Adrienne Daniels had just taken the job of deputy director of Integrated Clinical Services when ice and snow pummeled Portland last December, closing businesses, schools and public services. Most employees dared not drive on the snow-packed roads, and nonessential staff at Multnomah County were directed to stay home. After catching a bus to the Health Department Headquarters downtown, Daniels walked onto the deserted ninth floor.
But one light was on, in the office of her boss, Vanetta Abdellatif, who was already deep at work.
“You get this sense of reassurance that she’s going to be here for the County, no matter what happens,” Daniels said.
It’s not just the snow and ice. Staff who have reported to Abdellatif over her 16 years at the County say she has helped steer a department that has navigated rough seas from the instability of federal health care reform and local budget cuts, to an election that stirred anti-immigrant and racist sentiment, to internal accusations of systemic racism.
“I know she’s thinking about the things that could hurt us, but she’s making sure staff won’t get swallowed up in worry,” Daniels said. “She keeps things in perspective. She focuses on small positives, and on what we can do to help people in our county.”
Abdellatif has a way of shrugging off compliments and redirecting focus, giving you the sense that she’s uncomfortable with praise, even if it’s just about persevering during a storm.
“I spent two winters in Milwaukee, Wisconsin,” she said. “I’m not afraid of the snow.”
With a budget of $117 million and a staff of 686, Vanetta Abdellatif oversees the County’s 25 health centers including 12 student health centers, eight primary care clinics, seven pharmacies, six dental sites, a central laboratory and an HIV clinic. The clinics serve more than 70,000 residents each year — 75 percent of whom live under the poverty line, 62 percent of whom are people of color, and 44 percent of whom speak a language other than English at home.
The County system is one of the nation’s largest federally qualified health centers, a designation for organizations that provide affordable and vital health services to those most in need. The Community Health Council, comprised largely of clinic patients, partner with Abdellatif and her team to shape the way clinics operate.
“The consumer board really holds a lot of power — What's the strategic plan? Who do we serve? Are we in the right places?” Abdellatif said. “Empowering community members is why I got into health care in the first place. I’m a systems thinker, and I wanted a career where I could create lasting change.”
Abdellatif grew up in Oakland, where her mother, Johnetta Jeffery, worked as a hairdresser, and in Phoenix, where her father James Mills had fought to integrate the construction contractors’ union. Her grandparents were always nearby, having left Arkansas in the 1950s to protect their only child from the risk of violence of school integration. Her grandmother, Beatrice Walker, was a skilled seamstress, and her grandfather, Prentice Walker, worked as a janitor for the local Woolworths in Phoenix. As little girls, Abdellatif and her sister would go down to the lunch counter for pie, french fries and ice cream.
Her parents completed high school, but her grandmother only finished second grade, and her grandfather never attended school. Things would be different for her, they said.
“I remember my grandparents said, ‘You’re going to go to college,’” Abdellatif said. And she did. She earned a bachelor’s degree in social welfare, followed by a master’s degree in public health and health services administration. By the time she donned her graduation gown for the second time, her grandmother Beatrice had died of Lou Gehrig's disease. But her grandfather Prentice was there, and he snapped her graduation cap off her head, placing it on his own. “This is as close as I’m going to get,” he joked.
Abdellatif completed a series of internships, fellowships and jobs, first as an intern in physical therapy at a public hospital in California, then as an administrative fellow in hospital administration for Kaiser in San Diego, then as a long-term care fellow earning a nursing home administrator’s license in Nebraska, then Wisconsin.
She came to Oregon in 1995 to oversee quality assurance of a residential substance abuse treatment program for African American women at Legacy Health, then took over managing primary care clinics for Providence Health System.
It was Abdellatif’s impatience with the superficial that made her an attractive candidate in 2001 to a Multnomah County Health Department hiring committee looking for a director for the primary care clinics.
“The thing I remember very specifically is she was very candid,” said Consuelo Saragoza, who oversaw the student health centers and sat on the hiring committee. “She’s not a person who is meek and mild. She’s up front. She puts things on the table, questions things. That was a new kind of style for the organization.”
Abdellatif came into a department undergoing restructuring. In her first hour of her first day — in October 2001 — she was instructed to cut $250,000 from her budget. Within the first two years, the department engaged in a major restructure, moving programs that provide health services to individuals under one umbrella: primary care and dental services, Saragoza’s student health centers,pharmacies, lab services, and radiology, as well as the corrections health program in the jail were all folded into Integrated Clinical Services. Abdellatif, one of the only directors without medical training, the newest on the senior team and the youngest among her peers, was tapped to oversee the new behemoth.
“I think it was a good thing,” Abdellatif said, then paused. “It was a hard thing. But it was a challenge that I was happy to take on. It was an incredible opportunity.”
The restructuring strained relationships, as Abdellatif constructed an expansive vision of clinic services. But Saragoza said Abdellatif was the best thing that could have happened to them.
“She had a vision. She saw what needed to be done,” Saragoza said. “She sees where things need to go and she moves us there. It hasn’t always been easy.”
Among Abdellatif’s early wins was, in 2005, when she pulled health department records out of filing cabinets and loaded them into the electronic health record software system called EPIC.
“EPIC was my baby,” she said. “It allows us to actually be a system. We’re able to collect data, do reporting. We can look at trends, at how we’re managing disease in populations.”
