Many Miles to Go
Healthcare Journalist Taylor Sisk Reflects on the State of Rural Healthcare in the United States, Public Health and The Healing Power of Music | By Kimberly J. Soenen July 15, 2022
“Jim Borling, one of the music therapists we featured, said: ‘Music allows us to tap into that innate desire to grow that is already within us, that desire to move toward wholeness, that desire to heal.’ I really like that.”
—Taylor Sisk
Taylor Sisk is Nashville-based healthcare journalist whose work is primarily focused on how policies and practices affect people’s lives. He’s served as contributing, associate, managing and executive editor of several newspapers and online publications. Recent projects include reportage on racial health disparities, addiction harm reduction initiatives, recovery-oriented behavioral healthcare and pediatric hospice. Among the print and digital publications in which his work has appeared are 100 Days in Appalachia, The Daily Yonder, Kaiser Health News, National Geographic, Resolve Magazine, STAT News, USA Today, Washington Monthly and Yes! Magazine.
Over the course of several weeks, we engaged in an email conversation about the state of healthcare in the United States. I started by asking Taylor how he defines health and healthcare.
Taylor Sisk: I define healthcare very broadly. I wrote a piece awhile back that began with a quote from a community healthcare worker: “Housing is healthcare.” Amen to that. I’ve written about the lack of affordable housing in Chattanooga, Asheville, rural communities—it’s a crisis most everywhere, or is getting to be so.
I think healthcare is anything that affects your ability to nurture the physical, mental, emotional well-being of yourself and your family–to receive the services you need, to breathe clean air, to recreate, to be safe from violence.
Soenen: What has been your work focus over the last two years and how does it dovetail into the Public Health realm of journalism?
Sisk: My work in the past couple of years has been shaped, of course, by the pandemic. I’ve written a lot about issues that arose, directly related to the pandemic – vaccination hesitancy, for example – and others that were worsened by it – health disparities, for example.
I write about how policies and practices affect people’s lives, generally, ideally, underserved people. Sometimes my articles don’t fit exactly in that category. I’ve just pitched a story on pediatric hospice. I think it’s a compelling story – certainly it’ll be visually compelling – and maybe it will help some families better consider their options.
Soenen: How, in your experience, do healthcare policies and healthcare practices affect the lives of people?
Sisk: The healthcare policies set by governments at all levels – federal, state, local – have a tremendous effect on people’s lives. An obvious recent example is measures to combat COVID-19 and the degree to which jurisdictions chose to enforce them. Another dramatic example is how states will be responding to the Dobbs v. Jackson United States Supreme Court decision.
Or, take Medicaid expansion. Each state’s decision on whether to expand Medicaid to more individuals – as allowed for, and largely paid for by, the federal government – impacts so many lives. The Centers for Medicare and Medicaid Services recently reported that 21 million low-income adults in 40 states and territories have gained healthcare coverage as a result of Medicaid expansion.
It is not just low-income individuals whose access to healthcare is affected by governmental decisions. Whether to allow for a hospital to monopolize services in a region, and the degree of oversight of a granted monopoly, affects everyone.
By healthcare practices, most fundamentally I mean: What does healthcare look like in your community, and how is that evolving (or not)? What physical and behavioral healthcare programs are offered in your schools? (Is suicide being addressed?) What options are available for pregnant women? (Are midwives and doulas accessible, and properly compensated?) How is naloxone being distributed and used? (Used by First Responders only, or also by peers?)
A current deep-dive project is a look at addiction harm reduction initiatives/programs in Appalachia. As has been well reported, overdose deaths have risen precipitously through the pandemic. I want to examine efforts to keep people alive, and hopefully help counter the stigma around those efforts, most particularly syringe exchange. The photographer and I will be reporting from urban and rural communities.
Soenen: What about the mass-murder-by-addiction epidemic are you seeking to reveal in that work or what is the story you will be telling that has not yet been told and what, in your view, is the solution as companies continues to flood markets with opioids, barbiturates, narcotics and vet drugs?
