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November 25, 2002

Host: Michael Grant
Topics:
Major threats to public health in Arizona;
a report on a special clinic for disabled children
In-Studio Guests:
Dr. Robert England, state epidemiologist, Arizona Department of Health Services;

>> Michael: Tonight on "Horizon," fears about biological warfare continue to prey on the public's mind. Tonight, hear how we're at much greater risk from some very common pathogens.

>>> Michael Grant: We'll find out where our greatest public health dangers lie.

>>> Michael Grant: And we'll visit a very special clinic for disabled children. Some families drive a full day to visit this place. Find out why.

>>> Good evening, I'm Michael Grant. Before we get to those stories, the senate has just approved legislation tonight to reduce the State's projected budget shortfall by about $220 million. A special session began this morning at the State's capitol. Late this afternoon leaders broke a logjam that threatened passage of the budget reduction package. Formal votes to cut spending, raid special funds and spend new tobacco tax revenue are expected tonight. A companion bill to make additional changes may fall by the wayside. The House and Senate disagreed on whether to include money on that for court-ordered kidney dialysis for immigrants.

>>> Michael Grant: In terms of public health, we're fortunate to live in one of the healthiest countries in the world, but we are still at risk from a number of diseases. Some of which may come as a surprise. We visit a community health center at the edge of the valley for this story.

>> Bradley Meek: We see a large number of infants from migrant farm workers that they have no insurance. We see a lot of elderly people that have no health insurance. And we also see a lot of people who are between jobs.

>> Michael Sauceda: Patients at Clinica Adlante in Surprise come from all walks of life. From cradle to grave they are treated for a variety of illnesses. They have one thing in common, the need for affordable, accessible healthcare.

>> Linda Gorey: The wonderful thing about community health centers, they are just that. They are for the community. Basically, we try to give access to primary healthcare to people who have barriers to healthcare. Last year, we saw 21,000 individual patients. This year, it'll probably be closer to 24,000 individuals.

>>Michael Sauceda: At the clinic, doctors like Bradley Meeks serve patients in many ways. Among the most important, an effort to hold the line against infectious disease, but for a number of children, one of the most effective safeguards is being underutilized.

>> Bradley Meek: Immunizations are a huge role because most of the insurance companies don't pay doctors to give immunizations. Therefore most doctors in the city don't give immunizations, and they refer all of their patients to go to county health departments, et cetera, which not only adds a lot of additional travel for the parents, but a lot of times, they just don't have the travel or the ability to travel to get the children their immunizations. We're one of the few clinics in the city that give all of the immunizations. And we see a huge number of children.

>>Michael Sauceda: Regardless of challenges such as cost and access, healthcare providers stress the importance of this practice.

>> Bradley Meek: It's an issue that when you don't hear about it, you don't think about it. When you have an outbreak of whooping cough, would be a good example, which there was a rather large one several years ago, you've got to realize that half of the children that get it under age 2 are going to end up with permanent brain damage. And yet just a simple thing such as getting childhood immunizations you can prevent this.

>>Michael Sauceda: Children are not the only one for whom immunizations can prevent potentially serious health problems. Although thousands die each year in the United States from influenza and its complications, many adults continue to avoid the vaccine.

>> Bradley Meek: It's surprising to me in a way because, number one, it's so effective. Number two, it's so safe. Even a worst case scenario, you can only get sick for up to 12 hours from the flu vaccine. Yet the influenza, which is a severe respiratory illness, if you get it, you will be sick for six weeks in a row, at least six weeks. Half of those people are going to get other problems. They are going to get pneumonias, other complications. It's a major cause of people being admitted into the hospital today over age 60.

>>Michael Sauceda: For the patients at Clinica Adelante, the message is the same as anywhere else in the community. Prevention is the key to public health.

>> Bradley Meek: We take so much for granted in the United States that these illnesses are not dangerous any more. It's an issue taken for granted.

>> Michael Grant: Joining me to talk about these issues is Dr. Robert England, state epidemiologist with the Arizona Department of Health Services. Welcome back.

>> Dr. Robert England: Thank you, good to be back.

>> Michael: It's been a while. Let's start with the immunization issue. Are we immunizing fewer children statewide?

>> Dr. Robert England: Vaccine preventable diseases continue to be a big issue and getting children all of their vaccines by the age at which they are optimally needed before two years of age is an important target that we still fall short on. Right now, for example, we've got three outbreaks going for whooping cough, Pertussis going on in the state. Most of those childhood vaccines work because we get something called the herd effect going where you get enough people vaccinated to have enough immunity in the community that even if your vaccine didn't work, you are protected because you never get exposed to the disease. It can't bounce around. It can't find enough people to infect. And it's actually something that we need to do for each other to keep our immunization rates up so that we protect not just ourselves, but those around us as well.

