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Public Health: Paschal Nwako
42 Plays7 months ago
Dr. Paschal Nwako is the county health officer in Camden County, NJ. Listen to Paschal discuss health education initiatives, underfunding of public health programs and the role of public health departments during COVID-19.
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Transcript
Podcast Introduction and Guest Introduction
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare. I'm your host, John Neery.
00:00:21
Speaker
My guest today is Dr. Pascal Nwako. Dr. Nwako has served as the Camden County Health Officer since 2012. Under the direction of the Camden County Board of Commissioners, Dr. Nwako develops and administers a wide range of public health programs, including environmental health services, infectious disease control, and healthcare education. Dr. Pascal Nwako, welcome to the show. Thank you.
Role of Public Health Workers
00:00:46
Speaker
So I've heard you talk about this before, but can you talk about the behind the scenes efforts of public health workers that often go unnoticed? So public health workers, the boots on the ground. And people don't really find public health workers out there doing their work, except if there's a problem. That's when you see the focus on public health become obvious.
00:01:15
Speaker
The case in point is the pandemic. Nobody knew about public health until everybody wanted the vaccines that came from public health departments. Nobody knew about the fact that public health workers go to restaurants every day to inspect and make sure the foods we eat are very okay. But if somebody gets sick from eating food in a restaurant,
00:01:43
Speaker
we get called. So you don't really see the work of public health workers until there's a problem in the ecosystem. So
Health Education Initiatives
00:01:54
Speaker
public health workers, they are unsung heroes, people that really don't get recognized, they don't get acknowledged, except if there's a problem in the community.
00:02:05
Speaker
So public health workers cover a whole range of services in the community, but they are not noticed because everything is going smoothly. But when there's a problem, then that's when you start hearing about public health workers. Can you elaborate more on some of those services that your team works on in the Camden community? So our team is out there in the community every day, educating the community about health education.
00:02:34
Speaker
We go, we educate them about safe sex, use of condoms. We educate them about wearing sunscreen like now in the summer. We educate them about window guards so that people don't jump, kids don't jump off the window. We educate them about lead. There are some buildings still have lead paint and you don't want the kids to get contaminated with lead paint.
00:03:04
Speaker
We educate them about immunization, that their kids should have their vaccines to be in school.
Public Health Challenges and Issues
00:03:12
Speaker
We also educate them about so many things going from how to eat safe food, what to do in restaurants when they get to the restaurants to make sure that the restaurant is
00:03:29
Speaker
inspected and the restaurant passed the inspection. We also educate the public mostly in so many times about how to keep safe, how to lose weight, how to eat safe, how to exercise, how to go to the primary care provider and get the annual physical because health is wealth and we preach health.
00:03:58
Speaker
So when you think about Camden County as a whole, what kind of keeps you up at night? And like what are the three, say, three major health issues right now in Camden County? So currently we have issues with measles. Currently we also have issues with people not getting their vaccine, vaccine preventable diseases.
00:04:27
Speaker
And I'm concerned every day about the next pandemic because whether we like it or not, there will be another pandemic. It's just a matter of fact. We don't know when that will come. It might be a year, might be two years, it might be three years, but it's gonna come.
Importance of Primary Care
00:04:49
Speaker
So we are trying to make sure that we are ready for that next pandemic.
00:04:57
Speaker
Because we're in the summer, we have issues with bad air quality, indoor air quality. So we have the smokes and the fumes coming from metropolitan cities that's around us. And the air quality is not so good for vulnerable population, like the older people,
00:05:25
Speaker
the very young people with immunocompromised people that have medical condition, obesity, cardiovascular disease, people that do have diabetes, high blood pressure, cancer, all those things. So what we tell people and we preach every day is for people to make sure that they have
00:05:48
Speaker
a primary care provider that know their history, medical history, and be able to take care of them if there are issues that they will need to down the line with their health issues because they don't need to go to the hospital. The emergency room will be clogged if everybody goes there when they get sick. That's why you have urgent cares and you have your primary care provider.
Healthcare for Uninsured and Migrants
00:06:14
Speaker
So all these things get me
00:06:18
Speaker
awake in the night. There are a lot of people that don't have insurance. So if they get sick, they don't go to the hospital. They just go to the emergency room. And like it's during the pandemic, if everybody didn't follow our directions, wear your mask, wash your hands, stay six feet away from people,
00:06:44
Speaker
We would have had people falling off the street, dying on the street, and couldn't make it to the hospital. The hospital would be overwhelmed with people coming to the hospital. But because so many people followed public health directions, that's why we survived during the pandemic.
