In August, Jennifer Church’s dad suffered a brain aneurysm in McDowell County. Her stepmother immediately called 911. She was told an ambulance was being sent to their home in Iaeger. It was 10:30 p.m.

The ambulance didn’t arrive until after midnight, Church said. The responders told her they couldn’t find the house.

After a failed attempt at securing flight transport, Church said, the emergency responders took her and her dad to Welch Community Hospital for care — about a 30-minute drive from Iaeger without bad road conditions or difficult weather.

In rural southern West Virginia, access points to medical care can be few and far between, and the geography and population of these communities present difficulties — especially in emergency situations — that are easily avoidable in more urban areas.

Early in the morning, the doctors in Welch told Church her dad needed treatment they couldn’t give him. They sent him via helicopter to Cabell-Huntington Hospital, where he was rushed in for surgery at 7:30 a.m. He died six days later.

“Nothing went right for my dad that night,” Church said. “This was uncalled for, though. The extreme wait period cost my dad his life. Prompt attention could have maybe saved him.”

Teresa VanDyke, director of McDowell County 911 and Office of Emergency Services, said response times for ambulances dispatched in the county can be anywhere from 10 minutes — usually for scenes closer to Welch, where there are more resources — to 40 minutes, a norm in the more rural, less populated communities that make up a good portion of the county.

Emergency responders can be hindered by anything from weather and difficulty navigating unfamiliar areas to trains stopped on tracks that can block traffic, VanDyke said. On a case-by-case basis, emergency responders can call in for flight transport at their own discretion, but again — as in Church’s experience — this can be unreliable and eat up valuable time.

Wyoming County emergency responders face the same difficulties, said Zac Butcher, an EMT with STAT EMS. A baseline transport time in the county tends to be 45 minutes in his experiences, exasperated by the fact that there are no hospitals in the county, meaning responders may have to drive further to get patients the services they need.

“The only way to shorten response times would be by putting additional ambulances in more places,” VanDyke said. “From my understanding, though, that can be costly.”

In Mingo County, which in general can be less rural than many parts of McDowell, and has more people spread throughout a smaller area, similar issues can occur with emergency responders, according to Laura Fox, a representative of Elite Care ambulance service, one of two ambulance services in the county.

Responses, Fox said, tend to depend on where calls come from. As in McDowell, transporting patients to hospitals in more rural areas of the county can take an average of 45 minutes.

“Sure, more ambulances could make this better for everyone, of course we want that, I think anyone would,” Fox said. “It’s hard, though, to keep a demand for more because the number of people down there may not be enough to warrant spending so much on more services.”

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When Church’s father was admitted to Welch Community Hospital, another problem arose for him: they didn’t have anyone on staff they deemed qualified enough to perform the emergency surgery he needed to relieve the blood and pressure flooding his brain from the aneurysm.“I believe the doctors and nurses at Welch did the best they could with my dad,” Church said. “They really didn’t have the capability to treat someone with such a severe problem.”

Joe Letnaunchyn, president and CEO of the West Virginia Hospital Association, said this is another struggle commonly faced in rural health care communities like McDowell’s.

“There’s always the issue of accessibility — getting to the hospital or care provider — but there’s also an issue of securing treatment,” Letnaunchyn said. “It’s hard to recruit and retain doctors in this area, especially doctors qualified in specialty care. You have to love West Virginia for what we are — it’s a beautiful state, but we have our challenges.”

When populations in counties like McDowell begin to dwindle, they drag down with them other community resources that can be used to bring in expert talent. There are less things to do, less resources, less median pay and — ultimately — less reasons to come and stay.

The decline in population also means hospitals and health care centers have to make difficult decisions in what services to offer. Specialty services — like neurology, cardiology and gynecology, to name a few — can be expensive programs to maintain, Letnaunchyn said. If a limited number of patients seek those services annually, a hospital can cut programs to save money that may be better suited for more frequented departments.

In 1984, when Karen Addair, president of Willow Creek Health Clinic in Roderfield, began practicing as a nurse in McDowell County, she remembers the hospital regularly hosting rotations of specialists. This meant that a couple days a week, patients would be able to see experts in whatever field they needed care for.

Today, she said, this doesn’t happen nearly as much, meaning patients are regularly referred to providers further away and out of county — and sometimes out of state — for services unavailable within a convenient distance.

This, she said, puts a lot of responsibility on patients — who need available money, a car and time to drive to Bluefield, Huntington, Logan or Pikeville in Kentucky — to pursue sometimes crucial care. A lot of rural patients, Adair said, are also on fixed incomes. On the first of each month — or around the first — she’ll receive carloads of four or five people coming in to get care for whatever they need while they’re out buying groceries. For some, she said, that’s their “monthly outing.”

Addair, a licensed family nurse practitioner who wrote her master’s thesis in 2007 on rural health care access in McDowell County, said even at Willow Creek — which opened 6 months ago — she gets patients who regularly come in when they should be at a hospital.

“We’re starting to see business here pick up, and we’ve found that our patients like to come in because it’s close,” Addair said. “Still, though, we’re limited sometimes. Sometimes they’ll refuse to go to hospitals — they just don’t want to, or they can’t afford to — so you worry, but you have to treat them best you can with what you have.”

This is why Addair likes to put an emphasis on preventative care for all patients she sees. They may come in for a flu or a regular illness, but while they’re there, she’ll check their thyroid levels or run other tests, knowing it isn’t something they’ll think about seeking treatment for if the need occurs.

Letnaunchyn, too, said WVHA has been making preventative care a prominent factor in their approach to rural health services.

“From the hospitals’ perspectives, we provide the services we’re able to provide,” Letnaunchyn said. “We’ve been dedicated to providing education in these areas, so patients in the state can know about the services they should be seeking out, and where they should get them.”

Addair has found the education aspect — and getting patients invested in their health — most effective when it comes from a sit-down, one-on-one conversation, where dangers and risks can be explained to patients. Hospitals, she said, sometimes don’t have the resources to offer this.

“The patients here — we’ve thrived by building a trust with them. They know who I am because they see me in town, they know I live here. That trust, that’s not something that can be replaced,” Addair said. “That’s the culture here — people are private, they sometimes don’t like or trust outsiders. We need to be willing to understand that and begin tailoring health practices to meet those needs.”

Caity Coyne is a corps member with Report for America, an initiative of The GroundTruth Project. Reach Caity Coyne at caity.coyne@wvgazettemail.com, 304-348-7939 or follow @CaityCoyne on Twitter.