Guest guest Posted March 10, 2004 Report Share Posted March 10, 2004 PHILADELPHIA INQUIRER/Mon, Mar. 08, 2004 ATTACKING SCHOOLKIDS' ASTHMAPHILLY DISTRICT HAS A BUS AND ADULTS WHO CAREBy ROSE DeWOLFdewolfr@...SEAN PATTERSON Jr., age 8, stood in front of a truancy court judge one day last month to explain why he's missed 35 days of school so far this year.Truancy Court Judge Sunny Richman quickly determined little wasn't deliberately playing hooky. He was missing his lessons at the Wister School in Germantown because he suffers from severe asthma, a chronic disease affecting the ability to breathe. The boy's father, Sr., produced a doctor's note and the case was dismissed.But this was 's third appearance in truancy court - two last year also the result of multiple absences caused by asthma attacks. 's absences have caused him to fall seriously behind in his schoolwork. His dad says that although is in the second grade and a smart kid who wants to do well, he is only at a first-grade learning level." doesn't talk about it, but you can see his anger and frustration," says . "He's gone so often, the other kids treat him as an outsider. He never catches up in his homework." Jr. is a dramatic example of an escalating problem.While the School District of Philadelphia has no precise statistics on asthma-related absenteeism, it has come to recognize it as a major problem that has disastrous effects on student performance.When kids do badly in Philadelphia's public schools, critics usually cry "poor teachers" or "poor management." They don't say: "poor student health."Yet a recent study found that the 20 district schools deemed "underperforming" and turned over to private management several years ago had a significantly higher rate of asthmatic kids who didn't realize they had a disease.Richman says asthma is overwhelmingly the number one medical reason cited for truancy in her court, one of eight truancy courts held one week per month across the city. During one of Richman's recent sessions almost all the truancy cases that day were due to asthma - and students aren't sent to court unless they have missed 25 days or more of school.The incidence of asthma here and nationally has steadily grown in recent years. The American Lung Association estimates that nationally 14 million school days are lost a year due to asthma, with 5.2 million children affected.In a national survey of school nurses, more than half said asthma is more disruptive of school routines than any other chronic condition. More than a third said they had to respond to an acute asthma attack at least 11 times last year.According to the U.S. Centers for Disease Control and Prevention, the number of emergency room visits for asthma increased 36 percent between 1992 and 1999. It is estimated that about 6 percent of all Americans now have the disease.Dr. , allergies specialist at Temple University Children's Medical Center, says 85 percent of his patients are kids with asthma.And a report this month from the Pennsylvania Medical Society says that in this state alone, 42,000 more young people were diagnosed with asthma two years ago than was the case five years before. It found 138,000 or 6.6 percent of the student population during the 1997-98 school year had asthma vs. 180,000 or 8.6 percent during the 2001-02 school year."A sick child can't learn," says asthma expert Dr. Sal Mangione, clinical associate professor of medicine at Jefferson Medical College. Even when in class, a sick child finds it hard to pay attention, he says. 's dad says that even when his son is in school, he may have to leave his class two or three times a day to use a device that pumps medicine into his lungs.He says Jr. piles up unexcused absences because it's impractical to get a doctor's note every time the boy has an attack. Plus, on days when the s feel an attack is likely (such as on very cold days), they are afraid to send to school because Wister doesn't have a full-time nurse and the teachers aren't trained to recognize when a cough or wheeze needs immediate attention.No one knows why the number of asthma cases is increasing, says Mangione. But it is known that asthma is most prevalent in areas where children have less access to medical care and where they may live in old buildings where roaches, rats and mold, all known to trigger asthma, are found.The Asthma BusThe school district's serious examination of the asthma problem for kids began three years ago when the district agreed to cooperate in a research project organized by Mangione.Funded by a grant from GlaxoKline, Mangione turned a used double-decker bus from London into the Philadelphia Asthma Bus. The bus makes stops at Philadelphia schools and screens fifth- and sixth-graders for asthma symptoms.After screening close to 9,000 kids, mainly from low-income neighborhoods, Mangione reports, "We found one out of three has asthma. And only 25 percent of them knew it."The kids - and their parents - may assume the problem is a series of very bad colds. They may think the wheezing and gasping the kids do is normal. But on the bus, the students are shown a video of asthma breathing patterns in order to report whether they have them.It was a review of the data collected via the bus by Mangione's team of researchers that found a higher rate of kids with untreated asthma symptoms and more severe cases of the disease in the 20 schools turned over to Edison Schools Inc. compared with statistics from 65 other Philadelphia public schools.While that fact may not prove untreated asthma is the sole cause of poor academic performance, says Mangione, it does indicate that asthma is a major factor. Mangione delivered a paper on his findings to a meeting of the American College of Chest Physicians last October.Overlooking treatmentsWhat frustrates Mangione about the cases he sees is that asthma is totally treatable. With proper ongoing medication, asthmatics live normal lives."Often," says Mangione, "children with asthma don't exercise in gym for fear