Weeks before Tennessee took action to limit the spread of COVID-19, Teresa Dabney was changing how she served high-risk patients at the clinic she runs in the Clearfork Valley. First, she split her medical staff into two teams who work every other week, so if an outbreak hit her facility, “not everyone would be taken out in one sweep.” Then, in mid-March, she cordoned off the clinic into two groups: coal miners and everyone else.
Miners who opt for an in-person appointment enter and exit through a separate door, in a separate wing, with a separate waiting area. Patients can also use telehealth services, but Dabney said it’s less popular for miners her clinic sees, who are older and don’t always have internet access.
“Most of our miners are medically fragile, specifically with breathing problems,” said Dabney, CEO of Community Health of East Tennessee’s black lung clinic in Lafollette. The clinic monitors and treats patients who suffer from the incurable and fatal respiratory disease caused by exposure to coal dust. While Dabney has fewer diagnosed cases of black lung since her department opened in 1980, rates are surging in central Appalachia. Dabney said she serves roughly 750 miners with black lung symptoms annually.
The Clearfork Valley in Tennessee has 18 confirmed COVID-19 cases and one death as of April 23, which medical practitioners say is lower than expected. Daniel Yoder, a physician at nonprofit community health center Dayspring Health in Claiborne County, 25 miles north of Dabney’s clinic, said the low numbers could be because of a sparsely populated region, a lack of available tests, or that Tennessee’s stay-at-home orders are working.
“It’s a pretty tight-knit community so I think for people here, it’s not too hard to stay put,” Yoder said. “It probably helps during something like this, just the geographic isolation.”
Networks of mutual aid have existed among deeply connected rural communities for decades. Their usual forms of assistance — mowing lawns, delivering groceries, sharing resources — are being reinforced during the pandemic. But many of these areas, particularly those with a history of extractive industries like coal mining, face food insecurity, unreliable broadband, a lack of transportation, and a need for responsive and well-resourced health care.
Four counties — Campbell and Claiborne in Tennessee and Bell and Whitley in Kentucky — make up the Clearfork Valley, a mountainous region of twelve unincorporated towns sewn together by the Clear Fork River. The rugged hollers and steep valleys, originally home to the Cherokee Nation, were colonized by settlers who later became the first coal miners of east Tennessee. A prosperous mining area, most of the valley was eventually owned by a British coal company that repossessed homes and closed down entire communities after mines began shuttering in the 1950s. Of U.S. coal-producing states, Tennessee now produces the least, but much of the area’s land is still held by absentee mineral owners.
During the pandemic, coal companies are trying to wriggle out of their responsibilities to former coal miners like those suffering from black lung disease in the Clearfork Valley. As of 2017, over 25,000 miners and their dependents received black lung medical benefits. Three-quarters of that money comes from the Black Lung Disability Trust Fund, which is financed by a relatively low tax on every ton of coal mined and a $4 billion debt from the federal government. In March, the National Mining Association proposed saving operators about $220 million by cutting the trust fund tax by 55% and waiving fees to reclaim abandoned mine sites.
That could have major consequences for miners with black lung. Troy West, 74, worked near Dabney’s clinic for 41 years loading coal from deep mines. He developed black lung symptoms four years after retirement and was diagnosed by her department a decade ago. Over the winter, his condition worsened: He coughed so much his ribcage was perpetually sore, his throat filled up with phlegm, he couldn’t breathe when lying in bed at night. But his case for benefits is still pending, and he’s not hopeful he’ll see financial assistance anytime soon.
“They’ve changed the requirements [to receive benefits] so much you’d just about be dead before you meet the requirements,” West said over the phone.
Although the mining industry’s proposal isn’t yet in a coronavirus stimulus bill, a coalition of groups in Kentucky, Virginia, and West Virginia are pushing back. The National Black Lung Association and several Appalachian associations issued a sign-on letter to Congress on Thursday asking them to maintain the current rate of the excise tax for the trust fund, develop emergency standards to protect working miners from COVID-19, and continue to support Appalachian communities through unemployment, SNAP benefits, and emergency response to the coronavirus pandemic.
Courtney Rhoades is the black lung organizer for the Appalachian Citizens’ Law Center in Whitesburg, Kentucky, which represents miners and their families on issues of black lung and mine safety. She has been helping organize phone trees among clients and other folks in the community to prevent the spread of COVID-19. Though in-person meetings ended in early March, Rhoades regularly calls people to ensure they’re getting groceries and prescriptions, and offers to drop non-perishable goods on their front porches.
