Anthrax attacks, hurricanes and flu shot shortage test Agwunobi's skills.

John Agwunobi, MD, MBA, MPH, was on the job just one day as Florida's Secretary of Health when the urgent call came: A Palm Beach man had been exposed to anthrax.

The incident happened a month after terrorists hit the Twin Towers and nearly everyone, including Agwunobi, feared it could be the beginning of a bioterrorism attack--and possibly the worse public health crisis in the nation's history.

"Given the context of Sept. 11, everyone had the question in their mind, 'Is this an attack?'" Agwunobi recalls. The anthrax scare, which remains unsolved but has so far not been proven to be the work of terrorists, was the first of several crises that mark the charismatic 40-year-old pediatrician's term.

Since then, Agwunobi--who is known among his staff as "Dr. John,"--has had to handle such high profile public health issues as the outbreak of SARS, four devastating hurricanes in a span of two months and a severe shortage of flu vaccines in a state known for its large elderly population.

Agwunobi, who expects to eventually return to the private sector says the fast paced, $152,000-a-year job is educational. Not only has he learned about the inner workings of government, he has also learned about the importance of explaining his actions to the public.

For example, when his department--with a $2.2 million budget and 16,000 employees--decides to open a health clinic in one community, he not only has to explain why he chose that community, but why he didn't choose other communities.

"As a public official, it's not enough to do the right thing and say the right thing. You have to have some idea of how your actions will be perceived by the public," Agwunobi says. "I have to think through the process a little more. It makes for better decision making but it is a skill set that does not come naturally. It is one that I have had to develop."

Family medicine

For Agwunobi, born in Dundee, Scotland, medicine is a family business. His great grandfather was a pharmacist. His grandfather, John Shaw, was a general practitioner; and his father is a surgeon.

Agwunobi says visits to his grandfather's house in Edinburgh as a young boy inspired him to become a doctor. His grandfather, who went blind in his 30s as a result of diabetes, treated patients in an office on the bottom floor of his house. The office was filled with antique stethoscopes, bottled leeches and other medical artifacts.

"My mother would tell us stories of how he would treat people even after he was blind. He would have a nurse sit next to him and help describe things as he worked," he says. "I remember feeling like he was a superhero type of person."

At the time, Agwunobi's father was a medical student in Edinburgh. His father, who practiced and conducted research for several years in London, now runs a chain of small, 100-bed hospitals in his native country of Nigeria.

In addition to visiting his grandfather's office, Agwunobi spent much of his childhood in laboratories and hospitals in London. He remembers blowing out birthday candles in a room next to the wet lab where his father was conducting research on the kidneys of rats.

"All the usual memories most people have growing up, in my memory they all included something to do with health care--either the setting, or the people around me," he says. "It's good and bad. I am not good at anything much more than this. It's my work, my hobby and my passion. I both love and hate it."

Agwunobi's younger brother, Andy, also turned to medicine. He is CEO of Grady Memorial in Atlanta, the largest public hospital-based health system in the Southeast.

Like his brother, all of his childhood memories revolve around medicine. "Even around the table for Christmas, you couldn't eat the turkey without being able to name the bones and dissect it," Andy Agwunobi says.

The two brothers, who are 11 months apart, have almost identical career tracks. Both are pediatricians who did their residencies at Howard University. Both have MBAs. Both have had meteoric career rises.

"His (MBA) is from Stanford, so he thinks he's better," jokes Agwunobi, who has an MBA from Georgetown and a Masters of Public Health from Johns Hopkins School of Public Health. "We're very competitive, but he's also my best friend and I love him dearly."

Andy Agwunobi says he and his brother, who look alike and speak alike, are not carbon copies. He says his brother has gifts that surpass his own, including the ability to juggle many tasks at once.

"If I have a project, I have to close the door, sit down and work on that project. He can work on that project, listen to music, speak on the phone and answer e-mails--and do everything well at the same time."

He says his brother is also more charismatic.

"Wherever he is, he literally gathers friends like a suit gathers lint," says Andy Agwunobi. "If I go anywhere John has been, just a hotel he stayed at two days, people always come up to me and say, 'Are you related to Dr. John?' It could be the bellman or whoever else. If they've met John, they remember him."

Florida by chance

Agwunobi, a graduate of the University of Jos, Nigeria, began his career in the United States working as a resident in the inner city hospitals of Washington, D.C., where he rotated between Children's National Medical Center and the District of Columbia General Hospital.

In June of 1993, he joined the medical staff at the Hospital for Sick Children, a pediatric rehabilitation hospital and community health care provider in Washington, D.C. Five years later, he became medical director. A year later, he was named vice president of medical affairs and patient services.

He says his decision to move into administration was incremental. He started by volunteering on some boards. Soon, he was chairing them. Before long, he was hanging up his white coat.

"I think it is related to the fact that my father, as a surgeon, began to get into the administration and the building of small hospitals," he says. "I began to see there was much more to health care than just the practice of medicine. Both Andrew and I agree that the opportunity to serve an individual in a white coat and clinic setting is a unique and awesome privilege. We both miss active practices.

"We also both agree that the only thing more fulfilling is to serve entire populations and communities," he adds.

His move to Florida was happenstance. He says he decided to look for a job in government because he believed it would help his career to learn more about the way government works. "I told my wife it was sort of a fellowship with a view toward coming back to the private sector."

He applied for the job of Florida Deputy Secretary and Deputy State Health Officer for Children's Medical Services after spotting an ad in a trade journal. "At the time I had no political background or history about Florida. I wasn't even sure what party the administration was," he says.

