The Value of Health

As the 2012 election approaches, the health care debate rages on among candidates, businesses, and citizens. The debate centers on basic questions of who should pay for health care and what does health insurance include. But as the obesity epidemic widens, and questions over food production arise, a broader debate over the value of health is beginning to take place.

Hidden Costs

While U.S. citizens debate the structure of health care, the country is discovering a hidden cost to the overseas wars in Iraq and Afghanistan. U.S. troops return needing not only intense physical therapy for outward wounds, but also treatment to overcome inward trauma as they cope with what they have seen.

Interactive Transcript

They can never know. It doesn't matter how many times you tell them. Doesn't matter how, you can draw a picture, you can make a goddamn feature film, and they, they, would never totally be able to understand exactly what you're dealing with. So to confront that you just give up. And you, you know, hide in the woods.

Ever since I was a child I was absolutely enthralled with the idea of combat and battle and war and the history of war and, you know, all the rest of that. I played more war than anybody in my neighborhood, I was always that neighborhood kid running around with the toy guns.

When I was 18 I showed up the recruiter and told him I wanted to join the infantry. And, uh, he told me I didn't want to join the infantry, multiple times. And he showed me to the Battalion Commander or whatever they had in the recruiting office and he explained to me further that I didn't want to see, that I didn't want to join the infantry because I was going to and as he banged on his desk rhythmically, he says to me that I was going to 'see some shit.'

I had a very hard time during the first couple weeks, months, maybe even year, adjusting to the fact that I was a civilian again. And then the obvious culture shock of being a college student and uh, having to deal with, you know, just 18-year-old, 19-year-old kids and walking to school every day because you know, I was living close enough to campus and I could walk and I got a little backpack on my back and I'm going to school and you know, I should have a lunch box and mommy packed it. And like, you know, it's like, fucking you know, what, seven months earlier I was, like, killing people and now it's like I'm going to school.

I like to go out and ride my motorcycle. I feel like that helps clear my head a lot because it gives me something I need to focus on and that's the only thing I can focus on or I'm gonna die. I think a lot of people around here don't even realize that there's like veterans that go to this school and stuff.

My 20th birthday was in Afghanistan. We had a night patrol that night and it was like a ten-click night patrol. So on this night patrol, and every step I'm just thinking like, man, I'm gonna get fucking blown up on my birthday. And I was just thinking that the whole time. People talk about like, oh, my birthday sucked. You know, this year, I had to work or whatever. Like really? You had to work your four hours at like, Foot Locker on your birthday? I went on a goddamn foot patrol on my 20th birthday. I could have died.

You know, in the public media today, we hear post traumatic stress disorder, and people, unless you've studied it, don't really realize the depth of the impact on the individual, on the human soul as well as, you know, our thought process, um, our behaviors, and our emotions.

When a guy dies, especially in combat, we cover the body up with whatever you got. And you know, it's just an emergency blanket or a fucking poncho or whatever else. Uh, you never get the feet. The feet generally splay to the sides. Uh, and that's all you see. You see the feet and that's kind of your last image of your buddies that you have.

When I first got home it was, it was pretty bad. Uh, actually for a while, probably about three months, I could barely even fall asleep without drinking. There's no way I could live on Court Street, because I wouldn't be able to sleep at all on the weekends.

Just from, like, people yelling. Um, that's one thing that sets me off. Especially, like, during the day, if I'm just walking somewhere and I hear someone yelling, even if they're like excited, if it's from a distance and I hear someone's yelling it instantly gets my attention and I'm kinda like, 'Oh, what the fuck is going on?' Your brain is so conditioned from that stimuli, because you've been trained for so long to react to those situations like that. Um, that, you know, things that sound like gunshots or explosions or whatever. It's really hard to turn that off.

The mythic reality of yes, we're waving our flag and this is a good cause, you start questioning that when you see the atrocities that happen in war. And you see the bad things that happen to good people. Even our language is 'We engage the target.' We aren't trained to say, you're going to shoot a boy, or you're going to shoot a woman, or you're going to shoot a human being, or you're going to murder somebody. We don't use that language in our training. Our training is mythical and we're on automatic pilot.

We were on a presence patrol in Kandahar Province in Zhari district. And uh, a motorcyclist came up through the middle of the convoy and touched himself off. Uh, blew himself, blew the bike up. Killed Reiners, killed Wittman, killed Pagan.

No, I don't think you ever leave the desert. It's like a cage that you get stuck in and then you know, you got to battle it out and then when you get out, you might physically be out but, but, mentally you're still stuck there, and you're gonna be stuck there. And it just gets to the point where you accept that, that's reality and you accept that that's the norm and you accept that that's, you know, your life. And you're never gonna get out of it. Like I said, you accept the fact that you're gonna die and that's just the way it is. And you don't know when, but you accept the fact that you're gonna die and you write the stupid letter to your parents and all the people that you love and care about and you know, you just accept that's the last thing you're ever gonna say to them. And that's hard. That's a hell of a hump to get over.

That's probably the hardest thing you do in the entire, you know, time that you're in the infantry. But once you've gone past that point and you've accepted that I'm dead, then you're good. But you're only good for there. Because when you don't die and you come back, then you gotta live with the fact that you're not dead. And a lot of your buddies are. Uh, you have to confront the fact that a part of you, you left there with them. Because they didn't get to come home. Alive. Uh, and you know that there's, you know, a part of you that stayed there when they died. And it's never gonna leave.

Dear mom. The world is so much different here, sometimes I feel as if I'm just living in a really bad dream. Things that would seem unimaginably unbearable back in the States become commonplace here. We have no way to watch television here but knowing American media, I'm sure you've already. . .

I do remember when he came back from Iraq the first time, um, it was kinda sad because he was sitting at the kitchen table once and he just started crying and that was not like Eric.

