Thursday, October 5, 1978
Rural Areas Statewide Getting Response To Medical 1 Care Needs
Folks
itfjQreene bounty can
* remember when just about
every town bad its own
physician.
After World Warn, a half
dozen doctors were scat
tered throughout the
countryside in this tobacco
growjpg county of 15,000.
But the 1960 s only one
semi-retired physician was
left. The others had died or
followed the migration to
the cities.
The same thing has
happened all through rural
America, where some 57-
millita people still live.
From; Appalachia to the
Great. Plains, from North
Carolina to Washington,
towns are frantically trying
to lufc new, physicans. But
the appeals of rural 'life are
outweighed by ; doctors’
wariness of long hours, calls
in the night, and
professional and social
Eolation.
People in the Greene
County hamlet ‘ of
Walstonburg, population
170, spent 10 years trying to
get a. physician to fill the
vacancy left when Dr.
William A. Marlowe died.
“His old offices were empty
and waiting,” recalls
resident Jo Taylor. “We
wined and dined lots of
young doctors, but none of
them-decided to stay.”
New Approach Tried
Walstonburg never its
own physician. But in 1973 it
(Physical fitness ,* a
GROWING INTEREST AMONG
AMEKi£AAIS WHO SPENT ABOUT
12 OIUIOM POLLARS 0N
equipment -this year. yct. it
is that the average
AMERICAN SPEWPS ONLY ABOUT
70 MINUTES A WEEK ON EKERCISB.'
4E fr n<
SMTHe U.fc.ABMV,
SPENP AN AVERAGE
OF AN HOUR A PAY with
EXERCISES RANGING FROM
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EQUIPMENT AVAILA9LE AT
-TH6tR POSTS/
NOTICE!
All unsightly and unseasonable
flowers will be removed from
Vine Oak Cemetery and Beaver
Hill Cemetery on October 16,1978.
Anyone can remove their own
flowers prior to that date.
V
Your cooperation will be greatly
1 appreciated.
2 » t x i
• W. B. GARDNER
9 ADMINISTRATOR
•of IX LOTH jSBM
the IXUPBOARD WSm
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did open a modern health
center, tucked away next to
a cornfield on the edge of
town. Sore throats, finders
injured in tobacco loopers
and most other patient needs
were taken care of by a new
health professional, a
family nurse practitioner.
She also could screen
patients for referral to
physicians and provide
continuing care for those
with chronic conditions. She
got continual backup by
telephone and visits from a
readily available Wilson
physician.
“The Walstonburg Clinic
was one of the first nurse
practitioner clinics in the
country,” says Dr. Cecil G.
Sheps of the Health Services
Research Center at the
University of North
Carolina at Chapel Hill. Dr.
Sheps is- professor of social
medidhe'fin the UNC-CH
School of Medicine.
Back m 1969 he says he
encqujragqd community
leaders ,to abandon their
search for a physician and
develop a program built
around a nurse practitioner
with physician backup
because the situation was
almost hopeless. “Younger
doctors were increasingly
going into specialty
practice and wanted to work
in metropolitan areas.”
Since then, new interest in
rural primary care has
promoted it from a medical
stepchild to a national
priority.
Today there is an alphabet
soup of federal agencies
involved in providing health
care in rural areas RHI
(Rural Health Initiatives),
HURA (Health Underserved
Rural Areas), NHSC (The
National Health Service
Corps), as well as programs
operated by the Indian
Health Service, the Ap
palachian Rgional Com
mission and the Migrant
Health Program. There
are private philantropic
programs like Presbyterian
Medical Service in the South
gqjjrflinics funded by
The Robert Wood JoHHSotf
Foundation of Princeton,
N.J. And there are a few
state programs like North
Carolina Office of Rural
Health Services, and some
labor union programs like
the rural health centers
supported partly by the
United Mine Workers.
“What we need to do now
is find out which types of
rural health programs are
working best and why,” Dr.
