猫咪社区

In his history of Williamson, West Virginia, Okey P. Keadle鈥攁 member of Williamson High School鈥檚 inaugural, 1918, graduating class鈥攄escribes the fire of 1906 that destroyed some 20 downtown buildings. In the long run, Keadle writes, 鈥渁s is usually the case in such instances, the result was beneficial to the city for it removed all the old buildings on that street and gave room for new ones to be built.鈥�

Keadle鈥檚 positive spin on what others might view as calamity is certainly admirable. Though he died two decades before the Great Flood of 鈥�77, in which water rose to the mezzanine level of the Mountaineer Hotel鈥攄owntown Williamson鈥檚 most recognizable landmark鈥攁nd well before the beginning of the end of the coal economy through which Mingo County prospered, that brand of glass-half-full optimism undoubtedly served him well: Life in central Appalachia requires a resolute spirit.

Loretta Simon is likewise an optimist. Until Williamson Memorial Hospital closed its doors April 21, 2020, Simon served as head nurse and chief operating officer of the facility, the staff of which was known as 鈥淵our Friends on the Hill.鈥� The 76-bed hospital had been struggling financially; there were potential buyers, but the pandemic derailed that process.

鈥淭hings happen for a reason,鈥� Simon says. Lessons have been learned with the closure, perhaps the most critical of which is that a successful hospital in a rural community must leverage the full resources of that community.

Williamson Memorial is now scheduled to reopen, perhaps as early as September. The hospital鈥檚 new owner is the Williamson Health and Wellness Center, a, which over the past few years has been a catalyst in the community for a wide range of public-health initiatives. Simon will return; she鈥檚 busy with preparations.

The plan is for Williamson Memorial and Williamson Health to work in concert鈥攊n effect, to reopen the hospital while taking every measure to keep people out of it. The health of the community and viability of its hospital will be dependent on a successful symbiosis.

With a global public health pandemic that strained resources on the wane, rural communities throughout central Appalachia鈥攖hroughout America鈥攁re struggling with the question of how to continue to provide hospital care. In some cases, the answer is the merging of hospitals or acquisition by an outside entity鈥攕olutions that offer economy of scale (purchasing power, consolidated administration, access to advanced technology) and come at the risk of the loss of attention to the community鈥檚 needs and concerns.

The other option, maintaining an independent hospital, is increasingly difficult. Doing so requires rethinking.

Hospitals have been cornerstones of rural communities. The question for those communities today is, 鈥淐an we save our hospital, and if not, what are the consequences?鈥�

Williamson Mayor Charlie Hatfield fears the worst. 鈥淲hen you lose your community hospital,鈥� he says, 鈥渢umbleweeds.鈥�

But Williamson isn鈥檛 giving up. While an outsider might look upon the weathered edifices that slope up from a once-hyperactive rail yard and see a townscape in terminal decline, ask around.

Ask Michelle Lowe, a former Williamson Memorial nurse who with her husband, Mark, ministers and provides a food pantry for the community through their nondenominational church, Matthew 28:19. 

鈥淭his isn鈥檛 a dying coal town,鈥� Lowe says. This community is designing a healthier future.

The Ripple Effect

The University of North Carolina鈥檚 Cecil G. Sheps Center for Health Services Research documents. A study released in spring of last year found that because of financial stress. With the precipitous, many more are now in jeopardy.

The first consequence of a hospital closure is the loss of the emergency room. Access to specialty care is diminished. Then there鈥檚 the economic ripple effect. In many rural communities, the hospital is the biggest employer; tax revenue plummets, other businesses suffer.

News of the closure of Williamson Memorial last year hit the community hard. Generations of families have worked in the hospital; generations of babies have entered the world.

A hospital just a couple miles from downtown Williamson, across the Tug Fork River and also across the Kentucky state line, creates issues with insurance, both public and private. The closest in-state hospital is 35 minutes away in Logan, West Virginia. Neither is home to 鈥淵our Friends on the Hill.鈥�

Mingo County, of which Williamson is the seat, faces considerable health care challenges. It鈥檚 ranked as the in a state that鈥檚 consistently found at or near the bottom in.

Williamson鈥檚 population (about 2,800 today) has declined apace with its economy鈥攜oung people leave, in pursuit of opportunities 鈥� and its hospital鈥檚 patients, like those in most rural hospitals, tended to be older, less healthy and with lower income than the national average. Rural hospitals serve a higher percentage of patients covered by Medicare or Medicaid鈥攚hich reimburse at lower rates than private insurers鈥攐r who have no insurance at all, meaning they provide a lot of care for which they鈥檙e never paid.

Jim Kaufman, who heads the West Virginia Hospital Association, calls the challenge rural hospitals face a 鈥渄ouble whammy鈥� of a declining population and an inadequate payer mix. This creates a 鈥渄ownward cycle,鈥� Kaufman says, 鈥渂ecause you can鈥檛 buy new equipment, you can鈥檛 upgrade your facility, you can鈥檛 fix things.鈥�

The Williamson Health and Wellness Center plays a vital role in this community, offering, on a sliding-fee scale, medical, dental, and behavioral care; chronic-disease management; and wellness coaching. No one is turned away.

