让子弹飞
Black Pregnancy Dangers, Deaths Seen as a ‘Completely Preventable’ Health Crisis_我的网站
A |
HOUSTON — Tonjanic Hill was overjoyed in 2017 when she learned she was 14 weeks pregnant. Despite a history of uterine fibroids, she never lost faith that she would someday have a child.
But, just five weeks after confirming her pregnancy, and the day after a gender-reveal party where she announced she was having a girl, she seemed unable to stop urinating. She didn’t realize her amniotic fluid was leaking. Then came the excruciating pain.
“I ended up going to the emergency room,” said Hill, now 35. “That’s where I had the most traumatic, horrible experience ever.”
An ultrasound showed she had lost 90% of her amniotic fluid. Yet, over the angry protestations of her nurse, Hill said, the attending doctor insisted Hill be discharged and see her own OB-GYN the next day. The doctor brushed off her concerns, she said. The next morning, her OB-GYN’s office rushed her back to the hospital. But she lost her baby, Tabitha Winnie Denkins.
“This is a public health crisis as it relates to Black moms and babies that is completely preventable,” said Barbie Robinson, who took over as executive director of Harris County Public Health in March 2021. “When you look at the breakdown demographically — who’s disproportionately impacted by the lack of access — we have a situation where we can expect these horrible outcomes.”
In fact, Harris County ranks third, behind only Chicago’s Cook County and Detroit’s Wayne County, in what are known as excess Black infant deaths, according to the federal Health Resources and Services Administration. Those three counties, which also are among the nation’s most populated counties, account for 7% of all Black births in the country and 9% of excess Black infant deaths, said Ashley Hirai, a senior scientist at HRSA. That means the counties have the largest number of Black births but also more deaths that would not occur if Black babies had the same chance of reaching their 1st birthdays as white infants.
No known genetic reasons exist for Black infants to die at higher rates than white infants. Such deaths are often called “deaths of disparity” because they are likely attributable to systemic racial disparities. Regardless of economic status or educational attainment, the stress from experiencing persistent systemic racism leads to adverse health consequences for Black women and their babies, according to a study published in the journal Women’s Health Issues.
These miscarriages and deaths can occur even in communities that otherwise appear to have vast health resources. In Harris County, for example, home to two public hospitals and the Texas Medical Center — the largest medical complex in the world, with more than 54 medical-related institutions and 21 hospitals — mortality rates were 11.1 per 1,000 births for Black infants from 2014 through 2019, according to the March of Dimes, compared with 4.7 for white infants.
The abundance of providers in Harris County hasn’t reassured pregnant Black patients that they can find care that is timely, appropriate or culturally competent — care that acknowledges a person’s heritage, beliefs and values during treatment.
Regardless of income or insurance status, studies show, medical providers often dismiss Black women’s questions and concerns, minimize their physical complaints and fail to offer appropriate care. By contrast, a study of 1.8 million hospital births spanning 23 years in Florida found that the gap in mortality rates between Black and white newborns was halved for Black babies when Black physicians cared for them.
In 2013, Houstonian Kay Matthews was running a successful catering business when she lost the daughter she’d named Troya eight months and three weeks into pregnancy.
Matthews hadn’t felt well — she’d been sluggish and tired — for several days, but her doctor told her not to worry. Not long afterward, she woke up realizing something was terribly wrong. She passed out after calling 911. When she woke up, she was in the emergency room.
None of the medical staffers would talk to her, she said. She had no idea what was happening, no one was answering her questions, and she started having a panic attack.
“It kind of felt like I was watching myself lose everything,” she recalled. She said the nurse seemed annoyed with her questions and demeanor and gave her a sedative. “When I woke up, I did not have a baby.”
Matthews recalled one staffer insinuating that she and her partner couldn’t afford to pay the bill, even though she was a financially stable business owner, and he had a well-paying job as a truck driver.
She said hospital staffers showed minimal compassion after she lost Troya. They seemed to dismiss her grief, she said. It was the first time she could remember feeling as if she was treated callously because she is Black.
“There was no respect at all, like zero respect or compassion,” said Matthews, who has since founded the Shades of Blue Project, a Houston nonprofit focused on improving maternal mental health, primarily for Black patients.
To help combat these high mortality rates in Harris County, Robinson created a maternal child and health office and launched a home-visit pilot program to connect prenatal and postpartum patients with resources such as housing assistance, medical care and social services. Limited access to healthy food and recreational activities are barriers to healthy pregnancy outcomes. Studies have also shown a connection between evictions and infant mortality.
For Hill, not having insurance was also likely a factor. While pregnant, Hill said, she had had just a single visit at a community health center before her miscarriage. She was working multiple jobs as a college student and did not have employer-provided medical coverage. She was not yet approved for Medicaid, the state-federal program for people with low incomes or disabilities.
