Tyrrell County

shows a dentist and a dental assistant wearing masks, face shields, hair coverings, gowns and gloves to prevnt COVID working on a patient

Dental deserts: Lack of adequate oral health care across North Carolina

October 24, 2020 by Carolina Public Press

Dental deserts: Lack of adequate oral health care across North Carolina - North Carolina Health News

A shortage of oral health care providers, particularly in rural areas, hinders dental care access for low-income residents across the state.

By Christian Green

Carolina Public Press

The COVID-19 pandemic changed processes and protocols in the medical profession as exposure risk became a top priority for front-line health workers.

For oral health care providers, the once routine act of peering into mouths became a dangerous and possibly even deadly work hazard.

To avoid the risk, some dentists turned to teledentistry to connect with patients through video chat, coaching them to use their phones to photograph their mouths and offering consultations through screens.

The practice, born of necessity in the midst of a global health crisis, offered a path to help address a long-standing and widespread need in North Carolina’s health system: access to oral health care.

As of September 2019, an estimated 2.4 million North Carolinians struggled to get adequate dental care, according to the Health Resources & Services Administration of the U.S. Department of Health and Human Services.

Residents in 98 of the state’s 100 counties live in a region designated by the federal government as a Dental Health Professional Shortage Area, or HPSA.

“This has been a problem for years, and it continues to be a problem in our state,” said Dr. Darryl Smith, program coordinator for Friendly Dental Van, an organization that provides oral health care access to communities throughout North Carolina.

Too few providers

In the last 40 years, the number of practicing dentists in the state doubled, but the increase did not keep pace with the state’s population growth.

Although the number of practicing dentists rose from 2,207 providers in 1979 to 5,112 providers in 2017, the state’s dentist-per-population ratio lagged below the national average, according to data from the Sheps Center for Health Services Research at the University of North Carolina.

“North Carolina’s population is growing exponentially. It is one of the fastest growing states in the country, which makes it hard to keep up,” said Dr. Zachary Brian, program director of the N.C. Oral Health Collaborative.

In eight counties, the shortage affects patients of all income levels because there are not enough dental providers regardless of a patient’s ability to pay. Three counties in the state—Hyde, Tyrrell and Gates—have no actively practicing dentists, according to 2019 data from Sheps Health Workforce NC.

Increasing the number of dentists in the state, especially in nonmetropolitan areas, could help address the need, but training and retaining dentists remain complex challenges.

Recruiting and training North Carolina residents can improve the likelihood that they stay in state to practice.

On average, 90 percent of graduates from UNC Chapel Hill’s Adams School of Dentistry remain in North Carolina to practice, so an increased number of students will very likely translate to an increased number of dentists, according to data from the Sheps Center.

The total number of North Carolina dentists increased in the last decade, boosted in part by the 2011 opening of the state’s second dental school at East Carolina University, which focuses on serving rural and underserved populations.

Other providers, such as North Carolina’s more than 6,000 dental hygienists, could help address the critical need, but state regulations restrict who may perform some services without direct supervision by a dentist.

“We are not utilizing our workforce effectively,” Brian said. Relaxing the restrictions could allow for hygienists to travel to underserved populations to perform simple preventive and restorative procedures, he said.

A complex challenge

A shortage of providers is only one facet of the problem. “I think we do have a shortage, but it is much more nuanced and complicated than just that,” Brian said. Cost, geography and cultural misconceptions contribute to inequities in dental care throughout the state.

Cost is the leading barrier for access to dental care for adults nationally. Some areas, called population-based HPSAs, have enough providers for the population, but those without financial resources have difficulties accessing care. In 87 North Carolina counties, people are unable to access dental care because of income issues.

“You can live in an area with a dentist on every corner; that still does not mean you automatically have access to care,” Brian said.

The sliding-scale fee schedule at the state’s 42 federally qualified health centers, community organizations that provide care for underserved populations, allows some low-income populations to access dental services.

Low-income patients may qualify for Medicaid, which covers “medically necessary” dental care, but patients often have difficulty finding providers who accept Medicaid.

“There are already few Medicaid oral health providers across our state and our region, and even fewer are true Medicaid providers,” said Dr. Amanda Stroud, dental director for AppHealthCare, an accredited district health department for several counties in northwest North Carolina.

“Offices may be registered as Medicaid providers, but they might not be accepting new Medicaid patients, or they only provide it to a certain age or one day a month.”

Cost considerations factor into treatment decisions long before a person receives a dental bill. Hourly wage earners may be unable to take time off to visit a dentist, fearful of lost income or penalties for missing work, and some individuals lack access to the necessary transportation or child care to attend an appointment.

“I see people in their 40s who have never visited a dentist,” Stroud said. “They have been choosing between paying for groceries or their electric bill for the month instead of getting this cavity taken out.”

Beyond cost and access

Providing access to dental services is only part of the puzzle, said Smith, whose Friendly Dental Van regularly provides care for children across the state. Quality care depends on public understanding of the importance of oral health.

