Thursday, May 30, 2019

When rural and urban compete for resources

That's the scenario at stake in the proposal of the Centers for Medicare and Medicaid Services  to shift some reimbursement funds to rural hospitals.  Because the pot of money is (apparently) fixed, this is a zero sum game, meaning that urban hospitals will lose what/if rural ones gain.  Bloomberg Law reports this morning under the headline, "Rural Hospitals See $200 Million Medicare Win at Cities' Expense."  Here's the lede from Tony Pugh's story:
Low-wage rural hospitals would see more than $200 million a year in additional Medicare payments under a Trump administration plan to shift money from urban hospitals in areas with higher wages, a leading health-care law firm found. 
The proposal by the Centers for Medicare & Medicaid Services is designed to cut payment disparities between urban hospitals and rural facilities. Rural clinics and hospitals are struggling in many states that haven’t expanded eligibility for Medicaid under the Affordable Care Act. 
Since the proposed rule was published earlier this month, "hospital associations in states with higher concentrations of urban facilities" have been protesting.  Pugh cites the analysis of the Hall Render law firm, which shows, for example, that California's Medicare payments would be reduced by $108 million annually.  Other big losers would be New York ($41 million); Massachusetts ($19 million) and New Jersey ($18 million).  Southern states stand to gain most, presumably because the South is the most rural region in the nation.  The reductions would be phased in, taking full effect in 2021.

Sarah Jane Tribble, covering the same issue for NPR, provides an illustration of the "wage index," which has been around since the 1980s. 
[It] means under the current index a rural community hospital could receive a Medicare payment of about $4,000 to treat someone with pneumonia while an urban hospital received nearly $6,000 for the same case, according to CMS.
They "why" for the shift is hinted at in the article's opening line:  the wages paid by rural hospitals are lower than those at their urban counterparts, and Medicare reimbursements have typically been pegged to an "area wage index."  This has meant rural hospitals with low local labor costs have typically received lower Medicare payments than urban ones, albeit for rendering the same services.  A related story on NPR, by Sarah Jane Tribble, is here.

I'm very sympathetic to the needs of rural hospitals, and I'll be fascinated to see if this proposal goes into effect because I've never seen a proposal that takes from the urban (rich?) and gives to the rural (poor?) implemented--at least I cannot recall such a circumstance.  For example, since it was published in 2010, I have been pondering the careful word choice of the California Commission on Access to Justice Report, "Improving Access to Civil Justice in Rural California," framed to avoid a rural-urban contest for funding streams.  Here's a quote of one of the key recommendations from that report:
2.  Expand Funding for Rural Legal Services The significant lack of funding for California’s rural legal aid programs must be addressed. All legal aid programs face the challenge of inadequate resources, including programs in urban as well as in rural areas; therefore any initiative to address the severe lack of resources in rural areas should not be developed in a way that unnecessarily undermines urban programs. The goal is to increase the total resources available for all legal services programs across the state, not merely to reallocate existing resources. 
In fact, what has happened in the years since that report was published is that per "poor person" funding for legal aid organizations serving rural populations has fallen relative to that for organizations serving urban populations.  This just emphasizes again how hard it is for rural institutions to get their "fair share" of funding in all sorts of contexts.

Maybe this Robin Hood-like move at CMR will go forward, however, at least if the Trump administration sees it as currying favor with the president's rural "base." 

Tuesday, May 28, 2019

Suddenly, (small-scale) farming is hip everywhere (including the developing world)

An alternate headline might have been:  African millennials follow in the footsteps of their US counterparts (or might it be the other way around?).  In any event, the catalyst for this post is Sarah Maslin Nir's New York Times story, dateline Agotime Beh, Ghana, "Millennials 'Make Farming Sexy' in Africa, Where Tilling the Soil Once Meant Shame."  Here's the lede:
After he graduated from university, Vozbeth Kofi Azumah was reluctant to tell anyone — even his mother — what he planned to do for a living. 
“I’m a farmer,” he said, buzzing his motorcycle between freshly plowed fields on a recent afternoon. “Here, that’s an embarrassment.” 
In some parts of the world, farmers are viewed with respect and cultivating the land is seen as an honorable trade. But in a region where most agriculture is still for subsistence — relying on cutlass, hoe and a hope for rain — farming is a synonym for poverty.

