San Francisco Examiner - January 7, 2005

Sandra Hernandez, M.D. is CEO of the San Francisco Foundation, an organization that administers more than $65 million a year in grants to other Bay Area nonprofits. The majority of the $65 million is raised through private donations. Hernandez came to the Foundation in 1997 after serving three years as director of San Francisco's health department and she continues to practice medicine one day a week at an AIDS clinic at San Francisco General Hospital. She sat down with The Examiner's Josh Wein to share her thoughts on the current need for giving overseas, the public health issues that face the victims of the tsunami disaster and those we encounter in the Bay Area.

EXAMINER: During your career in public health, have you ever seen any disaster that required the complexity of coordination of care-giving, while not the scope, of the Indian Ocean tsunami?

SANDRA HERNANDEZ, M.D.: This situation is incredibly complex. It affects 12 different countries, each with different politics, different cultures and different religions. Many of the hard hit areas are poor, small island countries, which are isolated and have unsophisticated public health infrastructures to begin with.

So when you're trying to provide something like mental health support, it's critical to understand the cultural norms of each location. Many of these survivors will suffer from Post Traumatic Stress Disorder, and may develop great fears of water. These are people who live in areas where the economy is very water-driven, such as fishing communities.

Q: In natural disasters in the United States, such as the Loma Prieta and Northridge quakes, floods along major rivers or the hurricanes in the Southeast, we never hear much of anything other than humanitarian assistance and reconstruction. Are there serious health risks inherent in the natural upsets we Americans experience? Have they ever gotten out of hand?

A: We have one of the most sophisticated public health systems in the world. The Centers for Disease Control and Prevention does an amazing job of tracking and preventing the spread of diseases. People have criticized that it's not as sophisticated as it has been in the past. But when we have disaster in this country, we mobilize.

But we lost many more lives to AIDS than we should have and that was because we were slow to respond.

Q: What are the most serious threats to human health as a result of the tsunami, how do they arise, and what can we do to counter them?

A: The biggest issue you have is salt water that may have contaminated drinking water wells. Part of the process now is assessing every water source, and learning what water is safe and unsafe. Everyone has to have water to live, but we also must assume that the water sources are contaminated before people start drinking from them.

Antibiotics is another big issue -- getting the right antibiotics where they need to go, and monitoring where there are outbreaks of infectious diseases is going to be an enormous task. In modern history we have never had this magnitude of a potential public health crisis.

Q: Leaving aside the U.S. Government response, let's explore private giving and this huge disaster. Do you have any thoughts about the generosity of Americans? It has been said that in other countries assistance is provided through the government but that Americans as individuals are far more generous. Is that true?

A: This country and this region in particular, have a very strong philanthropic spirit. We are a much wealthier country than most others and I don't think it's as much a question of who cares more or who is more generous.

Disasters like this bring out the best in humanity; my hope is that this spirit won't fade too soon. I hope that we don't turn the channel.

Q: Has the S.F. Foundation played any role in channeling donations by individuals to the tsunami effort?

A: We have created a Tsunami Recovery Fund. We looked at a number of organizations that were on the ground before the disaster. Our focus is to work with organizations that were in these places before the tsunami and ones that will remain there after this acute relief phase is over.

Q: There seem to be an enormous number of relief organizations, from the Red Cross to The Salvation Army, UNICEF and many others, involved. In your experience does the multiplicity of hands help or hurt? Is it possible to coordinate so many players?

A: What we need to hope for is a strong coordination effort. I don't think it's about too many or too much. It's about coordinating and cultivating relationships between the countries that have been affected and the relief organizations.

But we really need to think long-term about this. It's been less than two weeks since the tsunami. In the long haul, people will need strong health care clinics, quality schools and a mental health care system.

Q: Health care and related educational and research institutions in San Francisco come right after tourism and convention business as major economic drivers of The City, at least insofar as they provide jobs and encourage businesses to operate here. Do you consider that an important strength of The City or does it skew our economy?

A: We have a lot of intellectual capital in the region and that intellectual capital is in many different areas. Much of the organized leadership is right to try and create an economy that capitalizes on that intellectual capital.

We have some of the best research institutions right here in Stanford and UCSF, and I think that is a good thing. It puts us in a very competitive position.

So does our geography. Our proximity to the Pacific Rim and our proximity to Latin America give us a diversity in this region that is a huge advantage. All regions need to figure out what can drive it's economy, and the Bay Area is a Mecca for health care.

Q: Health care has become such a concern that it now infects labor negotiations, as we saw during the recent hotel strike and lockout. HMOs and other organizations have sprouted to attempt to control health care costs but they seem to be spurting ahead again. Do you think that if we had a universal health insurance program administered by the state that there would be the cost discipline required?

A: I think it's very hard to address the skyrocketing costs of healthcare without reforming the entire system at the national level.

We are a society that feels everybody should have everything but that nobody should have to pay for anybody else's. We need to figure out how to reconcile that.

Ultimately the federal government would have to lead an effort to provide a standard of care with a focus on public health outcomes, chronic diseases and disease prevention. But I think it's difficult to expect any individual state to be able to tackle this problem without significant support from the federal government.

Q: Do you think that Care Not Cash is effective? Are you seeing fewer people at S.F. General because they are being housed with health care professionals available in their living area?

A: San Francisco General is not the best place to determine how well Care Not Cash is working. What we have seen is a commitment to get the homeless housed. I think the homeless situation is remediable. The City is starting to make some progress in terms of getting people off the streets and I think we're almost to the point where the general public would say they're making a real impact.

But this city is facing a large deficit and has already been forced to cut services. The question now becomes how do you go about reorganizing in a way that doesn't diminish cash assistance and not end up providing care services in its place.

I believe that supportive housing works, but we need more scale. I think it's very unfortunate that we didn't pass the housing bond. I think we need to keep at that, and come back and try again. And we have to keep an eye toward preventing new people from becoming homeless, which means providing more affordable housing.

SANDRA HERNANDEZ

Professional History: Hernandez joined the San Francisco Department of Public Health after completing her residency with UCSF. She served as director of that department between 1994 and 1997 before joining the San Francisco Foundation.

Education: Received a Bachelor of Science from Yale University before attending Tufts Medical School in Boston. She completed her residency with UCSF.

Recommended reading: "'The Plague' by Albert Camus is a book I have read many, many times."

To learn more about the San Francisco Foundation's Tsunami Recovery Fund, visit www.sff.org

2005: CHALLENGES AND OPPORTUNITIES

During the month of December, The Examiner is asking distinguished experts to give their views on the issues that confront our cities, our state and our nation, in the next year and beyond. The subjects of our interviews are leaders in their fields, people of creativity, foresight and innovation, who will help us examine the present with an eye toward the future on the subjects that define us and our times.

Today, in her role as CEO of the San Francisco Foundation, Sandra Hernandez discusses the public health and philanthropic needs of the tsunami disaster victims and examines

San Francisco's homeless problem.

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