“There are a lot of adults that still are terrified of the dentist and don’t see the need for dental care unless pain is involved,” Smith said. “People believe preventive dentistry is unnecessary when that is far from the truth.”

Bringing dental care to schools is one way to improve understanding about the importance of oral health care, Smith said.

“Half the children we see, going up to middle school, it is the first dental visit of their life,” he said. “We work hard to create a relaxed and friendly atmosphere. The impression they get from us is so important to prevent them from growing up into dental-phobics.”

Stroud, the AppHealthCare dental director, first saw a dentist as a middle school student, and the experience encouraged her to provide that same service to others.

“Kids get eye exams at school. Kids get hearing exams at schools. They aren’t charged for those, so why can’t we bring in more dental to meet children where they are?” she said.

Editorial cartoon from the early 1900s shows a man with Spanish influenza sneezing, and people in front of him falling down sick.

Historic Outbreak: Spanish Flu on NC Coast

May 2, 2020 by Coastal Review Online

Historic Outbreak: Spanish Flu on NC Coast - North Carolina Health News

A century ago, North Carolina was ravaged by a different epidemic than the one we are experiencing today. Again, it was a disease that was without treatment, spread easily and killed about 14,000 people in the state.

By Kip Tabb

Coastal Review Online

In April, Dr. Anthony Fauci, a key member of the national COVID-19 task force, called out shaking hands as a particularly dangerous custom that should be relegated to the past.

“ I don’t think we should ever shake hands ever again, to be honest with you,” he said in a Wall Street Journal podcast. “Not only would it be good to prevent coronavirus disease — it probably would decrease instances of influenza dramatically in this country.”

It was not the first time in our nation’s history that the custom had been called into question.

“Let’s quit shaking hands. It is a filthy and abominable habit from the barbaric past … Having served its day and purposes it ought to relegated to oblivion,” W.O. Saunders, the publisher of the Elizabeth City Independent, wrote on Feb. 7, 1919.

Fauci’s plea is in response to the COVID-19 virus; Saunders was writing at a time of the deadliest pandemic the world had ever seen — the Spanish flu.

The trenches of World War I may have been the perfect petri dish for the disease.

“The war fostered influenza in the crowded conditions of military camps in the United States and in the trenches of the Western Front in Europe … at the height of the American military involvement in the war, September through November 1918, influenza and pneumonia sickened 20% to 40% of U.S. Army and Navy personnel,” Dr. Carol Byerly wrote in The U.S. Military and the Influenza Pandemic of 1918–1919. The article, published in 2010, was written for the National Institute of Health.

But in the horrors of the war, there was little notice taken of a flu-like illness that seemed just one of many ways to die. And if notice was taken, no one wanted to let the enemy know the ranks of its soldiers were being thinned by disease.

It became known as the Spanish flu because the press in Spain, which was neutral in the war, could report on it in its uncensored newspapers. The disease spread rapidly across the globe, reaching its peak in 1918-1919, although there is some evidence that it continued into 1920. When the final tally was taken, the H1N1 strain of the flu virus had infected 500 million people and killed an estimated 20 million, although most experts feel that figure is low.

The first cases of a new virulent influenza-like disease may have occurred in January and February 1918 in Haskell County, Kansas. The county’s physician, Dr. Loring Miner, was so concerned about what he was seeing that he alerted the Public Health Service, the predecessor to the National Institutes of Health, according to John Barry the 2004 article “The Site of Origin of the 1918 Influenza Pandemic and Its Public Health Implications.”

“Miner considered this incarnation of the disease so dangerous that he warned national public health officials about it. Public Health Reports (now Morbidity and Mortality Weekly Report), a weekly journal produced by the U.S. Public Health Service to alert health officials to outbreaks of communicable diseases throughout the world, published his warning,” he wrote.

By March of that year, the first cases had appeared at Fort Funston, Kansas. Although Haskell County was 300 miles to the west, Fort Funston was where new recruits were sent to be trained for the trenches of World War I.

shows newspaper headlines that talk about influenza — A montage of newspaper headlines from the 1918-19 flu pandemic. Source: North Carolina State Board of Health

Although the Spanish flu was an influenza virus, it was novel, unlike any that had been encountered.

Flu viruses in the past had attacked the youngest and the oldest — the immature and weakened immune systems. But this new version of the virus assailed the young and healthy, attacking the lungs and filling them with fluid and often causing death within 48 hours. The blue death, it was sometimes called, as damaged lungs tried in vain to supply oxygen to the victim’s blood.

The official death toll from the Spanish flu in North Carolina was around 13,700. Relative to today’s population, that would be about 56,000 fatalities.

The first case in the state was recorded Sept. 19 in Wilmington. In two days, William Wright, 29, was dead, according to the Wilmington Star-News. Within a week the city reported more than 500 cases.

At the time, Wilmington was home to a state-of-the-art medical facility, the James Walker Memorial Hospital, but it was quickly overwhelmed by the patients who were streaming in.

The virus spread swiftly, taking advantage of the state’s transportation system.

