Ron Eller, director of the Appalachian Center at the University of Kentucky, a historian and a writer, says the role of mountain women has always been to hold the family together. "There were tragedies. You weren’t sure if your father or brother or husband would come back from mining or lumbering. The women had to be very strong and responsible for everyone."

Lennette is the responsible one. She schedules the doctor appointments and makes sure everyone gets there. She took in her alcoholic brother this summer and got him on Medicaid so he could have surgery he has needed for years. She got her father back on Medicaid this summer after he fell unconscious from a ruptured ulcer and, ultimately, lost both his legs to blood poisoning. Now she’s arranging for him to live with her after he’s released from the hospital. She administers everyone’s medicines from the bottles lined up above the door in her kitchen.

And then she doesn’t take her own. She can’t afford to. The Zoloft prescribed for her depression makes her drowsy. She’s already chronically fatigued from lupus, an autoimmune disorder that was diagnosed eight years ago after an attack that left her incapacitated for two weeks. She can’t nod off and still take care of all these people.

Lennette feels her family responsibilities include the father and husband who beat her. This too is common of Appalachian women, Eller says.

In a moment of panic, Lennette Kistner begins calling friends for a ride home from her children’s dentist’s office in Normalville. The friend who had agreed to take them to and from the dentist had not shown up for the return trip. Her sons, Martan, left, and Edward, play in the waiting room.

These women have believed, he said, that their own survival was connected to the survival of the family. "The loyalty to the group remains very strong no matter what happens in the family group. The tendency has been for the women to take care of the men, no matter what happened."

That is slowly changing, he noted. More mountain women are kicking out abusive and alcoholic men. Very recently, the number of Appalachian households headed by women has risen, Eller noted, as it did outside Appalachia a long time ago.

And more Appalachian women are going to college. Seventy-five percent of the students in Appalachian community colleges are women. "The women are more willing to go back and get a general equivalency diploma and go to a community college or get job training," Eller said.

That’s what the Department of Public Welfare wants, too, but it seems completely out of the question for Lennette. She lives on a mountain and has no transportation to work, job training or school. She can’t drive, and Clair, who lost his license before he stopped drinking, still doesn’t have one. There’s no public bus service up the mountain.