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New County Health Officer Faces Big Challenges, Advocates Call for Partnerships



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(Sacramento, CA)
Wednesday, February 08, 2012

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Dr. Olivia Kasirye was public health officer in El Dorado County. In Sacramento, she says she'll focus on combating sexually transmitted disease, controlling obesity, and reducing health inequities. As for the county's budget, she says it's an opportunity to take a hard look at core functions of public health.

KASIRYE: "What programs do we need to focus on, and what are the priorities in the community, because of course you realize when you don't have a lot of money that you can't do everything. So you have to look at what you're able to do."

But Kasirye's predecessor had a bleaker outlook on the department when she left the post several months ago. When Capital Public Radio talked to Dr. Glennah Trochet weeks before she left, she described an operation that had been nearly cut in half in a matter of years. 

TROCHET: "We have lost entire programs, we were always very proud of our field services. We had public health nurses... We lost all of our field servces last year."

The county reduced the number of clinics from six to one. Dental programs were left to scramble for funding. Trochet said the budget cuts also undermined their ability to track disease.

TROCHET: "We used to have a communicable disease controller and an STD/tuberculosis controller as well as the health officer. A public health veterinarian did rabies control. All those positions are gone except for the health officer."

Trochet left to work at a Sacramento medical center saying the functions of the public health were either not being done, or not being done well. And that could have a long term impact on public health.

TROCHET: "So our resources and our ability to protect the community are...have been reduced quite a bit."
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The county's financial hardship has necessitated a closer relationship with outside institutions in order to safeguard the public from disease. When the H1N1 outbreak hit, Jonathan Porteus of The Effort clinics says they stepped up to provide care to the undocumented.

PORTEUS: "It was quite a lot in a short time. If I remember there were a couple of hundred people within a matter a days who came through. You know, I think once we learned from that, we had more early warning, and more dialog up front with the county."

Porteus has kind words and optimism about the way county health officials have dealt with decreased capacity. Dawn Fox is a school nurse with the Sacramento School District. She says the schools were instrumental in meeting the state's new whooping cough vaccine requirement for teenagers. She hopes the county will become more of an umbrella for child immunizations at schools.

FOX: "''Cause they saw that the schools that were able to give their own vaccines were able to do a lot more with the TDAP requirement have more of their clinics and not rely so much on the county. And having the school districts with the ability to do that will put less of a burden on the counties for providing the vaccines."

OTO-KENT: "Leveraging those partnerships is really essential"

Debra Oto-Kent leads the Health Education Council. She says she hopes Kasirye works with ground-level groups on prevention for the area's most vulnerable.

OTO-KENT: "It's really important to have this place based perspective that it really matters where people live, work, play, shop, eat, you know, those dynamics impact health."

But Marty Keale of the Capital Community Health Network says a big part of the job is political.

KEALE:  "The county's priorities are in other areas, they're not in health."

He says moving a health agenda forward in Sacramento requires more than understanding health issues. The new health officer will need the finesse to make powerful players care.  

KEALE:  "You're not going to win any arguments with these folks strickly based on the science. But it's got to be part of it."

Kasirye worked for Sacramento county health before. That might help her restore the dismantled divison. And she'll be doing it with at least a 30% pay raise from her last job in El Dorado - making just under $200,000 a year.
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