At Broad Acres Elementary, educators say the school's busy health-care center is a necessity for many sick or trouble children.
The wall clock in the school health center ticks by 8:30 a.m., but the new family never shows. Nurse Ladys Lux gazes out a nearby window with narrowed eyes, as if searching for her missing patients in the knots of dark-haired children scurrying across the schoolyard through a biting, mid-December wind. 鈥淣ormally, we don鈥檛 schedule physicals when the families first get here because so many don鈥檛 stay,鈥� Lux says. 鈥淏ut we did this time when we saw this family had other problems.鈥�
The petite woman鈥檚 voice trails off as she turns away from the window and reaches for the phone on the reception desk. The family she speaks of is headed by a poor, single immigrant mother from El Salvador who recently moved into the surrounding neighborhood with her five children. One of the youngsters has spina bifida, a congenital disability that can require extensive medical care. It鈥檚 unlikely that any of the children have received much in the way of medical care during their young lives, Lux says, but that will change now that they鈥檙e here, at Broad Acres Elementary School. They will now have access to a pediatrician, a nurse practitioner, a nurse technician, a psychiatrist, a psychologist, therapists, and, of course, Lux herself.
The Broad Acres clinic is one of 1,500 school-based health centers nationwide that bring a wide range of medical, nutritional, and mental-health care to millions of students and their families. The centers, the first of which sprang up in the early 1970s in Dallas and St. Paul, Minn., provide an important safety net for children and adolescents鈥攑articularly the more than 10 million today who lack health insurance, according to the Washington-based Center for Health and Health Care in Schools.
For the community served by Broad Acres Elementary, Lux is more than a school nurse鈥攕he鈥檚 a lifeline. The school, though located in Maryland鈥檚 Montgomery County, a wealthy suburb of the nation鈥檚 capital packed with medical specialists, high-tech hospitals, and busy doctors鈥� practices, is at the heart of an unofficial village of squat, brick apartment buildings isolated from the world around it by class, language, and culture. Inside the buildings, it鈥檚 typical for two or more families to share a two-bedroom unit, adding to the stress the occupants already face each day as they juggle multiple low-wage jobs in hotels, restaurants, and landscaping and construction companies鈥攚ork that may be there one day, gone the next. Few of the working parents have cars, and some don鈥檛 even have telephones.
The school itself has the dubious distinction of being the 140,000-student Montgomery County district鈥檚 neediest; nearly 94 percent of its 500 pupils receive free or reduced-price lunches. Spanish is the dominant language spoken in the community, followed by Vietnamese, and nearly 30 percent of the students are enrolled in remedial English. Broad Acres鈥� student-mobility rate also hovers around 30 percent.
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Kindergartner Olivia Assoua rests with a warm towel over her eyes as treatment for an eye ailment. |
As such, the health center has the full support of Principal Jody Leleck, who is working to raise her school鈥檚 academic standing in today鈥檚 world of high-stakes testing. 鈥淵ou can鈥檛 understand the stress children suffer in a high-poverty environment,鈥� she says, 鈥渁nd that stress manifests itself in so many ways. If we didn鈥檛 have [the health center], my full-time job would be social services, and we鈥檇 never get to the learning piece.鈥�
In short, many of the heads of households here lack the money, time, language skills, and education to deal with an expensive and complex U.S. health-care system. The sheaf of paperwork required for medical assistance alone is enough to drive many of the parents away, Lux says, even when they have help, even when the forms are in Spanish.
Lux, a native of Ecuador who is fluent in both Spanish and English, has already cleared that hurdle with the Salvadoran family, a process that can take considerable time鈥攎inutes and hours that are not reimbursable under any public or private insurance plans. So, she is determined to track down at least the three children enrolled at the school to bring them in for physical examinations by a nurse or doctor.
鈥淲ho knows what we鈥檒l find,鈥� she says, a worried frown creasing her brow.
Lux鈥檚 concern for the new students is based in part on the experience that her patients鈥� health problems are sometimes not as simple as they seem at first glance. On a recent weekday morning, an overweight boy in a T-shirt sits hunchbacked, knocking his heels against the metal side of the examination table while the health center鈥檚 nurse practitioner, Cara Soifer, peers into his ears with a light. The 9-year-old has been a frequent visitor to the health center in the past. His complaint this morning is an earache, and he winces when the nurse touches his left ear. But it鈥檚 the extra pounds the boy is carrying that most concerns Soifer.
