Author: mnabavi

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During this visit, we learned about the Alabama Department of Health’s (ADPH) Southwestern Health District.  This district includes the following counties: Baldwin, Choctaw, Clarke, Conecuh, Dallas, Escambia, Marengo, Monroe, Washington, and Wilcox (see the image below for a graphic representation). It may seem odd to you that Mobile county is not included in this district, as it is so geographically close. However, both Mobile and Jefferson counties operate somewhat independent health departments and as such, have become their own districts.

The Southwestern District is largely rural with median household incomes per county ranging from ~51K (Baldwin) to ~24K (Wilcox). The percentage of folks who live in poverty ranges from 11.7% (Baldwin) to 35.4% (Dallas).  Baldwin has a higher socio-economic status than the other counties due to its lower half being a great destination for tourists and people who want to live by the beach. Dallas and Wilcox Counties are primarily African-American (70%). Naturally, we wondered how the Southwestern District Administrator addressed the diversity between counties with regard to income, poverty, race, and other social determinants of health.

Luckily, we had the opportunity to sit down with the District Administrator, Chad Kent, the Assistant District Administrator, Suzanne Terrell, and the Director of Field Services for ADPH, Ricky Elliott. We met them at the Escambia County Health Department and learned about the many programs and services offered at each of the local health departments, like the one we were in, throughout the District. These programs included, but were not limited to family planning, sexual health screening (STI and HIV testing), lead screening, home health programs, cancer detection programs, and diabetes education. Some counties even offered additional maternity services and included peer breast-feeding educators. We were also surprised and grateful to hear that in one county, the social worker actually brought birth control to a client who had no transportation. While this was likely an unlikely occurrence, the compassion of the local health department staff for their communities and their willingness to go above and beyond the call of duty does not go unrecognized. 

The commitment of the staff of the Escambia County Health Department and the Southwest District to their residents is impressive, especially with their dedication to make healthcare accessible to all that live here. While we were discussing this with them they shared with us a story of an elderly couple who would have had to drive over three hours one way to see a nephrologist at UAB.  The trip was difficult for the couple; navigating Birmingham’s traffic and parking was a source of great stress.  Through ADPH’s Telehealth Program, this couple and others can now “meet” their doctor at their local public health department.  Doctors can communicate with patients via a video call during routine follow-ups.  Some conditions can even be diagnosed and treatments recommended via this technology. This program is breaking down transportation as a barrier to accessing the care their residents need in order to live healthy and active lives.

While Telehealth is certainly a technological achievement, the District leadership was also very excited about two new changes coming to the District (and the state). First, a new electronic health record (EHR) system will be implemented later this year. An EHR system will allow for greater continuity of care within the ADPH system, as well as increase the ability to communicate with other providers. Second, Women, Infants and Children (WIC) is going somewhat digital as well. Traditionally, WIC clients have received vouchers that they can turn in for certain goods at their local retailers. Soon, WIC clients will receive a WIC card that will be loaded with a certain amount of money to purchase WIC items. This eWIC program enables clients more flexibility in the WIC items they can receive, saves time, and reduces any voucher and low income related stigma. Additionally, data from purchases will be used to inform other WIC services moving forward. Overall, technological advances have really increased the ability of ADPH to learn from their communities and adapt to better meet their needs.

Team 2 – Tessa, Kachina, and Dekennon

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The UAB Public Health Trailblazers headed to Atmore, AL after a restful but educational weekend. Our class includes students with heritage from most continents, and even some with Indigenous American heritage, but none who grew up in a tribal cultural setting. We were all outsiders as we entered the Poarch Creek Band of Indians.  We were there to visit the new tribal health department and health center and to meet with Sandra Day, the Director of Community Health.

Since our readers, like all of the student Trailblazers, probably would benefit from a brief background of this tribe’s history:

It is well established that the European settlement of North America led to various forms of systemic oppression, relocation, and genocide to the indigenous people that were here. In 1830, the Indian Removal Act forcibly relocated southeastern tribes to federally owned land west of the Mississippi River. The Poarch Band of Creek Indians circumvented this relocation and continued to reside in south Alabama, mainly in Escambia County.   They became a federally recognized Tribe in 1985. Although the acceptance of tribes across the United States has improved, the negative impacts of long term oppression still resound within tribal communities. As much as we’d like to think of this discrimination as ancient history, we must face the harsh realities of what happened not so long ago so that we can work towards genuine equity.

