from Caryl Carpenter, posted July 2023
Stoney Fork, Tennessee is an isolated area in the southwest corner of Campbell County. Stoney Fork is approachable from three ways, all over unpaved gravel roads. The road from the North comes in from Norma in Scott County, and at one point crosses a stream that, with any significant rainfall, makes the road impassable. The road from the southwest is a long bumpy one that connects with state Rt. 116 midway between Briceville and Petros. The shortest route, the one from the northeast, goes over Caryville Mountain with its 18 switchbacks where you can encounter coal trucks racing down the mountain to deliver the coal mined nearby. Weather can also interfere with this road.
Stoney Fork and the adjacent communities of Shea, Beech Fork, and PeeWee Camp were at one time in the heart of the deep mining coalfields. Including neighboring Clinchmore, the population was about 3,000 in the early 1970s. With the decline of deep mining, many were forced to move. In the Spring of 1964, during a period of heavy rains, a flood decimated Clinchmore and killed six people, forcing even more people to leave the area. There has been considerable speculation about the cause of the flood. Many people believe it was the impact of strip mining on the surrounding mountains.
The number of students in the old Stoney Fork School decreased from 300 in the 1960s to 80 in the early 70s. Most of the people lived in old houses or trailers on the one road through Stoney Fork. There were two small stores still open in the 70s and several churches up and down the road.
The churches were the center of activity in the community. Once each year, usually in early summer, there is a church homecoming where all people who have ever attended over the years come together for a day of services, singing, and home cooked meals. There are many out-of-state people at these gatherings, people who moved away to find work but always come back for homecoming.
The folks in Stoney Fork made a living in a variety of ways. Some worked across the mountain in Caryville or LaFollette. Others drove trucks or farmed for a living. Some received welfare or black lung benefits. In 1971, Stoney Fork had a 26 percent unemployment rate and a 70 percent underemployment rate. These rates continued to get worse throughout the 1970s.
As in other parts of Appalachia, Stoney Fork and the surrounding communities underwent significant change. When deep mining flourished, there were jobs. Even though people were poor, they enjoyed economic stability. Families stayed together and children never moved far from home. People in Appalachia have always been self-sufficient and fiercely independent. All the supplies and services they needed were nearby. Even though the terrain is rugged, most families had gardens.
Two factors significantly weakened the economic and social fabric of the area: 1) changes in land and mineral ownership, and 2) the closing of the deep mines. Around the early 1900s, large corporations began to buy up land, or if not the land, the rights to the minerals underneath it. People received what to them was a large sum of cash in exchange for their land or mineral rights, and they were told that they could still live on the land.
Mechanization in the coal mining industry put many miners out of work. As men were laid off from the mines, there were no other jobs for them in the area. Many moved north to Cincinnati, Cleveland, Chicago and Detroit. It was usually young families that left. In many cases, there were no young people to care for their elderly parents, as had been the tradition in the past.
People whose ancestors had sold the land were told to move. People who no longer owned their mineral rights found huge bulldozers on their property, ripping up pastureland, timberland, and gardens. Landslides caused by strip mining threatened their homes and destroyed the land. Serious flooding occurred with each rainstorm. Streams, wells and springs were damaged by acid and mineral seepage and by heavy silting.
Strip mining could be very profitable for the mine owners, but none of the profits remained in the area; they flowed elsewhere, even as far away as New York and England. In the five-county area (Campbell, Morgan, Scott, Anderson and Claiborne) that supplied 80 percent of Tennessee’s coal in the 1970s, 75 percent of the land was owned by outside landholding companies. Eighty-five percent of the coal wealth was controlled by fewer than 10 owners.
These were the factors that undermined the economic stability of the region. In no place was this truer than in Stoney Fork. There was no investment by local or state governments to revitalize the region, create new jobs, or provide support services, including health services. In the early 70s, Stoney Fork had been without a doctor for more than 25 years. Before that, the only doctor in Stoney Fork worked for a coal company that provided many of the jobs on the mountain. When the mines closed, the doctor left. By 1972, the nearest doctor was an hour away, over the three often unpassable roads that led to Stoney Fork.
