“Attending to Pre-Natal Care Needs of Women With Help from the Medical and Seminary Communities”

By Father Augustus Puleo • Posted February 20, 2017

(Read more about this award-winning essay here.)

“Before I formed you in the womb I knew you, and before you were born I consecrated you…” (Jer. 1:5)

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness …”[1]  In 2014 I baptized 267 mostly-Hispanic children at St. Patrick Church in Norristown, Pennsylvania.  Of those 267 baptized, I buried five, one-day old infants born at a local hospital where they died due to lack of proper health care for the mothers and the babies.  As the pastor of the “Spanish” parish in Norristown, Pennsylvania and adjunct professor of Pastoral Spanish at St. Charles Borromeo Seminary, I had to do something.  Each one of us is a child of God with a certain inherent dignity.  Saint John Paul II proclaimed the inviolable dignity of every human life:  born or unborn, rich or poor, healthy or sick, oppressed or free.  He wrote in his encyclical Evangelium Vitae, “The Gospel of God’s love for man, the Gospel of the dignity of the person and the Gospel of life are a single and indivisible Gospel.”[2]  Human dignity originates from God because we are all made in the image and likeness of God (Gn 1:26-27).

I was living out that plea of Padre Pio, “Recommend me to the Lord and to the Virgin Mary because I am in extreme need of their help.”[3]  For Padre Pio the relief of physical suffering was just as important as the spiritual guidance of souls, which are two expressions of the love of God and neighbor.  As a result, St. Pio of Pietrelcina founded a hospital, Casa Sollievo Della Sofferenza (“Home for Relief of Suffering”), for the sick in 1956 in San Giovanni Rotonda, Italy.    With renewed hope, I believed strongly that God would somehow intervene and provide help.  Again, I looked to Padre Pio for support as I remembered his words:  “Put all your trust only in God.”[4]  I knew that God would provide.  However, it seemed that I was living in a third world country, and not in one of the first world.

Even though I had never been married, I learned more about pregnancy than most biological fathers due to the fact that I was resolved to not bury any more infants.  The response given by the doctors and nurses to these numerous infant deaths was that the mother did not have proper pre-natal care and therefore, the children were being born with serious physical problems.  The National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention (CDC) reveals that in 2013 the infant mortality rate in the United States was 6.0 infant deaths per 1,000 live births.[5]  I almost had that number of infant deaths in my parish alone.

One of the major factors of the deaths and serious illnesses of infants is the lack of folic acid in the mother.  Folic acid is a synthetic form of vitamin B9, also known as folate.  Folic acid helps prevent neural tube defects (NTDs), or serious birth defects of the spinal cord, such as spina bifida, and the brain, such as anencephaly.  The neural tube is the part of the developing child from which the baby’s spine and brain form.  These tube defects occur in about 3,000 pregnancies each year in the United States.[6]  Neural tube defects occur at a very early stage in development even before a woman tries to conceive.  The Centers for Disease Control and Prevention (CDC) recommend that women take a daily dose of folic acid starting at least a month before conception and during the first trimester of pregnancy in order to reduce their baby’s risk of neural tube defects.  It has been studied that folic acid reduces these risks by up to 70 percent.[7]  In addition, folic acid helps to lower the baby’s risk of other defects such as a cleft lip, cleft palate and certain types of heart defects.  There are approximately 7,000 cases of orofacial clefts identified each year.[8]

This vitamin also reduces in women the risk of preeclampsia, a serious blood pressure disorder that affects pregnant women.  If preeclampsia occurs during pregnancy, the baby will have to be delivered almost immediately, even if he or she is not fully developed.  Preterm babies have an increased risk of serious complications.  Women who have had preeclampsia have an increased risk later in life of cardiovascular disease and kidney disease including heart attack, stroke and high blood pressure.  Having this disease once, increases the risk of having it again in future pregnancies.

It has also been proven that folic acid is an important nutrient for the body, needed to make normal red blood cells and prevent anemia.  It is essential for the production, repair and functioning of our DNA.  Therefore, having enough folic acid is very important for the rapid cell growth of the woman’s placenta and the developing baby.

