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    • Ashley discussing next steps with two associates

Balance of Power


Whether working with families to better manage their children’s asthma or helping residents take on an oil plant leaking toxins within walking distance of their homes, Fielding School alumna Ashley Kissinger assists a disenfranchised population in finding its voice.

For the mostly undocumented Latino residents of an economically distressed neighborhood in South Los Angeles, the health challenges inherent to living in an unfamiliar country with poor access to care are compounded by injustices all too common in low-income populations. Ashley Kissinger (MPH ’12) has become intimately familiar with two of them: the substandard housing conditions that send many of the community’s children to emergency rooms, and the toxic emissions leaked into the neighborhood by an urban oil-drilling site, leading hundreds of residents to experience health-related symptoms.

This doesn’t sit well with Kissinger, who served as a Peace Corps volunteer in Guatemala before earning her degree in Environmental Health Sciences at the Fielding School. “This is a highly diverse and vibrant community that hasn’t had a voice,” Kissinger says.

As project manager for Esperanza Community Housing Corporation, Kissinger is helping the community develop that voice. Under the leadership of Fielding School alumna Nancy Halpern Ibrahim (MPH ’93), Esperanza reaches about 120,000 people a year through partnerships with families living in the downtown Los Angeles-adjacent Figueroa Corridor on community development efforts to tackle poverty and the problems that spring from it. And as Kissinger has learned, grassroots public health strategies can make a world of difference for an otherwise marginalized community.

A group of three photos showing asthma triggers with caption.

Kissinger manages the Healthy Breathing Program, a collaboration between Esperanza and California Hospital Medical Center. With community health promoters (promotores de salud), she visits the homes of families in which a child has gone to the emergency room or been hospitalized for asthma, providing education and assistance in identifying and addressing concerns with the living environment. The program aims to reach as many as 500 children and their families. Says Kissinger: “We hope to show that an investment in public health can save hospitals a substantial amount of money through reduced trips to the ER.”

“Getting my MPH from the Fielding School gave me the tools to be able to make a difference. To be invited into people’s homes, establish relationships and use those tools to make a major impact on their lives is extremely rewarding.”
— Ashley Kissinger (MPH ’12)

The substandard housing conditions in the area help to explain why asthma can be such a problem for the children who live there. “We see families, living in terrible conditions, that are afraid to speak up because slumlords will use their immigration status as retaliation,” says Kissinger, who has given presentations to pediatric medical trainees on the importance of considering the home environment when taking medical histories and developing management plans for asthma patients. Severe infestations of cockroaches, bed bugs, dust mites and black mold – known asthma triggers – are common. Kissinger’s team has worked with a family whose 4-year-old girl has been to the ER five times in six months, living in a home with a severe cockroach infestation. Overcrowding is also common, as in the case of the family of seven sharing a one-bedroom apartment with a bathroom covered in black mold – to the detriment of their 11-year-old boy, who struggles with asthma.

At the home visits, the promotores identify asthma triggers, make recommendations for their removal and offer advice on the use of cleaning products that can help eliminate the allergens. They distribute materials such as air purifiers, as well as making referrals to quality, affordable health centers and environmental health resources. A major part of the program involves health education. “Many children aren’t on their asthma medications because their parents don’t know how to give them,” Kissinger says.

Ganar confianza – to win trust – is the project staff’s mantra. Kissinger has been greeted with apprehension by some residents suspicious that she was a bill collector from the hospital, or with immigration enforcement. “If we are going to shorten the learning curve we have to get to know families, and to do that we have to establish trust,” she says. “We are beginning to see that, and it’s leading to encouraging results.”

Trust also proved to be an asset when Esperanza assisted community members in a grassroots campaign to stop an oil producer from operating in their neighborhood.

A group of three photos of some of the children The Healthy Breathing Program is helping along with caption.

Hidden behind tall trees and high, nondescript concrete walls, an urban oil-drilling site sits as close as 25 feet from former substandard buildings purchased by Esperanza and renovated to provide quality housing affordable to low-income families. Kissinger notes that many didn’t even know the plant was there until 2010, when the company began to substantially increase production and residents started to report noxious odors, fumes and health symptoms that included headaches, spontaneous nosebleeds, chronic fatigue, eye and throat irritation, and nausea. “My 3-year-old son has constant, heavy nosebleeds,” a tenant of one of the Esperanza-operated buildings near the plant told Kissinger. “He’s never had nosebleeds before. I have to change his sheets every night because of the blood. I feel like I can’t take my kids outside anymore.”

In 2013, People Not Pozos (People Not Oil Wells) was established by community members in opposition to oil production in the neighborhood. Initially, some were reluctant to take on powerful interests. “It was a sense of, ‘We’re going to go up against this huge oil company? Yeah, right,’ ” recalls Kissinger, who helped to provide scientific background and translate exposure data for the effort. “But their stories resonated, and they kept saying, ‘We’re doing this for our children. We came to this country because we wanted a better life for them. We didn’t cross the border to live like this.’ ”

Soon, residents were holding “Pozole Not Pozos” meetings where they would serve Mexican soup and update each other on the latest developments. In consultation with Esperanza, they registered official complaints with the South Coast Air Quality Management District (SCAQMD) – several hundred over the course of three years. At town hall meetings held by the air quality agency, dozens of residents turned out to speak. Among those who became active in the campaign was the woman whose son was experiencing nosebleeds. A recent immigrant from Mexico, she testified before the Los Angeles City Council and SCAQMD, and helped to document health symptoms in the community.

Headshot of Ashley Kissinger.
Ashley Kissinger

Kissinger, who provided testimony before multiple Los Angeles City Council meetings and represented People Not Pozos in front of the U.S. Environmental Protection Agency, believes the turning point came when a Los Angeles Times article published in September 2013 attracted the attention of U.S. Sen. Barbara Boxer, who held a news conference urging the U.S. EPA to investigate and began pressuring the company to cease production until it was deemed safe. At a tour of the site by federal and county environmental health officers, several reported being overcome by the vapors. In November 2013, the oil company agreed to voluntarily suspend operations and spend $700,000 to improve the site. It was required to provide 15 days notice to the EPA of any intention to reopen. Esperanza and People Not Pozos are braced to continue the fight.

That suits Kissinger just fine. “Getting my MPH from the Fielding School gave me the tools to be able to make a difference,” she says. “To be invited into people’s homes, establish relationships and use those tools to make a major impact on their lives is extremely rewarding.”