The Connection Between Health and the Ability to Learn

    • October 16, 2015

Originally posted: February 28, 2002
Last updated: October 2, 2015

Position at time of award: Superintendent, Rogers Independent School District; Rogers, Texas

Current Position: Retired

There are not enough words to express my deep admiration of Dr. Bonds. Her accomplishments are innumerable. Within 12 feet of the elementary school you will find our pride and joy—a health center where a child does not have to miss class to see a qualified doctor. Regardless of income, they all receive the same quality care—care that some of them might not receive if it were not for Dr. Bonds.—Community Resident

Dr. Bonds believes in working collaboratively across social and economic lines to achieve a healthy community. She has, through personal grit and determination, developed partnerships and alliances with the major actors in her region in support of community health programs. Dr. Bonds has taken many risks to address the needs of her students. She placed her professional credibility on the line to garner support for her school-based clinic. She has succeeded in a strong Bible-belt, rural community, where others have failed.—Regional Hospital Administrator

Dr. Bonds has faced breast cancer and defeated death while expending energy toward her goals. She is a global-thinking individual with the ability to inspire others to achieve to their greatest potential.—School Principal in Dr. Bonds' School District

Carol Ann Bonds, PhD, was the first person not directly involved in the health care field to receive the Robert Wood Johnson Community Health Leadership Award. However, her professional experience—mostly with children in low-income schools—has made her acutely aware of the connection between health and the ability to learn.

A desire to serve. Bonds grew up in the South, the child of social activists. Thus, leadership was almost a part of her genetic make-up. "I don't remember not being a part of some cause," she says. Whether inborn or taught, her desire to serve led her into the field of education. As a young adult, she became an elementary school teacher in Houston, Texas. After a hiatus of some years, during which she helped manage family businesses, she returned to teaching in 1981, landing a job in rural Holland, Texas. In 1989, she was made principal of Holland's elementary school.

Holland, like its neighbor district, Rogers, was among the poorest, most underserved communities of rural Texas. Children at her school suffered from high rates of chronic asthma, sore throats, ringworm, scabies, impetigo, and lice. A visiting nurse came for half a day each week, but mainly to monitor immunization schedules and hearing and vision problems. Many local families had no phones, no means of transportation, and no funds to buy medicines. There was no local physician, dentist, or health clinic, so Bonds took on the responsibility—and potential liability—of transporting children and their parents to the emergency room at Scott and White Hospital, 25 miles away, where they were seen despite their inability to pay. She brought in lab specimens and picked up prescriptions, often paying for them out of her own pocket.

However, all this travel soon became too time-consuming, especially after she was diagnosed with breast cancer (from which she has subsequently recovered). She knew she had to prepare for the time when she could no longer make her special, individual efforts to help others. She also knew that all her energy would have to go toward her own health and well-being.

From personal services to a school-based clinic. So she began to cast about for ways to bring health care closer to her community. Bonds had already created several health-related programs at her school. One was a school lunch program to address widespread malnutrition among her students. Another program, covering six school districts, provided personal care for profoundly disabled children. Still another countywide program offered help to pregnant teens. And yet another provided diagnosis and follow-up for children with attention deficit disorder or attention deficit hyperactivity disorder (ADD/ADHD).

With the strong sense of her own mortality providing a driving impetus, Bonds found an opportunity to bring all these programs together, and expand the web of services offered. She discovered that the Texas Department of Health was considering grant applications for school-based clinics. Bonds wrote a proposal, together with the superintendent of the neighboring Rogers School District, for a clinic that would serve not only students but the entire community. This unusual twist caught the proposal evaluator's eye—however, the grant required that a physician be on call to oversee operations. Bonds had only one weekend to find one.

The physician she found was Michael Weir, MD, a local pediatrician with a commitment to rural health issues, and a head full of creative ideas for health improvement. Bonds' grant application was approved, and the school-based clinic was born. The grant financed two full-time nurses, a social worker, and a counselor. It also covered physicians' fees for those unable to pay, although Weir refused to take payment for his services.

But getting the grant and lining up the clinic's doctor was just the beginning. Bonds then had to win over the two school boards (giving ground over issues such as birth control while bringing them along on several other issues), get a class-D pharmacy license, set up a lab to read medical tests, and file many applications—for nonprofit 501(C)3 designation, for Medicare and Medicaid eligibility, and others. Numerous trips to Austin and Dallas were necessary, mostly during school hours. Her teachers were disgruntled, and Bonds had to mollify their anger so as not to lose staff.

Seeing the impact. However, within months of the clinic's opening, complaints melted away as the health center's impact began to be felt. The two clinics, one in Holland and one in Rogers, now serve about 50 clients per month, for a fee of $10 per visit. Those unable to pay perform community service at the schools where they read with the younger children, help to serve lunch, work in the gardens on the grounds, or wash windows on the weekends. When they opened, the new clinics were the only ones of their kind in Texas, and among very few in the entire nation, that served clients of all ages. They are now looked upon as national models for school-based health centers.

