Children with asthma in the dusty and impoverished Imperial County are far more likely to visit the emergency room, costing taxpayers for care often covered by state and federal health care programs.
One in five children ages 5 to 17 in the county has been diagnosed with asthma, which can be managed with medication. The rate of youngsters visiting the emergency room for asthma treatment is three times higher than the state average, according to the California Department of Public Health.
Marco Cisneros, 8, of Calexico, has visited the hospital nearly 50 times. His parents bought him a bicycle last year, but he is afraid to ride it.
On his birthday earlier this year, Marco blew out the candles and had a single wish: "I just want to run."
"He asks me, 'When am I going to be cured?'" his mother, Susana Tolentino, told the Los Angeles Times. "I would like a doctor who is magic, that they would tell him that he wouldn't have any more asthma crises."
Barbara Worth Junior High School in Brawley has so many students with asthma that the principal issues air quality alerts to teachers and regularly cancels outdoor activities.
"It impacts everything," Principal Luis Panduro. "It is a major issue."
Doctors and public health experts are unsure why Imperial County leads the state in hospitalizations for asthmatic children, but they note several factors that may exacerbate the problem.
The hot, dry county near the Mexican border is mainly desert and farmland and dust, some of it laden with fertilizer and pesticides. That may play a role, along with pollution from Mexico. The region far exceeds federal health standards for airborne particulates.
"All that smoke and air lingers and doesn't go anywhere," said Kimberly Calderon, a nurse practitioner.
About 20 percent of the 177,000 residents live in poverty, and some may use the emergency room to obtain care because they lack health insurance and regular doctors, said Afshan Baig, chief medical officer of the Brawley-based Clinicas de Salud del Pueblo.
Some children may not know how to manage their asthma, said Luz Tristan, a Calexico physician.
"They don't think a daily medication is needed, so they will stop taking it as soon as they feel well," she said. "It's denial and poor compliance."
ER visits for asthma also carry a taxpayer cost. More than 60 percent of asthma-related ER visits and hospitalizations in the county, for both adults and children, are paid through Medicare and Medi-Cal. The hospitalizations cost an average of about $16,600, the Times reported.
