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SUNDAY, DECEMBER 8, 2013 n STATE EDITION

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Wichita Mayor Carl Brewer hopes city staff has abetter 2014.

Brewer – and most council members – say theyare frustrated by a series of high-profile staff mis-steps that invited public backlash this year: thesurprise unveiling of the city’s water crisis and aproposal for fines of up to $1,000 toforce temporary conservation; thebelated vetting of backers of a pro-posal to drill for oil under CenturyII; the belated process to seek pro-posals to develop riverfront landdowntown; and the news that thecity doesn’t track the amount oftaxes it abates for businesses.

“When you’re getting the volumeof information we get, you’re al-ways going to have hiccups. I un-derstand that,” Brewer said. “But the percentages ofthem lately have been too high. We should havevery few.”

Brewer passed his concerns on to City ManagerRobert Layton at a recent planning retreat.

“The ‘I forgot to do that’ and the ‘I don’t know’ justaren’t acceptable before the City Council,” Brewer

HIGH-PROFILE SLIPUPS INVITE BACKLASH

Mayor hopesfor fewermissteps bycity staff BY BILL WILSONThe Wichita Eagle

Brewer

Please see MISSTEPS, Page 13A

Brightly colored chalkcovers the sidewalkoutside the Burkeys’home in west Wichita.

There are ABCs andnames: Mama, Daddy, Kam-ben and Maxton.

Kamben is a toddling19-month-old. He likes “Tho-mas the Tank Engine” and“SpongeBob SquarePants.”

But Maxton will forever be7 weeks old to his parents,Kelci and Kevin.

On May 17, 2011, Maxtonstopped breathing.

He was one of 247 Kansasinfants who died that year –and continue to die each

year, as the state’s infantdeath rates exceed the na-tional average.

In May 2011, Maxton wasat his second day at a homeday care. Though the sitterhad done everything right –

he was on his back, alone ina crib – when she checkedon him, he was blue.

Emergency responderswere able to resuscitate him.But nine days later, the Bur-keys made the painful deci-

sion to remove him from lifesupport.

“The only brain activity hehad were seizures,” KelciBurkey said. “He didn’t doany of the normal things. Hedidn’t have the pupil re-sponse or show any percep-tion to pain. He didn’t haveany of that. …

“It was really hard for us,

A ‘hole in the community’Kansas infant mortality rate higher than national average

Mike Hutmacher/The Wichita Eagle

Kelci Burkey looks at albums with pictures of her son Maxton, who died in 2011 when he was 7 weeks old. The officialcause of death was Sudden Infant Death Syndrome. Maxton was one of 247 Kansas infants who died that year.

Please see INFANTS, Page 15A

BY KELSEY RYANThe Wichita Eagle MORE ONLINE

For more photos and videosrelated to this story, go to Kansas.com.

Coming Monday: Ruralareas struggle with higher infantmortality rates

/Source: Kansas Department of Health and Environment

WASHINGTON — The deal looked sketchy fromthe start.

To outfit Afghanistan’s security forces with newhelicopters, the Pentagon bypassed U.S. companiesand turned instead to Moscow for dozens of RussianMi-17 rotorcraft at a cost of more than $1 billion.

Senior Pentagon officials assured skeptical mem-bers of Congress that the Department of Defensehad made the right call. They repeatedly cited atop-secret 2010 study they said named the Mi-17 asthe superior choice.

Turns out the study told a very different story,according to unclassified excerpts obtained by theAssociated Press.

The U.S. Army’s workhorse Chinook, built byBoeing in Pennsylvania, was found to be “the mostcost-effective single platform type fleet for the Af-ghan Air Force over a twenty year” period, accord-ing to the excerpts.

STUDY: U.S. CHINOOK MORE COST-EFFECTIVE

U.S.-Russiacopter dealfor Afghansraises flagsBY RICHARD LARDNERAssociated Press

Please see COPTER, Page 6A

Jerissa Roundtree lost her daughter 20years ago, but the grief hasn’t faded.

“I took two little outfits to the hospi-tal,” she said. “… You’re never expectingto not bring both of your babies home.”

Roundtree’s twins, Avree and Avana,were born April 17, 1993, at 32 weeks.They were a little more than 4 pounds

each.After a sickly pregnancy, Roundtree –

who already had a set of twin boys, aswell as another son and a daughter –was excited to bring home her two newbaby girls.

But she didn’t hear Avana cry when shewas born at St. Joseph Hospital. Doctorstold her Avana’s lungs were too small

Black infant mortality rate inKansas triple that for whites BY KELSEY RYANThe Wichita Eagle

Please see BLACK, Page 14A

Mike Hutmacher/The Wichita Eagle

Jerissa Roundtree lost one of hertwin daughters 20 years ago. Herdaughter Avana died severalhours after birth because ofunderdeveloped lungs.

ARTS & LEISURE, 1C

WWW.KANSAS.COM14A THE WICHITA EAGLE n SUNDAY, DECEMBER 8, 2013

and hadn’t developed proper-ly.

