Dr. Theresa Tran Carapucci: Houston's Health Dept. Does More Than You Think

Dr. Theresa Tran got the call about leading Houston's Health Department while she was pregnant. Baby Teddy was born July 24th. Her predecessor's last day was August 30th. There was no maternity leave — just one month to learn a 1,000-person department from scratch.

In this conversation with host Owen Conflenti, Dr. Tran lays out what the Houston Health Department actually does — and the answer is bigger than almost any Houstonian realizes. On the public side: 12 neighborhood multi-service centers, low-cost dental and clinical services, free vision care for kids through the See to Succeed program, WIC clinics, one of the nation's largest Area Agencies on Aging (which runs Meals on Wheels), Nurse-Family Partnerships for at-risk newborns, a Community Reentry Network for formerly incarcerated residents, and youth violence prevention programming. Behind the scenes: wastewater disease surveillance, syndromic surveillance pulling real-time data from hospital systems, a CDC-designated laboratory serving 17 South Texas counties, food and pool inspections, air quality monitoring, and warming and cooling centers during extreme weather — staffed by department employees who are all classified as Tier 1 emergency responders. Midway through the list, Dr. Tran pauses: "I'm not even halfway through yet." She also explains how the department stabilized after significant cuts to federal grant funding, why Ebola and measles are being actively monitored around the FIFA World Cup crowds despite not dominating headlines, and how Houston became the first city in the nation to partner with an entire academic institution — UTHealth Houston. And Owen learns something on camera he'd never heard before: sunburned skin loses its protective barrier function, making the body more vulnerable to overheating. Sun protection is also heat protection.

Thanks for listening!

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Transcript

SPEAKER_01 0:00

So I had basically a month between um when I had my baby and when my official like interim course day was gonna start to learn what the health department was.

SPEAKER_00 0:11

My story as a health department director is very much intertwined with my story of my baby's uh life.

SPEAKER_02 0:19

Incredible.

SPEAKER_00 0:19

And thankfully Teddy is uh Teddy is just as much fun as this job.

SPEAKER_03 0:25

From city hall in downtown Houston, this is 901 Bagby inside the mayor's office. Well, this week, the doctor is in on 901 Bagby. Dr. Teresa Tran Carapucci, director of the Houston Health Department. Thanks for being with us.

SPEAKER_01 0:41

Thanks for having me.

SPEAKER_03 0:42

This is uh great to meet you in person. Um, excited to uh talk to you about not just the health department, but a little about your background as well. One of the fun things about this podcast is for Houstonians not just to learn about the city, but who's running it as well. So uh can we go back a little bit? Do you do you remember, Dr. Tran, uh the moment that you were inspired for medicine? Were you a young person? Take me back a little bit.

SPEAKER_01 1:05

Oh my goodness. You know, I didn't think I wanted to be a doctor until um I took an anatomy class. I was at the University of Dallas. Uh, my anatomy teacher's name was Dr. Golman, and he actually wrote the anatomy textbook. And up until I was a sophomore in college, I thought I was gonna be a journalist. And I um and maybe do something in business. I was a business major with journalism in a modern language minor. And that class just made me want to get to know more about the human body. And um, I talked to my uh a pre-med advisor, which incidentally was one of my dad's biology professors when he was in college. And he said, you know, why don't you look into medicine and decide if that's something that you may want to do? Because you've got all these credits, you've clearly got a science-minded bend. And um just try it out. So I uh I turned it into a business venture actually and started a nonprofit organization called the Rotan Health Assistance Project, where I took myself and several other pre-med students, raised a bunch of money, and we went to Honduras to see if you know we could help out a clinic there. And in my mind, I thought if I can, if I have it in me to serve, then I think I could do this because I love the human body. I went to Honduras, had a great time, met an emergency medicine physician there who inspired me to go into emergency medicine. So my love for medicine grew with my love for emergency medicine and service to the underserved, and then I ended up here like way later.

SPEAKER_03 2:45

And it all started with that anatomy class.

SPEAKER_01 2:47

Yeah, it did.

SPEAKER_03 2:47

Yeah, interesting. It kind of all the pieces sort of fell together. So uh in in that sense, do did you kind of know public health was something that you wanted to do, or when did that kind of enter the picture?

