Knox County Health Department's Women-Infant-Children (WIC) clinic is part of a federal program that's funded through state channels. Low-income families with or preparing for children who meet residency and income criteria are eligible for nutritional counseling and vouchers that are redeemable for specific foods. There are currently 8,125 participants in the program, a record number, and 2,000 more than two years ago, when Congress last appropriated funds for WIC. With no increases in funding or staffing, the caseload for Knox County's WIC clinic has increased by 25 percent in two years. The realities of finite space, time, and money may soon lead to a waiting list for the clinic's services.
Lori Emond, Knox County's WIC director, says more and more clients seeking help doesn't just change the amount of work to be done, it also increases the difficulty of that work.
"There are long lines," she says. "It takes much longer to go through the process. We have to determine income and residence eligibility. The children have to be weighed and measured. Sometimes we also measure hemoglobin, which is a good overall indicator of a child's health. The children and the parent or caregiver then have a training session."
From KCHD's Dameron Avenue facility, WIC serves women who are prenatal or postpartum, and children up to age 5. If you've been in a waiting room with young children, you can understand the challenges involved for a person hoping to contain or entertain one or two or three toddlers for maybe an hour in a room full of strangers—a room that is bound to include at least one screaming infant.
On a recent afternoon, the waiting room demonstrates the diversity that is Knoxville: A young couple that would appear to be courting, were it not for the 8-month-old between them; a grandmother who is trying to exhaust the toddler in her care with laps around the carpet; lots of other young women alone or with supporting friends; and lots of babes in arms or in blanketed carriers.
"There's a lot that people don't understand," says Emond. "They think it's a drive-thru process and it's not. People think that government workers just sit around. Those of us who are here are seeing more people than we used to see. Our lobby is often overflowing out into the hallway."
WIC was designed primarily to educate, but also to supplement the income of a breastfeeding, working mother, who chose or needed to take time off after maternity leave. When that mother returned to work, her household income would rise back above WIC's eligibility levels, and she could ostensibly afford her own and her child's nutritional needs. Between the sluggish economy and the cultural quirks peculiar to East Tennessee and the Southeast, that design is beginning to show its flaws. Most important, breastfeeding is mysteriously unpopular in the Southeast, while smoking and obesity are common. So there are barriers to health education in general. With businesses restructuring and eliminating jobs, mothers or fathers aren't returning to work and forfeiting their WIC eligibility. So WIC is now supplementing families for longer periods of time, and it's attending to many more children near the upper age limit of five years.
WIC's financial eligibility criteria are relatively generous, and can be viewed online from KCHD's website. But to illustrate, Emond says that currently, a family of four would have to have a household annual income of less than $39,220 to qualify.
Marcie Singleton, nutrition director and breastfeeding coordinator at Knox County's WIC clinic, says she's aware that some people are frustrated by the increased time spent waiting in an increasingly crowded waiting room.
"I don't think anyone is going away without being served," she says. "Typically, we try to book about 180 appointments a day. A problem for us is that we never know what percentage of those appointments will arrive. These are people who are borrowing rides, walking, using public transportation.
"We issue vouchers for a three-calendar-month period. Toward the end of any month we tend to be very busy, because people need their vouchers for the next period."
According to Singleton, Knox County WIC takes some heat for issuing vouchers for formula. The grand goal is to educate the mother on the importance of nutrition and the benefits of breastfeeding, which would more or less ensure the health and good nutrition of the child.
"WIC has traditionally been involved in breastfeeding promotion," says Singleton. "We give what people choose. The Southeast has the lowest breastfeeding rates in the country, for lots of reasons. We issue vouchers for formula because we saw what non-breastfeeding mothers were giving their children and it was inadequate—things like powdered milk."
Emond says Knox County's WIC's budget is around $1 million annually. She also says that the vouchers disbursed by WIC and redeemed locally have a value of around $5 million. If your favorite grocery accepts WIC vouchers, it can be said that you and your grocer benefit from the program—the grocer directly, since aside from a processing delay the vouchers are cash in his or her register, and you indirectly by that store's stability during these uncertain times.
"The cost of the program is offset by the benefit to the community," says Emond. "The fallout, of course, is that now with rising food prices the vouchers don't go as far.
"A participant might be issued a $30 voucher that specifies certain quantities of milk, eggs, and cereal. We are prescribing nutrition. We've had to adjust upward, like when milk started going up. We've put restrictions on cheese, for example, so that the vouchers can only be used on store-brand cheese and not the more expensive national brands."
KCHD Director Mark Jones is justifiably concerned about the future.
"We've been trying to save money everywhere we can," he says. "The hiring freeze already in effect will be extended through the end of the year. As a way to fill certain positions without hiring, we've begun cutting back the hours at two clinics with low traffic.
"The funding for most of our health-related programs either comes directly from the state, or it's state money that's distributed locally. I think it's getting tight. There are going to be some issues. The problem is that we don't know what to expect. One thing that has been mentioned is simply cuts across the board."
Asked how readers might help, Singleton says, "If the readers are participants, tell them to keep their appointments.
"Time is relative," she says. "Time in the waiting room seems long while you're there. But once they receive their counseling and what we have to offer, it puts that in perspective. We try to make it so the entire visit is not longer than two hours. That's not always possible."