ARIZONA — THE BABY STATE

ARIZONANo. 1 BABY STATE IN A GREAT NEW SENSE

Arizona's super system proves that citizens working with their government can do great things by preventing problems before they happen.

By JAN SCHWENN and TIM HAYES

The most involved fact in the world Could have been faced when it was simple. The biggest problem in the world Could have been solved when it was small.

Arizona is a great place to live. Everyone knows that. But not everyone knows that Arizona is an even greater place to begin life: It is among the three safest states in the nation to be born in, in terms of its infant mortality rate. More importantly, perhaps, this low death rate among newborn babies is coupled with a remarkable reduction in the incidence of crippling disabilities among Arizona infants and most disabilities have their genesis during fetal life. None of this happy news can be credited to Arizona's renowned climate, its scenic vistas, or its Western heritage. But Arizona's prominence as a great place to be born can be counted just as great an asset, for its citizens and its visitors, as any of these. The real credit for this happy circumstance must go to a host of concerned and compassionate human beings who arrived first independently, and then in concert at a single and singular conclusion: That every baby regardless of its social, economic or geographical situation has a right to be "well born," to begin life sound of mind and body. The concern of these people medical professionals, social workers, lay persons, Arizona legislators, university staff members and all they have done since 1961 has turned Arizona around, from a miserable 37th in the nation in infant mortality and morbidity to a proud ranking among the top three states. An effective and interrelated system of transport and treatment transport from any of the remote areas of the state, to treatment in any of four sophisticated regional perinatal care centers stands as a lasting legacy to their commitment, and their hard work. And if these men and women have not yet made "perinatal" a household word, they have surely made it a word of enormous value in many Arizona households.

A Crucial Time for Mother and Baby

"Perinatal" defines the critical period from the 20th week of a woman's pregnancy, through the delivery process, and the period immediately after birth (the "neonatal" period). The regional perinatal care center embraces a whole new discipline of medical treatment, a new technology of electronic diagnostic and monitoring equipment, and a cadre of specially trained doctors, nurses and aides. Together, these elements have brought that somewhat mechanical word, perinatal, to a breathing and healthy life all its own. One of the more dramatic proofs of that lies in the ability of the total system not only to identify problems with the fetus, but from the 20th week of pregnancy to Arizona Department of Public Safety Bell Jet Ranger helicopter and transport team deliver a premature infant in specially designed incubator, from a remote Arizona community to St. Joseph's Hospital in Phoenix.

Lower right: Special training, modern equipment afford tiny premature infant that precious "equal chance" for a full and normal life. Sensors attached to baby monitor key life functions.

Editor's Note: Photograph taken November 4, 1974. Seven-month baby weighed one and onehalf pounds, at this writing and all reports are affirmative.

treat the fetus within the womb, correcting medical and nutritional problems before they spawn a crisis.

What is dramatic, in that ability, to the average person has become almost routine to the growing group of physicians whose training and experience qualify them as "neonatologists" - specialists in all the facets and phases of the perinatal period. The neonatologist brings a new dimension to the effort to reduce or eliminate fetal and newborn problems, and is a central figure in the effectiveness of the regional perinatal care center.

(An unexpected side benefit to the development of the system has had nothing to do with its medical values, but with its citizenship value: The evolution of the Arizona system proves that if citizens will view their government not as an adversary, but as a working partner, great things can be achieved in relatively short time. A warm and productive part-nership between Arizonans and their government stands at the heart of this success story.)

A Conversation - and a Commitment

Arizona's perinatal care system was conceived in 1961, when two nurses one in the neonatal service at St. Joseph's Hospital in Phoenix, the other a public health nurse with the State Department of Health found, in an informal conversation, that they shared a mutual and major concern. That concern centered on the inadequacy of care available to sick and premature newborns in the more remote areas of the state. From their conversation came the concept of a regionalized care center a central point, with complete facilities and resources, to which victims of fetal and newborn disorders could be directed for specialized treatment.

The two nurses did not let their concern die with the end of their conversation. They committed themselves to the idea, one broaching it to key medical figures at St. Joseph's, the other to a division head in the State Health Department. Preliminary meetings among all the interested parties produced agreement that a program of in-service education on premature birth problems would be a solid starting point.

Soon, the first of 12 medical teams attended an institute, at a leading eastern medical center, on the care of premature infants. With expertise now on the Arizona scene, the originators of the perinatal care center concept became the charter members of the Advisory Committee on Prematurity to the Arizona State Division of Maternal and Child Health.

Learning the Size of the Problem

The professionals involved needed to know the scope and scale of the problem, in Arizona terms. So a group from Arizona State University undertook a comprehensive study which identified the state's population distribution patterns, and the child delivery rates, in relation to medical need and the location of facilities for delivery and perinatal care.

The typical Southwest pattern of widely separated population centers, with remote and sparsely peopled areas throughout the state, raised a clear requirement for an efficient system for getting those who needed care to the point at which they could receive it.

The Premature Transport Program thus had its beginning, largely because Arizona had already established innovative test projects for getting seriously injured accident victims from remote areas to urban centers by air and because those directing the Arizona State University-Arizona Dept. of Public Safety Helicopter Project, and the Air-Evac Unit, saw an opportunity to meet another demonstrated need.

