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Description

The complications started around week 18 of Marquisse Watson’s pregnancy. Six weeks later, her baby girl Alana was born premature. Marquisse and her husband Antwon had bought the baby clothes, gotten the nursery ready… but Alana passed away 36 hours after she was born. This week, we talk to Marquisse about working through her grief seven years later. We’re joined by Venice Haynes and Meredith Shockley-Smith to talk broadly about social determinants and why black babies are twice as likely to die than white babies.

Resources from the episode:

• Learn more about Cradle Cincinnati: http://cradlecincinnati.org and Queens Village: https://www.cradlecincinnati.org/queensvillage/
• Check out Marquisse and Antwon’s Alana Marie Project: https://thealanamarieproject.com/
• Follow the US of Care on twitter: https://twitter.com/USofCare
• Read about the US of Care findings on Americans’ health care needs during COVID-19: https://unitedstatesofcare.org/humanizing-the-response-to-covid-19-by-listening-to-people/
• Watch the US of Care Voices of Real Life YouTube series: https://www.youtube.com/playlist?list=PLchtNczPer_8g7icvpiu2gmVNPr9XPENQ

Keep up with David on Twitter @CHIDavidSmith. 

Have you been hit with a surprise bill or had an infuriating run-in with the health care system? If you want to submit a patient story, email us at costofcare@lemonadamedia.com or leave us a voicemail at 833-453-6662.

Support for this episode of The Cost of Care comes from Healthline.com, America’s leading digital health brand. Visit healthline.com/costofcare now, and stay connected by following @healthline on Instagram, Facebook and Twitter. Healthline: Powering healthy actions and supporting you on your journey to well-being.

Support for this podcast comes from The Commonwealth Fund, a health care research foundation working to improve the U.S. health system. Visit commonwealthfund.org/costofcare, and stay connected by following us on Twitter, LinkedIn, and Instagram. Commonwealth Fund: Affordable, quality health care. For everyone.

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Transcript

SPEAKERS

Marquisse Watson, David Smith, Meredith Shockley-Smith & Venice Haynes

David Smith  00:00

Hey listeners, the cost of care is a 10-part series. We think it’ll make more sense if you start from Episode 1. So go back, start there. And we’ll be here when you’re ready.

Meredith Shockley-Smith

We want to know you before you get pregnant so that when you get pregnant, you are automatically celebrated. You don’t need to be heterosexual, married, and of age to be celebrated. But you know, when you get pregnant, we have Black babies coming into the world. And that is a joy to us and a celebration to us. And so if we know you, we can get you set up for joy and celebration, but also prenatal care. So there’s like this piece of the work that’s like a normal natural reality that marries itself very easily once you have relationship with people to supporting a healthy pregnancy and birth.

David Smith 

That’s Dr. Meredith Shockley Smith. She’s the director of community strategies for Cradle Cincinnati, a collaborative organization working to reduce infant mortality in Hamilton County. While her work is centered in Ohio, this is a national problem. In America, Black mothers and their children are dying at a staggering rate. According to a 2019, CDC report, black babies are over two times more likely to die than white children. Black mothers account for three times as many deaths as their White, Asian or Hispanic counterparts. And this story has gotten some attention in the press. But the message is not always reaching the people who need to hear it most.

Meredith Shockley-Smith

It seems as if because it’s in the national news that that means everybody knows. But if you’re in the corners of the earth, and you watch Netflix for the most part, and you work, you know, excessive days, you’re not necessarily coming through the news. And you’re also not trying to hear that like horrible, sad story, and then figure out how to divorce yourself, your physical body, that you’re already struggling that you’ve already experienced racism in and then like, let me just also consume that the likelihood that my baby will die, or I will die is like extremely high. It’s like, it’s a lot.

David Smith  02:05

But the responsibility to fix this problem should not fall on black women shoulders alone, policymakers and healthcare professionals have a lot of work to do.