SPEAKER_01 2:57

It's really interesting. I get asked this a lot, and no, I did not go into medicine thinking that I was gonna do public health. That what I have learned over the past decade or more is that when you are in the emergency department, you are part of the public health system. And so looking back, you know, using what I call the retrospectroscope, I look back at my uh career in emergency medicine and see that I have been working in a living laboratory of public health all along. And all of the levers that I would see pulled in administration, society, legislation, policy, um, just everything that was going on could be seen as a success or a failure in the emergency department. And when you start getting into leadership positions through emergency medicine, it becomes clear that there's so much more outside of medicine that has an impact on the patient's outcomes by the time they get to the ER. So it was really a natural evolution. I think that's when the mayor met me as an emergency physician, and I was speaking really the language of public health, though, as a physician, seeing patients in the front line that positioned me well to do this job. And I also remember saying, Well, I just found out that I'm pregnant with my baby, and so uh when do you want me to start? And he uh they had they said, you know, maybe over the summer or something, and I remember asking, can I just can I have my baby first? So I had my baby on July 24th, and um I Stephen Williams' last day was uh August 30th. So I had basically a month between um when I had my baby and when my official like interim first day was gonna start to learn what the health department was.

SPEAKER_03 4:57

So my material It's a welcome back from maternity leave, right?

SPEAKER_00 5:00

Well, there was no maternity leave. And my um so my story as a health department director is very much intertwined with my story of my baby's um life. Incredible. And thankfully Teddy is uh Teddy is just as much fun as this job.

SPEAKER_03 5:17

So now uh 10 months in, you've you've had uh a little bit of time to learn. What are some of the priorities that you're looking at now as we move into the future?

SPEAKER_01 5:27

There uh the very first, I think, overarching priority is the um it situation of funding. And when I started, the department had just gone through a massive reduction due to uh loss of grant funding, of federal grant funding. Um, the time that I spent at the department, thankfully things have stabilized, but we don't just rest there. And there's a lot to be said about efficiency and doing a good job. And um, and I think that that's what we've been doing in the health department. Uh part of that, though, is making sure that we are sustainable despite what's going on with grants. Um, and really in public health, when there's only so much funding for public health, both uh locally and um federally, the uh the thing that you have to do is innovate through collaboration. So by braiding funding streams and by having more partners, we're able to do a lot more. So I'm grateful that in my time here, we've partnered with academic institutions, hospital systems, healthcare systems, and then even other departments within the city to make things work better. We just part of the mayor's priorities I know is government that works. And that's what we are here to do.

SPEAKER_03 6:49

Those partnerships are huge in that sense. So um I do want to talk a little bit uh about the health department itself. Uh, I'm not sure that Houstonians know exactly what the department does. I mean, to from my perspective, I see it's part uh resources, but it's part services as well. Can you kind of break it down or maybe start with like the overall and then break down a little of what the health department does?

SPEAKER_01 7:10

Yeah. I um when I saw this question, I was like, how much time do they need?

SPEAKER_03 7:16

How much do we have or how much do we need?

