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.
Dozens of gold and silver mines once flourished around the home villages of the Seaside immigrants. Owned by American and other companies, they are abandoned now. Lead is a by-product of extraction and processing.
With cross-border traffic constant and fast, there has been no loss of access to native foods for California's newest immigrants. A single tortilla fresh from Oaxaca can sell in this town for $1, but most of the homemade favorites come by relatives or paid carriers in a deep and wide courier network. But without a full-blown investigation it is difficult to pin down the source of the lead poisoning precisely. And community health workers say any heavy-handed official attack on the traditional foods from home would be wrong and counterproductive.
At the Seaside clinic, poisonous levels in children's blood continue to turn up around once a week, month after month. Lead poisoning can lead to learning disabilities, diminished IQ, impaired motor development and anti-social behavior. Because there is no signal event -- no rash or fever, no sudden collapse -- it is difficult to convince some parents a child is endangered.
"We need to do a full-on investigation like we'd do with any other epidemic outbreak," Handley says. "Would this get more attention if these kids were in Pebble Beach?"
Meanwhile, the trust that Sanford and Hall clearly maintain on a personal level with the Seaside immigrant community is tested the longer they cannot absolutely determine the poisoning source. Hall, who is married to a Zapotec from one of the host Mexican villages, says her family will lay off of grasshoppers. Minerva's family may not.
"Why do anything different if no one is sure?" asked Minerva.