Episode 603: Health Barriers to Learning Series: The Impact of a School-based Health Center in Rural Georgia

A school nurse and a teacher work together to overcome a major barrier to learning: access to health services. Join us for the kickoff of our special series of episodes on Health Barriers to Learning with guests Amanda Dubreuiel and Shannon Bynum of Ben Hill County Middle School. 

TRANSCRIPT

Ashley Mengwasser: Hello, there. Welcome to Classroom Conversations, the platform for Georgia's teachers. This award-winning podcast series is the result of a healthy partnership between Georgia Public Broadcasting and the Georgia Department of Education. I'm Ashley Mengwasser, your host. What are you like in the throes of illness or having suffered an acute injury? If you're like me, are you helpless? Get me to a doctor or a nurse practitioner straight away. This season we've explored health barriers to learning. One of these is the barrier to healthcare. Students and their families may lack insurance coverage, may not have a primary care physician or parents and guardians may be at a distance or unavailable during a time of medical need. Affordability, access and transportation can be debilitating barriers when time is of the essence, if you will. Well, what if, while teaching and learning at school, you didn't have to go far? Here's the antidote. A school-based health center. A school-based health center is comparable to a doctor's office but within the school and it provides many basic services. Primary care, management of chronic diseases, counseling, immunizations, lab work, referrals, and more. It's the most effective approach to meeting student health needs while they are in school. Since schools sit at the heart of where we live, this is a win for students, their families, school faculty, and our communities. I have two guests here today to help us understand their school-based health center. At Ben Hill County Middle School, that's in Fitzgerald, Georgia, for nearly 20 years, Amanda Dubreuiel has been a registered nurse and she's currently employed by Ben Hill County Middle as the school nurse. Also with us is 25 year classroom teacher. She teaches STEM and art to sixth to eighth graders, and her name is Shannon Bynum. Please welcome to the show, Amanda and Shannon. Hi.

Amanda Dubreuiel: Hey.

Shannon Bynum: Hello.

Ashley Mengwasser: Don't you look lively today, women.

Amanda Dubreuiel: Thank you. So do you.

Ashley Mengwasser: How was your commute from Fitzgerald?

Amanda Dubreuiel: It was wonderful.

Shannon Bynum: It was good.

Amanda Dubreuiel: We had a good ride. We talked the whole way up here. We enjoyed it.

Shannon Bynum: We did.

Ashley Mengwasser: Were any chickens harmed in your drive?

Amanda Dubreuiel: No.

Shannon Bynum: No.

Ashley Mengwasser: What is it about chickens and Fitzgerald? This is great trivia.

Amanda Dubreuiel: They're very well protected, aren't they, Shannon?

Shannon Bynum: They are. They're like our symbol.

Ashley Mengwasser: Okay, so you should not hit a chicken when you're driving.

Amanda Dubreuiel: No. You actually get a fine for harming or hitting a chicken, so they're very well protected.

Ashley Mengwasser: They're pretty fast though.

Amanda Dubreuiel: Yeah, they're treated as more like pedestrians when they're crossing the roads.

Ashley Mengwasser: If I were a chicken, that's where I'd want to live. I have to admit, Amanda, I'm a bit of a fainter. Not for sport, only when I'm ill. So today I think would be the day for me to pass out mid-show because there is a registered nurse here.

Amanda Dubreuiel: Okay, well I got you.

Ashley Mengwasser: I wonder why this happens to me. I literally have no idea.

Amanda Dubreuiel: White coat syndrome, probably.

Ashley Mengwasser: Yeah.

Amanda Dubreuiel: Yep. That's a real thing. Real thing.

Ashley Mengwasser: White coat syndrome. What is that?

Amanda Dubreuiel: It's just where you just get anxiety. A patient usually just goes into the medical office and setting and they see someone that does medical, a doctor, a nurse, and usually their blood pressure rise or they fall really fast and they just get anxiety.

Ashley Mengwasser: Oh, yeah.

Amanda Dubreuiel: Just the unexpected. And especially their past experiences with medical too. So if they've had some trauma in their life or accidents or something, it may remind them of something-

Ashley Mengwasser: That's happened.

Amanda Dubreuiel: ... anxious. Yeah.

Ashley Mengwasser: I am a cerebral run. I bet I'm getting in my own head for sure. Do you know why you should never mess with a pediatric nurse?