鈥淵ou have a lot of fluid in your ears,鈥� she tells him. 鈥淯nfortunately, the kind of ear pain you have won鈥檛 be helped by medicine. You need to move around and drink more water.鈥�
Soifer, who doesn鈥檛 appear to carry a pound of extra weight herself, begins to quiz the boy about his weekend.
鈥淲hat did you do?鈥�
Played video games, the 3rd grader mumbles.
鈥淲hat else?鈥�
Nothing else.
鈥淲hat did you drink?鈥�
Coca-Cola.
鈥淲hat else?鈥�
Nothing else.
鈥淒id you go outside at all?鈥�
He shakes his head.
As in schools nationwide, a growing number of children at Broad Acres Elementary are overweight. The nurses here say it鈥檚 the result of inactivity and eating too much of the wrong foods. 鈥淭hat鈥檚 a real problem in this school because the kids only have gym class once a week, and there are very few after-school activities that are physical,鈥� Soifer says. 鈥淎nd all they drink is soda and juice.鈥�
鈥榊ou can't understand the stress children suffer in a high- poverty environment. ... If we didn't have [the health center], my full-time job would be social services, and we'd never get to the learning piece.鈥�
The nurse practitioner stands silently for a moment eyeing the boy before her with a hand over her mouth, as if considering her words carefully before she speaks. 鈥淵ou really need to take a break from the [video games] to at least stretch,鈥� she counsels him. Soifer鈥檚 patient refuses to meet her eye, but she is persistent, asking whether there are any physical activities he likes, such as playing outdoors with a soccer ball. The boy seems to pull inside himself, hanging his head to avoid the nurse鈥檚 gaze and picking at his hands.
Soifer lets him off the hook and wraps up the session. 鈥淲ell, I guess it鈥檚 cold outside, so it鈥檚 hard to go out with a ball right now. But you need to drink,鈥� she says, 鈥淎nd water, not soda. It will help thin out that snot that鈥檚 backing up into your ears.鈥�
She gives the boy Tylenol and sends him back to class. As she watches him shuffle back down the hallway that connects the health center to the main school building, Soifer shakes her head and raises a tissue to her own runny nose.
鈥淗e doesn鈥檛 get enough activity, but it鈥檚 not going to change,鈥� she says, sinking into one of the waiting-area chairs with a mug of hot tea. 鈥淗is father is overweight, he鈥檚 being raised by a babysitter, and it鈥檚 difficult to make them understand that this is a serious problem.鈥�
But, like other students here, the boy and his family have struggles beyond their weight. Soifer nods toward the suite of offices that houses the therapists and social workers who make up the other half of the Broad Acres health center. 鈥淭hey鈥檝e worked with the family a lot,鈥� she says.
Marta Contreras, a full-time mental-health therapist at Broad Acres, believes that the health of the mind and the body are inextricably linked, a philosophy reflected in the close working relationship between her program, called Linkages to Learning, and the health room. 鈥淵ou can鈥檛 look at the physical without looking at the mental health,鈥� she says.
A tiny woman with a mane of thick, curly black hair, Contreras leads a busy 14-person staff that includes a part-time psychologist, therapists, social workers, five interns from area universities, and a psychiatrist who comes twice a month to write and adjust prescriptions for children with conditions such as attention deficit hyperactivity disorder or anxiety. Linkages to Learning also offers English-language and computer instruction for parents, seminars on pressing health topics, nutrition counseling for families, and other services.
The mental-health staff itself posted 746 sessions during the last budget year, seeing a total of 32 clients, many of them in need of ongoing treatment for problems such as mood disorders and ADHD. 鈥淭hese families are under a lot of pressure,鈥� Contreras says simply.
And the referrals keep coming.
A kindergartner with a heart-shaped face beneath a heavy fringe of black bangs comes into the health center on a recent winter morning with her mother, who looks weary with her own hair pulled back from her face in an untidy ponytail. Her daughter, on the other hand, grins broadly at Soifer and even giggles as Lux translates the nurse practitioner鈥檚 questions into Spanish for the mother, and then relays the answers to Soifer in English. The 5-year- old鈥檚 complaint is a stomachache, accompanied by ear pain. Soifer does find an infection in one of the girl鈥檚 ears, but the nurse鈥檚 questions reveal that she suspects a potentially deeper problem.