“The virus moved westward, along railroad lines,” David Cockrell wrote in “A Blessing in Disguise.”

In Raleigh, 288 people perished by the end of October.

Then-Gov. Thomas Bickett quickly realized the enormity of what was confronting the state. On Oct. 3 he released a 600-word statement to the press that included a brief history of the disease.

Gov. Thomas Bickett

“The disease started in Spain in May, this year, involving 30 percent of the population of that country within a short time. Already the disease has invaded and practically passed through Europe …” he wrote.

The governor noted that the disease was transmitted through “spit swapping,” which included “coughing or sneezing into the air instead of a handkerchief… ; soiling the hands with spit … and using common drinking dippers.”

Finally, acknowledging that there was no treatment, he ended with, “In conclusion, public officials can do little to protect you. You can do a great deal to protect yourself.”

In his message, Bickett encouraged the public to stay home, to not congregate. The governor seemed to be ahead of his own health department and the federal government, according to Laura Austin in her 2018 University of North Carolina Charlotte public policy doctoral thesis, “Afraid to Breathe.”

“Despite the fact that the day before, Oct. 2, The News and Observer reported that neither the state nor the national health authorities considered quarantine measures practicable, the governor was encouraging people to stay at home in hopes of decreasing the circulation of the disease,” she wrote.

Bickett tried another tactic, reissuing the information he sent to the papers though the North Carolina Council of Defense, a statewide organization administered within each county that was created to support the war effort during the war.

That message got through to county officials, Austin noted, although each county decided for itself what measures to put into place.

“When Governor Bickett issued requests to the councils of defense in each county by telegram in early October 1918, the response was immediate,” she wrote.

In New Bern, Craven County, when a case of Spanish flu was diagnosed, the house was quarantined. Dorcas Elizabeth Carter , who died in 2009, was 4 in 1918 when her African American family became ill. Eight-five years later, in a 1999 interview she still recalled what it was like. The virus didn’t recognize racial boundaries, but society did at the time, as her memories make clear.

Dorcas Elizabeth Carter

“All of my family, there were six of us, had influenza. We had a black doctor. Dr. Fisher. There were six of us in one room. Coughing, Lord I thought we were going to die. He had a black nurse to go to all of us. Because all of the homes there were quarantined. A mother and child across the street from us died of it. And down the street another person.”

Cities were where the death toll was highest, but rural counties were also affected. Roy Sawyer’s article for the Tyrrell County Genealogical and Historical Society, “The Influenza Pandemic of 1918-1919. Life on the Alligator River,” examined the effects of the disease on Tyrrell County.

Columbia, the county seat, was a relatively thriving town on the Scuppernong River with a population a little more than 2,000 in 1918.

The first flu death in town was 14-month-old Samuel Baty on Oct. 14. More deaths followed, Sawyer writes, quoting Blanche Cohoon as saying the situation was, “the most dire situation” of her life.

“Folks were dropping dead throughout the county,” Cohoon said. “It was almost an hourly message that some friend had died.”

Columbia had two physicians in town, but there was still no treatment for the disease. The state has been estimated to have had a 20-25% infection rate. In the four months that the flu ravaged the town, the infection rate was 35%. Flu was the official cause of death listed for 18 residents.

But if Columbia and Tyrrell counties had doctors available to treat the sick, not every place did. And when doctors were flown in to treat Coast Guardsmen and others on the Outer Banks, not everyone here appreciated the kind of attention the newfangled aircraft attracted.

“Flying Machine Advertises Flu” the headline read on the front page of the Elizabeth City Independent Jan. 31, 1919. “Dare County Folk Don’t Like Publicity of Flu Fliers” was the subhead.

“Fighting the Flu via aero may be great sport for the U. S. Medical Corps and furnishes interesting headlines for newspapers but it isn’t making the strongest sort of appeal to the people of Dare county who are the beneficiaries (or the victims) of this latest adventure,” the article explained.

But Dare County was suffering from the flu epidemic like every other North Carolina county.

“B. G. Crisp, an enterprising lawyer of Manteo,” had conceived the idea of getting aid from the U.S. Public Health Service on the ground that influenza had broken out in Coast Guard stations, “of which there are a great number in Dare County.”

The Health Service stayed a week and declared “local physicians had the situation well in hand.”

It would seem, though, that they never got to Hatteras Island.

Navy Chief Pharmacist’s Mate George McNabb was sent to Hatteras Island in 1918. In 1926 he wrote “Reminiscences of an Influenza Epidemic” for the Navy Hospital Corps.

“In 1918 an epidemic of Spanish influenza was rampant in the area of Cape Hatteras, N.C. Under instructions issued to me I was to proceed to that vicinity and render treatment to the afflicted to the best of my ability. My medical outfit consisted of a 4-ounce bottle of tincture of iodine, 1 clinical thermometer, 1 pound of magnesium sulphate, and 100 vegetable-compound pills. A few days later the medical supplies were increased by one standard torpedo-boat medical box,” he wrote.

He spent two years trekking up and down the island, often with a Coast Guardsman at his side, his effort evidently successful.

