Health Care: No Jokes This Week. Well, not many.

My principal came to the faculty with a request. She presented it at our weekly staff meeting (7:15 Tuesday mornings -- another column on that horror some time) complete with a visual presentation and a guest speaker, to present data and details. The guest speaker didn't show up, but the principal made the presentation anyway, basically because with teachers, this one's a gimme.

The administration wants to create a school based health center, a small clinic, staffed during school hours and beyond by a nurse practitioner, who could diagnose, prescribe, and to some extent dispense. It wouldn't be on school grounds, though it would be right next door, and though students would have free access to it, so would anyone in the community; it would be funded by grants and donations.One of these is up and running at the elementary school, but they would like to put another in at the high school. She requested then that the teachers act as community advocates for the health center, so that community support could be raised in order to improve the access to grants and the long-term chances of sustaining the facility.

So I'm listening to this, and I'm nodding, because -- yeah. Health care is good, and free health care is better. This community has very little health care and even less money, and you can see the results in the students. High school students very clearly represent American economic divisions, with the wealthiest class interested only in what their money can buy them and flaunting their wealth because they have very little else of real substance, and yet somehow still remaining the target of envy and subservience (Think Paris Hilton, but in the case of St. Helens, much, much fatter.), a very small middle class who are generally the most capable students and who get the best grades, and then a very large, two-tiered lower class, divided into those who have some access to basic goods and services but not enough to get them all and so have to sacrifice food to pay rent or vice versa, and those who have nothing at all. Of those groups, the top level are glowing with health, and when they have a medical excuse to leave school, it's generally a lie that lets them go shopping; the middle class students rarely if ever miss school, and if they do they make up the work. These two groups would be less affected by the clinic, though there would be a real benefit to them. More on that later.

In the lower two groups, however, the problem of health care is more serious. The upper lower class are constantly missing school for health reasons because they are constantly sick: they generally have to work to help support the family, and the hours of school and work take their toll on their health. They also tend to avoid preventive care because it costs money, and they believe it's better to just tough it out and hope you get better. Then when they don't get better, the illness is often too serious to be dealt with cheaply, and so it goes untreated. I have a junior student, for instance, who has developed migraines, and now has three times the absences of last year; perhaps that would be inevitable with the specific condition (I don't know details), but the stress of having a job on top of school has absolutely exacerbated the problem. And so a B student is now an F student with an aching head. Of the lowest class, the only health care they seem to get from their families is, "What, you feel bad? Here, have some meth." Their health is exactly what you would expect, and so is their school attendance. Of course, these students are concerned much more with survival than with school, but in those rare instances when someone has the will to escape a family's generational poverty, health can often get in the way of that escape, because the school does not make exceptions with its attendance policy: the kid who misses 30 days of school because he was passed out over a plastic bag of gas fumes gets the same response as the kid who has decent grades despite being absent for 30 days because he had to take care of his little sisters when his mom was passed out over a bag of gas fumes: both get expelled.

The ones who would benefit most from a free health clinic attached to the school is that last kid, the one who is struggling and willing to struggle, the one who has all the odds stacked against him; and perhaps just as important, that kid's siblings, who would also have access to basic health care -- diagnosis, antibiotics, first aid, and so on -- that anyone could bring the kid in for with a parent signature. But clearly, free medical diagnosis and advice would help my student with migraines, and all the others in similar circumstances: when they tell their parents that they don't feel well, and the parent says, "We can't pay for a doctor right now," the kid could say, "I can go to the clinic at school. It's free." And then, of course, there is the most important kind of medical care for teenagers (and this would be a boon to every single student at the school, and probably every middle school student who was sufficiently mobile to get down here): medical care that their parents don't have to know about. So if they are worried about something embarrassing, or they forget to tell their parents to make an appointment, or if it might possibly involve something they don't want their parents to know they do, they could go get some basic health care at the clinic, and could get referrals to other doctors if necessary, and they could do it without having to worry about transportation and they could do it without having to worry about money. And the kids would be much, much better off. Everybody would.

Back at the meeting, again: I'm nodding, trying to think of ways I could support this, hoping the administrators aren't being too short-sighted about long-term funding (always an issue with school administrators), thinking of all the students who could really use the medical attention, when the principal brings up an issue that she obviously expects to be controversial. With an air of dispensing of it before it can engender argument, and clearly uncomfortable talking about this, she says, "Of course, with any school-based health care around teenagers, the two issues that always come up are reproductive health and family planning. As for reproductive health, those . . .parts are . . . body parts, and we would provide health care to . . . them . . . just like anything else. And in the case of family planning, we would deal with that on a strictly external basis. We would refer them to other health care centers, and we wouldn't be handing out condoms or anything like that."

