State wants lead out of all pipes in 20 years

By KALEY FECH
Capital News Service

LANSING — The Department of Environmental Quality (DEQ) has proposed replacing all lead water pipes in the state within the next 20 years.

“The new rules would require [municipalities] to start removing lead service lines at an average rate of 5 percent per year, which would get us to 100 percent over 20 years,” said Eric Oswald, director of DEQ’s Drinking Water and Municipal Assistance Division.

The rules would also reduce the acceptable level of lead in drinking water from 15 parts per billion to 10 parts per billion, Oswald said. But the main objective of the changes is to get lead out of drinking water.

That has always been a goal, Oswald said, but it picked up steam when Flint’s water crisis brought lead in drinking water to the national stage.

“There’s always been a known risk there, but Flint really exposed it and brought national attention to the problem of lead lines and lead contamination or lead poisoning from drinking water pipes,” Janice Beecher, director of the Institute of Public Utilities at Michigan State University.

One of the challenges facing replacement of lead service lines is funding. The state will not fund the line replacements, Oswald said. That responsibility will fall to the local governments.

“The state does have loan programs and grant programs that would be able to help out,” Oswald said. “But the majority of the burden would be on the local water supplies to remove those lines. We’re looking for the communities to be innovative in how they do that.”

Another problem facing the replacement is that often parts of the lines belong to the homeowner.

“The policy challenge is how do we get these lines replaced?” Beecher said. “And that’s complicated by the fact that in the majority of cases, those service lines that have the lead content are owned by the customer, not the utility, so it’s actually private property.”

This raises questions on the legality of having water systems pay to replace the lines on private property, said Tom Frazier, the legislative liaison for the Michigan Townships Association.

Oswald said there are some ways to get around this.

“The communities could pass an ordinance where they take the water line until it gets to the house so it all belongs to the community, similar to how gas lines are done,” he said.

Local units of government should focus on how they can best address public health issues, Frazier said.

“We’re in support of public health, but we don’t feel the rules as written the way they are now is the best way to do that,” Frazier said. “We think we should focus on replacing pipes in areas where there are elevated levels of lead and use funds to go after those sources, at least in the short term.”

Lansing has already replaced all of its lead water pipes. Starting in 2004, the city removed 12,150 active lead service pipes, finishing the project in Dec. 2016, said Amy Adamy, communications coordinator for the Lansing Board of Water and Light.

“When we started doing the removals, there was obviously a learning curve,” she said. “As we got better at it, we realized there was a better way to do it. It cut the price significantly, and it cut the time in half.”

Utilities from all over the country have since reached out to the Lansing Board of Water and Light, asking how it did it and what advice they can offer.

“We’ve been very helpful in providing resources and ideas,” Adamy said. “We had the learning curve, and we want to help them skip that part of it so they can immediately get to the and time saving methods so that it’s the most efficient work possible.”

The cost of the project was $44.5 million, Adamy said. The cost was built into the budget, spread out over 12 years.  

Good communication with customers throughout the process was a huge contributor to the success of the project, Adamy said.

Replacing all of the lead water pipes in the state would be a massive undertaking.

“You’re talking maybe 500,000 lead service lines in the state, in the billions of dollars to replace,” Oswald said. “It’s going to be an expensive proposition, but we want to get the lead out of the system.”

The draft proposal of the rules will be sent to the governor’s office where they will be put into legal format, Oswald said. The department hopes to open up public comment in mid-January and hold a public hearing at the end of that month. From there, the rules will be sent to the Joint Committee on Administrative Rules. It will then be up to the committee whether these rules take effect.

With Flint and other issues that have recently been brought to light, now is a good time to tackle this, he said.

“The public’s attention is on this, and I think we’ve got the backing to make this a priority,” Oswald said. “We may not go about it exactly how we think we’re going to, but I think the end result will be a rule that requires lead to be removed from the distribution center in one way or another.”

Thousands of Michigan kids caught in health insurance gap

By KALEY FECH
Capital News Service

LANSING — More than 100,000 Michigan children who don’t qualify for Medicaid but cannot afford private insurance are at risk of losing health insurance.  

The federal government failed to renew funding for the Children’s Health Insurance Program (CHIP) before Oct. 1. Now it’s uncertain if funding will be restored.

CHIP is an insurance plan for working families, said Meghan Swain, executive director for the Michigan Association for Local Public Health.

Most funds provide health care to children through the MIChild program and to pregnant women, said Angela Minicuci, communications director at the Department of Health and Human Services. There are 116,000 Michigan residents  covered by the program.