These serious medical problems are further complicated by the fact that women in my parish have no health insurance since they have no legal status in the nation due to a lack of papers.  At times the mothers have given false names to doctors and hospitals and have attempted the use the identification of friends with papers because of fear of being reported to the Immigration and Naturalization Services (INS) and then the risk of deportation.  As a result of their immigration status, they are ineligible to receive medical assistance as well as being excluded in coverage by the Affordable Care Act:  thus, local hospitals incur a financial loss due to caring for them.  As more and more pregnant women go to the hospital to deliver their babies, the more financially challenged the hospital becomes.  In many cases, however, these serious medical problems, according to medical personnel, could have been identified and even prevented if they had been detected at an early stage and treated; saving the hospital money and the family terrible pain and grief.

The United States of America has experienced an increase in the immigrant population in the last twenty years.  In 1990 the immigrant population in was 7.1 million and today it numbers more than 11.3 million undocumented immigrants in the United States.[9]  Montgomery County in Pennsylvania, where Norristown is located, has experienced a 124% increase in its Hispanic population since 2000.[10]

Recently arrived Mexican immigrants with their children make up about 80% of my parish.  The borough of Norristown has changed drastically with the arrival of these immigrants, especially the school system and many social service agencies.  I celebrate three Spanish masses every weekend that are very crowded.  Deacons and seminarians from St. Charles Seminary are sent to St. Patrick Church in order to learn Spanish in a parish setting.  They also gain a great knowledge of their culture and also the serious difficulties facing immigrants.  A lack of basic education and papers along with a language barrier present serious problems for treatment and care of these immigrants.  Most Hispanic immigrants in Norristown have no high school education and a limited fluency in English.

Hospitals in the Norristown area have seen an increase in immigrant patients, many of them uninsured or underinsured.  When told that with proper pre-natal care the deaths might have been avoided, I reached out to find help.   I learned that many pregnant women have never had regular checkups neither during nor after their pregnancies due to a lack of money and the fear of being reported to the INS.  However, a simple screening program at an early stage could have identified some of these serious problems during these pregnancies, and allowed for them to have been treated.

There were two regional hospitals in Norristown when I arrived — Montgomery Hospital and Mercy Suburban Hospital, a Catholic institution.  At that time Mercy Suburban Hospital had already closed its Maternity Ward due to financial difficulties incurred perhaps by a growing immigrant population, many of them uninsured.  The other one left the barrio and now is a new, state of the art medical campus miles from where most Latinos live.  Treating complications due to lack of care during pregnancy financially burdens a hospital.  However, Pope Francis in Misericordiae Vultus exhorts us to “reawaken our conscience, too often grown dull in the face of poverty.”[11] I knew that I could not establish a hospital as Padre Pio had done, but I kept thinking of his words, “In every sick person, there is Christ who is suffering.  In every poor person there is Christ who is languishing.  In every sick person who is poor, Christ is doubly there.”[12]  I had to look beyond my immediate area to find help.  With help of a professor and students from St. Joseph University and the staff and doctors from Mercy Suburban Hospital, a new plan of creating “Promotores de la Salud” (“Health Promoters”) was developed.   With the establishment of this program, parishioners were trained by professionals — doctors, nurses and professors — to become health promoters and they then began working with the community.  As a result, a monthly screening program has been instituted at St. Patrick Parish to help not only pregnant women with pre- and post-natal care, but anyone with health issues.

This program is based on a combination of three health models.  The first model is “Partners in Health” (PIH).  The mission of PIH states that “health is a fundamental right, not a privilege.  Through service, training, advocacy and research, we seek to raise the standard care for the poor everywhere.”[13]  The Catechsim of the Catholic Church explains that “to receive in truth the Body and Blood of Christ given up for us, we must recognize Christ in the poorest, his brethren” (no. 1397).  This model reinforces the Catholic Social Teaching that emphasizes that human dignity must always be protected and then a healthy community can be achieved only if human rights are protected and responsibilities met.

