April 2020 was colder than any April I had ever experienced. Against the evening sky was the dark outline of still-bare trees, and the wind that howled through their limbs was reminiscent of rattling bones. There was a chill in the air, as if Spring were hesitant to bloom in the stark despair that hung thick in the atmosphere. April left a gloomy aftertaste in my mouth, just as all of the Zoom meetings I sat through that day had. Around four in the afternoon, I geared up my laptop to suffer through another hour of staring at a screen, pretending that the intimacy of human connection was still present through a layer of glass and almost a hundred miles between my professor and me. I tried to smile at the end of the meeting when my professor said he had to go, that his DoorDash order had arrived. It was hard not to feel bitter. Living in rural eastern Kentucky, DoorDash or GrubHub are two words haphazardly thrown together with no use to me. Except, they do have meaning, though. They mean, “I live in middle-of-nowhere, Kentucky. I can’t use them.”
This pandemic was not supposed to last this long. I had been stuck in my hometown of Harlan, Kentucky, since the end of March. Because I have Type One Diabetes and no insurance save for state Medicaid, I could not travel back to my apartment in Tennessee. It was too dangerous. Because of the autoimmune disease I have had since I was a young girl, COVID-19 could put me in a coma or worse. I was thus relegated to staring blearily at a screen for hours on end, pretending my eyes were not bloodshot and my head wasn’t pounding. My misery of feeling trapped was stretching far too long for me to handle.
* * *
My Zoom tirades seemed arbitrary, however, in the face of the struggles of living in Harlan, Kentucky, in the midst of a pandemic. Rural Appalachia has always been years behind other regions in terms of technology and up-to-date conveniences. Keefe suggests that “in many ways, Appalachians have probably had to suffer greater stress than other Americans, considering the particular features of development in the mountains.”1 This became explicitly apparent at the start of lockdown, when cases started rising. My family and I still had to enter grocery stores because curbside pick-up isn’t an option at our local Walmart.
I live with my sixty-eight-year-old grandmother. Both of us are diabetic, and we require medications that must be picked up from the pharmacy at least once a week. Being a Type One diabetic in a town filled with inconveniences always presented problems. The poor selection of healthy superfoods in grocery stores and restaurants has always been an issue. The average Appalachian’s reliance on fast-food or unhealthy options at local grocery stores directly correlates to increases in heart disease and diabetes.2 Moreover, since Appalachians have limited access to health care providers locally meant that we were doomed to stay still and suffer, feeling neglected and forgotten about by the rest of America during the pandemic. Typically, I drive about thirty minutes to get to the nearest health food store or to buy any variety of nutritious and diabetic-friendly foods to eat. My diabetic specialist is also thirty minutes away. I have no choice but to brave the outside world during a pandemic. Many Appalachians do not have access to basic health insurance, and therefore may not visit a doctor even if they feel unwell.3 My family and I trudge through the sea of people who refuse to wear masks and still hold gatherings because COVID-19 “was just like the flu” as we risked our health weekly just to survive.
Technological advancements have been slow to reach Appalachia. Digital inequality has increased especially in rural central Appalachia where broadband and/or high-speed internet are not widely available.4 There have been times when I was supposed to be in my online courses that I could not attend, because my internet connection was either too slow or nonexistent. At other times I was unable to order convenient items on Amazon. Amazon would not deliver to my house. Again, I needed to drive over half an hour away and risk my health to buy a necessity. Appalachians are a self-reliant people and would rather not rely on technology5. However, that does not mean we should be ignored and excluded from modern advances.
* * *
“I have panic disorder,” I told my students upon our first week hearing about the virus. “I already carry around too much hand sanitizer. I’m terrified of being sick. This virus has had me on edge all week. My grandmother’s the same way, and she makes everything worse for me when I’m home.”
It was true. My grandmother warned me for years about taking any medications that weren’t my prescriptions. She was overly cautious of any bacteria, viruses, or illnesses that could permeate the air. She had panic disorder, just like I did, and the main factor in me knowing this came from being able to detect the same symptoms in her that I saw in myself. She was never formally diagnosed because of the lack of mental health resources in our area. Appalachians often have a hard time recognizing the symptoms of mental illness due to the lack of education and resources in the region.6 As much as I love my grandmother, and know she meant the world to me, I also knew that the COVID-19 pandemic was now a breeding ground for her hyper-fixations and panic over making sure we had a plethora of Lysol wipes and polypropylene masks for what was to come. She never had the therapy that I had to ease her fears and provide logic amongst her high-strung emotions.
I was, quite frankly, unfazed by her doomsday preparations, as it wasn’t the first time that I had witnessed them. Having no mental health resources in the area did have its perks, after all. I began to get used to the bouts of panic and irrational fears that came off in intense pungent waves from my granny. Having been used to it, her anxiety and irrational thinking didn’t set off my own as bad as it used to. I knew the school would reopen after spring break and I told my students as much.
“Don’t worry, I’ll see you all again next week. Same building. Don’t forget our classroom number!”
I never saw them in person again.
* * *
During the last week of March 2020, I left my apartment in Tennessee to journey the eighty-three miles north to Harlan, Kentucky, for spring break. It was my second semester of my first year of graduate school. I was exhausted. So much so that I was tired all the way down to my aching joints. I was excited for a much-needed period of rest, and honestly, the thought of staying shut indoors for a week sounded better than anything I could have imagined in that moment. There had been talk at the time of shutting down in-person classes for the rest of the term, but having never experienced a pandemic, I quickly dismissed those ideas. I can remember thinking a sickness could not shut down an entire university, much less an entire country, for two full months.
