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					D i S e a S e   D e T e C T i v e S   p R o T e C T i N g   o u R   C o M M u N i T y

                                      Miami-Dade County
                                      Health Department
                                      a N N ua l        R e p o R T       2 0 0 9
Disease Detectives
     Control of Communicable Diseases
     Whenever a disease outbreak affects our community, the Miami-Dade County Health
     Department (MDCHD) has a structure and mechanisms to identify diseases quickly in
     order to slow down its spread. The protagonists in that process are our epidemiologists, or
     “disease detectives.”

     Disease detectives include physicians, nurses, veterinarians, pharmacists, lab technicians
     and other experts, who understand that the chances of dramatically slowing or even
     stopping an outbreak are highest if they can recognize a disease early on and rapidly
     disseminate information and act against it.
our disease detectives will interview the infected people and ask them where      The disease detectives can also monitor the sales of over-the-counter drugs
they have been in the previous days and with who they’ve been in contact          as an early-warning sign that an outbreak may be imminent. in Florida, there
with. They coordinate and provide direction to local emergency rooms, asking      are about 100 physicians who report any unusual activity to the Florida
doctors and nurses to look for patients with symptoms and asking patients         Department of Health and the Centers for Disease Control (CDC).
their recent travel history.
                                                                                  Recently, our disease detectives played a vital role in making preparations
The information they gather is then used by public health and political leaders   against the outbreak of the virus H1N1 (known as swine influenza) that has
at all levels of government to make important decisions about how to stop the     affected the united States and other countries.
spread of the infection and the distribution of medication needed to repond
to specific medical and public health emergencies.                                in an effort to educate the public and discuss preventive measures against
                                                                                  the H1N1 virus, the Department partnered with community leaders in
These experts’ comprehensive analysis helps public officials and the Health       organizing a series of town hall meetings throughout Miami-Dade county.
Department decide whether to close schools, airports, borders and other           local municipalities, schools, colleges and other organizations partnered with
public places.                                                                    the MDCHD in this initiative.
                                                                                                 Miami-Dade County Health Department
                                                                                                                    2009 annual Report        6

                                                                                                                      Kids and adults are
                                                                                                                      having fun as they
                                                                                                                      are taught by public
                                                                                                                      Health officals the new
                                                                                                                      coughing etiquette.

Confronting the First pandemic of                                              partnerships that include The Children’s Trust, Miami-Dade County public
                                                                               Schools and our Health Department.
the 21st Century – 2009 H1N1
                                                                               The MDCHD habilitated four vaccination sites: Downtown Clinic, little Haiti
Immunizing the Community
                                                                               Health Center, West perrine Health Center, and the Juanita Mann clinic,
                                  The MDCHD started in october 2009 a          extending regular hours into the evening and weekends. Medical and
                                  mass vaccination campaign against the        nonmedical personnel were recruited to help with this communitywide effort
                                  2009 H1N1 influenza. partnering with         to address The president’s declaration of a national emergency to deal with the
                                  local health care providers, schools,        “rapid increase in illness” from the H1N1 influenza virus.
                                  community clinics, and federally qualified
                                  health centers, the Department offered       Federally Qualified Health Centers opened their doors as well to the mass
                                  the vaccine to high-priority groups, such    vaccination campaign. They were: borinquen Health Care Center, Citrus Health
                                  as children and pregnant women.              Network, Community Health of South Florida, Helen b. bentley Health Center,
                                                                               and Jessie Trice Community Health Center.
                                  The vaccine was given free of charge
                                  to the community, and in local schools       our sincere gratitude goes out to each individual who assisted with a
                                  immunizations    were     administered       successful campaign. Next year we will share with you the final outcome of
through the School Health Connect, a program funded by public and private      such unique endeavor.
Inside   08


                  Our Challenge


         12   |   Welcome Letters

         16   |   Community and Family Health

         22   |   Protecting the Community

         28   |   Public Health Preparedness

         30   |   Environmental Health and Engineering

         32   |   Community Relations

         36   |   Dental Program “Seals on Wheels”

         38   |   Highlights

         40   |   Senior Leaders

         42   |   Credits
                                                                           Miami-Dade County Health Department
                                                                                            2009 Annual Report    8

Our Challenge
The MDCHD protects our community from a wide range of public health threats such as tuberculosis, HIV/
AIDS, sexually transmitted diseases and other communicable diseases in general. Our activities include
identifying health risks; maintaining a safe and healthful environment; detecting, investigating and preventing
the spread of disease; promoting healthy lifestyles; and informing the public on health issues.

Our broad approach to public health spans environmental health to family planning, refugee health to
immunizations and nutrition for women, and infants and children to the prevention of chronic diseases.

We also participate in disaster planning and facilitate the staffing of shelters for people with
special health care needs in the event of hurricanes or other disasters. Further, we maintain the
county’s vital records of births and deaths, develop school health projects and educate the public
regarding healthy behaviors such as avoiding tobacco use, injury prevention and more.

We have three full service locations – in the north, central and southern regions of the
county – and operate other health clinics that serve specific local areas.

We have twice received the Governor’s Sterling Award for significant improvement and performance
excellence, demonstrating our commitment to the health and safety of the communities we serve.

Created by the Florida legislature in 1997, MDCHD is the local branch of a
state public agency, the Florida Department of Health.
Vision                                                     Strategic Priorities
To Be a World-Class Public Health System.                  1. Prevention and Preparedness
                                                           2. Return on Investment
                                                           3. Service Excellence
The MDCHD mission is to promote and protect the
health of our community through prevention and
preparedness today for a healthier tomorrow.

