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Practitioners of Last Resort: Appalachia’s Alternative Health-Care Providers



This story was originally published on Rewire.

Poverty limits access. To everything. Health care is no different. What’s unique about alternative or integrated care is that there is often no middle man, no gatekeeper.

When I went to my first appointment with a clinical herbalist, I trembled. Instinctively, I put my hand across my collarbone and took a long, slow breath. I’ve had this anxiety about medical practitioners since I was 6 years old and sick with rheumatic fever — the first of many illnesses that have had me in and out of doctor’s offices and hospital beds throughout my 37 years.

As I stood outside Caty Crabb’s door, worry threatened to overtake my hope. Would this new-to-me provider be able to help? Would this kind of treatment reduce my rheumatoid arthritis pain or address my food allergies? Or would it be more of the same—more tests, which would lead to even more tests? After months of research, I at least believed plant-based medicine could be safe, though scientists are divided on that as well as its efficacy.

A clinical herbalist is someone who uses plants for medicinal purposes. Herbal treatments, as well as the cultivating of plants and herbs for health reasons, are undergoing a resurgence in Appalachia. Plant-based medicine has always had a foothold in the region, in part because of tradition, but also, convenience and necessity.

Certified from the Southwest School of Botanical Medicine, clinical herbalist Crabb has worked with herbs for more than 20 years. In 2009, she opened her business, Wildfire Herbs, and her clinical practice, the Appalachian Ohio Herb Clinic, both in southeastern Ohio. Business is booming. As one of only two practicing clinical herbalists in the area, she sources some of her plant material locally, much from her own 86-acre farm. The next nearest resource for herbs is an hour and a half drive away.

That first day in her office, I sought help for years-long symptoms and a string of diagnoses. I was also facing the end of a marriage while feeling the looming death of my mother like an unavoidable shadow behind me. “You got anything for anxiety too?” I asked Crabb, chuckling inappropriately, as many of us do when revealing these heavy-burden, stigmatized details of our health.

Crabb did. “When I think about holistic, I’m also thinking about the person’s whole life,” she explained. “What’s going on in their life right now, what’s their support system like, what kind of stress are they under, what are they eating? Health is about more than just what’s going on inside your body. What’s going on outside your body affects your body a lot.”

Since I first said it to a close friend, years ago—“Western medicine has failed me”—I’ve heard others repeat those same words. Though there is always, inevitably, years of complex narrative unique to each person packed into the sentence, to me, there are huge, gaping holes in the Western approach, like wounds that haven’t been tended to. And those wounds will fester. Western medicine — or “allopathic” medicine, as many in alternative or integrated care call it — often focuses on treating symptoms, rather than taking the time and resources to uncover the root cause. It’s a remedy-based approach that depends primarily on drug or surgical intervention. Once the symptom is lessened or resolved, the patient is moved along. But chronic health concerns, like my own, in this system often end up with a dulling of symptoms, while the patient must manage the myriad side effects that may come with each pharmaceutical.

Don’t get me wrong: I’m not against Western medicine, entirely. I still gratefully took an anti-viral when I had shingles, a few years ago. I still trusted in a vascular surgeon to treat complications of thoracic outlet syndrome.

But that was back when I had health insurance through my employer. Shortly after, escalating health problems forced me to stop working a full-time job. Currently, I have no easy access to health care. Which means another dip back toward the poverty line. Covered by Medicaid, I’m among those in the 14.6 percent considered impoverished, according to 2017 statistics about Ohio.

It is largely accepted that poverty limits access. To everything. Health care is no different. What’s unique about alternative or integrated care compared to allopathic medicine is that there is often no middle man, no gatekeeper, no pages and pages of paperwork to be sent to multiple offices that will determine what part of your health is covered and what isn’t — and for how much.

