By Blaire Mirmow

On a bitter November morning in Newland, North Carolina, Ashton Johanson climbed aboard the purple dental bus parked outside High County Community Health’s medical clinic. 

Inside the cramped mobile unit, the floor heaters sputtered. Supplies were running low. The suction machine had been acting up for weeks.

His patient in the chair, a man who lost his dentures in the western North Carolina floods caused by the remnants of Hurricane Helene, needed care Johanson still couldn’t provide. 

“I’m not really doing any of the procedures that I learned,” the 29-year-old dentist said.

This was Johanson’s normal — only four months after the first day of his first dental position at Avery Dental. The clinic was in ruins, and he was working in a mobile unit with equipment incompatible with the needs of some of the adult patients seeking care.

“This isn’t sustainable,” he recalled thinking. 

For Johanson, Hurricane Helene marked more than just a natural disaster. It was the start of a grueling endurance test — as a father, a husband, and a rural health provider.

As the only remaining full-time dentist at a safety-net clinic in Avery County, a rural area already grappling with chronic provider shortages, Johanson has had to adapt to provide needed oral health care to the region. His story reveals the long tail of disaster recovery in medically underserved areas — especially as hurricane season, which stretches from June 1 through the end of November, starts up again.

Pulled to a profession

Just four months before the hurricane, Ashton Johanson officially graduated dental school in Salt Lake City, Utah.

As a high school student in Colorado, Johanson discovered a joy for tinkering while at a job  repairing musical instruments. After shadowing local dentists, Johanson thought dentistry was the perfect combination of his love of science and hands-on work. 

Once in dental school, he saw a whole other side of the dental profession when he worked on a research project linking oral and mental health. He realized dental services were a luxury for many, and he discovered what he wanted to do with his career.

With a heart for public health, he accepted a position at High Country Community Health, a nonprofit health center high in the Blue Ridge Mountains.

Growing up in the mountainous West, Johanson and his wife, Madi, yearned to leave behind familiar comforts for a new adventure in a place where their growing kids could run around in nature, away from screens and city life. 

“We knew that if we decided to go close to family, we’d never go anywhere else,” he said. 

A first job, upended

With their 2-week-old son and toddler in tow, the young family set off for North Carolina in July. By August, Johanson was starting his first day at Avery Dental.

Avery Dental, a satellite clinic of High Country Community Health, primarily serves patients with limited financial resources, regardless of their insurance status or ability to pay. For many in Avery County, where more than 2,500 of its nearly 18,000 residents lack basic health insurance, the clinic’s discounted fees are their only option.  

To meet the area’s extensive dental needs, the High Country team encouraged Johanson to use the full range of his new skills — precisely the type of work he wanted to do. Two part-time dentists who occasionally worked alongside Johanson helped ease the transition into his first dentistry job.

In his first month, he was adjusting to the rhythm of the clinic and his new coworkers, but he still felt like an outsider in Newland, a town of fewer than 800 people near the North Carolina-Tennessee border. The high turnover of dentists in rural clinics meant that locals in the tight-knit community were used to their share of new faces in the office. 

“People knew my name, where I was from, before I ever met them,” Johanson recalled. 

In Johanson’s seventh week at Avery Dental, life was finally settling into its new groove when warnings about Helene were sounded. Initially, Johanson wasn’t too alarmed. He expected wind and rain, but nothing crazy. 

The day after the county declared a state of emergency, High County Community Health sent an email closing all clinics on Friday, as a precaution. “Stay safe,” the message read.

Raging winds and rain

The storm’s full force hit the region the morning of Sept. 27.

Heavy rain and gusts of wind rattled Johanson’s home as he and his wife huddled inside with their two sons. Outside, trees swayed, straining beyond their capacity. As the storm’s strength and potential to wreak havoc became clear, Johanson rushed outside to move his family’s two vehicles to safety. 

Not long after that, a tree crashed onto the kitchen roof, shaking the whole house. Seven more trees groaned and snapped. Some left broken stumps in the yard, marking their place like gravestones. Others fully uprooted. 

Johanson and his family made it through the challenges that Helene threw at them that Friday morning, but the aftermath brought new crises. No power. A leaking roof. For four days, the family relied on flashlights and a camp stove to cook.

“We were trying to do laundry with a 3-month-old baby still in diapers,” Johanson said. “We don’t have any of their regular food. It’s just dark all the time. It was just not good.”

Without any internet or cell service, they listened closely to a hand-crank emergency radio for news from the outside world. As conditions settled, neighbors rallied. One brought over his chainsaw and helped them get the fallen tree off their roof. Others made rounds making sure everyone was okay.

