Vaccine Website Up and Running

As of Monday, March 8, 2021, the new online COVID vaccine registration portal is up and running at www.etxcovidvaccine.com. A result of the efforts of a volunteer group known as the Deep East Texas Partnership working with the Angelina County & Cities Health District, the website contains a simple to use bright red link to sign up for the vaccine as well as links to CDC and vaccine information and a link for those interested in volunteering to help with the vaccination effort.

 

The website details who is eligible to be vaccinated – currently Phase 1a (front line healthcare workers and residents at long-term care facilities), and Phase 1b (people 65 yrs. and older and those 18 yrs. and older who have chronic illness; education and child care personnel; employees, teachers and staff in pre-primary, primary and secondary schools; Head Start and Early Head Start programs; and licensed childcare providers). In the first couple of days that the website was live, more than 2,500 people signed up to get vaccinated. For those who cannot register online, they can still call the health district’s Coronavirus Call Center at (936) 630-8500, Monday - Friday from 8AM - 4PM.

 

This website and registration process is the result of many volunteers and organizations in the community coming together to implement what arguably should have been set up earlier. This paper justifiably was concerned about the missteps in preplanning for and coordination and implementation of a hub vaccination effort for Deep East Texas. Recently, however, they were unduly critical of what has essentially been a community volunteer effort to make up for lost ground and get a vaccine registration website up and running. I am grateful for the volunteer partnership that quickly raised a quarter million dollars and organized an army of volunteers to increase our vaccination rates. Sincere thanks are due to the TLL Temple Foundation, Angelina College, the Civic Center staff, and the many volunteers who have gone above and beyond to work with the health district, demonstrating what a community can do when it comes together.

 

So how are we doing with the vaccination effort locally?

 

As of March 9, 2021, 18.4% of the total US population has received at least one shot (23.9% of those age 18 and older). Texas is several percentage points behind the national rate at around 15.2% of the total population. In Angelina County, 12,484 people 16 years and older have received at least one dose (14.4% of total county population, or 18.6% of the eligible adult population). Yes, we are a little behind. The convention center hub is vaccinating 1,200-1,500 people a week. They have capacity to increase that number. With local, regional, and state leadership pressing our case, the hope is that a greater number of vaccine doses will be allocated to our Deep East Texas hub soon. After all, Hardin and Orange counties apparently are allocated so many doses that they have opened their COVID-19 vaccine appointments to anyone.

I have been heartened to read that more and more Americans are willing to get vaccinated. A recent Pew Research survey shows that 69% of the public intends to get the COVID-19 vaccine, or already has, up from 60% in November. This is incredibly encouraging news. About three-quarters agree that a large majority of Americans getting a vaccine for COVID-19 (i.e., achieving herd immunity) would help the US economy. We must keep heading that direction! Just this week, the CDC issued new guidance for those who have been fully vaccinated, including relaxed restrictions on indoor gatherings. There is a light at the end of the COVID-19 tunnel!

 

Regrettably, as David French points out in The Dispatch, “vaccine hesitancy breaks down sharply along partisan and religious lines, and that hesitancy is so profound in white Evangelical communities that it could disrupt the quest for herd immunity.” He notes that Evangelical vaccine hesitancy is both an information problem and a spiritual problem, with White evangelicals being the least likely to say they should consider the health effects on their community when making a decision to be vaccinated. As I have urged many times before, loving our neighbor is the heart of the gospel. For true believers, that love requires – no, demands – action. Two obvious and public actions to love others are mask wearing and getting vaccinated. I have been encouraged by those I know in the faith community who, with few exceptions, are planning to get (or have already gotten) vaccinated. In my estimation, Lufkin has long demonstrated that it is a living, loving community, far more willing to help others than most communities. Let’s hope our final vaccination numbers prove me right!

 

The www.etxcovidvaccine.com website will be an ongoing source of regularly updated information about available vaccines, vaccination locations, and the overall eligibility and registration process. Use the website; it is the easiest, most efficient way to get registered. But if you or your loved one do not have internet access, call (936) 630-8500. Either way, get vaccinated as soon as you are able. Together, we will we protect our community.

