Coronavirus in rural America (Part CVI): Out of central Washington from NPR this morning

Anna King reports from Okanogan County, Washington, population 41,120, under the headline, "Rural Health Systems Challenged By COVID-19 Surge."  The story leads with the death of a 66-year-old man suffering from advanced Parkinson's disease, at a long-term care facility in Tonasket, population 1,032.  

The town's health care system is in crisis, a striking example of the perilous state of rural health care.

Rural America has been the site of COVID-19 hotspots this year: prisons, nursing homes and meat packers. But there are few doctors, ICU beds and little backup when health care workers also get sick.

The deceased man's step sister explains, ""When we want to get a COVID test we have to go 30 miles away to Omak (Washington).  So we can't just go to our local hospital. They don't have enough."

Like some other stories I've heard or read, this one refers to the transfers coronavirus is necessitating between rural and urban hospitals.  

Confluence Health is a health system that covers north-central Washington, including Tonasket. It has a dozen clinics across a wide swath of the region. Incoming CEO Dr. Douglas Wilson says as his hospitals fill with COVID-19 patients, they're crowding out victims of car accidents, heart attacks and head injuries.

King quotes Wilson, 

You hate to put someone on a helicopter or in an ambulance and fly them over the mountains in the winter, when they would've done better had they been able to receive care here locally without traveling. That's a difference between life and death sometimes.

Another story about such transfers, this one out of Alaska, is here. 

I've also heard NPR reports (picked up from local affiliates) the past few days out of Boerne, Texas, Lubbock, Texas, and Durango, Colorado.  The Lubbock story is by Kaysie Ellingson.  The Durango story, featuring an interview with the mayor, is here. 

Coronavirus in rural America (Part CV): agricultural "towns"

Laura Reiley reports for the Washington Post under the headline, "Going it alone in two of America’s agricultural towns."  The two towns are Moorefield, West Virginia and Salinas, California.  Here's an excerpt:  

Moorefield, W.Va., is an Appalachian town of about 2,500 people, changed forever by Pilgrim’s Pride’s three poultry plants clustered at the South Branch of the Potomac River. Nearly 3,000 miles west, Salinas, in Monterey County, Calif., made famous by Nobel laureate John Steinbeck, is an agricultural city of 155,000 that produces a significant portion of the nation’s leaf and head lettuces, celery, broccoli and strawberries.

In these two American breadbasket communities, small farmers and ranchers have been left to improvise as their markets swivel and contract. In its early months considered an urban problem, the coronavirus has been especially brutal in rural agricultural communities, where farmworkers were slow to get personal protective equipment and effective safety protocols.

In both Salinas and Moorefield, the coronavirus has contributed layers of complexity to an already backbreaking professional path. Several years of historically poor planting conditions and retaliatory tariffs under the Trump administration have cut off potential for agricultural exports and left farmers with few reserves before the pandemic began to hopscotch across the country.

In terms of going it alone, I'm reminded of this post about small-town hospitals in the era of COVID, in particular their lack of bargaining power and struggle for PPE.  

Coronavirus in rural America (Part CIV): the Dakotas

Frank Bruni reported a few days ago for the New York Times under the headline "Death Came for the Dakotas."  Here's an excerpt that is quite harsh: 

The Dakotas are a horror story that didn’t have to be, a theater of American disgrace. Want to understand the tendencies — pathologies might be the better word — that made America’s dance with the coronavirus so deadly? Visit the Dakotas.Intellectually, I mean.

* * * 

The truth is that the Dakotas are as emblematic as they are exceptional, the American story — or at least a strain of it — in miniature. In resisting the lockdowns, slowdowns and sacrifices that many other states committed to, they indulged and encouraged a selective (and often warped) reading of scientific evidence, a rebellion against experts and a twisted concept of individual liberty that was obvious all over the country and contributed mightily to our suffering. 

“North Dakotans will come to each other’s aids in a heartbeat, but when asked to give up personal freedom for an amorphous common good — that’s difficult,” Paul Carson, an infectious-diseases doctor and a professor of public health at North Dakota State University, told me. Just recently, Carson said, a lawmaker from the western half of the state — whose denizens regard its eastern half, where Carson lives, as elitist and too liberal — wrote to him to share a famous quotation from Benjamin Franklin: “Those who would give up essential liberty to purchase a little temporary safety deserve neither liberty nor safety.”

