When Dr. Olivia Kasirye left her homeland of Uganda in 1991, she had just wrapped up an internship as a medical officer at Rubaga Mission Hospital in Kampala.
She and the African nation had survived the treacherous regime of Idi Amin, the killings of hundreds of thousands of people and a civil war.
As the violence wound down, it was evident that decades of unrest had unraveled the nation’s economy and scarred its infrastructure. This was not the time and place to launch a medical career.
“By the time I left, there was relative peace and a new regime,” Kasirye recalled. “But all the systems had been destroyed for years.”
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So Kasirye took her degree from Makerere University Medical School in Kampala and headed to North America.
Uganda’s loss ultimately became the county of Sacramento’s gain. Today, Kasirye is two years into her appointed position as public health officer for Sacramento County.
If you think the position of county health officer sounds vague and nondescript, consider this: She can put you in jail.
Disobeying the county health officer’s order, such as refusing to segregate yourself from others when you have a dangerous, infectious disease, is against the law.
“There are times when people have to do what I say, such as in tuberculosis control. I tell people you need to be isolated,” Kasirye said. “If they refuse, I need to put people in jail. To violate what the health officer says – it’s a misdemeanor. In cases where there’s an outbreak, you have to do certain things.”
Her office happens to be ground zero in the capital region’s battle against an unusually severe, deadly influenza season, and paradoxically increases in importance as funding support decreases. With fewer resources from the county supervisors, Kasirye must figure out how to cover more ground with less.
One way to do that is to gain the public’s trust, accurately gauge the disease’s progression through the community, urge vaccination and offer free flu shots.
So Kasirye is frequently out in the community, talking to skeptical groups, explaining Western medicine’s emphasis on prevention by immunization while overseeing reporting of deaths and other epidemiological data.
In battling the fury of the flu, the soft-spoken Kasirye, colleagues say, is like the calm in the middle of the storm.
This season’s severe H1N1 influenza virus is widespread, running ahead of expectations and has taken at least 27 lives in Sacramento County. About 115 local people have ended up in area hospital intensive care units, and not all make it out alive.
As public health officer, Kasirye, with a gentle but confident manner, must take charge of easing public fears while frankly describing the flu’s potential to kill and, above all, encouraging prevention.
“We do as much education as we can,” said Kasirye, “But we don’t want people to panic.”
When Dr. Glennah Trochet, who held the public health officer position before Kasirye, stepped down, she was not shy about broadcasting her disappointment at the Board of Supervisors’ decisions to cut funds for community health programs and facilities.
Since Trochet departed, however, Kasirye has seen some modest easing in funding cuts, which have included shuttering five of the county’s public clinics.
Trochet said she sees many positive attributes in Kasirye: “She is a very low-key person with a great passion for what she’s doing. She’s quiet and understated and so knowledgeable.”
Kasirye has been able to hire a part-time sexually transmitted disease controller. It isn’t the once-full-time STD controller post (Kasirye once held it), but it is a step forward in dealing with one of Kasirye’s biggest challenges: notoriously high STD rates in Sacramento County.
“We know that the county cannot deal with all the health problems by itself,” Kasirye said over lunch with an executive from Bloodsource, a nonprofit blood bank.
If Kasirye can get Bloodsource to educate youths about STDs during the two-hour period it takes to give donor blood, that’s a partnership worth exploring. “Everybody is spread so thin that it would be nice if we could put our resources together,” she said.
Dr. Christopher Gresens, senior medical director and vice president of global medicine for Bloodsource, is eager to forge a deal. It would reflect well to be affiliated with the county’s Department of Health and Human Services and do good in helping solve one of the county’s biggest public health problems.
“I would love to make this happen,” said Gresens. “I have great respect for what Olivia and her team are doing.”
Many in the public health community see Kasirye’s international background as a plus in being able to reach foreign-born populations that are trying to overcome health disparities.
