It started as a tightening in the bottom of her lungs on after an afternoon swim at San Francisco's Ocean Beach, a feeling like she wasn't getting as much air in each breath as she should have been, then the tightness began creeping up her chest. She could feel herself being smothered, suffocated, as her bronchial tubes tightened further and further. Megan Terheyden, was having another asthma attack.
Without an inhaler handy and with panic beginning to set in, her attack proceeded to get worse and worse. The world was getting dim. After an hour that stretched into an eternity, Megan sat in the emergency room sucking on an Albuterol inhaler. The inhaler, which is used to stop attacks in their early stages, didn't work. Megan couldn't take in enough breath to receive a sufficient dose of medication to stop her attack.
The next thing she knew she was being injected with an adrenaline shot to open up her bronchial tubes. Only 15 minutes later did the punchiness and disorientation give way to mere lightheadedness, after breathing pure oxygen from mouth and nose tubes for a few minutes the lightheadedness subsided too.
"It's an exhausting, traumatic experience," says Megan 22, "Being so close to death really shakes you."
Over 2 million Californians, more than 51,000 of them right here in San Francisco, are living with asthma. Asthma is a serious, possibly life threatening disease when not managed carefully and properly. When treated properly however, most people who suffer from asthma are able to live healthy, active, productive lives.
Nationally, those hit hardest by asthma are low-income urban youth, kids without proper medical care whose developing lungs are exposed to filthy, polluted air. According to a report by the San Francisco Department of Public Health's Community Health and Epidemiology & Disease Control, Asthma rates among children, African-Americans, and people living in large cities were all above the national average.
It should come as no surprise then that the highest asthma rate in the city belongs to the Bayview Hunters Point, home of the Hunters Point Power Plant and the city's largest sewage plant, home to many light industrial businesses, and neighbor to both Interstate 280 and Highway 101.
"There are several major contributors to high asthma rates in the Bayview Hunters Point, including all the diesel fuel emissions from the two freeways, the two nearby power plants, the sewage plant, and the toxic, radioactive materials around the Naval Shipyard," said Bradley Angel, Director of Greenaction, a local organization dedicated to mobilizing community power in an effort to promote environmental justice.
According to the Bay Area Air Quality Management District's 2000 Annual Report, the PG&E plant produces 22 pounds of Benzene emissions (Mirant produced 79 pounds) and 770 pounds of Formaldehyde emissions (Mirant produced 1,100 pounds) annually. Just for comparison, according to the same report, San Francisco State University produced 139 pounds of Benzene emissions and 1,240 pounds of Formaldehyde emissions annually.
"Both the PG&E plant and the Mirant power plant, a mile away in the Potrero District, are outdated, highly pollutant facilities that are unnecessary and unwanted in our community," added Angel, "Currently, our main goal is to have these antiquated, dangerous plants shut down and replaced with cleaner, more environmentally friendly means of generating power."
Asthma rates in the Bayview Hunters Point at 10 percent are nearly double the national rate of 5.6 percent, with an even greater disparity among children (7.4 percent nationally, compared to 15.5 percent in the Bayview Hunters Point).
"There is a lot of asthma out there (The Bay View Hunters Point)," says Christine Del Carlo, a nurse at San Francisco General Hospital for the last 29 years, "We're not sure exactly if those high rates are due to environmental factors, genetics, or diet, but there are certainly a lot of pollutants in that neighborhood."
With proper treatment, a doctor's care, medicine, and a working knowledge of what triggers attacks, patients with severe asthma are able to live normal lives without the constant fear of an emergency room visit, many even play sports. The problem is, that many children living with asthma in this neighborhood do not receive the proper medical care, nor are they living in asthma friendly atmospheres. Not only do Bayview Hunters Points residents have to deal with a number of outdoor pollutants which contribute to the development of asthma, but many are also exposed to a number of indoor pollutants in their homes.
