Once again, the experts are studying the startling infant death rate in Anacostia, the city's poorest neighborhood.
Only this time, they are analyzing what went right rather than what went wrong.
In 1980, Anacostia's Ward 8 had an infant mortality rate of 27.2 per thousand, the highest level of any ward in a city still struggling to keep from regaining its position as No. 1 in infant deaths among large U.S. cities.
By 1982, Ward 8 had made a seemingly miraculous turnaround, cutting its rate in half to 13.7--and accounting for most of the city's infant death rate decline from 24.6 to 20.3 during that period. Why the dramatic drop in Anacostia when the area changed little?
Though experts say its too early to know for sure, Anacostia in the last two years has been the scene of a multifaceted attack on infant death, with local hospitals, city officials and federal agencies launching a variety of new health programs.
Some were basic: teaching pregnant women to eat right, get plenty of sleep and come in for checkups. Some were complex: getting more training and equipment for hospital staff, a hot line to identify open beds at hospitals with specialized infant care and transportation to rush babies and mothers to them.
"What happened in Ward 8 was that we did a total approach to it," said Dr. John H. Niles, chairman of the Mayor's Advisory Board on Maternal and Infant Health. "If we did that in every ward, we could really make a difference."
The efforts of some in the Anacostia war on infant deaths stand out.
Dr. Dorothy Hsiao and Dr. Paul Domson at Greater Southeast Community Hospital, the only hospital in the area that delivers babies, worked on saving high-risk babies by purchasing more sophisticated equipment and intensifying staff training.
They put infant resuscitators into the delivery room for all high-risk pregnancies, added staff trained to do resuscitation and new neonatal monitors. They established policies for getting high-risk mothers and threatened newborns to higher intensity care available at other hospitals. As a result, Greater Southeast had a dramatic drop in the number of babies dying in the first 28 days after birth, when most infant fatalities occur.
Nurse Sallie Eissler of Greater Southeast started teaching expectant mothers about what they should do during pregnancy and delivery and after.
She found a "truly amazing" lack of information, she said. One patient got pregnant because she didn't understand that her birth control pills were to be taken orally instead of inserted vaginally. Another woman believed grape jelly would work as well as contraceptive gel with her diaphragm.
Meanwhile, Harold Ferguson, an outreach worker at Hadley Memorial Hospital, went out in a bright blue van and began literally knocking on doors to talk with women at home about health care and how to get it under a joint city/federal/hospital effort.
He would visit shopping centers and day-care centers and any other place young women might gather to pass out flyers and get them needed health care as early as possible, preferably before they became pregnant. He would make appointments for people, who would be called to reschedule if they failed to show up.
Hot lines to coordinate hospital resources and transportation systems were developed, and the city put a Women, Infants and Children (WIC) nutrition program in at Hadley that now serves about 1,000 area participants.
But as Ward 8's infant deaths dropped from 47 in 1980 to 23 in 1982, baby deaths in two other areas of the city increased. In Ward 5, a mostly poor section of Northeast, the infant mortality rate rose from 24.7 in 1980 to 32.3 last year.
"We had begun to realize that Ward 5 is changing, but we're not sure how . . . ," said Alicia Fairley of the city's Office of Maternal and Child Health. "We have been looking at it since last April."
Much of the effort to reduce infant deaths is focused on preventing problem births, particularly low-birth weights, which are directly linked with infant deaths. That meant simply getting pregnant woman to the doctor well before delivery.
"We believe there are young women at the housing projects that don't go outside . . . at all," Fairley said. "They just stay there and go to the hospital when they come to term."
Leonard Harris, Hadley director of stragetic planning, said helping women apply for Medicaid eventually leads to better health care and fewer infant deaths.
"It means access to health care," Harris said, because hospitals and doctors do not want to take patients who cannot pay.
Joyce Lynch is the mother of a healthy 3-month-old girl, Erica. Lynch lives near Hadley and went there when she was eight months pregnant, concerned that her doctor was not giving her enough information about her first pregnancy.
"He wasn't telling me anything I wanted to know," she said. "He would just check the baby's heartbeat and that was it." She delivered at Greater Southeast, and both there and at Hadley everything was explained in detail, Lynch said.
Francine Harris, who took part in a Hadley prenatal care program, is the mother of five children, including 3-month-old twin boys born at D.C. General. Her experience with the twins was different from that of the previous births, she said. "They were more like a family to me," she said of the Hadley medical workers. " . . . If I got too lazy to come, I got a phone call. They would fuss at me."
Despite such efforts, Eissler estimates that as many as one-third of the women who deliver at Greater Southeast still have no prenatal care.
More recent efforts to fight infant mortality include an infant transport system run by the fire department to get threatened babies to hospitals with specialized care. Georgetown University Hospital last summer started a maternal transport system, the only one in the city, to get high-risk mothers throughout the area to the specialized facilities at Georgetown before they deliver.
And the city's hospitals only recently agreed to allow outside inspection teams to look at their nurseries, find flaws and make suggestions for improvements. The inspections began last week.
The Greater Washington Research Center has won funds to develop a pilot project aimed at preventing low-weight births and Mayor Marion Barry has asked city school officials to develop a family planning program for junior high schools.
In the middle of all this is the crucial issue of money, particularly with sharp cutbacks in federal funding.
The mayor's advisory board has formed a nonprofit foundation that will solicit funds for city programs from national corporations and foundations to help finance a $14.5 million wish list aimed at reducing infant mortality in the District. Most of the money would be used to provide more high-risk infant care at city hospitals.
"We have done such a tremendous job with Ward 8," said Niles, chairman of the city advisory board on infant health. "If the money runs out, we can only go backwards."