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Martin County's Nov Health Caro Practice Providos
Hope for The Future
Kv A 4 x
PLANNING MEETING - Members of Martin County Community Action, Inc. discuss
operations at the NHSC practice in Jamesville, I r are Willis Williams, Vice Chairman;
Dallas Lyons; Ben Jones, Jr., Postmaster in Merry Hill; NW Slade, Chairman; Mrs. Doris
Wallace, Treasurer; Mrs. Milmer Williams; Haywood Harris, Executive Director, and Dr.
Terry Wallace.
NATIONAL HEALTH SERVICE CORPS
Set up to administer,
the Emergency Health Per
sonnel Act of 1970, the
basic purpose of the Na
tional Health Service Corps
(NHSC) program is
to redistribute scarce
health manpower re
sources into shortage areas
until such time as the
educational system brings
production into line with
needs and demands.
Not intended to create
long-term federal dependen
cy for health services, the
intent is the introduction of
a small number of scarce
health prbfessionals to
stimulate local community
development around health.
I This development includes
tne setting up ot linkages tor
the primary health care
team, outside the
community; resource
I development to provide a
f facility, equipment,
supplies, and comple
mentary staff, and local
X consumer education around
health issues.
The NHSC subscribes to
the World Health Organiza
tion definition of health as
"complete physical, mental,
and social well being and
not merely the absence of
disease or infirmity", and
as such there are several
client levels to which this
applies. These include: the
individual, the family or
household, and the com
munity in which the indivi
duals and families live. :
, Any community in the
' country can request to be
certified as a critical health
manpower shortage area.
Anyone can make that
request on behalf of a com
munity as the same proce
dural response is given to
a post card from a pri
vate citizen as a thick
proposal from a State
planning agency. Though
the initial applicant may be
- anyone, at the time of
assignment of personnel to
a community the official
applicant must be a non
profit incorpoated organization
After certification as a m
critical shortage area, per
sonnel are recruited and
placed for these areas. Pri-
mary consideration in this
placement is on professional
; categories such as
I physicians, dentists, and
i nurses.
Concerned with the
effectiveness and longevity
,of the assigned personnel,
NHSC specifically con
siders assignee preferences
(ie, urbanrural, profes-
sional expectations,
attitudes about communi
ties and health, and many
others including personal
considerations important
to the assignees and their
families) before making
a decision. OF equal concern
. is the consideration of the
community needs and expectations,.
ASSISTING WITH RECEPTION While receptionist Ms. Glenda McEachern wasoui
is dental assistant Delois Langford, '
J
40l , j Q - )J; y
CHECK-UP - Dr., Wallace gives a check-up, while Mrs. Delois Langford assists
t
Photos and Feature)
ly KELVIN A. IELL Aislftodi lf tVllYH SHELLEY JNCHUDP)
When we arnved at
11:00 the waiting room of
this National Health Service
Corps (NHSC) practice in
Jamesville was already
full. Young and old alike
waited for the opportunity
to be seen by the dentist,
one of the six in the county,
but the only black dentist in
the region. 1
They came for treatment
from as close as down the
road . or as far away as
Hampton, " Virginia. They
came, as did we, In the
pouring rain.
While we waited for a
moment's word with Dr.
Terry Wallace, one man
came out of the operating
area smiling; thanking the
receptionist for the oppor
tunity to come. It was
rather striking to see such
an atmosphere where blacks
and whites waited patiently
and happily for the chance
to get in we didn't under
stand why until we talked
with the dentist. '
The 1977 graduate of the
Howard University Dental
School was smiling a warm
friendly smile when we en
tered . the operating area.
The onslaught of patients
eagerly seeking his assitance
had caused him to forget
that we were coming. He
showed us to a room where
we could work and talk
while he schuttled from one
treatment room to another
taking care of the business
for which he had returned
to the county.
Dr. Wallace is "particu
larly concerned about the
size of the cavities in
children under age thir
teen." Problems such as
these are causing a need for
major endodonic work at a
young age.
Suggesting that child
ren be brought to the den
tist before they are three
years old, Wallace says
that regular flouride treat
ments would save money
and cavities. However, he
cautioned that "if they go
home and don't pick up
the toothbrush, then they're
still in trouble because of
the plaque and the germs."
Contrary to much of
what is believed of dentists,,
this dentist relates quite
well with his patients and
the rapor that Jie has estab
lished is helping to get
health care to a
number of people
area. :
Dr. Wallace felt an ob
ligation to return to his
community to help the peo
pie with whom he was
raised. This he does.
