The Public Health Puzzle

STORY BY PAM BURKE P COLIN THOMPSON

The question of what is public health is not one Hill County Health Department Director Kim Larson considered much when she was getting her bachelor’s degree in health promotion, but as it turns out her job in public health is not far removed from the goals she had envisioned achieving after graduation.

“I started out in nursing school, but I just want to be more in prevention and not treatment,” Larson said.

“Originally, I got my health promotion degree to work in cardio-pulmonary rehab and work with people to prevent heart disease or to come back and be healthier after they’ve had a heart attack,” she added. “And that was a personal thing for me because my dad had a heart attack when he was very young, when I was a seventh grader, and that just kind of – I would like to help people not have to deal with that.”

Larson, who grew up in Kremlin, said she moved to back to this area after graduating from Montana State University Bozemen. She wanted to find something more in her degree field so started with the health department working on a community needs assessment about 10 years ago. She stayed with the department after that and five years later was promoted to director and adviser to the the county health board. In midSeptember, Larson also accepted the role of health officer for the county, to be effective Oct. 1.

So, in a fortunate twist of fate, one of the primary functions of her job is prevention of diseases and other health problems.

Certified in public health management and nationally certified in public health through the National Board of HILL COUNTY HEALTH DEPARTMENT Kim Larson, director of the Hill County Health Department, stands outside the offices of the Hill County Health Department.

Public Health Examiners, which requires 50 continuing education credits every two years, Larson is also pursuing her master’s degree in public health. While this seems like a lot of studying for her, Larson said she likes that public health has so many continuing education opportunities.

Part of what drives those opportunities is the vast array of needs that come under the purview of public health.

It’s a different type of health care that is hard to explain to people who haven’t been a part of it through receipt or provision of services, Larson said.

“It’s hard to come up with that elevator speech when people say, ‘What do you do?’” she said. “It’s, like, ‘Well, a little bit of everything – and it’s all community based.’”

The health department website says, “Through collaborative efCOVID-19 disease (from other programs) during and, so far, hasn’t had to hire anyone ber, specifically with immunizations for back to school and flu season. tested so they can start the contact forts, we at the Hill County Health Department promote physical and emotional health, foster personal responsibility; prevent disease, injury and disabilities; and protect the environment.”

On a daily basis, she said, she oversees several programs that include Women Infants and Children or WIC, Family Planning, Parents as Teachers home visiting program, immunizations, Disaster and Emergency Services and communicable diseases.

A lot of what she manages is reporting duties in these programs and to grant organizations, as well as applying for grants, which allow the health department to supplement the programs already in place or target specific community needs.

“I have a Maternal Child Health block grant that we’re using this year to work on connecting community

“The pandemic is on a larger scale tracing process, but also to talk to for us, but we deal with communithem about what they need to do cable disease every day, and we do for quarantine while waiting for their contact tracing every day, but it’s just results. not on this scale,” Larson said. “We Even before test results are back, have a really good team that works health department nurses are workon communicable disease. We have ing to compile a list of contacts. one main nurse that does it day in As soon as someone show signs and day out, and she is just amazing. typical of COVID-19 and gets tested,

She has been at the health departhealth department nurses conduct an ment for over 15 years and then interview to help identify where they we have two other nurses that have might have gotten infected and who been brought on to communicable they might have infected. the pandemic to do contact tracing, and they’re doing a great job.” The health department, she said, has people on standby to help with If you are a direct contact of a confirmed case, you

COVID-19 contact tracing if needed, have to quarantine. new, “but we are in the conversation for that,” she added in mid-SeptemKim Larson Hill County Health Department Director

Hill County Health Department is notified every time staff at the “Our nurses contact them daily. We check in with them, we have

COVID-19 clinic on the Northern a certain list of questions that are

Montana Health Care campus runs a asked. Right at the very start they go test, Larson said. Health department over a lot of different questions as to staff then calls the people who are where they’ve been 48 hours before members to community resources 14 | LIVING Havre and the Hi-Line MAGAZINE | October 2020 and creating an online connect referral system,” she said.

While Larson’s role is management of the department, what the health department does in practice is everything from helping new mothers negotiate life with a new baby to ensuring the safety of the town drinking water or monitoring a communicable disease outbreak.

“Public health is incorporated in a lot, whether it’s environmental health and vectors such as mosquitoes with West Nile virus, or a pandemic, or inspections with food establishments,” she said, adding “Y’know, it’s different every day.”