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Jocelyn and mother Juni Lopez, recent immigrants from El Salvador, listen to Principal Jody Leleck, while nurse practitioner Cara Soifer and Lux confer behind them. |
The girl is bordering on what the nurses here call 鈥渇requent flier鈥� status, meaning she鈥檚 been to the health center a lot lately. The frequent fliers aren鈥檛 necessarily the children who come here for treatment of chronic illnesses鈥攖he 45 asthmatics, the two diabetics, or the handful of others with either liver conditions, ADHD, allergies, or seizures. Instead, these students tend to trot in regularly with complaints of runny noses, stomachaches, headaches, and other mild symptoms that can鈥檛 be traced to any underlying physical cause.
鈥淭ell me what鈥檚 been going on at home,鈥� Soifer urges the mother. Lux translates the question, and the mother turns to Lux and launches into a lengthy explanation in Spanish. 鈥淪he says that even though [her daughter] sleeps all night, she is complaining in the morning that she鈥檚 tired,鈥� Lux says. 鈥淓very day, she asks if the next day is going to be school. She wakes her up early, but she doesn鈥檛 want to get up. She says she doesn鈥檛 want to go to school.鈥�
In the next few minutes, Soifer learns that the pupil is performing well in her classes and has friends. The mother guides the daughter through the same wake-up routine every morning, and the girl seems to be fine when she arrives at school, where an older sister also attends classes. Yet her complaints of sickness arise in the evenings and mornings during the school week and disappear over the weekends.
The nurses conclude that she misses her mother and suffers anxiety when she knows they鈥檒l be separated. Soifer decides to write a referral for the pair to speak with one of the therapists on the Linkages to Learning staff. 鈥淲hen I first got here, I felt like I had to ration out the referrals to the school guidance counselor and Linkages,鈥� Soifer said. 鈥淣ow I don鈥檛 hesitate.鈥�
The 5-year-old boy on the exam table is not answering Dr. Phyllis Harris鈥� questions鈥攁t least not the first time she asks them. 鈥淒o your ears hurt?鈥� she asks.
Silence.
鈥淎re you coughing at all?鈥�
For the community served by Broad Acres Elementary, Nurse Ladys Lux is more than a school nurse鈥攕he's a lifeline.
Again, the kindergartner, dressed in tattered jeans and a red shirt several times too large for his tiny frame, says nothing. He simply squirms beneath the pediatrician鈥檚 searching hands.
鈥淗ow鈥檚 school?鈥� Dr. Harris asks. And again: 鈥淗ow鈥檚 school?鈥�
鈥淔ine,鈥� he says, perking up the second time she asks him.
鈥淗ave you been having trouble hearing?鈥� she asks loudly.
鈥淵eah,鈥� he replies, smiling up at the doctor.
The boy鈥檚 visit with Harris on a recent Wednesday afternoon is a follow-up appointment. Two weeks ago, he came into the health center seriously ill with a double ear infection, bronchitis, and a fever. Both ears are still infected. The boy says he finished the antibiotic prescribed at his last visit, but the doctor says it鈥檚 hard to tell.
A tall, thin woman with dark-rimmed glasses perched on her nose, Dr. Harris recounts a day early in the school year when the boy came into the health center wheezing, a sign of asthma. His mother insisted he鈥檇 never been treated for asthma before. But he was clearly familiar with the medicine dispensers for asthma when he was in here, the doctor says, and the mother ended up changing her mind when pressed by the health center staff.
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Spanish-speaking school nurse Ladys Lux comforts kindergartner Christopher Estrada, who has asthma. The Montgomery County, Md., school is located in a lower-income neighborhood where access to health-care services is limited. |
鈥淣ow I鈥檓 worried about how well he鈥檒l do in school if he can鈥檛 hear,鈥� Dr. Harris says. 鈥淲e鈥檙e not sure how reliable his mother is for proper administration of his medicine, and we have difficulty reaching her because she has no telephone. He appears to be dosing himself.鈥�
Fortunately, the boy is an exception, the doctor adds. 鈥淢ost of the parents here are very involved,鈥� she says, 鈥渁nd they鈥檙e very comfortable coming here.鈥�
The doctor鈥檚 positive assessment of the community is one expressed by every member of the health center staff. 鈥淭he parents here are very proud,鈥� Lux says. 鈥淭hey want what鈥檚 best for their children.鈥�
As for the new students who missed their appointments, Lux learns after several phone calls that two of the three children enrolled at Broad Acres were home sick the day of their scheduled physicals.
鈥淲e will have to try again, maybe after the holidays,鈥� she says, tucking a thermometer into the mouth of a little girl who was the school鈥檚 first case of flu this year. 鈥淲e need to get them in here.鈥�
