San Diego — Every Father's Day, over 100 San Diego youths, aged 8 to 13, get on a bus to spend a week at Camp Marston in Julian. While going to summer camp is not unusual, for many of these kids, it would be impossible without special intervention. Every camper has a medication schedule and list of foods to avoid, as all have moderate to severe asthma and many suffer from other allergies.

Sponsored by the American Lung Association, asthma, or "SCAMP" camp (Southern California Asthma Medical Program), has been held every June for the past 24 years. Originally held at Running Springs in the San Bernardino Mountains, the camp was moved to Julian in 1993. The camp is staffed by the lung association, the YMCA, and volunteers. Especially critical is the medical staff, which includes physicians, nurses, and other trained personnel, including the pediatric asthma coordinator, who plans the entire program. This year's coordinator, Rochelle de Ocampo, had little time to prepare.

"I just started this position in May. I came in when they were already planning it. This was my first camp, and I'm already planning next year's. It was really crazy, but it was fun, because I was learning everything that I had to do, but at the same time I was watching all the kids. A lot of them don't get the luxury of attending a regular 'normal' camp because of their asthma. Watching them have fun and just be like regular kids without having to worry about their asthma was the greatest part of it."

The health problems of kids who attend asthma camp are not limited to asthma. "A lot of times, children with asthma have many different kinds of allergies. Many of them suffer from the same kinds of allergies, such as allergies to nuts, certain berries, other food allergies, dogs, cats, things like that. Many of them have problems unrelated to asthma, like lactose intolerance."

Ocampo believes that the ability to forget their health problems and just have fun for a week is liberating for kids strapped with health problems. "Some of the evaluations that we've gotten back say things like, 'Thank you for making this special for us.' Many times they feel like outsiders because they have to take medication, but at asthma camp, everybody has to take medication, so no one feels 'left out.' They feel like they're not the only ones who have it, because everyone else is taking medicine. They're very sensitive to each other's needs because they all know what it's like."

The chance to feel "normal" for a week includes many activities. "They vary from canoeing to boating to archery to kayaking to wall-climbing -- which is the big event there. They play soccer and football and take hikes. They work in arts and crafts and take acting and dance classes. The day starts around 7:00. There are about ten kids assigned to each cabin with two counselors from the YMCA in each cabin. They get up at 7:00, and around 7:30 they go out to the field and raise the flag. At 8:00 they have breakfast. After that, their medications are dispensed by the medical staff. About 8:30 or 9:00, the organized activities begin -- these are activities they signed up for in advance. They'll do that for a couple of hours. About noon they come in for lunch, and then medications are dispensed again. One o'clock is siesta time, just a down-time for them to relax, write home, stay in the cabin, or whatever they want to do. At 2:00 they have more activities until 5:30, which is dinnertime. Meds are handed out again, then there are more activities until about 9:00. By 9:30, they're usually in their cabins, ready for bed."

One nonoptional event that every camper experiences is asthma education. "It's an hour each day for every kid. We have activities that teach them about asthma -- how to manage it, what the warning signs are. We have them draw things, such as 'How you feel when you have an asthma attack.' This year we had them sculpt Play-Doh models of what they thought their lungs looked like when they were having an asthma attack. They really enjoyed that."

Some parents may not like the idea of a child they think of as fragile being turned loose to engage in vigorous physical activities. Ocampo tries to respect parents' wishes while stressing that the camp is for the kids. "Parents will request certain things, but we're not there to parent the children. We're there to help them manage their asthma and help them to be as normal as possible. If they choose to climb the wall, that's their choice, and we will support that. If a parent requests that they don't, then that's up to them. They need to talk to their child about it. It's in the applications that we send out. They're aware that they need to talk to their child and communicate their worries with their child, because we can't parent 131 kids. It's impossible. We're there to help them with their asthma, to help them manage it, and to help them learn about it."

With the greatest concentration of asthma sufferers living in poorer urban areas of San Diego, asthma camp offers those kids a radical change of scenery that is affordable, regardless of income. "The cost varies, because it's based on a sliding scale. We try to get kids who've never had a camping experience before. We work with families that can't afford it. Some families pay as little as $25, while some will pay the full price of $250."

