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With the joint goals of reducing absences, clearing
out emergency rooms of nonemergency cases and helping
more families obtain low-cost health insurance, the
district and hospitals applied for a series of grants.
The hospitals kicked in funds and the district provided
money to operate the van. A year later, the van, which
cost $250,000 just to purchase, began making trips to
the schools. District officials said the mobile clinic
costs about $25,000 per month to operate.
Sharp's emergency room reported a 12 percent reduction
in the number of school-age children with nonemergency
problems last year compared to the year before, and
Scripps reported a 22 percent reduction. The number
of uninsured families also dropped from 69 percent to
57 percent during the same period, and district officials
think this is the fruit of the clinic staff's efforts
to connect clinic patients with low-cost insurance programs.
"I think [the van] helps by providing identification
of conditions that could be treated immediately, rather
than allowing them to fester and get worse and need
to be seen in the emergency department," said Sharon
Rudnick, RN, manager of emergency and mobile clinic
services at Sharp.
Doyle said attendance rates and test scores have improved
since the van's arrival, although he credits both partly
to improved educational policies at the school. Many
of the children who make van visits suffer from common
childhood problems like strep throat, ear infections
and communicable skin diseases-problems common to people
living in crowded or less-than-ideal conditions. But
asthma, on the rise in many urban areas, is another
major reason children visit the van.
McNitt-Silk had another leg up in earning the trust
of the community she now serves. She's spent most of
her 26 years as a nurse caring for low-income patients,
many of them new immigrants from all over the world.
"You have to know how to teach them and how to
be culturally sensitive," she said. "It's
a challenging group to work with, but it's a really
wonderful group to work with."
Everyone who works on the van is bilingual in English
and Spanish. But sometimes they need a little help from
Rangel.
Born in Mexico, Rangel lived there until she was 15.
She feels that her Hispanic patients trust her more
because of her ethnicity and because she understands
the culture of recent Mexican immigrants.
For example, Rangel said, sick Mexican children traditionally
are not given anything cold to drink, even though, in
the case of fever, a cold drink would help bring down
a child's temperature. The theory is that one shouldn't
mix hot and cold.
Sometimes, Rangel's knowledge can help her understand
what to others might seem an inexplicable injury. In
one case, a baby sitter damaged a boy's eardrum by rolling
paper into a cone and putting it inside the child's
ear.
The baby sitter did this, Rangel said, because in Mexican
cultures some people believe an earache is caused by
excess air in the ear. The air is removed, they believe,
by lighting a piece of paper on fire near the ear.
"If you're not familiar with the culture, you
might say, 'Oh my God, this woman is crazy,' "
Rangel said.
It didn't take long for McNitt-Silk and Rangel to discover
that health problems aren't the only challenges their
patients and families face. Many of the families are
poor and feeling the pressures of the economic downturn.
Finding decent housing and clothing, let alone presents
for their children at the holidays, is a struggle.
McNitt-Silk remembers one single mother-once a medical
assistant-who lost everything after she was injured.
The woman, who also has a daughter with asthma, was
living in a shelter where it was difficult to provide
her daughter with the medicine and care she needed.
The woman wanted to move to Tijuana, Mexico, where her
living expenses would be cheaper, but couldn't because
she would lose her monthly disability payment.
"Many families we see, such as this single mother,
have been working and haven't asked for help before,"
McNitt-Silk said. "They are kind of embarrassed
to ask for help and many are unaware of what resources
are available to them."
By working with families in need and asking for assistance
from friends and acquaintances, McNitt-Silk was able
to help this family and many others during the holiday
season by providing presents for the children, clothing
and basic necessities like toothpaste.
McNitt-Silk and Rangel aren't the only nurses doing
their best to help the children and their families.
School nurses like Frank DeLuca play an important role
as well. DeLuca knows that many of his students walk
to school because their parents don't have cars. When
children are sick and their parents can't drive to the
van's location, he takes over.
"I'll put them in my car and take them over to
the van," he said. Although he is busy, he knows
"it's more important the child gets seen."
According to McNitt-Silk, going the extra mile is all
in a day's work for the school and clinic nurses.
"This is an important part of what we do,"
she said. "We know families well and the school
nurses know them well. We get attached and can really
find out what they need."
Contact Jessica M. Scully at Jessicam_scully@yahoo.com
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