(Fred Lynch) [Order this photo]
Alana Alford is up to the challenge.
The second-grader at Orchard Elementary School in Jackson struggles at first with the math problem on the board: 53-26. Her teacher provides a little direction, a reminder on borrowing. Alana counts on her fingers, eyes focused. She taps a pinky on her desk, and she's got it. She writes the answer in red marker on her dry-erase board.
"I like to do math," Alana said in a soft-spoken voice, just a notch above a whisper. She coughs into her elbow. It's not a cold.
Moments before, Alana was back at the Asthma Nebulizer, pushing the misty medicine she needs through a tube line, helping soothe the inflammation of the 8-year-old's restricted airways.
She's breathing better, but the medicine's loosening effect is kicking up a constant cough.
Alana uses an inhaler and takes breathing treatments -- sometimes twice a day -- when her asthma is at its worst. She shrugs her shoulders when asked what it's like to live with the breathing disorder. She has lived with asthma for as long as she can remember. Some days are better than others.
Joyce McIntosh, school nurse at Orchard and wellness coordinator for the Jackson School District, has seen the panic that asthma brings. It's a face that's hard to forget.
"It's scary. They can have trouble just talking," she said. "A good indication that they are having trouble with their breathing is they have a desperate look in their face."
Asthma, debilitating and at times deadly, is the most chronic pediatric medical condition in the United States, accounting for nearly 1 million visits to emergency rooms and 15 million missed school days annually, according to the Environmental Protection Agency. As much as 9.7 percent of Missouri's children suffers from asthma, according to a report from the Centers for Disease Control and Prevention.
But McIntosh said asthma isn't keeping Alana from learning. The little girl's parents work with McIntosh on an action plan, identifying medicines, treatments and support the student needs to help her live and learn.
Like school nurses across Southeast Missouri, McIntosh knows how critical early intervention and planning are in assisting children with chronic medical conditions and other health-related obstacles. Whether its asthma, attention deficit hyperactivity disorder or vision or hearing deficiencies, health problems can stifle performance in the classroom.
"Some of them are falling behind," McIntosh said.
And when students fall behind early, too often they stay behind, educators say. That's why school health care providers say being proactive can make a big difference in keeping students on the right academic track.
Nurses in Jackson's public schools, for instance, developed 133 Asthma Action Plans last school year. Courtney McQuade, school nurse at Jackson's North Elementary and Gordonville Attendance Center, said the idea is to set goals and target treatment to eliminate full-blown asthma attacks.
"If we keep them controlled, they won't miss a lot of class," McQuade said.
The district's health services team developed 47 Individualized Healthcare Plans for students with chronic conditions or special health care needs, down from 97 such plans the previous year.
McQuade said health action plans require involvement and commitment from all stakeholders -- health care providers, parents, teachers, students. Sometimes, she said, parents refuse to cooperate. Often, it's a matter of economics, low-income families struggling to meet their children's health care needs.
Such was the case of a Jackson family with two elementary school-aged children with vision problems. The students needed eyeglasses, but the parents said they first had to save money before they could see the eye doctor. The district's children's foundation stepped in to help cover the cost, McQuade said.
But the students were just about to get the glasses they needed last week, at more than the halfway point of the school year. That's a semester-plus bearing the weight of an educational obstacle that should have been remedied long before, McQuade said.
In other cases, McQuade said, the parents just don't want to get involved.
"The best word I can come up with, it is just neglect," the nurse said. "I hate to put that word on anybody, but they simply have better things to do."
Sometimes, Jackson school nurses send several letters and make repeated phone calls to the home.
"We hound them, but ultimately it's the parents' choice if they want to take the child to the doctor," McQuade said.
On rare occasions, the Department of Social Services must be called in.
In the 2009-2010 school year, 61 of 68 Jackson School District students with vision screening deficits, nearly 90 percent, were referred for professional evaluation, down from the previous year when 74 of 79 students with vision deficits were referred, about 94 percent.
The numbers of students in need of health plan assistance varies from year to year. For instance, in 2009-2010, 35 of 39 students in Jackson's schools were referred for professional hearing evaluation, compared to 15 of 19 students in the previous school year.
Jackson health services officials say screenings and action plans are helping to cut down on the number of students facing health-related obstacles to their education.
Despite Alana Alford's struggles with asthma, she seems to be thriving in the classroom. This year she's learning cursive writing and tackling big math problems. And she appears to be coming up with the right answers -- in her health plan and in her education.
1402 Orchard Drive Jackson, MO