On a bright Saturday afternoon in a park on 23rd street, four-year-old Arianna runs through the playground laughing with her dad. Then she slows down, and you can hear a soft wheezing when she breaths.
“When she runs a lot, she starts coughing,” her father Luís said in Spanish. “It’s got me really worried, because we’ve never heard of an asthma problem in my wife’s family or mine.”
After a few seconds, Arianna catches her breath again, and the beautiful little girl who looks like a miniature Frida Kahlo runs off to play on the slide.
Sometimes she doesn’t feel better so quickly.
“Last night she cried for more than a half hour because she was coughing so much she couldn’t go to sleep,” said her mother Mónica, struggling to fight off tears. “When it’s really bad her lips turn purple. She can’t breathe, sometimes she can’t even move.”
Since Arianna was diagnosed with asthma in March, she’s been to the hospital six times, three of which were emergency room visits. Every day she uses a regiment of inhalers.
That’s a lot to handle for a four-year-old, but respiratory problems like Arianna’s are common in the Mission District, which has one of the highest asthma rates in San Francisco.
Asthma sent people to the hospital and the emergency room in the neighborhood at nearly twice the average rate for the whole city from 2005 to 2007, according to a study by the California Office of Statewide Health Planning and Development.
It affects more children than any other chronic disease in the country, and hospitalizations due to asthma contribute to overspending on health care, said Karen Cohn, chair of the city’s Asthma Prevention Task Force.
The average charge for an asthma hospitalization in California was nearly $24,000 as of 2005, according to a study by the California Department of Health Services.
Since government-funded health insurance programs pay for 60 percent of asthma-related hospital visits around the state, the disease cost tax payers $550 million that year.
Experts said one of the main reasons asthma rates are so high in the Mission, the city’s oldest neighborhood, is because of the age of the buildings. Many are plagued by mold, dust and pests, all of which are toxins known to lead to respiratory trouble.
“The fact of the matter is that there is a lot of sub-standard housing here in the Mission,” said Fernando Gomez-Benitez, deputy director of the Mission Neighborhood Health Center. “There are houses where carpets haven’t been changed in over 20 years and you have overcrowding and problems with mold. That’s not really a conducive place for a kid to be breathing clean air.”
Health and building code violations were nearly twice as common in the Mission as the city average in 2008, according to data from the Department of Public Health and the Department of Building Inspection.
Mónica said she constantly cleans to make sure the household environment doesn’t aggravate her daughter’s respiratory problems. The apartment is full of natural light and well ventilated, but each night a fine layer of mold creeps back onto the bathroom walls. It’s probably inside the structure of the old building the family lives in.
Even small amounts of mold can impact respiratory problems, but many undocumented immigrant families live in apartments where they are exposed to all kinds of dangerous conditions, experts said.
“We have seen a different level of exploitation where they are in a unit that is not meant to be habitated—somebody who’s subdivided a garage or put electricity out to a shed,” Cohn said.
“I’m not just talking about an in-law apartment, but they actually created spaces that aren’t supposed to be occupied, and people are paying rent for them.”
Illegal housing is often run by a master tenant who rents rooms out of a rundown apartment to young families who can’t afford to for pay anything else, said community organizer Oscar Grande, of PODER, a Mission-based community organization.
That often leads to asthma and other respiratory problems, he said.
That’s exactly what happened to Olga Hernández and her husband Wilfredo Osario Montenegro, who paid $600 a month to split a room with another family in an apartment that was home to 11 people on South Van Ness.
“The cockroaches crawled on us at night because we slept on a cushion on the ground,” said Hernández, who stands five feet tall and wears her thick hair in a bun. “Our room was especially infested. The carpet was really dirty, deteriorated and damp. The kitchen was like that too—it was the whole apartment.”
When the couple complained about their living conditions, the lease holder became threatening, Hernandez said.
“She always said she would call her lawyers, the police or immigration,” Hernandez said defiantly. “I’m just an illegal immigrant, but I wasn’t afraid.”
Hernandez was eventually forced to go to the hospital when she began to struggle for breath and was bedridden by a terrible cough and a pounding headache.
She had to pay $400 for the visit, she said.
“I think it gave us sinusitis, problems with our noses and breathing problems,” said Osario, who looks his 23 years but acts much older.
“We lost our sense of smell,” added Hernandez. “It’s really hard for us to breathe these days.”
After Hernandez was hospitalized, the couple filed a complaint with the Department of Building Inspection in August 2007.
Shortly thereafter, the apartment on Van Ness was issued nearly 20 housing violations for problems including a rodent and roach infestation, deteriorated carpets, mold in the bathroom, leaking pipes, dry rot and loose lead-based paint, according to documents obtained from the city.
The building was ordered to be reformed, and it now shows no signs of unsafe conditions.
Meanwhile, Hernandez and Osario moved out and now rent a garage in the Excelsior District that has been converted into a studio.
But a small patch of mold is starting to appear in the bathroom, and the couple continues to have trouble breathing.
The slumping economy, Hernandez said, means more families than ever are confronting unhealthy environments.
“It’s terrible, because now they are renting closets and kitchens and making profit,” she said. “If you’re poor you can’t afford to live in a small apartment.”
Back in the Mission, Mónica said she’s missed 10 days of work, using all her sick days to take care of her daughter when she has asthma attacks.
Arianna will start kindergarten next year, and Monica is afraid she may have trouble learning because of the regiment of asthma drugs she takes, which help her breathing but make her hyper and unfocused.
The family is determined to find a solution, Mónica said, but the doctors still don’t know exactly what’s causing Arianna’s asthma, and changing apartments is no easy answer.
“I know families living three or four to a room,” Mónica said. “I’m ready to move out from here, but since rent is so expensive throughout San Francisco, where am I going to move?”