HJAR Mar/Apr 2024

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2024 21 could no longer compensate. When you try to refer into a community with very fewmen- tal healthcare providers, and even those are being run down, it creates a very large void. I live in an area where I have these resources readily available, and it's still really hard to get patients in. Go into SouthArkansas, in the Delta, where there's very little access. That doesn't mean these patients don't suffer mental health con- sequences — maybe even more so due to isolation, the area, poverty, health literacy — but there's not access to that care. They get depression and postpartum depression, not uncommon in and of themselves. You add more social determinants of health, you add potentially substance abuse, you add stress- ors in the family … it's a difficult time. If we don't have the systems to support them, there are dire consequences. How can we get the systems in place for support? I think we have to put our money where our mouths are. Mental healthcare providers are not flashy, and it is a hard, hard job. How can we incentivize more people to go into some of these fields? And I mean all aspects of it. Certainly, there's the MD, but there are therapists, community healthcare workers, church advocates, and others. How can we help build some of these systems in place to help support them? And the more there are, that one person in that community then doesn't feel the weight of what they are lift- ing. Therapists are a wonderful tool to phy- sician care. I don't know what the job mar- ket is for that, but we can triple it and I know that they would be busy. Reimbursement does not reflect howmuch they are needed in our community. Joe Thompson, MD, MPH, who writes a column for us and has for years, speaks about how Arkansas should incorporate doulas more. What is your experience with them? I've worked with doulas. Someone people, nursing turnover, all of the ancillary staff. When you're talking about brand new people and an issue that they may not have seen in any significant length of time, you don't need them not knowing what the next best step is. That's where these AIM bundles come in place.They help these providers, these hospi- tals, these systems not have to think off-the- cuff — to be able to stabilize them so they can get to the next best place, ideally. The second bucket where we can help is trying to figure out how to get patients “heard.” If they come in presenting with X, Y, and Z, how do we make sure they know that that's not normal — if they go to their provider for that care, if they don't feel like they're get- ting what they need from that provider, how do they escalate their issues? How do they make sure that they are heardwith those con- cerns? How canwemake sure we've created a community around them that can help them navigate this healthcare system that we all know is so hard to navigate sometimes, even when you know all the pieces to it? I was just thinking you made such a valid point. Even when you know how to navigate it, it's hard to navigate the system. It's so hard. We had some healthcare con- cerns with some grandparents. My husband and I are both physicians. I have never been so frustrated, and I know a lot of people and can get help very easily. It really was so eye- opening that some of my patients with very little health literacy … I don't know how they navigate it. We need to help them. Talk to me about the third bucket. The third bucket, that really is the opioid crisis here. Substance abuse continues to be a very big issue, not just inmaternal care but overall healthcare of our state. We don't have enoughmental healthcare providers to pro- vide help. COVID really opened our eyes to it. People were compensating in ways prior to COVID that I think, after the pandemic, like access to providers, access to the cor- rect diagnosis to whatever ailment or issue they came in presenting with. The second bucket is going home from the hospital to about 42 days — things like having shortness of breath or other issues that occur in that postpartum period, and, for whatever rea- son, they either didn't seek care, didn't get the appropriate care, or didn't know to get to care. ACOG (American College of Obste- tricians and Gynecologists) has done a huge campaign called the Hear Her Campaign, and I feel like that really addresses the sec- ond bucket.The third bucket is fromabout 43 days to 365, and that ismaternal health issues like substance abuse, suicide, and homicide. Every one of these buckets has a differ- ent set of issues with regard to why they're there, so to say why we're in this state, we would have to look at each of these buckets very separately. What happens in this first part, hospital stay, are the things that we're working on nowwith theseAIMbundles. We became the 48th state to join the Alliance for Innovation and Maternal Health. It fol- lows the California collaborative bundles of healthcare. These are toolkits that have been validated and proven to be effective in some of the big obstetrical emergencies that we see at our hospitals — hypertensive emergencies, sepsis, postpartumhemorrhage. For these big “never events,” it shows very clearly if you follow this algorithm that anyone can step in and start that protocol. If you follow this algorithm, we have shown that there are bet- ter health consequences. For a state such as ours where we had 39 delivering hospitals at the beginning of COVID, falling to 37 very shortly into COVID, and nowmost recently 35, we need every one of these hospitals providing obstetrical care because they’re access points throughout our state. But some of these hospitals may only deliver two, three, five babies a year, which seems very small. They may not have seen a postpartumhemorrhage in sixmonths; they may not have seen a postpartum patient in two years. The staff has turned over tremen- dously. We all know what healthcare looks like right now. It's so hard to keep the same