Saint John Paul II has written, “Sacred Scripture continually speaks to us of an active commitment to our neighbor and demands of us a shared responsibility for all of humanity.  This duty is not limited to one’s own family, nation or state, but extends progressively to all … so no one can consider himself extraneous or indifferent to the lot of another member of the human family.”[14]  So, all of us have a responsibility to help those among us with or without papers.  PIH has three goals:  “to care for patients, to alleviate the root causes of disease in the community and also to share lessons learned throughout the world.”[15]

An effective methodology to combat these health issues is through education and preventative medicine provided by the Health Promoters of Partners in Heath through a community-based model of care.  This model includes access to primary health care, free health care and education serving the poor.  Based on this model, PIH has established successful programs in Haiti, Peru, Russia, Rwanda and Lesotho.  Regional coordinators are assigned to oversee the activities of the Health Promoters.  The Health Promoters teach and work on a personal level with individuals in their communities providing basic medical care and promoting prevention and health programs.

The second model is based on PIH, but was developed to create a more well-rounded perspective of community health.  The Creighton University Institute for Latin American Concern (ILAC) model implemented in the Dominican Republic was examined.  One great aspect of the program is to train Health Promoters to focus on the health of the community.  Doctors, nurses, regional coordinators and health promoters make up this program.  These professionals train, manage and provide supplies and medicines for all activities and programs. The Health Promoters, “los promotores de la salud,” work on a personal level with the people in their own communities.  They help provide education, basic medical care and prevention programs.

The third model examined is based on a program by the Dominican Sisters which focuses on the value and importance of education and community health.  In establishing schools, especially in Las Cruces in the Dominican Republic, they have helped many children and adults become educated and thus have aided the entire community.  The sisters have built a laboratory, pharmacy and bakery that are community run and help facilitate an improvement in the community’s health and nutrition.  The sisters began working with a group of women in the community who were leaders, and as a result these women began to undertake various initiatives to improve the community and its health.

After examining these models, a new program was developed by the Institute of Catholic Bioethics of St. Joseph University, Mercy Hospital Task Force and St. Patrick Parish.  The new program incorporated the successful and applicable aspects of each model examined and adapted them to this particular community in Norristown.  The main focus of the program is to stop infant mortality, to prevent serious diseases and to manage chronic health problems by providing medical care and services by partnerships with other already established organizations and hospitals in the area, i.e., the University of Pennsylvania Hospital, Temple University Hospital, Children’s Hospital of Pennsylvania.

This model of Health Care Promoters is a special case since it is one of those rare occasions when a third-world model is being utilized in a first-world environment.  This “Health Promoter” Program may serve as a model or paradigm for other hospitals to adapt to the changing world and challenges of reducing the infant mortality rate, providing better care for immigrants and helping reduce health care costs, particularly with the uninsured.

Los Promotores de la Salud are parishioners of St. Patrick Parish, who are leaders in the community.  They have an extensive knowledge of the Hispanic community’s history, life and people.  As a result, these selected parishioners received training provided by health professionals, doctors, nurses, professors, etc.  Each promotor had to meet criteria and norms for Health Promoters established by the Institute for Latin American Concern (ILAC).  The most important requirement was a strong faith and love of God and neighbor.  Other criteria included an age requirement of 18 years or older, as well as certain qualities of character dedicated to service, kindness, truthfulness, responsibility, etc.[16]  A candidate was accepted if he or she met the ILAC’s requirements.

Helping to determine the best candidates were the Missionaries of Charity, Mother Teresa’s sisters, who live in the church convent and work extensively with the Mexican immigrants by providing food, religious education for adults and children and even a summer camp.  Their help was based on the words of St. Teresa of Calcutta speaking to volunteers, “May God bless all your efforts to help refugees and displaced persons.  May you bring God’s love, hope and strength to the homeless and destitute.  Remember the words of Jesus, ‘I was a stranger and you took care of Me.”’[17]   Essentially, the newly-canonized saint was stating that those who serve the poor, serve God.

Health Promoter Candidates underwent an extensive and comprehensive training for approximately one year given at St. Patrick School on Saturday mornings.  They received education and practical training in health and nursing care.  Training and education included lectures, clinical demonstrations and practical components for the candidates in preparation for their various responsibilities.  Materials for this education and training were readily available in most hospitals.  Funding was provided by grants that helped make available materials such as a training manual, materials for monitoring one’s health care such as cards for the patients, thermometers, swabs, etc.

