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01/08/2003 - e e New Hanover County Health Department Revenue and Expenditure Summary November 2002 Cumulative: 41.66% Month 5 of 12 Revenues Type 01 Revenue Budgeted Amount Current Year Revenue Balance Earned Remaining Prior Year Revenue Balance Earned Remaining % Budgeted Amount % Federal & State $ 1,322,579 $ 339,566 $ 983,013 $1,~90,334 $ 251,555 $1,038,779 19.50% AC Fees $ 587,944 $ 230,447 $ 357,497 $ 533,044 $ 216,091 $ 316,953 40.54% Medicaid $ 1,035,388 $ 264,575 $ 770,811 $1,012,934 $ 265,805 $ 747,129 26.24% Medicaid Max $ $ $ $ 165,774 100.00% EH Fees $ 312,900 $ 98,044 $ 214,856 $ 312,900 $ 94,464 $ 218,438 30.19% H Health Fees $ 482,700 $ 138,710 $ 343,990 28.74%<$ $ 112,850 $ 69,117 $ 43,733 61.25% O~~:r.. W^ "^.... $ ~ ,670,64;4$ ~88,8~6.$ w 9~} ,838 . ~L.~% ~{ $1 :50~,;;.60 $ 551,486. $ w~55,074 36.61 % 1111I11II111IIIIIIIIIIIII1'llli1r.111 IIIJllllalllllfJlllll,illllll,lflll !lltlll.t,lta"'T~ Totals $ 5,412,153 $ 1 ,760,148 $ 3,652,005 32.52% k $4,766,622 $1,614,292 $ 3,154,330 33.85% Expenditures Current Year Prior Year Type 01 Budgeted Expended Balance % !11 Budgeted Expended Balance % EXDendlture Amount Amount Remalnlntl Amount Amount Remainlna ili~~ Salary & Fringe $ 9,184,413 $ 3,257,197 $ 5,927,216 35.46% ~ $ 9,007,754 $ 3,273,054 $5,734,700 36.34% Operating $ 1,917,481 $ 678,122 $ 1,239,359 35.37% I $ 1,634,590 $ 626,421 $1,008,169 36.32% j:i~ift~~!~*Mrimlmm $. ,.:~3.Z~"^,. $ 8,862 $ 174,884 4.82% ''$.: $ 126,307 $ 34,985 ,~.9~1.,~2~w' 27.70% JB~.MMiMtiiwm mnn~MllimW: fUrnn:m@Hmll~~~~@iW ~tl: Imffi~nU%Ngrt% imU@HHfll: w.lliM@ml~ft; Hm~hlfl Totals $ 11 285 840 $ 3 944 161 $ 7341459 34.95% !!'" $ 10758851 $ 3 934 460 $6 834 191 36.54% Summary Budgeted Actual % FY 01-02 FY 01-02 Expenditures: Salarie5 & Fringe $9,184,413 $3,257,197 Operating Expenses $1,917,481 $678,122 Capital Outlay $183,746 $8,862 Total Expendnure5 $11,285,640 $3,944,181 34.95% Revenue: $5,412,153 $1,760,148 32.52% Net County $$ $5,673,487 $2,184,033 37.00% Revenue and EXllenditure Summary Fiscal Year 03 As of November 30, 2002 9 e e e NEW HANOVER COUNTY HEALTH DEPARTMENT BOARD OF HEALTH (BOH) APPROVED GRANT APPLICATION STATUS FY 02-03 Date (BOHl : Grant:..' .::'.: ~':"..:::..'::: Recuestecl . Pendina Received Deil1ed' 1214/2002' No ac1lvl1y 10 report fo.~ December 2~ :.' ':':.".:.:'.:.:.. NC Health and Wellness Trust Fund-Taen bJJq Tobacco Use Prevention & Cessation Program 1 1/6/2002 ($100,000 per year lor 3 years) $100,000 $100,000 Safe Kids Buckle Up Program-North Carolina 10/212002 Safe Kids $5,000 $5,000 Developing Geographic Information Systems (GIS) Capacity In Local Health Department In Eastern North Carolina-Duke University Nicholas School 01 the Environment and Earth Sciences (NSEES) $18,000 $18,000 9W2002. -:7:.:..,. NO actlVltytorep()rtfo,'-SeptelTlber 2004L':::':; .'.:':' ..::, : :.",,: :': 772002 NO activity to reportlorAugusI201l20':,: ':. :..:..:'::'::':.::.:: .:: ...:,,":. 7 ~, INO.actlVlty to reportlofJiify .::i.':.. "". I:.:,..:'.: :::.:.:.: F:,: PROJECT STOP-Prenatal Health Education and Information/Referral Services- March of ~ Dimes Community Grant Program (Tho..MId as on intenllo apply tor $49,975- the actual application tor this grant went 6/5/2002 through In October 2002- the amount changed to $50,000) $50,000 $50,000 5/1/2002::,:.....:' .:.... 1'l.0ac1lvltytoreport for..M~. .,,: ,:",:"':",,'" ,. ..~ 4/312.:" 1'l0actlv ty 10 report for AIlr::"", ...~.,.' "". ,..:, ,...., NO ac1IV..ty.toreportlo'-M.rC!l2 :.: ,':....:: ;2',. ','" -:7'~ No..ac1IV tyto reportforJ'ebruary ;2::.'....... I:",''',. ,." : ... ;cc..'cc= o actl~ ty,,~()Jeport f06J8"UII,ry ,". ",~.,.,..., "."'.:'..:" ~ ".....:.: Diabetes Education, Management and 12/5/2001 Prevention - CFMF $60,000 $30,000 $30,000 Youth Tobacco Prevention Project- Robert 111712001 Woods Johnson Youth Center $11,800 $11,800 Teens Against Tobacco Use (TATU)-Health Action Council of NC $350 $350 Healthv Carollnlans- NC DHHS $10,000 $10,000 Family Assessment Coordinatlon- March 9/5/2oo1 01 Dimes $16,500 $16,500 Folic Acid Proiect- March 01 Dimes $16,618 $3,000 $13,318 Safe Kids Coalition- State Farm"Good Neiahbor' $500 $500 TB Elimination and Prevention - CDC, 8/1/2001 NCDHHD, DPH, T8 Control Proaram $10,000 $9,200 $800 Teen Aids PreventlonlTAP)- CFMF $45,500 $25,000 $20,500 Diabetes Today - Diabetes Prevention & Control 7/1112001 Unn, NCDHHS $10,000 $10,000 Lose Weight Wilmington - Cape Fear Memorial FOU& $75,000 $75,000 ~ .lotalS '$429,268' $150;000" .'$'122;850.'" $156;11l1:::i 7 , 34.94% 28,62% 36.37% Pending Grants 2 13% Funded Total Request 7 47% Partially Funded 4 27% Denied Total Request 2 13% Number of Grants Applied For 15 100% 10 As 0112/11/2002 . NOTE: Notification received since last report. ., " , . e e HEAL TH NEW HANOVER COUNTY BOARD OF CC'm~155IAUE:RS REQUEST FOR BOARD ACTION Meeting Date: 01/0&/03 O<g Department: Health Presenter: David Rice, Health Director Contact: David Rice, 343-6591 SUBJECT: Grant Application: North Carolina Department of Health and Human Services, Division of Public Health, Office of Public Health Preparedness and Response BRIEF SUMMARY: We are requesting approval to apply for a grant announced by the Office of Public Health Preparedness and Response (PHP&R) within the Epidemiology Section, North Carolina Division of Public Health. announced the availability of State fiscal year 2003 funds to upgrade local public health departments' preparedness for and response to bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies. The funds will be used to upgrade public health preparedness and response. It is expected that the average award will range from $20,000-$100,000; however, applicants are encouraged to apply for more funds and to prioritize the areas to be funded. New Hanover County Health Department's proposal will clearly describe the public health need in New Hanover County; action(s) to address the need, time line for project completion, and identifiable benefrts to be achieved by addressing the need. It will include a detailed budget as part of the proposal. NHCHD's proposal will include equipment and supplies use to upgrade public health preparedness for and in response to bioterrorism, other outbreaks of infectious disease, and other public health threats and emergencies. No positions are included, no county match required, and no requirements to continue when grant ends. RECOMMENDED MOTION AND REQUESTED ACTIONS: Approve grant and budget amendment if granl awarded. FUNDING SOURCE: Will above action result in: 0 a) A New Posnion o b) Position Modification Or Change o c) No Change In Position(s) Explanation: None a, b, or c ATTACHMENTS: Yes, 1 page letter about grant. 11 . e e North Carolina Depanment of Health and H_ Services DhioioD or Public BeaIlb 1931 Mail Service Center - RaIeigb. North Carolina '1:1699-1931 Te1919-733-3816- Pill< 919-715-3807 MicblIe1 P. Easley, Govemor Caanen Hooker BueD, Se=wy A. Dennis McIlDde, MO., M.P.H., Acting Division Director, Assistant Secrewy for Health and SllIle Health Director November 8, 2002 ' James K.irkpaIric:k CoordinatlB' Office of Public Health Preparedness and Response 22S N. McDowell StRel Raleigh, NC 27603-1382 AttentiOll: Directors of Public Health The Division of Public Health bas made available through the Aid to CouDIies process $3,000 per county to support your public health emergency preparedness and response activities. This is the first inolAllment of $2,763,000 that will be made available to fund loca1 hea1th departmeD1 projects in support ofbioterrorism and other public hea1th emergency preparedness and response capabilities. The initial distribution may be used im"""'illtely for education and training ofpublic hea1th per&lIIlIICl and their planning and response partners. This is part of the SIlIte's initiative to assist counties to prepare for a possible bioterrorism event and to strengthen the public hea1th iDIiastruclUre. The immMi~te $3000 distribution will follow the established Aid to County process. Counties will expend or obligate these funds and then apply to the state budget office for reimbursement. . These funds may be spent on the following: tuition; registration fees; purcbase of education or training courses or material available through any medium; travel and per diem up to the North Carolina state approved rate; facilities renlal; renlal or leasing of audio- video eqnipment nee ~ ry to deliver trlIininp lB' courses; bn:aks