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Jimmy Guidry, MD
State Health Officer and Medical Director, Louisiana Department of Health and Hospitals
PUBLISHED: September/October 2011
Jimmy Guidry, MD, is the State Health Officer and Medical
Director for the Louisiana Department of Health and
Hospitals (DHH). As Medical Director, Dr. Guidry is responsible
for medical consultation on a variety of health
care policy issues, including health care programs and
quality of care issues. He also serves as the Department’s
liaison with medical, nursing, pharmacy, and allied health
professionals as well as with professional associations
and organizations throughout the state. The Medical Director’s
Office also houses the Office of Emergency Preparedness
for DHH.
Dr. Guidry chairs various task forces, including the DHH
Obesity Task Force, the Child Death Review Panel, and the Governor’s Task Force on Tuberculosis, and represents the
state at medical and environmental engagements across
the country. Prior to this position, Dr. Guidry served as the
Assistant Secretary for the Office of Public Health and the
Acadian Region’s Medical Director. He has also served as
Director of Adolescent Services at LSU School of Medicine,
Pediatric Department, Earl K. Long Hospital.
Dr. Guidry received his Bachelor of Science degree from
Southwestern University, earned his doctorate from the
Louisiana State University School of Medicine and completed
his residency at Earl K. Long Hospital. He has been
Board Certified since 1984 and is a Fellow of the American
Academy of Pediatrics.
Smith W. Hartley: What are some of the current
public health initiatives that DHH is working on?
Dr. Jimmy Guidry: From the public health perspective
there are a number of things and it depends on which arena we’re
talking about. It used to be when disease outbreaks were reported
to the Office of Public Health they would send it by mail and
it would get there days or weeks after an event occurred. It was
a way of documenting what was going on in a community, but
there wasn’t a whole lot you could do about mitigating the spread
of infection—you’d lost some valuable time. Now with the technology
we have today, you actually have reporting of diseases in
real time and literally can put the word out to providers to be on
the lookout for an outbreak. We really got tested when H1N1 occurred.
It was handled very differently than in the past because,
one, of technology and then the fact that public health culture
now is that we’re available 24-7. It used to be it was a government
job, 8:00-4:30. Now when people are hired they’re told if something
is happening they’re literally going to be working around
the clock. So our employees are aware that if there’s a storm or
an outbreak or whatever the issue is, whatever it’s going to take
to take care of that issue, they have to be available.
So H1N1. There were years of planning. What if there’s this new
virus that comes out and starts infecting people and what if it’s
virulent, what if it’s going to kill people and if it is, how are you
going to mitigate that? Well you have to be prepared to give antivirals,
which is medication that has been stockpiled in case we
need it. Well Public Health has a stockpile and has to get it out
to the public if we have a real bad strain because it takes a while
to develop any vaccine. So while you are waiting for the new vaccine
development you have to be able to give these pills. During
the H1N1 event, thank God it wasn’t a real virulent strain,
but when it came out of Mexico everybody thought there were a
number of people dying so we were closing schools. Within one
weekend we got antivirals out in hospitals, nursing homes, the
entire state, with the help of our partners. What we’ve learned is
that public health, which used to be more about the knowledge
of the disease and working through the Centers for Disease Control,
is now really having to deal with the public’s health and so
we deal with spread of infection, food-borne outbreak, bioterrorism
events. It is just more and more varied. So your knowledge
base now, the learning curve, is huge because you have to be able
to deal with whatever the circumstance is to mitigate either infection,
mortality or morbidity. So it takes people that are very
knowledgeable, available, and working with all of our partners to
make things happen. For instance, with the antiviral. A private
company had to ship it, we had to store it, we got the National
Guard to help us deliver it, we had State Police escorts to help us
get the medicines. So you have numerous partners, private and
public, for one event.
SWH: With regards to providers reporting, how do
you characterize the challenges with that? Do you feel
like you are capturing everything or most of what’s out
there?
Jimmy Guidry: It used to be that people reported it once
they had made the diagnosis. As a result of 9-11, we now have
what we call syndromic surveillance. If there are certain syndromes—
cough, sneezing, sore throat—and there’s a large
number of them occurring, we are notified, before we even
know what it is, that something’s happening here that’s different
from normal. To show you how we use this, during the
oil spill, people were being exposed to chemicals. The question
was, was it impacting their health, was it creating problems
towards their acute health? So we had reporting from hospitals
and providers on what they were seeing out there. And
we literally went back and looked at the past three years at
what was the respiratory disease at that time of the year? How
many people were coming in with pneumonias, bronchitis or
sinusitis? And was there a difference now they were breathing
in these chemicals because you would expect it to impact your
lungs? It actually showed that the asthmatics weren’t coming
in any more than they had before and they would be very sensitive
to fumes. So acutely we weren’t seeing the illnesses as a
result of this event, where before we just wouldn’t have known.
