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Abbie Fentress Swanson/Harvest Public Media

NOEL, MO - It’s almost 9 a.m., and Noel Primary School teacher Erin McPherson is helping a group of Spanish-speaking students complete English language exercises. But it’s tough going.

One student in a bright blue T-shirt – 9-year-old Isac Martinez – has not yet picked up his pencil. He’s clearly sick. When McPherson asks him what’s wrong, Isac’s small voice is barely audible in between coughs. He says he threw up four times last night but did not go to a doctor.