- [Reporter] On this edition of "Impact."

A rise in sexually transmitted diseases leaves Montana healthcare providers with startling numbers.

- This increase of cases that we are seeing now is unprecedented.

We've never seen this before.

- [Reporter] And Montana roadways can be dangerous for humans and wildlife.

We'll show you what's in the works to improve safety and reduce collisions.

That's coming up on "Impact."

- [Commentator] Production of "Impact" is made possible with support from the Otto Bremer Trust, investing in people, places, and opportunities in our region.

Online at ottbremer.org.

The Greater Montana Foundation, encouraging communication on issues, trends, and values of importance to Montanans.

And viewers like you who are friends of Montana PBS.

Thank you.

- Welcome to "Impact," our new series featuring in-depth reporting on issues important to montanans.

I'm Breanna McCabe.

2022 Brought record high rates of sexually transmitted infections nationwide.

Montana was no exception with a particularly staggering spike in syphilis cases.

Montana PBS's, AJ Williams, takes us to one of the most affected areas in our state where healthcare providers are searching for solutions.

- Hi, Jenny.

What are you here for today?

- I need to get tested for syphilis.

Somebody I was with told me that they- - [AJ] Registered nurse, Kelly Gardner, and her STI team test a patient who suspects they have syphilis.

If the results are positive, it will be one of over 130 the clinic has confirmed in 2022.

- This increase of cases that we are seeing now is unprecedented.

We've never seen this before since records have been kept.

- [AJ] Gardner works for Riverstone Health in Billings which serves as the Public Health Department for Yellowstone County.

Here in 2022, we've seen year-to-date a 475% increase in syphilis cases over the previous five year average.

So that's, of course, alarming.

- [AJ] These staggering numbers are not just in Yellowstone County.

The whole state of Montana saw a 224% increase of syphilis cases in 2022 with the majority cropping up in Yellowstone, Roosevelt, Bighorn, Cascade, and Gallatin Counties.

- Any place that touches one of these sores is a place where sores can show up.

- [AJ] Syphilis is a bacterial infection, typically spread through sexual contact.

It's known among health experts as the great masquerader.

Starting out as a visible, but painless sore on the body that disappears only to come back as non-descript symptoms.

- [Kelly] On your palms.

Yep, it can be on the soles of your feet.

- [AJ] Which makes the infection difficult to track.

- There's a real lack of knowledge both in the general public and in healthcare providers.

Syphilis is a a very old STI.

You know, we hear about it throughout history and with stories of pirates and historical figures.

It is still around, the same old syphilis.

It's always been around.

- [AJ] Syphilis was common among many seafarers.

Even the U.S. Navy made training videos on how to mitigate contracting the disease while at port.

(ominous music) - [Narrator] That second examination showed just what I suspected.

Weiser had really lost the gamble.

It was syphilis.

- [AJ] This lack of awareness can explain the uptick in part.

Gardner says they also attribute the record high numbers to patients not having regular access to treatment during the height of COVID cases.

With many facilities shuttered for spread mitigation and resources diverted in the raging pandemic, Riverstone lost contact with many high-risk patients.

When a portion of the population isn't getting the care or knowledge they need, health outbreaks can occur.

- People should be screening for it as much as possible so that we can get it treated and get our arms around this outbreak.

- [AJ] In this outbreak, there are clear demographic disproportions.

According to the state's Department of Health and Human Services, the 2022 syphilis cases reported were 49% Native American, 27% white, 24% were Hispanic or other races.

To address this disparity locally, Riverstone and the Native American Development Corporation are working in partnership.

Public health experts say that there's a cultural concept known as the meaningful messenger, which is a person or organization that are trusted resources within the communities they often belong to.

- Kinda let me know what we have for patients there.

- Yeah, okay.

Okay, so we had 19 people come through today.

- Cultural competency piece that we carry with us is carried in who we are as an organization, but we don't just bring our own perspective, but we share that collaboratively amongst one another because we know that there's more than just one native culture out there.

