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States boosting flood prevention efforts
Damage costs from floodwaters soar

JEFFERSON CITY, Mo. — After devastating flooding this year, Iowa put $15 million into a special fund to help local governments recover and guard against future floods. Missouri allotted more money to fight rising waters, including $2 million to help buy a moveable floodwall for a historic Mississippi River town that's faced flooding in all but one of the past 20 years.

In Arkansas, Gov. Asa Hutchinson announced $10 million to repair damaged levees while creating a task force to study a system that in some places has fallen into disrepair.

The states' efforts may turn out to be only down payments on what is shaping up as a long-term battle against floods, which are forecast to become more frequent and destructive as global temperatures rise.

"What is going on in the country right now is that we are having basically an awakening to the necessity and importance of waterway infrastructure," said Arkansas state Sen. Jason Rapert, a Republican who has been pushing to improve the state's levees.

The movement is motivated not just by this year's major floods in the Midwest, but by more than a decade of repeated flooding from intense storms

such as Hurricane Harvey, which dumped 60 inches of rain on southeastern Texas in 2017. In November, Texas voters will decide whether to create a constitutionally dedicated fund for flood-control projects, jump-started with $793 million from state savings.

For years, states have relied heavily on the Federal Emergency Management Agency to pay the bulk of recovery efforts for damaged public infrastructure. While that remains the case, more states have been debating ways to supplement federal dollars with their own money dedicated not just to rebuilding but also to avoiding future flood damage.

Although President Donald Trump has expressed doubt about climate change, even calling it a hoax, a National Climate Assessment released last year by the White House warned that natural disasters in the U.S. are worsening because of global warming. The report cited a growing frequency and intensity of storms, heat waves, droughts and rising sea levels.

Preliminary assessments compiled by The Associated Press have identified about $1.2 billion in damage to roads, bridges, buildings, utilities and other public infrastructure in 23 states from the floods, storms and tornadoes that occurred during the first half of 2019. Those states also have incurred costs of more than $170 million in emergency response efforts and debris cleanup.

In addition, an AP survey of U.S. Army Corps of Engineers districts found that this year's floodwaters breached levees in about 250 locations in Arkansas, Illinois, Iowa, Kansas, Missouri and Nebraska. The Army Corps estimates that levee repairs could top $1 billion in the Missouri River basin, where most of the breaches occurred.

The AP's research shows that Nebraska was one of the hardest hit states, with a preliminary assessment of about $435 million in damage to roads, bridges, utilities and other public infrastructure from a March storm. Rain fell on a still frozen terrain, causing a sudden snow melt that sent huge chunks of ice barreling down swollen rivers.

Nebraska has a regional network of Natural Resource Districts that could direct local money toward flood protection. Like most states, it also budgets money to pay the state's share of FEMA disaster recovery projects, and the state plans to hire a contractor to help develop a long-term recovery plan.

But until now, the state has not had a coordinated strategy for taking steps to reduce flooding risks, said Bryan Tuma, who leads the daily operations of the Nebraska Emergency Management Agency.

Only a few Midwestern states have pumped much of their own money into flood prevention.

Minnesota created a grant program in 1987 that has since awarded almost $525 million to local projects.

After extensive flooding in 2011, Iowa launched a unique program that lets local governments keep a portion of their growth in state sales tax revenue to help finance levees, floodwalls other projects designed to hold back rising waters. The state expects to forgo nearly $600 million of revenue over 20 years to help pay for nearly $1.4 billion of projects in 10 cities. But applications for that program closed several years ago, leading Iowa legislators this year to put $15 million into a separate fund to pay for flood prevention and recovery.

Governors in Missouri and Arkansas both have appointed task forces to examine levee systems. The Missouri budget also includes $2 million for a moveable floodwall in Clarksville, a rural community of about 450 with a 19th century downtown that has been fighting an annual battle against the Mississippi River.

In Arkansas, Rapert began pursuing better levee policies four years ago, after flooding on his farmland along the Arkansas River.

The lawmaker discovered that the nearby levee hadn't been repaired after a 1990 breach and that its governing board was defunct. So he sponsored a law allowing local officials to re-establish dormant levee boards and requiring annual reports to be sent to the state. Although Rapert's local levee got fixed, he said most of the districts haven't filed reports, raising questions about whether their levees are being maintained.

"Until there's a flood, nobody really cares about levees. But when there's a flood, everybody's worried about them," said Jason Trantina, a farmer and convenience store owner near Conway, Arkansas, who was appointed president of Rapert's local levee district when it was re-formed.

Jewel City Kickball gets ready for HFD tournament

HUNTINGTON — For a decade now, the Jewel City Kickball league has been blowing off steam by turning the schoolyard favorite into an adults-only event.

Sunday, while many probably worked off the craft brew calories from Saturday's Rails and Ales, the league hosted five games in a tournament.

The league is preparing for a fundraising event for the Huntington Fire Department later this month. At 6 p.m. Friday, Aug. 23, pickup games of kickball will begin to allow players to become familiar with gameplay and the rules. Then at 9 a.m. Saturday, Aug. 24, the tournament begins. The tournament takes place at Ritter Park where the old Olympic Pool was located.

To register for the 2019 Local 289 Huntington Fire Department kickball tournament, visit by Monday, Aug. 19. Cost is $20 per player, and you must be 21 or older. Players can register the day of the tournament, but they will not get a T-shirt.

