2023 Annual Report

Foreword

By Zachary Moser, Administrator

At the time of writing this report, I have been at my post as Administrator for almost three years. I cut my teeth in public health during one of the most trying times in the history of the public health system, during the Delta wave of the COVID-19 pandemic in July of 2021. Since that time of crisis, the Dent County Health Center has emerged from the pandemic in a stronger position than ever before.

Financially, the operating budget of the Health Center increased from about $700,000 in 2021 to over $2,000,000 in 2023. We have grown from seven employees to fourteen. Our capabilities and service offerings have increased dramatically and have brought in so many new opportunities for patients.

This is not to suggest that I am the reason for the success. I have merely taken advantage of opportunities that have been presented to us. I put the staff in place, but they execute on our mission of improving and protecting the health of our residents.  Without our dedicated, passionate, and caring staff members, Dent County Health Center would not be what it is today. I can’t stress that enough! My sincerest “thanks” goes out to everyone who contributed to our mission in 2023. A full listing of their names and positions is found on the following page.

Likewise, I cannot do my job without a Board of Trustees who trusts and empowers me to go after new opportunities and to lead the organization. I am thankful for their guidance, understanding, patience, and devotion of time to the Dent County Health Center. Furthermore, the administrators who came before me had already done so much to ensure our success when opportunities presented themselves.

Our substantial cash investments were built up over many years of frugal leadership by all past administrators, but especially Janie Jadwin. Most of our important community partnerships were cultivated by Kendra Mobray during her time as administrator. Kendra also had the foresight to purchase a larger building, which enabled us to grow services quickly during the pandemic with minimal construction costs and lost time.

I am reminded of the famous quote by Isaac Newton, “If I have seen further it is by standing on the shoulders of giants.” Today, we proudly publish this report for the 61^st year of operations of the Dent County Health Center from the shoulders of the giants who have come before us. We hope that those who come after us will take this report and marvel at how far they, too, have come.

The People of Dent County Health Center

Mission Statement

Prior to December of 2023, Dent County Health Center’s Mission read as follows:

The Mission of the Dent County Health Center is to promote and protect the health of the citizens of Dent County through education, disease and injury prevention, regulation and delivery of public health services in order that all residents may achieve optimum health. We believe that Public Health Makes Life Better.

After a strategic planning process, the mission was clarified and shortened to:

The Mission of the Dent County Health Center is to improve and protect the health of Dent County residents.

This revised mission statement provides a clear definition of Dent County Health Center’s role in our community.

Shortly thereafter, a vision statement was adopted as well that reads:

The vision of the Dent County Health Center is for Dent County to be a community free of disease, food-borne illness, and preventable injury.

Residents will be healthy, vaccinated appropriately, and educated on healthcare issues and available assistance programs.

No residents will be harmed by use of tobacco, alcohol, or other substances. Dent County children will be safe from preventable illness, injury, and abuse.

Dent County will be a community in which access to affordable and effective healthcare is available for all.

WHAT IS PUBLIC HEALTH?

The Institute of Medicine has defined public health as “an organized community effort aimed at the prevention of disease and promotion of health.”  Unlike our health care system which provides medical services to individuals, our public health system focuses on the health of our city/population as a whole.

Public health affects us all, all of the time.  Public health efforts have increased our life span by nearly 30 years in the past century.  Simple actions we take for granted today such as drinking clean water and breathing clean air, eating fresh fruits and vegetables, wearing seatbelts and bike helmets, and using pedestrian cross-walks, are benefits that we owe to the efforts of a system that is dedicated to making good health available to every citizen. 

Our public health system involves many players.  The Health Department has legal responsibility for ensuring public health and employs professionals, such as disease investigators, environmental inspectors, social workers, and nurses.  The Health Department also relies on medical professions in public and private practice to perform public health functions and help patients practice prevention.  Police and fire departments play a crucial role in sustaining public safety and well-being, and even architects, housing developers, city planners and parks and recreation staff contribute through their everyday work to the safety and health of our community. 

Neighborhood and nonprofit organizations are also part of the public health system. Our department has active partnerships with the American Red Cross, area health departments, the Salem Memorial District Hospital, Compass Health, local pharmacies, physicians and veterinarians, the Division of Family Services, Dent County Fire Department, local law enforcement, and the Council for a Healthy Dent County.