It’s vitally important to providing health care to children of lower income families, said Emily Schwarzkopf, a health policy analyst for the Michigan League for Public Policy.

“Without it, children would not have access to regular doctors appointments, the ability to get preventive care or immunizations, Schwarzkopf said. “If a kid is sick, they can’t go to the doctor and they can’t get medication.”

The program provides health insurance to almost nine million children. Five states have already run out of the funding but received a little extra money from the federal government to help support the programs, Schwarzkopf said.

Michigan is in somewhat better shape.

“We have funding that will bring us through about April or May of next year,” Minicuci said.

But the agency is preparing to  warn participants of looming changes in early 2018.

“We will need to begin notifying residents that coverage may be ending or changing,” Minicuci said.

CHIP has had bipartisan support in Congress and until now there have been few obstacles to getting the funding reauthorized.

“Should we run out of funding, we would need to do a couple of things,” Minicuci said. That includes asking state lawmakers for new funds or finding another source of them or cutting the program.

“We could partially fund some programs,” she said. “We might need to change the types of coverage that some programs have.”

What happens depends on whatever funding solutions state legislators develop.

“There is the possibility that should we not have federal funding identified and the state is unable to identify funding to cover that CHIP funding, individuals could lose the coverage that they receive through CHIP funding,” she said.

Schwarzkopf said the league hopes if funding is not restored, the state will find a way to pick up the tab.

“Obviously that would be a lot of money that the state would not be receiving from the federal government, so you have to look at what funding is available,” she said.

HEADINJURIES TABLE

High school sports with the most head injuries, 2016-17. (2015-16) in parentheses.

Boys

  • 11-player football – 1,647 (1,907)
  • Soccer – 207 (269)
  • Basketball – 168 (247)
  • Wrestling – 251 (245)
  • Ice Hockey – 124 (126)

Girls

  • Basketball – 371 (454)
  • Soccer – 364 (406)
  • Volleyball – 174 (211)
  • Softball – 146 (147)
  • Competitive Cheer – 150 (122)

Source: Michigan High School Athletic Association

Head injuries decrease in high school but girls’ rate is higher

By EMILY LOVASZ
Capital News Service

LANSING — Sixteen high school sports saw a decrease in reported head injuries from the 2015-16 school year to the 2016-17 school year, according to the Michigan High School Athletic Association (MHSAA).

Head injuries increased or remained the same in 13 sports, according to the report. Overall, high school sport teams statewide reported 3,958 head injuries in 2016-17, down 11 percent from the year before. Boys and girls sports were reported separately.

Football led the list for boys and basketball led the list for girls. Soccer ranked second for both genders.

Of the 750 high schools in Michigan, 97 percent reported athletes’ head injuries to the sports association but not to the state.

The rate of injuries for girls is far higher than for boys, according to the report.

For every 1,000 girls who played basketball, there were 23.34 head injuries reported. For boys, that number was 7.90.

Similarly, softball had 10.70 head injuries reported for girls, while baseball had 3.89 reported for boys.

MHSAA promised its members not to release data for individual schools for fear it will be misinterpreted, said John Johnson, the MHSAA communications director. As a private organization, MHSAA isn’t required by law to release data it collects.

Although the MHSAA report shows changes from one year to the next, it is too early to call it a trend.

The numbers don’t mean anything, said Joanne Gerstner, the sports journalist-in-residence at Michigan State University and author of “Back in the Game: Why Concussion Doesn’t Have to End Your Athletic Career.”

Context is lacking because there are no numbers from five or 10 years ago, and some schools have a greater number of students, which could equal more head injuries, she said.

“We don’t know what it was 10 years ago,” Gerstner said. “We have our data set right here, and it is great. But we aren’t going to know what it means until 10 or 20 years from now when we can look at everything.”

Other factors come into play, such as reporting differences for girls and boys.   

In all the gender comparisons in similar sports, females have a greater risk for a concussion, said Tracey Covassin, an associate professor of kinesiology at Michigan State and an expert in the effects of concussions.

“One factor could be that females have weaker neck muscles, causing a faster rotation of their head. Since they have less mass, it is predisposing them to having more concussions,” Covassin said.

Studies also show that girls are more honest about reporting concussions.

Sports like football or hockey have a macho culture, Gerstner said, but it’s more acceptable for female athletes to admit something is wrong.

And Covassin said, “There is still a percentage of athletes who do not want to report their injury due to missing playing time. They do not think it is serious enough or they do not want to let their teammates down.”

