By Will Atwater

When Hurricane Helene ripped through western North Carolina, it downed power lines, leaving tens of thousands of residents without electricity for days, even weeks. 

Duke Energy reported “severe” infrastructure damage, including submerged substations, thousands of downed utility poles and fallen transmission towers. The company also noted that mudslides, flooding and blocked roads hampered efforts to quickly restore power.

At Duke Energy’s Marshall Substation in the town of Hot Springs, heavy rains and flooding forced the shutdown of the facility. But Hot Springs was more fortunate than most. In 2023, Duke Energy had installed a microgrid of solar panels and lithium-ion batteries to restore power quickly in case of emergency.

A microgrid is a self-contained electricity system that can operate independently of, or in coordination with, the main power grid. A common example is rooftop solar panels that supply electricity to homes, enabling residents to either disconnect from the main grid entirely or rely on it only as needed.

Hot Springs’ system, which can provide 100 percent of the town’s peak load and up to six hours of backup power, went live on Oct. 2, only five days after the storm. The microgrid operated continuously for the next 143.5 hours, providing power to the town’s center until power was restored to the area on Oct. 8.

The project, initially intended to be a proof of concept, worked to help the town get back online far ahead of its neighbors. 

“It wasn’t as luxurious as a typical grid-powered home,” said Sara Nichols, energy and economic program manager for the Land of Sky Regional Council, a multi-county, local government organization. “It kept that town going when most people had nothing. It’s a huge success story.”

Hurricane Maria provides example

Rural and community health centers are a vital safety net for millions of Americans.

“As the largest primary care network in the nation, community health centers serve one in three people living in poverty — many in communities most impacted by environmental and climate hazards,” said Kyu Rhee, president and chief operating officer of the National Association of Community Health Centers, in a 2024 news release.

“Community health centers [are] not for profit organizations that receive a limited amount of federal support to provide care to anyone —  [including] primary medical, dental, behavioral health, discounted Pharmacy [services]  — and there in all 50 states and territories,” said Ben Money, from the association. 

Money used to run the N.C. Community Health Center Association and knows the needs of this state well, including its extensive history of hurricanes disrupting power to crucial services. He pointed to Hurricane Maria, which devastated Puerto Rico’s power grid in 2017, as a turning point that accelerated efforts to equip health centers with solar-powered microgrids to improve disaster recovery.

Arturo Massol-Deyá, executive director of Casa Pueblo de Adjuntas, a nonprofit community organization based in Puerto Rico, described the conditions on the ground after Maria.

“The disaster in Puerto Rico was not the hurricane,” Massol-Deyá said. “It was the aftermath of the government’s [inability] to restore basic services and all the mismanagement of the situation.”

In the aftermath, Casa Pueblo used support from donors to help “democratize the energy grid” by installing solar and microgrid systems across communities — powering homes, schools, businesses and essential institutions.

“We have addressed health issues by building energy security,” he said, “because there’s a lot of people with chronic diseases — like high blood pressure, diabetes and respiratory issues — that require therapy and medication.”

Money echoed that point and emphasized the importance of keeping health clinics operational during and after emergencies.

“When community health centers are down, they can’t see patients,” Money said. “Those patients that need care end up going to the emergency room, where it costs an exorbitant amount of money to get something that could be delivered at a fraction of that cost at a community health center.”

“Each day a health center is closed due to a power outage puts the organization at a financial risk,” Money said, potentially leading to reduced services, staff layoffs or even permanent closure. By contrast, a solar microgrid system can lower operating costs, allowing centers to reinvest savings back into patient care and services. 

In 2024, the U.S. Department of Energy announced nearly $60 million in funding to support solar microgrid installations at rural community health centers. The investment is part of its Energy in Rural or Remote Areas program that’s managed by the Office of Clean Energy Demonstrations.

The initiative targets rural health centers across the southeastern U.S., a region that experienced 474 weather-related power outages in 2022 — more than any other part of the country, according to the National Association of Community Health Centers.

The NACHC was also awarded a contract by the Department of Energy in 2024 to equip rural health clinics in North Carolina and other Southeastern states with solar microgrids. While the project is still in the planning stage, it is moving forward — despite federal funding cuts and increased scrutiny of Biden-era climate investments, Money said recently.

