Clairton families are still figuring out what to do now that the city's only pediatrician has left.
Children's Hospital placed a pediatrician in the community two years ago and for parents like Shawnika Thompson, 25, it was a tremendous resource. Thompson started taking her 4-year-old daughter Shatawn to the office shortly after it opened and she liked the doctor's care. Thompson also appreciated that the office was only a 5-minute walk from her home.
But now, in a community where 24 percent of all households lack cars, Thompson and other Clairton parents face the prospect of taking sick children on long bus rides to find care. In some cases, they are taking two buses and traveling 80 minutes each way to Children's pediatricians in Oakland.
The hospital closed the pediatrician office in May because there weren't enough patients to justify keeping it open, according to a Children's official. Community members who used the office say there's plenty of need for a pediatrician there and they wonder if better marketing could have brought more patients to the office.
"Why do they want to make it so hard for people who have it hard already?" said Gloria Ford, director of a teen parenting program at Family Foundations Early Head Start in Clairton. "Make a mother with a baby take a stroller on the bus? It's crazy. ... If this was in Mt. Lebanon, they wouldn't think about taking it out."
Allegheny County is rich in medical resources, but the situation in Clairton shows how poorer communities that often have a higher percentage of minority residents don't always share in the bounty.
Twenty-eight percent of Clairton's 8,500 residents are black. Countywide, black residents make up 12 percent of the population. Regardless of race, more than 15 percent of Clairton families live below the poverty level.
The transportation barrier in Clairton exemplifies how the convergence of race and low socio-economic status can contribute to racial and ethnic health disparities. When providers aren't available in a community, it raises the concern that patients will go without care, said Dr. Karen Scott Collins, vice president of the Commonwealth Fund, a New York foundation that studies social and health policy issues.
"We know having a pediatric clinician who knows the child well is going to be in a better position to pick up early signs of things going wrong," she said.
Collins applauded Children's Hospital for its commitment to send the Ronald McDonald Care Mobile to the community every Monday to provide preventive services. But, she added, "You have to also recognize that a lot of opportunities could be missed."
The region's economic difficulties have taken a toll on access to health care. Not only does Clairton lack a pediatrician, their numbers are dwindling in surrounding communities.
There are only five pediatricians in the seven ZIP codes that represent Clairton and West Mifflin, Pleasant Hills, West Elizabeth, Library, Glassport and Elizabeth Borough and Township, according to Allegheny County Medical Society statistics.
One pediatrician listed in West Mifflin is part of a six-physician group in Brentwood that sends other doctors to the West Mifflin office. The three pediatricians in Pleasant Hills say they've added a fourth pediatrician to their office.
But Patricia Harkins, the fifth pediatrician in the area, is moving to Texas this summer and won't be replaced by another pediatrician. The fact that Children's Hospital closed another pediatrician office in the area last year -- that one in Pleasant Hills -- suggests the broader problem, Harkins said.
"This is a very difficult area for pediatricians," she said, noting the preponderance of seniors in the Mon Valley.
The average pediatrician in the United States sees 25 to 30 patients per day. But at the Children's Clairton office from July 2000 to June 2001, there was an average of four patients a day, said Chris Gessner, executive director for the hospital's primary care services.
That increased to six or seven patients a day in the past year, Gessner said, but it wasn't enough.
When the community got word of the proposed closing this spring, a citizens' group started a petition that collected more than 1,000 signatures to fight to keep it open. Barbara Thompson, one of the organizers, argued that Children's failed to promote the office and asked for time to get the word out.
Thompson was motivated to act not only because the office was convenient, but also because it was staffed by an African doctor.
"For our children, that was a good thing for them to see and try to mimic," she said.
Community members also asked if the hospital could staff the office part time, as it did its Braddock office, which was getting just seven or eight patients a day.
Gessner acknowledged that Children's could have done a better job marketing the Clairton office. But the hospital concluded that the facility was duplicating services already available in the community. Gessner said many families take their children to family practitioners in the area. UPMC's Latterman clinic in McKeesport, in particular, has family doctors and residents in that specialty who could serve the need.
"The residency program at Latterman represents a very high quality primary-care service," Gessner said. "So, if you couple that with the preventive services we will provide with the Ronald McDonald Care Mobile, I think we are doing the best we can. ...
"To the families that came to our office, they're inconvenienced, there's no question. But they will be able to find other physicians that can provide good care."
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