CHAPTER TWO: Themes

Introduction to Themes

This portion of the document reveals the important strengths and weaknesses of the community that surfaced repeatedly during the in-person interviews and focus groups. The team analyzed the data from these sources and categorized the information into nine themes: Sense of Community; Church/Religion; Governing Structure/Leadership; Land Use and Population Changes; Crime, Drugs and Alcohol; Recreation; Education; Senior Issues; and Community Health. For each theme the following information will be provided in this order: relevant secondary data, the perspective of the service providers that live outside of Snow Camp, the perspective of service providers that live in the Snow Camp area, the perspective of community members, the perspective of the team, and the differences of these opinions and feelings. For some themes, information was not available from each perspective.

Snow Camp- Where is it?

Various perspectives on the physical definition of Snow Camp exist. As a service provider from the community states, "the community has its own identity and is not easily meshed with other communities."

Among the various community members, one perspective is that Snow Camp is a very rural community, which does not have a center of business and is spread out in a .5-mile radius. Other opinions define Snow Camp as going from Bethel South Fork Road to Snow Camp Road or south to the Chatham County line. Some community members feel that the fire department district delineates the physical boundaries of Snow Camp. As one community member put it, "the center of Snow Camp depends on the age group." Through speaking with the community and hearing the many definitions the team got a better understanding of the Snow Camp area.

The key features of Snow Camp include: the Sylvan Elementary School, Fire Department, Ye Old Country Kitchen, Outdoor Drama Site, Snow Camp Market/crossroads, Yesterday's Grill, and the Post Office.

A Sense of Community

A great asset of Snow Camp is the sense of community. Service Providers outside of the Snow Camp area feel that people know their neighbors and have a lot of pride in the community. Service providers also feel that people "take care of their own" in Snow Camp. However, there is a concern that community cohesiveness decreases as people move away from the area and new people move in.

Service providers who live in Snow Camp also have similar opinions. Neighbors do not get in each other's way but are supportive, especially in times of crisis. As stated nicely by a service provider and community member, "It is a well-knit community. Everyone here is concerned about each other. There is lots of kinship and there is a lot of history." Another opinion was, if you are "willing to be a part of the culture" then Snow Camp is a "loving group of people." Like the perspective of the service providers outside of Snow Camp, the service providers who live in Snow Camp also feel that the sense of community is beginning to decrease as more individuals move into the area. As one individual states, "the community does not get involved as much as they used to from what I've seen."

Among the community members in the area, many of them feel that Snow Camp is a loving and caring place and that if people can find ways to help, they will. Many times people in Snow Camp have come together to help those in need. Examples of community support include, installing a needed security system, fixing a broken lawn mower, carpooling, providing support if someone's house has burnt down, or someone being diagnosed with a terminal illness. "This community will come to your aid if you need it, and try to help anybody", says a Snow Camp community member. While Snow Camp has strong supportive neighbors, the community feels the support is dwindling. "Neighbors do not know neighbors now, it was community and now I don't know who lives next door," said one Snow Camp community member.

Snow Camp community members also are very proud of their community. As one community member expressed, "Snow Camp is a good example of a dying kind of life in this country, a remaining example of a community where trees matter more then progress, where principles matter more than pay checks."

The team also felt the sense of community and pride every time we conducted an interview or went into the community. The team felt very welcome in the homes of community members and offices of service providers. There is a definite sense of helping and camaraderie among the Snow Camp community.

Regardless of the point of view a large sense of community cohesiveness and strength exists among Snow Camp residents. People come together and provide each other with support and need. While, some feel a sense of decreased community involvement, the kinship and friendly loving atmosphere of Snow camp still remains. Friends, families, and neighbors are still there to provide aid when needed.

Church and Religion

There are approximately eight to ten churches in Snow Camp, depending on the definition of the town limits. "We've got plenty of churches!" one resident proclaimed. Represented denominations include:

• Quaker
• Methodist
• Baptist
• Wesleyan
• Christian
• African Methodist Episcopal (AME)
• Pentecostal
• Holiness

There are Snow Camp residents who are of other faiths, from Jewish to Catholic, but there are no formal places of worship for those denominations within Snow Camp.

