Six of Eula Hall’s 10 full siblings lived into adulthood. Her family was among the more fortunate.

Growing up in rural Appalachian Kentucky, Eula has witnessed poverty; she lived it. She remembers regularly seeing children with staph infections that would peel their skin away.

Her mother knew to use disinfectant, Eula recalls today, seated at the command post of the health care clinic she founded in the little town of Grethel on the banks of Mud Creek.

The Eula Hall Health Center in Grethel, Kentucky. Photo: Taylor Sisk/100 Days in Appalachia

But most didn’t. Most had no names for the preventable conditions that befell their families, let alone effective cures. There were no health care professionals to minister to them in their rural Kentucky communities. Home remedies – turpentine or kerosene, for example, administered both externally and internally – only worsened these afflictions.

Eula could never abide such misery; from childhood, she was driven to alleviate it. So in 1973, with a $1,400 donation and two local doctors as volunteers, she opened the Mud Creek Clinic here in this Floyd County community of 1,500. Today, it’s part of a network of clinics providing quality, accessible health care.

‘It’s Not Living’

Eula Hall was born on Oct. 29, 1927, in nearby Pike County. It was coal mining country then as now – though not nearly so now as then.

Eula’s dad, L.D. Riley, farmed, felled trees and fathered 20 children, 11 with Eula’s mom, Nanny Elizabeth Riley, his third wife. She’s the last of those 20 still living.

When Eula was a girl, her mother would take her to sit with a sick neighbor, just to be there, to help out, “and I would see things that would keep you awake.”

“Tuberculosis was rampant. Pneumonia – you didn’t know what it was because you didn’t have a doctor. You’d get a toothache and your jaw would swell up and get infected. You’d see people die.”

“You’d wonder, ‘Who’s next? Who’s next?’”

Eula watched her mother nearly bleed to death in childbirth.

“You ain’t got no life,” Eula says. “If you’re living like that, and every day you’re scared, every day of your life you live in fear that this will be my little brother, my little sister – it’s not living.”

Then, of course, there was the slow death of the mines. In her chilling ballad “Black Lung,” Hazel Dickens laments: “Cold as that water hole down in that dark cave/Where I spent my life’s blood diggin’ my own grave.”

For Eula, the memory of black lung is a rattle in the night.

Her father never owned a car, so the kids walked wherever they went. “We would go to the neighbor’s house and play with the children or help the mother break up beans or whatever needed to be done,” she recalls.

Returning home in the dark, they’d pass people sitting on their porches. “You’d hear them cough and you might see the glow of their cigarette. You’d hear them wheezing, trying to get their breath. And it would be coal mining. They had black lung. They couldn’t sleep. They had no electricity, no air conditioning, no fan – they were sitting outside trying to breathe.”

“Both of my husbands were coal miners,” Eula says. “My brothers were coal miners. My brother-in-law got killed in the mines. My brother got his back broke in the mines. My sons – I had three sons that were coal miners. Scary.”

In the late 1960s and early 1970s, she served as president of the Kentucky Black Lung Association. She’d trained previously as a VISTA volunteer.

“I said, ‘If there’s going to be a war on poverty, there’s plenty of things to fight about, and there’s plenty of people to fight for if you can organize.’ I wanted to make known everything people was suffering from.”

She was a member of the Eastern Kentucky Welfare Rights Organization. Jesse Jackson came to Mud Creek. She drove Ted Kennedy around in her SUV. Mitch McConnell. Bill Bradley. Alongside Bishop Desmond Tutu, she was presented with an honorary doctorate from Berea College.

Through it all, her number-one priority was health care: access to services, attention to black lung, clean drinking water (she launched the Mud Creek Water District). Education was next.

“All the way down the line,” Eula says, “there were major, major problems that needed to be dealt with.”

An Ambition Fulfilled

Eula remembers how in the rural community of her youth, people built their homes without the benefit of  heavy equipment to level the land. The houses were constructed on slopes, the front porches on stilts.

She recalls the day a neighbor woman was climbing to her porch when a step broke, a 16-penny nail piercing her ankle. “She took tetanus and died. She died and left six little children.”

“I can remember them coming back – they lived close to where we lived; you could see their house from ours – and I can remember the day of her funeral. The little children come back and they laid down on the porch, and they cried.”

Eula Hall. Photo: Taylor SIsk/100 Days in Appalachia

“One shot probably would have saved her,” Eula says. “She didn’t go to the doctor; didn’t have money; no car. And it always stayed in my mind. We’re supposed to be living in the land of plenty – and people suffer like that?”

That experience, and countless others, drove her to effect change.

The first iteration of Mud Creek Clinic was in a rented home on Tinker Fork, but Eula soon recognized the need for more space. So she moved her husband and five children into a two-bedroom mobile home and converted their three-bedroom house into a six-examination-room medical facility.

In 1977, Mud Creek Clinic joined with Big Sandy Health Care, a nonprofit that operated a clinic in nearby Magoffin County. Big Sandy is today based in Prestonsburg, the Floyd County seat, and serves five southeastern Kentucky counties spanning the Appalachian foothills: Floyd, Johnson, Magoffin, Martin and Pike. The partnership provided Mud Creek with access to federal funds and a wider network of health care professionals.