“Only one death occurred out of over 500 cases treated,” he reported.

“It was with great reluctance that the writer left these good people, for, after having spent 2 years among them, he felt that he had become one of their own,” McNabb wrote of his time on the island.

A little boy is on his dad's arm, looking at a baby through a window at Martin General Hospital, which will soon stop offering maternity services

Eastern NC hospital nixes maternity services

September 30, 2019 by Liora Engel-Smith

Eastern NC hospital nixes maternity services - North Carolina Health News

Martin General Hospital says pregnant women can deliver their babies at other area facilities, but some locals say it isn’t that simple.

By Liora Engel-Smith

When Brittany Bullock left Martin General Hospital with her new bundle of joy earlier this month, she couldn’t help but feel sad. The birth of her second child, Emery Ann, went exactly as planned and the newborn, who took her first breath on Sept. 16, was well.

But Bullock, a resident who herself was born in the Williamston hospital, couldn’t shake the realization that her daughter is among the last babies to be born at the labor and delivery unit.

The Quorum Health hospital announced in a press release earlier this month that it was discontinuing labor and delivery services effective Oct. 21 “to better meet the community’s long-term needs.” The hospital will continue to provide inpatient and outpatient gynecological services, the release said, but there weren’t enough births in the unit to keep the maternity services going.

Instead, the release said, Martin General has set its sights on accommodating the region’s other needs, including behavioral health and cardiology.

A hospital building is seen from a distance, in front of it is a lush lawn and trees. The building is Martin General Hospital — Martin General Hospital announced earlier this month that it was stopping its labor and delivery services. Image courtesy of Martin General Hospital.

With birth centers at three Vidant facilities in a 35-mile radius — in Washington, Tarboro and Greenville — the hospital said, pregnant women in the region still have options.

An EMT by training, Bullock said it wasn’t that simple. Every minute matters in labor, she said, and longer trips to a hospital could pose risks to mothers and their babies.

“Anything can happen in 35 minutes,” she added. “I mean, anything can happen in five minutes. It’s just like a blink of an eye and you can lose both lives.”

The second-floor ward at Martin General is more than a convenience, she argued. It is a medical home where providers know her well. On the day of the cesarean section, she added, one of the nurses even showed up before the morning shift began to greet Bullock. The impending change to the hospital kept coming up during Bullock’s three-day stay.

“The nurses kept saying stuff like, ‘We enjoyed you … and we’re sorry that this had to happen.’”

A common refrain

Martin General Hospital isn’t the first to curtail costly, but essential services. Rural communities across the state have been contending with similar cuts for years.

A FY2017 survey by the North Carolina Healthcare Association found the state had 30 rural facilities that offered maternal or neonatal care. By comparison, 50 urban hospitals across the state offered these services in 2017, the survey found.

At least three of the rural maternity service providers listed in that survey no longer exist. Two Mission Health units in western North Carolina shut their doors in 2017. And in January, Cape Fear Valley Health said it would not reopen its Bladen County birth center following extensive damage from Hurricane Florence.

Martin General is the second hospital in the area to reduce the services it offers this year. Last month Vidant Beaufort, a hospital just one county over, closed its behavioral health unit.

Rural hospitals with maternity and neonatal services are green. Four rural hospitals who have either discontinued or will discontinue their maternity services are red. Urban hospitals are blue.

Note: This map has been updated thanks to feedback from our readers on an additional labor and delivery unit closure.

This map collates NC hospitals who had 25 or more deliveries in FY2017. We updated names of hospitals that have since changed, with the old name in parentheses. The data comes from North Carolina Health Association, who surveyed hospitals for the information. When hospitals didn’t respond to the survey, fields remained blank. Urban/rural designations are based on definitions from the Centers for Medicare and Medicaid.

The American College of Obstetrics and Gynecologists define OB level 1 as basic care, OB level 2 as specialty care, and OB level 3 as subspecialty care.

Data source: N.C. Healthcare Association. Map credit: Liora Engel-Smith

In an emailed statement last week, Martin General’s interim CEO John Jacobson said there weren’t enough births for the hospital to offer labor and delivery services feasibly. Almost half of the deliveries from communities around the hospital happen elsewhere, he added, leaving the unit with only three deliveries per week on average, Jacobson wrote. But the hospital has to staff the unit around the clock, even when there aren’t births.

Jacobson did not say how much the hospital will save by discontinuing its maternity services, but as a report by the Commonwealth Fund pointed out, the cost of providing these services has increased, outpacing health insurance reimbursement rates.

In his statement, Jacobson alluded to “limited resources,” but did not delve into the financial constraints and the role they played in the decision to discontinue maternity services at Martin General. A Medicaid cost report obtained from the N.C. Department of Health and Human Services shows that the for-profit, 43-bed facility lost just over $3 million from May 2017 to April 2018.

Martin General’s parent company, Quorum Health, lost more than $200 million in 2018, according to its federal Securities and Exchange Commission filing. As of 2018, the most recent SEC filing said, Quorum had a debt of $1.2 billion.

