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Anthony Bourdain’s Loss Hits Home in Appalachian Kitchens

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When Bourdain visited Lost Creek Farm, I knew who he was. It took his tragic death for me to understand why he truly mattered.

Last Friday morning started out well within the realm of the ordinary. Just before 7 a.m., I walked downstairs, put the coffee on and headed to my desk to make a to-do list for the day ahead. As I looked out the window of my home office and watched the fog rise from our bottom meadow, I drifted back to a conversation from the previous night. It was one I had with several friends about the time Anthony Bourdain visited last September, filming a scene for Parts Unknown

That retrospective exchange also seemed routine by then. Ever since the West Virginia episode aired in late-April, I’ve found myself immersed in endless chatter about Bourdain’s CNN show, in its 11th season. Everyone in the state seems to have opinions about the outcome, and almost everyone has questions about the experience. “What was it like,” they ask, “you know, to have been on his show? What was it like to have had his film crew at the farm? What was it like to have met Anthony Bourdain?”  

“It was surreal; It was stressful; He was cool, actually pretty down-to-earth.”

I’ve offered up some combination of those answers dozens of times by now, often just before pivoting away from Bourdain himself, to the fair and honest way I thought Parts Unknown represented the Mountain State, or how I hoped our segment might play a small role in celebrating Appalachian food, something my earliest culinary mentors thought belonged in the garbage, not on television. I never minded talking about Bourdain, but my responses seldom matched the enthusiasm of those who’d ask with the widest of grins and a gaze of the over-enamored.

The tables were set for a dinner conversation Bourdain had with local cooks, farmers, folklorists and food justice advocates during his visit to Lost Creek Farm last fall. Hannah Maguire Photo

When I got the call about Parts Unknown last summer, I knew enough about Bourdain to respect him, but I never embraced the fanaticism he seemed to attract. I hadn’t read his books, and having lived without a cable subscription for the past 15 years, I’d only seen a handful of his shows. While I appreciated Bourdain’s knack for telling underdog stories and digging beneath the surface in his travel destinations, my own limited exposure gave me few reasons to be enthralled by a celebrity with whom many seemed to have a wildly unhealthy obsession.    

We were in the front yard Thursday evening when someone asked what Bourdain had to say while he was at the farm. It’s a question to which there are dozens of potential answers, in both on-camera and off-camera categories. But what I chose to share that night, and what was on my mind the next morning, was what Bourdain repeated while sitting at the dinner table just across from my partner Amy and I, under the canopy of giant sugar maples, as he sipped on hard ciders and poked fun at Brooklyn hipsters. Facing the same meadow I can see from my office window, he’d remark just how beautiful West Virginia is. There were, of course, on-camera and off-camera versions of this statement, as well: “West Virginia is so beautiful,” and “Man, this place is f—ing beautiful.” It was obvious neither lacked sincerity.

At around 7:30 Friday morning, much earlier than my phone ever starts to buzz, notifications began coming in. I was suddenly bombarded with text messages relaying tragic, unexpected, unbelievable news. Bourdain, a new-found hero of Almost Heaven, and the subject of endless conversation thrust upon Amy and I for the past several months, had taken his own life.

Throughout the morning, I’d open Facebook and Twitter, each time more astounded by the hundreds of posts reflecting a widespread outpouring of grief. Personal, revealing, vulnerable in tone, these were no run of the mill tribute memes that tend to flood the social mediasphere when notable celebrities pass away. Before long, I realized my short-lived experience of hosting Bourdain meant so little compared to the intimate relationships some of my good friends and food industry colleagues shared with him for years, even if they’d never met in-person. 

As I sat speechless Friday afternoon, still struggling to wrap my head around the news, I was impressed by the tribute my friend Matt Welsch strung together so quickly. In his blog post, “Goodnight, Tony”, Welsch wrote, “Every chef I know–every chef, line cook, and dishwasher I’ve worked with–I’d wager everyone in every back of the house everywhere, was touched and inspired by Anthony Bourdain.”

Long before Welsch returned home to the Northern Panhandle to open The Vagabond Kitchen, he aimed for other careers. While he was in college, he took jobs as a dishwasher and a line cook, experiencing his fair share of grueling, high-pressure hours in the kitchen. It was overlooked, often thankless work, but there was something addictive about it. After graduation, Welsch caught the urge to travel, eventually landing in the Rocky Mountains, where he worked as a sous chef at an Idaho ski lodge. There, he picked up a copy of Kitchen Confidential, the blockbuster memoir that gave rise to Bourdain’s global notoriety and heroic status among restaurant cooks.

“It was like Bourdain was holding up a mirror to the kinds of people we are,” he said, insisting the book’s mix of romanticism and brutal honesty represented somewhat of a rallying cry, a source of pride for restaurant laborers who reached their limits each night, but always came back for more. Bourdain had taken hardscrabble, behind the scenes work and framed it in a way that made chefs like Welsch adopt professional cooking not as a part-time gig, but as a career.  “It was everything, what makes us tick, what makes us do what we do. Even the people who didn’t get it finally started to understand.”

A road warrior motivated by wanderlust himself, Welsch said he was inspired by Bourdain’s travels, especially the way he used his fame to connect broad audiences with people in the places he visited. “Bourdain used his fame and power in really positive ways,” Welsch said, pointing to the recent West Virginia episode of Parts Unknown as an example. 

“I didn’t grow up as the son of a coal miner, but we definitely had some of the same challenges,” he said. “And I think that’s what he did, he made us realize, even though our experiences are very different, in a lot of ways, we’re all the same.”

Welsch was raised on a dairy farm in the Northern Panhandle, his father a laborer in a glass factory, later in an aluminum mill. He said while the episode didn’t necessarily reflect his own upbringing, he could identify with and take pride in the stories Bourdain told.   

