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Second day of the state high school wrestling tournament, at Jim Whelan Boardwalk Hall, in Atlantic City, Friday, March 1, 2019. (VERNON OGRODNEK / For The Press)

Reducing infant, maternal mortality key to improving AC's health

ATLANTIC CITY — Nearly a year ago, Alyssa Spruill was at a prenatal visit with her doctor when she learned she would have to deliver her baby 16 weeks early after developing severe preeclampsia.

“I already thought I knew what the outcome would be,” said Alyssa, 30, of Atlantic City. “I really thought that she wasn’t going to make it.”

Preeclampsia is a rare disorder associated with high blood pressure and can be dangerous for both mother and baby. The best remedy is delivery.

Weighing under a pound, MaKenna was born via Cesarean section March 12, 2018, at AtlantiCare Regional Medical Center, the smallest baby ever cared for by the Galloway Township hospital. And after more than 100 days in the neonatal intensive care unit, “Mighty MaKenna,” as she was nicknamed by one nurse, was able to go home.

MaKenna and Alyssa avoided becoming an alarming statistic affecting residents of Atlantic City: Black babies born to mothers from Atlantic City are dying at a rate five times higher than the state average.

In particular, the rate of black infant mortality was cited as a major health issue affecting the city in a recent report to Gov. Phil Murphy released over the summer.

To improve outcomes, local health care providers and advocates are working to ensure women in Atlantic City have access to the necessary care and resources. Health professionals agree the best way to prevent infant mortality is to improve maternal health, but there is no one solution to the problem.

The infant mortality rate in Atlantic City is an indicator of overall poor public health, said Dr. Diane Timms, program director for Maternal Fetal Medicine and vice chairwoman of the Department of Obstetrics and Gynecology at AtlantiCare Regional Medical Center.

“I think that ensuring that our families are healthy is exceedingly important in making sure that as a city we grow in a healthy direction,” Timms said.

Pre-existing conditions among black women

The risk of infant mortality becomes higher for women with unmanaged diseases such as high blood pressure and diabetes, which can lead to preterm labor and preeclampsia. Smoking and obesity are also related.

“All the same things that are causes for poor health in patients who are not pregnant are the same for those who are,” Timms said. “There’s things on the surface that seem so very simple but are so complex.”

Melissah Drummond-Williams, 38, of Atlantic City, experienced four miscarriages and two stillbirths before becoming pregnant at 36 with daughter Blessyn, now 8 months old.

“I was very nervous the entire time,” she said. “I did have a few friends who were pregnant at the same time. All of them weren’t so lucky.”

Helen Hannigan of the Southern New Jersey Perinatal Cooperative said key factors in reducing infant mortality include quality hospitals and good prenatal care.

In her early pregnancies, Drummond-Williams was diagnosed by doctors with Luteal Phase Defect, which affects the body’s ability to carry a pregnancy to term. Her doctors recommended weight loss and healthy eating, among other things, to help her body keep the pregnancy, which she took to heart. She said her doctor’s advice and her faith helped her keep this pregnancy.

Hannigan said some women’s health issues could stem from poverty but are also tied to the availability of fresh food, jobs and safe living environments.

There is also something deeper that contributes, she said.

“We do believe there is an impact of bias and of lifelong stress for minority communities,” she said. “We also know that for our black mothers, the effect of bias is still seen even among our highest educated black women. They have the same infant mortality rates as high school educated white women.”

Access to care

While historically, women who are pregnant have access to health care, it is only recently that the insurance has become available for women in between pregnancies, said Hannigan. This access to care between pregnancies may prevent health issues, she said.

Other programs are also being developed to bridge the gap. Hannigan, director of MIS and administration at the cooperative, said the Healthy Women, Healthy Families initiative at SNJPC is designed to improve maternal and infant health and reduce racial disparities in birth outcomes.

The program, funded with a $1.1 million grant from the New Jersey Department of Health, is designed to address mortality among black infants and mothers by providing free outreach and support for the mother pre- and post-pregnancy. It is one of several programs in the city aimed at at-risk mothers and pregnant women, but publicizing the program has been difficult.