aod meals provided as part of a training up to the North Carolina state approved rates for each and UDder North Carolina SIlIte guidelines for such expenditores; vehicle reDIal; purcbase of or production ofbooks, m''''"AI., guides, aod other publications - ry to achieve training goals and objectives; and mailing supplies and postage llCC""o'ry to distribute any or all of the above; payment for sate1lite trainings, andfor use of the Public Health Teclmica11nformation NetwoJt or associated sites. There is no requirement for deJiverables in advance of disbursement or receipt of these funds. I have attached a copy of a standard ..!dPntbnn that you can use to request reimbursement of your $3000. The re"",ining $2,463,000 will be made available through the Aid to Counties process but will require submission of proposals on how the funds will be spent prior to the SIlIte approving use of tbose funds. The atI8Ched Request for Proposals will serve to guide your grant-writing efforts. In addition, the Public Health Regiooal Surveillance Teams will assist you in developing your proposal. We intend to fund these proposals as quickly as they can be received and evaluated The funds must be obligated by June 30, 2003. If you have any questions concerning this distribution please contact me at my office at 919 7l~734 or by email at Jim.Kirkoattick@ncllllill.net. Yours truly, James Kirlqlatrick JiiJ E~Jnm.E~~.~ Locolioa: 1J1O St MMJ'I S_ - ~ N.C 2760; ~ Ao ~ ~ I AJfi-sIi'" AcIion Emp 12 . I ' ,- C GI ~- "'= Q,o GlQ, ce .cD.. =- "'c _CD!! ..,%:C) b. 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Gl O:l:W ~B.2liSg~e ~~ G 8 I!! <3 ~ ~ tUW ~c:i"::!:Ql~ 'CgG> ~ o.Gl lA _z Jl! ,g~1- ~c G> 0. -....I l' 15 a: III 'Co. g- e ~l~ 2' ~>~8....1 19~ ~ Sl _0. t! l!! 1/)0. ~'2E C :is ..,.., 0 ~i g w ! ~ 0. C . . . ~",8z . . co x... (/) i N C") ~ It) ~ ..... GO 0 ... ii! 0. 13 e e e NEW HANOVER COUNTY BOARD OF COMMISSIONERS Ted Davis, Jr., Chairman (Jane). . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . .. . 313-0755 Home 7111 Creeks Edge Drive E 28409 e-mail: tdaviS@nhcgov.com 763-6249 Office 762-5175 FAX Robert G. Greer, Vice-Chairman (Lou) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 763-5961 Home 1218 Country Club Road 28400 e-mail: bgreer@nhcgov.com 619-7879 Mobile 763-5961 FAX Julia Boseman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 686 4442 Home 6605 Providence Road 28411 e-mail: jboseman@nhcgov.com 251-6975 Office 251-6976 FAX WIlliam A. Caster, (Diane) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452-1282 Home 310 Brookshire Lane 28409 e-mail: bcaster@nhcgov.com 452-2875 FAX Nancy Pritchett. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 791-2827 Home 637 Robert E. Lee Drive 28412 e-mail: npritchett@nhcgov.com 798-1706 FAX NEW HANOVER COUNTY BOARD OF HEALTH W. Edwin Link, Jr., RPh, Chairman (laurie). . . . . . . . . . . . . . . . . . . . . . . . . 343-1244 Home 306 Colonial Drive 28400 e-mail: Iinkrx@aol.com 763-0845 Office 762-6916 FAX Melody C. Speck, DVM, Vice-Chairman (Matt) . . . . . . . . . . . . . . . . . . . . .. 798-1436 Home 4605 Wrightsville Avenue 28400 799-5587 Office 799-8545 FAX Donald P. Blake (Cathey)....................................... .791-5230 Home 120 Windemere Road 28405 e-mail:donblake@aol.com 784-9191 Work Henry V. (Hank) Estep, RHU (Lisa) ................................ 792-9584Home 3213 Snowberry Court 28409 I? ~ e-mail: hankestep@isaac.net 232-8272 Office 11:Y( 792-0188 FAX Marvin E. Freeman, Sr. ~). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ..452-0504 Home 915 Roscoe Freeman Ave 28409 e-mail:freemanm@wrightcorp.com 655-2263 Work Ext.521 0 Robert G. Greer (Lou) . . . . . . . . . . . . . . . . . . . . . . . . . .. ...............763-5961 Home 1218 Country Club Road 28400 e-mail: bgreer@nhcgov.com 619-7879 Mobile Gela N. Hunter, RN, FNP (Jim)................................... 799-0723 Home 126 Quail Ridge Road 28409 e-mail: gelajim@hotmail.com 763-2072 Office 763-1586 FAX Sandra L. Miles, DDS. . . . . . .. .................................. 793-5622 Home 1 North 16th Street 28401 e-mail: iamsmileS@bizec.rr.com 815-0811 Office 815-0665 FAX Philip P. Smith, Sr., MD (Nancy).................................. 762-2230 Home 1810 Azalea Drive 28400 e-mail:ppsmithsr@aol.com John S. Tunstall, PE, (Dargan) ................................ . 686-6757 Home 902 Market Street 28401 e-mail: jstunstall@andrewandkuske.com 343-9653 Office 343-9604 FAX Edward Weaver, Jr., 00 (Sherry) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 762-6071 Home 1535 Magnolia Place 28400 e-mail:eweaver@ec.rr.com 791-6086 Work Janelle A. Rhyne, MD, Medical Consultant. . . . . . . .. ................ 686-2913 Home 1202 Medical Center Drive 28401 e-mail: janrhyne@hotmail.com 341-3245 Work David E. Rice, Health Director (Linda). . . . . .. ...................... 791-2092 Home 1008 East Primivera Court 28409 e-mail: drice@nhcgov.com 343-6591 Office 341-4146 FAX 612-1684 Cell 01/03/03 888-520-9299 Pager e 1:: III c3 - III I:: .~ .... III .!::! I:: III ~ oC;;- -Q 5i~ Ecci' .~ QI:: -S~ iiil ~ot:: !!! ~Q 1::-';;' :3 8 ... ~ Q I:: ~ :t ~ e :::: , <J) "'- ..- ~ Ol -c: E Ol " c: <J) OOOl o>~o c: Ol <J) ..c:-E rom~~ '" ~ Ol ~Ca. <J) c: Q) c 0 n:s E :J ~ m.Q 0 _-0 0 '" ~ :cctSU)(J :J 0 '(3 _0 ., el: - :::;Ol:J :C-Q) .<:: " 0:-0 J:lll '" 0> >~ "5 (J :.= C W 0: u.. E Ol 0: .ooC: eo z ::s.- ctI "0 0...!!1 E c: 0.. .~ ::J m I OJ: I I T Ol .2: ~ , (li"tm ~ai ~ ~OC) E Ol " ~ ~ -g <f. c: >- <J) c. '" en c: .r:. c:: 00> "-ait "2 a. c: co co co.=': 0 CI Q)~mt ~o ._ ::s ctl Q) ~.~ co'~ E C)c:(/)~ ",- ~ 0 EOO:::; -o(tl........- E g 'lijc. -0 J: :::; u.. Ol '" , ::s c: c: c 013 :5 g- el: " .J: E - CO'- ctI C ._ c: _ L.. (j LJ..(5C - Ol EOO ::0 0 Q)"O 0 ::: EI- ::S'- CJ)C 'Eu -0 a...~"O <0_ el: > :J I oal I I ~ 0 t3 Ol ~ 0 .;; ai Ol J: e ai c<J) C o Ol ai Ol..c: 0.>1 C E'" I- -2: c: m 00 '" Ol Ol 0: .~ 00 0 .g :c J: c: > 0.. el: c: w , ~ ~ ~..c: ~ E Ol- <J) ~<J) O>ai aiOl .- <J) co t'tS Q) U) 0.2 c: Ol o Ol <J) Q) C I Q) :J " m.Q 0 :~ 2: E'- J:~_>! E ~ <52: 0 'm -Ol ..c: " '" 2: 000 .oOl " ..., :.= C C Q) 000 jOO 00 .g.Q ~ C/) 0 Q,..!!l Q) .~ 0- J I I I I 0 . :' . ~ . . , . North Carolina Institute for Public Health New Hanover County Health Department Organizational Analysis - October 2002 Recommendation NCIPH Priority NHCBH Priority 1. Reduce the number of administrative levels between the health 1 director and the line staff. 2. Strengthen the central administrative staff of the 1 Health Director's Office. 3. Promote an internal and external image of the NHCHD as a single " organizational unit 4. Adopt a tean;~~nted manaaement e. 5. Improve strategic and management planning sYStems. 6. Provide for greater unity, flexibility, and coordination of nursing 2 3 and related personal health service nronrams. 7 Consolidate finance, budgeting, and billing 3 2 Systems. 8. Strengthen information systems management and resources. g. Centralize and strengthen health education, stall training, and communications capabilities. 10. Conduct a comprehensive review of personnel (human resources) policies and procedures and develop a written handbook of 4 4 them that is Interpreted and applied consistently throughout the oraanization. 11. Review current space allocation and use and explore aftematlves for improvement given existing funding and resources. . o- f .. e ~ 1 i .1 c:: ~~ 21 it-:' IS... A1:t -11 ~J I' ~1 sa 8 I c:: ! ~ .1l - ~~ ...- ... 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" ,6 8 z E :I: :Ii! 0. - i ~ Ii ~ ~ r-- t " Iii - ~ ~ .. .. .. - " '" Ii .. ~ i 1:: '6 " :E ~ ~ Iii ... ll. 8:~~ " g.~ ...~ 0 l ..- i!~ ,,- "OC!. '~ f!:!. oe . "'- ",- "'O!. '5_ " ;: I I I 0:::' " Z ~ i! "'~ :I: ~- 0. .. '" c .. " ,6 :I: " E 'E z E .l! :I: :Ii! :Ii! :Ii! :a " 0. 0. - '--- - ~ " ~ .802 .8:i I \ll h '" ~ "'<~ WI1.;:::" WI:::' iE i!~ 5, .c ~ '" " "ii "'- ...