Author: mnabavi

“How did this happen?” “Is this America?”  These are the contemplative and persistent questions that come to mind while walking through the Katrina Exhibit at The Louisiana State Museum.  The exhibit is housed at The Presbytère, an eighteenth-century architectural gem on Jackson Square in New Orleans.  It has been nearly thirteen years since Hurricane Katrina hit the city of New Orleans, but time stands still as we walk through the exhibit.  The exhibit opened in 2010 and features eyewitness accounts, historical artifacts, interactive exhibits, and historical as well as scientific information on hurricanes, geography, and the levee systems.  The museum was created to provide an educational experience highlighting the failed processes that led to the magnitude of the disaster and emphasizes the efforts toward recovery.  The museum inspires its visitors to think about the importance of mitigation, preparedness, and response operations and the relationship between poverty and disaster outcomes.

The Katrina Exhibit was designed to answer questions posed at the beginning of our blog.  From a public health perspective, it is important to evaluate the effects of hurricanes and how they impact the health and livelihood of a community.  To quote the philosopher, George Santayana, “Those who cannot remember the past are condemned to repeat it.”  The exhibit describes the history of larger hurricanes that have impacted Louisiana. After learning of Hurricane Betsy, a.k.a Billion Dollar Betsy, our group recognized post-disaster outcomes (e.g. disease, injury, death) and how these outcomes can be exacerbated by poverty and not having effective emergency protocols and mitigation systems in place.  The exhibit showcases photographs and personal stories of the destruction which can be prevented in future storms.

Katrina was not a discriminatory storm and affected all in her path.  The aftermath of the storm left immense environmental impacts.  As public health students, we recognized the social determinants of health while reading through the displays.  There are too many facts presented in the exhibit to mention in this blog, but there were a few memorable stories that stood out.  Seats from the Superdome were displayed to represent the shelter that was used at its height for 35,000 people.  The living conditions within the Superdome were unfathomable with stifling temperatures, filthy conditions, and a disgusting stench.  Another display features the diary of a gentleman, the late Tommie Mabry, who wrote about the conditions he experienced while stranded at his home.  His memories are somber to read with his thoughts on survival, his thankfulness for friends and neighbors, and how he kept busy during the period following Katrina.  Furthermore, Mr. Mabry wrote about being unwell and his worries about not having access to healthcare.  Both of these displays from the exhibit are demonstrative of how the residents of New Orleans suffered.

“The Hurricane was fair, we were all affected, all devastated. The aftermath was not, the resources were not, the breaches were not. It was an injustice.”

Over a span of thirteen years, many efforts have been dedicated to social, economic, environmental, and infrastructure recovery in New Orleans. The former mayor, Mitch Landrieu, declared in 2017 that New Orleans is “no longer a recovering city, but a city that has recovered and is now moving forward.” Some community members beg to differ.  Many residents believe that New Orleans has a long way still to go. 

There have been improvements.  New evacuation policies, procedures and routes have been put in place for quicker evacuation of residents from the city, including those with disabilities and lack of transportation. Statues have been erected that mark evacuation points throughout the city were people can congregate to board buses to be evacuated out of the city in an emergency. Despite mistrust in the city towards the Army Corps of Engineers and the Flood Protection Authority, new and improved levee systems have been put into place. However, we learned through an interactive display at the Katrina Exhibit that nothing can mitigate storm surges in southern Louisiana better than the natural protection of marshes and swampland. However, this barrier is slowly disappearing.

The Lower Ninth Ward had some of the most traumatic effects from the storm. Homes were swept away, knocked off their foundation, and some residents were found drowned in their attics.  On top of being a low-income neighborhood, Katrina left the community groveling for help and resources. The neighborhood is primarily African American and historically was the first neighborhood where African Americans could own homes. Many of the homes in the community have been passed down through the generations and very few had homeowner’s or flood insurance.

In a speech addressing the issues related to Katrina, President George W. Bush stated, “deep, persistent poverty in this region [with] roots in a history of racial discrimination…We have the duty to confront this poverty with bold action.”  When disaster struck the Lower Ninth Ward, the neighborhood was left with very few options on how to move forward. This community was not financially sound, uninsured, and eight feet below sea level.