Medical schools try to sell rural life
Institutions are touting benefits of Appalachia to boost workforce

BRISTOL, Va. — On a field trip to the Birthplace of Country Music Museum, Ashish Bibireddy put on headphones and scrolled through a jukebox of music from an influential 1927 recording session.

Bibireddy and nine other medical students had already been biking and rafting on their visit to rural Appalachia organized by a nearby medical college. But it wasn't just casual sightseeing; the tour was part of a concerted effort to attract a new generation of doctors to rural areas struggling with health care shortages.

The Quillen College of Medicine at East Tennessee State University is among a small group of medical schools across the U.S. with programs dedicated to bolstering the number of primary care doctors in rural communities.

The schools send students to live in small towns and train with rural doctors. Like Quillen, some also organize outings and cultural experiences to try to sell students on living there after they graduate.

Schools have taken students to a ranch to brand cattle, brought in an Appalachian story teller and catered local delicacies to show students who may have never lived without the convenience of a Starbucks or Target what rural life offers.

"It's a little sense of what the fun part of rural life can be," said Dr. Dana King, chair of the family medicine department at West Virginia University School of Medicine, where students in the rural track go to a ski resort, visit a coal mine and go whitewater rafting.

At the University of Colorado School of Medicine, students can meet with the mayor, police chief or other leaders of rural communities and interview residents to learn about the town.

"We want to give the students an idea about what goes into the workings of a small community," said Dr. Mark Deutchman, director of the school's rural track.

Jennifer Plymale, director of the Center for Rural Health at Marshall University, said a large goal of Marshall's Joan C. Edwards School of Medicine is recruiting from rural communities. Plymale said she and her colleagues travel to different high schools throughout the state of West Vir-

ginia to encourage and teach students, no matter where they're from, about attending Marshall's School of Medicine.

"The first step is if you want to get students to go back to their rural communities to practice, you've got to get them to college," Plymale said. "A lot of these students that are coming out of these rural communities, they want to go back and serve their community."

Marshall's medical school offers a Rural Scholars program, which allows students to participate if they agree to practice in rural communities once their residency is complete.

"We take fourth year medical students, they do rural rotations, they do rural research, they're required to come in and participate in monthly meetings," Plymale said. "We allocate dollars for students who agree to once they finish their residency to work in rural communities. For every $25,000 we give them, we require them to work a year in a rural community, and they're eligible up to about $50,000."

Marshall medical students have the opportunity to conduct research in rural areas as well. Former students have conducted research on obesity and vaping, and it is all sponsored by the Center for Rural Health.

"They're not sitting at the medical school doing the research, they're in the communities," Plymale said.

Most of the more than 7,000 facilities, population groups and areas in the U.S. facing a shortage of primary care physicians — often a patient's first point of contact for treatment — are rural, according to the U.S. Department of Health and Human Services. They need nearly 4,000 additional physicians to close the gap.

Most of the students who came to Quillen did not grow up or attend school in rural areas, but all expressed an interest in working with underserved populations, rural programs coordinator Carolyn Sliger said.

The students spent three weeks with doctors in rural towns in eastern Tennessee and a week in June exploring the region. After the museum tour, they visited a war memorial with an eternal flame and hulking U.S. military attack helicopter. The group then headed to a rooftop bar overlooking Bristol, where the brick-lined main street straddles the Virginia-Tennessee state line.

Bibireddy, 23, grew up in Edison, New Jersey, outside New York City, and attended the University of Central Florida medical college in Orlando. He never lived in a rural area but was impressed with what he saw of Appalachian life during the visit.

"The people here are genuinely caring," he said.

He was inclined to work in a rural area after medical school but acknowledged that building relationships with a community as an outsider would be difficult.

Jason Soong, another medical student in the program, said he has "always known" that he wanted to live in a sparsely populated place with open space. Soong, 23, grew up in a Philadelphia suburb and attended California Northstate University College of Medicine outside Sacramento.

"Living out in a rural area, you can just go outside your door, and you have nature right there," Soong said.

Katherine Schaffer and a few other students ended their day in Bristol around a patio table at a stylish downtown bakery.

Schaffer, 27, said she was excited to meet people who shared her interest in rural practice. Her medical school friends in Norfolk, Virginia, want to work in cities as specialists and worry they wouldn't have a social life in a small town, she said.

"I think it's very difficult in my medical school to find like-minded people," she told the group.

Administrators of rural track medical school programs say their graduates go into rural practice at considerably higher rates than other doctors. But many of those students are already inclined to practice in a rural area, so the figures may exaggerate the programs' success, said Dr. Randall Longenecker, associate project director for the Collaborative for Rural Primary care, Research, Education and Practice.

"We skim the cream off the top," said Longenecker, whose research has documented 39 accredited colleges of medicine and colleges of osteopathic medicine that have clearly delineated rural training tracks — about a fifth of U.S. medical schools.

For students from small towns, the programs can help maintain their enthusiasm for rural life, said Dr. Joseph Florence, director of rural programs at Quillen.

Florence said big city medical programs push students to become specialists and avoid primary care.

"They beat rural out of you by the time you leave," he said. The rural track programs, on the other hand, give the students "a place to be rural and not only be accepted but be appreciated for it," he said.

Dr. Darrin Nichols, 28, said the rural track program at West Virginia University School of Medicine confirmed his choice to practice near the West Virginia town of roughly 800 people where he grew up. He was struck by the camaraderie of coal miners he met during a trip organized by the school and said it reminded him of his own tight family bonds.

"I always wanted to stay near my family and practice in a community that had those types of relationships," he said.