HealthyCal.org

James Xiomg's older sister, Csee Cha, waters rows of onions in the community garden at Al Radka Park in Fresno.

By Genevieve Bookwalter, California Health Report

James Xiomg was tired of the rising price of onions.

So a year ago, when a friend invited Xiomg, 53, to the community garden at Al Radka Park in Fresno, he accepted. He and his wife, Yeng, soon signed up for their own plot, where they now grow rows of onions, heirloom greens, peppers and other crops.

“The same kind of onions, they cost a lot of money in the store,” Xiomg said. “We’re saving a lot of money.”

Fresno’s Community Garden Coalition is about to open its third garden in a city where statistics show the “food hardship rate,” or percentage of residents who have a hard time putting food on the table, is the highest in the nation. According to the Washington D.C.-based Food Action and Research Center, 27 % of Fresno residents worry about where their next meal will come from.

While not restricted to low-income residents, the city’s gardens provide a way for many without much money to grow nutritious produce at a low cost, said Tom Matott, Fresno Metro Ministry’s Community Gardens Coordinator. The ministry, a group of faith-based organizations that advocates for environmental and other health issues, runs the gardens for the city.

Community gardens are nothing new. Boston’s Fenway Victory Gardens began as part of a national effort to grow vegetables during the rationing and food shortages of World War II. First Lady Michelle Obama made headlines in 2009 by breaking ground on the White House Garden, which still is tended partly by school children and provides ingredients for state dinners.

Along with providing nutritious and affordable produce, the gardens at Al Radka Park and on Peach Avenue in southeast Fresno, along with others around the county, serve as a place for first-generation immigrants to socialize and health care workers to reach out to those who might not seek help from a doctor or mental health professional.

The city’s newest garden is going into the Lowell neighborhood, north of downtown and identified by the U.S. Census Bureau as the poorest in Fresno. More than half of its residents live in poverty.

The plot near Highway 180 is in a largely Hispanic neighborhood and should be ready for planting in March, Matott said.
Those minding the city’s existing community gardens are largely Hmong immigrants—many of them elders—who use the gardens as a place to grow their native foods and socialize with others who speak the language.

A lot of the vegetables are “things you can’t find in grocery stores,” said Matott, as he walked amongst rows of lemon grass and elephant ears, a large, fleshy-leaved green.

He looks forward to seeing the difference in crops grown on each site. In the Hmong gardens, for example, Matott said he doesn’t see many tomatoes—a staple in many Mexican dishes.

At Fresno’s Community Food Bank, President and CEO Andy Souza said his nonprofit is in early talks of supporting the community gardens in an effort to ease hunger and demand at the nonprofit. His group gave away about 12,000 holiday food boxes this Thanksgiving.

“Anything that promotes independence and sustainability is good, especially in an area that is hit as deeply as this is,” Souza said.

In addition, Souza said, garden vegetables make it easier for families to eat healthy food as obesity rates rise amongst school children nationwide.

The psychological benefits of gardening also have been recognized locally. Fresno County supervisors in November approved spending $180,653 in allotted state mental health funds on five gardens in the unincorporated county.

“It puts (gardeners) in the sun, gets them out of the house and relieves their symptoms of depression,” Markland said.

It also provides a place where county health workers can reach out to immigrant and low-income residents who might not visit a doctor or seek mental help if they’re having problems, Markland said. She envisions pavilions at each garden where, eventually, support groups like Alcoholics Anonymous or Narcotics Anonymous could feel at home.

At Al Radka Park, Xiomg, his wife and sister harvested tubs of onions, greens and peppers to take to family in Sacramento.

Xiomg came to Fresno from Laos, he said, and works as a custodian for Fresno Unified School District. He never gardened before visiting the park; he learned by talking to other gardeners.

Matott said some gardeners have problems affording the $3 monthly rent, but scholarships usually are found to cover the cost, Matott said. Other donations are common; Fresno County Sheriff’s Department often donates gardening supplies found on illegal marijuana farms, for example. Gardeners save seeds from one crop to the next.

The city recently turned down the ministry’s request for $35,000 to build the newest garden, Matott said, so neighbors are rallying to build the garden themselves.

