Could you introduce yourself? Where are you? And what are you
doing at the moment?
My name is Lauren Cooney. I’m an emergency manager with MSF. And I’m currently in the north of Nigeria supporting MSF’s response to acute lead poisoning in Zamfara state.
Can you tell me a bit about the situation in Nigeria?
We heard about an unusual number of deaths and a strange illness in a remote village in the northwest of Nigeria some weeks ago and went to investigate the situation with a Ministry of Health team. The village reported that several children had died in the last 2 to 3 months. When the team investigated further, they found 39 fresh graves in the village
and the community reported that all of those deaths were children less than 5 years old. In the community, there were very sick children, with fevers, convulsions and they were incredibly unwell. Further investigation was carried out, including surveys and sending blood and urine samples to a laboratory in Europe. We found incredibly high levels of lead in the blood of the children that were tested, and as a final indication, the symptoms matched what you would expect to see with lead poisoning. We were notified there were other villages that had a similar problem, and when we investigated further, we identified over 350 probable cases and possible linked deaths of over 160 in the previous 6 month period.
What is the scale of the problem? What sort of high levels do you mean?
A Centre for Disease Control (CDC) team has come to work with us and the Ministry of Health. There’s some screening in one of the villages. All of the children that were tested registered over 65ug/dL and that’s actually the highest that machine would read. We’ve since done some other confirmation testing that shows results between 100 and 400ug/dL for these children. Now, anything over 10ug/dL is dangerous and will probably need a response. Anyone with levels over 45ug/dL needs specific treatment, which we call chellation treatment, to treat the lead poisoning in their system. So basically, so far everyone who has been tested really needs treatment. So it’s an extremely urgent situation.
When did MSF start treating patients, and how are they being treated?
MSF started treating patients approximately 8 days ago (June 1, 2010), using a chellation agent, an oral drug called DMSA (Dimercaptosuccinic Acid). This treatment works by binding the heavy metal, in this case lead, in the patient’s blood which can be excreted harmlessly in the urine. It’s quite a long treatment: we’re doing a 28-day protocol at the moment. That means that the children or adults, need to take one tablet twice a day, for 28 days. And then two weeks after the treatment is finished, we need to recheck the lead levels again and see if they’ve stayed low enough, or if they require a second round of treatment.
And what are the long-term consequences of the poisoning?
There’s quite a lot of potential long-term consequences. Most significant of course is death. Other problems include delayed neurological development. Because children’s brains are still developing and they are still growing, it very easy for the lead poisoning to cause severe damage. Some of that may be resolved with treatment, but some may be permanent. Other long term consequences include high blood pressure, kidney damage, anaemia, neurobehavioral changes such as irritability, poor attention span, loss of memory, muscle weakness. Additionally, it can lead to infertility for men and associated with very high rates of still births for women.
How are the families coping? What is the situation in the villages?
I have spent a bit of time in the villages, talking to women, some of whom have already lost children but who still have sick children with very high levels of lead poisoning. I don’t think we can begin to really understand what is going through peoples’ minds and how they’re coping with a tragedy like this. In one village where every household was screened, they found that 30% of their children under 5 have died in the past year, most in the past few months. I don’t think we really know what unimaginable effects this has had on the community and the families.
In the last week we have seen some improvements in the children we are treating. One little girl, about 3 years old, wasn’t walking properly, as I said muscle weakness can be a consequence of the lead poisoning, so after her first week of treatment, she’s now walking properly. Another little boy, 2 years old, had convulsions on and off for the past week and hadn’t spoken to his mother for more than a week. He has stopped having convulsions and also started talking to his mum again. These are some of the positive sides of what is happening, but it’s only a small start, there’s an incredibly long way to go.
What is MSF’s main concern over the coming months?
The treatment is actually only one small factor of what needs to happen. Treatment is important and needs to be scaled up significantly, as well as by other actors so that the most vulnerable population can receive treatment in a timely way. But I guess more importantly really, is that this is an environmental contamination. Contamination was caused by mining done at local village level by people mining for gold. The ore that the gold is found in has a very high percentage of lead. That lead is what has caused this poisoning. It has contaminated the soil in the village, and inside the households. So the only solution is that this contamination is cleaned up. International environmental actors are working on that now with the appropriate government authorities and obviously the communities themselves. It really needs to happen quite quickly but it’s not easy – that means removing all the contaminated soil from these areas and then eventually replacing it with clean soil or possibly cement on the floors of the houses. Then there needs to be a concerted health education programme aimed at behavioural change to also prevent recontamination at these sites. As one of the experts in lead poisoning said, if you have to put all your resources somewhere, put 80% into cleanup and prevention of recontamination and 20% into treatment because that cleanup and stopping people from being contaminated is the only way to ensure that people get better and to ensure that no more people get sick or die.
Why are we only treating children, aren’t the adults sick as well?
At the moment, this is an emergency action. We’re treating the most vulnerable first. Because children are small, they are much more vulnerable to the effects of lead in their bodies. Also because of the stage of development, children less than 5 years old, especially those around 2 years old, are still developing their brains, they’re learning to walk, they’re learning to talk, so when you have a poison that is attacking those systems, of course the impact is much higher than in adults. We’re treating some adults, breast-feeding mothers as there is some risk of lead passing through the breast milk. We have to prioritise the most vulnerable at the moment to try to ensure that we see a decrease in mortality and a decrease in any permanent morbidity.