Health | Summer 2017

S O U T H W E S T U T A H P U B L I C H E A L T H F O U N D A T I O N | S U M M E R 2 0 17 SAFE SWIMMING

HAVE A HEALTHY BABY

HEAT SAFETY

PG. 12 &16

PG. 28

PG. 14

HEALTH MAGAZINE | SUMMER 2017

PREVENT

LET TER FROM THE HEALTH O F F IC ER Welcome to the 16th issue of HEALTH, the magazine of the Southwest Utah Public Health Foundation. We always look forward to putting out another publication filled with information that is designed to benefit individuals, families, and the population as a whole.

Public health is charged with taking on a host of challenges. As Benjamin Franklin said, “An ounce of prevention is worth a pound of cure.” You will see the message of prevention show up in many of the articles you read in this issue, from heat and sun hazards to wearing a helmet while on a motorcycle and preconception health for mothers-to-be.

There’s an old poem about the advantages of a fence on the cliff over an ambulance in the valley (see page 20). Society would save vast amounts of time and money if more attention were paid to preventing disease and injuries beforehand. It’s an endeavor that often goes unnoticed, and it’s difficult to measure how many people don’t get diabetes, heart disease, or vaccine-preventable illnesses because of public health intervention.

Still, those of us who work in the field of public health are passionate about what we do and hope to make a difference. We also hope you will take some time to read this magazine...you may be reminded of health principles you already know to be true, or perhaps discover some new ones.

Sincerely,

David W. Blodgett, MD, MPH SWUPHD Health Officer & Director

SWUHEALTH.ORG | PAGE 3

PREVENT

6 8

Back to

10

Vital

12

Swimmer's

SCHOOL

Past, present, & future

TUBERCULOSIS

By Kari Abeyta, RN, BSN

RECORDS

By Claudia Canales

ITCH

PROMOTE

14 16

Feeling the

HEAT Pool care & safe

SWIMMING

By Klint Frei

18 RECIPES 20 POEM

Healthy (& delicious)

A fence or an ambulance

By Joseph Malins

PROTECT

22 HELMET Wear a

By Roland Byrd

24

We can't do it

ALONE

By Paulette Valentine

26 TIMES

Changing

By Marlene Beagley

28 BABY

How to have a healthy

By David A. Blodgett, MD, MPH

O N T H E C OV E R S O U T H W E S T U T A H P U B L I C H E A L T H F O U N D A T I O N | S U M M E R 2 0 17 SAFE SWIMMING PG. 12 &16

HAVE A HEALTHY BABY PG. 28

HEAT SAFETY PG. 14

MAGAZINE BOARD

Cover shot: Reed and Nola Erickson in Kane County at the Coral Pink Sand Dunes

QUESTIONS OR COMMENTS?

Email info@swuhealth.org

EDITOR

PUBLISHER

David Heaton

Jeff Shumway

DEPUT Y DIRECTOR

Chris White

The entire contents of this publication are Copyright ©2017 HEALTH (the magazine of the Southwest Utah Public Health Foundation) with all rights reserved and shall not be reproduced or transmitted in any manner, either in whole or in part, without prior written permission of the publisher. Health magazine hereby disclaims all liability and is not responsible for any damage suffered as the result of claims or representations made in this publication.

Printed by Hudson Printing Company / Salt Lake City, Utah / hudsonprinting.com

HEALTH MAGAZINE | SUMMER 2017

DEPUT Y DIRECTOR

Gary House

HEALTH OFFICER

David Blodgett, MD

DESIGN Kindal Ridd

Ask your doctor if getting off the couch is right for you.

Side effects may include: healthy weight loss & maintenance; decreased risk of heart disease, diabetes, & cancer; improved mood, better sleep, and longer life. May cause even greater benefits when combined with healthy eating. Works best when taken most days of the week in the form of exercise for at least 30 minutes at a time. Also works well when taken with family, friends, pets, and fresh air. Consult your physician if you haven’t tried Getting Off The Couch for quite a while.

A

T R U S T E D

C O M M U N I T Y

SWUHEALTH.ORG | PAGE 5

R E S O U R C E

B A C K TO

Got kids? Here’s what you need to know about Utah’s immunization rules for schools and day care

S

ome parents may wonder why there is such an emphasis on vaccinations, especially among infants and children. Members of the older generations among us remember the days when diseases like measles, polio, and rubella were common; taking a toll of illness, disability, and even death.

Children are among the most vulnerable to these types of infections, along with the elderly, pregnant women, and people with

poor immune systems.

Fortunately, case numbers and deaths from these diseases have plummeted over the past few decades with increased worldwide vaccination efforts. They are now rare in most of the developed world. But they are still there, able to emerge in outbreaks among populations that have immunity below the threshold of protection.

sles killed an estimated 2.6 million people a year before vaccination use was accelerated in the ‘80s. Still, measles killed over 130,000 people in 2015, most of them children. Vigilance against infectious diseases is essential to protect entire communities and those who are especially vulnerable or cannot be vaccinated. Schools offer an ideal breeding ground for highly contagious pathogens, so a The World Health Organi- lot of attention is paid to inzation estimates that mea- dividual student immunity.

HEALTH MAGAZINE | SUMMER 2017

PREVENT

In Utah, proof of immunizations is required for students attending the following schools or programs: • Public, charter, private, and church schools (Kindergarten - Grade 12) • Licensed child care centers • Licensed family home care • Nurseries or preschools located within a school • Head Start Programs Children in early child care programs should be current on the immunization doses appropriate for their age, including those from the kindergarten list plus pneumococcal and Hib vaccines. School aged children get the following immunizations before entering kindergarten and 7th grade (influenza and rotavirus vaccines are also recommended but not required):

• 2 MMR (Measles/Mumps/Rubella) • All kindergarten requirements • 4 Polio • 1 Menningococcal • 2 Hepatitis A • 1 TDaP booster (Tetanus/Dipthe• 3 Hepatitis B ria/Pertussis) • 2 Varicella (Chickenpox), unless history of disease • 5 DTaP (Diptheria/Tetanus/Pertussis) To protect the health of all children, schools cannot admit students without written proof of immunizations. “Written proof” means records from a doctor, health department, pharmacy, community health center, or the Utah Statewide Immunization Information System (USIIS), with the child’s name, birth date, vaccine type, and date.

