Episode 13 –  Bringing Health, Research and Hope Back to Appalachia – with Dr. Fran Feltner

Episode 13 – Bringing Health, Research and Hope Back to Appalachia – with Dr. Fran Feltner

Dr. Fran Feltner, Director of the University of Kentucky, Center of Excellence in Rural Health, talks with Dr. Jones about bringing health, translational research and hope back to Appalachia.


Dr. Fran Feltner is the Director of the University of Kentucky, College of Medicine, Center of Excellence in Rural Health, located in Hazard, Kentucky. She also has joint appointments as adjunct faculty in the College of Nursing and College of Health Science and as Assistant Professor in the College of Medicine, Family and Community Medicine Department. Dr. Feltner received her Doctorate in Nursing Practice from the University of Kentucky, College of Nursing and a Masters in Advanced Practice Rural Public Health Nursing – Administration from Eastern Kentucky University.

Dr. Feltner has worked for more than 40 years in rural health care, from serving as a nurse in clinical and hospital settings, working with family practice residency and providing community education to her current role as director. One of her most important roles has been working with the community health worker (CHW) program.  Dr. Feltner’s work has focused on empowering the communities she serves to directly address the health disparities that affect them so seriously. Her current research interests are health disparities in Appalachia, effectiveness of CHWs on patient health outcomes, and finding solutions to the problems and barriers of the health and social system.

Full Bio: https://ruralhealth.med.uky.edu/meet-cerh-director


UK Center of Excellence in Rural Health in Hazard, KY


Appalachian Research Day (Next Day: April 18, 2018)


Transcripts are created using a combination of speech recognition software and human transcription and may contain errors. Please check the full audio podcast in context before quoting in print.

Dr. Jones: [00:00:00] We’re coming to you today from Hazard Kentucky in Perry County Kentucky and I’m joined today by Dr. Fran Feltner. Fran thank you so much for joining us today.

Dr. Feltner: [00:00:10] You’re welcome. I’m honored to be here.

Dr. Jones: [00:00:12] Thank you for taking the time. I know you are a busy lady and I appreciate you carving out some time. I told you before you are the inaugural nurse on our podcast we’ve had social workers up to this point and so we’re branching out. And so really excited about talking about your nursing career and just kind of your vision for this place here.

Dr. Feltner: [00:00:34] Well thank you for the opportunity today.

Dr. Jones: [00:00:36] I wonder if we could start out talking a little bit. You’re born and raised here in eastern Kentucky.

Dr. Feltner: [00:00:42] Yes I’m originally from Leslie County where my parents grew up and then and at a young age we moved to Perry County and I’ve lived here most of my life. My father was a Baptist minister so we did move around. But Perry County is my home.

Dr. Jones: [00:00:59] And you know you have kind of come to this place of the Center for Excellence affiliated with the University of Kentucky. You’re you’re a nurse by training. What drew you to nursing?

Dr. Feltner: [00:01:12] Basically I was around people in health care most of my life. My father and my mother and I was around many different doctors and nurses that really gave me the idea that caring for people was really what was worth it in life. And I had lots of nurses that take care of me at a young age that set good examples for me that I wanted to maybe model myself after because they really cared about the patients that they took care. And so I knew at a very young age actually age 8 that one day I would be a nurse and that I would find out how I could reach that dream and that I have lived that dream throughout my career.

Dr. Jones: [00:01:58] That’s great. So what brought you to this center for excellence or give us a little bit of history about this place here?

