WISE, Va. — COVID-19 has claimed more than 700 lives across the region’s coalfield counties, but that total could easily have been much higher without the work of the Health Wagon.
A health care institution serving residents of central Appalachia since 1980, the Health Wagon treated double its average number of patients in 2021 and modified its core mission to make treatment of the novel coronavirus one of its four “pillars of care,” along with medical, vision and dental.
Health Wagon Medical Director and Board Chairman Dr. Joseph Smiddy of Kingsport calls the past two years a “very stressful” but “needed” time in the organization’s history.
“The Health Wagon, because it’s not a hospital, has had the tremendous opportunity to use the nurse practitioners and the mobile clinics to have an amazing impact — saved hundreds of lives, treating people with COVID. It’s just been unbelievable,” Smiddy said earlier this month.
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“There would have been hundreds of people die that have been saved by the Health Wagon. Because I am a doctor, I get to say everything that happens at the Health Wagon is real. There is no fake medicine, no fake treatment. Everything that has happened has been to encourage patients with COVID, and their underlying diseases, that they can get help. We worked on an outpatient basis. It’s been a very stressful and very busy time but also a very needed time,” Smiddy said.
Far Southwest Virginia wasn’t immune from the global pandemic in 2020, but the waves of surges by multiple variants with exponentially higher rates of transmissibility seemed to target the coalfield counties and its health-compromised populations.
“We are a lung belt of asthma and COPD. I’m a pulmonologist. I get to say COVID has hit our population harder than anywhere else in America. And we already had lung disease before we got COVID,” he said.
While more densely populated parts of the region had higher numbers of cases and deaths, the impact in central Appalachia has been acute.
“It’s been unbelievable because our hospitals were overwhelmed all through our region. I’ve called on behalf of patients, and they’d say its 12 hours wait in the emergency room or the hospital is in diversion,” Smiddy said.
“The Health Wagon, fortunately, is not a hospital. Here we are with seven nurse practitioners, three mobile vehicles, three fixed clinics and thousands of monoclonal antibodies and the ability to get thousands of test kits. The Health Wagon is an example of test-and-treat right on the spot. We’ve been doing that as quickly as monoclonal antibodies were available. When Paxlovid [drug treatment] came on the market, we gave some of the first doses in this entire area,” he said.
Dr. Teresa Tyson, a nurse practitioner from Coeburn, has served as president and CEO of the Health Wagon for more than 20 years. These mountains run through her soul. Her father was a coal miner, and her mother dreamed of working in the mission field. Now 81, she has watched her daughter turn these hills and hollers into a medical mission field.
Everything about this work, Tyson said, is a “God thing.”
“We are a faith-based clinic, and you will see those resources just supernaturally line up. It is incredible to step back and see the hand of God upon this mission and how he has scaled it and how he’s paid for,” Tyson said with a broad smile.
Asked about their response to COVID, Tyson expressed pride in her team.
“We underpinned our public health system. Our staff put their own lives on the line to stand in the gap from keeping COVID from decimating this vulnerable population here,” Tyson said.
Numbers help tell this story for Tyson, and her staff of 50, who — in 2021 — performed nearly 15,000 COVID tests, gave 3,800 COVID vaccinations, infused more than 5,300 doses of monoclonal antibody treatments and distributed 40,000 masks.
The staff had more than 35,000 patient encounters in 2021 — the most in Health Wagon history — with the vast majority dealing with COVID-19. Along the way they established one of the nation’s first post-COVID treatment clinics.
Once monoclonal antibodies became available as a treatment for the virus, Health Wagon was the first to operate a mobile monoclonal antibody infusion center. Demand was so high they established a facility in Coeburn.
At one point, Health Wagon was giving 100 to 150 monoclonal antibody treatments per day. By year’s end they’d given more monoclonal antibody treatments — 5,300 — than every other health provider in Virginia, except one large regional health system, Tyson said.
“We never dreamed in a million years we would have to open an infusion clinic, but if there is a need we will find a way to do it. Whatever it takes we will find a way because an infusion center isn’t something you would routinely do in an outpatient clinic is give IVs, but we had to. We had to step up,” she said.
Tyson began by calling Pikeville Medical Center in Kentucky to borrow two IV pumps.
“We could give the monoclonal antibodies, but we needed additional equipment,” she said.
Health Wagon providers worked closely with Ballad Health System, Clinical Director Dr. Paula Hill-Collins said.
“Ballad was very good to us because they were overwhelmed too. It was a total collaboration with us and the health care systems and health departments. I don’t know how Ballad did all they were doing and maintained their other hospital patients. People could not get treatment for routine illnesses because it [hospital emergency rooms] was so overwhelmed. People wouldn’t go to the ER. We were going into people’s homes to give antibodies because they were afraid to go to the ER. … We would go into homes to test.”
During crunch times, Tyson said she and Hill-Collins were on the phone almost continuously from 6 a.m. until late at night trying to arrange care and schedule treatments.
“We never lost a person [treated] with the monoclonal antibodies. It’s all about getting to people fast and getting the treatment started quickly — within one or two days. You’ve got to move quickly,” Tyson said. “I think, at the end of the day, the Health Wagon will be noted for keeping this very vulnerable population from being decimated in this region.
“I believe that with all my heart because I know our staff is 100% fully vaccinated, but about 30 of our 50 staff had COVID — most before the vaccine was out. My staff are heroes. Everyone from that front line that intercepts the people to our nurse practitioners and infusion techs, they put their lives on the line.”
And they’re still treating, administering 16 antibody treatments just last week.
Initial and post-COVID care
Both women agree health care providers everywhere were overwhelmed by the volume of seriously ill COVID patients.