Students may qualify for conditional enrollment, meaning they can start school after they’ve had the first vaccine in the required series, are scheduled to get the remaining shots, and complete them on schedule. Parents can claim exemptions from immunizations based on certain criteria with the understanding that their child will be kept out of school or child care for the duration of any vaccine-preventable outbreak.

Do we take for granted the virtual absence of diseases that most parents used to worry about? Are we willing take advantage of public health interventions in order to keep those diseases at bay?

Roald Dahl, author of Charlie and the Chocolate Factory and James and the Giant Peach dedicated his book The BFG to his daughter Olivia, who died from measles at age seven.

He later wrote, “...there is today something that parents can do to make sure that this sort of tragedy does not happen to a child of theirs. They can insist that their child is immunized against measles. I was unable to do that for Olivia in 1962 because a reliable measles vaccine had not been discovered. Today a good and safe vaccine is available to every family…”

The Southwest Utah Public Health Department (SWUPHD) provides vaccinations with no appointment needed in each of the five county offices (see page 30 for locations and hours). Many doctors, clinics, and pharmacies also offer immunization services.

Many insurance plans cover immunizations. SWUPHD accepts Aetna First Health, CHIP, DMBA, PEHP, Medicaid, SelectHealth, Tall Tree, and United Healthcare. Children who are uninsured or are American Indian or Alaskan Native can get vaccines at a reduced rate of $20.50 per shot.

SWUHEALTH.ORG | PAGE 7

PA ST, P R E S E N T, & F U T U R E

By Kari Abeyta, RN, BSN SWUPHD Nurse

known as Mycobacterium Did you know that tuber- tuberculosis. At that time culosis (TB) is one of the TB was one of the leading oldest, deadliest diseases causes of death. known to mankind?

Treatment was limited but TB has been around in one it was found that bed rest, form or another for over proper diet, and improved 15,000 years. Originally sanitary conditions were the disease was known as beneficial. Those infected “phthisis” which means with TB were isolated in consumption.

It was sanatoriums. Many of the called this because of the sanatoriums were locatway the disease seemed ed in the mountains and to “consume” the person patients were regularly with weight loss. It was exposed to fresh air and also known as “the white sunshine as part of their plague” due to the extreme treatment. Here in the pallor seen in the infected United States the Rocky individual.

Mountains were a popular location for TB sanatoriThe cause of “consump- ums. tion” was unknown until 1882 when Dr. Robert Koch Many famous men and discovered the bacterium women have suffered and

THE PAST

died from this disease including U.S. Presidents (Andrew Jackson, James Monroe, and First Lady Eleanor Roosevelt), authors (Henry David Thoreau, George Orwell, Jane Austen, and the entire Bronte family), actors and actresses (Vivien Leigh and many silent film stars), musicians (Frederic Chopin, Tom Fogarty, and Ringo Starr, who was treated for TB and survived). People from all walks of life were affected - rich and poor, gangsters and Catholic saints.

It wasn’t until the middle of the 20th century that researchers discovered that a multi-drug regimen could cure TB disease.

HEALTH MAGAZINE | SUMMER 2017

THE PRESENT

Today TB is not much of a concern to most people. In fact, many of the individuals who visit the health department for a TB skin test required for their new job know nothing about TB. What is TB? It is a bacterial infection that usually affects the lungs but can also affect other parts of the body such as the brain or spine. If a person has the disease in their lungs and they are infectious, the bacteria can spread from person to person through the air in a manner similar to the common cold or influenza. Droplets containing the bacteria can be expelled when an infected person coughs or sneezes.

PREVENT

If the droplets are inhaled by another per- Active TB Disease: An individual with acson, he or she may become infected. tive TB disease in the lungs is contagious.

That person will exhibit symptoms such This may sound frightening, and one may as unexplained weight loss, night sweats, wonder why we don’t see many more cases fever, chest pain, and cough-producing of active TB out in the community. There mucus and possibly blood. are a few reasons why the rates of TB in the U.S. are so low: THE FUTURE A worldwide attempt to end the epidemic • We have good public health measures of TB is ongoing. There are many chalthat can quickly identify and respond lenges that need to be addressed in order to TB infection. to meet that goal. One of the biggest chal• We now have anti-TB medications that lenges is the occurrence of multi-drug-recan cure the disease. sistant TB (MDR-TB). These TB bacteria • Most people who are infected do not strains have developed resistance to anbecome sick and are not contagious; ti-TB medications that have been used for this condition is known as latent dis- decades. Resistance is caused by drugs beease. ing used inappropriately or if patients fail • Most people with latent disease never to complete their treatment as prescribed. develop the active disease.

There are second-line drugs that can be used to treat MDR-TB but they are toxic Latent TB Infection: When a person with and expensive. There is also a condition a healthy immune system is exposed to the TB bacteria, the body is able to con- known as extensively drug-resistant TB tain the germ and prevent it from multi- (XDR-TB) in which the TB strain is resisplying. It’s as if that germ is sleeping, or tant to first and second-line drugs. This latent. The individual does not feel sick form of TB often cannot be treated. and is not contagious. Only about 5-10% of people with latent TB will progress to Approximately one-third of the world’s active TB; however, that number goes up population is infected with TB. The disconsiderably for those who have weak- ease is found in all parts of the world but the vast majority of TB cases are located in ened immune systems.

India, Southeast Asia, China, Russia, AfriLatent TB can be treated with antibiotics, ca, and South America. preventing it from progressing to active TB. If latent disease is left untreated, there Although the current rates of TB in the is a chance that, over time, the immune United States are low, continued diligence system will weaken - thus allowing the TB in our public health practices is vital to germ to “wake up,” resulting in active TB. prevent a resurgence of this disease.

Catawba, Virginia Sanatorium (early 1900s) Courtesy of Internet Archive via Flickr Commons

SWUHEALTH.ORG | PAGE 9

V I TA L

By Claudia Canales SWUPHD Clerk

B

irth, death, marriage, and divorce are significant events that affect us in different ways. They also carry legal implications which can require official documentation.

The following certificates and permits can be obtained at your local health department office, usually during your visit . There are fees attached and photo ID is required.

Stop by your nearest location.

B E AV E R

IRON

WAS H I N G TO N

KANE

GARFIELD

75 West 1175 North Beaver, Ut. 84713 (435)438-2482

260 East DL Sargent Dr. Cedar City, Ut. 84721 (435)586-2437

620 South 400 East St. George, Ut. 84770 (435)673-3528

445 North Main Kanab, Ut. 84741 (435)644-2537

601 East Center Panguitch, Ut. 84759 (435)676-8800

HEALTH MAGAZINE | SUMMER 2017

PREVENT

Birth Certificate

Official record of birth, often used as identification verification for employment, passports, social security, etc.