The capital region has been called the most diverse in the nation, with about 28 percent of residents in the four-county Sacramento region speaking a language other than English at home. Roughly 4 in 10 of those residents speak English less than “very well.”
“It sounds like an asset to me that she comes from another country, has lived a life in another country,” Trochet said. “She has a perspective that can only enrich all of us.”
Kasirye is nothing if not passionate about cultural competence, a public policy term for being able to relate to diverse ethnic groups of people.
“The culture is certainly dynamic. It’s not static,” she said. “One of the things I like about this job is the chance to see people of all different backgrounds coming together for a common cause.”
A way to improve lives
Kasirye’s African roots gave her a gift of clarity: “Growing up in Uganda, in a developing country, it was so clear to me that education was the way to improve life,” she said. “Your chances of being able to serve and be of value to the community was so much better with education.”
She fondly remembers spending time with her grandparents, surrounded by many active siblings and cousins. “My grandparents lived in a village and, when we woke up, my grandmother would have hot water for us (to wash with). They had a banana plantation, and we would go up to the garden, eating fruits and running around.”
But it wasn’t just playtime at her grandparents’ house. One day a salesman came by and Kasirye’s grandfather purchased a set of encyclopedias for the kids to read. “My grandfather would tell us to focus on school, tell us to do our best.”
When Kasirye came down with malaria, she discovered her interest in a medical career. “I had access to a Reader’s Digest. I read about the first woman surgeon,” she said. “And so I got into the medical school, continued to do a lot of reading and hard work. At nights, I would go to the hospitals and try to get cases.”
Further along, during an internship, she remembers hospitals being swamped by the AIDS epidemic. “We would be taking in people who were abandoned by their families because they were afraid of the disease. We did a lot of education.”
In the course of a long, winding road of medical training – from Uganda to the Bronx; Youngstown, Ohio; and eventually UC Davis – Kasirye ended up shifting focus to the bigger picture of prevention, public health and epidemiology – a cluster of disciplines that act as a protective umbrella of care over an entire community.
Before becoming the county’s public health officer, she volunteered at the Department of Health and Human Services as a physician, obtained her master’s degree in epidemiology at UC Davis and was hired for a succession of jobs at the county health department.
She served as STD controller, TB controller and medical director of the Child Health and Disability Prevention program. She also was the communicable disease controller at the Maternal, Child and Adolescent Health program.
Then, El Dorado County recruited Kasirye to serve as public health officer there – before Sacramento County wooed her back to replace Trochet.
On the go
Spend a day with Dr. K, as she’s fondly known by many of her 176 employees, and you’ll see how she paces herself in order to turn a full agenda into progress – meeting by meeting, encounter by encounter, policy by policy, conversation by conversation. Rare is the day when she has time to remain in her office, concentrating on just one or two important topics.
During one recent workday, her appointments had her crisscrossing town, from an 8:30 a.m. meeting with her flu prevention crew; to a discussion in preparation for a meeting with her statewide counterpart, Dr. Ron Chapman; to a next-step meeting with epidemiologists working on the Maternal, Child and Adolescent Health program; to a gathering of the First 5 Commission (of which she is a member) for a briefing on the progress of fluoridation of Rancho Cordova’s water supplies; to a drop-in visit and hazardous materials demonstration at the county’s laboratory.
At age 50, and with two decades of experience in her field, Kasirye does not want for energy. When mysterious powders turn up in the mail, the FBI turns to Kasirye and her lab to identify any bioterroism agents.
She’s also at the vortex of rabies control, West Nile virus testing, emergency management programs and the screening of hospital samples for the virulent H1N1, a sort of a “zombie” virus that’s re-emerged full strength after causing 2009’s worldwide influenza pandemic.
Through everything, though, the lessons of growing up in Uganda have stayed with Kasirye.
“If someone asked me what is the single biggest thing I would change in the world, it would be prevention and access to improved education,” she says.
“One of the things we’ve seen is through education, there is progress. If you give someone a high school education, and then you give them a college education, health disparities among populations start to melt away.”