The Johansons had met their neighbors only briefly before the storm. Now, the whole neighborhood was coming together. With only sparse radio updates, Johanson, in a house high above the North Toe River, was largely unaware of the extent of the historic flooding that ravaged downtown Newland, only five minutes away.

Johanson ventured into town in search of fresh food and an update on the clinic. He navigated the recently cleared roads, flanked by hundreds of freshly severed logs.

The destruction shocked him.

Office in ruins

In Newland’s central park, a gazebo lay upside down 40 feet from its usual location. The town’s sidewalks and roads had cracked and shifted like tectonic plates. Other residents meandered through town in a daze, awed by the flooding’s impact. 

The scene was apocalyptic.

Off the main strip of town, Avery Dental remained standing next to a local barbecue restaurant in a small shopping center. In the cratered parking lot, a van was stacked on top of a car. The clinic’s windows were shattered.

Johanson unlocked the door and stepped inside in his boots, carefully trudging through the thick mud. He wasn’t prepared for the scene. A musty, damp odor flooded his nose. A portion of the ceiling had caved in and littered the muddy floor, blocking the entrance to his office. Water lines on the walls, four feet high, marked the depth of the water, sewage and mud that had caused the ruin. Treatment rooms were in complete disarray, like shaken snow globes filled with dental supplies. 

The clinic where Johanson’s first day began such a short time before was destroyed. 

“I really hope I have a job after this,” Johanson said he recalled thinking. “Right now, we really just need to get the kids out.”

Since the “stay safe” email had gone out only three days earlier, there had been radio silence from clinic leaders. Phone service and other communication channels were scarce in wide bands of western North Carolina. Johanson held his phone up, looking for a signal. The whole area was disconnected. He headed back home and found a neighbor with internet access and texted a friend in South Carolina: “Can we come stay with you?” he asked.

The next day, the family of four once again packed their bags and set off, unsure of when they would return — and what would be left of their new lives when they did.

Stark needs

Avery County is a dental health professional shortage area — a dental desert. Accessing needed care in Newland isn’t easy, especially for uninsured and low-income residents covered by Medicaid.

“My daughter is in desperate need of a cleaning. It’s been a nightmare trying to find somewhere to take her,” one Newland resident posted on Facebook after the storm.

Another resident expressed similar challenges. “We moved here two years ago, and it took us almost a year to find a dentist who took Medicaid,” they wrote. “It’s an hour and 15 minutes from my home.”

North Carolina’s dentist workforce is growing, but over half of new providers are concentrated in just five urban counties. Avery Dental had been an oral health lifeline for many of the county’s residents.

Six days after the storm, Johanson connected with Halcyon Inniss, chief dental officer at High Country Community Health, and explained that they were in South Carolina and unable to immediately go back home. Inniss told him the health center planned to start seeing patients again in a week and wondered whether he was willing to return to work.

If Johanson didn’t come back, the county would lose its only Medicaid dental provider. So, after one week, he left his family in good care and headed back up to the High Country.

The team naturally downsized in response to the flooding. One of Johanson’s coworkers, a seasonal dentist, told the team he would be heading back to Miami. The one other dentist would be shifting her work to the center’s Burke County site, 50 miles away. The weight of Avery County’s oral health rested on Johanson’s shoulders.

Inniss and her team quickly assembled a plan. They would repurpose their mobile bus, typically reserved for school-based services for kids. Through a stroke of luck, the mini clinic on wheels, typically parked in Newland, was moved a week before the storm to another site in nearby Boone. 

“If they had left it here in Newland, it would be a mile down the river,” Johanson said. 

Occasional emergency appointments and donation distribution filled each of the early days on the bus. Over time, more patients began showing up in need of care. But providing dental services from the bus was laden with complications.

Loud portable dental equipment and awkward patient chairs unable to recline fully or adjust in height encumbered the team’s ability to provide efficient care. 

“It was just killing my back trying to do work without equipment that’s suited for it,” Johanson said.

Alongside his assistants, he spent the next two and half months working on the bus. All the clinic’s regular supplies were ruined in the flood, and most had not been replenished. Operating at just 33 percent of Avery Dental’s original capacity, the team experienced a sharp drop in production, which slowed incoming funds.

Even in normal times, community health clinics rely on limited financial resources to survive. Chasing down funding from public and private grants to sustain and grow operations is a constant battle for clinic leadership. 

“It was definitely starting to wear on me,” Johanson said. “I was feeling pretty isolated because I’m still a new grad, working by myself, and then just working with almost no resources.”

His resolve to push through was wearing thin. 

