Apache County Public Health Services District
P.O. Box 697
St. Johns, AZ 85936
Fax (928) 337-7592
Phone (928) 337- 7532

APACHE COUNTY PUBLIC HEALTH SERVICES DISTRICT
ANNUAL REPORT
FY 2012/2013
This report is produced is response to the statutory requirement of Arizona
Revised Statute Title 36 Chapter 1 Article 4 Section 186 which requires the
Director of a county health department to “submit an annual report to the local
board of health, the county board of supervisors, each city in the county and the
director of the department of health services”.
Assessing the condition of public health in Apache is always a difficult task.
There are two distinct population groups and at least two distinct cultures in the
county served by two distinct medical systems and three public health units.
Disease information is generally reported for the county as whole making
analysis of health status and vital statistics information for communities almost
impossible.
This report deals with the County as whole and does not try to segregate data.
The analysis and recommendations contained in this report are for the County.
THE CONDITION OF PUBLIC HEALTH IN THE COUNTY
Generally speaking, the health of the population in Apache County is good.
However, there are issues that need to be worked on to improve the health of the
citizens in the county.
The County Health Rankings and Roadmaps published by Robert Wood Johnson
Foundation and University of Wisconsin Population Health Institute rank Apache
County #14 in Health Outcomes and #15 in Health Factors out of 15 counties in
Arizona. Health Outcomes rankings are based on mortality and morbidity
measures and Health Factors rankings are based on behavioral, clinical, social
and economic, and environmental factors.

