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Spring/Summer 2018: Appalachian Crossroads


Working as a “courier” for a nursing service that began on horseback and inspired legends in the mountains of eastern Kentucky, one Wabash man changed his vocation, another returned with Wabash in tow, and another came away realizing what it will take to tackle today’s complex health care issues. 

You don’t have to fly to a foreign country to have a life-altering immersion experience!

Working as a “courier” for a nursing service that began on horseback and inspired legends in the mountains of eastern Kentucky, one Wabash man changed his vocation, another returned with Wabash in tow, and another came away realizing what it will take to tackle today’s complex health care issues. 

You don’t have to fly to a foreign country to have a life-altering immersion experience! 

The first time kevin mccarthy ’12 saw the old black-and-white photo of a newborn baby in a saddlebag in a museum in Wendover, KY, he thought someone had lost their mind. 

Today he has the picture at home to inspire his work. 

His change of heart began during his junior-year summer at the Frontier Nursing Service (FNS) in Wendover, where he worked alongside nurses bringing healthcare to the underserved in Appalachia. He also learned the story of FNS, and of the birth of the nurse-midwifery movement in the United States. 

America was still a frontier country in 1925, at least for the 15 million people who had little or no medical care. 

That year, Mary Breckinridge, a public health nurse and midwife grieving the deaths of her two children, recruited nurse-midwives from England to serve a 700-mile area extending into four southeastern Kentucky counties. Each was responsible for both the general health of all of the families as well as prenatal care, labor and delivery, and postnatal care for women in their district. 

The narrow winding roads of Appalachia caused the nurse-midwives to ride for up to an hour on horseback to do their work. Because babies were often born soon after a nurse-midwifes’ arrival, more than a few schoolchildren in the area grew up believing that the women brought the newborns in their saddlebags. The image provided a powerful symbol for FNS fundraising efforts. 

By May 1931 FNS had attended to more than 7,500 men, women and children, including 2,000 babies and toddlers. The maternal mortality rate in Leslie County dropped from the highest in the country to well below the national average. 

Almost a century later the problems have changed—Leslie County is second nationally in hospitalizations due to opioid abuse— but access to healthcare continues to be a critical issue, and the work continues. 

As part of the Global Health Initiative, three Wabash men—McCarthy, Anthony Douglas ’17, and Matt Hodges ’19—spent a summer each in the FNS (now Frontier Nursing University) Courier Program, steeped in its history and working with nurses and social workers on their rounds as they treated patients in clinics and homes. 

WM gathered the three FNS Courier alumni on campus last winter for a conversation about what they experienced, the people they met, and how that summer changed their lives. 

WM: Kevin, it was just a day after you competed in the 2010 NCAA Track Championships that you left for Hyden, KY, and your Frontier Nursing internship, right? 

Kevin McCarthy ’12: Yeah, it was kind of a shock. Leslie County is just a five- or six-hour drive from Indianapolis, but so much is so different. 

I stopped to get some gas and couldn’t understand anything the guy behind the counter was telling me, just because of his accent. 

And there were only four radio stations— three of them were church music and sermons and the other some sort of country music. There aren’t a lot of people there— many live in isolated places—but they still have a Dairy Queen. 

Matt Hodges ’19: That Dairy Queen is still there! 

Matt, you were a Courier seven years after Kevin; Anthony, you were there in 2016. Were your experiences getting there similar to Kevin’s, as if you were entering a place worlds apart from Wabash and Crawfordsville? 

Matt: I got lost on the Daniel Boone Parkway, too. I pulled over, got out to check my GPS—nothing. 

But it’s interesting that you use the phrase “worlds apart.” Leslie County is very different, and the poverty and the housing issues are widespread and exacerbated, but the health issues in that part of Kentucky aren’t that different from the rural health problems we see in Montgomery County. 

Anthony Douglas ’17: The roads are ridiculous. I thought I was going to lose my life driving to Wendover. 

Matt: It’s a single lane, two-way road, and you’re weaving through these hairpin turns in the mountains… 

Kevin: …with coal trucks barreling at you. 

WM: So you made it there in one piece; how long did it take you to feel comfortable? 

Kevin: You go through stages, kind of like when you move into another country. Getting comfortable only took a couple days. But to actually become a part of the place itself took most of the summer. 

Anthony: Everybody in Leslie County knows what a courier is, they know what Frontier Nursing University is, and the staff that works there welcomed us with open arms. It also helped that it was my birthday when I got there, so we all bonded quickly over that. 

Matt: I’m a more introverted type, so that kind of welcome made me a little uncomfortable. Those first few days were actually a little weird for me. But once I got to work and I got into my clinic site, it didn’t take me long to slip into it. 

Kevin: I was the first person from Wabash at a time the program was changing ownership, so it wasn’t nearly as structured as it is now. I did a lot more shadowing, had a contact who did social work, and that’s how I met Trinity, the only man there doing personal care as a nurse. 