Certificates for Utah births can be obtained by you or one of your immediate family members ($20 for first certificate, $10 per additional copy). Older records may take longer to obtain or can be expedited for an additional fee.

Death Certificate

Typically used for legal purposes, such as obtaining death benefits and insurance proceeds. Utah death certificates can be issued to immediate family members of the deceased ($18 for first certificate, $10 per additional copy).

Baby Numbers (2016): There were 3270 babies born in southwest Utah in 2016, with males only slightly outnumbering females.

Here are the numbers, based on the mothers’ county of residence:

Garfield Kane Beaver Iron Washington

Marriage or Divorce Certificates

Available at the health department if the marriage or divorce occurred since 1978. Otherwise you need to contact the clerk’s office of the county you were married in or the courthouse where the divorce occurred ($18 for first certificate, $10 per additional copy).

Affidavit to Amend a Birth or Death Certificate

Used to make a change to a birth certificate such as the surname or minor spelling errors. An affidavit may be used one time only, unless a court order is obtained. For corrections to a death certificate, call the health department.

62 83 105 825 2200

Top baby names for southwest Utah (2016):

Voluntary Declaration of Paternity

Allows unmarried parents to legally declare the paternity of their child without obtaining a court order. This document gives each parent certain rights and responsibilities under Utah Law. Signing this document is voluntary. A parent who is not sure he is the father should not sign this document until paternity is proven.

Transit Permit

Required to transport remains (including stillbirth) to another city or state once the death has been registered ($7 fee).

Disinterment Permit

Used when a family wants to move a relative’s remains from one cemetery to another. Must be signed by the next of kin ($25 fee).

Need a vital record from another state?

Visit vitalcheck.com, an online method of ordering records for births, death, marriages, and divorces that occurred in the United States.

SWUHEALTH.ORG | PAGE 11

Girls: Abigail Ava Ellie Emma Lucy Olivia Boys: Daniel Henry Liam Lincoln Oliver

SWIMMER' S

A

s the water in Utah’s lakes and reservoirs warms up during the summer months, certain tiny organisms continue their life cycle near the shoreline, where they can accidentally come into contact with people and cause “swimmer’s itch.”

The best defense for swimmer’s itch is prevention and reduction of exposure. These creatures are part of our normal ecosystem and should not discourage us from enjoying the great outdoors. Here’s everything you need to know about this aquatic nuisance from the Centers for Disease Control:

How does water become infested with the parasite?

The adult parasite lives in the blood of infected animals such as ducks, geese, gulls, swans, and certain mammals such as muskrats and raccoons. The parasites produce eggs that are passed in the feces of infected birds or mammals.

What is swimmer's itch?

If the eggs land in or are washed into the water, the eggs hatch, releasing small, free-swimming microscopic larvae. These larvae swim in the water in search of a certain species of aquatic snail.

Swimmer's itch, also called cercarial dermatitis, appears as a skin rash caused by an allergic reaction to certain microscopic parasites that infect some birds and mammals.

These parasites are released from infected snails into fresh and salt water (such as lakes, ponds, and oceans). While the parasite's preferred host is the specific bird or mammal, if the parasite comes into contact with a swimmer, it burrows into the skin causing an allergic reaction and rash. Swimmer's itch is found throughout the world and is more frequent during summer months.

If the larvae find one of these snails, they infect the snail, multiply and undergo further development. Infected snails release a different type of microscopic larvae (or cercariae, hence the name cercarial dermatitis) into the water. This larval form then swims about searching for a suitable host (bird, muskrat) to continue the life cycle. Although humans are not suitable hosts, the microscopic larvae burrow into the swimmer's skin, and may cause an allergic reaction and rash. Because these larvae cannot develop inside a human, they soon die.

HEALTH MAGAZINE | SUMMER 2017

PREVENT

What are the signs and symptoms of swimmer's Can swimmer's itch be spread from peritch? son-to-person?

Symptoms of swimmer's itch may include:

Swimmer's itch is not contagious and cannot be spread from one person to another.

• tingling, burning, or itching of the skin • small reddish pimples • small blisters

Who is at risk for swimmer's itch?

Anyone who swims or wades in infested water may be at risk. Larvae are more likely to be present in shallow water by the shoreline. Children are most often affected because they tend to swim, wade, and play in the shallow water more than adults. Also, they are less likely to towel dry themselves when leaving the water.

Within minutes to days after swimming in contaminated water, you may experience tingling, burning, or itching of the skin. Small reddish pimples appear within twelve hours. Pimples may develop into small blisters. Scratching the areas may result in secondary bacterial infections.

Itching may last up to a week or more, but will gradually Once an outbreak of swimmer's itch has ocgo away.

Because swimmer's itch is caused by an allergic reaction to infection, the more often you swim or wade in contaminated water, the more likely you are to develop more serious symptoms. The greater the number of exposures to contaminated water, the more intense and immediate symptoms of swimmer's itch will be.

curred in water, will the water always be unsafe?

No. Many factors must be present for swimmer's itch to become a problem in water. Since these factors change (sometimes within a swim season), swimmer's itch will not always be a problem. However, there is no way to know how long water may be unsafe. Larvae generally survive for 24 hours once they are released from the Be aware that swimmer's itch is not the only rash that snail. However, an infected snail will continue to produce may occur after swimming in fresh or salt water. cercariae throughout the remainder of its life. For future snails to become infected, migratory birds or mammals Do I need to see my healthcare provider for in the area must also be infected so the life cycle can contreatment? tinue.

Most cases of swimmer's itch do not require medical attention. If you have a rash, you may try the following for Is it safe to swim in my swimming pool? relief: Yes. As long as your swimming pool is well maintained and chlorinated, there is no risk of swimmer's itch. The • Use corticosteroid cream appropriate snails must be present in order for swim• Apply cool compresses to the affected areas mer's itch to occur.