Religion and history are very intertwined in Snow Camp. As one community member put it: "part of what make up cultural roots [are] religious roots." As previously stated, Snow Camp was settled in the 1740s by Quakers relocating from northern Pennsylvania. The Cane Creek Friends meeting is the oldest continuously running Quaker meeting in central North Carolina, and just recently celebrated its 250th anniversary. However, there are some who are worried that this history is being lost. One community member stated: "my concern with Snow Camp is that while it's known for its Quaker upbringing, that is being diluted in generations." Still, several families within many churches are historically connected.

Churches or meeting houses and their activities often constitute social centers. In particular, activities for seniors and youth are often affiliated with church, such as senior groups, youth groups, and Sunday school. Many churches actively use and promote music. Most congregations also involve themselves with community service, from local projects to flood relief elsewhere in the state, to outreach in national and international settings.

Religious organizations are integral parts of the social support framework for residents of Snow Camp, facilitating everything from daily generosity by congregants to food drives and benefit suppers that generate thousands of dollars for the sick or unfortunate. People are quick to say: "churches take care of people." Rectors are not only spiritual leaders, but often become involved in various forms of counseling. Churches and church leaders are often called upon to solve problems within their community. Congregations have been behind community efforts such as the establishment of the Snow Camp Health Clinic.

Most of the Snow Camp churches have quite homogeneous congregations. There have been some community members who have felt as though people of minority or mixed races "were not welcome" at some churches, although many churches do emphasize their openness to diversity. Some parish leaders have periodically made attempts to have interfaith ministry meetings. Formally or informally, many community members do say that inter-denominational relations are strong. There are a few joint religious events, particularly a sunrise service on Easter and a Thanksgiving celebration. Likewise, many church benefits are joint efforts.

In recent years, many religious leaders and parishioners cite changes in church attendance and climate. Paradoxically, as the population of Snow Camp has risen, the size of most congregations has declined. Some estimate that "half of the people" in the town do not attend any religious activities. Many churches, such as Rock Creek AME, have historically been the central and unifying feature of their portions of the greater Snow Camp community. As some congregants described, "in earlier days the focus was on the school, the church. It was a great time when everyone got together but now things have changed." For many, church is still "home," but although churches like AME maintain an important presence in the community; a growing, changing, and increasingly mobile population has led to some de-centralization of the church's role.

It is also important to note that, since so many social and supportive activities are held through the church, it remains unclear what kind of resources are available to those who are not members of a congregation.

The team also observed the strong presence of the church in the Snow Camp community. The churches seemed to provide support and help to the community and are an integral component in Snow Camp. For many people the church seemed to be a place to gather and socialize. In addition, it is an important part of their history and culture. The historical roots of the Quaker church provide the community with a unique and interesting history.

Within congregations, both the parishioners and church leaders seem to share most opinions. Both cherish the supportive community they find within their spiritual home. Many congregations also offer services to the greater community and beyond.

Governing Structure/Leadership

A County Manager, Assistant County Manager, and five County Commissioners govern Alamance County (Alamance County Health Department, 2000). These elected government officials are responsible for setting policies for the county and allocating budgets for county agencies. Within Alamance County there are nine municipalities, each with a mayor and council members that create policies for their cities or towns (Fisher et al., 2001). Snow Camp is not an established municipality, even though the population of Snow Camp is estimated to exceed the population of two established municipalities (Alamance County Health Department, 2000).

Due to the fact that Snow Camp is not an established municipality, they do not have a town mayor or governing structure. Service providers, who are also community members, have the opinion that it would be nice to be able to incorporate Snow Camp to some degree. This could be done through a town board, leadership board, or steering committee. A committee would be able to address concerns and make sure everyone received equal representation. Right now, there is no formal means through which Snow Camp residents can voice concerns.

Among community members, the opinion is that there is no governing structure or "main leader" among the community. According to one community member, the governing structure in Snow Camp is "Kinship." For others the County Commissioners are their voice. Although some feel that being able to do what they want (because there is no town government) is important, others feel that this type of freedom can be bothersome to surrounding neighbors and the community. Also, as stated by one community member, "there are church groups, school groups, but no Snow Camp community meeting."

The team was also aware of the lack of centralized leadership in Snow Camp. A few main figures in Snow Camp were referred to as key leaders, but not everyone in the area is aware who those people are. As the community grows, the need for leadership will become stronger and more important in the community because as more people move into the community there may be a greater need for voices to be heard and changes may be needed to accommodate the growing population. Among all the above perspectives there is agreement that a town board or formal committee would help to incorporate change and help voice different perspectives in the community.

