2. Civilization & Peptic Ulcer Indiana Pacesetters Also Known As: A Rooster, Three Hens & A Chick

3. Outline n What is a peptic ulcer? n What are the characteristic symptoms of an ulcer in the stomach or duodenum (peptic ulcer)? n What are the causes of ulcer in the stomach? n Are genetic factors involved in the cause of peptic ulcers (stomach ulcers)?

4. What is a Peptic Ulcer Definition Definition A peptic ulcer is a circumscribed erosion in or loss of the mucous membrane lining of the gastro-intestinal tract. Peptic ulcers are chronic but may have acute exacerbations. peptic ulcererosionmucous membranetract Pepticulcerschronicexacerbationspeptic ulcererosionmucous membranetract Pepticulcerschronicexacerbations

5. Please Remain Calm…. EMERGENCY EMERGENCY

6. n Health Officer of Brahma County Dr. Foghorn Leghorn

7. n Background n Determine Outbreak n Process n Communities Effected n Action Taken Results Brahma County

8. Key Players

9. Background n n From 1996 to 1999, Brahma County went from 25 th to 1 st nationally. n n Syphilis cases reported in Brahma County during 1999 represented a 160% increase over cases reported in 1998.

10. Local, state, and federal officials had to decide what actions to take

11. Determining The Outbreak n What were existing problems? n How can we rectify them? At the time, there was no official CDC criteria to eliminate syphilis.

12. Process n Funding n Testing n Reporting & Notification n Surveillance

13. Funding Redirected funds n n reduced dollars for syphilis screening, testing, and treatment n n lack of visits by Disease Intervention Specialists (DIS) n n delays in partner notification

14. Testing n n lack of early diagnosis and subsequent treatment

15. Reporting & Notification n Reporting in a timely fashion Created delays in partner notification, education, and risk reduction of syphilis cases by DIS

16. Surveillance n BCHD staff was not conducting effective surveillance n Surveillance reports from physicians were not being reported. n CDC comes into play

17. Communities Effected n African Americans made up a large percent 87% of Syphilis Cases Syphilis Cases in Brahma County, 1999 416 39 362 15 050100150200250300350 400450 Total White Black Hispanic Number of Cases Reported

18. Factors Contributing to Communities Effected n n Poverty n n Lack of access to quality health care n n Recreational drug use n n High-risk sexual behaviors n n Jails

19. Action Taken An assessment of the MSDH syphilis program by CDC in 1999 was satisfactory, but CDC indicated it could be improved. Among the items suggested by CDC were to:   Increase surveillance;   Provide access to testing and treatment;   Implement a jail program to diagnosis and treat syphilis cases, and;   Identify areas as high morbidity areas to obtain financial support for staff/programs to combat syphilis.

20. Action Taken Cont.... 3 Funding 3 Staffing 3 Testing,Reporting, and Notification 3 Community Involvement

21. Pluck Out Syphilis n The coalition was formed in late 1999 to address the epidemic of syphilis occurring in Brahma County n BCHD’s health officer was instrumental in bringing community groups together around the issue.

22. Pluck Out Syphilis Cont.…. n Community members and organizations were notified when the BCHD would be coming out to test, screen and educate residents about syphilis n Four committees:faith & outreach, communications, men having sex with men, and evaluation

23. Pluck Out Syphilis Cont.... Member organizations reached out to the community, identifying risks for contracting syphilis, and attempting to remediate the problems that were occurring in this community. Billboards, bus placard,brochures,posters,community forums and radio ads.

24. Results Contributory factors leading to a decline n n increases in funding as well as staffing n n better testing n n reporting and partner notification n n collaboration between the community organizations resulting in an increase in community awareness and knowledge.

25. Overall n n This case study points out that with or without the existence of a disaster plan for epidemics, stumbling blocks such as funding, testing, reporting, notification, and surveillance can hinder even the best plans and policies.