“We’re looking at ways to prevent [the spread] and stay safe,” Rhoades said. “There is a lack of hospitals in our communities within Eastern Kentucky. If there is a major outbreak, particularly among those who have compromised lungs already, then we would worry about an overload of individuals onto these hospital systems.”
Since 2010, 120 rural hospitals have closed; over 450 nationwide are vulnerable to closure. Tennessee has the second highest number of closures of any state, but is one of 14 states that have not adopted Medicaid expansion. People living in the rural South are more likely to be uninsured and the region has some of the highest poverty and mortality rates in the country.
One of the valley’s biggest employers used to be Jellico Medical Center, but it was bought by health care conglomerate Rennova in 2018. These days, most people in the area work for the education system or a nearby factory. Some residents make round trip commutes of two to three hours for jobs in Knoxville.
Tonia Brookman is the director of the Woodland Community Land Trust, which protects 450 acres of land in the area and houses 17 low-income families, most of whom are unemployed. Brookman’s husband is the hospital’s only full-time respiratory therapist. She said the few employees who remain are essentially volunteering their time, with paychecks four weeks overdue in March, and then backdated in April. Jellico Medical Center did not return a request for comment.
Dayspring Heath, the clinic where Yoder works, has two other locations. Sarah McQueen, a physician’s assistant who works at one in Kentucky, said many of her patients lack cell phone service, internet access, or a smart device. To get information, they have to use a neighbor’s phone or come to the clinic in person. Yoder said his patients like using telehealth services, but accessing emergency services is a challenge. “In a situation like this I think it increases people’s anxiety to realize I’ll have to travel an hour or an hour and a half if I’m sick with something that can cause problems as quickly as COVID-19,” he said.
Transportation is a barrier to not only accessing health care and steady jobs, but also to food security. With schools closed, many residents don’t have vehicles to pick up the free meals school administrators organized on Tuesdays and Fridays. Brookman started a drop-off system, delivering at least 50 meals to children in her community twice a week. Each week, she grocery shops and picks up medication for 20 additional families.
“They just want to talk because isolation is a big issue,” said Brookman. “People just don’t have broadband or it’s very limited so they don’t have time to go on Facebook or the internet.”
April Jarocki is tackling the broadband issue: She runs the Clearfork Community Institute’s cyber cafe in Clairfield, which offers internet access, laptops, and printers. She had to close in late March because of the pandemic, but has come up with temporary solutions, including helping people connect from their cars and mounting an antenna on the main road. She said she might even bus a Wi-Fi hotspot around the community. But she worries how people will apply for benefits like unemployment or food stamps, file their taxes, or submit census data.
This work is an example of a broad aid effort in Appalachia. The Eastern Kentucky Mutual Aid out of Letcher County, Kentucky, and the Porch Sitters of West Virginia are organizing micro-grants and community assistance for those out of work, elderly, or immunocompromised. According to Ricki Draper of Eastern Kentucky Mutual Aid, in early April their request form had about 20 responses. While about half asked for financial assistance, the other half asked to help.
Although these rural communities have taken the “safer-at-home” order extremely seriously, Gov. Lee plans to let it expire on April 30, re-opening “the vast majority of businesses” by May. Several other Republican governors, including Georgia and South Carolina, are also partially re-opening, despite the fact that COVID-19 cases have increased by a third in rural counties in the last week, according to the Daily Yonder, and health officials worry a late wave of the virus could hit places that lack adequate testing. Health departments in Campbell and Claiborne Counties, home to about 70,000 people, are offering testing as of this week, Dabney said.
West has diabetes and a heart condition in addition to black lung, making him high-risk for COVID-19. He’s stayed home since early March, walking his dogs around his 3.5 acres and mowing the lawn. He only leaves for some trips with his wife, including drive-up church services on Sundays. The parishioners meet in the parking lot and tune their radios to stream the service together. Even when Tennessee’s economy reopens, West plans to stay at home, or inside the car, until the pandemic ends.
Austyn Gaffney is a freelance reporter in Kentucky covering agriculture, energy, and climate change. Her work has been featured in HuffPost, In These Times, onEarth, Sierra, Vice, and more.