Despite challenges of rural medicine, Pocahontas Memorial provides care for 9,000

By Elaine McMillion and Tricia Fulks

BUCKEYE - Limited resources, an independent streak among patients and lack of health insurance influence the way staff at Pocahontas Memorial Hospital tackle health care in rural West Virginia.

Located in Buckeye, W.Va., the hospital staff of 104 serves 9,000 people living in the 942-square-mile county. The hospital also operates a trailer-turned-clinic in downtown Marlinton, where one doctor, a nurse and receptionist care for patients.

In addition to issues related to tobacco use and obesity among patients, the rural county hospital deals with a lack of resources, specialized care and finances, as well as a high population of citizens who wait too long to seek medical care.

Recruitment Challenges in Pocahontas County
Dr. James Jarrett, an internist at the hospital and a 2005 graduate of the West Virginia School of Osteopathic Medicine, said he passed up other offers to come to a place where care is limited.

"Regardless of where people live and what's available, they still have the same needs," Jarrett said. "There may be a greater need here because of the poor access of health care that they have."

The hospital has only two practitioners and offers no capacity for surgeries or specialized care such as obstetrics, pediatrics or neurology. Instead the hospital strives to provide primary care and stabilization in order to transport patients to larger facilities.

Brian Gullett, director of the emergency room, splits his time between the Pocahontas Memorial and Wetzel County Hospital's emergency rooms. Gullett, 33, said rural hospital administrators must think more long term.

"In a place like Pocahontas County, sometimes I will have to hold on to patients for hours before I can get them a ride," Gullett said. "Or if the weather is bad and I can't fly them, I have to stabilize them enough for a three-hour, four-hour trip by ambulance."

Rebecca Eplin, an emergency medical technician and licensed ambulance driver, said 80 percent of the time during a night shift, high-elevation fog makes it impossible for helicopters to fly into the hospital. Eplin said even the most severe cases, such as a patient who had 75 percent of his body burnt in a house fire, have to be stabilized overnight and flown out to a tertiary center in the morning.

The closest tertiary center, which provides specialized care such as treatment for cancer or burn victims, is two-and-a-half hours away in Roanoke, Va. Elkins and Lewisburg hospitals are an hour-and-a-half away. Morgantown is more than three hours away by ground.

However, Reta Griffith, a county commissioner, said the hospital is very creative when it comes to providing healthcare. Once, when volunteer ambulance workers were unavailable, the hospital called a limousine from the Greenbrier Resort, in White Sulphur Springs, to transport a patient and nurse to a Lewisburg hospital.

"They go above and beyond to take care of patients and make that happen," Griffith said.

Even ambulances traveling within the county are affected by the rural setting and lack of cell phone service in the area. Due to the National Radio Astronomy Observatory in Green Bank, radio communications between ambulances and the hospital are often blocked.

"It's not uncommon for an ambulance to show up and we have no idea what they are bringing," Gullett said. "You just put some gloves on, stand by the door and hope for the best."

But lack of radio communications with ambulances is not Gullett's biggest concern.

"Ambulances coming in worry me less than somebody's four-wheel-drive truck pulling up to the door, because those are the people who are sicker," Gullett said.

"They generally will bring themselves and they are dying when they come through the door. And they have had no medical care en route. Very few people around here know basic life support."

Eplin, 36, said a lot of people without health insurance will drive themselves to the ER to avoid expensive ambulance rides.

"Truly Sick and Dying"
Ehab Awad, a physician assistant and pharmacist at the hospital, said residents who need care sometimes avoid seeking it. "They don't really want to come this far, so that doesn't help the hospital long term," Awad said. "They won't end up here unless they absolutely have to. So, until they get really sick they won't come to the hospital, they won't go see their doctor." Resident Jan Nelson said many people in the county do wait too late to seek medical attention. She said it is part of a rural mentality and desire to be self-sufficient.

"A lot of people in the rural areas like to feel independent and it will make them feel a little bit weak if they go to the doctor," said Nelson, a magistrate assistant at the Pocahontas County Magistrate Court.

Nelson's mother refused to go to the doctor because she said she just felt tired. A doctor later found out it was lymphoma. "Personally I even have some of that," Nelson said. "We hate to ask someone for help. We would rather take care of ourselves."

Kenneth Summerfield, 46, said he goes to the hospital only as a last resort. The Green Bank resident calls himself "hardheaded" and said he "toughs out" most illnesses.

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Another resident, Tina Sharp, 32, said she watched her grandfather die after he neglected to get his blood sugar checked. At age 73, Sharp's grandfather's untreated condition had done irreparable damage to his heart, eyes and legs. He died a year ago.

