Smiling, Rosa Felipe was already waiting outside her two-story stucco apartment building on Hill Street, southwest of downtown Los Angeles, for the team from the Esperanza Community Housing Corporation on this Wednesday morning in March.

The 35-year-old woman with long black hair and black-rimmed glasses hugged Consuelo Pernia, the asthma outreach specialist who had worked with her family for a solid year, helping her nine-year-old daughter, Itzayana, finally control her debilitating illness and regain a normal kid's life.

They were here today to follow up on the inner-city family because the agency had just been awarded an $875,000 Healthy Homes grant over three years - one of the first funded by the federal economic stimulus package - through the Department of Housing and Urban Development. Families with asthmatic children will be referred by St. John's Well Child and Family Center clinics.

After introductions, the mother of two led the older woman, a couple other members of Esperanza's Healthy Home team and a journalist through a hall to her back apartment. Inside the basically one-room unit was a round table by a window with a bowl of bananas, oranges and melons, two short couches, a wooden dresser and a coffee table, along with a TV and stereo in a built-in bookcase. The dark chocolate rug looked like it had just been vacuumed.

Off the living room was a small kitchen and opposite an even smaller bedroom, where Rosa slept with her husband, Alfonso, in one bed, and Itzayana and her 12-year-old brother, Alfonso, Jr., kitty-corner in bunk beds.

In contrast to the dingy street outside, nothing seemed out of place in the bright and painstakingly neat apartment. In fact, the living room --- with the morning sun coming through the draped window, and framed school honor roll plaques and certificates artfully displayed on spotless walls --- would have looked just fine as a color-spread in Good Housekeeping.

"You can see that Rosa's a very clean person," pointed out Gabriela (Gaby) Gonzalez, the veteran Esperanza worker who's heading up the new outreach program, which is slated to begin later this spring.

Rashes, hives and fears
Clean is good, certainly. But in assessing what makes a healthy place to live, cleanliness is only one factor, as Esperanza workers --- and the clients they serve --- know all too well.

"A lot of the myths you have claim that their apartments have to be dirty to have triggered asthma," noted Gonzalez. Referring to the Felipes' home, she continued, "This is very clean, and Rosa still has problems. Because it's the whole building."

But the Felipes' difficulties have really diminished during 2008, when Consuelo was working with the mother and her family.

"When my daughter was diagnosed with asthma at the age of six, I had heard the word but I did not know what exactly it was," Rosa confided in Spanish. "I thought it was probably contagious and that is how she had caught it. But Consuelo helped me a lot and explained to me that it is not contagious, and how strong liquid chemicals and other things affect it.

"Before, my daughter would get really sick with the asthma attacks. She would start coughing and wheezing, and then break out in rashes and hives. She would say, 'Am I going to break out again? What is going to happen to me?' And I would have to take her directly to the emergency room. But now her health is much better. She has not had an attack in over a year."

Consuelo told Rosa that asthma is a chronic disease whose symptoms - a shortness of breath and tightness in the chest, along with coughing and wheezing - are often set off by something that bothers the victim's lungs. That can be anything from colds to allergies to micro particles in the air.

She explained that common "triggers" were pollen from trees and flowers, dander or skin flakes from cats, dogs and other pets, as well as roaches, rodents and dust mites - tiny insects that can't be seen who live in carpets, bedding, upholstered furniture and even stuffed animals. She also warned about using harsh cleaning products like Clorox bleach, Pine-Sol and even dusting sprays.

The "promotora," or community health promoter, convinced Rosa to use hot water, vinegar and baking soda to clean, and to get rid of all of Itzayana's stuffed animals (except one, which is now washed every week). She provided the mother with anti-allergenic covers for her children's mattresses and pillows. And she got the family a big Honeywell air filter for the living room.

Equally important, Consuelo introduced the Latina housewife to one of Esperanza's partners, SAJE (Strategic Actions for a Just Economy) to learn about her legal rights as a tenant. And the agency was able, with intervention by the L.A. County housing department, to persuade the landlord to install new kitchen cabinets and plumbing, replaster walls and replace old drafty windows. The only asthma trigger that remains in the spick-and-span apartment is the brown rug, which the landlord claims is too new to replace.

"My daughter is much happier now," Rosa said, walking her guests to the door after nearly a two-hour visit. "She went to summer camp all by herself and was in a lot of activities --- yoga, karate, races. It has helped her self-esteem. Before she was scared what would happen to her. Now she knows what to avoid with all her allergies, so her health is much better.

"You can see that the results are real," she added, glancing back around the apartment. "I wouldn't know what to do if they were to take this program away. It brings about change, because I tell one mother and she tells another. And when my daughter hears that somebody at school has asthma, she tells them: 'This is what I do.'"

Substandard Housing
After a four-year organizing effort, the Esperanza Community Housing Corporation was founded by community residents under the leadership of Sister of Social Service Diane Donoghue in 1989. Today Nancy Halpern Ibrahim is the agency's executive director, overseeing not only housing, but also four other core areas serving low-income families along the Figueroa corridor neighborhood of South Central Los Angeles: health, economic development, education, and arts and science enrichment.

"While we have been focused on lead poisoning in substandard housing with our HUD grants over the years, there are many, many more conditions than lead that relate to health damage caused by substandard housing conditions," pointed out Ibrahim, who has a master's degree in public health. "The same kind of conditions in a home that produce lead hazards - water leaks, molds and mildew, chipping and peeling paint - can also bring on asthma attacks."

Over the last 13 years, Esperanza has trained and graduated 310 bilingual promotoras. Many of these workers, such as Consuelo Pernia and Gabriela Gonzalez, specialize in outreach work, going into homes to educate and advocate for tenants who have environmental medical conditions.

"It's really the building that's causing the health problems," Ibrahim stressed. "So it puts the responsibility on administrators, on housing developers, on cities, on code enforcement inspectors to make sure that the buildings we have are intact. Housing is a health issue."

Gonzalez, who will direct the new asthma healthy homes project, couldn't agree more. "We spend so much time in our homes, we sometimes don't realize that out health is affected by the condition of the home," she said. "So we'll be giving that information concerning asthma triggers to parents, and also putting on health fairs with the new HUD grant.

"We think we're going to go talk about asthma or lead poisoning, but the families have other priorities," she noted. "It might be domestic violence, especially right now with all the unemployment, or something else. I mean, we just never know what we're going to find."

Pernia, the asthma specialist, said a typical home visit takes about two hours. But when the promotoras run into other problems the meeting can be much longer as they try to come up with practical solutions. Oftentimes, this means referring the family to another social service, health or even law enforcement agency.

"Our work is asthma," she said. "But if we see other things, then we have to deal with them."

The community health worker, who's been dealing with asthma cases for a number of years at Esperanza, will be a vital member of the new three-year HUD grant project.

She will continue educating inner-city L.A. families with an asthmatic child about what brings on an attack such as molds, roaches, rats, dust mites in carpets, dander from pets and household cleaners. She'll keep on going back to families, making sure that the children are taking their medications and using their inhalers properly. And she will help families in the Figueroa corridor, like the Felipes, learn their legal rights as tenants.

"Even when I finish with a family, I haven't finished," Pernia said with a half-grin. "Like with Rosa, when she needs help, she calls me: 'Consuelo!' Always we are in contact. It's like a family."