Inspired To Heal
Stories of clinicians, educators, innovators, and researchers who built or led programs of excellence in government health institutions. Each guest has excelled in clinical medicine, program building, or public health. They persevered and succeeded through a clear vision, collaboration, and a passion for the mission of government-run health systems. Their stories will inspire those seeking change in their own organizations.
Inspired To Heal
Chicken Livers in NYC & Guppies in Los Angeles
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Dr. Sharon Balter, physician and poet, reflects on her career leading outbreak responses at the CDC and the public health departments of New York City and Los Angeles. Drawing on her experiences at the Federal level and in the United States’ two largest local public health jurisdictions, she offers a rare insider perspective on the strengths and complexities of the U.S. federated public health system.
Amid unprecedented challenges facing the field, she also delivers an optimistic message about careers in public health, offering perspective, reassurance—a much-needed balm for a frustrated workforce.
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Inspired to Heal, Season 2, Public Health Stories. An image of the sole of a shoe with a hole in the bottom symbolizes the importance of CDC investigators going into the field to identify and stop outbreaks. It represents the founder's oft-repeated phrase, shoe leather epidemiology. Today's guest embraced shoe leather epidemiology throughout her career. I'm Bill Trick, your host for Inspired to Heal. Today I'm privileged to host Dr. Sharon Balter, Director of Communicable Disease Control at the Los Angeles County Department of Public Health and former epidemiologist with the New York City Department of Health. Sharon, welcome to Inspired to Heal. Thank you. I want to start with acknowledging your interest in poetry. So how does someone who wants to write poetry for a living become interested in public health?
SPEAKER_02They came from two different places. You know, I think I always had the intention to become a doctor. It was sort of instilled in me from childhood that I would become a doctor. But I always liked to read and write, and I studied literature in college. My family let me know, probably correctly, that poetry was probably not a great way to make a living. But I also grew up in a family where everybody had a vocation and an A vocation. I mean, my father built metal trains and my mother made quilts. And I didn't think of the two as independent from each other. There are a lot of doctor writers out there. There are a lot of writers that do other things. And so I just carried on with both, really.
SPEAKER_01I think now it's probably 90% public health work. Do you find time to write?
SPEAKER_02I do a little bit of writing. And I do believe I'll come back to it. In fact, I just I had a long-standing writing group in New York, and I just met up with them online, and we talked about this the problem that especially the uh parents of of kids have in finding time to both work and write. So one can still come back to it. It's a great a vocation, not not just for the writing part, but it it's very meditative, you know, I think, especially in today's era when so much is online and so much is visual that, you know, it it it's a way to take a break from all that.
SPEAKER_01I did want to ask if it served as a an escape or an antidote to some of the stress that you have that you will pick up the pen and paper. Maybe the keyboard and type, or yeah.
SPEAKER_02I write prose with a laptop, but I still write poetry by hand. And not just by hand, but I use a number two pencil. So it absolutely does that. I don't I don't know if that was the initial motivation, but I think as I've gotten older, I've been able to appreciate the way in which I feel calmer after I do it, whether it's been successful or not.
SPEAKER_01Aaron Powell Do you find that process of writing poetry and and trying to solve a problem in public health, are there any parallels?
SPEAKER_02Well, I think you need patience in both of them. Like this is probably true in a lot of things people do, but you know, especially an outbreak investigation, which is the part of public health I do, you're not gonna find the answer right away. You're going to investigate a lot of things that you're not going to solve. You're going to go down routes of inquiry that aren't going to work out. And this is true for writing too. I don't know very many writers for whom the poet just comes to them. Their writing is the process. You have to sit down and you write a bunch of things before you figure out where you're going. Sometimes you write some things that don't work out and you just have to get rid of. And I think that's true with outbreak investigation too. It requires patience and kind of curiosity and enjoying the process. The actual process of an outbreak investigation where you really, really look at all the pieces and details and think about things. And then there's a moment when you see what it is. I don't love to do puzzles, oddly, but people people who love to do puzzles, I think, describe this too. And and and that comes with writing too. There's like a moment when it kind of all clicks together.
SPEAKER_01You applied to and were accepted to the CDC's Epidemic Intelligence Service. And can you describe your two years at in that training program?
