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On the Richter scale of premature labor, Myoshi Pizarro's contraction probably registered a mere three or four. But Myoshi is sixteen years old and had never been pregnant before, and when this Braxton-Hicks tremor hit she was sitting in her first-period class at Putnam Vocational Technical High School in Springfield. So she asked for a pass to the health center, where she was examined and told that her dizziness, shallow breathing, and the hardening of her belly were perfectly normal at this stage. The real tremors would hold off for another six weeks.
Now Myoshi sat in an examining room, all seven months of her pregnancy evident in the swell of her oversized polo shirt and complaints about disturbed sleep and other late-term discomforts, telling UMass nursing student Kimberly Denniss and YWCA maternity counselor Yoland Nogue who she wants to have with her when her baby boy emerges.
"My boyfriend will be there," says Myoshi. "So will my six-year-old sister, because she's already seen babies be born. And my mother. And Jeff."
Jeff is UMass student Jeff Sullivan, one of a team of caretakers who formed around Myoshi's pregnancy in the months since she became one of the dozens of mothers-to-be in her high-school class. Sullivan has helped with everything from leg cramps to information on baby-safe cribs; now his name and phone number are on Myoshi's medical chart so that he can be called the minute those contractions are no longer just her body practicing.
Since 1995, every future nurse at UMass has, like Denniss and Sullivan, spent a semester in the red-brick monolith known as Roger L. Putnam Vocational Technical High School in East Springfield. Over the course of any week, a dozen college students can be found there, engaged in duties from saying "Say `Ah'" to dressing burns received in culinary shop to addressing classes about vitamins or domestic violence. With ample technical and staff support from Baystate Medical Center where students also do some of their obstetrics practica this partnership has been a capital way of providing both a community health venue for UMass and a long-needed service for Springfield.
Well-maintained, well-fenestrated, and set back on a bright band of lawn directly across State Street from the august colonial-revival headquarters of MassMutual Insurance, the physical plant of Putnam doesn't trumpet "inner-city school." But the demographics of its 1,600 students say otherwise. Close to two-thirds qualify for the federal free lunch program. Among some 550 freshmen entering in any given year, 400 will be diverted from graduation by early employment, early parenthood, or transience. The everyday cases seen in the health center are those particularly plaguing the poor and disenfranchised: young people reacting to bad drugs; adolescent mothers like Myoshi in every grade; ailing or depressed teens whose families toil like serfs outside the increasingly closed fortress of the American health-care system; and a disproportionate number of students suffering from chronic problems like asthma, an ailment acutely on the rise in the inner city, where everything from bad air to cockroach dander is believed to exacerbate it.
The student body is half Hispanic, nearly thirty percent black, the rest white. UMass family-nurse-practitioner Courtney Gordon '95G who once worked at Kaiser Permanente in Amherst, where "the difference is night and day" is convinced, however, that the problems she sees at Putnam "have nothing to do with race; it's poverty." Poverty and its offspring apathy, anger, and despair are the great levelers here, and provide a daily challenge for caregivers like Gordon who must weigh what a student really needs psychological counseling, pricey prescriptions against what she knows that student's family can afford.
"There are parents who don't do what's needed because they have to take the whole family's interest into consideration," she said. "Is it better to get the meals on the table, or get the medicine for José?"
Sunlight streams into the all-glass waiting room of the health clinic, sited up two big landings and down long, locker-lined halls from the main entrance to the school. Passing beneath a Romanesque arch, patients step into an inviting atrium where visual contact with trees, grass, and sky would at least momentarily relieve most sorrows. Signs of loving attention were evident, in the weeks before the winter holidays, in ficus plants garlanded with tinsel and a Christmas tree twinkling in a corner. Putnam students waiting for appointments chatted in Spanish and English with the receptionist, on whose desk was a fresh vase of lace-white roses.
This shiny clinic was built only last spring, almost wholly by students from Putnam's vocational shops. Before that, recalls Gordon, it was housed in a cramped, poorly ventilated room "where we literally saw students in closets." It was impossible not to overhear conversations better held in private, and flus and coughs better suffered alone were shared freely among students crowding into the single room.
Gordon says good-bye to a student she has just seen and offers a long hand in greeting. A tall, friendly heron of a woman who favors browns and beiges under her white nurse's smock, she has painted her office, like the others off the wide corridor, in disarming pastels. The decor is faintly pediatric, with a fuzzy "Ronny Nose" perched atop an otomoscope. A poster of "Words Your Child Needs to Hear" is taped above her desk for the benefit of her patients, most of whom are still children who need to hear those same words themselves.
Pulling up chairs, Gordon describes how she worked as an RN before getting her nurse-practitioner's degree from UMass three years ago and coming to work at Putnam, where she provides direct care to the high schoolers and teaches a course on practical nursing to UMass students. Her first dose of Putnam reality came when she was still a student, visiting the school for a day; no sooner did she arrive than she was told to take a group of students and talk about the shooting death by police of a boy well-known to them. Without a second to prepare, Gordon found a "dusty, deserted auditorium" and began asking the students if any had experienced death. She was stunned to hear "every one of them say they had `my father, my cousin' Every one of those kids had experienced a male death in the family."
