Reading, writing and rural health care

Published: September 6, 2024

Dufur district nurse Kamala Malcolm gleefully cuts the ribbon officially opening the Dufur school-based health center Aug. 28. School board Chair Robert Wallace (left) and One Community Health Chief Executive Officer Jennifer Griffith (center) were on hand to enjoy the fruits of years of work. (Photo by Jake Arnold, OSBA)

Jessica Crew, with her three children in tow, went looking for Dufur's new school-based health center at the district's back-to-school night late last month.

Abby, her sixth grader, has a recurring medical appointment in The Dalles about 20 minutes away, the nearest place to receive health care. Taking care of it on campus would reduce the school Abby missed and the work Jessica missed. The new building also sends a powerful message to Abby about the adults in her school.

"They care about us," Abby said.

Dufur cut the ribbon on its new building Aug. 28, a visible symbol of the central role rural schools often play in their communities. That role has increasingly grown larger as schools are being asked to meet student needs beyond academics so that all children are ready to learn when they enter the classroom.

Dufur, a remote community with stunning views of Mount Hood's eastern face, had no health care providers in town. Students often had to miss significant school time traveling for even the simplest checkups. Parents, who mostly work outside Dufur, needed to take off even more time to ferry their children.

Kamala Malcolm, the district nurse who has worked with the school for seven years, started pushing for the center after seeing a school-based health center in a documentary.

"I thought: We need this. Our kids need this. Our parents need this," she said.

School-based health centers are a growing part of Oregon's medical services and fit school leaders' goals of making sure all students are ready to learn. As of July, Oregon had 87 certified school-based health centers in 28 counties, six more centers than two years ago.

Dufur, using grants and donations but not scarce general fund money, raised a new building on its preK-12 campus a short walk from its two school buildings. Dufur partnered with One Community Health, which already operates two Oregon high school-based health centers, to provide supplies and staffing.

The school-based health center is open two days a week for staff and students. Dufur has just under 400 students and around 50 staff members. One Community Health Chief Executive Officer Jennifer Griffith expects demand for services, though, to require increasing the hours and possibly serving the whole community.

The center first opened for two days during the summer for sports physicals. Every slot was taken.

The center's services are free for students and staff, although it will bill insurance if they have it and billing would not compromise the student's medical privacy. A physician assistant will provide routine care such as vaccinations, illness care, lab work and physicals. The new building has a separate room for a licensed social worker to offer mental and behavior health care, something school leaders say students desperately need.

"The Columbia gorge is a behavior health desert," said Dufur Principal Kristin Whitley. "Having direct access for students in crisis is huge."

It took roughly three years to arrange the financing, build the partnerships and bring parents on board.

Robert Wallace, the Dufur School Board chair, said school leadership had to form a common vision with the community about what the health center would look like.

"We had some scrapes along the way," he said.

Parents worried their children might access services such as abortion or gender transitioning without parental notification.

Community meetings with school leaders and One Community Health representatives candidly addressed what sorts of services would be available, Wallace said.

Under Oregon law, children 15 and older can consent to medical services without the permission of a parent or guardian. But the center doesn't offer the kinds of major medical and surgical procedures the parents were most concerned about.

Griffith said young people need to be able to access the care they need but the center wants to create an environment where children are discussing their needs with their parents.

Kristen Nicolescu, the physician assistant, said she always has the community's expectations in mind.

"I hope I have gained the trust of the community to provide reliable and high-quality care for their kids," Nicolescu said.

Rumors ran wild, too, such as that local law enforcement would be bringing prisoners to the campus center for care.

Wasco County Sheriff Lane Magill, a Dufur graduate, came to meetings to reassure people that wouldn't ever happen. He is a big supporter of the center and attended the ribbon cutting.

"When I heard the mental health side of it, I jumped on it," he said. "Healthy kids create healthy communities."

Superintendent Jack Henderson said a lot of questions had to be answered - from the school board, from the community, from the staff, from One Community Health - before building the center.

But he didn't question the need.

"It feels like one of the building blocks of education: You need staff and students to be healthy," said Henderson. "Now it's just a two-minute walk to care."

- Jake Arnold, OSBA
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