FRANCONIA, N.H. (AP) — For more than two decades, residents in this tiny tourist town in the shadow of the White Mountains knew they could just drive a few minutes down the road to their community health center for a physical, a Vitamin B-12 shot or to get checked out for a case of the sniffles or high blood pressure.
Employees at Ammonoosuc Community Health Services pack up the reception office as the clinic closes for good, Thursday, Oct. 23, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Employees at Ammonoosuc Community Health Services pack up the reception office as the clinic closes for good, Thursday, Oct. 23, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
The Franconia Range of the White Mountains dominates the landscape, Wednesday, Oct. 22, 2025, in Sugar Hill, N.H. (AP Photo/Robert F. Bukaty)
The Franconia Range of the White Mountains dominates the landscape, Wednesday, Oct. 22, 2025, in Sugar Hill, N.H. (AP Photo/Robert F. Bukaty)
The nearly 1,400 patients, who are often older and with more health problems than others in New Hampshire, will have to drive farther for their health care — a tricky prospect for some, especially during the winter months. More importantly, they will lose the close-knit bonds they forged with staffers like Diane LaDuke, who greets everyone with a smile from her perch at the front desk.
Marsha Luce, a patient at Ammonoosuc Community Health Services, delivers food to a Head Start program, Thursday, Oct. 23, 2025, in Littleton, N.H. (AP Photo/Robert F. Bukaty)
Marsha Luce, a patient at Ammonoosuc Community Health Services, delivers food to a Head Start program, Thursday, Oct. 23, 2025, in Littleton, N.H. (AP Photo/Robert F. Bukaty)
Marsha Luce, a patient at Ammonoosuc Community Health Services, wears a mask to avoid spreading her cold while volunteering at a local church, Wednesday, Oct. 22, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Marsha Luce, a patient at Ammonoosuc Community Health Services, wears a mask to avoid spreading her cold while volunteering at a local church, Wednesday, Oct. 22, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Marsha Luce, left, a patient at Ammonoosuc Community Health Services clinic, speaks with a friend while doing volunteer work at a community church food pantry, Wednesday, Oct. 22, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Marsha Luce, left, a patient at Ammonoosuc Community Health Services clinic, speaks with a friend while doing volunteer work at a community church food pantry, Wednesday, Oct. 22, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Marsha, left, and Kirk Luce, both patients at Ammonoosuc Community Health Services, prepare dinner, Thursday, Oct. 23, 2025, at their home in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Marsha, left, and Kirk Luce, both patients at Ammonoosuc Community Health Services, prepare dinner, Thursday, Oct. 23, 2025, at their home in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Town Hall stands behind a pair of colorful maple trees, Wednesday, Oct. 22, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Town Hall stands behind a pair of colorful maple trees, Wednesday, Oct. 22, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
On the center’s last day, longtime patient Susan Bushby, a 70-year-old housekeeper, stopped by to check her blood pressure — and to get a hug from LaDuke. Bushby had come to rely on LaDuke’s comforting words over the years and admits she is worried about finding the same kind of reception when she goes to one of Ammonoosuc’s other centers.
Susan Bushby, right, a patient at Ammonoosuc Community Health Services, and her son, Steven, sit in their home, Tuesday, Oct. 21, 2025, in Lisbon, N.H. (AP Photo/Robert F. Bukaty)
Susan Bushby, right, a patient at Ammonoosuc Community Health Services, and her son, Steven, sit in their home, Tuesday, Oct. 21, 2025, in Lisbon, N.H. (AP Photo/Robert F. Bukaty)
“I just really like it there. I don’t know, I’m just really going to miss it. It’s really hard for me to explain, but it’s going to be sad,” Bushby said.
Susan Bushby, a patient at Ammonoosuc Community Health Services, lights a cigarette at her home, Tuesday, Oct. 21, 2025, in Lisbon, N.H. (AP Photo/Robert F. Bukaty)
Susan Bushby, a patient at Ammonoosuc Community Health Services, lights a cigarette at her home, Tuesday, Oct. 21, 2025, in Lisbon, N.H. (AP Photo/Robert F. Bukaty)
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Exhausted from working several weeks straight at a nearby inn, Bushby was talking about the center as she relaxed on her couch at her modest home in Lisbon. She often ends her day with cigarette and a glass of champagne. An avid angler, Bushby’s house was filled with photos and other Native American memorabilia and her dog Smiley was a constant presence.
