00:00:11,600	S1:
Welcome to Bismarck Insights with mayor Mike Schmitz, a transparent and engaging conversational dive into meaningful topics impacting local government in Bismarck, North Dakota. Bismarck Insights is dedicated to removing barriers between the city of Bismarck and the citizens we serve every day.

00:00:31,960	S2:
Good morning and welcome to Bismarck Insights with myself, mayor Mike Schmitz. Today we are going to focus on Bismarck Burleigh Public Health and Renee Macke, who is the director. Renee, just give us a little background.

00:00:53,360	You've been with public health Department and as the director for ten years, um, how did you come to this point in your career and this job? S3:
Sure. I've actually been with public health for almost 20 years, and I've been serving as director for the last ten. Um, prior to that, I had some management experience with family medicine clinics, and I have a masters of Health Care Administration. Um, I really enjoy the work in public health, helping everybody, um, in the community, uh, underserved, all populations, um, the vulnerable population. And it's really been a rewarding career for me.

00:01:23,630	S2:
So kind of a ministry.

00:01:25,830	S4:
Would you say?

00:01:26,350	S3:
Absolutely.

00:01:27,030	S2:
Okay. And that is certainly important to serve those vulnerable or underserved individuals, because public health provides a services that are available probably elsewhere, but for a much larger cost. So.

00:01:42,870	S4:
Right.

00:01:43,470	S2:
But before we get to that, we have some exciting news that's occurred for for your operation and department. New facility.

00:01:51,070	S3:
New facility.

00:01:52,030	S4:
Yeah.

00:01:52,190	S2:
Let's talk about that a little bit.

00:01:53,470	S3:
Yes. We're very excited to be at our new location. We were formerly at 500 East Front Avenue, and we had been there since 2005. So about 18 years and just recently moved to our new location on South 26th Street. We were really excited to be there. We're close to the Public Works Department, so that's kind of nice to have a close city department in proximity to us. Um, in addition to that, we are close to some of our community partners. Um, ministry on the margins is just up the street, and a lot of our other community entities are easily accessible to us. Um, we're excited to be in a new location that was really built for public health and what we wanted and what we needed in order to serve our community. Um, so I can talk a little bit about that.

00:02:42,540	S2:
Let's talk about what that facility allows you to do now that maybe you couldn't do before.

00:02:47,340	S4:
Yes.

00:02:48,380	S3:
Um, one of the the major, main things that we're super excited about is our garage space. Um, if you remember, our mass immunization clinics that we've done, we've always been at the event center. Um, and, or we utilized our parking lot before, um, at 500 East Front, but now we have covered space for us to be able to provide services. So in addition to immunizations, if people come in for health screenings, they're able to utilize, um, the drive through method. We have some testing capabilities set up in our garage space, car seat fittings, all of that before it was out in the elements. And now, um, no matter if it's rain or shine or snow, we have the ability to be in that covered space.

00:03:32,130	S2:
So so it makes it obviously far more convenient for your staff.

00:03:36,370	S4:
Absolutely.

00:03:37,490	S2:
Certainly for the individuals who have to use those services to get out of the elements, or maybe they're not as physically capable to traverse longer distances. I guess that would help too.

00:03:49,850	S3:
Absolutely. So a lot of, um, people would come through with like a transit type of bus or a van where they don't have to get out of the vehicle to be able to get an immunization, for example, and to be able to provide that convenient service will be very helpful for us. Also, in addition to that, we have um, level parking. So it's main, um, main street, no steps, easy access. We have a nice drop off point. So people that are handicapped or disabled would be able to come right in on the main floor and not have a little bit more of a cumbersome access that we had previously.

00:04:28,560	S2:
Yeah. Because on the at the fifth Street location, you had to traverse some steps.

00:04:33,120	S4:
And yes.

00:04:34,040	S2:
Um.

00:04:34,600	S4:
Wasn't always that.

00:04:35,320	S2:
When we need to make sure we have appropriate accessibility.

00:04:40,120	S4:
Absolutely.

00:04:40,920	S2:
This is helpful. And with the population that served, that's probably even a greater need.

00:04:45,800	S4:
Absolutely.

