“If you can breathe, you can get TB”: RHHD takes on tuberculosis 

Sunday, March 24, is World TB Day. On World TB Day, public health workers commit to educating our communities about tuberculosis, an airborne bacterial infection that can lead to serious disease and death if it goes untreated.

At RHHD, we have a TB team committed to education and care! The team includes Public Health Nurses Rosalie Bieda and Kenneth Brown and Outreach Worker Mehrima Matrood. They work with TB screening, testing, and treatment across Richmond and Henrico.

With almost 48 combined years of experience at RHHD, Rosalie, Kenneth, and Mehrima have seen and heard it all when it comes to TB. Ahead of World TB Day, they share a few of the TB facts they wish more residents knew:

While there are clear risk factors for TB, anyone can get it.  

Some people are at higher risk for developing tuberculosis. Risk factors might include being exposed to someone who has active TB; spending time in a country where TB is common; or living or working in a congregant setting like a nursing home, a homeless shelter, or a prison.

TB risk assessments can help healthcare workers know if a TB test is a good idea. In Richmond and Henrico, TB experts work closely with RHHD’s refugee clinic to make sure that people coming from countries with a high TB burden are able to access the care they need easily.

While it’s important to make sure that populations most at risk for TB can receive testing and treatment, Rosalie wants people to know that TB is not just limited to one community or type of individual: “I’ve had patients from all backgrounds. I’ve had doctors with TB, teachers with TB, blue collar workers, anyone.” Recognizing this fact will lessen stigma around the illness, which can lead to a reluctance to get tested or treated.

“People often think [TB only impacts] poor people or people who are not from the U.S.,” Mehrima says. “But if you can breathe, you can get TB.”

TB actually shows up in two stages: latent and active.  

TB experts distinguish between a latent TB infection—which can cause no symptoms and will not show up on something like a chest X-ray—and active TB disease, which causes serious symptoms and is contagious.

Rosalie encourages people who test positive for latent TB to begin preventive treatment: “If you don’t treat, you have about a 10% chance of developing active TB disease and at that point, treatment is non-optional. It’s always easiest to treat the infection rather than the disease.”

Kenneth adds that treating latent TB is critical because we can’t always predict when our immune systems will face challenges: “Your immune system is what keeps TB latent, so I tell folks, ‘If you get a bad case of COVID, you’ll be dealing with COVID and an active case of tuberculosis. Whatever can compromise your immune system can cause TB to become active.’”

TB care doesn’t end with testing and diagnosis.  

Kenneth says that “TB is one of the more treatable diseases, unless it’s a drug resistant form. Once you get people on a therapy, they usually improve quickly.” Health departments are often the primary point of contact for tuberculosis cases because not all doctors have this specialty and because medications to treat active TB can be really expensive.

Community partners like Daily Planet Health ServicesCrossover Health Ministry, and The Healing Place now help treat latent TB for patients. When active TB disease is diagnosed, health departments like RHHD will get involved to lead contact tracing and to make sure that anyone exposed to active TB can be tested and offered treatment.

RHHD also works with clients to manage the long, necessary cycle of antibiotics. People on treatment for active TB participate in directly observed therapy, which means that someone is with you while you take your medication each day.

At RHHD, this person is Mehrima. As an outreach worker, she visits people at their homes and helps them navigate not only medication but also life challenges that might make staying on medication difficult. “Our job is to make sure people take their medicine, and in order for them to do that, they need food, they need housing,” Mehrima explains. VDH provides funding for social support for TB patients, and she connects clients to other services, too.

Mehrima often works with clients who may be unhoused or working complicated hours, so she adjusts her schedule to get to them daily. And because she sees patients for six months or a year at a time, she builds a lot of trust and connection: “I have clients who still talk to me 18 or 19 years later after a case finishes!”

The number one thing you can do? Learn the symptoms.  

Mehrima suspects that many people don’t get tested for TB because they mistake their symptoms for a respiratory illness: “People think, ‘I have a cold, I have pneumonia, I have the flu, but nobody thinks, ‘oh, I’m sick, I might have TB.’” If you’re experiencing symptoms like a lingering cough, night sweats, chest pain, or fatigue, you might want to ask your care provider if a TB risk assessment or test is a good next step.

Kenneth also cautions that TB isn’t just a disease of the lungs: “It can spread to other parts of your body. Someone might get a pain in their hip, their spine, their brain, and it doesn’t go away no matter what they try. In that case, you might need to check for TB.”

If you or a loved one are experiencing TB-related symptoms, or you have questions about travel or occupational risks, get in touch with RHHD’s TB team by calling 804-205-3501.

Thank a social worker today! 

