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INTRODUCTION 1

ADMINISTRATION 2

COMMUNICABLE DISEASE CONTROL 3

DENTAL HEALTH 5

ENVIRONMENTAL SANITATION 6

HEALTH EDUCATION 9

LABORATORY 10

PUBLIC HEALTH NURSING 11

STATISTICAL SERVICES 13

VETERINARY SERVICES 14

WELFARE 16

SAN ANTONIO METROPOLITAN HEALTH DISTRICT

CIYCONIL ---- BEXAR COUNTY

CITYCOUCIL ------ COMISSIONERS COURT

CITY MANAGER

STATE HEALTH DEPARTMENT -------- DIRECTOR ADVISORY BOARD OF HEALTH

PUBLIC HEALTH SERVICE --

DEPUTY DIRECTOR

PROJECTS MANAGEMENTS HEALTH PROGRAM COORDINATORI I

-Accounting-Budget

-Personnel

NURSING SERVICES-Adult Health-Child Health-Chronic Diseases-Crippled Children-Heart & Cancer-Home Health Agency-Maternal Health-Mental Health-Mental Ratardation-Nutrition

DENTAL HEALTH

-Clinics-Consultation

COMMUNICABLE|DISEASE CONTROL-Epidemiology-Immunization Project-Tuberculosis Control-Venereal Disease

Control

STATISTICAL SERVICES

-Health Cards-Permits-Vital Statistics

WRR:WLS:dlRev. August 1969

ENVIRONMENTAL SANITATION

-Air Pollution Control-Food & Premise Sanitation-Insect & Rodent Control-P. H. Engineering

HEALTH EDUCATION

-Health EducationMaterials

-Program-Coordination &

Consultation-Public Information-Training Programs

VETERINARY SERVICES

-Milk & Frozen Desserts-Meat & Poultry-Rabies Control

LABORATORY

-Chemistry-Clinical-Microbiology-Serology

WELFARE

-Casework Services-Emergency Cash Assistance

Grants-Food Stamp Purchases-Regular Cash Assistance

Grants

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INTRODUCTION

Present day public health concepts place emphasis on health goalsoffering greatest hope of attainment. These goals include control ofupper respiratory and intestinal diseases, chronic conditions such ascancer, heart, circulatory diseases, accidents and other incapacitatingconditions. Improved maternal and child health, industrial andmental hygiene and many other health problems are within thesegoals. The San Antonio Metropolitan Health District is especiallygeared to bring these goals to fruition.

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ADMINISTRATION

The Director and his administrative staff personnel are responsiblefor: budgeting, spending, personnel management, approving andestablishing policies, and following through with recommendedprocedures that bind the nine divisions into a single functionalcohesive health district.

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COMMUNICABLE DISEASE CONTROL

This Division is responsible for the surveillance of communicabledisease within the boundaries of the San Antonio Metropolitan HealthDistrict. The principle functions of the Division are Epidemiology andcontrol measures through treatment or prevention in four main fields.

Services in the field of Tuberculosis control are provided by the ChestClinic, the Case Register and the child centered case finding approach.The Chest Clinic is the focal point for diagnosis and treatment oftuberculosis suspects and contacts referred by other clinics of theDistrict and private physicians or located through case finding efforts.The Tuberculosis Case Register of all known or suspect cases in BexarCounty assists in control measures and supplies statistical data. Thecase-finding phase includes the skin testing of approximately 36,000school children (first and seventh grades) annually with follow up onpositive reactors.

Venereal Disease control is accomplished through early detection andtreatment of infectious cases and contacts. A diagnostic and treatmentcenter is operated daily as is an active epidemiological program forevery case of infectious syphilis. Gonorrhea, with its low morbidity andmortality is not followed as closely as is syphilis. Close liaison ismaintained with private physicians and laboratories as well as withother agencies interested in the control of venereal disease.

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The Health District has a vigorous immunization program with adaily Immunization Clinic operated in the District office as well asneighborhood clinics in lower socioeconomic areas. Immunizationsare also available in all Well Child Conferences run by NursingServices. Free immunizing agents are provided to private physiciansfor immunization of patients unable to afford such agents.

A Hansen's Disease Clinic is operated under the supervision of adermatologist for the diagnosis and treatment of this disease which isendemic in South Texas. Extensive epidemiological work is carriedon in cooperation with the Texas State Department of Healthprogram.

Consultative services are provided physicians in the field ofcommunicable disease control including prevention of rabies inhumans.

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DENTAL HEALTH

The Dental Health Program is designed to effect improvement in thedental health of the community by providing clinical facilities forchair-side health education, and the application of preventivetreatment procedures for indigent children through twelve years ofage, and furnishing dental health educational materials; such as,films, literature, and charts for individuals or groups to help maintainit. Also included are corrective treatment procedures for indigentchildren through twelve years of age designed to eliminate andprevent oral diseases and infections, and to prevent the loss of teethand the subsequent dental disorders caused by their loss.

