Not long after crossing the Ohio River into Northern Kentucky, skyscrapers and office parks give way to hills and fields. Subdivisions fade,Â and farms emerge. The city becomes the country.
The land is different here. Poverty is different here, too. The rural poor in America are more isolated and more likely to be white. They live in farmhouses and mobile homes instead of crowded apartment buildings.
But whatever the landscape, whatever the demographics, poverty is still poverty. A hungry child must be fed, whether she lives in the city or the country.
Increasingly, the rural poor are falling behind. Income is lower and poverty rates are higher in rural areas. Itâ€™s more difficult to find a doctor or a dentist. And when businesses close in small, rural towns, the options for the unemployed are often bleak.
Despite an economic recovery that began a decade ago, rural areas still have fewer jobs overall than they did before the Great Recession.
In a nation so often divided by race and geography, poverty plays no favorites. It punishes the poor wherever they live.
Today, in the final part of our yearlong series,Â “The Long, Hard Road,” we continue telling the stories of people who live, work and struggle along 80 miles in the heart of Greater Cincinnati.
Need looks different in rural America, but the struggle is not
Best with sound on. In the final installment of The Enquirer’s yearlong series “The Long, Hard Road,” we venture into rural Kentucky where the struggle to stay apace grows
Rusty Mardis peels back the wax on the Makerâ€™s Mark bottle, twists off the cap and gives himself a generous pour.
Then he hands the bottle to Zach McGuffey, who does the same.
Itâ€™s showtime for â€śVeterans in Bars Getting Bourbon,â€ť a public access TV production Mardis started to draw attention to the needs of Kentuckyâ€™s vets. The conversation is easy, thanks in part to the bourbon. The topics rarely are.
â€śI tried to commit suicide when I came home,â€ť says McGuffey, a Marine who did tours in Iraq and Afghanistan. â€śI failed, obviously.â€ť
The show, shot more than a year ago now, was a first for Mardis. Itâ€™s a little rough. The editing is choppy in spots. But Mardis watches it now on YouTube and Facebook and heâ€™s reminded why he does what he does, why he spends days and nights talking to veterans in bars or homes or American Legion posts all over Kentucky about where they can find help.
The need is great in a state where almost 40% of veterans live in rural areas. Thatâ€™s one of the highest concentrations of rural vets in the nation, and it means more vets here are living isolated lives.
â€śWeâ€™ve all got to work together,â€ť McGuffey tells Mardis in the video. â€śWeâ€™ve all got to build and weave these nets so less veterans fall through.â€ť
Mardis nods as McGuffey speaks. He gets it. He served 24 years in the Air Force, did a tour in Afghanistan,Â and commanded crews that oversaw satellites and nuclear missiles.
He was 46 when he got out in 2014 and was sure he was ready for whatever civilian life threw at him. He was wrong. The skills heâ€™d refined for years in the military didnâ€™t always translate to nonmilitary jobs, at least not in the eyes of potential employers.
As rejection letters piled up, Mardisâ€™ self-esteem took a beating. In the Air Force, he was a big shot, an officer who oversaw billion-dollar weapons systems. But back home, he felt like a nobody. And no one seemed to give a damn.
He didnâ€™t sleep well. He drifted from his wife and kids. Sometimes, like McGuffey, he thought about suicide.
When he went looking for help, he got lost in a maze of government bureaucracy and civilian charity groups. Everyone talked about helping vets, but no one was there to point them in the right direction.
Mardis decided he could be that guy. He could be â€śthe connectorâ€ť who helps rural veterans get the help they need.
He started gathering phone numbers and emails for groups that offered services for veterans. Job training. Medical care. Counseling for post-traumatic stress.Â
But Mardis knew he couldnâ€™t be preachy or condescending about sharing that information. Veterans are proud. He needed to talk to them veteran-to-veteran, like he and McGuffey had done over Makerâ€™s Mark.
So he made â€śVeterans in Bars Getting Bourbonâ€ť a regular thing, shooting a new show every month or so.Â
He also got a job with a veteransâ€™ group that connects struggling vets to resources. And he launched a second public access TV series called â€śThe Charlie Foxtrot Resource Show.â€ť
The name was inspired by military slang for a chaotic situation, which to vets like Mardis and McGuffey makes perfect sense. During their conversation, they talk about the damage chaos can do, not only on the battlefield but also back home.
