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Careers in Public Health
Tracking Down Bugs

Reproduced here with permission from the Bangor Daily News in Bangor, Maine. Original article by Tom Weber, August 20, 1996.

A few weeks after becoming the state epidemiologist 15 years ago, Dr. Kathleen Gensheimer found herself involved in a medical first in Maine. Considering the cause of the illness—an overdose of sodium fluoride, the widely used but controversial water-treatment compound—the investigation promised to be a sensitive one. In early October 1981, about 60 children and teachers at the Jonesboro Elementary School suddenly began complaining of nausea, abdominal cramps and headaches. All were bused to Downeast Community Hospital in Machias for observation and treatment.

Tracking Down Bugs: Epidemiologist part physician, part detective
Photo of Kathleen Gensheimer

School officials immediately suspected the drinking water, which that summer had been connected to a fluoridation pump in an effort to reduce tooth decay. When the custodian checked the fluoride level in the water, however, it was found to be double the acceptable amount. Closer examination showed that the anti-siphon valve had malfunctioned, allowing excessive fluoride to leak into the system and pass through the water fountains.

A team of doctors and nurses administered regurgitants to the afflicted to purge the toxins. The symptoms passed within eight hours or so, and only two of the children had to be admitted to the hospital for further observation.

Alerted to the poisoning, Gensheimer and other state health officials chartered a plane and hurried to the hospital's emergency room. After interviewing the sick and taking samples of the tainted water, Gensheimer returned to Augusta to prepare a detailed report on the accident.

Meanwhile, local physicians and fluoride specialists did their best to relieve parents' concerns. They said the fluoride was "well below a dangerous dose," that it would not cause cancer in their children, and that the overdose was the first such accident in Maine and only the fifth reported in the country. With proper monitoring of the equipment, they said, there was no reason the Jonesboro school should not continue the fluoridation program.

Not everyone was convinced, and nothing that Gensheimer could say about fluoride's proven dental health benefits would change their minds. An anti-fluoridation sentiment moved quickly through the community, fueled in part by outspoken critics who believed that the treated water was nothing less than forced medication of the masses or even an insidious Communist conspiracy.

"My job was to document exactly what went wrong so that the anti-fluoridationists wouldn't have the ammunition to say that the accident was really a government plot or something," Gensheimer recalled recently at her office at the Bureau of Health in Augusta. "In principle, fluoride is a wonderful way to prevent dental caries in children, and I had heard stories back then of high school kids who actually saved money so they could buy a full set of dentures one day. But at the next PTA meeting, it was voted unanimously to get rid of the fluoride."

Lacing water with fluoride for the greater good of a community— a practice that still has plenty of passionate detractors across the country—was just the first of many medical controversies that Gensheimer would face as Maine's public-health watchdog.

For the past 15 years, her mission has been to halt the progress of every illness and infectious disease that has swept through Maine in suspiciously high numbers. Her work, which she once did from a car with her children beside her, has taken her into restaurants whose food made diners so sick that they feared they had eaten the very last meal of their lives. She has monitored the sudden blitz of tuberculosis that infected 600 people in Bath; the emergence of an especially frightening strain of E. coli in Dover-Foxcroft that killed a young girl; a few sensational cases of flesh-eating bacteria; and all manner of food-borne illnesses that threaten to bring whole communities to their knees.

Part physician, detective, microbe hunter, researcher and educator, Gensheimer has spent her days warning Mainers about the genuine health threats that have infiltrated the state's borders, while easing fears about the nasty bugs that lurk on the horizon but never arrive.

In the process, Gensheimer has been labeled a "staunch defender of the public health" by appreciative medical colleagues, as well as a "Dr. Gunslinger" by some small dairy farmers who disagree with her uncompromising opposition to the sale of unpasteurized milk in Maine.

"Kathy definitely takes a lot of hard hits, especially when the public hears about an outbreak and wants someone to do something to stop it," said Dr. Kirk Doing, a microbiologist at Affiliated Laboratories in Bangor who has worked with Gensheimer over the years. "That goes with the job. Sometimes epidemiology cannot come up with the common link. But whether she has the answers or not, she never leaves a stone unturned."

Dr. Bernard Dahl, a Bangor pathologist, called Gensheimer "the keystone" in a system that acts as a clearinghouse of information for a worried public and a sometimes baffled medical community.

"When things are out of the ordinary, we'd be stuck without someone like Kathy providing a baseline for comparison," Dahl said. "A position like hers keeps a state from running amok with infectious disease."

Gensheimer works out of one of the small, cluttered cubicles that are arranged like a laboratory maze at the Division of Disease Control. A lean, intense woman with a seemingly limitless reserve of energy, she darts through the building in skirt and sneakers, often hitting the streets at noon for a stroll that one colleague describes as closer to a jog.

Stuck to a metal bookshelf near her desk is a bumper sticker that reads, "Epidemiologists give group rates," and another that says, "No, I am not a skin doctor." The first is an inside joke, the second speaks to the lay population's fuzzy notion of her work. Gensheimer may be a high-profile public health official, quoted as the voice of authority in nearly every news story concerning infectious disease in Maine, but she's the first to admit that there are many people who can't even pronounce what she does, let alone understand it.

"A lot of people get my work confused with entomology, which is the study of insects," she said, dismissing the mix-up with a smile and a shrug. "Or they think I'm a dermatologist, a skin doctor. Hey, between the words Gensheimer and epidemiology, I guess it's quite a mouthful for anyone."

