Right now, Storm Lake homes may be poisoning some of the children who live in them.
When a parent hears this news, they are stunned.
Three decades after the United States forced the removal of lead from paint, the toxins are still harming an estimated 310,000 American kids. In rural Iowa, the current number of lead poisoning cases is running at four times the national average, local health officials say.
In Storm Lake, the United Community Health Center alone has diagnosed 10-12 high-level child lead poisoning cases in the last year.
Old Houses, old Paint
"It is not something that people may think of as a problem today, so a parent is usually very surprised and concerned when we tell them their child has tested positive for high levels of lead in their blood. They want to know how this could have happened, and in every case we have worked with, they jump right on the recommendations for dealing with the problem," says Health Center Director Renea Seagren.
Why are cases showing up in Storm Lake?
"It's mainly the age of the available housing in Storm Lake - we have a whole lot of old houses that still have lead-based paint," says local nursing practitioner Linda McClintock. "Anything built before 1978 may have lead paint in them, and virtually every house built before 1960 had some lead."
Children will peel chips of paint or pick them up off the floor - lead-based paint has a sweet taste, the local health practitioners say.
In one local case, a child was recently diagnosed after playing in the dust that had collected on a windowsill - dust that included tiny bits of lead from the woodwork. The mother began frequently vacuuming the woodwork areas, and follow-up testing has shown the child's level of lead going down.
In another case, a child was exposed to lead in the air as its family was renovating a home, sanding and exposing older materials underneath newer ones.
There are other ways that children are being exposed to lead, adds Pam Bogue, Director of Buena Vista County Public Health.
"In Storm Lake, we see people coming back from Mexico bringing certain types of candies made there than may contain lead. We are discouraging anyone from eating candy brought in from Mexico," she said.
"Also, clay pots are used as a part of the Hispanic culture, and we find that they are often made from lead. In Storm Lake, we see some families that will use these pots primarily for beans, soaking a very large batch as they consume the beans over time - but as they soak, they also absorb lead from the pots."
In other cases, children get the lead from a parent who may work in an environment with a lot of lead materials or lead dust. This level of exposure may not hard the parent, but a child is vulnerable to lead poisoning at much lower levels of exposure, and the lead the parent brings home on their skin or clothing may be enough to harm the child.
"If there's one thing we know about children, it is that they want to touch everything, and sooner or later those hands go in the mouth," Bogue said.
Local cases have also been seen where homeowners have dutifully painted over old lead paint, but eventually the newer paint wears off or peels, leaving chips or dust from the paint of years ago exposed.
The state is taking strong action on the problem.
Following legislation, starting this school year all children are required by law to be tested for lead poisoning before starting kindergarten. The same law newly requires proof of dental screenings for kindergarten and ninth grade incoming students.
The tests are available from physicians in the Storm Lake area and from the United Community Health Center and the Women Infants and Children (WIC) program for those who qualify. Public Health does not offer the test at this time.
Just one test may not be enough, Seagren feels.
"The Iowa Department of Public Health actually recommends that a lead test be done before age 2. If a child is exposed to lead, that is when implications of brain damage can begin to show up," she says.
"A lot of health care providers will suggest to parents that a lead test be done during the one-year checkup. Although the state doesn't require it, that doesn't mean that a parent who feels they are in a risk situation shouldn't get their child tested more often. Once really is not sufficient."
Providers should also be doing some form of risk assessment, Seagren says. "People move to different houses - the situation can change. What the state has done is give us a good mechanism to ensure that each child has one test, but we don't need to stop there."
She says she also is not sure all insurance companies have kept up with the need and allowed for coverage of the cost of lead testing.
Property owners can request a home inspection for lead. They are supposed to disclose lead in the home before a home sale or lease agreement, but local health officials are not sure how many owners are aware of or complying with such regulations.
"It is not inexpensive to correct the problem. You really can't just cover the old paint. It has to be scraped and fully removed before the walls are refinished - and it is applies to outside paint as well," Seagren said.
"There is nothing that really forces a landlord to clean up their home environment," she adds. "A tenant may be reluctant to complain, because they worry about getting evicted if they do."
According to county health department officials, some parents who have been told their child was suffering from lead poisoning have moved to different homes.
"The next step has to be an effective way to find funding to make landlords do clean up. We can't have babies in cribs next to windowsills with lead paint," Seagren said.
When a child tests high for lead, parents are given an information packet (in English or Spanish) on what to do.
In most Buena Vista County cases, the child's lead level has gone down somewhat by the time they receive a recommended follow up test three months later.
"The parents are generally very alarmed. They have a checklist of possible problems in the home to look at," Seagren said.
The Health Impact
In an effort to help, the United Community Health Center has changed from sending blood samples to a private lab to use the University of Iowa - saving families a substantial lab fee. They are also obtaining new screening equipment that will perform the tests with much less blood taken.
Adults can suffer from lead poisoning too, if levels of exposure are high enough. Most often, cases involve people who work with lead materials - sandblasting, welding and so on, local officials said.
In an adult, effects may include anemia, and reproductive difficulties.
The prime concern, however, is the children. The Iowa Department of Health has estimated that as many as one out of every 14 children in Iowa is exposed to potentially-dangerous levels of lead.
"Most show no signs. Symptoms can include becoming easily excited, trouble paying attention, stomach aches, and being overly tired - but in all the cases I've seen those symptoms had not shown. Testing is the only way to know," nurse practitioner McClintock said.
In young children, lead exposure can impact neurological development.
"Lead poisoning affects them right in that key developmental stage - the problems it can cause are very serious, and they are the kind of problems that can impact them in a very serious way for a lifetime," Public Health's Bogue says.
Opening Our Eyes
Public Health's role is often to visit families in which lead problems have been diagnosed. They coordinate follow-ups, and may go directly to the home.
"We are seeing more cases here. It is a good thing that the state is now going to require screening," Bogue said. "I think we will catch a lot more now."
Current estimates are that 60-70 percent of children have had at least one lead test during their lifestime. In reaction to the new Iowa legislation, schools this fall will provide lists of incoming kindergarteners to the state, which will check them against databases of lead testing records. Notification will be made on those who show no test.
Is enough being done? No, the local health leaders agree.
"We haven't opened our eyes to the full extent we might have," Bogue reflects. "We want to hink that the homes we are living in are safe places, nice and clean - but until we have really addressed the lead threat, it is a problem that continues on here generation after generation."