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5.15.2001
By
PETER B. LORD
Journal Environment Writer
MANCHESTER, N.H. -- Sunday Abek was 2 when her parents brought her to
America to escape a long, bloody war in the northern African country,
Sudan.
The
family members are Dinkas -- a tribe of tall, elegant-looking people.
Their faces are somber as they speak of so many years of violence.
"Our
country is full of war. Children can't go to school," explained Martha
Anthony, a friend of the family. Sudan is so dangerous the U.S. State
Department warns Americans to stay out. The economy is in ruins, the roads
are often impassable, and shooting can break out anywhere.
Sunday
was tiny; her height and weight placed her in the bottom 5 percentile
of children her age. She was malnourished and had an iron deficiency --
probably from spending much of her life in a refugee camp in Egypt. More
than most children, she tended to pick up anything she could find and
pop it into her mouth.
Sunday's
parents wanted to take her to a place where she could go to school without
fear. So they fled Sudan and finally resettled in a rambling tenement
near the center of Manchester, a mill town of triple-deckers bisected
by Route 93, which carries skiers north to the White Mountains.
Sunday
never got to go to school.
In
April of last year, a week after arriving in the United States, Sunday
began vomiting and running a high fever. She was rushed to a local hospital,
and then transferred to the renowned Dartmouth-Hitchcock Medical Center.
Three
days later, she died.
She
was lead poisoned.
No
one knew why.
SUNDAY'S
DEATH served as a reminder to lead experts around the country that though
the United States is gaining ground in its war against lead poisoning,
there are still casualties.
Fortunately,
deaths now are quite rare: Sunday's was the first in about 10 years. By
comparison, during the early part of the 20th century, lead poisoning
killed scores of people every year.
But
lead still causes thousands of children to suffer in serious, but less
obvious ways. Most commonly, children ingest lead that flakes off the
walls of their homes, clings to the dirt they play in, or gets spread
by people sanding and scraping woodwork.
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LEAD
(led) n. 1. Symbol Pb
A dense metallic element used in solder, radiation shields,
paints, and antiknock compounds.
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The
acceptable unit for measuring blood-lead levels is the amount of micrograms
of lead to a deciliter of blood, expressed as ug/dl. Almost one million
children ages 1 to 5 in this country currently have blood-lead levels
at or above 10 ug/dl -- an amount so small, it's like adding less than
2 ounces of water into a 13,000-gallon back-yard swimming pool.
But
the 10 ug/dl level has generally been considered the threshold for altering
behavior and cognitive abilities. Nearly 3,000 children in Rhode Island
exceeded this threshold last year.
Generally
children under that level have been considered safe. But now, many experts
say no amount of lead in the blood may be safe.
The
"safe thresholds" for lead and other substances toxic to the
central nervous system have been continually revised as scientific knowledge
advances.
The
initial "safe" blood-lead level was set at 60 ug/dl in 1960.
Now children at that level are hospitalized for treatment.
The
safe level was revised down to below 10 ug/dl in 1990.
Now,
according to a recent report by the Greater Boston Physicians for Social
Responsibility, current studies suggest that there may not be any identifiable
level that is considered safe.
Last
year, Dr. Bruce P. Lanphear, of the Children's Hospital Medical Center
of Cincinnati, released a study of 4,853 children showing that for every
increase of 1 ug/dl of lead in their blood, there was a decrease of 1
point in their reading scores. This held true for lead concentrations
as low as 2.5 ug/dl. The study also shows that blood-lead levels of under
10 ug/dl cause deficiencies in reading, math, and short-term memory.
Lanphear
said his study shows that "acceptable" blood-lead levels should
be lowered by at least half -- or about 5 ug/dl.
He
also argued "for a policy shift toward primary prevention -- the
elimination of residential lead hazards before children are unduly exposed."
PEOPLE
HAVE known that lead is a poison for thousands of years.
Ancient
Greek physicians diagnosed lead poisonings. French authorities sought
to ban the practice of using lead to sweeten wines. Benjamin Franklin
wrote about people being poisoned by the lead in rum distilled in New
England.
Christian
Warren, author of a book published last year, A Brush with Death, a Social
History of Lead Poisoning , quotes a Charles Dickens character who was
poisoned while working in a local lead mill. The landlord explains the
tenant is poisoned "bad as can be . . . and her brain is coming out
at her ear, and it hurt her dreadful." High levels of lead poisoning
common at that time would cause dramatic brain swelling and would be agonizing
for the victims, according to the book.
