'The nurses' birthed a better place at Stinking Creek

WALKER, Ky. -- Midwife Peggy Kemner, 78 years old and bent over with osteoporosis like a tiny question mark, climbs into her dented car, peers over the dashboard and hits the gas.

"Hold on," she says.

The next 20 minutes of gut-twisting turns take Kemner on a familiar route: up a mountain hollow to help.

"I could've made it faster if these roads were straighter," she says with a laugh.

For 50 years, "Miss Peggy" and her schoolteacher friend, Irma Gall, have volunteered as missionaries along the winding watershed of Stinking Creek in Knox County, Ky., one of the poorest counties in America.

Kemner has been midwife for the births of 507 children, most in bleak mountain cabins with no running water and one light bulb stuck in the ceiling. She's nursed the sick, sat with the dying.

Gall has been a teacher and farmer, riding her horse up the hollows on muddy, rutted roads to teach at one-room schoolhouses in the late 1950s and 1960s. Together, they set up a community center called Lend-A-Hand Center, taught Sunday school and 4-H classes, and ran one of the nation's first home health care services.

Quietly, they advocated birth control and education for women. Viewed at first with suspicion and distrust, the women known as "the nurses" have, over the decades, proved how much hands-on caring can make a difference in the lives of individuals.

"We just wanted to lend a hand," says Gall, 72.

Back up in the hollows of Stinking Creek, where a couple of hundred people live, times are still tough. Nearly 35% of the 32,000 people in Knox County live below the poverty line, a rate three times higher than the national average. Still, life is better on Stinking Creek today than it was back then.

President Lyndon Johnson's "War on Poverty" brought billions of dollars in federal aid to the Appalachian region, from food stamps and health insurance for poor children to Head Start early-education programs and payments for men who suffered from black lung disease after mining the coal-packed mountains.

Women went to work, family incomes doubled and more children graduated from high school. More went to college, too. As throughout Appalachia, many people left for better opportunities elsewhere. But for those who stayed, particularly women, opportunities grew.

As family size shrank, the abject poverty that encased Stinking Creek began to ease.

The mountains opened up, and the people could see out.

Bringing quiet change

Sometimes it's hard to imagine just how hard, just how remote, life was 50 years ago for many of the people of Stinking Creek.

When Kemner and Gall arrived in August 1958, almost no houses had running water. Coal stoves provided the only heat. One electric plug worked the light, then the radio, then the light again. Big families — 13, 14, 15 kids — lived in tiny, three-room, hand-built, wooden cabins. Few houses were painted.

"Gray and brown and black," says Gall of the hills, the houses, the dust on the children's faces. "Everything was gray and brown and black."

Almost everyone had a pig or a couple of chickens, a garden and an outhouse. Land wasn't flat enough on the mountainsides to grow money crops such as tobacco. For the most part, families ate what they grew.

"There wasn't a lot of money left lying around," says Esco Smith, who runs a gas station and mini-grocery on Stinking Creek. He remembers the cabin he grew up in was so rickety, "You could see a chicken running around under the floorboards."

To scrape by, men did a little logging, a little mining and a little hunting. Most children didn't graduate from high school, and women had baby after baby after baby for 30 years.

"They didn't know any better," Kemner says.

Kemner and Gall brought a social revolution to the remote hollows of southeastern Kentucky.

They advocated birth control, civil rights, education for women and health care. All were seen as radical ideas. "People called us communists," Gall says.

Midwife Kemner birthed babies in the middle of snowstorms and in the middle of the night. She tucked bottles of hot water next to tiny newborns to keep them warm. She washed babies in cooking pans and, once, in a hubcap. Gall, though not a registered nurse, often helped.

Now, the mountains are filled with girls named Peggy.

Shrinking families

Looking back, Kemner and Gall say it was birth control, as much as anything, that changed the fate of Stinking Creek.

The daughters of women who had 14 or 15 children in the 1950s and 1960s grew up and had three or four. Their daughters and granddaughters now have one or two, or none.

"I saw how my momma lived, and I weren't gonna live like my momma," says Suzi Carnes Brown, who was born with Kemner's help. Her mother had nine children. She had four. Her daughter has one.

"I put a coil in, then I had my tubes tied," she says of the birth control she used on Kemner's advice. "I weren't gonna have no more babies."

Kemner and Gall came to Knox County because it was the only county in this part of Appalachia where they could find a doctor to sponsor Kemner's work as a midwife. Gall's earnings as a schoolteacher were supposed to support Kemner's volunteering.

When "the nurses" got here, no one would rent them a house. Finally, a man offered a house that had been flooded so many times that snake paths were cut through the mud on the floor. They cleaned up and got to work.

It wasn't long before the men of Stinking Creek were coming to their house in the middle of the night because a baby was being born.

In the still after the births, Kemner and Gall would strike up a conversation just loud enough for the women in the cabin to hear.

"You know, it doesn't have to be like this," one would say to the other, Gall recalls. "You don't have to be pregnant all the time."

Later, a sister or a female cousin would stop one of them and ask, "What were you talking about?" Then Kemner or Gall would explain birth control methods, such as the IUD or spermicidal foam and, later, the birth control pill. Women could come down to the health clinic at Lend-A-Hand and get birth control.

"I'd talk to them when their husbands weren't around," says Kemner. "Men didn't like it at all. Back then, a man's worth was the size of his family."

Shrinking family size meant more money for food, clothing and housing because there were fewer to feed, clothe and house.

Average household size in Knox County fell from 3.92 people in 1960 to 2.51 people in 2000. That was faster than the decline nationwide, according to the U.S. Census. Women went to work and family incomes jumped. The average income of women who worked in Knox County more than doubled to $21,000 in 2000 from $9,000 in 1960, adjusted for inflation, according to a report in July by the Population Reference Bureau and the Appalachian Regional Commission.

