Public Defenders
A glimpse into the work of those charged with safeguarding and promoting America's health

By Linda Childers
February 13, 2004

The man sat on the exam table exhausted from his long trek across the Mexican border. Shortly after crossing into California, he and his family were detained by immigration officials and taken to the ICE (Immigration and Customs Enforcement) Los Angeles Medical Staging Facility.

Lt. Stephen Gonsalves, MPH, MSN, FNP, greeted the man in Spanish and immediately put him at ease. During his examination, Gonsalves discovered the man suffered from hypertension and diabetes.

“Many of our patients suffer from medical conditions that haven’t been diagnosed or have been grossly undertreated,” said Gonsalves, who gave the man prescriptions for his ailments.

After talking with the patient about self-care strategies for his conditions, the man’s eyes filled with tears as he thanked Gonsalves. The man said this was the first time in his life he had received medical care.

Gonsalves is one of the more than 1,200 nurses who serve in the U.S. Public Health Service Commissioned Corps, working under the direction of the U.S. Surgeon General. Although the corps has been in existence for more than 90 years, many nurses remain unaware of the career opportunities it offers.

One of the seven uniformed services in the United States, commissioned nurses wear uniforms similar to their Navy counterparts, and serve as officers in local, state, federal and international health agencies in a variety of capacities. They help conduct research, design disease prevention programs and provide health care resources and access to underserved communities both in the United States and abroad.

A member of the corps for the past four years, Gonsalves is a health service administrator at the Division of Immigration Health Services. He and his staff provide routine medical care and screening services to a steady stream of undocumented immigrants.

“We screen for TB and other infectious diseases, both to protect the detainees and to ensure the greater health of the United States,” said Gonsalves, who first learned about nursing jobs in the corps while earning his master’s degree in public health at the University of Hawaii.

“The corps provides nurses with unlimited opportunities for advancement and professional development,” Gonsalves said. “Through my work in the corps, I’ve been able to make a clinical impact on both the local and international level.”

In addition to his work in immigration services, Gonsalves also serves on the Commissioned Corps Readiness Force. Team members are deployed to provide medical assistance during national and international disasters. After Sept. 11, Gonsalves worked for several weeks in a medical clinic several blocks from Ground Zero in New York. There, he treated rescue workers who had sustained a variety of injuries sifting through the debris of the World Trade Center.

“There is no typical day in the corps. Every day brings a new experience,” Gonsalves said.

Vulnerable populations

When Capt. Kerry Nesseler, MS, RN, joined the corps in 1986, her first assignment was assisting in the implementation of a prenatal clinic on an American Indian reservation in rural Minnesota.

But before she could begin caring for the expectant moms, Nesseler, a mother of four, found she had to earn her patients’ trust.

“My patients were used to traveling 30 miles to a clinic off the reservation to receive prenatal care,” Nesseler said. “Many felt a sense of discrimination, and didn’t think they were always treated with respect.”

Nesseler, who has a master’s degree in maternal-child health, used her expertise to make her new patients feel welcome while also fostering an environment of mutual respect.

The program proved successful in offering expectant mothers education, home visits, prenatal care and access to prenatal specialists.

Mobility in the corps is encouraged, and Nesseler went from Minnesota to Atlanta to work in the Bureau of Primary Health Care. Two years later, she transferred to the CDC, where she worked on the national breast and cervical cancer prevention program.

“Over the years, I’ve been able to partner with a lot of other wonderful health care practitioners to globally impact patient outcomes for mothers and their children,” Nesseler said.

She cites the work of corps members in areas such as infant mortality, perinatal transmission of HIV/AIDS and teen pregnancies. Corps nurses assist in managing the Title V program that provides funding to all states for their maternal and child health programs. Corps nurses also provide direct prenatal health services and education in community health centers, Indian health clinics and hospitals and the National Health Service Corps.

Corps nurses also direct the Ryan White Title IV program that provides grants to organizations to reduce the perinatal transmission of HIV/AIDS. The nurses are involved in the overall efforts to educate the public about the risks of HIV, reduce the transmission rates, and provide treatment and care to people with the disease.

In addition, corps nurses are involved in directing the two “Abstinence Only” education programs that provide funding to both states and communities. Corps nurses also offer educational and clinical services to school-based health clinics.