- ;i!o. 1- :1:" ,~ ! L- .. N n 1 E W NEW HANOVER COUNTY BOARD OF HEALTH 2029 South 17'" Street Wilmington, N.C. 28401-4946 Telephone (910) 343-6500. FAX (910) 341-4146 "-_._. W Edwin Unk, Jr., RPh, Chairman Melody C. Speck, DVM, VlClK:hairman Doneld P. Blake Henry V. Estep, RHU Marvin E. Freeman, Sr. Commissioner Robert G. Greer Gela N. Hunter, RN, FNP Sandra L Miles, DDS Philip P. Smith, Sr., MD John S. Tunstall, PE Edward Weaver, Jr., 00 Oavld E. Rice, MPH, MA Health Director Lynda F. Smith, MPA Asslslanl Health Director January 7,2002 President George W. Bush The White House Office of the President 1600 Pennsylvania Avenue NIN Washington, DC 20500 Dear President Bush: e The purpose of this letter is to advocate for liability protection for healthcare professionals administering the smallpox vaccine. With liability protection coverage, the New Hanover County Health Department stands ready to vaccinate healthcare workers who would respond to possible smallpox cases and to strengthen the public health infrastructure to immunize the public if it becomes necessary. As you are aware, the smallpox vaccination carries a risk of adverse reactions including Inadvertent inoculation of other body sites, generalized vaccinia, eczema vaccinatum, progressive vaccinia, postvaccinial encephalitis, and death. The vaccine can also impose a risk of spread for vaccine virus to others around those who have been vaccinated. The New Hanover County Board of Health is responsible for the frontline public health workers and Is concerned about liability. Liability protection for healthcare professionals administering the vaccine should be an essential component of any national immunization plan. Based our review of the Homeland Security Act, It is not clear if healthcare professionals and local health departments have Immunity. We are very interested In participating in the national plan, but wa must have liability protection. We appreciate your leadership on this issue by offering us protection from liability so that wa may move forward with you to finalize the national plan for smallpox immunization. Thank you for your time and consideration of liability protection for healthcare professionals. ~ W. Edwin Lln ,Jr., _ New Hanover Cou "Your Health - Our Pnonty>> , ,. I, ~, e - e Recreational Water Quality Program Shellfish Sanitation Section Division of Environmental Health NC Department of Environment and Natural Resources Mission "To monitor and evaluate the safety of recreational water quality and to notify the public when such waters are determined to be unsafe for primary contact' The Recreational Water Quality Program was initiated in 1997 to objectively look at water quality in coastal waters where people play and swim. Concerns over Pfisteria organisms found in coastal waters triggered heightened concem over human health for people in coastal North Carolina. Because there had been no monitoring specifically for assessment of these recreational waters for human health, the Shellfish Sanitation program was tasked with the responsibility to monitor these waters and to notify the pUblic of bacteriological hazards identified. Govemor Hunt authorized the creation of the program, funding the program with unspent State funds. Six additional employees were hired with two stationed at each of the regional offices, Nags Head, Morehead City, and Wrightsville Beach. The new employees collect water samples, conduct bacteriological analysis, and interpret the results. Protocol was developed to notify local officials when bacteriological water quality exceeded the standard for swimming. Waters are classified into high use and low use Swimming Waters. High use areas are sampled weekly from April through Labor Day. Low usage areas are sampled twice a month. During the off-season periods, all stations are sampled monthly to monitor water quality conditions. There are 220 sampling stations on the coast of North Carolina. New Hanover County has 16 sampling sites that are monitored; 8 sites that are classified as high usage and 8 sites classified as low usage. The program is now re-evaluating the sampling locations to determine if the stations are in appropriate locations and are properly classified. The Environmental Protection Agency (EPA) through federal legislation known as the Beaches Act has mandated recent changes to the Recreational Water Quality program. The major changes include the indicator organism used for samples, new standards for , 1 .) posting an advisory based on geometric means, and a single elevated sample which requires immediate posting of the site. e The waters are sampled for enterococci organisms. These bacteria are present in the intestinal tracts of animals and humans and are considered indicator organisms for pollution that would make the waters unsafe for swimming or primary contact. The standards currently used are as follows: Enterococci: Geometric mean of 35 colonies per 100 mi. (marine waters) Enterococci: Geometric mean of 33 colonies per 100 mi. (fresh waters) All are determined on the basis of 5 samples taken in a thirty (30) day period. In addition, the single sample maximum standard is as follows: 104 colonies per 100 ml. in High usage waters 276 colonies per 100 ml. in Medium usage waters 500 colonies per 100 ml. in Low usage waters When any of these standards are exceeded, an advisory is posted immediately, the site is resampled immediately, and the sign remains posted until the water quality is considered safe. e Below are the sampling locations and classifications for New Hanover County: County Sampling Location Location Use NEW HANOVER WILMINGTON BEACH ocean high NEW HANOVER HANBY BEACH ocean high NEW HANOVER KURE BEACH PIER ocean high NEW HANOVER CAROLINA BEACH BOARDWALK ocean high NEW HANOVER CAROLINA BEACH, NORTHERN EXTENSION ocean high NEW HANOVER CRYSTAL PIER ocean high NEW HANOVER JOHNNY MERCER PIER ocean high NEW HANOVER FIGURE EIGHT ISLAND, FIRST BEACH ACCESS ocean high NEW HANOVER CAPE FEAR RIVER, CENTER OF BASIN DAM sound low NEW HANOVER CAPE FEAR RIVER, BUOY #31 sound low NEW HANOVER CAPE FEAR RIVER, W END SNOWS CUT sound low NEW HANOVER MYRTLEGROVE SOUND, ICWW MKR #154 sound low NEW HANOVER MASONBORO SOUND, UNCW DOCK sound low NEW HANOVER GREENVILLE SOUND, BANKS CHANNEL sound low NEW HANOVER GREENVILLE SOUND, MONEY PT ICWW MKR#128 sound low NEW HANOVER MIDDLE SOUND, OFF JOHNSONS MARINA sound low e , , t" , , I- - e In addition, storm drains into recreational water areas create the potential for increased health risks. Although there is no heallh risk (while there may be safety risks which do cause concem) when the drain is not spilling water, testing of such drains after a storm event have shown very high levels of bacteriological contaminates. Because of the discharge of highly contaminated waters from drain pipes is storm-driven, it is more difficult to properly advise the pUblic of these risks. Current policy is to post an advisory sign when it is noted that storm water is discharging from a drain and for 24 hours following the end of the discharge. The Recreational Water Quality program is planning a series of public meetings in coastal counties during the spring of 2003. The general public as well as local officials, news media. and other stakeholders will be invited to leam more about the program and to provide feedback conceming the program. .1 I' NOTICE 1l\lS M'\T!;:!~ PROTECTED '.! lAW llITlE 11 ,. l e Chesley C. Herbert 25 The Impact of Leadership Upon the Community ,/ e Personal leadership may transform the behavior of an entire community. which. in turn. changes the role and identity of that individual. Such pbenomena can be studied by selecting a single town and delving into the patterns of interaction between groups and individuals. THE CASE OF WIlMINGTON, NOP.TH U.p.ouNA e In 1910. the sanitary conditions of New Hanover County and its county seat. the city of Wilmington, North Carolina. Were deplorable.' This seaport town with a population of nearly 25.000 had no organized plan for the disposal of garbage. Dead animals were hauled to the town limits and left to the buzzards. A pathetic number of human vultures made a living by scratcbing over the dump beaps in Wilmington and taking whatever tbey could find, whether a carton of decOmposed rood or a discarded mattress containing a typhoid hemorrhage. Sewage ran into the Northeast Cape Fear River, the source of the city's Water: the raw. un- treated product was delivered to the people of Wilmington for drinking purposes. Inside the city limits were 7;000 unsanitary surface toilets that made the top of tbe ground literally one huge cesspool. Many families kept cows and borses in the backyard; a number of houses were un- screened; Aies swarmed over the town. and tbe people of Wilmington sl,dfered an epidemic of typhoid fever each year. The notions of the people concerning disease and health were primi- tive. Sickness was regarded as the dispensation of an all-wise providence. 311 '~~MI.;';' . ~~I ~~ ~~ ~~ N 1.<.""'- 4J.t.