My bill for the initial visit to see Crabb was $60. I was there for almost two hours. It is has been my most expensive bill for consulting with her so far. The actual medicinal herbs I take range between $45 and $95 a month. That’s significantly less than what I paid for pharmaceutical medications at various times in my life — even with insurance. And, as my body heals, I take fewer herbs and pay less each month.

“Some people say herbalists are the practitioners of last resort,” Crabb said. “Because a lot of people don’t know about herbs and they don’t find them until everything has failed.”

Or everything has become unaffordable.

Before I found a clinical herbalist, I learned of osteopathic manipulation, another integrated medicine. I discovered it accidentally when I noticed my new primary care physician had a mysterious “D.O.” for Doctor of Osteopathy instead of the usual “M.D.” after her name on the office nameplate. At first, she proceeded as expected during my visit. She pressed her stethoscope against my back and across my chest looking for the cause of a breathing complaint. Then she had me lie back so she could feel for any imbalance. This was new. And weird. Her fingers made gentle, small motions around my ribs. I felt a shift in my chest, and then a rushing relief: a rib on my right side had been dislocated, compressing part of my lungs.

Then I found acupuncture. I wish I had known much earlier how effective it would one day be for me. My rheumatoid arthritis would cycle slower, sending me the aching, swollen, fatigued symptoms less often — and they were less severe. My sleep would be helped, digestion would be helped, inflammation would be helped. My chronic pain would, finally, be helped.

Through acupuncture, osteopathic manipulation, and herbs, I have found relief. But to receive osteopathic manipulation treatments, a patient must possess accepted insurance (which can often include Medicaid) and go through the usual channels of bureaucracy with a doctor’s office. A licensed acupuncturist is often not covered by any insurance, and at $65 to $135 per session, it is priced beyond the financial reach of someone living near the poverty line. Herbs, on the other hand, provide a relief that costs me about the same price each week as a small salad.

“My practice is completely full because of word of mouth, and really only word of mouth,” Crabb said, “People talk about things when they work.”

Since age 6, I’ve dealt with chronic health issues. I’ve had more doctors than I can count on both hands, been in hospitals all across the country, in cities big and small. I’ve had a top-ranked surgeon cut me open and stitch me back up. But finally and surprisingly, I found help in a rural town in Appalachian Ohio. Without going into debt.

Alternative care can give bodies like mine the right amount of attention to unravel medical mysteries. In this approach, symptoms are signposts helping navigate an underlying imbalance, and practitioners like Crabb look holistically at our whole lives to find just the right fit for treatments, which, in most cases, are the medicines that birthed modern pharmaceuticals in the first place.

This small town in Appalachia is the last place I expected to find quality, affordable health care. I still have chronic illness. I still need treatment. Yet, I have changed from a woman hunched over, winded with pain, to a woman skating on the local roller derby team, getting knocked down and jumping right back up.

This story was originally published on Rewire.

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Groups Say Smart Reclamation Of Mine Lands Could Be “Appalachia’s New Deal”



Stream restoration work in progress on an old mining site in West Virginia. Photo: Courtesy CVI

From solar farms in Virginia to a green energy subdivision in Kentucky, a new report by a group of regional advocacy organizations highlights 20 ready-made projects across the Ohio Valley that could give abandoned mining operations that were never cleaned up a second life, and create new economic opportunity across the region.

In the report, released Tuesday, the Reclaiming Appalachia Coalition, which advocates for high-impact mine reclamation projects throughout Central Appalachia, says innovative mine reclamation “could be Appalachia’s New Deal.”

“This report marks an important step as Appalachia citizens continue to re-imagine and work toward a future of sustainable and healthy local economies, where young people can find meaningful work and stay to raise their own families,” Adam Wells, regional director of community and economic development with Appalachian Voices, said in a statement.

Courtesy Ohio Valley Mushroom Farm
Acid Mine Drainage (AMD) at an Ohio wetland.

Virginia-based Appalachian Voices is one of the members of the coalition. Other organizations include Appalachian Citizens’ Law Center in Kentucky, Coalfield Development Corporation in West Virginia, Rural Action in Ohio, and Downstream Strategies in West Virginia.

