Careers in Public Health
Public Health on Front Burner After Sept. 11
here with permission from USA Today. Original
article by Anita Manning, December 26, 2001.
The doctors, nurses and lab scientists who labor, often
underpaid, in underfunded public health departments suddenly find
themselves in the limelight.
Once the poor relations of the medical field, now they're cast
as a kind of medical Delta Force standing between unknown
microbial threats and an anxious nation.
The deadly anthrax mailings that followed the Sept. 11 attacks
on New York and Washington, D.C., put a bright spotlight on the
importance of a strong public health system, health officials say,
moving it close to the top of the national priority list.
They pray it will stay there. "Maybe, maybe it won't just be
our 15 minutes of fame," says Mary Selecky, secretary of the
Washington State Department of Health. "This country can't afford
to walk away from public health. We must be prepared to identify
new and emerging diseases, and if we can do that, we will be
prepared for a bioterrorist event."
Public health is a network of government-funded and non-profit
services that monitor the health of the population, watch for
emerging diseases, establish medical policies and practices, and
make sure all citizens, rich and poor, have access to medical
care. Except when there's a shortage of flu vaccine or a new
disease, such as West Nile virus, public health rarely hits the
national radar screen. Terrorism has changed that.
Now, "we've been discovered," says Scott Becker, executive
director of the Association of Public Health Laboratories. Lab
scientists have been "thrust onto the public stage. They're under
the klieg lights, and they've performed amazingly well. They are
every bit the American heroes as the others heralded over the last
Those lights also have illuminated serious cracks in the
system. Some health departments function in outmoded buildings
with no computers or fax machines to speed communication of
crucial information. They're plagued by high staff turnover and
funding shortages. Many states had begun thinking about a response
to bioterrorism, but in most cases, planning was incomplete.
For those in all facets of the public health system, a vast
network of some 3,000 federal, state and local health departments
and labs, life since Sept. 11 has meant long hours and a new sense
of the urgency and importance of their work.
Stephen Morse of the Centers for Disease Control and
Prevention's Laboratory Response Network says that since early
October, nearly 70,000 samples suspected of anthrax contamination
have been testedincluding 45,000 in states that had no anthrax
"It has been very intense," says Katherine Kelley, director
of the Connecticut Department of Public Health Laboratory in
Hartford. Hers is one of the few labs in the country that detected
a positive case of anthrax. A 94-year-old woman in a rural
Connecticut community died in November after being exposed to
anthrax, possibly through contaminated mail.
The event brought together local doctors, public health and law
enforcement, she says. Lab scientists "were seeing a lot more
police cars. The FBI were here. These were new partners we didn't
see on a regular basis."
Kelley has been putting in 80-hour weeks, along with a dozen
scientists in her lab assigned to test hundreds of samples as part
of the investigation. All have been on 12-hour shifts, seven days
a week, since early October.
But nobody's complaining.
"I think they're very proud of the role they're playing,"
Kelley says. "We're the public health lab, and now we're the
first-response lab. This is a new role for us, but we've been
training for this. We can do it, and do it well."
Leslie Beitsch, Oklahoma health commissioner, says she now sees
"colleagues in our system are accorded a much greater amount of
Public health in America may well emerge from the tragedy of
terror stronger than it ever has been, officials say.
"This unprecedented attack on the nation has gotten
everybody's attention and allowed people to focus on issues and
concerns that weren't high on priority lists in past years," says
James Hughes, director of the National Center for Infectious
Diseases, at the federal Centers for Disease Control and
Prevention in Atlanta.
Tops on that list are two items that previously induced nothing
but boredom, despite the best efforts of public health agencies:
the need to shore up the public health infrastructure and to
prepare for potential disaster.
Some health departments lack the technology needed to access
information quickly. The need for more lab workers, lab space and
hospital capacity is clear, officials say. In a normal winter,
hospital emergency rooms overflow with flu sufferers. Imagine,
they say, what would happen if smallpox broke out.