Texas has the nation’s highest uninsured rate, with nearly 5 million Texans — or 20% of those younger than 65 — lacking coverage, said Anne Dunkelberg, a senior fellow with Every Texan, a nonprofit research and advocacy institute focused on equity in public policy. While non-Hispanic Black Texans have a slightly better rate — 17% — than that overall state level, it’s still higher than the 12% rate for non-Hispanic white Texans, according to census data. Health experts fear that many more people are losing insurance coverage as COVID-19 pandemic protections end for Medicaid.
Without full coverage, those who are pregnant may avoid seeking care, meaning they skip being seen in the critical first trimester, said Fatimah Lalani, medical director at Houston’s Hope Clinic.
Texas had the lowest percentage of mothers receiving early prenatal care in the nation in 2020, according to the state’s 2021 Healthy Texas Mothers and Babies Databook, and non-Hispanic Black moms and babies were less likely to receive first-trimester care than other racial and ethnic groups. Babies born without prenatal care were three times as likely to have a low birth weight and five times as likely to die as those whose mothers had care.
Hill’s twins, though premature, are now preschoolers. “I believe God — and the high-risk doctor — saved my twins,” she says.(Brandon Thibodeaux/KFF Health News)
If Hill’s miscarriage reflects how the system failed her, the birth of her twins two years later demonstrates how appropriate support has the potential to change outcomes.
With Medicaid coverage from the beginning of her second pregnancy, Hill saw a high-risk pregnancy specialist. Diagnosed early with what’s called an incompetent cervix, Hill was consistently seen, monitored and treated. She also was put on bed rest for her entire pregnancy.
She had an emergency cesarean section at 34 weeks, and both babies spent two weeks in neonatal intensive care. Today, her premature twins are 3 years old.
“I believe God — and the high-risk doctor — saved my twins,” she said.
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF. It has been published with permission.
。 开国上将韩先楚，外号“旋风司令”，打仗快、狠、准。
B | 可他在1965年做的一件事，比战场上的冲锋更让人佩服。 那年夏天，韩先楚回到湖北红安老家。红安是有名的将军县，可将军回来看到的不是风光，而是问题。 他走进一个公社，发现干部名单密密麻麻，数了数，竟然有好几十人。一个公社才多少人口？这么多干部，平时都干什么？ 韩先楚当场就坐不住了，把公社领导叫来，说得很直白：“干部太多了，要精简。
C | ”公社领导问减到多少合适，韩先楚回了一句：“精简到老百姓不叫苦为止。” 这句话很朴素，却说到了根子上。干部多，开销就大，开销大，负担就压在老百姓头上。
D | 韩先楚虽然是带兵的人，可算这笔账比谁都清楚。 但让韩先楚没想到的是，他说完以后，下面一点动静都没有。
E | 后来他到江西上高县视察部队，顺便了解地方情况，发现干部数量同样惊人。他多次向有关方面反映，都石沉大海。 韩先楚脾气上来了，干脆直接给毛主席写了一封信，把看到的情况一五一十说了。 信里没有拐弯抹角，核心就一条：地方干部队伍太庞大，老百姓负担太重，必须精简。
F | 毛主席收到信后，没有当成一般的群众来信处理。他安排人去湖南湘潭调查，结果发现，一个县城竟然有900多名干部。 这个数字让毛主席很意外。按照当时的实际需要，一个县百把人足够办事，多出来的都是老百姓在养。
G | 后来毛主席到杭州，听华东局汇报工作。 汇报开始前，他突然提起了韩先楚的来信，说：“韩先楚是个实事求是的人，他对我帮助很大。” 这句话让在场的人一时摸不着头脑。等毛主席把信的内容一说，大家才明白，这是要借这件事敲打地方。 毛主席当场提出要求：必须立即开展精简干部工作，而且要快。 这不是第一次提精简。早在抗战时期，边区政府就推行过精兵简政，目的就是节省民力、提高效率。 到了1965年，这个问题再次摆上桌面，说明机构臃肿不是一时现象，需要反复纠治。 韩先楚这封信，得罪人吗？肯定得罪。精简干部，就是动一部分人的饭碗。 他完全可以选择不说，反正他是军事干部，地方的事与他关系不大。 但他没有装看不见。他回乡看到的问题，就是老百姓天天面对的问题。 一个将军，能替种田的人算账，这比打一场胜仗更有意义。 毛主席对韩先楚的评价，也说明高层需要听真话。韩先楚不说漂亮话，只讲实际情况。 这种作风，在今天依然重要。干部队伍不在于人多，而在于能不能办事、办多少事。 如果一堆人坐在机关里，问题却没人解决，那精简就是应该的。
H | 韩先楚从战场到地方，始终没变的是那股实在劲儿。 他看到问题不绕弯，写信不粉饰，这正是“实事求是”四个字的具体体现。 这样的将军，值得后人记住。 #优质好文激励计划#返回，查看更多。
Current article:http://www.hanninhuaxituochunkui.pics/gnhft/2m3k6.htm
Published on:22:12:38