Far from dragging Gordon down, that session convinced her that this was the job she'd always been looking for. That many of her patients are destined to spin on the wheel of misfortune is a fact. It breaks her heart to read, during the course of an anonymous question-and-answer session in a health class, the plea, "How do I get them to stop hitting me?" in a childish hand. But Gordon believes that child has started healing just by having a place to ask the question. The work, said Gordon, "is highly fulfilling, the most fulfilling I've ever done."
Gordon teamed up with UMass nursing professors M. Christine King, Brenda Millette now acting dean of nursing; see "Branches of Learning, page twelve and Josephine Ryan, who served as project directors on the Putnam project's $1.2 million start-up grant from the National Institutes of Health. With a primary goal of functioning "like an emergency room plus acute care," the clinic's second mission was to promote health through prevention.
Ironically, that was exactly what worried early naysayers to the clinic, who worried that liberals from Amherst were going to come in and "propagate free sex," said Gordon. The city of Springfield prohibits the distribution of birth control devices to minors, and abstinence is always the first course urged at the clinic. But with an estimated sixty-five percent of ninth graders and all but a chaste fraction of seniors sexually active, human reproduction does command a large part of everyone's time: administering pregnancy tests, referring teens to family planning clinics, or testing for AIDS and other sexually-transmitted diseases via a program that visits twice a month from Baystate. All the nurses have their stories of calming girls astounded they conceived the "first time" or consoling girls disappointed that they didn't.
Laura Arocho's dexterity with the tools of her future trade the tongue depressor, the blood pressure sphygmomanometer is surprisingly polished, as is her bedside manner. In her spotless scrubs, the UMass nursing student from Puerto Rico and Holyoke moves smoothly but respectfully through the personal space of her patient, eleventh-grader Eric Finch. She asks Eric to breathe deep as she slips the stethoscope under his Methodman jersey and listens, through breastbone and deltoids, to the beating of his young heart. The ticker of this strapping appliance-shop student is fine, but his stomach seeing as it's just before lunch period is empty, as Arocho's instrument astutely picks up. They chuckle at the growling and gurgling going on in there, then at Eric's pager going off on the belt of his baggy Hoodwear jeans. Arocho found Eric when she stopped him in the hall an hour earlier and asked if he'd like to come to the clinic.
As it turns out, Eric's throat looks a little red, and Arocho can tell, by the way he jerks his head away with a yip, that there is some irritation in the right ear. Shining two spheres of white light in his eyes, she finds them clear but, taking him into the hall to read letters from a chart, tells him he sees better out of his right eye than his left. Having gained confidence in her, Eric also tells her he wants to gain more weight; at six feet and 166 pounds, he is afraid he is too skinny. She tells him his weight is proportionate and reminds him he's still growing.
For students like Eric this is the introduction to the Putnam health clinic, which they are urged to continue to take advantage of for any reason. More importantly, explains Christine King, they receive a more thorough exam than they will get even if they belong to an HMO, where a check-up is likely to be a much more time-limited affair.
Technically, Putnam's clinic is called a "child health clinic." In the changing health-care landscape, says King, fewer and fewer children are being seen in hospitals, which are being reserved for the most serious cases. More children are relying on nurses, particularly school nurses, even for primary care. Thus, UMass nursing students are doing at Putnam what they will be doing in the community-based jobs they are likely to hold. Nursing faculty envision the clinic expanding to include a daycare center and a student parents' support group as incentives for teen mothers to stay in school. They also want to start a group for children who have lost a family member to murder, or who have family members in prison. They believe there is a desperate need for mental health services beyond those that can be provided by the one counselor who comes in for half a day once a week. Someday, they want to open the clinic up to the city's poor elderly, as well as to those who dropped out of Putnam but, perhaps more than ever, need care.
The flip-chart illustrating the progression of symptoms in syphilis is, you might think, grim enough to deter anyone from casual sex. UMass senior Ligaya Lauron stands in front of the chart with a bundle of notes at her chest, winding up a lecture on AIDS with a graphic clinical description of Kaposi's sarcoma. It is a lecture she has been preparing for weeks as part of her degree work at Putnam.
It's hard to tell how many students here in Bonnie Elliston's health ed class are taking in these messages on the avoidable horrors of the flesh. One girl keeps teasing the boy in front of her by flicking the hood of his sweatshirt. Others, in apparent reaction to the morbid delicacy of the subject, titter hilariously. Lauron's small, polite voice bobs on a sea of chitchat, and every few minutes fellow nursing students Leah Phillips, Lashonda Rascoe, or Michelle Manbodh, or Mrs. Elliston herself, suggest listening up.
But a few Putnamites, despite their somnolent poses, are asking questions: Didn't they find a cure for AIDS? one girl asks. Does the AIDS virus turn into a treatable bacteria with AZT? inquires another. And if no condom is handy, will Saran Wrap do?
For Lauron, Phillips, Rascoe and Manbodh, this lecture to this class in this school and city is just the beginning. For the students in this health class, and for those who find their way to the clinic, it is also a beginning. With three successful years behind it, the Putnam clinic represents, its founder's hope, the launching of permanent relationships among the university, the high school, and the lives that have come to depend on the flourishing of their partnership.
