In Mississippi, it is not just abortion that is difficult for women to access. The poorest, without medical insurance, are unable to obtain basic health care, contraception and mammograms, or struggle to do so. For the past year, a free mobile clinic has crisscrossed the Mississippi Delta region to help them. The duty went to visit her while she was in Greenville, a small town nestled on the Arkansas border.
The exterior walls of the clinic, decorated with colorful murals, catch the eye. Inside, Antoinette Roby smiles proudly in front of “her” room for receiving patients, just at the top of the removable stairs that allow you to climb up there.
The community health worker is devoted to those who seek medical help and medicine, donated free of charge by the non-profit organization Plan A Health.
Its clinics, including the one on wheels, provide care in rural areas that are underserved and disadvantaged on many levels — the delta is the poorest region of the poorest American state — “with an emphasis on reproductive and sexual health says its mission statement.
That so many women in the Delta, a region in northwestern Mississippi along the river of the same name, seek free contraceptives from the mobile clinic shows a real problem at the source.
According to Plan A, nearly 45% of pregnancies are unplanned in the United States, and this rate is 20% higher in Mississippi. In this state, the rate of teenage pregnancy is 50% higher than the national average, and African American women will die of cervical cancer much more frequently than others.
Antoinette Roby indicates that the most frequent consultations are for screening tests for sexually transmitted diseases, HIV and cancer of the cervix, for problems of hypotension and hypoglycemia as well as to obtain means of contraception and prescriptions for mammograms. The contraceptive pill is offered, as is the installation of the IUD.
The majority of the clinic’s patients are women, she explains as she opens one of the clinic’s two gynecological examination tables.
“It’s all free,” she says with satisfaction, noting that many of her patients have no income. In Issaquena County, in the Delta, 43% of residents are below the poverty line according to the 2020 census.
The clinic’s patients are uninsured or “underinsured,” not to mention that those who do manage to see a doctor can’t always afford the prescribed drugs, she says: “Many people have to make a choice between buying medicines or feed their families. »
With less than 20 square meters, the truck nevertheless contains two examination rooms, a toilet and even a small “laboratory” space for the various analyses. “Seeing how much people need the clinic breaks my heart,” says Antoinette Roby.
The people of the delta are still among the forgotten, she laments, referring to this agricultural region rich in cotton fields that experienced the atrocities of slavery.
The very existence of the clinic speaks to the shortcomings of the state medical care system.
It may flaunt its lush vegetation around its bayous, but it is a medical wasteland in many ways.
Six rural hospitals have closed in the delta in recent years, leaving many patients orphaned. Mississippi has the lowest rate of doctors per capita of any state, according to the most recent report from the Association of American Medical Colleges.
Women who ride
The team aboard the clinic is all-female: two community medical workers and a nurse practitioner. ” That’s all. And we roll it,” says M.me Roby bursting out laughing.
This week, the clinic will travel more than 700 kilometers to visit four locations. The size of the truck and the distance do not scare Antoinette Roby, who will be driving: the woman has already earned her living driving freight trucks across the United States.
The number of patients they can examine per day varies enormously and depends on the size of the city visited. “We go to villages that sometimes only have 200 inhabitants. »
Those who cannot afford a visit to the doctor often struggle to get to a clinic when they have no means of transport, and those who combine odd jobs to survive cannot afford to miss a day of work – unpaid – to go to consult, explains Antoinette Roby, securely attaching the equipment to the examination tables before starting.
The clinic truck lets residents of rural communities know a month in advance when it will be visiting.
It travels the pinkish-beige roads of seven Delta counties — and sometimes more — thanks to donations from private foundations, individuals and corporations, plus a small portion of government grants.
What Antoinette Roby finds the most difficult? “Finding resources for my patients. The clinic cannot do everything. Female medical worker spends a lot of time looking for doctors for surgeries. How to have surgery when you are penniless? ” Good question. There are some government programs that help, and they sometimes offer the option of monthly payments. »
A matter of money
Alyssa Woods, in her early twenties, met outside a business on Martin Luther King Jr. Boulevard in Greenville, does not have medical insurance at her job at a fast food chain. To see a doctor, “I have to pay,” she says, a baby a few months old in her arms.
On the Internet, advertisements promise an appointment with a doctor “from $59”. That’s more than a day’s work for many workers in this state where the minimum wage is US$7.25 an hour.
Clarke Ware has medical insurance at a cost of $900 per month with a deductible of $6,000. When the man in his 60s had to have a double bypass a few years ago, his hospital bill showed $150,000. Despite his insurance, he had to pay $22,000 himself, he said.
“The health system is rotten in this country,” he said. Many people go bankrupt after a hospital stay, or they are in debt for the rest of their lives. »
Charles Modly of Sunflower County in the Delta laments Mississippi’s decision to refuse to expand Medicaid — a federal program for low-income adults. This explanation is supported by several studies, but rejected by others, who see it rather as a multifactorial problem. Access to care is complex in the United States, and can vary greatly depending on the many insurances, income and government programs.
As for the colorful clinic on wheels, it will continue to roll its hump in 2022, while soon expanding its offerings with the addition of dental care, like cleanings and extractions.
This report was financed thanks to the support of the Transat International Journalism Fund.The duty.