* * * 

“We maybe believed that our rural nature sheltered us from what cities like yours were experiencing,” Carson said. “Then we found out, very brutally, that was wrong.”

The story mentions the death of elderly loved ones of two Dakota politicians in nursing homes, one the 98-year-old grandmother of South Dakota governor Kristi Noem and the other the 99-year-old mother of a North Dakota Republican legislator.  

The tone of the story is pretty condescending, and it reminds me of this Tweet by Sarah Smarsh, which I caught a screen shot of a few days ago: 

The photos accompanying the story are from a street in Vermillion, population 10,751, in the southeast part of the state, home of the University of South Dakota.  

The second story is by Annie Gowen of the Washington Post, published just yesterday, dateline Mitchell, South Dakota, population 15,524.  The headline is "'God be with us.'  Covid-19 becomes personal in a South Dakota town as neighbors die and the town debates a mask mandate."  She leads here story with details of the death and funeral of a beloved local coach, Buck Timmins.  

As the funeral director tucked blankets over the knees of Timmins’s wife, Nanci, Pastor Rhonda Wellsandt-Zell told the small group of masked mourners that just as there had been seasons in the coach’s life — basketball season, football season, volleyball season — Mitchell was now enduring a phase of its own.

Pandemic season.

In a state where the Republican governor, Kristi L. Noem, has defied calls for a statewide mask mandate even as cases hit record levels, many in this rural community an hour west of Sioux Falls ignored the virus for months, not bothering with masks or social distancing. Restaurants were packed. Big weddings and funerals went on as planned.

Then people started dying. The wife of the former bank president. A state legislator. The guy whose family has owned the bike shop since 1959. Then Timmins, a mild-spoken 72-year-old who had worked with hundreds of local kids during six decades as a Little League and high school coach and referee.

His death shook Mitchell just as its leaders were contemplating something previously denounced and dismissed: a requirement that its staunchly conservative residents wear masks.

As Wellsandt-Zell led those mourning Timmins in the hymn “Jesus Loves Me,” the rumble of an approaching helicopter cut through the sound of the singing and the mourners’ soft tears. In Mitchell, the medical emergency helicopter, once a rare occurrence, now comes nearly every day, ferrying the growing number of people desperately ill with covid-19 to a hospital that might be able to save them. 

And here's a story with a similar them in that it is about how the death of a child, from COVID, transformed a Missouri town's stance on the pandemic.  The dateline is Washington, Missouri, population 13,892.  An earlier story out of that town, which might more accurately be described as exurban, is here.

Coronavirus in rural America (Part CIII): The Texas borderlands

The New York Times ran this story today out of the Big Bend area of Texas, dateline Alpine, population 5,905.  Sarah Mervosh reports:  

It is one of the fastest-growing coronavirus hot spots in the nation, but there are no long lines of cars piled up for drive-through testing and no rush of appointments to get swabbed at CVS.

That’s because in the rugged, rural expanse of far West Texas, there is no county health department to conduct daily testing, and no CVS store for more than 100 miles. A handful of clinics offer testing to those who are able to make an appointment.

Out past the seesawing oil pumpjacks of Midland and Odessa, where roadrunners flit across two-lane roads and desert shrubs freckle the long, beige horizon, the Big Bend region of Texas is one of the most remote parts of the mainland United States and one of the least equipped to handle an infectious disease outbreak. There is just one hospital for 12,000 square miles and no heart or lung specialists to treat serious cases of Covid-19.

Here's a related New York Times story, from early August out of Starr County, Texas, population 60,968, which is much farther southeast in the Rio Grande Valley, also Texas's border region.  Edgar Sandoval reports under the headline "'Like a Horror Movie':  A Small Border Hospital Battles the Coronavirus," and the subhead is "The hospital in Starr County, Texas, had no I.C.U. and only one doctor on duty for each shift.  Then the coronavirus began."  It's a story of an under-resourced hospital in a high poverty county with a large LatinX population.  (Read more about that region and its medical resources here and here, along with an Austin-American Statesman op-ed from 2015, which is no longer available).   

