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County bids farewell to Dr. Bob

Bob England didn't sign up for this. His stint as Pima County Health Director was supposed to last three months. But life has a way of screwing up even the best-laid plans, erecting roadblocks like a global pandemic that turned this interim gig into a nearly yearlong job managing the health of Pima County residents under some of the most trying circumstances imaginable.

Coming home

England joined the Health Department during the first week of June 2019, replacing former director Marcy Flanagan who left the job to take his old post as health director in Maricopa County. At the time, he had been "happily retired" since February 2018, after 12 years at the helm of Maricopa Public Health.

He took the Pima County position as a favor to Deputy County Administrator Dr. Francisco Garcia. They agreed England would stay six months at most, just long enough to help recruit a new, permanent director and to lay the foundation for that person to take over.

"I never started it thinking I would just be a warm body," England said. "What we agreed to was that I would defer most decisions to a successor, because they were the one who'd have to live with them. But this turned into a much longer time frame than we expected."

That’s probably the understatement of the year.

England did make some structural changes to the department, elevating the Community Health and Food Safety program into a stand-alone division and reshuffling some vacant positions to bolster the department's epidemiological team.

The move down Interstate 10 didn't take him into unfamiliar territory. He graduated from the University of Arizona College of Medicine in 1983 and he began his career in public health as an Epidemiology Program Manager with Pima County in 1987 after earning a master's in public health at UCLA. While his address changed, his surroundings were definitely familiar.

"It felt really warm and welcoming,” England said. “That didn't surprise me. What surprised me is just how good the people are here. There are a lot of really dedicated, really idealistic yet grounded folks who work for this department."

Health department staff have been equally impressed with England.

“Dr. Bob has been an amazing educator, cheerleader, and mentor to not only myself, but to the entire department and community,” said Assistant Health Director Paula Mandel, who has worked side by side with England at the County's Emergency Operations Center near Reid Park since the County mobilized operations there in early March. “He came in with such openness, and he is always willing to offer support and brainstorm ideas on how we might better meet our mission, expand community outreach or forge new partnerships.”

Long days and nights

Leading Pima County's response meant England spent long days at the EOC in seemingly endless meetings with staff, local leaders, healthcare partners and community groups while overseeing regular Health Department operations. England helped deal with the demands of the job and stayed engaged by drawing cartoons, a talent he first developed in medical school as a way to lampoon his professors. He even parlayed those skills into a part-time job as an editorial cartoonist for the UCLA student newspaper. His drawings have become highly prized gifts for many Health Department staffers.
cartoons
“Throughout the course of this experience, I have appreciated how his cartoons can lighten up difficult or frustrating situations,” said Health Department Community Relations Manager Aaron Pacheco, who scheduled dozens of interviews for England with local and regional media outlets clamoring for information on the pandemic. “He does a really good job of capturing the feeling in a room and, with a few strokes of a marker at the whiteboard, allows us to break the tension and have a laugh.”

The series of cartoons, at right, touch on a special interest of England's: racial and economic the concept of health equity, which seeks to eliminate disparities in health care among people experiencing poverty, racial or religious discrimination, unemployment or lack of education.

While the cartoons provide some spots of levity, the gravity of the current situation remains top of mind for England, who has worked to counter a number of pandemics in his career. He called COVID-19 the largest, most dangerous outbreak he's seen, far more virulent and infectious than the 2009 flu or SARS, which spread worldwide from 2002 to 2004.

Serving twice as the state of Arizona’s epidemiologist left England well-positioned to share his expertise with Pima County when the pandemic hit.

“I can’t tell you how lucky we’ve been to have Bob at the helm navigating this truly unprecedented situation,” said Garcia, the County’s chief medical officer and one-time head of the Health Department. “He has brought so much to the table, from his expertise in infectious diseases to his leadership role heading up large and small health departments to his work in migrant and community health. And he does it all with wisdom, grace and that crazy laugh of his.”

