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Top doc: Adjust attitudes
(Published October 4, 1999)
By REBECCA CHARRY
The tremendous health care problems faced by many District residents will not improve until those designing and managing the care get to know their patients a little better, says Dr. Ivan Walks, the man tapped by Mayor Anthony A. Williams to take over the D.C. Department of Health.
In his first two weeks on the job, Walks told various audiences that culture is the key.
"We must explore culture and tradition to root out the attitudes and behaviors that lead to...poor health," he said. "Why do our residents continue to resist healthy lifestyle changes? Why do African-American women in the District engage in unprotected sex, despite the potentially deadly consequences of this behavior? Why do men fail to seek health screenings or health care, even when they are aware of symptoms that indicate a problem?"
Walks, a neuro-psychiatrist, said the system must adapt to meet the needs of long-neglected cultural groups, whether that means hiring translators, making better use of school-based clinics, coordinating with the criminal justice system or expanding coverage for the uninsured. Health care must be "culturally tailored" to the needs of specific populations, he said.
With a budget of more than $1 billion, about a quarter of the entire city budget, the D.C. Department of Health is responsible for dozens of programs, from substance abuse treatment to lead poisoning prevention to breast cancer education. Two years ago, the health services function was separated from the Department of Human Services and was made an independent department. Since then, the department has seen a high turnover in top leadership and was without a permanent director for 15 months before Walks took the job in mid-September.
Walks comes on board at a time when the city’s rate of new AIDS cases is six times the national average and the life expectancy for black men – 59½ years — is the lowest in the nation. At the same time, the District has too many unused hospital beds and several of its large hospitals are in some degree of financial difficulty. About 20 percent of the District’s population, or about 80,000 people, are uninsured.
At a recent public forum sponsored by the League of Women Voters, D.C. Mayor Anthony A. Williams called the District’s health care problems "a crisis of our own making." He urged Walks to "confront these challenges directly, not tinker around the edges."
Walks has said one of his major goals is to unify the fractured and disparate pieces of the health care system. For example, he said, the District has a serious problem with AIDS among children.
"But we have school-based health over here, we have maternal and child health over there, and sexually transmitted diseases over there," he said.
There are as many as 4,000 drug addicts cycling through the city’s prisons and jails yet the city offers no drug treatment programs for inmates other than 12-step counseling, he said.
"We have people with four or five diagnoses and they cannot be treated separately," he said. "We have people with mental health, physical health, substance abuse and maternity needs. We can’t tell them we can only treat one and they’ll have to go somewhere else for the rest."
Walks pledged to support the mayor’s commitment to reducing the number of uninsured residents and increasing primary care capacity in under-served neighborhoods, particularly east of the Anacostia River. Walks said he plans to increase the role of school-based clinics and make sure translators are provided to those who need them. Walks also said his staff will present the mayor with comprehensive lead poisoning prevention legislation by the end of November.
The city’s budget for fiscal 2000, which began Oct. 1, includes funding to extend insurance coverage to 2,400 uninsured residents, age 50-64, without children and to 500 immigrant children.
Walks said he also has plans for changes within the department. He said he has hired a deputy director who will assess current programs. Within the next 60 days, every employee in the department will receive a detailed, performance-based job description. Some personnel changes may be necessary, Walks said. Councilman David Catania, R-At large, has repeatedly called for the removal of Dr. Deirdre Roach, director of the Addiction Prevention and Recovery Administration, part of the Department of Health.
"We’ll see who shakes out over the next several weeks," Walks said.
At his council confirmation hearing Sept. 24, Walks acknowledged that he never managed a budget as large as the health department’s — but he pledged not to under-spend, a problem that has hampered the department in the past.
At the hearing he also heard from city council members just how hard his new job would be.
"None of the previous directors left under circumstances that were entirely happy," cautioned Councilman Jim Graham, D-Ward 1, former executive director of Whitman-Walker health clinic. "There’s something about this department that is extremely difficult."
"There is a lot of anger, frankly, about the state of health care in this city," Catania said.
Walks will draw a salary of $198,000 annually plus benefits. That makes him the highest-paid D.C. government employee.
Copyright 1999, The Common Denominator