Meg McLaughlin is the director of health services at Middlesex School, a day and boarding school for grades 9-12 located in Concord, Massachusetts. In this spotlight, McLaughlin shares her story and discusses her philosophy about creating a schoolwide plan to combat COVID-19.
Response: Can you tell us about your path to public health and nursing?
McLaughlin: Well, it’s a long path because I’ve been a professional health care provider for over 30 years. I graduated from college with a nursing degree and then went on for a master’s as a nurse practitioner, then added on a master's of public health as well. I’ve done a lot with different patient populations, from home care to urgent care to working in colleges and even working overseas in Bolivia for over 3 years as a clinician.
When I returned from being overseas, we had two young children, and I was looking for something to ease my transition coming back to the US. I took a job at my children’s elementary school and found that I really liked it a lot more than I had anticipated. So that’s when I started looking for a position where I could work as a nurse practitioner within a school setting, which eventually got me to Middlesex.
It was really the experience overseas that got me interested in public health.
What was your original inspiration for pursuing health care?
Growing up, my parents had a lot of health problems, and as a child I thought I could make a difference. I saw so many problems that are preventable, and to me, it felt like such an important way to give back to the world. The US health care system functions as an intervention model and not on a model of prevention. More and more as a nation, as we see how important it is, we’re moving in the right direction toward models of prevention, but quite slowly.
What would you say has been one of your proudest moments?
I have so many experiences where I feel like the work that I do has a great purpose and meaning for me and others. Some of the most inspiring moments I’ve had have been in hospice care. And even though that’s somewhat antithetical to my previous point on prevention, it’s a moment where you can engage with people in some of the most important times of their lives. The dying process is a really special and unique one, and to be invited into that process in even a small way is a really, really special and memorable experience.
My experience overseas was also incredibly impactful. It was a time in my life when I really began to understand how health care systems could work in an entirely different way than the US. Bolivia is a poorer country than the US, and so they have fewer dollars to spend on health care and are forced to look at health care from a very different lens. It’s not a business enterprise. It’s a system to reach as many people with the biggest impact interventions.
I was brought there to open up a health center and see patients like we do here, but inevitably when you’re involved in a community, as well as seeing your patients, you’re also going out and treating babies in a day care for parasites, or you’re offering nutrition programs for pregnant women or vaccinating dogs in the neighborhood for rabies.
There isn’t such a premium on the patient-doctor office setting.
How would you say you’ve applied what you learned in Bolivia and your master’s program about public health to Middlesex?
The experiences that I have with students individually inform the work that we do as a school in terms of community wide programming and communication.
It is so important for me as the health director to be on a number of committees involved in doing that sort of programming, so that those individual experiences can help direct priorities and meet kids where they’re at. If we think the most important health issue is nutrition then we can create a program around that, but if those aren’t the issues I’m hearing and seeing on the ground, then maybe we’re spending a lot of time and energy on something that isn’t what kids are needing to hear about. One informs the other, and it does help me think about prevention.
With the COVID-19 pandemic, obviously this year is different from other years. How have you been able to apply lessons on prevention to life at Middlesex?
Certainly this isn’t the first pandemic we’ve dealt with as a school – we’ve had H1N1 and other threats. None to this extreme, but certainly we’ve had to manage different infectious disease outbreaks. Every year we struggle with the flu. And so there’s a certain amount of teaching, education, and community engagement that we have to build into every pandemic plan. And that’s definitely even more relevant right now, and we’re seeing it across the country. I’ve always said in my annual presentation to the kids that washing your hands is a public service. Wash your hands for your friends. Cover your coughs and sneezes for your friends. Get a flu shot for your friends. Don’t just do it for yourself, but also do it for the community.
We do things not only to improve our own health but also to be good community members and supportive of the entire community’s health.
Specific to this pandemic, one of the challenges is that there’s been such little guidance. Guidance is starting to come now, but it’s a little late to the game for schools. And so we as a school have been meeting, planning, talking, and figuring things out since March. We’ve had to take the principles of public health measures as they relate to a virus like this and apply them to our community in a way that we can implement. And these details are going to be different to every community that needs to implement them. Who they’re composed of, the dynamics of the parent population, students that may not have digital access – there are so many things for communities to figure out.
One size does not fit all. We have certain standards that we need to meet, but they’re going to be actualized in a different way depending on the community that you’re in.
