Dr. Nafissa Cisse Egbuonye is the director of the Black Hawk County Public Health Department in Iowa and a member of The Kresge Foundation’s Emerging Leaders in Public Health, an initiative that supports leaders at local and county public health departments across the country to strengthen their organizations and improve the health and well-being of the people in their communities.

During the 18-month program, teams of public health leaders worked together to think beyond the traditional role of a public health agency and implement approaches designed to enhance organizational and leadership competencies in business, planning and public health systems development.

In this interview, Egbuonye discusses the most pressing public health issues affecting her community and how her involvement in the initiative has helped her and her colleagues to better understand their community’s needs.

Kresge: For readers who may not be familiar with Black Hawk County, please tell us about your community.

“Black Hawk County is considered one of the most diverse counties in the state of Iowa. Our county is rural but it includes the city of Waterloo, which is a city that is known to welcome   immigrant and refugee communities. So, we have people from Burma, the Congo, Liberia and Bosnia, just to name a few. We also have African-American communities that historically migrated from Mississippi. And we are preparing to welcome some Afghan refugees soon, some of whom will likely settle in Waterloo. Just the other day, someone from the school district told me that there are 75 different languages spoken in the Waterloo school district.”

Kresge: Given Black Hawk County’s very diverse population, what unique challenges does the community face?

“We see a lot of disparities in income and in health. And it’s fascinating because our county has a robust health care system and community organizations. So, the resources exist within the community and yet the disparities are so evident. We are very much a segregated community. In fact, in 2018, the Wall Street Journal named Waterloo the worst place to live as an African-American in the United States because of the racial disparities. And we see that in the patterns of diseases here. Whether they are chronic or infectious diseases, the rates of disease are much higher in communities of color, which are the same communities that have difficulties navigating the healthcare system. So, as a health department, we are really focused on health equity.

Kresge: What strategies are you and your colleagues using to achieve greater equity in public health in Black Hawk County?

Part of the work involves building relationships with our community, letting them know that we want to be partners and address these public health challenges together. In recent years we have shifted our approach to build relationships with non-traditional partners, like the business community. We have adopted a philosophy of educating before enforcing so that people will be able to not only understand what we do, but also see that we bring value to the community. By building those relationships, we have been able to get a seat at Grow Cedar Valley, our version of a Chamber of Commerce. We have made great connections through that with business leaders. We have dismantled the notion that we are just there for enforcement. They understand now that we can help their businesses to succeed.

Another piece is making sure that our decisions are not driven by what we think is best for the community but instead by what the community is telling us they need. We’ve been making a big push to make sure that we are not only offering the services that our community is saying they need, but also delivering those services in a way that will be efficient and effective for them.

Kresge: How has that shift influenced your approach to the COVID-19 pandemic?

I always say that you don’t build relationships during a pandemic. You have to build them prior to the crisis, and fortunately we did that so that when COVID hit, our community was comfortable talking honestly to us about what was happening and what they needed. For example, Tyson Foods has a large plant here and there was an outbreak at their plant early on in the pandemic. Because we have relationships with community leaders and members, people were calling us – calling my personal cell phone – and informing us of what was happening in the plant. We were able to communicate with management, share our concerns, and work together for the betterment of our community. And that only worked because people weren’t afraid to speak to us. That trust is really important.

We also worked with community leaders to get out the message of the importance of the vaccine, and then we had a pharmacist who went around to nail shops vaccinating people. He also went to barbershops. And we had mobile vaccination units in the parking lots of the grocery stores that serve various immigrant communities. In fact, at one of those mobile units, one woman thanked us for seeing and remembering her and her community.

Another example of delivering our services in the way that is most useful to our clients is the initiative we are launching on WhatsApp, which is an app that is very popular among our immigrant and refugee populations. We know that a lot of  newcomers in our community get their information from WhatsApp, so we wanted to use that communication avenue to make sure they can get information from us since this is more conducive for them. We have recently hired two community health workers – one from the Congolese community and another from the Hispanic community – and are working with them to build and test that program in those communities.

Kresge: How have these experiences helped you to evolve as a leader?

When you have this title of executive director, it can be intimidating for people. But I am working in public service. I shouldn’t be intimidating. So, I work daily to remove that layer. I give myself permission to be a regular person, to go into the community and just talk to people and hear what they have to say. Doing that gives me a better first-hand sense of what’s going on in the community. It’s also taught me how people like to communicate. Some people love texting. Me? I am not a texter. But I learned to text to better communicate with those people. Some people like the one-on-one coffee. Some people like the phone call. And for some people, showing up at public events and making myself visible as a regular person who is curious about my community and wants to learn more allows people to be vulnerable and share with me their hardships and successes. And I think I am better at my job for it.