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Tuesday Dec 08, 2015

A Food Desert Reveals Much About Health -- and Community

When the only grocery store in my county closed earlier this year, many of my patients resorted to eating food purchased from gas stations and dollar stores. Morale was pretty low, and so was the nutritional quality of available food.

I reviewed the data on grocery stores, access to produce, farmers markets and obesity to see what the closing would mean to the health of my community, but what I didn't anticipate was a lost sense of community -- or how easy that is to restore.

My office partner worried about kids who rely on school-based nutrition programs going without food during summer vacation, but a few weeks before school let out, flyers appeared around town promoting free snacks and lunches for school-aged children at a building downtown. The same organization that stepped up to feed the children (a nonprofit that provides in-home care) also arranged for bus transportation to grocery stores in a neighboring county. Individuals could pay $7 for a round-trip ride to the grocery store. Given the distance (about 45 miles each way), the cost per ride wasn't much more than the cost of gas.

It turns out we aren't alone. A growing number of small towns in West Virginia have lost their local grocery stores(www.wvfocus.com) in recent years, but creative community-based efforts are trying to fill the void.

Based on the literature regarding the link between access to nutritious food and obesity reduction(www.ers.usda.gov), I was excited to see the greenhouse just outside town post a big, hand-painted sign that said "Fresh Produce." A family-owned business built the greenhouse before the grocery store closed and had been selling things like hanging baskets and garden plants. Adding fresh produce to the greenhouse's offerings was a huge asset to the town during the summer, and most of my patients took advantage.

I ask my patients questions about food all the time: What did they eat that day? Where do they buy food? Who cooks their meals? Who in their family hunts (and for what)? Do they have a garden? Part of this is self-motivated interest in food and the culture surrounding food, but it's also a natural way to learn about my patients' health.

I worry about the functional status of many of my older patients, but some bristle at questions such as, "Can you walk two blocks without becoming short of breath?" We can still have a conversation, though, so I ask how many quarts they were able to can the last time they processed something, and when that was. If one of my elderly ladies says she had to stop canning for any reason other than arthritis, I get worried. So I ask about canning in the summer and carrying firewood in the winter to assess my patients. They are proud of how they live, and most of their sustainable ways of living weren't affected by the grocery store closing. But even those people who didn't need a ride to a far-away store felt better knowing their neighbors and friends had access to a store if they needed it.

This fall, I changed the treatment plan for one of my patients because he told me he left the woods on the opening day of deer season. People here are willing to miss Thanksgiving dinner, work, school, doctor's appointments and more for opening day, so I knew this guy was really sick. His symptoms seemed like run-of-the-mill allergic rhinitis, or maybe a cold, but for him to leave the woods without a deer, I knew he had to have an abscess in there somewhere. Hunting is in part for the trophy, but the majority of my patients -- and West Virginians in general -- hunt to fill their freezers for the year. There is no school here during the opening week of deer season because attendance would be too low.

Although food deserts remain a big problem in my state, the good news locally is that my community has a grocery store again(claycountyfreepress.com), and it is wonderful. On the day the new store opened, I walked there at lunch and bought fresh-cut fruit and a cup of yogurt, which was probably the healthiest lunch I'd had in months. I walk to the store from my office a few times a week, and although it might seem hokey, there is a sense of excitement and community about the place, largely because I remember how we felt without it.

Before the store opened, people would go stand outside, knock on the doors and windows and ask if the people working inside could sell them anything. I doubt many went hungry, but people did long for real, healthy food.

Like anywhere else I go in our small town, I often see my patients in the new store. Last week I heard someone calling, "Dr. Becher?" down the aisle, and I answered the woman although I didn't recognize her. She had walked into the store and asked a cashier to help her pick out groceries because she had been told her cholesterol was too high. The cashier knew I was in the store and suggested the woman find me instead. First, I asked her what her LDL was. She reported it was 130 and I thought to myself, "Well, that's pretty darn good." But I proceeded to suggest some things, such as using healthier oils rather than shortening.

The electricity was out that day, so the store was quiet, and everyone in the building could hear every word the two of us said to each other. There are moments that I know I'll never forget and look back on as quintessential small-town doctor moments, and talking with that lady in the dimly lit baking aisle will always be one of them. My interaction with that woman -- and the fact that our town again has a grocery store that can help her live a longer, healthier life -- still make me smile.

Kimberly Becher, M.D., practices at a rural federally qualified health center in Clay County, W.Va.

Posted at 11:11PM Dec 08, 2015 by Kimberly Becher, M.D.

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