“What has shocked me is I think the medical community has let down the patients during COVID. We never did think, ‘OK, you’re positive, good luck with that.’ If I had a dime for every time I’ve heard that and they would get to us and get worse; we treated it from the get-go,” Tyson said. “We treated it naturopathically. We had vitamin regimens that we did. We never lost anybody we could get to early.
“We gave people pulse-ox [pulse oxygen], we ordered nebulizers by the hundreds. People who were acutely ill and having breathing problems; we could give steroids directly to the lung that would abate that. We gave blood thinners, we gave Vitamin C.”
Once patients recover from the virus, many come back for follow-up care.
“We’re still doing free chest X-rays on a daily basis, following up on people who had COVID because COVID can cause lung cancer-looking nodules. The folks who’ve had moderate to severe COVID need to get a follow-up chest X-ray,” Smiddy said.
The Health Wagon has treated about 600 COVID patients who suffer long after recovering from the virus.
“If you survive the COVID, the long-term effects are horrific,” Tyson said.
“Everybody is trying to get onboard with post-COVID clinics. We’ve seen that right after seeing our first COVID patients that they were having residual and possible long-term effects from COVID. We have saved lives through that clinic.”
The clinic is now conducting research after an early patient was diagnosed with a saddle pulmonary embolism, a rare large clot in the pulmonary artery, which can be fatal if not treated properly.
“We’re screaming to people about COVID, but they really don’t understand what we’re seeing,” Hill-Collins said.
Vaccines amid distrust
Since COVID began in 2020, nearly 39,000 residents of the Health Wagon’s six primary service counties have been diagnosed with the disease — including more than 26,000 in the past year. However response in those same counties to potentially life-saving vaccines has been far below state averages.
About half of the residents of each county in their service area are fully vaccinated against COVID-19 while 18%-25% of residents there have received a booster dose, according to the Virginia Department of Health.
“There is so much distrust of the government. That’s why people don’t want to take their vaccines,” Hill-Collins said. “I didn’t really understand it, but there is a spirit of distrust of our government on every level that people do not trust the government and what they’re telling us.
“They do trust Teresa and myself, and we were out there telling these stories — get your vaccine, get your vaccine — please. But the overall theme of ‘I don’t want to get vaccinated’ is ‘I don’t trust the government’.”
Tyson theorizes it traces back to people’s Scots-Irish heritage, moving to the mountains to escape oppression, holding a strong allegiance to the region but with a very independent spirit.
Do not call us hillbillies
Both women are passionate about dispelling the unfair, negative stereotypes these people are saddled with and an apparent lack of respect from Richmond.
“These people have been taken advantage of far too long. It was the coal barons at the turn of the century that perpetuated these negative stereotypes of the poor Appalachian hillbillies that Paula and I still deal with it to this day,” Tyson said.
Hill-Collins succinctly sums it up, saying, “Call us anything you want, but do not call us hillbillies.”
“Most recently with the drug companies that targeted the region that caused the opioid crisis because they know where the highest disability rates are in the nation — they are here. They targeted this region, and we are still dealing with the fallout of that. So people here continue to be taken advantage of.”
The region’s poor health is reflected in a new County Health Rankings report compiled by the University of Wisconsin Population Health Institute. Southwest Virginians experience some of the poorest health outcomes and face some of its most challenging health factors in the state.
The annual report ranks each locality in every state based on a series of health outcomes and the underlying factors that influence health, such as access to clinical care, food insecurity, alcohol and drug use.
The cities of Bristol and Norton, along with Buchanan, Dickenson, Lee, Russell, Smyth, Tazewell and Wise counties all rank among the bottom 25% of Virginia’s 133 localities, according to the report.
“Virginia is a very wealthy state and continues to turn a blind eye to this region and doesn’t give resources to this region like they should,” Tyson said. “We talk about it everywhere we go because we’re trying to change the perceptions of our region. These are beautiful, wonderful people — the best people on the face of the earth. It makes you ashamed to be a Virginian when there is such disparity that our people live 20 years less than our counterparts on the eastern shore. Virginia should be ashamed.”
Tyson said the disparities are stark given the economic circumstances — coupled with health outcomes — in areas separated by roughly six hours by car.
“To add insult to injury, we’ve been without a medical director here [LENOWISCO district] for two years — during a pandemic. Three areas here do not have a medical director,” Hill-Collins said. “We step up and try to help and they say, ‘Sorry, guess you have to use your own money.’”
Today the three Virginia Department of Health managed districts that serve all of Southwest Virginia remain without a full-time medical director. Dr. Sue Cantrell, who oversaw the LENOWISCO district since 1991 and the four-county Cumberland Plateau District since 2016, retired Jan. 1, 2021.
Dr. Karen Shelton, who oversaw the Mount Rogers health district since 2016 and was named interim medical director of the other two districts upon Cantrell’s exit, resigned in July 2021 to take a position with Ballad Health System.
In the nearly one year since Shelton’s departure, Dr. Noelle Bissell, medical director of the New River district, has been tasked with overseeing the other three on an interim basis.
“Luckily, the health department here was under the direction of Dr. Cantrell, and she had a phenomenal team and she had them so well trained. They followed her heart and her passion. She hired some good, quality people,” Hill-Collins said.
Founder’s seal of approval
Sister Bernadette Kenny established the Health Wagon out of the Volkswagen Beetle that she steered around those twisting mountain roads more than 40 years before. A nurse practitioner, she now attends events — like their recent dental clinic groundbreaking — to show her ongoing support.
“It has shown in COVID, without it many people here would not be living,” Kenny said. “I, myself, got COVID, and they took care of me. I chose to go to Health Wagon rather than go to a hospital.”
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