(Part II)
By Janet Wilson
EDITOR’S NOTE: This is the second and final part of an investigative report by California Watch, that chronicles the struggle of one Latino family from Maywood, Calif. – a small city in southeast Los Angeles County that sits in a sea of heavy industry — as they attempt to pinpoint the cause of their chronic sickness.
Waiting for results
Human testing is not simple. The overnight express company fails to deliver half the samples at the proper temperature, meaning they have to be discarded. It takes months, a second round of fasting, of blood being drawn. Life continues.
Junior is having nightmares. He doesn’t care if he graduates. His parents decide to send him to his uncle’s near Mexico City after Christmas. Peace replaces tension in the house. He is nervous about the test results, which will come while he’s away.
“I’m scared,” he admits.
Christmas passes. His family is unwilling to let him go. On New Year’s Eve, he wakes up numb around his mouth, fingers and feet. His mother rushes him to the emergency room. The doctors guess food poisoning, give him Benadryl and send him home. A few days later, he flies south.
Half a year after the initial samples were taken, the family finally will learn what is inside them. The news will come as brown water once again flows from their taps.
Adilene has braced herself for this moment.
“I’m not saying we should have something inside us,” she says as they drive to the doctor’s office on Jan. 31. “But it’ll be disappointing if nothing comes up and the water’s still coming out like that.”
Dr. Deborah Lerner, chief medical officer at Eisner Pediatric & Family Medical Center in south Los Angeles, has undergone such testing herself. She agreed to meet with the Martins and to deliver their results. She states firmly that she will not be able to tell them the sources of what’s inside them or what harm the chemicals might do. She’s doing this because she knows first-hand how unsettling it is to be told you have dangerous substances inside of you.
Lerner distributes a thick sheaf of papers and chooses her words carefully. The results still are jarring.
The Martin family had traces of eight dangerous heavy metals and 17 industrial byproducts in their bodies. Levels of arsenic, chromium, mercury, manganese and vanadium were far higher than for most Americans.
Junior had arsenic amounts in his urine that appeared to be above all Americans his age tested by the U.S. Centers for Disease Control and Prevention. Arsenic can be harmless, but the wrong kind in high amounts has been linked to liver, lung, kidney and bladder cancers. It is not clear what kind is in Junior. A recent study showed patients reported tingling of hands and feet at arsenic levels about twice what his were.
His sister Adilene had high amounts of vanadium in her blood, and her brother and sister exceeded national averages. Vanadium, a lesser-known silvery-blue substance, is in some foods and supplements, but fumes and dust can cause respiratory illness, and it is a possible carcinogen.
All four had higher levels of manganese than 95 percent of Americans tested, and Jos-efina appeared to be above all recorded levels. Manganese is the murky water pollutant that can cause Parkinson’s disease-like symptoms with high chronic exposure.
All had mercury levels that caused another doctor to recommend a state investigation of their home and neighborhood for sources, though Lerner does not tell them that. Mercury of the wrong kind is extremely toxic and can damage or fatally injure the brain, nervous system and kidneys in small amounts.
Headaches, fatigue and depression similar to the symptoms reported by Josefina and Anaiz have been reported in patients overexposed to mercury. Arsenic or mercury can cause numbness, such as that reported by Junior. Many chemicals, including vanadium or chlorine used to treat their water, could cause rashes like those on Adilene’s arms.
U.S. averages for copper aren’t available, but the Martins’ were two to five times higher than those for Germans. It is a necessary nutrient, but high levels have been linked to nose, mouth and eye irritation; nausea; stomach cramps; vomiting; and death. It is a possible carcinogen.
They had average levels of lead, cadmium, dioxins and furans. But experts caution that there are no known safe levels of lead or dioxins. The dioxins are the same type of powerful carcinogens released by the U.S. Environmental Protection Agency into May-wood residential streets in 1998 as part of its cleanup of the Superfund site. They can linger in landfills, unused attics and body tissue for years.
Josefina reacts first, laughing shakily.
“Well, I never expected all this, but it’s good to know what we have inside. I guess we just have to look at the information and ask the questions we have if someone else can answer them.”
Lerner tells them that the data will take time to digest, and they should not feel stupid if they can’t grasp it all, or are unnerved.
