From earthquakes and tornadoes to floods and bioterrorism, those working in the field have learned to expect the unexpected and must be prepared for any emergencies as well as tending to their regular duties.
"One thing I like about public health is you never know what is going to walk through the door," noted Kay Griffin, Scott County Health Department nurse practitioner of 20 years. "If there's something you don't like one day, the next day it could be completely different -- every day is a different day here."
Decades ago the Scott County Health Department's services basically included immunizations, family planning, the Women Infants and Children (WIC) program and treating communicable diseases, Griffin said.
"At first the general public didn't realize what public health did," Griffin said. "They'd come here for immunizations and learn the other things we did."
The Scott County Health Department originated in 1959 at Benton. Then in the 1970s, a branch office opened in Sikeston, which recently moved to a brand new facility. It has grown to 26 employees in 2004 -- up from the five employees in 1984 -- with numerous changes also taking place.
"When I started in 1984, we were just learning what AIDS was, how it was treated and how to take care of it. We've learned more about sexually transmitted diseases. We've expanded so much in so many different areas over the years," Griffin said.
Unlike years ago, public health now has several different vaccinations like chicken pox, hepatitis B and many others available, Griffin said.
"Methods of birth control have also changed. It used to be only pills. Now there's the shot and the patch," Griffin explained.
Flu shots were bigger this year than ever before, according to Debbie Pleimling, director of Stoddard County Health Center. Both Stoddard and Scott counties administered around 3,000 flu shots each this flu season.
However, Pleimling said immunizations at the Stoddard County center have declined from when it opened in 1991. Kids are getting their immunizations at rural health clinics, she noted.
Three employees made up the Stoddard County Health Center when it opened its doors in 1989 and today, the center has 15 staff members.
"Public health does so many different things and is pulled in so many different directions," Pleimling said. Setting up a bioterrorism plan is one of those directions public health is being pulled in.
Bioterrorism and being prepared is a key issue that public health is involved in, Pleimling said. "Bioterrorism planning -- which we didn't have for 9-11 -- is a very important part of public health," she said.
Bioterrorism planning is statewide, but it's also broken down to a county level, pointed out Scott County Health Department Administrator Barry Cook.
Basically when a natural disaster occurs, only the National Guard, American Red Cross and public health officials are allowed to help the injured, Griffin pointed out.
"For example, years ago there was the big tornado in Vanduser and three in Sikeston on the same night," Griffin recalled. "We were busy giving people tetanus shots and checking their well water."
In addition to bioterrorism, technology has also played a major role in change throughout the years, Griffin noted. "We used to have to do everything by hand. Now we can print out labels and letters from the computer and it saves a lot of time," Griffin said.
Copies of birth and death certificates can now be obtained at local health departments. Rather than having to mail a request to Jefferson City and wait for it to return, residents can go to their local health center and get a copy, Pleimling explained.
Health education awareness has also increased over the years with many health departments creating health educator positions.
"We do a lot of education in the form of programs, especially in a lot of the schools," Pleimling said. "I have a nurse and staff member that's doing dental education and hygiene programs. I have a health educator in every one of school districts providing nutrition education and physical education."
Not all the changes over the years have been positive ones though. Most recently, state budget cuts have affected public health. Scott County had to eliminate a nursing position and lost nearly $220,000 as a result of the cuts, Cook said.
Scott County's family planning program, which helps prevent low birth weights, was cut 100 percent. In 1984, there were 99 family planning clients in Sikeston and there were 1,000 clients at the time of the cut, Griffin pointed out.
Pleimling said Stoddard County hasn't had to cut any staffing due to budget cuts -- yet.
"I know we're coming up with another year of tough times," Pleimling said. "So we're just trying to be conservative and watch the way we spend money. Hopefully, we'll be able to wade through it until better times come."