Navajo Health Research: Dr. Johnnye Lewis Continues

Kerr-McGee Quivira I mine site near Church Rock, New Mexico, one of over 500 abandoned uranium mines in Navajo Country: most have had little or no remediation work [for a look at remediation plans for one monster site, see our Report from Church Rock] . Preliminary results from the DiNEH study associate proximity to uranium “legacy” sites with hypertension and autoimmune disease, as reported in the first part of this interview.
Interview and photos by ERIC SHULTZ

At the end of August, we posted excerpts from a interview with UNM Community Environmental Health Program director Dr. Johnnye Lewis. There she spoke about prior research on the health effects of uranium mining and milling among the Navajo, and discussed the current CDC [Centers for Disease Control and Prevention] Navajo Birth Cohort Study as an example of Community Based Participatory Research, in which Navajo agencies, organizations and individuals take part in the design as well as in carrying out an unprecedented public health investigation. Able to move from broad currents of history to molecular details of research procedure, Dr. Lewis presents such a nourishing discussion of the state of public health research within Navajo Nation, we couldn’t stop after one installment. It is our belief that health research such as the study Dr. Lewis is currently directing will have great relevance in any discussion of environmental justice for the Diné, and such research has long been demanded by the very people at risk from the uranium legacy. As we ended the first part, Dr. Lewis was discussing some of her Navajo collaborators and advisers, such as the filmmaker, Mr. Malcolm Benally, who is crafting short pieces for YouTube as a way of approaching teenage mothers to participate in the study.

Dr. Johnnye Lewis, director of the UNM Community Environmental Health Program and chief investigator for the CDC Navajo Birth Cohort Study.

Dr. Johnnye Lewis: [At the Tuba City public library, Navajo youths are] …all on the computers and they’re all on Facebook and they’re all on YouTube, and I look at the number of hits Malcolm [has gotten]… He’s serialized a movie called Bitter Water on YouTube. It’s actually interesting to have a look at. A series of interviews with elderly women who talk about the Hopi/Navajo land dispute… Malcolm, very fluent in Navajo both written and spoken, has been a tremendous asset.

And Dr. David Begay, who is on the Navajo Institutional Review Board, he’s also an adviser to the Diné Hataalii, which is the group of elders and medicine men, the keepers of the fundamental law… [Dr. Begay is] very, very sensitive to indigenous learning styles. He started the Indigenous Learning Institute in Santa Fe… We have lots of really good guidance. Some of the people in the Native Medicine Programs and the IHS facilities in Gallup and Chinle have been involved and are just excellent resources… Really solid understanding of culture and tradition and how we need to be addressing these questions.

La Jicarita: Fantastic. I’m halfway through my questions. I can go on and on. What you’ve said so far has been enormously helpful. So say stop when you need to do something else, but if we can keep going…

JL: I’m OK for a little while… One thing I didn’t mention that you might be interested in. We’re working with the Center for Development and Disabilities, a UNM facility that provides early intervention services and is a sort of ultimate referral point for any Native American kids in the State that get diagnosed with developmental delays…  and with the Indian Children’s Program, which is run through the Center for Development and Disabilities. But we are also working very closely with a program among Navajo called Growing in Beauty, and they are the early intervention case management providers so they actually do the early screening… They would manage cases and make sure that moms get [inaudible] to all the appropriate services they’re eligible for. And then if those children need additional help, they would be referred out by Growing in Beauty to the Center for Development and Disabilities. And there’s a parallel center in Arizona.

LJ: Just go over for me quickly some of the technical toxicological aspects of what we’re talking about because, from what I’ve read so far, I mean, I didn’t realize that uranium is toxic besides being radioactive. And I guess I didn’t appreciate that uranium by itself isn’t the only problem. There are the so-called progeny and there are also other heavy metals that are in the same minerals, so this is quite a cocktail that people are drinking or breathing. So could you talk a little about that?

JL: Yeah. I think the main concerns that you always have when you have things like heavy metals is that they can act in synergy, or at a minimum they can be additive and act through the same mechanisms, and how closely they interact is sort of a function of the form they are in. When we look at the water samples, though, about eight to 10 percent of the wells we’ve sampled have elevated uranium beyond the drinking water standards. About 15 percent have elevated arsenic. And about 70 percent of the time, those are co-located. Arsenic has vey much the same history as uranium in that the more we start looking for subtle effects, the more effects we find, and the lower the doses [that] are deemed safe.

