How three women in a truck are trying to solve health problems in rural Mississippi

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A brief filed by Mississippi Attorney General Lynn Fitch summarized the state’s arguments, writing that deer and Casey are misguided and outdated, in part because contraception is accessible, affordable, and effective, and because today “on a large scale, women are achieving both professional success and a wealthy family life.” This argument has been echoed by other proponents of restrictive abortion policies. But what Thomas and his colleagues have seen firsthand in about a year of running their clinic is that many Mississippians don’t have easy access to contraception — let alone other basic medical services. needed to plan families and thrive.

Rates of babies born underweight, for example, are very high in the Delta. It’s obviously bad for babies, but it’s also seen as a key indicator of mothers’ health, revealing that women in the region experience high levels of stress and limited access to healthcare. Additionally, the state, like many rural areas, suffers from a shortage of obstetrician-gynecologists. In more than half of Delta counties, there is not a single OB-GYN, according to federal data. Plan A asked an insured patient to contact them for help getting an IUD, as she could not find an appointment elsewhere for less than three months in the future.

The majority of patients who visit Plan A are uninsured or underinsured, struggling both to pay for health care and to physically access it in a sparsely populated area where the nearest hospital or doctor may be an hour’s drive away. Even a health care provider half an hour away can be unreachable without reliable public transit, and telehealth has limitations in the Delta, where many lack broadband access. Patients may also be reluctant to seek treatment, especially for a sexual health issue, because they feel alienated and judged by a medical system that does not always treat the poor or people of color with dignity. Some rural health providers do not offer family planning or gynecological exams at all. Meanwhile, the Covid-19 pandemic has caused many of the state’s beleaguered healthcare workers to leave the industry altogether.

To some extent, Weinberg, who got into public health after finishing medical school, anticipated these issues and thought a mobile clinic might help solve the central problem of geographic isolation. She hoped that having services free, as well as staffing the clinic with people who lived in the Delta and looked like their patients, would build the confidence needed to provide care around sensitive issues such as HIV, STIs and birth control. But, over time, the regional challenges she learned about before the clinic had ever seen a single patient turned out to be much deeper, prompting the organization to expand its services beyond reproductive health and to become a broad-based, basic-needs provider. such as primary care and vaccinations. It was only day two of Plan A, for example, when staff encountered their first medical emergency. The clinic had arrived at a Greenville factory to offer employees free health checks when a seemingly healthy woman entered the truck; she had a blood pressure of 220 over 110 – a potentially fatal level. Since then, there’s been a rare week where Plan A doesn’t see someone with high enough blood pressure to warrant a visit to the ER.

So far, Plan A’s mobile staff of three – Thomas, nurse practitioner Toria Shaw and another community health worker named Antoinette Roby – have traveled over 600 miles, visited over 30 cities and seen around 600 patients. More than half of their patients received sexual and reproductive health services. Plan A also distributed nearly 200 Covid-19 vaccines.

What has worked for Plan A over the past year has been cultural sensitivity and individualized care, along with an almost constant assessment of how they can best serve clients and a keen awareness of potential pitfalls. Weinberg knew that as a highly educated white New Yorker, she was “an outsider on every level,” in her words, when she devised Plan A, and so she tried to network with anyone who answered her question. phone in the Delta — elected officials, health activists, clergy, nonprofit leaders — to get feedback on his vision, as well as their tips for building trust. “It’s not fair to come into the community and not know how they feel,” says Jackie Sanders Hawkins, a former Delta outreach health worker who eventually joined Plan A’s board of directors. “She was able to connect with all these different stakeholders. If she hadn’t at first, the clinic probably wouldn’t have been there.

Inside the truck, Thomas and his colleagues go out of their way to make patients feel comfortable and constantly follow up to make sure patients pick up their prescriptions or go to appointments at a specialist. The patients, in turn, spoke to Thomas and his colleagues about a variety of issues affecting their health: relationship issues, infertility worries, sexual abuse, and lingering grief from a miscarriage. Many said they suffered from chronic pain and heavy bleeding caused by uterine fibroids. Others talked about relying on tissues to absorb menstrual fluids because tampons and sanitary napkins are too expensive. “Some people we touch,” says Thomas. “And they open up to us about certain things in their lives.”

Plan A’s approach has the potential to be replicated and the organization is striving to grow. But his work also underscores the magnitude of patient needs and shows how difficult it is to serve rural patients well and how much more resources are needed to address health inequities based on race and geography. more holistic way.

Health and race are inextricably linked in Mississippi. Black and Native American residents, for example, are much more likely than their white neighbors to die prematurely from treatable diseases. Black women in Mississippi are dying of cervical cancer at a rate nearly twice the national average. Pregnancy-related deaths among black Mississippians are nearly three times higher than among white women. Black babies are also dying at nearly twice the rate of white babies in the state.

The state is arguably the most extreme case of the much-discussed national rural health care crisis, in which politics, geography and demographics translate into bankrupt hospitals, provider shortages and deserts. of pharmacies. Covid-19, and the speed at which it has spread across rural America, has shed light on the disparities between urban and rural healthcare systems. Mississippi, whose health system is ranked by the Commonwealth Fund as the worst performing in the country, saw five hospitals close between 2010 and 2019. 27 others are classified as vulnerable, according to the National Rural Health Association, an organization in non-profit. Mississippi also ranks last among states in the physician-to-population ratio.

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