“The Madison County Board of Health met in the Commissioners’ room of the County Court House on March 9, 1949 with the following members
- Mr. Roy Roberts
- Mr. Steve Roberts
- Mrs. Edna Rhodes
- Mr. Willie Farmer
- Dr. Arthur Ramsey
- Mr. Hubert Roberts
Also attending was Dr. H.C. Whims of the Buncombe County Health Department. The purpose of the meeting was to discuss the formation of a Health Department for Madison County with the Buncombe County Health Officer serving on part-time basis as Health Officer for Madison.”
Dr. H.C. Whims was elected to be the Health Officer for the county by a unanimous vote and Dr. W.A. Sams was elected as the County Physician for Madison County. At this first meeting, board members were given information regarding the establishment of the county health department.
On July 6, 1949 the board met with county commissioners: Mr. Spence Rice and Mr. C.J. Wilde to discuss a budget for the health department. After discussion, the commissioners agreed on the budget and it was adopted.
In January 1950, the board began addressing topics such as:
- The question of a Milk Ordinance
- The law providing for the control of Rabies
- Investigation of those practicing medicine in Madison County without a license.
First health department staff included:
Dr. H.C. Whims, Health Officer
Elizabeth G. Baker, RN
Miss Hope Fisher, Secretary
Mr. C. Lendon Cox, Sanitarian
A Dog Warden Law was adopted by commissioners in 1952. The supervisor of the warden was to be Mr. C. Lendon Cox. His salary was to be $100 per month and seven cents per mile not to exceed $50 per month. The warden was to hold Rabies Vaccination clinics and charge 75 cents for each dog vaccinated. The money was to be placed in the “County Dog Fund” and used to purchase more vaccine. For vaccinations given at the dog owner’s home, an extra charge of
25 cents was allowed as a fee for the warden himself. “After the regular tax listing time the Warden is to turn in the names of the dog owner that have not listed for taxes. For each unlisted dog turned in, the tax listing department is to receive 50 cents.”
The dog warden provided a place at his own home for the purposes of keeping dogs. He was to feed and care for them. For any owners claiming their dogs from the warden, they were charged 25 cents per day for their care.
Dr. Whims resigned as Health Officer in 1954 and Dr. S.W. Vance was elected as acting Health Officer. Dr. Marjory Lord, Buncombe County Health Officer, agreed to serve Madison County also. Her salary was $150 per month with
$25 per month for travel. Dr. Lord and Dr. H.W. Stevens met with the Board of Health in December 1954. Members present included: Dr. A.M. Ramsey, Board Chairman; Mr. Jonas Chandler, County Commissioner Chairman;
Mr. William Peek, County School Superintendent; Dr. S.W. Vance;
Mr. Clyde Roberts; and Mr. Troy Rector. Topics included:
- Dr. David Kimberly recently established a clinic in Hot Springs that has grown so much that they would be open two times a month instead of one. The State Board of Health furnished the clinic with an examining table, scales, goose neck lamp, blood pressure apparatus and other instruments and the State Board also was paying Dr. Kimberly a small fee for each clinic.
- The Men’s and Women’s Civic Club in Hot Springs provided furniture and furnishings and some financial aid to help pay the rent for the building.
- Dr. Lord asked the board to enlarge their 1954-55 budget for clinic supplies from $300 per year to $500 per year.
- A report was given that the School Health Program was “proving highly satisfactory and that the dentist in Marshall and in Mars Hill were cooperating with the health department in giving dental services to indigent school children”.
- Dr. Lord and Dr. Stevens asked the board for encouragement of rabies vaccination clinics as rabies was “wide spread throughout the western counties”.
- The board asked Dr. Stevens to write some local news publicity and news releases on the activities of the Health Department.
Early Board of Health minutes covered very similar topics that are still discussed today: Rabies; Sanitation; Communicable Disease such as Poliomyelitis and Tuberculosis; School Health and sports examinations for football and basketball teams; Immunizations and Staff Salaries.
In 1956, the Health Officer spoke of “several important Health Department activities which we were not able to do. Too many privies located over streams; nurses feeling work was not adequate in following orthopedic cases; and too many babies delivered by midwives or neighbors not reported to us within
24 hours so a nursing visit can be made at once”. A proposal to build an annex to the courthouse that would house the health department did not receive approval however, the “County Home Site” was suitable.
Dr. Marjorie Lord wrote this letter to Mr. A. E. Leake in April 1957.
Dear Mr. Leake:
At a meeting of the Madison County Board of Health yesterday, motion was made seconded and carried that we ask you as our Representative from Madison County to prepare and introduce at the present legislative session, a bill to prevent any new privies or toilets built in Madison County, from dumping human waste directly into any branch or stream. It was thought by the Board that this step was necessary in view of the fact before too many years the North Carolina Stream Pollution Commission will order us to clean up the French Broad River.
As Director of the Health Department, I certainly appreciate what you are doing for our county in Raleigh and ask that you please help us with this urgent problem.