SPEAKER_02I had a fantastic experience. I worked in the respiratory diseases branch. My second year there, Ann Shook It was my supervisor. She's a wonderful supervisor, very patient, very thoughtful. And I learned a tremendous amount from her. But more importantly, I learned from my colleagues and then from the experiences I had. I was super lucky. I did a number of very interesting outbreaks. I had just I had just spent six weeks in the Dominican Republic doing a long-standing project when Anne came to me and said that there was this big outbreak of groups strep in Brazil. Actually, she we didn't know it was groupsy strep. She came to me and she said, there's a big outbreak of nephritis, which is an inflammation of the kidney, in this town in Brazil called Nova Serrana, where they made a lot of shoes and it was getting a tremendous amount of press in Brazil. And the Brazilian government really wanted help solving it because everybody they had sent to go solve it had gotten sick but had not been able to solve it. And it was hurting business. This is something that often happens in public health, that when things start to really impact the economy, that's when everyone takes notice. And the Brazilian government wanted to invite the CDC to come and assist, which is something that CDC sometimes does. And part of the excitement of being an EIS officer is that you will be asked to go on these outbreaks all over the world. There were a number of us in the office who all wanted to go, but due to various other commitments that the others had, I was, I got to go. I had literally just come back. And I remember Anne said to me, And do you speak the language? I said, No, I speak Spanish. And she said, it's okay, you can learn. I said, I don't, I don't know if I can learn this weekend. But actually, it turned out they're very close. You know, if it was a long flight, and if you're desperate, you can learn pretty quickly. I had to like drive to the embassy at the last minute to get our visas. They told me we could travel without a visa, but that did not seem like a good idea. I remember my car almost ran out of gas on the way down. Um and uh I had a fellow EIS officer who went with me, and we were gonna leave the next day. And then after I did, you know, ran around and did all of those things, I realized I didn't have any cash. And you could only take $400 in cash out of a cash machine at that time. And it was now after hours. There was nothing I could do. And I remember Anne went to the bank and she took $400 out of her account and $400 out of her husband's account and just handed it to me. And she was very, very generous, supervisor. And we went to Brazil, and it was super exciting. There was this little town, almost no one spoke English. There were 233 people who had erphitis or kidney infection. And it was our task to figure out why. And it was, I had a colleague, Andrea Bennin. We had two laptops and a bunch of swabs with us so that we could swab people and test them, some blood-drawing supplies. And we needed to get to work figuring out what was going on. And it we did really classic public health work. We worked with some kids from the local high school, I think, to do a case control study where they would call people up and ask them questions, you know, whether they'd had symptoms and what they ate. We we zeroed in pretty quickly on uh that idea just because it often is what somebody eats. We started swabbing people's throats and we sent it back to CDC and they were able to identify that it was group C strep. Zooepidemicus was the species. This is a kind of streptococcus that's most often seen in horses. It's actually not usually seen in humans, but it had previously been associated with unpasteurized milk products or queijo fresco in Portuguese. So we did have in our mind that it was likely to be a milk product. That said we ask about a lot of different things. And then we also did a household study where we went door to door and we attested seven families that had symptoms and seven families that didn't, and asked them extra questions and did a lot of extra tests. Some of the people in this outbreak were very, very, very sick. Like I remember we came across one girl who was having high blood pressure so terrible at the moment that we saw her that she she couldn't see. We got her right to the hospital. And we and three people did die in this outbreak. So it was a fairly serious outbreak. I would say that the thing that really, really helped us, though, even though we did all of these tools, as I said earlier, the case control studies, the phone surveys, the things that you traditionally associate with public health, we looked for outliers where you look for people who say don't live in the town, but were rumored to have the illness. So we we drove a great distance and we found a family where they had been given a gift of cheese from the town and subsequently gotten sick, although they hadn't been to the town. And this was a this was a really strong hint that that's what was going on. And then at aunt's suggestion, actually, we did something that has stayed with me for my whole career, which is we just got out and we went to grocery stores and looked around. And we got really lucky in one grocery store. Unpasteurized milk products were actually illegal to sell in Brazil at the time. And we were in the milk section of the grocery store. We were looking at all the yogurts and cheeses and things, which they were serving for breakfast in our hotel and my dad. And there were these cheeses in bags with handwritten labels in them. And the farmer who was selling them to the store happened to be there. And he lived in the next town over, Colombo de Gaia, I think was the name of it. And he invited us to his farm the next day. You know, we started asking him questions about his cheese, and he had was had a very successful unpasteurized cheese business. You can imagine something like this right here in the United States. And he was getting it into grocery stores and it was growing. And we took him up on his offer to go visit his farm. So the next day we went to the farm, where he very generously offered us cheese, which we declined. And we asked to swab the throats of the women there who were making the cheese. They really found it incredulous that this could possibly be the cause of the outbreak. So they generously let us do that. I felt a little bad about it. And you know, this often happens in public health where people are very helpful to you and you know that what you're doing, although it's going to save people's lives, because as I say, people died from this outbreak and a number of people ended up on dialysis. At the same time, it was also going to wreck his livelihood. Although we did not successfully get it from the cows, we did, we did culture it from the throats of the women who were making the cheese. And between that, the case control study, the outlier, I think all together made it clear that this outbreak was coming from this farm where this man had very, very successfully gotten his cheese everywhere. But probably because he was grazing horses and cows together, that's how the cows got it. It unfortunately got into the food supply and a number of people died or became very, very sick. I definitely felt a little bad for him, even though, as I say, in the long run, it was good for everyone else, and there were no more cases after that.