>> Michael: Are the reasons primarily economic why we are not doing it? Or are we getting complacent about some of these diseases or what?

>> Dr. Robert England: I think it's a combination of a lot of factors. Complacent, certainly. It's been a few generations since many of these diseases were widespread in the level of concern that parents had about them was up there where it used to be. There are a variety of factors, including economic and the need to continue to support vaccines for children who are underinsured or uninsured.

>> Michael: Complications from the flu kill thousands every year, most people do not get a flu shot.

>> Dr. Robert England: Typical year, 20,000 to 40,000 Americans die of complications of the flu, flu and pneumonia-like illnesses, including hundreds in Arizona every year. It is an incredibly preventible tragedy to lose some of those folks, especially if you are over 65 or actually over 50 or have any of a whole range of chronic health problems that might put you at risk for complications of the flu. It's really important that you get your flu shot. That includes some things people don't think about. Women who are pregnant who are going to be in the last two-thirds of their pregnancy during the flu season could benefit, and they will soon be more strongly than ever recommending flu shots every year for small children.

>> Michael: Is it just my imagination? It does seem to me, though, that you do have a stronger flu vaccination outreach program than we used to have. I mean, I notice a lot of employers, for example, will bring, you know, a team to the office and say you can get a flu shot here. There is flu shot clinics and those kinds of things.

>> Dr. Robert England: We try. You know, we never make enough flu vaccine to cover the entire population in a single year. But they try, especially to target those most at need, and usually there is plenty left over for everybody else who wants one. For employers, it's a deal. It saves money in the long run because it prevents absenteeism during the flu season.

>> Michael: It should be a pretty good preventative message and vehicle for the healthcare provider for the employer.

>> Dr. Robert England: Sure, and it's still the best way to prevent the flu, a flu shot.

>> Michael: You attended the bioterrorism conference exercise in Tucson last week. What happened?

>> Dr. Robert England: Yeah. It began with a day of presenting some background information and a scenario to us to show how the national pharmaceutical stockpile might be accessed. The national pharmaceutical stockpile is the federal government's stockpile of a number of drugs that might be needed in a crisis situation, both for bioterrorism or a naturally occurring epidemic.

>> Michael: Smallpox comes to mind.

>> Dr. Robert England: Sure, anthrax. The exercise last week used an anthrax scenario both in Maricopa County and Pima County, and then tested our ability to take the pharmaceutical stockpile, get it delivered at a National Guard base, have us then divvy up that vaccine where it needed to go and then had a mock distribution -- or vaccine, I'm sorry, the medication, and then had a mass distribution of the medication, both in Maricopa and Pima county.

>> Michael: Are we ready?

>> Dr. Robert England: In the drill for passing out the medication, we actually did okay. We made a lot of mistakes. But they were the kind of mistakes that we can -- it was good that we went through it because we'll fix it the next time and do it even better. If you're saying are we ready for bioterrorism in general?

>> Michael: Right.

>> Dr. Robert England: You know, we're as ready as any state in the country, I think. But we could certainly use more time, a lot of this hinges on the detailed preparations that go on at the local level, as well as at the state level, making sure we know every step of the response we need to do and having enough people trained to be able to do that properly. So more time we can get the better we'll be.

>> Michael: Tremendous communication issues, too, communication issues to the public.

>> Dr. Robert England: Sure, look at the anthrax scares that we had, with a very, very low-level of real world threat. That was exposing for the most part a very predictable group of people who were exposed to the letters that were sent with actual anthrax spores in them, but an incredible amount of concern and energy and time spent dealing with the disruption of all of that. People talk about weapons of mass destruction. This was just a weapon of mass disruption, as we tried to mostly deal with educational issues, rather than real-world threats.

>> Michael: Water safety in Peoria, obviously that has captured a lot of attention, understandably so in the past few weeks. Is the water safe in Peoria?

>> Dr. Robert England: Yes, the water being used right now is absolutely -- I'm absolutely confident is safe. First of all, you have to understand, these were two tragic cases of an incredibly rare disease that has affected less than 200 people worldwide ever that we know about. A water system is being the source of that disease has only been implicated once before and that was fresh water coming right out of the river un-chlorinated.

>> Michael: This was in Australia.

>> Dr. Robert England: This was in Australia, I believe back first in the '70s. Chlorination of even that water, even river water took care of the issue there. The water that people are drinking in Peoria right now is being chlorinated and the key point is that there is just an awful lot that's not known. The county has been extremely cautious in its handling of this to this point, and has erred very much on the side of safety, much more so than maybe some other jurisdictions might have. But we're doing that even though there is not or the county is doing that even though there is not a lot of real information known about the organism. For example, might it be in water systems in other places? Who knows? Does that necessarily mean anything? No, it doesn't necessarily mean anything. There are a lot of different organisms in the environment all around us, and clearly these are the first two cases ever in the United States that have had their source in a water system, at least potentially in a water system.

