01/13/11 — Health Department to focus on prevention in new year

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Health Department to focus on prevention in new year

By Phyllis Moore
Published in News on January 13, 2011 1:46 PM

The Wayne County Health Department provides a wide variety of services to county residents but Director James Roosen said the department's role can be boiled down to one crucial job -- prevention.

The department also is vital to helping many people who have no family doctor find appropriate health care.

"We're that little niche that provides all this extremely important medical care for folks who don't have access," Roosen said. "In prenatal care, we're the largest provider for pregnant women, to give them a link to prenatal care in this county. About 46 percent of all pregnant women come through the Health Department."

In a typical month, the department sees upward of around 5,000 people, either through its communicable disease clinics, family planning programs, prenatal care and its Women, Infants and Children (WIC) program. In addition, its Environmental Health office handles inspections of hundreds of restaurants and other food providers.

Maternity Program manager Rose Wagner estimated that there are about 500 prenatal patients currently being served by the department, with an average of 300 new patients seen each year.

The highest number of clients, however, are seeking treatment for communicable disease. The county's rate of sexually transmitted diseases is among the highest in the state. Tuberculosis also continue to be a problem.

"Currently we have got nine cases of active TB, maybe (more) that have TB infections and positive skin tests and probably been exposed to someone that's had TB in their lifetime," said Josa Raynor-Vaughn, the department's communicable disease manager.

"With communicable disease, the last time I looked last year we had some 1,000 cases of STDs in Wayne County and HIV, we're averaging about 25 new cases," Roosen said.

"A huge problem in Wayne County is that we have seen a syphilis epidemic. For 2003-04 we had three cases both years. Now over the last 18 months we have had over 18 cases that we know of. The problem is, what other illnesses will it cause? Increased infection rate of HIV but that's our big concern right now."

During 2010, one of the strategies to counter the rising numbers was to go out into neighborhoods and test people. Through "Get Real, Get Tested," some 300 residents were tested from high-risk areas.

The Health Department administers around 400 STD tests a month. The WATCH program, which operates a mobile health clinic, has also gotten on board, averaging about 30 syphilis tests a month.

But there is still a need for more to be done, Roosen said.

"I have been in touch within the state to get more help at the local level for a state employee for at least six months to help us with testing at the Health Department. We're very short-staffed."

One measure that has been proven effective is the "open access" system of seeing patients. Launched in September 2009, two years after introducing a similar process in maternity care, the set-up allows patients to be treated more quickly.

"Patients are scheduled every 15 minutes -- doing today's work today -- people can walk in and be seen today," explained Clinical Nursing Supervisor Wanda Westbrook. "I think we're seeing higher numbers of people but they don't turn anybody away unless they come at five to 6 and have to come back the next day."

The flu clinic has also tried to keep pace with the winter flu season and the Health Department was recently notified of money available to provide more flu shots. The department has administered about 1,000 flu shots so far and is still offering them to any resident for free.

"Public health is always the last one to try to clean things up so we'll get some funding to attempt to protect everybody that's in our community against flu. We're seeing a slight increase in our flu cases but we haven't really seen it erupt like it did last year."

With the state budget shortfall looming, Roosen said he is concerned that one key position on is staff will not be filled. The minority health coordinator has proved a valuable addition, but the person holding the job left in the fall and Roosen said he is worried that if the department's state funding is reduced, it might lose that position.

"That was an extremely valuable program. With state budget cuts, we're not sure if there will be any money available and won't know until July," he said.

"The issue is minorities unfortunately are affected by much higher rates -- heart disease, diabetes, out of wedlock births, teen pregnancy rates, cancer. One of the big reasons is the economics. Our rate of uninsured children is 15 percent higher than the state average. So I guess the main question is, 'Who's taking care of these kids? How are we identifying these kids and getting them into a system of care?"

One area that Roosen said has become a "huge resource" is the department's dental clinic. On average, about 20 patients are seen each day, but there is a gap in services for children.

"What we're attempting to do is get more Medicaid children into that clinic," Roosen said. "Only about 50 percent of those kids are seeing a dentist. Sometimes they're having severe decay that could have been fixed if they'd just seen a dentist at an earlier age. That's a big focus of public health.

"We had over 400 kids that were found in our schools by the state dental hygienist or the school nurses, with dental needs."

Preventive measures are also vital in another area, teen pregnancy. The Health Department is presently seeking $625,000 in grant money that will target subsequent pregnancies among teen mothers, Roosen said.

"This is to prevent secondary teen pregnancies. Over the last two years we have had a record number, about 500 pregnancies among teens ages 14 to 19 years of age," Roosen said. "Unfortunately, kids are getting pregnant."

The local teen pregnancy rate has dropped slightly, by 6 percent, he noted.

"We're still above the state average. We would like to get lower," said Steve Anderson, the department's family planning program coordinator. "We're doing everything we can to get it lower."

About 29 percent of patients seen in family planning are 19 years old or younger, Roosen pointed out. The problem is multi-faceted, he said, and the cost to society can not be underestimated.

"The average person paying taxes now doesn't understand the cost of teen pregnancy. Not only the up-front cost but also what it means to the future of our society," Roosen said. "It's a very complex issue in terms of what it means to our society, but I can tell you it affects our economy tremendously. These children are having children."

In Wayne County, the repeat pregnancy rate is 30 percent -- 27th in the state.

"There were 581 pregnancies among teens between 2008 and 2009," Roosen said. "Fifteen of those were girls age 14 or less. Right now our teen pregnancy rate is 22 percent higher than the state average, with 92 abortions among 15-19-year-olds in 2008-2009.

"Repeat pregnancies is something that we really need to work on and we're attempting to do that."