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Paradise Lost: Lake County, California

Lake County is aptly named, as the largest clearwater lake in California sits in its center.

The water is blue, with mountain like volcanic structures rising in the distance. The lake is beautiful, but plagued with an overgrowth of green algae that will begin to kill the fish as the summer temperatures rise. When this happens, the dead fish rise to the top and the air is filled with their stench. Some years are worse than others. Surprisingly, you won't see a lot of watercraft, and even fewer water skiers. Very few go in the water anymore and several locals shared with me that if they eat any of the fish caught in the lake, they limit themselves to one a month because of high mercury levels. It's a paradise lost.

The local economy is based primarily on agriculture, tourism, and the geothermal power industry. Lake County is an ultra-premium wine grape-growing area and also is famous for its pears and walnuts. Tourism, however, has dropped off and the economy is weak as evidenced by many run down lakefront resorts, empty or boarded up storefronts, and for rent signs. I imagine that in the heyday of Lake County, the place was bustling. Kind of like the place where Dirty Dancing was filmed, California style. But now, the failing economy, the despair in the hearts of the people who live there, and the hopelessness have taken over.

The poverty rate here is 22.8% (national average is 12.3%) and the overall county health ranking is 58/58. In a 2016 study that looked at all 3500 counties in the country for HIV and HCV vulnerability related to drug use, 220 were identified as particularly vulnerable, and Lake County ranked 196/220. There's a lot of substance use here; alcohol, meth, and heroin. And, a lot of crime, prostitution, illegal cannabis grows, and an extraordinarily high number of people on welfare. Unemployed people with habits to support will do what they have to do to get their needs met.

During the 3 months I was in Lake County, I stayed in the city of Lakeport, located on the northwestern bank of the lake. Of all the places I've been in Lake County, Lakeport serves up the most charm with a Main Street that boasts several decent restaurants, a bicycle shop (where I bought a new bike), a book store, a new ice cream shop, and various other businesses that are managing to stay alive. If you only came to Lakeport, you might be fooled into thinking that everything is A-OK.

On the southeast bank of the lake is a town called Clearlake, the largest city in the county. The problems are more evident there and in other towns like Kelseyville, Lucerne, and Nice. Many of the residential streets are not paved and the rains have created deep and irregular crevices, some 3 feet wide and deep enough to be problematic. My truck, with its big tires, easily takes these streets but even still, struggles as it navigates the uneven, gravelly, dusty terrain. Old dilapidated cars sit in yards cluttered with well-meaning projects now patinated with dust, long gone the hope of completion. Homes are in disrepair, with fallen gutters, dead grass, broken lawnmowers. It's almost like the twilight zone, zombie like, with only the occasional sign of life. It's so hot, folks don't go outside much.

My primary goal in the communities/counties I visit is to recruit primary care providers into a program called Project ECHO wherein we teach them to treat and cure hepatitis C (HCV) using videoconferencing technology to hubs at UCSF and UC Davis. My hopes for Lake County were high, as they always are when I go to a new geography. My own experience of being cured of HCV makes me an exuberant advocate for getting folks cured. In the 3 months I spent there, I talked to many healthcare providers and their staff, preaching the gospel of TEST, TREAT, CURE. But, when I left, my recruitment numbers were quite low; a reflection, in my opinion, of what happens in a place where resources are low, healthcare providers are overworked and likely underpaid, and hope is all but dashed.

I gave it my best. As I get deeper into this work, I'm reminded that you can lead a horse to water, but you can't make them drink. Systemic problems, compounded, are like a tangled knot that will require patience and determination of where to begin in the long process of untangling. My presence sowed seeds of awareness, hopefully, in the hearts and minds of those with whom I interacted. I hope some of those seeds sprout. It's so rare that healthcare providers can provide a CURE. To deny this to the lives of the people who live in Lake County is a shame. It saddens me. And, it makes me that much more determined to continue to try to change the hearts and minds of healthcare providers, and consumers of healthcare in the counties I'll be traveling to in the future.

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