From the asphalt playground at Prescott Elementary School in West Oakland, Calif., you can hear the rumblings of truck traffic on Interstate 880, which wraps around the neighborhood like the meandering curve of an ancient river.
Inside the 33-foot Winnebago parked in the middle of the play area, though, the sounds of industrial gridlock fade behind the beeps and hums of blood pressure machines and computerized breathing tests. This is the Breathmobile, a traveling clinic staffed by a doctor, nurse, respiratory therapist and social worker and run by the Prescott Joseph Center for Community Enhancement.
The first patient on a recent Tuesday morning is Juanalyisha Milton, a skinny 5-year-old wearing black high-tops and a shining grin. Just a few months ago, Milton couldn't run without losing her breath. Since getting treatment and medication here, she's bouncing around like a normal kindergartner, says her mother, Ketra Smothers.
The children in this poor industrial neighborhood are seven times more likely to be hospitalized for asthma than the average child in California, according to the most recent data. Washington Burns, the retired doctor who heads the clinic, blames poverty, pollution and lack of access to preventive care. West Oakland is surrounded by freeways and hemmed in by a major port, where ships and trucks spew diesel exhaust, a pollutant linked to high asthma rates. While details differ in other cities served by Breathmobiles -- in Southern California as well as Phoenix, Chicago, Baltimore and Mobile, Ala. -- the problem is basically the same: The people who suffer the most from pollution often have the least access to treatment.
Milton settles into the Breathmobile routine as respiratory therapist Priscilla Ward takes her vital signs and hands her over to nurse Spencer Weir, who measures her ability to propel air out of her lungs.
"Big breath in, fill up your lungs, and bloooooowww," he coaxes.
After Weir gets a satisfactory reading, Milton and her mother see the doctor, Nataliya Kushnir, who examines the child's lungs, heart, nose and ears, and tells her mom how to keep the asthma under control.
Education is an important part of the clinic's work. Patients who don't know how to control their disease have more frequent attacks and often end up in the emergency room. This is an ineffective and expensive approach to treatment, says Kushnir, an immunologist and allergist who works frequently on the Breathmobile.
By the time patients get to the emergency room, they're already in crisis mode. But with regular checkups and proper medication, most can avoid attacks and their unwelcome side effects. E.R. visits make children miss school and parents miss work. They also cost a lot: In West Oakland's 94607 ZIP code alone, asthma-related 911 calls, emergency room visits and hospitalizations rack up around $3 million yearly in healthcare costs, Burns estimates.
That makes the annual cost of the Breathmobile, which Burns puts at $515,000, seem more reasonable, although finding -- and justifying -- the money is always a challenge.
Prescott Elementary is one of 12 schools in and around Oakland the clinic visits regularly. Burns hopes to expand the program, which has already proven effective. The year before the Breathmobile came to Oakland, the students it serves visited emergency rooms well over 100 times, missing 101 days of school. Since its implementation last September, E.R. visits are in the single digits, and school absences have dropped to 14 days, says Burns.
As Milton and her mother leave, the respiratory therapist intercepts them to review how to use a holding chamber to improve inhaler effectiveness.
"You want to shake it up, and you want a good seal around the mouth and nose. One pump, and let her breathe six times," instructs Ward.
Milton and her mother practice a few times, and then, just 30 minutes later, they're back on the playground and on their way, through the heat, noise and particulate-filled West Oakland air.