From the Macon County Fire Department to a persistent group of contra dancers, a long list of groups is vying for the chance to use the old Cowee school once it is vacated by students in two years.

Stacy Guffey, who is helping to coordinate the effort, more than welcomes the interest.  

“I’ve been encouraging folks who haven’t been in the valley long, and folks who’ve been here for generations [to participate],” said Guffey, a consultant with The Land Trust for the Little Tennessee. “I think they all need to be at the table.”

The Cowee School was built in the 1940s and is still used as an elementary school today. It’s a fairly large school built out of local stone, which lends it a beautiful historic look, Guffey said.

Students from both Iotla and Cowee schools are currently crowded into the elementary school as they wait to move to the new consolidated North Macon elementary school by 2012.

Macon County commissioners have committed to take the building over from the school system and reserve it for community use. What that use entails is the question of the hour.

The many county departments interested in claiming space include the economic development commission, the sheriff’s department, the library, the recreation department and emergency medical services.

Incorporating county offices at the Cowee School simply makes financial sense, according to Guffey.

“It helps keep the lights on and keep the yard mowed,” Guffey said.

Other groups officially interested include Southwestern Community College, the Chamber of Commerce, the Eastern Band of Cherokee Indians, and a plethora of community groups.

Some are itching to hold basketweaving and other heritage classes there, while others want to display quilts. Still others are craving space to contra dance the night away. Dancers say the closest permanent contra dance floor requires a long drive over the mountains at night to Sylva.

Guffey said another possibility is providing the school’s commercial-grade kitchen to local farmers and holding food processing classes.

He’s heard from a strong contingent of local families who are adamant about keeping the school’s walking track, baseball field and playground in tact.

Ultimately, having a mix of uses would be ideal, Guffey said.

“It’s an opportunity to have a lot of things in on spot,” said Guffey. “It also makes it easier in terms of sustaining it financially.”

Input sought

A two-day public workshop will be held on the future use of the Cowee School and its role in the greater historic district. The public session runs at the Cowee School from 4 p.m. to 8 p.m. Thursday, Aug. 12, and from 9 a.m. to 3:45 p.m. on Saturday, Aug. 14. Free lunch provided at noon on Saturday in the cafeteria.

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“I’ll tell you what this is, and I’ll tell you what it’s not,” said Franklin Mayor Joe Collins, opening a public hearing on a special use permit for a proposed Wal-mart Supercenter just outside the town limits.

Collins had anticipated that the capacity crowd gathered in the town hall on Monday night had come to express their opinions about whether they wanted a new Wal-Mart. But he was keen to limit the discussion to a very narrow topic: the size of the building’s footprint and a request for larger signs.

“This is not the time or the place to have a general discussion about whether you do or do not want to have a Wal-mart,” Collins said.

Developers Bright-Meyers, LLC, appeared on behalf of Wal-Mart to secure a necessary special use permit to proceed with the new store.

According to Collins, the public hearing was a carefully proscribed step in a process that began on May 21, when the application was first submitted.

The project’s special use permit application was vetted in a neighborhood compatibility meeting on June 8 in which nearby property owners voiced their opinions, and it was stamped for approval by the town’s planning board on June 15 after a thorough fact-finding process.

At the end of Monday night’s hearing, which was full of opinions from opponents and supporters of the project, the town board voted 6 to 0 to approve the special use permit and open the way for the store. But the vote didn’t do anything to dispel the idea that Wal-Marts are still controversial. The hearing was boisterous and at times contentious, as supporters and critics of the project shouted back and forth.

The proposed Wal-Mart Supercenter would be located at the corner of Wells Grove and Dowdle Mountain roads just off of the N.C. 441 bypass. The 33-acre site is outside the town limits, but within its zoning district and adjacent to the site of a recently constructed middle school.

The town’s unified development ordinance, created in 2007, requires any building over 30,000 square feet to go through a special use permit process.

The Wal-Mart Supercenter will measure 120,000 square feet and include two additional outbuildings of 32,000 square feet and nearly 800 parking places. Wal-Mart also wanted larger signs than are allowed under the town’s ordinance — one on the side of the building and one at the development’s entrance.

Town Planner Mike Grubermann, who has overseen the application process, said the developer’s proposal met the standards of the town’s universal development ordinance in all respects except the two conditions outlined in the special use permit application. He said the roads that provide access to the site are overseen by N.C. Department of Transportation and would require their approval, but traffic counts provided by the developers met his department’s standards.

Franklin developer Marty Kimsey summed up the case for those in support of the special use permit, saying that in a down economy, the new store offered jobs and a boost for the private sector.

“The bottom line is that this site will not be used as a Wal-Mart unless the special use permit is given,” Kimsey said.

Opponents of the project questioned whether Wal-Mart would bring new jobs or hurt existing businesses. They pointed out the potential environmental impact of its placement on the banks of the Little Tennessee River and raised concerns about its effect on traffic patterns in close proximity to the new school.

“I don’t think you could choose a worse area to build something that big,” said Mike Kegan, a resident of Dowdle Mountain Road.

Collins, presiding over the hearing, policed the comments closely at first, but as the hearing wore on, the speakers increasingly used the microphone to talk about their general views on having a new Wal-Mart in town.