Sisk: We intend to illustrate the full range of services harm reduction programs provide. Distributing clean syringes is obviously critical. But so is offering HIV and Hep C testing, covid home tests, naloxone, wound kits, fentanyl test strips, condoms, water, support, empathy – and referrals to other available services in the community. Harm reduction programs do all those things
We hope to underscore that there’s genuine community among active drug users and among drug users and those who help and advocate for them. The fundamental objective of harm reduction is to keep folks alive and as healthy as possible until such time as the individual may be ready to stop using – and it’s saving lives each day.
I don’t have a solution for our drug crisis. No one does. It’s an epidemic of despair, disenfranchisement, chronic disintegration. What’s the remedy for all that? I don’t know.
Another deep-dive is research into the intersection of right-wing extremism and healthcare disinformation and how that’s playing out in rural communities. The extremism part of that is new territory for me. It’s compelling, and frightening.
Soenen: What is most frightening about it?
Sisk: What’s most frightening is how accessible misinformation (ill-informed) and disinformation (knowingly disseminated) are available and the ways that people are being manipulated. What we see is that bogus alt-health influencers reach people, particularly young people, using the same techniques that extremist groups use: a snubbing of authority; contempt for expert opinion that doesn’t jibe with what you’d prefer to believe; and an opportunity to belong to something, to be among like-minded people, insulated from reality.
“I learned that there wasn’t nearly enough music in my life – that there couldn’t be. I was so moved by the many ways that music is being integrated into the practice of healthcare, formally and otherwise. I had no experience of what the cultural connection of music could afford. The way it can open the door to trust in a healthcare provider. And the kinship it can engender.”
—Taylor Sisk
Soenen: Tell us a little about your work with photo essayist Matt Eich and what it meant to you?
Sisk: Working with Matt was a great pleasure. He has such a sensitive eye.
Something I really love about working on a piece for National Geographic is the depth of collaboration between photographer and writer. In most cases, with most other publications, the photographer enters once I’m well into my reporting. I’ll brief them on the nature of the story, the protagonists in the story, maybe give them a little background on those protagonists, suggest ideal settings for shooting them. There may be events that I’d like the photographer present for, but, otherwise, seldom are we on location at the same time.
With National Geographic magazine, that collaboration starts at the get-go – actually, prior to the get-go. You strategize together upfront and you jointly work through the logistics.
The story Matt Eich and I collaborated on was about the intersection of music and medicine. We profiled healthcare providers who are also musicians and illustrated how they incorporate their music into their practice. And we profiled music therapists, for whom the music is the practice. We reported from southwest Virginia and adjacent east Tennessee.
The photo editor assigned, Jamie Wellford, knew, I think immediately, who the right photographer was for the job. Matt was raised in Virginia, he lives in Virginia, and he has a deep love to Virginia. He has an ongoing project chronicling the state, and he renders, and honors, it beautifully.
A great example is the lead image in that story. We spent a day traveling along rural roads with Mark Handy, a family doctor who, yes, still makes house calls. We were going into people’s homes and observing Dr. Handy’s interactions with his patients, joining in on the conversation as appropriate and generally trying to stay out of the way. Our last stop was to the home of Cammie Frye, a woman in her fifties living with autism. She loves to sing; it seemed to lift her, delight her, and Matt captured it so movingly. In that lead image, Matt captures her in rapture, singing along to “Will the Circle Be Unbroken.” I love it.
(Photo by Matt Eich.)
I’m not going to say that it’s necessary to have that depth of knowledge, experience with a milieu to truly capture it – of course that’s not the case – but when a photographer does, it’s a value add that plays out in a number of ways.
Matt works quietly, in every sense. You hardly know he’s there, but he is, fully. A great example in the music as medicine article was with the lead photo.
Soenen: What did you learn about your own health, and the health of others while working on that story?
Sisk: Well, I learned that there wasn’t nearly enough music in my life – that there couldn’t be. I was so moved by the many ways that music is being integrated into the practice of healthcare, formally and otherwise. I had no experience of what the cultural connection of music could afford. The way it can open the door to trust in a healthcare provider. And the kinship it can engender.
In the article, we followed Dr. Joe Smiddy, a pulmonologist, to a free Remote Area Medical pop-up clinic in rural southwest Virginia. He’d come to do lung screenings and play the banjo. He’d approach people, ask where they were from and what their favorite song was. Instant rapport.