At the same time there was a tremendous amount of work and dedication required of the Health Promoters.  The goal of the course was to unite the parish with common goals of fostering life and empowering them to take ownership for their community with training in areas of leadership and stewardship.  The candidates were both men and women.  Each volunteer enlisted eventually realized that any “practical activity will always be insufficient, unless it visibly expresses a love for man, a love nourished by an encounter with Christ.”[18]

Educational materials and supplies for the continued screening each month comes from grants.  The undergraduate fellows from St. Joseph University receive financial assistance in their studies from the Gustafson Foundation that emphasizes research endeavors such as this model.  The Genuardi Family Grant also offers generous funding for this heath care initiative.

I began promoting screenings at the end of Sunday Masses during the months of July, August and September of 2014 while the health promoters continued to receive weekly training.  The first health screening session was held in October 2014.  In preparation for the screenings, we all began collecting the necessary materials for the screenings:  stethoscopes, pulse oximeters, blood glucometers, cholesterol monitoring devices, test strips, medical examination gloves, sharps disposal containers, a statistical database, etc.

In coordination with the local hospital, two residents are given time to attend and assist with the screenings on the first Sunday of the month.  Residents attended and assessed the patients and provided guidance in counseling and patient referrals to specialists for the program.  In addition, to anticipate the need for referrals of patients from the program to specialists, a doctor was cleared of her schedule on a Wednesday afternoon to attend to the higher risk patients.

After the noon Mass on the first Sunday of each month the “promotores de la salud,” doctors, interns, residents and university students provide screenings especially for pregnant women, but also for all members of the community.  At the end of Mass a doctor speaks to the congregation with a translator to invite families to visit the clinic housed under the church in the Parish Hall.  The focus for the community is not only on the spiritual well-being of the congregation but also the physical health of the individual.  The goal is to focus on the treatment of people before they are ill with community-based services, while they are in the hospital with acute-care services and after they are discharged from the hospital with community-based services.  As a result, St. Patrick has established a stable and reliable connection with the local uninsured Hispanic community and the different hospitals and doctors in the community.

Since I teach Pastoral Spanish at the St. Charles Borromeo Seminary, I usually have a transitional deacon at my parish who is completely bilingual.  These deacons and often seminarians have always attended Mass and then have gone to the monthly screenings with me using their Spanish by offering help by translating and encouraging parishioners to have a basic check-up each month.  This is excellent training for them who will become priests as they not only perfect their linguistic skills in Spanish, but they gain a new perspective on the strong faith of these parishioners in spite of their many difficulties of living in the shadows in this country.

The newest component to this program is a “Healthy Moms, Healthy Babies Program” run by a nurse, a doctor and Fellows from St. Joseph University in Philadelphia.  The medical personnel were amazed about the general lack of knowledge of prenatal and postnatal care for mothers and children.  The St. Joseph students responded quickly to the need for prenatal vitamins.   So, every first Sunday of the month students and Health Promoters distribute prenatal vitamins to women of childbearing age, reminding them of the importance of taking these vitamins before and during pregnancy.  A Rutkowski Family Research Grant and private donors provide the vitamins.

In addition, classes on nutrition and health for children and adults are provided to the community.  In fact, St. Patrick Church has renovated a room in the school building especially for health education with computers, books and a television screen.  The specific needs of pregnant women is my priority.  The Health Promoters from the community learn the basics of preventive care for pregnant women.  These empowered women educate pregnant women on how to properly take care of themselves and their developing child.  At the same time we connect these women with comprehensive standard care for women who are pregnant and safe delivery plans.  Our next initiative is to focus on post-natal care for women.

Attendance to the program is building slowly, but more families and children are coming.  In fact, we have expanded the program to include dental care as there are two dentists on hand every first Sunday of the month.  Referrals for more serious dental problems are given to our parishioners to go to dental clinics at local universities, i.e., University of Pennsylvania and Temple University.  In the fall of 2016 we started a new program to provide eye examinations and eyeglasses to those in need.  The exam and glasses are free of charge.

There still continues to be a significant suspicion among undocumented people who are afraid to go to hospitals and clinics for fear of being identified as persons without papers and then deported.  However, these immigrants feel very safe and very comfortable in the church community and more and more are coming for medical attention.  Therefore, it is essential that the transitional deacons and seminarians continue to perfect their Spanish as they are key in aiding these immigrants with their spiritual and physical needs.  Since the inception of this program, the infant mortality rate has improved greatly.