ACTIVITIES OF THE DEPARTMENT

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DIVISION OF CLINICAL SERVICES held clinics every Tuesday in Round
Valley and every other Wednesday in St Johns. Late clinics were held the
second Tuesday of every month from 1-6:30.
During 7/1/12-6/30/13 Apache County Clinical Services administered 2364
child immunizations and 1725 adult immunizations.
Flu clinics were for school students were held in Sanders, Alpine, Round
Valley, St. Johns, Vernon, Concho, McNary. Tdap/ MCV/HPV and “catch
up” school clinics were held in Ganado, Round Valley, St Johns, Alpine,
Vernon and Concho.
Community Flu Clinics were held at Round Valley Drug Store, St Johns
Drug Store, Alpine Community Center, Alpine Forest Service, Vernon
School, Concho Library, Greer Fire Department and Post Office.
To help the institutionalized population health, Flu, Pneumonia and Tdap
vaccines were administered at Angel Wings Assisted Living in Vernon,
Beehive Assisted Living in Eagar, Bannon Springs Assisted Living in
Vernon, Hinkson House Assisted Living in St Johns, Round Valley and St.
Johns Senior Centers. Numerous visits to private homes were made to
give Flu, Pneumonia and Tdap to home bound patients.
County Employee Flu and Tdap vaccine clinics were administered in
Ganado, Chinle, Sanders, Round Valley, St. Johns offices and Road
Yards.
DIVISION OF PUBLIC HEALTH EDUCATION administers the Tobacco
Use Prevention Program, CDSMP (Chronic Disease Self- Management
Program), WIC (Women, Infants, & Children), AZ Nutrition Network
Program and the educational component of the Smoke-Free AZ Act. PHE
is active in the Apache County Youth Council, Apache County Drug-Free
Alliance, and provide support for the Boys and Girls Club utilizing their
skills and resources to promote alcohol, tobacco and drug awareness and
reduce substance abuse in our communities.
Public Health Education applied for and received the NACCHO- 2013
Developing Capacity to Deliver Chronic Disease Self-Management
Program Grant funding, in the amount of $11,000. Only 12 sites
throughout the country received this funding.
Chronic Disease Self-Management Program (CDSMP) staffed hosted a
training for new trainers for the Chronic Disease Self –Management
Program (CDSMP), for Navajo and Apache County. One staff member
was trained to teach Tomando, the Spanish language version of CDSMP.
For the Fiscal Year 12/13, we accomplished the goal of having two
additional staff trained to teach CDSMP, along with 3 volunteers. We
currently have all four BTCD staff, plus three additional Health District staff
trained and certified to teach our Chronic Disease Self Management
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program. We also now have three staff who are certified to teach
Tomando, the Spanish language version of the CDSMP program. We
completed 17 workshops in Apache County, with a total of 507
participants. We continue to promote this program through distribution of
materials to local libraries, health care providers, the wellness center,
Senior centers and other key gathering sites.
We have been involved in many events including Health Fairs; LDS
Preparedness Fair, White Mountain Regional Medical Center Fair,
Window Rock Tribal Health Fair, Apache County Fair, and Round Valley
School District Information Fair. These events have become a normal part
of our summer routine. Our Staff also participate throughout the year in
many programs including: Back to School Activity Day, Fun Focus Day,
Safe Routes to School, Healthy Heart, Eglin/Project Alert- Tobacco
Prevention programs, and Teen Maze. We also provide second hand
smoke education by referral from the WIC program participants.
Two staff were trained and certified to teach the Su Corazon Su Vida
(Health Heart Program).
Completed the SHI/SHAC, School Health Index/School Health Advisory
Council Training, then hosted a training for local partners on the
SHI/SHAC guidelines
All four WIC Staff, completed the Baby Behaviors Training which assists in
providing infant cues and early development counseling to new WIC
mothers.
All WIC staff completed the Getting to the Heart of the Matter (GTHM)
training, which is used to provide accurate Nutrition counseling with
clients.
WIC began providing “at-home” Breastfeeding counseling with clients
upon request. All WIC staff have received training as Lactation
Consultants
DIVISION OF PUBLIC HEALTH PROMOTION consists of 2 Program
Coordinators, and 6 Health Educators. The division administers the
Community Health Program, Governor’s Office of Highway Safety
Occupant Protection Program, Health Start Home Visitation Program, and
Teen Pregnancy Prevention Program. All programs are grant-funded
through Arizona Department of Health Services.
Community Health Program continues its efforts to reduce the rates of
unintentional and intentional injuries for families residing in Apache
County. The program provides multiple services to meet this goal.
Northeaster Safe Kids Chapter: Northeastern Safe Kids Chapter
meetings continue to be provided in the communities of Apache and
Navajo counties. Providing meetings in both areas allows for a broader
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base of members to be served, (+80) and allows for community members
and agencies to collaboratively work towards the prevention of
unintentional childhood injuries. These include motor vehicles injuries
(including children as occupants, pedestrians and bicyclists): drowning;
fire and burns; suffocation; choking; unintentional firearm; falls; and
poisonings. Facilitators of the Northeastern Safe Kids Chapter members
are also members of the Navajo Nation Safe Kids Coalition, and Child
Fatality Review Team and have provided trainings on: ATV Safety, Chain
Saw Safety, Rocky Mountain spotted fever, Lightning and Rain Safety,
and other topics relevant for the community, and time of year.
Car seat educational classes/Car seat check events: The Community
Health Program continues its efforts to provide families with car seat and
seat belt education through classes provided by certified technicians. In
addition to helping our community, technicians of the program also assist
other programs within both Apache and Navajo counties with their car seat
check events. One-hundred fifty seven car seat classes were provided in
southern Apache County; 154 families received education for their car
seat and 3 families received education only for the seat they brought in.
Assistance for car seat check events in Show Low, Sanders and Window
Rock was provided by technicians of the program.
Child Passenger Safety Certification Trainings: Child passenger safety
instructors from Apache, Navajo and the Navajo Nation assist each other
with certification trainings held in their respective communities. Two
trainings were provided for Apache County residents; 1 at the Apache
County Road Yard in Springerville and 1 at Tse Bonito-Department of
Highway Safety. Assistance was also provided for Navajo County at
Pinetop Fire Department. Fifty new technicians are now out in our
communities aiding families because of this collaborative effort between
instructors.
In 2012, agencies in the community were invited to attend a technician
training held at Apache County Road Yard. Scholarships were provided to
6 individuals who became certified as technicians. All six of these
individuals now provide direct car seat educational services for families
they serve through their program and/or facility. Head Start, Living Hope
Women’s Center and Eagar Fire Department are all new distribution
points for car seats and education.
The program continues to assist Child Protective Services, and Little
Colorado Behavioral Center staff, (agencies that transport children) with
non-certified car seat educational classes. Foster parents are referred to
our program to receive car seat education for children that come into their
home.
Mental Health First Aid Trainings – Suicide Prevention
The Community Health Program will continue to work with facilitators from
Little Colorado Behavioral Health Center to bring Mental Health First Aid

