I had the opportunity to intern for the Blue-Ribbon Internship program for the Department of State Health Services(DSHS) at the Region 8 office in the Communicable Disease Program during the fall of 2017, working under the Communicable Disease Manager Elvia Ledezma. This Report will describe the differences between the state and regional offices, my internship activities, and how anthropology can help in the healthcare sector.
The DSHS region 8 is in San Antonio down in the medical district. The environment of the office was very welcoming because they have interns year-round everyone is willing to help and encourages you to ask questions. It was also nice to know that two of the epidemiologists I worked with who were once interns in the blue-ribbon program in past years. The office is sectioned off by departments with manager’s posts on the perimeter and cubicles set up in the middle.
As I soon learned public health is very interconnected, there are a lot of different departments, but they all connect in one way or another So, it was essential to understand the agency and who oversaw what. To start at the top of public health, we have U.S Health and Human Services (HHS) executive commissioner, the Department of State Health Services (DSHS) is a branch of this. Dr. Hellersted is the Texas Commissioner of Public Health. Below him is the Deputy Commissioner and the Assistant Deputy Commissioner. These are the main bosses at the central office in Austin. They oversee external relations, government affairs, Finances, Program operations, Academic Affairs, Health Statistics, Health Policy, and Process Improvement. As an intern, I got to meet with the Assistant deputy commissioner Kirk Cole and work on elevator pitches and ask questions. Dave Gruber is The Regional and Local health offices, associate commissioner. He works with the regional and Local Coordination Director, Operations of business and Support manager, Health and Emergency Preparedness and Response Director, Texas center for infectious disease director, border health operations and coordination director and all the Directors of the Public Health Regions (PHR ).
Blue Ribbon Interns also got the opportunity to tour and have seminars with several of these departments as well as Main lab, to gives us an overall look into the public health system and all its working parts. That finally brings us to region eight where Dr. Lillian Ringsdorf is the regional director, and Gale Morrow is the Deputy of Region Director Gale. works with the mangers of the communicable disease program, the Tuberculosis control program, preparedness and response programs, Sanitarians, and the Social Workers. My supervisor, Elvia is the Manager of the communicable disease program. The Communicable Disease program is divided into three programs Immunizations, Zoonosis an Epidemiology. Epidemiology is then divided into epidemiology program, HIV/STD program, and border health. The Tuberculosis Control program is so prominent in our region that they have their own department manager, yet are still considered a subsection of communicable disease and work very closely with Elvia.
When I started my internship, it was a start of a new fiscal year. Because of this, there was a lot of programs in their early development stages weighting on budgets. My intern role was to assist with projects; this was changing on a day to day basis. When I had downtime would walk around the office just asking if anyone needed help with anything, this is when I would find myself going on Direct Observational Therapy with the TB nurses, helping file or fax paperwork, or even sitting in on meetings. My main projects I worked on this semester were with Epidemiology, Tuberculosis Control Program, and border health. Within each project, I learned a lot but also used a lot of my education and skills I have gained already.
Epidemiology
The primary objective for the Epidemiology in public health is to investigate, control and prevent diseases that are contagious from person to person, offer subject matter expertise on diseases that pose a threat to the public and track and monitor the burden of disease in communities. Before I could be any assistance, I had to get Certified in National Electronic Disease Surveillance System (NEDSS). NEDSS helps connect the healthcare system to public health departments and those health departments to CDC. After certification, I was able to enter the investigation data for three enteric diseases, Salmonellosis, Shigellosis, and Campylobacteriosis. Then had to complete learning modules on each condition to have a basic understanding of the transmission, symptoms, and preventative measures. Finally, I got to work on conducting of the phone interview investigations. Typical investigations start with explaining to the patient who and why you are calling, then reiterating what they were diagnosed with giving background on the disease and the possible ways it’s transmitted. We then ask the patient when they first started have symptoms and ask about their symptoms, medical history, occupation or school location, travel history, food history, type of water they consume, and if anyone else they know got sick with the similar symptom. The final step in the interview is to give the patient some primary education on preventative measures such as proper handwashing, caution when handling raw and uncooked meat, avoid consuming raw meat, untreated water, unpasteurized milk and eggs, and Routine Hand Washing. Before I got to conduct interviews on my own, I had to work with the epidemiology team by shadowing them, practicing mock interviews, doing interviews with supervision, and then solo interview. It was a fantastic opportunity to experience the work of a real epidemiologist, and even better when we got to hear about the more dangerous disease that our team was investigating.