“This is going to help us in our community, because we’ve got all these problems in the water, and that shows right there,” says Josefina, pointing to the papers. Her fears tumble out. “I don’t drink from it, I drink bottled water; but still, I shower, I cook from that water.”
All summer, Josefina had stomachaches and bloody stool, even after having a polyp removed. Some days, she is nauseous; other days, she is simply exhausted, muscles aching. Lerner gently says the symptoms could be from any number of things, including stress.
Sal jumps in, “We got three water companies, and one had manganese, and the other has mercury.” He’s referring to the just-released regional manganese report and a water sample that contained mercury a few years earlier.
Lerner is intrigued. “I’m imagining in your community, there are going to be a lot of people whose exposures are like yours: high on things that you wouldn’t expect.”
They are given government ToxFAQs sheets about the substances, mercury advisories about Mexican skin creams and sheets explaining why the substances for which they were tested were picked.
At home, Josefina and Adilene pore over the materials. Josefina says they don’t have any Mexican products, then remembers lotion she bought on a recent trip. It’s not the type in the fliers. Adilene brings out a large can of dietary supplements she bought on the street. According to the label, it does not contain any of the substances for which they were tested.
Long-term exposure increases risks, experts say
Numerous doctors and scientists who specialize in environmental contamination reviewed the results. Most said they didn’t think the Martins were at immediate risk. While some of the levels were extremely high compared with average Americans, they are trace amounts, which do not typically cause immediate harm. For arsenic, chromium and mercury, it would depend on the type to which they were exposed. Follow-up testing showed that Junior did not have the dangerous kind of arsenic in him.
But experts agreed that if the family members continue to be exposed at higher levels, they face steeper odds of cancers and other serious health effects. Like tobacco smoke or radiation, these chemicals can build up for years in body fat or tissue, exacting a long-term toll.
“That’s what I worry about a lot more. This is a snapshot, but if further testing established that their levels are that high over the long term, then it is a serious risk,” said Scott Fruin, assistant professor of environmental health at the University of Southern California’s Keck School of Medicine. “There’s definitely something strange going on there with the extreme values. … Some of the heavy metals were unusually high.”
Scant research has been done on how combinations of chemicals can work together, several noted. All said that identifying sources was no easy task. The Martins eat fish and beef and use household cleaning products. But all of the substances present in them also are present in exhaust or manufacturing processes and byproducts within a mile of their home. The substances can enter the body via air, water or ground vapors. Even garden soil can collect dangerous contaminants.
Their area measured the highest levels of copper, lead, manganese and chromium across the entire 6,700-square-mile Los Angeles air basin in 2007, and the second-highest arsenic levels. Air quality was healthy just one in three days.
Living where they do increases the odds not just for them, but also for their neighbors, some said.
“When you think of the hundreds of families who live in very similar situations in their neighborhood, for each of these excessive exposures, they could be representative of many other people in their community,” said Sonya Lunder, a public health analyst with the Environmental Working Group, which does biomonitoring and compiles U.S. pollution databases.
Fruin agreed that where the Martins live puts them at higher risk.
Junior’s high arsenic, Adeline’s vanadium, and all the mercury and copper levels stood out for him. His team at USC has measured high levels of copper in multiple areas across Los Angeles near heavy traffic. Copper is linked to brakes in cars and trucks, he said. Vanadium is associated with highly polluting bunker fuel burned by cargo ships, and elevated levels in air have been found nearly 20 miles inland, he and regulators said. Arsenic and mercury are common in myriad industries near their home, and mercury is even in factory lighting and sky lifts.
One doctor was concerned about possible immediate health threats.
“There are some extraordinarily high numbers here; I’m puzzled and surprised they were exposed to that much mercury,” said Dr. Gina Solomon, a UC San Francisco associate clinical professor who treats patients for environmental contamination.
Solomon, also a senior scientist for the Natural Resources Defense Council, recommended the California Department of Public Health investigate the family’s mercury exposure and possible sources.
Nearby chemical processors and other industries could be sources if they were off-gassing substances improperly, she said. She agreed there could be other explanations, including what they eat and use to clean their home.
“The great part of biomonitoring is it tells you exactly what’s in your body,” she said. “The Achilles’ heel is it doesn’t tell you the sources.”
If the family were in the San Francisco area, she would order follow-up testing and break down mercury, arsenic and chromium samples to pinpoint any immediate risk.