Other dentists would
only have seen many of
them on an emergency, if
at all. But the way he treats
them and educates them,the
practice sponsored by
Martin County Community
Action, Inc., will continue
to grow.
Martin County Commun
ity Action, Inc. (MCCA)
was the applicant organiza
tion for the NHSC primary
care program, and as such
provided the facilities; over
sees the management of
specific functions; hires and
supervises support person
nel, and evaluates and moni
tors the ongoing practice.
greater
in the
The NHSC on the other
hand, provides continuing
medical education; pays a
salary to the dentist, and
assists the community or
ganization and the assignee
in . managing the practice
and solving problems that
arise.
STATE
Though minorities com
prise approximately 25 per
cent of the State's popula
tion, less than two per
cent of the physicians and
dentists are minorities. With
fewer than 150 black phy
sicians, the black physician
population ratio is about
1:8,000 while that of the
indian physician population
is about 1; 15,000. '
The statistics for minor
ity dentists reflects an even
more critical situation. With
fewer than seventy black
dentists practicing in the
State the ratio is about
1:18,000. Nearly half of
these are nearing retire
ment age. And though
North Carolina has the fifth
largest Indian population in
the nation (nearly 50.Q00)
there are no indian dentists
currently practicing in the
state. :
OPPOSITION
There has been much op
position to the placement of
a National Health Service
Corps dentist in Martin
County, as well as in Gran
ville County, where another
such practice has, more
recently, opened. The pri
mary source of this opposi
tion has, supprisingly, come
from, two of North
Carolina's dental societies
the Fifth District Dental
Society headed by Dr.
Wayne C. Anderson of
Jacksonville, and the North
Carolina Dental Society
headed by Dr. Harold E.
Maxwell V in C FayettevSlft..
The Old NotthStateDenta) t
Society, under the director '
of Dr. Curtis Bowens, "of
Chapel Hill has been an avid
supporter.)
"We have given a consid
erable amount of thought
and research to your
request for certification of
need J." began a letter
from the Fifth District
Dental Society to Hay
wood Harris, Executive
Director of Martin County
Community Action,
Inc.
"This letter is to indi
cate that we feel that Martin
County is not a shortage
area and we hereby wish
to inform you," the
letter continued, "that the
Society does not feel that
Martin County should be
qualified as an area for
the placement of a NHSC
dentist." '
The HEW criterion of a
dentist population ratio of
1:5000 (since lowered to
1:4500) for a declared
shortage area was their justi
fication. At the time the
ratio was "1:4979", accord
ing to the letter.
There was no indication
of the type of health care
being given to what segment
of the population, in the
letter from their president.
UUtSTlUN Or NEED?
''You'll always get the
discrepancy between
dentists as to the need
for additional dentists in
an area," said Dr. Edward
Price, whose six year old
practice handled about eight
patients per day during the
first 3-4 months. By the
end of the year that average
had risen to 10-11 per day.
Dr. Price noted a recent
ADA (American Dental As
sociation) article which
pointed out "that only half
of the people (in the U.S.)
went to dentists in the last
twelve months-but that
85 of the population has
dental problems so you
see that there is some dis
crepancy." He continued
by saying that "this may be
due to economic, social
or other reasons." With
his hygienist, Dr. Price
now averages about 24
patient visits per day.
The comments we re
ceived from the dentists
in the county did vary quite
a bit-from the "1 don't
MIXING - Wallace prepares material to make a gum impression for dentures.
know what to say about
it;' pf Dr. EJC. Wright,
Jr. to that of Dr.
"William H. Graya, veteran.;
of more than 25 years of
dental service in the
County, who said "I think
we have enough dentists
in the County to take care
of the County."
The latter indicated that
there was already an "over
supply of dentists" in the
area. When asked about pa
tients on Medicare or Medi
caid, his indignation further
surfaced as he refused to
provide information as to
how many patients he sees
or exactly how long he
had been in practice. -We
had already been informed
that he and his staff hand
led about fifty patients
per day including his nine
regular appointments and
mi iNJ ; ; mmw I i
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If
WAITING FOR AN, OPPORTUNITY TO SEE THE DENTIST
N.C. Health Haipowor Dovtlopntit Prograa
The North Carolina
Health Manpower Develop-
Ament Program (NCHMDP)
with headquarters in Chapel
t Hill, is an inter-institutional
program of the University
i of North Carolina. :
Designed to help meet the
I critical need for health
manpower in North Caro
lina, particularly in
minnritv and rlkflrtvan.
