Leaded Grasshoppers

SEASIDE, Calif. -- Elevated levels of toxic lead are being found in the blood of children at a small airy clinic in this central coastal town of 33,450 people. The culprit may be grasshoppers captured 2,000 miles away in Mexican villages, lovingly fried with garlic, salt and lime and sent by the pound in care packages to family members here.

Medics say the calamity illustrates how dangerously stuck in the past public health care may be, in an increasingly borderless world, and in a state where more than a quarter of the population is foreign-born.

"We all grew up there eating the grasshoppers and other things and nothing happened," puzzled Minerva, who prepared lunch one recent afternoon for three of her own children and a niece in a small, trim house cooled by an ocean breeze. Like most newcomers here, Minerva's husband, sister and brother-in-law, who share the house, and her immigrant neighbors work in laundry, hotel-maid and other service jobs in nearby, wealthier towns like Monterey and Pebble Beach. Minerva's healthy-looking 9-year-old daughter chatters in English as she wolfs down tostadas at the table with the other kids. She was among those found with dangerously high lead levels at a routine screening at the Seaside Family Health Center.

Seventy-five per cent of lead poisoning cases statewide in the last three years have been Latino children. Recent investigative news reports point to Mexican candy as one source. In November, because of the Seaside cases, State Health Director Diana M. Bont warned pregnant women and children especially against the grasshoppers treat. But community health workers say such developments mean lead poisoning has a new, inadequately recognized face. And they point to special challenges in reaching indigenous immigrants -- increasing in number -- who may be distrustful of doctors, illiterate or, like members of Minerva's family, undocumented.

"New solutions are needed because old ones won't work," said Dr. Margaret Handley of UCSF's Department of Family Medicine, who is investigating the local outbreak. Through careful conversation with mothers over the months, a Spanish-speaking nurse, Celeste Hall, and the clinic's Dr. Eric Sanford determined children born in two Zapotec Indian villages in the southern state of Oaxaca -- or U.S.-born children whose parents came from the villages -- were the ones testing high for lead. Other immigrant kids did not. Virtually all public service health education literature in California about lead poisoning -- even in Spanish -- refers to old paint as the source, but that was ruled out after inspections.

Local and state health departments were slow-moving and strapped for funds. Sanford and Hall spent their own time and money trying to track the poisoning source. One suspect was a distinctive green-glazed Oaxacan pottery found in Seaside homes. But even if families used the pottery for food it would produce a steady, low level of exposure, not spikes as seen here; moreover, it's universally used by regional immigrants, and only patients linked to the two villages exhibited high lead levels.

"The children's levels are either low or off the charts, so it's acute exposure we're looking at," said Sanford, who does believe Oaxaca is the source of the poisoning. One child's level jumped from two micrograms per deciliter to 35 after eating the grasshoppers. Levels above 10 are considered high. Sanford and Hall also sent other foods for testing that came from the villages -- favorites tamarind candy, pumpkin seeds, chocolate and tortillas -- and some were contaminated. They went to Handley, an epidemiologist.

Like a detective, Handley pursued leads. One breakthrough document: a British study on plants and animal life that developed amid old mine tailings in Wales and Ireland. "A highly significant relationship" existed between lead contaminated grass and grasshoppers around the abandoned mines, researchers wrote. Grasshoppers can carry high concentrations of the metal without being fatally poisoned.