“It shows how much it’s needed if you have people who can’t afford $3 a month,” Matott said. “It’s nice to be able to walk a few blocks and harvest dinner.”

Genevieve Bookwalter is a correspondent for the California Health Report at www.healthycal.org.

By Helen Afrasiabi, California Health Report

The Santa Ana Unified School District is launching a school safety measure with a grant of nearly $500,000, awarded by the Department of Justice.

A major part of the effort targets children at risk for gang involvement. The key is reaching kids far earlier than before, said school police chief David Valentin.

“Gang activity starts unfortunately very early in some instances,” Valentin said. “Really if you’re talking about true gang prevention, not intervention, you’re looking at elementary school aged kids.”

This could even mean kids as young as fourth graders, he said.

“They have a sibling who is incarcerated, or other family members already in gangs and these kids are on the track of following suit, for any number of reasons,” Valentin said.

The grant from the Department of Justice’s Community Oriented Policing Service office is awarded based on strong community policing plans and multi-agency partnerships, said DOJ spokesman Corey Ray.

Santa Ana has a tradition of community policing that dates back to 1973. The school district police officers commit themselves to a particular geographic location and getting to know the community.

Establishing strong relationships with stakeholders including kids on campus, staff and residents is key to prevention. Knowing who to speak to can make all the difference in prevention, Valentin says.

“The idea is get out in the police car, walk around and see who makes up community. If they hear rumblings, officers with that good rapport who are respected can get information and prevent a fight or assault,” Valentin said.

Valentin cites property crimes, theft of personal items, assault and vandalism to schools among the biggest problems at schools.

The grant money will go towards increased lighting at school campuses, closed-circuit televisions, gang prevention program literature and videos, student security pamphlets, protocol brochures and video cameras.

While some measures focus on protection, others are preventive, such as the literature and videos.

Increasing safety at school means reaching out to parents so they are able to recognize signs of trouble, too.

“Education enhances awareness and exposure to the issue,” Valentin said of their planned prevention efforts. Many parents, he said, aren’t familiar with warning signs that their kids may be involved with gangs.

Valentin also want to curb the absentee rates that occur as a result of students feeling threatened.

“When you talk about bullying, for example, it impacts students’ willingness and ability to come to class and do what they’re supposed to do,” Valentin said.

Bullying is sometimes gang-related and is not at other times, and it is important for police to be aware of the difference. The district police have to be vigilant of signs associated with gang-related bullying, such as graffiti nearby or the nature of any injury.

Whatever the cause of the bullying, Valentin said, it interferes with school attendance.

“That’s also going to be a priority…to do whatever we can to ensure our student population feels secure in just making it there,” Valentin said.

Efforts will be district-wide, with the money allocated across all schools. There isn’t one school or another that is more at risk, Valentin said, so much as different areas are being impacted for different reasons. Concerns like traffic safety are big at some schools, while vandalism is important at others.

Such concerns are important to safety, Valentin said, citing the broken windows theory. “If graffiti goes up and you just let it be, or someone throws trash there and you just let that be, it creates acceptance,” Valentin said.

Valentin brings years of experience with the city police department and expects to work closely with the School District and Board.

“The district has demonstrated that school safety is at the top of their priorities,” Valentin said.

Helen Afrasiabi is a correspondent for the California Health Report at www.healthycal.org.

Photo: courtesy SPCA.

By Lynn Graebner

The SPCA for Monterey County is pairing at-risk youth in Salinas with at-risk dogs, and the benefits are blooming on both ends of the leash.

Called “Take the Lead,” the program allows students at Washington Middle School and incarcerated youth at the Monterey County Probation Department Youth Center to train dogs that lack the social skills they need for adoption.

Counselors, teachers and SPCA staff say the program is a great way to provide a positive experience for kids having trouble academically and socially by giving them an opportunity to make a huge difference in the life of an animal.

“We definitely see the growth in the kids when they’re working with the dogs,” said Amanda Mouisset, Pet Behavior Specialist at the SPCA for Monterey County.