John Cantrell, a former high school teacher who was against the permit, was exasperated when Collins cut him off. Cantrell complained about the proximity of the giant commercial complex to the nearby middle school, but Collins deemed them unrelated to the permit application.

“Well, who is it, who is supposed to hear these concerns?” Cantrell asked.

“I don’t know. It’s not us. Not here,” Collins said.

After the hearing was closed, Collins explained the guidelines for public hearings on special use permits are governed by state statutes and that, at the advice of Henning, he attempted to keep the discussion focused on the issue of exceeding square footage requirements.

“It may be that there are [towns] that take a looser approach than this, but I think that’s risky,” Henning said, adding that the developers could appeal the vote of the board if they felt the hearing was stilted.

Kim Hibbard, general counsel for the N.C. League of Municipalities, agreed that quasi-judicial hearings must be held to a different standard from other types of public hearings.

“If it was a quasi-judicial hearing, there are different rules. It would need to be relevant to the situation,” Hibbard said.

However, exactly how much of the comments should have been reined in is subjective.

In the end, in spite of Collins’ best efforts, the meeting did provide a forum for the public to express their opinions about the proposed Wal-mart. While more members of the public spoke in opposition to the project than in support of it, the decision rested with the board and it chose to grant the application without requiring any additional measures from the developers.

Franklin Alderman Bob Scott recused himself from the vote on a special use permit for a Wal-Mart Supercenter this week after conducting an online survey on the issue. Town Attorney John Henning said he believed the survey compromised Scott’s impartiality, citing state statutes that govern the procedures for quasi-judicial public hearings.

The pertinent passage in G.S. 160A-388 says that “impermissible conflicts include, but are not limited to, a member having a fixed opinion prior to hearing the matter that is not susceptible to change.”

Kim Hibbard, general counsel for the N.C. League of Municipalities, said determining whether Scott had compromised his impartiality was ultimately a judgment call.

“Are they really impartial? Have they fixed their opinion already? Have they been getting communications from one side or the other?” Hibbard said. “That’s where you would need to make your judgment, whether the actions fall into that category.”

Scott said his survey was an attempt to gain perspective on the public’s opinion.

• View the results of Scott's survey

“All I was trying to do before all this came up was just find out how people felt. I wasn’t trying to make a determination of whether it was a pro or con, I was trying to feel what the feeling of the public was,” Scott said.

Scott also questioned whether the other aldermen were impartial, adding that it seemed they all had their minds made up which way they were going to vote prior to the meeting.

He did confirm that he would have voted against granting the special use permit had he been allowed to vote.

“I am concerned. If we have this ordinance then allow variances because it is Wal-Mart, is that fair? Why do we have the ordinance if we are going to grant exceptions?” Scott said.

Scott’s public survey had 329 respondents. Over 75 percent of them were in favor of the Wal-Mart. Over 80 percent had a favorable opinion of the company. Perhaps the most interesting response to the survey showed that 40 percent of the respondents thought the public should have a say in the store’s design scheme.

By the end of this year, nearly every student in the six westernmost counties will have unprecedented access to technology in the classroom.

Thanks to a collaborative project called WNC EdNet, high-speed Internet will become a reality for all public and charter school classrooms in Cherokee, Clay, Graham, Jackson, Macon and Swain Counties, along with the Qualla Boundary.

WNC EdNet recently got the go-ahead to connect The Highlands School — the last remaining school to join the regional network.

As late as 2000, schools in Western North Carolina could only transmit 1.5 megabyte per second. Now, schools with fiber can enjoy 100 megabyte per second connections.

Once these high-speed connections are in place, star pupils from far-flung schools can join together in a virtual classroom to take advanced courses that aren’t normally offered at their own schools. Live video will allow for face-to-face interaction between students and teachers.

“It’s not like an online class,” said David Hubbs, CEO of BalsamWest FiberNET, which implemented the WNC EdNet project. “You’re speaking to or interacting with a teacher in real time.”

Linking up to the state network creates access to The North Carolina Virtual Public High School, which already offers 72 courses including Advanced Placement and world language classes.

The widespread reach of fiber across North Carolina to even the most rural schools holds the promise of creating a level playing field for students, according to Bob Byrd WNC EdNet project manager.

“That’s our big push now, to narrow that digital divide,” said Byrd.

Moreover, fiberoptic technology makes professional training more readily available for teachers. Once colleges are hooked up to the statewide K-12 network, student-teachers at Western Carolina University or other colleges may observe teachers in actual classrooms without interrupting lessons.

Being on the same fiber network also decreases overhead for school systems, which only have to pay one Internet bill for all their schools, Hubbs said.

 

Jumping hurdles

 

The WNC EdNet project has traveled down a long road to get to where it is now.

Nearly 60 schools have been hooked up to their central office in the county via a fiberoptic line, which makes broadband Internet possible and also provides an important backbone for communication between the school district office and individual schools.

A separate project by a nonprofit called MCNC is in turn connecting these school district offices to a statewide fiber network, the North Carolina Research and Education Network. Now, MCNC is also working on linking colleges up to the state network.

WNCEdNet piggybacked onto the larger BalsamWest project, which has installed hundreds of miles of fiber underground to promote economic development in the Western North Carolina.

The mountainous terrain was a major obstacle BalsamWest had to overcome while installing equipment underground.

