APPALACHIAN CASE STUDY #2

Leona Sperry, aged 74 years, lost her husband, a preacher, to emphysema 2 months ago. Since that time, she has been living alone on a limited income from her husband’s Social Security. Mrs. Sperry states that she has lived in the same West Virginia community all of her life, just like her parents and grandparents. She is known in the community as Miss Leona and is respected for her knowledge of folk medicine and “deliverin’ babies,” which she has done as long as she can remember, just like her mother and grandmother.

All but one of her nine children live within 50 miles. Miss Leona does her own cooking, bakes biscuits and bread twice a week, and makes large pots of meat stew so she does not have to cook every day. A farmer neighbor supplies her with milk, eggs, and meat in trade for using the land from her small farm to pasture his cattle.

Even though she only went to the third grade, she enjoys reading stories in the Reader’s Digest, which she keeps on her bedside table. She also enjoys talking on the telephone with her children and sister, who lives about 5 miles away. Miss Leona lives on top of a hill and has to cross a footbridge to get to her home. Her driveway ends at the footbridge, requiring her to carry her groceries up a steep incline with many steps. Sometimes, a neighbor or the postman delivers her groceries when her children are unable to bring them to her.

Miss Leona’s granddaughter, a nurse who lives out of the area, called the Visiting Nurse Association and requested that someone see her grandmother. Miss Leona tells the visiting nurse that she has had arthritis in her hands, hips, and knees for many years. She has also suffered from “low blood” all her life. Now, she has other health problems as well, and some chest congestion, which is not responding to her usual treatment.

Her most recent health concern, she says, is “heart problems,” which her physician, Dr. Adi, tells her is from her high-fat diet. However, Miss Leona believes her heart problems were brought on by her husband’s death, because she did not have them until after he died. Her physician also gave her a jar of salve to put on a leg wound caused by an insect bite, which became infected when she scratched it in her sleep.

On her last visit to her physician a month ago, he referred her to a heart specialist at a medical center 50 miles from her home. He also wanted her to make an appointment with an arthritis specialist. So far, she has not made an appointment with either specialist because she does not know when one of her children will be available to take her to the medical center.

Besides, she says, her children have their own families and jobs, and she does not like to bother them with her problems. In addition, she tells you that she is looking forward to her 16-year-old granddaughter, who is 3 months’ pregnant, coming to live with her in a couple of months. After all, she misses being a midwife.

She admits not using the salve given to her by Dr. Adi because he told her to apply the salve according to the instructions on the jar. She has been drinking the brine from her home-canned pickles for her “low blood,” drinking ginseng tea for her arthritis, and applying a poultice made from bacon grease on the leg wound.

She tells you that she does not want to return to Dr. Adi because she cannot understand him, he does not listen to her, and he did not help her when she last saw him. She explains that she is a good “Christianwoman,” has lived right all her life, and does not interfere with her neighbors’ lives. She rarely misses Sunday church services because all her neighbors go to the same Baptist church and she “allus” has plenty of volunteers to carry (take) her to the church.

Study Questions

1. Why do the members of her community call Mrs. Sperry by the name Miss Leona?
2. What can the nurse do to assist Miss Leona to decrease the barriers to needed health care?
3. What might Dr. Adi do to ensure a more-trusting relationship with Miss Leona?
4. What historical precedence is there for distrust of “outsiders” in Appalachia?
5. What evidence do you see of the “ethic of neutrality” in this case study?
6. What is the difference between a minister and a preacher, as practiced by Baptists in Appalachia?
7. What do Appalachians mean by the term “low blood”? What are some folk treatments for this condition?
8. What advice would you give Miss Leona about her folk remedies?
9. What might you do to encourage Miss Leona to make appointments with the specialists recommended by Dr. Adi?
10. How might you help Miss Leona eat a more-nutritious diet?
11. What