LJ: Weren’t the standards just relaxed nationally by George W.?

JL: In drinking water the standards were tightened a few years ago, and the same for uranium. We actually worked to get the State to lower the uranium ground water standard by several orders of magnitude a few years back as well. Now our ground water standard is at the Safe Drinking Water standard. We couldn’t get it lower than that because people would have to treat the discharge water from drinking water facilities and nobody could quite get into that logic! But we do have an open invitation to come back when we get our data finalized, so…

What we’re very concerned about is arsenic and uranium acting together… Or, is the primary effect we’re seeing related to arsenic [alone]? There are studies coming out of South America where a particular water source became contaminated with arsenic and if you follow the kids that were born during that time… It was a three year period when arsenic levels went up very high and then they caught it [and] they were brought back down again. They were low before, then you get this one period, and then they were low again, so it was a really horrible situation, but a situation that we can learn a lot from by following kids that were born during that period. And what you see is a very huge increase in various cancers developing much earlier in life than you would expect in those kids that were born at that time. It leads us to believe that arsenic is going to be a major player in all of this. So our goal is that when we do these environmental assessments, we look at the full range of metals that might be present.

There’s also… When you burn coal, there’s mercury that comes off of it, there’s cadmium that comes off of it… Coal itself contains a lot of heavy metals. So… the focus has been the power plant emissions, but a lot of coal is burned in homes as well. We work with a group out of the University of Montana that’s done a lot of work around indoor stoves and looking at… if you make a stove that burns more efficiently in terms of the emissions at the stack, what do you get inside the home? And often, those are burning at such a low burn rate that when you open the door, you get a lot more smoke in the home than outside. We’re looking at things like that. If you’re burning coal in a stove that was designed for wood and has some leakiness to it, what kind of indoor emissions are there? All of that will be caught in the dust samples.

We also have oil and gas production [in Navajo Country] and a lot of sour gas fields, so you end up with a lot of hydrogen sulfide, and that also can cause developmental delays…

LJ: I’m sorry, I have to ask you to back up just a second. The dust samples, is that from dust in suspension in air that’s sampled, or you actually…?

JL: No, we’re looking at what settles on the floor, on solid surfaces.

LJ: Do you use like a piece of tape and stick it to it?

JL: Yeah, we have these little wipes that are called Ghost Wipes that are actually designed to collect dust samples in homes, so you have a little template that has a specific area… Chris [Shuey]’s crew is actually going to be doing this so he can probably show you what they look like. Then you take the whole wipe and put it in a tube, digest it with nitric acid, and it frees up the metals and you can run them through an ICPMS [inductively coupled plasma mass spectrometer] and actually get the distribution of metals.

LJ: Wow.

JL: So we’ll be doing that in all the homes and looking both in the area where people are sleeping… where babies especially are sleeping… but then also in the most active family gathering area.

LJ: But the technicians who are doing this will also have a checklist of what type of cooking stove they have, what kind of heating they have, etc….

 JL: Right, what kind of fuel they’re burning, and condition of the stove. We’re asking all of those questions. And then we’ll also look at radon. We’re doing indoor radiation surveys so we’ll have Ludlum detectors so they can check for radiation both in the walls and on the solid surfaces…

LJ: Is that like what we used to call a Geiger counter?

JL: Yeah. They’ll scan around the house and also measure indoors… Then we’ll place radon canisters, both in the room the baby’s sleeping in and again in the public areas. We’ve started piloting that, having people look at doing that in the field and I think it’s going to be a pretty comprehensive evaluation. If the moms move during the pregnancy and the kid’s raised in a different home, we’ll repeat that so we’ll have something from the time of exposure. And then from the blood samples and the urine samples, we’ll also look at metals, and if we can find additional funding, also look at polycyclic aromatic hydrocarbons [PAHs] that might be related to oil and gas production. But we will at least be able to get the indoor sulfur content.

Uranium is not the only industrial health threat on Navajo Nation, as an oil refinery near Gallup reminds us: for the upcoming study to measure for PAHs, additional funding will be needed.