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training to our community so families can be served and referred to
services they may need.
Program also attended an Applied Suicide Intervention Skills Training
(ASIST).
Improve the health of women prior to pregnancy
Community Health program staff is doing their part to increase awareness
of preconception health and health care to families served in the
community, and to medical service providers they work with. Community
Health program staff developed a Preconception Tool Kit to share with
Baby Sprouts, Living Hope, and Early Head Start home visitation staff.
“My Life, My Plan”, a goal and health oriented booklet geared for
teenagers is given to them during visits they have with their doctors during
sports physicals. Also duffle bags containing these booklets and
brochures regarding suicide talk, spit tobacco, drinking, drugs and driving,
tips for a healthy plate, MRSA, 101 ways to eat smart, Prescription Drug
Abuse, STDs, Stress, domestic violence, teens and cyber bullying, HPV,
abstinence, and energy drinks are provided. The “My Life, My Plan”
booklet is also given to teens during family planning visits at the health
district.
An Oral Health presentation, requested by Vernon school administrators,
was provided to 5th and 6th grade students at Vernon Elementary School
during a health fair. Students were provided with goodie bags filled with
toothbrushes, floss, toothpaste, and other health related items.

Health Start Program
Health Start is a neighborhood outreach program that helps high-risk
pregnant women obtain early and consistent prenatal care, interconception and preconception education, breastfeeding and well-child
care, home and car seat safety education for children and their family, and
timely immunizations. Health Educators of the program, who reflect the
ethnic, cultural and socioeconomic makeup of the neighborhoods they
serve, connect pregnant/postpartum women with community resources
that provide prenatal and related infant/child services. The families are
followed for two years after the birth of the child to assist with identification
of a “medical home” for each family member and to encourage
immunizations for all children in the family. Family follow-ups also focus on
the development of children on communication, gross motor, fine motor,
problem solving, and personal-social skills; all of these areas are
assessed using the Ages and Stages Questionnaire tool.

MEASURE

Health Start Measures
Fiscal Year

5

% Increase

2011-2012

2012-2013

/Decrease

# of families served

95

97

2.10

(+)

# of prenatal visits

191

146

23.60

(-)

# of family follow-up visits

452

453

0.22

(+)

0

7

∞

(+)

# Classes

Teen Pregnancy Prevention Program (TPPP):
The Teen Pregnancy Prevention Program provides services to Apache
County youth and families by utilizing comprehensive sexual health
evidence-based curricula in the school and after-school settings.
Curricula selected are approved by the Arizona Department of Education
for use in school-settings.
Wyman Teen Outreach Program® (TOP)
The Wyman Teen Outreach Program® (TOP) is a national youth
development program designed to prevent adolescent problem behaviors
by helping youth develop a positive self-image, effective life skills, and
achievable goals. TOP® is a nine-month long program that also focuses
on engaging youth in a high level of community service learning. TOP®
was implemented at the St. Johns Learning Center on September 18,
2012 and concluded in May 2013 with an initial enrollment of 18 students,
50+ classes were provided, and students averaged 20 hours of individual
and group service provided during the 2012-2013 school year.
Smart Girls Life Skills Training Program
Smart Girls is a twelve-week program for girls aged 12-14. The mission is
to empower young women by providing information and skills necessary to
develop healthy relationships and make smart decisions throughout life.
Smart Girls was piloted at Concho Elementary School in April 2013 as an
elective course. The program will continue to be provided annually at
Concho Elementary during their elective semesters.
Wise Guys Male Responsibility Program
Wise Guys is a 12 week program designed to prevent adolescent
pregnancy by teaching young males self-responsibility in the area of
sexual development. The program assists young men to answer the
questions: “Who am I, Where am I going, and how do I get there?”
In July 2012, TPPP hosted two-day training in Eagar, AZ. Arizona
Department of Health Services-TPPP contractors from Yavapai County,
Navajo Nation, Mohave County, and Navajo County attended as well as
Apache County staff.

