Responding to Hurricanes Katrina and Rita, the San Antonio Experience

California Environmental Health Association Volume 6, Issue 1 Spring, 2007

BulletinBulletin

The week after Hurricane Katrina fellupon the Gulf Coast, San Antoniolearned a lesson about itself. She

learned how people can come together tomake great things happen. She learned howmuch she had to offer, and how much hardwork she was capable of performing.

On the Thursday following HurricaneKatrina, the San Antonio Metro HealthDistrict (SAMHD) was notified that ourcity would be a receiving center forevacuees from New Orleans, who wouldbegin arriving within 24 hours. Quickly,working with the American Red Cross,local officials identified a warehousebuilding at KellyUSA, the former Kelly AirForce Base, to becomea temporary home forthe evacuees.SAMHD Food andEnvironmental Healthstaff rapidly went towork assisting inpreparations. It soonbecame apparent thisbuilding, lackingbasic facilities, wouldnot be ready in time.Officials then settledupon a former officebuilding, Kelly 171,set up as multipleunits and containingthe usual assortment of cubicles. Crewswent to work removing the excess cubiclesand setting up cots. One area of the largebuilding was left with its cubicles intact.This was to serve as the receiving andmedical screening areas. It later becameapparent this arrangement was a doubleedged sword. It allowed for some privacy,but became a maze in which securitybecame a problem. As was done initially,

Food and Environmental staff fromSAMHD inspected the facility and assistedin readying it for the new arrivals.

On Friday morning, September 2, 2005,the first of the 12,700 evacuees began toarrive at Kelly 171. They arrived by plane,bus, and private car. Most came from theSuperdome or the Convention Center inNew Orleans. As individuals arrived, theywere processed by the American Red Crossand asked to complete a medical evaluationform. Normally, though SAMHD is alwaysprepared to handle a public healthemergency, one would not expect ahurricane evacuation to require suchinvolvement from the medical sector.

However, many ofthe evacuees were inpoor physicalcondition, havingspent five or moredays with limitedfood and water.Many evacuees werewithout theirmedications, and anumber had spenttime stranded in fetidwater. From theintake survey(N=2556), 14%reported they werediabetic, and 60 %of these arrived in

San Antonio having fled their homeswithout their medications or had run out.This hurricane having hit at the end of themonth, when many were waiting for theirMedicaid checks to purchase their nextmonths’ supply of medication only madethings worse. In total, 42% of the evacueeswho responded to the intake survey

F E A T U R E S

Responding to Hurricanes Katrina andRita, the San Antonio Experience,Cherise J Rohr-Allegrini, Ph.D., M.P.H.Public Health Emergency Preparedness,San Antonio Metro Health District . . cover

Joining the Fight to Combat LeadPoisoning, Ihsan B. Dujaili, REHS,San Francisco Department of PublicHealth . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Sacramento County Serves Up Green,Yellow, and Red for Food Safety,Alicia Enriquez, REHS andZarha Ruiz, REHS . . . . . . . . . . . . . . . 13

C O L U M N S

President’s Message . . . . . . . . . . . . . . . . 3

Board Highlights . . . . . . . . . . . . . . . . . . 5

CCDEH . . . . . . . . . . . . . . . . . . . . . . . . . 7

Quarterly Puzzle –That Makes Me Sick! . . . . . . . . . . . . . 16

S P E C I A L A D D I T I O N S

International Environmental HealthWork After the Tsunami,Dennis Kalson, REHS . . . . . . . . . . . . . 7

Volpe Legislation UpdateSuzanne Du Vall Knorr, REHS . . . . . . 12

Environmental Health Ethics,Margaret Blood, REHS and LauraBarnthouse, REHS . . . . . . . . . . . . . . . 14

International Environmental Healthin Action, Letter from Ecuador . . . . . . 15

Lancaster Symposium . . . . . . . . . . . . . 17

I N S I D E T H I S I S S U E

Continued on page 4

Responding to Hurricanes Katrinaand Rita, the San Antonio Experience

by Cherise J Rohr-Allegrini, Ph.D., M.P.H.Public Health Emergency Preparedness, San Antonio Metro Health District

Figure 1. Percent of evacuees whoresponded they had one of these conditions

(N=2556)

Ricardo EncarnacionSouthwest Chapter [email protected]

Sophia JellaSuperior Chapter [email protected]

Zarha RuizSuperior Chapter [email protected]

NON-VOTING BOARD MEMBERS

Alicia EnriquezNEHA Regional Vice [email protected]

Margaret BloodCalifornia Department of Health ServicesREHS Program [email protected]

CEHA S U P P O RT S E RV I C E S

John Morihara110 South Fairfax Avenue, #A11-175Los Angeles, California, 90036(323) 634-7698 Phone(323) 571-1889 [email protected]

D E S I G N /P R I N T I N G

Concord Graphic Arts3270 Monument WayConcord, CA 94518(925) 682-9670

Spring, 2007

CEHA BOARD OF DIRECTORS

Darryl [email protected]

George [email protected]

Tracy Ford-RosslerVice [email protected]

Parvaneh [email protected]

Mike [email protected]

Melissa St. John-HarderImmediate Past [email protected]

Ann Marie VelazquezCentral Chapter [email protected]

VacantCentral Chapter President-Elect

H. Taren TsengCitrus Chapter [email protected]

Paula HaroldCitrus Chapter President-Elect

Deborah Smith-CookeMission Chapter [email protected]

Graciela GarciaMission Chapter [email protected]

Mamerto JorvinaNorthern Chapter [email protected]

Richard HarrisonNorthern Chapter [email protected]

Laura BarnthouseRedwood Chapter [email protected]

Greg PirieRedwood Chapter President-Elect

David LeDuffSouthern Chapter [email protected]

Vacant Southern Chapter President-Elect

Darryl YorkeySouthwest Chapter [email protected]

2 • CEHA Bulletin

CEHA M I S S I O N S TAT E M E N T

The California Environmental

Health Association is a nonprofit,

professional organization

dedicated to improving the

quality of life and health

through environmental

education and protection.

The CEHA Bulletin is the officialpublication of the CaliforniaEnvironmental Health Association. Forassociation members, subscriptions areincluded in membership dues. Some articlesmay represent the opinion of the authorand not CEHA’s official position. CEHAdoes not specifically endorse the productsand services of any of its advertisers.Articles may be reprinted with permissionof CEHA and contributing author(s) only.

Copyright © 2007, CaliforniaEnvironmental Health Association

CEHA PUBLICATIONS COMMITTEE

Kathy Hartman, Coordinator/[email protected]

Keith WinklerCentral Chapter

VacantCitrus Chapter

VacantMission Chapter

VacantRedwood Chapter

VacantSouthern Chapter

Julie DeGrawHeather StachelrodtSouthwest Chapter

Adam RockePast President’s Council

Margaret BloodDHS Representative

Sandi DonohueCalifornia State University, Fresno

If you are interested in serving as amember of the CEHA Bulletin EditorialCommittee, please contact theCoordinator/Editor, Kathy Hartman, [email protected] or (858) 792-1630

CEHA Bulletin • 3

Spring, 2007

Dear CEHAMembers,

As I writemy finalmessage to

you, I think backto how this allstarted for me.When I firstbecame anEnvironmentalHealth Specialist in

1990, I heard about CEHA from my co-worker and very good friend Ron Torres(CEHA President 2001-2002), who wasdoing his best to sign up new members forthe Northern Chapter at the time. Beingthe “rogue/anti-group” type person that Iwas, I declined his invitation. When Imoved to the Southern California area in2001, I was offered the opportunity to jointhe Southern Chapter Board of Directors.Thus was my start as a member of CEHA.

I can honestly say I did not know whatCEHA was all about when I became amember. I just thought it might be nice tomeet some new friends and learn about theway things are done in Southern California.I was in for a major attitude adjustmenttowards CEHA. What I found myself inwas a very dedicated group of individualsselflessly working together to promote theorganization and our profession. I wasamazed that these people were not just “goto work, get your check, and go home” likeso many others. No, they were not allsingle people without lives of their own.They were professionals who felt it wasimportant for them to do something tofurther our profession. They gave becausethey believed in what we do and expectednothing in return.

