It was 2005. I was sitting at my desk, 14 days into a new job, when the headlines started rolling in: "Hurricane Katrina -- A powerful hurricane batters the Gulf Coast from Louisiana to Alabama"; "Crisis Builds in New Orleans"; and "World Stunned as U.S. Struggles with Katrina." They were startling headlines for anyone, for sure. For me, they were personal.
Born and raised in Louisiana, I became a doctor and spent my life's work studying allergic disease and asthma in academia. A complex disease in the best of circumstances, asthma in a post-Katrina New Orleans and Gulf coast, I knew, would result in disaster for thousands of children and their families. Ironically, my new post as head of the nation's only nonprofit that focuses specifically on childhood asthma would mean that I could make a difference.
Here's what we knew day one:
- Children in New Orleans had more asthma and in some cases worse asthma than other kids in most parts of the country;
- Mold is a serious trigger for asthma and flooding would cause a tremendous increase in the amount of mold on structures and in the air; and,
- We suspected that as the mold spore counts continued to mount, the symptoms of children with asthma would get worse -- extremely worse.
I was ready to jump on a plane with my stethoscope. But my first call to the head of the New Orleans health department changed my plans. He advised me to wait; the city needed time to organize. He asked that I think long-term -- not about a quick fix -- and design a program that might address the childhood asthma problem in the months and years to come. A fix, perhaps, that not only would replace what the flood waters washed away, but might even improve the quality and access to health care problems that have plagued New Orleans for decades.
Five years later, the preliminary results of the program my organization designed for New Orleans with the National Institutes of Health, called Head-off Environmental Asthma in Louisiana (HEAL), confirmed what we suspected. We saw extreme sensitivities to environmental asthma triggers, especially molds, as a risk for more severe asthma symptoms and increased exacerbation in hundreds of New Orleans children. Nearly 80 percent of children with asthma in post-Katrina New Orleans were sensitive to mold, a figure about 30 percent higher than for children involved in a study in seven other U.S. cities.
While we have heard a lot about how Katrina changed the infrastructure of New Orleans, we are only beginning to learn about how the city's environment following the storm changed health. Indeed, there is an undeniable connection between the environment and the health of children with asthma. And, as such, we have learned from the post-Katrina experience that effective asthma management must go beyond traditional medical care to include steps to educate and assist patients in managing this condition as well as reduce exposure to the specific environmental triggers known to exacerbate the problem.
The mold that spread like a rash across New Orleans was one thing. The storm's devastating impact on the city's health care infrastructure was quite another. For many children with asthma, they had no ability to access even the most basic health care services or monitor and track their health status. Even today, five years later, there are still a number of children without health insurance or access to a safety net system of care.
So we structured HEAL to give a tailored case management approach to children and families that provided asthma education and a sense of empowerment which subsequently contributed to a stronger and more coordinated system for managing asthma than they had before the storm. The HEAL program partnered 184 children, four to 12 years old, with moderate to severe asthma, and their families with a team of health education specialists and community health workers who provided education and counseling to caregivers on how to manage their child's asthma in a transformed environment. Through case management that was customized to address the child's allergic risk profile and home visits to reduce asthma triggers, children in the program experienced significant reductions in their days with asthma symptoms.
Through this program we had a level of success that helped this relatively small group of children manage their asthma better. A positive step, but certainly just a fraction of what we need to be doing. We need to learn how to sustain these types of initiatives and to institutionalize this type of care management into health care systems that serve children with poorly controlled asthma. We need to empower families to recognize that they can control their child's asthma and that the condition need not control them. That's why my organization, the Merck Childhood Asthma Network, Inc. (MCAN) has just pledged nearly $2 million to Xavier University of Louisiana's Center for Minority Health and Health Disparities Research and Education to study methods of implementation of the asthma case management and environmental mitigation model into the care provided by community health centers and other providers caring for high-risk children in New Orleans. This is indeed "community-based translational research."
By more widely diffusing what we know already works - not just in the lab or at the hospital but also in the community -- we can control asthma in New Orleans.