Geoff: When it comes to health,
rural America lags far behind
the rest of the country.
The reasons are complex.
Including the sheer distances
people have to travel to see a
provider.
The challenges are the focus of
a series we start tonight.
In collaboration with the global
health reporting center, we
report from West Virginia for
our series, rural rx.
>> This is where I grew up.
I have lived in Morgan county my
entire life.
You are one hour from the
nearest Walmart.
[Laughter]
Some people may not want to live
that way but to us, this is
>> This mountain, this slice of
West Virginia has been home to
their family for six
generations.
She is visiting a family friend
who has chronic obstructive
pulmonary disease.
She struggles to afford her
medications and cannot live
without her oxygen.
The power in their house is
unreliable so there is a
generator at the ready so she
can always breathe.
>> It is hard finding someone
good around this area to help
>> She says these kind of
struggles are everywhere here.
>> There might be an option to
help.
>> We take care of her.
West virginians are all
connected.
We are all family.
My mission is to advocate for
people who are so vulnerable
that they do not have a voice.
When you look at West Virginia
specifically, you have the
highest number of chronic
disease, diabetes, heart
disease.
We are losing so many of our
people to death, and early to
death.
>> On nearly every health
metric, rural America fares
worst of the rest of the country
for life expectancy to
maternal mortality.
Residents are a third more
likely to die from diabetes, 20%
more likely to die from heart
disease and more likely to die
of cancer or accidents.
There are higher smoking rates
and fewer people with health
insurance.
In many health categories, west
Virginia, a heavily rural state,
ranks dead last.
These are the challenges that
this doctor and his colleagues
face.
He is chairman of the emergency
department at Berkeley medical
center in martinsburg.
>> For as many of the myths are
not urban legends, the reality.
The idea somebody waited four
they said they were having a
heart attack and could not get
transportation and did not call
911 because it cost too much but
it is free.
>> People in rural areas are
less likely to have access to
good, quality health care.
Compared to urban areas, rural
areas has fewer nurses and less
than half as many doctors per
person.
People have to go farther to
access care, unless they have
someone like Angie gray to help
them.
>> If you already struggle for
transportation, or you live in a
rural area where it will take
you one ever to access health
care, some places in west
Virginia, two hours to access
health care, you are less likely
to make it there and get help.
>> When people do come for care,
they are using the emergency
room as a doctor's office.
Something the doctor and his
team have turned into a virtue.
>> For a lot of those folks, we
can use our emergency department
as a primary care office at
times.
A number of those people are
here with kids for fevers.
We are giving antibiotics.
On any given day, you have three
rooms of eight euros with a flu,
two overdoses and people who are
elderly looking for admission
with diseases.
>> In some cases, he said, that
emergency room visit is the
first time a patient has seen a
doctor in their entire life.
>> Some of the folks I see have
never had health care ever and
they are in their 60's.
>> They don't have a doctor?
>> Correct.
They might not have had one as a
kid.
They might not have been
vaccinated.
For them, the opportunity to
meet a physician for the first
time or they comment and you say
do you have a history of high
blood pressure?
They say no and they are
hypertensive.
You have never been tested
before so you do not know.
>> Not going to the doctor for
preventive care is not uncommon
in parts of West Virginia.
The pattern that is repeated
across rural America.
>> If you want someone to come
to the hospital, you might as
will not write the prescription
if you give them $700 worth of
medication, just realized it
will not thrown away -- they
will throw it away because they
cannot afford it.
Places in the world were have
done disaster work have been
better off.
A percentage of my people do not
have indoor plumbing, access to
power.
There are a lot of places that
ambulances show up and say you
cannot send them back.
They will show you pictures,
they are living in a place that
is rat infested, there are
raccoons in the house and you
are like, this is where they
live?
It is the best I can do.
>> We go out and meet them where
they are.
>> Since getting to a hospital
can be difficult for some money,
she goes to them.
Delivering preventive and
essential care straight out of
for toolbox.
>> It looks like you have had
ear infections before.
We probably prevented a couple
urgent care visits today.
It was awesome.
We got to prescribe some
antibiotics.
We are just going right back to
old-school family medicine,
which is what we love.
>> Urgent care out on the
street.
>> At times, practitioners here
say the need can be
overwhelming.
>> Hello.
>> Especially when it comes to
mental health.
Rural Americans report higher
levels of depression and
suffered suicide rates more than
30% higher than people who live
in cities.
And yet, for those people, it is
harder to find help.
Rural areas have fewer than half
as many psychologists per
capita.
>> It means we have a year-plus
waitlist in our outpatient
clinic.
It was recently two years, we
got it down to 1.5 years for
adults.
>> She is a clinical
psychologist who works at the
harpers ferry family medicine
center.
In a typical fashion, she embeds
with this family practice to
make it seem less for patients
who.
Want mental health care
elsewhere, people face big
obstacles.
>> Kids are waiting a year-plus
for specialty services like
testing for ADHD, developmental
disabilities.
A lack of services overall.
>> So people who could be in a
crisis circumstance would call
and say can I get help?
And they are told --
>> Go to the emergency room.
That is all we can offer.
>> Can new start browning the
chicken while I get the
vegetables cut up?
>> Yes I can.
>> We caught back up with the
nurse after she visited her
friend.
How typical is that circumstance
of what we saw today?
>> Typical.
Very typical.
A lot of people I know,
personally, a lot of patients
that we have are all dealing
with that, trying to be able to
afford to get their medications.
Trying to get to health care.
>> Hoping the power stays on?
>> Hoping the power stays on so
you are not out of your oxygen.
>> She said these problems are
ultimately fixable but not if we
tackled them piecemeal, one
patient at a time.
>> There is a villager who walks
into the river and there is a
baby floating down the river.
Another one comes floating down
the river so he pulls the baby
out.
All the villagers are gathering
around the river and all these
baby star coming down the river
and they are jumping in and
pulling them out until one
villager walked upstream to see
who was throwing the babies in
the river.
We need to get more upstream.
>> She admits it is an uphill
climb but it is one the are
taking step-by-step.
For the pbs "Newshour," I am