Scott C. gestures expansively around the living area. “Welcome, welcome,” he says magnanimously. “It’s not fancy, but we’re comfortable here.”

The arrangement is agreeable enough, but with the autumn evenings getting cooler and hints of frost in the air, it won’t be comfortable much longer.

Because their two youngest children have lead poisoning, Scott and his wife, Meg – who preferred not to have their last name used in this story – don’t have much choice. Displaced from their home, the family is living in a pop-up camper in their back yard in East Corinth.

Together with their four kids – Courtney, 13, Nathan, 10, Heather, 5, and Abigail, 2 – Scott and Meg sleep, fitfully, wall-to-wall, in the camper. They cook on a gas grill. They get their water from an outdoor tap.

Their living room is the grassy, awning-sheltered area in front of the pop-up. Their furniture is plastic. When it rains … well, enough said.

The six of them have been out there for three weeks now and expect at least another week of this imposed al fresco lifestyle.

The novelty, if there ever was any, is wearing thin.

A few yards away, their handsome, three-story wood-frame house, built in the mid-1800s, is emptied of their possessions and essentially off-limits. Every day, workers in moon suits trudge through the high-ceilinged rooms like weary astronauts.

They’re removing the old wooden trim from the windows and doorways, scraping paint off the thresholds, sealing and carpeting the painted wood floors. When they’re through, the house will be safe for the family to move back in.

But there’s no undoing the damage the lead paint has done. Heather and Abigail have been poisoned by living in the pretty old house, and though right now they’re as boisterous, bright and engaging as any parent could wish, there’s no telling how the lead may affect their long-term development.

“I don’t think they’ve had any adverse effect,” says Meg, eyeing the youngsters as they race across the yard, splashing through puddles from a recent shower. “I think we caught it in time.”

Lead’s effect

Although lead paint poisoning often is considered a problem of low-income, inner-city neighborhoods, there is growing recognition that it respects no social or economic boundaries. Families who reside in picturesque 1880s rural farmhouses, elegant 1920s village homes or crumbling 1960s housing projects are all at risk of exposing their children to lead.

Maine has tens of thousands of old homes – the state boasts the seventh-oldest housing stock in the nation. A full 36 percent of Maine homes were built before 1950, when lead paint was at its most toxic, and are considered a very high-risk source of lead poisoning.

Though federal laws banned all lead from residential paints beginning in 1979, it lingers in older structures.

Paint particles are easily ingested through the nose or mouth as paint ages and chips off battered shelves and worn stair treads or is released as a fine dust from sliding windows and scraping doors. Renovations also release lead paint dust into the environment. It is essentially odorless and tasteless.

Once introduced into the intricate metabolism of a child’s developing body, lead circulates in the blood, replacing oxygen on the hemoglobin molecule and affecting normal cell health and growth. It also moves out of the blood and builds up in the liver, kidneys, bones and other structures. Over months and years, it releases back into the bloodstream to do more damage. It can take years for lead to be excreted, but the damage it does is permanent.The result is a complex of potentially devastating neurological problems. At low levels, children may suffer from headaches, irritability, hyperactivity, lowered IQ and behavior problems. Higher levels may result in stunted growth, mental retardation, severe brain damage, coma and death.

Most vulnerable are children under 6, pregnant women and their developing fetuses. While a few states mandate blood tests for all children before they enter school, critics point out that children are the most at risk from infancy through age 2. By the time a child is ready for school, they say, the damage is done. Although elevated blood levels decline over time, researchers believe lead’s damage to a child’s neurological system is never fully repaired.

For most children, the screening test consists of a quick finger stick. The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend universal screening of all 1- and 2-year-olds in high-risk areas. Maine officials agree that, because of the age of the state’s housing, our children are especially vulnerable to this crippling but wholly preventable disorder.

A need to get the word out

October is National Lead Poisoning Awareness Month, but other than a State House press event, no fanfare is planned.

“For us, every month is Lead Poisoning Awareness Month,” said Dr. Dora Mills, director of Maine’s Bureau of Health.

