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PHOTO BY BILL FAVIR
WE ARE INVITED to "live in each season" as we join the many birds, crabs, fishes and other ani
mals along the shore.
Live In Each Season
BY BILL FAVKR
Our hot weather this summer reminds us we live in
a place where we can cxpericncc
the seasons in all their glory. We
have just enough cold weather and
snow to let us know about winter,
i. and we have the most beautiful
J springs and autumns we could
Our summers arc hot and hu
mid, sometimes more so than at
others. We hear lots of people re
mark how nice a cold winter day
would be right now; just as we
heard some folks yearning for summer last January.
In the writings of Henry David Thoreau, we arc re
Live in each season as it passes; breathe the air,
drink the drink, taste the fruit, and resign yourself
to the influences of each. Let these be your only di
et-drink and botanical medicines...
Be blown on by all the winds. Open all your
pores and breathe in all the tides of nature, in all
her streams and oceans, at all seasons...
Grow green with spring... yellow and ripe with
autumn. Drink of each season's influence as a vial,
a true panacea of all remedies mixed for your espe
For all nature is doing her best each moment to
make us well. She exists for no other eml. Do not
resist her. nature is but another name for health.
While Thoreau here is writing about living off the
land in a piece he calls "Huckleberries," wc can appre
ciate the meanings for us today who cxpericncc the
healthful aspects of the natural world. We know wc
can find exercise and rest, excitement and content
ment, and refreshing change of pace in a natural set
ting. Such settings at this season of the year can renew
us and help us put our purposes and problems in better
What better advice can wc get than to "live in each
season" and to enjoy this special season along the
coast? So, "breathe the air, drink the drink, taste the
fruit, and resign yourself to the influences of the sum
mer as you join the birds and the fishes and the crabs
and other creatures along the seashore.
Engineer Offers Explanation
For Shellfish Waters' Opening
EDITOR'S NOTE: The writer is one
of two engineers from Powell Asso
ciates of NMB, Inc., under contract
to the towns of Sunset Beach and
Calabash to consult on the towns'
proposed central sewer system.
To the editor:
Reference is made to a letter pub
lished in the July 22 edition of the
Beacon from Mr. Frank Nesmith re
garding the temporary opening of
waters to shellfishing on July 10.
According to N.C. Shellfish Sani
tation Branch records, certain estu
arine waters in the Sunset Beach and
Bird Island area were temporarily
opened on July 10, 1993, and then
cluscd oil July 19, 1993. Siicimsii
Sanitation records also show that
similar openings occurred for 31
days in 1990, and that Jjnks Creek
was opened for six days in 1991.
What is most interesting about
this most recent temporary opening
is that the opening included all estu
arinc waters between the Intra
coastal Waterway and the Atlantic
Ocean from the N.C./S.C. state line
to Ocean Isle Beach, with the excep
tion of the estuarine waters directly
between the island of Sunset Beach
and the mainland west of the Sunset
Bcach bridge (the Blanc Creek
In other words, the opening in
cluded Mad Inlet, Tubbs Inlet, Jinks
Creek, and all waters west of the is
land of Sunset Bcach to the state
line, even including Little River
Inlet, but specifically excluded the
Blane Creek area. Why?
There were 40 sampling locations
within the area for which samples
were taken on July 6 and 7, 1993,
and tested for fecal coliform counts.
Of the 40 samples tested, the highest
fecal coliform count was measured
a? sampling station 33 on Blanc
Creek adjacent to the island of
duusci. Bcach. This siaucn showed a
fecal coliform count of 79.
The next highest fccal coliform
count measured was 23, which was
observed at two sampling stations.
One of these two stations is the con
fluence of Little River and the wa
terway, and the other, the Calabash
River at Calabash.
During periods of extended dry
weather, the groundwater level gets
?ower. Tidal fluctuations do influ
ence the groundwater elevation, but
the degree of influence diminishes
rapidly with distance inland from
the ocean. Mainland pollution of cs
tuarine waters from septic tank sys
tcr.s, and from other sources as
well, should be significantly reduced
during dry weather periods. It is
therefore not surprising that with no
rainfall and a lowered groundwater
elevation that cstuannc water quali
ty, in general, will improve.
But, hascd on our investigations
to date, it is also not surprising to
see an elevated fecal coliform count
around the island, despite the lack of
rain, as the island is more suscepti
ble to tidal influence on groundwa
ter elevations. Our previous investi
gations have shown a link between
scplic tank systems and water qua!:
ty in the groundwater and immedi
ately adjacent estuaries around the
island. Samples taken by the Bruns
wick County Board of Health on
June 30, 1993, in the canals and es
tuaries around Sunset Beach, as re
ported in the Beacon, provide fur
ther substantiation of the conclu
sions of our investigators.
We hope this information may be
of benefit to Mr. Nesmith and other
James R. Billups
North Myrtle Beach, S.C.
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MILLIKEN HOME CENTER
The Shallotte Electric Stores, Bus. Hwy. 17, Shallotte ? 754-6000
Baby, You Can Drive My Car
I've suspected all along lhal there
would come a day of atonement lor
my misspent youth. It's so close
now I can smell it.
