Dr. Guidry convened a first meeting of a History Council on Friday, June 22, 2007, to develop a comprehensive history of the Health District to include earliest known public health activities on Galveston and the Mainland.  The group provided information, photos, and newspaper articles about various services including animal services, sanitation, dental, 4C’s clinic, STD/HIV, directors, mosquito control, air/water programs, etc.  Many enlightening stories were shared, among prior and existing Health District staff, including early days when rats infested nearly ever building in Galveston.  The group will meet again to finalize a written history to be added to the Health District website and a presentation to be shared with new employees.   Dr. Guidry shared his belief that knowing the past helps us to be better prepared for the future.  Invited members included Reid Martin, Joe Vickery, Janet Greenwood, Milton Howard, DDS, Sandy Sherow, Shirley Carr, Jim Hilton, Judge Ray Holbrook, Bernard Milstein, MD, and Leta Melancon. 

Dr. Guidry, Ronnie Schultz and Kim Schoolcraft met with Dickinson City Manager, Julie Johnston and City Secretary, Carol McLemore to discuss animal services and the proposed changes to the Animal Services Policy/Regulations currently under public comment.  Ronnie Schultz had a follow-up meeting with Julie Johnston to discuss the issuance of a waste water discharge permit by TCEQ for a development along Gum Bayou that drains into Dickinson Bayou.  Finally, Dr. Guidry, Jay Holland, and Mike Carr met with Kemah City Manager, Bill Kerber, to discuss requested proposals to provide EMS services in the city. 

Epidemiology received a probable Pertussis case on June 25, 2007 from Harris County. The case is a 44 year old female residing in Friendswood (Galveston County) with a positive IgM serology. She met the clinical case definition with a cough illness lasting at least 2 weeks and paroxymal cough. She was diagnosed by her primary care physician and received antibiotic treatment.  Four household contacts were identified who were adequately immunized and are asymptomatic. The contacts did not require chemoprophylaxis since they were identified greater than 3 weeks after the exposure.   Contacts were educated and provided standard precautions.

Immunization Advisory Council met on June 5, 2007. The Council reviewed the outcomes of RWJ Vote & Vaccinate (499 shots) and National Infant Immunization Week (587 shots).  The council then focused on the next big event “Back to School Kids Health Fest 2007” that is scheduled for August 9 – 29, 2007.  The Council is welcoming volunteers and community support for parent and children incentives and entertainment in order to make the experience more pleasant for parents and their children. 

  Hurricane Exercise

On June 5^th through 7^th, GCHD staff from Public Health Preparedness and EMS participated in the statewide hurricane exercise at the Galveston County Emergency Operations Center in League City. Representatives from various county departments and each of the cities participated in the exercise. The main objective of the exercise was to test our ability to safely evacuate the residents of Galveston County. During the exercise, GCHD staff handled issues concerning the evacuation of medical special needs individuals.

• Staffing Update – Staff continues to search for two qualified medical providers.  The Administrative Clerk position has been filled by Elizabeth Esparza, who began on June 21, 2007. The 4C’s Nursing Director position remains vacant with candidates currently being interviewed. A referral clerk position will also be available as of July 18, 2007. Dental Services currently has two part-time Dentists and two Dental Assistant positions open. All Health District positions can be viewed at: http://www.gchd.org/hr/job.htm
  
• Clinic Leadership Team (CLT) – CLT approved a Referral Protocol which provides guidance on the information needed when completing referral forms.  This will be presented to all providers at the July 11, 2007, In-Service training. CLT also approved an informational sign to be placed in the 4C’s Clinics which describes who may be seen by the 4C’s Family Physicians and Mid-Level Providers.
  
• College of the Mainland Drug Tests – On June 22, 2007 College of the Mainland sent approximately 25 nursing students and one staff member to the Texas City Clinic to have drug tests completed. Patient Service, Lab, and Administration staff coordinated together to have tests completed without out any difficulties for the students and with no impact on 4C’s patients.
  
• Federal TORT Claims Act (FTCA) – Effective July 1, 2007, the Feds are implementing the first stages of a new process for deeming Community Health Centers as eligible under the FTCA.  The 4C’s staff has completed the first stage documentation for this process.

• Tuberculosis Prevention and Control –Budgets for the FY 2008 TB/PC contracts have been finalized, with the Department of State Health Services (DSHS) and GCHD has been funded $78,105.00 to continue conducting tuberculosis prevention and control activities.  This is an increase of $11,600 from the previous year.
  
• Community Outreach: Senior Health and Fitness Day - This event was held on May 30^th and was sponsored by Galveston County Department of Parks and Senior Services.  This event not only had speakers, vendors, and booths for educational information relevant to seniors, there was a walk in the morning.  An estimated 50 seniors attended this event, with our staff being called upon to provide emergency care to 4 participants who had acute incidents.  These citizens were sent to the emergency room via EMS.     
  
• Senior Health Advisory Council – The Senior Health Advisory Council (SHAC) met on June 19^th to discuss the application for 501c3 status.  The proposed name of the organization is Galveston Regional Outreach, Public Health, and Education Services (Galveston ROPES) and the vision is “Optimal Health for all of Galveston County”.  Its vision is to improve the well-being of Galveston County citizens by providing services and education to community seniors, families, and friends.  The application will now be submitted to the state for approval, if approved they will be eligible to apply for status as a Mainland United Way Program.
  