McGuffey tells Mardis he set up a charity, 22 Until Valhalla, to prevent suicide by easing the isolation vets sometimes feel when they return home. He put his personalÂ cellphone number on his business card.
â€śContact me anytime,â€ť he says on the video. â€śMy phone is always on.â€ť
When they were done talking that night, Mardis added McGuffeyâ€™s number to his contact list. Someday, he figured, someone would need it.
He was right. Heâ€™s referred several veterans to McGuffey since they shot the video.
Mardis still carries the number with him today, just in case.
(Veterans who need assistance can reach McGuffey at 859-663-7603.)
Rural America: Falling behind
Income tends to be lower and poverty rates higher in rural counties compared to urban counties.
Michael Nyerges, Cincinnati Enquirer
Daryl Burns looks out on his crop, and it is not a familiar sight. The 66-year-old lifelong farmer took a gamble with his crop this year.Â Â
â€śWe had to,â€ť said Addison Burns, Darylâ€™s 33-year-old son. â€śTobacco was done, and we had to try something new.â€ť
The Burnses are hemp farmers, at least for now.
This Campbell County family, like many across the U.S., hasÂ been dealing with declining tobacco profit. The labor wasnâ€™t worth it anymore.Â Â
They wonâ€™t know how profitable their first hemp cropÂ is until the process is over, and that makes Daryl Burns nervous.
The weather will determine if what they have grown is, in fact, legal.
Thatâ€™s because weather impacts how much CBD and THC a plant has. To have a profitable â€“ and not illegal â€“Â crop,Â the Burns family needs itsÂ plants to have a large percentage of CBD and a very low percentage of THC.
CBD, short for cannabidiol, is the nonpsychoactive chemical in hemp that is rising in popularity because itâ€™s believed by someÂ to reduce anxietyÂ and help with sleep and pain. THC, short for tetrahydrocannabinol, is the compound responsible for the psychotropic effects of marijuana.Â Â Â
At $3 a plant, the Burns family spent $24,000 to plant 4 acres of hemp. It was another few hundred dollars to put down special tape and plastic to help the plants grow, something tobacco never needed. Hemp takesÂ a lot of â€śbabysitting,â€ť as the family puts it.Â
Darylâ€™s days on the farm could span from 7 a.m. to 9 p.m. in the summer.
Â â€śWe donâ€™t go home for lunch. We bring us a bologna sandwich and spend the day here,â€ť he said.
The investment and time commitment could be worth it. In 2018, hemp processors reported $57.8Â million in gross product sales, compared with $16.7 million in 2017, according to the Kentucky Department of Agriculture.
But a lot could go wrong. Â
Hot temperatures, like the days Northern Kentucky had this summer, could produce more THC. Then the state can destroy the family’s crop. No one willÂ know the exact levels until the plants are sent to the processor. How long that takes depends on how the weather dries the plant.
CBD levels can vary as well, which means the pay scale varies. Plants have different levels, and some levels vary within the same plant.
â€śBut thatâ€™s farming,â€ť the elder BurnsÂ says. Once, he lost an entire acre of tobacco in a five-minute hailstorm. Â Â Â Â Â
In the barn, as hisÂ hemp dries, DarylÂ smushesÂ one of the dry plants between his fingers. Itâ€™s how to release the oil that has the CBD in it, he explains.Â
The market for this magic stuff is expanding. A farmer could do worse. Â
â€śI think,â€ť Daryl says, â€śweâ€™ll probably do it again next year.â€ťÂ
On the crest of a rolling Pendleton County hill, the doctor’sÂ office bustles with Friday business. At 10 a.m., in his white coat, Brian SchackÂ is already deep into his day as he opens the door into examination room No. 3.
Twenty years ago, while in medical residency, Schack says he toyed with choosing a specialty, which would mean life in a bigger city, more resources, more options. In the end, though, the boy from Peach Grove came back home to Pendleton County to practice primary-care medicine.