* * *
September 2020: Well, this sucks. My entire final year in school is going to be online. Here I am, completely isolated from the world that I want to be in.
Stuck in Harlan. Stuck in my car. To a drugstore. To a grocery store. To a restaurant. Praying I won’t run into the virus. Meanwhile my Appalachian neighbors struggle with the concept of mask wearing and claim COVID-19 is part of a political agenda.
“It will be over after election day,” I heard repeatedly.
“Those people don’t have to do this every damn day,” I thought, as I locked myself in my house, meticulously wiping every grocery item down with Clorox before placing it in the fridge.
* * *
Some people don’t have to worry whether COVID-19 will cause them to take their last breath. Some people don’t have to worry that someone they live with could get seriously ill or die. I have both. Yet, I have no choice but to frequent my local Walmart and out-of-town grocery stores because the United States government and American corporations refuse to update infrastructure and offer necessary services in rural small towns in Appalachia. Shah states that “rural areas may be among the hardest-hit regions due to their demographics and lack of resources.”7 I continue to live in absolute fear for myself and my family, watching the number of cases climb higher and higher in our small mountain home. According to the Appalachian Regional Commission (ARC), Harlan has access to only one-hundred-fifty hospital beds, seven ICU beds, and eighty-one staff beds.8 If a large outbreak occurs in my small community, we may not have immediate access to the care we need and would either have to quarantine without medical help or travel outside our county, risking infecting others. This breeds more panic as we have no idea if going to any store at all is safe. Over the summer, Harlan saw some of the largest increases of the virus in the state of Kentucky.9 This wreaked havoc among my family. It was beginning to get harder to rationalize going to the stores when we knew people were not taking COVID-19 seriously. I was exhausted, both mentally and physically. This fear, mixed with my graduate school anxiety, caused my panic disorder to worsen terribly. I have to choose with extreme caution who I am around, making sure they quarantined at home for at least two weeks before seeing me. I have to protect myself and my family.
* * *
“Hey, you wanna come to Johnson City to kick off the beginning of the school year with us?” Daisy asked.
I had hardly been to my apartment all summer, only to make sure my water and my freezer were still running. I had to mull over my friend’s request.
Do I want to go to Johnson City where there is actual curbside pickup? Yes! Do I want to go where I don’t have to wait three weeks for an Amazon shipment that was supposed to take five days? Yes! Would I love to gather with my friends and celebrate my achievements? Yes! More than anything! But would I risk my health and the safety of my grandmother just to have modern-day conveniences and human interaction outside of my immediate family? I could never.
* * *
I shouldn’t have to choose between modern technological advancements and keeping myself safe. I shouldn’t have to risk myself again and again because I need groceries. I shouldn’t have to choose between picking up my prescriptions and praying that I won’t bring an illness back home to my grandmother. I shouldn’t have to spend my second year of graduate school completely virtual, devoid of human contact, staring at a cold and lifeless screen. But I am. I continue my life down this dark and uncertain path that is COVID-19, praying for Harlan to at least consider DoorDash so I won’t have to risk my life every time I step outside my front door. At twenty-five years old, my life has become a panic- and virus-induced battleground. This has permeated so much of my life that I am unsure what a future would look like without COVID-19 looming in the background.
The pandemic was not supposed to last this long…
Susan E. Keefe, Appalachian Mental Health (Lexington: University Press of Kentucky, 2015), 22.
Melissa Gutshall, Kyle Thompson, and Ellen Lawrence, “Addressing Health Disparities in Rural Nutrition Practice: A Qualitative Model from Rural Appalachia,” Journal of Hunger & Environmental Nutrition 13, no. 1 (2017). doi:10.1080/19320248.2017.1337536
Gutshall, Thompson, and Lawrence, “Addressing Health Disparities,” 97
Cara Robinson, “An Exploration of Poverty in Central Appalachia: Questions of Culture, Industry, and Technology,” KOME 3, no. 2 (2015). doi:10.17646/KOME.2015.26
Sherry Hamby, Elizabeth Taylor, Alli Smith, Kimberly Mitchell, and Lisa Jones. “Technology in Rural Appalachia: Cultural Strategies of Resistance and Navigation,” International Journal of Communication 12 (2018): 1256. https://ijoc.org/index.php/ijoc/article/view/7052
Jennifer A. Correll, Peggy Cantrell, and William T. Dalton, III, “Integration of Behavioral Health Services in a Primary Care Clinic Serving Rural Appalachia: Reflections on a Clinical Experience,” Families, Systems, & Health 29, no. 4 (2011). doi:10.1037/a0026303
Darshana Shah, “The COVID-19 Crisis: How Rural Appalachia is Handling the Pandemic?” Marshall Journal of Medicine 6, no. 2 (2020). doi: 10.33470/2379-9536.1287. 2
Appalachian Regional Commission. (2020). https://www.arc.gov/coronavirus
Chris Kenning, “Once Seemingly Insulated, Kentucky's Appalachian Counties Scramble to Stop COVID-19 Outbreak,” Louisville Courier Journal (2020, July 31). https://www.courier-journal.com/story/news/local/2020/07/31/covid-19-appalachia-tiny-health-departments-struggle-outbreak/5526869002u