Although the lung association sponsors the camp, the YMCA provides the camp and the counselors. Other funding comes from donations and pharmaceutical companies. "We'll have their representatives come up, tour the area, and see what the camp is all about. Anyone who makes a donation is welcome to come up, and we give them a tour. They can stay for lunch or dinner or whatever they like. People want to come up and see how their money is being used. They usually like to spend time with the kids."

Just as important as the counselors is the medical staff of doctors and nurses. "This year's staff had a record 30 people to serve 131 kids. We also have respiratory therapists and others who assist. There is always a doctor on call, 24 hours a day. Somebody is always around. We have a shift of three days for the staff, then they switch shifts. There were at least 15 for every shift this year, if not more. A lot of them have been doing this since the beginning and some for at least ten years or more -- and they're all volunteers."

With all the extra staff on hand, prevention seemed to work. "There were absolutely no medical emergencies at all. I was really surprised, because they had told me stories about what it was like in the old days. I thought, 'Oh no! What am I getting into?' There were no asthma emergencies, and that's because we help these kids manage their asthma. A lot of people think asthma is not manageable, but it is. Managing means recognizing 'triggers,' communicating with an adult or parent about what you're feeling when you have an asthma attack, and learning how to take your medication correctly. And every child in camp has a written 'action plan' from their physician so we can know about their medications, dosages, and intervals of taking it. We follow the plan throughout camp, uninterrupted.

"The best thing about the kids with food allergies is that every year the cafeteria posts lists of what is in the food. A lot of these kids are old enough to know what they're allergic to, and a lot of them read the lists. They'll just say, 'Oh, I can't have that.' But everything that's in the food is posted, and the kids know whether they should or shouldn't eat it."

Seeing the gratitude and joy on the kids' faces made Ocampo's experience worthwhile. "Since this was my first year, I was learning the ropes, so my time with the kids was limited; I didn't get as much as I would have liked. But for many of the kids I came in contact with, it was their first time away from home. By the time we got to camp, they were very homesick...crying, upset, wanting to go home. But by the second day, they were all smiles; it was as if they had forgotten all about home. I think that was a neat part. For a couple of hours, they thought that they couldn't survive, but after that they made friends easily and just enjoyed the whole week."

* * *

Dr. Michael Welch has been the medical director for asthma camp since 1982. "That's the camp I started with when I was in training at UCLA. I take care of kids who have this disease, and I think there's a need for kids to get off to a camp like this. A lot of these kids are not going off to camp -- their moms are holding onto them. This is an opportunity for the mom to feel good about the kid going off to camp, knowing that he's totally supported by medical staff like me."

The idea of the parent as well as the child benefiting from asthma camp is consistent with the notion of asthma as a "family disease." "The parents are always appreciative that their kid had this opportunity and that the parent had the opportunity of not having their kid around. It works both ways. Sometimes, you see three or four kids in the same family go off to camp. One year we had four kids from the same family go up to camp. Each one of these kids had a lot of involved medications, so it struck me, as I saw us giving them medications two or three times a day, what their mother must be going through. That one year really impressed me in a major way.

"I'll never forget this one kid. I got a call from the ICU at Children's, saying, 'Your patient is in the ICU, you need to come and see her.' I got the name, looked in my file, and I had no patient with that name. But the name seemed familiar. I was curious, so I went over to the ICU, and it turned out that it was a kid that knew me from asthma camp. Just from going to camp she began to identify with me as her doctor. The reason she needed somebody like that was that they weren't seeing a doctor about their kid's asthma. They couldn't afford it. I became the doctor, because I saw that kid once a year. That was sad, because this kid almost died from her asthma in the ICU. That one year, we had two kids die between asthma camp from one year and asthma camp the next year."

