Dr. Isabel Pino. - Roaming Appalachia in a converted van, pediatrician Isabel Pino brings hope and healing to kids in places where doctors are scarce.

The long blue van rocks gently as it winds through the steep West Virginia hills on narrow roads that twist and turn through the sparsely settled hollows of Appalachia. It is a region of cruel contrast. Amid a lush natural setting, dense with oak and dogwood trees, stand many bleak artifacts of poverty, dilapidated frame houses and trailer homes, their yards often littered with abandoned toys and rusted cars. After a 42-mile journey from Huntington, the van arrives at the elementary school in Ranger. There, half a dozen children have gathered as if awaiting the Good Humor Man. In fact, they’re going to the doctor---or, rather, the doctor has come to them. One by one the kids step into the 34-foot van, which is actually a fully equipped mobile pediatric unit, staffed by a medical resident, two nurses and smiling, lively Dr. Isabel Pino.

“You have the most beautiful eyes,” says the Cuban-born Pino as she examines 4-year-old Autumn Williamson. “What am I going to find in your ears?” “Little men,” Autumn answers. The pediatrician smiles as she peers through her otoscope. “I might, because I have this magic light,” she says. “Yes, there are men in one and Goofy and Mickey in the other.”

Over the next five hours , Katlyn, Corey, Chastity and the other children are weighed and measured or hop onto Pino’s table for flu shots and TB tests. These are called routine checkups in most parts of the country, but not here in remote hamlets like Ranger. In the midst of a mining area, during one of the greatest economic booms in the nation’s history, many homes still have no running water or phone service---and it’s 20 miles to the nearest supermarket, never mind a doctor’s office. For nearly eight years, Pino’s swings through four Appalachian counties have brought her to each of eight sites at least once a month. Though cramped, her van offers most services found at a conventional pediatric clinic, even including chemotherapy for young cancer patients.

 “It’s hard to make people understand what this kind of isolation is,” says Pino, 47, an assistant professor at the Marshall University School of Medicine in Huntington, which---along with Valley Health Systems, a local network of community health centers---supplies her doctor, nurses and support staff. “Fifty miles of up and down roads going sideways and every which way, getting smaller and smaller and not in good shape. Still, we have to get to the children. That’s why our van is necessary.”
 Pino’s van is one of 18 provided by the Children’s Health Fund, a project with headquarters in New York City that is designed to bring pediatricians to indigent and uninsured children around the U.S. The fund was founded in 1987 by singer-songwriter Paul Simon, along with Dr. Irwin Redlener, a Manhattan pediatrician. Simon donated $85,000 for the first van, which still treats homeless children in New York City, and through benefit concerts---featuring the likes of Bruce Springsteen, Billy Joel, James Taylor and Bill Cosby---has raised $2.5 million for the CHF. According to Redlener, Pino is one of the project’s stars. “Isabel is exactly the kind of doctor we want,” he says, “committed to a high quality of care and a compassionate advocate for the children she cares for.”

 The West Virginia program started in 1992, thanks in part to Sen. Jay Rockefeller, who helped by donating $50,000. As Rockefeller recalls, acquiring the mobile unit was only half the battle. The other half was getting some of the more reticent rural poor to use it. “We discovered that families and kids can be nervous and don’t necessarily come---they’re sometimes afraid to find out that something’s wrong,” he says. “We had to get it out there and make it user-friendly. It took about a year to a year and a half for people to say, ‘I guess this is really okay.’” Adds Pino: “People out here are used to social programs coming and going, and they are still left behind. It isn’t difficult to understand why they were distrustful.”

 Now just about everybody seems to approve. Patients, most covered by Medicaid if they are insured at all, arrive on foot---or en masse, crammed into old cars or pickups. “It’s about a 45-minute drive to get to the nearest doctor,” says Opal Moore, a Ranger elementary school tutor and mother of two who is confined to a wheelchair. “I think the medicine is good. My kids have used it for three years now. They know everybody in the van, so they are comfortable being treated there.”

 Middle school teacher Bethana Brewer of Crum, 56 miles away, notes that because the van visits during school hours, it makes life easier for working parents who can’t always punch out for pediatrician’s visits. “It is difficult to hold a job if you are going to miss a lot,” says Brewer. “There are many times when probably I would not take the kids to the doctor. I’d try to over-the-counter them.” She adds gratefully that twice, Pino and her staff identified serious problems in her children. “They referred my second son to have X-rays and then treated him for pneumonia,” says Brewer. “My youngest, Brianna, who is 6, was vomiting and had diarrhea and a virus and was dehydrated. The doctors on the vans said, ‘Leave for the hospital now.’”
 