I don’t know that it had an immediate effect on my own health other than that it broadened the scope of music I listen to on a regular basis. It introduced me, for example, to the music of Amythyst Kiah, which led me to Allison Russell, which led me to … And that’s a healthy thing.
Soenen: Can we talk about the process of journalism at the granular level? How do you approach your work and what is the most pressing Public Health issue—and underreported health story—in your view?
Sisk: I don’t know that I’ve ever articulated that. I’m going to launch into this circuitously, and maybe eventually I’ll close in on a real answer. The ideal scenario is that I’ll find an issue or topic that I believe is underreported or that there’s something different to say about, and that I’m interested in learning more about. The issue or topic may be specific to a particular location. If not, I need to find the ideal location, or locations, to tell the story. Where is it being experienced the most particularly? Where are the ideal sources?
The next question is where do I take the story. Where is the editor who’s going to be engaged by this story and where is the idea audience? My steady gig is as healthcare correspondent for a digital publication called 100 Days in Appalachia, and most of my pitches go there first. And though Appalachia is my primary turf, I sometimes step out. Or sometimes I just feel that there’s a more appropriate home for a particular story, for any number of reasons. Sometimes I begin reporting a story before I have any idea of where it might land, and sometimes it never lands anywhere, though that’s rare.
I then further research the topic, explore more sources, narrow down to an “A list” of who I want to talk to and map out what I want to talk with each about. I’ll generally spend some time on all this before going out to report. Sometimes all the reporting is done from home. But that’s often hard for me. If it’s a story that’s very much community based, I have a hard time fully seeing it without being in that community, especially if it’s a rural community, and quite a bit of my stuff is rural focused.
When it’s time to write – which I put off as long as I possibly can, because it’s usually a little intimidating – I compile a document with notes and another with quote selects – basically, expository and narrative. One is essentially the who, what, where, when, why, and other factual scaffolding: history, stats, whatever else is needed. And the other is the shape of the story. Some quotes will be included verbatim, some will be paraphrased and some will be guideposts for my third-person narrative.
I then go from a rough outline to a discernible outline to a draft, then multiple rounds of tweaking. Then out it goes to the editor, and pretty much always comes back at least a little bit better.
As for the most pressing Public Health issue, I think inarguably (though I’m open to argument) through the past two years and counting it’s the pandemic. But let’s be optimistic and imagine that we’re getting through it – not that it’s going totally away, but that we’ll soon have it under reasonable control – let’s just imagine that.
I would then say that the most pressing issue is the drug crisis; most particularly, fentanyl. Fentanyl is scaring the hell out of folks working in addiction treatment, harm reductions folks, addiction-medicine doctors, researchers – everyone with an interest in substance use disorders. And of course, it’s scaring the hell out of people in active addiction, but so many of them are nonetheless seeking it out. It’s “the good stuff.”
Ok, so now I’m going to contradict myself, and argue that even throughout the pandemic, the most pressing healthcare issue has been the destruction of the Earth. I don’t know how anything could be more urgent than that. Hard to choose between global pandemic and destruction of planet.
So maybe our most pressing Public Health issue is our failure to acknowledge reality – to confront the most pressing Public Health issues of our time, open-eyed, with respect for a lifetime of research by experts, and reason and empathy. I’m not overly confident we’re anywhere close to that.
As for underreported stories, I think that’s in constant flux. Prior to the pandemic, I would have told you that racial health disparities were a grossly underreported issue. Because it was. But the pandemic really brought attention to it, which will hopefully help bring change. The American Medical Association at least appears to be making a concerted effort to address institutional racism in medicine and healthcare. I wrote a two-part series on the issue, and it really opened my eyes.
“By healthcare practices, most fundamentally I mean: What does healthcare look like in your community, and how is that evolving (or not)?
—Taylor Sisk
Soenen: How has the SARS-CoV-2 global pandemic impacted your own health and your view about healthcare and healthcare access?
Sisk: As far as I know, I’ve remained Covid-free, and, frankly, the pandemic has had minimal effect on how I work. When I’m not out reporting, I’m working at home, alone. So no big changes there. I didn’t go out reporting for a few months, at the outset, but I was then back out. Much of what I do requires that I’m out in the communities I report on – or I believe so. Or maybe it’s just what I want to believe, because I really want to be in those communities. Whatever the case, I was soon back out, taking all due precautions, mostly interviewing people outdoors, masking, distancing and testing.
