Reporting on Asthma

In the spring of 2012, Alison Yin, a freelance photojournalist, sent me a link to National Health Journalism Fellowship at USC Annenberg. She’d been wanting to explore the issue of asthma in West Oakland for years and thought this could be our chance. 

The first question I asked -- and continued to ask myself for months, as we took in new information -- was what the story would be, exactly, and how we’d tell it in a fresh way. After all, asthma is not a new concern. And my Bay Area News Group colleagues Sandy Kleffman and Suzanne Bohan had, as part of their fellowships at Annenberg a few years ago, published the well-researched and comprehensive project, “Shortened lives: Where you live matters,” about health and life expectancy by ZIP code. It included a story about children with asthma and the connection to pollution generated at the nearby Port of Oakland.

Early on, Alison and I decided we’d cover the human impact of this often overlooked and poorly understood disease, and its disproportionate impact on low-income and African-American children. Yes, that was pretty broad -- maybe even too broad to be considered a focus at all. But we kept it that way for awhile, as we didn’t want to narrow it prematurely.

I began by digging up statistics about asthma prevalence from the Centers for Disease Control and Prevention and, for counties in California, from California Breathing. That link also takes you to county-level statistics on ER visits and hospitalizations. Matt Conens was my contact for the California Department of Public Health, which hosts the California Breathing site. After each informal request, the department provided me with an Excel spreadsheet on asthma-related pediatric emergency room visits and/or hospitalization rates, by ZIP code. The latest data available by ZIP is 2010.

After the Fellowship seminars and roughly a dozen interviews with experts, we decided that while the nation’s rising asthma rates gave the story an important context and sense of urgency, we would focus on how families manage the disease, not the rates of diagnosis. We would report on what sets off bad attacks, how some might be prevented, and the physical and social consequences of “uncontrolled asthma.”

Then I took a look at the pediatric hospitalization rates for our area: Seven of the 10 highest rates in 2009 were in Alameda County, where Oakland is. In 2010, six of the county’s ZIP codes made the top 10.

That led us to our next challenge: getting into the hospital to visit families grappling with acute asthma.

We didn’t know until early December, three months after we began trying, that we would be successful. Along the way, no one had said `no’ -- more like `We’ll see’ -- so I just kept on asking. At one point we asked ourselves whether we could do a story about asthma hospitalizations without actually seeing the inside of a hospital unit. Fortunately, we didn’t have to find out. The photos and stories that we gathered there, as our project deadline grew uncomfortably close, were crucial to the project.

Our stories about childhood asthma in the San Francisco Bay Area appeared in the Oakland Tribune, Contra Costa Times, San Jose Mercury News and other Bay Area News Group publications in late February. 

I’ll share two writing and organizational tips that I learned from other journalists. I wish I could remember who offered these approaches to writing in-depth stories, as they helped me distill a half-dozen notebooks worth of material into a few newspaper-sized stories.

Tip 1: At the end of each major reporting session, I went home and did a “notebook dump.” It didn’t take very long. I just typed up the quotes, observations and stories of the people I’d met that day. That made it much easier to scan through and pull the material later -- and I avoided having to track down an old notebook or decipher my sloppy handwriting months after the fact. (Note: Alison audio-recorded many of the sessions too, for her multimedia piece, which I had for backup and used in a couple of instances.)

Tip 2: I started my longest story by breaking it into two stories, each with its own file.

The first file was the narrative thread, generated from the families we had met. Once I started writing those stories, in short vignettes, I discovered each one had a theme: how asthma caused one child to miss school and his parents to miss work (costs); how one mother first resisted putting her toddler on daily asthma prevention medication, fearing what it would do to his body (education, treatment); how, for one child, trips to the emergency room had become so routine that a 9-year-old knew exactly what to expect (the cycle of uncontrolled asthma); and how one mother had to figure out all the things that set off her son’s asthma (asthma attack triggers).

It was easier -- and much faster -- to let the stories flow, uninterrupted by statistics and studies.  Those critical pieces of information would be inserted later. But it also was a way to make sure the real people didn’t get overshadowed by a bunch of information.

On a separate document, I listed all of the facts and figures I didn’t want to forget to consider, even if I didn’t end up using them. I didn’t want to bog down the story -- or, on the other hand, overlook anything. I wrote those bullet points as complete thoughts, though not in any particular order. I didn’t want to think about where each would go until later. Then, one by one, I began to weave them into the narrative.

Tip 3: My last tip is for journalists who only occasionally, if ever, write about health: Don’t be afraid!

As an education writer whose public health reporting had been limited to flu scares at schools, I admit I was at times painfully aware of my knowledge gaps. What was the difference between an emergency department visit and a hospitalization? Did scientists know what caused asthma, or why the rates were rising?

Early on, a source kindly suggested that I “Google `asthma.’”

But this Fellowship -- the week in Los Angeles, guidance from our Senior Fellow, Martha Shirk, and the process of producing such an involved piece -- made health reporting less daunting and even more interesting than I’d expected. In one way or another, public health touches every news beat. Now that I’m covering higher education, I look forward to working with our health writer on stories where our beats overlap. I’ll just be sure to Google the topic first.

Photo Credit:  Allison Yin