“We’re the forgotten part of Missouri.”

Dogfight on the Rising River

Listen to part one of our series “Shortage in Rich Land”

For years, some small towns and farmers along the Mississippi River have been battling each other over a flood project set up by the U.S. Army Corps of Engineers.

On the western shore, farmers in southeast Missouri need the project to protect their valuable farmland. But small river towns on the eastern side of the river say the project protects those influential farmers at the cost of their small communities. As a last-ditch effort, the opposition to the project is asking the Environmental Protection Agency to kill the project altogether.

A big, metal gate designed in 1914 to protect Cairo, Ill., from flood waters marks the entrance to the town. Today, Cairo’s population has dwindled to about 2,800 due in large part to floods, evacuations and a suffering economy.

Lynn Bock is the attorney for the St. John Levee and Drainage District in New Madrid, Mo. He lives at the southern end of the floodplain. Part of the levee system there follows the Mississippi River path. On the other side of the levee are thousands of acres of productive farmland.

“When you look at these fields, that’s our strip mall. That’s our economy in this part of the world,” Bock says. “We make it or don’t make it based on how farmers do.”

The levee system protects some of the most productive farmland in Missouri that yields top notch soybeans, corn and wheat.

The levee system here is part of a $165 million dollar project called the New Madrid Floodway Project that’s designed to protect the land around the Mississippi River.

The area is part of a seven-county region that produces one-third of Missouri’s agriculture economy. Farmers grow millions of dollars’ worth of soybeans, corn, cotton and rice here.

The farmland isn’t without its weaknesses, though. During major Mississippi River floods, the Army Corps diverts the excess water into this floodplain, called the New Madrid Floodway. Construction on the project first began in 1928.

“We did everything imaginable to help people during that situation because it was awful.” -Cairo resident Monica Smith

Nearly 90 years later, the Corps is close to completing the levee system by building an earthen wall along a 1,500-foot gap to separate the land from the river. This final levee essentially cordons off the lucrative farmland in the floodway, protecting the crops from most floods. That’s good for Missouri farmers west of the river, but maybe not so good for Illinois and Kentucky towns east of it.

“[With] what we can produce in the floodway itself, in [those] 133,000 acres of farmland, we’re able to feed on an annual basis about 1.3 million people,” says Kevin Mainord, farm owner and mayor of East Prairie, Mo. He says closing that gap is critical.

The levee system protects the farms most of the time, but every 75 years or so, a major flood slams the area. Then, the New Madrid Floodway has to be opened up and used as, well, a floodway.

Mayor Tyrone Coleman of Cairo, Ill., opposes the New Madrid Floodway project. A major flood in 2011 forced his town to evacuate.

That’s what happened in the great flood of 2011. The floodwater was sweeping up to the edges of Cairo, Ill., a town of 2,800 with many low-income residents.

“We did everything imaginable to help people during that situation because it was awful,” says Monica Smith, who works at the Cairo library. “People had to leave their homes that hadn’t been out of their homes in years, and then some of them didn’t have any place to go.”

When the Army Corps planned to open up the floodway to help Cairo, the state of Missouri backed by members of U.S. Congress sued to stop it because the water level remained just inches below the mandated height. The state wanted to prevent damage to crops already planted.

For two days, the floodwaters crept up on Cairo. Mayor Tyrone Coleman says after the town was evacuated, some stayed behind to fight the flood.

“We had to utilize inmates from the maximum [security] prison, Corps of Engineer personnel, National Guard, and then there were a number of local citizens that helped with sandbagging,” he says.

After two intense and difficult days, Missouri lost the legal challenge and the Corps opened the floodway. But some say it was too little, too late. And after that flood, many residents never returned to Cairo.

“We lost some people over it which is sad because they were good people,” Smith says. “And you hate to lose your good people.”

On the other side, with the floodway open, the water wiped away acres of crops. Many of those residents never returned either.

Monica Smith works at the Cairo library and witnessed the flood of 2011 firsthand.

“The floodway was destroyed — completely,” Mainord says. “There are probably seven residents that are living there now, where there were hundreds before the flood of 2011.”

