A program targeting first-time mothers and their infants chips away at the poor outcomes for children experienced in Robeson County.

By Thomas Goldsmith

Stephanie Chase has worked for Robeson County’s Nurse-Family Partnership long enough to see a group of mothers and babies “graduate.”

Chase, a nurse from Lumberton, has worked for two-and-a-half years as part of a network of registered nurses in Robeson and Columbus counties, part of the national Nurse-Family Partnership effort. Nurses in the program visit first-time mothers weekly from the 28th week pregnancy until their children are two years old.

Parents and babies relax at a holiday celebration put on by the Nurse-Family Partnership in Robeson County. The Lumberton agency visits first-time mothers and provides information about healthy living. Photograph by Thomas Goldsmith.

“It’s been very rewarding,” Chase said at a recent celebration for moms and babies at the Robeson County Health Department in Lumberton. “I’ve been very attached to the babies.”

Partnership nurses felt the community’s need for help escalate after Hurricane Matthew, the catastrophic October storm with an aftermath that has continued to devastate communities in Robeson.

Nurses struggled to keep up their bi-weekly visits with mothers who moved from flooded homes into shelters. Some were “couch-surfing” and difficult to reach because their prepaid phone numbers kept shifting, said program nursing supervisor Darlene Gold.

“I personally have two moms who lost everything,” Chase said. “They pretty much had their diaper bags and the clothes on their backs.”

“Not a clue”

At the Lumberton event, Brooke Hunt, mother of 15-month-old Wyatt, recalled being nervous when she became pregnant for the first time.

“I had not a clue,” Hunt said. “Tamara [Bullard] started coming to my house and she calmed all my fears. I thought he was hyperactive. She said, ‘He’s a baby.’”

“I feel like Ms. Tamara’s a part of my family.”

LaQuanda Jones, of Fairmont, another young woman in the program, concurred.

“Even though you have your mom, she can’t tell you everything,” Jones said. “It’s a great program for support. I can text her or call [my nurse] anytime.”

Jones saw Matthew destroy her carefully made plans to save breast milk so that her son Braylon Regan, two months, could be nourished by it when she went back to work. She had pum

Tamara Bullard has worked with the Nurse-Family Partnership in Robeson County since 2012, visiting first-time mothers from 28 weeks of pregnancy until their children are two years old. Photo credit: Thomas Goldsmith

ped milk and saved it in a freezer that lost power when the storm came.

“Since the hurricane I lost a lot of storage; I lost a lot of milk,” said Jones, a collections representative in a call center. “I didn’t really want to put him on formula.”

Stats show health benefits for moms, babies

Part of a national effort started in the 1970s, North Carolina’s Nurse-Family Partnership is known for keeping careful track of the progress made by participants. Most recent numbers show that about one in five of the Robeson mothers had another child when working with the partnership, lower than the equivalent statewide rate of 28 percent.

Chris Bishop, state director of the Nurse-Family Partnership, said mothers in the Robeson County program completely reduced alcohol use during pregnancy and lowered their exposure to violence during pregnancy by more than 78 percent. Among those older than 18, nearly half were employed by the time their children were two years old.

Read about how other health leaders are working to make a difference in Robeson County.

The preterm birth rate for these Robeson mothers was 10.6 percent, lower than the statewide rate of 13 percent. More than two-thirds of mothers started breastfeeding, significantly higher than the state rate for African-Americans, who make up the majority of Robeson’s Nurse-Family Partnership mothers.

“We do a lot of teaching as well as referring them to resources,” said Tamara Bullard, a program nurse from St. Pauls. “We go to them so they don’t have to come to us.”

The positive results are particularly notable in Robeson County, which ranks last in health factors among North Carolina’s 100 counties, according to a survey by the Robert Wood Johnson Foundation. Some 650 families and babies have gone through the Nurse-Family Partnership since it started in Robeson in 2008.

The program began in Guilford County in 2000, and since 2008 has expanded to 22 counties and the Eastern Band of Cherokee Indians with funding from agencies including Duke Endowment’s Health Care and Child Care, the Kate B. Reynolds Charitable Trust and the state Department of Health and Human Services’ Division of Public Health. (see box).

“They are finding success in immunization and in mothers who are not smoking and not drinking alcohol,” said Dr. Laura Gerald, president of the Kate B. Reynolds Foundation, a Robeson County native and former North Carolina state health director.

Mothers interviewed at the Robeson event cited benefits such as help with breastfeeding, learning healthy eating habits and advice on what to do when babies couldn’t be consoled.

Success in breastfeeding

Mothers who remain in the Nurse-Family Partnership said they’re fully convinced of the healthful qualities of breastfeeding.

Even with the loss of her stored milk, Jones was able to feed Braylon with a combination of formula, her own milk and breast milk donated by supportive friends. Even so, she was separated from him briefly because of the storm.

Branches of the Nurse-Family Partnership from across North Carolina sent supplies to Robeson County after the disastrous flooding that followed Hurricane Matthews. Photo credit: Thomas Goldsmith.

“We had no water for like a week,” Jones said. “I sent him to the county to stay with relatives for a week.”

Some participants drop out, unable for various reasons to meet the program’s guidelines about regular visits, dietary habits and substance restrictions.

“Most of my moms would quit smoking while they are pregnant, so that’s a good thing,” Ballard said.

Nurses hired by the program spend a week in Denver, Col., to receive specific training from program developers before they make home visits. They have to tailor their schedules to meet those of their clients, who are encouraged to go back to work when they are able.

“We can’t encourage them to get a job, then drop them because they don’t get home until 5:30 or 6,” Bullard said.

“The data show that employment for the parent will help ensure better health outcomes for the family,” Gerald said.

Along with requirements for employment and healthy habits, mothers and babies in the program get incentives in the form of educational toys geared to the child’s development and the Halloween party for which the nurses dressed as witches.

The children are also signed up for singer Dolly Parton’s Imagination Library program.

“They’ll get a book for every month until they are five,” Chase said.

Leaders from rural hospitals look at what’s coming out of the incoming Trump administration and worry.

By Thomas Goldsmith

Joann Anderson, CEO of Southeastern Health in Lumberton, served as a national voice for rural health care Tuesday as two U.S. hospital associations made a case against the proposed repeal without prompt replacement of the federal Affordable Care Act.

Southeastern Regional Medical Center main campus in Lumberton. Image courtesy SRH.

There’s significant momentum for repeal of the ACA in the early days of a new U.S. Congress. But repeal would mean a projected loss of hundreds of billions of dollars to hospitals over 10 years, representatives of the American Hospital Association and the Federation of American Hospitals told reporters during a teleconference sponsored by the groups.

Anderson heads the 325-bed Southeastern Regional Medical Center in Lumberton, county seat of Robeson, where the ACA has had a significant impact. She said repeal of the act would be catastrophic for health care in Robeson County, recently hit hard by Hurricane Matthew, as well as in other rural areas across the country.

“Robeson was one of the most effective counties in getting people to enroll,” Anderson said.

“It was very positive for this area. People who had never had coverage succeeded in getting it.”

She said that before the law, people “had paid very little attention to their health because they didn’t have money to fund it.”

Southeastern Regional already operates a range of services, including rural health clinics, at a low margin of revenue compared to expense, Anderson said. Further cuts would likely mean the loss of services such as inpatient and outpatient behavioral health care, as well as neonatal intensive care and obstetrics services.

Southeastern Regional CEO Joann Anderson said told national reporters she is concerned about her hospital’s viability in the face of a repeal of the Affordable Care Act without a prompt replacement. Photo credit: Rose Hoban

“When I first heard ‘repeal and replace’ my gut kind of went into a knot,” she told reporters representing outlets from the New York Times to the Huffington Post.

“To think about going through another rapid change … is gut-wrenching. We need to know what the replacement is going to be. I don’t think we are significantly different from other areas across the United States. We cannot take additional cuts.”

Ryan: “We’ve got to repeal and replace”

Opposition to the ACA, sometimes called Obamacare, served as a popular campaign talking point for President-elect Donald Trump. House Speaker Rep. Paul Ryan has called repeal of the act Republican legislators’ first priority when Congress returns to Washington in January.

“We’ve got to repeal and replace Obamacare because that is really hurting families,” Ryan said on CBS News’ 60 Minutes program Sunday.

The incoming administration has not offered details of a replacement for the ACA, but Ryan said during the 60 Minutes interview that Republicans will develop a new approach involving  “patient-centered health care that gets everybody access to affordable health care coverage, so that they can buy whatever they want to buy.”

Hospital Groups: Loss of ACA Would Create Deep Holes

The hospital associations asked health-economics analysts Dobson | DaVanzo to study the effects of repealing the ACA. The firm based its projections on provisions of the GOP-sponsored bill HR 3762, passed in 2015, but vetoed by President Barack Obama.

Specifically, the trade associations’ report described a need for restoration of specific funding sources that were reduced under the ACA. These included Medicare and Medicaid payments to hospitals, inflation-based updates to Medicare hospital payments, and disproportionate share payments to hospitals that provide care for large patient populations with low incomes, no insurance and/or disabilities.

Rick Pollack, American Hospital Association president, and Chip Kahn, president of the Federation of American Hospitals, urged Congress, if it repeals the ACA, to provide equivalent coverage to the millions of people who would otherwise lose insured care.

Leaders of the hospital groups made several mentions of Anderson’s projections of what repeal of the ACA would mean for Robeson, whose citizens have among the lowest incomes and worst health indicators in North Carolina.

As is the case in other primarily rural communities, the local hospital, Southeastern Regional, is not only the county’s chief health care provider, but also one of its leading employers.

Releasing initial plans to provide new drinking water supplies for well owners near coal-ash waste, Duke Energy promises an unspecified “financial supplement.”

This story has been updated with a statement from attorneys representing families affected by coal ash.

By Catherine Clabby

Duke Energy intends to offer a “financial supplement” along with new water supplies to homeowners living near 14 utility properties around North Carolina that contain coal ash waste.

It’s not known how much money Duke will offer neighbors. Nor is it clear what terms or conditions would accompany any payment, utility spokeswoman Erin Culbert told NC Health News.

But the announcement acknowledges, to a degree, what some Duke Energy property neighbors have said for months: Proximity to once-obscure coal ash impoundments is harmful to property values.

“Neighbors have told us they worry about their property values or the burden of new water bills, and we’re exploring ways to address that as we provide permanent water solutions in these communities,” Mike Hughes, Duke Energy vice president of community relations in North Carolina, said in a written statement.

The news came tucked in a press release Wednesday where Duke Energy announced that it was almost finished with plans to offer new drinking water supplies to about 950 people living near millions of tons of coal ash waste stored on 14 properties.

The utility’s water-replacement proposal, required by state law and subject to approval by state regulators, was expected this month. But word of potential payments caught nearby property owners by surprise.

Amy Brown of Belmont, a neighbor to the Allen Steam Station, said she was confused by Duke’s announcement and contacted the utility Wednesday. But she learned nothing more.

Another coal ash Christmas because we can’t sell our homes while living on bottled water.. NOTHING HAS CHANGED~ 20 months #coalash pic.twitter.com/VZL38Pq1KP

— Amy Brown (@amyrbrown12_amy) November 27, 2016

A recent tweet from Amy Brown demonstrates that neighbors to coal ash impoundments remain concerned about affects on their property values. Brown, an outspoken critic of Duke Energy and DEQ, lives in Belmont, near Duke Energy’s Allen Steam Station.

“They say that they acknowledge our concerns and want to give us peace of mind. Why didn’t you acknowledge our concerns 20 months ago?” Brown asked.

“Why did they force us to hire an attorney? Why would I meet with them to discuss a financial supplement without my attorney?”

UPDATE (12/8/16): Attorneys representing hundreds of families living near coal ash impoundments on Thursday said Duke Energy’s announcement on Wednesday raised more questions than answers. It’s not clear how Duke will handle the costs and timing of replacing water supplies or address blows to properties values, concerns over long-term health effects and the nuisance of using bottled water for so many months, said a statement from attorney Mona Lisa Wallace, Bill Graham of Wallace & Graham, The Law Offices of Bryan Brice, Jr., and the Baron & Budd law firm.

Mandatory water supplies

Duke Energy has provided bottled water to hundreds of people living near its properties storing a total of 115 million tons of coal ash for months. Cooking and other household tasks using only bottled water has been both a challenge and source of stress for those neighbors, including Brown.

An amended Coal Ash Management Act passed by the General Assembly this past summer requires Duke Energy to provide new water supplies to households dependent on well water that are located within half a mile of any coal ash impoundments.

Preference must be given to linking homes to municipal water supplies, the legislation says. If that is cost prohibitive, whole-home filtration systems can be installed. One or the other, if feasible, must be completed by October 2018.