“He showed that we can all be connected,” Welsch said, describing a message he hopes will live on, even after Bourdain’s passing. “We can stop making choices about other people based on their religion or their skin color.”  

At a very young age, years before AuCo Lai imagined moving to what she calls her adopted home of Appalachia, she struggled with cultural identity, experiencing the ridicule and intolerance Bourdain so often spoke out against.   

Lai, now a sous chef at The Wrigley Taproom in Corbin, Kentucky, is the first American-born member of her family. Her parents, both refugees from the Vietnam war, attempted to impress an appreciation for Vietnamese culture upon their young daughter. But in their suburban New Jersey neighborhood, they struggled to balance Vietnamese culture with American norms and ideals Lai was exposed to around her young friends and classmates.

“It was actually a real source of pain for me during my adolescence,” she said of the cultural tension. At some point in her early teens, an interest in food led her to follow Bourdain’s travels on television. When he ended up in Vietnam for two consecutive episodes of the Food Network series A Cook’s Tour, Bourdain made her feel comfortable embracing her family’s heritage for the very first time.

“Here’s this guy talking about Vietnam in a way that my parents tried to show me, tried to get me to appreciate, but in a language that I could understand, especially through food,” she said. “He was eating all the foods that I grew up with, that all my friends told me were fishy or stinky or weird. He was savoring it, and valuing it for all of the things that I had been made to feel ashamed of.”

In 2012, while living among a large Vietnamese community in Minnesota, Lai suffered through a challenging bout with depression. In a moment when, she says, Bourdain “saved me from some of my darkest moments”, she read Kitchen Confidential and realized she wanted to turn her affinity for cooking — more specifically, Vietnamese cooking — into a career. Once she finished the book, she quickly picked it back up and read it again.

“I read it twice, back to back. It was talking about this career I wanted to be a part of, this process of making food for others, making food that people can care about,” she said. “It set me on the career path that I’m on now. It gave me the OK to cook Vietnamese food, or Vietnamese-inspired food, to make comfort foods and present them in other ways, to show that it doesn’t have to come from a high-end restaurant.”

“He made it safe for me to exist the way that I do, in the field that I do, and in the world in general”, she added of Bourdain. “I owe him so much.”

In the Appalachian foothills of Eastern Kentucky, Lai says she feels a special bond with her friends and neighbors, many of whom struggle with stereotypes, cultural identity and mental illness. She says such deep, empathetic connections solidify her decision to stay in Appalachia, passing up recent opportunities to earn more money in larger cities like Lexington, Louisville or Chicago.

“So many of my friends and people I’ve met in passing have so many similar stories that I relate to,” she said. “People here get it, and we care about the land and we care about food and we care about each other, even though it’s conflicted in many ways.”

“Conflicted” would be one way to describe the experiences of Blair Campbell, chef and owner of Pretty Penny Cafe in Hillsboro, West Virginia. For almost twenty years, Campbell has watched Bourdain, who, she says, inspires the way she travels, the way she interacts with the community, the way she’s strived at times to become a voice for the voiceless.  

“I feel like I just lost a friend,” she wrote of Bourdain’s death Friday morning, before telling me she never expected the death of a celebrity could affect her so deeply. “I’ve watched all of his shows. I’m talking all the way back to the very first ones.”

She said she appreciated the way Bourdain ended up off the beaten path, telling stories about people and places most celebrities and television hosts would never think to visit.

“There are all kinds of famous people who have a platform, and they’re never going to use it to go somewhere else, to lift people up and tell a story,” she said. “They’re just going to use it for themselves.”

Campbell says Bourdain could “always see the good in a place, but he wouldn’t sugarcoat it,” pointing to the uncomfortable conversations Bourdain tried to spark about issues such as race, women’s rights and gentrification, to name a few.

“He wasn’t afraid to open the door to issues people were scared to talk about,” she said. “He brought up things about how we interact with each other and the space we all share.”

Last month, when asked which issues Campbell wished Bourdain could highlight if he were to someday return to West Virginia, racism in her community was at the top of her list. It’s a deeply personal issue for Campbell and her family. Her husband, Charlan, a native of Jamaica, and the couple’s young children, Oliver and Penelope, are some of the relatively few people of color in rural, sparsely-populated Pocahontas County, which, according to 2010 census data, is almost 97% white. The National Alliance, which the Southern Poverty Law Center says was “for decades the most dangerous and best organized neo-Nazi formation in America”,  was once headquartered just a couple miles from Hillsboro. Some of its members and relatives of former leaders still live nearby. In 2014, Pretty Penny was vandalized by a disgruntled former employee’s acquaintance, who had spray-painted a racial slur on the building’s white wooden siding, an incident to which the community responded with a vocal outpouring of support for the Campbells and the cafe.

Campbell says while racism shows up in everyday life, it’s an issue residents are hesitant to discuss openly. That is certainly not a dilemma unique to Pocahontas County, or anywhere else in America.  She says the conversation isn’t as simple as identifying victims of racism, or accusing others of racism, because in small, rural communities like Hillsboro, residents with drastically varying backgrounds and ideologies interact with each other routinely. They send their kids to the same schools and babysitters, support each other’s businesses, and, in many other ways, rely on each other to survive. The dynamic is nothing, if not conflicted.  

“It wouldn’t be a pretty conversation, but I think he could have had it,” she said, noting Bourdain’s ability to challenge his subjects and ask hard questions. “Is it going to change anything? Maybe. Maybe not. But at least you can shed light on it and give people a voice.”

Although it will never be Bourdain facilitating, she hopes such a dialogue is still possible. She says, while he could have started the conversation, it would have been up to the community to keep it going. Starting this week, Campbell says she’ll start airing past episodes of Parts Unknown each Wednesday evening, hoping the conversations Bourdain had in communities around the world might inspire residents of Hillsboro to sit down together, share a meal and start talking.