A fisherman casts for trout at Pearl Lake, Tuesday, Oct. 21, 2025, in Lisbon, N.H. (AP Photo/Robert F. Bukaty)
A fisherman casts for trout at Pearl Lake, Tuesday, Oct. 21, 2025, in Lisbon, N.H. (AP Photo/Robert F. Bukaty)
Susan Bushby, a patient at the Ammonoosuc Community Health Services, offers an apple to deer passing through her backyard, Tuesday, Oct. 21, 2025, in Lisbon, N.H. (AP Photo/Robert F. Bukaty)
Susan Bushby, a patient at the Ammonoosuc Community Health Services, offers an apple to deer passing through her backyard, Tuesday, Oct. 21, 2025, in Lisbon, N.H. (AP Photo/Robert F. Bukaty)
As she talked about the center closing, Bushby had a basket of apples on the kitchen counter ready for the deer that show up in her backyard almost every day. She joked that the center’s doctor, Dr. Melissa Buddensee, doubles as her therapist at times because she “listens to her where other people don’t.”
For another patient, Marsha Luce, it’s mostly about ensuring her husband gets the kind of care he had come to rely on over the years. Recovering from cancer that resulted in him losing part of his left ear and jaw, Luce worries about longer waits to see his doctor and the loss of relationships built up over decades in Franconia.
Susan Bushby is weighed during an appointment at Ammonoosuc Community Health Services, Tuesday, Oct. 21, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Susan Bushby is weighed during an appointment at Ammonoosuc Community Health Services, Tuesday, Oct. 21, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Receptionist Diane LaDuke, right, shares a laugh with longtime patient Susan Bushby at Ammonoosuc Community Health Services, Tuesday, Oct. 21, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Receptionist Diane LaDuke, right, shares a laugh with longtime patient Susan Bushby at Ammonoosuc Community Health Services, Tuesday, Oct. 21, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Susan Bushby looks at her medical paperwork after an appointment at Ammonoosuc Community Health Services, Tuesday, Oct. 21, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
Susan Bushby looks at her medical paperwork after an appointment at Ammonoosuc Community Health Services, Tuesday, Oct. 21, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
The family, who moved to Franconia about 25 years ago, live in an old farmhouse that they renovated. Much of Luce’s time is spent caring for her husband, including keeping track of his appointment dates and all the various medications he needs to take. She also is a regular presence in the community, playing mahjong weekly with friends at the library and volunteering with the Head Start program.
Having to switch to another health center, she said, puts at risk the trust she and her husband have built up over the years at Ammonoosuc.
An exam table is moved onto a trailer on the final day of operation at Ammonoosuc Community Health Services as the clinic closes for good, Thursday, Oct. 23, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
An exam table is moved onto a trailer on the final day of operation at Ammonoosuc Community Health Services as the clinic closes for good, Thursday, Oct. 23, 2025, in Franconia, N.H. (AP Photo/Robert F. Bukaty)
“It’s going to be hard,” said Luce, who was wearing a mask because she had a cold. “It’s a relationship that you can talk to people and you tell them something and you go, yeah, well, I’ve had cancer. Oh, let’s see. Oh, yeah. There it is in your chart. Do you know what I mean?”
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This is a documentary photo story curated by AP photo editors.
CLARYVILLE, N.Y. (AP) — Autoimmune diseases like lupus, myositis and forms of arthritis can strike children, too. At a sleepaway camp in upstate New York, some young patients got a chance to just be kids.
That’s how a 12-year-old recently diagnosed with lupus found himself laughing on a high-ropes course as fellow campers hoisted him into the air.
“It’s really fun,” said Dylan Aristy Mota, thrilled he was offered this rite of childhood along with the reassurance that doctors were on site. If “anything else pops up, they can catch it faster than if we had to wait til we got home.”
Nicholas Toska, 11, center, of Harrison, N.Y., who has juvenile idiopathic arthritis, waters a garden with fellow campers at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Nicholas Toska, 11, center, of Harrison, N.Y., who has juvenile idiopathic arthritis, waters a garden with fellow campers at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Ethan Blanchfield-Killeen, 11, of Yonkers, N.Y., who has a form of juvenile idiopathic arthritis, plays a game of paint tag at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Ethan Blanchfield-Killeen, 11, of Yonkers, N.Y., who has a form of juvenile idiopathic arthritis, plays a game of paint tag at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Nicholas Toska, 11, center, of Harrison, N.Y., who has juvenile idiopathic arthritis, plays cards with fellow campers at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Nicholas Toska, 11, center, of Harrison, N.Y., who has juvenile idiopathic arthritis, plays cards with fellow campers at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Autoimmune diseases occur when your immune system attacks your body instead of protecting it. With the exception of Type 1 diabetes, they’re more rare in kids than adults.
“It’s very important that people know that these diseases exist and it can happen in kids and it can cause significant disabilities,” said Dr. Natalia Vasquez-Canizares, a pediatric rheumatologist at Children’s Hospital at Montefiore in New York.
When symptoms begin early in life, especially before puberty, they can be more severe. Treating growing bodies also is challenging.
Montefiore partnered with Frost Valley YMCA to bring several children with autoimmune diseases to a traditional sleepaway camp, after reassuring parents that doctors would be on hand to ensure the kids take their medicines and to handle any symptom flares.