Meredith Shockley-Smith

The policy piece is really important, and the medical professional pieces, like not just like, do you hear me? And like, did you go to an equity training, but also like, what’s your equity journey? Like when people say you need to do an equity training, for example, I’m like, that is absolutely under no circumstances a solution, like check the box and now you know the definition to social determinants of health. Or look, you get intersectionality, I walk through the door, and I’m both a Black woman and queer, like good to have, you win. What I need you to do is technically continue to take your next step, your next step, your next step.

David Smith 

So far this season, we spent a lot of our time talking about the health care system, which as we’ve said before, is only responsible for about 10% of our total health outcomes. So, over the course of the next few episodes, we’re gonna turn our attention to the other stuff, our communities, our lived experience, and the social factors that impact our health every day. Because if we actually want to help Americans live healthier, happier lives, we need to start way before they end up in the emergency room or a specialist office. So this week, we start at the very beginning, at birth. This is the COST OF CARE. I’m your host, David Smith.

Marquisse Watson 

They told us like basically they thought it was less than 10% chance that she would actually survive the delivery. So when she survived the delivery, it seemed like, okay, we can breathe a little bit like you know, she’s here. Obviously, we know a little 24-week baby would have a long journey ahead of them. But we really felt like you know, we had kind of crossed one bridge and we were on to the next phase of the journey with her.

David Smith  04:24

This is Marquisse Watson. Back in 2014. She and her husband Antoine, we’re expecting their first child, a little girl named Alanna. We’ve told you a story about premature birth on the series already an episode for Lauren Barton, her daughter Sadie, fought for their lives in the hospital, only to fight again when they came home to face outrageous hospital bills. There are a lot of similarities in today’s story. Marquisse and Lauren are both nurses, they both have bustling homes. You’ll hear Marquisse’ dog from time to time and her kids running around upstairs. And both women summoned an incredible amount of strength that help them through their darkest hour. Tell me about the moment when you knew something wasn’t quite right with your pregnancy with Alanna.

Marquisse Watson 

so it actually with her being her first pregnancy, it’s kind of one of one of those things like you don’t know what you don’t know, to a degree. And even being a nurse, obviously, I knew kind of the medical perspective on, you know what things you should be concerned about and things like that. But you know what the being my first pregnancy some of the symptoms to a degree, I kind of relate it to like this much just be related to being pregnant versus like that something’s going wrong with them. I kind of maybe even didn’t always think they were as bad as maybe they really were because I felt like, oh, I’m pregnant. I’ve never been pregnant before. And maybe this is why I feel so crummy without realizing like I feel so crummy because something’s going wrong.

David Smith

She started having complications around week 18 of her pregnancy. She went to her doctor and was diagnosed with gestational hypertension, a form of high blood pressure during pregnancy that generally goes away after delivery.

Marquisse Watson  06:14

And kind of in my mind, in a sense, being naive, I felt like, oh, you know, we’re halfway there. So you know, like, I just got to go another, you know, 20 or so weeks, and you know, we’ll be at the finish line.

David Smith

But a few weeks later, they went in for an ultrasound and Alanna was measuring much smaller than she should have been.

Marquisse Watson 

And, you know, the way the person was asking the questions during the ultrasound such as you know, when is your due date again? How far along are you? And obviously, I knew that she knew this information because she was doing my ultrasound, and then when she walked out the room, I just completely burst into tears and my husband’s like, what’s wrong? And I’m like, you know, she’s got to go get the doctor. That means something’s wrong. And he’s like, no, like, you know, everything’s okay. That’s just the part of what she has to do.

David Smith

But Marquisse was right, something was wrong. Alanna was still measuring small for her gestational age, the doctor explained, it could be due to the high blood pressure, so they prescribed new medication and bedrest. But a few weeks later, new symptoms appeared.

Marquisse Watson

I just completely was swollen, literally from like, you know, the hips down pretty much completely swollen. Short of breath, I had really bad headaches, and called my doctor’s office and said, hey, you know, something’s going on, I’m just not feeling very well. And they asked me to come in for an appointment. And basically at that appointment, which I thought was just going to be another checkup or you know, adjusting medications, I found out that I was pretty much in full blown Preeclampsia by that time and needed to be rushed right over to the hospital to be admitted.