“It will be interesting to see if conversations like this can still happen,” she said. “He’s left a major hole to fill, and I just hope there’s someone out there who can keep it going and have these conversations that are bigger than any one person.”

Is there someone out there who can fill the void Bourdain leaves behind? Of course. There are millions of us. What Bourdain did best wasn’t necessarily extraordinary — at least it shouldn’t have been. His gestures of compassion, open-mindedness and fairness lifted spirits, put opportunities within reach and saved lives. But they were merely simple acts, of which each and every one of us is capable. 

As the days, weeks and months go on, I’ll probably find myself weaving in and out of innumerable conversations with friends and colleagues about Anthony Bourdain. With each instance, I’ll grow increasingly appreciative of the indelible mark he left in Appalachian kitchens long before the cameras started rolling in West Virginia last fall. In an industry in which mental health struggles run rampant, in a region which faces extraordinarily high rates of addiction, depression and suicide to begin with, we need each other. Those of us in the food business are more than just colleagues. We’re reinforcements, not rivals; comrades, not competitors. It’s downright haunting to know so many among us might not be cooking, might not be so outspoken, might not be so inspired if it weren’t for this guy who showed up at Lost Creek Farm in September. 

Anthony Bourdain gave me some exposure. For that, I’m grateful. But what he’d already granted me, a cohort of supportive peers inspired to embrace their heritage, bring communities together and take up for the little guy — that’s more valuable than I’ll ever reap from several minutes on national television. While I’ll never be able to repay him, I’ll certainly be spending some time under the maples in the front yard, looking out over the bottom meadow, pondering how I might begin to pay it forward.  

Food editor Mike Costello (@costellowv‏) is a chef, farmer and storyteller at Lost Creek Farm in Harrison County, West Virginia. Through his cooking and writing, Mike strives to tell important stories about a misrepresented and misunderstood region he’s always called home.

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When Losing 14 to 1 is a Win — Sort Of

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Matthew Ferrence is a writer and college professor who ran a 14-day write-in campaign against an unopposed Pennsylvania state legislator. He got clobbered but finds something positive in the results. Photo: submitted by the author
A last-minute write-in campaign against an unopposed Pennsylvania state representative yielded 900 official votes. It wasn’t nearly enough to win, but it was enough to show that there’s more to Appalachia than the average TV pundit claims.
Well, I didn’t win. Let’s get that out of the way.But on the night of November 6th, 2018, after launching a last-minute zero-budget Green Party write-in campaign against an unopposed Republican incumbent, in a Pennsylvania district that perpetually votes at about a 70 percent clip for even Republicans who get absolutely blasted in statewide races (see: gubernatorial candidate Scott Wagner, soundly defeated by Tom Wolfe), I wound up making a nearly 5 percent dent.

The how isn’t quite as important as they why, I think, but in brief: exactly two weeks before the election, I announced on Facebook my intention to mount a write-in campaign for the Pennsylvania House of Representatives, disgusted that for the fourth time in seven elections, the local incumbent — Brad Roae — faced literally no competition. Nobody squared off against him in the Republican primary and nobody ran on the Democratic ticket. In fact, only twice in his tenure has he faced opposition from Democrats, each of them throttled to the tune of 60-40 or thereabouts in the general election.

As an even sorrier indication of the state of political engagement in the rural part of Northwestern Pennsylvania where I live, only once has a Republican ever challenged him in a primary. It’s smooth sailing every two years, which leads to a tepid, basic and uninspiring legislative track record. Taxes are bad, he says. And, oh, let’s have some laws to weaken environmental protections for gas well drilling. He has made public media posts that appear to equate school boards to Hitler, and he has argued that state funding shouldn’t support students who major in “poetry or some other pre-Walmart major.”

Yeah, that’s who I lost to, my 900 votes or so to his 13,000. And that’s the guy who has gone to Harrisburg for more than a decade representing my home. Among the many things that gall me about his incumbency is the way that, outside of Appalachia, a lot of people would probably nod their heads and say, yup. Brad Roae is the kind of representative people think Appalachia embraces, is the kind of person so many non-Appalachians see as purely representative of who we are and what we stand for.

But here’s the thing. I’m finding hope in my two weeks as a candidate, and in the sudden flurry of interest and support. I ran because there had to be some opposition for democracy to have any chance at all, and when I did so I hoped I’d get 1 or 2 percent, not embarrass myself, shoot for the bar of 300 votes. That would be the same number of votes I would have needed as signatures to get on the ballot had I, say, planned ahead.

Then a funny thing happened. I started making videos introducing myself and my ideas, and put together a platform paper, and people started sharing these materials on Facebook, and I had to work through the anti-Russian Bot regulations the social media site now has so I could finally “boost” two of those posts on the morning of the election, and even before all that the organic sharing of an electorate dying for something, anything, that pushed against Appalachian political stereotypes meant 9,000 people had seen my stuff. Then, even though people had to first know I was running and then actually bother typing my name in, I fared okay. I earned about 65 votes for each day of my campaign. And I spent $50 on stickers, $20 on my Facebook ads.

Brad Roae poses in the Pennsylvania House chamber with Pennsylvania dairy princess LeeAnn Kapanick. Roae has represented the 6th House district since 2007. The district covers parts of Crawford and Erie counties in the state’s northwest corner. Photo: Pennsylvania State Legislature webpage

Official county returns compiled right before Thanksgiving gave me 851 votes. The Monday following, I reviewed the official computations and found another 60+, if I include misspellings like Matt Terrance and, Michael Ferrence, and Matthew Fetterman (for a voter who maybe confused me with our Democratic Lt. Governor candidate John Fetterman), and That Guy Whose Name Starts With F, as well as The Guy on Facebook Ask (name redacted), as well as a litany of close-but-no-cigar last names coupled with Matt or Matthew: Ferrer, Ferraro, Fetter, Farreah, Ferrenc, Ferrous, Ferris, Ferentz, Ferrick, and DeFerence. I got 14 votes in neighboring state districts, and four votes for the U.S. House Race. Among other write-ins, I beat a slew of names that received a single vote or a handful, tough competitors like Brad Roae (who a few people wrote in, even though he was on the ballot), Stephen Colbert, Anyone But Him, Anyone Else, Jesus, God, and Red Breasted Nuthatch.

