A Silent Menace Stalks the Poor : Inner-City Children Living in Rundown Housing Are at High Risk From Lead Toxin Mostly Found in Peeling, Cracked Paint

Angel Varela, a rambunctious 4-year-old, darts back and forth across the living-room carpet and near the walls of peeling paint, playing with his dinosaur toys. He appears unaffected by the lead-based paint that is all around his family’s Pico-Union apartment.

It is when Angel is near someone eating that the effects of the lead he has ingested are noticed. The mere sight of anyone chewing makes him so nauseous, he vomits.

Children like Angel, who suffer the effects of lead poisoning, are found throughout the nation. Most of these youngsters, however, are in inner cities, where there are nearly three times as many lead-poisoned children as in more affluent areas. Although recent legislation has mandated procedures for lead-poisoning prevention and testing, government has been slow in providing the resources to reach inner-city children, including those in Los Angeles.

“Lead poisoning is really an issue of poverty,” said Donzella Lee, vice president of Administrative Affairs at the Watts Health Foundation. “No matter who you are, if you are poor and live in impoverished areas, you will have problems with lead poisoning.”

Of the lead-poisoning cases reported to the Los Angeles County Department of Health Services in 1992, more than 50% were in Central Los Angeles, mostly among black and Latino children. These children, like Angel, live in buildings or homes with peeling and cracking paint, or have parents who work in industries that use lead and bring lead dust home on their clothes. Federal health officials have called lead poisoning, which can cause developmental delay and reduced stature, the No. 1 environmental threat to young children.

In 1991, new research showing the potential damage from even low levels of lead in the bloodstream prompted then-Secretary of Health and Human Services Louis W. Sullivan to drop the threshold of lead poisoning in blood levels from 25 micrograms per deciliter to 10.

The question of how much lead in the bloodstream is harmful has roused much debate in recent years among prevention advocates, public health officials, landlords and homeowners. There is disagreement on whether to spend billions of dollars to clean up lead, given the existence of life-threatening childhood health problems, such as malnutrition and sickle cell anemia.

“In an era of shrinking public health resources, it is a fair question to say, ‘Why pay all this money to chase after lead’?” said Dr. Paul Papanek, chief of the county’s toxic epidemiology program.

In most cases, lead poisoning’s effects are so subtle that they can easily be chalked up to other sources. Hyperactivity, crankiness, slowed reactions, impulsiveness and difficulty in sticking to tasks are some signs of lead poisoning, but they are also symptoms of other childhood disorders. The difference is that the end result of lead poisoning is irreversible brain damage.

Erick Monroy betrays no trace of illness from lead. Two months shy of his third birthday, Erick is quiet around strangers, playful with his family and other children and occasionally cranky, says his mother, Georgina Morales. Ten months ago, during a routine checkup, a blood test revealed 30 micrograms of lead in his system, three times the acceptable level.

Lead checks of Morales’ apartment, in the Wyvernwood Garden Apartments in Boyle Heights, showed lead everywhere, from the windowsills and walls to the doors and the carpeting.

Erick’s blood lead level is now down to 12 micrograms, thanks to treatments and an increase of iron in his diet. But even at low levels, lead can reduce a child’s IQ level by five points, experts say. Nationwide studies have shown that learning and behavioral problems linked to childhood lead poisoning persist in adulthood.

“There are kids throughout this housing project who are probably walking around with lead in their blood,” said Linda Kite of the Lead Poisoning Organizing Project. Kite, who teaches lead prevention and safety to residents at Wyvernwood, is also working with Concerned Citizens of South-Central Los Angeles to start similar community groups in South-Central.

Nationwide, one in six children have at-risk levels of lead in their blood, according to the U.S. Public Health Service. Of those living in urban low-income areas, one in two children have at-risk blood levels of lead.

In Los Angeles, exact numbers of children in low-income areas with lead poisoning are sketchy because of scattered and limited testing. No records are kept of the number of children tested, but so far this year, 184 inner-city children have been found to have at-risk lead levels with 20 or more micrograms of lead per deciliter of blood, according to the county Department of Health Services.