How influential was he for you? 

Kevin: He would hop in a van for the whole day and go to people’s homes, meeting them in the hollers where they lived, making sure they were doing okay, following up on whatever meds or care they needed. 

On one run we drove up this muddy hill and walked over to this shack made of plywood. And out of this dirty, mucky place comes this beautiful little girl with a dog. It felt like a little ray of sunshine. We played with toys in the little playroom in front while Trinity was in the back helping someone who was sick and couldn’t take care of himself. 

Matt, Anthony, what were those rays of sunshine for you? 

Anthony: Coming back to Wendover for dinner every night because I grew really close to the staff there, the cooks, the ladies. They’re the sweetest people ever. They still write me on Facebook all the time. And we ate incredibly well—I mean, the best food I’ve ever had in my life was in Kentucky. 

Matt: For me it was the nurses and staff that I worked with at Little Flower Clinic in Perry County, Hazard. They have such pure intentions and such an endless drive to improve their community. Health care in Appalachia hasn’t always been the most ethical thing in the world, and to see this group of people working so hard to be a force of good in their community was inspiring. 

Anybody in particular? 

Matt: The nurse practitioners, Vera and Allison, were so in tune with the attitudes of the community. They were able to frame sound medical advice in a way that was very palatable to people with a different world view. 

But I also did a lot of shadowing with a caseworker named Helen. A couple times a week I would ride around with her on home visits. I learned so much from her. 

Any of those visits particularly memorable? 

Matt: There was this widower whose wife had recently died. He was an alcoholic and a diabetic. We visited him five or six times during the summer, just to check in on him. 

The first time I met him he was pretty drunk. He lived in a single-wide trailer. Very dilapidated. It was dirty, the cupboards that were open were empty, and this guy has a bottle of whiskey and a pouch of tobacco, and he’s rolling cigarettes. 

His priorities struck me. He is using what very little income he has to get his hands on liquor and tobacco, as opposed to a healthier diet. How do you address that? That’s so beyond conventional medical care. 

Nothing got my gears turning during my time down there quite like that visit. 

Kevin: That’s a mental health issue too. 

Matt: And mental health clinics are scarce in that part of the country. There’s still a big stigma around receiving mental health care. 

Anthony: I think part of the resistance is religious. Religion is so important in that area: They turn to church to solve their problems. For a mental health issue, they’d say, “Oh, you need to pray more.” Or, “You need to go to church more.” 

Matt: But that experience made me realize that if you want to be a good doctor, you have to think about more than medicine. You have to be an economist. You have to be a historian. You have to be a philosopher and a social scientist. And you can’t be all of those things. Not effectively. You don’t have enough time. You can have a baseline knowledge, but if you want to do your job well, you need help. You can’t do it alone. 

Kevin, you went to FNS with the idea of becoming a doctor, right? 

Kevin: Yeah, and it actually convinced me to not become one. My time there shined a light on nursing. It’s one reason I became a nurse. 

Matt: The things nurses do down there—amazing! 

Kevin: The nurses run the show down there. You have maybe a handful of doctors spread out over the three counties that cover everything, and everyone else doing that work are nurses. 

I went down there with the idea of one day becoming a rural family practice doctor—to have my black bag and my stethoscope, go house to house. My grandpa was that kind of doctor in Indianapolis. 

But I realized there that that kind of doctor hardly exists anymore. At the same time, I learned how much nurses can do. 

“That’s the beauty of the Wabash education. We get a very broad education that allows us to learn things that we don’t even know will help us one day in the field we’re choosing to go into.” 

Was it an easy choice for you to switch career paths and become a nurse? 

Kevin: No. Because I had seen medical school as the top of the top. If I went to nursing school, then I’d be stepping down and taking a lateral degree. So I had to wait awhile to let it sink in. I had to come back four years later and get my degree. 

But I’m glad I did. 

Anthony, did the experience shake up your career plans? 

Anthony: I was pretty confident in my career choice—I knew I wanted to be a doctor, and that didn’t change. But I did experience the opioid crisis up close. When I was down there, Dr. James “Ace” Chaney went to prison for life for giving out narcotics to patients and then running a treatment clinic. 

So I saw the darkness. But I also saw the work that nurses and the nurse practitioners were doing. It gave me much more appreciation for primary care as a field. I went there planning to do emergency medicine, and there wasn’t much that was going to turn me away from it. But it also drew me toward the idea of being a doctor that worked in an underprivileged or rural area, a doctor that was well known in the community, like Kevin’s grandfather. 

Matt, how did the experience affect your thinking about attending medical school? 

Matt: It drove home the importance of sound ethics in patient follow-up. 

The opioid crisis in that part of the country stemmed from improper post-op care. This issue, at least partly, falls on the shoulders of physicians. 

