Swine Flu and the Rubber Meets The Road

When a novel infectious disease makes its presence known, the public health infrastructure swings into action. Now, with the rapid emergence of swine flu in a number of countries around the world, this is a prime example of where the public health rubber meets the road.

Today, the World Health Organization raised the pandemic level for swine flu to Phase 4, meaning that there is now documented human-to-human transmission of a virus "able to sustain community-wide outbreaks". The WHO pandemic classification uses a scale of 1 to 6, with a rating of 6 signifying a global pandemic, a potential that officials are quick to say may or may not occur.

While no one in the United States has yet died from swine flu infection, the public health community takes the situation seriously, especially in light of the rising death toll in Mexico, and the emergence of disease in Spain, Scotland and Canada. in Queens, New York, a number of children who traveled to Mexico over spring vacation have been officially diagnosed with swine flu, and there are reports of school closings in various parts of the country.

Today, conference calls were scheduled by the CDC, state departments of public health, and other major players in the public health and emergency preparedness arenas.

Since I just recently attended the Integrated Medical, Public Health, Preparedness and Response Training Summit in Dallas last month, I am acutely aware of how the CDC's Strategic National Stockpile figures largely into the response to just this type of public health emergency, and word has it that large amounts of stockpiled antiviral medications are at the ready if mass prophyaxis of the population is needed.

I am duly impressed by the rapid response of the CDC, FEMA and other important agencies involved in the effort vis-a-vis the swine flu outbreak, and we are ready to activate our local Medical Reserve Corps chapter if emergency dispensing of medications or other municipal response is needed.

Speaking of the Medical Reserve Corps, this swine flu outbreak is yet another example of why we need more medical (and non-medical) volunteers to join their local chapters. The MRC is an important part of the public health and emergency response infrastructure, and having a network of thousands of screened, vetted and trained volunteers ready to be mobilized across the country to assist in the response to these types of situations is crucial to protecting local, regional and national responders from being overwhelmed in the case of a surge of need on the part of the public.

For up-to-date information on the outbreak, visit the CDC's Swine Flu Website. This is not a tie for panic, yet it is also a time for vigilance, good hygeine and handwashing, and a circumspectful caution vis-a-vis individuals who exhibit any signs of flu-like illness. Medical providers are receiving detailed information regarding the epidemiology, symptoms and treatment of swine flu. Any individual with flu-like symptoms should refrain from going to work, school or other public places. Such individuals should absolutely wear a mask when in public, and should visit a medical provider as soon as possible.

As a local public health official, I am watching this situation carefully along with my colleagues, and we are in frequent communication with our state department of public health, our local schools, area colleges, and other partner agencies.

The public health infrastructure is indeed in full swing, and I am currently swept up in the rising tide of surveillance as the outbreak widens and deepens.

World Malaria Day

Today, April 25th, is World Malaria Day, and according to the official website, there are currently 109 malarious countries in four regions of the world. Established goals have set December 31st, 2010 as the target date for delivering universal, effective, and affordable protection and treatment to all vulnerable persons at risk of malaria.

In concert with the United States Millennium Goals, eradicating malaria is seen to be equally important as eradicating poverty and realizing the laudable goals of protecting women's and children's rights around the world.

Some facts from the World Malaria Day website:

The following interventions need to be delivered worldwide by 2010:

• More than 700 million insecticide-treated bednets – half of those in Africa
• More than 200 million of doses of effective treatment
• Indoor spraying for around 200 million homes annually
• Approximately 1.5 billion diagnostic tests annually

What it will cost

• In 2009, roughly $5.3 billion will be needed for malaria control worldwide
• In 2010, $6.2 billion will be needed
• From 2011 to 2020, roughly $5 billion per year will be need to sustain the gains of control measures.
• In addition, about $1 billion per year will be needed for research and development of new prevention and treatment tools

What will be the impact

A dramatically expanded access to core anti-malaria interventions (protective nets, spraying, diagnostics and effective drugs) will result in a sharp decline of malaria cases and deaths. However, these measures will not eliminate the mosquito vector, the parasite or the favorable environmental conditions for transmission in many countries and regions. In some countries with naturally high transmission rates, control measures may need to be maintained for 15- 20 years or longer until new tools enabling elimination are developed or new research indicates that control measures can be safely reduced without risk of resurgence.

