Friday, September 19, 2014

Clatsop County bid farewell this month to two longtime members of its public health team.  Belinda Kruger and Christie Larson, whose careers with Clatsop County span a combined 66 years, have witnessed shifts in policies, programs and priorities and seen technology transform their work, but remained dedicated to the goals of public health.

"They have both been such an inspiration to me," Public Health Director Margo Lalich said.

After moving to Astoria when her husband took a job at Clatsop Community College, Kruger worked at Columbia Memorial Hospital when the facility was still located at the Owens-Adair facility. She joined the county in 1977 and two years later, thanks to a state initiative, gained certification as a nurse practitioner and joined the health department's family planning program.

Larson, a Knappa native, worked in operating rooms, including at an Air Force base during a stint in the service, as well as a psychiatric unit. She also worked at CMH before joining Clatsop County in 1981, and served a variety of roles before becoming the department's lead communicable disease nurse in 1998.

"I didn't know the scope and depth of public health until I got into it," Larson said.

Where private medical care is patient-focused, public health, while it offers services to individuals, is population based, and focused on the health of the entire community, the two noted. Along with family planning and communicable disease control, the Clatsop County Public Health Department administers maternal and child services such as the Women, Infant and Children (WIC) nutrition program, immunizations, environmental health, emergency preparedness and vital statistics.

"If public health is doing its job right, no one knows about it," Larson said. "People take for granted having safe food and safe water."

Kruger provided services including counseling and access to birth control, much of it under the federal Title X family-planning program for low-income people. Along with her Clatsop County duties, she also provided family-planning services for Tillamook County for several years and performed physicals for female Tongue Point Job Corps students.

"It's been a wonderful, rewarding career," she said.

Health programs have come and gone as funding priorities change and services come under different jurisdictions – at one time the department oversaw the school nurses for all the county's school districts. Medical advances have also changed how services are delivered.

Both remember people lining up at the department offices to get immunoglobulin injections against the hepatitis A infection – a laborious process that required each shot recipient to be weighed to determine the exact amount of antibody to inject. Today a vaccine provides protection, and hepatitis A is increasingly rare in the general population.

"I started in the era of polio vaccines and iron lungs – we don't have that anymore," Larson said.

Communicable disease remains a top priority, but as the infection and death rates from those illnesses has declined, public health has put more focus on promoting healthy lifestyles, including combating obesity and tobacco use, now two of the nation's top killers.

Technological changes, in particular the handling of data, have revolutionized public health. Even up to the late 1990s, communicable disease cases were tallied on note cards mailed to the state health department – it could be weeks before trends were spotted and an outbreak detected, Larson said. Now computerized databases allow state and local health workers to track illnesses and respond much more quickly.

It also used to take the entire department's staff to conduct the annual review of paper immunization records for county schoolchildren in order to issue exclusions for those without their required shots. Now a single staff member handles it via computer.

The computer age has its drawbacks, too – the Internet provides access to plenty of misinformation to people eager to diagnose their own conditions, Kruger said.

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