Advocating for microgrids

Long before Hurricane Helene battered western North Carolina, Sara Nichols had been working on ways to strengthen local power infrastructure in remote mountain locations — but she had struggled to gain traction with funders who denied multiple applications for support.

“We were working with designers and learning what projects needed — all the logistics,” said Nichols,whose organization serves four counties and 16 municipalities in western North Carolina.

Nichols said funders were hesitant to invest because the region lacked a history of major weather disasters.

“When I got a denial days after [Hurricane Helene] I was like, ‘Are you sure about that?’”

Despite being hundreds of miles from the coast and more than 2,000 feet above sea level, few expected the western North Carolina region to be so vulnerable. But Helene made one thing clear: No place is safe from severe weather. 

As a result of Helene — and with the Hot Springs example in mind — Nichols and others have renewed their advocacy around communities — especially rural ones — to include microgrid technology in their resiliency planning. 

“I feel like we may have better chances now being able to tie things to our hurricane relief work,” Nichols said.

‘Emerging technology’

While the microgrid in Hot Springs delivered power in the wake of Helene, Duke Energy spokesperson Logan Stewart cautioned that microgrids are still an emerging — and costly — technology. “They’re not the best solution in every situation,” she said.

Duke Energy is investing in another strategy: self-healing technology, which automatically reroutes electricity from functioning service lines when an outage occurs.

“It’s kind of like a GPS in your car,” Stewart said. “If there’s an outage on your line, it’s going to just automatically reroute you to another line. 

“We have [self-healing technology] integrated across about 60 percent of our grid in the Carolinas,” Sewart noted. “We’re going to continue to expand, but we have miles and miles of line, so it just takes [time] to do that.”

Stewart noted that self-healing technology is better suited for urban areas, where terrain is less of a challenge. 

“Microgrids can be a solution,” she said, “but it depends on the community terrain, cost and several other factors. It’s something we’re going to continue to explore — because the performance during Helene was fantastic.”

The post In the wake of disasters, rural health could end up running on sunshine  appeared first on North Carolina Health News.

Environmental justice efforts at the ten U.S. Environmental Protection Agency (EPA) regional offices have stopped and employees have been placed on administrative leave, per an announcement from EPA Administrator Lee Zeldin earlier this month. Former EPA employees involved with environmental justice work across the country say rural communities will suffer as a result. 

Before being shuttered in early March, the EPA’s environmental justice arm was aimed at making sure communities were being treated fairly and receiving their due protection under the Clean Air Act and Clean Water Act. Zealan Hoover, former senior advisor to the EPA administrator under the Biden administration, told the Daily Yonder that this work had big implications for rural places since there are pollution concerns in rural areas across the country. 

“EPA was very focused on making sure that not just on the regulatory side, but also on the investment side, we were pushing resources into rural communities,” said Hoover. 

According to Hoover, most of the pollution challenges the U.S. faces are not new. He said that the employees—now on leave—who staffed the EPA’s regional environmental justice offices were deeply knowledgeable on the issues affecting communities in their regions; issues which can go on for decades. Hoover said he worries about recent changes to the agency under the Trump administration, which also include a series of deregulatory actions and a proposed 65% budget cut. 

“I trust that the great folks at EPA who remain will still try valiantly to fill those gaps, but the reality is that this administration is pushing to cut EPA’s budget, pushing employees to leave, and that’s going to restrict EPA’s ability to help rural communities tackle their most significant pollution challenges,” Hoover said. 

One rural community that has faced years of environmental challenges is where Sherri White-Williamson lives in rural Sampson County, North Carolina. In 2021, the county’s landfill ranked second on the list of highest methane emitters in the U.S. The county is also the second-largest producer of hogs nationwide, and in 2022, it accounted for nearly three percent of all U.S. hog sales. 

The hog industry is known for its pollution from open waste storage pits that emit toxic chemicals into nearby neighborhoods. For years, concerns about North Carolina’s hog industry have centered on the disproportionate harm that its pollution does to low-income communities and communities of color since hog farms frequently locate their operations adjacent to such communities in rural counties. 

