Dear Madison County Health Department:

Pam & Beth – I have learned so much from the two of you this semester. About what a public health nurse does; about what public health nurses do far beyond their hours, job descriptions and salaries; about health concerns in Madison County; about the extent to which public health nursing reaches beyond seeing a client for a few minutes in an exam room – far beyond.

Thank you both for welcoming me at Cabbage Patch every Monday night and at every monthly meeting of the teen pregnancy prevention coalition. Thank you for introducing me to the participants of Cabbage Patch, making it so much easier for me to conduct my interviews.

Thanks for always making time for me, getting back to me (and so quickly) by phone and by email to answer my every little question. You were tireless sources of information, always patient, generous and kind, the way we hope nurses will be.

Holly, thank you as well for always getting back to me by phone and email to answer my every little question. Thanks for patiently interpreting data for me in a way that I could understand it, interpret it for others, and hopefully interpret it better on my own in the future.

Sonya, thanks for calling me back during what I imagined to be your only minutes of free time during the week – while driving to your 2nd job early on a Saturday morning! Thanks for sharing with me your passion for public health that motivates you to work so much.

Wanda, thank you for speaking so candidly with me that afternoon at Teen Matters and thanks for the tour of the clinic. You gave me very useful insight into the teen pregnancy issue in Madison County.

Finally, though not a staff member at the health department, you are definitely an active part of the programs there, Melanie, thanks for finding a way to open up to me about a delicate subject matter while still protecting the girls that you help so much. You have given me so much of your time this year. You’ve been patient and generous. You’ve always responded to my questions and generously offered me contacts who might provide even more information.

Everyone, it has been a privilege to get to know and to see the impact you make in Madison County.

So, thank you!
Sonya

Dear Madison Co. Beat Reporter 2011:

Here are just a few tips for you off the top of my head.

•Go to the MART (Madison Area Resource Team) meeting, also known as the Family Connection meeting, the 4th Tuesday morning of each month at the county courthouse. Get the exact time at the cooperative extension. The MART meeting will give you tons of story ideas and lead you to tons of sources, as it is a roundtable discussion for leaders of a number of community services as well as people interested in them.

•Give teen pregnancy a rest for a semester. I covered this subject to death this semester, and my sources were so kind, generous, and patient, and I would love for them to get a break from UGA journalism students.

•Don’t be sad – there are tons of stories. One I wanted to do, but never did, was the impact lack of transportation makes on public health and the delivery of health care services. Something a lot of people may not even think of. There aren’t any sidewalks or public transportation in Madison County, but there are plenty of people without cars. And the nearest hospital is nearly 30 miles away in Athens. How does transportation affect the ability to make and keep a doctor’s appointment? The health departments don’t take appointments; all services are all walk-in all the time, and part of the reason for this is the population’s difficulty keeping appts due to transportation challenges. And how about a sidewalk’s impact on physical fitness? A recent study I read about health disparities among rural people highlighted the increased obesity, diabetes and cardiovascular disease in rural America. The study revealed, however, that rural people are no less motivated to stay in shape and eat well, but they are isolated by geography – and some by lack of transportation - so opportunities to exercise or buy nutritious foods are limited.

•On that note, find out about the stroke and heart attack prevention program at the health department. It provides real incentives for clients to lose weight, and it seems to be working.

•Quite a few active members of the community and at least a handful of public health professionals attend Jones Chapel United Methodist Church. The nurse mgr. at the health dept. has mentioned her ability to serve the needs of the community not only through the health dept. but also through her church, and I’ve heard the pastor here has been a supporter of some of the projects of the health department. If you’re so inclined, attend a service here to get to know your community.

I’m sure I’ll think of more for you. And if you have any questions for me, feel free to contact me. Good luck! This is a great assignment! Have fun!
Sonya

Not a puff piece

I’ve learned a thing or two about writing in my life, and I know that words like “so,” “very,” and “really” are pretty much off-limits. I know that whether it’s a creative writing workshop or a journalism class, nobody really (oops) wants to read a piece about how wonderful someone or something is. In a poetry or fiction work, it’s drivel. In journalism, it’s a puff piece.

