, the health officer in charge of the Missoula City-County Health Department, said that in the past, when wildfire smoke polluted the air outside, nobody really talked about air filters.

“We’d always told people to go indoors, thinking the air might be a little better,” Leahy said. “Well, that was not necessarily true anymore.” The size and proximity of fires, coupled with weather trends and local topography, led to an inversion layer of dirty air that hung around communities for weeks on end. Without air filtration systems, it invaded indoor spaces, too.

Wildfire smoke is bad for , but especially older people and those with chronic heart and lung diseases. Joy and Don Dunagan, who live in Seeley Lake, Mont., check both those boxes.

“We put towels around the doors, the windows — everything,” Joy said. “Grime from the smoke came in through the whole house.”

The Dunagans are both 69 years old and on oxygen much of the time. Joy is a stroke survivor. Don recently developed asbestosis after almost 40 years working at an aluminum factory.

“I’ve got less than 50 percent breathing capacity right now,” he said. “Anything that I could have done a year ago, I can’t do now. And then that smoke on top of it — it was killing me.”

But with no family in the state and limited mobility, the couple had to stay inside their house all summer. , who directs a small nonprofit called , helped the Dunagans get two HEPA air filters and make a safe air space inside their home.

The unit resembles a space heater, but can actually  that are so hazardous to health.

“There’s a prefilter that takes out the large stuff, and then — that’s the HEPA filter,” Cilimburg explained, as she helped install the second filter in the Dunagans’ living room.

In early 2017, Missoula County’s Health Department launched a pilot program with Climate Smart to get HEPA air filters to homebound seniors in Missoula ahead of the fire season. But when wildfire smoke swamped Seeley Lake last summer, they also started to distribute filters to residents who have a high risk of developing breathing problems and other health issues related to smoke pollution. Local health providers helped identify those people, including the Dunagans.

Don said he slept in his recliner, near the air filter, every single night while the smoke was bad.

“I believe that machine saved my life,” he said. “I really do.”

Then the wildfires dragged on into the school year. And children, who are also extra susceptible to the pollutants because their lungs are still developing, sat in smoke-filled classrooms across the county.

Missoula County’s health department and Climate Smart scrambled to get air filters to the schools most deeply enveloped in smoke. Other nonprofits pitched in to raise money and buy filters. Almost overnight, the smoky haze inside classrooms disappeared.

The county health department’s Leahy said that strategy of finding a solution and taking action was a big shift away from the agency’s usual approach of issuing advisories to people to hunker down and stay indoors. And they need to keep acting, she said.

“There has to be a more concerted effort — which we are a part of — to provide clean, indoor air. Filtered indoor air. Messaging that the air isn’t good — isn’t enough,” Leahy said. “And that we have to plan to be able to do that, and deploy those systems much more quickly, as you would in an emergency.”

The challenge is figuring out who pays for it.

Portable HEPA air filters that can clean a big room cost just under $200 each. Even with a bulk discount, it cost about $30,000 to put those kinds of filters in just three of the 50 schools in the county last fire season. That didn’t even cover every classroom or grade, Leahy said.

Nor are individual filters necessarily the most efficient solution for schools and other big buildings — like day care centers, nursing homes or health clinics — said Missoula County air-quality specialist Sarah Coefield. It’s virtually impossible, Coefield said, to put a price tag on what it would cost to filter the air in every public space in the county.

“It would be a very high number, and I haven’t even wrapped my head around it,” she said.

Missoula County has one of the biggest and most experienced air-quality programs in the state, but the health department was not equipped to launch response on a large scale, Leahy said.

The health department is set up to regulate easily controlled, man-made sources of air pollution — such as factories or wood stoves — and to issue health advisories. The money the county contributed at the last minute to buy filters came from emergency funds, which quickly dried up.

Health officer Leahy said they all tried their best to respond to the need.

“But it was very, I would say, makeshift,” she said.

Scientists predict wildfires are going to get worse, so public health departments are starting to see a need for a more proactive approach.

“There’s not a new source of funding that we’re aware of,” Leahy said.

The state health department is in a similar bind. Currently, it has no resources specifically dedicated to protecting the public from wildfire smoke.

“I don’t anticipate that there’s going to be a lot of new monies coming,” said Jim Murphy, the chief of the at Montana’s Department of Public Health and Human Services. “Given the state’s budget crisis, I think it’s maybe making the best of what we already have.”

Cilimburg of Climate Smart said she’s proud of Missoula’s leadership and of the community’s efforts to step up. But she stresses that wildfire seasons are getting longer and more intense — the smoke will come back.

