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Too Many Patients : High Rate of Premature Black Births Fills Infant Intensive Care Unit

March 13, 1994|KAREN E. KLEIN | Dr. Xylina Bean is a neonatologist and director of the Rosa Parks Neonatal Intensive Care Unit at Martin Luther King-Drew Medical Center. Bean recently presided over the dedication of the neonatal unit by Parks, the 81-year-old seamstress whose refusal to give up her bus seat to a white rider in 1955 sparked the Montgomery, Ala., bus boycott, which in turn propelled the civil rights movement. Bean has worked at the medical center since her residency there in 1973. She was interviewed by Karen E. Klein.

There is a tremendous need in the South-Central Los Angeles community for critical care for premature and very ill babies. We've always had higher rates of infant mortality and prematurity in South-Central relative to the county and the state.

For many years, we averaged over 20 patients at our facility, which was licensed for only 10 beds. In 1975, we stopped taking transfers into our unit, and patients who delivered premature or sick babies in the area had to go to Long Beach Memorial Hospital.

We tried for many years to get the unit licensed for more beds, but we could not get licensed in our existing space. That's why we built the new unit. It was all built by county employees--we didn't contract out to a fancy firm--and as a consequence, it took a year and a half to build it.

The new unit opened in June, 1993, licensed for 42 beds, which we're phasing in. We're using 24 beds now. We have to get the county to allocate the appropriate resources, primarily funds for staffing, so we can use all the beds.

We never have problems getting patients. In 1975, the rate of women who were delivering babies here who had had no prenatal care was about 10%, a little higher than the rate of 8% for the country as a whole.

Then, as access to prenatal care became more difficult and the drug epidemic hit, we started to get rates of 30% of patients who had not had any prenatal visits with a doctor. In the last five years, Gov. Pete Wilson has made a commitment to providing prenatal care to the underserved population, and the waits at clinics for prenatal visits have dropped from two to three months down to one to two weeks for an initial appointment.

That has made a difference. We have seen the rate of patients with no prenatal care fall to about 18% recently, which is a dramatic decrease but still more than twice the rate of the country as a whole.

We have a continuing problem with infant mortality rates for African American women being much higher than they should be and with African Americans delivering three times more premature babies than would be normal for their population. For instance, about 12% of our deliveries are to black women, but black babies make up about 50% of our neonatal unit patients.

There have been all kinds of studies to try to determine why this is. It's a fundamental kind of thing, with drugs, lack of prenatal care and just the problems that go along with being black in this country all contributing factors.

We know that intervention--early intervention--works. Giving special attention and special care to this population will decrease the rates of infant mortality, but it's hard to get the extra resources allocated for extra programs. It's very frustrating, because we spend so much time and money on these very sick babies when, if their mothers had gotten basic care early on, they would not be born premature.

Also, we work so hard to save these babies, then many of them are released and go to homes that are unequipped to care for their special needs and they are dead two weeks later.

Death is a constant thing in our unit, and it's very hard for the nursery staff to cope with that. No matter how hard we try to save some babies, they still die on us. We try to tell our people that they have to do the best they possibly can and make their contribution matter.

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