Look, my day job is writing and teaching. I’m a professor at a small liberal arts college, chair of the Department of English, writer and teacher of creative nonfiction. I was born in southwestern Pennsylvania, among the played out coal fields and strip mines an hour east of Pittsburgh. I earned a Ph.D. at West Virginia University, where I specialized in Appalachian literature. I wrote a memoir about my brain tumor, and the geology of the Allegheny Plateau, and the curious exile of inhabiting the weird position of Northern Appalachian, which means you’re not quite normal American and not quite Appalachian. None of that adds up to politician, but all of it adds up to frustration. I’ve spent most of my life, other than brief adult stints in Arizona and France, living in a region that skews way right, even as that right continues to exploit and degrade the people and place. All Appalachia ever has been allowed to be is exploited. That’s it. And that’s all the rhetoric of the GOP offers, when you boil it down. Let’s Make America Great Again, like when black lung wrecked lives on the regular and, newsflash, is now roaring back to life since the unions have been busted, and the economy of the region stayed busted, so the people crawled down into mines without the protections hard fought with blood and love by the striking workers of Blair Mountain, and the striking workers of Pittsburgh steel, and the striking auto workers of the Rust Belt.

Ferrence knocked on some doors and created a Facebook page to promote his campaign. He did several short videos to explain why he ran and discuss issues. Photo: Matthew Ferrence for PA House, District 6 Facebook page

Public historian Elizabeth Catte gets it right (she’s the author of “What You’re Getting Wrong about Appalachia”) when she argues that Appalachians have been socialists all along. They just don’t know it. They gathered together. They fought the power of industrial dominion. They powered America with their coal, yes, but they also fueled the national movement for respect and dignity for labor. Then the GOP figured out how to weaponize hatred and fear, and there you go. You get Joe Manchin, alleged Democrat. And you get a region that votes more than 2/3 for Trump and Trump-esque troglodytes like Pennsylvania’s GOP gubernatorial candidate Scott Wagner, who claims that global warming is probably just accumulated body heat from a larger human population or happens because the earth is getting closer to the sun, and campaigns by saying he’ll dance on the governor’s face while wearing golf spikes.

It boils down to this: I am so tired of waking up on November Wednesdays in Appalachia, seeing election results and, worse, national punditry that says this is all we are and all we’ll ever be. The election map of my state is bright red, other than around a few urban centers, just like most of Appalachia. That seems to translate to the same conclusion we get over and over and over again: dumb hillbillies voting for the worst. That conclusion seems to be supported by the simple math of our state politics, where more than half of state legislators run unopposed in their general elections, and our incumbency rate is about 90 percent. Few candidates ever put up a fight to change that.

So what’s an Appalachian creative writing professor to do? You run a last-ditch campaign. You tilt against the windmills in a manner that is both impotent (because you get crushed at the polls) and, at least for me, hopeful. Because having a choice, any choice, other than the incumbent mattered to the 2,000 people who either voted for me or tossed in a symbolic protest write-in. Because people stopped me when I walked by, and messaged me on Facebook, and were angry when they learned about the campaign only after they voted because, damn it, they couldn’t vote for the incumbent, and leaving it blank is just what the GOP has wanted for so long. The story of Appalachian politics has been about that blankness, a cultivation of the sense — and you can read this in almost every national outlet at some point in the last two years, usually with a quote from that faux-Appalachian pseudo-pundit J.D. Vance — that there’s nothing but right-wing fools in these hills and hollers. Appalachia is given up for dead again, this time just as a tarnished example of the hatred and backwardness of politics in this strange, strange land.

That’s just not how it is. That’s not the Appalachia I know nor the one I saw in my brief campaign. Heck, I ran this mini-campaign focused specifically on lefty sustainability, as in ecology and tree-hugging, as well as economies that stop repeating the boom-bust cycles of our past, and I drew a mighty good swipe of votes all at once, in the end. There are a lot of people in my county who believe in the value of the environment, and the necessity of fine educations, and the rightness of universal healthcare, and the imperative of social justice, and the glory of love in all its forms. There are progressives in these hills, you know. And a lot of them, but also a lot who hear those same old stories and worry about what the neighbors will think, so they don’t vote, or accept the inevitability of political monoculture. Thus the slam happens again. And again. And again. Unopposed Republican. Platforms of no taxes. Tacit acceptance of the Confederate Battle Flags that flutter on too many once-Union farmhouses.

Yeah, I got creamed. But I think we also won something that night. And we’ll keep coming back for more, riding a blue wave tinged with green, fighting for a change in the rural center of America that so many figure is lost forever. You know the joke, about Philadelphia and Pittsburgh and a lot of Alabama in between. Well, Alabama has a Democratic Senator, and so does Pennsylvania. We can do more, do better, push against the dogged stupidity of a right-wing cultural war that makes us all weaker and worse off. We can step into these races, and we can square off and say, hit me, and we can get hit, and eventually we can win. I know I’ll give it another shot – with my name printed on the ballot next time. I’ll need at least a couple of months next time, to get enough votes to be competitive, if history holds. But I’ll vow, and I hope others will too, that no one gets to run unopposed anymore. No one gets to spit out tired political bullshit and not get called out. This is our Appalachia too.

This article was originally published by the Daily Yonder

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There’s a Tool that Claims to Predict Potential for Criminal Behavior. Should PA Judges Use It?

