"I left the hospital with supplies for Dickinson Gator aide HOPE clinic at the high school hoping to arrive after the rush and knowing the clinic must be slowing since I felt sure cold and flu season was behind us. Wow was I mistaken. The new seating donated by St. John Hospital was full of children and their parents.

The Dickinson nurse was on the phone calling a parent regarding her son who suffered a severe food allergic reaction. The medical director of the clinic was monitoring the young man who arrived 15 minutes earlier with shortness of breath and hives over his trunk, legs, arms, face and neck. Our Physician Assistant used her skills able to administer medication and monitor his heart rate and BP will maintaining airway till some of symptoms subsided. They had contemplated further anaphylactic treatment but he responded to the medication. The nurse reports mom is on her way while the medical director and nurse continue to monitor his vital signs.

Nancy Lounds, our Physician Assistant, continues her care of a beautiful six-year-old suffering from low-grade fever, nasal congestion and sore throat. Her sister is also seen by Miss Nancy for similar symptoms and they soon leave with prescriptions in hand. The nurse reports that mom was just laid off again. While these two are leaving Nancy continues to complete sports physicals. Our young sixth grader fails the vision test and Nancy speaks to his mom in Spanish about this and educates him on the need for glasses for many reasons – especially the importance of completing school work. He does not pass until mom takes him for a vision exam. One more sports physical is done while a young girl arrives with grandpa for a very red eye. Our young man with the severe allergic reaction is doing great and his mom arrives and the nurse and Physician Assistant update and educate her on details and future preparation.

My hour in this area made me feel so proud of the compassionate care we are providing, the attention to detail, education of students and parents on many topics – but most of all – these medical professionals working together to provide care to these students. Our total for that day was 21 students and it was only 1:45pm."

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A mother of a student called me because she wanted someone to check her leg for an infection. She was running a fever and had spreading redness on her calf. Although she has insurance – her deductible is high and her husband has been unemployed for several months – she went to see one of our nurse practitioners who was working that day. The nurse practitioner prescribed her an appropriate antibiotic and instructed her to follow up with me within two days if she was not significantly improved. The mother spoke with me two days later and arrived at our school based clinic with fever and worsening infection. Unfortunately she was sent to the ER with concern of cellulitis failing oral antibiotic treatment and she was admitted for three days. Clinically, we had done all the appropriate measures but the bacteria causing her infection was resistant to the antibiotic and she required IV therapy.

This case illustrates a very important aspect of our mission – to extend the healing ministry of Jesus Christ by providing primary healthcare services. If she did not have access to our services, she may have waited to seek care until too late. She could have easily become septic – where the infection spreads into the blood and affects the entire body. While we were unable to treat her infection on an outpatient basis, we did provide her with guidance and assurance that she a needed high level of care. We also gave her advice to speak with the finance office at the hospital to hopefully work out an affordable payment plan. Finally, she knows that we are only a phone call away and will assist her in a way we can.
 
Nipa Kamdar, RN, FNP-C
CHRISTUS School Based Clinic

A young lady came in with two of her six children to be seen for being sick. While filling out the consent forms for her children, she asked if she could be seen as well as she had no insurance. Upon eliciting a history from this young lady, She was complaining of having a "urinary track infection" and she was pregnant. She stated that she had a history of kidney stones and was told that she needed surgery a long time back; hence Medicaid and SSI were arguing over who was going to cover her pregnancy. The patient continued with telling me that her husband had just "been locked up for a long time, thank goodness" and her only support was her mother-in-law. I did a urine dip, and a physical exam with vital signs. My concern initially was that if she was in early stages of pregnancy, I needed to treat the UTI, and get her in to see an obstetrician as soon as possible. Much to my surprise, that her history actually showed that she was 35 weeks pregnant so now in risk of preterm labor! I sent her straight to Labor and Delivery at UTMB with a horrific UTI, where I checked on her that evening. My patient was three cm dilated and having contractions every three to five minutes (she had stated in my office that "I would think that since this is my seventh pregnancy, that I would get used to this baby moving this hard") That baby wasn't moving, she was having contractions! She was admitted, placed on IV antibiotics and is still pregnant today.

It was 3:00 p.m. on October 30, 2007; Troy was in Kindergarten in the bilingual program. His teacher sent him to the clinic based in his elementary school that afternoon because she thought he appeared ill. After arriving in the Clinic, he sat in a chair and almost immediately slumped over. With his head turned to the side, it was apparent that his heart was racing. Troy was placed on his left side on a cot and a pulse oximeter was immediately attached to his finger. Though his oxygen saturation was normal at 98-100%, his pulse rate was extremely elevated at 236 beats / min. The event lasted around 15–20 minutes. During the tachycardia episode the child was listless, pale, nauseated and extremely diaphoretic. His mother was reached by phone and arrived at the school within minutes. Through an interpreter, it was discovered that the child has had similar episodes, since 2 years of age. The mother would notice the “pounding” in the neck, would take him to a local emergency department, but the episode would resolve before any assessment was done. She commented about how one ER physician told her that her son was dehydrated and that all he needed was fluids. During this conversation it was apparent how frustrated she had become over the years, being the only person who saw these turn of events unfold. But on that day, she verbalized a sense of relief that someone else had now been a witness.

After referral to UTMB Pediatric Cardiology, Troy was diagnosed with Wolff-Parkinson-White syndrome. His mother was uneasy when she learned that their approach would be observation only. Upon her urging, the family was referred to Texas Children’s Hospital.

By August of 2008, Troy underwent a procedure at Texas Children’s Hospital which attempts to correct a pathway where electrical impulses are conducted. To this date, Troy has been free of any tachycardia episodes. He is a healthy first grader now!!

James was 4 years old when he was first referred to the School-Based Clinic by the school nurse for an update on his immunizations. After that first visit, his mother often sought the Clinic’s services. James began having ear infections when he was in 1st grade. That first year he was treated twice for an ear infection with a voucher for the prescriptions. For the next three years James treated once a year for an ear infection with a medication voucher. He and his mom would say that the Clinic Nurse was the one who always helped him. Over the years, if James’ ear would start hurting, he would come to the Clinic from class just for me to “check his ear.”

This year James is 9 years old and in 4th grade. He has not had an ear infection, but recently came to me with a toothache. He does not have routine dental care. Fortunately, through the alliance with a local dentist and CHRISTUS Health, we will be able to assist the family in getting the needed dental treatment for James, and both the parent and student are very appreciative. James will be leaving K.E. Little next school year for 5th grade. It is certain because of the relationship that has developed over the years with this family that they will continue to seek the services provided by the Christus St. John School-Based Clinics.