On sweltering summer days, when temperatures in Mississippi linger at 90 degrees or higher, a line of people will stand outside the mobile unit.
“[The heat]’s very unpleasant,” said Dr. Caroline Weinberg, founder and CEO of Plan A Health. “But inside it’s nice and cool.”
The “inside” in question is the interior of a 210-square-foot van that a team of women is driving around Mississippi’s Delta region. They offer free reproductive and primary healthcare services in the most rural parts of the state.
Weinberg hatched the plan for a mobile clinic in 2018, after learning that Mississippi had one of the worst health outcomes in the country. The New York doctor began visiting the area and fundraising for a mobile unit just before the coronavirus pandemic, building trusting relationships through collard green-and-cornbread dinners with local health professionals. Her dinner companions introduced her to more people and gave her tips on how to talk about the work she would be doing.
Weinberg raised $25,000 in her first year. Now, the Plan A Team has expanded to employ a host of women from the Delta region who recently celebrated one year on the road.
“The other day we were trailing each other (on the highway) and she passed me; she was gone,” Desiree Norwood said about her colleague driving the Plan A van. “I was just like ‘Wow, she is really driving’.”
Care in the community
Norwood is Plan A’s program coordinator. She first learned about the practice when the mobile unit was scheduled to visit her hometown of Sunflower, Mississippi, in 2020. Sunflower’s population of 1,068 people is 76% Black, and the median household income is $16,824. Half of the city’s population lives below the poverty line.
Without Plan A, Norwood would have to travel eight miles north or 13 miles south to receive care — a trip that people may not be able to take.
“I was just like ‘Wow, this is going to be something amazing’,” Norwood said.
Mississippi reported 8.3 infant deaths per 1,000 births in 2020. The infant mortality rate has decreased by about 6% since 2019. The state has been encouraged to improve maternal health for almost a decade by supporting policies that expand access to care, improve women’s overall health before becoming pregnant, eliminate racial and ethnic inequities, and increase breastfeeding and safe sleep practices.
However, the state’s maternal mortality rate is still the fifth-highest in the country. The maternal mortality rate is 22.1 for every 100,000, higher than the national average of 17.47. The state also had the highest rates of excess deaths, from coronavirus and chronic diseases like heart disease, between 2020 and 2022.
Mississippi is one of 12 states in the country that declined expanded access to Medicaid, leaving 15% of residents under the age of 65 without medical coverage, according to the latest census data.
Many of the small Delta communities lack a brick-and-mortar health clinic, and residents must drive to other cities for medical care. Weinberg says about 98% of their clients are Black women who seek prenatal and postnatal care.
The mobile clinic travels to about three destinations per week with Antoinette Roby at the wheel.
Roby was a truck driver for 10 years prior to working with Plan A. She studied healthcare administration in school, which qualified her to be both the driver for the mobile clinic and a community health worker.
The secrets of success
The Plan A Team has prioritized the power of relationships. Norwood said they have a vested interest in the communities they serve.
“A lot of people come to the Delta to do research, do programs, and then they leave,” she said.
Weinberg said she had to learn to adjust and let go of her initial dreams of what the mobile clinic could be after she began to learn more about the needs and wants of the communities she planned for the van to go to. Since the staff are from the area, they’re familiar with local government and religious leaders, they know how to talk to patients, and they understand the culture of the communities they serve.
“It’s not like I can just pick up what I did in this Mississippi and drop it in, like, Georgia or Louisiana,” Weinberg said. “You have to like, take that time to know the community, because every place is different.”
They were also warned by people in the community about how they may be perceived if they started conversations about access to birth control and passed out condoms (which are included within their services).
Roby said their success also has a lot to do with their welcoming attitudes and ability to share accurate information. Since many of the rural communities lack physical doctors’ offices, many seek information on the internet or by talking to those closest to them, rather than from trained medical staff.
“I pretty much have this outgoing personality and this smile, too,” Roby said
When the Supreme Court overturned Roe v. Wade this summer, Plan A was already working to increase access to reproductive services. Weinberg admitted she worries about the increased risk of maternal mortality. Plan A does not conduct abortions; however, patients can receive care regarding prenatal and postnatal care, and anything related to the cervix, uterus, and vagina. Patients also don’t have to identify as women to receive care.
Though they do their best, Weinberg admitted there’s a threshold to their capacity. Like any nonprofit, they continue to fundraise, but without policy changes at the state and federal levels, major risks remain for Mississippians.
“There are limitations to what we can do,” Weinberg said. “We can’t solve every problem, and that’s very scary and irritating. It’s like you see the problem that you want to be able to solve it and you just can’t always solve it.”
So oftentimes the Plan A team relishes their big wins, like serving 10% of a community in one day — even if that means they saw fewer than 30 people. To them, driving the 100 miles to provide care for someone in need will always be worth the trouble.
“I felt like it was bigger than, you know, just me,” Norwood said. “To be a part of this organization where they’re going into communities that don’t have a lot of access.”
Direct Relief, in collaboration with Bayer, has awarded $50,000 to Plan A through the 2022 Community Health Awards, which aim to increase and strengthen the provision of family planning services to vulnerable populations in the U.S.