Bruised Arms and Bruised Egos – They Will Heal

I have never seen people so grateful to feel flu-like before! Those who have been able to get their COVID-19 vaccinations are happy people. They are proud of their bruised arms and temporary achiness. They walk around with their head a little higher, with a little more spring in their step. It is as if a huge weight has been lifted off their shoulders, even though they still need to be safe.

A sore arm and temporary flu-like symptoms are a small price to pay for extraordinarily effective and safe vaccines. It turns out the Pfizer and Moderna vaccines are virtually 100% effective at preventing hospitalization and death from COVID-19. Out of more than 30,000 trial participants who received either vaccine, only one person became ill enough from COVID-19 to be hospitalized. The Johnson & Johnson vaccine looks to be equally effective at preventing severe illness and hospitalization. For those who have been reluctant to get vaccinated, this excellent news should be quite reassuring.

We are still in the midst of a severe outbreak in Angelina County. As February began, Texas was seeing a 20% decrease in coronavirus cases. However, Angelina County remains in the midst of an “extraordinarily severe outbreak” and at an “extremely high risk” level. Governor Abbott even surged a Department of Defense team to Lufkin to help with our high rate of hospitalizations. Angelina County has had more than 7,350 cases of coronavirus infection since the pandemic began with225 deaths, more than twice the death rate as Texas. Eighty-one of those deaths have been this year.

Unfortunately, most people have yet to get their first shot. They wonder when that day will come for them. The simple fact is, in order to vaccinate more people, we need more vaccine. Much has been made of the delay in getting Lufkin designated as a hub for coronavirus vaccinations, a designation that allows the state to send vaccine in greater numbers than we have been receiving thus far. Our collective frustration arises from the fact that we consider ourselves a healthcare hub for deep East Texas. We have high standards. We know what we can accomplish when we put our mind to it and work together.

Early vaccination efforts were scattershot based on who got vaccine. Each individual entity that received doses – hospitals, clinics like Urgent Doc, the Angelina County & Cities Health District, pharmacies – barely had the manpower to administer the vaccine they were allocated, much less the large volume needed going forward.

As this paper pointed out in last weekend’s frank editorial, we are frustrated that we weren’t one of the first places to be designated a vaccine hub. The hub designation “delay” clarified that communication and cooperation across organizations is an absolute must going forward. Egos have been bruised, not just vaccinated arms. No single person or organization bears all the blame. Lessons have been learned and it is time to move on.

While we were pointing fingers over the hub designation, we overlooked the fact that we are actually vaccinating people at a faster rate than the state and national averages. As of February 4, the day before Lufkin was designated as a vaccine hub, 8.2% of the US population had received at least one shot. Texas was at 7.2%, embarrassingly behind our neighbors New Mexico, Louisiana, Arkansas, and Oklahoma. Yet, 6,384 people in Angelina County had received at least one dose – 9.46% of the eligible population. Even before hub designation, more than 11,000 doses had been shipped to Angelina County since the start of vaccinations. That’s a good start, and a credit to both hospitals, various pharmacies, Urgent Doc, and the health district. But the demand for vaccine is astronomical. Brookshire Brothers – God bless them! – stopped taking names on their vaccination waiting list when an astounding 130,000-plus people had signed up.

Can we do better? Of course. We must. We need to be vaccinating several thousand a week, every week. A fabulous local volunteer effort, organized by Jane Ainsworth and Patricia Jones, will help Sharon Shaw and the Angelina County & Cities Health District get there. Angelina College is organizing staff and student volunteers and offering student nurses to assist with vaccinations. AC’s Krista Brown and Sarah Alvis will help with website and social media marketing efforts once registration and reporting software has been obtained. The TLL Temple Foundation has stepped up to help with that purchase. Rep. Trent Ashby is making sure the state gets more vaccine allocated to us, now that we have hub designation. The more we know, the more we realize this absolutely was going to require everyone’s support. It takes a village to vaccinate a village!

Still, the public needs ongoing information and reassurance. We expect transparent, timely, and reliable pandemic information. The health district, city and county need a designated pandemic spokesperson whose job it is to share facts and educate the public; otherwise, we will be consumed by rumor and fear. What exactly is “the plan” that got us the hub designation? How many are expected to be vaccinated over what period of time? Who goes when? How do people get on “the list” and have confidence that they won’t be forgotten when their appropriate time comes? What are we doing to assure equitable distribution to Black and Hispanic communities and to those who don’t have access to social media and online registration? Tell us, then tell us again; don’t make us beg for information.