White-Williamson is also an EPA veteran. She worked on environmental justice initiatives at the agency’s Washington, D.C. office for over a decade before moving back home to southeastern North Carolina. She is now the executive director of the Environmental Justice Community Action Network, or EJCAN, which she founded in Sampson County in 2020 to empower her neighbors amidst environmental challenges like those wrought by the hog farms and the landfill.

In her early work with EJCAN, White-Williamson said she noticed that conversations about environmental justice often centered on urban areas. Since then, White-Williamson said she has focused on educating the public about what environmental justice looks like in rural communities. 

“A lot of our issues have to do with what the cities don’t want or dispose of will end up in our communities,” said White-Williamson. “The pollution, the pesticides, the remnants of the food processing all ends up or stays here while all of the nice, clean, freshly prepared product ends up in a local urban grocery store somewhere.”

Another misconception about environmental justice, according to White-Williamson, is that it exists exclusively to serve communities of color. During her time at the EPA, White-Williamson said she spent time in communities with all kinds of racial demographics while working on environmental justice initiatives.

“I spent a lot of time in places like West Virginia and Kentucky, and places where the populations aren’t necessarily of color, but they are poor-income or low-income places where folks do not have access to the levers of power,” White-Williamson said. 

When pollution impacts local health in communities without access to such “levers of power,” the EPA’s regional environmental justice offices were a resource—and a form of accountability. Without those offices, it will be more difficult for rural communities to get the services they need to address health concerns, said Dr. Margot Brown, senior vice president of justice and equity at the Environmental Defense Fund. 

“They’re dismantling the ecosystem of health protections for rural Americans, and by dismantling them, they’ll make them more susceptible to future hazards,” Brown said of the Trump administration’s decisions at the EPA. “It will impair health and well-being for generations to come.”

Brown worked at the EPA for nearly ten years under President Obama and then under President Trump during his first administration. Her time there included a stint as Deputy Director of the Office of Children’s Health Protection. She, along with Hoover and White-Williamson, said that community members will likely need to turn to their state governments or departments of environmental quality in the absence of the regional environmental justice offices.

But White-Williamson noted that state governments, too, receive federal funding. Frozen funds across federal agencies and cuts to healthcare programs, including Medicaid, could wind up compounding challenges for rural communities trying to mitigate environmental health impacts. 

“The communities that most need the assistance and guidance will again find themselves on the short end of the stick and end up being the ones that are suffering more than anybody else,” White-Williamson said. 

Hoover described it as a “one-two punch” for rural communities. On the one hand, he said, rural places are losing access to healthcare facilities because of budget cuts.

“And on the other hand, they are also sicker because the government is no longer stopping polluters from polluting their air and their water.”

The post Closures of EPA’s Regional Environmental Justice Offices Will Hurt Rural America appeared first on The Daily Yonder.

By Grace Vitaglione

This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and The Silver Century Foundation.

Kristin Goforth and Lauren Cox, twin sisters aged 49, moved their father into a Piedmont Triad-area assisted living facility on March 13, 2021. Rick Goforth, then 75, was in good health; he was an avid walker who enjoyed being outside. But he was exhibiting signs of dementia — he had wandered off twice — so they decided a facility specializing in memory care would be safest.

He entered the facility at the lowest level of care available, passing all the assessments for activities of daily living such as independent bathing and eating.

Two months later, Rick was dead.

The sisters said they watched their father undergo a “drastic” decline in the facility; days after his arrival, he fell and broke his wrist. It turns out facility staff were giving Rick medicines the family hadn’t known about, including administering his usual dose of Xanax three times a day instead of his prior regimen of only once a day. Plus, he was getting extra “as-needed” doses. 

Because of the broken wrist, he lost the ability to use a knife and fork, nonetheless the staff didn’t cut up his food for him, Kristin said. 

Rick started falling repeatedly and staff put him in a wheelchair against a wall, with a table blocking him from moving.

Near the end of April, the family took him to the hospital – he was severely dehydrated, malnourished and in acute renal failure — “basically hospice-ready,” Cox said. 

Rick died a couple weeks later.

