Health Care Delivery : Van Brings Medicine to Children of Poor at Five Elementary Schools in Santa Ana

The young mother from Mexico, unable to read or write, dug into her purse for the scrap of paper from which she copied her name onto a medical form for her 7-year-old son, Jose.

Marielena Artiaga had brought the boy to the blue medical van parked next to Remington Elementary School on Wednesday morning because his teacher was concerned that recurring ear infections might have caused a hearing problem that was hampering his learning.

The van, staffed with a bilingual pediatrician, nurse and driver, began traveling last month to five schools in the poorest neighborhoods of Santa Ana and so far has treated more than 100 indigent children free.

The program, Healthy Tomorrows, was prompted by striking evidence of medical neglect among the poor and non-English-speaking population of Orange County.

Doctors began noticing that many children with preventable diseases were being admitted to Children’s Hospital of Orange County. Next, local pediatricians and the Orange County Health Care Agency conducted a survey in December, 1990, at Heninger and Roosevelt Elementary schools in Santa Ana and found that 88% of the students had untreated health problems. Many of them had never seen a doctor.

Also, Orange County statistics showed that Santa Ana has the highest child-abuse referral rate in the county, which was attributed in part to lack of family communication and education.

So after two years of planning, an outreach program was launched last month. Its founders describe it as an unprecedented collaborative effort of nine public, private and nonprofit agencies.

Participants include the Santa Ana Unified School District, the city, the Orange County Department of Social Services, Children’s Hospital of Orange County, the Orange County Health Care Agency, Cal State Fullerton, the Neighborhood Services Center, USC’s School of Social Work and the Orange County chapter of the American Academy of Pediatrics.

A 36-foot-long van with two examination rooms, specially designed and constructed at a cost of $100,000, is parked one day a week at Roosevelt, Garfield, Kennedy, Heninger and Remington schools.

The schools were selected because many of the students’ parents cannot afford to take their children to doctors and have no insurance.

“I don’t think a lot of people realize the kind of poverty next to them,” said Dr. Brenda Steffensen, a pediatrician fresh out of medical residency who is paid by Children’s Hospital to staff the clinic on wheels. “A lot of the families are living on $300 to $600 a month and many are illegal, so they are not getting food stamps or welfare.”

Steffensen said the immigrant families, especially those most recently arrived from Mexico, don’t know about the low-cost clinics offered by the county and Children’s Hospital or have no way to get to them. Or they mistakenly worry that going to the clinics could make them vulnerable to deportation.

So on Wednesday, parents and children came hand in hand to the van that was within walking distance of their homes.

A few of the children were frightened, clinging close to their mothers, because it was their first encounter with a doctor or a needle.

They came for immunizations against common childhood diseases and for tests to show if they are at risk for anemia or tuberculosis, ailments that tend to be prevalent among poor Latino immigrants.

But they got more than physical exams and prescriptions for drugs. The parents were told what kinds of foods would improve their family’s nutrition. Children showing signs of anxiety or disciplinary problems were referred to social workers.

When an 8-year-old boy screamed in terror and fought off the nurse who was trying to prick his finger for a blood sample, Steffensen shook her head.

“There is something else going on with him that makes him behave that way. A social worker needs to look into it,” she said, noting that the boy’s mother complained that the youngster is often afraid and won’t sleep alone at night.

This blend of medicine, education and social services is the core of the the Healthy Tomorrows program, said Lucinda Hundley, an administrator with the Santa Ana schools.

A comprehensive approach better addresses learning problems, she said. And by working in tandem, the agencies can more effectively use taxpayers’ dollars.

The program will apply for whatever reimbursement it might get from state and federal programs for indigent health care. And for the first three years of its operation, Healthy Tomorrows has received grants of $750,000 and commitments of $750,000 a year in free services, including the salaries of five county social workers working full time at the targeted schools.

The social workers are detectives who look for problems beyond medicine, whether domestic violence, child abuse or simply a family’s inability to buy hearing aids or glasses, which might be interfering with learning.

Besides working with individual families, the social workers conduct therapy groups for children and classes in parenting for their mothers and fathers.

Steffensen also works closely with the school nurses, who set up medical appointments for children who they believe need a doctor’s diagnosis and treatment.

Steffensen takes pride in the discoveries of untreated health problems she has already made, including that of a 7-year-old boy who might have lost the vision in his right eye if she hadn’t diagnosed an optical disorder and referred him to an ophthalmologist.

She has a list of private pediatricians provided by the American Academy of Pediatrics who have agreed to provide free follow-up care to her patients. But she said there is a shortage of specialists on her list. Currently, she said, she is unable to find a dermatologist to treat two sisters with a skin disease that is scarring their faces.

“It is real sad,” she said.

Next year, Hundley said, the program hopes to add dentistry. More than 60% of the children she sees have untreated cavities, she said.

But medicine can’t always provide an answer to a student’s learning problems, Hundley said. When she examined Jose Artiaga’s ears she found some wax, but not enough to make him hard of hearing.

So his difficulty in learning might stem from other factors that are often found in extremely low-income homes, she noted, starting with his mother’s illiteracy. She sent his case to the school’s social worker.