In December, relief arrived. High Country Community Health received an outpouring of community support after Helene. An insurance company donated a dental trailer for a six-month lease. A significantly better fit with proper dental chairs and equipment, the white rectangular trailer was parked outside HCCH’s Newland medical clinic, across town from Avery Dental.

The community demand for oral health services remained undeniable. “It’s a very small community, but it’s also a very poverty-stricken community,” Johanson explained. “There’s a ton of need.”

Excited for improved treatment for patients, Johanson and his team adapted to their unconventional circumstances, slowly settling into a routine. 

“I became really close with them just because we work in this little, tiny space every day,” Johanson said.

Making inroads

Working with Johanson was easy, and Jessica Hoilman grew to look up to him as a mentor. 

“I feel like I could go to him about anything work-related, child-related,” said his dental assistant, also a parent to young kids. 

The camaraderie was crucial.

The trailer lacked insulation, a necessity heading into the frigid winter season in Newland’s high-altitude climate. Temperature-sensitive materials risked ruin. Water lines froze. 

Freezing temperatures shut down the clinic multiple times, shifting operations inside a borrowed room in the medical building. But these rooms weren’t equipped for long-term dental operations due to the specific equipment and arrangement needed for dentistry. 

With her Carhartt overalls buckled over her scrubs for extra warmth, Hoilman frequently rushed back and forth into the medical building to sterilize and restock instruments, at times taking 20 trips in single-digit weather. 

Johanson was stretched thin. Juggling multiple responsibilities, he was now seeing even more patients than before the storm and taking on new administrative tasks to order needed supplies. More patients meant less space. Hoilman squeezed past patients in the makeshift waiting room inside the trailer. When they ran behind, the scene grew chaotic.

Since the pandemic, every position of the dental team has been difficult to fill. Without a hygienist, Johanson was tasked with playing the role of both dentist and hygienist, adding to his expanded demands. Fresh out of school, he felt the weight of being a solo dentist and needed the support of another dentist on site.

Despite these difficulties, Johanson grasped the importance of staying and pushing through. “Being the only dentist there, it’s like, ‘Well what would happen to the clinic?’” he said.

He wasn’t willing to abandon his coworkers or his patients. He was determined to make this work.

Unique experience

Newland was unlike anywhere the Johanson family ever lived. People felt genuine, as if no one was putting on a mask. 

The hurricane exacerbated disparities that he knew were there but didn’t fully understand before the storm. His eyes opened to how poverty can permeate every aspect of life. 

“In some situations, you can work to change your situation. And sometimes you really can’t. You’re stuck,” he explained. “I’m able to see it every day and talk to people about it.”

The space between Johanson and his patients diminished. They started to open up, and he was ready to listen. 

“I feel like he’s really come out of his shell and patients love to see him, especially the older women,” Hoilman said, chuckling. Johanson’s warmth as a provider began to shine.

Hurricane Helene took six lives in Avery County. Many residents lost their homes and were living in motels or campers. Aware of his privilege, Johanson understood his experience differed from the ongoing challenges that many of his patients faced. But surviving the hurricane gave them common ground that opened the door to so much more.

The storm helped him realize you don’t have to know how to integrate into a community. 

“You’ll figure out how to show up,” he said, “when you start showing up.”

In May, the six months working in the dental trailer came to an end. The Avery Dental team shifted operations to a rented office across town while High Country rebuilds the original clinic site. 

Inniss and her team have been a constant source of support for the Avery Dental crew, with Inniss making frequent in-person visits to be by the team’s side. They hope their Avery Dental clinic will be up and running again in the fall — roughly a year after the storm first hit. Until then, Johanson is still taking his first year as a dentist day by day, week by week.

In the summer of 2024, the Johansons were seeking something new, and a once-in-a-generation hurricane claiming over 100 North Carolinian lives and causing nearly $60 billion in state damages delivered an experience they never could have imagined. Despite this, he still hopes his family can experience normalcy in Newland. 

Johanson looks forward to his children experiencing their early childhood in the beautiful Blue Ridge Mountains, mucking around and playing outside, going to school. He’s looking forward to getting into a routine and making friends. To using his new dental skills and improving the oral health of the community where the need is so great.

Johanson’s life looks nothing like he envisioned when he drove across the country not even one year ago. One thing after another has thrown him for a loop. But he knows this will pass.

“I’m starting to believe that that’s just life,” he said. 

​​With a new chainsaw, a generator and Starlink internet access, Johanson isn’t taking any chances of facing another hurricane season unprepared. But for now, he is focused on what he moved to this small rural town to do — improve the community’s oral health, one patient, one day at a time.

Blaire Mirmow is a dentist with experience in public health settings across North Carolina who wrote this article for a UNC Chapel Hill journalism course in the spring.

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