Taking a group of afflicted youths out to the backcountry with its unique pollens has little effect in a camp where allergic reactions are the norm. "It's a common misconception that these kids are going to do poorly in the mountains. We have good medications for controlling both their allergies and their asthma, so what happens is that they probably take their medications consistently better than at any other time in their life, because it's so regimented. You want to know what the most common problem is at camp? Headaches. Stomachaches. They come wandering over to the infirmary, complaining of headaches or bellyaches, and when you probe a little further, in many cases it's just homesickness. But asthma?

"Our single major problem with asthma in the history of camp was when one of the medical-staff volunteers almost died from asthma. She was life-flighted out of Running Springs because of her asthma! She eventually died of her asthma. She was a nurse at UCSD. Most of the stuff we see up there, as far as the kids are concerned, is just run-of-the-mill camp stuff. Occasionally, their asthma flares up, and when it does, we're right on top of it, but that could happen off the hill too."

The most memorable problem with a camper came on an unforgettable morning. "It was the famous 'year of disaster.' It was in Running Springs, I think our last year there. There were two earthquakes that morning: Yucca Valley, then the Big Bear quake. We'd just arrived Saturday, when Sunday morning about 5:30, this quake hit, and we were right near the epicenter. It was chaos. Moms were calling, worried about their kids. We were doing phone calls, but then we found out that one kid fell off of her bunk and never told anybody. Around dinnertime, she's coming in, complaining of major headaches, nauseated, and vomiting. I was afraid she had a major concussion and needed to be attended to. So I took her to the Arrowhead hospital that has an ER. While we were waiting to be seen, I heard a call come in from the paramedics, saying, 'We're calling from a camp for kids with asthma and we're bringing a kid in.' Here I am, the medical director, hearing this, and now I have another kid coming in. This kid was very allergic to milk and accidentally -- the cook didn't know there was an ingredient that had milk in it -- the kid ingested milk. This kid was having anaphylaxis. It was just kind of funny to be on the receiving end, hearing about this camp over the radio from the paramedics, who didn't fully understand what the camp was all about. Everything turned out fine. The girl didn't have a concussion, and the boy with anaphylaxis came out okay. Those were the major catastrophes that I've seen. At this last camp, two of the medical staff -- one broke her ankle and the other had a severe sprain! It's seems to be more dangerous to be on the staff than to be one of the kids!

"We try to get kids into camp who have any kind of lung problem. We had a kid a couple of years ago who didn't have asthma. He had a problem with breathing. He'd forget to breathe and stop breathing. It's a very unusual disorder. You can imagine, his mom wasn't ready to send him off to the YMCA camp! He needed an apnea monitor, and he was a very precarious kid. His first year coming up, he decided to do one of his numbers. He just went to the ground. He scared the hell out of us, and he had to come off the hill by paramedics."

Like Ocampo, Welch believes the experience of campers spending time with other allergic kids is liberating. "It 'normalizes' them. They see themselves as not being 'deviant' from the other kids. It helps bring them a perspective that they're not the only ones who have this. So when they come back, they'll have a little more confidence about using their inhaler in front of somebody else. A lot of kids will not use their inhalers in front of other kids because they're embarrassed. They can go out and have this experience without calling mom for a whole week and be successful. It puts a little notch on their belt, which makes them want to go out and put another notch in. Take sixth-grade camp, for example. If I catch a kid in the fifth grade and send him to asthma camp, and sixth-grade camp comes around -- I know, he knows, the parent knows -- he can do it.

"There's a 50-foot climbing wall at Camp Marston, and it's a very symbolic structure to me. These kids come up that have a lot of hurdles and walls in their life. One of the favorite activities up there is climbing this wall. It's outdoors and totally straight up. What's neat about it is that they get harnessed, so they can be sure to get up the wall, but once most of them get up on the wall, they don't need any help, because it's one step at a time. It's one little rock at a time, and they eventually get to the top, and they are so happy. They look down and realize that they were afraid of heights, they're not physically capable of doing it -- all these things in front of them that limit them, then they go and do it. There's all kinds of people around, cheering them on. The symbolism is really great, because with asthma, if you do the things you're supposed to do every day to control your disease -- at the end of the week, at the end of the month, or at the end of the year -- because you've been doing it every day, you're out of the hospital, you're not in the ER, you're not missing school or anything else."