PĀHALA — On a bench behind Pāhala Senior Center one recent morning, 87-year-old Taka Fukunaga and George Andrade, 72, were waiting out a bout of heavy vog in the shade — about the best you can do in this community where not even the senior center has air conditioning.

"There's no place to go," said Fukunaga, who has asthma.

Andrade, who suffers from congestive heart failure, said he often struggles to get a full breath. On the worst vog days, he retreats to his car.

"You put on the air con," he said, "and it works real good."

It has been 27 years since Kīlauea started erupting and two since a new vent at Halema'uma'u Crater opened, doubling the amount of emissions and changing life for the thousands who live in Pāhala and other rural communities downwind from the volcano.

Even before the new vent opened, Kīlauea — among the world's most active volcanoes— was also the nation's largest producer of sulfur dioxide. Today, the volcano spews out 7,000 times the sulfur dioxide of a major industrial polluter. All that gas, plus other fine particulates in volcanic emissions, routinely make the air in areas of the Big Island some of the worst in the United States, according to federal figures.

In fact, Kīlauea is on average emitting comparable amounts of sulfur dioxide and fine particulate as the Icelandic volcano that recently halted air travel in Europe. The difference is that the Icelandic eruption is more explosive, sending tons more ash into the air — and sending it higher up into the air, where planes fly. Kīlauea doesn't emit nearly as much ash, and most of its emissions stay much nearer to the ground.

The vog in Pāhala and other Big Island communities is often so thick residents can smell sulfur in the air or taste it on their tongues. They try not to think much about what breathing it might be doing to them.

Last year, Hawai'i County had 225 days with "moderate" air quality, 36 days when the air was deemed unhealthy for sensitive groups and 17 days when it was "unhealthy" or "very unhealthy" for everyone, according to new U.S. Environmental Protection Agency statistics.

O'ahu had just one "unhealthy" day this year — New Year's.

Meanwhile, Health Department figures show that there were 194 instances in the past two years when sulfur dioxide and particulate levels in Pāhala and elsewhere on the Big Island failed to meet federal air quality standards.

In 2008, according to EPA figures, sulfur dioxide concentrations in Pāhala hit a high of 1,000 parts per billion over a three-hour period — double the federal standard for air quality and nearly four times more than the second-highest average found in the United States that year.

NO SAFE HAVENS

Air conditioning is nearly nonexistent in Pāhala, and people have few or no places to go on the voggiest days. Many retreat to their homes, closing windows and turning on fans. Not even Ka'ū Hospital has central air.

"We all live in the open," said Michael Schwabe, 60, who is administrator of the Wood Valley Temple, located above Pāhala.

Just about every corner of the state has had markedly heavier episodes of vog since March 2008, when the Halema'uma'u vent started emitting about 2,000 metric tons of sulfur dioxide daily, a number that has since dropped to about 1,000 metric tons of gas daily.

That's in addition to the average 1,000 to 2,000 metric tons a day emitted by Kī- lauea's Pu'u Ō'ō vent, which started up in January 1983.

If trade winds stop, O'ahu and Hilo get the haze. In Kona, skies were hazy before the new vent opened. Now, seeing blue sky is even more rare.

"It's becoming virtually intolerable at this point," said Hawai'i County Councilman Kelly Greenwell, who represents North Kona. "The new vent has intensified the vog by a factor of four (in Kona). You would think from the air quality here we were a highly industrialized country."

It is the people in the Big Island's Ka'ū District — a rural, economically disadvantaged chunk of the Big Island as big as O'ahu — who are being hit hardest. Lawmakers estimate about 20,000 people live in the state's voggiest corridor, where emissions have killed off crops of protea and other exotic flowers, a once-thriving industry in Ocean View and Pāhala, and triggered health effects in cattle and other farm animals.

Vog has made life miserable — and sometimes dangerous — for those with lung diseases, and even for otherwise healthy people. Some Ka'ū residents have left because of the vog. Others stay against the advice of their doctors — many because they have no choice.

"My life is the pits," said Debbie Wong Yuen, of Pā- hala, who suffers from asthma, which nearly killed her several times when the emissions increased. Four different doctors have told her to move. On the voggiest days, she is forced to stay in her bedroom, where she has an air purifier and an air conditioner.

Wong Yuen and her husband were considering a move last year, but the difficulty of finding jobs somewhere else kept them in Pā- hala. So did their fondness for their longtime home and hometown, where they have lived for 30 years, raised their children and were planning to retire.

"It's so hard to pick up and move when your roots are here," she said.

FEW STUDIES DONE

The long-term health effects of the heavy vog (a chemical stew of sulfur dioxide, fine particulates and other compounds) remain unknown. Everyone agrees that the volcanic emissions can't be good for anyone's health.

But no one can say what prolonged exposure to the thicker vog will mean, especially for kids, the elderly and people with chronic conditions.

