This is the first in a four-part award-winning series “Persistent Poison: Lead’s Toxic Legacy in the Bay Area.”
A 2017 Reuters report showed that a few Bay Area neighborhoods have some of the highest rates of childhood lead poisoning in the country. In Part I of the series, we meet the public health nurse who manages all the severe lead poisoning cases in Alameda County and one of the families she works with, whose lives were turned upside down when their son became lead-poisoned.
Part II: Lead and the Bay Area housing crisis
Part III: The lead-poisoning data gap
Part IV: A lead-poisoning solution within reachPublic health nurse Diep Tran thought she’d be out of her job by now. “Our plan was for lead poisoning to be gone, eradicated by 2010, and yet we are still getting too many cases,” she says.
This is the woman who manages all the severe lead poisoning cases for Alameda County. Diep is in her 60s, has a short bobbed haircut and a lot of energy. She works all the time. The first day we meet her, she barely sits down, constantly popping up to get something else that she wants to show us.
“I’ve been told that I say too much, I write too much!” she laughs.
It’s a good thing she has a lot of energy, because she has a full caseload. Alameda County has some of the highest childhood lead poisoning rates in the country.
Last year, Reuters released a report showing that some neighborhoods in the Bay Area have higher rates of childhood lead poisoning than Flint, Michigan, where a lead poisoning public health crisis made national news in 2014. Taken as a whole, the Bay Area has low rates of lead poisoning, but Reuters showed that certain zip codes — like the Fruitvale neighborhood and West Oakland — have childhood lead rates more than three times the national average.
Lead poisoning is also a problem in other parts of East Oakland, as well as Emeryville, San Leandro, parts of Fremont, and San Francisco’s Mission and Bayview-Hunters Point neighborhoods.
Children in Flint contracted lead poisoning from water running through old pipes. In the Bay Area, the poisoning comes from lead-based paint from our old housing stock. In Oakland, for example, eighty percent of existing homes were built before 1978, the year the U.S. banned lead paint.
Kids living in old homes can ingest lead, either by inhaling paint that’s turned to dust or directly eating paint that peels off baseboards. Lead actually tastes sweet, so kids have been known to eat paint chips. Little kids are most susceptible to lead poisoning, because they usually spend a lot of time on the ground and are more likely to put things in their mouths. Then lead, a toxin, can get in blood, bones, and brains, interfering with neurons, which is especially bad for kids with developing brains. They can lose their appetites, get anemia, and exhibit violent behavior.
This is how little lead it takes to be poisoned: Imagine lead to be like a packet of sugar that you use for a cup of coffee. If you took that sugar packet and sprinkled it around a room, and then a kid crawled through that room and put her hand in her mouth, that alone would be enough lead to poison that child.
Diep Tran works with the families of severely lead-poisoned children. She helps families treat the lead poisoning and arranges for tests to figure out the lead source, so the kid can stop being exposed.
It’s really intimate work. She visits the families’ homes and works with them for years to help them deal with the trauma of lead and its effects. Long term, it can cause permanent learning disabilities and behavioral disorders. She experiences those effects firsthand, too. One time, during a home visit, a lead poisoned child threw a ball at Diep’s head. That’s what lead can do to a kid.
Diep is like a walking Rolodex of families affected by lead. She tells us about one child she works with who ate paint off the windowsills in his Victorian home for two years. He now has speech and behavioral problems. Diep works with another lead-poisoned child whose mom was also lead-poisoned back in the 90s — two generations of lead poisoning in Oakland.
In Alameda County, almost a third of residents moved here from other countries, and people speak 53 different languages, so to gain trust Diep has to be a cultural translator, of sorts. She wears a headscarf when she visits Muslim families. With others, she goes by a different name.
During interviews with families, we heard about another medical provider, someone these families called Doctor Mariposa. Mariposa’s the Spanish word for butterfly.
We ask Diep who Doctor Mariposa is, and it turns out, it’s her. She says Spanish-speaking families often have trouble remembering her name. “I tell them Diep means mariposa in Vietnamese, and they all call me mariposa, which is fine.”
"I've seen parents go into shock. Some feel guilty and go into denial, which is not good for the child." - Diep Tran, public health nurse for Alameda County's lead poisoning prevention program
Diep says when she first meets families, she spends an hour talking to them and getting to know them as people. She tries to tread lightly, knowing that when parents find out their kid has lead poisoning, they can get pretty emotional.
“I've seen parents go into shock,” she says. “Most of them are anxious. Some feel guilty and go into denial, which is not good for the child, because parents in denial don't want to work with us.”
From following Diep, we’ve really come to understand that lead poisoning complicates lives, not just for the kid, but for the whole family.
Bracing for a diagnosis
Being a mom is a full-time job, but being a mom to a kid with lead poisoning, it’s like also having to work the night shift.
Diep introduced us to Anabel Razo, a mom whose family life got really complicated after her son’s lead-poisoning diagnosis.