You know, there's an urban native culture and even amongst that, you have individual tribes and identities.

- [AJ] NADC can test patients for syphilis through their clinic, BUIHWC, the Billings Urban Indian Health and Wellness Center.

If they test positive, they get referred to Riverstone.

The two health centers also work together to put on events to get public health resources where they're needed in the ways that will be the most effective.

- We're just trying to educate our providers, educate our staff about these different things that are on the rise and syphilis is one of them.

We have a lot of information that's been given to us from Riverstone Health about syphilis that we put out in our common areas, our waiting rooms, things like that.

Just so that our clients and patients are aware, they can see these things as well.

So if they have concerns, they know that we can address those issues for them.

- [AJ] Public health experts say that health centers who receive public funding need to be strategic with their resources.

And ultimately, when it comes to taxpayer dollars, funding ongoing STI care in the exam room is far less expensive than funding crisis care as the case advances later on.

- If those big diseases end up in hospitalizations and very costly treatment or even entry into an emergency room and there is no source of payment, that actually ends up costing the rest of us in terms of increased premiums.

From a prevention standpoint, it behooves all of us to take care of each other.

Making sure that everybody has access.

- [AJ] According to Gardner, syphilis cases caught in early stages are easily treatable in an exam room.

- It's an antibiotic.

It's quite easy (laughing).

Most people require one dose of, it's called bicillin, it's a version of penicillin.

- [AJ] If the infection is caught in a later stage, it could require additional doses or turn into what's called neurosyphilis.

- So, it's gotten into their brain.

Then that requires hospitalization and IV antibiotics for a period of time.

So Jenny, we should have results for you here in the next day or two and at that point we'll reach out to you and call you and bring you back in if we need to and get you treated.

- [AJ] For getting a syphilis case under control, the treatment is straightforward, but for getting their overall numbers back to normal, Gardner is clear that there's no overnight fix.

- [Kelly] I think we're looking at probably a three to five year effort as far as having a large impact on what we're seeing.

And that's just because it's such a big problem and it is such a tricky illness.

So, I think we're kind of looking at the long game a little bit as far as effectively getting it back under control.

We get almost a new case a day, but if we could just get those numbers to slow down at least that would be phenomenal.

- Gardner says prevention efforts across the state have been piecemeal based on jurisdiction and she hopes to see more resources from the state and CDC to educate the general public.

To learn more about the state's efforts and the startling rates of congenital syphilis, we went to Helena and met with the state's STD section supervisor.

- We're here to talk about the syphilis rise in Montana.

Can you talk about those numbers and what we're seeing?

- We've seen a rise in syphilis cases over the last several years and we've also seen a significant increase in the numbers of congenital syphilis cases.

In 2020, we had two cases of congenital syphilis.

In 2021, we had nine cases of congenital syphilis and two of those were syphilitic stillbirths and one was an infant death.

This year so far we've had 13 cases of congenital syphilis and three of those have been stillbirths due to syphilis.

- Wow, okay.

So, for people who are watching what does congenital syphilis mean?

- So, congenital syphilis is transmitted between a mother and her infant during pregnancy.

It can then present itself after delivery with a number of different poor health outcomes such as anemia, jaundice, enlarged liver and spleen, bone deformities, and issues with teeth, and neurological effects as well.

40% of pregnancies where the woman has syphilis will result in miscarriage, stillbirth, or potentially infant death.

- That is a large statistic.

- Yeah, we want everybody to get in for that prenatal check in the first trimester and get treated so that we don't see any of these results in the future.

- Is this normally something that people who are pregnant get screened for?

- So, typically at the first prenatal check, women are screened for syphilis and if everything goes well we would know right at the beginning of pregnancy and be able to treat that mother so that her infant wouldn't have effects.

But, some people don't get prenatal care.

So, one of the things that we're seeing is a high correlation with women who have not received prenatal care at all during their pregnancy and the first time that they're presenting to care is at delivery.

