New academy member, John Bartkowski, DrPH, RN, FAAN, has been Chief Executive Officer at the Sixteenth Street Community Health Center in Milwaukee since 1988. Eight years ago, faced with alarming statistics on the prevalence of childhood lead poisoning in the neighborhood served by the center and confronted with numbers from the City Health Department that suggested lead poisoning was even more of a problem in other areas of the city, Dr. Bartkowski set out to test his premise that the predominantly Hispanic population on the south side were not having their children tested at the same rate as children in other parts of the city. He also worked to create a project in concert with the Health Department and funded by a local foundation that would find children who had not been tested, develop a program to prevent children from becoming lead poisoned, and keep already poisoned children from becoming more severely poisoned.
In 1995, when the Community Outreach Lead Poisoning Prevention project started, 36% of south side children were found to be lead poisoned. By project year 2000/01, that number had fallen to 17.6%, and this year, a more significant decrease to 9.5% has been obtained. According to a study published in the Wisconsin Medical Journal last year, the rate of childhood lead poisoning has been reduced by 47% in the neighborhood served by the Sixteenth Street Community Health Center, a greater decline than in any other part of the city.
Dr. Bartkowski points to these results with pride and credits the project's comprehensive approach, which includes relying on bilingual community outreach workers (Spanish/English and Hmong/English), the coordinated testing program at the Sixteenth Street primary care clinic, the openness of the Women, Infant & Children Nutrition Program (WIC) to adapting their program to incorporate blood lead testing and prevention education, a continuing grant from the State of Wisconsin, the in-kind program support of the City of Milwaukee Health Department, and partnerships within the community, most notably the South Side Parents Against Lead.
However, the success of this project rests on constant program change to respond to conditions in the community and a series of action steps to adjust how the project operates to reflect trends in the collected data. When the project began, community health workers went door to door to find children who had not been tested for lead poisoning. An in-home capillary blood lead test, teaching to families about lead hazards, follow-up visits by the outreach workers in which teaching is repeated, and low-cost/no-cost home repairs to reduce exposure to lead hazards showed immediate results. Hundreds of children were being tested for the first time, and an increased understanding spread in the community about the dangers of lead poisoning and what can be done to keep children from being poisoned. Evening and weekend hours were added to the program when fewer families were found at home during the day due to implementation of Wisconsin's welfare to work program. Although blood lead testing continues to be defined as an “unallowable expense” for our WIC program, additional state funding was acquired to fund a Lead Registrar to coordinate testing of children as part of their WIC visit. This funding allowed families to have their children tested for lead poisoning as part of their WIC visit and was a new way for us to reach thousands of children who would have been missed otherwise.
The Lead Project continues to serve the community with outreach workers, and efforts are coordinated with the city during times when funding has been available to actually remove lead hazards from homes. With 67% of families that the clinic serves living in housing with moderate to severe lead hazards, efforts to prevent lead poisoning through outreach and education need to continue. This year, an early intervention phase of the project has been started to intensively focus on children between the ages of 12 and 30 months who have low levels of lead poisoning (a blood lead level of 6-9 micrograms per deciliter ug/dL) with the objective of keeping that level below 10 ug/dL, a level that just a few years ago was thought to be safe. In the next project year, Dr. Bartkowski is more hopeful than ever that the Healthy People 2010 goal of ending lead poisoning as a major childhood disease can be reached.
The Sixteenth Street Community Health Center provides health care, dental services, behavioral health counseling, health education, and social services for residents of Milwaukee's culturally diverse south side. Last year, more than 16,000 individuals made more than 140,000 visits to the center. Services are offered in English, Spanish, Hmong and Laotian, with respect for cultural values and on a sliding fee scale for patients without health insurance.
John J. Bartkowski, DrPH, has been Chief Executive Officer at Sixteenth Street since 1988. He holds a BS and MS in Nursing from the University of Wisconsin-Milwaukee and a DrPH from the University of Illinois at Chicago.
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