We are all responsible to support these important global programs, and days like World Malaria day serve to remind us of the importance of protecting the most vulnerable members of the global community from diseases which are 100% preventable.

New Nurses: Where to Go?

It seems that newly graduated nurses who want to remain in New England may need to rethink their job-hunting strategy.

According to nursing students that I know who are graduating next month, the lack of nursing jobs in New England---especially in the Boston area---is an enormous disappointment. According to one student I spoke with today, only four of her fellow graduates have landed a post-graduation job, whereas in previous years, recruiters were falling over themselves to hire new grads as fast as they could pass the state boards.

While a nursing shortage still seems to be cooking in the health care cauldron, the economic engine driving the creation of new nursing jobs is sputtering, at best. And while New England currently seems to have a hiring freeze in place, states like Texas, Florida, California and Montana are apparently the places to go for new nurses---or seasoned ones---to find gainful employment.

If hospitals and health care facilities are still short-staffed but unable to hire, what are they doing to their nurses whom they still employ? Are double-shifts and mandatory overtime being touted as the answer to the shortage? With hiring freezes in place, do the nurses on staff work harder, care for even more patients, and sprint headlong towards burnout? What are the human resource consequences when conditions prevent new nurses from being brought into the workforce despite an ongoing shortage?

I'm no expert, but I can see that the nursing economy has been hit hard by the current economic downturn, and if I was a new nurse just out of school, I would think outside of the box, look as far afield as I could, and be willing to travel wherever the work was. Be it Florida, Texas or Montana, getting one's feet wet as a novice nurse is crucial, and spending some time in an unfamiliar region of the country might not necessarily be a bad thing, especially if one is young, unattached, and prepared to relocate for gainful employment.

I have encouraged many people to go to nursing school, and I hope that those who have heeded my advice don't rue the day that they made the fateful decision to become a nurse. But like all situations, this current economic reality will also pass, and nursing's economic and employment landscape will also change.

Lucky and blessed to myself have an interesting (but not terribly well-paying) job, I wish these new grads luck, and hope that they can navigate these current waters with grace and a modicum of patience.

Every nurse deserves a job, and every patient deserves a well-educated and well-paid nurse. My hope is that this current crop of new grads will find the employment they need, the experience they desire, and rest assured that they have chosen their new career well, no matter the current economic conditions.

Nurses and Social Networking

This afternoon, I spent two hours teaching a group of public health nurses how to blog. Curious about the blog that I'd created for the municipal health department that I work for, I was asked to train them this new and curious skill. Nurses and blogging just go together. Period.

When asked why nurses should blog and why local health departments should have their own blogs, the answer is easy. Nurses are repositories for vital information which, if not communicated, remains hidden from the public. Nurses (and other health professionals and officials) have a great deal to share with the public, and blogs offer an excellent venue for disseminating that information quickly and easily.

While a local newspaper might perhaps do a health-related story from time to time, the likelihood of a newspaper actually interviewing a nurse for such a story is slim. Research has shown that when the media is looking for a health care "expert", doctors are almost ubiquitously called upon to weigh in with their highly respected opinions. No offense to our medical colleagues, but nurses' voices also need to be heard, and many nurses now offer their expert opinions as bloggers, utilizing new media as a way to compensate for the mainstream media's ignorance of nurses' valuable collective voice.

As for health departments themselves, my vision is for all of the health departments in our region to have blogs, and for a network of public health blogs to be created in which information is shared, collated and disseminated to the public. Offering such an invaluable repository of information and collective intelligence to the public at large is a great service to the citizens of our region of New England, and such a network could become a model for others to follow and emulate.

In terms of social media, in two weeks I'll be providing a two-hour class in the use of Twitter for emergency preparedness and public health. This is yet another way that information is being shared among multiple players in real time, putting more important data into the right hands where it can be used for the common good.

Social networking and new media are a boon to the work of health care professionals, and I am doing my best to make sure that more individuals and agencies have the tools they need to gather and share information that can improve lives, save lives, and impact the health of the nation and the world.

Semper Gumby!