Population Growth and Land Changes

Snow Camp is a growing community. Snow Camp residents have different feelings about these changes. Population growth is affecting many different aspects of the community including land use, transportation, traffic/roads, and ethnic diversity.

Land Use

According to individuals who are both service providers and community members, Snow Camp has grown a lot within the last five years. A majority of the changes can be seen through the transformations in land use. There is a concern that so many people are coming into the area and buying farmland from the younger generations who no longer want to maintain the family land. In addition, people are renting their land, and in many cases mobile home units are being established, increasing the number of septic tanks and wells in the area. Some service providers are apprehensive about these new settlements, in large part, because of the lack of zoning restrictions in the county.

The pace of development, especially within the last 10 years has raised concern among the community as well. The lack of zoning restrictions in the Snow Camp area is an apparent problem to some community members. Zoning restrictions are used to regulate the quantity of homes in one location. According to one community member the new population and subdivided land is overwhelming the infrastructure (the schools, fire department, single family dwellings) of the community. As another community member states, "The real biggest shift will come because the land has been divided into these very small plots".

Many community members feel that Snow Camp has quickly become a "bedroom community," meaning that people live in Snow Camp, but work outside the community. Some people feel that these commuters do not become involved in the Snow Camp community. Some community members welcome newcomers and although Snow Camp is a friendly place, they feel "we have to get to know you [first]." There is an overwhelming concern that, "farming is a thing of the past," as another community member puts it, leaving no industry in Snow Camp.

Transportation

Private owned vehicles are the primary mode of transportation in Alamance County (Fisher et al., 2001). Public transportation in rural areas of Alamance County is nonexistent. According to service providers who live outside of Snow Camp, transportation is seen as a major problem. The lack of transportation and the location in the rural community makes it difficult for individuals to access services. In addition, as a service provider who lives in Snow Camp states, "transportation is definitely an issue for a lot of people, some people have to rely on family members and such." While some community members feel this way, many others do not see transportation as a problem in Snow Camp. They feel that many people either own a car, rely on a family member or friend, or carpool with others in the community. However, as traffic increases there may be a need for some type of public transportation system.

Roads/Traffic

From the perspective of individuals who are both service providers and community members, traffic and roads are an increasing concern as population growth continues. They feel that if they do not deal with the land development issue and new population growth, traffic is going to become a problem in Snow Camp. One individual believes that traffic has increased 40 to 50% in the last four years.

Many community members feel that state funding to pave roads is a large issue. Some feel that roads are not a priority for Alamance County. Table 3 below, shows that 12.9% of the highway mileage in Alamance county is yet unpaved. In addition, community members are concerned because roads are not plowed when it snows. Another concern is that most roads run north/south, leaving a lack of roads going east/west. This may become a problem as the community grows.

Reference: Fisher et al., 2001

Ethnic Diversity

Although Snow Camp is predominantly white, there is diversity within the community. Among the visible groups is a growing Latino population and a historical presence of both Native Americans and an African American community. Interviews and focus groups revealed several different viewpoints regarding racial relations in Snow Camp. Although some felt that those of different races were simply "neighbors" just like any other residents, others felt as though minorities are not as intimately included in civic and church activities. However, many community members do feel that integration has been especially successful among the youth of Snow Camp.

The Alamance County Health Department reports that the Latino population in Alamance County is growing exponentially (Alamance County Community Health Assessment, 2000). According to the director of Centro: La Communidad, in 1998 there were 7,600 Latinos in Alamance County and in 1999 the number grew to 8,733 (Alamance County Community Health Assessment, 2000). The 2000 US Census found that Latinos make up 6.8 % of the population in Alamance County.

Snow Camp seems to be just beginning to see the effects of the increase in the Latino / Hispanic demographic. However, by most local accounts, there are "a few families" who live in the town, some of whom hold local jobs in the agricultural and service sectors. According to some interviewees, there are residents who are apprehensive about this change, although most people interviewed cited good relations between Latinos and other racial and ethnic groups. In addition, some community members mentioned that informal soccer games at nearby fields have served both as a chance for Latinos to socialize, and for young people of other races to join them.

