A lead-poisoning solution within reach
This is the last story in our four-part series “Persistent Poison: Lead’s Toxic Legacy in the Bay Area.”
In Alameda County, which has some of the highest lead levels in the country, an energetic public health nurse helps families after their child has been lead poisoned. But her work is a stopgap solution. What’s the answer to preventing leading poisoning before it starts? Below is an update from the reporters since the series originally aired.
In her job as a public health nurse, Diep Tran deals with the worst cases of lead poisoning in Alameda county. She has a lot of hard days, but today is a good day.
She’s visiting the Akbari family at their home in San Leandro. Mom Rona Akbari greets her at the door. Diep takes off her shoes and walks onto the plush white carpet, the kind you only find in brand-new apartments like this.
Four year old Samim pops his head around the corner of the hallway. “Oh, there he is!” Diep says excitedly. Samim’s acting shy, but he’s known this woman for over a year.
The Akbaris met Diep — the primary public health nurse for Alameda County’s lead poisoning prevention program — when a blood test showed Samim had lead poisoning, actually the highest lead levels Diep had ever seen. Now, a year and a half later, his levels have dropped significantly.
“When I saw him in the hospital, he was just skin and bones,” she says. “He didn't even have cheeks. Now he has little cheeks.”
Samim’s lead poisoning could have lead to permanent brain damage. Luckily, he’s doing fine except that he still doesn’t want to eat much. Loss of appetite is a common symptom for lead poisoning, but it’s hard to understand because his mom, Rona, is such a good cook. She brings out a tray of beautiful Afghan pastries and encourages Samim to eat.
The Akbaris moved here from Afghanistan almost three years ago. At least a third of Diep’s clients are immigrant families and she says she tries to be sensitive to all of her client’s cultural practices. She learned how to say the word for lead in Farsi and she’s worn a headscarf to the Akbari’s house today.
Diep says a lot of families come to the U.S. with already high lead levels because of lead-based products from their home countries: pots from Mexico, turmeric from India, or the eye makeup called kohl or surma that’s common in Afghanistan and many parts of the Middle East and Asia.
“Most Afghan children, when they come here, have a blood level between five and nine,” Diep says. Those numbers are significant because the Centers for Disease Control say the threshold for intervention is anything above five micrograms of lead per deciliter of blood. Usually, Diep says, when Afghan children come to the U.S., their lead levels go down. “But if they're living in a house that's old and has lead contaminated peeling paint, then — boom.” Their lead levels can spike.
Kids can accidentally ingest lead by eating paint chips or touching the ground where paint flakes or dust settles and then putting their hands in their mouths. That can result in lead poisoning.
When SamimAkbari came to the U.S., his lead level was eight micrograms of lead per deciliter of blood. After living in an old house in Oakland, his lead levels shot up higher than 70.
His case was so extreme, he made the local news.
When the Akbaris moved to the Bay Area, they first found an apartment near International Boulevard in Oakland. Samim loved to play outside, bouncing a ball near a wall that had peeling paint. He touched the ball, then touched his mouth, and that’s how he ended up in the hospital with lead poisoning.
His mom, Rona was terrified. “That was a bad situation and I will never forget it,” she says.
Samim had to undergo chelation, an aggressive treatment for lead poisoning. During chelation, doctors put a chemical in the blood that binds to heavy metals, like lead. The body then flushes them out. It’s hard on the kidneys, which suddenly have to filter a lot of lead. Samim stayed in the hospital for weeks.
"It starts out as lead poisoning education, but then it goes to social services education, domestic violence, nutrition development." - nurse Diep Tran
This all happened in the Akbari family’s first year in the U.S. They already had a lot to deal with: learning English, finding jobs, figuring out their way around. Now they had a sick kid in the hospital and they had to quickly find a new place to live to get Samim away from the lead source.
They ended up moving to the most affordable place they could find, a friend’s house in Antioch, far from dad, Ismail’s work, and the kids’ school. Ismail says, with a two and a half hour commute, he spent most of his time outside of work stuck in traffic. He says his kids felt like they never saw him anymore. “The first year in the United States was not good for me, honestly.”
Diep says at one point, Ismail told her his homelife had been better in Afghanistan. “In a moment of despair, he said ‘In Afghanistan, we only have the Taliban as a problem,’” Diep says.
