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The aromatic humidifier purrs on the desk, while the Hermosa School secretary, Connie Graziano, puts her arm around the back of kindergartner Charlee Johns who talks to a nurse in Sioux Falls over the computer.

"Do you have lavender?" asks Charlee, referring to the flavor of the apparatus about to inspect her nasal cavity. 

"Lavender," exclaims Graziano. "Essential oils. That's a girl after my own heart."

The teamwork here — secretary, student, a mobile tablet computer and a nurse in Sioux Falls — is the new school nurse at Hermosa, an elementary and middle school for 220 students in the Custer school district.

Previously, they shared the full-time nurse at Custer once-a-week for three hours. Now, thanks to a grant from Avera e-care, this rural school 30 minutes from the nearest hospital, has a nurse named "Jo Jo," which the students voted for.

And the name originator was Charlee, who has come to the principal's office on this Thursday morning to see about an ailment.

"The first day it diagnosed a skin condition," said Principal Lori Enright. "In the old days, we might've had to send the child home or just tell them to put some ointment on it."

As of Nov. 1, Hermosa is the 24th school in South Dakota and North Dakota to use Avera's eCARE school nurse program. With small budgets, many schools either have cut nurses or never had a nurse. Jo Jo costs about $9 per child and works basically like a real nurse — sometimes to even scary levels.

"I've had to tell a child in North Dakota that I would not be giving her a shot," said Sheila Freed, who directs Avera's eCARE telemedicine for schools program. "I wasn't even in the same state."

The nurses — Freed oversees a team of three — are housed in a quasi-phone and health care center in Sioux Falls. They respond to students who need medication for sore throats and tummy aches that only seem to arise during mathematics.

And this relieves some diagnosing pressure from school staff playing nurse.

"It helps us keep a lot of kids present in school," Enright said. 

The machine itself — in addition to a digital screen with internet connection — comes with a photoscope, a blood-pressure reader and heart-rate monitor. An individual on campus is trained to be a handler, helping hold up the equipment to an ear or throat. 

At Hermosa, that's Graziano.

"It's just like Facetime," she said.

On Thursday morning, Charlee stood before the kiosk with an untied shoe lace and informed "Nurse Melissa" — whose smiling face filled the screen — that she was experiencing what she termed a sore nose.

"Not on the outside but the inside," the kindergartner with a rainbow colored flower headband told "Nurse Melissa," who nodded her head. 

"Well let's get that fixed," the nurse said, confidently. 

Following a quick round of questions about runny noses and after some initial checks — and a little fumbling with either a spotty internet connection or unresponsive device — the check-up aided by Graziano went ahead swimmingly. No extra mucus. No inflammation. Maybe just a little lingering soreness from a fever.

"She's a little lethargic," Enright said. "We'll probably send her home for the day."

Avera's nurse can accomplish a lot through the screen. In fact, Freed said, the magnification via the photoscope of nasal or ear cavities is an improvement upon an in-person check-up.

"There are definitely limitations," Freed said. "The very best model is to have a nurse in your school all day. We can't push on the stomach to do a palpitation exam, for example."

But Avera developed their telemedicine program to solve a seemingly impossible situation: hospitals and schools too far or too small for direct medical attention. Now, through a screen, they have that.

Approximately 20 children a day may make it into the principal's office with health complaints, but some vetting by Graziano means only two or three calls are placed daily to the nurse in Sioux Falls — even in the peak of flu season.

"It's always flu season in a school," Enright said.

But now, regardless of the season, there will be someone at the school in Hermosa to help out.

Soon Charlee's grandfather arrived in construction reflective yellow in the lobby of the school.

"She'll be OK," Enright told him. "Probably just needs a little rest. "

And the kindergartner said goodbye to Nurse Melissa and was off to grab her book bag before heading home for the afternoon. 

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Contact Christopher Vondracek at Christopher.Vondracek@rapidcityjournal.com.

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Education reporter