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06/10/05
This Life and Times health care special is made possible by a
grant from QueensCare, a public charity providing health care to
the low-income and uninsured residents of Los Angeles County.
Val Zavala>> Tonight on Life and Times --
They practice medicine in other countries, so why can't they see
patients here?
Orangel Gutierrez>> You have to certify that these people know
what they know. You're not going to let anybody just come in
and say I'm a doctor, I have this paper here, you know, from
whatever country and it says I'm a doctor, can I go practice?
Val>> And then, helping kids in polluted neighborhoods breath a
little easier. Plus, the changing role and workload of the
school nurse.
It's all straight ahead on tonight's special health care edition
of Life and Times.
Life and Times is made possible through the generous support of
the L.K. Whittier Foundation dedicated to improving the quality
of life by supporting innovative endeavors in the fields of
medicine, health, science and education.
And by a generous grant from Jim and Anne Rothenberg.
Val>> Welcome to this Life and Times health care special. It
used to be that the school nurse handled problems like skinned
knees and runny noses. But these days, the problems are more
serious, everything from diabetes to feeding tubes, and many are
handling caseloads that are four times what the state
recommends. Toni Guinyard takes a look at school nursing and
how it's changed over the years.
Marta Nunez>> "We'll get you some ice on that and then we'll
let you sit in here for ten minutes, but then I want you to come
back at lunchtime so I can check you."
Warren Omohundro>> Some people may have the idea of a school
nurse dispensing band-aids or putting ice on a small scratch or
something. We do that, but we end up having to do a lot more on
a daily basis.
Marta Nunez>> "Okay, you sit right here. You sit over here,
sweetie, and then let me look at your eye."
Toni Guinyard>> Marta Nunez is a school nurse for the East
Whittier City School District. We caught up with her at
Leffingwell Elementary, one of four schools she's assigned to
work.
Marta Nunez>> When I came here to East Whittier, I was hired as
a special ed nurse.
[Film Clip]
Marta Nunez>> Leffingwell was my only campus and I had fifty
students. Now I have four schools and over 2,600 kids.
Toni Guinyard>> Nunez, like many other school nurses in
California, is assigned to multiple schools forcing her to
scramble from campus to campus and child to child.
Marta Nunez>> It's difficult. It's been really hard sometimes,
but because our school district is small, I'm able to travel
from one school to another.
Watson Omohundro>> School nurses do have a lot to do and she's
very good at it.
Toni Guinyard>> To say Nunez is good at her job is a huge
compliment coming from Leffingwell principal, Watson Omohundro.
Leffingwell has a unique mix of general education and special
needs students. From preschoolers to fifth graders, many attend
the same classes sitting side by side.
[Film Clip]
Toni Guinyard>> The school is also home to the Whittier area
infant family program for babies born at risk or with severe
development delays.
Watson Omohundro>> We're unique in the sense that we have so
many students with special needs that we're going to be faced
with on a daily basis problems that most other elementary
schools would not be faced with. It's a school with a very
unique personality. If a new student arrives and they were in a
wheelchair or had a walker or were deaf and needed an
interpreter, it wouldn't raise an eyebrow.
Toni Guinyard>> Nunez will tell you that all of them are her
children and her responsibility, but she can't be everywhere at
the same time.
[Film Clip]
Toni Guinyard>> The California School Nurses Organization
recommends there be one school nurse for every seven hundred
fifty students. The nurse to student ratio in California public
schools is one nurse to 2,921 students.
Marta Nunez>> "You put this where it hurts and I'll get the
phone."
Toni Guinyard>> Many of whom have health problems Nunez didn't
see when she first became a school nurse twenty-eight years ago.
Marta Nunez>> I had no students who were diabetic, very few
asthmatic kids.
Marta Nunez>> "Now I have it connected, so now what do I have
to do, Gabe? Put the medicine in."
Marta Nunez>> I have a lot of special ed kids that have medical
problems. They have trachs. They have G tubes where you have
to feed them through a tube. They have seizures.
Marta Nunez>> "Turn it on, and how high do I go on? Six? Okay,
I have it on six. Anything else that I need to do? That's
good? Okay. Then we'll sit here."
Marta Nunez>> We have students who are diabetic who don't give
themselves insulin, and we are required by law to provide these
services. So if a student needs insulin, I can't say, no, I'm
not going to do it, I'm too busy, I'm at another school.
