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How Austin’s Only Doctor Fought HIV In A Town Indiana Left Behind

In his new book, "Canary in the Coal Mine," William Cooke recounts the opioid epidemic that led to the infamous 2015 outbreak.

When Austin, Indiana, made national headlines in 2015 for its HIV outbreak, William Cooke was the only doctor in the tiny Scott County town. In his new book, Canary inthe Coal Mine, he details the opioid addiction and needle sharing that led to the crisis. And he hopes to alert us about the consequences of a phenomenon that is now national.   

“It’s meant to be a warning,” Cooke says of the book, written with Laura Ungar. “Across America, there are racial and socioeconomic fault lines. We have to see them to repair them.” As Austin’s public health crisis intensified, Cooke’s small family medical practice was pushed onto the national stage. Canary in the Coal Mine is an account of how Cooke learned to better advocate for his patients, including a meeting with then-Gov. Mike Pence, whom Cooke implored to legalize a needle exchange program. The book spotlights people whose lives have been upended by drug addiction and poverty. Some are suffering from lack of routine care, with treatable illnesses that progressed beyond help. Nearly all carry the shame and stigma of using drugs, trapped in an addictive cycle they can’t break on their own.

Cooke, who grew up in New Albany and Jeffersonville, is the same age Ryan White would have been, their birthdays one day apart. White’s HIV diagnosis, shunning from the community, and death in 1990 impacted the way Cooke thinks about patient care. “Facing the stigma and community backlash, it really struck me as a Christian,” Cooke says. “I always felt compassion was necessary to help people feel safe and connected. I see my role as listening to people, to reshape their story so they don’t feel so helpless or victimized—to play an active role in their own story.” His parents, Carolyn and Bill Cooke, were his models of perseverance. Both attended IU Southeast when he was a child, where his father studied psychology and his mother studied nursing. His mother, who dropped out of high school at 16, went back and finished at 24. She went on to become a doctor, and now practices medicine alongside her son in Austin.

Though progress has been made in Cooke’s small town, the challenges of COVID-19 have complicated life for already-vulnerable populations there. During the initial lockdown, virtual clinic visits helped, though not for those who lacked internet access and housing security. The clinic delivered food and medicine to patients, and checked in by phone. In 2015, isolation was a contributing factor for many of the opioid addicts in Austin; while quarantined in 2020, many relapsed. Now in another trying time, Cooke’s faith sees him through. “I don’t think there’s an alternative,” he says. “I’ve failed over and over again. I tell patients and my children: The only time you truly fail is when you refuse to get up.”

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