When Dr. Genny Carrillo, moved to South Texas in 2007, she realized that asthma was, in her words, “a big problem.” Determined to use her background in environmental health to help, she formed the McAllen Asthma Coalition (MAC) in 2008. Over the years, this program has brought together various collaborators to develop a curriculum to teach children with asthma and their parents how to identify asthma triggers and manage symptoms.
Recent research indicates these interventions are working, with drops in asthma-related hospitalizations, number of doctor visits needed and total asthma attacks.
An estimated 617,000 children in Texas, or 9.1 percent, had asthma in 2013. Those in South Texas may be especially vulnerable, due to high levels of pollen in the air, high use of agricultural pesticides and a high poverty rate, said Dr. Carrillo, an associate professor at the Texas A&M Health Science Center School of Public Health in McAllen. The asthma hospitalization rate in the Rio Grande Valley is 13.4 percent.
There were 10,075 asthma hospital discharges reported among children in 2012, according to the 2014 Texas Asthma Burden Report. The number visiting emergency departments for asthma was undoubtedly much higher. “These visits represent over $650 million in health care costs, 90 percent of which is totally preventable,” Dr. Carrillo said. “The amount of money the state is expending on asthma by not preventing asthma attacks in kids is huge.” These numbers might be underreported, due to a lack of a standardized health electronic system that allows for tracking of patients from one hospital to another.
During her time in South Texas, Dr. Carrillo began to notice patterns of issues—cultural, financial, and situational—that perhaps contributed to uncontrolled asthma that led to these emergency room visits.
Many of the parents were unaware of how to control and manage asthma in their children. “Medication adherence is extremely important, and many don’t understand that asthma is a chronic condition and that to keep it controlled, children need to keep using medications even when they’re feeling good,” Dr. Carrillo said.
Cultural issues also play a role. For example, according to Mexican folklore, if a Chihuahua dog sleeps by an asthmatic child, the asthma will transfer from the child to the dog. Therefore, one of the first steps of the intervention is to educate parents about this myth and guide them away from these folk remedies and toward scientifically proven treatments.
Financial issues are also a concern. Many of the parents work long hours, so finding time for them to attend these interventions can be difficult. Also, the public health professionals lose track of families because of their “hard-to-reach” status (in other words, they cannot pay their cell phone bill, lose coverage, get new phone numbers when they do resume service, and they are highly mobile.)
There are other barriers unique to the border area. Dr. Carrillo described an asthma educational event she had planned where she expected a large group of parents and other community members to attend. However, that same day the border patrol agents were doing sweeps for undocumented immigrants, and many were afraid to leave their homes.
“It’s a cycle, because of poverty, lack of health insurance and lack of information about resources in the community,” Dr. Carrillo said, “that keeps asthma in these children uncontrolled.”