The Brentwood, Tenn.-based organization, which operates 26 hospitals in 14 states, closed one hospital and sold 10 others since 2016, according to a March story in Becker’s Hospital Review. The same report also said that Quorum intended to sell some of its underperforming hospitals, reducing the number of health care facilities it owns to roughly 20.

Jacobson did not indicate in his response if Martin General was one of those underperforming hospitals or if any other service reductions were on the horizon.

“We’re excited about treating patients locally for important health care needs such as behavioral health and cardiology services,” he wrote in response to a question on the topic.

The hospital’s continued viability is important to the county, said Martin County Manager David Bone.

So when Martin General asked the county board of commissioners to amend the lease that allows the hospital to operate in the county-owned building on South McCaskey Road, the commissioners agreed. The commissioners voted unanimously to amend the lease at a Sept. 11 meeting.

“We understand that this is an emotional decision, there’s a lot of emotions involved — the [Labor and Delivery department] has provided great services over the years and we’re not discounting that,” he said. “ … Unfortunately, you can’t take financial aspects out of it.”

Voicing concerns

Vickey Manning, social work supervisor at the Martin-Tyrrell-Washington District Health Department, spoke against the impending move at the September meeting.

In a phone conversation earlier this month, Manning said the health department cares for numerous pregnant women, many of whom are either uninsured or on Medicaid. She said the department currently serves about 50 pregnant women from Washington and Martin Counties, and a number of them planned to give birth at Martin General.

The women the department typically cares for will likely struggle with longer trips to hospitals out of the county, she said. Some women prefer to receive their prenatal care with the doctor who would eventually deliver their baby, but she worried low-income women may not have that option because of the cost of travel or the increased time commitment for out-of-county appointments.

Medicaid recipients, she said, can use county transit to get to medical appointments, she said, but that option may not work for everyone. And public transportation may compound the time commitment, especially if women have to leave well in advance to catch a shuttle.

“My concern is if we have a woman who, let’s say has a preschool child, and she does not have childcare,” Manning said. “Well, if she has an appointment now, she’s gotta go to Greenville or Tarboro or Washington for her prenatal appointment and her child cannot ride on that transit with her [because] he’s not a patient.”

Taking to Facebook

As news of the decision to discontinue labor and delivery services rippled through the community, local women formed a Facebook group in protest. As of last week, “fight for mgh ob/gyn!!” had just under 700 members. Alongside calls to action, questions and comments, members shared birth stories and photos of babies born at Martin General.

A screenshot of a Facebook group called — Almost 700 locals joined a Facebook group after Martin General Hospital announced that it will no longer offer maternity services.

Williamston resident Cindy Bembridge joined the group, even though she figured the hospital probably wouldn’t change course.

“The main concern, I think, in the community, is what’s gonna happen in a true emergency if they don’t have something available,” she said. “If a mom goes into labor at 29 weeks and she’s here in Williamston. 30 minutes is gonna make a big difference.”

Bembridge has other worries, too. Though the hospital said it will continue to provide gynecological services, the Williamston resident wasn’t sure if her doctor would remain with the hospital after Oct. 21.

Bembridge said keeping her doctor was important to her. She was the one who delivered Bembridge’s daughter, Carly, who is now 12, and performed surgeries on Bembridge, and screened her for cancer once a year.

“These doctors, it’s not like they live somewhere and they come here from (elsewhere),” she said. “The doctors in that office live in the community too … it’s just a sad situation.”

In his statement, Jacobson said that “a number of employees” from the unit accepted other positions in the hospital and fewer than 10 full-time employees chose to leave Martin General.

But as of last week, Bembridge did not know if her doctor was staying or leaving.

“I personally will follow her wherever she goes,” she wrote in a Facebook message. “[I]f it’s close by.”

shows a street sign reading, "Watch for Senior Citizens"

Matthew & Florence taught NC lessons: Storms like Dorian threaten old people

September 5, 2019 by Thomas Goldsmith

Matthew & Florence taught NC lessons: Storms like Dorian threaten old people - North Carolina Health News

The serious perils that older people in North Carolina face during hurricanes are lurking again in the gales and rainy torrents of the powerful storm Dorian. Across the state, prepared professionals and private citizens are stepping up to minimize harm.

By Thomas Goldsmith

The specters of catastrophic hurricanes Matthew in 2016 and Florence last year are looming darkly over this week’s preparations for Hurricane Dorian, the latest unwanted newcomer to the Tar Heel State.

Across North Carolina on Wednesday, older people and those charged with looking after them made preparations, checked registries of vulnerable residents, and pondered some lessons of these recent massive storms. For older North Carolinians, Florence created a particularly tragic legacy where two out of every three of the 39 people killed by the storm were 65 or older.

shows an old man with a sharp gaze sitting in a room with many cots and blankets — At 103, Wilmington resident George Alsberg was likely one of the oldest voluntary evacuees of Hurricane Florence in 2018. He spent time in a shelter in Raleigh while he waited out the storm. Photo credit: Taylor Knopf

“Our counties overall do a tremendous job of working with the Emergency Management Center and local EMS,” said Laura Alvarico. She’s the director of the Albemarle Commission Area Agency on Aging and works with 10 coastal county governments to make sure seniors are safe. “What worries me is that flooding can be the worst part of a hurricane.”