When the SPCA launched the program in 2008, Washington Middle School’s principal, Judith Roney- Peterson, and teachers there embraced the idea.

“It’s part of a social/emotional network we have,” Peterson said. “We target kids who are having difficulty and match them with activities that will help them. Animals seem to calm kids down,” she said.

Now other schools are lining up to participate. And with more than $86,000 in grants acquired for next year, with more pending, the SPCA is gearing up to triple the number of program participants to 198 children and 75 dogs, said Susan Koza, Director of Development for the SPCA of Monterey County.

How it works

Mouisset selects five dogs at a time for the five-week program. Many of them have been surrendered to the SPCA by their owners for behavioral problems. None of them have aggressive tendencies, just bad manners.

Twice a week Mouisset takes the dogs to Washington Middle School and the Youth Center. At Washington counselors have a “watch list” of students with challenges, said Stacy Picciuto, the physical education teacher who coordinates Take the Lead for Washington. They may not be engaged in school, or they have trouble integrating socially or have suffered some kind of abuse.

Take the Lead also includes children with mental disabilities like autism or Asperger’s syndrome. For some of those kids Mouisset will bring in her own trained dogs.

“It gives them a really cool success story that they can build on,” Picciuto said.

One of the most common comments from participants in Take the Lead is that they are gaining more patience.

“It’s helped me not to get frustrated,” said Thomas Nieto, a Washington student. “It’s helped me with losing, I’m a sore loser,” he said.

At the Youth Center, staff selects teens who are performing well at the Center to participate, so the program is an incentive for them to stay on track. These kids are 14 to 18-year-olds incarcerated for crimes like selling or using drugs, assault and battery and theft.

“A lot of these kids are robbed of their childhood,” said Alex Carrillo, a probation aide at the Youth Center, who coordinates the Take the Lead Program at his facility. “The staff at the SPCA is really great. The kids talk to them and open up to them and you see these kids smile. You don’t see that a lot.”

Making a connection

One of the biggest changes teachers and counselors notice is that kids open up when they make a connection with an animal, especially with one looking to them for guidance, approval and compassion.

Some kids come in with the attitude that, “I’m a tough kid, I know what I’m doing, just give me the dog,” Mouisset said. But when they realize the animal has issues and feelings, she sees the kids start responding to the animal’s needs.

“For a lot of kids, that’s a first,” she said. “When the kids start seeing the dogs really focusing and working with them, and they see the dogs start looking forward to working with them, you start seeing the change in the kid,” Mouisset said.

Rigo, a resident at the Youth Center, trains a pit bull he named Estrella after a dog he had that ran away while he has been incarcerated. He remembers the first day this new Estrella came into his life.

“She came straight to me, she picked me,” he said, beaming.

Building comradery is another benefit of the program.

At the Youth Center, Carrillo looked out over a grassy field where the residents train the dogs.

“We have kids from opposing gangs in this group right now. But when they’re working with their fellow residents to train a dog, they’re out there talking to each other, working together and praising each other,” he said.

He remembers one kid, Luis, who was training a huge unruly Saint Bernard named Chaplin. Luis really bonded with Chaplin and lobbied to repeat the program. When he left the Center, he volunteered at the SPCA and was later hired as an employee. At a Youth Center event honoring volunteers, Luis gave a speech thanking Mouisett for helping change his life.

“That place was in tears,” Carrillo said. “Luis felt he could relate to that dog because he too felt locked up and forgotten.”

A sense of responsibility

At the Youth Center, residents are preparing themselves to reenter their communities. They get family therapy, drug and alcohol counseling, academic and vocational education and help dealing with gang issues. But one of the most popular programs at the center is Take the Lead.

“Take the Lead is the only group that gives the kids a responsibility, Carrillo said.

“In a life they have no control over, now they have the responsibility of caring for another life.” And there’s always a waiting list of kids who want to participate.

“We’ve never had to kick a kid out,” Carrillo said. “There have been zero issues. It’s a privilege to be here and they know if you mess up, there are 20 kids ready to take your place.”

Sal, one of the Youth Center residents, is training Janie, a tiger-striped Pit Bull who looks at him adoringly. Janie was attacked by another dog and needs to learn how to be social with other dogs and people again, Sal said.