Amanda Dubreuiel: Why is that?

Ashley Mengwasser: They have very little patients.

Amanda Dubreuiel: Yeah, that's a good one.

Ashley Mengwasser: I thought you'd like that.

Amanda Dubreuiel: I've got a pediatric nurse practitioner, a good friend of mine. I'll have to tell her that one.

Ashley Mengwasser: Tell her that one. Tell her that one. Why did you get into education, Shannon?

Shannon Bynum: It wasn't my original plan. I was a business major and we had to take a class called the birth order class and we had to read a book about the birth order of children.

Ashley Mengwasser: Really?

Shannon Bynum: And the different personalities depending on firstborn, middle, the baby.

Ashley Mengwasser: Oh, eldest daughter syndrome right here.

Shannon Bynum: And it's true. It is true. And so after that class, I started thinking about something different and then I graduated and I started work and it just wasn't... And so went back for education and I love it.

Ashley Mengwasser: 25 years later.

Shannon Bynum: 25 years later.

Amanda Dubreuiel: She's wonderful. Wonderful.

Ashley Mengwasser: You've got a fan here.

Shannon Bynum: Yeah, I do.

Ashley Mengwasser: Well, she's also a fan of you. We're going to get into that shortly. How about you, Amanda? How did you end up as a nurse in a school?

Amanda Dubreuiel: In the school? Okay, so I've been a nurse right at now, 19 years. I got to thinking about it last night, right at 19 years. Most of my experience with orthopedic and OR. When I became a single mom, I wanted to spend more time with my child and being at his location and performing my duties as a nurse was just the right mix. That's when I decided to take on the role of a school nurse.

Ashley Mengwasser: And you are an employee of the school, is that correct?

Amanda Dubreuiel: Yes.

Ashley Mengwasser: But Shannon told me you also teach on campus.

Amanda Dubreuiel: I do. I teach one class period a day. That's Intro to Healthcare, it's actually a high school course taught at the middle school. It's available to eighth graders. It's the only course in eighth grade that they are available to get one high school credit towards their graduation credits. So it's a really good opportunity for our eighth graders and it's really popular class with eighth grade. They love it. It just drives them to be more ambitious, successful. They feel like they're doing something that matters, a respected position. It's been going really well.

Ashley Mengwasser: I'm glad you're both at Ben Hill County Middle. Shannon, you teach sixth to eighth grade?

Shannon Bynum: Sixth to eighth grade.

Ashley Mengwasser: STEAM, right?

Shannon Bynum: STEAM and art.

Ashley Mengwasser: And Art, okay. Who are you outside of school? What don't your students know about you? What are your hobbies? Tell us about your family life.

Shannon Bynum: I'm married, and I have two children at the University of Georgia, and I have a favorite child, who's my dog. And I like photography. That's my joy outside of school.

Ashley Mengwasser: I'm curious about your dog. What sort of dog is this?

Shannon Bynum: A Cheweenie.

Ashley Mengwasser: A Cheweenie. I don't know if I've ever seen one of those.

Shannon Bynum: It's a mix of a Dachshund and a Chihuahua.

Ashley Mengwasser: You say that like it's disappointing.

Shannon Bynum: He's not very friendly.

Ashley Mengwasser: But he loves you.

Shannon Bynum: He loves me.

Amanda Dubreuiel: That's what matters.

Ashley Mengwasser: Because he's your favorite child. What about in your free time, Amanda?

Amanda Dubreuiel: I used to, my free time used to include horse ride, and I used to barrel race. I've retired that. As my son got older, his hobbies were fishing and hunting and as a boy mom, my hobbies are what he wants to do, so I hunt and fish with him and honestly, I enjoy it so much. That's probably what I'll continue doing after he's out of the house because he's in high school now. But I just enjoy it so much. I love being involved in nature and outside and it just forces you to be alone and some quiet time and I just love it.

Ashley Mengwasser: Heck, yes.

Amanda Dubreuiel: I'll probably continue those hobbies on.

Ashley Mengwasser: Yeah, he's not in school right now actually. He's here in the control room watching, which is awesome.

Amanda Dubreuiel: Yes, this is a wonderful opportunity for him. He's sitting back there smiling.

Ashley Mengwasser: Yeah, he's got to be proud mom. I'm proud for him, if not.