Cairo gets a lot of the spotlight when it comes to the 2011 flood, but just 20 minutes up the road, the flood hit Olive Branch, Ill., hard, too.

“The agriculture impact was way worse here, than it was in the floodway,” engineer Jeff Denney says. “It was just all about Missouri and their farmers, but you’re doing the same thing to farmers here, you know?”

Environmental groups, such as the National Wildlife Federation, have also been fighting the project for years. They say cutting off the floodway with a plug would be catastrophic for the 50,000 acres of wetland that fish and waterfowl call home.

Project engineer Danny Ward says the corps’ most recent environmental impact statement is meant to appease those concerns.

“We [sought] to balance the socioeconomic impacts associated with floods, as well as the environmental benefits derived from the flooding,” he says.

The environmental impact statements have come under fire for not going far enough to address the concerns of independent scientists. The most recent report released in March is criticized for using flawed models, underestimating wetlands impact and not clearly showing the project’s economic benefits would exceed the cost to taxpayers.

Bottom line, many in the river towns are concerned farmers backed by powerful politicians on the Missouri side are winning the battle to protect their farmland at the cost of their communities. They say there is no guarantee that gap closure won’t affect them and that future lawsuits won’t delay the floodway operation again. Ward disagrees.

“We’re actually mandated by federal law to operate the floodway…” — Army Corps Engineer Danny Ward

“It’s not like if we were to build the closure we would not operate the floodway anymore,” he says. “We’re actually mandated by federal law to operate the floodway and we will continue to operate it.”

But Cairo Mayor Tyrone Coleman, who had a front-row seat to the devastation in 2011, isn’t buying it.

“If this was a viable project, then it wouldn’t have gone beyond that 60 year period to make it happen,” he says. “Because it is controversial and because of the dynamics of what can happen behind something like the tragedy that had taken place, it doesn’t take a rocket scientist to see what’s happening here.”

As a final play, Cairo has teamed up with other river towns and conservation groups to ask the Environmental Protection Agency to use part of the Clean Water Act to kill the entire project. If vetoed, it would be the 14th project shut down under the act since 1981.

Engineer Jeff Denney in Olive Branch, Ill., says the farms on the Illinois side of the Mississippi River were devastated, too. His photos in his office tell the story of how the flood of 2011 destroyed parts of Olive Branch.

Desperately Seeking Doctors

Listen to part two of our series “Shortage in Rich Land.”

It’s early morning. The sun is shining brightly on the corrugated metal siding of the Otto Bean Medical Center in Kennett, Mo., and inside the building, Judith Haggard is pricking the soles of her patient’s feet with a pin.

Otto Bean is part of the SEMO Health Network, a Federally Qualified Community Health Center which operates several clinics across southeast Missouri.

Haggard is a nurse practitioner and one of the ranking medical providers here at the clinic, which has no full-time doctor. She has just 15 minutes to spend with her patient, a 71-year-old diabetic on Medicaid.

Judith Haggard is one of two nurse practitioners at the Otto Bean Medical Center in Kennett, Mo. The clinic has no full-time doctor so Haggard works with a collaborating physician outside of the SEMO Health Network, which runs Otto Bean.

15 minutes is the standard length of a visit here. In that time she must examine and educate him, prescribe medicine and discharge him. 15 minutes, she says, is hardly enough time.

“Diabetics take longer,” Haggard says. “And you don’t get through with a diabetic in 15 minutes unless they are totally controlled and that patient generally is not.”

In a perfect world the patient would see an endocrinologist — a doctor who specializes in diabetes. Time spent with a nurse practitioner, diabetes educator or even a nutritionist would make up for the time the doctor couldn’t give.

But this is the Bootheel, a region emblematic of the social and medical problems facing rural Missouri, and really, all of rural America. Life expectancy here is among the lowest in the state. A fifth of the population lives in poverty. About a quarter are smokers.

“If you look at a sociology map,” Haggard says, “we are the red flags of the state.”

And adding to those red flags is a critical shortage of doctors, especially for the region’s poor, like the patients at the Otto Bean Medical Center.

“It has been at least two years at this point [since we’ve had a physician],” Haggard says, adding, “And every time somebody leaves it’s another full year at least before we get somebody back in.”