The likelihood of coastal flooding from Dorian meant that operators of long-term care centers were keeping close contact with Alvarico and others about whether assisted-living and nursing homes should evacuate residents or tough out the storm in place.

“We are working with all the long-term care centers to make sure they are either evacuating or if they are staying put that we get a copy of their emergency plans,” said Alvarico, who works with Camden, Chowan, Currituck, Dare, Gates, Hyde, Pasquotank, Perquimans, Tyrrell and Washington counties.

“They put a lot of consideration into where the storm is headed, also their elevation, also the things they have in place, like generators.”

Checking one by one

A bill to require generators in assisted living facilities stalled in the General Assembly this spring when industry representatives argued the requirement would cost more than state reimbursement could cover.

When older people in the community register for county assistance such as in-home aides, they can be placed on a special needs registry, like the one in New Hanover County, that details what help they’ll need in times of disaster. Staff at the nonprofit agency Resources for Seniors in Raleigh were already calling people on the Wake County registry Wednesday, said Heather Burkhardt, program manager.

“We are calling all of our clients and their family members to see if they are in need,” Burkhardt said. “We do a pre-disaster call-down to see if they need anything in the next few days.”

The Resources for Seniors staff, like other experienced workers across the state, plan for needs that others might not predict. When a storm nears, they print out long physical lists of phone numbers they will need and take them home, so they can check with clients via cell phones even if electricity is down. If agencies can’t fill their in-home aide slots, social workers make sure family members, friends, or neighbors can fill in.

‘Floodwaters can be deadly’

floodcdc_exhaust — The exhaust or fumes from a portable generator could kill you in minutes if you breathe it in. Image courtesy the Centers for Disease Control and Prevention.

“So many of our clients depend on in-home aides. They need to have backup plans in case their aides can’t get there,” she said. “It’s intertwined in our daily business and it doesn’t just happen in hurricanes. It can be ice storms or just somebody calling in sick.”

Planning like this can forestall some of the deadly developments seen in Florence among people older than 65: the six of 11 vehicle-related drowning victims, three out of the five people who died while cleaning up their properties, and a couple, 86, who died after lighting candles because they had no power all were 65 or older.

Already on Wednesday, the state marked the first death connected with Dorian when a Columbus County man, 85, fell from a ladder while getting his home ready for the storm. Gov. Roy Cooper announced the death during an afternoon press conference. He also cautioned North Carolinians about a perennial hazard: “We know all too well that floodwaters can be deadly.”

Just don’t do it

The vehicle drowning deaths fall in too-familiar territory for Steve Marshall, director of the Injury Prevention Research Center and an epidemiologist at UNC Chapel Hill.

“The primary advice always has to be, don’t drive on flooded roads,” Marshall said.

“With water that’s muddy and you don’t know what’s here, there could be a rock, could be anything. You’ve got no idea what you’re driving into or over. So, if not for your own protection, at least for the safety of others, don’t try it.”

People tend to underestimate greatly the power of water that’s running parallel to the direction of the road, Marshall said.

“A lot of people have pickup trucks or big SUVs,” he said. “But, you’ve got to realize that these vehicles are still designed for dry land, not developed with the idea of driving through rapidly moving water.”

Preparations such as those connected with the special needs registries can preempt the need for urgent missions into flooded roads.

“People in disaster situations are often trying to act with appropriate caution and take care, however, they also have a lot of other things going on,” Marshall said. “Sometimes they’ve got to get food, or go get supplies, or tend to a loved one, or go check on Grandma. People are stressed and wanting to go and verify that their loved ones and family and neighbors are safe.”

Sometimes making sure in advance that both older people and their caregivers have plenty of supplies and charged-up cell phones can keep both parties safely at home.

oral health advocates visit legislators' offices, they're met at the door of one of them in this photo by a young woman

Raising the Profile of Better Oral Health

June 6, 2018 by Jared Weber

Raising the Profile of Better Oral Health - North Carolina Health News

Many of North Carolina’s communities lack the recommended number of dentists. Oral health advocates gathered in Raleigh on Tuesday to raise awareness for this issue, which disproportionately affects rural communities and minorities.

By Jared Weber

For many rural North Carolinians, there’s no quick fix for a nagging toothache.

Last year, the state Department of Health and Human Services reported that only 18.8 percent of the state had a sufficient number of dentists. Three counties — Camden, Hyde and Tyrell — lack a single dentist within their boundaries.