But Mr. Azumah is among a growing number of young, college-educated Africans fighting the stigma by seeking to professionalize farming.
The entire story is well worth a read.  An interesting factoid:  60% of Africa's population is under the age of 24, but the average age of a farmer is 60.  This trend is similar to that in the US, where farmers are a rapidly aging group.  Seems like that might be changing, albeit slowly, on both continents; at least one can hope.

Monday, May 27, 2019

For rural folks (including physicians), things are tough all over (including in Russia)

The New York Times reported out of Russia a few days ago that physicians in rural areas (even those in the western part of the country; we're not talking Siberia) are striking for better wages.  The dateline is Okulovka, in the Novgorod region between St. Petersburg and Moscow, and the story is headlined "In Russia's Provinces, the Doctor Is In (the Streets)."  Andrew Kramer's story, however, is not only about health care professionals, it is about the enormous divide between the haves and have nots in Russia, the latter often languishing in the "the provinces."  As Kramer expresses it, Okulovka "might just as well come from a different century," and the photos certainly give that impression.  About a third of the residences have no indoor plumbing, and the life expectancy there is among the very lowest in Russia.  (A prior post out of this region is here).   

Here's an excerpt from Kramer's story that focuses on state of health care, in particular doctors' salaries. It discusses the situation of Dr. Korovin, a general and colorectal surgeon: 
One issue gaining traction in particular is the impoverishment of doctors in rural Russia. After a medical procedure, it is more often the doctor than the patient who winds up with sticker shock — not because the payments are so outrageous, but because they are so small. 
Dr. Korovin, who is paid about $8,670 a year and extra for after-hours operations, recently treated a man with a stab wound to his lower abdomen.
* * * 
For that hour-and-a-half, after-hours operation, the hospital, which is funded by Russia’s state-run insurance program, paid Dr. Korovin 500 rubles, or $7.70.
It's thus not surprising that physicians and nurses are pressing for "local authorities fulfill a decree signed by Mr. Putin that doctors be paid twice the average salary of the region where they work."  In the Novgorod area, that would be about $11,448, about a third more than Korovin now earns.  Compare that to the average salary for a physician in the U.S., which is $313,000.  Indeed, where hospitals are able to keep their doors open, jobs in healthcare are critical to sustaining rural economies

Interestingly, Dr. Korovin says he voted for Putin, "we all voted for Putin."  That brings me to this terrific line from Kramer's story:
But the brush fires of provincial discontent highlight the disconnect between Russia’s chest-thumping rise abroad and its stagnating economy at home.
As in the earlier Russia story about which I posted nearly six years ago, there seems to be a big disconnect between the local and the national in Russian politics.  Putin is attractive as a strongman on the national stage, which may help him escape backlash over failures of lower scales of government. 

Sunday, May 26, 2019

And now for my 147th post on "defining rural"

The occasion for this post is Andrew Van Dam's piece in today's Washington Post, "The real (surprisingly comforting) reason rural America is doomed to decline."  It's partly about ecological definitions of rural and urban.  When Van Dam contacted me about 10 days ago, while writing this story, I referred him to the "defining rural" tag on this blog.  That's when I realized I'd written more than 140 posts on the topic--an average of once a month since I founded this blog about 12 years ago.  Van Dam found me, by the way, via my 2006 law review article, "Rural Rhetoric." 