Dr. Feltner: [00:02:04] OK. The Center of Excellence in Rural Health (CERH) was put here actually in 1991 and the first program was our family practice residency program and then we had medical laboratory science and we had college of nursing students here. They were preparing for their master’s degrees because vocational schools were starting to offer the RN program and they needed faculty to teach. And so a little bit later the College of Social Work joined us with the social work program. We have the bachelor’s degree and the master’s degree medical laboratory science is now offered through the college of health science and also doctorate in physical therapy classes are here at the center of excellence in Rural Health. Along those programs and along that line the same time legislative mandates put us here as a center of excellence in Rural Health. Every state got an office approach health through federal funding. We were also legislatively mandated as a State Office of Rural Health along not 94 Kentucky Homeplace was a program that was developed by the Center. This is a community health worker driven program that has been nationally recognized as a model that works that serves many people throughout the year. Right now there is about a hundred and fifty thousand people that have received services that they would have gone without without our community health workers working in the community where they build trust and where they build confidence in the people that work with them to get the need get the services that they need. Also this is I want to say you get your degrees close to home. A lot of our mountain students cannot travel to the universities and they may finish their associate’s degree at the community college level. So one of the things that the concepts that was thought out when we were first put here is let them get their associate degree at a community college. Then we would have classes for them here at the Center of excellence and Rural Health that they could finish their baccalaureate degree or their masters degree close to home. And so we’ve had many students that have come from different walks of life and maybe coal mining industry shuts down and students want to go back to school to finish a different degree. And we’ve had those students here at the CERH that can change their lives and serve people. We’ve had colleges social work graduates that now work for the Center of Excellence in Rural Health. And so that’s a success story in itself. Many of our family practice residents that have graduated their family practice residency they’ll work as faculty here at the CERH. So I think that that is a success in the making when we can graduate our students and then we can have them here at home providing services for the people and the idea that if you train Family Practice residents in a rural area that they’ll stay in a rural area to practice and we could fulfill the workforce needs in the rural area to take care of access to care for the people here in the mountains. It’s hard to navigate in our terrain sometimes to get to Lexington, Louisville and the big city as we call it for our healthcare. So the number one idea was to develop family practice residency so that we could keep our doctors here at home.

Dr. Jones: [00:05:32] And is that happening are the doctors staying here in this region?

Dr. Feltner: [00:05:36] Absolutely we’ve been very lucky to recruit the physicians here. They finished their medical degrees with the universe Kentucky. Then they come here for three years of residency and about 60 to 80 percent of them according to which year of graduates they do stay in the rural areas of Kentucky to practice if not other rural states. And so I feel like that that mission has really been successful and the fact that now when we recruit it’s local people that live here in the mountains that are coming back to their family practice residency and they stay here.

Dr. Jones: [00:06:14] Can you talk a little bit. I have a wife who is from Letcher County and I went to Berea college as an undergraduate and I just love this part of Kentucky and think it’s so special. I wonder if you could talk about the special challenges health challenges of eastern Kentucky and maybe of Appalachia in general.

Dr. Feltner: [00:06:35] When you think about the health and Appalachia and you think about the mountains that we call home here a lot of things are on the front page of the newspaper or on the radio each day about the high rates of disease that we have. Chronic disease such as heart disease hypertension diabetes cancer lung cancer. Particularly in this area we have had challenges as far as obesity the risk factors that we have each day. Higher rates of smoking things that we really can do something about as far as getting physically active and eating healthy. Other things that you can’t do anything about. As far as heredity and those things but just about everywhere you look in a publication we’re the highest of everything if you pull out a map of Kentucky and you look at the counties of Appalachia they’re always red on that map showing the high rates of disease that we have here.

Dr. Jones: [00:07:37] I know that you’re very interested in translational research and that is research that can be implemented and helpful in addressing some of these health issues that you’re talking about. Can you talk a little bit about that that concept of translational research and maybe some of the things that you’re doing here at the center that is that are going to help these health crises?

Dr. Feltner: [00:08:03] I truly do believe in research but not just to write a paper or to get your degree. The research is that you do with the community that I really think is necessary to find out where the solutions are what the trends are and to hear from the community about what they think their problems are. And for you to work with them to find solutions and you can’t do that unless you bring the research back to the community your results your findings. I wanted to develop a way that we could get back to the community. One of those ways is our Appalachian research day and I named it come sit on the porch. And the reason I did that is because in Appalachia a lot of us have porches we still sit on our ports swings or we sit in a rocking chair on our front porch. And as my grandfather taught me that’s where conversation happens. You do a lot of not complaining but identifying problems and looking at solutions that together you can solve. And so each year I invite researchers that work in Appalachia to bring back their results. Talk to the community that they took the results from. Share that with them and look at what solutions that we can come up with in our community. So I think the buy into the community is so important to me and looking at the people that we serve how can we best serve them or how does the research show what we need to do to improve the health of can take.