North Carolina is home to approximately 99,550 Native Americans (North Carolina Commission on Indian Affairs, 2002). There are eleven state-recognized tribes and/or native organizations, but others are present as well. In Alamance County, there are approximately 460 Native Americans, (North Carolina Commission on Indian Affairs, 2002). In Snow Camp, community members said that in the past, the Native American population often associated themselves with the African American population. Although the two groups were initially segregated, this assimilation allowed the Native Americans access to some opportunities that would have otherwise not been available, such as education. Currently, some Native American residents seek to keep their history alive and appreciated by giving demonstrations and displaying their crafts at Snow Camp Historical Site events.

Rock Creek, a community within the northern part of Snow Camp, is a historically Black area of town. Although an African Methodist Episcopal (A.M.E.) church still binds many residents together, integration, economic, and cultural forces have reportedly led to some de-centralization of that community. Holding on to this sense of community is important to many African American residents, but they also consider themselves active members of the greater Snow Camp community. By some accounts, there has been an increase in dialogue between the white and African American residents of Snow Camp. "Pathway to Freedom," an annual play about the anti-slavery 'Underground Railroad,' and the 'Quakers' role, is performed at the Snow Camp Outdoor Drama Center and has served as a catalyst for increased understanding. There are also some inter-faith activities that include the A.M.E. church.

In summary, although Snow Camp may give some the first impression of being a "white" community, there is also a growing amount of racial and ethnic diversity. Most residents cite positive relations, but many also acknowledge the need for further efforts to raise awareness and appreciation of all groups within Snow Camp.

Crime, Drugs, and Alcohol

The 2000 crime index rate for Alamance County showed there were 4,290.4 violent crimes per 100,000 persons, which was lower than the state average of 4,921.5 violent crimes per 100,000 persons (Fisher et al, 2001). However, the number of juvenile crimes in Alamance County is increasing, which is a serious concern in the county. Community members and public officials have created community programs for youth in an effort to curb the increase in juvenile crime.

Substance abuse is also a significant concern cited by county officials and residents, and was ranked as one of the top three most important health issues for Alamance County (Alamance County Health Department, 2000). Alamance County has higher rates than the state average for "health related consequences of alcohol and drugs, liquor law violations, substance abuse treatment admissions, and especially drug possession" (Alamance County Health Department, 2000). Alamance County residents have voiced a need to eradicate drugs and violence in schools and to provide youth with skills to resist pressure to smoke, drink and use drugs.

Many service providers are concerned about the issues of crime, drugs, and alcohol in the community. However, many Snow Camp community members state that crime, drugs, and alcohol are not problematic in their town any more than they are "a problem everywhere." But other residents have also become concerned about these issues. One stated "I perceived it to be somewhat safe until seven years ago. . .now crime is on the rise."

Community members identified some recent trends in crime. Burglary is foremost, with many residents citing repetitive break-ins. One resident, for example, has been burglarized seven times. Another had three break-ins in one year. Likewise, arson has also been on the rise. Of the relatively few structure fires in Snow Camp, in the past year, half were from suspicious causes (Snow Camp service provider and community member).

Many people relate the occurrence of crime to drug problems. Some suspect, for example, that burglaries are committed under the influence of drugs and perhaps motivated by the desire for money to buy drugs. Some residents said that they were aware of marijuana being grown on land inside of Snow Camp. Likewise, some community members felt there was a link between high usage rates of alcohol and the lack of a center for recreational activity. An even broader connection was made between the entire issue of crime, drugs, and alcohol, and the economic problems facing many in and around Snow Camp.

Although there are resources available related to the prevention of and response to problems with crime, drugs, and alcohol, there is a gap in services physically offered in Snow Camp proper. Alamance/Caswell Mental Health and Substance Use Authority offers relevant services ranging from substance use counseling to mandatory programs for Driving While Intoxicated (DWI) offenders. This agency is located in Burlington. Likewise, law enforcement and crime prevention activities originate from outside the town. The Alamance County Sheriff's Department is the most commonly called upon. The North Carolina Highway Patrol also responds to calls within the town. A concern about long response times for public safety and emergency services was a common theme in interviews and focus groups. Although part of this problem might be inherent for a rural community, some suggested that the problem was also due to policy or departmental decisions as well as budget constraints.

