A few years ago I had the unique opportunity to do some mission work in Zambia, a small landlocked country in Southern Africa. Although I was curious about the country’s natural resources and beauties, such as the Victoria Falls, I was as equally intrigued about the status of its healthcare. Prior to my trip, I did a little research and found some pretty staggering statistics. There were approximately one million people living with AIDS. The life expectancy at birth was approximately late 40’s. Maternal mortality was high at 650/100,000. The physician/patient ratio was quite poor at .12 physicians/1000 people. And as expected, malaria was a common infectious disease.
Once I arrived and had a chance to travel across the capital city of Lusaka and its surrounding villages, the reality of those statistics became more than just numbers. I was overwhelmed with the poverty, the untreated conditions of hypertension, and the inadequate efforts of the public health system in regards to HIV prevention and treatment. There were people in the country that still believed that sleeping with a virgin would cure HIV. While there, I was even instructed by my translator, a local medical student, that I should not disclose to a patient that I suspected that they were HIV positive, even though they presented with obvious tuberculosis and appeared severely emaciated.
So even though those above findings were concerning, they were unfortunately expected. However, in this well respected democracy called the United States and in the great state of Missouri, we should not expect the recent findings from the North St. Louis Health Care Access Study Task Force. Should a society as technologically advanced as ours have health outcomes that resemble those of a third world nation? What type of community would do that to its own citizens?
Community and healthcare regional leaders were contributors to this task force that studied zip codes 63106, 63107, 63112, 63113, 63115, 63120, and 63147. These zip codes were all considered “North St. Louis.” The findings of the study were submitted to the Board of Alderman December 2008.
The task force looked at several socioeconomic factors such as education level, household income, vacant lots, unemployment rates and crimes against property. In every category but one, zip codes 63106 and 63107 ranked in the top five zip codes of concern. The economic indicators studied correlated with negative health and public health outcomes in regards to infant mortality, sexually transmitted diseases, mortality and morbidity rates, environmental conditions, and lead toxicity.
During my Zambian mission trip, I recall men, women, and children standing in line for hours to get a chance to see the “American doctors.” Many of those patients had never even seen a Zambian doctor. The people of the villages were often cared for by health workers who had little training but were the only source of care available. And for some of those people, they had to walk quite a distance just to see them.
Unfortunately for the people of North St. Louis, access to care is also a problem. The task force held many focus groups and the results were heart-breaking. Many individuals felt like the only care they could receive was via the emergency rooms or clinics and they felt like the care they did receive was sub-optimal. Many felt like they were treated differently than those individuals who were insured privately with commercial plans. One individual shared that they felt like the clinics were over-crowded and under staffed. The participants in the focus group felt like it was a luxury to have a primary care provider and that poor people were relegated to the clinics.
With that in mind, the task force also noted that the north side had one of the highest rates of Medicaid, out-of wedlock pregnancies and mothers participating in the Women Infants and Children program. Focus group participants felt like part of the problem in the north side was the large number of liquor stores and the lack of quality grocery stores. “They (whites) have communities and we have neighborhoods, which makes it where the (whites) have resources and we don’t have resources.” (North St. Louis HCASTF, 52)
After reading and re-reading the results of the task force, I asked myself about the most logical next steps. How do we impact these social determinants of health? I am convinced that change only occurs when change is demanded. Our legislators, city planners, and city business leaders have to be reminded that North St. Louis is as important as other areas of our metropolis. And as community members we must engage with the local hospitals and clinics to ensure they are performing well and meeting the needs of the people. Each citizen has his own individual role to play in lifting North St. Louis from third world status.
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