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ENVIRONMENTAL SANITATION

The Environmental Sanitation Division helps provide the communitywith a healthful environment in which to live and work. This isaccomplished by surveillance and inspection techniques used toevaluate the adverse health influences of our society. After needshave been established, proper levels of control and correction are setforth according to current acceptable state and local health practicesand requirements. The area of work covered by the EnvironmentalSanitation Division is varied and includes inspection of privatepremises and food establishments, insect and rodent control, publichealth engineering and air pollution.

Premise Sanitation

Inspections of private premises are made to locate and correct healthhazards and nuisances. Included in these inspections are sewer andwater connections, fly and mosquito breeding, harborage, garbagestorage, rubbish, trash and weeds.

Food Sanitation

The Food Sanitation Section has supervision over the physical plantand sanitary operation of food establishments. This includes theprocessing, manufacturing, storage, preparation and service of foodintended for human consumption in retail and wholesale trade.Advice is given on proper equipment to be used, methods ofcleaning, storing, preparing and serving of food products, andconstruction and maintenance of establishments.

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Insect and Rodent Control

Activities of the Insect and Rodent Control Section include controlof mosquitoes, flies, roaches and rats on public property.

Mosquitoes are controlled by draining, stocking with minnows orspraying standing water in rivers, creeks, ditches and other placeswhere water collects and presents a mosquito-breeding area. Otherwork of this section includes destruction of rats, rat fleas, flies androaches to prevent those diseases transmitted by them. Control isaccomplished by eliminating breeding sites where possible, orinstigating control measures where sites cannot be eliminated.

Engineering Section

Responsibilities of the Engineering Section include water qualitycontrol, liquid waste disposal, institutional health, occupationalhealth, rendering plants and mobile home parks.

Routine sanitary surveys for detection of pollution hazards are madeof water supplies including swimming pools. Samples are collectedfor bacteriological and chemical analysis to determine if the waterquality is safe.

Supervision of septic tank system installations and operationalproblems, where no sewers are available, and the operation of sewagetreatment plants to minimize water pollution are other concerns ofthis section. Special problems regarding sewer overflows, brokensewer mains, mis-use of the sewage system (oil, acid wastes, grease,etc.), and liquid waste disposal for new subdivisions are also activitiesof the Engineering Section.

This section also surveys industrial establishments to detectoccupational hazards (dusts, fumes, mists, toxic chemicals, radiationexposures, etc.), and their control.

Rendering plants are placed under Engineering Section personnelwho work with management in bringing the physical plants up to astandard assuring sanitary operation. Operation of the plants, as wellas the vehicles used to collect materials to be rendered, is alsoincluded.

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Mobile home parks inspections for water supply, swimming pools,liquid and solid waste disposal are also conducted by the EngineeringSection.

Air Pollution

The Air Pollution Control Program has the function of samplingambient air, locating air pollution emissions, and controllingdischarges into the outdoor atmosphere of contaminants which areinjurious to humans, plants, animals or property, or which interferewith enjoyment of life and property.

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HEALTH EDUCATION

The function of this Division is to inform citizens on mattersconcerning health and related problems. Knowledge in theapplication of an "ounce of prevention is worth a pound of cure" isthe theme of the Health Educator. To accomplish this, each citizenshould realize his responsibility to his loved ones, friends andneighbors. Disease epidemics flourish where people are careless aboutimmunizations, sanitation and personal hygiene. Therefore, itbecomes the health educator's responsibility to conduct TV andradio programs, give lectures, show films, distribute pamphlets, writenews releases, work with community groups and healthorganizations, and inform citizens of the importance of a healthenvironment. This division works closely with other divisionsassisting them with educational needs to help accomplish theirpurpose.

In cooperation with San Antonio College this Division offers varioustraining courses to the local food industry. These courses aredesigned to acquaint the food handler with methods of food-bornedisease prevention.

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LABORATORY

As a Regional Laboratory of the Texas State Department of Healththis Laboratory serves not only San Antonio and Bexar County buttwenty surrounding counties and the Cities in these counties.However, approximately 90% of the samples and specimens receivedare from San Antonio.

Laboratory activities are essentially those which implementdepartmental objectives in communicable disease control. In additionto isolation and identification of pathogens, the laboratory is calledupon to perform tests on samples of food, milk and water, and onswabs and rinses on utensils, equipment and containers to insure thatclean wholesome food and drinks reach the consumer. The chemistrysection has been expanded recently to include the laboratory testsneeded for air pollutants and the amounts of each present in the airand to determine effectiveness of control measures.

Along with the great emphasis placed on epidemiology and diagnosisof communciable disease (tuberculosis, venereal diseases, diphtheria,etc.) and the quality control testing of food, water and air there is anincreased demand for clinical testing to be done on the medicallyindigents for early detection of chronic diseases. To the present, inthis laboratory, this work has been pointed primarily to blooddeficiencies, heart conditions and diabetes.

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PUBLIC HEALTH NURSING

The primary goal of Public Health Nursing is the provision of nursingservices that promote and make possible the achievement andmaintenance of optimal health for all people in a community. It isone of the basic organized community health services whichcontributes to a healthy and happy way of life.

Public Health Nursing services may be directed to an individual or afamily, either at home, at school, at work, or in a public healthcenter. The public health nurse is known throughout the communityand her services are available without distinction to race, color,creed, economic, educational, or social level.