But the pandemic has certainly deepened my understanding of the disparities in healthcare access. That’s been a real awakening. I’ve been very much informed, and enriched, by the people I talked with for those articles.
The pandemic opened my eyes to – or at least broadened my understanding of – a lot of issues with the United States healthcare system, or absence thereof. It’s made me further appreciate the extent to which the burden falls on local hospitals, clinics and individual providers that aren’t adequately funded or otherwise supported.
Soenen: As an accomplished, successful freelance writer publishing in the top publications of our time, do you have commercial health insurance and/or access to high quality healthcare?
Sisk: I pay for my own health insurance, through the Affordable Care Act health insurance marketplace in the United States. Working as a freelance and contract journalist has its plusses and minuses. I love being able to, for the most part, choose to work on stories that compel me. But though I do have a reasonably priced plan, I’d love to have someone help pay for it.
Soenen: The health of everybody is interconnected. Much like the greatest musicians in the region you’ve covered, what one musician does impacts another and how they react. What, in your view, do you think we can learn from musicians about health?
Sisk: In the final paragraphs of the piece, I wrote on music as medicine, I asked, “Does music truly have the capacity to heal?” Jim Borling, one of the music therapists we featured, said: “Music allows us to tap into that innate desire to grow that is already within us, that desire to move toward wholeness, that desire to heal.” I really like that.
His colleague Noel Anderson closed the piece with: “Music gives us a way to explore our feelings and get them out of our body. We can make feelings less abstract by putting them into a tangible medium.” The music can then be shared with others, “helping us realize that we’re not alone. That experience of belonging, support, and emotional release through music is healing.”
Soenen: People are saturated by images of struggle, addiction, harm and death. How do you make your writing and your visual collaborations cut through that saturation?
Sisk: That’s a very good question, one that I regularly ask myself – or at least mean to, because it’s critical that it be front of mind when plotting a story and then writing it: “What is there to say here that hasn’t already been said?”
I think the first and foremost objective is to explain what you’re talking about clearly, concisely and comprehensively – that’s the most effective way to cut through the clutter.
Then, in writing about addiction, you’ve got to bring it to life. Most everyone knows someone who’s struggled with addiction. Appeal to your readers’ empathy. Working with a talented photographer of people, like Matt Eich, elevates that opportunity to connect immeasurably.
Soenen: Do you support the enactment of National Improved Medicare For All / Single Payer Universal Healthcare in the United States, and if so, why/why not?
Sisk: If you believe we have fundamental rights as human beings, then surely access to quality healthcare is among them, right? I support universal healthcare. I’m open to what that may look like, but I think expanded and improved Medicare is a good way to frame it.
I saw a recent study that determined that up to 25 percent of total national healthcare expenditures are spent on administrative costs – as much as $1 trillion a year of the total healthcare costs of $3.8 trillion. That’s crazy. And too much healthcare is practiced in siloes. We need to adopt a more holistic, person-centered approach. And that will require better coordination, more cooperation.
Soenen: Are you optimistic about the future of Public Health and Safety in the United States?
Sisk: Whew. It’s difficult to be optimistic that the political will is there to fix anything in this country right now. We’re living in a more troubled time than I’ve known in my lifetime, and I think most of us feel it’s going to get a lot worse before it gets better. So to be optimistic that we’re going to come together to take a more rational approach to Public Health is a bit too much to ask.
But…I witness solutions being put into practice, at the community level, every time I’m out there – out there in Appalachia, or wherever I may be. I always try to make my articles solutions oriented. I always try. So, I’m always scouring about for innovative and/or resourceful ways that healthcare providers and other community members are meeting the needs of their community, ways that can be replicated elsewhere. And they’re not hard to find. Witnessing what these people are doing makes me hugely optimistic in the moment. I try my best to extend that moment.
Soenen: Up for a few fun questions?
Taylor: Yes. Not enough fun. Here we go.
Soenen: What is your favorite food or restaurant?