- So, what are the barriers to care that pregnant women face and pregnant people that we're not really thinking about a lot of the time?

- Yeah, I think it's really important to think about barriers to care for pregnant women and for all people.

Some people have difficulty accessing care for a variety of reasons.

For some it can be transportation, they may not have reliable transportation.

It's also important to note that some pregnant women, have other children and it might be difficult for them to find childcare or to take children to multiple appointments or they could be following up on care with their other children and may not prioritize their care.

And then additionally, some people don't access prenatal care because they're afraid for a variety of reasons to access care, particularly in people who may be injecting drugs or have other barriers in their lives or challenges, it might be difficult for them to access care.

- And so as far as, you know you mentioned there's a pretty substantial increase of all syphilis cases across the state.

What's the process of slowing that down and what is DPHHS' role in that?

- The process for slowing it down is working with our public health and our medical partners to increase testing, to make sure the that people are treated appropriately.

We provide a lot of support to local partners in order to do that, whether through supporting them with the case investigations or providing training and resources so that it's easier for them to identify cases.

And then we also work with them, we provide access to low cost bicillin, which is the treatment for syphilis, so that then they can also treat people in their community.

So, those are some of the things that we're working on with partners in order to stop the spread.

Riverstone is a federally qualified health center and a public health department.

And those relationships are really important to us as we make sure that people have access to services across the state.

- For people who suspect they may have it or know of an exposure, is this something that is gonna go away on its own eventually?

- Syphilis is not something that's gonna go away on its own eventually.

That infection is spreading essentially.

So, the bacteria that causes the infection will continue to grow and will affect different organ systems.

It causes damage to a number of organs, including your spleen, and liver, your brain.

It's really important to also test and treat their sexual partners so that both the sexual partners don't pass it to other people or reinfect the original person.

So, testing and treating for syphilis, it's completely preventable.

- Those who suspect they've been exposed to syphilis can get tested at their doctor's office or their local public health clinic.

Every 26 seconds a driver collides with an animal on American roadways, resulting in about 200 human deaths every year and killing up to 2 million large animals.

A new statewide partnership combined with federal funding aims to lower these numbers.

Montana PBS's, Joe Lesar, shows us the strategy behind making our roads safer for both people and wildlife.

- [Joe] After 24 years on the job, MDT maintenance crew chief, Rusty Burt, no longer notices the smell.

Five days a week he and his employees at the Hamilton Maintenance Department cruise the highways looking for animals that have met an unfortunate, yet not uncommon demise.

- Yeah, just leave those uncovered and we'll cover 'em up when we get there.

- [Joe] The carcasses become compost.

That's about all that can be done after the fact.

But now, more light is being shown on ways to mitigate collisions before they happen.

Montana has the second highest rate of wildlife-vehicle collisions in the nation behind West Virginia.

According to data collected by the Montana Department of Transportation, maintenance crews collected 6,000 carcasses in 2020.

That figure is certainly an undercount 'cause not all animals die right where they're hit.

Along with the obvious safety hazards that animals on roadways pose, collisions with large animals are costly.

Between animal removal, medical costs, and vehicle repairs, the average cost of a deer-vehicle collision is about $8,000, $25,000 for an elk, and around $45,000 for a moose.

Animals lose out as well.

Roads form barriers to their movement and fragment their habitat.

And as human populations increase and development continues, these collisions are becoming more frequent.

But there's an effective and well documented way to greatly reduce the numbers of these collisions.

- [Rusty] They work very well.

We've got research that proves it.

- [Joe] Wildlife crossing structures combined with fencing to guide animals to them have been shown to reduce collisions by as much as 97%.

MDTs Environmental Bureau chief, Tom Martin, says Montana's original land stewards brought forward these solutions in the late 90s.

- Well, the Confederated Salish and Kootenai Tribe had a different way of looking at the highway.

It was the highway was a visitor on the landscape and it wasn't gonna be a permanent thing.

It's just there for a while.

And that was their viewpoint.

