THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Monday, December 18, 1995 TAG: 9512170001
SECTION: DAILY BREAK PAGE: E1 EDITION: FINAL
SOURCE: BY DIANE TENNANT, STAFF WRITER
LENGTH: Long : 323 lines
THE FUTURE OF Chesapeake stood alone in a trailer lot, head bowed.
A visiting home-health worker approached the child. Did you bump your head on the trailer hitch? she asked.
Three-year-old Ashley shook her head - no - but she didn't speak. The only word the home-health worker had heard that day from Ashley was ``Mommy.'' But Mommy didn't answer, because Mommy was busy talking about a one-way ticket to Chicago. A one-way ticket for one, leaving her five children behind with her husband.
``When I'm ready to come back, I'll get another ticket,'' Mommy said. ``I honestly don't know if I want to come back.''
``But they need you to come back,'' the health worker said, gesturing at the children, and turning to talk to the 20-month-old boy. ``You need your mommy, don't you?''
``Mommy,'' Ashley said again, easing out the trailer door. Her shirt caught on a nail protruding from the broken door frame. She tugged at it futilely, but she didn't call out again.
The health worker had brought two packs of disposable diapers, several cans of infant formula, a mobile for the baby's crib. Mommy examined the pre-mixed formula, remarked that a friend got this kind all the time from the WIC program and never had to cut it with water.
``Maaaaan, some people have all the luck,'' Mommy said.
Ashley, her shirt finally free, slipped out the door and closed it behind her.
The baby's father had been asking to see her, but Mommy was reluctant.
``So he wants to see her, he can put some cash in my hand,'' Mommy said.
``You want him to pay to see her?'' asked the health worker.
``Why not?'' Mommy replied.
Where's Ashley? the health worker asked, looking around. On the porch, Mommy said. But Ashley wasn't on the porch.
``We need to find out where Ashley is,'' the health worker said, kneeling on the sofa to look out the window.
``She'll stay in the yard. She's very good about that,'' Mommy said.
The health worker walked outside. Ashley wasn't in the front yard.
The health worker walked around the corner and found Ashley standing silently by the hitch. You OK? the health worker asked, and Ashley nodded. The worker would be back another day, but with a caseload of up to 50 such families, she couldn't linger. She got in her car and drove away.
The children of Chesapeake live in great disparity.
At the bottom of the economic ladder are the 14 percent of Chesapeake's children, ages 5 and younger, who live in poverty. That's 2,099 children, according to the 1990 census.
They also live invisibly. The poor sections of Chesapeake are well hidden from middle or upper-income residents. But these sections are well-known to the Chesapeake Health Department.
To reach children and mothers for whom regular medical care is a luxury or an afterthought, some Hampton Roads' public health departments, including Chesapeake's, have adopted a decidedly old-fashioned approach: home visits.
``The beauty of the home visit is you see the whole picture, you see things that may need immediate attention,'' said nurse Beth Somers. ``There isn't anything like the good old-fashioned public health nurse visit.''
It's not a safe job. Some of the patients have bullet holes in their doors; some are victims of domestic violence; some are afraid to let their children outdoors.
The nurses try not to obsess about their own safety. Somers trusts her white lab coat and stethoscope for some measure of protection. But, mindful that the danger increases as the sun begins to go down, the public-health workers try not to enter most of their clients' neighborhoods after 3 p.m.
Two programs take home-health workers into poor neighborhoods: BabyCare and CHIP (the Comprehensive Health Investment Project). Funded by Medicaid, BabyCare sends nurses into homes that meet federal low-income guidelines to check on the health status of high-risk pregnant women and children to age 2. CHIP, funded by government and private grants, sends home visitors to check on children up to age 6.
The programs have been unarguably successful in some ways. Up to 95 percent of the home-health workers' clients are up to date on their immunizations, far higher than the state average. But doing medical checks isn't the workers' only role. Both CHIP and BabyCare emphasize prevention, and they do so through case management of entire families. The social problems that plague the poor, the workers say, have major effects on the health of children, and those problems can't be treated with shots.