Medical care remains a scarce resource forÂ rural Americans. Federal and state programs promise new doctors relief for education debt in exchange for two or four years of providing primary care to country towns such as Butler. Still, itâ€™s a hard sell.
In 2000, the Patient First practice in Northern Kentucky had been looking for a provider in its Butler office for two years. When Schack called about the job, â€śThey dropped the phone. When they picked it back up, they said, ‘How soon can you come to talk to us?’ â€ť
For some years, Schack was the only doctor for miles around. In 2007, St. Elizabeth Healthcare bought the practice.Â Three more doctors and two nurse practitioners now work with Schack taking care of about half of Pendleton Countyâ€™s 15,000 residents.
The staffing alleviates the old problem of accommodating patients who need regular checkups, especially when those numbers grew with the Affordable Care Act.
On this Friday, Tom and Carolyn Edwards are in exam room 3, waiting for the doctor who theyâ€™ve known all his life as the best friend of their son.Â Â
Tom Edwards lost his left leg in an airplane accident 30 years ago and is paraplegic. He asks Schack about a stubborn pressure sore, and Carolyn says their home health aides want the doctorâ€™s advice.
Then Carolyn pulls back her right sleeve to reveal a swelling on her upper arm the size of an orange. â€śItâ€™s gone from nickel-sized to this.â€ť
Schack, his hands on the swelling: â€śDoes it hurt?â€ť HeÂ takes notes on his laptop to send Carolyn for testing.
Schack has a wish list for his office:Â an ultrasound machine or an X-ray machine with a radiologist,Â and a gymÂ for cardiac rehab patients and others who need to build stamina.Â Â
For more testing, Schackâ€™s patients usually travel to Covington or Fort Mitchell or Edgewood, “and thatâ€™s a 45-minute drive. The elderly, they donâ€™t like to drive outside the community. We struggle getting people to agree to see specialists.â€ť
The mammogram van visits the Butler office a few times a year, but often patients canâ€™t even get to that.
PatientsÂ like Tom and CarolynÂ get access to more care out of town because two adult children live nearby and can drive them. Sometimes Schack will make a house call on Tom or another patient who canâ€™t get in.
Â â€śBut,” the doctor says, “I donâ€™t advertise that.â€ť
In his front yard, Arnold Hughes pulls on a green bungee cord holding down the Cadillacâ€™s trunk. It works.
Hughes then moves to the driverâ€™s seat, unsure if the car will start. Itâ€™s 44 degrees, and the snow from a day before has melted. But thereâ€™s something wrong with the battery and has been for a while.
The car was given to him. There was a problem with the engine,Â and it was more trouble than it was worth for the previous owner. So Hughes fixed it â€“ heâ€™s worked as a mechanic before â€“ and now uses it to get to doctor appointments.
The 65-year-old turns the car on every day. Even on days like today whenÂ he has nowhere to go. If he doesnâ€™t, itâ€™ll never start.
Arnold Hughes is a man who is his car. Not because he loves cars, but because he is broken, too.
HeÂ lost his masonry job in 2016 because of crippling arthritis in his foot. It once kept him in bed for seven days and still bothers him just about every week.
When Hughes was a child, he worked in coal mines with his dad in southeastern Kentucky. He farmed tobacco and sold bait on the side of the road. That never made them that much, but his family needed everything itÂ could get.
Hughes was in fifth grade when his dad died of cancer.
At the time, his mom was pregnant with the couple’sÂ 10th child. As one of the older kids, Hughes helped raise the younger children. It meant he had to dropÂ out of school.
And itÂ meant an 11-year-old Hughes regularly walked along the railroad tracks near hisÂ home collecting coal that had fallen off trains. Thatâ€™s how his family heated theÂ house in the winter.
Hughes also hunted, and the family ate deer, squirrel and rabbit. There was no McDonaldâ€™s nearby. And if there was, the family couldnâ€™t afford it.
In the town where he lives now, an unincorporated community in Pendleton County, there is a post office,Â but not much else.
As Hughes aged, he wore a back brace to lift bricks at work. His neck started hurting about three years ago, and he canâ€™t look up without pain.