David Smith 

Preeclampsia is a pregnancy complication that usually begins around the 20-week mark, the most common symptom is high blood pressure. And if it’s left untreated, pregnant people face serious, sometimes fatal complications for themselves and their child. The most effective treatment for preeclampsia is to deliver the baby. But when you’re as early in your pregnancy as marquees was the possibility of giving birth is unimaginable.

Marquisse Watson 

At that moment, I just felt like complete shock. Like I thought, there’s just no way like when I first got to the hospital, they really didn’t tell me up front that I was going to be delivering they told me I was going to be monitored. So in my mind, I thought, okay, I’m going to be here for like the next, you know, 16 weeks, basically, until I have this baby. Still not in my mind really registering like that, it was even a possibility that they would tell me like you know, that you need to deliver and we need to induce you. You know, that was a really hard pill to swallow that we were going to have to do that.

David Smith

At 24 weeks, a mother’s body doesn’t want to naturally give birth yet. So Marquisse Watson had a difficult delivery that lasted nearly 37 hours, the doctors made it clear that Alanna’s odds of survival were very low.

Marquisse Watson 

They pretty much said, you know, we don’t expect that she’s going to make it, you know, through this delivery. And they actually didn’t even like usually when you’re in labor, they have you connected to the monitors and things like that to monitor the baby’s heartbeat. And basically, they told me like, we’re not going to hook you up to the machine because we don’t think she’s going to make it through the labor. So like they would come in like every six or so hours and like check for a heartbeat. And every time they came in, you know, the heartbeat was still going really strong. And you know, that happened throughout the whole 37 hours. So we were really just praying and hoping that number one she would be born alive and number two that you know they could actually put the breathing tube in to get her to the NICU right away.

David Smith 

After 37 grueling hours, Alanna was born alive. She was quickly taken to the NICU and Marquisse was left to recover.

Marquisse Watson  10:10

So, Antoine would send pictures, updating me, you know, this is what you know how much she weighs, and all of her first pictures and all of that. And then the next day, I was able to go down to the NICU and be with Alanna for the first time. So that Friday morning, actually, the resident from the NICU who came up to my hospital room, and said, hey, I really, you know, want to update you guys on Alanna’s progress. And at that time, things were kind of looking, you know, a little, you know, like, not so good. And she said, hey, you know, these are our options, this is what we can do. Obviously, you know, we’ll fight as long as she wants us to fight. And, you know, immediately, I was like, let’s see it down here. Let’s see her, you know, let’s see how she’s doing.

Marquisse Watson 

And, you know, we spent that whole Friday with her basically, until we had to make the choice to withdraw care, because she was not doing very well. It was definitely really hard. Obviously, probably one of the hardest things I’ve ever had to do. And I hope one of the hardest things I ever have to do, really. But really, for us, it was just, you know, we were really thankful to just even have the time we did have with Alanna. So, you know, as hard as it was to make that choice. It was like, you know, basically, we had 36 hours that some other families never get to have with their babies.

Marquisse Watson

And really, for us, we didn’t want Alanna to basically die connected to the machines. We wanted to be able to hold her and to have those moments with her. So that’s why we decided, you know, if she doesn’t want to fight, we’re not going to be selfish. And you know, as much as we want her to be with us. We’re not going to, you know, force her to be on the machines and all of these things. We would really rather have you know, that time with her while she’s still alive, get to enjoy that with her.

David Smith  12:17

As any parent can imagine, the loss of Ilana was devastating. But marquees Antwan held on to each other and knew they still wanted to family. And a year later, they were blessed to discover they were pregnant again, this time with a little boy, their rainbow baby. Often, that’s where these stories end. A family experiences terrible grief. But after the storm of loss comes a rainbow, a healthy baby, happily ever after. But life is more complicated than that. Marquisse was still coping with a tremendous trauma.

