Fighting Syphilis For The Newborn Of N. Phila. The Disease Is Spreading. Outreach Workers Are Getting Expectant Mothers To Get Care.

Posted: May 12, 1995

Cruising down Jefferson Avenue, Gene White notices the young woman with the swollen belly.

"There's one," he says, backing up to park near the corner grocery store she had just entered.

White grabs his bag filled with pamphlets and fliers and stands patiently outside. When the woman emerges, he jumps into his delivery. Soon he has her home phone number and permission to visit later in the week.

The scene is repeated throughout the day as White navigates through North Philadelphia, looking for bleary-eyed women with distended bellies, looking to score drugs; young pregnant girls with misguided impressions of motherhood; working women too overwhelmed to seek regular prenatal care; and the homeless ones with no means of taking care of themselves, much less a child.

White, an outreach worker for the Philadelphia Health Management Corp., talks to the women about syphilis, yet another scourge hitting some North Philadelphia neighborhoods. He encourages the women to be treated, if not for themselves then for their unborn children.

"Just approaching them is tough," says White. "People on the streets don't trust what you're saying. They think it's a gimmick."

It's not. Though public health administrators believed syphilis had declined over the last 20 years, a resurgence began in the mid-1980s. Health officials around the country began seeing an upsurge in infections in urban areas and more babies being born with the disease.

More than half the cases reported in Philadelphia were among pregnant women who were getting little or no prenatal care. Often they used crack, traded sex for drugs or a place to stay, or had a history of syphilis.

The city's congenital cases peaked in 1991, with 301 babies infected; in 1981, only five cases were reported. Most of the increase has occurred in zip code areas 19121 and 19132, the area making up lower North Philadelphia.

To stem the rise, last year the Philadelphia Department of Public Health began requiring that doctors at city health clinics strongly advise pregnant women to be tested for syphilis. Disease intervention specialists became more aggressive in tracking the female partners of men who had tested positive for syphilis.

Then, last summer, the health department, the Family Planning Council of Southeastern Pennsylvania and the Philadelphia Health Management Corp. developed the Community Prenatal Care Project to seek out high-risk women and provide them with prenatal care.

During the project's first three months, outreach workers recruited 47 women. Now 132 women participate: Forty-five percent have used or still use crack, 44 percent had no prenatal care before enrolling, and 35 percent are either infected with syphilis now, have a history of infections, or both, said Arwyn Elden, the project coordinator.

"None of the women who met the qualifications have turned down enrollment in the project. The help is appreciated," she said. "Also, we're not seeing a high rate of congenital syphilis in our clients' children."

Syphilis during pregnancy can bring babies with brain damage, blindness and deformities who are prone to early death; it can make women sterile and destroy their bones, give them heart attacks and liver disease, cause dementia and make them more prone to catching the AIDS virus.

Treatment up to 30 days before delivery can prevent the passing of syphilis to an unborn child, though it cannot prevent possible birth defects.

That's why Gene White got Yvette C., 33, now 4 1/2 months pregnant and fighting a drug and alcohol addiction, to join the program.

"I was sitting at the corner and he pulled up," she said, recalling her initial meeting with White three months ago. "I saw him backing up, so I went into the house. He followed me and told me about the project.

"Two weeks later they came back and took my blood," said Yvette, a mother of three who has had syphilis. "He got all my information and said he would come back again. I was like, 'Oh, he ain't coming back.' But sure enough, he came back and kept coming back."

That persistence from White and two other outreach workers who work the streets daily is a big reason the project has been effective. They are responsible for getting the women signed on with a clinic, escorting them to their first appointment, arranging regular blood tests, helping them apply for food stamps and drug rehabilitation programs and visiting them at home.

White cruises some of the city's most depressed neighborhoods in a beat-up brown station wagon.

Cecil B. Moore and Ridge Avenue. Broad and Girard. Strawberry Mansion. Broad and Erie.

As he drives, his eyes dart back and forth between busy street corners and dark alleyways. When he's not working the grocery stores or bus stops, he's riding buses or visiting abandoned buildings, crack houses and seedy hotels on foot.

He sees four or five clients a day and sets aside time to recruit new ones.

"We get them at all ages," White said. "We've had them as young as 15. The oldest client I had was 52."

It's not always easy.

"We have to come to them on their level and make them feel comfortable,

because a lot of people on the streets don't trust us," White said. "You've got to get their respect because, in some neighborhoods, the drug dealers run the streets and they can dictate whether you're going to come in there or not."

But White, a former drug addict, is well-acquainted with the code of the streets and has managed well, mainly because he's honest about his past with the people he tries to reach. And the dealers know he's trying to help the community. It doesn't hurt that he gives out condoms.

Still, it's not easy convincing women leery of a strange man who seems a little too interested in their pregnancy. Some are afraid he's trying to scam them. Others think he's working under cover for the Department of Human Services and may take their children away.

White, with his reassuring voice and genuine concern, is undaunted.

He quickly introduces himself and explains what he's doing. Then he tries to lure them in with the promise of free gifts, toiletries, nightgowns and slippers for when they go to the hospital to deliver; subway tokens for doctor appointments; and $45 - $20 when they are accepted in the project and $25 after delivery.

The gifts usually pique the women's interest. But it's what they learn once they join the program that keeps them going back.

"It surprised me," said Aja G., 16 and pregnant. "I didn't know so many people were getting this thing, especially in our area."

Aja said she contracted syphilis because she, like some of her peers, was naive.

"They get involved with people they believe are faithful and they stop using protection," she said. "That's what happened to me and it really hurt."

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