What Your Vote Means September 18, for the Rest of Alabama


Yesterday, I told you a few things about rural medicine in Alabama and how worried I am about the havoc even a brief dip in funding could cause if we don’t vote Yes next Tuesday.  I got a call Monday afternoon from Dale Quinney, the Executive Director of the Alabama Rural Health Association.  He agreed that the situation is critical—we must have reliable, continuous funding of our state Medicaid program or we risk losing life-saving medical services in rural counties.  And he gave me information I had not heard, information that worries me even more.  My friends know I am asleep by 9 at the latest, unless I’m on call.  I’m not on call, and I’m up typing at 11 pm because I really want you to hear what he had to say before you vote.

If you live in or near one of the larger cities in our state, you may think of those lovely green swathes of land beside your car as a picturesque blur of scenery between you and Atlanta.  Did you know that out of our 67 counties, 55 are considered rural?  I’m glad I have a chance to do another piece on rural healthcare today, before getting to the cities.  We need to remember our vote next week will have the most immediate and life-altering effects on citizens of the most remote, beautiful and often severely poor areas.  Alabama is not just Birmingham, Huntsville, Mobile and Montgomery.  We are Benevola, Guin, Flomaton, and Dixon Mills.

There are communities so small, my mother-in-law in Pickens County can ask me if they said anything about her in the paper, and it’s a normal question—the Pickens County Herald will mention if your children came to visit for Sunday dinner and what you had on the table.  I hate to be stereotypical, but from what I’ve seen, these are some of the hardest working, make-ends-meet folks you’ll ever meet, and some of the most generous.  They know how to do right by family, how to show up with a cake or a pot of stew when they are supposed to, and how to make sure a sick neighbor’s garden gets taken care of.

If we don’t want most of the land in our state to turn into a mass of ghost towns, we need to remember the effects city voters have on the rest of Alabama.

Mr. Quinney told me we need to be most concerned about obstetrical services in these counties—the ability of the local hospitals to continue doing deliveries.  He said that in 1980, 46 of 55 rural counties had labor and delivery services—now there are only 19.  In the Black Belt, there were 10—now only 2. Why?  There are fixed costs associated with delivering babies, such as highly trained staff and specialized equipment.  If a hospital doesn’t do enough deliveries, it loses money and must carry those costs on the backs of other services.  No matter how much a community wants its hospital to deliver babies, there’s a financial breaking point.

After our conversation, I did some hunting around online about rural maternity services.  I found a story from last year about a hospital in Demopolis where the whole community pulled their resources together to save their labor and delivery unit.  The doctors took large pay cuts voluntarily, and the community did fundraising—it’s an impressive story of a town that cared so much about its newborns.   If the funding is still as much in jeopardy as this article describes, a cut in Medicaid payment could be devastating.

What are the consequences if that hospital has to close its maternity ward?  What happens in those 36 other rural counties where there is no hospital to deliver newborns?

If you are tired of hearing about our state being at the bottom of some rating list, cover your ears now.  Alabama is consistently in the worst handful of states for infant mortality.  It varies from county to county—look at this comparison.  Do you see the truly frightening death rates for newborns in some rural counties?  Having a local hospital that does deliveries isn’t the only factor.  What happens when a county hospital can’t deliver their newborns anymore?  The obstetricians move somewhere else, and prenatal care goes with them.

Expectant families in counties that can’t deliver their newborns face difficult choices.  If they know they may have to travel 50 or 70 miles after going into labor, will they risk the baby being born in the back of the pickup truck or in a ditch?  Or will they feel forced to schedule a planned c-section—a procedure that can be life-saving in some cases but otherwise significantly increases both the cost and the complication rate for mother and baby?

Mr. Quinney told me that the loss of obstetric services also sets in motion a process where the whole hospital is at risk of losing community trust and support.  He said that if the hospital where you live can’t offer that most basic of services, the safe delivery of your newborn into the world, so that you have to drive by it, you may continue to drive by for other medical services even when it would be safer to pull over and get care where you are.  He said, “The loss of obstetrical service in our rural areas is threatening the natural bond between rural residents and their local hospital.”

I am saddened by learning how many hospital services we’ve already lost in Alabama.  I did not know.  If there is anything I can do to help save one of these hospitals, for the sake of the babies who could be born there, I would be glad.  At the very least, I can try not to hurt them by yanking their funding around like a yo-yo.  I’m voting Yes next week, Yes to the babies of Demopolis.  What will you say to them?

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