He was here near the 4th of July. We walked around the neighborhood and then coming back, one of the, um, boys that he used to play with apparently set off a big firecracker, M-80 or something of that category. And it just stopped Eric in his tracks. It was just like you had hit him with a ball bat. It just stopped him.

You feel alone all the time. You understand, you come to an acknowledgement that no one else around you has any idea what you're dealing with. They don't have a clue. And uh, for a while you're angry about that. You're really bitter about the fact that all these mother-fuckers don't have any idea what, you know, I'm dealing with. And you know, you're sitting in line in Subway and this douchebag in front of you is bitching because you put too much mayonnaise on a sandwich or something. And you're like, dude, you don't know what problems are. Like, you know, nobody in this place is wounded seriously or dead or you know, nobody's life just changed because they put too much fucking mayonnaise on your sandwich.

I don't really wanna say that I have PTSD, even though I've been diagnosed by the VA, because it, just because of that huge social stigma that goes along with it. What a lot of people don't know about the VA is that it sucks. Um, so they diagnosed me with PTSD or whatever and then, which this kinda shocked me, is that they haven't really followed up on it at all, and this is almost a year ago now. But all they did when I went there was just throw drugs at me. And I was like, well I guess I'll have to figure this out on my own.

PTSD is too simplistic in its definition. It's listed in the Diagnostic and Statistical Manual of Mental Disorders as an anxiety disorder. That's the category that it's under: anxiety disorders. Anxiety is only one piece of that. It is more in depth and more comprehensive in what it does to the human spirit.

We are not ready for the numbers of veterans coming back from war, to reintegrate them into our communities. We really need to train our mental health professionals to, um, understand and recognize the cause of the symptoms that our veterans, especially, but other domestic violence and all the other trauma victims have, is the direct result of the trauma itself, and you have to treat that trauma and you have to treat the whole person, um, with several different, uh, interventions. Where we get into trouble I think is, we treat those symptoms with medications. We sedate people, and we don't get at the root cause, which is the trauma itself.

You got to, you know, continue moving. Yeah, they might be dead, but you're still alive. And that's, that's the key. That's why you always have to keep in mind in combat is that you have to keep breathing. You have to keep moving. And even if you're shot, you know, you have to continue moving. And that's, uh, that's the lesson.

That's the lesson in life, is that you have to keep moving. Combat brings out the most fundamental primal lessons of life that you won't get any other way and people can tell you that shit when you're a little kid, they can tell you it, you know, while you're growing up a million times, and it never really sticks until it's life or death. And you realize that this is really what I have to do if I'm going to continue existing on earth. I have to keep moving.

On their way home, a late night stop at a deserted gas station made Ethan realize something in him had changed.

Calmly, Ethan recalls leaving the restroom stall and unexpectedly coming face-to-face with a man. “[He looked] straight out of Afghanistan, he’s got the big beard, the long hair, he had the full white turban, exactly like those guys had, with the camouflage jacket on. This guy literally looked like a Taliban dude.”

“It’s a game changer for everybody’s life. No matter what.”

Ethan Kaiser

Ethan says his reaction surprised both the man and himself. “I almost took up like he was about to fight me or something, even though this guy had never seen me before and I had never seen him,” he says. “He looked scared out of his wits, because I was standing there like I don’t even know… what my face looked like. But [it] probably wasn’t very nice.”

Ethan hesitates thoughtfully, taking a breath, as he realizes the gravity of what he is about to say. “That kind of made me realize,” he continues. “I still had… my brain responded to stimuli differently. And I know it does because if that happened to me when I was like 17 years old, I probably would have just opened the door and just said, “Oh sorry, dude, go ahead.” I wouldn’t have thought anything of it.”

Ethan says that when he began to understand the effects of his time in Afghanistan. He began to realize that he suffered from Post-traumatic Stress Disorder or PTSD. PTSD is an anxiety disorder that can develop when someone witnesses a startling, upsetting event. According to Dr. Roger Buck, the director of the Counseling Center at Hocking College, symptoms of PTSD can include flashbacks, depression, nightmares, hyperawareness, and thoughts of the event invading everyday activities.

Dr. Buck, who has worked with student veterans and has extensive experience working with trauma victims, says, “The human response to trauma is varied, I mean is different for everybody…and people, unless you’ve studied it, don’t really realize the depth of the impact on the individual, on the human soul as well as our thought process, our behavior, and our emotions.”

Ethan seems to compartmentalize his experience in Afghanistan. When going to class or hanging out with his girlfriend and friends, he appears to be just any other student. But then, he says, he is reminded that he is not. Loud noises, especially ones that sound like gunfire, trigger an immediate response from him, his head snapping around as he looks for the source.

“If someone’s yelling,” he says, “it instantly gets my attention, and I’m like, “What… is going on?” I don’t think anything of it at first, until I notice that everybody else is off in la-la land, walking along, going about their business.”

One thing that makes PTSD particularly prevalent in veterans is the intense training and conditioning they had while in service. Dr. Buck says that soldiers are conditioned to react automatically to certain stimuli, making reintegration into civilian life difficult. Ethan, who served as a gunner on a humvee and the point person on patrols, became conditioned to be hyperaware of his surroundings.

This constant vigilance is evidenced by his surroundings. Ethan owns four guns, sleeping with one right next to his bed. He is licensed to carry a concealed weapon. His dog, Yogi, serves as a security system, barking when someone comes to the door. Yogi, and the guns, provides Ethan with both a sense of security and a way to ease the tension he feels.

Dr. Roger Buck explains the changing nature of war.

According to Dr. Buck, the pervasiveness of PTSD in veterans comes from the nature of the wars in Iraq and Afghanistan. He explains there is a “mythic reality” to war, in which the person deployed expects war to be the result of evil in the world that must be addressed. But the “sensory reality” of war - the sights, tastes, textures, and smells of the place - are often not as the person expected. The enemy is not always another uniformed man. It can be a person unseen, a woman, or even a child. This creates a disconnect that can lead to PTSD.

