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Questions for Carol Garvey

Garvey announces plans to retire.

Dr. Carol Garvey, longtime Potomac resident, has been Montgomery County’s top health official since 1995, and has overseen county efforts on many health-related issues. Prior to her county position, her career involved work in family practice and public health. She spoke with The Almanac from her office in Rockville on Friday, Jan. 3. She will retire March 31.

Q. How did you enter the medical field after receiving an English degree?

A. “There were two basic aspects to it. One is knowing I was getting close to the end of my education, I decided to take some basic science my senior year, and I enjoyed it. … So [Tom Garvey] knew that the subject matter would interest me.

“The other thing was… as far as my parents were concerned, I had to come home with an engagement ring, and [my husband] basically said that he wouldn’t marry me if I didn’t agree to go to medical school. … I was coerced.”

“Both of his parents and his sister are physicians. I think he figured he wouldn’t know how to deal with somebody who wasn’t a physician.”

Q. What interested you in the public health?

A. “When I got into clinical medicine, the thing that impressed me most was how economics affected the context of the care. ... I wanted to work on the issues of access of public care, so that really got me pointed towards public health, really from my first clinical rotation.”

“What I was looking for was some way to combine public health and practice, because what I did find during my residency was as important as I thought public health was, I loved taking care of patients, so I didn’t want to be in a purely administrative job.”

Q. How did you become involved in Montgomery County’s public health system?

A. “Starting after [my son] left for college in ’88, I became kind of a nudge or gadfly to the county, and I got very involved in Gail Ewing’s breast cancer screening program. The county set up [in 1990] a system to pay for mammograms, but since 15 percent of breast cancer can’t be found by mammograms, I insisted to the health officer that it was not appropriate just to do the mammograms and not have a clinical breast exam. The result was I ended up coming to this building every Friday afternoon and doing breast exams on all the women that were having mammograms.”

Q. What has been your favorite time as the county health official?

A. “I think I have two favorites. One is to see the development of a primary care program. … I had gone around and tried to build up support for the concept of a primary care coalition with the medical society, the health department, and the five hospitals.”

“Everyone was actually quite willing to sit down together and try to work on the problem of access to care, but it took the involvement of a physician named Horace Burnton… ”

“Now it’s got a big office in Silver Spring, a lot of employees and is working with the community on a tremendous number of projects to improve access to care.”

“My other favorite thing… is having people begin to … recognize and address the severity and disparities in health status among the various groups in the county. I think we really benefit from the tremendous diversity we have, but the diversity really creates challenges; not just financial but also cultural and language challenges and barriers.”

Q. What public health issues do not receive enough attention, in your opinion?

A. “Risk communication is one of the most important, but also one of the most difficult, tasks of public health.

“To me the out-and-out biggest public health problem that we have is the lack of fitness, terrible eating habits and inactivity. And it’s hard to get people excited about that.”

“I think the things that concern the public are things with which they are unfamiliar, and areas in which they feel like have no control. They’re very familiar with their food and their activity, and feel as though they could control it if they chose to do so.”

“Something like West Nile, being new and unfamiliar, is very frightening. Influenza kills thousands and thousands of people every winter, for instance; that doesn’t mean that everybody goes out and gets a flu shot, but we could prevent more deaths if everybody did get a flu shot.”

Q. What impact will President Bush’s smallpox plan have on Montgomery County?

A. [Points to a filing box nearby.]

“That box is all smallpox. I keep it on my desk because I get so much stuff every day that I can’t go across the room to file it.

“We have submitted a plan to the state for immunizing, and we will begin immunizing people on Jan. 27.

“We will be immunizing people from our own staff, and also people from hospitals in this county, and also several adjacent counties. …That is going to provide us with a core of immunized people both in the hospitals and outside who will be ready to respond should there be an event. "

“We do not plan to immunize the general population, and that’s because we really think number one, the risk of an outbreak is still very low; number two if there is an outbreak, we know that the ring vaccination technique has been effective. …

Q. What are some challenging aspects of bioterrorism response exercises that might not ordinarily occur to people?

A. “With September 11, the federal government sent everybody home. That immediately put many thousands of cars on the road. Our department of transportation has the ability to remotely control traffic lights. … We need to have the ability to respond by changing traffic patterns.”

Q. How have you seen the county’s mental health policies change during your time at this position?

A. “What I’ve seen, which has been very distressing, was the disappearance of Community Psychiatric Clinic, which was really a venerable institution for over 60 years. The whole issue of mental health care and financing is so complex and I don’t think this is all the fault of Medicaid, and I don’t think it’s the fault of privatizing, although both play some role.

“The problems are the same as they’ve always been, although I think it’s probably to a worse degree now. … I don’t know what the way out of it is; I don’t know how we replace what we’ve lost."

“The one exception is our multicultural program … that the county has retained. That, I think, is unique and actually pretty wonderful, because one of the biggest challenges is trying to provide mental health care when there’s a language barrier.”

Q. What are your favorite non-work activities?

A. “I love to travel; I love to be on Cape Cod. We have a family farmhouse. … It’s just kind of a rambling which takes perpetual effort. At home, I love gardening too.”

Q. What is your favorite part about living in Potomac?

A. “We moved to Potomac specifically because we wanted to be near the C&O Canal and the towpath, and we’ve enjoyed it greatly — just walking or bicycling and enjoying the beautiful scenery.”

“[Potomac] has become more suburban. We felt as though we were moving to the country in 1976.”

Q. Does retirement mean more time in practice, or more time at Cape Cod?

A. “I’m not planning to practice. It means more time for four generations. My parents are in Baltimore, and my son’s wife is expecting a baby in June, and I’m really looking forward to being a grandmother.”

“I don’t plan to disappear. I plan to continue the advocacy on access to health care for low-income people. … I expect to do it as a private citizen.”