Marquisse Watson

You know, there was a lot of nerves, the whole entire pregnancy about, you know, what if I, you know, get Preeclampsia early, what’s going to happen? Can I go through this again, and all those kind of feelings. I did have Preeclampsia with him again, also. So that was a pretty traumatic experience as well. He made it much further in pregnancy. He was born at 33 weeks, and did spend some time in the NICU. But obviously, you know, he was in the same NICU where Alanna passed away. So that was a pretty painful experience to go back at the same NICU were just you know, a year prior, we lost the baby.

Marquisse Watson 

And now here we are with another baby, thankfully, who is healthy and doing very well. But you know, that was still a process to go through. It’s hard not to stress when you kind of have been through a situation like that. But it would have been really helpful for me to you know, have a place where I could go and you know, get some strategies on how to handle all those emotions and feelings on top of the crazy hormones for being pregnant and you know all the peace that comes along with that.

David Smith  14:08

After the break, we’ll talk to two experts about how communities can build these kinds of spaces for women like Marquisse.

David Smith

We’re back. At the beginning of this episode we talked about the similarities between Lauren and Marquisse. Of course, there are two important differences. Lauren survived while Marquisse’s did not. And Lauren is White and Marquisse is Black. It’s impossible to draw a straight line between cause and effect here, but the numbers don’t lie. Statistically, Marquisse baby was twice as likely to die as Lauren’s, why is that? Let’s start by talking about social determinants of health.

Venice Haynes 

Where you live, so your neighborhood and built environment, your economic stability, most often commonly tied to your job and how you make a living. Your social surroundings, in a lot of cases, your social and cultural networks and things that are around you, your educational stability, and of course, your health care. I push the envelope a little bit, and I actually add race and racism to that as well.

David Smith

That’s Venice Haynes, director of research and community engagement at United States of care. You’ll hear more from her later this season. She’s not pushing the envelope very far to include race and racism and a conversation about social factors that determine our health. Too frequently, people assume that if an issue is impacting Black mothers, it must be a matter of poverty. But that’s not true. Look at Marquisse, she’s a well-educated nurse. Racial disparities and infant care are not explained by socioeconomic class. According to a recent study from Cradle Cincinnati, a Black mom with private insurance is more likely to lose her child than a White mom with public insurance. Venice’s own background growing up in Atlanta helps her think about social determinants in a very tangible way.

Venice Haynes  16:26

I think about how I grew up; I wasn’t the most privileged, we moved around a whole whole lot. And I was always thinking about in the back of my mind, like, what are people’s experiences when you take any one element of their life out, right? You think about where somebody lives? If they move abruptly, how does that upset other things, and in this case, health care, if you lose a job, what does that do to your living condition that upsets your health care, right? It’s not just about health care, it’s about the whole person and everything surrounding that.

David Smith 

We didn’t use the phrase social determinants, but we talked about this in Episode 1 with my own family story. My dad lost his father when he was just 11 years old. And it’s set off a sequence of chaotic events that contributed to at least two generations of negative health outcomes. Again, we can’t draw a straight line that definitively confirms causation. But the issues my dad experienced? Housing insecurity, addiction, chronic illness, and untreated mental disorders, all of these are associated with health risks. So social determinants of health are not inherently about race.

David Smith 

But here’s the thing. I have a lot of tough things happen in my life. But as a White guy, the system is set up in my favor. When I looked for work to support my family, or I went to the doctor for medical treatment, the people in the position to help me usually look just like me. And that’s not a coincidence. We’re all impacted by our own unique circumstances. But then we’re all thrust into the same system when we need care. And that system is much more welcoming to some than others. Even if you’ve never heard the phrase, social determinants of health, I promise, you’ve lived it in some way.

Meredith Shockley-Smith  18:27

That’s one of the things that I’ve had to work on as an academic come into this space is that we create language. And then we talk about it and the people on grot, like what social determinants of health.

David Smith 

That’s Dr. Meredith Shockley Smith, again, who you heard at the top of this episode, Meredith is very good at simply spelling out the connections between social factors, and things like maternal health.