-, 1tw Iiltl fh,qr. ~~ & fn\. ~ ~ . and in the face of an epidemic a man merely prayed that he and his family might be spared.' Many felt that a gold wedding ring rubbed on the eye would cure a sty and that earrings improved one's sight. There were, th.Q$e who believed tuberculosis to be hereditary. and the smell ofa hOfl;;-clllble was considered a cure for consumption. The attitude to,,:iid any form of public health service was one of scorn. and anyone who preached public health was regarded as "somewhat of a crank. a fanatic:. or an ordinary job hunter.'" As far back as 1875 Wilmington had provided for a City Superinten- dent of Health. The Superintendent and his Board of Health were active in submitting recommendations for ordinances to the Wilmington Board of Aldermen, but often the board refused to adopt such measures. In August. 1910. Superintendent Joseph Akerman stated to the Board of Aldermen that the death rate in the city was little. iran)'. worse than usual at that time of y~ar. with only about 60 cases of typhoid fever in Wil- mington in the last three months.~ Yet. just five years later an official ofthe United States Public Health Service declared New Hanover County to be leading the nation in school sanitation. The general death rate for Wilmington and the county had dropped from 29.43 per \000 In 1911 to 16.4 per 1000 in 1915. TypJ."i_ deaths per 100,000 population had been slashed from 100.98 dea~ns i" 1911 to 9.2 in 1915. The Wilmington community had developed an impres- sive "public health sense" in a remarkably short span of years.' The purpose ofthis paper is to show how a dedicated leader. Charles T. Nesbitt. through skillful use of communication. was able to transform the somber situation of 1910 into the enlightened. healthy one of 1915.. r 318 The Stronger from New York In October. 1906, Nesbitt came as a stranger from New York to Wilmington. Born in Maryland in 1870. Nesbitt graduated fTom Allegheny College in Meadville, Pennsylvania. before studying medicine at the Uni- versity of Maryland. After graduation in 1893 he had two years oftraining at Bellevue Hospital in New York City and then began his private practice in the oil fields of West Virginia. He served as an assistant surgeon during the Spanish American War. and after the War he practiced in Wheeling. West Virginia. until 1904. when he returned to New York for postgraduate study. He then went to London for furthet study. and returned to New York in 1906. shortly befote his visit to Wilmin~ton.. . For Ihl~ paper. lavish 115e, Wll' mad~ ur lhe Nt.blll I'njlen. which include sc",p\xio,\ts ..r no" 'raper c1ippinBs. NoshiU', ~rSlihal a~d "'!ici~1 "orre.pondc!'Ce. and a row ~amrh"" and aniclt. rolallnllll1 Ihe heallh 51luollollln Wllmlnglon. Ex<<pt ......re othol'1l"'sc 1101'- lho malo rial ror Ihis paper "alne from lhe! No.bill Papers. " , , " e e < .. e The Impact of Leadership Upon the Communlly 319 The purpose of Nesbitt's visit was to get a few months' rest in a warm climate. The area pleased him. and the local health conditions proved to be of great interest. As a result. the doctor decided "to stay here a few years in order to study physiologic and pathologic problems of this semi- tropic climate at close range." He began to make a close study of the local infections. Not until four years had passed. however. did Nesbitt find his calling. ' The turning point came at a meeting of the North Carolina State Medical Society held at nearby Wrightsville Beach in the early summer of 1910. There Nesbitt heard the presentation of a paper b)' Charles W. Stiles. the discoverer of hookworm disease in America. Stiles' analysis of the effects of soil pollution made a deep impression on Nesbitt and led him to make an exhaustive statistical investigation of the health situation in Wilmington. He examined the local death rates and prepared a compari- son of these to the rates of eight other cities throughout the United States. including New York. Chicago. Key West. and Raleigh. North Carolina. Wilmington stood second in the total death rate for all causes and second in the deaths from typhoid fever. In diarrheal diseases it ranked third. Early in July. Nesbitt presented his startling results to the local medi- cal society. He called on the other 26 physicians present at the meeting to cooperate in a movement to clean up Wilmington. Most of the doctors were indifferent or hostile. but a few agreed to help. Nesbitt Was amazed when at the close of the meeting ~e was called to account by George C. Thomas. President of the State noard of Health and a resident of WU- mington. for presuming to critici:te that fair city. The meeting broke up in some confusion. but it fixed Nesbitt more firmly in his purpose to remain in Wilmington. Nesbitt presented his statistics at a meeting ofthe city board of health on July 14.; The membe.-s of the board were alarmed. and they promptly sent a report "setting forth the bad sanitary conditions ofthe city" to the mayor. who caJled a special meeting of the Board of Aldermen for the next day. Disturbed by the report from the board of health. theatdermen at their July IS meeting made an appropriation ofS5.000 "for putting the city in a thorough sanitary condition."1 Such concern by the Board of Aldermen. howevet. quickly subsided. Nesbitt then decided that lhe first thing needed in a campaign. for improved health was to educate the people to the poor conditions and to possible remedies. Realizing the importance of developing a pub\.ic health sense among the educated people of the area. he said. . . . \\.e must first teach the thinking people what to'think abOut public health and sanitation. because the poor white will ask his doctor. his school teacher. his farm demonstrator. the merchant who c~rries him . . '. 320 e Chesley C. Helben i I ! I! , on crop mortgage, the blacksmith. the miller. and the itinerant preacher for advice; and the advice he receives must be or the right sort. Nesbitt understood that through patient and persistent use of educa- tional publicity, he would have to change the popular attitude from one of hostility or apathy to a desire for reform before Wilmington could hope to get substantial improvement in public health:. There is just one way to secure reform and only one. Whatever is necessary must be desired. When enough people desire a particular standard of living everyone gets it. The thing to set about is creating the desire in people for whatever is good for them. . . . The first thing to do is to make these people want something they haven't got and want it bad enough to work to get it. It makes little difference what it is they want. Anything from a pait of suspenders to a Ford will do to open the way to wanting other things and to be willing to work for other things. Everyone in every community can be made to want things. A certain percentage of these wilt Want them bad enough to _ work for them and the rest belong on the scrap heap. For these God _ provided hookworm, pellagra, malaria, tuberculosis. etc., to speed them on their way. He laid the situation before James H. Cowan, the editor of Wil- mington's EI'ening Dispatch, who agreed to help. The Dispatch started to print a series of articles that revealed the poor health conditioJ)s in Wil- mington and set forth possible remedial measures. Different diseases were Ceatured and statistics Were ptesented shOWing that. with the exception of Raleigh. nearly all the common diseases Were more prevalent In Wi!- mingtfln than aIlywhere ebe in the South. None ofthe articles Was signed. but practically all Were written by Nesbitt. Cowan supported Nesbitt with editorials that cited unsanitary conditions and challenged citizens not only to maintain sanilary situations ill their homes but also 10 demand .that city offieials correct the filthy conditions in Wilmington. Trying to rally the people to the cause of better health, Cowan wtote, "We must all move solidly together fot a beUer. a c1eanet, healthier Wilmington. which can soon be obtained, The lltesent situation demands it and life comes above bluster. money and all else. 11 may be yoUt wife or your child next." In addition. Cqwali placed short sayings throughout issues of the Dispatch advocating ptoller health measures. One said. "The man who owns and rents properly arid doesn't wanl 10 spehd a few dollars making it e sanitary while he Is enjoying the benefit of sewerage and a screened home loves mohey. but not hUlnallily,." . the articles ill the Di!patch received instant and widespread atten- I I .1 Ii II ;' . ~ . .