By Najat Abdrabbo Alyafei, Head of Oral Public Health Operations, Primary Health Care Corporation, Qatar
Services Offered by SHCs
School Health Centers will allow school children to find more comfortable access to comprehensive medical services provided by the multidisciplinary team of physicians, nurses, dentists, dental hygienists, dental assistants, pharmacists, laboratory technicians, social counselors, dietary counselors, researchers, and other professionals.
The SHCs can be established in three geographical locations, which entail North, Central, and West of Qatar. The SHC will aim to cater to school children’s needs of several public and private schools in each area. Following the introduction or establishment of SHCs, parents may consent for their children to be assessed and treated during school hours. Parents may also book an appointment with the SHCs and accompany their children.
Besides, the school health center will allow students and parents more comfortable access to a safe and appropriate healthcare environment, allowing for proper assessment of children’s health. Early assessment of students’ health status and early treatment provision will reduce the suffering and improve children’s school attendance and academic performance.
The primary services offered by SHC include emergency services, general medical, dental, and new students screening, vaccination, health museum and enrichment center, health education, student counseling services, skill training, wellness, activity-oriented health laboratory services, and Health Fair (HF). A creative design for the students’ health center has shown in Figures 1, 2.
School Students’ Emergency Services
An emergency section for school students receives all the acute cases that come either from schools at the morning school duty for urgent treatment, and transfer a patient if urgently to the emergency department in a hospital if needed, or receive other cases that may pass during the day or night.
General Medical, Dental, and New Students Screening.
General medical services will include timely first aid, different health services for common health diseases, including sore throat, fever, gastroenteritis, and skin infections. Other general services that SHCs will provide are continuous patient monitoring, care coordination, and management with telemedicine and follow up for chronic diseases, such as diabetes, epilepsy, obesity, and asthma.
Also, age-specific medical services will be delivered in the SHCs. School children will receive treatment for acute diseases like flu, dental pain, age-appropriate asthma management, and diabetes management. Other medical services available in the SHCs will be primary medical care for injuries, immunizations, and emergency cases. These general medical services will be coupled with well-equipped medical laboratories and pharmacies. Referrals and coordination may also be required, and this will be provided with other service providers, including PHCC, HCs, HMC, and private clinics. General medical services will be provided together with dental screening procedures.
The impacts of oral health problems on school time are an essential part of school-based programs because most students miss approximately 52 million hours of school time annually.
Since most dental problems can be prevented, improving preventive care services for school children is essential. The school-based health centers in an era of health care reform will provide general services ranging from oral health education to preventative oral health treatment, emergency treatment, cavity treatment, malocclusion, and treatment of other dental diseases. The medical and dental screening will be performed on all enrolled school children.
Mandatory Screening and Vaccination Services
Screening and vaccination are also the mandatory services offered by SHCs. Following the establishment of SHCs, school children get mandatory routine screening, health care assessment and developmental processes, assessment of their nutritional habits, scoliosis, oral health, vision, hearing, and mental health status. School children can also receive mandatory annual flu vaccinations and tetanus vaccination, especially for adolescents.
Student Counseling Services.
Counseling services will include confidential, personalized, and tailored programs organized by liaising with parents, school staff, psychologists, counselors, and social workers to help in the early assessment, treatment, and referral of children with emotional and behavioral health issues. The close association between teachers and students for most of the day will help identify any behaviour changes quickly.
Due to developmental stage and particular problems, adolescents are considered a select group that requires a specific counseling service. Counseling is necessary to address adolescent health issues. The teenage stage is a process of emotional stress and strain, and children at this stage are often jostling in the pursuit of their independence and the need to seek guidance.
Adolescents have the potential to make decisions than adults without taking into consideration the associated consequences. Therefore, the provision of timely support and counseling makes adolescents more equipped to cope with the anxiety of school examinations, depress prion, family-related stress, addiction to digital media usage, bullying, substance abuse, peer pressure, and other related behavioural issues.