Amanda Dubreuiel: Thank you.

Ashley Mengwasser: Did either of you have to visit the school nurse when you were in school? Do you have a memory of that?

Amanda Dubreuiel: Actually, I did not.

Ashley Mengwasser: Really?

Amanda Dubreuiel: But I was pretty healthy kid. But I was a bookworm in school and I think I was just so focused on my schoolwork. I never really thought to go to the nurse when I was younger. However, I think I remember a fellow Pierce students going, but I never had actually had to go.

Ashley Mengwasser: Shannon, did you? As a younger person.

Shannon Bynum: I was reared by my grandparents, and I do not remember even having a school nurse. I think we went to the office and if they deemed it necessary, they would call home. But I was pretty healthy. I was rarely absent.

Ashley Mengwasser: So, it came for you much later in life. I'm teasing something that we'll talk about a little bit later. I did have to go to the school nurse. I remember I was an itchy child and I'm now an itchy adult, but I had poison ivy and it was so bad, my eyes were swollen shut. So I remember going for some aid and some care at that time.

Amanda Dubreuiel: And at that age you're really embarrassed about it.

Ashley Mengwasser: Oh, yeah. You're like, "Oh, my gosh, my face. I'm drooling. I'm so swollen."

Amanda Dubreuiel: Yeah.

Ashley Mengwasser: "I look like a zombie. Will I still have friends tomorrow?" A lot goes through your mind when you're young like that. I have gathered a couple of useful health facts for us to digest together. I wanted to see what you think of these. Amanda may already know them, but I thought we'd get a kick out of them, Shannon. This is fun. That laughter makes your heart rate increase and it's because you take many deep breaths and that oxygenates your blood. And there's actually a 2023 study that showed spontaneous laughter reduces the stress hormone cortisol. So I thought maybe we could just try that, just a little...

Amanda Dubreuiel: Yeah, yeah. Well, it's actually scriptural too. Says laughter's the best medicine.

Ashley Mengwasser: Yes.

Amanda Dubreuiel: I believe in that. It is. I think the mind is connected to your body.

Ashley Mengwasser: Yes.

Amanda Dubreuiel: And I think your state of mind, because I mean you think about it, people that have depression are usually have more illnesses. And more positive and mentally healthier folks usually have higher, improved health. So I'm a firm believer in that.

Ashley Mengwasser: So, get laughing.

Shannon Bynum: And it's a feel-good response. I feel energized when I laugh.

Ashley Mengwasser: All those endorphins that hit your body. My dad used to always say, "Laughter is what we're after." And I thought that was just such a silly little rhyming expression. But it's true. It is what we're after.

Amanda Dubreuiel: I agree.

Ashley Mengwasser: And this one cracks me up. If you're hoping to grow taller, you should measure your height first thing in the morning because your spine decompresses when you sleep without gravity compressing your discs. I wish I knew that when I was younger and I was trying to get above my height, which is 5'6".

Amanda Dubreuiel: I tell my son that.

Ashley Mengwasser: Yeah, just measure yourself first thing in the morning. Might get a little extra height. How tall are you women?

Shannon Bynum: I'm 5'5".

Ashley Mengwasser: 5'5"? How tall are you, Amanda?

Shannon Bynum: I'm 5'6".

Ashley Mengwasser: Yes. Okay. You and me. 5'6". We lot are considered an average woman's height, so I don't like the word average, but it's okay.

Amanda Dubreuiel: It's okay when it comes to height.

Ashley Mengwasser: Yeah. As with any health provider, the best way to get into our discussion is to start with a patient testimonial. I was hoping that we could hear from Shannon, who cannot say enough about Amanda and her school clinic. Something happened not long ago where Amanda spotted you sitting on a bench in school and you needed some aid. So would you like to tell us that story, Shannon? Or you want Amanda to tell it?

Shannon Bynum: Add in Amanda. But I was feeling really weird after a faculty meeting and I stood up really fast and so I felt like I needed to sit down, and I let Amanda go from there on that day.