They whisked her away andhooked her up to machines tohelp her breathe, but themedical staff wasn’t hopeful.

Avana lived about sevenhours, until Roundtree –who had gotten the awfulprognosis from the doctors –told them to unhook her fromthe machines. She wanted tohold her daughter.

“She’s dying anyway,” shetold the doctor. “I want her todie in my arms.

“And so they took her off ofthe little ventilator and thelittle monitor, and they hand-ed her to me.

“They let me hold her aslong as I wanted to.”

The Roundtree family hasexperienced much loss. Otherrelatives have lost infants toSIDS and an accident athome. Another had a stillbornson.

Their story is not unlikethose of other black familiesin Kansas.

In 1993 – the year Avanadied – the black infant deathrate was about three timesthat of whites. Even today, it’striple the rate for whites,though both rates have gonedown.

“It’s still high and amongthe highest. It’s still happen-ing, and it’s very frustrating,”said Jerissa Roundtree’s moth-er, 79-year-old Eddis Round-tree, who helped start theBlack Nurses Association,which has worked to combathigh infant death rates.

“When you think that it’sgoing down and you’re mak-ing headway, you find it goesback up again. We’ve seenchange in cancer, diabetes, alot of things we’ve focused on,but not infant mortality in ourcommunity.”

Eddis Roundtree said shenever lost any of her sevenchildren. She says she doesn’tknow what she would havedone if she had.

“We need to bring attentionto this and make people thinkabout why we are losing all ofthese babies.”

Causes of death

The leading cause for infantdeath varies among ethnicand racial groups. Amongnon-Hispanic blacks, the lead-ing cause is prematurity orlow birth weight, followed bySIDS, according to state data.

Some of the risk factors forlow birth weight – which isdefined as less than 5 pounds,8 ounces – are obesity, smok-ing and lack of access to pre-natal care.

For non-Hispanic whites,the leading cause is congen-ital abnormalities, followedby SIDS.

And for Hispanics, it’s con-genital abnormalities fol-lowed by prematurity and lowbirth weight.

The state has not studiedwhy the leading causes ofinfant death vary by ethnicity,said Greg Crawford, KansasDepartment of Health andEnvironment’s director of vitalstatistics data analysis.

“We are trying to put a lotof information out there toempower local groups andgive them the informationthey need and to make surethey understand the signif-icance of it so they can act onit,” said Crawford, who notedthat health outcomes for oth-er conditions are often pooreracross the U.S. for blacks thanfor whites.

“That is an unacceptablerate. We deal with those num-bers and continue to try toreach the community.

“There’s a substantiallysmaller number of blackbirths and much more in theway of unacceptable out-comes statewide.”

Access to care

Some of the more complexfactors related to lack of ac-cess to care and infant deathsare social determinants, likepoverty, discrimination andracism, health care expertssay.

Preconception stress plays arole, said Teresa Lovelady,executive director of the Cen-ter for Health and Wellness, asafety-net clinic near 21st andGrove in Wichita.

“When you live in an envi-ronment that has so manynegative societal factors ham-mering down – when youlook at poor academic perfor-mance, when you look atcrime rate, standards of hous-ing, brain drain in certainneighborhoods – it createsan environment that breedsviolence and has a lack ofresources to support themeven before they becomepregnant,” she said.

Once they become preg-nant, women often don’tknow where to go, despitethere being two major healthsystems and several clinics intown, Lovelady said. Theyalso often don’t know how toenroll in Medicaid or when toseek care.

At the Center for Health andWellness, officials have hadwomen come in for their firstprenatal care checkup whenthey were already in theirthird trimester.

Lovelady said health servic-es in town are too disconnect-ed and providers should coor-dinate care better so thatpregnant women can more

easily navigate the system.The environment often

doesn’t improve following thebirth of the child.

The mother and her babyreturn to a home with littlesupport, Lovelady said, whichstarts the cycle again. One ofthe reasons the Center forHealth and Wellness wasstarted was to address theissue of infant mortality.

“Fifteen years later, it’s stillthe hot topic issue,” Loveladysaid. “This area is still knownfor a higher than averageinfant mortality rate.

“It’s almost one of thosethings that nobody talksabout. Nobody talks aboutthat kid that died.”

Stillbirths

Non-Hispanic blacks havethe second-highest rate ofstillbirths in the state, accord-ing to 2012 data from thestate. Stillbirths are countedseparately from the infantdeath rates.

At eight months pregnant,Maelee Tolbert, 19, had astillborn daughter. She namedher Miracle.

“I found out I was pregnantthree days before my highschool graduation,” Tolbertsaid. “It was crazy because Ihad also just made the cheersquad at Emporia (State)University and then I foundout I was pregnant. I stillwent to school, but I didn’tget to cheer.”

As a full-time bio-chemistrymajor, her stress level washigh, she said.

Complications started whenshe was seven months along.She was dizzy and had highblood pressure, so she went tothe emergency room in Empo-ria, where she was diagnosedwith pre-eclampsia.

