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Classes, health care wheeled in

In Appalachia, trailers expand schools that can't afford buildings, and vans bring medical care where there are no doctors

Sunday, November 26, 2000

By Diana Nelson Jones, Post-Gazette Staff Writer

HUNTINGTON, W.Va. -- In Appalachia, lots of children say "ahhh" and recite their ABCs in wheeled vehicles. Trailers are appendages of schools that can't afford capital improvements, and vans with eye charts park along rural routes to provide kids with checkups where there are no doctors.

With Connie Maynard looking on, medical resident Donna Bolden checks 6-year-old Christopher Maynard in the West Virginia Children's Health Project van. The Maynards, from Salt Rock, W.Va., are among several hundred rural families whom the van serves. (Steve Mellon, Post-Gazette)

A blue mobile clinic is Dr. Isabel Pino's office three days a week. Since 1992, the West Virginia Children's Health Project has made her van part of a national program to deliver health care in sparsely populated places. One of its sponsors, Sen. Jay Rockefeller, donated $50,000 of his own money to set it up.

The van serves three counties and operates out of Huntington, an Ohio River city of 52,500 in Cabell County. It spends several mornings a month in the parking lot of East Lynn Elementary School along Route 152, where a sultry summer breeze can rustle fragrance from the clover. A rock toss away, Vernick's market sells oil -- oil for your car, oil for your lamps, and oil for your skillet.

On those same afternoons, the van stops at a small Presbyterian chapel in the hamlet of Dunlow, where one day a group of high-school students from a Missouri church mission was repairing a family's roof across the street.

Pino greets her patients in the cramped hallway of the van. She, her nurse practitioner, Mary Kelly, and a medical-school resident have to inhale to pass each other.

Round and jolly, Pino tweaks the children and makes them grin: "You have an ear ache?" she says, incredulously. "Then we'll have to cut your ear off!"

She asks her patients whether they wear helmets when they ride their bikes, and she asks their mothers, "Do you wear your seat belt? You have to set an example."

Pino is a 46-year-old pediatrician whose brother, also a pediatrician, recruited her nine years ago to come to Huntington to supervise residents at the Marshall University School of Medicine. The school's original mission remains service to the rural underserved, and Pino, a Cuban native who was raised in St. Louis, says, "I think I have become a part of this place."

Tammy Parsons and daughter Brandi, 8, of Branchland, W.Va., joke with Dr. Isabel Pino during Brandi's appointment for a sinus infection.

Pino believes, like any native West Virginian, that she lives in a place blessed with beauty and cursed by need. "We don't just do medicine here," she says. "We are sometimes the first people to spot a speech problem. We refer kids to Head Start. Schools ask us to come in and do workshops on nutrition. We try to get parents to sign up for as many things as they qualify for."

Debbie Spaulding arrives with David, 12, and Chris, 10, in tow, both sunburned. Spaulding is a home-health technician for a county-run program for senior citizens and makes $6.20 an hour. Her boys have medical cards. Most of Pino's patients are on Medicaid.

The Spauldings live 33 miles from the nearest clinic, a drive that takes an hour "by the time you chase the curves and the coal trucks," Spaulding says. It takes less than half as long to bring her boys to the van. She apologizes to Pino, saying they spent the morning at the swimming pool, where "the adult in charge didn't make them wear sunscreen."

"You're killing me," Pino says, handing Spaulding a tube.

Three mornings a week, Pino and her staff -- with six residents in rotation -- take off from Huntington ahead of the van. Driver Paul Gram serves as staff receptionist.

Patients do not have to be needy. Many are children of two parents who both work and have insurance. Sometimes, however, their insurance does not cover well-child visits.

"Stupid policy," says Pino. "Well children is what pediatricians are all about."

During school, parents can opt to let Pino see their children in their absence. "It keeps people from having to take off what work they might have."

For most of her patients and their families, "poverty is too strong a word," says Pino. "It's more a case of being left behind."

But like people everywhere, Appalachians recognize a hierarchy of status. A 10-year-old patient told Pino that his peers at school made fun of him because his clothes smelled of a wood-burning stove.

"I love the smell of a wood-burning stove, but apparently it is a stigma," she said. This dig at his family's lifestyle came from other Appalachian children.

"He said to me, 'You know, I'm really a nice kid.'

"There are some things you can't cure."

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