This editorial was originally published on Cardinal & Pine.
Seventy of North Carolina’s 78 rural counties are considered “medical deserts.” That means patients often can’t get the care they need, and in many cases, die younger.
Rufus Whitaker Jr. remembers what it was like growing up in Halifax County in the 1950s and 60s. Many families, including his own, struggled to scrape by. More than 61% of families lived under the poverty line.
Whitaker, now 77, recalls how his family and many others lacked health insurance and couldn’t go to a doctor.
“My family predominately couldn’t afford health insurance, especially my uncles and aunts. My mother was poor, and my family, we were in the welfare system,” he told Cardinal & Pine.
The lack of access to medication and care meant many community members, including members of Whitaker’s own family, died at an early age.
“I didn’t understand why people were dying at age 49, 51. People had diabetes but they couldn’t get any health care, because they couldn’t pay for health care. They couldn’t pay for diabetes medication,” he told Cardinal & Pine.
Whitaker, who was diagnosed with type 2 diabetes in his 40s, has been more fortunate. He can afford his medication. But not everyone in his community is as lucky.
Today, Halifax County’s life expectancy remains among the lowest in North Carolina. Women in the county live an average of 74.5 years, while the average life expectancy for Halifax County men is just 66.6 years of age. By comparison, women and men in Wake County can expect to live to 83 and 79 years old, respectively.
While the area’s uninsured and poverty rates have declined since Whitaker’s childhood, they remain well above average compared to the statewide uninsured and poverty rates. More than 16% of people in Halifax County are uninsured, while one in four people live in poverty. Without money and insurance, health care becomes harder to access.
Data from KFF shows that in 2023, half of uninsured Americans didn’t see a doctor at all, while 22.6% skipped “needed care” because of the cost.
“Some of the biggest health challenges I’ve seen for patients in Halifax County are delays in care or diagnosis. Patients may have had cardiovascular disease or diabetes for many years, and in many cases were never able to afford or find a place to go see their doctor or providers,” said Dr. Ray Antonelli, a primary care physician in Halifax County.
“If the diabetes isn’t well managed, they can develop complications like blindness, kidney failure, limb amputations—and we see a lot of cases of all of those things here in patients who either had a delayed diagnosis or were not receiving routine primary care.”
Healthcare access struggles persist across rural NC
Accessing care and medications is a struggle far beyond the borders of Halifax County.
Seventy of North Carolina’s seventy-eight rural counties are considered medical deserts due to a shortage of primary care providers. And while 33% of the state’s population lives in rural areas, only 12% of physicians in the state practice there. Twenty counties in the state don’t have a single pediatrician, while another twenty don’t have a hospital.
This lack of healthcare infrastructure can be deadly. According to the Centers for Disease Control (CDC), people in rural communities are more likely than their urban peers to die prematurely from all five of the leading causes of death in the US: cancer, strokes, heart attacks, chronic lower respiratory disease, and unintended injuries.
“In an ideally functioning healthcare system, it’s thought that there should be around 10 primary care physicians per 10,000 people. In many parts of North Carolina that is closer to 6 in 10,000, and in this region it’s actually closer to 3 in every 10,000 residents,” Dr. Antonelli said.
Pamlico County, just east of New Bern, is one of the counties without a hospital. There is only one urgent care and four primary care providers for the county’s 12,500 residents: the Pamlico County Health Department, CCHC Pamlico Medical Center, Contentnea Health-Pamlico, and Hope Clinic.
Hope Clinic provides cost-free services to uninsured residents and households in Pamlico, Craven, and Beaufort Counties who earn 300% of the federal poverty level or below.
“They make too much for Medicaid, although they can’t afford either private insurance or the Affordable Care Act plans that are out now,” Yolanda Cristiani, the executive director of Hope Clinic, said of the program’s 200 patients.
Hope Clinic provides primary care and has partnered with specialists in the region and the urgent care facility.
“We have a lot of specialist visits we’re able to send our patients to through help of Carolina East Health Center. They have a lot of specialty physicians, such as orthopedics, rheumatology, those kind of doctors. They have financial aid applications that way the patients can be seen there,” Cristiani said. “We also work with [the] Coastal Carolina Healthcare system. They do a lot of our imaging studies for us at no charge, and they have a couple providers who do pro bono work completely.”