With so few options on how to advance, the neighborhood turned to government support and outside help. We learned of three programs that began after Hurricane Katrina to help the residents were “The Road Home” program, the “Make it Right” program, and Habitat for Humanity.  Not all programs were successful or equitable. Director of lowernine.org, Laura Paul, gave us insight into the rebuilding projects within the community. “The Road Home” project initially was based on tax appraisal values, rather than the costs of rebuilding. Homes in the area had not been appraised in the years before Katrina.  So residents were left without the resources to rebuild.  There was a major court case lodged against the program that won. At this point, however, a lot of the money allocated to the program had already been spent, so it could not really contribute further to the rebuilding of the Lower Ninth Ward. The “Make it Right” foundation, founded by Brad Pitt, has accepted environmentally sound housing designs from all around the world. Using these designs, various homes have been built within the Lower Ninth Ward. Curtis, our navigator, who has been driving through the Lower Ninth Ward numerous times following Katrina, noted the gradual improvements within the community with each visit. Despite the advancements made in this community, there is still much to work to be done as evident by the conditions of the road including inoperable fire hydrants and open storm drains. With the efforts from long-term disaster recovery organizations, such as Laura’s, hopefully we will continue to see further development in the Lower Ninth Ward.

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Our Daughters of Charity, an organization older than New Orleans itself, and operating within the city for more than half of its history was founded in the 1600s by St. Vincent de Paul. This rural priest became concerned when visiting a sick family that their farm would fall into disrepair and called on his congregation to step up in order to assist this family in maintaining their livelihood while they recovered. Much to his surprise, his community jumped at the offer, showering the family with assistance in the form of food, caring for their livestock, and his idea began to evolve. Through his inspiration the Daughters of Charity were formed in Paris, working directly with the people of their communities where they lived, making an impact by really considering where their patients lived and worked.

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The nuns and healthcare providers associated with Our Daughters of Charity lend a hand in many areas of public health and population health, founding hospitals and orphanages in many countries, including the first hospital west of the Mississippi River. With their unyielding focus on community health, this organization has evolved even further to what we see today, hard workers in the Big Easy, establishing comprehensive health centers in underserved areas to fill the gaps left behind, especially after Katrina. In fact, the Daughters of Charity–which is now a recognized Federally Qualified Health Center (FQHC) — is an extensive network of care centers which opened several locations in the NOLA area just one month after Katrina decimated 80% of the healthcare entities in Orleans parish. The organization, lead now by CEO Michael Griffin, a doctoral student in the UAB School of Health Professions, has since opened 10  health centers spread throughout the greater New Orleans area.

The Carrollton Healthcare Facility, in particular, has an interesting renovation story. The current building was formerly a Chase Bank that sat just below sea level. After Katrina, any renovations to buildings over a certain square footage and new buildings had to be built at a higher level. The health center was built around, and above the old bank leading to an interesting series of stairs and elevators to get around the clinic. One hallway even takes you past the old bank vault! What a great metaphor for their work the center does in securing the health and well-being of their clients! Unfortunately, the vault is below sea level and would not be an appropriate safe space during hurricanes or flooding, but it would be great during tornados!

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The organization impressively covers a wide array of services in their health centers; adult, pediatric, diagnostic, pharmacy, dental, chronic disease management and prevention, optometry, women’s health, behavioral health, counseling services, and many more. These centers have taken on a Patient-Centered Medical Home (PCMH) designation allowing them some flexibility when working in the best interest of the community.  In addition, Our Daughters of Charity has created many community-focused programs to address some of the significant health concerns of the population including diabetes and cardiovascular health.  The diabetes program includes a support group for members of the surrounding community. In fact, they were preparing for a meeting with those enrolled in the program while we were there.  This program educates participants about their condition and shows them ways to manage their health by providing them with fresh vegetables and other groceries and teaching ways to prepare them in a healthy way. Bags of nutritious foods were already prepared, ready and waiting.

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One of the amazing capabilities of Our Daughters of Charity is its electronic medical records system, which is connected to other providers around the city.  Staff at Our Daughters are notified if one of their patients checks in to an area emergency department. This ability leads to greater continuity of care and enables staff to identify which patients are having to utilize emergency services most often. This knowledge will be used to prioritize the tasks of newly hired community health workers funded as part of a new Robert Wood Johnson Foundation grant that Our Daughters of Charity has received. Through this grant, the community health workers will be able to identify and work directly with those individuals who frequently utilize emergency health services. Their work will extend into communities to address the barriers their patients have in living a healthier lifestyle.  This will truly be an amazing program that benefits the communities through personalized attention.

By the end of our visit, we were truly amazed at the work that Our Daughters of Charity has been and is doing in the city of New Orleans.  They are able to maintain their Catholic values while adhering to the federal requirements of being an FQHC and, at the same time, work to meet the needs of the community they serve.

