Montreal -- Myrto Carignan is sitting in her office on the second floor of
Ecole Saint-Jean-Baptiste when two six-year-old girls walk in, hand-in-hand.
One of them, who has a symmetrical pattern of red blotches across her face
and neck, speaks only a Chinese dialect. Her friend, speaking in rapid-fire
Portuguese, has come along to offer moral support.
Ms. Carignan, the school nurse, takes a quick look, immediately recognizing
the marks as the bites of an insect, probably a spider.
She gives the girl a comforting smile and stroke of the hair before
dispatching the girls back to class. Then she sets out to find an
interpreter so she can contact the parents, remembering that she also
requires the services of a Bengali interpreter so that she can talk to
another family about a child's head lice.
"As the population of the school has changed, so has my role," says
Ms.
Carignan, who has served as the school nurse for more than 20 years.
"Today,
the biggest challenge for me is language."
At last count, 58 languages were spoken among the 300 children at
Saint-Jean-Baptiste, and almost half the student body attends "classes
d'accueil," an integration program for refugees and new immigrants.
The newcomers pose a challenge for the school nurse, and not only
linguistically. It is one of the few schools in the country that routinely
screens children for tuberculosis, and almost one-third test positive.
But school nursing is about adapting to the needs of children, Ms. Carignan
says. And it is, above all, an education role.
In fact, the nurse spends the bulk of her time in the classroom, not in the
tiny school clinic. "In 20 years, I have never turned away a child who
appeared at my door. But our role is not first aid. It's teaching children
to be healthy," Ms. Carignan says.
For example, she teaches children -- and in many cases their parents --
about nutrition by cracking open their lunch boxes. "Generally, you find
that children get too much bread and too many sweets, and not enough
vegetables or milk products," she says.
For children who live in the urban neighbourhood within walking distance of
the school, there are road-safety courses. For those who are bused in --
virtually all the newcomers to the country -- the nurse teaches school-bus
safety.
All the children, from pre-kindergarten on up, are taught the basics of
hygiene, with an emphasis on hand washing. (Studies have shown that schools
with a nurse have a far lower incidence of absenteeism among students and
staff, due largely to better hygiene.)
There are also mass vaccination programs that take up a lot of the nurse's
time. And every couple of years, there is an outbreak of measles or
meningitis that requires an emergency campaign.
More routinely, every Grade 4 student is vaccinated (in three doses) against
hepatitis B, a sexually transmitted disease.
That fact, as much as anything, is indicative of how children have changed.
Families have changed, too, and that is shown in the cases nurses see.
Ms. Carignan says the No. 1 problem of children who come to her office is a
stomachache. But that is a reflection not so much of diet, but of the
stresses children face, such as family breakdown, the pressure to succeed
and sexual abuse.
"You know, everything goes through the stomach -- food and emotions. What
you realize is they don't really have a pain in their stomach, they have a
pain in their heart."
What most children who come to see the nurse need, Ms. Carignan says, is TLC
-- tender loving care. "They want to talk, and I listen."
For the older children -- the primary school goes up to Grade 6 -- Ms.
Carignan teaches a course on sexuality. Because Saint-Jean-Baptiste is a
Roman Catholic school, that can be controversial.
"Some of the teachers feel uncomfortable with the subject matter, and they
prefer someone come from the outside. That's usually the nurse," she says.
But she remains puzzled by the years of heated debate that have surrounded
the course, a controversy that was quieted by allowing parents to take
children out of the course.
"The course is about knowing your body and the changes that take place.
It's
important for every child to have this knowledge," Ms. Carignan says.
If there is a frustration in her work, it is that in this day and age, some
children are so ignorant of their bodies and development. The nurse is
saddened when girls of 10 or 11 come to her office and "they know
absolutely
nothing. They don't know what puberty is or menstruation. The parents have
to play a more active role."
While Ms. Carignan agrees with the emphasis on education, she is worried
that it has been to the detriment of other useful health programs.
School nurses, for example, used to do routine vision screening tests. Now,
they merely send a letter urging parents to get their children's eyes tested
at age 5 and 10.
They used to also have more time to tackle chronic problems such as head
lice. Saint-Jean-Baptiste, unlike many primary schools, does not do routine
nitpicking, opting instead to respond when a problem occurs.
These little routines were important not only for their underlying goals,
but also for the intimacy they provided. Because the nurse is such a trusted
figure, "a lot of simple tasks reveal much larger problems," Ms.
Carignan
says.
For example, children will tell of being sexually abused while having their
eyes tested, or they will, while getting a scraped knee bandaged, reveal
that their mother is a victim of domestic abuse.
Yet, despite the obvious benefits, the role of school nurses is diminishing.
In the past five years, the number of school nurses in Quebec has fallen 24
per cent, to 355 from 468. Practically, that means there is one full-time
nurse per 2,402 students, compared with a ratio of 1 per 1,553 in 1994.
"Governments sometimes make strange decisions and one of them is to reduce
the number of nurses in the school setting," says Gyslaine Desrosiers,
president of the Quebec Order of Nurses. "The health needs of our children
are more complex than ever before, and that's why the need is greater than
ever."
She argues that school nursing is one of the most cost-efficient health
investments, that preventing one sexually transmitted disease or teenaged
pregnancy, dissuading one child from smoking or catching one case of
malnourishment or sexual abuse early can save the system hundreds of
thousands of dollars.
Ms. Carignan agrees. She recognizes that, in the Plateau district, the
nursing ratios are among the best in the country because local public health
officials consider the program a priority.
Still, she now works the equivalent of only 1.5 or 2 days a week at the
school. That is because Ms. Carignan is also responsible for the well-baby
program in the neighbourhood, meaning that she visits all new mothers at
home to do education work.
And, increasingly, she has to fill in at the local public health clinic
because of the growing problem of nursing shortages.
"The schools around here are spoiled, relatively speaking, but every one of
them wants more, they want the service full-time," Ms. Carignan says.
"The attitude of school principals is: The young people are here; come and
get them and teach them about health. They feel it's a part of the
children's education that will last a lifetime," she says.
"And, you know, they're right. We could do a lot more in the schools."