In general, the team felt very safe when frequenting Snow Camp. The team did not notice any suspicious behavior or dangerous areas. However, the team did hear many stories of repeated break-ins, which came as a surprise to team members. The consensus about crime and substance abuse in Snow Camp is two fold: patrols and response by public safety agencies are not as rapid as many would desire, and extension services for problems such as substance abuse are rarely offered within Snow Camp. All relevant organizations seem to be aware of this problem and desire a resolution, but are often constrained by a lack of funds or conflicting departmental demands. There is some momentum towards advocating for a Sheriff's Department substation in southern Alamance County, which could improve the safety of the Snow Camp community.

Recreation

The 2000 Alamance County Community Assessment identified that Alamance County residents feel a need for more recreational opportunities and facilities. Currently there are four large parks operated by the Alamance County Parks and Recreation (Fisher et al., 2001). None of these parks are located in Snow Camp and the closest park is about 20 minutes away. There are also a couple movie theatres and a few public libraries, but these are also located at least 20 minutes from Snow Camp.

Many service providers felt that the Snow Camp residents have to "travel to bigger cities, for parks and recreations, entertainment" though some of them were able to identify existing recreational opportunities within Snow Camp such as restaurants and the Outdoor Drama Site.

In responding to questions about the availability of recreational facilities, many community members were able to identify various recreational opportunities for people of all ages, such as church functions and baseball games. Many community members also identified the drama site and restaurants as places for recreation. People take pride in the Outdoor Drama Site, which has grown larger, and is in its 29th season. The drama not only attracts business from community members but also from those outside of Snow Camp. School and church were also cited as centers for social activities, irrespective of age group.

Adult participation in recreational activities is shaped by "individual's interest" and "work-based social groups." Snow Camp residents actively participate in outdoor activities such as hunting, fishing, boating, horse riding, gardening, golf, hiking trails, and walking the track at the school. They also take part in the Molasses Festival, the 4th of July Celebration, country music at the Grand Old Opry, Saturday night music at the Fire Department, and plays at the Outdoor Drama Site.

The Sylvan Athletic Association formed 30 years ago, enthusiastically sponsors baseball, softball, and basketball teams, as well as some church softball leagues in Snow Camp. Most children get involved in ball teams. Ball games were seen by many as a good opportunity for family and community involvement and also an opportunity for children and parents from diverse races and ethnicities to interact and socialize. As one community member stated, "parents, grandparents, friends, [and] neighbors, come out watch the game and socialize with each other." The community member further added that "the ball field is where the integration is going to occur-integrate on the kid level, go from there."

Many youth in Snow Camp participate in youth group activities (such as service projects and other church events. They also go to the Open Gym in Eli-Whitney and take dance or piano classes in Graham. Some community members did stress the lack of recreational activities available for this age group in Snow Camp, but the team was not able to get the youth perspective on recreation due to time constraints.

Although there are some recreation opportunities for children, there seems to be a lack of variety. Children, who are not interested in sports or are not a part of church, may not be able to find activities. One community member cited that the "lack of recreational opportunities for kids might lead to undesirable behavior and increases in juvenile problems." Another community member further stressed the lack of opportunities by stating that "[I] don't think there is a place for kids to hang out. For 17 and under, [there is] school, church, or none at all." Another community member echoed similar concerns, " my cousins grew up in Snow Camp and they did complain of being bored, nothing to do much."

There is no recreational center in Snow Camp and many community members voiced the need for "a community center" for recreational opportunities. Community members also expressed the need for the center specifically to meet the needs of the increasing senior citizen population. "Church activities are the social centers, if it's not with church, they don't [have many social opportunities]." A concerned community member further echoed the need for the community center, "[I] wish we had a Recreation Center…folks [seniors] might be more involved if we had one but somebody needs to take the initiative".

The team observed that recreational opportunities in Snow Camp are limited. However, for those who are interested in playing baseball or softball, there are excellent opportunities to get involved. Unfortunately, for women and seniors there is a lack of activities designed specifically for these groups. In addition, there is a need for youth oriented activities for those who are not interested in sports and who are not involved with the church.

All perspectives seem to agree that there is a need for some type of community center, a place where the community can go and participate in a variety of recreational opportunities that fit all age groups.

