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Children's Health

Chickens do their part in school program on healthy eating

The chickens at Clarke Middle School serve as a basic introduction to agricultural animals.

The chickens at Clarke Middle serve as a basic introduction to agricultural animals.

Two Thursdays each month, the family and consumer sciences classroom at Clarke Middle School in Athens buzzes with conversations about gardening, recycling, mindful eating, and how families can reduce their carbon footprints.

Each student has an idea about what can or should be done. The sound of their excited young voices mingling together leads a visitor to the room.

Just outside the classroom there’s a chicken coop, which houses two roosters and three hens.

The classroom group, coordinated by family and consumer sciences teacher Hope Zimmerman and agricultural sciences teacher Debra Mitchell, calls itself the Sustainability Corps.

It’s an offshoot of the school garden program, which has grown rapidly since Mitchell started it in 2012.

Mitchell originally came to the school as an AmeriCorps VISTA volunteer. She registered the Clarke Middle School garden with the Edible Schoolyard project, which was started by chef Alice Waters and fosters healthy relationships between children and the food they eat by teaching in a school garden.

Edible Schoolyard currently has 3,797 registered garden classrooms and 476 kitchen classrooms worldwide.

It fits into the nationwide movement to encourage healthier eating, especially among children.

Farm to School, for example, is an initiative that emphasizes not only buying food from local growers, but also teaching children to raise their own vegetables in school gardens. The Georgia effort is led by Georgia Organics, a nonprofit group that promotes Georgia farms and locally grown food.


Cooking on wheels


Americans eat a varied diet, and crops are seasonal, so schools can’t rely solely on locally produced food. But in a major agricultural state such as Georgia, such food is often available. And Farm to School helps teach urban and suburban kids how important farming continues to be to our state.

The garden fits into Edible Schoolyard’s “kitchen garden” category because it grows produce that is cooked by Zimmerman’s students and is occasionally served at the cafeteria salad bar.


Debra Mitchell tends to the garden at Clarke Middle School.

Mitchell and her students sell extra produce to shoppers at the West Broad Farmers’ Market, right down the street from the middle school. Mitchell and Zimmerman also hope to launch a student-run restaurant. This summer they brought in local chefs to work with students.

“It’s kind of funny,’’ said Mitchell. “It’s just serendipitous that all these people, all at once and all of these organizations, everybody’s pulling together and saying, ‘hey, well let’s just do it then.’”

School administrators and county nutrition officials actively support the program.

Zimmerman has a full kitchen set up in her classroom, but Mitchell works from a wheeled cart provided by the school. She has made pesto from herbs grown in the garden, cooked eggs laid by the school’s chickens and prepared fried green tomatoes and green beans, all on her mobile cooktop.

Mitchell and Zimmerman say that access to the garden and to fresh eggs have made students more willing to try new things.

Students who are more reserved in a traditional classroom setting gain confidence in the garden as well as the kitchen, get their hands dirty, and become more adventurous, said Zimmerman.


Poultry in action


The entire program continues to expand, with the chicken coop being one addition. All five of the chickens came to Clarke Middle by way of Hilsman Middle School in Athens.

Having the chicken coop right outside their classrooms allows Mitchell and Zimmerman to teach sustainability and mindful eating in a different way.

The chickens serve as a basic introduction to agricultural animals. Some students have never had any previous experience with livestock. Before they interacted with the little flock of egg producers, many of the children had rarely, if ever, asked questions about where their own food comes from.

Though their eggs are on the menu, the chickens themselves are not.

The students “always say, ‘You’re not gonna eat them, are you?’ and I’ll say ‘Nooooo.’ ’’ Mitchell said. “But then, it’ll be like, ‘but you do know that’s where your Chick-fil-A sandwich came from!’ ”

While the students are fond of the chickens, sometimes their excitement gets the better of them. They need regular reminders not to chase the skittish birds.

“I always tell them, ‘We’ve got to respect the chickens! They’re terrified of us!’ ” Zimmerman said.

Kids in Sustainability Corps gain knowledge and confidence from participating, and Mitchell and Zimmerman hope it continues to expand. People who would like to become involved can buy Clarke Middle School produce at the West Broad Farmers’ Market, volunteer in the garden, and — soon — eat at the student-run restaurant.

Visit Clarke Middle’s Edible Schoolyard page, Athens Farm to School on Facebook, or for more information.



Lauren Schumacker is pursuing her master’s in health and medical journalism at the University of Georgia. She also holds a certificate in culinary arts and enjoys writing about all things food-related.

The loneliness of a grieving child: Where does help come from?

