Edna Ruiz saw her two-year-old daughter Estellah’s lips start to turn purple as the child gasped for air. She had asthma attacks before, but this was the worst.
When they arrived in the emergency room of El Centro Regional Medical Center about 10 p.m. in January, Estellah had a temperature of 104 degrees.
“It’s really scary to know when she’s coughing, she could stop breathing,” Ruiz said.
The doctor confirmed Estellah’s asthma diagnosis and prescribed medications that helped her improve and return home.
But her mother lives in fear of the next of about a dozen trips to the hospital for asthma since Estellah was an infant.
In Imperial County, Estellah is one of about 12,000 children diagnosed with the chronic respiratory illness. The county had more than double the state’s rate of asthma-related emergency room visits and hospitalizations for children, between ages 5 and 17, in 2015, according to state public health figures.
Another threat looms at year’s end, when mitigation water transferred to the deteriorating Salton Sea, which straddles Imperial and Riverside counties, will end as part of an agreement with the state. The result over time, scientists say, will expose much of the sea’s bottom, potentially releasing considerably more harmful dust into the air.
In an e-mailed statement, the California Department of Public Health wrote, “It is unclear whether the levels of exposures associated with increased dust from the Salton Sea might increase asthma exacerbations or incidence.”
When mitigation water flow to the sea ends, the full impact of the accelerated decline will not be felt immediately – perhaps not until 2020, said Bruce Wilcox, assistant secretary of Salton Sea policy for the California Natural Resources Agency. State lawmakers last year approved $80.5 million for the first phase of the Salton Sea Management Program, which will start to address dust control and wildlife habitat on exposed ground around the perimeter of the sea.
A draft of a 10-year plan for the Salton Sea was released March 16. A series of workshops seeking public input on the $383 million plan will begin soon, Wilcox said. Construction on that first phase would begin in late 2018, he said.
But scientists, health care professionals, local government officials and parents worry now what the environmental effects of the sea’s decline may mean for the respiratory health of an already stressed region’s children over time.
The increase in windblown dust from evaporation and an exposed lake bed may lead to more wheezing, asthma attacks and respiratory infections and hurt developing lungs in children, said Shohreh Farzan, assistant professor of preventive medicine in the division of environmental health at the University of Southern California’s Keck School of Medicine.
“We do think that children are especially vulnerable to the effects,” Farzan said, adding that others at-risk include the elderly, anyone with existing asthma or other chronic illnesses, those with already compromised immune systems and people who work outdoors.
Asthma causes wheezing, tightness in the chest and coughing, particularly at night or early in the morning, said Ying-Ying Meng, co-director of the chronic disease program at the UCLA Center for Health Policy Research. The disorder may be caused by genetic or environmental factors or both. Some children outgrow asthma, which cannot be cured, but managed through medication, constant monitoring of your environment and regular visits to a physician, she said.
“You really need to have an asthma self-management plan and tailor it to the patient’s need,” Meng said.
The receding Salton Sea is not the only factor contributing to the Imperial Valley’s poor air quality and high rates of hospitalizations and emergency room visits for children with asthma. Experts also cite the proximity to the border and its accompanying pollution from lines of cars and trucks emitting exhaust, the pesticides from commercial farms and the area’s desert heat and heavy winds. Additionally, the area has a shortage of primary care health services – parents like Ruiz cannot always get appointments when they need them.
Imperial County, California’s poorest based on per capita income, stretches across the southeastern part of the state. Here, about 25 percent of the county’s 170,000 residents live in poverty, according to census data.
Graciela Ruiz noticed the change in the air and her asthma as soon as she moved to the area from Northern California. She did not have to take medication for years, but now has to take her asthma medicine daily.
“When you come to the Imperial Valley, you don’t see anything green … you just see dust everywhere,” said Ruiz, a community health worker with the Imperial Valley Child Asthma Program.
Through the program, Ruiz visits homes to educate families about how to control asthma. She conducts environmental assessments in which she looks for triggers such as mold in the bathroom or under kitchen sinks, the presence of fans or broken air conditioners, pets, the types of cleaning materials used and air filters that require changing.
She said for many parents, already struggling with poverty, maintaining consistency on all these measures is hard.
That’s why home visits are crucial for many of the region’s families, from making sure the right inhaler technique is used to checking for gas leaks, said Esther Bejarano of Comite Civico Del Valle, a nonprofit in Brawley. She just completed running a temporary home visitation program for 200 families, and works with ten schools on a program that involves daily air quality monitoring and using brightly colored flags to alert the community about whether students can safely be outdoors.
Bejarano says she reaches only a small part of the population that needs help.
“There’s a huge gap,” Bejarano said. “What happens to the other thousands of families in Imperial County and their children who suffer from uncontrolled asthma on a daily basis?”
Lack of access to pediatric pulmonary specialists is another challenge, said Leticia Ibarra, director of programs for Clinicas de Salud del Pueblo, also in Brawley. So, the clinic helps to train primary care doctors to be able to address asthma in a more specialized way, she said.
“We need our primary care providers to be more prepared to be able to treat these more serious cases,” Ibarra said.
Amid the concern about what lies ahead, many are collecting data about the region’s existing air quality and residents’ health to measure against what may come.
The California Health Interview Survey, conducted by UCLA’s Center for Health Policy Research, for the first time will expand to include an additional sampling of about 350 people who live in areas on the Salton Sea – like Bombay Beach and Desert Shores, and the survey will include more questions about respiratory health, said Paula Kriner, epidemiologist with the Imperial County Public Health Department.
The survey will “give us a baseline of the Salton Sea communities,” said Imperial County Board Supervisor Ryan Kelley, who was born and raised in Brawley and advocated for the broader survey.
Similarly, Farzan of USC is co-leading a study that is analyzing the level of toxic contaminants in dust samples collected by the sea and health risks to those who live there. Results are expected this summer.
And the Imperial County Public Health Department will receive an $850,000 grant over three years to help bolster coordination, communication, data-sharing and leveraging of resources to address asthma in the region.
The outcome of current pilot projects to address wildlife habitat and dust suppression along the sea will help inform the construction that starts in 2018, said Wilcox, the assistant secretary of Salton Sea policy and former Imperial Irrigation District environmental manager. The state is playing catch-up on the Salton Sea, he said, in part due to litigation, the recession and differing opinions among stakeholders about how to address the sea’s fate. He said the $80.5 million pledged so far won’t cover all that needs to be done.
Many are frustrated by the delays.
“We are in the corner of California – the farthest point from Sacramento. We don’t have that access to Sacramento, like San Mateo or San Francisco counties,” said Kelley, the county supervisor. “That’s the hardest part for us. Down here we don’t get that attention. We don’t have the resources of Los Angeles or Orange counties. ”
At home in Calexico, Edna Ruiz, who is studying to become a nurse, remains vigilant to prevent Estellah and husband Efrain, who also has had asthma since birth, from having another attack. Though she has a 10-month-old baby, Emanuel, Ruiz keeps a baby monitor in Estellah’s room so she can see and hear her daughter at night. The family had to give away their dog. There are no plants or stuffed animals in the house.
But on a good day, Estellah loves to run around the yard, arms extended, and pretend she’s an airplane – a sight her mom relishes.
“My biggest fear is for her to get worse – to get to the point that she can’t enjoy what she does now,” Ruiz said.
Journalist Marisa Agha is based in Southern California.