This document discusses lead poisoning in children in Zamfara, Nigeria caused by mining activities. It provides details on blood lead levels found in children, which were as high as 109-370 mcg/dL. Nearly 97% of children tested had blood lead levels exceeding 45 mcg/dL. The challenges in addressing this crisis included fear and misunderstandings between communities and aid organizations, as well as differing agendas among stakeholders. Over time, remediation efforts helped reduce mortality and the number of children requiring treatment, though some challenges remained such as recontamination and new outbreaks in other areas. Effective communication, understanding local cultures, and providing consistent information were emphasized as important to resolving crises like this.

1. Dr Natalie Thurtle
@Turtle1doc
Lead Poisoning In Nigeria

2. Lovely Colleagues in Australia

3. Zamfara, Northern Nigeria
Wikipedia creative commons

4. HRW vid
©Human Rights Watch. For full video go to http://www.hrw.org/features/a-heavy-price
(editing gaffs in this shortened version are mine)

5. March 2010
2 yr old boy in status
epilepticus.

6. Blood lead levels (BLL) 109-370 mcg/dL
(very super high)
MSF unpublished data April 2010

7. Zamfara (initial): 97% >=45 mcg/dL
Flint: 5% >5mcg/dL
Notes from the Field: Outbreak of Acute Lead Poisoning Among Children Aged
<5 Years -Zamfara, Nigeria, 2010. MMWR July 16, 2010 / 59(27);846
Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water
Crisis: A Spatial Analysis of Risk and Public Health Response.
Hanna-Attisha M et al. Am J Public Health. 2016 Feb;106(2):283-90.

9. Lovely Colleagues in Australia

10. Critical?

11. Chelation (treat the kids)
Remediation (clean up the mess)
Safer Mining (turn off the tap)

12. Challenges

13. Ebola
Picture Credit: © cdc.gov Story Written By Elizabeth Smout LSHTM scidev.net

14. Communication

15. Fear

16. Cultural (mis)Understanding
“Up until now, support for the Ebola outbreak has focused on improving
public health measures by increasing facilities and equipment, fast
tracking vaccine and drug trials. However, without knowledge and
understanding of local communities this life-saving work can often fail”
Dr Jeremy Farrar (Director, Wellcome Trust)

18. Mixed Messages
• 1) MANY people
• 2) MANY conversations
• 3) DIFFERENT languages
• 4) DIFFERENT cultures
• 5) DIFFERENT agendas

19. Access

21. Credit: TerraGraphics International Foundation

22. Maps
http://missingmaps.org
http://openstreetmap.org

23. Summary - Difficulties
• Fear
• Language differences
• Cultural misunderstandings
• Mixed messages (Lots of stakeholders)
• Agenda variance
• Getting bogged with no map

24. Too Hard Basket?

26. Where are we now?
• 8 villages remediated
• 3.8% Mortality
• 3000 discharged from follow up
• Good relationship with miners
• Mining continues, some safer aspects
• Government engaged
• Buy-in for partner agencies
• New challenges
– tweens and teens
– some recontamination in Zamfara
– Niger state outbreak
– Congenital lead poisoning

27. Critical Care
• Calm the fear (stick around)
• Talk the same language
• Learn the culture (read some anthropology)
• Give consistent messages
• Figure out what the agenda is
• Dig yourself out when you get bogged
• Get a map, or make one.

28. Thanks
• Zamfara and Niger communities
• Zamfara and Niger teams past and present
• TerraGraphics International Foundation
• Prof Paul Dargan – Clinical Toxicologist
• Dr Jane Greig – Operational Epidemiologist,
MSF
• Dr Simba Tirima – Environmental Scientist,
TerraGraphics