Genevieve Liu (center, at podium) sings at a memorial service for her father in Chicago. Photo credit: Jamie Manley/Chicago Maroon

Genevieve Liu (center, at podium) sings at a memorial service for her father in Chicago. Photo credit: Jamie Manley/Chicago Maroon

Two years ago, Sicily Kolbeck, 12, of Marietta designed a 128-square-foot house as part of a school project that she planned to work on with her dad.

But before the two could complete the tiny house, her father was killed in an automobile accident. With him gone and with grief overcoming his daughter, the construction came to a halt.

Coping with the loss of a close friend or family member is among the hardest challenges that a person can face. The challenge is even more difficult when a child loses a parent.

JoAnna White, of Georgia State University’s Department of Counseling and Psychological Services, says that in the initial stages of grief, activities that brought pleasure are often no longer of interest, especially when they are closely related to the deceased parent.

“When a child loses a parent, it is the most significant and difficult loss that they could experience, and they will deal with it the rest of their lives,” says White.

Children in this situation need constant, loving support from the surviving parent and other family members who are also grieving.

If this support is provided, eventually children can get beyond the inward stage of grief and begin to focus on their lives again. None of this is simple or easy, but if children can get there — giving of themselves outwardly, rather than handling everything inwardly — that is therapeutic in itself, says White.

“Following any parental loss, we have minimal mental energy in the beginning,” says White. Later, giving back can be very beneficial, she adds. And that’s what happens as part of the healing process.

The interior of Sicily Kolbeck's house project

The interior of Sicily Kolbeck’s house project. Credit: La Petite Maison blog


As Sicily Kolbeck recounts in a recent Huffington Post blog, she hoped that completing the house would begin to provide the life skills that really mattered, such as using tools for construction.

Ultimately, with the help of the community and a few friends of her father’s, her tiny house was completed. Only then was Sicily ready to move on with her teenage life, she says, as well as to move from Georgia to Maryland with her mother.


Building new connections


“The deeper you love, the longer you grieve,” says Trudy Post Sprunk, a licensed marriage and family therapist in the Atlanta area.

“For children, if there is a close relationship, the longer the healing process will take,” Sprunk says. This is especially true with the traumatic death of a parent.

Research shows that most people can recover from loss on their own. But it takes time, social support and encouraging healthy habits.

Dr. Donald Liu

Dr. Donald Liu

In Chicago, Genevieve Liu’s father, Donald, a pediatrician, died in August 2012 after trying to rescue two children caught in a strong Lake Michigan current. The two children survived.

It’s a tragedy that Genevieve will never forget.  But she wanted to go beyond just remembering. She wanted to help others.

She built a website during her healing process. The site, called, was created to provide a supportive community where users can discuss what they’re going through after the loss of a parent.

“Genevieve is an amazing and articulate individual who has found such healing in developing this website,” Dana Suskind, her mother, who is also a physician, said in a Chicago Tribune article.

Now 14,  Genevieve says she was inspired by her friendship with a classmate whose mother passed away. It was after her friend’s loss when she decided to create SLAPD: Surviving Life After a Parent Dies. This is a website where young people can find a sense of community and, hopefully, some solace, says Genevieve.

“The mission is to let a lot of people who’ve lost a parent know they’re not alone and to gain strength from each other,” she says. “I think there’s huge power through community.”

Here in Georgia, Christen Bartley graduated from Columbus State University last year without three people she had once hoped to see smiling in the audience: her mother, father and sister. The three perished in a plane crash in July 2012.

The graduation was difficult for Christen. But she focused on “how lucky she was to have them for 23 years. Not everyone is that fortunate,” she told the Columbus State News.

It’s getting back up and finishing what was important to your loved ones before their deaths that helps, experts say.

Sicily Kolbeck says, “Sometimes when people get a hard knock, they stay down. I didn’t. That’s my claim to fame. I didn’t only want to show it is possible to live with less waste, and that anyone can build their own house; I also wanted to show that when I was handed lemons, I not only made lemonade. I made a lemon cake. And I ate it. And it was delicious.”

Here’s a video on Sicily and her house from her blog La Petite Maison:


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Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.




‘Water lady’ on front lines in campaign against arsenic in Georgia wells

McMahan preaches the use of water filters to eliminate contaminants in household water from wells.

Janet McMahan preaches the use of water filters to eliminate contaminants in household water from wells.


Janet McMahan figured it out five years ago — just before her son Ben was diagnosed with cancer.

Starting in 2008, she had skin cancers erupting all over her body, including parts “where the sun don’t shine.” Her two dogs had also developed cancer.