Integrity, Customer and Community Focus, Accountability,
Teamwork, Excellence, Respect for People.
Miami-Dade County Health Department
                 2009 Annual Report   11
12   Miami-Dade County Health Department
     2009 Annual Report

                              From the Mayor
                              Dear Friends and Residents:

                              It is with pleasure that I join the MDCHD in presenting its annual report.

                              I have been pleased to have MDCHD as a partner in recent initiatives aimed at promoting awareness and
                              healthy living among members of our community. For the past several years, my office has worked on the
                              To Life! campaign with the Alliance for Aging and the MDCHD’s Consortium for a Healthier Miami-Dade to
                              promote wellness and safety for seniors.

                              As part of that initiative, we educated thousands of seniors on the Medicare Part D prescription drug
                              program, trained dozens of senior service caregivers on fall and fire prevention, and held workshops for
                              medical and health professionals on educating seniors about hurricane preparedness, healthy eating and
                              how to properly take their medications. We also held health expos and fairs throughout Miami-Dade,
                              where seniors received blood pressure, bone density, glucose, cholesterol and other screenings.

                              In these and other activities that promote healthy lifestyles among our residents, MDCHD has been a crucial
                              partner. Planning discussions with MDCHD leaders on future health projects that benefit the community
                              are underway.

                              On behalf of Miami-Dade County’s 2.4 million residents, I want to thank to MDCHD Administrator Lillian
                              Rivera, RN, MSN, PhD, for her leadership. I also want to congratulate the MDCHD for its accomplishments
                              and commend its dedicated employees for safeguarding the health of our residents and visitors.


                              Carlos Alvarez
Miami-Dade County Health Department
                 2009 Annual Report   13
14   Miami-Dade County Health Department
     2009 Annual Report

                              From the Surgeon General
                              To the Citizens of Miami-Dade County:

                              As State Surgeon General of the Florida Department of Health, it gives me great pleasure to join the MDCHD
                              in presenting its 2009 annual report.

                              The Florida Department of Health is dedicated to improving access to health care and the quality of the
                              services we provide. The MDCHD has been a leader in this front and has seized opportunities to improve
                              public health through prevention programs and services. It has established crucial partnerships at all levels
                              to advance public health projects and initiatives.

                              With the challenges our nation has ahead, the role of the Florida Department of Health in promoting and
                              protecting the public’s health has become more important. However, challenging moments provide us the
                              opportunity to evaluate how we conduct business and explore creative, more efficient options.

                              I want to congratulate the leaders and employees of the MDCHD for their achievements in 2009 as this
                              organization continues its commitment to public health and access to affordable, top-quality health care
                              for all the residents of Miami-Dade.


                              Dr. Ana M. Viamonte-Ros, MD, MPH
                              State Surgeon General
                              Florida Department of Health
                                                                                          Miami-Dade County Health Department
                                                                                                             2009 Annual Report         15

From the Administrator
To the Community:

It’s with great satisfaction that I present this 2009 annual report to our community. The MDCHD is an organization committed to safeguarding
the public health and safety of all the residents and visitors of our county. This goal would be impossible to achieve without the commitment,
dedication and innovation of our employees.

The health services we provide to those who need them and all the health initiatives we advance in Miami-Dade are also possible because of
the tremendous support we receive from partners, volunteers and close collaboration with national, state and local government agencies, as
well as various community organizations and local businesses. During the past year, 1,470 volunteers and partners provided over $29 million
in health care services to more than 57,082 uninsured and underinsured men, women and children.

Though recent times have been challenging for us, we continue focusing on what we do best: protect the health of the community we serve.
We keep expanding health and preventive services in our existing clinical sites and are closely following the construction of the new Center of
Excellence for Research, Diagnostic and Treatment, at the historic 1350 Building.

Protecting the public’s health from diseases, disasters, and bioterrorism is a priority for public health departments nationwide. Pandemic
influenza, infectious diseases, terrorism and catastrophic natural disasters remain serious threats. We at the MDCHD work everyday to advance
our public health system to respond to a range of threats, from naturally occurring diseases to bioterrorism.

In late April, 2009, the World Health Organization announced the emergence of a novel influenza A virus known as H1N1. Our county and
the world can now reap the benefits of investments, over the last five years, in pandemic preparedness. Thanks to our Miami-Dade partners
and their due diligence we have designed local plans to respond to this new threat. Influenza pandemics, whether moderate or severe, are
remarkable events because of the almost universal susceptibility of the world’s population to infection.

I know the future has in store for us other challenges that we must face with enthusiasm, optimism and professionalism because providing
health care services and advancing our prevention philosophy is a business we know well and one in which we will continue to excel.

I’m very proud of what we have accomplished in 2009 and the excellent work the MDCHD, its employees and leaders have done in protecting
the health and well-being of our community.


Lillian Rivera, RN, MSN, PhD
Miami-Dade County Health Department
16      Miami-Dade County Health Department
        2009 Annual Report

     Community and Family Health
     Immunization Services                                                            School Health
     Goals Exceeded                                                                   Bringing Health to Students

