With the swimming season rapidly approaching, the Guilford County Department of Public Health would like to remind residents that National Recreational Water Illness Prevention Week is May 24-30, 2010. This recognition highlights the importance of healthy swimming behaviors to prevent recreational water illnesses (RWIs). Outbreaks of RWIs continue to occur every year in the United States. A large number of these outbreaks are related to the chlorine-resistant pathogen, Cryptosporidium, (“Crypto”) which is introduced into the pool by swimmers who are ill with diarrhea and are spread to other swimmers when they swallow contaminated water. These outbreaks underscore the continuing need to educate people about RWI prevention and ensure a healthy swimming experience.

Awareness of RWIs and healthy swimming behaviors play an important role in stopping the transmission of these illnesses. Germs on and in swimmers’ bodies end up in the water and make other people sick. “Even healthy swimmers can get sick from RWIs, so it is important to practice healthy swimming behaviors,” says Tobin Shepherd, Environmental Health Director with the Guilford County Department of Public Health. Young children, elderly people, pregnant women and people with compromised immune systems are especially at risk.

These five steps can help protect you and your family from RWIs:
1. Do not swim when you have any diarrhea or any intestinal illness.
2. Do not get pool water in your mouth or swallow any pool water.
3. Practice good personal hygiene. Shower with soap before swimming (this includes children) and wash your hands well after using the toilet or changing diapers.
4. Take children on regular bathroom breaks and change diapers often.
5. Please change children’s diapers in a bathroom, not at poolside.

Recreational water activities are an important source of exercise. To ensure a safer summer while enjoying the water and prevent RWIs, the Guilford County Department of Public Health and the Centers for Disease Control and Prevention urge swimmers to adopt healthy swimming behaviors. For more information visit http://www.cdc.gov/healthyswimming

Heart disease, cancer, cerebrovascular disease (strokes), chronic lower respiratory disease and diabetes are among the top ten leading causes of death in Guilford County.  They all have something in common.  They are examples of a chronic health condition – a personal medical issue that a person may have to deal with for years.

Chronic health conditions are some of our most common and costly health problems.  Diseases such as diabetes, arthritis or lupus take a physical, emotional and financial toll on the individuals who have them as well as their family members.  Patients and caregivers often struggle with quality of life issues as well as lost or reduced productivity at work and at home.

The Guilford County Department of Public Health, with support from the Piedmont Triad Council of Governments Area Agency on Aging, is offering its first Living Healthy Chronic Disease Self-Management Program series for individuals with chronic health issues.  The series will be held on six consecutive Thursdays, beginning June 3 and ending July 8 from 12:30 – 3:30 p.m. at the Chavis Life Long Learning Branch of the Greensboro Public Library, 900 South Benbow Road in Greensboro.  There is no cost for the series, but interested individuals must pre-register.  Attendance is limited to 18 people due to the high level of interaction during each session.

Living Healthy is an evidence-based program designed by the Stanford Patient Education Research Center.  It is designed to help individuals better manage their chronic conditions and live healthier and happier lives.  Topics covered include:  symptom management; communicating effectively with your health care provider and family; fighting fatigue; problem solving; and action planning.

For more information or to register for Living Healthy, interested persons should contact Sandy Ellington at the Guilford County Department of Public Health at 641-6704.

One of the duties I most enjoy is performing medical screenings of refugees to Guilford County.

Today I saw a young man from an African country who a decade ago was sitting under a tree with his family.  A militia threw a hand grenade into their midst and then started shooting.

Their “sin” was being of a different village.

He had shrapnel scars on his chest and a bullet wound on his leg.  He can’t hear out of his left ear because the concussion of the grenade perforated his ear drum.

His family fled into the jungle and made their way to a refugee camp in a neighboring country.  He lived there for a decade and now he has come to our county.

He is so happy to be here in the US and shows no anger or hatred towards those who tried to kill him….

It occurred to me that we (natives of the US) have no concept of why they…these tribes… are killing one another.  Their disagreements are to me unfathomable.

But we can get caught up in the same dialogue.  We just have a different tribe to fight. Christian versus muslim.  Republican versus Democrat.  US versus an historic parade of enemies…most of whom are our friends now.  (When was the last time we as a nation felt hatred about people from Britain, Portugal, Spain, Germany, or Japan?)

He was ticklish and had a great laugh.