Amanda Dubreuiel: Yeah, because I remember it very well. I was actually, it was towards the end of our work day. You're ready to go. I've clocked out. I'm excited going home and I just happened to look to the left as I was walking out of the building, or right before I walked out of the building and looked through the glass window and I seen Ms. Bynum on sitting over there on the bench, just alone, but she just didn't look right. And just my gut stopped me. I was just going to head out, but then my gut just kind of just pushed me back. And I looked at her and I just walked in there and I said, "Are you okay?" And she just kind of was confused talking to me and she wasn't herself and she was extremely pale and almost yellow, and I knew something wasn't right. And the first thing I thought of, "Well, okay, maybe her sugar, she's kind of acting like her sugar's low, a little hypoglycemic." And so we were actually near a refrigerator that we carried juice in. So I poured her a glass of juice. Within a few minutes she still wasn't coming to and acting clear-headed. I went and got my glucometer and checked her sugar. It was actually normal. I said, "Something is not right." She almost looks like a patient that's had some blood loss. And I did remember that she had just recently had some surgery and so I said, "We've got to get you seen about." So I called her family and her family come up there and we all talked and she was supposed to go to the hospital. So we ended up using the clinic services. And you go from there, Shannon. And what did you end up doing?

Shannon Bynum: Well, I sort of pushed through that weekend. Maybe this was a Thursday or Friday when that happened and then school started. It was a Wednesday right after all that. And I felt really bad getting ready for work. And so I drove to work anyway and when I walked in, I felt like I couldn't walk anymore and I sat down and that's whenever someone went and got Nurse Amanda. It was then that she was checking me out and decided that I needed to go to the school clinic, which was wonderful. And after seeing Ms. Casey there, that's when I had left to go to the emergency room and I ended up having a bleeding ulcer and had to have a transfusion. So that's what was going on.

Ashley Mengwasser: Wow. Wow. Your gut was right.

Amanda Dubreuiel: Yeah, definitely. Definitely. I'm just so glad I didn't go on and leave that day.

Ashley Mengwasser: Yes.

Amanda Dubreuiel: Oh, my gosh. I'm just so glad that I turned around and seen about her and we was right on the money. She definitely had some blood loss going on.

Ashley Mengwasser: I know you speak so highly of Ms. Amanda in the school-based health center, so we're going to talk about that next. What health concerns, be they physical, behavioral, dental, vision, other, were you experiencing in your community that prompted Ben Hill School District to open a school-based health center?

Amanda Dubreuiel: We do live in a high-poverty area and before I started working for the school system, I did not realize how many grandparents are raising kids and single parents. They need to be at work and for them to have to get off work to come get their sick child, which just put their jobs at jeopardy and just put more stress on the families. Having the clinic there and having that as an option, as long as they have consent filled out on the child, the child can just be called from the classroom right down to the clinic and be seen and possibly not even leave school.

Ashley Mengwasser: Right. Amazing.

Amanda Dubreuiel: So, the parent will be able to stay at work and get a phone call of what's going on with their child. It's been amazing. Amazingly convenient for families, especially families that are struggling to stay at work and things like that. So it's been amazing.

Ashley Mengwasser: So, access and timeliness was a big benefit it sounds like.

Amanda Dubreuiel: Yes, definitely.

Ashley Mengwasser: How has the health center been able to address concerns for people coming in who could be seen right in the school? Do you think it's made a positive impact?

Amanda Dubreuiel: Oh, definitely. Yes. I can't say enough good things about it. It's been a wonderful benefit in so many ways. I didn't realize before we had the clinic, until we had the clinic, but it's just been almost a fix-all.

Ashley Mengwasser: Wow. What do you have to add, Shannon?

Shannon Bynum: Yes. I don't know what we would've done. I want to go back to not having a clinic and school nurse.

Ashley Mengwasser: Absolutely not.

Shannon Bynum: And it's just such a benefit. We didn't have it when I was growing up and I don't know how we lived without it.

Ashley Mengwasser: Right. And you said it's only been there what, two or three years, right? It's relatively new.

Amanda Dubreuiel: Right, right, right.

Ashley Mengwasser: What staff work there to make this operate? And if you could describe for us physically, where is it in the building, what does it look like, things like that.

Amanda Dubreuiel: Okay, so the clinic, we call it the Hurricane clinic, that's our team. But the clinic is located down towards our gymnasium area and it has its own parking lot, so you have plenty of parking space and there's also its own entrance down there, which is secured. So the patients and students have to be let in, so it's not something they could just come in and out of there themselves, but that's where they will go and they will gain access inside the clinic there. It's pretty easily accessible.