By the end of this summer, my
15-year-old son Patrick will possess
legal authority to operate a motor
vehicle as long as 1 am there. In the
"death scat." Curled in the fetal po
sition with my face contorted in a
silent scream reminiscent of Edvard
Munch's "The Cry."
This is serious business for both
of us. For three hours a day for the
past two weeks, we've left home
every morning at 7:30 to get him to
driver's education class, after which
he has ? without pleading, threaten
ing or any manipulation whatsoever
from mc ? actually studied the man
For the past several Sunday after
noons, he has disappeared to the car
port with a handful of cassettc tapes
to spend hours washing and waxing
our vehicles and cruising all ten feet
of driveway to the sounds of bands
with names like Green Jelly.
He even bought a can of paste
wax with ? and only 1 know how in
credible this is ? his own money.
"I'm going to be driving them, so
I want them to look good," he says,
his expression as sincere as the
witch's must have been as she sat
Hansel and Gretel down to a sump
1 am thankful for driver's cd. It's
one facet of my parental responsibil
ity I cheerfully abdicate to the N.C.
Department of Public Instruction.
I grew up in South Carolina,
where you could get a daytime dri
ver's liccnsc at 15. I got mine after
my dad look me out in the country
and put me behind the wheel of a
'64 Chevy Impala until I could stay
in the right lane without having to
squint and line up the chrome hood
trim with the shoulder of the road.
My only classroom training was
what we called "hamburger on the
highway" films from the Highway
Patrol. These gruesome shockumen
laries were shown in health class ?
usually after lunches of cold greasy
barbecue and warm coleslaw ? in a
futile effort to dissuade our class
mates who owned GTOs and Super
Sports from exceeding the posted
speed limits. As if they had any
brains to leave on the pavement...
I'd like to think that the kinder,
gentler modem method of driver's
education will leave my only child
with a keen sense of responsibility
and a profound awareness that the
most dangerous thing about a motor
vehicle is the loose nut behind the
For his own protection, I wish I
could find him a Chevy like the one
1 drove. By 1969 standards, it wasn't
a big car. Today, it would be a veri
table land yacht, with length and
breadth of steel able to withstand al
most any serious assault by Hyundai
A side benefit would be that he'd
only be able it) afford a fraction of
the cruising 1 could gel for my 32.1>
cents a gallon (plus a quart of trans
mission fluid every fill-up.)
My childless friends attempt 10
soothe me into this new era by say
ing things like, "Just think, you
won't have to run any errands after
he gets his license. You can send
him after groceries, to return ihe
videos, 10 lake the cal to the vet..."
Like I don't remember the fact
that as a teenager 1 never ran a sin
gle errand that took less than four
hours. And that I have yet to pro
duce a dime of change from those
many fives, tens and twenties with
which I was entrusted.
Like 1 don't remember that any
errand, be it only a half-block mis
sion to fetch the dry cleaning, was a
call to cruise every high school
hangout in town. In my little town
these included Hardee's, the Tastcc
Free/, and the football stadium, any
of one which was five miles from
It was necessary, of course, to
slay at each place for a little while in
order to sec and be seen. And Mama
surely would understand how all
that errand-running had left me with
a hunger only a chili chcesedog and
fries could satisfy, even though sup
per might be on the table at home
that very minute. After all, it was
just a couple of bucks. Her bucks.
They don't call it a trip to the
cleaners' for nothing.
Program Reduces Medicaid
Costs , Improves Care Quality
BY \V. VANCE FRYE
Ten years ago, the Kate B. Rey
nolds Charitable Trust received a
proposal to fund a program designed
to achieve two objectives that many
people considered to be in direct
conflict: to reduce Medicaid costs
and to improve the quality of health
care for Medicaid recipients.
Today, after three grants from the
trust totaling S744.000 and thou
sands of hours invested in education,
training and coalition-building, Car
olina ACCESS, a managed health
care program, has proved its merit
and is being expanded to reach al
most every person in North Carolina
who is eligible for Medicaid.
That it has taken 10 years for the
demonstration project to get this far
illustrates that changing the health
care system takes time, patience and
cooperation. It also illustrates that,
with the proper approach, costs can
be reduced at the same time quality
of care is improved.
The Division of Medical Assis
tance, which operates the state's
Medicaid program, projects that
Carolina ACCESS will generate a
net savings for the state of S778.000
in Medicaid costs this year, S2.0
million in 1994 and S3. 5 million in
1995. Full implementation of the
program could result in savings of
S30 million a year. At the same
time, thousands of people ? many of
them children and the elderly ? now
have their own personal physicians
for the first time.
As the nation struggles with the
question of how best to reform the
health care system. North Carolina
has already begun to address the
problem through Carolina ACCESS.
It is becoming a model for other
states, and many people see it as a
bridge between today's system and
the health care delivery system of
the future for the nation's poor.
The project was conceived and
has been nurtured along by Jim
Bernstein and staff of the North
Carolina Foundation for Alternative
Health Care Programs (NCFAHCP)
in conjunction with the Division of
Medical Assistance, a unit of the
Department of Human Resources.