Toni Guinyard>> Observing Nunez at work provides some insight
into the number of children facing a wide variety of medical
problems and the increasing number of children taking prescribed
drugs every day.
Marta Nunez>> And then these are my daily meds. There are a
couple of meds that are given daily, but they are kept in the
classroom in a locked cabinet.
[Film Clip]
Toni Guinyard>> Over the course of just three hours, Nunez
dispenses medication, checks teachers being tested for TB --
Marta Nunez>> "Have a seat, Miss Jenny, and I'll check your arm
for you. Let's see your arm. Good deal."
Toni Guinyard>> -- treats bumps and bruises, and consults with
the mother of an injured child.
Marta Nunez>> "Okay, he was in here earlier and he was hit in
the eye and his eye is clear, but now he's complaining of a
headache."
Toni Guinyard>> And this is a slow day, but Nunez is on the
move and she's able to make sure everyone gets the care they
need with the help of a health clerk and trained school staff
members. Although there are fewer than ten thousand students
enrolled in the East Whittier City School District, this
district averages about fifty thousand student visits to the
health office every year. Now those students may be treated by
the nurse, the health clerk or even a secretary or perhaps the
principal.
Watson Omohundro>> I don't like to ask people to do things that
I can't do, so I went when we first had to do the tracheotomy
training to be able to remove and replace it. I went to the
training with some of the instructional assistants and actually
did it and that was one of the hardest things I've ever done.
Marta Nunez>> I don't think the parents understand that there
is not a school nurse on campus at all schools.
Maria Rivera Klein>> I think that they need to know.
Toni Guinyard>> Maria Rivera Klein is President of the
California School Nurses Organization southern section.
Maria Rivera Klein>> People really basically come to schools
and think that there are school nurses taking care of their
children at each school site.
Toni Guinyard>> And what's the reality?
Maria Rivera Klein>> The reality is that, in many of our
schools, there are people that are not licensed that are taking
care of their children.
Marta Nunez>> In our school district, we're lucky we have
health clerks.
Toni Guinyard>> But by law, there are limitations to what
health clerks are authorized to do.
Marta Nunez>> They don't understand that they can't okay orders
from the doctor, that a school nurse has to do that. You know,
because they're in the health office, they're thinking anybody
who works in a health office must be a nurse.
Maria Rivera Klein>> We're trying to align the regulations of
the Board of Registered Nursing with the California Department
of Education. At this time, they're not aligned.
Toni Guinyard>> The California School Nurses Organization is
supporting a bill that would detail what a licensed assistant
personnel can and can't do when providing health services and to
clarify the roles of school nurse as supervisor and trainer.
Maria Rivera Klein>> I love what I do and I can see that we
could make a big impact in the health of our communities, but
you know, we can only do so much and we need to do more.
Toni Guinyard>> And most school nurses say they're willing to
do what it takes if it results in keeping youngsters healthy and
in school.
>> "Nine kids came to school. Nine children came to school
today."
Toni Guinyard>> I'm Toni Guinyard for Life and Times.
Kcet.org is the place to look for the very latest on Life and
Times. You'll find previews of upcoming stories, transcripts
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and Times".
Val>> Southern California's air quality is notoriously bad and
little wonder that twelve percent of Californians suffer from
asthma and children are the most vulnerable.
[Film Clip]
Val>> For some children, taking a deep breath can be hazardous
to their health.
[Film Clip]
Val>> Asthma is on the rise. It's now the number one chronic
disease among children, the number one reason why they miss
school and the number one cause of child hospitalization.
Dr. Kenny Kwong>> Asthma is a growing phenomenon, a growing
problem worldwide.
Val>> Today the Los Angeles County Breath Mobile is making a
stop at Rowland Elementary School in East Los Angeles. Dr.
Kwong has been seeing children here regularly.
Dr. Kenny Kwong>> "Sounds pretty good. Have you blown in the
machine yet? All right. We're going to have you blow in the
machine, all right?"
Dr. Kenny Kwong>> Everyone thinks of asthma as essentially, you
know, if you go see the movies, the kids with the inhaler and
short of breath, but it's a little bit more than that.
[Film Clip]
Val>> An asthma attack is when the lungs become inflamed and
breathing is difficult. Attacks are triggered by exercise, cold
air or airborne toxins and can be frightening. Asthma runs in
families, but recent studies show that dirty air, especially
microscopic particles from exhaust, plays a significant role in
the growing number of asthmatic children.
