The Element of Danger
More than two decades after lead was banned in paint, it continues to poison children
By Phil Campbell
JULY 5, 1999: "We don't want the child to be the canary. We would rather do primary prevention."
Debbie Wire of the Memphis and Shelby County Health Department uses that metaphor frequently. Although few people here have seen the inside of a coal mine, most will recognize the analogy. The small birds were taken in cages into the shafts by miners. If the bird succumbed to carbon monoxide, the workers knew where the danger lurked.
Like the canary, Memphis children are faced with an insidious threat, one over which they have little control. Health and housing experts here will tell you that the best way --oftentimes the only way -- to find homes with dangerous amounts of lead is after the young children living there have already been exposed to it. Many of the studies aren't conclusive, but experts believe that lead poisoning can lead to kidney and bone-growth problems, not to mention a lower I.Q. and a tendency toward anti-social behavior.
It's not as if Wire or the dozen or so other officials in charge of dealing with the lead poisoning of Shelby County don't want to track down the lead-filled homes before the children living there can be hurt. It's that the problem is already too widespread for anyone to dream of dealing with the issue any other way.
An estimated 12 percent of Shelby County's children have an abnormally high level of lead in their blood. This is not just a local problem. Nationwide, an estimated 1 million children have an unsafe concentration of lead in their blood.
The use of lead as an ingredient in paint in the United States was officially banned in 1978, so any home built after that time is not going to face this problem. Many of the children living in East Shelby County, then, are safe from lead poison. Midtown, North Memphis, and South Memphis, however, are filled with homes that were built before the 1970s, with some even dating back to the turn of the century. When these homes are allowed to deteriorate, the lead-based paint starts to peel, flake, chip, and fall to the ground, contributing to the dust and debris that covers floors and outside porches, possibly even the exposed soil in people's yards. Toddlers and small children, forever putting their hands in their mouths, are literally eating lead.
Fighting this threat takes both education and money, things not in ample supply in Memphis' poorest neighborhoods. The city's Housing and Community Development Division (HCD) and the Memphis Housing Authority (MHA) are working with the Health Department to tackle the issue that, after a couple generations, will inevitably go away.
Meanwhile, it's an uphill war to save the impoverished children of Shelby County. It's a war where the individual battles are determined not by local needs but by federal funding and federal regulations.
It's also an enormously expensive, reactionary war that diverts local housing officials from the progressive goal of rebuilding the inner city. The public sector has little choice but to spend as much as $25,000 to take a dilapidated home with a serious lead problem and miraculously convert it into a dilapidated home without a serious lead problem.
On InspectionIt's a Thursday morning, and Health Department inspector Elizabeth Bradley, a tall and cheerful woman with a Baltimore accent, arrives at the house that she is to inspect today. The white stone one-story structure on Zanone Street in South Memphis looks worn but solid. A beige minivan sits unusable in the yard, its windows smashed out. The first two signs of potential lead are readily visible from the sidewalk: exposed soil and peeling paint. Grass tends to contain lead, but dirt doesn't. The paint is cracking like the skin of a reptile, the classic trait of lead-based paint.
"You'll have to excuse the mess because we just got up," says renter Mitchell Robinson when she answers the door. Her boyfriend is busily sweeping the front room. The dirt he collects could fill half a dozen dustpans, but he takes it all up in two huge scoops before dumping it into an unlined garbage can.
One room is cluttered with furniture and junk, and there's a giant hole in the wood floor. In another, it's dark and stuffy. Nine kids, in a tangle of arms, legs, and torsos lie on a bed sleeping or watching TV. There don't appear to be too many other beds in the house. The laundry room is musty and dank. Clothes that were washed two days ago sit unsorted on the floor. The kitchen's most distinctive feature is the wall above the sink and stove: A few months ago, a fire left the wall pockmarked, cracked, and burned, with some parts missing entirely.
The house is among the worst you could see, Bradley confides, out of earshot of Robinson. Code inspectors could spend hours issuing citations on violations. Then they'd probably condemn it anyway.