Full stop. This town, despite having more than 10,000 residents and acting as the county seat and business center for thousands more, has no family planning. There is one gynecologist and one of those Christian "pregnancy care" places that apply the full-body press to every pregnant woman to bear the child to term, even if the woman happens to be a child herself. The story was out this week that across this nation, 1 in 4 teenaged girls now has an STD. One in four. I have something like 100 female students (Though as an English teacher who doesn't teach honors, I skew heavily male -- the female-to-male ratio in honors English is something like 10:1. Something about girls being more mature, or something. Whatever.) which means that in my one classroom, there are 25 girls who have an STD. And though that's a national average, which means some populations have higher rates than others, this particular population is white, Christian, and poor. Guess which of those three has the most influence on early sexual activity. But let's ignore the STD's like the rest of the nation does (Because the last time I heard a story about AIDS in America was . . . ) and just discuss the teenaged pregnancies. I was describing a student who was missing school with migraines, who has missed maybe two-thirds of my English class this year; that is partly because my class is at the end of the day, so by the time my class rolls around, that kid is tired of struggling with the headache and goes home. But as bad as that makes the English grade, the kid is able to do better in other classes; this is a problem that could be managed by good scheduling almost as easily as good health care. And no, we don't have good scheduling, either. Let's compare that kid to the four students I have had in the last year who have been mothers, shall we? Easy: all four dropped out. Two came back, and one may actually be able to finish up and graduate. But the other three are simply -- gone. Which is what happens to most teenagers who get pregnant in this town: they just drop out and go to work in McDonald's, and keep on pumping out kids. You can see them walking around town, going to Wal-Mart surrounded by three little children. They are usually grossly overweight, usually smoking like chimneys, and they look twenty years older than they should. They look miserable. They are miserable.

But by all means, let's make sure that the high school's health center doesn't provide family planning. Let's make sure that the nurse practitioner cannot hand out condoms to kids who are sexually active. Let's be absolutely clear that we do not want to deal with reality, that the morality that we think we teach our children (but don't) is a strong enough shield to keep them out of harm's way.

It isn't.

It staggers my mind that in this day and age there can be an educator, a professional, educated adult who lives in this town, who grew up in this town (and don't think for a minute that I'm limiting this to the principal; she made that comment as she did because she knew she had the whole-hearted support of much of our Christian, conservative, head-in-sand [and don't think for a second that I didn't think of another place I could describe their heads being] faculty) could honestly believe that home-taught morality and abstinence only education are anything other than a joke. Because I am an educator, and a professional, educated adult, and I can tell you absolutely without a single doubt: they are not. Abstinence education only influences those who don't need it, and some of them slip through regardless. In a small town, where the clerk at the store knows your name, your address, everyone in your family, and talks to your mom at church, there is no good access to condoms. But when given the choice between sex without a condom and no sex, every single teenager on Earth who considers that choice will have sex. Maybe not the first time the choice is presented, but at some point, they will. Every time. On the other hand, when given a choice between sex with a condom and sex without a condom, while I can't say that every teenager will make the right choice, a lot of them will. A whole lot. And every one is one we save.

This is a town that teaches that the teenaged years are for fun, because after high school you need to go to work and start a family. It teaches that high school is the single best place to find that mate for life. It teaches that social life, particularly dating life, is far more important than education. The very best thing we could do for the children of this town is stop teaching these things, but that isn't going to happen, because that's what the parents were taught, and so it's what they teach their kids; the only way to break that cycle would be to move all of the kids out of St. Helens. While that's a good idea, it isn't going to happen. The very next best thing we can do is give these kids a means to protect themselves, one that works, one that is simple enough for them to understand, and one that they will, if given the opportunity, make use of.

If there is to be a health care clinic at St. Helens High School, it must provide family planning -- REAL family planning, in which all of the options including abortion are presented as genuine possibilities, and the choice is left up to the girl -- and it absolutely positively must provide free condoms, no questions asked, to any and every kid at the school. Anything less than that is a travesty, because not only is it not providing the one kind of health care that our teenagers most desperately need, but it is sending a message to those kids that sex is not a matter for health care professionals, not a matter that one should be open and honest about with adults, one that should be secret and shameful. I think our public figures have done enough to make that message clear. Let's let our educators, those who are supposed to care about what's best for their students (though it's beginning to seem to me that I, the anarchist liberal anti-establishment agitator who never even liked high school to begin with and never wanted any children of my own, am one of the very few adults that actually do care about the kids' best interests) counteract those Puritanical lies, and teach the students the truth.

Here's the truth, for those who weren't paying attention. Teenagers have sex. Condoms do not inspire teenagers to have sex, they inspire teenagers to make water balloons. Condoms do, however, give teenagers a way to protect themselves, one that they might actually make use of. Teenagers in this town, as in all towns, need and deserve that chance. It is our duty as the adults in their lives to give it to them.

So let's do it. Please, if anyone reading this is given the chance to talk about school based health care, make sure that the people you are talking to understand that the first health care that we must provide is family planning and reproductive health and that means condoms. If a school does not provide those things, it must be induced to begin providing them. If a school clinic will not provide those, it should be opposed. If we are to care for their health, we must face the reality of who they are. We should face that reality, anyway. All of us would be better off.