ACC.10

Taking a brief break from my self-assigned pregnancy beat, I attended one day of ACC.10 – the 59th session of the American College of Cardiologists in Atlanta yesterday. A couple of story ideas came from it.

There were three posters that I’d like to find a way to work into one story and (but how?) relate to Madison Co.

• “Government-Sponsored Health Insurance and Lack of Insurance Are Associated with Adverse Cardiac Effects.”

• “Money Left Over at the End of the Month and Outcomes After Myocardial Infarction.”

• “Medical Cost Burden and Outcomes After Acute Myocardial Infarction.”

All three support the theory of Unnatural Causes: financial stress has an adverse effect on your health.

I’m not sure what the news article would be here. Just to say that these studies were done and what the result was? Is that enough? How to relate to Madison Co.? Sure, I know the people who care for the financially stressed in Madison County, but what to ask them?

The other story ideas came from the session on the Hospital to Home initiative (H2H). 25% of patients with cardiovascular disease are readmitted to the hospital within 30 days of discharge, and H2H’s mission is to reduce this rate by 20% with the collaboration of hospitals across the country.

I’m interested in two aspects of this initiative:

Community Collaboration: The focus of H2H is on improving the transition from hospital to home through follow-up home visits, phone calls, education, overseeing of meds, etc., and the creators of the initiative emphasize the importance of the community, such as pharmacists and community organizations, in helping carry out its mission.

This was interesting to me because I recently spoke with Gary Rost, executive director of Savannah Business Group on Health (SBG), who has been working on the development of a coastal Georgia health coalition for the past few years. Rost believes that no single health organization – such as public health – can possibly respond to the health needs of all the people. He believes the health coalition concept (or strategic partnerships, as H2H calls it) is “absolutely” the answer. Both SBG and H2H hold that the health of the community is the responsibility of the whole community.

Dr. Zsolt Koppanyi, director of the West Central health district (Columbus, GA), said that even though public health has beautiful plans in place for all types of situations, there simply aren’t enough people to carry out these plans. Finally, I spoke last week with Kevin Caspery, an MPH who works for a private firm that does consulting for the CDC. He commended the CDC for its reaching out to so many branches of the community in order to create strategies; he also seemed to feel that this is the way to respond to health needs.

So my story idea is the community health coalition as a possible solution to a public health system that has no money and is severely understaffed.

Transportation and Health: One way H2H wants to improve the transition home is through scheduling follow-up appointments for dates sooner after discharge and making sure the patient actually has a way to get there. The speakers in this session said that too often follow-up appointments are not kept and, when scheduling the appointments, healthcare providers don’t ask the patient how he/she will get there.

This reminded me of Madison County. In my first meeting at the cooperative extension, Debbie Phillips told me that lack of transportation is too often a barrier to the poor getting care and services that they need. County nurse manager Beth Heath has also mentioned lack of transportation as a significant barrier to getting proper care. This is compounded in Madison County by lack of any public transportation – or even a sidewalk for that matter – no hospitals and only a private ambulance service. We don’t always think that whether or not one owns a car could impact one’s health.

Maybe this is a story idea?

First Cabbage Patch Class

Monday, February 8, 2010

I’ve started to cover the pregnancy beat in Madison County, which – as far as social services are concerned – means the teen pregnancy beat because, according to Beth Heath (Co. Nurse Mgr.), most of the moms they serve are teens.

Tonight I went to my first Cabbage Patch class, a program that Beth started when she was in Jackson Co. and that she replicated in Madison Co. (There's Beth above, signing the attendance sheet for one of the moms-to-be.)

Cabbage Patch is a weekly class for expectant mothers (and their partners and families) that runs nine weeks. While it isn’t expressly designed for teens, the majority of the group is teen-aged (some are very young teenagers) and the remainder is 20-21 years old.

Each class is on a different topic, such as nutrition, newborn care, and delivery. There are pre-tests and post-tests on the topic at the beginning and end of each lesson from which the district’s epidemiologist collects data on the outcomes of the class.