SPEAKER_00Yeah.
SPEAKER_01Hopefully he learned to be able to sell cheese with pasteurization techniques.
SPEAKER_02Yes, exactly. If you just boil the milk, things will be good.
SPEAKER_01So a number of a couple of things really stood out to me as kind of classic EIS stories. One is you came back from one trip, and I don't know, did you even unpack your suitcase and you were on a flight to another country?
SPEAKER_02Aaron Powell That is exactly what happened. And can I add that while I was there, I remember there was this groupie strep study that Ann wanted me to do in Connecticut, and she asked me how soon I could leave after I got back from Brazil. And I said jokingly, I feel like I should sublet my apartment. And she said, that's a great idea. The other thing is, like in those days, there was no internet connection. We had these two laptops. They one of them broke. The other one, we had those, you know, those discs. It wasn't flappy disk. We it was the hard disk, but the the thing that ejected the disc broke, so we were pulling it out with tweezers. We had to drive to the nearest city, which was Divinopolis, to send specimens back and forth. It was very, very EIS. I always described it as it was just a big enough outbreak that it was super exciting, but not so big that it was an international event, in which case as, you know, we really got to just do the outbreak ourselves. And as I say, the lessons of that outbreak where you, yes, you do all your case control studies and the things that you're supposed to do, but the go out, get out of the office, sort of visit, look around, see what you learn, talk to people, that has really stayed with me and been very valuable.
SPEAKER_01It does remind me of Jon Snow's outbreak and where there were people away from the pump that was implicated in the cholera outbreak. People from other neighborhoods had cholera. And he went to them and said, you know, how did this happen? How did you get cholera? And one of the households said, Well, we moved from that area, and the water is so much better at the Broad Street pump that I sent my kids to get water from that pump. You've spent time both in New York City's health department and in Los Angeles. You're kind of the bicostal epidemiologist. And I was hoping to hear a couple of outbreak stories from each of your stops and maybe how the places contrast.
SPEAKER_02Well, so one outbreak that that was a lot of fun and stands out was um we we were lucky enough in New York to get a grant from the Centers for Disease Control to fund a student team to help us with foodborne outbreaks. And it's fantastic on multiple levels. One, it gives health departments more resources, you know, people to help with outbreaks. Two, it educates public health students who get a different view of public health, it's not all academic, just to see the way data's collected, which isn't always quite as clean as it seems when you when you read all these studies. And then three, I think also it's great for people like me who've been doing public health for so long to have students around because they're always excited. Every foodborne outbreak is exciting to them, even though we're like, oh no, it's another salmonella and eggs outbreak. And they ask good questions and they just they have so much enthusiasm, you don't want to be jaded around them. Unfortunately, I think CDC no longer has the funding for those teams. So I think even in in New York, they don't have it anymore. But but for this golden period, we did, we had the team.
SPEAKER_01Pennies and dollars to fund these activities.
