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Lack of child care forced her to delay cancer treatment. Then this Dallas group stepped in

Fort Worth Star-Telegram - 11/20/2022

Alexandrea Ruiz is sitting in a waiting room at Parkland Memorial Hospital, listening for her name to be called.

Ruiz, 26, has spent a lot of the last year waiting.

She’s waited for results from the biopsy that would tell her whether the lump in her cervix was cancerous. She’s waited for treatment in emergency rooms, where she goes when the pain from the tumor becomes too much to bear. Now, she’s waiting to learn whether the weeks of treatment have effectively curbed the growth of cervical cancer in her body.

Ruiz’s ability to get treatment in the first place was made possible through access to a scarce and precious resource: child care.

While Ruiz was waiting to see a doctor at Parkland clinic on a recent Tuesday, her oldest daughter was preparing lunch. Three-year-old AmandaLyn was cooking a feast: burritos, tacos, eggs and juice. She boils water for tea using a miniature toy kitchen, and serves her teacher a cup. While AmandaLyn makes lunch, her little sister Riley naps nearby.

Ruiz’s daughters are being cared for at Annie’s Place, the child care center that sits on a quiet street on Parkland’s campus. Annie’s Place, which opened in 2020, provides free, drop-in child care to any Parkland patient who needs it, as well as back-up child care for Parkland staff.

When Ruiz was diagnosed with an advanced stage of cervical cancer last year, she missed multiple early appointments, delaying the start of her treatment. The single mom knows only a few people in Dallas, and said she had no one she could ask to safely watch her daughters while she got care day after day, sometimes for hours on end. She couldn’t afford traditional day care or a babysitter.

Eventually she was referred to Annie’s Place. It is believed to be the first day care center of its kind in the nation. Annie’s Place, operated by the Dallas nonprofit Mommies In Need, partnered with Parkland to offer free, high-quality child care to patients five days a week. Parkland patients can leave their kids at Annie’s Place while they get a check-up for their diabetes, while they’re visiting their newborn in the neonatal intensive care unit, or while they’re getting chemotherapy and radiation treatment, like Ruiz did daily for almost five months.

For some patients, like Ruiz, the free child care makes the difference between getting cancer treatment and going without.

“I wasn’t going to my appointments or anything like I should have been,” Ruiz said about the time after her diagnosis.

In the midst of her treatment, Ruiz brought her daughters to Annie’s Place every day while she got radiation therapy.

“Honestly, if I hadn’t found and started using Annie’s Place, I wouldn’t be here today,” she said.

The origin of Annie’s Place

In 2013, Natalie Boyle was juggling a cancer diagnosis, two toddlers, and a calendar that included multiple surgeries.

“It was a very challenging time to try and take care of kids while I was also just so, so ill,” Boyle said.

At the time, Boyle relied on her family in Dallas and hired a nanny when she was too sick to care for her twin daughters.

In between recovering from surgeries and coordinating care for her daughters, Boyle thought about how mothers without her advantages — having family nearby to turn to, and the ability to hire in-home child care — would fare during a health crisis.

A year later, Boyle was cancer free, but her friend Annie was faced with a similar crisis: She had been diagnosed with colon cancer, and was facing months of intense treatment without someone who could care for her children.

Boyle offered to send her nanny to her friend, with a crowdfunding campaign to pay for the child care. As they raised money, they heard from people who knew of other parents facing similar crises and needing child care.

Boyle found that there were very few organizations offering free, in-home child care for parents facing health crises, and most of those that did exist were cancer specific. She realized that when a parent’s personal health crisis collided with the existing child care crisis, caregivers were left stranded.

So she created Mommies In Need, a nonprofit dedicated to providing care for children so parents could access needed medical care.

Initially, Mommies In Need provided in-home care. Any family facing a medical crisis — be it a cancer diagnosis, a high-risk pregnancy, treatment for substance use disorder, or something else — could qualify for six months of free, in-home child care for up to 40 hours a week. Mommies In Need serves up to six families at a time with in-home care in Dallas and Collin counties. In all, Mommies In Need has provided in-home care for 77 families.

But as the nonprofit grew and began serving more families, Boyle realized that in-home care was a difficult service to grow.

“That could never really scale to 600 families at a time,” Boyle said.

So Mommies In Need approached the Parkland Health and Hospital System, which serves as Dallas County’s public, safety-net hospital, about a possible partnership.

When Parkland officials began considering the idea, they surveyed 300 women across Parkland clinics. Parkland, like its counterpart JPS Health Network in Tarrant County, serves a large volume of patients without health insurance, or who, like Ruiz, use public insurance programs like Medicaid or Medicare. Among the Parkland women surveyed, the top reason women gave for missing doctors’ appointments, or skipping other health needs, was lack of child care. More than half of those surveyed — 52.7% — said lack of child care had prevented them from going to the doctor.

