They shared a room to allow Grandma to keep an eye on their granddaughter’s breathing. Burciaga was awake with the sun and roosters, while her sisters slept in different bedrooms throughout the country home. Bright summer days at the farm taunted Burciaga. Burciaga remained inside, while her sisters were out on the farm. She was a small child when she developed severe asthma. All the joys of Grandma’s land quickly became threats to her respiratory condition. What was grass meant to do? The trigger. Dander from farm animals? An indicator. Are you worried about dust in your aging barns or play areas? An asthma trigger. She was not able to get treatment at the country clinics. She remembers carrying her medication bag everywhere she went. She would need to take medication and do breathing exercises in an emergency. After years of suffering from episodes, some very severe that ended in hospitalizations, she was able to learn how to manage her condition. She was referred to Vicksburg’s pediatrician, and she never left home without her inhaler. Her mother worked for the Army Corps of Engineers. The robust federal insurance helped her family get inhalers, treatment, and reliable healthcare. She feels like she is slipping back after years of managing her asthma, despite changing jobs and insurance. At times, she has had to go without her inhaler or extend its shelf life. Burciaga, who is 38 years old, was diagnosed with the coronavirus this summer. She claims her asthma symptoms aren’t as severe since childhood. Ironically, Burciaga believes her asthma history may have helped her COVID-19 diagnosis. She was able to detect it early and knew how both to manage and treat the chest tightness. It wasn’t severe. She had a headache that progressed into sinus congestion and chest tightness. She began exercises and home remedies to relieve her symptoms. She says that it helped her to understand her body, and especially her lungs. “I pay attention to every symptom I get. It helped me a lot. It was very, very early. She said she could feel the disease starting, and noted the tightness in her chest. Although she is now fully recovered, she worries about the unknown effects of COVID-19 to her already compromised respiratory system. Although she is now well, doctors are still not sure of the long-term effects of COVID-19. While treatments are improving, researchers have difficulty keeping up with new coronavirus developments. Jackson metro is the U.S. asthma capital. Jackson has the highest number of asthma-related deaths per capita. This includes people living in areas with similar demographics, environmental conditions, and poverty. It is also the most fatally affected area in the country. This worrying sign speaks less about the disease itself but more to the lack of treatment. Burciaga’s story is not unusual. Research shows that Black Americans are at greater risk for lung conditions and less likely than other people to receive the proper care. Black Americans are twice as likely to develop asthma than white Americans, and three times more likely that they will die from it. Early diagnosis and treatment are key to lung cancer. However, Black Americans are 16% less likely than white Americans to be diagnosed with the disease early. They also have 19% less chance of receiving surgical treatment and 7% less likely not to get any treatment. According to a new American Lung Association report, Black Americans are 7% less likely to receive any treatment. Burciaga is a high school teacher and has state insurance. However, she has not found a primary doctor who can prescribe her affordable inhalers under her high-deductible plan. Burciaga struggles to find the same for her children, 12 and 10, who are eligible for the state’s Childhood Health Insurance Program (or CHIP). One of them has severe asthma and the other has severe allergies. Although she claims she can manage on a tight budget as a single mother, she doesn’t feel that she has any financial or medical protection in case of an emergency. COVID-19 was a reminder to her, as she rode it at home, using home remedies that she had learned over decades. The disparities in COVID-19’s impact on Black Americans in the early days of treatment have highlighted a gap in American pulmonary care. Although the disparities have decreased over time due to more people contracting the coronavirus, the impact of COVID-19 on Black Mississippians and Black women is still significant. Although both black and white women have seen approximately 26,000 cases in which race has been determined, the proportion of Black women who are affected is higher than that for white women. Nearly 5% have been positive for lung cancer in Mississippi, while 3% of white women have had their test. Lung cancer, chronic lower respiratory diseases such as asthma, emphysema, and COPD are more prevalent in Mississippi than they are elsewhere. This means that health care workers who are devoted to treating lung conditions are often unable to handle the worst cases. The role of respiratory therapists was highlighted during the pandemic as a bridge between pulmonologists’ daily treatments and the role of pulmonologists. There aren’t enough, so hospitals fear that their shortage will limit the availability of specialty treatment for severe COVID-19 patients as the epidemic spreads. According to the Bureau