BabyCare programs operate in Portsmouth, Virginia Beach, Norfolk and Suffolk, in addition to Chesapeake. CHIP operates in 10 localities statewide, including Norfolk, Portsmouth and Chesapeake.
Nurse Kathy Ingram looked at the remnants of Foundation Park and shook her head. Most of the people had been moved out of the buildings that look like one-story barracks, with shattered windows and weed-grown yards. Still, BabyCare has some clients here.
If people knew about this side of Chesapeake, Ingram said, they wouldn't stand for it. ``It's like you can't believe you live in America,'' she said. ``I guess that is what we're all trying to work on, is how did this happen and what can we do about it?''
CHIP worker Sheila Hopkins loaded up her car one October day with packs of donated disposable diapers, infant formula and simple books with teaching titles like ``What Happens When I Go To the Doctor'' and ``Boots Loses a Tooth.''
Hopkins' first stop was a woman from the Virgin Islands, an unwed mother whose two teenage sisters want to move to Chesapeake too, with her infant niece and their two fetus-swollen bellies.
The client had landed a job and dropped her main welfare benefits, then was cut back so many hours on the job that she needed to sign back up for welfare while she hunted for employment again. ``Sometimes it's like a never-ending story,'' Hopkins said.
She pulled into an apartment complex where many of the buildings were boarded up because of asbestos contamination. A dead kitten lay smashed in the street.
Two women eyed Hopkins as she locked her car. A toddler on the sidewalk chewed on a bare pork-chop bone.
Hopkins had to knock twice before the door opened into a sparsely furnished apartment with a hole in the wall.
``Hey, Javante, how's it going?'' Hopkins said, as a 2-year-old skipped into the living room and danced to imaginary music. ``He is a happy boy.''
``I had a nurse appointment this morning and I forgot,'' his mother said. It is hard for these clients to remember routine doctor appointments. A doctor is someone you see when you're sick, very sick. Why take your child to the doctor when she's not sick? Why should you see the same doctor each time you go?
``Javante is caught up on his shots, right?'' Hopkins asked.
Javante started to climb over the end of the couch. Mom grabbed his arm and made him walk around the front to sit down. He tried again. So did she.
``You don't want him to play?'' Hopkins asked.
The apartment was closed tightly, stifling. Javante's mom fears the neighborhood, so he rides his plastic three-wheeler up and down the hall. Since Hopkins has been coming during the past year or so, Mom has relaxed a little. She talked wistfully of wanting to take him to the Children's Museum of Virginia in Portsmouth.
But Mom didn't even have $59 for the rent.
Javante's mom is afraid to move to a smaller, less expensive, place, because it is, she said, in a bad neighborhood.
Hopkins asked about the pregnant sisters. She doesn't want them to move in and freeload off her client.
``Hunh uh!'' the mom said, vehemently. ``I'm tellin' you, ain't gonna happen. You know what happens when people go to live with friends? They end up on the street. Because that is what happened to me.''
Javante picked up a bent piece of metal off the empty entertainment center. ``Hai yah!'' he shouted.
``Javante! No!'' his mom called harshly.
The boy eyed her for a moment. ``Hai yah!''
``Will you take it to your mama?'' Hopkins asked softly. ``Will you give it to me? Don't put it in your mouth.''
Javante laid down the metal and bounced away. Hopkins walked across the room and lifted the metal to a high place, out of the child's reach. Teaching by example, she hoped.
Hopkins gave Mom advice on finding another apartment, told her how to sign up again for welfare. But she wouldn't do either task for her. The Chesapeake home-health workers are adamant about one thing: They try to teach clients how to care for themselves, not create dependency.
Nurse Somers calls it the ``teach a man to fish'' concept, where clients learn coping skills they can use when the health workers aren't around.
Hopkins embraced Javante one last time, and moved on.
The object of the home visit is to reduce future drain on government funds by ensuring that moms have healthy newborns, and that poor children have regular medical care. But there is more. The five BabyCare nurses and four CHIP workers try to ensure that their clients are loved.
They teach money management, social skills, parenting skills as basic as hugging and cuddling, and job-hunting techniques. Such skills are important because social problems often are harder on the health and welfare of small children than are germs.