00:07:03
Speaker
You mentioned the uninsured as being an issue. Some of the folks who are uninsured are undocumented. So can it be a challenge to sort of deal with public health issues and what the folks who are undocumented within your community? So each community have their issues. Wherever you are in the world, there are public health issues that each community deal with.
00:07:28
Speaker
It could be clean water in some areas, and it could be toilet facilities that's not available in some areas, in rural areas. So here in Camden County, yes, we do have migrants that come, but they are also human beings, and we also want them to have the health care that we have. So if you don't take care of those migrants,
00:07:56
Speaker
If there are communicable diseases that go through the society and goes into that community, then it's difficult to stop that communicable diseases from spreading. So we try as much as possible to accommodate them in our public health clinic.
00:08:15
Speaker
and in other federally qualified health care centers. So we try as much as possible to open our doors to people, whether they have insurance, people come to our clinic with insurance and without insurance.
Community Health Strategies
00:08:31
Speaker
So we don't discriminate. So we open up our clinics. But if people do not have insurance, we don't build them. And those clients can come to us anytime.
00:08:46
Speaker
You mentioned earlier about education programs being a big part of what the public health department does. In terms of preventative care and education programs, what are the most effective strategies to really get people to do some of the hand-washing vaccines and so forth that we really need them to do? Yes. Health education is one of our strengths, being that public health is all about prevention.
00:09:14
Speaker
So we want to prevent the disease before it comes. The hospitals control the disease. We prevent it from coming in the first place. So our job is to make sure we educate the community.
00:09:30
Speaker
We promote health, prevent disease, and protect the health of communities that we serve. That's the three Ps in public health. So we go as much as go to schools, we go to the communities.
00:09:46
Speaker
We are booked this whole summer in all the events in the communities that they do, like fairs, community outreach, events, any parks that's having an event, we are there. We are trying to get the community to understand what we do in public health.
00:10:06
Speaker
What do we tell them when we get there? We give them flyers, we talk to them, connect them to where they can see a primary care provider or connect them to where they can get help depending on what they are looking for or what their health issue is at the time. So that is the job that we do because what people don't realize is that the community, especially those that do not have primary care providers,
00:10:36
Speaker
do not know how to get health services, health and wellness services. How do they know what to do when they are having headache?
00:10:49
Speaker
Now we have telehealth. We can connect them to telehealth or they can also come to our clinics. So we are out there in the community. Our main aim is to make sure that Camden County residents are healthy and they have a longer life to live.
Funding Public Health Programs
00:11:09
Speaker
We expect the life expectancy in Camden County to be above 80 years old.
00:11:16
Speaker
80 to 90, 80 to 100. So we want to be the best that we can to make people live longer in Camden County.
00:11:25
Speaker
I heard you give a presentation back in 2021 to the Rutgers School of Public Health about health inequities. And I think the number you mentioned was that you were at 20% funding of what you would really need to have a minimum level of services for a community. So that's definitely, it must be frustrating to feel like you're underfunded. Where do most of your funds come from right now?
00:11:52
Speaker
So currently most of our funding come from the state health department. And we do get some grants of one or two federal grants and the rest is from the county. So I would say our overhead 60% or 65% comes through the county and the other one comes through the state through grants.
00:12:20
Speaker
currently, but free pandemic used to be the county funds everything apart from like 20 or so percent from the state. So it goes down every year. Free pandemic, like you said, our funding was so not good because the county, we have to wrestle with
00:12:48
Speaker
the schools and other things the county provides. We have to wrestle with other county priorities. We have the public works, they fix the road, they clear the snow. We have to wrestle with the police department. We have to wrestle with other county departments. But what we do, Conscience Health, from the time you wake up in the morning to the time you go to sleep, you interact with public health.
00:13:17
Speaker
So, and that's very vital that people don't realize that.
Impact of Public Health on Daily Life
00:13:21
Speaker
So I also mentioned that the air you breathe, the water that you use in brushing your teeth in the morning and hopefully brush your teeth, stepping out of the bed, walking into the bathroom, taking shower, getting out of bed, going into your car and
00:13:46
Speaker
Driving, all those have public health notations, okay? So your seat belt, all right? You're driving to work, you want to get to work, and you want to get there safely. If you didn't sleep well, that might impact your driving from point A to point B because you don't want to get into an accident. So that's public health too.