So there I was, not sure if I wanted tocommit my spare time and energy to anorganization that did not pay anything formy hard work. Does this sound likeanyone you know? Well, I can assure youthat being a member of the SouthernChapter changed my mind quickly. It wasrefreshing to be with people who actuallydidn’t think of themselves first and enjoyedworking together as a team. The 2004 AESwas our proving ground and we formed atight bond that still holds to this day.

Being a member of CEHA has been thegreatest experience that will be with meforever. I have learned much more about our

P R E S I D E N T ’ S M E S S A G E

profession, those who run our profession,those who think they run our profession, andthose who work with our profession. But,what I treasure the most from myexperiences with CEHA are the wonderfuland talented friends that I have made overthe past years. I doubt that I would haveever met them had it not been for CEHA.

One person in particular that I finallyhad the pleasure of talking with is ForestWalker, Jr. (California Association ofSanitarians President 1959-1960). I calledhim as I was curious about his views of thegrowth of our profession and whether ornot if he was pleased with the way CEHAhas evolved. He spoke highly of a man hereferred to as “Mr. Sanitarian”. You mayknow him as Walter Mangold. Mr. Walkerconsidered Mr. Mangold as the forefatherof our profession (though he never waselected as president, but should have beenaccording to Mr. Walker). Mr. Mangoldstressed that the Health Inspector (yes, thatis the title that was originally used for ourprofession) was to, “act professional, behonest, fight for everything you earn, andto treat everyone with respect…but neverapologize for what you had to do as yourduty”. These were sage words that mademe think of some of the issues that I haveencountered during my presidency. Mr.Walker would only tell me he has observedthe many changes and challenges to ourprofession over the years, some good andsome that could have been better, but whatwas important is that we remember ourpast and use what we learned to make ourfuture better.

Adam Rocke (CEHA President 1979-1980) told me to enjoy every minute of mypresidency, as it would be a very specialand unique time in my life; and it wouldend as fast as it started. He was right.There is so much more that I wanted to doand accomplish for CEHA. Lack of timewas my constant companion during mypast year as president. There were neverenough hours in a day to complete what Iwanted, or needed to do. With the help ofthe 2006-2007 Board of Directors, theCommittee Chairs, and the many dedicatedCEHA members, we were able to achievemy primary goal in increasing ourmembership. The total number as I writethis letter stands at 852 members.However that final number is yet to bedetermined at the 2007 AES when my termends, as I’m reminded by John Morihara(CEHA Support Services). I do feel

Darryl C.F. Wong, REHS 2006-2007

CEHA President

confident a new foundation and directionhas been set for CEHA, and incomingboards will continue to keep CEHA growingand prospering over the years. CEHA is notcompletely “out of the woods” financially,but we have made strides in meeting ourcurrent financial goals.

I am currently working on a letter torequest that CEHA be recognized as anAccrediting Agency for continuingeducation. I have appointed a committeeto oversee this monumental task ofdesigning the structure and implementingthe program that will carry CEHA to thenext level and new frontier for thisorganization.

We are also working on offering On-linetraining courses and organizing theTraveling Seminars to provide you theaffordable and accessible training that isneeded to meet the requirements forcontinuing education. CEHA cannotafford to pass on this opportunity. We allneed to be involved with this issue toensure the viability of our profession andour future.

There is still much more work to bedone, and I know my successors will carryon the hard work we have started this pastyear. I realize that our organization is stilldivided on many issues. I can only suggestwe take a good look at where ourprofession is going. There will soon be ashortage of REHSs in the coming years. Ifwe do not invest our time now to promoteour profession and help those seeking tobecome registered, we may go the way ofthe dinosaurs. It’s time to put aside yourpersonal differences and needs and worktogether. I hope you all take it uponyourselves to promote CEHA and inviteothers to join this great organization, yourorganization. It stands for our profession.It stands for you.

It has been an honor and privilege tohave served you as your president. Myexperience has been rewarding, and mycontinued support for CEHA will neverend. I wish to thank all those who gaveunselfishly to CEHA to help thisorganization grow and flourish this pastyear. I also wish to thank those whohelped me accomplish my goals for CEHA.I could not have done it without them andthey deserve much applause. We can makea difference. We can make positive changes

Continued on page 6

reported they were out of their medicationsor about to run out. At least 14% of theevacuee population had a heart conditionand more than 10% were experiencingchest pain at the time of arrival (Figure 1).In addition to the chronic illnesses, 25% ofthe evacuees who responded reported skinproblems such as wounds and rash (20%).Though all evacuees were asked tocomplete the intake survey, most were tooexhausted from their ordeal. Within theweek, there were so many different groupswanting to conduct surveys, the evacueessuffered from “Survey Fatigue.”

After medical needs were determined,evacuees were brought through the “MedicalServices Area” where acute medical needswere addressed, including writingprescriptions for the daily medications manyhad already gone 5 days without. Woundswere attended to, and tetanus shots wereoffered. Over the course of the following 4weeks, among other vaccinations offered, theSAMHD Immunizations Division inoculated10,090 people against tetanus, and 6,183against hepatitis A,.

The SAMHD Food and EnvironmentalHealth staff had their work cut out forthem. The first shelter was set up with cotsin a series of large rooms cleared ofcubicles. Being a former office building, ithad carpeted floors, which initially seemeda good idea, as this was more comfortable.However, the Food and EnvironmentalHealth staff soon recognized a problem:carpeted floors could not be easily cleaned.This was especially problematic when therewere instances of nausea and vomiting.

The next challenge was the food. SanAntonians bring food. It’s what we dowhen there’s a crisis. It’s how we show ourconcern. It’s a wonderful aspect of ourlocal culture; if you’ve ever experienced oneof San Antonio’s many fiestas, you canappreciate this. SAMHD’s Food andEnvironmental Health staff was taskedwith inspecting all food items as they dofor all licensed eateries throughout the city.Though generously offered, the staff wasforced to turn the homemade items away,as they were unable to verify the safety inpreparation and storage. Given the level ofthe conditions from which the evacuees hadjust come, and the orderly but crowdedshelter, there were significant concerns thatthere could be an outbreak of agastrointestinal illness. Indeed, at varioustimes throughout the shelter operations,there were sporadic reports ofgastrointestinal illness. On this front, theSAMHD Food and Environmental Health

staff were invaluable. In addition toinspecting the facilities, along with theteams from the CDC who came to assist,they educated the volunteers on properfood handling and provided hand hygienereminders to the evacuees. They madecertain items like hand sanitizer wereavailable at every dining area table. Theychecked the hand washing facilities to makesure they were always functioning, thatsoap and water was always available. Thisbecame a challenge in the second shelter,which didn’t initially have toilet facilitiesbut instead set up portable lavatories andhand washing facilities (Figure 2).Eventually, City of San Antonio PublicWorks crews built restroom and showerfacilities in this second shelter. Thoughthere were occasional reports of agastrointestinal illness, the quick work ofSAMHD epidemiologists andenvironmentalhealth staff, as wellas the medical staffat each shelter,prevented theseevents frombecoming large-scaleoutbreaks.

Over the initialthree days, threemore Mega Shelterswere opened in SanAntonio: a secondat KellyUSA (Kelly1536); at the oldLevi Straussbuilding; and at thevacant MontgomeryWards store atWindsor Park Mall.Each of thesefacilities posedsignificantchallenges. And ateach, SAMHD staffinspected kitchens and restrooms andestablished clinics. The clinics wouldeventually be taken over by local healthcare organizations: CentroMed, BarrioComprehensive Family Health Care Center,and the TX-1 DMAT team. SAMHDEpidemiology staff, with the assistance ofCDC teams, monitored infectious diseasesin the shelter. Using a modified syndromicsurveillance system, the clinic staff notedhow many illnesses of various types hadbeen addressed. These data were analyzedwith particular attention to “illnesses withepidemic potential.” Whether due to thestellar clinic services provided, the constantvigilance of the sanitarians andepidemiologists, or sheer luck, there were

no major outbreaks of any disease, andonly very small, localized gastrointestinalillness events. Daily syndromic surveillancewas conducted as long as the shelterremained open. Interestingly, while theacute health concerns died down, and thechronic conditions were brought undercontrol, the number of evacuees whoreported being depressed increased from30% on the day of arrival to nearly 40%on October 27, some 7 weeks after arrival.

