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No More Snakes In The Mountains? by Elaine Dillhunt Snakes were not mentioned in the 1977 final report of a group of allied health students working in Appalachia. They did, however, report finding several cases of diabetes, hypertension, sickle cell anemia, and child abuse. The omission of any mention of snakes is significant in that two years before, in a similar project report, snakes had a major role. A nursing student on a home visit found a snake in the bed of one of her patients. Arc we to conclude that there are no more snakes in the mountains? No, but there was a major difference in the educational experiences of the two groups of students. One group was Appalachian and the other was not. For the past several years, universities and colleges from all over the country have been sending their health science students into the Southeastern Kentucky mountains for a "clinical rotation." Their typical objectives are: broadening the clinical experience of the students, delivering health care to deprived Appalachians, recruiting health manpower for the area. A comparison of two 1977 summer health teams proves the point that regardless of how much money, time, professional energy goes into a program, it will fail to meet its objectives if Appalachian culture shock is operating. The University of Kentucky's Summer Interdisciplinary Team Experience (SITE) was a federally and state funded eight-week program with seven health science students recruited from as far away as New York. Its coordinators had doctor's or master's degrees. Over 1200 manhours went into its preplanning—not counting the time devoted to obtaining funds. The Southeast Community College's Appalachian Leadership Community Outreach (ALCOR) was a seven-week program funded with private foundation, state and federal funds. Its 10 health science students were recruited from Harlan County, Kentucky. Its coordinator had a bachelor's degree. About 120 manhours were devoted to preplanning, not counting the time for obtaining funds. Both programs were conducted in Harlan County. Their objectives were to broaden the professional experiences of health students and at the same time deliver health care to Southeastern Kentucky Appalachians. Subconscious objectives may be contained in the titles of the two programs: ALCOR is an "outreach" and SITE is an "experience." Paper (letters, proposals, reports, questionnaires, evaluations) in the SITE program exceeded that in the ALCOR program 10:1 by a "conservative" estimate. 35 Here are students' answers regarding achievements of the above objectives. Question: What did you do this summer? SITE 1. Our main project was a survey in the Tri-Cities area asking people if they knew about the home health service in the county; we found out they did not know about it. 2. We also relieved the home health nurses of some of their case load by taking seven of their patients and seeing them during the eight weeks. ALCOR 1. The main thing we did was set up ten community health centers in parts of the county where people don't utilize health services for various reasons.* We identified a volunteer in each of the communities while we were there doing screenings and health education programs and trained him or her to do simple first aid, blood pressure checks, weight and height checks. We supplied each center with an industrial size first aid kit, blood pressure cuff, stethoscope, scale, health education materials, snake bite kit, thermometer. 2. We performed about 2,000 screenings for diabetes, urinary tract infection, vision, hearing, blood pressure, sickle cell, parasites. Whenever we found something we referred the person to a Dr. and checked to be sure they had transportation . 3. We distributed 1200 pamphlets and brochures on things like breast selfexamination , warning signs of cancer, nutrition and things like that. 4. We gave out a bunch of dental kits, band aids, deodorant, shaving cream, and screening kits for lung cancer. 5. At the end of the summer we had a health fair with different screenings and tests and health education and about 75 people attended that. *The typical reasons are: distance (some are as much as one hour from the nearest health facility), transportation (many do not have cars), finances (if you can't pay...

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