Her two little kids chase each other down the hallway at Highland Hospital in Oakland, while Anabel tries to fill out paperwork at the intake desk. Anabel likes to dress them like twins because it makes it easier to keep track of them. Today, they’re wearing matching red flannel shirts and slicked-back hair. Anabel yells after them to come back.
It’s no wonder these kids see the hospital as a playground. They’ve been here many times.
A year ago, when he was just a year old, Anabel’s son Antonio stopped eating. She told her doctor, and he tested Antonio for lead.
Doctors diagnose lead poisoning with a blood test. The Centers for Disease Control say there’s no safe level for lead, but the threshold for intervention is when the blood shows more than five micrograms of lead per deciliter of blood. Any level of five or above is considered too high and cause for intervention.
Antonio’s lead level was 30.
They’ve visited the hospital four times since then, to monitor his blood lead level in the hopes it is going down. In the meantime, Anabel's youngest son Alex was born, and he has a little lead in his blood — just under five — so she’s keeping an eye on him as well.
A nurse calls Anabel’s number, and the little family is escorted down the hallway, into a hospital room. Anabel sits in the patient chair with Antonio on her lap. It’s his turn first. She circles her arms tight around him, while the nurse draws his blood. He pouts a little, but overall handles it like a pro.
Then it’s his younger brother Alex’s turn. He is not as used to this yet. He wails loudly as the nurse draws blood. It’s over quickly and soon even Alex is back to high spirits.
Anabel scoops up one child in each arm and heads back down the hallway. A lab will test the blood for lead, and Anabel will find out the results in a few days.
The family makes one more stop: the vending machine. Anabel buys the kids a bag of cookies to split, doling the cookies out slowly as they walk back to the car. “Every time I bring them here, I give them a prize,” she says. She’s trying to keep this a positive experience, because it’s definitely not the last time they’ll be at the hospital for a blood test.
A world turned upside down
We met Anabel in September of last year, after asking Head Start day care programs in Oakland if any families living with lead poisoning wanted to share their stories. Anabel said yes. She graciously welcomed us into her family’s life and let us tag along with her many times.
She ended up having a more complicated story than we thought we’d find; not the kind you can tie up neatly in a bow.
Anabel lives in an older house off a main drag in the Temescal neighborhood of North Oakland. On the first day we visit, her kids — Alex, Antonio, and two pre-teens — are playing in the yard outside with their puppies.
Anabel tells us Antonio’s lead poisoning diagnosis turned her world upside down. “It changed my life.”
She really struggles with one of the common symptoms of lead poisoning: a lack of appetite. For the last year, Anabel says, Antonio only ate one tortilla a day and drank milk. Little kids are often picky eaters, but lead poisoning makes it severe. Anabel says she has to beg him to eat, and he just cries and cries.
He also acts out. Remember, lead poisoning can cause behavioral problems in kids.
“Antonio is violent and angry,” she says. He picks fights with his siblings in a way that the other kids don’t.
Lead impacts kids under the age of six the most, because their brains are still developing. This is another way that living with lead is so scary. A kid can have a blood lead level of five, 10, even 15 and not show symptoms, but lead can still be taking its toll on the brain and lead to learning disabilities.
If he’s not well now, she worries he won’t be well in the future. She’s afraid the lead will cause permanent damage.
"I think about it every day. It's not easy to know that he has that in him." - Tony Godinez
Anabel’s partner, Tony Godinez, arrives after work. Little Antonio couldn’t be happier to see him. He runs to the gate to greet him, and Tony swoops him up in his arms.
For Papa Tony, lead poisoning haunts him. “I think about it every day,” he says. “It's not easy to know that he has that in him.”
Tony says he hates feeling helpless, but he hates the blood tests even more. Tony went once to his son’s lead test but won’t go back. “It was hard to see him cry,” he says. “Oh my God, it breaks my heart."
The only way to get lead out of the body is through a process called chelation. Doctors put a chemical into the blood that binds to heavy metals like lead, making it easier for the body to flush the lead out. Chelation also draws lead out of the bones. All of this is hard on the kidneys, which suddenly have to filter all this lead. It’s an aggressive treatment, but it can be life saving.
If Antonio’s lead levels get too high, he may have to spend weeks in the hospital undergoing chelation, while doctors monitor his kidneys. Anabel actually seems as scared of the chelation treatment as she is of the lead itself.
"I’m scared he’ll end up in the hospital. I don’t want to see him there in pain.” - Anabel Razo
To avoid this, Anabel has been really focused on another treatment: good nutrition. Medical providers say foods high in calcium, iron, and Vitamin C keep the body from absorbing lead, so it’s good for kids to eat things like leafy greens and drink milk. Of course, that’s hard to do since kids with lead poisoning don’t want to eat.
“That’s the most difficult part,” she says, “because he only eats one tortilla, and I’m scared he’ll end up in the hospital. I don’t want to see him there in pain.”
