Serving and Learning in Appalachia

About 120 miles north of Knoxville, just across the Kentucky line, is Clay County, a community of people who possess a fierce love of heritage and family, an unshakable pride in the land, and a deep belief in God. However, it is also a place of extreme poverty where, in some of the rural areas, 64 percent of the water source is contaminated and the county ranks near the bottom of the state’s counties for major health indicators.

It is here that UT faculty, staff, and students have been working alongside community partners to improve the county’s wellness and disaster readiness through practical and innovative methods. The Appalachia Community Health and Disaster Readiness Project—led by the UT Global Disaster Nursing graduate program—is also giving students the opportunity to learn through service and gain hands-on real-world experience in improving the lives of others and helping to bring about meaningful change.


A bridge leading to homes on the other side of a creek suffered damage in recent floods.

The interdisciplinary project combines the expertise of faculty and students from the College of Nursing, the College of Architecture and Design, the Department of Civil and Environmental Engineering, and the Law Enforcement Innovation Center to address Clay County’s needs.

“This is a much more holistic approach to solving community issues when dealing with water, sanitation, housing, disaster preparedness, and communication,” says Tracy Nolan, a registered nurse and director of community outreach at Red Bird Mission, one of the project’s partners and an agency that has been ministering in that region of Appalachia since 1921. “Having architects, nurses, law enforcement personnel, and civil and environmental engineers at the table opens up new opportunities to solve problems in ways never before explored.”

The three-year, $1.5 million project, which began in fall 2013, is funded by the US Department of Health and Human Services Health Resources and Services administration.

A year into the project, students and faculty have listened to the concerns of Clay County residents; taught classes on winterizing homes; offered winter safety education, including distribution and use of carbon monoxide monitors based on the type of heating sources many families use; conducted health surveys; assessed damage caused by severe flooding; trained hospital officials on basic and advanced disaster life support; and developed prototypes for homes. Program coordinators are seeking other grants that will fund water and sanitation projects, construction, and implementation of other solutions to health and preparedness challenges.


Illustration by Haley Allen (’14) and Marion Forbes (’14), both of whom worked with the Appalachia Project as architecture students.

“After our research team leaves, I would like to see the community put into action some of the solutions we’re offering and carry those out themselves,” says Stasia Ruskie, a doctoral student in the Global Disaster Nursing program. “That way, they’re empowered to take over and better their own community.”

A Good Partnership

UT’s relationship with Clay County was established years ago when nursing students, through a partnership with Red Bird Mission, began practicums to gain experience in community and public health nursing. It paved the way for collaboration  on the current Appalachia Project.

As part of the grant, Susan Speraw—research professor,  director of the Global Disaster Nursing program, and the  project’s principal investigator—secured commitments from  the Red Bird Mission and David Watson, executive director of Manchester Memorial Hospital and director of Emergency Management Services for the county. Their support was critical in the project’s success and facilitated building relationships with the residents.

“It took time for the residents to get to know us, gauge our sincerity and commitment to them, and feel comfortable that  we understood their community and weren’t going to violate their trust,” Speraw says. “From our partners, we heard reports of universities that have come into the area in the past,  conducted research, collected data, and left nothing beneficial  in their wake. It was clear the community’s experiences with universities in the past have not been positive. Our intention is to fulfill our promises.”

As part of the project, faculty and students have taken on the entire community as the client and are looking for ways to address the challenges on a countywide basis. Many residents live in isolated hollows tucked away in steep mountains. There is practically no cell phone coverage, which makes communication difficult. Lack of infrastructure translates into nonexistent septic systems or sewer lines, so many residents straight-pipe raw sewage into streams and creeks. Leaky pipes contribute to the growth of interior mold, which compounds lung problems such as asthma and black lung, which stems from years of working in coal mines. A major flood in spring 2013 severely damaged foundations and compromised the safety of homes.

This past fall and spring, students and faculty made numerous trips to Clay County to become more familiar with the  area and to learn from residents and community partners. In architecture studio classes, students immersed themselves in Appalachian history and culture. “Without first learning about their history and what’s important to them, you couldn’t successfully design for them,” says Holly Harris, a fifth-year undergraduate architecture student.

Designing for a flood-prone area was unexpected because it’s not a condition students typically have to tackle, says Steven Whitmore, a Master of Architecture student.