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Allegheny County Courthouse in downtown Pittsburgh. Photo: Connor Mulvaney/PublicSource

The Pennsylvania Commission on Sentencing is considering a “risk assessment” tool, which, according to social justice activists, would reinforce existing bias in the criminal justice system. But the tool’s designers say it would give judges more data to base sentencing decisions on as opposed to primarily relying on uniform guidelines.

The commission is hearing public feedback about the risk assessment tool on Thursday, Dec. 13, from 10 to 11:30 a.m. at the Allegheny County Courthouse (436 Grant St., Pittsburgh).

How would the “risk assessment” tool work? Say you’re facing a criminal charge. In addition to the usual information about your present and past — as in the crime for which you are on trial and your prior record, if any — the judge also has a report trying to predict your future. On a scale from 0 to 18 points, an algorithm has indicated how likely you are to reoffend, based on data about recidivism rates.

Read more about how the risk assessment tool is used to calculate sentences from PublicSource.

This story was originally published by PublicSource based in Pittsburgh.

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Diving Deep into Harm Reduction

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Medicine worker disposing medical waste into plastic containers with protective glove. Photo: Adobe stock.

Part 1: Why W.Va.’s Largest Needle Exchange Closed

In December  2015, with support from the city of Charleston, the Kanawha-Charleston Health Department launched a harm-reduction program that included a needle exchange. The primary goal was to reduce the risk of diseases commonly spread by sharing needles.

Now, only thing that remains of the harm reduction program is a syringe kiosk where people can deposit used hypodermic needles.

At its peak  the program served more than 400 people a week,mostly from Kanawha County. But some came from surrounding counties as well,a factor that became a point of contention for many in the city.

“It became basically, a line of people just to line up to get needles between 10 and 4 on any given Wednesday,” said outgoing Charleston mayor, Danny Jones who been an outspoken critic of the program.

In the months before it closed, Jones publicly called the program a “needle mill” and “mini-mall for junkies.”

“On any given Wednesday, they might have given out 12,000 needles,” he said during a recent interview.

In reality, the average number of needles given out during the weekly Wednesday exchange was about 5,000 serving about 190 visitors, according to data obtained from the health department. That’s about 26 needles per person, per week. The highest number of  needles the program ever gave out in a single week was just over 11,000 to 417 people.

While 5,000 seem like a lot, the average heroin user injects several times a day. So 26 needles a week gets a person about three injections a day with a clean needle.

“A syringe exchange program should really be called a harm reduction program,” said Dr. Artis Hoven, an infectious disease specialist with the Kentucky Department of Health.

She said harm reduction is an all-encompassing idea to reduce the risk of many things associated with addiction such as “provide naloxone, provide referral to care for people with substance use disorder, they do HIV and Hepatitis C testing.”

And in Charleston, it seemed to work.

While the Charleston program was open, the city did not see an HIV outbreak, according to interviews conducted by Charleston-Gazette Mail. During that same time period, 15 counties in southern West Virginia did have a small HIV outbreak — none of the three counties where the outbreak started had a harm reduction program, according to a Centers for Disease Control and Prevention Report.

Recorded incidents of Hepatitis C rates in West Virginia did increase — by a lot — during the course of the program, but so did efforts to test more people.

But in Charleston, reports of discarded needles in the community began to skyrocket and people were alarmed.

Firefighters reported having to crawl over them while putting out fires in abandoned structures; a local elementary school requested a biohazard container from the city so they could clean up an alley before school; and police officers reported finding huge numbers of syringes on people who were arrested.

Both the Fraternal Order of Police and the Charleston Professional Firefighters Association wrote letters to City Council expressing major safety concerns for first responders.

Concerns might have been exacerbated because the program grew really fast. In the two years the program was open, more than 651,000 needles were distributed. Only about 66 percent of those needles were returned.

According to the Centers for Disease Control and Prevention, the risk of contracting HIV is nominal for for healthcare professionals stuck by needles on the job — around .3 percent — with some studies suggesting even less. Outside experts like Peter Davidson from the University of California San Diego say needle litter is an annoyance but not the major public health concern an HIV or Hepatitis C outbreak would be.

“No one in the world has ever obtained HIV from stepping on a needle in the street,” said Davidson. “Needles in the street are a piece of trash. It’s not something you want seeing laying in the gutter, but they’re not actually a very hazardous object.”

In some ways, it doesn’t matter what the risk is. If someone finds a dirty needle on a playground or in a shopping mall bathroom, public reaction is strong. And for non-users, any risk of contracting HIV or hepatitis from a dirty needle is too much.

But closing a harm reduction  program in the biggest city in the state could have huge public health implications for the region, according to former state Commissioner for Public Health Rahul Gupta. Gupta said it’s “not in the best interest of the community” when needle exchange programs like this one are shut down “reactively.”

“It plays into that stigma and is more harmful long-term than it is beneficial,” he said in an interview shortly before he left his job.

Gupta said it’s more harmful because not only are you removing your best tool for preventing needle-born illnesses, but, as we’ll hear later in this series, the closure may impact public perception and support for other harm reduction programs across the state that are trying to open or stay open.

Part 2: Public Safety and Public Health

Best practices for harm reduction programs call for flooding a community with clean hypodermic syringes. Research shows that in addition to reducing the prevalence of blood-borne pathogens in the community, well-run programs help remove potentially infectious syringes from the community. But some people say that wasn’t happening in Charleston.

Photo: Todd Huffman via Flickr [CC BY 2.0]

Reports of needles found in public places in Charleston began to escalate in early October 2017.

Mayor Danny Jones said the city tried numerous times to complain and the Kanawha-Charleston Health Department didn’t do anything to address their concerns.

Then city health officer Michael Brumage took issue with that accusation,pointing to efforts, such as the founding of the statewide harm reduction coalition. He said one of the objectives of the coalition was to bring needles into other communities so there wouldn’t be such a burden on the city.