     The Special Immunization Program (SIP) provides immunizations for children       The School Health program has established a partnership with Miami-
     and adults. It operates three pediatric and one adult immunization sites, plus   Dade County Public Schools and the Children’s Trust to enhance student
     a clinic for travelers going abroad. During the years 2007-2008, the program     health care services. It is part of Health Connect, a large-scale initiative
     vaccinated 91.8 percent of Miami-Dade County two-year-olds, exceeding            that also involves local health care providers.
     Florida’s 90 percent goal. Another SIP highlight was a broad flu immunization
     campaign brought to health fairs and other events that benefited at-risk-        Health Connect aims to help children in 165 Miami-Dade public schools
     populations. SIP also provides back-to-school immunizations, educates and        by improving access to and use of quality health services, building
     monitors Hepatitis B-positive mothers and children, watches for disease          awareness of healthy behaviors though education and facilitating
     outbreaks, helps schools update and maintain records, and assures that           community environmental and lifestyle changes. Through this initiative,
     pediatricians store vaccines properly.                                           these children now have access to a team of professionals who address
                                                                                      their physical, mental and behavioral health needs. Our School Health
                                                                                      program – with its nurses, social workers, health support technicians
                                                                                      and other personnel – plays an important role in this project.
                                                                                                                                                                                                                                                  Miami-Dade County Health Department
                                                                                                                                                                                                                                                                                                         2009 Annual Report              17

                                                                                                                                                                                    Actual to Planned Revenue Ratio (Current)
                                      Years of Potential Life Lost Prior to Age 75 (per 100K Pop.)                                                                                  Actual to Planned Revenue Ratio (Current)                                                                                 Actual to Planned Expendiure Ratio (Current)
                                                                                                                                     Percentage of Planned Revenue

                                                                                                                                                                                                                                                             Percentage of Planned Expenditures
                               8000                                                                                                                                  120%                                                                                                                         120%
                                                                                                                                  Percentage of Planned Revenue

Years of Potential Life Lost

                                                                                                                                                                     100%                                                                                                                         100%
                                                                                                                                                                     80%                                                                                                                          80%
                               7000                                                                                                                                  60%                                                                                                                          60%
                                                                                                                                                                     40%                                                                                                                          40%
                                                                                                                                                                     20%                                                                                                                          20%
                                                                                                                                                                            01-02   02-03     03-04   04-05    05-06   06-07   07-08 DOH Target
                               6000                                                                                                                                   0%                                                                                                                           0%
                                      01-02   02-03     03-04    04-05      05-06     06-07       07-08 MDCHD Target                                                        01-02   02-03     03-04     YEAR
                                                                                                                                                                                                      04-05 05-06      06-07   07-08 DOH Target                                                            03-04     04-05    05-06      06-07       07-08   DOH Target
                                                                     YEAR                                                                                                                               YEAR                                                                                                                     YEAR

                       MDCHD                          Best FL Peer                  State Total              Best National Peer                                                Best FL Peer                   MDCHD                                                                                                MDCHD              Best FL Peer
                                                                                                                                                                               Best FL Peer                   MDCHD
18      Miami-Dade County Health Department
        2009 Annual Report

     Healthy Start                                                                        Special Supplement Nutrition Program for Women, Infants
     More Services Provided                                                               and Children (WIC)
                                                                                          Helping Families
     Pregnant women and children under three years old receive health care
     services and education through a partnership with the Healthy Start Coalition        Eligible pregnant, breastfeeding and postpartum women, infants and children
     of Miami-Dade. The MDCHD tabulates the data for the entire county.                   to age five receive special nutritional assistance. Benefits include nutrition
                                                                                          counseling and education, breastfeeding support and a monthly package of
                                                                                          healthy food.
     Vital Statistics
     Keeping Birth and Death Records                                                      In 2008, the WIC program served a total of 114,464 people at 18 service
                                                                                          locations. Our clients received more than $58.9 million in food benefits.
     The Office of Vital Records issues all certified records of birth, death and fetal
     death certificates in Miami-Dade County. For the 12 months ending June 30,           Access has been increased through the addition of Saturday service hours.
     2008, Vital Records issued a total of 109,961 birth, death and fetal certificates.   WIC maintains a trilingual appointment hotline – (786) 336-1300.
     At the same time, a total of 23,889 live births, 18,513 deaths and 219 fetal
                                                                                          Breastfeeding assistance is available through a 24-hour help line – (786) 336-
     deaths were registered. We service 101 funeral homes, seven local hospitals,
                                                                                          1336. Callers can learn about breast pump loans and link up with trained peer
     one birthing center and all home births in Miami-Dade County.
                                                                                          counselors who offer assistance through WIC offices and several local hospitals.
                                                                                                                      Miami-Dade County Health Department
                                                                                                                                        2009 Annual Report         19

Women’s Health                                                                   The MOMmobile provides prenatal and postpartum care to uninsured
                                                                                 pregnant women on a state-of-the-art medical service bus. Services include
Healthier Families                                                               education and counseling, pregnancy testing, WIC eligibility/referral, Healthy
                                                                                 Start screenings, referrals, prenatal care, postpartum care and initiation of
The Women’s Health and Preventive Services program promotes and protects         family planning services.
the health and well-being of women and their families in Miami-Dade County
through education, prevention and prompt attention to their health care needs.   The Medicaid Family Planning Waiver program extends family planning services
                                                                                 to women between 14 and 55 who have lost their full Medicaid coverage.
Women’s Health oversees six family planning clinics. Services include baby
spacing, pre-conception counseling, pregnancy testing, birth control choices     In an effort to help reduce disparities in oral health among school-age
(including abstinence), dispensing of emergency contraception pills, yearly      children, a school- based mobile dental program called “Seals on Wheels” was
exams for men and women, STD testing, counseling and treatment, and HIV/         launched in 2007 to provide not only preventive dental services but oral health
AIDS testing and counseling.                                                     education. Underserved public school children in second and seventh grade
                                                                                 are eligible. Services are provided on school grounds, during school hours, in
The Project SCREEN program serves uninsured and underserved women in             collaboration with the Miami-Dade County Public Schools.
Miami-Dade and Monroe counties between 50 and 64 years old by providing
breast and cervical cancer screenings.
20      Miami-Dade County Health Department
        2009 Annual Report

