Columbia pediatrician makes home visits in rural Missouri

Thursday, July 7, 2011 | 8:11 p.m. CDT; updated 10:43 a.m. CDT, Friday, July 8, 2011
Pam Elledge, a registered nurse for Whole Kids Outreach, reaches for 8-month-old Emma Keele, who was playing in the lap of her father, Charles Keele, on Wednesday. Elledge makes regular house visits to the Keeles and other families in Butler County. Columbia pediatrician Robert Harris went along for a day of home visits this week.

POPLAR BLUFF — Paradigms shifted for two seasoned medical professionals on Wednesday.

Robert Harris, a Columbia pediatrician, drove across the state to work with Whole Kids Outreach. The organization, based in Ellington, addresses unmet maternal and child health needs in a rural, six-county area, hosting programs and sending nurses to visit new mothers and children.

Pam Elledge, a registered nurse for Whole Kids Outreach met Harris and brought him along for a day of visiting families. She drives an average of 130 miles each workday, spending at least an hour at every stop and offering health and safety advice, basic checkups and a kind ear.

Harris, with 50 years in pediatrics, came southeast for a week to serve the needs in rural areas and to learn how he could better serve in the future, since he felt compelled to effect changes to infant mortality rates in rural areas of Missouri.

Neither anticipated the joy and tragedy that would unfold during the day. The experience proved to be eye-opening for both of them.

Elledge saw a doctor moved to tears with compassion, and Harris witnessed health struggles on a personal front as he cared for patients in their homes.

Surmounting odds

The two met at a Break Time gas station in Poplar Bluff and drove together to their first home visit, a little neighborhood of identical looking brick houses. They stopped at one with a "House rules" sign on the door requesting good behavior. Curtains hung across windows, darkening the interior. A young mom, dad, newborn son and a little dog, Princess, met Elledge and Harris at the door.

Princess ran in between and around legs, while others made introductions and slowly took each other in. The mother, Maria Morin, held 8-week-old Elijah Thompson, while the father, David Thompson, cleared a few items off the couch to make room.

With permission, Harris began a checkup, peering in Elijah’s eyes and ears and feeling his skull. The baby was spitting up too much, Morin said, stroking and rocking him when he began to cry. She worried he had acid reflux.

Meanwhile, Elledge discussed life and gave moral support. The couple has two older sons, and Morin has had no family in Missouri during any of their births.

“It was difficult because I had no one to hand my child to,” she said. “It was all just us.”

Without vehicles or steady jobs, transportation hassles have made every task, from grocery shopping to looking for work to visiting the doctor, an expensive or time-consuming endeavor. Two years ago, Whole Kids nurses stepped into their lives, getting to know them, checking on their health during regular visits, and bringing diapers and other needed items. Elledge has been visiting the family for a year.

“Those two have been through a lot,” Elledge said, smiling at them.

Thompson is now attending Three Rivers Community College, where he is majoring in construction. Wednesday was his second day of class.

Harris was thrilled. “I can tell you in just a short time that you all are intelligent and you have a chance to advance,” he said. He spoke at length with Thompson about the value of education.

The visit ended with handshakes, and Elledge departed, squeezing Morin’s hands and saying, “Thanks for putting up with me, Babe.”

The visit ran late, so Harris and Elledge had time only for a quick stop at Casey’s General Store for lunch before driving about 15 miles out of town to visit the next home.

Elledge said she began working with Whole Kids through “divine intervention.” She nodded at Harris, who also credited miraculous coincidence in finding Whole Kids when he did.

“Once I took this position and got into it, I felt very strongly about it,” Elledge said. She said she is grateful to the mothers who let her in to their homes: “Those who choose to partake and learn something — I thank them for that.”

She wants to help babies from disadvantaged families have better chances to survive. A recent study showed that a Whole Kids’ partner organization in St. Louis, Nurses for Newborns, has effectively reduced infant mortality rates among the people it serves.

Material needs prevent Whole Kids nurses from accomplishing all they would like to, though. According to a rough assessment by the organization, the traveling staff would have to double in number in order to visit all the women referred and in need in the area. At this point, such funding does not exist.

In June, Elledge had to stop serving four of her mothers and newborns in Madison County because funding sources shrank. Elledge had told the families she hoped to stay with them through the babies’ first years of life, but that did not work out.

“It broke my heart,” Elledge said. She said she fears lack of funding could cut out more families in the future. The visiting nurses program is free to the families who participate.