There have been studies done in these sour gas fields that show that when there is a pressure change from outdoors to indoors at night, sometimes the houses will actually breathe and pull material in, so you can get hydrogen sulfide concentrations inside the home that are greater than what you would see outside at the time.

LJ: I hadn’t thought of this… but is hydraulic fracturing used in these gas fields?

JL: Not as far as I know on Navajo per se. There has been fracking that has gone on up in the Four Corners area, but as far as I know, and I could be off base on this… But for right now we’ve… measured levels of hydrogen sulfide outdoors that are of concern, and so depending on what’s happening in the houses… We’ve never had the resources to look at [levels] indoors and the community members have been very concerned about that for a long time and we’ve just not had the resources. So that’s something else that we’re really looking forward to answering with this study.

LJ: If you can stand just one more question, and some of this has already come up, but just as an overview, could you talk about what you expect the study to give back to the community.

JL: Sure. I think you know we talk a lot about different levels of response, of benefit back to the community and there’s one level that will go back to the individuals who participate. I mean there will be incentives, but that’s more compensation for giving your time… What people will learn on an individual level is having those indoor home assessments at the beginning of the pregnancy… [to] give people an understanding of where risks might be. We’re also looking at things like indoor hobby activities that might be creating risks. We’ve done a little bit of measurement in Pueblos, looking at what kinds of metals are produced with indoor jewelry making, and some of the silver solders have lead, still. They’re sold as silver solder but if you go back to the contents, they used to have cadmium and I would suspect some of that is still circulating out there, and they still have lead.

LJ: Because someone inherits grandpa’s jewelry making kit…

JL: Some of the processes have changed, so some of the materials have changed, so doing things that traditional way may not be OK anymore and if they’re in a home and they’re not vented and the kids are crawling around, we may be seeing impacts develop. The people who go into the homes are going to be trained to look at anything about the home environment that might be unsafe or be presenting an additional risk. Being able to take action and make sure that the pregnancy is as safe as possible, I think will be fabulous.

So that’s on an individual level. And then also at an individual level, we’ll be looking at development at two months, six months, nine months and a year, whether or not the child has any symptoms of delayed development. So the tests that we do should allow us to identify children at the earliest possible stage if there’s any developmental delay, and in that kind of situation, we can link that child up with services through Growing in Beauty, and very rapidly get that child care that will ensure that their development is maximized. It doesn’t always mean that you can reverse things, but there’s been enough done to show that early intervention really helps maximize development, so those are very direct benefits to people who participate in this study.

At a community level… we will be able to give chapters [townships] information that will help them in planning. So helping them to identify areas that are presenting the greatest risks, both on the Navajo Nation level, but also within an individual chapter, will help in their planning decisions and help them understand what their decision’s impact might be on community members.

At a  Navajo Nation level, regardless of the effects of the uranium, this will be the most comprehensive study on development of Navajo children… We’re also doing studies of diet and looking at some of the nutrient levels… There hasn’t been a published study on nutrient levels on Navajo since 1981. That alone is going to be informative. And learning how children develop is going to be really an important asset for Navajo Nation in their planning as they move into having a Department of Health. And for Growing in Beauty, we’re also working with the developers of one of the screening instruments and trying to create norms for Navajo. There hasn’t been that look at Navajo-specific data to decide where the cutoff points [are]… Do Navajo children develop on the same… pattern that you see in this big sample that was used to create these standards for this test? We may find that in some categories Navajo children just tend to develop either more quickly or more slowly and we’re labeling too many people or not catching enough. We’ll be giving Growing in Beauty that information so they can be making better decisions about who to put into early intervention. So I think that’s going to be good.

For Navajo EPA, I think we’re going to have another very strong collaboration between Navajo Division of Health and Navajo EPA. Looking at environment and health in that integrated way, because we have common staff, I think that will start coming out as well. And then for Navajo Nation, they have a ban on uranium mining right now. I think we’ll be able to provide information that either says yes, that ban needs to stay in place, or gee, it doesn’t look like there are ongoing problems, so maybe you don’t need to have that ban in place… I don’t believe that’s where we’ll go, but it’s possible. I mean, at least we’ll know and right now we don’t.

I think right now there’s a lot of fear, there’s a lot of concern. There’s not a really good, solid answer to the question, and so being able to identify what those problems are I think also helps in prioritization of cleanup. What sites present the greatest dangers? What exposure routes? How much does arsenic contribute? Is arsenic the bigger problem than the uranium? Being able to understand that interplay will just give people a better basis for decision making and for planning long term. So, I think… benefits at every level.

