Dr. Lisa Patel (4:26)

My daughter started kindergarten on Zoom during those wildfires. And so we were trapped inside for days at a time while she did a few hours of Zoom with her fellow kindergarteners. And it felt apocalyptic. Well, it was apocalyptic for a day when our sky turned orange. I'm a pediatric hospitalist, so everything shut down in March, and I was still going into work when we didn't know how Covid got transferred. We didn't have enough ppe. I was updating my wood because I wasn't sure, you know, what. What risks I was exposing my kids to. So all of that is happening and then on top of all of it, we had a really terrible wildfire season. And I remember leaving my house. There was ash on the ground as I was walking to my car. And then I walk into our hospital and the smoke outside was so overwhelming, you could actually smell it inside the neonatal intensive care unit where I work. And it. It just felt crazy. We live in this country, which is very well resourced, and I'd always like to think that I'm doing the best that I can for my patients and particularly premature infants that are, you know, 32 weeks and up and feeling that day like I couldn't. The world had set me up for failure.

Gloria Rivera (5:40)

You mentioned smoke in the neonatal ward. What is that smell? What does it smell like?

Dr. Lisa Patel (5:47)

Oh, smells like distress. It smells like.

Gloria Rivera (5:51)

Smells like distress.

Dr. Lisa Patel (5:53)

Yeah. I don't know. It burns your nose. I actually have asthma myself, so whenever I smell it, the first place my mind goes to is like, well, where are my medications? I need to start taking them. That's where my train of thinking goes. For any of us that have smelled like a campfire before, it smells a little bit like a campfire, but it smells more rancid than that, more toxic than that.

Gloria Rivera (6:17)

The wildfire smoke likely carried pollutants that spread for miles and miles. And unlike hospitals, not all homes have the filters needed to keep the bad stuff out. The most concerning type of pollutant in wildfire smoke is particulate matter, or PM2.5. It's a huge health risk, especially to our youngest.

Dr. Lisa Patel (6:38)

We used to think that the placenta provided some protection, but we've actually found evidence of this pollution in a developing fetus. And actually during the Australian wildfires, obgyns there said that they delivered blackened placentas. The amount of wildfire smoke there was so overwhelming. Now, that PM2.5 pollution, it causes premature mortality, certain forms of cancer, cardiovascular disease, asthma, in the long term in terms of exposure. And what's concerning about wildfire smoke is that we think it's up to 10 times as toxic as the regular air pollution we breathe from burning fossil fuels. All of these things are toxic to any human being, but particularly to infants and young children because their lungs are rapidly developing, developing in those first few years, and pound for pound, they're breathing in more of it because they breathe faster than an adult does.

Gloria Rivera (7:30)

Dr. Lisa says these pollutants are known as respiratory irritants, which does exactly what it sounds irritates. It irritates your nose, mouth and lungs. These pollutants can trigger wheezing or even asthma.

Dr. Lisa Patel (7:46)

So asthma is the most chronic childhood condition. Six million children in this country suffer from asthma, and we expect the number of asthma cases to get worse with worsening wildfires. We do see more children showing up to the emergency room during periods of wildfire.

Gloria Rivera (8:04)

What do you see in the patients you treat today? What does asthma look like in them?

Dr. Lisa Patel (8:09)

Not only are there millions of children who suffer from asthma, but there are huge disparities in who suffers from asthma. And so we see more often children of color, black children, Latinx, Hispanic children tend to be disproportionately impacted. And that's multifactorial. So one of them is straight up structural racism. So places that are redlined are more likely to have things like freeways go through them, toxic industries that live close by, because these are communities that are considered politically disenfranchised. And so let's place the polluting facility there. And so these children, like I said that we know that that pollution crosses the placenta. So children, before they've even taken first breath, have already been exposed to this pollution, and then they're continued to breathe in that poll that is damaging their lungs.

Gloria Rivera (8:59)

And how often, how often are you seeing children between the ages of 0 and 5 diagnosed with asthma?

Dr. Lisa Patel (9:06)

Oh, it's, it's like the number one reason why I get called to the emergency room is, is asthma or a kid that's wheezing. Yeah, it's very common.

Gloria Rivera (9:15)

And in your mind, there is a clear link between asthma and the wildfires and climate change.