The Main Functions of a Public Health System:

1. Preventing diseases and decreasing transmission of existing diseases
2. Protecting against environmental hazards
3. Preventing injuries
4. Promoting and encouraging healthy behaviors
5. Responding to disasters and assisting communities in recovery
6. Ensuring the quality and accessibility of health services
7. Ensuring every child has a healthy start

Public health is a vital function that requires broad public concern and support in order to fulfill society’s interest in assuring the conditions in which people can be healthy.  History teaches us that organized community effort to prevent disease and promote health is both valuable and effective.  It is this philosophy of assuring a healthy environment, promoting healthy behaviors, and preventing disease that the staff of the Dent County Health Center is committed to practicing now and in the future.

COVID-19 Pandemic

The COVID-19 Pandemic, which was officially declared by the WHO in March of 2020, continued throughout 2021 and 2022. The State of Missouri declared COVID-19 as “endemic” in April of 2022, though some enhanced reporting requirements and special authorizations continued. In 2023, COVID became a part of the “new normal,” with periodic surges in cases that never reached the levels of prior years.  As a result, the community and the Health Center were able to start moving forward into a variety of new areas, while still maintaining the services that were initiated due to the pandemic.

Vaccines

COVID vaccines became commercialized in September of 2023, bringing new challenges for their distribution to patients. However, DCHC offered Pfizer and Moderna COVID vaccines throughout the year.  

Testing

The Health Center remained the first and only place in the county to offer COVID-19 testing without a doctor’s order. The Health Center tested 373 people for COVID-19 and other acute illnesses in 2023.

Treatment

Treatment access continued through April Greener, Family Nurse Practitioner. Patients could make an appointment with her and receive necessary treatment for COVID-19 or whatever illness they had, aided by the diagnostic power of the Biofire RP-EZ.

Case Investigation

Detailed case investigations ceased in April of 2022. Basic information on positive cases continued to be collected throughout the year. Cases were reportable at an individual level throughout 2023. Health Center staff recorded 511 COVID-19 cases in 2023. Dashboards were not published in 2023. Instead, periodic updates in the form of press releases were made during spikes in transmission.  

Clinical Services

Nurse Practitioner Hired

In June of 2022, April Greener, FNP, joined the Dent County Health Center under collaboration with Dr. Jessica King from Texas County Memorial Hospital. Dr. King would later become the Health Center’s medical director after the resignation of long-serving Dr. Yvonne Prince.

April was instrumental in the success of the Health Center throughout 2023.  With April on the team, DCHC was able to offer acute illness visits, on-demand visits for Show-Me Healthy Women, well-child visits, Family Planning, and more for the first time. The positive community feedback on these services has been overwhelming.

Family Planning

In April of 2023, the first Family Planning patient was seen. This program supports free or reduced cost family planning services, including long-acting reversible contraceptives (LARCs), among other services related to family planning. Supported by a grant from the Missouri Family Health Council, this program offers access to contraception not previously available within Dent County.

Communicable Disease

Surveillance, Investigation and Prevention

The purpose of communicable disease investigations is to identify the causes of the disease and decrease the incidence of new people becoming sick. Communicable diseases are those diseases that are a concern to public health.  They are reported and tracked by the state or federal government.  All states must collect information on the federally reportable list.  In addition, they may choose to mandate the reporting of other diseases of interest to the state officials.  Public health officials at state health departments and CDC continue to collaborate in determining which diseases should be nationally notifiable.  A disease may be added to the list as a new pathogen emerges, or a disease may be deleted as its incidence declines.

As part of its activities in keeping the community informed, the Communicable Disease Prevention Program is responsible for the maintenance and operation of the Dent County node of the Missouri Department of Health’s Health Alert Network (HAN).  This notification system targets physicians, hospitals, local health departments, veterinarians, ambulance services and other first responder agencies.  Disease alerts, warnings, recommendations and other information can be transmitted through this system to all or selected recipients. The communicable disease department is critical in emergency planning for our community to identify and contain disease outbreaks.

The reporting of communicable diseases to the health department assists in identifying how many people are affected and who else is at risk. Another critical component is to protect those at risk. Individuals may qualify to receive confidential testing and treatment for a communicable disease by contacting our office.

