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Great Health Divide: Stroke patients face greater challenges in rural America

Updated: May. 7, 2021 at 7:33 PM EDT
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ROANOKE, Va. (WDBJ) - In our series the Great Health Divide, we’re learning how Appalachians have greater obstacles when it comes to getting care for strokes. And we’ve learned some of our hometowns have among the highest rate of strokes in not just Virginia, but the nation. Appalachia in general and southwest Virginia in particular struggle with poorer health outcomes. But there are people in our community dedicated to seeing that change.

Jeff and Nancy Rudder will have been married 38 years this year. Every one of those years has filled with the high and low moments you expect of a marriage, and some you could never see coming.

“The last 12 years have certainly not been what we planned for,” said Nancy Rudder.

Twelve years ago this week the Danville family’s lives changed forever.

“I mean it happens in an instant,” Rudder said, snapping her finger.

While out to dinner celebrating Mother’s Day, Jeff suffered a stroke at age 54. It would be the the first of three strokes he would have in the next few months and years.

Jeff cannot speak and has physical disabilities that have rendered Nancy his full-time caregiver.

“It’s a lonely journey and in our case it’s a very quiet, lonely journey,” she said.

While it is lonely, they are certainly not alone, by the statistics.

According to data from the Virginia Department of Health and the CDC, in neighboring Martinsville, the rate of stroke is staggering.

While the number of strokes per year may only be in the teens, from 2016 to 2018 it had the highest rate of stroke in the entire Commonwealth. While the most recent data show that number has come down some, the rate of stroke in the small town is more than twice that of the national average, when looking at it through a lens of per 100,000 people.

“It’s shocking,” said Nancy Bell with the West Piedmont Health District. “It’s a small community, and to have that many people dying of stroke is alarming and it’s tragic.”

Bell said the health district has higher rates of smokers, obesity, heart disease, and diabetes, compared with the rest of the state, and less access to care.

“We still have problems with access. Not only do we not have enough physicians, we don’t have transportation system,” she said. “We have some medical transport - it’s spotty. But access is a big deal. If you do not have a regular doctor and you do not have transportation, then you’re not going to get help unless you’re already sick.”

She says the life expectancy of a person in Martinsville is 67.8 years.

But for the average Virginian, it’s 79.5 years.

“So your zip code definitely has a lot to do with your life span and to me that’s something we really need to work on,” she said.

Care centers of any kind for stroke patients in Southwest Virginia are few and far between, according to maps by the CDC. The nearest one for someone in Martinsville is in Danville. But in Danville, neurologists are only available via telehealth.

Prior to his stroke, Jeff Rudder was healthy. An avid runner and baseball coach, he only learned after stroke number three, he had a heart condition that put him at risk.

It’s something Nancy Rudder believes might have been detected earlier with more stroke care centers nearby.

“We can’t wait much longer,” she said, in a request for more care. “Those out there who have a stroke this evening or tomorrow or next month.”

Rudder says being a full time caregiver is challenging and expensive. They sometimes struggle to afford his medication or speech and movement therapies.

“You know I’ve realized that... there’s no shame in asking for help,” Rudder said. “There are people, there are friends, there are neighbors in this community, that will help and that have helped a lot.”

Nancy Bell says rates of stroke in African Americans in Virginia and the country are even higher. But as they work to get this population vaccinated for COVID-19, they’re hoping the connections made will help expand education and promote lifestyle changes.

“We have actually made partnerships and inroads into that population that we hope will serve us beyond the pandemic,” Bell said.

These days, Jeff and Nancy want to spread the word about stroke awareness and the highs and lows and unexpected circumstances that come with being a survivor and a caregiver.

Jeff can understand everything said, but can only communicate with a small device.

He types out a message while Nancy explains despite the challenges, she remains committed to his care.

“He knows, I will never give up,” she said with tears welling in her eyes. “Never.”

Jeff hands over the device. The message he has to share, “I want to live.”

“What does it mean to you to hear that?” this reporter asks.

“That he hasn’t quit either,” Nancy says. “...I have never met a kinder man. So, I got pretty lucky. All those years ago.”

May is stroke awareness month and we also spoke with Dr. Edna Gordon, an emergency room physician for SOVAH Health in Martinsville and Danville, who works with stroke patients.

She believes education about lifestyle changes and stroke signs and symptoms can go a long way in improving outcomes.

So the reminder is the FAST acronym - watch for Face Drooping, Arm drifting and Speech Difficulties. If you see any of these signs, you need to call 9-1-1.

“Currently, most of our patients who present with stroke-like symptoms come by private vehicle,” Dr. Gordon said. “I believe that certainly can delay the treatment available to these patients.”

Nancy Bell says all of the data on stroke for the region are sobering, but give them a way to show leaders why southwest Virginia needs greater support.

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