More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Grace Rangel (right) is a nurse with a mobile clinic that makes regular visits to several schools in the Chula Vista, Calif., school district. Here she examines a student with medical assistant Lourdes Aranda.

With two asthmatic children and health problems of her own, life hasn't always been easy for Tammy Mayo. The Chula Vista, Calif., mother of three had health insurance through her husband's job, but it paid little of her or her children's medical expenses-only $2,000 of a recent $10,000 hospital bill.

After Mayo's now 13-year-old son Dionne had a series of asthma attacks that left him struggling for breath and suffering bouts of severe coughing, she found help through nurse practitioner Evy McNitt-Silk, a nurse at a mobile clinic.

"Evy got him on all the right medicines to control his asthma," Mayo said. "She even gave me a [nebulizer] machine for when he has attacks, so I wouldn't have to run to the emergency room. I can do it here at home."

Mayo is one of hundreds of parents in Chula Vista receiving help through a partnership between the school district and two local hospitals.

In 1999, Sharp Chula Vista Medical Center and Scripps Memorial Hospital along with the school district began operating a mobile clinic for the district's children in a 40-foot van. Staffed most days by nurse practitioner McNitt-Silk and Grace Rangel, RN, the van makes regular visits to several schools in the 20,000-student district.

Chula Vista is the largest elementary school district in California and faces many challenges. Roughly half of the children are on a subsidized lunch program. About 60 percent of the students are Hispanic, many recent immigrants from Mexico. Some families in the district are homeless, living in tents or shelters. Many families move frequently, some going back and forth across the Mexican border. Before the van clinic, the emergency rooms at the two local hospitals were the only source of medical treatment for many children in the district.

Caring for these children has presented more than a few challenges for McNitt-Silk, Rangel and others involved in the partnership. One of the first was gaining the trust of the children and their families.

The nurses can boast of many accomplishments in the three years since the mobile clinic began. They have managed to obtain free prescription medicine and breathing machines for asthmatic children like Dionne. By using their holistic nursing training to look beyond an illness and to understand all the problems patients are facing, they have helped families make their way through rough times.

Linking resources

Before the partnership, hospital administrators found their emergency rooms crowded with school-age children suffering from nonemergency problems. Usually, their uninsured parents had nowhere else to take them. Meanwhile, across the school district, school officials were concerned about student absentee rates. The high rates not only reduced the amount of money the district was awarded from the federal government, but also disrupted student learning.

School officials and hospital administrators eventually realized their problems were intertwined. When children with health insurance had an earache or other problems, they could get treatment quickly and would miss little school time, Assistant Superintendent Dennis Doyle said. Uninsured children often were not treated promptly and spent more days out of class, he said.

"A child without insurance will try over-the-counter and traditional remedies for several days, and pretty soon that child is septic and screaming in the night, and the emergency room becomes the care of last resort," he said.

Next Page