Pino has high praise for van driver Paul Gram. “He is the driver, the registrar, the computer person, the maintenance man, the scout,” she says. “Without him, this unit wouldn’t be here.” Recently, when the van broke down, she recalls, Gram, 35, patched a suspension problem with rubber bands. “Paul does amazing things with paper clips and duct tape,” says Pino. Still, the hearts and soul of the Appalachian unit is Pino herself, who leavens her medicine with a warm bedside manner.
 “She has a great sense of humor, and that works very well with kids,” says licensed practical nurse Sherrie Fulton, who works on the van. “She breaks the ice.” Pino doesn’t break the skin, though---she lets Fulton or nurse practitioner Mary Kelly administer injections because she can’t stand to inflict pain on her patients. The doctor does, however, hand out the stickers---dinosaurs, Barbies, cartoon characters---as a reward for everyone who gets a shot.

“Is your arm still there?” Pino jokes, postinjection, with one teary 7-year-old. “Imagine you’re blowing out the candle on a birthday cake,” she instructs another child, who is taking a breathing test. (Asthma is a chronic problem in the area, and home heating is usually provided by coal-or wood-burning stoves, which aggravate the condition.) Nearly every patient gets quizzed on their progress in school. “I think of these children as my kids---I’m very possessive about them,” says Pino, who is single and childless. “When a child walks in the door, I’m not looking at a possible ear infection. I’m trying to examine their life.”
 Pino strongly emphasizes preventive medicine and nutrition, which she and her staff teach at local schools. Ironically, despite their impoverished circumstances, many of the kids are overweight. “They eat a lot of fried foods, biscuits and gravy,” Pino says disapprovingly. As always, she tries to get her message across in ways that make the learning fun. Acting like a cheerleader in front of a class in Ranger, she calls out the name of a healthy food---apples---and students respond with a chorus of “Yes!” Fried chicken and ice cream are a “No!” Frozen yogurt: “Sometimes!” With each chorus, Pino thrusts her fist in the air and cries, “Yesss!” Some of her other lessons to live by: “Always go swimming with a buddy. Wear a protective helmet on a bicycle. When you play a game, someone has to lose, but it’s important to have fun.”
 A passion for healing and empathy for the unfortunate were ingrained in Pino early on. Her father, Fernando, now 79, was a physician, and her mother, Georgina, 76, a lab technician. The family of five lived a comfortable middle-class existence in the coastal city of Cardenas in Cuba even after Fidel Castro took power in 1959. But when the promised democratic elections never materialized and freedom of the press was abolished, Fernando began to oppose the Castro government vocally.
 After the failed Bay of Pigs invasion in April 1961, Fernando and other dissidents were herded onto a baseball field by machine-gun-toting militiamen and imprisoned in the pens of a converted chicken farm. Visitors were not allowed, and his family did not know if they would ever see him again. “Those are things that stay with you,” say Pino, then 9, who vividly recalls her mother taking packages of food to the guards, to be given to Fernando. “My dad never got any of the packages,” she says. “He ate because other people shared.”

 After a few weeks, Fernando was released from his coop and placed under house arrest at a local hospital, where he continued to practice medicine. Then, in July 1961, as thousand tried to leave Cuba, Fernando---who had obtained a visa before Castro---managed to emigrate to the U.S. Arriving in Tampa with just one suitcase, he quickly found work at a small hospital there. After an agonizing bureaucratic nightmare, his family joined him on Dec. 25. “It was the best Christmas present we ever had,” Pino says.
 Money was tight, and the family collected S&H Green Stamps to replace household goods left behind, all along believing that their American sojourn was temporary. “We expected to go back to Cuba after Castro left,” Pino says. In 1963 the Pinos moved to a suburb of St. Louis, where Fernando did his residency in psychiatry. Later, Isabel attended the University of Salamanca in Spain for a year, then when her family moved to Orangeburg, N.Y., commuted to nearby Marymount College. All her life she’d dreamed of becoming a doctor, and when she wasn’t admitted to a U.S. medical school, she earned her M.D. in the Dominican Republic. Finding her niche in pediatrics, she spent the 1980s in training in Jersey City and Mineola, N.Y.

 In 1991, Pino got a call from her younger brother Eduardo, now 42, an assistant professor of pediatrics at Marshall. (Older brother Fernando, 49, a psychiatrist, and U.S.-born sister Helen, 35, schoolteacher, both live in Miami.) There was an opening in Huntington, he told her, for a director of an ambulatory clinic. “Do you want to come to the hills of West Virginia?” he asked. Pino took the post, and the mobile clinic hit the road in January 1992, two months after she arrived. “I was with the van from day one,” says Pino, who also supervises medical residents at Marshall. In her off-hours she indulges interests in motorcycles, ice hockey and TV cooking shows. But Pino’s great passion remains her young patients, whether they’re in a state-of-the-art university clinic or a long blue van in a lonely mountain hollow. “In what other profession can you inflict pain or tickle someone and get paid for it---and in the end they say thank you?” she says with a laugh. “You have to be a pediatrician, right?”
Richard Jerome

 Giovanna Breu in West Virginia
  PEOPLE WEEKLY NOVEMBER 29, 1999