Throughout her tenure as principal of Holland Elementary, and after 1995, as Superintendent of the Rogers School District, Carol Ann Bonds was a prolific and successful grant writer, bringing in millions of dollars in funds on behalf of her district. One of these was a telecommunications grant that allowed the district's schools to become wired for the Internet. The idea began with Weir. He asked Bonds if she'd ever thought about letting kids become the change agents for the school and community, using technology as the primary tool for the change. She hadn't, but from that moment on, the two tracks—health centers and restructuring through technology—began to merge.

"That statement began our whole philosophy and vision of 'Kids as Agents of Change,'" she said later. "From that point on, we began to pull groups of kids together to try to solve problems."

Addressing community issues in groups, including elders. The health center became a center for project-based research, learning, and problem solving, while offering a wide range of activities for people of all ages—computer terminals hooked into the Internet, areas for senior citizens to do walking and aerobic activities, and a craft and quilting room. Bonds hoped the center would be a space for generations to learn from each other, thus building stronger intergenerational communal bonds. She instituted an annual competition, where students from second through twelfth grades worked in groups on yearlong projects, researching a problem in the community and trying to solve it. Each group had a senior citizen on its committee, and an expert mentor from another organization, with whom the students communicated by email.

The problems these projects have dealt with since 1994 have not all been health care related, but many are. One group researched organic farming and the effects of pesticides on health; others dealt with issues such as teen depression and suicide, the dieting habits of rural teenage girls and their connection with self-esteem, and the correlation between brain development and classical music. Still others studied the effects of ultraviolet radiation, the benefits of physical fitness, neurological birth defects related to environmental issues, the needs of the deaf, and the accelerating effects of certain herbs on the relief provided by asthma inhalers. Groups gathered data on incidences of heart disease, diabetes, breast cancer, and tuberculosis in the region. One project brought pets to visit seniors in local nursing homes, and studied the effects on the seniors. After synthesizing their findings, the students made computer-based school and community presentations on illness prevention and health care. The information not only raised awareness among students and families, but involved the whole community in health matters. The seniors who participated in Kids as Agents of Change enjoyed a marked increase in their quality of life. Their physical condition improved, and they became computer- and Internet-proficient as well. The entire community, spurred by its children, was finding the strength to solve its own problems.

One major study investigated local water quality and its relationship to the high incidence of dental cavities. It found there was a lack of fluoride additive in the lake water that provided the region's drinking water. Adding fluoride to the water has been shown to prevent dental cavities. The students shared their results with regional town councils, and some agreed to re-test the water and add fluoride to the supply. Bonds then landed a grant to cover dental work for those who needed it. This project was later featured on Charles Osgood's radio series, "Osgood Files."

The Community Health Leader Award. For these efforts, Bonds (she received her PhD in public school leadership and Educational Administration from the University of Texas in 1994) was honored for creatively integrating education and health in 1996 by the Robert Wood Johnson Community Health Leadership Award. Bonds used the $100,000, plus other funds that the award helped leverage, to build an Intergenerational Activity Center, which she felt was "the missing piece in what we were trying to do." The building is used by schoolchildren during the day, but includes space for community aerobics, organized recreation for seniors, as well as facilities for blood pressure checks and flu shots. Here, too, the seniors do much of their work with the students on their group projects.

The Community Health Leadership Award also afforded Bonds the opportunity to meet with other winners of the award at annual retreats. "They are massively invigorating for me," she reports. "They're struggling just like I am, and if they can do it, I can too." Bonds also took advantage of the Community Health Leadership Program's technical assistance and computer training. More importantly, the award gave her instant credibility with other funders and potential partners, and leverage with her local legislators and Congressman, to whom she now enjoys access.

After winning the award, Bonds expanded her health-related educational programs, particularly through the increased use of technology such as teleconferencing. Mentors now conduct weekly tele-seminars with the students, rather than just communicating via email. Bonds continues her grant writing at a rapid pace, although she is now helped by a personal assistant.

She capped her education career by serving for seven years as superintendent of the San Angelo Independent School District, retiring on August 31, 2015.

To Carol Ann Bonds, leadership is only partially something that can be taught. "I can teach you Steven Covey's 'Seven Effective Habits of Highly Successful People.' But I can't force you to have good interactive people skills. I can't force you to have a sense of humor. I can't force you to have the work ethic that the clock and the 40-hour work week means nothing to you."

Through the years, Bonds has accomplished much for her community and her students. She has faced down cancer, married and raised two children, gotten her PhD, and won several other awards. But for her, the chief reward is seeing her students, her teachers, and her community become capable of affecting improvements and changes on their own. "This is only the beginning," she says. "My dream is that we open the world to these children, and remove the health and social obstacles to their success."

Postscript. In retirement, Bonds said, she and her husband, Charlie, planned to "stay here and continue volunteer work on community boards and in our church. We want to continue to give back to a city that has given so much to us."

RWJF perspective: The Foundation recognized the first 10 RWJF Community Health Leaders in 1993—unsung and inspiring individuals who work in their communities, often among the most disenfranchised populations, to address some of the nation’s most intractable health care problems. The last round of leaders was chosen in the fall of 2012. The program closed at the end of 2014. For more information, see the Special Report.