Health Center a Vital Aid in Distressed Community : A Success Story in Watts: Infant Death Rate Coming Down

A baby born in Watts is more than three times as likely to die in infancy as a baby born 20 miles away in Santa Monica, and more than twice as likely to die as a baby born in the San Fernando Valley.

In fact, babies born in Watts die at more than twice the rate of babies born almost anywhere else in Los Angeles County, according to county records of births and deaths for 1983, the last year for which statistics are available.

But a community health center in Watts is trying to improve the outlook for those infants by providing better prenatal care for their mothers, and state officials credit the program with contributing to a recent drop in the Watts-area infant mortality rate.

The Watts Health Center’s 3-year-old Maternal and Child Health program guides women through pregnancy with a combination of motherly advice, medical care, education and professional counseling.

Many Women ‘At-Risk’

“Many of the women we see are handicapped in a variety of ways that make them ‘at-risk’ for a poor pregnancy outcome,” explained program director Rosyland Frazier. “They may be poor, uneducated, unmarried teen-agers; they (may) smoke, drink and have poor diets; they (may) live in homes where there are financial problems and stress, a lack of emotional support.

“And they don’t realize what effect all this has on their pregnancy and their chances of delivering a healthy baby,” Frazier said. “We have to educate them as well as care for them.”

The maternal and child health program is one of several projects sponsored by the Watts Health Center aimed at improving the health care and the lives of residents of one of the county’s most distressed communities.

Created with a small federal grant intended to temporarily “supplement” almost non-existent health services in Watts 18 years ago, the Watts Health Center has grown to a $50-million private enterprise that now is open seven days a week.

It treats more than 50,000 area residents a year, making it one of the largest community health centers in the nation. With its jobs and job-training programs, educational seminars and counseling services, the center has, from its start, dispensed hope, as well as health care, to tens of thousands each year.

One of the clinic’s major projects is to cut the community’s infant mortality rate and find out why babies in Watts die so frequently.

In 1983, more than 25 of every 1,000 children born in Watts died before their first birthdays, compared to 10 of every 1,000 babies countywide who died in infancy.

While Los Angeles County’s infant mortality rate among all races has been dropping steadily for the last decade, the death rate among black babies is still almost twice as high as the death rate among white infants.

Theories abound to explain the difference, but one thing has been proved--women who receive medical care early in their pregnancies give birth to healthier babies than those who do not.

“We don’t know the answer to ‘why?’ but we do know that the ability of a baby to survive infancy is related to the health of its mother and the prenatal care she receives,” Frazier said.

More than 1,000 women went through the Watts program last year, most of them in the midst of pregnancies classified as “high-risk” because of factors such as their age, income level, nutritional deficiencies or childbearing history.

Education, Counseling

In addition to being given medical care, the women are taught the importance of proper nutrition and life-style changes during pregnancy, receive psychological and financial counseling to help them deal with the changes wrought by pregnancy and parenthood, and attend parenting classes to learn how to care for their infants.

Although statistics are not yet available to document the exact effect of the Watts Health Center’s maternal-child health program, state officials believe that the program has accounted for a drop in the infant mortality rate among babies in Watts. They trace that to a drop in “low-birth-weight” babies, who are more likely to die in infancy.

“We’ve seen a reduction of low-birth-weight babies among the women who are being cared for (in the Watts Health Center program),” said Dr. Meridee Gregory, chief of maternal and child health for the state.

“Their rate of low-birth-weight babies is less than for their mix of population across the state,” she explained. “It’s better, it’s improved, but it’s still not equal to the rate in the white population.”

The state allocated $433,000 to the Watts program this year from federal maternal-child health funds, and the Watts Health Foundation--the nonprofit, community-based health conglomerate that is the parent group of the Watts Health Center--provided almost as much in matching funds.

Several county-run prenatal care programs in the Watts area are funded by the state, but the Watts Health Center program is one of the largest privately run programs in the state and one of the most popular among Watts-area residents.

“The people there really care; they’re not just there to get a paycheck,” said Sheri Wilson, 22, whose 2-month-old son Dale Emmanuel was born with the help of the health center’s program.

Wilson had a difficult time emotionally during her pregnancy--she separated from her husband when she was six months pregnant and was forced to move in first with her grandmother and then with friends.

“But the baby came out just fine, in spite of everything,” she said. “The people at the health center were really good about helping me. If you ever needed anyone to talk to, you could confide in someone there.”

Through the center’s prenatal classes, Wilson learned about proper nutrition, childbirth exercises and birth control for after the baby’s birth. Because she was not working and had no income, program counselors directed her to the federally funded Women, Infants and Children supplemental food program, which provides free, high-protein food to pregnant women and nursing mothers.

But for many mothers-to-be in Watts, adequate prenatal care is the exception, rather than the rule--girls such as 15-year-old Cora, pregnant with her second child, or women such as Maria, who bore three children, two with severe health problems, without ever visiting a doctor during pregnancy.

“For most of the women we see, even those in the advanced stages of pregnancy, this is their first visit to a doctor (during pregnancies),” Frazier said.

About 40% of the program’s patients are on Medi-Cal, which pays for the mother’s care during pregnancy and the delivery of her child, and the rest are “working poor” who are just above the poverty line, or undocumented residents who are reluctant to apply for Medi-Cal.

Those patients pay only $15 per visit for prenatal care, compared to $20 at county health centers and up to twice that much for private physicians.

“It’s common knowledge that anyone can deliver at the county hospital for free, so many women go through their pregnancy without any medical care, then they just show up (at Martin Luther King Jr. Hospital) when they’re in labor,” Frazier said. “Those women tend to have a very poor outcome.”