     Up and Coming                                                                                    1.0
                                                                                                                    Births to Teens (ages 10 - 14) per 1,000 Females

                                                                       Birth Rate per 1,000 Females
     New Center of Excellence for Research, Diagnostic and Treatment

     Sneak Preview / Early 2011



                                                                                                            01-02     02-03    03-04     04-05    05-06    06-07      07-08
                                                                                                                    MDCHD                Best FL Peer              State

                                                                                                                     Rate of Children Under Two Fully Immunized

                                                                       Percent Immunized


       BEFORE                                                                                          25

                                                                                                            01-02      02-03    03-04     04-05    05-06   06-07       07-08
       AFTER                                                                                                                            YEAR
                                                                                                                     MDCHD               Best FL Peer              State

                                                                                                            Vaccine Preventable Disease Rate per 100,000 Residents

                                                                       Rate per 100,000



                                                                                                            01-02      02-03    03-04     04-05    05-06   06-07       07-08
                                                                                                                    MDCHD                Best FL Peer              State
Miami-Dade County Health Department
                 2009 Annual Report   21
22      Miami-Dade County Health Department
        2009 Annual Report

     Protecting the Community
     Epidemiology and Disease Control                                                     Community Health and Planning
     Vigilance Against Communicable Diseases                                              Promoting Healthy Lifestyles

     The Epidemiology and Disease Control program monitors and investigates               The Office of Community Health and Planning program focuses its efforts
     incidents involving more than 80 communicable diseases, animal bites and             on preventing chronic diseases by promoting healthy lifestyle choices, good
     environmental conditions such as lead, mercury and pesticide poisoning.              nutrition, eliminating tobacco use, increasing physical activity and stress
     During the year 2008, we investigated over 5,000 illness cases and 200 food          reduction. During 2008, 20,000+ clients received services that included
     and water-borne health risk situations. And to reduce the threat of lead             education and screenings.
     poisoning, we screened hundreds of at-risk children and inspected day-care
     centers and homes in Miami-Dade. This program administered thousands of              Another important component is the continuing efforts of the Consortium
     vaccinations against hepatitis, particularly in high-risk settings, such as jails.   for a Healthier Miami-Dade, which is comprised of various local organizations
     In 2005, we installed an electronic monitoring system in 16 of the county’s          which addresses health issues in an open forum. Acting U.S. Surgeon General
     largest hospitals to provide early warning of natural or bio-terrorism threats       Steven Galson presented the Consortium an award for its efforts in addressing
     based upon alerts from emergency department visits.                                  the obesity epidemic in Miami-Dade county.

                                                                                          Last year, we partnered with our community for the fifth year to celebrate
                                                                                          Step Up, Florida 2008, a statewide initiative promoting physical activity and
                                                                                          healthy lifestyles.
                                                                                                                        Miami-Dade County Health Department
                                                                                                                                            2009 Annual Report           23

Miami-Dade County Health Action Network                                         Public Health Nursing
Improving Access to Primary Care                                                Playing a Vital Role

The MDCHD has partnered with the Health Council of South Florida to create      Our 100 public health nurses represent the largest group of health care professionals
the Miami-Dade Health Action Network (MD-HAN) aimed at improving                in the agency. They perform in many roles and settings – as clinical practitioners,
access to comprehensive primary health care for the uninsured population        program directors, health educators, care coordinators, case managers and
of our county by maximizing the existing network’s capacity.                    community partners. One of their most important tasks is to assess the health
                                                                                and safety needs of the community and to link individual clients and their families
MD-HAN identifies and utilizes new and available resources, including cutting   with support and services that meet their medical social and cultural needs. Our
edge technology, to provide affordable and cost-effective healthcare to the     nurses are strong advocates for the health of the community. Their professional and
uninsured. This will be accomplished through efficient sharing of health        personal connections with clients are the key to assuring successful prevention and
information, implementation and use of an effective county-wide referral        treatment outcomes. In a natural or man-made public health crisis, nurses become
system, and provision of continual, managed, and coordinated care through       the first line of defense against disease, illness or other situation that requires an
a medical home.                                                                 emergency response.

                                                                                A new initiative called Fast Track Clinic, in partnership with Jackson Memorial
                                                                                Hospital, now helps uninsured individuals and families find appropriate care.
24      Miami-Dade County Health Department
        2009 Annual Report

     Community Health Action Teams                                                            is diagnosed with an STD. In a continued effort to detect undiagnosed infections,
                                                                                              memorandums of agreement were developed with community partners who
     Responding to Emergencies
                                                                                              tested girls between the ages of 15 and 24 for chlamydia and gonorrhea. This
     Health professionals participate in health fairs and other health initiatives to bring   population otherwise likely would not have accessed services in a traditional
     the preventive messages and screenings to the public. Team members are trained           setting such as an STD clinic, especially if they were asymptomatic or not referred
     to respond during a hurricane and other disasters or emergencies.                        by a partner.