The original concept of the founda
tion was to build public-private part
nerships that address health care
needs in the state, and Carolina AC
CESS was an excellent example ot
what could be attempted.
Although it is a quasi-governmen
tal organization, NCFAHCP has
transcended state politics. It was es
tablished in 1982 during the admin
istration of Democratic Gov. Jim
Hunt, received support during the
two terms of Republican Gov. Jim
Martin and continues with Hunt
again in the Governor's Office.
The goal of Carolina ACCESS is
to provide quality health care ser
vices to all citizens, regardless of
their ability to pay, without exhaust
ing the state's limited resources. Its
original objectives were to:
?Improve access to comprehen
sive and quality health care for the
?Improve the participation of pri
mary care physicians in Medicaid:
?Reduce inappropriate use of
emergency rooms, specialists and
?Strengthen the patient/health
care provider relationship;
?Promote the educational and
preventive aspccts of health care;
?Maximize the investment in
care for recipients.
Those were lofty objectives, con
sidering the challenge in changing
the system. To achieve them, NC
FAHCP had to deal with a large
number of parties, many with vested
interests. It also had to obtain wai
vers from the Health Care Financing
Administration, secure massive
changes in the state's computer sys
tems and create behavioral changes
among Medicaid recipients.
The role of the Kate B. Reynolds
Charitable Trust has been to provide
the funding for the administrative,
technical and educational support
needed to get Carolina ACCESS on a
sound footing. NCFAHCP provided
staffing throughout the nine startup
years. Now that the program is estab
lished, full responsibility and control
has been transferred to the Division
of Medical Assistance, and the two
foundations can give their attention
to other innovative programs.
The demonstration project was
conducted in Wilson County in the
mid-1980s at the request of the med
ical community there. During the
first year of operation, the average
number of hospital days per Med
icaid patient declined by 58 percent.
The net savings to the state and to
Wilson County was more than
S300,(XX) in that 12-month period.
Ironically, the two private clinics
that were involved in starting the
project have been dissolved by the
participating physicians, and Wilson
County is rebuilding its program.
In 1991, after two years of prepa
ration, the demonstration was ex
tended to Durham, Edgecombe,
Henderson and Moore counties.
Local implementation continue 1 to
advance painstakingly, gaining pri
vate support and recipient participa
tion while responding to territorial
concerns of local government units.
The results in these counties mir
rored the results in Wilson. An inde
pendent report by the Office of State
Therapeutic, professional massage given in the privacy of
your own home or mine, for your convenience. Please call
and make your appointment today.
C1993 THE BRUNSWICK B?ACON |
Budget and Management document
ed a net savings of S25 per Medicaid
recipient between September 1991
and February 1992 in the initial five
Currently, 16 counties arc partici
pating in the program: Beaufort,
Buncombe, Burke, Caldwell, Dur
ham, Edgecombe, Forsyth, Greene,
Harnett, Haywood, Henderson, Ma
dison, Moore, Nash, Pitt and Wayne.
The Division of Medical Assis
tance wisely has resisted pressure to
hurry the program across the state.
The division is adding counties only
as they indicate a desire to partici
pate and demonstrate a capability to
implement and sustain the program.
Approximately 85,(XX) citizens arc
enrolled now, and it is projected that
enrollment will increase to 3(X),(XX)
within two years.
In the participating counties, Car
olina ACCESS has the support of
primary care physicians, private
clinics and hospitals, the Depart
ment of Social Services, the Depart
ment of Public Health and local gov
ernmental leaders as well as the re
cipients of Medicaid. These local
coalitions have been built one at a
time across the state.
As a managed carc program, Car
olina ACCESS enlists the participa
tion of primary care physicians and
allows them to accept any number
of Medicaid patients up to 1,200.
Physicians usually take only a small
number of patients until they be
come comfortable with the program.
They agree to provide Medicaid re
cipients with 24-hour availability of
primary care or referrals for other
neccssary medical services, just as
they would do for their other pa
tients. In addition to their normal Ice
for services, they receive a S3-a
month administrative fee for each
Medicaid patient assigned to them.
Medicaid recipients arc permitted
to choose their primary carc physi
cian from among the list of partici
pating physicians in their county.
Once they have made that choice, all
of their health care is coordinated
through that physician. If they try to
see another care-giver, they arc told
that they first need the approval of
their primary care physician. This
practicc has reduced inappropriate
use of emergency rooms, has virtu
ally eliminated the duplication of
services and prescription cum* and
has provided a continuity of preven
tive carc that reduces the likcliluxxl
of more expensive carc later.
The dilemma for all states has
been how to provide quality health
carc services to all citizens, regard
less of their ability to pay, without
exhausting the state's limited re
sources. While many states have fo
cuscd on reducing costs through
their Medicaid managed carc pro
grams, North Carolina has attempted
to find ways to get more mileage out
of currcni resources. Few states have
changcd the delivery and utilization
of health carc services as successful
ly and substantially as North Car
olina has been able to do through
Vance Frye is director of the
Health Care Division, Kate B. Rey
nolds Health Care Trust, Winston