SPEAKER_02Yes, it's not even that much money because the students are paid very little. But anyway, the students also all sat in the same room. And although, you know, certainly living in Los Angeles, I see the advantage of working from home a lot. There is something lost, especially in public health, when we're not all in the same room. So the students would sit in the same room and they would interview people about what they ate. The other thing is, is this is not a taste that anybody can do for more than a year or two. I mean, I would listen to them, and even I would be losing my mind, you know, did you eat blue cheese, cottage cheese, feta cheese, cheddar cheese, you know? It's like pages and pages long in the interview. So there was an outbreak, and the students started to notice that a lot of the people, we ask people questions that really help us narrow down a food because many of us eat, you know, within our ethnic group, we eat specific food. So it can really help target things. And they noticed that a lot of the recipients who had this specific kind of salmonella, salmonella Heidelberg, and again, CDC was helping us sequence them all, uh, so we knew which kind of salmonella it was, that a lot of the people said that they either spoke Yiddish in the home or they kept a kosher diet. So this suggested that it was a highly orthodox community that was eating this, the product, whatever it was. I mean, we didn't know what it was at the time. And we decided, because we knew that sometimes salmonella can be in multiple food products, we didn't want to kind of contaminate what we were doing. We wanted a pretty tight case definition, which is something you create when you're investigating an outbreak. So we narrowed it down to those people. And the same students again went back and re-interviewed and re-interviewed. And one of them sort of realized that everybody said they were eating chicken. And the problem is that this was a community in which chicken is eating a lot. So they started asking specifically about what kind of chicken. And it turned out that a lot of them had eaten chicken livers. And that allowed us to narrow down what we were looking at and to figure out where they were getting their chicken livers and what kind of chicken liver they were eating. And it turned out that when we did the traceback on the food, and this was a case where we could do our own traceback. Usually we have to work with FDA to do the traceback because most, you know, New York City doesn't produce a lot of food. But as it turned out, these chicken livers were being produced in New York City. And the label on the chicken livers said partially cooked, additional thermal processing necessary. This had been an FDA-approved label. And the thing about a chicken liver, I don't know if you eat a lot of chicken liver, is if you cook it just a little bit, it looks like it's cooked. You know, and and people who like chicken livers, and this is not just in the Orthodox Jewish community, this is true in all communities. We had chicken liver outbreaks in every community in New York, is they like it a little bit rare. You know, most people do not like their poultry rare. You know, that rare chicken is not a thing, rare duck is not a thing, but rare chicken liver actually is a thing. And and the words additional thermal processing necessary were not very clear to most people, especially people whose native language was Yiddish. And it also just wasn't very clear. Like it felt to me like a very jargony way to label food, which is must cook before eating, it seems to me, is what it should have said. Um so we were able to do the whole traceback on that to go to the plant with the FDA than to just issue a very quick warning and bring that one to a stop. So it was very, very satisfying outbreak. It was great for the students, I have to say. And I will also say that I don't know if we could have solved it without those students because they had the time to do these long, long, long detailed interviews. And there were just a few of them. They were sitting in a room talking to each other, and they really helped us figure it out.
SPEAKER_01I imagine there are a lot of kids saying, I told you I shouldn't be eating chicken livers.
SPEAKER_02I used to like chicken liver as a kid. But we definitely had chicken chicken liver outbreaks in very, very high-end restaurants in New York because people like their chicken livers raw, which I can't recommend. I will say that at the time of that outbreak, I have this weird thing where whatever I investigate, I suddenly crave. So I had made chicken liver in a long time, but I made chopped liver for the office and brought it in because many people had never had it. And I remember one of the supervisors said it sounded disgusting. And so I actually made it brought into the office then.
SPEAKER_01You have to have a dinner party with uh I'll call it queso fresco because I don't speak Portuguese, but queso fresco and chopped chicken livers.
SPEAKER_02Actually, when I came back from Brazil, Ann gave a party and we did, I think we served pasteurized queso fresco.
SPEAKER_01So we'll transition to to Los Angeles. So you took the job as the director for the division of communicable diseases. And then are there any outbreaks that you can share with us in from Los Angeles?