~ . ... e e e The tmpod of leadership UpOn the Community 321 tion. At first the citiz.ens. like the dOcton at the medical society meeting. were indignant. Many welt-meaning people resented what they regarded as attacks on their city. As other newspapers in North Carotina began commenting on the articles conceming Wilmington's health situation. some short-sighted people of the city became alarmed.' Their chief fear was that. if it became widely known thal. typhoid was prevalent In wu- mington. tourists WQuld stop coming to .Wrightsville Beach. just eight miles away. The Dispa'ch responded by asserting that the fact or WU. mington's awareness of the unhealthy situation and Its efforts to correct it was the greatest advertisement the city could b8ve. At a meeting of the Board of Aldermen on July 20. 1910. two mem- bers implied that the health conditions as outlined In the Dispa,ch were false and referred to the neWspaper's articles as being "sensational" and "higb-colored." The Dispa,ch replied (speaking of the two), Well. all they have got to do is to scrap their gray maUer and look at the statistics. They are servants of the people and it's their business to investigate and not stand back and wait for something to come their way. But. of course. the city might arrange to have a few hundred folks die for their special benefit.. CITIZEN REACTIONS Soon a number of Wilmington citiz.ens began to heed the articles ita the Dispatch. They found that if there were inaccuracies in the articles. they were on the side of understatement. powerful opposition, however, emanated from Wilmington's political ring. which actually prospered from the very conditions that had to be changed. ibe head of the rina. the polillcal boss of Wilmington. Was John J. Furlong. Although this genUe- !Dan presided over the Recorder's Court. he gained most of his income from the municipal contract he held for deaning the city's sevenl thousand surfac~ closets. In fact. his workmen did not alway' clean them. ~, yet his collectors nevet fotgdtto collect the twenty-live cents evelJ .~ : householder was required to pay for this service. The toilet deaning. . '. when done. was performed superficially. irregularly. and. in many see- .tions of Wilmington. hardly at alt. The main demand of the bealth move- . mentJlias for sanitary privl~ ot a city-owned sewet -system. and f~r the abot~~tol' the urtsanltary surface closets. Such a demand. of course. mc~~M!~>>l,,~~ltatS out oft~c boss' oW\t pocket. the boss who controlled , t . '..~hlnetY of Wilmington. 'lilt there had been increasing agitation In Wilmington for . ,jtbe commission plan for the city. in earty 1911 the 'North . ..IISt.turt granted Wilmington a neW charter. providini for live .~_n who were to be chosen by ~ards. The commissioned ,..O~- ".- " ~ I .. 322 Chesley c. He.A I ", . I ! were given plenary powers to manage the city's affairs and were made subject to recall. The legislature also I>assed the Health Law of 1911. which increased the duties of city supetintendents of bealth. living them the responsibility both of examining school buildings and school children. and of functioning as quarantine offlCet.' Wilmington's lirst set of commissioners was selected in the sprina of 1911. In two wards. Furlong succeeded. In controlling the vote and pultina his men on the commission: in two other wards. delinitely prolressive candidates were elected. The fifth commissioner, then. whose political leaningS were unknown. held tbe balance of power; The rlrSt test of the caliber of the new commission came at an early session when Nesbitt, without any soliciti!\& on his part and to his lreat surprise. was appointed City Superintendent of Healtb at an annual salary of $2.000.'8 The doctor appeared before the commission and stated that be would refuse the posi- tion unless he was glven~ entire control or the city's sanitation and the funds necessary for a complete program of sanitary Improvement. 'The commission promised what be requested. and he took office early in June. 1911. It I .I 0\ The New P.tO\me The new superintendent immediately set to work. Within a week of his election he submitted to the city board ofbealth a resolution regulatlna tbe keeping of cows and horses within the tesidential districts of Wil- mington. The resolution wlis promptly passed and sent to the city coun- cil.1I Another p~l>lem ,was poor municipal plumbina: many houses were completely undedaId witb sewage that had leaked from the terra cotta ground lines. There was a fairly good plumbing law among the city ordi- nances. and several thousand copies of It had. at one time. been printed for distribution. Yet, when Nesbitt took control of the Health Depart- ment. the only copy In existence was In the files oftbe city clerk's ofl"ac:e. The others had -been used to produce heat In tbe city hall. Nesbitt employed a vigotous young man to do the plumbing inspection. and then publiciz.ed and enforced the plumbing law. . Nesbitt kept his files and records open to the public. encouraging all who were interested to becolll~ familiar with tbe healtb department. The rcsponse was surprl!\lngly large. Visitors to the otJ'lCe found posted tbere 11 maps of tbe c:Ily-oJie fot each of the classified communicable diseases-witb the siteS ot active cases marked with colored tacks. In showing cit.IUIiS. the pnlltimity of any disease to their homes In .. a graphic manner. the doctor be!ped vital statistics take on a more peWIIaI meiminJ. In fact, be teduced everything to mapS. charts. and diagrams. Occ~lonally, in one of the shOw windows on Front Street he would ,\ . . .. .' . I e ne Impacl olleodeMlp Upoo the CommuniI'( 323 exhibit a chart showing the decrease in the death rate or the prevalence of some disease. The public began to acquire the habit of studying these illustrations of local health conditions and commenting on them. In the office of the health department the superintendent early met Mr. Eben Piner. who had been chief sanitary inspector and general fac- totum for Nesbitt's predecessors. The doctor had been warned that he would have to get rid of Piner or there would be two superintendents of health. Nesbitt put Piner into a handsome uniform that gave his huge physique a new dignity. gave him the title of Chief of the Sanitary police. and quickly won Piner's devotion and loyalty. The superintendent or- ganized a uniformed corps of sanitary police. under piner.l! that was legally vested with authority to enforce sanitary regulations. conduct sanitary inspections. place "condemned" signs on appropriate edifices. and even to tear down condemned surface privies which were notable menaces to the public health. The superintendent utilized his sanitary police in a massive attack on typhoid. When he took office. the annual epidemic was well under way. The health department had to take some immediate step to conltolthe epidemic. not only to protect the peollle but also to justify its own exis- tence. Nesbitt immediatety wrote all the doctorS of the city. requesting their cooperation in the fight against typhoid. He considered the annual epidemic to be caused by the thousandS of ny-infested open surface privies. but a quick survey showed \00 much filth to be carted away at public expense. So. the doctor decided to disinfect the entire town to discourage the flies from prol>agatinl. He chose as his weapon pyroligne- ous acid. a byproduct o(turpenline manufacture. and with this. he began a general massacre of the flies. He organized a fighting torce of t6 men. armed them with sprinkling canS. and placed carts with barrels of the acid at alternate street intersec- tions. The men. under the superVision of Captain Eben Piner. saturated every place that could be a bteeding place for flies. The entire city was covered 'five times at intervals of ten days. The lirst application'began on June 8. just twO days after Nesbitt had assumed his office. The epidemic reached its height on June 23. four days after the second disinfection. and declined rapidly thereafter. Convinced of the connection between the open surface toilets and typhoid. Nesbitt began a war against them. He caught the attention of the public with this statement: "Anyone who had typhoid fever had taken sometbing in his mouth that had passed through someone else's bowels:' Many citizens were indignant. but the superintendent )lad succeeded in attracting attention to his work. On June 28 Nesbitt got the board of commissioners to adopt an ordinance making it illegal to maintain an unsanital1' privy after September I. 1911. Only the can toilets. which were 1: .1" ~ , f e - . 