But that's not Bradley's job. She is only there to prove that the place is covered with lead.
Bradley opens up her large black case and gets to work. She starts with the baby wipes. She finds the dirtiest part of a floor and rubs a baby wipe on it. She puts each used wipe in an individual plastic tube and covers it, labeling each tube carefully. She checks all the floors.
Then Bradley breaks out a device that looks like a police radar gun. The gun emits tiny, radioactive gamma rays into the surface at which it is aimed. It can study the surface of a door jamb at the atomic level. When the rays bounce back, they bring news of how much lead was encountered.
Bradley keeps careful notes with a microcassette recorder. "Wall A. Center Wall. Poor condition," she speaks into the recorder before shooting the gun. Judging by the reading, it's relatively clean, but the window sash next to the wall is full of lead. In all, Bradley takes about 150 samples in cracks, corners, floors, and spaces inside and outside of the house. If Robinson had hired an independent inspector to do this work and an independent laboratory to analyze the results, it easily would have cost her several thousand dollars, Bradley says.
Inside the house, I try to get more information from Robinson. She looks tired, and it's around 10:30 a.m. "How many children or grandchildren do you have?" I ask. She looks like she's already reached middle age.
"Eleven. I have 11 kids," she says. Just as quietly, she says, "I'm 33. I'm 33 and you think they're my grandchildren?"
When Bradley finishes, she reports some of her findings back to Robinson. There's high levels of lead in the laundry room and kitchen. The laundry room is dangerous because the lead could be falling on the clothes that clutter the floor. The kitchen is dangerous because the lead could be getting in the children's food. All this helps explain why two of Robinson's daughters, 5-year-old Tresha and 3-year-old Felicia, have elevated levels of lead in their blood.
Robinson tells Bradley, "I'm trying to move. I'm going to move whether the Health Department helps me or not." But finding a new place to live with so many children has been an insurmountable challenge so far.
Outside, Bradley contemplates one of the most difficult aspects of her job: persuading people to take the lead-based paint threat seriously. "With having 11 children, lead poisoning must not be high on her mind," she says. "She probably spends her time thinking, 'How am I going to feed these children? When am I going to get a minute to rest?'"
The ThreatWhen lead is ingested or inhaled, it can stay in the human body for a long, long time. Significant reduction in a person's blood-lead level can take several months, sometimes several years. Lead can stay in a person's bones -- including the teeth -- for decades. The most recent study on lead poisoning, published in the Journal of the American Medical Association, indicated that lead poisoning could account for as many as 11 percent of cavities in children.
Pregnant mothers and children ages 6 and under are particularly vulnerable. Their bodies tend to absorb more lead in their systems, as much as 35 percent more lead in their gastrointestinal tract than men or non-pregnant women.
What can too much lead do to a child?
The answers to this question are not all in yet, though lead has been linked to a host of problems, from enzyme production to cell maturation difficulties, from the interference of regular skeletal growth to the disruption of normal kidney function.
Lead also attacks the nervous system, and that fact lends credence to the belief that lead is more than the individual victims' problem. The studies are not conclusive, but there is growing evidence that lead poisoning is another factor perpetuating crime and unemployment, the worst problems associated with the inner city. One 11-year study found high-school students who had experienced high lead levels as children to be at greater risk of a host of problems, including reading disabilities, lower class standing, greater absenteeism, and deficits in vocabulary, fine motor skills, reaction time, and hand-eye coordination.
One of the most provocative of these studies took place in 1996 in Pittsburgh. About 300 schoolboys were studied over four years. During that time, teachers and parents ranked the children with high lead levels as being significantly more anti-social and aggressive than those children with low lead levels. Furthermore, these children were characterized as suffering from greater anxiety and depression. They also had more difficulty concentrating for long periods of time.
