Twana Fortune spotted a young woman standing near a pay phone in southeast Washington, parked the van and walked across the street.
"Excuse me, Miss, are you pregnant?" Fortune asked. The woman looked stunned for a moment, then chuckled and shook her head.
"OK, thanks," Fortune said, already walking toward her next potential client--a woman with a broad waistline and three small children in tow. That woman was not pregnant either, but she said her friend was, so Fortune gave her a flier and instructions that the friend should call a number for information about maternity services.
Fortune, 30, spends her days wheeling round the District of Columbia's poorest neighborhoods, searching for pregnant women she can coax into using the city's prenatal care clinics, in an effort to stem the city's high infant-mortality rate.
High Death Rate
Last year 211 of 10,043 babies in the District died during their first year of life--a rate of 21 deaths per 1,000 live births. That is about twice the national rate of 10.4 deaths per 1,000 live births.
Fortune, an outreach technician, drives D.C.'s green-and-white Maternity Outreach Mobile--the MOM van. The office on wheels, initiated last spring with an annual budget of $85,000, is Washington's latest effort to combat the problem of infant mortality.
"We know our biggest problem is prematurity," said Pat Tompkins, director of the Office of Child and Maternal Health, which is responsible for MOM. She explained that insufficient or nonexistent prenatal care, drug abuse and poor nutrition lead to small, underdeveloped babies who are more susceptible to disease.
Even when infants make it home with their mothers, those from poor families are more prone to sudden-infant-death syndrome, accidents and trauma, Tompkins said.
City officials using special panels and campaigns have been battling the problem for a decade with marginal success. One of the big stumbling blocks has been that many women are reluctant to seek care.
The outreach mobile was the brainchild of health-care workers and D.C. Public Health Commissioner Reed V. Tuckson, intended as a way to "take the services where the women were."
Since May, Fortune has put almost 3,000 miles on the van, roaming city streets and chatting with pregnant women and new mothers about nutrition, prenatal and pediatric care.
She hands out brochures, fliers and telephone numbers for an assortment of related services. Fortune also provides transportation to and from clinics and tracks down women who don't show up for their appointments.
The health department recently hired a nurse practitioner to ride with Fortune and do pregnancy testing and some preliminary medical screening in the van.
"It's not that services aren't available--they just won't come," Fortune said. Her solution is to park the van where it will draw attention--grocery stores, schools. When welfare and pay checks come in, Fortune stations herself at check-cashing centers or at a department store in the southeast part of the city.
The Children Know
When she visits housing projects, she talks to the children, because they always know who in the neighborhood is pregnant. "Adults don't talk," Fortune said, but "you get the scoop from kids."
Fortune knocks on doors looking for clients, and she rarely overlooks a pregnant woman or someone carrying an infant.
One day recently she stopped 16-year-old Dena Springs outside an apartment building to ask if the young girl was taking her baby to a pediatrician regularly.
Springs, the mother of 4-month-old Travis, said he did have a doctor. Nevertheless, Fortune offered the teen-ager a pamphlet warning against feeding babies water sweetened with sugar. "It will rot the baby's teeth and can damage the permanent teeth," Fortune said.
Most of her clients are relatively healthy women in their early 20s, but she occasionally runs into a tough case. Recently a pregnant 35-year-old woman strolling through the parking lot of a health clinic spotted the MOM van and stopped to question Fortune.
The woman swayed as she talked; her swollen, chapped hands and feet were telling signs of heroin addiction. "I don't want no baby with a drug problem, but help is too far away," the woman said, explaining that she had to wait a month to enter a drug treatment program for pregnant women at D.C. General Hospital. "I tried to kick (the drug habit) myself, but it didn't work," she said.
Fortune and Prynn Waters, a nurse at the clinic who is also pregnant, told the woman they could arrange an appointment for her the following morning. Waters told the woman that her fetus was already addicted and would require special medical attention.
The woman, who lived only a few hundred yards from the clinic, promised to meet Fortune there the next morning for a ride to D.C. General Hospital.
"She didn't show," a frustrated Fortune said the next day. She went to the woman's house, hoping to catch her at home, but hadn't after several tries.
Despite the disappointments, Fortune relishes her job as counselor and readily identifies with many of the very young women she meets. "When I was 12, I thought I knew it all," said Fortune, who admits she was a rebellious teen-ager.
Now the mother of two boys, she welcomes the opportunity to share what she learned. "I tell them I understand; I was poor, too."
Before she began driving the MOM, Fortune worked for a similar, privately run program called For Your Baby's Sake. She is intent upon making a difference, she said recently, recalling a chubby, 14-year-old girl who frequently came to a store that Fortune worked in about 10 years ago.
She said that she and a girlfriend suspected the teen-ager was pregnant, but they never asked. The girl received no prenatal care and died during delivery.
"The baby lived, but she died, and I always felt guilty. . . . We could have made a difference," Fortune said.
"I think when a young lady is pregnant, sometimes she doesn't realize she is responsible for another life," she said, adding later that she has met several pregnant women who do not seem to know how to care for themselves.
The most difficult part of her job she said, is "talking sense" into people. For example, she said, a misconception she hears often is "that one beer, one cigarette, one joint will not hurt an unborn baby . . . but their 'one' is 'one a day.' " Fortune said she tries to explain that such habits are unhealthy even once in nine months.
It is too soon to calculate the impact of the MOM van, but people on the streets are beginning to recognize it, and it's a popular feature at neighborhood fairs.
Waters, the clinic nurse, said Fortune "is a help, because our public-health nurses are bogged down." Waters said she increasingly relies on Fortune to keep track of problem patients.