SPEAKER_01 7:18

We have so the health department is massive and it provides a lot of services because public health is the engine that underlies a lot of people's just quality of life. Um so the thing that people see probably the most prominently are our multi-service centers. We have 12 multi-service centers in the neighborhoods in Houston, strategically located throughout, um, and especially in areas where uh people need to come together as a community. Um, those are places where people can come in and get services. And one of my back to your pri the priorities, one of my priorities is to utilize those multi-service centers even better to serve the community and to provide even more resources to the community at all times. That is one. Another area, though, is we have, of course, health clinics. We don't do primary care, and that's where we look for partnerships with other uh healthcare providers and institutions, but we do have certain services that are compliant with the state mandates that we have to make sure that certain diseases are taken care of for communicable diseases and infectious diseases that would spread, like STDs, tuberculosis, um, vaccine preventable diseases. We invest in that as public health. We also have low cost dental clinics. We do provide vision services through our See to Succeed program for children who were found to have poor vision but were not able to see a physician or uh or to get glasses or eye care. We provide that to them free of uh charge. Um so that's our clinical services side. We have a Bureau of Chronic Disease Prevention because part of what public health does is try to keep people from having problems to begin with. So a huge bureau of chronic disease, we do a lot of community outreach through them, a farmers market, uh, and then big services uh centered around human services, including the Area Agency on Aging. So the Older Americans Act established Area Agency on Aging in the United States. One of the largest ones is right here in Houston, run through the Houston Health Department. Um, some of the services that you may see from them are, for example, Meals on Wheels. That is a grant that's funded directly through the Area Agency on Aging and administered uh through the health department. We have a Women Infant and Children's or WIC program and WIC clinics where we see patients and see people through life, nurse family partnerships where our nurses are going into these homes and helping children or babies that um are at risk of being underweight grow to be healthy up to the age of two. Um and then we we do a lot of programs with uh with just justice and violence prevention. Um, so we have the community re-entry network program. It is a program where individuals who have come out of the prison system can get rehabilitated into society, help them get jobs, write CVs, and just get the guidance that they need to get back up on their feet. Um, and then we do youth violence prevention programs, adolescent health programs. One of the things that we know is that when youths are busy with uh organized activities like uh sports, for example, they're able to have a little bit more focus outside of just the classroom and keep out of trouble. So that in that way we we're doing violence prevention for the youth as well.

SPEAKER_03 11:01

And the multi-service centers are great places for Houstonians to connect with these services?

SPEAKER_01 11:05

Absolutely. Yeah, they can connect with them in and our multi-service centers are tailored to the needs of the community that are there.

SPEAKER_03 11:13

So some of them to their neighborhoods or the neighborhoods.

SPEAKER_01 11:16

Yeah, exactly. So some of them will have the exercise programs, some of them will have um the like our um area uh our uh ADRC, which is the aging disability resource center, aging and disability resource center that's located out in Kashmir uh multi-service center. Um and then I'm not even halfway through yet. Keep going, keep going. This is great. So then the other half of our department is the background stuff that's, you know, we we we talk about programs that people engage in, right? So then there is all this underground work that we're doing. And when I say underground, I mean literally we're surveilling the wastewater to look for diseases and make sure that we are on top of emerging disease threats before they become a big problem in the community. We have uh data that we pull from the hospital systems and the emergency systems so that we can understand when there's syndromes or when there's patterns of the diseases and infectious issues that we're concerned about, that we can start to respond immediately. Um, we have a big laboratory, which I love talking about because we are the LRN or the laboratory resource network that is established by the CDC. We support 17 counties in the uh re in the South Texas region. And um we in the expansion of that laboratory, which is going to be completed hopefully by next summer, we're gonna be able to respond even faster. But um all of that work is being done in the background at the genealogists, our disease investigators and surveillors, they're uh putting together data, and then we have a robust informatics program where we're taking that information and analyzing it and turning it into real action that we can take or we can uh provide uh guidance on for the community and for our hospital provider network. Um, and then we have, of course, our uh Consumer Health Bureau and our uh pollution bureau. So, you know, the fire that uh just happened recently, um, we had our air pollution monitors out there every day monitoring the air quality and helping the fire department. Uh and then we uh the food inspectors, we we do food inspections, we do mobile truck inspections, ambulance inspections and permits, pool inspections and permits. So we're like kind of all over the place there.

SPEAKER_03 13:51

We didn't even mention the pollen count, right? Isn't that you guys too?

SPEAKER_01 13:53

That's us too, yeah. So air quality and pollen, yeah, we do the pollen count, we do the heat alerts for the city. Uh, and then when it speaking of weather, uh anytime we have inclement weather, um, when we use stand-up warming centers and cooling centers, that is all run through my department as well. Well um, so we're the um, because we have the multi-service centers. And so when we transform those to uh meet the needs of the community during inclement weather or whenever we need to run shelters, um it's uh the majority of the individuals are pulled from um the health department. We're all we are all considered tier one employees.

SPEAKER_03 14:32

How has that uh played into the big crowds that that we're getting this summer with FIFA? I mean, Houston's a little busier this summer. Is that uh, or what impact, if any, has that had on the on the health department?