Dr. Lisa Patel (9:21)

It's hard to know for an individual child that comes in what is driving that child's asthma, but I'll tell you. We know, for example, that climate change is driving worsening pollen seasons. So more pollen and pollen that is around for longer. And we think that does two things for kids. One, we think it potentiates more kids to be allergic because there's so much more of it around. And then second, if a kid is potentiated, it tips them into having an asthma exacerbation. And we're seeing more of that. So more, more kids are having asthma attacks because of a worsening allergy season. More kids are having asthma attacks because of hotter days that are driving more ozone, also because of climate change and then wildflo pollution on top of it.

Gloria Rivera (10:03)

We're going to take a quick break. When we get back, Dr. Lisa gives parents and caregivers advice on how to help kids in this changing climate.

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Gloria Rivera (12:15)

We're back. Dr. Lisa is watching the effects of the pandemic and wildfires collide. Between the airborne virus and the smoke, air quality suddenly became a big concern, especially in schools. It was more important than ever to ensure kids could breathe and clean air.

Dr. Lisa Patel (12:34)

I was not an expert in ventilation. I became one because my daughter was at a public school and many of the interventions that we were talking about for Covid had to do with air quality, how to improve air quality. And so I became an expert. I learned about H vac systems, I learned about portable air filtration devices. What I learned in that process was how under invested our public school infrastructure has been. So in California, I think we estimate something like an $8 billion infrastructure gap. And it became painfully clear right when the CDC was coming out with its guidelines of we'll open the windows to allow fresh air in finding out that a lot of schools had their windows painted shut because they lived in over police neighborhoods where security was a concern. So what I was worried about is that we were doing patchwork solutions for Covid and that the next year when kids went back to school in person in San Francisco Unified, they were just going to open the windows. And I was thinking to my what's going to happen? You're going to open the windows to protect from COVID but then you're going to let that fouled wildfire smoke in? Sure enough, that is exactly what happened. And so I was on the phone with somebody from Department of Public Health asking, well, which one is worse? Is it worse that they sit outside in the wildfire smoke for lunch or is it worse that they sit inside and take their masks off and potentially get Covid? And I'm thinking this is insane. You know, like this is like being caught between a rock and a hard place with a poo storm on top. This is not a position we should be placing any of our children.

Gloria Rivera (14:08)

No, we definitely shouldn't. Iraq and a hard place and a poop storm. That is not good. But, Dr. Lisa, I do want to ask you, with everything that was going on, what were you most worried about when you were treating kids during the wildfires?

Dr. Lisa Patel (14:24)

This is another piece, frankly, of my anxiety is that I think a number of families don't know or don't understand what the risks are, especially for their younger ones. A lot of the families that I work with in the nursery are medi cal patients. High levels of food insecurity, high levels of levels of housing insecurity, high levels of energy insecurity. So I've made it a practice of mine to talk to all of my families about whether they have access to air conditioning, because there's a higher risk of mortality in the first week of life for infants born during a heat wave. But to me, what makes me more worried is how poorly we've done both in my own profession, amongst health professionals, but how in the public health community, I feel like we're behind on educating the public on what the risks are, especially to young infants and to young children, and making sure that caretakers, parents, teachers are all aware of what those risks are to keep them safe.

Gloria Rivera (15:16)

Dr. Lisa, when you look back at the wildfires and what your kids experienced, what are some practical tips you wish their teachers or their schools had known?

Dr. Lisa Patel (15:27)

Yeah, I'm sure that daycare facilities have to have some checklist in terms of emergency preparedness, and I think climate preparedness should be built into that. So being taught to be thinking about, like, what the temperature is indoors, outdoors, and be thinking about checking the air quality index and making sure the kids are staying inside more if it is a poor air quality day, for example. But then the flip side of this, I'll say, right, we've talked a lot about the problems, also creating opportunities for hope and for rejuvenation. And so really putting more of our resources into creating green spaces for kids, not only because it makes the outdoors safer for kids to play in, but also ensures that kids have the opportunity to be outside because they can't go playing on an asphalt playground that that could give them thermal burns, but they can be underneath some trees, you know, on a hot day and still get that time outside. I was actually recently asked to review some materials for Sesame street that they're putting together for kids to start teaching them some of these principles about climate change. And as I was reading through it, I was thinking we should Start building in the nuggets of information for kids as they can receive it and as they can have some agency to do something about it. Right. You know, I've noticed with my kids, and I don't know if you have noticed this as well, is that. But often they feel more anxious or afraid of something when they don't understand the why. And so if we can start building in the why for our kids earlier, yes, this is all distressing and it is scary. But if we can build their agency in terms of knowledge to start and then the solutions as they continue to grow in their education, I think it's an opportunity to take something that is distressing and turn it into a positive for a better world.

