Attorneys R Us
In her cover story, "Street Sweepers" (December 24), Kathy Glasgow did an excellent job portraying the difficult choices faced by homeless people, their advocates, and the police. We felt, however, that your readers should be informed of another important service available to homeless people living anywhere in Miami-Dade County.

With the support of the Miami-Dade County Homeless Trust, Legal Services of Greater Miami has developed a special project designed to provide legal representation to homeless clients. The issues we can assist with include: getting into the shelter system; obtaining identification, food stamps, Medicaid, Aid to Families with Dependent Children, and SSI/Social Security; and housing problems. We can also help ensure that children remain in their old schools when their families become homeless.

To get help from Legal Services or to find out about some of the other legal matters we can assist with, homeless or low-income individuals should come to our main office at 3000 Biscayne Blvd., Suite 500, Miami 33137 any time between 9:00 a.m. and 4:00 p.m., Monday through Friday. We can also be reached by telephone at 305-576-0080. Any questions about our homeless project, or about our other office locations, can be referred to the same address and/or telephone number.

Jeremy Rosen
Vivian Zaribaf
Legal Services of Greater Miami

How Does Miami Love Its Homeless? Let Us Count the Ways
As sexton of the Miami City Cemetery I am at ground zero in homeless territory. Awhile back a man was apprehended for throwing a homeless woman to the ground and assaulting her in the cemetery. The city officials who dealt with the matter humiliated the woman. She was mocked and told she got what she deserved. Her attacker was released and told he had already been punished enough because his victim has AIDS.

Recently a city official told me I could not give any homeless person a drink of water from the cemetery office. I replied I could not deny a person a drink simply because he or she was homeless. That would be discrimination. My reply so infuriated the official that he stated, "I hope I can find something on you so I can arrest you."

Is this the new and improved City of Miami government or just a new cloak to appease the ACLU and the courts?

Clyde Cates
South Miami

Some DOH Employees Are Silenced by Fear
Ted B. Kissell obviously did extensive research before writing his article on public health care ("The Doctor Is Out," December 10). I do need to inform your readers that the critical comments about physicians attributed to me at the end of the article are actually the comments of some of my patients (adolescents seen at the STD clinics). They mentioned certain physicians when they described how they were treated. This, however, should not be a generalization of all STD physicians.

Also note that the core public-health functions are epidemiology and assessment, policy-making, and assurance. Epidemiology is one of the priorities of Dr. James Howell, secretary of the state Department of Health (DOH). I was, therefore, enthusiastic about being director of epidemiology and disease control. Having worked at Jackson Memorial Hospital for several years, having a private practice, being a pediatric pulmonary consultant for Children's Medical Services and several health plans, and also being a member of the medical staff at several hospitals, I am keenly aware of the inequity in health care received by our citizens. I expected to use the data that is routinely collected by DOH to address some of the health problems that exist in our county.

Because of the financial troubles of the department, the administration had to make difficult choices about the personnel whose positions were eliminated. I was concerned, and remain concerned, about how those choices directly affect the ability of the department to perform the core functions of public health.

Several years ago I learned the role politics plays in public health. During my year as a scholar at the Public Health Leadership Institute of Florida, College of Public Health, University of South Florida, I also learned the importance of looking at the big picture when making decisions that affect the health of so many people.

In the past two years the need for strong leadership in public health has become obvious to me. In one of the first leadership classes organized by the Office of Quality Assurance/Improvement, we were taught that the most admired qualities of successful leaders are honesty, forward thinking, inspiration, and competency.

Developing a strong infrastructure in public health is crucial to the health of all our citizens and visitors. Partnerships with other providers of health care must be developed. There are many employees in the Miami-Dade office of the DOH who have dedicated their lives to public health. They have expressed their concerns about public health in Miami-Dade privately and publicly. Unfortunately many have been unable to disclose their names owing to fear of retribution. Therefore their opinions have not been heard. Although I have been accused of having a personal agenda, my problem is that I spoke candidly and on the record when Mr. Kissell interviewed me.

