It's missing a business manager, too, as well as a deputy health officer. It's missing case investigators, nurses, sanitarians and women's health clinicians.
And twice last year, it didn't have a health officer. That left Guy Miller, an epidemiologist by training, to captain a ship taking on water as key staff left and few new hires could come on to plug the holes.
It is an overwhelming task, said Miller, who is 31 and now oversees a staff of about 60 employees.
"You hear from businesses a lot, like, it's really hard to deal with staffing and everything during COVID-19. We feel that in an extreme way," Miller said. "We're working to do the same thing, make the same adjustments, do the protocols, then write the protocols, but then we have all those local partners who turn to us for the COVID-19 response."
Berrien County's Health Department staffing crisis remains dire, and many other Michigan health departments know the feeling. Health officers say low wages, chronic underfunding, and a deeply politicized workplace have made public health work undesirable. The result has been an overarching infrastructure that is less resilient than it was in March 2020, and, they worry, less prepared should another public health crisis arise.
"Right now, if we staffed all our positions, we'd have 80 staff. But we have 22 positions available," Miller said. "So we have quite a few positions that we've been unable to hire for."
Miller describes the staffing losses as casualties in a "war on talent."
In the metaphor, private health care employers and public health departments face off in the hiring market. Private employers compete by offering higher wages and less rigid workplaces. Public health departments offer a mission-oriented career and the stability of nine-to-five hours.
To Miller, it's no surprise that private employers win out. One of the first casualties in the war was his former boss, Health Officer Nicki Britten. Britten served as Berrien County's Health Officer for 10 years. In the Summer of 2021, she took a job at Spectrum Health Lakeland.
Rudderless, Deputy Health Officer Courtney Davis stepped in as interim health officer, only to resign as well four months later. In a statement, Davis cited "the politicization of public health during the pandemic," and said that the role had taken a significant toll on her mental health.
So Miller took the helm and steered Berrien County through not only the Omnicron wave, but also a parallel crisis of lead-contaminated water in the city of Benton Harbor, which is within the county.
The competing pressure illustrates another problem that has health officials worried. Throughout the pandemic, health departments have had to pick and choose what jobs they can competently do with limited staff. Naturally, COVID response was an all-hands on deck scenario, while other health department roles — like restaurant inspections and lead monitoring, received less attention.
Kayleigh Blaney, Deputy Health Officer in the Genesee County Health Department, said the same phenomenon had been occurring in her county, which encompasses Flint and is one of the most populous in the state.
"With expectations and requirements of health departments' normal work returning, it is very difficult to manage the expectations related to the COVID response along with the normal functions of the health department," said Blaney.
In Genesee, Blaney says 20 staff were hired with COVID funding, which means their positions "will not continue when COVID funding is no longer provided to local health departments."
At District Health Department No. 10 (DHD10), the state's largest geographical health department, some help came from the Michigan Department of Health and Human Services and the CDC Foundation, a non-profit arm that supports the Centers for Disease Control and Prevention. Both provided support staff with a strict COVID-only focus. Both provided surge staffing, which allowed regular staff to pivot back to restaurant visits and septic inspections, which were also holding up construction in a busy season for developers, Hughes said.
"They are focusing entirely on dealing with COVID while our other staff are trying to deal with the other services that it's expected we're going to provide," said Hughes.
Hughes said DHD10 — and every county — faces a similar problem. For years, health departments have existed in a 50/50 funding partnership with the State of Michigan, according to a mandate within Michigan's Public Health Code.
However in 2019, a report commissioned by MDHHS found that the State of Michigan had not been meeting its 50 percent funding commitment to county health departments. The report found that the state was only meeting 25-30 percent of it's cost share.
The unmet commitment has put the onus on health officers to source 50 percent of each health department's funding, in addition to the amount the state fails to pay. It's a tall order, especially for departments like Berrien, where the business manager position remains vacant.
"Either you're going to the counties to ask for more money or you're looking at raising fees," Hughes said. "Obviously the counties don't like to do that."
The study affirmed what public health experts had already known for years: that health departments in Michigan have been chronically underfunded, and that temporary hires and relief money are a Band-Aid, rather than a long-term solution.
"It's been a problem for 27 years," said Norm Hess, Executive Director of the Michigan Association for Local Public Health. "We were on a very shaky scaffolding before all this started. And when all the surge funding goes away, we're going right back to that."
When Hess speaks with legislators, he leads with the study, but says it often falls on deaf ears. Legislators feel like there's already money in public health, Hess said, so they don't prioritize it.
"They don't necessarily need it right now, but in the coming years, they definitely will," Hess said. "Or we'll be in worse shape the next time a pandemic comes around."
While funding evaporates, what likely will remain is the charged political rhetoric that has vilified public health officials for doing their jobs. In the Upper Peninsula, Luce, Mackinac, Alger and Schoolcraft county health department (LMAS), Director of Community Health Kerry Ott said her case investigators were used to regular threats when they call residents to figure out when they might have contracted COVID.
"The majority of people have been OK with receiving these communications, but the other calls take a toll on staff mentally," said Ott, who also serves as the department's communication's officer in the wake of a vacancy in that position. "Much of this work has continued seven days a week."
In Southwestern Michigan, Danielle Persky of the Van Buren-Cass Health Department said her employees have been out of fuel for months. But her staff have banded together with a kind of survivor's mentality forged by the worst of times.
In part, Persky said, that's because one of the department's nurses died of COVID-19.
"There's a lot of this mentality where, if I walk away, I know how much it hurts my teammate, so I won't walk away," said Persky. "It's like the bond that you have in a war-torn situation. That's not just a cliche, it's what the pandemic has required."
That bond might be less common than the alternative — retirement, resignations and, ultimately, distance from a field that is physically and emotionally taxing.
"For one you get burned out," said Linda Vail, Health Officer for Ingham County, which encompasses Lansing. "Then two, you look around and realize that your profession is getting disregarded, dismissed, disrespected. We're going to have to recover from that."
(c)2022 The Record-Eagle (Traverse City, Mich.) Distributed by Tribune Content Agency, LLC.