Treatment for veterans usually begins with a Veterans Affairs, or VA, hospital where they can receive health care for little or no out-of-pocket cost. Ethan initially went to the VA for PTSD treatment, but says stopped after being placed on several medications.

“There’s way too much of a focus on drugs. They gave me some muscle relaxers for my back and some sleeping pills,” he says. “The sleeping pills that are like, only take it if you have at least ten hours of sleep. I’m like, okay, I’m going to college, I’m not going to sleep ten hours every night. I took them like twice and they just gave me these crazy dreams. I felt really groggy the next day.”

Dr. Buck says often the symptoms of PTSD are treated, rather than the trauma itself. He recommends approaching treatment with different types of therapy, including relaxation and animal therapy. Another approach is Cognitive Behavioral Therapy, which helps to “normalize” the events that happened through related exposure to sounds or experiences that remind the person of the traumatizing event.

These therapies, however, take time and money. Nearly 30 percent of people that have spent time in an active war zone experience PTSD. With more veterans returning home and seeking treatment, the VA “are very much overtaxed,” Dr. Buck says. VA offices in Southeast Ohio repeatedly declined requests for interviews.

Dr. Buck says that veterans living in Southeast Ohio face another roadblock to treatment. Health facilities are limited and often a long drive away. “You’re [also] talking about a culture here, as well, you know, in Appalachia,” Dr. Buck says. “We have a kind of 'pull yourself up by your bootstraps' kind of philosophy, and you don’t share your dirty laundry with others. You take care of yourself.”

“You’re [also] talking about a culture here, as well, you know, in Appalachia. We have a kind of pull yourself up by your bootstraps kind of philosophy, and you don’t share your dirty laundry with others. You take care of yourself.”

Dr. Roger Buck

According to Dr. Buck, a support system is key to treating PTSD. The stronger the network of friends and family, the more likely a person is to recover.

Ethan relies on the other men in his unit for this support, giving him an outlet to discuss what happened during his deployment with men who experienced it, too. He is also part of the Combat Veterans Club at Ohio University. The group meets once a week to talk about their service and be among friends.

“Even though I didn’t serve with any of the guys who are in it,” Ethan says, “I still feel like we’re brothers, you know? We’ve all been, obviously not the same exact thing, but relatively similar circumstances… everybody knows what it’s like. And I kinda, I don’t honestly have that bond with anyone else on campus.”

Ethan wears a symbol of his bond with another Marine brother on his wrist, a band in honor of Bob. Bob and Ethan served in the same unit and were extremely close friends.

“We had this group of buddies,” Ethan explains. “we called it the Boots of the Round Table, which, the boots were like the new guys… We got really tight, we got really close.”

The fishing trip, where Ethan realized he had symptoms of PTSD, was Bob’s idea. In January, Bob killed himself. He was 24 years old.

“Nobody knows exactly why,” Ethan says. “[His parents] said that they thought part of it was he missed… the camaraderie of hanging out with… with his buddies. Hanging out with us.”

Ethan was a pallbearer at Bob’s funeral, along with several other men in their unit and Bob’s brothers. During the funeral, one of Bob’s brothers said something Ethan has carried with him ever since.

"I remember his brother saying at the funeral, 'Don’t use that as an excuse to be depressed or fall into that hold that Bob fell into. Use his death as a reason to live your life, to go forth and do great things' I kinda took that to heart and that’s been a lot of my motivation for staying in school.” Ethan says.

“I remember his brother saying at the funeral, don’t use that as an excuse to be depressed or fall into that hold that Bob fell into. Use his death as a reason to live your life, to go forth and do great things. I kinda, took that to heart and that’s been a lot of my motivation for staying in school.”

Ethan Kaiser

For now, Ethan continues attending classes and coping with his PTSD. He knows his time in the Marine Corps has left its mark on him.

“The thing about Afghanistan is,” he says, “that when I came home, all my friends were like, ‘You don’t really seem that different, you seem like a regular guy.’ Even though inside you feel like a completely different person.”

Dr. Buck has been there himself. As a Navy veteran, he knows firsthand what some of these men and women are going through. He says a person may emerge from military service different, but not necessarily for the worse. “I believe you can be permanently changed, but you don’t have to be permanently damaged.”

Statistics of Post-Traumatic Stress Disorder

Access to Health

Veterans are not the only U.S. citizens voicing concerns over health care. Access to health care, particularly insurance, can be limited by income. The hidden costs of healthy living go beyond trips to the doctor, however. A low income often denies families’ access to knowledge about healthy lifestyles, and fresh foods and produce can quickly put a hefty dent in small budgets.


John Hunnell from Athens

Being [a veteran] myself, I think that when they write that check, that blank check for anything and everything, including their life, I think they should receive a blank check when they get back.

John Hunnell

Athens, OH

Opinions on Health Care

The Patient Protection and Affordable Care Act, passed by President Barack Obama in March 2010, involves sweeping changes to the current healthcare system in the United States. Included in the law, a mandate that will require individuals to have health insurance or pay a penalty, beginning in 2014. The U.S. Supreme Court will review the law later this year and decide whether or not it is constitutional for Congress to regulate states and individuals at a federal level. Across partisan boundaries, most Americans have strong opinions about the state of health care and ramifications of potential policy changes.

Critical Choices
Interactive Transcript

I had my first heart attack in 2007, then my last heart attack was in 2011. When you don't have nothing and your health is bad and you don't have nobody to turn to, and you've got to go somewhere and they won't see you at the hospital, because you don't have insurance, I know what that is first hand.

It's hard for a man of my age, sixty years old, to get a good job with any benefits or anything like that. I left a job making $42,000 a year to nothing. I didn't have no money to pay for the hospital bills or nothing like that, so I had to file bankruptcy on them.