But in October 2017, the city public safety office established a code for needle pickup calls to help the city accurately collect data on locations, numbers and types of needles to be picked up.

About a week later, the city proposed running a pilot program with retractable needles. The idea was that if the needles could only be used once and then retract into a plastic chamber, it would reduce the risk of needlestick injuries to the community and first responders.

At the time, Brumage was all for the idea. He wrote an an email, which was part of documents released to West Virginia Public Broadcasting through a Freedom of Information Act request, to city attorney Paul Ellis.

“[T]he limitations … are acceptability and cost. Should we get support or donated supplies, I am all in for a pilot with evaluation. This could be a very interesting trial. We would like to bring in some researchers for this as well. Let’s do it! It’s worth a shot.”

Over the next few weeks, the Charleston Fire Department found a manufacturer willing to donate the needles in exchange for tracking how well they worked. After consulting with Brumage and his staff, the city requested 250,000 needles from the manufacturer for a six-month trial.

Everything seemed to be on track to start a pilot project using retractable needles in early spring 2018.

At least that’s what the city thought. Meanwhile, Brumage was in communication with a researcher at Johns Hopkins University in Baltimore, Maryland. The researcher reinforced something with him that  he said he already knew — that “retractables were unpopular among people who used IV drugs.”

In 2010, the national Harm Reduction Coalition issued a statement against auto disable syringes. They said the syringes do little to help control epidemics of HIV, hepatitis C, and other blood-borne viruses among people who inject drugs because many people inject drugs a half dozen times a day. Without needles you can use more than once, users revert back to sharing equipment.

“So, at that point I was kind of in a bind since I told the city we would implement the retractable syringe program. But now knew if I did, we’d actually be putting the public at risk,” said Brumage.

So given the current recommended practices, Brumage and the Johns Hopkins researcher decided to reduce the pilot instead to about 10 to 12 people. In meeting minutes from a call, also released in the FOIA,, Brumage’s staff appeared to confirm the new plan with the company that had agreed to donate the syringes.

Brumage said he thought the needle manufacturer then told the city about the change. But no one did. So city officials said they felt blindsided several weeks later when they learned the pilot program no longer included the entire patient population.

“They refused retractable needles,” Jones said in an interview.

It was more complicated than that, but it probably felt like a refusal to the city because of the  change in plan wasn’t communicated. And I mean, remember, law enforcement, emergency responders and some members of the community were now expressing a lot of concern about needle litter and felt like they had to do something.

“I want to protect the public. I want to protect the law abiding public,” said Jones.

In late March of this year, Charleston Police Chief Steve Cooper decided — as he was legally empowered to do — that the health department may only give out retractable needles.

Essentially, Brumage said, the police were “ directing the health department to adopt — what appeared to be from the medical literature to be dangerous and unethical practices.”

But other public health experts said making a harm reduction program fit the needs of the community takes a lot of compromise.

“Public health has never been and will never be about my way or your way. It will always be what’s the best way to input science and marry it with art and put it into practice,” said former public health commissioner Rahul Gupta.

From a public health perspective, harm reduction programs are still the best tool the city a city? has to prevent the spread of needle born illnesses. But politically — at least in the state’s largest city — it’s closed indefinitely.

Part 3: Community Acceptance, Perception and Stigma

A girl is telling her friend a secret. Photo: Adobe Stock.

Less than two years after it began, the Kanawha-Charleston Health Department shut down it’s harm reduction program. Among other things, the program provided thousands of clean needles to drug users with the goal of reducing needle borne diseases, but faced significant pushback from some in the community.

As the state continues to grapple with the drug epidemic and its impact to public health, those running harm reduction programs in other West Virginia communities say the closure of the Charleston program, and the narrative that the needle exchange program was destroying the city, is having a negative impact on public perception of harm reduction efforts.

“Everyone understands that this drug epidemic is the biggest public health issue that we have dealt with,” said Terry Harlin, administrator of the Fayetteville harm reduction program. “I feel like what happened in Charleston hurt us a little bit.”

Harlin said when the Charleston program closed in [insert when here], members of the community began questioning the necessity of the Fayette County program.

“We definitely started hearing people locally, ‘well it didn’t work in Charleston so why would you continue doing that here?’” she said. “Even though there’s lots of evidence and research out there that show that harm reduction does help to prevent the spread of disease and does help to get people the help that they need.”

A Shifting Narrative

The trickle effect to other programs like Fayetteville’s likely happened in the last six months the Kanwaha-Charleston program was open, when the narrative around the program shifted. Outgoing Charleston Mayor Danny Jones was especially outspoken critic of the program.

“Needles were everywhere and our property crimes went through the roof,” he said.

No study has been done quantifying whether the harm reduction program caused an increase in needle litter, making it hard to confirm the veracity of the claim. But we do know, according to data from the health department, that during the two years the program was open, more than 650,000 needles were distributed and only about 66 percent of them were returned.

West Virginia University public health researcher Robin Pollini said that doesn’t mean the unreturned needles ended up on the street. In West Virginia it is legal to dispose of sharps in the trash if you package them and label them in a certain way, she said.

“And so the Charleston program, just like many programs across the state, gives out puncture proof containers and information on how to dispose of those safely,” said Pollini. “And so we don’t have any idea how many of those ended up properly disposed of in household trash and how many didn’t.”

Dr. Susan Gardner, assistant dean of the University of Charleston School of Pharmacy, said she has seen little evidence of widespread needle litter.  The school of pharmacy was one of the volunteer groups very involved in the Kanawha-Charleston Harm Reduction Program.

“There are times where I just took a walk on the East End looking — looking!,” she said. “[I say to myself] ‘ok, if it’s this bad surely I’ll see it.’ And the only time I’ve ever come across a needle in Charleston is doing a syringe cleanup.”