Gloria Rivera (17:10)

Well, Dr. Lisa, this conversation in its entirety gives me a lot of hope and was inspiring. I just want to thank you for sharing your clearly deep expertise on all of this. You've broken it down. You've made it digestible for us and our listeners. And that is a great gift. So thank you very much.

Dr. Lisa Patel (17:28)

Thank you so much. It was a pleasure being here.

Gloria Rivera (17:32)

We're going to take another break. When we get back, I'm joined by Susan Gilmore. She's the director of the North Bay Children's center in Northern California. After schools closed down during the wildfires, Susan and her team knew their work was just beginning. That's after the break.

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Gloria Rivera (19:35)

Susan, can you take me back to a moment when you first started to realize, okay, wait a minute. Climate change is the issue for us.

Susan Gilmore (19:44)

I would say probably the most recent drought cycle in California because we're hearing about climate change and now we're experiencing what we're seeing as more impact, intense, a longer, more intense drought, drought after drought and then you know, obviously the fires that having a climate related catastrophe like something none of us have ever seen before was a huge, huge wake up call for us.

Gloria Rivera (20:14)

Susan is talking about her team at North Bay Children's center which provides high quality childcare and preschool programs. Susan has worked in childcare for over 40 years and helped co found the center. In those early days, North Bay had a maximum of 60 students. Today they enroll over 600 students across 13 soon to be 14 locations. Tell me who the children and families are that the North Bay Children's center.

Susan Gilmore (20:42)

Serves most of the families that we serve. English as a Second Language. The families we serve live at or below the poverty level and they are our essential employees and they are our vineyard workers. They work in hospice hospitality. They are the backbone of our local economy and could not live or work here without affordable child care. Most of them are qualified for state subsidies and that's how they're funded. And then we do have families that don't qualify for subsidies. But you know, we refer to some of these families as our working poor that, you know, they live in a very expensive area. And while they don't qualify for subsidies, it's still childcare is a huge expense. It's the next largest expense in the family budget after rent or a mortgage. And that's just with one child. And if you have more than if you have two children, it's almost cost prohibitive. And the other thing that's changed since I was a young teacher is how much time children spend in childcare and you know, having those family support services as well. It's not just childcare. When you're working with a population that is a vulnerable population, you are so much more than just the childcare program.

Gloria Rivera (21:59)

Walk me through what happened during the most recent fires, how you had to pivot and what roadblocks you encountered.

Susan Gilmore (22:09)

All 13 of our locations are in climate vulnerable areas and nine of which were in evacuation areas multiple times over the three years of fires. And the very first fire, the Tubbs fire, you know, came in the middle of the night without warning. And I got a call from my program director at three in the morning, hysterical, you know, her parents home just burned down. In Santa Rosa, Cal.

Unknown Advertiser (22:36)

Fire says three of the top five deadliest wildfires in our state's history happened since 2017.

Gloria Rivera (22:43)

And one of those was the Tubbs.

Unknown Advertiser (22:44)

Fire in Santa Rosa.

Susan Gilmore (22:45)

22 people were killed.

Gloria Rivera (22:47)

The Tubbs fire was one of the most destructive fires in California history at the time. For even seasoned residents, it was a catastrophe unlike anything they'd ever seen. Since then, intense and disastrous wildfires have become the new normal.

Susan Gilmore (23:04)

There was not a system that was easy to navigate with all this. There wasn't a playbook. So the first thing we're thinking about is, you know, we need to account for everybody, all of our teachers. You know, we started a phone tree at 4am Finding everybody. So we were using phones, Facebook to communicate with our parents. We created Google Docs that we were real time tracking where the parents were. Were they in a shelter, were they with a family member somewhere else or a friend? Where are the kids, what are they going through? And how do we get them into a classroom with their teachers, with their friends and with a predictable routine while this is all going on and we have no idea when it's going to end?

