DURHAM, N.C. — Memorial vigils were held across North Carolina last week to honor people who have suffered or died because they lacked health insurance. Creston resident Richard Horodyski said until last year, he hadn't seen a doctor in more than two decades.

Horodyski has worked in construction and owns a small fruit farm. He and his wife are long-time foster parents. He said many foster parents are caring for children with special needs, while not being able to see a doctor themselves.

"It's a stressful thing, especially when you're working with kids with developmental disabilities. That was who we specialized in,” Horodyski said. “After awhile, we realized that a lot of the children we were getting had fetal alcohol syndrome, so we kind of specialized in that. It was really, really hard."

North Carolina is one of 14 states that have chosen not to accept federal dollars for Medicaid expansion. It's estimated that nearly a half million people, mostly uninsured adults, would become eligible for coverage if the state chose to expand the program.

As of 2015, North Carolina had more than 10,000 children in foster care, and the state is struggling to recruit foster parents. There is little data available on the number of foster parents who lack health coverage, but Horodyski thinks having health insurance might make more people inclined to take on the responsibility of raising children.

"You can go county by county and see the demand. They are begging for foster parents and they're trying to do trainings to focus on pulling foster parents into the system,” he said.

An estimated 11% of North Carolinians are uninsured, according to the Henry J. Kaiser Family Foundation. Among adults ages 19-64, an estimated 16% are uninsured.

COVID upended many routines, including Texas parents getting kids in for regularly scheduled childhood vaccines. Data from the Texas Department of State Health Services showed the childhood vaccination rate dropped during the pandemic.

Starting in June, the Hispanic Access Foundation partnered with the U.S. Department of Health and Human Services to bring COVID-19 vaccine clinics to Latino churches in three Texas communities.

Aurie Garcia, secretary of Hope of Life Church of God in Houston, said COVID is still top of mind for many people, but children need protection from a variety of potential illnesses.

"And it's very important to protect the children," Garcia stressed. "Because they go out, they go back to school, so it's very important for them to have the COVID vaccine and the other vaccines."

If you have not kept track of immunization records, they're available from state-run immunization information systems.

A study published in the journal Vaccine found from 2019 to 2020, immunization rates fell 47% among five-month-olds and 58 % among 16-month-olds.

Garcia noted some Hispanic people avoid doctors because they're worried materials won't be available in Spanish and a translator will not be on site. She added it is a way the Hispanic Access Foundation can help.

"We explain to them that we partner with the Health Department in Houston," Garcia remarked. "I am bilingual, I speak Spanish; that's my primary language, and Harris County Department, they also have some of their people that speak Spanish."

Health care providers say many families skipped doctor's visits during the pandemic to avoid exposure to the COVID virus. Other parents do not immunize children for religious reasons, and still others are worried about potential health problems associated with some vaccines, although the risks are reported to be extremely small.

A popular fishing site on the Columbia River for members of the Yakama Nation has been listed as Superfund site by the federal government.

Now comes the hard part.

Toxins near Bonneville Dam at a place called Bradford Island prompted the U.S. Environmental Protection Agency to put the area on the National Priority List in March.

Laura Klasner Shira, environmental engineer for Yakama Nation Fisheries, said the area near Bradford Island is a toxic soup for resident fish, with chemicals like PCBs among the most hazardous.

"The take-home when you start to look at all the individual effects of each of these chemicals or chemical groups is that it really affects multiple systems, it affects multiple organs, it can cause cancer," Shira outlined. "It's especially harmful to small children, fetuses and immune and thyroid-compromised persons."

The U.S. Army Corps of Engineers dumped electronics near the island for decades, leading to the current toxic situation. People are advised not to eat nonmigratory fish up to a mile from the dam. Today at noon, Columbia Riverkeeper is hosting a webinar, featuring Shira and speakers from the EPA and the Corps of Engineers, on what Bradford Island's Superfund listing means for the region.

Shira pointed out the Yakama Nation took the lead in calling for Bradford Island to be placed on the National Priority List with the states of Oregon and Washington backing up those calls.

"It was very important to have NPL listing because we thought it could lead to a more protective cleanup," Shira explained. "But we also realized that with NPL listing, it's going to require a lot of work still."

Shira stressed despite their leadership, the Yakama Nation has been cut out of recent discussions on cleanup. The Corps of Engineers said the process has to go through regulators first, including the states, the EPA and Corps, but is inviting the public to be involved later. She added it is discouraging because it is an ancestral site for tribal members, where fishing has gone on since time immemorial.

Shira also noted fishing continues there, making cleanup a pressing issue.

"A lot of members aren't going to change their diets because of a fish advisory," Shira asserted, "Or they might accidentally catch a resident fish and their culture teaches them that every fish is a gift from the creator."

A pilot program launched by the Todd County School District and the county's local health department offers free mental-health case-management services to all public-school students.

Abby Dill, Axis program supervisor for the Todd County Health Department, said anxiety, depression and self-harm are on the rise among Kentucky youths. She explained there are not enough therapists and counselors in rural communities to meet the growing need, and said in the aftermath of the pandemic, students are struggling with emotional well-being.

"Doing a case-management model allowed us to do a needs assessment," Dill pointed out. "And really provide wraparound services and work with people in our rural community to tap into services that existed and see where service gaps existed, so we could build on those within our program."

Research from the Annie E. Casey Foundation shows the state saw a 28% increase in children's anxiety or depression between 2016 and 2020. And recent data shows more than one in seven Kentucky high school students reported having seriously considered suicide. If you or someone you know is experiencing a mental-health crisis, contact the national Suicide and Crisis hotline by calling or texting 988 to get help from a trained crisis counselor.

Mark Thomas, superintendent of the Todd County Public School District, said the Axis program also helps students access food, clothing, housing and transportation, and substance-abuse treatment.

"It's one of those ideas of 'it takes a village to raise a child.' We incorporate that," Thomas emphasized. "And then we also think of ourselves as a family. We're all one big family looking out for the best interests of each other, not just our children, but also with our staff."

Allison Adams, vice president for policy at the Foundation for a Healthy Kentucky, said Thomas was recently recognized for his efforts with a Kentucky Healthy Champions Award. She added across the state, individuals are coming up with solutions to improve their communities.

"There's opportunities to lift up people in your communities who are working to influence health," Adams stressed. "Think about who that person is in your community and consider nominating them for the Healthy Kentucky champion class of 2023."