鈥淲e started looking at the community holistically,鈥� says Donovan 鈥淒ino鈥� Beckett, the health center鈥檚 co-founder, CEO, and chief medical officer, born and raised in Williamson.

鈥淕oing through med school, I had a sense that I would come back home,鈥� Beckett says. 鈥淚 just liked that feeling of being on the front line 鈥� and it was a way to give back to a community that I felt very fortunate to grow up in.鈥�

The health center is committed to addressing the. It鈥檚 structured around the conviction that health care extends to housing, employment, transportation.

Alan Morgan, CEO of the National Rural Health Association, says that when he鈥檚 conversing with rural health professionals, 鈥淲e spend more time talking about housing, transportation, and access to food and dietary issues鈥� than anything else. 鈥淚f I鈥檓 in a meeting, and the issues of transportation and housing aren鈥檛 brought up, I鈥檓 in the wrong meeting.鈥�

Williamson Health and Wellness Center delivers fresh fruit and vegetables throughout Mingo County and oversees a community garden in a public-housing complex. It operates a medically assisted addiction-treatment program ( found that between 2006 and 2016, almost 21 million prescription painkillers were delivered to two Williamson pharmacies, four blocks apart) and recently received funding for a workforce-development initiative to help get those in the program back to work.

Amy Hannah, the health center鈥檚 community resource network director, recalls attending her first national health care conference and hearing that 鈥測our ZIP code can determine the longevity of your life鈥濃�攖he consequences of living in an area with no public transportation, for example, no grocery store, no sidewalks鈥斺�渁nd I鈥檓 thinking, 鈥楾here鈥檚 no way.鈥欌��

But as she began to understand the impact of social determinants, she set about to translate what she鈥檇 learned to her community to overcome those obstacles.

鈥淚t鈥檚 been a challenge,鈥� Hannah allows, 鈥渂ut we鈥檙e getting there.鈥� The health center convenes small focus groups. 鈥淲e pull people with lived experience to the table鈥� to 鈥渇reely speak about what matters.鈥�

鈥淲e need people who have been there and done that and can say, 鈥楴o; that doesn鈥檛 work; this is what does.鈥欌��

Carolyn Dillard, 40, a single mother of two young boys, is one such person, a 鈥渃ommunity champion,鈥� Hannah says. Dillard experienced postpartum depression and counsels women on confronting it, on the importance of focusing on their mental health. 鈥淓ventually, it鈥檚 going to catch up to you,鈥� she tells them. 鈥淎nd if you鈥檙e not in a good place mentally, then your kids are going to suffer from it too.鈥�

Fierce Loyalty

Several generations back, when coal was king, Williamson鈥檚 2nd Avenue was lined with businesses run by immigrants from all over the world鈥擨talians, Syrians, a vibrant Jewish community. There was an opera house. In the 1930s, the population was close to 10,000.

In 1918, as Okey P. Keadle was plotting his future, Williamson Memorial Hospital opened its doors. Two years later, a nursing school was built next door.

In 1927, the hospital was destroyed by fire, and a year later, a three-and-a-half-story gabled-roof hospital was built atop College Hill, a half-mile as the crow flies from the Mountaineer Hotel, the heart of downtown Williamson. For 60 years, it gazed reassuringly on the town.

In 1988, a new Williamson Memorial was built just down the hill, and over the decades, the staff there forged a fierce loyalty, among themselves and with their patients. It seems most everyone in Williamson has a story to tell of one or the other of those hospitals.

Tammy Chapman, Amy Hannah鈥檚 sister, began working as a lab technician at the hospital in 1998. 鈥淥ur hospital had a working-family atmosphere,鈥� she says. 鈥淚 didn鈥檛 realize how close we were until we went through it all.鈥� By 鈥渁ll,鈥� she means the hospital鈥檚 closure.

鈥淚t was devastating,鈥� Kathy Carey, a longtime nurse, says. 鈥淵ou kind of knew it was going to happen, and they did tell us a couple of weeks before it closed that it was definitely going to happen. So, it was just a sense of dread. Every day you go to work, you thought, 鈥極h, my gosh, pretty soon this is gonna be the end.鈥�

鈥淭he last day together was really, really hard,鈥� she says. 鈥淲e came back at midnight when they closed the doors. We all gathered around and had a farewell party.鈥�

Carey now works at Tug Valley ARH Regional Medical Center, the hospital across the river, where she sees many of her former Williamson Memorial patients. 鈥淭hey鈥檙e all the time saying, 鈥極h, we hope the hospital reopens鈥� and, 鈥楾here鈥檚 no place like Memorial.鈥欌��

鈥淟ook What I鈥檝e Done!鈥�

In 2012, the Williamson Health and Wellness Center launched a CDC-funded community health worker-based program addressing diabetes that. The program hired local people to visit patients at home, monitoring their blood sugar, making sure they knew how to take their medications, talking about nutrition鈥攊n general,  determining what鈥檚 needed for this person to live a healthier life. They then leveraged the program鈥檚 success to confront congestive heart failure and chronic obstructive pulmonary disease. are foundational to the center鈥檚 success.

