School and health series: Who comes to our aid?

MEDICAL personnel in public schools are outnumbered by the thousands of students who, not only have to face daily challenges in learning in poorly maintained infrastructure, but also face myriad medical concerns.

Picture this: There 74 public high schools and 285 elementary schools in Davao City.

There are only three dentists and 13 nurses throughout the city. These medical personnel have to cover over 8,000 teachers and non-teaching staff, 250,000 elementary pupils, and 74,000 high school students.

There is no medical doctor assigned for schools. The ideal ratio for nurses to students is 1:5,000. For dentists to students, it’s 1:10,000. If this is to be followed, the city needs 64 nurses and 32 dentists.

Medical staff is outnumbered by students.

But teachers come to help.

Raymund Pedregosa, DepEd nurse said that “clinic teachers” provide ancillary services in in the absence of school nurses but their functions are limited only. “They only provide first aid,” he said.

But for health examinations, only nurses assigned to the district can facilitate these.

The 285 elementary schools in the city are covered by only 11 nurses, who also cover 72 other high schools.

Each of the other two nurses are permanently housed in their respective public schools: Davao City National High School (DCNHS) and Baguio National School of Arts and Trade.

These personnel are distributed per assignments—each is assigned to look into two clusters of schools. There are currently 20 clusters in Davao City. The number of schools per cluster vary.

The Buhangin cluster for instance, has 17 schools with over 18,000 students. Marilog cluster has 40 schools.

Pedregosa, for instance, is assigned in Buhangin and Malabog clusters, and has to cover 30,000 students both high school and elementary.

What does the lack of medical personnel mean to students?

When school clinics are unable to give medical treatments and medicine, school level health concerns are instead escalated to government hospitals like Southern Philippines Medical Center or to the City Health Office when necessary.

School level concerns, unfortunately, are not always given high priority because both establishments also have communities and patients that they have to take care of. This inconvenience discourages students to seek medical attention, delaying required treatments or aggravating conditions.

Physical examinations for both students and teachers also require the functions of a medical doctor.

DCNHS school nurse Leah Yngayo said that the primary function of the clinic, given its limited space and resources, is to provide first aid to students in need.

Medical treatments (say, for ailments that need weeklong medicines) are not possible yet for the huge population of the school. On the average, the school clinic accommodates 60 to 90 students per day who walk in with common concerns: fever, headaches, and fainting.

These ever perpetual needs of students for care will always call for medical professionals and not just access to first aid kits. A look into the complexities of dental health among students, for instance, gives context.

Biting into reality

Dr. Heide Gutierrez, dentist from DepEd’s health and nutrition section said that every month, the department examines more than 1,000 students per month. And as if that’s not a Herculean task itself, the dentists also need to be able to treat at least 30 percent of the dental problems reported by that thousand.

Edgar Panelo, another dentist from DepEd, said that dental caries (tooth decay) are a common concern among kids and teens.

He said that kids aged 2-3 years old have decayed teeth; tooth decay is considered as a chronic childhood disease worldwide. “For every hundred kids, only three have perfect teeth,” he said, mentioning teeth breakdown—as resulted by bacteria—as a commonly reported problem. These students may experience pain and difficulty with eating. Some are unable to study well and are unable to pay attention in class.

He said that DepEd’s interventions come in the form of educating parents and children on prevention, given the limitations of school clinics which can only extend best assistance: giving pain relievers.

Even with this, medicine and some toothbrushes given by the city government to elementary school students yearly are not enough.

Panelo said that they focus their services on far flung areas where dental services are hard to come by.

Lack of resources not a hindrance

Dr. Cheryl Chan-Tabin, dentist at the Family Dental Care clinic in JP. Laurel corner Cabaguio Streets, pointed out that the lack of resources should never go in the way of developing good oral habits.

“I don’t believe that social class plays a big factor in keeping good oral health,” she said.

She said that two of the most important factors that affect dental health are actually hygiene and diet.

Good dental habits should start at home, she said, and should be continuous supported in school. She encouraged constant monitoring and sustainable dental practices be maintained not just once a year because habits are defined by frequency.

She added that toothbrushes are available in various price points. In the absence of fluoride toothpaste, the use of salt can also greatly improve a kid’s dental health.

Poor diet and dental decay are also correlated, she said. Eating fish and vegetables, and avoiding sugary foods, can help promote good oral health.

Dr. Rovic Cuasito, dentist at AiM Dental Avenue in Robinsons Cybergate Lanang, emphasized the importance of starting good dental habits at home.

“The parents play a big part on taking care of their children’s oral health. Supervised toothbrushing with the parents is a must for children 8-10 years old,” he said, adding that parents should always find time to look into dental care of their kids and to visit a family dentist regularly, when these aren’t available in schools. “They should also be focused on accessing dental care for their children.”

Cuasito shared that kids who see him report severe gingivitis and tooth decay.

According to the World Health Organization and the FDI World Dental Federation, toothbrushing using toothpaste with fluoride is the most realistic way of reducing tooth decay by up to 50 percent. New oral infections of up to 39 percent can also be reduced when implementing recommended dental programs in school.

According to the Essential Health Care Program in Schools manual for teachers, students should be able to brush their teeth at least once a day in school as a group activity, with the teacher supervising them. Students are also advised to cut down sugary snacks and drinks, and to get into the habit of eating fresh fruits as snacks.

The remaining problem is that hygiene and health isn’t a priority of some impoverished families who mostly focus on livelihood and food. Concerned government units from both local and national levels can do so much if they add manpower who can zoom into medical concerns of children.