Yale returned in 1975. The Greenwich Board of Health had requested a study by public health professors and students of the Yale School of Medicine to try to determine some of the causes of the quick turnover in health directors, and to decide if a medical degree was an absolute qualification for the position. The study concluded that while a medical degree was desirable, it was more important that the director be committed to public health and to have strong administrative skills (Marsters, 1976). This led to the hiring of Dr. James Lieberman, a former assistant Surgeon General and a career officer in the United States Public Health Service (Annual Report, 1977).
The United States Public Health Service (USPHS) is one of the uniformed services of the United States government (like the Army and the Navy). It is a group of physicians and other medical professionals who can be deployed by the government to deal with public health emergencies, and is organized along military lines and uses naval uniforms and ranks. It numbered about 6,000 persons in 2006, and is directed by the Surgeon General. Historically, it descends from a network of federally sponsored hospitals caring for sailors and other servicemen, and its physicians screened immigrants from Europe, at Ellis Island for example, during the mass immigration of 1890 to 1920 (USPHS website). The USPHS sent forty-six doctors and one hundred nurses to work in temporary hospitals in Connecticut during the 1918 influenza epidemic (Winslow, 1920). Greenwich had previous experience with the USPHS in 1913, when some of its officers advised Dr. Klein, the Health Officer, on water and sanitation issues (Annual Report, 1913).
Dr. Lieberman’s tenure saw a conceptual change in the practice of public health. The 1975 Yale report recommended that the new health director make it a priority to assess the needs of Greenwich and use this information to devise programming (Marsters, 1976). Up to this point, health departments, including Greenwich’s, had simply offered a set of services called the “Big Six”. They were: sanitation, communicable disease control, maternal and child health, health education and laboratory services (Shonick, 1995). The new philosophy reflected in the Yale report was crystallized in the 1988 Institute of Medicine report, The Future of Public Health. This report identified the core function of a health department as threefold: assessment of community needs; policy development in order to meet those needs; and assurance that the needs were being met. These functions were to be expanded and developed by the Core Public Health Functions Steering Committee (which included representatives from the USPHS), which in 1994 produced the document “The Ten Essential Public Health Services”. These provided a working definition of public health and a guiding framework for the responsibilities of local public health departments. (They are listed in Appendix B of this document) (CDC: “Essential Services” website). A further conceptual framework was provided by the “Healthy People” documents which provide science-based, measurable goals for improving the health of Americans. The first one was the 1979 report: “Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention” (“Healthy People” website). In 1991, Dr. Lieberman participated in a meeting sponsored by the National Center for Health Statistics to discuss goals for “Healthy People 2000” (Annual Report, 1991). The Greenwich Department of Health currently uses “Healthy People 2020” to guide its work.
In Dr. Lieberman’s first annual report (1977) he emphasized the importance of prevention: “It is clear that in the future the concept of prevention must take its rightful place in our program plans, since unbridled increase in expenditure for medical care will not necessarily enhance the quality of our lives or the state of our collective health”. He reiterated this in his 1988 report. Prevention became a theme of the laboratory’s work as well, and would be articulated in the first and second of the Ten Essential services: to monitor the community to identify and solve health problems, and to investigate health problems and health hazards in the community (“Essential Services” website). In an evaluation of the laboratory in 1978, William Adams of the CDC reported on its work, including its air pollution program, and its other environmental and clinical services. He also found that other divisions of the department were requesting that the laboratory expand its food and well water testing capabilities, and offer diabetes and fecal occult blood screening. He made suggestions for the future development of the laboratory, incorporating input from Dr. Redys of the State Laboratory in Hartford, who once worked in the Greenwich Department of Health Laboratory.
