The city of Crab Orchard is a couple of streets tucked into a Tennessee hillside, in the shadow of Big Rock Mountain.
In early May, the Appalachian hills outside town are grassy meadows, bursting with color and life: wildflowers, bumbling honeybees, and darting ruby-throated hummingbirds. Further on, sandstone bluffs jut from dark pine forests on the slopes of the Cumberland Mountains.
Crab Orchard sits in a gap between those mountains. The town began as a way station for travelers: A roadside inn, and then a tavern, and eventually a mine. An interstate now bisects the community. Most people who come to Crab Orchard are just passing through.
The few hundred people who call this place home are often unemployed or underemployed, and are frequently poor. They face insufficient housing, healthcare, education, and opportunity.
By some estimates, the median household income around Crab Orchard is less than half the national average. And rural Tennessee is among the places hit hardest by the country’s opioid epidemic: In 2019, Tennessee providers wrote 74.6 opioid prescriptions for every 100 people in the state, the third-highest opioid prescription rate in the country.
Those challenges mean Crab Orchard is a place to love Jesus Christ by loving the poor, Sister Mary Lisa Renfer, RSM, tells me.
The people of the Appalachian region, which stretches from Georgia all the way to New York state, are usually reduced in the American popular imagination to stereotypes and punchlines.
But the people of Crab Orchard are men and women made in the image of God, Sr. Mary Lisa reminds me, and like all of us, cherished sons and daughters of a loving Father. They ought to be treated as such.
That’s why the Religious Sisters of Mercy of Alma come to Crab Orchard, with doctors and nurses joining them. They come in a mobile medical clinic, to treat chronic illnesses or long-festering wounds for patients without insurance or the money for a doctor.
But the sisters and volunteers also come to love.
“We’re really here to serve. And our patients have dignity just because of who they are as children of God,” Sr. Mary Lisa tells me.
“Nobody comes to this clinic without having some significant suffering in their life,” she adds.
“We have a unique opportunity when we minister to our patients, when we show them love and respect. That's the picture that they get of the Church, and of the Lord's love. And so our work is definitely an opportunity for evangelization that way, just through the actions of what we're doing.”
“Our new patients, when they first come in, often they haven’t received medical care for years — and they’ve been treated as ‘less than,’ over and over, again and again. So it starts with hospitality, and how we greet and receive people, and being there for our patients, not in a judgmental way. And just letting them know that we are really here to serve them.”
“And that’s our biggest goal in what we do here.”
Sr. Mary Lisa is a physician, and the medical director of St. Mary’s Legacy Mobile Medical Clinic.
The clinic is a converted touring bus. Inside are exam rooms, lab equipment, and a nurses’ station. It comes to Crab Orchard twice a month, and every month visits six other rural cities in the Eastern Tennessee Diocese of Knoxville. The clinic sees more than 100 patients across the state each month.
The mobile clinic is supported primarily through a fund begun with proceeds from the 2011 sale of St. Mary’s Health, a local Catholic hospital sold to a for-profit health system.
The sisters and volunteers offer primary medical care, prescriptions, and referrals to any patient without health insurance. The clinic does not prescribe contraceptives, or, owing to the opioid epidemic in the region, narcotics. Knoxville’s Bishop Rick Stika tells me he hopes to eventually fund a dental clinic for the project.
On the day I visit, the clinic is parked outside Crab Orchard Christian Church, the project’s local partner. Volunteers sit in rocking chairs on the church porch to welcome the clinic’s patients, and point them to the restroom, if it’s needed.
In a squat cinderblock building just outside the clinic, a novice sister, Sister Joan Miriam, RSM, makes appointments and keeps files straight, while volunteer nurses triage patients before their appointments.
Those nurses, drinking coffee and catching up with each other, tell me they check blood pressure and heart rate, take medical histories, and make sure patients don’t have a condition so immediate it would require an ambulance.
On a clinic Tuesday in Crab Orchard, one volunteer nurse practitioner, now retired from full-time nursing, tells me she likes helping out with the clinic. She sees friends, keeps her nursing skills sharp, and stays up on requirements to keep her license intact.
And she likes knowing that she’s helping the clinic’s patients: local people, she says, mostly employed but without insurance. She tells me patients come to the clinic for help with chronic conditions or medication management, for the kinds of things anyone might see a doctor about.