                                                                                              The STD program staff conducted STD 101 trainings for community providers,
                                                                                              implemented an education and screening demonstration project at two local high
     Sexually Transmitted Disease Prevention & Control Program                                schools, partnered with Miami-Dade County Schools to conduct STD education
     A Broad Strategy with Many Facets                                                        for teachers, presented posters, published articles, and promoted STD awareness
                                                                                              on television and radio. Highlights included participation in the National STD
     The Sexually Transmitted Disease (STD) Prevention & Control program seeks to             Conference, Florida Public Health Conference, South East Gay Men’s Health
     reduce the incidence of those diseases by diagnosing and treating infected               Conference, CDC national webinars on syphilis, and a report to the governor’s
     individuals, and providing partner services to include examination, laboratory           office on the impact of methamphetamine use on sexual health.
     testing, treatment, counseling, and provider referral. In the past year, we focused
     our efforts on health education and outreach screening for teens, men who have
     sex with men, and STDs in corrections facilities, while maintaining an emphasis on
     STD prevention in the community at large. Nationally, one out of four teenage girls
                                                                                                                   Miami Dade County - Health Department
                                                                                                                                      2009 Annual Report       25

Refugee Health                                                                  Tuberculosis Control and Prevention
                                                                                An “I’m Stopping TB Focus”
Health’s Front Line
                                                                                Our Tuberculosis Control and Prevention program has successfully reduced
Our Refugee Health Assessment program is the largest of its kind in Florida
                                                                                the number of TB cases in our county over the last five years. In 2008
and indeed the entire United States. In 2006-2007, we screened over 18,000
                                                                                we experienced a 1 percent up-tick to 197 cases compared to 182 for
refugees to identify and control communicable diseases among new arrivals.
                                                                                2007. However, the downward trend continues when compared to 203 cases
Those eligible for services include refugees, asylum-seekers including Cuban/
                                                                                in 2006 and 268 cases in 2004. The program is a collaborative partnership
Haitian asylum applicants, Cuban/Haitian entrants, Amerasians and certain
                                                                                with Corrections Health Services and the Corrections and Rehabilitation
victims of human trafficking.
                                                                                Department, which ensures that public health recommendations and
In 2006-2007, a total of 17,261 Cuban refugees were screened. This accounted    protocols are followed to improve the efficiency and accuracy of TB contact
for 97.8 percent of all screenings conducted. After Cuba, the most frequent     investigations in institutional settings. A strong working relationship with
countries of origin of refugees screened are Haiti, Colombia and Venezuela.     Jackson Memorial Hospital contributed to 58 percent decrease in TB/HIV co-
                                                                                infection in the county over the last five years.

                                                                                Last year, the program celebrated the World TB Day conference under the
                                                                                theme: “I Am Stopping TB.” The focus was to educate and raise awareness
                                                                                about the importance of urgent reporting of TB cases.
26      Miami-Dade County Health Department
        2009 Annual Report

     Clinical Laboratory Services                                                   HIV/AIDS
     Over 85,000 Patients Served                                                    Prevention Services

     This program provides rapid and accurate laboratory diagnostic services to     Our Office of HIV/AIDS has a number of cutting-edge program initiatives underway.
     assist in disease control and prevention. Among our customers are 22 clinics   We seek to prevent the spread of HIV/AIDS by raising community awareness
     concerned with sexually transmitted diseases, tuberculosis, family planning    regarding prevention and providing leadership on local and statewide research
     and health care for women and children.                                        projects. At the same time, we seek to improve delivery of patient care services
                                                                                    while strengthening the overall continuum of care. Programs include:
     In 2008, more than 85,000 patients received laboratory services. The program
     performed more than 90,000 in-house tests and collected, processed and sent    • Proactively participating in a statewide Sista’s Organizing to Survive Women’s
     more than 100,000 specimens to reference laboratories.                           Conference aimed at mobilizing black women on the impacts of HIV/AIDS and
                                                                                      developing action plans that prevent the spread of the disease.
                                                                                    • Contractually agreeing with the Center of Disease Control and Prevention to
                                                                                      evaluate the effectiveness of AMIGAS, an adaptation of the SISTA HIV prevention
                                                                                      intervention, for use with Hispanic women.
                                                                                                                            Miami-Dade County Health Department
                                                                                                                                              2009 Annual Report        27

• Engaging the support of the private sector through “Business Responds to AIDS/                           Test Miami
  Labor Responds to AIDS” – a CDC initiative where 152 Miami-Dade businesses
  promoted HIV education, awareness and policies in the workplace.                                           Our program recently launched the campaign “Test Miami”,
                                                                                                             an unprecedented collaborative effort between the
• Hosting the 12th annual United States Conference on AIDS, the nation’s largest                             MDCHD and Florida Department of Health, HIV counselors,
  AIDS-related consultation. The 2008 theme was “Looking Back, Moving Forward.”                              community-based organizations, the private and public
• Collaborating with Florida International University, Nova Southeastern University,     sector, and other local partners.
  University of Miami (UM) and Emory University, among others, in disseminating          This initiative is aimed at promoting routine HIV testing by physicians,
  current research findings to community providers and local shareholders.               improving Miami-Dade residents’ understanding of HIV and reducing the
• Partnering with the UM’s Developmental Center for AIDS Research funded by the          transmission of the disease.
  National Institutes of Health to improve and promote AIDS research.
• Assessing the feasibility of adapting the SIHLE intervention for Hispanic adolescent
  women and developing a homegrown intervention for Hispanic males.
• Completing a three-year patient care comprehensive plan targeting persons
  living with AIDS in Miami-Dade County.
28      Miami-Dade County Health Department
        2009 Annual Report

     Public Health Preparedness
     Coping with Emergencies
                       Our Public Health Preparedness program has been working very diligently to foster a
                       preparedness culture in our community. The program has been engaged in a myriad
                       of planning and preparedness activities that will allow them to achieve a higher level
                       of response capabilities to better recover from disasters, natural or man-made.

     Our City Readiness Initiative has been recognized as one of the best practice models on the national level and has
     been emulated by others. Meanwhile, our Medical Reserve Corps has made many strides in the recruitment of
     community volunteers who have accepted responsibilities and challenges for different types of emergency situations.

     Also, the Hospital Preparedness Consortium has become stronger as community
     hospitals unite to discuss and strategically prepare against disasters.