324 Chesley C. Herbert covered. sanitary, and ny-tight, were allowable; and these were to be cleaned and disinfected by contract with the city under the direction of the superintendent of health. The ordinance also levied an annual tax offour dollars, to be paid to the city for each sanitary privy maintained. This ordinance meant that the board of health could See that Furlong's com- pany was paid only for each privy actually cleaned. Thus, Furlong's rack- et was brought to a hall. Nesbitt also hll,litened the death of the unsani- tary surface privies by prosecuting blatant violators of the Sanitary Ooset Ordinance. With typical humor. the superintendent spoke of the removal of the filthy surface privy and of the general cleaning of the city: The situation as it stands is simply one in which there was once a bog hole. a surface privy, or a trash pile where there is now none of these things. The vacant places are not occupied by ornamental statuary, fountains. or flower beds. The truth is we must be satisfied with the bare ground which is not lovely, and must exercise constant vigilance to prevent the re-erection of the ancient monuments to individual liberty. -I t I e RENEWED PROTESTS A number of vocal citizens hated to lose their "individualliberly," and they formed a strong opposiUon to NesbiU. Many of these owned tenement property that had to be improved under the sanitary regulations. Formerly, these landlords could leave their tenements. which were mainly occupied by blacks. in filthy condition. visiting them only to col- lect the monthly rent oUIS to $25. Although the improvements required by the health department for each dwelling Were not particularly costly, for landlords who had extensive holdings the total cost could be quite large. Protests against Nesbitt's work were mainly in the form of mass meetings. but in July. 1911, he received an anonymous letter threatening his'life: the doctor's work, however, was not affected by the threat. In the late summer of 1911, the opponents of Nesbitt's work thronged to mass meetings in the courlhouse to protest the Sanitary Ooset Ordinance. There was even some demand for recall of the commissioners in office. who were generally supportive of the health work. On August 31.1911. 700 citizens packed i"to the courthouse to hear J. W. West refer to Nes- bitt as "the King of Wilmingtoll" and declare that it was the superinten- dent who Was running the city. not the men who were elected ~o have_ charge of It. Once. a groUp of the strongest opponents of the health work. actually had a pot of hot tar ai1~ feathers at the courthouse. and Nesbitt was invited to be present. Knowing exactly what would happen. he was ." t' e J e -- lhe Impact of leadership Upon the Communlly J25 ,. ,. .' eager to go and face these men: only the strongest persuasion by Nesbitt's friends convinced him not to go." The mass demonstrations apparently did not dishearten Nesbitt nor daunt his enthusiasm: in fact. he probably liked the mass meetings be- cause they drew public attention to his work. Furthermore. he seemed to enjoy being involved in such fights. One night in early September. 1911. Nesbill had a notable stroke of good fortune in his struggle against the opposition. Another of the gatherings had been scheduled. but when the crowd began to arrive at the courthouse. they found the doors locked and the building dark. The organizers of the meeting had neglected to inform the janitor of the event! Three more meetings Were called. but the crowds were small and the gatherings were marked by a lack of speeches against Nesbitt's work. Yet, the opposition to the doctor's efforts to replace the filthy surface privy with a sanitary fly-screened privy continued. Speaking of the superintendent and his assistants as the "Tili Can Gallg." a candidate for councilman in the spring election of 1913 promised that his platform- . . . will put the rollers ulider the "Tin Can" gang. and roll them to the swamp. never to be teSUrtected. They have dug their own grave and gotten in it, and it is our duty to cover them up and preach their funeral. singing Long be the Doxology and pray for them to repent and bid them a long fatewell. . Nesbitt prosecuted a numbet of cases under the Sanitary Closet Or- dinance. He had warrants issued in eVery case to the wealthier among the offenders in order to save the poor the expense of showing that the health department was in earnest about enforcing the law. The cases. however, were tried in Furlong's Recorder's Court, and the boss generally let oft' even the most nagrant offenders with the minimum penalty. In the sum- mer of 1912. upon application to the Governor by the Good Government League. Judge Frank Carter Was sent to preside at a term of the Superior Court in Wilmington; a nutnber of cases from the Recorder's Court were cited to Judge Carter, and the session turned into an indignation meeting against Furlong as his methods Wete publicly exposed. This court session proved the final blow that loosened Furlong's grip on Wilmington. One issue that demonsttated the differences between Nesbitt and marlY of the local medical people deVeloped in 1913. It had become obvi- ous to the superintendent that much of his health work would be rendered ineffective unless the test of NeW HanoVl!t County wete included. He therefore began to work for the amalgamation of the health departments of the city and county. The moVement Was endorsed by the Boat-d of County Cpmmissioners, the Wilmington Chambet of Commerce. and the ~ '. I . . . , 326 Chesley C. Herbert City Council. in February 1913. and the consolidation bill was drawn up to be presented to the North Carolina Legislature. It called for a superinten. dent of the con~o1idated boards of health, a position with extensive duties and a good salary .14 Realizing that Nesbill might be elected to this new position. a group of local doctors tried to prevent passage of the bill. For a while they managed to hold it up in the house. but it finally passed both houses and was ratified on March 3. The bill was to go into effect on May 7. when the County Board of Health was to select the superintendent of the consoli- dated boards of health. As the time of election approached, Nesbitt never shirked what he considered to be his duty as Superintendent of Health of Wilmington. no matter how much his actions might affect his chances of being elected on May 7. In late April he compelled the city hospital to stop dumpillg sewage in an open ditch behind the hospital and to desist from burying stillborn babies in the yard ofthe hospital without a death certificate or burying permit. III so doing. he incurred the wrath of some of the influential members ofthe hospital's Board of Managers. who proceeded to work against Nesbitt's election. Effeds upon the leadet e The massive opposition made "Nesbitt homesick for the big city he had enjoyed as a student. At the same time. his sense of humor enabled him to tolerate unpleasantness. During the heat of opposition he wrote: I certainly do get homesick for the tall buildings and hard pavements. Just at this moment nothing on earth could be more lovely to me than the scenery along the route of the subway from the Battery to Ninety-Third Street. No nectar provided fOf the delectation of the immortal gods on Mount Olympus.'could possibly compare. in my estimation. with a half litre of Wurlzburgef in any little old dump on the island of Manhattan. Some driveling idiot once w8."(ed eloquent over the misfortune of being ten miles from a lemon. That individual " was within walking distance of what he wanted, and equality of his misfortune in my opinion pales int,o insignificance alongside the poi- gnant state of being seven hundred miles from a glass of beer and a Frankfurter. it certainly is hell. May 7, 1913, was a crucial day in the fight for public health in Wil. mington. Concetning the opposition and the approaching election. Nesbitt wrote to a friend, "They have used every possible means to defeat me this time and if they fail I think it will be the last battle." The meeting of tha five-member County Board of Health was held in the tourt room to av commodate the crowd of some 200 citizens who came to observe this . 