Story & photos by  ARNO HOLSCHUH

THERE IS A NETWORK OF PEOPLE IN HUMBOLDT County. They do not come from a single culture, generation or religion. They are spread across the county. Most are women. What they share is the goal of providing the highest quality medical services possible to the women of Humboldt County. From the "doula" in Garberville to the hospital mammographer, their network helps all the women of Humboldt to prevent pregnancy or become healthy mothers, avoid cancer and sexually-transmitted diseases and remain strong as they age.

Not that everyone in this network always gets along. There are disagreements -- especially over the issue of reproductive choice. But the respect and care for womens' health issues shared by all ties the system together.

And the women of Humboldt reap the benefits. From cutting-edge breast cancer detection technology to a clinic providing free contraception to teens, the signs are everywhere: The system here listens and responds.

Changes in the county's health care delivery system came in dramatic form on Oct. 3, 2000, when St. Joseph Hospital owner, the Sisters of Orange, purchased General Hospital -- its chief competitor -- creating a monopoly in hospital care in Eureka (see Journal cover story, "One on One with St. Joe's CEO," Oct. 19 2000). For more than three decades, many in the medical community believed two hospitals in Eureka meant duplication and waste, and consolidation was long overdue. But St. Joseph is a Catholic hospital, which follows church edicts concerning reproductive health, and that had some women worried -- and a few upset. Some General Hospital nurses declined employment offers from St. Joseph. One physician pulled up stakes and moved her practice to Arcata and became affiliated with Mad River Community Hospital.

"I cannot justify working in a Catholic health care system that doesn't support contraceptive care, genetic counseling, sterilization or pregnancy termination," said Dr. Kim Ervin in a recent interview (photo at left).

Dr. Ervin was head of obstetrical and gynecological care at General, serving more than 4,000 women, and the decision to move was not an easy one. Ervin comes from a Catholic family and is raising her children, including a son who is a junior at St. Bernard School, in the Catholic faith. But the purchase of General caused her to re-examine her faith.

"I'm disillusioned with what's happened locally," Ervin said. "I feel really strongly that the Catholic Church should not be involved in health care. I felt really strongly that I couldn't be part of a health system that didn't allow me to offer what my patients feel they need to have done.

"It is important for me to feel that I could offer a full range of choices, even if I wouldn't choose it for myself," she added.

Mike Purvis, chief executive officer and administrator of St. Joseph Hospital, responds to such criticism, saying, "There is a point of misalignment between the issues of a woman's right to choose, which we respect greatly, and religious rights to follow one's beliefs, which we also respect.

"There is no active denial or attempt to change anyone's thinking," he said, even though certain services, like tubal ligation or more complex abortions, are no longer available to women in Eureka or anywhere in the southern half of the county. (The Sisters of Orange also owns Redwood Memorial in Fortuna.)

"There are some procedures and services that do not fit our [ethical] guidelines," he said.

"[The buyout] certainly makes some things less accessible," said Tina Shelton, executive director of Six Rivers Planned Parenthood. Although the full range of reproductive health services General provided are available at Mad River Hospital, Shelton said the commute to Arcata may be too much.

"For some of these people, 10 miles down the road is quite an obstacle."

Debbie Hartridge and Tina Shalton of Planned Parenthood

RU-486, the newly-approved "abortion pill," could eventually make abortions more accessible, but so far no one Shelton is aware of is currently offering it, "We'd like to offer it," she said, but since providers are legally required to have ultrasound equipment on site, it will take at least until next year.

Mad River Hospital has seen a 50 percent leap in the number of births at its facility, but surprisingly, neither Mad River nor Planned Parenthood has experienced a surge in demand for abortions in the wake of General's purchase. Shelton said in fact, demand for all abortions is down slightly.

Shelton said it's important to remember that women's health care encompasses a great deal more than abortion or contraception. In other areas, like gynecological care or breast cancer detection, she is quick to praise the efforts of the Catholic health care delivery system.

"St. Joe's does a lot of good work," she said.

"We do things in women's health that probably aren't available through any other health care provider in the region," said Purvis. The St. Joseph system provides shelters for women escaping domestic violence and others in crisis, and provides free parenting classes and health fairs.

Those public services will only increase now that the organization is larger, Purvis said, because St. Joseph Health System is committed to spending about 11/2 percent of its revenue on community health initiatives. The purchase of General Hospital increased revenue by 40 or 50 percent, which means that much more for these programs in the future.