If the utility provides the water supplies and makes dam repairs where needed, the state could allow Duke Energy to leave coal ash in unlined pits at half of the 14 properties, including the three largest.

On Wednesday, Duke announced it wants to offer public water connections or water-filter systems to homeowners living close to Allen Steam Station in Belmont, Buck Steam Station in Salisbury, the Cape Fear Plant in Moncure, H.F. Lee Plant in Goldsboro, Marshall Steam Station in Terrell, Rogers Energy Complex in Mooresboro and Weatherspoon Plant in Lumberton.

Duke is proposing offering filter systems, along with maintenance of the systems, for neighbors living in “remote” areas near Belews Creek Steam Station in Belews Creek, Mayo Plant in Roxboro and Roxboro Plant in Semora.

This Duke Energy chart reports the amounts of coal ash on 14 utility properties in North Carolina as of June 2016. Ash is being moved off grounds to lined waste sites at sites marked (2). “Path to low” refers to sites where Duke can keep ash in unlined impoundments after any needed dam repairs are finished and after neighbors receive new drinking water supplies.

Properties near the Dan River and Riverbend plants are already connected to public water supplies, the utility press release says. The utility is still finalizing plans for neighbors to the Asheville and Sutton plants and must submit them to DEQ by December 15.

Still a proposal

North Carolina started its push to require Duke Energy to clean up unlined coal ash pits at the 14 sites in 2014, after a February spill that year at  the Dan River Steam Station site released tens of thousands of metal-laced sludge into the Dan River.

The utility pleaded guilty to nine criminal violations of the Clean Water Act after the spill and agreed to a $68 million criminal fine and to donate $34 million to environmental projects as a result.

The original 2014 state Coal Ash Management Act required that pollution risks be assessed one by one at each utility property. But the amended version, passed last summer and supported by Duke Energy leaders, allows DEQ to automatically designate the seven Duke properties as low-risk, as long as Duke energy meets the water-supply and well-repair requirements.

DEQ must assess the utility’s water supply plans. The agency’s staff will review the “type of water, location of house, cost of installation and any other proposals,” said agency spokesman Mike Rusher.

The financial payments Duke described so vaguely Wednesday are not required by law, however.

“We believe offering a new water supply, which is required by law, and volunteering financial supplements address the concerns they’ve shared with us,” Culbert said. “Beyond that, it would be up to those individuals to decide next steps. It’s worth noting that our financial supplement is being offered to all eligible well owners in the half-mile radius, whether they have legal representation or not.”

Some neighboring property owners and many environmental groups want Duke energy to dig up all the coal ash at all of its properties. Contamination from the waste has been detected in groundwater at each location, raising concerns that if not dug up and placed in lined pits it could spread.

“These communities and their water resources will be safe only when Duke Energy moves its coal ash out of dangerous and polluting unlined pits to safe, dry lined storage,” said Frank Holleman, a senior attorney with the Southern Environmental Law Center who has engaged in multiple court battles with Duke over coal ash risks to public waters.

Duke Energy stressed that monitoring data has not proven that coal ash basins are contaminating neighbors’ wells. Research published by Duke University scientists, for one, recently showed that carcinogenic hexavalent chromium found in some nearby wells is likely a natural byproduct of local geology, not leaching coal ash.

Once DEQ approves a plan, Duke Energy will work directly with owners of about the 950 households to discuss their options and obtain their choices — where offered —  for new water supply sources. Duke will submit all of that information to DEQ for final approval before proceeding.

The Lumberton native says she’s determined to bring focus to places like her home town, from her new position at the head of the Kate B. Reynolds Trust.

By Thomas Goldsmith

When pediatrician Laura Gerald conducted a checkup with an older teenager in Robeson County she was taken aback by the youth’s plans for life after high school graduation.

Dr. Laura Gerald, center, president of the Kate B. Reynolds Charitable Trust, greets guests at an event in Winston-Salem this fall. Photo credit: Thomas Goldsmith

Gerald, a physician who’s also the high-profile president of the Kate B. Reynolds Charitable Trust, maintains a clinical home in the city where she grew up. Concluding the recent 10-minute exam, she had asked the young man what he saw in his future.

“With this young man, his mother answered, ‘Oh, he’s going to go on disability,’” Gerald recounted during a homecoming celebration earlier this year at Southeastern Regional Medical Center.

“We have come to a place where poor health is a more viable economic opportunity than having a job,” Gerald concluded. “We have real problems.”

Gerald has traveled far and wide since leaving her hometown of Lumberton and has a high-level resume: An undergraduate degree from Harvard University, an M.D. from Johns Hopkins School of Medicine, and a master’s in public health from Harvard. She served as state health director and director of the Division of Public Health for the North Carolina Department of Health and Human Services in 2012-2013 and is the market medical director at the for-profit Evolent Health company.

“It’s been quite the journey,” Gerald said at her Kate B. Reynolds Trust office in Winston-Salem’s Reynolda Village. “It’s been fascinating and rewarding.”

Before her term as state health director, Gerald served as executive director of the North Carolina Health and Wellness Trust Fund and chaired the N.C. Eugenics Task Force. Her first job after completing medical training was taking care of children in Lumberton, where she saw the positive aspects and the deep health challenges that faced residents.

Robeson County placed last in the state in health rankings compiled by the Robert Wood Johnson Foundation.

Gaps seen in resources, opportunities

“As someone who is from Robeson County, what I can say in growing up there, and in some ways continuing to be a member of a rural community, there is no gap in community strength, in desire for health for ourselves and our children. There is no gap in worthiness to have good health outcomes,” Gerald said.

Dr. Laura Gerald greets long-time friend Dr. Pearly Graham-Hoskins at a homecoming event for Gerald at Southeastern Regional Medical Center in Lumberton. Photo credit Thomas Goldsmith

“We have a gap in resources and we have an opportunity gap,” she argued. “Generally, there are community assets you could have that would result in better health. When we think about what some of those are, rural communities often find themselves on the short end of the stick as far as investments that would turn those indicators around.”

Gerald must consider the entire state in her new role at the Kate B. Reynolds Trust, from which much of the $30 million in annual grants goes to rural health concerns. The nonprofit foundation helps to fund projects in Robeson County including the Nurse-Family Partnership, several programs at Southeastern Regional Medical Center and an effort to send paramedics to visit patients recently discharged from hospitals.

“One thing that we know is that most of the issues we are facing in health and well-being are multifactorial and require the kinds of collaborations that can address those issues,” Gerald said. “Of course it is true that we need to have individuals engaging in healthier behaviors, exercising, eating right, not smoking.

“But again, we also recognize that those negative health behaviors are more likely to occur in communities that aren’t supportive. You need opportunities for walking and exercise and access to healthy food in your neighborhood.”

In short, she said, a healthier Robeson County will require neighborhoods that support healthy behavior.

“Whether it’s philanthropy or government, we need to make investments in neighborhood and community – housing, food, putting away money for their child’s education,” Gerald said.

“To give people the bandwidth to focus on health, they need to have their needs met.”

Among additional policy changes that would support community health, Gerald cited raising the minimum wage and increasing access to health insurance.

“A very positive experience”

Gerald has positive memories of her childhood in Lumberton, where family, church and community provided opportunities for advancement such as summer programs and community plays. But she was also aware of the negative aspects of a Southern upbringing for an African-American child.

“I grew up in a segregated community, right on MLK [Drive], where many African-Americans live in the city,” she said. “We were aware of historical divides and issues; that is not lost on you as a child. I was probably in ninth or 10th grade before I saw a swimming pool.”

Gerald attended the N.C. School of Science and Mathematics, the statewide public high school in Durham, for her junior and senior years.

“I had PhDs as teachers and was taking courses with people as teachers who were really quite exceptional,” Gerald said. “When I went to Harvard from the North Carolina School of Science and Mathematics, I did not necessarily feel educationally deficient.

“It wasn’t really until I was an adult that I began to recognize how disadvantaged my background had really been.”

When she saw her home community on a national list of underserved communities, Gerald went from medical school at Johns Hopkins back to Lumberton, where she worked for three years in primary care.

“We had inpatient care, outpatient care, public-health patients,” she said. “We would literally leave the office and go over and deliver babies at the hospital.”

These days, Gerald is concerned that the stresses of life in Robeson are causing residents to undergo epigenetic changes, or effects on their genes that are caused, even before birth, by stressful life experiences.

“There are connections between stress and the production of stress hormones that can result in heart disease or diabetes — that’s true for an adult and it’s true for children,” she said.

“If a child is growing up in poverty, that results in certain stresses and trauma that result in physiological changes that result in chronic disease.

“That can have manifestations in future generations. The cycle of poverty will have to be broken if we are going to see differences in chronic disease.”

Hurricane Matthew flooding will produce multiple hazards at home, indoors and out. Accurate information and time are required to help families cope.

By Catherine Clabby

There’s little worse than the vast flooding Hurricane Matthew has unleashed in North Carolina. Dirty water has breached homes, storefronts, nursing homes. People have been trapped in cars stalled in rushing water. Death tolls are rising.

But as people of this coastal state know too well, the trouble will not fade when Matthew’s floodwaters recede.

A rising crest of health threats is also on its way, public health experts say, including some unexpected risks. Families already battered by flood damage need to take steps to protect themselves all over again.

“People get very concerned about dirty water, that fuel oil might have leaked or sometimes their septic tanks. In reality, most of that doesn’t pose much of a health risk,” said Dr. Julie Casani, head of the state public health division’s Public Health Preparedness and Response branch.

“I worry more about people getting injured during the cleanup.”

Floyd, Fran and friends

Experience from previous storms backs that up. After a flood, homes that normally are shelters become altered environments hosting all sorts of hazards, contributing to an expected post-flooding uptick in emergency department visits.

For six weeks after Hurricane Floyd struck in 1999, incidence of bone and tissue injuries, respiratory problems, gastrointestinal trouble and heart disease were higher at 20 hospitals in 18 counties than they were over the same period the previous year.

Suicide attempts, dog bites, fevers, skin problems, and people seeking help with basic medical needs such as oxygen and medication refills, dialysis and vaccines all were more common during the six weeks after Floyd. So were spider bites, diarrhea, asthma attacks and injuries from assault, gunshot wounds and rape.

People can take steps to protect themselves. To begin with, people should stay clear any water that is slow to drain, said John Morrow, PItt County public health director. Its depth can be deceptive and may pose a drowning risk, the most common cause of death from floods.

“Just stay out of the water, period. Particularly children,” Morrow said. “They are too likely to say I’m just going to swim out there and get my ball.”

Casani agrees. “You can’t see what you can’t see. While plodding through water you may not be able to see something that is submerged. People can get cut. Or they trip and fall or sprain an ankle.”

Air it out

During a flood cleanup, people sometimes bring petroleum-powered devices — generators and power washers included — inside their homes or garages. That should never occur, Morrow said, because the carbon monoxide emissions can be deadly.

“Exhaust collects. Before you know it, you get dizzy and can’t get to fresh air or turn the thing off in time,” he said.

Ten cases of carbon monoxide poisoning were reported in weeks after Hurricane Floyd, compared with none during a comparable period in the previous year.

There is plenty to do indoors. And while water laced with chemicals or sewage is not the biggest threat people will encounter while cleaning up their homes, that remains a potential risk. So cleaning with protective gloves and boots is recommended.

“You don’t want flood water to come in contact with your face or mouth. The risk of sickness is low. But pathogens can pass through cuts and scrapes,” said Tim Kelley, the director of the environmental health program at East Carolina University.

The North Carolina State University Extension offers detailed guidance on how to proceed with cleanups at home after a flood. A priority is to shovel out mud or silt before it dries and to wash down flooded walls and floors with hoses and then get them dry.

Drywall acts like a sponge, extension materials warn, and it might be necessary to remove wall board above the flood line. Wet insulation also must go. Sometimes holes must be drilled into the siding to fully dry walls, a process that can take months.

Much of that effort is required because of mold growing inside a home. Mold isn’t a health risk to everyone, but it can be a serious risk to people with asthma and allergies, or people with suppressed immune systems due to HIV infection, cancer treatments or other health conditions.

“One of the things about eastern North Carolina is that we’re surrounded by mold. You can’t avoid it, it is so damp and musty. There are thousands of species,” said Paul Barry, from the Department of Public Health at ECU.

The state Department of Public Safety recommends people treat every item touched by floodwaters as contaminated and disinfect those items with household cleaning products. It also recommended that people stay clear of any flood-damaged material that may contain asbestos. Discard mattresses, upholstered furniture, carpets and padding, and books and paper products touched by floodwaters, department officials urge.

