"Public Health In Appalachia Essays From The Clinic And The Field" Edited by Wendy Welch--Book Review

Welch, Wendy, Editor: Public Health In Appalachia Essays From The Clinic And The Field (Jefferson, North Carolina, McFarland And Company, 2014)

This book is one work in a series of books from McFarland and Company in Jefferson, North Carolina, called the Contributions To Southern Appalachian Studies series which in the last twenty years has produced roughly forty books.  It is a book I should have read and written about promptly after it was published in 2014 since one article in the book quotes substantially from an article which I co-authored in 2005 with Dr. Heather Ambrose, Ph.D. on the topic of "Culturally Appropriate Counseling and Human Services in Appalachia: The Need and How to Address It" which was published online by the American Counseling Association and which we delivered in a presentation at the 2005 National Conference of the ACA.  However, that quotation and citation is not the best reason for me or anyone else to read this book.  The real reason you should read it is that it is a compilation of ten very cogent and informative essays written by more than a dozen human services and/or education professionals in the Central and Southern Appalachian region.  The subtitle, "Essays From The Clinic And The Field", explains very aptly why I consider this book to be a fine resource for human services and education professionals working in the region.  It is taken directly from the mouths of more a dozen of the "horses" who have been pulling the load in some very tough professions in the region and who clearly demonstrate their professional skills and cultural competence in their writing.  

In the opening paragraph of the Foreword, John Dreyzehner addresses one of my pet peeves for nearly all my life which I have always confronted in the header to this blog.  Mr. Dreyzehner has begun his introduction to the book by saying: 

"Many years ago a young college student from Chicago signed up for a brief Catholic mission experience deep in rural Appalachia.  One of the first things the ignorant young man noticed was that the locals and the host clergy didn't pronounce "Appalachia" right.  What they said sounded more like "apple-AT-cha".  Fortunately, he did not try to correct them, nor they, more kindly, he in saying "app-a-LAY-cha".  That was the beginning of an education in cultural sensitivity and cultural literacy.  There was a lot to learn." (Dreyzehner, Public Health In Appalachia Essays from the Clinic and the Field, p. 1)

I cannot think of a finer way for any non-native resident of Appalachia to begin a discussion of the region.  My own aforementioned header to this blog uses nearly identical words to address the same topic:

"An ever growing site of non-fiction,flotsam, fiction,memoir,autobiography,literature,history, ethnography, and book reviews about Appalachia, Appalachian Culture, and how to keep it alive!!! Also,how to pronounce the word: Ap-uh-latch-uh. Billy Ed Wheeler said that his mother always said,"Billy, if you don't quit, I'm going to throw this APPLE AT CHA" Those two ways are correct. All The Others Are Wrong." (Roger D. Hicks, see above)

This book makes a meritorious attempt in several of the articles to address that need for cultural competency and the same article which quotes my work, written by Bob Franko, also quotes and cites  the work of my friend and mentor Loyal Jones from his book "Appalachian Values" on which I have based much of my writings about the need for cultural competence in writing about or working in Central and Southern Appalachia.  It was quite refreshing to see anyone directly addressing the widespread and deliberate mispronunciation of the name of our homeland.  One of my very early blog posts,  and I am proud to say one of the most frequently read on this blog, directly addressed this issue.  I also frequently mention the excellent, early Appal Shop movie "Strangers and Kin: A History of the Hillbilly Image", which is one of finest attempts ever made to address the negative attacks on Appalachia and Appalachians.  Those of us who have fought this battle for most of our lives can truly appreciate the effort by Franko and Dreyzehner.

But there are numerous other reasons to appreciate this book and the greater series from McFarland and Company.  Nearly every article in the book has direct applications for both professionals working in the region and native Appalachian who simply want to be understood by the greater America around us as an unappreciated and frequently maligned minority which are generally denied minority status.  The first section of the book contains four articles which address a quartet of the most serious problems facing the region today: cancer, diabetes, drug addiction, and inadequate dental care. The second section is comprised of three articles about culturally appropriate health care delivery systems.  All three of these articles are well written by individuals who understand exactly what they are talking about.  Steve North, M. D. wrote a very good article about telehealth in Appalachia.  But I must take offense with the general need for telehealth in Appalachia or anywhere else in a country which mistakenly claims to be the most advanced in the world.  I am still offended that in America we have reached a time where it is necessary for people in any part of the country to participate in telehealth in order to participate in the health care system.  I also take offense when I am seen at one of the best hospitals in the entire southeast and I am unable to see a person who is actually a medical doctor.  I have worked with and know several highly qualified nurse practitioners and physicians assistants but I will never believe that this country could not, if politicians and health care administrators would allow it, produce a health care system in which every patient would meet with a physician at the moment of initial contact.  Such a system would require us, as a nation, to actually create new systems of taxation, education, and healthcare delivery. Such a system would allow every qualified applicant to be accepted into a medical school without fear of losing their future freedom of choice because of paying off education loans.  Other countries with far less average gross domestic product pay for a college education for every qualified applicant.  We should also.  If those applicants choose to become nurse practitioners or physicians assistants instead of becoming doctors, we should support them just the same.  A free public college education for every qualified applicant in America would vastly increase our gross domestic product, average income, and general effectiveness as a nation.  But for the time being, I do admit that the current system of using medical practitioners who are less qualified than full medical doctors does give us the ability to delivery minimally effective health care to the greatest number of patients especially in remote areas of Appalachia, the Deep South, and the far west.  But it should never be accepted as the best or most widely used system. 

The third section of the book contains three articles on cultural theory and clinical policy.  One of those articles written by Tauna Gulley, RN, on fatalism and its effects on Appalachian youth.  Fatalism is one of the old topics which has been repeatedly used as a club with which to beat Appalachia and Appalachians.  In my opinion, this article could have been left on the cutting room floor and the overall book would have been better.  Fatalism is an easy place to fall back on if an author is attempting to continue the denigration, defamation, and defeat of Appalachia.  It is not nearly as prevalent or important as some people believe. At the time of publication of this book, Ms Gulley was a professor of nursing at the University of Virginia College at Wise.  Today, she is the coordinator of a nursing program at the University of Pikeville and apparently now holds a doctoral degree.  I do not know her or her educational or personal background.  But it has generally been my experience that the topics of fatalism, familism, and internecine squabbles, when used in reference to Appalachia are most generally used by non-natives of the region as a way to justify  what they mistakenly believe to be our shortcomings as a people and a region. 

Do not allow the couple of negative assessments I have made of individual articles to overly color your opinions of this book.  The strengths of the work strongly overcome any weaknesses a couple of articles may exhibit.  Read the book and benefit from it.  Read it with a critical eye and use the parts of it you are willing to accept at face value.  Use the parts with which you disagree to broaden your own knowledge base about how to overcome or counterbalance the alleged weaknesses those authors may discuss.  And realize that the opinions of any particular author may well not represent those of the editor or the other authors.  This is a book from which to learn. It is a tool.  Use it wisely!