Civilization & Peptic Civilization & Peptic UlcerUlcer

Indiana PacesettersIndiana Pacesetters

Also Known As:A Rooster, Three Hens & A Chick

Outline Outline

What is a peptic ulcer? What is a peptic ulcer? What are the characteristic symptoms of What are the characteristic symptoms of

an ulcer in the stomach or duodenum an ulcer in the stomach or duodenum (peptic ulcer)? (peptic ulcer)?

What are the causes of ulcer in the What are the causes of ulcer in the stomach?stomach?

Are genetic factors involved in the cause Are genetic factors involved in the cause of peptic ulcers (stomach ulcers)? of peptic ulcers (stomach ulcers)?

What is a Peptic UlcerWhat is a Peptic Ulcer

DefinitionDefinition

A A peptic ulcerpeptic ulcer is a circumscribed is a circumscribed erosionerosion in or loss of the in or loss of the mucous membranemucous membrane lining of the lining of the gastro-intestinal gastro-intestinal tracttract. . PepticPeptic ulcersulcers are are chronicchronic but may have but may have acute acute exacerbationsexacerbations..

Please Remain Calm….Please Remain Calm….

EMERGENCYEMERGENCY

EMERGENCYEMERGENCY

Health Officer of Health Officer of Brahma CountyBrahma County

Dr. Foghorn Dr. Foghorn LeghornLeghorn

BackgroundBackground Determine OutbreakDetermine Outbreak ProcessProcess Communities EffectedCommunities Effected Action TakenAction Taken ResultsResults

Brahma County

Key PlayersKey Players

C am on a H ea lth C lin ic

B rah m a C ou n ty H ea lth D ep artm en t

M in orca S ta te D ep artm en t o f H ea lth

C D C

BackgroundBackground From 1996 to 1999, Brahma County went from

25th to 1st nationally.

Syphilis cases reported in

Brahma County during 1999

represented a 160% increase

over cases reported in 1998.

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

Determining The OutbreakDetermining The Outbreak

What were existing problems?What were existing problems? How can we rectify them?How can we rectify them?

At the time, there was no official CDC At the time, there was no official CDC criteria to eliminate syphilis .criteria to eliminate syphilis .

ProcessProcess

FundingFunding TestingTesting Reporting & NotificationReporting & Notification SurveillanceSurveillance

FundingFunding

Redirected fundsRedirected funds reduced dollars for syphilis screening,

testing, and treatment lack of visits by Disease Intervention

Specialists (DIS) delays in partner notification

TestingTesting

lack of early diagnosis and subsequent treatment

Reporting & NotificationReporting & Notification

Reporting in a timely fashionReporting in a timely fashion

Created delays in partner notification,Created delays in partner notification,

education, and risk reduction of education, and risk reduction of syphilissyphilis

cases by DIScases by DIS

SurveillanceSurveillance

BCHD staff was not conducting BCHD staff was not conducting effective surveillance effective surveillance

Surveillance reports from Surveillance reports from physicians were not being physicians were not being reported.reported.

CDC comes into playCDC comes into play

Communities EffectedCommunities Effected African Americans African Americans

made up a large made up a large percentpercent

87% of Syphilis 87% of Syphilis CasesCases

Syphilis Cases in Brahma County, 1999

416

39

362

15

0 50 100 150 200 250 300 350 400 450

Total

White

Black

Hispanic

Number of Cases Reported

Factors Contributing to Factors Contributing to Communities EffectedCommunities Effected

Poverty Lack of access to

quality health care Recreational drug

use High-risk sexual

behaviors Jails

Action TakenAction Taken

An assessment of the MSDH syphilis program An assessment of the MSDH syphilis program by CDC in 1999 was satisfactory, but CDC by CDC in 1999 was satisfactory, but CDC indicated it could be improved. Among the indicated it could be improved. Among the items suggested by CDC were to: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.

Action Taken Cont....Action Taken Cont....

FundingFunding StaffingStaffing Testing,Reporting, and NotificationTesting,Reporting, and Notification Community InvolvementCommunity Involvement

Pluck Out SyphilisPluck Out Syphilis

The coalition was formed in late 1999 to The coalition was formed in late 1999 to address the epidemic of syphilis address the epidemic of syphilis occurring in Brahma Countyoccurring in Brahma County

BCHD’s health officer was instrumental BCHD’s health officer was instrumental in bringing community groups together in bringing community groups together around the issue.around the issue.

Pluck Out Syphilis Cont.….Pluck Out Syphilis Cont.….

Community members and organizations Community members and organizations were notified when the BCHD would be were notified when the BCHD would be coming out to test, screen and educate coming out to test, screen and educate residents about syphilisresidents about syphilis

Four committees:Four committees: faith & outreach, faith & outreach, communications, men having sex with communications, men having sex with men, and evaluationmen, and evaluation

Pluck Out Syphilis Cont....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 thiscommunity.

Billboards, bus placard,brochures,posters,community forumsand radio ads.

ResultsResults

Contributory factors leading to a decline increases in funding as well as staffing better testing reporting and partner notification collaboration between the community

organizations resulting in an increase in community awareness and knowledge.

OverallOverall

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.