D.C. Health Chief Focuses on Teamwork
Vigilance Says He Will Target Heart Disease, Obesity, Hypertension, HIV-AIDS

By Susan Levine
Washington Post Staff Writer
Thursday, April 17, 2008

Pierre Vigilance received his share of congratulations after being named the District's health director seven weeks ago. The good wishes came as no surprise: He would be leaving his position as Baltimore County health officer for a bigger, more visible job under a high-energy, activist mayor virtually the same age as he.

But colleagues and friends also offered somewhat joking condolences. In Washington, greater visibility triggers greater scrutiny and criticism. And, they noted, leading the D.C. health department has offered little employment security of late. Vigilance, 38, is the fifth director in the past decade.

He doesn't seem worried. Rather, he seems determined and focused on what he considers "a really good opportunity."

The opportunity includes a chance to tackle the burden of chronic disease in the city, to do things in ways "not as they've been done before" and to stabilize and advance a too-often troubled department. "I don't know if opportunities like this one come along very often," he said, before realizing the unintended irony of his words, given his predecessors' short tenures. Vigilance took over as director this month.

In Baltimore County, he improved uninsured residents' access to health care. Before that, in Baltimore, he oversaw education and outreach programs dealing with HIV-AIDS and sexually transmitted diseases. He emphasized a "shared responsibility" for health.

"It's not just how much the [D.C. health] department does for residents, but with them," he said. "We talk about screening people a lot, but then the issue is: Having screened someone, you've got to educate them to wanting to do something."

He knows how programs within a public health agency, and certainly within a city, can operate as islands unto themselves. But in Baltimore city and county, he got people talking and cooperating across their usual borders. He said he intends to do the same in the District. Even before he started here, Vigilance proposed a forum with various community organizations so that they can meet him and share their concerns about the department.

"I challenge that notion that we're already doing everything we can do," he said.

Joshua Sharfstein, Baltimore's health commissioner, gives Vigilance a good chance of success.

"He was always very interested in collaborating," said Sharfstein, who had begun working with him on a regional health disparities project involving hospital, church and other local leaders. "Pierre brings a very effective communication style and a very creative way of thinking about problems. It will serve him well."

Many people in the District are counting on that.

"He has a difficult task ahead of him," said Kim Bell, executive director of the D.C. Area Health Education Center, who made some calls to Maryland after Vigilance's appointment. She said she liked what she learned about his time there, especially his interest in partnerships to tackle disparities.

"That makes me optimistic that he will come in here and put a whole different face on the department," Bell said.

Vigilance, whose accent reflects a touch of his British birth, had lived in the District before. He went to college at George Washington University and, after medical school at Johns Hopkins University, did several years of emergency medicine training at Howard University Hospital. But he never expected to be a practicing physician. His interests lie more in administration, he said. He also has a master's degree in public health from Johns Hopkins.

Here, he will confront a department long criticized for an inadequate response to the city's high rates of heart disease, obesity, hypertension and HIV-AIDS, to name just four health issues that Vigilance said he wants to keep front and center. The department also has been faulted for a poor record of recovering funds from Medicare and Medicaid, as well as for ineffectively spending federal dollars for certain projects. On Oct. 1, much of those funds will be pulled away for a new health-care financing agency. The goal is marked improvement all around.

"The department has been able to do X, Y and Z, but some of the other letters in the alphabet have not been hit," Vigilance said.

He will confront numerous competing agendas. Enrique Cobham, interim executive director of La Clinica del Pueblo in Northwest, said he hopes services to the city's burgeoning Latino population remain equitable to those for other minorities. At the same time, Cobham noted, health issues often transcend racial or ethnic lines. Take diabetes, for example. If Vigilance can truly work in concert with Latino and African American groups, "that's one area that may offer significant improvement," Cobham said.

The chairman of the D.C. Council's health committee would have the new director concentrate on nuts-and-bolts needs.

"The temptation is always to come out with a new program to make a big splash, but I candidly would like him to focus on the staff," David Catania (I-At Large) said. While such detail is not the most glamorous, training and organization might need the most attention. "Building a world-class bureaucracy is essential to delivering services," Catania said.

Sharon Baskerville, executive director of the D.C. Primary Care Association, will look for the big picture. After six months, she would like to see a new sense of mission and direction at the agency.

"A department that believes in and is confident in its director," she said. "A department that's working with its director instead of against him. A department that has a clear road map of where it's going."