of Labor Statistics, Mississippi has one respiratory therapist per 100 COVID-19 patients as of October. This is the highest ratio in the U.S., and nearly doubles the average national caseload. When breathing becomes difficult, a respiratory therapist can manually assist your body. This could be due to a trauma injury blocking airflow, or a disease like COVID-19 that affects the ability of the lungs to function normally. Each unit is occupied by a respiratory therapist who manually breathes in each patient. This can be done either by “bagging” the patient with a handheld pump or by making sure that the ventilator and intubation tubes work at the correct speeds. Allasica Byrd is a Clarksdale respiratory therapist. She says that despite their role as the safety net for hospitals in responding to the pandemics, she and her colleagues don’t get enough pay or respect. They’re also burning out, which is something that hospitals all across the country and Mississippi are aware of. She said that people didn’t realise how crucial respiratory therapists were until crises and pandemics struck. It’s a serious shortage. They’re working too hard and not paying enough. Byrd stated that we are the peanut butter between the bread and the glue that holds everything together. “I must breathe for you – I have to know what my doing when I’m breathing in your lungs.” Mississippi is home to the lowest-paid respiratory therapists in America. According to the Bureau of Labor Statistics Mississippi has the lowest number of respiratory therapists per 1000 jobs and per capita. However, the state also has the highest rate of lung diseases and deaths per capita. The state has more lung specialists than it needs, but they are in greater demand and have higher case loads due to the high need. For patients and practitioners who pay attention to public health factors, the year has brought many challenges. These include spotlighted respiratory disparities using COVID-19, ongoing challenges for patient accessibility that’s exacerbated due to shortages of health care workers; and efforts to address institutional racism and bias within health care. This was sparked by renewed attention on Black Lives Matter after George Floyd, an unarmed Black man was shot and killed by white police officers in May. The American College of Chest Physicians launched a new initiative called listening, keeping all of these factors in mind. Their virtual Listening Tour was launched in September in Jackson where one in seven Jackson residents has a chronic lung condition. This is 57 times more than the national average. The tour was organized by the group’s philanthropy arm, the Chest Foundation. It brought together Jackson’s patients like Burciaga, caregivers and community leaders to discuss the real-world obstacles that make Jackson’s lung conditions so common and chronic. Participating in the new listening effort, providers said that starting in Jackson requires acknowledging that access to healthcare has been a problem for many people. This will require an intersectional approach. They also said that health care must go back to basics and not only treat the patient’s disease. We have a major health problem in Mississippi, but we also have a larger heart problem. It’s not a matter of Black or white, it isn’t about insured versus non-insured, and it’s also not about low versus high classes, it is about dignity and humanity,” Dr. Justin Turner, a Jackson internist, said. Jackson is the epicenter of state medical care and a microcosm for barriers to accessing it. Each of the 26 Jackson-based pulmonologists, which is the most populous in the state, would have over 1,600 patients if they had an equal share of all patients with lung conditions. Moreover, 16% residents are not insured, so finding specialty care isn’t the only problem. The new tour’s first stop identified three main barriers to Jackson’s overall lung health. These were all anecdotal but also documented in research. They are access to care and treatment, equity imbalance, lack of Black doctors, health disparities, and lack of trust in the system. The foundation based on the report of the tour recommended actions for the pulmonology industry. These included: teaching providers how to make sure patients can afford medications and keeping up with prescriptions; ensuring that information is easily available about low-income doctors; educating providers to understand and identify barriers to accessing care; and raising awareness of local resources to address social determinants that contribute to disparities. Social determinants of overall health are those who live in poverty, lack of education, and cannot meet basic needs such as food and shelter. This is something that public health advocates have been arguing for since the beginning. It’s often lacking proper insurance that covers unexpected medical costs. Burciaga hopes that sharing her story will help other people learn more about lung health, and the disparities in accessing care. Vickie D. King/Mississippi Today She said that healthcare is a political game. “That’s why it’s so frustrating that they (lawmakers use healthcare as a game piece, but they don’t really consider how it affects people’s lives or how many people depend on it.” It is sad that the United States, despite being the image it is supposed to have, is not what it is.