Dora Mills was a panelist at a recent HSPH event.

A girl grows up in a town of 5,000, becoming the first in her 10-generation family in Maine to earn a medical degree. She leaves New England, trains and practices in Southern California, performs medical service in rural Africa and Asia.

Lured back to her hometown of Farmington, ME by its desperate need for a pediatrician, she recognizes how much of the illness in the families she treats stems from poverty and lack of education. Maintaining her full-time practice, she commutes twice a week to HSPH for two years to pursue an MPH, rising at 3 a.m. to make the eight-hour round trip.

Then, even before she dons her cap and gown for graduation, the governor of Maine taps her to become the state’s Director of Public Health.

"When I went into the field, I never dreamt of becoming a public health director," said Mills. "It is a tremendous honor to serve the people in my home state, and it is exciting."

A recent health emergency, in fact, could have made a dramatic episode in the TV series. In April, the sudden illness of 16 parishioners at a church in the remote town of New Sweden, ME raised an alarm about a deliberate poisoning. Mills dispatched a nurse epidemiologist to interview the victims and a medical toxicologist to analyze a suspect pot of coffee. One victim died, but aggressive treatment, using antidotes the health department had just obtained with antiterrorism funding, kept the remaining 15 people alive.

Incidents like this punctuate the more routine but no less important challenge of extending common public health services to 1.3 million people scattered thinly across a vast and relatively impoverished state.

Maine lacks the customary system of county and local health agencies. Outreach, instead, is mainly through telephone hotlines and the media, communications through schools, hospitals, health centers, churches and granges "that even in rural areas provide some structure," said Mills. The Maine Bureau of Health partners with the Maine Center for Public Health, a non-profit organization established by the state’s legislature and headed by HSPH lecturer Paul Campbell.

Since the attacks of September 11th, 2001, an infusion of federal funds has helped Maine knit together a stronger response system to prepare for bioterrorism and other health emergencies. Joint exercises have brought together health and law enforcement officials, and new two-way communications links are being put to use. This all proved beneficial in the poisoning crisis.

"It’s becoming much clearer to us that when you build the infrastructure for bioterrorism preparedness, you are building for a number of different public health emergencies," noted Mills.

The health director said that public service runs in her family: "My dad is a lawyer, and he was in the State Legislature and State Senate. He was US Attorney for Maine for several years. I used to go to the State House with him when he worked. Two of my siblings are in the legislature. And my grandfather was a state senator as well."

During her medical missions in Tanzania, Nepal, and India, Mills lacked the pharmaceuticals and high-tech tools she had trained with. Treating diseases like infant diarrhea and malaria became a matter of basic public health interventions –identifying clean drinking water, encouraging people to use those sources, providing mosquito nets, and educating people about how to avoid mosquito bites. She was "pleasantly surprised," she said, at the effectiveness of these measures.

The perspective she acquired in these regions stayed with her when she returned to Farmington, where her patients included members of families she had known for years. "They were facing health problems that I knew their parents or grandparents had faced, but these were not genetically transmitted," she said. "The common thread was poor socioeconomic status." The problems included tobacco addiction, tooth decay, and poor nutrition.

And so this microcosm of the state’s health issues helped prepare her for the job she has now held for seven years.

"I thought I would just be able to improve the health of my home town," Mills said. "To do this statewide–this was something I couldn’t pass up."

--RS