00:14:10
Speaker
and you have to drink coffee. Is that coffee okay? Was it made with the right water? Was it made in a good restaurant? Where did you make your coffee? And the food that you eat impacts you. So these are the things that people don't realize because it's there and they take it for granted every day. But we in public all know that
00:14:34
Speaker
We are leaving and the hospitals are not overwhelmed because of what we do every day. We are the unsung heroes, the boots on the ground that people don't really realize. Part of the ecosystem that people do not know that exist except if there's an emergency.
00:14:53
Speaker
Yeah, you basically just outlined that public health touches almost every minute, every second of our lives. And as we said in the beginning, right, a lot of behind the scenes work, unsung heroes. When you think about the different levels, right, you have local health departments, county health departments, state health departments, and federal health authorities. What health issues do you feel like are handled best at the county level?
00:15:19
Speaker
all preventive medicine, preventive healthcare gets handled in local health departments. The county is also a local health department. In New Jersey, we have about 103 local health departments.
00:15:39
Speaker
The county, Camden County used to have 37 local health departments within the county, but they're consolidated into one, and they are all, the county is a local health department, two, all the municipalities. So if you go to excess county, they have so many local health departments for each municipalities, and then they have the excess county health department, and also excess regional health department.
00:16:07
Speaker
So those are all local health departments. That's the way we group it in New Jersey, even though it's a county, but it serves as the local for those municipalities that they serve. All right. So going back to the question you asked, it is very important that the county and the local health departments
00:16:33
Speaker
all make sure that what they do impact the citizens of the municipalities that they serve, okay? In New Jersey, we try as much as possible to work together as local health departments because diseases actually don't have jurisdictions. Like if you go one block away here, you see Gloucester County.
00:17:02
Speaker
We work together and that's what we should do as local health departments, working together and making sure that we get our priorities, which is saving the community, providing health, protecting the cities, protecting the health of citizens and doing health promotion. In New Jersey,
00:17:25
Speaker
It is, we are in a state whereby we have high density of population. And the only way that we can make sure that we get to all everybody is by people coming to our clinics in such a way that there are people that cannot afford even the co-pay to go to the primary care provider.
00:17:54
Speaker
We do preventive care and that's the best book for our money.
New Jersey's Public Health Services
00:17:58
Speaker
What is preventive care? We have immunization in our clinics. Most of the immunizations are free. We have sexually transmitted diseases clinic in all the local health department, most of them. So these are preventive care that we give to the community.
00:18:16
Speaker
We've had situations whereby people don't want to go to their primary care provider when they get sexually transmitted diseases, they come to local public health department because we treat them well and their situation doesn't get exposed to the community. We help the municipalities to get
00:18:43
Speaker
to vaccinate the animals, the dogs, the cats, that's part of public health, that's what we do. We go out there to inspect the restaurants, that's what we do in public health. We also get involved with emergency preparedness. Like if there's a flood, a big flood, a hurricane and things like that,
00:19:08
Speaker
We have planned to shelter the community in place where they can be until that climate or climatic conditions is over so people can go back to their homes. We have places where people can go during a very hot day like this so that they can cool down if they don't have electricity at their homes. So we have all this in place.
00:19:38
Speaker
so that people can, the community can live happily and live healthy. We go to houses to inspect their houses for maybe rats, mice, roaches, bed bugs, leaking, selling funds, no water, no hot water, no heat. We do housing inspections, garbage in the backyard,
00:20:07
Speaker
things like that. That's what we do in public health. These are preventing things that nobody else can do, okay, except public health. And that's why we need the funding to continue doing the things that we do in the community. We are very, right here in Camden County, we are blessed to have senior citizen services here, whereby the seniors come in to
00:20:37
Speaker
to enjoy themselves, to come together and play games. We have so many services for the seniors and we help them make sure that they are in good health and also see each other because loneliness is an issue and we're trying to tackle that as a public health issue. While we are there,
00:21:03
Speaker
We also deal with gun safety. We try to let parents know how to have, if they have firearms at home, how to secure those firearms. We also let parents know how to get help if they have mental health issues, emotional health issues. If they have substance use disorders, we help them
00:21:33
Speaker
refer them to places that we work with so that they can get the services that they need. So these are all the preventive services that we do. We render in New Jersey. And we don't render it in a vacuum.
COVID-19 Response and Coordination
00:21:47
Speaker
We work with all that local health departments around us to make sure that we make our citizens healthy.