“The very things that we love about our rural area create challenges for technology,” said Hubbs.

Constructing in the remote area between Cashiers and Highlands was another challenge. BalsamWest had to speak individually to every property owner to get permission to build.

“We had more private easements between Cashiers and Highlands than we did everything else put together, over 300 miles,” said Hubbs. About 15 grant applications had to be submitted to lock down funding for the $6.1 million WNC EdNet project. The project was partly funded by the Golden LEAF Foundation, which chipped in $2.2 million, and the Cherokee Preservation Foundation, which contributed $1.7 million.

Even with 12 different partners — including Southwestern NC Planning & Economic Development Commission, the Western Region Education Service Alliance, seven school districts and three colleges — WNC EdNet was smoothly coordinated.

A similar project in eastern North Carolina had failed due to infighting, according to Leonard Winchester, chairman of the WNC EdNet technology committee.

WNC EdNet coordinators were asked to come to Raleigh and explain how their particular project ended in success. Winchester said cooperation was key.

“We had a group of people that trusted each other,” said Winchester. “That trust, you can’t give to somebody else.”

As Macon County closes in on a steep slope ordinance, some members of the building and real estate industry fear the new regulations will pose an unwanted barrier into a construction economy that is already hurting.

“No one so far has explained why we need this thing,” said Paul Higdon, a contractor who oversees sewer, water and septic projects. “Other than it’s just another level of bureaucracy that private landowners have to go through.”

But Lewis Penland, the planning board’s chair, has billed the ordinance as a way to protect lives and property from slope failures.

“We’ve got to have development,” said Penland. “All I ask is that when you build something above me, it doesn’t fall down on me.”

Penland, who works as a developer and grading contractor, also backs steep slope rules as a way to level the playing field between the contractors with scruples versus the ones who cut corners and can offer cheaper rates as a result.

“The way the system is set up now, you’re punishing the people who are doing it right,” Penland said.

Higdon is no stranger to regulation, having worked as Macon County’s environmental supervisor for 10 years. But he believes the county’s erosion control and subdivision ordinances already put enough restrictions on developers even though they don’t deal directly with mountainside construction.

“My concern is in a down economy –– a construction-based economy –– it will inhibit it that much more,” Higdon said.

Higdon also fears that landslide hazard maps, developed by the North Carolina Geological Survey, will become material facts that must be disclosed during land transactions, forcing Realtors to inform potential buyers if a house or lot lies in a landslide hazard area.

Higdon thinks the maps may open the door to more litigation on the one hand or lower property values on the other.

What role the newly created landslide hazard maps should play in steep slope regulations has proved controversial. The maps were created in the wake of the Peek’s Creek landslide that killed five people in Macon County in 2005.

“We’ve got to educate people on the maps,” Penland said.

But advocates of the slope rules aren’t stopping there.

The planning board has launched an education campaign in which its members will travel to communities around the county to educate people about the proposed regulations.

Some citizens have already joined the discussion. Last month, 12 people came to a planning board meeting to voice their reservations.

Bill Vernon, a retired developer who created the Featherstone subdivision in 2002, is another critic of the proposed elements of the ordinance. He thinks the engineering fees the ordinance requires in certain cases would prohibit development.

“The big issue I see is what will it will do to construction,” Vernon said.

He disputes the planning board’s estimates that engineering fees could range from $500 to $8,000 for projects that occur on slopes of a 30 percent grade or more, estimating instead that costs could climb to $20,000 on a house.

“If you’re going to add $8,000 to the cost of a building in this economic environment, I’m against it,” Vernon said. “I’m against it if it’s $20.”

Steep slope committee member Reggie Holland is president of the Macon County Homebuilders Association. Holland doesn’t think the steep slope ordinance will hurt his trade.

“I really don’t think this is going to be so significant an expense that it would cause people not to buy here,” Holland said, adding most buyers would want their home to comply with the cut and fill and soil compaction requirements.

For Holland, who changed his mind about the regulations during a year of slope committee meetings, the ordinance speaks for itself.

“When I was first on this committee, I felt similarly to Paul and Bill, thinking we didn’t need another government program to intervene in the work we’re doing,” Holland said. “The more I investigated it and thought about some jobs in the past where there were failures, I really thought there needed to be some standards.”

Penland said the development of the actual ordinance will take some time and he doubted if the commissioners would take the issue up before the November election. Between now and then, he hopes to turn doubters into supporters through a series of community meetings.

Holland doesn’t think the sell job will be a tough one.

“I think most people who are against the ordinance –– not all of them –– are people who haven’t really read it,” Holland said.

The Macon County Planning Board will hold its next meeting at 5 p.m. on Thursday, July 15, at the Pine Grove Community Center.

 

Macon slope rules in the works

 

In April, the Macon County Board of Commissioners charged the planning board with the job of drafting an ordinance that would regulate development on steep slopes. The directive came after the planning board’s steep slope committee had spent the better part of a year creating a set of guiding principles for the ordinance.

Below are the key elements of the committee’s recommendations.

For any development on slopes over 30 percent grade:

• Cut slopes over 8 feet in vertical height cannot be steeper than a 1.5:1 ratio.
• Fill slopes over 5 feet in vertical height cannot be steeper than 2:1.
• No cut-and-fill slope can exceed 30 vertical feet.
• Fill must be compacted and cannot contain stumps and logs.
• 30-foot setback from streams.