Choose caution

Then there’s food and drinking water safety to attend to.

When it comes to food, be conservative, health officials say. Discard any food touched by floodwaters, including edibles in cans, bottles or jars. Food that was in a refrigerator or freezer that reached more than 40 degrees should be thrown away, the N.C. State University Extension materials recommend.

If all the above isn’t enough, there are also disease-carrying insects to worry about. Mosquitoes lay their eggs in water and multiply more quickly after big rains and floods. State health officials recommend people wear insect repellent and empty any standing water in birdbaths, tires, flowerpots and other containers.

Casini, who lost a home to damage from Hurricane Isabel in Maryland in 2003, stressed that natural disasters, and all the challenges that follow, put a strain on anyone’s mental health.

She encourages people to slow down and not try to put everything back together at once, indoors or out.

“This isn’t your standard fall cleanup. This is happening in treacherous conditions,” Casini said.

Instead, do only what is feasible to tackle safely, she said. Try to get your family on what feels like a normal schedule. And reach out to other people in the same boat.

“Maybe they were never your friends,” Casini said. “But something like this becomes a collective experience.”

The post When Floods Recede, Troubles Rise appeared first on North Carolina Health News.

Hospitals throughout the eastern part of North Carolina have been affected, but none more than Southeastern Regional in Lumberton.

By Rose Hoban

On Saturday, as Hurricane Matthew’s eye scraped the southeastern-most edge of North Carolina, the power went out at Southeastern Regional Medical Center. But Joann Anderson, the CEO of Southeastern Health, which has it’s flagship at the Lumberton hospital, was ready.

Hospitals are required to have generators for just such an occasion, but in anticipation of a “water event,” Anderson’s management team had asked many staff to stay.

“I have had nurses and other staff who have been here since Friday and have not been home, I have many people who are working and can’t get home,” Anderson said by phone Wednesday. “Their houses are in the flood area and they can’t get to them.”

Many of Anderson’s staff have had trouble making it to work. Floodwaters surround downtown Lumberton where the hospital is located, effectively making the downtown an island.

“We have a number of employees who have attempted to get into work and can’t,” she said. “We’ve had others who would have taken 30 minutes to get here and it’s taken hours, they’ve had to go very convoluted routes to get here.”

And finally, others have come in because they have nowhere else to go.

“We have others who were boated out or rescued, or evacuated prior to the flooding occurring, they know they’ve lost their home, but they’re here with a smile on their face and taking care of people and just being thankful that they have a place to work and that they’re safe,” Anderson said.

She laughed. On the other end of the line, one can imagine Anderson shaking her head.

“It’s been a time…”

Power, water, internet

Anderson was doing her first interview in days because she has been working almost steadily to keep the hospital going. Also, the Internet was down until Wednesday morning and other forms of communications were spotty.

“We’re finally digging through emails we’ve received,” she said. “The landline was necessary and we’ve had to depend on our cell phones as much as possible, but service has been sporadic.”

Being offline was the least of Southeastern Regional’s problems, though. The generators that are keeping refrigerators humming and surgical lights shining can overheat and fail, much like a barely used car doing a high speed, cross-country trip. Twice.

Anderson said that one generator failed Wednesday morning. Luckily, state officials supplied them with a temporary generator. A press release from the hospital Wednesday morning noted excessive diesel exhaust outside the facility.

But Southeastern’s biggest problem is water, or lack of it: The water treatment plant in Lumberton, which supplies the city and the hospital, is under water.

“We lost that, I believe, on Monday,” Anderson said, noting the days have run together.

Hospitals use a tremendous amount of water, from hand washing to flushing nasty bodily fluids down the drain, to cooking, sterilizing surgical equipment, and performing most laboratory tests.

“For instance, we have no sprinkler system, we had to put in a manual fire watch,” Anderson said. “We have people roaming the building looking for fires so that we would manually see it, because we have no other way to catch a potential threat. That’s a continuous fire-watch situation.”

And, with no municipal power and no municipal water, there only way to flush a toilet is by hand.

“We’ve had to have staff going from bathroom to bathroom to bathroom, flushing commodes, manually, using a bucket of water and pouring it into the commode to flush them,” she said.

Anderson said the main hospital had deployed a temporary water treatment plant that is currently supplying potable water to about half of Southeastern Health’s main campus. But there’s still issues at the long-term care facilities operated by the network.

“Just the human resource needed to handle those needs has been tremendous,” she said.

The hospital has evacuated many critical needs patients to other facilities.

Community support

North Carolina Hospital Association spokeswoman Julie Henry said the hospital is lucky to have Anderson, who’s been at the helm of rural hospitals for two decades.

“I’d be surprised if she’s slept,” Henry said.

Henry, who has experience handling natural disasters from her time at the state Department of Health and Human Services, said that, flooding is probably the worst crisis for hospitals.

However, the state hospitals have a system of mutual aid during disasters that has been in effect for the past week.

“From our perspective, the number one goal was to help the state officials assess the situation,” Henry said. She explained that much of the response is lead by the Division of Health Services Regulation and the Office of Emergency Medical Services, offices that have been through disasters before.

“Several folks I’ve talked to have mentioned what we learned in Floyd,” Henry said, noting that these situations are why hospitals run tabletop and real-time disaster drills several times a year.

“A couple of CEOs who have been around since Floyd said the things they learned… have helped, if not in the preparation, at least in the recovery,” she said.

Anderson and Henry both said state officials have been very responsive to needs, as well other hospitals via those mutual aid pacts. Southeastern has an agreement with Charlotte-based Carolinas HealthCare System, which deployed their mobile emergency/operating room, Med-1, to Lumberton. It arrived Tuesday.

“We’ve had offers from Columbus Regional, from Cape Fear Valley, from FirstHealth, from Duke, Novant,” Anderson said. “On a regular business day we might be in competition with each other, but that just went out the door, and we’re all in health care, and we’re all taking care of people, and tell me what you need and we’ll make sure you’re taken care of.”

Then there’s the local community. Anderson said her people put out an appeal on Facebook and on the hospital website for nurses and other licensed professionals to help give her own staff a break.

“We’ve had tremendous response from the community, overwhelming,” she said. “The phones were flooded within no time. We have three pages of names of people, nurses and others, who have just said, ‘Tell me what you need, when you need me to work and I will be there.’”

The post Hospitals Cope with Lost Power, Contaminated Water in Matthew’s Wake appeared first on North Carolina Health News.

Damaging flood waters steal so many things, including the reliable drinking water supplies people usually take for granted.

By Catherine Clabby

If the floodwater would get out of his way, Rob Armstrong could get on with the job of restoring drinking water to the battered city of Lumberton. But that is going to take time.

“We’ve got four feet of water over our only treatment plant. It’s damaged quite severely at this point,” the city’s public works director said Thursday.

Not only is the power grid down in the Robeson County city, so is a drowned back-up generator at the plant. Equipment used to sanitize drinking water and extract sediment is very likely damaged too. No one knows how many busted water pipes are waiting to be discovered in a system 20,000 people are sorely missing right now.

It’s the cruelest of ironies. When floods deluge towns and cities they frequently disrupt public drinking water supplies. So it’s been in Eastern North Carolina where Hurricane Matthew’s rains have raised multiple waterways to record-breaking levels in the Neuse, Cape Fear and Lumber river basins.

More than 30 water systems,in flood-stricken zones in eastern counties as of Thursday (down from 40-plus on Wednesday) were recommending that customers boil their tapwater. Water system managers do that when bacteriological contamination may have breached a water supply until testing can confirm the water is safe.

Floods raise that risk because rushing water is muscular enough to damage underground water pipes, potentially exposing drinking water to pathogens and other contaminants. “In a lot places, roads got washed out. We run water lines adjacent to those roads and bridges,” said Chad Ham, the Environmental Programs Manager at Fayetteville Public Works Commission.

Water systems don’t always know when or where a length of pipe is broken during a flood. But the loss of water pressure is an alarm bell.

Under pressure

Pressure problems started in Fayetteville’s network of water pipes on Saturday night, while Hurricane Matthew was still pelting Eastern North Carolina with heavy rain. “In parts of the systems where elevations are higher, we could not maintain sufficient pressure. It got very low and in some cases there was none at all,” Ham said.

In addition to the system’s boil-water advisory, Mayor Nat Robertson declared a “water shortage crisis” in Fayetteville.That required citizens to use water only for essential needs, such as drinking water for themselves and their animals, minimal cleaning, medical care, firefighting and other necessities.

Finding and sealing off a broken 22-inch mainline pipe on Sunday helped the situation. By the next day, public works crews had found others, shut them down, and could start restoring pressure.

Next crews flushed the water lines, pumping up the pressure higher than normal to expel, at fire hydrants, any solids that may have contaminated the system. Then testing could begin, at 14 preselected locations. By Wednesday lab results showed adequate levels of sanitizing chemicals and no unwelcome bacteria.

Given the high volume of water in the Cape Fear basin, Ham said leaders of his system are not concerned that they’ll pull drinking water supplies from the Cape Fear River contaminated by agricultural or other wastes. If that sort of trouble does strike, the water can draw from Glenville Lake, its second water source.

Lethal floods

As of Thursday afternoon, the state Department of Public Safety said 22 people in North Carolina had died due to Hurricane Matthew. In advice about how to keep safe where flooding strikes, departmental leaders recommend people not drink well water from land that flooded until it’s deemed safe.

In Lumberton, water supply may not be restored for weeks, a situation that the local hospital, Southeastern Regional, and individuals have been scrambling to cope with for days. On Thursday, volunteers were still carrying bottled water to people trapped in neighborhoods cut off by high water, said Linda Oxendine, Lumberton’s director of public services.

But Armstrong, Lumberton’s public works director, has a plan to move things as quickly as possible. With help from the U.S. Army Corps of Engineers and Federal Emergency Management Agency (FEMA), the city intends to use more than a dozen rented and otherwise procured pumps to clear flood water from the plant. That may take seven to 10 days.

Armstrong said he is not confident the intake that normally draws water from the Lumber River into the system will be functional. So his team will instead draw water from wells they usually use to dilute the river water.

A new generator should be running by the time it’s needed. But equipment repairs could take more time. If so, staff can always add sanitizing chemicals to the water by hand.

“We’ve got two things going for us. Most of our chemicals are okay and vendors are bringing more. And the well water we intend to use is easier to treat. It doesn’t have as much organics in it,” he said.

As sections of the water system come online, the Lumberton water system staff will start shipping water to homes and businesses, with a boil-water advisory intact. Then they’ll follow the same flush and test steps Fayetteville took to ensure clear and safe drinking water.

In two to four days, Armstrong said, with audible hope, the operation may approach “some semblance of normalcy.”

The post Drinking Water Woes Complicate Matthew Cleanup appeared first on North Carolina Health News.

In the wake of the storm, many folks who have lost food will be eligible for temporary benefits. County officials will start taking applications  on Saturday.

By Rose Hoban

Residents of areas affected by Hurricane Matthew will be eligible for emergency food benefits through the U.S. Department of Agriculture Disaster Food and Nutrition Services Program, state officials announced Friday afternoon.

State officials held a late afternoon phone conference to detail the emergency program, which will provide people in 18 counties who are currently not receiving benefits Supplemental Nutritional Assistance Program (also known as food stamps) with a way to get food.

“Folks who have been impacted by flooding, lost food, lost their home, significant loss of jobs, or other impacts are eligible and can apply for assistance with the disaster application process,” said Wayne Black, director for social services and county operations for the state Department of Health and Human Services.

People who simply lost all their food because power to their homes was out for more than 8 hours are eligible, along with the people who have had more significant losses of property.

The application period is short – only from Saturday through Wednesday – so people will need to act fast.

“There’s another part of this… current recipients of Food and Nutrition Services will receive the maximum benefit, based on their household side… automatically through our NC FAST system a supplement,” Black said. He emphasized that those folks do not have to come in to apply for extra benefits, but the benefit will be applied directly to their Electronic Benefits Transfer cards.

To be determine eligibility, applicants for the disaster benefits will need to provide:

• Identification:  Photo ID or any other document that verifies your identity
• Residency (if possible)
• Utility bills, tax bills, or insurance policies, or a collateral (friend, employer, pastor, etc.);
• Social Security Number and date of birth for each household member (do not need Social Security Cards, just the number);
• Amount of take home pay for each household member

“With the D-SNAP program, many of the normal qualifications will be waived by the USDA,” said David Locklear, the chief of economic services for the state Division of Social Services. “Therefore, we will be accepting the client’s statement for other verification, other than identification.”

Locations for receiving applications will only be open for a few days, and they can get help for a one-month certification. (see table below)

“Individuals who wish to be considered for ongoing eligibility would have to return to their social services agency to apply for the regular food and nutrition services program,” Locklear said.