McMahan had just given a talk about world hunger at an Irwin County church, and had read about Bangladesh. In that impoverished South Asian country, millions of people were being exposed to arsenic in their drinking water from wells.

She says she woke up in the middle of the night in October 2009, contemplating pieces of a puzzle. “God put it together,” she says.

She told her husband, Dr. Howard McMahan, an Ocilla family physician, “I know what is wrong with me.”

The water.

The McMahans got their water from a private well on their Ocilla property.

They had the water from their tap tested, and it came back with negligible levels of arsenic.

At about the same time, their son Ben, a Valdosta State University student who had been a three-sport athlete in high school, grew sick.

Ben McMahan

Ben McMahan

The family thought at first that Ben’s problem was food poisoning. But he was diagnosed that November with gastro-esophageal junction adenocarcinoma. He was 24.

“It had to be the water,’’ Janet McMahan says now.

Seeing a pattern, the McMahans stopped drinking their well water.

Since that horrible diagnosis five years ago, Janet McMahan has been a crusader on environmental health in South Georgia, and especially on contaminated well water. During that time, health officials in Georgia came to recognize the potential danger of arsenic in well water.

Officials of the state’s Department of Public Health sent alerts last year to elected officials in 10 counties in South Georgia, as well as to UGA Cooperative Extension agents, health care providers, veterinarian facilities and local libraries, urging people to test their well water regularly to ensure what they were drinking was safe. A news release on the issue was sent to local media.

Public Health repeated the warnings this year.

But McMahan says many people across South Georgia haven’t yet gotten the word that the water coming out of their taps should be tested to make sure it isn’t endangering their health.



The unseen contaminant


McMahan says arsenic and other elements in unfiltered water from wells have led to many cancers and other illnesses in the southern part of the state.

She also believes that in agricultural areas, some of the arsenic contained in poultry litter fertilizer has seeped into the water that people drink. The drought of 2008 concentrated the arsenic at an abnormally high level, she says.

The family’s arsenic situation became clearer in early 2010, she says, when a woman who helped with Dr. McMahan’s medical billing said her husband had been hospitalized with arsenic poisoning.

Water contamination issuesAn extension agent had tested that couple’s tap water and found a negligible level of arsenic. Then he tested a sample drawn from their water heater, which showed much higher amounts of arsenic.

So the McMahans tested water that came from their own water heater. That sample had high levels of arsenic, iron and manganese, Janet McMahan says.

The state Department of Public Health estimates that one in five Georgians regularly drinks water from private wells — a figure that might surprise people in developed urban areas.

“We have a lot of rural areas that don’t have access to municipal water,’’ says the Department of Public Health’s Chris Rustin.

Most people in Irwin County drink well water, says Dr. McMahan, a past president of the Georgia Academy of Family Physicians. “There is no safe level of arsenic exposure,” he adds.

At least partly due to Janet McMahan’s advocacy, many people in Irwin County and surrounding counties have begun testing their well water for arsenic and other contaminants.

“Janet started it all,’’ says Wanda McLemore, a longtime UGA extension service employee in Fitzgerald before her retirement this year. “She’s brought a lot of awareness to it.”

“Everybody knows Janet,’’ says Betty Metts, 39, who has survived an extremely rare form of breast cancer.

Together, Metts and McMahan take reporters around an area near the Alapaha River in Berrien County where, they say, many residents have had cancers. All are from households that use well water.


Well-known but poorly understood


Arsenic, classed as a heavy metal, is an element that occurs naturally in certain rocks, ores and soils. The amount varies by region.

Ingested in large quantities, arsenic causes severe gastrointestinal illness and death relatively quickly. From ancient times until fairly recently (when advances in science made it more detectable), it was the favorite poison of murderers. Members of the Borgia clan of Renaissance Italy were infamous for using arsenic to dispatch their political enemies.


The South Health District has 10 counties.

Today at least, the greatest danger from arsenic is not homicidal, but environmental.

When the element is present in drinking water, people can ingest small amounts over a long period of time without realizing it. Though the effect is not as swift or dramatic as what happened to the Borgias’ victims, serious health problems can develop.

Arsenic enters drinking water supplies from natural deposits in the ground or from agricultural and industrial practices, according to the EPA. It does not affect the taste of the water.

According to a fact sheet prepared by the National Institute of Environmental Health Sciences (NIEHS), arsenic is a known human carcinogen associated with skin, lung and bladder cancer, and it has also been connected with kidney and liver cancer. The fact sheet adds that ingesting arsenic can also predispose children to other health problems later in life.

