Hope, Fear, and the COVID-19 Pandemic

As I write these words, shipments of Pfizer's COVID-19 vaccine based on breakthrough mRNA technology have been arriving to hospitals for several days, with the first shots already having been administered. Simultaneously, we've now surpassed an awful milestone of 300,000 Americans lost to the virus, which is akin to the entire population of Pittsburgh being wiped out. With frequently more than 3,000 dead on any given day (the comparison being that we lost approximately 3,000 people on September 11th, 2001), the expected post-Thanksgiving surge is upon us, just as experts forewarned (and the public ignored).

With Christmas and the New Year ahead of us, now is not the time for the doffing of masks and giving up on social distancing and other recommended measures. In fact, it's time for us to double down and work together in order to move us into 2021 with hope for seeing this pandemic in the rearview mirror.

Nurse Keith's 4-1-20 COVID-19 Roundup

In these days of the COVID-19 pandemic, it seems like the world is upside down and inside out. We are all reeling from the overwhelming disruption of most every aspect of human life: economics, work, and career; education across the lifespan, from preschool to post-doctoral research; faith communities; migrant workers; the undocumented; the frail, elderly, and vulnerable; transportation; small business; and the actual details of survival, including food, clothing companionship, and shelter.

Other than those still living who experienced World War II, the Holocaust, or even the 1918 so-called "Spanish Flu", none of us have a memory of such a devastating worldwide event. The AIDS epidemic at its awful zenith in the 1980s is the closest we've come since the Second World War, and that was enough to strike fear into the hearts of many and cause massive loss throughout the 80s and 90s until we got a handle on the virus and rendered it mostly a chronic illness that can be survived for decades by most infected individuals.

Photo by Tai's Captures on Unsplash

The Obesity of Americans--and Nurses

It appears that the American Medical Association has decided to designate obesity as a disease. So, if one in three Americans is now classified as being obese, does that mean that one in three nurses is obese as well?

A "Silver Tsunami" Among The Homeless

We all know that there are millions of homeless Americans of all ages. According to some recent studies, approximately 21 out of every 10,000 citizens is homeless. So, as the population ages across the board, how do we address the fact that a great number of homeless Americans are reaching the time when they should be retiring and enjoying the remainder of their lives rather than struggling on the streets?

Congresswoman Eddie Bernice Johnson Introduces the National Nurse Act of 2013

Since the issue first came to my attention several years ago, I have strongly supported the passage of the National Nurse Act and the establishment of a National Nurse for Public Health. The following is a press release distributed on February 4th by the National Nursing Network Organization Board of Directors. It is reproduced with their kind permission.

Haiti, Cholera, Water, and a Crisis

With the cholera outbreak making itself known in the streets and slums of Haiti, we are again reminded how those of us living in various industrialized nations take sanitation, health, clean water, and access to proper medical care for granted.

Here in the United States, an outbreak of cholera would be as unlikely as a massive epidemic of bubonic plague. But in the case of Haiti, deplorable conditions pre-dating the relatively recent earthquake have created a situation wherein otherwise preventable diseases can spread rapidly and dangerously from rural to urban areas (and back again) in a matter of days.

In the Western Hemisphere, Haiti remains a symbol of failed economic policies, illegal coups, and inappropriate interventions by the United States and other global bodies who have crippled this poor nation and left its citizens lagging behind as the poorest country in this half of the world, with the majority of its 9 million citizens living below the poverty level.

International aid organizations, many of whom have had boots on the Haitian ground for decades, are now scrambling to provide education, outreach and improved sanitation in order to head off an outbreak that has already killed hundreds and could very well kill thousands if the tide is not quickly stemmed. Some groups, like Doctors Without Borders, are building makeshift cholera clinics, and others are distributing chlorine tablets for the purification of water and oral rehydration fluids for those at risk of dehydration in the absence of clean drinking water.

