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When Maternity Wards in Black Neighborhoods Disappear When Maternity Wards in Black Neighborhoods Disappear
(32 minutes later)
Shamya Bland had both of her children at St. Bernard Hospital in the Englewood neighborhood on the South Side of Chicago. When she found out the hospital would stop delivering babies until further notice “to respond more effectively to the increase in patients who are sick with the Covid-19 coronavirus,” according to an announcement issued on its Facebook page, she was devastated. “It’s heartbreaking,” she said. “It’s in the heart of the hood. Most black people in the neighborhood were going to go there.”Shamya Bland had both of her children at St. Bernard Hospital in the Englewood neighborhood on the South Side of Chicago. When she found out the hospital would stop delivering babies until further notice “to respond more effectively to the increase in patients who are sick with the Covid-19 coronavirus,” according to an announcement issued on its Facebook page, she was devastated. “It’s heartbreaking,” she said. “It’s in the heart of the hood. Most black people in the neighborhood were going to go there.”
Englewood, which is 95 percent black, is slowly becoming a maternity-care desert, with two other nearby hospitals closing their maternity wards within the past year. St. Bernard Hospital has coordinated transporting women in labor to Mercy Hospital, about six miles north, according to St. Bernard’s media relations representative David Rudd, but transportation is not the main concern for doctors and patients in the neighborhood.Englewood, which is 95 percent black, is slowly becoming a maternity-care desert, with two other nearby hospitals closing their maternity wards within the past year. St. Bernard Hospital has coordinated transporting women in labor to Mercy Hospital, about six miles north, according to St. Bernard’s media relations representative David Rudd, but transportation is not the main concern for doctors and patients in the neighborhood.
Research has shown that black patients receive better care and communication when they see black doctors. Official statistics weren’t available, but St. Bernard boasts a racially diverse care team, according to staff members like Dr. Joi Bradshaw-Terrell, M.D., an OB-GYN. “There’s a trust factor,” Dr. Bradshaw-Terrell said. “We have black men and women taking care of you. We got you.”Research has shown that black patients receive better care and communication when they see black doctors. Official statistics weren’t available, but St. Bernard boasts a racially diverse care team, according to staff members like Dr. Joi Bradshaw-Terrell, M.D., an OB-GYN. “There’s a trust factor,” Dr. Bradshaw-Terrell said. “We have black men and women taking care of you. We got you.”
Black women in America are three times more likely to die of pregnancy- and childbirth-related causes than white women are, according to the Centers for Disease Control and Prevention. In Chicago, that tragic disparity doubles, with black women six times more likely than white women to die because of pregnancy and childbirth and even more experiencing injury or trauma.Black women in America are three times more likely to die of pregnancy- and childbirth-related causes than white women are, according to the Centers for Disease Control and Prevention. In Chicago, that tragic disparity doubles, with black women six times more likely than white women to die because of pregnancy and childbirth and even more experiencing injury or trauma.
Bland, 24, came back to Chicago to give birth after moving more than two hours west to a town near the border of Iowa, seeking a doctor she could trust. “I was five months pregnant and having heart palpitations. I knew something wasn’t right, and my doctor kept telling me it was fine,” she said. He told her it was her weight and her heart “pumping for two.”Bland, 24, came back to Chicago to give birth after moving more than two hours west to a town near the border of Iowa, seeking a doctor she could trust. “I was five months pregnant and having heart palpitations. I knew something wasn’t right, and my doctor kept telling me it was fine,” she said. He told her it was her weight and her heart “pumping for two.”
Bland drove to St. Bernard Hospital to see a black doctor, who quickly ordered EKGs and a CT scan and told her she had a heart condition — the leading cause of maternal death. “I was out there with new doctors and new faces, and I was kind of getting blown off,” she said. “But here I got taken care of and treated as if I actually mattered.”Bland drove to St. Bernard Hospital to see a black doctor, who quickly ordered EKGs and a CT scan and told her she had a heart condition — the leading cause of maternal death. “I was out there with new doctors and new faces, and I was kind of getting blown off,” she said. “But here I got taken care of and treated as if I actually mattered.”
Her story could have ended differently, and she’s concerned for the fate of the women in Chicago’s South Side neighborhood whose birth stories will soon unfold in a different hospital than they originally planned. Dr. Bradshaw-Terrell shares that concern.Her story could have ended differently, and she’s concerned for the fate of the women in Chicago’s South Side neighborhood whose birth stories will soon unfold in a different hospital than they originally planned. Dr. Bradshaw-Terrell shares that concern.