Basically, Van Dam is using the federal government's classification schemes for rural/urban and metro/nonmetro to put a positive spin on the ongoing urbanization of America. This treats the process  or system as s a zero-sum game, which it basically is.  If rural is the remainder of that which is not urban, then as places grow and population clusters get large enough to meet the threshold for "urban"--or more precisely "metropolitan" (a county-level designation)--that which is designated or defined as rural shrinks.  It seems inevitable, right?   Van Dam uses a clever farm team v. big league analogy: 
In a way, rural areas serve as urban America’s farm team: All their most promising prospects get called up to the big leagues, leaving the low-density margins populated by an ever-shrinking pool of those who couldn’t qualify.
The problem with the analogy is that it could be read to suggest that rural people can't "qualify" for urban life--that if they could, they'd move to town where the successful folks inevitably go.  That is, you could read it at the individual level, as another way of looking at the rural brain drain.  On the other hand, you could also read it as referring just to the population clusters rather than to the individuals--those that grow will be redefined as urban.  I think this latter construction is Van Dam's intent. 

It's also worth noting that Van Dam's approach does not really account for the fact that many places are not only "not growing" and therefore not becoming urban, they are in fact shrinking.  Population loss--and not only stasis-- is a huge part of the rural American story right now--and it's not just loss to cities; it is natural decline because of low birth rates and such. 

In any event, read this clever piece in its entirety and note the references to Amanda Kool's recent piece in the Daily Yonder and to the fabulous demography work of Dan Lichter of Cornell, Kenneth Johnson of the University of New Hampshire/Carsey Institute, and John Cromartie of USDA, who have been tracking the extent to which "rural" places (as defined by the U.S. Census Bureau) are being subsumed into "metropolitan counties" (as defined by the Office of Management and Budget).

Then there are my quotes about the cultural angle on all of this:  how people and places "stay rural" culturally in spite of their "places" transmutation (by a government definition) into "metropolitan."  I also talk about how easy its gotten for policy makers to overlook rural needs, in part because of elite/progressive disdain for rural folks, which was also a theme of this piece, which showed how the rural bashing is not just a Trump-era phenomenon; it started in the 2008 election season.

Thanks to Van Dam and WaPo for the high profile treatment of an issue so important to those of us who advocate for and value the rural.  Here's to another 150 (or so) posts on "defining rural" in Legal Ruralism's next dozen years. 

Wednesday, May 22, 2019

Water, water everywhere, but not a drop to drink?

Oconaluftee River, Cherokee, North Carolina
March 2019 by Lisa R. Pruitt
It's an old adage, and it's one that (somewhat) accurately describes a phenomenon as much (or more) associated with rural America than urban places:  lack of clean, accessible, reasonably priced drinking water.

The lack of potable water in many places in rural America is a topic that has been on my mind for  a while.  It's been brought back to the fore by this recent story in the New York Times about the water crisis in California's Central Valley, in this case in East Orosi (population 495) in the Great Central Valley.   Jose del Real reports under the headline, "They Grow the Nation's Food, but They Can't Drink the Water."  Here's an excerpt:
Water is a currency in California, and the low-income farmworkers who pick the Central Valley’s crops know it better than anyone. They labor in the region’s endless orchards, made possible by sophisticated irrigation systems, but at home their faucets spew toxic water tainted by arsenic and fertilizer chemicals. 
* * *

Today, more than 300 public water systems in California serve unsafe drinking water, according to public compliance data compiled by the California State Water Resources Control Board. It is a slow-motion public health crisis that leaves more than one million Californians exposed to unsafe water each year, according to public health officials.
Del Real quotes Susana De Anda, a water-rights organizer:
Clean water flows toward power and money,Homes, schools and clinics are supposed to be the safest places to go. But not in our world.
As for solutions, well, Gov. Gavin Newsom "has proposed a tax of about $140 million on urban water districts and the agriculture industry to pay for redevelopment in districts serving unsafe water."

I'm delighted that my colleague, Camille Pannu who directs the Aoki Water Justice Clinic at UC Davis is quoted in the story:
Flint is everywhere here.  
Pannu also comments on a local conflict between East Orosi and its bigger neighbor, Orosi, population 8,770.
Because Orosi has clean water, they don’t want to take on rate payers from East Orosi who they think are so poor they’ll skip out on their bills. Unfortunately, you have poor people versus poorer people.
I'm so grateful for the work Prof. Pannu does, even more so that our UC Davis law students have the opportunity to do real legal work to redress injustices such as these.