Gloria Rivera (23:54)

For the next week, 24, 7 Susan and her team were in crisis response mode. While schools and non evacuation areas stayed closed, Susan prioritized reopening their childcare centers as soon as possible. Even during a disaster, Susan wanted to make sure kids could have a stable, predictable routine. They even opened an additional classroom specifically to look after children of firefighters. Because Susan and her team went above and beyond in their jobs, Essential workers could do what they needed to do.

Susan Gilmore (24:26)

Our families are essential employees and they're needed in the community right now. That's where we are, the first responders for the first responders. Which played out the same way again with the pandemic and our medical first responders. So that was our aha moment and realization that childcare supports all these other industries. And without it, these parents who are needed right now during this disaster can't go to work and do what they need to do to keep us all safe.

Gloria Rivera (24:56)

Childcare centers are scrappy and creative by nature. They have to be because they're constantly running on razor thin margins. Despite providing resources on par with social services, Susan says the center was actually able to expand their services after the wildfires thanks to pandemic funds from the federal government. But a huge chunk of that money, 24 billion expired in September 2023. That's left a lot of childcare centers just hoping they can keep their doors open.

Susan Gilmore (25:28)

90% of our budget is funded by state funding. And we're all scared to death because the childcare programs that are state funded, like the North Bay Children's center and all the things I've been describing is dependent on that funding. A consistent, stable funding sour. And having that, I could tell you it's the first time in my history of the 36 years of running North Bay Children's center that I wasn't waking up in the middle of the night trying to figure out how to cover the payroll we just released a week ago. Being funded the way we should be funded had such an impact on the children and families in our care and the professional development of our teachers and the organization's strength. The fires really prepared us for the pandemic. The playbook that didn't exist before now did. There were many providers that were like, we're not going to put our teachers, you know, in danger. You know, it's always the child care community that has to do this. And my feeling was if there was ever an opportunity for childcare to have the national importance and recognition that it deserves, this is the opportunity. As everybody's closing down and the only way that these people could go back to work is if their child care is up and running. We've learned how we respond to threats we never even dreamed of. And how do we own that and say, we know how to do this and we're going to do it it? We'll figure it out.

Gloria Rivera (27:06)

That playbook needs to be edited every year.

Susan Gilmore (27:08)

Yes, exactly.

Gloria Rivera (27:16)

For over a decade, the shadow of the climate crisis has only drawn closer. Dr. Lisa told us how our children may not even be safe from these pollutants in the womb. With the climate changing so rapidly and not for the better, everything has changed, changed. Kids are going to keep getting hurt by this, especially kids of color and those from low income families. So parents, educators, and people in power need to adapt now to keep kids safe. Susan Gilmore in the North Bay Children's center did just that. She showed us how child care workers are also part of the front lines in a crisis. They are the first responders to the first responders. By taking climate change as a gift, they can do their jobs faster and better when the next crisis inevitably comes. So shout it from the rooftops. Climate change is a childcare issue and not just in some faraway science fiction future. To actually secure a better future for our children tomorrow. We need to be thinking about it. There's more no One Is Coming to Save Us With Lemonada Premium subscribers get exclusive access to bonus content like unheard clips from our interviews. Subscribe now on Apple Podcasts. No One Is Coming to Save Us is a Lemonada original produced with Neighborhood Villages. I'm your host, Gloria Rivera. Crystal Genesis is our senior producer. Tony Williams and Tiffany Bowie are our producers. Tony Williams and Johnny Vince Evans are our audio engineers. Our music is by Hannis Brown. Jackie DanZiger is our VP of Narrative Content. Executive producers are Stephanie Whittles Wax and Jessica Cordova Kramer, along with me, Gloria Rivera. The series is presented by Imaginable Futures, the J. Willard and Alice S. Marriott foundation, the Baynham Family foundation, and the Conrad N. Hilton Foundation. If you like the show and you believe what we're doing is important, please help others find us by leaving us a rating and writing a review. And most importantly, tell your friends. Follow no One Is Coming to Save Us. Wherever you get your podcasts or listen, ad free on Amazon Music with your prime membership. Thanks for listening and we'll be back next week. Until then, hang in there. You can do this.

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