A Project That They Can Feel Good About : Health Care for Students at a School in Cudahy Was Earning Failing Grades Until Dream for a Campus Clinic Became Reality

The kindergartner died of pneumonia, leaving behind a trail of questions for teachers at the Elizabeth Street Learning Center in Cudahy.

How could a seemingly healthy 5-year-old succumb to such an illness? Hadn’t he seen a doctor?

School officials might never get answers--the family has returned to Mexico for the burial--but they believe prompt medical attention could have saved the youngster’s life.

The tragedy at the end of June served as a cruel reminder of the lack of health care in this impoverished immigrant community--a situation that is about to change.

Later this month, Elizabeth Street--a year-round, pre-kindergarten through 11th-grade school with nearly 3,000 students enrolled--will open a campus health center where students and their families can get low-cost care. An accompanying family center will provide other services, including bilingual counseling and assistance in applying for Medi-Cal and other benefits.

The facility, a complex of renovated shop rooms on a corner of the school grounds, is the first of its kind in the Los Angeles Unified School District.

The forces behind the project include the district, St. Francis Medical Center in Lynwood and Cal State Dominguez Hills. They share a simple philosophy about grass-roots health care: To create better students, schools must address social problems beyond their gates.

That means teaching parents about unhealthy practices in the home such as smoking, a habit that administrators say contributes to a number of asthma cases in the Elizabeth Street student body.

It also means immunizing students against tuberculosis and other diseases that thrive in the crowded homes, motel rooms and converted garages where many families live.

Officials have high hopes for their plan, which they would like to see duplicated at schools across the district.

“It’s like a dream, something every school nurse hopes for,” said Elizabeth Street nurse Stephanie Ono. “We’re going to empower parents so they can take care of their children.”

By all accounts, the Elizabeth Street community desperately needs better health care.

Most families have no medical insurance and cannot afford to take their children to the doctor. Those who can pay for medical attention often cannot find it close by.

A 1991 study by the Community Health Foundation of East Los Angeles found just one primary-care physician for every 13,345 residents in Cudahy. By comparison, the study found one doctor for every 275 people in Beverly Hills and Malibu.

The vacuum has left parents with few options. Some travel miles by bus to crowded county clinics, facing long lines and a language barrier. Others rely on local clinicas that health experts say are often unregulated and provide questionable care.

Still others turn to neighborhood curanderos, trusted faith healers, or try their own homespun remedies.

When Roxana Ojeda Gonzalez’s son fractured his thumb at school earlier this year, she attempted to temporarily repair the appendage with a sandwich of Ben-Gay, tongue depressors and bandages.

Eleven-year-old Bill whimpered in pain for a week while Gonzalez scraped together $150 by cleaning houses to pay for a visit to a clinica in Huntington Park.

“I was sad that I couldn’t take my son to the doctor” right away, said Gonzalez, 27. “I felt very bad. I would cry.”

Some children who fail to get adequate medical care wind up in Elizabeth Street’s nursing office, where Ono sees up to 60 students each day.

Ono treats simple playground scrapes with Band-Aids and ice packs. But she is not equipped to handle children with serious ailments such as bronchitis, anemia, ringworm and scabies.

In such cases, she contacts parents and advises them to seek medical care.

“I tell them they should take their child to the doctor, and the child will come back the next day with the same symptoms,” she said.

The kindergartner who died of pneumonia was one of the cases that Ono was unable to treat.

The child, whose name has not been released by school officials, showed up in Ono’s office on a Monday morning in late June, sick to his stomach and vomiting.

Ono notified the child’s family, who took him home. The next day, the boy began running a high fever and was rushed to the emergency room at King-Drew Medical Center in Willowbrook. He died at the hospital one day later.

The boy had not visited Ono on a regular basis, and his teacher said he appeared healthy until the day he was sent home. It is unclear whether he had seen a doctor, but a family member told school officials that his mother had no health insurance.

The child’s sudden death stunned the school and set off a wave of unfounded rumors among teachers and parents that he had died from infectious meningitis.

“I was quite concerned that this would blow into a panic situation,” said Principal John Kershaw, who called his teachers together to discuss the cause of the student’s death.

With the opening of the health center later this month, students in similar circumstances will get immediate medical attention, school officials say.