Mr. Leake responded that “It just happens that my desk-mate down in the Legislature happens to be Honorable J. Raynor Woodard, the Representative from Northhampton County, who happens to be Chairman of the Committee on Health. Raynor tells me that there is state-wide legislation pending which will take care of this matter. In view of this information, I would prefer to handle the matter in this way instead of introducing a local bill”.
In July 1958 a survey was made in Sleepy Valley which included Paint Rock and Shut-In. There were 128 homes visited and 108 water samples taken. Attention was called to the large number of contaminated water supplies. Some privies were in poor condition and nine families had none. The real purpose of the survey was to determine the number of children in these families to have parasites but the sanitation problems needed to be corrected first.
The first board meeting held in the new Health Center was on October 21, 1958. Eye clinics and x-ray clinics were scheduled and Dr. Otis Duck was in charge of starting a new maternity clinic. Dr. Eugene Powell and Dr. Whitson agreed to help. A Pediatrics clinic was to begin in Hot Springs to follow the new babies in the Hot Springs and Spring Creek area.
With the prenatal clinic in place, the board learned that in 1959 there were no maternal deaths and the county’s infant death rate was 28.8 per 1000 live births compared to the North Carolina average of 32.8.
In 1961, Dr. Lord remained focused on sanitation and environmental health concerns, requesting the board adopt an ordinance requiring a permit for construction of septic tanks. Any person violating the ordinance would be fined $50 or imprisonment of not more than 30 days in jail. The ordinance became effective in August.
Marshall experienced a flood in October 1964 which led to a discussion by the board of health on the health department’s responsibilities during and following flooded conditions which involved schools, water supplies, homes and business buildings. The local Sanitarian Consultant supervised the clean-up of activities to help make class rooms, school grounds, and any flooded areas safe for use.
Dr. Lord presented a letter of resignation effective April 1, 1968 but agreed to remain until her replacement could be found. The board of health wanted to explore the options for a new health officer. On April 30, 1968, the board of health met at the Madison Grill to hear a presentation by Dr. Ronald Levine, Director, Community Health Division, State Board of Health. He presented a plan and a budget to develop a District Health Department including Madison, Mitchell and Yancey counties. There was discussion and many “direct” questions after the presentation. “The feeling of the group seemed to be: We would be investing more financially in this arrangement than the other counties and we would lose our identity in not having our own Board of Health but being a part of a combined one”. No action was taken.
Dr. Barbara Wood Smith of Asheville was hired as the new health director in
July 1968. She served through July 1970, then resigned to enroll at the School of Public Health at UNC-Chapel Hill to continue advanced studies. In November 1970 minutes reflect that Lawrence Burwell was appointed Health Director who remained in the position until 1974. Mr. Ed Morton became Acting Health Director after Mr. Burwell’s departure.
Public health topics continued to focus around environmental health and the landfill, the animal shelter, clinic services and more during these years.
The health department services continued to expand and there were increases in staff resulting in concerns about space. In 1974, funds were obtained from the State Department of Public Health to purchase a trailer unit to double the department’s current space.
In 1976, the board voted to endorse the “bi-valent flu vaccine program which included immunization for the Swine Flu and the Victoria Flu. A mass immunization clinic was held in October. Garnette Sprinkle, Nurse Supervisor, led the efforts. Her reports at board meetings reflected clinic and community activities. She worked hard to keep members up to date about the services available at the health department. The WIC Program that began in 1977 became a quick success, with a case load of 750 patients after the first six months of the program.
A contract with the Hot Springs Health Program for medical and pharmacy services was approved in 1982 and Dr. F.B. Jones agreed to serve as medical consultant for the health department. Sandy List, nurse practitioner, joined the health department the same year. In 1983, Mrs. Sprinkle discussed the need to emphasize dental services especially in the area of prevention. Dr. Coverdale, pediatrician, recommended the health department offer fluoride medication for low-income infants and children as a means of preventing dental caries. The board agreed to promote dental prevention education and fluoride medication.
Preventing Preterm Labor was a new project in 1984, otherwise known as
“Baby Love”. The purpose was to address the high rates of infant mortality across North Carolina. In 1985, three staff members attended a training session in Raleigh “to learn to use a new computer and bring it back to Madison County”. This was the first step for the health department in the area of technology.
Mrs. Elizabeth Baker, RN, the first public health nurse for the county, retired in June 1985 after 30 years of service. Her efforts in maternal and infant health, school health and immunizations, and community health outreach will long be remembered. Gone was the era of navy or pinstripe uniforms, caps, and the nursing bag for home visits.
Elizabeth DuVall, RN, served as a long-time public health nurse with a major focus in school health. She was the first school nurse for Madison High School. In 1987, she presented the first “AIDS Education Program” to high school students. With help from Dr. Otis Duck, the program was quite a success and Dr. Duck requested this be presented at least annually. She was known for her caring spirit and did not hesitate personally to help any school child or health department patient that was in need of medicine, food, or to pay a doctor bill.