A recent study at Martin Luther King Jr. Hospital, which delivers “high-risk” mothers from throughout South-Central Los Angeles, showed that babies born to mothers receiving no prenatal care had a one-in-four chance of being admitted to the hospital’s special care nursery--reserved for small, sickly infants and those with potential health problems--compared to only one in 10 among mothers who received prenatal care.

A review covering five months last year showed that 17% of the women delivered at the hospital had received no prenatal care, according to Dr. Teiichiro Fukushima of the hospital’s obstetrics department. Those women accounted for almost one-third of the hospital’s perinatal deaths (deaths of infants up to 28 days old).

A report released this month by the Los Angeles city and county Human Relations commissions emphasized the high infant death rate as one of Watts’ most pressing problems.

That report, based on public hearings convened to assess progress made in Watts since the 1965 riots, concluded that although “significant progress” has been made in providing health care for Watts residents, many problems still remain.

“South-Central Los Angeles still has the highest infant mortality rate, the lowest rate of immunization, the highest incidence of communicable disease, an alarming rate of drug abuse and the fewest doctors per capita in the county,” the report said. “The area leads the county is morbidity (illness) and mortality (death) rates.”

But the picture is considerably brighter for Watts than it was almost 20 years ago, when inadequate health care was cited as one of the reasons behind the 1965 riots that rocked the community.

Then, there were no public health centers, no hospitals and only a sprinkling of private physicians in Watts. Bus service was so poor that traveling out of Watts to the nearest county health centers--each about 14 miles away--was an all-day chore.

“It was a four-hour bus ride each way, so anyone who had to depend on public health care had to decide whether they hurt enough to give up an entire day and whether they could cope with all the (travel) problems,” recalled Dr. Clyde Oden, president of the Watts Health Foundation. “People were waiting until the last possible moment (to seek care). They’d go from the receptionist to surgery, and many did not make it out.”

Like the county-run health centers and hospital now located in Watts, the Watts Health Foundation was created as part of government’s post-riot efforts to ameliorate the community’s health problems.

With $3 million in federal funds, a group of Watts community activists and health professionals, along with officials of the USC Medical School, started the Watts Health Center in 1967 in a collection of prefabricated trailers clustered in the shadow of the Jordan Downs public housing project.

Combination of Skills

The center brought together doctors in several specialties--including dentists, ophthalmologists, podiatrists and surgeons--to treat the special health problems of the long-neglected community.

To combat the high unemployment in the area, scores of Watts-area residents were hired to staff the center, and job training was offered for health-related jobs such as that of dental assistant.

“We started getting the community involved, providing jobs, providing health services, having a community-based board of directors,” recalled Oden, 40, an optometrist with master’s degrees in business administration and public health.

Watts resident Alice Harris remembers the center’s early days, when residents took petitions door-to-door to demonstrate community support for the clinic.

“We’ve all had a part in helping that health center grow,” said Harris, a 25-year resident of Watts who watched the clinic begin from the window of her apartment in Jordan Downs.

“We did whatever we had to to protect that center because it was all we had. We had some devoted doctors and a community that needed it,” she said. “There was such a need here, the center had to grow to meet it.”

Today, the Watts Health Center is housed in a $6.6-million building, built in 1979 with a combination of federal funds and a state-guaranteed loan. The busy clinic spans a city block, and is one of the biggest private employers in Watts, with more than 300 employees, including 35 doctors and 75 nurses.

Patient fees generated about $2 million for the health center last year, another $3.5 million came from government grants for the care of indigent patients, and another $1.5 million was funneled to the clinic from the health center’s parent corporation.

Besides dental, vision and medical care, the center offers a wide range of services aimed at overcoming long-standing obstacles to the delivery of health care in Watts.

Because its population is accustomed to crisis-oriented medical care, the clinic offers health education classes that focus on preventing illness; because so many patients depend on public transportation, a fleet of vans is available to provide transportation to and from the clinic; because of the high drug abuse and crime rates in the community, residential programs for drug and alcohol abusers and women felons seeking to reform have been established nearby.

And the center has a special day-care program for the neighborhood’s infirm elderly, and a home-health agency that sends teams of health workers to visit home-bound patients.

Although the clinic was started with federal funds, it is totally self-sufficient today, thanks to the success of its United Health Plan, a prepaid health maintenance organization started in 1973 by the Watts Health Foundation.

Of the foundation’s $50-million budget last year, more than $40 million was generated by the nonprofit medical plan, which is reimbursed by the state and federal governments for treating Medi-Cal and Medicare patients and by local businesses whose employees are enrolled in the plan.

Starting from a few doctors’ offices in Watts, the United Health Plan has branched out to offer medical care through 350 doctors at 20 medical groups and 25 hospitals from northern Orange County to the Ventura County border. Plans call for the program to be expanded into Northern California this year, Oden said.

“We’re no longer a poverty program, we are mainstream,” he said proudly.

Revenue Is a Cushion

The health plan was created to provide revenue to cushion the clinic against the loss of grant money when federal funds dried up in the 1970s, Oden said. Starting with total government funding, the Watts Health Foundation today gets only 20% of its budget from government contracts, foundation grants and patient fees.

“We realized a long time ago that if we wanted to continue to do some community good, we’d have to put up all the dollars,” Oden said.

Foundation directors expect the United Health Plan to generate $64 million this year, with that money going to further expand clinic operations and begin construction on a six-story, $10-million office building planned for a vacant lot across the street from the clinic.

Called the New Watts Tower, the office complex will provide office space for several city and county social service agencies, as well as professional firms and administrators of the health foundation, Oden said.

“We’ve got a social mission--to serve those people who have fallen through the cracks--and we’re depending on our success as a business to support that mission.”