A November, 2018 story by Jack Healy, out of Armenia, Wisconsin (population 707) also compared a rural water crisis to the higher profile one in Flint, Michigan.  The headline for that story was "Rural America's Own Private Flint:  Polluted Water Too Dangerous to Drink."  People in Armenia are among those who no longer drink the water, or even want to shower with it, because it is contaminated with run off from poorly regulated industrial farms.  Healy explains: 
In Wisconsin and other Midwestern states where Republicans run the government, environmental groups say that politicians have cut budgets for environmental enforcement and inspections and weakened pollution rules. In Iowa, for example, the Republican-led Legislature dismissed a package of bills that would have blocked any new large-scale hog operations until the state cleaned up its nitrogen-laden rivers and streams.
The Trump administration is now proposing to weaken federal clean water regulations, too.

He quotes 77-year-old Gordon Gottbehuet of Armenia, whose "nitrate contaminated well sits next to a field injected with manure." 
The regulations favor agriculture. When they keep cutting enforcement and people, there’s nobody to keep track of what’s happening.
But the problem is not limited to the Midwest, as Healy writes: 
Now, fears and frustration over water quality and contamination have become a potent election-year issue, burbling up in races from the fissured bedrock here in Wisconsin to chemical-tainted wells in New Hampshire to dwindling water reserves in Arizona.
I've written about the issue of CAFO contamination of rivers here, in particular a river in my home county in Arkansas.  (That matter is also the subject of many posts here on Legal Ruralism; here is just one).

In any event, these stories of poor water quality in rural America are in sharp contrast to images like the one at the top of this post, a photo of a dramatically clear stream that flows through the Smoky Mountains (North Carolina) town of Cherokee, which I visited in March.  I took the photo because the steam was so strikingly clear, though the photo doesn't quite do justice to that quality.  I'd not seen a stream that clear since I was in Glacier National Park in 2011. 

Tuesday, May 21, 2019

Financial insecurity, health care deficits plague rural Americans

National Public Radio reported today on rural Americans financial precarity and health care access woes.  The story, by Joe Neel and Patti Neighmond, reports on on a poll of rural Americans conducted by Harvard's T.H. Chan School of of Public Health and the Robert Wood Johnson Foundation.  It's the second such poll conducted by these partners in less than a year.  The first was last fall, and the results are the focus of this blog post.  This second poll focused on rural Americans' access to health care, which in theory has improved with the passage and implementation of the Affordable Care Act, as well as on economic security.  Here's a summary of the findings, which are reported in greater detail (and with some cool graphs) in the NPR story:
A substantial number (40%) of rural Americans struggle with routine medical bills, food and housing. And about half (49%) say they could not afford to pay an unexpected $1,000 expense of any type.
This latter finding and the question on which it is based seems linked to this story, which is not limited to the rural, from several years ago, as well as this one from early 2019.

The findings regarding health care access are also telling, not least because they speak to the practical realities of getting care--as in getting to the health care provider when material spatiality gets in the way.  Here's a breakdown of the survey's findings: 
Of those not able to get health care when they needed it, the poll found that 45% could not afford it, 23% said the health care location was too far or difficult to get to, and 22% could not get an appointment during the hours needed.  (emphasis added)
On rural hospitals in particular, Neighmond and Neel report that rural America has lost 106 rural hospitals since 2010.  The current census of rural hospitals is 1,860, of which more than a third, 673, are at risk. 

Finally, the story reports on sense of community, a topic oddly absent from the lede:
Yet even with the high levels of financial insecurity that we found, there is abundant optimism and satisfaction with the quality of life in rural America. Almost three-quarters (73%) of rural Americans rate the overall quality of life in their local community as excellent or good. And a majority (62%) are optimistic that people like them can make an impact on their local community. 
The story quotes Dee Davis of the Center for Rural Affairs regarding his observations of rural Kentucky; he makes his home in Whitesburg:
People may be living a more hardscrabble existence than folks in the suburbs or a lot of the folks in cities, but it doesn't mean they're not living a decent life.  Most people are pretty happy with it; they've got friends and neighbors they rely on and they're where they want to be.
NPR quotes a Whitesburg resident and activist, whose husband was recently hospitalized, regarding this phenomenon: 
My neighbors come and mow my grass, feed cattle, get eggs every day for the last few weeks.  That says so much to me. [It] makes me feel the emotion now of what it feels like to have such warm, wonderful support and I know that's the blessing of living in rural America.  
The survey found that 49% of rural Americans volunteer with an organization that works "to make their local community a healthier place to live."

