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Sex in the city

He's black, he's male and he's a school nurse. Ian Palmer is the new face of health education. Elaine Williams reports.

Ian Palmer is surrounded by a gaggle of giggling girls and large pieces of paper spread out on the floor covered with all the words the group can think of for sex, and male and female body parts.

He studies the words with wry amusement. "So, if you went to the doctor, would you say, 'I've got a bit of a rash on my flange', or 'I had a bit of rough last night.'" (The girls fall about.) "What words would you use? Why do we have so many words for sex?" Liz, 15, who is taking a keen interest in what Mr Palmer has to say, answers: "Because we want to hide behind them, hide what we feel about sex."

This is the King's Centre in Birmingham, a pupil referral unit for excluded children and school refusers, and Ian Palmer is its school nurse, breaking the ice as he kicks off a sex education course. "I let them write down all the words they know about sex, let them have a good laugh, get it out of their system, then we move on."

Mr Palmer, 41, black, lithe and male, is as far from the stereotypical, bosomy matron image of the school nurse as you can get. An upfront approach to sex is just one of the tactics he uses to cover the topics of relationships, safe sex and parenthood. In partnership with Jo Mawby, a teacher at the King's Centre, he has taken this course to all of Birmingham's six pupil referral units, tackling groups of boys, then girls. Once the jokey play with rude words is out of the way, he moves on to more sobering issues such as self-image and statements for discussion such as "a woman needs a man to be happy" or "all women make good mothers".

Jenny, 15, is not sure about the latter. "My mum does love me but her mother couldn't show love, and that has imprinted on her." With boys, he raises the issue of being able to say no. "A boy often feels that a girl expects him to have sex with her," he says. "It's important to be able to talk about these preconceptions."

Mr Palmer is a school nurse for special education, a pound;17,000-a-year post created two and a half years ago by Birmingham Specialist Community Health NHS Trust and which he has developed in his own fashion. He serves two schools - one for pupils with physical disabilities, the other for children with learning difficulties - and three pupil referral centres: King's for secondary-age children, and the Ashbourne and Key centres for primary pupils.

Mr Palmer says being black allows him to play a significant role in supporting disaffected boys - particularly as black pupils are over-represented among the excluded. "Many have no significant male role model in their lives," he says. "Some of them like to take the mick out of me because I am a man and a nurse, but I use it as an opportunity to discuss the concept of macho and what sort of jobs are good for a man. I like to show that there are no boundaries to what you want to be."

Emotional health, he believes, is inextricably linked to physical wellbeing. So he sees his role not only as filling in the gaps in health records for pupils who have been out of school, often for long periods, but also as building bridges between parents, pupils and their education, giving everyone an opportunity to speak about how they feel.

The conventional tasks of a school nurse - medicals, immunisation and health promotion - are all there, but Mr Palmer has developed the role, building in time to approach children "holistically". His caseload of 300 to 400 children - substantially fewer than many school nurses, who typically work with 1,500 to 2,000 pupils - gives him an opportunity to work with parents too, re-establishing the connection "between parents and their child's needs", fitting "all the pieces of the jigsaw together".

He says:"A child out of school can have a strong negative impact on the home. In some ways, giving time is the most important aspect of the job. I see myself as having a semi-counselling role. I am in a position not only to ask them about, say, their asthma, but how they feel in general and what they think they are good at.

"Giving children such an opportunity can have a positive impact. Many boys say they have no one they can talk to and that no one takes them seriously. If they believe that what they feel and say is unimportant, trust goes. I once asked a boy what he thought was good about himself, and he could think of nothing. Wanting to turn that attitude around is what drives me."

Mr Palmer worked as a children's hospital nurse in Walsall for five years before taking up his present post, welcoming the opportunity to work with children in a community setting. He says his own experiences of schooling as a black, "sickly" child in Wolverhampton have given him the empathy he needs. Asthma forced him to miss chunks of education and, because he was behind, he lost confidence and began to truant. "I left school with few qualifications but if I'd had somebody to talk to, it might have made all the difference."

He also believes in teaching by example, being around at breaktime to pass the time of day, creating time to play basketball with pupils and take part in dance lessons to show the importance of exercise. "I juggle my caseload to make this happen. I could just stand and talk to them about the dangers of obesity and lack of exercise, but if they see me joining in, getting hot and sweaty, having a heart attack; if they can laugh at me for being an old man, then we are in it together. The rapport makes them much more receptive to what I have to say."

He also tries to make teachers aware of physical issues that can affect learning. Early intervention for primary children excluded from school is particularly critical, he says. "Once they are out of school, getting them back into the system is difficult. I once did a hearing test on a young boy who had been excluded. He never seemed to listen and was very disobedient, but he was, in fact, deaf in one ear. Neither the school nor his parents had realised."

Mr Palmer hopes to create a drop-in service, where pupils or parents can come to talk through problems. He also wants to create packages, similar to the one on sex education, on issues such as bullying and obesity. His contribution is regarded as crucial by PRU managers and teachers.

Stephen Grace, head of the King's Centre, has been so impressed with the effectiveness of Mr Palmer's approach that he has bought him in for extra periods to work on specific projects or with individual pupils. "He is a good role model and uses his larger-than-life personality and humour to great effect. He always considers the feeling of the individual."

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