Rebuilding a Community
In St. Thomas, a 31-square-mile island that is home to just over 42,000 residents, Dr. Penn is one of only three pediatricians focused solely on outpatient pediatrics. Out of six pediatricians, three trained in combined internal medicine and pediatrics and now split their time between caring for adult and child populations.
This translates to a very busy practice with a diverse range of patients from across the U.S. Virgin Islands, which includes the islands of St. Croix and St. John in addition to St. Thomas. Dr. Penn says she has seen needs change dramatically over the last five years.
“Our population base was very different [prior to the hurricanes] – we used to have 80 percent insured,” she says. “Now we have 60 percent insured and 40 percent self-pay or uninsured.”
Because of the U.S. Virgin Islands’ status as an unincorporated territory, patients’ access to insurance differs from the mainland United States.
“We have a medical assistance program,” she says. “It’s similar to Medicaid, but our Medicaid can only be utilized at the public health clinics or the hospital. It cannot be used in private practice.”
For specialty services like speech or physical therapy, patients need to go through an authorization process to receive medical assistance, which can be cumbersome especially when faced with multiple visits over months or even years.
As a result, Partners4Kids spends a lot of time helping families navigate the system to get the help they need to pay for health care, especially now, as many struggle to find work in a challenging economy devastated by the hurricanes. Businesses were destroyed and the cruise ships – a staple of life on the island – stopped coming.
The population of St. Thomas dropped a stunning 18 percent between 2010 and 2020, according to the U.S. Census Bureau, likely in part a result of residents choosing to start over elsewhere after the hurricanes destroyed homes and livelihoods.
Longstanding health care-related challenges in the Virgin Islands were also exacerbated in the aftermath of the storms. In a 2018 report from the Kaiser Family Foundation, residents reported “difficulties managing chronic conditions without power and with limited access to fresh food” and water even months after the hurricanes, while the number of residents experiencing anxiety, depression and post-traumatic stress disorder rose dramatically.
Then, just as communities started to recover, the COVID-19 pandemic hit. The cruise ship industry once again shut down, which had ripple effects on the hotels, shopping districts and “mom and pop” stores in town.
“A lot of businesses closed or left due to the storms,” Dr. Penn says. “And then again from the pandemic. Now you have mostly a government-employed community, especially with the lack of tourism.”
Renovation to damaged school buildings has been slow, which has impacted the health of children in many ways.
“There was a lot of water damage,” she says. “Not every school has had a chance to rebuild or remediate their mold issues.”
And then the pandemic added further challenges especially when it comes to mental health. Public schools have been closed since the pandemic began in 2020, she says, and only recently reopened. Many kids have found the transition difficult.
“I’ve been working with patients who are very anxious,” she says. “You’ve been forced to be by yourself. And now you have to go out in the world of public school and you have 30, 40 kids in your class.”
She’s concerned about patients who have skipped routine screenings over the past several years. The goal is to rebuild partnerships with local schools through an island-wide school health initiative to make preventive care as accessible as possible to kids who need it.
“We haven’t been able to go into schools to provide physicals or do any educational talks,” she says. “That is one of the things that we did pre-pandemic that I would very much like to resume.”
Dr. Penn also looks forward to relaunching a successful physical fitness program in partnership with a local gym certified in CrossFit specifically for children. The six-week session, open to kids ages 5 to 18, focuses on building strength, conditioning, flexibility, and endurance – all of the building blocks for a healthy body. It stands to meet an important need in the community.
“We’ve seen children gain weight during the pandemic because they’re sedentary,” she says. “There’s definitely been an increase in obesity.”
Parents and family members are invited to attend demonstrations on how to prepare quick and healthy meals as well as sessions with a nutritionist.
“The parents have to be involved as well because you can’t just educate the child,” says Dr. Penn. “You have to educate the whole family.”
Telemedicine, which she began experimenting with over five years ago, has been a helpful alternative to phone calls in certain situations, as it allows her to physically see the child as well as bill for the time.
“The parent feels like it’s time well spent and they are willing to pay that co-pay,” she says. “It’s a good option for a lot of people who are solo practitioners — you maximize your time and get compensated for what you do because you’re giving the information anyway.”
With the practice now firmly ensconced in St. Thomas, Dr. Penn reopened the Tortola office in 2019 until the pandemic forced it to close again for five months in 2020. Partners4Kids brought in another pediatrician in January of 2022 and hopes to hire a third by the summer – in time for school physicals. She plans to resume weekend urgent care hours at the St. Thomas office.
Between the expanded team of physicians, as well as several specialist partners including a physical therapist, speech therapist and clinical psychologist, the goal is to ensure that kids in the U.S. and British Virgin Islands have access to the care they need, despite the myriad challenges facing the community.
“We are so elated to have the additional provider support to enable us to reach more children,” she says.