Wire is a wealth of information on lead poisoning. Early in my reporting, she provides me with several binders' worth of federal documents, articles, scientific papers, and informational brochures on the topic. I never interview her personally, though. For several weeks, she is an authoritative, disembodied voice on the telephone. "Did you know that some people think the Roman Empire declined because of lead poisoning?" she says at one point. One theory is that the Romans used too much lead to make their aqueducts. The lead apparently leached into the drinking water, poisoning both children and adults.
The Numbers and the RulesThe Memphis Housing Authority is faced with a serious lead-based paint problem. All of the MHA developments were built before 1960, when lead paint was still being used. MHA has discovered that six of its developments contain lead in everything from walls to porch rails. The housing authority is now in the process of cleaning up the mess. Families are moved out of an apartment unit if the children have elevated levels of lead in their systems, according to Diane Mosby, manager of capital improvements for MHA.
"It's all about funding," Mosby says. "We deal with it as we receive funding." With so many housing units and other issues involved, lead poisoning is just one part of MHA's agenda to renovate its apartment buildings.
Abatement can take a number of forms. Most of the time, it means tearing out and replacing whatever was coated with lead-based paint. Sometimes, it just means containing the lead. For example, if HCD encounters a home exterior that's covered with cracking lead-based paint, it will often decide to just cover up the paint with a plastic wrap and new vinyl siding. The process can take days to weeks. MHA has been shuttling families between apartment units. HCD owns a special housing complex near downtown where families stay while their homes are being treated.
HCD gives me a list of the homes that it had treated for lead by late May. James Suddeth, the agency's deputy director for housing and code enforcement, estimates that there are several thousand homes in the city that need treating. The city agency is in the process of applying for a $4 million federal grant to continue its lead-paint removal program. So far, it has spent almost $3.9 million.
In all, HCD claims that it has completed work on only 92 homes. Of those homes, 51 cases were "priority-one" cases, where there is a young child living in the home who has an elevated level of lead in his or her blood.
HCD is a little behind. The Health Department says it had referred 186 priority-one cases to HCD.
Of the 92 homes, 40 are "priority-two" cases, where lead is present but, for one reason or another, has not yet affected the children living there. The Health Department has forwarded 87 priority-two cases to HCD.
HCD officials say they're doing the best they can. While the agency has only performed 92 home abatements, it has closed 264 cases in all. Some of these cases were closed because, after a lengthy inspection, no lead was discovered. Others were closed because the homeowners refused the city's help, despite the potential presence of lead in their home. Other cases were closed because the homes themselves were condemned -- too dilapidated for repair, much less lead abatement.
But HCD's own tight restrictions may also explain why it isn't doing more. For example, homeowners don't qualify for the program if they make 80 percent of the area's median income, a number that varies according to the size of a household. Since lead testing and abatement are so expensive, even someone who makes twice the median income might have a hard time paying for the process.
Also, property-tax delinquents are barred from the program. Tax delinquents who need lead-based paint abatement may be among the poorest of Memphis' poor.
In both cases, children are assured to suffer from lead poisoning because their parents, legal guardians, or landlords are in a certain financial condition.
Suddeth says his agency will be reviewing those policies this year. "We don't want to be doing lead abatement for a millionaire's home," he says, adding, "we are on the same learning curve as the other recipients of these [federal] grants."
The Problem Made HumanTo understand the program better, I visit about three dozen homes in North and South Memphis that have already undergone lead abatement. I keep in mind the warnings of Anita Walker, HCD's lead-based paint program coordinator, who is concerned about a negative media spin.
"We're not there to renovate the house. We're there to do exactly what HUD says to do in order to remove lead from their homes. But I don't care how many times you explain it to them, they'll ask, 'Well, why didn't you replace my central air and heat?'" The $20,000 to $25,000 in federal funds spent to abate each lead-contaminated home isn't about the redevelopment of the inner city. It's about eliminating the threat of lead poison.
Patricia Fullilove and her family are typical examples of what I found. Fullilove says the city treated her home on Trigg Avenue for lead poisoning four months ago, after her 8-year-old grandson Kevin and her 10-year-old granddaughter Shantell registered high lead levels in their blood.