"A lot of the time when people are diagnosed with asthma, the hospital sends somebody out to the patient's home to try to identify potential asthma triggers," says Del Carlo, "The home assessors find all sorts of triggers in patient's homes, such as pets, old rugs, dirty linens, walls covered in flat paints (which are much harder to keep clean than high-gloss paints), and mold growing in damp areas. Clearing all these potential triggers is a highly effective means of combating asthma, simply making sure that the patient's home environment is clean and dander free can reducing the likelihood of an attack nearly in half."
According to the 2000 Census, 79 percent of the residences in the Bayview Hunters Point were constructed before 1980, during an era in which homes where still being built with asbestos insulation and decorated with lead paint. Asthma attacks can be brought on by a vast variety of triggers, such as air pollution, dust mites, pollen, mold, tobacco and wood smoke, paint, perfumes, hair sprays, animal dander, all sorts of organic matter such as dead skin particles, hair, and saliva.
Once diagnosed, asthma patients ought to see their doctors regularly for check ups to make sure that their medications are continually effective, that their asthma triggers haven't changed. This isn't always easy for Bayview Hunters Point residents. According to the Bayview Hunters Point Health and Environmental Task Force Community Survey, nearly 20 percent of the area's residents are uninsured, and, typically they have to leave their neighborhood to receive medical care (73 percent reported that their regular source of medical care was outside Bayview Hunters Point, with only 14 percent reporting that they regularly receive medical attention in the neighborhood).
"There are a lot of kids with Asthma in Hunters Point over by the shipyard and every time they have an attack they take them to San Francisco General Hospital and give them Albuterol (which is used to prevent attacks at their onset, but doesn't prevent future attacks or stop full-blown attacks once they have begun)," says Juanita Hennington, 48, a longtime resident, Bayview Hunters Point homeowner, and foster parent, "They aren't actually helping the kids in the long term, just giving them temporary relief from oncoming attacks."
According to Audrey Plough, Clinical Coordinator for the University of California at San Francisco's Asthma Clinical Research Center, many of the children who are brought in for treatment only see doctors after the onset of serious attacks. She believes that this is partially because many Bayview Hunters Point residents simply can't afford the doctors visits and prescription costs.
"One big problem that we have in treating asthma is that these kids don't get seen until they have a serious exacerbation," says Audrey Plough, Clinical Coordinator for the University of California at San Francisco's Asthma Clinical Research Center, "Often, by the time these kids receive any type of medical treatment, they are doing it in the emergency rooms because they're really sick."
What's more difficult in some cases than traveling to receive health care, is paying for it. Asthma medications aren't cheap, the most common preventative inhalers typically costing $48.99 (the generic brands cost about $30), and the most popular medicine in the long term treatment of asthma costs $108 for a one month supply. Even though most residents have some form of health insurance, not all plans cover all medications, and most require some patient co-pay for prescriptions. In a neighborhood where the median household income is among the lowest in the city ($37,146 as of 2000 Census, $29,472 among black households), finding the money to pay for preventative prescriptions can be tough.
"Asthma medications are expensive, very expensive," says Plough, "Just walking in the door at the emergency room costs $200, and the most common inhalers they prescribe usually cost about $120. Because the medication costs are so high, many kids don't receive the proper preventative medications for their long term health."
Although the PG&E plant is scheduled to close in 2005, with the Mirant plant being expanded to replace its energy production, there is little hope that any of the other major outdoor air pollution contributors will reduce the environmental impact anytime soon. Despite the continued abuse of the environment in Bayview Hunters Point, residents can minimize their risk for asthma attacks by staying away from triggers.
In some cases removing triggers from your home is as simple as asking smokers to do so outside, removing pets from the house, and vacuuming rugs and washing linens more regularly. People suffering from asthma are also recommended to stay indoors, in an area free of triggers, when they feel that outdoor air pollution is bringing on attacks, staying home if necessary.