THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Sunday, April 9, 1995 TAG: 9504070275
SECTION: VIRGINIA BEACH BEACON PAGE: 10 EDITION: FINAL
TYPE: Cover Story
SOURCE: BY JO-ANN CLEGG, STAFF WRITER
LENGTH: Long : 213 lines
JUST BEFORE three o'clock on a recent blustery Thursday afternoon, Camille McKinnis of Green Run dashed across the parking lot of the Princess Anne Recreation Center, her 18-month-old son, Wesley, in her arms.
``Are you still open?'' she called to public health nurses Judy Brown and Alisen Guyet, who were standing beside a large buff-colored van with the words ``Health Department'' on the side.
``For you, we are,'' Guyet said as she ushered the McKinnises inside and began asking the questions and giving the instructions that go with the routine immunizations.
By 3:10 Wesley, a couple of tears still trickling down his cheeks, was well on his way to being fully protected from the likes of measles, mumps, rubella and polio.
``This is the first time I've used the mobile van,'' Navy wife McKinnis said. ``I read in the paper that it was going to be here so I decided to come over. It's a lot easier than trying to get him into Navcare for his shots.''
Karen Kher of Red Mill had a different reason for getting her children's immunizations through the Health Department.
``I have four kids and we're without health insurance right now. My pediatrician suggested that we get (the immunizations) from the Health Department and then my neighbor saw in the paper that they were going to be out here today so I decided to come.''
The savings for Kher, who brought two children in for shots earlier that afternoon, were significant. Most immunizations offered by the Health Department are free.
The van is used primarily for immunizations, blood pressure checks and educational purposes in Virginia Beach. It services city residents only one week each month because it is shared with health departments in Chesapeake, Portsmouth and on the Peninsula.
While the mobile van is easily the most visible of the department's services, it's far from the only one. The health department offers everything from stress management seminars and health screenings to monitoring the safety of food and water. Environmental health workers made more than 22,000 visits to restaurants and well sites last year, while at the same time residents visited the health department's various medical clinics more than 50,000 times.
Working out of an office on 19th Street, nursing supervisor Kim Costello leads a field team of four full-time nurses who still make home visits in the tradition of the old visiting nurse system. Their job is to monitor clients in home settings and pull together community resources for their care. Referrals come from both public and private health care providers.
Costello and her nurses have no swift injections, no quick fixes. Much of their caseload comprises pregnant teens whose needs can include everything from medical care to housing to child care so that the mother can return to school after the baby is born.
The housing issue alone is a time-consuming, frustrating job. Only a few shelters can meet the needs of a pregnant teen or take in a 14-year-old with a child.
``When I'm working on a case like that I just get on the phone at least once a week and call every shelter that I know about to see if they have any space,'' nurse Janie Spence said.
Both teams, in their own way, define the mission of public health.
``I like to say that we're in the business of providing the three P's: prevention of disease, promotion of health and protection of citizens,'' said Dr. Suzanne Dandoy, who became director of the Virginia Beach Health Department last September.
During the recent meningococcal outbreak at Norfolk Academy, three Virginia Beach Health Department nurses helped in delivering the preventive shots because so many of the private school's students live in Virginia Beach.
``We also fielded a lot of telephone calls from anxious parents, and appropriately so,'' Dandoy said. ``(Preventing the spread of the disease) is definitely the kind of business you want your health department involved in.''
So is Frank ``Skip'' Scanlon's end of the public health business. He's the department's environmental health manager, the man responsible for the safety of everything from hot dogs sold by sidewalk vendors to the water drawn from wells in Pungo.
``Public health started for sanitary purposes,'' Dandoy said. ``Regulating and protecting water and food is a governmental function. It's something we do well and that only health departments can do.''
It's a vital service, especially in a city which is a major tourist attraction. ``What we definitely don't want,'' Dandoy said, ``is a major food-borne disease outbreak.''
Scanlon agrees. ``Food protection is a real public health issue,'' he said. The increased popularity of festivals, and the small food booths that go with them, keeps Scanlon and his staff especially busy.
Other major issues for the environmental health people are water protection and limiting the spread of rabies.
``We processed 3,400 applications for wells last year,'' Scanlon said. ``That's up from 400 in 1990.'' Each new well requires an average of two site visits from sanitarians to assure the safety of the water supply.
As for rabies, Scanlon has his thoughts both on the disease and the animals most apt to carry it.
``We've got the greatest habitat in the world for raccoons in Virginia Beach,'' he said. ``We've got lots of vegetation, lots of water and lots of people who think they're cute.''
Promotion of good health is the third prong of Dandoy's approach. ``We want to provide people with the best possible information so that they can make decisions concerning their own health,'' she said. To that end, her department works with businesses and community agencies to get the information into citizens' hands.
Health educators also provide programs on request to schools and community groups on stress, weight management, sexually transmitted diseases and other topics.