The South Memphis resident sits in her furniture-packed living room and points to the opposite wall. "They left patches. And then they said they couldn't repaint." To address one lead source, HCD had to remove Fullilove's fireplace. They layered sheetrock over the wall that used to be behind the fireplace, but didn't do anything else.
Mostly, however, Fullilove is just glad her grandchildren's blood-lead levels are decreasing. The Health Department drops by periodically to make sure Kevin and Shantell are all right. HCD has either removed or contained the lead-based paint, and the children were given extra instructions about washing their hands and the fruits and vegetables they might eat.
Had the Fullilove children registered higher levels of lead, they would have to undergo a painful medical process called chelation therapy, in which drugs "encourage" the lead to pass through the body. And the children would still be vulnerable to lead poisoning if they were placed in a lead-filled environment.
The lead problem seems to plague this entire family, though. Fullilove now worries about two of her other grandchildren, who live in MHA property.
Her daughter, Bridgett Campbell, lives in the Fowler Homes near E.H. Crump Boulevard. She's been watching her two daughters' lead levels rise for the past four months, and she suspects it has to do with her MHA apartment, a tattered unit with a leaking ceiling and peeling, mildew-ridden wallpaper. Campbell produces copies of her children's latest blood analyses.
One daughter, 4-year-old Tara, had a blood-lead level of 11 micrograms per deciliter in February. By late May, she registered 12 micrograms per deciliter.
Her other daughter, 5-year-old Deandre, registered 12 micrograms per deciliter in February. By late May, her blood count had inched up to 14 micrograms per deciliter of lead.
According to the guidelines of the Centers for Disease Control, 10 to 14 micrograms per deciliter is cause for concern, producing "adverse health effects." Abdominal discomfort, irritability, mild fatigue, and lethargy may result. HCD will take action when a child's blood-lead levels is above 10 micrograms per deci-liter, but MHA won't act unless the two children's lead levels rise consistently above 15 micrograms per deciliter.
Dr. David Jacobs, the director of HUD's office of lead-hazard control, says in a phone interview that MHA is acting according to federal guidelines. "This is a triage type of approach," he says.
Campbell has received some attention. She says the Health Department has been by to teach her to help her children avoid lead poisoning, such as advising them never to put their hands in their mouths.
But that doesn't alleviate Campbell's concerns. Her children still may be living in a lead-poisoned environment. "They [MHA] told me that I was on the waiting list and that this wasn't an emergency." There are 100 people ahead of her on that list, she says she was told.
Mosby insists that no children should be having lead problems in the development where Campbell lives. "The test results from Fowler Homes did not indicate any major areas [of lead concentrations]," she says. "The results noted negative on the areas that they tested, interior and exterior."
There are two possible explanations. Either Campbell's children are ingesting or inhaling lead from somewhere else, or her apartment has lead in it that MHA doesn't know about. Because HUD only requires random lead sampling of public-housing units, the second possibility is just as likely as the first.
War on Two FrontsIn the meantime, the Health Department and HCD continue to find children with high lead levels. It's a war fought on two fronts: education and lead removal. The informative brochures that the agencies pass out are probably helpful to some people, but no one has yet to find the perfect way to reach everybody.
Sometimes, HCD finds children with high lead levels when their guardians apply for home rehabilitation programs. Lately, the Health Department's been working with the Young Women's Christian Association to test children in day-care centers. With each visit, about two or three new cases of lead poison are being found, Wire says.
Among other things, the Health Department official likes to speculate on the variables that are making this problem worse. "There's an unknown mechanism between Vitamin D metabolism and lead absorption," Wire says. "What makes Vitamin D? Sunshine. As soon as it gets pretty hot in the spring, we see the lead levels go up. And they're really high cases. And it's been as bad, if not worse than any other year."
Questions like these won't go away until all the lead-based paint is removed from old inner-city homes. By that time, however, experts will be studying something else. They'll be watching the population of children who absorbed all that lead and wondering how many other victims in that generation went unnoticed.
The miners, at least, knew when the canaries were suffering.
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