A Washington Post story from last month covered the struggle of small health providers to acquire protective equipment.  A quote about what's happening in rural Texas follows:  

The Texas Organization of Rural and Community Hospitals had never bought members any type of supplies until its president, John Henderson, started getting frantic daily calls about PPE from many of the state’s 157 rural hospitals. “We were at the end of the supply chain, and the supply chain was broken,” he said.

TORCH, as the group is known, began developing relationships with vendors and buying and collecting donations of masks, hand sanitizer and other gear. It crammed boxes into its Austin offices and created chains of volunteers to drive, relay-style, across Texas’s expanse for deliveries.

Now, as the pandemic surges in West Texas, stressors are reemerging, and gloves are a particular trouble spot, Henderson said. But most of the state’s rural hospitals are far closer to having what they need, according to Henderson and several hospital chief executives.

And here's a September 2019 Washington Post story by Eli Saslow about the physician shortage in far west Texas.  This was reported, of course, long before the pandemic.  The headline is "‘Out here, it’s just me’: In the medical desert of rural America, one doctor for 11,000 square miles."  The dateline is Van Horn, Texas, population 2,063, about an hour and half drive from Alpine, though just one county separates the two.  

Another big story out of this region from nearly five years ago is here.  It involves Justice Antonin Scalia's death while on a hunting trip to the region--and the bureaucratic consequences of that area's isolation.  

Coronavirus in rural America (Part CII): "Rural is left out of the conversation"

That's a quote from this 14-minute segment on NPR this afternoon, a segment in which two rural nurses are interviewed.  The statement was made by one of the nurses, but there's no opportunity made/taken to unpack what she means by that.  Does it mean public health messaging has not been culturally sensitive?  that these rural nurses don't have the PPE that they need?  that the sense of rural disenfranchisement associated with how rural folks have been voting recently spills over into the public health arena?  I'm not sure.  

In any event, both nurses lament that so many of those they serve don't believe the coronavirus is "real" and many refuse to wear masks.  One disclosed that her husband, a welder, had expected coronavirus to go away on November 4.  In other words, he thought it was a hoax, even as he sees how she is struggling with work and what she is dealing with there.  

Keep an eye out for when the transcript of this is posted so you can read the entire interview.  

There's lots of other rural COVID 19 news to peruse.  Here's another NPR story, this one out of rural Kansas, about public health officers resigning and retiring because of public hostility.  James McLean reports. 

In July, Nick Baldetti resigned as director of the Reno County [population 64,511] Health Department in Kansas.

But it wasn't the 80-hour workweeks that drove him to quit, it was the hostile political environment and threats to Baldetti's family.

"I had the local police watching my house because my family was home and I was not," said Baldetti, who also served as the department's health officer. "There was a period of time that I had escorts to and from work."

Baldetti spent years preparing to deal with a public health crisis like the COVID-19 pandemic. He never imagined that when the moment arrived, he would encounter such antagonism for simply doing his job.

"By the end of the day, you just felt like you were on an island by yourself," he said. "Whatever decision I made, 50% of people were going to be upset because it was too 'restrictive' and the other 50% were going to be upset because it wasn't restrictive enough."

Here's a story from last week about a strained rural women's health clinic in Brownwood, Texas, population 19,288, in the central part of the Lone Star State.  Reporting is by Shannon Najmabadi of the Texas Tribune.  The story is only marginally about the pandemic--the point being that this clinic, unlike urban counterparts, can't "pivot" to telehealth.  An excerpt follows:

Women come from more than one hundred miles away to Building 35 in a red brick public housing project in rural Brown County, a housing unit turned health clinic where virtually every item, even the beige exam tables, is donated.

The clinic is walk-in only — no appointments — a better bet for patients with unreliable transportation or unpredictable schedules. Without federal funds, Midway Family Planning in Central Texas would have shut its doors long ago, its director says, as state budget cuts dried up family planning dollars from the Gulf Coast to the Texas Panhandle.

Instead, the nonprofit clinic has endured as a small health care lifeline, where low-income and uninsured Texans — far from busy cities with many doctors — can get free or low-cost contraceptives, cancer screenings and treatment for sexually transmitted diseases. 