Team 2 – Tessa, Kachina, and Dekennon

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While experiencing record high heat in NOLA, we navigated the busy streets to City Hall, where the New Orleans Department of Health (NOHD) is located. We made our way through security to the 8th floor, overlooking the city that is known for its vibrant culture, jazz musicians, and amazing food.

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“Hello, everyone! Welcome!” exclaimed Monica Hernandez-Wilmer, Special Assistant to the New Orleans Health Director, while we stood in the dim, marble-lined hallway. Greeted with smiles and open arms, we all felt welcomed and at home when we were introduced to everyone. Fran Lawless, the NOHD Health Director, greeted us and explained to us the mission and vision that they refer to when they are protecting the health of the residents of The Big Easy.

After getting settled in, Katherine Cain, the Quality Improvement & Performance Management Program Leader, led a presentation that described the city, its demographics and health statistics. She discussed the numerous programs that the department has incorporated. The goal? To improve the health and well-being of all of its citizens.

We found that the NOHD is very much aware of the many health disparities throughout the city, and they are doing everything that they can to eliminate them with the limited funding they’re given. They are partnering far and wide with entities such as the LA state health department, the LA Public Health Institute and many non-profits throughout the city (such as Our Daughters of Charity, which is next up on our tour) to provide the needed services and programs that the health department doesn’t have the funding to do alone. They are applying for grants and looking for other sources of funding to supplement the federal pass through dollars they receive from the state and the limited budget they receive from the city (0.3% of the city’s total budget goes to public health.) They are walking the tightrope between prevention and treatment on a rope made of limited funding.

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The mission of the New Orleans Health Department is to protect, promote, and improve the health of all where we live, learn, work and play. This is seen through the programs and services that they have available for the public. The two programs that seem to enhance and protect the culture of the city are the smoke-free ordinance and the soundproof initiative. Within the smoke-free legislation, restrictions are placed on where people are able to smoke cigarettes (regular and e-cigarettes) and vapes. Whereas, the sound proof initiative is to protect the community from loud noises through education (exposure and length) and hearing protective devices. According to Cain, these ordinances allow for the protection of not only the public, but of the musicians who keep the music flowing and the culture alive. Another important program is Healthcare for the Homeless. This allows for men and women, regardless of health insurance status, to receive primary health care services.

Included in the care are the following:

* Annual check-ups

* Immunizations

* STD and HIV testing

* Dental Services

* Medicaid Sign-up

* Behavioral Assessment

Without the expansion of Medicaid in New Orleans, certain programs would not have been accessible or even possible. This expansion led to health insurance coverage to be widely spread throughout the state, especially dental care and mental health services. To improve on the mental health care status of the city, the New Orleans Health Department has a partnership with NOLA police. Within this collaboration, the officers are trained to identify and communicate effectively with persons with suspected mental health issues. Not only are the police trained in sensitivity, but they are able to refer the people to case managers and get them the care and treatment they need.

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It is the citizens of New Orleans that make this city thrive, so it is vital that they are healthy no matter their socio-economic status. Torrie Harris, DrPH, MPH, the NOHD’s Health and Equity Strategist, stated the importance of health in all policies, and ensuring that those policies are equitable for everyone in the city. As the department continues to support the community efforts that fill the voids left in the city, they continue to launch additional efforts to achieve health equity. It is without a doubt that New Orleans is the heart of Louisiana, and even in sweltering heat there is no place like NOLA.

https://www.nola.gov/health-department/

Team #3 — Alyse, Danielle, & Deanne

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As we drove along the bumpy dirt road outside the city of Purvis in south-central Mississippi, it was hard to believe that we would be standing on the site where not one, but two, nuclear detonations had occurred. We were driving back in time to 1964, the height of the cold war. The arms race with the Soviet Union was in full force, and the country had recently experienced the threat of nuclear annihilation during the Cuban Missile Crisis. To reduce the escalating tension, the US signed the 1963 Partial Test Ban Treaty with the Soviet Union. The treaty banned nuclear testing in the atmosphere, space, and underwater but not underground because there was no reliable method to detect and measure underground testing. The US government was on alert, and Americans were afraid.

Under these conditions, the US Atomic Energy Commission (AEC) developed Project Dribble with the goal of learning how to detect or avoid the detection of underground nuclear testing. There were two detonations carried out in the geologically unique Tatum Salt Dome, 2,700 feet below the earth’s surface, and 21 miles from Hattiesburg, Mississippi. On October 22, 1964, the first nuclear blast, one-third the force of Hiroshima, left a cavity 110 feet wide in the solid salt deposits far below the ground. Before the detonations, the government authorities explained the general plans of the project which was code-named Project Salmon to area residents but failed to adequately discuss the potential hazards or address some citizen’s concerns. Some local citizens protested against the planned nuclear testing but were generally ignored and told that the role they played in supporting the project was a great service to the country.