Meredith Shockley-Smith

So there’s an easy way to draw a link between the social determinants of health for example, transportation, and infant mortality. So I’ll just use one around getting to your appointments or prenatal care appointments. So we had named that the problem was, they can’t get there. Like, I don’t have a vehicle, the bus isn’t always running on time. And we know that hospitals are running on 15-minute increments for their OB-Gyne. So if you’re late, you back everybody else up. And that depends on how many people were late prior to. And then there’s the victim blaming piece of like, why are you late and like this lack of understanding.

Meredith Shockley-Smith 

And then there are solutions that are created, but without Black women at the table. So you have you know, this new creation of like, oh, well just send somebody part as part of your insurance, you make this call, and then somebody will come and get you. No one considered that that person might also be late, and might leave you at your appointment over and over. So these are stories that we get from women about that system is it can also be broken.

David Smith 

This is why it’s important to acknowledge race as a factor in social determinants. Black women are being disproportionately impacted, but also left out of the conversation.

Meredith Shockley-Smith 

The problem isn’t solving itself and one of the things we have not tried is allowing Black women to lead and to be the significant voice and the extra voice in their own reality.

David Smith  20:07

So that’s exactly what Meredith and her colleagues are doing with Queens Village, an initiative of Cradle Cincinnati.

Meredith Shockley-Smith

Our first conversation in Queens Village is about being a Black woman. And so there’s that blanket reality of one of the things we don’t have to do in this space is placate other people. When we talk about race, or when we talk about women, it is a sacred space. So a space that we create intentionally for black women to rest, relax, free power, because when we went to listen to them in the city, and we asked what do you need as an intervention to change outcomes for birth, they said, I don’t feel heard, seen or listened to. So it’s really a community of folks who are just here to support pregnancy, birth and Black women in general. But with the goal of lowering infant mortality.

David Smith 

Queens Village is doing profound work on the ground offer group prenatal care and advocate for policy level change. But their ambitious work started in a simple place, dinner at Meredith’s house.

Meredith Shockley-Smith 

We invited folks over to […] so you can bring whenever you wanted a bottle of wine, a box of Kraft mac and cheese, or you could also just come because you were hungry, and so found that being that there would be 30-40 people would come on a Wednesday night, every Wednesday for seven years, I think, you know, you walk through the front door, and you see a packed house with kids running around and music going on. And it’s like 1000 degrees, because there’s no air conditioning in the summertime. And where people were saying around their coats on in the wintertime, and the backyard had a fire pit. And you might come in late at 11 o’clock and catch a drum circle or storytelling in the backyard. And so that’s sort of the premise on which Queens Village stood.

David Smith 

Meredith said that she learned a lot about herself at those meals.

Meredith Shockley-Smith  22:03

One of the things I learned about the needs of Black woman and family dinner was that I am one of those Black women, I’m always like, let me help. Let me help. Let me help, let me help. And I’m just like, you know, this helps me like this is like real for me. Black women show up for folks. And I would also say that reality that I said about my myself is also real for Black women in general. So they are trying to help everybody else. And then they put themselves last and no one is also thinking of them, which is why they get to not be at the table with leaders, which is why they not get to be centered in the issue. That’s concerning them and we’re more powerful than we know. And we deserve to be at those tables, and have solutions to our problems. And we know that because we have been solving them unlimited as is why we’re still here by ourselves, because nobody else was showing up for us.

Meredith Shockley-Smith

The approach of Queens Village is to create community and support, to create a network of people so that as I’m having this conversation, somebody is telling me that I’m with you, and I’m here for it. So we’re going to be able to make these changes that shifts our outcome without like, so much burden that we can barely stand up, or we don’t can’t go to work, or we’re like in tears. It’s a lot. And also it’s a lot to support these women who are lost babies. I mean, it’s just an awful situation to be sitting with somebody who’s had that experience. It’s unreal. And I think that that’s the part of the work that keeps us going the part where we are like this doesn’t have to be real for as many people as we see and we want to get to zero. But every baby we save is super worth it.

David Smith 

One of the women helping people at Queens Village by sharing her expertise is Marquisse Watson. When we come back, we’ll hear how she’s sharing her experience and helping her community.