He doesnâ€™t know what the problem is. All he knows is he has a long list of medications that cost him money.
After years of the type of work a man with a fifth-grade education does to make a living, Hughesâ€™ body has been defeated. He wishes he had the education to find a job he could still do.
While the number of jobs in the United States has increased since the economic recession in 2008, that growth has lagged in rural areas. And according to the U.S. Census Bureau, household income for a high school graduate is nearly double that of someone without a high school education.
So when Hughes says heâ€™s had a rough life, itâ€™s a statement of fact â€“ not a complaint.
Outside his home, he waves to every car that drives by. Three of his grandchildren live with him. The oldest one is at school right now, and Hughes says he is doing well.
Yesterday, Hughes went hunting. He hoped to catch a deer that would feed his family for months. He didnâ€™t.
Today, after a moment of doubt, his car sputters to life.
â€śOne day at a time,â€ť he says.
Tonya Sims guides her granddaughter through the grocery store, passing produce and bread and milk. Sophia Allen stands on the back of the cart as her grandmother pushes.
â€śI promised you candy, too, because you were good,â€ť Sims tells the 4-year-old. Sophia isnâ€™t tall enough to reach the candy bag hanging above her head, so she jumps to point out her choice: sour gummies.
The Dollar General Market in FalmouthÂ is the second grocery stop of the day for Sims, who lives one county over, in Bracken County. She likes the comfort of country living and doesnâ€™t mind the nearly 20-mile drive to Falmouth for food.
But the Dollar General doesnâ€™t have the freshest produce, and it doesnâ€™t always carry things like spaghetti squash, avocados or grapefruit, Sims says.Â
The meat is overpriced, so Sims shops for that elsewhere.
Billie Conrad, another shopper on this recent weekday, prefers to buy her meat in bulk. So sheâ€™ll drive about an hour, either north to Florence or south to Lexington, to stock up.
Access to nutritious food inÂ rural areas can be challenging for some. About 5 million people in places like FalmouthÂ must travel 10 miles or more for groceries, according to the U.S. Department of Agriculture. And a lack of transportation infrastructure can exacerbate the problem.
Once one does arrive at a rural Kentucky grocery store, research has shown that the mostÂ nutritious items are more expensiveÂ than in urban areas.Â
Milea Fultz is acutely aware of the benefits and challenges of rural life. The open spaces surrounding her home outside Falmouth bring tranquility,Â but also transportation trouble.
Fultz canâ€™t drive due to an epilepsy diagnosis. She used to live in Evendale, and when she lost her license due to seizures, she started riding a bike. That improved her physical and mental health.
Thatâ€™s not an option out here. Everything is just too far away.
When it opened about six years ago, the Dollar General provided a second grocery option in Falmouth. Staples like milk and eggs are cheap, shoppers say.Â
But the market came at a cost to taxpayers. The city government footed the approximately $100,000 bill for utility work for the market. The city spent another estimated $278,000 to buy the farm where the market is located, according to city officials.
Back inside the store, Sims and Sophia are wrapping up their shopping. Sims, who shops for a family of eight, wishes sheâ€™d grabbed the bread at Wyatt’s, the other Falmouth grocery store. It was on sale there and about 50 cents cheaper.
â€śI hustle to get the deals,â€ť she says, before turning to her granddaughter, who clutches her bag of sour gummies like treasure. â€śLetâ€™s go get your toothpaste, and weâ€™re out.â€ť
Layered, gray clouds hang low in the sky as Tabitha Bates gazesÂ at the tiny gravesite. It is markedÂ “Owen Bates” with an aluminum plate, similar to a license plate. And bunches of colorful flowers. Baby colorsÂ â€“ yellow, white, pink.
It was not long ago that Tabitha held Owen in her arms.
From the nose up, he looked like his daddy, she said, but much of the rest was her.
â€śHe got my mouth, my chin, the shape of my head and the amount of hair. But not the color. That was his dadâ€™s.â€ť
On this cold October day,Â it isÂ about five months since Tabitha hasÂ seen, or held, OwenÂ â€“ Â since the tubes were gently pulled out and the machines turned off.
