Surry County Health and Nutrition Center

OUR MISSION
The mission of the Surry County Health & Nutrition Center is to protect
and promote personal, family and community health; to insure a safe and healthy environment; and to prevent or control the incidence and spread of disease.

OUR VISION
A healthy and educated community where families are allowed to reach their full potential in a safe and clean environment.

HISTORY

Introduction

In a 1936 Public Health Survey and Brief History Report, the following was written about the Surry County Health & Nutrition Center...

"Progress marches on and Surry County Health Department is keeping pace in all field of activity, participating and expanding the services to meet the needs of the community.. At no time in the past 35 years has the service lagged or fallen below standards. The services increase each year and as the need arises the Surry County Health Department and its staff and governing board will be there ready to meet it. There have been many difficult times as in all worthwhile endeavors, but these difficult times have better fitted us to go for bigger and better things for the future. We have a dedicated staff, as reflects in the number of years the majority has been working."

Sixty-six years later, the Surry County Health & Nutrition Center is still growing and "keeping pace" with the needs of the community. Their goal was and will always be, "to promote and protect the health of the citizens of Surry County."

From the Past to the Present

The Surry County Health Department was organized in 1920. Dr. L.L. Williams was the Health Officer. The entire staff consisted of Dr. Williams and his secretary. A nurse was added the following year. They worked out of an office in the old Mount Airy City Hall building, on Moore Avenue. In the 1920's, the Health Department operated on a $900 yearly appropriation from the City of Mount Airy and $2000 a year from the county. The city also furnished office space, fuel, lights, water and janitor services, making its contribution total between $1500 and $1800 per year. Later, the town of Elkin appropriated $1500 per year plus offices and utilities for the operation of a satellite clinic in Elkin. In 1934-35, the budget was $6,216.18 with the Health Director receiving a monthly salary of $250. By 1956, the Health Department had out grown its original offices and was relocated to the former nurses' residence for Martin Memorial Hospital on Gilmer Street in Mount Airv. The Health Department had branch offices in Elkin, Dobson, and Pilot Mountain. Today the Surry County Health & Nutrition Center is centrally located in Dobson. The original building on Hamby Road was built in 1983. In 1995, the building was renovated and enlarged to include not only the Health Department, but also the Surry County Government Center. The Government Center houses the & Nutrition Centers of Social Services, Environmental Health, Building Inspections, Recreation & Nutrition Center, County Manager, County Commissioners and Veteran Services. In 1998 the name of the department was changed to the Surry County Health & Nutrition Center to reflect the varied ways that public health protects and promotes health for our citizens. The Health Center has grown from the initial two employees to a staff of over 220 in 40 various programs with a budget of over $8 million. Public Health - Then and Now

Clinical

In the 1920's, a leading cause of sickness and death in Surry County was pellagra. Pellagra is a deficiency of B complex vitamins that leads to nerve and skin disease. In 1936, 105 cases were registered with the Health Department. After the Second World War, the federal government, recognizing malnutrition to be a major public health problem, set forth to increase the percentage of fat and protein in the populations' diet. The federal government spent money to create high-fat beef cattle and to support production of dairy products. Additionally, they supported the creation of cookbooks which taught people how to utilize the higher fat products in their daily diet. Pellagra has been eradicated from Surry County. Unfortunately, the use of increased fat and protein in diets has led to an increased incidence of chronic disease such as heart disease, diabetes, hypertension, and cancer. Nutrition recommendations now emphasize lowering fat and cholesterol in diets. In 1995, the Surry County Health Department published its 75th Anniversary Cookbook. The cookbook has a dual purpose - to promote healthier diets in our community and to raise funds for the Surry County Health Foundation. The cookbook contains recipes submitted by staff members of the Surry County Health Department in their original version. Following the recipe is an easy to follow list of ingredient and preparation substitutions to make the same dish in a lower fat, lower cholesterol, lower salt version.

