It wasn't until a routine medical evaluation recently, Azalee Bodden said, that she learned that her daughter, Guiterra Clarity, 3, had unusually high levels of lead in her blood, a condition called lead poisoning.
Lead poisoning can be lethal and can cause brain damage, coma or convulsions. When Bodden's physician discovered the lead in the child's blood, he followed a routine procedure and called the city's Lead Poisoning Prevention Program for assistance in locating the source of the problem. Investigators found that small pieces of lead-based paint were peeling from the walls and windowsills in every room of Bodden's apartment and, apparently, the child had been eating pieces of the paint.
Since the initial discovery of lead poisoning, Guiterra has been hospitalized three times, and investigators of the Lead Poisoning Prevention Program have recommended that the child not live in the apartment building. The building is one of approximately 100,000 residential buildings in the city that are still coated with lead-based paint, according to Karen Ehrman of the Committee for Lead Elimination Action, a citizens' group seeking to remove the hazards of lead in the environment.
The lead prevention program, which is credited with increasing public awareness of lead's dangers and identifying more than 13,000 Washington children suffering from lead poisoning since 1973, is in jeopardy because of federal budget cuts at a time when city officials and citizens' groups say lead poisoning is still a serious problem.
The program's officials say that the federal funds for lead testing may be cut in half under the federal government's block grant program, which now forces the lead poisoning program to compete with other social service programs for a portion of a large federal grant. Before, the program received a specific amount of money.
Some of the program's health officials worry that without aggressive lead testing and investigation the numbers of lead poisoning cases in the city may rise dramatically.
Lead-based paint was considered an expensive, premium product from the early 1930s through the early 1950s, and was used on thousands of older buildings in cities across the country because of its durability, housing and health officials say.
But even lead-based paint eventually weathers and peels. The dangers of lead-based paint became better known in the early 1960s when social workers, concerned about the health and learning problems of low-income children, found that many of the symptoms they discovered could be attributed to the paint chips young children had been eating.
Lead poisoning continues to be a problem in the inner city, because lead paint has not been removed from many of Washington's older buildings. In addition, about 300 of the city's public housing projects have been found to have lead-based paint interiors and exteriors since the city began inspecting the properties eight months ago, according to Thomas Butler, chief housing inspector for the city's Department of Housing and Community Development.
Although the housing department has an inspection program to identify, remove and replace any hazardous lead paint in the city's public housing units, the inspection is not scheduled to be completed until December.
For many of the children who live in these buildings, the Lead Poisoning Prevention Program's inspectors may be the only people who will make sure that they and their environments are tested for excessive lead levels, said Ella Witherspoon, the program's chief.
"Many of these children do not see a doctor because their families don't have doctors," Witherspoon said.
Officials of the Lead Poisoning Prevention Program are involved in screening children for lead poisoning, tracking down and keeping records of children who have been detected with lead poisoning, educating parents, operating a lab unit to analyze blood and organizing environmental cleanup.
Dr. Martin Levey, an administrator with the program, said next year's allocation will be $137,000. This year's budget is $300,000. "This level of funding would obviously not be adequate to maintain the level of quality we're at," said Levey. Nonetheless, Levey said, the program is a high priority with city health officials even though it is unclear whether the city can fund the program at its current level with local rather than federal funds.
Betty Robinson, an investigator with the District's Lead Poisoning Prevention Program, is concerned that less funding will make it impossible to continue the program at its present standard.
"It seems like a losing battle sometimes," she said. "It hurts when you're doing something this important to think that you might not able to do as good a job. With less funds I don't see how it can be done."
Ehrman, of the Committee for Lead Elimination Action, said the reduction of funds here and nationally is a major setback for preventative health care.
"It's not like we've gotton rid of the problem. We've just learned to keep it under control," she said.
In 1973, when the lead screening program began keeping records, more than 30 percent of 8,300 D.C. children screened were found to have elevated levels of lead in their blood. Last year less than 2 per cent -- 205 -- of more than 12,000 screened had too much, a percentage below the national average.
"The lead program has been very effective. The community has worked hard to get the lead levels down to 2 per cent. We're saying just because the program has been successful is no reason to scale it back," Ehrman said.
Witherspoon said there is a concern that there are "clusters" of children who have never been tested for lead toxicity by investigators who randomly visit day-care centers and schools taking blood samples and looking for symptoms of lead poisoning among children.
Less money would make it almost impossible to go into the "high risk" areas to test chilren, said Witherspoon. "What we do in the high risk areas with homes built prior to the mid-1950s, especially in Southeast and Northwest Washington is go in and periodically check kids. Sometimes we go in and they're okay, but you go back six months later and the kids have lead in their bodies.
"If these services are not provided to the community one can expect an increase in children's lead levels, which can mean brain damage," said Witherspoon.
Despite cutbacks to the lead screening program, there is a new city effort to combat lead poisoning. The City Council is considering legislation that would make landlords responsible for cleaning up the exteriors of their buildings. The current law holds them responsible for cleaning the interiors once the lead hazard is detected, and, in cases in which a landlord is slow to make the repairs, the city may elect to clean up the building and add the cost to the building's tax bill.
Dr. Vernon Houk of the Centers for Disease Control in Atlanta said, "Lead poisoning is still a very significant childhood disease, especially for children in the inner city. Relatively low levels of lead tend to reduce children's ability to learn."
Because of the large numbers of residential buildings in Washington still covered with lead-based paint, health officials say, the danger to children like Guiterra Clarity will continue.
Ellen Silbergeld, chief toxic scientist for the Environmental Defense Fund, a public interest group, said that an old paint chip smaller than a thumbnail is toxic enough to damage young bodies.
"It does not take much to send the blood level of small children way over the danger threshold," Silbergeld said.
Bodden said that because of the severity of the problem of peeling paint in her apartment, she had difficulty keeping Guiterra away from it.
"The wall breaking is easily in her reach," Bodden said. "It's all in the windowsill, in the pantry, and in the children's bedroom where she plays. That's how it all started."