After Hurricanes Floyd, Fran and Irene, people in affected counties were eligible for similar benefits. Wayne said about 98,000 people received the disaster food relief after Floyd in 1999.

AS OF NOV. 7, additional counties have been added. Application sites will operate for five non-consecutive days, Wednesday, Nov. 9 through Thursday, Nov. 10 and Monday, Nov. 14 through Wednesday, Nov. 16, for the eight additional counties.

The post UPDATED: USDA Approves Emergency Food Benefits for Matthew Victims appeared first on North Carolina Health News.

In addition to caring for students physically and emotionally, officials and students from the Robeson County campus reached out to the surrounding community after Matthew’s floods.

By Thomas Goldsmith

Hurricane Matthew dumped more than a foot of water and a load of problems on the University of North Carolina at Pembroke on Saturday, Oct. 8.

The mighty storm spared the college some of the damage visited up on nearby Lumberton, where the flooding Lumber River brought about widespread destruction and several deaths.

No one died at UNCP, but the storm brought two to four feet of flooding. Most students left campus, reducing the student body of 6,300 to about 800 on the day the storm arrived, then to about two dozen. While looking after the physical and mental health of students, campus leaders and the facility itself also served as a key resource and as lodging for emergency personnel from across the state. Students and staff who returned to campus have continued to help other hard-hit communities in Robeson County.

Interviews with students, faculty, administrators, emergency workers and local residents showed that the college benefited from comprehensive emergency response planning and crafted aid for the nearby community as well as ensuring student and staff safety.

Here’s how the story unfolded:

Monday, Oct. 3: Hurricane Matthew heads for Cuba and UNCP officials take serious notice.

On that same day, Randy Faircloth, an Iraq veteran and Connecticut transplant, starts work at a Lumberton upholstery factory after other jobs don’t work out. He, wife Mary and daughter Kara, 9, live in a mobile home with their five dogs. They will be among more than 1,000 Lumberton residents displaced by Matthew who receive help from UNCP staff and students.

Wednesday-Thursday, Oct. 5-6: Travis Bryant, associate vice chancellor for campus safety and emergency operations, and other officials keep watch on Matthew, hoping that it will track far enough east to miss UNCP. Bryant gets out his 80-page disaster plan and the cheat sheets for specific tasks.

“It was coming up on the weekend and we were talking to students about emergency planning,” Bryant said. Administrators urge students to go home for the weekend. Most leave.

Dr. Robin Cummings, UNCP chancellor, holds regular meetings with his cabinet and leadership. Initially, he prepares to send help to UNC-Wilmington, based on projections of Matthew’s path.

Saturday, Oct. 8: The university is inundated by 12.5 inches of rain ending just before 6 p.m.

“Matthew sort of changed its mind,” Cummings said. “Suddenly we’ve got three to four
feet of water on campus.”

Saturday morning, Oct. 8: As water starts to pour into their mobile home, Mary and Kara Faircloth shelter on higher ground at a friend’s nearby brick home. Kara, who is on the autism spectrum, is severely shaken by the storm. Randy stays to look after the family’s animals.

Around 1 p.m.: UNCP campus loses power with 800 students on campus. The 16-member police department fires up its natural-gas generator.

“The rain and the wind were frightening,” Bryant said. “Without lights, it’s difficult to respond to an emergency. When you lose power, you lose communications.”

Staff members for Sodexo, the generator-equipped campus food vendor, prepare food for remaining students, serving 2,300 hot meals and 900 box meals using generator power. Many staff members have flooding or other problems at home, but most remain on the job. Staff delivered food to students who worried about leaving their dorms.

“These people are in absolutely desperate situations but they are helping each other,” Bryant said.

Students are told not to drink the water on campus. Some use the solar panels in front of the library to charge their phones, but heavy cell traffic prevents calls from connecting .

Sunday, Oct. 9: UNCP’s Counseling and Psychological Services, or CAPS team, begin a week of on-call duty to help students. The employee assistance program offers help to those who need either mental health aid or help with flood damage, financial issues, etc.

“Our first goal was to take care of our 800 students on campus,” Cummings said. “Over the week we whittled that down to 20 to 25. We did things like posting a guard in every dorm.”

Sunday evening, Oct. 9: A student’s family calls from Lumberton, asking directions to UNCP so they could pick up their daughter. Instead of trying to steer them down treacherous roads in the dark, Bryant takes a pickup truck and delivers the daughter and two friends at about 7:30 p.m.

Sunday afternoon, Oct. 9: Mary and Kara are evacuated from flooded Lumberton, with only the clothes on their backs.

Monday, Oct. 10: Crystal Moore, a nurse practitioner in UNCP student health services, checks the campus along with other staff to ensure student safety.

With his trailer in ruins, Randy Faircloth catches a bus picking up storm evacuees. It happens to take him to Robeson County’s Purnell Swett High School on Deep Branch Road, where he is reunited with Mary and Kara. The dogs are housed free at at the county animal shelter in St. Pauls, except for Stewart, a Jack Russell who ran off in the storm. During Hurricane Katrina, emergency officials across the country learned that many people will refuse to leave home without their pets.

Whitney Jackson, center fielder on the UNCP Braves softball team, serves flood evacuees as one of what she called an “outrageous” number of students working at the community shelter set up at Purnell Swett.

“The chancellor named Monday a service day. The community came together here and absolutely outdid everything,” Jackson said. “There were people who needed 24-hour care and got it. We didn’t know how bad it was going to be.”

Both gyms at Purnell Swett are full of people and additional shelters are set up at Southeast Robeson High School and other locations.

As disaster aid from across the state arrives Monday in hard-hit areas, those workers need places to stay.

“We had all these National Guard members and first responders asking was there someplace they could sleep,” Cummings said. ”We said, ‘Oh, yeah, we have a gym that’s 9,000 square feet.’”

Also on Monday, staff drive the food produced for the expected 200 emergency workers to Lumberton when the workers’ large vehicles are hampered by flooded roads.

Tuesday-Wednesday, Oct. 10-11: Power is restored to campus and cleanup begins.
Emergency workers, including swift water rescue teams with specially designed boats, work out of UNCP in Lumberton and other flooded areas. Moore and other campus health staff work in shelters as few students remain on campus.

October 12: Gov. Pat McCrory visits UNCP with state Emergency Management Director Mike Sprayberry to assess situation as part of his tour of areas hit by Matthew.

Thursday-Friday, Oct. 12-13: Previously planned fall break allows time for campus to recover.

Thursday, Oct. 12: Mary Faircloth returns to her old neighborhood and locates Stewart, their missing Jack Russell terrier.

Friday, Oct. 13: EMS worker Robin Roberts from Johnston County arrives on campus with other EMS workers.

Nearby communities including Lumberton and Fair Bluff continue to experience devastation. UNCP provides overnight lodging for emergency workers from Buncombe, Franklin, Wake, Durham, Johnston and other counties.

UNCP starts a hurricane relief fund to help students who lost computers, clothes or other belongings when their residences flooded.

Monday, Oct. 16: Campus reopens for some staff members.

Tuesday, Oct. 17: Classes resume and UNCP offers the community a free showing of the acrobatic “Shanghai Nights” as relief from the stress and tragedy of the preceding nine days. The performance is full.

The Faircloths, among 300 people still in shelters, make plans to move to Fort Bragg, where Randy’s veteran status affords them a motel room. They accumulate donated possessions, but Mary contracts a gastrointestinal illness that she attributes to contaminated flood water.

Thursday, Oct. 20: Robin Roberts and other emergency workers are still living in the UNCP gym, responding to the ongoing need for help in flooded areas.

“Everybody has been extremely grateful,” Roberts says, as workers on another shift sleep nearby. “Even the students walk by and say thanks.”

Intact, but in low spirits, the Faircloths leave Purnell Swett for Fort Bragg in Randy’s aged Pontiac. They’ll have the dogs to pick up and a temporary home as they meet with FEMA about a new place to live.

Friday-Saturday, Oct. 21-22: In another stress reliever, UNCP opens up a Friday performance by the Prince tribute band the Purple Xperience free to students and community members. Homecoming weekend is celebrated as the Braves face the Catawba University Indians in football.

The post UNC-Pembroke’s Reaction to Hurricane Also Aided Community appeared first on North Carolina Health News.

Health outcomes in the far southeastern part of North Carolina are some of the worst in the state. But some folks are making a concerted effort to turn those numbers around.

By Thomas Goldsmith

When pediatrician Laura Gerald returned to her hometown of Lumberton as head of the Kate B. Reynolds Charitable Trust, she told the welcoming crowd that she had plenty to discuss with them.

“Normally, I’d only be up here for about 10 minutes, but I’m home, so you might as well settle in,” a smiling Gerald told a gathering at Southeastern Regional Medical Center in September.

But the Harvard- and Johns Hopkins-educated physician left no doubt that she was well acquainted with the health challenges faced by residents in Robeson County in Southeastern North Carolina.

A person born in Robeson County has a life expectancy of about 73 years. About a hundred miles away in Wake County the comparable life expectancy is 81 years, she told the crowd, in numbers referenced in a Robert Wood Johnson Foundation report.

“Why should something as simple as the Zip code you were born in give you seven more years of life?” Gerald asked.

One in three

Robeson County, with a population of more than 133,000, lies in the state’s scenic Sandhills region. Multiple factory closings in recent decades has lead to an unemployment rate that’s stuck at nearly 7 percent, down from years of recession-driven double digit rates.

And one in three Robeson County residents lives in poverty.

“A lot of rural North Carolina issues relate to poverty, like obesity and this recent opioid epidemic,” said Dr. Pearly Graham-Hoskins, a friend of Gerald’s and hospitalist and medical director at Cape Fear Valley – Bladen County Hospital. “The thing people forget is that it’s an economic issue. People are selling drugs and they’re trying the drugs.”

Graham-Hoskins was in Lumberton, the county seat, to attend Gerald’s first hometown appearance since she was installed as president of the Kate B. Reynolds Charitable Trust. The Winston-Salem-based foundation is among the nonprofit, academic, public and private entities working to address health problems in the county.

(The Kate B. Reynolds Trust has also granted NC Health News with funds to focus on rural health issues through a donor-advised fund at the Winston-Salem Foundation.)

Public health officials say the county’s troubling health statistics arise from a number of factors, some of the most persistent linked to ingrained cultural issues as well as the county’s lack of economic dynamism. Young people in Robeson experience a death rate 60 percent higher than the state average. And the overall homicide rate is more than triple the state average.

‘There are historical divisions’

One key to the rate of violent crime could be a statistic that also makes Robeson distinctive: A diverse population that’s 39.9 percent Native American, 32.2 percent white, 24.4 percent African-American and 8.3 percent Hispanic, according to 2015 census numbers.

“There are historical divisions and tensions between different groups on the ethnic side,” Gerald said.

Dr. Joseph Bell is a Lumbee Indian and Robeson County native who earned first a pharmacy degree, then a medical degree from the University of North Carolina at Chapel Hill before founding Pembroke Pediatrics in Pembroke. He agreed with Gerald’s assessment of tensions that can lead to stress and violence between ethnic groups.

“The old historic tension and racial prejudice — anyone would be naive to think that that had totally gone away,” Bell said.

A mix of resources

Lumberton is home to the 452-bed Southeastern Regional Medical Center, a nonprofit facility which treats 16,000 inpatients and 68,000 emergency patients from across the region annually. The hospital and its parent organization, Southeastern Health, held the homecoming for Gerald.

“We have great hospitals and great doctors,” state Sen. Jane Smith, who represents Robeson and Columbus counties in the General Assembly, said at the event. “The outcomes are mostly attributable to the poverty rate.”

Many Robeson County residents wind up in a hospital emergency department for care because they can’t afford regular medical care, Smith said. She also expressed frustration that the Republican legislature refused to expand Medicaid, as is allowed for under the Affordable Care Act.

Smith, a Democrat, ran for reelection this month, stressing the need for a strengthened education system, job creation through economic development organizations, promoting business and agriculture, and ensuring that rural areas get their fair share of resources.

She lost to Republican lawyer and military veteran Danny Britt, who said Smith had been ineffective in Raleigh.

“We have the opportunity to market our positives, our location and resources, to bring jobs and wealth back to Robeson and Columbus Counties,” Britt told the Robesonian.

Obesity, asthma, vehicle crashes plague county

One of Robeson County’s problems, both economic and health-related, is the presence of food deserts, regions where fresh produce and other items are absent from stores or difficult to obtain.

“One of the biggest problems is the access to healthy food,” said Tim Bell, CEO of Children’s Health of Carolina. “We have obesity in both children and adults.”