One of North Carolina’s greatest assets is its outdoor beauty.  However, ticks and mosquitoes are a part of the state’s landscape and they can carry dangerous diseases.  Guilford County Department of Public Health is offering some simple steps you can take to reduce insect breeding conditions around your home and lower the threat of insect bites.

Tame those ticks

• Keep grass around your home mowed and bushes and plants in your yard thinned out.
• Remove plants that will attract wild animals, such as deer and rodents.
• When walking or hiking, try to avoid brushing up against any vegetation.
• Don’t sit on the ground or any logs in brushy areas.
• Wear light-colored long-sleeved shirts, long pants and socks.
• Check yourself, your family members and your pets for ticks after being outside.

Tick removal (humans and pets)

Proper and prompt removal of ticks is the key to preventing any infection.  Begin and end by washing your hands.  Use fine-tipped tweezers to remove ticks.  Get the tweezers as close to the head of the tick as possible and pull steadily.  Don’t jerk or twist.  Once removed, look closely to make sure no part of the tick was left embedded in the skin. Clean and disinfect the bite area.  Note the day that you removed the tick on a calendar.  If you or your pet becomes ill within the next three weeks, tell your health care provider or veterinarian the date you removed the tick.

Rocky Mountain spotted fever (RMSF) is the most common tick-borne illness in North Carolina.  Guilford County recorded nine cases in 2009.  Lyme disease is another common tick-borne illness.  No cases of Lyme disease were recorded in Guilford County for 2009.

Mosquito prevention

Mosquitoes can breed in just two teaspoons of stagnant water.  Following these simple steps can help reduce the chance of mosquito breeding:

• Throw away all containers that hold water such as tires, bottles, flower pots and saucers, small pools, buckets and tarps.
• Empty birdbaths at least every seven days.
• Keep gutters clean and in good repair.
• Repair leaky outdoor faucets.
• Screen or cover any outside rain barrels used for water conservation.
• Make sure screens on windows and doors fit tightly and are not torn.

La Crosse virus, Eastern equine encephalitis (EEE) and West Nile virus are common mosquito-borne illnesses found throughout North Carolina.  If you are going to be outdoors, you can limit your exposure to mosquito bites by wearing long-sleeved shirts, long pants and socks.  Insect repellents can also be helpful.  Be careful and make sure you read and strictly follow the manufacturer’s instructions.

Take time to check your yard and home to make sure you aren’t giving ticks and mosquitoes a comfortable place to live!  For more information, contact Guilford County Department of Public Health at 641-7777 or www.guilfordhealth.org.

The Guilford County Department of Public Health, with support from the Piedmont Triad Council of Governments Area Agency on Aging, is offering its first Living Healthy Chronic Disease Self-Management Program series for individuals with chronic health issues. The series will be held on six consecutive Thursdays, beginning June 3 and ending July 8 from 12:30 – 3:30 p.m. at the Chavis Life Long Learning Branch of the Greensboro Public Library, 900 South Benbow Road in Greensboro.

There is no cost for the series, but interested individuals must pre-register.

Attendance is limited to 18 people due to the high level of interaction during each session. We need your help promoting this new program.

Contact Sandy Ellington at 641-6704 for a brochure or to register.

Are you or someone you know trying to quit smoking?  Would you like some help?  Our High Point site has two QuitSmart series coming up in May. The dates and times are:  5/5-5/26 5:30-7:00pm and 5/6-5/27 12noon-1:30pm.  Contact Cindy Simpson (7654) for more information and to register. Greensboro also has a series scheduled (5/5-5/26 6-7:30pm).  Contact Kim Herzing (420-0933) or Catherine Richardson (4718) regarding the GSO series.

Marc Ambinder has written a very interesting article in the May 2010 Atlantic Magazine about the ongoing issue of obesity in the US. It speaks to many of the issues that are driving us to gain weight and the difficulty of finding a solution. Take a look and let me know what you think.

The Guilford County Department of Public Health is offering the QuitSmart® smoking cessation class series in both Greensboro and High Point in May. The series consists of one class per week for four weeks. Each class lasts 90 minutes and there is no cost to the participants for the session or materials. These classes are open to any Guilford County adult resident. Class size is limited to 12 participants.