Newly living in the American Southwest, I’ve recently been learning how contentious an issue water has become in the 21^st century. Native American tribes have been forced to utilize the courts in order to gain access to water to which they previously had the rights for generations, and just a few weeks ago, bloggers worldwide participated in Blog Action Day, this year focusing their attention on water as a global issue of critical importance.

In Haiti, an economically crippled country was only recently brought to its knees by a massive earthquake that left more than a million homeless Haitians living in various tent cities as they await a more permanent housing solution. According to reports, sanitation and hygiene is actually worse in the urban slums, where water used for drinking and washing is contaminated with fecal matter, proliferating the spread of diseases such as cholera.

As some of us here in the Southwest argue over how many rain barrels we can afford to buy in order to have enough water to irrigate our decorative gardens, millions of Haitians long for the opportunity to simply have sufficient water to provide proper sanitation, healthy hydration, clean and hygienic clothing, and irrigation for life-sustaining crops.

In this world of plenty, Haiti’s current state is a sign that the priorities of the human race are tragically askew. Meanwhile, the conspicuous consumption and epidemic obesity of those of us in the industrialized world only further illustrate our loss of a collective vision of how life should be for all.

Haiti needs our assistance, our empowerment, and our generosity. And we can only hope that, given time and adequate resources, the poorest country in the Western Hemisphere will one day be relatively free of disease, poverty, and the misguided geopolitical interventions of those who have only sought to exploit her.

Global Handwashing Day and Blog Action Day

Today, October 15th, marks the first ever Global Handwashing Day (being celebrated in more than 70 countries around the world) and the fourth annual Blog Action Day, wherein bloggers from around the world post about a single topic of global interest, and this year's topic is water.

Every day, more than 5,000 children die from diarrhea, and this is largely due to lack of access to clean water and soap with which to practice hand hygiene. And over all, 42,000 people die every week from lack of access to clean water. With more than a billion people worldwide (that's one in eight human beings) lacking access to clean water, the proportions of this issue are staggering and the implications for public health, disease management, economic development, food production and simple survival are staggering.

From the dual perspectives of Blog Action Day's theme of water and Global Handwashing Day's emphasis on clean water to facilitate handwashing and the prevention of disease, there is a natural symbiosis. With drought and desertification becoming an increasing global problem, action is needed on all fronts to combat this issue and turn the tide, so to speak, on the global water crisis.

Here is the Blog Action Day YouTube video which is well worth watching for a quick synopsis of the movement's mission:



And please watch this video from The World Bank, and feel free to visit the Global Handwashing Day website to get involved.

Rabies!

Today, while walking in the outskirts of Silver City, New Mexico, I was charged by a trio of dogs, one of whom managed to bite me on the inner thigh as I tried to turn and walk away from their barking ferocity. Normally a dog lover ( I have a dog myself), I am rarely frightened by dogs and generally have a way with them, but this triumverate were none too friendly, and I limped back to our campground as I called my wife on her cell phone and asked her to boil some water and ready the First Aid kit. (My wife and I have been traveling in an RV for six months, chronicling our adventures on our travel blog.)

Here's a photo of my wound.....


Interestingly, the Silver City Animal Control Officer was reluctant to come to see me at the campground, although he indeed paid a visit to the dogs' owner, who accused me of trespassing, a conclusion which I summarily rejected as false. Trespassing or not, a loose dog without a collar, identification or civilized manners had charged me and managed to sink a few teeth into my tender flesh, and the only thing truly on my mind was rabies.

According to the CDC (and most other authorities on the matter), if a person is bitten by an animal whose rabies vaccination status cannot be determined, that individual should receive a series of five rabies vaccinations (Post-Exposure Prophylaxis, or PEP) beginning on the day of the bite (also referred to as "Day Zero"), followed by vaccines on days 3, 7, 14 and 28. Rabies immune globulin (RIG) should also be administered as a second vaccine on Day 0, with up to half of the RIG vaccination injected into the tissue surrounding the site. Rabies is a serious illness with serious consequences, including contractions, high fever, confusion, agitation, coma and death.