Dr. Kenny Kwong>> The Southern California basin is one of the
nation's worst in terms of air quality, both in terms of things
like diesel particulates from all the trucks and also from stuff
coming out of the refineries, also the way the basin is laid out
geographically. Everything gets trapped there.
[Film Clip]
Val>> Today Dr. Kwong is examining a boy with a persistent
cough. He decides to have him tested for allergies. It's not a
pleasant experience. Asthma hits minority communities hardest.
Eighty percent of Latinos live in neighborhoods where the air
quality exceeds federal standards and children, with their young
developing lungs, are the most vulnerable.
A major long-term study of Southern California children by USC
is underway. Already there are some surprising findings. For
example, asthma often subsides as children get older, but
researchers have found that lung damage can last a lifetime,
that teenagers whose lungs have matured are five times as likely
to have low-lung capacity if they grew up breathing smoggy air.
In other words, some will suffer from low-lung capacity all
their lives.
A couple of miles away in Huntington Park, we met Bahram Fezeli,
Lizette Ruiz and Robert Cabrales. They are with Communities For
A Better Environment and they introduced us to the residents of
Cottage Street.
Bertalina Chavac>> Last year, my niece was admitted to St.
Francis Hospital twice.
Val>> Bertalina Chavac says her nephew and niece had asthma
when they were children.
Bertalina Chavac>> I'm furious because I don't know why they
haven't been able to determine what's causing the asthma.
Val>> The residents here live right next to the town of Vernon,
a city with only three hundred people and the rest is heavy
industry. On top of that, they've been living with a huge
mountain of concrete, dusty debris from the freeway, right
across the street. Virtually everyone on Cottage Street has a
story about health problems.
Elyjah Glowski>> You can't go outside and play catch or play
football because of where we live and the dust.
Val>> Elyjah Glowski had asthma for three years between ages
nine and eleven. He's convinced the lumber yard across the way
was at least partially responsible. And it goes on, you were
saying --
Elyjah Glowski>> -- twenty-four hours a day.
Val>> Twenty-four hours a day?
Elyjah Glowski>> I hear it at two in the morning. They shut
down, I guess, to cool down and it starts up again. I'd say at
six in the morning when I wake up, I'd say it's already going.
Before I go to school for about twelve years, it's been every
morning.
Val>> And you've lived here all your life?
Elyjah Glowski>> All my life.
Val>> Nancy Pina is a mother of two. Her little boy has
breathing problems when he's sleeping and both children have
serious nosebleeds.
Nancy Pina>> And I'm always getting phone calls from the school
saying your daughter has a bloody nose or your son has a bloody
nose.
Elyjah Glowski>> You wash your car, I'll give you less than
twenty minutes and it will be all dusty.
Bertalina Chavac>> And that's important for people to know
because my nephew was healthy up to the age of ten. But when he
wanted to join the Navy, he wasn't able to pass the physical
test and that's why we're so angry.
Nancy Pina>> Before, when I first moved here, I wasn't
concerned. I mean, I would just get up, go to work, come back
and that was it. But I hear all these problems that everyone
else is having and it sounds a lot like the problems that I'm
going through, that my son has and my daughter has, so most of
the neighbors complain about the same thing.
Val>> Lizette and Robert both grew up in the area and had
health problems themselves.
Lizette Ruiz>> My little brother had nosebleeds. He used to
have them every day and, during the cleanup, I actually started
getting some myself.
Robert Cabrales>> I can remember when I was seven or eight
years old, I would be playing outside with my friends and
neighbors and suddenly I'd have this chest pain and I would drop
to the ground. You know, it was one of those early experiences,
but I would have those constantly, you know, through the years.
Val>> Robert's family had no health insurance and a visit to
the doctor was out of the question.
Robert Cabrales>> When I went to the school nurse and
complained about breathing problems, I was just relaxed. So I
managed to, you know, develop some kind of relaxed pattern.
Val>> Robert would have loved to have had the Breath Mobile
around when he was growing up. Parents often go away with as
many as five medications. If they don't have health insurance,
the treatment is free and it's certainly cheaper than being
hospitalized. The average hospital visit for asthma costs
thirteen thousand dollars. Dr. Kwong says if parents and their
children make three visits to the Breath Mobile, they will
usually continue and the disease can be controlled.
Dr. Kenny Kwong>> Well, that's the paradigm, but you know, even
without all the scientific debates and mumbo-jumbo, if you have
a kid who's having asthma attacks all the time he's in school,
at the very, very, very least, you know, you treat them, they're
able to be normal kids and do what they're supposed to do.