- [Joe] CSKT tribal leaders told MDT that they wouldn't approve a lane widening project on US Highway 93 unless steps were taken to mitigate impacts on wildlife.

MDT crash data was combined with native knowledge of animal movements and construction began, resulting in one of the densest clusters of animal crossings in the U.S..

The project was lauded across the country.

- We took what we were learning there, even at the same time, and started incorporating that south of Missoula.

And so, what you'll see now is over 40 crossings accommodations south of Missoula as well as over 40 north of Missoula.

And now we have over 125 crossings accommodations statewide.

- [Joe] Martin is careful to make the distinction between crossing and accommodation.

While the majority of accommodations in the state are underpasses, measures also include vegetation reduction near roadways, wildlife friendly fencing, or electric mats like this one on Highway 287 where it crosses the Missouri River.

- [Martin] It's like a prohibitive walkway that goes on the edge of exclusionary fencing.

So if an animal steps on it, they get an electrical shock, not enough to hurt 'em, but enough to startle 'em and it'll repel them back from getting caught in between.

- [Joe] But of all the accommodations MTT uses, the most effective are also the most expensive.

Large mammal underpasses cost between 250 and $600,000.

Overpasses between one and $7 million.

And the proper fencing costs around $50,000 per mile.

If an accommodation is built in Montana, it's because it gets tacked onto an existing project like bridge repair or lane widening.

This means wildlife crossing specific projects like the one on highway 93 have become the exception rather than the rule.

But 2023 will bring big changes to the way wildlife crossing projects are funded and implemented.

The 2021 Infrastructure Investment and Jobs Act injected billions of dollars into 15 transportation programs and expanded their eligibility for wildlife crossing projects.

It also created the Wildlife Crossing Pilot program, the first ever federal program dedicated entirely to wildlife crossing structures.

This money is set to become available later this year.

- Yeah, these federal programs are absolutely transformative.

So, this marks a real paradigm shift in which wildlife considerations are being incorporated into transportation planning at a whole nother level than existed previously.

- [Joe] After it was signed, Anna Wearn, with the Center for Large Landscape Conservation, dug into the text of the bill to figure out how transportation departments and local governments could get in on the action.

- Our coalition has been doing outreach with interested applicants to make sure that they're aware of the funding opportunities, they're aware of the grant criteria, and they're aware of best practices for designing wildlife crossing structures so that they can put forth a competitive proposal for what is hopefully a successful project.

- [Joe] Wearn has high hopes for these new federal resources.

She believes successful projects will demonstrate their value and lead Congress to solidify the new pilot program and increase funding in the next infrastructure bill.

- And so, it's really encouraging to see this ground swell of support and momentum building.

- [Joe] Support and momentum is also building at the state level.

In the coming weeks, MDT will unveil a new mapping tool that combines different data streams to highlight areas of concern on Montana highways.

And later this year, an entirely new process for getting wildlife accommodations on the ground will begin.

It will allow anyone from city governments to private landowners to bring wildlife specific plans to MDT, bypassing the need for an existing highway project.

- We're hoping that will really engage a lot of other stakeholders and help us get more wildlife accommodations on the ground.

Pretty exciting.

- [Joe] Wearn says this issue is rare in that it has bipartisan support and clear solutions.

And now with more resources right around the corner, she believes action is bound to follow.

And with action, perhaps fewer pickups for crews like Rusty's.

- Clearly there is more work that needs to be done and now is the time to invest in and engage in those partnerships, those projects, those processes to really drive forward and propel these efforts to bring proven solutions here to Montana that will reduce wildlife-vehicle collisions and improve habitat connectivity.

- [Joe] For "Impact," I'm Joe Lesar.

- Beyond being struck and killed by cars, roads fragment animal habitats, affecting their ability to find food, reproduce, and migrate.

Rob Ament from the Western Transportation Institute says, "Accommodating wildlife benefits the entire landscape."

- So, if an animal or a group of animals are restricted from crossing a road, what effects does that have on those animals?