The clinic aims to be the long-term primary care center for its patients, to build lasting relationships of trust. Some of the clinic’s earliest patients, who first were seen in 2014, are still coming regularly to see a doctor.
“Building that relationship is so important,” Sr. Mary Lisa tells me between appointments with patients.
“I can give people medications left and right, but if everything is messy in their family life or they’re in a horrible situation, they’re not going to take it. Or they’re not going to come back. So this relationship is giving them a safe place where they can come and we can help them with other resources too, and then, [if a patient isn’t taking medication as prescribed or has put off seeing the doctor], helping them to know that it’s ok, that life is crazy sometimes.”
Sr. Mary Lisa says she talks with patients often who are suffering.
“We had a new patient a few weeks ago, and...she had worked her whole life and then she had several injuries in a row. So she lost her job and then she wasn’t able to really move around much anymore. So she was at home by herself all the time.”
“Her family kind of lost touch, and so she attempted suicide. But her gun misfired.”
The patient was referred to the medical clinic from a mental health center in the area.
“Just being able to tell her: ‘You know, the Lord clearly wanted you here.’ That really changed her whole perspective, to have that moment,” Sr. Mary Lisa tells me.
“And we saw in her the change of realizing that she doesn’t have to fall into despair — that there is hope. Just giving them the spark of hope. For us, that moment was incredible.”
Sr. Mary Lisa tells me that when she talks with patients in pain, she emphasizes especially the interior life, and the redemptive power of suffering.
“People who go around with chronic pain: It's exhausting and it's real. And I think recognizing that and talking to them about it is helpful — recognizing the reality that, yes, this is difficult, this is hard.”
“You're never going to totally fix that chronic pain. And so it's saying that out loud [helps]. I think we're often scared to say things like that out loud. Sometimes we don't want to tell people something's not going to go away or not going to get better, but we have to be honest.”
“And then we can talk about accepting that. And then helping from a human perspective. What kind of support system do you have and how do you get through every day and what kind of things can help you? And that's really how I approach pain management — how is this affecting you as a person?”
Sister Joan Miriam, RSM, is a second-year novice in the Religious Sisters of Mercy. She’s been working as a scheduler with the clinic for less than a year.
Like a good religious novice, Sister Joan Miriam wanted to be obedient to her superior. She told me — probably 10 times — that she needed permission from her superior before talking to a reporter. Once she got the okay, Sister Joan Miriam told me her experience at the clinic has become a source of hope in her own vocation to religious life.
“Honestly, the witness of our patients, and just working with our staff, it puts things in perspective. To see the hardships that our patients face, but also to see the joy that they have. To know that we all face hardships, but to give that to the Lord. And then to be able to pray for our patients — to bring them to prayer, which is our main vocation always,” Sr. Joan Miriam told me.
“And then — we want to respect the dignity that is inherent in each of our patients. We’ve had patients referred from the health department who say that the health department didn’t treat them well — or treat them as a person.”
“Not that other providers aren’t good — but there’s a personal aspect that we try to bring to each of our patients, and a wholesomeness — not just caring for our patients physically, but spiritually.”
Sr. Mary Lisa, too, tells me that the spiritual life is central to the clinic’s work.
“The gift of our life is that our horarium and schedule of prayer really keeps us centered.”
“And no matter how crazy things are when you go out, when you come back to the convent, you come to that life of prayer and you’re able to receive the Eucharist.”
“And then you have the common life to really ground you, talking to all the sisters. And so that, we know, is first in our life. And so those things are huge helps. I think the gift of obedience and being in good communication with your superiors is also a gift that we have, one that not everybody has, because we know that what we’re doing, we can trust it if we’re going forward in obedience.”
“I think for any Catholic who's active in the world, it's, you know, where are you centered? And are you recollected interiorly?”
“And so when you notice that you're all moving around, like crazy on the inside, you have to say, ‘Okay, where am I?’ And then you have to go back to the Lord.”
Soon after she finishes her day in Crab Orchard, and brings her patients to prayer before the Lord, Sister Mary Lisa, with Sister Joan Miriam and the doctors and nurses who help them, will pile back into their mobile medical clinic.
They’ll drive to another town tucked in Tennessee’s Appalachian hills, and they’ll hear the same call to love Jesus Christ in the faces, and bodies, and hearts of the poor.