dyin' in their 30s and 40s. For the last 10 years here, it's disease, then death. I mean
young people. It ain't all old people."
'We need better doctors'
Whatever the cause, most families here have seen a close one die at an age most Americans
would consider two decades too young.
In May, David Culbertson, the family patriarch and a longtime miner, died of leukemia at age 55.
Diana Culbertson Sisson, his youngest child, died of bone cancer on Aug. 16. Many suspect the
county's high incidence of cancer can be traced to the working conditions in the mines and the
polluted soil and groundwater the coal industry left behind.
A few days after Sisson's death, about 60 mourners sat on benches and chairs at her funeral at
the Church On the Rock In Jesus Name, a narrow building with salmon-covered walls and red
polka-dotted curtains. Many wept as a guitar-playing minister raised his voice to a booming
crescendo and sang and spoke about how no one who believed in Jesus could deny that Diana
was going to a better place.
Then the Rev. Jack Martin suddenly turned quiet. "We endure, folks, we endure," he said, pausing
by Sisson's open casket, her withered arms folded around a purple teddy bear. How else, he
asked, could they deal with so much tragedy around them -- like the 25-year-old man who last
year shot dead his 5-year-old son before killing himself, or Martin's own 19-year-old son, who
drowned the year before.
"You don't know the real feeling of sadness until you lose someone you love," Martin said in a
singing whisper.
Martin ended the service and slipped out of the building quickly, leaving the mourners to grapple
with their sadness. And bitterness: How, they asked, could so many die so young, and with no
one in the government treating it as an emergency?
"What burns me up is that we're in Iraq building sewer and water systems, and health systems,"
said Danny Brown, an assistant to funeral director Widener. "Are these people in Washington ever
going to look at this county here?"
Carless Kegley, 34, Sisson's brother-in-law, stood outside the church in jeans and a T-shirt,
frowning, his arms crossed.
"We need better doctors," he said. "If you get a cancer diagnosis, there ain't nothing you can do.
That's it. You die. Or if you're sick, try to find insurance. It's almost impossible."
An hour later, Sisson was buried next to her father, whose gravestone reads, "Gone But Not
Forgotton." Her mother, Dorthy Culbertson, said the young woman was her "miracle baby," whose
fetal heartbeat was so weak that doctors didn't know that Dorthy was carrying twins until she
delivered them. Words failed her now. Death had stolen her husband, her daughter, and now her
voice.
On a bench near the burial site, Sisson's sisters, Mary Mullins and Arbutus Culbertson, and her
sister-in-law, Rosie Culbertson, told stories about the family's perseverance, true to the preacher's
word.
Two years ago, they had resorted to begging. For 13 days, often from dawn to dusk, they stood
on the yellow dividing line of two-lane Route 52, the county's main east-west thoroughfare. They
held up signs saying: "David Culbertson Needs Help for Medical Bills, Transportation to Doctor."
The father, home in bed, had objected, but the relatives insisted it was the only way they could
pay for his treatment. Insurance covered only part of his medicines. Sometimes they collected up
to $200 in a day in their Our Family brand ice cream cartons.
"Diana was out there with us, too," Arbutus Culbertson said. "We stayed discouraged a lot. We
felt we weren't doing enough."
There are angels amid the despair in McDowell County. Some are dedicated public servants;
others are missionaries who pray with the people and then fix their roofs for free; still others are
health professionals who helped start a rural health advisory council.
"Sometimes we don't have many victories," said Jay Crumpacker, 28, a civil engineer from
Roanoke, Va., as he drove a beat-up pickup truck owned by the McDowell Mission to rural areas
in the southern part of the county. "Sometimes the victories are small."
He and his wife got active in the mission last year. They had been living about 150 miles from
McDowell County, but had no idea of the extent of the poverty and isolation there. Parts of the
county, he said, "feel like the ends of the earth."
Over two days, he visited people who had asked for help in repairing their homes. They talked to
him about their problems, first with the houses, later in their lives. He saw one after another, all
over the western part of the county, listening to their stories, taking notes, then holding their
hands as they prayed for help.
