The first thing you notice is how tiny they are: Row upon row of babies, some no older than this day, hooked to grotesque jumbles of tubes. Press your palm against the incubator wall and the infant inside disappears from view.
It takes a while for something much sadder to occur to you: In a room full of newborns, dozens of them, there is no crying. The sound of beeping heart monitors, the rustle and murmur of observing doctors, but no crying.
“They’re too small and too sick to cry,” explains a passing nurse.
This is the newborn intensive care unit of the Regional Medical Center of Memphis, universally known around this city as The Med, perhaps two miles from the blues clubs and rib joints of Beale Street.
And these are the children with a fighting chance.
Some of them, a small fraction, will join the sparse field of little corpses buried in wooden boxes at the county cemetery, distinguished only by little metal plates and identification numbers, perhaps remembered with a stray and shriveled balloon.
Others will go home with mothers in a few days, a week, a year, and they will begin a life fighting impossible odds in this city’s worst neighborhoods, forging a struggle against poverty entrenched for generations.
Twice the U.S. average
A 2002 federal report put this city at the top of the list for infant deaths in American cities: 692 dead babies over a four-year span, a rate of more than 15 deaths for every 1,000 births, more than twice the U.S. average.
Broken down by ZIP code, centering on the poorest places in this very poor city, there are spots where babies die at a higher rate than they do in some Third World countries.
Some health officials object to that characterization because the figures are small enough to call their statistical significance into question. But no one denies that there is an epidemic of dead babies here.
It is difficult to explain exactly why. It is even more difficult to say whether it will get significantly better any time soon.
Ask people here about their city and they are quick to acknowledge the problems — particularly poverty and racial disharmony, the one exacerbating the other for decades.
They also will physically grab your arm and insist that this is a place with a lot of people pulling for it. And trying very hard, desperately, to figure out a way to save more of the smallest among them.
A child who never turns 1
Infant mortality gets reported and tracked and scoured for trends in the agate box scores of medical journals, right along with lung cancer and tuberculosis and heart disease. But it is a different animal entirely.
It is not something you catch. There is no vaccine. There is no prescription to make it better. It is not really even something you can describe, beyond the umbrella definition: Infant mortality is a child who never turns 1.
It includes babies born after just five- or six-month pregnancies, children who enter the world with holes in their hearts or devastated lungs and who die in their mothers’ arms.
It includes babies born to mothers who simply do not know about sudden infant death syndrome — “crib death” — and who suffocate from being placed on their stomachs to sleep.
It includes babies born into poor homes with unguarded space heaters or chemicals within easy reach under the kind, children who are fed potato chips and Coca-Cola and die of malnutrition.
The U.S. infant mortality rate is just under seven for every 1,000 live births, according to the most recent figures from the Centers for Disease Control and Prevention.
Global reports consistently place the United States near the worst among industrialized nations; analysts have blamed extreme disparity in the health-care quality depending on race and income level.
Premature birth and low weight main causes
But here in Memphis, a few other statistics drive home both the severity and the intractability of the problem:
- In 1990, about 20 black babies died for every 1,000 born in Shelby County, and about seven white. In 2006, the numbers were little changed: 19 black, seven white.
- Premature birth and low birth weight are by far the biggest causes of infant death. In 2002, they accounted for about a quarter of infant deaths in Shelby County; in 2006 the figure was more than 31 percent.
- Shelby County lost 209 babies in 2006, according to state Health Department data. No other Tennessee County lost more than 93.
And it is a problem with yawning demographic disparities. In Shelby County, which includes Memphis, about 17 black babies died for every 1,000 born in 2004. For whites, it was about six. Statistical maps that track infant mortality in the county darken ominously in Memphis’ poorest neighborhoods.
“It touches on every inequality and unfairness you can think of in our day-to-day life,” says Dr. Sheldon Korones, who started The Med’s newborn intensive care unit in 1968 and still roams it day and night.
Korones, who is 83 years old, speaks in a whisper and literally laughs off the question of retirement, is still this city’s foremost expert on infant deaths, and he seems haunted by the problem’s intractability.
He filled out a psychiatric questionnaire once. One of the questions was: What gives you the most pleasure?
His answer was: Turning blue babies pink.
Fighting for the littlest ones
There are foot soldiers in Memphis’ war on its infant death problem — medical, governmental, religious. And then there are people like Rosanna Stepley, an AmeriCorps volunteer.
She was assigned to Porter-Leath, a Memphis nonprofit children’s center. And now she is holding the hand — figuratively and, once in a while, literally — of a 19-year-old named Crystal Owens, steering her through her first year as a mother.
Today Stepley is driving through the streets of Hollywood in north Memphis, a place with all the telltale pockmarks of poverty in an American city — graffiti and closed shops, cracked roads with leaning street signs, glares at the unfamiliar.
The topics today are stress management and nutrition — the former for Crystal and the latter for Jaquarius Butler, her 4-month old son, who is smiling up and giggling from an infant seat on the floor of the sparse home where Crystal lives.
(Where Crystal “stays,” as she puts it. Her mother kicked her out of the house after learning she was pregnant with her boyfriend’s child. The boyfriend’s mother has taken them in.)
Things are improving: Crystal has found a job, as a cashier at Burger King, and has begun taking night classes. She had no job, no classes and no prenatal care when Stepley approached her, two months pregnant, at their church.
