Jim Cole  /  AP file
Benita Nahimana, 3, foreground left, sits on the chipped-paint wood floor as she plays with her sister Sophia, center, and neighbor Gloria in their Manchester, N.H., apartment. She is recovering from lead poisoning.
updated 5/11/2005 11:58:32 AM ET 2005-05-11T15:58:32

They come here to escape war, starvation and desperate lives in such places as Liberia and Somalia. They bring their children, believing they will thrive in the United States.

Instead, these youngsters, having survived crowded refugee camps and treacherous travel, now are being poisoned in their new American homes.

The culprit is lead. It killed 2-year-old Sunday Abek, whose family escaped from Sudan. And it has sickened at least 40 other African refugee children in the last 18 months, including Benita Nahimana, a 3-year-old who landed in the hospital soon after arriving from a camp in Tanzania last summer.

Once health officials spotted the problem, they moved quickly to treat the children and assess their living conditions. Working with the Centers for Disease Control and Prevention, they also alerted other cities with refugee populations and began investigating why the refugees seem so much more susceptible to lead.

Investigators still are analyzing results of questionnaires to the families, but one theory is that refugees are more likely to eat their meals on the floor instead of at tables, increasing exposure to leaded dust.

Officials also believe African children might absorb lead more readily because they’re malnourished from living in squalid refugee camps, the only homes most have ever known. Their families fled from torture, rape and murder in their homelands only to spend years in cramped mud huts and tents where hunger and disease became new killers.

Infants, toddlers at risk
Though Manchester is far safer than Benita’s homeland of Burundi, her father says he is frustrated that a rundown apartment he can barely afford made his daughter sick. The toddler wasn’t eating much and was losing weight when doctors discovered that her blood lead level was about five times higher than the amount that can affect a child’s intelligence or cause other health problems.

Nine months later, Benita still takes medicine but appears healthy, darting barefoot across the clean wood floors. Speaking through an interpreter, her father, Razaro Ntahondi, said his family had moved out while windows were replaced and walls were painted but had to return because the lease isn’t up until May.

“If he had money he wouldn’t come back,” said Honore Murenzi, who counsels the city’s refugees on everything from finding housing to how to change light bulbs.

Health officials once assumed refugee children were poisoned before they got to the United States because they came from countries that still use leaded gasoline, said Dr. Mary Jean Brown, chief of the CDC’s lead poisoning prevention branch.

But because all refugee children resettled in Manchester are now tested for lead soon after arrival and again a few months later, officials know that Benita and the others were poisoned here.

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The major source of lead exposure among children is paint and dust in deteriorating buildings constructed before lead-based paints were banned from housing use in 1978. A community is considered high risk if 27 percent or more of its housing was built before 1950. In Manchester, more than 80 percent of housing in the city’s center was built before 1940.

Infants and toddlers are at the highest risk because their normal behavior — crawling around and putting things in their mouths — puts them in contact with leaded dust and paint.

Lead can affect nearly every system in the body. Low levels are associated with decreased intelligence, stunted growth and poor hearing; higher levels can cause coma, convulsions and death.

Sunday Abek was running a fever and vomiting just three weeks after she arrived from a refugee camp in Egypt in March 2000. Initially diagnosed with strep throat, her brain swelled, she fell into a coma and died, becoming the nation’s first lead poisoning fatality in 10 years.

In response, Manchester started testing all refugee children up to age 16 for lead within three months of their arrival and again three to six months later. Lead poisoning cases declined over the following few years, but that changed when the city got a large influx of African refugees last summer.

“We learned of this because the system we put in place several years ago is working. This is unique,” said state medical director Dr. William Kassler. “This is like the canary in the coal mine. We have identified something that is probably true in many other cities and states, but they’ve been unable to detect it.”

Federal law requires property owners to warn prospective tenants or buyers about the hazards of lead paint, but New Hampshire’s state laws don’t offer much protection, said Richard Dipentima, Manchester’s deputy health director. Only after a child has been poisoned can a property owner be ordered to remove the lead — a situation Dipentima called unacceptable.

By contrast, the state recently outlawed the use of lead fishing sinkers to protect water birds that swallow them and are poisoned.

“In a perfect world,” Dipentima said, “my public health sense tells me what we should be doing is what we do for loons.”

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