City struggles to save its smallest citizens
MEMPHIS, TENN. — The first thing you notice is how tiny they are: Row upon row of babies, some no older than this day, hooked to grotesque jumbles of tubes. Press your palm against the incubator wall and the infant inside disappears from view.
It takes awhile to realize something much sadder:
In a room full of newborns, dozens of them, there is no crying. The sound of beeping heart monitors, the rustle and murmur of observing doctors, but no crying.
“They’re too small and too sick to cry,” explains a passing nurse.
This is the newborn intensive care unit of the Regional Medical Center of Memphis, universally known around this city as The Med, perhaps two miles from the blues clubs and rib joints of Beale Street.
And these are the children with a fighting chance.
Some of them, a small fraction, will join the sparse field of little corpses buried in wooden boxes at the county cemetery, distinguished only by little metal plates and identification numbers, perhaps remembered with a stray and shriveled balloon.
Others will go home with mothers in a few days, a week, a year, and they will begin a life fighting impossible odds in this city’s worst neighborhoods, forging a struggle against poverty entrenched for generations.
A 2002 federal report put this city at the top of the list for infant deaths in American cities: 692 dead babies over a four-year span, a rate of more than 15 deaths for every 1,000 births, more than twice the U.S. average.
It is difficult to explain exactly why so many babies die here. It is even more difficult to say whether it will get significantly better any time soon.
Ask people here about their city and they are quick to acknowledge the problems -- particularly poverty and racial disharmony, the one exacerbating the other for decades.
They also will physically grab your arm and insist that this is a place with a lot of people pulling for it. And trying very hard, desperately, to figure out a way to save more of the smallest among them.
Infant mortality is not something you catch. There is no vaccine. There is no prescription to make it better. It is not really even something you can describe, beyond the umbrella definition: Infant mortality is a child who never turns 1.
It includes babies born after just five- or six-month pregnancies, children who enter the world with holes in their hearts or devastated lungs and who die in their mothers’ arms.
The U.S. infant mortality rate is just under seven for every 1,000 live births, according to the most recent figures from the Centers for Disease Control and Prevention.
Here in Memphis, a few other statistics drive home both the severity and the intractability of the problem:
In 1990, about 20 black babies died for every 1,000 born in Shelby County, and about seven white. In 2006, the numbers were little changed: 19 black, seven white.
Premature birth and low birth weight are by far the biggest causes of infant death. In 2002, they accounted for about a quarter of infant deaths in Shelby County; in 2006 the figure was more than 31%.
Shelby County lost 209 babies in 2006, according to state Health Department data. No other Tennessee county lost more than 93.
And it is a problem with yawning demographic disparities. In Shelby County, which includes Memphis, about 17 black babies died for every 1,000 born in 2004. For whites, it was about six.
“It touches on every inequality and unfairness you can think of in our day-to-day life,” says Dr. Sheldon Korones, 83, who started The Med’s newborn intensive care unit in 1968 and still roams it day and night.
A helping hand
Rosanna Stepney, an AmeriCorps volunteer, is a foot soldier in Memphis’ war on its infant-death problem.
She was assigned to Porter-Leath, a Memphis nonprofit children’s center. And now she is holding the hand -- figuratively and, once in a while, literally -- of a 19-year-old named Crystal Owens, steering her through her first year as a mother.
Stepney is driving through the streets of Hollywood in north Memphis, a place with all the telltale pockmarks of poverty in an American city -- graffiti and closed shops, cracked roads with leaning street signs, glares at the unfamiliar.
The topics today are stress management and nutrition -- the former for Owens and the latter for Jaquarius Butler, her 4-month old son, who is smiling up and giggling from an infant seat on the floor of the sparse home where Owens lives.
Where Owens “stays,” as she puts it. Her mother kicked her out of the house after learning she was pregnant with her boyfriend’s child. The boyfriend’s mother has taken them in.
Things are improving: Owens now works as a cashier at Burger King, and has begun taking night classes. She had no job, no classes and no prenatal care when Stepney approached her, two months pregnant, at their church.
They navigated the pregnancy together, and now they are navigating Jaquarius’ first year.
“Start him on the cereal,” Stepney tells Owens. “That’s a four- to six-months food. Make sure he gets his proper vegetables and fruits. If he doesn’t want to eat it, you know, just put a little applesauce on there.”
These are the basics. Many young mothers in Memphis are lacking prenatal care, and with it they are lacking some of the most basic dos and don’ts about carrying a child to term.
Humble burials
A pickup truck and a backhoe show up on the days, usually Tuesdays and Thursdays with good weather, when babies are buried at the county cemetery. The first carries the little wooden coffins, and the second digs the hole, maybe 3 feet wide, where they are placed a foot apart.
The caretaker is an ordained minister named Robert Savage who has done the job for three decades, and some days before or after driving in the stakes to mark the numbered plates above the coffins, he will offer humble comfort to families who show up there. The mothers are often missing, still in the hospital.
In 2005, the Memphis Commercial Appeal newspaper published an award-winning series called Born to Die that all but forced the people of Memphis and Shelby County and their leaders to confront the ghastly infant mortality figures.
“Folks had no idea it was this bad,” says Yvonne Madlock, who heads the city and county health department.
Within a year, the state of Tennessee -- ranked 48th in the nation for infant mortality -- had launched a program called 1 For All that took aim at all sides of the problem, encouraging healthier pregnancies and preaching how to care for children.
Still, Madlock acknowledges, the obstacles can seem daunting.
Maybe a young mother-to-be can’t get sick leave to see her doctor.
Time off is money lost for rent. Maybe she’s in denial, and doesn’t even have the pregnancy confirmed until the baby has already been harmed. Maybe she is ashamed to visit a clinic. Maybe she has no insurance.
While devoted health officials here have been working quietly on the problem for years, only in the last two years did Memphis and Shelby County launch a broad, coordinated attack.
The governor’s office committed more than $3 million in grants to boost grass-roots programs that try to keep women of childbearing age healthy and to pay for better equipment and add workers at city health clinics.
At the moment, health leaders in Memphis are placing their faith in a relatively new idea called “centering pregnancy,” which gathers about a dozen women with similar due dates and coaches them through their pregnancies as a group.
The county has the program up and running at one of its clinics, with plans for two more soon. And Christ Community, where Taylor works, is expecting a state grant to start one of its own.
“They are acknowledged. They are heard,” she says of the program. “They interact with each other. It produces a community support for each other. You’re actually growing a community and teaching women to take care of themselves.”
And yet it is difficult to spend much time talking with Korones, who at 83 is still entirely devoted to saving babies, and come away feeling anything but despair for the babies in this city where they die at such an alarming rate.
“We have treated 48,000 babies here,” he says.
“Infant mortality is still a problem, and the reason for that, my friend, is we are after the fact. We’re a Band-Aid. As soon as a premature baby is born, society has failed.”