The other thing that people don’t want to talk about is fear, Gerstner said. Many don’t know what a concussion is, they don’t want to admit that it’s possible or they’ve heard scary things about it, so they don’t say anything.

“People knew of the term concussion, but it was more along the lines of a knock to the head or, ‘it’s a little thing, get up and keep going,’” Gerstner said. “Now people are taking it much more seriously.”

Awareness has increased even in the last five years, she said. Being more proactive by working on neck strength, having less contact in practices and games, and even reducing practice time have helped prevent head injuries.

Every state has a law regarding youth sports and concussions, Gerstner said. If a child is thought to have sustained a head injury during practice or a game, he or she cannot play.

Johnson said schools continue to make sports safer by making sure they’re officiated properly, that rules emphasize safety and that equipment continues to get better.

“There is no one policy, no one rule or no one piece of equipment that will ever prevent a concussion or any injury,” Johnson said. “All we can do is put ourselves in the best position to minimize the risk.”

Schools are using the MHSAA head injury report as a surveillance system. Every high school must report to the association the total number of athletes it has in all sports and any time an athlete suffers a head injury.

That helps schools and the MHSAA find out what sports the concussions are happening in and what athletes are at a higher risk.

Covassin said, “We are more aware of concussions, we are better at diagnosing and evaluating concussions and I also think more athletes are more aware of the signs, symptoms and dangers of playing with a concussion.”

The reporting system is great, Gerstner said, but that alone doesn’t reduce injuries or risk. Rather, it’s everyone doing their part that helps.

“Using the reporting system has been a step in the right direction. Recording everything in a scientific mode is missing in most discussion in the media and pop culture,” Gerstner said. “The data is so new and we do not have a lot to show, but we are getting there.”

Policies that protect high school athletes under scrutiny

BY JACK NISSEN
Capital News Service

LANSING — The Michigan High School Athletic Association (MHSAA) is fighting a national report that says it isn’t doing enough to protect student athletes.

The claim was in a nationwide study that analyzed policies related to student athletes. The Korey Stringer Institute, a part of the University of Connecticut that advocates for student athletes, ranked Michigan at 41st.

While Michigan scored points for heat exertion policies it has in place, it lost points for not requiring athletic trainers be onsite for contact sport practices, as well as having an undeveloped athletic emergency action plan.

MHSAA says the institute’s method for ranking states is flawed.

“They try to take a one-size-fits-all approach, and basically it’s a one-size-fits-nothing,” said John Johnson, MHSAA’s director of broadcast properties. “There’s lots of things it totally misses the mark on.”

Michigan has a coaches’ education policy and mandatory concussion reporting, two policies that Johnson said aren’t acknowledged in the report.

“There are too many things that vary from state to state, that you can’t just dump it into a matrix and it spits out rankings.”

The reason behind the study is to develop better state policies to address common reasons students die in high school sports, said Samantha Scarneo, the director of sport safety at the institute. The four primary causes of death in high school sports are heat stroke, brain-related trauma, cardiac arrest and a sickle cell trait, she said.

“We appreciate states that aren’t happy with where they are ranked,” Scarneo said. “The purpose of this study was not to point fingers, but to educate parents.”

The rankings were based on public information that the institute compiled. Any policies or laws the state and athletic association mandated for school districts to follow, coupled with how clear the wording of those policies were, helped determine the score each state received.

The ranking relied too much on the same laws standardized across all states, Johnson said. If you think about summer conditioning and climate change, it’s very different for those that practice in the middle of July in Alabama or the end of August in Michigan, he said.

“You’re not going to get that kind of standardization in 50 states on anything,” he said. “Even in Michigan, you can go to DeTour and find completely different weather on any given day than what you find in Detroit or Decatur.”

But the ranking method accounts for these factors, modifying the scores to reflect laws relative to the state, Scarneo said.

“We’re not saying every state has to have the same exact policy. What we’re saying is every state has to have a policy. That’s what sets the standard of care.”

For Michigan’s athletic trainers, the standard of care means taking a proactive role in keeping student athletes healthy. Some cultures promote a win-at-all-cost mentality, Mitch Smelis, who chairs the secondary school committee of the Michigan Athletic Trainers Society, wrote in an email.

“At some point a student’s participation in competitive athletics will come to an end. When that happens, what is the health status and how then are they able to function in society in the years ahead?” he said.

The trainers’ society says it looks at the institute’s report as a bridge to discussion about being more prepared.

