Shared+Questions+New+Orleans

=Shared Questions: Asthmatic Spaces New Orleans= = = The goal is to encourage people to think about how asthma is produced, experienced and cared for in particular spaces – in particular neighborhoods, cities, counties, or in particular countries, for example. In each place, we will ask the following:

//What spatial units (city or county limits, U.S. States, regulatory regions) are in play in the space of concern? What spatial delineations offer analytic and comparative purchase?//
 * Accounting for Asthma**

The American essayist Charles Dudley Warner remarked in the late 19th century, “I never could find out exactly where New Orleans is. I have looked for it on the a map without much enlightenment.” Similarly, I am not sure that my domain of inquiry is locatable on the map. Not only because the space of New Orleans and New Orleanians overlap less than any other North American city and its public –interestingly spilling into asthma hotspots like Atlanta, Houston, and Tennessee--but also on account of the new collectivizing of atmospheric encounters as displaced residents from all over the Gulf Coast filed into (not so) temporary mass-produced housing. (Largely back) New Orleanians were dis-lodged as the levees broke and inundated eighty percent of the city and (mostly white) Mississippi residents, who bore the brunt of the Hurricane Katrina as it swung east before making landfall, faced a similar domestic destruction. Over a hundred and fifty thousand Gulf Coast residents from Texas (due Hurricane Rita, which ripped at the inseam between Texas and Louisiana a month after Katrina) to Alabama were exposed to similarly toxic formaldehyde-laden trailers supplied by the Federal Emergency Management Agency (FEMA). Not only were Gulf Coast communities rearticulated as they came to dwell in increasingly similar indoor environments, for spatially disparate communities were also brought together in the form of a multi-district lawsuit seeking compensation for the manifold pathologies produced by long-term formaldehyde exposure (released from the particleboard walls of the trailers). This is a lawsuit with plaintiffs from across the gulf coast and legally binding consequences beyond state lines. So in many ways I am looking at little spaces that are mass produced and dispersed across a region (from the occupant’s private property to socially isolated FEMA trailer camps) as apposed to a geographically continuous space of asthma, but that latter formulation of space is not to be disregarded even if it appears to be ephemerally inapplicable. Many of the New Orleans neighborhoods historically gripped by social violence and long complicated histories of asthma epidemics in the mid-twentieth century (then the “greatest respiratory health problem in the United States”) are also those neighborhoods that were displaced at the highest rates and therefore most likely to be exposed to noxious indoor environments. In summary, I am dealing with multiple configurations of space: collective experiences of accounting for asthma (and other symptoms) in a multi-district litigation that does not trip on states lines; I am looking at a diasporic place that filters into many of the key research locales of this project; I am looking at neighborhood inequality and the production of asthma across time (ie the overlap of geographies of neglect and of geographies of respiratory pathophysiology); and, most centrally, I am looking at the interior space created by trailers.

I think my approach to and what I have seen of people trying to deal with asthmatic space has a touching resonance with Emily Dickenson’s following meditation upon her own ambiguous woe:

A nearness to Tremendousness— An Agony procures— Affliction ranges Boundlessness— Vicinity to Laws

Contentment's quiet Suburb— Affliction cannot stay In Acres—Its Location Is Illocality—

While I won’t try to weave these lines into the narratives I am seeing emerge (well, at least for now) I think that Dickenson’s term “Illocality” is one worth collectively thinking through. How does the experience of suffering, which ‘ranges on boundlessness,’ compare with our own analytics of space? Do places of illness (ie ill-localities) have have elements of non- spatiality, as the experience of illness often does?

//How prevalent is asthma, and who is tracking asthma prevalence?//

As reported by the Columbia Mailman School of Public Health and The Children’s Defense Fund (2008), a longitudinal study of 1,082 (randomly selected) displaced Gulf Coast households found that “rates of clinically diagnosed asthma among their children increased from 18% percent to 26%.”The Head-off Environmental Asthma in Louisiana ( HEAL ) Research Project, has conducted a recent study of childhood asthma in New Orleans, which finished a couple weeks after I left my during my summer (‘09) trip. The trial, which is looking at childhood asthma in particular claims to be “the largest inner-city asthma study population ever recruited from a single geographic location”( Source ).