Luckily, the Akbaris say, they had Diep to help. Diep is a nurse but she ends up doing a lot more.
“It starts out as lead poisoning education,” Diep says, “But then it goes to social services education, domestic violence, nutrition development.”
Often, it’s helping families find affordable housing. Imagine — in this housing market — if you found out that your home poisoned your child? What would you do?
You can paint over peeling lead paint and contain the hazard, but many families want to move after finding out their was child lead poisoned by their home. In the Bay Area, where affordable housing is scarce, that often means having to move to a different city or out of the area entirely. Diep says she sometimes has to suggest that families go to a homeless shelter, only because she’s seen that, as soon as they move, the kids’ lead levels start going down.
The Akbaris got very lucky. Diep helped them enter an affordable housing lottery and they won a spot in this beautiful, brand new, affordable housing complex in San Leandro. Over thirty thousand families applied for the 150 apartments here.
Ismail is reserved and matter of fact, but it’s obvious he’s very happy to be here. This new apartment is just a five minute drive from his work. Rona likes the schools. Most importantly, it’s brand-new and lead-free.
“I was the first man to come in here,” Ismail says. “The doctor and nurse, they all come here and they said, ‘You're lucky. There will be no lead. You can stay so safely here.’”
Even though they’re safe, the Akbaris are being cautious. Samim’s lead poisoning even changed their social life. Ismail says they won’t go back to their old neighborhood in Oakland and stopped visiting friends there. They’re basically convinced the entire city of Oakland is poisoned. They make their friends come visit them in San Leandro, instead.
They’re being cautious, not just for Samim, but for their newborn baby, Ferdous. Diep, the nurse, is obsessed with him, holding him and cooing, “Look at this face. He's beautiful.” Diep even went to visit Rona and the baby in the hospital when he was first born.
"The doctor and nurse said, 'You're lucky. There will be no lead. You can stay so safely here.'" - dad Ismail Akbari
As we are about to leave, Diep notices something on the baby’s forehead. “Yoohoo mommy, what did you use?” she asks Rona.
It’s surma, Rona tells her, the eye powder that can have lead in it. The night before, Rona says, a friend came over and noticed that the baby didn’t have any of the powder Afghan families traditionally put on new babies’ eyelids. That friend became angry with Rona, saying that the baby was so cute, he needed surma to ward off the evil eye. But Rona reminded her friend about Samim’s ordeal with lead poisoning. She didn’t want to risk her other child being poisoned. They compromised, and put surma on the baby’s forehead instead of on his eyelids.
As Rona recounts this, Diep cheers her on. For Diep, it’s a big deal that Rona didn’t put surma on her baby’s eyes, that she insisted her friend only put it on the baby’s forehead, and that she talked to her friend about lead poisoning at all. It’s progress.
Over the past year, Diep has spent hours working with the Akbaris to lower Samim’s lead levels and get them into this lead-free, affordable new home.
Multiply all that work by the 150 other families in her caseload, and it’s a lot of hours spent on what is really just a stopgap solution for a problem that health officials have been saying we’ve needed to solve since the 1970s.
Larry Brooks is Diep Tran’s boss and the director of Alameda County’s lead poisoning prevention program. He wants the city to address the lead problem before kids get sick.
“The only real way to attack child lead poisoning is a more proactive, preventative approach,” he says.
Larry says, the state can test more kids to get a better sense of who is at risk, the counties can beef up their lead education, but everyone knows the biggest culprit in lead poisoning in the Bay Area: old homes with lead paint.
In Oakland, which has zip codes with some of highest rates of lead poisoning in the country, more than eighty percent of the houses were built prior to 1978, when the U.S. banned lead paint. In order to truly address the lead problem, the city would need a solution to contain all that lead paint.
Right now in Oakland, if you’re a low-income tenant or homeowner — or if you’re a landlord who rents to low-income tenants with kids — you can call the county and arrange for a test. An inspector comes with something that looks like the radar gun cops use for speeding, but this one tests for lead in the walls, floors, and window sills — everywhere. If they find lead, the county can provide some limited funds to help with repairs.
