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Rachel Warden, RN and Heather Johnson, LPN

How did you two begin your friendship?


Rachel:  I’ve been with the health department for two years, going on three. Shortly after I started, our supervising nurse went on maternity leave and COVID hit while she was out. So I became the COVID nurse. Then when she came back, she took another position at one of our local schools, and there was no way I could continue by myself.


Another part of our job is working on grants, and one of the important ones was for lead. Heather got hired as our lead nurse. But she didn’t get to work lead very much. Instead, we’ve been working as a team. Some days we’d work from eight in the morning until 10 at night, and we had another nurse, a paramedic, and a contact tracer who would come in at night and help, too. Working long hours and weekends, you get to know each other really well. We’ve become good friends. Well, we basically became family, because we lived together for like 150 hours of overtime a month for a long time last year.


Heather:  At our local ambulance district where we have mass vaccination events, we’re called "Thing One" and "Thing Two".

How do you complement each other?


Heather:  She’s the talker and I am not. I could be looking at her and I know what she’s thinking. We seem to have the same thoughts and nothing has to be said. It’s a rare find to have a partnership like we do with somebody you enjoy working with.


Rachel:  We have similar personalities, too. When COVID would be overwhelming and we’d both come into work, we’d just start to organize. She would understand that I needed to move things around to feel less stressed, and she’d be right there with me, moving things around to feel less stressed.


A fun fact about Heather is she likes mail. None of our letters ever sat in our health department overnight. Even when we were working long hours, she’d make sure all the letters were mailed. It’s a true blessing to find somebody you can work with 12, 13, or 14 hours a day and not hate your job. We just find joy together. When you’re doing a hard job, not sleeping much, telling people to stay home, and getting push-back, emotions run high. Heather’s positive and very good at keeping our office upbeat. She’s just a gem.


What was your role in COVID response?

Heather:  We had so many COVID cases in November 2020, and that was when we were able to call each individual person to tell them, "You’re really sick. We need to send an ambulance for a well-check or you need to contact your doctor." People didn’t know what they were to do. So we just tried making sure they followed up on things, or that we called to check on them every few days. As cases grew, we had to table that. Early on, we had to educate folks about what COVID was. Because they might have thought, "Oh, I just got the flu."

What other challenges did you face during the COVID pandemic?


Rachel:  Sometimes the public thinks us health professionals are just the people telling them the rules. We’ve had our fair share of resistance. It was really hard during the holidays to tell families about the risks they were putting their grandparents or their loved ones in if they didn’t quarantine. To call and tell people to isolate away from each other during some of the biggest holidays — that was probably one of the toughest things I had to do emotionally. ​​We’d try to offer people solutions on how to still celebrate, but differently.


Initially, when COVID started, everybody wanted us to call them. And we’ve had some people who we’ve called and sternly talked to. But for the most part, they wanted to hear from us to know what to do. They want the information, they want to isolate, they do stay home. They want to do the right thing. Now there’s so much information on social media and from the news. You can google what to do and get guidance. But when people look things up and see other advice, that puts us in a rough spot.


And on a state and federal level, I feel like we’re losing some of our credibility because of how frequently information changes. We’ve always followed the CDC and Department of Health and Senior Services guidelines. So when we’re telling a community one thing and the next day it’s different, it makes it difficult for the public to want to hear from us or to take what we say seriously. But you have to follow a set of guidelines because if you don’t, you’re going to be all over the place. What happens from the top does cause ripples, and it affects us locally.

Where do you find support when COVID takes a personal toll?

Rachel:  Personally, I’m a crier. Through some of the pandemic, I’ve definitely shed a lot of tears. But it’s good sometimes to let yourself feel those emotions, let yourself have a good cry, let yourself realize this is unprecedented, and you are making a difference. You’re the one who’s interrupting the transmission of disease. Sometimes you’re the one who’s calling the ambulance for the sick person, or you’re the one telling them you want them to get help. I’m dealing with people who are very scared. And I realize I’m the one offering them some hope or

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peace. I think realizing that in itself just helps me to be emotionally okay.


Every morning when we start our day at the health department, a group of us  pray together and ask God to bless our community and our county and give us strength. That has really had a big impact on me, personally. We lean on God and the staff leans on each other a lot throughout this. It’s hard to come home and tell your family what kind of day you faced when they haven’t lived through the work we do every day. Spending time with my family and my kids is also so important to me. And, honestly, being able to talk to Heather and knowing we’re not in this alone makes a big difference.