Education

The Alamance County high school dropout rate (3.77) was slightly higher than the North Carolina rate (3.43) in the 1997-1998 school year (Alamance County Health Department, 2000). Service providers also affirmed a large high school drop out rate at Southern High School, which is where many Snow Camp children go to school. Opinions about this issue are mixed. As stated by a service provider, "Young kids, think 'I can just finish high school' and don't envision having something better." However, some community members feel that a good portion of Snow Camp high school students graduate and go to college.

Sylvan Elementary School is the only school in Snow Camp and is one of the smallest schools in the county. Sylvan was the first consolidated high school in North Carolina. There were many positive statements made about Sylvan School. In general, both service providers and community members were satisfied with the education children in Snow Camp receive. According to service providers living in Snow Camp, the community provides support and guidance for the school through the Hammer Board and an endowment fund. In addition, support for the school is evident from the following statement, "there is lot of support from community members and several churches and community groups like the Ruritans, the Fire Department, and Sword of Peace." In addition, other service providers feel that the school is a community center, providing a ball field, gym, and a place for residents to hold meetings. As a service provider states, "Sylvan school is the heart of things." Service providers assert that the there was a great public outcry when there was talk about closing the school and the community really came together to keep Sylvan open.

Service providers expressed their concern about the inadequate communication between teachers, parents, and children. Some feel parental involvement in children's school activities has decreased. Service providers were concerned about parents' apathy towards children's academic activities and some feel as if they do not have parental support. One service provider feels that this is due to, "the transitory nature of the people in the community."

Community members expressed satisfaction with the teachers and staff, describing them as motivated, caring, and wanting the best for the children. Sylvan's greatest strengths include: after school tutoring, small class size, and the physical education program. In contrast some community members felt concerned about teacher turnover and the uncontrolled growth of low-income housing that is overwhelming the infrastructure of the school. Parents also expressed similar sentiments about the lack of communication between teachers and parents. The increase in diversity among students has been gradual. Service providers identify the diversity in school by stating that, "we have about 300 students. We have 8 black students and maybe 11 ESL- Spanish children out of 300 and they get along well." Community members also acknowledge the changing trend and the ethnic diversity in the Snow Camp, as one respondent said, "when my son (age 26) went to school at Sylvan-there was only one black child, now [there are], more Hispanics than Blacks."

Currently, there is no daycare available in Snow Camp and a pressing need identified by individuals who are both service providers and community members was the establishment of a good day care in the community to prepare 3-4 year olds for kindergarten. However, service providers were not sure if everyone could afford to send their kids to daycare. As one service provider stated, "…. I am not sure if the parents can afford $24 for the week."

The importance of the Sylvan School was apparent to the team early in the community assessment process. The school is a historical landmark and a source of pride for the community. Many feel that the school is the center of Snow Camp and is the hub of many activities and opportunities for social interaction for parents and kids alike.

In general people are satisfied with the school in Snow Camp. Both service providers and community members feel that improvements in communication between teachers and parents are needed. Service providers feel that parental support is needed while community members are concerned that there is a high turnover in teachers as the growth of Snow Camp continues. In addition, service providers felt that a daycare to help prepare the children for school is needed, but may not be affordable for the community.

Senior Issues

Alamance County has a larger percentage of people over age 65 than the state average, 14.1% compared to 12% (Census 2000), which places additional demands on the county. Many service providers living outside of Snow Camp feel that transportation is an issue for seniors. As one service provider stressed "transportation is definitely an issue for a lot of people, some people have to rely on family members and such." On the other hand, some community members feel that "there is no problem with transportation. Most everyone around here drives or family or friends that take them."

Service providers living outside of Snow Camp also acknowledge that there is a lack of awareness among seniors regarding availability of services. According to one service provider it "seems like a lot of people still don't know about the resources or what the health department has to offer even though we try …a lot of people still don't know." Some community members also feel that lack of awareness of the available resources is a problem. However, some senior community members were able to identify services available in the community, which include Elder Care (an organization that provides information to seniors about where to go for services), Meals on Wheels, a local nurse practitioner who voluntarily does home visits, and Hospice services. One way that some seniors gain access to information about senior services is through the Golden Agers, a senior group housed at the Bethel Methodist Church. The Golden Agers are connected with the Burlington Senior Center and meet once a month for a covered-dish lunch, which provides social opportunities and information about services for seniors.

