Miami-Dade County Health Department

Disease DetectivesControl of Communicable DiseasesWhenever a disease outbreak affects our community, the Miami-Dade County HealthDepartment (MDCHD) has a structure and mechanisms to identify diseases quickly inorder to slow down its spread. The protagonists in that process are our epidemiologists, or“disease detectives.”Disease detectives include physicians, nurses, veterinarians, pharmacists, lab techniciansand other experts, who understand that the chances of dramatically slowing or evenstopping an outbreak are highest if they can recognize a disease early on and rapidlydisseminate information and act against it.

Miami-Dade County Health Department2009 Annual Report 6Kids and adults arehaving fun as theyare taught by PublicHealth Officals the newcoughing etiquette.Confronting the First Pandemic ofthe 21st Century – 2009 H1N1Immunizing the CommunityThe MDCHD started in October 2009 amass vaccination campaign against the2009 H1N1 Influenza. Partnering withlocal health care providers, schools,community clinics, and federally qualifiedhealth centers, the Department offeredthe vaccine to high-priority groups, suchas children and pregnant women.The vaccine was given free of chargeto the community, and in local schoolsimmunizations were administeredthrough the School Health Connect, a program funded by public and privatepartnerships that include The Children’s Trust, Miami-Dade County PublicSchools and our Health Department.The MDCHD habilitated four vaccination sites: Downtown Clinic, Little HaitiHealth Center, West Perrine Health Center, and the Juanita Mann clinic,extending regular hours into the evening and weekends. Medical andnonmedical personnel were recruited to help with this communitywide effortto address The President’s declaration of a national emergency to deal with the“rapid increase in illness” from the H1N1 influenza virus.Federally Qualified Health Centers opened their doors as well to the massvaccination campaign. They were: Borinquen Health Care Center, Citrus HealthNetwork, Community Health of South Florida, Helen B. Bentley Health Center,and Jessie Trice Community Health Center.Our sincere gratitude goes out to each individual who assisted with asuccessful campaign. Next year we will share with you the final outcome ofsuch unique endeavor.

Inside08 | Our Challenge10 | Vision-Mission-Values12 | Welcome Letters16 | Community and Family Health22 | Protecting the Community28 | Public Health Preparedness30 | Environmental Health and Engineering32 | Community Relations36 | Dental Program “Seals on Wheels”38 | Highlights40 | Senior Leaders42 | Credits

Miami-Dade County Health Department2009 Annual Report 8Our ChallengeThe MDCHD protects our community from a wide range of public health threats such as tuberculosis, HIV/AIDS, sexually transmitted diseases and other communicable diseases in general. Our activities includeidentifying health risks; maintaining a safe and healthful environment; detecting, investigating and preventingthe spread of disease; promoting healthy lifestyles; and informing the public on health issues.Our broad approach to public health spans environmental health to family planning, refugee health toimmunizations and nutrition for women, and infants and children to the prevention of chronic diseases.We also participate in disaster planning and facilitate the staffing of shelters for people withspecial health care needs in the event of hurricanes or other disasters. Further, we maintain thecounty’s vital records of births and deaths, develop school health projects and educate the publicregarding healthy behaviors such as avoiding tobacco use, injury prevention and more.We have three full service locations – in the north, central and southern regions of thecounty – and operate other health clinics that serve specific local areas.We have twice received the Governor’s Sterling Award for significant improvement and performanceexcellence, demonstrating our commitment to the health and safety of the communities we serve.Created by the Florida legislature in 1997, MDCHD is the local branch of astate public agency, the Florida Department of Health.

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14Miami-Dade County Health Department2009 Annual ReportFrom the Surgeon GeneralTo the Citizens of Miami-Dade County:As State Surgeon General of the Florida Department of Health, it gives me great pleasure to join the MDCHDin presenting its 2009 annual report.The Florida Department of Health is dedicated to improving access to health care and the quality of theservices we provide. The MDCHD has been a leader in this front and has seized opportunities to improvepublic health through prevention programs and services. It has established crucial partnerships at all levelsto advance public health projects and initiatives.With the challenges our nation has ahead, the role of the Florida Department of Health in promoting andprotecting the public’s health has become more important. However, challenging moments provide us theopportunity to evaluate how we conduct business and explore creative, more efficient options.I want to congratulate the leaders and employees of the MDCHD for their achievements in 2009 as thisorganization continues its commitment to public health and access to affordable, top-quality health carefor all the residents of Miami-Dade.Sincerely,Dr. Ana M. Viamonte-Ros, MD, MPHState Surgeon GeneralFlorida Department of Health

