Clinic Adapts to Special Needs of Patients
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The specialized exam table is designed to make transfers from wheelchairs easier and safer for patients.
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The UAB Reproductive Health Clinic for Women With Disabilities is one of a handful of such facilities in the region and the only clinic in Alabama that offers specialized gynecological care to disabled women. The clinic began in 1988 to serve women with physical disabilities who often encounter physical, attitudinal, and informational barriers to health care. Its specialized services draw patients from across the nation, especially from Florida, Virginia, and Arkansas.
“Our clinic is successful because we have eliminated many obstacles these patients face,” says UAB Physical Medicine and Rehabilitation Chair and clinic founder Amie B. Jackson, MD. Nationwide, women with disabilities make up one of the most underserved populations for preventive health care, according to the FISA Foundation, an organization that provides grants to nonprofit groups working to improve the lives of girls and women with disabilities.
“A problem as simple as moving from a wheelchair to an exam table is one of the major obstacles these women must overcome,” she says. UAB’s clinic has a wheelchair-height obstetric and gynecology chair that reclines into an exam table. Clinicians also can use alternative positioning to perform gynecologic examinations. Patients’ disabilities range from severe spasticity to problems with flaccidity, that make use of a traditional exam table difficult.
Unrecognized Problems
Uncommon problems accompany certain disabilities, Jackson says. “People with quadriplegia complicated by autonomic dysreflexia sometimes find the gynecological examination painful or uncomfortable. The way their bodies feel and react are no longer under their conscious control, and they respond atypically.” In addition, autonomic dysfunction can lead to extremely high blood pressure, headache, stroke, and death.
“Such situations can become medical emergencies if the doctor does not know what is causing the problem and does not take measures to correct it,” she says. Disabled women also experience related conditions, from chronic pain to mental changes associated with stroke or traumatic head injuries, urological difficulties, and unusual musculoskeletal and joint problems.
Many women with disabilities report attitudinal barriers from health care providers who assume they are asexual and do not offer preventive health care such as contraceptive counseling or screening for sexually transmitted diseases. Of the 12,000 individuals who sustain a spinal cord injury in the United States each year, only 20% are women, and most postinjury sexuality information emphasizes care for male patients (J Midwifery Womens Health. 2006;51[6]:450-456).
Jackson also provides sexual counseling for women with disabilities. “Many of these women lack knowledge about their conditions. I counsel them about sexual adjustment problems their disability can cause and make sure they have a clear understanding of birth control,” she says.
Jackson refers patients with disabilities who need obstetrical care to UAB’s Division of Maternal and Fetal Medicine, which specializes in high-risk pregnancies. “Disabled women require care from clinicians who understand their reproductive health and disability,” she says.
For more information contact Dr. Amie Jackson at 1-800-UAB-MIST or at mist@uabmc.edu.