An Ounce of Prevention

Sarah Alward Redding '83 finds her calling in preventive care for expectant mothers and newborn children

When Sarah Alward Redding '83 and her husband, Mark Redding, left Ohio in 1989 to spend three years in Kotzebue, Alaska, Redding didn't even know what preventive medicine was. But working with the Community Health Aid Program run by the Native Corporation made her a believer in the old adage that "an ounce of prevention is worth a pound of cure."

While they were in Alaska, Sarah Redding managed the Maternal and Child Health Program for the Native Corporation. The program trained community women to assist pregnant women or households where there were young children in obtaining the health and other care they needed," says Redding, who notes that their time in Alaska also enabled her and her husband to pay off their loans from medical school at Wright State University, where they earned their degrees in 1988. "The first task was to locate those in need of services. The fact that the women who did the canvassing were peers made a tremendous difference in their ability to assist mothers and children. The workers also earned college credit for their efforts.

"The improvement in the self-esteem of the women who worked with us, let alone the benefit to those they assisted, was remarkable," she recalls. "By helping their communities they were helping themselves. Some actually went on to become nurses and even, in one case, a physician."

Following their stint in Alaska, Redding went on to specialize in preventive medicine while earning a master's degree in public health from the Johns Hopkins University School of Public Health. While in Baltimore, Maryland, she worked for the Healthy Start Program, an initiative to decrease infant mortality. Redding was able to use what she learned in Alaska as a model. "Although the setting was urban rather than rural, the same community-based approach was applicable," she says. "At the time, Baltimore was one of only fifteen sites for this program in the country; since then, it has been greatly expanded."

As a result of her experience working with poor families, Redding feels strongly about the inequities that exist in the health-care system. "Mark and I are a physician couple, so when we have to go in for care, we get the red-carpet treatment," she notes. "Medicaid moms in the managed-care system are treated very differently. They often get bad information.

"I remember a case in Baltimore in which a teenage mom, who had pre-term labor symptoms at twenty-eight weeks, called her managed-care provider and was told to lie on her back and drink lots of water. Fortunately, someone from the Healthy Start Program came by and concluded that she needed to be hospitalized. Her labor was stopped, and ten weeks later her baby was born full term. As a result of these kinds of preventive efforts, we saw a drop of 60 percent in the incidence of very low birth weight babies--less than 2.2 pounds--in Baltimore."

In spite of programs like the one in Baltimore, the infant mortality rate in the United States is still appreciably higher than that of other developed countries. "If you look at the haves and have nots, it's getting worse. Many of us fret over things like whether our kids are in the right day-care program. But the families we deal with have much more elemental worries, like living in homes without heat, or not being able to afford formula," says Redding who, while a strong advocate of breast feeding, recognizes that it is not readily accepted in some communities. "In spite of the obstacles they face, there are a lot of really great moms out there, with virtually no resources, raising terrific kids."

For Redding and her husband, family really does come first. "My husband and I both took a year off from medical school after we were married to get to know each other," she says. "We wanted to start things off on the right foot." When she was accepted into the preventive-health program at Johns Hopkins, she deferred her admission for a year in order to care for their first daughter, Hannah, born in 1992. Two years later, her second daughter, Kate, was born. "When I told people at the university that I was pregnant, I would hear, `But what will that do to your career?' I told them that it would actually help my career, because my focus was on mothers and children," says Redding. "They came around in the end.

"My family is my top priority, but that doesn't mean I let my career slide," she adds. "It's very much a juggling act to have a family and career, but it is doable. I always felt, `So what if I ended up getting a degree two years later than otherwise.' In the end, a year or two, one way or the other, doesn't make much difference."

After she earned her degree at Johns Hopkins in 1997, Redding and her family moved to Mansfield, Ohio, where she works between twenty and twenty-five hours per week for the Ohio Department of Health as the medical director for the Bureau of Children and Family Health Services, which oversees the management of both Title V (maternal and child health) and Title X (family planning) federal block-grant programs for the state. When she took the job, she was already pregnant with her third child, a son, David, who was born in February 1999.

In addition to her job and home responsibilities, Redding spends about eight hours each week volunteering for Community Health Access Program in Mansfield. "Under this model, a pregnant woman gets a visit every two weeks and then, close to the end, every week," she says. "The peer Community Health Advisers are trained to assess if there are any social, medical, or financial problems and then make appropriate referrals. We're the only program in the country like this that bills for its services. In our case, the changes in the welfare structure have actually worked to the benefit of the program's recipients.

"Although I miss aspects of clinical work, it's best for our family right now not to have two people on call at night," says Redding, whose husband is a pediatrician. "I feel very good about the work I do. I felt worse when I was a regular physician in an emergency room and saw abused or neglected kids. There really wasn't much I could do about their situation. Being able to do something ahead of time is much better."

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