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[Mar. 5, 2003] -
We're hearing more about public health these days. Last summer departments kept busy tracking the spread of the West Nile virus. Now local agencies prepare for potential bioterror attacks. For a long time, just a few cities and counties in Nebraska had local health departments. But changes in state law and money from a lawsuit against tobacco companies led to the expansion of public health coverage to the entire state. Statewide's Brad Penner looked at what that means for Nebraskans.
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Transcript of Healthy Growth
[Brad Penner/Reporting] This looks a lot like a doctor's office. Physician Assistant Linda Acuna examines her patient to see what's wrong. But Linda Acuna doesn't work for a private medical practice.
[Linda Acuna] At this time we see uninsured patients, and probably about 80-percent of those are spanish-speaking.
[Brad Penner] Linda is Clinical Services Director for the East Central District Health Department in Columbus. The medical clinic provides basic care. Local physicians regularly volunteer their time to treat patients who can't afford an office visit.
[Linda Acuna] A lot of these patients, they haven't seen a doctor, they just try to muddle through on their own. They feel embarrassed to come here cause they don't like to have to ask for help. But that's what we're here for. We want to help those that wouldn't have anywhere else to go.
[Rebecca Rayman] That clinic was set up based on a gap in the community.
[Rebecca Rayman, East Central Director] We have a lot of employers who are having to look at how they can save cost in tighter economic times and so they're dropping health insurance. And so we're having a greater number of people who are uninsured. In Nebraska, just last year, they dropped over 32 thousand individuals from Medicaid.
[Brad Penner] Rebecca Rayman helped start this health department in 1999. It's based in Columbus, but now serves 4 counties: Platte, Colfax, Boone, and Nance.
[Rebecca Rayman] There are three core functions in public health and those are assessment, assessing the needs of the community, policy development, developing policies or programs that meet and take care of those needs. And then assurance. Assuring that the programs that are in place are doing what they were designed to do.
[Brad Penner] Rayman says they used several focus groups and surveys to learn what people want. They made a special effort to include spanish-speaking residents.
[Rebecca Rayman] And so we literally sent people out and knocked on doors and said, you know, would you like to fill out a survey for us.
A concern we found in the focus groups was a lack of dental care. That was a concern we found when we went door-to-door and did surveys was a lack of dental care.
[Brad Penner] Rayman expects to open a dental clinic next year.
Some of the state's newer health departments are still assessing the needs of the people they serve. Small staffs make it difficult to offer many services. Dr. Arturo Spindola predicts that will change.
[Dr. Arturo Spindola, Chief Operating Officer] As they mature and grow in scope, we will see the results. We're seeing one result now, Nebraska is the leader in the nation as far as bioterrorism preparedness is concerned.
Local health departments play a key role in the state's smallpox preparation plan. They're involved in education, prevention, and potentially treatment if an outbreak occurs.
[Betty Plankinton] I have done 30 smallpox presentations in the four counties since November.
[Brad Penner] Bioterrorism manuals fill a shelf in Betty Plankinton's office. She's responsible for the local smallpox plan.
[Betty Plankinton] Now we know where it comes into for our area. We know that we have to go get it, we know how it's going to be distributed out, we know who's going to get it there.
Nebraska's chief medical officer pushed for legislation that led to the statewide system of local health departments.
[Dr. Richard Raymond, NE Chief Medical Officer] If we were 2 years ago where we didn't have health departments in Nebraska, I don't know how we would've got this done. We would've had to go to the community and asked for volunteers; the physicians clinics, the hospitals, community action agencies, and in every community it would've been a different group that stepped up. It would've been very disorganized. I just can't imagine how we could've possibly achieved these goals 2 years ago.
[Brad Penner] Rebecca Rayman compares Nebraska's public health system to law enforcement.
[Rebecca Rayman] So I think that's an important piece for people to know, that public health is there to protect their health. Protect their health from tuberculosis or hepatitis or now with the bio-terrorism threats that it's public health that is there doing a smallpox preparedness planning. That we're really here to serve the whole community. Public health is not just about one sector of the community or one segment. Without public health, it places the whole community at risk. I can equate having a local health department as opposed to the state health department in the same way that we have local police stations. And here in Columbus, we have a local police department and then we have the state patrol. And they both serve vital functions. But without-with just the state patrol, we'd have to wait a long time every time there is a burglary or every time there is a local problem. And that's the same thing with public health. If you have something locally, they can respond much faster and more efficiently.
[Brad Penner] But a local health department does more than react to outbreaks.
Nurse Rosa Hardesty examines children in the WIC program. WIC stands for Women, Infants, and Children. Pregnant women and mothers who meet income guidelines get vouchers for food, and guidance on how to use it.
[Rosa Hardesty, WIC Nurse] I really enjoy the program because I can really keep track of the progress of the children. A lot of them come in and they're not really on target as to their development and their hemaglobin might be low, and then of course with the help that we give them nutritionally you can see the improvement.
[Rebecca Rayman] The WIC Program alone does a thousand five hundred and sixty-seven visits a month currently in our four-county area.
[Brad Penner] Monica Reyes says her son Jesse likes to eat the food she receives through WIC. She likes the guidance Rosa provides.
[Monica Reyes, WIC Client] I like the information because it's really helpful.
[Brad Penner] In Columbus, that help is available in English or Spanish.
Selia (Sally) Meza usually spends part of her day interpreting for clients who don't speak English. Most of the time she's at the front desk doing paperwork or answering the phone.
[Selia Meza, Clerk/Translator] I've got a lot of people, like my regulars, and they'll call me and say is my appointment today, or what's today's date, is it ok if I come in now. A lot of time we encounter a lot of women who don't take interpreters to their doctor visits so they turn to us with questions you know.
[Rebecca Rayman] And what we have done is to recruit and train individuals from the community who are bilingual, bicultural. And so I have 36 employees on a contract staff who make the health department run. And about 15 of those are bicultural bilingual individuals. And when you're serving a population that is 60 per cent on-English speaking, you have to address that.
[Linda Acuna] We work really hard to make it a comfortable place. And part of that is the bilingual staff that we provide. And also any type of signs that we have up we try to make them bilingual.
I think we've really met a great need that a lot of our patients that don't speak any english find it difficult in any other place to get service. Here they kind of understand what's actually happening.
[Brad Penner] In the clinic, Linda Acuna and the volunteer physicians often see patients with conditions that could grow much worse if left untreated. Without the clinic, they might end up in an emergency room, costing the hospital and the bill-paying public.
[Dr. Arturo Spindola] By keeping the population from reaching the acuteness point of going to the hospital, I think we're doing a big service to the community and not only to our target audience.
[Rebecca Rayman] A public health department has the responsibility to protect the health of the citizens within its jurisdiction. And so I think that's the most important thing is that public health is for everyone.
[Linda Acuna] I'm never bored. And the patients are just awesome. They are so appreciative, and that just makes all the difference for me.
[Brad Penner] Nebraska's new local health departments won't look exactly like the east central health department, but they will work to make Nebraska a healthier place. Reporting for Statewide, I'm Brad Penner.