Carrie Brogoitti is the public health officer for Union County. She estimates she has the part-time help of about 15 other people. But she says, when there's an emergency, some responsibilities get dropped.
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"Public health" is the health of an entire population.
So it means getting rid of lead in school drinking water and radon in the air; it means immunizing people against the flu; fighting food-borne illnesses; reducing smoking; providing prenatal care; and the list goes on.
Doing all that by yourself in a small town would be overwhelming, to say the least.
“This is unfortunately more complicated of a question than how many employees do you have,” said Carrie Brogoitti, the public health administrator for Union County.
Oregon's public health system is lacking. A recent report found minimal coverage in a third of towns.
Brogoitti estimates about 15 other part-timers are working on some aspect of public health in La Grande. “They have multiple different hats that they wear," she said.
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"And a lot of this is a result of the way that funding comes to us. So we’ll have a small amount of funding to do something like communicable disease and then we have another small piece of funding to do immunization coordination. And so, kind of by putting those pieces together, you can fund one position.”
All told, Brogoitti estimates there’s the equivalent of three full-time-positions in Union County — funded by a mixture of state, county and city money, as well as by grants and contracts.
Nearby in Wheeler County, the total is more like two-and-a-half positions.
They’re positions like the nurse practitioner who staffs the school health center. She delivers primary care in La Grande. But she also deals with family planning and communicable diseases, as well as supervising a team of nurses.
Brogoitti said the system works. But when there is an emergency — like someone turns up with a suspected case of tuberculosis — there’s a problem.
“You know for TB, it’s not like you just come in and you’re diagnosed," Brogoitti said.
Andi Walsh is the emergency preparedness officer in Union County
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"They have to do the sputum testing and they have to do it over the course of a few days," she said. "So the nurse takes time away from other duties to do that.
"So the question is: What is she dropping to respond?”
“She dropping her clinic time ... she has appointments day to day, in the clinic," said another Union County public health worker, Andi Walsh.
Walsh said it’s not just a TB scare that can strain the system. It might be a cryptosporidium outbreak — like the one in Baker City a few years ago — or the salmonella scare at the LaGrande charity fundraiser last month.
Walsh said the person responsible for finding out what happened in that case had to drop his job inspecting local restaurants and water wells, “If you have 150 people that attend this event, and you have one person in this role of doing a foodborne illness investigation, there’s a lot of time lost,” she said.
So, are people dying because of these public health gaps?
“It’s a great question," said Brogoitti.
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"On a day-to-day basis, people are probably not dying in our community because we’re having communicable disease outbreaks. I think as a system, we’ve been able to respond to that. But when I think about public health, our real goal is to do prevention work.”
And Brogoitti said, jumping from one emergency to the next doesn’t allow for the kind of prevention work that can save lives — and money.
So, what’s the state doing about it?
Instead of $200 million this fiscal year, the Oregon Health Authority said it wants a third more money next year.
That would bring Oregon's spending closer to that of its neighbors. The state spends an average of $25 a person on public health each year. That compares to $40 in Washington and $95 in Idaho.
