Holly Brekhus, director of health promotions at First District Health Unit, stands in the FDHU’s new mobile unit March 20. Among features of the unit are two exam rooms, a cooling unit for vaccine storage and seating for four passengers.

First District Health Unit shifted into a new gear in serving its seven-county area with the addition of a new mobile unit that arrived Feb. 28.

The district used COVID-19 response grant dollars to acquire the mobile unit, which will be bringing both existing and new services to the region.

Lisa Clute, executive director at First District, said the decision to add a mobile unit was made after hearing from residents during focus group discussions a year ago. Clute said the purpose of the focus groups was to learn about community needs and concerns.

“We talked about the barriers that people have and some of it is transportation barriers,” Clute said. “We’re just trying to try to come up with creative ways to improve access to the things that they are indicating are primary concerns.”

One concern was the need for wellness checks for rural elderly. The mobile unit will take public health nurses into more remote areas for wellness checks and other screenings and referrals.

Another concern heard repeatedly was lack of access to mental health services.

“We certainly heard loud and clear, from clergy particularly and from our health care providers. They just have trouble accessing any sort of crisis mental health services and also just mental health providers,” Clute said.

First District is teaming with North Central Human Service Center to bring mental health providers into rural areas that are struggling with lack of services through the use of its mobile unit. North Central’s service area is slightly different from First District’s region, but Clute said once operations are functioning well with North Central, First District will reach out to other neighboring human service centers to investigate how to bring them on board as well.

“The other thing is we certainly have seen an increase in tuberculosis throughout our communities,” Clute said. Often, those patients require intensive services, and because the disease is contagious, they may need people to bring them necessities such as food and medicines. A mobile unit provides an optional way to bring care to these patients.

Additionally, the mobile unit can be used by environmental health staff as they work with food safety at county fairs and other large events, both in Minot and around the region, Clute said.

A primary function of the mobile unit will be making flu clinic stops requested by businesses. Rather than lugging equipment into a building, the unit will be set up to operate as a clinic, Clute said. That efficiency will make it possible to conduct more of these events, eliminating the need for residents to travel as far, she said. Because the unit will have special cooling units, it can carry multiple types of vaccines and have them available if requested.

“One thing that we have seen is a decrease in our vaccination rates over the last few years.That puts us at risk for vaccine-preventable diseases, and we just want to make sure that people are getting access to them if they want,” Clute said.

“The intent is to really make things more accessible for the public, and particularly in the rural area,” she said. “The possibilities are endless, and it is really a good opportunity to possibly get to hard-to-reach populations, such as the homeless.”

The focus groups also generated a variety of ideas specific to individual counties that the health unit has been able to implement. For instance, in Sheridan County, residents wanted a school nurse program. First District now contracts to bring the county nurse into the McClusky school once a week for about five hours, Clute said.

Each of the seven counties in First District has at least one public health office.

“They are so important to have,” Clute said of the county offices. “Those are small communities. They know that person that’s been in the office. There’s a trust and a relationship with them.

“We’d rather have things happen in our own little communities and not travel into Minot all the time. It’s just more personal and it just provides them the access. It would be extremely difficult to have access if we didn’t have offices out there,” she added.

The district was formed to pool resources, helping smaller counties sustain services that they would have difficulty providing on their own. A central administration office in Minot handles the budgeting, payrolls, grant writing and management. It also serves as headquarters for certain functions, such as environmental health, that operate districtwide.

First District’s roots go back to the Minot City Health Department, established in 1892. In April 1942, a joint health department was formed with Ward County.

In 1943, the North Dakota Legislature passed a law enabling two or more counties adjoining each other to combine and pool their resources to form a full-time health district. In that year, Burke and Ward Counties combined to form the Burke-Ward Health District.

The name “First District Health Unit” was adopted in 1945 after being joined by McLean County in 1944 and Renville County in 1945. It was the first multi-county health district in the state. The First District expanded to include Bottineau County in 1948, McHenry County in 1950 and Sheridan County in 1955.

Today, more than 60 staff provide a variety of public health services such as preventative health care, environmental health protection, nutrition counseling, and health promotion and safety education programs.

The health unit investigates food-borne illness outbreaks, licenses and inspects food establishments and operates a supplemental nutrition program for women and children. It provides water testing, food safety and beverage server training, testing for sexually-transmitted disease and HIV/AIDS, tobacco cessation, a falls prevention program and partners in programs such as youth farm safety and emergency response as well as serving as a health information resource for the region.

Among new programs added in recent years have been those in response to increased substance abuse in the region. The ability to provide Narcon to treat opioid overdoses and a syringe safety program are key in that effort.

First District is governed by its Board of Health, which consists of county commission appointee from each county. Due to its population size, Ward County has four appointees. The board has the ability to adopt codes, develop work plans and response plans based on specific community needs and resources. The district is not affiliated with the state Health Department or with any county or political subdivision but is a standalone entity, Clute said.

The Board of Health develops a budget proposal that must be approved by each of the counties. Each county contributes the same number of mills to the district. For 2023, the district has a budget just over $1.45 million, Clute said.

The City of Minot also contracts with the district for services for $318,000. The district charges consumer fees and can collect from private health insurance and from Medicare and Medicaid. Consumer fees are budgeted for this year at $1.77 million, with collections from Medicare and Medicaid at an additional $380,000.

Clute said there are a few smaller revenue sources, such as a contract with Minot Public School for school nursing. However, in general, about a third of the district’s revenue comes from local taxpayers, a third from consumer fees through insurances and licensing and a third comes from grants, largely from the federal government.