Editor's Note: For National Public Health Week, the Tacoma-Pierce County Health Department is sharing stories of their work with community partners invested in the health of Pierce County. Here's STD Surveillance Specialist Shannon Parker's story.
My public health story began three years ago when I started as a summer intern for the Communicable Disease Division. I moved into a health education position and eventually became a Communicable Disease Surveillance Specialist, sometimes known as a Disease Investigation Specialist or Disease Investigator. Our team of nine people has a combined total of over 100 years experience in STD/HIV services!
Our team does the behind the scenes work when it comes to tracking and helping prevent the spread of sexually transmitted diseases in Pierce County. We are often out at community events providing education and testing to the public, offering walk-in HIV testing at our clinic, and following recent diagnoses. When patients are diagnosed with an infection like Chlamydia or Gonorrhea, the Health Department is notified by the medical provider so we can work their case. “Working the case” means we track each person down to ensure they and their sex partners get treated. It is our goal to intervene in the spread of disease and make sure that everyone who has been exposed gets treatment. To give you a feel for disease investigation, I’m going to walk you through a recent case I worked. For confidentiality purposes, let’s call this client Jane Doe.
Monday morning, I received Jane’s case report on my desk. According to her physician’s notes Jane is a 15 year old, diagnosed with Chlamydia, showing no signs or symptoms of the infection, and is neither aware of her infection nor has she received her medication. The case report includes her demographic and contact information.
I first try to reach Jane by phone, but my call is met by a recorded message: “At the subscriber’s request, this phone does not accept incoming calls. Goodbye.” Great. Next I write a letter (a real, paper and ink letter, that is) encouraging her to call me about “a very important health matter” although I know it is unlikely that she will respond to snail-mail.Chlamydia in Pierce County by the numbers 4,161 (# of Chlamydia cases in 2011) 2,576 (# of partner interviews in 2011) 2,132 (# of partner treatments provided in 2011
While her phone might not accept calls, I bet she has a Facebook account connected to her phone. Our team has accounts set up through numerous popular social networking sites so we can contact people who have been reported to us. With just a few quick searches, I’m able to find Jane Doe and learn a little more about her.
Jane’s Facebook profile is open, and I’m able to see that she is a student at a local high school, plays a few sports, is in a relationship with Partner X, and can’t wait to go see the final Harry Potter. I send her a private message through Facebook, letting her know I need to speak with her about a very important confidential matter and that she needs to call me ASAP. Ten minutes later, Jane calls.
I make sure I’m talking to the right person and ensure she’s in a safe place to talk confidentially. I let her know that I’m from the Health Department, and this is a follow up about the appointment she recently had at ABC Clinic. I tell her that she was diagnosed with Chlamydia. Jane is immediately upset; she had no idea! I am able to console her and calm her down. We discuss the infection, how it is spread and cured, and the types of complications that can arise if she and her partners don’t get treated.
Carefully, I segue into asking about her partners and how to best get in contact with them. She lets me know that she’s only been dating Partner X for the last week, but before him was another boy, Partner Y. Since she has only had sex with these two partners in the last three months, they both need to be treated for the Chlamydia infection. I let Jane know that we can do it one of two ways; she can notify the partners and give them medications for free, or I can notify them and leave her out of it. Jane wants to tell the guys herself. She said she’s going to do for them what she hopes someone would do for her if the situation was reversed.
We pick a participating pharmacy within walking distance of her house since she does not have her license yet, and I fax over three prescriptions for her to pick up free of charge for Jane Doe, Partner X, and Partner Y. I let her know that I will still be following up with both Partner X and Y to make sure they got their medication and answer questions they may have. I finish by stressing the importance of retesting in three months and getting an HIV test. She and I set up an HIV testing appointment for Thursday after school.
Jane is one simple example the type of work we do, but she’s an easy example. We routinely have clients that refuse to give out partner information, hang up on us, or refuse to believe that their infection came from anywhere but the toilet at the gym, etc. At any given moment, each disease investigator on my team is tasked with working about 70 cases. We’re part detective, counselor, mentor, and salesperson. We are often a shoulder to lean on during the most challenging moments of people’s lives. We go above and beyond to stop the spread of infections by meeting clients wherever or whenever to get them medication. We are disease investigators. We are public health.