“As an organization we look forward to partnering with others across the state,” Gretchen Goodman, the society’s president, wrote in an email, “as we engage in meaningful dialogue and implementation of plans and resources to help promote the safety and well-being of our secondary school athletes.”

In 2011, the Licensure of Athletic Trainers in Michigan was enacted to require that all athletic trainers meet several standards if they want to practice in the state. That includes a degree from an accredited college program, a certification from the Board of Certification and maintaining continuing education every three years.

Between 1982 and 2015, 735 students died as a result of participation in high school sports, according to the National Center for Catastrophic Sport Injury Research at the University of North Carolina.

MHSAA mandates its members report head injuries and, offers concussion insurance and sideline testing programs. We’ve been at the leading edge of addressing issues like concussions, Johnson said. “We’re not Johnny-come-late to the party when it comes to head issues.”

Johnson says there are enough policies in place that some high school coaches and administrators think MHSAA has too many rules. “So maybe the silver lining in the institute’s ranking is so we can point to it and say ‘here is someone who thinks differently.’ But there’s no way we’re 41st.”

State program boosts school nutrition with local foods

By JINGJING NIE
Capital News Service

LANSING — More Michigan students can enjoy fruits and vegetables from local farms because of the expansion of a state program that supports buying them.

The 10 Cents A Meal program is administered by the Department of Education.The state offers up to 10 cents per meal for schools to purchase Michigan grown or processed food.

Sixteen school districts joined the program its first year in 2016, serving more than 3.8 millions meals to 48,000 students, according to the program’s legislative report.

The state recently announced that 32 school districts will receive the funding this year. More than 90,000 students will benefit from it.

Almost 80 schools applied for the program this year, according to the Department of Education. Criteria for choosing them includes whether they are near farms, distributors and food hubs.

The grants are for foods such as local fruit, vegetables or dry beans, said Diane Golzynski, the interim state child nutrition director at the department.

“We’re just very excited about this program,” Golzynski said. “It’s really exciting and we’ve seen Michigan farms be able to get additional funding to help them grow and provide more products to local schools.”

This is the fifth year that Traverse City schools have participated in the program because it started there as a pilot program.

The Traverse Bay Area Intermediate School District partnered with the Groundwork Center for Resilient Communities to launch the initial version, said Tom Freitas, food service director for the district.

The local program prompted Sens. Darwin Booher, R-Evart, and Goeff Hansen, R-Hart, who chairs the Senate Appropriations Committee’s K-12, School Aid, Education Subcommittee, to initiate a statewide program two years ago.

“We are pleased that this is something that is being seen as a win-win by legislators for investing in the health of our kids and the health of Michigan’s economy, and we’re pleased that it is getting bipartisan support,” said Diane Conners, senior policy specialist at the Groundwork Center for Resilient Communities, a nonprofit organization based in Traverse City.

“The 10 Cents a Meal program is helping expose children to locally-grown produce options in the school setting and is creating partnerships between school districts and their local agricultural producers,” Hansen said in a news release.

And students apparently notice.

“Kids can tell differences. When the food service ran out of Michigan apples, they can tell the difference and say ‘what’s going on with the apple?’” Conners said.

Freitas agrees: “If you get a Honeycrisp apple versus a Red Delicious apple, they just like Honeycrisp much better, which is more of a local apple.”

Traverse City Area Public Schools receives produce almost everyday, Freitas said.

Even in the winter, when there is nothing growing in Michigan, schools still have supplies of frozen cherries, blueberries, strawberries and apples from local processors.

James Bardenhagen is the owner of Bardenhagen Farms. His farm and his co-ops sell apples, potatoes, grapes, apricots, nectarines, plums, leafy greens, carrots, kohlrabi to schools in Leelanau County and Traverse City.

Kids now want to eat at school rather than bring their own lunch, said Bardenhagen.

10 Cents A Meal means a new market for him.

“It’s a great program, and it benefits the farmers and school and the kids,” he said.

“Our hope is to get it across all of Michigan,” Freitas said. “Every time it grows a little bit, that is a good thing not just to schools but the Michigan economy and the farmers.”