As one can imagine, aside from administering First Aid to the site, and flushing it with hot soapy water and hydrogen peroxide, identifying whether or not a rabies vaccine series was necessary was first and foremost in my mind. Luckily for me, once we involved the local Sheriff's department in the case, we were informed within two hours of the incident that the canine in question was indeed up-to-date on his vaccinations, a conclusion that was obviously a happy one for us travelers.

Needless to say, dear Readers, rabies is a serious illness and must be taken seriously. If you or someone you know is bitten by an animal of unknown origin or vaccination status, prompt First Aid and rabies Post-Exposure Prophylaxis is paramount. Act quickly, seek medical attention, and be sure to follow all recommendations for treatment of such an injury, and you will be happier and healthier for it!

The Demise of the Public Health Nurse

Back when H1N1 was on the rise, the city of Worcester, Massachusetts laid off all but one of its public health nurses, much to the consternation of the public health community. Public health has rarely been understood by Americans in general, and perhaps the H1N1 pandemic has brought the benefits of the public health infrastructure into the spotlight for both the public and politicians.

Back in October when I left my position as a public health nurse for a small college town in Western Massachusetts, I felt guilty that I was leaving at a time when I was needed the most. Luckily, I was quickly replaced by a skilled and capable nurse who was able to pick up the gauntlet and lead the town through the maze of H1N1 prevention and immunization clinics.

Now I have learned that the public health nurse position in that particular town has been eliminated, and the new director---a former public health nurse for the town---will fulfill the responsibilities of both nurse and department head, a monumental task that seems altogether untenable, no matter how capable and earnest this individual can be. From the surveillance of infectious disease to the management of tuberculosis, public health nurses need time and resources to fulfill their duties, and more and more nurses are being asked to decrease their hours and the scope of their practice, significantly limiting their overall effectiveness.

Public health is often seen as an expendable expense by politicians and bureaucrats, and the signs all point to the fact that public health---and public health nurses---are still not appreciated for the ways in which they safeguard the health of the population and work to prevent the spread of infectious disease.

The gutting of public health programs around the United States is a travesty, and when the ability of a local public health department to fulfill its responsibilities is emasculated in the interest of saving money, everyone loses.

Facing the Unknown

The health care debate seems to be full of unknowns these days. As the arguments over health care reform heat up to the boiling point, the notion of a government-run program raises the hackles of so many people across the spectrum, and cries of socialism are heard across the land. Will our care be rationed? Will grandma be left to die when a bureaucrat decides that she has reached her life expectancy and her surgery is not cost effective based on her age? Misrepresentation and misinformation abounds.

Meanwhile, H1N1 challenges the public health infrastructure, and the availability and distribution of the vaccine poses questions that still cannot be fully answered. And as the manufacturing of that new vaccine is ramped up, seasonal flu vaccine distribution has been slowed to a veritable trickle, confounding the plans of even the most earnest local health department.

Speaking of H1N1, studies now show that many pregnant women and others eligible for the H1N1 vaccine will refuse to receive it, leaving public health officials wondering just who will want it, anyway? In our local circles, many of us are asking the following question: "If we throw an H1N1 party, will anyone come?"

H1N1 Creeps Along

The H1N1 virus, otherwise known as Swine Flu, is creeping along at a slow but steady pace, and my work as a public health nurse amidst the outbreak of a novel influenza virus has certainly ebbed----for now.

As predicted by many, the virus is currently no more virulent than your average seasonal influenza, and while more cases and deaths are indeed expected, the rate of the spread of H1N1 is slow and steady rather than rapid and diffuse.

Still, there is a great deal of uncertainty as to what will happen when H1N1 goes somewhat underground over the summer, only to resurface in the Autumn, mutated and ready for the seasonal flu season. Epidemiologists are concerned due to the fact that the 1918 influenza pandemic began with a novel virus emerging in the Spring, spreading slowly but steadily, diminishing in the summer and reemerging in the Autumn, hundreds of times more virulent. Only time will tell.

