I am an Advocate by Mary Cerulli

At the Health Annex, my role with the prenatal team is to be a patient advocate. I let patients know that I’m here for their non-clinical care needs, for the miscellaneous tasks and challenges of navigating the health system while they’re pregnant. The priorities of the doctors and midwives in the clinic may not be the priorities of the person in their day to day life. One of the most important and unglamorous aspects of my role is to be a receptionist for the prenatal extension. The providers, nurse, and medical assistant all rotate between sites. The extension is one of the only ways a patient can reach a human being at the Health Annex. Sometimes people need to reschedule their appointment because they couldn’t take off work, or they’re unsure how to schedule their ultrasound, or they need their medical records faxed to an immigration status evaluation provider, or they want to share the good news that they had a healthy baby. Sometimes they call because they need a prescription refilled, or a breast pump ordered, or clothes for their new baby. By answering their call and making their concerns my concerns, I am an advocate. By making outreach calls, following up, and relaying messages to providers, I am an advocate.

Pregnancy involves a lot of appointments, a lot of appointments, some with primary care, many with the prenatal team, and several at a hospital. Navigating between health care institutions can be overwhelming for anyone, but it can be especially daunting if English isn’t your first language, you’re unfamiliar with Philly, or nobody explained why you need the appointment in the first place. Patients can be blamed for inefficiencies or miscommunications of the health system, and their care can be disrupted. Tracking down medical records and birth reports from years ago, which contain essential information for the providers, often involves incorrectly listed fax numbers, multiple hospital department transfers, and an outside contracted recordkeeping company. When I go down a medical records rabbit hole, or speak to a frustrated registrar at the hospital, or when I explain the codes on a paper script, I am an advocate.

It’s extremely difficult to access proper prenatal care if you don’t have good, or any, insurance, even if you do come to all the appointments. We don’t offer ultrasounds or specialized prenatal testing at the clinic, and medications can be expensive. I spend a lot time with patients talking through their health insurance options, explaining what documentation is needed, and how they will be able to use it. I spend almost as much time calling in messages for county assistance case workers, compiling documentation of high risk care, or citing little-used sections of the handbook to combat hasty dismissals. When I review official forms with patients, when I reapply, when I provide information for reconsiderations, I am an advocate.

Having your questions answered, making specialty care appointments, and getting insurance applications approved are aspects of prenatal care that should be accessible to every patient. These things should be easy; my role is to make sure they still happen even when they aren’t.


This is one of many portraits of patients and community members painted by Bartram High School students that decorate the Health Annex walls.