Health care: Women and children, modern miracles
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Health care for women and children has improved by leaps and bounds. Better access, facilities and procedures are leading to longer, fulfilling lives.
In the 1990s, when H. Stacy Nicholson was a professor of pediatrics at Children’s National Medical Center in Washington, D.C., only half of children diagnosed with leukemia survived. But times are changing. “Today, the survival rate is close to 90%,” says Nicholson, a pediatric hematology oncologist who is now president of children’s services and pediatrics chairman at Charlotte-based Atrium Health.
Alisa Starbuck, vice president of women’s and children’s health service at Winston-Salem-based Wake Forest Baptist Health and president of its Brenner Children’s Hospital, also has witnessed the trend, which has accelerated with each medical breakthrough during her 35 years of caring for sick children. “We don’t know what the discoveries of tomorrow will be, but the potential is always there,” she says.
Wake Forest’s more than 150 pediatric specialists treat more than 4,500 children each year. “The children who may have a grim diagnosis today may not have such a grim outcome five years from now,” Starbuck says.
Medical advances are reshaping health care for women, too, adding years and quality to their lives. Michael Sundborg, a gynecologic oncologist with Pinehurst-based FirstHealth of the Carolinas, points to advances in cancer testing and prevention as an example. “Cervical cancer is among the deadliest cancers in women, but learning more about the high-risk human papilloma virus combined with administering pap tests in younger women has probably saved more women’s lives than any other test in the history of medicine,” he says. Mammography has made similar strides. “Even now, research and better techniques to screen for breast cancer have improved survivability,” he says.
Creating these improvements starts with work and dedication by patients and providers. But advances also include better access to care, improved hospitals and clinics, fine-tuned and technology-enhanced procedures, and better-trained doctors.
Most women’s health care centers are in urban centers, where they serve large populations packed in small places. But in rural regions, where that dynamic is reversed, technology helps providers traverse miles, caring for patients without the need for bricks and mortar. “We are constantly evolving and re-inventing ourselves when it comes to personalized care for women,” says Pam Oliver, executive vice president of Winston-Salem-based Novant Health and president of Novant Health Physician Network.
Greenville-based Vidant Health has been instrumental in providing care for women in rural communities east of Interstate 95. “We cover 29 counties. Many have populations with social disparities and sparse access to specialized health care for pregnant women,” says James deVente, an East Carolina University associate professor and Vidant Medical Center’s director of obstetrics. “As we look at safety and quality of care at our hospital, we realize that our ability to care for pregnant patients is dependent upon how they were taking care of themselves before they got to us.”
Angela Still, a Vidant Health administrator in women’s care, assembled an outreach team to learn how to become an effective tertiary care hospital for women in rural regions. “One way we have extended our care is through telemedicine,” she says. “The patient and her local primary care doctor can sit in front of a computer and consult with our fetal medicine experts.” Women in rural regions can get a high-risk pregnancy consultation, for example, without leaving their hometown.
Vidant’s Enhancing Community Health Care Outcomes program uses online conferencing platforms to provide comprehensive patient care. “This involves setting up a huge Zoom meeting with physicians, ultra-sound nurses, social workers and other specialty care providers to put patients in front of our subject matter experts,” Still says.
Outreach is happening west of I-95, too. Atrium, for example, offers women’s care at satellite offices in many small communities, including Shelby, Boiling Springs, Rutherfordton, Kings Mountain and Denver. “We have teams of subspecialists who go into towns outside of Charlotte, giving patients access to them either virtually or within a relatively short distance,” says Suzanna Fox, enterprise service line leader for women’s health and deputy chief physician. “Atrium Health recently became an enterprise service line through a partnership with Wake Forest University. I’m excited about our partnership with Wake Forest, and we are looking forward to advancing what we already consider a robust research and education component to what we already offer. We will be able to extend our reach for clinical trials, robotics and our ability to provide care virtually.”
Modern women’s health centers are comprehensive clinics dedicated to all aspects of care. Children’s specialty hospitals play a central role in meeting the unique health care needs of their community’s youngest patients, ranging from prevention measures to critical care.
Novant Health’s Maya Angelou Women’s Health & Wellness Center offers a variety of health services for women of any age. “As we continue to build out our network, we make sure we have specialists to coordinate women’s care across all types of diseases,” Oliver says.
The state-of-the-art Women’s and Children’s Pavilion at CarolinaEast Medical Center in New Bern has been providing patient-focused care to mothers and their infants since 2018. Shawn Klabo, clinical nurse manager, says that includes allowing mother and baby to remain together from hours after delivery until it’s time to go home. “After birth, every-thing we do for the baby is bedside,” she says. “From weighing newborns to performing routine tests, our program is designed to allow mothers to know everything that has happened with their baby from the minute they arrive to deliver their baby to the minute they go home.”