Every Bootheel county is a designated Health Professional Shortage Area (HPSA) — a measure of a population’s access to healthcare based on their ratio to providers.

There are three categories for which this distinction exists — primary medical care, mental health and dental — and the Bootheel is short on all of them.

Travis Weiss is a physician assistant at the SEMO Health Network in New Madrid, Mo. Through the Network, Weiss had access to the National Health Service Corps loan repayment program.

For perspective, the Health Resources and Services Administration, for an area to be designated a HPSA its population to provider ratio must be at least 3,500 to 1 for primary care (3,000 to 1 in areas of high need). For dental the ratio must be 5,000 to 1 (4,000 to 1). 30,000 to 1 (20,000 to 1) for mental health.

Standing against the wall of a busy classroom in Sikeston, Mo., Sandy Ortiz reflects on the need those numbers represent.

“It’s such a simple statement,” she says. “We’re just short of healthcare providers.”

Ortiz is Executive Director of Southeast Missouri’s Area Health Education Center — one of seven regional centers in the state, called AHEC for short.

AHEC’s aim is to grow the area’s healthcare workforce and fill the provider gap. To do this, they give medical students in Missouri a taste of rural medicine by placing them in clinical rotations in the area; hoping the students like it enough to return here after their residencies.

But the Bootheel’s small communities lack the allure of big cities, as well as their critical mass of people to sustain a medical practice. Even a loan repayment program through the National Health Service Corps — where doctors working at certain clinics in the area can have their student debt repaid by the federal government — often isn’t a big enough draw.

Usually it’s the people from the area who are most likely to return. And that’s why Ortiz and AHEC also work with students before they finish high school, which is what brings her to this classroom at the Sikeston Career and Technology Center.

“If you look at a sociology map, we are the red flags of the state.” — Judith Haggard

“We do have some kids go into healthcare professions but they don’t come back to the area,” she says. “We just need to show more kids, get more kids interested in healthcare professions and then come back to this area to practice.”

One of those kids is 17-year-old Erin Schlitt, a student in the health occupations course. Before joining this class, Erin didn’t always see herself in a health profession. This was a chance to try it on for size.

“I knew nothing about [health professions]” Erin says. “I was like, ‘Oh I should try this [class] just to see if I like it and if not I can drop it at semester, no big deal.’ And ever since then I’ve liked it. Definitely changes the outlook on life.”

AHEC doesn’t run this class but they do visit once a month with a hands-on activity, sometimes taking the students out into the field. And they look for other ways to engage students like Erin with the kind of science learning that schools in small, rural districts generally cannot afford.

The health occupations class at the Sikeston Career and Technology Center in Sikeston, Mo. Racheal Baker (far right) of SEMO AHEC brings a hands-on activity to this class once a month to engage students about careers in healthcare.

Pointing to a photo on the wall of the classroom, Sandy Ortiz says, “This is showing a young student how to give injections on an orange.”

“The schools with budget cuts and such as, we bring kids together and dissect cow eyeballs, we dissect minks.”

Terry Richey is Chief Nursing Officer for the SEMO Health Network. Part of her job is recruiting health professionals to join the Network.

Today’s lesson is not quite as exciting. The students are learning about jobs in oral health by playing “Inter-professional Pictionary.” Erin draws a picture with fellow 17-year-olds Kaylan Butler and Dajanay Wallace.The girls were given clues about what to draw, they think it’s probably a dentist though they’re not sure.

“Want to see our drawing?” Kaylan asks.

“No!” Erin shouts. “It’s so ugly, it’s so bad.”

Dajanay is decidedly less embarrassed. She points out the details of the drawing.

“There’s the teeth,” she says, bumping the other girls out of the way. “There’s the toothbrush. There’s the mirror. There’s the little chair that they use.”

Kaylan joins in, adding, “and that’s the health professional person.”

While oral healthcare might not be their calling, all three girls do want to join the medical field. Erin is looking at anesthesiology, Kaylan at pediatrics and Dajanay wants to be a registered nurse.

From AHEC’s perspective that’s the first step toward success. The next challenge is getting them to return after they’ve been trained. And right now the girls are on the fence.