Gensheimer was born 46 years ago as Kathleen Friend, the middle child of seven siblings. Her father was a dairy inspector whose job caused the family to relocate often throughout rural farming towns of New Jersey, Pennsylvania and upstate New York. In Binghamton, N.Y., the family's home was on a dirt road -- impenetrable in springtime but ideal for keeping a few chickens and cattle. Gensheimer was a serious, hard-working student who cared for her younger siblings, played the violin and dreamed of traveling the world.

After a year in South Africa as a high school exchange student, Gensheimer went to Penn State, where she changed majors to suit her shifting interests. She dropped journalism to study German, for instance, in order to attend the University of Cologne. Later, after deciding to study medicine at the University of Rochester in New York, she struggled with any course that smacked of the technical.

At medical school she met Gregory Gensheimer, a bright and budding eye doctor with a persistent habit of knocking on her apartment door whenever he needed a meal. "Oh, I couldn't stand him at first," she said of her husband, who now practices ophthalmology in the Bath-Brunswick area. "I mean, he was the type who just breezed through medical school. I did well, but I always had to work so hard. But by the fourth year of school we got married. I figured I'd be feeding him anyway, so why not?"

After a pediatric internship in Philadelphia, Gensheimer did her residency in public health in Trenton, N.J. Intrigued by the work, she later joined the Epidemic Intelligence Service run by the prestigious Centers for Disease Control in Atlanta. The military-style corps required that she dash off to investigate epidemics at any hour of the day, even if it meant taking her baby daughter along on occasion.

"Public health really grew on me," said Gensheimer. "Instead of having an individual as a patient, I had a whole community as my patient. The idea was to do the most I could to help the greatest number of people, and it was exciting to intervene to help stop unnecessary illness and unnecessary death."

The Gensheimers, expecting their second child and desperate to flee Atlanta for a less urbanized life, moved to Maine in 1981. Gensheimer was hired as an EIS officer by the Bureau of Health, which quickly made her state epidemiologist in the Division of Disease Control. Before she had even found her desk on the first day, she was called out to investigate an outbreak of illness at a wedding reception in Lewiston. By day's end, she had located the bacterial culprit lurking in a salad that had been left out too long.

Gensheimer, eager to be a true "shoe-leather epidemiologist," roamed the state to track down outbreaks, often taking her children along on holidays and weekends. On one July Fourth weekend, while investigating a fast-food restaurant suspected of sickening several people, Gensheimer confiscated some of its food for testing and absent-mindedly stashed it in the car. When she returned from her interviews, she found the kids happily munching away on Mommy's work. When they didn't get sick, Gensheimer was able to drop her parental concerns and get down to business: She used the kids as controls in the study.

The highlight of her early years in Augusta, she said, was when she solved a mysterious outbreak of illness among hundreds of people who had eaten their Thanksgiving meals at the same restaurant. After weeks of interviewing restaurant workers and diners, and poring over all the fixings on their plates that day, Gensheimer was able to detect a heavy dose of salmonella in the spoiled giblets that went into the gravy.

"When I come onto the scene, it's because there seems to be an unusual problem," said Gensheimer, who has a master's degree from Harvard School of Public Health. "I come in at the worst stage.

Whether I am smart enough to figure it out, or have the time to, is another question. In this case, the food had made a lot of people sick and no one knew why. My job is not to shut every restaurant down—people make honest mistakes—but to make sure people learn how not to repeat it."

Dr. Allen Bloch, a tuberculosis specialist with the CDC who has worked closely with Gensheimer over the years, called her a top-notch physician and epidemiologist who manages to balance harsh responsibilities with a compassion for the welfare of Maine workers.

"She has a real good sixth sense as a detective, and knows from experience how diseases occur in populations and how to stop them from spreading," Bloch said. "But she also internalizes and personalizes her responsibilities, and has a real compassion for Maine people.

Gensheimer brought that logical balance to this summer's widespread fear about a parasite in strawberries that had sickened 1,000 people nationwide. Unlike in California, where health officials urged the destruction of the entire berry crop to be safe, Gensheimer assessed the risk in Maine berries and issued a note of healthy caution instead.

"A good thing, too, because the parasite turned out to be not in the California strawberries but in Guatemalan raspberries," she said. "A story in Time magazine had a headline that said something like `Oops! Sorry. Wrong Berry.' It was amusing, sure, but destroying the crop ruined people's livelihoods and would have done the same thing here. We have to be careful that we have all the information we need."

Gensheimer's biggest concern these days—one that is shared by epidemiologists across the country—is the threat of emerging infectious diseases that can rear up at any time to stymie the best efforts of medicine. Resistant to standard antibiotics and meaner than their ancestors ever thought of being, the new organisms pose the most serious challenge in a career filled with them.

"But Kathy loves the mystery—she has a passion for it—and combines skepticism with a willingness to believe that almost anything is possible," said Geoffrey Beckett, the assistant state epidemiologist and head of a program that monitors cases of HIV and sexually transmitted diseases in Maine. "She grasps the bigger picture, and has fought hard to make people understand that Maine is not an isolated part of the world. No matter what people want to think, it can happen here."

For the most part, though, Gensheimer continues to hold the front line of defense against the more familiar enemies—keeping tabs on the threat of infection in day care settings, putting the lid on the occasional outbreak of flu frenzy, and monitoring a food supply that grows more diverse and exotic all the time.

As her job has become more bureaucratic, she sometimes longs for the "shoe-leather" days when she chased down microbes in her car and used the family's refrigerator to store the odd specimens she picked up along the way.

"But I could get a call today that could change my life for a month," said Gensheimer. "Not much time goes by when we aren't dealing with something new, something we haven't seen before. I can assure you that no days are dull around here."

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This page last reviewed November 17, 2004

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