Abdellatif pushed to extend the electronic record system to patients treated while in custody at county jails, ensuring providers in the community could track any treatment provided while their patients were detained. She also began screening inmates for health insurance eligibility.
“People end up in jail often time because of poor access to mental health care, or something has made their life go awry,” said Sami Jarrah, who served as deputy to Abdellatif before taking over as chief operating officer of the Philadelphia Department of Public Health. Ensuring inmates had insurance also meant the County could seek reimbursement for some of the expenses it accrues, and thereby allowing it to offer services to more people.
“One thing I really like about her is she doesn’t just think about the expense, but the revenue side,” Jarrah said. “The drumbeat often is, ‘How do you trim? How are you going to cut expenses?’ But she’s also thinking of how to get revenue or bring in partners, not just cut, cut, cut.”
Over the past 16 years, Abdellatif has overseen the expansion of clinic services including the opening of the East County Health Center in Gresham, dental services across the county, and a new building for the North Portland Health Center on North Lombard. She also oversaw a partnership with Central City Concern to open the Billi Odegaard Clinic, and expanded student health services to David Douglas and Centennial high schools.
Under Abdellatif’s watch, clinics implemented a team approach to care that stressed prevention, early intervention and community-based management of chronic conditions such as diabetes. Primary care teams including doctors, a community health nurse, panel health managers, clerical assistants, and behavioral health specialists began sharing workspace and coordinating care. As a result, clients got in to medical appointments sooner, had better access to providers and got medical questions answered more quickly. This “medical home’’ approach earned eight primary clinics recognition from the state as Tier-3 patient-centered care homes.
“I am very proud of what we have accomplished.” she said.
People who work for Abdellatif say she’s able to innovate because she gives her staff space to explore possibilities and keeps the focus on the future.
“She is the most solution-focused manager I have ever worked for,” said scheduler Jordana Sardo, who served executive directors at area nonprofits for three decades before hiring on with the county. “Some managers can get wrapped up in the problem. But she focuses instead on, ‘What do we need to do differently?’ She gives people the room they need to grow.”
Abdellatif rarely has time to chat (although staff say she breaks for birthdays and babies), and that affords her time for earnest conversation.
“I have the sense that what I’m getting is the real deal. She is very direct, but there’s an element of honesty and kindness,” Sardo said. “Some people can be direct and it feels like you’ve been bitten. But with her, there’s a kindness and a feeling of not being judged, and that’s really quite refreshing.”
Her deputy, Adrienne Daniels. said it’s that combination of honesty and focus on the principals that makes her feel she can think big.
“She is someone who is always open and honest and willing to give feedback,” she said. “You don’t want to waste her time, but when you’re present, she’s present too. She’s going to give you her full attention, a real conversation, not just nodding.”
Real conversations have consumed County departments this fall, as employees of color spoke out about constant micro aggressions, racist comments and systemic racism following the dismissal of Public Health Director Trisha Tillman, who is black. For department leaders, it was hard to watch and harder still to know how to respond.
"It’s been painful,” said Abdellatif. Employees say they see her as a role model, especially because she is a woman of color in leadership.
"As both a leader and woman of color, I have been successful because I choose my battles carefully. If I go to battle on every little thing, that’s not being strategic,” she said. “I try to keep the patients and access to service top of mind, and my team members. I ask myself, ‘Am I creating a space they’ll be proud to be in?’”
Staff of color have shared with her feelings they are treated differently because of the color of their skin, and she tries to be listen without judgment.
“That’s super important. Without actually hearing colleagues of color, their experiences are often minimized or invalidated,’” she said. “You can have a whole career where people say everything you think is wrong and then people don’t trust themselves. And people can’t be innovative and creative if they’re second-guessing themselves. We need people to be innovative and creative, bold and confident.”
She also tells people to focus on what can change.
"I’ve been the first in a lot of places and what’s happened to me doesn't mean it will happen to other folks. The timing may be different,” she said. I ask them, ‘What do you have to contribute? Where do you want to make a difference? There are ways you can be seen and heard, so they can be as effective, despite all the racism and sexism, ageism, all that stuff that happens.”
Abdellatif has also experienced many of those same barriers in her professional career, and she takes her own advice.
"The diverse staff, the diverse patient population, or how much good work we’re doing that is very, very mission driven,” she said. “The trauma-informed approach to work and workforce equity activities; Those are the things that have kept me here even when things can be frustrating and complicated."
As the County searches for a Health Department director to replace Joanne Fuller, who retired this fall, Abdellatif has stepped in to share leadership with co-interim director Wendy Lear. She’s keeping the focus on the future of clinical services.
She would like to continue to develop the community health council, give clinic directors more leadership opportunities, supporting the next generation of health leaders, and continue to support her staff as they navigate the changing winds of national politics and fluctuating budgets.
“I’ve had some good leaders and I’ve worked with bad ones. And you learn from both. I’ve learned it’s about being focused on the future, a commitment to a larger mission, and communication,” she said. “We’re trying to increase access, deliver high-quality service, stay financially sustainable, and retain good people. We’re trying to be first in class.”
Her goals are lofty, to be sure. But it’s that perpetual dissatisfaction that serves her so well. When she reflects back on the dream of her 20-something self, she considers whether she’s happy with how far she’s come.
She shakes her head and smiles.
“No,” she decides. “But it’s definitely directionally correct.”