The Appalachian Regional Commission (ARC) defines Appalachian counties and states in socioeconomic terms. In total, there are in Appalachia 420 counties, of which 84 are in the “Economically Distressed” category. These counties have three-year average unemployment rates at least one and a half times the national average, per capita market income no greater than two-thirds the of national average, and poverty rates at least one and a half times the national average. Of the 84 counties in this category, 40 of them are in Kentucky (Kentucky has 120 counties, so that amounts to a third of the state that is economically distressed).

Pike County, whose county seat is Pikeville, is the easternmost county in Kentucky. It thrusts between the borders of Virginia and West Virginia, as you can see by this map. It is the largest county by area in Kentucky, and the 11^th largest by population.

Pike County is in the “At-Risk” category. At-Risk counties are so-called because they are at risk of becoming economically distressed. In 2000, the population of Pike county was 68,736 (Kentucky’s population was 4.04 million—Kentucky’s Appalachian population is 1.14 million). Per capita income in 2002 was $21, 172. Per capita market income (excludes child support, alimony, retirement income and the like) for the same time period was $14,697. To put this in perspective, that rate is better than Kentucky Appalachia as a whole, but is still barely half of the US rate for the same period. Pike County residents, in general, earn half of what an average American earns.

The poverty rate in Pike County is 23.4%. This is nearly twice the national average.

In Pike County, 61.8% of residents have high school diplomas. The rate for college degrees is 9.9%.

Pike County, while better off than 40 of Kentucky’s counties, is certainly at risk.

But I did say that this was about a miracle, didn’t I?

Prior to 1996, there were two accredited medical schools in Kentucky—one at the University of Kentucky (student population 27,000) and the other at the University of Louisville (student population 22,000). In 1996, a third was added—at Pikeville College, a private Presbyterian college with a total student enrollment of 950. Most urban high schools in Kentucky have larger enrollments.

It began with a vision and a dream, as most things of worth do. The Kentucky mountains have long been plagued by a shortage of qualified doctors. There is still a high risk for live births, as there aren’t enough doctors. Patients sometimes have to travel more than a hundred miles to see a specialist. Many towns do not have practicing general practitioners or family doctors. People die simply because there aren’t enough doctors.

Imagine that you are a medical student at UCLA, or NYU, or at any of the other medical schools in the US. You are hundreds of thousands of dollars in debt, you see a career that can make you millions, you’re attracted by the glamour of state-of-the-art facilities in Chicago or Dallas or Portland or Phoenix. Want to take that hard-earned degree to Virgie, Kentucky? How about Slemp? Or if you’re really squeamish, how about Hazard? Pine Knot? Pippa Passes? At least there’s a college there. Come on down.

That has been the problem. No one wants to come to the mountains where a Chevy truck is better for the terrain than a Lexus. Where you actually have to go and see the people at home, because there isn’t a facility for them to come to¸ even if they could get there. Some of the places are so remote that even after you park your Chevy truck, you still get to walk for half an hour.

And then, if you don’t know the culture and understand these people, you won’t have any patients anyway. Mountain people have an extreme distrust of outsiders, and you can understand why. The mountains have been exploited for a hundred years and more, and mountain folk always come out on the short end. If you’re going to treat them as patients, you’ll die of starvation. Treat them as people, and you’ll have them for life.

Now imagine, if you can, that you are a mountain kid. Always wanted to be a doctor. Your family income is $20,000 a year. You can’t afford to be a doctor. The training is more expensive than your family’s take-home.

The Pikeville College School of Osteopathic Medicine (PCSOM) will give you a scholarship, paid for with coal severance tax funds. And books, computers and supplies?

"When students enter here, they're given state-of-the-art laptop computers and all the software they will need. We buy all of their textbooks. Last year we spent $330,000 on books. We buy their stethoscopes and other equipment, even their scrubs and lab coats. Many of these kids are coal miners' kids. They don't have any money. So we provide what they need. Think about the textbooks. Typically, a medical student will buy a text, use it, and then, the minute they get out of that class, they sell it. So they never develop a reference library. By our buying textbooks for all the students, they don't have any reason to sell them—and, really, they don't have anyone to sell them to. So they develop a beautiful reference library. I know of no other medical school that does all that for their students. They may require them to have laptops, but they don't buy them for them."

Kentucky residents who are accepted in the program (nearly 2,000 apply each year; 60 are accepted), and agree to provide primary care services in Kentucky after they have completed their schooling, can receive a scholarship.

John Strosnider, the school’s dean, says that when the idea of a medical school in Pikeville was first proposed, "many people felt it was foolish and impossible. We've proven them wrong. We've graduated our first class, and 90 percent of our graduates went into primary care. That's an unheard-of percentage, higher than we dared hope for. We have residency programs established. We have post-doctoral programs established. So we pick students from the mountains and train them in the mountains. They can do their residencies in the mountains, and we believe most of them will stay and practice in the mountains."

It’s a miracle. Maybe not the kind the Catholic Church would recognize, but a miracle all the same.