A Film About Casper (1972)

the first settlers who came to Casper Wyoming faced many hardships they had chosen a Barren and seemingly heartless land and they brought little with them that would have help them in their struggle to conquer it other than their own tenacity in fragile wagons loaded with meager supplies they crossed the North Platt River on their way west into the comparative safety of Fort Casper and under the protective wing of the Cavalry this passage to the West was not an easy one and the settlements along the way were tenuous dots of civilization on a wide and empty expanse settlers here had to surmount their problems without outside help that took a special courage here in the Mountain West the Indians told the newcomers of another Hazard Legend says the soldiers who came first were told to forsake this country the Indians spoke of The Valleys of the aching joints of areas where many had sickened and died judging from army records and other information for this period it is quite possible that among these mysterious fevers was the one we know as rheumatic fever the people of contemporary Wyoming are well aware of this problem the fever that puzzled the Indians remains a serious health hazard today in the northern Rockies towns like Casper lie within what has been referred to as a strep belt one of the five so-called belts in the United States this means that these communities report a relatively High prevalence of infection with the microbe known as the strepto cacus and as a result a high rate of rheumatic fever and rheumatic heart disease but in Casper the citizens decided to do something about this they have created and enforced a CommunityWide strep tockle surveillance and treatment program that has all but eratic at rheumatic fever in their school age population and which has become the model for a Statewide program under the Wyoming State Health Department and for the US Public Health Service control programs in Colorado and Alaska [Music] romatic heart disease begins as an infection with a particular strain of strepto cacus certain people react to this infection with the fever and aching joints known as rheumatic fever one attack of rheumatic fever tends to follow another every time the susceptible person is infected with the strepto cacus the aching joints and fever disappear but repeated attacks lead to damage of the heart valves rheumatic heart disease of the rheumatic fever victims who are left with heart damage something under 20% of the total some may undergo corrective heart surgery some may not all will have to live within the limitations dictated by chronic heart disease and in any case the romatic fever victim once recovered from his first acute attack must undergo continuing surveillance and prophylaxis to prevent a recurrence of the illness to which he is left more not less susceptible a streptococcal infection may also lead to Chronic glome maralon nephritis or Brites disease a serious kidney disorder that may eventually require the victim to undergo repeated expensive treatments on an artificial kidney machine the average victim of rheumatic heart disease spends between 25 and $50,000 on his illness during his lifetime there are more than 1 and a half million such persons in the United States alone and each year 16,000 of them will die of a disease that has been called the most common serious preventable disease the Casper Community became Disturbed at figures like these and with the help of local residents such as cardiologist Dr Brendan fibs organized an efficient system for detection and treatment of streptococcal infections thus getting at the heart of rheumatic fever control if you went to a doctor and uh he told you you had cancer or leukemia or that your child had Polio you'd be terrified and rightly so on the other hand if you went to a doctor and he said your child has a strep throat you wouldn't be very excited about it the ironic thing is that the strep infection in either the throat or skin could be just as deadly as cancer and just as crippling as poo we Physicians who lived in Casper realized that this was one of our major public health hazards we determined to do something about it their program of disease prevention at the Grassroots level started its fight against dramatic fever in 1954 now every morning when school is in session a team composed of volunteers arrives at each of the Casper elementary schools these individuals usually mothers with school-aged Children of their own go to a room set aside for them by the school and prepare their equipment for the morning routine some schools will take and have a team of mothers that will come in a week straight and then they'll be off for five or six weeks like we do it here we have teams of two they come in once every other week I found that this is probably the easiest on everybody because they know every other Thursday is their day the women are provided with the equipment they need by the strep tockle controller program they are preparing to inspect a certain number of children for signs of sore throat or fever and to swad the throats of those who are likely to have streptococcal infections at the same time the classroom teachers are determining which children should appear for inspection any child who says he has a sore throat is sent as is any student who brings a note from home requesting that he be checked and every day one row of children is sent as well in the case of kindergarten classes all the children are sent for inspection daily the age group between 5 and 18 is by far the most susceptible to rheumatic fever this is why a surveillance program centering around the elementary and Junior High Schools is effective in controlling the disease in any Elementary classroom as many as one child in four may be carrying strepto cacus in his throat the children may or may not feel or appear ill all who carry the strep tacus are vulnerable to romatic fever and all are capable of passing along the infection the children who do not appear ill are the asymptomatics okay come on okay hi there how you doing this morning okay you can go symptomatic kids are children with no particular sore throat they're not complaining of any symptom of strp so we swab them anyway these are the kids that you want to pick up they're not complaining of any illness or any problem