Because of this, AtlantiCare now offers several services in Atlantic City such as birthing classes, pediatric care, obstetrics and gynecological services.

“One of the things that we’ve tried to do is to bring the care to them,” Timms said. “We’ve opened a practice in the city so that people can walk to see us if they need to.”

Timms said providing access where it’s needed is also one of the goals of the new health care building proposed by AtlantiCare.

The Southern Jersey Family Medical Center has also been operating here for decades and has worked to lower the rate of black infant mortality. The Atlantic County Health Department also offers services for women and families.

Hannigan said it would be more helpful if Atlantic City could beef up its own Health Department to ensure the right services were available to city residents.

Drummond-Williams said she was also lucky to be connected with the right people in Atlantic City — a doctor from Southern Jersey Family Medical Center, a visiting nurse from Nurse-Family Partnership, consultants from the local Women Infants and Children office and a supportive family.

“You have to want to know, you have to ask questions,” she said. “People don’t know, but there are a lot of resources available here in the city. WIC is more than just formula and food. They have the lactation counselors, they are able to help you with information about SNAP and food stamps. Oceanside Family (Success) Center, uptown, they helped a lot.”

Spruill said despite the complications, the care she received for MaKenna was much better than with her other children. She considers herself lucky to be able to take MaKenna home alive, especially being born so early.

“My daughter was born 16 weeks early, and in some states they don’t believe in putting them on a ventilator,” she said. “A lot of people take things for granted.”

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Oldest house in Cape May Point lost, but may save others

CAPE MAY POINT — Workers last week cut through 200-year-old, handmade nails and pulled up 16-foot floorboards from what is believed to be the oldest house in the borough.

They were salvaging what they could from the home on Cape Avenue, much of which was built in 1800 to 1815 in Lower Township and moved twice — landing in its current location in the 1940s, according to architectural historian Joan Berkey.

It is about to be demolished by its owners to make way for new construction, part of a trend that has longtime locals worried their sleepy beachside community of historic homes and cottages is disappearing under the pressure of high real estate values.

Large new homes are selling for more than $1 million, while two-bedroom, one-bath cottages are on the market for about $500,000.

“Developers come down, change everything around, and the borough is weak about protecting its buildings and houses,” said John Reilly, who has lived here at least part time for most of his 62 years.

Many old structures have already been lost, or soon will be, Reilly said, including St. Mary’s By the Sea, a 1909 retreat for nuns that is one of the most recognizable buildings in town. The nuns plan to demolish it in 2021, or soon thereafter, and return the land to nature because of an ongoing erosion problem.

The house that is being demolished sits on a large lot and was sold in 2015 for $800,000 by the Theobald family, with the verbal understanding it would be preserved, some members have said.

But now, owners Dinkar Savji Bhatia and April Adams, of Potomac, Maryland, have gotten permission to demolish it to build new. They could not be reached for comment.

Borough Commissioner Robert Mullock, who said he has seen evidence the house was part of the Underground Railroad to help slaves escape to freedom, was working with a group to save the house by moving it. But there wasn’t enough time, he said. The borough has no laws to stop the demolition.

But that may soon change. The fate of the Cape Avenue home has reignited a move to change local laws to protect historic structures, advocates say.

The state is ready to help the borough craft a protection ordinance, said Jonathan Kinney, certified local government coordinator with the state Division of Historic Preservation.

Cape May Point sits at the southernmost tip of the state and has a population of just 285, making it the smallest community in Cape May County.

It started out as part of Lower Township, then became its own summer community of mostly two-story homes in the 1870s, according to a report for the state by the architectural firm Barton Ross and Partners, of Livingston, Morris County. Smaller bungalows popped up from 1900 to 1955.

Pastor Donald Theobald and his wife, Betty Walkingstick Theobald, bought it in 1952 for $5,200 and hosted scores of family and church visits for decades, said grandson Jonathan Edwards, of Winnipeg, Canada.

Edwards said he is heartsick over the loss of the house, as are other family members.

Berkey based the estimated age of the house on the nails used in the attic flooring and other aspects of construction she examined recently.

