Commentary Health Systems

Practitioners of Last Resort: Appalachia’s Alternative Health-Care Providers

Ellee Achten

Poverty limits access. To everything. Health care is no different. What’s unique about alternative or integrated care is that there is often no middle man, no gatekeeper.

When I went to my first appointment with a clinical herbalist, I trembled. Instinctively, I put my hand across my collarbone and took a long, slow breath. I’ve had this anxiety about medical practitioners since I was 6 years old and sick with rheumatic fever—the first of many illnesses that have had me in and out of doctor’s offices and hospital beds throughout my 37 years.

As I stood outside Caty Crabb’s door, worry threatened to overtake my hope. Would this new-to-me provider be able to help? Would this kind of treatment reduce my rheumatoid arthritis pain or address my food allergies? Or would it be more of the same—more tests, which would lead to even more tests? After months of research, I at least believed plant-based medicine could be safe, though scientists are divided on that as well as its efficacy.

A clinical herbalist is someone who uses plants for medicinal purposes. Herbal treatments, as well as the cultivating of plants and herbs for health reasons, are undergoing a resurgence in Appalachia. Plant-based medicine has always had a foothold in the region, in part because of tradition, but also, convenience and necessity.

Certified from the Southwest School of Botanical Medicine, clinical herbalist Crabb has worked with herbs for more than 20 years. In 2009, she opened her business, Wildfire Herbs, and her clinical practice, the Appalachian Ohio Herb Clinic, both in southeastern Ohio. Business is booming. As one of only two practicing clinical herbalists in the area, she sources some of her plant material locally, much from her own 86-acre farm. The next nearest resource for herbs is an hour and a half drive away.

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That first day in her office, I sought help for years-long symptoms and a string of diagnoses. I was also facing the end of a marriage, while feeling the looming death of my mother like an unavoidable shadow behind me. “You got anything for anxiety too?” I asked Crabb, chuckling inappropriately, as many of us do when revealing these heavy-burden, stigmatized details of our health.

Crabb did. “When I think about holistic, I’m also thinking about the person’s whole life,” she explained. “What’s going on in their life right now, what’s their support system like, what kind of stress are they under, what are they eating? Health is about more than just what’s going on inside your body. What’s going on outside your body affects your body a lot.”

Since I first said it to a close friend, years ago—“Western medicine has failed me”—I’ve heard others repeat those same words. Though there is always, inevitably, years of complex narrative unique to each person packed into the sentence, to me, there are huge, gaping holes in the Western approach, like wounds that haven’t been tended to. And those wounds will fester. Western medicine—or “allopathic” medicine, as many in alternative or integrated care call it—often focuses on treating symptoms, rather than taking the time and resources to uncover the root cause. It’s a remedy-based approach that depends primarily on drug or surgical intervention. Once the symptom is lessened or resolved, the patient is moved along. But chronic health concerns, like my own, in this system often end up with a dulling of symptoms, while the patient must manage the myriad side effects that may come with each pharmaceutical.

Don’t get me wrong: I’m not against Western medicine, entirely. I still gratefully took an anti-viral when I had shingles, a few years ago. I still trusted in a vascular surgeon to treat complications of thoracic outlet syndrome.

But that was back when I had health insurance through my employer. Shortly after, escalating health problems forced me to stop working a full-time job. Currently, I have no easy access to health care. Which means another dip back toward the poverty line. Covered by Medicaid, I’m among those in the 14.6 percent considered impoverished, according to 2017 statistics about Ohio.

It is largely accepted that poverty limits access. To everything. Health care is no different. What’s unique about alternative or integrated care compared to allopathic medicine is that there is often no middle man, no gatekeeper, no pages and pages of paperwork to be sent to multiple offices that will determine what part of your health is covered and what isn’t—and for how much.

My bill for the initial visit to see Crabb was $60. I was there for almost two hours. It is has been my most expensive bill for consulting with her so far. The actual medicinal herbs I take range between $45 and $95 a month. That’s significantly less than what I paid for pharmaceutical medications at various times in my life—even with insurance. And, as my body heals, I take less herbs and pay less each month.

“Some people say herbalists are the practitioners of last resort,” Crabb said. “Because a lot of people don’t know about herbs and they don’t find them until everything has failed.”

Or everything has become unaffordable.

Before I found a clinical herbalist, I learned of osteopathic manipulation, another integrated medicine. I discovered it accidentally, when I noticed my new primary care physician had a mysterious “D.O.” for Doctor of Osteopathy instead of the usual “M.D.” after her name on the office nameplate. At first, she proceeded as expected during my visit. She pressed her stethoscope against my back and across my chest looking for the cause of a breathing complaint. Then she had me lie back so she could feel for any imbalance. This was new. And weird. Her fingers made gentle, small motions around my ribs. I felt a shift in my chest, and then a rushing relief: a rib on my right side had been dislocated, compressing part of my lungs. 

Then I found acupuncture. I wish I had known much earlier how effective it would one day be for me. My rheumatoid arthritis would cycle slower, sending me the aching, swollen, fatigued symptoms less often—and they were less severe. My sleep would be helped, digestion would be helped, inflammation would be helped. My chronic pain would, finally, be helped.

Through acupuncture, osteopathic manipulation, and herbs, I have found relief. But to receive osteopathic manipulation treatments, a patient must possess accepted insurance (which can often include Medicaid) and go through the usual channels of bureaucracy with a doctor’s office. A licensed acupuncturist is often not covered by any insurance, and at $65 to $135 per session it is priced beyond the financial reach of someone living near the poverty line. Herbs, on the other hand, provide a relief that costs me about the same price each week as a small salad.

“My practice is completely full because of word of mouth, and really only word of mouth,” Crabb said, “People talk about things when they work.”

Since age 6, I’ve dealt with chronic health issues. I’ve had more doctors than I can count on both hands, been in hospitals all across the country, in cities big and small. I’ve had a top-ranked surgeon cut me open and stitch me back up. But finally and surprisingly, I found help in a rural town in Appalachian Ohio. Without going into debt.

Alternative care can give bodies like mine the right amount of attention to unravel medical mysteries. In this approach, symptoms are signposts helping navigate an underlying imbalance, and practitioners like Crabb look holistically at our whole lives to find just the right fit for treatments, which, in most cases, are the medicines that birthed modern pharmaceuticals in the first place.

This small town in Appalachia is the last place I expected to find quality, affordable health care. I still have chronic illness. I still need treatment. Yet, I have changed from a woman hunched over, winded with pain, to a woman skating on the local roller derby team, getting knocked down and jumping right back up.

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