• Bathe in Epsom salts or baking soda • Soak in colloidal oatmeal baths What can be done to reduce the risk of swim• Apply baking soda paste to the rash (made by stirring mer's itch? water into baking soda until it reaches a paste-like consistency) To reduce the likelihood of developing swimmer's itch: • Use an anti-itch lotion • Do not swim in areas where swimmer's itch is a Though difficult, try not to scratch. Scratching may cause known problem or where signs have been posted the rash to become infected. If itching is severe, your warning of unsafe water. healthcare provider may suggest prescription-strength • Do not swim near or wade in marshy areas where lotions or creams to lessen your symptoms. snails are commonly found.

• Towel dry or shower immediately after leaving the water.

• Do not attract birds (e.g., by feeding them) to areas where people are swimming.

Source: www.cdc.gov/parasites/swimmersitch

SWUHEALTH.ORG | PAGE 13

FEELING THE

O

ur sun is a perfectly spherical ball • Stay hydrated with plenty of water of gas - mostly hydrogen and he(avoid sugary drinks), even if you’re not lium - and among a smaller class thirsty. of stars, although it's 864 million miles • Take frequent rests in the shade, if posin diameter. The sun has about 5 billion sible. more years before its expiration and is the • Never leave children or pets alone in a important source of life on earth. Sunlight vehicle. is actually radiation, and although it's the most important source of life on earth, Heat Exhaustion: Can occur with prothese rays and the resulting heat can be longed exposure to heat and dehydration. hazardous to humans.

Heat is the number one weather-related killer in the United States, resulting in approximately 400 deaths per year. To prevent heat-related fatalities or injury: • Limit or avoid strenuous outdoor activities in the heat of the day, especially if you are elderly or unaccustomed to the climate. Try to stay in an air-conditioned place. In fact, air-conditioning is the best protection against extreme heat.

• Wear lightweight, loose clothing and a hat.

Symptoms:

• Heavy sweating • Skin becomes pale, cool, and moist • Rapid, weak pulse • Muscle cramps • Tired, weak • Dizziness, fainting • Headache • Nausea, vomiting

Treatment: Drink cool, non-alcoholic beverages (water is best), go to an air-conditioned building or vehicle, take a cool shower or bath. Seek medical attention if

HEALTH MAGAZINE |SUMMER 2017

PROMOTE

symptoms last over an hour or the person increases the risk of skin cancer, so protection is important. The best ways to prevent has a history of heart problems. sunburn are: Heat Stroke: A serious condition that occurs when the body is no longer able to • Apply sunscreen. Although no sunscreen is 100% effective, wear one with sweat and cool down. at least a 15 SPF (Sun Protection Factor), which blocks about 93% of damaging Symptoms: rays. It will need to be reapplied every two hours or after being in water. An • Very high body temperature (103° F SPF of at least 30 is recommended for and above) children under six years old. The ben• Skin becomes red, hot, and dry efits of anything over 50 SPF are ques• Rapid, strong pulse tionable. Look for a “Broad Protection” • Throbbing headache sunscreen, which protects against both • Dizziness UVA (aging) and UVB (burning) rays.

• Nausea • Wear a hat (⅓ of skin cancers occur on • Confusion the nose) • Slurred speech • Wear sunglasses (look for 100% UVA & • Unconsciousness, seizures UVB protection) • Seek shade, especially from 10am to Treatment: Get immediate medical as4pm sistance while cooling the victim using any methods available until temperature Treatment: Avoid repeated exposure to drops to 101-102° F at the most. Do not give the sun. Take frequent cool baths or showfluids to drink. ers to relieve pain. Gently pat dry then apply a moisturizer containing aloe vera.

Sun Burn: Sunny days in the outdoors Apply over-the-counter hydrocortisone means potential sunburn. You can also to particularly painful areas but avoid usget exposed from sunlight reflected off ing anything with “-caine” in the name, as sand, slickrock, and water. Utah has the they can cause irritation or allergic reachighest rate of melanoma (skin cancer) in tions. Take aspirin or ibuprofen if needed the nation, due in part to sun exposure at and drink plenty of water. high elevations and time spent outdoors.

Southern Utah averages up to 300 sunny While the sun is vital to the ongoing exdays per year. While some exposure to istence of life on earth, it can also be hazsunlight can actually be beneficial, dam- ardous if we are exposed to its heat - and age can start after about 15 to 20 minutes rays - beyond our ability to stay cool and without protection. Sunburns can cause covered. Enjoy the sunny days of summer, long-lasting damage to the skin, which but respect the source.

SWUHEALTH.ORG | PAGE 15

SAFE

By Klint Frei SWUPHD Environmental Scientist

W

ith nearly 700 bodies of water in the five counties comprising the Southwest Utah Public Health district, it’s important for anyone taking a swim to learn or refresh themselves on safe-swimming practices. The only way to lower drowning risk to zero is to avoid water entirely, which is impractical in an area where summer temperatures can easily exceed 100 degrees. These steps to prevent drowning will greatly reduce the risk, however, and apply to both swimming pools and other bodies of water; including lakes, ponds, reservoirs, and rivers.

dren to swim. Swimmers should stay in waters suited to their skill level. Attempting to swim long distances in deep water is dangerous if someone is still learning the basics.

idea for the family backyard pool as well.

Third, stay sober. Becoming inebriated will increase your risk of drowning while around water, and the more you drink the higher the Secondly, do not swim risk will be. alone. A swimming buddy can serve multiple purpos- Fourth, do not mistake es, such as encouraging toys for safety equipment. safe practices, assisting if Blow-up mattresses and there’s trouble, and seek- pool noodles can be fun, ing help if the other per- but mistaking those for son becomes injured. If a safety equipment can be companion is unavailable dangerous. The best perthen it is best to swim at sonal flotation devices are a lifeguarded pool rather life vests certified by the than risk injury and being United States Coast Guard. unable to seek aid. Children under the age of 14 Fifth, remain aware, esshouldn't swim without pecially when swimming the supervision of an adult. with children. Pay attenFirst and foremost, learn to This is a legal requirement tion to your surroundings swim and teach your chil- for public pools and a good and know where your chil-

HEALTH MAGAZINE |SUMMER 2017

PROMOTE

dren (or any you are responsible for) are at all times. If your children are near the water, your eyes should be on them. No distractions. If your child is an infant or toddler, you should be within arm’s reach at all times. If there are multiple children and adults in the water, designate an adult “water watcher” and take turns supervising the group of children. Supervising children swimming may require some additional effort in this age of smart phones.

Leaving your phone behind will help you avoid distrac-

A

s temperatures rise, many people are drawn to immersing themselves in a cool body of water, which is commonly the local municipal pool or a private backyard pool. It is in the interest of the public health to ensure that these pools remain as safe, clean, and sanitary as possible.

