Communicable Unease

Mel Bowie gets paid to tell people they're HIV-positive. Sometimes they don't want to hear it. A public-health specialist for the Kansas City Health Department, Bowie tries to persuade people to come in for counseling. Once he visited a couple to break the bad news to the husband. The man's wife rushed into the kitchen, yelled that she was going to kill herself and reemerged with a butcher knife. She began to cry. Her husband was going to die, she shouted. No one would take care of her kids. It took several minutes for Bowie and the husband to wrestle the knife away from the strong woman.

Kansas Citians with health insurance don't have to think about the health department much. But the KCHD, which was created more than 100 years ago, provides crucial city services. The department oversees the city's food inspectors and rat exterminators. It measures air quality. At its on-site clinics, kids get free immunizations and adults receive no- or low-cost treatment for sexually transmitted diseases and tuberculosis. Department workers take health education programs to elementary schools and daycare centers, and KCHD nurses visit community centers to check up on senior citizens' physical well-being.

"The only time the public hears of us is when something goes wrong," says department employee Michael Swoyer.

Lately, however, the public has heard quite a bit from the health department. At the end of October, trace amounts of anthrax showed up at the United States Postal Service's underground Stamp Fulfillment Services center, which processes collectors' stamps. Investigators confirmed that mail from the anthrax-contaminated Brentwood facility in Washington, D.C., had found its way to Kansas City. KCHD employees fielded phone calls from a worried public, conducted interviews with stamp-center workers to help determine the extent of their possible exposure and handed out antibiotics.

With the public wanting to know whether the city could withstand a large-scale bioterrorist attack, the health department's director, Rex Archer, quickly became a familiar face on television.

That was fine with Archer, who came to the department in the summer of 1998. For years he has pushed for a better plan to slow the spread of communicable diseases.

In case of a massive bioterrorist attack, the health department's workers wouldn't be on the front line in the same way as firefighters and police or paramedics and emergency room physicians. But they would be at ground zero when it came to providing the critical information each of those groups would need to coordinate their efforts. The faster hospitals and emergency-service providers were in touch with each other and with the department, the faster a potential outbreak of any deadly infection or toxic chemical could be identified and treated. Archer uses a highway analogy to describe the need for better coordination. "You wouldn't think of the interstate highway system where two bridges don't meet over the road," he says. "But we frequently don't come together and say, 'These are our priorities.'"

Away from the spotlight, however, all is not well at the health department -- and some employees think that has to do with the department's internal priorities.

Last February, an employee survey showed that the department's employees had been infected by a culture of boilingdresentment. Workers and managers don't get along -- almost 10 percent of the staff has turned over in the last year -- and the department is clogged with allegations of racial discrimination. Many current and former employees wonder how the department will be able to handle a citywide crisis if it cannot solve its own.

Last fall, the Kansas City Council wanted to make city agencies more receptive to residents who don't speak English by hiring more bilingual employees and by printing city documents and posting city information online in more than one language. In November 2000, the health department formed a diversity council, made up of seventeen volunteers who had been recommended by their supervisors, to look at the same issues. But after a few meetings, the diversity council's focus began to shift as members realized they couldn't meet those progressive goals when no one was addressing basic discrimination complaints.

For years, life at the health department had been tense. Employees felt undervalued by their managers. Minority employees believed their white counterparts had an automatic edge among those reviewed for promotion. Vacant jobs rarely were posted in-house; outsiders scooped them up, limiting opportunity for advancement, especially for clerical staffers. Mel Bowie, who is a member of the diversity council, believes that promotion practices had the effect of segregating many of the black and white employees into different KCHD buildings around town.