Service providers feel that "many times when they go out into the home they see bags of medication that are old-that they may still take." This can be problematic and is a source of concern for the service providers. Community members also recognize that the elderly population has problems with prescribed medication relaying that "old people take their medications in strange ways." One community member hoped to get his son to do a program about prescription drugs with senior citizens.

Though service providers identify many barriers to health care services, some community members feel that "the older people are better networked than the younger people" and "have support from the community." Many of the senior respondents enjoy living in Snow Camp because it is "home" and the community is caring and supportive. For example, some community members volunteer to take seniors to doctor appointments and go shopping for them. According to one senior, "special groups [like the elderly] are taken care of by 'society'."

Community members and service providers agree that the community has an aging population, and a lot of people are retiring to Snow Camp. Both groups strongly feel the need for a community health center to address the lack of availability of primary care in the community. Community members and churches also strongly feel that adult day care has become a necessity, as many of the younger generation have their own families and work full time away from Snow Camp.

Community members are also aware of the long-term needs for a retirement center for seniors in the community. As one respondent stated, "my parents are getting older and my father has diabetes. Though, most of them have been successful to stay pretty healthy and active, we need a retirement center. I think it would benefit the community in the long run."

During community events the team noticed the large numbers of seniors living in Snow Camp. Many of the interviews we conducted were with senior community members. Ironically, the team found that many of the older community members were unconcerned with senior issues, where as, younger community members felt that the seniors of Snow Camp had unmet needs.

Both community members and service providers agree that health resource information needs to be more widely available. However, many of the seniors in Snow Camp feel that they are able to get around just fine and do not have many needs. Other community members and service providers are concerned that as Snow Camp ages, the need for local health care will be greater.

Community Health

In the 1997 Alamance County Health Department Community Assessment, Alamance County residents described their major health concerns. Major issues included the lack of adequate health insurance (partly due to jobs without benefits), the high cost of medical care, a need for more local health care, and dissatisfaction with the location of Alamance Regional Medical Center (2000). There are working relationships between health providers and agencies in Alamance County, which is way to reduce these barriers to health care in Alamance County, but many of these problems persist.

There are several health resources available to residents of Snow Camp. The majority of these, however, are located and offered outside of the area, typically in Burlington and the Alamance County seat. These services include:

• Alamance-Caswell Area Mental Health, Developmental Disabilities and Substance Abuse Authority
• Alamance County Health Department
• Alamance Regional Hospital
• Clinics (Charles Drew, Moses Cone, Scott)
• Alamance County Emergency Medical Services (EMS)
• Hospice of Alamance
• Meals on Wheels
• Elder Care
• Home Care

The Alamance-Caswell Area Mental Health, Developmental Disabilities and Substance Abuse Authority offers several services responding to substance use, Driving While Impaired (DWI) offense, developmental disability, and children's issues. Their Consultation and Education Services division works with other Department of Health and Human Services agencies, providing trainings, brochures, and health-related media campaigns. The Alamance County Health Department includes a children's dental clinic, a pre-natal and maternal clinic, a Well Child clinic, a WIC clinic, a women's and family clinic (which administrators cite being underused), teen pregnancy prevention programs, child hearing and vision screening, kindergarten physicals, car seat checks and injury prevention outreach, and a "baby love" program (provides resources for pregnant women in the community). Representatives of the Health Department are also involved with several inter-disciplinary coalitions, addressing topics such as Asthma, Substance Use, Access to Healthcare, and Child Abuse. Their Environmental Health Services (EHS) section is active in vector control, well and septic system inspection, overseeing trash disposal issues, monitoring lead levels, and inspecting the health and safety of restaurants and food services, day cares, nursing homes, hotels, and pools. EHS is also active on the asthma coalition.

Alamance Regional Hospital in Burlington is the nearest full-service hospital. In addition to acute, inpatient, and outpatient clinical care, they are involved in some community health activities. These include running a Wellness Program, participating in smoking cessation efforts, and aiding in the leadership of the Healthy Alamance initiative. The Charles Drew, Moses Cone, and Scott (Pleasant Grove) clinics are all located outside of Snow Camp, but are patronized by some residents.

