Inside the Pediatric Mobile Health Unit

Nothing is more universally certain than people's innate fear of needles, even though the stick of that shot rarely even stings for a moment or two. Fifteen year old Melody, a student at a local Englewood high school, cringes at the thought as she sits inside St. Bernard's Pediatric Mobile Health Unit. Her braids wound meticulously together but starting to break apart, Melody loathes the idea of an immunization shot but is otherwise at ease. She's talkative, somewhat perky, and she's got no qualms about recounting her failed pregnancy almost one year ago when she delivered a still-born child. In addition to her shot, Melody will receive a physical exam on this visit, at which point she divulges her belief that a second pregnancy may be imminent.

The story is neither shocking nor unbelievable to St. Bernard's Nurse Practitioners on the Mobile Unit. Risky behavior is not uncommon in the community, where drug use and unsafe practices are common precursors to illness and pregnancy. "Some of these kids will clean themselves up and lead good lives," one Practitioner says. "Some will die. Some will contract HIV, or Hepatitis." And as with all teenagers in every socioeconomic class and every race, their actions are based on the preeminent illusion that "they don't think they'll ever die."

All of these factors play into the origin of the Pediatric Mobile Health Unit, launched in 2003 to address the increasing need for comprehensive health care among underserved youth in Englewood and surroundings. Thanks to the generosity of private benefactors who backed the project financially, the Mobile Unit hits the road almost daily to provide vaccinations and physical exams to children ages 3-18.

For these kids, the PMHC may be the only visit they make to a doctor all year, and that makes the St. Bernard staff vital to their overall well-being.

"There are just basic health care opportunities that some people may take for granted," says Walter Repuszka, Mobile Unit Manager. "The Pediatric Mobile Health Unit brings essential care to kids who might not otherwise receive these very basic treatments. By providing immunizations, we are able to keep kids in school before they are turned away for not having current vaccines. And, our physical exams may find a clean bill of health, or perhaps a treatable condition that can be addressed through physician referrals (to in-hospital agencies like Family Focus) or just plain good advice."

On the brink of the young school year's first vacation break - the day before Thanksgiving - the Reverend Jesse Jackson roams inside the school, mingling with staff and giving away turkeys for the holiday. St. Bernard Hospital is on the outside, giving physicals and administering booster shots in the 40-foot Mobile Unit parked outside the school's main entrance.

By 10:00am the first student arrives for a routine physical. For starters he looks to the eye chart for a brief eyesight exam, and struggles to read even the most decipherable lines. Finally, he concedes that he wears corrective lenses, but they were broken and have not been replaced. The test reveals that his eyesight is poor, which can only detract from his abilities in the classroom.

Shortly thereafter, another young man named Tyson stares at the same chart. He, too, strains his eyes to read the letters on the wall. Later, a 16 year old girl says she probably needs glasses, and she is right. Over the course of a few hours, the lack of optical care is grossly apparent as so few students can identify the letters correctly, if at all.

Dental health, like vision care, also ranks among the primary concerns facing these inner city youth - a main reason why St. Bernard began implementing a Pediatric Oral Health Initiative in 2006, opening the hospital's in-house dental clinic in January, 2007. In tandem, all of these pediatric services make up a solid comprehensive care package aimed at promoting healthy living among Englewood youth - something that Mobile Unit staff find evidently lacking and continually strive to address. The absence of parental support and guidance also hinders these kids' ability to carve solid, healthy lives. Yet in an environment where gun shots ring out and pockets of violence erupt, the term "healthy" has many levels of definition.

For today, PMHU caregivers will deal with issues they are equipped to tackle. Tyson pretends not to be nervous about the shots while being taunted with notions of pain and suffering by a nearby friend. The shot are uneventful, and Tyson moves to the back of the Mobile Unit for his physical.

Though hard to imagine, many of these teens have never before received a physical examination. As a result, medical conditions can linger for years before treatment. Part of the challenge for St. Bernard staff is acquiring up to date medical history reports, provided by parents as part of a consent package. Often incomplete and sometimes inaccurate, these forms can at times prevent the student from receiving treatment on the Unit. Today, up to eight students will be turned away because their paperwork is not nearly complete.

Sometimes the burden of dotting and crossing falls on Clinical Assistant Kenya Benniefield, who fills in the blanks on informational forms while at the same time testing blood pressure and body temperature - the middle link in a three-step, close-quarters tour spanning three rooms: a waiting area with television and radio, a common area for initial testing and storage, and a full examination room. Over 4000 faces pass through each month.

A young man named Michael needs a tetanus shot in the arm before he goes back to classes, but his brother has signed the consent form. Because his brother is neither a parent nor guardian, the consent is not valid, and PMHU staff tries to at least establish a verbal agreement with his mother via telephone. A call to Michael's house is productive only because we learn his mother has gone shopping. Now, Michael takes the phone and calls his mom's cell phone number, with no luck. His shot will have to wait.

Near lunchtime, a departing field trip has helped slow the flow of students, giving Mobile Unit staff a chance to breathe, answer phone messages, or whip up a cup of hot chocolate. But only a precious few minutes pass before three more young men come to the Mobile Unit. One of them reads the eye chart with no problem. He's the first to do so. All three pass their physical exams and head back to school as two young girls arrive to receive shots. Finally, having expected to see up to thirty students on this day, the Mobile Unit treats only about a dozen. The school's field trip, the pending holiday, and failed consent forms limit the number of students who visit the van.

If anything, this insures that more students here will seek care in the Mobile Unit when it returns in December.

*For the purposes of anonymity, student names have been changed.

Originally published in the St. Bernard Viewpoint newsletter