The Story of Fransheska and Her Younger Sister Yolamar

Monroe Plan for Medical Care (Rochester, N.Y.)

Fransheska and younger sister, Yolamar, members of an immigrant Puerto Rican family living in Rochester, N.Y., have had asthma since early childhood. Their mother, Yolanda, remembers one particularly frightening experience. She was rushing Fransheska, then a toddler, to the hospital for treatment and got caught in a traffic jam. Unable to breathe, the little girl started turning blue.

The disease also had less dramatic impacts. Their mother calls the two girls her "little fishes," a reference to their favorite activity, swimming. Asthma used to keep them out of the water. Some days it also kept them out of school, a particular disadvantage for youngsters learning in a second language.

Thanks to an asthma control program developed in Rochester by the nonprofit managed care organization Monroe Plan for Medical Care, those problems now appear to be in the past for Fransheska, Yolamar and their mother.

In August 2002, the Monroe Plan identified Yolamar, then 7, as a high user of medical services and sent her mother a letter inviting her daughter's participation in a new program aimed at demonstrating model asthma control measures. During a follow-up home visit conducted by a bilingual outreach worker, the mother explained that Fransheska, then 12, also suffered from asthma and would benefit from participation as well.

The two girls, both classified as having moderate-persistent asthma, received a prescription for controller medication and underwent allergy skin-testing. In addition, the family got asthma education and a home environmental assessment that resulted in mattress encasings to combat dust mite allergies and a HEPA (High Efficiency Particulate Air) filter for the furnace.

Over the program's two-year follow-up period, the outreach worker kept in close contact with the family, making 18 phone calls to facilitate the girls' medical appointments and helping with transportation arrangements, including providing taxicab service.

After the two years—with controller medication, an understanding of inhaler use, support from their school nurses and the in-home improvements—the two girls were leading normal, active lives and had no current asthma problems, according to their mother.

She reported that Fransheska, in addition to being sure to take her daily medication, was even wearing a mask when she cleaned her room to prevent dust inhalation.

(Based on information and quotations reported to RWJF by the grantee organization.)

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