Alamance County EMS maintains a Paramedic Quick Response Vehicle (QRV) "Medic 1" which is the closest pre-hospital emergency resource for Snow Camp, at approximately seven miles away. The closest Paramedic Ambulance is approximately fifteen miles away. Hospice of Alamance has a "Hospice House" in Burlington, but also frequently offers home hospice care to Snow Camp residents in need. Likewise, Meals on Wheels, Elder Care, and Home Care conduct outreach activities.

Collaboration is one of the greatest strengths of every one of these diverse agencies. "Agencies are so good at working together. . .if we have the same mission, why not combine resources and work together?" said one service provider. Even with such efforts, however, keeping up with health needs is challenging. "No services are underutilized," summarized one health worker, "There is a wait list. . .there is more need than [there are] providers."

Inside the perimeter of Snow Camp, there are far fewer services. They are, essentially:

• Snow Camp Fire / Rescue Department
• Snow Camp Clinic

The Snow Camp Fire Department (SCFD) has four stations in the district for which they provide coverage. Their emergency response includes fire fighting and suppression, extrication (for motor vehicle crashes, etc.), rescue services, including a dive team, and Emergency Medical Services (EMS) medical first response. In the last year, the Fire Department responded to approximately 340 calls, with EMS first response accounting for the bulk (70-75%) of their call volume. The Fire Department also offers fire prevention educational interventions with students at the Sylvan Elementary School and Scouting troops, as well as playing a leadership role in several community events and activities. Currently, SCFD is entirely comprised of volunteers with the exception of one paid firefighter/Emergency Medical Technician (EMT) who is on-duty from 8:00am to 5:00pm from Monday through Friday. The Fire Department hopes to add one to two more paid personnel to provide seamless coverage. Budget cuts affect the department both directly and indirectly, by decreasing their own assets and ability to hire personnel and purchase equipment, and by putting constraints on other departments on whom Snow Camp depends, such as Alamance County EMS.

One local resource, the Snow Camp Health Clinic is currently closed. The Clinic has a long and complex history. It has been open as a private practice and/or hospital satellite program off and on for the past several years. There is a Board of Directors that includes community members. The Board of Directors responsibilities include contracting with medical providers who then use the space to offer healthcare in Snow Camp. The Board has contracted with new medical providers who are scheduled to re-open the clinic in July of 2002.

Finally, agencies, organizations, or individuals who collaborate in community health efforts in Snow Camp include:

• American Red Cross
• Sylvan Elementary School
• Churches
• Neighbors

Community perceptions of health issues in Snow Camp often fall into several patterns. First and foremost is the fact that very few services are actually conducted in Snow Camp. In response to an inquiry about whether or not this situation is acceptable to residents, one said, "it's not alright, [we've] just gotten used to it." Likewise, response times from emergency services such as EMS, Sheriff's, and Highway Patrol are typically very long, and are an area of concern for many community members. "Emergency services are the biggest need for anybody [in Snow Camp]," said one community member. Whereas remote response services such as Lifeflight, the aeromedical program from UNC Hospitals, do make up valuable time in some trauma calls, the same is not true for medicine patients. "If you're having a heart attack, you're out of luck" is one description of the situation. Virtually everyone, however, has high praise for the Snow Camp Fire / Rescue Department and their response.

There are a variety of opinions on the role of the Snow Camp Clinic. People debate the frequency of its past use, but many acknowledge that seniors used it quite often. In one era of its existence, the physician could not accept patients under the age of 13, a source of frustration for some community members. To some, its closure was a grave problem. "Those who went to the health clinic then, [they] don't go anywhere now. . .Now they just sit at home and wait it out," said one senior. Likewise, the relative need for a local pharmacy is debatable, with some residents feeling it is important, and others unconvinced of the need. Finally, in spite of a frequently cited need for more locally available health and safety resources, community members have clearly developed a supportive network for each other. In the words of one community member: "A service provider in Snow Camp is your neighbor."

Service providers and community members tend to agree on the overarching community health issue in Snow Camp: a lack of local health care options. There are Alamance County agencies and officials who are not very aware of the health needs of Snow Camp. Others, however, are cognizant of the problem of access to health resources for Snow Camp residents. There is some evidence of progress, including the re-opening of the Snow Camp Clinic. Field providers as well as vocal citizens of Snow Camp note that budget and policy decisions must support outreach efforts in order for them to be successful.

An Introduction to Snow Camp

The Snow Camp Community Meeting