Us Versus Them

But without a study of Charleston’s needle litter, there’s also no way to prove that the 200,000 unreturned needles didn’t end up on the streets.

Members of the Charleston police department said they’ve observed much less needle litter since the program closed, but the department also has reams of photographs from first responders and community members of needles found in public spaces.

Comments on news articles and Facebook posts seem to paint a community drowning in needles.

On some level, needle litter itself, isn’t the issue.

“So part of the narrative that was built around the Kanawha program was this us and them of like ‘we’re the community and those people are drug users,’” said Pollini, from WVU. “Those people are part of our community they’re West Virginians right?”

In Wyoming County a Different Narrative

Wyoming County launched its needle exchange program in May. Executive Director Fred Cox said their program has been relatively well-received — he guesses because they had a small HIV outbreak prior to the program opening.

“A picture’s worth a thousand words I’d guess you’d say,” Cox said. “So, that picture was really clear to us here and I really do think that help changed some minds.”

He said if they hadn’t had the outbreak he doesn’t think they would have had to support to open the program as a prevention measure.

Some speculate that may be another reason Charleston’s program struggled in the end.

Outgoing Charleston mayor Jones said there were no reports of outbreaks of hepatitis C or the AIDS virus prior to the launch of the city’s harm reduction program.

“It’s not up to us to ruin a town over the fact that people have communicable diseases,” he said.

Rahul Gupta, formerly the head of the state’s public health department, said harm reduction is a multifaceted idea that encompasses not just needle exchange, but testing and family planning and treatment of diseases.

“And other issues that come across that are consequential in some ways like needle litter and other things there have to be plans in place to address those — what we can’t afford to do is ignore them,” he said.

There often are demands, Gupta said, to do things differently. But he believes there’s always a middle ground you can get to with negotiation. And you do that, he said, because “people’s lives are at stake.”

Part 4: Best Practices vs. Community Acceptance

Current best practices for harm reduction programs include a couple provisions: No retractable needles should be distributed, patients should get as many needles as possible regardless of how many they bring back, and barriers to accessing needles should be as low as possible. But sometimes those recommendations are at odds with community acceptance for the practices.

Photo: Ashton Marra, 100 Days in Appalachia

In late March, shortly after the Kanawha-Charleston Health Department closed its harm reduction program, Mayor Danny Jones wrote a letter to Rahul Gupta, then state commissioner for public health, asking that the West Virginia Bureau for Public Health audit the program.

“The review provided very specific recommendations that needed to be met in order to restart the program,” Gupta said.

These included improving data collection and analysis about exactly how many people were using the program and what services they were using; putting in place a plan to deal with needle litter; improving communication with community stakeholders and requiring that people pick up needles they need in person.

After the audit came out, the Kanawha-Charleston Health Department requested a review of the audit from seven harm reduction experts around the country, including Dr. Peter Davidson from the University of California San Diego. All seven letters were critical of the audit.  

“I think the best way to describe it was that the people who wrote the audit had a very particular idea in mind about what a syringe distribution program should look like,” said Davidson.

In his letter Davidson wrote that “almost all of the recommendations in the audit represent severe, and in some cases unconscionable, barriers to effective, evidence-based, primary prevention of blood borne virus transmission.”

“You know one of the reasons syringe distribution programs exist in the way they exist at all is because is because the sort of traditional public health clinic model hasn’t served people who use drugs very well at all,” Davidson said. “And it hasn’t been very good at providing them with the basic tools they need in order to prevent the transmission of infectious disease and prevent overdose.”

Davidson said ideally, harm reduction programs have as low a barrier of entry as possible so the maximum amount of people will participate. And the recommendations made in the audit would raise the threshold of how easy it was to access resources, but he also says there’s room to adjust programs to fit the communities they serve.

“I wouldn’t expect a needle exchange in rural Appalachia to look the same as a needle exchange in San Francisco for example,” he said. “That would likely lead to a program that didn’t serve the population very well at all.”

And in Charleston, there were actually two harm reduction programs being held simultaneously: the one at the health department and a much smaller, clinic-based program operated by Health Right, the biggest free clinic in the state.

“Back in 2011 we noticed an increase in patients that were coming in with various stories, histories of being diabetic, they would pick up the needles for the program but not the insulin,” said executive director Angie Settle.

She said they began to suspect an increase in IV drug use among their patient population.

“So we kind of quietly started the program with the needle exchange it was mainly internal not something we broadcasted, but those patients that needed it knew of the service and as they came in we were screening every patient for IV drug use,” Settle said.

Because Health Right is a clinic working with a limited number of patients with whom they already have close relationships, they could run their program differently than the health department, which was trying to do a mass public health push, serving the whole city.

Health Right is also a one for one exchange — you bring a needle back, you get a fresh one — which for most harm reduction experts is not considered best practice. But since patients can come as many times a week as they want, Settle said it seemed to be the best choice for her program.

They also require every patient to meet with a counselor when they come in for needles. Basically, participation in Health Right’s program requires a lot more effort from patients, which means not everyone will use it, but Settle said that running a conservative program is preferable to not having a program available at all.  

“You know the reality here is you’ve got a drug-using population that, in fact, is going to keep using drugs whether or not you have a syringe exchange program or not,” said Dr. Artis Hoven, an infectious disease specialist with the Kentucky Department of Health.

But without a program, she said, the community is just opening itself up to the easier spread of communicable diseases.

“There is something called the art and science, if you will, of risk or harm reduction,” said Hoven. “And for many of us we are still learning what that art is and what that science is. We’re trying to make it better and to make it something that is effective.”

But if Charleston were to consider harm reduction again, a lot of community healing, conversations, and compromise would likely have to occur. And the biggest barrier may be one of the most intangible ones — addressing stigma.

Part 5: A Community Divided

When the Kanawha-Charleston Health Department closed its harm reduction programs, one of the biggest criticisms of the program was that it led to an increase in crime, vagrancy and homelessness. Those claims are not without merit.

