Here at the Department we’re proud of the hard work and dedication of all of our staff across the Commonwealth. And we’re not alone. Now the national magazine Health Leaders has named DPH Commissioner Cheryl Bartlett and DPH Sexual Assault Nurse Examiner Kristine Aznavoorian as national “Health Leaders” in a roundup of only 20 such health professionals recognized across the United States. Read more:
Cheryl Bartlett, RN—Public Health Advocacy, From Bottom to Top
written by Margaret Dick Tocknell, for HealthLeaders Media. This profile was published in the December, 2013 issue of HealthLeaders magazine.
“I have realized that while I like hands on, I also see that the higher up you get in an organization the more ability you have to influence the outcome systemwide.”
Cheryl Bartlett, RN, hasn’t been paid as a nurse in many years, but she maintains her nursing license and says she still brings the perspective of a nurse to her job as the commissioner of the Massachusetts Department of Public Health.
“Nurses have a wide range,” she explains. “They think holistically about the person and not just about a particular condition, risk factor, or disease. They think about what a person needs from a social determinants perspective.”
The DPH is the perfect place for that kind of thinking. As the commissioner, Bartlett is responsible for the work of 10 bureaus that oversee a laundry list of healthcare activities—health and nutrition, community health, infectious diseases, substance abuse, environmental health, research and statistics, licensure, perinatal services, and patient safety. Four public hospitals are also part of DPH.
Her path to DPH was somewhat circuitous. She began her nursing career at Yale-New Haven Hospital in cardiac intensive care, then moved on to Nantucket Cottage Hospital where she says she did every type of healthcare job, including running the dialysis clinic and working as an emergency room and operating room nurse, to moving up the ladder to director of nurses and director of clinical services.
Eventually she gravitated to public health, which she describes as “where my heart is.” She founded the Nantucket AIDS Network and worked in social services and patient advocacy in Cape Cod, Martha’s Vineyard, and Nantucket. Along the way she served on the board of selectman in Nantucket and worked for a nonprofit preservation organization.
She came to DPH in 2008 as deputy director of the bureau of community health and prevention. It was an opportunity, she says, to “take everything I learned to this place that really helps people across the state. I think I bring a lot of on-the-ground experience to all the work we do.”
She was named bureau director in 2010, interim deputy commissioner of DPH in January 2013, interim commissioner in May, and she was tapped as commissioner in June.
Bartlett inherited a department still stinging from two recent scandals: a national fungal meningitis outbreak linked to a compounding pharmacy in Framingham and the mishandling of drug evidence at a former DPH crime laboratory.
The department has also struggled to continue its public health mission in the face of a weak economy, which has increased demand for DPH services and produced challenging budget cuts.
Bartlett says the top priority for DPH is to build the infrastructure necessary to strengthen the core foundation of the Massachusetts public health system. She points to compliance with licensure surveys for healthcare facilities, inspections for food establishments, the state’s food protection program, and oversight of the pharmaceutical industry as areas that have struggled and need more attention.
She also wants to see more emphasis on health information policy and informatics to help identify efficiencies in delivering DPH services. Community engagement is also a priority. The department has $60 million in a prevention and wellness trust fund to create collaboratives with community-based organizations, municipalities, and healthcare providers to improve clinical care in early 2014. Bartlett says DPH will look at whether accountable care organizations can deliver community-based care at a more affordable cost. Another mandate is to certify some medical marijuana dispensaries by January 2014.
Despite some challenges, she characterizes herself as “someone who can get things done. I am like a dog with a bone. If I believe something should happen and it makes sense to me, then I am very persistent. I know how to navigate the waters and find the right people.”
A typical work day, which often stretches well into the night, will find Bartlett visiting communities around the state to see DPH programs in action. “I like to dig in to the work. I think the more I know about the challenges and barriers, the more I can help solve problems and help the system be better.”