Mills said staff members from the bureau’s Childhood Lead Poisoning Prevention program, or CLPP, have been working for several years to raise awareness among parents and health care providers statewide. Brochures, letters, public service announcements, posters and personal visits all have been used, she said.

Still, screening rates for lead remain frustratingly low. CLPP statistics show that only about 15 percent of all Maine children under 6 were tested for lead in 1994; by 1999, the rate had dropped to about 12 percent. A year later, the rate rose to 13.7 percent.

Statistically, children whose low-income families qualify for Medicaid are at least twice as likely to be diagnosed with lead poisoning than their higher-income peers. Federal law requires that all Medicaid-enrolled youngsters have their blood tested for lead at ages 1 and 2, the most sensitive age.

But for at least the past five years, only between 10 and 20 percent of those children in Maine have been tested.

MaryAnn Amrick, director of CLPP, estimated the screening rate for Maine’s general population of 1- and 2-year-olds, not just Medicaid-enrolled youngsters, at 30 percent, but said she was waiting for confirming data.

Amrick couldn’t say why Maine’s testing rates for children on Medicaid are so low, but suggested multiple factors are at work. “There are lots of social issues that affect that population,” she said.

Universal screening?

New legislation went into effect in July that mandates that health care providers test the blood of all Maine children at age 1 and 2 unless, through a set of pre-established screening questions, a child is determined to be at little risk. A decision not to screen must be documented and justified in the child’s medical record.

Given Maine’s low compliance with the federal Medicaid requirement, Dora Mills acknowledged that the new state law might be hard to enforce. But, she said, it should help raise awareness and it gives the state “another tool for communicating with health care professionals.”

But Susan Thornfeldt, an outspoken citizen advocate and longtime critic of the state’s response to the lead poisoning issue, says the new law is not only unenforceable, it doesn’t get to the heart of the problem.

Thornfeldt, director of the Portland-based grass-roots organization Maine Lead Action Project, said too many doctors are still not educated about the nature of the problem in Maine and continue to profile lead poisoning as a disease of low-income city dwellers.

Despite whatever information they may be getting from CLPP, doctors “just don’t take the Bureau of Health very seriously,” Thornfeldt alleged.

DHS – friend or foe?

Perhaps most importantly, Thornfeldt said, some physicians and many parents hesitate to trigger the state actions that follow the mandated reporting of a child’s elevated lead level.

Those actions may include education, home inspections, referral to local agencies and a requirement to make the home safer.

“Families are very wary of getting involved with the Department of Human Services,” Thornfeldt said. “They don’t understand what the role of DHS is. On one hand, [DHS is] an agent to protect children, but they’re also empowered to remove a child from the home. In some cases, it needs to happen, but the policy isn’t clear. There are no set protocols.”

Amrick said it’s very rare for her program to refer to DHS’ powerful Child Protective Services, but acknowledged that it has happened – perhaps two or three times in the past 10 years.

“It’s not something we’d look to do,” she said. “Most parents are loving parents. They’re already feeling guilty, but it’s really not their fault. To blame them would be moving backwards.”

Thornfeldt said the state needs to be clear in its policies and work harder to assure wary parents and providers that DHS is on their side in attempting to identify and treat children with lead poisoning.

Treating the problem

Most of us have lead in our blood, the legacy of lead paint, leaded gasoline, lead in our water pipes and soils. So much lead is in our contaminated environment that the CDC considers 10 micrograms or less in a deciliter of blood “normal.”

At the other end of the spectrum, blood levels of 45 mcg/dl or higher call for aggressive efforts to remove the lead by introducing materials into the body for it to bond to and be excreted. Because this treatment is itself risky, unpleasant, expensive and only moderately successful, lower levels of poisoning are not treated medically but by minimizing exposure to lead, boosting nutritional intake and letting nature take its course.

When Maine children are tested, levels between 10 and 14 mcg/dl are reported to the state for statistical purposes, and a packet of information is sent to the family. Levels of 15-19 mcg/dl trigger a visit from a public health nurse and the offer of a professional lead inspection of the home, paid for by the state.