“We’ve seen a significant decrease in the areas of infant mortality, perinatal transmission of AIDS and teen pregnancies in the last decade,” Nesseler said. “Our nurses are directly involved in policy development and implementation of national programs to effect positive health changes in these and other areas.”

Two years ago, Nesseler was appointed associate administrator for health professions in the U.S. Department of Health and Human Services’ Health Resources and Services Administration.

“In the past, this position has always been held by physicians,” she said. >>

“I’m excited and honored to be the first woman, as well as the first nurse, to serve in this job.”

With a budget of $882 million and a staff of 350, she directs a variety of health professions programs affecting the nation’s physicians, dentists, nurses, allied health professionals and health workforce issues.

One of Nesseler’s highest priorities is working to increase the ranks of nurses across the United States. She notes that by 2010, the country expects to have 808,000 openings for registered nurses.

“The secretary of the HHS is committed to alleviating the critical shortage of nurses in this country,” Nesseler said.

The federal budget for nursing programs is in HRSA, the Bureau of Health Professions, which Nesseler directs. She is responsible for overseeing funding for many programs that will increase the ranks of nurses including the Nursing Education Loan Repayment Program; the Nurse Scholarship Program; the Nurse Faculty Loan Program; Nursing Workforce Diversity; and the Nursing Education, Practice and Retention Program.

“These programs all provide scholarships, loans or grants to individual students and practitioners as well as eligible nursing schools in the hopes of increasing the number of students entering and graduating from nursing school,” Nesseler said. “Some of the funds are being spent on examining the workforce environment for nurses and retention practices.”

In addition to the nursing budget, the bureau directs the National Health Services Corps, which unites communities with health professionals. The group provides partial repayment of educational loans and scholarships for health professionals, including advanced practice nurses, who serve at approved sites. The bureau also directs programs that help K-12 students to pursue a career in the health professions.

Addressing the shortage

Lt. Cmdr. Annette Debisette, DNSc, ANP, RN, began her career with the Commissioned Corps as a nurse consultant. She brings 13 years of teaching experience and 21 years of clinical patient care to her job as chief of the advanced education nursing branch within HRSA.

Debisette works to decrease the national nursing shortage by providing funds to nursing schools seeking to hire additional teachers. Her office also provides grants for nursing students to help defray tuition costs.

“We’ve had a healthy response recently in terms of nurses applying for grant monies,” said Debisette, who funds training programs ranging from certified nurse assistants to doctoral programs for qualified nurse candidates.

Debisette, who grew up in Philadelphia, saw firsthand the health disparities that exist within urban cities and wanted a job where she could make a difference

Like her colleagues, Debisette describes her job with both passion and enthusiasm. She finds rewards in the camaraderie of the corps and notes that the admiral and chief of the nurse corps are responsive and accessible to nursing personnel.

Although much of her job involves attending a number of meetings and making administrative decisions, Debisette remains ACLS certified and maintains that it’s critical to keep up with her clinical skills.

“We may be in meetings one day and called out to assist victims of an earthquake the next day,” Debisette said. “It’s important for nurses in the corps to remain flexible and be open to change.”

Disaster preparedness

The next time the country goes to Code Orange, it’s going to be a busy day for Cmdr. Roberta Lavin, MSN, RN.

Lavin serves as chief of staff for the HHS’s Office of Public Health Emergency Preparedness, the federal agency responsible for meeting the health needs of the United States during emergencies.

In cooperation with other federal agencies and the private sector, the office coordinates the federal health and medical response and recovery activities. Lavin’s office serves as the medical “911” for all national disasters.

In addition to her work in the United States, her job in the corps has taken Lavin just off the Kamchatka peninsula of Russia, where she served as the medical officer for a national crew conducting water sampling and testing. She also has worked at an immigration detention facility in New York and at the Bureau of Prisons in Tucson, Ariz.

“A lot of my work revolves around policy and ensuring that all the right agencies are on board,” said Lavin, who, despite working in an office, manages to maintain her clinical hours by spending a couple of weeks each year working for the Indian Health Service.

“I do miss direct patient care, but I chose to leave clinical work for a policy job with the corps,” Lavin said. “Working at the bedside, I was able to impact the lives of individual patients, and by doing policy work I’m able to see the lives of thousands of patients changed with the stroke of a pen.”

Contact Linda Childers at eastbaypr@aol.com.