Miami-Dade County Health Department2009 Annual Report 15From the AdministratorTo the Community:It’s with great satisfaction that I present this 2009 annual report to our community. The MDCHD is an organization committed to safeguardingthe public health and safety of all the residents and visitors of our county. This goal would be impossible to achieve without the commitment,dedication and innovation of our employees.The health services we provide to those who need them and all the health initiatives we advance in Miami-Dade are also possible because ofthe tremendous support we receive from partners, volunteers and close collaboration with national, state and local government agencies, aswell as various community organizations and local businesses. During the past year, 1,470 volunteers and partners provided over $29 millionin health care services to more than 57,082 uninsured and underinsured men, women and children.Though recent times have been challenging for us, we continue focusing on what we do best: protect the health of the community we serve.We keep expanding health and preventive services in our existing clinical sites and are closely following the construction of the new Center ofExcellence for Research, Diagnostic and Treatment, at the historic 1350 Building.Protecting the public’s health from diseases, disasters, and bioterrorism is a priority for public health departments nationwide. Pandemicinfluenza, infectious diseases, terrorism and catastrophic natural disasters remain serious threats. We at the MDCHD work everyday to advanceour public health system to respond to a range of threats, from naturally occurring diseases to bioterrorism.In late April, 2009, the World Health Organization announced the emergence of a novel influenza A virus known as H1N1. Our county andthe world can now reap the benefits of investments, over the last five years, in pandemic preparedness. Thanks to our Miami-Dade partnersand their due diligence we have designed local plans to respond to this new threat. Influenza pandemics, whether moderate or severe, areremarkable events because of the almost universal susceptibility of the world’s population to infection.I know the future has in store for us other challenges that we must face with enthusiasm, optimism and professionalism because providinghealth care services and advancing our prevention philosophy is a business we know well and one in which we will continue to excel.I’m very proud of what we have accomplished in 2009 and the excellent work the MDCHD, its employees and leaders have done in protectingthe health and well-being of our community.Sincerely,Lillian Rivera, RN, MSN, PhDAdministratorMiami-Dade County Health Department

16Miami-Dade County Health Department2009 Annual ReportCommunity and Family HealthImmunization ServicesGoals ExceededThe Special Immunization Program (SIP) provides immunizations for childrenand adults. It operates three pediatric and one adult immunization sites, plusa clinic for travelers going abroad. During the years 2007-2008, the programvaccinated 91.8 percent of Miami-Dade County two-year-olds, exceedingFlorida’s 90 percent goal. Another SIP highlight was a broad flu immunizationcampaign brought to health fairs and other events that benefited at-riskpopulations.SIP also provides back-to-school immunizations, educates andmonitors Hepatitis B-positive mothers and children, watches for diseaseoutbreaks, helps schools update and maintain records, and assures thatpediatricians store vaccines properly.School HealthBringing Health to StudentsThe School Health program has established a partnership with Miami-Dade County Public Schools and the Children’s Trust to enhance studenthealth care services. It is part of Health Connect, a large-scale initiativethat also involves local health care providers.Health Connect aims to help children in 165 Miami-Dade public schoolsby improving access to and use of quality health services, buildingawareness of healthy behaviors though education and facilitatingcommunity environmental and lifestyle changes. Through this initiative,these children now have access to a team of professionals who addresstheir physical, mental and behavioral health needs. Our School Healthprogram – with its nurses, social workers, health support techniciansand other personnel – plays an important role in this project.

Miami Dade County - Health Department2009 Annual Report 25Refugee HealthHealth’s Front LineOur Refugee Health Assessment program is the largest of its kind in Floridaand indeed the entire United States. In 2006-2007, we screened over 18,000refugees to identify and control communicable diseases among new arrivals.Those eligible for services include refugees, asylum-seekers including Cuban/Haitian asylum applicants, Cuban/Haitian entrants, Amerasians and certainvictims of human trafficking.In 2006-2007, a total of 17,261 Cuban refugees were screened. This accountedfor 97.8 percent of all screenings conducted. After Cuba, the most frequentcountries of origin of refugees screened are Haiti, Colombia and Venezuela.Tuberculosis Control and PreventionAn “I’m Stopping TB Focus”Our Tuberculosis Control and Prevention program has successfully reducedthe number of TB cases in our county over the last five years. In 2008we experienced a 1 percent up-tick to 197 cases compared to 182 for2007. However, the downward trend continues when compared to 203 casesin 2006 and 268 cases in 2004. The program is a collaborative partnershipwith Corrections Health Services and the Corrections and RehabilitationDepartment, which ensures that public health recommendations andprotocols are followed to improve the efficiency and accuracy of TB contactinvestigations in institutional settings. A strong working relationship withJackson Memorial Hospital contributed to 58 percent decrease in TB/HIV coinfectionin the county over the last five years.Last year, the program celebrated the World TB Day conference under thetheme: “I Am Stopping TB.” The focus was to educate and raise awarenessabout the importance of urgent reporting of TB cases.

