Dr. Willie Mae Hubbard, back center, career Pediatric physician, and certified medical assistant April Caslin, right, encourages Koreyon Redding to exhale rapidly into a new digital spirometer that measures lung function last week at Family Health Service in Eastdale.
The Vitalograph unit is designed to one way clinics are helping to fight asthma in the schools.The young woman was exhaling as hard as she could into the plastic spout she held tightly in her mouth, but everyone standing around her kept telling her to "blow-blow-blow-BLOW-BLOW-BLOW-BLOW."
With a final gasp she pushed the last remaining air from her lungs and then inhaled deeply, as her colleagues at the Family Health Center on Wilcox Boulevard cheered.
The staff at the health center had been training for several days on how to use their new spirometer, a $1,000 handheld device that measures a patient's lung capacity.
"That is how we measure how well the lungs are functioning," said Dr. Willie Mae Hubbard, who along with Dr. Jacqueline Shaw is one of the co-founders of the center. "Some people don't realize they are not functioning at a normal level, because they are so used to living in a compromised state."
The spirometer was one of three donated this month to local clinics that serve students from poor neighborhoods by the Pediatric Health Improvement Coalition for the Tennessee Valley, a nonprofit organization funded by the Lyndhurst Foundation that hopes to improve the health care of area children.
The coalition, Hamilton County Schools system nurses and several area doctors are all part of an effort to use the school system to help some 4,400 students from the school district's poorest neighborhoods get access to health care and cut down on absences.
The group is targeting asthma because it is the leading reason kids miss school, which also often causes their parents to miss work.
"Asthma is our No. 1 health problem," said Sheryl Fletcher, nurse coordinator for the school system. "It is a chronic health condition, and when parents are struggling to feed kids, and get them to and from school, it is often not a priority - you can't see asthma. So a kid says he can't breathe, but the parents don't see the problem."
But asthma is a serious disease if not treated promptly.
"Having asthma long term can scar the lungs and cause permanent damage," Hubbard said.
Besides the spirometers, the coalition has donated video-conferencing equipment to five Hamilton County elementary schools - East Ridge, Eastside, East Lake, Orchard Knob and Woodmore - which will allow school nurses to communicate with a nurse practitioner at T.C. Thompson Children's Hospital at Erlanger or on the Ronald McDonald Care Mobile.
The video hookups are part of a major upgrade in how school nurses respond to students who show up sick. That upgrade includes the installation of nebulizers that help asthmatic students breathe more easily in 60 of the school system's 79 schools.
In the past, school nurses' options were limited if a student appeared to be having a major asthma attack.
"When a child is struggling to breathe, it is not going to stop on its own, you have to intervene with steroids and if medicines don't open up the airways, you try to find somebody to come and get them," Fletcher said. "If you can't do that, then you have to call 911 and get them to the emergency room."
But now nurses have additional tools. The nebulizers push a mist containing a decongestant into an asthma sufferer's lungs. The video hookup allows the school nurses to consult with nurse practitioners, who have additional training, to determine if they have made the correct diagnosis. School nurses also can do tests for the flu or mononucleosis or strep throat.
"If you have a student with a sore throat, the nurse can do a strep test, and if it is positive she calls a nurse practitioner up and says 'look at this,'" Fletcher said. "Then the NP can call in a prescription for an antibiotic, and they notify the parent to swing by the drug store and pick it up."
The video connection allows the nurse practitioner at the remote location to enlarge the image up to six times normal size. The school nurse can also hook up a stethoscope to the video feed so the nurse practitioner can listen remotely to a child's heartbeat and breathing.
Hubbard emphasizes the goal is not for the school to take the place of a child's pediatrician.
"We do not want this to replace the child's medical home," she said. "The primary care doctor is the person who has followed your history, who knows what works and doesn't work. We want to encourage parents to call private doctors."
"These children's parents may be working three jobs, or they may not have a job, or not have a car, or food may be more important than their child seeing a doctor," said Darcy Knowles, the CEO of the coalition. "But it is important for them to see a pediatrician."
Getting parents to understand their children need regular visits to a family doctor can also reduce health care costs. Seeing a family doctor "eliminates a lot of emergency calls and emergency room visits that are costly," Fletcher said. An emergency room visit costs at least $200, while the co-payment for a visit to a primary care doctor may be only $15, she said.
Fletcher said while school nurses are still working out the kinks in their telemedicine procedures, she already has her next target: teachers and other school staffers. Helping them get access to health care at work "would decrease absentees from work, and reduce the time they miss out of the classroom," she said.
Contact staff writer Steve Johnson at 423-757-6673, sjohnson@timesfreepress.com, on Twitter @stevejohnsonTFP, and on Facebook, www.facebook.com/noogahealth.