Barb Bryson, family nurse practitioner, moves quickly from examination room to waiting room and back again, dozens of times.  She has many patients to see today.  She has many patients to see every day at the South Eugene High School Health Center, an in-school clinic that charts more than 2000 student visits a term.  She sees kids for cramps, cuts, fever, strep throat, asthma, stomachaches, toothaches, headaches (and heartaches), urinary tract infections, sinus infections, orthopedic injuries, pregnancy tests and pelvic exams. Students come through the door needing medication, physicals exams, sometimes just someone to talk to.  Some students make appointments, but many just drop in.

            Although four school-based health centers are located in Eugene high schools, all students in the district, as well as their siblings, from birth to 19 years, can receive care here -- care they might not receive elsewhere because their parents have no health insurance.  At South, 29 percent of visits in the 2003-2004 school year were from uninsured students; at the health center housed in North Eugene High School, estimates run to 44 percent. Statewide, 113,000 Oregon children, more than 12 percent of the population under 18, are uninsured, a percentage that parallels the national figure.

            Nearly half of the 8.5 million uninsured children in the U.S. have not had a routine checkup in the last year, according to a report from the Centers for Disease Control and Prevention. Uninsured children are also nine times less likely than insured children to have regular access to a pediatrician or family doctor. As the wave of low-income adults locked out of health care swells, the number of their children left uninsured rises in the wake. Many lack access to the most basic services and often rely on hospital emergency rooms for routine care, or go undiagnosed for major problems.  That’s why clinics like the one at South Eugene High School are becoming increasingly important.

            But even as demand continues to increase – the district’s four clinics had 13,000 visits last year -- funding is unstable. The Oregon legislature authorized a $2.2 million fund this year to operate the state’s 43 school clinics and a mandate to establish at least one health center in each school district in the state.  (Many schools are without even a school nurse.)  But state funds provide only a small portion of operating costs.  The budget for the clinics in the Eugene school system alone is $1.26 million.  To cover operating costs, the district cobbles together funding from school district money, state and foundation grants, third-party billing and individual donors. But, while the clinics try to maintain consistent services, the funding tide ebbs and flows. Next year will determine if the Eugene school system gets caught in the undertow when a three-year city levy is set to expire.  Unless the levy is reauthorized by city residents, the clinics will be operating on reserve funds alone.

            This morning two middle school students are the first scheduled appointments; one is getting her thyroid checked, the other needs a routine physical.  But even routine physicals can be less than routine.  As part of the exam, students fill out a Periodic Adolescent Questionnaire that asks them their medical history, about their friends and family, attitudes about school, eating habits and weight issues, and drug alcohol use. Under the section Emotions, question number 50 is easy: Have you had fun during the past two weeks? Number 51, a bit more direct: During the past few weeks, have you often felt sad or down as though you have nothing to look forward to? Then the straightforward number 52: Have you ever seriously thought about killing yourself, made a plan or actually tried to kill yourself? And finally, number 53: Have you ever been physically, sexually, or emotionally abused.

            Students take the form seriously. They tell. They reveal openly and directly. From these questions, Bryson learns her patient, a 14-year-old girl, is sad — and for good reason: Her father has molested her.  She is thinking of suicide. She is a cutter, or has been in the past, self-mutilation being a common response in girls who have been sexually abused.  Bryson would like to see her in counseling, but she is refusing. She wants to cope with her problems herself and have nothing to do with her adoptive mom, who has clamped down on the incidents of cutting.

            Bryson cannot keep the girl’s thoughts to herself.  She has to tell the mother who, it turns out, is seeking counseling to get ideas. Unfortunately, not all parents are as concerned or seek help. The week before, another girl, an early morning walk-in, asked for pain medication for a headache. Before Bryson could probe any further, the girl blurted out: “But you may not want to give it to me when you hear what happened.”