I taged communities, the
major objective ot tne f ro-
gram is to attract, recruit,
! counsel, and retain min
ority group students in
health professional pro
grams and careers particu
larly medicine, dentistry,
nursing, pharmacy, public
health, and in allied health
fields.
In addition to increasing
the number of minority and
4 disadvantaged persons
trained and employed in the
health careers, NCHMDP's
immediate and long-range
goals include: increasing th'
availability of health ser
vices to . jnjnprity cjammun
ities; increasing the com
mitment of all service agen
cies and mechanisms in
North Carolina on behalf of
improved services to minor
ity peoples, and to improve
the quality of health care
delivery and services for
minority communities.
The National Health
Service Corps will be assist
ed by the NCHMDP in
the establishment of new
dental health care practices
in NHSC scarcity area
sites in North Carolina. The
program will act as a bason
between the NHSC and se
lected minority communi
ties to insure that potential
applicant agencies are tho
roughly familiar with the
procedures and require
ments involved in establish
ing a local health care prac
tice through a National
Health Service Corps part
nership which will provide
NHSC manpower.
Through its central office
and regional centers, the
NCHMDP will furnish
personnel, materials, and
equipment necessary to
identify and orient a min
imum of ten communities
(selected, from a total of 41
counties) toward partner
ship opportunities for
establishing health care
practices with the National
Health Service Corps. Two
sites are currently in operation-one
in Oxford (Gran
ville County) and one in
Jamesville (Martin County).
"work-in" time.
Other comments from
county dentists included
those of Dr. David Marsh
burn, an eleven year veteran
of the area who said he
really didn't know that
much about the Jamesville
practice, but that it "hasn't
made any difference in my
practice."
"Sure, it will serve a need
in the community" he said
in responding to that
question. However, he was
quick to add that he
thought that the "amount
of work that he does is sort
of slow." According to Dr.
Marshburn, he averaged 10-10-15
patients per day
during his first two years,
but that with the current
office staff of ten girls
(including five dental
assistants and two hygien
ists) he now averages be
tween fifty and sixty pa
tients per day.
Citing that his original
objection as based on
the placement of a NHSC
practice . jn Robersonville,
which he felt could have
' crippled his practice which
opened there in August,
1976, Dr. Henry A.
Kearney III said "I haven't
really thought about it
since then." Having al
ready pointed out that
during the first 28 weeks of
his practice, he saw an
average of eight patients
per day, Dr. Kearney says
that depending upon what
he is doing, he now averages
between 8-10 patients per
day.
Serving a designated area
which includes parts of
some fifteen counties and
two thirds of their county
seats, Dr. Terry Wallace, in
his six-month old NHSC
practice in Jamesville, is al
ready averaging at least 15
patients per day and is
already booked into June.
Apparently there is a rather
great need being filled by
this practice. :
In response to a request
for a waiver of the certifica
tion of need by local and
state dental societies, Ass
istant Surgeon General
Edward D. Martin wrote, "In
as much as 45 per cent of
the critical dental shortage
areas in the United States
are in Region IV, the
waivers are both appropriate
and commendable in re
sponding to community
needs."
SERVICE AREA
"Community needs"
as it refers to Dr. Martin's
statement and HEW direct
ives would include eleven
of the more than 55 North
Carolina counties pre
viously designated by HEW
as being "critical dental
shortage areas".
Cavities and Pyrhea
(a gum disease) are listed
as the fifth and sixth most
prevalent health care prob
lem in the area behind
hunger and malnutrition,
high blood pressure, high
risk pregnancy, and
ulcers. With a median age
of about 27, education
coupled with dental health
care that Dr. Wallace is pro
viding will ensure that the
dental health of the area
will increase as does the age
of its population. Lectures
on proper dental care,
which have been given by
Dr. Wallace, have already
shown significant results. :
. What is evident is that
in the past, patients (resi
dents of the county) have
gone to dentists only in
the event of emergency (Le.
toothache), and that there
has been little or no
education as to proper oral
maintenance. '
"This is one of the most
prolific problems in the
area, pointed out Dr.
Wallace. Patients have not
been taught how to appro
priately care for their teeth.
Therefore their past visits
to the dentists have been
basically a "removal" type
situation merely treatment
of the problem and not
the causes...'
What is evident is that in
the past patients have gone
to the dentist only in the
event of an emergency
perhaps now that will
change at least for
those fifteen counties
and the host of communi
ties which this practice serves.
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- Hlt!r - yTi
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EH ... -, I- v d .xivL .a -
DR WALLACE CHECKS PATIENTS DENTAL PROBLEM