Overall, North Carolina has 3.9 dentists for every 10,000 people. Nationally, that number is closer to 6.1 per 10,000.

woman speaks using a microphone — Zulayka Santiago, who emceed Tuesday’s event, wraps up Oral Health Day with some closing remarks. Santiago, a first-generation immigrant who grew up without access to adequate oral health care, said the issue is more than cosmetic. “Oral health impacts peoples’ economic viability; it impacts their children’s ability to concentrate in school; it’s a massive issue in rural areas,” Santiago said. “It has massive ripple effects, both on individuals and communities.” Photo credit: Jared Weber

About 135 advocates gathered on Bicentennial Mall in front of the General Assembly building on Tuesday morning to voice their concerns at their second annual legislative Oral Health Day.

The event was put on by the North Carolina Oral Health Collaborative, a program which partners with organizations that share a common goal of providing affordable oral health care to all North Carolinians.

Zulayka Santiago, the program’s director, said the oral health issues stem from the state’s restrictive dental hygiene laws.

According to North Carolina’s Dental Hygiene Act, licensed dental hygienists can only perform their work if a “licensed dentist directs in writing” to do so.

Santiago said those dentists tend to be protective of this privilege, limiting the scope of practice for dental hygienists. Allowing hygienists to provide care to more people is at the core of her program’s initiative.

“There’s no reason — and this is supported by science and evidence — that hygienists shouldn’t be able to do more,” Santiago said.

‘A good starting way to come together’

It’s unlikely that any bills will be passed this year to extend affordable health care to rural North Carolinians, as lawmakers are racing toward the end of this year’s legislative work session.

Lawmakers sent their approved state budget proposal to Gov. Roy Cooper’s desk on Friday evening. That budget made no change to the amount of money appropriated for oral health preventive services in 2017, with just under $5 million set aside.

Republican legislators hold veto-proof supermajorities in the House and the Senate, so regardless of what action the governor takes, the budget is expected to become law.

That didn’t worry Santiago and the other advocates on Tuesday, though. Santiago said the day was “generally about awareness.”

“[Oral Health Day] is a reminder about the importance of integrating oral health into these conversations, which are getting a lot more traction, around whole-person care,” Santiago said.

For now, Santiago said the program’s goal is to maximize access to oral health care under the state’s current laws.

“Who wouldn’t get behind more access to preventive oral health care for children in school systems?” she said. “We’ve been having conversations with the oral health section, with the North Carolina Dental Society, to figure out how we can come together around our goal.”

Both sides of the aisle did come together for the event when Rep. Donny Lambeth (R-Winston Salem) and Rep. Gale Adcock (D-Cary) gave a joint speech about the importance of oral health.

Lambeth is a primary sponsor of the Carolina Cares bill, a Medicaid expansion bill proposed last year.

He said that since his reform plan would pay for patients having better outcomes, rather than just paying for services rendered, it will encourage better oral health care from a younger age.

Language justice

Since poor oral health adversely affects communities of color, the collaborative made an effort to make Tuesday as inclusive as possible.

One of the ways they ensured a welcoming environment was by striving for “language justice,” said outreach coordinator Suzanne Martin.

woman writes on a sheet of paper taped to the wall — Suzanne Martin scribbles down audience suggestions to consider for next year’s Oral Health Day. “My background is as a social worker … focused on social justice issues,” said Martin, the event’s outreach coordinator. “So, for me, oral health is about the disparities between different communities in regards to their oral health outcomes.” Photo credit: Jared Weber

The collaborative hired two professional Spanish translators for the day, who alternated with one another to provide a live translation of all English speakers to Spanish-speaking attendees through headsets, which were handed out at the start of the day.

Martin said the decision was a no-brainer.

“We espouse that we value inclusive environments,” she said. “This is really acting on that.”

Iareli Renteria, a Spanish speaker and mother of three, attended the event with the group from El Pueblo, Inc., a Raleigh-based Latinx advocacy group.

She said she really appreciated the bilingualism of the event.

“Using my own language is always easier. Without it … you only more or less understand what the others say,” Renteria said.

Moving forward, differently

The collaborative has a busy next year planned after the short session wraps up, including a complete shift in the way they provide disadvantaged communities with financial support.

In the past, Martin said, they have identified issues, partnered with community organizations, and then given them money to make changes, with no additional oversight.

“We’re flipping that model,” she said. “We’re working with community partners from the onset and saying ‘We have money. What do you self-identify as the issues?’”

Martin said the change is being made because of a lack of progress in spreading oral health awareness in recent years. She’s encouraging anyone who’s interested to get involved with the program in their own community.

“It’s important to know that you’re not alone; that there’s a place to go to find basic information about oral health, and to find out who else is a part of the conversation,” she said.

A Plea for Oral Health

April 6, 2017 by Education NC

A Plea for Oral Health - North Carolina Health News

North Carolina ranks 47th in the country in the number of dentists per person and some counties don't have any dentist at all.

By Alex Granados

EducationNC

Zulayka Santiago knows what it feels like not to have access to oral health care. When she was a child, a few years after she and mother moved to Louisiana from Puerto Rico, her mouth started to hurt.

While her family managed to get coverage for some medical costs, dental care was not included. Her mother worked a series of barely minimum wage jobs, and paying for a dentist was nearly impossible.