LJ: Fabulous. Thanks.

JL: Assuming we can get into the field and get started.

LJ: Chris said something about the Office of Management and Budget still hasn’t released the funds?

JL: Yep. We have funding but we can’t start enrolling anyone until they give us the official go-ahead. So the approval process… This is a collaborative effort between CDC, IHS, Navajo Division of Health and us, and because it’s set up that way, all of the federal oversight agencies become involved. We normally would’ve had to go through Human Research Protections review anyway, from both UNM and Navajo Nation. I also have a colleague working with us from Yale, so their ROB (Research Oversight Board) and then CDC’s. We knew about that. As federal regulations increase over the last years, they’re bringing more and more of these studies into that oversight. So we’ve been required to comply with the Federal Information Security Management Act. That delayed things a bit. It’s not something the University systems have gotten accredited for so we had to go through CDC’s systems, so it’s just another task that we had to accomplish. And now we’re at the Office of Management and Budget and they wouldn’t look at anything until we had all these other steps in place. We’re hoping within the next month or so…

LJ: You don’t know of any particular snags?

JL: No. It’s just asking for more information and more information and more information. We just sent them a few feet of material last week. We’re hoping that will be sufficient, but we’ll see. I don’t foresee any major problems. I think it’s just getting their blessing in the end. They need to see letters on how we get information back to people, what we’re going to say about the results… You know, nothing bad, nothing we weren’t planning to do, some stuff  we had to quickly manufacture that we didn’t have finalized yet, but that part’s been good, so soon, hopefully.

LJ: Is there anything I’ve overlooked…?

Small flock, southwest corner of Standing Rock chapter, near Kerr-McGee and UNC uranium sites. Plant uptake of radioactive isotopes and accumulation in food animal species pose long-term health concerns.

JL: …One other benefit that I didn’t mention that to me is really exciting [is] this collaboration with the Center for Development and Disability and the Indian Children’s Program. Prior to working with us, environmental exposures were not major things that they considered. And so through this collaboration, I think they’ve become much more aware of where their cases are relative to some of these sites that we’re concerned about. And we’re also now having a lot of discussion about how we move forward to understand the impact of environmental exposures on child development on tribal lands. I think that’s another real benefit that all the communities will get and hopefully that will also have an impact on policy. Right now, environmental exposures is not consistently considered in each of the three states, Arizona, Utah and New Mexico, among criteria for early intervention services. We’re hoping that data that we get will help change those policies to make them consistent.

LJ: I’m sure a lot of communities besides the Navajo Nation are or will be very interested in this study, both in how it’s carried out and the results it produces. Have there already been indications of that?

JL: I actually just got… in fact there’s a community in Oklahoma called Tar Creek that actually has many tribes under it. There are eight tribes… and it’s lead chat piles. There are efforts to do similar studies there. One of the investigators there is working with us so we’re trying to coordinated… They’re going to have a conference there soon. One of the community leaders just sent me an invitation. But I think Laguna, you mentioned Laguna… I think it becomes very interesting for them as well.

LJ: I there any Laguna involvement at this point?

JL: There is not at this stage. The congressional language is very specific to the Navajo. Hopi is another big issue. They’re right on Moenkopi Wash, which was the discharge area from the Rare Metals mill in Tuba City. We’re actually having discussions on how we can make sure that we are looking at Moenkopi Village at least. We do not at this point have agreements with Hopi but there is an individual from Hopi who’s on the Health Board at Tuba City who’s talking with us about how we can do that so they’re not excluded.

Governor John Antonio of Laguna at the time was very active in the testimony in front of [Rep. Henry Waxman’s Committee on Oversight and Government Reform in] Congress to get the Five Year Plan moving… You probably know that Jackpile has just received designation as a Superfund site and that’s a huge step, but there have not at this point been specific congressional funds to look at Laguna. I think that’s something that we’ve been concerned about and Chris I think can talk with you a little more about that too. There’s an organization called MASE (Multicultural Alliance for a Safe Environment) and Laguna is very active in that as well. At the Navajo Nation Fair next week we’ll be sharing a table with MASE.

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