The Spindle City
In Fall River’s heyday in the mid 19th century, textile mills lined the Quequechan River. The city teemed with Portuguese, French Canadian, and Irish immigrants, drawn to the prospect of steady jobs and a regular paycheck. The booming population led to infrastructure and growth: Frederick Law Olmstead designed three parks in the city. Fall River is also the hometown of the infamous Lizzie Borden, who in the late 1800s was acquitted of murdering her parents, a story that inspired the well-known nursery rhyme. By 1860, Fall River was the largest textile producer in the United States. “Spindle City,” as Fall River came to be known, produced half of all cotton cloth in the United States in 1876. Only Manchester, England, bested the city in textile production globally.
The city’s fortunes took a turn in the 1920s, when textile companies began to move to the southern United States. The Great Depression further cemented Fall River’s economic woes. Like many former manufacturing towns in the United States, the city has struggled to find its economic footing post-World War II. Although Rapoza points to several regional hospitals and Amazon as major employers, the numbers tell a stark story. Fall River is experiencing 5.6 percent unemployment, as compared to the state of Massachusetts at 3.3 percent. The city’s poverty rate is 19.7 percent, well above the national average of 10.5 percent according to 2019 figures from the U.S. Census Bureau.
All of these needs put pressure on the city’s social services and public infrastructure at a time when Fall River struggles to raise the tax dollars for critical services.
“Most people that grew up in the city years ago have moved out to the suburbs,” Rapoza says. “They still work here but they don’t really live here.”
Pediatric Associates of Fall River is there to help fill in the gaps. She says many families walk to the office from several housing projects in the neighborhood. They serve patients experiencing homelessness, and until recently, had a social worker available to help them one day per week.
“She was getting them services, trying to find shelter for them, dealing with some food issues,” says Rapoza. “I know it’s hard to believe in this day and age, but unfortunately you can’t get services if you don’t have an address.”
The COVID-19 pandemic resulted in the elimination of a nutritionist position that was funded through Steward MassHealth ACO. A social worker, also employed through the ACO, scaled back from four days per week with the practice to one. Rapoza is hopeful both positions may be fully reinstated once the patient volume is back to normal.
“We could actually use somebody in this office as a social worker or behavioral health person five days a week,” she says. “There’s so much need.”
Drug use in the community is a challenge – Rapoza says they have in the past had to deal with heroin use in the parking lot and office bathroom. The practice often treats babies born dependent on opioids, which requires close coordination with the NICU and a team of health professionals. Although the challenge is still there, Rapoza says outreach and increased treatment options are beginning to pay off as the number of opioid-dependent newborns has decreased in recent years.
“A lot of it is education and trying to get people connected to the right places with their addiction,” she says. “I think that that’s probably one of the biggest things we’ve seen.”
Gangs also threaten the health and well-being of Fall River patients. A 2017 report from the Crime and Justice Institute at Community Resources for Justice found that “across demographic, economic, and educational dimensions, Fall River youth are at greater risk for many of the factors associated with gang involvement and delinquency.” The report notes 33 active gangs with over 400 members, many of whom are “school-aged youth.” Although the city has implemented several programs to provide alternatives to joining gangs, Rapoza and her colleagues continue to see fall-out from the violence.
“We’ve had a couple of shootings the next corner up, where one 14-year-old was killed,” she says. “It’s tough.”
Over the last year, the COVID-19 pandemic hit the children and adolescents of Fall River particularly hard. For many, school is where they get nutritious food and have a cadre of adults ready to help. When schools transitioned to remote learning in the spring of 2020, those resources and connections went away. Two suicide attempts by adolescents in the neighborhood in one week, during the height of the pandemic, hammered home the importance of schools as a check on kids at-risk.
“They didn’t have the social connection,” says Rapoza. “They didn’t have the teachers. They didn’t have somebody making sure everything was okay.”
The staff at Pediatric Associates of Fall River felt consequences from the closure of schools as well, as they work closely with teachers and school nurses to understand what is happening with their patients at home. Often, it’s a teacher who will be able to identify a child in need of mental health services or other medical attention. Without that additional window into the lives of kids, it became more challenging to provide holistic care.
“We have a great relationship with the teachers,” says Rapoza. “They do pick up on a lot of things with kids and their home life. When the kids weren’t going to school because of the pandemic, that was a big loss.”
Now that schools are moving back to in-person learning, Rapoza is optimistic that the practice will once again be able to work with teachers and nurses to identify children in need and get them appropriate help, whether it is nutritious food, a visit to the eye doctor, or more serious interventions related to abuse or neglect.
“Hopefully everything will resume like it used to be in September,” she says. “That’s what we’re hoping for.”
Reliable access to pediatricians goes a long way towards building strong relationships with families in Fall River.
“We’re here every day of the week,” says Rapoza. “Every holiday except Christmas and Thanksgiving. We’re here every evening. We are open all the time. I think that’s always built strength in our relationship with our patients, that they know that when their kids are sick, they’re going to see their doc or they’re going to see a pediatrician. They don’t have to go to the ER. They don’t have to go to the pharmacy.”