In the early years, communicable disease was the leading health problem in Surry County. Tuberculosis and syphilis were very prevalent, as was diphtheria, scarlet fever, whooping cough, polio and pellagra. Original services of the Health Department were targeted to the control, prevention, and treatment of communicable disease. Public Health Nurses were responsible for visiting the homes of scarlet fever patients and putting bright yellow QUARANTINE signs on the home's front door. Public Health Nurses educated patients about cleanliness and hygiene. They often brought cleaning supplies and helped the family clean the home. The early Public Health Nurses often visited homes with no electricity, no running water, dirt floors and some, with live chickens inside the home. Today, scarlet fever is almost non-existent in our county. Tuberculosis, almost unheard of a few years ago, is again a concern. Today's Public Health Nurses can be found working in Health & Nutrition Center clinics, giving educational programs at community meetings and schools, doing blood pressure checks or cholesterol screenings at Health Fairs, flu shots and pneumonia shots at worksites and community locations, giving childhood immunizations, and making home visits when necessary.

In the early years of the Health Department Tuberculosis (TB) patients with active cases were sent to the Sanitorium at Black Mountain, North Carolina where they stayed for treatment until they were discharged. One of the doctors from the Sanitorium would come to Surry County monthly to follow the cases. In 1936, there were 38 recorded cases of TB in Mt. Airy. The Sanitorium at Black Mountain is now closed and the chest doctor no longer comes to see patients. TB patients are now followed by their family doctor or a chest specialist. The Health & Nutrition Center continues to do TB skin tests and TB related chest X-rays. Either the family doctor or the state TB doctor reads the X-rays and gives medical orders for drugs that are recommended. These drugs are furnished free to the patients through the Health & Nutrition Center.

In the early years of the Health Department, immunizations were only given on certain days of the week. Early vaccines were DTP, Typhoid, Smallpox, and the TB skin test. Later, IPV and Oral Polio were added and smallpox dropped. Around 1960, MMR, influenza and pneumonia were added. The most recent additions to the vaccines given were the Hib and Hepatitis B. Syringes were made of glass and had to be cleaned and sterilized for reuse. The first needles had to be cleaned, sharpened, and sterilized for reuse, too. Now the Surry County Health & Nutrition Center gives immunizations every workday to infants, children and adults. Through use of a computer system, children who miss their scheduled vaccines are identified and parents are contacted with a reminder to get the life- saving vaccines. Many of the life-threatening diseases encountered and treated by the Health & Nutrition Center in its early years have been brought under control through the advancements in the field of immunization, along with the discovery of Sulfa drugs, penicillins, and tetracyclines. Through the immunization programs, measles and rubella have been brought under control. Diphtheria, whooping cough, and polio have also been conquered. A primary focus of today's Health & Nutrition Center is prevention. To that goal, shot clinics are held throughout Surry County in the fall to provide flu and pneumonia shots. Annually, the Health & Nutrition Center gives about 5000 flu shots and several hundred pneumonia shots throughout our community.

In our southern states, as in many other areas of the country, Public Health Nurses visited patients in their homes who had communicable or chronic diseases. These nurses monitored the patients and their medications or treatments. During these visits, the nurse helped the entire family, especially children in need of vaccinations or other services. The family was dependent on the nurse helping them. From time to time, a family member was sent home from the hospital with some type of need that the family did not know how to care for, so they would call on THAT NURSE from the Health & Nutrition Center that visited "Uncle Joe" when he had TB and ask her to go out and help the family. This was the beginning of home health care services in our area. In 1966, the Federal Government (HCFA) started paying for some of these services in the home. They offered hospitals the opportunity to participate in providing this care. However, hospitals declined this involvement so health & Nutrition Centers became certified agencies . In February 1967, the Surry County Health Department was certified as an agency by Medicare. The agency started out with 22 patients the first year and has grown continually.

In 2001, the Surry County Health & Nutrition Center Home Health Agency served 486 Home Health patients and 109 Personal Care Services patients. Senior Services served 878 patients with over 58,000 visits. They provide a broad range of services including skilled nursing, aide visits, speech therapy, physical therapy, occupational therapy and IV therapy. The program helps people remain at home and is cost effective. With all the changes in managed health care these days, home care is the leading service to help control cost and provide the patient with needed services in the place we all want to be "Home Sweet Home".

