Doctor answers call to serve the underserved in Perry County

Many rural counties in Alabama, especially in the Black Belt, are “maternity care deserts.”

Perry County, one of the poorest counties in the state, is staying off that list thanks to the services of a family practice physician with Cahaba Medical Care.

Dr. Laura Lishman offers prenatal care at a Cahaba Medical Care clinic in what is known locally as the site of the “old, old Dollar General store” in Marion, near the train depot.

Cahaba Medical Care is based in Centreville, the county seat of neighboring Bibb County. It’s only 30 miles from Marion, but the social and cultural distance is so great that Cahaba classifies the Marion clinic as its “frontier” program.

“There is a severe lack of resources,” Lishman said. “We are geographically removed from the nearest center of health. Patients that have grown up in this health care desert have not had proper medical care.”

Longterm lack of care leads to “more complicated” patients with untreated diabetes, hypertension and morbid obesity, among other chronic conditions, Lishman said.

“Then when they have preexisting conditions going into pregnancy, they are now unhealthy human beings who are pregnant, which is a much more complicated situation,” she said.

Many family practice physicians who provide obstetrical care refer their complicated patients to obstetricians, but Lishman said she and her team handle all but the most difficult cases close to home at the Marion clinic.

Transportation is one of the major obstacles to care, Lishman said. Her staff helps patients schedule transportation through Medicaid, and some public transportation is available. A van can take a patient to UAB if she needs to see a specialist, but it’s an all-day trip, which is a hurdle for some patients with a job or other kids.  

Transportation is even more complicated if a delivery is too risky to be performed in Marion, according to Lishman. “Using an ambulance is not my favorite thing to do because there is only one in the county, and I don’t want to tie it up,” Lishman said. “I hate to leave the county without an ambulance if someone is having a heart attack.”

She said she tries to avoid transportation issues by scheduling inductions when possible.

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Seeing the doctor early in the pregnancy is also important, and Lishman said she has seen an improvement in that area. “I’ve been here seven years, so the word has gotten out,” Lishman said. “I’ve seen a trend of mothers coming in at the beginning of their pregnancy. I think we’ve built that trust.”

Seeing the patient early in the pregnancy allows her to accurately “date” the pregnancy, Lishman said. An estimate of the due date based on the patient’s last period can vary by weeks, she said.

“Also, seeing the patient early means we are part of the routine,” Lishman said. “We can catch problems early, and we can manage those problems. It’s all about making sure mom and baby are healthy during delivery.”

“We have a lot of amazing success stories,” Lishman said. “I had a patient who came in late in her first pregnancy, but on the next pregnancy she came in at the very beginning and avoided all those complications. That’s what keeps me going.”

Lishman, who grew up in a Chicago suburb, wound up in Perry County through a fortunate misunderstanding. When she was in high school, she was researching Judson University in Elgin, Illinois, when she came across Judson College in Marion, Alabama, instead. When she saw that Alabama’s Judson was affiliated with a Christian church and was an all-girls school, she was hooked.

“Marion became home to me,” Lishman said. “I can’t explain it with logic. It just felt like home.”

When she went to medical school at the University of South Alabama in Mobile, she found the pull to Marion “unwavering,” and she returned to Perry County to visit once or twice a month.

She also found her call to serve the underserved to be unwavering.

“I felt called to be a doctor, to be a medical missionary,” Lishman said. “I saw myself working on a dirt-floor hut in Africa. In my first six months at Judson, I felt like God opened my eyes. He said, ‘This is your mission field right here in your backyard, not on the other side of the world.’”

She completed her residency in family medicine at Cahaba Medical Care and completed a fellowship in obstetrics. She now responds to her call by running the clinic in Marion, and she travels to Camden several times a month as well.

Cahaba Medical Care serves Bibb, Perry, Chilton, Shelby, Wilcox and Jefferson counties. Cahaba Medical Care offers residency programs for family practice physicians, psychiatrists and nurse practitioners at clinics in Birmingham, Tuscaloosa, Centreville and Marion/Camden.