"People do wait too long," Sharp said as she stood on the porch of the hospital clinic in Marlinton. "He died because he was not taking care of himself throughout the years."

In November 2008, Marlinton resident Robert Mann almost bled to death from an untreated condition.

After ignoring his symptoms, Mann became weak and was taken to the county emergency room. Doctors discovered that Mann, 67, had a bleeding ulcer and transported him to Lewisburg where he spent over three days in intensive care.

Gullett said the hospital provides on-site community health education programs, but getting people to participate is difficult.

"That's why there is a stigma in rural West Virginia," Gullett said. "They wait until they are truly, truly sick and dying before they will come in."

Kyna Moore, chief of nursing services at the hospital, strives to battle this stigma by encouraging residents to be aware of their wellbeing at an annual health fair that offers free lab work.

Since starting the fair 15 years ago, Moore said as an overall trend triglyceride and cholesterol numbers have dropped, as well as the number of heart disease incidences among patients.

"People tend to think sometimes that West Virginia is illiterate when it comes to health care," Moore said. "It's a means of motivating people to do what's best for them."

Health Insurance Woes
Lack of insurance is another local challenge.

A recent analysis using Census data for 2004-2006 suggests that around 279,000, or 15 percent, of West Virginians do not have health insurance, according to Jason Butcher at the West Virginia Offices of the Insurance Commissioner.

In addition, more than 22 percent of adults age 18 to 64 in the state have no health insurance, according to the 2005 West Virginia Behavioral Risk Factor Survey.

With a high poor and elderly population, Moore said 85 percent of patients at Pocahontas Memorial are covered by Medicare and Medicaid.

According to hospital records between July 2007 and June 2008, 2,210 of 12,552 patients had no health insurance.

Gullett, a Logan County native, said he sees many patients coming to the ER for minor complaints, sore throats and fevers that a family doctor would normally treat in addition to traumas, heart attacks and strokes.

"Nowadays with fewer people having health insurance, they worry about having to pay for their office visit," Gullett said. "People always know that they can go to the emergency room and we can't turn you away."

Gullett said the ER treats around 6,000 patients a year.

Moore said the community's use of the ER as a primary care center tends to deplete resources.

Dr. Jarrett, 40, said the county's shortage of year-round employers makes health insurance difficult to obtain.

However, Award, 48, said even those employed in the county are not always guarantee health insurance.

"There are people who have fallen through the cracks because their employer doesn't offer insurance and they can't afford to buy it on their own," Awad said.

The hospital does offer a sliding-scale program that adjusts the bill's amount according to a person's income and size of their family and a charity care, Eplin said. Sixty percent of the hospital's patients receive some sort of discount, according to Eplin.

Wannessa Cassell, business manager, said the hospital also offers and income based discount program, which covers costs of uninsured visits.

However, to receive this coverage patients must bring in several forms. Cassell said getting the patients to bring the proper documents is difficult, and most do not take advantage of the program.

Despite the challenges, Awad, who previously worked at larger hospitals in Summersville and Fairmont, said one benefit to rural healthcare is the personal care and attention each patient receives.

"You will spend more time with a patient," Awad said. "You will try to help them out as much as you can, because you know that they may not have as much money. They may not have the time to come see you again for a long time."

Linda McCoy, a registered nurse at the Pocahontas County Health Department, says most people in the county are satisfied with the hospital.

"I think most people realize that it is what it is," McCoy said. "Most people are just grateful that it is there."

Mann is one of those fortunate for the care provided.

"We need the hospital, it's very necessary for the treatment we get here," Mann said. "We'd be lost without it."

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A performance hall comes full circle since its beginning almost a century ago

By Megan Bowers and Jessica Rhodes

MARLINTON - At the corner of Third Avenue and between Eight and Ninth Streets, in Marlinton, W.Va. you will find a large buttercream-yellow building with arching white painted windows and wooden double-doors.

The hanging street-side sign reads "Opera House, circa 1910," but this building has hosted more than traveling acts and local bands during its near-century. Local residents remember the building as a car dealership and a lumberyard longer than they remember it as a performance hall.

The Black Mountain Bluegrass Boys:
A Family Tradition

The Black Mountain Bluegrass Boys are a Pocahontas County legend with three generations of musicians in their hometown band. Richard Hefner, leader and banjo player has been in the band since it's inception in 1968. The band started when Hefner's uncle Glen "Dude" Irvine, who despite being disabled by polio, taught his brothers and nephews how to play various instruments. After Irvine's passing, the band continued and generations have come and gone. They have played all over the United States and Europe, but they always return home to Pocahontas County.