“I’ve learned patience,” he said. “Having animals around keeps you really sane. This [program] shows you a little bit of responsibility,” he added.

Sal and the other participants in his group will have a graduation ceremony with their dogs and will write letters about them to be posted next to their kennels at the SPCA to educate prospective adopters about the dogs’ personalities and what kind of homes would be good for them. The kids craft these letters very carefully, they all know what’s at stake.

“They’ll sit there for days writing a good letter,” Carrillo said.

Linking at-risk dogs with at-risk youth and adults isn’t a new idea. It’s slowly catching on around the country. The Peninsula Humane Society & SPCA in San Mateo is partnering with the San Mateo County Sheriff’s office with a two-year-old program at the minimum security Maple Street Transitional Facility in Redwood City. That program is called TAILS (Transitioning Animals into Loving Situations).

The dogs live at the facility and two residents are assigned per dog. They are responsible for all of its training and care. Pet Food Express donates supplies for the dogs and a local dog trainer volunteers her time.

“People are getting a great dog if they’re adopting a dog from this program,” said Scott Delucchi, a spokesman for the Peninsula Humane Society & SPCA.

The dogs do give something in return.

“They say the presence of the dogs has changed the atmosphere there. More people are smiling,” Delucchi said. “They all take pride in the program.”

That pride shines through at Washington Middle School as well. The students are clearly tuned into and very protective of the dogs in their care.

Robert Martinez, a Washington student, works with Roscoe, a very nervous but playful terrier mix who spent the first year of his life in a backyard without much attention. Earlier in the session Roscoe got excited and peed on Robert’s shoe. And when someone moved suddenly, Roscoe retreated in panic.

“He’s a little bit nervous,” Robert said, kneeling next to Roscoe, embracing him and talking to him in hushed tones. “His heart is racing, give him a minute,” he said to the trainer. That’s music to Mouisset’s ears.

What motivates her to keep investing her time and talent in the program?

“Knowing we’re helping the children who are our future and part of our community,” she said. “We’re giving the dogs a second chance, and with the children, hopefully that compassion and empathy that we’ve worked on sets in.”

Doctors reflect on the undervalued specialty of primary care

By Helen Afrasiabi

Second year family practice resident Dr. Ernesto Medina is happy with his specialty, despite the challenges of primary care.

“The value of primary care is found, quite simply, in the continuity of care you get for every member of your family,” Medina said, taking a break from his work at UCI Family Health Center in Santa Ana.

Faculty and residents see twenty or more patients daily at the center. The clinic, which serves 20 percent of the county’s safety net patients, provides the training environment vital to his preparation for serving low-income people, Medina said. He’s getting an understanding of their specific needs and learning how to navigate the system for them.

As an undergraduate, Medina volunteered with medical teams traveling to Tecate, Mexico, to administer care to the region’s poor. His experiences affirmed his desire to be a primary care practitioner, especially one that helped the underserved.

“Seeing physicians interact with and being able to treat the entire family, and seeing individuals from an underprivileged background be at ease with these doctors, showed me the value of being in this specialty,” Medina said.

But quantifying the effects of this work can be difficult, said Program Director Dr. Charles Vega. The program, which trains doctors like Medina in addition to providing care, is always in need of additional funds, and grants are hard to come by.

“There are ever-increasing financial pressures out there, and we’re feeling it too,” Vega says.

The program lacks the resources needed for the documentation and evaluation work that grants typically require.

“This takes a lot of effort and can sometimes be lost in the moment-to-moment care of very sick people,” Vega said.

And the pool of grant money is dwindling. The federal government is considering cutting programs like Small Community Health Grants, totaling $62 million, because it hasn’t produced health outcome measures that are scalable at a national level, according to the Office of Management and Budget.

The state has filled in a bit of the gap. UCI Family Health Center has gotten one grant this year from the Office of Statewide Health Planning and Development’s (OSHPD) Song Brown fund, which favors clinics in underserved communities that have diversity in their clinical staff. The grant was created for increasing the primary care workforce and will pay one resident’s salary at the health center, which totals between $45,000 and $52,000 per year.