00:21:58
Speaker
So what was your role? Can you just talk about some of your responsibilities during COVID as the Camden County Health Officer? Okay. So during the pandemic, as a public health officer, based on New Jersey Statutes 852, I was overseen the entire public health organization that was
00:22:26
Speaker
reaching out to the community, getting all the names of people that passed away from the medical examiner's office, looking at all the cases. Sometimes they get us a thousand cases. And remember, there we got a thousand and eight cases, new cases of COVID positive patients. We try to reach out to them
00:22:56
Speaker
the very day we get the information from the state. And we had to organize the team. Our team is the best. The public health team here we have in Camden County is the best. We opened the biggest Mound County Health Department vaccination site in south of New Jersey at the clinic in Blackwood.
00:23:26
Speaker
our hub in Blackwood. We were seeing patients, we are seeing people come through to get their vaccines. And people register online and they come and get their vaccine and they leave. They have to stay for 15 minutes just to check to see everything is fine after receiving the vaccines. And during that time also,
00:23:48
Speaker
We didn't close shop. Other things that we do here in public health, we are still going on. We are reaching out to the communities that
00:23:57
Speaker
didn't want to come out to get their vaccine because we know that there are so many issues with people don't want to receive vaccines, especially COVID vaccine. So we try as much as possible to reach out to those communities. As we are going, we were giving them hand sanitizers, we were giving them face masks, and we are also educating them on the right thing to do regarding six feet apart and also
00:24:26
Speaker
not congregating in a place where they will unfortunately pick up COVID. And so we try as much as possible during that time to reach out to the community. It was a difficult time for every public health officer because apart from doing all those things, you have to sit in meetings, remote meetings,
00:24:55
Speaker
most part of the day to one, know what's coming down from the state or from CDC regarding public health notifications. Things change. What you know in the morning could not be, could not
00:25:14
Speaker
a 180 what will happen in the evening. So we have morning sessions, afternoon meetings, and sometimes we are called
00:25:26
Speaker
in late in the evening to tell us something new that's different from what was told in the morning. So communication became the key at that time. And we were given a lot of information, a lot of communication we were receiving. So it was difficult for so many public health workers to observe a lot of information at the same time. We had a lot of burnout.
00:25:55
Speaker
People, some of our staff members had to take long vacations just to get themselves together. But I give it to the team because we all work together.
00:26:11
Speaker
working public health came from different departments to help us out, especially at the beginning of the pandemic, March 2020. We had to train them very fast for them to be contact tracers. So who are contract tracers? Those are the people that
00:26:28
Speaker
call the community like Jack had COVID and we got Jack's phone number. The person that talks to Jack the next hour or minute that we got that information asking questions, where were you last night? What happened? How long did you have getting symptoms? How long you have the symptoms be? What's your symptoms? So those are the contact tracers.
00:26:56
Speaker
Those people did a lot of work during the pandemic and it was something that they needed to do to stop them, the pandemic, to stop that person from infecting another person and to make sure that person is isolated or quarantined for a while before that person can now continue with their lives.
Reducing Health Inequities through Social Determinants
00:27:20
Speaker
So true or false on this, if you eliminate
00:27:25
Speaker
income inequality the best you can, your public health issues go away. They will not go away 100%. Public health inequities in general. Inequities will reduce. Let me say it will reduce. Yes. If you provide those public health inequities will reduce, but you still need to sustain it for it to be able to go away.
00:27:51
Speaker
Are there some communities that are in a tough spot where they're going to have persistent health inequities because if a person gets a job that gives them more money or they find opportunities elsewhere, they'll move out of that community and they will continue to have a community that has poor social determinants of health? Is that something that happens? Is kind of like a goal of yours to
00:28:17
Speaker
not only increase people's social determinants of health, but also to retain them in that community so that things will stay stay well there. So we have seen communities that go through revitalization around the country and around the world. And the goal of public health is to make sure everybody wherever they find themselves
00:28:48
Speaker
have a good health, wellness. We promote health, we prevent diseases and protect the health of the community. So if people get a better job, if somebody gets a better job and endow themselves and want to leave the community, we won't prevent the person. That's a good thing. That's American dream.
