T A B L E++T A L K

Is there hope for the cleaning impaired? Mothers who don't mop discuss solutions to their dilemma in Table Talk

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R E C E N T L Y

Shunning and shaming
By Fiona Morgan
Berkeley rallies around a mother and her murdered child
(08/28/98)

Your call is important to us. Not.
By Sallie Tisdale
The real message of the insincere recordings that have invaded our lives: Stop complaining
(08/27/98)

I want you so bad
By Carol Lloyd
Now that our president has confessed to adultery, will the American people follow him to the pillory?
(08/26/98)

Drama Queen
Green eggs and Spam: Meals that make kids barf -- and other culinary delights
(08/26/98)

The heat is on
By Lisa Moskowitz
Soothe your savage summer beast
(08/25/98)

BROWSE THE MOTHERS WHO THINK FEATUREARCHIVES

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Mamafesto
By Camille Peri
Why it's time
for Mothers Who Think

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BY ARTHUR ALLEN | As the nurse at Daniel Payne Elementary, a tidy little school in a rundown area near the U.S. Capitol, Delois Freeman has seen her share of sniffling kids and hungry kids and vomiting kids and kids with epileptic seizures. One thing she's never seen, though, is an asthma attack. So it came as a shock when, in the second-to-last week of her third year at the school, Freeman conducted an informal survey and discovered that at least 49 of the 410 kids at Payne were asthmatics. Amid the schoolyard clamor, she'd failed to notice an epidemic of breathlessness.

The woman who brought the epidemic to Freeman's attention was Eleanor Thornton, a Howard University asthma counselor who came to Payne to lead a workshop for the students. What surprised Freeman was commonplace to Thornton, who is part of a national research alliance that is studying the rise of asthma in America. Over the past two decades the team has discovered that inner-city black children are twice as likely as other kids to suffer from the disease, and six times more likely to die from it. The percentages of asthmatics at Daniel Payne were typical of inner-city schools across the country.

Asthma, which affects 15 million Americans and kills 5,000 every year, is caused by a constriction of passageways in lungs that are inflamed by an allergic reaction. Like most other common diseases, it has a sketchily understood genetic component, one that big pharmaceutical companies are spending millions of dollars in research money to understand. But while the gene pool hasn't changed since 1980, childhood asthma rates have nearly doubled in that period. So, for the past 20 or 30 years, scientists have been searching for environmental factors to explain the dramatic increase in asthma rates.

As it turns out, there are many elements feeding the biochemical chain that leads to asthma. Allergies to dust mites, cat dander, cigarette smoke, cockroaches, ozone and mold are common triggers. Living in tightly sealed houses containing any of those allergens aggravates the risk, as do stress, obesity, low birth weight and inconsistent health care. Ironically, while researchers dutifully compiled the factors that caused asthma, American society was busy aggravating most of them.

In the apartment blocks and row houses of Southeast Washington, D.C., one of the main asthma triggers is a protein found in the feces of and the body parts of dead cockroaches. Thornton didn't bother getting into that at Payne Elementary, though. There is really no way a 9-year-old boy in a bad Southeast neighborhood could entirely avoid cockroach dung. Thornton's mission at Payne was to teach kids how to use their inhalers and asthma medications properly, to assure them that asthma is nothing to be ashamed about and to encourage them to talk to their parents about the disease.

Considering the serious message, that summer vacation was imminent and the auditorium broiling hot, the 14 third-, fourth- and fifth-graders with asthma whom Nurse Freeman had gathered in the front rows for Thornton's workshop were awfully attentive -- even gravely so. Thornton, 39, stood next to a video monitor and played a tape about an animated girl named Roxy and her boyfriend Malcolm, a basketball-loving kid who is embarrassed to admit he has asthma but is forced to deal with it after he collapses on the court one day in the middle of a big game.

Thornton gave the kids plain talk -- she didn't patronize them or ghetto-talk them, but laid out what they needed to do for themselves, in simple language. Maybe the children were listening so closely because it was the first time an adult had ever really explained to them how to deal with the disease they battled daily. Maybe it was because in a few weeks a lot of them would be more or less alone with it, running and playing, maybe, or sitting in stifling apartments watching TV to avoid dangerous neighborhoods. With their parents off working or whatever, they would be afraid and alone when that horrible wheeze built to empty-lunged panic.

Asthma isn't something that goes away when you aren't having a coughing fit, Thornton explained. It's a condition that follows you around, stays in your body and becomes worse and worse if left untreated. Thornton told her audience that they should take anti-inflammatory pills and sprays every day, regardless of whether they're suffering an attack. These medications would help keep their lungs from becoming swollen and constricted, she said, and bronchodilators -- the inhalable "rescue medicine" -- should be taken at the first sign of a cough to head off a crisis. Thornton, a trim woman in a white blouse and dark slacks, explained that she is an asthmatic, too, and has a 9-year-old asthmatic son who sometimes has to take three drugs every day.

"How many of you take medicine each day?'' she asked.

A few children raised their hands.

"How many brought their medicine to school today?''

Two children raised their hands.

"How many of you have been to the emergency room for an asthma attack?''

All 14 kids raised their hands.

"How many have spent the night at the hospital?''

All the hands shot up again.

After the presentation, nurse Freeman shook her head. "I didn't realize a lot of you had asthma," she told the kids. "Now next year I want you all to come see me." Although asthma has obviously been a traumatic experience in each of these children's lives, none of the parents had managed to communicate this to her. Under D.C. school regulations, it is illegal for these kids to carry around medication in their backpacks. If they need the medicine in school, they're supposed to get a letter from their parents authorizing Freeman to keep the drugs stored in a safe cabinet so she can administer them. Not one parent had ever approached her about doing this. "Three years at the school and no one has been referred to me yet for asthma."

Thornton isn't at all surprised. Suburban moms might take their kids for a well-child visit every several months. They might also have the time and energy and confidence to claw through the HMO bureaucracy to get reimbursement for those visits, and for the nebulizer (a machine hooked up to a mask that breaks up liquid medicine into an inhalable mist), inhaler spacer (a tube that asthmatics attach to the inhalers they carry around to give themselves shots of emergency medicine) and the full regimen of corticosteroid inhalants, the anti-inflammatories recommended for asthmatics. But even for those wealthier parents and the doctors they see, managing asthma is a trial made more torturous by managed care. "Let's say I have a patient in my office and their asthma is under control, but I want to see them again in a month,'' says Los Angeles pediatrician Gary Rachelefsky, until recently the president of the American Academy of Allergy, Asthma and Immunology. "The follow-up visit isn't approved. In the meantime, the patient has two ER visits, misses five days of school, etc., etc. This happens to me every day in my practice. And every day I get five messages from the HMO reviewers saying, 'You have this patient on medicine X. We want him to be on medicine Y.'"

N E X T_ P A G E: "You can't afford to let that $7.50 an hour go if the kid ain't coughing."