“If I had to deal with that in a real-world context and I hadn’t had this experience, I wouldn’t know what to do,” he says. “We struggled, and when you struggle with being in an uncomfortable position, you’re going to learn a lot.”

Whitmore added that collaborating with students from other disciplines was a tough but rewarding challenge. “In architecture, we have our own language,” he says. “But once you’re working with others, you have to change that and learn how to effectively communicate your ideas.”

Participating in the Appalachia Project has required laying down the idea that one person or entity can solve Clay County’s challenges, says Lauren Oppizzi, a second-year student in the Global Disaster Nursing program. “We all are drawing from each other’s strengths and we’re able to show that collaboration is a very valuable skill,” she says.


In the spring, senior engineering students met with local officials and toured the community’s existing dam to understand water supply issues. They subsequently developed a preliminary design and cost estimate for an extensive new water reservoir to serve the entire county. Clay County officials will use the students’ report as a talking point when they meet with their federal representatives to seek assistance for a project that is likely several years away, says John Schwartz, associate professor in the Department of Civil Engineering.

“Interacting with public officials was a great experience for students because it gave them a sense of how real this is,” Schwartz says. “In senior design, project outcomes typically are not used for public service. But this is actually something people are going to use.”

This fall, nursing, architecture, and engineering students will embark on a smaller project to design and build a water kiosk at Red Bird Mission. Rural community members can fill up and then take the clean water back home, Schwartz says.

The Law Enforcement Innovation Center, based in UT’s Institute for Public Service, is working with Clay County law enforcement and first responders to review response plans, provide disaster planning training, and discuss acquiring technology, vehicles, and communications equipment—such as radios and cell phone towers—to create a more effective response during critical incidents, says Don Green, the center’s executive director.

The Appalachia Project is in discussions with the Red Bird Volunteer Fire Department about the prospect of building an addition to the fire station for a training center as well as bays to park additional trucks to aid in quicker response times, says John McRae, a professor of architecture. The design will take place in the fall. The project will apply for a grant from the rural development division of the US Department of Agriculture to cover the cost of the addition.

McRae envisions solutions that come out of the Appalachia Project during the next few years will become a model of interprofessional practice that can help other rural communities improve their quality of life and prepare for disasters and other large-scale public health emergencies.

Beyond being better prepared for emergencies, Speraw  would like to see some of the county’s challenges addressed through policy changes. UT faculty will also apply lessons learned in Clay County to the training of disaster professionals, allowing them to more effectively deal with what they might encounter in rural communities.

“I’d like to see us as a university disseminate crucial messages about the needs of families in disaster, which would allow the voice of the people in these areas to be heard in a way that is more powerful at a policy level,” Speraw says.

When the Appalachia Project concludes, participants  anticipate results will include a strong disaster preparedness plan, improved homes, clean water access and septic solutions, and, most importantly, a safer and healthier community.

“I am humbled and grateful to UT for choosing to work  with Red Bird Mission and the Clay County community, for seeing the strength and worth in our people, and believing they can work with us to empower us to bring sustainable positive change,” Nolan says. “UT’s team of professionals and students give all of themselves, offering up their unique skills and knowledge, and honor our community through their respectful, compassionate engagement.”

For more information about the Appalachia Project or to find out how you can help, contact Susan Speraw at or 865-974-7586.

Illustration by Haley Allen (’14) and Marion Forbes (’14)

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Dan August 19, 2014 - 8:05 pm

As great as it is that UT is reaching out to help the less fortunate, shouldn’t it be a TENNESSEE county that we are helping?

Lisa August 20, 2014 - 3:19 pm

I’m so proud of this interdisciplinary work UT is doing to assist people of Appalachia. We can all learn from these projects and see how valuable it is to work across disciplines as a team to address these important issues. GO VOLS!

Elizabeth September 7, 2014 - 3:25 pm

What a beautiful story that demonstrates the power and impact of community-engaged scholarship! Asset-based, respectful, and effective problem-solving in the community not only crosses traditional disciplinary boundaries, but crosses traditional boundaries of the academy, as well.

Brenda September 13, 2014 - 2:00 pm

I live in Clay County and involved in several groups that are right now trying to improve our county and I have never heard of this program. I would like to know more about what they have done and through what officials?

Cassandra Sproles September 15, 2014 - 12:45 pm

Currently, the UT group is working with Red Bird Mission and community partners like the Emergency Management Services for the county. You can find out more at or by calling project director Susan Speraw at or 865-974-7586.

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