The U.S. government has put limits on how much of this toxic element is allowable in drinking water. The maximum level of inorganic arsenic permitted is 10 parts per billion (ppb). But while public water systems are routinely tested for it, there are no regulations that mandate testing of water from private wells.

Approximately 7 percent of wells in the nation are thought to have arsenic levels above 10 ppb, NIEHS says.

No Georgia or federal regulations govern wells that have fewer than 15 connections (water meters) serving fewer than 25 people. Owners of these wells are under no obligation to check the water for harmful bacteria or minerals.

Given that situation, most people who rely on these private wells “don’t know what they’re drinking,” the head of the University of Georgia’s water-testing laboratory, Uttam Saha, told GHN earlier this year.

A basic water test picks up most common problems affecting private wells. But homeowners can ask for broader testing to detect bacterial contamination or heavy metals. “You should ask for arsenic tests in South Georgia,’’ Rustin of Public Health says.

The arsenic in South Georgia’s water is linked to the Gulf Trough, a natural deposit of sediment underneath the Floridan aquifer that runs from the Florida Panhandle through South Georgia. It slashes straight through the health district that includes Irwin County.

Aside from a few outliers, most water samples that tested higher than the federal limit for arsenic came to the University of Georgia’s testing lab from wells along the Gulf Trough.


Thomas County water study


In 2011, a Thomas County resident told state officials that arsenic concentrations in private drinking water wells in that area exceeded federal standards. The Department of Public Health followed up with a study.

“The resident described health problems and reported that neighbors have health complaints they think may be a result of arsenic exposure, including cancer, weight loss, difficulty swallowing, night blindness, fatigue, hair loss, stomach, kidney and bladder problems, and sick pets,” said a 2012 report written by Jane Perry, director of Public Health’s chemical hazards program.

Thomas County

Thomas County

The University of Georgia Cooperative Extension analyzed 36 private water samples from Thomas County for arsenic. Twenty-five tested positive, and 18 exceeded the maximum level of 10 ppb. The report noted that the rates for several types of cancer were elevated in Thomas County.

As McMahan and others note, arsenic is sometimes used in agriculture, where it can seep into the water supply. (Agriculture is the main business in much of South Georgia.) The EPA says high arsenic levels can come from certain fertilizers and animal feeding operations.

U.S. poultry farmers were allowed for years to feed their chickens an antibiotic called roxarsone, which contains arsenic. The drug was pulled from the U.S. market in 2011. American companies can still use a different arsenic-containing drug, nitarsone, to protect turkeys and other poultry from deadly infections.

Litter is a mixture that includes manure, feathers and other materials from where poultry are kept. Farmers often choose it as a cheap and effective fertilizer. But litter from chickens that have ingested arsenic-containing drugs can retain arsenic, a UGA Extension Service report says.

Wells that have been tested in agricultural areas more often contain trace elements such as arsenic than did those in urban areas, the U.S. Geological Survey reported in 2011.

And in Southern states, including Georgia, farmers would dip their cattle in large vats containing arsenic to ward off pests, up till the 1960s.

When arsenic seeps into the ground, it doesn’t break down or decay over time.

Buying more time


Ben McMahan’s cancer was very unusual, his father says.

“Nobody in their 20s has this,’’ says Dr. McMahan. “He was very healthy — never had a health problem,’’ he adds.

(A decade earlier, Dr. McMahan says, he had noticed some strange esophageal cancers among his patients.)

Ben received treatment at Memorial Sloan Kettering Cancer Center in New York, where surgeons removed most of his esophagus, the top third of his stomach, and lymph nodes in his chest.

“He had a tremendous response,” and his health improved, Dr. McMahan says. The next year, Ben had 10 inches of his colon removed at Sloan Kettering.

Then, in 2012, Ben had a recurrence. He took chemo again. He had surgery on his colon, again at Sloan Kettering.

“They couldn’t find the tumor anywhere,’’ Janet McMahan says.

Again, Ben recovered.


Spreading the word


Public Health officials and extension agents in Georgia have sent out advisories about arsenic and well water since 2011. David Kissel, head of the Agricultural and Environmental Services Laboratories at UGA, sent county extension agents an email about high levels of arsenic (and uranium) in some well water samples. The arsenic samples “were widely distributed geographically in Camden, Irwin, Tift, Bibb and Lowndes counties,” he said in the email.

“It is not our intent to alarm the public,’’ Kissel said, but his message urged agents to “encourage more testing of private wells used for drinking water.”

When Ben McMahan was battling cancer in 2012, Perry of Public Health sent his mother an email that said, in part: “The drought concentrates the levels of arsenic in groundwater.

The two McMahan dogs that developed cancer.

The two McMahan dogs that developed cancer.