In High Point, the May evening series begins May 5 and ends May 26, and will meet each Wednesday. The sessions will begin at 5:30 p.m. and end at 7:00 p.m. The daytime series begins May 6 through May 27, and will meet each Thursday. The sessions will begin at 12 noon and end at 1:30 p.m. Both series will be held at the 501 East Green Drive location. For more information or to register, please contact Cindy Simpson at 845-7654.

In Greensboro, the evening series will begin on May 5 and ends May 26, and will meet each Wednesday. Classes will be held from 6:00 until 7:30 p.m. at the 1100 East Wendover Avenue location. For more information or to register, please contact Kim Herzing at 420-0933 or Catherine Richardson at 641-4718.

The QuitSmart® classes are being funded by the Office of Minority Health and Health Disparities, North Carolina Department of Health and Human Services. QuitSmart® utilizes evidenced-based techniques (cognitive behavioral strategies, brand-fading, self-hypnosis compact disc, patented cigarette substitute) that have proven to be more effective than other stop-smoking programs. In a study at five U.S. Air Force bases, sixty-six percent of Quit Smart participants were still smoke free six months after quitting, compared to 16-30% in other stop smoking programs (source: Shipley, et al., Federal Practitioner).

Tobacco use is the number one preventable cause of death in our state and in our nation. It creates health risks for smokers as well as those around them. There is no known safe level of exposure to secondhand smoke. For women, smoking creates some unique health risks. For example, women over age 35 who smoke and use birth control pills have a higher risk of heart attack, stroke, and blood clots of the legs. Smoking is a risk factor for having a low birth-weight baby and low birth-weight babies are more likely to die or to have learning and physical problems.

Individuals interested in quitting can also receive free expert support by using QuitLineNC. For more information or to talk with a Quit Coach, call 1-800-QUIT-NOW (1-800-784-8669)

Information provided by Health Director, Merle Green to the Board of Health regarding Guilford Child Health and Guilford Adult Health programs on 19 April 1010.

About the GUILFORD CHILD HEALTH program:

Key point: Assurance of adequate health care for children is a mandated public health service.

Until July 1996, Guilford County via the Guilford County Department of Public Health provided services directly through its own child health clinics. However in that decade, demand for child health services exceeded GCDPH’s capacity to provide them. In response, County Commissioners, Board of Health members, the Health Director, and executives from Moses Cone Health System and High Point Regional Health System created a jointly sponsored medical home for children, Guilford Child Health, Inc. (GCH).

Guilford Child Health grew into its current state: a superb provider of primary care to children. The Department of Public Health continued to independently provide several critical services for children: immunizations, communicable disease tracking and follow-up, medical case management, school nursing programs, child day care consultations, dental care and nutritional services (WIC).
Funding for GCH began with the agreement that each partner (Guilford County government, Moses Cone Health System and High Point Regional Hospital) would contribute 1/3 of the operating budget. Guilford County has continued to escalate its yearly cash contributions.

In the initial agreement (1996-1997), Guilford County committed to pay GCH $50,000.00 (fifty thousand dollars) per month, plus an additional $62.50 per visit for indigent non-Medicaid patients who met the eligibility criteria. Guilford County also created a reserve fund of $100,000.00 (one hundred thousand dollars) to be used in the event of an operating loss. This formula has since been modified, but increasing cash contributions from Guilford County to GCH continue.

As anticipated, GCH has approached financial self-sufficiency through billing 3rd party payers (such as Medicaid) for the delivery of clinical health services. GCH provides efficient services that are supported predominantly by private and public insurance. Recent audits of GCH show that other than Medicaid, Guilford County’s continued contributions to GCH are their largest source of outside revenue. Other support comes from private grants.

Last year, Guilford County contributed $1.8 million. In the current negotiations with its partners, Guilford County has offered an increase in support to $1.9 million (rounded) for the fiscal year beginning July 1, 2010.

About the GUILFORD ADULT HEALTH program:

Key point: The provision of primary health care for adults is not a mandated public health service. However, the Guilford County Department of Public Health believes these services are crucial to its mission: “In partnership with the community we serve, the Guilford County Department of Public Health protects, provides, and enhances the health and well-being of all people and the environment in our county.”

In the mid to late 1980’s, two local community advocates, Stewart Rogers, MD and his wife, Betty Rogers, RN had a vision of health care for uninsured adults in Greensboro. (The abbreviated history of HealthServe Community Health Clinic below is excerpted from the HealthServe Community Health Clinic page on the Moses Cone website):

1988 – Stewart Rogers, MD, and Betty Rogers, RN, begin providing medical care at Greensboro Urban Ministry’s Pathways shelter.