Other conditions, such as a rate of inpatient hospitalization for asthma among children 14 and younger that’s twice the state average, could be linked to longstanding unhealthy habits.

“There’s a high percentage of asthmatics,” Bell said. “We know there’s a fair amount of smokers.”

And high rates of substance abuse correlate to notable deaths from unintentional motor-vehicle deaths — 35 per 100,000 compared to a statewide average of less than 20 per 100,000.

Solutions to some problems come from concentrated efforts such as the Robeson-Columbus counties Nurse-Family Partnership. The partnership’s registered nurses work with first-time mothers until their children are two years old, boosting positive outcomes and improved statistics in key areas such as immunization and breastfeeding rates.

Five-year effort brings results

Some problems are so intractable as to require even broader interdisciplinary efforts, such as the North Carolina Academic Center for Excellence in Youth Violence Prevention, known as NC-ACE. The initiative won nearly $6.5 million in federal funding to allow UNC researchers, led by School of Social Work professor Paul Smokowski, to work toward community support and solutions for preventing and reducing youth violence in Robeson County.

The UNC effort is nearing an end in December, when a full report of its work will be released. But results already in show impressive outcomes from its Teen Court, Positive Option and Parenting Wisely programs, Smokowski said in a phone interview Friday from his new post at the University of Kansas.

“Very briefly, the difference with Teen Court is that it reconnects them largely to community service,” he said. “Instead of a sentence we call it a sanction. They have to do community service, they have to make reparations from whatever the damage is.”

Youth who have gone through Teen Court in Robeson have a recidivism rate of less than half that of those who are handled by the juvenile justice system, he said. Positive Option works with middle-school students to create a more positive school climate by decreasing behaviors like bullying and disrespect. Parenting Wisely helps mothers and fathers manage conflict with their teenage children.

“Parent-child conflict is a risk factor for delinquent behavior, for substance abuse, for violence and aggression, and for teenage promiscuity,” Smokowski said. “When you can decrease that conflict between parents and children, it keeps the adolescents closer to the family. There’s less aggressive behavior and less violence.”

Gerald said no one person or organization can solve Robeson County’s problems alone.

“It’s going to take public health, colleges, community colleges, the faith community and the business community. It takes all of those sectors working together,” she said. “We want to secure a future of hope and opportunity for our children.”

The post In Robeson County: Fighting Grim Statistics with Work and Hope appeared first on North Carolina Health News.

A program targeting first-time mothers and their infants chips away at the poor outcomes for children experienced in Robeson County.

By Thomas Goldsmith

Stephanie Chase has worked for Robeson County’s Nurse-Family Partnership long enough to see a group of mothers and babies “graduate.”

Chase, a nurse from Lumberton, has worked for two-and-a-half years as part of a network of registered nurses in Robeson and Columbus counties, part of the national Nurse-Family Partnership effort. Nurses in the program visit first-time mothers weekly from the 28th week pregnancy until their children are two years old.

“It’s been very rewarding,” Chase said at a recent celebration for moms and babies at the Robeson County Health Department in Lumberton. “I’ve been very attached to the babies.”

Partnership nurses felt the community’s need for help escalate after Hurricane Matthew, the catastrophic October storm with an aftermath that has continued to devastate communities in Robeson.

Nurses struggled to keep up their bi-weekly visits with mothers who moved from flooded homes into shelters. Some were “couch-surfing” and difficult to reach because their prepaid phone numbers kept shifting, said program nursing supervisor Darlene Gold.

“I personally have two moms who lost everything,” Chase said. “They pretty much had their diaper bags and the clothes on their backs.”

“Not a clue”

At the Lumberton event, Brooke Hunt, mother of 15-month-old Wyatt, recalled being nervous when she became pregnant for the first time.

“I had not a clue,” Hunt said. “Tamara [Bullard] started coming to my house and she calmed all my fears. I thought he was hyperactive. She said, ‘He’s a baby.’”

“I feel like Ms. Tamara’s a part of my family.”

LaQuanda Jones, of Fairmont, another young woman in the program, concurred.

“Even though you have your mom, she can’t tell you everything,” Jones said. “It’s a great program for support. I can text her or call [my nurse] anytime.”

Jones saw Matthew destroy her carefully made plans to save breast milk so that her son Braylon Regan, two months, could be nourished by it when she went back to work. She had pum

ped milk and saved it in a freezer that lost power when the storm came.

“Since the hurricane I lost a lot of storage; I lost a lot of milk,” said Jones, a collections representative in a call center. “I didn’t really want to put him on formula.”

Stats show health benefits for moms, babies

Part of a national effort started in the 1970s, North Carolina’s Nurse-Family Partnership is known for keeping careful track of the progress made by participants. Most recent numbers show that about one in five of the Robeson mothers had another child when working with the partnership, lower than the equivalent statewide rate of 28 percent.

Chris Bishop, state director of the Nurse-Family Partnership, said mothers in the Robeson County program completely reduced alcohol use during pregnancy and lowered their exposure to violence during pregnancy by more than 78 percent. Among those older than 18, nearly half were employed by the time their children were two years old.

Read about how other health leaders are working to make a difference in Robeson County.

The preterm birth rate for these Robeson mothers was 10.6 percent, lower than the statewide rate of 13 percent. More than two-thirds of mothers started breastfeeding, significantly higher than the state rate for African-Americans, who make up the majority of Robeson’s Nurse-Family Partnership mothers.

“We do a lot of teaching as well as referring them to resources,” said Tamara Bullard, a program nurse from St. Pauls. “We go to them so they don’t have to come to us.”

The positive results are particularly notable in Robeson County, which ranks last in health factors among North Carolina’s 100 counties, according to a survey by the Robert Wood Johnson Foundation. Some 650 families and babies have gone through the Nurse-Family Partnership since it started in Robeson in 2008.

The program began in Guilford County in 2000, and since 2008 has expanded to 22 counties and the Eastern Band of Cherokee Indians with funding from agencies including Duke Endowment’s Health Care and Child Care, the Kate B. Reynolds Charitable Trust and the state Department of Health and Human Services’ Division of Public Health. (see box).

“They are finding success in immunization and in mothers who are not smoking and not drinking alcohol,” said Dr. Laura Gerald, president of the Kate B. Reynolds Foundation, a Robeson County native and former North Carolina state health director.

Mothers interviewed at the Robeson event cited benefits such as help with breastfeeding, learning healthy eating habits and advice on what to do when babies couldn’t be consoled.

Success in breastfeeding

Mothers who remain in the Nurse-Family Partnership said they’re fully convinced of the healthful qualities of breastfeeding.

Even with the loss of her stored milk, Jones was able to feed Braylon with a combination of formula, her own milk and breast milk donated by supportive friends. Even so, she was separated from him briefly because of the storm.

“We had no water for like a week,” Jones said. “I sent him to the county to stay with relatives for a week.”

Some participants drop out, unable for various reasons to meet the program’s guidelines about regular visits, dietary habits and substance restrictions.

“Most of my moms would quit smoking while they are pregnant, so that’s a good thing,” Ballard said.

Nurses hired by the program spend a week in Denver, Col., to receive specific training from program developers before they make home visits. They have to tailor their schedules to meet those of their clients, who are encouraged to go back to work when they are able.

“We can’t encourage them to get a job, then drop them because they don’t get home until 5:30 or 6,” Bullard said.

“The data show that employment for the parent will help ensure better health outcomes for the family,” Gerald said.

Along with requirements for employment and healthy habits, mothers and babies in the program get incentives in the form of educational toys geared to the child’s development and the Halloween party for which the nurses dressed as witches.

The children are also signed up for singer Dolly Parton’s Imagination Library program.

“They’ll get a book for every month until they are five,” Chase said.

The post Partnership Aids First-time Moms in Hard-hit Robeson County appeared first on North Carolina Health News.

Leaders from rural hospitals look at what’s coming out of the incoming Trump administration and worry.

By Thomas Goldsmith

Joann Anderson, CEO of Southeastern Health in Lumberton, served as a national voice for rural health care Tuesday as two U.S. hospital associations made a case against the proposed repeal without prompt replacement of the federal Affordable Care Act.

There’s significant momentum for repeal of the ACA in the early days of a new U.S. Congress. But repeal would mean a projected loss of hundreds of billions of dollars to hospitals over 10 years, representatives of the American Hospital Association and the Federation of American Hospitals told reporters during a teleconference sponsored by the groups.

Anderson heads the 325-bed Southeastern Regional Medical Center in Lumberton, county seat of Robeson, where the ACA has had a significant impact. She said repeal of the act would be catastrophic for health care in Robeson County, recently hit hard by Hurricane Matthew, as well as in other rural areas across the country.

“Robeson was one of the most effective counties in getting people to enroll,” Anderson said.

“It was very positive for this area. People who had never had coverage succeeded in getting it.”

She said that before the law, people “had paid very little attention to their health because they didn’t have money to fund it.”

Southeastern Regional already operates a range of services, including rural health clinics, at a low margin of revenue compared to expense, Anderson said. Further cuts would likely mean the loss of services such as inpatient and outpatient behavioral health care, as well as neonatal intensive care and obstetrics services.

“When I first heard ‘repeal and replace’ my gut kind of went into a knot,” she told reporters representing outlets from the New York Times to the Huffington Post.

“To think about going through another rapid change … is gut-wrenching. We need to know what the replacement is going to be. I don’t think we are significantly different from other areas across the United States. We cannot take additional cuts.”

Ryan: “We’ve got to repeal and replace”

Opposition to the ACA, sometimes called Obamacare, served as a popular campaign talking point for President-elect Donald Trump. House Speaker Rep. Paul Ryan has called repeal of the act Republican legislators’ first priority when Congress returns to Washington in January.

“We’ve got to repeal and replace Obamacare because that is really hurting families,” Ryan said on CBS News’ 60 Minutes program Sunday.

The incoming administration has not offered details of a replacement for the ACA, but Ryan said during the 60 Minutes interview that Republicans will develop a new approach involving  “patient-centered health care that gets everybody access to affordable health care coverage, so that they can buy whatever they want to buy.”

Hospital Groups: Loss of ACA Would Create Deep Holes

The hospital associations asked health-economics analysts Dobson | DaVanzo to study the effects of repealing the ACA. The firm based its projections on provisions of the GOP-sponsored bill HR 3762, passed in 2015, but vetoed by President Barack Obama.

Specifically, the trade associations’ report described a need for restoration of specific funding sources that were reduced under the ACA. These included Medicare and Medicaid payments to hospitals, inflation-based updates to Medicare hospital payments, and disproportionate share payments to hospitals that provide care for large patient populations with low incomes, no insurance and/or disabilities.

Rick Pollack, American Hospital Association president, and Chip Kahn, president of the Federation of American Hospitals, urged Congress, if it repeals the ACA, to provide equivalent coverage to the millions of people who would otherwise lose insured care.

Leaders of the hospital groups made several mentions of Anderson’s projections of what repeal of the ACA would mean for Robeson, whose citizens have among the lowest incomes and worst health indicators in North Carolina.

As is the case in other primarily rural communities, the local hospital, Southeastern Regional, is not only the county’s chief health care provider, but also one of its leading employers.

The post N.C. Rural Hospital Leader Worries About Looming ACA Repeal appeared first on North Carolina Health News.

Releasing initial plans to provide new drinking water supplies for well owners near coal-ash waste, Duke Energy promises an unspecified “financial supplement.”

This story has been updated with a statement from attorneys representing families affected by coal ash.

By Catherine Clabby

Duke Energy intends to offer a “financial supplement” along with new water supplies to homeowners living near 14 utility properties around North Carolina that contain coal ash waste.

It’s not known how much money Duke will offer neighbors. Nor is it clear what terms or conditions would accompany any payment, utility spokeswoman Erin Culbert told NC Health News.

But the announcement acknowledges, to a degree, what some Duke Energy property neighbors have said for months: Proximity to once-obscure coal ash impoundments is harmful to property values.

“Neighbors have told us they worry about their property values or the burden of new water bills, and we’re exploring ways to address that as we provide permanent water solutions in these communities,” Mike Hughes, Duke Energy vice president of community relations in North Carolina, said in a written statement.

The news came tucked in a press release Wednesday where Duke Energy announced that it was almost finished with plans to offer new drinking water supplies to about 950 people living near millions of tons of coal ash waste stored on 14 properties.

The utility’s water-replacement proposal, required by state law and subject to approval by state regulators, was expected this month. But word of potential payments caught nearby property owners by surprise.

Amy Brown of Belmont, a neighbor to the Allen Steam Station, said she was confused by Duke’s announcement and contacted the utility Wednesday. But she learned nothing more.