At Parkland and other Texas hospitals, the lack of child care manifested in various ways. Nurses would hold babies in hospital hallways during exams, toddlers would run through waiting rooms, or moms would be turned away from their appointment altogether because children weren’t allowed in exam rooms.

Parkland and Mommies In Need decided to work together. Parkland would provide a vacant building on its campus, free of charge, to Mommies In Need, and would cover the cost of utilities, security, janitorial services and IT. Mommies In Need would raise money to cover the cost of renovation, and hire the staff and operate the facility as a licensed day care.

The center is licensed to care for 62 children at a time, but in reality, Boyle said, they usually care for about 35 kids, so they can keep the staff-to-child ratio low. After opening in November 2020, when the COVID-19 pandemic was continuing its spread and stretching health care staff thin, Annie’s Place also decided to offer emergency child care to Parkland staff. The child care was so needed, that Annie’s Place has decided to expand its Parkland footprint and offer daily child care for 100 children of Parkland staff, in addition to the drop-in child care for patients.

In addition to providing child care services to patients experiencing a health crisis, Boyle and her colleagues are also hoping to reframe the conversation around child care and health care, an intersection that is rarely researched or discussed. Child care, Boyle says, should be understood as a “social determinant of health,” a concept that refers to the conditions outside of the exam room that affect people’s health and well-being.

Today, doctors and public health officials will frequently discuss how housing stability, neighborhood conditions, air quality and other factors impact a person’s well-being. But child care is rarely listed among those factors.

“Nowhere in there are people talking about child care,” Boyle said. “What we discovered is when we asked a hospital to start tracking it, it was a huge part of the reason that people were missing appointments.”

A cancer crisis and no child care

In 2021, Ruiz found herself in the worst-case scenario that Boyle had envisioned.

Ruiz, a single mother of two children, had moved to Carrollton in 2020 for a fresh start. She has a few family members in the Dallas area — she’s living with her mom and other family members — but didn’t have anyone who could watch her oldest day after day for hours on end while she worked. And almost all available child care providers were non-starters: Without a job, Ruiz didn’t have the cash to pay for child care. Without child care, she couldn’t get a job.

In September, when Ruiz was pregnant with her second daughter, she starting noticing blood in her underwear. After her daughter Riley was born, the tests confirmed that the pain, the unusual bleeding, the difficult pregnancy were caused by a cancerous tumor in her cervix.

But even with a cancer diagnosis, Ruiz couldn’t start treatment in earnest because she didn’t have any place to take her daughters. COVID-19 safety protocols meant she couldn’t take them with her to her appointments, and even if she could, most doctors discourage parents from bringing their children to appointments that might be emotionally difficult or last for hours, like a typical chemotherapy appointment.

After missing several scheduled appointments at Parkland, someone reached out and told Ruiz about Annie’s Place. She was skeptical at first.

But that changed when she went to pick her daughters up. AmandaLyn, then 2, had had an accident, staff said. Annie’s Place employees cleaned her up and dressed her in clean clothes, Ruiz said. They had cleaned and dried her soiled clothes, and offered a lasagna for the family to take home.

“I just loved it,” Ruiz said.

With a safe and free place for Ruiz to take her daughters, Ruiz started her treatment plan in earnest. Every Tuesday for 10 weeks, Ruiz spent hours in a chemotherapy room. Then, every day for 10 weeks, she received external radiation treatment. After that, another five weeks of internal radiation.

For each hour of treatment, day after day and week after week, Ruiz brought her kids to Annie’s Place instead of missing appointments.

Annie’s Place will accept patients’ kids regardless of the patient’s health needs or appointment. Parents with infants in the neonatal intensive care unit have left their older children at Annie’s Place so they could tend to their newborn. Caregivers with chronic conditions like diabetes or heart disease can go to their regular check-ups . Moms can keep their kids out of the exam room when they’re having pelvic exams or Pap tests.

The partners behind Annie’s Place said they found no true counterparts when they launched the center in November 2020. A Small Miracle Foundation provides in-home child care to families where one member has received a cancer diagnosis. A branch of the Armed Services YMCA hosts “children’s waiting rooms,” where kids are supervised for up to two hours during medical appointments. But they haven’t found anything else quite like Annie’s Place: A day care built in partnership with a hospital system that provides completely free drop-in care for patient’s children.

Waiting for information

Ruiz is still waiting for more information.

She doesn’t yet know if the daily radiation appointments shrunk the tumor in her cervix. Over the summer, the tumor began pushing on Ruiz’s uterus and blocking it, refluxing urine into her kidneys. In order to go to the bathroom, to survive, doctors had to install nephrostomy tubes on the sides of her body to relieve the pressure on her kidneys.

But while she waits, with a diagnosis that she said leaves her without much hope, she gets through each day because of her daughters.

“The only thing that actually makes me happy through the days is my kids.”

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