In rural Avery County, Helene washed away one of the only dental clinics
By Jaymie Baxley
When your house is flooded and all your soggy belongings are piled on the street in front of your home, having a cavity or a toothache might seem like a small problem.
But it could become a bigger problem for residents of Avery County, where one of the primary dental clinics was inundated with floodwaters generated by the remnants of Hurricane Helene in late September.
More than a month after the storm, most stores and restaurants in Newland, the county seat, are still closed. Piles of ruined belongings sit waiting for collection in the yards of battered homes throughout the little town, which lies in a bowl surrounded by mountains and is bisected by the North Toe River.
On a recent afternoon in the lobby of Avery Medical, a clinic near the center of Newland, two women shared stories about the devastation they’d witnessed. One told the other she would have been “assed out” if the floodwaters that surged through her home had risen just a few inches higher.
“I’m just blessed that we made it out alive,” she said.
A total of 102 Helene-related deaths have been confirmed in North Carolina as of Nov. 8. At least five people from Avery County perished in the storm.
Avery Medical is run by High Country Community Health, a nonprofit that provides affordable care to low-income patients who lack health insurance. Many people in this rural county, which has a population of about 17,500, depend on the organization.
Nearly 15 percent of Avery County’s residents live below the federal poverty line, and 14.6 percent are uninsured, according to data from the N.C. Rural Center. The median household income for the county is only $53,500, well below the statewide average of $70,800.
Alice Salthouse, CEO of High Country, said seeing the storm’s toll on the struggling community has been “gut-wrenching.”
“Every day on my way to work, I drive past people’s homes — and everything they’ve owned is outside waiting for somebody to come take it all to the dump,” she said. “We’ve got older adults who have lived in their homes for years and years, and now their homes are gone. People’s lives have changed and will never be the same again.”
Care during a crisis
High Country moved quickly to help residents in the immediate aftermath of the storm.
Providers for the organization, which has nine locations in western North Carolina, deployed southeast of Avery to Hickory Regional Airport in Catawba County to care for patients who had been evacuated there from nursing homes and rehabilitation centers in Helene’s path.
Staff members traveled hazard-strewn roads to deliver food, medicine and other essential items to people in the federally declared disaster area. Avery Medical became a distribution hub for supplies donated by local charities and churches.
But the organization did not emerge unscathed from what The Avery Journal-Times described as the “one of the greatest natural disasters” in the county’s 117-year history.
Avery Dental, a High Country-run clinic in Newland, suffered heavy flooding, with waters rising as high as four feet inside the facility. Salthouse said everything in the seven-chair clinic, from dental equipment to the insulation packed behind its sheetrock walls, was either destroyed or contaminated.
“We’ll have to put up new walls, put down new flooring and redo the electrical,” she said. “It’s almost like building a whole new place, only more complicated.”
High Country experienced an estimated $3.6 million in lost revenue and property damage in connection with Helene, with most of that tally tied to the ruination at Avery Dental.
Salthouse said it will be months before the clinic reopens.
Dearth of dentists
Avery Dental shares a plaza with a half-dozen other businesses, including the Times-Journal, in Newland’s commercial center near the North Toe River. Those businesses also flooded, but the loss of the clinic dealt an especially harsh blow to an area where access to dental services was already limited.
According to data from the University of Wisconsin Population Health Institute, the average ratio of dentists to residents in North Carolina is 1-to-1,630. But in Avery County, there is just one dentist for every 2,200 residents.
Salthouse said the disparity was much worse before Avery Dental opened its doors in 2015. That year, there was only one dentist per 5,860 people.
While there are other dental offices in the community, the clinic is the only option for many residents because of its sliding-scale fee system. Patients are charged what they can afford to pay based on their income.
“They can come in and see the dentist for far, far less,” Salthouse said. “I mean, when was the last time you went to the dentist and got your teeth cleaned for $45?”
Avery Dental is also one of the only local providers that accepts Medicaid. Data from the N.C. Department of Health and Human Services show that more than 4,300 Avery County residents are currently enrolled in the program, with children accounting for about 43 percent of the county’s enrollees.
“You have a huge population of children that are on Medicaid,” Salthouse said. “Having a dentist in this county is crucial, but recruiting them to this county is difficult.”
One barrier to recruitment, she said, is the area’s topography. The roads to Avery County cut through snow-prone mountains, making travel hazardous in the winter.
The mountainous terrain also amplified Helene’s impact on the county. Steep slopes and ravines funneled water from the swollen North Toe River and its tributaries into low-lying areas.
Serving the underserved
Ashton Johanson joined the staff of Avery Dental less than two months before the clinic was flooded.
A disc golf enthusiast from Colorado, Johanson earned his degree in dental surgery from the Utah School of Dentistry and went on to work with low-income patients at public health clinics in the Salt Lake Valley. He had been thinking about moving to North Carolina when he learned about a job opening for a dentist in Newland.
“I had a few opportunities around the state, but this seemed like the best fit for me and my family,” he said. “We wanted to try something different, and this was an area with a population that really needed dentists. It seemed like a chance to serve the underserved, which is something I’m passionate about.”
Johanson, who began seeing patients at Avery Dental in August, was still adjusting to his new environment when the environment was upended by Helene.
Since early October, he has been working out of a van parked in front of High Country’s medical clinic about half a mile from the waterlogged dentist’s office. The vehicle was previously used as a mobile clinic for cleaning children’s teeth at local schools.
While it can’t accommodate all the same services as the dental clinic, the mobile unit has enough space and equipment for Johanson to provide emergency exams, tooth extractions and fillings.
“The first week we were open, we had a hard time getting patients in here,” he said. “Even if people had tooth pain or some other dental emergency, their houses were underwater and the roads weren’t drivable. They had bigger problems than coming in to see us.”
Business began to pick up once the waters receded. Johanson said more than 100 patients have visited the mobile unit over the past month, with about eight people stopping by each day.
In the meantime, High Country has contracted with a demolition crew to gut the flood-damaged interior of Avery Dental. After the facility has been stripped to its frame, air quality studies will be conducted to ensure that it is free of mold spores and disease-spreading bacteria.
High Country is soliciting bids to rebuild the clinic at the same location and restock it with dental equipment. Salthouse estimates the project will cost between $500,000 and $750,000.
“This is a very big deal for this county, for us to get this dental clinic back up and running,” she said.
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