The first hospital bill I paid myself, it cost me $10,000 out of my pocket. But I didn't have a job, it took all my life savings I had, took everything I had. You could say why didn't God save your home out there. I don't know why. But I know that I live for the Lord, and he said he'd take care of my needs and I needed a home, I needed insurance, but I didn't have any, he provided me a clinic to go to.

We see anywhere from twenty-five to forty-nine, that's the most we've ever seen is forty-nine, and usually it averages out between twenty-five and thirty-five. So we are strictly for people who have no insurance whatsoever. And we have a lot of people like that in Gallia County. And they have to be Gallia County residents.

I was so sick when I went there the first time, and I wanted to make sure I got there before the crowd, so I went two hours early and set before they opened up.

How tall are you sir?

About six foot. How much now?

140, 198.

The impression that I had was that all citizens here in the United States have access to medical care and basic health care. Much to my surprise there is a good percentage of the entire population of the United States are uninsured, which is, to me, very significant.

Last night, I had fries, and a couple hot dogs, and big old pickles.

It is, how much, it is 283 the normal is 120.

Whoo! 160 more huh? Wow.

What will happen is, if your sugar goes high, it will affect your kidney, it will affect your heart, and it will affect your eyes. Ok. Ok. And you have enough trouble. Alright. Right? Right.

The medical community and the public health community have know for a long time that we have a huge segment of population in this -- let's say tri-state area, which is the upper part of Appalachia -- that do not have medical care coverage. No type of insurance, either not offered or they cannot afford it. If it is offered it's astronomical and they can't afford it. It takes out of their take home pay so they just don't carry it.

It's too high. They want $50 a week for the insurance on me, and they want $100 a week for my wife. That's $150 a week, with the salary I get, I make $500 a week. Take $150 off that, and I'm just doing nothing but working and paying insurance. By the time I pay all my other bills and things, you wouldn't have nothing; you wouldn't have no money for groceries. So I don't have no health insurance, I can't afford that. I don't make the greatest wages, but I'm making a wage for this area to sustain you. But you go out there and buy insurance, you can't afford it.

Cardiac disease is rampant in this area. Smoking is right up there with it, and so you have problems with lung cancer, cardiac disease, stroke, hypertension, and by the time we see them, they're up in their 50s, maybe 60s, and then you've got long term chronic problems that could have been taken care of and fixed years before that time. So when you look at it from a public health standpoint, we're failing miserably. We really are.

“I couldn’t even hold my head up," he recalls. Despite a history of heart attacks, the flu virus was the only reason he went to the clinic that day. Now Earnest goes on the last Thursday of every month, the only day the clinic is open, to get his blood pressure and cholesterol levels checked.

“I found out they were a great bunch of people. Like Dr. Nugget, who came out of retirement at 76 years old, and I thank God for his expertise and eagerness in wanting to come out and help somebody," Earnest says.

He lost his job 25 years ago at Meridian and went from a $42,000 annual salary to no income at all. “When they shut the doors I lost all my benefits, all my insurance, everything." He was unemployed for several years before finding a job as a truck driver for L&L Scrap Metal in Gallipolis.

According to the U.S. Census Bureau, the percentage of people covered by employment-based health insurance decreased to 55.3 percent in 2010 from 56.1 percent in 2009. The number of people covered by employment-based health insurance decreased to 169.3 million from 170.8 million. In 2010, the number of uninsured people increased to 49.9 million in 2010 from 49.0 million in 2009, while the number of people covered by government health insurance increased to 31 percent (95 million) in 2010 from 30.6 percent (93.2 million) in 2009.

Earnest says he does not have the $125 it costs per visit to see the heart doctor at the local hospital, but says he can go to the free clinic and the doctors help him there. "They cared about me and saw that I got better," he says.

For many uninsured adult residents of Gallia County, the French 500 Free Clinic is the only accessible health care facility in the area. While some alternative, low-cost health care facilities exist nearby, such as Ohio Quickcare in Gallipolis, they are not free. Yet the Free Clinic is only open for two hours once a month, on a first come first serve basis.

“With the salary I get making $500 a week, I’d just be doing nothing but working for paying insurance. By the time I payed all my other bills and things, you wouldn’t have nothing. You wouldn’t have no money for groceries."

Earnest Cook

The clinic provides everything from routine physicals to sick visits for colds or pneumonia. However, the clinic is limited in supplies and volunteers, so they cannot do blood work or x-rays at their location. In these cases, the patients are referred to local practices or hospitals.

Joann Elliot has worked at the Free Clinic for over three years and says that, while they see some patients like Earnest who come back for monthly blood pressure checks, "This is more of an urgent care type of situation, where you try to take care of whatever is wrong with the patient."

"When you don’t have nothing and your health is bad and you don’t have nobody to turn to and you gotta go somewhere and they won‘t see you at the hospital because you don’t have insurance," Earnest says, "I know what that is firsthand. And that’s the reason why I go up to the clinic."

Earnest says the cost of insurance would be $150 a week for him and his wife.

“With the salary I get, making $500 a week, I’d just be doing nothing but working for paying insurance. By the time I paid all my other bills and things, you wouldn’t have nothing. You wouldn’t have no money for groceries," Earnest says.

Without the Free Clinic, Earnest says he would have to go the emergency room, but it would mean another bill he could not afford. Before moving back to Gallia County, he had to file for bankruptcy because of mounting bills from Holzer’s Hospital and high mortgage payments on his home.

“A lot of children would not participate in Special Olympics if we didn’t come and provide the physicals."

Dr. Isabel Pino

“I lost my home. I owed the doctor $10,000 from putting that stent in there, but I didn’t have a job so it took all my life savings I had. I moved in this place here and it was condemned and I had to fix it up to even live in it.“

Earnest has had two heart attacks since 2011. The doctors at the Free Clinic referred him to the hospital again last year for another stent. Earnest had another heart attack at the hospital and received yet another stent. Earnest says the Free Clinic saved his life.