but they're the ones that are running around class spreading it all over all the selected children appear in the swabbing area the volunteers inspect each of them for swollen glands a red throat or perent drainage and swab those children who have any of these signs [Music] the strep lives up in back of the uula and if you take your swab and go at a downward angle first and make a circle coming up and do it properly the child will gag which pulls the strep down to where the swab can pick it up have to be rough while the swabbing progresses careful records are kept the swab has given a number which corresponds with the child's name and school we usually just take turns one of us will do the swabbing one day and one of us will do the records if we have a huge amount of children coming through at one time we just work together whichever way works out the best the team usually works for only 15 or 20 minutes each morning they then gather their materials and leave one goes home while the other takes a side trip to deliver the swabs she and her teammate have collected to the John B triony Jr romatic fever control laboratory named for a local pharmacist who died of rheumatic heart disease mothers from each of the schools bring their swabs to the laboratory every morning and laboratory Personnel then prepare culture plates these plates are incubated overnight the following day the presence or absence of the strepto cacus can be determined laboratory analysis of plates made from throat cultures is the only way to positively identify a streptococcal infection a Visual Diagnosis by a physician is inadequate when working with strepto cacus after the identification of a positive growth one of the lab Personnel telephones each school with the names of children who have group a beta hemolytic streptococus the strain of organism that leads to rheumatic fever we processed on the average of 1500 cultures a day last year we processed 156,000 cultures in the laboratory alone out of that we had 740 some strepto caco infections clap clap this go drop drop drop all the way [Music] to this desire patosi has positive culture I've contacted her mother and she children who have a positive culture are required to take a note home explaining this to their parents the note states that the child will not be readmitted to school until he has been adequately treated by a physician or until subsequent culturing proves that he no longer has the infection the real problem comes in when a child says but I don't feel sick I don't have a sore throat I don't cough then you have to say but this is the bad part that this disease can be in your body and you not know it and thank goodness we can find him and make sure that he doesn't grow Ro sometimes you just have to out and out love them and cuddle them and explain the whole thing again about how serious this can be and and how marvelous it is that we have U the ability to help them through this illness in a very real way the entire prevention program hinges on this legal right to exclude a child with an infectious disease from school until he has been treated for his infection Most states have this right the Casper prevention program runs smoothly now there are more than 400 volunteer mothers there is a well equ equipped laboratory and the citizens are fully informed about the necessity of such a program but like all projects of this magnitude the Casper program's Beginnings were marked by the problems involved in getting large groups of people from different walks of life to work together two men in particular were responsible for conceiving and initiating the plan that would develop into a full-fledged program Dr fibs a cardiologist approached Dr Donald Becker a pathologist with the idea for a strep tockle control program some initial testing needed to be done in the schools so that there would be sound statistical evidence to show the County Medical Society local Service Groups and others who would have to become involved if the program was to work someone was needed to do the lab work we were both interested in the possibility of some sort of an intellectual stimulation in terms of a project or something uh that could be done here in this community with the facilities that we had at hand Brandon course has always had a major interested in cardiology and rheumatic fever is has been a problem in this community for many many years so one day quite informally in a a conversation Ren and I discussed the possibility of trying to do something about the rantic fever program now the key part of the whole program boils down to what you convince the throat swappers to do or teach them to do and that is to get a throat swab up behind the uula or the red spot is here at the back of the throat and that's where you find the stre to cacus mobilizing enough volunteers to cover the school system was a major undertaking these women had to learn to inspect with the aid of a tongue blade and a flashlight for the signs of a streptococcal infection and to swab a throat properly interested Physicians did the initial training then the volunteers began to recruit and train each other I'd never heard of a strep culture program before we moved here but when school started and the kids brought home a note from school about the program we were in the motel for a month before we got our house and would you believe it I was involved in the program before I got out of the motel I figured that when I do it for other children I'm also protecting my own training the mothers was one thing training the lab Personnel was another because they required Technical Training the hospital lab soon found they could not handle the growing volume alone Mrs Joanne Taylor a registered nurse was pressed into service she had no background in microbiology but she trained and trained and now does most of the identification work in the laboratory I'd been doing cultures at the kindergarten where my children were going to school and on my way to work I would bring the cultures and stop and talk to the technician who was doing the cultures and Dr Becker one day called me and said Joanne would you like to work in throat culture program doing microbiology and I said yes I'll try it for one year I worked with Dr Becker every day until towards the end of the year he put me on my own and since then I