I am grateful a more comprehensive vaccination machine is getting ramped up and ready to go, in the end due to the very cooperation, communication, volunteer spirit and get-it-done attitude that make Lufkin and Angelina County a special place to live. We shine as a city and county when we all work together toward common goals for all our citizens. That’s a #LufkinStrong shot in the arm we all need!

What If We Don’t Flatten the COVID-19 Curve?

On April 5, 2020, US Surgeon General Jerome Adams said, “The next week is going to be our Pearl Harbor moment. It’s going to be our 9/11 moment.” The same day Dr. Anthony Fauci, arguably our most trusted spokesperson during this coronavirus crisis, said, “We’ve got to get through this week that is coming up because it is going to be a bad week.” One oft-cited set of projections showed deaths from COVID-19, the illness caused by the novel coronavirus, and resource use (including ICU beds and ventilators) were expected to peak this weekend. That all of this is happening during Easter and Passover only adds to the sorrow.

For those of us in Texas, the wait to peak is a bit longer. Estimates a week ago were for peak resource use on May 6, 2020, but that prediction has now moved up to April 22, with peak in daily deaths on April 24. Texas appears to be flattening the curve. In Angelina County, we have 16 confirmed cases of COVID-19 as of April 9, but only 283 people have been tested so far. We can only hope that the wise and early decisions by our local elected officials, including the Stay Home – Stay Safe order, will have flattened our curve enough to avoid the healthcare crisis experienced in New York, New Orleans, and other cities.

But what if our hopes are unfounded? What if we get a surge of COVID-19 cases beyond what our healthcare system can handle? In New York City, some COVID-19 victims could be temporarily buried in mass graves in a park, as morgues don’t have the capacity to handle the mounting casualties.

Thankfully, doctors across the nation have been giving much thought to this grim prospect. After the 2003 SARS outbreak, North Texas physicians came together to answer that very question: What would they do if a really big pandemic hits and hospitals are overwhelmed? The result was the formation of the North Texas Mass Critical Care Council. The council established that during a time of crisis, the ethical, moral, and medical approach should be that “access to treatment would be based upon the patient’s ability to benefit from it, using objective physiologic criteria.” In other words, medical evidence – rather than insurance status, social standing, what have you – would guide decision-making about which patients are most likely to benefit from ICU interventions when there are not enough ICU beds or ventilators for every patient. The goal – as it should be in any medical crisis – is to save “as many lives as possible.”

In a similar fashion, CommonSpirit Health, the Catholic health system that is the second-largest nonprofit hospital chain in the US (and the parent of CHI St. Luke’s Health Memorial Lufkin), developed Crisis Response Guidelines for Hospital and ICU Triage Allocation. These guidelines are not based on opinion or guesswork. The many criteria used to prioritize who would benefit from ICU and ventilator support are validated in the medical literature and have been compiled to arrive at a robust sequential organ failure assessment (SOFA) score, based on the degree of dysfunction or failure of the heart, lungs, liver, kidneys, brain, and blood system. This SOFA assessment, well known to emergency and intensive care specialists, is used routinely to predict mortality in any critically ill patient.

Based on SOFA scores and other medical criteria, doctors might determine that an elderly patient with COVID-19 whose organs are functioning well is more likely to recover using a hospital ventilator than a young patient with multiple organs shutting down from the virus, but the decision would be based entirely on whether the treatment is likely to help the patient recover. Doctors are expressly prohibited from considering social status, money or other nonmedical criteria when making these decisions. The last thing doctors want to be accused of is indiscriminately playing God.

A recent Wall Street Journal opinion implied that merely considering apocalyptic scenarios would lead to legalizing euthanasia, and that not having guidelines (and thereby wasting resources on those that would not benefit) was morally superior to sound medical decision making. Texas Health and Safety Code §166.009 acknowledges that sometimes difficult choices have to be made and states that provision of life-sustaining treatment is not required if it “cannot be provided to a patient without denying the same treatment to another patient.” There is a larger problem of futile care in this country that did not start with the coronavirus pandemic and it won’t end once this virus is under control.