When he first interviewed, Agwunobi, who is married with three children under the age of 10, was reluctant to take the job because he didn't want to leave Washington, D.C., for the small town of Tallahassee. But he changed his mind after meeting Florida Gov. Jeb Bush. "By the end, I was enamored with his leadership and administration," he says.

Ten months later, his boss, then Secretary of Health Robert G. Brooks, resigned to teach at Florida State University. Bush named Agwunobi Secretary.

The governor announced the appointment at a press conference on Oct. 3. The next day, which was Agwunobi's birthday, he was part of the nationally televised press conference revealing that an ill Palm Beach man had been infected with anthrax. The 63-year-old man died a few days later.

Zachariah P. Zachariah, a Broward County physician who was on an obesity task force with Agwunobi, says he was thrilled to learn Agwunobi was chosen.

"I got to know him as deputy secretary," he says. "He really impressed me by his knowledge in public health and medicine." Zachariah says he also was impressed by Agwunobi's handling of both the flu vaccine shortage and the hurricanes.

"During the hurricanes, he got very involved in traveling all over the state. Also, with the flu vaccines, he was right up front to let the public how we can handle this important issue," Zachariah says. "I think he has been a very effective leader for Florida."

Ready for anything

For Agwunobi, the job has been fast paced. After giving a speech to the Area Health Education Center in Tampa one day in November, he sprinted from the hotel so he could catch a plane to make it to his next meeting.

"Hectic, hectic, hectic," he says.

While the anthrax outbreak set the tone for his busy tenure, in some ways it proved to be a strange blessing. It taught him, he says, that he could trust the staff he inherited. It also helped him gain the confidence of the governor's office.

"It validated right away that our organization was up to the task," he says. "In some cases, that kind of trust can take years or months to develop."

But Agwunobi's handling of the ordeal wasn't without its criticism. A few days after the anthrax discovery, Agwunobi found himself on the under the hot glare of television lights, including Good Morning America, explaining why Florida authorities waited three days to shut down the tabloid newspaper building where the victim worked. The state waited to close the building until it found anthrax on victim's keyboard and in the nasal passages of a mailroom worker.

The anthrax ordeal was followed by other high profile health issues, ranging from the outbreak of SARS to the shortage of flu vaccines. Agwunobi's office, and the country, is still trying to resolve the flu vaccine shortage. Agwunobi says part of the problem is that there is a higher demand than ever before for the vaccine. But, "clearly next year we have to be better prepared."

He says of everything he has had to handle he is most proud of how his department, and the health community at large, handled the four hurricanes, Charley, Frances, Ivan, and Jeanne, that hit the Florida in 2004.

"On an average day, everyone (in the health community) is doing their own thing. Very rarely are all these sectors--the hospitals, the physicians, community based health care providers and public health--drawn together to face a common challenge. The hurricanes did that," he says.

"Collectively we got through something I don't know if any other state could have gotten through." He says he believes the response proves that Florida would be able to handle any health crisis.

"If anyone asks. 'Are you ready to take on bioterrorism?' I would point them to what we faced during the hurricanes," he says. "It was a challenge even our most serious enemies would be hard pressed to match. We came through in a way that surprised everyone."

RELATED ARTICLE: JOHN AGWUNOBI, MD, MBA, MPH

Current Position: Florida Secretary of Health, Tallahassee, Fla.

Previous Positions

* Florida Deputy Secretary and Deputy State Health Officer, Tallahassee, Fl Nov. 2000-Oct. 2001

[ILLUSTRATION OMITTED]

* Vice President Medical Affairs and Patient Services Medical Director, Hospital for Sick Children, Washington, D.C. July 1998-Nov. 2000

* Vice President of Medical Affairs & Patient Services, the Health Services for Children Foundation, Washington, D.C. Nov. 1998-Nov. 2000

* Medical Director, Health Services for Children with Special Needs Incorporated, Washington, D.C. Mar. 1999-Nov. 2000

* Attending Pediatrician, The Hospital for Sick Children, Washington, D.C. June 1993-Nov. 2000

* Pediatrician (adjuvant), Special Care Nursery. Providence Hospital, Washington, D.C. Oct. 1993-Nov. 2000

* Pediatrician (adjuvant), Pediatric Emergency Room, General Hospital, Washington, D.C. Oct. 1993-Sept. 1998

* Medical Officer, Airospress Medical Clinic (Surgery), Jos, Nigeria Aug. 1988-Dec. 1988.

* Education/Training: Master of Public Health, Johns Hopkins University, Baltimore, Md. April 2001-May 2004

* Certified Managed Care Executive, American Assoc. Health Plans (AAHP) Foundation Fellowship April 1999-June 2002

* Master of Business Administration, Georgetown University, Washington, D.C. Sept. 1998-April 2000

* Member, American College of Physician Executives Aug. 1997--Present

* Pediatric Residency, Howard University Hospital, Washington, D.C. June 1990-June 1993

* Transitional Internship, University of Nigeria Teaching Hospital, Enugu, Nigeria June 1987-June 1988

* Medical Education/Training, Faculty of Medical Sciences, University of Jos, Nigeria June 1983-June 1987

* Premedical Science, University of Jos, Nigeria Aug. 1981-June 1983.

Free Time: Agwunobi enjoys art, particularly sketching portraits and painting with oils.

Hero: His grandfather, who was a family practitioner in Scotland, tended to patients even after he lost his eyesight to diabetes.

Twila Davis is a freelance writer and former L.A. Times newspaper reporter living in St. Petersburg. Fla.