Another novel aspect of this virus is that, unlike seasonal influenza---which predominately impacts older adults and those with chronic illnesses---the majority of H1N1 cases are those between the ages of 5 and 20, with the vast preponderance being between the ages of 11 and 15. The assumption is that those generations of children have never been exposed to this virus before, whereas the rest of us were alive in the 1970s during the last H1N1 outbreak. And whereas most children and young adults are healthy enough to fight off the infection, there are concerns about children with weakened immune systems and chronic illnesses. When children die from otherwise benign infections, people take notice, and this is an eventuality we all want to avoid.

Be that as it may, the H1N1 scenario is relatively calm for now, and those of us working in public health and other sectors of the health care industry watch, wait, listen, and hope that nothing more comes of this outbreak of a novel virus making its inexorable way around the world.

Twitter, Social Media and Emergency Preparedness!

Today, I spent an hour or so introducing a group of Medical Reserve Corps leaders to the world of Twitter. I have personally been using Twitter for a number of months. In fact, this blog feeds to my Twitter account automatically.

Now, for those who are working in the fields of emergency preparedness and public health, Twitter has a great deal to offer in terms of the aggregation of vast amounts of information on specific topics of interest. Swine flu has been an excellent example of Twitter's utility for keeping track of trends vis-a-vis the development of the disease, especially when such players as the Centers for Disease Control, the Department of Health and Human Services, FEMA, and the FDA chime in on their Twitter feeds multiple times per day.

Someone in our training stated that it's remarkable that the CDC and other large organizations actually pay someone to aggregate their material and post it on Twitter, Facebook and other social networking sites. However, I would beg to differ. I would actually find it remarkable if these organizations chose to not utilize social networking as a means of getting their message out there. There are segments of the population who rely on social networking for news, friendship, professional networking and entertainment, and savvy organizations with something to communicate are intelligently jumping on this bandwagon.

In terms of my friends and colleagues in the emergency preparedness world, one of my warnings was that, while Twitter and other sites can be fun and informative, it is best to keep a tight rein on who one chooses to follow and how much time one devotes to such an endeavor. Social media can be an enormous time waster, and even the most diligent of us can be unwittingly sucked in, even when the clock is ticking and there is work to be done.

That said, if one is interested in knowing the latest information on swine flu, public health threats, fires, product recalls and disease outbreaks, there is a veritable river of useful information flowing on Twitter that can keep one up to speed on a daily basis.

Social networking has certainly found a variety of audiences, and it remains to be seen how these applications will change and grow as they become more popular and their creators decide how to monetize them. Twitter is still a free service that's 100% free of ads, but I'm fairly certain that we will eventually see some form of ads on Twitter, just as we have seen ads develop as Facebook found its place in the online universe.

For emergency preparedness folks, tracking the trends and keeping in touch with colleagues on the front lines is a very useful way to apply Twitter to the work that we do. When emergency response teams on the ground can post brief and informative up-to-the-minute tweets about their current status vis-a-vis an ongoing emergency, everyone wins. And when we can easily track the progress of a new disease or other emerging threat with an application that's easy to use and free, there truly seems to be nothing to lose.

I'm happy to be opening my colleague's eyes to the uses of blogging and social for public health and emergency preparedness and response, and if these processes and applications actually serve to improve lives or otherwise positively impact our good work in the world, then I am a happy nurse indeed.

Swine Flu Fatigue?

Dear Readers, I apologize for not posting since Monday. My work life has been consumed with swine flu and its effects here on the local level, and Digital Doorway has suffered from a lack of attention. This situation will now be remedied.

So, a lot of people are already complaining of Swine Flu Fatigue. Of course, the media has latched onto this breaking news, disseminating information---and misinformation---throughout the 24-hour news cycle that is part and parcel of our 21st century lives. Still, a novel virus making its way around the world is certainly cause for concern and conversation, and the public health infrastructure is certainly responding as it should in such a circumstance.