The Women’s and Children’s Pavilion has 16 beds and labor and delivery rooms. Klabo says its operating room includes a designated cesarean-section suite that allows newborns to stay with their mothers immediately after birth. Its specialists include obstetricians and gynecologists, labor-and-delivery nurses and lactation consultants.
Atrium’s Levine Children’s Hospital opened an expanded and renovated pediatric emergency department in September. Three months later, it cut the ribbon on The HEARTest Yard Congenital Heart Center, a next-generation pediatric outpatient clinic that was built with a gift from former Carolina Panthers tight end Greg Olsen and his wife, Kara. The 25,000-square-foot center offers enhanced treatments and resources for patients from prebirth through adulthood. It has the region’s only cardiac neurodevelopmental program.
Asheville-based Mission Health is adding to its offerings, too. In addition to access to world-class care through Sarah Cannon Cancer Institute and a $3.7 million renovation of Mission’s surgical oncology clinic, Mission Children’s Hospital recently opened its own emergency department. “This is a huge opportunity for the western North Carolina region to have a more kid-friendly environment with board certified pediatric emergency medicine providers,” says Ansley Miller, a pediatric hospitalist at the hospital, which serves a 50-county region.
Mission Children’s Hospital has 130 beds and averages 3,100 admissions to its inpatient units, 3,900 outpatient pediatric surgeries and nearly 12,000 pediatric emergency department visits annually. “We treat babies from a couple of days old up to teenagers transitioning into adulthood,” Miller says. “They all have different needs due to their changing bodies, their varying developmental stages and the
types of illnesses they have.”
Women’s specialty care involves teams of physicians and specialists who provide a total approach that Novant’s Oliver believes is paramount to keeping women healthy. “Women have unique concerns and needs, not just in their reproductive health but across many diseases,” she says.
“Women’s risk factors for heart attacks are much different than men’s, particularly during pregnancy. Women need to hold us accountable to make sure we continue to evolve care to serve their unique needs. We are constantly looking for ways to evolve and reinvent ourselves when it comes to personalized care.”
At Atrium Health, doctors use the robotic da Vinci Surgical System for minimally invasive surgeries, Fox says.
“This approach is less traumatic for women, and even hysterectomies that at one time kept women hospitalized for up to 10 days can now perform same-day surgery,” she says.
For women who have undergone invasive surgeries, such as mastectomies, an appointment with Leif Nordberg, a plastic surgeon at Cape Fear Valley Plastic and Reconstructive Surgery in Fayetteville, could be a stop on their road to recovery. “About 70% of what I do is breast reconstruction after mastectomy,” he says. Surgeons have used skin and tissue from elsewhere on a patient’s body for rebuilding breasts, but that approach is changing. “Using bioengineered tissue from a patient’s cells, we are getting to the point where we can essentially grow a new breast,” he says.
Mission’s Miller says medical centers offer subspecialities in pediatric medicine, identifying each child’s needs and tailoring therapies to fit specific patients. It’s paying off. Children are surviving diseases that were once deadly and living into adulthood. That’s creating new breeds of doctors.
Modern pediatric subspecialties run the gamut — pediatric nephrology, gastroenterology, pediatric pulmonary disease, infectious diseases, sleep disorders, eating disorders, mental health issues and many more. They have made a difference in the lives of young patients and their families. “Before all these specialties existed, [many of these] kids did not survive into adulthood,” says Atrium’s Nicholson. “Access to pediatric subspecialists is relatively new. My subspecialty as a pediatric hematology oncologist was established in the 1970s, and I was certified in that subspecialty in 1992.”
Wake Forest’s Starbuck points to an adult congenital heart disease subspecialty, which was developed in 2012.
“Some doctors started out as pediatric heart specialists, but where they once were treating a child with a congenital heart defect, they found themselves treating a 30-year-old whose heart defect had been repaired,” she says.
The new subspeciality certification provides doctors with the training necessary to address the health needs of adult patients who grew up with congenital heart disease. According to the American College of Cardiology, adult congenital heart disease patients have now surpassed the number of pediatric patients needing care, which was unheard of only a few decades ago.
Nicholson says gene-therapy advances allow re-engineering of defective cells, giving kids suffering from diseases, such as cystic fibrosis and sickle cell anemia, a chance at healthier and longer lives.
“This is a very hopeful time in medicine and pediatrics,” he says. “The developments in pediatric subspecialties have improved the lives of children with serious illnesses and will continue to improve in years to come as we gain more scientific knowledge.” ■