HIV and Sexually Transmitted Infection Services

The Dent County Health Center provides comprehensive HIV and Sexually Transmitted Infection Services aimed at promoting sexual health and preventing the spread of infections within our community. We offer testing for sexually transmitted diseases, including gonorrhea, chlamydia, HIV, syphilis, and others, with a commitment to confidentiality and sensitivity. Moreover, we provide free treatment for gonorrhea, chlamydia, and syphilis, ensuring accessibility to necessary medical care for those affected. These services reflect our dedication to supporting the well-being and sexual health of all individuals in Dent County.

Changes in CD in 2023

The STI testing program grew from about 2 tests per month to about 8 tests per month under the leadership of Trisha O’Neil, RN. The success was attributed to the greater availability of free testing and the promotion of the service in the community.

Lead

DCHC applied for and was awarded a grant from the Centers for Disease Control and Prevention in 2023 to address lead poisoning. Dent County has a high rate of lead poisoning, despite the low rate of testing. There are three main goals for the new program:

1) To increase the number of children appropriately tested for lead poisoning.

2) To increase the community and provider awareness of the problem.

3) To assist families who are experiencing lead poisoning with hands-on interventions.

DCHC hired a Lead Risk Assessor using grant funds to promote community education and to provide in-home assessments for children who are lead-poisoned.

The award was timely, as a new Missouri law, called the “Get the Lead Out of Schools Act,” required all Missouri schools to test their water for lead for the first time, and set a strict standard of 5ppb for acceptable levels. At least three of the schools had lead in some of the water outlets. DCHC used the opportunity to educate on lead poisoning and direct individuals to testing.

Environmental Public Health Services

The Environmental Public Health Services offered by the Dent County Health Center encompass a wide range of critical functions aimed at safeguarding public health and ensuring regulatory compliance. One key aspect involves the enforcement of state ordinances governing various aspects of food service, retail food sales, and on-site wastewater disposal specific to Dent County. Our dedicated team conducts thorough inspections of food service establishments, retail food stores, schools, licensed daycares, lodging establishments, and public swimming pools to uphold sanitation standards and protect community health.

Additionally, we facilitate the issuance of construction permits for on-site sewage disposal systems in collaboration with the Department of Health and Senior Services. Our commitment extends to the sampling of private water supplies and the investigation of environmental complaints, ensuring the safety and well-being of Dent County residents.

Furthermore, our team plays a vital role in responding to incidents involving distressed foods, including vehicular accidents, fires, floods, and other emergencies, while also actively participating in emergency response planning efforts throughout the county. These comprehensive services reflect our dedication to promoting a healthy and sustainable environment for all members of the Dent County community.

Food Protection

Food protection is a responsibility of the Environmental Public Health Program.  The program handles inspections for all food establishments in Dent County.

Food protection is also responsible for the investigation of any and all truck wrecks (trucks carrying food, drugs or cosmetics) that occur in Dent County for proper disposal of damaged or contaminated products.  Food protection responds 24 hours a day, seven days a week to all fire investigations and natural disasters that involve any food establishment.

In 2023, a new food regulation/licensing was passed, for implementation in 2024.

Lodging Inspections

The Environmental Public Health Program partners with the Bureau of Environmental Health Services at the Missouri Department of Health and Senior Services to inspect all lodging establishments within Dent County.

The licensing year is from October 1^st through September 30^th.  Licenses may be obtained by completing an application that is mailed to each establishment on August 1^st by the Bureau of Environmental Health Services.  Establishments must include an approved inspection for the current year and payment of the appropriate licensing fee with their completed applications.

Inspections are unannounced and can take place anytime throughout the year.  Establishments that meet the sanitation and safety standards outlined in the lodging rule, 19 CSR 20-3.050, will receive an approved inspection report.  Re-inspections are conducted as needed on non-compliant establishments, and no license will be issued until the violations are corrected.

Child Care Inspections

The Health Center works with the Department of Health and Senior Services staff to assure that annual sanitation inspections are conducted in all licensed child care facilities.  Inspections are conducted to protect children in and out of home care from environmental hazards such as exposure to disease, harmful chemicals, lead hazards, building safety and food safety hazards. 

Online Reports

Throughout the year, inspections were posted and available on the website.