In addition to the three Mega Shelters,Baptist Child and Family Services (BCFS) wererequested to set up “Special Needs” Shelters.Over the course of the year following, officialshave better defined what constitutes “SpecialNeeds.” At the time of Hurricane Katrina,however, this was not clear. In an effort tokeep families together, if one member of afamily had a special need, the entire familygroup, which could sometimes mean 20

people, was broughtto a Special NeedsShelter, most ofwhich were housedin churches. TheBCFS and itsvolunteers did anamazing job ofsetting up andrunning the shelters.However thesefacilities were notdesigned for specialneeds or for longterm care. In onefacility, therestrooms were on aseparate floor. Thisbecame a problemfor individualsunable to walk upthe stairs. Inanother shelter thathoused a number offamilies with small

babies, there were no diaper changingfacilities. Parents changed the babies on theircots, the same area where they ate and slept.The one true cluster of gastrointestinal illnessduring the shelter operations occurred at thisshelter, and the epidemiologic investigationfound most cases associated with babies whohad diarrhea, and whose diapers werechanged on the caregivers’ cots. Theepidemiologists and sanitarians responded bysuggesting a diaper changing station whichcould be sanitized, had hand washingfacilities, and was far removed from whereevacuees ate. Overall, everyone involved in theshelter operations were indebted to the workand dedication of BCFS staff in addressingthose with special needs.

4 • CEHA Bulletin

Spring, 2007

Katrina, continued from cover

Figure 2. Lavatory and Handwashingfacilities at Kelly 1536.

to make use of the lessons we learned, andour staff performed admirably, we are in amuch better position to respond shouldsuch an event ever occur again.

Acknowledgements: Many individualsmade this work: all the SAMHD sanitarians,particularly Lori Calzoncit, MontyMcGuffin, and Terry Ricks; Public HealthEmergency Preparedness, Texas Departmentof State Health Services, Region 8 EpiResponse Team, and teams from the CDCand HHS who came to assist. Students fromthe University of Texas Health ScienceCenter, San Antonio and from the Universityof Texas School of Public Health atHouston, San Antonio Campus, particularlyCara Hausler contributed greatly to thestudies conducted.

Dr. Cherise Rohr-Allegrini has workedwith the Public Health EmergencyPreparedness, San Antonio Metro HealthDistrict as an Epidemiologist since July2005. Her duties include establishingprotocols for response to public healththreats, with particular reference tobioterrorism and pandemic influenza;developing new tools for monitoringinfectious diseases; investigation ofreportable diseases within the communityand disease surveillance; responding topublic health [email protected]

CEHA Bulletin • 5

Spring, 2007

Just as things were quieting down in theshelters, Hurricane Rita reared her uglyhead on the Texas coast. Not having yetrested from the initial response, SAMHDstaff kicked into high gear to respond tothis new wave. Evacuees from HurricaneRita began arriving on September 21, 2005,many of whom had evacuated from NewOrleans to Texas once already. Thoughmany were able to return home to Texascities within a week, those from the harderhit areas of East Texas continued to arrive inSan Antonio over the following weeks.Nearly 12,000 evacuees arrived withHurricane Rita. There were less acutemedical conditions to address, but theshelter population swelled. As always,concern for any outbreak of infectiousdisease was at the forefront of the minds ofall sanitarians and epidemiologists involved.

San Antonio Metro Health District staffworked around the clock the first weeks:setting up the medical facilities, inspectingshelters, providing medical services,conducting disease surveillance, andparticipating in emergency operations. Whenasked what worked, SAMHD sanitarianssaid “The dedication, commitment, and hardwork of our staff.” Not only SAMHD, butall the city agencies involved pulled togetherwhen it was most needed, and continued todo so as long as the shelters were open.When asked what didn’t work, there were ofcourse a number of considerations. Forexample, well meaning shelter staff hadarranged a room for child care for tiredevacuee parents. However this was initiallyset up outside proper guidelines and wasforced to close due to a lack of safety andsecurity. Lack of sufficient shower andrestroom facilities was always a problem.Not having laundry facilities, there was aquestion about what to do with dirtylaundry. For some time, soiled clothes weresimply thrown into a room, that quicklybecame full with a mountain of clothes. Theinitial shelter, Kelly 171, being a formeroffice building had many small rooms. Whilethis seemed useful initially, it posed a securityproblem; security officers had difficultykeeping track of people, and evacueesexpressed concern for their safety. Medicalcare was provided by stellar teams; howeverin one shelter there was no option of privacy,limiting the ability of the medical staff toaddress some conditions. As a result, morepatients were transported to the hospitalthan might have been necessary. Anotherproblem, was simply knowing which taskone had to perform. While staff stepped upand did whatever was asked of them, manywere in roles very different from their normaljobs and required a bit of a learning curve.

By mid September the medical serviceshad already been turned over to localhealth care organizations. In mid-October,a private contractor, The Shaw Group, tookover shelter operations from the AmericanRed Cross and brought in ComprehensiveHealth Care Services which was largelystaffed by medical workers displaced fromMississippi. Three of the mega sheltersclosed, as did the special needs shelters, andeveryone was moved to Kelly 171. Theshelter remained opened until Dec 23,2005. Throughout this time, SAMHDsanitarians and epidemiologists played anactive role. Initially present around theclock, by mid-October visits were madedaily until the shelter closed.

Over the course of the year and a halfsince, SAMHD, City of San Antonioofficials, regional health officials and stateofficials have spent a great deal of timeplanning for another hurricane. Manylessons were learned through theKatrina/Rita (or “Katrita” as it came to becalled) experience. Standard OperatingProcedures, which address shelter facilities,food and environmental services, daycare,medical care, and special needs have beendeveloped. Staff have been pre-assignedroles and are being trained where necessary.Agreements are in place with localorganizations to provide assistance andvolunteers. Though we hope to never have

Board Highlights January MeetingBy Mike Wetzel, Secretary

• CEHA to begin the process of becoming an accreditation agency for continuing education.

• Motion to direct legislative committee to investigate incorporating REHS requirement into the professions code and investigating the establishment of penalties for violating existing legislation.

• Nominations for 2007 -2008 officers are as follows

President -Tseng / Wong nominates Nakamura President Elect -Pirie / Harrison nominates Ford-RosslerVice President -Wetzel accepts nomination.

-Ford-Rossler / Bryth nominates Yorkey.Secretary -DeGraw accepts nomination.

-Smith-Cooke accepts nomination

• Approved rate increase for Certified Public Accountant.

• Motion to purchase a portable badge maker from support staff budget with maximum of $600.00 to print AES, Update Badges, and membership cards.

• Current membership has been increased to about 850 members

• Final process of selecting venue in San Diego for 2008 AES.

• Looking for a Lancaster Delegate.

• Developing online training courses.

to our profession. We cannot survive if wefail to work together as one.

Lastly, I want to acknowledge and thanka very special person who has been mymentor, friend and confidant. It was herdrive, encouragement, and commitmentthat ultimately lead me to become yourpresident. I remember her calling me uplate one night, I was suffering from a badcold and really did not want to bebothered, but she was excited aboutchanges she wanted to make as theincoming President of Southern Chapter.She asked me to consider running forSouthern Chapter President-Elect and helpher to make these changes. I felt I wasintruding on a position that “belonged tosomeone else”. She spoke to me of theneed to find people with new ideas forCEHA; to stand up with conviction, and toovercome those who thought only ofthemselves. I am forever grateful to AkikoTagawa for her wisdom and knowledge inhelping me serve you.

I wish you all the best in your endeavorsin life. Be well. Be safe.

