Health Workers Try Community Approach To Tackle Asthma On Navajo Reservation

This story was produced as part of a larger project led by Eilis O'Neill, a participant in the 2019 National Fellowship.

Other stories in this series include:

On the reservation, asthma is especially tough to control

Students Want To Fix Air Quality For People With Asthma On The Yakama Reservation

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Asthma is on the rise across the U.S., and people of color are more likely to have asthma.

On NATIVE AMERICAN reservations, the problem is particularly grave. Asthma rates are high, and the cases are often severe.

Researchers are trying to understand some of the environmental factors influencing asthma among children on the Navajo Nation.

Reporter Eilís [eye-LEASH] O’Neill traveled to the Navajo Reservation in northeast Arizona and has this report.

OUTRO: That story was funded in part by the USC Annenberg Center for Health Journalism.


Ambi: reservation ambi

0.27: The Navajo Reservation is a vast desert landscape--more than twenty seven thousand square miles. That’s about the size of West Virginia.

It’s dry, dusty, and windy, and bitterly cold in the winter.

Chelsea Holtsoi lives on this reservation, with the five of her children who are still at home.

Ambi: Holtsoi home

Her son Ethan is ten. He likes playing football with his friends, and his favorite subject at school is math.

When he was younger, Ethan was often really sick.

Once, when he was three years old, he got a terrible fever.

Act: CH1, 0.13

He’s burning up. I started getting scared and ice water we got. We put a rag in it. We rung it out. We’re just wiping his body down. Pretty soon the water was warm from just wiping him down.

0.06: When the ice water didn’t help, Holtsoi gave her son ibuprofen, but she says his temperature just kept going up.

Act: CH2, 0.06

It’s really a scary experience, especially when they’re that small. It just hurt just looking at him.

0.17: Holtsoi rushed him to the nearest clinic. There, the doctors told her Ethan didn’t just have a fever: he was having an asthma attack, and his oxygen levels were alarmingly low. They wanted to send him to an intensive care unit in Phoenix, which would be a five-hour drive AWAY.

So Holtsoi and Ethan boarded a med-evac plane, and they went.

Act: CH7, 0.09

I just kept looking at him and I was scared. And I just kept praying and praying and praying when we were in the plane. No parent should ever experience that.

0.20: Ethan had to spend about a week in the ICU before he was well enough to leave.


The National Institutes of Health reports that approximately thirteen percent of American Indian children has asthma, compared with nearly nine percent of children in the general population.

The Navajo Nation has the largest population of all Native American nations, and the reservation spans across three states.

Act: DH1a, 0.03

The environmental exposures here are impossible to control. 

0.05: Diana Hu is a pediatrician who’s worked on the Navajo Reservation for thirty-five years. 

Act: DH1b, 0.07

We have, you know, Russian thistles or tumbleweeds everywhere. We have elms everywhere. We have cottonwoods everywhere. 

0.19: Those are all plants that can set off kids’ allergies, which can trigger an asthma attack.

There’s some evidence that climate change is increasing the amount of pollen in the air, which some researchers say is contributing to the rise of asthma.

Coal mines and long rides on diesel school buses also contribute to asthma on the Navajo Reservation.

And there’s something else:

Act: CH4, 0.08

We always had a wood stove. That’s one thing I didn’t really want to use as a heating source, but it’s all we could afford.

0.23: That’s Chelsea Holtsoi again. Like sixty percent of families here, she heats her house with a wood stove. 

Ambi: Holtsoi home

It’s black, with a little door for putting wood in and a wide stove pipe coming out of the back. It has no filter to keep smoke and ash out of the cabin—the way more expensive wood stoves do.

Holtsoi says she can’t afford anything else, though she wishes she could.

When it’s smoky, it triggers Ethan’s asthma.

Act: CH5, 0.10

He gets really mucusy. It’s like boogers, and it’s like you can hear it. You can hear those boogers, and he’ll try to spit it out and sounds congested.

0.09: To try to keep him healthy, Holtsoi makes sure the stove pipe is clean so smoke won’t blow back into the cabin. 

And she always has a pot of water on the stove so there’s steam in the air.

Act: CH6, 0.10

The doctors told us to make sure you always have a pot of water to keep the air kind of humid, not dry.

0.13: In the past, when federal agencies like the CDC tried to help lower asthma rates on the reservation, the efforts were often met with resistance because of mistrust of the government. 

That’s why, on some reservations, researchers and health care providers are trying new, community-based approaches.


Act: LG1, 0.09

We’re basically taking proven interventions that we’ve done on non-Native communities and adapting them for these Native communities.

That’s Lynn Gerald. She’s a professor at the University of Arizona who’s developing a community asthma education program on the Navajo Nation.

Gerald and her team are working with health representatives from the Navajo Nation to reach out to families to improve their care of children with asthma. She says families and schools can make minor changes that can help prevent asthma attacks. 

For example, to help kids avoid breathing in diesel exhaust from school buses, 

Act: LG3, 0.16

One of the things that can be done is keeping the windows up on the bus so that the diesel that’s outside doesn’t get in. If the pollen levels are very high, then a child with asthma might need to stay indoors that day rather than going outside for P.E. or outside to play.

Gerald says educating the community has been challenging.

For one thing, older generations on the reservation aren’t always familiar with the condition. There isn’t even a word in Navajo for “asthma,” so it’s hard to explain to grandparents, who are often the caretakers, that it’s a chronic condition that needs regular medication.

Ambi or something to transition back to the Holtsoi family?

Back at the Holtsoi home, Ethan and one of his brothers sit on a couch next to their mom, eating chips.

Ethan is now ten and is doing better.

Holtsoi says the doctors put him on a new medication,

Act: CH8, 0.14

He’s been doing pretty good in PE and stuff.

Kid’s voice: He usually plays football.

Mom: I usually tell them, like, if you’re going to go running, make sure he takes a puff before he does his workouts.

Kid’s voice: Mom, he plays football and tackle.

Mom: I just want him to get better.

0.03: For Here and Now, I’m Eilís O’Neill.

[This article was originally published by wbur.]