An area that has traditionally been the province of public health departments, the provision of medical care for the poor, is rapidly changing, Dandoy said.
``Public health in Virginia has been very much seen as indigent health care,'' she said. ``We're now beginning to move away from that.''
The change has come about as a result of two separate movements: staff cutbacks and the manner in which Medicaid clients receive health care.
``We have a number of people taking early retirements,'' Dandoy said. For the most part, those staff members will not be replaced.
That reduction in staff will have a major effect in dental services. Dr. Louis Guarnieri, the program's one full-time dentist, will retire in June, leaving only three part-time staff members to do the work.
``We hope to get private sector dentists more involved in providing care,'' Dandoy said.
While private involvement is currently only a hope for the dental program, it is a reality for other clinic services.
Ten years ago, there were no hospitals in Virginia Beach delivering babies to indigent patients. Because Medicaid paid little for maternity care and because the risk involved in treating young, low-income mothers and their infants was so great, there were also few doctors who would accept Medicaid cases.
With increased payments and the move toward managed care (HMOs) for Medicaid recipients, most families can now get these services outside the public health system.
Dandoy believes that's as it should be.
``Taking people into health plans gives them a medical home,'' she said. ``We were never able to provide nighttime or weekend services,'' she added. That meant that low-income patients frequently relied on hospital emergency rooms for treatment.
The pediatric clinics, which have been among the department's most popular programs, will still be available for those who need them. Fees, as they have been in the past, will be based on ability to pay.
Dandoy sees the future of the clinics in serving those who have the most difficulty getting health care: those who have too little income to have insurance, yet too much to qualify for Medicaid. ILLUSTRATION: Staff photos by MORT FRYMAN
Elizabeth Carpenter, 5, gets a checkup from Janet Rogers, a nurse
practitioner.[cover photo]
Health Department Services mobile van visits neighborhoods.[cover
photo]
At one of the health department's many clinics, nutrition assistant
Julie Marcado counsels Karin Aronson on what's best for her baby,
Justin.
``I like to say that we're in the business of providing the three
P's: prevention of disease, promotion of health and protection of
citizens,'' said Dr. Suzanne Dandoy, director of the Virginia Beach
Health Department.
Registered nurse Bettie Green, left, gives 1-year-old Paige Cosgrove
an immunization, as her mother, Shelby, provides comfort.
Staff photo by D. KEVIN ELLIOTT
Public health nurses Alisen Guyet, left, and Judy Brown brought the
mobile van to Princess Anne Recreation Center for its monthly
visit. The van is shared with Chesapeake, Portsmouth and the
Peninsula.
Graphic
CLINICAL SERVICES
COMMUNICABLE DISEASES: Information and/or consultation for
persons concerned about tuberculosis and other communicable
diseases. 431-3500.
DENTAL CLINIC: Routine and emergency dental care for children who
are income eligible or enrolled in the school lunch program.
431-3465.
FAMILY PLANNING: Confidential family planning services for women.
A fee may be charged based on ability to pay. 431-3500 or
491-5122.
HOME VISITING/CASE MANAGEMENT: Nursing and other special
services may be provided in home to families with special needs.
Require physician referral. 491-5159.
IMMUNIZATION CLINIC: Free routine immunizations for childhood
diseases and adult tetanus. No appointments are necessary. Call
for times and locations. 491-5122, 431-3500. Mobile van makes site
visits the last week of each month. Check Community News listing in
The Beacon or call 427-4281 for schedule.
PEDIATRICS: Well baby checkups for infants and children whose
parents can't afford private care. Fees may be charged based on
ability to pay. 431-3500 or 491-5122.
PREGNANCY REFERRAL SERVICE and MATERNITY CARE: Referrals to
clinics and private physicians for prenatal care. 491-5122 or
431-3500.
SEXUALLY TRANSMITTED DISEASE CLINICS: Free confidential
education, diagnostic and treatment services for individuals
concerned about sexually transmitted diseases. 431-3500.
NON CLINICAL SERVICES
HEALTH EDUCATION: Educational materials, programs for schools and
organizations on health topics. 427-4281.
ENVIRONMENTAL HEALTH SERVICES: Food, kitchen, well, pool and
septic inspections; rodent and rabies control. 491-5940.
WIC PROGRAM: Supplemental food vouchers for pregnant women,
nursing mothers and children through age 5 who qualify under federal
guidelines. 431-3484.
LOCATIONS
Clinics: Human Services Building, 3432 Virginia Beach Blvd.,
Suite 103. 431-3500; and 1081 19th St., 491-5122.
Educational and Community Services: Municipal Center. 427-4281.
Environmental Health: 1206 Laskin Road, Suite 120. 491-5940.
KEYWORDS: HEALTH CARE INDIGENT HEALTH CARE by CNB