Another coal ash Christmas because we can’t sell our homes while living on bottled water.. NOTHING HAS CHANGED~ 20 months #coalash pic.twitter.com/VZL38Pq1KP

— Amy Brown (@amyrbrown12_amy) November 27, 2016

A recent tweet from Amy Brown demonstrates that neighbors to coal ash impoundments remain concerned about affects on their property values. Brown, an outspoken critic of Duke Energy and DEQ, lives in Belmont, near Duke Energy’s Allen Steam Station.

“They say that they acknowledge our concerns and want to give us peace of mind. Why didn’t you acknowledge our concerns 20 months ago?” Brown asked.

“Why did they force us to hire an attorney? Why would I meet with them to discuss a financial supplement without my attorney?”

UPDATE (12/8/16): Attorneys representing hundreds of families living near coal ash impoundments on Thursday said Duke Energy’s announcement on Wednesday raised more questions than answers. It’s not clear how Duke will handle the costs and timing of replacing water supplies or address blows to properties values, concerns over long-term health effects and the nuisance of using bottled water for so many months, said a statement from attorney Mona Lisa Wallace, Bill Graham of Wallace & Graham, The Law Offices of Bryan Brice, Jr., and the Baron & Budd law firm.

Mandatory water supplies

Duke Energy has provided bottled water to hundreds of people living near its properties storing a total of 115 million tons of coal ash for months. Cooking and other household tasks using only bottled water has been both a challenge and source of stress for those neighbors, including Brown.

An amended Coal Ash Management Act passed by the General Assembly this past summer requires Duke Energy to provide new water supplies to households dependent on well water that are located within half a mile of any coal ash impoundments.

Preference must be given to linking homes to municipal water supplies, the legislation says. If that is cost prohibitive, whole-home filtration systems can be installed. One or the other, if feasible, must be completed by October 2018.

If the utility provides the water supplies and makes dam repairs where needed, the state could allow Duke Energy to leave coal ash in unlined pits at half of the 14 properties, including the three largest.

On Wednesday, Duke announced it wants to offer public water connections or water-filter systems to homeowners living close to Allen Steam Station in Belmont, Buck Steam Station in Salisbury, the Cape Fear Plant in Moncure, H.F. Lee Plant in Goldsboro, Marshall Steam Station in Terrell, Rogers Energy Complex in Mooresboro and Weatherspoon Plant in Lumberton.

Duke is proposing offering filter systems, along with maintenance of the systems, for neighbors living in “remote” areas near Belews Creek Steam Station in Belews Creek, Mayo Plant in Roxboro and Roxboro Plant in Semora.

Properties near the Dan River and Riverbend plants are already connected to public water supplies, the utility press release says. The utility is still finalizing plans for neighbors to the Asheville and Sutton plants and must submit them to DEQ by December 15.

Still a proposal

North Carolina started its push to require Duke Energy to clean up unlined coal ash pits at the 14 sites in 2014, after a February spill that year at  the Dan River Steam Station site released tens of thousands of metal-laced sludge into the Dan River.

The utility pleaded guilty to nine criminal violations of the Clean Water Act after the spill and agreed to a $68 million criminal fine and to donate $34 million to environmental projects as a result.

The original 2014 state Coal Ash Management Act required that pollution risks be assessed one by one at each utility property. But the amended version, passed last summer and supported by Duke Energy leaders, allows DEQ to automatically designate the seven Duke properties as low-risk, as long as Duke energy meets the water-supply and well-repair requirements.

DEQ must assess the utility’s water supply plans. The agency’s staff will review the “type of water, location of house, cost of installation and any other proposals,” said agency spokesman Mike Rusher.

The financial payments Duke described so vaguely Wednesday are not required by law, however.

“We believe offering a new water supply, which is required by law, and volunteering financial supplements address the concerns they’ve shared with us,” Culbert said. “Beyond that, it would be up to those individuals to decide next steps. It’s worth noting that our financial supplement is being offered to all eligible well owners in the half-mile radius, whether they have legal representation or not.”

Some neighboring property owners and many environmental groups want Duke energy to dig up all the coal ash at all of its properties. Contamination from the waste has been detected in groundwater at each location, raising concerns that if not dug up and placed in lined pits it could spread.

“These communities and their water resources will be safe only when Duke Energy moves its coal ash out of dangerous and polluting unlined pits to safe, dry lined storage,” said Frank Holleman, a senior attorney with the Southern Environmental Law Center who has engaged in multiple court battles with Duke over coal ash risks to public waters.

Duke Energy stressed that monitoring data has not proven that coal ash basins are contaminating neighbors’ wells. Research published by Duke University scientists, for one, recently showed that carcinogenic hexavalent chromium found in some nearby wells is likely a natural byproduct of local geology, not leaching coal ash.

Once DEQ approves a plan, Duke Energy will work directly with owners of about the 950 households to discuss their options and obtain their choices — where offered —  for new water supply sources. Duke will submit all of that information to DEQ for final approval before proceeding.

The post Coal Ash Families Get Word of Water Replacement Plan appeared first on North Carolina Health News.

The Lumberton native says she’s determined to bring focus to places like her home town, from her new position at the head of the Kate B. Reynolds Trust.

By Thomas Goldsmith

When pediatrician Laura Gerald conducted a checkup with an older teenager in Robeson County she was taken aback by the youth’s plans for life after high school graduation.

Gerald, a physician who’s also the high-profile president of the Kate B. Reynolds Charitable Trust, maintains a clinical home in the city where she grew up. Concluding the recent 10-minute exam, she had asked the young man what he saw in his future.

“With this young man, his mother answered, ‘Oh, he’s going to go on disability,’” Gerald recounted during a homecoming celebration earlier this year at Southeastern Regional Medical Center.

“We have come to a place where poor health is a more viable economic opportunity than having a job,” Gerald concluded. “We have real problems.”

Gerald has traveled far and wide since leaving her hometown of Lumberton and has a high-level resume: An undergraduate degree from Harvard University, an M.D. from Johns Hopkins School of Medicine, and a master’s in public health from Harvard. She served as state health director and director of the Division of Public Health for the North Carolina Department of Health and Human Services in 2012-2013 and is the market medical director at the for-profit Evolent Health company.

“It’s been quite the journey,” Gerald said at her Kate B. Reynolds Trust office in Winston-Salem’s Reynolda Village. “It’s been fascinating and rewarding.”

Before her term as state health director, Gerald served as executive director of the North Carolina Health and Wellness Trust Fund and chaired the N.C. Eugenics Task Force. Her first job after completing medical training was taking care of children in Lumberton, where she saw the positive aspects and the deep health challenges that faced residents.

Robeson County placed last in the state in health rankings compiled by the Robert Wood Johnson Foundation.

Gaps seen in resources, opportunities

“As someone who is from Robeson County, what I can say in growing up there, and in some ways continuing to be a member of a rural community, there is no gap in community strength, in desire for health for ourselves and our children. There is no gap in worthiness to have good health outcomes,” Gerald said.

“We have a gap in resources and we have an opportunity gap,” she argued. “Generally, there are community assets you could have that would result in better health. When we think about what some of those are, rural communities often find themselves on the short end of the stick as far as investments that would turn those indicators around.”

Gerald must consider the entire state in her new role at the Kate B. Reynolds Trust, from which much of the $30 million in annual grants goes to rural health concerns. The nonprofit foundation helps to fund projects in Robeson County including the Nurse-Family Partnership, several programs at Southeastern Regional Medical Center and an effort to send paramedics to visit patients recently discharged from hospitals.

“One thing that we know is that most of the issues we are facing in health and well-being are multifactorial and require the kinds of collaborations that can address those issues,” Gerald said. “Of course it is true that we need to have individuals engaging in healthier behaviors, exercising, eating right, not smoking.

“But again, we also recognize that those negative health behaviors are more likely to occur in communities that aren’t supportive. You need opportunities for walking and exercise and access to healthy food in your neighborhood.”

In short, she said, a healthier Robeson County will require neighborhoods that support healthy behavior.

“Whether it’s philanthropy or government, we need to make investments in neighborhood and community – housing, food, putting away money for their child’s education,” Gerald said.

“To give people the bandwidth to focus on health, they need to have their needs met.”

Among additional policy changes that would support community health, Gerald cited raising the minimum wage and increasing access to health insurance.

“A very positive experience”

Gerald has positive memories of her childhood in Lumberton, where family, church and community provided opportunities for advancement such as summer programs and community plays. But she was also aware of the negative aspects of a Southern upbringing for an African-American child.

“I grew up in a segregated community, right on MLK [Drive], where many African-Americans live in the city,” she said. “We were aware of historical divides and issues; that is not lost on you as a child. I was probably in ninth or 10th grade before I saw a swimming pool.”

Gerald attended the N.C. School of Science and Mathematics, the statewide public high school in Durham, for her junior and senior years.

“I had PhDs as teachers and was taking courses with people as teachers who were really quite exceptional,” Gerald said. “When I went to Harvard from the North Carolina School of Science and Mathematics, I did not necessarily feel educationally deficient.

“It wasn’t really until I was an adult that I began to recognize how disadvantaged my background had really been.”

When she saw her home community on a national list of underserved communities, Gerald went from medical school at Johns Hopkins back to Lumberton, where she worked for three years in primary care.

“We had inpatient care, outpatient care, public-health patients,” she said. “We would literally leave the office and go over and deliver babies at the hospital.”

These days, Gerald is concerned that the stresses of life in Robeson are causing residents to undergo epigenetic changes, or effects on their genes that are caused, even before birth, by stressful life experiences.

“There are connections between stress and the production of stress hormones that can result in heart disease or diabetes — that’s true for an adult and it’s true for children,” she said.

“If a child is growing up in poverty, that results in certain stresses and trauma that result in physiological changes that result in chronic disease.

“That can have manifestations in future generations. The cycle of poverty will have to be broken if we are going to see differences in chronic disease.”

The post Laura Gerald Brings Statewide Clout to Health Problems in Her Hometown appeared first on North Carolina Health News.

By Rose Hoban

After three months of working with thousands of people in eastern North Carolina affected by Hurricane Matthew, representatives from the Federal Emergency Management Agency say time to sign up to get help is coming to a close.

FEMA counselors and disaster relief specialists will stop accepting new registrations for aid at midnight Monday, Jan. 23, said spokesman Mike Wade.

“As of close of business [Tuesday] there were a total of 80,275 households who had applied to FEMA for assistance,” Wade said. He said the agency had given out more than $89 million in assistance to individuals.

Wade said that people can still apply for assistance over the weekend. The first step is to call a registration number, or get online to register. Once a person registers, a FEMA inspector will come out to a person’s home and verify that damage has occurred.

“We want them to stay in their home if at all possible, we may provide them money for immediate repairs to make their home safe, sanitary and secure,” Wade said. “That’s our goal.”

Filling in the gaps

In the foyer of the Duplin County Department of Social Services in Kenansville this past week, three FEMA workers buttonholed people as they went in and out for appointments, asking if they needed disaster assistance.

“There’s a lot of people who didn’t know to register,” said Juan Ramirez, a FEMA worker. He said more than half of the people they’d encountered were Latino. “Many of them did not know that they could register or didn’t know much about FEMA.”

Ramirez’ co-worker Joy Shannon said she approached several dozen people each day, but only had conversations and gave instructions and literature to about half those people.

“We approach them to find out do they have any damages and do they need any help,” she said. “and then they come and we individually counsel them.”

“We’re filling an important gap, trying to get the folks who are falling between the cracks,” said FEMA worker Karl Fredericks. “Maybe they’ve been denied and given up hope. We’ve been able to make some contacts and get them on the right track.”

The workers had piles of printed information to hand out, everything from manuals on mitigation and retrofitting instructions, to how to repair sheet rock and insulation, and the importance of flood insurance. Shannon said that all their printed materials are available online, but frequently, in a flood, people have lost access to the internet.

They even helped one man who lost his dentures during the storm.

“He tripped during the hurricane and I think he had his partial [denture] in his hand, and it got smashed,” Shannon said.

“We needed some information from his dentist, that’s what the gap was,” Ramirez said.

Better late than never

Wade said that it’s important for people to register on the FEMA website, as well as with the Small Business Administration. FEMA’s assistance tops out at $33,200. Above that, the SBA can give people low interest loans to cover their losses.

He stressed that people should go ahead and fill out the application for an SBA loan, even if they don’t want to take the loan.

“Even if they’re approved for a loan with SBA, they don’t have to accept it, but at least they’ve gone through the process to see if they’re eligible,” Wade said. He said there are other ways to get help even if a person doesn’t accept an SBA loan, but he stressed the first step is registering on the FEMA website.