“It’s a big disadvantage to our population in Englewood,” she said. “Black women have more pre-eclampsia, more hypertension, gestational diabetes. People here are high-risk, and to feel like you have abandoned them is a horrible feeling.”“It’s a big disadvantage to our population in Englewood,” she said. “Black women have more pre-eclampsia, more hypertension, gestational diabetes. People here are high-risk, and to feel like you have abandoned them is a horrible feeling.”
A 2019 study, among others, found that patient outcomes are better when hospitals not only understand but also focus on the experiences of the communities and populations they serve as part of the care they give. Racial bias in health care and consequently black people’s distrust of the health care system are well documented. Hospitals in black communities that employ black doctors and health care workers combat this by reimagining health care to fit the needs of their population, Dr. Bradshaw-Terrell said.A 2019 study, among others, found that patient outcomes are better when hospitals not only understand but also focus on the experiences of the communities and populations they serve as part of the care they give. Racial bias in health care and consequently black people’s distrust of the health care system are well documented. Hospitals in black communities that employ black doctors and health care workers combat this by reimagining health care to fit the needs of their population, Dr. Bradshaw-Terrell said.
“Half of the time I’m basically a social worker and a psychologist. If you don’t have water at home, I’ll bring you a case of water,” she said. “I don’t have to do that, but these are real-life issues.”“Half of the time I’m basically a social worker and a psychologist. If you don’t have water at home, I’ll bring you a case of water,” she said. “I don’t have to do that, but these are real-life issues.”
Disregarding the importance of race, poverty, gender and other social factors on health outcomes makes it all too easy for institutions to prioritize the financial bottom line over saving lives, say those who track the connection between race and health outcomes.Disregarding the importance of race, poverty, gender and other social factors on health outcomes makes it all too easy for institutions to prioritize the financial bottom line over saving lives, say those who track the connection between race and health outcomes.
Andre Perry, a fellow in the Metropolitan Policy Program at the Brookings Institution think tank and author of “Know Your Price: Valuing Black Lives and Property in America’s Black Cities,” said that as the coronavirus pandemic moves the United States into an economic downturn, cities and states will start looking to cut budgets.Andre Perry, a fellow in the Metropolitan Policy Program at the Brookings Institution think tank and author of “Know Your Price: Valuing Black Lives and Property in America’s Black Cities,” said that as the coronavirus pandemic moves the United States into an economic downturn, cities and states will start looking to cut budgets.
“They’ll create austerity measures,” Perry said. “Oftentimes that means shutting down resources or assets in the black community. Black people and our assets are sort of like sacrificial lambs of this virus.”“They’ll create austerity measures,” Perry said. “Oftentimes that means shutting down resources or assets in the black community. Black people and our assets are sort of like sacrificial lambs of this virus.”
Budget-driven closures of both urban and rural hospitals have plagued communities nationwide over the past decade. Since 2010, nearly 130 rural hospitals have closed, leading to an increase in births without proper obstetric care and preterm births in rural areas.Budget-driven closures of both urban and rural hospitals have plagued communities nationwide over the past decade. Since 2010, nearly 130 rural hospitals have closed, leading to an increase in births without proper obstetric care and preterm births in rural areas.
Dr. Laurie Zephyrin, M.D., vice president of delivery system reform at the Commonwealth Fund, an independent health care research foundation, said inner-city hospitals and safety-net hospitals (which see patients regardless of financial or insurance status) tend to run on tight operating margins, putting some of their health care services at risk. “When it becomes about funding and it becomes a budget issue, they forget about the people we’re trying to serve,” Dr. Zephyrin said.Dr. Laurie Zephyrin, M.D., vice president of delivery system reform at the Commonwealth Fund, an independent health care research foundation, said inner-city hospitals and safety-net hospitals (which see patients regardless of financial or insurance status) tend to run on tight operating margins, putting some of their health care services at risk. “When it becomes about funding and it becomes a budget issue, they forget about the people we’re trying to serve,” Dr. Zephyrin said.
