Field school

Eastern North Carolina’s Hyde County has the unique distinction of being the only county in the state without a stoplight. And while its residents may embrace that particular characteristic of their community, the county’s lack of health-care providers is far from quaint.


Farmer Chris Stancill explains the safety procedures unique to a peanut harvester during the agricultural medicine course.

So when family nurse practitioner Sally Messick of Hyde County was invited to participate in the North Carolina Agromedicine Institute’s first-ever core course on agricultural medicine November 30–December 4, in nearby Greenville, she was grateful for the opportunity.

“I’m the only health-care provider in Hyde County right now,” she said. “I have a nurse that is with me, but I am the only clinician. We do just about everything, so we stay busy. To have this training offered so close is wonderful.”

The week-long course was open to the public and intended for physicians, nurses, veterinarians, health educators, migrant health clinicians, and others interested in learning about the unique health and safety challenges faced by area farmers and farm workers. And while the course alone cannot increase the number of health care providers in rural areas, it can improve the quality of care that is available.

“This is the first year the agricultural medicine course has been offered anywhere in the South. We have physicians, nurses, extension agents, fire and rescue folks—just all kinds of people here—learning about respiratory diseases, skin diseases and other exposures and health hazards farmers and farm workers are at risk for,” said Robin Tutor, interim director of the North Carolina Agromedicine Institute.

The North Carolina Agromedicine Institute is based out of East Carolina University, and is a University of North Carolina interinstitutional program that combines the efforts of ECU, North Carolina State University, and North Carolina Agriculture & Technology State University to provide support for agricultural workers and their families through outreach programs like AgriSafe-NC, of which the agricultural medicine course is a component.

AgriSafe originated at the University of Iowa as a response to noticeable increases in illness and injury among farmers, workers, and their families. In the years since its inception, AgriSafe has expanded into 10 states across the country and continues to improve agricultural occupational safety by connecting health professionals to farm workers through clinics, advocacy, education, and on-farm training and medical care.

For Messick, the course helped her gain insight about the people she cares for in Hyde County.


The cotton picker is one of the unique pieces of farm equipment the participants of the agricultural medicine course had the opportunity to see in action.

“In the area where I am, one of the primary occupations people have is farming. So many of my patients are farmers or work on farms. I’ve gotten a much better appreciation of how the equipment is used and what farmers are actually doing all day long,” she said.

Farm safety, especially regarding farm machinery, is an important component of the agricultural medicine course. While participants spend most of the course in a conference setting attending presentations on topics ranging from general environmental hazards, to zoonotic diseases, to agricultural pesticides, and even musculoskeletal diseases and ergonomics, they also tour a real working farm where they can see potential hazards first hand.

In this course, participants visited nearby Stancill Farms, a family owned, 4,500-acre, row-crop operation near Gardnerville, North Carolina. Without the cooperation of area farmers like Chris Stancill and his family, the agricultural medicine course would lack context. One must stand next to the towering combines, cotton pickers, peanut harvesters, and other farm equipment to fully understand how dangerous they can be.

“One of the things we’ve learned in this course is how much more prone people are to have accidents when they are tired or stressed,” said Messick. “And being someone who is from a farming community, and grew up around agriculture, I know that there is often a window of opportunity to complete an agricultural task—like when a hurricane is coming. So you’ll see the lights from the combines lined up across the field at one o’clock in the morning. And you’ll see them working constantly, for as long as it takes to get their crop in before the water comes. I can’t think of anything more tiring or stressful than that.”

Along with many physicians and professors from ECU and the Brody School of Medicine at East Carolina University, including William A. Burke, MD; Edward D. Crotts, Jeffery D. Ferguson, MD; William Joel Meggs, MD; Mani S. Kavuru, MD; and Sharon Louise Rutledge, AuD; the course also drew experts from all over the United States to serve as presenters. The institute was particularly honored to welcome Michael C.R. Alavanja, DrPH, of the National Cancer Institute, and a team of AgriSafe pioneers from Iowa, including the program’s founder, Dr. Kelley J. Donham.

“It’s very rewarding to see this course being offered here in North Carolina,” said Donham. “I’ve been working with the folks here for about 12 years, since they were just starting to think about forming an institute. If you think about an investment, of time or money, or whatever it is, and you hope to get a return, this has been a fantastic return on investment.”

For Donham, seeing his program expanded to a new state is another milestone in his 35-year career improving the health and safety of the farmers and farm workers who are so vital to our nation.

“We have this rural population that is out here feeding the rest of us, and it’s a natural resource that we really need to take care of,” he said.

Visit the North Carolina Agromedicine Institute to learn more.