Ashley Mengwasser: And not a security concern.

Amanda Dubreuiel: Right.

Ashley Mengwasser: What about staff? What staff are in there?

Amanda Dubreuiel: We have a nurse practitioner, we have a receptionist, we have a medical assistant in there to help Casey also work these patients up for her, to cut down on some time.

Ashley Mengwasser: Casey's who you saw. Is she the nurse practitioner?

Shannon Bynum: She is. And you can enter from outside to that clinic without coming into the school.

Ashley Mengwasser: Yes.

Shannon Bynum: I really like that about where it's located.

Amanda Dubreuiel: Yes, yes. But it's also secured.

Ashley Mengwasser: Open to the community amazed me when I first heard about this. I was surprised to hear, oh yeah, teachers could go there too. Staff could go there too.

Amanda Dubreuiel: Yes.

Ashley Mengwasser: And then when you said community-wide, the general public can come in here and be seen, that blew my mind.

Amanda Dubreuiel: Mostly the open community that comes in, I would say would mostly involve the students' families, like students' mothers and grandparents and siblings, stuff like that, and spouses. So it is beneficial all the way around.

Ashley Mengwasser: They know that it's there. Shannon, what would be the process for a student in your class? Let's say that they seem to have a need or there's something medical going on. Who do you contact first? What's the process?

Shannon Bynum: They carry agendas with a hall pass and for security, the teacher has to sign that. And so they leave the room and we send them to Nurse Amanda, and then she checks them out and they go from there. But I haven't had anything that was major that I would feel the need to send them to the clinic directly.

Ashley Mengwasser: Got you. So Amanda checks them out first.

Shannon Bynum: Amanda checks them out.

Ashley Mengwasser: What's your interaction with them, Amanda? Do you speak to the parents?

Amanda Dubreuiel: Yes. The clinic down there is a billing service and we do that for several different reasons. We keep students out of the clinic. There might be some students that's just trying to get out of class and they don't really have anything going on, so that kind of cuts that off on that also. But the parents don't want just to get a bill, an unknown or unexpected bill. So we do contact the parents and let them know they're going down to the clinic. And especially if they don't have consent, we'll have to contact the parents especially because they'll have to come out and fill a consent form out for them to be seen.

Ashley Mengwasser: What specific services does the school-based health center provide?

Amanda Dubreuiel: It's a walk-in clinic, basically. They offer sick visits, they offer vaccinations. They also offer a mental health services.

Ashley Mengwasser: Oh, wow.

Amanda Dubreuiel: Yeah, so they have a counselor with their office and students actually go down there and see her also, Ms. Hayden. So that's been a beneficial to us because the counselor that we have at our school, she stays so busy, so it's really helped her out also. And that way we can better meet the needs, these mental health needs of students.

Ashley Mengwasser: That's incredible. And I know we were talking about how the clinic also can provide physicals. What's the impact on the sports teams?

Amanda Dubreuiel: Right. Oh, man. There's so many students that are active that come from single parent families. They can't get them to the doctor to get these physicals completed. I have seen several students before our clinic got there that could not get involved with the sports they were wanting to get involved in. So this has really opened up so many opportunities to students because they can get their physicals done while they're at school and they don't have to leave school. The parents aren't inconvenienced and the physicals are done there and then that opens up the opportunity for them to go be active in any sport they choose.

Ashley Mengwasser: Absolutely. And Shannon, what services did you receive when you had your medical scare?

Shannon Bynum: Wow. And I'm like a frequent flyer down there. And I really am pretty healthy, but I've been for different things. Maybe having a lot of inflammation and the joint inflammation, things like that. And also the bleeding ulcer that day. My husband has visited the clinic, one of my children has visited the clinic.

Ashley Mengwasser: Amazing.

Shannon Bynum: We've all been there.

Ashley Mengwasser: You've all been.

Amanda Dubreuiel: I've been there myself.

Ashley Mengwasser: You have. Good. Well, it's a service for you. Our audience may be wondering how is a school-based health center funded, and I looked this up. Apparently in 2022, Governor Kemp announced $125 million to supercharge Georgia's school-based health center program. And so it's the Governor's Office of Planning and Budget or OPB that funds the Georgia Department of Education and providing grants that support planning infrastructure, space renovations that may be necessary, startup staffing, startup medical supplies for school-based health centers in our state for approved Title I schools in Georgia specifically. And I think it's interesting to hear that there's a wide opportunity right now to get school-based health centers out there.