The Vanderbilt Student Health Coalition identified Stoney Fork as a good location for a health fair and began organizing in the area in 1972. The first health fair was in the summer of ‘72. Unlike some other communities where the Coalition worked, Stoney Fork did not have an organized group to work with. However, many people in Stoney Fork had heard about the health fairs in other communities. A loosely-knit group formed to work with the Coalition workers to talk about their health needs. Eventually the group requested a health fair. The health fairs took place in June and July of that year.
A key player in the health fairs at Stoney Fork and other communities was the Tennessee Valley Authority (TVA). TVA had an elaborate mobile health laboratory it used for its own employees at some of its construction sites and remote locations. Coalition representatives asked TVA if they could borrow the lab, and they said yes. This gave the Coalition free lab space, a place to take blood samples, do EKGs, chest x-rays and other tests. A smaller, less elaborate TVA trailer was used as the clinic in Stoney Fork until a permanent building was completed.
After the health fairs, law students from Vanderbilt helped the community form and incorporate a health council. The Stoney Fork Health Council was incorporated on August 30, 1972. The three incorporators were Odes McKamey (who became the president of the health council), Harold Wilson, and Ruby Lawson. They began the process of building a permanent clinic at Stoney Fork.
Odes McKamey working on construction of the Stoney Fork Clinic
A second set of health fairs took place in Stoney Fork in 1973. There were 62 adults seen at these events. Only 40 percent of the adults had seen a physician in the last 3 years. The most frequent diagnosis among the adults was some form of heart disease, followed by COPD, Black Lung disease, and dental caries. Eighteen percent of the chest x-rays provided and 18 percent of the EKGs were abnormal. Most patients with abnormal results were referred to Coalition-affiliated physicians (48 percent) and 29 percent were referred to local doctors.
There were 49 children screened at the health fairs. The most common diagnoses for these children were dental caries and parasites. The majority of those seen were up-to-date on their immunizations, ranging from 84 percent for DPT to 67 percent for rubella.
Odes and Shelby McKamey were among the most cherished local hosts for members of the SHC when the health fair arrived in their remote mountain community of Stoney Fork, Tenn. Odes and Shelby both came from coal mining families. Shelby was born at home in Rosedale; Odes was born in Lafollette. Odes drove a gravel truck for the county. Shelby eventually became the clinic receptionist. Odes’ father, Walter, was one of the first patients at the clinic.
After the Stoney Fork Clinic was established, the McKameys also housed and hosted visiting doctors who came to the clinic, including Tom John. Odes died in August 2017.
You can read Tom John’s eloquent memoirs about his time with Odes and Shelby here. As he explains in that essay, Odes and Shelby were the “bedrock of our involvement in Stoney Fork…I know that for Bill Dow, for me, and for numerous other SHC folks, our friendship with Odes was an integral part of the profound influence that the Student Health Coalition had on our lives.”
In his remembrance, Tom John mentioned Papaw (Walter) McKamey. The elder McKamey had worked in the coal mines, and by the time of the health fairs, he had serious heart and lung disease. Walter’s conditions required him to see a doctor at least twice a month, sometimes more often. Before the clinic opened, he had to travel more than an hour over the switchbacks of Caryville Mountain to see a doctor in LaFollette. Once the clinic opened, he could walk to see a doctor.
In an interview with a reporter for TVA’s magazine, Odes said, “this is about the best thing that has ever happened to Stoney Fork. Before we got the health center, we had to travel an hour in any direction to find a doctor, although there is a doctor within 15 miles. Here in the mountains you don’t measure distance in miles, but in time. The roads are steep and mostly bad. Many are not paved. Some are just dirt. You don’t cover much distance very fast.”
In a 2017 interview, Shelby McKamey and their daughter, Sheree McKamey Craig, talked about the kind of leader Odes was. He was someone who knew how to get things done. As Shelby said, “he could charm the pants off a snake to get what was needed.” Without him, the Stoney Fork Clinic never would have come into existence. Sheree said, “you always went to Odes if you wanted to get something done. I’m proud of my Dad.”