     We continue to work closely with the County Office of Emergency Management in planning and
     preparing to provide countywide health and medical services as emergencies emerge.
Miami-Dade County Health Department
                 2009 Annual Report   29
30      Miami-Dade County Health Department
        2009 Annual Report

     Health and Engineering
                                                                                   inspection. In addition, the various programs made 42,391 routine inspections
     Environmental Safety
                                                                                   from January to December, 2008. The Drinking Water and Beach Monitoring
     Wide Range of Services                                                        programs also took 7,527 water samples which were submitted to the local
                                                                                   laboratory for testing.
                             Environmental Health and Engineering’s main purpose
                             is to prevent human activities from harming the       In 2008, the Division received the approval of the Miami-Dade County
                             environment as well as to prevent the environment     Commission to levy local fees for the services that it provides. Up until this
                             from harming humans. Its mission is to detect and     time, many of the inspections that were performed were mandated but not
                             prevent disease caused by natural and man-made        funded. With budget cuts affecting all sectors of state government, it was
                             factors in the environment.                           necessary to find a new source of revenue to allow the programs to continue.

     In response to this mission, the Division is responsible for overseeing       The revenue generated by the county resolution
     programs relating to drinking water, beach monitoring, indoor air quality,    will allow us to continue our mission.
     community hygiene, food and group care, biomedical waste, public bathing
     places and onsite sewage treatment and disposal.                              During 2008, the Biomedical Waste, Mobile Home/
                                                                                   Migrant Housing, Body Piercing and Tanning
     In calendar 2008, the Division of Environmental Health and Engineering        programs achieved scores from 96.2 to 100% on the
     investigated 1,265 complaints and responded to 4,718 requests for             program self audits. The Drinking Water program
                                                                             Miami-Dade County Health Department
                                                                                               2009 Annual Report          31

                        achieved an “excellent” rating and a score of 86.7% on its own program audit conducted by
                        local and Tallahassee officials.

                     Our program continues its collaboration with community partners. Many training sessions
                     were provided to staff at the Miami-Dade County Public Schools and at several county
                     detention centers as well as for some of our public and private facilities, including child care
                     centers and pool operators. We continue our research efforts concerning the state of our local
ocean bathing waters with staff at the University of Miami and co-authored a chapter entitled “Future of Microbial
Ocean Water Quality Monitoring” in the book “Oceans and Human Health Risks and Remedies from the Seas.”

In order to be prepared for the increasing possibility of hurricanes wreaking havoc on our tri-county area, we initiated
an effort to outfit the Golden Glades office to function as the MDCHD command center in the event of a natural or
man made emergency. This will provide the building with improved drainage, shutters and a backup generator to
provide the necessary power to meet the Department’s operations in times of disaster.

In addition to completing routine inspections to assure compliance with minimum
standards for the facilities regulated by Environmental Health, the Division responds
to complaints and other requests for inspections from fellow agencies and the public
at large.
32      Miami-Dade County Health Department
        2009 Annual Report

     Community Relations
     Office of Communication and Legislative Affairs                                    Volunteers Expand Reach
     Informing the Community                                                            Our Volunteer Services program promotes access to health care for the
                                                                                        medically underserved and uninsured population in Miami-Dade with
     The Office of Communication and Legislative Affairs is continuously exploring      the help of many volunteers and partners, including physicians, dentists
     the most effective ways to provide the community with public health                and health care professionals.
     information. The local media have been extremely supportive of these efforts
     and have worked closely with the office in this critical role. In 2008, 95 local   From July 1, 2007 through June 30, 2008, more than 2,364 volunteers
     press releases were issued to 152 media outlets resulting in hundreds of new       provided services to over 60,000 uninsured and underserved men,
     stories in English, Spanish and Creole. During the same period, the office         women and children. The value of their donated services exceeded $36
     responded to 599 media inquiries on public health issues.                          million.

     The office prepared and distributed informational materials on two new             The key to the success of this program has been the sustained support
     programs: Cover Florida, a health insurance plan for Floridians; and the Florida   and active involvement of various professional associations, public/
     Discount Drug Card, aimed at lowering the cost of prescription drugs for           private partnerships and individuals who want to help our community.
     uninsured residents.

     The Office of Communication and Legislative Affairs, working closely with
     the Miami-Dade County Emergency Operations Center, is a vital link in any
     emergency response.
                                                                                                                                                                                                     Miami-Dade County Health Department
                                                                                                                                                                                                                                              2009 Annual Report            33

                                     Media Inquiries                                                                                   Targeted Legislative Funding                                                                                           Miami-Dade County Funding
1000                                                                                                            10                                                                                                                      3
                           892 892   886 886
 800                                                                                                             8                                                                                                                     2.5

                                                                                                                                                                                                              In Millions of Dollars
                                                                                       In Millions of Dollars

 600   590 590                                                     601 601   598 598                             6
                                               550 550   552 552
                 489 489
 400                                                                                                             4

 200                                                                                                             2

   0                                                                                                             0                                                                                                                      0 1980 to
       2001       2002      2003     2004      2005      2006       2007     2008                                      1996-2000       2001-2005           2006            2007            2008                                                   1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
                                        YEAR                                                                                                            YEAR                                                                                                         YEAR
                 Received                   Answered                                                                            Received                   Requested                                                                                Funding
                                                                                                                     *Funding was received for all requested items through community budget issues
34      Miami-Dade County Health Department
        2009 Annual Report