Amanda Dubreuiel: It's so good.

Ashley Mengwasser: And to expand them. So if we could just give a pitch for this, what would you say the overall impact has been on students of Ben Hill and community-wide in terms of their medical health?

Amanda Dubreuiel: All positive. All the kids, and even the kids enjoy going down there and getting seen. I think they feel cared about.

Ashley Mengwasser: Oh, yeah.

Amanda Dubreuiel: I think it makes them feel better to be able to get through the day or this coming week, especially if they've got something that's a cold or something, they've been coughing, and they feel like they're disrupting class and whatever. I think it's impacted the students, just I think they just feel seen. Instead of just some of these kids go home and they don't never maybe get to the doctor. And I think it's just had a positive impact on the kids as well.

Shannon Bynum: And I think attendance, it's for staff and students. It's helped with keeping them in school.

Amanda Dubreuiel: Yes, definitely.

Ashley Mengwasser: Good point. Because they might not need to leave and be gone for days.

Amanda Dubreuiel: Right.

Shannon Bynum: Right.

Ashley Mengwasser: They could be seen right there and sent back to class or come back the next day. What reactions have you heard? What has staff and administrators and families said about the center? Do you have any word of mouth stories you can share?

Amanda Dubreuiel: Some of the parents are not aware of them, which most people are aware by now. But some of the parents that I've called and they sound like, "Oh, I can't get off work right now," and they'll just sit there. There's almost a silent period where you can hear the parent thinking, "What am I going to do?" I'll tell her, "Hey, we have this clinic at school," and you can almost hear immediate relief in their voice. "Oh, really?"

Ashley Mengwasser: Yes.

Amanda Dubreuiel: And I'm like, "Yes, ma'am." Usually that excites them and it relieves their stress of not having to feel like they're having to leave work all the time. It's been a positive impact to the families.

Shannon Bynum: I've only heard positive. I've never heard anything negative about-

Ashley Mengwasser: Only good things. And for you too, Shannon, it's your student who is in your class who might have a need, that kind of preoccupies your mind for the rest of the day. So to know that they're still in the building, maybe you get an update that everything's okay as opposed to having left the building. That's got to provide some peace of mind.

Shannon Bynum: It does.

Ashley Mengwasser: What is your advice or words of wisdom to other school districts who are maybe amid planning or implementation of their school-based health center? What do you want them to know, look out for, be aware of?

Amanda Dubreuiel: As far as advice, I would think the only thing that I would probably suggest is just when you're designing the space, I think I would probably consider more space. Because we actually, our clinic grew so rapid that they have outgrew their space.

Ashley Mengwasser: Wow.

Amanda Dubreuiel: And I have talked to Casey about that, and I think that would be the only thing that we'd probably do a little bit different is just consider your space.

Ashley Mengwasser: Prepare for growth.

Amanda Dubreuiel: Yes, prepare for growth, definitely. Because you're going to have it.

Ashley Mengwasser: Yeah.

Amanda Dubreuiel: So that would probably be my only advice. But as far as being the school nurse, being able to have the nurse practitioner there, she communicates with me so well. I get informed of even what things that are going around. So I'm knowledgeable of what to look for in the students and expecting and what she's seeing versus what I'm seeing. So we have really good communication between me and her. So a good relationship with the clinic.

Ashley Mengwasser: Yeah. You guys have an army of healing heroes in your school.

Amanda Dubreuiel: Yeah, yeah.

Ashley Mengwasser: Double the force. What is your advice for anybody considering a school-based health center in their district?

Shannon Bynum: It's not just a great thing, it's a necessity.

Amanda Dubreuiel: Right. Yeah, that's a good one.

Shannon Bynum: It is.

Ashley Mengwasser: Well said. Well said, Shannon. Like you said, think about when you were younger, you didn't really have a school nurse and I remember having one. But look at this evolution to now, and now that you've experienced this as a teacher, as a staff member and for your students, you've got to be excited for them. I think we should end with a success story, and obviously Shannon is a big one. But if you can think of a student's story where a student has benefited from your school-based health center, let's share it.