SPEAKER_01 14:42

Uh so we have just been scaling like every other department. Everything that we've done is evidence-based and um practice-based. And so we take that and just scale up. That's uh the impact uh for the most part has just been that we've had to do a lot more planning and preparation, but um we haven't seen a negative impact or um you know from from anything. We don't feel uh particularly strained because we're so well prepared.

SPEAKER_03 15:12

Sure. And I know you you talked even before the the event uh about Ebola or measles potentially heading into the tournament. So kind of back to that, the data, uh whatever happened with that, whether it was a fear or worry that people were having, do you think we've passed that now or or how is it?

SPEAKER_01 15:29

I think it's important to note that um there there is a a lot of fear and mistrust in public health. And I think that's where some of this um this fear came from. I have a lot of faith in our public health system locally because I work in it and um I I know I I know that I trust our team. The reality is that um Ebola is a big problem and it is become is a an even bigger problem. The CDC actually just uh raised the response level to the highest response necessary for Ebola because it is not contained in um the DRC. And that's a problem that's going to go on far beyond um the World Cup. The uh so the screenings at the airport and all of that work that was news at one point is still ongoing and the response is um still there and we are still maintaining awareness and preparedness. Um but just because we're not talking about it doesn't mean that it's not something that we're thinking about. And because we're thinking about it, I'm not worried about it. So um that's that. And then measles, same with measles, is we're monitoring it. Um, and uh you know, as the local health authority, it is my duty that if ever there was a concern that any disease process, where whether it be measles or um a foodborne illness, even or a bull or something more serious like Ebola, if that becomes a public health threat, that it's my job to let the public know. And um that's what I'll do.

SPEAKER_03 17:10

It's interesting because that we think about just health in general, you just think of the body, but there's so many outside factors when it comes to health. I was just interested to to think about you guys. Okay, no, we're doing food safety. We're doing all of these other things that that impact health. One thing that comes to mind for me is screen time.

SPEAKER_02 17:27

Oh, okay.

SPEAKER_03 17:28

Uh when, you know, as a doctor, when you when you look at maybe the dangers to public health, is there a place where, I don't know, too much scrolling comes into play or screen time for our mental health?

SPEAKER_01 17:38

Yeah, this uh Health and Human Services actually recently put out an advisory to parents that too much screen time is um is has a net does have a negative impact on mental health, especially for our youth. Um interestingly, we're on a podcast that's gonna be on it.

SPEAKER_03 17:57

The irony's not lost on me, Doctor.

SPEAKER_01 18:00

But you know, screens where they are, right? Screens and technology are not going anywhere. They are a way of life, and um they they're necessary in order to get around and to live in modern society. And so there is a time and a place and a use for it. What where screen time becomes um dangerous is when it's taking the place of other meaningful activities. Where um there, you know, because children are sitting and are sedentary for over an hour because they're just looking at a screen, then they're losing any health benefits uh um and mental health benefits of going and playing and just moving around and being active. So um, you know, there's there's a lot of physical um needs that we have as human beings just to be active, moving around, and then uh even just sitting in front of each other and and having uh communications and and talking and having normal conversations. Um when screen time is taken too far and then when it's being used to replace those types of interactions and those movements, um, that's when we start to see the negative health effects.

SPEAKER_03 19:09

Uh let's let's flip that. Let's talk positive. When you when you look at Houston, when you look at our population, what are some of the the bright spots that you see or or maybe a positive direction that we're heading in?

SPEAKER_01 19:20

Uh well, from my standpoint, having a mayor that really cares about public health and that um that is willing to invest time and energy in public health is huge and is meaningful because there are a lot of people who can care about issues and advocate on issues, but then if they can't do anything about it, it's really difficult. Um, one big issue that I uh I saw as an emergency physician was the um the homeless individuals and not being able to get care. And under Mayor Whitmeyer's administration, the collaborations around hard-to-reach, hard-to-help individuals, and they're not hard to help because they're obstinate or being stubborn necessarily all the time. It's just because it is so resource-intensive and you need to be with them for such a long time, not just you know, in front of a camera or momentarily. It is the um persistence and tenacity that it takes to believe in someone through their ups and downs. Uh, that's something that I think I've seen Mayor Whitmeyer um really help uh us as directors do for the long run and um is setting up a public health system that's helping those who need the most help. And that's such a bright spot um of working in Houston.