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Wise Guys was piloted at Concho Elementary School in April 2013 as an
elective course. The program will continue to be provided annually at
Concho Elementary during their elective semesters.
Native STAND (Students Together Against Negative Decisions)
Native STAND is a program developed to meet the needs of today’s
Native youth by embracing the power of traditional teaching and cultural
strengths that Native youth have within themselves and their communities.
This program was implemented in February 2013 at Ganado High School
in all health classes reaching 72 students. A Memorandum of Agreement
between Ganado School District and Apache County Public Health
Services was approved in November 2012 which allows the program to be
provided in all health classes. This agreement permitted an expansion to
the northern part of the county and an additional TPPP staff was hired and
housed in Ganado, AZ.

Agreement with Apache County Superior Court and Juvenile Probation
Annual meetings are held with Apache County Superior Court Judge
Donna Grimsley, Juvenile Probation Manager, Juvenile Probation
Treatment Counselor, and Juvenile Detention Center Manager. In July
2012, a meeting reinstated an agreement that Community Work Service
credit hours would be issued by Juvenile Probation Officers for those who
successfully completed a Teen Pregnancy Prevention Program (TPPP).
This annual meeting also allows a time to inform and update staff on
programs and ideas for collaboration. The TPPP also provides weekly
classes at the Juvenile Detention Center; the meeting allows for an update
to be provided on services as well.

Outreach and/or Collaborative Efforts
Beginning March 2013, collaborative meetings were held between the
Navajo Nation Program for Self-Reliance, Apache County Public Health
Services, and Navajo County Public Health Services to provide education
to youth and parents in Chinle, AZ. In June 2013, middle and high school
aged students were provided the Making Proud Choices and Native
STAND programs in a community-setting. Parents attended an Active
Parenting workshop. This was a three-day workshop that reached 29
students and 20 parents.
In May 2013, all School Districts received program information. Meetings
were held at Round Valley High School, St. Johns High School, St. Johns
Learning Center, Concho Elementary School, Ganado High School,
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Ganado Middle School, Window Rock High School, Red Mesa High
School, Tsaile School, and Round Rock Elementary. Schools in which
meetings were not able to be scheduled were provided a program packet
of services available and a follow-up phone call was ensured.
Teen Maze Program:
Apache County works with the local Youth Council, high schools, and
other organizations within the community to implement this project. The
purpose of the maze is to provide primary and secondary prevention and
health promotion education to youth on topics including but not limited to:
teen pregnancy, responsible sexual behavior while stressing abstinence,
date rape, substance abuse, school and domestic violence, suicide
prevention, diversity, physical activity, nutrition, higher education, and
vocational/career options.
A Teen Maze event was held February 25-25, 2013 at Ganado High
School. Topics addressed by local agencies included: bullying, teen
pregnancy prevention, sexually transmitted infections, alcohol/drug abuse,
healthy relationships, etc. A total of 389 students attended the event.
Collaborators for this event included: Apache County Health Start
program, Navajo Nation Health Education, Navajo Nation Office of Youth
Development/Boys and Girls Club, Navajo Nation Museum, Indian Health
Services, Ganado High School Physical Education, and Window Rock
District Court.
The Teen Maze event was such a success that the Principal Robin Pete
invited us back in April 2013 for a Teambuilding day! Collaborators for
that event included: Apache County TPPP, Navajo Nation Health
Education program, and the Office of Youth Development/Boys and Girls
Club of Dine Nation.