Projects highlighted in the report run the gamut and include proposals to use acid mine drainage in Perry County, Ohio, to create paint and a proposal by a West Virginia wholesaler to build a livestock processing facility in Kanawha County.

The region has struggled to clean up thousands of abandoned coal sites since the Abandoned Mine Land (AML) fund was created in 1976. State and local governments have sometimes struggled with how to find new uses for old mine sites, and some high-profile projects have fizzled.

In the report, the authors argue, well-planned reclamation projects can spur economic development and offer best practices for how they should be proposed. Those include selecting appropriate locations near infrastructure and ensuring redevelopment projects are environmentally sustainable and financially viable over the long term.

Stream restoration work in progress on an old mining site in West Virginia. Photo: Courtesy CVI

In recent years, Congress has boosted resources available for that effort. Beginning in 2017, more than $100 million was appropriated for the Abandoned Mine Land Pilot Program. Many of the projects highlighted in the report have applied for funding through the AML Pilot Program.

But another federal effort has not been passed by Congress despite bipartisan support. The “Revitalizing the Economy of Coal Communities by Leveraging Local Activities and Investing More,” or RECLAIM Act would accelerate reclamation of abandoned mine lands by dispersing $1 billion of Abandoned Mine Land funds over a 5-year period with an eye toward economic development.

Combined, the report’s authors say, the 20 projects would require about $38 million of investment but would generate more than $83 million in economic output as well about 540 jobs to the region.

This article was originally published by Ohio Valley ReSource

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Sports and Storytelling: ‘More a Unifier than a Divider’



A rusted field goal post and practice equipment sits on the practice field outside Municipal Stadium in Portsmouth, Ohio. Photo: Jack Shuler

When we launched our religion vertical, we said, “because religion is community” in Appalachia.  When we talked about a sports vertical, we said, “because sports is religion” here. It is a topic that transcends the playing field —  and brings many of Appalachia’s stories into focus – from the political to the economic to the cultural. Former ESPN sports editor Keith Reed and Pittsburgh native promises a complicated look at the region through this prism.

— 100 Days in Appalachia


Many people are going to see that 100 Days is launching a sports vertical and question it, thinking we’re now bringing them scores and draft updates, but that’s not exactly the goal. What is your vision for our work in this field?

I’m fascinated by sports as a cultural connective tissue. The games themselves are competitive entertainment, but how we consume sports gives us a great opportunity to examine where and how we live. There are so many examples, but the sports economy is a great one. You can tell a community’s priorities based on how it spends its money. Well, in the U.S., we spend billions of dollars every year on sporting events and related items and infrastructure. Professional team owners are mostly plutocrat billionaires. Big time college athletes are indentured labor to millionair coaches while generating billions of dollars for institutions under the guise of amateurism. This says a lot about where American priorities are, even though I’d guess “sports” isn’t the first thing that comes to people’s minds when you say, “Appalachia.”

We’re designing this vertical with that kind of context in mind. Everyone has instantaneous access to scores, stats, trade rumors and fantasy updates in their pockets. What they don’t have  that we can provide, is a way to pull back the curtain to see where sports is a barometer on where communities stand with regard to race, wealth, public policy and cultural understandings and divides. That’s where we come in.


Much like religion or food, sports is such an integral part of communities not just in Appalachia, but around the world. What is it about your life experience that makes it such an important topic to you?

Almost every kid has a sport they grew up playing, or watching or at least a team their parents loved. I grew up in Pittsburgh loving the Steelers, Pirates and Penguins. I played basketball. I still start or end most days with a boxing workout or exercising with a group organized by a friend who’s a former NFL player. I even coach a team in a women’s kickball league. My sons both grew up playing sports: football, track, wrestling, rugby.