Given the challenges of raising funds, the members of the Stoney Fork Health Council (SFHC) concluded it would be difficult to operate as a solo clinic in a small town. The SFHC decided to join with health councils in Norma (Scott County) and Petros (Morgan County) to form Mountain People’s Health Councils (MPHC). They decided to use the model developed by United Health Services in Campbell County of a circuit-riding physician who regularly visited small clinics that were staffed by nurse practitioners. The National Health Service Corps agreed to place nurse practitioners in each Mountain People’s community, along with a full-time physician who would visit each clinic once or twice a week. Mountain People’s also received Federal funds from the Rural Health Initiative Program to cover operating expenses for the three clinics. The MPHC Board also hired a full-time administrator, Duane Sexton, and a secretary, Janice Laxton, to provide administrative services to the three clinics.
The Stoney Fork Clinic opened in the summer of 1974. Rick Davidson, a Student Health Coalition alum, was the first circuit-riding physician who visited Stoney Fork once a week. The first nurse practitioner was Pat Karpinski. The second nurse practitioner was Kathy Bowman, a graduate of the Master’s program at the University of Pennsylvania. Shelby McKamey was hired as the receptionist and lab assistant. Kathy Dougherty was hired as the outreach worker.
Kathy Bowman liked to tell the story of Mack McGhee, an elderly patient at the clinic who was skeptical about seeing a female nurse practitioner. Mack had congestive heart failure. Kathy wanted to check his legs for swelling and water retention, but Mack was having no part of it. After Kathy had been at Stoney Fork for over a year, Mack marched in to the clinic one day, sat down, rolled up his pant legs and said, “I guess you can check them out now.”
After two years, Kathy Bowman was replaced by Kaye Bultemeier, a graduate of Vanderbilt’s Master’s program for nurse practitioners. Kaye was the longest-serving nurse practitioner at Stoney Fork. Eventually, Kaye spent part of her time at Valley Health Services in LaFollette, a National Health Service Corps site that grew out of the Black Lung Clinic in Jacksboro. In a 2017 interview, Kaye talked about her background and her experience as a nurse practitioner in Stoney Fork.
Kaye found the people in Stoney Fork very accepting of her role as a nurse practitioner, in large part because she stayed for so long, unlike the typical physician or nurse practitioner in the National Health Service Corps.
Her philosophy was that patients know best who they need to see. If someone preferred to be seen by a physician, they were scheduled on a day the Mountain People’s doctor was there. Kaye (and also Janie Hiserote in Petros) felt strongly that she didn’t want to be a mini-doctor. She believed she had complementary skills to the physicians she worked with and did not want to be seen as a physician substitute. In the 2017 interview, Shelby said “everybody loved Kaye. She was so down-to-earth and matter of fact. Everyone trusted her.”
The first National Health Service Corps physician at Mountain People’s Health Councils was Rick Davidson, an alum of the Student Health Coalition. In an interview, Rick said his acceptance in the community was enhanced by his participation in a local band called the New River Boys, most of whom were from Stoney Fork. Rick played bass with the band and performed with them throughout the area.
All of the Mountain People’s clinics had an arrangement with Dr. Chuck Darling, an OB/GYN physician in Oak Ridge. The nurse practitioners in the clinics would provide the pre-natal and post-partem care to patients. Dr. Darling would deliver the babies at Oak Ridge Hospital. Dr. Darling was very popular with the patients.
In her 2017 interview, Shelby McKamey remembered that Dr. Darling donated medicines to the clinic, but most patients didn’t want to take them. They thought anything for free must not be good quality. That reminded Caryl Carpenter of a discussion she had with the Stoney Fork Health Council about raising fees. The Council was in favor of raising fees because they wanted everyone in the community to understand that the clinic was just as good as an doctor’s office.