“Where’s the tension?,” “Where’s the conflict?,” would read the comments scrawled across my manuscript were I to write a story about nice people doing nice things.

So I feel that – although I’ve used my reporting this semester in stories for Professor Thomas’s class, Dr. Hume’s class, and the GA Public Health News Bureau – I haven’t had the opportunity to say what I think about the people I’ve encountered this semester, i.e. how so really very wonderful they are. So in this blog post, I’d like to take the opportunity to throw all good writing conventions out the window and speak freely. You've been warned.

Covering Madison County for this class and reporting for the GA Public Health News Bureau, I have interviewed public health nurses, doctors, emergency preparedness specialists, environmental health specialists, and nursing and public health professors (and I’m probably leaving some other professions out), and in doing so, I have met some people so dedicated to the well-being of their community, of the public, and of many people who do not have the means – or do not know they have the means – to be dedicated to their own well-being.

When I first went to the health department in Madison County, I admit, I expected to meet burned out, jaded state employees (and they have good reason to be – making at least $20k less than those who work in private hospitals and constantly absorbing the effects of seemingly endless cuts to state spending on public health). I believe I have probably met (in person or by phone) about 50 public health workers this semester, but I have not met a jaded or burned-out one yet.

When I first met Beth Heath – Madison County nurse manager and tireless source for many of my stories! – I thought she was special. I still think she is special, but I thought her willingness to work for very little just so she could be a public health nurse at a county health department was unique. Special it is, but since meeting Beth, I have met doctors, nurses, dentists, and environmental inspectors who work two jobs rather than give up public health in order to work a more lucrative job full-time.

Beth, however, does seem to embody the community spirit of public health. She took not one but two pay cuts in order to serve her community in the way she feels a public health nurse should. When Beth finished nursing school, she “had to” take a high-paying job as a pulmonary nurse at Athens Regional because, though she really wanted to work in public health, health departments at the time didn’t hire new grads. So she bided her time at ARHC until an entry-level job opened up in Jackson Co. She worked there a few years and even got promoted, but when an entry-level job opened up in Madison Co., she took it and another pay-cut. Beth believes that the community is best served by a public health nurse that lives in that community, so she applied for the demotion in order to work in the county where she lived. Sure, working close to home must have had personal advantages for Beth, but it seems to me that she wouldn't take another pay-cut just to shorten her commute by a few minutes. She had greater benefits in mind.

And it’s not just the sacrifices these folks make, it’s the modesty! In my first interview with Beth, I said, “So you took a pay cut when you left Athens Regional?” And she said, “Yeah, but everybody takes a pay cut who works in public health.”

When a dentist at the Chatham Co. health dept. mentioned that he worked a second job, I didn’t mask my admiration, and he said (with a shrug in his voice), “I don’t know anybody in public health that doesn’t work two jobs.”

Sonya Willard is one of them. She’s a nurse in Madison County, and in her “free time” she’s going for a higher nursing degree and in the remaining “free time,” she moonlights at a hospital. When I asked her why she didn’t just work in a hospital full-time – where she could easily double her salary at the least – she said she loved working at the health department too much.

Karen Palmer is an area nurse manager in the Gainesville district, and she said that when she gets a check from her weekend hospital job, she has to remind herself why she stays in public health, but that one of the reasons she stays at the health department is the opportunity it gives her to empower women to learn about and take care of their bodies.

Most people I interviewed said the health departments gave them opportunities private hospitals did not to really care for patients comprehensively, which means taking care of the whole person – not an acute issue – on a long-term basis with plenty of follow-up.

It’s not just nurses. Dr. Lynne Feldman, director of Valdosta’s Southwest district works two jobs, too. Imagine that – a doctor working two jobs. She said, “Salary and benefits are always an issue, but whether or not you like the work is also an issue.” I wish more people felt that way. (Personally I have always thought enjoying what you do is more important than the pay – yes, I know this attitude is a luxury that many can’t afford – but I know a lot of people who would think my attitude absurd.)