Just the other day, someone taught me a new term that I really love---"Semper gumby". For those of you rusty on your Latin, "semper" means "always" (as in the U.S. Marines' "Semper Fi"). Now, bringing our old friend Gumby into the picture, the notion of flexibility becomes more apparent.

Flexibility in this life is certainly an important characteristic to nurture, and one that we would all be smart to adopt in a big way. From the economy to the multifaceted nature of post-modern life, being flexible in mind and body is a way to adjust to an ever-changing world that consistently keeps us on our toes.

So, here's to flexibility of mind, body and soul, and the wisdom to cultivate that characteristic, no matter our age, rank, class, or position in life. Semper Gumby!

Change of Shift, Once Again!

The newest edition of Change of Shift---our favorite blog carnival with a nursing flavor---is up again at Emergiblog. I haven't contributed in months, and I must change that error forthwith!

Pay Kim a visit and read what nurses have to say!

Generating Praise

Every generation seems to have its own label, character, or raison d'etre, and for several months, I've been thinking a great deal about the current generation who are now in their twenties.

Having a child in his mid-twenties (and a niece and nephew who are young adults as well), I have been watching this generation come of age from a parental and avuncular vantage point, and I feel blessed and lucky to have had many occasions to spend time with this particular cohort of young Americans.

What strikes me so clearly about this generation is, of course, its technological savviness, but also its level of political, social, and environmental sophistication. I have met young political activists, organic farmers, parents, educators and students who are, to me, light-years ahead of where my generation seemed to be when we were in our twenties, numbed by Reaganism and the cynicism of the 80's.

Now, while many Baby Boomers will quickly claim that their generation was the one that irrevocably changed the world---and indeed it was a powerful cohort whose influence is felt deeply and profoundly within our culture to this day---I am moved to say that the generation currently growing and developing in the midst of their third decade of life on earth will also have an equally profound effect on the course of world events.

What I see in this generation is a level of awareness unmatched in its sophistication and astuteness, and an open-mindedness that reflects the increased tolerance and diversity evidenced in our society at large. Perhaps the dawn of the Information Age has indeed assisted these young adults in being so connected with one another and the world on a 24/7 basis. While activists in the 1960s relied on the U.S. Postal Service and Ma Bell for communication, the current crop of activists use Twitter, Facebook, SMS, text messaging and other social networking tools to gain support for their causes and foment change from the grass roots level.

As someone in my forties who is watching the younger generation come into its own, I am decidedly surprised and pleased with what I see, and I have no doubt that the political and social leaders emerging from this bright cohort will no doubt revolutionize our society in ways still unforeseen.

From my nephew who writes about politics with incredible intelligence, to my niece who is currently in Southern Sudan on an agricultural internship, to my son and his beloved who work with the developmentally disabled, to the other young people who have crossed my path---I view with optimism the impact that this generation is having---and will continue to have---on our culture and society. And as I age, I will no doubt be grateful for their continued success in changing the world for the better as my generation cedes the reins to their capable and inspiring hands.

Your Pain

Your pain is the breaking of the shell
that encloses your understanding.

Even as the stone of the fruit must break, that its
heart may stand in the sun, so must you know pain.

And could you keep your heart in wonder
at the daily miracles of your life, your pain
would not seem less wondrous than your joy;

And you would accept the seasons of your
heart, even as you have always accepted
the seasons that pass over your fields.

And you would watch with serenity
through the winters of your grief.

Much of your pain is self-chosen.

It is the bitter potion by which the
physician within you heals your sick self.

Therefore trust the physician, and drink
his remedy in silence and tranquillity:

For his hand, though heavy and hard, is guided
by the tender hand of the Unseen,
And the cup he brings, though it burn your lips,
has been fashioned of the clay which the Potter
has moistened with His own sacred tears.

- Kahlil Gibran

"The Adventures of Bob the Nurse"

Some of you may have seen several recent posts featuring my Male Nurse Action Figure. Well, he will continue to appear here on Digital Doorway from time to time, but it is now apparent that he needs his own space to grow and blossom. Thus, a new blog---The Adventures of Bob The Nurse---is born. I don't know how long this adventure will last, but for the moment, Bob has many places to go and people to see. Please bookmark and visit Bob periodically to keep up with his many adventures as he broadens his horizons and provides me (and my wife Mary, of course) with a fun and creative outlet.