00:04:46,800	S3:
Yeah, it's been convenient for that as well. And in addition to that, we have some larger exam rooms than we had previously. We have a lot of families that come in for services. If you have multiple children, they may need immunizations before school or if they're doing wellness screenings. They can come in together as a family and all be in the room and not have to be crowded or take up two exam rooms, for example. And the nurses can serve the entire family in one exam room. So that's been another great addition for us.

00:05:19,110	S2:
It's wonderful. So did we expand our space so we have more more room. And in one location where we separated before in any way, shape.

00:05:28,590	S4:
Or form or just.

00:05:29,870	S2:
Crowded.

00:05:30,670	S4:
We.

00:05:30,910	S3:
Were a little crowded. I think the the space that we have now is more efficiently designed for us. All of our staff are together like the health care, clinical nursing staff, environmental health staff. They're all together in office space versus being separated in different parts of the building. So that will improve our communication and efficiency. Um, for that and um, the, the space wise, we had about 17,000ft² that we occupied at our former location. And at this location it's about 22,000, but that includes the garage space. So it is a little bit larger, but it includes that additional garage facility.

00:06:09,540	S2:
And just more efficiently.

00:06:10,540	S4:
Designed. Exactly.

00:06:11,540	S2:
So is it allowing us to expand our services or are there any services we weren't able to perform that we really should have been performing?

00:06:18,060	S3:
Um, at this point, our services that we provided at our former location are coming with us to the new facility. So we'll be providing the same types of services, but we could be doing them in a different way. Um, so if we have the drive through capability, for example, or if we're doing a health screening, um, if you wanted to do a for Covid testing, we did a lot of Covid testing. That was drive through capability. People could come through, get a swab, and we have the testing machines right in our garage space. So those types of things are new.

00:06:49,610	S4:
Okay.

00:06:50,170	S2:
So let's talk about services. What are the services that your department, Bismarck Burleigh Public Health provides? We have a long one.

00:06:58,370	S4:
It is a long list.

00:06:59,850	S3:
There are several divisions within our agency. And I think what I'll first talk about is our health services division. That is our registered nursing staff that are seeing clients in the office doing appointments. So typical appointments might be immunizations, injections, TB testing, cholesterol screening, blood pressure screening, those types of things. Also we have a car seat program where people are getting their car seats fitted. Um, in addition to the new mom baby types of education, wellness visits, breastfeeding support, lactation counseling. So that's our health services division. And then with health maintenance that is our home health nurses. So those are all registered nurses as well, but they're going out into the home to provide service. So someone that might be an elderly person or disabled and make it hard to get to the clinic, for example, they could qualify to be seen by our nurses once a week for maintenance types of things.

00:08:06,960	S2:
So when you talk like med med medication or just general.

00:08:12,400	S4:
Medication testing and checks.

00:08:14,440	S3:
Yep. A typical visit includes, um, the medication set up. So they do their weekly medication planners. A lot of them are on several medications, have several chronic conditions that the nurses are helping to manage, and they'll do a head to toe assessment to make sure everything is going okay. The one nice thing about having those nurses go into the home, um, is the ability for them to catch things that may not be caught. Otherwise, if someone has some swelling or a wound that looks infected, they're able to assess that and then contact their health care provider to make them aware. And a lot of that has prevented hospitalizations.

00:08:54,510	S2:
So let's talk about that a little bit. And because it is an outreach program and obviously we have a facility and a lot of people come to that. But you go to the homes and not just in Bismarck. We go to the entire county of Burleigh.

00:09:06,870	S4:
Correct?

00:09:07,270	S3:
Absolutely. We are going out into Burleigh County. We do school nursing in the rural Burleigh County schools. We take flu shots out every year to the senior centers out in the county. Um, and when we are asked to do any sorts of presentations or anything along those lines, as far as education goes, um, our nurses are willing to do that. So serve the entire the entire area.

00:09:31,590	S2:
Do we make home visits out into the county?

00:09:34,230	S3:
We do make home visits as well. Yes. We have a nurse that goes out into the county and has a client caseload. Um, so she will make those once a week visits to the county residence.

00:09:44,470	S2:
I think it's important for people to know that you're not just sitting in the facility in Bismarck and only worry about the the residents or citizens of Bismarck. This is truly a county wide program.

00:09:56,140	S4:
Absolutely.

00:09:56,980	S2:
So are there other services on the health side or that you're providing? I know there are some other areas that you are responsible.