On slopes greater than 40 percent, developer must hire an engineer or design professional to create a slope plan. An engineer is also required on slopes greater than 30 percent if they lie in high or moderate landslide hazard areas.

For development on slopes between 30 and 40 percent grade, an engineer is not required, but a site plan, showing the areas to be graded, cut and fill heights, and a drainage plan, is required.

The ordinance applies only to the portion of a tract that exceeds the slope threshold, not the entire tract.

Measuring the overall health of a population at the local level is an elusive and cumbersome task. As a result, there have been few statistical studies historically that hint at how Western North Carolina stacks up.

But this year, an unprecedented study compiled health rankings for every county in each state across the country.

The results weren’t good news for Swain County, which ranked in the bottom 10 percent in several categories. However, Haywood, Jackson and Macon counties went against the stereotype of poor health in the Appalachian Mountains and ranked in the top third.

“The western part of the state is a good deal older. When you control for that, the east part of the state seems a good deal unhealthier,” said Dr. Tom Ricketts, past director of the North Carolina Rural Health Research Program at the University of North Carolina at Chapel Hill.

Compiled by the University of Wisconsin, the study divided heath rankings into two broad categories: health outcomes and the health factors that cause them.

Swain County ranked 91st out of 100 counties in the state — the lowest ranking of any county in WNC when it comes to health factors. Meanwhile, Jackson, Haywood and Macon Counties are ranked in the healthiest third at 31, 19 and 15 respectively.

Diet, smoking, drinking, exercise, access to quality health care, social and economic factors, and the physical environment all play into the ranking.

“Health and health behaviors and care are all tangled up in a multi-complex system,” said William Aldis, a World Health Organization representative to Thailand who lives in Sylva and has taught health classes at Western Carolina University and at a university in Thailand. “You can never completely separate these things.”

Aldis said he notices the difference in health as soon as he steps off the plane and into the airport terminal when he returns to the United States.

“It surprises me when I come back how sick people look here compared to other countries,” he said.

While the University of Wisconsin study took on an enormous task, the rankings are not universally accepted by public health officials.

Linda White, director of the Swain County Health Department, has not used the information in any strategic planning because she thinks the data may be skewed.

She often compares Swain to Graham County in her planning because the populations are similar. But she noticed the study reported Swain to have the highest percent of smokers in the state while failing to report a percentage of smokers in Graham.

“It causes me to question the validity of the data,” White said.

Macon County Health Director Jim Bruckner said some counties may need to look harder at some of the statistics to determine their quality because of the sampling methods. But Bruckner said the health department has a lot it can glean from the statistics.

Every three years, the health department uses a variety of statistics to create a “snapshot” of health outcomes and contributing factors in Macon County. Bruckner said the county health rankings will now be included in the project.

“We hope to use this report to shed light on what more we can do to help residents lead healthier lives and to mobilize community leaders to invest in programs and policy changes that will improve Macon County’s health,” Bruckner said.

 

Health behaviors

 

The University of Wisconsin study looked at key health behaviors — which will ultimately affect people’s health in the future — such as diet and exercise, tobacco use, unsafe sex and alcohol use.

The study uses obesity as the measure for a county’s commitment to diet and exercise. Although obesity is a problem across the state, Jackson, Macon, Haywood and Swain Counties are no worse than the state average, according to the County Health Rankings.

North Carolina is the 10th most obese state in the nation with an adult obesity rate of 29 percent, according to the Trust for America’s Health “F as in Fat” 2010 report.

And North Carolina has grown heavier. In 2009, North Carolina was the 12th most obese state, 16th in 2008 and 17th in 2007.

“Obesity is one of the most challenging issues and has had the more lasting impact on our society,” said Carmine Rocco, Haywood County Health Department director.

Reducing childhood obesity is a big focus for health departments in Western North Carolina.

“We’ve attempted to combat that for years,” White said. “It’s a lifestyle change. Kids will eat what’s offered to them.”

White has worked with schools in Swain County to get healthier food on the menu. Between five and six years ago, the health departments removed the deep fryers from the school cafeterias and purchased them ovens instead, White said.

But it’s other health behaviors that earned Swain County its low ranking. Swain has the highest percentage of smokers in the state and one of the highest teen birth rates, which is used to indicate unsafe sex tendencies.

Dr. Mark Engel, a family doctor in Swain County, said he thinks part of the problem with Swain’s health is that preventative care has not been emphasized until recently and that Swain has been more isolated than the counties to the east.

“Swain has been socially isolated long enough,” Engel said. “It will be an uphill climb for better health.”

He’s noticed higher social support for both smoking and teen pregnancy, he said, adding that it will take generations to change the population’s attitudes.

Forty percent of adults in Swain County smoke compared to 23 percent across the state.

“We’ve come leaps and bounds,” White said, who questioned the accuracy of the statistics. “We work on lessening those numbers regardless of what they are.”

Both Dr. John Stringfield and Dr. Michael Brown, who are family doctors in Waynesville, said that they’ve seen a decrease in the number of smokers in their offices even though the study reports that Haywood still has a higher percent of smokers compared to the state average.