* * *  

While clinics in cities like Dallas and Houston easily pivoted to telehealth visits to minimize face-to-face contact when the pandemic hit, that prospect makes Midway’s director, Carole Parker, laugh: Most of her patients don’t have access to stable internet connections.

Hillbilly Elegy as Rorschach test

And if don't believe me, just look at the comments on my recent "op-ed" about the new film, "Hillbilly Elegy." That short essay was published on The Conversation.  

The commentators make the film about rural America, class, politics, identity politics, and drug addiction.  I think the most striking--in the surprising sense--is how many commenters centered rurality, though I didn't even see the film as being about rural and carefully avoided using the word in my essay.  I had written a paragraph explaining why "Hillbilly Elegy," the film, is not about rural America--at least not after you get past the opening scenes in Jackson, Kentucky.  But the comments go even beyond rurality to link that concept--and by extension Hillbilly Elegy--to the family farm. 

A photo essay about women's high school basketball in nonmetro North Carolina

NPR reports from Kinston, North Carolina, population 21,677.  An excerpt follows, but click through to see the photos, which are the real attraction. 

In Kinston, N.C., basketball is king — or queen, as the case may be.

The town has a reputation for producing more NBA players than anywhere else in the country and the boy's team is often in the spotlight. Yet the girls team wins just as often as the boys. The girls often receive top grades — in the spring, two players graduated at the top of their class — and after graduating, many stay in the community, sometimes serving as assistant coaches for the team.

* * * 

Growing up in Kinston isn't always easy. In the 2017-18 school year, more than half the students at Kinston High were economically disadvantaged, according to the most recent state report card — and that was before the pandemic hit. The school also rates below the state average in math and English language arts.

Head Coach Chris Bradshaw understands that basketball can only take the girls so far. "The most important thing is academics," Bradshaw explains. "Athletics come and go, but what you learn in academics you can take with you for your whole life."

Kinston is the county seat of Lenoir County, population 59,495. 

Coronavirus in rural America (Part CI): Impact on state and local governments

The New York Times headline is, "In Blue States and Red, Pandemic Upends Public Services and Jobs," and Patricia Cohen reports.  the subhead is "As a standoff over federal aid persists, state and local governments are making deep budget cuts. “Everything’s going to slow down,” one official said."

What follows are some paragraphs focusing on states popularly thought of as "rural." Long and short of it is that they are suffering mightily, in part b/c of loss of oil and gas extraction, in part because of loss of tourism revenue, and for many other reasons:  

Wyoming, Alaska and North Dakota, Republican-led states that depend on energy-related taxes, have been walloped by the sharp decline in oil prices. Places where tourism provides a large infusion of revenues, like Florida and Nevada, face revenue declines of 10 percent or more, as does Louisiana, which relies on both tourism and energy.

Elsewhere, the steep falloff in sales and personal income taxes — which on average account for roughly two-thirds of a state’s tax revenue, according to the Pew Charitable Trusts — is forcing Republican and Democratic officials to consider laying off police officers, reducing childhood vaccinations and closing libraries, parks and drug treatment centers.

On "Hillbilly Elegy," the film, and cultural and geographical divides in the United States

I published this today in The Conversation, about the new Ron Howard/Netflix film, "Hillbilly Elegy," based on J.D. Vance's book by the same name.  Here's an excerpt:

I admit to delight when I read professional critics trashing the film, which is based on J.D. Vance’s widely praised memoir detailing his dramatic class migration from a midsize city in Ohio to the hallowed halls of Yale Law School. I was expecting the worst based on my dislike of the book, and these reviews confirmed my expectations.

But once I saw the film, I felt it had been harshly judged by the chattering classes – the folks who write the reviews and seek to create meaning for the rest of us. In fact, the film is an earnest depiction of the most dramatic parts of the book: a lower-middle-class family caught in the throes of addiction.

Everyday viewers seem to find the film enjoyable enough – it has solid audience reviews on IMDB and Rotten Tomatoes.

So why the big gap between the critical response and audience reaction? Could it be yet another sign of the country’s steadily growing class divide?

