Essay Instructions: Required Reading:
1. Coal mining in Eastern Kentucky
http://www.coal-miners-in-kentucky.com/
2. Martin County, Kentucky
http://en.wikipedia.org/wiki/Martin_County,_Kentucky
http://en.wikipedia.org/wiki/Martin_County_Sludge_Spill
3. Black Lung
http://www.courier-journal.com/cjextra/blacklung/index.html
4. Kentucky Tele care
http://www.mc.uky.edu/kytelecare/mobile.asp
5. Mobile clinic brings medicine to coal miners http://news-expressky.com/articles/2006/12/04/news/02clinic.txt
6. WVU study links chronic illness to coal-mining pollution
http://www.health.wvu.edu/newsreleases/news-details.aspx?ID=844
Recommended Reading:
1. Companies leave coal miners gasping for health payments
http://newstandardnews.net/content/index.cfm/items/3942
2. Rural West Virginia winning over healthcare workers
http://www.globalaging.org/ruralaging/us/wv.htm
3. CDC National Institute for Occupational Safety and Health
http://www.cdc.gov/niosh/topics/minerescue/
A. What is Coal? Coal is a fossil fuel - meaning it contains the remains of plant and animals. It is believed to have been formed over millions of years from organic matter growing in swamps which decompose becoming peat. This peat was buried and compressed over millions of years forming coal. The more pressure and heat – the harder the coal. There are 4 types of coal: Lignite (soft), Subbituminous (medium – soft), Bituminous (medium-hard) and Anthrocite (hard)
B. Coal Mining History: Check out the Eckley Miners Village site for a brief history of a “patch town” http://www.eckleyminers.org/
C. Coal Mining Today :
- Coal mining is a job with a long history of struggles.
- It is estimated that > 100,000 miners have lost their lives in accidents throughout its history
- The worst year was 1907 where 3200 miners died
- There have since been significant safety improvements since then – but, mining is still a very dangerous job. About 300 miners have died in the last 10 yrs.
- There are about 65,000 coal miners today. The nature of the job will always expose the miners to dangers: ceiling collapses, explosions from methane gas, carbon monoxide toxicity, and fires.
- Black lung is caused by inhaling coal dust.
- Health effects reach beyond the miner himself. Coal- mining pollution has been linked to chronic illness in residents of coal-mining communities.
D. A Coal County:
- There are no longer company owned “patch towns” from years ago – the reminants of which can be seen all over NEPA.
- A county where coal mining makes up more than 3% of income
- Poverty levels substantially above national median
- Low median levels of education
- High levels of unemployment
- Communities have had few employment alternatives to coal.
- People work in the coal mines because they have to – not necessarily because they want to.
E. Martin County, KY
- Martin county is located in eastern Kentucky
- Population in 2000 was 12,578
- 54 persons per square mile
- Median household income $ 22,768 in 2004.
- High school graduates only 54%
- No hospital within Martin county lines – regional healthcare centers elsewhere in Eastern Kentucky.
Comparison of Luzerne, Co. Pa. and Martin County, Ky (US Census data)
Martin Co.,
Ky Kentucky Luzerne Co.,
Pa Pennsylvania
Population 2006 est. 12,093 4,206,074 313,000 12,440,621
High school grads, % of persons age 25+, 20000 54% 74.1% 81.1% 81.9%
Bachelor’s degree or higher, % of persons age 25+, 2000 9.06% 17.1% 16.4% 22.4%
Median household income, 2004 $22,768 $37,046 $36,968 $43,714
Persons below poverty, %, 2004 30.56% 16.3% 11.5% 11.2%
Persons per sq. mile 54.5 101.7 358.3 274
F. Health concerns of mining towns
1. Mining dangers such as ceiling collapses, fires, explosions. All of these dangers have been lessened by increased safety precautions – but, there is still significant risk
2. Black lung from inhaling coal dust. Although more precautions have been taken – it is still a problem
3. Pollution from mines causing an increase in chronic disease of nearby residents.
- 70% increased risk for kidney disease
- 64 % increased risk of COPD
- 30% increased risk of HTN
G. Barriers to health care in mining communities
- Miners themselves resistant to screening for fear they may be diagnosed with black lung and then be unable to work in the mines. So, they tend to just keep working – until the disease has progressed to a late stage.
- Mining communities are in rural areas – with all the problems of access to care as any other rural area.
- These communities are usually underserved by the health care system.
- Difficulty of miners with Black lung to obtain benefits from coal companies
After miner uprisings in WV in 1968 let to the creation of a federal
black lung benefits program to pay for health and living costs miners.
The government funded the program until 1973 when the coal mining companies
took over the financial responsibility – since the coal mining companies have
fought against every black-lung claim.
H. Health care intervention in rural mining communities:
1. Need to increase screening available for miners and the high risk diseases
common in the mining communities.
2. Patient education on the importance of screening for both miners and their families
3. Use of mobile clinics as in Martin County, Ky
Using above reading material answer these 2 discussion questions:
DISCUSSION QUESTIONS
1. Discuss a barrier to care in the coal mining community such as:
a. Miner’s reluctance to be screened for black lung
b. Barriers to miners receiving black lung benefits from coal companies
c. Coal mining pollution and chronic illness in the community
d. Education level and/or poverty levels
2. Discuss how health professionals (chose nurses, nurse practitioners, social workers, etc) could help to overcome this barrier to the care of miners and their families.
