Complicated Circumstances: Asthma and Incarceration

Sep 16 · 3 min read

By Enrico Cullen

Part 2

This is the second part in a series about Mariluz Garcia, an AIRnyc Community Health Worker. Mariluz has been helping a mother navigate gaps in health and social care, a process that intensified this year due to intimate partner violence and housing instability. The mother also has two sons who have been diagnosed with severe asthma. Part 1 is available here.

A family’s journey through New York City’s shelter system and in hospitals can be harrowing, and even more so following a father’s return from incarceration and his threat of violence. To put the severity of the circumstances in context, I read a 2016 Economic Policy Institute review of studies on the impact that having an incarcerated parent has on a child’s well-being. The review incorporated a range of studies across disciplines, including criminal justice, health, sociology, epidemiology, and economics.

Asthma stood out among many challenging conditions identified in the studies:

“The pathway between stress and asthma is also worth explaining, as an understanding of it can help shape policy solutions. Psychological factors — a child’s own mental and emotional state as well as his or her mother’s — can trigger the onset of asthma as well as worsen the disease. If a mother is emotionally unwell — for example, if she is dealing with the stress of her partner’s incarceration — her mental state is likely to increase her child’s physiological response to harmful external stimuli as well as disrupt the child’s hormonal production. The child may appear fine externally, but these internal biological changes can contribute to the later onset of asthma.”

Since Part 1 of this blog was published, the mother and her two sons continued to free fall through crisis in April and in the following months. They missed an appointment with Dr. Joshua Needleman because they were moved to a new shelter after the children’s formerly incarcerated father searched for and found them there. The man had threatened them with violence and the mother was fearful that he might harm her or the two boys.

The stress caused one of the sons to have an asthma attack, for which he was hospitalized at BronxCare Health System. Mariluz was there to assist, providing information in Spanish about asthma medications and Dr. Needleman’s Brooklyn clinic, where Mariluz had first met the family. Mariluz briefed the BronxCare doctor regarding the child’s asthma and translated for the mother. The doctor also wanted to speak with Dr. Needleman over at Maimonides Medical Center. Continuing to be the bridge and translator, Mariluz connected the two clinicians and they discussed a plan of action to help the mother and the boys. Unfortunately, the family had to move to yet another shelter in the Bronx later that week, an additional stressful moment that strained the family and caused yet another asthma attack. The boy was again admitted to a BronxCare on a Friday, was intubated the following Sunday, and spent another three days in the hospital. The mother decided to stay in the Bronx, hoping the father would not find them again. Mariluz has continued to help along the way. As of September 2019, the mother and her two sons remain in a shelter and are piecing their lives back together. The boys’ asthma is under control, at least for now.

This is the professional life of a Community Health Worker. Mariluz engenders trust, fills the gaps in understanding, clarifies concepts, and facilitates communication. She is the link that helps this family find the care they need to stay safe and hopefully live healthier lives. But she also assists the clinical staff, ensuring that their care plan is followed properly and that their guidance makes as big an impact as possible. Incarceration, housing insecurity, intimate partner violence, and poverty have directly affected health of these two boys, as evidenced by the severity of their asthma, while also harming the mother’s wellbeing. In this context, it’s not difficult to see that so much of what makes us healthy starts where we live, work, play, and raise families.

Enrico Cullen is AIRnyc’s Chief Strategy Officer.


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AIRnyc’s Community Health Workers meet people where they live to improve health, connect families to social care and build health equity at the community level.

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