Tuberculosis Control Program
The Tuberculosis’s (TB) control programs Provide Tuberculosis treatment to people diagnosed with TB disease, Prevent the spread of Tuberculosis disease, Identify people exposed to a person with Tuberculosis and provide testing and preventative treatment and Educate the public and healthcare providers about Tuberculosis infection and Tuberculosis Disease. Like I mentioned earlier I got to travel with the TB nurses when they were doing Direct Observation Treatment (DOT). “DOTS control strategy recommended by the World Health Organization. According to WHO, “The most cost-effective way to stop the spread of Tuberculosis in communities with a high incidence is by curing it.” I got to meet the patients and within the hour car ride ask a lot of questions about Tuberculosis. I helped most with Latent Tuberculosis Infection (LTBI) data collection. We looked at about 180 cases from June of 2016 to October 2017 of incomplete TB400 A forms. Our jobs were to collect the necessary information and supporting documents to enter the database and file. TB400 form requires three different type of support documents, a positive Tuberculosis test which can be a Tuberculosis skin test (TST) or a blood test sometimes both, Negative results of chest X-ray, and documentation the patient had no signs or symptoms of Tuberculosis. This was a long process which consisted of contacting labs, and physicians to get all the necessary information the state needs. I quickly learned this is not well functioning symptom especially because of the Latten Tuberculosis infections is a relatively new reportable condition in Texas, a lot of the medical providers weren’t completing the forms right or even completing a chest x-ray on patients. This is where I learned you have to be flexible when working in public health. Obviously, there will need to be more funding for this department because without the four of us interns devoting all of our time to this project there no way the Tuberculosis department could have completed this with all their other job duties. As an aspiring medical anthropologist, I took a particular interest in the fact that Tuberculosis can affect anyone but is more likely to target specific populations. The populations at risk are those who are born in a foreign country where Tuberculosis is prevalent, persons living with diabetes or HIV/AIDS, persons who abuse alcohol and other drugs, persons who live in congregant settings (including prisons and other detention centers), and the homeless. These specific populations are also more likely to be financially impoverished. The fact that some health providers were not giving Latent Tuberculosis infection the proper attention, when there are preventable measures and treatment out there blew my mind. The lack of adequate education for the patient and with our region also have high rates of Diabetes it’s only a matter of time before the Tuberculosis infection turns in to Tuberculosis disease. I’m just baffled that our is healthcare not focusing the same amount of attention on preventative measures as they do on treatment.
Border Health
Border health program Support International Health councils work to meet healthy border objectives, conduct investigations of unincorporated communities and monitors diseases, conditions and environmental hazards. Health community’s initiative with an emphasis on tribal nations is a program still being developed. Elvia assigned me specifically to help because of my Anthropology background. The program’s goal is to Identify and implement the best practices for reducing obesity within tribal nations among the Texas Mexico border. Emphasis on tribal nations. The Tribe that is in our region in western Maverick County is known as the Kickapoo Traditional Tribe of Texas(KTTT). The Kickapoos are located just south of eagle pass within the Texas Mexico Border, right on the Rio Grande. The KTTT had a population of 960 enrolled members and was officially recognized by the Texas Indian Commission in 1977. Although there is no Specific data for Kickapoo tribe is not available, per the Department of Health and Human Services’ Office of Minority Health, Native American Indians and Alaska Native adults are 1.6 times more likely to be obese than the American White population. Also, almost 33 % of all Native American Indians and Alaska Natives are Obese. It was my responsibility to help Rosy Del La Santos the border health program manager with the literature review research, making a powerpoint about the risk of obesity and diabetes, as well as make focus group questions for tribal leaders, tribe youth, and tribe elders. Elvia and Rosy didn’t want to conduct focus groups with the tribe until they knew that the program was finalized and set in stone. Region 8 values their relationship with the tribe, the tribe, assisted a lot with our volunteer flu tracking system and helped with Zeka education this past summer. I don’t know all the detail, but there were still some kinks that needed to be worked out from high up who didn’t quite value the relationships of the tribe. I was very excited to work on this project even if I didn’t get to see it through, I think this is a great program, and valued my supervisor for standing up for the tribe and making sure this program will be benefited and flexible to their needs.
My anthropology education helped me in my situations throughout this internship, and I was valued for my education background, getting handpicked picked to assist in specific projects. For the first time outside of the anthropology department saw my value of being able to look at health care through a different lens and saw it beneficial. This was very motivational for me. Being able to implement biocultural approach out side of the class room and beyond discussion was very rewarding. It helped when I was doing the literature reviews to find programs with a holistic approach to their interventions, as well as being open to the idea that cultural differences are essential and should be respected.
Conclusion
Through this opportunity, I gained a lot of knowledge about public health, form the regional office to the state central office. Getting exposed to all the working parts. I learned that that to work in public health you must be flexible and willing to change and grow this can be done through new scientific discoveries new laws, new policies, budget cuts. I also saw that there is a lot of work that needs to be done and there is not always the appropriate amount of staff to complete. I value my anthropology education even more so when I got to stand out of the crowd and to be something different to the table. I see that there is a significant opportunity to help people through public health, and a lot I can still learn. Working with the Kickapoo project got me excited about program development for lower economic communities, this has led me to apply for graduate school, and pursue my master’s in public health. More specifically the dual master’s in public health and anthropology.
References Cited
http://www.dshs.texas.gov/
https://www.dshs.texas.gov/idcu/disease/tb/
http://www.apa.org/pi/oema/resources/ethnicity-health/native-american/obsity.aspex.