On the day of the blast, schools closed, the government ordered the evacuation of a 2-mile radius around ground zero and compensated residents: $10 per adult, $5 per child. Eye-witnesses said the force of the blast caused the ground to move like waves in the ocean, foundations and chimneys were damaged, wells went dry, and some reported that the force killed cattle lying on the ground during the blast. The second underground nuclear detonation, Project Sterling, was carried out in 1966 in the subterranean crater left by the first blast. This test was a much smaller, and the shock waves were muffled 100-fold because the explosion occurred in the cavity as opposed to solid salt or earth. Residents did not notice the effects of the second blast and no damage was reported. The project was considered a success because valuable knowledge about underground nuclear testing was reaped from studying the blasts.

The magnitude and damage from the first blast were much more severe than residents had been led to believe from government estimates. The local newspaper in Hattiesburg (21 miles from ground zero) reported that its office building swayed for three minutes after the blast. Testing of the area soon after the first detonation showed no radioactive contamination of soil, water, or air. Two months after the testing was completed, researchers drilled a hole into the cavity to lower measurement instruments. Soil and water right around ground zero were contaminated when the drill was brought back to the surface. Attempts were made by the federal government in 1964 and 1966 to clean up the site. In 1972, the buildings at the test site were bull-dozed, and the waste was sent to the Nevada Test Site. The remaining radioactive material (solid rock, dirt, and water) was buried and sealed in the cavity left by the detonation 2,500 feet below the surface. The Department of Energy erected a granite marker and brass plaque warning future generations not to drill or dig at the site.

Not long after the testing, residents began complaining of poor health. There was growing suspicion that the blast had exposed them to harmful radiation speculated to be primarily through water contamination from the site. Decades-long monitoring and testing of the area has never shown evidence of harmful contamination of drinking water.  A seed of mistrust grew over the years, and many residents of Lamar County began to attribute cancer deaths to Project Salmon. In an attempt to allay those fears, the federal government helped residents build a pipeline to assure that drinking water came from a source far from the Project Salmon site. Regular testing protocols were put in place to guarantee the health and safety of the public. Epidemiologic studies were conducted to look for a connection between incidences of cancer in the area and the project. No correlation could be concluded based on scientific data. Despite these efforts to assure residents that there is no evidence of harm to their health from the project, their trust remains eroded.

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Regular testing of soil, water, plants, and animals continues today and is conducted by the state of Mississippi which was deeded the land above the site in 2010. The Mississippi State Department of Health’s Division of Radiological Health carefully monitors the ground and surface water around the site for any elevated levels of tritium, the isotope that results from the decay of the nuclear material sealed in the Project Salmon cavity. Trace amounts of tritium occur naturally in the environment. It is harmless to people and animals at low levels. The Division of Radiological Health is an expert team lead by B.J. Smith. We met Director Smith as well as the leading health physicist, Karl Barber, and his team of dedicated scientists at the Project Salmon site. Every three months, they collect surface water around the site and send it to their lab for analysis for tritium. The same testing is conducted every 18 months on samples drawn from 70 different individually drilled wells around the project site. Even the frequency of testing can bring about suspicion in the community. As Mr. Barber explained, ‘If you test more often, people worry. If you test less often, people worry.’ The amount of tritium measured in water samples from the test site, private wells, and municipal water supplies has been far below the maximum level set by the EPA for safe drinking water. To provide transparency about the site, the Division of Radiological Health shares the results of all testing and provides an explanation of those results with the public in an online annual report.

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Some residents still believe Project Salmon was harmful to their health despite scientific data and repeated testing that proves otherwise. Communicating with the people is essential.  If the Department of Energy had held community meetings, formed a focus group, or given interviews about the project plans with local journalists before the project started, they would have earned the public’s trust from the beginning. Since 2010, the staff of the Division of Radiological Health has met with members of the community to listen to concerns and provide answers. The team from the Division of Radiological Health has even hosted community fish fries with fish from area lakes to prove they are safe to eat. Nevertheless, local legends of alligators with antlers supposedly resulting from Project Salmon-contaminated water persist. Once trust is eroded in a community, it may take generations to restore it. By listening to residents, we will better understand their needs and be able to work with them to meet those needs. Fully engaging area residents in a project from the planning stage to the evaluation stage is essential to good public health practice.