The sisters had difficulty finding justice for their father’s death. First, the family called the county department of social services, which said they didn’t find anything wrong at the facility. Then they complained to the state, which found the facility had violated regulations resulting in death or serious physical harm, abuse, neglect or exploitation of a resident. Eventually, the state fined the facility $19,000.

Cox called that “a slap on the wrist.” The family sued the facility and came to a settlement subject to a confidentiality agreement that limits Cox from being able to say more. 

Advocates say Goforth’s story is an example of how the regulations overseeing assisted living facilities in North Carolina can be out of date, and public officials’ enforcement of those regulations can vary from county to county.  

When officials do fine facilities for violations, facilities have the ability to negotiate those penalties down to very little, advocates said. A NC Health News analysis found that fewer than half of penalties levied in the last three years were paid in full by facilities. 

Assisted living over time

In North Carolina, assisted living facilities are referred to as “adult care homes” or “family care homes.” There are more than 1,200 of these facilities in the state, according to the North Carolina Department of Health and Human Services, and they can range in size from family care homes — licensed to have two to six residents — to larger adult care homes licensed to have more, with some housing more than 100 residents. 

Residents of these homes may need help with activities of daily living, such as eating, dressing and bathing. They may require 24-hour supervision, but they don’t need regular nursing care. These residents are supposed to have less-complex health needs than those in skilled nursing facilities, or nursing homes, where residents’ needs require regular medical intervention.

The severity of patients’ conditions in adult care homes has become more profound over the years, said Mary Bethel, board chair of the NC Coalition on Aging. People who in the past would have been placed in a nursing home now live in adult care homes, she said.

In recent decades, adult care homes were also the destination for many former psychiatric hospital patients when the state undertook a process of deinstitutionalization for people living in them, said Hillary Kaylor, an ombudsman who advocates for residents in long-term care in Mecklenburg and eight surrounding counties.

Many of the facilities weren’t prepared to take on that mental health population and weren’t given support to do so, she said.

“We over-built [the industry], we under-supported, and then we expected a lot,” she said.

Eventually, North Carolina’s overreliance on adult care homes to house psychiatric patients led to a settlement with the U.S. Department of Justice over improper institutionalization of mental health patients in violation of the Americans with Disabilities Act and the subsequent Supreme Court Olmstead decision. 

‘Working with an old book’

Adult care homes are regulated primarily at the state and county level, whereas most nursing homes, which can receive Medicare payments, have to follow federal rules as well.

Kaylor said oftentimes, the rules for care in an adult care home are set by a contract between family members and/or residents and the facility, so the levels of care can vary. Some facilities may have a registered nurse there eight hours a day, and some may have one that only visits twice a week, for example, she said.

But as patients’ conditions in adult care homes become more severe, Kaylor said that might call for updated regulations to accommodate those changes.

“Sometimes we’re working with an old book,” she said.

There is an enhanced license associated with having a special care unit, or a secure wing specifically for dementia patients, said Elizabeth Todd, lawyer for the Goforth family. Her practice focuses on nursing home and assisted living negligence. 

Facilities must apply for the enhanced license, which comes with higher staffing and training requirements. But some facilities can get around those rules by calling their dementia wing a “memory care unit” and just locking the door, she said. 

In adult care homes, most of the regulations are pretty generic, Todd said.

In contrast, “there’s a regulation for everything in a skilled nursing facility,” she said. “I don’t want to call it the wild west in adult care homes, but it’s not far off.”

The rules governing adult care homes have to be “readopted” every 10 years; the most recent round was completed in 2025, according to a NC DHHS spokesperson. Many areas were strengthened in the last few years, including infection prevention and control, emergency preparedness, administrator and management requirements, and resident discharge requirements.

Jeff Horton, executive director of the NC Senior Living Association, an advocacy organization for adult and care homes, said regulations have become much more stringent over the last couple decades to keep up with acuity levels.

For instance, positions such as medication aides and personal care aides have to undergo a certain amount of training, he said.

If the state were to increase requirements, such as requiring adult care homes to have registered nurses on staff, then the state should also increase reimbursements to facilities that receive public funds, Horton said.

Vacancies and turnover at the state level

Adult care homes are monitored by county departments of social services and the NC Division of Health Service Regulation through complaint investigations and annual surveys.