“There’s been an increase in education and peer pressure against smoking,” Brown said.

Only Macon County with 19 percent of the population being smokers falls below the state average.

Ricketts said that there is a strong correlation between smokers and more rural environments. He suggested that smoking might be a form of entertainment where few other options exist.

“It’s hard to explain,” Ricketts said. “It just is.”

 

Clinical care

 

Another key component in assessing an area’s health is the availability of healthcare. Researchers at the University of Wisconsin examined several factors, including the percent of uninsured adults, the number of primary providers in the area and preventable hospital stays.

Jackson and Swain Counties have poor clinical care rankings at 86 and 93 respectively while Haywood and Macon Counties are both in the top 15, according to the study.

“In the early ‘70s, the main problem was that there’s been a misdistribution between urban and rural areas with primary care physicians,” said John Price, director of the N.C. Office of Rural Health and Community Care. “The issue over the years has changed a little. The issue is economic access to care.”

Three of the four counties — with Haywood being the exception — have more than 22 percent of adults without health insurance.

That portion is noticeably higher compared to about 15 percent of American and 17 percent North Carolinians who are uninsured.

The Good Samaritan Clinic in Jackson County is a free clinic that treats uninsured adults. A volunteer doctor at the clinic, Dr. David Trigg, said there are often misconceptions about who the uninsured are.

“They’re not unemployed. They’re just uninsured, and they certainly aren’t lazy,” he said,

But in the clinical care rankings, other factors have a role in bringing down Jackson and Swain counties’ rankings.

Swain County has a high rate of hospitalization for typical outpatient services, according to the study. This suggests that outpatient care in the area is less than ideal or that the people overuse the hospital as the primary source of care, the researchers wrote.

A strike against Jackson County’s ranking is a low percentage of diabetic Medicare patients getting annual blood sugar control tests. The tests are considered a standard of good healthcare — a standard at which Jackson is the lowest in the state.

“One reason that could be lower is the way it’s recorded,” said Paula Carden, the Jackson County Health Department director. “Whether all the numbers get reported or not is hard to say.”

Carden said doctors are responsible for reporting the screenings when their patients come to get them. The codes used by doctors in Jackson to report the data may be different from those in other counties.

In one aspect of clinical care, the number of primary care doctors per capita, the study found all four counties at or above average.

But some of the physicians are counted twice, inflating the number of doctors for Western North Carolina. Many doctors in Jackson, Macon and Swain counties practice across countylines — with their main office in one county but a satellite office in the other where they hold weekly office hours. These doctors appear to be counted in both counties.

“Even if there are enough providers to the population by the numbers and they appear at the right levels, they’re not,” Good Samaritan Clinic director Becky Olson said. “The problem is that Jackson County doctors don’t just serve Jackson County alone.”

The study also fails to take into account the influx of seasonal residents and tourists to the area. Doctors in Western North Carolina said they can tell when the part-time residents begin to arrive in the spring.

“It’s an elusive number, hard to quantify,” said the Haywood County Health Department director Carmine Rocco. “But it’s a reality we have to deal with when we plan health care. If something happens, we have to be able to respond.”

Flu and respiratory illnesses keep his schedule filled during the winter, and during the summer, he sees an influx of seasonal residents. Some older residents who come for four or five months in the spring and summer have chronic conditions that require a physician’s monitoring, said Dr. John Stringfield, a doctor at Waynesville Family Practice.

“What keeps me busy is different for each season of the year,” he said.

But Ricketts said he wouldn’t call seasonal homeowners or tourists a stress on the Western North Carolina healthcare system.

“For a rural place, it generally does pretty well on physician supply,” Ricketts said.

He gave the motorcycle rally in Sturgis, S.D., as an example of something that would cause stress on the system. In 2008, the rally brought more than 400,000 bikers and three rally related deaths to the small town.

“[Tourism in Western North Carolina] doesn’t necessarily provide stress but provides income,” Ricketts said.

 

Social & economic factors

 

Research has shown that social and economic factors also play a key role in determining health.

“To have an overall picture of health, it’s affected by economic factors,” health director Carden said. “If you don’t have enough money for the good health care, your overall health is affected. … Economics plays an important role in our overall health whether we like it or not.”

According to the University of Wisconsin study, Swain County has the lowest high school graduation rate, fewest college degrees, highest unemployment and most single-parent households compared to the other three counties.

“More educated people are in a much better position to analyze health choices,” Aldis said. “Education is a powerful tool in expanding people’s health choices.”

Aldis said that in his work in foreign countries where the populations are less literate than in the United States, women who can read are more likely to get their children vaccinated even if they haven’t had any medical training.

But even less educated patients are attentive and willing to learn how to make better health choices, Trigg said about his patients at the free clinic. But without the clinic, they don’t have the same knowhow about getting health information, he said.

“They don’t get on the Internet and look up health information the same way someone from the university would,” he said.

Hand-in-hand with education, poverty also limits a people’s health options in that they can’t afford the best or at times adequate care, said Stringfield, a Haywood doctor.

“Those in a lower social economic status may tend to have more medical problems,” Stringfield said. “Sometimes that has to do with access to care or access to medicine. Many simply can’t afford to fill a prescription.”