Team C³– Clair, Courtney, Catherine

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Boswell Regional Center – Then

Today, we traveled back into the early twentieth century, and learned about a man who believed that all people deserve access to healthcare regardless of race, status, or age. We first learned about Dr. Henry Boswell from Gloria Beckett, MPH, a Branch Director II with the Office of Tuberculosis and Refugee Health at the Mississippi State Health Department (MSDH). Dr. Boswell worked tirelessly on providing a holistic approach to treating all people that were diagnosed with tuberculosis.  Dr. Boswell, an Alabama native, moved to Mississippi in the early 1900’s where he practiced medicine.  Shortly after his move, he contracted tuberculosis. He was treated in El Paso, Texas at a local sanatorium where he was inspired to design a tuberculosis sanatorium to serve Mississippians with the disease. So when he returned to Mississippi in 1916, he went before the state legislature to obtain initial funding for the sanatorium – $8,000.  The city of Magee, MS, generously donated 200 acres of land to the cause.   A later allocation of $25,000 by the Mississippi legislature allowed further expansions at the site.  Dr. Boswell saw his vision come to life as his sanatorium prevented and suppressed the disease by providing a relaxing green space with healthy foods. This facility encompassed a healthy living environment that included a patient residence area, infirmaries, power plants, laundry, a post office and a nurse dormitory. It was a self-sufficient community (at one time named Sanatorium, MS) with a dairy farm and gardens on site.  We had the pleasure of touring the sanatorium grounds, guided by Kara Kimbrough, Public Relations at Boswell Regional Center (BRC), were we were able to visit the Mississippi State Sanatorium Museum and tour some of the original buildings that still remain from the early years of the sanatorium. 

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Because of the innovations of not only Dr. Boswell but the many other physicians and staff that worked at the site, Mississippi saw healthier outcomes for its communities.  Reductions in TB diagnoses were seen across Mississippi in the mid-twentieth Century.  These reductions were partly due to the work of those at Boswell, and partly because of the implementation of portable treatment units by the department of health that would go out into the communities to find those with TB.  The advent of antibiotic treatments made even greater strides in controlling the disease. Even though the sanatorium closed its doors in the 1970s, tuberculosis continues to be a relevant concern in Mississippi. Today’s concerns are multifold and linked to the social determinants of health. Antibiotic resistance is a growing global concern. The MSDH cited a few reasons for this phenomenon including lack of patient compliance, lack of medication adherence, and improper medication dosage. The MSDH also has fewer and fewer resources to devote to the issue.  Every year their budgets are reduced even though they are overspending the TB budget by millions of dollars to conduct testing and reach those with TB across the state.  Due to lack of resources, the fight towards managing tuberculosis still remains a challenge in the state of Mississippi.

What really surprised us during this visit was that in the 1930’s as part of the mission of the TB Sanatorium, a Preventorium was established in the name of a preventative program for TB in children. What actually was happening during this time of the Great Depression is that children were being dropped off at the gates of the TB Sanatorium because parents could no longer afford to feed their children. The staff at the time knew that this was the right thing to do, and did not turn these children away. Ms. Kimbrough shared that some of these children returned as adults to tour the site and share their stories and experiences with those at the BRC. 

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Boswell Regional Center – Now

When the TB sanatorium closed in the 1970s, the Mississippi Department of Mental Health acquired the facility and transformed it to the Boswell Regional Center that provides a continuum of care and services for individuals with intellectual and developmental disabilities (IDD). When the center was established, the primary focus was to provide permanent housing services and care for up to 35 people with IDD. Today more than 100 individuals live on campus at the BRC and another 300 individuals who live in the community with varying degrees of assistance and services (i.e. transportation, companion care, community support, living assistance, worker training, enrichment services, job services, etc.) from the BRC.  If one were to visit the BRC, one would see the dedication and sense of community that permeates. You can really see how staff are working to help each individual live a more independent and fulfilling life in whatever community they reside.

Mental health stigma continues to be a growing public health issue throughout the United States.  The BRC recognizes this and is working tirelessly to combat this in Mississippi.  Boswell’s policy is to never reject a patient despite their ability to pay. Improving the quality of life for individuals living with IDD, their families, and their community is at the heart of the BRC’s work to”make dreams a reality one person at a time.”

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What is public health without preparation and prevention? We don’t know either, and we aren’t sure that we want to find out! People like Jason Smith and Heath Williams, who work for Mississippi’s Center for Emergency Services at the University of Mississippi Medical Center (UMMC), use their years of nursing and emergency medical technician (EMT) expertise to conduct training sessions to make sure that both pre-hospital and hospital staff and responders across Mississippi are properly trained to care for patients with infectious diseases, such as Ebola.

