THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Sunday, February 11, 1996 TAG: 9602080155
SECTION: CAROLINA COAST PAGE: 05 EDITION: FINAL
SOURCE: BY JACK DEMPSEY
CORRESPONDENT
DATELINE: OCRACOKE LENGTH: Long : 155 lines
Whether you live on this isolated island or are just visiting, your ailments and injuries probably will be treated by Kenneth A. DeBarth.
He's Ocracoke's only provider of primary health services, 24 hours a day.
DeBarth has played this solitary role since arriving five months ago as the new administrative and clinical director of the Ocracoke Health Center.
The physician assistant welcomes the challenge.
``Anybody can work at a Johns Hopkins Hospital with hundreds of backup specialists within walking distance,'' DeBarth says. ``But here I have to do it all. That's a remarkable challenge, and it's why I'm here.''
DeBarth, 47, works under the medical supervision of Dr. J. Seaborn Blair III, who is based at the Hatteras Medical Center on the other side of the Hatteras-Ocracoke ferry. Administratively, he reports to the board of the non-profit Ocracoke Health Center, chaired by Randal Mathews.
When DeBarth arrived last September with his wife, Gloria, he found a program with great seasonal variation in demand.
``We average 200 clinic visits per month in the winter and 600 in the summer months,'' he says. ``I have yet to experience the summer crunch.''
DeBarth works out of the island's small, one-story clinic that contains two patient care rooms.
He began his medical career as an Air Force medic in the Vietnam era, spending most of his time in a military hospital's emergency room. ``It was a valuable experience, but I wanted to do more,'' he says.
After completing his undergraduate studies at the University of Colorado, he enrolled in Penn State's two-year Primary Care Physician Assistant Program, graduating in 1978.
``Make sure you tell people it was at the Hershey campus, not where (football coach) Joe Paterno is,'' he says. ``The entire program was geared to preparing students for rural practices.''
Physician assistants work directly under the supervision of licensed physicians, DeBarth says, and their services may not exceed the scope of the supervising physician's practice. That means, for instance, that he provides no obstetrical services on Ocracoke because they are not part of Dr. Blair's practice.
DeBarth first practiced as a PA in rural South Dakota. He left after three years when his supervising physician went to Alaska.
DeBarth moved to Heuvelton, a town of 500 residents in upper New York State near the Canadian border, where he practiced for 14 years. ``It was a great place to live and work,'' he says, ``But after awhile, doing the same thing day after day became, well, boring. I needed a new challenge.''
That's when he learned of the Ocracoke opening. ``I welcomed the idea of warmer weather and being close to the ocean, but mainly it was the challenge. On this island, I'm it, 24 hours a day.''
He also relishes the island's informality.
``It's the first job I ever interviewed for in shorts,'' he says.
In addition to his primary care credentials, DeBarth brings to Ocracoke a history of active participation in professional circles and in the community.
He has volunteered his services to a fire department, been a Scoutmaster, served on a school board, written extensively in professional journals and lectured widely in training programs. He served as president of the New York State Society of Physician Assistants.
DeBarth's staff at the Ocracoke Health Center consists of Dot Gayne, a full-time nurse, and Crystal Roffey, a full-time business manager/receptionist. Dr. Blair visits once a week, reviews every case and provides continuous telephone consultation.
That's about it for the 700 year-round residents and waves of seasonal visitors. No pharmacy. No full-time physicians or dentists or mental health counselors. Just two ambulances with four emergency medical technicians.
Distance provides an ever-present complication. ``We had this feral cat that got caught in a fishing net,'' DeBarth recalls with amusement. ``It bit the woman who tried to free it, so we had to rule out rabies. Since we don't have a kennel or anything, we jury-rigged a crab pot for the cat and sent it on the Swan Quarter Ferry for testing on the mainland.
``When they tried to remove it for testing, it escaped, so I had to give my patient the whole series of shots.''
Helicopters provide the only reasonable alternative for patients with life-threatening illnesses or injuries. Although helicopter services in Greenville and Norfolk have been quite responsive to Ocracoke's needs, the round trip is still dangerously long, and not available at all in blustery weather.
Aside from the lack of on-island resources and the problem of distance, DeBarth has found clinical demands quite similar to those in previous positions. Infections of all types, cuts requiring suturing and medical treatment of chronic illnesses such as diabetes and arthritis dominate the caseload.
Noticeable by its absence is an X-ray machine.
``It would help only a little,'' DeBarth explained, ``because we have no nearby radiologist for a final reading. Patients are better advised to go directly to a facility with X-ray and orthopedic resources, and I make arrangements for them.''
The greatest difference between upper New York and Ocracoke cases lies in the nature of environmental exposure. ``I treat no frostbite here, and I treated no jellyfish stings up there,'' he says.
Dr. Blair, the supervising physician, lauds DeBarth's work.
``This man thrives on responsibility,'' Blair said. ``He has great experience. He's been well-received by the community. He's doing a great job.''
Both Blair and DeBarth stall when asked about needed improvements in the Ocracoke program. Although equipment always needs upgrading, and although both want to improve their medication capacity for coronary patients, the overwhelming problem lies with the summer's inundation upon the program's tiny staff.
``We don't want Ken to burn out,'' Blair said. ``The clinic's open all day Monday through Friday, except Thursday afternoon. Then he has his administrative duties. And he's on call for all of the rest of the time, 24 hours a day. That's a load. We hope we can get some part-time help over there this summer.''
Mathews, the board chairman, also worries about the summer crunch.
``We have people coming here from all over the country, and we hope they appreciate the work we've done to put this program together,'' Mathews says.
``We wouldn't even be here without a supplemental grant from the North Carolina Office for Rural Health. They consider us the most remote operation in the state, and their $60,000 grant is the difference between life and death for us. We just don't break even with fees and contributions, and we receive no grant-in-aid from Hyde County.
``By accepting the state grant, however, we also add to the list of regulations that keep us from doing all we can do. For instance, we can dispense medication only to our patients. We cannot fill prescriptions visitors bring with them. That's a real inconvenience for many of our visitors.''
Cards on the bulletin board of the waiting room indicate that patients are pleased with the care they get.
One mother thanked the staff for continuing her child's allergy shots while they vacationed there. A resident expressed gratitude for the speedy transport of her spouse to a Norfolk hospital that saved him from a fatal heart attack. Several others took the time to send in their comments of appreciation for timely service.
Meanwhile, DeBarth prepares for the summer crunch with some worries about his personal life. He's had no time for his boating and fishing hobbies, and has yet to start his motorcycle since coming here.
Will he have free time when his two sons, who live with their mother in Canada, come to visit?
He seems unfazed by such questions, because the challenge has been so rewarding to date. Still, the telephone provides a constant reminder of DeBarth's 24-hour duties.
``I was called to the clinic four times last weekend,'' he says. MEMO: Visitors to Ocracoke will find a directional sign to the clinic shortly
after entering town. For advance information, call (919) 928-1511.
ILLUSTRATION: Staff photo by DREW C. WILSON
``Anybody can work at a Johns Hopkins Hospital with hundreds of
backup specialists . . . But here I have to do it all,'' says
physician assistant Kenneth A. DeBarth.
Photo by JACK DEMPSEY
``Anybody can work at a Johns Hopkins Hospital with hundreds of
backup specialists . . . But here I have to do it all,'' says
physician assistant Kenneth A. DeBarth.
by CNB