Emergency crews try to contain chemicals spilled into the Elk River in West Virginia.

[imgcontainer] [img:ChemicalWater02.jpg] [source]Photo by Ty Wright/AP[/source] Emergency crews try to contain chemicals spilled into the Elk River in West Virginia. [/imgcontainer]

West Virginia Water Crisis. The chemical spill that contaminated the water supply of 300,000 West Virginians puts some coalfield politicians in an uncomfortable position.

On one hand, West Virginia Gov. Earl Ray Tomblin says the leak of a chemical used in coal processing is unacceptable and must be cleaned up as soon as possible. On the other, Tomblin is among a raft of politicians who regularly criticize the Environmental Protection Agency for being too heavy handed in enforcement of coal-industry regulations.

But, says Tomblin: “This was not a coal company incident. This was a chemical company incident.”

West Virginia Gazette reporter Ken Ward Jr. has the story this morning.

The group Appalachian Voices says the number of water customers affected by the chemical spill (16% of the state’s population) is greater because some rural residents got on the municipal water system after their wells were contaminated by coal mining.

In a Sunday story, Ward also reports on the lack of a plan to deal with the chemical, “crude MCHM,” even though thousands of gallons of a sudsing agent were stored a mile upstream from the water company’s main water intake.

Monday marks the fifth day that 300,000 residents in and around Charleston cannot use tap water for drinking, bathing, cooking or cleaning.

Meanwhile, Jason Linkins comments in Huffington Post about the lack of discussion on Sunday TV news shows about the chemical spill, which he calls the most significant environmental disaster since the Deepwater Horizon oil spill in the Gulf of Mexico.

The Sunday pundits focused on the impact of New Jersey Gov. Chris Christie’s traffic-jam scandal on his possible presidential bid two years from now, the anniversary of the Hudson River landing of U.S. Airways Flight 1549 (three days away) and the public debut later this week of a panda cub at the National Zoo.

“I guess if you want coverage of a chemical spill, it better happen inside the bubble,” Linkins writes.

Veterans Health Group to Meet. The Veterans Rural Health Advisory Committee of the U.S. Department of Veterans Affairs meets Tuesday and Wednesday in Salt Lake City, Utah. The committee is responsible for identifying ways to improve health care for veterans living in rural areas.

The Salt Lake Tribune reports Utah’s veterans are nearly twice as likely to live in rural areas as the general population:

Rural veterans also tend to be in worse health than their urban counterparts, said John Gale, a research associate at Muskie School of Public Service at the University of Southern Maine. That’s partly because the rural vets are more likely to work in blue-collar jobs that take a toll on the body, and they have a tougher time obtaining medical care, especially specialized care.

As an example, Gale said veterans of the two Gulf Wars have reported muscular injuries associated with carrying the heavy packs and body armor that have become part of the combat soldier’s uniform.

“The [rural doctors] may not be as familiar with that and may not be looking for it,” Gale said.

Wisconsin Rural Schools. Wisconsin’s geographically biggest school districts are also among the smallest in enrollment, a state panel learned in a hearing last week.

The Wisconsin Task Force on Rural Schools met in the northern part of the state last week to hear from residents and school leaders about the state of education in the Northwoods. The Antigo Daily Journal reports from the hearing:

One surprise: The sheer geographical size of the districts, which based on enrollments, are among the smallest in the state.

[Antigo Director of Business Services Mary Jo] Filbrandt told the lawmakers that Antigo, at 540 squares miles, has a population of three students per square mile. Fisher said that Elcho and White Lake, with a combined area of 530 square miles, has an average of one student per square mile.

That translates to staggering transportation costs that eat up seven or eight percent of the overall budgets.

Filbrandt and [Bill] Fisher [district administrator for the Elcho and White Lake school districts] both urged additional transportation aid, calling it key for the future of rural schools.

Some of the other topics that may sound familiar to rural education advocates in other states were the impact of state budget cuts and funding inequities, lack of local funding and low teacher pay.

“Village Post Offices” Aren’t, Letter Carrier Rep. Says. “Village Post Offices,” which are managed by private businesses who contract with the U.S. Postal Service, can’t replace real post offices, says Thomas Gamble, president of the Ohio Rural Letter Carriers’ Association.

“The post office should be in the post office,” said Gamble about the U.S. Postal Service’s program, which started in 2011.

Village Post Offices provide the most popular postal services like P.O. boxes, stamp sales and some package shipping. The privately run service-centers are part of the Postal Service’s strategy to trim its budget as it closes or reduces the hours of some regular post offices, especially in rural areas.

“My sense is they’re not working out very well,” Gamble said. “The franchisers buying into them are not familiar with postal items, and these aren’t postal employees. They’re not making the kind of money they were told they would be.”

The Postal Service says Village Post Offices are a “complement” to the agency’s own post offices and delivery networks. Village Post Offices are located in more convenient locations, typically in existing retail outlets, and they often are open longer than traditional post offices.

Gamble’s comments were part of a longer story on cutbacks to small post offices in north-central Ohio outside Mansfield.

Rural Hospitals and ACA. Small, rural hospitals are coming up with new ways to respond to reforms that are part of the Affordable Care Act, reports Cristina Janney in a long piece for the Gatehouse Media newspaper chain.

A key issue is scale, Janney reports. Reforms designed to improve the quality of care seem designed for urban hospitals with lots of patients and admissions. But rural hospitals, some of which may have only a few patients a day, have a tougher time with the accountability measurements that are part of ACA.

The problem sounds similar to the difficulty that standardized testing measurements create in small rural school districts. Small sample sizes can skew results from year to year. A small change in class composition can create big changes in test scores that have little to do with teacher or administrator performance and some of the other things the tests are supposed to help measure. In hospitals with only a few admissions a day, a single complicated medical case can skew evaluation data.

Some rural hospitals are trying to work together to address issues of scale, Janney reports. Here’s an excerpt:

Rural hospitals in some states are forming Hospital Engagement Networks, which bring health educators in to work with hospital staff on best practices, such as approaches to reducing hospital-acquired infections and harmful medication interactions. The network collaborations help rural hospitals improve quality of care so they can maximize Medicare payments. A Louisiana Hospital Engagement Network, for example, has helped decrease pre-term births at its participating hospitals by 40 percent.

Hospitals and other health care providers also are forming Accountable Care Organizations, groups designed to improve coordination and management of patient care. The idea is to have a team look at the whole patient to improve care and reduce hospital admissions. These organizations then issue one bill for a bundle of services, rather than Medicare receiving a series of bills for each service. …

But scale also can be a challenge for rural hospitals interested in joining an Accountable Care Organization. Under the Affordable Care Act, an ACO must have 5,000 patients, far more than many rural communities have. …

Margaret Mary Hospital of Batesville, Ind., has dealt with the scale issue by joining the National Rural Accountable Care Organization, which will include nine other hospitals, some smaller and some larger. This national organization helps small member hospitals meet the 5,000-patient requirement and share ways to increase efficiency.

S.C. Tobacco Barns Crumbling Away. South Carolina should create an income-tax credit to go to folks who restore and preserve tobacco barns, says Andy Brack, publisher of the Statehouse Report.

Tobacco barns used to cover the countryside. But there are now no more than 2,000 standing, Brack reports. The state is in danger of losing a cultural icon.

“In the Pee Dee, a tobacco barn is next to a church steeple in terms of importance in the rural community,” said state Commissioner of Agriculture Hugh Weathers.

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