Rural Students Learn From 'Culturally Relevant' Health Program
BIG FLINT HOLLOW, W.VA.--In a three-room schoolhouse couched in a green hillside here, teacher Kathy Fawcett begins her 3rd-grade class with a song.
"Smoking's not for me; I hope it's not for you; it causes lung cancer and emphysema, too,'' sings Ms. Fawcett.
Then the class chimes in: "I won't smoke, I won't chew. Tobacco's not for me, I want my body to be well and live to one-0-three!''
Ms. Fawcett then circles the room with a oversized plastic jaw, called "Mr. Grossmouth,'' that is speckled with black cancer growths.
"Eww, that's gross,'' says one boy after examining the blackened rubber tongue on the table before him. The whole class then erupts into a chorus of moans.
This lesson on the hazards of chewing tobacco is particularly appropriate for this group of 8- and 9-year-olds, many of whom had already tried snuff at least once.
While many rural classrooms typically use health-education materials that were developed with urban children in mind, the students at Carr Elementary are using a health curriculum specifically tailored for them.
As part of a federally funded program run by the school of physical education at West Virginia University in Morgantown, local school teachers and professors jointly developed a health curriculum for K-3 classes in two sparsely populated West Virginia counties. Using materials developed by the American Lung Association, community substance-abuse programs, the American Academy of Pediatrics, and others, the educators devised a program that was intended to be "culturally relevant'' for these youngsters.
Government statistics have shown that rural children have a high infant-mortality rate, poor nutrition habits, and, as a result of their environment, often have more learning disabilities than their urban counterparts.
And though rural health programs like Carr's receive less than 20 percent of the grant money under the Education Department's comprehensive school health-education program--$850,000 of the program's $4.4 million total last year--education experts see them as potential models for other rural health-education efforts in the future.
"The [federal] program's major purpose is to provide health education to give them the skills they need to live healthy lifestyles,'' said Shirley Jackson, the director of the program.
Programs Specific to Region
The federal grants are generally used to bolster staff development, to provide teacher training, and to encourage parental and community involvement in the school health programs. But each community is different, and requires a regionally specific approach if it is to be effective, Ms. Jackson says.
In the Northwest, for example, the Northwest Regional Educational Laboratory, which runs the program in that region, developed snowmobile safety classes for Alaskan students in an isolated community. In another school, in a remote part of Montana, where doctors are scarce, they set up a young-paramedics class where students learned how to administer basic emergency aid.
Dodridge County, where Carr is one of four elementary schools, is a place where kindergartners have their own guns, and 3rd graders get excused from school to go ground-hog hunting, the teachers explain.
All of Carr's 68 students are from poor or working-class families. They are the sons and daughters of farmers and coal miners. Some of their houses lack running water, and few eat nutritious meals regularly.
All of the students at Carr Elementary participate in the National School Lunch and Breakfast programs.
Although the state has mandated that students receive one year of health education in order to graduate, teachers here say such instruction usually consists of simply reviewing lessons in a textbook and giving quizzes. The teachers felt they needed to teach health more thoroughly, according to the program's coordinator, but the lack of materials, limited time, and lack of expertise were significant barriers.
With the three-year federal grant, awarded in 1991, the project's directors selected five schools in the area to participate, based on the level of need and school's interest.
The program organizers wanted to use technology to facilitate communication between its schools, which were spread across mountains. They set up monthly interactive televised sessions to link the teachers and enable them to confer as they developed and implemented the program.
The result, teachers here say, has been a boon to the area.
"Kids need to learn that what families are doing can be basically wrong,'' says Pam Stout, a 2nd grade teacher at Carr, who says the units on the dangers of alcohol and smoking and on self-esteem were particularly helpful.
"How they apply information can save somebody's life,'' she adds. "And if you can make a difference, it's worthwhile.''
Ms. Fawcett agrees. Noting that half of her 3rd graders have their own guns, she says she is looking forward to teaching gun safety.
In that unit, a police sergeant visits the class and uses a video featuring a cartoon character to explain to children the dangers involved in using weapons of any kind.
"I can't believe the number of kids in my class who go hunting,'' says Ms. Fawcett. "We definitely need gun safety here.''
One 9-year-old boy in her class, Nathaniel Hoskinson, seems to prove that point when he proudly describes his personal arsenal to a visitor.
"I have a 20-gauge shotgun and a .22-caliber rifle and two B.B. guns,'' says the freckle-faced boy. "I go hunting with my dad.''
In addition to their instructional duties, teachers in the rural health-education program also act as surrogate nurses.
Dodridge County has only two doctors, both an hour's drive for most residents. So the teachers provide regular screenings for students on height, weight, and flexibility. They also teach units on growth and development, mental health, fitness, nutrition, and first aid.
"I'm needed here in the country,'' says Ms. Fawcett, who lives nearby.
She sends each of her students home with a hygiene pack filled with toothpaste, soap, and washcloths, and shows some of them how to wash and brush their hair.
This could never happen in an urban environment, she speculates, where parents might consider such a program to be meddlesome.
"When I talk about bathing here, they are grateful,'' she says, "whereas in the city, I'd get calls from parents saying, 'How dare you!'''
In fact, the organizers of the West Virginia program were careful to include members of the community when developing the entire curriculum.
"We didn't want to say, 'We are going to cram this down your throat,''' says Karen Douglas, a professor at the school of physical education at West Virginia University and the project's director. "We wanted them to make a commitment and give us input.''
Program's Effect Unknown
So far, it is still unclear what the program has accomplished. But the teachers plan to begin their evaluation of the project, beginning this fall.
But because of their focus and their rarity, health educators say, programs like this are likely to be used as models for the Clinton Administration as it evaluates ways to improve the access and affordability of rural health care.
President Clinton has already suggested that his health-care reform plan, which is expected to be unveiled next month, will place a strong emphasis on prevention.
"Most of the health problems that are causing problems in our young people are preventable,'' says Ms. Jackson, the Education Department official.
Learning About the Heart
Over the mountain from Carr, a class of 4th graders at Sedelia Elementary demonstrate another way the program is helping introduce health concepts to a rural population. These students are playing a sophisticated anatomy game called "Walk Through The Heart.''
A colorful plastic diagram of a healthy heart and lungs lies on the floor. Standing at one end, the teacher flashes cards saying "pulmonary arteries'' or "aorta,'' while the students, divided into teams, race to plant their feet on the corresponding part of the organ. One pair, in the heat of competition, almost capsizes on the right ventricle.
It is important, the program's organizers say, to educate children early about their bodies so that they can understand the effects of unhealthy behaviors.
"Country kids sometimes lack family structure, and the kids must learn responsibility,'' says Beverly Terlosky, the program's coordinator.
Teachers, she adds, must sometimes help to counteract the children's unhealthy behaviors. "This is about empowerment,'' she says.
Ms. Terlosky hopes that, when the televised exchanges end next year, the teachers will continue to use the materials and curriculum on their own.
For one teacher, at least, the program has already transformed her teaching. Ms. Fawcett of Carr Elementary, a 19-year veteran at the school, says she is a different teacher than she was before the rural-health program began.
"It's turned me into a more conscientious person,'' she