As a nurse practitioner at one of Baltimore's school-based health clinics, Pat Hauptman knows firsthand the problems caused by lack of adequate access to health care. Like other clinic officials, she also knows that contraceptives are only a small part of the school clinic story.
In recent weeks, plans to make the contraceptive implant Norplant available in school-based clinics have brought national attention to Baltimore. The contraceptive is currently provided only at a school for pregnant girls and new mothers, but criticism of the plan from some city council members and a group of East Baltimore ministers has led to two stormy council meetings and much heated rhetoric.
That's politics. But the day-to-day routine at West Baltimore's Walbrook High School, where Ms. Hauptman works, is a better gauge of reality.
The school-based clinics offer a range of primary care, including routine physicals, sports physicals, dental referrals and mental health and substance abuse counseling. City-wide, only about 14 percent of visits to the clinic involve family planning, for either males or females. There have been no parental complaints -- in large part because parent and community groups are consulted about the operation of the clinics.
No student can be seen by the clinic without a parent's consent. At Walbrook, about 850 students of a total student body of around 1,350 are signed up for clinic care.
In many cases, the school clinic is the only regular health care students receive, except for visits to the emergency room. Sometimes routine visits turn up serious problems. A girl who checked out fine in her ninth-grade physical came back a year later with a significant curvature of the spine. That would be a problem for any adolescent, but for an athletic, vivacious girl who hopes to become a dancer, it could easily mean the end of a cherished dream.
Ms. Hauptman promptly contacted the girl's mother and referred her for treatment. She set up the necessary appointments and made sure the girl got there. Now she is monitoring the case to see that the girl gets the brace she has agreed to wear in hopes of avoiding surgery.
She recalls other serious cases: The girl with a severe heart irregularity that, without the clinic, might still be undetected. The boy whose neck was bulging from a large goiter. The numerous, less serious heart murmurs and arrhythmias, many of them detected in sports physicals required for participation in athletic programs. The countless teeth decayed beyond repair. Dental neglect is a major health problem among teen-agers, Ms. Hauptman says.
Contraceptives are not new in school based clinics. And judging by the posters displayed in the clinic designed to discourage pregnancy, sex is clearly a topic that gets a lot of discussion.
It should. Last year at Walbrook, Ms. Hauptman says there were about two dozen pregnancies. So far this year, there have been fewer than 10. Ms. Hauptman says the students, girls and boys, seem more willing to discuss their sexual behavior with her than other dangerous habits, such as drug abuse.
Norplant is not available at Walbrook's clinic, but girls who are interested can get information about the contraceptive and, if they want to pursue it, they are referred to a city clinic where it can be inserted. So far, there seems to be more curiosity than genuine interest.
For girls who are sexually active and who are "committed to contracept" as clinic lingo puts it, the method of choice remains the pill. Many girls express reservations about the irregular bleeding that is one of Norplant's possible side effects.
One of the ironies of the Norplant flap is the charge that the implant will give a girl a license to be sexually active without worrying about protection against AIDS and other sexually transmitted diseases. But that is equally true of the pill. In any case, that danger is one that Ms. Hauptman and other clinic officials fight every day. "I'm pretty brutally honest with them," she says.
Students often tell Ms. Hauptman they are sure they will recognize someone who is infected with the AIDS virus. Education about HIV infection -- such as the fact that symptoms don't appear until long after exposure -- is as crucial as sermons about condoms or chastity.
Yet far more important than any sermon or service a clinic can provide is the underlying message schools send to students by making health care accessible. It is the message Walbrook students celebrated Wednesday morning in a special assembly marking the anniversary of their clinic: "Your body is your most prized possession." That is a message about much more than sex, but it is the kind of message that helps young people grow into responsible behavior, sexually and otherwise.
Sara Engram is editorial-page director for The Evening Sun.