Health Program Bridges Insurance Gap : Medicine: Volunteer service is in its third year of helping schoolchildren. Organizers and outsiders praise it for filling a need without government help.

Six-year-old Norma Martinez bravely removed her sock, revealing a dozen white, bubbly blisters on her foot to the nurse at Madison Elementary School. Norma’s mother, Guadalupe Martinez, cradled her child as she told the nurse that the other foot was blistered too.

The problem was not serious--a form of athlete’s foot that can be easily remedied. But without Young and Healthy, an innovative health project in Pasadena schools, Norma would have gone on with blistered feet.

Instead, school nurse Hevia J. Cromar contacted a health coordinator to arrange a same-day appointment for Norma to see a physician free and to have a pharmacy provide a free prescription if required.

Young and Healthy, in its third year, seeks to use the skills of volunteer health professionals to help meet the medical, dental and emotional needs of Pasadena Unified School District elementary and middle-school children whose parents lack health insurance.

“The program is quite unique. I’ve not seen any other community like Pasadena come together to do something for children,” said Dr. Philip Porter of Harvard University’s Division of Health Policy.

Porter plans to publish a booklet on the program, and the American Assn. of Pediatricians is using it as a demonstration of what its members can do. Former President George Bush’s Points of Light Foundation honored it, and community groups in Riverside plan a similar program there.

The need is clear. One in six children in the United States is uninsured. The number rises to nearly one in four California children, and one in three in Los Angeles County--863,000 children, according to Prof. Richard Brown of the UCLA Medical School. In Pasadena, the ratio is also one in three.

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When the program began in October, 1990, 18 physicians volunteered, said Mary Donnelly-Crocker, the project director who coordinates appointments. Now, 118 physicians, 24 mental health counselors, 12 dentists and seven optometrists treat students free on a rotating basis. Nine area pharmacies supply free prescriptions, and a local laboratory performs free tests. Huntington Memorial and St. Luke hospitals allow participating physicians to use their emergency rooms.

A coalition of community groups, the school district and the city, coordinated by Lorna Miller of the Office of Creative Connections at All Saints Episcopal Church, developed the program.

After 2 1/2 years of planning, the Health Coalition for Children and Youth decided that it could not wait for legislative action to rescue uninsured children and would seek an antidote in its own volunteer community.

Chairman Dr. Don Thomas quoted South African Archbishop Desmond Tutu’s response to how one individual can change apartheid, when referring to the coalition’s efforts: “How does one eat an elephant? One bite at a time.”

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Young and Healthy operates through the health offices of the district’s 26 elementary and middle schools. Children without insurance or Medi-Cal who need medical care are identified by school nurses who visit each school one or two days a week.

When children need further help, the nurse contacts Donnelly-Crocker, who refers the child to a health provider and arranges transportation, translation and free prescriptions.

“Word of mouth and the recession--with its loss of jobs and reduction in health benefits--have all contributed to the growing demand,” said Donnelly-Crocker, who notes that 84% of the children’s parents work.

She said the program made 370 referrals last semester, compared to 227 during its first semester in 1990.

“It’s the most valuable program I’ve ever come across as a nurse in the school system,” said nurse Cromar, who works at Madison and Cleveland elementary schools.

Funding for Young and Healthy comes from private foundations, mostly through five-year demonstration grants, Miller said. The coalition has raised $361,362 in foundation grants, she said, but hopes the school district and city will take over the cost in 1995.

The group has raised $44,191 locally to pay for materials such as X-rays, casts and fillings.

All Saints pays Donnelly- Crocker’s salary, and the school district provides the assistance of Pat Lachelt, its health services coordinator, and office space.

“We will do anything for this program,” Lachelt said. “It really makes good health care possible for our children.”

A side benefit, she said, is that children are absent fewer days because of illness, which in turn saves the district money. She estimates the program is responsible for securing as much as $120,000 in attendance money from the state that otherwise would have been lost to sick days.

Local hospitals also save money. Elsie Sadler, vice president for development at Huntington Memorial Hospital, said prompt attention to children’s illnesses keeps them from ending up with a serious condition in a hospital bed their parents can’t pay for.

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Thomas, former medical director of Huntington’s emergency department, is seen by many as the driving force behind the volunteer recruiting effort, writing to fellow physicians and hosting dinners at his house to persuade others to join.

“What has been so wonderful about this program is doctors and dentists have been able to give a bite-sized chunk of time. They don’t have a day at a clinic, they just slip the child into their regular schedule,” he said.

The Martinezes are typical of families helped by the program. Manuel Martinez works as a roofer; Guadalupe Martinez baby-sits. But they generally earn no more than $200 a week between the two of them and lack health insurance. They pay $275 rent per month for a single room in a house with three families; their two daughters attend Madison Elementary, where 75% of the children are uninsured.

The Martinezes used the program for the first time in September, when 7-year-old Selina went to the school nurse with pneumonia and a temperature of 104 degrees.

Before then, Guadalupe Martinez used her grandmother’s old country remedies.

“Thanks to this program, the medical attention my children receive is very good,” said Guadalupe Martinez, who now tells others about it.

After the nurse saw Norma’s blisters in November, she arranged for Thomas to see the child in Huntington’s emergency room. Thomas diagnosed the blisters as a type of athlete’s foot that had spread because Norma wore tennis shoes all the time. He recommended sandals and prescribed medication.

“The mother is a very good mother,” he said. “The visit helped ease her anxiety. I am glad she came down.”

The program has helped provide tonsillectomies and ear operations at private and county hospitals. A prosthetic-eye specialist created and fitted an eye for a girl, and another child is receiving treatment for a cornea scar at UCLA’s Jules Stein facility.

“It is a great idea that provides good quality health care to kids who wouldn’t have access,” volunteer pediatrician Cheryl Breitenbach Wickham said.

Breitenbach Wickham said she has seen a child a week since she joined the program just over two months ago. Typically, she said, the children have infectious or chronic diseases, with ear infections particularly common.

Occasionally, a child appears with more serious problems, she said. Recently, she treated a child with seizures who never had seen a doctor about the condition.

She said the network of doctors offered by the program allows her to refer children with particular problems to experts.

“Because there is a coordinator, a doctor’s recommendations for care are followed through,” Breitenbach Wickham said. And that, she said, means that a child she has seen will not return in worse condition later.

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Dental hygiene is a growing priority.

“A lot of kids are beyond pain,” volunteer dentist Matallie Hogue said. “They haven’t been to the dentist and often don’t have toothbrushes; I usually end up giving them to the whole family.”

Thomas acknowledged that preschool-age children and high school students fall between the medical-care cracks; the coalition wants to expand to cover these children, but expansion would require more staff to handle the referrals.