EAST CHICAGO — A hundred years ago, this city on the south banks of Lake Michigan had a problem: Most babies died before reaching their first birthdays.
The community had been incorporated, just decades earlier, as a regional steel and railroad hub. Like many industrial cities of its day, East Chicago struggled with overcrowding, lack of sanitation, a spoiled food supply, contagious diseases.
"Infant mortality last year in East Chicago was six out of 10," a Mrs. A.T. Cox said at a 1915 meeting of the state Child Welfare Round Table, according to a newsletter from the time. "(T)here is only one place in the world that has a worse record. That is somewhere in Russia."
Back then, Indiana's infant death rate was 87.7 per 1,000 live births. East Chicago's was 600.
By 1916, at the insistence of Cox and fellow members of her local women's club, East Chicago had hired its first health inspector. Her club also solicited local businessmen for donations to hire a visiting nurse.
At a subsequent meeting of the child welfare group, Cox gave an example of the work the visiting nurse did. The nurse had gone to a home where the child had an infected bone that had been neglected for a year and a half. The nurse insisted that the mother clean up the house, but the woman resisted.
"You will either take care of this child, or I will come with proper authority to take the child from you and place it in a home with proper sanitation," the nurse told her, according to Cox. The woman cleaned the home.
Fast forward to 100 years later.
In late December 2016, visiting nurse Djenaba Shine stopped by the East Chicago apartment of April Allen, a 21-year-old college student who was seven months pregnant with her first child. The public housing building where Allen lives with her boyfriend, mother and brother stands in the shadows of the smokestacks of the massive ArcelorMittal steel plant.
Shine, who works for Nurse-Family Partnership, took Allen's blood pressure. It was high. Shine called Allen's midwife at a local safety-net clinic.
"They want you to go the hospital," Shine said, after hanging up the phone. "Go straight to labor and delivery."
Allen and the child's father, Orlando Graves, got ready to leave. Graves teased his girlfriend about her salt intake, saying her high blood pressure was the result of all that bacon and Flamin' Hot Cheetos she'd been eating lately. They had no idea what was about to happen.
A few days later, Amari Lee Graves was born, six weeks early, at a local neonatal intensive care unit. He had a low birth weight of 4 pounds and 7 ounces.
Over the past 100 years, public health improvements like clean drinking water, vaccinations and food inspections have decreased the East Chicago infant mortality rate dramatically. But other things haven't changed. Home visiting nurses and social workers are still on the front lines of saving babies. And this city still has the highest infant death rate in Indiana.
The state's infant mortality rate is 7.3 per 1,000 live births. East Chicago's is 16.3.