Dr. Jones: [00:09:36] I think that’s so important and correct me if I’m wrong here but it seems like that so much of the research that’s been done here has has been people and just other things that have been done here but have been people coming here and doing their research leaving and it not coming back full circle or not being it. It feels like the well here have been used in some way.

Dr. Feltner: [00:10:03] You’ve got that exactly right. And more than a few years ago I would be asked to say how can you get the community to participate in research. You know I’m from Appalachia and I believe if you come here to do research you have to have someone open that door for you to Appalachia you don’t just walk in and say I’m from the University of wherever and I want to do research in your community and expect people to participate. They don’t know you. They don’t trust you. You have to build that trust before you can do the research. And so what was happening is this they would come to their research and Appalachian people have been researched to death. I once reviewed a grant that said give us the money so we can live – give us the research results. Show us how we can better our lives in eastern Kentucky or in Appalachia.

Musical Interlude: [00:10:55] [acoustic guitar plays].

Dr. Feltner: [00:11:10] And so I think that because we’ve started Appalachian research day we have gained the trust of the community that they’ll step up to participate in research like never before.

Dr. Jones: [00:11:21] It’s great. That’s a very powerful concept that you came up with and I love the front porch conversation idea as well. I want to switch our focus a little bit to social work. Since this podcast is called social work conversations I’d like for you to talk about how you see social work and social workers helping here and in eastern Kentucky. What is their role. What is their future here in terms of better health outcomes. What do you think about social workers?

Dr. Feltner: [00:11:55] Well first of all I would like to say that you know we celebrated 20 years of social work here at the CERH this past year a very proud moment that we have so many graduates that are working in eastern Kentucky and throughout the state that are providing the needed services for families. And it is so important for us to have social workers and now more than ever. There is so much emphasis being put on behavioral health and the social needs the social determinants of health that as we look at a person as a whole it takes an interprofessional team to pull together nurses social workers doctors dentist psychiatrists psychologists all of those things to pull together a holistic look at the people that we serve. Social work plays a huge part of that. You know if your family is struggling with unemployment for an example or they’re struggling with opioid use and misuse. Where are the children and all of that? You know and so many of our children are not even living with parents now because of the problems that we have. We really need as many social workers as we can graduate to help these families. I can also think of the higher rates of diabetes that we have and heart disease that we have. And we actually have a program here at the Center of Excellence in Rural Health in our North Fork valley clinic that pulls a diabetic team together and a social worker is on that team. We also have a clinical social worker that works with our population here in the clinic. More and more we need them on the medical side as well as the family side and looking at the people as a whole and how we can improve the health of our families.

Dr. Jones: [00:13:44] I want to ask you a question about this place in this home that you have – we have listeners really all over the world that are listening to this and some may have never been to eastern Kentucky to Appalachia. What do you hope that people know about your home here. What do you want them to know?

Dr. Feltner: [00:14:07] Well first of all I’m very proud to say that these mountains are my home and I’m very proud to be from here. A lot of people want to stereotype people from Appalachia and I want to uplift Appalachian people. We’re very strong. We’re very community minded very patriotic. We take care of our neighbors and friends. We listen to our neighbors and friends and sometimes when I leave and I fly to D.C. for an example and I come back home and I land in Lexington and I walk to my car and I start home and just outside of Lexington when I turn on Winchester road and I come out on the parkway I can see the mountains and I know I’m home. And so I may travel all over the world. But this is my favorite place to be. And right now is a really good time since we talking springtime and things are starting to burn and bloom and soon things will be white and they’ll be lavender all over these mountains. And my grandparents I ask them a question one time about why do we call these redwood trees when they actually Bloom lavender and purple. And so you’ll see those along the highway and along the mountains that really brighten up the day to see that. The people here are beautiful. I mean there’s there’s so many problems but there’s so many good things too about our our home.