Crisis guidelines are not written to decide who lives and who dies; they help direct the most aggressive care to those who are most likely to benefit so that the most lives can be saved. Regardless, all patients are to be treated with dignity and receive appropriate and compassionate care. If I, as a physician and community leader, have little to no chance of survival if placed on a ventilator – based on solid medical criteria – but an illegal immigrant (for example) has a good chance of survival, guess who gets the ventilator? Not me. And that is the way it should be.

We must continue to follow the social distancing recommendations of our city, county, and health district leaders in order to minimize the impact of the coronavirus locally. We can do this – we ARE doing this. As the Lufkin/Angelina County Chamber of Commerce is encouraging us, we are #BetterTogether and #AngelinaStrong.

A True Community Health Needs Assessment

The IRS requires charitable hospital organizations to conduct a community health needs assessment (CHNA) every three years and to adopt an implementation strategy to meet the community health needs identified through the CHNA. CHI St. Luke’s Health Memorial recently completed their 2019 Community Health Needs Assessment and will now begin the process of developing, adopting, and implementing a strategy to address identified needs. Much of this strategy will depend on working together with community stakeholders, many of which participated in the assessment data collection and interview process. Additional data was obtained from sources such as the Texas Department of State Health Services, the US Census Bureau, the Centers for Disease Control and Prevention, the Episcopal Health Foundation, and the Robert Wood Johnson Foundation’s County Health Rankings.

The 2019 CHNA was created by the Center for Community Health Development at Texas A&M University at the request of CHI in collaboration with multiple non-profit community organizations, churches, school districts, and individuals. The entire CHNA is published on the CHI website at www.chistlukeshealthmemorial.org/about/health-needs-assessment/. Because CHI St. Luke’s Health Memorial is a regional health system, the assessment covered not only Lufkin and Angelina County, but a seven-county region that included Polk and San Augustine counties, where CHI facilities also are located.

I have a number of thoughts after reviewing this recent assessment.

1. The health of a community is dependent on far more than just availability of health care. This is well-demonstrated by both the Robert Wood Johnson Foundation’s County Health Rankings (www.countyhealthrankings.org/) and the Episcopal Health Foundation (www.episcopalhealth.org/en/research/county-health-data/). To improve health, we must identify and address everything from education level and health behaviors to racial, ethnic, and socioeconomic factors that affect a community’s health.

2. The 2019 CHNA is community-driven, and solutions to our health needs must include the community as well. So many partners exist, including Burke, the Angelina County & Cities Health District, the Coalition, our many school districts, DETCOG, the Texas Forest Country Partnership, and, of course, our city and county governments. All will need to be engaged in moving the needle to improve the health of our communities.

3. The role of the hospital in the community has changed. In the past, hospitals were primarily a destination to deal with an acute episode, like having surgery or managing a heart attack. Now, hospitals must be part of the chronic care management team for patients with heart disease, diabetes, cancer, mental health issues, and more. Hospitals are being graded – and paid – on how successfully they keep patients out of the hospital, if you can believe it! That requires coordination with community partners to ensure that people get the care they need both before and after they require care in a hospital facility.

4. Risk factors – behaviors – such as smoking, obesity, and exercise must be addressed, as well as substance abuse and mental health needs. We are doing this already, to some extent, across organizations and municipalities. More can be done.

5. Education is widely recognized as one of the primary social determinants of health. The St. Luke’s region has a lower proportion of residents with a college degree (14.2%) than either Texas (28.7%) or the US (30.9%). Within the region, the rate varies from a low of 11.6% in Jasper County to a high of 16.7% in Angelina County, yet both are significantly lower than Texas or the US. Household income and insurance status, which are closely linked to education level, also impact community health. Affecting change in these areas will require a generation of effort.

6. One of the key findings of the CHNA – and one that will require a lot of thought and planning to address – is the inadequacy of local and regional transportation. Lack of transportation impacts access to preventive services and early detection of illness as well as access to treatment and follow up.

As a result of the needs identified in CHI’s 2019 CHNA, with few exceptions, premature death rates in our region are higher than the State in virtually every category. This CHNA must not be an exercise on paper only. Follow up must happen. We have a good idea now of the need. We also have strong communities with excellent resources that can come together to find and implement solutions. Our health depends on it.

