Aishani Moore gets tested for lead at a pop-up mobile clinic operated through Wayne Health. Photo by Nina Ignaczak
When Alashna Moore took her 4-year-old son Aishani to sign up for preschool at United Children and Family Head Start on Harper in early August, she took advantage of an unexpected opportunity to test him for lead poisoning.
A mobile health unit stationed in the parking lot behind the school building was staffed with health care professionals ready to test for lead poisoning and provide other family health services. Moore decided to get her son tested.
Aishani, dressed in a Spider-Man t-shirt, sat with a brave face on a chair as a nurse swabbed his finger with an alcohol pad. It took two tries at a finger poke to collect his blood in a thin glass capillary tube, but Aishani remained calm and curious throughout the ordeal. He got two lollipops for his effort — and, after his sample was run through a machine in the lab — a clean bill of health. No elevated lead in his blood.
Aishani has been tested every year since he was born, Moore said, and fortunately has never had an elevated blood lead level. But hundreds of Detroit kids do show elevated levels every year. In 2020, 2,619 children under age 6 across Michigan had elevated blood lead levels (EBLLs) — and 598 of those were in Detroit. In Detroit, as across the nation, lead poisoning disproportionately impacts Black children in low-income families.
Those numbers are a steep decline – more than 36% – from the previous year.
In 2019, 4,113 children had EBLLS statewide, with 838 of those in Detroit. But 2020’s lower numbers do not reflect a decline in lead exposure in the city. Instead, they reflect the impact of the pandemic, during which time fewer children visited primary care doctors for well visits, where most receive lead testing. Not all kids are tested for lead, but Michigan Medicaid policy requires that all Medicaid-enrolled children get tested at 12 and 24 months of age, or between 36 and 72 months of age if not previously tested.
In 2019, a total of 143,140 children were tested in Michigan — but that number plunged to 104,830 in 2020, a drop of nearly 40%.
Source: Michigan Department of Health and Human Services
What that means is that fewer families with lead-poisoned children across Michigan received public health counseling on how to reduce lead exposures in their home environment during the pandemic — at the same time many were spending more time inside homes at high risk for exposure.
Lead is a potent neurotoxin that leads to problems with learning, behavior, hearing and speech. Exposed kids may have reduced IQ and attention problems, which can impact them throughout their lives. Once a child is identified as having an EBLL, it’s imperative to identify and reduce sources of exposure from the child’s environment and take measures — such as through diet and iron supplements — to bring lead levels down below the U.S. Centers for Disease Control and Prevention’s 5 micrograms per deciliter (µg/ml ) action level. There is no safe blood level for lead.
“Even a little bit of exposure can have big impacts, particularly in children,” Dr. Jen McDonald, a consulting preventive medicine physician, and pediatrician with the Michigan Department of Health and Human Services, told Planet Detroit.
McDonald’s role includes reaching out to educate primary care physicians about the importance of lead testing in young children and helping coordinate a public awareness campaign to educate parents about the importance of lead testing.
“It’s impossible for me to know when a child is just sitting in front of me in a clinic, whether they’ve been exposed to lead. A blood test is the best way for me to know if a child is currently being exposed,” McDonald said. “And then, when I know that, I can take action to reduce their exposure. That’s why I think it’s really important for kids to be tested.”
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In an effort to boost the numbers of children getting screened for lead this year, and catch up with missed screenings, local health care providers launched a mobile clinic campaign staffed by a mix of licensed nurse practitioners, physicians’ assistants and non-clinical staff. Tucked into a sort of campervan, the clinic opens up to reveal an array of medical and testing equipment.
The clinics also offer general health care screening such as blood pressure, weight, height, waistline, blood oxygen levels and temperature, in addition to COVID-19 testing and vaccination. A grant from the Michigan Department of Health and Human Services added the lead testing equipment in May.
Jacob Winkel is a project coordinator with Wayne State University and leads the mobile lead testing for Wayne Health, a nonprofit physicians group associated with Wayne State University. The program’s aim is to increase lead testing in kids under six and pregnant women in zip codes known to have a high risk for lead exposure and a decrease in testing during the pandemic. Testing is free.
The program also prioritizes areas with an Action Level Exceedance (ALE) for lead in the water system. Local water utilities are required to test and report the results of annual lead sampling, and utilities with a 90th percentile value of over 15 parts per billion (ppb) are required to take corrective action. Highland Park was found to have an ALE in 2019.
So far, the effort has tested more than 170 children and has referred several to primary care physicians to evaluate elevated EBLLs. Kids with a finger prick test exceeding 4.5 µg/ml receive venous confirmatory testing at the mobile clinic, and staff follows up to make sure families receive the test results and connect with a primary care physician. The program began in June and will run through October; its goal is to test 2,000 kids. Wayne Health has secured funding to repeat the project next year, starting in May.
Winkel said families he’s encountered are grateful to have the service in their neighborhood, including one mom who came in because she had a suspicion that her family might be exposed to lead due to demolitions in her neighborhood. Demolitions are a known source of lead exposure in Detroit — children living within 400 feet of a demolished house were 20% more likely to test positive for an EBLL.
“She was appreciative not to have to go through a healthcare system or visit a doctor to get her youngest daughter tested,” Winkel said. The young girl’s capillary lead test showed an elevated blood lead level, so clinic staff performed a confirmatory venous test and referred the family to a primary care physician within Wayne Health.
Michigan Department of Health and Human Services provided funds to launch the program this year, marking the first time the agency has funded a mobile lead testing program, according to Aimee Surma, a nurse consultant with MDHHS. Although progress towards the goal of testing 2,000 children has been slow, Surma said the experiment has revealed lessons for how state and local health departments, physician’s groups like Wayne Health and organizations like Head Start can better collaborate to meet children in need of lead testing where they are.
As successful as this program might be, however, MacDonald would like to see it become obsolete.
“We need to work towards a system that doesn’t react to people already being exposed, but really truly has primary prevention — which is getting the lead out of the environment and preventing exposure before it happens,” she said.
For Alashna Moore, the clinic offered peace of mind as she enrolled her son for school this fall.
“If it’s available, why not get the test?” she said.
Families can find the Wayne Health Mobile testing schedule here. Testing is free.
Planet Detroit’s Solving Lead & Asthma in Detroit series is underwritten, in part, by the Erb Family Foundation.