Regards,

Darryl C.F. Wong, REHSCEHA President

Spring, 2007

6 • CEHA Bulletin

Presient’s Message, continued from pg. 3

Environmental-Public HealthLeadership

I n the 19thand 20thcenturies,

public healthmeasures such assanitation andvaccination helpedwipe out manyinfectious diseaseslike cholera, yellowfever and typhoid.But the nation’senvironmental-

public health system has not been updatedsince the 1800s. Today chronic diseases arethe number one killers of Americans, eventhough 70 percent of these diseases arepreventable. Now is the critical time tofully modernize the environmental-publichealth system to ensure we can fight bothbioterrorism and everyday health threatslike cancer and asthma. A national leader isneeded to make this a reality. For nearly 40years, neglect has withered theenvironmental-public health system whilethe demands and need for protection frombioterrorism to chronic disease havedramatically increased. We are a nation atrisk of new health threats, as well as theresurgence of many chronic and infectiousdiseases.

F U N D A M E N T A L S O F T H E

E N V I R O N M E N T A L - P U B L I C

H E A LT H D E F E N S E

We need to strengthen the corecomponents, the infrastructure, of theenvironmental-public health system. Thecomponents – used everyday to protectcommunities from illness – are:

• Early-warning and communications systems;

• Fully equipped public health laboratories;

• Trained health detectives; and

• Disease and exposure tracking systems.

The environmental-public health systemmust be a multi-purpose system. The samepeople and resources that might be calledupon to respond to sudden healthemergencies are also responsible fortreating people who have chronic diseases, such as asthma, diabetes, cancer andParkinson’s disease.

V I S I O N F O R B U I L D I N G A

M U LT I - P U R P O S E

E N V I R O N M E N T A L - P U B L I C

H E A LT H D E F E N S E

Every health department must be fullyprepared with increased capacity so thatevery community is protected. A goodhealth defense system requires vision andleadership. Areas that should bemodernized are:

• The Troops: A well trained and sufficient workforce ;

• The Tools: Nationwide disease tracking and exposure monitoring; increased and modernized laboratory capacity;

• Communication: 24/7 operation at all key levels ;

• The Generals: Strong, qualified public health leaders ;

• The Tactics: Aggressive public health detective work and greater investmentin disease prevention.

We’ve failed to modernize our nation’sfront-line defenses to protect the health of

our communities from the full range of21st century threats. As leaders inEnvironmental Health, in California, weneed to forge a consensus on the best wayto protect and improve the health of ourpeople. Now more than ever, we need astrengthened public health system and thepolitical will to ensure sustained support.

Dean D. Peterson, PE, REHS

President, CCDEH

Are you curious to see if your candidatewas selected for a deserved award?!

Please tune in to the Awards Lunch at the 56th AnnualEducational Symposium and show your support!

Doing environmental healthwork in a developingcountry is something very

few of us ever get to do

We have asked Dennis Kalson, aCEHA member, and Past Director forHumboldt and Sonoma Counties toshare some of his experiences in doinghumanitarian environmental healthwork and he has graciously agreed.The following is an edited letter fromDennis to his pal Desmond (Des)McCall. In the letter, Dennis writesabout his work in Banda Aceh,Indonesia after the great Tsunami onDecember 26, 2004.

In future Bulletins we will bring yousome of Dennis’s notes and letters about hisexperiences in Honduras and Eritrea. Laterthis year, Dennis will be returning to post-tsunami Indonesia for more environmentalhealth work.

We hope these letters may provide thatbigger picture that we always hear talkedabout and perhaps it will motivate someCEHA members to become so interested,that they will wish to join with Dennis inhis work abroad. Dennis is always lookingfor new recruits to participate in the“world” of environmental health.Information on how to contact Dennis is atthe end of this article.

[Editor’s note: Dennis thought it wouldbe helpful for readers to know a little aboutthe person this letter was addressed to sohe offers this description of his friend Des:

Desmond McCall is a young, brightengineer from Ireland, (currently workingin Southern England). Des and I met onthe plane to Indonesia, and became almostinstant friends, since like me, he hasinterrupted his career several times to workin developing countries. He is one of thesubjects of an earlier letter, as we traveledto Singapore and Medan together to renewpassports and share a few beers. A greatguy, even though he is an engineer.]

D E A R D E S ,

Nice to hear from you. And thanks toofor the Christmas card. It welcomed mehome on December 21st upon my returnfrom Aceh to this quiet house. I’m happythat you are well.

Oh for the warmth of embers in thehearth of a rural pub on the coast! I can

only imagine the dim light; part from thegrey sky looking in with envy above thecurtain in front, part from the rose neonfrom an unassuming Kilkenney sign behindthe bar, a flickering of fire, and the glow offriends chatting at the tables. I could usethe pint, or two as well. And, we couldtalk through the afternoon into the Irishnight, finally stumbling out into the streetand down to the shore to howl at theNorthern sea.

Aceh was good to me on this trip, andmy work with food sanitation in traditionalmarkets is now moving well. I’m sureyou’ve been listening to newscasts about therecovery, about how the pace and quality ofhousing is not as good as one would hope.You’ve read about the continuingcompetition—at times cut-throat— amongthe do-good agencies to spend billionsbefore some imagined deadline. It’s all true.It is all good fodder for the cynics. But,most news stories are missing someimportant aspects of the recovery.

The Acehnese themselves have rebuilttheir tremendous spirit, and it is as palpableand vibrant as the call to prayer beforeevery dawn, before every dream. Sidewalkcafes are open and crowded, coffee shacksare full and expanding daily. Couples onmotorbikes crowd the roads every weekendto go to the beaches or cruise the city.People are more playful now, and there is aconstantly humming motorbike community,moving like a great river along newly pavedroadways day and night.

Maimon, one of our former nationalstaff, bought a new camera (at a cost of1,200 USD) and already produced oneaward winning photo. I have two friends(you may remember Pak Myrza), who havepurchased cars; there are weddings and

fresh babies everywhere everyday. Iwent to an international art exhibit atthe university, to a poetry reading, toan awards ceremony for the bestAcehnese novel, and to a traditionaldance concert. Even my adoptedniece, Ms Ratna is prospering. She isstill cooking for the (InternationalRescue Committee) IRC staff. Ratnahas now remarried, to a gentle,caring man who her daughter adores.She has built the first neighborhoodstore, and on weekends sells grilledcorn to tourists and weekend couplesalong the beach.

None of that stuff has made thenews. But it is truly the most remarkablepart of the post tsunami effort to date, andno international NGO can take the creditfor it. None can plaster a sticker on it, orstencil their logo across the new store wall.And, no one can photograph it to claimvictory in their agency portfolios to sell tofuture donors. It is the resilience of thehuman spirit—the Acehnese soul—thatcannot be owned, nor claimed, bought,stenciled, nor photographed.

That soul, that spirit, is most evident inthe coffee shops (“Warung Kopi” or war-kop for short) where reporters never stop,except to buy souvenir coffee rumored tocontain ground marijuana. Likeneighborhood pubs in Ireland, the localwar-kop is the place where the richness ofculture is open and free and welcoming. Ispent nearly every night of the past monthin one coffee shop or another, sipping pintsof that sweet dark Aceh spirit-brew, lettingold men tease me for my slow acquisitionof Aceh language, and teenagers practicetheir “hey meester” mastery of English.

Spring, 2007

CEHA Bulletin • 7

Dennis and other relief workers

International Environmental Health Work After the TsunamiComments from Dennis Kalson, REHS

Continued on page 12

Meat stall in outdoor market

Joining the Fight toCombat LeadPoisoningBy Ihsan B. Dujaili, REHSSan Francisco Department of Public Health

L ead (Pb) is a heavy metal that wasfirst mined in present day Turkeyin about 6,500 BC. Lead’s

properties, including low melting point,easy workability, corrosion resistance, anddurability, have made its use very popular,especially in the paint industry.

