I’ve been a school nurse in Philadelphia for almost 25 years. I’ve seen lots of blood and a finger almost amputated by a door accidentally slammed. I’ve seen head injuries, seizures, and high and low blood sugar levels in diabetics. The very worst moments I’ve experienced as a school nurse, however, are those that were spent with children who were having an asthma attack.
Asthma is a sneaky, dangerous disease. It can emerge full-blown in a child who never, ever before had an asthma attack. It can resurface after years of quiescence. It can occur in a child whose disease has been well-controlled until their insurance is dropped and parents can’t afford to pay for inhalers out of pocket. We know that asthma affects almost 20 percent of kids in Philadelphia. That’s a lot of kids. We now know, from sad experience, that asthma can kill an otherwise healthy, active child.
For instance, one girl -- I'll call her M. -- came to see me during her 9th-grade year and told me she had a bad cold that made her feel awful. She had trouble, she said, “catching her breath.” Although she denied ever having asthma and her school health records corroborated her assertion, when I listened to her lungs with my stethoscope, she was wheezing. I called her father and advised him to seek immediate medical care. When he tried to tell me that M. had a “little cold,” I responded by saying that if she were my child, I would take her to the doctor’s and failing that, to the hospital. The father called the next day to thank me. His daughter had been admitted to the hospital with a diagnosis of asthma.
Aside from M.’s comments about feeling “awful” and saying that she was having trouble catching her breath, she looked like a child with a bad cold. I see children like that every winter during flu season and, indeed, all they have is a bad cold. It was only in my training as a nurse, where listening to a child’s lungs is part of the physical assessment, that I knew there was something wrong.
We don’t know the particulars of Laporshia Massey’s attempt to communicate her distress to a responsible adult who would know what to do. We don’t know whether she carried a rescue inhaler to school every day, which is permissible according to School District regulations. We don’t know the severity of her illness. We also don’t know the time when Laporshia first reported her symptoms or to which responsible adult she spoke.
We do know, however, that there was no nurse in the building that day, a nurse who, if she or he became aware of Laporshia’s condition, would have known to listen to her lungs with a stethoscope and take appropriate action based upon what she or he heard.
The School District would have the public believe that a “plan” developed by the nurse should suffice for emergencies like Laporshia’s illness. Even the most carefully developed and orchestrated plan cannot take into account the staff’s lack of assessment skills that are part of a nursing practice. A plan is not a substitute for the expertise of a certified school nurse.
The “doomsday” budget did not, however, just remove nurses from what should be an encompassing web of caring adults. The majority of schools have no regular counselor in the building on any given day, no vice principals, and a greatly reduced number of secretaries. Obviously, these key personnel do not have the training to determine whether a child is having an asthma attack. But each would have provided another set of eyes, ears, hands, and brains to consult in an emergency. Sadly, Laporshia became ill in a school where there simply were not enough adult hands on deck to help her.
Very significant numbers of our students with asthma -- and other serious health conditions -- attend schools staffed by skeleton crews. Each of these schools is a mere step away from a potential disaster. The hardest-working principal, the most caring teacher, and the most dedicated nurse cannot hope to make up for the fact that all of Philadelphia’s schools are dangerously understaffed. There are huge holes in our children’s safety net, gaps in care put there deliberately by adults who pretend otherwise. How many more children are going to fall through those holes?
Eileen M. DiFranco, R.N., is a certified school nurse who has proudly served the schoolchildren of Philadelphia for 23 years. She is a lifelong resident of Philadelphia.