While at the UMMC Infectious Disease Special Care Unit, we participated in an Operations Level Biosafety training where we were able to learn about the types of personal protective equipment (PPE) that health care professionals must wear when they are caring for a patient who may be infectious. During this training, we were instructed by Smith and Williams on how to work as a team to navigate the checklists and properly execute each step when donning (putting on) and doffing (taking off) PPE (which includes protective clothing and respiratory protection). This training is vital to not only ensuring the patient’s safety, but that of responder and hospital personnel. However, this is no easy process. From donning the many layers of protective clothing and gloves to wearing a powered air-purifying respirator hood, we realized it is not how it looks on TV!  This is far from looking like McSteamy from Grey’s Anatomy. However, there is no way around it. Any shortcut could lead to contamination and increased risk for contracting Ebola. 

MED-COM: Expecting the unexpected.

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When you walk into the MED-COM center at UMMC, Mississippi’s state-of-the-art emergency response communications center, you feel as if you are entering the Starship Enterprise. There are multiple screens so that the dispatchers can constantly monitor weather, traffic, helipad locations, and ER to ER emergency transfers. In mass casualty events MED-COM staff can help figure out which hospitals have the resources to accommodate multiple patients.  Also, due to the training and previous experience of the MED-COM dispatchers, they are able to assist paramedics in anticipating and meeting the needs of their patients. This leads to improved response times, improved transport times, and ultimately, improved patient outcomes.

From this visit, we learned exactly how much collaboration occurs between the various agencies and regional hospitals throughout Mississippi. When different health care and responder organizations are able to effectively communicate with one another, they are better able to coordinate resources and execute response operations across the state, potentially saving many more lives. Being prepared in the event of infectious diseases, mass casualties, and natural disasters is the best way to ensure that patients are able to receive the quality of care they need during those events. This visit gave us a glimpse of the type of coordination and activities that need to occur so that you and I have access to trauma care if/when we need it. It also showed us how important it is for communities to have the infrastructure necessary to facilitate effective response operations to large scale events.

Team #3 – Alyse, Danielle, & Deanna

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“MBK’s mission is to reduce health disparities throughout the United States by addressing the health and well-being of minority and marginalized populations through leadership and collaboration with the public and with community healthcare practices.” – http://mbkinc.org/

Through the past few decades a silent epidemic has been bubbling up throughout the Bible-Belt, HIV. In 2016, Mississippi was ranked 4th in the nation for new HIV diagnoses.  Though local health institutions and agencies are able to combat this disease through mitigating its effects on residents through treatment, challenges in funding and personnel to direct initiatives have left gaps in preventative treatments and programming. In the Jackson area, where My Brother’s Keeper focuses much of its work, an alarming 4 out of every 10 men who have sex with men(MSM) in the Jackson area have tested positive for HIV, the highest rate in the nation. If these men had their own country they would have the highest HIV infection rate in the world. In addition, to complicate the problem further the overwhelming majority of those infected are African American men–an all too common health disparity across our nation.

For more information on the HIV epidemic in the Deep South, check out this New York Times Magazine article: https://www.nytimes.com/2017/06/06/magazine/americas-hidden-hiv-epidemic.html

Team Blazin’, along with the rest of the Blazing the Trail team, had the opportunity this afternoon to visit My Brother’s Keeper. Having completing pre-trip presentations about the topic at hand, our group was not prepared for the level of enthusiasm that we encountered. One might expect that working in the field of HIV in Jackson, MS would be tiring, disheartening, and lead to significant burn-out. However, we were greeted with exuberance. The staff is dedicated, caring, and compassionate. They act like a family because they believe that we are all family, all people deserving of love and respect. 

After noticing that many of their clientele felt uncomfortable seeking healthcare due to a fear of judgment, stigma, My Brother’s Keeper decided it would open its own clinic. And just as they learned the needs of the community from the community, the name of their clinic was determined justly. Though My Brother’s Keeper has been functioning to meet the needs of underserved populations since 1999, one of their many amazing programs has only been operating since 2013. The Open Arms Healthcare Center –the name of which was crowdsourced from the community members who would utilize that care–is rightly named. To me, open arms are the symbol of an impending hug, and I love hugs. They make me feel cared for, loved, trusted, and above all like I belong. As we met with the staff, one member told us that individuals access spaces, in this case, health care centers, where they feel like they belong. Open arms, hugging, belonging, you get the idea. Open Arms cares for an impressive 4,000 clients a year and that number is likely to grow (with over 520 new diagnoses every year of HIV in MS). 