In the early years of the Health Department, midwives delivered many of the babies born in Surry County. In the 1940's, midwives in our area were trained and certified by the Surry County Health Department. Doctors such as Robert Caldwell also came to the homes and delivered the babies there. Eventually, almost all babies were born in area hospitals. Early Public Health Nurses had the job of transporting premature babies born in Surry County to hospitals such as Baptist that had a premature nursery. The babies were transported in a hand-held incubator heated with a hot water bottle and a small tank of oxygen attached to the end of the carrier. Today, the Surry County Health & Nutrition Center is actively involved in promoting good prenatal care and reducing the infant mortality rate in our county. Several programs are in place for this purpose. The Prenatal Clinic provides prenatal care to women in an effort to reduce prenatal complications and to help assure that every pregnancy will end in the delivery of a healthy baby and a healthy mother. This clinic is administered through Mt. Airy OB-GYN. The Maternal Outreach Program (MOW) provides services to high risk Medicaid eligible women enabling them to fully avail themselves of health and social services known to promote better birth outcomes. Lay outreach workers provide supportive services. Maternity Care Coordination (MCC) provides case management services that assist Medicaid recipients in gaining access to medical, social, educational, and other services. MCC's assure that patients maneuver through the service maze and receive health care services for improved pregnancy outcomes. The RIM program (Reducing Infant Mortality) promotes the health of Surry County infants from their first heartbeat in the mother's womb to the baby's first birthday. A series of twelve classes called, "Babies and You" is offered at no charge to Surry County industries. Monthly hospital classes are also provided. Follow-up is provided to patients who are at risk for early repeat pregnancies to help increase spacing, between pregnancies. A Teenage Pregnancy Prevention Council and a Vasectomy Counseling Team have been formed. The SIDS program (Sudden Infant Death Syndrome) provides counseling to patients who suffer the loss of a child to SIDS.

Clinics for the control of venereal disease were started by the Health Department in 1931. The clinics were held twice each week at the Health Department in Mount Airy. Patients were referred for treatment by their family physician or the "Welfare Department". Patients who refused treatment during the contagious stage were placed in the county jail and given treatment for at least thirty days. The Sexually Transmitted Disease Clinic at the Surry County Health & Nutrition Center works to reduce the incidence of sexually transmitted diseases through screening, treatment, education, counseling, and contact of known cases. Any individual requesting service is eligible. All services are free of charge. The AIDS program provides testing, counseling, referrals and education for individuals and families dealing with the AIDS virus. The program is open to all residents of Surry County. No fee is charged for these services.

In the 1930's, all schools were visited by the Health Department when they opened in the fall. All pupils were vaccinated for smallpox who had not already been immunized. The Health Officer would then examine the children for such diseases as diseased tonsils, adenoids, defective teeth, defective vision, defective heart or lungs and orthopedic defects. Notices were sent to the parents about any problems urging them to see their family doctor. Pupils through the fifth grade were weighed and their weight recorded each month. Notices were sent to the parents of those whose weight was ten percent under weight. A half-pint of milk was furnished by the Red Cross, Kiwanis Club, and Parent Teacher Association for those under-weight children who could not pay for it. The nursing services in the school included inspection for skin diseases, lice, weighing the children, investigation of communicable diseases, and routine examination of vision and teeth. There were no dental clinics. Correction of problems were left entirely to the parents, and in many cases, nothing was done because of a lack of funds. The Health & Nutrition Center school health nurse's primary coal is to promote the maximum physical, social, emotional, and education growth of children through activities that are aimed at determining the individual health status of each child. The nurse's responsibilities include reviewing immunization records and coordinating ninth grade physicals. Scoliosis screening is conducted in grades 5, 6, and 7. The nurse is contacted to screen and follow-up all skin and scalp diseases and communicable diseases. The nurse serves as health advisor, educator, and counselor to the school faculty, parents, and students as the need arises. The Dental Health Program services include educational sessions for school and community groups, fluoride mouthrinse program, plaque control, sealants, school fluoridation, dental screening, and referral services. The Children's Special Health Services program provides early detection, diagnosis, and treatment and follow-up of chronic conditions of the ear, nose and throat. The Orthopedic Clinic offers physician exams and consultation, physical therapy, nutritional counseling, diagnostic X-rays, limited outside treatment and follow-up observation and monitoring for eligible children with orthopedic problems. The CSC (Child Service Coordination) program provides service coordination for children with, or at risk for, developmental disabilities, chronic illnesses, and social/emotional disorders. The Developmental Evaluation Clinic (DEC) is a traveling clinic which meets the needs of children who have special problems and require comprehensive evaluation before proper plans for the future can be made. This clinic provides an in-depth physical, mental, and social evaluation of the child. The clinic serves persons aged 0-21 who have developmental disabilities. The Pediatric Clinic at the Surry County Health & Nutrition Center provides comprehensive health services to infants and children in need. Children receive physical assessments, developmental evaluations, lab tests, vision and hearing screenings, nutritional assessments, immunizations, health education, and counseling. The services of the Pediatric Clinic are provided on a sliding scale basis.