Native Americans experience higher rates of chronic liver and respiratory diseases, assault and homicide, self-harm and suicide, and alcohol and drug abuse when compared to white communities. The Poarch Band of Creek Indians Tribal Health Department is working to decrease these health disparities through access to services, health education, and several specific grant programs.

One such grant is the Good Health and Wellness project sponsored by the United South & Eastern Tribes (USET) and the Centers for Disease Control and Prevention (CDC). Mrs. Wynell Bell, the grant manager, detailed some of the programs they have implemented to address diabetes, obesity, and hypertension – the top three health indicators affecting their tribe. Incentives encourage the use of a monthly farmers market on the reservation. Wellness Wednesday is an event for the whole community, young, old, and in between, to survey individuals’ health and engage elders in physical activity. “They value their youth, and they value their elders,” Day told us. This event brings both together in a fun interactive event to pursue better health. As a reward for participating, vouchers for the farmer’s market (another result of this grant) are handed out to attendees.

Despite the efforts of the Poarch Creek Health Department, the tribe faces numerous barriers to improving their health. After a history of discrimination, distrust for nontribal members resonates throughout. To this day, the reservation remains a food desert. After elevated disease rates lower life expectancies, tribal members accept fatalistic perspectives toward health. The history of the Poarch Band of Creek Indians has shaped their health outcomes, but the devoted employees at the tribal health department remain optimistic. Programs that rely on grant funding are hard to sustain once the funding dries up. According to Bell, “this does not deter them from providing evidence-based programs and services that will work to improve health outcomes over time”.

It was very apparent from our visit that this community is completely family-oriented. We could feel it. And as we departed, we were left asking ourselves how can we reach out to help a community with a history of distrust of outsiders? How can we encourage young tribal members to seek training in medicine and public health and return to the reservation in order to improve health in their community? These and many other questions weren’t answered in a day. We won’t find a one-size-fits-all solution. Nor can we work in isolation; it will take a collaborative approach from many people from different sectors to provide comprehensive solutions. For the Poarch Band of Creek Indians, improved health outcomes can be achieved by programs that involve the whole family and partner with other organizations to seek common goals. With every stop, we gain a deeper understanding of how essential collaboration, trust, and community-focus are for achieving greater health equity.

Team 1 – C³ – Catherine, Claire, & Courtney

Ahoy Matey!

After a week of excursions throughout the Deep South, we spent our Saturday on Ship Island, at a popular and historical destination off the coast of Biloxi, Mississippi. Discovered by the French in 1699, Ship Island was considered the “Plymouth Rock” of the Gulf Coast. Fort Massachusetts, which played a role in the civil war, is located on the island and housed one of the nation’s first quarantine stations beginning in the 1870s. The quarantine station operated at the height of the yellow fever epidemic and monitored vessels, cargo, and passengers as a first line of defense into the Port of New Orleans. Today, the island does not look like it previously did due to damage left from the impacts of Hurricane Camille in 1969.

After an hour and a half on the boat known as “Captain Pete”, we arrived on West Ship Island, home of Fort Massachusetts. Our initial purpose was to search for plastics and microplastics along the beach; however, the park ranger informed us shortly after arriving that two other academic groups had beat us to it leaving no plastic in sight! We did notice a few measures the National Park Service is taking to protect the environment on the island including handing trash bags to visitors upon arrival and having receptacles for people to deposit trash as they leave the beach.  The island is also known as a Least Tern nesting area.  A large majority of the islands sandy shores are roped off for these seabirds so that they can nest in peace.  Park Rangers were clear that heavy fines will be leveed to anyone that ventures into those areas. 

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Even though we weren’t able to recover plastics from the seashore while on the island, we were able to address an equally important public health issue…mental health and self-care. As students, we know how it feels to be overwhelmed by stress and visiting places like Ship Island is a great way to de-stress and just have fun. We saw families and friends of all ages spending quality time together and building new memories on this historic island.

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So remember matey’s, always reduce, reuse, and recycle your plastics and even pirates need a day off.

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“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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