In South L.A., nutrition advice may be the most important snack

Cedars-Sinai medical team provides free health services from L.A.'s skid row south to Inglewood

The giant brightly colored van has become a familiar sight on the street outside Florence Griffith Joyner Elementary School, just across from the Jordan Downs housing project in Watts.

It's not as popular a destination as the roving paletero selling ice cream or the display of fluffy pink batches of cotton candy peddled on the street corner. But a medical team from Cedars-Sinai is working to change that.

Nurse practitioner Anne Traynor slips in a plug for exercise whenever she ushers a mother and child inside the van for a medical exam. Social worker Sandra Gutierrez reminds students about nutrition during school counseling sessions. Even van driver Dwight Magee pitches in, manning a "Rethink Your Drink" game that pits sugary drinks and high-calorie juices against cool, refreshing agua.

The van is part of a mobile program that provides free health services to low-income families from skid row south to Inglewood. A pair of vans make regular rounds to more than two dozen schools, parks and social services centers. Children get their eyes checked, ear infections treated and immunizations updated. Their parents get links to food banks and family counseling.

But in an area where 55% of teenagers are overweight or obese, its most important product may be health and nutrition advice, clearly explained and gently delivered.

"We're looking at health as not just all about shots and medicine," said program director Michele Rigsby Pauley, a registered nurse.

The van itself is a promotional tool. It's decorated with colorful drawings of beaming children turning cartwheels, jumping rope and munching on apples.

"They know us because we come on a regular basis; same place, same team," Rigsby Pauley said. "When you're talking about something so personal, trust counts a lot, we've learned."

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Rigsby Pauley has been around since the creation of COACH for Kids and Their Families, a program of Cedars-Sinai's Maxine Dunitz Children's Health Center. When she began in 1994, they had one van, one nurse and a focus on helping families living near skid row.

She remembers her first day on the van. She'd examined a child who was uncomfortably congested; he needed a humidifier, but Rigsby Pauley figured the family couldn't afford that. "I'm thinking I'm being resourceful, I'm going to help this mom," she said. "I'm explaining how you go into your bathroom, run the shower and steam it up for him."

The mother's blank look registered the nurse's error. "I realized they were staying in a shelter," she said. Mom couldn't commandeer the public bathroom to ease her child's congestion. And she couldn't afford the medicine that would have helped him feel better.

That was an education for Rigsby Pauley. "I realized we have to meet them where they are," she said. You can't assume they have $3 to buy the PediaCare. You need to know if they have a refrigerator before you give out that bubble-gum-pink bottle of amoxicillin to treat an ear infection.

That forced her to pay attention to the economic factors that contribute to poor health outcomes. And that has guided the program's growth since then.

"I see these families," she said. "I treat their asthma, ear infections, scabies, whatever they have. Then we send them home to live in a car. We can't just ignore that."

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In Watts, the mobile staff sees lots of young mothers with big families and strained resources. For them, the van can be a conduit to other services. Gutierrez, the social worker, screens with each patient privately in her makeshift office in the cab of the van. "Since we've been around for a while, families are willing to open up to us," she said.

"We explain to them about mental health … that having a problem is nothing to be ashamed of," Gutierrez said. "They'll tell us 'my husband drinks' or 'I lost my job,' and we can connect them to places where they can get help."

Through gifts, grants and partnerships that augment Cedars-Sinai's funding, the COACH program has been able to offer dental screenings and fluoride treatments, eyeglasses and vision exams, a gardening club for children and a monthly nutrition clinic for overweight adults in Jordan Downs.

But promoting healthy eating is no easy task in a neighborhood where money is tight, supermarkets are scarce, and indulgences rare and cherished.

I watched Dafne Sanchez's eyes light up as a cart loaded with junk food passed us on the sidewalk outside the van. It was pushed by a woman with a baby strapped to her back; walking alongside wasa little boy devouring a bag of Flamin' Hot Cheetos.

Dafne, 8, had just finished her medical checkup with good results; her reward was a dollar from her grandmother. She dashed over to the cart with nurse Traynor close behind. Traynor tried to nudge her toward healthy choices, as Dafne studied the snacks.

"I'll bet they have water," Traynor said. Dafne reached for a bag of Flamin' Hot Cheetos instead. The nurse leaned in and together they read the ingredient list on the package aloud. Dafne reluctantly put it back.

Funyuns? Dafne turned the bag over, read the nutrition label to Traynor and returned it to the cart.

The little girl stood for several minutes, studying snack bags sullenly and fingering her dollar bill. Every now and then Traynor would mention water again.

Finally Dafne backed away and waved the snack seller on. "I'm not getting anything now," she announced, slipping the dollar bill back into her pants pocket and heading off with her grandma.

I considered it more a standoff than a victory for the forces of good health. That dollar was likely burning a hole in Dafne's pocket. And there was another mother pushing another snack cart just around the block.

sandy.banks@latimes.com

Twitter: @SandyBanksLAT

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