Research has shown that children who murder often have grown up in homes where there is no empathy or nurturing, said nurse Kathy Ingram. Infants whose cries are not answered grow up to neglect their own children.
Nurse Judi Pulley's last client of the day thinks her son is a living doll. But when the 15-year-old tires of playing with him, she wants to put him, like an old toy, aside.
Reluctantly, Mom slouched on the couch to endure the nurse's visit, and stared off into space while Pulley hugged the infant.
``How much does he eat when you feed him?'' Pulley asked.
``I don't know. A lot.''
``Uh oh, what's that I hear?'' Pulley said, cuddling the baby. ``My baby's got a cold. Does he have a cold? Has he run a fever?''
``Huh?'' Mom asked, leaning her chin on the arm of the couch.
``It was 99 (degrees),'' Mom's 16-year-old sister volunteered, holding her own baby in one arm.
``That's not bad. We need to listen,'' Pulley said, tucking her stethoscope into her ears.
``Sweetheart, he is rattlin' all the way through. He needs to go to the doctor. When was the last time he's been?''
Mom grinned and shrugged her shoulders.
``Tell me how much coughing he's doing,'' Pulley pressed on.
``I don't keep up with that.''
``Does he have a lot of junk coming out of his nose?''
Mom grinned again, but mumbled the answer.
``Was that yes or no?''
``Yeah.''
``Was he rattling like that and coughing last week?''
``Uh huh.''
``Have you got a way to get him to the doctor? Can you call the doctor's office?''
``I don't know the number.''
``Well, we can solve that. I've got the number in my car.''
Pulley handed the baby back to his mother. She perched him on her knee and slouched back. The baby began to cry.
``Is he ready to eat?'' Pulley asked.
Mom shrugged.
``He's not a happy camper. `Give me something to eat, Mama,' '' Pulley urged, speaking for her tiny client.
Mom left the baby on the couch alone, crying. A third toddler, the daughter of another of Mom's teenage sisters, stood crying next to him. For several minutes, nothing changed. Finally, Mom's sister gave the boy her thumb to clutch, and he quieted. The toddler kept on crying. Pulley picked her up and snuggled the child on her lap.
Mom came back with a curved bottle, and stuck it in her son's mouth, upside-down.
Take him to the doctor, Pulley instructed again. Don't forget your own doctors' appointments next week.
Mom and Mom grinned again. Bye, they said.
BabyCare nurses have many premature babies in their care, with lingering medical or developmental problems from the early birth. That's why BabyCare also looks after pregnant women: The more premature births the nurses can prevent, the fewer infant medical problems Medicaid has to provide for later.
It is hard for these women, sometimes. Love is difficult to show when stress is so high. Nurse Beth Somers tries to emphasize love's importance.
``The moms are getting younger. I have had them as young as 12 in the last two years,'' she said. ``Most are just too young to have experience at parenting. They're focused on such basic things - food, shelter, transportation - that other things - stimulation, reading, toys - are just not important. Smiling, touching, holding and those things that we consider routine, they are unaware of the importance of that.''
Her first stop on this day was an 18-year-old unwed mother. The girl is a success story for the BabyCare program, although she is unemployed and a high school dropout. She is a success because she hasn't become pregnant a second time, and the baby is now 15 months old. She has completed an education program for teen parents. She would go back to school if she only had a way to get the baby to child care. Her child is up to date on immunizations and medical checkups.
``We hope this is preventative work we're doing, but it's hard to measure,'' Somers said. ``This (avoiding a second pregnancy) is one yardstick I use.''
Another thing Somers tries to prevent is developmental delays in her clients' young children. To check whether they are keeping up with other kids their age, learning gross and fine motor skills, language skills and more, Somers watches them play. Because some of the homes are so poor, she takes her own toys with her.
It was developmental testing she needed to do on her last visit of the day. The 16-year-old mother slouched on the couch, nibbling her fingernails. Mom has two children, the elder one 2 years old. That child is older than Mom's own sister, who is 1.
Somers pulled five wooden blocks from her briefcase.
``Can you build a tower for me?'' she asked the 2-year-old. It took some coaxing, but he stacked the blocks three high.
