DISCUSSION: APPALACHIAN CASE STUDY #1

DISCUSSION: APPALACHIAN CASE STUDY #1

DISCUSSION: APPALACHIAN CASE STUDY #1

William Kapp, aged 55 years, and his wife, Gloria, aged 37, have recently moved from an
isolated rural area of northern Appalachia
to Denver, Colorado, because of Gloria’s
failing health. Mrs. Kapp has had pulmonary t
uberculosis for several years. They decided
to move to New Mexico because they heard that the climate was better for Mrs. Kapp’s
pulmonary condition. For an unknown reason, they stayed in Denver, where William
obtained employment making machine parts.
The Kapp’s oldest daughter, Ruth, ag
ed 20, Ruth’s husband, Roy, aged 24, and
their daughter, Rebecca, aged 17 months, moved with them so Ruth could help care for
her ailing mother. After 2 months, Roy return
ed to northern Appalachia because he was
unable to find work in Denver. Ruth is 3 months’ pregnant.
Because Mrs. Kapp has been feeling “mor
e poorly” in the last few days, she has
come to the clinic and is accompanied by her husband, William, her daughter Ruth, and
her granddaughter, Rebecca. On admission, Glor
ia is expectorating greenish sputum,
which her husband estimates to be about a teac
upful each day. Gloria is 5 ft 5 in. tall and
weighs 92 pounds. Her temperature is 101.4°F,
her pulse is regular at 96 beats per
minute, and her respirations are 30 per minute
and labored. Her skin is dry and scaly with
poor turgor.
While the physician is examining Mrs. Kapp, the nurse is taking additional
historical and demographic da
ta from Mr. Kapp and Ruth. Th
e nurse finds that Ruth has
had no prenatal care and that her first chil
d, Rebecca, was delivered at home with the
assistance of a neighbor. Rebecca is pale and
suffers from frequent bouts of diarrhea and

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colicky symptoms. Mr. Kapp declines to offer in
formation regarding his health status and
states that he takes care of himself.
This is the first time Mrs. Kapp has s
een a health-care provider since their
relocation. Mr. Kapp has been treating his wife
with a blood tonic he makes from soaking
nails in water; a poultice he ma
kes from turpentine and lard,
which he applies to her chest
each morning; and a cough medicine he makes from rock candy, whiskey, and honey,
which he has her take a tablespoon of four
times a day. He feels this has been more
beneficial than the prescription medicati
on given to them before they relocated.
The child, Rebecca, has been taking a
cup of ginseng tea for her colicky
symptoms each night and a cup of red ba
rk tea each morning for her diarrhea.
Ruth’s only complaint is the “sick headach
e” she gets three to four times a week.
She takes ginseng tea and Epsom salts for the headache.
Mrs. Kapp is discharged with prescr
iptions for isoniazid, rifampin, and an
antibiotic and with instructions to return in
1 week for follow-up based on the results of
blood tests, chest radiograph, and sputum cultures.
She is also told to return to the clinic
or emergency department if her symptoms
worsen before then. The nurse gives Ruth
directions for making appointments with the pr
enatal clinic for herself and the pediatric
well-child clinic for Rebecca.

Study Questions

1.Describe the migration patterns of
Appalachians over the last 50 years.
2.
Discuss issues related to autonomy
in the workforce for Appalachians.