Its heavy timber frame is “all pegged together and would be easy enough to unpeg and save,” she said. “That type of framing used to be very common, but there are very few remaining, and most that do remain are in Cape May County.”

Some of the old floorboards from the Cape Avenue home will be reused in a Harriet Tubman museum planned for Cape May, Mullock said, and in the family home Adrienne Scharnikow is moving from Avalon to Cape May.

“We are trying to turn the story around. We need to salvage everything we can,” said Scharnikow.

Under state law, municipalities may designate properties as historic and regulate what can be done to them through a local preservation program, said Kinney. First they must establish an ordinance and seat a historic preservation committee.

“The zoning law is maintained, but this adds one additional layer,” said Kinney. “Municipalities can tailor it to their resources, goals and how strict they want to be with regulations. The key to preservation is the local level when it comes to private property.”

He said the borough already has documented its historic areas, and only needs to pass an ordinance to protect them.

Mayor Robert Moffatt said he was involved with trying to get a preservation district started in the Point years ago, before becoming a commissioner, but there was a lot of opposition.

“People didn’t want to become Cape May,” which greatly restricts what owners of historic buildings can do with their property, he said. “But it doesn’t have to be like that.”

The borough could opt for a less restrictive approach, he said.

“This was a done deal before I knew about it. That’s the way things work — it’s private property,” said Moffatt. “The only thing we can do is ask them to delay a little bit. It’s a shame, but yes, I hope it can stimulate the community to get behind preservation.”

How can Atlantic City keep people from falling through health care cracks?

ATLANTIC CITY — Within these 48 city blocks, men, women and children are falling through the cracks of health care.

People are dying from overdoses at alarming rates. Mothers and their unborn babies, especially in families of color, risk delivery complications and possibly death. And poor lifestyle, exercise and nutrition habits have led to higher than average obesity rates, which creates additional health risks.

Under a state takeover since November 2016, the city is facing a mountain of issues, from blight to unemployment to poverty, but no less important has been the struggle to improve the health of its residents. Identified as a priority, state, county and city officials, along with medical partners, are addressing the city’s health issues.

In February, The Press of Atlantic City began reporting on those critical issues, focusing on blight. March’s spotlight focuses on the health of the city’s residents.

Like many stubborn social issues, the problems are often intertwined.

A July report by Leslie Kantor and other researchers at Rutgers School of Public Health found deaths related to chronic illness and gun violence in Atlantic City exceed state averages and rates in other major New Jersey cities. The city’s rate of infant mortality — about 10 deaths per every 1,000 births — is one of the highest in the state, according to the Department of Health.

Black infants are even more at risk. Babies born to mothers from the city are dying at a rate five times higher than the state average.

Addiction, along with mental illness, poverty, trauma and stress, are linked to the city’s significant homeless population, said Laura Rogers, chief program officer of Jewish Family Service of Atlantic & Cape May Counties.

The data and research have been used by state and local leaders who say it’s critical to work together to find ways to reduce poor health outcomes and improve quality of life for residents.

These problems are all taking place in a city where most residents live no more than two miles from a level II trauma center and hospital.

Primary care offices, specialty care providers, wellness center and social services agencies are also close by.

But those facilities may not be solutions to the most pressing issues.

“What is happening here and nationally is that larger health systems recognize that we need to look at things differently,” said Lori Herndon, AtlantiCare president and CEO. “Having an acute care hospital is great, so if you have an accident or a stroke, we’re there for you, but there’s so much we can do in partnerships for the community on what to spend more time, energy and money on.”

Rogers said customized care plans, direct outreach and wraparound services for things like housing, transportation and nutrition are the answer, not traditional approaches.

“If you don’t have a healthy home situation, how can you have good health?” she said. “The hallmark of our work has been meeting people where they’re at.”

In the end, improving the health of the city and its residents will be a collective effort.

“We’re all in it for the same reason, which is to improve the health status of the community,” Herndon said. “We collaborate, and there’s always more to do. It’s been relevant to align everyone, more so in this last year and few months, so we can get more done if we work closer together.”

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