SPEAKER_03 20:45

Yeah. Um when you look into the future, do you, I mean, I know you've haven't been in the job quite a year yet. Um what are some big goals or some uh some you know, place you want to be in the future or a place you want the health department to be in the future?

SPEAKER_01 20:59

I uh well, I think one of the thing things we've already done, which was announced recently, was we became an academic public health department and uh the first one in the nation to um to partner with an entire institution. So the entire uh UT Health Houston Institution partnered with us. I'd like to see the health department do even more partnerships, um, not just with academics, but like I said, we've been working, we already work and partner very well with our counterparts over at Harris County Public Health, uh Harris Health, the Harris Center, um, large local entities. And I think that we can partner even more and bigger beyond that in the Texas Medical Center and across industries. So I'd like to see that because the real um the to me the real uh um success of public health in my eyes will be when non public health. Is speaking the message of public health. And so I would love for other industries to know and understand safety and hygiene and be preaching it so, you know, so that it's not just public health doing the doing the work of spreading the message of health and disease prevention. So the more partners I think that we get into larger audience that we can get outside of just the public health department and getting outside of those silos and getting the messages outside of those silos would be to me considered a huge success.

SPEAKER_03 22:35

Do you think sometimes in public health it does get kind of lonely out there saying, oh, we need to do this, we need to do this, and maybe not everybody's listening.

SPEAKER_01 22:43

That's true, but we still want to take care of everybody. And that's actually been the most interesting um part of communications in my job is understanding, you know, there are um there are lessons learned from good messaging and bad messaging. You gotta be really, really careful with um when you have the authority to say a message, you have to really know where you're going with it. Um, you have to be um understanding that different people have different understandings of whatever the situations are and being willing to just be very open and understanding with um the people. Uh so it it's um it's been a great learning experience in really just communications. But um, you know, kind of to your point, uh I would say it could be difficult to to hear people or to say that um to um to listen to someone's like not believe something that you're saying. Um, but I really take it as a sign of, okay, I think most people are reasonable for the most part. And is there something that I'm just not communicating correctly? And can we as a can I as a person um or can our department as a whole do a better job of communicating so that reasonable people are able to understand and to um and and to take care of themselves?

SPEAKER_03 24:14

And we are such a diverse city. So in addition to that, the communication has to go in many languages too. That's true. Which you know very well, right, as a as an immigrant family that you came from. What's that challenge like trying to, you know, operate in such a giant city? You're an immigrant family, maybe it's a it's a new place, the language is is different. That's gotta be a challenge, and I know it's important for you to connect with those families as well.

SPEAKER_01 24:37

Absolutely. We do we try to message in as many different languages and using as many different channels as possible. And it is a disparity that I still see um all the time, and even in my practice or or just going out onto the streets. I think that the message and the way that um messages are conveyed in a culturally appropriate way. And culturally appropriate isn't always just language. We have to go beyond that and think about what are customs and norms and um how do we help the community understand best within their customs and norms how to be as healthy as possible. Uh, so that is always a challenge of public health in a diverse city like this. And um the lucky, uh lucky for us, our teens are caring and they try their best. And you know, and we have a lot of community members that do give us input. Um, so that is always like a it's always a work in progress, but um it's something that we're working on.

SPEAKER_03 25:42

Well, speaking of the messaging, I mean, here we are in another um hot summer. Do do we want to do a skin cancer thing real quick? Do we want to do a sunscreen reminder for everybody?

SPEAKER_00 25:52

Yes.

SPEAKER_03 25:54

We can never do enough of those, right? Give me your best shot. I I I try to put it on the kids two or three times when they're out at the pool. I mean, I'm doing my best, Doctor. What else can we do?