Districts now in the program include Alanson Public Schools, Bear Lake Schools, Benzie County Central Schools, Boyne Falls Public School District, East Jordan Public Schools, Frankfort-Elberta Area Schools, Glen Lake Community Schools, Harbor Springs Public School District, Kaleva Norman Dickson Schools, Manton Consolidated Schools, Onekama Consolidated Schools, Pellston Public Schools, Public Schools of Petoskey, Traverse City Area Public Schools, Belding Area Schools, Coopersville Area Public School District, Grand Haven Area Public Schools, Hart Public School District, Holland Public Schools, Lowell Area Schools, Montague Area Public Schools, Saugatuck Public Schools, Shelby Public Schools, Thornapple Kellogg School District, Whitehall District Schools, Ann Arbor Public Schools, Bedford Public Schools, Dexter Community School District, Hillsdale Community Schools, Jackson Public Schools, Monroe Public Schools, Ypsilanti Community Schools.

CNS community:

Harbor Springs Public School District, Public Schools of Petoskey, Traverse City Area Public Schools, Holland Public Schools, Glen Lake Community Schools, Kaleva Norman Dickson School District

 

Burnout, training and retirements challenge nursing shortage

BY JACK NISSEN
Capital News Service

LANSING — Dawn Kettinger recalls a nurse who had just completed a 15-hour shift, got into her car to drive home and fell asleep before leaving the parking lot.

Imagine that same nurse working one more hour in an environment where patient care is top priority. She asks: How can someone be asked to work in lifesaving situations when they can barely stay awake at the end of their shift?

“It contributes to the loss of experienced nurses in the field,” said Kettinger, the government affairs director for the Michigan Nurses Association.

The national burnout rate for new nurses is high. About 17 percent leave within the first year and 33.5 percent leave within two years, reports the Robert Wood Johnson Foundation.

That’s costly for hospitals, harmful to patients and creates a shortage of nurses needed to replace retiring ones.

A manageable caseload during a nurse’s 12-hour shift is usually four patients, Kettinger said. But they often work mandatory overtime and care for six, seven and even eight patients at one time.

That workload risks patient safety and increases the already high burnout rate, pushing nurses to find work elsewhere, Kettinger said.

Some lawmakers are attempting to address the issue.

Rep. Jon Hoadley, D-Kalamazoo, has introduced a bill that would set caps on how many patients a nurse can have, depending on the unit they’re in. The bill, which has bipartisan support, also would prohibit a hospital from forcing a nurse to work longer than 12 straight hours.

“When it comes to taking care of your loved ones, that’s something everyone relates to,” Hoadley said. “We need champions in the Legislature who are willing to make sure we’re putting patients and nurses first.”

Some hospitals maintain safe numbers, Hoadley said. But it’s important that the legislature establishes what is acceptable and safe for those that do not. Right now, there are no legal limits on a nurse’s patient load.

“We have a moral and ethical obligation to act, because of medical errors and staffing ratios have contributed to thousands of deaths or injuries,” Hoadley said.

While there is no way of knowing how many incidents are due to a lack of nurses, according to a 2014 Michigan Health Association report, there were 52,000 incidents, near misses and unsafe conditions in Michigan hospitals.

State lawmakers have unsuccessfully tried to regulate hospitals over nurse conditions before. While not yet taking a formal position on the current legislation, the Michigan Health and Hospital Association has opposed similar bills.

“We believe that our local hospitals are best equipped to make the decisions in caring for their patients, and that includes staffing ratios,” said Laura Wotruba, the association’s director of public affairs. “Clinical care decisions shouldn’t be made in Lansing. They should be made in the local communities that take care of the people.”

The association is committed to working with nurses, but understands there is a burnout rate for new nurses when they enter the field, she said.

“Mandatory overtime is not the preferred option to staff a hospital, and they employ a number of different efforts to avoid that,” Wotruba said. “But it does happen because we’re caring for people around the clock.”

To address the stressful environment of hospitals, the association’s solution to burnout isn’t  more nurses, but more training and education. The more nurses holding a bachelor’s degree at a hospital, the better the results for patients.

Several studies show that training, not more nurses, improve patient care, Wotruba said.

Randolph Rasch, dean of the Michigan State University College of Nursing, agrees. While an increase in nursing staff does improve the patient outcome, the level of education is a key indicator, he said.

“One of the consistent things is that in those institutions that consistently had better outcome for patients, there was a higher percentage of nurses prepared with a bachelor’s degree,” Rasch said.

An outcome of such studies by the Center for Health Outcomes and Policy Research at the University of Pennsylvania is the Magnet program, a gold standard awarded to hospitals that meet high standards for nurses. To be eligible, 75 percent of a hospital’s nurses must have a baccalaureate degree—a BSN.

Michigan has 12 magnet hospitals. While there’s no way of knowing how many are also pursuing the status, Kettinger says it’s becoming a barrier for students wanting to work as nurses.