Sheps says. And that’s what
he plans to do. He is
directing the UNC-CH
Health Services Research
Center and Department of
Health, Education and
Welfare’s joint national
evaluation project.
“The results will make it
possible to provide financial
and technical assistance in
ways that will do the most
good,” he says.
More Clinics Opened
The Walstonburg Clinic
was successful...so suc
cessful that people in other
towns in the county wanted
local medical care too. That
led to the formation in 1976
of Greene County Health
Care Inc., which has opened
medical centers in Snow Hill
and Hookerton.
Jo Taylor is chairman of
the board of the community
controlled non-profit cor
poration. She enjoys talking
about the staff of 61 in
cluding two physicans, two
physican assistants and a
dentist and about the
comprehensive care they
provide local people. There
are after-hours service,
weekend and evening hours
and even a home health
program serving
homebound patients in
Greene and two neighboring
counties. Visitors come
from all over to see how the
people in Greene County
managed it.
“In the early days we
thought small,” Miss Taylor
says. “We had to start with
Waltsonburg first. The
longer we had the project,
the more capable we were of
thinking big.”
Many Programs
At Work
North Carolina has
continued to be a leader in
brinang primary health
Fare to rural areal. As the
nation’s most rural state, it
also has been one of the
hardest hit by the shortage
of primary care physicians.
In some ways, says Dr.
Sheps, it is a microcosm of
the types of programs that
have sprouted up around the
country to bring care to
underserved areas.
One of the most successful
programs is the N.C. Office
of Rural Health Services.
“This is the only state with
an agency committed to
placing health programs in
rural areas,” says Jim
Bernstein, its founder and
director. “In many ways,
the agency grew out of the
Walstonburg experience.”
Bernstein, one of the
earliest specialists in rural
care, worked for three years
with the community of
Walstonburg as a planning
consultant while he was an
HEW research fellow at the
UNC-CH Health Services
Research Center. He was
asked to direct the Office of
Rural Health Services
when it was established in
1973. Since then, his office
has helped set up 18 more
medical centers, most of
them staffed by nurse
practitioners or physicans
THE CHOWAN HERAT. n
assistants. The office also
is attracting an impressive
30 to 40 additional physicians
a year to rural areas of
North Carolina, a state with
a population just more than
five million.
North Carolina also has
the nation’s largest Area
Health Education Centers
program, which has become
a model for getting students
from medical, dental and
nursing schools into rural
areas -to train, providing
continuing education to
health professinals
everywhere in the state.
Federal Programs
Federal programs are
represented too. There are
about 40 National Health
Service Corps physicians
working in rural North
Carolina as part of the
national education loan
forgiveness program.
Many community
operated clinics, like those
in Greene County, receive
help in meeting their
operating costs through two
related federal efforts,
First Cut
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Rural Health Initiative and
the Health Underserved
Rural Areas program, which
send some $55-million a year
into rural America for
community health
programs.
The nation’s largest
'w Pr
CLINICS PROVE HELPFUL At the Walstonburg Community Health Center, Kim
Vincent, a physician assistant, examines Mrs. Lena Walston.
privately funded effort in
primary rural care is the 19-
million Rural Practice
Project of The Robert Wood
Johnson Foundation, which
is administered by UNC-CH
Since 1976, it has funded 10
community - responsive
demonstration practices
around the country, in
cluding one in Bakersville,
in swhich physician
administrator teams work
with new health
professionals to provide
care.
Page 5-A
An increasing number of
private physicians and
hospitals have opened
satellite offices to bring care
to isolated rural areas.
Future Looks Better
It will be several years
before the full impact of all
these programs is known.
But already North Carolina
is seeing some im
provement. Medical
manpower shortages were
eased in 70 counties out of
100 between 1970 and 1976,
while shortages got worse in
just 12. The majority of the
state’s citizens live in rural
areas, and like rural people
everywhere they are letting
their representatives know
they want their share of
quality medical care.
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