Welcome to THE "Based on a True System" storytelling proJECT

We always thought the worst thing that could happen out here was the mill closing. Or the storm flooding out the bridge again.

Turns out, it was them shutting down the maternity ward.

I remember the day they posted the sign on the old sliding doors at [redacted]. “Labor & Delivery Unit Permanently Closed.” All official-looking, printed on crisp white paper. Cold words, neat font, like it wasn’t gonna kill nobody.

Like it wasn’t gonna kill me.

I was five months pregnant when the clinic turned me away the first time.

“Lena, baby,” Nurse Carla said, not meeting my eyes. “We lost the discount contract for the pharmacy. Can’t fill your meds anymore. And your Medicaid app still pending?”

I nodded. I’d been waiting three months for the state to call me back.

“We can see you in three weeks,” she said, quiet.

I smiled, polite-like. But in my head, I was counting the miles to the next closest place that still saw Black mamas with no insurance.

Sixty-four.

Most folks out here never even heard of no 340B. I ain't neither, not till they started talking about it in the clinic.

It’s this federal thing. They say it's meant to help hospitals like ours, ones that treat poor folks and folks with no insurance. Drug companies are supposed to give big discounts on medicine, and in return, those hospitals stretch the savings to keep the lights on, keep the doors open. Ain’t tax money. Just a deal: lower drug prices for places that need it.

Back when the program worked like it should, the clinic could afford to hand out prenatal vitamins, fill prescriptions for folks like me, even pay for things like blood pressure meds or a ride to the big hospital if you needed it.

But Nurse Carla said, the drug companies started changing the rules. Said they’d only give the discount if the clinic jumped through all these hoops or handed over private patient information. She said some even told the clinics and hospitals like ours, they had to pay full price up front and maybe get some money back later. Folks in charge of the clinic called it a chokehold.

All I know is, once they did that, our pharmacy shut down, and I couldn’t get my meds no more.

They say it was something about “rebates” and “data-sharing,” but all I saw was the shelves go empty and the clinic stop calling.

While we were out here rationing blood pressure pills and praying a fever would break on its own, you just know somewhere...somewhere behind some glass tower conference table, them people were laughing their long, rich people laughs.

The kind that sound like an old hog laughing from the belly: fat, full, and far away from the butcher’s block. Laughing that drawn-out, greasy kind of “hohhh—hoh—hoh—hoh” that don’t mean joy, just money. Clinking glasses over our clinic’s death.

That’s what it’s like to be forgotten. Like your whole town got turned inside out, and nobody but you noticed it was bleeding.

Our car ain't got no AC, tires bald, transmission slips if you take the hills too fast. But that day, I tried to drive to Tifton for the check-up anyway. Got as far as Alma before I turned around. The gas light came on. My back hurt. And my babies, two of ‘em already, were home alone with peanut butter sandwiches and gospel on the radio.

I told myself I’d go next week.

Then the week after that.

Then came the blood pressure.

I knew something was wrong. Felt it in my ankles, thick and tight like someone had stuffed cotton under my skin. Felt it in my head too, like a dull hammer behind my left eye. I laid in bed and listened to the walls creak with the heat, sweat rolling down my stomach. I thought about the "rebate" program the way folks used to talk about food stamps: something you didn’t want to need, but when it was gone, you knew just how much it saved you.

They took it, piece by piece. First the pharmacy discounts, then the maternity ward staff, then the whole damn ward. Said it was “unprofitable.”

You know what else is unprofitable?

Me bleeding out in a truck cab on Route 19.

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I went into labor too early.

I tried to stay calm. My oldest, Nia, was crying. My son was banging on the bathroom door, saying he couldn’t find his sneakers. I called 911 but the operator said the ambulance was 40 minutes out.

“There’s only one crew on tonight,” she said, flat like it wasn’t life or death.

Keonte, my neighbor’s boy, heard me screaming. He came running, shirtless, keys in hand.

“Miss Lena, let’s go,” he said, voice shaking. “Hold on. I’ll get you there.”

But we didn’t make it.

My water broke near the county line. We pulled over on the gravel shoulder and I screamed into Keonte’s hoodie while Miss Adella, bless her, held my legs apart and prayed louder than the cicadas.

Promise came out purple. Quiet.

I thought she was gone. Honest to God, I thought I was too.

But she gasped once. Then again.

Keonte took us the rest of the way fast as he could. I don’t remember much else...just waking up with a line in my arm and a nurse saying we “got lucky.”

The hospital flew Promise to Macon just to be sure. She stayed a few days.

I named her Promise anyway, because they broke theirs and I had to fight every day to keep mine.

---

Now I sit here on this porch, rocking her while the heat clings to our skin like sorrow.

I hear about women in Atlanta with birthing tubs and doulas and apps that track their baby’s heartbeats. White women with choices. White women with time.

Me?

I got a cardboard box of meds the clinic gave me from leftover stock.

They reopened the maternity ward rotation last month...only Tuesdays and Thursdays. The news say they got some state grant or the other, some church money, a lawsuit that went through, something about West Virginia holding the line on them "rebate" contracts. The details are murky, but I know for a fact is, we didn’t die.

They took photos of me and Promise for a story and put it on the clinic wall. I didn’t want it at first. I didn’t want to be the poster child for surviving what shoulda never happened.

But then I thought of all the girls like me: Black, rural, broke, pregnant, scared, walking into the same quiet rooms, wondering if anybody sees them.

I let them take the picture and hang it on the wall. Not for the clinic...just for the ones the system don’t make no space for.

The ones who have babies with first breaths outside a system that forgot how to hold us.

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Inspired by the lived experiences of thousands. Told through fictional voices. Rooted in real policy and real harm. This story is a work of fiction and is a part of CRPHI's "Based on a True System" storytelling project. Any resemblance to specific individuals is coincidental — but the systems, patterns, and consequences are real.

© 2025 Center for Regulatory Policy and Health Innovation (CRPHI). All rights reserved. No part of this story may be reprinted, republished, or reproduced without the express written consent of CRPHI.

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