Facilities at Waianae schools aid access and attendance

Health centers based at Waianae Intermediate and Waianae High schools are not only providing convenient medical care, but keeping students from missing classes and helping with overall attendance.

Waianae students can visit on-campus health centers for a variety of medical needs, including burns and cuts, flu, strep throat, physicals and vaccinations. A two-year federal grant of more than $600,000 obtained by the Waianae Coast Comprehensive Health Center paved the way to open the health centers, one at each school, in March.

When Nicole McGregor, a seventh-grader at Waianae Intermediate, needed a sports physical, she went straight to the school’s new full-service health center, saving her and her parents the trek to her doctor’s office in Ewa.

McGregor, a member of the cross-country team, said she also took her friend to the school-based health center when she scraped her knee.

“They know exactly what to do,” McGregor, 12, said of her experience getting her physical at the clinic. “I think it’s good. Kids don’t have to leave school.”

Transformed from teacher workrooms, the centers are staffed during school hours by a nurse practitioner, who can prescribe medication, a clinic manager and a health care educator/coordinator. The setup is similar to a doctor’s office: There’s a check-in and waiting area, exam tables, thermometers, vision tests and other equipment. Parents are able to designate the nurse practitioner as their child’s primary care provider. All students are seen, including those with no health insurance.

John Wataoka, Waianae Intermediate principal, said the health center has contributed to an increase in the overall attendance rate, which is 2 percent higher this year than last. Prior to the clinic, he said, students could be sent home for health reasons and then would miss a second day to see their doctor. Wataoka added that many families have difficulty scheduling medical appointments during the weekends and school days.

“It’s one less appointment that (parents) have to make,” Wataoka said. “We want to support all of our families and help students get to school.”

Local efforts to open school-based health centers follow a national trend that seeks to expand access to health care by providing medical services at schools. In Hawaii about 3.4 percent of children, or nearly 11,000, do not have health insurance, according to 2014 census data.

Kahuku High and Intermediate School, in partnership with the Koolauloa Health Center, was the state’s first school-based health center; it opened during the 2013-2014 school year and provides medical and dental services. Koolauloa Health Center was awarded a $500,000 federal grant in 2011 to start up the clinic, now called the Red Raider Health Center.

Terrence Aratani, Koolauloa Health Center’s CEO, said due to the challenges of funding the school clinic, officials opened the facility this year to parents, staff and the community. The clinic serves about 12 to 15 patients per day for medical services and more than 15 for dental care, with a mixture of students and residents, he said.

“The challenge has always been that we’re considered rural, and there is a need for providers,” Aratani said. “Hopefully we can see more school-based clinics start popping up in Hawaii.”

Although not considered school-based health centers, Hawaii Keiki, a partnership between the state Department of Education and the University of Hawaii’s School of Nursing and Dental Hygiene, has placed nurses at 10 schools on Oahu, Kauai and Hawaii island.

The nurses focus on incorporating health education into the schools’ curriculum as well as providing medical services. Schools were chosen based on high absentee rates and the number of students with limited access to health care, said Mary Boland, dean of the UH nursing school.

“We’re not a clinic in the traditional sense,” Boland said. “It’s really about understanding that interdependence of health and education. You need better health in order to be ready to learn.”

Nationally there are more than 2,300 school-based health centers, an increase of 20 percent from 2010-2011 to 2013-2014, according to the Washington, D.C.-based School-Based Health Alliance. In rural communities the presence of these centers has grown by about 7 percent during the same period, which accounts for the largest increase among suburban, urban and rural areas, the Health Alliance found. About 68 percent of these rural health centers serve other patients in addition to students.

“It’s no longer just a Band-Aid (approach) to the problem,” said Hokulani Porter, one of the Waianae schools’ nurse practitioners, adding that the center offers much-needed help to homeless families that have little to no access to health care. “They’re seeing this as a health promotion.”

At Waianae Intermediate 394 students from August to the start of October visited the health center, 370 of whom were treated for headaches, rashes, shortness of breath and other ailments. Of those students, 346 returned to class after treatment.

About 25 students who visited the center were turned away due to no parent consent form, staff inability to reach their parent or guardian, or an insurance plan that was not accepted at the time, according to counts taken by the Waianae Coast health center.

At Waianae High 470 students visited the school’s health center during the same period, with 384 being treated for nausea, fever and allergic reactions, or undergoing physicals. Of those students, 372 returned to class after treatment.

Disa Hauge, Waianae High principal, said students face many challenges, including “the incredible stresses on the families as they try to survive.” Prior to the clinic opening, students were sent home if they went to the health room to use an inhaler, she said.

But many of these students can now return to class after the clinic’s nurse practitioner assesses them. She said the nurse practitioners, who are required to earn a master’s or doctorate degree, can provide a broader range of medical services than the school’s health aide, who is trained in first aid and CPR.

“You have lots of families where kids are responsible for their siblings because both parents are working. You have a high rate of homelessness out here,” Hauge said. “We have a lot of unattached kids who simply don’t have a family taking care of them. And getting a good education and us providing as much health care as we can really helps those kids get a foundation … so they don’t have to worry about the same things when they have their own families.”

Calvin Endo, whose son is a senior at Waianae High, said it is a relief to know that his son can be treated at the health center if he is sick or injured.

“We find the students don’t miss classes as much. That’s the nice thing,” said Endo, vice president of Waianae High’s PTSA. “From what I’ve heard so far, it’s been very, very positive.”