Going viral

England was only a few months into his post when the COVID-19 outbreak hit. When the County mobilized to address the pandemic, County leaders tapped him to record daily public health updates. The 53 videos he recorded made England something of a local celebrity and became some of the most popular content on County social media accounts, generating more than 650,000 total views and hundreds of comments. 

In his final video as Health Director on May 29, England thanked colleagues and the community at large for their support. In return, members of the public praised England for his candor, easy-going manner and informative updates, with some dubbing him the Dr. Fauci of Pima County. See a sampling of the comments here.

County Administrator Chuck Huckelberry doesn’t object to the Dr. Fauci comparison, but thinks England’s easygoing demeanor also shows a striking similarity to one of TV’s all-time nice guys, Mr. Rogers.

“The public desperately needed accurate, trustworthy information during this crisis, and Bob provided that,” Huckelberry said. “But what I appreciated most was that he delivered his updates in such an honest, approachable, straightforward manner. We’re indebted to him for being that steady voice during these turbulent times.”

Gratitude from the Board

Huckelberry shared his appreciation for England’s work at the June 9 meeting of the Pima County Board of Supervisors, where England received a framed proclamation marking the day as “Dr. Bob England Appreciation Day,” a glass Philabaum Award (complete with its own face mask) and kudos from the Board.
“Dr. Bob provided that unfiltered advice that we all needed during this crisis,” said Board Chairman Ramón Valadez. “His credentials are excellent, his compassion unparalleled and his leadership unquestioned. We’re truly indebted to him as a community.”

Board members also played a tribute video to England at the June 9 meeting.

England said he appreciates the praise but insists he gets far more credit than he deserves.
Chuck Huckelberry and Dr. Bob England
"Whatever we've achieved hasn't been me. It's been a whole bunch of people who are working every bit as hard and are just incredibly dedicated. I'm so grateful to have these people here when we went through this. And I'm incredibly grateful to the community.”

He particularly praised individuals and organizations who stepped up to make homemade personal protective equipment such as face shields and cloth face coverings, businesses such as distilleries that switched their production to hand sanitizer and disinfectants and community members who offered to shop or run errands for at-risk neighbors. He also singled out the thousands of people deemed "essential workers" – those who work in food service and grocery stores as well as nursing assistants and housekeeping staff in assisted living facilities -- who have put themselves at the greatest risk to care for clients and who endured the worst local outbreaks.

Passing the stethoscope

England will focus his remaining time with Pima County on helping Dr. Theresa Cullen (see related story), who started officially as Health Director June 1, get up to speed. He expects to leave June 20. When he finally packs up his Tucson apartment and heads back to Phoenix, he and his wife will concentrate on taking care of their family, dividing their time between his parents in Fountain Hills and her mother in Massachusetts. While the pandemic won’t dominate his every waking moment, he will keep up with COVID-related developments here and statewide and remain available as a resource for his successor. He predicted Cullen will succeed in helping the community find its way toward a "new normal."

"Terry is coming at this from a personal and ethical place, and with an understanding of the underlying issues that meshes really well with what is already here in the Health Department," England said. "She is an outstanding person, an outstanding doctor and an outstanding person.”

For her part, Cullen said she feels fortunate to receive the baton from England, a medical school classmate and long-time friend. The two forged a bond while serving on the University of Arizona College of Medicine's Commitment to Underserved People (CUP) program, where each first developed their commitment to community service and an understanding of how socioeconomic and cultural factors impact health. 

“Bob really guided me and made sure I understand what is important to the community and what is important to the Health Department’s staff, as well as helping me get acclimated to Pima County’s culture,” Cullen said. “He eliminated the complexity of it all. I feel so much more prepared than I would have been otherwise. I think if Bob hadn’t done this for me, it would me much more difficult. As it is now, it just seems hard. It doesn’t seem difficult.” 

Having been the director of both larger and smaller health departments, in Maricopa County and Milford, Conn., respectively, England believes the Pima County Health Department is particularly well-suited to address the current crisis and rebound from it. The department, he believes, is large enough to have sufficient resources to meet the needs of its community and small enough to do so nimbly and effectively. England said he couldn’t think of a better way for his career way to come full circle, back where it all started, in Pima County.
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