Benjamin Franklin famously said, “An ounce of prevention is worth a pound of cure.” Proper pre-natal care dramatically increases the likelihood of a good outcome for mother and child, thus proving that Mr. Franklin knew what he was talking about. With this axiom in mind, the OB/GYN clinic at the Gainesville Health department was born.
The clinic is not a mandate of public health but rather a very unique collaboration that came about from the understanding that healthy moms and healthy babies are the goal of every pregnancy. Ultimately, an uncomplicated birth with a good outcome is less costly than than dealing with the health problems that a sick mother and child can face when prenatal care is non-existent or inadequate.
Working together to run the clinic are the doctors and midwives at the Longstreet OB/GYN clinic in Gainesville, the Northeast Georgia Health System and Medical Center (where the babies are delivered) and the District 2 Public Health Department. District 2 Public Health covers 13 Northern Georgia counties including Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, and White.
According to Alan L. Satterfield, BSN, RN, BS and County Nurse Manager for the Hall County Health Department, the clinic serves uninsured and underinsured expectant moms living in the 13 county district for the entire nine months of pregnancy for a modest fee of $1200 that can be paid in installments. Most patients are self-pay and about 5% of patients have Medicaid.
Satterfield notes though, that should the mother become unable to pay the entire fee, she will still be treated. For a time, the Babies Born Healthy initiative provided some clinic funding and the clinic received several grants that also supplemented the clinic’s monetary resources. Those avenues of funding have since gone away and the clinic is entirely funded by patient fees and the willingness of the doctors and the hospital to offer services at a significantly reduced rate.
There is no set number of patients the clinic will see. If a woman qualifies, the clinic will see her. To qualify, the mother must have a positive pregnancy test, live in one of the 13 counties and prove she is unable to afford insurance or adequate insurance. Satterfield points out that with the changes in immigration, the numbers have dropped, but at one point, the clinic was responsible for about 1/4 of the deliveries at the medical center.
Jeffry J. Bizon, MD of the Longstreet OB/GYN Clinic has been working with the program for 18 years. He says that early on there was a significant number of undocumented, uninsured women who came to the emergency room in labor. Unfortunately, because of their situations, these women had had no prenatal care and Dr. Bizon says, “Often these (deliveries) were disasters. The mother was sick and the baby was sick.” In fact, he says that even though he’s been around 18 years, he’s still “new” to the program.
Some of the partners in the practice who have since retired said that at one point it was so bad that women were coming into the emergency room one after the other and the reason they were coming in is because they were already so sick. However, patient compliance increased significantly once the word got out about the clinic in the early 2000’s.
The clinic offers ultrasound services and Dr. Bizon says, “Nothing will get a woman to her prenatal appointment like an ultrasound.” After the baby is born, women come back to the clinic for their six week checkup at which point they receive a pap smear and contraceptive services if desired. In fact, if permanent birth control is requested, for an extra $1000 fee, the mother can have a tubal ligation while she’s in the hospital to deliver.
Cherylin Woodruff, RNC at the Hall County Health Department says that because they offer a family planning clinic and post-natal contraceptive services, they’ve seen a decrease in the teen pregnancy rate. In addition to pap smears and contraception, women over 40 may also receive a mammogram.
The health department is currently participating in the genomics program where patients can get free bloodwork and screening for the BRCA genes which indicate breast cancer risk. Dr. Bizon points out that sometimes, prenatal care is the only medical care some of their patients have received and secondary health issues are often diagnosed.
Most common are diabetes and thyroid issues. Supplies and counseling are provided to patients with gestational diabetes and if the condition is permanent and not pregnancy induced, patients are referred to the clinic where they can receive post-natal diabetic care. John (Jack) McGuire, a CNM with the Longstreet Clinic says that since the clinic’s start in 1986 or 1987, the clinic has seen a number of changes and that those involved have worked hard to keep up with those changes. As a CNM (Certified Nurse Midwife) McGuire has personally worked to make sure that as many women as possible have an uncomplicated vaginal delivery…the best option possible for healthy mother and baby.
Since the clinic’s inception, demographic changes have necessitated staff changes. Currently, there are 10 interpreters on staff at the health clinic and Woodruff says that Satterfield has worked hard to make sure there is an interpreter phone line available to staff for patients who may speak a language staff interpreters are not equipped to address. There is even someone fluent in American Sign Language who can come in and assist with deaf patients.
Dr. Bizon is quick to point out that the quality of the care received at the OB/GYN clinic rivals that of the care received by patients with adequate or excellent insurance coverage. There is one area where the clinic would like to see improvement and that is in the recruiting and retention of qualified nurses. Naturally, the clinic cannot compete salary-wise with hospitals and established medical practices so it takes a special person to come in and be willing to work for a lower salary. Usually, that “someone” will have a passion for ensuring that all women receive proper pre-natal care. Gwen Cooper, Human Resources Director at District 2 Public Health says that currently, they have seven positions that they would like to fill. Cooper points out that retention is difficult because the lure of a better salary elsewhere is often powerful. However, she remains optimistic that the right nurses for the job are out there…nurses hearing the call to work with mothers needing quality pre-natal care and the best possible delivery.
For more on celebrating nurses, visit www.ajc.com/ajcjobs/celebrating-nurses/.