Safe swimming is ultimately the responsibility of the individual, or in the case of younger swimmers, their designated guardian. That said, there are things we can all do to keep the water safe to swim in.

First and most importantly, the swimming pool is not a bathroom. There are obvious “accidents” which lead to pool closures. In public pools, all children under the age of three are required to wear three layers: a swim diaper, plastic pants, and a swimming suit. While not one hundred percent effective, these layers will greatly reduce the likelihood of an accident becoming so severe that the pool needs to be closed. Please re-

tion, not to mention reducing the risk of the device getting ruined by water.

Finally, learn CPR and first aid. If there are lifeguards or paramedics present during swimming-related emergency, stay out of their way and follow their instructions. If professional first responders are not on hand, call 911 immediately. At that point, having a basic knowledge of CPR and first aid could be the difference in saving someone’s life.

POOL CARE member to change diapers in the restroom, not at the poolside.

For everyone else, frequent bathroom breaks are important. A trip to the restroom should be planned at least once every hour while swimming.

Taking a thorough shower before entering a pool or spa is another step we can take to increase the safety of our recreational water.

Simply wetting your hair before entering the pool is not sufficient. Public pools and spas are sanitized by an oxidizing agent (usually chlorine), and these oxidizers are reactive to many bodily fluids including sweat and urine. Taking a cleansing shower before entering the pool removes a large portion of the substances on the human body that use up the oxidizer, leaving more of the chemical free to disinfect the water. A full shower has the added benefit of removing oils from the skin which can clog and reduce the efficiency of filtration equipment.

Pay attention to the water

SWUHEALTH.ORG | PAGE 17

before you get in. If you notice problems, notify the person in charge as soon as possible. Notify a lifeguard if there is one present, the front desk at a hotel, or a board member for planned community pools. These problems might include changes in the water color,, a scum layer on the surface, or a strong chlorine smell.

Each public pool is required to have an assigned qualified pool operator who monitors the pool regularly in order to ensure the quality and safety of the pool water. They test and adjust chemical balances in the water and maintain the pool equipment. These people are usually very experienced and have at least one certification from a national agency in pool care and maintenance. However, it is impractical for them to be poolside all the time.

Pool use is a communal activity, and we as individuals can make that experience safer and more enjoyable if we take responsibility to prevent and report potential problems.

HEALTHY (& DELICIOUS)

Try these recipes for your next summer gathering indoors or out

Grilled Salmon with Thyme and Lemon serves: 4 prep: 1 hr marinate cook: 12 min • 4 6-ounce salmon fillets • 1/4 cup lemon juice • 2 tablespoons olive or avocado oil • 1 tablespoon lemon zest • 1 1/2 teaspoons fresh thyme leaves, lightly chopped • 1-2 cloves garlic, minced • 1 teaspoon sea salt

1. Combine lemon juice, zest, oil, thyme, and garlic in a large resealable bag. Add salmon and turn to coat. Seal bag and refrigerate for 30 minutes to 1 hour.

2. Preheat grill for medium high heat. Right before placing salmon on grill, oil the grill grates well using large tongs, folded paper towels, and oil. Make several passes across the grates.

This will help the fish from sticking and breaking apart.

3. Remove salmon from bag and place on hot grill. Brush salmon with marinade from the zip-top bag. Grill salmon for about 8-12 min. Remove from heat once the internal temperature of fish reaches 145 degrees F. Salmon should be light in color and flake easily through the thickest part. Serve with your favorite sides.

HEALTH MAGAZINE |SUMMER 2017

PROMOTE

Asparagus & Honey Glazed Carrots serves: 4-6 prep: 5 min cook: 10-15 min • 1 bunch asparagus, ends trimmed • 1 lb carrots • 2 tablespoons olive oil • 2 tablespoons honey • sea salt, as needed • lemon zest 1. Rinse all vegetables under cold water. Drizzle asparagus with olive oil and a generous sprinkling of sea salt. Drizzle carrots with honey and lightly sprinkle with sea salt.

2. Preheat oven to 350 degrees then cook the carrots and asparagus for 15 to 20 minutes, or until they're done to your liking.

You may also grill the veggies in a charcoal grill or BBQ depending on your flavor preference for about 10 to 15 minutes.

3. Top the asparagus with some fresh lemon zest. Enjoy!

Simple Fruit Smoothie serves: 4 prep: 5 min • 2 cups frozen whole strawberries • 1/4 cup frozen pineapple juice concentrate • 1 banana • 2 cups cold water 1. Combine in a blender until well-mixed 2. Divide into glasses and enjoy!

SWUHEALTH.ORG | PAGE 19

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OR AN

By Joseph Malins Joseph Malins (1844-1926) emigrated to the United States from England and became an advocate for temperance, or reducing the use of alcohol. He eventually returned to England where, in 1895, he wrote his famous poem, which was later included in "The Best Loved Poems of the American People".

‘Twas a dangerous cliff, as they freely confessed, Though to walk near its crest was so pleasant; But over its terrible edge there had slipped A duke and full many a peasant.

So the people said something would have to be done, But their projects did not at all tally; Some said, “Put a fence ‘round the edge of the cliff,” Some said, “An ambulance down in the valley.”

HEALTH MAGAZINE |SUMMER 2017

PROMOTE

But the cry for the ambulance carried the day, For it spread through the neighboring city; A fence may be useful or not, it is true, But each heart became full of pity For those who slipped over the dangerous cliff; And the dwellers in highway and alley Gave pounds and pence, not to put up a fence, But an ambulance down in the valley.

“For the cliff is all right, if you’re careful,” they said, “And, if folks even slip and are dropping, It isn’t the slipping that hurts them so much As the shock down below when they’re stopping.”

So day after day, as these mishaps occurred, Quick forth would those rescuers sally To pick up the victims who fell off the cliff, With their ambulance down in the valley.

Then an old sage remarked: “It’s a marvel to me That people give far more attention To repairing results than to stopping the cause, When they’d much better aim at prevention.

Let us stop at its source all this mischief,” cried he, “Come, neighbors and friends, let us rally; If the cliff we will fence, we might almost dispense With the ambulance down in the valley.”

“Oh, he’s a fanatic,” the others rejoined, “Dispense with the ambulance? Never!

He’d dispense with all charities, too, if he could; No! No! We’ll support them forever.