More children graduated from high school. More went to college, too, though still far fewer than nationwide. College graduation rose to 8.8% in 2000 from 7.3% in 1980, much below the 24.5% graduation rate nationwide.

For the young girls of Stinking Creek, Kemner and Gall were the first women they'd ever met who had college educations and were independent and living on their own.

"Miss Peggy's been an inspiration to me," says Myrtle Brown, 29, who is graduating from Eastern Kentucky University soon with a degree in nursing. She's got $40,000 in student loan debt and borrowed money from Kemner, too, to go to college.

"What's being done in Appalachia is the classic strategy for the developing world," says Greg Bischak, senior economist at the Appalachian Regional Commission. Birth control, education, health care and infrastructure work together to ease poverty, he says.

"It works here, too."

New chances

In a crowded trailer perched on a hillside above Stinking Creek, three generations of Sizemore women sit and visit every week.

The grandmother, Margaret "Baby Lu" Sizemore, had 10 children and raised them on her own after her husband left her. Kemner helped at the birth of half of them.

"I raised my own hogs, I killed 'em, and I made my own ham," says Sizemore, 79.

She sent all her children to Sunday school and 4-H classes at Lend-A-Hand.

One daughter, nicknamed Peggy after Nurse Peggy, left Stinking Creek after high school and lives in a suburb of Atlanta with her husband and two children. "My life isn't anything like my mother's," says Alice "Peggy" Pruett, 48.

"From the time I was a teenager, I always knew there wasn't anything (in Stinking Creek) for me. There just wasn't, wasn't any jobs, wasn't anything."

Her other siblings are closer by. But none has a big family like their mother did.

"They preached birth control, and we preached it to our kids," says her sister, Debbie Smith, 45, who lives nearby in Bimble, Ky.

She says that because she had fewer children, she was able to work outside her home and is now going to community college with her daughter, Ashley, 19. She's getting a certificate to be a home health aide. Her daughter wants to be a dentist.

Ashley is a modern girl who says she "can't imagine" how her grandmother lived, raising animals, killing them, living with coal heat and having babies at home with a midwife. She shivers. "I can't live without my iPod."

Stinking Creek doesn't look the same anymore.

Wooden cabins have been torn down and replaced by mobile homes. Almost everyone has running water and indoor plumbing.

Satellite TV dishes hang off window sills. And some neat brick ranch houses and bigger two-story colonials have sprung up in the wide, more-prosperous land at the mouth of the creek. Most homes are neatly painted, some in bright colors.

Lend-A-Hand has a computer, and most folks have cellphones.

Government programs have helped, of course. But they've also bred dependency on welfare. Nearly 37% of people in Knox County got some kind of government help in 2004, according to the Kentucky Cabinet for Health and Family Services.

And many people, including some along Stinking Creek, make money from growing marijuana and selling drugs such as Oxycontin and methamphetamine. Kentucky is the second-largest producer of pot in the nation, behind California, and Knox County is one of the biggest growers in Kentucky, according to the U.S. Drug Enforcement Administration.

"One thing's different, that's the drugs," says Ken Messer, whose father, Elis Messer, ran a country store 50 years ago on Stinking Creek.

"You got to lock your doors now because they'll steal anything to buy drugs."

An uncertain future

Kemner and Gall say they are retired, but they both work all day long. "Nurse Peggy" still makes the rounds of the hollows, checking on sick and elderly patients, and runs a weekly health clinic where truck drivers can get a checkup required by law for $25, instead of the $150 a doctor would charge.

The women grow almost all of their own food on a self-sustaining 600-acre farm that itself is a thing of the past.

Gall breeds, raises and slaughters cows, goats, sheep and pigs. She's rebuilding a split-rail fence and finishing rock work on a restored mountain log cabin that she had moved onto the Lend-A-Hand property and expanded. She lives there now.

Kemner and Gall, with some hired help, built two houses, a chapel, a barn and several outbuildings. They hired a crane to build a rickety bridge across Stinking Creek and even widened the creek with backhoes to ease its flooding. "Like the River Nile," says Gall.

Each year, dozens of church and university groups volunteer to help at Lend-A-Hand. They travel from cities across the nation to live and work at the center for a couple of weeks. Kemner cooks all their dinners.

Through the years, fewer volunteers have come, as people in other areas have gotten more attention than the poor in Appalachia. "We have a lot of competition now," Gall says.

On a late winter day, two volunteers hunch over the garden, digging up potatoes from last year for dinner.

Laura Hahnfeld and Kristen Borst are going to college in Michigan, and they spend vacations and summer breaks helping Kemner and Gall. They teach Sunday school and help run the farm.

One day, Kemner and Gall hope, the two young women might take over the work they do at Lend-A-Hand. But the young women aren't sure if the work here is relevant anymore.

"I wonder: What are the needs now?" says Hahnfeld, 26, of Midland, Mich. "The face of poverty has changed. It's all about access to technology now."

Borst, 27, of Grand Rapids, Mich., agrees. "I wonder if it's the 'working farm idea' that will keep Lend-A-Hand relevant in the future," she says. "The kids are in danger of a total disconnect from the earth." At least, she says, "We can show them that sweet potatoes don't come from the grocery."

It's a future Kemner and Gall don't worry about. If Lend-A-Hand goes on after they're gone, that's fine. If not, that's fine, too.

They'll just keep working until they can't work anymore.

"If the Lord sees we need help," says Gall, "he'll send it."

Mindy Fetterman's father, John Fetterman, who was a Pulitzer Prize-winning reporter for The Courier-Journal in Louisville, wrote a book about the area in 1967 called Stinking Creek: The Portrait of a Small Mountain Community in Appalachia. She went with her father several times to Knox County as a child.