It takes strikingly little lead to cause lead poisoning. A child only would have to ingest an amount of lead equal to one granule of sugar each day during the toddler stage to reach a blood lead level of 35 micrograms. Children between 6 months and 6 years, who constantly touch things and put them in their mouths, are most likely to get lead poisoning, experts say.

Joan Reyes, a public health nurse with the Department of Health Services, said most of the inner-city children who have tested positive have blood lead levels of 20 micrograms or more. About 10% of inner-city children tested by the health department have levels as high as 45 micrograms, she said. That amount requires chelation, a painful process that involves several injections of medicine to remove lead from the blood. But by the time a child has ingested enough lead to require chelation, the metal has been permanently absorbed in the brain.

The bulk of lead-poisoning cases handled by the health department are in South-Central and East Los Angeles, where a large number of families with small children live in older buildings, many of which are improperly maintained, Reyes said.

In the three-bedroom attic apartment of the dilapidated, turn-of-the-century house where Angel Varela has lived with his family since he was 1, flaking paint is all over the walls, windowsills and doors. Angel’s mother, Krina Sanchez, believes her son got lead poisoning from eating chips of paint that fell from a hole above his bed.

Angel’s first lead test in June, 1992, revealed a blood lead level of 45 micrograms, requiring chelation and an investigation by the county. Under county regulations, health investigators must visit homes and test for lead when children test at 20 micrograms or above.

Angel’s blood lead level has dropped to as low as 15 micrograms since his first test. But little has changed around his house, where lead-based paint remains exposed. Three other children--1 and 6 years old, and 2 months--live in the apartment with Angel, his mother, his grandmother, Sabina Gonzalez, and an aunt and uncle. None of the other children have been found to have at-risk lead levels in the blood.

Although lead-based paint is the primary source of lead poisoning in children, the metal can also be found in drinking water, food grown in contaminated soil, lead-tainted dust and some Mexican clay pots that have a clear lead-based glaze and are used by many Latino families for cooking beans.

High levels of lead are in several traditional folk remedies, such as Azarcon, Greta, Pay-loo-ah and Surma , used most often by Latinos, East Indians and Asians for indigestion, fever or skin infections.

It was Indian herb pills, with extremely high levels of lead and mercury, that poisoned 6-year-old Sahil of Lafayette Park with a blood lead level of 86 micrograms.

“When the doctor told me that he had lead in his blood, I feared for his life. I didn’t know if this would kill him,” said Sahil’s father, who asked that the family’s name not be used.

Such high levels of lead in the system can cause severe retardation, some experts say.

Sahil’s parents got the pills six years ago from a doctor in India, who said they would help Sahil, who was born developmentally delayed. Sahil’s parents gave him the pills every day for four years. Last year, when Sahil began looking pale and withdrawn, his parents brought him in for tests and the lead was discovered. With such large amounts of lead in his system, the metal accumulated in his bones and marrow.

Sahil, a playful child with a friendly smile and large brown eyes, has been hospitalized twice in the past year and has chelation injections when his lead level tops 50 micrograms. His lowest level has been 45 micrograms. Sahil’s parents and his pediatrician, Dr. Robert Adler of Children’s Hospital, believe the lead has slowed down whatever progress Sahil will make. He just started walking last month with staggered steps and is beginning to say basic words such as no, ma and pa .

Lead from any source is harmful to children, but lead paint remains the major source of poisoning, experts say. Banned for most uses in 1978, lead-based paint still can be found in millions of homes, especially those in urban areas. Most often children are not poisoned by eating lead paint chips, but by inhaling lead-tainted dust emitted from cracked or peeling paint, or released through the friction of opening and closing doors and windows.

The continuing presence of lead-based paint has prompted many advocates and health officials to insist that lead abatement is the only solution. But the costs are staggering.

It would cost about $300 billion to abate all the lead paint in the United States, experts say. Over the past five years, as childhood lead poisoning has moved more into the public’s eye as the problem has spread from inner cities to middle-class neighborhoods, federal and state legislation has been pushed to deal with lead abatement, disclosure of lead in homes and testing children for lead.

For instance, federal regulations require landlords to either cover up exposed lead with stucco or remove it. But most inner-city landlords have not complied, citing the high cost of lead abatement and a lack of resources to turn to for help.