“Providing some money upfront can save you money down the road,” Cilimburg said. “And we’re just not very good sometimes at thinking about it. We’re good at responding to disasters, and not as good as being prepared for them upfront. That’s kind of the conversations we’d like to spark.”

For now, the county health department will continue to partner with Climate Smart. This winter, they’re busy building on the foundation they established over the summer — spreading the word about the usefulness of air filters and the message that clean air is a collective responsibility.

The program has a cache of about 100 filters to help those in need. And they’re working with larger public institutions, like school districts, to help them improve their air filtration systems — and encouraging them to add such systems to their own budgets.

Don Dunagan said the responsibility is also on everyone who lives in the area to acknowledge the risks of living with wildfire, and to create their own clean-air space.

“A lot of people don’t realize what that smoke will do to you,” he said. “You might tough it out now, but if you go long enough, you’re going to have breathing problems.”

This story is part of a partnership that includes , and Kaiser Health News.

Ñî¹óåú´«Ã½Ò•îl Health News' coverage of these topics is supported by , and

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

The smoke from the fires was so thick outside, Loesch said, the family couldn’t see the trees across the street, so they stayed inside. It was still really hard to breathe.

“These guys were miserable,” she said. “I think each one of them ended up having to go to the doctor.” Everyone needed inhalers.

The family is typically pretty healthy, but not this year. Loesch got pneumonia and the kids had bloody noses. And now, even with the smoke long gone, the children continue to have trouble with their lungs.

“They’ll wake up hacking,” Loesch said. “They’ve all been sick. I’ve had to take them in for upper-respiratory infections.”

Seeley Lake is in Missoula County, which had several large wildfires that lasted from the end of July through mid-September — weeks longer than usual — and led to the worst season on record for wildfire smoke.

Researchers don’t know a lot about what that kind of extended smoke exposure does to the average person. Most previous studies have focused on indoor wood-burning stoves, urban air pollution and the effects on firefighters.

But the way the smoke piled up and stuck around a whole town this summer was new. Seeley Lake is in a valley. Every day, as the sun set and evening temperatures dropped, cold air traveled down from the mountain and trapped the smoke from the nearby Rice Ridge fire on the valley floor. This phenomenon is called a temperature inversion.

As the wildfires burned on, and nights grew longer and colder, the inversions grew stronger. Over time, the accumulating smoke made it harder for the sun to break through and warm the ground. That intensified the effect.

The experience was really tough on residents, and it handed scientists an unusual opportunity to learn much more about the health effects of breathing smoke.

, an epidemiologist with the state health department, has been tracking how many people went to emergency rooms complaining of respiratory-related symptoms during the 2017 wildfire season.

For people who live in Missoula and Powell counties, that number more than doubled in 2017 compared with the year before — from 163 in 2016 to 378 in 2017.

“That’s a statistically significant increase,” Hinnenkamp said.

Researchers can’t say whether all those ER visits were directly related to the Rice Ridge Fire, but Hinnenkamp said most visits happened about a month after the air in the region first became heavy with smoke.

The more a person is exposed to polluted air, the worse it is for their health.

“The smoke that we saw this year in Seeley Lake was like nothing we’d ever seen,” said Sarah Coefield, the air quality specialist for the . It’s her job to quantify just how bad the air was.

Pollution from wildfire smoke is typically measured as the concentration of fine particulate matter, she explains. The  a daily average concentration of more than 35 micrograms per cubic meter of polluted air is unhealthy.

The county’s air quality monitors max out at 1,000 micrograms. In Seeley Lake last summer, Coefield said, the monitors maxed out 20 times. “So there were 20 hours that we don’t know what the actual number was over a thousand,” she said.

Most public health guidelines aim to protect groups that are the most vulnerable to wildfire smoke in the short term — children, pregnant women, older people and those with chronic heart and lung diseases.

But the off-the-charts summer in Seeley Lake is bad news even for people who aren’t at high risk, said , an immunologist and assistant professor in the University of Montana’s School of Pharmacy.

“Usually these exposures are maybe a couple weeks at high levels,” Migliaccio said. “This was over a month at really unprecedented levels. We have no idea what the long-term effects are.”

He’s part of a team of UM researchers trying to fill in those gaps in knowledge. Working with the county health department, they’ve started tracking a group of Seeley Lake residents, documenting changes in their physical and mental health over time.

