JG: When I was in west and central Africa as the regional medical director, I was responsible for maintaining the health care of approximately 800 volunteers, which included training the volunteers directly, providing administrative oversight for the providers, looking at disease patterns of the population of volunteers and the quality of facilities that they used. I was practicing public health for target populations, which is what I am doing in my current position.

JG: My responsibilities include helping to guide the overall Health Department’s medical direction—development and evaluation of standards of medical care throughout the Health Department, providing medical direction to the physicians within the department and advising Health Commissioner John Domzalski in terms of medical policy. I don’t have direct oversight. I’m really more of a policy advisor for the various services and programs.

JG: My policy advisement piggy-backs with in the health commissioner’s initiatives, which include areas such as reducing infant mortality, closing the disparate gap in infant morality in particular African American neighborhoods in Philadelphia. Other areas include increasing immunization rates in particular neighborhoods throughout Philadelphia, improving the epidemic of STD rates in 15- to 19-year-olds in Philadelphia. Our initiatives are in line with Mayor Street’s focus on children and youth. We’re in the process of developing protocol and policy for the health clinics and for the prison system with regard to screening and treatment of Hepatitis C—there will be a set of state-of-the-art guidelines in place.

JG: One thing that I suggested we do is to develop a public-private consortium to address the issue of infant mortality. The consortium will include medical providers, community advocates, hospitals, public and private health-related agencies and government leaders to begin to share ownership of the problem of infant mortality. This group will explore causality and also evaluate the effectiveness of programs that are currently in the community, including Health Department programs. For the immunization rate program, we are continuing to fund a project which started before I got here which, according to our latest statistics, seems to be having some effect. It entails partnering with community-based groups, which are doing direct outreach to the neighborhoods in order to get the public back to their providers to get their immunizations, and to identify those families with children who are under-immunized. These are preexisting community health organizations that have a partnership agreement with the Health Department specifically to go door-to-door and ask mothers and caregivers whether or not their children are immunized against specific childhood diseases and then give the names of providers in the area where they can go to get vaccinated.

JG: Philadelphia has been doing well. The rate of immunization has dropped specifically among African Americans in particular neighborhoods in the city. With the assistance of the community outreach group the rates have increased up to about 70 percent. We’re pleased that the numbers are going in a positive direction. We monitor childhood immunization rates on a quarterly basis.

JG: Sure. I think that, if physicians can be aware of the immunization status of the patients that they’re seeing and continue to make a concerted effort to ensure that the children they see are appropriately immunized. Continuing to share the information with the Health Department with regard to our immunization registry is also helpful in terms of keeping our database and statistics current. Obviously, the ultimate goal is to enhance the health of the community, which I think everyone is interested in doing.

JG: I’m not aware that we have vaccine shortages at the moment. We supply vaccines to every private physician who will in turn supply their immunization data to the Department.

JG: The city is aware of the fact that there is currently an epidemic of chlyamidia and gonorrhea among teenagers. We can to treat as many 15- to 19-year-olds as possible and we have been trying to be creative in terms of reaching them in a number of settings, including recreation facilities. We plan to do screenings in all public high schools in Philadelphia. It’s currently done in five high schools.

JG: We have a lead abatement program that involves identifying children who’ve been affected by lead poisoning, and often relocating the family for a period of time when the abatement will take place-scraping where paint has chipped off and painting over all of the painted surfaces in the home. That has not been done in the past by the Health Department. There are also social workers who go out to a family and give advice on ways to prevent further lead poisoning, ways to enhance a child’s diet in order to decrease the effect of lead in the system and also to ensure follow-up.

We’re also currently involved in an initiative at the city’s eight health clinics to insure as many insurable individuals as possible, while continuing to serve as a safety net for those people who are not able to be insured. We’ve been fortunate to partner with a number of private and community advocacy groups, and with other agencies and departments within the city who volunteer staff for these efforts.

JG: We have in place a biological response plan to handle an infectious disease epidemic that is updated as new information becomes available. We work closely with health agency colleagues and have developed an enhanced communication network in southeastern Pennsylvania and participants are committed to sharing information. We have an epidemiologist at the Health Department’s Division of Disease Control whose job it is to develop a coordinated response to a potential bioterrorist event. We plan to hire an additional epidemiologist, as well as additional personnel who will be trained in first response procedures. We’re in the process of developing a video which will be used to train the police and fire departments about infectious organisms that could be used in bioterrorism. We are part of the city’s Emergency Preparedness Group, along with police, fire, HAZMAT and others, which has been meeting regularly since initial planning efforts around the Republican National Convention in Philadelphia in 2000.