It is a sense of belonging, a sense of validation that appears to be one of the core tenets of MBK. They strive to serve the whole individual and the whole community, through what we might call a whole-person view of health, to eliminate health disparities and promote health equity for all Mississippians.

One program run by the MBK staff was called Man-Date. On a typical Man-Date, ten to twelve men would come together and be invited to write down whatever it was they wanted to talk about and place it in a fishbowl in the middle of the circle. Topics would be drawn out one by one and discussed with no judgment or shame involved. The goal of this fishbowl exercise was to engage with the whole person, not just their HIV status, their sexual orientation, gender identity, other health status, just a person with feelings, fears, desires, and aspirations. A person who belongs. And as we have seen, once belonging is established, healthcare can be accessed.

Though they still do tremendous work in both preventing and treating HIV, MBK has also taken the initiative to reach adolescents with programs such as Teen Pregnancy Prevention (TPP) and Future Ready which focuses on sexual and reproductive health. TPP is an evidence based intervention that focuses on using a full-scale approach to ensure a safe and supportive environment and partnering with youth oriented organizations to reach large diverse groups of the public. Future Ready provides sex education by establishing relationships within the community and incentivizing participants. 

My Brother’s Keeper prides themselves on creating a better quality of life for their patients. The organization is multifaceted with a focus on health disparities in the community. It is gratifying to know there is a group committed to fighting the HIV epidemic in the region with the level of enthusiasm and love of the MBK staff!  

Team 2 – Kachina, Dekennon, and Tessa

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“What keeps you coming in?” Dr. Lisa McCormick asked the room of officials and directors at the Mississippi State Department of Health (MSDH). We, the students, fell silent, leaning in to understand why. Why continue fighting against health disparities in Mississippi? Why continue fighting against the conflicting values of culture and politics and religion and community? Why keep taking on additional roles amid an ever-shrinking budget? Why?

“We want to make a difference for the folks in Mississippi,” said Kathy G. Burk, Director of Health Services.

“The need,” said Dr. Paul Byers, the State Epidemiologist. “The role we fill is unique.”

“The diversity,” said Meg Pearson, Pharm. D., Director of Public Health Pharmacy, referring to the group of people working together with different strengths and experiences towards the same goal of a healthier state.

            Many youth and adults in the Bible Belt take trips around the world each year – mission trips with their churches or youth groups designed to create an experience for Americans to minister to people in different countries. However, the United States contains places and communities that are in just as desperate need of support and care as a developing nation. According to Mitchell Adcock, CPA, CIA, CFE, CPM and Chief Administrative Officer, this state is one of those places. You don’t have to look far to see poverty and suffering. The people of Mississippi are in great need of additional health services. And the people that were in the room before us on this Monday are tasked with planning, implementing, and evaluating programs to deliver these services. 

  The atmosphere in the room was heavy with equal parts humidity and the weight of the responsibility of improving public health in one of the states with the most drastic health disparities. Public health services are not valued by the public until there’s a disaster. Additionally, ongoing disparities don’t often affect the most powerful and influential politicians or their constituents. After a series of budget cuts and administrative reorganization, the MSDH is trying to spread their resources over competing demands, including maternal and child healthcare, disaster preparedness, preventing and treating HIV infections, preventing and treating tuberculosis, and providing education to promote healthier behaviors.

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            While accomplishing this, officials must sashay through bureaucratic red tape, pirouette around cultural barriers, and glide in step with community organizations. Toes get stepped on. Sometimes they stumble. But fighting against the powers that be won’t create better health outcomes. And so they dance, working with partners in federal, state, and local government, places of worship, non-profits, community leaders, and rural areas. Their mission doesn’t belong to a political party or affiliation. All they want is for the people of Mississippi to thrive and prosper in health and well-being.

The social, environmental, and economic factors that influence both individual and population health outcomes (social determinants of health) for Mississippi residents are many. In the shadow of the Antebellum South, Jim Crow law, and systemic racism, Mississippi has the highest percentage of black residents than any other state in our nation. While schools teach abstinence as the only method of sexual education, teen pregnancy rates soar. While communities enjoy cultural southern delicacies, Type 2 Diabetes, and Hypertension claim lives. While stigma effects those living with HIV, rates of new infections in Jackson, MS rival those of underdeveloped nations. Competing values clash, and the most vulnerable residents are left in the wake.

            To address health, the MSDH can’t merely address prevention and disease treatment. Instead, they must waltz with Washington, cha-cha with community non-profits, tango with hospital systems, foxtrot with public education, and tap dance with religious organizations. They wake up and put on their figurative dancing shoes daily on behalf of Mississippians.