Photo: Adobe stock

“I mean, that’s some of the stuff that people don’t really think about,” said Sgt. Matt Webb, who has been on the Charleston Police force for 20 years. During a ride-along, Webb was tracking a case of a man who was stealing vehicles and using them in other crimes. He pulled into an office parking lot where about eight cars were parked around a side-by-side ATV – effectively making it impossible to access the off-road utility vehicle.

“It’s the bigger picture of the drug issues. Guys out stealing somebody’s side-by-side … those people probably work hard every day to try to take care of their families and have things like that, and here he’s trying to support his drug habit and he goes and steals a side-by-side.”

During the 2018 mayoral election, crime and safety related to the drug epidemic became a political theme.

“One of the issues we have in our downtown area and is not just perception — it’s become reality unfortunately — is there is a belief that there is a public safety issue in downtown Charleston,” said mayoral candidate J.B. Akers during a fall debate between him and then-candidate Amy Goodwin televised by WCHS.

Akers was publicly critical of the syringe exchange component of the Charleston harm reduction program during his campaign. In the months leading up to the election, the program increasingly became a politically charged, divisive issue.

This fall, the City of Charleston completed a $100 million renovation on the Charleston Civic Center. The Civic Center overlooks the Elk River and abuts the Charleston mall. On other side? The Kanawha-Charleston Health Department.

“That health department shouldn’t be there,” said outgoing mayor Danny Jones.

The Charleston harm reduction program happened once a week. And as the program grew, that meant up to 400-some patients were coming through in a six-hour period for needle exchange as well as getting vaccinations, testing for diseases and accessing family planning services, among other services. This volume was a big deal for the downtown community.

“Having a program that was outside the city limits or at least within the city limits but in a less trafficked place by regular business people and people doing shopping in the city of Charleston would be an important thing to do as well,” said former city health officer Michael Brumage. Brumage said one of the lessons learned from the program was that they’d likely rethink the location.

Over the last couple of years, complaints of vagrancy and a rise in a criminal transient population have increased — a change Jones attributes to the harm reduction program and the geography of the state.

“It’s the confluence of the interstates,” he said.

Charleston is at the intersection of two major interstates — 64 running east to west and 77 running north to south, which Jones said made it easy for people outside of the city to come in and utilize resources meant for residents.

“I know it’s been a long time since I’ve started this profession, but when I first began this profession, I knew of two homeless people in town,” said Sgt. Webb. “And now, I mean, they’re all over the place.”

Sgt. Webb said that addiction and a bad economy go hand-in-hand.

“I’m pretty certain that the addiction aspect of what we’re dealing with has a lot to do with the economy,” he said. “You know, when you’re down on yourself you look for ways to make yourself feel better. I’m far from a doctor, but I’m sure a lot of people who are out here addicted to drugs had some kind of traumatic experience or they’re trying to fix something.”

A few months after the program closed, a Facebook group started, called “Charleston Has Had Enough!”, where members post photos of other people using drugs, stealing packages, panhandling, etc. Now, almost one of every 10 Charleston residents is a member.

None of the ten administrators or moderators returned requests for an interview, but in a Sept. 16 post, one of the founders wrote: “Word is going around that this group is all about shaming junkies. Anyone who believes that is an idiot. No. This is a group about shaming the so-called leadership that got us in the mess, namely the Kanawha County Health Dept. who convinced the city that free needles were a great idea.”

Danny Jones is a member.

“It was a really bad situation for our city. Needles were everywhere. Property crimes went through the roof. And now that it’s over, our property crimes have gone way down,” Jones said.

That’s a slightly misleading assertion. Larceny — meaning theft of personal property — has actually fallen considerably from 2014-2017, according to data obtained by West Virginia Public Broadcasting from the Charleston Police Department.

Burglary/breaking and entering spiked in 2016 (the first full year the program was in operation) but then fell to pre-program levels the second full year the program was in operation.

Breaking and entering into a car has risen continuously since 2014. And there was a massive spike in auto crimes in 2016 and no decline during the program’s second year of operation. But data like this does not prove why some crime went up after the harm reduction program opened and some went down. And speculations only seem to divide community.

In an off-the-record conversation, a member of the Charleston Fire Department said the closure of the Charleston program had set the city back 10 years in terms of acceptance of harm reduction. How to move forward is a subject incoming mayor Amy Goodwin addressed in the October debate televised by WCHS.

“Leaders lead,” she said. “Leaders don’t take the blame or cast the blame on someone else. They look at what they’ve done wrong and they say, ‘let’s improve it.’ They look at something that may be a problem in the city and they work with everyone; they bring everyone to the table. They don’t villainize; they don’t marginalize folks.”

At this point, bringing everyone to the table is going to take a lot of work, but it’s not impossible.

“I would be interested in being on some kind of board where they hold discussions about trying to find answers to these questions,” Sgt. Matt Webb said. He said it’s really challenging working with a population struggling with addiction.

“It’s frustrating,” he said. “If we go to somebody’s house and they’re having a heart attack, we send them to a doctor and the doctor can hopefully fix their heart. They give them a heart cath, they give them open heart surgery, they’ll do bypass – whatever. When it comes to somebody who is addicted to opioids – a lot of times, I know it’s not true, but they give off the impression that they don’t want help but it’s because the addiction is so great they feel like they don’t want help.”

And if someone does want help, he said, it doesn’t get much easier.

“Are there beds available in rehab places? How are they going to pay for it? Those are sometimes hard answers to get.”

But whether a board is created to discuss these issues like Webb mentioned — or even if enough people are willing to sit down and really listen to one another to address the still present public health risk of needle borne diseases — remains to be seen.

This series was originally published by West Virginia Public Broadcasting. Read them individually: Part 1, Part 2, Part 3, Part 4 and Part 5

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