it will bring on an attack. Yet there are Olympic gold medalists who have asthma." Track star Jackie Joyner-Kersee, diver Greg Louganis and figure-skater Kristi Yamaguchi are three.Temple's Dr. says that, with rare exception, even the most serious cases can be turned around.But thousands of Philadelphia schoolchildren aren't getting ongoing care. Mangione has found that a child suffering an asthma attack may be taken to a hospital for emergency treatment and still not get continuing medical care. Without it, the disease becomes increasingly severe and disabling. In extreme cases, asthma attacks can lead to death.Seven months ago, with a grant from the CDC, the school district hired Mathew as full-time program coordinator for asthma education. Mathew's job is to work with school nurses, teachers and coaches, among others, to ensure they know what to do to help asthmatic kids."The football coach has to know how to get help if a kid is wheezing at practice," for example, she said.One full-time asthma staffer may not sound like a major assault on the problem, but Myrna , head nurse in Chicago's public schools, says Philadelphia is ahead of other districts in the country. She said she would love to have a full-time asthma staffer to coordinate asthma initiatives in Chicago. What Chicago has is a manual on how to help kids with asthma that it distributes to school staff.Mathew is also involved with the asthma bus, where kids who report asthma symptoms get a letter to take home to their parents.For some parents, a diagnosis either from the asthma bus or their doctors is a call to action.Eleven year-old Skor frequently skipped school at Sharswood Elementary in South Philadelphia because of asthma attacks. Today, with his asthma under control, he no longer misses classes and, he adds proudly: "I'm on the school basketball team."But not all parents will seek medical help.Some hesitate because they don't have a family doctor.Some don't see the need, says Mathew, because "they are also asthmatic and when they were growing up, the many treatment options now available didn't exist. They were taught to 'lie down and have a drink of water.' Asthma was something you just lived with - and they assume that is also true for their children."And then there are the bureaucratic hurdles. The schools can't administer medicine without parental consent, and that means multiple forms to be filled out. "School nurses are prepared to help parents fill out the forms," said Mathew, "but it still takes effort on the parents' part."Often these are parents who are already overwhelmed with other problems.Maureen Skalski, principal of Sharswood, recalls the bitter reaction of a mother whose asthmatic son Skalski had just sent to Jefferson Hospital's emergency room."The mother has three other children at home. She has no car. Just getting to Jefferson meant terrific stress," said Skalski.Money is a big issue, especially for those without health insurance."Asthma medications are expensive," says Spezelberger of the Lung Association of Southeastern Pennsylvania. "I know a mother of three daughters with asthma. She only buys rescue medicine for them (used to combat an attack) because she can't afford to also pay for controllers - the medicine taken every day to prevent attacks."The equipment needed is expensive," says Spezelberger. "A peak flow meter [a device measuring the lung's ability to push air out] costs $25. A spacer [a container attached to an inhaler that slows the release of medicine and thus enables a child to breathe in more of it] is also $25. The newest medications that are most effective are the most costly, as much as $60 a dose." Sr. asks, "If you can't afford the medicine, how can you treat the child?"There's also the practical matter of getting to school - not so simple for an asthmatic. Judge Richman said she's often told of children who can't walk the entire distance to their school and the parents can't afford bus fare. (Richman will order the school district to provide free tokens.)In one case, Richman said, the child was assigned to a school an eight-block walk away even though the school in the next district was across the street from her home. Richman says while truancy court can deal with problems like these, the need for expensive medication is another story. That's not something a judge can simply order to be provided."There's a need for a whole lot of money to be poured into medical services to give these children the help they need," Richman said.Mathew says school nurses are prepared to advise parents who qualify by income how Medicaid or 'CHIP' - the state's medical insurance program for children - or city health clinics can pay for asthma medication. But, she says, some parents won't take advantage of them anyway.And then there are the parents' personal habits. While nobody knows asthma's cause, there is no doubt about conditions that make it worse, and one is being around smokers. Yet, says Spezelberger, "I've seen a mother come into a hospital emergency room with a gasping child in one hand and a cigarette in the other."Overcoming the many obstacles to better treatment of asthma, both Mangione and Mathew contend, is critical to overcoming the learning failures of thousands of Philadelphia kids.The Philadelphia Asthma Bus project recently received a $50,000 grant from the Aetna Foundation for a bilingual call center to link families of children with high absentee rates directly to medical providers and other resources.And Mangione would like to see state legislation mandating asthma screening for every schoolchild, so that medical care can be provided as soon as possible. "Schools screen for scoliosis (curvature of the spine) before a child is admitted to school, but not for asthma," he says. "Politicians are just awakening to the problem." www.healthyschools.org READ, ENDORSE NEW NATIONAL CALL TO ACTION Quote Link to comment Share on other sites More sharing options...
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