SPEAKER_02This is an example of you have to sometimes investigate things that that aren't going to pan out. And this we were part of a multi-jurisdictional outbreak. And I think it's interesting just because of the way public health works in the United States. And I think what a lot of people don't realize is how little like real power CDC has. They have no jurisdiction locally. For CDC to come to do an investigation, they have to be invited. In the same way that the government of Brazil had to invite them. The government of California has to invite CDC to come. You know, when I was in at CDC, I got to do so many exciting field investigations. And sometime after that, I think shortly after 9-11, CDC started putting more and more officers into the field. So there were always some officers, but now there are a lot of officers in the field. So we in LA and we also in New York had our own officer. And there can be a little vying of, you know, a little competition over who gets to lead the outbreak. But if if there's a big outbreak in Los Angeles, then our officer is going to lead it. And this means that officers at CDC haven't gotten the same opportunity to go into the field as they did in our day. I have to take the big shoe off the uh certificate. Right. But uh but anyway, but but the supervisors at CDC genuinely want their officers to have the chance to go into the field, not to just do computer work. So there was a case, actually, it wasn't even an outbreak of melioidosis, which is bacterial infection usually associated with travelers. It's found almost entirely in Southeast Asia and Australia, although recently they have discovered in Mississippi there's some as well. But it was a woman in Massachusetts who hadn't been to any of those places, had melloidosis. And the Massachusetts Health Department had done an exhaustive investigation and concluded that she had probably gotten it from her tropical fish. They tested the tropical fish tank and they detected melloidosis. The United States is the largest importer of tropical fish and water plants in the world. And in the United States, the largest importers are all located right here in Southern California. And so CDC called and said, we want to send our officer out to test all these fish. And the thing about working in a local health department is it seems like a burden to have CDC come. And that's terrible to say because I had I worked at CDC myself. My colleagues are there. I love many people there. But there's all this paperwork involved. And, you know, we had an officer. We're talking about testing some guppies here. I'm like, you know, our officer can just go out and test the guppies. And they said, no, no, no, we really want our officer to go. So we did all the paperwork. And then this was in like November of 2019. And they said, okay, well, we're going to come at the beginning of the year. I'm like, okay, whatever. So lo and behold, you can see where this is going. The beginning of the year happens and COVID is coming, right? So our entire lives are being completely upended. I can see this wave of disease that's coming. I'm really trying to get the attention of everyone to be worried about it. And just as we got our very first case of COVID, before it really took over in the United States. So this was in late January, is when they were scheduled to come. And I was like, oh my God, do we really have to be testing guppies at the same time? But a deal is a deal. So as we were holding the press conference to announce our first case of COVID, our officer and two officers from CDC went out in the middle of the night, because that's when the guppies arrived, and swabbed guppies and water plants to see if they had malloidosis, which I might add, none of them did. Of course, I was, you can imagine how sarcastic I was about all of this at the same time. Like, yes, that's what we need to be doing right now is swabbing guppies. But I will also say this that when you have your first case of COVID, which is the third or fourth case in the United States, there's a lot of attendant issues that come up. And it was incredibly useful to have the officers and that they stayed for an additional two or four weeks to help us. But I think it's an example of where, you know, we can cooperate together. It it wasn't the beginning of a big issue of people wanting tropical fish and getting meloidosis, but it might have been. And you have to investigate things to find things. In that case, we didn't, but sometimes we do.
SPEAKER_01These were spared.
SPEAKER_02Yes.
SPEAKER_01I hate to think if you tested on positive what would happen to those poor guppies.
SPEAKER_02But it's also the fun part of what we do. You know, you you probably never thought about where all these tropical fish came from and and the tropical fish importers and how all of this works and where they are located. You need to learn about all these things.
SPEAKER_01And how to swab a guppy. And I probably you probably should add that no guppies were harmed during the outbreak investigation.
SPEAKER_02Aaron Powell Yes, no guppies were harmed.
SPEAKER_01So we talked a little about you being in both places. You I can't remember the number of years. I think it's almost an equal amount of time, maybe? Maybe a little longer in New York, yeah. Yeah.
SPEAKER_02I spent it's actually twice as much time. I spent 16 years in New York, and I've now been here for eight. I'm getting over.
SPEAKER_01I'm curious about the styles. I mean, you went from one extreme well, maybe one extreme to the other. I don't know if it's just superficially laid back in LA, but what contrast those two organizations.
