By Thomas Gase
|
The first thing you feel is a tightness in your chest.
The next thing you feel is dizziness and a slight wheezing, but only you
can hear it, kind of like when you have a cold and the nose makes a whistle
sound that only gets louder and louder. As the wheezing starts to get
louder the next thing you feel is embarrassed as everyone in the room
starts to look around and wonder what is wrong with this person. It feels
like someone is putting their hand over your mouth and you are just trying
to find a break between the fingers so you can breathe. But that break
never comes." |
-Stacy McKenzie, on her last asthma attack two months
ago. |
The Community Health Epidemiology and Disease Control in the San Francisco Department of Public Health defines asthma as a chronic inflammation of the airways leading to narrowing of the airways in response to triggers. The bronchial constriction causes the symptoms of asthma that can include wheezing shortness of breath, and a chronic cough in the absence of a respiratory infection. Chances are you don't have to tell this to anyone in the Bayview Hunters Point. They already know.
The national average for people with asthma is 5.6 percent according to San Francisco health agencies. A community survey conducted by the Health and Environmental Assessment Taskforce in 1999, found that 10 percent of people have asthma in the Bayview Hunters Point. Someone has asthma in the Bayview Hunters Point about as often as Barry Bonds hits a homerun.
What is more alarming though than any Bonds tape-measure shot into the bay is the percentage of children with asthma in the Bayview Hunters Point, which stands at 15.5 percent, or 1 in 6 children. According to the Asthma in America Survey Project, the rate of asthma has more than doubled since 1980 to affect more than five million children in the United States, leading to the death of 600 children each year across the country. In the last six months, two children have died from an asthma attack in the Bayview Hunters Point. The last one was 14.
"With the technology we have these days, nobody should be dying at 14 of an asthma attack," said asthma educator and chair of the Asthma Task Force, Veronica Lightfoot.
The rate of asthma in children less than 5 has risen by 160 percent in the past 15 years. Based on a national estimate, 1.8 million Californians have asthma, including half a million children. As one of the most common chronic conditions in children, asthma is a leading cause of school absences and hospital admissions for children.
In fact, asthma accounts for 10 million lost days of school missed annually. The estimated cost of treating asthma in those younger than 18 years of age is $3.2 billion per year.
The estimated annual rate for emergency room visits among children under the age of 5 is 137 per 10,000- the highest of all age groups. Asthma is also the number one cause of hospitalization among children under 15 and it is the first-ranking chronic condition. It is the leading cause of school absenteeism attributed to chronic conditions. The people of Bayview know this already because it's worse there than just about anywhere.
Many factors can be attributed to the cause of such high rates of astbma in the Bayview Hunters Point. One is that there are many toxins in the air that surrounds the neighborhood. The area has a high concentration of facilities that currently produce air pollution including two power plants, most of the city's diesel refueling sites, and a sewage plant that processes 80 percent of the city's wastewater. The area has 20 of the 39 pollutants measured by the Bay Area Air Quality Management District. This is the highest concentration of any in the Bay Area.
The city seems to have this on its mind as well. In the Community Survey, respondents from households with one or more members who had health problems thought to be related to pollution were asked what types of pollution they believed were to related to health problems. Ninety percent of respondents blamed air pollution. Fifty-seven percent of the households reported environmental exposure to exhaust within one block of their home was the culprit.
"When we first moved out here in the late '60s and early '70s there was a bad stink in the air. I just knew that there had to be some kind of toxic waste in the air. I mean it just wasn't an ordinary smell," said Ernestine Howard, a Bayview resident.
Social factors also contribute to the high rates of asthma health experts say. There is no hospital in the Bayview Hunters Point, just a small clinic. Some parts of the neighborhood require three buses to get to a General Hospital, and those lines aren't always reliable with their times. The quality of the housing facilities in the Bayview Hunters Point isn't the greatest either. Roaches have been shown to be a significant asthma trigger along with mold spores and dust mites, all prevalent in the area's sections of under-maintained and older housing.
Tobacco smoke is also a contributor. According to the Community Survey, 43 percent of households reported that one or more of their members smoked. "You have all these houses with second hand smoke and then you combine it with all the violence going on in the area.