Larry wants to see all homes regularly inspected like this. It’s the best solution he sees to prevent lead poisoning. Especially because, he says, in this housing market, tenants are reluctant to ask landlords to look at any home repairs, including lead hazards. “We have an affordable housing crisis here in the Bay Area. People do not want to take the risk of being evicted.”
That’s why, Larry says, inspecting must be proactive. He believes the city has to test apartments for lead before people rent them, or the apartments have to be tested regularly.
Many cities have programs like this in place.Take Rochester, New York, for example. It had a childhood lead rate ten times the national average, but starting in 2005, the city proactively sent inspectors to test for lead in rental units, without waiting for kids to get sick or renters to complain. Landlords had to address any lead hazards found. With this program, Rochester reduced its childhood lead poisoning rates by eighty five percent in ten years.
Community groups in Oakland have pushed the city to create a proactive program for almost a decade.The City Council has considered the idea for about seven years. In 2017, members agreed that they want a rental inspection program that would proactively inspect rental units for habitability issues, not just for lead but also for things like mold and fire hazards.
Now, a working group needs to hash out all the details. Should the city test every rental unit for lead? Or only ones in zip codes with high lead poisoning rates? Should inspectors just look for lead hazards like peeling baseboards? Or should they actually run tests for lead paint? How often should the city inspect rental units? Every year? Every five years?
The details of the program will, of course, determine the cost.
One study from 2014 shows that a comprehensive rental inspection program will cost the City of Oakland about sixteen million dollars over the next twenty years, including two million for the first year of start-up and trial inspections.
The working group hoped to present a plan to the City Council by this spring, but it’s behind schedule and may not be ready until the fall.
Meanwhile, Larry worries about that the upcoming election. “We could find ourselves in a situation where we have newly elected officials who have to go through the learning curve all over again,” he says.
Whenever councilmembers finally see a proposal, they’ll have to weigh this program against Oakland’s other issues.“They're facing the usual challenges that cities have in terms of limited dollars and priorities,” Larry says.
The lead problem often doesn’t get prioritized because, unless you’re part of a family with a sick kid, lead poisoning can be a pretty invisible problem.
Meanwhile, there are some very visible signs of our housing crisis right now, like the tent cities under the freeways. “It's really hard not to see that people out there on the streets that are homeless, and be worried about how being out there in the elements is impacting their health,” Larry says.
On the other hand, Larry says, “There are people who are not homeless but they're living in these hazardous housing situations that need to be addressed.” Lead isn’t the only hazardous condition people face in their homes. Children might get asthma from mold growing on their walls and Oakland residents know too well the tragedies that can occur when firehazards are left unaddressed.
With lead, we sometimes see it when it’s too late — when a kid like SamimAkbari ends up hospitalized.
Sometimes we never see it. Over time, kids exposed to even low levels of lead can end up with lower IQs and behavioral problems, without ever realizing they were lead poisoned. Studies have even show links between lead poisoning, ADHD, and violent crime later in life. Lead-poisoned kids might end up with more than just the obvious health issues. They might have a hard time in school,and may even end up in the prison system.
“These lead-poisoned children are having a profound impact on the educational system, the criminal justice system, the medical system,” Larry says. “If you really start adding up the dollars, its, you know, it’s scary.”
Larry says, though Oakland has a limited budget, one could argue that by solving the lead problem now, the City will save money later.
“I often think that the the next Bill Gates, the next person who's going to discover the cure for cancer, might be out there right now being lead poisoned and as a result, will never meet that potential,” Larry says.
He and many others have preached this message to city and state governments for years, advocating for better testing of kids, more lead poisoning education, and inspection of houses.
Still, Larry stays surprisingly hopeful. “At the end of the day it really just boils down to, if we can save one, we can save another one, and another one, and another one.” He hopes that more cities around the Bay Area will prioritize the problem of lead poisoning. “Maybe one day, Oakland city council will adopt that rental inspection program and ten years from now we'll be able to say that the child lead poisoning rate has gone down ninety percent. My job is to put myself out of work.”
Until then, Larry and Diep, the public health nurse, will be busy as ever, until we get rid of the problem of lead poisoning once and for all.
This is part of our series “Persistent Poison: Lead’s Toxic Legacy in the Bay Area.” The original air date was March 29, 2018. To find a list of resources on lead poisoning, click here.
Special thanks to Jesse Rhodes who helped with production for this story.