>> Michael: Do we routinely test public drinking water for specific kinds of -- or do we test broadly?

>> Dr. Robert England: No, there are a lot of different potential disease-causing organisms, and it's just -- the best way to test the water to make sure none of those are in there are -- is to do a broad spectrum test looking for bacteria, looking for total coloforms and fecal coloforms, using that as a marker for the potential that, hey, something got in there, so we better clean up our act and make sure the water is safe. Most of the time when you find those bacteria, there is no harmful disease causing bacteria there, but it's a good marker for the fact that something is amiss. We need to either find the source of contamination and clean it up or chlorinate it to take care of it.

>> Michael: And the chlorine treatment will knock down almost all of this stuff? Is it the weapon of choice?

>> Dr. Robert England: At this point, it's the weapon of choice. We know, for example, even with this rare amoeba that it does respond well to chlorine, and in the one case in Australia, even though it was river water being used, exposed to the elements, presumably potentially teeming with this organism, when they chlorinated, the problem went away and the cases stopped.

>> Michael: Let's touch on a couple of other things, the west Nile virus has gotten a lot of attention. That thing is ultimately going to get to us; right?

>> Dr. Robert England: Yeah, yeah, I somehow managed to go back east just in time to be part of the hot zone for West Nile. Yeah, it is spreading across the country. It almost certainly will be here probably next mosquito season, next summer.

>> Michael: It is mosquito borne. Here, I'll talk while you grab your microphone and put that back. It is mosquito borne?

>> Dr. Robert England: It is a mosquito-borne virus that infects birds for the most part without harming the birds. Mosquitoes come along, feed on the birds, travel to other birds, build up the level of infection during the summer, and the problem arises when you get a species of mosquitoes that feeds on both birds and people and then might feed on an infected bird and then come around and feed on us and transmit the disease. It's a situation where again there will be a lot more concern once it hits here than it will be actual health threat for the most part.

>> Michael: Most people don't actually develop symptoms who have --

>> Dr. Robert England: The vast majority of people who are infected don't develop symptoms at all. Some develop minor symptoms and an unlucky few develop very serious life threatening and occasionally fatal disease. It's a real issue, but one in which we have a lot more control over than people might think when they think of mosquito-borne diseases. That sounds very random, but if you you do a good job, for example, of dumping standing water in your yard, the water that collects -- there are a whole variety of species of mosquitoes, many of which are implicated in transmitting this disease, which breed in those little, tiny bodies of rain water. If you dump that out during the summer, use common sense precautions like mosquito repellant if you are being eaten alive by mosquitoes outside. And if we do a good job of keeping an eye on the indicators of the disease as it's spreading so that we can knock down mosquito populations or breeding areas when they are beginning to develop, then we can keep it down to a level where it would only be an occasional rare case. Frankly, we can't do any batter than that.

>> Michael: Dr. Bob England, good to see you again. Appreciate the information.

>> Dr. Robert England: Thanks.

>> Michael: The pilgrims who go to St. Andrew's in Nogales, Arizona, have come to expect miracles. But these are medical miracles and they take place not in a church but a place that has come to be known as the clinic of love.

>>Pam White: Once a month, extraordinary things happen at a church on the U.S. side of the border in Nogales. There won't be any praying or sermons, still, many make a tremendous sacrifice to get here, hoping for salvation.

>> They come to you. You don't have to look for them. They come in from Guadalahara, from Oaxaca, Sinaloa, all over Mexico.

>>Pam White: Inside the parish already busy helping those who have come, lots of volunteers. They cook, clean, do clerical work and drive families back and forth to the border. They are also medical specialists. People like Francisco Valencia, Jill Feldhousen and Tracy Oberg. Their time and hearts are devoted to treating disabled children from Mexico's needest families. [ Speaking Spanish ]

>>Coco Romero: This family came from -- their drive was about 10 hours to get here, and they've been pretty faithful in coming up every six months. Their child has cerebral palsy which is a disease that limits the use of his muscles.

>>Pam White: Many people come because they've heard about the miracles that can happen here. [ speaking Spanish ]

>> Joanna Mota first came here when she was 3 years old. A horrible birth defect was preventing her from having any chance of normal life. [ speaking Spanish ]

>>Pam White: Now after several years and many surgeries, she's one of the clinic's greatest successes.

>>Reverend K.E. Gustafson: Probably around the neighborhood of 400 surgeries to help people walk. You've seen some of those around here today. You've seen some miracles around here. And you're in the process of seeing more happening today. And they just go on and on and on.

>>Pam White: Father Ed is head of St. Andrew's crippled children's clinic, also known as the clinic of love.