Another dentist – few health departments have dental programs, and the existing ones are really hanging on by (may I make a bad pun?) the skin of their teeth – took a voluntary 20% pay-cut in order to prevent his county’s dental program from being retrenched, and his hygienist voluntarily gave of 10% of her pay.

A public health authority who I interviewed asked not to be quoted on the following, and I will gladly acquiesce because it’s clearly not true. He said, “Those who work for state and county public health are either very dedicated or they can’t get a job anywhere else.”

Clearly, they can all get jobs anywhere else, and they all do! So he was right on one count: public health professionals are really, so, very dedicated.

-Sonya Collins

NOTES:
*I would like to apologize to every teacher, student, editor and peer-editor I’ve ever had for using so many “writing profanities” in this post.

*I’d like to acknowledge that there are many, many more people who sacrifice for public health and the health departments. I have met only a few of them and mentioned far fewer. Just a couple others are Wanda Strickland, Pam Smith, a whole crew of people in the Coastal, North, Northwest, West Central, South and Clayton Districts, i.e. they’re spread across our entire state. And since I’ve abandoned all efforts to avoid cliché and other undesirable writing conventions, I’ll sign off with this: If you meet someone who works in public health in any capacity whatsoever, please tell them thank you.

Nothing to do today? Or nothing to do tomorrow?

I’ve been talking to Madisonians about teen pregnancy since January, and no matter whom I interview – teen mom, nurse, epidemiologist, counselor, parent, advocate – I always ask the question, “Why is the teen pregnancy rate so high in Madison County?”

Those who don’t work in healthcare or social services all shrug and say, “I guess because there’s nothing to do.” But I couldn’t accept that answer. There’s nothing to do in suburbs all across America. What makes Madison County different?

Poverty, of course, sets Madison County apart from the suburbs. But what does poverty have to do with pregnancy?

When I first met Melanie, she also said that it must be because there’s nothing to do. Melanie was a teen mother herself, and the daughter she bore at age 17 went on to become a teen mother. In addition to running a teen parents support group at Madison Co. High School, Melanie’s a member of the Teen Pregnancy Prevention Coalition, and she’s an active advocate for teen pregnancy prevention in this small community. So I thought she was going to give me more than “there’s nothing to do.” I expected her to have the answer. Nothing to do may explain teenagers having sex, but it doesn’t explain so many of them getting pregnant.

Because Melanie is a major player on my teen pregnancy beat, I’ve run into her many times this semester. Last week we sat down for an official interview. We met in the conference room at the health department before the March Coalition meeting and as the meeting was just getting started, she said to me, “Sometimes I feel like a double agent. I’m supporting the teen parents one day at my support group, and I’m over here trying to prevent teen pregnancy the next.”

I said, “But aren’t you trying to prevent more teens from needing support?”

She said, “Sure, but I wonder if the girls would think I was betraying them. Sometimes I think they don’t even think teen pregnancy is a problem.”

Now we were getting somewhere. It’s not that there’s nothing to do. If girls don’t think there’s anything wrong with having children before they finish high school (yes, children, I’ve now spoken to or heard of many who had 2nd and 3rd children before they were 18; I’ve learned that it’s not just a battle to try to keep girls from getting pregnant in the first place, but it’s just as hard to try to keep them from getting pregnant again), then why would they go out of their way to prevent it?

A couple of days later, I met with Wanda Strickland (pictured above), the nurse at the Teen Matters Clinic.

I asked her, “Is this [the clinic where we were sitting] where girls find out they are pregnant?”

“Yes.”

“What is that moment like?”

I was ready for her to tell me about the tears and the terror in their eyes.

“A lot of them are happy. A lot of teenagers want to be pregnant,” she said.

I was stunned silent for a minute – mainly because the following questions I had pre-written were based on the answer I expected to my last question but didn’t get. Now I could only ask, “Why?”

“It’s generational poverty. If you have no goals and your parents have no goals, you set up a whole different standard of norms. For some people the goal is just to survive, to get the rent paid for the week.

“So I ask every kid who comes in here, ‘What grade are you in? Where are you going to college? What’s your goal? Because for some of them, nobody has ever asked them that.”