As the complications contin-ued, she stayed at Via ChristiSt. Joseph Hospital forThanksgiving. She lost Mira-cle the next day.

“She was just a pretty littlegirl,” Tolbert said. “I had aphoto shoot with her becauseit kind of just looked like shewas sleeping. She came outlooking like me.”

A memorial was held Dec.9, 2012.

The experience has beenhard for Tolbert. Miraclechanged her life.

“It made me want to domore,” she said. “I didn’t wantto just be depressed. … She’skind of like my motivation.”

Tolbert plans to go back tocollege in January.

Last year, there were 195reported stillbirths in Kansas,which is defined by the stateas a birth of a fetus thatweighs more than aboutthree-fourths of a pound.

The stillbirth rate was high-est for Hispanics at 8.7 per1,000 births. Black non-His-panics had the second highestrate at 6.7 per 1,000, followedby Native Americans at 5.1,Asians at 4.9 and white non-Hispanics at 3.9 per 1,000.

Search for answers

In 2010, the SedgwickCounty Fetal and Infant Mor-tality Review board was cre-ated to collect data on infantdeaths using hospital charts,prenatal records and coronerreports.

The group reviews informa-tion – after removing identi-fying data – and then pre-sents it to a case review team

that has doctors, social work-ers and clinic directors fromaround the area.

“They look at the cases andsee what gaps or services wewere missing or what couldhave helped that client in thatpregnancy that might havehad a better outcome and giveus recommendations,” saidCrystal Bacon, a registerednurse and member of thereview board that works withthe health department.

The recommendations arethen taken to a communityaction team.

“They will be the moversand the shakers that will de-cide what changes need to bedone in the community,” shesaid.

Sedgwick County also offersthe Healthy Babies program,which has prenatal and par-enting classes as well as homevisits by nurses for familieswith children up to 2 yearsold. The program is free re-gardless of income.

Healthy Babies also receivesfederal grant money to help itidentify families in certain ZIPcodes – 67214, 67208 and67218 – roughly between21st Street and Pawnee, andBroadway to Woodlawn.

These are neighborhoods thathave been identified as havinghigher infant mortality rates.

Although many groups inthe state are working to col-lect data on black infantdeaths, it’s time they putplans into action, Loveladysaid.

“At what point do we say,‘Enough is enough, let’s dosomething about the datawe’ve collected?’ ” she asked.“… Your neighbors’ babies aredying more often than thosein Third World countries.”

‘These kids need care’

Roundtree said she hasthought of Avana every dayfor the last 20 years, wonder-ing what she would look likeand how she would act. Herdaughter Avree is now 20 andis a mother, too.

She said it saddens her thatinfant deaths are still so com-mon, particularly amongyoung African-Americanmothers.

“These kids need to knowthat it’s OK to say they’repregnant,” said Roundtree,who has heard of girls whobound their stomach withbandages to hide their preg-nancy.

“They’re not going to thedoctor when they should be,as soon as they should be …because they’re so worriedthat Mom’s going to get madand kick them out or Dad’sgoing to get mad or whoeverthey’re living with. Or so-and-so is going to look down onthem.

“Let’s not do our kids thatway. I really think it makes adifference because these kidsneed care as soon as possible.”

For families that lose achild, the grief is everlasting,Lovelady said.

“All the excitement and joy,”she said. “You bring the kidhome and you have the roomset up. You have this additionto your family and if you haveother kids, they’re connectedto this child and, ‘It’s my littlebrother,’ ‘It’s my little sister,’and then all of a sudden thatbaby is not there anymore.

“That’s a hole in a soul.That’s a hole in the mom, thedad, the kids, the grandma.It’s a hole in the community.”

Reach Kelsey Ryan at 316-269-6752

or kryan@wichitaeagle.com. Follow

her on Twitter: @kelsey_ryan.

BLACKFrom Page 1A

HEALTHY BABIES PROGRAM

The Healthy Babies program through the Sedgwick CountyHealth Department is free for pregnant and new moms. It offershome visits and classes from nurses and teaches safe sleep,breastfeeding, relationships, how to quit smoking and how toprevent early birth.

Mothers who participate in the program can earn items likediapers and other products.

Call 316-660-7433, e-mail healthybabies@sedgwick.gov or visit www.sedgwickcounty.org/healthdept/healthyba-bies.asp.

Courtesy photo

Jerissa Roundtree lost one of her twin daughters 20 yearsago. Avana, right, died hours after birth because of under-developed lungs. Avana and Avree, left, were premature.

Mike Hutmacher/The Wichita Eagle

At eight months pregnant, Maelee Tolbert had a stillborndaughter she named Miracle. African-Americans have thesecond highest stillbirth rate in Kansas, after Hispanics.

“It’s almost one ofthose things thatnobody talks about.Nobody talks about thatkid that died.”

