Summer Issue 2020

WeCare: Connecting Plain Communities to Healthcare

By Hunter Ricketts

In Christian County, Kentucky, about half a mile down from the Jefferson Davis Memorial, lies a clinic run by the Anabaptist community. It is easy to miss while driving because it does not look like a clinic at all, but you know you’ve missed it by about 5 miles if you make it to the Hopkinsville Dollar General Store. The structure was built like a house, with a wooden front porch with handicap access. There is a wooden sign a little off the road out front that reads, “The WeCare Clinic For Special Children,” adjacent to a long gravel driveway that leads to a parking area featuring a hitching rail for horses and a carport attached to the building. It was built up from the foundation by volunteers within the Anabaptist community. Once completed, women of the community decorated the interior. 

When entering a contemporary, allopathic clinic, most would imagine a waiting room with white walls, a receptionist behind a desk, health posters with grotesque pictures of human anatomy, and either a TV or radio playing a station on repeat. The WeCare clinic appropriately adjusts this interior stereotype to better accommodate the people and patients it serves. Bible verses take the place of health posters, and when the clinic is actively providing medical care to families, there is little need for the ambience of a TV or a radio. What would be the living room has been re-furnished into a waiting room, with chairs lining the walls. Two bedrooms were repurposed into office spaces, while the kitchen and the master bedroom have been transformed into patient assessment rooms. This clinic has been open for 2 years now, and is the southernmost WeCare clinic. While the clinic does not currently have a physician, it functions as a site for genetic testing, vaccinations, education about current healthcare topics, and community outreach for those who have family members or friends afflicted with the genetic conditions to which the Anabaptist community is particularly prone. 

Before speaking about the specifics of this community, it is important to understand some terms used for Anabaptists as a “group.” The term, “Anabaptist,” is a reference to Mennonite and Amish beliefs that arose in the sixteenth century. However, when used vernacularly to refer to a community, it implies both groups as a whole, not simply their religious beliefs. Another term for this group is the “Plain” community, which is derived from their modest lifestyle and dress. These terms are often used interchangeably within this community, despite their meaning different things. There are differences between those who live an Anabaptist lifestyle, specifically in how and to what degree they embrace technology. When I began this project, I was told, “If you meet one Amish or Mennonite man, that is all you have met. They’re all individuals.” This describes how some families may use certain technologies (cars, for example) while others may not. Understanding this in regard to healthcare practices is crucial for working at the clinic.

A traditional stigma for the Anabaptist populations is their use of naturopathic and dietary treatments rather than allopathic medicine. This is not always correct. Some Mennonite folk will take ibuprofen for a headache or Tylenol for a fever. However, an aspect of healthcare that has seemingly remained naturopathic in Mennonite life is obstetrics. Midwifery is still common practice in the Plain communities. Kathryn Shirk, a midwife in Christian County, is one of six midwives who provide obstetric services to the community. Shirk is also a co-owner of Dutch Kuntry, a general goods store, and has lived in the area for 16 years. In her time as a midwife, she has been present for roughly 250 births. When asked about her experiences as a midwife, she recalled a specific story from when she lived in Iowa:

We lived in Iowa and I went to Minnesota for births. This lady called; she was 3 weeks early. I wasn’t looking for her birth yet. I went. When I checked her cervix, the baby grabbed a hold of my fingers. That was scary! Anyways, the father encouraged me to try and turn the baby, and we did. I was too scared because I was afraid the cord would go around the neck, so I didn’t try really hard. The father tried. And we ended up transporting. That baby actually had its hand…its hand was coming out with the cord in her hand. We went to Waterloo, Iowa and they did a surgery immediately. I think that baby was born within 11 minutes when we got to the hospital. Her heart rate was dropping and um, by the time she was born, that was a very close call, by the time she was born she was having seizures and things. Yeah, it was scary… The doctor calls her Katie the miracle baby because she snapped out… Two years ago, I met one neighbor who said she’s doing fine, she’s going to school and you wouldn’t think anything’s wrong with her. That was very scary because that baby was having seizures… I hope I never get to see that again.