Getting inside

Elledge and Harris stopped next at a small home outside of town. Concrete steps led to a carpeted living room where a mother and father waited with an 8-month-old baby girl in a pink, flowery outfit.

This family had different needs — Charles Keele works, while Hannah Keele quit her job intentionally to be a stay-at-home mom. They have a car, so access to health care is not a problem.

In fact, Hannah Keele and baby Emma spent the first month after her birth in three different hospitals, as Emma was premature and small. During that month, Keele hardly slept and suffered from postpartum depression.

For that reason, a St. Francis Medical Center worker had referred her to the visiting nurses program, and Elledge and another nurse had started stopping by. Keele said she’s not quick to meet people she doesn’t know, so having the women come to her house helped her get to know and trust them.

“They’re not strangers any more,” she said. “I didn’t trust them when I first met them, but I do now.”

She said the nurses also provide medical advice that suits her needs. “They actually go to the homes and go through stuff with the kids and they look up stuff on the Internet.”

While she talked, Emma smiled with big blue eyes and reached for everyone in the room. Her parents took turns holding her, blowing on her tummy and kissing her face. The baby shrieked with joy.

Harris offered advice when the topic turned to health. He told Keele to place Emma on her back at night as a precaution against Sudden Infant Death Syndrome. Keele was already aware of this, but said she was having trouble enforcing it as Emma liked to roll.

Harris mentioned a recent study that showed air ventilation, such as a ceiling fan, has been correlated to less frequent occurrences of SIDS. Elledge and the Keeles were all ears. Harris added that taking all precautions greatly reduces incidents of SIDS — he said he hadn’t seen a mother lose a baby to the syndrome in 15 years.

Elledge concluded the visit by giving Keele pamphlets on other topics, including prescription drugs and shaken baby syndrome, saying, “I teach you in your home and you can go out and teach other people ... Pass it on.”

As Harris and Elledge left, Hannah Keele said, “We’re going to put that fan up today.”

Not a statistic

The next house was in another neighborhood in Poplar Bluff, this one with older houses pocked with boarded windows. Across the street, a child with long, dangling hair played shirtless in the backyard, and several adults teased Elledge for driving up in a nice red car.

She knew them. She used to visit them. She seemed a little fazed but said, “It’s nice to see they see me as a person and not just as that nurse who comes to see them.”

The woman Elledge came to visit wasn’t home. She’d forgotten the visit — in spite of the text Elledge sent that morning — and was shopping at Walmart. Elledge drove to a corner store, chatting with Harris and waiting for the woman to return. They were driving back a third time to check at the house when Harris got a phone call.

His tone grew intense as he questioned someone for several minutes. Then he hung up the phone and told Elledge that one of his patients, one who had grown up in his pediatric care, had that day lost a baby to SIDS.

“Damn,” he said, then quickly apologized. “As far as I can tell, she did nothing wrong.”

He made another call, asked for the mother and finally passed on a message. Minutes later, his phone rang again. “It’s her,” he said.

“I’m so, so, so, so, so sorry,” he said into the phone. He repeated the phrase, adding, “I grieve with you.” His voice cracked, and he listened to her talk for several minutes. “I love you like a daughter,” he said before hanging up the phone; his voice was breaking with emotion.

The car was silent for a moment, and then he turned to Elledge and said, “My job has just started.” He explained he would talk to the family once he returned to Columbia; he would support them and visit them. “She needs it.”

Elledge said she was moved. She made home visits her job but didn't know a doctor these days who still did that.

A little later, Harris’ thoughts grew more agonized.

“Who is punishing me — God or the devil?” he said. “Here I am trying to prevent infant mortality in southeast Missouri and one of my own patients dies at home.”

Elledge listened and spoke a little. “Nobody is given tomorrow. We just share with what we’ve got.” Earlier she'd mentioned an infant in Poplar Bluff, one served by Whole Kids, had died of SIDS a couple of weeks before.

"That's why it's called SIDS," she'd said. "No one knows why it happens."

Elledge hugged Harris goodbye and told him she admired him.

“Most doctors,” she said, “stop feeling each death. It’s amazing that he’s so compassionate after so many years. It feeds my—” she shook her hands in the air “—whatever that is. It encourages me to keep doing what I'm doing.”

On the car ride home, Harris grieved with more peace than before. “Will this help me work better to remember how it feels?” he said. “I have to believe there’s a purpose for it.”

Harris continued speaking with mothers and checking children at Advanced Healthcare Medical Center in Ellington on Thursday and will do so again Friday. He also plans to return next year for a longer period of time.

"I see this as a beginning, not an end," he said.

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