00:10:03,940	S4:
For your.

00:10:04,740	S2:
Health, but they're not personal health.

00:10:06,340	S4:
Necessarily, right?

00:10:07,420	S3:
One thing I'd like to mention, too, is we've recently got a medical mobile medical vehicle, so it's actually a transit van that is set up for us to be able to do immunizations and outreach clinics. So we have done some immunizations at Ministry on the margins, Sacred Pipe Resource Center. They have events in the community that we've been invited to, and we can take all of our supplies and everything in our van and take it to them, where the people are coming for an event or an activity or food pantry or services, and be able to provide immunizations for them on site, rather than them having to schedule an appointment to come to us. So that's another outreach activity that, um, with the last couple of years we've been doing.

00:10:55,050	S4:
And again, community.

00:10:55,890	S2:
That's not just limited to within the city limits.

00:10:58,410	S4:
Correct.

00:10:59,130	S2:
If it is Wilton.

00:11:00,850	S4:
Correct, we could take it.

00:11:02,050	S2:
There.

00:11:02,450	S4:
Or.

00:11:02,970	S2:
Yep, or wing or wherever we would need to go.

00:11:06,810	S3:
Absolutely.

00:11:07,410	S4:
Yes.

00:11:08,090	S2:
That's wonderful. Um, any other health care directly related services.

00:11:14,810	S4:
That.

00:11:15,290	S3:
I think that those are probably some of our main, our main programs and services that we have. Another one is wellness screenings, health tracks program. Um, that's for Medicaid children zero to age 21. Um, they have to have an annual screening and they do development testing and that type of thing. So that's another service type of program.

00:11:37,090	S2:
So let's talk about some of the other areas that your division department is required or does.

00:11:43,400	S4:
Do.

00:11:44,120	S2:
Provide services.

00:11:45,000	S4:
For.

00:11:45,480	S3:
One of the programs that you may have heard about before is the Women's Way program, and that is a breast and cervical cancer screening program for income eligible women that might be, um, underinsured or non insured and need to have those preventive screenings done. Women's way will enroll the individual with this program and then have the ability to go through and do their pap smears or their breast exams or their mammograms. And then if they find anything during that time, there is another option of our Women's Way Resource Fund that can help individuals support treatment if something is caught on those screenings. So really a valuable resource for women.

00:12:30,960	S2:
So do you find as a health professional, health care professional that that's a very large need of an underserved population.

00:12:38,920	S3:
It has been a very large need. I know we've gotten some changes in the last few years with preventive services being covered with the Affordable Care Act, so that has changed somewhat, but there still are a lot of individuals that may have really high deductibles or just need the reminder or the encouragement to go in and have a screening done. And when they know that you have a nurse that can do some case management for you, that helps to get them in for that appointment and do some preventive screens.

00:13:10,390	S2:
And do we provide this program at the facility or is it is there outreach with it as well?

00:13:15,270	S3:
There is outreach with that as well. Once again, she, our case manager, will go out into the health care facilities, provide education that this program exists. So we get a lot of referrals from the health entities, also community organizations. And just being out in community events. She'll do a lot of events just to call attention to the program so that people are aware of this opportunity and trying to get people enrolled as much as possible.

00:13:46,170	S4:
Okay.

00:13:46,930	S2:
Do you have any sense for how many individuals we might be serving through Women's Way as an example?

00:13:52,930	S3:
I know that they usually have a goal every year, and I think it's a couple of hundred that she's had in the last couple of years, if I remember correctly. I can't think of the exact number, but I know, um, they have a goal every year to serve a certain amount of people, and we are grant funded with that program. So that comes through, um, the state health department, where we're able to have funds to support those efforts.

00:14:19,410	S2:
Am I back up? I should have asked you that about just general, the the prior health care conversation we were having in general for public health, roughly how many clients patients are we handling through the normal, what people might think as public health vaccinations and so forth?