It’s the people — the black women living in neighborhoods marked by poverty, violence and the chronic stress they both cause — that Dr. Bradshaw-Terrell worries about most. “I have a lot of patients say if they wanted to deliver at another hospital, they would have gotten care there. They trust me. They know we’re going to take care of them, and now we can’t,” she said, expressing concern that some patients might skip out on prenatal appointments altogether and show up at an unfamiliar hospital while in labor.It’s the people — the black women living in neighborhoods marked by poverty, violence and the chronic stress they both cause — that Dr. Bradshaw-Terrell worries about most. “I have a lot of patients say if they wanted to deliver at another hospital, they would have gotten care there. They trust me. They know we’re going to take care of them, and now we can’t,” she said, expressing concern that some patients might skip out on prenatal appointments altogether and show up at an unfamiliar hospital while in labor.
Thanks to better data from the National Center for Health Statistics, public health officials have made progress in talking about the high maternal mortality rate for black women in the United States. Still, the maternal mortality crisis stands to worsen in light of the coronavirus pandemic, the other crisis killing black people at higher rates.Thanks to better data from the National Center for Health Statistics, public health officials have made progress in talking about the high maternal mortality rate for black women in the United States. Still, the maternal mortality crisis stands to worsen in light of the coronavirus pandemic, the other crisis killing black people at higher rates.
Updated June 2, 2020 Updated June 5, 2020
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Limiting access to neighborhood labor and delivery services is yet another barrier for already vulnerable women in majority-black areas. “There’s always risk of increased mortality or increased morbidity with limited access to care,” Dr. Zephyrin said. “There are clear consequences if a woman wants care, had care and now feels left out in the wind.”Limiting access to neighborhood labor and delivery services is yet another barrier for already vulnerable women in majority-black areas. “There’s always risk of increased mortality or increased morbidity with limited access to care,” Dr. Zephyrin said. “There are clear consequences if a woman wants care, had care and now feels left out in the wind.”
In Philadelphia, a majority black city, a case study found that when 13 of the area’s 19 obstetrics units closed down from 1997 to 2012, the remaining hospitals became overwhelmed with the sheer numbers and needs of their new patient population, citing “a greater need for support services, including those provided by social workers.” Because pregnant women in Philadelphia’s black-majority areas were getting prenatal care in their own neighborhoods and then required to give birth somewhere else, the closures caused a lack of continuity in care. Ultimately, maternal deaths in Philadelphia increased among black women and other populations between 1997 and 1999, a fact researchers associated with the hospital closures.In Philadelphia, a majority black city, a case study found that when 13 of the area’s 19 obstetrics units closed down from 1997 to 2012, the remaining hospitals became overwhelmed with the sheer numbers and needs of their new patient population, citing “a greater need for support services, including those provided by social workers.” Because pregnant women in Philadelphia’s black-majority areas were getting prenatal care in their own neighborhoods and then required to give birth somewhere else, the closures caused a lack of continuity in care. Ultimately, maternal deaths in Philadelphia increased among black women and other populations between 1997 and 1999, a fact researchers associated with the hospital closures.
It’s simply not a trend that we can afford to let grow nationally, said Dr. Zephyrin. “There really needs to be an intense effort targeted to those communities, to those hospitals, so that they can stay open and thrive after Covid-19 because they serve a key population of people,” she said.It’s simply not a trend that we can afford to let grow nationally, said Dr. Zephyrin. “There really needs to be an intense effort targeted to those communities, to those hospitals, so that they can stay open and thrive after Covid-19 because they serve a key population of people,” she said.
Dr. Bradshaw-Terrell said that she didn’t want to see the care and sense of community that hospitals like St. Bernard provide go away, and that she hoped the ongoing plight of black birthing women across the nation doesn’t become a footnote to the growing coronavirus pandemic.Dr. Bradshaw-Terrell said that she didn’t want to see the care and sense of community that hospitals like St. Bernard provide go away, and that she hoped the ongoing plight of black birthing women across the nation doesn’t become a footnote to the growing coronavirus pandemic.
“I can’t help but to worry about my community — my overlooked and underserved community that is being impacted the worst,” she said. “It’s just really sad that where people need care the most is where we’re lacking the resources.”“I can’t help but to worry about my community — my overlooked and underserved community that is being impacted the worst,” she said. “It’s just really sad that where people need care the most is where we’re lacking the resources.”
Kelly Glass is a freelance journalist whose interests focus on the intersections of parenting, health, race and diversity. Follow her on Twitter @kellygwriter.Kelly Glass is a freelance journalist whose interests focus on the intersections of parenting, health, race and diversity. Follow her on Twitter @kellygwriter.