But the money doesn’t help to meet other pressing needs.

One problem is that their patient population is 60 percent Hispanic, and few residents speak Spanish. The clinic has hired a language coach to help residents reach more patients.

A lack of preventive care is also common among patients.

“Ours are patients who don’t have a simple vaccination, mammogram or access to green open space or healthy food,” Vega said.

The lack of preventative care frustrates Medina. Some patients have difficulty affording primary care, but others will go straight to a specialist when they feel ill, forgoing a primary care physician.

Frequently, Vega finds himself dispelling the idea that family medicine is a chore among medical specialties. Nothing could be further from the truth, he said, especially considering that caring for those patients coming through the doors at UCI Family Health Center continues to present new challenges everyday.

For primary care to successfully address the poor community’s needs, it has to be kept innovative but simple, Vega said.

“We need simple technology because our patients are poor, even just things that help address problems with blood pressure and body weight. Once it gets too expensive, there’s nothing to pay for it.”

The bottom line, Vega said, is that the cost associated with running a Family Medicine training program such as his are unlimited, and the specialty is saddled with impediments such as proving outcomes and low reimbursement rates that just don’t go the distance. There is simply not that much money in talking to patients, Vega said.

That hasn’t deterred residents like Medina, who plans to continue working with the same population in Orange County after his residency.

“We’re not in it for the sports car,” Medina said.

Mayor Jean Quan canvases a West Oakland neighborhood.

By Heather Tirado Gilligan

Mayor Jean Quan walked purposefully from door to door in a West Oakland neighborhood on a Friday afternoon in early December. A mass shooting, just blocks from where Quan was canvassing, had recently shocked the city. Seven people were injured, including a critically wounded one-year-old boy.

When Quan’s knock was answered, she talked with residents and asked for their help with the case. When no one came to the door, she left a flyer with the number of a dedicated tip line curled into railings or screen door handles.

Some people stopped to talk to Quan on the street. One question was on everyone’s mind.

“Did the baby pass?” asked Jerry Garrett. He held a young boy on his shoulders as he talked to the mayor.

“He’s not doing well,” Quan answered.

The child, Hiram Lawrence, was shot in the head while his father was holding him. Lawrence was removed from life support a few weeks after the shooting and died at Children’s Hospital in Oakland on Dec. 9.

Residents were reluctant to help the police in their investigation of the crime, according to Mayor Quan and acting Oakland Police Chief Howard Jordan.

A hesitation to cooperate with police after high profile crimes is typical in poor city neighborhoods, said sociologist Waverly Duck, a University of Pittsburgh professor who studies life in high crime urban areas.

The reasons for the hesitation are more complicated than not wanting to be seen as a snitch, Duck said. Residents want crime in their neighborhood to end, but fear that sharing knowledge with police won’t actually make them safer. They’re also frustrated that police don’t flood their neighborhood looking for perpetrators after every shooting.

The Oakland shooting happened in the early evening on a crowded corner but no eyewitnesses came forward after the crime, Jordan said. Police are currently holding six people of interest in the shooting on unrelated charges.

Outreach work helped to solve the murder of another toddler in East Oakland, Quan said, another neighborhood with high rates of violent crime.

But for some residents of West Oakland, the canvassing efforts were too little, too late.

“I think it’s a shame it took a kid getting shot in the head for this to happen,” said Tracy Washington of Quan’s efforts to reach out to area residents. Washington said she has lived in West Oakland for 24 years has seen shootouts in the streets.

“This is an area that’s been overlooked,” Bishop J.E. Watkins said. He took part in the canvas along with other members of the Pastors of Oakland, a citywide faith-based organization.

Residents of high crime areas often feel overlooked – and attention from politicians, police and the media after high profile crimes does little to ease that feeling.

The threat of violence is a fact of life in West Oakland, as resident Tracy Washington pointed out.

Crimes like the West Oakland shooting typically result from retaliations and are part of an ongoing cycle of crime, Duck said.

But what gets attention and resources, he added, aren’t the everyday acts of violence, but the handful of high profile cases each year that involve victims who are outsiders to the neighborhood, local business owners or bystanders like Hiram Lawrence.