Wellness
Wellness-based therapies will be integrated into the SHCs to provide physiotherapy, gym, sauna, swimming sessions, hydrotherapy, and aqua fitness for school children. The wellness-based therapies will facilitate lifestyle modifications and the establishment and maintenance of good health. The services will be accessed before, during, and after school hours to achieve productive health goals.
Research Center
The State of Qatar, in its research and policy agenda, prioritizes the health and wellbeing of children. In the last decade, substantial progress has been obtained from numerous researches globally. However, there are many problems in children’s healthcare that remain unaddressed. A multi-dimensional approach would help understand illnesses that affect children and identify the most optimal treatment for them. Similarly, the various risk of illnesses related to environmental, social, biological, and psychological factors need to be investigated.
Various fields may be targeted during the conducting of dedicated research on children’s healthcare. The fields include research into asthma, obesity, weight, exercise, substance abuse, addiction, mental and dental health. Moreover, performing risk behaviour assessment and incorporating the research from targeted fields may enhance the steps towards improving children’s health and wellness. At SHC, school-going children’s quality of life will enhance by focusing on developing and implementing policies and programs suitable for the health care sector.
The inception of Dental Stem Cell Bank at SHCs
Stem cells refer to those cells that have extensive renewal capacity. They also possess daughter-cell generation ability, which is then set for differentiation. Stem cell therapy in regenerative medicine is slowly becoming prevalent. To ensure that stem cell therapies and their future applications are harnessed during research into dental illnesses and wellbeing among children, researchers will need to establish a Dental Stem Cell Banking at the SHC.
Current Stem Cell Applications
Various stem cell applications are already in use in the health care sector. The illnesses where stem cell therapy has been used in treatment include leukemia and lymphoma cancers, Alzheimer’s, Parkinson’s disease, Multiple Sclerosis, Cardiovascular diseases, failure syndromes, Spinal cord injury, gum disease, failure syndromes, and cartilage repair.
Emerging Applications
Emerging stem cell therapy applications are in Crohn’s disease, kidney disease, heart attack and defects, muscular atrophy, tooth loss, cerebral palsy, type 1 diabetes, stroke, and brain injury. Also, stem cell applications are being developed for tooth loss, facial reconstructions, and jawbone regeneration.
In the future, it is indubitable that dental stem cells will lead to enhanced health outcomes in children. The potential of stem cells may make dental stem cells preferred compared to hematopoietic stem cells. Hematopoietic stem cells are harvested from the umbilical cord and can only differentiate in the immune and blood-related cells. In contrast, dental stem cells’ potential is unlimited because of their pluripotency. Pluripotency refers to a cell’s ability to differentiate into several types of cells.
The harvesting of the dental stem cells may be removed from deciduous and permanent teeth. The human exfoliated deciduous teeth are used in stem cell extractions. When dental stem cells are obtained from permanent teeth, they are extracted from the supernumerary and impacted teeth, and those that are explicitly removed for orthodontic purposes.
Stem cell viability is relatively high, regardless of when the sample was obtained. New sample stem cells have been proven to have similar viability to those extracted twenty years earlier. By initiating Dental Stem Cell Banking at SHCs, the children’s possibility of getting access to quality and effective degenerative disorder management will improve. Management of degenerative disorder management through the initiative will be enhanced by adopting regenerative therapies and their future advancements.
Activity-Oriented Health Laboratory Services
Helping school children engage in health and hygiene-based activities and exercises at SHCs is an essential way of improving their ability to learn about health using an entertaining approach. The most common activity-based health activities that school children should engage in and that make learning a fun activity are building the food pyramid, fishing for healthy food, meditation of food digestion, heart functioning, kidneys and lung functions, tooth brushing, hand hygiene, and traffic safety.
