When I meet new people, my Appalachian dialect typically tips people off that I might have grown up a little off the beaten path. In fact, I hail from Oliver Springs, Tennessee: a sleepy little town with three red-lights, a substantial livestock to human ratio, and a 30% poverty rate. The history of Oliver Springs is a testament to the resiliency of working class communities throughout the rural Southeast. Through the years it has provided enough labor to sustain interests of companies that sought business in the area due to its natural resources. It was originally a resort town with mineral hot springs that drew the upper echelon of society from as far away as Europe to the southern limit of the Cumberland Mountains in unassuming Anderson County, Tennessee. The resort burned to the ground in 1905 and was abandoned. Around the same time, the nearby mountains began to be mined for coal. The mines would operate through the late 1980’s until they were no longer deemed fruitful enough to maintain due to various legislative acts. In 1942, the nearby area of Oak Ridge was secretly mobilized by the US government to assist in the development of the atomic bomb, and Oliver Springs would provide the manual labor for the facilities. Electricians, pipefitters, contractors, and the like would help construct the buildings that non-native scientists, engineers, and professors would work in to arm the US with the nuclear weapons. As the Cold War came to an end in the 1980’s and nuclear disarmament protests reached a fever pitch, the demand for Oliver Springs’s labor went away as eventually two of the three security complexes were moth-balled. No matter the ebb or flow of commerce, the town persevered.
While industries come and go from the area, the natives tend to remain. Life takes on the tenor of the John Mellencamp song “Jack and Diane”: a simple life with simple pleasures with no misgivings about how little of an effect they have on what is reported by the NBC Evening News. Most families in Oliver Springs have been rooted there for generations. They have family businesses that are passed down, and children following in predetermined footsteps. They grow up, marry their high school sweetheart, work hard by the sweat of their brow for a few decades, try to stuff their proverbial mattress with as much cash as possible, raise a couple of kids, and before you know it the cycle starts all over again. As for the people who do aspire to drink in more of what the world has to offer, they tend to find many roadblocks that ultimately discourage them from rising above their station. The education system treats many of the county schools as afterthoughts. I began my secondary education in a high school with less than 350 students combined in all four grade levels, and even then we did not have enough of our dilapidated, outdated textbooks for everyone to take one home for homework. Teachers felt futile in their attempts to educate as their students’ potential was often derailed by circumstances of drugs, domestic abuse, or soul-crushing apathy from people telling them nothing they do will ever matter to the world. Every graduating class saw attrition as students had to drop out to help financially support families, manage unplanned pregnancies, or deal with repercussions of breaking the law. Even the students who had enough academic success to pursue college found financing it a greater burden than it appeared to be worth. In this context, pursuing an honest wage and resigning to simply maintain the status quo has become more an obligation rather than a conscious choice.
My own parents were products of Oliver Springs. Both of them, as the oldest of three kids, were expected to help shoulder the burden of raising their younger siblings as well as being self-sufficient at an exceptionally young age. My mother grew up in government housing and, at times, was supported only by food stamps. Neither of my parents were afforded the opportunity to attend college, but this circumstance belies their fervent work ethic. My mother worked her way from a simple bank teller’s position to the level of branch management. She has since translated that experience into a management position in city government and is using her new position of influence to help promote green energy in our region. My father completed a local electrician apprenticeship immediately out of high school and worked diligently for years at the mercy of government budgets and the possibility (sometimes the all too true reality) of furlough. He kept his head down and plied his craft until one day he found himself being contracted by the US government to help negotiate nuclear non-proliferation initiatives overseas.
My mother and father have ceaselessly fought to provide a life for my sister and me that they never got to possess for themselves-a life of boundless opportunities to pursue whatever our hearts desired unfettered by happenstance or misfortune. They always implored me to never settle and to constantly pursue more than they were able to. With their support, I clawed my way out of the circumstances of small town life through the pursuit of education. With every AP test, term paper, and lab report; I wrote my way out of Oliver Springs. In my mind, I was running as far away as I could from the mediocrity and complacency that I witnessed crush the will of so many friends and relatives. I thought if I studied hard enough, I could permanently separate myself from where I grew up and never have to subject myself to it again. When I received the phone call that I had been accepted to medical school, I thought I had succeeded.
When I came to Quillen College of Medicine, I took an interest in the Rural Primary Care Track as a means of diversifying my learning experience. While it certainly has given me a unique first year experience, it has managed to bring my life full circle. I now find myself learning how to provide clinical care to people in a community that is uncannily similar to Oliver Springs. I am witnessing the clinical manifestations of rurally isolated communities that lack the resources of even an average sized municipality. I am meeting and caring for strangers that I seem to have known my whole life. The family stories I heard growing up of my ancestors who worked as coal miners, school teachers, farmers, and moonshiners have suddenly been given a much larger sense of narrative that transcends their humble geographical and socioeconomic setting. It is the story of rural America: living for the sake of it in spite of the outside world’s insistence that you that you do not matter.
In spite of their perseverance, these communities have become increasingly invisible to the rest of the world. They need advocates who understand their lives. They need people who will help fight for their right to a voice in order to stop the systematic exploitation of skilled labor by big businesses and government, to secure their access to healthcare, and to provide them opportunities to rise up through conscious endeavor rather than being resigned to maintain the status quo. There may be no medical diagnosis for these types of problems, but their outcomes are measurable. Programs, like Quillen’s Rural Primary Care Track, are exposing students in the nascent stages of their professional development to real world issues taking place not just in Africa or South America but in our own state and across our country as well. Through this exposure, I believe we can raise a generation of physicians that transcend the strictly scientific aspects of medicine and who strive to recognize and rectify the social inequalities that continue to plague rural communities. We can be instrumental in bringing a voice back to these areas and in getting them the resources they sorely lack. Until we can make this change, I am sure the Oliver Springs and the Rogersvilles of the world will go on about their business as they have for ages, but I am no longer ignoring these problems or running from my past. Instead, I am running towards it with eyes wide open for an opportunity to make a difference.