Phyllis Stump, 59, told him that she weighs 278 pounds, that she suffers from diabetes and heart
and back problems, and that her fear of dying is so great that she often calls her sister in the
middle of the night, seeking reassurance.
William Kennedy, a whiskered 59-year-old who lives alone in a rundown trailer, said he was
diabetic, then told sad stories about his troubled family: the brother who burned down the local
school, another brother who, at the age of 20, blew his head off with a shotgun in the living room.
"I believe he went crazy," Kennedy said. "He wasn't the only one."
And Norma Rose, deathly pale in the cheeks and jowls, told how she has lived alone since her
first husband, a miner, died of a heart attack at age 40. She is trying to stay near her children, but
it is increasingly hard to hang on.
One man determined to help is Thomas C. Hatcher, a local historian and the mayor of War, the
state's southernmost city. He said McDowell County residents have a long and proud history of
self-reliance, an almost truculent spirit of independence. But the loss of most of its coal industry
has meant a new dependence on government handouts.
Hatcher and City Clerk Mary Ann Justice point to the tax rolls of War's 567 households. More
than a third of the city's listed residents are retired and living on some pension or government
benefit. Thirty percent are on some sort of disability or public assistance benefit. Only 33 percent
have a job.
Among those with work in the county, teachers were among the highest paid, with some earning
more than $40,000 annually.
Police in War start at minimum wage, $5.50 an hour, and do not receive paid health insurance.
"The city can't afford it," Hatcher said.
Justice, the city clerk, said she just qualified for Medicare benefits, which for her was reason to
celebrate. After more than four years of working for the city and not getting insurance coverage,
she said, "I can finally go to the doctor again."
Addressing the problems of poverty and its byproducts -- like the lack of insurance -- is a
long-term undertaking, to say the least. So some are attacking problems of a more manageable
scale.
Jennifer Orren and Dana Cook, who lead the county's Rural Health Advisory Council, decided
earlier this year to focus on an intervention as basic as this: trying to get more residents to
exercise by walking every day.
Often they have found that the first step toward health and hope is simply finding the will to get
moving again.
Supported by a budget of $20,000, the two women have advertised what they called "Welch
Walks" on five billboards; placed ads on television, radio, and in newspapers; and enlisted high
school students to help recruit participants. They signed up 1,500 county residents who pledged
to walk at least 30 minutes a day.
The program won praise from residents and outsiders, and the state is trying to expand it to other
counties.
"Even a place where the roads are crooked and the mountains are steep, almost anybody can get
out and walk for 30 minutes," said Ross Patton, a public health specialist at Marshall University,
in Huntington, W.Va. "They've done a tremendous job."
A place of heartbreak
Atop Bear Wallow Mountain in Crumpler, Dorthy Culbertson now lives mostly by herself. Family
members take turns spending the night with her.
Ringing her trailer are apple, pear, and cherry trees, and grapevines. A burro named Jasper with a
white cross on his chest roams in a fenced-in field nearby.
It is another place of beauty in the county, and another place of heartbreak.
Culbertson's life is in pieces. Her sole income is $422 a month from Social Security. But she still
has a $5,040 bill to pay for Diana's funeral and $2,000 left to pay for her late husband's medicines.
In the last few months, her family has been holding bake sales outside a Dollar Store to chip away
at the remaining debt. At one recent sale, they earned $70.
The day after she buried her daughter, Culbertson, red from head to toe in her work shirt and
velour pants, walked up to Jasper. She squinted into the wind as if someone had pinched her, and
started picking burrs off the burro's back.
"It's good to have a distraction," she said, and then she started to cough.
She has tried and failed three times to give up smoking, she said. She has chronic bronchitis and
was hospitalized last year with heart trouble. During the prolonged periods of taking care of her
husband and daughter in the trailer's cramped livingroom, she regularly canceled her own doctors'
appointments. "I just didn't want to leave them," she said.
"I have to see a doctor," she said softly, patting the burro, as yellow butterflies fluttered around
them.
"I have a weak heart, and now it's even weaker -- because when your daughter dies, it's part of
your heart that's gone, too."
John Donnelly can be reached at donnelly@globe.com
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