Childhood Asthma in the Imperial Valley

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Burning fields in Calexico

Fields are commonly burned to prepare the ground for the next crop, creating large plumes of smoke. Permits and specific burn dates are assigned to control air pollution. (photo: Helina Hoyt)

Imperial County is known as Southern California’s agricultural oasis. Environmental allergens abound because of the vast desert region’s extreme climate changes, air pollution and pesticide exposure. Multiple regulations exist within the county in attempts to decrease pollutants entering the air. Farmers must water dirt roads to decrease dust, burn permits regulate the burning of fields and crop dusters have limitations on spraying near vulnerable populations, such as schools.

Despite these stringent efforts, Imperial County has a significant problem with asthma. Asthma is a chronic disease that inflames airways and causes recurrent wheezing, coughing, difficulty breathing and chest tightness. Attacks can be mild to deadly. If controlled, most affected people lead active, healthy lives. According to a 2005 Border Asthma and Allergies (BASTA) Study conducted by the California Department of Public Health, 20.2% of children in Imperial County are diagnosed with asthma. The national average is 13.7%. Imperial County consistently has the highest asthma hospitalization rates among all California counties. Health care providers realize we can’t change the environment, but more can be done to diagnose children early so that proper maintenance leads to active, healthy lives.

Both of my children have had asthma symptoms.  We were fortunate to travel to San Diego for specialized care at Rady Children’s Hospital in the allergy/asthma clinic. It was interesting to learn that many of the children in the Imperial Valley may have an allergy to sugar beets, which is harvested locally. Fortunately, my children had early treatment and have now outgrown their symptoms. Unfortunately, this is not the case for most. Local school nurses and health care providers are fighting to get each child on an asthma action plan to ensure no additional deaths occur from a manageable disease.

Unfortunately, the county is plagued with a lack of health care providers, limited specialized resources and a large population of uninsured.  From 2000 to 2004, ten asthma deaths occurred in Imperial County. The problem has gained recent attention with the death of a local 16 year old girl. Since 2001, public health, local hospitals, community health agencies, the Centers for Disease Control and the California Department of Public Health have all collaborated to provide all levels of prevention for asthma. 

The Imperial Valley Child Asthma Program (IVCAP) is funded by the Imperial County Children and Families First Commission, and operated by El Centro Regional Medical Center in partnership with Pioneers Memorial Hospital. The program is designed to reduce health disparities, and to improve the development and school readiness of young children from birth through age five who suffer from asthma or asthma related symptoms. The IVCAP follows the National Institute of Health asthma guidelines. A free referral is provided by a local health care provider or parents can self-enroll. Community health workers and Aidee Fulton, RN,  provide case management services. 

Lessons include:

  • 1) What is asthma?
  • 2) asthma medications
  • 3) preparing for clinic visits and collaborating with your child’s MD
  • 4) proper use of inhaler, nebulizer and peak flow meter
  • 5) limiting asthma triggers at home
  • 6) recognizing early asthma symptoms and what to do when they worsen
  • 7) use of an asthma action plan

Currently, hospitalization rates are declining here, but still remain the highest in California. Both hospitals are leading the initiative because the majority of people in the Imperial Valley do not have access to primary care services. This means that they come to the ER with mild to life-threatening conditions. IVCAP is currently facing an uncertain future. Without additional grant funding, the program will end. Fullton is seeking additional partners and looking into expanding services to people ages 0-17, while exploring the addition of a mobile clinic to better serve outlying areas.

The American Lung Association has also been actively involved in bringing the Open Airways Program into local schools. Several school districts have looked into using a colored flag system to identify when air quality is poor, and additional measured need to be taken for those with asthma to prevent attacks.