The System Comes to Full Life

Just six years after that casual but serious conversation between two nurses, and with some federal funding back of it, the Regional Perinatal Care System came to full life in Arizona. St. Joseph's Hospital and Medical Center, and Good Samaritan Hospital, both in Phoenix, were designated as the first two intensive perinatal care centers.

A specialist in neonatal medicine directed key refinements in the early stages, providing 24-hour special care services.

With the transport element now at work, it didn't take long for the impact of the patient load to be felt. Neither did it take long to begin reversing the mortality and morbidity trends, even with the limited funds available to the system then.

The first major use of the air-transport and care facilities was by infants in small rural hospitals. And while that patient factor is still part of the scene, the regional care centers now handle two other major patient groups: Referrals from physicians in urbanized areas who recognize their patient's needs for specialized care; and a proportion of the women entering the hospital for expected normal delivery, who indicate problems not identified or anticipated before they came to the hospital.

Arizona's Lawmakers Show Leadership

By 1971, the project could demonstrate its success statistically, and in human terms. It was time, clearly, for the system to become truly statewide in its application.

The Arizona Legislature, with leadership from key members in both the House and Senate, that year authorized the appropriation of state funds to establish and maintain The Arizona Premature Project.

It's been estimated, on the basis of available figures, that Arizona has so far applied more in state money to the care of sick newborns, and premature babies, than the federal government has expended for the rest of the country.

Substantial Long-Range Benefits

There is, of course, no way to place a dollar value on human life. And lives have been saved at the four regional perinatal care centers the two in Phoenix, and the centers established at the University of Arizona Medical School, and the Tucson Medical Center. Tucson also has the March of Dimes Perinatal Laboratory. And the March of Dimes also provides some funding for the center at St. Joseph's, in Phoenix.

Even if the value of lives saved cannot be equated to dollars, there is a measurable dividend from the presence in Arizona of such an effective transport and treatment system.

With the vast majority of crippling disabilities a product of the perinatal period, proper treatment of mother and fetus during these crucial weeks can forestall the development of such problems.

Pilot sets an Arizona Department of Public Safety jet helicopter down gently on the landing pad directly adjacent to St. Joseph's Hospital in Phoenix, with the infant patient, nurse and trained paramedic on board. BELOW, fisheye lens shows the scope of personnel and equipment at each of the regional perinatal centers.

By preventing the occurrence of disabilities such as brain damage, the system lifts an enormous burden from the taxpaying citizens of Arizona. Current figures indicate that institutional care for a person born with a crippling disability costs the state some $3,733 a year. With an estimated life expectancy, for such victims, of 45 years, the total comes to more than $150,000 a person. And about 43% of all institutionalized persons sustained their disability in the perinatal period.

Contrast that staggering cost picture with an average cost of $3,100 for caring for a sick newborn or premature infant within the Arizona transport and treatment system a onetime cost which is borne, in roughly equal parts, by the project itself, by third-party (insurance) services, and by the families of the babies.

All this adds up to an estimated annual saving to our state of $4.5 million, directly attributable to the effective and timely delivery of perinatal and neonatal care.

An Equal Chance to Begin Life Right

But the real story lies in the proven ability of the system to provide that opportunity for Arizona infants to be "well born" despite such relatively commonplace but dangerous problems, for pregnant women, as diabetes, toxemia, extreme thyroid deficiency, and heart trouble. It also opens up heartening new potential for women with Rh negative blood, and those expecting delivery of their second or third child by successive Caesarean section.

All these high-risk mothers are offered a "new lease on life" for themselves and their babies, in the watchful and responsive atmosphere of the perinatal care center.

No one is denied access to any of the four care centers, or to the transport system, because of inability to pay. But those who can pay are charged in relation to their ability to do so.

The costs, of course, are likely reduced by the concentration, at one site, of diverse medical resources.

Beyond that, there are clear economies of time and energy crucial to the pregnant woman who needs to be relieved of all unnecessary tension and turmoil.

For example, a mother-to-be with diabetes would ordinarily be under the concurrent care of an obstetrician, an internist (for the diabetic condition), a neonatologist, and other medical and laboratory personnel. All are at hand in the regional center. (And all have the interesting perspective that they are really treating "three persons" the mother with diabetes, the fetus being affected by its mother's diabetes, and the mother as a pregnant woman).

There's no need for her to travel from one doctor's waiting room to another, to a separate lab, from one clinic to another. Everything, and everyone, needed is close at hand in the regional center.

"It's Only the Beginning..."

None of this should be read as evidence that the total problem is now solved, or that resources are now so complete that public and private dollar support is no longer needed.

With its burgeoning population, Arizona will clearly need to expand and refine its system of perinatal transport and care.

But there are, just as clearly, great satisfactions for the many men and women who have dedicated themselves to the beginning of the system, in knowing how much they have already achieved.

For decades, before Hawaii and Alaska attained statehood, Arizona the 48th entrant to the Union, in 1912 was known familiarly as "The Baby State." It could well be, in the years ahead, that Arizona will come to be known again as "The Baby State" but in a totally new and more deeply significant sense.