Public Health and the Healthiest Nation

Since this is the end of Public Health Week, I wanted to share a link to a site created by the American Public Health Association which is encouraging Americans to make our country the healthiest in the world within one generation. Contrary to popular belief, the United States lags far behind most other industrialized nations in numerous measurements of health and well-being, and it will take concerted effort to turn those numbers around.

Were you aware that the U.S. ranks 46th in terms of life expectancy in the world---far behind Europe, Japan, Jordan, and South Korea?

How is it that a baby born in the United States is more likely to die before its first birthday than a child in any other industrialized nation in the world?

Why is almost 1 out of every 20 adults in Washington, DC---the nation's capital---HIV-positive?

Why do more than 10 million American children lack health insurance?

How does one American under the age of 29 contract HIV every minute?

These are questions of enormous import and gravity, and even as I write this post, municipalities across the country are laying off Public Health Nurses and decimating the public health infrastructure in reaction to the economic downturn.

Please watch the video posted below, visit the website, and decide if you would like to take action, contact your legislator, or find another way to support public health in your town, state, region, or nationwide. The health of our country has been driven to a precipice that we do not need to collectively drive over. And like the website says, one person can effect change, and the actions of many individuals can potentially turn the tide.

Public Health Layoffs During Public Health Week

At a time when it is universally agreed that the fight against communicable and infectious disease is an absolute necessity, right here in New England the city of Worcester, Massachusetts is choosing to dismantle its public health infrastructure, laying off its public health nurses during the celebration of Public Health Week.

Public health nurses provide case management for patients with active tuberculosis, provide crucial surveillance of communicable and infectious disease, and perform a myriad of tasks that help to protect citizens from harm and injury. Worcester's short-sighted decision is seen as potentially catastrophic, and I share with you below the text of a press release from the Massachusetts Nurses Association:

FOR IMMEDIATE RELEASE

WORCESTER, MASS — As the City of Worcester prepares to celebrate National Public Health Week, the city manager has recently announced the elimination of nearly all funding for public health services and the layoff of nearly all the nurses who provide public health protection to the state's second largest city.

The public health nurses serve all the people of Worcester, providing vital preventive services to immunize against, track and manage over 150 infectious diseases, including tuberculosis, hepatitis, salmonella, the flu and West Nile Virus. The cuts in services and staff leave the city vulnerable to the unwarranted spread of infectious diseases. It will also deprive the city's most vulnerable children and adults of access to immunizations and other health screening services.

The decision by the City of Worcester to lay off all six of its public health nurses, along with the chief public health nurse and secretary for the department, is a shortsighted and dangerous decision that will shred the health care safety net for the city's 172,000 residents. The layoffs, which were announced last week, will take effect on April 17.

While everyone understands we are in a fiscal crisis, this decision places hundreds, if not thousands, of our residents at risk for harm and leaves the most vulnerable in our city stranded without necessary care," said Anne Cappabianca, chair of the bargaining unit of the Massachusetts Nurses Association, which represents the Worcester public health nurses. "The public has a right to know what they are losing and what they will be exposed to as a result of these cuts."

Fact Sheet on Public Health Nurses

► A public health nurse is a special type of registered nurse who focuses on providing health promotion and protection to an entire community or population. There are currently six public health nurses serving a population of more than 172,000 residents in the City of Worcester.

► During the past year the nurses investigated 300 communicable disease cases, including tuberculosis cases at local colleges and high schools, requiring tuberculosis skin testing of hundreds of individuals.

► The nurses track at least 100 residents each month that may have been exposed to TB and are now living in the community. They make more than 35 visits each month to the homes of those residents with active TB to ensure they are receiving proper care and are taking their medication. In so doing, they prevent the spread of this highly infectious disease while at the same time assist those infected in getting well. Without the services provided by the public health nurses, these patients are less likely to follow their treatments, and are therefore at much greater risk to become more seriously ill, and much more likely to spread this disease throughout the community.

► In preventing the spread of disease, public health nurses are responsible for immunization of vulnerable segments of our population against the spread of disease. For example, more than 2,000 vaccines were administered to children and adults during the last 10 months by the public health nurses.