     Creating and Expanding Public Health Resources                                               In late April 2009, the World Health Organization announced the emergence
                                                                                                  of a novel influenza A virus known as H1N1. The Office of Communication and
     In seeking opportunities to expand public health resources, the Office of                    Legislative Affairs has been involved in providing up-to-date information on
     Communication and Legislative Affairs continues to partner with Miami-Dade                   the presence of the virus in the community and the precautions the public can
     County and works closely with the mayor, state legislators, commissioners, county            take against the spread of the virus. Communication with the media has been
     manager and others. During 2008, we secured $2.1 million in county funds and to              key in keeping the community informed and getting the public health message
     date, the office has secured a total of $19.2 million. The support of the mayor and          out. Press releases were issued, press conferences were held, and one-on-one
     the county commission over the past year has once again enabled us to continue               interviews with media outlets were granted. Updates continue to be sent to the
     needed services. Each of the county-funded programs was highly successful and                media and media interviews held. More than 400 media requests have been
     led to improved health in our community. Some of the funded programs include                 received regarding H1N1. The media has been an excellent partner in providing
     HIV/AIDS, Environmental Health, STD, Immunization, Epidemiology and Disease                  information to the community. In addition, the Office of Communication and
     Control, TB, and Community Health and Planning.                                              Legislative Affairs has collaborated with the public information officers of the
                                                                                                  different agencies involved.
     Further, in 2008 the office was instrumental in securing the final appropriation
     to replace our main clinic complex. The appropriations approved in 2006, 2007                Community Outreach
     and 2008 totaled $19.5 million. To date, the office has secured a total of $29.5
                                                                                                  During 2007 and 2008, we launched several campaigns that targeted users
     million to replace two clinics and build a new one. The office was also instrumental
                                                                                                  of public schools, day care centers, libraries and community centers with
     in obtaining support from the Greater Miami Chamber of Commerce for our
                                                                                                  disease prevention messages. As part of the community outreach efforts, we
     legislative priorities. In addition, the office led the legislative effort for approval of
                                                                                                  also established partnerships with organizations and the local government to
     a new fee structure.
                                                                                                                          Miami-Dade County Health Department
                                                                                                                                              2009 Annual Report           35

post public health information on public transport throughout Miami-Dade          AWARDS
and in community centers. Some of the partners in this project are Miami-         We received the Governor’s Sterling Award in 2002 and 2006 for performance excellence.
Dade Transit, Miami-Dade Library System, the local school district and YMCA       As part of our Sterling journey, we built a fact-based performance improvement
of Greater Miami. Also, our website,, was revamped,            system and made considerable progress in the areas of leadership, strategic planning,
adding new features to continue informing the public about services,              customer focus, measurement, analysis and knowledge management, human
programs and health initiatives.                                                  resource focus and process management. We utilize a systematic process to develop
                                                                                  new services or improvement activities to enhance customer satisfaction and service.
INFORMATION TECHNOLOGY                                                            We have invested in training our work force in process management techniques in
Our Office of Information Technology is responsible for the operations, support   order to improve outcomes and achieve greater efficiency.
and development of the IT infrastructure that includes a unified help desk,
desktop support, network and security services, infrastructure management         Paths of Public Health Awards
and telecommunications. Through efficient IT services, this department
enables our employees to better serve Miami-Dade residents. The IT division       Administrator Lillian Rivera; Samir Elmir, Director of the Office of Environmental
received a $100,000 grant from the Agency for Health Care Administration to       Health and Engineering; and Stephanie M. Atherley, a recently retired nurse from
provide a full-featured electronic health record system in two of our clinics.    the Office of Epidemiology and Disease Control, were honored in 2009 as recipients
                                                                                  of the Florida International University’s Robert Stempel School of Public Health,
                                                                                  Paths of Public Health Awards, which were established to recognize individuals
                                                                                  and organizations in public health for their contributions and commitment to
                                                                                  promoting and protecting the health of the South Florida community.
36      Miami-Dade County Health Department
        2009 Annual Report

     Dental Program “Seals On Wheels”
     Dental Services for Children
                              The school-based “Seals on Wheels” mobile dental sealant program was launched by the MDCHD
                              to help reduce disparities in oral health among the children in our community and provide
                              preventive dental services to vulnerable populations less likely to receive private dental care. Dental
                              examinations, oral hygiene instruction, cleanings, fluoride varnish applications, x-rays and sealants are
                              provided on school grounds, during school hours at no cost to the children or their families.

     The mobile dental van is staffed with dental professionals and consists of a reception and educational area, a sterilization area and
     two fully equipped dental operatories. A grant from the Health Foundation of South Florida facilitated purchase of the vehicle.

     During the 2008-2009 academic school year, over 5,500 preventive dental services were provided to approximately
     1,000 school children. Over 2,000 sealants were applied and 1,300 second graders participated in oral health
     educational presentations that were offered in the classroom settings prior to receiving dental services.

     Outside of the classroom setting, 5,200 children, along with their families, have received oral hygiene instruction at community
     health fairs. Our program also participated in five Give Kids a Smile events, to give 300 children free dental care.

     The ultimate goal of our program is to significantly improve the oral health of the children of Miami-Dade County.
Miami-Dade County Health Department
                 2009 Annual Report   37
38      Miami-Dade County Health Department
        2009 Annual Report