“The levels of arsenic are high enough to increase the risk of cancer in south Georgia and we are seeing statistically significant rates of some arsenic associated cancer types in some counties; e.g., lung. . . . But as you know, it is very difficult to prove a cancer cluster, and even harder [to prove] that it might be caused by this or any other environmental exposure. Arsenic is the most complex chemical, in that it causes several different cancers. Most chemicals are organ system specific. However, I am impatient to get the word out too so that people reduce, eliminate exposure, and that those who haven’t tested, do so.”

The agency last year sent out an advisory for people in 10 South Georgia counties to test their well water for arsenic. It sent out another advisory this year.

But Rustin of Public Health, in an email to Georgia Health News on Friday, said that at this time, his agency cannot attribute cancer cases in Georgia to arsenic exposure. “It is important to note while the study indicates elevated incidence of some forms of cancer, they are not cancers typically associated with arsenic exposure.’’

Yet the Thomas County study found elevated levels of lung cancer for males from 2005 to 2009. That’s a type of cancer associated with arsenic.

Arsenic is not easily absorbed by the skin, and does not “stick” easily to hard surfaces (such as dishes) or clothing, so cleaning, laundering, brushing teeth, and bathing are not considered routes of exposure, Rustin added.


Smoking gun is elusive


High cancer rates have been found in the 10-county district that includes Irwin County. The rate of bladder cancer, which can be associated with arsenic, is slightly higher than the state average in four of the 10 counties: Lowndes, Ben Hill, Tift and Turner, according to the National Cancer Institute.

For Georgia as a whole, 18.6 people per 100,000 will be diagnosed with bladder cancer each year.

In the four counties mentioned above, annual incidence rates ranged from 20.4 to 20.8. In the other six counties of the district, the likelihood of being diagnosed was either negligible or no different from the rest of the state.

Irwin County

Irwin County

People living in the 10-county area are also more likely to be diagnosed with lung cancer, another tumor associated with arsenic. Each year, 81.6 new cases of lung cancer will be diagnosed for every 100,000 people, which is significantly higher than the state average of 71 new cases per 100,000.

There’s a competing explanation for this, however: South Georgia generally has higher rates of smoking than other areas of the state, and smoking is the top cause of lung cancer.

Yet an Irwin County nurse who worked with an area hospice says she recalls four people who did not smoke but had lung cancer. “All of them were on well water,’’ says Crystal Brown of Irwinville, who gets water from a well herself. “I have children, and it definitely concerns me.”

The incidence of skin cancers, another common malignancy associated with arsenic, is statistically insignificant throughout most of the counties in the district, according to the National Cancer Institute.

Carcinogens can be identified in an area’s water, but it is very difficult, if not impossible, to determine whether a specific case of cancer is directly attributable to a water source.

Cancer clusters are also notoriously difficult to identify. In a true cluster, according to the CDC, a greater-than-expected number of cancer cases must hit within a specific period of time. Each case must either be the same type, or derived from the same cause.

One problem with establishing direct causation is that cancer is all too common. As the CDC points out, it is the second-leading cause of death in the United States. Nationwide, one out of four deaths are due to some type of cancer.

Since 1990, state and local health agencies around the nation receive about 1,000 inquiries each year from people wondering if deaths in a particular locality constitute a cancer cluster. Very few of these reports qualified as true clusters.

Still, McLemore, the longtime UGA extension service employee in Fitzgerald, says the area surrounding Irwin County has “an awful lot of cancers.”

“Clean and safe drinking water is essential to a healthy environment,’’ says Stephanie Stuckey Benfield, executive director of GreenLaw, nonprofit law firm that works to reduce pollution. “Many Georgians depend on private wells as their primary source for drinking water. Arsenic in well waters can be a health concern, as long-term exposure above the EPA limit increases the risk of some types of cancer.”


Water heater debate


Janet McMahan’s emphasis on water heater samples has raised skepticism among some water experts.

“You’re supposed to drink cool water and cook with cool water,” says Jake Mowrer of the Agricultural and Environmental Services Lab of UGA. “You don’t drink from the hot water heater.”

Sediment from the house’s water pipes builds up inside the tank over time – and since it’s not cleaned out regularly, trace amounts of minerals can accumulate into thick piles, he says.

“Given that drinking hot water heater water is not recommended and that no person would be expected to quaff back a huge Mason jar of orange water, common sense tells me that this water is not representative of what the well owners are actually drinking,” Mowrer adds.

The lab uses a special filtering process for water heater samples, he says.

McMahan argues that arsenic builds up in a water heater like it builds up in a human body.