After two years, Rick left to complete his residency in internal medicine at Vanderbilt. The National Health Service Corps (NHSC) placed Alan Miller at Mountain People’s. Two years later, Mountain People’s had to look for a physician to replace Dr. Miller. Caryl Carpenter, the MPHC administrator at the time, and Bill Dow reached out to Bob Hartmann who was an SHC alum just finishing his residency in internal medicine, at UNC-Chapel Hill. Bob was looking forward to returning to the communities where he had worked with the SHC, serving as SHC Director in the summer of 1973.
At the same time, another physician, Chet Caster, expressed interest in coming to practice in Morgan County. Dr. Caster was a graduate of the University of Michigan Medical School and had just finished his residency in family medicine in South Bend, IN. Dr. Caster was a member of the Brothers of the Holy Cross. He and fellow members of the order hoped to move to Morgan County together to work in the community.
All of the communities in Mountain People’s were familiar with Bob Hartmann because of his work with the Student Health Coalition. Dr. Caster was not familiar to them. Board members from Norma and Stoney Fork wanted Dr. Hartmann to be their next physician. Board members in Petros were happy to have Dr. Caster work exclusively for them. So for the first time, Mountain People’s had two physicians.
Because Dr. Hartmann now had extra time, Caryl Carpenter, the administrator at MPHC at the time, arranged for Dr. Hartmann to spend some of his time at Valley Health Services in LaFollette , staffed by two NHSC physicians.
Working with the Norma and Stoney Fork clinics was a memorable experience for Dr. Hartmann. In a 2018 interview, he recounted an interaction with one of his Stoney Fork patients who couldn’t afford to pay for his family’s health care. Periodically, the man would ask for Bob’s car keys. At the end of the day, Bob would find a side of venison in his car trunk – the payment for services rendered.
In that same interview, Bob talked about what he learned from working in the East Tennessee clinics and how that shaped his future work as a physician. He eventually started a practice in a small town in Northern California, where he also served as the county public health officer.
After Kaye had been working in Stoney Fork for eight years, she received a call from the National Health Service Corps. Kaye had stayed at her post much longer than the NHSC expected. Her choices now were to work with Dr. Firestone, the NHSC physician at Valley Health Services, to take over the clinics as a private practice or be reassigned to another NHSC site. Kaye chose to leave (as did Sally Kimberly, the nurse practitioner in Norma and Dr. Firestone). Kaye did stay in the area, working with Dr. Chuck Darling, the OB/GYN who had provided obstetrical services to MPHC patients.
After Kaye left, it was hard to find a nurse practitioner who would venture over the mountain roads to work in Stoney Fork, even on a part time basis. For a while, Betty Stanley, the nurse practitioner in Norma, would visit Stoney Fork once a week, even though the road from Norma to Stoney Fork was the one that required her to drive through a stream. Eventually even that arrangement fell through and the Stoney Fork Clinic closed for good in the 1980s.
In their 2017 interview, Shelby McKamey and Sheree McKamey Craig talked about Stoney Fork today. About 75 percent of the population has left. Those who have moved in are not the same as those who left – they are “off the grid”, as Sheree would say. There are very few jobs. The school is closed. Opiod addiction plagues Stoney Fork as it does much of Appalachia.
Nonetheless, Sheree and Shelby cross the mountain through Petros every Sunday to attend church, unless there’s ice on the road. The church still has homecomings where those who left can reunite for a couple of days of faith, food and festivities. One change that is hard to believe for those who worked with the Stoney Fork Clinic in the 1970s – all the roads to Stoney Fork are paved, even the one that comes through Smokey Junction from Norma. And the road over Caryville Mountain, with its 18 switchbacks, has guard rails.
This story about the clinic in Stoney Fork draws on the Vanderbilt Center for Health Services Annual Reports for 1972 and 1973 and interviews with Kaye Bultemeier, Bob Hartmann, Rick Davidson, Tom John, Shelby McKamey, Sheree McKamey Craig, (links to those interviews embedded in this essay) plus an article in TVA magazine.