Under the new system, Ono will refer serious cases to a nurse practitioner, who will, among other things, stitch together gashes, perform physical examinations, diagnose illnesses and prescribe medication--services that before would have been available only through an outside doctor.

The health center will also maintain a computerized database of local health and social services so staff can refer patients who need specialized attention.

“I know students are going to get the care they need,” Ono said. “I won’t have to worry whether a parent took their child to the doctor.”

The health center is also expected to provide complete immunizations for Elizabeth Street students, to protect against whooping cough, polio and other diseases that can quietly take hold. Ono estimates that one in five of the school’s 2,500 students lack the full complement of immunizations.

Health care will be free for Elizabeth Street students. Family members will pay for their own treatment on a sliding scale, depending on income. Medi-Cal will also pick up some of the tab.

Parents are excited about the opening of the health center. One mother, Angelica Cervantes, said the new facility will put her mind at ease because of the low cost and the proximity, just three blocks from her front door.

Cervantes has no driver’s license and no health insurance. When her daughter broke an ankle about six weeks ago, Cervantes had to rely on a friend for transportation. The bill from the hospital they visited in Downey was more than $700, which Cervantes is paying off slowly, about $50 a month.

Soon, things will be much easier.

“If something happens to [my children], they can go right here,” Cervantes, 34, said of the school. “It’s the best choice to bring them here.”

Cervantes is one of dozens of Elizabeth Street parents already taking advantage of classes at the school’s family center, which opened its doors earlier this year.

Some parents are studying English, others are enrolled in parenting classes that teach them how to communicate more effectively with children and about other topics, including the deadly effects of tobacco and drugs.

Parents drop their children off at an on-site child-care center while they attend class.

When the health center opens, Cervantes and others will be able to take advantage of additional services. Among them:

* A health educator will teach classes and distribute literature about the prevention of tuberculosis, HIV/AIDS and other diseases.

* Workers from St. Francis will help families apply for Medi-Cal, Social Security benefits and other services.

* Mental health student counselors from Cal State Dominguez Hills will provide free one-on-one sessions for Elizabeth Street students and their family members.

* Nursing students from the university will also visit families at home to document health problems and recommend solutions.

The project is being funded by a $737,000 grant from the W.K. Kellogg Foundation, a private organization in Michigan that helps sponsor community-based health services.

The ambitious ideas behind the Elizabeth Street programs took shape three years ago.

After the Los Angeles riots of April, 1992, a group of educators from the school of health at Cal State Dominguez Hills began talking about ways to bring better services to impoverished communities. Coincidentally, St. Francis was considering opening a health center on a local campus.

At the time, Elizabeth Street was interested in offering health and social services on its campus and was planning to start a “health academy” that would prepare students for health-related careers.

Diane Vines, then dean at Dominguez Hills’ school of health and adviser to the health academy, brought together the school, the university and St. Francis.

“It was like a marriage made in heaven,” she said. “The school was thinking a health clinic for its students. When we [Dominguez Hills and St. Francis] mentioned that it would be for families as well, they couldn’t believe it. The philosophy was just perfect.”

Dominguez Hills and St. Francis officials said they were particularly impressed with the school’s plans for the health academy, the idea that students would promote healthy practices in their homes and neighborhoods.

That is exactly what has happened. Several of the academy students are now working as volunteer outreach counselors through a program with St. Francis.

The students speak at community meetings and at youth groups about living healthy lifestyles--for example, discussing the dangers of smoking--and about how to prevent communicable diseases such as tuberculosis.

Some of the students said they hope to pursue careers as doctors and health educators. When they talk about the subject of medical care, they sound more like professors than 10th-graders.

“Many people are dying from diseases they shouldn’t die from--like TB, a common problem that has been out for years,” said Raymond Gonzalez, 15, who has learned how to give cardiopulmonary resuscitation and take blood pressure readings. “People are dying from this disease because they don’t have any knowledge.”

ON THE COVER

Stephanie Ono, school nurse at Elizabeth Street Learning Center in Cudahy, checks on Maria Lepe, 10, a fourth-grader at the school who was hurt playing soccer. An ice pack helped stop the swelling.

Soon, a new on-campus health-care clinic will open to help take care of the health needs of students and their families who live in the impoverished immigrant community that surrounds the school. An accompanying family center will serve other needs, including bilingual counseling.

“It’s like a dream, something every school nurse hopes for,” Ono said. “We’re going to empower parents so they can take care of their children.”