"There's no question these services will expand," he said.

Purvis isn't the only administrator around who has reason to boast about his hospital's dedication to women's health. Mad River Hospital has become a leader in breast care technology, in one case approaching product designers before they were even ready to market their wares.

Doug Shaw, administrator at Mad River Hospital, said just before the close of a medical conference, "Somebody got up and said, `By the way, our product was just approved by the FDA.' I ran back and ordered 100 right then." What Shaw received was a supply of Mammopads, foam pads that cushion the breast during a mammogram, and Mad River became the first in the nation to use the new device.

"The new Mammopad makes the patient who is having a mammogram feel more confortable,'"says Lisa Mielke, mammographer at Mad River Hospital.

Other cutting-edge technologies are being used today at Mad River as well. Ductal lavage, which checks for abnormal cells in the breast's milk duct as an early detection procedure for cancer, has been available at Mad River since last year (see Journal cover story New Tools for Cancer, Jan. 18). Again, the hospital was one of the first in the country to use the new technology. Stereotactic breast biopsy, a less invasive way of sampling breast tissue to check for cancer, is already available at St. Joseph and will be coming to Mad River soon.

Breast health isn't the only area where Mad River is a pioneer. The hospital was the first in the county in the 1970s to establish homelike alternative birthing rooms, the first in the county to provide combination labor-delivery-recovery rooms in the early 1990s. Today Mad River's birthing "suites" include postpartum care as well and are even equipped with Jacuzzis.

The birthing services at the old General Hospital have recently been combined with St. Joseph in its new patient tower wing. Those facilities, too, include homey rooms with Jacuzzis.

Humboldt County has a full array of people to help a woman through birth, such as Carol Meyer (photo at right), a midwife who works for Redwood Women's Health Center in Fortuna.

"It's an honor to be part of such an important moment for families," said Meyer, who has delivered babies since 1989.

Meyer said she has never had a problem finding a physician to back her up when births become difficult, but that wasn't the case recently for four midwives in Eureka, employees of St. Joseph, who were laid off in April.

Purvis said that the closure of the midwife practice wasn't indicative of a lack of respect for what they did, but rather a change in direction for hospital policy spurred by the retirement of the physician who was providing back-up. Since midwives must have a physician on call, it made more sense for them to contract directly with a doctor rather than have an agreement brokered by the hospital, Purvis said. Two of the four midwives have found positions with Eureka primary care groups.

Meanwhile, another class of birth helpers has emerged in Humboldt County to help midwives and mothers through birth -- doulas. A doula is "the one that mothers the mother," said Kate Maguire, practicing doula of 24 years.

Doulas are needed, Maguire explained, even when the father and midwife attend the birth, because they are trained to help the mother "articulate her vision" of the birth experience.

"The hospitals have great midwives, but if they have to pay attention to the fetal heart monitor or are checking an IV, they're distracted. The doula is focused on just helping the women through labor," Maguire said.

New parents John Haumeder and Shana Langer with their son Jeremiah and doula, Kate Maguire.

The project has helped train approximately 40 women -- and one man -- who attend births in Humboldt County. Their services, based on a sliding scale from $50 to $450, aren't covered by insurance, but if a woman doesn't have enough money to pay, Doulas by Nature steps in and pays a stipend. On the other hand, if a doula gets paid well for attending a birth, "she may give some back to the project's coffers," Maguire said.

Health care is only as good as a woman's access to it, and Humboldt County has many uninsured and low-income women -- this is where three very important state-funded programs come in. Two are aimed at cancer screening and one at family planning.

The Breast and Cervical Cancer Control Program and the Breast Cancer Early Detection Program both reimburse care providers for performing cancer screenings on low-income women. They have had a large impact on Humboldt County: St. Joseph performed more than 1,300 free screenings just last year. About 20 percent of those screened get abnormal results which require follow-up tests.

"It used to be that you had to have insurance or money" to be screened, said Mary Langley, head mammographer at St. Joseph Hospital. "Now any woman can get a mammogram and find someone to pay for it."

The situation is the same for family planning for low-income Californians. A program, Family PACT (Planning Access Care and Treatment), was created when then-Gov. Pete Wilson signed a law that pays for family planning services for those who earn less than 200 percent of the poverty level.