Continue CPRIT Cancer Research Funding

The Cancer Prevention and Research Institute of Texas (CPRIT) was created in 2007 when Texas voters supported legislation setting aside $3 billion for cancer research and prevention. Since then, results have been measurable and effective. In addition to clinical services that have reached every county in Texas, more than 1,200 grants have been awarded to fund cancer research, product development, and cancer prevention. That amounts to up to $300 million in grant funding annually with 90% dedicated to cancer research. Those dollars have brought world-class research teams and amazing recognition to Texas.

One CPRIT scholar, Jim Allison, PhD, chair of Immunology and executive director of the Immunotherapy Platform at The University of Texas MD Anderson Cancer Center, was awarded the 2018 Nobel Prize in Physiology or Medicine for launching an effective new way to attack cancer by treating the immune system rather than the tumor. Another, Sean Morrison, PhD of The University of Texas Southwestern Medical Center, was elected to the National Academy of Medicine. A CPRIT grantee, Livia Schiavinato Eberlin PhD, an assistant professor of chemistry at The University of Texas at Austin, won a MacArthur Foundation Fellowship, unofficially called a “Genius Grant”.

CPRIT is governed by an appointed nine-member Oversight Committee, who operate under a Code of Conduct and Ethics. CPRIT grants are merit-based and peer reviewed and given to Texas-based entities and institutions for cancer-related research, product development and the delivery of cancer prevention programs.

In my area, the Angelina County & Cities Health District participates with researchers at UT Tyler and with the American Cancer Society to provide colorectal cancer screening and prevention services to indigent and uninsured patients in the East Texas area. This is but one example of how CPRIT funding reaches a local community and an underserved population.

But CPRIT funding is at risk. Legislators are being asked to authorize $600 million in funding for CPRIT over the next two years as well as to pass a bonding authority bill that would ensure sustainability of CPRIT for another 10 years. Programs like CPRIT cannot limp along a year or two at a time; they need sustained funding in order to plan, implement, complete, and report out research and prevention successes and failures.

Some have questioned whether or not CPRIT funding, while “unquestionably noble”, is really an essential function of state government. I get it. But, CPRIT is more than cancer research and prevention. It is an investment in our state and our economy. More than 98,000 jobs have been created and $10.9 billion in economic activity has been generated through CPRIT programs. Ray Perryman, president and CEO of the Perryman Group, an economic and financial analysis firm based in Waco, Texas, said that for every dollar taxpayers have invested into CPRIT since 2007, Texas has gained $2 in tax revenue.

Public opinion is behind CPRIT as well. According to a poll conducted by Public Opinion Strategies, 70% of Texans would support reauthorizing the legislature to increase the bond issue for CPRIT by another $3 billion to extend the program for another 10 years. Nine out of ten voters (89%) say it is important for Texas to remain a national leader in cancer research and prevention by providing state funds for CPRIT.

Texas is doing the right thing when it comes to cancer research and prevention. We can all get behind CPRIT: for cancer research, for Texas, and for our future.

County Health: Where Do We Begin?

First, let me say that the title implies that we are not doing anything for community health, which is certainly not true. The Angelina County & Cities Health District does amazing work, day in and day out, to provide primary care, immunizations, preventive services, and much more. Our two hospitals – and the physicians, nurses, and other personnel who staff them – are monumental institutions of care, providing both emergency and specialty services (like heart surgery, neurosurgery, neonatal care, and cancer treatment) that many towns our size could only dream of. Our city and county governments help in their own way, with everything from parks, sidewalks and public transportation to smoking ordinances that, together, form a net of support for any broad public health initiative.

But now what? Last month, I wrote of our poor county health ranking (as determined by the Robert Wood Johnson Foundation) and the fact that Angelina County is dead last in Health Behaviors, which includes adult smoking, adult obesity, physical inactivity and access to exercise opportunities, excessive drinking and alcohol-impaired driving deaths, sexually transmitted infections, teen births, and food environment index. Collectively, we’ve got to do more to improve the health of the residents of Angelina County.

As President and CEO of the Episcopal Health Foundation Elena Marks loves to say, health is not healthcare. We cannot spend our way to health by doing more medical procedures writing more prescriptions for illnesses. Once people reach the healthcare system (emergency room or hospital, for example), so much of what determines true health has already been ignored.