Aren’t we picking up folks just as fast as they fall?

And shall this man dictate to us? Shall he?

Why should people of sense stop to put up a fence, While the ambulance works in the valley?”

But the sensible few, who are practical too, Will not bear with such nonsense much longer; They believe that prevention is better than cure, And their party will soon be the stronger.

Encourage them then, with your purse, voice, and pen, And while other philanthropists dally, They will scorn all pretense, and put up a stout fence On the cliff that hangs over the valley.

Better guide well the young than reclaim them when old, For the voice of true wisdom is calling.

“To rescue the fallen is good, but ‘tis best To prevent other people from falling.”

Better close up the source of temptation and crime Than deliver from dungeon or galley; Better put a strong fence ‘round the top of the cliff Than an ambulance down in the valley.

SWUHEALTH.ORG | PAGE 21

WEAR A

By Roland Byrd Guest Columnist

I’ll never forget the feeling of my head slamming into the asphalt.

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he minivan cut across my lane, hit my bike like Thor’s Hammer, and punched me into the air. I was airborne, flying over the freeway at nearly 55 miles per hour. My motorcycle flipped and tumbled away from me, spitting chunks of tarmac and dirt as it spun off the pavement.

The road rushed to meet me. I couldn’t fly forever and there was no safe landing. Interstate 15 loomed, an executioner, ready to pound nails into my coffin.

Years of martial arts training took over. I tucked my chin to my chest, extended my right arm, and prepared to roll through the impact.

It’s called the “tuck and roll”. When performed correctly, it redistributes the force of your fall and allows

you to roll back to your feet. one just played chopsticks You hardly feel it. But I was on it with a sledge hammer. going to feel this…

The paramedics and emerMy forearm hit and I start- gency room doctors were ed my tuck. WHAM! My amazed that I survived and chin was pulled tight to walked away mostly intact. my chest but my head They rarely see that. Far too still slammed into the as- many motorcycle accident phalt. I rolled through and victims end up in an intenfelt every bit of my body sive care unit or worse, the pound the roadway. Too morgue. fast… I was rolling too fast!

I bounced off the ground, How did I survive? I was entered another tuck. wearing full riding gear, WHAM! My head hit again, plain and simple. That inand again I rolled through. cludes an armored motorI rolled four times, cover- cycle jacket, carbon fiber ing over two-hundred feet reinforced gloves, motorof freeway before a road cycle boots, jeans (armored marker hit me in the mid- pants would have been betdle of my lower back, stop- ter), and most importantly: ping me. My head struck a helmet. the asphalt each time.

My wrist was broken, my Make no mistake, without shoulder injured. The rest my helmet I would have eiof my body felt like some- ther died or been left with

HEALTH MAGAZINE | SUMMER 2017

PROTECT

severe brain damage. The g-forces were too great to keep my head from hitting the asphalt. Despite knowing how to fall, the first impact would have knocked me out or killed me. Then my body would have rag-dolled down the freeway. My kids would have lost their father, my wife her husband, my parents their child, and my youngest son would never have been born. And for what; to feel the wind in my hair?

wearing my helmet, most of my body would have been shredded.

It also seems there’s a misconception that scooters are safer than motorcycles. While a person on a scooter wearing full motorcycle racing gear might be extreme, surely there must be a balance between that and flip-flops, shorts, dresses or skirts, and thin shirts. True, most scooters top out around 40 mph, but you’re going to hit the ground Helmets are cheap insurance. In 2015, 40% of motorcycle just as hard on a scooter as you would on a full sized bike accident deaths were the direct result of failure to wear a at that speed. helmet. The helmet I was wearing cost just over $100. It saved my life. How much is your life worth? The truth is, Finally, most motorcycle - and scooter - accidents are no amount of protective gear can guarantee you’ll emerge caused by other drivers. People should watch for motorunscathed from an accident. But wearing full gear in ad- cyclists but most don’t. These accidents are usually on dition to a helmet definitely improves your odds. Why city streets during short trips around town. Even at slower not stack the odds in your favor? speeds, protective gear can do wonders to increase your odds of survival.

Think of it this way: asphalt is hard. Asphalt is also like coarse sandpaper against your skin. Chip-sealed roads If you have gear, great! Wear it. If you don’t have any gear, are even worse - they’re a motorcyclist’s bane. It doesn’t get some and wear it, especially a helmet! Your brain will matter if you’re only going 10 mph; you’re getting road- thank you. rash. I hit the road at 55 mph and only had two small patches of road-rash. One on my wrist and one on my Roland is a network engineer, author, fitness enthusiast, huslower leg where the fabric ripped away. If I’d only been band , and father.

SWUHEALTH.ORG | PAGE 23

WE CAN'T DO IT

By Paulette Valentine SWUPHD Director of Emergency Preparedness & Response Division

A Report on Southwest Utah’s Emergency Capabilities

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hether nationally or closer to home, recent events have demonstrated the importance of comprehensive preparations for emergencies such as natural disasters, emerging disease threats, and terrorist attacks. A region’s capabilities to handle events of this magnitude are focused on prevention, protection, response, and recovery. They are best achieved through the coordinated efforts of local first responders, regional partners, and community members.

State and national resources can be accessed emergency status is declared by the Governor or even the President, but immediate response comes from the citizens and coalitions already in place in the community. When familiar relationships have been developed over time, negative outcomes from potentially devastating events are greatly reduced. Emergency response partners in the southwest Utah region practice together frequently and often invite residents to participate. If a real-life event were to occur, it’s likely that this group has already trained to handle this and most other likely emergency scenarios. State and national emergency management officials often react with amazement when they are able to observe and assess the preparedness level across this region, which is largely accomplished due to a strong ethic of cooperation among agencies and the inclusion of civilians.

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A Southwest Utah Rural Preparedness Summit was held this past February with the theme “We Can’t Do It Alone”.

The objectives of the Summit were to: • Update and strengthen rural emergency plans • Understand how to work together for quick and effective response to emergencies • Improve preparedness capabilities from the organizational down to the individual level • Define the various roles in emergency response so that each acts as part of a solution, not part of the problem

WHAT ARE THE MOST LIKELY DISASTERS WE MIGHT HAVE TO DEAL WITH IN SOUTHWEST UTAH?

The Summit was sponsored by the Southwest Utah Public Health Department, Dixie Regional Medical Center, Dixie State University, and the Medical Reserve Corps.