She takes reporters to a rural area in Ben Hill County where four children were diagnosed with cancer within nine months back in 2008. Each was within a 6-mile radius of the others, and all drank well water, McMahan says. She believes that a severe drought during that period elevated arsenic levels in the water. Two of the children had acute lymphoblastic leukemia, while the other two had different forms of cancer, she says. All four are alive today.

Gage Kicklighter is one of the four. Nicole Kicklighter thinks her son’s cancer was caused at least partly by well water he drank. She admiringly calls Janet McMahan “the water lady.”

A survey conducted by UGA researchers found that Georgia had about 648,000 private wells in 2012. The Soil, Plant and Water Testing Lab receives samples from about 23,000 of those wells every year, or roughly 3.5 percent.

High levels of uranium — a naturally occurring element found at low concentrations in virtually all rock, soil, and water — were recently detected in Monroe County well water. This is a public health concern because drinking water with elevated uranium increases the risk for kidney malfunction.

(Thanks to a federal loan of close to $2 million, Monroe County will finally be able to provide water to the area where many home wells are polluted by uranium, the Macon Telegraph reported Saturday.)

At UGA's Soil, Plant and Water Lab (SPW),  tests determine how much coliform bacteria are in each sample. Each cell in this tray contains E. coli, the most dangerous type of coliform.

Well water can also contain dangerous bacteria. At UGA’s Soil, Plant and Water Lab (SPW), each cell in this tray contains E. coli, the most dangerous type of coliform bacteria.


Public Health officials urge Georgians to test their well water once a year for bacterial contaminants, and every three years for minerals such as arsenic.

Water tests are fairly cheap – $15 for the basic test, $30 for the bacteria test – and highly accurate.

McMahan preaches the use of water filters to eliminate contaminants in household water. She buys such filters “for little old ladies and for kids.”


Grief redoubles resolve

Since Ben’s illness began, Janet McMahan has been an evangelist for water testing.

She has a Facebook group that has topped out at 5,000 friends. “About 1,000 are moms of kids with cancer; about 1,000 have cancer; and about 1,000 have a family member with cancer.”

Janet McMahan with a photo of her son Ben.

Janet McMahan with a photo of her son Ben.


Ben McMahan’s cancer came back again in January 2013. This time it was inoperable. And by that point, his body couldn’t tolerate more chemo.

A third recovery was not possible. But though doctors gave him two to six months to live, Ben lived for 14 more months. He died in April at age 28.

His death has spurred Janet McMahan onward. She is a one-woman clearinghouse for people with possible water contamination or other environmental health problems in Georgia.

She has met Erin Brockovich, whose crusade against contaminated water in California was the basis for a hit movie.

On the importance of testing water and using filters, McMahan says, “I hammer, hammer, hammer it.”

“I have this bulldog tenacity,’’ she adds. “When I take on something like this, I can’t let it go.

“This is how I keep Ben’s story alive.”


Lee Adcock is a master’s degree health and medical journalism student at the University of Georgia. She is also a music critic for various media outlets.


Lee Adcock is a first-year health and medical journalism student at the University of Georgia. She is also a music critic for various media outlets.

– See more at:

Lee Adcock is a first-year health and medical journalism student at the University of Georgia. She is also a music critic for various media outlets. – See more at:
Lee Adcock is a first-year health and medical journalism student at the University of Georgia. She is also a music critic for various media outlets. – See more at:


The Medicaid pay raise: Doctors finally got it, but soon may lose it

Dr. Evelyn Johnson examines a patient in her Brunswick office.

Dr. Evelyn Johnson examines a patient in her Brunswick office.

Dr. Samuel Church is among Georgia physicians who received their first pay raise in more than a decade this year for treating Medicaid patients.

The extra money gave a financial boost to Church, a family medicine doctor with a solo practice in the mountain town of Hiawassee.

With the increased reimbursement, he says, “I can cover the [office] overhead and a little more. . . . We’re already operating at narrow profit margins as it is.”

That Medicaid pay increase, though, will disappear in January if the budget recommendation from the Georgia Department of Community Health to the governor and Legislature holds up during the state’s budget process.

The proposal approved by the Community Health board last week for this fiscal year and next did not include what experts estimate as $50 million to $70 million in annual state funding to extend the pay hike for primary care doctors treating Medicaid patients.

Currently, the pay raise is being funded entirely by the federal government, as a provision of the Affordable Care Act, bringing doctors’ pay for Medicaid up to the level of Medicare.

The additional reimbursement, which goes to family physicians, pediatricians and internists, is scheduled to run out at the end of December.

