School-Based Clinics in 2021
I first provided care in school-based clinics in the 1990s. My most memorable crisis was an early morning page from the clinic nurse who had a flare for the dramatic. We didn't have cell phones back then, so I found the coins to call her from a pay phone at the cafe where I was having breakfast with a colleague.
"I think I have a student in labor. Can you get in here fast?" Stacy's voice struck a shrill register.
The student had walked, or rather waddled into the school clinic before classes that morning. She wasn't one of our prenatal patients, a service we ran for teens at the senior-high trying to keep them in school as much as possible. The school-based program even provided day-care, so after the delivery the teen-mother could return to classes and her baby was well cared for.
The student was indeed in labor. She had hidden the entire pregnancy from her parents, teachers, and friends by wearing large, bulky sweaters which were as popular back then as they are today. I had the challenge of calling her parents and diplomatically telling them that they were soon to be grandparents and that they should meet her in the Labor and Delivery ward at the local hospital.
It's no surprise that 2021 is packed with crises as we negotiate this once in a century pandemic. Administration is stretched thin trying to negotiate the COVID safety rules and supporting harried teachers. Students are trying to get used to attending classes in person and staying in their seats for at least 40 minutes. They find reasons to go to the clinic, offering them a little stroll through the halls. Or teachers are quick to send disruptive students to the clinic so they can get through their lesson plans. Then there is social media. More on that later!
I started helping to oversee the medical flow at two school clinics in the heart of the city. One clinic is in a middle school, the other in a senior-high. In addition to the chaos in the school, families are stressed. Parents can't break away from their low-paying jobs to pick-up their sick kids and have a hard time securing COVID tests to allow their children back in school. Some parents aren't even allowed to answer their cell phones at work. Undocumented families have even more hurdles.
Children show up in the clinic with headaches or stomach complaints and the first question staff have learned to ask is: When did you eat last? Followed by: What did you eat? Often hunger is the problem. So, the clinic has a supply of snacks.
Last year clinic staff managed only 20% of the students in the school; the rest attended school virtually. The increased numbers stressed the old clinic work flows, plus the changing COVID guidance add to the challenge: One major and one minor symptom and the student goes to isolation until the parent can pick them up. Who oversees the students in isolation? Now it is one major and two minor symptoms . . .
Then there was the national TikTok Challenge to destroy your school. Yes, someone posted a challenge to videotape destructive pranks at your school and share them on TikTok. The threat arrived from a middle school student late last week: The next Friday someone was planning to shoot staff in the clinic. How to respond? How seriously to take it? Could all the entities work together to ensure safety?
After multiple conversations and emails between school administration, school clinic staff and health care organization supervisors, Friday came and went peacefully. Police were present outside the school in the morning, and clinic staff saw patients in their Halloween costumes. I footed the bill for pizza. Crisis averted!
I like solving problems. I am reminded of the video I've used in the past: building the plane while flying. My mantra these days: show up and care, listen well, model flexibility, and remember humor. There are no protocols for much of this. Life is stranger than fiction, or at least it can inspire some unbelievable plots and characters.