“In the winter of 1984, the pain in my mouth had gotten so bad that I could barely stop crying,” Santiago said. Fortunately, her mother was eventually able to find a dentist across town that would help, and Santiago’s pain went away.

Santiago, director of the NC Oral Health Collaborative, told the story at the Oral Health Day at the legislature which brought together oral health advocates to educate legislators about the issue in North Carolina. Santiago’s personal narrative opened the event.

“That’s the point that brings us here to this place and time. To this moment,” she said. “I am here to highlight that for too many North Carolinians, finding a dentist who will see them in a timely manner, that they can afford and can communicate with, is difficult if not impossible.”

A young man speaks, while others look on. — Left to right, Leighton Harrell, Parrish Ravelli, Jacquelyn Hedrick, and Carolina Le talk with Rep. MaryAnn Black. Photo Credit: Alex Granados/EducationNC

The event included many groups, including the National Children’s Health Foundation, Youth Empowered Solutions (YES), and North Carolina MomsRising. Representatives of the groups and other advocates gathered on the Bicentennial Capitol Mall in front of the North Carolina General Assembly for a series of speakers before heading into the legislature to meet with lawmakers.

They shared statistics like 13 percent of kindergartners in the state have untreated tooth decay. Fifty five percent of American Indian and 52 percent of Hispanic children get tooth decay. Only 30 percent of white children do. And children with poor oral health are three times as likely to miss school because of dental pain.

Beth Messersmith, campaign director for NC MomsRising, was one of the morning’s speakers. She said that tooth decay is the most common disease in early childhood. In fact, it is two to three times as common as asthma or childhood obesity, she said. Despite that, some children still fall through the cracks.

“Dental care remains the single greatest unmet need in our state,” she said, adding later “The most important thing that we all know is that this is totally preventable. There is no excuse.”

It is an issue not just of concern to mothers, but also to high schoolers like 17-year-old Sanderson High School student Jacquelyn Hedrick. She joined two other high schools students — 17-year-old Enloe High School student Leighton Harrell and 17-year-old Raleigh Charter High School student Caroline Le — in meeting with legislators where the students shared facts about oral health.

They are all staff members at YES. Jacquelyn joined about two years ago. Before that, she did not know much about the state of oral health in the state.

“As a relatively affluent young person living in the ever-so-glamorous suburbs of North Raleigh, I kind of coasted through the majority of my life blissfully unaware that so many people around me, so many people within my community and my state, were suffering because of a lack of access to oral health care,” she said in a speech Wednesday morning.

When she joined YES, Jacquelyn learned about the oral health inequities in North Carolina. For instance, she became aware that there are three counties in the state with no dentists whatsoever: Hyde, Camden and Tyrell. Meanwhile, in Wake County there are more than 500 dentists, she said.

“I realized that as someone who has always enjoyed the privilege that is ease of access to care, I had an obligation to bring the voices of young people who don’t experience that privilege to the table with decision makers,” she said.

Rep. MaryAnn Black talks to the students from YES! Photo Credit: Alex Granados/EducationNC

Jacquelyn, Leighton and Caroline went with YES Team Lead Parrish Ravelli to the offices of lawmakers like Rep. MaryAnn Black, D-Durham, and Sen. John Alexander, R-Wake.

Leighton explained to Black why they were there and what they wanted to impart.

“It’s an issue that not a lot of people know about,” he told Black. “And it’s really a much bigger problem than is kind of talked about.”

Hedrick explained some of the limitations that North Carolina places on oral health practitioners, affecting their ability to care for patients in need. For example, she told Black that North Carolina is below the national average for dentists but above the national average for dental hygienists. Those dental hygienists could theoretically fill in the gaps, but a clause in the Dental Practice Act hampers them.

The clause essentially provides that before dental hygienists can perform certain practices, patients have to receive an examination from a dentist, Hedrick said.

young woman talking to a man and a woman standing in an office doorway. The young woman looks animated, using her hands to make a point — Left to right, Jacquelyn Hedrick, Parrish Ravelli and Sen. John Alexander’s Legislative Assistant Perry Wester meet to talk about oral health. Photo Credit: Alex Granados/EducationNC

“Which means for everything they could provide, there is an extra step added in that hinges on having a dentist present,” Hedrick told Black. “And we know that there aren’t always dentists present.”

At Sen. John Alexander’s office, he was not available to talk with the students, so they met with Legislative Assistant Perry Wester instead.

“We just want it to be something that’s thought about,” Hedrick told Wester, before informing her about the inequity between the three counties that have no dentists and bigger districts like Wake County. “This kind of leads to lack of access across the board.”

While oral health is not necessarily on the forefront of many people’s minds, it is important because lack of oral care can affect lives in substantial ways, Caroline told the crowd at the Oral Health Day event.

“Oral health determines our ability to eat and speak,” she said. “…a day at school would not be possible if we are constantly thinking about what is happening in our mouth and the pain.”

The event did not target any specific legislation, nor did the advocates focus on swaying any particular political party in the General Assembly. They just wanted to get the facts out. Santiago says oral health is not a partisan issue.

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