In 1982, the clinic burned to the ground, a suspected act of arson. Eula set about to rebuild it.

The Appalachian Regional Commission put up $320,000; a radiothon, raffles and soup-bean suppers were held; Eula stood in the middle of the road with a gallon collection bucket; and donations arrived, she says, from half the states in the nation and the United Mine Workers Union.

The morning after the fire, Eula set up office on a picnic table under a willow tree. Staff and patients arrived; health care was provided. Among the missing essentials was telephone service to call prescriptions into the pharmacy. So Eula contacted the telephone company, explained the situation and requested that they come out and install a phone.

Where would it be installed? Install it on this tree here beside me, she instructed. The phone company folks paused to ponder. You put telephones on poles at mine sites, she reasoned, you can put one on a tree at a health care site. The telephone was installed.

“It was that kind of determination that nothing, nothing, stops us from seeing the patients,” says Big Sandy CEO Ancil Lewis.

“I tell that story when we have a little bit of snow and some of the staff wonder if we should close,” he says. “Or if we have a power outage at a clinic or something. ‘Should we close?’ I remind them of Eula’s determination to continue to see patients.”

‘Finance or Finagle’

In most respects, things are better today in this region than when Eula was a child. But well-paying jobs – jobs that might buy you a little security, maybe allow you to afford to see a doctor – are still few and far between. The needs were, and remain, considerable.

Floyd County ranks 114th of Kentucky’s 120 counties in health outcomes; the other four counties Big Sandy serves are in the bottom 20 percent. Four of the five counties have family poverty rates above 30 percent, compared with Kentucky’s 21.5 percent and 16.7 percent nationally.

Big Sandy Health Care is a federally designated community health center, the mandate of which is to provide health care services to low-income, uninsured people on a sliding-fee scale.

For this rural community, like most in the country, transportation is a major barrier to access. It’s therefore critical to provide as many services as possible under one roof. Eula has always embraced that imperative. Big Sandy’s resources have allowed her to advance it.

Now called the Eula Hall Health Center, the clinic in Grethel provides primary care, behavioral health care, dental and optometry. There’s a pharmacy, a food pantry and a free-clothing center. Telemedicine is also being introduced to access psychiatric care at the University of Kentucky.

“It’s certainly part of Eula’s mission to bring health care to where it’s needed and to provide health care to anyone irrespective of their ability to pay,” Lewis says. “That’s something that Eula’s always been a strong advocate for. And she’s been, I would say, a master at finding ways to get care for people, finding ways to either finance or finagle.”

Eula has a memory from childhood of a doctor’s office with a little red sign in the window that read, “All outpatient services strictly cash.”

“Well, “ she says, “people didn’t have cash. My parents didn’t have money.”

“I was always imagining having something like what we’ve got now, like Big Sandy Health Care, where people can go in, and nobody kicks you out because you’ve got no money.”

Committed to Community

Eula Hall has been fighting this war for a lifetime. Trust that she’s fighting it still.

“At my age,” 91, “people might think, what can she do?” she says. “But you don’t know what I do,” and it’s plenty.

She no longer drives, but her four-wheel-drive is still on the road, transporting patients to and from the clinic and elsewhere as needed. Each morning, she convenes with staff member Linda Adams to assess the day’s challenges. Who’s going to need a ride into the clinic? Who may not have their co-pay? Who’s hungry? This is holistic health care.

And that telephone remains by her side. Eula knows who to call when a neighbor’s having trouble collecting their benefits or a fundamental need proves elusive.

The memories are still vivid, of the constant fear of death in these faraway hollers. Many on staff at the clinic were raised in this region. They know the area well and have committed to serving it.

Robin Holbrook is a long-time employee of the Eula Hall Health Center. Photo: Taylor Sisk/100 Days in Appalachia

“This clinic has been more of a community center than anything,” says Magoffin County native Robin Holbrook, a physician’s assistant who’s worked at the clinic for nearly 30 years.

Holbrook emphasizes the importance of understanding the culture, and of then helping convey a healthy-living agenda throughout the community: “Diabetic education and proper nutrition, immunizations – preventative medicine has always been the key component of rural health.”

“It takes a real unique person to work here,” Eula says. “Just anybody wouldn’t want to work here. It’s hard work, long hours and you’re on your own. But we’ve been blessed. We’ve really been blessed.”

Regarding her own health, she says: “I’m glad to be alive. I feel good. I’ve got some medical problems. I’m a diabetic. But I don’t have major problems to be my age. I tell you what I’ve got that I thank God every day for: I’ve still got my mind. I know what I’m doing, and I know how to do it.”

Eula arrives at the clinic at 8 o’clock. She says it’s the encounters with patients who need her help that push her to get up each morning. “That’s what gets me here every day.”

“We’re here,” Eula attests. “We’re going to take care of these patients. We’re going to take care of them the best way we can, however we can.”

“We’re just people that help people.”

Editor’s Note: This story originally identified the worker’s rights organization Hall volunteered with as the East Kentucky Worker’s Rights Organization, but has been updated to reflect the name of the organization at its incorporation, the Eastern Kentucky Welfare Rights Organization.