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We left the building with a newfound appreciation of the complexity and balance required for statewide public health practice. It’s certainly not an easy task but a worthwhile and necessary one. While Mississippi has a long way to go to reach health equity, it has a team of dedicated and passionate professionals fighting or dancing in its corner.

Team C³ – Claire, Courtney, and Catherine

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Today we loaded the bus and left for Jackson, Mississippi. But before we get to our first stop, we wanted to share what we’ve been doing to prepare for the trip.

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We started on Monday, May 7^th learning about principles of effective teamwork.  We did a couple of team building exercises, the most memorable being around team communication.  Students were broken into teams of three and each team member was assigned a specific role:  Looker, Runner, or Builder.  The Looker was responsible for looking at a simple structure built of tinker toys and relaying instructions to the Runner on how to begin recreating it in another room.  The Runner, who was not allowed to see the structure personally, then relayed instructions between the Looker and the Builder who were separate rooms.  This exercise demonstrated how hard it can be to communicate simple instructions and how easily a message can be misinterpreted!  One student, Tessa Graham, stated that this was one of the best team building exercises she had ever participated in and that it really drove home the point of how hard it can be to communicate between stakeholders who have different viewpoints or come from different backgrounds.   

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Next, we had the opportunity to visit the UAB Archives and talk with Tim Pennycuff, Associate Professor and University Archivist.  Mr. Pennycuff brought out many historical documents that related to the themes and topics that we will be discussing in this course and sites that we will be visiting.  He highlighted historical events and discussed how these events have shaped the health disparities we see today.  “It was exciting to see our very own Dr. Michael Saag in newspaper clippings from the 1980’s at the forefront of the battle of HIV/AIDS” said student and UAB employee, Claire Auriemma.  Especially knowing that he is still working just as hard today through the UAB Center for AIDS Research and the 1917 Clinic to reach the goal of zero new HIV infections in Alabama.

And finally, students collaborated on drafting working definitions of key themes we will see when on the road: population health, health inequities, and social determinants of health.  Each stop along the way was researched by student groups and introductory information was presented to the rest of the class before we set off on our journey.

All of this to say, we are excited, prepared and ready for what we will see and learn over the next two weeks!

Stay tuned for more blog posts from the UAB SOPH Explorers!

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Fifteen students will travel from Birmingham to Mississippi, Louisiana and Georgia to study population health and how social determinants of health and inequities are affecting health outcomes. The trip is led by Lisa McCormick, DrPH, associate dean for Public Health Practice and associate professor of environmental health science in the School of Public Health and Ms. Meena Nabavi, MPH, program manager for the Office of Public Health Practice.  

A nuclear test site, a tuberculosis sanitarium, and a quarantine station designated in the late 1800’s are just a few of the stops students will make on a two-week long journey that looks at both historical and contemporary public health issues across the deep south. Students will explore issues around poverty, pollution, infectious disease outbreaks and biosafety, chronic diseases, natural disasters and mass casualty disaster response. Officials from local, state, tribal and federal public health agencies will meet with students to discuss programs and infrastructure in place to advance health equity and address the social determinants of health impacting the populations they serve.  

The sum of this experience will illustrate the interdisciplinary nature of public health practice and introduce students to the value of working in rural, medically underserved communities and/or on behalf of medically underserved populations.  

The sites we will be visiting include Baxterville, Mississippi (population 7,343), where nuclear weapons were tested in 1964 and 1966 as part of a governmental project at the Salmon Test Site, Ft. Massachusetts on Ship Island, Mississippi, where one of the nation’s first quarantine stations was located, the lower ninth ward in New Orleans where effects from Hurricane Katrina can still be seen today, Tuskegee, Alabama to learn about the legacy of the Tuskegee Syphilis Study, and the Carter Center in Atlanta to learn about President Carter’s initiative to eradicate Guinea Worm across the world.  

Students will also visit the Mississippi State Department of Health, the New Orleans Health Department, the Poarch Band of Creek Indians Tribal Health Department, the Southwest District of the Alabama Department of Public Health, and the Centers for Disease Control and Prevention.  The Alabama Department of Agriculture and Industries will open the doors of the Thompson Bishop Sparks State Diagnostic Laboratory in Auburn, AL to teach students about the surveillance and monitoring of animal populations.  Auburn University School of Veterinary Medicine will meet with students to discuss the intersection of human and animal medicine. 

The students will leave Birmingham on May 13^th and return on May 25^th and will be blogging every day!  So make sure you bookmark our blog and follow our adventures daily!