That begs the question of why all crimes aren’t treated equally, Duck said. “Why isn’t it the case that all violent incidents are investigated and treated with the same diligence as it is when an innocent bystander or a child is hurt or harmed?”

The sudden attention to crime after a high profile shooting may not encourage residents to talk to police, Duck said.

Locals might have information about the incident through the rumor mill, but rarely have first-hand knowledge of the crime. They are reluctant to put themselves and their families at risk by sharing the little bit of knowledge they have with law enforcement – especially when they think police aren’t generally interested in what’s going on in their neighborhood and won’t be able to keep them safe if they do cooperate.

“There are no winners in this situation,” Duck said. “Police officers have a very dangerous job. There is a part of police that wants to let their guard down and get more involved.”

Developing a relationship between the community and law enforcement is good for police and residents. “Taking concern with minor issues and building relationships with kids would be a good direction,” Duck said, “and becoming a part of the community.”

That means having cops in the community all the time to help people with everyday problems – a policy that the Oakland police department has actually had in place for several years now.

Oakland has problem solving officers, or PSOs in every district in the city, and their job is to build relationships with the neighborhood that is their beat, said OPD spokeswoman Johnna Watson.

PSOs are responsive to what residents need from the police, Watson said. “It’s a two-way street,” she said. “Asking what does the community want? What do they expect from us?”

Additional PSOs from districts throughout the city were sent to West Oakland in the wake of the shooting, too. They were working diligently to encourage the community to cooperate with the police, Watson said.

Asking for help in tense moments following a high profile crime – when residents may fear for their own safety – is unrealistic, Duck suggested.

“To implicate a community that is already struggling, to get them involved in these cases, is putting a real burden on this community,” Duck said. “You are asking people to put themselves at risk when they have very limited information. And there is no guarantee that they will be or remain safe when these incidents are so common.”

By Melissa Flores

Medicare is the major source of funding for hospice patients. But reimbursements from the federal program don’t cover the full cost of care for facilities that help people in the last stage of terminal illnesses or offer palliative treatment for patients undergoing substantial medical treatment.

“They have to find alternative sources of revenue,” said Jennifer Pettley, the director of communications for Hospice Foundation, a Central Coast organization.

This article is one in an occasional series on aging with dignity, independent living and public policy that affects both. For a complete archive of the articles, click here.

The foundation gave out $1.4 million in grants to 12 nonprofits this year, including the Natividad Medical Foundation, in Salinas, and the Community Hospital of the Monterey Peninsula’s Hospice of the Central Coast.

Hospice Foundation is gearing up for one of its most visible fundraisers of the season – the “Tree of Life” tree lighting ceremonies. The agency collects donations for a tribute light that will be lit in honor or remembrance of a loved one. The event is also a memorial for people who have lost a loved one. Each light represents a donation and is dedicated in someone’s name.

The Hospice Foundation supports nonprofits and hospitals that offer hospice or palliative care programs for residents in the Monterey, Santa Cruz and San Benito area. Palliative care is a program that offers pain and symptom management for patients who are still seeking treatment for a chronic or terminal illness. Hospice patients are those who have been diagnosed with a terminal illness and given less than six months to live.

To qualify for hospice, patients need to forego life-extending treatment.

Cathy Bargenquast, the assistant director of the Hospice of the Central Coast, said the services offered range from in-home medical assistance to social workers to grief counselors for the patient and friends. They also work with a network of volunteers who can offer services from massage therapy to aromatherapy to healing touch. The agency offers hospice for adult patients.

“Most of them are older,” Bargenquast said, though it is not unusual to see patients in their 50s or 60s.

Seniors who accept hospice service can revoke that request and go back to receiving treatment in the future, Bargenquast noted.

“People think once they’ve elected hospice that means they are choosing hospice service and are forfeiting the Medicare benefit for treatment,” she said. “They feel there is no turning back. If they start feeling better and they want to go through treatment, they can revoke it at any time.”

Most people who go into hospice after undergoing harsh treatments such as chemotherapy start to feel better initially.

