Kacey Eichelberger (’18) develops first clinic in Upstate South Carolina for pregnant women with substance use disorder

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Kacey Eichelberger grew up in Columbia, South Carolina. Kacey’s mother was an oncology nurse, and her picture hangs in Kacey’s office today. “She is just a deeply compassionate person. I told her one day that I wanted to be a nurse, and she laughed and said, ‘You don’t want to be a nurse. You like to be in charge too much. You want to be a doctor.’” Today, Kacey is a professor and chair of the Prisma Health Department of Obstetrics and Gynecology in Upstate South Carolina.

She had an interest in social justice and medicine from the start, but Kacey wasn’t always sure of her path. After graduation from Duke University, she spent one year in Zimbabwe working with people living with HIV, an experience that solidified her desire to become a doctor.

Witnessing the impact of substance use disorders

During her residency training in North Carolina, Kacey witnessed the impact of the rising opioid epidemic and the lack of widespread training in the field. “We started seeing so many women coming in for prenatal care who very clearly had stories consistent with a substance use disorder disease, yet we had no formal training in that. We simply had not been taught how to treat it.”

As Kacey continued in her career and became a maternal-fetal medicine subspecialist, the dissemination of knowledge and treatment of substance use disorder was still not widespread in her field.

 A lot of us would provide what I would consider exceptional care for very complex medical diseases in which we had been trained. We would get together at meetings and cover a list of conditions like heart disease and diabetes. But when it came to substance use disorders, none of us had significant training or knew where to start.”

One evening, Kacey’s path crossed with a patient that would deeply impact her. Intensive Care Unit (ICU) doctors requested her help with a pregnant patient that overdosed and was on life support. “Up to that point, this patient had done everything right. She had gone to all of her appointments; she had made the right steps to get care. Now she and her child would both die. When I realized that I had been the doctor to read her first ultrasound, it suddenly felt very personal to me. It was a wake-up call for sure.”

Deciding to take action

Kacey was in her Liberty Fellowship seminars at the time and continued to think about what would be needed to create change.

I was in reading and deep dialogue with people from lots of different backgrounds, and we were having this conversation about what would be the thing that you wanted to change for South Carolina? What would be the fingerprint that you want to leave, even if it’s tiny?”

Designing a new model of prenatal care for women with substance use disorders became Kacey’s Liberty Fellowship Impact Venture. “One of the sweetest invitations of Liberty is to enter an exercise with other South Carolinians around the moral imagination. What would it look like for this to be a better place? For me personally, the question is: What would it look like to reframe a healthcare environment such that the provision of care and the experience of care feels infinitely more loving and satisfying for the medical team and the patient?”

She knew she was going to need help. “I had no unique skills in that space. I knew very little about mental health. I knew nothing about addiction medicine. But I knew there were folks in the community who did.” Kacey decided to reach out to Kimbley Smith, women and children services director at The Phoenix Center and Serenity Place.

Collaboration to create The Magdalene Clinic

Kimbley still remembers her first conversation over coffee with Kacey nearly six years ago. Kacey drew her idea on a piece of paper. “She understood that although doctors and medical care are important, the key piece is creating a program and support system that will help the patient sustain recovery,” Kimbley said.

First, the patients would come together for treatment and services under one roof. Pregnant women with substance use disorder are typically dispersed throughout offices and clinics, and that was not the treatment approach for other pregnant women with other diseases

At each appointment, patients could not only receive prenatal medical care, but also talk with a peer support specialist and receive help from a social worker. Kacey would serve as the clinic’s physician through Prisma Health, who also provided the space and the social work support, and Kimbley would provide the peer support specialist, licensed clinical counselor, and a pathway into residential care from The Phoenix Center.

Kacey and Kimbley acknowledged an obstacle they would face is creating an environment where the patients would feel safe seeking treatment. “There’s so much stigma and shame, that many of these women aren’t even getting the prenatal care. I have seen cases of women giving birth in their bathtub,” Kimbley said.

Pregnant women with substance use disorders can feel judged by society. Our goal is to say, ‘You are deeply cared for, deeply valuable, and what you are dealing with is wholly treatable.  Having a substance use disorder is not a moral failing.  It’s a chronic medical condition. Those of us in medicine have done a really poor job of understanding that for many years. We’re sorry, and let’s see what we can do moving forward,” said Kacey.

The first clinic and early years

On November 1, 2017, The Magdalene Clinic treated its first patient. Kacey and her staff called other clinics and hospitals to encourage other providers to refer their patients.

“It was a peer support specialist, a social worker, a nurse, and me. That was it,” Kacey said.  “We went to the grocery store and bought every healthy snack we could think of. We would sit down with patients during visits and say, ‘We have 45 minutes together. I would love to hear your story or whatever part of it you are comfortable sharing.’ That never happens in medicine. That type of time to just listen and bear witness to someone’s story visit after visit is not the way the system has traditionally been built.”