The environmental portion of the laboratory’s work (two thirds, in 1977) included the air pollution and water pollution programs. The air pollution work began to include indoor air and auto emission studies in addition to what has already been described. The laboratory monitored the air of Cos Cob when traffic from I-95 was rerouted through residential areas following the collapse of the Mianus River Bridge in 1984. Asbestos monitoring apparatus was obtained in 1987 to assist in the asbestos abatement of town buildings. The program for monitoring the interiors of police vehicles for carbon monoxide was initiated in 1983. By the early 1980s, the laboratory was performing monthly water pollution monitoring of inland bodies of water for evidence of bacterial contamination from sewage, nutrients from fertilizer runoff such as nitrates and phosphates, and heavy metals. Monthly monitoring of the public distribution water supply was also initiated, and in 1987, laboratory tests demonstrated an increase in sodium content in the water during the winter, presumably due to runoff from salting the roads. This testing was performed on the atomic absorption spectrometer purchased by the laboratory in 1987. A pamphlet called “Groundwater and Wells” was prepared in 1984 and distributed with well permits. This resulted in an upsurge of private citizens using the laboratory to test their own wells (Annual Reports: 1977, 1983, 1984, 1987).
The clinical aspects of the laboratory testing focused more around prevention at this time. During this period, urine screening for diabetes was offered, as well as screening for elevated cholesterol levels. Hematology testing equipment was purchased in 1987, allowing hemoglobin and hematocrit screening to assist the Family Health Division in examining children for its Well Child Clinics, and blood lead screening was performed on this population as well. Routine urinalysis was performed for residents of the Nathaniel Witherell nursing home. State laws required that couples applying for a marriage license be tested for syphilis and rubella, and the laboratory began to provide this service in 1985. Adam’s report of 1978 recommended the addition of fecal occult blood testing to screen for colon cancer, and this was being done by 1987. In 1990 a graphite furnace was obtained to allow the testing of paint chips for lead by atomic absorption spectrometry (Annual Reports: 1978, 1985, 1987, 1990).
New and emerging health threats challenged the laboratory and the Department as a whole at this time. In the 1980s, the laboratory performed medical parasitology procedures (stool screens) in response to epidemiological issues relating to immigrants from Southeast Asia. An AIDS counseling and testing program was begun in the fall of 1986; its complex blood tests were done at the State Laboratory in Hartford. Lyme disease, a tick borne infection endemic to Fairfield and Westchester counties, was first mentioned in the annual report of 1985. Deer ticks were being sent to the Connecticut Agricultural Experiment Station for analysis by 1990. In 1997 the laboratory began to test live ticks for the Lyme disease bacteria by direct immunofluorescence analysis, and by 1999 was able to test all ticks using a DNA amplification technique. In the 21st century, it was found that ticks carry other diseases besides Lyme disease, and the laboratory developed a procedure to test them for the most common co-infection Babesia microti. Another emerging arthropod borne disease was West Nile Virus. The laboratory cooperated with the state in tracking the progress of this mosquito borne disease by receiving dead crows found in the town and forwarding them to the Connecticut Agricultural Experiment Station for analysis. Staff from the laboratory also participated in a serosurvey in 1999 to examine the prevalence of West Nile Virus in the community. Still another emerging threat that had to be dealt with at this period was radon, a colorless odorless radioactive gas emitted from the soil and collecting in the basements of homes. Exposure to radon was found to be the second most important cause of lung cancer in the United States. In 1988 the laboratory performed a radon risk assessment survey of fifty sites in the town, using funds from a state grant. By 2000 the laboratory was offering a program of radon testing for homeowners (Annual Reports: 1985, 1986, 1988, 1990, 1999. 2000).
