News: CJ Exclusives

A steep road to care

Driving long distances to see a doctor or for emergency care just part of life in remote Graham County 

David Lee Satterfield of Robbinsville says medical care is in short supply in Graham County, but residents stay there because they like the area and have relatives nearby. (CJ photo by Dan Way)
David Lee Satterfield of Robbinsville says medical care is in short supply in Graham County, but residents stay there because they like the area and have relatives nearby. (CJ photo by Dan Way)

ROBBINSVILLE — David Lee Satterfield is a big man stuffed into blue, bibbed overalls. He’s wearing a well-worn orange baseball cap, and a thatch of impressive white whiskers flow around his weathered face. When he shakes your hand the powerful grip and leathered skin are evidence of a life hard work. 

It’s ironic yet sobering to hear Satterfield, who is 68, tell how his pint-sized granddaughter may have saved his life by getting the better of him. 

“She likes to wrestle with PawPaw,” Satterfield said of the active 2-year-old. “She run across the couch, and like she slid into home base, she put both knees right in my hip.” He felt a sharp pain, and his skin immediately began turning blue. 

“The doctor said it was a blessing she did knee me because it caused the blood to come to the top of the skin. It had been bleeding a couple of days,” said Satterfield, who didn’t realize he had a problem. He had been stiff, sore, and swollen, but shrugged it off as a pulled muscle or arthritis. 

It was more ominous. As it turned out, a ruptured blood vessel was steadily spurting blood into his body.  

His wife drove him from their remote Graham County home to Swain [County] Community Hospital in Bryson City, some 40 minutes away. 

“I almost passed out a few times” Satterfield said. “If it had been up to me to drive over there, I would never have made it.” 

He was told he might have lost as much as four pints of blood. 

Emergency room doctors stabilized him that night, but transferred him by ambulance to Harris Regional Hospital in Sylva the next morning because no beds were available. He stayed at the Jackson County hospital nearly three days. 

Satterfield said if his granddaughter hadn’t been horseplaying, “I’d probably bled to death.” He takes the undiagnosed injury, sudden emergency, driving distance, and hospital shuffling in stride. After all, his 83-year-old mother had an even worse ordeal. She suffered a heart attack several years ago, and was evacuated by medical helicopter to Asheville, a nearly three-hour trip by ground transport. She underwent a triple bypass. 

“You just have to put up with it,” Satterfield said, echoing what person after person said when asked why they live in such a severely medically underserved county. 

“It makes you rethink. But this is home. I own my own place here and everything, and get along with all the people here,” Satterfield said. “You’re born and raised here. All your kin people was born and raised here.” He worked all over the United States as a heavy equipment operator for Phillips and Jordan, a national civil construction company once based in Robbinsville. 

He returned home and is semi-retired. 

“I don’t never go to the doctor here in Robbinsville,” Jamie Carver said as she waited at the Graham County Health Department for an appointment about WIC benefits. At the time, Carver was 33 weeks pregnant and was making the 1 ½-hour round-trip to get the prenatal OB-GYN care unavailable in Graham County. 

“I’m not worried,” Carver said. But what do women do if they go into labor and don’t have anyone to take them to the hospital? “You would have to drive,” she replied, seemingly bemused by the question. 

Mike Stevenson, CEO of Murphy Medical Center in Cherokee County, said a little more than 50 percent of Graham County residents go to Bryson City and Sylva for hospital services, usually because they see doctors there. 

“We get probably slightly less than half of the patient population load from up there,” Stevenson said. “There are a couple of physicians in Andrews on the eastern side of our county down the hill from Graham County. The patients from over there will go to their doctors, and they kind of migrate this way and utilize this hospital” in Murphy. 

Generations of mountain people carved hardscrabble communities out of logging camps, lumber mills, and family farms in this Tennessee border county. They are reconciled to living in what experts call a medical desert. They see it as fair exchange for living far from the frenzied crowds, crime, family and social decay of urban settings. 

But the population is aging. Twenty-three percent of its 8,541 residents are older than 65. Loss of the tobacco cash crops has decimated family farms. The handful of factories whose payrolls composed the lifeblood of the business community have folded along with many shops. 

Twenty percent of residents live in poverty, and the population declined 3.6 percent from 2010 to 2017. Graham was the only western North Carolina county to shed population. It has a population density of 30 people per square mile, the sixth-lowest among North Carolina counties. For comparison, the state average for population density is 204.5, and Mecklenburg County is 1,932. 

“Most people’s happy here,” Satterfield insists. “We sort of help one another. If my neighbor needs help I go and help him. If I get down sick he’ll come and help me. We’re sort of a tight community and stick together.”   

“The very nature of mountain people is still there, especially with the older folks taking care of your neighbors, having pride in your family, and community, and also the religious base of the community is still very strong,” said Butch Sanders, director of the Graham County Department of Social Services. 

“The pace is much slower than it is in the outside world, and with that comes a kind of a purity of everything,” he said.

“Here in the mountains this is a proud, independent culture,” Sanders said. “Farmers, for the most part, and hunters, gatherers, etc. They’ve been independent as long as you can see in the past. By that very nature people have a great hesitation to come into our offices for assistance.” 

His clientele is primarily senior citizens and younger people, mostly women. 

The older population has a strong work ethic, and battles despair due to job scarcity. Separation anxiety builds when younger family members move away in search of employment. 

Younger people fight their own inner turmoil. 

“If you can’t make any money in this farm-based population with not only crops, but cattle and goats, livestock, if you can’t raise enough to support a family with that, then of course the guilt thing,” Sanders said. Breaking the strong ties that bind not only affects immediate family, but cousins, nephews, nieces, grandparents, neighbors, and members of the community, Sanders said. 

Graham County’s population is 7.4 percent Native American. Many tribal elders don’t speak English, and fundamental culture shifts are occurring all around them, said Sanders, a member of the Eastern Band of Cherokee Indians. 

“You can see the conflicts Cherokee people have to go through on a constant basis with the elders that are still holding on to the ‘quote-unquote’ cultures and traditions like the language.” Or the use of organic home remedies made with herbs, tree barks, honey, and roots to ward off minor illnesses, lower cholesterol and blood pressure, reduce fever, and cure thrush. 

At the same time, they warn younger tribal members against fast-paced, worldly fixtures such as the internet, smartphones, TVs, and movies. 

The white and Indian populations increasingly cope with the pressure of social upheaval through substance abuse — primarily marijuana and methamphetamines  but some black tar heroin, and, increasingly, opioids. 

“It’s not uncommon to hear of or see a van that’s been transported into a kitchen — a portable meth plant,” Sanders said. 

In an area known for illegal alcohol stills, Sanders cautions against suggesting meth is the new moonshine. 

“I wouldn’t draw that precise correlation, because moonshine is kind of like mountain medicine in a way,” he said. “I don’t think it’s quite the same connotation.”