That's largely because there have been few studies on the effects of volcanic emissions on populations around the world. Researchers say that although studies on the health effects of sulfur dioxide from urban or industrial pollution provide some insight, they don't provide answers because components of vog aren't quite the same.

"We live in the vog. We live in it daily," said Guy Enriques, Hawai'i County councilman for Ka'ū district. "The trees are losing their leaves. The crops are going. What we don't know is what's happening to us."

And all the while, Kīlauea continues to vent gas. In 2008, Kīlauea sent out more sulfur dioxide than it has since annual emission rate measurements began in 1979.

There are at least two large studies under way to track the potential health effects of vog, including one that shows significant links between vog exposure and "acute airway problems, headache, cough, asthma exacerbations" and sore throat, according to the study's authors.

The results of that study, the second phase of the Kī- lauea Volcano Health Study, have not yet been published. But co-investigator Berna- dette Longo, a professor at the University of Nevada, said information collected so far has shown an "increased burden of disease," especially in children.

Longo has published other studies that also link vog to health problems. A two-year study conducted before the new Halema'uma'u vent opened showed that Ka'ū residents were more likely to develop acute bronchitis than residents living elsewhere on the Big Island.

Meanwhile, an ongoing study is tracking 1,986 Big Island children. Dr. Elizabeth Tam, of the John A. Burns School of Medicine, found that vog exposure before the Halema'uma'u vent opened could not be correlated to higher rates of asthma.

She is now trying to identify potential problems associated with higher vog exposure among the group and whether children exposed to vog have different growth rates. So far, she has found no direct link between vog exposure and growth rates. Tam is fairly sure that she won't.

"I think it's actually impossible," she said. "There are so many other factors that really mix things up."

Those other factors range from exposure to a parent who smokes to living in a house with mold or dust mites, Tam said.

STATE STUDIES

The state Health Department, meanwhile, is conducting a new review of hospital admissions in voggy areas. The study is not yet complete.

It did release a study last year that looked at whether emergency room visits for respiratory distress went up on very voggy days. Only Ka'ū Hospital showed a statistically significant increase in visits.

In response to questions about concerns from Ka'ū residents about the health effects of vog — and whether the state is doing enough to track problems — the Health Department said it is working with other agencies to determine potential areas of study.

Dr. Linda Rosen, chief of the DOH Emergency Medical Services and Injury Prevention branch, said that officials have also looked at ambulance usage data from 2008 and found no link to voggy days.

And she said DOH is also trying to get outpatient data from HMSA to see whether more people in voggy areas are going to their doctors complaining of symptoms related to vog.

"We feel the burden of health effects may be on the outpatient data — sinus visits, asthma that's difficult to control," Rosen said. "We were looking at the severe end (of symptoms). Now, we want to look at other effects."

Studies of health problems associated with sulfur dioxide (from industrial sources) have found short-term exposure is linked to respiratory symptoms, including coughing, wheezing and shortness of breath, and decreases in lung function among asthmatics, according to the EPA.

The effects of long-term exposure are harder to pin down: A link between the gas and long-term medical conditions has not been established.

Studies have connected long-term exposure to airborne particulates with reduced lung function, development of chronic bronchitis and other health problems, but scientists are wary of drawing conclusions about whether the particulates in vog, which reach high levels, have similar effects.

'A TICKING TIME BOMB'

For now, with no signs that higher levels of volcanic emissions are abating, Big Island residents are trying to get by — even as the proportions of what state Rep. Bob Herkes calls an "ongoing natural disaster" grow.

"It's a ticking time bomb," said Herkes, D-5th (Ka'ū, S. Kona).

Jessie Marques, executive director of the Ka'ū Rural Health Community Association, is determined to make sure that bomb doesn't go off. Her organization is taking the lead in Pāhala in trying to get a handle on the effects of vog — and getting help to deal with them.

Marques said part of the solution is education, such as telling people not to exercise in heavy vog and getting them to quit smoking and live healthier.

"At least we can make that difference," she said.

Marques, who has become an advocate for her community, testifying at the Legislature and pushing for more discussion on the effects of vog, has her own health problems. Her doctor told her that if she stayed in Pāhala she would die. Marques suffers from severe asthma and her husband, who recently had a stroke, has asthma and diabetes.

But Marques said moving is not an option.

"This is where my home and family is," she said, sitting at the association's offices — a small yellow house tucked away off the main street.

During an interview, she stops to close the front door of the home to keep the voggy air out. She speaks with a wheeze, and coughs — often — to clear her throat. She never seems to get a deep breath.

Marques said she has lived with asthma and vog all her life. Her symptoms worsened severely after March 2008, though.

And, Marques stressed, she's not the only one.

"There are many people in our community who are worse off," she said. "The children are subjected to it, and we must not forget our elders. We all cannot simply move away."