Since the program has begun, Madison County has seen reductions in preterm labor, low birth weight and prenatal smoking, and increases in birth control use, spacing of pregnancies, and initiation and duration of breastfeeding.

The program itself is a portrait of the ways in which public health is overworked and under-resourced. First of all because there is statistical evidence of the value of this preventive program, but the state still does not have money to invest in it.

When Beth started the program, with then-county nurse manager Pam Smith, who is now the District Nurse, there was no public health funding for prenatal classes, so if they wanted to proceed, they would need to find grant money on their own. They were finalists for a March of Dimes grant though they did not get it. And they were recipients of a Jackson EMC Operation Roundup grant for two years, and they were able to stretch the money over three years.

The current session of Cabbage Patch ends March 22, and it will only run again if the clinic gets another grant.

Pam or Beth teaches most of the lessons, and a few are covered by other specialists, such as a certified breastfeeding peer counselor. The grant money, then, is needed for incentives. Each week, every expectant mother gets some really nice swag for attending the class, such as a Moby Wrap, the famous What to Expect When You’re Expecting, ear thermometers, bath thermometers, and – following their nutrition lesson – a gift card for a local supermarket with which they are challenged to buy healthy foods that they wouldn’t normally buy. But the pièce de résistance, and certainly a major stimulus for most students’ perfect attendance, is the new car seat they receive on the last night.

The final lesson is two hours long and given by a certified car seat technician who properly installs the seat in each expectant mother’s car.

Each county clinic is required to stay open late one night per week, so Cabbage Patch classes are held on their late clinic night when Beth would be there anyway. But Pam is there on her own time. And both she and Beth, as well as other members of the clinic staff, regularly and voluntarily stay past 7 because of this class. And they make runs to Wal-Mart for the incentives and research and write grants often on their own time as well. As Pam said, “Beth and I both live in Madison County, so the way we see it is that we’re just doing something for the community.”

Sigh.

When I asked Dean Phillip Williams of the College of Public Health why anyone would go to work for the state or at county clinics when they can get so much more money working for federal agencies or in the private sector, he said, “They are just very dedicated.”

I’ll say.

More to come about the moms-to-be at Cabbage Patch.

Family Connection Meeting

Tuesday, January 26, 2010

As soon as I tell anyone what I am doing in Madison County, they respond – without pause – “Teen pregnancy. That’s the health issue in Madison County.”

It was first mentioned to me in a meeting at the cooperative extension with Leigh Anne Aaron, county extension agent, and Debbie Phillips, county program coordinator.

I admit, my first thought was, Yeah, yeah, sure. What else have you got? To my mind, it was a retro-topic. The stuff of after-school specials. I wanted something sexier.

About a week later, I went to the Family Connection meeting at the chamber of commerce (see image) – a monthly summit of the representatives of a handful of county resources. Around a large conference table sat the county nurse manager; a representative from a community garden organization; the coach of a baseball team for children with special needs and the mother of a player; a parent representative of PRIDE, a safe driving program for teens; and, finally, a parent representative from the Teen Pregnancy Prevention Coalition and, announced in absentia due to the flu, Melanie Berryman, the leader of Madison County High School’s Teen Parent Support Group. Of the handful of focused issues represented at the meeting, teen pregnancy was the only one that was repeated.

I had come to this meeting to find another story idea. Then, as if I hadn’t eaten my vegetables the night before, here they were waiting for me at the breakfast table.

Teen pregnancy was not what I thought I’d be writing about, but now it seemed wrong not to. I knew I wanted to write about the health concerns that mattered most in this county. Who was I to decide which issues were “cool enough to matter”?

The media have the power to make health issues seem to disappear when they are no longer in fashion. But what if journalists continued to cover an issue as long as it continued to be an issue – covering the story until it disappeared, rather than forcibly making it disappear?