Running a state department with a more than 3,000 employees and a $906 million budget means Bartlett has had to relinquish some of the hands on participation that she enjoys. “I have realized that while I like hands-on, I also see that the higher up you get in an organization the more ability you have to influence the outcome systemwide. I enjoy that, too.”
Kristine Aznavoorian, RN, MS—Working to Heal Sexually Abused Children
written by John Commins, for HealthLeaders Media. This profile was published in the December, 2013 issue of HealthLeaders magazine.
“When it comes to evidence collection and an examination, we just try to do it as efficiently as possible without traumatizing the child any further than they already have been.”
Kristine Aznavoorian, RN, MS, had been a practicing pediatric nurse in Boston for about five years when she became aware of the subspecialists known as Pediatric Sexual Assault Nurse Examiners, or pedi-SANEs.
“It fascinated me,” Aznavoorian recalls. “These children are looking for certain help, and I really enjoyed that thought of helping them in a very crucial and traumatic time of need.”
Now, in addition to her work as a pediatric emergency nurse at Boston Children’s Hospital, Aznavoorian also works part-time as a pedi-SANE for the Massachusetts Department of Public Health at the Essex County Children’s Advocacy Center, where she investigates two or three sexual abuse cases each week.
For pedi-SANEs, there is no such thing as routine. The one constant, though: Dealing first-hand with the young victims of heinous crimes is never easy.
“Every case is different,” says Aznavoorian, who has been a pedi-SANE for two years. “Every child deals with a traumatic event a little differently. It depends on the developmental level of the child, how old they are. It plays into how they are going to handle the situation, but it is across the board.”
In some cases, if there is an opportunity to gather physical evidence of sexual assault for prosecutors, Aznavoorian asks the victim or their families for permission to perform a physical examination.
“The older the children are, the more they kind of get what is going on exactly,” she says. “And depending upon what their unique situation is depends upon if they are going to be open to coming to see me, or if they are open to having an exam done. I never know what kind of child we are going to get and if they are going to be willing to see me or even talk to me.”
“I try to go in as if I were with any of my patients, such as when I work as a staff nurse in the emergency room. I go in. I introduce myself. I am as friendly as possible. Children feel afraid if they feel certain vibes from medical professionals so I try to give off an open and friendly vibe. Every child reacts a little differently,” Aznavoorian says.
“We try to keep the parents in the room. As the children get a little older and become adolescents then maybe they want a little more privacy and they don’t want the parents around. But when they’re younger we typically have the parents stay because they know their child well and they know best how to comfort their child,” she says. “It takes a lot of patience, especially with younger children. But you work as slowly as possible just to make sure they are not afraid. We have a ‘stop’ rule. If the child is scared or upset or crying, we stop. We don’t force the children to do anything they don’t want to do. When it comes to evidence collection and an examination, we just try to do it as efficiently as possible without traumatizing the child any further than they already have been.”
It’s important work. But it is also stressful.
“The burnout factor is actually a concern within our program. It’s tough work. I definitely don’t take things home with me. I do my job. I focus on the family and the child,” Aznavoorian says. “We have monthly meetings where we share our feelings with the rest of the pedi-SANEs and talk about the struggles that we having doing the job and the work that we do. We rely on each other to talk about the tough days and the good days.”
The rewards aren’t monetary. The satisfaction comes with knowing you have played a role in helping a child recover from a potentially devastating ordeal.
“The older the children are the more they realize that what happened was wrong or wasn’t supposed to happen. They tend to think that as a result something is wrong with their body and that people can tell what happened to them just by looking at them,” Aznavoorian says.
“This particularly is true with the adolescent population and the young teens. They think something is wrong with them. It’s happened to me on numerous occasions where I examine these children and they look at me and say, ‘Really? You can’t tell something happened?’ I say ‘No, I can’t tell. Your body is perfectly normal just like every other 11-year-old body would look like.’ And they are so excited about that. That is what keeps me doing what I do every day.”
(DPH Note: Kristine Aznavoorian has joined the Department on a full-time basis since the above article went to press.)
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