Yesterday, we took a car ride with environmentalist Margaret Gordon on a toxic tour of West Oakland to see how community members in the East Bay are dealing with industrial pollution. Addressing those issues is critical in West Oakland and all throughout Alameda County, because diesel emissions cause major problems for the kids who live there.
KAREN HARDY: Asthma, for starters, is a very common problem, and especially common in urban settings.
That’s Doctor Karen Hardy, director of the pediatric pulmonary and cystic fibrosis center at Children’s Hospital Oakland.
HARDY: The closer that a child lives to the freeway, especially 880 where there is more truck traffic, diesel fuel, etcetera, the closer they live to that freeway, the more likely they are to have attacks, the more likely they are to have emergency room visits, and the more likely they are to need admission, and the more likely they are to die. So all of those rates are increased and they’re directly related to how many feet away from a freeway you are.
West Oakland has the highest rates of childhood asthma hospitalization in Alameda County. Dr. Hardy says many people don’t realize asthma is a potentially fatal disease. One of her patients, a seven-year-old, recently died of asthma. Dr. Hardy says in some cases, severe asthma isn’t diagnosed correctly.
HARDY: It turns out that if you look at the patients who have died from asthma, about a third of the patients had very mild asthma and they’d never even been hospitalized with asthma. Yet they have a death event from asthma. And any time that we make the diagnosis of asthma we have to make sure and educate parents about how fickle asthma is and how suddenly it can turn to be a very bad thing.
That’s what our next story is about: education. And in West Oakland, that education comes on four wheels. In the second part of his two-part series, Sam Harnett tells us about the Breathmobile, a traveling clinic that has been visiting elementary schools in Alameda since last September.
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SAM HARNETT: It’s close quarters in this children’s asthma clinic, but then again, this isn’t your typical clinic. The Breathmobile is a 33-foot Winnebago RV staffed with a nurse, a pediatrician, a respiratory therapist and a translator. Most important, it’s completely free – paid for by the Prescott-Joseph Center in West Oakland. Today, the Breathmobile is at Wilson Elementary School in San Leandro.
SPENCER WIER: OK buddy, do you remember the test? All right. Let’s do it.
MIGUEL RIO: I got a little bit better at blowing.
RIO: I got better at blowing.
WEIR: You got better at blowing? All right.
At the front of the bus, 8-year-old Miguel Rio’s mom, Janette, is talking with the
Breathmobile’s translator, James Acuna, about how Miguel has been doing with his asthma. Meanwhile, Miguel is about to take a pulmonary function test called spirometry with Nurse Spencer Weir.
WEIR: Why don’t you tell Sam what we do?
RIO: Well, we have to blow and when we blow sometimes the chicken and it runs and it has to get all the way to the red flag.
HARNETT: That takes a lot of blowing.
Dr. Jennifer Louie, the pediatrician on-board, says spirometry is a luxury they have on the Breathmobile because they spend 30-45 minutes for an initial visit instead of the 10-15 minutes allocated at a standard clinic. Just teaching children how to use the machine can take up all of that time.
WEIR: What do we do first though? Right, we want to breathe.
RIO: We put on the nose clip, and we get the air, and we get the air a little and once we are already ready, we blow.
As Miguel blows into the air tube the machine graphs his intake and exhale volumes on the screen.
WEIR: Just relax, ready? Deep breath in. Blow. Run rooster. All right, Miguel. Perfect as usual.
HARNETT: How long have you had asthma?
RIO: I don’t know, for like almost two or three weeks.
Dr. Louie tells Miguel's mother, Janette Rio, that he has been having trouble for the last two or three weeks because of pollen and the changing seasons – he has had asthma since he was four.
JANETTE RIO: The doctor and all the personnel here help you a lot understanding more, because sometimes you go to the doctor and they only have 15 minutes just to take you in. And you know, ask how he is doing this and that.
After the spirometry test, Rio and his mother take a short questionnaire together on asthma triggers and treatment.
JANETTE RIO: Cleaning products like bleach? Yes. Cats, dogs, birds.
MIGUEL RIO: No.
JANETTE RIO: Yes! Pollen,weeds and grass?
MIGUEL RIO: No.
JANETTE RIO: Yes. Lizard snakes and fish.
MIGUEL RIO: No. We don’t even have a lizard!
JANETTE RIO: I know but they don’t trigger your asthma. I used to have a fish.
The Breathmobile visits mainly low-income areas where not only pollution, but also home conditions trigger asthma attacks. Translator and driver, James Acuna, explains what they encounter driving from school to school.
JAMES ACUNA: If they are living in poor homes and have a lot of mold in their walls and the landlords aren’t taking care of business, we find that a lot. We find a lot of people in poor homes who have cockroaches, rats and mice. That is pretty common. West Oakland now is one of our tough spots.
So they teach families about small life changes such as removing a rug, dusting curtains and avoiding potential triggers like dairy and pollen.
JANETTE RIO: Do not allow smoking in the home.
MIGUEL RIO: Yes.
JANETTE RIO: Okay true or false…
Rio and his mom have both learned a lot since coming to the Breathmobile.
JANETTE RIO: You see this questionnaire? I didn’t know that bleach was bad for them. I was using bleach all the time in my house. Since I found out that maybe it was causing him the asthma attacks. You know things like hairspray, perfume. There are all the things I have been learning here that now are helping me to keep his asthma controlled. And he had been well controlled since coming here.
After the questionnaire, pediatrician Jennifer Louie brings the Rios in for a consultation.
JENNIFER LOUIE: Since we last saw him, has he missed any school because of his asthma?
JANETTE RIO: No.
LOUIE: OK, good.
Children with asthma miss a lot of school. And that’s not only bad for students, but for districts as well because they lose state funding. Dr. Washington Burns, director at the Prescott-Joseph Center, says the $515,000 cost of the Breathmobile is offset by what it saves districts by keeping asthmatic students in school.
WASHINGTON BURNS: Every time a kid misses school, the school district loses $75 – that is a per diem that the state pays. It’s $75 to $100. In Oakland Unified School Districts alone, there are 6000 kids with asthma. And the average time that an asthmatic kid is out of school is two-and-a-half days. Do the math. 6000 times two-and-a-half, times $75, comes to over $1 million, that the school district saves if we keep those kids in school. And it makes those kids more productive.
Recent data show Breathmobiles across the country lower asthmatic ER visits by over 70 percent, saving huge costs individually and for Medi-CAL and Medicare. Burns says he wants to extend Breathmobile services to adults once the pediatric program is more established.
LOUIE: Are you using your Albuterol before you play at recess every time?
MIGUEL RIO: Yes, and at P.E.
To keep Miguel Rio in school, he and his family must understand how and when to take asthma medication. Dr. Louie spends a good portion of the visit explaining how his mom should manage all of his different medicines. Then, at the end, the doctor gives Janette Rio a personalized plan for how to control his asthma.
It's time for the next patient to come in and for Miguel to head back to school. The Breathmobile is an important place for children at a school like Wilson Elementary.
The grounds are downwind from the Oakland Airport and only blocks away from the 880 Freeway. As kids empty the playground after recess, you can hear the trucks on the roads nearby and watch jets overhead as they prepare for landing. That's just part of the background noise for the kids who live here.
In San Leandro, I’m Sam Harnett for Crosscurrents.
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