“I have been sick [since] the first of the month and had to wait all month to go. But you just have to wait and do what you gotta do... I thank them for helping me get through [this] life," Earnest says.

He says that in today’s health care environment, tax dollars from people who cannot afford health insurance go toward paying for the insurance of the more affluent. The upcoming presidential election will determine the reformation of the health care landscape to come.

“We’re just the same as they are, they get their healthcare paid for, we pay for theirs, and they don’t have to worry about it. The president don’t have to worry about his healthcare, we pay for it," Earnest says.

According to Cincinnati News website, if President Obama’s universal coverage health care plan is upheld by the Supreme Court, almost everyone will be required to have insurance. Under this law, insurers would be prohibited from denying insurance to people who are ill and tax-credits for middle-income and low-income people will lower expensive insurance premiums. Medicaid would be expanded to help people that cannot afford insurance.

While these proposals focus largely on fixing financial problems to accessing health care, in some cases affordability is not the only barrier. In Huntington, West Virginia, the national organization known as the Children’s Health Fund collaborated with the Department of Pediatrics at the Joan C. Edwards School of Medicine at Marshall University to create a mobile pediatric clinic. The wide blue bus houses a full-fledged pediatric clinic with two private exam rooms and a middle section with a long, blue vinyl couch serving as a lobby.

“There are many factors that make a project like this one necessary," says Dr. Isabel Pino, the director of the West Virginia Children's Health Project. “You can look at geography as being one, lack of access to care; which can be due to lack of insurance or lack of transportation.“ In this relatively low-income area of West Virginia, “You have a lot of people who may have insurance but don’t have a doctor nearby, or [they have] parents who are working and can’t take off from work to take their child to the doctor. So, all of those are barriers to accessing medical care and a project like ours helps to tear down those barriers," says Pino.

While the mobile clinic does not make house calls, the bus parks at local schools and provides routine checkups, sick visits, and even annual physicals for the Special Olympics. “A lot of children would not participate in Special Olympics if we didn’t come and provide the physicals," Dr. Pino says.

The Children’s Health Fund is a nonprofit organization like the Free Clinic, but the West Virginia Children’s Health Project bills for its services because they see children who have Children’s Health Insurance Program (CHIP) coverage or Children’s Medicaid. Dr. Pino says the mobile clinic tries to help improve access to these programs by always carrying CHIP applications on the bus.

However, parents who live without insurance in circumstances similar to Earnest’s end up having difficulty supporting their children’s health, even with the help of these federally funded programs. Earnest’s adult daughter is beyond the age to qualify for children’s coverage options, but Cook says she gravely ill.

“How can you fix it when there ain’t nothing there?"

Earnest Cook

“She’s been all the way down through the clinic, all the way down through the hospitals. Can she get any help? No,“ Earnest says.

Earnest represents the American family that can only access health care at certain stages in life, and then once adults or once without a job, not at all. He wonders what the election will fix about health care when there is nothing available to him and his daughter to begin with.

“How can you fix it," he says, "when there ain’t nothing there?"

Wholistic Food

There is a growing population that has abandoned processed foods and joined a more whole, sustainable food movement. In Athens, Ohio, personal relationships form every day between local farmers, distributors, restaurant owners, and consumers. These unique food communities contribute to the good health of their members and the local economy.

The Market

View Photo
The Farmacy
from the farm to the market

The Restaurant

View Photo
Casa Nueva
from the market to the restaurant
Valerie Fox

The Farmer

View Photo
from the market to the consumer
The End Consumer

The Consumer

Watch Video

The Locavores

“I just love carrots!” little Kat Kramer squeals, her red curls bouncing as she jumps to her feet. “That’s my job in the garden, I pick the carrots… I go like this!” She exclaims as she acts out the scene, reaching to the ground and pulling up an imaginary carrot while bursting out a sound effect, “Pop!”

It is not often you meet a kindergartener whose favorite snack is carrots, whose first choice of dessert is strawberries, and whose ideal dinner is homemade pasta with fresh pesto. Kat, however, has an enthusiastic affinity for all these foods and one of the most mature pallets you might ever find on a child her age. She has grown up eating a diet of whole, organic, and local foods. The majority of what she eats is produced within a 100-mile radius of her home. At the ripe age of five, she can already be considered a locavore.

A locavore, as defined by the Oxford American Dictionary, is a person whose diet consists only or principally of locally grown or produced food. Kat’s mother, Barbara Fisher, became a key player in the movement when she was featured in TIME magazine’s piece, “Local-Food Movement: The Lure of the 100-Mile Diet,” thus becoming one of the first people to nationally publicize the effort.

Barbara’s appreciation for local food began at a young age. Her grandparents owned a small farm in West Virginia, so she was able to interact with most of the food she ate while growing up.

“We didn’t have a lot of money, but we always had food” Barbara recalls with a warm smile. “So that became one of the big, chief pleasures [for my family].”

Her early exposure to whole foods and sustainability made a lasting impression that grew into the passion for local food that is a driving force in her life today.

locavore (n.) A person whose diet consists only or principally of locally grown or produced food

According to Worldwatch Institute, a Washington, D.C. nonprofit, the typical produce purchased from a grocery store will travel over 1500 miles before making it to the plate of the consumer. Barbara’s ingredients typically travel less than 50 miles. She can also tell you exactly where each came from and the names of those who produced it.

Beyond “tasting better,” the produce Barbara uses is the most ripe and nutrient-rich available. Many vitamins, including Vitamin C and B vitamins. are sensitive to light and heat, so their levels degrade rapidly during the typical shipping and storing process. Due to the proximity of Barbara’s suppliers, she is able to use ingredients at their peak nutritional value. She says once you get used to these fresh and whole ingredients, it is hard to go back.

Her family agrees.