In 2020, though, much of what she does is manage the COVID-19 pandemic.

“About 99 percent of what I do this year is pandemic-related,” Larson said.

symptom onset, if they do have symptoms, and then it’s from their test result,” she said. “If it’s positive then we go back a certain number of days and ask where they’ve been. We touch base on that every time we talk to them because it’s hard to remember where you’ve been and sometimes it comes back at different times, and that’s where we get their contact list.”

From there, health department staff reaches out to those people who had contact with the person who tested positive.

“We have that followup every single day just to follow up and make sure that if they were asymptomatic that they’re still asymptomatic. If they get symptomatic, and their original test was negative, we send them in for a followup test to see if they are now positive,” Larson said.

If someone goes to the clinic because they are symptomatic, but the result comes back negative, they are no longer in need of quarantine or isolation, she said, but they are still sick so should stay home to treat that.

Quarantine is for 14 days after the

last known contact with someone who tested positive because that is the incubation period during which symptoms will show, if that person is infected with COVID-19.

“If you are a direct contact of a confirmed case,” Larson said, “you have to quarantine.”

This can be difficult for individuals or households, she added, so part of what the health department does is make sure that the person or family’s needs are met.

“We assist those families with a lot of stuff. Sometimes it’s an entire family that’s isolated and quarantined, and they don’t have people in this town to help them get groceries and necessities that they need,” she said. “So every day when we talk to them we ask if there’s anything that they need, if there’s anything that they can’t get – food, water anything – and we make sure to get it there and we deliver it.”

They also make sure the quarantined people know to look into different COVID-specific sick leaves, as well as unemployment available for the quarantine period.

“If you are identified as a close contact, we will contact you,” she said.

“But if there was a large event in our community where there was a possible exposure and we don’t know who all was there,” Larson added, “there would be a public announcement put out that if you were at this event, contact us because you might’ve been exposed.”

This happened in early August, when Toole County Health Department put out a notice that anyone who attended the Aug. 1 Shelby Car Show might have been exposed to COVID-19.

“That’s all evaluated on a case-bycase basis and so far we haven’t had that happen,” Larson said.

Her department does have to offer guidance to people planning events, gatherings, and necessities like school and college openings.

Larson and her husband Mark live and work in the community and their two boys go to Havre schools and attend the Boys & Girls Club of the Hi-Line on their off-school days.

People want to be living their lives and need to be making a living, but the health department is vigilant about chance of outbreak in the community or that could affect the community.

The county does have a protocol in place, should it happen, she said.

One of the keys to staying on top of the pandemic is Hill County Health Department’s long-established partnerships with local, neighboring county, reservation, state and federal entities, she said, and these partnerships have been strengthened quite a bit with COVID-19. This includes daily contact with Chippewa Cree Tribe and Chouteau County public health representatives, along with representatives in other neighboring counties, she said.

Every-other-week conference calls with the Association of Montana Public Health Officials have been particularly helpful, she said, because the organization connects the public health leaders in smaller counties in the state who offer advice, support and resources to one another.

Lil ’ Shots Carni val Willow Riggin grimaces as nurse Jessica Kennedy-Stiffarm puts a bandage over where Riggin had a shot on her right arm as nurse Wanda Meredith gives her another shot on her left arm during the Hill County Health Department Lil’ Shots Carnival. The health department normally holds the carnival each year to entertain children while making certain back-to-school shots are up-to-date.

Montana health departments, Larson said, receive guidance from county health boards, as outlined in Montana Code Annotated.

Hill County Board of Health has five members: the three county commissioners, Mike Wendland, Mark Peterson and Diane McLean, along with two appointees, Kristi Kline, who has extensive experience in water systems and waste water treatment plants, and environmental and water systems, and Montana State University-Northern’s Little River Institute Director Erica McKeon-Hanson, who holds a master’s degree in public health.

The resignation of the volunteer health officer in mid-September prompted Hill County Board of Health to realign the duties of the health director to include the role as Public Health in 2020

Because so much of her time is spent on COVID-19 matters this year, she said, her other programs aren’t getting as much attention right now as she normally gives them.

She said she works on grant reports at home at night after a day of fielding phone calls and emails, she added, reviewing a lot of plans – such as how to operate a street dance to school attendance can be done within pandemic safety guidelines, working with schools, working through trouble shooting with contact tracing and more.