March has been officially recognized as National Social Work Month by the White House. In March, we celebrate the valuable skills social workers bring to our communities, and we consider the social challenges—things like increasing mental health needs and substance use—that make our social workers more vital than ever.

Margo Webb, RHHD’s Director of Community Programs, is a social worker by training. She says social work is critical for the success of public health programs: “The social workers at RHHD are passionate about helping individuals and families understand the complex healthcare system and social and human services landscape. We approach working with clients from a strengths perspective and we want to empower families to look at the strengths they bring to the table even during difficult times. We understand how deeply broken that many of our systems are, and we try to approach these difficulties with honesty and realistic solutions.” Below, members of her team reflect on their impact as social workers in public health:

Maria Cotty-Mercado, Human Services Specialist:“Social Work is not just a profession; it’s a deeply rooted commitment. We stand by people during their darkest moments, rescuing kids, rebuilding relationships, and so much more. In difficult situations, people need support and empathy for their struggles. We don’t judge individuals, rush them, or ignore them. Instead, we listen to those who need our help. We might be the only person they have listening to them at their darkest hour. We are passionate about how our assistance helps others and transforms their lives. It is not just rewarding; it’s life-affirming.”
D’atra Franklin, Unite Us Community Engagement Specialist:“Our work extends far beyond stereotypes of removing children from homes or handing out assistance. We work in a range of settings like hospitals, government agencies, private practices, and non-profits. We often hold advanced degrees or go through training processes. We empower clients AND play a crucial role in shaping policies that reduce poverty, discrimination, and injustice. Working with aging populations, foster care, child welfare, and homelessness has highlighted for me the critical role of preventive measures and early intervention in public health. It has also taught me the value of community-based solutions and the need for policies that support the well-being of all community members, especially the most vulnerable.”

Militza Lopez, Social Worker, Maternity Navigation:“We know that what we do has a purpose that is bigger than us. We work to improve people’s lives by seeking solutions, adapting to circumstances, and finding ways to serve better. Public health is an area of great need where we can all find our ikigai (the Japanese secret to a long and happy life) and wake up every day with the purpose of serving with passion and mission.”

This month (and every month), RHHD is grateful for Margo, D’atra, Maria, Militza, and the rest of our social workers!

Spotlight on Virginia Prison Birth Project 

This week, we continue highlighting some of the newest Health Equity Fund (HEF) recipients. The HEF—which is administered by the Richmond and Henrico Public Health Foundation and supported by the City of Richmond and RHHD—announced its most recent round of funding at the end of January.

At its heart, health equity is about recognizing when our existing care and social systems fail to reach and serve particular groups of people. It’s a practice of asking, “who’s missing from this picture?” when we talk about health and well-being in our communities.

For founder Sara Zia and the team at Virginia Prison Birth Project (VAPBP), some of the people who are most invisible in healthcare spaces are pregnant people and those who’ve recently given birth while incarcerated. “This is the most vulnerable segment of birthing people in our state,” she says. “Reproductive health equity, it’s not just the right to have a baby or not, it’s also the right to have a baby in a safe way and to feed your gestating fetus adequately and to house yourself. It’s so much larger, and it matters to the work we do because this population is hidden.”

Women are the fastest growing proportion of people incarcerated in Virginia’s jails and prisons. Estimates suggest that up to 12,000 pregnant people are incarcerated nationally each year, although no agency keeps an official count. These pregnancies are at high risk for complications because of limited access to healthy nutrition or prenatal care among other factors. And in Virginia and nationally, Black residents are overrepresented in incarcerated populations, which compounds disparities in maternal health and mortality for Black women.

Like all doulas, VAPBP’s doulas are trained to make sure that a pregnant person’s voice is heard both before and during labor. Because they work with clients in prison, VAPBP doulas do this advocacy and support work in both medical and carceral spaces. The organization began in the Charlottesville region, where Sara and her doula team created cohorts for 12 weeks of education, nutrition, movement classes, and emotional support before clients give birth. In these sessions, they talk about the anatomy and physiology of pregnancy, fetal development, prenatal care, childbirth while incarcerated, separation, lactation, parenting from inside, and reunification as a parent.

As VAPBP expanded services into Henrico County Jail, they also worked with the sheriff to bring in nourishing and familiar foods. Sara thinks that enjoying a meal together before class contributes to good nutrition and creates a “convivial” space for the group. And the cohort model is key: “Each cohort can form a pretty tight unit, especially at the prison because they live together and so it’s huge when one of them [gives birth]. We know the others are thinking of them and are ready to receive them when they come back—they know what it’s like.”