'e e e The Impact 01 Leodershlp Upon the Community 327 important election. After asking Wilmington Mayor Parker Quince Moore to serve as temporary chairman. Martin S. Willard. Chairman of the Board. placed Nesbitt In nomination. The two doctors on the board then nominated a Dr. Ayer of the Philadelphia Health Department. The vote' turned out to be a tie-the two doctors for Ayer and the two voting lay members for Nesbitt. Hence. the responsibility of breaking the tie vote lay with the acting chairman. Mayor Moore. He stated that he was facing the hardest decision of his life. On one hand he faced two doctors to whom he owed the life of his little girl. who had been ill two years before. On the other hand he felt that a majority of the people of Wilmington wanted Nesbitt. As he cast his vote for Nesbitt. there was a burst of applause from the crowd. Nesbitt immediately began carrying out his duties as Superintendent of the Consolidated Boards of Health of Wilmington and New Hanover Counly. He selected. as health officers for the county. natives of the region who would have no difficulty in establishing friendly relationships with the people. men who chewed tobacco and spoke the vernacular of the region. Of the two men he used in the country among the farmers. Nesbitt said: Each was selected because of his powers to attract attention. One has a big wen on his Adam's apple. It Is very red and moves up and down wheil he talks. He Is very bow-legged. and rarely shaves. The other is a wild-eyed religious fanatic whom 1 have made believe that cleanli- ness is Godliness and that Hell Is a great big surface privy. He exhorts in seasons and out of seasons. The man with the wen is openly irreligious and is the most gifted and inoffimsive liar in this section. He is the best health officer 1 ever saw and is welcome wherever he goes. . Although some members of the city council were still determined to squelch the superintendent's ,work, Nesbitt's opposition never again equaled what it was prior to the May. 1913. election. At the end of his first summer as Superintendent of the Consolidated Boards of Health. Nesbitt spoke of his first three months in office: . . . a sort of Welsh tarebit nightmare. We have been fighting the City Council. the politicians. the Catholic priest. the State Board of Health. three or four prominent doctors who Were forrnerly"on the local health boards ahd who do riot like comparisons. stingy land- lords. nies. mosquitoes. an Impending epidemic of typhoid and sev- eral other species of verrnirt. So far we have licked them all except the mOSquitoes and I consider It a fair summer's work. 1 have been very much like the man who caught a grizzly bear by the tail. I have . " 328 Chesley C. Herben It had to hang on or get chewed up. Just now the grizzly shows unmis- takeable signs of fag. and 1 must confess that 1 am in a lather of sweat and my tongue is hanging oUt. I am looking forward to the time when I can let go and lie down for a nap. The grizzly bear. indeed. Was liring out. In the spring of 1914. Nes- bitt's health department began a campaign to paint polluted water pumps bright red as a warning of dangerous water, The superintendent was pleasantly surprised to find only six citizens objecting to this action by the health department. The last significant olJposition by the city council occurred on May 29, 1914. when by a vote ofthree to two it cut the health budget by almost SS.OOO.ln response, the citizens held a mass meeting in the courthouse on June I to protest this action by the city council. The Evening Dispatch described the gathering: The object of the meeting Was diametrical to that of a meeting held in the Court House on the night of August 31st, 1911, when several hundred cilizens, opposed to t~e health work in the community, gathered thete to protest against the enforcement of the sanitary __ closet law. which was olie of the first steps taken by the present administration. In the three years there has.been an almost complete change of sentiment as regards health work. Although the meeting last night was composed of a different class of citizens, on the whole. than the one three yeats alo. yet one may judge from this alone that the health work In New Hanover Is now receiving greater encouragement than ever before. Overwhelmed by popular opinion, the city council held a special meeting on June 4. at which it unanimously rescinded its action of May 29 and passed the health budget. granting the full amount requested by the board of health. '. ConclusioN Unquestionably. the victory for public health in Wilmington cannot be attributed e~c1usively to anyone cause. Rather. it was the product ofa number offorceS working together. The cooperation and interest of James H. Cowan of The Evening Dispatch were vital to the suc~ess of the movement. The change to a commission form of municipal government in_ 1911 was innuential ili that it led to a more progressive city leadership and. a more workaNe sltucture of city government. The fact that Wilmington:s health conditions were so much worse than many other cities' made the . . . .. e e - . The Impoe;t olleodenhlp Upon the Community 32q situation far more striking to the people once the facts were made known. Furthermore. a growing national interest in health reform and the public health movement surely contributed to the victory. Yet, after all other factors have been taken into consideration, in large measure it was the leadetship of Charles T. Nesbitt that mobilized the other factors and gave direction and force to the health movement in Wilmington. His communication skills enabled him to reach the people. to educate them. and to lead them to desire change. He persuaded Cowan to publicize the health conditions and used the embarrassing statistics to gather public attention. He opened the health department to the public and utilized graphs and charts to make health matters more personal and comprehensible. He used dramatic statements and controversy to sustain public intetest and employed health officers who were acceptable to the common man. thereby minimizing the threat of change. The fight for public health brought numeroUs improvements to Wil- mington and New Hanover County. Before the State Board of Health began inspecting restaurantS. Nesbitt was conducting food inspections in Wilmington. The red light district of the city was eliminated ihrough his efforts, His department established a baby welfare clinic and ran a baby- feeding slation in conjunction with it. He employed a school nurse to look afier the children in the primary grades. By the fall of 1915. every home in New Hanover County had a sanitary privy. And in the spring of 1916. Nesbitt triumphantly reported that typhoid was completely broken at last; not a single case had alJpeared in four months. By 1917 there was a well established public sewer, and premises were being connected to it at the rate of 50 a montb. Through Nesbitt's efforts a positive public interest-a "public health sense" -was developed among the people of Wilmington. Local doctors became sympathetic to the caUse. and six physicians volun- teered to gi,,'e an hour each school day for the inspection of tbe city's school children. Wilmington's excellent sanitary conditions and the efficiency of its health department were Widely used as advertisements to attract both vacationers and permanent residents to the city. Before Nesbitt began his fight. Harvard and Johns Hopkins Universities would send to Wilmington for slides of the blood or malaria patients for teaching purposes: as a result of the doctor's work. these requests had to go unfilled. The infant death rate per 100.000 population dropped from 1125.03 in 1911 to ~74.2 in 1915. In the same period typhoid deaths Were reduced by greater than 90 per- cent. Perhaps the most striking piece of evidence Is the decrease in total deaths. In 1911. at the begillnlnllofNesbiU'S superintendency. there were 781 deaths in a population of 25.748: in 1915 there were only 599 deaths in a population of 32.473. Upon seeing the results of Nesbitt's work. Melville C. Whipple. a / / . :l:lO Chesley C. Herbe" sanilary engineer in the Harvard School of Engineering. wrote him. ". . . I should sa)" thai if ever a man was vindicaled by the results of his labor you are that person." Charles T. Nesbitt was such a man. a lrue leader who. by skillful communication. was able 10 develop public desire for and adherence to modem public health standards. REFERENCES I. Nes"ill. C. T.: Th. Resulls of Our Public H.allh Work sine. 1911. In Our Communal H.a1th. December. 