Teresa Lovelady, Centerfor Health and Wellness

WWW.KANSAS.COM SUNDAY, DECEMBER 8, 2013 n THE WICHITA EAGLE 15A

and that is not an easy deci-sion that any parent shouldhave to make. But as parents,we knew that that wasn’tMax,” she said. “Max was –he never smiled – but he wasa happy baby. He was alwayssticking out his tongue. See-ing him lay there like that,that wasn’t Max.”

Authorities recorded theofficial cause of death as Sudden Infant Death Syn-drome.

“We were mad,” Kevin Bur-key said. “We wanted a rea-son or a why and that’s noth-ing. That’s completely in-conclusive.

“Basically, they don’t knowthat it’s anything else. It washard to hear.”

Slow progress

That’s the heartache behindthe numbers.

Although the state of Kansashad record-low infant deathrates in 2011, the rate in-creased 2.8 percent in 2012,when 254 children in Kansasdied before their first birth-day.

For some groups, such asAfrican-Americans and resi-dents in rural areas, the rateof infant deaths is even high-er.

Longer term, rates for infantdeaths in Kansas have steadilydeclined since the state begantracking the numbers morethan 100 years ago. Generally,worldwide, infant mortalityrates decline as health care,living conditions and nutri-tion improve for mothers andtheir children.

“We consider every infantdeath a sentinel event andsomething to pay attentionto,” said Greg Crawford, Kansas Department of Healthand Environment’s director of vital statistics data analysis.

The estimated rate of infantdeaths for the U.S. in 2013 is5.9 out of 1,000 live births,only slightly better than coun-tries such as Croatia and Bos-nia, according to the CIAWorld Factbook.

The U.S. ranks 50th best of224 countries, worse thanHungary (5.16), Japan (2.17)and most of Europe.

According to the KansasDepartment of Health andEnvironment, the overallKansas resident rate was 6.3infant deaths per 1,000 livebirths in 2012.

One statistic that has espe-cially troubled Kansas healthcare providers is the histor-ically high rates of mortalityfor black infants. It’s stillabout three times higher thanwhites, even though all of therates have declined over thelast 20 years.

There are also differences inrates between rural and urbancounties. State statistics for2012 show that rural anddensely settled rural areashave higher rates than urbancounties.

Reducing SIDS risks

The factors behind infantdeaths are complicated, saidChristy Schunn, executivedirector of the Kansas InfantDeath and SIDS Network, anonprofit support networkbased in Wichita that providesservices to families across thestate and works to raiseawareness of sudden infantdeath.

“The death of a child is acomplicated loss,” Schunnsaid. “It is unnatural. Oursocietal norms are that olderpeople die and that parentsdie before children.

“So it’s an unnatural processto have a child die before aparent. We don’t anticipatethat, and we have no prep-aration.”

In 2012, the leading causeof infant mortality in Kansaswas prematurity or low birthweight, followed by congen-ital abnormalities and SIDS orsuffocation in bed.

Although most people haveheard of Sudden Infant DeathSyndrome, it is more a de-scription than a cause, and isnot well understood by med-ical researchers.

The number of cases classi-fied as Sudden Infant DeathSyndrome in Kansas has de-creased over the last 15 years,Schunn said. But what ishappening, she said, is a reca-tegorization of infant deaths,where the death is listed asundetermined instead of asSIDS.

“This is a national trend aswell,” Schunn said. “If there isa loose blanket in the bed, apillow in the bed or the babyis in an unsafe position, it’s

difficult to determine if thecause of death was SIDS or due to that item in the bed.

“There are SIDS deaths and there are sleep-relateddeaths, and so the actual SIDSnumber has gone down butinfant mortality has not.”

Research on SIDS has in-creased in the last 10 years,Schunn said. Although thereis no way to completely guardagainst SIDS, there are waysto reduce risk.

“If you put a baby on itsback, alone in a crib in asmoke-free environment, youreduce the risk,” she said.“But there’s still a potentialthat you can do all of the risk reductions and the infantwill still die of SIDS, andthat’s where the research isneeded to find out exactlywhat’s going on with thebrain stem, with the way thebaby is breathing and func-tioning.”

Schunn said research hasdetermined that SIDS is oftenthe result of a combination ofseveral things happening at the same time: an underly-ing abnormality in the infant,

its age and an additionalstressor.

“Say we have a baby with abrain stem abnormality, wehave a baby that is vulnerablebecause of their age, and then when that is combinedwith a third stressor – whichcould be a blanket, a smokingenvironment, a position on the tummy or the babygetting too warm – thosefactors coming together at thewrong moment is when wehave SIDS.”

First, healthy women

Over the last several years,health care providers andpublic officials have formedseveral groups to addressKansas’ infant mortality rates,including the Kansas BlueRibbon Panel on Infant Mortality and the SedgwickCounty Fetal Infant MortalityReview board, which has a case review team that talks about every infant mor-tality death in SedgwickCounty.

The Sedgwick CountyHealth Department has theHealthy Babies Program, afree program for pregnantand new moms that offershome visits from nurses andteaches things like safe sleep,breastfeeding, relationships,how to quit smoking, basicbaby care and preventingearly birth.

