EPIDEMIOLOGY AND AN EVENT AT THE POST OFFICE

I’m writing with quite a bit of detail in regards to nursing because an instructor from the University of Washington, Bothell, asked if she could share the link to the blog with some of their Community Health students.  I’m usually much, much briefer, aren’t I?  = )

These past three days have been very rewarding and interesting.  My initiation as a public health nurse is providing many opportunities to learn, this week very on-the-spot.  The State of Alaska Epidemiology Office in Anchorage faxed our office on Monday morning with lab results showing that a young boy who had been tested for Pertussis (whooping cough) by our nurse practitioner last week was positive.  Because one of our public health nurses is on leave, another one was out sick, the visiting one had a full case load of appointments and the Coordinator was busy, I was asked to follow up with an investigation and do the necessary reporting and documentation.    

I found all of the forms I would need, poured a hot cup of tea and settled into the project.  By the end of the day I had talked with the boy’s mother, interviewing her regarding the boy’s current symptoms and plan of treatment and asked her about symptoms that she and other members of the house were experiencing.  They were all being treated with either Azithromycin or Sulfamethoxazole, the boy for his active case of Pertussis, his sister for symptoms and the mother prophylactically to prevent contraction of the disease.

She gave me the names and telephone numbers of eight people that he had been in close contact with over the past two weeks, some in Barrow and others in Anchorage where the family had traveled over the weekend.  The investigation involves calling all contacts, asking them questions related to symptoms of Pertussis, demographics and the date of their last Tdap or DTaP immunization.  If unknown, which was the case with most people I called, I looked them up in the state data base.  When questioning one of the contacts, based on the length of time she had experienced symptoms and because of visits to urgent care and the ER, I came to believe that she was most likely the person who had infected the boy.  At a meeting with our Deputy Director, Coordinator, nurse practitioner and the visiting public health nurse, we all thought she had been misdiagnosed and that she had carried an active case of Pertussis to the boy and perhaps others.  This necessitated determining who all of her close contacts were and calling each of them as well.  By the time I wrapped up my calls today, I had documented information on 17 people.  The ones with symptoms of Pertussis are being tested and treated and the ones who are not current on their immunizations were encouraged to get them updated.  No one in the boy’s household or any of his contacts or the contacts of those with symptoms of Pertussis have been in contact with anyone in either of the highest risk groups, infants under one year old and pregnant women in their third trimester and none of the contacts were elderly people.

Because the boy was on an airplane and in many locations in Anchorage, I needed to call the Public Health Department in Anchorage to let them know that he had been there with a confirmed case of Pertussis.  The nurse on the telephone assured me that we weren’t sending them anything they didn’t already have…there are currently between 160-170 confirmed cases there. 

I contacted the elementary school nurse asking her to contact both children’s teachers and to advise parents of other children with symptoms to come into the Wellness Center or go to the hospital to be tested and/or treated. 

The testing is very intrusive, using a long swab inserted into one of the patient’s nares and down into the pharynx twice to obtain two cultures.  The young girl who we believe has Pertussis will be in tomorrow and under the direction of the nurse practitioner, I’ll do the test and she’ll be started on treatment.  I haven’t seen any patients on my own yet, so am feeling a bit nervous about taking the lead during her appointment, but it will be good experience.  In about a year, this will all seem like second nature, I’m sure, or at least I hope! 

I’m hoping, I like to think for the sake of the little girl, that her lab tests come back negative for Pertussis…I’m sort of hoping for my sake too.  I’m ready to learn other areas of public health nursing and begin being mentored by the visiting one while she is here.  There is so much to learn!  I still need to fax a summary of the investigation along with the reports on the boy and each contact to the Epidemiology Office in Anchorage and fill out encounter paperwork for each person.  An amazing amount of telephone and paperwork related to this single case, but in looking back, if questions arise, the information will be in its various and appropriate places.

Two students from Gustavus Adolphus College in Saint Peter, Minnesota are with us for the next three weeks doing their clinical rotations here after having done their OB clinical rotations in Fairbanks.   We asked how they were selected to come to Alaska and if they had had a choice of locations.  They said that they hadn’t been given a choice, but were told that they were going to Fairbanks and Barrow and would be gone for six weeks.  All of the rest of their classmates are in and around the Saint Peter area in Minnesota.  One of the staff asked the two students if they felt that they had won a booby prize or the lottery and they both said “the lottery!”  I feel the same way.  I’ll be traveling with them to one of the villages in early November to represent Public Health Nursing, so we’ll meet and strategize about what we’d like to focus our presentations there on.  It will be good working with them. 

On a more carefree note, I was able to use some of the comp time I’ve earned and leave the office early today, walking to the post office to pick up two packages that I had notices for in my box.  It’s such a refreshing feeling to not take anything for granted.  I remember many, many times going to the post office in the various places I’ve lived and sometimes feeling bored while waiting in line.  On the walk there I found myself thinking “in just five minutes, I’ll be at the post office!” and while standing in line my level of excitement was very high.  Although I was hoping that the packages Sandi had sent would be handed to me over the counter, I am happy to be restocked with cod liver oil, Raw Revolution bars and three months’ worth of Vitamin D.  I’ll finally be able to pick up my pallet of boxes sent before I moved tomorrow or Friday.  Someone told me that they ship them back to where they came from if not picked up within a certain amount of time.  That would not be good, especially the ones containing any sort of food at all.  I'm about to be inundated with things like hazel nuts, walnuts, almonds, olive oil, apple cider vinegar, sesame oil, sea salt, sesame and pumpkin seeds, soy protein, carob, coconut oil...these are a few of my favorite things...Sister Maria and I are humming this often these days.

The weather is becoming familiar…it’s cold every day, sometimes brilliantly sunny and other times overcast and gray.  I absolutely love having a cold face and the rest of me is grateful to feel toasty warm beneath layers of down, fleece, my vest and Gortex…oh and the silk long johns Mom and Dad gave me several years ago.  There is a storm advisory in effect for this weekend with six foot waves expected at the beach.  Trucks have been hauling gravel to reinforce the berms that are already there protecting buildings and property from advancing waves.

Although I’m happy to be here, I find myself missing talking and spending time with and hugging family and friends.  I hope Jordan and Keira don’t forget who their Oma is = ).  Just two and a half more months before I can apply for time off and a trip to Washington.  I’m counting the days = ).