At
the turn of the 20th century, lead poisoning was considered largely a
workplace problem. Companies that used lead knew it made their employees
sick, according to Warren.
Hundreds
of people died every year. Lead companies offered their most dangerous
work to immigrants and there was little compensation when they became
sick or died, he said.
Though
a few doctors were diagnosing childhood lead poisoning in the early 1900s
and numerous foreign countries banned its use inside houses, it was to
take the better part of 50 years for the majority of U.S. health experts
to become convinced that the widely used metal also posed a threat to
the health and development of children.
Many
cases went undiagnosed. One medical textbook in the 1920s reported: "An
infrequent cause of convulsions in young children is an encephalopathy
due to lead poisoning. We have seen eight such cases, six of which were
fatal. The poisoning was caused in each instance by the child's nibbling
and swallowing the paint from his crib or furniture."
SUNDAY'S
DEATH on April 21, 2000 initiated an eight-month investigation by city,
state, and national health authorities.
It
was clear she was lead poisoned.
But
why? What was the source?
Local
health officials insisted there was no sign of lead inside the New Hampshire
apartment. They wondered if she had been poisoned in Africa.
So
with help from the U.S. Centers for Disease Control and Prevention and
the Egyptian Health Ministry, samples were taken from Sunday's neighborhood
in Cairo and an Egyptian powdered milk product that she was fed.
State
and city health investigators consulted national experts on childhood
lead poisoning, analyzed samples in four state and national laboratories,
and used sophisticated examinations of isotopes to compare paint samples
collected in Sunday's Manchester apartment with lead in her body.
In
the end, they determined that Sunday was probably killed by the carpet
of peeling, flaking gray paint covering the porch outside her Manchester
apartment, where she often played.
The
porch paint was 37 percent lead by weight.
To
get a sense of how toxic that porch was, consider that in the face of
increasing criticism in the early 1950s, the lead-paint industry voluntarily
agreed to set a new limit on the quantity of lead it would allow in interior
paints.
The
new limit was less than 1 percent by weight.
And
some city health departments believed that level was still so dangerous
that warnings should be put on paint cans.
THOUGH
THE average blood-lead level of Americans is decreasing, environmentalists
and child health advocates remain deeply concerned about the remaining
dangers.
"The
number of government hearings on childhood lead poisoning has increased,
as has the number of landlords sued for negligence because of lead paint,"
Warren writes. "The reason for this apparent irony is that the fight
to end lead poisoning is part of a complete reshaping of the definitions
of acceptable risk and wellness, and of how society views its duties to
the poor."
One
impediment in the early part of the century was the tendency of many public
health officials to blame victims rather than the environment or their
employers for their health problems.
Rather
than call for bans on lead paint, doctors blamed children for a behavior
called pica, a tendency to eat non-food items such as dirt or paint, or
blamed parents for poor supervision.
But
as bad as conditions were at the turn of the century -- with heavy industry
spewing lead and landlords and homeowners covering their homes and furniture
with toxic lead paints -- things only got worse in the 1920s.
General
Motors, Dupont, and Standard Oil struck a deal to produce leaded gasoline.
They were looking for a way to make gasoline burn more efficiently and
to reduce engine knocking.
They
settled on tetraethyl lead, despite warnings from health officials that
it would distribute toxic lead across the countryside and despite numerous
deaths and injuries of workers at plants that manufactured it.
An
estimated 7 million tons of tetraethyl lead were produced by just one
maker, the Ethyl Corp., for 60 years until the late 1970s, when the country
phased out leaded gasoline, primarily because it damaged catalytic converters.
Automobiles
emitted tiny lead particles throughout the country. Because lead does
not break down, all that lead is still with us, mixed in soils, residing
in sediments under water.
From
1976 until 1980, when leaded gasoline was finally taken off the market,
the U.S. Environmental Protection Agency charted the public's average
lead levels and found they declined -- from 16 ug/dl to less than 10 ug/dl
-- at nearly the identical rate that leaded gasoline use decreased.
ONE
PROBLEM with detecting lead poisoning is that it often is only obvious
at really high levels.
Lead
workers went blind, suffered convulsions or died after horribly painful
swellings of their brains.