I'm grateful that I’m not the only one that needs to figure this out. We have a team of 15 administrators all coming at it from a different angle and perspective. So if I say everyone needs to be 6 feet apart in the classroom, I can have teachers challenge that and say, “This is going to be difficult---what kinds of structural and technological changes can we make to make this work?”
A pandemic like this affects people in so many different ways, and so bringing together voices across disciplines is crucial to fitting a solution to your scenario.
Definitely, and it’s incredibly important that these solutions are coming from a unified administration. If just one person is writing and imposing guidelines, it’s difficult to hold people to those standards. Everyone has to buy into not only why it’s important but also how it’s going to work. How are we actually going to ask people to follow these guidelines?
To make things more challenging, there are always going to be people who can’t reasonably do something. So you have to be firm and clear about what’s needed and expected, but you have to be flexible when something just isn’t possible. To do that successfully, you need a lot of people to not only have a high conviction about the requirement, but also patience and empathy to deal with those who legitimately have a lot of obstacles even if they’re trying their hardest.
What would be some other challenges you’ve been facing in the health center as you anticipate students coming back on campus, and what advice would you have for other health directors?
There are so many issues. A lot of schools are struggling with the balance between having kids arrive and then trying to prevent them from going anywhere – where they try to seal themselves off to decrease exposure to the community. We are trying to find the right balance because we are not entirely a boarding school. We have a lot of day students, and that number has only been increasing as we try to safely house fewer students in dorms. And so we can’t exactly seal ourselves off from a population that we’re grateful for – our day students. We have to be accommodating while also imposing some restrictions on kids who want to go to club sports or an arts competition.
You need to find the perfect balance of accommodation and restriction. We have to thread that needle over and over again as we discover new dynamics in the pandemic and new points of tension for our student body.
Keeping on the topic of challenges you’ve faced with COVID, what challenges did you experience in trying to find PPE before you found Response?
Most of the schools have suppliers that they’ve used for years, and as it became clearer that PPE was going to be limited, I started looking for suppliers but quickly was frustrated by market forces. The price inflation. As more companies started to come online, I thought that the prices would rebalance, but I also just had to secure the products for our needs. And so it felt like I had to wait a period of time and then act, but it wasn’t easy to know when that would be. And so I found myself stressed and anxious about finding supplies no matter what the price is.
That was the tension point for me and Response was helpful in that it was a singular place that I could go to for comparative information. And without Response, it’s labor-intensive to go from one website to another and compare and contrast. And you don’t truly know what you’re getting and at what price based on the quantity you’re ordering. It became very challenging.
While I didn’t have a specific budget just for PPE, when you’re looking at the total impact of this pandemic on the bottom line of any school, you have to worry about every single thing. Everything costs a lot – the people, the testing, the supervision, and the PPE. And so at first, you can’t just say, “I’ll pay whatever it costs.” Ultimately, you make that decision if you have to, but no one wants to do that. Money isn’t endless.
At the end of the day, no one likes to get price gouged, but sometimes you just need to buy anything you can, and that puts buyers in a really tricky situation. Unfortunately, there are sellers that take advantage of that, and so we’re happy you found Response since we’ve had such a strong focus since day one on making sure people don’t get scammed. Even if you found PPE at the right price, how did you know who to trust?
That’s a great question because when you’re not using an established vendor, you don’t know if you’ll get supplies at the quality that you expect. And as I mentioned, it was labor intensive to go through sites, make an inquiry, either hear back or not hear back.
With cloth masks as an example, I didn’t work with Response, and there are a lot of companies that have been changing their operations to produce these masks, and so many companies were trying to solicit our business.
The way to separate the wheat from the chaff was to ask everyone to send me a sample. If people said, “We can’t do that.” Then I said, “Forget it.” And so it was mind-boggling to me that companies would reach out asking if I would buy 5,000 masks, and when I asked them to send me just one mask they said, “We can’t do that.”
With Response, I could find products that actually met the needs that I was trying to meet and find PPE at the right price and quality.
Meg McLaughlin is the director of health services at Middlesex School, a day and boarding school for grades 9-12 located in Concord, Massachusetts. McLaughlin holds a bachelor's in nursing from the University of Pennsylvania and a master's in nursing from Boston College. As director of health services, she oversees health initiatives and strategy for a student body of over 400.