Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, March 17, 1991 TAG: 9103170087
SECTION: NATIONAL/INTERNATIONAL PAGE: A/1 EDITION: METRO
SOURCE: PETER T. KILBORN THE NEW YORK TIMES
DATELINE: GRETHEL, KY. LENGTH: Long
Every square foot of Big Mud's damp banks seems cluttered with trash, like the lungs of many patients at Eula Hall's Mud Creek Clinic, about 7 miles along Big Mud.
Hall is the founder and de facto boss of the Mud Creek Clinic in the dingy hamlet of Grethel, although her title is simply "social director." A slow-talking, soft-talking woman, she is an example of how a private individual with modest credentials, modest means and a home-grown vision keeps a distressed community afloat.
This is black lung country. And in this remote coal-mining community of junked terrain, junked jobs and junked bodies, Eula Hall is a local legend who cuts red tape and badgers bureaucrats.
She is social worker, jobs counselor and benefits coordinator for men in their 40s and 50s, many illiterate, who sleep with breathing machines and have heart ailments from straining to breathe and who bring their privation and ailing bodies to the single-story brick command post of one woman's lifelong war on poverty and disease.
Hall, 63, is of this soil. She stopped school after completing the eighth grade. Her first husband, whom she divorced and has since died, was a miner, and her second husband has retired from mining with various ailments.
Three of her four sons cannot work because of illnesses and accidents incurred in the mines. She earns $22,000 a year and lives in a cabin that a now-defunct coal company built for miners.
"I was raised poor," she said, "and I've never gotten above my raisin'."
With the help of charitable contributions and an $800,000 subsidy from the U.S. Public Health Service, the clinic treats the physical and emotional complaints of about 8,000 patients, handling 50 to 75 a day.
The clinic's charges are in line with patients' incomes. The 53 percent who do not qualify for Medicare or who have incomes below the poverty line but still do not meet Kentucky's standards for Medicaid pay just $5 for a doctor's visit and $4 for a prescription.
The federal health service supports about 1,500 such clinics for the poor, 60 percent of them in rural areas.
From one room of a trailer behind the clinic, Hall also runs the Mud Creek Water District, which she helped organize two decades ago. It pipes potable water to 800 homes, 90 percent of which had contaminated wells when the district was organized in the 1960s.
From another room she distributes free food at the end of the month, when people's food stamps run down. From a third room she gives away clothes collected by churches.
Hall works from 8 in the morning until 7 or 8 at night, takes no vacations and pays for the gas she uses on her rounds in her four-wheel-drive Chevrolet Suburban, a gift of the Kentucky Department of Human Resources.
She ferries medicine, food, clothing and counsel to the housebound and brings them to the clinic, to the hospital and to government offices to apply for health and welfare benefits.
If people reproach her, it is for selflessness in the extreme. "She's a heroic figure," said Dr. Ellen Joyce, who came to Grethel from Watertown, Mass., to spend a decade as the clinic's principal doctor, leaving three years ago when her husband entered law school in Louisville.
"But it's hard to work with a saint sometimes," Joyce said. "She works till she's sick, which she is, with heart disease and arthritis."
Hall got the clinic off the ground in 1973 with a private donation of $1,400 and a commitment from two doctors from a nearby hospital to work two days a week. The clinic now has two doctors on its staff of about 10.
Jim Stewart, executive director of Big Sandy Health Care Corp., a non-profit organization that processes grants for the clinic and manages its accounts and pays its workers, said the clinic's cost has been climbing about 8 percent annually while the federal subsidy this year is up just 1.5 percent. "Right now our pharmacy is running out of medicine."
Helping men with black lung disease inflates the clinic's costs, both in treating them and in helping them qualify for disability pay. Many tests and procedures are required to prove the presence of this progressive condition in which an accumulation of coal dust ravages the lungs and breathing passages.
Miners who can prove they have the debilitating, sometimes fatal disease, as well as that it incapacitates them and that they contracted it mining coal, can tap their former employers - if they can be found. If not, the Department of Labor's Black Lung Disability Trust fund is available.
