Last summer, most of the public had never heard of anthrax. All that changed, of course, after Sept. 11, when the infectious spores began showing up in America's mail.

Public health nurses, however, were well-acquainted with the microscopic organism from their bioterrorism training. When anthrax-laced letters appeared in the weeks following the World Trade Center and Pentagon attacks, the nation turned to public health experts for answers.

"Clearly our role is much bigger now. We're in the front and center where we weren't before," said Gerry McKee, Ph.D., MPH, director of the Wyoming Department of Health.

Increased interest in public health also has brought nurses greater respect and renewed their vigor for work, according to JoAnn Blevens, MPH, RN, a Wyoming public health nursing administrator.

A lack of respect for nurses in general and a lack of knowledge about public health nursing had been frustrating many nurses for years, Blevens said. Now, her nurses are being looked at for their expertise. They are members of local emergency planning committees and are asked to speak to community groups.

"We weren't seen as an important part of the team. Now, we're seen as a knowledgeable resource," Blevens said.

Thirty years ago, when Marie McDougall, RN, started as a public health nurse in Hot Springs County, Wyo., she spent much of her time on home visits. It's a rural county of about 4,900 people, covering more than 1,950 square miles of mountains and plains where fluorescent green minerals erupt from the soil, release a strong sulfa scent and cascade into bubbling earthen baths in its county seat, Thermopolis, a small resort town where McDougall's office is.

Many people in her community were homebound, especially in the winter. McDougall and another nurse would visit and care for their patients. "It was very satisfying," she said.

But then the role of the public nurse changed and McDougall found herself focused on maternal-child health issues in her community.

She struggled to reduce the number of teen-aged mothers and counseled people who made choices in life that led to risky behaviors.

"If you could go into a person's house and help them, that's satisfying, but trying to change behavior in a community, that's tough and not particularly satisfying," she said.

McDougall felt the respect for her profession slip as she spent more time away from direct care. "We were having a hard time defining the role of public health," she said.

McDougall sat on the county's emergency management team, but said it was a token role. The team said it needed a nurse, but it wasn't sure what to do with her. Oil wells dot the horizon and most of Hot Springs' emergency plans revolved around a hazardous material spill.

During the summer of 2000, wildfires threatened the county. The emergency management team reacted, but McDougall said she wasn't involved. "There was nothing for me to do," she said.

All that changed a year later.
New focus
"Sept. 11 was the most horrible thing to happen in my life and then to be followed so quickly by anthrax," she said. "I felt a tremendous responsibility to educate myself and to know more.

"I was obsessed with watching CNN, reading books and the newspaper, so I could be a better resource to the community."

McDougall also took part in bioterrorism training offered by the Wyoming Department of Health on compressed video. She attended teleconference meetings and training with the Wyoming Emergency Management Agency, the state attorney general's office and the FBI.

The Hot Springs County sheriff asked McDougall to join him on the radio with the chief of police to answer questions from the community. She has since spoken to many different groups in the county.

"I felt pretty valued as a resource," she said. "I was seen as an expert by our law enforcement. They were getting panicked phone calls and they came to me to help them calm people down and provide information to the people."

McDougall said she has learned more and reached a new professional plateau, just as she was beginning to think about retirement. And if another wildfire threatens the community, she said she'd know what to do.

"Just knowing what is available and deciding in my own mind who I was going to call first is important," she said. "Are people going to need tetanus shots or are we going to have to get people here to make our water safe? I'm trying to anticipate possibilities rather than being blindsided."

New equipment
Public health nurse Donna Griffin, MPH, RN, said the change is in more than just the community.

"The same is true in the central office," she said. Griffin is the bioterrorism coordinator for Wyoming's public health nurses. "We've told them we're important. Now, they're listening."

The exposure has brought with it riches, not in salaries yet, but in equipment. All 30 public health nurse stations across the state are receiving fax machines and cell phones or pagers-some offices never have had that type of equipment before.

The nicest part, Blevens said, is that she hasn't had to beg or grovel for the equipment as in the past.

The new equipment was due to arrive before Feb. 8, the start of the 2002 Olympic Games.

Salt Lake City sits a mere 70 miles from the Wyoming border, and there's not much in between. Wyoming's public health nurses were on the alert to provide disease surveillance, especially along the two interstate routes.

In the event of a bioterrorism attack, patients could be evacuated and taken to the state hospital in Evanston, Wyo. It's a hospital built to service the 500,000 residents of the Cowboy State.

Tabletop emergency exercises have been held throughout the state in the wake of the terrorist attacks and in preparation for the Olympics. Public health nurses have had to brainstorm every possible tragedy, including what to do with too many dead bodies.

"In the past, public health has never gone to an incident command," Griffin said. Now, it's in charge of one.

Blevens would like to see this level of recognition attract some people into nursing who might not have considered it before. Some nurses, Griffin said, eagerly want to know everything they can about bioterrorism and others find it difficult to keep up with their regular duties along with the bioterrorism training sessions.

She worries about both.

"One of the challenges is to keep our finger on the pulse to make sure we're not burning people out," Griffin said.

Unfortunately, the renewed interest in public health hasn't translated into more workers.

"Patriotism and enthusiasm didn't jump the gap to employment," McKee said. In past times of national crisis, people have flocked to public service jobs. That hasn't happened yet.

"Over time, we may see an increase in people joining public health," McKee said. "I think it will help salaries in the long run. Budgeting is a political process. When people understand the need for public health, clearly that will make a difference."

Contact Joanne Bowlby at jabowlby@yahoo.com