That
was how Sunday died. Her brain swelled uncontrollably against her skull.
But
it's much more difficult to diagnose someone suffering from low-level
lead poisoning.
Dr.
James "Jeff" Brown, who has run a lead clinic in Providence
for the last 30 years, said lead poisoning affects some children much
more than others, and it's nearly impossible to diagnose without blood
tests.
As
far back as the 1940s , scientists found that low levels of lead poisoning
caused poor school performance, impulsive behavior, short attention spans,
and restlessness in children.
Lead
poisoning also reduces intelligence. Some research indicates that for
every 10 ug/dl of lead, people lose an average of 3 IQ points -- that's
not much for the average person, whose IQ, or intelligence quotient, is
about 100.
But
the physicians group argues that losing a few points has a big effect
at the low and high end of the intelligence scale, taking many people
out of the gifted range and pushing many people with lower-intelligence
into the retardation range.
If
the entire U.S. population had its IQ lowered by just 5 points, 3.4 million
more people would be classified as retarded and 3.6 million fewer people
would be considered gifted, according to a report by the physicians group.
Other
studies show lead causes abnormal brain development, affecting both the
cell structure of the brain and its chemistry.
Newer
studies found that lead exposure correlates with aggressive, destructive,
and delinquent behavior. Some scientists are pressing to test the blood
of young offenders who have tempers and short attention spans, which are
symptoms of lead poisoning.
THE
FUNERAL was held in late April. A spring snowstorm hit the region so the
skies were dark and the streets were wet.
In
Sudan, Muslims and Christians are killing each other. In Manchester, refugees
from both faiths spent the day with the grieving family.
They
quietly cooked chicken in the morning and prepared for a meal to be shared
after the funeral and burial.
Sunday's
mother, Mary Alorout Kuol, stayed in bed, grief-stricken.
The
funeral service was held at St. Ann's Catholic Church, an ornate red brick
building in downtown Manchester. Reflecting the diverse audience, prayers
were said in English, Arabic, and Dinka.
Afterward,
family, friends and local relief workers filed out, climbed into cars
and drove across the city to the cemetery. The snow fell, soft and thick,
muffling sounds from the nearby highway.
Under
a small tent, the priest said a few more prayers over the tiny coffin.
The women wore their brightly colored African dresses and tried to keep
warm with knit hats and overcoats.
Family
friend Martha Anthony asked the priest if the family could sing. He said
yes.
Melodic
African prayers rose from the mourners. Tears streamed down their cheeks.
Then
it was over.
Family
and friends returned to the apartment where Sunday briefly lived. The
men sipped tea. The women prepared the chicken and rice and vegetables
in the kitchen.
Mourners
talked about this new killer. Because of Sunday, health officials tested
other family and friends and found that they, too, have elevated levels
.
John
Yen, an Episcopal priest from Sudan, says his test came back at 32. He
shrugs.
"In
Africa, we don't know about lead," he says.
TEN
MONTHS later, Richard DiPentima, deputy public health director for the
city of Manchester, says there are still some uncertainties about Sunday's
death. For instance, health officials don't know if she had elevated lead
levels when she arrived in this country.
But
officials are convinced most of the poisoning occurred during the short
time she was in Manchester.
The
flaking porch where she and other children played was badly contaminated.
The fact that she was malnourished, had an iron deficiency, and tended
to eat non-foods she picked up probably contributed to her body absorbing
more lead, which caused greater harm than it would in a healthier child,
DiPentima said.
"The
rest of the family all had negligible amounts of lead," he said.
"This was something unique to the child -- her own medical condition
and the pica."
Sunday's
lead level was 391, nearly 40 times higher than the level considered poisoned.
It
was an astronomical level, by any standard.
The
Manchester Health Department now screens all immigrant children arriving
in the city, DiPentima said.
The
lead paint on the porch still hasn't been abated. The landlord cleaned
up the interior last year, but winter came before he fixed the porch.
The state's 150-day notice period has run out. State officials thought
the tenement was going to be sold, but the sale fell through. Now they
say they will press the owner to finish the job.
A
new family has moved in, but at least the children are older, according
to Neil Twitchell, the state's lead program manager.
DiPentima
says he hopes something good comes from Sunday's death.
"I
hope more comes out of this in terms of education and funding," he
says. "To think that these people survived all they did to come here,
and this happens. . . ."
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