Public Health Emergency Preparedness

Background

Any number of public health emergencies could occur in Dent County ranging from disease outbreaks, to food, environmental and health needs after a natural disaster.

The Health Center plans for and responds to such events. It is not enough to write plans to address public health concerns. The staff works with volunteers and community partners to develop and exercise these response capabilities.

In the event of a serious occurrence of a communicable disease, the counties must be prepared to execute functions not normally required during events normally planned for by other disciplines such as law enforcement and fire service. These include disease surveillance and investigation, mass prophylaxis, isolation and quarantine, mass patient care and even mass fatalities.

Over the last several years, the health department staff have deployed in response to prolonged power outages due to ice storms or tornados. We also assist the EMD and the American Red Cross by inspecting emergency shelters and/or mass feeding sites and providing food safety guidance to volunteers.

Shelters were opened by the staff as requested by EMD and the City of Salem during the power outage of 2005, the ice storm of 2007, the derecho winds of Spring 2009, and the straight-line winds Memorial Day Weekend 2017. The staff has made onsite visits to merchants during emergencies and disasters to assist them in the mitigation of product losses and provide education and assistance as to product viability.

Our Role

It is important to remember that many disciplines will have a role in events as serious as a natural disaster and that it may not be contained within the county limits of Dent County; nor will any communicable disease outbreak.

Dent County staff maintains ongoing working relationships with public health agencies in neighboring jurisdictions and other government agencies. They participate in several committees and subcommittees that meet to plan and coordinate responses to public health emergencies. The department has a Memorandum of Understanding with the American Red Cross to offer support for functional need clients in emergency shelters. The Dent County Health Center is actively involved in a regional partnership with Region I State Emergency Management and meets regularly to improve our ability to respond to various emergency events.

Community Partnerships

The Dent County Health Center partners with the Phelps County Medical Reserve Corps which works to recruit citizens to join the Health Departments to serve as volunteers.  They are taught how to keep themselves safe and healthy and to impart this same information to people in their circle of influence, such as their family, friends, co-workers, neighbors and faith family. This effort supports the goal to keep the communities informed and engaged in the prevention of the development of chronic disease as well as responding appropriately to public health emergencies.  These citizens will perform a critical role during public health outbreaks and crisis, as well as during health information campaigns designed to keep the community healthy.

Through these and countless other activities, the program strives to ensure the health and safety of the citizens and visitors of the counties. Plans evolve to meet the increasing challenges of these changing times.

Medical Reserve Corps maintain a trained, background checked list of volunteers to allow a surge of public health services in case of an emergency or disease outbreak.

Maternal/Child Health Initiatives

The Maternal/Child Health Program works to improve the health of women, children and families over their lifespan through community engagement, partnerships, education and advocacy. Our most recent focus in Dent County has been on substance use prevention and injury prevention. These programs have achieved positive, measurable outcomes with a strong community partnership with Healthy Dent County and the local school.

For the upcoming contract year, the Dent County Health Center will be working with several community partners in conjunction with Healthy Dent County Prevention Coalition to focus our efforts on Child and Adolescent Intentional and Unintentional Injuries, with an emphasis on Substance Abuse awareness and prevention. 

Child Abuse/Injury Prevention

The Health Center works closely with new mothers to promote and educate parents on safe crib standards and infant bedding to prevent accidental suffocation and SIDS deaths. A Children’s Trust Fund grant support personnel to provide education and safe cribs to program clients.

Childcare Health Consultation

We have health professionals that are prepared to offer consultation and education to providers, parents and children in daycare settings.  The consultation and education services provide credit hours to childcare providers to qualify for licensure.  The education provided focuses on child safety, CPR, communicable disease prevention and emergency response.

Show-Me Healthy Women and WISEWOMAN

The Show-Me Healthy Women program offers free breast and cervical cancer screenings to women ages 35-64, or older if they do not receive Medicare part B. To qualify, women must have a household income at or below 200 percent of the Federal poverty level and have no insurance to cover the services or be unable to pay the deductible for the insurance. The Health Center partners with Salem Memorial District Hospital to offer mammogram screenings and sends a healthcare provider to facilitate the program.  

The WISEWoman program is a companion to Show-Me Healthy Women. It provides free blood pressure, cholesterol, and diabetes screenings for women who qualify.

