Health Care on Wheels 

The Oakland-based Breathmobile drives from school to school, helping kids with asthma.

The neighborhood near Woodrow Wilson Elementary School in San Leandro bustles with people. Walking by, you can hear kids running tirelessly around their black asphalt oasis. But heading east, about 300 yards or so, the neighborhood abruptly changes. First, there's truck-choked Interstate 880. And across the overpass is the city's industrial area and its large factories. Immediately, you realize why more than twenty of the school's students under the age of ten are afflicted with mild to severe asthma.

Twice a month, though, while the kids run around the schoolyard hitting yellow tether balls and yelling cheerfully, help arrives in the form of a 33-foot Winnebago full of medical personnel. It's the Breathmobile.

The Breathmobile officially made its first stop in the East Bay last September at Anna Yates Middle School in Emeryville. Anna Yates alone has fifty students with mild to severe asthma. And it, too, is not far from I-880. The busy freeway and its pollution-belching vehicles have exacted a steep toll on East Bay kids for decades. "Statistics show that many of these kids that get sick miss out on so much school that they are declined opportunities to better themselves through the educational system," explained Dr. Washington Burns, executive director of the Oakland-based Prescott-Joseph Center.

Burns and the Prescott-Joseph Center decided four years ago to bring the Breathmobile to the East Bay after of one his staffers heard about it at a conference. Burns was so impressed he worked persistently to put together the staff, equipment, funding, and collaborations necessary to get the Breathmobile rolling. The van alone came to $154,000 and the program costs about $500,000 a year to keep running. "We have been doing in-house fund-raising, so we haven't had to hire a professional company," Burns said. "But we might have to soon because it has been tough getting the $500,000."

Begun at the University of Southern California in Los Angeles, the rolling health-care program has been gaining popularity throughout the nation. Other major cities such as Phoenix, Baltimore, New Orleans, and Mobile, Alabama now have Breathmobiles, too.

In Alameda County, the problems created by polluted air are widespread. For example, in the Oakland Unified School District, about 6,000 students have mild to severe asthma. "This is why we have been so gung-ho in getting this program to more schools around the Easy Bay," explained patient representative and main Breathmobile driver James Acuna.

Acuna, who used to work for Contra Costa Health Services, is the first person kids meet when they step onto the van. On a patient's initial visit, child and guardian fill out a medical questionnaire to help the staff understand the seriousness of the kid's breathing problem, and whether he or she has been diagnosed with asthma and is on medication. Unfortunately, many kids with asthma don't know how to take care of themselves properly or have access to the right meds. So they end up leading sedentary lives in order to avoid frequent attacks. "We see a lot of kids with asthma become overweight because they think the only way to avoid stress is by doing as little physical work as possible," explained Spencer Weir, a resident nurse.

Weir works the second station on the Breathmobile with Priscilla Ward, a respiratory therapist and certified asthma specialist. Weir's bedside manner helps make the tests and equipment on board less intimidating. At one point during the van's visit to the San Leandro elementary school, a third grader knocked on the Breathmobile door repeatedly trying to say hello to his favorite staffer.

Weir checks kids' basic vital signs, administers allergy tests, provides general education for treating asthma, and conducts a spirometry test. Spirometry measures the volume of air that each child's lungs can handle along with how fast he or she can inhale and exhale. To make the test easier, Weir turns it into a game. One option is a computerized cake with ten candles. When instructed, the child takes a deep breath and blows into a tube. The more candles that go out, the stronger the child's lungs. Other options include blowing up a balloon and pushing an object that rolls across the screen.

While Weir works with the kids, parents discuss their kids' needs with Ward. "Many parents are unsure of how to properly take care of their children and don't realize that many environmental factors, especially in the home, can contribute to attacks," Ward said. Talking to one mother, Ward reviewed the basic information about childhood asthma and asked questions about the child's home life. The mother revealed that the family lived in an apartment that recently incurred mold problems.

The third and final Breathmobile station is operated by Dr. Jennifer Louie, the on-board pediatrician. Louie looks over the child's medical background and test results, and then prescribes the necessary drugs and inhalers, while also making sure that both parent and child know how to use them correctly. Prescriptions written on the van can only be filled at the patient's health-care provider, but the Breathmobile will supply needed medication to a patient if the family has no access to health care. Generally, it will only be enough medicine to last until the next visit, which usually is about a month.

Afterward, staff members input the child's information, medical history, emergency room visits, missed days from school due to sickness, and even work missed by parents into a database called AsthmaTrak. This system compiles information so that doctors and practitioners can track trends in asthma care and determine what treatments work best. AsthmaTrak uses data from all over the country — not just Breathmobiles. In addition, information from Breathmobiles around the country is sent to a database at USC to determine which programs are succeeding and which need improvement.

Currently, the Breathmobile travels to schools in Emeryville, Oakland, and San Leandro, but Burns hopes to expand into Richmond and Berkeley as well, along with pre-schools. After years of budget cuts, most California schools no longer have nurses on staff, let alone physicians with asthma expertise.

And besides helping kids, the rolling clinic can help a school's bottom line. That's because Oakland schools lose $37 dollars a day in state funding for each child who misses school due to illness, according to district spokesman Troy Flint. And students with asthma average about 2.5 days of absence per year due to the illness. In other words, asthma-related illnesses are costing the cash-strapped Oakland public school district about $555,000 every year.

Moreover, students miss out on educational opportunities and many parents have to leave their jobs in order to care for their children. Burns said that about one-third of the Breathmobile patients belong to Kaiser, and since this program began, families have saved money by not having to go the hospital as often. Breathmobile programs around the country have reduced emergency room visits by 68 percent.

If additional schools join the Breathmobile program, then Prescott-Joseph Center will raise funds to buy another van to keep up with the growing number of patients. "We can only get out 22 to 25 times per month," Burns said. "So we will be ordering to new Breathmobile within the year — if all goes according to plan."

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