Melissa Kennedy, 54, had long suffered from rheumatoid arthritis, type 2 diabetes, and hypertension. 鈥淚 made preparations to die,鈥� she says. 鈥淚 mean, I was that sick. 鈥� My grandbaby was 6 years old, and I kept thinking, 鈥業 won鈥檛 see him turn 10.鈥欌��

Kennedy was put in touch with Jerome Cline, a Williamson Health and Wellness Center community health worker. Because of COVID-19 precautions, their first visits were via telehealth. Cline鈥檚 first question in their initial session, she recalls, was, 鈥溾�榃hat did you have for breakfast?鈥� And I said, 鈥業鈥檓 a cereal eater.鈥� 鈥榃hat kind did you have?鈥� I said, 鈥楥ocoa Pebbles.鈥� He said, 鈥楳elissa, you don鈥檛 know anything about sugar?鈥� And I said, 鈥楴ot one thing.鈥欌��

She told Cline that her father鈥檚 lower leg had been amputated because of diabetes, 鈥渂ut I don鈥檛 know anything about what he can eat and what he can鈥檛.鈥�

鈥淗e said, 鈥楾ake your computer and turn it around. I want to see what medicines you have. I want to see what kind of food you have. Open your refrigerator; open your cabinets.鈥欌��

Cline arranged for Kennedy to take nutrition classes with Melissa Justice, the center鈥檚 community health worker project director. She remembers Justice calling her in the mornings, saying, 鈥淕o in there and check your sugar. I need to know what it is.鈥�

鈥淭here is a huge realization of the cost savings of diabetes management,鈥� the National Rural Health Association鈥檚 Alan Morgan says. 鈥淭he outcomes are just dramatic.鈥� It鈥檚 a matter of saying, 鈥淚n this community, here are easy ways that you can take control of your own health.鈥�

鈥淓very major insurance company now, they鈥檙e all launching their own chronic-care management programs,鈥� Morgan says. 鈥淭hose guys are in it for the money, and they wouldn鈥檛 be doing it if it didn鈥檛 work.鈥�

Kennedy had relied on a wheelchair or a walker; she now uses neither. Incrementally, through counseling and encouragement, her health has improved. The 鈥渃are and guidance鈥� of Cline and Justice 鈥渉as changed my life,鈥� she says.

Now, when she goes into the health center for an appointment, 鈥淚 sort of feel like I could jump up on top of the picnic table and say, 鈥楲ook at me! Look what I鈥檝e done!鈥欌��

Taking Control

鈥淚t used to be we were going to provide every single service in our community, and I think people realize we can鈥檛 do that,鈥� Jim Kaufman of the West Virginia Hospital Association says. The most essential question for rural hospital administrators today, he contends, is, 鈥淗ow do we get creative?鈥�

The financial damage inflicted on rural hospitals by the pandemic is expected to accelerate mergers and acquisitions.

But, Morgan says, 鈥淚 think there is a role for a small independent hospital that has a strategic alliance with a larger health system,鈥� a hospital that鈥檚 focused on preventive health and chronic-care management and on 鈥渆mpowering the community to take control of their own health, as opposed to just treating them only when they show up in the emergency room.鈥�

Burgess Dalton worked in underground coal mines for 25 years; he suffers from stage 4 chronic obstructive pulmonary disease. Cline, the community health worker, has regularly scheduled visits with him, too, and shows up in between as needed with antibiotics or a steroid shot. Before their visits, Dalton was in the emergency room every month or two; it鈥檚 been 14 months since he was last there.

That, of course, is the objective鈥攌eeping people out of the hospital. Meanwhile, Loretta Simon prepares for the reopening of Williamson Memorial. She鈥檚 also been helping administer COVID-19 vaccines at a drive-thru site. 鈥淭o be able to see the faces, to connect our purpose with that patient鈥攖hat鈥檚 been my driving force.鈥�

It was a rough winter in Williamson. Then one spring morning, Simon arrived for work, and it was as if, overnight, every bud had blossomed. 鈥淚t gives hope,鈥� she says. 鈥淲here flowers bloom, there鈥檚 hope.鈥�

The hospital will reopen in phases starting as soon as this fall. The first phase will include the emergency room, diagnostic services, an extended-hour Williamson Health and Wellness Center clinic, and a few other services. Initially, some 80 people will be employed. 

Simon assures her neighbors that preparations are progressing. 鈥淪o many people are watching and waiting.鈥�

This story was funded by the National Geographic Society. It also had financial support from the 

This first appeared on and is republished here under a Creative Commons license.