Conducting health fairs
When schools participate in Health Fairs at the SHC, students stand to benefit in various ways such as:
1. Providing opportunities for them to explore the community’s and other students’ interests in healthcare.
2. Enhancing health awareness among the students.
3. The fairs will equip the students with knowledge that they may use to educate others on health-related illnesses and disorders and the various health behaviors that may lower a person’s risk of getting poor health outcomes.
Skill training service.
Training plays a crucial role in equipping school children with the necessary and invaluable life skills. Training also aids in developing and improving communication skills, self-confidence, and teamwork among students. School administration must establish special training sessions for school children to deliver age-specific training based on the age groups.
In the training program, first aid, nutrition, hand hygiene, oral hygiene, menstrual hygiene management for adolescent girls will also be incorporated to train school children on self-care behaviors. Having fun and adding scenarios to act as one of the medical or dental professionals will attract students to enroll in medical or dental fields.
Auditorium & Health Museum
This section outlines the educational tour, health education, and Enrichment Services.
Educational tour
An educational tour is a prearranged school visit. Children visit a health museum to gain a rich immersing experience in an informal setting. In SHCs, the Health museum has a crucial role in improving school children’s awareness and educate them on health, the human body, fun facts, and games.
During the Health Museum, students will learn about various medical and dental specialties through posters and films. Also, an introduction to the first Qatari medical and dental professionals in Qatar, the history of the development of medicine, the different medical and dental tools used in the past and present.
Children will also receive health information pamphlets and leaflets for use in reinforcement after the visit. Health museums will also be available for school staff to increase their knowledge of various health fields and encourage students to join the medical field later. This museum will stimulate high school students to think about entering any of the medical specialties, and it will also show the State of Qatar’s needs for different medical fields.
Health education
The SHCs will provide an auditorium where national health and dental events will occur. That will facilitate outside learning and give educators enough space to teach school children versatile, age-specific health-related topics, including nutrition, healthy snacking, eating disorders, body hygiene, and oral health. School children will also receive education on adolescent health, lifestyle education to prevent non-communicable diseases, digital addiction and screen time, and cyber safety.
This health education aims to improve the health literacy of children. The educational sessions will also include posing children questions on health care, painting, games, and other fun activities to enhance students’ interest and attention as they learn.
Health information literature on different health topics will be made available. Besides, schools can participate in various health activities by arranging in advance to present it to other schools that will attend the educational theater at the time allotted for it.
How will the Services be delivered?
The operations of SHCs will be under the PHCC in collaboration with Hamad Medical Corporation (HMC) and Ministry of Education for both public and private schools. To ensure that all schools are adequately served, the SHCs’ locations will be distributed based on geographical ranges and boundaries. The number of SHCs in a geographical range or boundary will depend on the students, workers, and schools in the area. The auditorium and museum theater can be in one of SHCs and not in all.
Facilities within SHCs
The SHCs facility will consist of emergency services, patient reception, the triage room, general physician clinics, optometrist clinics, ENT clinics, and dental clinics. The SHCs will also have Radiographic imaging rooms, medical laboratory rooms, pharmacy, student counseling office, research center, administration offices, health museum, wellness center, activities-oriented health laboratory, and the auditorium.
SHCs Staff
The SHCs staff will involve family physicians, pediatricians, ENT specialists, Ophthalmologists, psychologists/ student counselors, and general nurses. in addition, it will involve dentist, pedodontist, dental hygienists, dental assistant, optometrist, social workers, dietary counselors, pharmacists, physiotherapists, and lab technicians. Other staff members of SHCs are radiologic technologists, researchers, lifestyle coaches, receptionists, and administration staff.
Recommendation
This paper presents an SCH design that can be used in the State of Qatar. Due to its efficacy, the SHC design may be applied in other countries to improve the health and quality of life by creating a platform for lowering infection rates and risk factors.
(The first part of the article was published in the December 2020 issue of Public Health and can be read here)
A students’ health center design for Qatar - Part 1
