Urban Doctors Feel Sense of Hopelessness

Each day, Sidney Jones wages a frustrating and sometimes futile battle to save the innocent victims of drug abuse and poor prenatal care.

“When you lose a child there’s a feeling of defeat,” said Jones, who as head of obstetrics at D.C. General Hospital is confronted by Washington’s infant mortality rate, the worst in the nation. “You’ve had every hope of saving this person and you suddenly feel hopeless.”

In the hospital’s neonatal intensive care unit, eight babies lie fighting for their lives. One is just 15 days old.

He tests positive for the AIDS virus and has syphilis. His body is not producing red blood cells properly, causing his stomach to bloat.

White swatches of cloth are bound around his tiny ankles, holding down his legs to keep him from hurting himself. He suffers from what doctors here call “tremblisness.” Adult drug addicts call it the shakes. At just two weeks of age, this unnamed baby is going through withdrawal.

His mother is a cocaine addict. Her name and whereabouts are unknown. Hospital officials do not expect her to return to claim the child.

To varying degrees, this picture is repeated at urban hospitals across the country, hampering efforts to reduce a national infant mortality rate that already lags behind Japan and most of Europe. Each year, about 40,000 American babies die before their first birthday, for a national rate last year of 9.9 deaths per 1,000 births.

Washington’s rate of 23.2 per 1,000 births was more than double the already distressing national figure, substantially above the world average for developed nations of about 17, and far worse than rates for Western Europe and Japan.

In Britain, for example, the rate is 9.1 per 1,000 births; in West Germany, 8.3; in France, 7.6; in Sweden, 5.7, and in Japan, 4.9.

Washington’s large black population is afflicted in particular with high infant mortality. The National Center for Health Statistics said black infants nationwide are nearly four times more likely to die as a result of prematurity and low birth weight.

Many of these babies suffer from seizures due to brain damage, cerebral hemorrhage, increased heart rate and stunted organ growth.

Most of the 244 infants who died in the District of Columbia last year were born to drug-addicted mothers, many of whom sought no prenatal health care, said Reed Tuckson, the city’s health commissioner. Under such circumstances, officials say, there is frequently little that doctors such as Jordan can do.

“The reality is as tragic as we predicted,” Tuckson said.

Prenatal care in Washington costs an estimated $400 per mother, but the lifetime costs of caring for low birth-weight infants can easily run into the tens of thousands of dollars, Tuckson said.

“If you went to Chicago or to Boston, you would see the same phenomenon,” said Gordon Avery, chairman of the neonatology department at D.C. General. “Other cities say between 10% and 15% of babies there are born to drug-addicted mothers.”

Avery said one pregnant woman he encountered went into labor prematurely while snorting or smoking cocaine, which can cause the uterus to contract and cut off oxygen to the baby.

Of the children who do survive, many are abandoned. Hospital officials have termed them “boarder” babies.

For example, D.C. General had 11 boarder babies in July. They remain at the hospital an average of 124 days before they are adopted or placed in foster care.

The cost to the hospital for boarder babies last year was $500,662, officials say.

A commission of the U.S. Department of Health and Human Services thinks a national plan to combat infant mortality may be one answer to the problem.

“Thirty years ago, we as a nation made a commitment to care for the elderly,” said Rae Grad, director of the National Commission to Prevent Infant Mortality. “The elderly can get Medicare and Social Security. We are saying that we as a nation have not made a commitment to children.”