“I always wanted to get away from Sikeston,” Kaylan says. “But there is something about that hometown that you always want to come home to. I might come back. Start up a little business for all the kids who can’t afford it and try to give back to them later in life.”

“If I decide to come back,” she adds.

Erin is planning to go to college away from the Bootheel, and she think’s she’ll miss home.

“I’ll come home and be here for a few years,” she says. After reflecting further she adds, “then I’ll get tired of it and move away finally.”

Judith Haggard felt the draw of home 15 years ago when she finished her own training and started practicing down here in the Bootheel.

“It was everything they told me not to do,” she says about working as a nurse practitioner in Kennett. “’Don’t go without a doctor!’ But I was here. I lived here. I didn’t want to travel. And so it started.”

The hope now is that, when the time comes, these students will feel the same way.

The Small But Mighty Rice Farm

Listen to part three of our series “Shortage in Rich Land.”

Chuck Earnest drives along a dirt road next to his rice fields near Steele, Mo. It’s not planting season yet, so the fields are flooded. Flocks of ducks and other waterfowl take turns floating on the rippling water and flying above it.

“This has turned out to be the duck hunting center of Middle America, right in this territory,” he says. “There might be 1,000 ducks out there.”

Chuck Earnest’s rice fields near Steele, Mo., are a waterfowl sanctuary during the non-growing season.

For such a small region, this sprawling landscape of the Bootheel has some of the most productive farmland in the U.S. A solid water supply and nutrient-rich flatland creates a fertile environment to grow some of the most diverse crops not readily found in the rest of the state. You can find watermelons, sweet potatoes, cotton and a small but strong sector in Missouri growing rice.

For Earnest on this windy but clear day, ducks aren’t really what are on his mind.

Like many of his neighboring rice farmers, he’s ready to expand his rice fields. He says free trade agreements across the Gulf of Mexico and the Pacific Ocean could open up new markets and raise prices. That would be a boon for Missouri’s rice farmers who are directly competing with the top rice producing states Arkansas and California.

“We have to have access to far more markets in order to be able to move our crop.” — Farm owner Chuck Earnest

“About 40 percent of the American rice crop is exported year after year,” Earnest says. “So we have to have access to far more markets in order to be able to move our crop.”

Earnest says the Trans Pacific Partnership, or TPP, could do exactly that. Twelve nations — from New Zealand up to Canada — are trying to hammer out a deal that could open up tariff-free trades across many industries, including automobiles and pharmaceuticals.

But perhaps the trickiest negotiations surround agriculture products. That’s mostly because of Japan, which is protective of its so-called five sacred commodities: beef and pork, wheat, sugar, dairy and rice. Five seems to be loosely interpreted here.

“In trade negotiations, they have tied those to motivations such as preserving culture and food security or food safety,” Wyatt Thompson, a University of Missouri agriculture economist, says. “And also other things you might not think of like flood control or having pretty countryside.”

So, he says Japan’s farms have a strong influence on food policy — hence the country opposes dropping agriculture tariffs, which would allow more foreign competition. Although more competitors might hurt producers in Japan, Thompson says it could mean cheaper prices and more variety for Japanese consumers.

As for the U.S., eliminating tariffs mean more beef, pork and rice could be sold to Japan.

Chuck Earnest says he and other farmers in the Missouri would benefit greatly from more international trade deals.

“So for a range of commodities we might increase our exports to Japan, which means higher U.S. prices for these commodities and somewhat greater revenue to farmers and producers,” he says.

But in the U.S., there are other concerns.

Some food safety groups contend the agreement may lead to imports that don’t meet strict American safety standards. Seafood tops the list of concerning products. But because exact terms of the deal are unknown, experts say it’s hard to speculate.

Those in favor of an agreement, including U.S. Secretary of Agriculture Tom Vilsack, say it’s crucial to strike a TPP deal.

“If we don’t get this done, the void will be filled by China and China will set the stage and set the rules for trade with Asian nations in the future,” Vilsack says. “We don’t want to cede that opportunity to China.”

Vilsack says if the 12 countries can agree on the TPP, he wants the deal to happen quickly. That’s why he and previous agriculture secretaries have asked Congress to grant “Trade Promotion Authority” to President Barack Obama. It would basically allow the president to negotiate the trade deal and fast track it to Congress for approval.

Ultimately, Vilsack says nailing down a TPP agreement would help create momentum for an even bigger trade agreement with the European Union.

Rice farm owner Chuck Earnest says Bootheel farmers are eager to get a chunk of the estimated $3 billion increase in agriculture exports the deal could bring.

“Is [rice] going to be as big of a market as it was in ’63 when it first opens? Maybe. Maybe not.” — Farm owner Paul

“That’s a lot of money,” he says. “For Missouri producers to get our share of that would be a significant thing. It would either draw the rice price up or it would increase rice acres in Missouri. Either of those are good things.”

Earnest says he’s excited about a TPP deal, but it’s actually another deal with just a single country that could boost rice sales big time for Bootheel farmers.

“Cuba has been a market we believe we should have been in 20 years ago,” he says. “And it is a constant policy that we have wanted for a long time. Now we finally have a president who is willing to talk about it.”

Neighboring rice farm owner Paul Combs agrees.

“We’re excited about normalized relations with Cuba,” he says. “Until 1963, Cuba was the largest importer of U.S. rice.”

That’s rice farm owner Paul Combs. A few miles up the road from Earnest, he pulls up in his truck on a clear winter day to check in with some rice that’s being loaded into bins for shipping. He says some of this rice ends up in milling operations stateside for grocery stores or beer.

“The other big outlet for us in the Bootheel is the Mississippi River,” he says. “Most of that rice gets loaded onto barges as unprocessed rice — what they call rough rice — and then gets exported. The primary markets for that export market are Mexico and then all of the countries in Central America. “

Rice farm owner Paul Combs says Cuba could be huge for not only the Missouri’s Bootheel rice industry, but other sectors as well.

He says since Cuba sits smack dab in the middle of a busy U.S. trade route, Cuba would be able to score higher quality rice at a cheaper price than what they are currently buying from Vietnam. That would be a big deal for the island with a big import market, according to agriculture economist Bill Messina at the University of Florida.

“They’re a small country but they’re having to import 60 percent of their food requirements to feed the population,” he says.

In 2014, Cuba bought $2.2 billion worth of food products, according to Messina. Rice is just the tip of the iceberg when it comes to what Missouri farmers could sell to the island. Commodity groups including wheat, pork and rice have jumped on board calling for the end of the U.S. trade embargo. But that takes an act of Congress.

Missouri Sen. Claire McCaskill visited Cuba recently. She says now is the time drop the embargo which would not only help Missouri producers, but help Cuban citizens too.

“The Castro government is using the American embargo as an excuse to the people of Cuba to explain their lack of prosperity. It’s time we rip away that excuse,” she says.

Reversing the embargo is gaining momentum among Democrats and some Republicans. McCaskill says balancing this trade will ultimately strengthen the economy of Missouri and the U.S. That’s exactly what Bootheel farmers and residents like to hear.

Many locals say the vitality of the region depends on the success of the agriculture industry. Indeed, rice farm owner Paul Combs says rice could actually act as the gateway commodity for the rest of Missouri’s agriculture industry. And then, the small rice industry in the state would open up doors for its sister commodities.

“Is [rice] going to be as big of a market as it was in ’63 when it first opens? Maybe. Maybe not,” he says. “But as time goes on, if their economy improves because of increased tourism, then you start to sell them the higher priced agricultural products like beef from Missouri or pork from Missouri.”

Offseason in the rice fields of Missouri’s Bootheel region.

The Unspoken Crisis

Listen to part four of our series “Shortage in Rich Land.”

It’s a cold afternoon in Kennett, Mo. The lawns in this low-income housing neighborhood are still wet from yesterday’s rain. And just inside the door of her mother’s brick home, 27-year-old Marylouisa Cantu sits on a couch, pregnant and draped in a blanket.

Her mother beckons, through the storm door.

“Come in, come in.”

Marylouisa Cantu (left) with her case worker Lucretia Cox (center) and mother Star Tafolla.

Lucretia Cox, Cantu’s caseworker from the Missouri Bootheel Regional Consortium (MBRC), is also here, sitting on a couch across the room. MBRC connects low-income women like Cantu to medical and support services to help them deliver healthy babies.