“It’s a marketing ploy,” she said. “Hospitals brag about the status, but it doesn’t mean they have safe patient-to-nurse ratios.”

To become a registered nurse, individuals have to pass a test. It can be taken by people with associate or bachelor’s degrees in nursing. Kettinger worries the push by hospitals to become magnet programs is making two-year programs offered at many community colleges less attractive, even though they are a more cost-effective route to becoming a nurse.

“We reject the premise a bachelor’s degree is required and preferred to be a bedside nurse,” she said.

The shift in preference for bachelor’s degrees is also impacting current nurses, who may have years of experience under their belt but only two-year degrees.

“We already have nurses with all the right education,” said Rep. Roger Hauck, R-Mount Pleasant and a supporter of the bill. “The problem is we’re going to have a shortage of nurses by requiring them to go for four years instead of two.”

Hauck’s daughter is a nurse with a BSN and his wife is a nurse with an associate degree, he said. The hospital is making his wife go back to school.

Worried a nursing degree from two-year programs could become useless, the Michigan Community College Association based in Lansing has supported past legislation to allow its members to administer four-year nursing degrees.

“If there is a nursing shortage, it would make sense to remove the number of barriers to get more hired,” said Mike Hansen, the group’s president. “You don’t want to jeopardize professional standards. However, if there are more technical or bureaucratic laws keeping people from getting hired, then why wouldn’t you make it easier?”

But the Michigan Association of State Universities, based in Lansing, whose members provide those four-year degrees, says there are already enough programs to accommodate the nursing shortage.

“Whether it’s the BSN degree in nursing or any other occupation, we believe community colleges offering a four-year degree would represent mass duplication of those programs and enormous inefficiency of taxpayer dollars,” said Daniel Hurley, the association’s chief executive officer.

In a state already facing a decline in high school graduates, it makes little sense for community colleges to offer four-year degrees, he said.

But Rasch said the extra two years in the BSN program helps raise the level of competency for a nurse. It prepares them for the complexity of care now necessary in the field.

The bill would also mandate that hospitals make their staffing ratios public. Right now, they aren’t obligated to release that information.

Hoaldey said, “Some hospitals are saying ‘we’ve got this, trust us, but we don’t want to prove to you we’re doing things correctly. When someone gets sick or there is an accident, you don’t know how many people are working.”

Much of Hoadley’s bill is based on a 2004 California law. It resulted in nurses caring for one less patient than nurses in other states, a significantly lower mortality rate and a higher level of job satisfaction, according to a study of 225,000 California nurses by the Center for Health Outcomes and Policy Research.

But even if the burnout rate falls, Michigan needs yet more nurses to replace those who are retiring. More than 40 percent of the state’s registered nurses are 55 or older, according to 2017 data collected by the Michigan Annual Nurse Survey Project. Most will retire within the next 10 years

“Right now, we have a large number of our nursing workforce that have reached 65,” said Carole Stacy, the Michigan League for Nursing president. “They are retiring in hefty numbers and we’re losing a big brain trust.”

Poet writes about damages from dementia and to the environment

By KATE HABREL
Capital News Service

LANSING — Janet Kauffman — poet, teacher and environmental activist– writes in the shadow of a wooden raptor statue.

“It sits in the corner, kind of over my shoulder,” said Kauffman, who lives in Hudson. “It sort of captures the tone that I need. I tend to be fairly quiet and reasonable in daily life, and that’s not really what lies below or above. It’s my raptor on the inside.”

The result? Poems containing vivid images and their author’s energy.

This is the tone captured in her latest poetry collection, “Eco-Dementia.” It explores the relationship humans have with the environment, based on her work as an environmental advocate and her experiences with her father’s dementia. This is her seventh book.

The poems of “Eco-Dementia” are a collage of images that inspire visceral reactions. From “Keratella Offshore:”

“…bloom red, balloon, show yourself

whip-snap, weave complex paisley fabrics

from foot-glue, mix media on slow water,

raft the whole conglomeration into shore.”

The book is one part of a mixed-media project, also called “Eco-Dementia.”

The project came together over 10 years. Kauffman had been involved with issues of water quality in Lake Erie, particularly the effects of runoff from liquid manure on farm fields. After years of sitting in on committees, hearings and other meetings, Kauffman said she was frustrated by the lack of real change.

Around the same time, Kauffman’s father was diagnosed with Alzheimer’s. This forced Kauffman to look at language differently.

“A lot of the poems show the kind of language that my father used,” she said. “When you don’t recognize your own children, when you don’t know where you are and you want to go home — that really had an effect on me.”