For Magdalene Clinic patient Faith Godfrey, she knew she was in the right place during her first visit. “The first time I went to the OBGYN, I knew that they were going to be drug testing me. And being pregnant, I know that brings up like DSS and all that stuff. They told me about the Magdalene Clinic. I met with Dr. Eichelberger, and she was great. I didn’t feel any judgment from her whatsoever. I could talk openly with her about what was going on, and I felt like I was in the right place.”

An important part of the services Magdalene Clinic provides is access to a peer support specialist at every visit. This is someone who has lived experience with substance use and recovery and stays in close touch with the patient to offer support.

“I got to meet with the peer support specialist Stacy during my first appointment. I told her I wanted to get help. She kept in contact with me the entire time. Even on a personal level, she gave me support, encouragement, hope and prayers. I still talk to her to this day,” Faith said.

When a patient’s substance use disorder is mild or moderate, their treatment is facilitated fully by the services and staff at The Magdalene Clinic. Patients with more severe substance use disorder continue prenatal treatment at the clinic and are also encouraged to apply for Serenity Place, a residential treatment facility for mothers operated by The Phoenix Center. That was the case for Faith.

“Well, it took a little time for me to be ready. But they didn’t give up on me. The staff at Magdalene Clinic helped communicate with me the whole time. After making excuse after excuse, I was able to stay clean for about a month and then went into Serenity Place. It’s been amazing ever since.”

Admission to Serenity Place is need-based, and patients reside there for 90 days with their children. The facility offers an ABC licensed daycare for the children while patients participate in treatment, parenting classes, therapy and other services. After completing Serenity Place, patients have the option to transition to the Lotus program, transitional housing and continued support on the same campus.

“Serenity Place was the first thing I have ever completed in my life. Then, my daughter Sophia and I moved into the transitional housing on campus called LOTUS. I took classes on budgeting and job readiness. They also help you with school and to be mentally prepared to have your child in daycare,” Faith said.

Ultimately, the goal with recovery services is to help the patients achieve self-sufficiency for themselves and their families. “We don’t talk about how the patient is going to complete a program. We talk about the steps to achieve self-sufficiency and how we are going to get there,” Kimbley said.

Faith and her daughter Sophia have moved into new housing. Sophia is now a thriving toddler, and Faith is working and studying for the G.E.D. with the hopes of eventually enrolling in Greenville Technical College.

I didn’t say when I was a little kid that I wanted to grow up and be an addict. I had parents that were addicts and alcoholics. All the trauma and stuff growing up, that’s not what I wanted to be. I wanted to be anything but that,” said Faith. “Being able to wake up with my daughter every morning, being able to cook her breakfast and get ready together, providing her with safe travel to daycare, and then picking her up after work, it’s everything that never seemed possible before I walked into the Magdalene Clinic.”

Growth and outcomes

Kacey and Kimbley expected to treat 30 patients during the first year of the clinic. They treated 90.

With this quick growth and early success came a five-year $1.15 million Healthy Greenville Grant. The grant funded nurse practitioners to provide the prenatal care, more Phoenix Center staff time, and advertising to help reach potential patients. The grant was also used to bring in Melissa Fair and the team from the Institute for the Advancement of Community Health at Furman to run the data analytics.

“The average Magdalene Clinic patient enters the Magdalene Clinic program at 21.7 weeks pregnant. The majority of patients have combined diagnoses where they may have multiple substance use disorders. The most commonly seen disorder is opioid use followed by stimulant use,” said Melissa. “When patients are discharged from Magdalene Clinic, we are seeing approximately fifty-seven percent reduction of patients with active substance use.”

As of 2023, The Magdalene Clinic has treated more than 570 women in five years from across Upstate South Carolina.

What’s next?

Although the five-year expansion grant expired in June 2023, the clinic continues to operate every Wednesday through the providers that already work at the Prisma Health OBGYN Center. While some of the services Prisma and the Phoenix Center offer to expectant moms are billable to insurance, not everything is. Magdalene Clinic also plans to seek additional funds through grants and private donors.

Other medical providers are expressing interest in replicating The Magdalene Clinic model. A Prisma Health Family Medicine practice in rural Oconee County, South Carolina has recently started a small version of the model in their office.

“Some of our patients were driving an hour from more rural areas in the Upstate to come see us, and we know transportation can be difficult. The group in Oconee was awarded a $500,000 expansion grant to implement the model with their own fingerprint in that community with their local recovery center,” said Kacey.

“We want to share the idea. We want to see it implemented in other communities. And I believe that it can be tailored to the community’s needs with the right partners and the right people who have the passion, expertise and willingness to make it happen. It doesn’t have to look exactly like it does here,” said Melissa.

The Magdalene Clinic staff hope that a long-term outcome of their work is increased understanding of substance use disorder as a highly treatable medical condition, not a moral failing or lack of willpower. If some of the stigma around substance use is reduced, the hope is that more women will feel safe to seek prenatal care and recovery services.

These women are survivors. The stories they share with us of trauma and resilience are an extraordinary gift. It’s honestly a privilege for us to be a part of their journey,” said Kacey.

 

To learn more about The Magdalene Clinic, visit magdaleneclinic.com.