The first social work position was added in 1991. Sandy Marler was hired to work in the new Child Service Coordination Program. She later took over the “Baby Love” Program at the health department.
Mr. Morton retired as health director in 1991 and Mrs. Carolyn Haynie was named as his replacement.
The Madison County Health Department is dedicated to the purpose of disease prevention and health promotion for all Madison County residents.
Healthy People, Healthy Communities
Integrity- We are committed to treating all people honestly
and fairly, with dignity and respect.
Accountability- We are committed to fiscal and program accountability and evaluating our performance
in terms of benefit to the public.
Excellence- We strive for excellence in services to our customers and in leadership throughout the public
Teamwork- We are committed to working collaboratively with others to enhance public health services for our
residents and our communities.
Responsiveness- We are committed to a strong, professional, responsive public health system that meets
the challenges of promoting and protecting
the public’s health and adapts to a rapidly
Key Beliefs of Public Health Practice
Public health not only seeks to assure the health of whole communities but also recognizes that the health of individuals is tied to their life in the community.
The Madison County Health Department has adopted the following key beliefs of public health perspective from the 2002 Public Health Leadership Society “Principles of the Ethical Practice of Public Health”.
- Humans have a right to the resources necessary for health.
Article 25 of the Universal Declaration of Human Rights states in part “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family…”
- Humans are inherently social and interdependent.
Positive relationships among individuals and positive collaborations among institutions are signs of a healthy community. The rightful concern for the physical individuality of humans and one’s right to make decisions for oneself must be balanced against the fact that each person’s actions affect other people.
- The effectiveness of institutions depends heavily on the public’s trust.
Factors that contribute to trust in an institution include the following actions on the part of the institution: communication; truth telling; transparency; accountability; reliability; and reciprocity. One critical form of reciprocity and communication is listening to as well as speaking with the community.
- Collaboration is a key element to public health.
The public health infrastructure of a society is composed of a wide variety of agencies and professional disciplines. To be effective, they must work together well. Moreover, new collaborations will be needed to rise to new public health challenges.
- People and their physical environment are interdependent.
People depend upon the resources of their natural and constructed environments for life. A damaged or unbalanced natural environment, and a constructed environment of poor design or in poor condition, will have an adverse effect on the health of people. Conversely, people can have a profound effect on their natural environment through consumption of resources and generation of waste.
- Each person in a community should have an opportunity to contribute to public discourse.
In the process of developing and evaluating policy, it is important to discern whether all who would like to contribute to the discussion have an opportunity to do so even though it may not be addressed in the final policy.
- Identifying and promoting the fundamental requirements for health in a community are of primary concern to public health.
While some important public health programs are curative in nature, the field as a whole must never lose sight of underlying causes and prevention. Addressing the fundamental causes rather than more proximal causes is more truly preventive.
- Knowledge is important and powerful.
We are to seek to improve our understanding of health and the means of protecting it through research and the accumulation of knowledge. Once obtained, there is a more obligation in some instances to share what is known.
- Science is the basis for much of our public health knowledge.
The scientific method provides a relatively objective means of identifying the factors necessary for health in a population, and for evaluating policies and programs to protect and promote health. The full range of scientific tools, including both quantitative and qualitative methods, and collaboration among the sciences is needed.
- People are responsible to act on the basis of what they know.
Information is not to be gathered for idle interest. Public health should seek to translate available information into timely action.
- Action is not based on information alone.
In many instances, action is required in the absence of all the information one would like. Values inform the application of information or the action in the absence of information.
Principles of the Ethical Practice of Public Health
The Madison County Health Department has adopted the “Principles of the Ethical Practice of Public Health” listed below as defined by the 2002 Public Health Leadership Society.
- Public health should address principally the fundamental causes of disease and requirements for health, aiming to prevent adverse health outcomes.
- Public health should achieve community health in a way that respects the rights of individuals in the community.
- Public health policies, programs, and priorities should be developed and evaluated through processes that ensure an opportunity for input from community members.
- Public health should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all.
- Public health should seek the information needed to implement effective policies and programs that protect and promote health.
- Public health institutions should provide communities with the information they have that is needed for decisions on policies and programs and should obtain the community’s consent for their implementation.
- Public health institutions should act in a timely manner on the information they have within the resources and mandate given to them by the public.
- Public health programs and policies should incorporate a variety of approaches that anticipate and respect diverse values, beliefs, and cultures in the community.
- Public health programs and policies should be implemented in a manner that most enhances the physical and social environment.
- Public health institutions should protect the confidentiality of information that can bring harm to an individual or community if made public. Exceptions must be justified on the basis of the high likelihood of significant harm to the individual or others.
- Public health institutions should ensure the professional competence of their employees.
- Public health institutions and their employees should engage in collaborations and affiliations in ways that build the public’s trust and the institution’s effectiveness.