Lead is highly toxic and particularlyaffects the developing nervous system.Thus, children six years of age or less areespecially vulnerable. Lead has no knownbiological role in the body. The toxicitycomes from its ability to mimic otherbiologically important metals such ascalcium, iron and zinc. Lead is able tobind to and interact with the same proteinsand molecules as these metals. When thishappens, the molecules will fail to functionproperly. One such reaction prevents theproduction of normal hemoglobin, resultingin anemia in individuals with elevatedblood lead levels. Lead can also blockneurotransmission by glutamate in thebrain. It can reduce intelligence quotient(IQ) scores by interfering with memory andlearning ability. Level, duration, andtiming of exposure determine the type andseverity of lead poisoning.

There are many possible sources of leadin a home. Examples include lead-basedpaint, glazed pottery, dishes, crystalstemware, lead-soldered cans, importedspices, traditional medicines, importedcosmetics, imported vinyl miniblinds, oldbathtubs, antique furniture, water fromold pipes, and soil. Adults can also bringlead dust home on their clothes. The mostcommon route of exposure is whenchildren play with toys on dusty floors ornear window sills; they are likely to ingestlead dust through normal hand-to-mouthactivity. There are no apparent symptoms.Primary prevention (as in entirely avoidingexposure to lead), is the best solution.

Ninety-one percent of San Francisco’shousing stock was built before 1978,making it one of the cities with the highestconcentration of living units potentiallycontaminated with lead in the country(Figure1). In 1992, the San FranciscoBoard of Supervisors determined that lead

poisoning is the most environmentallyimportant threat to the health of childrenin San Francisco. Thus, “The ChildhoodLead Prevention Program” was born.

In 1995, when I began working as avolunteer in the San Francisco ChildhoodLead Prevention Program, blood lead levelreporting was still limited and was notperformed in a systematic manner. Thevision was to design a comprehensive datacollecting and reporting system that wouldprovide this information. My first task wasto identify the laboratories that analyzeblood lead samples. The next step was toidentify the health institutions that utilizedthis information. Subsequently, thecommunication and standardizationprocesses utilized by these institutions were

examined in order to clarify thelogistics of the lead reportingprocess. Lead reporting is anessential part of any effectiveprogram because it provides aroad map and allows the programto make adjustments necessary toaccomplish its goals.

With the encouragement of GailHerrick, the case manager at thetime, and the support of KarenCohn, the program manager, alllaboratories responded to ourinformal request to report theresults of all lead levels of concernand to provide demographicinformation on a voluntary basis as

illustrated in (Figure 2). Consequently, alllow but elevated blood lead (LEBL) results,10-14 µg/dL (micro grams of lead perdeciliter of blood), including thedemographic information in San Franciscohave been faxed to our program since1997. The new reporting processsupplemented the State-required reportingof blood lead levels at 15 µg/dL or greater.

Today the Childhood Lead PreventionProgram has seen the vision of having acomprehensive data collecting system cometrue. Collection of LEBL levels allows usto intervene in a timely manner byproviding educational home visits and toplay an important role in preventingongoing exposure to lead hazards. These

8 • CEHA Bulletin

Spring, 2007

Figure 1. pre-1978 houses

The Reporting Sources of Blood Lead Results in San Francisco The little boxes indicate the frequency of the reporting.

Childhood Lead Prevention

Program/Children’s Environmental

Health Promotion

Kaiser

UCSF Chemistry

Lab.

MNHC

Not performed regularly Not

performed regularlyWeekly and

monthly

Monthly

Weekly

St. Mary’s Medical Center Lab.

NEMS^

Quest* Diagnostics

SK

Mayo Medical

Lab.

Monthly

Daily Monthly

t10Pg/dL only

Not presently

done t

Specialty Lab.

UniLab.

SFGH Clinical Lab.

*Quest Diagnostics Laboratory acquired Smith Kline Bachman Laboratory. ^NEMS currently analyzes their own samples.

Figure 2.

CEHA Bulletin • 9

Spring, 2007

educational home visits also provide eachfamily with a floor mat, mop, bucket, handsoap dispenser, set of towels and educationalhealth materials in the appropriate language(Figure 3). In San Francisco, officialdocuments are usually made available inthree languages, English, Spanish andChinese (figure 4). Our staff members arehighly-motivated with multi-ethnicbackgrounds, and are capable of serving thediverse populations in San Francisco.

The program is in touch with a widerange of community-based organizations inthe City working to educate people on thedanger of lead poisoning. One example ofthis cooperation resulted from a case oftoxic candies that occurred in the MissionDistrict. A rotating program ofpresentations was held at hospitals andhealth clinics to alert new residentphysicians to this problem. Anotheroutreach is a project designed to alertpeople to the dangers of lead that might beencountered during renovation andpainting. This project targeted homeimprovements stores and retail paintdealers throughout the city. (Figure 5)A third project targeted the automotive

radiator and body repair shops in certainneighborhoods to address the issue of“Take Home” or work related lead dustcontamination that can affect families intheir homes. (Figure 6)

In 2001, The Childhood Lead PreventionProgram began to utilize digital photographsin the code enforcement process (Figures 7and 8). Although, as can be seen in figure 8,the owner of this building corrected thepeeling paint, it was done in a manner thatcontaminated the adjacent park. As a result,the park was closed for two weeks until thelead contamination was removed and thepark was cleared to re-open. The availabilityof documentation combined with clearimages has greatly improved codeenforcement and compliance. Digital photosare also valuable as an educational tool, andfor use in our brochures, leaflets and otherhealth-related educational materials.

The growth of the of the Childhood LeadPrevention Program would not have beenpossible without the efforts and thecontributions of many individuals: JanHolsbo of Smith Kline BeckmanLaboratory (SK), Judy Hewson of theChildren Health and Disability Program(CHDP), Byra Mattes of the MissionNeighborhood Health Center (MNHC),Mr. Long Ji of the North East MedicalCenter (NEMC), Mr. Kirk Sujishi of theUniversity of California San Francisco(UCSF) Chemistry Laboratory and SusanFisher Gross of the San Francisco GeneralHospital (SFGH), clinical laboratory. Theydeserve an Oscar award for the work theyhave done to improve and advance theblood lead reporting process.

The most important task in winning thewar on lead poisoning is to promoteknowledge and understanding. I believe inthis cause, and if my endeavors assisted inreducing the blood lead level of one child,then it was worth the effort. All staffmembers including certified lead inspectors,health educators, public health nurses,

Figure 3. Outreach materials

Figure 4. Multi-language materials

Figure 5. Cautions for renovations

Figure 6. Don’t take lead home

Figure 7. Before correction of peeling paint

Figure 8. After correction of peeling paint

Continued on page 12

Spring, 2007

10 • CEHA Bulletin

Pre-Conference Activities

Monday, April 23, 2007

Registration7:30AM – 12:00PM

Cal Code Course (Day 1) 9:00AM – 3:30PM (Limited to 60 attendees)

NEHA REHS/RS Credential Exam 10:00AM – 3:00PM

Sherry Roney Memorial Golf Tournament 11:00AM

Tuesday, April 24, 2007

Registration7:00AM – 5:00PM

Cal Code Course (Day 2) 9:00AM – 3:30PM (Limited to 60 attendees)

EPI Intro Course 9:00AM – 4:30PM

Roadmap for All-Hazard Preparedness 9:00AM – 3:00PM

AES Program

Wednesday, April 25, 2007

Conference Registration 7:00AM – 5:00PM

Exhibit Viewing 7:30AM – 8:50AM

Opening Session & Keynote Address 9:00AM – 10:45AM Ray McDonald Evans, REHS, MS

Student Forum 10:45AM – 11:50AM

Exhibit Viewing & What Is New (WIN)10:45AM – 11:50AM

CEHA Awards Luncheon 12:00PM – 1:20PM

Technical Sessions 1:30PM – 4:20PM

Housing Epidemiology Liquid Waste Food Plan Check

Exhibit Viewing & Reception 5:00PM – 6:30PM

Old Hysterical Walk of the Dead 6:30PM (Limited to 50 attendees)

Thursday, April 26, 2007


Exhibit Viewing 7:30AM – 9:20AM

Technical Sessions 8:30AM – 11:50AM

Exhaust Ventilation Seminar 9:00AM – 11:50

California Environmental

Health Association

56th

Annual Educational Symposium

April 23-27, 2007

Radisson Hotel Sacramento

CEHA Bulletin • 11

Spring, 2007

NIMS/SEMS/ICS Course for the EH Professional

Exhibit Viewing & What is New (WIN) 10:30AM – 11:50AM

CEHA Business Luncheon 12:00PM – 1:20PM

Technical Sessions 1:30PM – 4:20PM

International Drinking Water Disaster Preparedness Recreational Water

Banquet, Entertainment & Dance: Gold Rush5:00PM – 12:00AM

Friday, April 27, 2007


Continental Breakfast 7:30AM – 8:30AM

Technical Sessions 9:00AM – 11:50AM

Career Management Food Solid Waste Vector Control Miscellaneous

CEHA Installation of New Board of Directors Luncheon 12:00PM – 1:50PM

Closing Session 2:00PM – 3:30PM Dr. Mark Horton, MPH, MD

NEHA REHS/RS CredentialFor more information visit:

http://www.neha.org/pdf/cred/Credential%20Application.pdf

Registration packets will not be be mailed.