On Twitter, on grocery lines, and in workplaces, various individuals claim that the government is overreacting, that public health officials are making a mountain out of molehill, and that the media is fanning the flames for the benefit of increased revenue in dark economic times. But I must beg to differ.

As a (relatively novice) public health official, I am impressed and heartened by the rapid, comprehensive and thoughtful reaction by the global public health community to this new viral threat. I have taken part in numerous conference calls with the CDC, with our state Department of Public Health, FEMA, and other players, and I can see that officials are acting responsibly and appropriately to a credible threat.

When Hurricane Katrina was bearing down on New Orleans and our government was essentially asleep at the wheel, FEMA and other emergency management agencies fell down on the job, and their negligence and slow response certainly resulted in increased suffering, loss and death in the ensuing days during and after the storm. In retrospect, the public and media called for answers, recognizing clearly that preemption of calamity is an essential aspect of managing such situations before they mushroom out of control. The initial Katrina response was essentially a failure, and lessons learned at that time are still being analyzed and digested.

With swine flu, we have another opportunity for the machines of government, public health, surveillance and emergency preparedness to swing into action before all-out calamity strikes. While the current measures and attention being paid to the situation may appear to some to be somewhat overblown, one must only imagine what we might all say at some future date if the government's reaction to the early stages of the outbreak were less robust.

If this indeed becomes a global pandemic of massive scale in the months to come, it will be certain that we will be thankful that the assets and resources made available by the government and associated agencies were activated so early in the development of this viral process.

With antiviral medications at the ready and vast amounts of information being made available to the general public, the media, and the medical community on an up-to-the-minute basis, we can rest assured that the situation is being monitored vigorously by those in positions to make clear and intelligent decisions.

Here on the public health front lines, we local boards of health rely on the federal and state governments to guide us as we answer the public's questions, assuage their fears, and prepare our own local assets for appropriate and timely response. We are very appreciative of the responsiveness of the CDC and our other response partners, and without their guidance, this process would be infinitely more challenging.

In a few weeks or months, if the pandemic proves to be short-lived, we will all breathe a sigh of relief, knowing that we were properly prepared for a feasible and credible threat to public health. While some would potentially point fingers and make light of our credibility vis-a-vis such threats, we will still maintain our thankfulness that we reacted so swiftly and comprehensively based on the information available at the time the outbreak began.

If the outbreak does indeed develop into a larger-scale pandemic, then our reactions will also have been proven to be prudent and correct, and we will be well prepared to face the mounting threat.

Whatever the outcome, I see the national and global response to swine flu as an excellent example of how the public health infrastructure can mount a credible and rapid response on the local, regional, national and global levels when needed. This is a test---no matter the outcome---and in my view, the reaction to swine flu has been an excellent example of prudence, intelligence, and collective preemptive action at a time when such qualities are sorely needed and duly delivered.

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.

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.

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.

Welcoming Spring!

Well, here in New England, the colder days are slowly being outnumbered by the warmer ones, (emphasis on slowly). The mornings can be quite nippy and the nights still drive the mercury down. However, the crocuses are up, the birds are returning, windows are opening and people are out with their bicycles and running shoes in droves.

With my new job being right downtown, I plan to take advantage of the warm weather by doing outreach to local businesses, visiting churches, and making inroads to various groups within our community. I find that many individuals and organizations have no idea what the local Health Department does, and most people don't even know that our town has a Public Health Nurse. In fact, some nearby towns have no nurse to call their own, so we are especially blessed to have such a well-funded Health Department.

Our Medical Reserve Corps (MRC) chapter has historically been relatively small, usually between 30 and 40 members, only a fraction of whom are actively involved on a regular basis. Although our title emphasizes the medical aspect of our mission, all MRC chapters welcome laypeople and non-medical professionals into our midst, since a diversity of talents and strengths is indeed important in emergent situations. Thus, we are actively recruiting veterinarians, clergy, business owners, IT professionals, HAM radio operators, and any other people who are simply interested in being of service when the proverdial feces hits the fan.