N.B.  "Rural" was defined for purposes of this survey as not living in a metropolitan area, and on that definition, don't miss this piece

Wednesday, May 15, 2019

Rural poverty and its consequences: Here, there and everywhere

A few major stories about rural poverty and related aspects of rural disadvantage have caught my eye in the past few days, first from the United States and then yesterday out of the north of England.  Population loss, the elderly, and the high cost of service delivery to rural populations are implicated in them.  Two of the stories feature extraordinary photography.

The first is this major piece in the Washington Post on the looming closure of a hospital in Fairfax, Oklahoma, population 1,380.   Eli Saslow, journalist extraordinaire, brings us not just another story of a down-on-its-luck, near death rural hospital, but of the juxtaposition of this pending closure against the circumstances of community:
Childhood poverty climbing up above 30 percent. Accidental deaths doubling in the past decade. Increasing rates of diabetes, heart disease, drug addiction and obesity.
Saslow then puts what's happening in Fairfax, a town in Osage County, population 47,987, and co-terminous with the Osage Nation, in national context:
More than 100 of the country’s remote hospitals have gone broke and then closed in the past decade, turning some of the most impoverished parts of the United States into what experts now call “health-hazard zones,” and Fairfax was on the verge of becoming the latest. The emergency room was down to its final four tanks of oxygen. The nursing staff was out of basic supplies such as snakebite antivenin and strep tests. Hospital employees had not received paychecks for the past 11 weeks and counting. 
The only reason the hospital had been able to stay open at all was that about 30 employees continued showing up to work without pay, increasing their hours to fill empty shifts and essentially donating time to the hospital, understanding what was at stake.
In 2016, the 15-bed Fairfax Community Hospital had been purchased by EmpowerHMS, a Florida-based company that held itself out as “a savior for struggling rural hospitals.” Soon after the takeover, however, Empower began to default on some of the hospital's bills.  Fairfax was one of nine of Empower's hospitals that had since declared bankruptcy; another four had already closed.

The story includes an interesting profile of Dr. James Graham, 67, who has served the hospital and community for 41 years.  Yet with his malpractice insurance premium unpaid by Fairfax Community Hospital, Graham was on the verge of losing his license.  Be sure to give the story a read in its entirety.  Another recent story about a rural hospital closure is here, those one from NPR, featuring Fort Scott, Kansas, population 8,087, and county seat of Bourbon County.