In the 1930's medical care and hygiene in industrial plants in Surry County were entirely under the supervision of the individual plant. Most plants employed a doctor who was subject to be called at any time. Typically, each employee paid approximately fifty cents per month for this service and in case of illness, there was no extra fee. No nurses were employed at any of the plants. Today, the Surry County Health & Nutrition Center has a WATCH (Worksite Approach To Controlling Health) program which is designed to improve health and prevent disease in participating local businesses and industries. The program includes health risk appraisals, risk reduction counseling and health awareness classes and activities. It is available to any worksite for a reasonable fee.

In 1935, the leading causes of death per 1,000 population in Surry County were Pneumonia, Nephritis, Tuberculosis, diseases of the heart, and cancer. In 2001, the leading causes of death were heart disease, cancer, cerebrovascular disease and chronic lower respiratory diseases. The Adult Health Clinic programs aims to contribute to early diagnosis and treatment of chronic diseases, enhance public awareness and understanding of chronic diseases, disease related risk factors, and prevention. Services provided by the General Adult Health Clinic include immunizations, TB skin tests, and laboratory and X-ray services. The Breast and Cervical Cancer Control Program (BCCCP) is designed to reduce the incidence of breast and cervical cancer through pap smears and breast exams. Patients are referred to local contractors for mammograms. The Diabetes Education Program treats individuals who have been diagnosed with diabetes and their family members or others who need to know more about the disease and how to prevent complications associated with uncontrollable diabetes. The program offers educational classes/workshops at the local community college. Other education materials are provided. The Colorectal Clinic provides early detection of cancer or pre-cancerous conditions through the use of sigmoidoscopy.

Environmental Health

In the 1930's the hotels, cafes, and soda fountains were under the supervision of the County Health Department and state laws. The cafes were periodically and spasmodically inspected, the frequency of which was governed by the condition and reputation for cleanliness. All employees in the cafes and hotels were required to hold a health certificate from the Health Officer showing, he or she was free from communicable diseases. In the 1930's the retail dairies were inspected on an average of about three times per month by the County Sanitary Inspector under the direction of the Health Officer.

Today, the primary function of the Environmental Health program is to assure that food and ground water are safe and that the public is protected from environmental disease and contaminates. The Food, Lodging, and Institutional Sanitation Program conducts inspections and gives sanitation ratings four times a year at restaurants, meat markets, and school lunch rooms, two times a year at institutions and bed and breakfast establishments, one time a year in places of confinement, motels, schools, and seasonal establishments, and daily at temporary food stands. The Rabies Control Program conducts rabies vaccination clinics at least once yearly, investigates animal bites, controls stray dogs and cats, provides educational material, provides rabies diagnosis services for dogs, cats, and other mammals, and provides on-going canvassing to identify unvaccinated dogs and cats. The On-Site Sewage Treatment and Disposal Program evaluates building sites for suitability for on-site wastewater systems, the layout and permitting of on-site systems, and the inspections of completed installation. The division acts as liaison between local citizens and the Department of Environment and Natural Resources, investigates complaints, recommends and enforces corrective actions, and educates the public on proper sewage treatment and disposal. The Water Supply Program inspects private water supplies upon request, collects and interprets water samples, advises and assists on corrective actions, answers complaints, and provides educational materials regarding location and protection of supplies.

