She had a hole in her heart, which made it difficult to breathe, let alone go to school and learn. Only, nobody knew about the hole. Nobody sensed a thing last March, because Devon Southard's family, lacking health insurance, couldn't afford the doctor's visits she needed.
So, without a clue, her mother sent the 9-year-old off to school in Fairfax County nearly every day and waited for her child's coughing and wheezing, which she mistook as symptoms of a sore throat and allergies, to run their course.
They didn't, of course. Last spring, Inova Health System and its partners were searching for children who had fallen through cracks in the health care system, as part of a much-ballyhooed new program. But they had not yet discovered young Devon Southard, whose ailments, and her family's financial woes, epitomized everything the Inova group hoped to remedy.
Devon's mother had begun wondering whether the child might have asthma. Periodically, she would lean back in her desk in her third-grade class, gasping audibly, struggling to breathe.
Margaret Meath, her teacher at Saratoga Elementary, remembers: "She didn't miss much school. She'd really try, but she was just so without energy that she had problems concentrating."
A note was finally sent home: Please take your daughter to the doctor.
Devon's mother, Kymm Shifflett, immediately complied, hoping against the odds that her ex-husband was carrying her three children on his health insurance policy. He wasn't, and Shifflett, a waitress who was making too much to qualify for Medicaid but not enough to afford private health insurance, soon found herself stuck with a doctor's bill that she struggled to pay.
Turning to Saratoga school administrators for help, Shifflett was put in touch with officials at Inova who, the year before, had spearheaded a public-private program to identify Fairfax children without health insurance or a family doctor and link them to physicians and available coverage.
The program, known as Partnership for Healthier Kids (PHK), paved the way for Devon to receive insurance and, ultimately, the surgery to repair her damaged heart.
"The operation by itself would have cost us tens of thousands" of dollars, Shifflett said. "We couldn't have even paid for the cardiologist's consultations, which were like $250 apiece."
Partnership for Healthier Kids debuted in spring 1998 as a pilot program at Braddock Elementary School, which serves an inside-the-Beltway section of Annandale where 26 languages are spoken. Braddock officials gave PHK coordinators the names of parents who listed neither a doctor nor an insurer on their school registration forms. Inova, working with the nonprofit Northern Virginia Family Service Organization, then contacted 86 uninsured families, eventually steering more than 100 children toward medical care--about 18 percent of Braddock's student body.
Buoyed by those results, Inova expanded the program this school year to 50 of Fairfax's 133 elementary schools, giving an additional 1,659 children access to health care. Inova's funding has been supplemented by PHK's corporate and philanthropic benefactors, including Mobil Corp., the Virginia Health Care Foundation and the Campbell Hoffman Foundation.
On the heels of Fairfax's success, Alexandria school officials have expressed interest in a pilot PHK program, prompting Sherrie Smith, director of PHK at Inova, to say, "We think we'll be helping more than 2,000 children in Northern Virginia this year and many more in the years to come."
The poorest families are eligible for Medicaid. Others, such as Kymm Shifflett's, can obtain health coverage from the federal Children's Health Insurance Program, which assists states that offer health insurance to uninsured families ineligible for Medicaid.
Partnership for Healthier Kids is a response to the escalating costs of uncompensated care and untreated conditions that can spawn lengthy, more expensive hospital visits. "Sure, we'd like to keep kids out of emergency rooms," Smith said. "But the paramount reason is that the community has a responsibility. How can a child succeed if not healthy?"
Shifflett asks herself that same question these days. "I'm just amazed when I think how long Devon went without care," she says of her daughter, who recently turned 10. "But the scary thing is we might never have gotten the care if it wasn't for the program coming in when it did. She can breathe now--even do PE. She's finally a student like everybody else."
CAPTION: Devon Southard had surgery on a heart defect detected through Inova Health System's Partnership for Healthier Kids. Her mother, Kymm Shifflett, is at left.