When incarcerated pregnant people give birth, family members are not present, so the doula functions as needed support and a familiar face. And they also help clients navigate a painful “separation visit,” where they say goodbye to their newborn before returning to prison. When people who are incarcerated give birth, they usually have only a day or two with their newborn before the baby goes to family members or other caregivers. “It’s so hard to prepare for that, but we help smooth things out and facilitate communication between the hospital, the prison, and the family and client in that space,” Sara says.

VAPBP doulas will often make sure the parent has spent time with a soft blanket that goes home with the baby and that the parent gets to keep the baby’s first warm hat. This way, both have something that smells, comfortingly, like the other. Sara explains that “helping to establish that connection and advocating for clients to be treated like human beings is worth all the struggles of working within this institutional framework. We aim to nurture clients’ connections with their babies however much we can within the constraints of giving birth in custody. Thinking of creative ways to do this comes naturally to our doulas.”

One of the most necessary things about VAPBP work is expanding efforts to reach each individual client while also keeping in mind the systemic changes—in sentencing and incarceration, in addiction and substance use treatment, in mental health care—that could address these challenges at their roots. From Sara’s perspective, “The biggest problems are community problems that will take a community solution.” She cites prison nursery initiatives that keep mothers and children together for longer as a step in the right direction: “We need facilities that house mothers and babies so that they have a chance to catch their breath and we can come in and hear from them what their needs are.” And, she says, “If we want to have alternatives to incarceration that are not punitive but more compassion-based, we have to use evidence-based practices to genuinely promote wellness and talk about the whole system of health equity.”

As part of its efforts to address this range of community needs—from maternal health to substance use to food access—Health Equity Fund support will cover comprehensive doula work for 25 new BAPBP clients in Richmond City. Support includes weekly perinatal education, movement classes, and doula advocacy during and after childbirth. And with each client VAPBP serves, and each time Sara shares this work, the picture of our health equity landscape becomes a little clearer.

If you’re interested in learning more about or supporting the work of VAPBP, you can visit their website. VAPBP continues to look for restaurant partners willing to provide comforting meals during the training sessions and for support to send additional doulas to Prison Doula Certification training. You can also return to our blog for conversations with other HEF recipients, including Daily Planet Health Services and Gateway Community Health.

From the Director: A transitional anniversary

Four years ago this week, the World Health Organization declared COVID-19 a pandemic, and we entered the first of many emergency declarations at the national, state, and local levels. The pandemic has had an overwhelming impact on all of our lives—it shaped our experiences at home, in the workplace, and at school. We lost beloved family members and friends.

For me, this anniversary is a time to recognize the magnitude of the last four years, to share in our community’s grief, and to express an immense gratitude to our community and especially the staff at RHHD. Whether you were working at a health department, hospital, grocery store, or post office during the early days of this pandemic; protecting loved ones and strangers by following public health measures; or learning how to communicate new health information to young children, each of us contributed something essential.

We know that COVID-19 is still with us, even as this is the first anniversary since the lifting of the national public health emergency. CDC’s updated respiratory virus guidance reminds us that simple public health principles continue to be the most effective ways for keeping ourselves safe from serious illness: we can make sure we’re up-to-date on recommended vaccines, stay home and away from others when we’re sick, and practice good hygiene.

RHHD staff has risen to the challenge time and again in the last four years, taking on needed services like contact tracing and vaccination. We look forward to continuing to support our neighbors, friends, and community members even as the nature of those services shifts.

And if you still need a 2023-2024 COVID-19 vaccine—or if you are over 65 and newly eligible for a second dose—please reach out! Schedule your vaccine appointment with RHHD by calling 804-205-3501 or visit vaccines.gov for more information.

With gratitude,

Dr. Elaine Perry, Director of the Richmond and Henrico Health Districts

Active RHHD! 

On Friday, Mar. 1, Senior Health Educator Charles Lee and Employee Health Nurse Shannon Campbell attended Sportsbackers’ Active RVA Awards Breakfast at the University of Richmond. The program recognizes workplaces and schools “implementing innovative programs to promote physical activity.”

The award recognizes Charles and Shannon’s efforts to make sure RHHD incorporates regular activity and well-being into daily operations. From promoting walking and biking to leading occasional yoga classes, and even including efforts like CPR training, Charles and Shannon are keeping us all healthy while we work to support healthier communities. We are proud to receive this award!

CDC updates respiratory virus guidance, Part Two: Show me the science!  

If you’re someone who likes understanding the why behind updated guidance, CDC has issued an explainer for its changes to respiratory virus recommendations.

The agency released a long background document that explains the decision-making behind the updated guidance. It walks readers through the data that experts consulted.

