The homemade powder, called kumkum, that Venkat Rachakulla and Lakshmi Ginnela applied on their daughter’s forehead was meant to enhance her intuition. The yellow turmeric, which the couple bought from a local Indian grocer and sprinkled regularly into her food, was supposed to keep her healthy. And the tiny gold bangles were a gift from the baby’s grandparents in Hyderabad, India – a way for them to send good fortune.
These items were meant to keep 1-year-old Vaishnavi safe.
But it turned out they were contaminated with lead, and had raised the level of lead in the little girl’s body to five times the amount that federal agencies consider safe.
In recent years, incidents of lead poisoning in places such as Flint, Michigan, and East Chicago, Indiana, have brought an old public health problem back into the spotlight, raising awareness of the damage lead-contaminated paint, water and soil can inflict on the developing neural and nervous systems of young children.
Far less attention has been paid to other, atypical sources of lead poisoning that disproportionately affect immigrant communities whose members unknowingly bring in contaminated products from their home countries.
“We were very, very shocked,” Rachakulla said in an interview at his home in Gaithersburg, a Maryland suburb north of Washington. “I have never known that these things would have been contaminated with impurities.”
Some products containing lead, such as kajal, have been banned by the Food and Drug Administration, but can still be purchased at specialty grocery stores or brought by travelers from overseas. A 2010 report from the World Health Organization found that 19% of all the herbal products manufactured in South Asia and sold in South Asian grocery stores in Boston contained lead.
From as early as 1991, medical journals have reported cases of elevated lead levels in immigrant communities across the country. These tend to be isolated incidents, however, and do not often elicit a strong or broad-based response from local officials.
The problem is “not something that is an epidemic, but [is] certainly very persistent,” said Lance Chilton, a medical toxicologist from Albuquerque who worked on a case similar to Vaishnavi’s in 2013.
Aparna Bole, the chair of the American Association of Pediatrics’ Council on Environmental Health, agreed, adding that lead poisoning from imported products is a well-described issue among pediatricians, but not particularly well known among parents.
Kelly Johnson-Arbor, the co-director of the District’s National Capital Poison Center, said she sees at least one incident a year of children of immigrants poisoned with lead-contaminated imported products. Health officials in Virginia’s Fairfax and Arlington counties reported two to four such cases annually, often involving families who emigrated from South Asian, Middle Eastern or African countries. Sources can include makeup products, spices and glazed kitchenware.
Montgomery County officials said county data does not suggest a higher incidence of lead exposure in any particular racial or ethnic category. In 2017, the total number of lead poisoning cases in the county was so low that it did not qualify for additional state funding for dedicated outreach programs.
Vaishnavi’s parents were alerted to the problem at a routine checkup in May, when she registered a lead level of 35 micrograms per deciliter. Most children who are born in the United States, as Vaishnavi was, have a lead level below three.
The turmeric was the only substance the baby actually consumed. But health officials told her parents that sediment from the makeup and jewelry also probably made its way from her hands and into her mouth.
In the weeks since Maryland health officials visited their home, the couple have swapped out their daughter’s gold bangles out for plastic ones, substituted CVS-bought Maybelline makeup in place of the Indian powders they once used for the dot on her forehead, and tossed their old spices in favor of new products from Costco.
At her most recent blood test, Vaishnavi recorded a lead level of 16.
Rachakulla is relieved but said more needs to be done.
“The information has not spread. It was first-time information for us,” said the 39-year-old software engineer, who moved to the United States in 2008. “If we knew, we’d be the first to shout it out aloud. . . . There needs to be an alarm.”
In recent weeks, Rachakulla has tried to warn other South Asian immigrants in his neighborhood and at his workplace about the risks of lead contamination from imported products. He confronted the owner of one of the Indian grocery stores he frequents about the turmeric but said all he got was a half-believing shrug.
In Rachakulla’s experience, immigrant families are not hesitant to part ways with tradition once they realize there are health risks. The challenge, he said, is that people often find it hard to believe that items so deeply rooted in their cultures can be dangerous.
“This needs to be addressed as a serious, serious thing,” Rachakulla said, sitting in his apartment with Vaishnavi beside him. “I want it to be seen as a problem.”