ENGELHARD - It's a long commute for Sally Messick every week, making the four-hour drive from her home outside Pittsboro to Engelhard in Hyde County on the coast.

As a family nurse practitioner, she could find work closer to home. But it would not bring her the same satisfaction. "Health care providers are one per square inch in Wake and Durham and Chatham counties," she says.

There is only one medical practice in mainland Hyde County, and Messick is in charge.

She works at the Engelhard Medical Center, which operates from an 1,800-square-foot double-wide trailer next to the town fire department. In this rural, coastal county famous for its bird-watching, she is an essential link in the basic-survival chain. She frets over sick children, draws up wellness plans and writes prescriptions for the county's 5,300 or so residents.

Officially, she sees patients on Tuesdays, Wednesdays, Thursdays and on Friday mornings. Unofficially, if she's in town, she will help no matter the hour.

About a year ago, Messick stitched up Ann Spencer's right pinkie finger after she caught it in the garage door. Spencer, who lives in nearby Fairfield, called Messick about 10:30 p.m., and the pair met at the clinic.

Otherwise Spencer would have driven to Belhaven, about 50 miles away. Spencer appreciates that Messick is always available and takes the time to get to know her patients.

"She'll listen to you," says Spencer. "She sits there and talks to you. She explains everything."

People know they can call her when they need help.

"I guess half the people here have her cell phone number," R.S. Spencer Jr. says before rattling off the digits.

R.S. Spencer, who is not related to Ann Spencer, owns a hardware store in Engelhard and serves on the board that runs the medical center.

"The county loves Sally," he says. "She's an angel."

For more than 50 years, county residents depended on Dr. Henry J. Liverman, a family doctor. After he retired in 2002, Hyde County was without primary-care services for about two years.

Engelhard Medical Center opened in 2004. It is one of 30 rural health centers that operates with help from the N.C. Office of Rural Health and Community Care. The nonprofit centers are public-private partnerships, each with a local board. The state provides limited funding, recruitment help and technical assistance.

The Engelhard center is not free, but everyone is seen regardless of ability to pay. In addition to Messick, a group of five, including a registered nurse and an office manager, helps staff the practice.

Before the center opened, Messick worked some temporary assignments around the state for the rural health office. She came to Engelhard not long before it opened its doors to help get the center running.

No longer temporary

This assignment was supposed to be temporary. That was four years ago, and Messick has no plans to leave.

"I love this practice," says Messick, 59, who enjoys being a part of an everybody-knows-everybody community. "I feel like I'm doing something worthwhile."

It can be difficult to recruit physicians to rural areas, as doctors burdened with student loans gravitate toward bigger paychecks and communities where their children can play soccer and dance ballet.

The Hyde County Health Department provides immunizations, as well as child-health and nutrition programs. The medical center and health department work together closely, but Messick is the county's only provider of primary-care services.

If someone needs to see a physician, Messick can send patients to doctors in Belhaven or Greenville.

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