Now there’s actually input and we have surveillance going on.
Not every provider out there is doing this, not every hospital
is doing this. You don’t have to have them all doing it, but you
need to have key places doing it so you can understand what’s
going on in that community. You just have to realize that something’s
happening that’s very different and what the reason is
for that. Obviously the earlier you find out something’s happening
the earlier you can mitigate the end result. So if there’s
a bioterrorism event and somebody has put anthrax out there
then you are seeing a bunch of folks coming in with these
symptoms, you’re catching it early enough to give medicine
to people. There’s actually a public health plan that if we have
some kind of anthrax event we will literally be handing out pills
to whoever has possibly been exposed within the first 48 hours.
They’ll all get Cipro or Doxycycline quickly because once you
get anthrax there’s 98% mortality. You really have to be ahead
of the game to prevent mortality. That’s one of the more serious
ones bioterrorism brought to our attention. Because of that
we are more serious about surveillance and seeing what’s out
in the community, before we ever know what the diagnosis is.
SWH: So you rely on immediate provider notification
and then you have other systems behind that can
mitigate?
Jimmy Guidry: The network is quite extensive. We have
CDC with all their experts that are sharing with us what’s
going on at the national level and international level and we’re
sharing what we’re finding at the local and state level. There’s
so much more communication and sharing of information. I
literally, as State Health Officer, get reports every day from
CDC on what are the infections and diseases that are out in
the world and trying to figure out before it ever gets here that
we are alerted that it’s out there, it’s near here, where is it?
And to look for it. Because now that we have a global economy,
some of these things we would never have seen before. So
when they come in that medical provider may not recognize
it. When CDC is telling us there’s an outbreak of measles and
where it is, we are sharing that with medical providers in the
state through a health alert network, telling them to be aware.
It makes people more aware of what they might be seeing that
they may not recognize.
SWH: Let’s shift gears a little bit. With regards to
childhood obesity, what can a state agency do to improve
that problem?
Jimmy Guidry: This is an interesting question for me because
my background is as a pediatrician. I still see private patients
to keep an idea of what’s happening out there in the community,
and what I’m seeing is children showing up with adult
diseases. By that I mean, normally you have adult onset diabetes
and usually that’s much later in life. We are now seeing it in
twelve-year-olds, fourteen-year-olds as a result of obesity. I am
very concerned about what we are going to do to turn the tide
because we have a huge issue of diabetes, end-stage renal disease,
dialysis, hypertension, heart disease—very serious health conditions
as a result of obesity that we are going to see at a much
younger age if we don’t do something to change behavior.
When it comes to obesity, it is multi-factorial. I have worked
very closely with the Pennington Biomedical Research Center
to try to figure out what are some of the things that would
work to change what we’re seeing with this trend, which is
people getting heavier and heavier and heavier. We know that
what you eat and the amount you exercise are critical, but what’s
going to make a difference? We had a researcher come present at
Pennington last year that had done research and pilot projects in
schools where they changed the menus, increased the exercise,
they did all these things that we know should make a difference in
weight and obesity. In these multimillion dollar studies they didn’t
show much of a difference. You would predict that if you focused
on all of this it would, so it doesn’t make sense why doing all of
these things doesn’t make a difference. What it boils down to is
that we are less active, we eat more, we drink more sweet drinks,
sport drinks, a number of things that aren’t good for us, so literally
some of it is about behavioral choices, the amount of exercise
you do, your choices in what you eat. If you curtail that in school
it should help, but if you go home and continue the bad habits,
you just make up for it. It has to be wholesale change. It literally
has to be society deciding that we’re going to make sure that the
choices are limited. We are not going to have food with trans fats,
or we’re going to encourage bike paths, we are going to make sure
every opportunity for exercise is available, we’re going to encourage
exercise and eating correctly.