I want to be clear that I didn't see the film depicting rural in any sustained or meaningful way.  Middletown, Ohio, Vance's home town is not rural by any measure.  Indeed, it's not even technically Appalachian.  But about the first 10 minutes of the film take place in Jackson, Kentucky, the Vance Family's ancestral home.  That's Vance's real claim to "hillbilliness," and I don't dispute that a certain hillbilly culture followed his family into the Rust Belt.  

Cross-posted to Working-Class Whites and the Law. 

More on the rural vote, this time out of Wisconsin

Bill Hogseth, Chair of the Dunn County Democrats (Dunn County, population 43,857), wrote this opinion piece for Politico, published under the provocative headline, "Why Democrats Keep Losing Rural Counties Like Mine."  Guess what?  It's down to the economy.  Here's a salient excerpt: 

Why did Trump do so well with rural voters? From my experience, it’s not because local Democrats failed to organize in rural areas. Instead, after conversations with dozens of voters, neighbors, friends and family members in Dunn County, I’ve come to believe it is because the national Democratic Party has not offered rural voters a clear vision that speaks to their lived experiences. The pain and struggle in my community is real, yet rural people do not feel it is taken seriously by the Democratic Party.

My fear is that Democrats will continue to blame rural voters for the red-sea electoral map and dismiss these voters as backward. But my hope is for Democrats to listen to and learn from the experiences of rural people.

The signs of desperation are everywhere in communities like mine. A landscape of collapsed barns and crumbling roads. Main Streets with empty storefronts. The distant stare of depression in your neighbor’s eyes. If you live here, it is impossible to ignore the depletion.

Rural people want to share in America’s prosperity, but the economic divide between rural and urban America has widened. Small-business growth has slowed in rural communities since the Great Recession, and it has only worsened with Covid-19. As capital overwhelmingly flows to metro areas, the small-town economy increasingly is dominated by large corporations: low-wage retailers like Dollar General or agribusiness firms that have no connection to the community.

The source of our wealth is in the things we grow. But today, those things get shipped off into a vast global supply chain, where profits are siphoned off and little remains for us to save or invest.

But you really gotta' read the whole piece.  Also, I'll note that many of these themes are reflected in U.S. Senator Jon Tester's (MT) book, Grounded (2020), which I'm reading now.  I'll write more about that in a future post. 

The difference between two "rural" counties in Georgia and the 2020 Election

My big takeaway from this story of two Georgia counties is that one remains more truly rural (culturally and economically) while a contiguous county is more exurban/suburban, with much of that shift having come in the past four years.  Halsten Willis and Griff Witte report for the Washington Post under the headline "In neighboring Georgia counties, election revealed a growing divide that mirrors the nation."  The subhead gets into details on the specific counties and contrasting vote counts:  "President-elect Joe Biden won Newton County, Ga., by 11 points. President Trump won neighboring Jasper by 53."  The dateline is Covington, Georgia, population 13,118, and an excerpt follows:  

Not long ago, Elizabeth Allen and Wanda Cummings were on the same side of America’s political divide.

Both were reliable Republican voters in a reliably conservative part of a reliably red state. But Cummings and Allen have changed, and so has their state, Georgia. They just haven’t changed in the same way.

Allen, a nurse, grew up idolizing Ronald Reagan but couldn’t stomach President Trump’s disregard for facts or civility. When she cast a vote for Joe Biden this year — helping him to swell his margins in the fast-growing suburbs of Newton County and claim Georgia’s 16 electoral votes — it was the first time she had ever marked a ballot for a Democrat.

Cummings, a retired antique store owner, moved from Newton and found ideological kinship just across the county line, in rural and ever-redder Jasper. She reluctantly backed Trump in 2016. But after his four years in office, she — and her new county — turned out for the president with gusto.

Allen and Cummings crossed lines that in America today increasingly resemble a chasm. Unlike some previous elections marked by either a blue or a red wave, the 2020 vote featured both. And in many parts of the country, they crested side-by-side, with the turnout and margin for Trump surging next door to areas that boomed for Biden.

And that reminded me of two podcasts I've heard recently, both of which explore the shifting role of exurban voters in the U.S. electorate. The first is the late November episode of the Trillbilly Workers Party and the second is the episode of Densely Speaking, also from late November.  Both are well worth a listen.