Poverty also influences people’s food choices. Fruits and vegetables are expensive compared to a value menu at the local fast food restaurant. Snack food is also cheaper but contains unhealthy ingredients such as excess salt and high fructose corn syrup, Aldis said.

“There’s not a sense of autonomy of choice,” he said. “We have a very interesting inversion going on. Obesity is a disease of the poor.”

To learn more, visit www.countyhealthrankings.org/north-carolina.

 

 

How WNC stacks up

The University of Wisconsin ranked all counties in all states by health outcomes and health factors. Within health factors, four subcategories determined the rankings: health behaviors (30 percent), clinical care (20 percent), social and economic factors (40 percent), and physical environment (10 percent).
There are 100 counties in North Carolina. A ranking of 1 would denote the healthiest county while 100 would signify the unhealthiest in that category.

Health Factor Rankings denotes overall health. The others show what went into determining the rankings.

Health Factors Rankings
Macon    15
Haywood    19
Jackson    31
Swain    91

Health Behaviors Rankings
Macon    12
Haywood    35
Jackson    39
Swain    97

Clinical Care Rankings
Haywood    11
Macon    14
Jackson    86
Swain    93

Social and Economic Factors Rankings
Haywood    16
Jackson    19
Macon    33
Swain    79

Physical Environment Rankings
Swain    14
Jackson    35
Macon    51
Haywood    72

Percentage of Smokers
Macon:    19%
Haywood    27%
Jackson    28%
Swain    40%
State Average    23%

A raffle drawing and silent auction will be held on 6 p.m. Saturday, July 24, at Mountain View Intermediate School in Franklin with proceeds going to the Roy Rickman Scholarship.

The Rickman Scholarship is Macon County’s largest local private scholarship. Each year the Franklin Rotary Club awards a $10,000 scholarship and several $1,000 scholarships to deserving Franklin High School graduating seniors based on demonstrated academic achievements, civic involvement and financial status.

The winner of this year’s vehicle raffle grand prize can choose either $15,000 in cash or one of three automobiles: a Ford Focus from Franklin Ford, a Chevy Malibu LS from Smoky Mountain Chevrolet or a Dodge Caliber from Jim Brown Chrysler.

A ticket entitles the purchaser to admission for two to the silent auction and drawing for the grand prize as well as dinner during the event. Cost $100. For more information, call Ashley Vinson at 828.534.3321.

With the single-mindedness of Ahab and the devotion of a wounded heart, Phil Schmidt is building a monument for his wife.

“If I didn’t have this to do, I don’t know what I would do,” Schmidt said.

The Martha Jean Memorial Garden, as it reads on the wrought iron work over the driveway, is a private garden in South Otto, the Macon County hamlet just north of the Georgia line.

Begun the week after his wife Martha Jean died from cancer that began in her lungs and spread to her bones and brain, Phil Schmidt spends 10 to 12 hours a day tending a garden that approximates the beauty of his lost bride.

On one side of the house is the part they built together, a mature perennial garden and fruit orchard that is a paradise for the bluebirds and butterflies. On the other side is the memorial, beds of rose bushes and flowering perennials situated on a slope surrounding a Koi pond and dotted with sculptures.

“My only goal in life is the preservation of this wonderful person that Martha Jean was,” Schmidt said, trying to describe his work.

But Schmidt’s devotion to his purpose is not as simple as his mission. Working on the garden has been his mechanism for dealing with the grief of losing a younger wife to a disease that could have been caught earlier.

“In the nine days, Martha Jean was in hospice, I read the Bible to her from my knees and she passed away anyway,” Schmidt said. “And I thought well...”

Schmidt is angry Martha Jean wasn’t diagnosed earlier after she complained of chest pains and went for x-rays in 2006. He’s angry that a woman he met too late in his life, died too early in her own.

The two of them met in St. Petersburg, Fla., at a bar and restaurant called The Spice of Life, which Phil owned and operated after retiring from a career as an industrial engineer.

“Martha Jean was the hostess, and I was the alcoholic,” Schmidt joked.

Schmidt said the couple fell in love in a way they had not in their first marriages.

“We both had terrible first marriages and were blessed to find each other,” Schmidt said. “We adored each other.”

Phil Schmidt is no stranger to heartbreak. Two of his sons have died before him, his oldest in a freak mountain climbing accident in Hawaii.

“I beat my head on the coffee table when I heard about my first son. I was surprised I didn’t break it,” Schmidt said.

But he counts his 36 years of marriage to Martha Jean as sweet ones.

“I touched her all the time she was near enough. A couple of times she told me I should get a hobby, and I looked at her and said ‘I’ve got one,’” Schmidt said.

The couple purchased the piece of historic farmstead in South Otto where Schmidt still resides after living parttime in a different house up the valley.

“We loved this valley. We used to walk around this place so one day we put a note in the mailbox telling them if they were ever interested in selling, we’d be interested in buying,” Schmidt said.

Once they moved to North Carolina from Florida full-time, the couple threw themselves into gardening. Schmidt said Martha Jean was a tiny, fastidious person who loved to tackle projects independently. Her nature forced Phil to work to keep up with her.

“She always thought I had a green thumb, but I don’t,” Schmidt said. “It’s just perseverance. You have to take care of everything everyday.”

Caring is something Schmidt can do. He cared for Martha Jean through nine months of radiation and chemotherapy that couldn’t stop what was happening to her body.