But it’s taken years for us to get this trend going the way it is and
it’s going to take years to possibly reverse the trend. It’s not hopeless,
but what it’s taught us is that we’ve gone from being less of a
society that works at hard labor to one that sits around and most
of our work has to do with sitting and with availability of all kinds
of foods. We are going to have to change our behavior in a way
that it’s so easy that you can’t not do it. We’re going to need the
help of industry, fast food, everybody to make sure the things we
are offering are better and better. People are not going to change
easily. Fast food restaurants have tried selling salads alongside
the fast food. People still eat the fast food.
The future doesn’t look so bright. All you need to do is go on a
plane and see people for whom the seats aren’t big enough. I went
to talk about obesity in New Orleans and the parents were upset
that the desks weren’t large enough to hold the children. The emphasis
is in the wrong place. It should be how do we get our children
smaller, not bigger desks. So it is worrisome from where I’m
sitting that the whole country is looking at this and there aren’t
some very simple answers. It’s very complex and it’s going to take
a lot of folks working at this to change behavior. In public health,
when you want to change health outcomes, if you want people to
live longer and healthier, they have to change their behavior. You
can’t change genetics, but that represents about 20% of your
health outcomes. Fifty percent of your health outcomes are impacted
by personal choices. If you don’t make the right choices
you are going to end up with poor results. As providers we can
tell people all the time, “Hey this is what you need to do to stay
healthy,” but at the same time when every function we do in
Louisiana is around eating, you are fighting a really tough battle.
It’s very different to get together for a Fun Run than to get
together for a jambalaya and that’s the kind of behavior changes
we are going to have to make.
Is it possible? We see it in California and New York, where people
have paid attention to exercise and are eating healthier and
they don’t have some of the issues that we’re dealing with. I
think the education system plays a huge part in preparing people
to make proper choices as they get older. It’s been shown
in public health that the higher your level of education, usually
the higher your income, more access to healthcare, better
choices. So literally the moment that child is born they need
the most help they can get to be successful. And making sure
from in utero on that the options are healthy ones so that the
foundation is built and as they get older they can continue to
make the right choices.
SWH: I guess with regard to health statistics, Louisiana
generally falls behind. Would you characterize that as
being “this is our culture” and maybe that’s part of the
problem of why we, in so many public health categories,
seem to lag toward the bottom?
Jimmy Guidry: I’ve been asked that before. Why in Louisiana
are we 49th or 50th when you look at health outcomes? Some
of the answers are difficult to show, but what I’ve been able to
show is that if you focus on those things that really make a difference,
and you make changes, then you can change behavior.
One of the best public health preventive medicine efforts is vaccination.
Those diseases that can cause horrendous complications
are totally preventable if children get vaccinated. So how
do you change the fact that for the longest time we were 49th and
50th in vaccination of our children? It’s provided at no charge or
very little charge. It’s provided in multiple places. How are you
going to make sure that something so simple gets done? Well,
we worked very diligently to put a plan together for making it
readily available and sending out reminders to parents that their
child is due for vaccination and making sure that at every opportunity
that a child walks in a medical provider’s office that they
get vaccinated. We are in a poor state. When it comes to health
outcomes we have poor numbers. Here’s one that with changing
behavior and making sure parents take their jobs seriously
about getting their children vaccinated makes a difference. We
worked with principals whose jobs with older kids are to say the
child can’t enter school unless they get vaccinated.
We got bioterrorism grant funds to practice mass vaccinations
because if there was an event, how would we vaccinate everybody?
We took that money and made a real drill out of it so that
we would provide vaccines to kids right before school starts
and we did it in the thousands to show we could do mass vaccinations.
And we moved up from almost last to second in the
country, in a poor state where you would think that’s impossible.
We’ve got all kinds of private partners, private providers,
hospitals, after hour clinics giving vaccines on the weekends
and after hours. We’re just totally focused on every time you
can give a vaccine you get it in the child and prevent a disease.
For every dollar spent on that vaccine you save $20 in healthcare
costs.
Another issue in public health is cancer in Louisiana. People
say we live in “cancer alley.” Not so. When you look at the cancer
rates we are about average. We are about middle of the pack
for the states in cancer incidence. Somebody getting cancer in
Louisiana is not as bad as people think it is and it’s not due to
cancer alley. Most of the cancer seen in Louisiana is a result
of choices, like alcohol or tobacco. But in Louisiana, if you get
cancer, we are first or second in the country for the likelihood
you will die of it, because we diagnose it later. Because people
don’t go get checked for it. People don’t get diagnosed early. If
it’s diagnosed later, the outcome is worse. So you are looking
at a possible access issue, but you are also looking at a possible
choice issue in that people won’t seek the care, get an early diagnosis,
get treatment early. As a result, our outcome is if you
get it in Louisiana, the likelihood is you will die of it, more
than anywhere else in the country. Because of an educational
level, because of finances, because of choices—just a whole
complex number of issues.