Sisk: I get excited about a lot of food. I love a lot of different things. But if I had to pick one ethnicity, I’d pick two: Indian and Vietnamese. That said, I’d like to note that I’ve nurtured, through a lot of hard work, a modest reputation with friends and family for my capacity for heat, Scoville-wise. And I do live in Nashville. So I’d like to add Nashville hot chicken – the real stuff, with real heat.
Soenen: Do you have a favorite band?
Sisk: Again, here, eclectic. To name a few artists: Father John Misty, Thievery Corporation, Rhiannon Giddens, Mindy Smith. Some long-long favorites: Harry Nilsson, John Prine, Nanci Griffith and War.
Soenen: What are you currently reading?
Sisk: The Urge: Our History of Addiction by Carl Erik Fisher; This Old Man by the late Roger Angell; What My Bones Know: A Memoir of Healing from Complex Trauma by Stephanie Foo; and I’m catching up on New Yorker fiction.
Soenen: Who are some of your favorite and most inspiring writers in both fiction and non?
Sisk: Nonfiction: I’ll read anything Kathryn Schulz writes. Fiction: I’m grateful that Carson McCullers is there when I need her.
Soenen: Where do you go to truly unplug and relax?
Sisk: Most any beachfront is medicinal. But most particularly, the coast of North Carolina.
Soenen: If you had a blank check advance to write the book you have always wanted to write, what would that book be?
Sisk: A book about Huntington’s disease. A dear friend lives with the disease, and I’ve done research intermittently, very intermittently, for a book for some years now. The Help 4 HD International annual symposium is in Nashville this year, in October, and I’m excited about that. I’m hoping that’ll rekindle a fire under me. Some money for a book would be nice.
Soenen: Trains or planes?
Sisk: I love travel by train but have few opportunities. I don’t mind flying.
Soenen: Bike or car?
Sisk: Bikes of course are cool. But I have to say car, because my work requires that I drive many miles a year – and I love to drive. I can get so much done. I rarely listen to podcasts; never listen to books on tape. Occasional radio. But mostly I just do some housecleaning in my head. I catch up on things. Take notes. Outline the next story. I got 372k miles out of my last Jetta. I’ve got 230k on this one. Many miles to go.
Soenen: Manhattan or The Smokies?
Sisk: Love both. Truly.
Soenen: Procrastinate on deadlines or git r done?
Sisk: I procrastinate up to a point, then git r done.
Soenen: Thank you, Taylor. Looking forward to continuing to follow your ongoing exceptional work on the southeastern region and rural areas of the United States especially.
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ADDITIONAL RECOMMENDED RESOURCES >
READING
As Appalachian hospitals disappear, rural Americans grapple with limited healthcare: As rural hospitals close, small towns in communities throughout central Appalachia grasp for creative solutions, by Taylor Sisk (National Geographic magazine)
What You Are Getting Wrong About Appalachia, by Elizabeth Catte (Belt Publishing)
The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth, by Sam Quinones (Bloomsbury Press)
Empire of Pain: The Sackler dynasty’s ruthless marketing of painkillers has generated billions of dollars—and millions of addicts, By Patrick Radden Keefe (New Yorker magazine)
When McKinsey Comes to Town: The Hidden Influence of the World's Most Powerful Consulting Firm, by Michael Forsythe and Walt Bogdanich (Knopf Doubleday)
Dopesick, by Beth Macy with photographs by Josh Meltzer (Little Brown)
FILM
Recovery Boys, by Elaine McMillion Sheldon
EXHIBITIONS
Matt Eich and Tyler Mitchell: Sunlight, Shadow, and a Rainbow - Saturday July 16, 2022 through Sunday, November 6, 2022 at The Cleveland Museum of Art
CHARITY HEALTHCARE FOR UNITED STATES HEALTHCARE REFUGEES
Remote Area Medical Triage Primary Care, Dental Care, Vision Care and Veterinary Care
ACCOUNTABIILITY
McKinsey and Company Consulting Settles for Nearly $600 Million Over Role in Opioid Crisis: The consulting firm has reached agreements with 49 states because of its sales advice to drugmakers, including Purdue Pharma, the manufacturer of OxyContin.
Opioid Death-by-Addiction Data
Rural Healthcare Access Crisis in the United States Data
ABOUT THE PHOTO ESSAYIST > Learn more about Matt Eich