Notes From the Field
Policy and Law
Joe C. Garrett is an epidemiologist for the Zoonosis Control Division of the Texas Department of Health in Austin, Texas. He graduated with a D.V.M. from Texas A&M University and an M.P.H. in Epidemiology from Tulane Universitys School of Public Health and Tropical Medicine. He also holds an M.A. in International Relations from Salve Regina University.
Garret is a member of both the American College of Epidemiology and the Association of Military Surgeons of the United States. He served with the Army Medical Department from 1971 to 1998 in Europe, Southeast Asia, and various locations in the United States. Before joining the Texas Department of Health, he worked as a Support Epidemiologist for the Texas Animal Health Commission in Austin, Texas.
JF: What should rural physicians know about the West Nile Virus; its vectors, epidemiology, identifiers, and treatment?
JG: West Nile virus (WNV) is very similar to the other arboviruses we already have in Texas. The transmission pattern and the disease syndrome is much like St. Louis encephalitis (SLE), eastern equine encephalitis (EEE), western equine encephalitis (WEE), and dengue. The virus is carried by birds and transmitted from the birds to humans by mosquitoes. There is no transmission from people to other people or to mosquitoes.
Most people infected with WNV will show no symptoms. A few people may develop fever, headache, body aches, skin rash, and lymphadenopathy. Of those individuals who become ill, a minority will develop more severe symptoms that include meningitis or encephalitis. Death from WNV is rare. Serum and CSF may be tested by the Texas Department of Health (TDH) laboratory for all of the arboviruses, including WNV. Treatment of patients with these viruses is purely symptomatic.
(This article appeared without an abstract).
After what seemed like an interminable mid-March eighteen-hour flight from Los Angeles to Melbourne, Victoria, Australia, I took a cab from the airport to the Mercure Hotel in the downtown area. Melbourne is a city of approximately 3.2 million people and it sits on the Yarra River and Port Phillip Bay. My hotel was adjacent to a large public park area.
Later that afternoon, I met Mike Cormack, National Director of the Australian Healthcare Association, and Carl Putt, Director of the Victoria Hospital Association, at the VHAs downtown headquarters. Both of these distinguished-looking chaps were very hospitable and Mr. Cormack provided me with a brief overview of the Australian health care financing system. This overview, as well as an outline of the Australian system of government, are summarized in Attachment 1. Essentially, Australia has a socialized system, much like its mother country England. The Australian system is funded from a combination of a 1� % tax on personal income as well as matching funds from each of the countrys eight states. The funds are based upon varying demographics and the application of some rather complicated formulas. Featured in a special issue, the Australian Health Review (2002) provides a series of comprehensive articles that outline each states patient demographics and funding. Copies or reprints of this publication may be obtained by contacting the Publications Manager of the Australian Healthcare Association (www.austhealthcare.com.au).
A striking difference between the Australian health care financing system versus the American one is that the Australian Medicare program covers all citizens, regardless of their level of income (Australian Healthcare Association, 2002). The Australians have no Medicaid program and Medicare is the sole government payer. Many people carry some form of private or commercial insurance to supplement Medicare and to allow them greater choices for elective surgical procedures. Unlike the American Medicare program, Australian Medicare requires no deductible, co-insurance payments, eligibility requirements, or means testing for participation in the program. Any Australian citizen is eligible for Medicare services provided they meet the criteria for care established by the Medicare program.
Rural Texas has a continuing need for primary care clinicians. To address this need, the Department of Family Medicine at the University of North Texas Health Science Center (UNTHSC) at Fort Worth has developed the Rural Family Medicine Track, a longitudinal elective rural training program designed to prepare medical students to live and practice in a rural community. One important goal is to immerse students early and often during their education in the life of a rural community. This article will describe how rural lifestyle elements are incorporated into the family medicine educational experience, identify the activities utilized, and discuss obstacles encountered in the implementation.
Key words: family medicine curriculum, lifestyle elements, rural health, Texas. (Texas Journal of Rural Health 2002; 20(3): 16-25)
The purpose of this article is to describe capacity building and demonstrate areas where its use could benefit communities in the management of public health programs. Capacity building is a wise, economical, and results-oriented approach to the delivery of public health programs. It lessens duplication of services, strengthens communities, and more importantly, it encourages public health agencies and the community-at-large to realize that public health is a community concern, and cannot be addressed by the government or one segment alone. Capacity building can increase the publics understanding and involvement in public health issues and reduce barriers to needed services because local resources are being utilized. This concept could be used to address reductions in HIV/AIDS, poverty, and illiteracy, for example. It could also be utilized to help improve housing, increase the food supply, and eliminate child labor. In this article, a model strategy for this concept is provided. Individual responsibilities are also outlined.
Key words: capacity building, coalition strategies, public health (Texas Journal of Rural Health 2002; 20(3): 26-30)
Coalitions and community-based partnerships can be important tools for change. The state of Mississippi was successful in increasing immunization rates through a statewide immunization coalition. Mississippi officials realized that a coalition could unite people and interests, combine knowledge and resources, rally people to action, and encourage acceptance of new ideas. Established in 1994 and reorganized in 1999, MSIC, Inc. sets specific objectives for each year, develops market plans and surveys, and uses implementation strategies to improve immunization rates.
Key words: coalitions, community-based partnerships, immunization, Mississippi, MSIC. (Texas Journal of Rural Health 2002; 20(3): 31-37)
The Lower Rio Grande Valley of South Texas has the highest poverty rate in the United States. Providing health care to the growing population on the border is an ongoing challenge due to the financial, language, cultural, and educational barriers. To overcome the challenge, it will take drastic socioeconomic changes in Mexico as well as a united communitys commitment to improving the living standards and health care access of the indigent population along the border.
Key words: border health, colonias, poverty, Texas (Texas Journal of Rural Health 2002; 20(3): 38-51)
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