While members of the MRC are all trained to respond to emergencies and lend a hand when police, fire and other entities are overwhelmed (MRC's have assisted in hurricanes, floods, fires, and other incidents), we also like to do community outreach and emergency preparedness education. Thus, some of my Springtime efforts will include outreach to seniors, church groups, civic organizations (like the Knights of Columbus), and private and public groups of all sizes and persuasions.

Beyond that, working in town also gives me a route by which to take the "pulse" of the town, talk to people about my work, and enlist community partners in improving public health in its myriad aspects.

Spring has certainly sprung, and I want to take advantage of the pervasive feeling of optimism in the air, reaching out to those who might be willing to contribute to improving the overall health of our community.

Surfing the Learning Curve

I spent today sitting in a conference room with public health nurses, people from our state Department of Public Health, and other professionals who focus their professional lives on the surveillance and prevention of infectious and communicable disease.

As dry as this topic may seem, there is a passion that people in the public health world feel for this work, and many people have dedicated entire careers to this avenue of work. As a newcomer, I listen, watch, and feel my way through this maze of information, and I consider the many decades of human effort that have led us to this point in history.

The 20th century was very much focused on the control and eradication of communicable diseases like polio and measles. We've done a pretty good job in that arena, and vaccine-preventable diseases have been on the run for some years, at least in the industrialized world.

Now, multidrug-resistant TB, HIV/AIDS, malaria and other diseases have us on the run, and the fight is raging around the world. Billions of dollars are being spent every year, and philanthropic organizations like The Gates Foundation feed a great deal of private capital into some of the larger public health engines that drive the action.

For myself, I'm a very small cog in a series of multilayered wheels that turn in combinations still beyond my comprehension. While I see my actions as very small when compared with what's happening "out there", I also recognize that my interventions on a local scale---counseling a patient with TB, vaccinating a child, preventing illness---are part of a wider web that is made even more meaningful (and, in fact, effective) based on the very small, local actions of a multitude of individuals.

Prevention, surveillance and protection of the public is a year-round and frequently thankless job. Public health happens in the background, if you will, and the public and the media generally only think about such things when something goes wrong. This is understandable, and if the price of such vigilance is relative anonymity in a world made more healthy and safe by their diligence, most public health professionals would probably accept that outcome with a knowing smile.

I am still surfing on the learning curve, gleaning what I can from every day on the job, and relishing the lessons that bring new personal and professional meaning and importance to my work. It's an interesting ride, and I'm often impressed by the multifaceted nature of the field into which I have so recently stumbled.

Reaching Out To the Margins

Yesterday, I received a call from a young college student with an interest in Public Health who wants to volunteer at our health department. After a telephone conversation and a string of emails, I gleaned that she is from Cape Verde, speaks Cape Verdean Creole (Portuguese married with African dialects) as her first language, and also speaks and understands some Spanish. Thinking quickly, I realized that this is a golden opportunity to utilize this individual's language and cultural knowledge to reach out to the Cape Verdean community in our town. While not as sizeable as our Chinese, Tibetan, Cambodian, and Latino communities, I know for a fact that a pocket of Cape Verdeans are scattered amongst the population, and this young woman may be the key to doing some important outreach to a marginalized segment of our municipality.

The director of our health department is dedicated to issues of racial justice and social equality, and a significant multi-year social justice grant has given our department just the push it needed to bring to life her much appreciated vision. With a part-time worker devoted to fulfilling the social justice grant and a Cambodian outreach worker dedicated to the Khmer community in our area, we are well aware that there are ethnic and racial groups that also deserve our attention.

