In an ideal situation with any epidemiologic investigation the investigator has medical records in hand with practitioner interviews and a willing patient/guardian participant. This idea situation often does not exist and it is more difficult with certain conditions than others. Those conditions for which it is a larger challenge are those that people do not want to talk about due to embarrassment or social stigma and some others just are not seen as important enough to the general public and they simply do not want to waste their time talking to a public health official about the experience. Often times too, they do not remember enough to answer all of the investigators questions. Those are typical problems for most investigators throughout the United States. Texas has those, plus some.
Here in Odessa, we have a boom and bust oil industry. With that comes an expanding and contracting population. Of course we all know that with people comes disease. They can be genetic, chronic, contagious, or regionally atypical. They come in all shapes and forms in our community and, as such epidemiologists, health department workers, and health care worker in Odessa have their work cut out for them.
For most lay persons is it about recognizing and treating a certain condition and that should be all there is to it. Right? Not so. For a great many conditions there is little beyond the treatment that needs to happen. There are a number of conditions (most of them fit into the categories of common or extremely severe) that we like to keep track of. They are ailments that give us a picture of the whole population and tell us where we need to focus our efforts in terms of care.
When a person is reported to the health department as having been diagnosed with one of these conditions the next step is to go over the patient's records and determine (based on a set of criteria) whether or not they need to be reported. This reporting is guarded very strictly by the Health Information Privacy Protection Act (HIPPA). Often the records provided do not answer all of the questions that we need in order to have an accurate picture (specific symptoms, medications taken etc.) and we need to call the patient. That is where the roadblock happens.
In Odessa there are a large number of individuals whom do not live and/or work legally in the U.S. Often when they are ill they seek care and provide erroneous phone numbers, addresses, and if we are lucky enough to contact them they refuse to answer any questions.
The bottom line is this: that is not the concern of the health department. We do not look into citizenship status, credit ratings, arrest records, CPS files, or anything of that nature. Our only goal is to monitor and attempt to improve the overall health of the entire population. It is difficult to do this without some level of cooperation from the public.
We have to attempt to educate the public and understand that there is a larger picture, but to complete that picture everyone needs to play a part in its creation.