“Thank goodness for localhealth departments. That iswhere the work is gettingdone,” said Crawford, theKDHE official. “They developlocal solutions and identifythe needs of the communityand respond.

“That’s the best effect we

can have to move infant mor-tality downward.”

For local health departmentofficials, the issue and itssolution are complex.

“There’s a lot of social determinants and social fac-tors that influence thesehealth outcomes, and all of the health outcomes anddisparities in the community,”said Roderick Harris, divisiondirector for children and fam-ily health at the SedgwickCounty Health Department.

“So we can do our part as ahealth department … as theHealthy Babies program toinfluence it – but we can’t doit all.”

One major issue is access toprenatal care.

“We need healthy women tohave healthy babies,” Schunnsaid. “We need to havehealthy young girls to becomehealthy young women to havehealthy babies.

“It’s astonishing to me thatthe infant mortality rate is sohigh based on the number ofprograms and medical know-ledge that we have. It’s apuzzle trying to get to thebottom of why the rates are sohigh.”

‘Rainbow Baby’

Kamben, at 19 months, ispast the age for SIDS, butKelci Burkey still checks tomake sure he’s breathingduring the night.

She calls him their RainbowBaby.

“A Rainbow Baby comesafter the storm,” she said. “Itdoesn’t mean the storm didn’thappen or wasn’t terrible, butsomething good can come outof it, and that was Kamben forus.

“We were scared and happymore than anything, but Kam-ben was hope for our families.It told them, ‘Hey, they’regoing to make it.’ ”

“We have nieces and ne-phews and friends with kidsin the same age group as Max,so we always wonder, ‘Would

he be doing that, too?’ or‘What would he be sayingright now?’ ” Kevin Burkeysaid.

“A lot of ‘What ifs?’ ”The Burkeys try to look

at the positives. They wereable to donate Maxton’s heart valves. And through afundraiser, they helped theHoisington ambulance service get equipment to helpinfants. They both grew up inthe Hoisington-Great Bendarea.

Kelci has also pursued herdream to become a physi-cian’s assistant. She had triedtwice to get into the programat Wichita State Universitybefore Maxton died.

“We were in the hospital for nine days and had in-credible nurses, PAs and phy-sicians for the worst days ofour lives,” she said. “It reit-erated why I wanted to be inmedicine.

“We left and Kevin said,‘You will apply again becausethis is what you’re supposedto do.’ And that year I got in. Iwill graduate in July 2014.”

They’ve also come closertogether.

“They say a lot of times thiscan break marriages apart,but in all honesty I think thatMax has made us nothing butstronger,” Kelci said.

“We really had to be in tune with each other. WhenKevin was having a bad day, I knew it was just a bad day. It wasn’t because of me, it was because our son haddied. … I still have really baddays and Kevin rescues meand says we’re going to beOK.”

Kevin wears a necklace andKelci wears a ring with Max-ton’s fingerprint.

“I got to spend two monthswith my son,” she said. “Thebest two months I’d ever had,and I got to spend them withhim.”

Reach Kelsey Ryan at 316-269-6752or kryan@wichitaeagle.com. Followher on Twitter: @kelsey_ryan.

SOME LOCAL RESOURCES

n Kansas Infant Death and SIDS Network: 316-682-1301,www.kidsks.org

n Sedgwick County Healthy Babies Program:316-660-7433, healthybabies@sedgwick.gov, www.sedgwickcounty.org/healthdept/healthybabies.asp

n Sedgwick County Women, Infants and Children (WIC):316-660-7444, www.kansaswic.org

n Sedgwick County Health Department pregnancy test-ing and family planning, 316-660-7300, www.sedgwickcounty.org/healthdept/familyplanning.asp

n Medicaid services for pregnant women and children:Visit a local safety net clinic for in-person help to apply, or call800-792-4884 or visit www.kancare.ks.gov/apply.htm.

THE ABC’S OF SAFE SLEEP

Experts encourage infants to be Alone, on their Back andin a safety-approved Crib as a way to reduce the risk ofSIDS.

n Avoid loose blankets in the crib.n Do not use bumper pads.n Remove all loose bedding, toys and stuffed animals from thecrib.n Make sure the room is a comfortable temperature and not toohot.n Don’t put a baby to sleep with its head covered.n Don’t co-sleep with an adult or another child in bed.

Information: www.kidsks.org/Safe-Sleep.html

Mike Hutmacher/The Wichita Eagle

Kelci Burkey holds photos of her son Maxton and her husband, Kevin. Maxton died of SIDSin May 2011 when he was 7 weeks old.

INFANTSFrom Page 1A

Mike Hutmacher/

The Wichita Eagle

Kelci Burkeywears a ringwith thethumbprint ofher sonMaxton, whodied in 2011 atthe age of 7weeks.

Kelsey Ryan/The Wichita Eagle

Chalk on the front sidewalk at Kelci and Kevin Burkey's home in west Wichita spells out thenames of family members, including Maxton, who died in 2011.