have used him as a backup whenever I had have had a question on any culture that has been involved in the program one very important group to pull into the program early was the local Physicians they were needed to help with the initial volunteer training but most of all they were to become involved in the treatment of children whose cultures were positive the Natrona County rheumatic fever committee was set up to coordinate the education of the total Community by the medical society all of us in Casper that it's not necessary for the physician to reexamine this child all that needs necessary is that the nurse verify whether this child is allergic to penicillin this is very important because it cuts cost to the family and any means that the cost can be kept to a minimal level the more successful the program the treatment of beta hemolytic group a strip is either penicillin by injection or oral or Romy orally if given by injection this is long acting penicillin or if it's given orally by penicilin or arthis it's 10 days of oral medication specifically 10 days of medication Casper was the first Community to attempt a comprehensive program of this type and since it was the first the project had to be designed from scratch the laboratory was The crucial area lab procedures had to be both effective and economical effective so that there was little or no faulty identification and economical so that the service could be provided to the community at little cost there were some previous studies in the field to consult and there were Professionals in the medical world who would give advice about technique and procedures but beyond that it was all up to Casper and the people of Casper after many years of working with this program on a very very tight budget we now have some of the finest equipment in our laboratory that can be bought including our fluorescent antibody microscope the microscope is quicker more accurate than any other means of streptococcal detection the conjugate stains only the group a strepto caucus the others Fade Out that you see nothing but the A and it's a round chartreuse Circle very predominant the lab itself is now a well supplied and highly technical installation it was not always so well supplied functioning on an auster budget the technicians had to keep an eye open for good bargains and use all their resourcefulness so did everyone involved in the project we quite often have fathers who are traveling into town bringing cultures in on their children from the ranches we have many outlying districts we have bus drivers who bring in cultures the mothers have taken at school uh we have even one time had a team of a father and a mother actually I believe they were grandparents who went every Thursday afternoon and did throat cultes on the kindergarten children the Casper strep shako prevention program is now somewhat of a local institution in the beginning it was necessary to educate the public but now a well-informed public is keeping its own watch over the program Casper doctors say that any physician who tried to tell a Casper mother that her child had a strep infection without first having taken a throat culture would get one standard retort how do you know since its Inception the program has grown in many ways in many directions it has grown out into the community at large for instance it is not uncommon for parents to come directly to the laboratory and request that their throats be swabbed or to bring their preschoolers in for the same reason funding of any Community program is always a problem Casper raises its own money through a local fundraising organization each year this health Foundation gathers enough money during a week-long drive to provide the culturing service free to the community even the children contribute on Valentine's Day they give to the fund instead of exchanging cards with their classmates but the program has reached farther than Casper other towns began conducting similar throat swabbing sessions in the schools and mailing their swabs into the Casper laboratory in fact the state is now dividing itself into two sections towns in northern Wyoming send cultures to Casper while Southern communities send theirs to the public health department laboratory in Cheyenne this state involvement helps to keep money available for the laboratory there is no doubt that this community has developed and managed to sustain a successful strep tacle prevention program the nature and extent of the success is not difficult to evaluate this much is known not one case of rheumatic fever has been reported among the 14,000 school children in Natrona County in more than 4 years the rate of streptococcal infection in Casper school children has dropped to Less Than 3 per 100 rather than 25 per 100 but nobody knows how many Casper children who are now young adults did not get rheumatic heart disease because because of the program nobody knows how many school days these children would have missed if there had been no program or how much money the program has saved the community and the people in it questions like these are rarely asked in Casper those who are involved in the program are surprised at such inquiries they have proven the feasibility of this program to others but most importantly to themselves and that seems to be enough when has to face certain facts about strepto coal disease and follow those facts to their logical conclusion first one must Grant the fact that strepto coal fitis preceding rheumatic fever is very often so mild that the victim never brings it to anyone's attention granting further the fact that rheumatic fever is at its peak incidence in school children during the school year admitting therefore that most streptococcal infections preceding rheumatic fever will not be detected or treated then the logic behind an organized attack on the reservoir of streptococcal infection in the school child population is tremendous Casper's gratifying results can and have been duplicated in other strep tockle control programs these methods were extended over the entire state of Wyoming with equal success and when the United States Public Health Service copied the Wyoming experience in a high-risk area in Colorado they met with excellent results thus the end of the film about Casper should be and is just the beginning [Music] e [Music]