BY MATTHEW DOUGHERTY
GEORGE HARVEY, A 5-YEAR OLD LIVING IN HARLEM, IS A FUN-LOVING child who likes to play with Pokemon toys and draw in coloring books. But George and many of his friends in kindergarten deal with breathing problems caused by asthma, which more than 25 percent of Harlems children have. The percentage is startlingly higher than the national average of 5 percent to 7 percent of children.
Fortunately for George and his pals, an intervention program run by the Harlem Childrens Zone, a non-profit community-based organization, with P&S and Harlem Hospital Center helps families deal with many factors that contribute to the childrens asthma. Faculty at Columbias Mailman School of Public Health serve as consultants to the project, called the Harlem Childrens Zone Asthma Initiative. Geoffrey Canada is CEO of the Harlem Childrens Zone. Dr. Vincent Hutchinson, associate clinical professor of pediatrics at P&S, is medical director of the asthma initiative.
Researchers are not sure why pediatric asthma is so prevalent in Harlem but health-care professionals in the initiative are searching for answers. The program began screening children 12 years old and younger for asthma in 2001 at schools, Head Start and other day-care programs, and community events. The health-care workers have screened almost 2,000 children about 90 percent of the 2,200 children in the first section of Harlem they targeted. Children with asthma are offered a broad range of asthma services. The first step is to ensure that they have a regular and knowledgeable doctor, appropriate medications, and an asthma action plan. But successful asthma management requires much more.
The initial part of the project encompasses about 24 blocks, or one quarter of Harlem, stretching from West 116th Street to West 123rd Street between Fifth and Eighth avenues. The program will expand north to 135th Street next year and possibly farther in the future, says Dr. Stephen W. Nicholas, associate professor of clinical pediatrics at P&S, director of pediatrics at Harlem Hospital, and principal investigator of the asthma initiative.
Under the program, community workers visit Harlem homes to interview and educate parents on the best ways to reduce asthma attack triggers cigarette smoke, dust, and pet dander and, therefore, to keep asthma under control. The program nurse educates parents and children about the asthma action plan, medication use, use of peak flow meters that measure medication effectiveness, and use of the health care system. The ultimate goals are to improve childrens health, reduce missed school days, and limit the number of asthma-related trips to the emergency room. Families in the program receive free vacuum cleaners, air filters, and cleaning, repair, and pest control services if needed.
In Georges case, he has shown improvement since Keith Faulkner, a community worker in the Department of Pediatrics at Harlem Hospital, met Georges mother, Valerie, at the familys apartment in June 2003. Mr. Faulkner brought dust covers for Georges mattress and pillows and checked for dust, bugs, and water leaks as part of an environmental assessment. He recommended that the Harvey family try to reduce its use of aerosol sprays, which can irritate Georges lungs.
On his second visit, in October, Mr. Faulkner brought a mask to help George inhale his asthma medication and gave Mrs. Harvey plastic food containers in which to put cereal to keep bugs out. Mr. Faulkner and other community workers follow up at three-month intervals during the first year to assess the effectiveness of interventions and provide additional services where needed.
In the three months before Mr. Faulkners first visit, George had been to the emergency room twice for treatment during asthma attacks. Since Mr. Faulkners June visit, George has not needed to go to the emergency room or make any unscheduled visits to his doctor.
The program also offers social, legal, and most recently smoking cessation support. Support groups for parents and children with asthma are based on the Touchpoints model, a system developed by T. Berry Brazelton, a 1943 P&S graduate, that helps parents cope with their childs illness. Volunteers of Legal Service, a legal aid group, linked the asthma initiative with the New York law firm LaBoeuf, Lamb, Greene & McRae LLP to push landlords to repair and clean apartment buildings. A new grant from the Legacy Foundation enabled the program to hire smoking cessation counselors to help families refrain from smoking one of the worst triggers of an asthma attack in their apartments.
Leaders of the initiative are seeking more funding to keep the project growing. The Robin Hood Foundation, a charity founded by a group of Wall Street executives, provides about $650,000 a year for the initiative. To expand up to 135th Street we need double funding at the least, at a minimum, Dr. Nicholas says. He has been disappointed that additional funding has not resulted from media coverage of the program.
Aside from financial concerns, Dr. Nicholas and his colleagues appreciate the opportunity to help families bring asthma under control. It so often happens that poor, inner-city populations are studied but get only empty promises that the research will help change things. We feel this program, as an intervention coupled with research, is very different, Dr. Nicholas says.