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Teen Patients Take Patience

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By MARILYN BROWN, The Tampa Tribune

Published: January 5, 2008

Updated: 01/04/2008 11:56 pm

TAMPA - Working with teenagers who ignore signs of illness and refuse to take medicines with ugly side effects was never pediatrician Jonni Klapper's goal.

She didn't even like teenagers.

"Oh, my God - they drove me crazy," Klapper said.

That has all changed.

As the only doctor employed by Hillsborough County's school district, Klapper has gained understanding and great affection for teens and their troubles.

"Once you sit and listen to them, they let you talk," Klapper said. "They're very amenable."

Her work with students is now her life, she said: "This has become my love. I could do this forever."

That would be fine with Jacqueline Allen, an assistant principal at Tampa's Robinson High School, where Klapper spends a day each week. "If we could just have more of her working with young people," Allen said. "She melts that fear a young person would have."

The secret, Klapper said, is understanding the complexity of teenagers. They are not even close to being adults in their thinking, Klapper said.

"Just because they look grown up and have grownup responsibilities may not mean their thought processes are," she said. "Their thought processes are very concrete."

For example, in middle school any threat to a student's appearance can be "catastrophic," Klapper said. Side effects of medications such as weight gain or acne mean many students shun drugs for chronic illnesses.

"They'd rather die than take it and get pimples," she said. "Accept that that's what's important to them, not the disease. Their concept of death is not real."

It Started In New York State

How Klapper grew from being irritated by teenagers to appreciating their moods and their needs is a story that started 56 years ago in Far Rockaway, N.Y.

Klapper was one of four children born to a family with two working parents. Her father was a carpenter, her mother a nurse for nearly 40 years.

That's where the tradition of caring for others' children began.

"She was always the one everyone in the neighborhood would call when something was going on with their kids," Klapper said. After her mother died last year, an old neighbor recalled a night she was called to their house and she stayed through the night - "in her fuzzy bathrobe and fuzzy slippers" to care for their child with a high fever.

After high school, Klapper followed her mother into nursing, but after two years she decided she wanted to be a doctor.

"I loved the way nursing is very nurturing - and the emphasis on communication," she said, but "I wanted to be a little bit more independent."

Klapper, with only a short, intense Spanish course, started medical school in Mexico, then transferred to Ross University in Portsmouth, Dominica, where she was awarded her M.D. in January 1981. The foreign schools were a quicker route to her medical degree than a U.S. school would have been, she said.

Medical school in Spanish "was an experience," Klapper said. Her language skills quickly improved and have come in handy. "I can still get through a physical in Spanish," she said.

Klapper moved for her clinical work to South Florida, where her parents had moved. She transferred to Tampa nearly a year later.

After taking an elective course in pediatrics, she decided to go into that field and did her internship and residency at the University of South Florida and Tampa General Hospital, where she worked with Louis Barness, chairman of the pediatrics department at USF. She also worked as a nurse to help pay for medical school.

Tampa is also where she met her future husband, Raymond J. Fernandez, a Tampa native and pediatric neurologist, and where their son, Elon, now 22, and daughter, Marty, 20, were born.

In July 1984, Klapper returned to New York with her new husband for her fellowship in community pediatrics at St. Vincent's Hospital, caring for homeless and shelter children.

"I saw a lot of teenagers," she said. "I saw kids who were involved in things that were unbelievable. Their rate of getting sick with the HIV virus was unbelievable. We didn't know what it was."

A year later, she became a consultant for Children's Medical Services, Florida's program to provide care for chronically ill children. She was also an assistant professor at the University of South Florida Department of Pediatrics.

Speaking Up For Student Health

In 1991, Klapper was hired as the physician for Hillsborough County Health Department's Healthy Student Program, then transferred with that program as medical director in 1992 when it was moved to Hillsborough County Schools.

Under that program, Klapper supervised nurses and nurse practitioners who dispense over-the-counter medications to high school and most middle school students with parental permission.

When district officials dropped the program in August to cut costs, Klapper spoke out. Pressure from school board members and the community pushed district officials to try restarting it at several schools just before the holidays as they look for more funding.

Much of what Klapper does now is continue the school physicals for any family that needs them. She also helps families find resources through school nurses and community contacts. She usually spends a day each at Robinson High, Tampa Bay Technical High, Waters Career Center, Hillsborough High and one day split among three middle schools.

Nurse practitioners split up supervision of the district's other schools, dispense medications and perform physicals, calling on Klapper if they have questions as they evaluate student needs and respond to emergencies.

Days before the winter break, Klapper gave 15-year-old Dylan Wimpee a physical, required for a baseball tryout. His father, Louis Wimpee, said it was appreciated: "He didn't have to miss school and I didn't have to leave work."

The physical showed high blood pressure, which Louis Wimpee said the family is now monitoring at home.

Of the nearly 1,000 student physicals Klapper alone gives every year, at least a third reveal a concern that needs follow-up, she said.

That could be anything from high blood pressure or diabetes to poor vision, or anemia. Recently, a high school student was discovered with diabetes.

"Some of these students have not been seen by a doctor since their kindergarten physical," Klapper said.

Klapper said she saw a student with a large growth on her thyroid gland when the girl came into the clinic for a Tylenol and a nurse watched her swallow it.

The girl's mother said she knew the lump was there but had no medical insurance. Klapper was able to get her in to see an endocrinologist with state help.

"That kind of stuff happens all the time," Klapper said. "If they don't have insurance, parents don't know where to go for help."

National reports of soaring childhood obesity, diabetes and high blood pressure are no exaggeration, Klapper said. She sees increasing problems associated with poor nutrition.

"Our No. 1 concern is the weight," Klapper said. And "access to mental health is a very big problem."

Overall, from what Klapper has learned about teenagers over the years, her advice to parents is to pay as much attention as they can to what their children eat and how much physical activity they are getting.

"Stay involved in their lives," she said. "You have to ask, you have to talk."

No matter what a child's age, parents still play the most critical role: "Kids really need them."

Reporter Marilyn Brown can be reached at (813) 259-8069 or mbrown@tampatrib.com.

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