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Saturation & Social Determinants of Health

Updated: May 15

I approached week two with optimism. I was excited to be on my own. When I had walked in Virginia just before Covid, I did so alone, even during a snowy week that changed to a shorts week. So, I felt like this would be similar-a piece of cake. Also, even though it was helpful having my husband, Craig and dog Ruffle with me as back-up, the first few days made staying in different places nightly more complicated so I thought being alone would be a blessing. 

Well, that thought was short-lived. In my first mile leaving Lumberton, I realized I was entering difficult territory. My back started hurting early on as I am not used to carrying a 20 pound backpack with a computer and other devices in it. Also, I had planned and wanted to live stream on my GoPro, but after working to set it up realized you can’t do that-at least where I was- without a hotspot- so that goal was put on hold and instead I took a lot of footage-both pictures and GoPro along the way.

My route took me next to I 95, which is under construction. Walking in the access lane was fine, but certainly not pretty with no sidewalk and minimal shoulder, let alone bike lane, and not for the faint of heart. I made the most of it though and felt good about it. One thing I wonder though is that we have interstate highways, but why not interstate walkways? The United States was founded by explorers, people who did things differently; why don’t we do things differently, and have active vacations where we walk or wheel from state to state or within state? From my viewpoint, it could be a way to stimulate local economies and allow people the opportunity for active, healthy transportation. Maybe we could also slowly reverse and/or incentivize against our current practice of kids who go to school having their parents drive them? Of course we need to make it accessible so that people with mobility impairments or sensory impairments can safely travel in the same lanes as people riding bicycles and tricycles; but if we can be inclusive in our planning we could do this. And it’s all about the built environment of which Sustain Our Abilities will have another blog by an expert soon.

As I travelled the southernmost North Carolina countryside, I again passed many abandoned and dilapidated houses. I also realized there were many that were just overgrown hiding in the roadside woods. It reminded me of the town Pripyat next to the nuclear disaster at Chernobyl in Ukraine where abandoned homes are now attracting dark tourists. Is this what the United States is heading towards?  I’d like to go back and knock on  these doors asking, if there are people living there, their opinions and determine their knowledge levels about common issues. Do they feel their homes are in need of repair and would they be interested in the help? Or are they beaten down, feeling helpless? Are they content their situation? If they are, how much of their living situation is fueled by alcohol, nicotine and drugs?

What comes to mind as a physician is the concept of social determinants of health-which per the Center for Disease Control include: economic stability, education access and quality, health care access and quality, neighborhood and built environment and social and community context. But what I am seeing when I am walking is much more than just health. This is people’s lives and an intergenerational problem related to repeated trauma—I think of young children being born into a difficult environment and parents without the capacity to change.

The walk from Lumberton to Rowland was 20 miles. The closest place that looked safe to stay at in Rowland was an Airbnb in a barn which at $50 per night was a cheaper and seemed a peaceful option. It was beautiful to see the horses in the lobby and I appreciated the quiet.    

I had another lesson though.   Because of the weight on my back, I hadn’t brought food with me for the evening. I’d eaten snacks along the way and the free breakfast free at the Springhill Suites so I didn’t want to carry any extra weight. I had 60 ounces of water along the way and I didn’t want to carry more. But when I got to the barn, I wasn’t sure if the tap water in the upstairs bathroom was drinkable. Largely to get some fluids, I tried to get Uber eats and waited 2+ hours to realize that  Jersey Mike’s cancelled my order because they wouldn’t deliver that far away. So, I was excited to go get food the next day. But, I tried to walk to a restaurant and it was boarded up and in the middle of what looked like a tornado had hit years prior and no one made repairs. The only place to eat was in the “lucky seven” where two women were working hard to provide heaping plates of fried food to the 10 or so people waiting in line. It took about 15 minutes to get the food but I enjoyed a conversation with some workers who told me I was right, and there was nowhere to eat in Rowland  and that I would find more food choices at my next stop in Dillon South Carolina.

For those of you that have driven I 95 from the northeast to the south you’ve probably seen the signs for South of the Border, a tourist attraction that has been there for probably 50 years. As I started to see these signs, I became intrigued to see what I would find. Still, as I walked along the property, I couldn’t  force myself to go in the buildings. I went to see the colorful, funky animals to attract children, which I did some photo op with, and I decided to explore the firework store because I have never been in one. Aside from the obvious environmental effects, the sounds frighten me, and I remember stories of my youth when kids were killed playing with them so I’m not a fan, but I thought it might be educational so I went in. I was amazed with was how much money people can spend on fireworks and the absurd variety. Sadly, in the next town over you can’t get a salad to eat but here you could buy any type of firework you’d like.

Moving along I saw what made in America means. A few miles down the road, next to some trucks designed for transporting pigs there was a sporting goods company looking for seamstresses. With the national minimum wage at 7.25, my suspicion is that these workers wouldn’t be receiving more than that, based on the fact that North Carolina uses the national minimum wage law.  I also realized as I looked minimum wage up there are five states without a minimum wage law-hmmm.. They are South Carolina, Alabama, Mississippi, Louisiana and Tennessee.

