The Grubby Work of Public Health: Well, Somebody Has to Do It . . .

The case of the homeless, drug-abusing prostitute with syphilis was a confounding one, even for a veteran investigator like Pat Dumalski. For nearly a month, Dumalski and her colleagues had scoured the shabby streets and back alleys of Wilmington, unable to find the woman.

The grizzled-looking guys who lived near the dumpster hadn’t seen her. Neither had anyone else that Dumalski encountered on her rounds. At times it seemed that the illusive “Mary” had simply disappeared, leaving only a trail of syphilis-infected men in her wake.

Then, out of the blue, there she was one day last week, standing on a street corner eating Corn Nuts. “This is a coup!” Dumalski exclaimed as she quickly loaded the disheveled Mary into her Toyota and headed for the health clinic. “I actually found her!”

Small Victories

Dumalski and 105 other county public health investigators savor moments like those. It is the small victories that compensate for the frustrating times when hot-tempered people slam doors in their faces, when nasty dogs that may be rabid nip at their heels, or when they are called upon to cut the heads off dead animals slated for lab inspections.

But such is the life of a health investigator. Even by their own account, they are an unusual breed of people who earn next to nothing for jobs that next to no one wants to do.

“We’re kind of like the garbage pail of health services,” said Dumalski, 36. “It’s not like we bring joy and happiness into people’s lives. Most folks don’t enjoy hearing that their pets will have to be quarantined or that they may have contracted a communicable disease.”

In recent weeks, public health investigators have gained attention for their work in the county’s crackdown on gay bathhouses. They inspect the clubs for evidence of unsafe sex and have also been given the job of compiling evidence against club owners who violate the county’s new health regulations. But E. Keith Weeks, director of the Bureau of Public Health Investigation, said his staff spends much more of its time tracking down diseases in humans and animals.

Having Tough Times

These are especially tough times for disease police. In addition to AIDS, they are required to deal with a skyrocketing number of cases of syphilis and gonorrhea in Los Angeles County and with the ultra-resistant strains of the diseases such as penicillin-resistant gonorrhea.

The investigators compiled reports on the 25,000 animal bites in Los Angeles County last year. They also tracked a good number of the 38,000 cases of gonorrhea and 11,000 cases of syphilis that occurred in 1987, alerting people who may have been exposed. They were among the first people on the scene at the start of the Jalisco cheese poisoning epidemic of 1985, which was the the biggest food poisoning case in California history.

They are also responsible for preventing the spread of diseases like diphtheria, hoof and mouth, leprosy and meningitis, and for posting warning signs at hazardous sites. But despite all these activities, they are still frequently confused with the staff of sanitarians who inspect restaurants. “We have lived in their shadow for years,” Weeks said.

Numerous Applicants

Public health investigators earn between $23,000 and $29,000 a year. Most of Weeks’ staff members, about 20% of whom are women, are college graduates with public health degrees. Despite the unusual nature of the work, Weeks said he is never short of applicants.

“The power of the health officer can be quite remarkable,” Weeks said. “We deal with some very serious communicable diseases. And the people that join us tend to stay with it.”

The investigators have an unusual assignment, according to Dr. Ellen Alkon, county medical director for public health. Alkon said most other metropolitan areas employ a variety of people to handle the jobs that are undertaken by one health investigator.

Alkon said the job requires someone who is intelligent, well-trained, observant, good with people and well versed in how to respond to vastly different situations.

“Over the years their responsibilities have expanded to the point where they were doing a lot of disease-investigation type of work, especially on sexually transmitted diseases,” Alkon said. “It’s a fascinating job, and it’s not something that exists everywhere.”

Some health investigators privately complain that they are overworked and underpaid. But administrators say turnover is surprisingly low.

Dumalski has been on the job for 14 years. When she graduated from California State University, Long Beach, with a degree in public health, she expected to work for the federal government. But the idea of relocating did not appeal to her, so she turned to the Department of Health Services.

Dumalski, the mother of two, vividly remembers her first job interview, when a supervisor asked if she would be capable of severing the heads of dead animals that needed to be taken to a laboratory and examined for evidence of rabies. “I said sure,” Dumalski recalled. “Then, after I got the job, one of my first questions was: ‘You were only kidding, right?’ ”

While gruesome-sounding, the beheading part of the job is vital to the profession, since doctors must examine certain brain cells to determine if rabies exists. An animal that tests positive--and this often includes bats--is known as a “hot head.” Dumalski estimated that she has “hundreds” of head removals behind her. Like all health investigators, she was issued a badge, rubber gloves and a sharp knife on the day she started the job.

A Day’s Work

Dumalski’s workday begins at about 8 a.m. when she and the other investigators at the Torrance Health District chart their stops for the day. By 9 a.m. they are usually on the road, clutching a metal clipboard that contains the list of maladies facing them in the field.

When a prostitute was recently diagnosed as having penicillin-resistant gonorrhea, the woman led investigators to the homes of about 40 men she had had sex with over a period of several weeks. Controlling such a wide spread of disease can be a frustrating task.

“I was really gung-ho in the beginning,” Dumalski said. “I thought that I was the one who was going to conquer gonorrhea in Los Angeles County. Now I’m not so sure.”

Dumalski’s first stop on her rounds last week was a fashionable section of Manhattan Beach. A neighborhood cat that had bitten someone needed to be quarantined for 10 days, the incubation period for rabies. As it turned out, the cat had broken its leg and would spend the next week or so at the veterinarian’s anyway.

Her second stop was a new business in Torrance called Pet City, where she explained the county’s rules on keeping parakeets. A supervisor nodded politely as Dumalski told her that all the birds must have bands on their legs to ensure that they have been treated for disease.

Marital Problem

The next stop involved a much touchier case of alerting a woman that her two-timing Romeo of a husband may have exposed her to an extremely contagious case of gonorrhea.

When the Torrance woman failed to answer her door, Dumalski left a note that contained her name and telephone number and then headed for a house in Harbor City where another pet had to be quarantined. This case involved a small brown-and-white dog that had bitten a neighborhood child.

While Dumalski was posting a sign on the house, the homeowner pulled into the driveway and emerged from his pickup truck with the dog on a leash. As Dumalski told the man about the quarantine, the dog suddenly jumped into the air and lunged at her leg. “I don’t need this,” Dumalski muttered as she returned to the car shaking her head. “These are silk pants.”

The fifth stop found Dumalski back on the gonorrhea trail. A 17-year-old Wilmington girl who had been diagnosed as having the disease was refusing to come in for treatment.

“The key here is not to blow her cover if her parents answer the door,” she said. “I try to deal with teens by themselves because we don’t want them thinking that the Health Department is the enemy. We may be starting a long-term relationship with this person.”

Stop six was another gonorrhea case, this one involving a 23-year-old man whose disease had recently been diagnosed by a private doctor. Dumalski planned to tell the man about the nature of the disease and persuade him to contact anyone who might have contracted it from him.

Once again, however, there was no answer, and Dumalski was forced to leave another note before heading to the apartment of a man with leprosy. Dumalski’s job was to make sure that he was taking the proper precautions to avoid spreading the disease.

She was not relishing the encounter, since the man had a habit of slamming the door in her face and spewing a torrent of obscenities. But the big payoff was just around the corner. As Dumalski drove away from the apartment, the prostitute named Mary who had not been seen for a month suddenly appeared in her rear-view mirror.

Within minutes Mary was safely in the back seat of Dumalski’s car and on her way to a clinic, where she would be treated for syphilis. Dumalski, meanwhile, had a feather in her cap. “Interrupting a disease process is a good feeling,” she said.