It also inspired the word that became the book’s title: eco-dementia. According to Kauffman, it’s the paradox that even though humans love this planet, they still damage it in sometimes drastic ways.

The book is broken into three sections based on that theme.

The first has poems that are more physically oriented, describing the joy found in the natural world. The second is a long prose poem about environmental undercurrents in everyday life set aside for its uniqueness, Kauffman said. The third deals with the sense of loss brought on by dementia.

“I wanted the language to stay as close to feeling like physical material as possible,” Kauffman said. “I love those places where you walk into a stack of grasses or something that’s almost impenetrable. That feeling of being held by vegetation so it’s your equal – I really like that kind of immersion. I hope there’s a little of that feel in the poems.”

Even though the poems are about nature, make no mistake: they’re not about the flowers and plants themselves. From “Every Shot-Through:”

“Don’t say that they’re not

those sticks at your feet,

a lie, a limit, the crimped

stalks of beech drops,

a scrawl diagrammed,

flower and all.”

These poems are more about experiences and connections than concrete things. Readers might not come away with a clear idea of what the poems were about – and that’s okay.

In the end, Kauffman says it’s the overall message that matters most.

“We really need to find a new way of living in the world,” she said. “We have to stop doing the damage we’re doing. We have to stop being crazy. And we have to find a way to protect our planet, protect our home.”

“Eco-Dementia” is available from Wayne State University Press for $16.99. You can find out more about Kauffman at her website, www.janetkauffman.com.

Kate Habrel writes for Great Lakes Echo.

Outstate health officials prepare for hepatitis A cases

By STEPHEN OLSCHANSKI
Capital News Service

LANSING — The number of hepatitis A cases related to a Detroit-area outbreak is closing in on 400, prompting some outstate health officials to monitor its spread across Michigan.

It’s not a matter of if it will spread, but when it will spread, said Bay County health officer Joel Strasz.

“We’re talking about a specific strain down there that seems to be more virulent than typical cases of hepatitis A,” Strasz said. “We live in a mobile society and people travel.

“We just anticipate that this is going to come here in some form or fashion,” he said.

Hepatitis A is viral liver disease that can cause yellowing of the skin or eyes, diarrhea, nausea, stomach pain and fatigue.It’s often spread through person-to-person contact and consumption of infected food or water.

Of the 397 cases tied to the Detroit-area outbreak, 320 resulted in hospitalizations and 15 people died. The outbreak dates to Aug. 1, 2016, and has predominantly affected the Metro Detroit area, including Macomb, Monroe, Oakland, Wayne and St. Clair counties.

Ottawa County, which has had two cases of hepatitis A, is monitoring the situation in Detroit and trying to stay vigilant in case the disease were to spread, Kristina Wieghmink, a communications specialist for Ottawa County, said.

Primarily, the county is looking at strands of the disease when cases arise and checking to see if it matches the Detroit-area outbreak. So far, it hasn’t, Wieghmink said.

But since people travel, there is always concern it could spread, Wieghmink said.

Strasz said Bay County is focused on prevention and vaccination,

“Hopefully, it’s not going to come in as great of numbers as what’s happening in Southeast Michigan,” he said. “But we’d like to anticipate that to get as many folks vaccinated as possible.”

People most vulnerable to the disease are heavy drug users, the homeless and males who have sex with males.

Recently, Bay County held an event to vaccinate homeless people.

“They’re a particularly vulnerable population that needs to be targeted,” Strasz said. “Obviously, No. 1, they don’t have homes and in a lot of cases they don’t have a free and adequate supply of sanitary facilities.”

High-stress living conditions of many of the homeless weaken their immune system, leaving them more vulnerable to the disease, he said.

“Those with history of injection and non-injection drug use, homelessness or transient housing, and incarceration are thought to be at greater risk,”Angela Minicuci, the communications director for the Michigan Department of Health and Human Services, wrote in an email.

“No common sources of food, beverages, or drugs have been identified as a potential source of infection associated with this outbreak,” she said.

An additional 42 cases of hepatitis A unrelated to the outbreak have been reported so far in 2017 across multiple counties. Apart from the Detroit-area outbreak, Kent County and Sanilac County reported the most cases with five each. Saginaw, Ingham and Washtenaw counties each registered four cases.

Calhoun, Genesee, Isabella, Lapeer, Livingston and St. Joseph counties all registered three cases. Berrien, Hillsdale, Lake and Ottawa counties all registered two cases.