So we work diligently at the Department of Health to educate
people on what you can do to diagnose cancer early, make
screenings as available as possible, get the private sector to
provide it free of charge. It’s still not done near as much as it
should be because people don’t choose to go do that. And they
don’t choose to go do that because they don’t realize that in this
country one in three people will have cancer in their lifetime.
So there’s a high probability that we will all get cancer. Live long
enough and it will get even higher. For screening and routine
visits, you have to be able to afford it, it has to be readily available,
you have to have access, and people have to choose to take
advantage of those opportunities.
SWH: Do you think we are doing enough from an epidemiology
standpoint, interpreting where these problems
are coming from?
Jimmy Guidry: I think we are getting better now that we
have the technology to monitor all of this information we can
capture. I’ll show you a study we did years ago in Baton Rouge.
They did a study to find out where the mothers of premature
babies lived, where were these infants coming from? Premature
births lead to increases in infant mortality, which is a measurement
of health outcomes. And when they mapped out where these premature
births were occurring, they found it was only certain areas of
the city where most of these babies came from. It pointed to some
very poor neighborhoods and young mothers. If you were going to
spend your dollars wisely to address that issue, you would spend it
in those areas that have the highest risk. If you are going to change
behavior you need to change behavior where the highest risk is. So,
literally, the ability to capture all this data and do epidemiological
studies is available. What we perhaps don’t have enough of are analysts.
What does the data mean? What makes it useful information?
How do you change behavior based on that information?
So if you look at Louisiana, with the grants we write and the studies
we do, we have renowned Pennington Center that studies obesity,
we have some cancer centers that are internationally known,
we have a lot of things that are very, very good, but we have a lot
of medical issues. The question then becomes how can you use
limited dollars to have the most impact and that really becomes
a challenge. If you are in a poor state and people don’t have the
wealth they need to do these things appropriately then how do
you change it? You change it by making the information available
to people, educating people, but you also have to focus on, as I said
before, making sure that child’s education is the best and enhance
their ability for success. You also have to make sure that the kids
we spend so much money and time on making sure they’re successful,
that we keep them here. If they leave the state it doesn’t
do us a whole lot of good and we’re not benefitting from that investment.
I’m sure that’s one of the Governor’s arguments all the
time—how do we make sure we have the economy here to keep
our kids here once they finish their education?
SWH: We’ve had a few secretaries over the past few years.
I wonder if you would describe Bruce Greenstein’s impact
in the short time he’s been here and comment on his leadership
style and direction?
Jimmy Guidry: The reason I smile is that this is my fifteenth
year and this is my fourth secretary and so I’ve got a wealth of knowledge
from having worked with different personalities and different
styles. What I find refreshing about Bruce is that he comes with a
wealth of knowledge about economies and technology, which is such
a need in Louisiana. To take this wealth of data we have and make
sense of it and change the way we deliver healthcare. He’s willing to
fight the fight, because the fight for change is incredible. People
will put up every barrier possible so that you don’t change the
status quo because that’s the way you normally get paid, because
that’s the way healthcare gets delivered and change threatens
your livelihood and your future. But he can’t threaten the fact
that we are 49th and 50th, he can only take us up.
It’s going to take making tough decisions using the best data
available and fighting that upstream battle of making changes.
What I’ve seen is energy and a willingness to do that. That’s
refreshing to me even though I’m getting older and I’ve been
through many fights, because I’ve been through a number of
disasters. I’m the lead for ESF-8, which is health and medical for
disasters, so I’ve dealt with Katrina, Rita, Gustav, the oil spill.
What I’ve learned is that you’ve got to fight the fight to make
a difference. But you need a lot of folks, a lot of partners, and
you have to be willing to give it everything you have and utilize
those resources to the best of your ability. What I have seen in
him so far has been very appealing because it’s something different
and I think Louisiana needs that, to bite the bullet and
make these serious changes. Whether it works or not, we don’t
know, but it can’t be worse. Let’s make a change and see what
happens. So far he has been very encouraging, he allows his experts
to do what they need to do, he’s very supportive, and he’s
willing to take the battles to make a better Louisiana. I’ve been
working at it a number of years and I welcome a fresh, young
person coming in with these capabilities. So far I’ve been very
pleased about working with him.
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