Current Health Center Services

* Among the variety of programs and services that touch the lives of all Surry County residents are: Chronic Disease and Cancer Screening and Diabetes Management and Education through Adult Health
* Child Care Health Consultant; Ear, Nose & Throat (ENT) Clinic; Pediatric Clinic - sick and well visits - through the Child Health Program
* Communicable Disease surveillance and investigation including AIDS Control Program & HIV testing and Sexually Transmitted Disease Program
* Environmental Health, including Animal Control; Restaurant, day care and residential facility inspections; Waste system permits and site evaluations; and Water sampling
* Family Care Coordination including Child Service Coordination, Maternity Care Coordination, Family Planning and Breast and Cervical Cancer Program including, follow-up of abnormal PAP Smears using Colposcopy, through Women's Preventive Health
* Health Education and Promotion, including Infant Mortality
* Immunizations
* Maternal Outreach Services and Postpartum and Newborn Home Visits >LI> Migrant Farmworker Health Program
* Nutrition counseling and the WIC (Women, Infants & Children) supplemental food program
* School Health Services
* Senior Services including Chore/Respite Program, Friends of Seniors and Home Health
* Vital Records - Birth & Death Certificates

…to the Future

In 2002, the Surry County Health & Nutrition Center celebrates 82 Years in Public Health. What will the focus be for the Health Center as we look ahead to the coming years? The aging of our county's population will require more resources to meet the health care needs of our seniors. Chronic disease and "lifestyle behaviors" will be a focus in prevention and in programming. Environmental health will expand to include more aspects of air quality and chemical use. Preparation for response to bioterrorism and emerging pathogens will become the routine.

Public health has always had to "do more with less". As resources are rationed, we will need to review efficiencies in our services and determine what is needed to provide for the public's health. More outside sources of funding (grants) may be needed to initiate or sustain programs. We are always evaluating our programs and should be accountable to our citizens. What should we be doing beyond the core functions of public health? We will extend our role in any way needed to fulfill our role of protecting and promoting health for Surry County. Our agency has had a distinguished and proud history. We are able and ready to successfully meet challenges in the days ahead.

HEALTH DIRECTORS

Dr. L L Williams 1920 - 1929
Dr. Lancester 1920 - 1929
Dr. Johnson 1920 - 1929
Dr. M T Foster 1929 - 1931
Dr. T C Britt, Sr. 1931 - 1933
Dr. N T Ennett 1933 - 1934
Dr. Allen Whittaker 1934 - 1935
Dr. Ralph J Sykes 1936 - 1939
Dr. Robert C Franklin 1939 - 1961
Dr. Robert M Caldwell 1961 - 1986
Dr. J Dale Simmons 1986 - 1992
Claudia Bryant, RN 1992 - 1995 (interim)
Dr. Walter J. Linz 1995 - 2000
David Stone 2001 - 2007

Compiled from:

* Public Health Survey and Brief History, 1936 with October 1967 addenda
* Surry County Health & Nutrition Center History (circa1996)
* Board of Health minutes
* Interviews with Mount Airy News

BOARD OF HEALTH

Dr. Terry Warren, Chair (Optometrist)
Frances Bryant, Vice Chair (Public Member)
Andrea Johnson (Registered Nurse)
Gary Gant (Public Member)
Dr. Wayne Gilreath (Dentist)
Pat Halsey (Public Member)
Mark Hiatt (Engineer)
Randy Lawson (Pharmacist)
Donna McLamb (Veterinarian)
Paul Johnson (Commissioner)
Dr. Darryl B. Rhyne (Physician)