A rural Western North Carolina clinic offers care to those who’ve ‘fallen through the cracks in the system.’
By Taylor Sisk
Monday evening at the Community Care Clinic of Franklin, and Bill Langston, 60, is among the first to be seen.
Langston has been coming to the clinic since 2013, but this will be his final visit now that he’s covered under the Affordable Care Act.
The Community Care Clinic has filled a void for Langston, who lost his glass business in the recession. It provides services to those at 150 percent of the federal poverty line ($23,850 for a family of four) or below and operates on a payment scale that slides down to zero.
Franklin, 60 miles west of Asheville, is the county seat of rural Macon County, situated along the Georgia border and home to the Nantahala Forest. Macon dropped this year from a Tier 2 to a Tier 1 county, placing it among the most economically distressed in the state.
“They’re unbelievable,” Langston said on this wintery evening after treatment for severe allergies. “I can’t say anything else. I was in bad shape. Out of work. I’d just lost everything in the recession. And they nursed me back to physical and mental health.”
Langston isn’t sure where he’d have otherwise gone for care. “Probably, the emergency room,” he said.
This evening’s visitors to the clinic come from vastly different backgrounds and arrive with a variety of ailments. Like most rural, underserved areas, this region of Western North Carolina faces a number of challenges to the administering of effective health care: poverty, meandering mountain roads that remain impassable through inclement weather, a shortage of services in the vicinity.
The Community Care Clinic of Franklin is a godsend to many.
The clinic was launched in 2010. It’s open every Monday evening and has recently added one Wednesday a month to better meet demand. The doctors and many of the support staff are volunteers.
An average of two dozen patients are seen each clinic night. The schedule tends to stay booked up about five weeks in advance, but walk-ins are accommodated as the number of no-shows permits. Two-thirds of those seen are 42 or older.
About a third are Hispanic.
“We see lots of homeless, lots who are really having a hard time,” said Christy Armstrong, the clinic’s executive director and a native of Franklin.
She worked in Raleigh for the Department of Health and Human Services before returning to “my home people” in March 2014 to fill the vacant director’s position.
According to the North Carolina Institute of Medicine’s Task Force on Rural Health, the county has only a dozen physicians and no psychiatrists. The clinic’s staff is called upon to respond to multiple and varied needs.
Armstrong said they see a lot of diabetes and hypertension, lots of people who have run out of their medications and can’t afford to go to urgent care, which is only open during the day anyway.
So they resort to the ER, which provides stopgap services and then refers them to Community Care. The clinic provides diagnoses and treatment, lab work, meds and referrals. It offers behavioral health counseling and case management for those with chronic conditions. It’s recently received grant money to offer classes in the management of diabetes, hypertension and stress.
Beyond dealing with the most immediate needs, the objective is to provide some basic information about preventive care, said David Ramsey, a now-retired family physician who drives over from Sylva once a month to volunteer. “Many haven’t seen a doctor in years.”
“Some of these people are just beaten down,” Armstrong said, “so we try to lift them up.”
The clinic receives strong support from the community. It operates on grants and donations and is bolstered by the free drug samples local doctors share, meals the churches provide and the volunteers who arrive because it’s what you do for a neighbor.
“It’s very much needed,” said Sissy Pattillo, a former town alderman and a clinic board member and volunteer. “The patients have been so appreciative. I’m all for it.”
“We’re a small community,” Pattillo said. “We can all help.”
Armstrong said the majority of the clinic’s patients are those who aren’t eligible for Medicaid or Medicare, the uninsured, like Steve Rice, 52, a former executive with the Boys & Girls Clubs of America who comes from a farming family with deep roots in the community.
Rice was referred to the clinic by his cardiologist in Asheville after a heart attack.
“It was Valentine’s Day,” Rice said. “I was carrying groceries, preparing to do the Valentine’s-evening thing. It was going to be a picnic in front of the fireplace – a proposal, for real.”
He was carrying his groceries into the house, “And I got so tired; I just had nothing left. I thought I’d pulled something in my chest.”
Rice sat down on the porch and took off his shirt and shoes. “I was just burning up.” He managed to get inside, and “tried to go Zen with the moment.”
But he couldn’t catch his breath. A neighbor drove him to the emergency room at Angel Medical Center in Franklin. He was having a massive heart attack, and was transported by ambulance to Mission Health in Asheville. He was unemployed and had no health insurance. He’d signed up for the ACA in October, but learned he’s among those ineligible for assistance due to the state’s decision not to participate in Medicaid expansion.
Dr. Ramsey is looking at a rash that’s developed from head to toe, a reaction to the meds. He’s ordered some tests for tomorrow and arranged to consult with the cardiologist. The plan is to wait six weeks to see if Rice can survive and benefit from open-heart surgery.
“We’re doing the let’s-figure-it-out game,” Rice said.
The ‘gospel way’
People seek out the clinic from Clay, Cherokee, Graham, Swain, even Rabun County in Georgia.
“Distance here is a huge obstacle,” Armstrong said. “Fifteen miles in Raleigh is no big deal; but 15 miles across mountainous terrain,” especially when the weather’s bad, as it threatens to be this evening, can be a task.
For many here, transportation options are limited. Macon County Transit will pick you up from your home, but only operates till 5.
Maria Trujillo, 64, alternates stays with her daughters in Florida, Texas and Franklin. Her son was deported. She has a pain this evening in her arm, a result, she said, of hard work and old age.
Trujillo speaks no English and has no car or money. Her daughter can drive her, but works during the day, so it’s fortunate the clinic’s open at night.
“I’m a man of faith,” Ramsey said, quoting Matthew 25: “For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me.”
“And who was that?” he asked. “That was those who were in need. That’s who it was. That’s what you see here. It’s people who, for one reason or another, have fallen through the cracks in the system.
“Maybe some of them have made bad choices. Who knows? All I know is you see someone in front of you who’s sick and … they don’t have the means to afford other health care, and so you take care of them.”
It’s the “gospel way,” he said, “and the physician’s way, where we take care of whoever comes in front of us.”
Through an interpreter, Trujillo expressed gratitude for the care she was provided.
Steve Rice proposed to his boyfriend in the emergency room at Angel: “I used a piece of tinfoil from a gum pack that one of the nurses made into a ring.”
The answer was “yes.”
“I’m facing a lot of unknowns, honestly,” Rice acknowledged. “There doesn’t seem to be a consensus on how much damage has been done and what the best course forward is.”
His background is in fundraising, and when he gets strong enough he plans to help the clinic in any way he can.
“Pay it forward,” he said.[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]