While Shirk is not afraid of calling an ambulance during a troublesome labor, she typically sticks to natural and dietetic remedies for prenatal care. When asked to list a few examples of common remedies, she recommended: vitamin C, eggs, fruit, vegetables, peppers, and especially garlic. She also recommends what she calls, “good salts.” When asked what that meant, she replied: No bad salt: potato chips, lunch meats, all the bad salts. Start using Redman’s salt or sea salt, or Himalayan salt. But not using the table salt or iodinized salt.”

While the naturopathic remedies of the community effectively address the majority of their medicinal needs day to day, the Plain people are facing a new foe: genetic diseases.

There are a multitude of diseases and conditions that affect the Anabaptist population, but some of the most common genetic diseases are maple syrup urine disease (MSUD), propionic acidemia (PA), Lynch syndrome, and spinal muscular atrophy (SMA). These diseases themselves are not fatal; rather, the complications that arise from having one of these conditions can be deadly. The majority of the genetic diseases, including the four listed above, are homozygous recessive. This means that both parents need to be carriers of a recessive gene, and their child needs to receive both copies of that gene to have the condition. Fortunately, it is typically only a twenty-five percent chance that the child will receive both copies. This is contrasted with a fifty percent chance that they will become carriers themselves, and a twenty-five percent chance that they will not carry the gene at all. Without a blood draw and genetic testing, it is practically impossible to know if a parent is a carrier of one of these genes, although there are families who have documented their family tree throughout the generations and have kept records if someone had a genetic disposition. For most families in Southcentral Kentucky, the closest genetic specialist is located at Vanderbilt University. Due to the distance, and the prevalence of MSUD and PA in Christian County, the Mennonite community came together to establish the “WeCare Clinic For Special Children.”

The clinic has a board of directors consisting predominantly of men from the community. Additionally, there are others on the board who serve primarily as advisors during board meetings that are from outside of the community. The clinic is staffed by Marlene Schmucker, who is a Registered Nurse. All board meetings begin with four-note shape singing, followed by a reading of the letters. The board, in conjunction with the advisors, makes decisions regarding normal business matters, outreach, and future events to be held at the clinic. The most notable events that have occurred at the clinic have been the annual Genetic Disease Days and SMA Day. 

The annual Genetic Disease Days are educational events where speakers, typically healthcare professionals who specialize in the problems the Plain people encounter, give informative talks about a specific topic. The most recent Genetic Disease Day focused on PA and Lynch syndrome. After the talks are done, the audience is able to ask questions directly or by writing on a slip of paper. Afterwards, during lunchtime, families are able to speak privately with the speakers. 

SMA Day was a genetic testing event where families could come to the clinic and get tested for SMA for free. According to Schmucker, 

Clinic For Special Children had gotten a grant from a drug company. They had just formulated a new drug for spinal muscular atrophy… and they wanted to get out to as many Mennonite communities as possible to get blood work for patients/families/parents to be tested to see if they are carriers or not because it is one of the most common genetic disorders among Mennonites, not so much the Amish, but the Mennonites.

Although the disease is not common in Amish communities, an Amish family did attend SMA Day so they could talk to the genetic counselor and get a diagnosis for one of their family members. This proves the willingness of families in surrounding communities to travel to participate in allopathic medicine. 

While the clinic has a mailing list of nearly 2,000 addresses, it is difficult to provide educational events and care to those who need them directly. The board believes that spreading awareness of the clinic’s presence, as well as hosting events, will draw attention to this new facility. However, it does not stop there. When asked about the overall goal of the clinic, Schmucker replied, “Well, the board’s big vision is to see as many children among the Plain community with genetic diseases as possible. They would like to branch out, maybe Southern Illinois? Tennessee. And of course Kentucky, especially in the surrounding counties.” This clinic connects Plain communities and families in Southcentral Kentucky to informative and potentially life-saving healthcare for which they would otherwise need to make extensive travel plans. If the board’s goals are met, an entire medically underserved population would have the opportunity to be screened for potential problems and treated if necessary.

Hunter Ricketts is a Western Kentucky University graduate who majored in Biology and minored in Folk Studies. He has worked as an EMT at the Medical Center EMS in Bowling Green, Kentucky, for 2 years and interned at the WeCare clinic in Christian County for 1 year. He will attend the University of Pikeville’s College of Osteopathic Medicine in the fall of 2020 and is interested in providing medical care to underserved communities in Kentucky.