David Smith  24:00

We’re back. In 2018 Marquisse  and her husband and Antoine started the Alanna Marie project in honor of their daughter. They help provide grief support packages to families experiencing a loss.

Marquisse Watson 

Helping other families as they experience a loss has been a really an important part of my own healing. And really even before we officially started the organization, I kind of always if I would hear if someone I would like you know how can I get them a card or what can we do to help?

David Smith

Marquisse is also on the board at Queen’s village with cradle Cincinnati. It’s a chance for her to help people but she gets a lot out of the service experience, too.

Marquisse Watson 

Cradle has been really beneficial and it’s a great support. First of all, it’s really opened my eyes even more to know the work that we do is needed. Obviously on their end, you know they want every baby to make it to their first birthday, and they will work hard until, you know, they can get as close to that. And you know, in a perfect world, every baby would make it to see their first birthday. So I think for Cradle, and with kind of under the Cradle umbrella Queen’s village, it’s really just been a safe space to meet other families, also to meet women and other people in the community that have such a passion behind maternal and infant health. And obviously, you know, for the families that do experience a form of loss for us to be able to be a resource and offer our services to help any of the families if needed.

David Smith 

Having a sense of purpose, and a community support system has been essential from Marquisse. But here’s the thing about grief, it doesn’t stick to a timeline. Today, she has three little boys, AJ, Andrew, and her eight-month-old Aiden, it’s been seven years since she lost her daughter, but she’s still working through that grief.

Marquisse Watson  26:04

Just in the past, I would say, less than six months, basically, I started seeing a counselor. And really, am I after my last pregnancy. With our little guy that’s only eight months old. I had a lot of postpartum anxiety with him. And I think a lot of that came from, you know, the fear, like there’s something would happened to him. And it really came out of nowhere, like, I felt like I was fine. And then it just became like, you know, when he would be asleep, I would be so worried, you know, what if he doesn’t wake up? Or what if something happens to him. But I really had no really like logical reason, per se like to be concerned about his health or safety or anything like that. But it was just like, almost like a post traumatic kind of response to like, what if something else happens to like someone I love? So I started seeing a counselor.

Marquisse Watson

And I think, why didn’t I do this sooner, like, you know, obviously, helping other families after they experience a loss has been a really an important part of my own healing, and really offering that support and being there with them. But also in the same token, there are some parts of my grief that I never really dealt with. But I really just, you know, I grieved, of course, but also, you know, that we had AJ that we had Andrew and then we had Aiden, you know, you have all these things in life. And really, you know, there were certain parts that I’d never really dealt with. And I’m happy I did, you know, take the opportunity to go and meet with a counselor, and really open up and share some of those painful parts that I hadn’t really talked to anyone about.

David Smith

I can only imagine the immense pain and grief of losing a child. But I do have some experience coping with loss. It’s taken me a long time to grapple with the grief of losing my dad, my brother and my little sister. First, I just tried to survive, I thought I was dealing with it because I persevered and avoided being dragged down by the sadness. Eventually, I realized that any surface success that I achieved was just sitting on top of this well of unresolved trauma. And if I didn’t deal with it, it was gonna boil over. I told Marquisse that when I finally did start to unpack that pain, it was like discovering I’ve been walking around with a backpack filled with rocks.

Marquisse Watson  28:39

The rocks of the backpack, I feel that so much. It’s just like you thought like, you know, you were carrying like baggage, basically, then you feel like, you know, when you start unpacking it, it’s like, oh, geez, I had like boulders in this bag that I didn’t even know about, you know, I thought I like had my grief together in a nice little package. And but, you know, it seems like it was more controlling me which I didn’t like that part of it at all. So it was really good to just talk and you know, really lead out basically like six plus years of like feelings that I’d never really, you know, openly talk to, you know, some of those very deep pieces that maybe I felt embarrassed or ashamed about. And I thought, oh, I wish I would have done that sooner, like much sooner.

David Smith 

If you were talking to somebody else, and it sounds like you have opportunities to do this that are going through that process and they say no, I don’t need to see anyone I’ve impacted I’m just sad like what would you try to help them understand about your experience to seek out that support and better understanding their grief?