Dr. Feltner: [00:15:38] I was once asked why don’t you just move you know you have such high rates of disease. I would be a mountain girl no matter where you put me. And this is my place that I call home. And I want to see things happen in a better way for our population. I think that’s one of the passions that I have about working here at the Center of Excellence in Rural Health. We truly do have a team of (I call them) excellence in action that really care about the people that we work with that we serve and that we provide this is for and I think it takes heart. It takes mind and takes mission and it takes passion to improve the health of our state.

Dr. Jones: [00:16:19] You know one thing that has really moved me in teaching down here is that so many of my students have shared with me that they may they may be the first ones or family to go to college or they come from a background of domestic violence you know drug abuse whatever and it just strikes me that that that resilient piece of them found their way here to the center to complete their college degree. I mean to me that’s very very powerful.

Dr. Feltner: [00:16:53] Absolutely. And also it builds up their confidence and gives them an opportunity to come away from that and to be successful. And so that’s that’s one of the biggest success stories that we have here at the center is seeing someone improve their lives and take care of their families. You know we all strive to be able to work and to live in the mountains here and take care of our families and leave something better behind. And so that really gives an opportunity for students close to home.

Musical Interlude: [00:17:22] [acoustic guitar music].

Dr. Jones: [00:17:32] So this kind of leads me into my – well I have two final questions for you. One is we tend to ask people on this podcast about their self care what do they do. You are in a stressful role. You have a lot of worries about grants and just different things so how do you take care of yourself. What do you do for self care?

Dr. Feltner: [00:17:55] That is a hard one because it is very stressful. We deal with many different situations on a daily basis. You know I work with every college at UK to try to bring people together and to develop solutions for our population here in the mountains and across the state our rual areas are you know they have healthcare shortages as far as providers and many different things when you look at the Delta region of the state you look at the Appalachian region of the state. So sometimes it can be very stressful. And I know in my heart that I can’t change everything. I mean we know that but if we can make the difference in a day in just one person’s life then we’ve done our job. To de-stress I love to walk left to hike in the mountains I call home. I have a wonderful family that 10 grandkids that I hear from on a daily basis and a wonderful husband and just wonderful family you know that know that the work that I do is stressful and they pitch in wherever needed and help me through that.

Dr. Feltner: [00:19:06] Also your work family I mean we’re pretty close knit and we know when each other are struggling and we step up to help each other and I think that the team effort and getting the job done is absolutely part of being successful.

Dr. Jones: [00:19:25] You ever come across any copperheads while you’re out hiking?

Dr. Feltner: [00:19:27] Absolutely (ha ha ha). Actually the house that we live in now it’s a subdivision and when they were developing the subdivision I was told that there was 88 copperheads there to start if as they were building and we say want occasionally you know but we also see elk and deer in the rabbits and the squirrels and every bird that you know noted mansion and since I live the farm so so much like Sandy going home I saw 12 years they were of different ages you know living in a family and of course I like look at this neat little family here that that is driving together in mountains. And so that’s de-stressors. You look at the creation and how beautifully is the sunsets and the sunrises over the mountains.

Dr. Jones: [00:20:18] So what are you – What do you dream about here if you look down the road 10 15 20 years for the centre and for your work. What do you dream about?

Dr. Feltner: [00:20:28] If you could improve the health of our children and they are the the future and working with our youth with the many different things that they’re faced with today. When when you see a population in Appalachian that is the highest rates of every chronic disease how can we start with our children and teach them to live healthier lives and then as they have children those children will have healthier lives. The education is so important that it’s for your success you know do a job that is your dream. You know if you want to be a nurse, be a nurse. If you want to be a wonderful social worker be it to the best of your ability to help the people that you serve. And so if we can improve the health access you know it would be great if our economy would improve. You know you can tell he’s been hit so hard with the coal mining jobs going away and then people moving away. So you lose friends and family to different states and I guess the main thing is that our youth would have hope – hope that Appalachia would still be home.

Dr. Jones: [00:21:42] I want to thank you for coming on our podcast and I just thank you for your work and for using your life. It inspires me to hear from people like you that love their home and are really working to make their home a better place. And I just really appreciate so much the work that you’ve done in your appreciation for social workers. Thank you for supporting, Fran, I really appreciate that.

Dr. Feltner: [00:22:08] Absolutely thank you for having me today.