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About Helina Hoyt, RN, MS

I have always had a passion for people, and nursing has provided great opportunities to help those within my community. I was born and raised in the Imperial Valley. I grew up in a farming family. At the age of 16, I was anxious to get started with nursing and become a Certified Nursing Assistant through Imperial Valley Regional Occupational Program. After graduating from Holtville High School in 1991, I pursued a bachelor’s degree in nursing at Azusa Pacific University. While at Azusa, I worked at Children’s Hospital Los Angeles. Post-bachelor’s degree, I was one of 14 to participate in a Critical Care and Trauma Nurse Internship through Parkland Memorial Hospital in Dallas, Texas. After marrying my high school sweetheart, we returned to the Imperial Valley so that our children could be raised with family nearby. Initially, I worked at Pioneers Memorial Hospital in Brawley, CA as a Charge Nurse in the ICU. After a rough pregnancy, I decided to enter school nursing, and attended San Diego State University to earn a master’s degree in Community Health Nursing, as well as a School Nurse Credential. After nearly nine years in school nursing, I became the RN-BS Program Coordinator for San Diego State University-Imperial Valley. I am thrilled to have an opportunity to improve the health of our community through nursing leadership and evidence-based practice, as the president of the Imperial Valley Nursing Council. I am married and love being a mom to two children, ages 8 and 12. I am proud to be a cancer survivor and an advocate for Type I Diabetes, since my son’s diagnosis at the age of 7.

Comments (5)

  1. H Gill says:

    Very informative article!

  2. Ms Helina,
    I wrote a long note about my work here in San Diego with asthma and then I lost it on the desktop. I am a School Nurse Practitioner here with San Diego Unified School District and we have had a cooperative agreement (grant) with the CDC/DASH for the last two and a half years focusing on asthma friendly schools and school asthma management.
    I have read your description of asthma in Imperial Valley and I read about BASTA and talked with a county public health nurse from IV last year but have not made any further contact. I am somewhat aware of the conditions even though it’s been a long time since I visited Imperial Valley even though I grew up in Calipatria until I was 15 years old. Looks and sounds like you are doing your best and striving towards the best for children of the Imperial Valley. Hope this reaches you. Please email with your thoughts or suggestions.

  3. Helina Hoyt, RN, MS says:

    Hello Mr. Martin,
    I was thrilled to receive your comments. Growing up in Calipatria, you are well versed with the challenges of living in the Imperial Valley. I am excited about your work as a School Nurse Practitioner. Aide Fullton, RN is the go to person in the Imperial Valley for asthma initiatives. Clinicas de Salud del Pueblo has also been very active in trying to get asthma action plans developed for anyone diagnosed, but there are multiple barriers. I believe we must realize that we will not be able to change our environment and shift the focus to primary and secondary prevention. We will not solve the problem by adding more regulations. The bottom line: we live next to Mexico that has few regulations. Our children must be provided with education & opportunities to better maintain allergies so that the flare ups to not occur routinely. The schools are pivotal to this……. It sounds like you are already ahead of the game plan. Please feel free to let me know how else I can be of assistance. Helina

  4. Can you imagine this conversation interuppting “work”,
    I found your above posting as I re-read about IVCAP and Ms. Fulton.
    I’m leaving the office to a couple of schools, next week off calendar.
    Now I know how to check back. The older ones (over fifties) don’t exactly know how to use their computers.

  5. Richard Friedel says:

    A relevant but strangely ignored or not generally known fact about asthma is that the change between weak (asthmatic) and strong (healthy) breathing is dependent on abdominal muscle tension. Slackening the muscles here causes abysmally weak and asthmatic breathing. Training the muscles, for example by “abdominal hollowing” (see Web articles) produces an antiasthmatic effect. Abdominal muscle tension plays a prominent part in Asian martial arts. I tend to breathe asthmatically after an evening meal or in pollen-laden air.
    So it is fair to assume that there is a natural breathing spectrum with an asthmatic tendency at one end and Ku Fu or Karate breathing at the other end. For a few words on the Japanese version of Asian breathing see http://www.lrz.de/~s3e0101/webserver/webdata/OBT.pdf
    Breathing powerfully into my lower abdomen with tensed muscles provides an effective cure for me. But then I’ve always been sceptical about medical wisdom on asthma: such a paradoxical and doctor-baffling increase in the last 40 years with modern inhalers. Respectfully, Richard Friedel