They navigated the pregnancy together, and now they are navigating Jaquarius’ first year. On this visit, Stepley is concerned about Crystal’s newly packed schedule. “Exercise is good for you,” she says. “Or relax in the bathtub.”
For Jaquarius, Stepley recommends Peek-a-boo and baby push-ups.
“And start him on the cereal,” she says. “That’s a four- to six-months food. Make sure he gets his proper vegetables and fruits. If he doesn’t want to eat it, you know, just put a little applesauce on there.”
These are the basics. Many young mothers in Memphis are lacking prenatal care, and with it they are lacking some of the most basic dos and don’ts about carrying a child to term.
Margaret Taylor, a nurse midwife who works at a Christ Community Health Services on a particularly gloomy section of Broad Avenue in Memphis, can tick off what she hears:
If you raise your hands over your head your baby will become wrapped in the umbilical cord. If you feel sick, open the medicine cabinet, any bottle will do. Or just as bad: Stay away from everything in the medicine cabinet.
“I’ve been in health care for 28 years,” Taylor says. “There have been so many programs over time. But you still have women that don’t take advantage of it. So you have to look at the culture. What makes people believe things that have no medical basis? It’s been passed down.”
Tiny, precious graves
A pickup truck and a backhoe show up on the days, usually Tuesdays and Thursdays with good weather, when babies are buried at the county cemetery. The first carries the little wooden coffins, and the second digs the whole, maybe three feet wide, where they are placed a foot apart.
The caretaker is an ordained minister named Robert Savage who has done the job for three decades, and some days before or after driving in the takes to mark the numbered plates above the coffins, he will offer humble comfort to families who show up there. The mothers are often missing, still in the hospital.
In 2005, the local newspaper here, The Commercial Appeal, published an award-winning series called Born to Die that all but forced the people of Memphis and Shelby County and their leaders to confront the ghastly infant mortality figures.
It told the heartbreaking story of a 19-year-old mother named Fredesha Bradley who gave birth to twins; one who died of seizures in intensive care and one who survived and slept face-down in a bed, with a baseball bat nearby for safety.
Nine babies in the family’s last three generations had failed to turn 1.
The newspaper series landed on this town like a lead safe.
“Folks had no idea it was this bad,” says Yvonne Madlock, who heads the city and county health department.
Within a year, the state of Tennessee — ranked 48th in the nation for infant mortality — had launched a program called 1 For All that took aim at all sides of the problem, encouraging healthier pregnancies and preaching how to care for children.
Still, Madlock acknowledges, the obstacles can seem daunting.
Maybe a young mother-to-be can’t get sick leave to see her doctor. Time off is money lost for rent. Maybe she’s in denial, and doesn’t even have the pregnancy confirmed until the baby has already been harmed. Maybe she is ashamed to visit a clinic. Maybe she has no insurance.
“I’m not crazy. I’m not Pollyanna,” Madlock says. “Change isn’t immediate. Certain things just take sustained effort.”
While devoted health officials here have been working quietly on the problem for years, only in the past two years did Memphis and Shelby County launch a broad, coordinated attack.
The governor’s office committed more than $3 million in grants to boost grass-roots programs that try to keep women of childbearing age healthy and to pay for better equipment and add workers at city health clinics.
At the moment, health leaders in Memphis are placing their faith in a relatively new idea called “centering pregnancy,” which gathers about a dozen women with similar due dates and coaches them through their pregnancies. They take their own measurement at each meeting, call each other with questions.
The idea: Solve the medical problem by getting vital prenatal care to women who otherwise might not have it, and chip away at the social problem by building a community who women who trust and rely on each other, and perhaps as well at some of the shame and inaccurate information that may have been passed down in families.
Two studies in the journal Obstetrics & Gynecology, including one that came out this August, have found the models led women to be better prepared to handle their pregnancies. One of the two studies also found the model led to higher birth weight, especially for premature babies.
The county has the program up and running at one of its clinics, with plans for two more soon. And Christ Community, where Taylor works, is expecting a state grant soon to start one of its own.
Taylor, who wears earrings depicting babies in the womb — head down, the optimal way, she points out when a guest inquires about them — can barely contain her excitement.
“They are acknowledged. They are heard,” she says. “They interact with each other. It produces a community support for each other. You’re actually growing a community and teaching women to take care of themselves.”
'A man possessed'
Sheldon Korones grew up on the Lower East Side of Manhattan, and his grandfather, a Russian Jewish immigrant, was a wainwright, a powerful man who fixed wagons.
The grandfather observed the Sabbath on Saturday, and closed his shop then and worked instead on Sunday, in violation of city blue laws. One Sunday he was working on a wagon, chained to an anvil to keep it in place, when the cops showed up and ordered him to stop.
The police picked up a sledgehammer and went for the chain. The man puts his fists there and said, “You break the hands first.”
That is, at 83, how Korones sees his work. You would have to break his hands to stop him from trying to save the babies who keep turning up at the intensive care unit he started 40 years ago.
And yet it is difficult to spend much time talking with him and come away feeling anything but despair for the babies in this city where babies die at such an alarming rate.
“We have treated 48,000 babies here,” he says. “Infant mortality is still a problem, and the reason for that, my friend, is we are after the fact. We’re a Band-Aid. As soon as a premature baby is born, society has failed.”
But the statistics: When the intensive care unit was started, about a quarter of the babies who arrived there died. Last year, the unit admitted 1,200 and lost just 35, about 2 percent. Twenty of the 35 weighed less than 2 pounds.