School district’s medical clinic offers a lifeline for families
Southwest ISD site in area at higher risk of serious problems
Adriane Garcia treats two dozen patients a day, mostly from her computer screen, inside a small school-based clinic on the outskirts of San Antonio.
But at the end of the day, it can feel like so many more because patients on the video calls usually ask for medical advice for other people in the household: parents, siblings, children.
“They’re not on the appointment,” Garcia, a licensed physician assistant, said during a quick pause between patients at the Southwest Independent School District clinic. “But it’s in regard to the entire patient, so that means treating everyone else that has been affected. I’m doing this with every patient, so it puts me a little behind. There’s nights where we stay until 7 or 7:30.” The doors close at 5 p.m. The clinic is run in partnership with University Health, which also has two clinics in San Antonio ISD and one in Harlandale ISD. University Health is working on adding a clinic in Edgewood ISD and two more school-based clin
ics on the North Side.
At the Southwest ISD clinic, Medical assistant Crystal Casias was putting on a gown and preparing a cart with supplies before meeting a patient in the parking lot. That’s how the clinic conducts COVID-19 swab tests — through the car window.
Garcia said these are ways the staff has had to adjust to the pandemic. “We’re trying to keep the clinic as safe from COVID as possible,” she said.
Most of the people who work in the clinic graduated from Southwest High School. Garcia is one of the few who didn’t, but her husband did.
Casias lives in Natalia, a small town 20 minutes away. Her mother works for Southwest ISD, and her son goes to Southwest Elementary.
“This is more of a home to us. Not just work,” she said. “I do anything I can for this clinic.”
Since opening in 2015, the Southwest ISD clinic has served as a lifeline for students, faculty, staff and the surrounding community.
Business Operations Manager Elizabeth Manrrique said University Health does this by providing patients access to affordable, convenient medical care services where there were none before.
Many patients qualify for University Health’s financial assistance program, called Carelink, which helps offset the cost of needed medical care for Bexar County’s most vulnerable residents.
“We just try to work with the family as best as possible,” Manrrique said. “So we figure out what their needs are, and then see what kind of visit they truly do need so that we can get them the care they need at what they can afford.”
Over the past year, the clinic has become even more of a resource for the school and its nurse as they deal with COVID-19 transmission and infection control requirements on top of the usual health concerns such as vaping, depression and teen pregnancy.
School administrators and the nurse have Manrrique’s cell phone number and meet often to try to stay ahead of troubling trends.
Long before the coronavirus arrived in the U.S., people living in this part of Bexar County had been at higher risk of serious health complications resulting in shorter life spans.
The federal government designates this area near Southwest High School as a place with a severe shortage of primary care professionals, noting most of its population has a low income.
More than 84 percent of students are economically disadvantaged, compared with 60 percent statewide, according to Texas Education Agency data.
Students from this district are overwhelmingly Hispanic — more than 90 percent identify as being of Latino descent — much higher than the county’s 61 percent.
Latinos are more likely to die from diabetes and poorly controlled high blood pressure than non-hispanic white people. This population is also more likely not to have health insurance through an employer, and those who do more likely can’t afford to use it.
Those are some of the reasons the school district partnered with University Health, the county’s hospital district, to build the clinic on the edge of its main campus, just off Loop 1604 on the Southwest Side.
Teri De La Haya, University Health’s senior vice president of community health and clinical services, said the health system initially collaborated with school districts for onsite clinics using federal funds available through the Delivery System Reform Incentive Payment program.
The health system’s first schoolbased clinic was with Harlandale, then Southwest and Southside ISD clinics opened; however, Southside has since struck a deal with a different provider.
Once these federal dollars dried up, De La Haya persuaded University Health officials to keep these partnerships going as an investment.
Outpatient clinics are not usually profitable, but she advocated to keep the clinics running because they help prevent illness and disease among county residents who would otherwise likely show up in emergency rooms needing costly care.
Typically, a school-based clinic is open to current students, then their siblings, then the school staff and lastly the general community.
The health system’s deal with Edgewood ISD would follow a different model, serving its employees before its students. The plan calls for recommissioning a clinic on Old Highway 90 into a health center for employees that would eventually serve students and then the entire West Side neighborhood.
“The reason for that is because Edgewood wanted to provide more preventive health services to their own staff to get them to be a little more proactive in their health,” De La Haya said. “They’ll be able to be checked for chronic health conditions more frequently, and having a clinic that’s accessible to them is very critical. That’s an attractive offer to provide those services for your staff or even cover the co-pay for their visit.”
School-based health centers first opened up years ago in Northern states, and there’s robust evidence showing that regular child well-visits and vaccinations keep students in school.
The Southwest ISD clinic has been a lifesaver for many.
Medio Creek Elementary teacher Amanda Gonzales said her oldest son struggled with severe asthma, which caused him to miss school for sick days and medical appointments.
It wasn’t until they saw Garcia at the Southwest ISD clinic that they were able to find the right treatment, a preventive inhaler.
Since then, Gonzales said, she’s relied on the clinic and Garcia as a trusted medical provider to keep her family of four healthy — including through a spate of the coronavirus.
The family lives and works outside San Antonio city limits, but they never have to travel far for a same-day medical appointment or annual flu shots.
Growing up, that wasn’t the case for Gonzales’ mother, who also worked for the school district. Any time they had a medical appointment, they had to miss a day of school.
“The best thing is that when I’m sick I can get an appointment the same day with no issues, and I can also go during my conference period,” Gonzales said.
So in January when the entire family came down with COVID-19, she knew who to call.
Her husband and their boys had mild symptoms, but she was knocked back.
Health researchers say the COVID-19 pandemic has only further driven a wedge between those who can afford to take a sick day and those who cannot.
“I had the worst headache of my life,” said Gonzales, 35, recalling how even walking and breathing became difficult.
At the school clinic, Gonzales was given a free pulse oximeter, a device she placed on her fingertip to monitor her heart rate and oxygen saturation. That’s how she knew when it was time to go to the ER.
The kindergarten teacher who previously was in good health and loved to exercise found herself hospitalized for three days and then out of work while she recovered.
“I finally was able to wash dishes and do a few loads of laundry. I’m able to kind of slowly get back to normal. Even right now, it’s difficult to talk, but I’m on the end of it.”