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Posted on Wed, Jul 17, 2013 : 6 a.m.

From amebiasis to West Nile Virus: Public health takes on communicable disease

By Washtenaw County Public Health

Mary McCloud 2009.jpg

Mary McCloud, Communicable Disease Nurse

Name: Mary McCloud, RN
Employer: Washtenaw County Public Health
Occupation: Public Health Nurse

While en route to my office at Washtenaw County Public Health, I begin my day by stopping by the apartment of one of my tuberculosis (TB) clients. I have his TB medication with me, which I hand to him and watch him swallow (this is called Directly Observed Therapy).

His course of disease is unusual in that his TB is multi-drug resistant. This means he will be on treatment for two years, and a public health nurse must observe him take his pills every day (including weekends and holidays). Fortunately, I have several co-workers who share this task with me. After he takes his medicine, I remind him about an upcoming appointment I scheduled for him with audiology (hearing loss is a potential side effect of one of his TB medications) and inquire about his appetite and if he has enough food on hand.

Arriving at my office, the first order of business is to follow-up on a 3-week-old infant diagnosed with Pertussis (also known as Whooping Cough). While inquiring about the infant’s course of illness and treatment, I discover that both the infant’s mother and grandmother have been coughing for weeks. Their symptoms match the case definition of Pertussis, which means I do follow-up and charting on three cases rather than one.

I teach the infant’s mother and grandmother about the disease: the cause, how it is spread, appropriate treatment, and prevention measures so others will not become ill. All family members need to be treated with antibiotics and be immunized against Pertussis as soon as possible.

I receive a report from the Michigan Department of Community Health (MDCH) Laboratory with a negative rabies report on a bat that was submitted for testing two days ago. A county resident had awakened in the middle of the night to find a bat flying around in her bedroom. This is considered an occult exposure to rabies (she could have been bitten while asleep and not be aware of it). She was able to capture the bat and called our office for instructions on what to do next.

Public Health has a contract with a local veterinarian’s office where the bat was euthanized and prepared for submission to the MDCH Lab. I authorized the bat for testing and directed her to the vet’s office. Since the bat has tested negative for rabies, she will not have to undergo rabies post-exposure prophylaxis (Rabies Immune Globulin and the rabies vaccine series). When I call her with the lab results, she is relieved to hear the bat tested negative.

This afternoon I am scheduled in our immunization clinic. The schedule is full for the next three hours, and everyone is showing up for their appointments today. We offer all recommended vaccines for children and adults, plus TB skin testing at our clinic.

One family who comes in is a mother and her four children who have recently emigrated from Iraq. The mother wants to make sure her children are up-to-date on their shots before she enrolls them in school. The family speaks little English and their shot records are written in Arabic. I use a telephone translation service to assist me with figuring out the shot records and, after I assess what immunizations the children need for school, to assist me in educating the mother about the shots the children will receive today.

Mom asks me about local doctors in the area and I give her a listing of low cost health care providers within the county. I notice that she is pregnant so I also refer her to our WIC office which is right across the hallway. I check my e-mail and return a couple of calls before calling it a day.

Last year, public health nurses in Washtenaw County followed up on 275 cases of reportable communicable disease, ranging from Amebiasis to West Nile virus. They also followed up on 284 potential rabies exposures (animal bites or bat exposures).

Washtenaw County Public Health promotes health and works to prevent disease and injury in our community. Visit us online at http://publichealth.ewashtenaw.org.

Comments

Sam S Smith

Thu, Jul 18, 2013 : 2:01 p.m.

Thank you RN McCloud and all other healthcare workers who provide such wonderful services!

Sarah Rigg

Wed, Jul 17, 2013 : 1:02 p.m.

I always like your "day in the life" of a public health worker type posts. Very interesting to know what a "typical" day is like for them.