The state regulatory division had a 25 percent vacancy rate in March 2025 and a turnover rate of 11 percent in 2024, according to a NC DHHS spokesperson. In the past two years, that turnover rate was even higher.

Former Gov. Roy Cooper’s last four recommended budgets included additional positions for adult care surveyor positions, but the NC General Assembly didn’t put funds for additional inspectors into any of their final budgets.

Complaints to the state about adult care homes and family care homes have also increased, the spokesperson said. From 2020 to 2024, complaints rose over 22 percent.

At the county level, regulation can vary depending on resources, Kaylor said. For example, Mecklenburg County has staffers focused solely on adult care homes, but in more rural counties, social services staffers end up stretched thin.

Adult care homes in the eastern part of the state have complained they face stricter enforcement than those in the west, according to Horton. County social services staff in the east tend to be more aggressive and levy fines more readily, association members have told him.

New Hanover County Social Services Director Tonya Jackson said in a statement over email that the team works with staff from the state Division of Health Service Regulation to make sure all complaints are investigated and addressed promptly.

“Additionally, county staff participates in standardized state training each year to ensure a full understanding of rules and regulations,” she said.

The state division gives the same training to all county social services staffers who monitor adult care homes, said a DHHS spokesperson, and the state can provide technical assistance as needed. Situations can vary in each facility, so enforcement happens differently according to each specific place, the spokesperson said.

Inconsistent enforcement

Bill Lamb, a longtime advocate for seniors, sits on the board of directors of the advocacy nonprofit Friends of Residents in Long Term Care. He said the wide variation in penalties and citations across the state shows that enforcement is inconsistent. 

Lawsuits like the one pursued by the Goforth family are sometimes the only way to hold a facility accountable, Lamb said.

Yet even then, some facilities have clauses in their contracts that require residents or family members to agree to settling disputes through arbitration rather than in court. When a consumer signs admission papers for themselves or a loved one into a facility home, these clauses are often tucked among the dozens of pages of legalese in the contract. 

Such provisions eliminate the opportunity for a consumer who ends up in conflict with a nursing home to go to court. Plaintiffs often win less money in these types of cases, Todd said.

State lawmakers have also enacted a cap on noneconomic damages, such as compensation for pain and suffering, for medical malpractice in North Carolina. Those are usually the primary type of damages in a case against an assisted living facility, Todd said. 

That cap can make it harder for plaintiffs to find a lawyer who will take the case, which can take months or even years to pursue. Lawyers often are paid a percentage of the damages as payment, she said.

“The caps on damages is unjust primarily because there is absolutely no limit to the amount of damage these facilities can do, but there is a limit to what they have to pay for having killed people,” Todd said.

‘A leaky bucket’

When state or county inspectors find that an adult care home violated a regulation, they can levy a penalty. If facility administrators disagree with that finding, they can appeal through an Informal Dispute Resolution or go to the state Office of Administrative Hearings. 

Fewer than half of the penalties levied against adult care homes in the past three years were paid in full, according to records from the N.C. Division of Health Service Regulation analyzed by NC Health News. Around 26 percent of the penalties were settled with the state, 11 percent were not paid and referred to the Office of the Controller, 13 percent were in the appeal process and 4 percent were blank.

Lamb said those numbers showed a lack of full accountability.

“That’s a pretty leaky bucket if you ask me,” he said.

Wealthier chains of adult care homes can “lawyer up” and drag out the appeal process, Lamb said, sometimes for years.

Using penalties effectively 

The maximum penalty for a violation resulting in death or serious physical harm, abuse, neglect, or exploitation to a resident is $20,000 for an adult care home, licensed for seven or more residents. The facility can then be fined up to $1,000 each day the violation remains unaddressed.

“That’s what a life is worth in our state,” Lamb said. 

Horton was previously a nursing home regulator, and he said there are times when regulators get things wrong — that’s why it’s important to have an appeals system. A settlement isn’t always bad, either, he said, as sometimes that means the penalty is waived in lieu of extra staff training.

Training can make more of a difference towards improving outcomes than a penalty, Horton said. Penalty dollars don’t flow back into any part of the long-term care system, though. They are designated — by law — to support the local school district.