Mike Hutmacher/The Wichita Eagle

Kelci and Kevin Burkey live in west Wichita with their 19-month-old son Kamben. She calls him their Rainbow Baby.

Courtesy photo

Kevin and Kelci Burkey's son Maxton was “a happy baby,”Kelci said. “He was always sticking out his tongue.”

“It’s astonishing to me that the infantmortality rate is so high based on thenumber of programs and medical knowledgethat we have. It’s a puzzle trying to get tothe bottom of why the rates are so high.”

Christy Schunn, executive director of the Kansas

Infant Death and SIDS Network

Kansas comMONDAY, DECEMBER 9, 2013 75 CENTS

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Only a handful of projects remains on the Wichitaschool district’s bond issue to-do list.

But with bond funds and capital outlay moneydwindling, district leaders face some tough deci-sions.

“The main issue is where we come up with moneyfor the expanded projects,” said school board mem-ber Joy Eakins.

“We’ve got to do something,” she said. “But we asa board need to decide what the best thing movingforward is, and what’s fair, so I think it’s difficult.”

At issue is whether the district can afford to buildan auditorium at Robinson Middle School and re-place an aging wing of classrooms at Caldwell

ON TO-DO LIST OF SCHOOL BOND ISSUES

Mike Hutmacher/The Wichita Eagle

Robinson Middle School seventh-gradersrehearse for a program in the old auditorium.

Board totake hardlook atprojectsBY SUZANNE PEREZ TOBIASThe Wichita Eagle

Please see PROJECTS, Page 2A

JOHANNESBURG — South Africans on Sundaybegan a week of commemorations following thedeath of Nelson Mandela with what officials called aday of prayer and reflection, gathering in places ofworship, homes and open fields to offer spiritualhomage to the man who embodied the battleagainst apartheid.

For the country’s politicians, it was a time to urgeunity and continuity after the death Thursday ofMandela, 95. But for others, the eulogies wereweighted with concern about the future, adding asharper edge to their prayers for peace in the post-Mandela era.

In the vast squatter camp of Diepsloot north of

FORMER LEADER PRAISED FOR HIS HUMANITY

S. Africansembark onday of prayerfor MandelaBY LYDIA POLGREEN AND ALAN COWELLNew York Times News Service

Please see MANDELA, Page 2A

For Waylon Schaefer, therewould be no baby showerand no nursery.

“I couldn’t come hometo a house with a nursery andno baby,” said AmandaSchaefer, a sixth-grade teach-er at Emporia Middle Schoolwho found out when she was25 weeks’ pregnant that herson, Waylon, had a congenitalabnormality that kept hisdiaphragm from developingproperly. His chances of sur-vival were about 50-50.

“I held off completely once Ifound out how sick he was,”Schaefer said.

“I hate to say it was moth-er’s intuition, but I knewsomething wasn’t right. Withmy daughter, everything wasdone. The bedroom was fin-ished and ready to go.”

At 32 weeks, she went intopre-term labor and was trans-ported from Emporia to Kan-sas City with her husband,Hoyt, to have their son.

Waylon was born on March3, weighing just 3 pounds, 11ounces. Doctors tried for 30minutes to stabilize him, buthe died.

In Kansas, infants die athigher rates than the nationalaverage. And the infant mor-tality rates in Kansas are high-er for babies born to womenwho live in rural and denselysettled rural areas comparedto infants born to women

who live in frontier (less thansix people per square mile),urban and semi-urban areas,according to state vital statis-

tics data from 2008 to 2012.The Schaefers live in Lyon

County, which is considered adensely settled rural area,

with 20 to 39.9 people persquare mile.

Although the rates are high-er for those rural areas, about70 percent of the state’s in-fant deaths last year occurredin semi-urban and urbanareas.

Kansas has struggled toimprove infant mortality ratesover the past couple of dec-ades. Although the state’s rateof infant deaths has improvedover that time, as has thecountry’s in general, Kansas

Certain rural areas havehigher infant death rates

Mike Hutmacher/The Wichita Eagle

Anna and Noah McLaughlin lost their son Tristin to SIDS in December 2011 when he was 5months old. Twin sister, Rustin, 2, and sisters Harley, 3, and Hope, 10 months, visit his grave.

/Courtesy photo

Tristin McLaughlin, who died of SIDS in December 2011 whenhe was 5 months old, is shown with his twin sister, Rustin.

Lack ofaccess tocare may bea factor

ONLINEFor more photos, video

and an interactive mapshowing birth rates andinfant mortality rates bycounty, go to Kansas.com.

Please see INFANT, Page 5A

BY KELSEY RYANThe Wichita Eagle

Alijah Keckler is enjoying hisnewfound freedom.

Last month, the 18-year-oldmoved into a one-bedroomapartment at McComas Cross-ing, Starkey’s newest apartmentcomplex designed to help peo-ple with intellectual disabilities.It is the first time Keckler hasever lived by himself.

Until now, he has lived mostof his life in foster homes. Justlast week he was released fromstate custody and now, for thefirst time, is his own guardian.

