School-based medical care will make trips to

the doctor easier

on families.

WEST FAIRLEE, Vt. (AP) – As a retired pediatrician living in this hilly, remote community, Dr. James Hughes knows what a conscientious parent with a full-time job has to go through to take a child to the doctor in the middle of the school day.

There aren’t many jobs around the four towns of the Rivendell Interstate School District, so many parents work far away in Lebanon or Hanover, N.H., or in Bradford.

If called to pick up a sick child, they must leave work, drive 20 or 30 miles back to the school, drive another 20 miles away to the doctor, and then repeat the process.

For someone on an hourly wage, that trip is a hardship.

“There’s a real time cost for getting primary pediatric services,” said Hughes, who is leading a drive to build a clinic at the school in West Fairlee to help make pediatric services more accessible. “They can miss half a day of work in going to the doctor.”

Hughes is an Idaho native who bought land in Vermont in 1959 before graduating from medical school, and moved to West Fairlee for good in 1997. He took to small-time life right away, getting himself elected justice of the peace and president of the town historical society.

His latest project is the Kimball House School Based Health Center Corp., a proposed pediatric clinic and dentist’s office that would be built in a vacant 150-year-old home on the grounds of the Westshire Elementary School in West Fairlee.

The clinic would be similar to one at the Molly Stark Elementary School in Bennington, which offers pediatric health and dental services. Clinics at the Lawrence Barnes and H.O. Wheeler Elementary schools in Burlington offer physician services now, and will offer dental care as well in September, said Burlington Superintendent Lyman Amsden.

Right now, the Rivendell school district, which includes the towns of Vershire, Fairlee and West Fairlee in Vermont and Orford, N.H., is starved for primary care health services, said Hughes and other people who are working on the project.

The 40-mile-long district has a population of about 3,500 residents “and there’s not a physician office in it,” Hughes said. The nearest full-service pediatrician is 17 miles away, in Bradford; the nearest dental office that accepts Medicaid is also 17 miles away, Hughes said.

Because it’s so difficult to get to, many parents put off preventive care, said Noelle Vitt, superintendent of the Rivendell district.

“The sore throat that needs looking at, routine immunizations, often just don’t get done because it’s difficult,” said Vitt. “Not because parents don’t care, but it’s a hardship.”

School officials see that need when they ask parents at the beginning of the school year who their primary care provider is, said Principal Joe Greenberg: Many families say they don’t have one.

The area has vacationers and second-home owners, but it also has a large population of families supported by relatively low-income hourly workers.

“It’s basically a population of people who are lab techs, lab secretarial staff, maintenance people, housekeeping – folks who go down to work” at Dartmouth Hitchcock Medical Center in Lebanon, N.H. 22 miles away, Hughes said. When they miss work, they don’t get paid.

The clinic organizers have started out by acquiring Kimball House, a 35,000-square-foot, 11-room home built in the mid-19th century.

Long unused, the building is furnished with odd bits of furniture, some posters from the 1970s and an out-of-tune grand piano. But Hughes was proud and expansive on a recent tour, making a special trip to the basement to point out the foot-square granite posts that hold it up. He was enthusiastic about bringing life back to the old house.

Outside, children’s voices floated over from the Westshire playground.

The clinic’s planners are still choosing from various options for the property, and the home itself might end up being used partly for elderly housing, with an addition holding the clinic. Elderly housing is another strong interest for Hughes, and a pressing need in the area, he said.

Right now, though, he’s focused on the health clinic. He envisions the center offering pediatric services first because that’s his lifelong career interest; because he sees the need; and because it’s relatively easy.

“Kids in Vermont are so well insured that it’s easier to start this kind of program in Vermont than it is in a good many states, and it’s a heck of a lot easier to start with kids than in adult care,” he said.

Services would be offered three days a week, from 3 to 6 in the afternoon. Hughes, who doesn’t practice medicine anymore, already has a provider lined up: a nearby pediatrician who has agreed to drive to the clinic.

The plans call for the clinic to provide the space, and the providers – which will include at least one nurse practitioner – to bring in all the elements of their practice, such as their records systems and their malpractice insurance.

The whole project is expected to cost about $350,000, which Hughes said he’d have no trouble raising from public and private grants. The house, which the group is in the process of buying, cost $70,000.

Among other things, the American Academy of Pediatrics has donated $500, and 60 individual donors have given more than $22,000. An architect and structural engineer are donating their time for the renovation, and legal services and contracting services are being donated at cost, or at minimal cost, said Hughes.

A family foundation in New Hampshire gave $20,000, and United Way of the Upper Valley in New Hampshire gave $5,000.

The clinic would also include mental health services from social workers, said Vitt. And recently, organizers have started talking about adding a dental clinic as well, with a dental hygienist who could do preventive care.

Only 43 percent of children on Medicaid in Orange County saw a dentist last year, Hughes said – below the state average of 47 percent.

“There is an even greater need for dental services than there is for medical services, and the state is very much encouraging us to look at that,” Hughes said. “There really are no dental services right around here.”

Supporters see the completed clinic as a place that provides local care – and therefore better care.

“There would be a perception of security and trust if there were a local health care provider here,” said Greenberg.

AP-ES-05-18-03 1515EDT