Doctors say if that cutoff happens, Georgia’s poor will find it harder to find a physician to treat them. Roughly 60 percent of Georgia physicians currently accept Medicaid patients.

A spokeswoman for Gov. Nathan Deal, Sasha Dlugolenski, said in an email to GHN on Thursday, “The governor will be developing his budget recommendations throughout the fall and is aware of this issue – one of the early, blatantly obvious examples of Obamacare unloading costs onto the states. This was a short-term Band-Aid to a long-term problem, and now the states are left holding the bag.”

Sen. Judson Hill (R-Marietta) told the AJC that he supports compensating doctors fully for treating Medicare and Medicaid patients. But he told the newspaper that he is opposed to the state “being forced’’ to picking up the entire cost of maintaining the pay increase.


Taking new patients


For Church, going back to the former pay rate would be a big setback.

The area around Hiawassee, in the scenic Blue Ridge Mountains near North Carolina, gets its main revenue from tourism. But the population base is small, and many residents have low incomes. The area has a severe physician shortage, Church says, and roughly 30 percent of his patients are Medicaid beneficiaries.

Dr. Samuel Church with a patient in his Hiawassee practice.

Dr. Samuel Church with a patient in his Hiawassee practice.

“It’s really scary,’’ says Church. “You have to be able to pay staff and overhead” to keep a practice going.

Recently, two physicians moved out of the area, he notes. “I’m the only doctor taking new patients in the community.”

Inadequate payment, Church says, “makes it difficult for new providers to choose service to vulnerable groups, even if their heart is there.”

The federal health law required that the raise be paid for two years, 2013 and 2014.

But the money didn’t arrive till this year. Eligible doctors received the pay hike retroactively, back to Jan. 1, 2013. Delays in the payments occurred in many states, including Georgia, that use managed care in their Medicaid programs.

A Kaiser Family Foundation study estimated in 2012 that the increase in Georgia’s Medicaid payment rate for doctors would be 48 percent.

A handful of states have announced they will continue to pay the higher rate in 2015, out of their own budgets. The six states include Alabama and Mississippi, according to a recent Kaiser Health News article.

The Medical Association of Georgia says it’s studying the impact of the loss of the extra pay in terms of physician participation in Medicaid. When fewer doctors participate in Medicaid, fewer patients have access to care.


Hard choices for physicians


Dr. Evelyn Johnson, a Brunswick pediatrician, says losing the pay hike would be devastating for physician practices.

A large majority of her patients in Georgia’s coastal region are on Medicaid. Johnson, president of the Georgia chapter of the American Academy of Pediatrics, says if the pay reverts to the former rate, “I wouldn’t be able to take new Medicaid patients.”

“I’m trained to serve the underserved,’’ Johnson says. But she adds, “There are only so many patients I can see in a day. If kids can’t get into a doctor to be seen, they will wind up in urgent care or the emergency room,” which will run up higher costs for the state.

Many physicians don’t take Medicaid patients, or limit the number they will take, notes Johnson, a solo practitioner.

Extending the pay raise “is the right thing to do,’’ Johnson says. Children, who make up the majority of Georgia’s Medicaid beneficiaries, need the medical foundation that pediatricians provide, she adds.

For Dr. Michael Satchell, an Albany family physician, the pay raise “has been instrumental in accepting more Medicaid patients in my practice.”

It has allowed him to hire a nurse practitioner and a medical assistant. “Before that, what I was paid wasn’t covering my overhead,” Satchell says.

If the state doesn’t act to preserve the current rate, patients will find access to care more difficult, he says, with “fewer providers to choose from.”

Home cooking: Schools put new emphasis on locally grown lunches

Chef Josh Aaron (far left) and Debbie Morris (far right) prepare the salad with food service manager Debra Patton.

Josh Aaron  and Debra Morris (far right) prepare salad with food service manager Debra Patton.

Fresh, locally grown fruits, vegetables and meats are the emerging stars of school menus across Georgia.

“Farm to school [programs] and bringing local foods into the school has been increasingly popular over the last couple of years,” said Nancy Rice, state director of the Department of Education’s school nutrition division.

Some schools purchase produce from nearby farms while school is in session, Rice said, while a few contract with local farmers who freeze summer produce that can be used during the school year.

The Jackson County School System is doing more: Chef Josh Aaron is building special menus around Georgia-grown food. Aaron owns The Savory Spoon restaurant in Jefferson, where diners feast upon fresh and locally sourced ingredients.

On a chilly day in mid-April, all 12 schools in the district served a “Spring Salad with Chicken and Local Lettuces,” featuring Georgia-grown Bibb and Romaine lettuce and fresh chicken. Other ingredients included strawberries from North Florida, apples, Parmesan cheese and Italian dressing.

