Category Archives: United States

Startling Facts about Maternal Mortality in the U.S.

By Amanda DiMeo, AmeriCares Monitoring & Evaluation intern
By Amanda DiMeo, AmeriCares Monitoring & Evaluation intern

When one thinks of mothers dying during childbirth, the United States is probably not a country that comes to mind.  It’s common knowledge in the international community that a large majority of maternal deaths occur in developing countries.  The World Health Organization reports steady progress in the reduction of maternal deaths since 1990, with a 45% global decrease. However, when looking at the figures specific to the U.S., the statistics tell a different story.

The U.S. is the only developed country in a group of eight where maternal deaths have increased between 2003 and 2013, according to the Institute for Health Metrics and Evaluation. In 1990, the maternal mortality ratio was 12.4 deaths per 100,000 live births. In 2013, this number is much higher at 18.5 per 100,000 live births, which the Lancet suggests is underreported. The report ranks the U.S. 60th for maternal death on a list of 180 countries, meaning 59 countries are doing a better job at keeping their mothers alive than we are.

US1211_AO_DSC_0732Most alarmingly, some of America’s cities suffer higher rates. The city of Detroit has a maternal death rate triple the national average. Between 2008 and 2011, Detroit’s maternal mortality ratio averaged a disturbing 58.7 per 100,000 live births. This number is even more startling when compared to the rates of similar developed countries. From 2009-2013, the maternal mortality ratios of the United Kingdom and Sweden averaged 8 per 100,000 live births and 4 per 100,000 live births, respectively.

The hardest thing for me to grasp when seeing these numbers is the fact that many of the causes of maternal death are preventable. Women die as a result of major complications of childbirth, including severe bleeding, infections, and high blood pressure (leading to eclampsia).  In the developing world, these causes could be attributed to lack of resources, among other factors. However, in the U.S., we have well-equipped facilities and skilled health care providers. We are the country that spends more on health care than any other developed country (17.9% of GDP, according to World Bank), and we have the resources to prevent maternal mortality.

So then, my question is: why are they still dying? [inlinetweet prefix=”” tweeter=”AmeriCares” suffix=””]This upward trend in maternal mortality likely reflects some inequalities in the health care system[/inlinetweet]:  a complex combination of lack of access, poverty and ethnic/racial disparities. To put this into perspective, the CDC (2003) reports that African American women in the U.S., regardless of education level, had maternal mortality ratios that were three to four times those for white women.

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One of the many rewards I’m finding as part of my internship at AmeriCares this summer is seeing the work that the organization is doing to help lower rates of maternal mortality both in the U.S. and abroad.  As an example, within the U.S. partner network for FY14, AmeriCares provided enough prenatal vitamins and folic acid to fill about 200,000 prescriptions. Abroad, AmeriCares works with partners in countries such as Afghanistan, where we provide safe birthing kits at Afshar hospital, just outside Kabul.

[inlinetweet prefix=”” tweeter=”AmeriCares” suffix=””]To improve the maternal mortality ratio, maternal health must be a priority. [/inlinetweet]

Slipping Through the Cracks – Why We Might Always Need Free Clinics

by Sal Migliaccio, U.S. Medical Assistance intern at AmeriCares
by Sal Migliaccio, U.S. Medical Assistance intern at AmeriCares

Imagine you are a child living in West Virginia. You have one sibling and two working parents. Your father, a coal miner, has lung cancer. Your parents’ combined income totals $40,000 per year, or 168 percent of the Federal Poverty Line (FPL). Even though your state expanded Medicaid under the Affordable Care Act, you remain ineligible for the program.

Instead, your parents must purchase health coverage through West Virginia’s state exchange, which consists of only one insurer. They opt for the lowest coverage plan because its $10 monthly premium is all that fits into their tight budget. Each time someone in your family receives medical care, 40 percent of the treatment cost must be paid up front, out-of-pocket.

This is what it can look like to be underinsured in the United States in 2014.  Despite its name, the Affordable Care Act (ACA) can be unaffordable for some West Virginians, says Jim Harris, Executive Director of Health Access Inc. in Clarksburg, West Virginia. I spoke with Jim this past week, and he gave me a detailed picture of the state’s health care landscape. I learned that while West Virginia was one of 27 states (including D.C.) to expand Medicaid, residents who earn at or above 133 percent FPL are ineligible for the program and must purchase one of the few health insurance plans offered through the state-federal exchange. For those in the state that have registered for the low-premium bronze plan, out-of-pocket costs can escalate.

Jim Harris, Executive Director of Health Access in Clarksburg, West Virginia.
Jim Harris, Executive Director of Health Access in Clarksburg, West Virginia.

