A mobile asthma clinic designed to keep kids in school and out of the hospital debuted Thursday at Malcolm X Elementary School in south Berkeley.
The Breathmobile, a 33-foot-long Winnebago RV, drew inquisitive looks and questions from students throughout the day. The vehicle was parked in the school courtyard to offer easy access to families that signed up for its first day ever in Berkeley. The program, which provides free asthma and allergy treatment, has ties to ongoing city-wide efforts to target the achievement gap and bring more accessible healthcare to a high-risk population.
Dr. Washington Burns of the West Oakland-based Prescott-Joseph Center for Community Enhancement brought the Breathmobile program to the East Bay in 2009. It began in Emeryville and has since expanded to serve 18 sites around the Bay Area. It’s the only one of its kind in Northern California, according to Burns’ staff, though there are also about a dozen other Breathmobile RVs that operate across the nation.
Nanci Armstrong-Temple, a Berkeley mother with twin kindergartners at Malcolm X, said she signed up for an appointment for her daughters after seeing a flier at school.
“One of my daughters was coughing a lot after running, and both get allergic reactions to things like pollen and cats,” she said Thursday. “The appointment answered questions I’ve had for a long time.”
Armstrong-Temple said the on-site visit was much less disruptive to her daughters’ schedule than a typical doctor’s office visit. Instead of missing, for example, part of lunch, afternoon classes and their after-school program, the girls had an hour-long visit inside the Breathmobile then immediately returned to their normal activities.
Armstrong-Temple also said she appreciated the Breathmobile team’s expertise regarding asthma and allergies, as well as the kid-friendly environment. (Drawings by dozens of children decorate the walls and ceiling of the RV, surrounding charts and diagrams about asthma and respiratory health.)
“You definitely have some new fans,” she told one of the nurses after the visit.
Dr. Janet Berreman, who runs the city’s public health office, said bringing the Breathmobile to Berkeley is part of the city-wide 2020 Vision campaign to close the achievement gap by the year 2020.
“I think sometimes, in the 2020 Vision conversation, it’s been a little bit hard to communicate how health is involved,” she said. “And I think that, with asthma and school attendance, there’s a really clear connection. People understand that, if your child has asthma, and you don’t have access to care, your child can miss a lot of school.”
Berreman said data have shown for quite some time that black children under 5 show significantly higher rates of hospitalization due to asthma than other children. A range of factors, such as physical environment, limited access to care and higher levels of stress, can all contribute to the inequity, she said. As a result, children in this group are more likely to miss school and fall behind.
“We know that kids who are healthier do better in school, in part just because they’re there,” she said. “Kids who do better in school end up healthier and living longer the entire rest of their lives. The health and education nexus is a two-way street.”
Berreman said the city public health department has been working closely with Berkeley schools to find a way to address the problem in hopes of narrowing the achievement gap.
Enter the Breathmobile. Because the service is located on school campuses, time spent missing class is minimized. Instead of several hours, or longer, spent seeing doctors or waiting in an emergency room, children are in and out in 30 minutes to an hour.
Berreman said city health workers teamed up with the Berkeley Unified School District to help identify which schools had the most children with asthma and asthma-related absences. The health department then helped broker an agreement between Berkeley schools and the Prescott-Joseph Center to bring the Breathmobile to Berkeley. The van will begin with monthly visits to Malcolm X and has plans to add Rosa Parks Elementary to its rotation in the spring.
Keiko Barfield, a Prescott-Joseph Center staffer who helps run the Breathmobile program, said the results of the service speak for themselves. Families sign up for appointments and begin with an hour-long assessment, then return for follow-up visits every four to six weeks.
From its start in September 2009, through August 2012, according to data collected from patients by Breathmobile staff, families have reported drastic reductions in emergency room visits, hospitalizations and school absences.
The 283 patients seen by the Breathmobile health team reported a drop in ER visits from 247, in the year prior to being connected with the program, to 11 after starting treatment. The group reported 92 hospitalizations in the year prior to receiving Breathmobile care, and just four afterward. School absences for the group dropped from 613 days to just 38.
“We haven’t been around that long, so to have these kinds of dramatic results over a three-year period is pretty spectacular,” said Prescott-Joseph Center Deputy Director Diann Castleberry. “We’re very pleased with the results, and we want to continue to do this work.”
Inside the van, patients find an intake station and small waiting space, along with a testing area for vital signs and skin allergens, as well as an exam room. The Winnebago has two computer systems, a health risk assessment system for asthma, a screening module for pre-diabetes, and an electronic medical records system called “AsmaTrax.”
The health team inside the Breathmobile includes a doctor, nurse practitioner, nurses and patient services coordinator.
Barfield said all the records collected during Breathmobile sessions are shared with primary care physicians “so they also know what’s going on. We’re just there to provide the specialty care.”
The Prescott-Joseph Center provides all services free of charge with the help of individual donations, along with grants and foundation support from organizations like the Bay Area Air Quality Management District and the California Endowment.
Fast facts on asthma via the Prescott-Joseph Center
- In California, about 1.5 million children aged 5 to 17 have asthma. That’s about one out of every six kids.
- In Alameda County, one in four children in this age group has asthma.
- Black children visit emergency rooms at a rate four times higher than Hispanic and white youth and 12 times higher than Asian/Pacific Islanders.
- Of all the cities in Alameda County, Oakland has the highest rate of emergency room visits, 40% higher than the county rate.
- In West Oakland, black children are five times more likely to be hospitalized for asthma than other ethnic groups.
- 20% of all children and 37% of all adults have asthma in West Oakland.
- Other areas with similar demographics, such as southwest Berkeley, Emeryville, parts of Contra Costa County and Bay View Hunter’s Point in San Francisco, have similar asthma problems.
2020 Vision aims to close achievement gap in Berkeley [10.18.12]
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