Mary Ann Sewell doesn't just dispense aspirin and Band-Aids.

Sewell, the school nurse at Bok High in South Philadelphia, tends to 187 asthmatic teenagers. She treats insulin-dependent diabetics, kids with cystic fibrosis, sickle-cell anemia, and seizure disorders.

As part of its latest round of budget cuts, the Philadelphia School District will lay off 141 employees, including 47 nurses, effective Saturday. Sewell and about 50 others gathered at district headquarters Wednesday to protest.

They called it "Occupy 440," a nod to the district building's North Broad Street address. The protest was not organized by Occupy Philadelphia, but some Occupy Philadelphia members joined the cause.

Losing nurses will hit students hard, and designating someone else to hand out pills in a pinch won't fix it, said protesters, who waved signs, made speeches, and chanted for about an hour.

"It's not like the suburbs," said Sewell, whose 23 years of seniority mean she will not be laid off. "It's not like these children have easy access to health care."

Even relatively well-off schools will struggle, nurses predicted.

Greenfield Elementary in Center City, which has long had a full-time nurse, will have its services reduced from five days a week to two. Peg Devine, the Greenfield nurse, said the principal will give out medication when she's not there.

"But there's nobody to listen to lung sounds, and 27 percent of my students are asthmatic," Devine said.

The protest was organized by Eileen DiFranco, school nurse at Roxborough High. DiFranco kept her job, but said she can't stomach the way the cuts are being made.

"There are so many injustices," DiFranco said.

DiFranco and others are angry that the district's Promise Academies, or turnaround schools, have fewer cuts to contend with and receive more money per student.

They also think the district is giving too much money to charter schools. But charter funding is set by the state, not the district, and it lags behind a year, so Philadelphia's cuts in state aid won't hit charters until next year.

District spokesman Fernando Gallard said the Promise Academies had had "significant cuts," including the elimination of the entire central office staff that supervised those schools, which was also axed as of Dec. 31.

Earlier this year, the district announced a budget gap of $629 million, but officials recently said they needed to slash $39 million more. The cuts protested by Occupy 440 are not the last, officials have warned.

Nurse Michele Perloff, who lost her husband to cancer five months ago and received notice she would lose her job at J. Hampton Moore Elementary in the Northeast last week, worries about what will happen to her family, which will lose health insurance Saturday.

But Perloff also worries about the students who will go without nursing services.

"It's not just about medically fragile kids," said Perloff, who had worked for the district for four years. "It's about connecting kids to resources in our community."

The district has said medically fragile students will still have adequate services.

School nurse Eileen Duffy said that's not good enough. Students need consistent medical professionals who build relationships, said Duffy, who kept her job.

In urban schools, "every child is fragile," Duffy said. "Whether they are in kindergarten or high school, this fragility is manifested in somatic complaints - be they headaches, stomachaches, panic attacks. We listen, we calm them, we send them back better than when they arrived, ready to learn."

Sharon McGeehan, a nurse at South Philadelphia High, celebrated her birthday by protesting her layoff. She marched with a stethoscope around her neck and broke down in tears at one point.

"It's going to take a tragic event - to have a child die or get seriously hurt - to see that this was a mistake," McGeehan said.

The group, which gathered for about an hour, said it would reassemble every Wednesday to protest until its questions were answered.

The teachers' union, which represents nurses, has said it would fight the layoffs.

Contact staff writer Kristen Graham at 215-854-5146, kgraham@phillynews.com, or @newskag on Twitter. Read her blog, "Philly School Files," at www.philly.com/schoolfiles.