On Jan. 30, the Summers County Health Department had 13 cents in the bank. So the four-person agency in Hinton, W.Va., decided to do what any group of impoverished people might do: Apply for foreign aid.
Out went letters to the Soviet Union, Britain, France and the World Health Organization. There's still no word on what other developed countries might do for the patch of Appalachia, but the small-town health department's bravado has focused a spotlight on problems in the U.S. public health system and generated enough private donations -- $17,000 -- to allow the county's medical services to continue for another year.
"All the public health departments are in tatters," said Stephen D. Trail, a sanitation specialist and spokesman for the county health department. "I figured, hey, we're citizens of the world, too, and there's no difference between a baby dying in Appalachia than in Ethiopia or India."
Over the past three years, local budget problems have crippled health care in Summers County, located 100 miles southeast of Charleston, which ranks third highest in the state for heart disease and fetal death, fourth highest for breast cancer and No. 1 for deaths caused by chronic pulmonary disease.
Major companies have left the community, sapping its tax base. Once benefiting from $20,000 a year in county and school tax revenues plus state money, the one-building health department now survives on state funds alone -- $5,000 a month -- to serve its population of 15,000.
In February, budget shortfalls meant the four-member staff of the health department -- Trail plus one nurse, one part-time doctor and a clerk -- were paid late. Clinics for diabetes, high blood pressure and gynecological exam smears had to be discontinued. Bills mounted to nearly $14,000. And the utility company sent a service cut-off notice.
The staff reacted first by appealing to the county commission and then writing to the state health department, the U.S. Public Health Service, even President Bush. Each referred them back down the chain of command. The state, in a timely letter, advised them to "seek novel avenues of funding."
"They used the word 'novel,' and that just seemed a bureaucratic way of getting rid of us," Trail said. "We thought about it, and our conditions here are as bad as any Third World nation. So we figured why not go after the same aid they do?"
The letters were sent to countries Trail considered the most powerful and the most receptive to their request. The one appealing to former Soviet Ambassador Yuri Dubinin describes Summers County as a "small rural county" that has "Third World poverty associated with First World technology."
"We realize that your nation only gives foreign aid to Third World organizations," the letter to Dubinin says, ". . . but nevertheless our people exist and suffer as do others in the world.
"We will not bore you with all our immediate problems, but we are desperately seeking monies . . . we have with great regret been unable to acquire sufficient monies within our nation to take care of only our basic needs," the letter continued.
Trail said he has yet to get any funds from the countries. Media coverage of his request, however, has drawn free supplies from medical companies as well as private gifts.
Joan Kenny, director of the Division of Local Health with the state Bureau of Public Health, said she was surprised when she first heard of Trail's approach but is not inclined to do anything to squelch his complaint.
"I'm in a rage as it is over how public health is treated in this country," she said. "Our funds are down to the bone. We have women and children, we have babies, we have public health matters that need to be addressed in this country, and we still haven't made this a priority.
"I can see the plus in what Steve's doing. When he raises consciousness, when he raises public concern, we all benefit," Kenny said.
Full services at the Summers County Health Department resumed in March.
Meanwhile, the agency has begun exploring ways to generate revenues for the next year, such as charging its patients for some services that now are free.
Whether that will be enough to continue services is still anybody's guess, said Trail, who has worked for 21 years in the county health department.
"We as a nation send millions to Panama and Nicaragua, and we can't get $20,000 for our babies here?" he said. "It's a crime."