While penalties can be a deterrent for breaking the rules, Horton said it’s important to look at the end goal of what they achieve in terms of improving care.

If the facility demonstrates a pattern of breaking the rules, state surveyors can suspend admissions, as well as downgrade, revoke or suspend their license, according to NC DHHS. If the facility has outstanding unpaid fees, the department will not issue them a new license or renew their license.

Despite her family’s settlement with her father’s facility, Kristin Goforth said she still doesn’t feel good about the situation — there should be better protections for older people. Lauren Cox said there should be more accountability for facilities overall.

“This can’t be the way we treat people who have spent their entire life contributing to society…they work, they pay their taxes, they do everything right, and then at their end of life, we do this?” Cox said.

The post ‘A slap on the wrist’: families and advocates call for increased accountability from assisted living facilities  appeared first on North Carolina Health News.

Hurricane Helene wrought historic devastation when it hit western North Carolina last September. Nearly 100 people were killed in the region and thousands were left injured, traumatized or homeless.

Hundreds of volunteers arrived within hours and began assisting with everything from food delivery to housing to medical care. Their presence was a godsend. But for many of the area’s medical professionals, the crisis underscored their own advantage: They knew the place, the people, the culture.

“A lot of questions I don’t have to ask my patients, because I know already,” said family medicine physician Tim Bleckley, who returned to his hometown of Franklin after residency to take over the practice of a retiring doctor.

Rural Americans are more likely to suffer from, and die prematurely of, a number of chronic conditions, including cancer, heart disease and diabetes. Effective management of such diseases is bolstered by long-term doctor-patient relationships, and studies show that cultural awareness provides a firm foundation for these relationships.

Cultural awareness is, essentially, having an understanding of and being sensitive to a community’s customs and rhythms. For health care providers, it’s having a sense of what your patients arrive with when they enter your office.

Bryan Hodge is chief academic officer for the Mountain Area Health Education Center. He’s tasked with convincing young health care professionals of the virtues of practicing medicine in a rural community. Hodge said in the storm’s aftermath, he felt “so much pride and inspiration for the way in which people showed up.”

He also witnessed “the value of knowledge of the fabric of a community.” Those attuned to its rhythms were uniquely well-placed. It reinforced Hodge’s conviction that “the more local the care can be, the better.”

A ‘Comfort Zone’

Health care administrators in Appalachia are striving to meet two objectives at once: addressing a critical shortage of providers by nurturing homegrown talent.

Case in point: Tim Bleckley.

Bleckley was born with a heart defect and underwent surgery at a month old. While initially pediatric cardiology was his ambition, he changed his mind while in residency. He wanted to go home to Franklin, but knew the town was too small to sustain such a practice. So he chose family medicine instead.

His patients, he believes, are in a “comfort zone” when they visit him. They like that he’s aware of what they experience, how they operate, “the things that matter to them.”

“Primary care is very personal in terms of understanding where people come from, and understanding what their lives are like,” he said. “People are very comfortable with the fact that I’m a hometown boy who’s come home, and they feel very at ease coming to see me.”

He’s been able to translate that cultural awareness into change, one step at a time. He knew that his patients — like so many mountain folks — have a tendency to take the advice of their doctor without question. He wanted them to take more ownership of their care, to know why they’re taking a particular medication, when it should be taken and potential side effects. He uses the teach-back method to have them describe what they’ve been told about medications their cardiologist or nephrologist prescribed.

“I want them to feel confident they know what they’re doing.”

Rivers Woodward had a similar career trajectory.

When Woodward was a junior in high school, his sister was stricken with an illness for which traditional means of medicine proved inadequate. The family turned to Patch Adams — a physician with an alternative approach to medicine (and the subject of an eponymous motion picture starring Robin Williams) — and she made a remarkable recovery.

This experience inspired Woodward to pursue a career in health care, to help reinvent the way it’s delivered. Further, he wanted to realize that ambition in a rural community.

Like Bleckley, Woodward was raised in Franklin, in rural Macon County. Today, he’s a family medicine physician at Blue Ridge Health, a federally qualified health center in the town of Lake Lure, in the same mountain region in which he was raised.