SPEAKER_02I think that those things seem like they will be different. I I would not say I find the health department more laid back on the West Coast than the East Coast. I'd say the health department feels more or less the same. LA is much bigger. New York was 321 square miles. It was the densest place in the United States. We are 4,000 square miles just getting around. You know, sometimes at the end of the day on a Friday afternoon, if you have a specimen in one part of town and it needs to get to the lab, that can be a three-hour drive. So there's the physical size, there's there's more outdoors here. There's different animals, there's a few different diseases. You know, they have riquetial pox in New York, and we have typhus, marine typhus here, which they don't have there. But I would say that the number one thing I find different here compared to New York is the form of government. And this is something I was totally not aware of before I came here, which is in New York, it's very traditional. You have a mayor and you have a city council. The mayor has most of the power, the city council has a little power. The mayor appoints the commissioner of health. There's one school district, there's one jail system, there's one water system. It's very simple and straightforward. The commissioner of health serves at the pleasure of the mayor. Um and again, it's very straightforward. In LA or in all of California, there's a county system. I know I listened to your podcast with Sarah Cody, and she alluded to this a little bit too. So the power sits with the county, and the county is run by a board of supervisors. And then we have 88 cities, and then we have unincorporated areas. And the cities can choose to opt into county services or opt out of them. So, for example, the LA County Department of Public Health is the public health department for all of LA except Long Beach and Pasadena, who've opted to have their own health departments. There were a couple of cities that during COVID tried to opt to have their own health departments, and it's harder than they thought it was. So it didn't work out. But um, they thought they could just hire a health officer and declare themselves their own health department. There are more requirements than that. But this also means that the cities can opt in for the schools, for the fire department, for the police department. So I live in Culver City. We have our own police department and our own fire department, but not every city does. Then there are some things that are completely independent, vector control, which does sit in the health department in New York. Here it's completely independently elected. So they report to no one, not even the board, although they just deal with mosquitoes. And this is very, very complicated in public health. You know, in New York, if you had a problem in the school system, like for example, with H1N1, when we wanted to get vaccines into the schools, there's just one school system to call. Whereas here, you have 80 different school districts that you have to deal with. And they all have a different opinion on whether or not they want that vaccine or whether they want it offered in their school. There are some more than 30 different entities that can arrest you in LA. So it's it becomes very, very complicated to reach people, to get things done, to figure out who's in charge. You know, is it the city, is it the county? I told my colleagues in New York, it's as if the city council were running the city, but you also had, you know, 80 different mayors to deal with. So things don't change as quickly. We've had the same director since I came here. In New York, that would never happen because every four to eight years, with the turnover of the mayor, the commissioner would change. This can be either good or bad. When things are really good in New York, they're really, really good. I think that the system was set up maybe to guard a little bit against this idea that, you know, if you have a bad mayor, everything's going to fall apart, kind of thing. So things are just going to run more at an even keel. It's much, much more bureaucratic because there's so many more layers of government and much, much more complicated. And you have to do a lot more team building to get people to agree on things. So that to me is the biggest difference. Yeah, the weather is different and it's bigger, and I have to spend more time in the car. But the biggest difference is a form of government, at least when you're working in public health, because public health is so closely tied to government.
SPEAKER_01The other thing I wanted to ask you about, having been at CDC and worked closely with them, you recognize the value of having the federal institution. You said it's really to provide guidance. Their jurisdiction isn't over the health departments. If you could redesign it, yeah. What works, what doesn't?
SPEAKER_02It is a really big country with a lot of different opinions. And I can also see, you know, now, if I'm just frank, I don't agree with a lot of what the federal government is doing. So investing them with a lot more power would be complicated. Um, you know, the like it's a constitutional system. There's no way around it. The states were given a certain amount of power. And we are more of a union than, say, the European Union. But we don't agree on everything. Especially right now, it's easy to see where having local control over some things is important. And public health is ultimately a local activity. This is what I remind everyone these days when they get a little demoralized because people are so against public health. But but it is a local thing where you go to the schools and the guppy and porters and the chop deliver factories, and you try to figure out what's going on and you try to persuade people to take measures that will protect themselves and their community. And a lot of what we ask of people in public health that I think is up for debate right now are things that are not only to protect yourself. You know, if we ask people to get vaccinated against measles, we're asking them to protect themselves and also to protect other people. That's a local thing that involves your own community. And I think that's an easier sell at a community level than it is at the national level. Everybody's in favor of giving the federal government more power when they agree with what the federal government is doing. And they tend to be less in favor of it when they aren't. And that on balance, I think this works in public health. I also think that most people aren't aware of how it works. You know, we we in public health tend not to be very noticeable when things are going well, and very noticeable when things aren't going well. Would it would it maybe have been better if we could have been like New Zealand where they were all on the same page and, you know, they didn't have COVID pretty much during the pandemic? I don't think that would have been possible because we aren't as isolated and we have more people and it was frankly already here. It would have been different, you know. But I I don't know that it's possible in the United States. I think we just have too many different opinions.
