Nurses in Schools: The MOKO project

1 November 2013

The MOKO project: from itchy kutu-infested head to playground advocate

The tale of one little girl sums up for Ivy Tan the difference a school-based nurse can make.

“We had a little girl come to us riddled with kutu (head lice)… her head was down, her hair was all knotted, and she just looked miserable. When we checked her head, she had sores on her head infected from just being attacked by all these kutu.”

“So we started her on antibiotic treatment, and every day, she would come to us and we would do the kutu combing,” says Tan, one of two nurses working for the MOKO project serving Kaitaia schools.

The MOKO team rewarded the little girl for enduring the daily combing sessions with little lucky dip gifts and watched her blossom as they got on top of her kutu and sores.

“Now she’s bubbly and bouncing around. Every time we go to the school, she’s the MOKO advocate. She says, ‘MOKO’s here – whose got an itchy head’ and brings up friends and children from the playground to be checked.”

Tan says this once sad little girl not only has greater health awareness but also helps bridge the gap between the other kids and the service, and the roll-on effect is seeing less kutu infestation in the classroom.

The MOKO project also carries out skin condition checks and treatments along with regular throat swabbing and for Tan the reward is not only better health but the difference it can make to a child’s demeanour and learning.

“Having impetigo, scabies, or kutu – it’s really distracting when they are in the classroom,” says Tan.

“Actually being able to see that progress when children can actually sit and learn without scratching heads or sores [is inspiring].”

The Manawa Ora, Korokoro Ora (MOKO) project comes under the umbrella of award-winning GP Lance O’Sullivan’s Navilluso Medical practice.

The project began a year ago from a base at the old dental clinic at Kaitaia Primary, after earlier winning Ministry of Health funding to deliver rheumatic fever throat swabbing programme to initially ten, and now 14, schools in the Kaitaia area, covering about 2,000 children in all.

Project manager Lisa McNab says it also gained additional ministry funding to assess and treat skin conditions at eight of those 14 schools, but with the support of children’s charity KidsCan, delivers skin services to the full 14 schools.

MOKO has two nurses and five kaiarāhi (health workers) who work in three teams across the 12 primary and two area schools that are all within 30 minutes drive of the project’s base.

Each school has a MOKO nurse visiting at least once a week, and three times a week, they are visited by the kaiarāhi, who go into each classroom to ask whether anybody has a sore throat, itching head, or any sores they are worried about.

Using smartphone technology means the “awesome” kaiarāhi are in constant contact with the nurses and are trained to take temperatures, oxygen saturation, and can take and send a photograph of any hakihaki (skin disease or suspected scabies) they are concerned about. Tan says she also has remote access to MedTech so she can check out any patient notes or relevant history before making a decision on whether the child needs to be seen that day or can wait a day or two.

The nurses also operate under standing orders, overseen by O’Sullivan, so they can generate prescriptions for not only antibotics for confirmed strep throat but also for skin conditions like impetigo or scabies. Thanks to KidsCan – who also provide assistance like shoes and kutu treatment packs for children – the prescriptions are free.

Tan says that is one of the aspects she loves about work: being able to act and follow through if she sees a child with bad hakihaki by not only providing an antibiotic prescription, but if need be, picking up the medication and dropping it directly to a whānau that may struggle with transport. She also says that Dr Lance O’Sullivan is available if a child needs urgent attention.

Each week, they meet with O’Sullivan for case reviews and to discuss issues like whether a whānau may need support cleaning their house to overcome an MSRA outbreak or other healthy housing or family support.

Tan, a former well child health nurse, says the MOKO nurses also have good working relationships with the public health nurses, who also visit schools usually once a week, and refer on issues outside of the MOKO focus.

McNab says the ministry contract funding skin services runs until mid-2014 and MOKO is in negotiation with the district health board about continuing the service beyond that date.