“For me it’s physical health,” shares Nik Kramer, Barbara’s husband. “[And] it’s family health when we can sit together and have good food, and we can talk about the food, which is always fun… [Kat] knows the farmers as we do and that’s just fun.”

Nik goes on to talk about another layer of “health,” the family is concerned with: the health of the community. Through their work with Community Food Initiatives, an Athens-based group that assists individuals and families “to secure and grow food, develop self-sufficiency skills and become ‘nutritionally literate’ on issues of hunger, health and sustainability,” Barbara and Nik stress that adopting a local diet can enhance personal health as well as the region’s economy.

As the Kramers gather around the table for their special Sunday dinner, they feel good about the food they are eating. They are proud of the ingredients they have selected and the meal that was prepared. They know exactly where their food comes from, that it is free of pesticides and growth hormones, and that its purchase supports a community member’s livelihood. Barbara and Nik are happy because the food they consume is healthy for their bodies and their community. They are sure it will help both their daughter and their local food-economy grow.

Healthy Start

The choices that lead to a healthy lifestyle are often made in the early stages of life. Studies show breastfeeding strengthens immune systems and can be the first line of defense against obesity. As different groups push for healthy childhoods, the debate over women’s health care in general has become a flashpoint for the larger discourse concerning insurance, the options available to women, and just exactly what medications and services should be guaranteed to patients.

But mom speaks to him softly as she bounces him calmly on her knees. Liz, 19, became aware she was carrying the unexpected bundle of energy just as she graduated high school. And she immediately knew that she would breastfeed.

“I had breastfeeding in my birth plan. My mom nursed so that was helpful,” Liz says.

Her 22-year-old friend Shireen Aftabizadeh, also from a breastfeeding family, sits across from Liz, cradling her 8-month-old son Silas. They are both full-time students taking 12 hours of class per week — Liz at Hocking College and Shireen at Ohio University.

Both moms start their weekdays with 8 a.m. classes. Liz’s husband works, but she only has to take Landon to class in the rare event that the usual babysitters, her grandparents, are unavailable. But, Liz has become comfortable breastfeeding almost anywhere.

“It’s convenient when you go to the movies. I took him when he was 4 weeks old and all he did was sleep and nurse. We saw Cars 2 and The Muppet Movie, so I didn’t feel bad since everyone else had kids,” Liz says.

“It’s convenient when you go to the movies. I took him when he was 4 weeks old and all he did was sleep and nurse. We saw Cars 2 and The Muppet Movie, so I didn’t feel bad since everyone else had kids."

Liz Nichols

“That’s the easiest place because you are already sitting down and it’s dark so nobody’s going to see what you’re doing,” Shireen says.

Breastfeeding is becoming more and more common in the United States. However, the nation lags behind most other counties in breast-feeding rates. According to the 2011 Center for Disease Control's Breastfeeding Report Card, 35 percent of women in the U.S. exclusively breastfeed for up to three months — up by 2 percent from 2010. In Ohio, 31 percent of women exclusively breastfeed for the same amount of time. Both numbers, however, are below the goal international objectives.

UNICEF's World Breastfeeding League Table from 2008 indicates that in China, 77 percent of women exclusively breastfeed for the first four months. Rwanda is the top of the league for breastfeeding with a 94-percent rate of exclusive breastfeeding for the first four months.

Women are starting to breastfeed more often in public, without concern over the judgments of others. Breastfeeding mothers are protected by an Ohio law, which states that a woman can breastfeed anywhere she is legally allowed to be. Many other states have similar laws and some even have laws enabling women to breastfeed or pump breast milk while at work.

That is further evidenced by the certification of the Baby-Friendly Hospital Initiative in many hospitals throughout the country. The initiative is a worldwide effort to increase breastfeeding rates and to promote, support, and protect women and babies learning to breastfeed during their stay at the hospital. The Centers for Disease Control, World Health Organization, Department of Health and Human Services, and UNICEF all support this initiative. O’Bleness Memorial Hospital in Athens recently decided to stop handing out formula samples to new moms in accordance with one of the criteria required for the Baby-Friendly Hospital certification.

O’Bleness Lactation Consultant, Michele Biddlestone, says studies have shown that sending formula samples home with new moms undermines their confidence in their ability to provide their child with everything they need from their breast milk, even though breast milk is naturally tailored to fit each individual child’s needs.

“A lot of governmental agencies are supporting breastfeeding," Michele says. "It’s trickling down but what really needs to happen is women need to trust that breastfeeding is going to work for them.” She also says that the cost of formula can be anywhere from $1,000 to $2,500 to feed a baby for a year.

“With breastfeeding, the only true cost is increased calories. A breastfeeding woman needs to increase her caloric intake by 500 calories per day,” Michele says.

“With breastfeeding, the only true cost is increased calories. A breastfeeding woman needs to increase her caloric intake by 500 calories per day.”

Michele Biddlestone

However, Michele says there are many studies indicating that when a woman goes home with a discharge packet with a formula company’s name on it — even if the formula sample has been removed from the packet — it lowers the mother’s confidence in her ability to breastfeed, and she is more likely to buy that brand of formula.

Liz faced that effect.

“I actually got a sample pack of formula at my baby shower and threw it out because I was afraid it would discourage me,” Liz says.

When Landon was born prematurely, he had trouble latching on to her breast, and she says her nipples were painfully sore. With Michele’s help at O’Bleness, Liz learned to use a syringe to push a tiny bit of breast milk into Landon's mouth while he sucked on her pinky finger. That gave Liz a break and discouraged nipple confusion for Landon while teaching him how to latch on.