"You have people so scared of the violence that they are keeping these kids inside with no windows open," said retired school nurse Marie Hoemke. "With all the smoke floating around this can't be good for the health of these people."
Hoemke knows all to well about what may be the biggest factor contributing to the high number of children with asthma in the Bayview Hunters Point. She became a nurse in the district in 1965 and stayed there until retiring in June of 2002. She says the way nurses dealt with the children when she started has drastically changed.
"Prevention was the big thing in 1965," she explained. "We knew the families and sometimes were even invited to their houses. We got to know the families, we got to know the children, and if they had any illnesses we knew what to expect ahead of time. Now it is not prevention, it is all about intervention. These days the kids are just some other person that is dropped off at school by the bus or their parents. We usually don't know them at all until something bad happens like a cold, seizure, or an asthma attack.
That's if they have a nurse at least. One of the biggest factors in preventing kids from having asthma attacks is that most schools these days don't have anyone to help them. The days of every elementary and junior high having a school nurse are over.
Because the school district can't afford it, not every school has a nurse and most in fact do not. With Proposition 13, which rolled back property taxes in the early '70s, there is little money for schools to staff nurses. Most of the money for nurses comes from grants and the city's Department of Public Health. The grants are usually short-term, lasting about two or three years. Arlene Ackerman, the new superintendent of schools just got 10 more nurses and 10 more social workers. But that still leaves many schools without a nurse.
There are many programs in the area to help kids deal with their asthma. One of them is the Bayview Hunters Point Health and Environmental Resource Center also known in these parts as HERC. They offer classes every Monday and Friday to teach people about asthma and how to deal with it. They also have the Breathing Counts Project, which is an empowerment model of community based health education for people living with asthma. In collaboration with other agencies, the program provides education, information and referrals to individuals who have been diagnosed with asthma or who have asthma-like symptoms. It consists of in-school asthma education programs like the one's taught at Carver Elementary School by Veronica Lightfoot.
Lightfoot is from Georgia and contracted asthma there but says her condition has gotten worse since she have been working in the Bayview Hunters Point.
"When I come into the Bayview, you can just sense right away that there is something wrong. You just don't feel good right away," said Lightfoot. Lightfoot is very good at teaching the kids how to deal with asthma as shown in a KQED documentary by Irving Salaf and Allie Light. In the documentary, "Children and Asthma," which aired in November, Lightfoot asks the kids in her class if they knew anyone with asthma. It is as if she had just asked them who wanted candy; everyone raised their hand.
"We wanted to show that asthma is not just the problem of those who suffer from it. Asthma is everyone's problem," said filmmaker Salaf. "The causes are not only in our homes, they're in the air we breathe, the schools we attend, the land we farm, and the neighborhoods we live in."
Lightfoot hasn't stopped at just teaching kids how to deal with their asthma problems. In 1995 she helped start the Bayview Hunters Point Asthma Task Force. It is a partnership between concerned Bayview Hunters Point residents, the San Francisco Department of Public Health, the University of California at San Francisco. They also have even received help from Kaiser Permanente. From this task force the Community Survey was made in 1999.
Even with all these programs the problems still continue. In 1998 the Bayview Hunters Point Asthma Task Force asked for $2.5 million to hire outreach workers and establish a local asthma treatment center. The Board of Supervisors rejected it. Mayor Willie Brown came up with $250,000 for the program, but pushed the Department of Public Health to make other cuts and not add new services. And then General Hospital's satellite pharmacy facility was closed. Department of Public Health director Mitch Katz also fired deputy director Bob Prentiss, considered a strong advocate of asthma prevention with the Department of Public Health.
So the next thing that happens to help with this situation is the strategic plan, which will be issued to the Board Of Supervisors this February.
"We are going to insist that there has to be some kind of training program for the people that are taking care of these kids in the schools," said Hoemke. "We have about ten things we want, five we think we can get, five of them we are just hoping.
There is a school mandate that says there has to be at least twenty hours of hea1th education in each class per year. The citizens have spoken and said they want more hours dedicated to this. The School District is saying that they need more hours committed to other forms of education.