► The nurses also provide all varieties of childhood immunizations to those who can not afford them, such as children living in family homeless shelters, etc.

► Worcester public health nurses also play a vital role in the city's disaster response plans. During the ice storm in December 2008, the nurses staffed the shelters at Burncoat High School and Doherty High School to provide care to victims, including fragile elderly residents.

"In addition to the loss of existing services, the elimination of the public health nurses prevents the city from initiating a number of health and wellness programs planned for the recently established wellness clinic in the department. These programs included screening services for diabetes, hypertension, kidney disease as well as obesity.

"In the long run, all of these programs save money and save lives, while increasing the wellness of all our citizens," Cappabianca said. "Those who suffer the most from these cuts are those in our community for whom these services matter most. In abandoning these programs, particularly all our services related to disease surveillance, we jeopardize everyone in our community unnecessarily."

Founded in 1903, the Massachusetts Nurses Association is the largest professional health care organization and the largest union of registered nurses in the Commonwealth of Massachusetts. Its 23,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public.

Emergency Response and Preparedness

After five days of hearing about emergency preparedness and response at the Integrated Medical Public Health, Preparedness and Response Training Summit, I'm ready to go back to work and hit the ground running. I have my work cut out for me, and this conference fed me ideas and inspiration for how to move my own agenda forward in our town of 30,000.

People of all stripes flocked to this very well-organized first-of-its-kind summit, and we all rubbed shoulders and elbows in dozens of trainings pertaining to emergency response. With visits from the Deputy Surgeon General and other dignitaries, many words were shared about how the United States is now better prepared than ever in terms of having the capability to respond to disasters of many kinds.

As a new public health professional, many of these concepts are relatively new to me, and I certainly do not live and breathe these subjects as so many of my colleagues do. Still, as coordinator of a local chapter of the Medical Reserve Corps (MRC), it is my responsibility to make sure that our town's readiness to respond to public health emergencies is robust, and my primary goal at this point in time is to recruit members for our MRC, creating a body of credentialed and registered volunteers who can be mobilized at a moment's notice when the need arises, whether it be to vaccinate elders against the flu or staff a Red Cross shelter during a blizzard.

While "disaster" is one of the operative words in the preparedness world, many MRC's simply take part in activities that enhance the public health of their communities, and I'm striving to create an active and engaged MRC that does just that. The importance of volunteerism is one of the hallmarks of President Obama's overall message to the American people, and I plan to capitalize on that message as I take the gospel of the Medical Reserve Corps to medical practices, retirement communities, and civic organizations where interested people are just waiting for a way to give back.

I have many responsibilities in my job as a Public Health Nurse, and emergency preparedness is only one of the hats that adorn my head on a regular basis. This conference was certainly an eye-opener, and I hope that I can translate my new learning and inspiration into action on the ground and a new group of eager volunteers ready to do their part.

Male Nurse Action Figure Visits Dallas

Greetings from Dallas, Texas!

I am here in Dallas attending the 2009 Integrated Medical, Public Health, Preparedness and Response Training Summit which is sponsored by the U.S. Department of Health and Human Services.

As a Public Health Nurse and Coordinator of a local chapter of the Medical Reserve Corps (MRC), I am taking part in this summit as a local public health official and MRC leader trained to respond to any emergency endangering the health and safety of any citizen. Groups of firefighters, EMTs, veterinarian specialists, animal rescue specialists, Medical Reserve Corps members and leaders, and a host of other emergency preparedness and response players are here to network, connect and learn in a robust and collaborative environment.

Subjects covered in the summit include mass fatality events, terrorism, animal rescue, weather emergencies, decontamination, volunteer recruitment and management, and all manner of detailed trainings geared to enhancing emergency response on a local, regional and national level.

I hope to glean a great deal of valuable information from this training, subsequently bringing home crucial learning that will enhance my ability to effectively achieve the goals of my multifaceted professional responsibilities.

Male Nurse Action Figure Meets Intravenous de Milo

Electronic Medical Records and Wal-Mart?

Every week, I receive emails asking me to review a product, comment on an article, or react to something happening in the world of health care. From nursing to union organizing, the requests come in fairly regularly.