Val>> Life has also gotten better for the residents of Cottage
Street. After a hard-fought battle, their mountain of concrete
was finally hauled away, distributed to other landfills.
Nancy Pina>> I am so glad. I can see the sun, the sunsets
(laughter) because it covered -- I mean, it was huge.
Val>> But improving the air for millions of people who live in
heavily polluted areas is a much bigger challenge. Bahram says
they have a strategy.
Bahram Fezeli>> Facilities here have to be regulated
differently from facilities elsewhere. They have to be more
stringent conditions on facilities here to reduce the overall
impact of pollution and, of course --
Val>> -- so you're saying the standards for a factory or a
manufacturing plant should be different if it's right next to a
residential area than if it's out in the middle of nowhere?
Bahram Fezeli>> Absolutely. Ideally, you don't want to have
polluting facilities next to, you know, schools and that's also
one of the things that we are asking and pushing for is that we
believe that there should be buffer zones between polluting
facilities and residential populations, especially sensitive
receptors like hospitals, day care centers and schools.
Val>> They say it's a matter of environmental justice and, as
long as minority neighborhoods suffer disproportionately from
toxic air and breathing problems, Robert, Lizette and Bahram
will have their work cut out for them.
You can find more information and resources about asthma at the
website for the Asthma and Allergy Foundation of America,
Southern California Chapter, or give them a call.
To send a comment or a question to our program, you can reach us
by mail at this address:
Life and Times
4401 Sunset Blvd.
Los Angeles, California 90027
You can also call our viewer comment line (323) 953-5555) or
contact us the fast way by e-mail at kcet.org.
Val>> There is a desperate shortage of physicians in Southern
California's minority and poor communities and, at the same
time, there are hundreds of physicians who would love to
practice medicine, but can't. Hena Cuevas tells us about a
program that is bringing these two needs together.
[Film Clip]
Hena Cuevas>> When Vicky Cabarello came to the United States
from Mexico, she came with a prized possession: a medical degree
in family medicine and more than five years' experience treating
patients in western Mexico. She was hoping to turn her training
into a successful practice here in Los Angeles, but she never
imagine it would take fifteen years before she could practice
medicine again.
Vicky Cabarello>> We have a title over there in Mexico, but it
doesn't mean that we can work over here.
Hena Cuevas>> Her degree from the Universidad Autonoma de
Medicina wasn't valid in the United States, so to survive,
Cabarello set her pride and skills aside and took a job making
mini-blinds. How difficult was it after having been a doctor to
then go work in a factory making blinds?
Vicky Cabarello>> Very difficult, really depressing and hard to
assimilate.
Hena Cuevas>> Her story is a familiar one to Dave Ramos who
works with doctors from other countries who immigrate to the
United States.
Dave Ramos>> Physicians who had high levels of education, in
many cases, specialties, are working as taxi drivers and
construction and what have you.
Hena Cuevas>> Ramos is the Director of COPHYLA, the Consortium
of Physicians from Latin America, a nonprofit group based in
Santa Ana in Orange County. Its mission is to help health care
professionals from other countries navigate the complicated
revalidation process.
Dave Ramos>> Obviously, the person isn't working in their
country and they're not using their talent here, so it's a huge
waste of talent. One can just imagine the uses that there could
be for this untapped human resources which is international
health care graduates.
Hena Cuevas>> Foreign-trained physicians often have to start
the long and expensive process of medical school education all
over again when they come here. That usually means going back
to basics.
[Film Clip]
Hena Cuevas>> This is one of the evening classes offered by
COPHYLA. All of the students here have medical degrees from
their home countries and are eager to get back into their field.
The class is designed to help them with the first of two
licensing exams. If they pass, they can then apply for a
residency at a hospital. There are limited slots nationwide and
they are up against domestic medical graduates. Not every
doctor who arrives will be able to become a doctor. According
to Ramos, every new student is told it can take up to eight
years before they can even enter a medical residency program.
After that, the three to five years it takes to complete, and
we're talking about a process that can take well over a decade.
Even against those odds, there are many willing to give it a
try.
[Film Clip]
Hena Cuevas>> Two years ago, thirty year old Orangel Gutierrez
returned to Southern California where he grew up. When he was
in elementary school, his family was forced to move back to
Nicaragua. After he finished high school, he went on to the
Universidad Americana in Managua where he became a surgeon.