A 1990 lawsuit filed against the state Department of Health Services by the NAACP Legal Defense & Education Fund required the state to institute universal lead screening through the federal Child Health and Disability Program. As a result, legislation was passed in November, 1991, mandating universal testing of children 6 months to 6 years old.

However, it has taken Los Angeles County’s health department and other county agencies nearly two years since the state directive to issue lead-screening plans. Although the county used existing staff since November, 1991, to work on lead-poisoning prevention issues, no funding has been set aside in a separate budget, said Dr. Arthur Lisbin, director of the department’s child and adolescent health program. The county accounts for 50% of the state’s lead-poisoning cases, state health officials said.

In April, 1992, the Los Angeles Unified School District contracted for all children in its Head Start program to be tested. The city Housing Authority made arrangements this past June to test children in all of its housing projects.

The county health department has been running a piecemeal childhood lead-poisoning prevention program since November, 1991, after the state required universal testing. But efforts to provide a budget and staff to work solely on lead-poisoning issues did not start until this January, when a lead abatement task force was formed after county Supervisor Gloria Molina pushed for the program and additional investigations in homes.

“The county has had no money to put all these programs into place even though we know it needs to be done and we’ve wanted to do it,” Papanek said. “The money has to come from somewhere.”

Right now, most children are tested free for lead poisoning at small private community clinics with CHDP contracts. Latinos tend to visit community clinics and blacks more frequently use county clinics or hospitals. Of those who test positive for lead poisoning under the CHDP program, 85% are Latino and 5% are black.

Patients seeking the free tests at county clinics or hospitals are referred to special labs as far away as Pico Rivera. In addition, parents who use county facilities must specifically request CHDP exams, whereas lead tests are automatically administered in community clinics.

“We’re just trying to keep our heads above water to handle all of the cases we have now with children at lead levels of 30 (micrograms),” said Janet Comey, chief environmental health specialist in the county health department’s lead-poisoning abatement program.

Six staff members out of the health department’s 26,350 workers are assigned exclusively to lead-poisoning abatement. Other staffers and public health nurses work on lead poisoning in addition to their other duties, Lisbin said.

A $440,000 grant from the federal Centers for Disease Control will be used to pay for additional staff to run universal screening in seven of the county’s high-risk health districts in South-Central and East Los Angeles. The program is expected to begin in November if approved by the county Board of Supervisors in the days ahead.

In addition, the state will provide $2.8 million for the county to hire 65 additional staff to deal with lead-poisoning prevention through a trust fund established with fees paid by petroleum and paint companies, Lisbin said. However, a pending lawsuit against the state by companies mandated to pay the fees may halt distribution of those funds.

The county is also expecting a $6-million grant from the U.S. Department of Housing and Urban Development to provide homeowners and compliant landlords with loans to abate lead.

Lead abatement in Los Angeles County would run about $10 billion, experts say. For a landlord, the costs could range from $10,000 to $50,000, depending on the contractor and whether the abatement would mean actually removing the lead or covering it up.

Herb Dones had to pay $15,000 to clear lead from a home he rents on West 103rd Street after his tenant’s daughter tested positive for lead poisoning and county health officials ordered him to fix the problem. The abatement was relatively minor--removing two walls, all of the windows and repainting the outside of the home. Dones was lucky enough to get a loan to help him cover the costs.

“If I wasn’t financially able to do this, I would either have had to do nothing and lose my building or go around the city to collect my rent,” Dones said.

Stanley Sundin wasn’t as lucky in seeking to abate the lead problem in the Pico-Union house where Angel Varela lives. Sundin, 82, got three bids--from $30,000 to $60,000--from contractors to abate one unit of the house and repaint the outside, said his daughter, Anne White. Sundin was unsuccessful in efforts to obtain a loan and sold the house in September, White said.

“With all the work (the contractors) said needed to be done to the house, we weren’t even sure if it was worth it to fix because we weren’t going to get that money back in rent,” White said.

The high costs of abating lead in homes have redirected discussions toward lead safety.

“There’s no way to do 100% abatement,” said Gary Rochlin, owner of LeadTech, a lead-paint inspection and abatement company in Venice. “So if we can’t make these places lead-free, at least we can make them lead-safe. It could be as simple as educating the people and getting people to clean their windowsills.”