The federal government seems to be thinking about that. In
mid-December, Congress passed a $2.9 billion bioterrorism bill
that includes more than $1 billion in grants to state and local
health agencies to improve preparedness and lab capacity, $450
million to the CDC, and more than $1 billion to pay for expansion
of national stockpiles of drugs and medical supplies, including
more smallpox vaccine.
President Bush is expected to seek at least $15 billion in his
2003 budget proposal for domestic security needs, including
funding for communications equipment for public health agencies
and hospitals so they would be better able to deal with a
"That we are no longer immune to the threat of bioterrorism is
abundantly clear," Rep. Billy Tauzin, R-La., said after the bill
he co-authored passed 418-2. "In a post-Sept. 11th world, it's
critically important that Congress strengthen our public health
infrastructure at the national, state and local levels."
To many in public health, these words signify a sea change.
"The 'new normal' is that public health is now on everyone's
mind," Selecky says. "For me to hear someone in Congress use the
phrase 'public health infrastructure,' which used to be a
fall-asleep phrase, is just amazing."
Infectious-disease specialist Rathel "Skip" Nolan of the
University of Mississippi Medical Center in Jackson sees the
change in his daily work. For months, Nolan had been offering a
series of lectures on bioweapon exposure to medical personnel,
under contract from the CDC and the state health department.
"The response was lukewarm," he says. "My audience was
polite, but they thought, 'This was pretty silly, it's not going
to happen here.'"
Then came the first case of inhalation anthrax, which killed a
photo editor in Florida on Oct. 5. A week later, an NBC employee
tested positive for the skin form of anthrax.
"The phone began ringing off the hook," Nolan says. Suddenly,
his lectures were full, and he became "the anthrax poster
child." He has given 20 lectures since early October. Now, he
says, "The urgency is there."
Getting out the information
Physicians are on high alert and hungry for information
about agents of bioterror that might show up in hospitals and
doctors' offices. Now that doctors better understand the urgency
of reporting diseases to state health departments, CDC officials
and state health directors say they hear daily from doctors who
wonder whether what they're looking at is chickenpox or smallpox,
a respiratory virus or inhalation anthrax.
"We're looking at adult chickenpox and young people with
pneumonia more closely," says Mississippi state health officer Ed
Thompson, who has sent information packets on biowarfare agents to
hospitals, clinics and doctors throughout the state. "Every one
of us has had to increase the awareness of our primary-care
doctors, emergency room doctors, those on front lines who would be
the first to see any of these diseases."
Information flows more freely from public health agencies to
the front lines than it did in the first weeks of the anthrax
incidents, says Robert Carr, a family doctor in Washington, D.C.
Tying in to family doctors
"What we didn't have early on was specific information.
The public health people were responding and learning as they went
along," Carr says. "They did a good job under the circumstances,
(but) it may not have been apparent early on that we were the
people who would be seeing the vast number of patients. Television
was saying, 'If you're concerned, see your family doctor'and
we didn't have the information."
Efforts are being taken to improve communication between public
health and private practice doctors, says the CDC's Hughes. "The
cultures are different, and there have always been communication
issues, but these gulfs have to be bridged. When you get into
state and local preparedness, the clinicians and public health
community have to be at the table."
And time is of the essence. Georges Benjamin, president of the
Association of State and Territorial Health Officials and
secretary of health for Maryland, says, "We're functioning on a
much faster turnaround time for a whole range of things. It used
to be that our epidemiologists did their work quietly. That's not
true anymore. They're truly functioning in a fishbowl."
The "sudden marriage between the public health community and
the acute-care medical community will persist," Benjamin says.
"It's almost a dependency. The need to work together on this
crisis was so apparent that I think the relationship that has been
fostered will strengthen our ability to respond to this in the
future. The recent terrorism has pulled us together in new ways.
And I think we're better for it."
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