While the data is currently ‘secure,’ the PI (informally) told me last August that it looks like childhood asthma may be on the wane for returned children, he suspects this is due to cleaner home environments of the rebuilt as opposed to original homes. So regardless of the cause, there may be a large spatial disparity of asthma in diasporic children and returned children.

//What are the costs of asthma to families affected by asthma, to government, to businesses (in lost work days, for example)? Who is producing this information?//

A HEAL plug on the City of New Orleans website states that “In New Orleans asthma is an even worse problem and is more than 3 times higher than in the rest of the nation and is believed to be the number one cause of school absences accounting for nearly 20 million lost school days each year.” This may be somewhat alleviated by this legislation passed this summer to allow students to carry asthma medication at school. Louisiana was the 49th state to pass such legislation, leaving only North Dakota with an inhaler ban in schools.

//How has asthma been covered by local media?//

The local media coverage was much more focused on asthma in the mid-1950s and late-60s when autumnal asthma regularly epidemics gripped the city center. I have an excel index of these articles and photocopies, I will try to scan them and upload them in the coming months. As of recent has not been much media coverage other than that surrounding the HEAL study ( Video Newspaper ). The troubles of New Orleans are manifold and many are very visible, so without epidemics asthma is a largely an unmentioned feature of the local healthscape.

//What kinds of civic organizations (environmental groups, patients or caregivers groups) are involved in asthma surveillance and care?//

None, to my knowledge. The Deep South Center for Environmental Justice has done some work just up river from New Orleans in a community in the Shadow of a Shell refinery, which sported childhood asthma, rates as high as 34.5%

Also, just found out about the Louisiana Bucket Brigade, who may be doing some associated work.

//What kind of research has been done on asthma-related issues in, and what are the findings?//

Contemporarily, just HEAL in NOLA, whose findings are not yet available and the above-cited longitudinal study in the diaspora, CDC promised a study several years ago but it has stalled.

As far as what //has// been done: · Haven’t made it all the way through this one yet but wouldn’t be surprised if it ended up accidently pathologizing black culture: Peterson, Jane W. [1], Yvonne M. [2] Sterling, and James W. [3] Stout. “Explanatory Models of Asthma from African American Caregivers of Children with Asthma.” //Journal of Asthma// 39 (2002): 577-590.

· Lifetime prevalence of wheezing was 39.4%, and lifetime prevalence of asthma was 24.4%. Wheezing during the previous 12 months was reported by 25.7% of the sample. Twenty-one percent of respondents reported having one or more attacks of wheezing per year, with 5.6% reporting four or more attacks per year. Many participants reported sleep disturbance (15.4%), with 6.2% reporting sleep disturbance more than once a week. The 12-month rate of speech limitation due to asthma exacerbation was 6.6%. Exercise-induced asthma was reported by 16.9% of the students, and nocturnal cough (not associated with cold) was reported by 27.3%. Overall, boys reported higher rates of symptoms than girls, and younger children (aged 6–7) reported greater symptoms than older children (aged 13–14). These findings show that prevalence of asthma in this population is elevated, Webber, Mayris P., Kelly E. Carpiniello, Tosan Oruwariye, and David K. Appel. “Prevalence of asthma and asthma-like symptoms in inner-city elementary schoolchildren.” //Pediatric Pulmonology// 34, no. 2 (2002): 105-111. · Gulf Coast yields some allergenic environments · Rabito, Felicia A., Shahed Iqbal, Elizabeth Holt, L. Faye Grimsley, Tareq M. S. Islam, and Susanne K. Scott. “Prevalence of Indoor Allergen Exposures among New Orleans Children with Asthma.” //Journal of Urban Health// 84, no. 6 (10, 2007): 782-792.