00:14:36,890	S3:
Um, Gosh, that's hard to say. Off the top of my head, I know that. Um, it kind of depends on number of services and what area that you're talking about. I know during, um, when we were doing lots of vaccinations and mass vaccination clinics, um, just in that time period in the last three years, we had Covid vaccinations going on and, and that and I know it was close to 25,000 people that had come through just for those vaccinations. Um, so it can vary year to year depending upon what's going on. During H1n1 influenza, for example. That was another time where we're serving a lot more people than than normal. So it can fluctuate. Um, but we're open to anyone and anyone can come through if you have insurance or not. We are able to bill insurance, um, for immunizations. Um, I will say that our nurses are really the experts when it comes to immunization schedules and getting people in on time. I know there's certain age. Certain ages and numbers of years to be eligible for vaccines, but they're really on top of those schedules and can help people get up to date.

00:15:47,750	S4:
So.

00:15:48,070	S2:
So if we just step back and say, well, we're in one year, maybe we serve 25,000 people and maybe that's relatively consistent. Maybe it's a little lower than that on a normal year. But that's a pretty significant portion of the residents of Burleigh County.

00:16:00,670	S4:
Absolutely.

00:16:01,590	S2:
That that are either they're coming, maybe they have insurance, they're not underinsured, but a whole lot of those people may well be underinsured. And if that's 20, 25% of our population, this is a very critical need.

00:16:13,390	S3:
Absolutely. And we're there no matter what. So one nice thing you can call public health. I know we get calls about all sorts of topics similar to fire and police. If you have a question or if you have a fire, you may not have never experienced that, but they are available to you if you do need them. And same with us. We've gotten phone calls about different types of things. Head lice outbreaks, for example. What do we do with a child that has head lice and bedbugs? How do we handle handle that? Somebody had stayed in a hotel and and brought bed bedbugs back home. Just that education piece to call and assist. They can call us anytime and anybody can call us anytime.

00:16:55,420	S4:
Sure.

00:16:55,820	S2:
So so education that you bring that up and we kind of talk about it a little bit.

00:17:04,580	But what are the educational programs that you're offering? S3:
We have a lot of different educational topics. Our tagline is prevent, promote, protect. So we're really doing a lot of prevention efforts, wellness screenings. We have a dietitian, Katie Junkie, as our dietitian and does worksite wellness types of activities out in the community. Um, she's doing, um, different cholesterol types of activities, action, cancer prevention. It's just a wide range of topics. And we have a lot of experts in our area that are able to speak to the different topics based on the need and the request.

00:17:40,210	S2:
Well, wonderful. And you mentioned experts. So what what experts do we have on staff? What are their general field of knowledge?

00:17:49,610	S4:
Sure.

00:17:50,330	S3:
So a majority of our staff, they're registered nurses. So bachelors their BSN Bachelors of Science in Nursing. In addition to that, we have public health educators who have an education and background in public health education, prevention, that type of thing. We also have environmental health specialists. And those individuals are going out into the home sometimes to do an assessment on vulnerable adult, and they're going out into businesses there doing the food inspections, tanning facilities, lodging facilities, all of those types of things. So a wide variety of professionals.

00:18:29,730	S2:
Okay, let's talk about environmental health a little bit more. You mentioned it briefly here.

00:18:36,080	What do you have to do? S3:
Environmental health is a big division and they have a lot going on. So all of our restaurants get licensed every year. So we have inspections that these individuals are going out into the facilities to ensure that the food is being kept at proper temperature, and everything is meeting the safety guidelines. Um, in addition to that, there's tanning facilities, lodging facilities that they're going in and, and licensing and inspecting throughout the year. Um, they also do a lot of, um, things with junk or nuisance complaints. I know that it's more of a public health nuisance. So if you think of, um, junk storage, there could be the potential for vector, um, rats, mice, that type of thing. A concern where they're going out if it's on a complaint basis. So if someone sees something, we do get calls and then they'll react to that. And then they do an annual spring survey of the community just to kind of see if there are needs that aren't, um, so addressed.

00:19:40,350	S2:
So what would be the process if somebody feels there's a location in the community that is cluttered, maybe a place to harbor nuisance pet pests?

00:19:55,590	S4:
Yes.

00:19:56,470	S3:
So the process right now, you can call our office, our environmental health division will take that complaint and document that, and then they'll have an environmental health specialist go out and do an inspection, provide a report back on what was found. And then that is compared to the ordinance. And there are our city ordinance and title eight, several areas that are listed that if it meets any of those criteria or if it's not following ordinance, then that, uh, gets a notification letter sent out to say, hey, this is in violation and give them the opportunity to clean that up.