1915. Charles T. Nesbill Pap.rs. Duk. University L1'brary. Durham. North Caronna. 2. Hend.rS<ln. A.: North Carolina: Th. Old Nonh Sial. and th. N..... Chicago. Lewis. 1941. 3. Lotspeich. J. t.: Th. Developm.nt of Slate Control of Public Hcallh in :-Ionh Carolina. Unpublish.d Masl.r's thesis. Depanm.nt of History. Duk. University. 1928. p. Ill. 4. Records of tM Board of Alderman. Wilmington. North Carolina. ..\ugustl. 1910. ~. SliltS. C. W.: l.ads in Soulh in Sanitation. In Th. Gateway of Progress: Wilminlllon. Norlh Caronna. March 191~. In Nonh Carolina Pamphltls Coll.ction lMisc.llan.ous). _ Duk. UnhersilY library. . 6. North Carolina: Rebuildins an Ancient Commonw.alth. Vol. 4. N.... Yon. American Historical Society. 1928. 7. Minut.s. (Wilmington Board or Health] New Hanover County Board of H.alth. July t4.1910. 8. R.cords of the Board or AId.rmen. Wilmington. Nonh Carolina. Jul)' I~. t910. 9. N.sbill. C. T.: How Wilmington was made a healthy city. In McCulloch. J. E. (Ed): Th. South Mobilizing ror Social Service. Nashvill.. 1913 p. 11.4 10. Minut.s. City Council. Wilmington. North Carolina. June 9. 1911. tl. Minut.s. (Wilmington Board of H.alth] N.w Hanov.r Counly Board or Health. Jun. I!. t911. 12. Minutes. Cby Council. Wilmington. North Carolina. July II. 1911. 13. Statem.nls by Mrs. Paul R. J.nn.wein and Mrs. Mary Franc.s Kilburn. personal inl.rvi.w. WriShtsvill. Beach. Nonh Carolina. March 28. .I~. 14. Public-local Laws of th. Stat. of Nonh Carolina passed by The General Ass.mbly at its Session of 1913. Ral.ish. 19t3. " e , - d).l). CM.e.o ;200 ~ d)M<~GV:J - 02 ()o~ tf}~Fcu:J-f/f 1)0 c: JO~cv:J - / / tCL~~~ 5" -/rr1J c1<-<2& - 9r; :- tI~ - CLJ~-q ac/A.LU - J~ ~JLJ - 19 ()oTad (}tV2M kcf~ ~ -~~ dcp atv"1- ~~ i'#Kd /JoT ~i4<~ f;(e ~. &u&;/J1~ ~~ (~m~a.L{ ~~^1~~) . _ fJ.J: 13~ ~cR 4~ _ _ ~ IIw~ noT U/J!~ _ dcdt~ ~M CM~ _<>,h.p j(} jf\5 ,r \ ...... t1<-ja.... .. . . .. .......1'< ...... ~. ~ . ~.~ Published for Members of Local Boards of Health November 2002 President's Message Phil Lyons This year has really passed by in a hurry. It seems as if all of the personal goals that I set for NAlBOH have taken a back seat to some things that seemed to get in the way, such as my heart attack in early April. Since our convention in New Orleans, I've felt like I'm ready to get going again on NAlBOH business. Most of the success that NAlBOH has had this year can be attributed to people that have a sincere desire to make local boards and public health function effectively As President, this year has been very rewarding. The people that I have met as I have traveled on your behalf has been an inspiration to me. To see . the commitment that others have for public health makes me very proud to serve on a local board. In September, NAlBOH Executive Director, Marie Fallon and I attended the Association of State and Territorial Health Officials annual conference in Nashville, TN. We had the opportunity to interact with leaders from our partner organizations who are major players in public health. The more I visit and travel with those who share our same interests, the more I can see the need to be involved with those associations. In past NewsBriefs I have discussed some of the major projects NAlBOH has been instrumental in bringing forth. Many of NAlBOH's members have spent countless hours making projects like the Public Health Performance Standards a success. Perhaps nothing could be more important to the long term success of NAlBOH than the work that the Board of Directors has done in drafting a governance document for the board. With this document in place, NAlBOH should be able to Continued on Page 2 THE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS PROGRAM A Vision for Excellence in State and Local Public Health Submitted by Shepard Cohen, North Atlantic Regional Director The National Public Health Performance Standards Program (NPHPSP) was officially launched on June 20~ in Washington, DC and is now ready for implementation. This program is comprised of three instruments to be used to strengthen state public health systems, local public health systems and local public health governance. The state and local tools have been approved by the Office of Management and Budget (OMB). OMB approval is in process for the Governance tool and expected by year end. Resources are now available to support implementation of the NPHPSP This assessment tool is an activity covered under Focus Area A of the CDC Bioterrorism Grant Program. As you move toward implementation, the NPHPSP partners, including NAlBOH, will provide extensive support including training and technical assistance through our office and our website at <www.nalboh.org> Bringing excellence to local and state public health agencies is the ultimate purpose of the National Public Health Performance Standards Program. It is designed to help states and local communities understand, assess, and improve their public health infrastructure and programs. Through Continued on Page 3 I.;;l I ~I I" I NI I ' I ~ ..; o ~ ~ 0 "" " " " 0 o 0. ~ ~ Q. =. no-g 0,< o . gg's. -0.0. ~ '" ;:;;. o.a'5'. :;:'3 [ ~ ;. o' 000 ;a no o. g :: ? .... :T ~ ;:;;. oog ~cr' 9. ;;;: ~ . o - e; o. o 0 ;::z", . 0 . " 0. , ii- tTl 0 ~~~ . .. "''''0 e.~ 0_ o 0 -0: 0- .; 0:" . . 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'" .... 6'1'.1 o .. :>"0 00 IC3 -;:;'"0 o . :sr 3 .... -I oR 010 .... 0 I C'l~ :::J C'" ~g~:iOJ ~@'O-< g ......~o ~:,. .....0 "" 3""? w n \.ov3~ ':'0. 1'.1 0 :::J.., mO:;' ~g~8nr 61 ,..,. .., i:l. lD CD () 3 :;, '" n (3-1 CD - -, 93 n "', lD QI < - 0;' ro :3 ~ '" ~ ~ ' ., u ,.u I :NALBOH's 11th Annual Conference I I I , Boards of Health: Stewards of Local Public Health July 16-19, 2003 Wyndham Baltimore Inner Harbor Baltimore, Maryland For more information contact the NALBOH office by phone: (419) 353-7714, fax: (419) 352-6278 e-mail: <nalboh@nalboh,org>, or visit our website at <www.nalboh.org> For a virtual tour of the Wyndham Inner Harbor Hotel, visit <www.wyndham.com/hotels/BWIIH/main.wnt#> National Association of Local Boards of Health 1840 East Gypsy Lane Road Bowling Green, OH 43402 E-mail: <nalboh@nalboh,org> Website: <www.nalboh-.org> NON PROFIT ORG, U.s, Postage PAID Bowling Green, OH Permit No, 47 ~ \ "---- ' \ J ------- Lynda Smith 01/071200303:41 PM To: donblake@aol.com, iamsmiles@bizec.rr.com, jstunstall@andrewandkuske.com ee: David E Rice/NHC@NHC, Frances DeVaneINHC@NHC, Iinkrx@aol.com, steven.bower@coastalahec.org, (bee: archive, mediaarch) Subject: New Board of Hea~h Members Photos for Directory eB '. ~ - . ~..::-.....:: ~. For new Board of Health Members, I have scheduled you to have your photo taken at the Area Coastal Health Education Center (AHEC) (just behind the Health Department Building next to New Hanover Regional Medical Center) immediately following next month's February Board of Health Meeting. On Wednesday, February 5, 2003, Steve Bower will be expecting you between 9am and lOam (anticipating the BOH meeting will be over around 9:30am). We suggest you dress professionally, with your suit, dress, or jacket darker than your skin tone to enhance the colors in the photo. The photos will be taken in the studio area in the Distance Leaming Classroom in the basement, but Steve requests that you come by his office, or call him (phone # 343-0161-Ext 309) to meet you in the classroom when the BOH meeting is over We will prepare the photo and mount in on our directory in the Health Department's Administration Lobby. Steve's office is near the AHEC Audio Visual Library (phone # 343-0161-Ext 309) .. Directions: From the Health Department you may walk and leave your vehicle in our parking lot. Go out the side Health Department Auditorium entrance Go toward New Hanover Regional Medical Center Enter the first entrance (Cameron Building Entrance) Go up one floor to the main level Go past the hallway from Coastal Rehab to the Main Hospital Go past the administration area At the next hallway (the big Crosswalk), tum left, and Steve's office is the first door on the right. Lynda F Smith, Assistant Health Director New Hanover County Health Department 2029 South 17th Street Wilmington, NC 28401 Phone (910)343-6592 Fax (910)341-4146 Ismith@nhcgov.com htlp:/lwww.nhchd.org ODNOTJCE. E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized county official. . .-(