There were a number of personnel changes in the laboratory during this period. After Laura Morrison retired in 1984, the laboratory was reorganized as part of the Division of Laboratory and Environmental Services to allow closer coordination between the two entities. Robert Brown became the Director of the newly formed division, and wrote the annual reports for the laboratory. Arthur B. Morris became the laboratory supervisor, and continued until 1990. At this point, Caroline Calderone Baisley, who had been hired as a sanitarian in 1981, became Director of the Division. The laboratory was managed by Carrie Buchannan until she left to join the Navy. Hugo Santillan, the laboratory’s environmental chemist, was appointed Laboratory Supervisor in 1991. He resigned in 1996, and the laboratory was run by Kenneth Roper, who had replaced Rafael Sotil as laboratory technician in 1995. Frank Buckalew was hired as the bacteriologist and worked until 1996, when he resigned due to illness and his place was taken by Doug Serafin (Annual Reports: 1981, 1984, 1990, 1995, 1996).
An assessment of the laboratory was conducted in 1995 by Dr. Gary Davidson of Columbus Ohio. The resulting report discussed laboratory operations and the position of laboratory supervisor, and recommended that the laboratory be reinstated as a separate division of the Department of Health. This was done in 1997, and Doug Serafin became laboratory director. This lasted until 1999, when an anonymously initiated and funded assessment of the Department was conducted by the Fairfield County Community Foundation. The result of this study was a combining of the laboratory with Environmental Services once again. Mr. Serafin remained the laboratory director under Michael Stewart Long, Director of Environmental Health Services, who replaced Caroline Baisley when she was appointed Director of Health in 1999. After the hiring of Mrs. Yvette Perez Ghannam in 1998, the staff of the laboratory became what it is today (Annual Reports: 1995, 1997, 1998, 1999).
Doug Serafin led the Greenwich Department of Health Laboratory into the 21st century, and he developed the laboratory program into a flexible tool to meet contemporary needs. He holds a masters degree in microbiology, and had previously worked eight years for the State of Connecticut Department of Health Laboratory in Hartford, where John Redys had once been the director. Mr. Serafin also holds a Masters of Public Health degree, and is a Certified Health Education Specialist. This enables him to develop the role of the laboratory in terms of community health education. The local laboratory plays a significant role in public health, as it provides a level of interaction with its customers that is not available in large regional laboratories, in order to explain results or to educate them to make changes for a healthy lifestyle. It provides quicker turnaround times and more flexibility to meet local needs, which is an advantage to the agencies that use its services as well as to the individual customer.
Mr. Serafin emphasizes the importance of pure drinking water, which has been a concern of the Greenwich Department of Health Laboratory from the very beginning. For example, he arranged for the purchase of a new atomic absorption spectrometer/graphite furnace (in 2004) as well as other instrumentation for the testing of drinking water for chemicals. A rapid method for testing beach water was introduced (Annual Report, 1998), which allows recreational waters to be rapidly monitored and reduced the number of closed beach days. He was responsible for the development of the tick testing program to test live ticks (Annual Report 1998), and then all ticks (Annual Report 2000) for the Lyme disease organism, and added a test for the babesiosis organism (Annual Report 2011). Mr. Serafin also set up the laboratory’s current radon testing program (Annual Report 2000). During the original attack of West Nile Virus, he supervised the collection of birds and their referral for testing to track the progress of the outbreak (Annual report 2000). Recently (2011) he collected information and prepared presentations to educate community groups about a current public health nuisance, the reappearance of bedbugs in the town. Mr. Serafin has established programs using Point of Care technology for clinical tests such as hemoglobin, blood lead, and cholesterol (Annual Reports 2002, 2006). These allow immediate reporting of results, which provide the best opportunity for health education advice to be received and acted upon by the patient.
Mr. Serafin directed that as many laboratory procedures and records as possible be kept on computer databases (Annual Report 1998), which has made the laboratory one of the most paper-independent divisions of the Town of Greenwich administration. His goal is to create a LIMS (Laboratory Information Management System), which will allow the organization of all the laboratory’s data and records in a systematic way. Other goals of his include the ability to test drinking water for volatile organic compounds, and to test ticks for the bacteria that causes ehrlichiosis.
Mr. Serafin also developed and continues to direct the Greenwich Department of Health Laboratory’s response to the greatest public health challenge of our era.