SPEAKER_01 26:02

Nowadays they're so they're really good skincare products that, you know, I think something that kids don't like to do, because my own children included, is slather on sunscreen and then have to wait for 30 minutes. They have spray versions of sunscreens now. Um you know, just remember to spray their whole head. Light, cool clothing that covers as much of the body as possible is important. Um, and sun protection is uh not only important to prevent sun uh skin cancers and you know signs of aging, which your children will thank you for later, but uh also um to help with uh the overheating aspect, which we always worry about here in Houston, because you know, something that we don't really consider all the time is our skin is our largest organ. And having burnt skin, um, and skin is meant to be a protective barrier. And so when skin burns, that is one less protective barrier between you and the heat. And so people overheat when they get burns on their body as well. And so um, you know, we we always take uh seeing somebody's sunburn as a sign of they've been out in the heat too long. And that heat outside of just the sun and radiation on its own, of course, has effects, especially when the heat index is above 104 degrees. Um, there is more stress and strain to the human body to stay um cool. So uh and then in our humid uh Houston climate, it's even harder. So we're working against a lot of things. Um, so sun protection, aside from being a uh a way to prevent skin cancer, is actually also a way to make sure that you don't overheat.

SPEAKER_03 27:48

I'd never heard that before. I just learned something brand new today. That's fascinating. Let me ask you this just a practical question from a dad. Should I force my six-year-old to wear that swim shirt?

SPEAKER_01 27:57

Yes.

SPEAKER_03 27:57

Okay, good. So I'm doing the right thing. Even though he completed it.

SPEAKER_01 28:00

And if not, then just spray spray them down with sunblock. Or, you know, some one other thing that you could do is every 30 minutes or so make sure that they're coming into the shade so that they're not getting continuous um exposure to heat. And so taking those breaks is actually. Yeah, taking breaks and air conditioning is is important. You know, fans, even in um in uh like if it if it's really, really hot outside, a fan isn't gonna really help. It'll make you feel a little bit better. But uh pouring water on somebody and then fanning them off has a better cooling effect than just like a fan on its own.

SPEAKER_03 28:39

Okay, that's great. I love that because we still got a little bit of summer left too. We're not ready.

SPEAKER_00 28:43

Yeah, a lot of summer.

SPEAKER_03 28:44

So when when do um I shouldn't say this, well, not that we have kids listening, but when do we start talking back to school vaccines, shots, and all that? Is it too early for that?

SPEAKER_01 28:54

Year round. We we advise people to just stay on top of their immunization schedule. So as children, you know, not uh, yes, we think about vaccines for back to school because a lot of schools ask for vaccine records, but the reality is children's vaccine schedules are based on their birth dates. And so we should be thinking about vaccines year-round uh based on your child's vaccine schedule. Um, vaccines are one of if not the most uh I'd say vaccines, seat belts, helmets, and um uh smoking cessation have been um like huge uh fac huge public health campaigns that have really improved health and uh uh for children. And um so we we don't want to ever forget the importance of where and how vaccines have made us, you know, be able to be here and um where we are today and and look forward to new medical advances.

SPEAKER_03 29:54

That's an interesting list. I'm glad you brought that up. Do you think alcohol's entering that picture now?

SPEAKER_01 29:59

I think it is. You know what's interesting is um I read somewhere that mocktails and myself, I like I alcohol is just not that interesting to drink anymore. There's so many yummy mocktails out there. Um, but I think that generationally I um alcohol is becoming less and less of um a uh just a desired substance, I think. Now, unfortunately, I think that there are other things like THC and um, you know, in in marijuana, which there was a a time when um it was perceived that marijuana was not as dangerous as anything else, but studies have come out now to show that especially for our youth, that um it does cause irreversible um brain damage and memory loss and issues with um mood disorders in the future.

SPEAKER_03 30:48

Interesting. Um this has been a really great conversation, Doctor. I really appreciate your time. I want to ask you one thing before we get out of here. Uh, if there was just one thing, one thing that you wanted everyone in Houston to know about this health department right now, what would that be?

SPEAKER_01 31:03

Please visit Houstonhealth.org to get to know our department. And if you have a question or an issue, call. We have a call center and someone will be happy to guide you to the right place. Um, there is uh no reason that somebody living in the city of Houston shouldn't be able to get some help from somewhere. Um, and our health department is there to answer your questions, whether it's connecting you somewhere else or providing the services ourselves, we're happy to do it. And we're here for you.

SPEAKER_03 31:35

That's great to know that that's out there. Thank you for your time, Doctor. Appreciate it.

SPEAKER_01 31:38

Thank you.