In January 2011, the Surgeon General initiated a call to action in support of breastfeeding. In a 2010 study conducted by the Childhood Nutrition Research Centre at the Institute of Child Health in London, feeding babies formula was found to contribute to at least 20 percent of adult obesity. In response to the new finding, first lady Michelle Obama has added support for breastfeeding to her campaign against childhood obesity. Breastfed babies also have a lower risk of ear infections, pneumonia, diabetes, gastroenteritis, asthma, atopic dermatitis, leukemia, and Sudden Infant Death Syndrome.

Breastfeeding has significant health benefits for the mother. It reduces the mother’s difficulty of losing weight gained during pregnancy, breast and ovarian cancers, heart attack, high cholesterol, vascular disease, high blood pressure, metabolic syndrome, diabetes, and Polycystic Ovarian Syndrome. For those reasons, the WHO strongly recommends exclusive breastfeeding for the first six months after the child is born up to two years of age with the introduction of complementary foods.

The World Health Organization strongly recommends exclusive breastfeeding for the first six months after the child is born and for up to two years of age with the introduction of complementary foods.

Biddlestone says that moms who go home without the support and education like that which Liz received end up feeling that they have nowhere to turn but to the formula companies. Still, she acknowledges that some mothers have medical reasons for choosing formula, though they are rare cases.

Melissa Alfano, director of the Athens-Perry Women, Infants, and Children program, says she supplements breastfeeding with formula for her 3-month-old son Vincent, but not by choice.

“He just lost too much weight and I wasn’t producing enough milk,” Melissa says. According to the WIC website, production of breast milk increases as demand for the breast milk increases. However, Melissa always puts Vincent to the breast before allowing him to bottle feed in an ongoing attempt to increase her milk production.

Melissa says coming to terms with this realization has been emotional and difficult because she always wanted to breast feed. She says she knows that her breast milk is specially made to provide every thing that her baby needs, while the label on a can of Similac states that it is made "For all babies."

“We have one can of Similac here for millions of babies, and I don’t think it’s going to provide the needs for every baby,” Melissa says.

Interactive Transcript

Like, I don't try to fit in but I just don't fit in. I can't really explain how different I am.   I just feel like I watch more what I do, and I think before I do stuff but they don't.  Normal teenagers aren't supposed to, but I do, I think.  When I got pregnant, I felt ashamed.  

I don't think I got scared until it all set in and I had to tell people.  I never thought I would have an abortion. It wasn't right for me.  And some people brought up adoption but if I touched my belly he would kick back like he was touching me.  I could just imagine when he was older, I guess playing like that. I knew that I wanted to keep him. 

It was a little hard for us at first but we kind of arranged mine and my husband's schedule,  that way we could help take care of Braylen while she goes to school.  

I don't want him to struggle with what I've experienced.  It's very exhausting. It's a lot of fun, too, but if I ever had a free day, I would just sleep.  My mom always offers, "Do you want me to take him for two, three hours?"  And I'll try to lay in here and I just can't. I can't sleep, because I'm wondering what he's doing.  

I don't know if there's such a thing but she's addicted to Braylen. I really do.  

School's hard with him.  He don't make it hard; I'm not blaming it on him. 

It's just, like at night he goes to sleep about 11:30  and then I get up at six o'clock and go all day again until about 11:30 at night, again.  They always say children of teen moms are more likely to be abused or go to prison and teen moms abandon their babies,  but I'm not going to. Me and Braylen aren't going to be a statistic. 

A Change of Plan

It is a typical lazy Sunday spent in pajamas for 17-year-old Jessie Strawn of Nelsonville, Ohio. She sits cross-legged in a well-loved armchair. The TV in the corner is blaring loudly and the screen is filled with dramatic images of a post-apocalyptic world. However, Jessie’s eyes are not fixed on the screen but on her 18-month-old son Braylen.

As Braylen plays with a toy frog and wobbles around the room as fast as his little legs can carry him, his mother is constantly watching over him. Her eyes shine with love for the little boy who changed her life.

Braylen’s mother sees him as every mother sees her child. “He’s kind of perfect," she says. "I know nothing can be perfect, but I think he is.” Jessie is not a typical mother.

Jessie discovered she was pregnant on her 15th birthday when she went to the doctor with her mother to get a prescription for birth control. She was shocked when the doctor informed her that she was five months pregnant, especially because she was still having regular periods. Despite her age and the shame she initially felt about her pregnancy, Jessie refused to hear any options that the doctor may have had to offer her. She was determined to keep her baby.

He’s kind of perfect. I know nothing can be perfect, but I think he is.

Jessie Strawn

“I didn’t even consider abortion. I couldn’t kill someone … and I couldn’t imagine giving my baby away.” Jessie stresses the fact that is her personal opinion regarding abortion.

Jessie had been dating her boyfriend since they were 12. She does not talk about Braylen’s father much. When Jessie first found out she was pregnant, he said he wanted to be involved in Braylen’s life. He has not really kept that promise.

Jessie says she is not interested in any boys other than her son. She does not hang out with many friends outside of school, except texting and messaging on Facebook. Once home from school, all of Jessie’s attention turns to Braylen, who does not stop until almost 11 p.m. She says the single hardest thing she has dealt with since having Braylen has been that she is always exhausted. Jessie rarely does homework at home. Instead, she fits all of her studying into a first-period study hall.

Despite the exhaustion and limited social life, Jessie is not alone in the choice she made. More than 50 percent of teen pregnancies in Ohio result in the birth of a child. Nevertheless, the teen birth rate in Ohio has dropped by 32 percent in the past 20 years.

That trend is partially due to the ease with which teens can obtain birth control. According to Gary Dougherty, the state legislative director at Planned Parenthood Affilliates of Ohio, the nonprofit offers birth control on a sliding scale based on income. Some students can receive it for free.

The trend may also have to do with the choices young women are making, not only to have safer sex but also to abstain from sex completely.

A Higher Calling

Laura LaBorde and Billy Rillero have made the faith-guided decision to abstain from sex until marriage.