What are the determinants of health? Dr. Paul McGaha, formerly with the Texas Department of State Health Services and now Chair of the Department of Community Health in the School of Community and Rural Health at UT Health Science Center in Tyler, describes four broad categories that determine a community’s health. First are social and economic factors, which are 40% of health determinants. These factors include education level, employment, income, family and social support, and community safety. Health behaviors, such as tobacco use, diet and exercise, alcohol and drug use, and sexual activity, accounts for 30% of a community’s health. Our physical environment, such as air and water quality and housing and transit availability, are responsible for 10% of our health. That leaves only 20% for what most people think is actually responsible for a community’s health, and that is actual access to and quality of healthcare. Unfortunately, healthcare expenditures nationwide are so unbalanced that 97.5% of spending – a staggering $3.3 trillion – is for that clinical care which only accounts for 20% of health. In other words, only 2.5% of healthcare spending goes to 80% of what determines our health as a community.

The facts are that US healthcare spending – dollars spent on actual care – far exceed other countries, and US spending on “social services” – including education, parks, public safety, transit, public health, etc. – is significantly less than other countries. What do we get for all that healthcare spending? Worse outcomes and lower life expectancy. Yet spending on healthcare continues to rise.

If we are to improve our county health rankings, we must attack determinants of health on all fronts. Much of that attack must come from outside the healthcare community, though those of us in healthcare need to both inform and encourage that discussion. We must consider the community health needs and ramifications in everything we do. How do we affect overall community health by curriculum choices in the schools, choice of grocery store displays (not to mention availability of fresh, healthy groceries), availability of parks and sidewalks, public safety, welfare, public health spending?

To that end, DETCOG has an opportunity to work with the Episcopal Health Foundation to access county by county data on healthcare and social services spending (analyzed by health economist J. Mac McCullough, PhD, MPH) so that we can learn how spending decisions impact the health and well-being of our residents. From that, we can explore opportunities to impact the health of our entire community by allocating our precious city and county funds for the biggest bang for the buck. Along with possible school-based initiatives mentioned last month, we must continue to look outside the box of traditional healthcare spending for ways to actually improve community health. As they say, it isn’t brain surgery. And that’s the point.

We can’t afford to pay for all the healthcare we are currently providing and projected to need in the future. The beautiful thing is, by wisely directing our resources now, we will be healthier and less of a burden to care for in the long run. That, my friends, is a win-win!

A Health Problem We Can’t Ignore

On Thursday, the Chamber of Commerce hosted the 11th annual Salute to Healthcare Banquet, where we recognized the importance of the healthcare sector and its role in the local economy as well as celebrated four great individuals for their contributions to our local healthcare community.

Amber Warner received the Nurse of the Year award for her work as a certified hospice and palliative nurse at Hospice in the Pines and her volunteer work in the community; Pat Todd was honored as Individual of Merit for her advocacy for suicide awareness and prevention; Sharon Shaw got the Healthcare Professional of the Year nod for her tireless work on behalf of the uninsured and underinsured at the Angelina County & Cities Health District; and Dr. Tom Willis was honored with the Lifetime Achievement Award for 30-plus years as an internist in Lufkin as well as his civic and charitable contributions. It was a wonderful night of celebration.

It was also a night of sober education about the poor state of health in our schools and our community at large. Dr. Jeremy Lyon, a retired Frisco ISD superintendent who has a passion for healthy kids and schools, presented a compelling talk titled, “Strong Kids in Healthy Communities: Creating Our Future.”
Angelina County is not healthy. That unfortunate fact is supported by data used to rank counties nationwide and compiled by the Robert Wood Johnson Foundation. These rankings are available for anyone to review at http://www.countyhealthrankings.org.

In Texas, Angelina County is in the lowest 20% for the state for Health Outcomes. Sadly, for Health Behaviors we rank dead last. Eighteen percent of adults smoke, compared with 14% for the state at large (and may states smoke much less than that). One-third of Angelina County residents are physically inactive. And fully 40% of Angelina County citizens are obese! On average in Texas, 28% are obese, with some counties as low as 21% - nearly half of where we are in Angelina County. Finally, life expectancy in Angelina County is almost 2 years and 9 months shorter than for the US as a whole.

