The case of the homeless, drug-abusing prostitute with syphilis was a confounding one, even for a veteran investigator like Pat Dumalski. For nearly a month, Dumalski and her colleagues had scoured the shabby streets and back alleys of Wilmington, unable to find the woman.
The grizzled-looking guys who lived near the dumpster hadn't seen her. Neither had anyone else that Dumalski encountered on her rounds. At times it seemed that the illusive "Mary" had simply disappeared, leaving only a trail of syphilis-infected men in her wake.
Then, out of the blue, there she was one day last week, standing on a street corner eating Corn Nuts. "This is a coup!" Dumalski exclaimed as she quickly loaded the disheveled Mary into her Toyota and headed for the health clinic. "I actually found her!"
Dumalski and 105 other county public health investigators savor moments like those. It is the small victories that compensate for the frustrating times when hot-tempered people slam doors in their faces, when nasty dogs that may be rabid nip at their heels, or when they are called upon to cut the heads off dead animals slated for lab inspections.
But such is the life of a health investigator. Even by their own account, they are an unusual breed of people who earn next to nothing for jobs that next to no one wants to do.
"We're kind of like the garbage pail of health services," said Dumalski, 36. "It's not like we bring joy and happiness into people's lives. Most folks don't enjoy hearing that their pets will have to be quarantined or that they may have contracted a communicable disease."
In recent weeks, public health investigators have gained attention for their work in the county's crackdown on gay bathhouses. They inspect the clubs for evidence of unsafe sex and have also been given the job of compiling evidence against club owners who violate the county's new health regulations. But E. Keith Weeks, director of the Bureau of Public Health Investigation, said his staff spends much more of its time tracking down diseases in humans and animals.
Having Tough Times
These are especially tough times for disease police. In addition to AIDS, they are required to deal with a skyrocketing number of cases of syphilis and gonorrhea in Los Angeles County and with the ultra-resistant strains of the diseases such as penicillin-resistant gonorrhea.
The investigators compiled reports on the 25,000 animal bites in Los Angeles County last year. They also tracked a good number of the 38,000 cases of gonorrhea and 11,000 cases of syphilis that occurred in 1987, alerting people who may have been exposed. They were among the first people on the scene at the start of the Jalisco cheese poisoning epidemic of 1985, which was the the biggest food poisoning case in California history.
They are also responsible for preventing the spread of diseases like diphtheria, hoof and mouth, leprosy and meningitis, and for posting warning signs at hazardous sites. But despite all these activities, they are still frequently confused with the staff of sanitarians who inspect restaurants. "We have lived in their shadow for years," Weeks said.
Public health investigators earn between $23,000 and $29,000 a year. Most of Weeks' staff members, about 20% of whom are women, are college graduates with public health degrees. Despite the unusual nature of the work, Weeks said he is never short of applicants.
"The power of the health officer can be quite remarkable," Weeks said. "We deal with some very serious communicable diseases. And the people that join us tend to stay with it."
The investigators have an unusual assignment, according to Dr. Ellen Alkon, county medical director for public health. Alkon said most other metropolitan areas employ a variety of people to handle the jobs that are undertaken by one health investigator.
Alkon said the job requires someone who is intelligent, well-trained, observant, good with people and well versed in how to respond to vastly different situations.
"Over the years their responsibilities have expanded to the point where they were doing a lot of disease-investigation type of work, especially on sexually transmitted diseases," Alkon said. "It's a fascinating job, and it's not something that exists everywhere."
Some health investigators privately complain that they are overworked and underpaid. But administrators say turnover is surprisingly low.
Dumalski has been on the job for 14 years. When she graduated from California State University, Long Beach, with a degree in public health, she expected to work for the federal government. But the idea of relocating did not appeal to her, so she turned to the Department of Health Services.