By Jaymie Baxley
In North Carolina, first-time public schoolchildren and students who have moved here from other states are required to have a physical health assessment within 30 days of their enrollment. Those who don’t run the risk of suspension, which could make them fall behind academically.
The risk is heightened in rural, economically distressed areas like Duplin County, where many residents lack health insurance and providers are scarce. More than a quarter of the county’s children live in poverty, according to a 2022 study of health needs.
Duplin County has about 49,000 residents, a quarter of them under 18 years old, and only four pediatricians. Several surrounding counties have even fewer providers.
Over the past three years, medical students from East Carolina University have provided free physicals for hundreds of schoolchildren in Duplin. The effort is part of Healthier Lives at School and Beyond, an initiative launched by the university in 2016 with funding from the U.S. Department of Health and Human Services.
Originally a telemedicine program, Healthier Lives was expanded to offer in-person health screenings after the university converted a Wi-Fi-enabled transit bus into a mobile clinic in 2020. The bus now makes regular visits to K-12 campuses in Duplin, Jones and Sampson counties.
Lauren Nuriddin, a third year M.D. candidate at ECU’s Brody School of Medicine, gave an overview of the program during last month’s Rural Health Symposium in Greenville. The at-school physicals, she said, have “been successful in addressing barriers to care that the children in our rural communities face.”
Some of those barriers include “medical mistrust,” immigration status and limited access to transportation, according to Nuriddin. She said many parents are unable to take their children to a medical provider because they can’t afford to miss work.
“All children deserve the right to education and should not have to forfeit this right based on reasons beyond their control, such as not having a school health assessment,” Nuriddin said, adding that she and her classmates “know the negative impact of suspension on school-aged children, and we are committed to doing something about it.”
Effects of suspension
Nuriddin said suspension can cause several “research-proven, negative long-term side effects,” especially in older children. They may fail to graduate on time, she said, and could face difficulty “obtaining employment with a living wage” after they do.
A 2021 study by the American Institutes for Research found that suspensions had a “consistent negative effect on […] long-run educational outcomes for students.” The study was based on a decade’s worth of suspension data for middle and high school students in New York City.
Another study, published in 2022 by the nonprofit Learning Policy Institute, found students were “less likely to earn a high school or college degree” after being suspended. An analysis of national data showed that suspensions were “meted out disproportionately to Black students, Native American students, and students with disabilities,” according to the study.
North Carolina has seen a similar disparity. A 2020 report by the N.C. Institute of Medicine revealed that Black students were more likely to be suspended than their white peers.
“In the education system, children of color are disproportionately punished through mechanisms like short-term suspension from school,” authors of the report wrote. “These punishments inhibit academic achievement and open a gateway that can, in time, lead to subsequent involvement with the justice system.
“Lower educational attainment and incarceration both have long-term negative impacts on health and well-being by decreasing employment opportunities and income potential.”
While the bus physicals currently make up a small percentage of the Healthier Lives program’s encounters with students, Nuriddin said the share is growing. She hopes the service will contribute to the institute’s goal of lowering the state’s short-term suspension rate by 2030.
Seeing the impact
Nuriddin and her fellow medical students have helped more than 300 schoolchildren avoid suspension since ECU began offering mobile health assessments.
She said the effort has saved parents an estimated 330,000 miles worth of travel. It has also “increased instructional time for students who otherwise would have had to miss school” to attend doctor’s appointments.
Kristen Hall, chief officer for district effectiveness and student support services for Duplin County Schools, called the program an “invaluable service.”
“Beyond the students’ enjoyment of the unique experience of having their assessments conducted on an ECU athletic bus, our school system reaps significant benefits from this service,” Hall wrote in an email to NC Health News. “The seamless integration of the mobile health assessment bus contributes to the overall efficiency and effectiveness of our school system, ensuring the well-being and accessibility of healthcare services for all enrolled students.”
The bus physicals aren’t just helping schoolchildren, they’re “benefiting students at all levels,” according to Nuriddin.
“For public school students, reducing school suspension by completing required health assessments [results in] improved academic engagement and performance,” she said. “For medical students, providing school-based outreach opportunities in the curriculum enhances learning and engagement.”
Nuriddin described her time in the program as a career-affirming experience. She said she feels “blessed” for the opportunity to make a difference in the lives of children.
“Gaining this direct experience with children in their schools was invaluable and inspired me to see the impact I can make as a future physician beyond the clinic walls,” she said.
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