The aim is to avoid something like what happened the last time Cantu was pregnant. She was living in Memphis at the time and with her due date still weeks away, she came here to Kennett to visit her mother. But when she began her two-hour drive home, something didn’t feel right.

“I felt sick and I just felt weird,” Cantu recalls. “So I pulled over to a gas station by Blytheville [Ak.] over there and I just started feeling the baby was coming.”Like so many babies born premature, Cantu’s daughter was sick. The hospital wanted to rush the baby to the neonatal intensive care unit (NICU) at the St. Francis Medical Center in Cape Girardeau, about a hundred miles away.

Dr. Alan Barnette is a neonatologist in the NICU at St. Francis Medical Center in Cape Girardeau, Mo. where Cantu’s newborn was taken in 2013.

“They come in they’re like, ‘well we’re going to have to take the baby because she’s having respiratory breathing problems,’” Cantu remembers. “‘She’s blue, she don’t look right.’”

This is an unfortunately common experience for women in the Bootheel. Almost 17 percent of the babies born here in Dunklin County, where Cantu now lives, are born premature. According to data from the World Health Organization, if this were a country, that’d be the fifth highest rate in the world.

And almost 10 out of every 1,000 babies born here die before they turn one, well above the state and national averages. For African-Americans the rate is even higher at about 16 of every 1,000 babies. For comparison, the World Factbook estimates the infant mortality rate of the Gaza Strip at 15.46 deaths per 1,000.

Sitting around a large wooden conference table at the New Madrid Health Department are five women who have been tasked with lowering the infant mortality rate of the region. They’re from Bootheel Babies and Families, an initiative that partners MBRC with the Bootheel Network for Health Improvement (BNHI).

The initiative is tasked with lowering the region’s infant mortality rate by 15 percent in 10 years. One of the big challenges to bringing the rate down is making the community aware there’s even a problem.

Everyone at the table replies with a simple “no” to the question, “Is there a general understanding that infant mortality is a problem in the Bootheel with people in the Bootheel?”

Teletia Atkins is a program assistant from BNHI who knows first hand about the issue of awareness.

Almost 17 percent of the babies born here in Dunklin County are born premature.

“I lost a child 11 years ago,” she says. “I just thought it happened to me. And I’m pretty sure it’s a lot of people who think it’s just happened to them.”

The initiative’s goal is an ambitious one, especially considering the complex web of factors that lead to infant mortality. Premature births are the leading cause, but other contributors include issues of general poverty and poor nutrition as well as even just finding a ride to the doctor’s office.

“We need to remember we can do things to counteract it and to make the numbers better,” says MBRC’s Chantal Herrion, one of two project management coordinators for the initiative.

They’ve identified a set of indicators, which they believe, if they can improve will reduce the rate. Lyn Williams, Herrion’s counterpart from BNHI, names a few of them.

“Pre-conception health,” she says. “Encouraging women to take care of their bodies and to maintain a healthy weight and healthy diet. And to postpone parenthood until they are physically and emotionally ready.”

Prenatal care, interconception health and education are also on the list. But it’s hard to imagine the initiative could do more than what these two organizations already do on their own.

Bootheel Babies and Families. From left to right, Kathleen Vaught and Chantal Herrion of the Missouri Bootheel Regional Consortium, Jayne Dees of the New Madrid Health Department, and Lyntoria Williams and Teletia Atkins of the Bootheel Network for Health Improvement.

The health departments that make up BNHI already administer the Women, Infants, and Children (WIC) program, a federal program that provides healthcare and nutrition assistance to low-income mothers and their babies. In every Bootheel county at least 75 percent, and sometimes as high as 98 percent of newborns are enrolled in WIC.

And MBRC runs Healthy Start, the federal government’s own infant mortality initiative. In 2008, one in four women in their program had a low birth weight baby. By 2012 they lowered that rate to just one in ten.

But that’s kind of the point of the Bootheel Babies and Families initiative. Until now these two groups were working on their own.