Some health department programs are not as busy as normal, not because they aren’t needed right now, she said, and some, like the health officer.

As the health officer, Larson will take on some authority to implement isolation and quarantine, implement different safety measures to protect the public and cancel events in coordination with the health department, Larson said. The full list of duties can be seen on page 17.

“Basically, we’re kind of changing the role of the director of the health department to be the full-time health officer/director,” Larson said. “Other health departments do that, a lot of the bigger community health departments do that. Helena, Missoula, Flathead, they have a full-time health officer on staff, so that’s what we’ll have now. We’ll just have to find a provider who’s willing to be our medical director.”

Because past health directors had home visiting program and WIC, are being run virtually. Some program numbers are down because she has had to make some hard decisions about time and resource allocation.

“We’re not really able to advertise as much about (some programs) when we have other things going on with COVID-19,” she added. “It’s kind of a hard balance to find.”

She works to maintain a balance between work and safety for the nine members of her full- and part-time staff, as well.

“We’ve been pretty well equipped to work at home. We have a continuity of operations type of plan for our department, so the majority of people have laptops and if they also been medical providers they had served as medical director, too, so the health board will be looking to fill that position.

“(Medical directors) sign our standing orders. We renew our standing orders every year and that allows us to do our immunizations, to run any labs at the public health lab, treat communicable diseases and everything like that,” she said.

In general, the standing orders state that the department will following the Advisory Committee on Immunization Practices recommendations and the Centers for Disease Control and Prevention guidelines and recommendations for treatment of communicable diseases, Larson

said. need to they can they go off site and work,” Larson said. “We’ve worked with our IT department on that. It’s all secure, so that’s been really nice.”

They also have a new phone system through Triangle Communications that allows them to route their office phones through to their computers.

“Being the director, there’s more I have to learn about the political part of it and being more active in all that,” Larson said. “That’s been a pretty big learning curve for me, but it’s been interesting, and I like that every day really is different with what you have to deal with.”

Hill County Health Department 302 4th Avenue 406-400-2415

10 Essential Public Health Services

1. Monitor health status to identify and solve community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. In form, educate and empower people about health issues. 4. Mobilize community partnerships and action to identify and solve health problems. 5. Develop policies and plans that support individual community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and ensure the provisions of health care when otherwise unavailable. 8. Assure competent public and personal health care workforce. 9. Evaluate effectiveness, accessibility and quality of personal and population-based health services. 10. Research for new insights and innovative solutions to health problems.

Powers and Duties of Local Health Officers Montana Code Annotated 50-2-118

Powers and duties of local health officers. In order to carry out the purpose of the public health system, in collaboration with federal, state, and local partners, local health officers or their authorized representatives shall:

(1) make inspections for conditions of public health importance and issue written orders for compliance or for correction, destruction, or removal of the condition;

(2) take steps to limit contact between people in order to protect the public health from imminent threats, including but not limited to ordering the closure of buildings or facilities where people congregate and canceling events;

(3) report communicable diseases to the department as required by rule;

(4) establish and maintain quarantine and isolation measures as adopted by the local board of health; and

(5) pursue action with the appropriate court if this chapter or rules adopted by the local board or department under this chapter are violated.

Smokey Pancetta Wrapped Shrimp

Fall in love with shrimp all over again with our Smoky Pancetta Wrapped Shrimp. Your pancetta will crisp up quickly while your shrimp cooks, Shrimp. Your pancetta will crisp up quickly while your shrimp cooks, giving you the perfect crispy, smoky, salty, “let-me-grab-another-please” giving you the perfect crispy, smoky, salty, “let-me-grab-another-please” bite! Serve hot off the grill to wow your guests with your new and bite! Serve hot off the grill to wow your guests with your new and improved appetizer game. improved appetizer game.

Prep Time: 10 mins Cook Time: 5 mins Total Time: 20 mins Yield: Serves 6 Ingredients:

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Instructions:

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Steak Gyros

7HODOESNTLOVEAGOODGYRO!MIXOFSAVORYMEATTANGY tzatziki, and fresh veggies this is the recipe for the perfect meal. Prep the components ahead of time to whip together a fresh sandwich everyday and you’ll be the talk of the lunch room!

Prep Time: 60 mins Cook Time: 15 mins Total Time: 75 mins Yield: Serves 2-4 Ingredients: Steak: Pita:

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