Amanda Dubreuiel: Well, I have had asthmatic students, they don't come to school with an inhaler, for example. And I'm real sure exactly what was going on at home, why he wasn't able to get to the doctor to get his inhaler. But through the clinic, we were just able to... Mom just never could come get him. Mom never really could. She'd had to work. Mom never was able to take him somewhere off campus to go to the doctor. With him, I really truly know that's how we've kept his inhalers just refilled is him able to walk down the hall to get a prescription renewed. That would probably be the most successful story as far as just chronic.

Ashley Mengwasser: You had a good story, which I really enjoyed about the student with the injury in PE.

Amanda Dubreuiel: Yeah, her knee was dislocated. Yeah.

Ashley Mengwasser: Wow.

Amanda Dubreuiel: Yes. So she was playing basketball or some sport they were playing in the gymnasium and they said that she had fell and she was in pain. And I go down there with a wheelchair expecting having to use a wheelchair. And obviously her knee was dislocated. It was obvious, she didn't need an x-ray for it. It was popped out of its socket. So wheeled her over to Casey and Casey was able to order her some x-rays of course.

Ashley Mengwasser: Amazing.

Amanda Dubreuiel: And we ended up having to send her to the emergency room because to fix that problem, she was going to have to be medicated. But just having that service there to support me, I don't know. I feel like an advantage. Like I'm not the only one alone in the building for 700 students. I feel like I've got backup.

Ashley Mengwasser: But that a nurse practitioner, is there someone with the power to order x-rays-

Amanda Dubreuiel: Right, right. That's right.

Ashley Mengwasser: ... amazes me.

Amanda Dubreuiel: Yes.

Ashley Mengwasser: Absolutely. Anything to add there, Shannon?

Shannon Bynum: No, it's just wonderful. I really cannot say enough.

Amanda Dubreuiel: She's a cheerleader.

Shannon Bynum: I love having our school nurse and our clinic. We need both.

Amanda Dubreuiel: Yeah, thank you Shannon. And actually I too would like to add that we still have our local health department in Ben Hill County that does a great job to have wonderful staff. We still try to utilize them. They've just been there for us all these years. So we do refer, like students that need their vaccinations, we do refer them out to our local health department. They also provide some dental screenings there. They don't provide any dental services, but they do provide screenings and so forth. So we do still try to utilize our health department, but we also have the dental bus that comes around to our school.

Ashley Mengwasser: The dental bus?

Amanda Dubreuiel: Right. And it's a mobile bus that provides the services on the bus like cleanings and even fixes some minor cavities. But where the clinic comes in to play with that, and it's so important is if you have a child that comes in with a toothache that day, the dental bus only comes a few times a year. So that child doesn't have to miss school for that either. If we can send them down, refer them down to the clinic, the school-based clinic, and she can assess that if there's an abscess going on, she can get it treated while in the meantime referring them out to a dentist. So that helps, and that child not be in pain while he's waiting on a dental referral. But the health department, we still try to use them for their vaccinations, but the clinic does provide vaccinations for parents that struggle with transportation. So if the transportation is an issue, the clinic is there to provide that service as well.

Ashley Mengwasser: Well, may this continue to grow in Georgia. Shannon and Amanda, together, you actually represent every role inherent to the school-based health center. You are nurse, you are teacher, you are patient in Shannon's case and both of you certainly supporters of the school-based health center. We appreciate your accounts today. And hopefully Ben Hill County Middle School's health center will keep healing the masses.

Amanda Dubreuiel: Yes.

Ashley Mengwasser: I'm sure it will. Thank you for being here.

Amanda Dubreuiel: Thank you.

Shannon Bynum: Thank you for having us.

Amanda Dubreuiel: Yes, thank you.

Ashley Mengwasser: Of course. Great guests. And it was Virgil who said, "The greatest wealth is health." I think you'll both agree.

Amanda Dubreuiel: Yes.

Ashley Mengwasser: And we sometimes see this emblazoned on the wall in school health centers, the quote, "Students must be healthy to be educated, and educated to be healthy." As school-based health centers continue to expand in Georgia, so shall it be. Thanks for helping us band together to overcome more health barriers to learning. You're a great teacher. I'm Ashley, and I'd like to point out that I'm alert and I didn't faint once, but I do have to sign off now. So we'll return next week with more classroom conversations. Goodbye for now. Funding for classroom conversations is made possible through the school Climate Transformation Grant.