Only one case was reported in Barry, Bay, Charlevoix, Clare, Clinton, Delta, Eaton, Grand Traverse, Huron, Ionia, Jackson, Kalamazoo, Montcalm and Van Buren counties.

While those cases are not linked to the Detroit outbreak, there is a possibility that strain of the disease will move.

“Diseases do not know boundaries,” Minicuci saidw.

The latest Michigan Disease Surveillance System report shows cases in 34 of Michigan’s 83 counties.

The current tally of all hepatitis A cases in 2017 stands at 439, an increase of 307 from all of 2016.

The  Department of Health and Human Services is targeting potential sources.

“Working with community partners, vaccination efforts are being implemented in targeted locations such as homeless shelters, soup kitchens and rehabilitation facilities,” Minicuci wrote. “Partnerships are also being developed with area emergency departments, county jails and state prisons.”

Lack of contractors slows lead removal from Flint and other Michigan homes

By JACK NISSEN
Capital News Service

LANSING — Since receiving $24.8 million from Medicaid to remove lead from contaminated homes almost a year ago, the Department of Health and Human Services has abated only 23 homes of lead in Flint.

Another 47 Flint homes are undergoing cleanup. So far, $660,200 of those Medicaid funds have been spent in Flint and another $730,500  spent elsewhere, state officials said.

It can take a long time to remove lead from a house—close to three to five months—but before  removal can happen, contractors need to be available. And there just aren’t enough.

“It’s the biggest impediment to spending those dollars,” said Tina Reynolds, the health policy director of the Michigan Environmental Council. “Lead risk assessors and contractors are in short supply. It’s related to us only having so much money to hire them so there was only a small pool of people willing to do the work.”

Michigan is the first state to receive Medicaid funding for lead removal. Some of it can be spent in communities other than Flint, which received nationwide attention for lead contamination in its drinking water.

To fully take advantage of that money and combat the shortage, the health agency has hired someone to help increase the number of lead contractors. The new workforce development coordinator is entrusted with finding those that could become lead contractors.

“His role is to really get out into communities, starting in Flint, and looking at who’s available in the community to take the training that may have a little bit of construction knowledge,” said Carin Speidel, the Lead Safe Home Program manager. “It’s going to be a big undertaking because it’s not an overnight process.”

The reasons for the shortage date back to the recession in 2008, when many contractors couldn’t find work and began finding jobs elsewhere.

“The industry is maxed out in terms of its capacity,” Speidel said. “It’s a nationwide issue.”

Lead-removal services include paint, walls and water lines. Reynolds says there is a disconnect between the program and eligible residents. They may not know about program, or they don’t want to do the paperwork. Sometimes there’s a language barrier as well.

Toeducate people about the program and the dangers of lead in general, the state is taking steps to reduce confusion.

“So people are now going door to door to encourage people to get tested,” she said.

So far, 190 eligible people have enrolled in the Medicaid program. One hundred and fifty of them have had tests conducted on their homes.

While most of this money would go to Flint, there’s $6 million available for consortiums and local health departments that could providet services outside of Genesee County, including West Michigan.

It’s a welcome source of money, said Paul Haan, the executive director of the Healthy Homes Coalition of West Michigan, but there are problems with getting it to people after his coalition receives it.

People are used to a lot of restrictions when it comes to getting federal housing funds from the U.S. Department of Housing and Urban Development, Haan said. There isn’t a lot of confidence the funds will be easily accessible. But Medicaid money is much easier to get.

Haan’s coalition oversees some of the hardest-hit places for lead poisoning like Kent County, which found more than 6 percent of its children under age 6 testing positive for lead poisoning in 2016. The Healthy Homes Coalition has applied for $1.5 million from the Medicaid fund.

Health and Human Services received six applications from consortiums for the abatement money and will announce its awards in late Novemberd.

 Muskegon County, which has also applied for funds, struggles with even finding the opportunity to tell people about the services.

“A lot of the time, they will not let folks in their house to even provide education,” said public health education supervisor Jill Keast, of Muskegon County. “They may not want you to see their living conditions, or they may worried about (Immigration and Customs Enforcement) and deportation.”

Muskegon County also has one of the highest lea -levels in children under the age of 6, at 4.3 percent. Keast says she likes it that more money is coming into the state, but says it’s still not enough.

“Flint should be a priority., We understand that and I do appreciate they need the funding right now,” she said. “However, it’s not helping our communities. Putting all your resources toward Flint doesn’t eliminate the issue of lead in other areas.”