In Depth

‘Hidden America’ Put Focus on Kids

Sawyer’s ‘20/20’ Report Exposed Hard Life in Region

For Diane Sawyer’s “20/20” report “A Hidden America: Children of the Mountains,” ABC News producers and camera crews spent nearly two years in central Appalachia looking at how children in particular are coping with adult-created problems, from their parents’ drug addictions to unemployment.

The hourlong program, which aired Feb. 13, provoked strong reactions from residents, some of whom complained about the repetition of old stereotypes.

But by casting a national spotlight on the stubbornly impoverished region, “20/20” stirred many others to take a look at the obstacles and solutions to reversing long-entrenched problems, particularly the difficulty of reaching the medically underserved.

Ms. Sawyer recently fielded some questions about the issue of Appalachia’s medically underserved from TelevisionWeek special correspondent Elizabeth Jensen.

TelevisionWeek: Your special wasn’t just about the medically underserved in Appalachia, but that was a big part of the story of this hidden part of America. What makes you so passionate about this topic, aside from the fact that you are originally from Kentucky?

Diane Sawyer: This piece happened to take place in the mountains of eastern Kentucky, and I do feel a connection to the area because my ancestors came through those hills. But over the last few years, I’ve reported on other hidden Americas, including the crisis of the foster care system and children living in urban poverty in Camden, N.J. Seeing the country through the eyes of children who live amid daily despair, but yet are still dreaming big dreams, serves as a call to action for all of us—basic needs like ordinary health care and lack of access to dental care.

TVWeek: Lack of access to health care seemed to be an underlying theme of many aspects of life in central Appalachia. I couldn’t help but wonder if the high rate of drug addiction and the questions about health safety for mine workers were related to a lack of doctors and health care professionals, and not just the dire economic situation. At the same time, given the issues with over-prescription of painkillers, one could question whether the doctors who are there are focused in the right place.

Ms. Sawyer: There are many remarkable doctors in central Appalachia, but the region needs more qualified physicians. The physical stresses of mining and the lack of other job opportunities create a fertile climate for prescription drugs. Now, dealers do what’s called “doctor shopping”—traveling to places like Detroit or Philadelphia and purchasing pills such as OxyContin in bulk at a cheaper price. They then come home to the mountains and mark up the drugs for as much as an $80 profit per pill.

TVWeek: You talked to an 81-year-old woman who has been running a clinic for area residents for several decades; she was featured on “Good Morning America” back in 1983. Has the situation improved at all in the intervening years?

Ms. Sawyer: New roads have been built, so it’s easier for mobile health vans and emergency vehicles to travel to these remote hollows and get people to hospitals in Pikeville or Hazard, Ky. But problems like lung cancer, cervical cancer and toothlessness all still exist at rates higher than the rest of the country, and the region could use dozens of clinics like hers.

TVWeek: Did you see some possible solutions to the problems of health care access for the children of the region? The traveling dental truck you profiled seemed to be doing wonderful work, but is it just a drop in the bucket?

Ms. Sawyer: Dr. [Edwin] Smith is a true hero of the mountains. His dental van and the other mobile health vehicles that travel the region seem to be the most practical way of providing health care to kids who live in the most remote hills. After our program aired, PepsiCo indicated that they’ll support his work through the purchase of another dental van and education outreach. It will be wonderful if the company provides a long-term commitment to these kids, a real model of hope and compassion.

TVWeek: Reaching the medically underserved can be a dry topic, and it’s clearly a complex one that has to do with federal designations of underserved areas and finding appropriate incentives to lure doctors to areas where the financial payoffs won’t be as obvious. I assume that was part of the thinking behind telling the stories through the eyes of the children? They were amazingly open with you about the challenges in their lives.

Ms. Sawyer: When we tell stories that blast through the statistics with detail of what it is to struggle daily as a child in the hills, the answers are more urgent. For example, in Kentucky, newspapers are now writing editorials promoting legislation that will increase Medicaid reimbursements so more dentists will be motivated to work in Appalachia. When the kids tell us that they pull their own teeth because of lack of access to dentists, it’s something we simply can’t ignore.