“I actually think that’s been one of the biggest successes down in the Bootheel,” Melissa Logsdon says, “these two organizations coming together and working as closely as they are.”“I’ve heard from them that they really didn’t even talk to one another before,” she adds.

Logsdon is a program officer at Missouri Foundation for Health, which is funding infant mortality initiatives in both the Bootheel and in St. Louis. (Full disclosure, the foundation also provides funding for the KBIA Health & Wealth Desk).To be fair, it’s not like the MBRC and BNHI were bitter rivals. They just focused on their own programs. Although with scarce funding available for public health in the state, at times there was a perception of competition.

“It’s really about funding a collaborative approach.” — Melissa Logsdon

Chantal Herrion acknowledges this back in New Madrid when asked if the two organizations used to be competitors.“Yes, but now we’re at the table together,” she says after a brief pause. Everyone laughs.

“That’s what makes this initiative so different,” adds Jayne Dees, Administrator of the New Madrid Health Department. Logsdon says bringing these two groups together was important.

“This isn’t about funding programs necessarily,” she says, “But it’s really about funding a collaborative approach.”

From left to right, Missouri Bootheel Regional Consortium’s Emily Nyaga, Addie Walker and CEO Cynthia Dean.

The approach is called collective impact framework, a term coined in 2011 for a model of collaboration to tackle complex problems in communities. In 2006, Milwaukee used a similar model on an awareness campaign targeting the city’s high teen pregnancy rate. Within 7 years that rate had dropped by 50 percent.

Bootheel Babaies and Families is now trying to replicate that same kind of success. They’re gearing up to hold their first public events: two community round tables the second week of April.

The hope is by getting the community talking, they can help more women like Marylouisa Cantu deliver healthy babies.

Cantu’s daughter made a complete recovery and is now a healthy, trouble-making 2-year-old. This time, she’s hoping for a happy, healthy boy.

“Hopefully that’s what I’ll get,” she says. “Ain’t no telling.”

Counting the Invisible

Listen to part five of our series “Shortage in Rich Land.”

Anthony Smith has a spiel he will deliver many, many times today.

“I’m Anthony Smith with the Family Counseling Center,” he says, “and today is identified as the ‘point-in-time count’ for the state of Missouri. The governor’s office does this annually. We try to conduct a winter count to identify individuals who are homeless, or at risk of being homeless in our community.”

Joe Fox is a resident of Safe Haven in Kennett, Mo.

Anthony is the director of housing and vocational services at Family Counseling Center. The organization provides an array of services across southeastern Missouri, including the Safe Haven in Kennett, which has eight apartments for the chronically homeless. Safe Haven is where Anthony works.

Today is a big day for Anthony. He is trying to count every homeless person in Dunklin County. And, thankfully, he is not alone. A small team of volunteers — who all also happen to be employees of the Family Counseling Center — pile into a minivan for this endeavor.

Emily Parker, housing case manager, is driving them in her van. Anthony sits up front. In the back are Paula Driskill and Lisa Brown.

Their first stops today are to the local police and count sheriff, to let them know the count is happening in case they receive any 911 calls about people breaking into abandoned buildings.

Safe Haven’s Clinical Manager Kristen Borh and Director of Housing and Vocational Services Anthony Smith.

Anthony and Emily walk into the office of Bob Holder, Dunklin County sheriff. It’s in a converted old paper factory that’s also home to the county jail.

Anthony gives his spiel. When he’s done Sheriff Holder recounts a recent run-in his office had with a homeless man.

“We had a situation back last summer that the Blytheville P.D. brings a guy over here, dumps him off at the Pemiscot County Hospital,” he says.

“They didn’t like it,” he continues. “Pemiscot County takes him and dumps him back over in Blytheville. They call an ambulance and the ambulance brings him over here and puts him in this hospital.”

Resources are pretty sparse down here in the Bootheel. No single town has every service to meet the homeless community’s needs. The apartments at Safe Haven in Kennett where Anthony works, for example, are permanent beds for the chronically homeless. The nearest emergency shelters are either in Blytheville, Ark., and Paragould, Ark., both about 30 miles away.

And the closest shelter that’s still in Missouri is in Poplar Bluff, about 45 miles to the north. Homeless individuals are often transported between communities for their various needs. But because everyone down here is already strained for resources, this leads to the type of “not in my back yard” disputes Sheriff Holder is describing.