Jim told me that this has led many West Virginians to drop their insurance plans, reverting back to care at their local free clinic. With many living just above the new Medicaid threshold, free clinics continue to be their most affordable option for medical care.

Jim explained that because West Virginia has consistently high rates of uninsured residents, many patients have relied solely on free clinics for care. This demand has created a strong infrastructure of safety net health care providers across the state, with most accepting patients regardless of their ability to pay or their insurance coverage. Harris said that it’s important that the infrastructure of free and charitable clinics be maintained, especially while the details of the ACA are still being worked out.  Jim added that this is true in other states as well: Despite a declining uninsured population in the U.S., [inlinetweet prefix=””” tweeter=”@AmeriCares” suffix=”””]free and charitable clinics may continue to be the only affordable form of health care for millions[/inlinetweet] of low-income folks across the country.

Sal2I learned that while the health insurance system is much different today, it can be unaffordable or unattainable for our country’s most vulnerable patients. It’s clear to me that, regardless of the degree to which states implement the ACA, gaps will exist. As illustrated by Jim’s experience in West Virginia, the ACA is, by no means, the be-all end-all solution to the health care crisis in the United States. In fact, I’m not sure such a solution could even be created.

AmeriCares understands the continued relevancy of free and charitable clinics across the U.S. during this transition period and in the future. This summer, I’ve had the pleasure of working with the AmeriCares U.S. Medical Assistance Program, which remains committed to its 650 partner organizations as the largest donor of medicines, medical supplies, and equipment in the country. Whether for day-to-day operations, or when responding to emergencies, our program supports organizations such as Health Access that work to make affordable health care a reality for all people across the country.

The True Importance of Mental Health Relief

Katie DeVoll, -- Intern
By Katie DeVoll, U.S. Medical Assistance Intern at AmeriCares

In 2012, Hurricane Sandy hit the East Coast of the U.S. hard, killing 73, destroying tens of thousands of homes, and forcing thousands into shelters. In a situation like this, the mental health of the survivors is often overlooked. It’s put on a backburner and deemed less important than other health issues. However, many people are left without their basic belongings, their home, and a family or community support system. During Sandy, houses filled with water, children and adults were forced to swim to safety, and many witnessed the death and suffering of loved ones.

111112americares51MATTAs a psychology major entering my senior year, I’ve learned how important mental health is to both an individual and a community. Since the beginning of my internship here at AmeriCares, I’ve been made aware that it’s common for survivors of great trauma to develop and suffer from psychological disorders. Resulting illnesses include PTSD, Depression, and General Anxiety Disorder. Given that these illnesses can have a huge impact on survivors’ lives, mental health services should be made a priority during natural disaster relief efforts alongside the distribution of food, water, and medical supplies.

After Sandy, AmeriCares did not stop their work in New York and New Jersey once survivors had adequate food, water, and medicine.  AmeriCares worked as a support system for people in need when they were stripped of their physical and mental resources and put at great risk for later serious psychological disorders.

2Among its many recovery programs, the organization helped sponsor and run various mental health relief projects in the tri-state area. Partnering with the YMCA of Greater New York, AmeriCares supported a 12-week therapeutic and education program for children, teaching them how to speak about and cope with their experiences.

In Gerritsen Beach, Brooklyn, AmeriCares helped fund a mobile mental health clinic that provided clinical care, case management, and mental health education to local residents.

AmeriCares also helped to sponsor a Pediatric Disaster Mental Health Intervention, in which pediatricians in the tri-state area were trained to identify mental disorders resulting from natural disasters as well as how to apply mental health first aid and how to refer patients to other mental health professionals.

I am a psychology major, driven humanitarian, aspiring world traveler, and grateful AmeriCares summer intern. At my university, I have learned of the history, causes, symptoms, and treatments of various mental disorders.

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[inlinetweet prefix=”” tweeter=”@AmeriCares” suffix=””]At AmeriCares, I have seen the real life importance of mental health relief at the most extreme times[/inlinetweet], something that cannot be studied in a classroom. AmeriCares takes a holistic approach to disaster relief, working as a support system, security blanket, educator and backbone to survivors.

Innovative Care Delivery: A Charitable Health Center and Pharmacy Tale

By Christina Newport, Program Manager, U.S. Medical Assistance Program in Medical Aid, Health Initiatives, United States

[inlinetweet prefix=”” tweeter=”@AmeriCares” suffix=”Find out here:”]Can a simple change in the delivery of care impact patients’ health?[/inlinetweet] As I opened the door to the Martin Luther King (MLK) Health Center in Shreveport, Louisiana, I was eager to find out.