For me as Padre Pio remarked, “As the days pass, I see ever more clearly the greatness of God and in this light, which grows brighter and brighter, my soul burns with the desire to be united to Him by indissoluble bonds.”[19]  I have become more optimistic and appreciative of God and his grace.   To quote Pope Francis’s words at Assisi, “The Lord’s thirst is indeed quenched by our compassionate love; he is consoled when, in his name, we bend down to another’s suffering.”[20]

The program continues each first Sunday of the month with all of us — myself, the pastor, the deacon, seminarians, doctors, university students, los promotores — working with renewed energy, confidence and trust in God completely in accordance with the words of Padre Pio, “Faith guides us as we follow the light of Christ which conducts us all to God and his homeland.”[21]  A place where there is no suffering or death and no need of papers.

***

Father Gus Puleo is pastor of St. Patrick Parish, Norristown.

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[1] Charles Dickens,  A Tale of Two Cities (New York:  Barnes & Noble Books, 2004) 7.   

[2] John Paul II, Evangelium Vitae, March 25, 2995, 2.

[3] Padre Pio, “Padre Pio’s Words of Faith,” http://padrepiodevotions.org/padre-pios-words/

[4] Ibid.

[5] The Henry Kaiser Family Foundation, “Infant Mortality Rate (Deaths per 1,000 Live Births),” 2013, http://kff.org/other/state-indicator/infant-death-rate/?current Time frame=0&s (accessed Sept. 30, 2016).

[6] CDC, “Spina Bifida and Anencephaly Before and After Folic Acid Mandate, United States 1995-1996 and 1999-2000,”  MMWR 2004:  53(17):362-365.

[7] Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities.  Facts about Folic Acid.  Accessed:  Sept. 29, 2016.

[8] Hoyert DL, XU JQ.  Deaths:  Preliminary Data for 2011.  National Vital Statistics Reports; vol. 61, no. 6, Hyattsville, MD:  National Center for Health Statistics, 2012.

[9] Pew Research Center, “5 Facts about illegal immigration in the U.S.,” by Jens Manuel Krogstad and Jeffrey S. Passel, November 19, 2015, www.pewresearch.org/fact-tank/2015.

[10] Greater Philadelphia Chamber of Commerce, “Hispanics in the Region,” 2015.

[11] Pope Francis, Misericordiae Vultus, April 11, 2015, 15.

[12]Reverend Candice Murphy, O.P., “Padre Pio-Home for the Relief of Suffering,” St. Saviour’s Magazine, December 2, 2012.

[13] Partners in Health.  PIH Model of Care-Partnering with poor Communities to Combat Disease and Poverty.  2006.   http://www.pih.org/what/PIHmodel.html.

[14] Saint John Paul II, Centesimus Annus, May 1, 2991, no. 51.

[15] Partners in Health.  PIH Model of of Care-Partnering with poor Communities to Combat Disease and Poverty. 2006.  http://www.pih.org/what /PIHmodel.html.

[16] ILAC Staff.  Health Promoters:  ILAC Training Stages and Formation of New Health Promoters Manual.  Translated by Ann Marie Jursca, Faith Justice, Saint Joseph’s University.  ILAC Center, Santiago:  Dominican Republic, 2004.  5.

[17] Mother Teresa’s letter to a priest, March 4, 1991 found in Reverend Brian Kolodiejchuk, MC, A Call to Mercy:  Hearts to Love, Hands to Serve:  Mother Teresa, New York:  Image,2016,  p. 56.

[18] Pope Emeritus Benedict XVI, Deus Caritas Est, December 25, 2005, 34.

[19] Padre Pio, “Guide for the Journey,” Living with Christ, New London, Connecticut, Sept. 2008.

[20] Pope Francis, “Thirst for Peace:  Faiths and Cultures in Dialogue,,” on Tuesday, September 20, 2016 at Assisi, Italy for the World Day of Prayer for Peace.

[21] Padre Pio, “Guide for the Journey,” Living with Christ, New London, Connecticut, Sept. 2008.