Last year, Congress passed a law requiring that, starting in 1995, purchasers and renters of pre-1978 housing be told of possible lead hazards. The legislation also calls for gradual abatement of federally owned and assisted housing, starting with older buildings.

Legislation has been proposed by Sen. Bill Bradley (D-New Jersey) and U.S. Rep. Benjamin Cardin (D-Maryland) to establish a trust fund to raise $10 billion by 2003 to clear lead from 2 million of the worst housing structures in the country and to assist landlords with abatements. The proposal may not be voted on until 1994.

“Everybody is a victim of lead--the tenant and the landlord, in some cases,” Rochlin said. “But this is a prevalent issue that needs to be dealt with. The numbers alone show how astounding it is.”

Lead-Poisoning Cases

The bulk of the lead-poisoning cases handled by the county Department of Health Services are primarily in South-Central and East Los Angeles. Many children in those areas show blood-lead levels of 20 micrograms, twice the federal government’s acceptable level. About 10% of inner-city children have levels of as high as 45 micrograms. Here is the breakdown of cases for January through August:

Central: 5

Mid-City: 31

East: 39

Southwest: 11

Southeast: 18

South: 80

Source: County Department of Health Services

Protecting Your Child

Here are several suggestions from the California Department of Health Services on protecting children from lead poisoning: * Do not put children’s cribs underneath windows that signs of chipping paint, or that are opened and closed often. Lead dust can be emitted and inhaled by the child.

* Regularly wet mop floors and wipe down windowsills, where lead dust can accumulate and be inhaled by children.

* Change out of work clothes that might have accumulated lead dust and shower before coming in contact with children.

* Do not sand or scrape paint unless it is certain that the paint does not contain lead.

* Do not use older, imported or hand-made dishes that have glazes or designs that might contain lead. Mexican clay pots used for cooking beans often have a glaze that contains lead.

* Encourage children to wash their hands before eating.

* Feed children calcium- and iron-rich foods, such as meat, chicken, milk, cheese, yogurt, raisins and dried fruit.

About Lead Poisoning

* Most children contract lead poisoning from lead dust attached to toys or other objects that children touch or put in their mouths.

* Children ages 6 months to 6 years should be tested for lead.

* Most children with lead poisoning do not appear or act sick, unless there are extremely high doses of lead in their systems.

* Several ethnic home remedies and herbs contain high levels of lead and can cause severe lead-poisoning problems in children if administered repeatedly over long periods of time. Some of these folk remedies include azarcon and greta from Mexico; pay-loo-ah, ghasard, bali goli and dandu from Laos and other Asian countries; alkohl-kohl in Arab countries; and surma , used in Armenian and East Indian communities.

* Houses built before 1950 are most likely to contain paint with high levels of lead. People living in public housing should ask their landlord or housing manager to have the apartment tested for lead paint. HUD regulations require local housing authorities to test for lead paint in public housing built before 1978.

Source: Los Angeles County Department of Health Services

Where to Get Tested

The following area laboratories provide testing for lead poisoning: Cedars-Sinai Medical Center--Department of Pathology and Laboratory Medicine, 8700 Beverly Blvd., Room 3719, Los Angeles 90048; (213) 855-5335

Los Angeles Childrens Hospital--Clinical Chemistry Laboratory, 4650 Sunset Blvd., Los Angeles 90027; (213) 669-2455

Harbor/UCLA Medical Foundation Inc.--Clinic Laboratory, Medical Foundation Professional Building, 21840 S. Normandie Ave., Torrance 90502; (310) 222-5115

Central Analytical Lab Service Inc.--8432 Birkbark Ave., Pico Rivera 90660; (310) 806-2581

Pacific Toxicology Laboratories--1545 Pontius Ave., Los Angeles 90025; (213) 479-4911 or (800) 238-6942

* Rancho Los Amigos Medical Center--7601 E. Imperial Highway, Room 307, Downey 90242; (310) 940-7985

* Pico Rivera Health Center--6336 S. Parsons Blvd., Pico Rivera 90660; (213) 907-3230

* Martin Luther King Jr. Hospital--I&R; Physicians Building, 12012 Compton Ave., Room I-220, Los Angeles 90059; (310) 603-4647

* Offer testing only for patients eligible through the CHDP program.