                         ‘Healthy Stories’ Program Earns Award                           A Public Health Leader
                         The National Association of County and City Health              The University of South Florida’s College of Public Health honored
                         Officials honored a project called Healthy Stories with         Administrator Lillian Rivera as the Florida Outstanding Woman in
                         its Model Practice Award. Healthy Stories was one of 25         Public Health for 2008. She was recognized as a woman whose career
                         local public health programs selected from across the           accomplishments and leadership have contributed significantly to the
                         nation to receive this recognition. Healthy Stories is a        field of public health in Florida.
                         compilation of vignettes concerning the promotion of
                         public health and reflect experiences of our employees.         CDC Director Visits MDCHD
                                                                                         Dr. Thomas Frieden, the newly appointed director of the Centers for
     Sterling Conference                                                                 Disease Control and Prevention (CDC) visited the MDCHD and met with
     Our employees attended the 16th Annual Sterling Conference. Established in          a group of employees from different programs and other invitees that
     1992, the Florida Sterling Council is a public/private not-for-profit corporation   represented local organizations. Frieden, the first CDC director to visit
     supported by the Executive Office of the Governor, and it’s comprised of public     MDCHD, was briefed about local health initiatives and the recent efforts
     and private sector members. We are a two-time winner of this prestigious            launched by the Department to cope with the H1N1 virus.
     award, in 2002 and 2006.
                                                                             Miami-Dade County Health Department
                                                                                                2009 Annual Report         39

Consortium’s 5th Anniversary
The Consortium for a Healthier Miami-Dade marked five years of progress in pursuing its goal of promoting well-being, and preventing illness,
disability, and premature death in our community. The consortium is a vital partnership of 50 organizations and 150 individuals which follow
a common set of goals and guidelines that are modeled after those of Healthy People 2010, a national blueprint for wellness and longevity.

Refugee Health Receives Award
The Refugee Health Assessment program was cited as 2008 Refugee Health Program of the Year during the statewide Tuberculosis
and Refugee Health Conference held in Orlando, Florida. The program’s poster board presentation received second place
recognition. Our program is the nation’s largest of its kind, having provided 17,651 new refugee screenings during 2006-2007.

Honoring our Volunteers
We honored a large group of volunteers who provided medical and dental services to thousands of uninsured persons at a
South Miami Hospital reception last October. The honorees included physicians, dentists and other health care professionals.

AIDS National Conference
Under the theme “Looking Back, Moving Forward” and sponsored by the National Minority AIDS Council, the 2008 U.S.
Conference on AIDS took place in Ft. Lauderdale with the participation of dozens of employees from our HIV/AIDS
program. More than 4,000 government officials, health care workers and those living with HIV/AIDS attended.
40       Miami-Dade County Health Department
         2009 Annual Report

     Senior Leaders

     Lillian Rivera, RN, MSN, PhD              Samir Elmir, MS, PE, DEE                      Fermin Leguen, MD, MPH                 Yesenia D. Villalta, MSN, ARNP
     Administrator                             Division Director, Environmental Health       Medical Executive Director             Director, Women’s Health & Preventive Services
                                               and Engineering

     Rene Ynestroza, MBA, MSMIS                Onelia Fajardo, MPH, Dr, BA                   Alicia Reyes-Perez, RN, BSN            Karen Weller, RN, BSN, ICCE
     Senior Public Health Services Manager     Director, Refugee Health Assessment Program   Director, Public Health Preparedness   Director, Office of Community Health and Planning
                                                                                                 Miami-Dade County Health Department
                                                                                                                      2009 Annual Report   41

Thomas Burns, MPH                    Reynald Jean, MD, MPH   Pamela Toomer, RN, BSN, MPH, NCSN           Denise West, RD, LD/N, MPH
Program Manager, STD                 Director, TB Program    Director, School Health Program             Director, WIC & Nutrition

Olga Connor, BA                      Morton Laitner, Esq.    Evelyn Ullah, BSN, MSW                      Maribel Zayas, BPA, JD
Director, Office of Communications   Chief Legal Counsel     Director, HIV/AIDS                          Financial Administrator
& Legislative Affairs
42      Miami-Dade County Health Department
        2009 Annual Report

     Charlie Crist - Governor
     Jeff Kottkamp - Lieutenant Governor
     Dr. Ana M. Viamonte-Ros, MD, MPH - State Surgeon General

                                                            DELEGATION                      Rep. James Bush III
     Barbara J. Jordan – District 1
                                                                                            Rep. Esteban Bovo
     Dorrin D. Rolle – District 2                           Sen. Frederica S. Wilson
                                                                                            Rep. Erik Fresen
     Audrey Edmonson – District 3                           Sen. Nan Rich
                                                                                            Rep. David Rivera
     Sally A. Heyman – District 4                           Sen. Dan Gelber
                                                                                            Rep. Carlos Lopez-Cantera
     Bruno A. Barreiro – District 5                         Sen. Alex Diaz de La Portilla
                                                                                            Rep. Anitere Flores
     Rebeca Sosa – District 6                               Sen. Alex Villalobos
                                                                                            Rep. Juan Carlos “J.C.” Planas
     Carlos A. Gimenez – District 7                         Sen. Larcenia Bullard
                                                                                            Rep. Marcelo Llorente
     Katy Sorenson – District 8                             Sen. Rodolfo “Rudy” Garcia
                                                                                            Rep. Julio Robaina
     Dennis C. Moss – District 9                            Rep. Eduardo “Eddy” Gonzalez
                                                                                            Rep. Dwight M. Bullard
     Javier D. Souto – District 10                          Rep. Oscar Braynon, II
                                                                                            Rep. Juan C. Zapata
     Joe A. Martinez – District 11                          Rep. Yolly Roberson
                                                                                            Rep. Ron Saunders
     José “Pepe” Diaz – District 12                         Rep. Richard L. Steinberg
     Natacha Seijas – District 13                           Rep. Luis R. Garcia
Miami-Dade County Health Department
                 2009 Annual Report   43
y o u R                  H e a l T H                            i S           o u R              b u S i N e S S


Miami-Dade County Health Department

Miami-Dade County Health Department • 8323 N.W. 12th Street, Suite 212 • Miami, Florida 33126
T. 305.324.2400 • F. 786.336.1297 • Florida Relay Services 1.800.955.8771 •

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