Emergency Preparedness Funding and Ebola: A Look into the Efforts Being Made by a Rural Local Health Department in Ector County, Texas

Amanda Robison-Chadwell, Emergency Preparedness Lead, Ector County Health Department, TX

Amanda Robison-Chadwell, Ector County Health Department, TX

Infectious diseases continue to pose a threat to communities, with Ebola being in the spotlight over the last six months. The threat of Ebola has also increased attention on local health departments and their role in preparing for and responding to emerging infectious diseases. To better understand how local health departments are utilizing preparedness funding to prepare for and response to the threat of Ebola domestically, NACCHO and Local Public Health Practice and Policy Scholar, Junaed Siddiqui, spoke with Amanda Robison-Chadwell, who leads emergency preparedness efforts at Ector County Health Department in west Texas.

Can you provide us with some background on the community that Ector County Health Department serves?

Ector County is located in west Texas, approximately 90 miles from the New Mexico border. The Ector County Health Department serves a predominantly rural population with the exception of the City of Odessa. The population is highly mobile and oil is the county’s dominant industry. Public health resources are more limited than in large urban areas and most preparedness funding comes from federal sources (i.e., Centers for Disease Control and Prevention (CDC) Public Health Emergency Preparedness (PHEP) grants.) Although many health department employees receive incident response training, Ector County has only one full-time employee– Ms. Robison-Chadwell– whose sole focus is preparedness. Ms. Robison-Chadwell shared details of Ector County’s Ebola preparedness and response activities during a recent interview with NACCHO.

What successes have you had in preparing for and responding to Ebola in your community?

Dedicated preparedness resources and funding are limited; therefore, a key component of Ector County health departments’ strategy to prepare for Ebola (and other emerging infectious diseases) is leveraging local partnerships and relationships.

In October 2014, as fears of Ebola were spreading throughout the country, Odessa hosted an International Oil Show, bringing people from across the oil industry and all over the world, including West Africa, to Ector County. To help qualm fears, Ms. Robison-Chadwell, in her role as the lead for public health emergency preparedness at Ector County Health Department and who is an epidemiologist by trade, engaged directly with oil executives, planners for the International Oil Show, and the local Emergency Preparedness Council to educate them about the risk of Ebola transmission, symptoms, and procedures that were in place to protect the public and respond should a case arise. This included providing educational literature and inviting stakeholders to participate in calls and briefings hosted by the Ector County Health Department and CDC. Ector County officials also provided trainings for law enforcement, emergency medical services (EMS), and homeland security partners on donning and doffing procedures for personal protective equipment.

PHEP funding and guidance have provided a venue for the Ector County health department to build these community relationships. When Ms. Robison-Chadwell began as the PHEP Manager she made it a priority to build relationships with healthcare, law enforcement, fire, emergency management and other community organizations by including them in trainings and exercises and attending stakeholder meetings and functions. She also helped strengthen relationships with police departments and correctional facilities through closed points of dispensing agreements. These relationships proved valuable in preparing Ebola and the oil show because she already knew who to contact, how to contact them, and was able to anticipate their needs.

What was/is the greatest challenge that your health department has faced in regards to preparing for Ebola?

A primary challenge was risk communications. In the early stages of planning for Ebola – before the first case in Dallas and before CDC had published a lot of guidance – public health officials and their community partners in Ector County experienced difficulty locating information and subject matter expertise on Ebola to inform their preparedness plans. When guidance did become available, sometimes it was full of technical jargon that only an individual with a public health background would understand. In rural Ector County, Ms. Robison-Chadwell, who has studied Ebola for 15 years, was the primary (and sometimes only) source of authoritative information on the disease for her community. There was no one else with similar expertise and risk communications training = to help cull through all the Ebola guidance, pull out relevant pieces, and put it into appropriate level talking points for the public and media. Ms. Robison-Chadwell often had to sit down with PIOs in Ector and surrounding jurisdictions in order to aid them in message development. The overall lack of information and knowledge about the risk of Ebola and how the disease can be transmitted by the public resulted in sensationalism and misinformation, which was often magnified by the local media.

Risk communications challenges were not isolated to Ector County. As part of its technical assistance to local health departments during the height of the Ebola response, NACCHO heard from many rural and urban local health departments that changing or unclear federal guidance and a lack of protocols for some sectors (e.g., waste management, water, law enforcement), particularly during the early stages of the response, resulted in inconsistent messaging about the risk of Ebola to community partners and the public.

What did you do to respond to this challenge?

In a smaller community, local public health has the benefit of being more accessible and personable to local media channels. To help correct misinformation and get accurate messages out to the public, Ms. Robison-Chadwell leveraged her media partnerships and positioned herself as a trusted and reliable source of information for local media representatives. She quickly learned that speaking and writing in sound bites and avoiding technical jargon was the most effective way to communicate messages to the media, who are not experts in epidemiology or public health.

For future public health events, Ms. Robison-Chadwell would like to see more risk communications materials from federal and state sources that include graphics and are written at an appropriate reading level for the audience. This would save her valuable time from having to sift through a bunch of technical information and synthesize it into a paragraph for the media.  She would also like to see more tools, trainings, and frameworks to support risk communications at local health departments who may not have a full-time public information officer.

In considering your Ebola preparedness activities, are there any challenges you feel are specific to rural communities? 

Because of the nature of Ebola, acquisition and training on how to use personal protective equipment (PPE) was a large concern. In rural areas, such as Ector County, even if they were able to acquire sufficient PPE, storage capacity is limited. Rural areas do not often have facilities to appropriately storage large caches of equipment and supplies in the appropriate conditions (e.g., temperature controlled).

Although not specific to Ebola, Ector County has also faced challenges in volunteer recruitment. Volunteer programs are often cited as a solution for surge capacity during emergencies. In Ector County, the population is small and mobile, so it is difficult to get people to commit to being a volunteer. Further, even if there were a robust volunteer corps in place, current public health capacity would be insufficient to manage and oversee the program.

NACCHO would like to thank Ms. Robison-Chadwell, MPH, PhD (A.B.D), and the Ector County Health Department for contributing the content for this article. 

Junaed A. Siddiqui, MS, who contributed to this article, is a Local Public Health Policy & Practice Scholar at NACCHO and a Doctoral student at University of Maryland School of Public Health in College Park, MD. 

About Katie Dwyer

Katie Schemm Dwyer is a Director in NACCHO's Preparedness Division. Her work focuses on supporting local health departments strengthen public health preparedness systems through governance, coordination and liaison with federal preparedness organizations, policy, and program management.

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