What barriers do people in your community face to accessing healthcare?


Heather:  We’re a pretty rural community, so sometimes funds for gas for the commute to a healthcare facility is a barrier for people. Also, getting information to people, because a lot of folks do not have Internet. We advertise on the radio and there’s a local newspaper that reports on clinics and community events we’ve done.


Rachel:  At every community event in our county, you’ll probably see me or Heather’s face. We’re at the county fair, the health fair, the pumpkin festival. Everywhere people gather, we try to attend and educate or offer services to help bridge some of those informational gaps. We offered vaccines one night at the fair. We work well with the healthcare entities in our area like the Ambulance District and local hospital. So they’ve even assisted to try to help bridge gaps and help our community the most.

Heather:  When our health fair happens, the hospital and health department and everyone come together at the school to offer different services. This year, we’re going to be offering COVID vaccines.


Rachel:  One agency attended a few years ago that made parents aware of how to detect drug use in their children. They had a booth set up like a teenager’s bedroom, and they’d hide things and teach parents what to watch for. So the event touches on so many areas of health. It has a pretty good turnout too.


How does your community prepare for emergencies like the COVID pandemic?

Rachel:  Prior to COVID, our health department attended a lot of trainings. I did an emergency preparedness training in Jefferson County where we practiced a mock emergency. We had to learn how to be dispensers and how to get a lot of people medicated in a very precise and safe amount of time. We also had trainings that we went to frequently about assessment and surveillance. We take TB training, vaccine training, and epidemiology training, and we have to continue those throughout the years.

Heather:  Community partnership is definitely one of our region’s strengths, and that was evident during our COVID mass vaccination clinics. Everyone pitched in, from hospitals to volunteers, and it went flawlessly. Our local courthouse even closed part of their office and their staff came to help schedule appointments. All of the vaccines had to be administered by appointment, and every person was personally called. Our banks provided food, so did Walmart and Country Mart - a lot of our businesses in town really showed us love and support.

What changes have you seen in perceptions about public health?


Rachel:  People may not know what public health is. Before I started working as a public health nurse, I didn’t know the extent of what public health does, and what public health roles are. Professionals in this field do a lot of things behind the scenes, from working in different programs to doing disease investigations. So when COVID started, it seemed new to the world that health departments are quarantining people and calling and investigating. But the truth is we’ve investigated diseases for years. That’s what we do. We also work in epidemiology. So it wasn’t that our role changed. But unless you’ve had Rocky Mountain spotted fever or cryptosporidiosis or some other reportable illness and we’ve called you, you wouldn’t know that’s always been something we’ve done.

What are some programs that people may not realize the Health Department offers?


Rachel:  Pretty much every health department does pregnancy testing. We do STD testing and treatment. We sign individuals up for temporary Medicaid. We do rabies follow-ups. We offer blood pressure checks and have a blood pressure program free to anyone over 18 with high blood pressure. We have a free crib program.


We offer a Show Me Healthy Women and a Wise Woman program, which provide pap smears and mammograms at no cost to eligible women. We also do lab work during those visits. That’s all covered under the program. People do have to meet certain income and age criteria for these programs. But if a woman with no insurance who meets those criteria comes in, and a breast lump is found or something like that, she will be covered through our programs for her entire treatment.


We also offer discounted labs. It’s drastically reduced — a full normal doctor’s blood panel is about $75. We do lead testing for children ages six and under. And we have the WIC department, which is really thriving. They just won an award. They’re one of eight WIC programs in the state that won.

Heather:  Washington County also has a history of lead mining from the 1700s, and a lot of local mines now have homes on them. Children can be at risk if they’re exposed to that lead dust, so we monitor children, the properties, and the well water. The Environmental Protection Agency comes in to remediate some of the properties. So we try to educate our community on the importance of preventing lead poisoning.


Rachel:  High lead levels in children can cause physical issues, but mostly it’s long-term learning deficits like ADHD. The biggest at-risk group is six months old to six years old. Then, once kids hit first grade, second grade, third grade, you start seeing the effects of lead poisoning.

Rachel Warden, RN and Heather Johnson, LPN

Public Health Nurses

Washington County Health Department

NOTE:  Rachel and Heather shared their stories in fall 2021. Some information about COVID has changed since that time. 

Storytelling and photos by:

Humans of St. Louis / Ava Mandoli

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