1989 – Leadership Greensboro helps solicit start-up gifts to support the operation of a storefront clinic at 414 Battleground Avenue. The first full-time employee is hired to coordinate the all-volunteer staff.

1990 – The Greensboro Urban Ministry Clinic opens in May at 414 Battleground Avenue. 1,700 patients are seen in the first year.

1993 – HealthServe Ministry Inc. is incorporated as a 501(c)3 organization. A new permanent facility is built at the corner of Lee and Eugene Streets through Greensboro Urban Ministry’s capital campaign. The new facility opens with one staff physician and one nurse practitioner.

2002 – HealthServe Medical Center becomes a department of Moses Cone Health System and a provider in the continuum of care for the newly formed Guilford Adult Health. HealthServe Ministry is dissolved.

2003- Guilford County, Moses Cone Health System, and High Point Regional Medical Center enter into agreement to create Guilford Adult Health (GAH) patterned after the successful model of GCH. Adult health services would be offered in Greensboro as a part of HealthServe Medical Center, and in High Point as a part of HP Regional Health System.
Guilford County initially contributed $1.3m to GAH. The County’s current annual contribution is $1.6m. In the current severe economic recession and drop in County revenues, continued financial support of GAH by Guilford County government is being weighed.

DISCUSSION:
Our partners, Moses Cone Health System and High Point Regional Health System, have announced they will discontinue the operation of Guilford Child Health unless the county continues to provide funding ($1 million minimum) to Guilford Adult Health. Our partners have said that GCH and GAH are intertwined and cannot operate separately.
Guilford County has never conceived of GCH and GAH as a single medical entity. As outlined above, Guilford Child Health is several (6) years older than Guilford Adult Health.
• There are separate contracts for each
• They operate from separate buildings, miles apart
• They have separate medical staffing
• They serve clientele of different ages
• They have separate budgets
• They have separate 501 ( c ) 3 charters

Our partners’ promise to abandon Guilford Child Health (if funding for Guilford Adult Health is not found) speaks to the fact that they too believe these are easily separable entities.

It is Guilford County’s mandate to assure the provision of child health services. Hence the county has offered our partners a contract for GCH with an increase in funding. Guilford County interprets the health systems’ statements as using GCH as “leverage” to force funding for GAH.

The current severe recession is forcing Guilford County and Guilford County Department of Public Health to restructure the provision of health services to the community. We are examining each and every program and service for its mandate and importance.

Medical care for Guilford County’s children is mandatory.

Medical care for Guilford County’s adults is crucial, but not a mandated service of the Guilford County Department of Public Health.

If it becomes necessary, Guilford County will once again provide the medical home for childhood clinical services for our population without hesitation.

Guilford County Department of Public Health is committed to assuring the availability of quality health care services for all children and adults in our community.
 
Guilford County Department of Public Health has a mandate to assure health services are provided in the County for our children.  “Assure” does not mean that county government must provide the services but that the services are available to the community.
 
Guilford Child Health and Guilford Adult Health are two separate programs.  Funding for each involves two separate contracts.  Disagreements over funding of one should not preclude agreement over funding the other.  Negotiations between the County and Moses Cone Regional Health System and High Point Regional Health System regarding the two separate contracts for Guilford Child Health and Guilford Adult Health have been ongoing for months. (Indeed at one time, these discussions included a third contract for the new medical clinic for low-income adults planned for southeast Greensboro.   The inability to reach consensus on the southeast clinic and the urgency of medical needs of the southeast community led to the County to contract with a private medical provider, PHS, Inc.)
 
With the County projecting significant decreases in revenue, the request by Moses Cone and High Point Regional for the County to increase its financial support is not tenable. The contract with Guilford Child Health, which did include a funding  increase,  was deemed acceptable to the county and has been repeatedly submitted for signature.   

Instead of agreement, the contract has been held to leverage more funding for Guilford Adult Health.   The message has been sent by Cone and High Point Regional that they will “give back” Guilford Child Health and return all responsibility for child health care to the County.  The Department of Public Health values the excellent care given to children through Guilford Child Health.   We are shocked that Cone and High Point Regional would abandon their critical role in providing health care to children.
 
If this is the outcome, Guilford County will fulfill its responsibility to the children of this county and move to assure clinical services are available by some other means.