“It’s nice,” he said.Starkey’s McComas Crossing,

near Central and West Street,has 22 units for people withintellectual disabilities. Con-struction on the $2.2 millionapartment complex began inFebruary. Keckler was the first

person to move in; additionalresidents are set to move inthrough December and earlyJanuary.

Starkey serves nearly 500people in the Wichita area,helping to provide employment,life enrichment and case man-agement programs. It has about45 homes in the area and twoapartment complexes wherepeople can live with some staffsupport.

“It is the final level of inde-pendence we can offer peoplebefore they find their ownapartment and home in thecommunity,” said Colin McKen-ney, CEO of Starkey Inc. “This issomething we had been think-ing about for a long time.”

The new apartments are inaddition to Starkey’s Kouri PlaceApartments, built in 2004 at 140

APARTMENTS FOR THOSE WITH INTELLECTUAL DISABILITIES

McComas Crossing complex gets first tenantBY BECCY TANNERThe Wichita Eagle

Please see TENANT, Page 6A

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still exceeds the national averages for infant deaths.

The overall Kansas residentrate in 2012 was 6.3 infantdeaths per 1,000 live births,according to the Kansas De-partment of Health and Envi-ronment. The estimated na-tional rate for 2013 is 5.9deaths per 1,000 live births,according to the CIA WorldFactbook.

In rural counties, wherethere may be relatively fewbirths, even small increasesin the number of deaths yearto year can look drastic be-cause of the smaller pop-ulation. To help combat that,public health officials oftenlook at numbers on a five-year rolling average to findtrends.

“In a small county like inwestern Kansas, 12 infantdeaths can be a really highrate,” said Greg Crawford,Kansas Department of Healthand Environment’s director ofvital statistics data analysis.

For instance, RawlinsCounty in northwest Kansas,which has a population ofabout 2,500, had the highestinfant death rate on averagefrom 2008 to 2012, but ithad a total of three infantdeaths during those years.

Access, prenatal care

Women in rural areas oftendon’t have the same access tocare as women in more ur-ban areas.

Of the roughly 40,000 livebirths in Kansas last year,nearly 18 percent of pregnantwomen received “inadequate”or “intermediate” prenatalcare, according to state data.Lower levels of care weremore likely to occur in ruralareas than in urban areas.

Among the counties withthe highest rates of “inade-quate” prenatal care, accord-ing to state data, were Chau-tauqua, Comanche, Edwards,Finney, Grant, Greeley, Ha-milton, Kearny, Meade, Se-ward, Stanton, Trego andWichita – most of which arein western Kansas.

Three of the five countieswith the highest birth rates inthe state are in southwestKansas: Finney, Ford andSeward. The other two areWyandotte and Geary coun-ties.

Statewide, more than 2,100women who gave birth in2012 didn’t seek prenatalcare until they were at leastsix months’ pregnant, accord-ing to the KDHE report. Morethan 350 women neversought prenatal care beforebirth.

Socioeconomic disparities,including insurance coverage,also play a role in how andwhen women seek care dur-ing pregnancy.

Christy Schunn, executivedirector of the Kansas InfantDeaths and SIDS Network,said it can be difficult to getinformation about safe sleeppractices and other prenatalcare to women who live inrural areas.

“Access to health careseems to be a concern,” shesaid. “I talk to a lot of fam-ilies who have had infantsdie, and they didn’t havemedical insurance and by thetime they got insurance, theywere halfway through theirpregnancy. We need earlyprenatal care.”

According to the KansasHealth Institute, those wholive in western Kansas coun-ties are more likely to beuninsured.

In cases where rural fam-ilies know they are at risk ofhaving complications witheither the delivery or thebaby, the distance to a neo-natal intensive care unit alsocan play a role.

“If transported, it may betwo or more hours beforethey can get to a Level 3NICU,” said Diane Daldrup,state director of programsand government affairs forthe Kansas chapter of Marchof Dimes. “In those ruralcommunities, they may nothave a hospital at all andcertainly won’t have a high-level NICU.”

“For those pregnancies theyknow are going to be difficultdeliveries, where maybe themom needs to deliver at afacility that has more intenseservices, you see some ofthose births directed to Wich-ita hospitals or to Topeka orKansas City,” said Crawfordof the KDHE.

“(Rural) hospitals make agood effort to do that, but

the risk factors are thosedeliveries that they thoughtwere going to be fine andsomething happens wherethey can’t really quantify ituntil things are starting.”

For lower-income families

who know there will be acomplicated birth, it can befinancially difficult to go tocity with an NICU and waitfor the baby to come, Dal-drup said.

“Folks might not have mon-ey for hotels, and they needa place to stay while theywait,” she said.

Maternal factors

Infant mortality is a reflec-tion of community health,and the health of the motheris a key indicator of howhealthy a pregnancy will be,Daldrup said.