Studies show that those who were raised in a rural community or trained in one are more likely to practice in a rural region. Both are true of Woodward. While in medical school at the University of North Carolina, he was selected for the Rural and Underserved Scholars Program, a collaboration of the University of North Carolina and the Mountain Area Health Education Center.

“Things move at a different pace” in a rural community, Woodward says. His sense of that serves him well. His cultural awareness provides a foundation from which he offers empathetic care, which, he says, entails “listening with curiosity because I actually want to know someone’s experiences.” It requires listening without judgment.

Regardless of where you come from, rural cultural awareness can be learned with time and patience, assuming you’re receptive to it. But for many, it requires a reset.

“The more insular your upbringing,” Woodward says, “whether that’s in New York City or in Macon County, the more difficult it is to tap into cultural humility with people who may not look like or speak like or think like you.”

Woodward’s upbringing was an unconventional one; learning was experiential. His family took extended trips through Latin America, traveling by bus, staying with local families.

At times, he felt tensions in his relationship with his hometown: that he was somewhat “other.” He says his practice of rural medicine, listening with curiosity, has allowed him “to heal that tension.”

Designing a New Model

In reflecting on his community in the weeks since the storm, Woodward references a paper written for the Episcopal Relief and Development agency on the emotional stages of a community that’s experienced a natural disaster.

“There’s a peak immediately afterwards that’s fueled by adrenaline and cortisol,” he explains, “survival mode, basically.” Next is “this feeling of the community coming together and supporting each other, which we saw.

“But then after that, there’s this long downhill slide into disillusionment, before the upward slope of rebuilding.”

There’s much work to be done in Western North Carolina. Its health care needs, like those of most of rural America, are urgent; solutions require systemic change.

Bryan Hodge recalls so many people being overwhelmed by the attention they were extended in the aftermath of the storm. They were accustomed to going without. This underscored for him the critical need for an overhaul of rural health care. And it underscored the heightened importance of cultural awareness to inform that overhaul.

Woodward was recently named Blue Ridge Health’s associate chief medical officer. One of his primary responsibilities is to help design new systems of care for its rural clinics.

“My hope is to leverage all of the resources we have within a really large organization to make sure that we’re meeting people where they’re at, regardless of their location and their condition,” he says.

This could mean, for example, recognizing what a huge issue transportation is in rural communities and taking better advantage of telehealth, or providing more home visits.

Tim Bleckley’s immediate community was spared from major damage in the storm. But a number of his patients live in communities that weren’t. The morning after, he was on the road, checking in on those he couldn’t contact.

“These are people I know,” Bleckley says. “They’re not numbers.”

He plans to continue to practice medicine in his hometown, using his cultural knowledge of the place to improve care, one patient at a time.

“I never regret or feel like I should have done this differently. Not at all.”

The post In North Carolina, Helene’s Destruction Underscores the Value of Homegrown Rural Health Care appeared first on 100 Days in Appalachia.

Reversing trend of NC rural women’s health care services drying up will require tracking, enforcement and incentives in policies and laws.

Too costly to keep, but too important to lose. Solving paradox of NC rural women’s health services is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

Women’s services often lose money for NC rural hospitals. State doesn’t track lost services or require hospitals to sustain care.

Financial pressures prompt women’s services cuts at NC rural hospitals is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

NC data shows labor and delivery and other women’s services reduced or eliminated at rural hospitals, with negative health implications.

Deserts for women’s health care services expand in rural NC counties is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.

Con el objetivo de responder a la falta de acceso a servicios de salud, la organización Vecinos en el oeste de Carolina del Norte inaugurará una clínica que brindará atención médica gratuita para personas de bajos recursos y sin importar el estatus migratorio.

La entrada Nueva clínica ofrecerá atención médica y apoyo legal a migrantes en el oeste de Carolina del Norte se publicó primero en Enlace Latino NC.

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Over 100 years. That’s how long the Lumbee have been denied federal recognition. Now, President Donald Trump is pushing for that to change.

For Lumbee tribe, ‘the time has come’ to finally be federally recognized is a story from Carolina Public Press, an award-winning independent newsroom. Our breakthrough journalism shines a light on the critical overlooked and under-reported issues facing North Carolina’s 10.4 million residents. Please consider making a contribution to support our journalism.