[Written by Diane Lauver, February 2018]
Growing up, I was close to my paternal grandparents; they lived in a pastoral valley looking at Appalachian hills in a northern state. With their 8th grade educations and practical wisdom, they taught me how to garden and “put up” its produce. My maternal grandparents worked for a travel agency and liked to have new experiences. These grandparents were involved in different types of Protestant churches.
Socialized in the church, I was active in youth fellowship in high school. Led by young, liberal, divinity students, we had space to discuss social and ethical issues, such as poverty, burning of inner cities, and “The War” of the 60s. I was questioning traditional church doctrines, social power structures, and sex roles for women. I was uncomfortable with how quickly news traveled in our small town. I was ready for more independence when I moved to Nashville and Vanderbilt University.
About 1973 – 74, Nancy Raybin presented a wonderful slide show — synchronized with music — about working in East Tennessee with the Appalachian Student Health Coalition (SHC). The whole message about working in Appalachia was appealing; “it felt right.” I was drawn to the geography of rural Appalachia and her people. And, I wanted to gain skills as an expanded role nurse and contribute to the social good.
Presumably, my early influences contributed to me being drawn to the SHC. Although the people I met in east Tennessee had different accents than my paternal grandparents, they were similar in their values and living close to the land. While my maternal grandmother encouraged new experiences, the church youth group discussions had sparked reflections about status and power in society.
In the summer of ’74, I traveled with the Health Fair in southwestern Virginia and Tennessee, working as a nursing student assessing the health of children. After the traveling fairs, I stayed in Robbins, TN to follow-up with health fair attendees who had abnormal findings. As I recall, my roles were to connect the attendees with needed follow-up resources and to maintain good relationships with the local, identified leaders. Robbins was quite small; it had a post office near a school on the highway and a scattering of homes seen from the road. I stayed in a ranch style home with a welcoming family who had several children around my age and older. I had a room at the front of the house facing the railroad tracks where a train whistle blew nightly at 1:00 a.m.
Being involved with the Coalition was transformative for me in many ways. For example, the SHC embraced a broad definition of health. This definition encompassed function and quality of life; this resonated with me. The definition was not based on a medical model, but rather included peoples’ multi-dimensional well-being and rights to healthcare. Importantly, the SHC not only espoused this broad definition in its recruitment of student participants but also applied it in their actions.
I first learned about community-based, participatory initiatives for health through the various roles and through personal experience in the SHC, not from books. Learned in this way, these are lessons have never been forgotten…
Living with my summer family, I had first-hand experience with the interconnections of personal health, the environment, and policy. Prior to this, I had read about the environmental dangers of strip mining, seen scars on the mountainsides, and the ugly, cupcake-like, mountain-tops left behind. Although we could not see any strip-mining from our usual routes around Robbins, TN, my summer family’s tap water smelled like sulfur and didn’t taste great. The sulfur smell and poor taste was a consequence of strip-mining that created abnormal erosion and atypical water run-off. This run-off entered streams, mixed with other elements, caused sulfuric acid, and contaminated local families’ water sources. Because my summer family would not drink water from their tap, prior to each meal, one of the youngest would take orders for pop and run up the road to a small, weathered building. They would return from the store with cold, bottled drinks for the meal.
This set of experiences provided me with an embodied understanding of the interconnectedness of the land, water, mining, and economic policies. These experiences explained the high rates of dental caries we had seen when screening children. Because of the degree of dental caries, some Appalachian girls asked for dentures as a high school graduation present!
I recall that Bill Dow challenged us in an evening discussion, about ’74. He asked, “Why doesn’t the U.S. have universal health care?” What a sensible idea! Yet, to this day, this challenge remains…I learned by experiences with the SHC that many barriers to good health care – such as affordability, accessibility, and acceptability — are consequences of policy decisions based on economic issues, rather than the social good. Yet, some people in government and health care often have falsely and unfairly attributed poor health only to individual level factors, such as people’s behaviors.
Although I had wanted to be a nurse prior to knowing about the SHC, learning about the SHC led me to hear about and experience the expanded role of the nurse. Because of the SHC, I became an Nurse Practitioner and have identified as an NP.
In my role as a nurse educator, I have consistently invited nursing students to consider the breadth of influences on people’s health. My motivations for asking health professional students to think more broadly about this issue were consequences of SHC experiences. When naïve students have tended to attribute health status to people’s own characteristics, such as laziness, I have asked them to consider alternative contexts similar to those that I had experienced. I ask them to consider situations in which people are lacking finances to pay for basic health care, lacking reliable transportation to get to health centers, and lacking confidence they would be treated with dignity if they were to show up at a health center.
In my role as a nurse researcher, I have enjoyed proposing and evaluating influences on health behaviors, based on integrated theories or models. The theories and models I have tested were chosen, based on SHC experiences. These theories /models include system-related factors including policies, geographic accessibiIity, financial affordability, and cultural acceptability of services. Other theories / models that lack these components are conceptually inadequate because they do not reflect peoples’ experiences in rural Appalachia and other parts of the U.S. In my years of teaching nurses and NPs, I have taught health professional students to be critical of theories and models that do not reflect the barriers that their patients experience in seeking services in improving their health status.