• Obesity Prevention through Evidence Based Programs - Janice Jamison, Community Health Nurse, attended a conference May 30^th and 31^st reviewing evidence-based obesity prevention programs.  Three programs were highlighted:  Steps to a Healthier Houston-Harris County Consortium (CATCH), Active for Life, and ENACT (Environmental Nutrition and Activity Community Tool).  A brief background of the three models was presented with their target populations and the factors that contributed to their success.  After discussing these programs, Community Health Services intends to form a focus group to decide how to determine the fitness and nutrition needs of Galveston County and discuss plans implementing a program using evidence-based principles.
  
• Tuberculosis Intensive – This program was attended by Dr. Arceneaux June 5^th through June 8^th and was intended to provide an overview of the TB program for the Heartland Region and an update on current protocols for treatment and referral of TB patients. Several topics were discussed including the availability of Quantiferon Gold, an ELISA test for the diagnosis of tuberculosis to be used instead of the tuberculin skin test currently used.  Some of the perks to this test are it is given once as opposed to having to come back for a reading, administration error is less of a worry, and this test can be given to those who have been on the BCG vaccine.  Some problems with this test are the cost and availability.  Though it is not widely used in Texas yet, other states have current protocols for its use in BCG positive patients.     
  
• Galveston County Gulf Coast Black Nurses Association - Nursing Knowledge Symposium – Diana Luna, RN attended this conference to represent the Community Health Nurses on June 9^th.  Its purpose was to educate the community on health issues that traditionally impact minority communities.  The four topics addressed were: 1) the major effect cancer continues to have on the black community, 2) childhood obesity and its link to overweight adults, 3) bariatric surgery and its role in obesity management, and 4) the leadership role nurses can have in developing community leaders. The symposium was a venue to empower health care workers of all races to continue to share information with their families, churches, and communities and to try and help reduce the health disparities in the minority community in a culturally competent way.
  
• Breast and Cercal Cancer Services (BCCS) Conference – The BCCS conference was held June 12-13 in Austin and was for the 48 BCCS contractors to learn about the new TWICES computer module that will be implemented July 1^st for the BCCS program at the Galveston County Health District.  The TWICES program will better serve the BCCS Program and our patients by providing all the necessary information for the organization in an easily accessible way.  Other topics addressed were the Medicaid Treatment Act which allows eligible patients with cancer to receive Medicaid, and how to run a “Paperless Office”.  This conference was attended by BCCS staff member Antoinette Jensen and Pam Castile from D’FEET.
  
• Immunizations Tri-annual Report – The Immunization tri-annual report for January through April 2007 was recently completed.  The purpose was to report on the objectives from the Immunization Grant and Call to Action Funding.  Some activities highlighted in this report were: vaccine loss was reduced at the 4Cs by sending specialists to work with staff and check inventories weekly; Imm Trac, a statewide immunization tracking system, was aggressively promoted at health fairs using remote access to the internet with laptops and air cards; daycares were audited for immunization compliance; incentives and brochures were provided for potential clients in other areas of GCHD (WIC, Vital Statistics).  The program is working hard toward achieving its objectives so that Immunization Grant dollars will continue and so that Galveston County will have as few vaccine preventable diseases as possible.
  

• Animal Services Advisory Committee - The Animal Services Advisory Committee met and certified a quorum on June 20^th to review several items including the animal services policy progressing through the United Board of Health approval process, the work of the Animal Disaster Planning Committee drafting plans for pre and post disaster animal care and sheltering, and discussed reappointments to the committee.  The FY 2008 budget was reviewed and unanimously approved to be sent to the Board for final approval towards the end of the fiscal year.     
  
• Overcrowding at the Shelter – The animal shelter during the month of May processed 1275 animals coming into the shelter from across the county.  The sharp increase can be somewhat attributed to intake of puppies and kittens. In addition, 24 dogs were seized during a cruelty investigation and all were awarded to the shelter.  This overcrowding is an everyday occurrence and stresses our resources not to mention the stress on our staff.  Currently one part-time position is open and applications are being taken.  As part of the FY 2008 budget request, two part time positions have been added to respond to the increased need in this vital service.
  
• Galveston County Storm Water Collaborative – The Office of Environmental Health Programs called a meeting of the storm water collaborative to rekindle interest of the county and cities in the federally mandated storm water program.  The storm water collaborative has been in existence for about five years; however the committee has been inactive awaiting issuance of the state storm water permit.  This permit, once approved by the Texas Commission on Environmental Quality, will require small municipalities and populated areas of the unincorporated county to apply for a storm water discharge permit.  Each municipality will be legally responsible for the pollutants that enter their storm water conveyance system.  The program is based on objectives or goals, such as public education, public involvement, inspection of construction sites, investigation of illegal discharges, etc.  Once the permit is approved (anticipating approval summer of 2007), the cities and the county will have 90 days to submit their application and five years to fully implement the program.  Many of our cities and the county are looking at the Health District to oversee and operate one unified program to address this need as efficiently and cost effectively as possible.
  

• Staffing Update – 29 full time positions remain vacant.  There are two applicants scheduled for testing and six calls out for applicants to come in for testing.     
  
• Hurricane Season Operations – Part of G.A.A.A. responsibilities include assisting the City of Galveston should an evacuation be called for a Hurricane threat.  Staff members have been trained in their roles and responsibilities in hurricane evacuation situations.  The City of Galveston and Galveston County Office of Emergency Management gather information on persons with special needs who may need assistance in an evacuation.  Those who appear to need ambulance transportation are forwarded to G.A.A.A. where they are contacted and the need determined.  Should an evacuation occur, persons who contact Emergency Operations expressing an ambulance transportation need will be evaluated and included as needed in ambulance evacuation activities.
  
• Budget Process – GAAA staff members are busy developing information for the budget process for the County of Galveston and City of Galveston.  The process will continue through the summer with the new fiscal year beginning on October 1, 2007.