West Virginia has a reputation for being nearly the worst for everything in the US, except for the beautiful scenery. We Mountaineers have the 4th highest poverty rate in the United States: 16.9%, equal with Alabama and just slightly better than Kentucky, Mississippi, New Mexico and Louisiana.
I was, therefore, astounded when NBC Nightly Newsfeatured our hometown, Morgantown, WV (poverty level 27.7%), as having the lowest unemployment rate (2.7%) in the nation in this past December's survey. (The rate has since risen, but we're still among the lowest in the country.) As a nurse-midwife and women's healthcare provider in a private clinic, I see life through the eyes of my patients. If we're doing well, it must be catastrophic everywhere else.
Molly McDonald sits on the guest chair in my exam room. She's a 28- year-old housekeeper at the hospital. There are tears in her green eyes. "I don't know what's going on," she tells me. "Ever since I went back to work, I can't quit crying. I love my job, don't get me wrong and I'm grateful to have one, especially since Leonard got laid off at the sawmill… New home building has slowed and they ain't selling much lumber."
"How old are your kids?" I ask sympathetically.
"Just four months and three. Leonard's at home with them now but he's drinking and in my face all the time, complaining that I don't give him much love. But I'm just so tired…" The patient trails off and stares at the white cupboards over the sink. "I'm just so tired of holding the family together."
I can't fix Molly's family or get Leonard his job back, so I give her a hug and a prescription for anti-depressants.
Rose Esposito waits for me in the thin, blue cotton exam gown on the end of the examination table, swinging her legs. The thirty-four year old always makes me laugh with her stories of her trips overseas as a flight attendant on a corporate jet. I glance at her chart and realize I haven't seen her for twenty-one months.
"Hi Rose. Long time no see. I missed you last year."
The usually cheerful, single blond glances down at her bare feet. "I know. . . I should have come, but I lost my health insurance. Actually I lost more than that. I lost my job too. I've been looking for work all this time and there's nothing in the travel industry in Morgantown. . . I could move, I've thought of it, but I just bought a little house and fixed it up real nice." A smile spreads across her pleasant oval face, then drops away. "Now I'm about to lose my home too. I don't think I could get what I've invested even if I could find a buyer."
I take a seat on my rolling grey exam stool and rest up against the wall. "I thought you worked for that big mining engineering firm in town. What happened? They aren't laying off workers are they? I hadn't heard anything. . ."
"No, not yet. It's just a cutback. The CEOs had to sell one of their private jets…" I see some tears now and she wipes her eyes with the back of her hand. "But, I've got to do something. I'm behind two months and I'm afraid of foreclosure."
I can't pay the mortgage on Rose's sweet little cottage, so I change her birth control pills to generic so that she can get three packs for twenty dollars at the discount pharmacy. As the once bouncy young woman slumps down the hall, I call after her. "Keep your chin up."
Cindy Tottle, dressed elegantly, as usual, in her white stole and pale wool slacks, is standing when I enter the exam room, in front of the small corner mirror. She's fixing her carefully coiffed silver hair. Cindy is a divorced, fifty-year-old owner of an interior design business in the new shopping complex at the edge of town. When she turns, I see that her face is etched with worry. "I've closed the shop," she says by way of a greeting.
I frown, plunk down on my stool and review her chart. The exam was listed as follow-up on hormone therapy. "What happened? Last year you were doing great."
"I was until September, but I just can't afford to keep going. There's no new building going on in town, except for student housing. No new homes. No business. No contracts." She sits and carefully crosses her legs.
"So what are you going to do?"
"I don't know. I have two kids in college, maybe pull them out. My mom has a farm in Preston County. I thought I might move back there and commute to town, put the condo up for rent, if I can find renters. I used to teach design, but I don't think the department at the U. is hiring."
I think of myself as a problem solver but I have no clever suggestions for Cindy and wonder, as I rummage in the lab for samples of estrogen patches, how our women's health center is holding up. I know we had to take an advance from our credit line to pay the taxes. At least we have a credit line. Most people don't. When Cindy says goodbye she reminds me that this is the last month she will have insurance and she may not see me next year. I tell her about our 30% self-pay discount.
According to a study by the Department of Health and Human Services, nearly half of women (45%) have failed to seek medical care in the past year because the cost was too high. This includes skipping doctor's visits, recommended medical procedures and medication for themselves or their families. That will be Cindy and Rose unless they find work with decent health insurance.
In addition, more than 40% of women report their health has declined over the past five years and the most common reasons given for this are stress and weight gain. 60.9 % of workers earning between $5.15 and $7.00 per hour are women. That would be Molly. Her insurance co-pay for the visit today was $30.00.
If you're driving one day over the beautiful West Virginia mountains from DC and across the bridge into this economic oasis, you'll see no closed factories or boarded up Circuit Cities along the interstate but that's only because we never had factories or Circuit City here. The major employers in Morgantown are the medical center, the big pharmaceutical company, and the university, and they're still doing great. The coal mines in the surrounding counties continue to haul out the black gold and the high tech corridor west of town is booming. It looks nice on paper and we're glad, for once, to get some good press, but I see in the lives of my patients that already the recession looms over us.
If NBC didn't tell us we were doing so well, Molly, Rose, Cindy and I wouldn't know.