Administrator, Washington County Health Department
What was your career path into local public health?
I wasn’t planning on going into public health, but I really believe God had this plan for me, even all the way back when I was a little stinker. He knew my heart, that I love my community and the people in it, and that I wanted to be helpful in some way. I feel like this job was provided to me to help make a difference here. So that’s what I’ve always tried to do.
In January 2022, I’ll have been at the Washington County Health Department for 35 years, but I’ve only done my current position for two. I kind of took it over during the midst of COVID. Before that, I was the WIC coordinator and then moved into a maternal and child health position. When I took over as administrator, I actually kept those other two jobs.
I’ve lived in this town my whole life and was always just happy with a support position. I’m not great at pushing on people if they’re doing something they’re not supposed to. I want to be the good guy and not the bad guy. Thankfully, everyone here is a great team player. We all encourage each other to continue to do well, and acts of kindness are contagious.
Cara Sims, an RN here, took over the WIC program, and she’s done an incredible job. She and her WIC breastfeeding department team just won an award, and there were just a few given out in the nation. That’s a big deal. I’m really proud of them. I’m proud of the entire team at the health department.
Every person who works here cares so much about our community and the people who come in. It’s not just a job for them, either. They get involved in their patient’s lives and the lives of their patients’ families. I’m usually the cheerleader of the group, but there have been times when I’ve gotten down myself and even I have to talk with my coworkers. One couple in particular are wise beyond their years, and I know I can always count on them to talk to. We talk each other back into that positive place we all need to be.
What was your work environment like during the COVID pandemic?
When the pandemic hit, we did the lockdown like everybody else, although we never completely closed our office. We just limited how many people were in the building at the same time. Most of us all have our own office, so we could also social distance. But we had to quit eating lunch together, which was hard because that’s when we can all decompress. We’re still trying to be cautious and limit the number of people we’re in contact with at the office. That way if one of us falls ill, at least we don’t take out the whole department.
Last year, some staff worked seven days a week, 10 or 12 hours a day, and I know it hurt their families. Staff were permitted to bring their kids in on weekends and nights to play in the playroom or boardroom or watch TV, because I didn’t want parents to have to find childcare or a babysitter. Then we went back to a little bit of normalcy with our hours because our numbers dropped so much. But, as of late, numbers have been going back up. So we changed our approach. Now we’re still able to provide quality care while respecting the amount of time it takes us to do that. And I’m trying to encourage staff to go home at night, to not put in the hours we were putting in before.
During the COVID pandemic, how did you get resources out to people in your rural community?
We have so many people who don’t have wifi and internet, so education was a big problem. Our students really suffered — emotionally and academically. School was a safe place where kids were fed and watched over and protected. For them to be out for such an extended time, I’m sure it was rough for a lot of them. Mandated reporters weren’t able to see these kids, and things were getting missed.
We have a lot of poverty in Washington County, so it’s hard for us to tell somebody they need to quarantine for two weeks, because then they can’t work. If they live in a small home and their five-year-old gets exposed and can’t isolate, caregivers are quarantined until the last day their child is quarantined plus another 10 days. So that can turn into a very lengthy time for families who can’t afford it. I know that caused some people to not be truthful. And you can’t blame them. They have to work.
We have situations where we try to help people hook up with all of the resources — the bill pay, the electric bill, the food pantries. But sometimes it’s still not enough. And I get it. If you’re the only source of income, and you’ve got a family to feed and lights to keep on, for the health department to come in and say, "Sorry, you’re down for a month," that’s a big deal. So it does cause people to be reluctant to share contacts with us. We knew there were people in quarantine who continued to work. How do you deal with that? It’s a tightrope. But they did what they had to do to take care of their families, and I see that side of everything, too.
What other challenges did your organization face during the COVID pandemic?
No health department received any direct federal funding during the pandemic.** Hospitals got it. Schools got it. I feel like everyone got a piece of the pie, even the economics sector, and nothing went directly to health departments. Thankfully, we have a commissioner’s team who was very kind and good to us. Everything we needed got funded and costs were reimbursed. Many counties cannot say the same. So we did what we had to do during that time, and now we’re still doing what we have to. But we’re also prioritizing the wellbeing and mental health of everyone who works here, too.
We now have some money we can spend through emergency preparedness and adult immunizations, too, but it’s a very small amount that has to be spent on what we’re told to spend it on. We must meet deliverables that Missouri DHSS set for us, and can't use it for salary reimbursement. There are all these stipulations, and it doesn’t seem the same for schools and hospitals. And it’s not that they don’t deserve the money. They’re killing themselves out there. But we’ve had to beg for every penny we’ve gotten. Why does it seem like we got overlooked?
