Manuel León’s fight for his own life began long before la sequía – the drought – swallowed up the water under his East Porterville home and with it, his only escape from reality.
He was sick before the backyard cherry, apple and pear trees shriveled, before the onions and roses wilted, before his vivid green lawn turned to dust.
León, 49, has had colon cancer since before researchers saw the drought coming. It was diagnosed in 2001. He had a colostomy in 2002. The sickness came back in 2010, just in time to watch his rural community dry up and his wife become the sole bread-winner as they raised three boys on a farmworker’s earnings.
“The only thing I can do is sit here,” he said in Spanish. “If I wash the dishes, my nails break. They are brittle. You can say I don’t do anything.
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“I used to go out there and mow the lawn. It’s a distraction. Now I’m holed up here, angrier, bored.”
Experts say people affected by the drought also face stress, which can escalate to anxiety, depression and a host of other mental conditions.
With Sierra Nevada snowpack at its lowest in 500 years, the worst period in his life coincides with the most severe drought on record in California. East Porterville families like the Leóns are sick of the drought – physically and mentally. In a town whose problems already include air pollution, water contamination and poverty, the drought has spurred a growing health crisis, worsening respiratory conditions and burdening those with other illnesses.
It gets worse.
Experts say people affected by the drought also face stress, which can escalate to anxiety, depression and a host of other mental conditions. Studies show those findings are especially true for people who rely on water for economic survival, such as farmers, and people living in rural areas with fewer options for income and care.
Nearly half of East Porterville wells are dry. Many of the more than 7,000 residents live without running water as Tulare County struggles to keep up with demand for temporary tanks and the waiting list lengthens to drill deeper wells.
Most East Porterville residents are farmworkers. The median family income is under $30,000, according to the American Community Survey.
That is true for León’s family. His wife, Aida Beltrán, 41, rises at 4 a.m. six days a week and drives an hour each way to Bakersfield for work. This month she is picking grapes.
On León’s bad days, Beltrán leaves for work wishing more than anything that she could stay and keep her husband company.
“There are days he’s lethargic because of the medicine,” she said in Spanish. “Some weeks he gets very depressed, feels sad.”
But if Beltrán doesn’t work, the family doesn’t eat. So even on her own bad days, when her diabetes makes her nauseous or exhausted, she forces herself out of bed. Nine hours of manual labor distracts her from her own thoughts.
Detecting mental issues
Dr. Lananh Nguyen, a clinical psychologist in Porterville, has not asked her patients outright how the drought affects their health, but said those who have mentioned the drought consider it additional stress on top of issues they already face.
That’s not to say they aren’t suffering, Nguyen said. But mental illness and poverty are not a shock to people who were living with those issues before the drought. The same issues might be more stressful for a successful farmer, who is not accustomed to facing them.
“Unfortunately there hasn’t been any objective way to assess to what degree the drought affects people in this area,” she said. “Part of the issue is they don’t verbalize that, maybe partly because they don’t see it as something they can control or that I can help them change.”
According to the CDC, some of those most at risk for drought-related health effects are people living in rural areas who depend on water from private wells, the quality of which is more susceptible to environmental changes. East Porterville fits that description.
A small but increasing number of academic studies detail the impact of sustained drought on mental health. One study that examined farmers and ranchers in the Midwest found suicide rates in the 1980s were nearly double the national average for white men. That decade saw record drought, declining land values, unstable prices and indebtedness.
In 2010, the Centers for Disease Control and Prevention and other federal agencies published a guide about protecting public health during a drought. The guide refers to studies in Australia and India that showed elevated levels of suicide among farmworkers living in rural areas affected by severe and extended droughts.
Among those most at risk for drought-related health effects, it says, are “people living in rural or remote areas who depend on water from private wells and small or poorly maintained municipal systems, the quality of which is more susceptible to environmental changes.”
Elisaveta Petkova, project director at the National Center for Disaster Preparedness at Columbia University, studies the effect of natural disasters on health and how communities can better adapt. Petkova’s team is analyzing drought studies from Australia, focusing on mental health. She plans to launch studies in California using the information from Australia to inform which issues to monitor.
Petkova said drought is so long-term that its impacts aren’t as clear-cut as in other natural disasters, such as injuries or deaths during a wildfire. And she said the effects on mental health are especially devastating and the most difficult to address.
“Drought is likely to increase in duration because of climate change,” she said. “What we’re seeing now is something that won’t go away.”
Nguyen, the psychologist at Sequoia Family Medical Center in Porterville, recalled one patient who is bipolar saying that watering her plants was a stress reliever and helped keep her symptoms at bay. Having to cut back on water use has been problematic.
Most people in the Porterville area show up with physical symptoms such as high blood pressure or back pain, Nguyen said. Physicians experienced at detecting anxiety refer those people to her for therapy.
“I think in the future what we’ll see is a lot more people with physical symptoms first, and those developing into mental or psychological symptoms,” she said.
‘A second disease’
The CDC guide calls drought a “slow-rise event” that, unlike some natural disasters, can be anticipated well before it becomes a threat to the health of a community. Despite that, people like the Leóns are being affected now.
Seven years ago, their lives were on the upswing. León and Beltrán refinanced and remodeled their brown one-story stucco house before cancer and the drought blindsided them.
Now they have no means to move. Even the most beautiful house won’t sell if it has no water.
I don’t go outside. I don’t want to see what I’ve lost.
As long as León is alive, he counts on hope to get him and his family through each day. Ironically, they have less reason to feel despondent because of León’s disease. They’ve watched the community pull together and rally around them.
After their well dried last November, a local nonprofit placed plastic water tanks outside their home and refilled them weekly. In June, they received a 2,500-gallon county tank (the county prioritizes sick people). Volunteers regularly check up on them.
But the family’s economic survival depends on Beltrán. On the one day a week she doesn’t work, she drives León to UCLA for a chemotherapy clinical trial, which he receives three times a month. All other types of chemo didn’t work and his condition has remained largely unchanged for the past year. The three-hour drive each way makes for a long day trip, but they can’t afford to stay overnight.
Their oldest son, Jose León, 21, finished a term at Porterville College in June and started working full-time at Burger King, in part to help his family financially and relieve his mother of the near-weekly trip to Los Angeles. After the family’s two older cars began stalling, Jose started making payments on a new one.
Manuel León, the middle son, is 19 and attends the University of California at Merced on a full scholarship. The youngest son, Alex, is 16 and goes to Granite Hills High School. He works alongside his mom every Saturday to buy his own school clothes and snacks.
The family has adjusted to living modestly. They are used to León’s persistent cancer. Drought is the one thing they can’t help.
“It’s a second disease,” she said.
Gardening was also Beltrán’s stress reliever. She would come home from work every day and silently tend to the plants alongside her husband. Seeing what is left of their garden makes her nostalgic and sad.
“I don’t go outside,” she said, “because I don’t want to see what I’ve lost.”
Beltrán admits her own mental health has taken a toll, peppering her descriptions with the same words used by many East Porterville residents grappling with the drought: Frustrated, stressed, anxious, desperate, depressed.
León tries to stay positive. But, limited by disease, he helplessly watches his family suffer.
“When there was water, I had fun,” he said, remembering the garden. “I was already sick. But for this type of illness, it seems like the sadder you are, the more it advances.”
This story is the third in an occasional series about the drought’s effects on health. Andrea Castillo’s reporting was undertaken for the California Health Journalism Fellowship, a program of USC’s Annenberg School of Journalism.