For Cindy Herford, the wife of a medical student, walking into the local welfare office and signing up for food stamps was not easy.

"That was an ego blow," said Herford, whose husband is entering his second year at the Pikeville College School of Osteopathic Medicine. "I was embarrassed."

But she took comfort in knowing that others were in the same situation at the medical school, which draws many of its students from chronically poor central Appalachia and strives to send its graduates back to the same region.

"We have a high percentage of students who are poor," said the school's dean, John Strosnider. "We try to offer them every opportunity that is legal and available to help ease the financial strain of medical school."

Because of the private nature of welfare programs, no one at the medical school knows how many students are on welfare. Estimates range from as little as 10 percent by the administration to more than 50 percent by an auxiliary group. That group also estimates that 80 percent to 90 percent of the nontraditional students at the school are on food stamps, and it even distributed informational packets to reassure incoming students they should not be ashamed if they need them.

"Most of the med students are on food stamps," the literature reads. "It's just for a short time and it really helps out. So go for it."

Still, the Association of American Medical Colleges says the widespread welfare present at Pikeville is rare at other medical schools.

Robert F. Sabalis, the organization's associate vice president for student affairs, said the vast majority of medical students across the country pay their way "through a combination of federal and private educational loans, scholarships and grants, spousal employment, family support, and a frugal lifestyle."

Strosnider said the medical school's mission is to increase the number of primary care physicians in central Appalachia. That means students who are residents of impoverished central Appalachia are recruited heavily. Often, Strosnider said, they are the sons and daughters of coal miners and may be the first person in their families to attend college.

"These kids are not driving Cadillacs," he said.

Citing privacy issues, the medical school declined to identify students who enrolled in government welfare programs. But Strosnider acknowledged that some Pikeville medical students, especially nontraditional students with children, receive benefits such as food stamps or government-subsidized housing.

Pikeville medical student Mike Garrett said many of his classmates are on tight budgets, living on loans to cover living expenses and the $28,000 a year in tuition. He said those who qualify should not be begrudged government benefits.

"The public might think that all medical school students are rich, but that's not necessarily true," said Debby Murphy, adviser to the student auxiliary that distributed the informational packet. "Some are struggling to make ends meet."

The informational packet sent to students contains addresses of local schools, day-care centers and banks. It also gives the addresses and phone numbers for the local housing authority, where students can apply for housing assistance, and the local welfare office, where they can apply for food stamps and Medicaid for children.

The Pikeville medical school was established in 1996 with $10 million from private corporate and government donors. Its goal from the start was to address medically underserved central Appalachia, which despite a push to recruit doctors still has just one primary care physician for every 1,200 people. That falls far short of the standard in urban areas of one for every 900 people.

The ratio is even lower in the region's most economically distressed counties. For example, Owsley County, with 4,800 residents, has only two doctors.

The first group of 40 homegrown physicians produced by the school opened offices throughout the mountain region last year. An additional 50 will finish residency programs next month and begin new practices.

There are 270 students enrolled at the Pikeville school, with 180 more now going through three-year residency programs in osteopathic medicine, which places a special emphasis on the interrelationship of organs and body systems. Osteopaths undergo training similar to that of medical doctors, and like MDs, can prescribe drugs and perform surgeries.

Garrett said medical students spend their weekdays in the classroom and have to spend their evenings and weekends studying. That, he said, leaves no time for jobs to support themselves and their families.

Baron Herford, a Texas native, is the son of a mechanic and was the first in his family to graduate from college. He worked 15 years as a respiratory therapist in Atlanta before enrolling in medical school. He and his wife have two sons, ages 7 and 3.

They receive loans to cover the cost of tuition and rent on their small apartment in the central Appalachian town that is home to the medical school. Those loans, Cindy Herford said, are not enough to cover food for a family of four.

"It has been a financial struggle," she said.

Even so, the decision to apply for the food stamp program was a difficult one. She said one of the staffers in the welfare office eased her trepidation by telling her that everyone needs a helping hand sometime.

"We have gotten over the 'Oh, I'm so embarrassed,' " she said. "We are doing something here to make a better life not just for ourselves and our children but for the community we serve after medical school."

Baron Herford, a medical student, and his wife, Cindy, rely on food stamps to feed their family of four. Herford gave up his job as a respiratory therapist to attend the Pikeville College School of Osteopathic Medicine.