DIVISION OF PUBLIC HEALTH EMERGENCY PREPAREDNESS
Apache County Public Health Services Districts training and exercise
program is a vital area of preparedness activities for staff to better serve
the communities within Apache County. Public Health Emergency
Preparedness (PHEP) had set a goal for the past year to further educate
its staff for emergency response focusing on the Emergency Management
and Training and Exercise plans. Another key area of focus was training
and exercising with our partners and continuing with outreach within our
communities. PHEP also encouraged outside training for public health
staff. Apache County Public Health has also completed the threat hazard
identification risk assessment (THIRA) which ties into our existing plans as
part of a two phase contract with NOMAD consulting. The second part of
this contract is the Continuity of Operations plan for Public Health which
will be completed in the first quarter of 2014.
The following training and exercise coordinator activities support the goals
listed above:

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2013 Exercises
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ADHS SNS Exercise 2/27-3/1/13
PHEP SNS after action review 3/7/13
ADEM Resolute Angel Exercise (Call Center stand up)4/11-4/13/13
Resolute Angel after action review 4/18/13
Navajo County train derailment exercise 7/30-7/31/13
ADHS Full scale Power Outage Exercise 11/6-11/8/13
Mass Power Outage after action review 11/21/13

Apache County Public Health Trainings
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SNS Roles & Resp. 1/24/13
SNS warehouse training 2/7/13
ICS in relation to SNS training 2/14/13 & 2/21/13
Volunteer Reception Center training 3/14/13
Call Center Operations 4/4/13
ICS in relation to Call Center Activities 4/8/13
Go-kit basics 7/25/13
The role of Public Health in an emergency 10/3/13 & 10/7/13
Incident Commander role specific training 10/8/13
Operations role specific training 10/9/13
Logistics role specific training 10/10/13
Public Information Officer role specific training 10/16/13
Safety officer role specific training 10/17/13
Planning role specific training 10/22/13
Finance role specific training 10/23/13
St. Johns staff role specific training 10/21/13 & 10/28/13

Apache County Public Health outside Training
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Center for Domestic Preparedness, Train the Trainer 1/6-/-13/13
ADHS Training and Exercise Seminar 3/27/-3/28/13
SNS controller/evaluator training
CERT Train the Trainer 3/19-3/25/13
Center for Domestic Preparedness, Healthcare Leadership training
5/12-5/18/13
Wallow Fire Public Health response, AZ. State Nursing Association
5/22-5/23/13
Center for Domestic Preparedness, Incident Command training 5/266/1/13
POD training 8/27-8/29/13
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•
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SNS Workshop 9/11-9/12/13
Center for Domestic Preparedness, FRAME training 9/15-9/21/13
VRC training, Hands on Greater Phoenix 10/26/13

Apache County Public Health Community Outreach
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St. Johns LDS Fair 2/16/13
Chamber of Commerce Small Business Summit 5/17-5/18/13
Apache County fair 9/3-9/7/13
Round Valley LDS Fair 9/21/13
Chamber of Commerce Lighted River Walk 12/7-12/14/13

Community Partnerships
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Annual Participation in the Navajo Nation Planning Team for Exercises
Navajo County
Chamber of Commerce Axillary Member
LEPC member
AVERT partnership
311 committee member
Red Cross
Salvation Army
White Mountain Radio