In a community with limited primary care providers, places like Hope Clinic are a lifeline.
Vicki Gable, 63, moved to Pamlico County from Pennsylvania in 1997 with her husband and son. They were enrolled in Medicaid before they moved and assumed their coverage would carry over to North Carolina.
“We just assumed, as it was a federal program, as far as we knew, that we’d get it down here. But it doesn’t work that way,” Gable said.
In North Carolina, she and her late husband did not qualify for Medicaid, despite working minimum wage jobs.
Gable’s husband had Type 1 Diabetes and couldn’t afford to go without his medication. That put the family in an impossible position.
“[He] could not find work for eons, could not find health care because we could not afford a doctor. We ended up having to split the family up, and he ended up having to move back to Pennsylvania for a couple of years, [and] took his old job back,” she said. “He would have died if he stayed down here.”
When Hope Clinic opened in early 1999, the Gable family qualified for its services and was able to reunite. In the 27 years since it opened, the clinic has served more than 3,000 patients.
Gable, who now works as a paid caregiver for her autistic son, remains a patient at the clinic, where she is treated for high blood pressure and depression. Due to her employment, she doesn’t qualify for Medicaid and can’t afford private insurance plans. The clinic is the only reason she’s able to get treatment.
“My husband died 15 years ago, in 2011. I’ve been my son’s full time paid caregiver since that time,” she said. “In all that time, I have not qualified to be able to get insurance. I just cannot afford it.”
Transportation is another barrier to care
While limited access to primary care doctors, high costs, and a lack of insurance worsens healthcare outcomes in communities like Pamlico and Halifax, other roadblocks exist too. Both Antonelli and Cristiani see transportation as a barrier. In Halifax County, specialty care is scarce, and many patients have to travel for more specialized or advanced care.
“If you need a high sophistication procedure or a really advanced specialist, really the only options may be for you to go to a place like Duke, or UNC, or ECU, and all of those places are an hour and a half or more from here. Sometimes that’s okay, some patients can make that work. A lot of patients, they don’t have the transportation, they don’t have the gas money,” Antonelli said.
A 2023 study found that adults in rural areas are more likely than those in urban areas to miss an appointment because of transportation issues.
Getting to Hope Clinic can be a challenge for patients, Cristiani said. To ease the burden, the organization operates five mobile clinics every quarter across the three counties it serves.Hope Clinic’s leadership found that the mobile clinics helped patients suffering from diseases like high blood pressure.
“The patients that live in that area come to the mobile clinics. We found that by doing that, it definitely helped with the transportation problem. It also helped the patients who were canceling appointments because they couldn’t get to the Bayboro office, [they] were more consistent about staying with their visits. And we actually saw some impressive numbers with our high blood pressure patients. The numbers were improved because they had better access,” Cristiani said.
‘We do our best’
Ultimately, for many North Carolinians, the biggest barrier to healthy and getting needed medications is simply being able to have regular access to a doctor. In medical deserts like Halifax County, that access can be months away.
“When patients need to get in to see a primary care doctor, there can often be monthslong waiting lists. At our office for example, a new patient, we’re almost six months behind. We can sometimes try to squeeze them in somewhere sooner on our schedule,” Antonelli said. “At the same time, because there’s so few primary care providers here, we do our best to see as many patients as we can in a day. But often we’ll have 15, 20, 30 requests for patients to come in and see us in one day, in spite of having a full schedule.”
Whitaker says he’s personally received good care for his diabetes and regularly takes his prescribed medications, but emphasized the financial cost. He spends roughly $200 to $300 a month on medication to stay alive.
“The care that I receive in Halifax County is good because I pay a lot,” he said. “But a lot of people don’t receive that care because they don’t have health insurance, and they can’t afford to pay $500, $600, $700 a month.”
Dylan Rhoney is an App State grad from Morganton who is passionate about travel, politics, history, and all things North Carolina. He lives in Raleigh.
Cardinal & Pine is owned and operated byCOURIER, a pro-democracy news network that is building a more informed, engaged, and representative America by reaching audiences where they are online with factual, values-driven news and analysis at the local and national level.
