Orleans County is a small agricultural community located approximately midway between Rochester in Monroe County and Buffalo in Erie County. Orleans County sits north of Genesee County and boarders Lake Ontario. According to the 2018 United States Census Bureau estimates, the population of Orleans County is 40,612 with 50.1% of the population being female. 19.3% of the total county population is under the age of 18 years old, while 17.9% is 65 years or older. The Orleans County population is fairly homogeneous in race with 90.0% of its citizens being white, 6.6% black or African-American, 4.9% Hispanic or Latino. Approximately 15.2% of the total county population is living at or below the Federal Poverty Level. 15% of related children under the age of 18 are living in poverty, as well as 7% of those aged 65 years or older. There are approximately 1,299 migrant or seasonal farm workers who move to Orleans County during the growing season, departing at the completion of the harvest season. There are an estimated 69 camps for Migrant and Seasonal Farm workers located in Orleans County.
Genesee County is also a small agricultural community. The population of Genesee County according to the 2018 Census population estimate is 57,511. Genesee County is 50.3% female with 18.7% of the population over the age of 65. The county is 93.0% White, 3.2 % Black or African American, 1.2% American Indian or Alaska Native, and 0.7% Asian, with 3.4% of the population identifying as Hispanic or Latino. In Genesee County, the poverty rate is significantly higher in the City of Batavia: an estimated 21.8% of the total population of the city live below the poverty level, while the percentage is 10.8% for the county overall. In comparison, children under 18 in Genesee County overall have a poverty rate of 17.5% and children under 5 have a rate of 23.5% below the poverty level. Genesee County has special populations with the Tonawanda Reservation and Migrant and Seasonal Farmworkers. The Tonawanda Reservation according to the 2000 Census, the population was 517 with a median age of 36.3. There is an estimated number of 784 migrant and seasonal farmworkers that reside in Genesee County.
Residents of each county have limited local access to experts for diagnosing, treating and managing Tuberculosis (TB) disease and latent tuberculosis infection (LTBI). Orleans ratio of population to primary care physicians is the worst in the state at 13,780:1 according to the 2019 County Health Rankings & Roadmaps”, and that for Genesee County is 2,920:1. Individuals residing in these counties requiring care have to travel significant distances to access care. Goals included to seek out inter-municipal agreement with Monroe County Health Department (MCHD) an urban county to the east, to provide specialty care for Genesee and Orleans County residents with TB, develop a telemedicine process for TB care management, share an electronic medical record system between the three counties.
The TB inter-municipal agreement was written by MCHD attorney. The agreement was submitted to Genesee and Orleans County attorneys for review. After each county attorney approved of the inter-municipal agreement it was then submitted to each county's legislature for adoption. The inter-municipal agreement was adopted by all three counties in 2016.
MCHD has been seen patients from both counties since the inter-municipal agreement was put in place in January 2016. MCHD saw 16 Genesee and Orleans County TB patients at their clinic and there were 32 telemedicine appointments from 2016-2019.
All of the objectives were met to implement the TB inter-municipal agreement. The TB program in both Genesee and Orleans Counties have been utilizing this operational process since 2016.
The inter-municipal agreement between the three local health departments has streamlined and achieved efficiencies within the TB Control Programs in Genesee and Orleans Counties by diagnosis and treatment, accessibility and convenience of TB care that allows rural residents access to expert TB care. With the increasing threat of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis and the complex management of these infections this agreement helps align Genesee and Orleans Counties with the five recommended priority actions of the World Health Organization's End TB and Elimination Strategies. The utilization of an inter-municipal agreement between rural and urban counties with more robust services can be reproduced throughout the country.
Orleans County Health Department website: http://www.orleanscountyny.gov/publichealth
Genesee County Health Department website: https://www.co.genesee.ny.us/departments/health/