``Now can you put this green one on the red one?'' Somers asked. ``Now can you put this one on top?''
Many of BabyCare's clients have no toys in the house. The public health workers use a $2,000 grant from Southland Corp. to give $20 worth of books and toys to their neediest families. Somers checks to see what developmental skills her clients lack, then provides toys that will build those skills.
``Where's your nose?'' Somers asked the 2-year-old. ``Where's your ear?'' And to Mom, ``Can you turn that down a little bit?'' pointing to the blaring TV.
With the volume down, Somers heard something worrisome. Mom said that her 9-month-old had been diagnosed with asthma, but she hadn't yet filled the prescriptions.
Doctors complain that many poor patients don't keep appointments, don't comply with their orders. ``They miss appointments but people don't have a clue how hard it was to get there at all,'' said Ingram, who once mapped for a client the shortest bus route from Bowers Hill to drug treatment in Great Bridge: a seven-hour trip.
``Clients are non-compliant often not because they don't care, but because they can't comply. If you don't work with this population, you just don't realize that what we take for granted is so hard.''
Somers took the prescription slips. ``What I'm gonna do is get these filled today because he really needs them,'' the nurse said. ``Asthma is a scary thing.''
The 2-year-old hurled a ball across the room, and Somers watched to see Mom's reaction.
``Come here,'' Mom said. ``Let's talk, let's talk. Let's talk about the ball. Go get it. Say `Excuse me' and go get your ball.''
No hitting. No yelling. No medicine, either, but change comes slowly. Mom was still in school, and the children were up to date on their immunizations. Somers was still pleased with the visit.
The recovering drug addict cried, wiping her eyes with one hand, cradling her month-old infant with the other.
The HMO you have chosen, said BabyCare nurse Judi Pulley, just won't pay for me to come see you anymore. Some do, some don't. This one won't.
Medicaid requires all its patients to be covered by an HMO by Jan. 1. Of the three largest ones in the area, only two will cover case management such as BabyCare provides. That means even fewer children receiving health department services. Mom, who hadn't used drugs since the BabyCare nurse started visiting, was upset.
``I can still be your friend,'' Pulley assured her.
``I know that but, dag, Miss Pulley,'' the mom replied. ``Will you still come see me?''
``I'll still come see you as a friend.''
The client's sister took the infant and listened quietly as Mom spoke eloquently of what Pulley had done for her.
``She look at you like you was SOMEBODY,'' the mom said. ``She never made me feel like an addict.
``The first time I met her she gave me a hug. People just don't touch me because they think `You've been out there.' We feel we're dirty, too. But I remember she gave me this hug. And it wasn't no business or no political hug. She look at me like she sees something I don't see in myself.''
``You could have done it,'' Pulley said, embarrassed by the praise.
``Yes, I could, but would I?'' the mom asked. She looked at her sleeping son. ``I didn't want no part of him. I wasn't real sure who the father was. I felt ashamed about that, too. But you made me feel not so ashamed anymore.''
``You're all right,'' Pulley said.
``Yes,'' the mom replied. ``I'm gonna be all right now. I am. I fell in the mud and I laid there and wallowed in it for a while and you said, `Get up.' I trust myself now.''
The infant needed changing. Mom took a wipe out of the box and reached toward him, then snatched her hand back. ``Uh oh, I forgot to warm it up,'' she said to her son, rubbing the wipe between her hands. ``I apologize. I apologize. I'm sorry.'' She kissed the child.
The mother-child bond made Pulley smile. She filled out a card to place the infant on the Joy Fund Christmas list, a Virginian-Pilot-sponsored charity that provides gifts for poor children. A guardian angel pin flashed on her shoulder as she wrote.
``That's exactly the right thing for you,'' the mom said, looking at the pin. ``They need a bunch of you, Miss Pulley.'' ILLUSTRATION: Color photos by Beth Bergman, The Virginian-Pilot
Medical care, parenting and other survival skills are only some of
the services that home health nurses like Judi Pulley provide for
Chesapeake families.
Pulley goes into low-income homes...
"The beauty of the home visit is you see the whold picture," said
Chesapeake home health nurse Beth Somers.
by CNB