She and her husband, Nicholas, were only with their baby for 10 days.
In their trailer home in DeMossville, an unincorporated town in Pendleton County where she and Nicholas and his parents live, there’sÂ a memorial to the infant.Â Â Photos of the newborn, first with life-saving equipment, then without. A framed image of Owen’s footprints, time of birth, weight, length.
Owen Gabriel Cole Bates should be nearly 8 months now.Â He died May 12 atÂ Cincinnati Childrenâ€™s Hospital Medical Center instead.
He had been born prematurely. Tabitha carried him for eight months with no known complications. Theyâ€™d named him sometime in March, because thatâ€™s when they learned she was having a boy. She learned because she was getting prenatal care.
Everything seemed to be going just fine until the earliest hours of May 2. Tabitha had worked a long shift as a nurseâ€™s aide at a nursing home and got home well after midnight.
Once home, she felt what she could only imagine were contractions.
â€śI started having pains in the bottom of my stomach,â€ť she said. She had heard that a warm bath might stop false labor, so she tried that.
It did not work.
â€śBefore I knew it, I was in full-blown labor.â€ť
Nicholas’ mom, Emily Bates, was there the whole time, calming her, helping her. And it was EmilyÂ who called for an ambulance when it became apparent thatÂ this was the real thing.
Tabitha was rushed to St. ElizabethÂ hospital in Edgewood, 39 minutes away from their trailer by ambulance. She says the medic told her to breathe but notÂ push on the way.
They arrived at 9:10 a.m. â€śAt 9:13, he was born,â€ť she said.
But something had gone terribly wrong.
â€śDue to the fact he was stuck in the birth canal too long, it had deprived him of oxygen,â€ť she recalls being told.
â€śThey got him on a ventilator right away.â€ť
Owen was promptly transferred to Cincinnati Childrenâ€™s, where medical staff performed life-saving procedures. Even so, an MRI showed that his brain was damaged.Â
Tabitha and Nicholas learned the despairing news that their baby could not breathe on his own.
â€śThey asked me if there was anything I wanted them to do for me,â€ť Tabitha remembers.
At some point they got the family a big hospital bed. TabithaÂ could curl around her baby and hold him. Sometimes, she held him skin to skin, an infant-care technique for premature babies that can help stimulate bonding and, maybe, development.
“He still seemed like his color was good. We were hoping.â€ť
But then one part of her baby’s face seemed to droop. TabithaÂ feared heâ€™d had a stroke. He couldn’t feel anything, she was told. But the new mother could not shake the idea that maybe he could feel pain, just not express it.
At 10 p.m. May 12, Tabitha and Nicholas decided to have life support removed.
Owen died at 11:03 p.m. â€śI was holding him,â€ť she said.
Owen Gabriel Cole Bates was in his parentsâ€™ world for just these 10 confusing days.
It was through thisÂ blur of emotion and exhaustion and grief that they managed to go see Mary Hillenmeyer, to plan their baby’s funeral.
Funerals, they learned, can be expensive. Even a small plotÂ could cost about $1,000. That includes the cost of digging the grave.
TheyÂ bought aÂ coffin and vault combination from Woodhead Funeral Home to save money. They opted for the less expensive marker.Â Nicholas asked what the cost for the plot would be if he could dig the grave.
So the little boy’s father and a few family members headed out to Mount Moriah Cemetery on Ky. 17, very near where the family now lives.
They brought their own shovels.Â
A large stone was in the way and, for a moment, they were afraid that the baby would not have a final resting place that day.Â
But Nicholas’ uncle missed the funeral and, instead, got a pickax and broke the stone’s hold on the ground in time for the interment.Â
The family then laid the tiny casketÂ into the small hole, prepared by his father, who saw the ground-turning not as a way to save money,Â but a father’s way to still do something meaningful for his child. In the end, he also placed a stuffed animal in the casket, for comfort.
It was allÂ an act of love. A privilege.
The family still owes $133 to the funeral home,Â which has worked for years to know the community and has arranged a lot of payment plans for bigger displays. And some just as modest. They understandÂ the hardship. They know it will be paid.