It’s a hard thing to see, but important to understand. It is easy to have a summer experience that makes your future profession look awesome and really happy and exciting and a lot of fun, and this didn’t do that. This is not a bright chapter in the history of Western medicine. 

But I would encourage anyone in their undergraduate years to try to have an experience that puts their future career in a negative light. I think that’s helpful in forming your career choice. You need to know the good and the bad potential of what you want to do. It’s good to have that warning, so you know what to avoid. You learn a lot from mistakes. 

What was the most important lesson for you, Kevin? 

Kevin: I expected to find that things down there were really different, and at first that’s how it seemed. But I actually left realizing a lot of things that were similar. They’re just people like you and me who live in another part of the country, in a different environment that actually isn’t all that different. They’re our neighbors. 

What’s different is that they don’t have access to what they need in that community. 

Anthony, how does this experience set you apart from other first-year medical students? 

Anthony: It gave me a little different perspective on life—that life is much simpler than what a lot of people make it. I feel like life in Kentucky, Appalachia, is very simple. The family, church, and food. They weren’t distracted by many of the things that city folks get distracted by. 

So I entered medical school with a deeper understanding and experience of the core ideals that are important and that we should always keep in mind. 

You all worked with Global Health Director Eric Wetzel, and one of the things he says is that he wants students to be “disturbed” by these experiences. How important was it for you to be disturbed in this experience? Just to be taken out of your comfort zone? 

Kevin: I think that’s the only way that you can really learn. By putting yourself into a stressful environment and allowing yourself to flex, to retract, to push back, to get challenged. 

Anthony: You grow more when you’re uncomfortable. I went to Leslie County with a vision of everything that I would do, what the day would be like; when I got there, it got turned on its head. That was a good thing. That’s why I took so much away from the experience. 

Matt: It’s important not only to be disturbed initially, making yourself uncomfortable, but then staying uncomfortable. It doesn’t do anyone any good if you have this experience and your mind is opened to these new things, and then you come back and you immediately slip back into this sense of complacency that you had before.

things I saw that made me uncomfortable; when I came back and saw them I was still uncomfortable here. 

Halfway through the semester, [Global Health Initiative Coordinator] Jill Rogers said, “Hey, the Montgomery County Health Department needs somebody who can put together a health profile and assess health inequalities and use those to propose possible strategies to address them.” That’s what I’ve been doing for the past few months. Using a very similar skillset that I developed, kind of, down there in that atmosphere first, and all of those skills have been very transferable back to my own community. 

Should an experience like this be part of a liberal education, regardless of a student’s major?

Kevin: I would recommend it to everybody. This program is less about medicine than it is about understanding people. It’s about community. It’s about community service. It’s learning everything you can about a new environment. And that’s exactly what education should be. 

Anthony: That’s what I really appreciate about the Wabash education: Although we choose majors, our experience and our education is in many other areas than that one, specific path. 

I came to Wabash to be pre-med, but I did so many different things with Wabash Democracy and Public Discourse. I had this rural health experience; I went to Israel and saw the conflict between the Palestinians and the Jews there. 

That’s the beauty of the Wabash education. We get a very broad education that allows us to learn things that we don’t even know will help us one day in the fields we’re choosing to go into. 

Do you guys still feel like one person can make a difference? 

Kevin: No. I think a community makes a difference. One person can be a catalyst.

Matt: I think one person can make a difference if they enlist the right help. 

Anthony: I agree.

Matt: You can’t do it alone.


In November 2016, Anthony Douglas returned to Leslie County not as a courier, but as a Democracy Fellow with the Wabash Democracy and Public Discourse initiative. 

Douglas, along with Macallister Norton ’17, John Janak ’19, Michael Lumpkin ’18, and WDPD Director Sara Drury, led a community conversation on economic opportunities for the area. 

“At the end of the Frontier Nursing experience, you have to do a Courier project, and I decided to try to incorporate the WDPD,” Douglas says. “I kept hearing from community leaders that there’s a lot of negative energy, as if there’s nothing anyone can do to stimulate economic growth in Leslie County specifically. So, I sat down with Joel Brasheer, a leader who wears so many hats in at community, and I told him about our organization, some of the jobs we had done. I asked him if there was a way we could be of any service.” 

Brasheer asked the WDPD to come up with some plans of action to stimulate economic growth. 

“So the Democracy Fellows, we did our job, researching and figuring out some solid directions they wanted to move in to stimulate growth. We took that information, put it into a guide, and then we went there and led a conversation.

“We had a great turnout, excellent discussions, and many new ideas. The guys had an amazing time and got to meet some of the wonderful people I met while I was there. 

“I felt like I was going home, because everywhere I turned, I saw someone that I had an experience with there. 

“One of the security guards at Wendover said he’s never seen a Courier come back before. It made me feel good about being able to go back, and knowing that people appreciate those who return, maintain these relationships. 

“That’s what touched me most.”