All registration forms for AES activities will only be available by downloading from the

CEHA website. If you are unable to download the forms, please call (323) 634-7698 and leave

a fax number or send an email to [email protected].

Registration Fees

Member Rates Before 4/02/07

After 4/02/07

1-Day Package 2-Day Package 3-Day Package * Student EPI Intro CourseHazard Preparedness Old Sacto Hysterical Tour Golf Tournament

$140 $280 $390

$20/Day $75 $75 $25 $55

* Banquet included Non-member rates & registration fees for the Cal Code

Course are available at www.ceha.or g.

The Radisson Hotel Sacramento is just minutesaway from Old Town Sacramento, Cal Expo,

Arden Fair Mall, state government offices and the California State Railroad Museum. Other

attractions convenient to the Hotel Sacramentoinclude Crocker Art Museum, Capitol Park,

Sutter's Fort and Waterworld USA.

For more hotel information visit www.radisson.com.

Special group rates based upon availability when you mention CEHA.

Single/Double: $125.00 Triple: $135.00 Quad: $145.00

Call (800) 333-3333 to make your reservations. Group rate expires

March 23, 2007

Agenda and schedules subject to change. Check the CEHA website for updates and more

detailed information! www.ceha.org

$185 $325 $435

$20/Day $75 $75 $25 $55

9:00AM - 11:50

Spring, 2007


secretaries, epidemiologists, nutritionists,coordinators and managers have workedhard to establish rapport with all parties ofconcern including, but not limited to,parents, tenants, property owners,contractors and property managers to betterserve and educate the public. The jointefforts of all these people is truly making adifference in the lives of affected children.

It behooves us to make an effort tounderstand the dynamics of every case foridentifying the source(s) of lead exposure andfor successful lead hazards abatement. Thisrequires the full cooperation and coordinationof many agencies and departments. Thus, acomprehensive approach involving effectivesurveillance, quality education, properintervention, and careful enforcement isnecessary to achieve the final goal of ensuringthat all children can play, learn, and grow ina lead safe environment.

Ihsan B. Dujaili has a B.Sc. in Biologyfrom Basrah University, Iraq. He passed atransfer degree from M.Sc. to Ph.D. fromUniversity of Wales, Cardiff, Great Britainin Microbiology. He is a State ofCalifornia certified lead inspector assessor.He has worked for the San FranciscoDepartment of Public Health for twelveyears, and is currently an EnvironmentalHealth Investigator in the Childhood LeadPrevention Program.

Related links:

www.sfdph.org/cehpwww.dhs.cagov.childlead/www.epa.gov/lead

References:

• Interim review of scientific information on lead; United Nations Environment Program Dite/Chemical, October 2006.

• Measuring Lead Exposure in Infants, Children, and Other Sensitive Populations, National Research Counsel.1993. National Academy Press. Washington, D.C.

• Article 26 of the San Francisco Health Code.

• http://www.emedicine.com

• Wikipedia, the free encyclopedia.

I met an Acehnese worker from IRCCalang who says that Danda is fine (I talkedto Danda briefly in the War-kop beforeleaving). Calang is still the best place towork; still tight knit and a bit independent.Reconstruction is going okay there, and byall reports, you wouldn’t quite recognize theplace. I saw photos of a new landfill therethat is a work of art by any standard. TheIRC staff is competent and caring and stilltaking a leadership role in Calang, atradition begun when you and Bob firstarrived on that devastated peninsula.

And, I finally found the Aqua-chlorchlorine generator donated to the IRCin the post tsunami days. Still in the box,the local IRC staff had no idea of itsfunction (even though there’s a good photoin the in-house wat-san manual). Iarranged to demonstrate its use for the wat-san staff, and now they plan to put it online in Calang...as the tons of HTH stockedafter the tsunami are rapidly declining instrength; a much more sustainable solutionsince the continual production of chlorinefrom salt, water and electricity is easier andmuch cheaper than future procurement ofgranular disinfection products.

I left Aceh on December 20, just a weekbefore the second anniversary of that sadnightmare. After another tearful/joyfulfarewell, I walked across the same tarmacthat just two years ago was stacked withthe tools and equipment and cargo of theworld’s caring response. My send-off thenwas the sight of wrecked carcass of anAustralian helicopter being lifted back toBanda Aceh, slung like a broken dragon fly

from the bottom of some larger insect.This time in the same part of the sky, it wasa white hawk—a black-shouldered kite,only larger—stalling above the tall wavinggrasses next to the landing strip. As Iboarded the plane, the kite dove to seize itsprey, a reassurance that life goes on, thatnature heals.

Now back in America, I’ll finish my tripreport for USAID in the next few days.Then prepare for my next gig in Hondurasand Guatemala in February. I’ll probablygo back to Indonesia in April for a longerstay I hope. Maybe in the next week or soI’ll finish another Aceh story too for friendsand family.

This note has gotten too long, as if wehave stayed in that pub for a few too manypints. Still it is great to talk with you, Des.Keep me posted on your travels or non-travels, on your spiritual journeys andsocial ones too. I’ll do the same. I’m surethese lines will intersect again, and we willfind the time to stumble down to the sea tohowl together at waves.

Take care,

Dennis Kalson

A special request is made to all who maybe interested in more information or inactual volunteering. Please contact Dennisdirectly at:

Dennis Kalson794 Carly RoadSanta Rosa, CA 95405707.579.4034

[email protected]

Volpe Legislation UpdateBy Suzanne Du Vall Knorr, REHSVentura County Environmental Health

Assemblymember Lieu recentlyintroduced AB 506 to increase penalties forcommitting battery against a “codeenforcement officer”, defined as any personemployed by an agency with enforcementauthority for health, safety, and welfarerequirements and authorization to issuecitations or file formal complaints — putinto the Penal Code by SB 919 in 2003.This includes REHS by defining our duties.If AB 506 passes, the maximum penalty forbattery would increase to $2,000 fineand/or one year in jail, or 3 years in prison.CACE backs this bill, seeking increasedprotections despite difficulties passingVolpe Legislation. CEHA members willbenefit from this bill.

Kathy Raphael from CACE requestedinformation from REHSs and CEOs on theirexperiences with violence in the field, just as wedid before with SB 919. All the informationshe gathers, and articles on the Volpe andSausage Factory murders, will be presented topersuade the Legislature to pass AB 506. It’s along tiring road to greater protection under thelaw for our profession, but we will achieve ourgoal step by tiny step as long as we patientlywork towards success. Send information to:

Inspector Kathy RaphaelCommunity Preservation ProgramP. O. Box 1988 (M-19) Santa Ana, CA [email protected].

Thank you to everyone for yourparticipation and support of moreprotection for our profession.

Lead, continued from pg. 9Tsunami continued from page 7


Spring, 2007

business operators to assist them inunderstanding how the system works.