“If I had known more about cancer, I wouldn’t have let her do it,” said Schmidt, recalling the horror of the treatments.

Schmidt was diagnosed with prostate cancer in 1988 and received seed implants and radiation that kept it in check since then. He says his urologist now gives him two to three more good years.

“I have to die some time so that’s not too disconcerting. I just need to get this done,” Schmidt said.

What does he need done?

“The story out in the public. That this woman was such a wonderful person that her spouse would spend 12 hours a day building a garden in her memory so other people could know,” Schmidt said.

Schmidt has gone farther than devoting the remaining days of his life to the garden. He’s also dedicated his land to it.

After learning from a hospice organization that the house wouldn’t meet their needs, Schmidt wrote a provision into his will that deeds the land and the house to anyone who will maintain the Martha Jean Schmidt Memorial Garden for 10 years.

His own family has declined to take him up on the offer.

“My kids are not happy about it, but it will be preserved,” Schmidt said. “That’s all there is to it.”

The memorial garden is decorated with hundreds of stones, more than 30 rose bushes, a 17th century bronze statue, beds of brightly colored perennials, and the ashes of Martha Jean Schmidt.

Phil has planted his flowers so there is color in the garden throughout the year. He has installed a waterfall for the Koi pond and seeded over 4,000 square feet of wildflowers.

He has planted the vegetable garden with corn, beans and squash. His berry bushes are already yielding ripe fruits. This year, three pairs of bluebirds have nested in the garden, and the hydrangeas and wisteria were the brightest they’ve ever been.

Schmidt doesn’t think the proposition spelled out in his will is a simple deal.

“This is a lot of work. There was a horticulturalist who came out here and said, ‘My God, it would take six people to keep this place up,’ and I said, ‘Well now I don’t feel so bad,’” Schmidt said.

If you’re ever in south Macon County, stop by the garden. It will be there for at least another decade.

“I consider it a labor of love,” Schmidt said. “Some people don’t want to get dirty, but I stay dirty.”

Hikers and map geeks will revel in poring over a new map of the Bartram Trail being released this week.

The map covers a 75-mile stretch of the Bartram Trail that winds through the Nantahala National Forest of Macon and Swain counties. The map labels campsites and springs for water sources, scenic vistas, prime wildlife viewing areas, picnic areas, canoe access and sundry other points of interest.

“When creating the new map, day hikers, backpackers, exercise runners, nature photographers, wildflower enthusiasts, and area history buffs were all kept in mind,” said Ina Warren, a member of the N.C. Bartram Trail Society.

As a perk, the map has driving directions to many of the trail heads, and phone numbers and locations of forest service ranger stations.

Topo lines are at 50-foot intervals. The map’s scale allows for smaller creeks and finger ridges — ones that usually go unnamed on most maps — to be labeled.

The full-color, two-sided map features heavyweight, glossy paper that will hold up to being hauled in and out of your backpack pocket.

The long-distance trail follows the 1775 route of William Bartram, an early explorer and naturalist, through the region.

Plant collecting in new lands was all the rage during Bartram’s time, often funded by the royal crown back home. Bartram’s journey was popularized at the time in the book Bartram’s Travels. In addition to collecting plant and seed specimens, Bartram described the landscape and the Cherokee Indians with admiration.

In keeping with Bartram’s spirit, the map features native flora and fauna notes from along the trail.

“We hope this attractive, colorful and informative map will excite folks enough to plan a recreation outing or hike in their national forests and gain many years of enjoyment from the map.”

A grant from the Blue Ridge National Heritage Area laid the ground work for the map project and was matched by substantial contributions from the Highlands Biological Foundation, The Wilderness Society, Nantahala Outdoor Center, private donors and members of the Bartram Trail Society.

The Bartram Trail Society has given out over 1,000 free maps to schools, public and college libraries, summer camps, chambers of commerce, visitor centers, nature centers, museums and other groups.

The map goes on sale this week at local outfitters and forest service ranger stations. It may also be ordered online at ncbartramtrail.org or by mailing a check for $12 (which includes postage) to NC Bartram Trail Society, P. O. Box 968, Highlands, NC 28741. This email address is being protected from spambots. You need JavaScript enabled to view it..

The Veterans Administration’s community-based outpatient clinic in Franklin will be just two years old in August, but it’s already operating at capacity.

The clinic’s three full-time doctors have full dockets, and to them, that’s a sign the V.A.’s new service delivery model is working.

The Franklin community-based outpatient clinic is the only place the over 10,000 veterans from the far western counties in North Carolina and north Georgia can get basic services without driving all the way to the Charles George V.A. Medical Center in Asheville.

Kathy Spence, an Air Force veteran who lives in Clayton, Ga., comes to the Franklin clinic at least once a month for a variety of ailments from Parkinson’s to fybromyalgia. Previously, she’d drive two hours both ways to the V.A. Medical Center in Asheville.

“It makes a big difference for me,” said Spence. “Everybody here is friendly. If you have a question, they work on it as quickly as possible and when I talk, they hear me. They all treat me like a human being.”

Dr. David Ramsey, the clinic’s director, said the community-based outpatient clinics are the future of the V.A. medical system, and with two wars still going, he expects to see more of them in Western North Carolina.

