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As originally published in the San Francisco Chronicle on Sunday, February 19, 2023.

Heeva Ghane has been a surgical nurse with Planned Parenthood for a year, but since the Supreme Court overturned the constitutional right to an abortion in June, she has taken on a new role: helping people from other states get an abortion in California. 

She is a “patient navigator.”

It is through the eyes of the 32-year-old Ghane that we can see an early snapshot of the chaos and emotional heartbreak the Supreme Court triggered by unleashing a patchwork of conflicting abortion laws across the country. 

Ghane’s official title is director of case management at Planned Parenthood of Orange and San Bernardino Counties. Her new patient navigator responsibilities have become a common — and necessary — job at clinics across the state. There are now two dozen staffers doing some form of patient navigation across California’s seven Planned Parenthood affiliates.

The need is there. Since the Dobbs v. Jackson Women’s Health Organization decision overturned Roe v. Wade last June, the procedure is now virtually banned in 14 states. Four other states won’t allow it after anywhere from six to 18 weeks of pregnancy and three more states have seen their bans blocked by the courts, according to the Guttmacher Institute

But the need to end unwanted pregnancies never ended. It has just forced pregnant people to go to extraordinary and emotionally exhaustive lengths to obtain a common, safe medical procedure that typically lasts less than 10 minutes. 

Many are coming to California, which — led by Gov. Gavin Newsom — has cast itself as a national haven for abortion. A place where patients and doctors don’t have to look over their shoulder for someone who wants to prosecute them for terminating an unwanted pregnancy. 

But someone has to help pregnant people get to that haven. That requires paying for transportation, lodging, food and other related costs involved in traveling across the country, typically on short notice. It usually costs about $1,000 to help a patient traveling from Texas, which is where many of the people Ghane has helped are from — although people are traveling from as far away as South Carolina and Florida, and several other states, too. 

The role of the navigator is part travel agent, part hand-holder, and in the case of Ghane, includes being a skilled clinician in the room during the procedure. 

Juggling those roles can be a challenge. Many of the people Ghane helps are scared, haven’t traveled far from home or even taken an Uber ride before. Many are poor and live in rural areas and small towns. Many are afraid to even get an ultrasound in their home states. 

“They’re scared to go get an ultrasound because if somehow in their medical history it shows up that they had an ultrasound and they’re pregnant and now they’re not pregnant and they don’t have a child, they get scared,” Ghane said. “They want to know: ‘Will someone track them?’ ” 

Some fear just searching for information about abortion.

“One patient wanted to know how she can clear her internet browser because she was worried that by Googling ‘abortion in California,’ like it would flag her IP address,” Ghane said. The staff showed her how to scrub her search history.

Many of the people who Ghane has helped have stories similar to the first patient she assisted.

The woman was in her early 20s and already had an 18-month-old child. Her boyfriend, the father, was now out of the picture and wanted nothing to do with her. 

“And she had never been on a plane before. She had never traveled anywhere outside of Texas before,” Ghane said. “So not only did she have the anxiety of being able to have this service, she had the anxiety of having to travel across state lines to go to a state she had never been to before. It’s just so heartbreaking.”

Then there was the woman from Utah who didn’t feel comfortable telling her family, friends or the father that she was pregnant. Complicating her journey: She also had never flown before, Ghane said. 

“She’s scared of flying. So she said she was going to drive. But her only companion and her emotional support was her dog,” Ghane said. “So she asked, ‘Is the hotel by any chance dog- friendly?’ ” 

Navigators helped the woman secure the hotel. They also provided her with gas money for her eight-hour drive to Planned Parenthood’s San Bernardino clinic. The woman arrived at the clinic early in the morning, after having made the trek overnight. She got her procedure, stayed overnight in a hotel with her dog, then drove back the next day. 

She had to, Ghane said. She couldn’t afford to miss a shift of her waitressing job.

The woman’s challenges getting to California echoed so many of the 300 out-of-state patients who have visited the Orange and San Bernardino clinics since Roe fell. (Planned Parenthood said it has not compiled the number of out-of-state patients who have traveled to California.)

Even though her clinic can often offer services as soon as the next day, Ghane said sometimes patients tell her, “I can't make an appointment for another two weeks, because I need to coordinate (my) life.” 

“The stories are so similar,” Ghane said, “Many have never traveled. They don't have support. They can’t tell anyone. They’re scared. They’re scared to even talk to us.”

Sometimes, they’re so frozen with fear that even Ghane and her fellow navigators can’t help them. Like the woman who was stuck at the airport in Los Angeles, struggling to catch an Uber ride to the clinic. She had never taken an app-based ride before. She didn’t have a credit card, so Ghane and fellow navigators had to walk her through every step of her journey.

When she finally arrived at the clinic, Ghane was waiting for her. She was not just her navigator, but her nurse, too. But an ultrasound — the first that the patient had received — revealed her pregnancy had progressed past the legal limit to perform an abortion in California. (Abortions can be performed up until about 24 weeks of a pregnancy or unless the patient’s health or life is at risk.) 

It was too late.

“When the ultrasound technician came and told me, I was so filled with emotions,” Ghane said. She sat at the nurses’ station, struggling to compose herself. She had to, she said. She had three other patients to treat. A colleague gave her a supportive hug and asked whether she wanted to take the rest of the day off. She didn’t. She finished her shift.

That case haunts Ghane “because of the fact that she came to us for help. And I couldn't help her. She didn’t want to continue a pregnancy. And because of how far along she was, we couldn’t help her. I couldn’t help her.”

Ghane wonders what the woman is doing now. “Was she able to get prenatal care? Does she have the support that she needs to have? Have her and her boyfriend figured out their financial needs for them to support each other to support this baby? Those are the questions that run through my mind. And I don’t know the answers to those.”

Nevertheless, Ghane remains optimistic, in a sense, after the first seven months, post-Roe: “It has just reaffirmed to me how resilient women are.”



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