- Well, as you isolate populations it becomes more difficult, say a wildfire comes in and they can't leave that habitat or the habitat's transformed, it's charred, there's no food left.

So, you can see why animals need to move for the seasons, for food, for shelter.

So, there's many reasons why we always have to make sure that animals are safe to move about the landscape so that they can fulfill their needs, both daily, seasonally, and then the long term, what we call gene flow so that young adults can disperse and find new mates and keep the gene pool healthy.

- So, let's talk about migratory big game animals, deer, elk, moose, pronghorn, those sorts of animals, roads and human development are making it harder and harder for them to complete these migrations that they've done for thousands of years.

So, how do disruptions from roads impact migratory species and the ecosystem as a whole?

- As many of those species, as researchers have put radio collars or GPS collars on the animals and see their movement, there's been a lot of information showing how our busiest highways are actually creating a total barrier or at least a partial barrier to their crossing of the road.

So, basically busy highways continue to fragment and make the usable habitat into smaller and smaller pieces.

So, that's why the mitigation measures such as wildlife overpasses and underpasses not only reduce the collisions for motorists, but they allow that connectivity and that ability for wildlife to continue on their historical migratory pathways.

- So, wildlife overpasses are among the most effective solution, but they're also the most expensive solution.

And you've done some research into finding ways to make these structures more cost effective, more affordable which would hopefully result in more of them being built.

So, can you tell us a little bit about some of those findings?

- Yeah, well, so yeah, wildlife crossings are expensive, relatively speaking, but depending on what the crash rates are with the wildlife, they can actually be a smart investment.

But still as like anything, we always wanna do things more effectively and cheap, more cost efficiently.

And so, we're always looking at new designs.

A new project we've been working at at Western Transportation Institute is looking at new materials instead of the traditional concrete and steel.

We know how long it takes to build a bridge on a highway, sometimes up to six months, et cetera.

You have to stop traffic.

We've been looking into a fiber reinforced polymer bridges.

In Europe they've built these wildlife overpasses with this new material and they're actually with just traditional machinery they can just drop the overpass in, in four to eight hours.

So you can imagine, and it's lightweight so it can be shipped on a truck semi-trailer.

So, we have actually been in a design, it hasn't been built, but we've come up with the very first design for North America on a project in northern California.

- Cool.

So, scientists are able to study the movements of animals in quite great detail, like you explained.

And we know that these crossings are extremely effective.

So, you know, the science is there, the solutions are clear.

Are you hopeful that we, as a species, will be able to embrace these solutions and keep the the American West and the world, you know, as connected as possible?

- Yeah, I think, in the last 20 years I've been active in this field, there's been tremendous transformation from, again, the common line, "Oh, overpasses are too expensive."

Actually they're really smart investments in particular locations.

So, I think that society wants to have healthy wildlife populations.

We're sort of a wildlife culture here in Montana.

We wanna share our landscapes with all these wonderful species.

And so, we just need to invest with our roads, invest in the kind of things that make it safe for both us and for our wildlife.

- As the population continues to grow in Gallatin County, Western Transportation Institute is in its first phase of a project to assess the stretch of highway between Four Corners and Big Sky.

Well, that's all for this edition of "Impact," but here's what we're working on for next time.

As Montana schools navigate a shortage of qualified teachers, we head to the Highline to see what Havre Public Schools is doing to grow its own.

And honeybees get all the attention even though they aren't native to North America.

See what we can learn from Montana's Wild Bees on the next edition of "Impact."

Until then, I'm Breanna McCabe, thanks for joining us and we'll see you next time on "Impact."

(upbeat music) - [Commentator] Production of "Impact" is made possible with support from the Otto Bremer Trust, investing in people, places, and opportunities in our region.

Online at ottobremer.org.

The Greater Montana Foundation, encouraging communication on issues, trends, and values of importance to Montanans.

And viewers like you who are friends of Montana PBS.

Thank you.

(light music)