26Miami-Dade County Health Department2009 Annual ReportClinical Laboratory ServicesOver 85,000 Patients ServedThis program provides rapid and accurate laboratory diagnostic services toassist in disease control and prevention. Among our customers are 22 clinicsconcerned with sexually transmitted diseases, tuberculosis, family planningand health care for women and children.In 2008, more than 85,000 patients received laboratory services. The programperformed more than 90,000 in-house tests and collected, processed and sentmore than 100,000 specimens to reference laboratories.HIV/AIDSPrevention ServicesOur Office of HIV/AIDS has a number of cutting-edge program initiatives underway.We seek to prevent the spread of HIV/AIDS by raising community awarenessregarding prevention and providing leadership on local and statewide researchprojects. At the same time, we seek to improve delivery of patient care serviceswhile strengthening the overall continuum of care. Programs include:• Proactively participating in a statewide Sista’s Organizing to Survive Women’sConference aimed at mobilizing black women on the impacts of HIV/AIDS anddeveloping action plans that prevent the spread of the disease.• Contractually agreeing with the Center of Disease Control and Prevention toevaluate the effectiveness of AMIGAS, an adaptation of the SISTA HIV preventionintervention, for use with Hispanic women.

Miami-Dade County Health Department2009 Annual Report 35Highlightspost public health information on public transport throughout Miami-Dadeand in community centers. Some of the partners in this project are Miami-Dade Transit, Miami-Dade Library System, the local school district and YMCAof Greater Miami. Also, our website, www.dadehealth.org, was revamped,adding new features to continue informing the public about services,programs and health initiatives.Information TechnologyOur Office of Information Technology is responsible for the operations, supportand development of the IT infrastructure that includes a unified help desk,desktop support, network and security services, infrastructure managementand telecommunications. Through efficient IT services, this departmentenables our employees to better serve Miami-Dade residents. The IT divisionreceived a $100,000 grant from the Agency for Health Care Administration toprovide a full-featured electronic health record system in two of our clinics.AwardsWe received the Governor’s Sterling Award in 2002 and 2006 for performance excellence.As part of our Sterling journey, we built a fact-based performance improvementsystem and made considerable progress in the areas of leadership, strategic planning,customer focus, measurement, analysis and knowledge management, humanresource focus and process management. We utilize a systematic process to developnew services or improvement activities to enhance customer satisfaction and service.We have invested in training our work force in process management techniques inorder to improve outcomes and achieve greater efficiency.Paths of Public Health AwardsAdministrator Lillian Rivera; Samir Elmir, Director of the Office of EnvironmentalHealth and Engineering; and Stephanie M. Atherley, a recently retired nurse fromthe Office of Epidemiology and Disease Control, were honored in 2009 as recipientsof the Florida International University’s Robert Stempel School of Public Health,Paths of Public Health Awards, which were established to recognize individualsand organizations in public health for their contributions and commitment topromoting and protecting the health of the South Florida community.

36Miami-Dade County Health Department2009 Annual ReportDental Program “Seals On Wheels”Dental Services for ChildrenThe school-based “Seals on Wheels” mobile dental sealant program was launched by the MDCHDto help reduce disparities in oral health among the children in our community and providepreventive dental services to vulnerable populations less likely to receive private dental care. Dentalexaminations, oral hygiene instruction, cleanings, fluoride varnish applications, x-rays and sealants areprovided on school grounds, during school hours at no cost to the children or their families.The mobile dental van is staffed with dental professionals and consists of a reception and educational area, a sterilization area andtwo fully equipped dental operatories. A grant from the Health Foundation of South Florida facilitated purchase of the vehicle.During the 2008-2009 academic school year, over 5,500 preventive dental services were provided to approximately1,000 school children. Over 2,000 sealants were applied and 1,300 second graders participated in oral healtheducational presentations that were offered in the classroom settings prior to receiving dental services.Outside of the classroom setting, 5,200 children, along with their families, have received oral hygiene instruction at communityhealth fairs. Our program also participated in five Give Kids a Smile events, to give 300 children free dental care.The ultimate goal of our program is to significantly improve the oral health of the children of Miami-Dade County.

