• During COVID-19 Pandemic, Public Health Is Personal

    I became the Wilson County, Kan., health officer eight years ago after the previous health officer -- a family friend -- died unexpectedly. I agreed that for $400 a month I would review vaccine protocols for the health department, inspect an occasional lagoon and work on community health needs assessments.

    I had no experience in public health, but I've been a family physician for more than a decade. Family physicians are well-suited to lead public health efforts because we are trained to take care of whatever our patients need. We see the patient as a whole person, who is part of a family, which is part of a larger community. We see our communities as part of the larger world.

    As family physicians, the time we spend one-on-one with patients in exam rooms is extremely personal. Patients share secrets, fears and even hugs with us in these encounters. I think many of us perceive public health as less intimate. But COVID-19 has taught me many lessons, and I am now convinced that the work we do in public health can sometimes be even more personal than the interactions we have in our exam rooms.

    I have practiced for the past 10 years in the same small, rural town where I was born and raised. Many of the people I try to protect today are the same ones I grew up with or looked up to as a child. This community is my home, and the people in it are my family.

    I have always felt an obligation and desire to support my community through service and involvement -- as the school board president, as founder of both a community foundation and a local growth initiative, as an owner of three local businesses, and as a physician.

    When COVID-19 came to Kansas in early March, I did what I've always done as a family doctor. I studied the emerging science, communicated with my public health and medical colleagues, and cared for people in my practice and in my rural community. I stepped forward not knowing exactly what I needed to do. I did not have access to more information than anyone else, but I tried to soak up all the credible information I could (including the plethora of resources and information from the AAFP). I knew our community would need leadership, teamwork and appropriate care.

    I began my health officer work on COVID-19 by convening a countywide meeting with leaders from local schools, hospitals, businesses, churches and governments. I would not have been able to gather these stakeholders together had I not spent the past decade building trusted relationships in which I established myself as a reliable and accountable partner. These meetings became a weekly exchange that brought key community members together. Because of these efforts, our COVID-19 case numbers have remained much lower than in the surrounding counties.

    I started doing weekly Facebook Live information sessions with the health department administrator in mid-March. We knew our community was scared, uncertain who to trust, and in need of data and reassurance. We promised the public transparency and an open dialogue from the beginning. These stakeholder meetings and Facebook Live sessions have become quite personal. It has been extremely rewarding to hear that participants in both these initiatives appreciate our familiar faces and our open communication, and they trust the information and perspectives we share.

    This pandemic has become personal because I work with my 76-year-old father, who has served this community as a general surgeon for the past 40 years. The virus doesn't care that he has dedicated his life to protecting others. He is part of the most vulnerable population of people. My partners and I have worked to protect him by seeing his patients who have fevers or respiratory symptoms in the clinic or in the ER for him. Although he would gladly take care of these patients -- because he wants to protect his daughter -- it is my turn to protect him.

    My accessibility and availability in the COVID-19 era have made public health personal for me. I answer every text, Facebook message and phone call from people asking what they should do or wanting more information. If someone asks about the details of quarantine and isolation or if they should have their mom over for dinner, I am ready to guide them. And as the country talks about reopening schools, and I think about my kids and my friends who are teachers and the fears they are facing, it feels personal.

    But public health has also become personal for me because some of the people I am working so hard to protect are angry with me. Even though the virus is the enemy, their anger and frustration are often directed at me.

    When a business owner expressed anger toward me for requiring his employee to quarantine after close contact with a patient who had tested positive, I felt personally attacked.

    When a county commissioner told me I'm trying to violate his constitutional rights by asking him to wear a mask, it felt personal

    When one of my fellow school board members told me in a public meeting that she's an adult and no one can tell her who she can shake hands with at graduation, it felt personal.

    When a person I have golfed with drove by my house and filmed my property because I had an outdoor dinner for my clinic staff (using appropriate social distancing) to thank them for their hard work, it was personal. And when someone posted on social media that I was having a "huge party" because of that video and that I "don't think the rules apply" to me, it felt personal.

    Every day I try to educate people on the best science and new information we are learning about coronavirus. I am working each day outside of my normal family medicine practice to keep my family, my neighbors' families and our county's families safe and healthy. I know my community, and all of our communities, will get through this if people rely on science and if we work together. Family physicians and public health officers will likely continue facing the challenge of caring for people who will make things personal until the pandemic affects them directly.

    Even after COVID-19, we will continue to provide personalized care to individuals and the communities where we live because we are family doctors, and we take our roles personally.

    Jennifer Bacani McKenney, M.D., owns a private family medicine practice in her hometown of Fredonia, Kan. She is the Wilson County health officer, a member of the Fredonia U.S.D. 484 Board of Education and assistant dean for rural health at the University of Kansas School of Medicine. You can follow her on Twitter @jenbacmck.


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