So sports have been a major part of my personal life and I know how influential that can be. In your formative years, you might meet someone you never would have encountered but for the basketball court or football field. Whatever differences you have, you put away because you need your teammate to help make you better and help you win. Coaches can be enormous positive or negative influences. For elite athletes, sports can be life-changing or life-saving. I’ve seen sports across all those transformative aspects, and I believe most people, regardless of background, will be able to relate to those stories.


100 Days in Appalachia’s goal is to take back the narrative people on the outside looking in have created for our region and show the true diversity of this place. How will this vertical expand upon or support that mission?

Sports stories are almost perfect for creating a geographic and cultural sense-of-place. In two well-written paragraphs, I could contrast the atmospheres at a UVa basketball game and a Tennessee Titans game and you’d gain an appreciation for how different a college town in the hills of Virginia is from urbanized Nashville. The populations, infrastructure and community priorities and needs in those two places are very distinct, and that will show up in their sports fans.

One of my favorite stories I’ve ever edited was for ESPN the Magazine, for the very first “One Day-One Game” issue. We sent a bunch of writers and photographers to Houston to cover a Steelers-Texans game, and there was a piece about tailgating and how Steelers fans were exporting this white, working-class ethos and culture common to formerly immigrant communities with them. All those people moved in the 70s and 80s after the steel mills in Pittsburgh closed, and now there’s a diaspora of Pittsburghers living in other cities and following the team from stadium to stadium. A lot of what you see in some of the characters in that story, which I believe we did in 2011 or 2012, showed up at the polls and in the rhetoric around the presidential election in 2016. That tailgating story, about an old-school, blue-collar Pittsburgh guy who talked funny and drank a lot of beer, was a canary in the coal mine.


Rivalries in sports and the divides they create can be almost even more intense than the divisions created by our current political climate. How can storytelling and journalism in this area bring people together?

I think sports fandom, especially rivalries, are more a unifier than divider. Think about that kid who meets somebody from across town on the basketball court. As adults, they may move to different parts of the country, have different levels of education and income, but they keep up with each other over social media and they find common ground in their rooting allegiances. There’s no easier way to get people who’ve grown apart or who have very little else in common than sports trash talk.

I’m a Red Sox fan who lived in Boston and wrote about the team, who dated a Yankees fan.  I’m a Pittsburgh native who’s lived in every other AFC North city, plus Boston. I have friends from Baltimore, Boston, Cincy and Cleveland — all these cities that are supposed to be “rivals” because of sports. Yet, sports is the thing that brings us together. So I think our storytelling can be an entry point for lowering some of the polarized rhetoric from other parts of our lives and engaging one another as fans, and then as people.


What is the potential impact you hope to see?

I don’t have any agenda besides finding and telling good stories. I’ve never done a geocentric, hyper-regional sort of journalism project like this before, so I’m happy to explore what that looks like. I’d like to give opportunity to some talented, young and hungry writers with a passion for telling interesting stories and seeing where those stories lead. That could mean something investigative centered around college athletics or it could be something more fun and interesting. At this point, I just want the storytelling to be good and well-received.

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‘If We Can’t Mine Coal, What Are We Going To Do?’



In this excerpt from the book After Coal, documentary filmmaker Tom Hansell describes how his media work in the coalfields of Central Appalachia led to a different understanding about what might come next for coal communities.

“EPA = Expanding Poverty in America.”  

See also: BEYOND COAL: Appalachia and Wales. Jim Branscome reviews Tom Hansell’s book “After Coal”

This statement is written in three-foot-high letters on a banner stretched over a bandstand in a public park in Pikeville, Kentucky. It is June 2012 and I am just starting production of the After Coal documentary. The crowd around me is dressed in the reflective stripes of mining uniforms or in T-shirts reading Friends of Coal and Walker Heavy Machinery. I am documenting a coal industry-sponsored pep rally before a public hearing on new water-quality regulations proposed for mountaintop-removal coal mines.  