Childcare Assistance Program

In 2022, the Health Center applied for a grant designed to mitigate the social impacts of the COVID-19 pandemic. Access and cost of childcare was consistently brought up by our community as problematic, so DCHC designed our grant application to address this issue which was worsened by the pandemic.

Through this program, any person using a childcare provider in Dent County could qualify for free and reduced cost childcare. We contracted directly with over 30 childcare providers throughout the county. At one point, over 200 children were in the program. Results of our surveys indicated that because of the program over 50 parents were able to return to work. In 2023 alone we distributed over $400,000 in subsidies and over $700,000 was distributed over the entire program.

Building Communities for Better Health

In 2023, the Dent County Health Center hired a community engagement specialist to grow support for improving the health of Dent County residents by changing the built environment. The two areas of focus were active transportation and smoke-free air.

DCHC hosted a walk audit with city leaders, regional leaders, and local residents to demonstrate the need for improved walking infrastructure.

Janelle Moore, Project Manager, led the development of a youth coalition, primarily to address vaping in teenagers. She also brought new partners into the Healthy Dent County Prevention Coalition, which eventually helped introduce a smoke-free parks and city-owned property ordinance in Salem, which passed the Board of Aldermen in early 2024.

Immunizations

We provide all immunizations for children and adults. Off-site clinics at SMDH, area schools, and places of employment are offered regularly and can be scheduled by request.

Immunizations are available by appointment, Monday thru Friday, 8:00 a.m. to 4:30 p.m.

We offer free vaccines for those who qualify. Vaccines for Children are always free.  

Laboratory Services

Outpatient lab services are provided at greatly reduced rate to clients with an order from a medical provider. We offer any test currently conducted by Labcorp. In addition, we have a variety of rapid testing available for results in an hour or less.

Community Engagement

Public Health Information is provided to the community in the Your World Today, local newspaper, local radio, and the Health Center Facebook page as well as the website, www.dentcountyhealthcenter.org. 

Health Education and Promotion

In response to the growing obesity epidemic, the Health Center works with other community partners on a number of healthy eating and active living initiatives.  These include The Salem Fitness Center, health fairs, and community gardens, walking programs, workplace health planning and support for healthy foods in schools.

WIC (Women, Infants and Children)

What is WIC?

WIC is a supplemental nutrition program for women, infants and children. WIC helps to prevent health problems and improve the health status of participants through good nutrition. The WIC Program supplements the diets of qualified participants with nutritious food items by issuing a food “prescription.” WIC promotes breastfeeding as the optimal feeding for infants and provides education and support.

Who qualifies for WIC?

1. Women who are pregnant, breastfeeding (nursing a baby up to one year old), and postpartum (up to 6 months after a pregnancy has ended)
2. Infants (a child under one year old)
3. Children (from 1 year old up to age 5)

All women, infants, and children must meet income guidelines and medical criteria to qualify for WIC.

WIC will not provide all of the foods needed. WIC foods are intended to supplement the diet. The food packages approved for use in the Missouri WIC program are designed to help meet infants’ developmental needs and current pediatric feeding recommendations, and to complement the eating patterns of preschool children. WIC foods also supplement the special requirements of pregnant and breastfeeding women and help to re-supply the nutrient stores women use during pregnancy.

Vital Records

Our local registrars can print birth and death certificates on-site during normal business hours. This important service is necessary for people applying for identification, signing up for school, life insurance, and other situations. The fees are established by the State of Missouri. Birth certificates are $15. Death Certificates are $14 for the first copy and $11 for each additional copy.

Finances

DCHC had a strong financial year. Revenue was $2,199,574.91 vs. expenses of $1,707,343.39, resulting in a net income of $492,231.52. DCHC uses the cash method of accounting, and at the end of 2022 there was a large loss of $331,789 because of the way certain grant payments were made as a part of the Childcare Assistance Program. When considering this, the more modest income of about $160,000 reflects conservation of resources and taxpayer funds.

As of the end of 2023, the balance sheet showed $934,329 in cash, CDs, and savings accounts and $629,137.70 of fixed assets for total assets of $1,563,467.03. Total liabilities were $198,115.32 and equity was $1,365,351.71 for total liabilities and equity of $1,563,467.03.

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