"It is a great program," said Carolyn Jones, information director for the Open Door Community Health Centers. "It provides men and women of reproductive age birth control supplies, annual exams, testing and treatment for sexually-transmitted infections, pregnancy testing and treatment for some women's health problems that can affect fertility."

What makes the program even more effective in Humboldt County are the people who have the creativity and dedication to find ways to include normally hard-to-reach populations.

Susan Riesel (photo at right), a physician's assistant at the Open Door Clinic, started a walk-in teen clinic program about six years ago.

"There were teens who needed a place in Arcata that was teen-friendly -- someplace where you didn't need an appointment and there would absolutely always be someone there," she said. (There are similar clinics run by Planned Parenthood in Eureka. The Mobile Medical Clinic, which provides health care throughout rural Humboldt County, administers a teen clinic in McKinleyville.)

Riesel said teens are sometimes too intimidated to come in and get the care they need to avoid a life-threatening illness or life-changing pregnancy, and she wanted to create a place that was comfortable for them. That's why when you walk into the room that houses the teen clinic in Open Door, you won't initially see Riesel anywhere. You'll see Sarah Horowitz, her 16-year-old daughter, and her friends. After all, if the idea is to make the clinic teen-friendly, what better group to staff reception than teens?

"We usually have the radio going. It's comfortable," Horowitz said. "The patient population" -- predominantly young women with a few young men -- "would not otherwise come."

Sarah Horowitz, Elise Tessler, Katie Cole and Celeste Passant, teenagers who staff the Teen Clinic

Several Humboldt health-care providers are also adapting to provide care to another special group of women -- Humboldt County's fast-growing Latino population. Aside from the obvious language barrier, providing care across a cultural boundary presents additional challenges, said Fortuna midwife Carol Meyer, who is fluent in Spanish.

"You have to schedule flexibly because time is different for them," she said. "And they all come together as a family, so it can be difficult to speak to the women alone."

Meyer said she particularly enjoys working with women from Latin cultures.

"They are intensely devoted to their pregnancies and they love their children. They enter into prenatal care early and are very respectful of any treatment we suggest." In other words, ideal patients.

Every clinic and hospital spoken to for this report -- six in all -- now employs an interpreter. St. Joseph has 30 Spanish-speaking staff members on duty at any time. Some organizations even have bilingual care providers, like Meyer. Their numbers are likely to grow with the population of Spanish-speaking women.

As the baby-boomers age, the women among them are going to become the next big challenge for women's health care in Humboldt County, said Dr. Julie Ohnemus (photo at right), director of obstetrics and women's health at the Open Door Community Health Centers. Issues like osteoporosis, hormone replacement therapy and dealing with incontinence may belong to the field of geriatrics now, "but the baby boomers will make them more evident."

"And this generation of women wants to stay lively into old age," she added.

"They're a lot more active than they used to be, and wearing diapers just isn't the scene."

That's why Ohnemus, who chairs a steering committee at Mad River Hospital, has been looking at the idea of starting centers for incontinence, osteoporosis and aesthetics to help women deal with issues such as hair loss or the cosmetic effects of breast cancer surgery. Some or all programs could become part of the Women's Health Care Center now in the planning stages at Mad River.

Already on the horizon are two breast health centers, one at Mad River and one at St. Joseph. The two centers will work along the same concept -- to make the experience of maintaining breast health easier, Ohnemus said.

"We're trying to make the system as seamless as possible," Ohnemus said. "Sometimes a patient who has received a positive diagnosis will get different recommendations from different sources. The plastic surgeon says this, the oncologist says that, and the patient is caught in the middle trying to figure out which way to turn." A breast health center would facilitate communication.

Ohnemus, a breast cancer survivor herself, said an important component of a center will be a "patient navigator" program. Patient navigators are women, usually breast cancer survivors, who can coordinate a woman's care, provide information and advocate for her.

The concept of a breast health center was formed in response to community needs, Ohnemus said.

"Mad River got interested because that's what the community wanted."

It is that responsiveness to changes in population and women's desires that keeps Humboldt County's level of health care high.

Some things the Humboldt community can't do on its own, said Shelton. "There is not much [state] funding for women who are out of child-bearing age," she said, for example.

But that which is within grasp is used and reflects continual improvement in meeting the health needs of women.

"I think this community just really supports womens' health," Shelton said.

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