RHHD’s Data Team found this graph, shared as part of the background research, especially important for understanding the updated guidance. The graph comes from the Respiratory Virus Hospitalization Surveillance Network (RESP-NET) and shows weekly new hospital admissions of patients with COVID-19, influenza, and RSV:

RHHD Deputy Director Dr. Melissa Viray offers some insights into what she sees in this graph:

  • Year over year, we are seeing fewer hospitalizations with COVID-19. We are also seeing decreases in deaths with COVID-19 (although that’s not shown in this graph!). Our population has more overall immunity from infection, vaccination, or both, and we have tools like vaccination and treatment that we didn’t have before.
  • We can also see here that hospitalizations with influenza and RSV are contributing more to the overall hospitalization burden for respiratory viruses, even as overall rates are decreasing. This is an important reminder that flu and RSV can also result in serious illness, emergency visits, or deaths, especially for children and people over 65 years old. Updated respiratory illness guidance also highlights the steps we can take to protect against those viral illnesses.
  • COVID-19 has not disappeared. That’s why we need to use our powerful protective tools—like vaccines, which you can find at vaccines.gov, or treatments, which are available for free through Home Test to Treat. These tools help reduce the risk of serious illness or death from COVID-19 and other respiratory viruses.

Other preliminary data shared by CDC show that the majority of adults hospitalized in October–November 2023 with COVID-19 had not received the 2023-2024 COVID-19 vaccine or the previous bivalent booster. Dr. Viray encourages residents to schedule a vaccine today if they have not gotten the updated vaccine, saying, “We’ve learned things about immunization, ventilation, and hygiene that we should take with us into respiratory illness season every year.”

Updated CDC Respiratory Virus Guidance

On Friday, March 1, CDC released updated guidance for respiratory viruses, that including standardizing the isolation guidelines for COVID-19, flu, and RSV: 

Standardizing this guidance helps you take immediate steps to keep your loved ones healthy when you’re sick, even if you don’t have a test available to figure out which illness you’ve contracted. 


Take these precautions to avoid contracting a respiratory virus
 

  • Stay up-to-date with vaccines for COVID-19, flu, and RSV. Call 804-205-3501 to schedule an appointment at an RHHD clinic. 
  • Practice good hygiene: Wash your hands for a full 20 seconds with soap and water, cover any coughs and sneezes, and disinfect frequently used surfaces.  
  • Improve ventilation by opening windows or spending time outside. 

 

Ask yourself these questions before returning to normal activities: 

  • Are my symptoms clearly getting better? These could include sneezing, coughing, fatigue, or muscle aches. Not every case of respiratory illness will cause a fever. 
  • If I have had a fever, have I been fever-free for a whole day without using fever-reducing meds like Tylenol or ibuprofen?  

 

When you return to normal activities, take these precautions for 5 more days. 

  • Wear a well-fitting mask.  
  • Continue to practice good hand and respiratory hygiene.  
  • Take social events outside or keep distance from others.  
  • Plan to test for COVID before events or close interactions.  

These steps will help keep your loved ones and neighbors safe, especially those who are at high-risk of serious illness. 

 

new CDC COVID and respiratory virus guidance

Severe Weather Awareness Week 

March and April are traditionally the most active months for tornadoes in Virginia, and the National Weather Service is encouraging everyone to make some basic preparations ahead of the season. Their Severe Weather Awareness Week runs from March 4–8 and mixes a little education with some recommendations. We’ll be sharing updates from their content throughout the week (follow us on Instagram @richmondcity_hd). In the meantime, a couple tips to get you planning while the skies are still clear:

  • Locate safe shelters in the places you spend the most time. You’re looking for a small room or hallway with no windows, in a basement or first floor. Once you’ve identified your shelter, make sure you communicate that plan with family members or co-workers so everyone knows where to go when a tornado warning sounds.

  • Choose your reliable news source and stay up-to-date on the weather.

  • Consider participating in Virginia’s statewide tornado drill on March 7 at 9:45 a.m. More details are available at the National Weather Service website.

  • Register for an in-person or online SKYWARN class to learn how to spot and report dangerous storm systems.

Some early preparation will help you feel ready when bad weather heads our way!

Farm-to-table: Meet Natasha Crawford   

Many RHHD employees are committed to health and well-being in their personal lives as well as their professional ones. That’s true for Enivronmental Health Tech Specialist Natasha Crawford. Natasha is the founder of Healing Hope Urban Gardens, which was recently featured in MarketMaker.

