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Life & Times Transcript
11/04/05 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 Zavala>> 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. Announcer>> 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 Zavala>> 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 twenty six hundred 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 developmental 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 two thousand nine hundred twenty-one 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, Demitri 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 it or 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 today. Nine children came to school today." Toni Guinyard>> I'm Toni Guinyard for Life and Times. Announcer>> Kcet.org is the place to look for the very latest on Life and Times. You'll find previews of upcoming stories, transcripts and audio of past episodes and links to some of our most interesting features. Just go to kcet.org and click on "Life and Times". Val Zavala>> 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 Zavala>> For some children, taking a deep breath can be hazardous to their health. [Film Clip] Val Zavala>> 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. [Film Clip] Dr. Kenny Kwong>> Asthma is a growing phenomenon, a growing problem worldwide. Val Zavala>> 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 Zavala>> 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 Zavala>> 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. [Film Clip] Val Zavala>> A couple of miles away in Huntington Park, we met Bahram Fazeli, 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 Zavala>> 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 Zavala>> 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 Zavala>> 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 Zavala>> 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 Zavala>> And you've lived here all your life? Elyjah Glowski>> All my life. Val Zavala>> Nancy Pena is a mother of two. Her little boy has breathing problems when he's sleeping and both children have serious nosebleeds. Nancy Pena>> 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 Pena>> 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 Zavala>> 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 Zavala>> 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. [Film Clip] Val Zavala>> 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 Zavala>> 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 Pena>> I am so glad. I can see the sun, the sunsets (laughter) because it covered -- I mean, it was huge. Val Zavala>> 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 Fazeli>> 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 Zavala>> -- 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 Fazeli>> 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 Zavala>> 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 Zavala>> 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 imagined 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 his 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 life 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 I 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 Zavala>> 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. Sponsored in part by:  | |
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