Miami-Dade County Health Department2009 Annual Report 39Consortium’s 5th AnniversaryThe Consortium for a Healthier Miami-Dade marked five years of progress in pursuing its goal of promoting well-being, and preventing illness,disability, and premature death in our community. The consortium is a vital partnership of 50 organizations and 150 individuals which followa common set of goals and guidelines that are modeled after those of Healthy People 2010, a national blueprint for wellness and longevity.Refugee Health Receives AwardThe Refugee Health Assessment program was cited as 2008 Refugee Health Program of the Year during the statewide Tuberculosisand Refugee Health Conference held in Orlando, Florida. The program’s poster board presentation received second placerecognition. Our program is the nation’s largest of its kind, having provided 17,651 new refugee screenings during 2006-2007.Honoring our VolunteersWe honored a large group of volunteers who provided medical and dental services to thousands of uninsured persons at aSouth Miami Hospital reception last October. The honorees included physicians, dentists and other health care professionals.AIDS National ConferenceUnder the theme “Looking Back, Moving Forward” and sponsored by the National Minority AIDS Council, the 2008 U.S.Conference on AIDS took place in Ft. Lauderdale with the participation of dozens of employees from our HIV/AIDSprogram. More than 4,000 government officials, health care workers and those living with HIV/AIDS attended.

40Miami-Dade County Health Department2009 Annual ReportSenior LeadersLillian Rivera, RN, MSN, PhDAdministratorSamir Elmir, MS, PE, DEEDivision Director, Environmental Healthand EngineeringFermin Leguen, MD, MPHMedical Executive DirectorYesenia D. Villalta, MSN, ARNPDirector, Women’s Health & Preventive ServicesRene Ynestroza, MBA, MSMISSenior Public Health Services ManagerOnelia Fajardo, MPH, Dr, BADirector, Refugee Health Assessment ProgramAlicia Reyes-Perez, RN, BSNDirector, Public Health PreparednessKaren Weller, RN, BSN, ICCEDirector, Office of Community Health and Planning

42Miami-Dade County Health Department2009 Annual ReportCreditsCharlie Crist - GovernorJeff Kottkamp - Lieutenant GovernorDr. Ana M. Viamonte-Ros, MD, MPH - State Surgeon GeneralBOARD OF COUNTY COMMISSIONERSBarbara J. Jordan – District 1Dorrin D. Rolle – District 2Audrey Edmonson – District 3Sally A. Heyman – District 4Bruno A. Barreiro – District 5Rebeca Sosa – District 6Carlos A. Gimenez – District 7Katy Sorenson – District 8Dennis C. Moss – District 9Javier D. Souto – District 10Joe A. Martinez – District 11José “Pepe” Diaz – District 12Natacha Seijas – District 13MIAMI-DADE COUNTY LEGISLATIVEDELEGATIONSen. Frederica S. WilsonSen. Nan RichSen. Dan GelberSen. Alex Diaz de La PortillaSen. Alex VillalobosSen. Larcenia BullardSen. Rodolfo “Rudy” GarciaRep. Eduardo “Eddy” GonzalezRep. Oscar Braynon, IIRep. Yolly RobersonRep. Richard L. SteinbergRep. Luis R. GarciaRep. Ronald BriseRep. James Bush IIIRep. Esteban BovoRep. Erik FresenRep. David RiveraRep. Carlos Lopez-CanteraRep. Anitere FloresRep. Juan Carlos “J.C.” PlanasRep. Marcelo LlorenteRep. Julio RobainaRep. Dwight M. BullardRep. Juan C. ZapataRep. Ron Saunders

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y o u r h e a l t h i s o u r b u s i n e s sFLORIDA DEPARTMENT OFMiami-Dade County Health DepartmentMiami-Dade County Health Department • 8323 N.W. 12th Street, Suite 212 • Miami, Florida 33126T. 305.324.2400 • F. 786.336.1297 • Florida Relay Services 1.800.955.8771 • www.dadehealth.org