Prematurity is one of thetop factors for infant mortal-ity. Some of the main factorsassociated with prematurebirths include the age of themother, with higher risks foryounger and older women;infection; carrying multiples;high blood pressure; stress;late prenatal care; and usingtobacco or other regulatedsubstances.

In 2012, more than 5,400pregnant women in Kansassmoked at some point duringtheir pregnancy. On average,maternal tobacco usage ratesat any time during pregnancy

are lower in urban areas,according to KDHE data.

“(Smoking) is one of thehighest factors in low birthweight and premature ba-bies,” Daldrup said. “And ifthose babies go home towhere parents are still smok-ing, it has a detrimental im-pact on them. Those babiesdie of SIDS more often.”

In 2012, the counties withthe highest percent of ma-ternal tobacco use – greaterthan 25 percent at any timeduring pregnancy – wereAllen, Atchison, Brown,Chautauqua, Cherokee,Cloud, Norton, Rooks, Russelland Stafford.

Higher instances of teenpregnancy also lead to higherrates of premature births,Daldrup said.

Teen pregnancy rates havesteadily decreased through-out the state, and 2012 –with 3,331 teen births – hadthe lowest pregnancy rate forwomen under 20 in at leastthe past 20 years.

The highest rate for birthsto unwed teens is in frontiercounties – those with lessthan six people per squaremile.

“(Teens) don’t have thesame social support adultwomen have in many in-stances,” Daldrup said. “Ifthey are in high school, theymay have lost peer relation-ships because they’re preg-nant, and sometimes theylose family support becauseof the issue.

“If teens get into socialsupport groups, they havemuch improved birth out-comes. They want to investin their own pregnancy andtake better care of them-selves.”

‘Keep me going’

But even when familieswork to do everything rightto ensure they have healthybabies, things can still gowrong.

In El Dorado, Anna andNoah McLaughlin werestunned to find out they werehaving twins.

“We had just wanted onemore, but God gave us two,”Anna McLaughlin said. “Itwas a shock, and we werejust so overwhelmed andexcited and scared and ner-

vous all in one.”She went into pre-term

labor at 32 weeks and had aboy, Tristin, and a girl, Rus-tin, on July 9, 2011.

Tristin had a metabolicdisorder and was in NICU fortwo weeks.

“At 5 weeks, he camehome. Everything was goinggreat, getting into the grooveof having two babies and(our oldest daughter) Harley,who wasn’t even 2 yet.”

When Tristin was 5 monthsold, Anna McLaughlin laidhim down for his afternoonnap.

“When I went to get him,he was gone. I started yellingfor Noah, and he did CPRand everybody came, but itwas too late,” she said.

They held the funeral theday after Christmas.

“I don’t know how she doesit – staying here where ithappened,” Noah McLaughlinsaid of his wife, who is ahomemaker.

“I get to go to work everyday and get away from here.Even now, almost two yearslater, if I have a day off, I justcan’t hang around here. It’sjust an uneasy feeling ofwhat happened.”

“One thing that’s hard isyou’re trying to grieve, but Ihave other little girls to takecare of, so I have to buck upand take care of them,” AnnaMcLaughlin said.

“But in another way, it’s ablessing to have them to keepme going and not just bestuck in a dark place. Wehave a great church familythat’s helped us, and ourfaith has helped us a lot,knowing that even thoughwe think we’re better care-takers, Christ is the ultimatecaretaker.

“We go out and visit Tris-tin. We know where Bubbais, right?” she asks herdaughters Harley, 3, Rustin,2, and Hope, 10 months.

And every year aroundTristin and Rustin’s birthday,the family goes to the cem-etery and releases balloons.

Reach Kelsey Ryan at316-269-6752 orkryan@wichitaeagle.com. Followher on Twitter: @kelsey_ryan.

INFANTFrom Page 1A

Mike Hutmacher/The Wichita Eagle

Tristin McLaughlin’s sister Hope, 10 months, visits Tristin’s grave in El Dorado with thefamily.

/Courtesy photo

Amanda Schaefer’s son Waylon died shortly after birthfrom a congenital defect called congenitaldiaphragmatic hernia. The Schaefers live in Emporia.

DEFINITIONS

Frontier: Less than sixpeople per square mile

Rural: Six to 19.9 peopleper square mile

Densely settled rural:20 to 39.9 people persquare mile

Semi-urban: 40 to 149.9people per square mile

Urban: 150 or morepeople per square mileInformation: KansasDepartment of Health andEnvironment

RISK FACTORS FOR

PREMATURE BIRTHn Age of the mothern Infection n Carrying multiplesn High blood pressuren Stress n Late prenatal caren Using tobacco or other

regulated substances

RESOURCES

n Kansas Infant Deathand SIDS Network:316-682-1301, www.kidsks.org

n Kansas Women,Infants and Chidren:785-296-1320, www.kansaswic.org

n March of Dimes,913-469-3611, www.marchofdimes.com/kansas

n Medicaid services forpregnant women andchildren: Visit a local safetynet clinic for in-person helpto apply, call 800-792-4884or visit www.kancare.ks.gov/apply.htm