All of these factors can be traced back to habits and behaviors we pick up as kids. In 1982, The Dallas-based Cooper Institute launched FitnessGram, a health-related fitness assessment used annually in tens of thousands of schools, reaching over 10 million children across the United States. But even with FitnessGram assessments in our schools, we are not changing behaviors.

Dr. Lyon presented factors in our culture that contribute to negative youth health outcomes as well as barriers and opportunities to improve youth health outcomes within schools and communities. One model - the Center for Disease Control’s (CDC) Whole School, Whole Community, Whole Child (WSCC) model, developed in cooperation with the Association for Supervision and Curriculum Development (ASCD) - is designed to improve learning and health in our nation’s schools. That model starts with the premise that every child in every school deserves to be healthy, safe, engaged, supported, and challenged. The CDC and ASCD understand that health and learning are inextricably intertwined.

The Texas Forest Country Partnership, the Chamber, the Angelina County & Cities Health District, Angelina College, LISD, and hospital and community leaders have already had an information-gathering meeting with Dr. Lyon to consider what steps we may take in Angelina County to improve our county health rankings. Goodness knows, they can’t get much worse. This will require a long-term, coordinated, multi-institutional approach to health and wellness with the entire community providing support.

Together, we can - we must - move the needle toward a healthier Angelina County. Literally, our children’s lives depend on it.

A Truly Community-Wide Cancer Program

Every three months or so, I chair a meeting at CHI St. Luke’s Health Memorial in Lufkin of the Cancer Committee. As an accredited cancer program through the American College of Surgeons Commission on Cancer (CoC) since 1995, we have many different standards we have to meet dealing with quality of care and services provided. Our Cancer Committee – which is composed of the radiation, chemotherapy, and surgical doctors, radiologists, pathologists, and others (nursing, social work, etc.) involved in cancer care – is charged with maintaining a program that meets or exceeds the CoC standards.

There are around 1,300 CoC-accredited cancer programs in the U.S. This represents about 25% of hospitals. However, accredited facilities treat nearly 70 percent of recently diagnosed U.S. cancer patients annually. A multidisciplinary approach to cancer treatment is a key defining feature of accredited programs. In other words, do your cancer physicians communicate with one another and work together on a plan of care for you. The patient is the center and focus of care.

The benefit to you as a cancer patient is knowing that you are receiving quality and comprehensive care, close to home, with a complete range of state-of-the-art services and equipment. A multidisciplinary team approach ensures you are offered current, national guideline-recommended treatment options, including access to clinical trials if desired. Prevention and early detection programs, cancer education and support services are available. Some of these services are in the Temple Cancer Center (radiation treatment) or the East Texas Hematology and Oncology Clinic (chemotherapy), but others may be in local surgeon’s offices or even in the hospital.

Actual diagnosis and treatment of cancer is just the tip of the iceberg of a comprehensive cancer program. As I chaired our Cancer Committee meeting last week, I heard reports about all the great things we are doing out in the community related to cancer patients. Our community outreach coordinator, Tina Alexander-Sellers, presents cancer prevention and screening information to literally thousands of people each year at health fairs and industry and workplace events, educating our community on getting screening mammograms and Pap smears, smoking cessation, colorectal cancer screening, and even lung cancer screening for smokers at high risk for getting lung cancer.

We got an update from Sharon Shaw on the colorectal cancer screening efforts for under- and un-insured patients through the Angelina County & Cities Health District as part of a state grant in which we participate. Angie Whitley, our nurse over Women’s Special Services, detailed the number of low income women reached for mammograms and Pap smears through our state grant in her area.

Jay Gilchrist, our Vice President of Mission Integration, talked about CHI’s Community Needs Assessment and a new FQHC (Federally Qualified Health Center) branch office to be opened soon in North Lufkin, further expanding the healthcare options for our minority and underserved populations.

We discussed how we can meet a need we have in the community for more and better palliative care, which extends beyond just cancer patients and end-of-life care. Palliative care is focused on providing relief from the symptoms and stress of any serious illness, even while curative or aggressive treatment is being administered. It is a recognition that all patients and families want to maintain or improve quality of life even when dealing with a serious illness, not just when an illness is terminal.