00:20:34,500	S2:
Do we do those inspections outside of the city limits of Bismarck as well?

00:20:40,940	S3:
So for those, it depends if it's a public health nuisance or not. I know that we also work with our planning and Zoning division for Burleigh County. So they do some of those items when it comes to zoning specific. But if it's a public health nuisance that gets involved. So if there would be rodent, you know, infestation or we've gotten some calls about feral cats, for example, and and trying to control the population for that. So um, those types of things would be our, our responsibility in the county.

00:21:16,300	S2:
So it's very important that we're working together with whatever other department might be involved, planning and zoning being probably a very good example in the city and outside.

00:21:24,420	S4:
The county.

00:21:24,820	S2:
And the county, because there are there are building and and inspection related issues there. To correct that, you have to coordinate with. Is there are there other things? Other services you currently are providing that uh, I haven't talked about.

00:21:40,730	S4:
Here with you.

00:21:41,370	S3:
I guess the one thing I would maybe want to mention is our, um, mosquito control program. I know that's another part of our environmental health program. Um, every year they are a seasonal, um, group that comes in and they work out in the field. They're doing spraying of public spaces. So along the parks and the trails, uh, and then they're doing some, some traps, setting the mosquito traps and doing some counts. Um, they'll do species to see if there are, um, West Nile types of mosquitoes. It's really a small program compared to some of the other ones in the state, but certainly a value to be able to control some of that, um, mosquito population.

00:22:22,730	S2:
It is. I mean, when you stop and think about, okay, now we're looking and testing to see if we have a pest, so to speak, coming in that could be bringing disease in. That seemed kind of out of what public health maybe was designed for in someone's mind anyway, right? All the way from that to taking care of health of an individual.

00:22:42,720	S4:
So yeah, it's.

00:22:43,560	S2:
A broad department.

00:22:44,880	S3:
Wide variety.

00:22:46,480	S2:
So what do you think about your future challenges and opportunities? What do we have going on that we need to deal with?

00:22:53,000	S3:
Yes, there's a lot of issues going on right now, and I think a lot of community issues can be focused back on public health just because we are so broad. I know a big thing that we're working on right now is the Behavioral Health Coalition and the efforts that we're doing there with our overdoses, our opioid program, um, behavioral health and addiction. And that's an increasing problem nationwide. And we're certainly seeing that here in Bismarck and Burleigh County as well.

00:23:23,080	S2:
And and what are we seeing in the community that you think is driving that or is there? I mean, I feel as I drive around, there's I can see it. I believe that there has been an increase. A number of individuals who appear to be distressed.

00:23:37,790	S4:
Yes.

00:23:38,470	S3:
We are working with our law enforcement. I know that there are some grant opportunities coming up to address some of these issues. Um, for opioid overdoses, for example, we've provided Narcan to some of the first responders. So they're able to, um, administer that in case of an emergency. We've done education to the public to save a life for Narcan administration if they see someone that's overdosed. We provide that service in our office and really trying to do education on prevention and what we can do, because a lot of what we do is prevention. And we're not about treatment necessarily. We have partners in the community that are doing treatment. But what can we do to prevent the addiction and Education.

00:24:24,940	S2:
Who do we need to get in front of? To get that education going that is going to have a dramatic impact to help these these individuals.

00:24:32,260	S3:
So we work a lot with the schools and I know that it starts it seems like it's getting younger and younger every year. As far as what education we're providing, um, we're seeing additional vaping going on in the schools and really trying to work with the school nursing and the school resource officers to be able to get some of that prevention education in the schools early on.

00:24:54,700	S2:
Well, that's that's awesome. Renee, and I really want to thank you for joining me today. This has been very enlightening, and I hope our citizens and the in the city and in the county have learned a little bit about your department. Um, there's probably way more for them to know. And as you mentioned, they can certainly call and ask questions. Again, thank you for joining me today on Bismarck Insights with myself, mayor Mike Schmitz.

00:25:15,980	S3:
Thank you.

00:25:27,770	S1:
Thank you for watching Bismarck Insights with mayor Mike Schmitz. If you have specific topics or questions you'd like addressed in future episodes. Email Mayor Schmitz at Bismarck and.

00:25:40,450	S1:
Recall the City of Bismarck at (701) 355-1300.

00:25:45,690	S1:
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