“Being in the 95th percentile is pretty surprising,” she said. “This does need follow-up and shouldn’t just be dropped.”
State public health regulators from the same agency that has failed to tell Maywood residents about the risks of manganese declined to do testing or investigate.
“If the family has concerns about their lab test results, they should contact their clinical medical doctor,” Dr. Rick Kreutzer, chief of the Division of Environmental and Occupational Disease Control, said in an e-mail.
Through a spokeswoman, federal biomonitoring officials also declined comment, saying, “We don’t provide that kind of service.”
The family’s COBRA benefits from Sal’s job had expired. The one nationally certified environmental health clinic in Los Angeles County, at UCLA, was closing.
Funding was obtained to further analyze Junior’s first arsenic sample — the single highest reading. His contained no dangerous forms, meaning he was in the clear for that substance.
Ruthann Rudel, a toxicologist and director of research for the Silent Spring Institute near Boston, which examines cancers and environmental factors, said she was not surprised by the Martins’ biomonitoring results, their difficulty getting follow-up care or officials’ lack of interest.
She said regulators routinely are underfunded and subject to political pressures, while most doctors across the U.S. are poorly trained in environmental health issues. The gap is even greater in poor communities that have fewer doctors and potentially face greater hazards. Maywood has one full-time doctor for every 4,840 residents, according to the California Office of Statewide Health Planning and Development.
“There is a completely inadequate ability to get help around environmental contamination in these communities,” Rudel said. “There’s very little medical infrastructure, and clinical doctors in particular do not receive adequate training in environmental health and contamination.”
Some regulators agree there are hazards.
“These communities are under attack,” said Florence Gharibian, who recently retired as manager for the Southern California Enforcement and Emergency Response Program of the state Department of Toxic Substances Control.
Critics note some of the substances detected in the Martins are not monitored or regulated in the U.S., including manganese, vanadium, copper and carcinogenic forms of chromium.
“It’s an unconscionable gap,” said Solomon, who co-authored a recent paper on disease clusters in neighborhoods near hazardous industrial facilities that concluded that “the regulation of toxic chemicals in America has been a failure.”
After test results, life goes on
Adilene speaks with Baltz for an hour on the phone after receiving their results. “It sounds like we’re not going to die right now, but we could be worse off in the future. It’s not good.”
She is struggling to find scholarships to continue her nursing studies and works for minimum wage at a T-shirt shop meanwhile.
“When I grow up, I want to move out of here,” she says. “If someday I do have a family, I want my family, as well as me, to go somewhere else and hopefully be healthy.”
Sal has looked for properties elsewhere, but prices are too high. The family’s only income right now is from its rental units. He and other neighbors have taken control of their water district board. This May, for the first time in four years, manganese levels did not exceed state secondary limits. But disinfectants that can carry their own long-term risks are being mixed in the water supply.
Junior hates the results.
“I wish I hadn’t done it, so I wouldn’t know. I want to move, but there’s nowhere to go,” he says. He does return to high school after a doctor praises his weight loss and exercise. She tells him to quit wasting time and get back in class. He’s earning excellent grades.
Josefina is satisfied. She says such testing may not be for everyone, but for her, it was worth it. The next chance she has to see a doctor, she will bring her biomonitoring results and ask about the mercury.
“It doesn’t end all the worries, but at least we get to follow up on these results and see about all this stuff,” she says. “It’s really good to know what we have in our bodies.”
Anaiz is happy not to be “the one” with the worst readings.
And she’s gotten her high school diploma. She worked with her brother’s English teacher three days a week at the dining room table, reading stories and doing quizzes. He told her to watch television shows and write him grammatically correct complaint letters.
She has the diploma tucked in the living room armoire between her siblings’, and if she can do it, she wants to attend community college.
“I overcame,” she says.
By late September she is sick again — experiencing more asthma attacks and symptoms of irritable bowel syndrome.
By October, discolored water is once again flowing from their taps.
Janet Wilson can be reached at janetwilson66@gmail.com. This story was edited by Robert Salladay and Mark Katches. It was copy edited by Nikki Frick. This story was produced for the USC Annenberg Dennis A. Hunt Fund for Health Journalism and for California Watch at the Center for Investigative Reporting. This article originally appeared in California Watch.