Beyond the call of duty: Answering the call for care in rural communities

If you live in rural North Carolina, you might know the names of almost everyone in your town-maybe the names of their children and grandchildren, too. You may bump into them at the grocery store or at church. It’s not unlikely that you went to school with your electrician or your dentist or the person who cuts your hair.

Your days might have a little less hustle and bustle, and your nights might have more stars in the sky. There’s a whole lot of good that comes with rural life.

That’s the case with Wallace, North Carolina.

Founded in 1873 as a railroad depot in Duplin County, Wallace is your quintessential small town. It has a main street with two stop lights and is dotted with family-owned boutiques and restaurants, a bakery, a library, an auto parts store and a few churches. Though its residents cross paths at many of these places, the one event that draws the people out en masse is the town’s annual Strawberry Festival in May.

But for all its unique charms, Wallace shares the exact same health care challenges as rural communities across North Carolina and the U.S. at large-an alarming shortage of health care providers.

According to the National Institute of Health, “Rural Americans are more likely to die prematurely from the leading causes of death in the U.S. These include heart disease, cancer, lung disease, and stroke. They have higher rates of obesity and diabetes. And they’re at greater risk of fatal car crashes, suicide, and drug overdoses.”

There are three primary care physicians (PCPs) in Wallace. All have long wait lists, and oftentimes they’re not able to accept new patients. There is one dental practice, two optometrists, one physical therapist, a chiropractor and one ambulance for its 4,000 residents. Then, there are an additional 6,000 people who may not live within the town’s borders but who frequently call upon its services.

Because in Wallace, borders don’t mean much. Their first responders simply respond.

So, one hot day last summer, when a call came in that a 90-year-old woman had fallen and suffered a head injury four miles outside of town, it was Chief of Police Jimmy Crayton and his team who showed up to provide medical support until the ambulance arrived.

And then, in June 2022, the dispatcher received a call that a woman at Walmart was unconscious and in cardiac arrest. Crayton, who keeps his radio on to make sure he’s aware of the location of the town’s ambulance, knew it was responding to another emergency at the time. So he ran out of his office, yelling at others to follow. By pure luck, one of the officers had an AED-an automated external defibrillator-in his patrol car, and with two shocks from the AED and 15 minutes of CPR, they were able to resuscitate the woman until the ambulance arrived.

“It’s not uncommon for the police department to be the first ones there, long before a rescue squad or anything like that,” Crayton says. With the nearest hospital, ECU Health Duplin Hospital, located 20 miles away, EMS staff are stretched thin. “Honestly, and I think this is probably true for rural, southeastern North Carolina, they rely heavily on EMS. You need to see a doctor, you go to the emergency room.”

With the average ER visit in North Carolina costing $1,589, and Duplin County coming in at 23.5% below the state’s median income, high medical costs create an unaffordable health care ecosystem for locals, and the effects of that ripple out to North Carolina at large.

Wallace’s population is largely senior citizens. “I don’t think they know what’s available to them, or that they should be taking advantage of things that are available to them, or know that they even have an issue,” Crayton says.

So, to get ahead of emergencies, the police department created a “call-in” list for its citizens who have disabilities or are elderly. If they don’t hear from someone on the list, that person gets a call. If the police can’t get a hold of them, an officer will drive over to check on them.

“Do they sign up to be paramedics?” Crayton asks. “Do they care that that’s what they’re called to do sometimes? Not a bit. Everybody helps everybody. Everybody pours into those who pour into them.”

Crayton, who is a volunteer firefighter in addition to serving as Chief of Police, leads free fitness classes and is an active member of the Rotary Club. That’s where he met Logan Smith, a Territory Engagement Advisor at Blue Cross and Blue Shield of North Carolina (Blue Cross NC), who grew up in Duplin County and now resides there permanently. As part of the company’s County Engagement Team, her job is to meet with community leaders that range from nonprofit organizations to commissioners, civil servants, schools and churches. “We ask, ‘What are the primary needs?’ Then we take that back to [Blue Cross NC] and share it,” she says.

At one Rotary meeting, Crayton recounted the Walmart story to Smith, pointing out the need for the town’s police officers to be better outfitted to handle medical emergencies. “She was like ‘Let me see what I can do to assist with that’.” Soon after, Blue Cross NC bought two AEDs for the department.

These local investments-uniquely tailored to a community’s specific needs-can make a huge impact.

“Access to care is a priority for us,” Smith says. “This is an immediate need in the community. We can partner to quickly resolve at least one little piece of the puzzle. It’s not going to fix everything, but we want to do what we can to help save lives.”

Crayton is personally invested in solving the gaps in health care for rural towns like Wallace. His son, Eli, was born prematurely at 24 weeks. Now 15, Eli, who lives with special needs and is non-verbal, has spent his entire life in and out of hospitals. More than100 days at a NICU in Greenville, five weeks at Presbyterian in Newark, New Jersey, and two months at Johns Hopkins. Though he sees the Wallace optometrist for eyeglasses, that is only medical service he gets in town. His feeding tube was administered in Wilmington, his ophthalmologist is at Duke and his GI doctor is in Chapel Hill. Crayton travels a minimum of 45 minutes to any of Eli’s doctor appointments.

“Anything beyond primary care, whether it’s dermatology, oncology, an MRI…anything short of an X-ray, you’re going somewhere else,” Crayton says.

Just as Crayton is adamant that Eli receives top-level care-no matter the distance-he is fully dedicated to preventive health care for his fellow officers. He created a wellness plan for his officers, which includes an annual physical by one of the town’s PCPs, a bi-annual physical fitness test with a bonus for those who receive a satisfactory assessment, and an annual mental health evaluation (studies show that law enforcement report much higher rates of mental health conditions compared to the general population).

According to Crayton, mental illness is the greatest health challenge in the community. The nearby inpatient mental health facility at ECU Health (formerly Vidant Duplin Hospital) closed in August 2020. Since then, those who are involuntarily committed are sent to Butner in Granville County, a 2-hour drive away. In fact, 94 of NC’s 100 counties qualify as mental health care shortage areas, and Duplin is one of them.

“Access to psychiatrists is a huge issue around here,” Smith says. “There’s also still the stigma around mental health. And so, I think it’s going to take a unique approach that’s tailored to this community to bust through that.”

This kind of localized, on-the-ground approach to community health is what Smith and others across Blue Cross NC are focused on building and growing through partnerships with leaders like Crayton. “Change only happens at the speed of trust and the ability to establish a relationship. And that takes time,” Smith says. It also takes being present in the communities you serve. It becomes personal. As Smith says, “It’s about giving back to the community that I was raised in. The reason I’m here [at Blue Cross NC] is because they are local, and they do care. That’s why I do what I do.”

Rural North Carolina faces a critical shortage of doctors, therapists and emergency medical services-and it shows in the declining health of the people who live there. They rely on their families, friends and community members to reach across the gap and offer support. Not every town has a Jimmy Crayton-but most have people who are similarly bound by a desire to care for their fellow neighbor. Unfortunately, that, on its own, isn’t enough.

Blue Cross NC is continuing to live and work in rural communities across the state, establishing relationships and building partnerships that help remove barriers and improve access to health care.

Because, in a small town, everybody helps everybody.