Laura LaBorde lays back comfortably in her bed, snuggled up with her boyfriend of more than a year, Billy Rillero. On the wall above the young intertwined couple hangs a silver crucifix and a quote reading:

“Rejoice in the Lord, Always.” The two lovebirds have made the faith-guided decision to abstain from sex until marriage.

While that may not be the norm for most young couples, especially college students, Laura and Billy feel their relationship is based on true intimacy and respect for each other and the Lord. Remaining abstinent in college is certainly a struggle, Laura admits, but she finds strength through her faith as well as through the support of her Bible study group.

Every Tuesday night, a group of women — most of whom wear Greek letters emblazoned on their clothing — gather for the Greek Bible Study at the First United Methodist Church in Athens. Laura is a member of an all-female Bible study group made up of women from Ohio University sororities. Though they are all members of different sororities, they are brought together by friendship and a common desire to live their lives for the Lord.

The group members see sex as a sacred act between husband and wife. They believe that by abstaining they are not only respecting themselves and their faith but also their future husbands. While there are religious motivations involved, they feel their choices help build deeper relationships as well.

Niki Shirkman, who graduated from Ohio University in 2011, says she was sexually active in high school, but when she rediscovered her spirituality in college, she decided that she wanted to make changes. When she began a relationship with her future husband their junior year, they did not even kiss until becoming engaged.

“The intimacy in our relationship was so much deeper than with anything physical than we had ever had before, and we really communicated and knew each other on that level. I’s not an obligation, ‘oh the Bible says we can’t do this,’ but I don’t want to because I know that God has a perfect design for it,” Niki says.

Even though these women are abstinent, it does not mean that they do not benefit from the use of birth control. Angela Yacovazzi, also a member of the Bible study group, is taking birth control for its medical benefits.

A Medical Necessity

Hannah Atkins has been diagnosed with polycystic ovary syndrome and needs birth control to regulate her symptoms.

According to a recent study conducted by the Guttenmacher Institute, about 14 percent of women who take birth control use it solely for non-contraceptive reasons.

Angela Yacovazzi suffers from a disease called endometriosis. The condition causes the type of tissue which lines the uterus to also grow outside the uterus. During the menstrual cycle, the tissue thickens and breaks down, regardless of where it is growing. Angela always had extremely painful periods and period-related symptoms. There were times that her menstrual cramps were so bad that she says they caused her to faint. After years of trying to figure out what was wrong with her, she finally found a doctor who recognized her symptoms as more than just PMS.

She takes birth control as a method of preventing her symptoms as well as to regulate her period. The birth control also slows the progression of her endometriosis.

Despite her religious beliefs, Angela questions legislation which might block women’s access to contraception or abortion. While she believes that the people behind such legislation may have good intentions, she knows from personal experience that some women use the drugs in birth control for more than just pregnancy prevention.

Although they are both abstinent for primarily religious reasons, Angela and Laura agree that while they look forward to having children someday, they do not feel ready to start a family until they are married and have someone to help share the responsibility of raising children.

Though most women want to wait to have children when they feel ready, the reality is that accidental pregnancy is very common. In 2006, about 54 percent of pregnancies were unplanned.

A Lifelong Education

Julie Huston absentmindedly pets the purring gray cat that has decided to settle in her lap as she recalls her college years. She is sitting comfortably on her daughter’s couch in a living room full of children’s toys and family pictures. The pictures tell a story of a time before Julie was a proud mother and grandmother, a time when she was still a child herself.

Julie, who is from a suburb of Columbus, remembers being in college before Roe v. Wade. She knew a girl who went to New York to get an abortion. She was not able to access the proper care after the procedure and was hospitalized for a serious infection. By the time she was a junior in college, Roe v. Wade had passed, and abortion was legal.

Julie was on birth control when she first became sexually active, but in the 1970s when the pill was still new, the hormones were much stronger, and Julie’s body reacted negatively. She remembers her doctor telling her that because she had not become pregnant in her first year of being sexually active, she probably would not get pregnant. He recommended that she use spermicidal foam as birth control.

"I have had children, miscarriages, and an abortion … Being pregnant, when you want to be pregnant, when you are in a loving relationship, is the best feeling in the world."

- Julie Huston

“I don’t remember ever discussing condoms, and as worldly as I was in some ways, I really didn’t know much of anything about condoms or let alone have the nerve to ask a guy to use condoms,” Julie says.

According to Planned Parenthood, spermicidal foam is about 70-85 percent effective for preventing an unwanted pregnancy when used as the only form of protection. About two out of 100 women who always use condoms correctly will get pregnant. Among couples who do not always use condoms correctly, about 18 out of 100 will get pregnant.

“Knowing what I know now about the effectiveness of foam,” she teases, “I really wish I had something I could beat that doctor with.”

Julie says that if she had a better understanding of birth control when she was younger, she would not have found herself sitting in a coffee shop breaking the news that she was pregnant to her fiancé of three years. He told Julie he was in love with someone else.

For Julie there was no other option, any future with her fiancé had been pulled out from under her, and she still had a year left in college. She could not afford to carry, let alone raise, a child while in school; a child who would forever bind her to her ex-fiancé.

Julie terminated her pregnancy during a break from school. She used a borrowed ID because at the time a woman had to be 21 in order to get an abortion. She says she does not remember much about her abortion, except that that she felt ashamed. She did not want her parents to know she was sexually active, and she felt foolish for getting pregnant when she could have easily prevented it had she been on the pill. Looking back, she wishes she had been more educated about safe sex.

Julie laughs as she remembers her college doctor telling her she could not get pregnant. When she was married, she got pregnant with her daughter as soon as she stopped taking birth control. She also eventually had a son with her second husband after going through a traumatic miscarriage.

“I have had children, miscarriages, and an abortion,” Julie sighs. “… Being pregnant, when you want to be pregnant, when you are in a loving relationship, is the best feeling in the world.”

Teen Pregnancy Statistics