County Public Health Nurse Deirdre Arvidson came before the Board of Regional Commissioners Wednesday to update them about

County Public Health Nurse Deirdre Arvidson came before the Board of Regional Commissioners Wednesday to update them about just what the county does when it comes to public health.

Arvidson, a nurse for 25 years, came to work for Barnstable County seven years ago and in that time has expanded to or added six programs, she said. She ticked off a list of services the county provides, which center around immunization programs, disease screening services and health education.

Many of the programs offered by the county are held across the Cape, "from Bourne to Provincetown," Arvidson said. For most of the programs, "we go where the people are," she said.

One of the biggest thrusts of public health nursing is the immunization programs, and the county health nurse's division offers a wide variety of services on that front. On Tuesdays and Thursdays the nursing division operates a vaccination clinic in its offices in the Old Jail Building in the Barnstable County Complex on Route 6A in Barnstable Village. The clinic is by appointment only and open to all county residents. To make an appointment, call 508-375-6617.

The county offers vaccines for hepatitis A and B, tetanus/diphtheria/pertussis, varicella, mumps/measles/rubella, shingles, HPV, and meningitis, as well as vaccines for whatever flu is expected to arrive. The county also goes out into the community to offer flu vaccines, providing services to public safety departments and school staffs. In the most recent flu vaccination program, Arvidson said 1,743 people got vaccinated.

One area where Arvidson saw a need and expanded services was travel vaccines. Anyone seeking to visit or work in areas where typhoid or yellow fever is present had limited places on or near Cape Cod to get immunized. The county clinic now offers travel vaccines, she said.

Vaccines are not free, but from the county they are relatively inexpensive because the county health nurse division purchases them directly from pharmaceutical manufacturers at a public health discount. Last year the county spent $63,000 on vaccines and the program returned nearly $90,000 in revenues, Arvidson said.

The immunization programs "have provided a huge resource for the community," she said. The main challenge has been getting out the message that these services are available. Arvidson said she has been promoting the services to local media and to local physicians and health care providers.

The county health nurse division offers a variety of health screening services, but makes a special effort to reach "vulnerable and underserved populations," she said. One program that she believes has been very successful is the health screening clinic held in local food pantries. A public health nurse will spend two to three hours several times a year at a food pantry to perform health screening and provide information about healthy living.

The focus is on screening for diabetes and hypertension, she said, and flu shots are offered in season. The program has had many anecdotal successes, such as finding people with pneumonia or other illnesses where the person needed to be hospitalized.

The public health nurse program also collaborates with the hunger network related to the food pantries on a "Foods to Encourage" program, aimed at providing information, screening and appropriate nutritive foods to those at risk for diabetes or high blood pressure.

Finally, the health nurse division offers each town an annual clinic to screen for a variety of factors, including bone density, cholesterol, hearing, vision, body mass index and skin cancer.

The world of public health medicine is changing rapidly, and today there is competition to provide the services once limited to county health nurses.

Pharmacies, Arvidson said, are getting more and more into the public health business. While not a bad thing for consumers of health services, it has disrupted what had been the best opportunity for public health agencies to test out emergency preparedness procedures. Flu clinics and other services of that kind were an excellent venue to hold emergency preparedness drills, Arvidson said.

The other area of competition has come from the Visiting Nurse Association, which for the commissioners was a head-scratcher. Most towns on the Cape don't hire a public health nurse, but instead contract with the VNA for that service instead of the county, despite the county's services being offered at a lower price.

"I've been advocating this for years, so I feel your frustration," said the chairman of the board of commissioners, Leo Cakounes. "Everybody talks regionalization, but we seem to get this psychological pushback."