The American Cancer Society representative, Daisy Drinkard, updated us on the impact the ACS is having by reaching patients through our oncologists at the East Texas Hematology and Oncology Clinic and at the Temple Cancer Center as well as through their strong work at the ACS office.

The Temple Cancer Center social worker, Apollonia Ellis, described how she is helping meet the needs of dozens of cancer patients already this year with navigation needs, be it transportation, lodging, or psychosocial and spiritual support. Our nurse practitioner, Kim Burnett, and oncology nurse, Madelene Collier, reviewed programs we recently developed dealing with genetic counseling and testing as well as cancer survivorship.

In addition, patients that are diagnosed and/or treated at CHI St. Luke’s Health Memorial in Lufkin are tracked and followed by our Cancer Registry, which has entered more than sixteen thousand patients since 1990. Our certified tumor registrar, Ginger Strange, can analyze patient data over the years for type of cancer, stage, treatment given as well as results.

As you can see, a comprehensive cancer program is about so much more than “simply” treating cancer patients, as if that alone was simple! Quality, multidisciplinary care includes recognizing and providing solutions for the needs of cancer patients both in and out of the clinic. I am proud of our truly community-oriented cancer program at CHI St. Luke’s Health Memorial in Lufkin. Kudos to all who are a part!

Colorectal Cancer Screening: 80% by 2018

Katie Couric has raised awareness of colorectal cancer ever since her husband died of the disease in 1998. Yet colorectal cancer remains the second leading cause of cancer death in the United States, only surpassed by lung cancer. Both are preventable: lung cancer by not smoking, and colorectal cancer by screening for and removing precancerous polyps.

The American Cancer Society has teamed up with the CDC (the Centers for Disease Control and Prevention) and other organizations to set an ambitious goal of screening 80% of eligible people for colorectal cancer by the year 2018. Screening for colorectal cancer is incredibly important because removing precancerous polyps actually prevents colorectal cancer. Across the nation, if 80% of the eligible population gets screened, it would prevent 277,000 new cases of colorectal cancer and 203,000 deaths (270 of those in Angelina County!) within 20 years. Those are staggering numbers.

Why so high? Because one in three adults in the United States between ages 50 and 75 – about 23 million people – are not getting tested as recommended. In Texas in 2016, there will be 9,680 new cases of colorectal cancer and 3,520 deaths. This translates in Angelina County to about 36 new cases and 14 deaths this year alone. Remember, these are preventable deaths.

How are we going to achieve this screening goal locally?

The Angelina County & Cities Health District, CHI St. Luke’s Health Memorial, the Temple Cancer Center and our local gastroenterologists have teamed up with the American Cancer Society and CPRIT – the state-funded Cancer Prevention Research Institute of Texas – to educate our area population and screen eligible patients for colorectal cancer through a cooperative grant headed by UT Tyler. Most insurances cover routine screening, but this group stands ready to make sure that any eligible patient, whether insured or not, has access to life-saving screening and, if a cancer is found, treatment as well.

There are many ways to be screened, but I want to focus on the two most available. These two  - colonoscopy and FIT testing – are also funded under the CPRIT grant and by almost all insurances. Having a colonoscopy is the best test, in my opinion, because if any polyps are found they can be removed right then and there. If the colonoscopy is negative, nothing else needs to be done for 10 years! My wife and I had ours done the year we turned 50, and it really is not a big deal. Yes, you have to do a bowel prep to clean out your colon, but that is a small price to pay for peace of mind for 10 years.

The second test covered under the CPRIT grant – and the one that will be done most often at the Health District – is the FIT (fecal immunochemical) test. It is a test for hidden blood in the stool, which can be an early sign of colon cancer. This test is done at home by using a small brush to collect some stool and place it on a test card. The test kit is then mailed back to the clinic for processing. The FIT test must be done every year, as opposed to the colonoscopy every 10 years, but it is cheaper and doesn’t require a bowel prep. If the FIT test is positive, a colonoscopy is then necessary.

If you are between the ages of 50 and 75 and have not had a colonoscopy in the last 10 years or had an annual FIT test, ask your doctor to schedule you for one. If you do not have insurance, call Angelina County Connects at (936) 633-1442 and ask the eligibility specialists if you qualify to be screened under the CPRIT grant. Let’s work together to prevent cancer and get to 80% by 2018!