Skip to content

Life, Family, and Community in Appalachia by Caroline Efird

SOHP field scholar Caroline Efird is a PhD student in the department of health behavior at Gillings School of Global Public Health.

Have you ever been to a goat and lavender farm in the Blue Ridge Mountains? If not, it is every bit as idyllic as you can imagine. On a breezy day in July, I had the pleasure of sitting down to iced tea with a vivid storyteller named Marilyn Cade, a (semi) retired nurse and farmer. While you will not be able to see all of the lovely scenery, you too can listen to Mrs. Cade’s interview by visiting the Stories to Save Lives: Health, Illness, and Medical Care in the South project found within the Southern Oral History Program’s archive.

In her interview, Marilyn Cade shared detailed anecdotes about her life, family, and community in the South Toe River region. As healthcare providers, Cade and her husband moved to the region about 45 years ago, to offer much needed medical care to a rural, Appalachian community. As an oral historian and public health researcher, I was especially interested in learning how the healthcare needs of her community have changed throughout her lifetime. In particular, Cade was deeply concerned about the recent closure of the labor and delivery unit at her community’s nearest hospital.

Marylin Cade: “…to think that the dangers for people having a healthy and safe delivery [in this community] have gone backward, I can’t put into words how shocked I am that medical care was better forty-five years ago. I really can’t get over it. And I don’t know what the new solution is going to be. We are feeling very sad and stricken by [the closing of our labor and delivery department]. Our children are through having babies, but our friends’ children aren’t finished. All the people that we know and work with, our whole larger community in the mountains has a deep threat to health. And it’s not just mother and child care, it’s across the board. If all you can get is excellent emergency care, then you have already put yourself in danger. People are in meetings, people are protesting, people are writing, people are doing everything that they can think of to do to help alert both the community to the fact that it’s changed and then the people who are doing this or the people who could change it. So whatever can be done right now in the face of this is being done.”

The words and actions of Marylin Cade and other members of her community are both haunting and inspiring. Local healthcare advocates are actively engaged in trying to raise awareness about this critical need, as they do their best to advocate for the return of the labor and delivery department. However, the current reality is that pregnant residents must drive over an hour on windy roads through rural Appalachia to reach a hospital that offers obstetric services.

I wonder, how can oral historians support the work that is already occurring in this community? We have documented their calls for change in a public archive, but what would it look like for us to reinforce their efforts in other ways? How can their stories help save the lives of women and infants in their mountain community? These are the types of questions that we Field Scholars are pondering as we head into the spring semester. Our goal is to share their oral histories more broadly, through both academic and public platforms, so that the voices of these narrators can help ensure that this “deep threat to health” does not go unnoticed by the people who have the power to change the situation.