The second big story is out of the United Kingdom's Lake District, in northern England.  Specifically, it features the town of Alston, population 1128, in northeastern Cumbria.  Wikipedia notes that Alston is a market town with several "listed buildings" and also an Area of Outstanding Natural Beauty, surrounded by moors.  Yet the story reported by Ceylan Yeginsu is as depressing as they come, as are Laetitia Vancon's extraordinary photos, particularly those of elderly residents and their living conditions.  A major cause of the human suffering:  government austerity.  The opening excerpt features 77-year-old Trevor Robinson:
Mr. Robinson’s isolation, shared by thousands of older people in Britain, is the result of a chain of cause-and-effect that stretches from rural Cumbria to the halls of power in London. He used to ride a subsidized bus to town until the local council discontinued the route. The council was responding to steep budget cutbacks stemming from the Conservative-led government’s decade-long austerity program.
* * *
But a free bus pass [for the elderly] is of little use if buses no longer reach you, and many retired people have discovered that apparently minor cuts — the elimination of a bus route, the closing of a tiny health care center, community center or post office — can profoundly upend their lives.
Cumbria is impoverished and rapidly aging, yet Alston is an hour from the nearest hospital bed. Yeginsu quotes Peter Thornton of the Cumbria County Council:
It’s always been expensive to deliver services to rural communities because the population is so spread out. But since the central government cuts that started in 2010 this becomes more of a challenge each year.
Cumbria is in the part of England commonly referred to as the Lake District, where tourists have long flocked to walk the moors and enjoy lakeside mansions.  But one of the photo captions observes: 
The idyllic landscape masks pockets of deprivation, inequality and poor health comparable to some inner-city areas.
This reminds me of a thread of the work of British geographer, Paul Cloke, who wrote about the juxtaposition of rural poverty with natural beauty.  I quoted him in my article about rural environmental injustice a few years ago:
Hard times” can be “naturalized in to [such] landscapes” (Cloke, 1997:264), causing rurality to “signify itself as a poverty-free zone” (Cloke, 2006:381). The idyll-ised rural thereby “both exacerbate[s] and hide[s] poverty in rural geographic space” (Cloke, 2006:381).
The third story I'll excerpt here is a bit older, having been published in the wake of California's Carr wildfire last year.  That fire struck Shasta and Trinity counties.  Sam Harnett reports for KQED, the San Francisco area NPR affiliate, "Low-income Communities Struggle to Recover after a Wildfire."  His vignettes of fire victims are nuanced and haunting, but he also provides extraordinary data such as this:
A paper published last year by the National Bureau of Economic Research analyzed 90 years of natural disaster data. It found that major catastrophes increase a county's poverty rate — the percentage of people living below the poverty line — by an average of 1 percent. That's because disasters encourage those who are well off to leave, and it makes those with low income poorer.  (emphasis added)
Indeed, I see Harnett has reported frequently on various aspects of California wildfires.  Another story about disparities in disaster recovery is here, from High Country News.  Sara Viner reports, "Fires are indiscrimiant.  Recovery isn't."

Thursday, May 9, 2019

Krugman in NYT reveals how Trump's policies hurt rural folks (with a focus on farms/ag)

Paul Krugman today published a column in the New York Times, titled "Trump is Terrible for Rural America." To a great extent, Krugman conflates rurality with agriculture, as with his focus on tax "reform" and tariffs:
The Trump tax cut largely passes farmers by, because they aren’t corporations and few of them are rich. One of the studies by Agriculture Department economists that raised Trumpian ire showed that to the extent that farmers saw tax reductions, most of the benefits went to the richest 10 percent, while poor farmers actually saw a slight tax increase.
Krugman notes that nearly half of U.S. produced soybeans and wheat are exported, and Trump's expanded trade war has sent grain markets sharply lower.

The other big theme of the editorial is the differential impact of cuts to the safety net, noting that rural America relies disproportionately on the safety net:
 Of the 100 counties with the highest percentage of their population receiving food stamps, 85 are rural, and most of the rest are in small metropolitan areas. 
* * * 
Medicaid is also a key factor keeping rural hospitals alive; without it, access to health care would be severely curtailed for rural Americans in general.
Lastly, Krugman takes up the question, "What's a Trumpist to do?"  There he talks about rural folks' perception that coastal elites condescend to them, a topic I wrote about here.  Have a read for yourself. 

P.S. A postscript on agriculture and trade is here

Tuesday, May 7, 2019

Crime in rural Maine (Part II): Miscellaneous

I'm following up here on my earlier blog post about local media coverage of crime and related issues in micropolitan Maine, with the first installment here.  I'm going to present other issues here as bullet points:

From the Courier-Gazette (of Knox County and surrounding communities for 173 years) of April 25, 2019, four of seven front page stories implicate crime and policing.  A fifth story is about the City of Rockland seeking legal costs in a fight over a zoning law:

  • "Former lawyer pleads not guilty."  This reports that Anita Volpe, 73 of Tenants Harbor (part of the village of St. Geroge), accused of stealing tens of thousands of dollars from three "vulnerable" people pleaded not guilty.  
  • "Man accused of assaulting pregnant girlfriend deported"  This story reports that a 34-year-old Bosnian man awaiting trial on the charge was deported.  He had been living in Cushing, population 1,534, and Hope, population 1,536.
  • "Policing comparison set for heating," dateline Thomaston (population 2,781), reports that residents will have the opportunity to ask questions and look at the cost comparisons for law enforcement at a public hearing.  Implicated is the decision whether to disband the Thomaston Police Dept. and contract with the Knox County Sheriff's Department to provide police protection.  I noticed that a headline in the Hancock County paper, which I visited online, was also discussing closure of one of the municipal police departments.  
  • "South School burglarized, doors damaged," reports on damage done to South School, an elementary school in Rockland, population 7,297. Among other things, the nurse's office was broken into and students' medications stolen.  

The Bangor Daily News April 29, 2019 edition includes a few national news items, including the Poway, California synagogue shooting.   The only local crime story is "Still unauthorized, Church of Safe Injection expands."  The "church" is a free naloxone distribution site at a public square in Bangor.  This "mobile syringe exchange" has distributed "more than 600 naloxone kits and hundreds of clean syringes in its six months." 

One pattern I noticed from reading many different papers was that, the smaller the community the paper served, the greater the number of crime and criminal justice stories--or at least the more prominent the stories were.  Larger papers were, of course, covering not only state but also some national stories. 

Friday, May 3, 2019

A cross-generational "fix" for rural population loss in Korea

The New York Times last week published this heart-warming story out of rural South Korea.   The headline is "Running out of Children, South Korea School Enrolls Illiterate Grandmothers," and the dateline is Gangjin County, population 49,254.  The nation's birth rate is one of the lowest in the world, having fallen dramatically in recent decades; it is now less than one child per woman.  As in most of the places suffering population loss, the areas hit worst are rural
where babies have become an increasingly rare sight as young couples migrate en masse to big cities for better paying jobs. 
Like other rural schools, Daegu Elementary...has seen its students dwindle. When Ms. Hwang’s [the 70-year-old who is the story's central character] youngest son, Chae Kyong-deok, 42, attended it in the 1980s, it had 90 students in each grade. Now, the school has only 22 students in total, including one student each in its fourth- and fifth-grade classes.
One of the things that I love about this story and what is happening in this rural area is the way it is bringing or keeping generations together.  Ms. Hwang rides the school bus with her three grandchildren.  Also striking is the fact that these elderly women are in need of literacy.  Journalist Choe Sang-Hun explains:
Decades ago, Korean families often focused what little resources they had on educating their sons. Many girls were expected to stay home and look after younger siblings while their parents worked outside.

Wednesday, May 1, 2019

Crime in rural Maine, as reported by (state and local) media (Part I): child deaths at the hands of caregivers

As will be clear from my last few posts, I have been in Maine for the last several days.  I spent the last few days mid-coast to downeast, between Portland and Acadia National Park.  This took me through Sagadahoc (35,293), Lincoln (population 34,457), Waldo (population 38,786), Knox (population 39,744) and Hancock (population 54,418) counties.  I found myself perusing the local newspapers--and listening to Maine Public Radio--as often as I could.  One theme that jumped out at me was crime in these largely rural environs.  In this post, I'm going to recount some of the headlines about crime, with particular attention in this Part I about child deaths at the hands of caregivers.

First, as I drove on April 30 and May 1, Maine Public Radio frequently repeated news of a conviction of a Wiscasset woman who had killed a 4-year old child in late 2017.  What was never clear from the broadcast  news stories was whether the child was Gatto's own?  Probably not, or that would have been specified.  But what was the woman's relationship to the child and how did she have the "opportunity" to neglect her?