But nationwide, only 4 percent of the applicants last year qualified, compared with a peak of 48 percent in 1979, when standards were looser. And some have to spend years appealing for the benefits after rejections while the disease keeps wearing them down.
"You have to be near dead to get it," Hall said.
Among the patients in her clinic one day in February was Omery Compton, 59. He worked for several mining companies about 12 years, then worked for the state as a heavy equipment operator before being laid off.
He was back in the mines in 1980 and 1981, despite evidence of black lung, because other jobs were scarce. His lungs forced him to quit.
Compton was first denied black lung benefits in 1973. He said he had been rejected repeatedly at various levels of the government since, despite the positive findings of eight doctors. "I got a breathing machine now," he said.
The clinic provides other services, like refuge for physically abused wives, which Hall once was.
People here say Hall's forte is cutting red tape and badgering bureaucrats. She learned bureaucracy through her congressman, Carl D. Perkins, a Democrat and chairman of the House Education and Labor Committee, who died in 1984 and was succeeded by his son, Carl C.
A legend around here, the elder Perkins was the father of the first black lung legislation in 1969, and he would go to bat for Hall in wresting assistance from federal agencies.
John Rosenberg, head of the Appalachian Research and Defense Fund in the Floyd County seat of Prestonsburg, about 20 minutes north of Grethel, said many Floyd County people are illiterate and intimidated by officialdom, so Hall helps them file and negotiate claims for workers' compensation, black lung disability benefits, food stamps and other forms of aid.
Hall said her efforts to help the poor began in her youth. She was the second child and first daughter of the seven surviving children of L.D. and Nanny Elizabeth Riley.
The Rileys lived in Pike County, the turf of the Hatfields and McCoys, without electricity, running water or an automobile. She walked to the nearby grade school but did not go to high school because it was several miles away.
"My daddy was a saw logger and a farmer," she said, cutting trees for timber as well as to make furniture. The family's circumstances made Hall realize early the importance of health care.
"I saw mommy almost bleed to death when she had a baby because there was no doctor," she said. "I got typhoid fever as a child. I was 11. All of my hair come out from the high temperature. I had a little brother and sister.
"I always worried because there was no doctor to take them to. My dream from the time I was a child was a health facility where nobody would be turned away."
At 17, she married a miner. "He brutalized her," Joyce said. Hall divorced him after 33 years and married Oliver Hall, a retired miner who has heart and lung ailments.
Hall's small ranch house became her clinic after the first year when it outgrew the original site. She and her husband and her five children moved into a trailer. An arsonist looking for drugs burned the clinic down in 1982. Joyce said Big Sandy Health Care Corp. suggested the patients use a more distant clinic and that the staff stay home until decisions could be made about building anew.
Hall's response has become Floyd County folklore. Patients and a doctor, unaware of the fire, arrived the next morning. Hall and a doctor set up shop on a picnic table, under a willow tree. They needed a telephone to order prescriptions. Hall called the telephone company and asked for a phone on the tree. Joyce told the story this way:
"`We don't put phones on trees,' " they told Hall. " `You put them on poles at coal mines,' " Hall told them. " `You can put a phone on a tree. I got to stay in contact with these people.' She got the phone."
They worked that way for three days. Since school was out for the summer, the School Board let her move the clinic into the elementary school. Then the state Department of Health and Human Services bought a secondhand trailer for her, the one that is now the water district office.
To build a fully equipped new clinic, she needed $400,000. The Appalachian Regional Commission, a federal development agency, agreed to put up $320,000 if she raised $80,000. With quilt raffles, radiothons and reaching for donors far beyond Kentucky, she raised $120,000. The new clinic opened in late 1984.
Now that clinic, too, is overtaxed, and so is Hall, who has clients parked in her tiny office, with books for children on one wall, waiting to see her for help with their foods stamps, Medicaid, or other government benefits.
Their waits can stretch for hours, particularly when Hall gets a call from someone sick or an abused woman, and she darts off to her car. "But they'll wait on me," Hall said. Except for emergencies, she said, "They know I don't want to put anybody in front of anybody."
by CNB