Glen Cavenaugh’s step-mother’s place didn’t flood, but rain got in through the roof, damaging the walls and floors during the storm.

“[The FEMA agent] was telling me what they could do, get her a low interest loan, I didn’t know,” he said. His step-mother is still staying with friends but if the family could get her house repaired, she would move back in.

“She applied for it a couple of days ago, and they sent an adjuster to look at it already,” Cavenaugh said.

A tree limb fell on Jimmy Byrd’s trailer during the storm, and it took days to get someone out to help get it off the roof. Now the damaged roof allows rain in and has begun to damage the walls and floor in his bathroom. But Byrd, who is developmentally disabled, doesn’t read or write and couldn’t use the internet to register.

“It’s leaking, and if it doesn’t get fixed, the trailer will be destroyed,” said Byrd’s sister-in-law, Emma Byrd. “He doesn’t have the money to fix it because he’s disabled.”

The two sat with the counselors for about a half hour, registering and getting information. Emma Byrd said she didn’t know if their request would be fulfilled.
“You comfort yourself that you’ve tried, done all you could,” she said.

Correction: This story originally said FEMA would stop work in Eastern NC at midnight Monday. FEMA will stop taking registrations for assistance at that time, but a FEMA spokesperson stressed the agency will continue to work in the region. 

Last chance to sign up for FEMA help:

Disaster assistance may include grants to help pay for temporary housing, emergency home repairs to make your home habitable, and for other disaster-related needs.

FEMA assistance is nontaxable and will not affect eligibility for Social Security, Medicaid, Medicare or other federal benefits.

How to register:

Online at DisasterAssistance.gov.

Call the FEMA Helpline at 800-621-3362 for voice, 711 and Video Relay Service. If you are deaf, hard of hearing or have a speech disability and use a TTY, call 800-462-7585.

Download the FEMA Mobile App and apply.

FEMA mitigation specialists will be at the following locations until the close of business Friday:

Hyde County: Government Center 30 Oyster Creek Road Swan Quarter, NC 27885

Bertie County: Windsor Community Building 201 South Queen Street Windsor, NC 27983

Bladen County: Bladen County Library 111 N. Cypress Street Elizabethtown, NC 28337

Duplin County: Dept. of Social Services 423 North Main Street Kenansville, NC 28349

COUNTY	REGISTRATIONS	ASSISTANCE FOR DISASTER-RELATED HOUSING NEEDS	OTHER NEEDS ASSISTANCE	TOTAL
Anson (County)	86	$6,741.04	$2,460.00	$9,201.04
Beaufort (County)	666	$314,613.98	$178,218.70	$492,832.68
Bertie (County)	1,015	$591,570.12	$254,063.79	$845,633.91
Bladen (County)	2,938	$1,811,193.83	$399,341.59	$2,210,535.42
Brunswick (County)	765	$252,097.09	$32,369.93	$284,467.02
Camden (County)	198	$214,616.79	$23,143.42	$237,760.21
Carteret (County)	43	$48,451.39	$3,319.00	$51,770.39
Chatham (County)	25	$13,342.36	$750.00	$14,092.36
Chowan (County)	206	$99,275.77	$11,065.59	$110,341.36
Columbus (County)	5,142	$4,224,077.24	$1,683,754.46	$5,907,831.70
Craven (County)	605	$515,099.92	$102,314.98	$617,414.90
Cumberland (County)	14,506	$9,924,515.46	$4,890,103.96	$14,814,619.42
Currituck (County)	313	$228,290.56	$32,034.37	$260,324.93
Dare (County)	1,105	$971,732.59	$270,817.34	$1,242,549.93
Duplin (County)	1,284	$912,046.14	$183,286.73	$1,095,332.87
Edgecombe (County)	3,099	$5,884,057.90	$2,785,902.69	$8,669,960.59
Gates (County)	155	$138,577.59	$43,819.71	$182,397.30
Greene (County)	577	$506,886.72	$123,494.11	$630,380.83
Halifax (County)	461	$247,859.69	$67,445.02	$315,304.71
Harnett (County)	1,761	$1,092,815.81	$232,964.44	$1,325,780.25
Hertford (County)	447	$237,808.47	$65,896.09	$303,704.56
Hoke (County)	1,902	$577,800.23	$135,315.57	$713,115.80
Hyde (County)	188	$67,508.76	$34,416.58	$101,925.34
Johnston (County)	1,783	$1,645,086.39	$547,476.68	$2,192,563.07
Jones (County)	217	$315,181.70	$61,680.53	$376,862.23
Lee (County)	216	$146,282.42	$24,909.24	$171,191.66
Lenoir (County)	3,254	$2,528,977.90	$1,431,899.33	$3,960,877.23
Martin (County)	205	$131,314.39	$35,209.67	$166,524.06
Moore (County)	380	$231,205.35	$84,973.78	$316,179.13
Nash (County)	917	$430,497.83	$227,878.79	$658,376.62
Northampton (County)	244	$151,749.94	$21,324.18	$173,074.12
Onslow (County)	414	$154,768.82	$32,128.34	$186,897.16
Pasquotank (County)	456	$192,316.19	$80,772.73	$273,088.92
Pender (County)	933	$1,691,795.90	$268,594.01	$1,960,389.91
Perquimans (County)	102	$31,624.09	$17,713.19	$49,337.28
Pitt (County)	3,257	$1,261,115.91	$829,882.03	$2,090,997.94
Richmond (County)	155	$55,908.56	$13,015.15	$68,923.71
Robeson (County)	18,372	$15,191,925.50	$8,216,254.98	$23,408,180.48
Sampson (County)	2,181	$1,637,670.49	$294,022.63	$1,931,693.12
Scotland (County)	518	$78,721.02	$15,388.35	$94,109.37
Tyrrell (County)	286	$193,211.86	$86,208.45	$279,420.31
Wake (County)	834	$427,110.04	$103,098.30	$530,208.34
Washington (County)	310	$129,480.56	$43,554.39	$173,034.95
Wayne (County)	6,590	$6,175,575.46	$2,861,169.73	$9,036,745.19
Wilson (County)	704	$447,867.87	$421,389.89	$869,257.76
Total	79,815	$62,130,367.64	$27,274,842.44	$89,405,210.08

The post Time is Running Out To Apply for Matthew Assistance appeared first on North Carolina Health News.

The post Teens Avoid the “Bad Tattoo” of Arrest & Conviction appeared first on North Carolina Health News.

By Rose Hoban

After three months of working with thousands of people in eastern North Carolina affected by Hurricane Matthew, representatives from the Federal Emergency Management Agency say time to sign up to get help is coming to a close.

FEMA counselors and disaster relief specialists will stop accepting new registrations for aid at midnight Monday, Jan. 23, said spokesman Mike Wade.

“As of close of business [Tuesday] there were a total of 80,275 households who had applied to FEMA for assistance,” Wade said. He said the agency had given out more than $89 million in assistance to individuals.

Wade said that people can still apply for assistance over the weekend. The first step is to call a registration number, or get online to register. Once a person registers, a FEMA inspector will come out to a person’s home and verify that damage has occurred.

“We want them to stay in their home if at all possible, we may provide them money for immediate repairs to make their home safe, sanitary and secure,” Wade said. “That’s our goal.”

Filling in the gaps

In the foyer of the Duplin County Department of Social Services in Kenansville this past week, three FEMA workers buttonholed people as they went in and out for appointments, asking if they needed disaster assistance.

“There’s a lot of people who didn’t know to register,” said Juan Ramirez, a FEMA worker. He said more than half of the people they’d encountered were Latino. “Many of them did not know that they could register or didn’t know much about FEMA.”

Ramirez’ co-worker Joy Shannon said she approached several dozen people each day, but only had conversations and gave instructions and literature to about half those people.

“We approach them to find out do they have any damages and do they need any help,” she said. “and then they come and we individually counsel them.”

“We’re filling an important gap, trying to get the folks who are falling between the cracks,” said FEMA worker Karl Fredericks. “Maybe they’ve been denied and given up hope. We’ve been able to make some contacts and get them on the right track.”

The workers had piles of printed information to hand out, everything from manuals on mitigation and retrofitting instructions, to how to repair sheet rock and insulation, and the importance of flood insurance. Shannon said that all their printed materials are available online, but frequently, in a flood, people have lost access to the internet.

They even helped one man who lost his dentures during the storm.

“He tripped during the hurricane and I think he had his partial [denture] in his hand, and it got smashed,” Shannon said.

“We needed some information from his dentist, that’s what the gap was,” Ramirez said.

Better late than never

Wade said that it’s important for people to register on the FEMA website, as well as with the Small Business Administration. FEMA’s assistance tops out at $33,200. Above that, the SBA can give people low interest loans to cover their losses.

He stressed that people should go ahead and fill out the application for an SBA loan, even if they don’t want to take the loan.

“Even if they’re approved for a loan with SBA, they don’t have to accept it, but at least they’ve gone through the process to see if they’re eligible,” Wade said. He said there are other ways to get help even if a person doesn’t accept an SBA loan, but he stressed the first step is registering on the FEMA website.

Glen Cavenaugh’s step-mother’s place didn’t flood, but rain got in through the roof, damaging the walls and floors during the storm.

“[The FEMA agent] was telling me what they could do, get her a low interest loan, I didn’t know,” he said. His step-mother is still staying with friends but if the family could get her house repaired, she would move back in.

“She applied for it a couple of days ago, and they sent an adjuster to look at it already,” Cavenaugh said.

A tree limb fell on Jimmy Byrd’s trailer during the storm, and it took days to get someone out to help get it off the roof. Now the damaged roof allows rain in and has begun to damage the walls and floor in his bathroom. But Byrd, who is developmentally disabled, doesn’t read or write and couldn’t use the internet to register.

“It’s leaking, and if it doesn’t get fixed, the trailer will be destroyed,” said Byrd’s sister-in-law, Emma Byrd. “He doesn’t have the money to fix it because he’s disabled.”

The two sat with the counselors for about a half hour, registering and getting information. Emma Byrd said she didn’t know if their request would be fulfilled.
“You comfort yourself that you’ve tried, done all you could,” she said.

Correction: This story originally said FEMA would stop work in Eastern NC at midnight Monday. FEMA will stop taking registrations for assistance at that time, but a FEMA spokesperson stressed the agency will continue to work in the region. 

Last chance to sign up for FEMA help:

Disaster assistance may include grants to help pay for temporary housing, emergency home repairs to make your home habitable, and for other disaster-related needs.

FEMA assistance is nontaxable and will not affect eligibility for Social Security, Medicaid, Medicare or other federal benefits.

How to register:

Online at DisasterAssistance.gov.

Call the FEMA Helpline at 800-621-3362 for voice, 711 and Video Relay Service. If you are deaf, hard of hearing or have a speech disability and use a TTY, call 800-462-7585.

Download the FEMA Mobile App and apply.