SPEAKER_01So instead of describing the United States as an imperfect union, I guess we could say it's a perfect disunion.
SPEAKER_02Something like that. I I think it's a good term. I I do think I do think it works. More or less. Is it there is no perfect outcome. And I think many of our colleagues who are serving in the federal government and who feel like the government is actively against them are feeling that strain. I just don't think there is a perfect solution. And I think much as maybe the LA County government was set up to guard a little bit, I mean, I don't know for sure, but I've just assumed against maybe an imperfect person leading, that this system also does that. It guards against an imperfect setup at the federal government.
SPEAKER_01Before I get to my last question, is there anything that I miss that you want to talk about?
SPEAKER_02Public health is a great career. It's a super interesting thing to do. You get to really know your community. I remember in New York I used to joke, my goal was to get to the end of every subway line. You know, you get to see things you don't get to see in normal life. You know, you go behind the scenes at hotels and you visit schools and churches and mosques and factories that you didn't even know existed in your jurisdiction until until they had an outbreak. And and that's really, really interesting. You meet all kinds of different people, you learn about all kinds of different cultures. And I think right now everybody's there's this feeling of exhaustion in public health, and it's easy to forget that. And there's maybe an anti-public health feeling, but I think we forget how how much public health has accomplished. I I remember when I decided to go into public health, I was in medical school in in the early 90s, and you know, tuberculosis was rampant, and now there's so little tuberculosis. Same thing with HIV, actually. It's it's miraculous to me, you know, how far we've come in a combination of obviously medical science and then public health, which is why it's, I think, so sad to many of us who've been doing this for so long that everybody would suddenly want to defund both medical research and and public health at the same time. So I just wanted to put a plug in for public health as a career.
SPEAKER_01The public health generation before us, we'd look at them and say, boy, they really tackled polio, didn't eradicate, but really was successful in smallpox. And then for us, we've seen amazing strides with hepatitis.
SPEAKER_02Hepatitis measles. You know, measles elimination happened while I was at CDC. And right now we're we have a varicella outbreak, and you know, people think of varicella as very benign. But I remember when I was a kid in school, there there was a kid who'd had varicella encephalitis and and had been severely disabled by that.
SPEAKER_01Chicken pox.
SPEAKER_02Yeah. Sorry, chicken pox, yeah. Even even in our lifetime, there have been these remarkable advances. And so I think that's why, you know, some of us are sad about it. But I think in the midst of being sad, people people forget that it is a great and interesting career. And I just wanted to put that out there.
SPEAKER_01Thank you. So my final question.
SPEAKER_02Yeah.
SPEAKER_01If you could choose one item, literal or figurative, to put in your public health backpack, what would it be?
SPEAKER_02Oh my goodness. In the old days, I would have said a notebook to write things down. But I'm currently trying to get everybody to go digital, even in the field.
SPEAKER_01Because the process is Except when you're writing poetry. Number two pencil.
SPEAKER_02When writing poetry, but the process of transcribing everything from paper into the computer is a fraught with errors and to be uh very expensive because you have to pay people to do it. But it would be something like that. Because because having a conversation with people is ultimately you know how a lot of a lot of outbreaks are solved. So something to take notes from that conversation.
SPEAKER_01Well, this is um this has been fantastic. Thank you, Sharon.
SPEAKER_02Well, thank you. It's lovely to talk to you.
SPEAKER_01Many thanks to our guests for sharing their words, but more importantly, their acts of service. Please email us your inspiring governmental healthcare or public health stories at info at inspired to heal.net. Thank you for listening.
SPEAKER_00Inspired to Heal podcasts are for informational purposes only and should not be considered as health or professional advice. You're not responsible for any losses, damages, or liabilities that may arise from the use of this podcast. The views expressed do not necessarily represent those of the host or the guest's current or past employers.