There were nearly 300 attendees, including a wide range of government and private entities, along with volunteers and interested civilians. Presentations and panels covered subjects such as emerging biological threats, the impact of an electromagnetic pulse (EMP) strike, communications, mental health resources, mass fatality plans, and disaster psychology. Gaps in response plans were identified and working relationships were established or strengthened.

The overall takeaway from the two day Summit was a renewed commitment to improving preparedness efforts and increased confidence in local cooperation.

Disasters don’t wait until everyone has everything perfectly planned and ready, which is why it’s vital to work together for a successful response. Rural communities have been faced with many challenges over the years. Examples include the earthquakes in Wells, Nevada, chemical spills in Wasatch County, and heavy floods in Hildale, Utah.

Amanda Ripley, in her book The Unthinkable, asserts “These days we tend to think of disasters as acts of God and government. Regular people only feature into the equation as a victim, which is a shame, because regular people are the most important people at a disaster scene, every time.” Our regional emergency response plans are important, but the challenge for each of us is to consider anew about how resilient we are as individuals, families, and neighbors.

FIRE

FLOOD

EARTHQUAKE

If you are interested in being more involved in local emergency response and preparedness planning, contact your local city or county offices to sign up for Citizen Emergency Response Team (CERT) training. The local Red Cross Chapter is also looking for assistance.

The Southwest Utah Medical Reserve Corps (MRC) is open for volunteers. The MRC was created to support local public health efforts and health-related emergency response but you do not need to be a medical professional to help out. Go to www.utahresponds.org and select “Southwest Utah MRC” to sign up.

SWUHEALTH.ORG | PAGE 25

PANDEMIC

H AV E C H A N G E D

By Marlene Beagley SWUPHD Finance Clerk

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grew up in the 60’s when there weren’t personal electronic devices, so we had to actively create our own entertainment. Our group of friends gathered to play from the time chores were done until dinner time; playing baseball, red rover, and - in winter - played in the snow until our fingers and toes stung. I think TV was the only thing we wasted time on, but we still had to get up to change the channel.

There were no buttons to push or screens to swipe.

There was daily exercise in school plus recess in the morning and afternoon. There was no school lunch program, so you either brought a brown paper sack or a cool lunch box. Some of us ran home and back to eat, which is how we got to school in the first place since a mile was too short for a bus.

HEALTH MAGAZINE | SUMMER 2017

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I remember that food portions and dinner plates were smaller and no one walked around with a drink in their hand all day.

This is not to say that there haven’t been some wonderful advancements in health and technology since then. We can stay in contact with friends and family all over the world at no cost, and the information about virtually any topic can be found by typing a few words into a search engine.

stitute (NHLBI) found that serving sizes have increased significantly over the past twenty years. Individual portions of bagels, muffins, movie popcorn, and most snacks have doubled in size, for example.

Portions of French fries and soda have tripled. Not surprisingly, adult obesity in the United States has more than doubled since the 1960s.

Many of my generation have fallen into the same habits of screen time, low activity, and diet. Getting off the couch and becoming active while eating less (and better) food are essential for our own well-being. Plus it sets a good example for our children. Stretching, walking, hiking, biking, and swimming are a few examples of simple, inexpensive activities that you can start right after reading this magazine.

Do them most days of the week and you’ll soon notice a difference in how you feel and what you’re able to do. And that applies to all of, whether we grew up in the The National Heart, Lung, and Blood In- 60s or the new millennium.

Most of us, including teenagers (and many children), have a smart phone or tablet and spend hours a day online and checking social media. This is where some problems can start that impact our health.

Most electronic activity and gaming is done indoors while sitting down, without face-to-face interaction with other people.

This lack of physical activity is taking its toll. Combine that with American eating habits and you have the recipe for chronic disease and obesity, even in children.

As tempting as computer games, YouTube, and smart phones are, most kids will enjoy being reintroduced to activities that involve more movement, adventure, and actual social interaction.

Here’s a way to get started: Several years ago in Heber City, Utah, two fathers decided to develop a fun way to replace their kids’ screen time over the summer. The “Play Unplugged” program has now spread to multiple communities throughout the state, including St. George and Cedar City. Businesses and organizations sponsor collectible tags which correspond to a specific activity, like basketball, bug hunting, volunteering, water fights, visiting a museum, or playing night games. Parents bring their kids to sponsor to get the badge, which gets the adults involved and increases foot traffic for the business.

Play Unplugged starts when school gets out and continues until the next school year. To get your family involved, visit WePlayUnplugged.com.

SWUHEALTH.ORG | PAGE 27

H O W TO H AV E A H E A L T H Y

By David A. Blodgett, MD, MPH SWUPHD Director & Health Officer

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recently had a conversation with a friend who described how excited she was to learn of her first pregnancy.

After learning of the pregnancy, she immediately made an appointment with her OB/GYN for her first prenatal care visit. “I really wanted to be the best mom I could be,” she told me. “I wanted this baby to be healthy and happy.” It was no surprise that the first question she asked her doctor was, “What can I do to make sure this baby is healthy? I will do whatever it takes!”

cy test, which is usually at about 5 to 8 weeks. The heart and major blood vessels begin to develop by about day 16. The heart begins to beat by day 20, and the first red blood cells appear the next day.

Most organs begin to form by about 3 weeks. Shortly thereafter, the area that will become the brain and spinal cord begins to develop. Almost all organs are completely formed by about 10 weeks. The exceptions are the brain and spinal cord, which continue to form and develop throughout pregnancy.

Let’s consider what has happened already in the life of a baby before the mother misses her first period and gets a pregnan-

Most birth defects occur early in pregnancy while the organs are first beginning to form. This is when the baby is the most vul-

HEALTH MAGAZINE | SUMMER 2017

nerable to the effects of drugs, alcohol, radiation, and illnesses.

My friend told me that she was not prepared for the answer she got from her doctor: “It’s too late for this pregnancy; we will have to start preparing for the next one.” My friend was concerned, but came to understand that most of the critical initial development of the baby had already happened by the time she even knew she was pregnant. It isn’t that prenatal care isn’t important, it’s just that the health and lifestyle of the mother before she gets pregnant is actually far more important. In medical terminology, it’s called preconception care.

PROTECT

Let me suggest some ways that you can begin to prepare calories from sugar and processed foods, artificial sweetnow for a healthy pregnancy and a healthy life. eners, and caffeine. Eat foods that are high in protein.

