Find Events Find People Find Jobs Find Sites Find Help Index


July 8, 2002

Migrant clinic is new world for students

By Eric Rangus

On the surface, the classroom at Sunset Elementary School is like any other. Young children scurry to-and-fro, dodging colorfully decorated desks and bulletin boards, while adults twist and turn to avoid their random wanderings.

A closer look though, makes this group stand out. First of all, the children in this southwest Georgia school are all Hispanic. Their parents, for the most part, are migrant workers. Sunset Elementary is located outside Moultrie, in Colquitt County, about 225 miles south of Atlanta. Colquitt County is one of the state’s agricultural centers with 75 cash crops and a migrant population that reaches 10,000 at its peak.

An even closer look reveals that these children have gathered in this too-small classroom for a specific purpose. At one table, a little boy inspects a breadbox-size set of teeth made of construction paper. His tablemate holds a construction-paper toothbrush. Many of the children grip plastic bags filled with toothpaste, dental floss and—for some—the first toothbrush they have ever owned.

Among this claustrophobic chaos, Heather Watkins finds a small space in between two desks and collapses in a heap on the floor.

Over the past two weeks, the Atlanta dentist (and now periodontics student at the Medical College of Georgia) has peered inside the mouths of hundreds of people—both children and adults—and pulled so many teeth she says she has lost track. With no Medicaid or insurance available to migrant families, dental care among them borders on the abysmal.

“You know, I’d really be enjoying this if I wasn’t so tired,” she says.

For Watkins to admit being tired is saying something. The upbeat, approachable dentist has more energy than the Tasmanian Devil after a double latte. Watkins remains seated for about 45 seconds.

“But this is what I like,” Watkins says as she bounces up off the floor upon hearing that an 11-year-old boy in dire need of checkup has been found. He had wandered off a few minutes before.

Welcome to the Migrant Family Health Program, which is led by the Nell Hodgson Woodruff School of Nursing. The program encompasses undergraduate and graduate nursing, dental hygiene and physical therapy students from several Atlanta-area universities who team up to provide basic health care services and education to migrant workers and their children—one of Georgia’s most underserved populations.

From June 9–21, more than 1,000 migrant workers and their children received basic health care through the program.

Taking his seat, the eyes of Watkins’ aforementioned patient never meet hers as she explains to him that he has an abscessed tooth that needs to be removed. She tries psychology (“Girls don’t like boys with nasty teeth,” is a particularly good line), but he never shakes his veneer of misplaced cool. After the lecture, he leaps off the seat and bolts out the door.

“I call this ‘intensive immersion service learning,’” says Lorine Spencer, who created the program at Georgia State University in 1994 and brought it to Emory this year. She and Judith Wold, visiting professor of nursing, direct the program for the nursing school.

“Most of the students haven’t been to rural America. They had no idea how food goes from the field to the market. I’ve had more than one student say that they would pay more for food so that the lives of the people who picked it would be better,” Spencer says.

The program is a masterstroke of coordination and cooperation. While Emory provides the nursing students and faculty, the hygienists are from Clayton State College and University and the physical therapists and psychologists from GSU. And South Georgia College in Waycross provides a van for the program’s mobile clinic in the evening.

The students’ mornings are spent at Sunset Elementary a few miles south of Moultrie, where they treat the school children, ages 3–16. When they enter the gym where the clinic is set up, each child’s name is written on masking tape and stuck to his or her chest and back. The youngsters then weave a varied path among stations that measure blood pressure, height and weight, and vision.

In one corner is the pharmacy where neat stacks of children’s Tylenol, chewable vitamins, cough medicine and Klout (which combats lice) wait to be placed in brown paper bags for children who might need them.

Written in blue, ball-point pen on the half dozen or so bags awaiting delivery are the names and addresses of the children in question. Rather than send medicines home with the children, outreach workers with the Colquitt County Farm Worker Health Program—accompanied by an Emory nursing student—will deliver the meds personally to families and explain how they should be administered.

Next to the makeshift pharmacy is where nurse practitioner students are conducting exams. Their private work is hidden behind walls of white sheets.

In the opposite corner of the gym are the physical therapists. Some of the children are undergoing physical tests; others are coloring on large sheets of paper taped to the floor or constructing small towers with blocks. These activities test cognitive skills.

Behind the physical therapists, nursing students are pricking fingers for hemoglobin tests. This is usually the last test the children will undergo, since no one wants blood to be everywhere. On the opposite end of the school, are the hearing tests and dental room.

Each night, a caravan of vehicles—punctuated by the “Nightingale Van,” which resembles a rock band’s tour bus—leaves the Hampton Inn on the Moultrie bypass, where everyone stays, to set up the program’s mobile clinic. On June 20—the last night the students are in town—they set up at the L&M packing shed part of town.

In 10 minutes, the crew of student nurses, hygienists, physical therapists, et al turns a concrete slab used for loading and unloading vegetable trucks into a free clinic with tables for administrative duties, a dentistry area, padded massage tables and a couple dozen chairs. Everyone pitches in. Susan Aydlotte, a nursing school faculty member at Grady, even brought daughters Nell and Zan (a senior and sophomore, respectively, at Lakeside High School) to act as runners. Patients are waiting in line even before all the equipment is unloaded.

“The question is,” says Elizabeth Downes, assistant professor of nursing and one of the Emory faculty members leading the program, “Who takes longer to set up a tent? The therapists or the hygienists.”

It’s the hygienists, who must deal with netting that will surround patients who come to get their teeth pulled. But it’s a close race.

Unlike the elementary school, the patients who visit the evening clinic are almost exclusively adults. Most of the men have the dark, leathery skin signifying someone who spends a great deal of his time in the sun. Both the men and woman look much older than their years. Working in the fields can make a 26-year-old woman resemble someone who’s 40. Few speak English.

“This is definitely harder than working at the school,” says nursing student Corinne Leonard. “People have a lot more serious problems, and that makes this more challenging.”

This night, Leonard worked the front table—triage—with fellow nursing student Carly Brooks. Their job was to listen to the people seeking treatment; do an initial, informal diagnosis, then direct them to the appropriate station. Hundreds of people came through the mobile clinic over the two weeks, but Brooks said this evening was lighter than previous ones. Dental and back problems were most common, Brooks said. One person appeared to have an ulcer and another a sexually transmitted disease. There also were two people with heart problems.

One group that is particularly busy is the physical therapists, who treat men with a host of ailments. Something that isn’t always easy.

“We had one person who we wanted to squat instead of bend,” says Serena Lund, a physical therapy student at Georgia State. Lund earned her undergraduate degree at Emory and works as a research specialist in neurology while attending GSU. “He said he’d get in trouble for sitting down.”

Everyone remains well past 10 p.m. The previous night, Watkins and her team pulled teeth outside a local Baptist church until midnight. (“Until I ran out of patients or instruments, whichever came first,” she said afterward.)

In between the day and night clinical work (which numbers 100 hours), Emory’s undergraduate students meet for an hour-long seminar, which is where part of their grade comes from (there also is a final paper, a take-home exam and a daily journal).

Two weeks of nearly nonstop work more than 200 miles from home clearly takes its toll. In their final meeting—in between a group discussion of child health and a rollicking trivia game regarding the same subject—the students’ crankiness shows as the class almost en mass expresses its displeasure about a variety of things.

Just as quickly as the orneriness rears it’s head, though, it’s gone.

“We’re not really like that,” says Tammy Renn, in an unnecessary apology afterward. The students unquestioning professionalism in the clinic would win over even the most cynical doubter. “I think everyone’s just really tired,” she says, turning down the hall to complete her final journal entry.