If a child’s lead level is above 20 mcg/dl, CLPP initiates a full lead inspection and the family is required to make the home “lead-safe.” In some situations, the child may not return to the home until the work is done.

For most families, not just the very poor, the cost of mitigation is prohibitive. To remove lead paint completely from a larger home can run into many tens of thousands of dollars. Less drastic measures – repainting chipped surfaces, carpeting over painted floors – can be equally out of reach for some households.

The state has some financial aid for low-income homeowners, but in many cases it’s not enough to cover the work that needs to be done.

Since 1998, the Maine State Housing Authority has administered about $5 million in federal grants from the federal Department of Housing and Urban Development. The money is available to income-qualified property owners who need to make their homes lead-safe.

MSHA program director Roger Bondeson said HUD gave Maine $2.16 million in March of this year to cover a projected 160 abatement projects over the next 21/2 years. He already has received 93 applications, and he expects to run out of HUD money long before the grant period is over. “We’ll just have to ask for more money,” he said.

The Department of Environmental Protection also plays a role in preventing lead poisoning, by licensing lead inspectors and offering training programs for contractors and do-it-yourselfers.

Caught in the net, and glad

Many parents, like Scott and Meg, feel lucky to have been caught in the state’s safety net, thankful for the assistance they’ve received in getting their family past this frightening episode. Before moving into their home three years ago, Scott said, he removed old horsehair plaster from the walls and replaced the battered windows, thinking he was addressing the most significant lead paint hazards. Chagrined, he said he now realizes how little he understood the scope of the problem.

The family’s Bangor pediatrician, Meg said, had never raised the issue of lead. After a heating consultant pointed out the many old painted surfaces in her home, Meg insisted on having her two youngest girls tested. The results came back with elevated levels – 17 mcg/dl and 19 mcg/dc.

Courtney and Nathan were not tested, Scott said, because they are older and at less risk of developmental impairment.

After the two youngsters were tested, the doctor and his staff simply told Meg to bring her daughters back every three months to monitor their blood lead levels. Meg said the staff offered no further information and gave only “generic answers” to her requests for guidance. “I needed to be educated. I didn’t know if it was ‘lead poisoning’ or just high levels,” Meg said. “They didn’t tell me about the effects, or if anything could be done.”

It wasn’t until she vented her frustration that the doctor’s office put her in touch with Amrick’s program. The state, Meg said, was “wonderful.” CLPP sent information about lead poisoning and its effects. They had a nutritional consultant come out from Penquis CAP and talk with Meg about the need for extra iron and calcium in the girls’ diets. They also gave her housekeeping tips for controlling the amount of lead dust settling on the surfaces of her home.

And, critically, they set the wheels in motion for having the lead paint problem corrected. Through Penquis CAP, the state sent a licensed lead inspector to their home to conduct extensive testing, which revealed multiple layers of lead paint on many surfaces. A consultant devised an “abatement design” to make the house lead-safe.

Agency staff helped the couple, whose income is modest, to file an application with MSHA for grant funding to help pay for the pricey project. They helped the family line up a certified lead abatement contractor to do the job.

The family has been awarded $16,000 for the project – the upper limit of MSHA’s capacity to fund a single project – and will pay another $1,200 or so out of pocket.

All Scott and Meg had to do was move all of their belongings into storage and their family out to the back yard for a few inconvenient weeks.

They said they feel lucky, but they are certain that most homeowners – and apparently, some doctors – don’t know enough about lead.

Lead-free with the CDC

The CDC has asked states to develop “lead elimination plans” with a goal of eliminating blood levels of 10 mcg/dl or greater among young children by 2010. Dora Mills at the Bureau of Health says there’s work to be done to get physicians on board with the need to screen all young children, at least with the verbal assessment tool.

Families concerned about the expense of making their home lead-safe should feel confident that the state would help them, she said.

But her “dream plan,” Mills said, is a shift in focus, away from screening and treating children and toward screening and treating their homes, before exposure to lead occurs.

“If we did that effectively,” Mills said, “we would dramatically reduce the incidence of lead poisoning.”