Dr. Natalia Vasquez-Canizares, left, examines camper Dylan Aristy Mota, 12, of New York City, who has lupus, at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
Dr. Natalia Vasquez-Canizares, left, examines camper Dylan Aristy Mota, 12, of New York City, who has lupus, at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
Dr. Natalia Vasquez-Canizares, right, examines Ethan Blanchfield-Killeen, 11, of Yonkers, N.Y., who has a form of juvenile idiopathic arthritis, at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
Dr. Natalia Vasquez-Canizares, right, examines Ethan Blanchfield-Killeen, 11, of Yonkers, N.Y., who has a form of juvenile idiopathic arthritis, at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
“Their disease impacts how they can participate and a lot of the time the parents are just very nervous to send them to a summer camp,” Vasquez-Canizares said.
Ethan Blanchfield-Killeen, 11, has a form of juvenile idiopathic arthritis, causing joint pain and stiffness and “my legs get, like, sleepy.”
But at camp, Ethan said he’s mostly forgetting his illness. “The only time I get pain is like when I’m on long walks, my legs start getting stiff, and then I kind of feel pain, like achy.”
One day a doctor examined his hands at camp. Another day, he was running across the lawn splattered in a fierce game of paint tag.
Ethan Blanchfield-Killeen, 11, of Yonkers, N.Y., who has a form of juvenile idiopathic arthritis, takes his medication at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
Ethan Blanchfield-Killeen, 11, of Yonkers, N.Y., who has a form of juvenile idiopathic arthritis, takes his medication at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
Dylan Aristy Mota, 12, left, and Ethan Blanchfield-Killeen, right, 11, play a game with Nurse Mary Ramos ahead of their examination at the wellness center at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
Dylan Aristy Mota, 12, left, and Ethan Blanchfield-Killeen, right, 11, play a game with Nurse Mary Ramos ahead of their examination at the wellness center at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
Ethan Blanchfield-Killeen, 11, of Yonkers, N.Y., who has a form of juvenile idiopathic arthritis, plays a card game with bunkmates at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
Ethan Blanchfield-Killeen, 11, of Yonkers, N.Y., who has a form of juvenile idiopathic arthritis, plays a card game with bunkmates at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
Dylan Aristy Mota, 12, of New York City, who has lupus, second from left, and fellow campers take shelter from the rain at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
Dylan Aristy Mota, 12, of New York City, who has lupus, second from left, and fellow campers take shelter from the rain at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
Dylan Aristy Mota, 12, of New York City, who has lupus, poses for a photograph at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
Dylan Aristy Mota, 12, of New York City, who has lupus, poses for a photograph at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Thursday, July 31, 2025. (AP Photo/Matt Rourke)
“It’s really nice just doing the special activities and just messing around with your friends and all day just having a blast.”
To the doctor, forgetting their chronic disease for a little bit was the point.
“They blend perfectly with the other kids,” Vasquez-Canizares said. “You can just see them smiling, running, like any other normal child.”
Campers run to the waterfront for an evening swim at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Campers run to the waterfront for an evening swim at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Dylan Aristy Mota, 12, of New York City, center, who has lupus, splashes in the water during an evening swim at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Dylan Aristy Mota, 12, of New York City, center, who has lupus, splashes in the water during an evening swim at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Dylan Aristy Mota, 12, of New York City, who has lupus, swims at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Dylan Aristy Mota, 12, of New York City, who has lupus, swims at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Nicholas Toska, 11, center, of Harrison, N.Y., who has juvenile idiopathic arthritis, reaches for a ball at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Nicholas Toska, 11, center, of Harrison, N.Y., who has juvenile idiopathic arthritis, reaches for a ball at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Campers take an evening swim at the Frost Valley YMCA, which partnered with Children’s Hospital at Montefiore so kids with autoimmune diseases could attend the sleepaway camp for the first time, in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Campers take an evening swim at the Frost Valley YMCA, which partnered with Children’s Hospital at Montefiore so kids with autoimmune diseases could attend the sleepaway camp for the first time, in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Dylan Aristy Mota, 12, of New York City, who has lupus, stands at the water’s edge during a headcount following an evening swim at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Dylan Aristy Mota, 12, of New York City, who has lupus, stands at the water’s edge during a headcount following an evening swim at the Frost Valley YMCA sleepaway camp in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Campers walk to their bunks after an evening swim, at the Frost Valley YMCA, which partnered with Children’s Hospital at Montefiore so kids with autoimmune diseases could attend the sleepaway camp for the first time, in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
Campers walk to their bunks after an evening swim, at the Frost Valley YMCA, which partnered with Children’s Hospital at Montefiore so kids with autoimmune diseases could attend the sleepaway camp for the first time, in Claryville, N.Y., Wednesday, July 30, 2025. (AP Photo/Matt Rourke)
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Neergaard reported from Washington.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
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This is a documentary photo story curated by AP photo editors.