“We’re able to get symptoms under control,” Bargenquast said. “They are not vomiting. Constipation (is gone.) They get their pain managed and start to feel better. They start eating and gain five pounds. It’s a really interesting progression in that way.”

She talked about one of the patients she worked with, an elderly woman who wanted to undergo one more round of chemo. The hospice staff recommended that the woman go onto hospice care to get her strength up before trying the treatment again.

“We sat down and talked about the recommendation with an adult child and she signed onto hospice,” she said. “No one felt she was really strong enough (for treatment.) We got her pain under control and she lived a better, good quality of life for three or four months.”

The patient decided not to go back for treatment.

“She died on hospice but it so enhanced her life,” Bargenquast said.

She said that even some patients who sign on for hospice are still in denial about death.

“Some are in denial until the day they die,” she said. “That’s really the goal of the social worker and spiritual counselor to move people to that place.”

With the $534,450 grant received this year, the staff and volunteers are going to be trained through the “We Honor Vets” program. It is a program created by the National Hospice and Palliative Care Organization to train clinical staff about the special needs of veterans.

“If they were in combat, were they in extreme heat or cold, what physical problems they might have, substance abuse, how to handle that,” Bargenquast said.

She noted that the closest full-service VA hospital is in Palo Alto, 75 miles north of Salinas.

“People don’t want to go to Palo Alto for their final days,” Bargenquast said. “We help them stay home.”

One of the key services that Hospice of the Central Coast offers is bereavement counseling for family members. They host Caregiver Connection meetings that give family members of someone with a terminal illness a chance to meet with others in similar situations.

“It gives them some socializing with people who are in the same boat,” Bargenquast said. “They see its okay to get angry. It’s more than a support group. It’s a really good connection.”

While Hospice of the Central Coast focuses on adults in need of hospice care, the foundation donation to Natividad Medical Foundation will allow them to expand their palliative care services to perinatal and pediatric patients.

From the beginning they helped the hospital “put a perinatal bereavement program for moms and dads to come in to have a stillbirth,” said Judith Lavoie, the nursing director of women’s and children’s services. “Years ago they were a great support of helping us launch it. We’ve built a pediatric palliative care program and they’ve been great supporters.”

Lavoie said the grant this year of $17,100 will help the hospital refurbish quiet spaces for family bereavement counseling. They also want to remodel a hospital room so it is more like a family space, with couches, tables, a small refrigerator and a microwave.

“They’ll have the ability to sleep there, eat there, and if they chose they can go out and bring in food and keep it in the refrigerator,” Lavoie said, of families with a child diagnosed with a terminal illness. “They can do family activities together in the room.”

Lavoie said the improvements have been a dream of the staff members for a while.

“With Natividad being a safety net (hospital) we serve the underserved,” she said. “We want to make sure equal treatment goes to anyone that walks through our door.”

Fourth grader Andrew Alvarez, 9, has his temperature taken by school nurse Janene Armas at Teague Elementary School in Fresno.

By Genevieve Bookwalter

Thirty years ago, kids with cerebral palsy—a loss of certain motor functions caused by brain damage—rarely lived through their teenage years, let alone attended high school.

Now, modern medicine allows them and other students with potentially life-threatening diseases to graduate and live well into adulthood.

But these medical miracles also have gradually transformed school nurses’ offices from a warm place to get a bandage or ride out a headache to a modern-day care center. Now, nurses regularly do everything from give insulin shots to empty urinary catheter bags.

At the same time, state budget cuts mean the number of school nurses in California is shrinking. As a result, nurses say, they are responsible for more students every year and are largely consumed with keeping “medically fragile” children in class.

The result: they have less time to work with students whose milder symptoms, like a stomach ache or headache, could be signs of larger problems that school nurses traditionally helped find and address, such as bullying, chronic hunger or child abuse.

“Around 30 percent of the students who come into the health office are there because of mental health issues,” said Linda Davis-Alldritt, president of the National Association of School Nurses and based in Sacramento. “So when a child comes in with a mental health issue and the nurse is busy providing insulin to one child, suctioning a (tracheostomy) and providing a gastric tube medication to another child, the child who has the mental health issue may get lost in the shuffle.”