MLK Outreach 2014The center is like many safety net health organizations that I work with as part of AmeriCares U.S. Medical Assistance Program team. The MLK Health Center serves more than 1,000 low-income, uninsured and underinsured patients a year, many with chronic disease. But this center is using a unique group scheduling model and patient-centered care to improve patients’ health, their experience of care, and to reduce costs – the Triple Aim framework for health care reform endorsed by the Institute of Healthcare Improvement and other national experts.

Because the U.S. team at AmeriCares is rolling out a new chronic disease care program with the support of the GE Foundation, I wanted to see for myself these innovative approaches to quality care work at a charitable health center, a critical sector of the U.S. safety net.

I could see the difference in the waiting room: Patients were greeting each other by name. I felt like people really knew each other.

And I found out they did: Because they share a diagnosis of diabetes, these patients’ appointments are grouped together and held on the same day every three months. “Setting up clinic days for patients – having patients with the same condition come in regularly as teams with assigned providers – is one way to ensure that patients aren’t slipping through the cracks and are getting the care they need,” Janet Mentesane, Executive Director of the MLK Health Center, told me. Patients have individual appointments with their doctors but also meet together as a group, giving them an opportunity to connect and socialize.

Integrating care this way is having a measureable impact. “We have shown that our approach produces enhanced patient understanding of their conditions and improves health related behaviors,” Robert H. Jackson, MD, founder and Medical Director said. “We have also shown statistically significant improvement in a critical measure of diabetes control.” The MLK Health Center is also at the forefront of diabetes prevention: It is the only charitable clinic currently listed in pending status on the CDC’s National Registry of recognized diabetes prevention programs and offers the National Diabetes Prevention Program (DPP), a lifestyle change program targeting patients at-risk for developing type 2 diabetes.

At the MLK Health Center, I saw how simply providing an opportunity for patients to connect and share with others in similar situations can boost the feeling of humanity in medicine and improve the overall experience of care in a safety net setting. Through the generosity of the GE Foundation, AmeriCares U.S. Medical Assistance Program is working to continue to build capacity in other free and charitable clinics throughout the country.

We can use the experience of those like the MLK Health Center not only as a model for our work but as an example for others to learn from.

Supporting Mental Health on a Global Stage

 

While communicable diseases such as cholera and HIV place a substantial burden on global health, these diseases represent just a portion of the need, overshadowing the burden of non-communicable diseases such as mental health. In fact, according to the World Health Organization, the most burdensome disease in the world today is depression — especially in areas affected by disaster or poverty. Yet mental health programs are often underfunded in emergency response and health interventions alike.

AmeriCares has not overlooked this need.

It’s been more than two years since a massive earthquake and tsunami devastated Japan, and the emotional burden still lingers. In the past two years, we have funded more 92 grants totaling $2 million for programs that promote the mental well-being of survivors. A number of these grants support community directed initiatives — smaller scale projects designed to bring residents out and connect them to other survivors through communal activities.

One such initiative, a community gardening project, supported the planting of more than 300 varieties of flowers by residents throughout the grounds of the Ohashi temporary housing complex. Not only did the project enhance the physical environment, it reduced loneliness and isolation and helped establish friendships among residents. Initiatives like this also restore a sense of community to villages and towns that suffered immense physical destruction. This pride and community are an integral aspect of Japanese culture.

Here at home, the need for programs addressing mental health issues was clearly evident in aftermath of Hurricanes Katrina and Sandy. To date, AmeriCares has provided more than $1 million in funding for domestic mental health projects – most recently to benefit Sandy survivors. One grant, to the Pediatric Disaster Coalition in Partnership with Maimonides Hospital, trained 58 providers in pediatric disaster mental health to adequately assess and provide care for children. The grant aims to reduce symptoms related to children’s exposure to the traumatic experience, while enhancing their skills to manage current and future stressors.

Unlike communicable diseases which have clearly recognizable symptoms, mental health issues are more difficult to diagnose and treat. While an MRI or blood test can often quickly reveal physical infection, diagnosing mental health disorders are much more subjective, and require more intensive examination. Treatment is neither a simple distribution of medication or resources, but entails complex and highly individualized care, sometimes spanning longer timeframes.

By funding both community-directed programs and caregiver training programs in Japan and in the U.S., AmeriCares is providing both immediate and lasting mental health support for disaster survivors. These are just two examples of our commitment to deliver help that may not otherwise receive attention or funding — but is desperately needed. Health is not merely the absence of illness. This comprehensive work of AmeriCares will create a truly healthy world for all.