AVERT (All Volunteer Emergency Response Team) the volunteer
emergency response team in Apache County is named AVERT.
Volunteers participated in the following trainings, exercises and activities
in order to increase their capabilities in the support of First Responders:
Exercises
• ADHS SNS Exercise – 2/27/2013
• ADEM Resolute Angel Exercise utilizing volunteers for staffing of call
center – April 11, 2013
• Attendance at Resolute Angel after action review – April 18,2013
• ADHS full scale power outage exercise – November 6, 2013
• Mass power outage after action review – November 21, 2013
Activities in response to First Responder requests
• Traffic control for St Johns Police Department at the Holiday Light
Parade – December 13, 2013
• Staffed the Command Center DUI checkpoint for the Eagar Police
Department – December 31, 2013 to January 1, 2014
Trainings
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•
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SNS Roles – January 24, 2013
SNS Warehouse training – February 7, 2013
SNS within the ICS structure – February 21, 2013
Volunteer Reception Center Training – March 14, 2013
CERT Train The Trainer – March 19-25, 2013
Call Center Operations – April 4, 2013
Call Center Activities within the ICS structure – April 8, 2013
Go-Kit Fundamentals – July 25, 2013
POD Training – August 27-29, 2013
SNS Workshop – September 11&12, 2013
Role of Public Health in an Emergency – October 3, 2013
Role Of Incident Commander – October 8, 2013
Role of Operations Chief – October 9, 2013
Role of Logistics Chief – October 10, 2013
Role of Safety Officer – October 17, 2013
Role of Planning Chief – October 22, 2013
Role of Finance Chief – October 23, 2013
Traffic Control Training offered by Eagar Police Department for AVERT
members – December 10, 2013

DIVISION OF ENVIRONMENTAL HEALTH employs one full time
Environmental Health Specialist who performs inspections of permitted
facilities and septic tank systems. The Health Director is also the
manager of the Environmental Health Division. In March 2013 the
Environmental Health Specialist left employment with the Apache County
Public Health Services District to pursue a master’s degree in engineering.
The Health Director became the field inspector in addition to his other
duties.
In Apache County there are 178 food establishments, 2 public and semipublic pools, 3 children’s camps, and 22 public accommodations.
Regarding food safety, there were 242 routine food establishment
inspections performed, 21 re-inspections, 6 pre-opening inspection for
new establishments, 1 foodborne illness investigation conducted and 13
complaints on food establishments investigated. Forty-six food worker
training classes were presented to a total of 342 food workers. At the
request of food establishment operators 4 consultations were provided.
Both pools were inspected, two of the three children’s camps were
inspected and 35 inspections were conducted on the twenty-two public
accommodations.
Additionally, there were 67 septic tank system applications reviewed and
approved, 125 septic tank system inspections, 14 well applications

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reviewed and site inspections performed and 87 environmental complaints
investigated.
Assistant Health Director Report
Staff Development
In the fiscal year 2012/2013, the staff development and training program
continued the priority of addressing the eighth Public Health Essential
Service; ENSURE A SKILLED, COMPETENT PUBLIC HEALTH
WORKFORCE and to ensure National Incident Management System
(NIMS) training compliance for all staff. The ACPHSD leaders believe that
quality services can only be delivered by well trained, knowledgeable staff.
New employees are introduced to public health practice by taking
online courses that include an introduction to public health and an
orientation to the Incident Command System (ICS 100 & ICS 700).
While learning their job duties, new employees build a foundation in
public health upon which they will add layers of knowledge as they
continue their careers.
Additionally certain classes are mandated while others are elective in
nature. In the 2013/14 fiscal year blood-borne pathogens, confidentiality
and HIPAA training were required for staff. Public Health staff is also
required to maintain current CPR certification. The majority of the
trainings have been facilitated by current public health staff and other
local experts in an effort to keep training costs down and to utilize local
talent.
2013 classes include:
• Blood-borne Pathogens
• Mandatory Reporter
• Confidentiality
• First Aid and CPR/IAD
• Mental Health First Aid
• Domestic Violence 101
• County Food Handlers class
• True Colors personality styles
• HIPAA
• Healthy Living Workshop Leader
• Excel
Vital Records:
The St. Johns vital records office is the primary location offering services
from 8 am to 4:00 pm, Monday through Thursday. Birth and death
certificates are also issued on a part time basis in Springerville, Ganado
and Chinle.
Deaths: The office of Vital Records registers deaths and issues certified
death certificates. The Vital Records office grew from a staff of four to a
staff of five in the 2012/2013 fiscal year.
Dr. James Sielski has been the Alternate Medical Examiner (AME) in
Apache County since 2009. The AME is responsible for the certifying
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violent, suspicious or unexpected deaths. The AME authorizes
cremations and orders autopsies for deaths occurring in southern
Apache County. Fifteen autopsies were ordered by the AME in the
2012-2013 fiscal year.
Births: The office of Vital Records began processing birth certificates in
August 2010. The Vital Records office processes corrections and
amendments and prints certain birth certificates.