00:29:13
Speaker
But what we want to do is to rebuild the community that is not up to par with everything concerning public health. We want to make sure that the communities that they are leaving to go to somewhere else is taken care of. Because if not, you're going to create another cycle of another
00:29:39
Speaker
low-income person living in that community that will fall below the poverty level and go through the same health issues. So what we want to do is to sustain that community, to make sure that number one, students graduate from high school. When that graduation rate is up,
00:30:02
Speaker
Then they graduate from high school, they will be able to get a job. Even if they don't go to the university, they can also go to other trainings that they can get. They can be trained as plumbers, electricians.
00:30:20
Speaker
clerical workers and community health workers that we need in public health and other health areas. So with that training, they can be able to get a job and still live in that community. I've seen some people that don't wanna live their community. They wanna stay in that community, but to better, they want things and ways to better their community. So, and that's where public health comes in. Are there parks in that community?
00:30:50
Speaker
that people can walk around? Are there walkable parks, non-smoking parks? Are there places where they can go and buy fresh fruits and vegetables in the supermarket, not in the daily, where they can go buy foods that we don't preach in public health? Do they have ample amount of public health
00:31:16
Speaker
their primary care providers in that community? Or do they have to go five, 10 miles away to see their primary care provider? What do they have in terms of after school programs? And these are the things you have to have a holistic view of what's happening in the community for you to know what the problem is.
00:31:46
Speaker
Are we treating gun violence in communities that have a lot of violence? How do we treat that? We can't lock up everybody.
00:31:57
Speaker
Putting more cops on the street might be a good thing, but it has a negative effect if you don't take care of public health. Why do people go into violence? How is their mental health, how is their emotional health? You start with that. We're working with the police department because at the point you have to work with them, we all come together and say, how do we solve this problem? We can continue locking people up.
00:32:26
Speaker
And how do we have where does where do we start from the beginning from the grade school. And then we'll walk our way up to the high school and then when the graduate high school are there jobs for them to do so these are the things that we are looking to.
00:32:47
Speaker
And wherever there is a break in transmission between grade school to high school, then there's a problem. You have to fix it. If not, it will impact that community down the line. So that's why we are preaching very hard. And also, lead and water in some communities, and thank God it's not here in Camden County, there's a high
00:33:15
Speaker
a high level of lead in water. So children drink that water and you wonder why they're not doing so good in school. And then these kids will come out tomorrow not to have good paying jobs and they still live in that community. Of course, that community will not
00:33:35
Speaker
do well 20, 20 years down the line.
Advocacy for Prevention over Control
00:33:38
Speaker
So these are the things that public health, the part that public health plays in communities to make sure that people live very well. With that, it's time for a lightning round, a series of fast-paced questions that tell us more about you. Go ahead. So what's your go-to workday lunch? I eat a lot of apples.
00:34:01
Speaker
So I'm not a breakfast person. I come in the morning and straight to work. My last meal is always by nine, eight or nine at night. And the next meal is around one or two in the afternoon. And that's, I break my fast with apples. I eat like four or five apples a day. That's my lunch. And then I only eat dinner, one meal a day. What's a TV show you're watching right now?
00:34:30
Speaker
Hey, I don't really, for some time I haven't really watched a lot of TVs because I've been busy with so many things in life. But when I want to watch TV, I watch the news. So I really watch CNN, ABC, NBC, Fox, and
00:34:54
Speaker
Those news, I try to catch up with the daily news around Philadelphia. That's our news network. What's your favorite holiday? Christmas. What advice would you give your teenage self? Leave everything better than you found it. Everything you do in life, make sure that you leave it
00:35:23
Speaker
better that you found it. That's it. Make the best that you can as a person. And everything you touch in life, make it better that you found it. And lastly, if you only choose one, what is one change you'd like to see in health care? More funds. Funds in health care.
00:35:50
Speaker
It's very important you cannot deal with healthcare without talking about funds, grant funds. Control is not the answer, prevention is the answer. You prevent a lot of things and you pay less to prevent and you pay more to control.
00:36:13
Speaker
So you want to prevent things before it goes bad because when it goes bad, it's a lot of money. We're paying the United States is spending a lot of money in healthcare because the prevention is we do not pay a lot of attention to preventing that
00:36:37
Speaker
those issues that could have been prevented before it gets to the point of controlling it. So we pay a lot of money to sustain hospitals. Healthcare is off the roof, but how do you control those things? It's true prevention and the solution is public health. All right, Dr. Pascale Nalaco, thanks so much for joining the show. Thank you, thank you, thank you, thank you again, and thank you listeners. And I hope to be with you next time.
00:37:17
Speaker
Thanks for listening to The Wound Dresser. Until next time, I'm your host John Neery. Be well.