“We do have two wars going on. We do have folks who will be returning, and it’s likely that we’ll be having more community-based outpatient clinics, but we’ll need to start thinking about how to handle these numbers,” said Ramsey.

The Franklin clinic is designed to provide integrated outpatient services for veterans in Western North Carolina so they don’t have to schlep back and forth to Asheville for all of their needs. But the benefits go beyond that.

“One thing I’ve seen is it’s a small community. Veterans know other veterans, and once they’re comfortable the word will spread,” said Dr. Mike Newberry, the clinic’s full-time psychiatrist.

Newberry and Ramsey are part of a new breed of V.A. doctors. Both men have experience with the military but spent decades in private practices. Their career shift to treat veterans was a calling, but they quickly found the V.A. was on the cutting edge of new health care models, like integrated medicine.

“If I’m with someone and all of the sudden they’re not feeling well, all I have to do is walk them down the hall,” said Newberry, the psychiatrist. “It’s a great way to practice medicine.”

The team approach — which stresses communication between providers rather than compartmentalized fields of medicine carried out in separate offices — is a national trend.

“You’re not a lone provider on the frontier anymore,” Ramsey said.

In addition to three full-time doctors, one of whom is a psychiatrist, the clinic has a full-time psychologist, a registered nurse, and two social workers. It offers an eye clinic, primary care, mental health services, and a remote lab.

“Putting all of those services together is a huge number of visits saved for the veterans,” Ramsey said.

In addition to saving veterans the travel time, the clinic also offers a more intimate environment.

“It does make it a more comfortable place to come,” said Newberry. “They don’t like big crowds, big buildings and lots of noise.”

The local setting made a real difference when a suicidal veteran called the clinic in the midst of making an attempt on his life but would not reveal his identity. Doris Elders, part of the clinic’s staff, recognized the man’s voice, called 911 and saved his life.

“It connects the veterans more to the providers and less to the facility,” said Ramsey.

For Ramsey, who has only been with the V.A. for two and a half years, part of his job is showing the veterans that the system has changed.

“The V.A. has improved so much in the past 15 years, and unfortunately some of the veterans have been in the system longer than that and almost felt like they were serving the V.A.,” Ramsey said. “Sometimes you have to let people know that they’re number one.”

Larry Funke, a 60-year-old Vietnam veteran from Murphy, never dealt with the old V.A. Funke said he hadn’t seen a doctor in 35 years when he was hospitalized for heart failure in 2006. He still travels to Asheville for many of his specialized treatments, but the Franklin clinic allows him to travel shorter distances for his checkups.

“Everybody I’ve ever dealt with in the V.A. has been wonderful people,” Funke said.

Another aspect of the V.A.’s shift in service delivery is the move towards a web-based platform. My HealtheVet, a new program, allows vets to access their records, schedule appointments and monitor their treatments via the web.

The program builds on the V.A.’s use of computerized medical records, which are far better than paper charts still used in most private practices and can track patient data from state to state.

With a new generation of tech-savvy veterans, the Web-based approach may be the future of the system, but in the western counties the bulk of the population is still Vietnam-era and older.

“Moving the V.A. into the next generation, we also have to keep hold of the previous generations,” Ramsey said. “We have OEF vets using I-phones and older vets who don’t have computers.”

Serving a unique population

Veterans are a particular kind of medical population. According to Ramsey, they have a suicide rate seven times greater than the general population and a rate of diabetes three times as great.

Both of those numbers can be linked to high rates of alcohol abuse. Ramsey said the V.A.’s record of treating the veteran population speaks for itself.

“We have generally a sicker population, but we have better outcomes than any other healthcare system in the country,” Ramsey said.

Sandra Melter, the clinic’s administrator, knows the veteran population firsthand. Her brother was a Vietnam veteran who died of cancer as a result of his exposure to Agent Orange, and his experience has shaped her life.

“It leaves a lasting impression on you that you never get over,” Melter said.

Melter’s husband was a World War II veteran who fought in the Pacific, and while he didn’t speak a lot about his wartime experience, it was part of their marriage.

She uses her experience as motivation to provide better care to the veterans she deals with on a regular basis.

“They are different from everybody else, and I have the greatest respect for what they went through for us,” Melter said. “Most of them are always in some kind of pain, and you have to realize they might not be happy all the time. The veterans have so much support right now, but they may not always know it.”

As a psychiatrist, Newberry sees the challenges young returning veterans face when they re-enter society. Post-traumatic stress syndrome leads to substance abuse, but the veterans avoid seeking mental health services for fear it will hurt their job prospects, Newberry said.

The nightmarish caricature of the V.A. system paints a picture of a veteran negotiating a Kafka-esque bureaucracy equipped with a file folder and an ID number, wandering the halls of an endless antiseptic hospital building begging some brown shoe doc to legitimize his claims.

The reality now is that more doctors, nurses and administrators are coming to the V.A. from the private sector because it offers meaningful work, stable employment, and good benefits.

That fact — along with the addition of the smaller community-based clinics — has made the V.A. experience a lot like what you would find in a civilian doctor’s office.

After spending two decades in private practice in Sylva, Ramsey, who grew up an Army brat, saw the V.A. as a great way to end his career.

“I wanted to help the people I grew up around,” Ramsey said.