Not long ago, I was asked by a website called Software Advice (who offer free advice on software to consumers) to examine a new partnership between Wal-Mart and eClinicalWorks. It seems that Wal-Mart, in its infinite wisdom (or lack thereof) has decided to go into the Electronic Medical Record (EMR) business, partnering with eClinicalWorks to sell a $25,000 software and hardware package to physicians at Sam's Club outlets.

In terms of EMRs, I'm no expert, and while I have used a number of EMRs that were variable in quality and usability, I cannot speak to the quality or usability of eClinicalWorks' products. However, as a consumer, I know that I have never set foot in a Wal-Mart due to the fact that I am staunchly opposed to Wal-Mart's labor practices, their dumbed down sales pitch, and their ubiquitous ability to sap the life out of local business wherever they pitch their (ever enlarging) tent.

The article by Software Advice about these unlikely bedfellows makes a good point that "team members" at Sams Club and Wal-Mart outlets will no doubt be woefully inadequate in their ability to provide adequate information to potential buyers of this software, and physicians who suffer buyer's remorse after taking home their new acquisition may rue the day they set foot in Wal-Mart to buy toilet paper and subsequently walked out with an EMR they didn't know they needed.

The Software Advice writers seem to feel that eClinicalWorks' software is a quality product that can deliver the goods, and I have no qualm with that opinion. But when it comes to Wal-Mart sticking their noses into such a specialized area of health care delivery, my squeamishness meter goes through the roof.

Good luck to eClinialWorks as they partner with a wholesale behometh that has basically co-opted the local store in towns from Canada to Mexico and beyond. Many readers of Digital Doorway most likely are already aware of my disdain for such companies as Wal-Mart, and if I were a doctor shopping for an EMR, I would certainly not plunk down my credit card for a $25K investment sponsored by a retail giant whose reach is already far too long. In the words of someone famous and dead, caveat emptor!

Male Nurse Action Figure Contemplates His Navel

This Modern World

In the midst of a very busy day, I was struck today by the notion of just how complex the world has become and how our lives are so enmeshed with technology. I was remembering the mid-1980's when I bought my first telephone answering machine, and how stunned I was that a small device could record the voices of my loved ones, preventing me from simply missing their calls. The simplicity of that technology is almost laughable now, but at the time it was close to revolutionary.

Now, we check our email while climbing mountains, text message while shopping for groceries, and use Twitter, Facebook, Linked In, and any number of digital venues to remain connected with the world at large.

Amidst this frenzied activity, I am led to wonder what we're missing and where we are disconnecting. What are we losing as we stare into the screen? What opportunities for serendipity and happenstance are ultimately squandered when our eyes are on the keyboard rather than the scenery around us?

Yes, we are connected, and the sophisticated communication systems which light up our globe do indeed bring us together. I myself have found old friends on Facebook, met new friends on Twitter, and made unexpected and important connections---both personal and professional---through blogging. I am, admittedly, totally consumed by the online world, checking my email multiple times per day, posting on Twitter and updating my Facebook profile daily.

So, amidst the tumult of data, the blog posts and updates and profiles and emails, there is a mass of real live humanity, flesh and blood actors walking across the stage of my life, entering stage left and exiting stage right. I can connect through the small screen, and I can text and type to my heart's content, but it is the face to face encounters, the hand on the arm, the twinkling of an eye, that surely should not be forgotten or overlooked.

Walking down the street tomorrow, try looking at those around you. Notice their clothing, their hair, their eyes, their facial expressions. Hold open a door, shake a hand, offer a smile, and connect in real time in the 3rd dimension. And when you're back at your computer or staring at the Blackberry, remember the faces behind the text, and send those emails with an extra dose of humanity and vulnerability.

We are connected. We are connecting. And we must always remember to remain present in the here and now, even as our attention is drawn once again to the virtual world. It is a tangled and complex web we weave, but our ability to connect with one another in meaningful ways is truly so very simple. I want to invite more of that simplicity into my life, and if you have found a way to do so, I would be happy to hear how you have managed to keep your head above the digital waters. Life is rich with the possibility of connection, and I welcome those connections with open arms and a happy heart.