The chef himself strolled among the lunch tables at North Jackson Elementary School, an imposing but friendly presence.

“I’m there to talk to the kids about local produce and get them interested,” Aaron said. He wants the kids to know more about the food whether they actually like eating it or not.


Push from first lady


Meanwhile, healthy school lunches made national headlines this week, as first lady Michelle Obama vowed to fight industry efforts at rolling back federal standards.

A House bill up for consideration this week by the Appropriations Committee would allow schools to apply for waivers from the federally mandated standards if the school’s food program has recorded a financial loss for six months in a row, the Washington Post reported.

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Mrs. Obama urged health activists to fight agribusiness’s lobbying efforts to allow schools to opt out of the mandates to reduce sodium, increase whole grains, and increase servings of fresh fruits and vegetables in lunches.

In Jackson County, though, Chef Aaron wants to expose children to as many kinds of fruits, vegetables and fresh, unprocessed meats as possible.  If kids broaden their tastes while they’re young, their “number one, go-to” food is less likely to be fried chicken fingers or nuggets, he said.

This is the second Georgia-centered meal the chef has created for local schools. The first featured slow-cooked pulled pork, braised collard greens, and carrots marinated in a citrus vinaigrette. The carrots and the collard greens were harvested in Georgia, and the meal was served to all 12 schools in the Jackson County school system in March.

The goal is for students to know and care where their food comes from and to appreciate “good, wholesome, non-processed foods,” said Debra Morris, nutrition director for the Jackson County School System.

If a child is asked to imagine a carrot, Morris wants them to visualize root vegetables that grow in soil and vary in size and color – not a plastic bag of uniform “baby” carrots milled by machines.

Similar efforts are under way throughout Georgia.


‘Feed My School’


The Georgia Department of Agriculture (GDA) sponsors a program called “Feed My School for a Week,” and schools vie to take part.

Recently announced 2014 participants are Annie Bell Clark Elementary in Tifton, Cave Springs Elementary in Rome, Claxton Elementary in Claxton, Commerce Primary School in Commerce and Mossy Creek Elementary in Cleveland.

For a week next spring, these schools will serve meals made mostly from Georgia-grown ingredients. GDA will help the schools create recipes and get local food. The schools will host guest speakers who will teach students about food and agriculture, and run contests and taste tests.

This 3-year-old program aims to improve the health of Georgia students by changing cafeteria menus and bringing farms and lunchrooms closer by helping schools with Farm to School initiatives.

Farm to School is a nationwide initiative that emphasizes not only buying food from local growers, but also teaching children to raise their own vegetables in school gardens. The Georgia effort is led by Georgia Organics, a nonprofit organization that promotes Georgia farms and locally grown food.

Georgia’s Farm to School program “was a little slow for the first two years back around 2007, but the demand is higher than ever,” said state director Erin Croom.

Only a few schools signed up at first, but when the U.S. Department of Agriculture conducted a national Farm to School census in 2011-2012, more than half of Georgia’s school districts  (52 percent) were on board. Another 19 percent said they might join in the future.

Nationwide, just 43 percent of schools had Farm to School activities during the 2012-2013 school year, and only 13 percent were considering such programs.

Although Georgia’s programs look successful by comparison, they have room to grow. During the 2011–2012 school year, respondents spent close to $10 million on locally grown food, but their overall spending on food was close to $155 million. However, more than half of the schools (66 percent) said they plan to supply their cafeterias with more local food in the future.

Josh Aaron answers questions from students

Josh Aaron answers questions from students at North Jackson Elementary

In Jackson County, chef Aaron’s initiative is gathering momentum. Commerce City Schools have served his two local food menus to their students, and the Jefferson City School System may join next year.

The chef says there is much more work to do, and he doesn’t see his partnership with the schools ending any time soon. His plans include creating more and better menus for kids and a hub where local, certified naturally grown and organic farmers can send their produce for school distribution. Aaron has already spoken with farmers who are interested in supplying the schools, even if they just break even.

“We have a large group of local business [owners] who have a vested interest in these kids’ health and want to do whatever it takes to make them more energetic and successful in the classroom,” Aaron said in an email.

Putting fresh, locally grown food on the menu was just Aaron’s vision a year ago. Now that it’s become reality, he wants to see more fresh food coming down the cafeteria line. “We’re right on the first stepping stones of this work, “ Aaron said. “Now [we’ve] got the next steps to take.”


Hyacinth Empinado is a freelance science writer. She is currently a first-year graduate student in the health and medical journalism program at the University of Georgia.

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