Elsa DeHart likes to say that when public health is working, nobody notices it. Public health workers spend most of their careers in the background, quietly tracking down stray tuberculosis cases, getting infants vaccinated and answering teenagers’ questions about STDs.
That changed in March, with the COVID-19 pandemic. Public health officials around the country have been thrust center stage.
Here on Kodiak, DeHart has become one of the faces of the COVID-19 response. Officially, she is the medical liaison for the Emergency Operations Center and Emergency Services Council, advising public officials on the latest science and coordinating with medical providers.
But it’s more than that. She’s also been on KMXT more times than she can remember and appears every week on the EOC’s weekly update on Facebook Live, videos that get watched thousands of times. It’s not something she ever thought she’d be doing.
“I didn’t know all that would happen,” DeHart said. “But it really feels important that the right message gets out there.”
The message is being heard too.
“She really speaks in layman’s terms about what’s going on,” Kodiak Mayor and Emergency Services Council member Pat Branson said.
“You don’t need to be in the health care industry to understand what’s going on … She’s our Dr. Anne Zink of Kodiak. Dr. Zink is everyone’s hero, and I think Elsa DeHart fills that role for our community.”
DeHart works out of a cozy office on the bottom floor of the Griffin Building that looks out on the harbor. Basil grows in the windowsill and tapestries hang on the wall.
She grew up in Iowa and then met her husband in Wyoming. They moved to a small cluster of homes in northern Idaho. There weren’t any schools there, and she and her husband had always talked about moving to Alaska. When they had kids, they packed up everything and headed north.
“We looked like the Beverly Hillbillies with all that stuff stacked on our truck,” DeHart said.
They were in Fairbanks for a few months, then Valdez for four years, and then they came to Kodiak, where DeHart has been for the past 30 years.
At first she was a lay midwife, helping women deliver babies at home. Then the rules around midwifery changed, and she wasn’t able to do as much. She and her husband had four kids at that point, and she felt like she needed to do something that could help support them.
At first she thought about going to school to be a certified nurse midwife. But she shifted toward public health instead.
She went to nursing school in Anchorage. While she was in school, she got what was called a Fuld Fellowship, a program designed to introduce nursing to students in public health and health policy. It pulled one student from each state in the U.S. Dehart represented Alaska.
They went to Washington, D.C., New York and elsewhere and heard experts talk about public health and how changes upstream in the health ecosystem could help countless patients downstream.
“When you’re taking care of a person in a hospital or in a clinic, you’re making a difference to that person and their family, but when you’re changing policy, then you’re influencing the lives of so many people. It’s just the bigger picture,” DeHart said.
That realization pushed her into the field where she’s been ever since. She got her degree as a family nurse practitioner, and then applied for a job at the Department of Public Health in Kodiak, where she’s been ever since.
She was a public health nurse for over a dozen years, and at one point left for a year to work at the “one nurse station” in Haines.
Now she’s a reproductive health consultant. That means when there isn’t a global pandemic looming over the world, DeHart thinks a lot about syphilis, contraception and the like. She writes policy about reproductive health, helps educate other public health nurses around the state, helps manage the pharmacy in Kodiak, and a host of other responsibilities.
In her years working in public health, DeHart has seen Alaska’s public health budget get cut over and over. That’s one consequence of always working behind the scenes, she said.
In most places in the U.S., public health is run locally by counties and cities. Public health in Los Angeles, for instance, is run by Los Angeles County.
That’s not the case in Alaska. Article 7, Section 4 of the Alaska State Constitution reads as follows: “The legislature shall provide for the promotion and protection of public health.”
It’s only one of eight states in the country whose constitution mentions public health.
That means the state provides public health services, but it’s no guarantee it won’t cut them down too. Alaska, like much of the U.S., has whittled away at public health budgets recently.
In 2014, the state spent $28 million on public health nursing and $7.6 million on epidemiology. Budget cuts have reduced those numbers to $22 million and $2.2 million this year.
Staffing has dropped too. The 2014 budget called for 110 public health nurses, while the 2020 only included 89. In the 2020 budget, the authors of the public health section wrote about staffing woes under the header “Key Component Challenges.”
“Professional registered nurses and administrative staff continue to decline job offers or seek other employment, making it difficult to recruit and retain qualified staff … The reduced workforce decreases capacity to provide timely and effective response to emerging outbreaks and threats while maintaining other core services,” it read.
“I think all of the people who worked in public health were frustrated,” DeHart said. “But I think people also understood that budget cuts needed to happen and public health just isn’t out there when it’s working.”
Then COVID-19 happened. In March, Alaska Gov. Mike Dunleavy scrambled to allocate $13 million in new funding to mitigate the virus by hiring 10 new public health workers.
On Kodiak, the EOC convened its first meeting in mid-March and decided to bring on DeHart as its medical liaison.
Mike Tvenge, the manager of the city of Kodiak, the head of the EOC, and another public face of Kodiak’s COVID-19 response, called DeHart and asked for her help.
“She’s wonderful to work with,” Tvenge said of DeHart. “She’s very engaged and she’s knowledgeable.”
Not only that, but DeHart works for the state, and not one provider, giving her a larger scope.
“We didn’t need one provider versus another provider sitting in that role advising the EOC and the ESC,” Branson said. “We needed a neutral party. She has just been the perfect choice for that.”
The pandemic has presented huge challenges to public health workers. They must track down every case, call strangers and ask personal questions, manage data, field media questions, talk to the public and more.
It’s piled onto an already full plate. There’s a whole other world of other diseases, for instance, that haven’t gotten any less deadly or contagious since COVID-19 appeared. They still need to be managed. There are still kids who need shots and prescriptions that need to be filled.
“We’re down to our basic, highest-priority needs,” DeHart said. “We’d like to do everything for everybody. And we can’t right now, so it is hard … COVID stuff is really interesting, but it’s also stressful and it’s just all-consuming. ”
When it comes to talking to the public about this complex disease, DeHart credits her experience in church leadership with her communication skills. She’s been a deacon at St. James the Fisherman Episcopal Church for years.
“Over the years I’ve gotten used to talking to people and having to do that,” she said. “Who ever knew that would pay off, right?”
And as all-consuming as controlling the spread of COVID-19 has been so far, public health might even have a bigger job down the road. Once a vaccine is available, DeHart and her team will likely play a big role in distributing it.
“We’re already starting to think about how we’re going to do that,” DeHart said.
As for her, DeHart thinks she’s got a few more years of work left before she retires. She and her husband still own their place in Idaho, and that’s where they’ll eventually land. She said she might do some online teaching if she gets the chance.
“You never know. I thought I was going to be a certified nurse midwife. I never thought this would be where I am at this point,” she said. “But you just kind of go through the door that opens for you.”