According to Sacramento County’s PublicHealth Officer Glennah Trochet, M.D., thegoal of the new program is to reducefoodborne illness. “Food safety practicesare critical to the prevention of foodborneillness,” said Trochet. The Centers forDisease Control and Prevention (CDC)estimates that nationwide, there are 76million cases of foodborne illness each year,including 325,000 hospitalizations andover 5,000 deaths.

EMD Director Val Siebal explains thatthe yellow and red inspection placards willalso include summary checklists to indicatewhat types of food safety violations wereobserved at the time of the inspection.“We included this section based on inputfrom consumers who said they wanted thisadditional information on the sign,” saidSiebal. The EMD website address whereinspection reports may be viewed,www.emd.saccounty.net, is alsoprominently noted on the signs, as well asan inspection history, revealing the resultsof the food facility’s previous inspection.

The placards are posted near the frontdoor and must be visible to the public fromoutside of the facility. All retail foodfacilities in Sacramento County will have asign posted by July 2007, including in thecities of Sacramento, Folsom, CitrusHeights, Rancho Cordova, Elk Grove,Isleton and Galt, as well as in theunincorporated areas of the County.

Color-coded placards are just onecomponent of EMD’s Food Safety ProgramEnhancements. Other activities include:

• Food Safety Education and Trainingcourses for food facility personnel, offeredin multiple languages. EMD holds thesecourses at their offices, as well as private

classes offered at community centers andrestaurant sites. There has been atremendous demand for these educationalopportunities. To date, EMD has held 84classes with over 2,200 participants.

• Outreach to retail food businesses,industry groups, chambers of commerceand related interested groups representingthe retail food industry.

• Outreach to the public throughvarious media outlets.

• Increased inspection frequencies andadditional staff. Full food preparationfacilities are scheduled to receive 3inspections per year while EMD is currentlytraining 7 REHS candidates and looking tofill 5 vacant positions.

• Improved enforcement processes.Enforcement policies and procedures arecurrently being updated and revised toaccommodate the new disclosure system.

• Standardization training for staff. EMDis focusing on inspector standardization byoffering regular in-house training as well asusing the retail food inspection field guideto maintain consistent code interpretations.Sacramento County’s retail food inspectionfield guide was also distributed to all 5,500food facility operators prior to theinception of the new placard program.

• Continued web posting and onlineeducation for the public and businessowners, including Compliance AssistanceBulletins designed to provide information tothe regulated business community on newand emerging environmental regulations.

If you have questions about the new foodsafety rating system, contact the EMDoffices at (916) 875-8440, contact them viae-mail at [email protected] orvisit the EMD website atwww.emd.saccounty.net.

Sacramento CountyServes Up Green,Yellow, and Red forFood SafetyColor-coded inspection programlaunched in January 2007

By Alicia Enriquez, REHSand Zarha Ruiz, REHS

I n January 2007, Sacramento County’sEnvironmental Health staff beganposting brightly colored inspection

placards at fixed food facilities to disclosehealth inspection results. The placardsrepresent a new disclosure system launchedin January 2007 by the County’sEnvironmental Management Department(EMD). This new color-coded ratingsystem, provides the residents and visitorsof Sacramento County with an instantmessage, effectively relaying the foodfacility’s most recent health inspectionresults and compliance with food safetylaws.

A green or “PASS” placard denotes ahigh level of compliance with zero or onemajor violation (corrected duringinspection). A yellow or “CONDITIONALPASS” placard is posted at facilities thathad more than one major violation (alsocorrected during inspection). Reinspectionsfor facilities receiving a yellow placard areconducted within 24-72 hours. A red or“CLOSED” placard is posted at facilitieswhen an immediate public health andsafety hazard is found. A field guide thatoutlines CURFFL and provides examples ofmajor violations was developed anddistributed to over 5,500 retail food

Green Placard ("PASS"): A high level ofcompliance achieved.

Yellow Placard ("CONDITIONAL PASS"):Violations observed that required immediate

correction and a follow-up inspection.

Red Placard ("CLOSED"): Closure is requiredwhen an immediate danger to public health or

safety is observed. The facility must remain closeduntil the danger has been eliminated and verified

through a follow-up inspection.

E thics is the study of standards ofconduct and moral judgment. Inenvironmental health, some of our

behaviors may be very clearly defined as rightor wrong, but there are also many choices wemake that are in the gray zone.

Obviously, taking a payoff or bribe towrite a favorable inspection report is bothimmoral and illegal. But consider thisscenario that most of us have experiencedin one form or another:

It is 100˚ F outside, late in the afternoon.You are hot, tired and thirsty and just wantto be done with your inspections for theday. As you are writing up the inspectionreport at the last food facility for the day, awell-meaning operator brings you a tall,cold soft drink. Do you take it?

If you have completed your inspection,delivered and received the signed copy ofthe report, is it okay now to take the sodafor the road? If you take the drink, will theoperator expect leniency in the future? Hasthis changed the relationship and reducedyour perceived authority? Will you feelmore sympathetic to this individual sincethey gave you this small gift? Is it just life-saving liquid from a kind soul andirrelevant to your inspection andinvestigation duties? We face many grayareas where the ethical answer is notobvious.

You could ask yourself the followingquestions to help you decide the answer toyour dilemma:

• Is there transparency?

• What are the effects of your actions?

• Is there an unfair advantage?

• Is there a conflict of interest?

Keep in mind, though, that usually if youhave to ask yourself if it is ethical, itprobably is not, or is questionable at best,and should be avoided.

A conflict of interest occurs when yourpersonal interest influences your decision asa professional or public official. Conflictsof interest are specific to particularcircumstances, require professionaljudgment and may be real, potential orperceived. In general, we expectgovernment officials to act in the bestinterest of the public at large. A conflict ofinterest describes a circumstance where the

best outcome for the professional conflictswith the best outcome for the public. It isimportant to remember that the perceptionof a conflict of interest requires the samedisclosure and scrutiny as a real conflict.

You avoid conflicts of interest by revealingany private financial interest you (or yourimmediate family) may have within yourjurisdiction. Are all relevant personalcircumstances surrounding your decisionsknown to your employer and the public?Most of us are required to complete CASchedule 700 from the Fair PoliticalPractices Commission. Schedule 700records your financial interest in property orbusinesses located within your jurisdiction.

How do you identify conflicts of interest?Michael McDonald suggests in his paperEthics and Conflict of Interest, to use thetrust test:

“Would my employer, clients, colleaguesor the general public trust my judgment ifthey knew I was in this situation? Trust, inmy opinion, is at the core of this issue.Conflicts of interest involve the abuse,actual or potential, of the trust people havein professionals. This is why conflicts ofinterest …damage the whole profession byreducing the trust people generally have inprofessionals.”

Conflicts of interest are not the onlyethical questions that face the REHS.Instances also occur where your owncounty or department policy iscontradictory to sound environmentalhealth practices. An individual REHS maybe torn between loyalty to his/her employeror coworkers and his/her responsibility toprotect public health.

Unethical practices may be personalitydriven. Personal and group dynamics canlead inspectors to use poor judgment. Aweak, unfortunate operator may play toyour sympathies encouraging you to “lookthe other way”. An inspector with a lessempathetic personality may be more likelyto “throw the book at him”. Knowinghow you are likely to react can help you beprepared in challenging situations.

Aside from ethical standards of conduct,we also each have our own moral compassthat guides our life and the choices wemake. Other people, including co-workersand management, may not share the samemoral guidelines, potentially resulting inserious conflict in the workplace.

Conflicts can lead to complaints.Individual REHSs are subject to aninvestigation process when a complaint isfiled against them. You can lose yourregistration and even your job for seriouslapses of judgment or clearly unethical orwrongful behavior.

Anyone can file a written complaintagainst a REHS to the CDHS, butanonymous or verbal complaints are notinvestigated. Following the receipt of acomplaint, program staff compiles anywritten documentation, writes a summaryof the complaint, collects all backgroundinformation, and interviews thecomplainant, the REHS and otherwitnesses. The preliminary report ispresented to the EHSR Committee in aconfidential closed meeting. CDHS isavailable to provide guidance, support andinformation regarding ethical questionsrelative to the practice of environmentalhealth.