 //What social, technical, political-economic, and biophysical features of the city (and its population) may contribute to asthma prevalence and patterns?//

Simply put, New Orleans has wall problems. As mentioned above the formaldehyde paneling in the trailers yielded a noxious living space, but in addition to that the very walls that delineate lake, river, industrial canal and city are inadequate. As can be deduced from the topographical map I have uploaded to the AF site about 50 percent of the city lies below sea level. It is not surprising that income is correlated with elevation and crime inversely so. These salient geopolitics are all the more important due to New Orleans’ high nativity rate (the highest urban rate in the country I have been told) and unprecedented numbers of families that even stay on the same block across generations. Exposures to industrial site-specific industrial toxins are thus compounded. Can you guess which NO neighborhoods hosts Louisiana’s largest polluter?

New Orleans is a poor city and has had housing quality and quantity problems since the 1930s.

FEMA trailer camps were intentionally inhospitable. Camps lacked community space and as a result they felt like ghost towns. Children would return from school and go straight to into their chemical filled trailers and hunker down.

Sen. David Vitter (LA) held up the senate approval of Paul Anastas as EPA's Director of Research and Development in order to slow down the toxicity reports on formaldehyde. Read about it on one of my informant’s blog

//Are there notable occupational drivers of asthma in this area?// There was a first diagnosis of a respiratory disease associated with workers handling sugar cane was in NO, but I am unsure of its relation to asthma.

There are associations with coffee bean processing in NO with sensitization in the 1980s, but I don’t think that it translated into asthma.

Also there may be some maritime occupations that cultivate asthma but these do not appear to be a major contributor to asthma in the city.

//What is known about air quality and dynamics?//

Historically asthma epidemics were associated with temperature inversions, and slightly correlated with winds from the southwest.

National Resources Defense Council has some neighborhood-by-neighborhood indoor and outdoor air quality test results.

//What can be learned about cumulative community risk using EPA databases and assessment tools?//

hmmmm, I think these questions are not really geared for the kind of etiologies I am looking at. NOLA might just be somewhat of an oasis in a region of severe air quality issues. The 2007 Louisiana air burden report stated that lifetime asthma diagnoses were higher in rural (11.3%) than urban (9.6%).

//How is asthma experienced by diversely situated people?//
 * Experiencing Asthma**

(More Formaldehyde than just asthma) Videos 1 2 3 4

For, perhaps, problematic assertions of different asthmatic experiences see:

Peterson, Jane W. [1], Yvonne M. [2] Sterling, and James W. [3] Stout. “Explanatory Models of Asthma from African American Caregivers of Children with Asthma.” //Journal of Asthma// 39 (2002): 577-590.

//How is the space of concern conceived as a site of health, environment and politics? Is the space known as an asthma “hotspot,” for example?//
 * Comparing Asthmatic Spaces**

Hot Spot? The trailers, yes. New Orleans, no (compared to the rest of the state). The asthma heavy parishes (LA’s equivalent of a county) are largely clustered in the northeast and the south.

//How has asthma in the space of concern changed since 1985? Are there new organizations working on asthma? Are there new technologies or treatments for asthma? Are more doctors or medical centers caring for people with asthma? Are pharmaceutical companies involved in new ways? Have government agencies changed the way they think about and respond to asthma?//
 * Histories of Asthma**

See “Dimensons” under asthmatic spaces New Orleans.

Picking up where that piece leaves off: “asthma continued to be one of the biggest problems in Charity’s Emergency room throughout the 1980s and into the 1990s. An area know as the asthma cubicle is usually filed with patients, lying on tables, who are treated with intravenous and aerosol bronciodilators, cortisone and oxygen. Their arivale in large numbers in the emergency room is anticipates when the weather changes, especially in the late fall during periods of thermal inversions. The line of asthmatic patients awating treatment is often backed up, and with current budget cuts, there are sometimes not enough medications to treat them. [Dr.] Lauro laments that in 1986 the supply of basic medications in the emergency room at Charity was lower than ever before. ‘At times we’re completely out of ordinary anti-asthma medications [… recently] we had no broncoodialtors. (Salvaggio 1992 //New Orleans' Charity Hospital: A Story of Physicians, Politics, and Poverty:// 269-70).