And both men agree those resources have been strained even more ever since the state’s mental health center up in Farmington, Mo., shut down its involuntary psychiatric care services back in 2010.

“When they closed Farmington,” Sheriff Holder says, “that was a big mistake.”

“There is nowhere to house these individuals. We were able to take on six of them in Pemiscot County at our facility, but there’s just a number of those individuals wandering around the community. They were there for a reason.”

“There are just a number of those individuals wandering around the community.” — Anthony Smith

Anthony leaves a stack of point-in-time count surveys with the sheriff and says goodbye.

“If you run into some problems let me know,” Sheriff Holder tells him, “and be careful.

Anthony and Emily head back to the van.

The crew is equipped with all the tools they need for this count: flashlights, bottles of water, warm blankets, even an emergency radio. But perhaps none is more important than these surveys.

The pont-in-time count happens one day a year in Missouri, this year’s date is January 28th. In every county in the state, teams like this one are responsible for filling out a survey for every person in their area who has no place to sleep for the night.

The questions are pretty basic: What is the individual’s living situation? What’s their reason for being homeless? How old are they? What’s their race and ethnicity? Are they a veteran? Any medical conditions?

The surveys are sent to the Missouri Housing Development Commission, which compiles the data and sends it to the U.S. Department of Housing and Urban Development (HUD). The count is actually required by HUD to help track each state’s progress toward ending homelessness.

The point-in-time crew look for a dog hiding in the basement of an abandoned motel.

The data is also used as a planning tool by both the state commission and by HUD — which is government speak for deciding where money gets spent.

Back in the minivan, the next stop, and one of the most exciting, is a wooded area behind the local Wal-Mart. There is a trail back here and the whole point-in-time crew pushes through the overgrowth looking for any signs a homeless person has been sleeping here. Lisa doesn’t see any.

“Haven’t been back here in a while,” she says pointing to the brush. “It’s grown up.”

As she’s talking, Anthony breaks through to the other side.

“I don’t see any signs of anyone inhabiting over here,” he says.

Emily pops out of the brush and into the grassy corridor where Anthony is standing.

“Well this is a nice hide out,” she says.

They find some empty beer bottles and coffee cups, but they all agree if someone does sleep here, they’ve probably already found a warm place to wait out the day. Back to the minivan.

Michael Wilson is a resident of Safe Haven in Kennett, Mo.

They make many more stops throughout the morning, mostly passing out surveys to other agencies that might encounter homeless people. Kennett Headstart, for example, as well as some faith-based assistance organizations and a non-profit that assists migrant farm workers with housing.

But the first homeless person they encounter all morning is Michael Wilson, a resident they see back at Safe Haven when they break for lunch. The story of how Michael wound up here helps explain why.

“I’ve done a lot of house hopping, you know, from friends and family,” he says while sitting at a table in the common area.

“But you know, being an alcoholic,” he adds, “they’re not welcoming, you know? Because nobody wants somebody like that around. Especially if they have kids.”

During last year’s point-in-time count, only 11 “unsheltered” homeless people were counted in Dunklin County. HUD’s definition of unsheltered homeless doesn’t include people like Michael who find temporary shelter. The “sheltered” make up the majority of the homeless down here. At 22, there were twice as many sheltered homeless counted in Dunklin last year as there were unsheltered.

It’s a lot harder to count people who have a temporary place to sleep, but those individuals still have a need for services. And Anthony says that underscores the importance of the point-in-time count.

“Our situation is more cumbersome,” he says, sitting behind his desk at Safe Haven.

“We have to do a lot more due diligence to ensure that individuals see that we have a homeless issues here in these small communities.”

The team eats at the Chinese buffet next to the Wal-Mart, before quickly heading back out. There’s a lot of ground to cover today and they’ve only barely left Kennett.

The next week, after all the surveys were collected, the unofficial count was 11 unsheltered individuals and 35 sheltered.

An abandoned gin in Kennett, Mo. Before the gin was fenced up, it was a congregating spot for homeless individuals.

Originally published at digital.kbia.org on March 20, 2015.

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