FEMA mitigation specialists will be at the following locations until the close of business Friday:

Hyde County: Government Center 30 Oyster Creek Road Swan Quarter, NC 27885

Bertie County: Windsor Community Building 201 South Queen Street Windsor, NC 27983

Bladen County: Bladen County Library 111 N. Cypress Street Elizabethtown, NC 28337

Duplin County: Dept. of Social Services 423 North Main Street Kenansville, NC 28349

COUNTY	REGISTRATIONS	ASSISTANCE FOR DISASTER-RELATED HOUSING NEEDS	OTHER NEEDS ASSISTANCE	TOTAL
Anson (County)	86	$6,741.04	$2,460.00	$9,201.04
Beaufort (County)	666	$314,613.98	$178,218.70	$492,832.68
Bertie (County)	1,015	$591,570.12	$254,063.79	$845,633.91
Bladen (County)	2,938	$1,811,193.83	$399,341.59	$2,210,535.42
Brunswick (County)	765	$252,097.09	$32,369.93	$284,467.02
Camden (County)	198	$214,616.79	$23,143.42	$237,760.21
Carteret (County)	43	$48,451.39	$3,319.00	$51,770.39
Chatham (County)	25	$13,342.36	$750.00	$14,092.36
Chowan (County)	206	$99,275.77	$11,065.59	$110,341.36
Columbus (County)	5,142	$4,224,077.24	$1,683,754.46	$5,907,831.70
Craven (County)	605	$515,099.92	$102,314.98	$617,414.90
Cumberland (County)	14,506	$9,924,515.46	$4,890,103.96	$14,814,619.42
Currituck (County)	313	$228,290.56	$32,034.37	$260,324.93
Dare (County)	1,105	$971,732.59	$270,817.34	$1,242,549.93
Duplin (County)	1,284	$912,046.14	$183,286.73	$1,095,332.87
Edgecombe (County)	3,099	$5,884,057.90	$2,785,902.69	$8,669,960.59
Gates (County)	155	$138,577.59	$43,819.71	$182,397.30
Greene (County)	577	$506,886.72	$123,494.11	$630,380.83
Halifax (County)	461	$247,859.69	$67,445.02	$315,304.71
Harnett (County)	1,761	$1,092,815.81	$232,964.44	$1,325,780.25
Hertford (County)	447	$237,808.47	$65,896.09	$303,704.56
Hoke (County)	1,902	$577,800.23	$135,315.57	$713,115.80
Hyde (County)	188	$67,508.76	$34,416.58	$101,925.34
Johnston (County)	1,783	$1,645,086.39	$547,476.68	$2,192,563.07
Jones (County)	217	$315,181.70	$61,680.53	$376,862.23
Lee (County)	216	$146,282.42	$24,909.24	$171,191.66
Lenoir (County)	3,254	$2,528,977.90	$1,431,899.33	$3,960,877.23
Martin (County)	205	$131,314.39	$35,209.67	$166,524.06
Moore (County)	380	$231,205.35	$84,973.78	$316,179.13
Nash (County)	917	$430,497.83	$227,878.79	$658,376.62
Northampton (County)	244	$151,749.94	$21,324.18	$173,074.12
Onslow (County)	414	$154,768.82	$32,128.34	$186,897.16
Pasquotank (County)	456	$192,316.19	$80,772.73	$273,088.92
Pender (County)	933	$1,691,795.90	$268,594.01	$1,960,389.91
Perquimans (County)	102	$31,624.09	$17,713.19	$49,337.28
Pitt (County)	3,257	$1,261,115.91	$829,882.03	$2,090,997.94
Richmond (County)	155	$55,908.56	$13,015.15	$68,923.71
Robeson (County)	18,372	$15,191,925.50	$8,216,254.98	$23,408,180.48
Sampson (County)	2,181	$1,637,670.49	$294,022.63	$1,931,693.12
Scotland (County)	518	$78,721.02	$15,388.35	$94,109.37
Tyrrell (County)	286	$193,211.86	$86,208.45	$279,420.31
Wake (County)	834	$427,110.04	$103,098.30	$530,208.34
Washington (County)	310	$129,480.56	$43,554.39	$173,034.95
Wayne (County)	6,590	$6,175,575.46	$2,861,169.73	$9,036,745.19
Wilson (County)	704	$447,867.87	$421,389.89	$869,257.76
Total	79,815	$62,130,367.64	$27,274,842.44	$89,405,210.08

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By Taylor Knopf

This week, a group of UNC-Chapel Hill students piled into their vehicles and headed off for spring break. But instead of heading for the coast or mountains, their first stop was the Robeson County city of Lumberton.

Close to two dozen students opted to spend their vacation taking a service-learning course aimed at helping communities affected by Hurricane Matthew. UNC partnered with churches and local health organizations to offer two free health clinics – the first on Tuesday in Robeson County and the second on Thursday in Columbus County.

“I’ve lived here all my life, but didn’t know a lot about the rural population,” said UNC-Chapel Hill freshman Alexis Payton from Raleigh. “I knew there was a disparity between rural and urban counties. I’m just getting to learn more about that.”

Inside the health clinic on Tuesday, medical stations lined three rooms of a former Lumberton ammunition factory. It serves as a temporary site for Robeson County Church and Community Center displaced by the hurricane.

At intake tables, community members filled out basic forms with age and gender but no identifying information. Student volunteers asked for some brief medical history such as tobacco use, diabetes, high blood pressure and asthma.

From there, patients could visit the nutrition table, get their vitals taken, or have an eye exam or HIV screening. Multiple stations offered information about free local programs, including some for new or expectant mothers or people with diabetes. Volunteers at a health care navigation table showed Robeson residents available services and helped them schedule appointments.

Many stopped at the mental health station where two professionals screened for depression and substance abuse. Often people wanted to share their experiences of Hurricane Matthew.

One woman confided in volunteer Richard Unkiewicz, a psychologist from Goldsboro’s Cherry Hospital, about her husband’s cocaine use. Unkiewicz said she is stressed and doesn’t know what to do, so he wrote her a referral to get some help.

“We try to get them to tell us a little bit about themselves,” he explained. “If they don’t want to talk, that’s fine. Usually, more cases than not, they will start talking. They start revealing things, but they have to connect with you.”

Despite the rain Tuesday morning, clinic volunteers saw more than 50 patients that afternoon. Organizers decided to extend the Lumberton clinic a second day and handed out flyers at motels where many are still homeless as a result of the hurricane.

Matthew’s destruction

When Matthew raged through Lumberton in October, about 20 inches of rain filled the sanctuary of Branch Street United Methodist Church.

The church lost everything except three pews and a piano. A month went by before the congregation could even hold a service in its adjoining fellowship hall. Three out of 60 church members were displaced from their homes due to flooding.

“We were on an island, you go this way hoping you could get home, you would have to turn around and go another way because of the floods and bridges washed out,” said Rev. Douglas Locklear.

“We’ve never seen anything like this. For weeks it looked like you were on the shore lines, so much pure white sand,” he continued.

Locklear said that without flood insurance, it will take about $150,000 to repair the damage to his sanctuary. Church members have worked three nights a week on repairs.

Matthew hit Robeson County hard, and many are in a similar bleak situation as they pick up the pieces of their lives after the storm.

Forty-year Robeson County resident Sheila Hammonds took advantage of the Lumberton health clinic Tuesday. She and her two children have been living with her sister since the hurricane and she said she considers herself lucky not to be in a shelter or motel. The first floor of Hammonds’ apartment complex flooded, and she’s been told by management she can hopefully return home late this spring.

Hammonds works at the Church and Community Center where donations are received and redistributed.

“We are trying to help people get back on their feet,” she said. “It may not be as good as it was before, but at least they have somewhere in the community they can come and receive care.”

Branch Street UMC partnered with Christ United Methodist in Chapel Hill which also sent volunteers with the UNC clinic team. Christ United sends volunteers to the area every few months.

“The idea is you keep coming down,” said church volunteer Scottie Pitner. “Don’t forget people, because they feel forgotten.”

Locklear said he and his community appreciate the students and volunteers who set up the health screenings.

“For UNC-Chapel Hill to come and do this health clinic means so much to us, especially our elders who live on a fixed income,” he said. “They have to make a choice every month to get their blood pressure or diabetes checked or pay their light bill.”

Local partners

Students and staff from UNC-Pembroke were not on spring break, yet came by to lend a hand.

Jennifer Twaddell, UNC-Pembroke Interim chair of nursing, said Pembroke is a name community members recognize and acts as a bridge into the community. So when UNC-Chapel Hill asked Pembroke to partner in the clinics, she couldn’t say no.

“These guys are doing this out of the goodness of their heart, they are not getting credit for this,” she said of her students working the clinic.

Christina Tunstall is a second year nursing student at UNC-Pembroke who volunteered Tuesday taking blood pressures at the clinic. She said all the people she checked ran high.

“A lot of people specifically in this area may not have the finances or insurance to go to the community hospital or clinic where they sometimes charge for things like blood pressure or blood glucose checks,” she added. “So it’s really important for people to have a place to go to for simple screenings.”

Tunstall lives in Fayetteville and her husband serves on Fort Bragg. Being from a military family and moving a lot, she said she didn’t always connect with the residents around her. But she is glad to connect with the community members in Robeson County.

“It’s awesome to go to a school that places a lot of importance on serving the local community,” Tunstall said.

The post Spring Break For UNC Students Includes Matthew Relief appeared first on North Carolina Health News.

By Catherine Clabby

When Tona Jacobs, the vibrant principal of Pembroke Elementary School, fainted twice at work five years ago, she figured she was just weak from giving blood earlier that day.

But no.

After her staff insisted she take an ambulance to a local hospital, an ultrasound revealed waxy plaque narrowing the arteries in her carotid arteries, connecting her brain to the rest of her body. That’s serious business, a symptom of atherosclerosis, which can lead to stroke, heart attack or death.

“That was a scare. I may not have known that until it was too late. I thought I was healthy,” said Jacobs, 56, a health-conscious member of the Lumbee Indian tribe clustered in and near Robeson County.

As it turns out, simply being an American Indian puts Jacobs and other Lumbee woman at increased risk of developing cardiovascular disease, or even prematurely dying from it.

Death rates from the disorder among Indian women in southeastern North Carolina are among the highest in the country, said Jada Lynn Brooks, an assistant professor of nursing at UNC-Chapel Hill.

Brooks, who is also Lumbee, wants to find out why.

Brooks suspects one problem could be people’s environmental exposures, possibly from minute particles emitted from the tail pipes of the gas- and diesel-powered vehicles traveling up and down Interstate 95 in Robeson County.

Psychological factors could be in play, too.

If Brooks cracks the mystery, she wants to then help reduce the scourge, something that could extend the lives of Lubee woman.

“I’m always looking for solutions to a problem,” said Brooks, who landed a $741,355 National Institute of Environmental Health Sciences grant and help from more senior scientists at UNC to tackle her query.

Loyal to home

Brooks, who is 37, grew up in the Lumbee Prospect Community, not far from UNC-Pembroke, where she enrolled to study science straight out of high school.

When she peppered a pediatrician she shadowed at that time about root causes of the many asthma cases he saw among patients, he recommended she get graduate training in public health to help her find out. She did, at the elite Gillings School of Global Public Health at UNC Chapel Hill.

As her interests in clinical care and the bigger picture grew, she earned a second bachelor’s in nursing and then a doctorate, too, at Duke University, working with premature babies back home in Robeson County and, eventually, having three children of her own.

Already a veteran health researcher, Brooks has worked on projects to improve mammogram screening rates among minorities, expand access to smoking-reduction program for similar populations, and better understand the challenges faced by mothers whose babies are born premature.

“All of my research has been aimed at understanding health disparities and trying to figure out what we can do to address them,” Brooks said.

There’s plenty to do. Significant numbers of Lumbee people historically have grappled with poverty, high rates of obesity and chronic illness—diabetes and depression among them—at rates higher than white North Carolinians. As recently as 10 years ago, Lumbee people were, on average, less likely to have health insurance and access to affordable health care.

But the statistics don’t fully explain the disproportionate burden of disease among Lumbee women, said Brooks, who will recruit 120 tribal women ages 28 to 45 to help her find answers.

The project aims to take blood samples from each woman and use EPA air pollution measurements to look for any correlation between a woman’s exposure to particulates in the air and biomarkers in blood associated with atherosclerosis. In addition, Brooks and her research team want to explore whether a woman’s positivity, or lack there of, is associated with higher or lower inflammation markers.

The women will be queried about how frequently they feel interest in their lives. She’ll also ask about love and pride, and how often they feel contempt, embarrassment and guilt.

To help her conduct studies that are culturally appropriate, Brooks has solicited advice from leaders within the community, including Jacobs, the elementary school principal.

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Those advisors have nudged Brooks to inquire about religious beliefs and practices when probing mood, since so many Christian churches steeples — mostly Methodist and Baptist — are found in Lumbee communities.

During a phone meeting earlier this week, some members also questioned her closely about what she planned to do with the blood samples after her study is finished, about five years from now. Brooks said she may destroy them, though she is not sure. No matter what the plan, her consent form for the study will put research subjects in charge of how the samples are used.

“You have to be careful with consent so that people know what they are giving permission for signing up for,” Brooks said.

A link in a chain

Martin Luther Brooks, a Lumbee physician with a general medicine practice in Pembroke since 1958, is also on Jada Lynn Brooks’ advisory team.

He has long observed gaps in the medical care Lumbee women receive. One example from early in his practice was his discovery that there were no statistics on cervical cancer among North Carolina Indian women in state records.

They were not immune. They were just not getting the pap smears that detect that cancer, a deficit he worked hard to reverse, despite opposition from his patients due to modesty, lack of funds and ignorance about the risks they faced.

“We’re still aren’t getting women enough basic fundamental information about their own health. Self care has to predate health care. If it does not, when health care arrives, it gets there too late,” said Brooks, who is not related to the UNC researcher.

Jacobs, the principal, says she thinks wider cultural forces could play a role in Lumbee women’s higher rates of cardiovascular disease. Possibly like women in many communities, they focus more on others – parents, children and spouses – than they do on themselves.

“We don’t focus on ourselves. You are considered the backbone. You can’t be sick,”  Jacobs said.  “You have to take care of all these other things.”

The cardiovascular study that Jada Lynn Brooks is launching could help women understand why they must work harder to look after themselves too, Jacobs said.

“There is so much that could come from this study — to help people my age but also to better educate our children,” she said. “We need to put things in place to help our children.”

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