Our Earth, Ourselves: Clinicians Make a Difference in Environmental, Public Health
While PAs and NPs are often on the front lines of care for farm workers in rural clinics across the country, they receive very little formal training about how to handle pesticide poisoning. Amy Liebman, MPA, MA, hopes to change that through her work with the Austin, Texas–based Migrant Clinicians Network (www.migrantclinician.org).
Liebman, director of the network’s occupational and environmental health initiatives, coordinates continuing education and mentorship programs for 160 different migrant health centers in the United States.
“We’re all about trying to figure out ways clinicians can better recognize, better understand, and better treat occupational and environmental exposures,” Liebman says. “It’s about working strong, and working small, to make significant changes.”
Liebman’s group encourages clinicians, when they are taking a health history, to ask migrant farm workers about their occupation, particularly whether they are exposed to any substances at work or at home that might be harmful to them.
Migrant Clinicians Network CME programs cover such topics as how to document occupational exposure for workers’ compensation claims, the long-term health effects of pesticides, and what protective gear to recommend for farm workers. The organization also helps rural providers prepare for a large emergency, such as the one in Tampa, and set up decontamination areas.
Meanwhile, Liebman’s counterpart, Helen Murphy, MHS, DrPH(c), who practiced as a family nurse practitioner before entering the public health realm, is launching a similar effort in Seattle. Instead of reaching clinicians already in the field, Murphy’s program through the Pacific Northwest Agricultural Safety and Health Center targets PAs and NPs who are still in school. A pilot project is under way at the University of Washington’s PA program and Seattle Pacific University’s NP program, among others.
Murphy’s program offers a Web site loaded with real case studies, photos, videos, and details from medical charts to give clinicians more practice in identifying pesticide-related illness before they enter the workplace. “The instructors can just go into this database,” Murphy says, “and all of the class materials will be there.”
Both projects receive funding from the US Environmental Protection Agency’s Office of Pesticides. For more information on these programs, contact Liebman at aliebman@migrantclinician.org or Murphy at hmurf@u.washington.edu.
Tracking Environmental Health Threats
Nurse practitioner Frances Medaglia doesn’t work in a traditional primary care setting. In fact, she doesn’t work in a traditional setting at all. But she does have a positive impact on the health of children in Massachusetts every day. In her position with the Massachusetts Department of Public Health’s Bureau of Environmental Health, Medaglia’s work has touched on everything from preventing prenatal exposure to chemicals to reducing childhood asthma rates and making indoor air safer for school children.
Medaglia recently became the state’s clinical coordinator for an exciting new program, funded by the CDC, that will help health care providers monitor local environmental health issues, such as cancer, lead poisoning, and air and water pollution. The program, known as the Massachusetts National Environmental Public Health Tracking Network, currently has data from 26 states. The CDC hopes eventually to include all states in the US.
“With this tool, you can see how prevalent asthma is in your county,” Medaglia says. “Maybe even down to the zip code level.”
Medaglia says she drew on her clinical background while entering all of the pediatric asthma information into the database for the entire state of Massachusetts. She gathered the data by working closely with school nurses across the state.
Medaglia’s medical training has come into play before, such as when she worked with public health staff members to analyze developmental delays in babies born near the Housatonic River. The river had been contaminated with polychlorinated biphenyls (PCBs) years earlier, so most of the staff believed that was the cause of the defects. But Medaglia found epidemiologic studies that showed pregnant women in the area had a very low rate of prenatal care. The town (Pittsfield, Massachusetts) also had a high number of women who smoked during pregnancy. Many of the homes in the area were old and had lead contamination.
“I bring something to the table that might not be thought of by the other folks,” Medaglia says. “That’s the contribution nurses can have in public health.”
From 60s Activism to the CDC
Like the current US president, Geoff Beckett, PA-C, MPH, used to be a community organizer. During the 1960s, Beckett was involved in the antiwar effort. He also encouraged people to support Cesar Chavez’s workers and boycott grapes.
Since community organizing didn’t pay well back then, Beckett took a side job as an orderly at a New Mexico hospital. That’s when he got hooked on medicine and joined one of the first PA training programs in the 1970s.