In 2009, the National Association of School Nurses ranked California 42nd in the ratio of school nurses to kids. According to those figures, the most recent available, one California school nurse is responsible for 2,187 students. In Vermont, the state with the lowest ratio, one nurse looked after 311 students.

Nancy Busch, who teaches the online School Nurse Credential Program at Cal State University Fresno and worked as a nurse in Clovis Unified School District for 23 years, said she commonly sees one nurse looking after students in four different schools.

In an extreme example, Busch said, one Southern California district assigns one nurse to 13,000 students. In more rural areas of the state, she said, one nurse could take care of 600 kids in schools that are hours apart.

“The thinner we’re spread, the less we can do,” Busch said.

The shrinking number of school nurses comes as California deals with ongoing financial woes and school budgets shrink. Unlike some states, California does not have a law requiring a nurse in every school, or to oversee a set number of kids.

As result, when schools face ongoing budget crises, nurses are often some of the first positions cut, Davis-Alldritt said.

Over the past three years alone in California, the number of school nurses dropped 9 percent, from 2,901 nurses to 2,474. Meanwhile, the number of students dropped less than 1 percent.

Aside from the state’s recent economic crisis, which has resulted in a sharp drop-off in tax revenue to state coffers, Davis-Alldritt places blame for the dwindling number of school nurses on Proposition 13. The 1978 California ballot measure limited property taxes to 1 percent of a property’s sale price. It also limited the tax’s growth to no more than 2 percent per year — even if the property’s value increased — until the property was sold again.

Many education advocates blame Prop. 13 for hampering school funding, which is paid largely through property taxes. Although overall school spending has increased, along the state’s population since then, critics say that the measure, which remains popular among voters, dramatically slowed the rate of growth of public education spending so that it hasn’t kept up with needs.

“Before Prop. 13, every school in California had a school nurse,” Davis-Alldritt said. “After that the number of school nurses gradually declined, more or less by attrition.”

Davis-Alldritt said her group is looking for outside possibilities to help pay for school nurses. Ideas include everything from designated state funding to money from insurance companies, she said.

Some nurses say they see the latest budget and care challenges as a new reality.

At Fresno’s Central Unified School District, Health Services Coordinator Patricia Gomes said the district is adjusting to less money and increased demand by tapping medical aides and licensed vocational nurses, who have less training than certified school nurses but can administer different levels of basic care and give some medications.

The district currently has 10.5 full-time, certified school nurses; 6 licensed vocational nurses; and six health aides to serve 15,000 students and 22 school sites.

Certified school nurses “really need to be case managers,” Gomes said. Those nurses are the only ones who can help kids with chronic conditions plan their at-school treatment, she said. One student with newly diagnosed Type I diabetes, for example, requires hours of attention to learn how to check blood sugar levels and when he needs insulin.

To further help with schools’ increased demand for medical care, Gomes said teachers are asked to stock their desks with bandages to cover kids’ minor scrapes. Teachers also are encouraged to let kids with headaches, for example, put their heads down for a few minutes during class as opposed to sending them immediately to the nurse’s office.

“Teachers have their hands full too,” Gomes acknowledged. But “if you have a simple headache, that doesn’t mean you have a disease.” The nurse’s office now, she said, must focus largely on critical care.

William Peverill, president of Central Unified’s Board of Trustees and a retired teacher, said he sees the demand nurses face, but the district can’t do much more with its current budget situation.

“It’d be nice if we had (a nurse) at every school,” Peverill said. “I wish we had more teachers and smaller class sizes, too, but that can’t happen.”

Melissa Pernsteiner has a daughter in fifth grade at Herndon-Barstow Elementary School, which is part of Central Unified. She also serves as president of the school’s Parent Teacher Association.

Pernsteiner said she sees the shift in nurse’s priorities and staffing as long-term, as state and local economic woes continue. However, Pernsteiner said she’s been pleased with how Central Unified has handled the challenge.

“I speak to quite a few parents,” Pernsteiner said. “The feedback I’m getting is that the district is doing a good job with the resources it has. I feel that way as well.”