Strong leadership that can work with (rather than under pressure from) our politicians and other partners will be essential as we enter the next millennium. Managers are being taught leadership and team-building skills. It is time to allow and enable them to put these skills into practice. That will be an important step toward quality public health.

Kunjana Mavunda, M.D.
Coral Gables

And Here's One of Those DOH Employees
As an employee of the Miami-Dade County office of the Department of Health, I applaud Ted B. Kissell's excellent and thoroughly documented investigative article. I also commend those health care workers who contributed to it by venturing to tell the truth about what passes for public health in our county. After working for more than three years in public health among Miami-Dade County's poorest residents, I would like to see a sequel about health care in our county with the headline: "Is There a Doctor in the House?" For hundreds of thousands of residents, the answer is a resounding no.

Lack of access to health care in Miami-Dade County is an acute problem with, quite literally, epidemic potential. An understaffed and poorly administered health department conducts surveillance of a number of communicable diseases that are reported to the agency by hospitals, doctors, and laboratories. Unfortunately residents with a reportable communicable infection -- anything from Giancana (an intestinal parasite) to hepatitis -- are frequently without access to health care for their disease or preventative treatment for their family members. Even basic public-health services such as screening children for lead poisoning or administering rabies vaccines after an animal bite are unavailable through DOH.

The origin of this situation that puts the health of all of us in jeopardy rests in the relationship between DOH and the county's Public Health Trust. Over the past several years the DOH has divested itself of many essential primary-care services, such as prenatal and pediatric clinics. Funds for these functions were channeled to the Public Health Trust with the agreement that services would be provided by Jackson Memorial Hospital and associated clinics.

But the Public Health Trust has failed to make many services accessible to the poor, and DOH has reneged on an integral part of this deal: assurance. The DOH has the responsibility to ensure that services are available to indigent county residents. Assurance is a central public-health function, but it is a function the Miami-Dade office of DOH is not fulfilling.

Somewhere between 150,000 and 200,000 children in our county have no health insurance, according to an estimate by the Human Services Coalition. The agency estimates that of the 400,000 school-age children in our county, 40 percent live at or below the federal poverty level. Kid Care, the state initiative to provide health insurance to uninsured children (using funds from tobacco lawsuits) is understaffed and has been slow to do essential outreach and recruitment in the county.

Many, many children have formidable barriers between them and the medical care they need. When I investigate a child's case of a communicable disease, I all too often find that the child does not receive necessary follow-up treatment because the family lacks the insurance and resources to pay for expensive medical services. Parents tell me that when they take their children to Jackson Memorial Hospital, they receive bills they cannot begin to pay. Thus, children return to classrooms and day-care centers untreated and contagious. Cases of salmonella in infants, which one does not expect to see in large numbers in a country like the United Sates, are occurring with alarming frequency. Moreover, an understaffed DOH is not investigating such cases promptly. A child who is bitten by a stray dog receives a rabies vaccine in a hospital emergency room, but his distraught mother later finds that subsequent vaccines, which she cannot afford, are unavailable through the DOH.

There are two measures that could be taken in improving the health of our children and our county. First, the Kid Care initiative needs to be vigorously staffed and implemented to provide health insurance to those kids who need it. Second, the Miami-Dade office of the Department of Health needs to assume the responsibility of assuring accessibility of health care to those who cannot afford it. Only then will those of us who know the truth about the public-health status of our county be able to sleep well at night.

I have learned that the administrators of the DOH do not deal well with issues of policy and principle. To protect my ability to continue working for the public health of the community, I must make these comments anonymously.

Name Withheld by Request

Warning: This Letter Has Been Heavily Edited
This is a simple and sincere thank-you for publishing some of my letters to the editor over the past three years. It has been very interesting to see the edited versions of what I have submitted. I have learned a great deal about myself in the process.

Although some of my comments have been rather pointed, I have never meant personal insult to anyone.

Paul Berry


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