Engelhard, North Carolina, is coastal country, nestled between Lake Mattamuskeet and Pamlico Sound. Every May, this commercial fishing and agricultural area hosts a seafood festival that draws people from around Hyde County—which boasts a population of 5,000. Yes, that’s the entire county.
“The nearest anything is an hour away,” says Sally Messick, a family NP who is pretty much the primary care provider for the county. “It’s just a wonderful, isolated place.”
Messick isn’t even one of those 5,000 souls. She lives in Chatham County, about four hours away, and every week she makes the long commute to Engelhard Medical Center to provide care to the people who need it most. “My husband fends for himself during the week,” this 59-year-old mother of five grown children says with a laugh.
Even though she’s not a native, the community has embraced Messick as one of its own. The owners of the hotel where she stays during the week even renovated a room especially for her, making it her semipermanent home away from home. “This community and my staff are just so loving to me, and I feel so appreciated,” Messick says. “That’s a huge factor.”
When she’s on duty (and sometimes even when she’s not), Messick sees about 22 patients per day at the medical center, which is currently housed in a double-wide trailer. Thanks to grant money from the North Carolina Office of Rural Health and Community Care, as well as local fundraising efforts, a new building is in the works. But the current practice setting has its own charms.
“We have rocking chairs on the front porch, so when the waiting room is full, people go out on the porch and rock,” Messick explains.
Since she is literally the sole provider for miles around, Messick’s practice is extremely varied. “We’ll see anything in any one day, from newborn babies to the very, very elderly.” While Messick doesn’t have any patients who have passed the century mark, “I have a good number who are between 95 and 100.”
In addition to her clinical skills, Messick relies on a combination of common sense and an ability to improvise. She has to, since she’s largely on her own out there. Messick’s supervising physician, Tom Irons, is a professor at East Carolina University in Greenville, which “gives us a connection to a major medical center—although it’s two hours away,” Messick says. “We have no drugstore. The nearest emergency room is an hour away in either direction.”
The choice to live and work in that kind of isolation may be inexplicable to some, but not for Messick, who “grew up in a place that was very much like this.” Most of the people who live in Hyde County have done so their entire lives. “The folks who live here like being here,” Messick says. “But that comes with the isolation and knowing that if you have a heart attack or if you have a major farming accident, you are pretty far away from any medical care.”
While Messick enjoys the challenges of her job, she says it is extremely hard to see a patient who needs medical care or medications that he or she simply can’t afford. About a third of her patients are Medicare/Medicaid beneficiaries, another third are privately insured, and the rest self-pay with help from a medical access program funded by the state’s rural health office. “It’s not being able to get things for people that they need that bothers me more than other things,” according to Messick.
While she loves her work, Messick does appreciate why not everyone would want to be in her shoes. “I can understand why somebody who has a college education and professional training doesn’t want to raise a family in a place where they don’t feel their kids would have the same opportunities that they might somewhere else,” she says. “It’s a wonderful adventure and a wonderful life for somebody that wants to do it. But you know, you just have to be suited to this, I think. And I don’t know how we [can] teach that.”
Maybe, she suggests, greater exposure in school to the joys and challenges of rural practice would encourage more clinicians to pursue a career in such an area. Or “perhaps it’s recruiting the people who don’t need the things that are never going to be here,” she muses.
In the end, it may be that financial incentives, loan repayments, and reimbursement really aren’t what will drive health care providers to underserved areas. A community such as Engelhard—small and welcoming, certainly, but the equivalent of the end of the earth to some—is a place you have to want to be. Sally Messick does—and that’s why she makes a difference.