In the San Antonio Metropolitan Health District public health nursesare involved in the operation of the following clinics involving healthteaching for the family: Well-Child, Maternity and Adult HealthConferences, Immunization Clinics, Leprosy Clinics, VenerealDisease Clinics and Chest Clinics.

Home visitation is the core of public health nursing. This serviceincludes visits in the interest of Crippled Children, Premature Infants,Preschool and School Age Children, Prenatal Care and any ChronicIllness, which includes those related to diabetes, cancer,cardiovascular and communicable diseases.

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Two nutritionists are available for counseling with patients at therequest of the individual or referrals from other sources. Acomprehensive Nutrition Program has been established for the ModelNeighborhood Area.

The Nursing Services is also certified as a Home Health Agency forMedicare. Services through Medicaid are also provided. Registerednurses, licensed vocational nurses and home health aides areemployed to provide bedside care in the home.

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STATISTICAL SERVICES

The Statistical Services Division maintains about 600,000 birthrecords and 300,000 death records dating back to 1873. Theresponsibility for recording all births and deaths occurring in BexarCounty was given the division on January 1, 1968. Approximately18,000 births and 6,000 deaths are recorded each year.

Also, we handle the administrative transactions and money to issuelicenses or permits for food estabilshments, food handlers, milkproducers and distributors, ice cream and frozen desserts, trailercourts, rendering establishments, massage parlors, livestock,slaughterhouses, meat processors, poultry inspections, percolationstests, septic tank inspections, dog licenses. These actions produceabout $500,000 annually.

In addition, the division prepares statistical data regarding births,deaths, and compiles statistical records concerning communicablediseases and departmental activities. These statistics provide theDirector with information about the status of health in thecommunity. They also provide an aid to the evaluation of healthprograms, need for additional immunizations, and an index of thesanitary status of the community.

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VETERINARY SERVICES

The Division of Veterinary Services functions in areas involvinganimals and their relationship to the well-being of humans. TheDivision is composed of three sections, i.e., Milk and Frozen DessertsInspection, Meat, and Rabies Control. A veterinarian is employedand available for professional consultation with employees onproblems peculiar to animals and their health. The wholesomeness ofthe large volume of food products of animal origin is a responsibilityof this Division.

Milk and Frozen Desserts Inspection

This section performs inspections of dairy farms and milk and icecream plants, and obtains samples for laboratory examination fromeach of these sources. The effective combination of these effortsassures citizens of San Antonio a safe, wholesome supply of milk anddiary products. Particular attention is given to the sanitation andfunction of equipment and surroundings utilized in the production,storage, hauling and manufacture of dairy products as well as to thehealth of the cows producing the milk. Complaints received by thesection are discussed with the individuals involved and correctionaffected.

Rabies Control

The control of the disease rabies is the chief function of this section.This is accomplished by placing biting dogs under observation for tendays from the date of bite, picking up sick, injured and unwanted

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dogs, reducing the number of strays, and obtainingvaccination-licensure of owned dogs.

If a biting animal dies while confined, the brain is removed andforwarded to the laboratory for examination for rabies. The outcomeof the confinement and laboratory tests are forwarded to medicalpersonnel and are relayed to the victim and animal owners.

Unwanted dogs may be taken to the City Rabies Control Facility inBrackenridge Park for humane disposition.

The City Rabies Control Facility is operated by this section. Hereowners may reclaim lost dogs upon showing some evidence ofownership. Unlicensed and unvaccinated animals must be vaccinatedand licensed before being released from the shelter. Problemsinvolving dogs may be discussed with the shelter personnel.

Meat Section

The meat section is charged with the surveillance of the meat sold inSan Antonio. It is the section's responsibility to assure the citizens awholesome, unadulterated, and properly labeled meat supply.Surveillance is maintained on all meat wholesalers to assure that meatis from an approved source and is handled in a sanitary manner. Allequipment and facilities of meat retailers, transporters, and meatstorage facilities are checked to assure that they are maintained in asanitary condition, and that the meat is handled in such a mannerthat prevents contamination. This activity can remove fromconsumer channels products found to be adulterated, contaminatedand mislabeled.

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WELFARE

Public Assistance

The City Division of Public Welfare provides cash assistance grantsfor needy families or individuals provided the individual isunemployable, and provided no adult member of the immediatefamily is employable, unless illness of another member of the familyrequires their physical presence in the home for care. Theunemployability must be based on the diagnosis and prognosis of aphysician legally licensed to practice medicine in the State of Texasor employed by the U. S. Veterans Administration or Armed Forces.The physical incapacity must exist for a period of thirty days orlonger.

Emergency cash assistance grants are made as follows:

1. The family must have an Aid for Families with DependentChildren (A.F.D.C.) application pending, or

2. The breadwinner is incarcerated, waiting sentence, or sentencedfor less than six months, or

3. The breadwinner is deceased and Social Security is pending.

Food Stamp Purchases

By reason of the State-City-County contract, the Department maypurchase Food Stamps only for those individuals or families withoutincome.

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