Coming back to the United States, he knew he wasn't going to be
able to practice as a surgeon, so he took the first job that
came his way.
Orangel Gutierrez>> When I first got here, I wasn't doing
anything. I was sitting around the house. My aunt cleans
houses and I'm not doing anything and she told me how much she
was making cleaning houses and I'm like, I'm there.
Hena Cuevas>> It was while working with his aunt that he heard
about COPHYLA. According to Ramos, they recommended he at least
start working at something related to his field.
Dave Ramos>> They can refine their medical terminology in
English, make contacts, get letters of recommendations they need
to get for their long-term goals and understand how the system
works here.
Hena Cuevas>> For starters, they helped Gutierrez get a job as
an interpreter at the University of California Medical Center in
Irvine. He then worked his way up to medical assistant.
Because he's only thirty, Gutierrez is giving it his all to
practice surgery once again.
Orangel Gutierrez>> There are some people that choose to take
nursing or take other passages, you know. That's all good, but
for me, when I have my eyes set on a goal, I'm going to do
everything possible to accomplish it.
Hena Cuevas>> Gutierrez has time on is side, but what about
older doctors and nurses?
Dave Ramos>> A lot of them say, you know, Dave, I just don't
want to go through it. You know, I've got a family. What
happens if I pass all the exams and I can't find a residency --
which happens a lot. And especially sometimes when they're
older, they say, Dave, I don't have the years. Why don't I just
go into nursing or physician assistant?
Hena Cuevas>> That was the case for Cabarello. Married with
four kids, it was impossible for her to spend all that time
studying. So COPHYLA steered her in another direction within
the medical field. She started out as a medical assistant and
then went to school to become a physician's assistant.
Vicky Cabarello>> I do everything that medical doctors do, but
we have to work under the license of a medical doctor, M.D.
Dave Ramos>> They share less experiences with their patients.
For instance, if you really think about it, the patients that
they're treating in Latin America, do the immigration
demographics, the type of same patient we're going to see here
especially in Southern California.
[Film Clip]
Hena Cuevas>> Cabarello says her language skills and cultural
experience help her greatly in this predominantly Hispanic area
and studies show that Spanish-speaking health professionals are
sorely lacking in Los Angeles County. In 2002, there was a
shortage of more than ten thousand and, that year, only forty
thousand Spanish-speaking doctors graduated from area schools.
That's what Ramos is hoping to do: use the skills these men and
women bring to fill that void. Are they taking jobs away from
domestic graduates?
Dave Ramos>> No, they're not because jobs, even when they don't
go in as physicians, these internationally-trained medical
doctors are going also in other high-need areas. There are not
physicians who are looking for jobs in the United States and
saying I can't get a job because of these international medical
registrants. It's just not happening.
Hena Cuevas>> Ramos says they get between ten to thirty new
students every week, some driving from as far away as
Bakersfield. And even though all of them may not make it,
Gutierrez says he understands why the process is so difficult
and time-consuming.
Orangel Gutierrez>> They're not going to let anybody just come
in and say I'm a doctor, I have this paper here, you know, from
whatever country and it says I'm a doctor, can I go practice
here? We're not going to let them do that.
Hena Cuevas>> Gutierrez is scheduled to take his first exam
later this year. It's the first step toward being able to use
that scalpel once again. As for Vicky Cabarello, she's been a
physician's assistant in Anaheim for almost two years now. How
difficult has it been?
Vicky Cabarello>> Difficult, but if can do it, everybody can do
it.
Hena Cuevas>> They can't call her Dr. Cabarello, but it's a far
cry and much more satisfying than making mini-blinds. I'm Hena
Cuevas for Life and Times.
Val>> Thanks for joining us on this special health care edition
of Life and Times. I'm Val Zavala. Thanks for watching. We'll
see you next time.
This Life and Times health care special was made possible by a
grant from QueensCare, a public charity providing health care to
the low-income and uninsured residents of Los Angeles County.
By the L.K. Whittier Foundation dedicated to improving the
quality of life by supporting innovative endeavors in the fields
of medicine, health, science and education.
And by a generous grant from Jim and Anne Rothenberg.
Val>> Next time on Life and Times --
How did a law meant to protect wild horses wind up sending
dozens of them to slaughter?
>> It was a sense of just complete -- how do I explain it?
Deceit, I think is the word, of betrayal. Because even in
countries where they eat horsemeat, the American wild horse is
seen as an icon.
Val>> That's next time on Life and Times.
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