It can be hard for people to access primary care, so we bring health care to them.
On Their Own Turf
A school-based medical clinic in Spryfield helps kids and their families access health care when and where they need it
Every morning during the school year, kids and parents climb the sloping sidewalks to Rockingstone Heights School, a primary to grade 9 school perched at the top of Regan Drive in Spryfield, N.S.
“Everyone calls it ‘The Rock,’” says family physician Dr. Karen McNeil. “The school is the heart of this community.”
Dr. McNeil works in the school’s youth health centre, which provides primary and pediatric care for students and their families. Many schools in Nova Scotia have similar centres, but they’re typically only staffed by social workers or nurses. It’s unusual to find physicians in the mix.
At Rockingstone, Dr. McNeil is joined by family physician Dr. Mandi Irwin and pediatrician Dr. Tara Chobotuk. Every Tuesday there is a family physician available in the health centre, and once a month, Dr. Chobotuk is on-site seeing patients.
“It can be hard for people to access primary care, so we bring health care to them,” said Dr. McNeil. “It’s about familiarity and already established trust with the school team that makes the health centre work.”
The clinic is providing an important service for students, parents, teachers and the broader community.
It all started eight years ago, when then-principal Steve Gallagher wanted to do something about the growing numbers of students struggling to access health care.
He teamed up with public health nurse Cindy Campbell, Dr. McNeil and her director, Dr. Joanne Zed. It took them a year to work through the red tape before they established the clinic in 2013. Drs. McNeil and Chobotuk have worked at the health centre from the beginning and Ms. Campbell remains its full-time coordinator.
It’s a familiar and safe place for kids and parents. “Families feel comfortable coming here because it’s on their own turf and they don’t have to leave their community,” said Dr. Chobotuk.
The health centre is tucked inside the student lounge and resource room near the school’s main entrance. With comfortable sofas and colourful posters, the waiting area is where kids in the lunch program gather each day.
“When a family has a need, this clinic is often the first place they go for help,” said Eva Doell, guidance counsellor at the school. “Our families are large, and parents are often overwhelmed when they have a sick child. Here, they get care faster than going to a walk-in clinic.”
Rockingstone Heights has 312 students and Ms. Doell estimates that one third are newcomers. “When I register a new family and they don’t have a family doctor, this clinic helps expedite the care they’ll receive,” she said.
Spryfield is a community in transition. “There’s always families coming and going,” said Dr. McNeil. “Sometimes, they come in without a family doctor or they have had a family doctor where they lived before, but for whatever reason they can no longer access them.”
The school health centre helps bridge that gap, shielding students and parents from an endless cycle of walk-in clinics, missed classes and missed workdays.
Parent Chrystal Malay has raised five children on her own and has visited the clinic many times over the years. “I like that I don’t have to take my son out of school for the entire day to go to an appointment,” she said. “I just take him here and then he goes right back to class.”
It was a different story with her second-eldest son, who attended Rockingstone before the clinic existed. “He had a lot of appointments at the IWK and he missed a lot of school time,” Ms. Malay recalled.
“I wasn’t able to work because of that. And when you’re a single parent and have to go downtown for an appointment, you need to pull all of your kids from school. This clinic is a blessing and I’m even able to see the doctor, too.”
When a child visits the clinic for the first time, they or a parent provide informed consent, which lets them decide which team members are part of their circle of care (teachers, administrative staff, the guidance counsellor or the social worker). This helps connect students with resources faster and lessens communication barriers among the team.
Dr. Chobotuk says the team approach also helps her gain a full picture of what each child is facing. “A teacher will pop down before a student’s appointment and fill me in about their situation,” she said. “It’s a lot easier to gain input from people who know what’s going on and what’s needed to address their needs.”
Many students and families are grappling with the social determinants of health. “Limited income and social supports, and challenges in the physical environment,” said Dr. McNeil. “These factors can lead to health inequities. Having health-care access simplified is a leg up that makes things more manageable.”
Equally important is meeting people on their own terms when it comes to the treatment that’s offered. “We try to customize care for what’s possible for them,” Dr. McNeil said. “They may not be able to do everything we want. They may not have transportation to go for blood work, for example. We problem-solve a lot and do our best to elevate people and support them.”
Working with patients and their families to find what will work best for them is what Dr. Chobokuk enjoys most about Rockingstone. “When a patient is struggling with something like undiagnosed ADHD, it affects their whole life,” she said.
“I can make suggestions that result in positive changes, which lead to better behaviour at school and at home, and better relationships with everyone. They can take off the pressure and enjoy life more.”
Finding solutions and building relationships with her patients is gratifying for Dr. McNeil. “It’s rewarding to help people navigate the health care system, use the resources in our community and have positive outcomes,” she said.
“It’s all about the relationships with patients. They teach us so much.”