Vital Records & Medical Examiner Measures
Measure
2012/2013
Total # of certified
death certificates
1117
issued
# of autopsies
15
ordered
Total # of certified
birth certificates
1107
issues

Ganado and Chinle Measures
Measure
2012/2013
# of death and birth
certificates issue in
243
Ganado
# of death and birth
certificates issue in
369
Chinle

Smoke-Free AZ
Apache County Public Health Services District receives a grant from the
Arizona Department of Health Services to provide education about the
Smoke-Free AZ Act. Complaints under the Smoke-Free AZ Act are
responded to by a delegation agreement.

Smoke-Free AZ Act Measures
Measure
2012/2013
# of businesses who received
284
education
# of complaints investigated
1

CHARACTER AND EXTENT OF ALL DISEASES REPORTED
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The diseases listed in this section are reportable diseases and are above the
Arizona rate. Information below was taken from the 2012 Arizona Health Status
and Vital Statistics and Control of Communicable Diseases Manual, 19th Edition.
Pertussis (Whooping Cough) is a serious disease in infants and child 5 years old
and younger. Medical literature indicates that parents and grandparents transmit
this disease to infants. In adults Whooping Cough symptoms are manifested as
coughing or similar to a cold. Arizona rate is 17.4 cases/100,000 population and
Apache County rate is 38.7 cases/100,000.
Pertussis is a vaccine preventable disease.
Campylobacteriosis in humans is causes diarrhea (frequently with bloody
stools, abdominal pain, malaise, fever, nausea and/or vomiting. Poultry and
cattle are the most frequent carriers of this disease. Other animals that may
carry the bacteria are puppies, kittens, swine, sheep, rodents, and birds. The
Arizona rate is 14.5 cases/100,000 population; Apache County rate is 48.4
cases/100,000 population.
The spread of Campylobacteriosis can be minimized by proper hand washing
after handling or slaughtering animals and proper cooking of meat from poultry,
cattle, swine and sheep.
Salmonellosis in humans is characterized by acute inflammation of the small
intestine and colon, with sudden onset of headache, abdominal pain, diarrhea,
nausea and sometimes vomiting. Dehydration among infants and the elderly
may be severe. Wild and domestic animals including poultry, swine, cattle,
rodents, and pets such as iguanas, tortoises, turtles, chicks and other baby
poultry, dogs, cats and hamsters. The Arizona rate is 13.2 cases/100,000
population and Apache County rate is 24.9 cases/100,000 population.
Control of Salmonellosis can be achieved by through cooking of meat and eggs,
pasteurization of milk, maintaining a sanitary kitchen, excluding rodents from the
home and hand washing before preparing food, after handling meat and eggs,
after handling animals and pets.
Tuberculosis common signs and symptoms are cough, fatigue, fever, night
sweats, weight loss and chest pain. Arizona rate is 2.9 cases/100,000 population
and Apache County rate is 8.3 cases/100,000 population.
Best prevention is prompt diagnosis and treatment.
Gonorrhea is a sexually transmitted disease. Females with a gonococcal
infection are often asymptomatic while males have an acute purulent discharge.
Conjunctivitis may occur in newborns with resultant blindness if not rapidly and
adequately treated. Arizona rate is 89.4 cases/ 100,000 population and Apache
County rate is 102.5 cases/100,000 population.
Treatment is with antimicrobial agents
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Preventative measures include early detection and treatment, consistent and
correct use of condoms with all partners not known to be infection-free, avoiding
multiple sexual encounters or anonymous/casual sex, and mutual monogamy
with a non-infected partner.
Chlamydia is a sexually transmitted genital infection manifested in males
primarily as urethritis, and in females as a cervical infection. Up to 70% of
sexually active women with chlamydial infections are asymptomatic.
Complications and abnormal conditions resulting from a chlamydial infection
