Oakland 'godmother’ who curbed black infant death rate retires

Eleven-month-old Rae’shon Barfield relaxes on Sandra Tramiel’s lap during her last full day of home visits in Oakland.
Photo Credit: Lea Suzuki/San Francisco Chronicle

This article originally appeared in the San Francisco Chronicle

Oakland reluctantly parted with a godmother last week, as public health nurse Sandra Tramiel made the final rounds of a career devoted to reducing an African American infant mortality rate that remains among the most stubborn in the country.

Her in-home nursing visits were the last of thousands over the past decade in which she taught, chastised and advised women who often needed her life lessons as much as her health care. Letting go was as difficult for the young mothers as it was for Tramiel, 68, during this final walk on the baby beat Tuesday before a retirement party Friday.

“Oh, you ain’t going nowhere. I’ll see you at church, and you better pray I don’t end up at your doorstep,” said Tabetha Young, 25, as she held Tramiel tightly in a housing authority apartment that had been infested with bed bugs and stripped of most furniture to ward them off.

Nearby were cherub-cheeked testaments to Tramiel’s work. Young’s boys, Davontae, 7, Amani, 3, and Nickai, 6 months, had all been on Tramiel’s client list.

And all were thriving, despite illnesses and surroundings that could prevent them from seeing their first birthday and becoming part of a black infant mortality rate of 10.0 deaths per 1,000 live births in Alameda County over the last decade, compared with the county’s overall rate of 4.5, and a white rate of 3.1.

“These are my babies ... my babies,” Tramiel said between kisses she planted on the belly of Nickai, whose bare feet churned in bliss.

Tramiel’s retirement is a bittersweet milestone, an end to work in a county known in public health circles for its dogged fight against the infant death rate among blacks. Alameda County has nearly halved the rate since 1991, when 17.7 black infant deaths per 1,000 births compelled it to apply for the Healthy Start program, a federally funded effort overseen by the U.S. Health Resources and Services Administration to reduce infant death where rates are highest in the country.

Sandra Tramiel, who cried as her retirement party, says she will continue to serve women as if they were her daughters.
Photo Credit: Lea Suzuki/San Francisco Chronicle

Nurse’s important role

Kiko Malin, director of the Family Health Services Division at the Alameda CountyDepartment of Public Health, called Tramiel’s role in tackling the infant mortality rate with two other public health nurses unparalleled.

“I’ve never seen families respond to a nurse the way they respond to Sandra,” Malin said. “She is so committed to the work, she just turns herself inside out for them.”

But Tramiel’s departure also coincides with a resource-stretching shift in how to address the unpredictable death rate going forward.

From 2009 through 2011, the black infant mortality rate had dropped in Alameda County to 7.6 per 1,000 African American births. But in 2012, the most recent year figures are available, the rate shot back up to 10.5.

Meanwhile, 55 nations worldwide, including some developing countries, have lower infant mortality rates than the U.S.’ overall rate of 6.2 deaths per 1,000 births.

So the federal agency that sends $2 million a year to Alameda County and funds 86 other communities nationwide to fight infant mortality, has directed its Healthy Start programs to essentially double the number of women they reach. But counties will be given no extra money to do it — raising questions of quantity versus quality intervention for children who face difficult odds to survive.

Davontae was born with limited prenatal care when his mother was a teen. Amani was born into homelessness. Nickai is showing signs of asthma, and relatives who care for him while Young works fast food shifts may be exposing him to second-hand smoke. The three different fathers to the boys were present only in frameless snapshots on the living room wall.

Instead of helping 450 women and their children a year, Alameda County must now reach 1,000.

Malin said it will be a challenge to delve as deeply into the lives of women as they did during Tramiel’s tenure, but she has a plan to divvy up her workforce in a way she hopes will meet the new standards and continue to reduce the death rate.

Divvy up workforce

She will redefine the role of nurses like Tramiel, calling on them to visit with mothers only when a child is medically in need. She will utilize social workers to do the work of improving the lives of the mothers, and creating safer surroundings for their children.

It seems like an obvious division of labor and expertise. But Tramiel’s last day of in-home visits were a window into lives on the margins, where medical and social needs intersect. She was a trusted, one-stop-shop to address them both with a single visit.

At the Oakland apartment of Roseanda Hersey, 21, her 11-month-old son Rae’shon was a giggling display of newly acquired baby steps. He traipsed and tripped from his mother’s arms, to Tramiel’s, to those of his uncle, Oliver Hersey.

But the boy needed something essential to his health, and the mother something essential to her social services: a screening for lead exposure.

Hersey works graveyard shifts at Walmart stocking shelves, but needed food stamps to make ends meet. The federal Special Supplemental Nutrition Program for Women, Infants, and Children, requires the screening as a way to counter low rates of lead checks among the children of food stamp recipients.

But Hersey had not taken her child to a pediatrician, even though Medi-Cal would pay for the screening. Tramiel had badgered her on the telephone for weeks to get the screening done or go without the food stamps.

“You know what to do,” Tramiel said sternly.

“I’m in trouble ... I’m so sorry, Sandra,” Hersey said sheepishly.

Then she made the call to set up the appointment. Tramiel took it in stride, peeling away Rae’shon’s onesie and weighing him on her baby scale: 22.6 lbs.

Oakland public health nurse Sandra Tramiel (second from right) is honored by client Maya Jefferies (second from left).
Photo Credit: Lea Suzuki /San Francisco Chronicle

'Like our mom’

“She’s like our mom,” Hersey said. “She won’t let us put things off.”

Asked if she thought Alameda’s doubling of clients would allow for such close relationships, Tramiel looked away and repeated quietly: “I don’t know. I don’t know.”

On her final official visits, she gave each mother ways to contact her as a friend, and invited them to her retirement party. Tramiel said she’s not going away, she’s just not getting a paycheck to help them.

“Now I can give unconditionally,” said Tramiel, with rain tapping the Oakland streets at day’s end, as if to tally all the mothers and children she has reached.

“Now I can develop and establish my own criteria. To serve them as I would serve my own daughters.”

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