Natasha’s journey to agriculture and farm ownership was a long one, but her passion for the project never wavered. After time in the military, traveling, and earning a degree in nutritional sciences, Natasha and her wife moved to Richmond in 2017. She began work on the gardens in 2021. Natasha credits Virginia’s farming communities with helping make her dream a reality: “One thing I love about Virginia is that you can reach out to any farmer. There are gardening groups all throughout Richmond, Henrico and Chesterfield who are willing to help each other out. That’s been crucial to my success—I’ve had people who’ve provided me with support, guidance and mentorship. I knew I wanted to be a farmer, but sometimes as you get older, it feels hard to get started. All I had to do was voice my desires and passions. I had so many people who really saw my vision and what I wanted to do and really believed in me.”

While Natasha sees a vibrant farming community across the region, she also knows there’s work to be done in making sure that agriculture is an accessible field for all. She still sees gender disparities in farming, for example: “Over the last ten years, you’ve seen more and more women becoming interested—and it’s not something we haven’t always been a part of. Farming is not something that’s foreign to women—I learned from my great-grandmother. But statistically, when we’re counted among our male counterparts, the numbers are really low. I love it when people see me or hear me talk—I know I’m changing the idea of what a farmer looks like and who can be a farmer.”

Natasha is also proving that public health workers belong in the garden! As an Environmental Health Specialist Senior by training and the new EH Tech Specialist, Natasha works with and trains the teams who ensure food safety in the restaurants, food production, nursing homes, and childcare industries. The skill sets are similar, she says: “a lot of the concepts that we talk with our operators about are the same concepts that you want to have on the farm so that we make sure we are growing and handling food safely for the consumer. A lot of the things I preach on this job, I practice on the farm. I’m washing my hands and washing my lettuce and making sure we’re using potable water.” As a public health worker, Natasha is also invested in wellness and talking to community members—she loves meeting people at farmers’ markets and teaching them how to incorporate more fresh produce into their diets.

Public health is only one of the fields required for a version of farming committed to food justice and food sovereignty, key concepts for Natasha: “I tell kids, there’s more to agriculture than just growing vegetables. We need people who can develop apps that make the work more efficient. We need people who can write grants and repair equipment and invent tools. Farming can be what you want it to be. Agriculture can be what you make it. We have the ability and knowledge to really change what agriculture looks like for the future.”

If you’re interested in dipping your toes into agricultural practices, Natasha strongly encourages connecting with Central Virginia’s community gardens: “There are always volunteer opportunities that really turn into lessons and support. You’re finding that connection where you can learn together and from each other. Organizations like Happily Natural, Real Roots Food Systems, and Richmond City’s Community Garden Program post volunteer opportunities. Once you feel comfortable, you still have someone who will support you with seeds and equipment.

And if you’re already doing some backyard gardening, expand your practice with learning opportunities! Natasha says that the Virginia Department of Agriculture and Consumer Services offers valuable online trainings and webinars. She also likes the agricultural education platform at Cornell and has worked with sustainable urban agricultural courses at Virginia State University.

Follow Natasha and Healing Hope on Instagram (@healinghopeurbangardensto learn more about her work, volunteer opportunities, and food justice events around our community!

CPR instruction comes to RHHD!      

What do Aretha Franklin’s “Respect,” Lady Gaga’s “Bad Romance,” and Eurythmics’ “Sweet Dreams” all have in common? Their tempos are all within the 100-120 beats per minute that help you keep track of CPR compressions!

These songs were all on the playlist greeting RHHD employees as they attended the American Heart Association’s (AHA) Basic Life Support training in February. Participants learned how to administer CPR for adults, children, and infants under the guidance of newly certified in-house instructors. Congratulations to RHHD employees Shannon Campbell, Dylan Knight, Charles Lee, Stephanie Mbengue, and Ed Porner on becoming accredited instructors.

According to the AHA, more than 350,000 cardiac arrests happen outside of hospital settings in the United States each year. That means that for most of these 350,000 cardiac arrests, a trained medical provider won’t be the first responder. In 2023, only 40% of people who suffered cardiac arrests received bystander CPR before emergency medical services arrived—but CPR can double or even triple the chance of survival.

Shannon says, “the more people who know how to do CPR, the more we’re able to help!” Check out a few fascinating tidbits from the training and look for a class near you

  • Babies are cute when they’re chunky, but all that cuteness makes it more difficult to locate a pulse on their necks or wrists. The best spot to check for one is on the brachial artery, on the inner side of an infant’s bicep.

  • CPR is designed to keep a victim’s blood and oxygen circulating while waiting on emergency services. It’s a great idea to know where the Automated External Defibrillator (or AED) is located in your workplace or school.

  • CPR can save a victim’s life, but the rescuer’s life matters, too. The first step of emergency response is always checking the scene to make sure you can intervene safely.