include inflammation of the fallopian tubes with subsequent risk of infertility,
ectopic pregnancy, or chronic pelvic pain. Infection during pregnancy may result
in premature rupture of membranes and preterm delivery, and eye infections and
lung infections of the newborn. The Arizona rate is 466.5 cases/100,000
population and the Apache County rate is 930.4 cases/100,000 population.
Treatment is with antibiotics.
Prevention is through education emphasizing use of a condom during sexual
intercourse. Annual screening of sexually active adolescent girls should be
routine. Screening of adult women should also be considered if they are less
than 25 years old or at increased risk.
Streptococcal Group A (invasive) may cause any of several clinical syndromes
including pneumonia, skin infections, deep soft tissue infection, meningitis,
peritonitis, osteomyelitis, septic arthritis, postpartum sepsis, neonatal sepsis, and
non-focal bacteremia (Case Definitions for Reportable Communicable
Morbidities, Arizona Department of Health Services, August 2006). The Arizona
rate is 3.1 cases/100,000 population and the Apache County rate is 11.1
cases/100,000 population.
Treatment is with antibiotics.
Prevention is educating the public the modes of transmission, the importance of
hand hygiene and the need for prompt diagnosis and completion of the full
course of antibiotics prescribed by their physician.
Streptococcus pneumonia (invasive) causes pneumonia, blood infection, ear
infections and meningitis in infants. Infants who survive may have speech,
hearing or visual problems, psychomotor retardation, or seizure disorders if there
has been meningeal involvement. The Arizona rate is 3.1 cases/100,000
population and the Apache County rate is 11.1 cases/100,000 population.
Intravenous penicillin treatment of women colonized with group B streptococci at
the onset and during labor will interrupt transmission to the newborn.
Prevention for the pediatric population is immunization with a pneumococcal
vaccine.
EXPENDITURES OF THE DEPARTMENT
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Expenditures of the Apache County Public Health Services District for FY
2012/2103 were $2,554,493.64. The revenue amount was $2,374,420.31. The
discrepancy between the revenue and expenditures is due to the fact that the
ACPHSD deals with grant budget years that start in July, October and January.
We provide services in one fiscal year and are not paid for those services until
the next fiscal year.
Another issue is the ACPHSD is tasked with paying for Restoration to
Competency (RTC) and Title 36 Court ordered Evaluation holding time. Because
the number of people who will be incarcerated in the RTC program and the
number who are being held until in a behavioral health facility is unknown at the
beginning of a fiscal year, budgeting for this item is extremely difficult.

RECOMMENDATIONS OF THE DIRECTOR
A relentless, consistent public health education campaign with an easily
understandable message regarding the above diseases needs to developed,
funded and promoted throughout all Apache County.
There are other areas of concern that are not disease related that need to be
researched and solutions developed. The following death rates from nondisease related causes are higher than the State of Arizona rates. Deaths from:
accidental poisonings, motor vehicle accidents, falls, diabetes, suicide (especially
in the adolescents and young adult population), chronic liver disease and
cirrhosis, septicemia and alcohol all need thought, resources and effort to make a
meaningful impact in reducing the number of deaths from these causes.
The County and incorporated areas should be proactive in attracting businesses
and industry to locate in Apache County. As gainful employment increases,
families are better able to provide for themselves, their healthcare improves, their
outlook on life improves and the health of the population improves. Having good
paying jobs with good fringe benefits improves public health.
Respectfully submitted,
Chris G. Sexton, Health Director

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