The best solution for Antonio is to get him away from the source of the lead.
Last year, when Antonio’s blood tested high for lead, the hospital sent his results to the county. Then Diep, the public health nurse for the county’s lead poisoning prevention program, showed up to Anabel’s house with her team to identify where the lead was coming from.
Anabel says Diep and the county tested everything: the windows, the doors, the floors, and the paint on the walls. They even tested the soil in the backyard because, over time, lead paint can chip off of a house and accumulate in the ground.
Anabel says Diep and her team found “nothing” and the tests didn’t indicate that the house was the source of the lead. Maybe a “little bit” from outside, she says, but Antonio never went outside. She says he barely ever crawled on the floor.
Grief and guilt
When we bring this up with Diep, with Anabel’s permission, we get a very different story.
"It's the house,” Diep says “She’s in denial. The house is old. The paint was peeling. It tested positive for lead, and the child was crawling on it.”
Diep says a lot of parents feel like lead poisoning is their fault. For many families, it’s like going through the seven stages of grief. A lot of times, Diep ends up doubling as a therapist.
‘It’s not my role, really, but in order to get my work done, I have to do that.”
She coaches parents through depression, anger, even denial. She says denial can be the most time-consuming reaction for her to deal with, because the parents become resistant to working with her. Still, she has to try. “If you give up too soon, the child doesn't recover,” she says. “If the child doesn't recover, he surely will end up with behavioral and learning problems.”
Diep has about 150 cases any one time. She says she can’t spend her whole day chasing after families that don’t want to work with her.
“It's a very fine balance,” she says. She loses sleep at night trying to decide which families to visit in the morning. “Should I continue running after Anabel, or should I just move on to the next family, because I keep getting new families?”
In some ways these clients are like her family. Diep says she can do this job because she doesn’t have kids to worry about at home. Plus, her husband works and travels a lot. “So that frees me to toss and turn at night and worry about the next day!” she says, laughing.
That’s what makes parents in denial even more frustrating for Diep. She herself loses sleep over these kids.
There’s no law, though, that requires families to work with the county if lead poisoning is detected. “The parents have their rights, too, and that's the right not to be harassed,” Diep says.
If Anabel is in denial, it might be that she’s still going through the grieving process. Diep says she’s just taking longer than most parents to accept what happened to her child.
"It's too late now. You cannot go back in time. You just now move forward and make sure your child recovers." - Diep Tran, public health nurse
Diep says lead can also cause tension between parents. She had one case where the parents blamed each other for the child’s lead poisoning and ended up divorcing. Diep says she had to tell the parents, “Stop fighting. It’s too late now. You cannot go back in time. You just now move forward and make sure your child recovers, and he’s getting the help he needs.”
An impossible choice
We visit Anabel Razo and her family again a few months later. Little Antonio and baby Alex are playing with blocks on the floor, while Anabel and Tony sit on the couch. They’re talking about Antonio’s lead levels which, luckily, are dropping. Anabel still has to make him eat, but she says, Papa Tony often caves when it’s his turn to feed Antonio.
“I'm too soft,” Tony admits. “When Antonio doesn't want to eat, I don't force him to eat.” Tony says Anabel is more strict. “Because I see him normal,” Tony says. “I don't see him sick.”
Anabel gets a little upset. “Antonio is getting better because of me!” she tells Tony. “You’re not helping.”
Anabel and Tony also disagree about where the lead is coming from. Anabel still insists it’s not coming from the house, but Tony thinks otherwise. “To be honest, just by the test saying it was in the floor,” he knows his son could have easily gotten poisoned here.
Tony’s a contractor, and he says when the county told him that his house had exposed lead paint, he knew what to do. He patched up the peeling paint and put carpets over the floors. “It didn’t cost me that much,” Tony says. “I got the cheapest stuff at Home Depot.” The whole family worked together to install it. “Even her mom was installing the carpet!” he laughs.
He covered the lead hazards, and when county inspectors came back out to the house, they said Tony’s repairs worked. The county would have helped Tony with the cost of the repairs. It offers up to $10,000 to low-income tenants and landlords to fix lead hazards, but Tony didn’t think it was worth getting his landlord involved.
Tony is actually friends with the owner, and he tells us they have a plan to tear the house down and build a new apartment building on the property together. Tony says he’ll do the construction and, in exchange, his family will get to live in one of the new apartments for free.
Some families would try to find a new place to live, but Anabel and Tony decided to do this temporary fix — one that worked. Now they’re waiting it out until they can build a new home.
The promise of affordable housing means they were willing to take that risk. This is the quandary for so many lead-poisoned families in the Bay Area. Who wants to stomach the thought that your house is poisoning you, especially if you can’t afford to live anywhere else?
This story is part of the KALW News series “Persistent Poison: Lead’s Toxic Legacy in the Bay Area.” It was originally broadcast on March 26, 2018.