Wow. A lot to digest.  Also what came to my mind as I kept walking was the lack of change between states--usually as you pass from state to state in the US, you can see some differences, but there weren’t really any differences this time

Dillon is a highway town with many fast food restaurants and lower cost motels. As such, I found some sidewalks, but needed to jog across the four-lane highway. I stayed at the Comfort Inn in Dillon and had a great meal from Taco Bell and Seven Eleven. My room was supposed to be nonsmoking but still had the lingering smell of tobacco-I guess this was par for the course.  

Down the road, I was back to the train tracks, and more poverty. There are some brief stretches of farms with the inter-stretched beauty of nature, including lovely swamps, with croaking frogs, and some fields with the purple majesty expressed in our national anthem. But definitely, no sidewalks and no bike lanes and still lots of garbage on the side of the road.   

One thing that does stick out is the absence of garbage cans throughout our country.  There is also an inability to recycle in many places and lack of benches to take a rest. What would it take for individual towns, counties, and states to try and become friendly to active transportation? This would be a great way to stimulate local economies. It is also something that can be done with money from the Inflation Reduction Act in the US and I hope people are applying for these funds and using them well.

My next stop in South Carolina was Latta where I experienced life on the other side of the tracks. I stayed in an Airbnb because the only Motel option in town seemed scary to me and because this was “nonsmoking” and I have an issue as you might have guessed from cigarette smoke. This time I was greeted by an owner who reminded me of the Bates Motel and  my options for dinner were a six course meal at the property or going to a pizza place-because of course the local Japanese restaurant I tried to go to was boarded up. So I had a meal of chicken with mushrooms and onions from the pizza place.

All these experiences were emotionally draining to me and very depressing. I started this journey to bring attention to the issues of persons with disabilities and here I was in an environment where life seemed impossible for someone to live with a disability. I realized I needed a day to catch up and organize my footage. I made the decision before I went to sleep to take the next and Uber to my next stop – Florence, which, as I was staying at a Hyatt, and there are many signs on route 95 for Florence, I thought would be a big accessible city.

After experiencing all the poverty on the route, I felt guilty, having a breakfast at a table with a tablecloth, seated alone next to a fireplace. But, I countered this, realizing I had volunteered my time to highlight my important cause of promoting healthy living environments.

Still having a healthy living environment brings us back to the social determinants of health which also involves being able to have transportation. Fortunately attempted to get an Uber to Florence. There was nothing available so then I called six cab companies and either the numbers were out of business, no one answered or no one would pick me up. One company told me it wasn’t worth their while if I couldn’t pay cash, which I never carry, so I started walking, hoping I would come up with some access to transportation as I got down the road. I walked the mile to the local pizza place and went inside and asked the waitress, “Do you think there is anyone that would drive me to Florence if I venmo them some cash?” Craig and I had been in a similar situation in northern Maine and been able to find someone that drove us for three days so I thought just maybe this would work. But no such luck this time.  Fortunately I called back all the cab companies again and this time one answered saying they might be able to get me someone.

So I got a cab and was driven to Florence.

I suspect you probably haven’t been to Florence. If you haven’t been there; I wouldn’t bother. There is an airport, a train station, a hospital, and a few restaurants which seemed rather pricey. But there were also a lot more broken down buildings and the most interesting thing seemed to be a sign about a civil rights protest there that happened in the 60’s.

I did, however, have an epiphany when I got to Florence. I realized I reached saturation-and by this I mean the term that is often used in qualitative research when the research has spoken long enough to different people that they aren’t learning any new concepts. My walk-through South Carolina wasn’t making any sense and I wasn’t going to learn anything new.  I realized I’m not helping anyone by emphasizing all the broken buildings, poverty, hoarding, garbage, and lack of transportation. What I was living was a walk-through of  the social determinants of health which was exemplified by the woman at the Hyatt who told me she had to take cabs home from work every night because there were only buses three days a week and in South Carolina its against the law to schedule an Uber. I also realized I wasn’t going to be able to walk this state on my own without backup because I couldn’t commit to walking 50 miles in a day between places to stay, nor could I confirm my safety, even if I could do it. I tried to rent a car to drive home and there were no cars to be had for four days-the Amtrak came at 3 am and the receptionist told me it wasn’t safe to walk to the train and that no one would pick me up-but I was lucky-I was able to get a ticket to get back home on American. Three flights a day to Charlotte and then on to Daytona. But check out the sign they put up when you are boarding below-a great way to get on a plane for someone that is afraid of flying!

So, although part of me felt and still feels like a failure, I realized I needed to go home, be nourished and come up with a post South Carolina strategy to finish my journey to Key West and emphasize the need for the Graham-The Green Route Aiding Health Adaptation and Mitigation. I’m a survivor so I will do it. I can adapt and have resilience. I can do this and as Dorothy says, “There’s no place like home. There’s no place like home.”


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