The speaker onstage is speaking proudly of his family’s heritage in the coal industry. He concludes his passionate statement with a question: “If we can’t mine coal, what are we going to do in eastern Kentucky?” 

Good question. As a filmmaker who has spent my career living and working in the coalfields of eastern Kentucky and documenting coal-mining issues, this is an important and difficult question to answer. My earlier documentaries Coal Bucket Outlaw (2002) and The Electricity Fairy (2010) were intended to start a civil conversation between workers in the coal industry and other community members about a shared vision for good jobs, clean air, clean water, and a safe working environment. However, the conversations almost always broke down as soon as someone pointed out the obvious: the coal industry had long been the only model of economic development in the central Appalachian region. More examples of what life after coal might look like were desperately needed to move the conversation forward.  

As I struggled with the haunting question “If we can’t mine coal, what are we going to do?” the image of Welsh mining villages rising from the ashes left by the coal industry captured my imagination. I thought that if I could just learn a few details about how Welsh communities made the transition, then I could identify specific solutions to help coal communities in Appalachia. However, I quickly learned that the secret to life after coal was not that simple. …  

The author (holding the boom mic). (Photo provided.)

On my own quest for solutions, in 1990, I began my career at Appalshop, a rural, multidisciplinary arts center located in Whitesburg, Kentucky—the heart of the central Appalachian coalfields. From my young and naively privileged perspective, moving to eastern Kentucky was an act of opposition to the materialistic consumer-driven world. I had a goal of living self-sufficiently, fulfilling my needs with what I could make or grow, and buying as little as possible. And, as an aspiring environmental activist, the clear moral lines around the issues in the Kentucky coalfields, especially strip mining, were appealing. The battle call of union songs such as “Which Side Are You On” charged up my little post-punk heart.  

However, my experience at Appalshop quickly taught me that the struggles of coal communities were not as simple or straightforward as I had imagined. Working as part of this artistic collective, I produced radio and video documentaries and taught community media workshops. As a young artist and activist, I quickly absorbed Appalshop’s mantra of providing a platform for mountain people to speak in their own words about issues that affect their lives. I attended hundreds of community meetings: school board, the fiscal court, mine permit hearings, and union meetings. I also documented dozens of direct actions where citizens blocked roads to stop mining, took over government offices to protest the lack of enforcement, and set up picket lines to enforce union contracts.  

Retired Welsh miner and labor leader Terry Thomas (left) meets retired Kentucky miner Carl Shoupe (right). (Screenshot from the documentary, After Coal)

My experiences working on the front lines of the environmental justice movement in Appalachia gradually developed my understanding of the complexities of how culture, place, and politics had shaped the situations I was documenting. I witnessed firsthand the incredible power of community to support people as they faced threats against their homes and families. As a result, I expanded my ideas about self-sufficiency from an individualistic vision of each person taking care of their own needs to a larger vision of individuals living in symbiosis with their neighbors and the natural environment—community self-sufficiency. 

Participating in cultural exchanges at Appalshop also provided me with valuable lessons. Meeting artists from the mountains of western China and rural Indonesia opened my eyes to some of the universal challenges faced by regional cultures in an increasingly globalized economy. I hoped that an international exchange with another coal-mining region such as south Wales could identify resources and strategies that would help Appalachian coalfield communities create a future beyond coal.  

The process of creating the After Coal documentary took more than five years. During that time, I learned to stop looking for concrete solutions and start supporting an ongoing conversation about how to create healthy communities in former coal-mining regions. International efforts to address climate change make this challenge especially intense for coal-producing regions. As our economy shifts from fossil fuels, how can we ensure that places where fossil fuels were extracted do not continue to bear an unfair share of the costs of extraction?  

I believe there are as many solutions for life after coal as there are residents of mining communities. I hope these stories from south Wales and central Appalachia will inspire people to discover solutions that work in their home communities. 

This article was originally published by Daily Yonder.

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