Shamala Seville-Ferguson, holding her newborn Gianna, walked out to her driveway, where an American Medical Response vehicle was parked.
There was no emergency. The Community Health Care Van, repurposed in late April as a mobile clinic to provide COVID-era postpartum visits to mothers and their newborns, had broken down earlier in the week. AMR had provided a temporary back-up vehicle for this mid-June visit.
The baby was fine. But the advanced practice nurse, Sharon Joslin, found Seville-Ferguson had dangerously elevated blood pressure.
“You don’t feel that bad,” Joslin explained, but it’s a “nightmare scenario” that can lead to a stroke or cardiac event.
Seville-Ferguson, a certified nursing assistant, has two other kids. Her husband works late hours. She has no child care. Even in normal times, “to get anywhere with a baby takes a lot of preparing,” she said. “With everything that’s been going on now, I just didn’t want to take them out anywhere.”
The Community Health Care Van has become a key way for mothers like her to get to appointments without worrying about transportation or the risk of contracting COVID-19.
“We’ve been able to diagnose some important things that might not have been picked up had the mother missed appointments at the clinic for fear of being exposed to COVID,” said Rick Altice, an infectious disease specialist and professor of medicine at Yale School of Medicine, who created the CHCV in 1993.
Since then, the 40-foot mobile medical clinic has been traveling directly to New Haven’s poorest neighborhoods, offering free care and community outreach to people impacted by HIV/AIDS, substance use disorders, homelessness and mental illness.
By late March, the shelter-in-place mandate had sidelined most of those services. Around that time, Yale pediatrician Leslie Sude contacted Altice. She and her colleagues had been talking with their patients, many of whom are low-income and rely on public transportation.
“They were fearful about coming to the clinic and signaled they’d be willing to skip their postpartum visits,” she said. “Those visits are critical to identifying postnatal issues and preventing later complications for both babies and mothers.”
After cutting through some red tape, a partnership ensued. CHCV has been able to use the community outreach to distribute facial coverings and educational materials while safely delivering care for some 150 mothers and their newborns in their own neighborhoods.
The CHCV, the first mobile unit in the state dedicated to such care, has seen some serendipitous developments in the past few months, according to Altice — among them, a wealth of donations from the community, including diapers, formula, and food staples.
“Many of these women have no child care so that’s one less outing to a high-risk area,” he said. “It allows them to stay in their homes and focus on their children, and not put themselves and their children at risk.”
Point-of-care testing, which provides immediate information about a patient’s condition, has also proved beneficial, according to Joslin.
“Remember, these are mostly new moms, and the babies are to them very fragile,” she said. “It’s an amazing thing to be able to tell a mom whose baby’s bilirubin [indicating jaundice] was high is now down and her baby’s fine, and see her shoulders just go down three inches.”
While funding remains limited, Sude said the mobile model has attracted interest from community organizations.
The March of Dimes, which has expanded its mission into promoting the health of mothers and babies into the “fourth trimester,” Sude said, has been a dedicated supporter, donating breast pumps, breastfeeding supplies, and a substantial supply of diapers.
The program also has been the recipient of grants from the New Haven Community Foundation and United Way, as well as the Yale Community for New Haven Fund. The Yale Child Study Center has signaled interest in a potential mobile mental health model.
Beyond the Pandemic
As the state began its reopening in the third week of May, Sude found herself considering what role, if any, the CHCV would play in the future for mothers and their newborns.
The support from community partners, as well as the positive feedback from the mothers visiting the CHCV, she said, “was telling me the mobile health model was meeting a very real need and might make sense, at least as an alternative model, even beyond the pandemic.”
That was before the killing of George Floyd and the heightened urgency in conversations nationwide about systemic racism, including in the healthcare field.
“Healthcare may never go back to where it was, because in many ways it was complicit in those systemic structures,” Sude realized.
The traditional model, she said, “is to make healthcare available around us: you’ve gotta get here, here are the hours, we take an hour for lunch, and if you’re 15 minutes late, we might not see you.”
“That often means taking at least an afternoon off work, arranging and paying for transportation through ride sharing or a bus, hoping there’s no delay, waiting for the doctor to see them, waiting for the doctor to complete the visit,” Sude said.
“Time is money, and we should respect everyone’s time,” she said. “We need to make sure everyone is given the same opportunity for advancement and parity — in workplaces, in housing, in access to healthcare.”
In that regard, the mechanical breakdown of the CHCV might have been perversely fortuitous.
On learning that the van would be unavailable for a week, Sude immediately reached out to AMR. She’d already been in talks with its manager of clinical services, Mike Turcio, about a longer-term partnership that might involve building additional services like delivery of vaccines into the same areas.
“We help healthcare providers bring clinical expertise into the community to meet patients where they are,” Turcio said. “The mother-infant program aligns with our mission.”
The SUV-sized AMR vehicle proved to be a game-changer, according to Joslin.
“Being able to park in a driveway, even if it was only for the four days the van was in the shop, actually opened our eyes to a whole new way of getting to women that can’t even get to the van, so you really were able to reach people closer to their world,” Joslin said.
Yet there was enough distance that it was more a house call than a driveway call.
“What we found is that mothers were very happy that we came up to their homes without going inside, into their space,” Joslin said. “They’re new mothers. They’re exhausted. The last thing they need is to think about neatening up for visitors.”
Based on feedback from both Joslin and the mothers that the van could have been a bit bigger, Turcio said AMR is currently trying out other vehicles that might better fit the needs of both the team and the patient.
Even so, the driveway calls felt festive, Joslin said.
“A few times the fathers came out and everyone was smiling. There is a feeling that this is special, this is unique,” she said.
“When an AMR ambulance drives up, everyone’s scared that someone’s sick, or having an emergency, or dying, and then they realize it’s all about making sure people are healthy and doing well.”
That seemed to be the case with Seville-Ferguson and her baby.
“We just walked out of the house and into the driveway and I handed the baby to the nurse,” she said. “It worked perfect.”
She reported her blood pressure is under control, and she’s feeling fine. “But tired,” she added with a laugh. “Having a newborn will have you up in the middle of the night.”
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