Marquisse Watson 

I would say the port for me and maybe that would be helpful for other people was to know like, I feel like sometimes and I say I went through a phase where I felt guilty like you know, I had done something wrong. And I feel like it’s hard for people to You know, even share that with someone like I feel guilty like something I did cause this to happen, obviously, you know, no one will blame you for something you had no control over. But I feel like a part of it is like feeling guilty about like what that person will say when you really start opening up and sharing those things with them.

Marquisse Watson  30:17

And for me, obviously, I shared a lot with my husband, Antoine, but he’s not a professional counselor. He’s not a mental health professional. And, you know, when someone else is grieving, you know, that’s a lot to basically throw on them on top of their own grief process. So really, just by seeing a professional, it really is just a safe place for you to not only just open up and share those feelings, emotions, thoughts, in a very nonjudgmental way. But also to walk away with some strategies on you know, how can I move forward with my grief.

David Smith 

Grief isn’t like a broken ankle, you can’t just identify the problem on an X ray, set the bone and then wait for it to heal, grief and trauma and depression and anxiety. These are all invisible wounds under the surface that can just chip away at us if they go untreated. And I know we talk a lot about how our system sucks, and it does. But you know what? Our system knows how to treat a broken ankle pretty damn well by now. But give me charge you an arm and a leg for it. But a doctor is probably not gonna let you leave the hospital with a shattered bone. And yet, somehow, we still treat mental health like it’s this optional thing. This is the problem we’ve been talking about since Episode 1.

David Smith

We invest all of our resources into the 10% of the system that deals with broken bones. And then we treat everything else like it’s this afterthought. We talked about social determinants In this episode, and bear with me because I’m going to throw out one more big public health phrase now. Bio-psycho-social factors of health. Essentially, everything about us is interconnected. Our biology, our psychology, or social circumstances. All of these things add up to the state of our overall well-being our health. For Black mothers in America, bio-psycho-social well-being means access to quality prenatal care, acknowledging the stress of systemic racism, and providing community centered supports.

David Smith  32:41

For Marquisse that also meant coping with her unresolved grief over the loss of her daughter that she’d been carrying around for years. She could have easily kept that trauma sitting up on the shelf bubbled up year after year until it just exploded. My dad didn’t deal with his grief for decades, and in the first few years of my childhood, it wasn’t a big deal. until it was and that trauma he carried around with him and eventually ripped our family into shreds and had this irrefutable impact on our health. It’s not a coincidence that I have two siblings who died before the age of 25.

David Smith

So Marquisse following her instincts and getting counseling is a huge step towards a healthy future for her family. And all the birthing people who benefit from hearing her share her story through her work with Queen’s village. Next week, we stick with the bio- psycho-social framework. And we’re going to take a hard look at the twisted state of kidney care and talk to three experts who are disrupting that system and focusing upstream.

Speaker 5

You have 10s of millions of Americans with a disease they don’t know they have. It is progressive. So as it starts to progress through stage three, stage four, now you’re 18 to 24 months away from having your kidneys fail. So the big tragedy from my perspective, I think from a lot of observers perspective is that all of the time, attention and focus in this country has been on the half a million Americans on dialysis, and virtually none in an organized fashion on the 36 million with kidney disease prior to kidney failure.

CREDITS  34:34

The COST OF CARE is a Lemonada Original. The show is produced by Jackie Danziger and Kegan Zema. Our associate producer is Giulia Hjort. Music is by Hannis Brown. Executive producers are Stephanie Wittels Wachs, Jessica Cordova Kramer and David Smith. Help others find our show by leaving us a rating and writing a review. If you have a story to share, call us at 8334-LEMONADA or send us an email at costofcare@lemonadamedia.com. Follow us at @LemonadaMedia across all social platforms or find me on Twitter at @CHIDavidSmith. Lastly, we want to express our appreciation for the men and women who get up every day and work in this system with a passion for improving our health. We are grateful for the work you do. We’ll be back next week.