By Reid Forgrave
Enquirer staff writer

Peggy Haley, RN, checks Cynthia Spina's blood pressure at the Lynchburg office. High blood pressure often goes undiagnosed and untreated in the area.

LYNCHBURG - Sixty-four-year-old Emmanuel Rinckhoff, hobbling from arthritis in his knee, sticks his thumb across the door frame in Peggy Haley's tiny office in the food pantry.

"Hi, Emmanuel!" says Haley, an outreach nurse in rural areas of southwest Ohio for Mercy Clermont Hospital. "How's your finger doing?"

Rinckhoff, who came from Mowrystown to the Hope Emergency Program east of Fayetteville, shows Haley his now-healthy thumb, recently recovered from a nasty infection that lingered for months. His right thumb had been swollen beet-red with a boil-like knot, but he wouldn't go to the emergency room.

"I think I got rid of it OK," he says. "I was just coming here to check and see how things are with you."

Like many who visit Haley, Rinckhoff doesn't consider regular check-ups an option. His Social Security income is $670 a month.

Haley looks at his thumb, checks his blood pressure, reminds him to do the Medicare paperwork before he turns 65, and sends him on his way.

Lynchburg is in one of the poorest Appalachian sections of Ohio. The Hope Emergency Program is operated by Ursuline nuns and provides food, furniture, clothing and basic medical guidance out of a converted warehouse. Mercy Clermont Hospital supports Haley's medical outreach. She also spends two days a week at a church in Felicity.

"This is so far removed from the city, but the same poverty and hunger problems exist here, just in a different way," Haley says.

"It's just not as visible as in the city. A lot of them don't usually go for medical care, and when they do it's usually for an emergency. They're not used to having regular check-ups. It's that hands-on thing I do that makes a difference to them and gets them thinking about their health."

Serving nine counties

At 9 a.m. one recent Wednesday, 50 people wait outside the food pantry just east of the border between Brown and Highland counties.

Tucked among the miles of corn and soybean fields, it's the largest food pantry for rural counties east of Cincinnati. People from nine rural counties come for food, clothing and special requests - mattresses, furniture, kitchen appliances, underwear - as well as Haley's medical care.

"We try to make it a personal relationship," says Joy Bierman, a pantry volunteer. People are treated with respect , she says.

About 180 families a week come for food.

Volunteers try to break the cycle of poverty through education. The warehouse is filled with posters: Free mammograms and pap tests, free eye exams and eyeglasses, GED classes and an early childhood health fair. There's a voter registration booth and a sign advertising free school supplies.

Haley sees herself as a first line of defense in the health care system. If people need food, they typically need medical care, too.

Haley, a nurse for 23 years, is also trained as an HIV educator and used to make home visits for high-risk pregnancies. On Tuesdays and Fridays she is a nurse at a food pantry at Felicity United Methodist Church.

"Doing outreach to the poor and underserved goes back to our original mission as Sisters of Mercy: to bring the mercy of God to people, to truly be mercy," says Sister Joan Nemann, the hospital's director of mission services. "We can only touch the surface. There are so many needy people out here, and it seems to have gotten worse the last four or five years. Peggy helps as many people as she can with our budget."

Her 2005 budget is $91,400.

With its outreach program, Mercy Health Partnerships, the hospital enlists doctors to treat patients who are unable to pay. The program also helps with medical costs and, with help from Kroger, offers reduced-cost prescriptions.

High blood pressure is the most common health problem here.

"Hypertension is one of those things they call the silent killer," Haley says. "You'd be amazed how many people have high blood pressure and don't know it." "The system can be so overwhelming. People just give up when they don't qualify for certain types of med care. And that's never the answer, because they'll just end up in the E.R. A lot of what I do is preventive medicine.

In the corner of Haley's office are crutches, colostomy supplies and diabetic supplies, all donated. There's a bookcase filled with free over-the-counter medicines.

Haley sees herself not just as a nurse but more as a medical advocate for the underprivileged.

"I always encourage people to stand up for themselves, sort of a social justice thing," Haley says. "You have the right to be heard. So I try to give the people the information and resources and then let them do it for themselves."

Gaining their trust

Haley is short and pleasant and wears a cross on a necklace.

Hers is a job that takes patience and people skills.

"In her profession she has to be genuine," says Ruth Miller, 82, of Mount Orab, who checks in with Haley weekly. "You treat people like you want to be treated yourself. That's what Peggy does."

"We're dealing with a clientele who doesn't trust outsiders, and Peggy has developed an excellent rapport from visiting with them time and time again," says hospital mission services director Nemann. For Cynthia Spina of New Vienna, Haley is a nurse, a friend and a therapist.

"She makes me feel like part of her family," says Cynthia. "I don't look at her as a nurse. It's like she's my older sister looking after me. I feel comfortable around Peggy."

Back in her nurse's office, Haley is talking with Rinckhoff. She's juggling her multiple roles as nurse and as mother, as a voice for the poor and as an adviser for those overwhelmed by the health care system.

"Do you have any insurance at all?" she asks him.

"Just Social Security," Rinckhoff replies. "I'm not old enough for Medicare until 65, and they don't want to give you any insurance. It makes it tough, you know? If anything happens I just have to go to the emergency room, and hopefully they write it off."

"Well, we're going to do flu shots again this year, so you be sure you get one," Haley instructs him as he leaves. "It'll be the same girl as last year. She's a good flu-shotter, you remember? You didn't even feel it."

Haley knows that he lives in a small, deteriorating house, and that his living conditions and poor diet don't help his health.

"He just won't go to a doctor, but for him to feel safe enough with me, that's great," Haley says. "In a perfect world, he would have gone to the ER, got a prescription, got the thumb lanced. But my perfect world isn't his perfect world. In his perfect world, no way. At least he's coming back to let me look at it and see if it's getting better, or at least not getting any worse."

E-mail rforgrave@enquirer.com