At the CEHA AES in Sacramento wehave invited John Gregg, UC Davis,Director of Controls and Accountability tospeak to us on the topic of ethics in thepractice of environmental health. Wewould like him to address specific questionson ethical conflicts in the context ofenvironmental health work.

Please send your questions to:Margaret Blood, REHS

REHS ProgramMS 7404

PO Box 997413Sacramento, CA 95899-7413

All questions will be presented anomalouslyunless requested otherwise. You maydescribe a current, past or potential eventor situation.

Reference

Michael McDonald, 2004. Ethics andConflict of Interest.

http://www.ethics.ubc.ca/people/mcdonald/conflict/htm. March 3, 2007


Spring, 2007

Environmental Health EthicsBy Margaret Blood, REHS and Laura Barnthouse, REHS

International Environmental Health in Action


Spring, 2007

At this time, on behalf of the International PublicHealth Foundation, Health Program for the town ofEcuador, we want to express to you our gratitude forthe donation of a laptop computer that was brought tous by a wonderful man who is engaged in the healthand education of the inhabitants of the Santa ElenaPeninsula, Bob Swift. This donation (computer) servesa great deal in the education process that ourfoundation carries on.

Wishing you success in your daily work and may Godbless you always.

A t the 2006 Northern Update heldlast October in Santa Rosa, BobSwift, former CEHA

Environmental Health Specialist of theYear, presented a section on hisoutstanding volunteer work assisting aremote village in Ecuador with building a

clean, safe and reliable water supply. Bobhas a number of other environmentalprojects on the drawing board for this samevillage, but funding is always difficult.After his presentation at the Update, we“passed the basket” and attendees werevery generous! With that money, along withwhat he earned selling native handicrafts,

he was able to purchase a much-neededlaptop computer for use by the villagers,and specifically for a student whose highereducation he is now funding. By helpingBob and his projects in Ecuador, we canvicariously help those who are most inneed. This is the letter of thanks received asa result of the donation.


Spring, 2007

*Answers on back cover


Spring, 2007

LANCASTER SYMPOSIUM

July 5-7, 2007Edge Hill College

Ormskirk, EnglandCEHA is twinned with the North Western Centre, England. Each year, the two groups reciprocate delegations. The application for the2007 CEHA delegate can be found below. This year’s conference theme is food. Please complete, and return the delegate applicationno later than April 20, 2007. The chosen delegate will have the opportunity to meet delegates from the North Western Centre at theCEHA AES, April 25-27, in Sacramento.

International Exchange PolicyThe CEHA Board of Directors has adopted the following policy on International Exchanges. This policy is to be followed whenever aCEHA International Exchange opportunity presents itself. A CEHA International Exchange opportunity is one where an individual isspecifically selected to represent CEHA at an international function, as a delegate, in a recognized on going exchange.

Chapter 24 – CEHA Policy and Procedure ManualB. President’s Policy on International Exchange Delegation Selection.

1. The following criteria will be used in the selection of delegates for participation in CEHA coordinated professional and academic international exchanges:

a. Long term or outstanding service to CEHA and/or the profession:(1) Held elective office(s);(2) Served on one (1) or more committees;(3) Contributed to professional REHS development (e.g., EHSRC, active involvement with education or

continuing education);(4) Completed a project that benefits CEHA, REHSs or the people of California regarding environmental health.(5) Participated in CEHA via contributions to the publications or as a speaker at an AES or Update: Ability to commit

all requisite personal funds for the cost of trip that may include airfare and ground transportation, hotel accommodations, food, passport and VISA fees, plus appropriate gifts for international hosts; Be willing to undertakeall necessary physical exams and immunizations at own expense; Be willing to sign a waiver releasing CEHA of any and all liability resulting from physical, logistical or political problems; Ability to commit to assisting with fund-raising for reciprocal delegations; Ability to commit to sharing experiences with CEHA membership via the Bulletin,AES or Updates, or with board.

Name: ______________________________________________________________________

Address: ____________________________________________________________________

Phone: (work) _____________________ (home) ____________________________________

Current Employment: _________________________________________________________

Previous and current service to CEHA and/ or the Profession __________________________

__________________________________________________________________________________________________________________(Feel free to attach additional information)

I have read the President's Policy on International Exchange Delegations, and agree to abide by the terms in the delegate selection criteria. I am in good physical health.

______________________________________________________ _________________(signature) (date)

Return completed applications to:

Diane Eastman, Chair CEHA International Committee 6098 Cardinal StreetVentura, CA 93003


Spring, 2007

C E H A C O R P O R A T E M E M B E R S

Garrison Enterprises Inc. P.O. Box 690426 Charlotte, NC, 28227 (704) 569-0801contact: Cameron Garrison 2006 AES Bronze Sponsor

Mars Air Doors14716 BroadwayGardena, CA 90248(310) 532-1555 Contact: Dana [email protected] AES Silver Sponsor

H2O Enviro-Tech Corporation 150 Post Street San Francisco, CA 94108 (800) 667-0097 contact: Temer Garner [email protected] www.wastedirect.com

Same Day Distributing, Inc.5692 Buckingham Dr.Huntington Beach, CA 92649Outside Orange & LA Counties(714) 379-2060(800) 735-2261Contact: Susan Hickswww.same-day.com

Taylor Technologies31 Loveton CircleSparks, MD 21152(410) 472-4340Contact: Tom Metzbowerwww.taylortechnologies.com

American Food Safety Institute1 Green StreetHulmeville, PA 19047800-723-3873Contact: David Nash www.americanfoodsafety.com

Underwriters Laboratories Inc.333 Pfingsten RoadNorthbrook, IL 60062-2096 USA(847) 664-1579Contact : Jim [email protected]/regulators

Western Exterminator305 North Crescent WayAnaheim, CA 92801 (714) 517-9000 x148Contact: Jesse Fultonwww.westernexterminator.com2006 AES Silver Sponsor

Southern California Gas Company 9240 Firestone Bl. SCERC 7Downey, CA 90247(562) 803-7323Kristen Towner

WESTERNEXTERMINATOR COMPANYAIR DOORS

UnderwritersLaboratories Inc.®

UL®

Check the websitefor updated informationwww.ceha.org

Spring, 2007

California Environmental Health Association

110 South Fairfax Avenue, #A11-175Los Angeles, California, 90036

Address Service Requested

April 7, 2007World Health Day http://www.who.int/en

April 23 -27, 2007CEHA AES - Radisson Resort Hotel 500 Leisure Lane, Sacramento, CA 95815(916) 920-7362; www.radisson.com

April 24, 2007Board of Directors Meeting (1:00 pm to 5:00 pm)Radisson Hotel; 500 Leisure Lane, Sacramento, CA 95815

April 28, 2007Board of Directors Meeting (9:30 am to 4:30 pm) Radisson Hotel; 500 Leisure Lane, Sacramento, CA 95815

June 18-21, 2007NEHA 71st Annual Educational Conference, Atlantic City, NJhttp://www.neha.org

October 11, 2007CEHA Northern Update, Lake Tahoe Conference Center http://www.ceha.org

C E H A C A L E N D A R O F E V E N T S

Please Note: CEHA has a new mailing address. The new address is: 110 South Fairfax Avenue, #A11-175

Los Angeles, California, 90036

The new phone, fax and email are: (323) 634-7698 Phone (323) 571-1889 Fax

[email protected]

Please visit the CEHA website at www.ceha.org

PRESORTEDFIRST CLASSUS POSTAGE

PAIDPERMIT 275

94615

PRSRT STDUS POSTAGE

PAIDPERMIT 275

94615


PAIDPERMIT 130

94565

PRSRT STDUS POSTAGE

PAIDPERMIT 130

94565


PAIDCAREFUL DESIGN

94565

PRSRT STDUS POSTAGE

PAIDCAREFUL DESIGN

94565

TO BE USED AT OAKLAND OR PITTSBURG

TO BE USED AT OAKLAND ONLY

TO BE USED AT PITTSBURG ONLY

Documents

Responding to Hurricanes Katrina and Rita, the San Antonio Experience