>>Rev. K.E. Gustafson: When the clinic became bigger than the church, and I made a decision with the consent of the board of directors of the clinic to go full time with the clinic and gave up the church. Now there's another wonderful, wonderful priest here in charge of the church, and I just take care of the clinic.

>>Pam White: Standing in line from Nogales, Sonora. Maria Guadalupe Valenzuela is on a mission. A single mom with no money, recently, her 17-year-old son Armando lost a leg in a car accident, and with it, dreams for a future. [ speaking Spanish ]

>>Pam White: In a wing of the church, another child struggling for survival, and helping her, nutritionist Jill Feldhousen.

>> Jill Feldhousen: All of the cases that I see are children that can't grow, that can't gain weight and most significantly because of all of that, their immune systems are terribly depressed. So, they have no muscles to chew, to swallow, and they constantly get sick. A sore throat, a strep infection may wipe them out, and then they are further down the line.

>>Pam White: You won't find kids here with a cold or flu. Most of them are severely disabled and this is their only option if their families can't afford medical specialists.

>> Reverend K.E. Gustafson: They may end up going to a Shriner's hospital. We may operate on them here. They may be getting medicine from us. They may get a wheelchair, any number of things, hearing aids, all kinds of things that go on.

>> Reporter: Francisco Valencia began volunteering here when he was 15 years old as an interpreter. He was so inspired by the experience, he decided to become a doctor.

>> Francisco Valencia: It was just something that obviously hit me, touched me deep inside, and it just kept me coming back. You're able to take some children who have some orthopedic condition and in a sense, they are a liability for their community. They can't go to school. They can't run. They can't play, and because of that, it interferes with their life, and if you're able to do something to help improve on that, whether it's from a surgical standpoint or you brace 'em, and it's very rewarding to see the smiles on the children's faces and also on the parents' faces. A lot of times we're not able to cure the conditions, but at least we're able to improve the situation for the child and for the parents who have to take care of them on a daily basis.

>>Pam White: It's the first trip to the clinic for U of A medical student Tracy Oberg and an unforgettable lesson.

>> Tracey Oberg: Not only a service to the patient but a service to medical students to learn how to deal with a lot of these rare diseases, to just gain better rapport with our patients. It just helps us. We learn from them just as much as they learn from us, so it's a great thing.

>>Pam White: The clinic began almost three decades ago when a Tucson doctor started visiting a group of disabled children in Nogales, Sonora. Soon he brought more medical professionals with him to see more children. It grew quickly, and they moved from meeting in homes to the local orphanage.

>> Coco Romero: At that time, people would hide those kind of kids. They would be ashamed of them or something. I was not. At that time I had already two more. So wherever we went, we would take him.

>>Pam White: Coco Romero has a child with cerebral palsy and was one of the first parents to go to the clinic. Now she helps run it.

>> Coco Romero: Kids walk that didn't walk. They were crawling, and we have so many things.

>>Pam White: In 1976, the clinic moved to the U.S. because of licensing concerns about American doctors practicing in Mexico. St. Andrew's Episcopal Church opened its doors. Since then, more than 10,000 children have received medical care.

>> Rev. K.E. Gustafson: Once they were on this side of the line, then it began to grow. Pediatrics came along, neurology. Then they started bringing in other therapies, physical therapists, occupational therapists, nutritionists, speech therapists, audiologists.

>>Pam White: But the clinic could never exist without teamwork.

>> Fransico Valencia: People from all walks of life who have come together for this one purpose, and it always amazes me that that group of people can make something happen.

>>Pam White: Finally, Armando gets to see the doctor. During his visit, the good news they've been praying for. The Shriners Hospital in Sacramento will fit Armando with a prostheses, and he'll spend six weeks there learning how to use it. Medical costs as well as airfare and lodging for Armando and his mother will all be taken care of. [ speaking Spanish ]

>>Pam White: And so many are touched by these children's plight, they can't help but make coming here a ritual.

>> Coco Romero: Once you come once, you can't stop.

>> Coco Romero: You saw everything that happens here. You just can't let go.

>> Michael: If you'd like more information about the program, please visit Channel 8's Web site at www.kaet.asu.edu. Just click on "Horizon" and follow the links.

>>> Tomorrow we'll take a look at the problems and the controversies surrounding the issue of clean elections.

>>> Wednesday, an interview with U.S. Supreme Court justice Sandra Day O'Connor conducted by Arizona's Supreme Court Justice, Ruth McGreggor.

>>> Thursday, we are preempted for the holiday, but we'll be back on Friday with coverage of the Walter Cronkite award luncheon, and this year's honoree, Sportscaster Al Michaels. Thanks for joining us on this Monday evening. I'm Michael Grant. Have a great one. Good night.