One thing Migliaccio predicts the scientists might see is an uptick in respiratory infections — because those fine particulates in wildfire smoke can damage and even kill cells in the lungs that get rid of the harmful substances people inhale. And that leads to more people having a compromised immune system.

“I can’t tell you, ‘You will be susceptible. You will get the flu.’ But because of these exposures, you’re probably at an increased risk,” he said. “We haven’t done these studies. And that’s something we want to follow with this Seeley Lake cohort. Let’s follow them. Let’s see how they do this winter.”

Right now, the biggest hurdle to getting that information is funding. The health scientists are applying for grants to keep their research going. They hope to track people for years, to find out whether the health effects of extended smoke exposure dissipate — or linger.

This story is part of a partnership that includes , and Kaiser Health News.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).

“Getting high in your car in front of the store; that ain’t a big deal,” said Miranda Kirk.

Kirk works on the reservation, which is about 40 miles south of the Canadian border. She said no one even bothers to hide their drug use.

“Leaving your paraphernalia out in the open for someone to walk in, that’s all right. Having and seeing needles everywhere, that’s OK. Even talking about selling your needles — that’s normal too,” Kirk said.

“People are saying they’re seeing it as young as third grade because [kids think], ‘Oh that’s OK, I see that at home — my aunt does this, my mom does this, my dad does this, my grandpa does this.’ So, they can’t see the error in it. Or they don’t see it as a risk,” Kirk said.

Kirk and her sister, Charmayne Healy, felt as if everyone had given up trying to do anything about the rampant drug use. And they worried about their kids falling into the same trap. So they went to tribal leaders last year and said someone needs to do something — immediately.

George Horse Capture Jr., vice president of the Fort Belknap Tribal Council, helped the sisters persuade the council in January to declare a state of emergency about methamphetamine use. Tribal leaders then gave Kirk and Healy $150,000 to fund a substance-abuse prevention and treatment program.

The sisters were caught off guard, but Kirk immediately hunted for a model that might work with the strengths of Fort Belknap. She heard about something called peer recovery, a movement centered on the idea that people successful in conquering their addictions are uniquely equipped to coach others.

“The lightbulb came on,” Kirk said. “That works, because what got me clean, in a sense, were peer mentors. They’ve been there. That made it easier for me to be able to express myself and not feel judged or condemned. Like I’m a horrible person for what I was going through.”

She’s determined to break the stigma attached to reaching out for help.

In early 2016, Kirk and her sister officially launched the Aaniiih Nakoda Anti-Drug Movement, a Native American-led peer recovery project.

Jessica Healy, 30, came knocking before they were even up and running. The state put her only son in foster care last year. (Jessica Healy and Charmayne Healy are not closely related.)

“They helped me. And it took a big step. … [I]t took all that I had,” she said. She had been using drugs on and off since the age of 18.

Once a week, one of Kirk’s peer recovery groups, the Life Givers Circle, meets at the Hays-Lodge Pole Elementary School.

“We talk about stuff and we make ribbon skirts, [do] activities, and we just help each other out,” Jessica Healy said.

It’s one of about four peer support groups that Kirk and Charmayne Healy have helped start, both on and off the reservation.

“It was a good feeling to be clean and to be close to people that had been going through the same thing. To know that there are others out there,” Jessica Healy said.

In addition to peer meetings, Aaniiih Nakoda members go to schools and talk to kids about prevention. They help organize events like zombie walks, in which people pretend to be the drug-addled walking dead.

There’s only one outpatient drug treatment facility in Fort Belknap, and no emergency housing or sober-living facilities. The only longer-term support available is Kirk’s group.

Dr. Aaron Wernham, of the , said that what Montana needs is a more integrated, team-based approach to treating addiction. That means primary care doctors working next to behavioral health professionals, and coordination of care from the start.

“Peer recovery fits in very well with it, but if you decided you were just going to build a whole treatment system around peer recovery, you probably wouldn’t end up getting the results you want,” he said.

A new enacted in March goes a long way toward recognizing peer support specialists as legitimate members of a treatment team. The law sets clear professional standards and paves the way for billing insurance companies and, potentially, Medicaid.

The challenge is how to bring that comprehensive care to Fort Belknap.

Until that happens, the sisters’ grass-roots peer program is one of the only options available for the community. And Kirk is intent on doing that work, no matter what.

“You have to keep your phone on during the night, because addiction don’t sleep — and normally we don’t either,” Kirk said.

This story is part of a reporting partnership with , and Kaiser Health News.

, a journalism project at the University of Montana, also collaborated on this story. 

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).