Politicians have a lot of demands on public health. They wanted us to set up standards and put down mask mandates and enforce quarantines. It was just wild how much was dropped in our lap. Before, public health was the quiet, helpful partner on the sidelines that made sure the drinking water was safe and took care of septic issues and did restaurant inspections and immunizations. Then COVID came along and it was like, "This is your problem." And we had little to no direction. Even the state department of health dropped the ball on us. I know it was new for them, too. And in their defense, the same thing is happening to them with the CDC. When they’re not getting clear guidance from the federal government, it’s hard for them to give guidance from the state down to the local levels. It can be very discouraging.
When the pandemic started, they basically wanted everything shut down. But how do we enforce that? What do you do? Go after people? Put them in jail because they kept their business open? At one point, we closed the small mom-and-pop shops, but there were still 500 people at Walmart every minute of every day. On Main Street, there might have been a shop with barely 10 people in there all day and those are the places that got closed down. But Walmart, because they’re ‘essential,’ they were open and the place was packed. Our mom and pop shops could have stayed six feet apart just fine. People could have worn masks. It didn’t make sense. But again, that’s all in hindsight. Nobody knew at the time what things would look like afterward.
**NOTE: Shawnee shared her story in fall 2021. Some information about COVID response funding has changed since that time.
How did you and your staff reach out to help your community?
Our team tried to be sympathetic with everyone and do what we could to provide people with the connections they needed. Once the staff even got together $57 to help a guy pay his payday loan interest just so he could be off work and in quarantine for a week. We’re not uncaring, and it’s not that we don’t understand people are in all these tough situations. We’re definitely glad school’s back in session though, and that kids are being fed and watched over. Still, our case numbers have climbed back up.
We also have a lot of vaccine hesitancy. I wrote an article for our local paper about it. Again, it’s a fine line to walk, not to condemn people. The people aren’t the enemy, the virus is the enemy. So we try to be thoughtful. And we’re thankful for those who take the vaccine, but we understand others have genuine concerns and fears about it. Whether they’re right or wrong, they’re genuine. People obviously feel afraid. So we have to approach it the best way we can and continue to educate and encourage people to get their vaccine. And for the ones who won’t, we try to get them to stay home if they’re sick, keep good hygiene, and social distance.
Some just won’t talk to us. And then there are those who have come in now that Pfizer is FDA approved.* We’re still giving vaccines every day, so that’s a positive sign. With this Delta variant, people are sicker.* It’s getting children and younger people this time. So I see some of those personal instances of things happening that have changed peoples’ minds about the vaccine.
*NOTE: Shawnee shared her story in fall 2021. Some information about COVID has changed since that time. Please see the CDC's website for the latest information on COVID.
How is your organization using Missouri's Foundational Public Health Services model to address issues in your community?
I can say right now that almost all of those things went to the back-burner. COVID took precedence over every aspect of that whole circle. So all of those things suffered. People with chronic diseases or mental health weren’t going to their regular doctor’s appointments sometimes because they couldn’t get appointments. And we weren’t able to do certain inspections.
However, one positive was how our community came together in a huge way when it came to emergency preparedness and response. The hospital, the Ambulance District, local government, partners, schools, FQHCs, the health department, all united to attack COVID as a team. We did weekly meetings at the beginning, then it went to monthly, and now we're back to weekly where we break down the current issues into smaller pieces. Every partner brings something to the table, and we’re working together to get the community vaccinated and get resources out.
Our health department was doing vaccine clinics before they were cool. We were at the Ambulance District giving 800 or 900 vaccines a day at the drive-through. No one had to wait, and there was no chaos. The first mass clinic we had, I’d say 65% to 70% of the people who came weren’t even from Washington County. They drove miles to find an available vaccine. Our locals were hesitant to take the vaccine, but we were busy giving vaccinations to people from everywhere else. I wanted there to be more people in the area, but at the time they just weren’t open to that.
That has improved though. Later on, we had a couple of clinics that were almost all local. The County Clerk’s office, along with other elected office personnel, closed down for a day or two to help us do registration more than once. The County Commission even graveled a drive out by the Ambulance District so there could be a drive-through to make it safer for people, and we got the road workers to bring highway signs and cones. The whole community actually put into that. They sent volunteers, nurses, and everything we needed. Almost everything we did was local. We didn’t have to get help from the state, we all came up with those resources ourselves. Now we know if we ever need it, we’re ready. We know our routine works. We know our drive-through clinics work.
We did have the National Guard help us with one clinic where we did 2,000 vaccines. It went well, but the ones that we did locally went just as well. We just had such a strong, united front from all of the local players, and it was amazing.