In search of more information, I came across this story (from early April) in the Portland Press-Herald, which reveals so much.  Among other critical bits of context, the story reveals that Shawna Gatto, the 44-year-old convicted of "depraved indifference murder" was effectively the victim's grandmother.  That is, Gatto was engaged to the victim's grandfather, which raises really interesting issues of gender expectations and double standards.
[Assistant Attorney General Donald] Macomber cast Gatto as a woman who was overwhelmed by the circumstances of her life. She had raised two boys of her own and was looking forward to spending time with her fiancĂ©, Stephen Hood. Then one of her sons had a child and she became a full-time baby sitter. Then Chick, the daughter of Hood’s son, was placed with them because both of her parents struggled with substance use disorder. Finally, Gatto’s son had another child.

“She went from an empty-nester to caring for two toddlers and an infant, “all day, every day, by herself” the prosecutor said.

“She said she didn’t have any ‘me time,’” [Assistant Attorney General Donald] Macomber said, adding that Gatto would often call her mother to “let off steam” about how challenging the children were. “On Dec. 8, they talked for two hours."
Interestingly, the prosecutor seems to have played up Gatto's selfishness in wanting "me time." Indeed, it seems clear the woman was overwhelmed by caring for three young children.

That said, the injuries to the child were extensive:
at least 15 distinct injuries that were consistent with acute child abuse ... Chick died from blunt force trauma to the abdomen, which lacerated her pancreas, but she had head trauma as well, including a bruise that had forced one eye swollen shut.
Gatto's lawyer said at one point that he would argue the injuries were accidental, noting the child "was born drug-affected and was developmentally delayed and clumsy."  The population of Wiscasset, the seat of Lincoln County, is 3,732, but I note that Gatto was tried by a judge in Augusta.  I haven't read in any press a reason the trial was held in a neighboring county, but I did read that Gatto waived her right to a jury trial.

The Press-Herald report links to two related stories, one about the death of a 10-year-old in Stockton Springs (population 1,591),  just up the coast, a few months after Chick's death.  That death was also at the hands of a caregiver.  Another linked story is about the need for reform in Maine's child protection system.

Yet a third similar child death case from the mid-coast Maine area was on the front page of the April 25, 2019 issue of The Republican Journal, a weekly "serving twenty-six communities in Waldo County for 190 years."  The story by Jennifer Osborne (of the Ellsworth American, reporting on Hancock County) reports that a  judge had ruled that 21-year old Savannah Smith would be held without bail in the killing of two-year-old Kloe Hawksley, the daughter of Smith's boyfriend.  The death had occurred about 19 months earlier, but Smith was apparently not arrested until April of 2019, following the indictment by a grand jury.  Two of Smith's own three children had been taken into the custody of the the Maine Dept. of Health and Human Services on the day of Kloe's death, and the third child (apparently born just before Smith's arrest) was residing with its biological father.  At the bail hearing, the defense attorney (based on Bangor) had argued that Smith is "local," with numerous family members living in Bucksport, and also poor:
Her life is local.  Her set of contacts is local.  This is a family of limited means.  Most of them do not own property.
Later Smith's attorney spoke to the media on the courthouse steps:
Smith is young and never been in trouble.  She's upset.  Plus she gave birth three days before she was arrested.  I feel for her.  Hopefully, we'll sort this whole thing out.
Smith has been living in a Bucksport motel since the toddler's death, but a Maine DHHS supervisor testified about concerns over the woman's unstable living situation, in part because "methamphetamine users" have been living in the hotel room with Smith.  Plenty of tragedy all around in this story, and no doubt a lack of social service and other supports in this rural area.  As with the Wiscasset story, I find myself wanting to know more about the roles played by the man in the children's lives--here, Kloe's father, and in the case of Chick, the child's grandfather, who apparently lived with the woman convicted in the child's death.  How is it that women came to be charged but not men.  What evidence exculpated the men?  It would be great if the journalists told us more, and we can only assume the courts in the respective cases probed or will probe where the father and grandfather were and why the blame fell on the women.

Page A7 of that April 25, 2019 issue of the Republican Journal, under "Crime & Courts," reports on "Grand Jury Indictments" and "Waldo County Unified Court Closes Cases," and it also features a "Police Blotter."

I'll return to Part II of this series shortly; it will address the array of other rural criminal justice issues that showed up in the (mostly local) media during my recent visit.