Add more fruits and vegetables, as they are nutrient dense foods that your body and baby will need. Limit the Have Regular Doctor Appointments amount of fish that you eat. Seafood contains mercury, See your doctor now, before you get pregnant. Even if you which may cause birth defects if eaten in large amounts. are healthy and feel like you’re ready for a pregnancy, you For example, limit tuna intake to 2 cans per week. and your future baby will benefit from a head start. Your doctor will assess your current health along with your If you are underweight or overweight, it is best to try to health history and make sure you’re caught up screenings reach your ideal weight before you get pregnant. Being and immunizations. Certain lab and blood tests may be overweight during pregnancy may increase your likeliordered as well. Your doctor will talk with you about any hood of high blood pressure, diabetes, miscarriage, stillmedicines, herbs, and supplements you are taking and birth, birth defects, and having a C-section. might recommend some changes . Chronic health problems such as asthma or diabetes should be under control Make sure you get enough Folic Acid before you get pregnant.

Take a vitamin and mineral supplement that includes at Stop Smoking, Drinking Alcohol, and Taking Il- least 400 micrograms of folic acid. Folic acid is a B vitamin that reduces the risk of birth defects, especially problegal Drugs. Limit Caffeine lems with the baby's spine. Remember, once you know If you smoke, drink alcohol, or use drugs, you should stop you are pregnant, it is too late to get the maximum benefit before you get pregnant. They can make it harder to get of taking folic acid. pregnant, increase the chance of losing the baby before it is born, or cause harm to the baby.

Exercise Alcohol can harm a growing unborn baby, even in small amounts. Drinking alcohol while you are pregnant can cause long-term problems for your baby, such as intellectual disability, behavioral issues, learning disabilities, and facial and heart defects.

Exercising before you get pregnant may help your body deal with the changes that pregnancy and labor will bring. Most women who already exercise regularly can safely maintain their current exercise program throughout most of their pregnancy.

Even if you are not currently exercising, start on an exercise program of 30 minutes of exercise 5 days per week, both before conceiving and throughout pregnancy. The amount of exercise you are able to do during pregnancy should be based on your overall health and how active Drugs that are not prescribed by a doctor (including you were before you got pregnant. street drugs) can be dangerous for you to take at any point in your life, and especially while you are pregnant. They Stress, Rest, and Relaxation are extremely dangerous for the baby as well.

While you are trying to get pregnant, try to relax and Try to cut down on caffeine while trying to get pregnant. reduce stress as much as possible. Get plenty of rest and Women who consume more than 2 cups of coffee or 5 relaxation. This may make it easier for you to become cans of caffeinated soda daily may have difficulty getting pregnant. Most Americans don’t get enough sleep; you should try to get 7 to 8 hours every night. pregnant and a greater chance of miscarriage.

Women who smoke during pregnancy are more likely to have a baby with a lower birth weight. Smoking also makes it harder to recover from pregnancy and puts your child at greater risk of health problems later in life.

Limit unnecessary medicines or supplements. Discuss with your doctor both prescribed and over-the-counter medicines, along with any supplements you take before you try to conceive. Most medicines have some risks, and many have unknown risks.

As my friend learned from her doctor when asking about prenatal health, the best time to prepare for having a baby isn’t after you are pregnant, it is before. Healthy pregnancies (and babies) depend on how healthy the mother is when she conceives. The idea of good preconception care is not a new one, just one we need to take Eat a Balanced Diet more seriously. And in reality, whether you are planA balanced diet is always good for you. Follow a healthy ning to get pregnant or not, these suggestions for health diet before you get pregnant. To get started, reduce empty will benefit you for a lifetime.

SWUHEALTH.ORG | PAGE 29

SOUTHWEST UTAH PUBLIC HEALTH DEPARTMENT Our mission is to PROTECT the community's health through the PROMOTION of wellness and the PREVENTION of disease.

B E AV E R

IRON

75 West 1175 North 260 East DL Sargent Dr. Beaver, Ut. 84713 Cedar City, Ut. 84721 (435)438-2482 (435)586-2437

WAS H I N G TO N

KANE

GARFIELD

620 South 400 East St. George, Ut. 84770 (435)673-3528

445 North Main Kanab, Ut. 84741 (435)644-2537

601 East Center Panguitch, Ut. 84759 (435)676-8800

SW U H E A LT H . O R G

NURSING SERVICES Baby Your Baby Breastfeeding Consultation Case Management Child Care Resources/Referrals Early Intervention Health Screenings Immunizations International Travel Clinic Maternal Child Health Mobile Clinic (rural counties) Pregnancy Testing Prenatal Resource Referrals Reproductive Health School Exemptions Education & Tracking School Health/Nursing WIC

HEALTH PROMOTION

ENVIRONMENTAL HEALTH

Bicycle Safety Car Seat Classes Certified Car Seat Inspection Points Community Training and Outreach Healthy Dixie Liaison Healthy Iron Co. Liaison Injury Prevention Safety Resources Physical Activity & Nutrition Resources Resources to Quit Tobacco Tobacco Compliance Checks Tobacco Education(retailers) Tobacco-Free Housing Data

Air & Water Quality Body Art Regulation Child Care Inspections Food Handler Permits Hotel Sanitation Inspections Pool Inspections Restaurant Inspections School Inspections Septic System Inspections Tanning Bed Sanitation Inspection/Enforcement Temporary Mass Gathering Permits Used Oil Utah Indoor Clean Air Act Inspection/Enforcement Water Lab

EMERGENCY PREPAREDNESS Bioterrorism Prep/Planning Community Training & Outreach Free Emergency Resources Hospital Surge Planning Mass Flu Vaccination Events Medical Reserve Corps Pandemic Prep/Planning Preparedness Buddy Strategic National Stockpile (SNS) Coordination

HEALTH MAGAZINE | SUMMER 2017

VITAL RECORDS Birth Certificates Death Certificates Disinterment Certificates Divorce Certificates Marriage Certificates

COMMUNICABLE DISEASES Disease Surveillance & Control Epidemiology Tuberculosis Program

You are WANTED at our next mass vaccination event. Get immunized at your nearest flu shootout.

Cedar City (Sept. 23) St. George (Sept. 26) Kanab (Oct. 7) Beaver (Oct. 11) Panguitch (Oct. 19) Ruby's Inn (Oct. 23)

It's quick, convenient, and low cost (or no cost with some insurances)

visit swuhealth.org for details

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