While public health does indeed involve immunizations and infectious disease surveillance, the 21st century has brought the very enlightened awareness that the control of chronic disease is where we should be focusing in the wake of the 20th century's successes vis-a-vis the virtual eradication of vaccine-preventable diseases such as polio and measles. However, to control chronic diseases and improve quality of life and lifespan, we must also ascertain why and how health disparities occur amongst various ethnic, racial and socioeconomic groups, subsequently taking concerted action to assuage those disparities. From infant mortality to rates of diabetes, people of color are more burdened than their caucasian counterparts. While some genetic differences may account for a small portion of these differences, it has been demonstrated time and again that socioeconomics and the very stress of living in a racist society can indeed have a significant impact on health outcomes. Of this we are now certain, although some are still not convinced.

So, enter my new, young and earnest Cape Verdean volunteer, who is excited that I even know anything at all about her language and culture. When health care professionals and agencies take pains to make contact with marginalized and vulnerable segments of the population, everyone benefits. Gathering data on sub-populations and ethnic groups is a useful and intelligent undertaking which, as a bridge-building exercise, encourages dialogue, communication, and the building of trust. Vulnerable citizens with poor English-language skills and discomfort with American culture are more likely to reach out for assistance and utilize existing services if they feel seen and understood. While a well-meaning white outreach worker without appropriate language skills can make some inroads, a worker who is a native of the target population's country and who speaks the language fluently can make significantly more progress within a community that may feel collectively invisible.

My town may still be white by a vast majority, but our segments of Latino, Caribbean, and Asian citizens is apparently growing by the month. Cambodians, Tibetans, Cape Verdeans, Central Americans---these communities are all growing, and even as their children learn English and quickly become Americanized translators of culture and language for their elders, reaching out to those elders who are less comfortable with the transition to American life is key. I will use this new volunteer energy to my benefit, and to the benefit of our town, our department, and the people who we serve.

Reaching out to the margins is crucial, and as bridges are built, those living on the edges become significantly less marginalized. The margins make us see that we are all more similar than we are disparate, and taking culturally sensitive action in order to serve those who are most vulnerable improves the quality of life for all concerned. The reach of the human heart and its compassion is without measure, and I have seen for myself how magic can happen when our arms are opened wide enough to embrace those who lack our cultural, economic, and social privilege. Our community's diversity is an enormous strength, and our ability to welcome all into the heart of the community speaks volumes about our singular and collective humanity.

(c) 2009 NurseKeith

Social Justice, Public Health, and the Pursuit of Happiness

The health department where I am currently employed is the recipient of a three-year social justice grant from a large national foundation. Despite a steep learning curve vis-a-vis emergency preparedness, the coordination of our local Medical Reserve Corps, and developing wellness programs for town employees, the social justice mission of our little health department is one of the most intriguing aspects of my new workplace.

When one generally thinks of public health, one thinks of communicable and infectious diseases, vaccinations, disease surveillance, and epidemiology. But I am learning that access to health care, food insecurity, and access to adequate housing can all be seen under the umbrella of public health, especially when looking at these issues through a social justice lens.

In addition to our social justice grant, our health department also boasts a Cambodian outreach worker who is responsible for outreach to the Cambodian refugee community in our area, a sizeable cohort which has varying levels of need vis-a-vis health care access and other social issues.

For American-born citizens, refugees and immigrants alike, free and equal access to adequate health care is indeed a privilege in this country, but it is a privilege that many of us prefer to view as a basic human right.

Along with housing, employment and education, my progressive heart wants to see every American have free and unfettered access to as much education as his or her heart desires; comfortable and affordable housing; gainful employment; sufficient quality and quantity of food; and high-quality and accessible health care. Call me a bleeding heart, but my personal vision of social justice includes what I see as essential components of "life, liberty, and the pursuit of happiness."

In terms of my work as a Public Health Nurse, I want to remind myself that the "public" aspect of my job entails my responsibility to the public, the people who live within the geographic area of my jurisdiction. The Human Rights Commission in our town is very active, and I see part of my duty as the PHN to reach out to this group (and others) who spend their time assuaging the suffering of our homeless, hungry, and uninsured.

Aside from the nuts and bolts (and syringes) of my work, I want to delve into the area of social justice wholeheartedly. There is nothing more worth fighting for in my book, so why not start right here at home?