Getting the Lead Out

The tortillas looked bad -- unnaturally pale, with an odd, clammy texture -- but that didn't stop Houston toddler Angel Faz from grabbing one and gobbling it quickly before his mother tossed the rest into a dumpster. It was three years ago, and the pair was riding home after a family visit to Mexico. The tortilla, Orlanda Faz says, promptly gave her son a fever, cramps and diarrhea. To Orlanda, these were all symptoms of empacho, a stomach ailment well-known in Mexican folk culture. In Angel, the problem dragged on for two years, despite numerous visits to doctors. So Orlanda Faz returned to her hometown of Monterrey to pick up some of the empacho remedy that her grandmother used to dispense: a bright orange powder called greta. After returning to Houston, Orlanda fed Angel a spoonful of the medicine, flavoring it, as is the custom, with sugar and lard.

But what Angel Faz's mother fed him that day menaced more than his teeth or his cholesterol count; it also had the potential to threaten his life. That spoonful of greta was about 99 percent powdered lead.

Over the last few decades, as lead-lined pipes have been replaced and lead-based paints phased out, the problem of lead poisoning in the U.S. has been greatly reduced. But in areas such as Houston, at the same time that some sources of lead have been eliminated, others have cropped up to take their place. The problem has a unique dimension in the Hispanic community, where folk healers called curanderas are trusted as much as or more than doctors -- and commonly prescribe greta for stomach problems.

That, at least, is John Bremer's take on the situation. Bremer, an occupational health specialist for the Harris County Health Department, says that greta and similar remedies called azarcon, Maria Luisa, coral or rueda are "huge problems." According to the county health department, fully half the lead-exposed children they monitor have used greta, or other lead salts, as medicine. And in the past year, 30 of the roughly 100 children treated for lead poisoning at Ben Taub Hospital had been exposed to the folk remedies.

If you talk to representatives of the Houston Health Department, though, you'll hear that greta is no longer a major threat here. Tina Garcia, who serves as community educator in the city's three-year-old Childhood Lead Prevention Program, says lead-based paint is still the major problem. According to Garcia, of the more than 25,000 Houston children screened for lead since 1992, only seven to 12 were found to have high lead levels because of lead-based home remedies.

The difference in the way that the city and county view the greta problem is hard to understand, especially given that representatives of the Lead Prevention Program and the Harris County Health Department meet weekly at Ben Taub to go over what's happening in the fight against lead. Part of it may simply be a question of jurisdiction: within the city limits, where the housing stock is older, there's still more lead paint to worry about, and it's outside the city limits that much of the immigrant Mexican population has been settling.

Even if it's simply an issue of bureaucratic priorities, it's one that can have potentially serious results. Much of the information about lead for both the city and county comes out of the city's Lead Prevention Program. While the program has not ignored greta -- after receiving a statewide alert on greta in 1992, it distributed bilingual fliers at health fairs and alerted the media most likely to reach Hispanic audiences -- it has tended to underplay it. At least three school nurses in heavily Hispanic parts of town told the Press they'd never heard of greta. "I hadn't received any advisory about it," said nurse Linda Blakewood of Sanchez Elementary. "But I would certainly have it translated into Spanish if I had one."

Lead is an insidious toxin; unlike some other poisons, its effect isn't immediately clear. One of the main problems with lead poisoning, doctors say, is that its symptoms vary with each child and each dosage. While even relatively low levels of lead are linked to behavioral problems -- combativeness, a short attention span, perhaps a vocabulary too limited for a child's age group -- a parent can easily mistake these for personality quirks. And by the time a child starts showing more obvious symptoms, such as hearing loss, severe learning difficulties or disruptions in motor coordination, the lead in his or her system has likely caused irreparable damage. At its worst, lead poisoning can lead to mental retardation and even death.

Given this, it might seem simple to convince parents that feeding their children lead is a bad idea. But Bremer, for one, says that in the past year, the number of greta-exposed kids he's tracked actually rose. The problem is that greta is a long-trusted -- and even temporarily effective -- home remedy. And the people who use it can be hard to reach through traditional public education techniques such as pamphlets, health fairs and doctor's visits.

The quirky nature of greta use has made health agencies' jobs a tough one. Although U.S. health researchers have known about the remedy for more than a decade, it was only in the past three years that anyone studied it in Houston. Over the last few years, doctors nationwide began noticing higher lead levels in children, and Houston physicians started taking a new look at the issue. It was then that the federally funded Lead Program was born, and a lead clinic was established at Ben Taub to treat its referrals. Dr. Mark Hanfling, who's worked in the lead clinic since it opened, says that only then did he start noticing the children who maintained high lead levels even after they'd cut out all contact with lead paint, tainted water and the Mexican crockery whose lead glaze gives food a rich, sweetish flavor. Asked whether efforts to warn the Hispanic public about greta have worked in his time at the clinic, Hanfling gives an emphatic, "No." The warnings, he says, haven't been effective. And if the city of Houston has statistics showing that fewer people are claiming they're using the medicine, he'd be surprised. In his personal experience, says Hanfling, "There's nothing to suggest [that usage has dropped]."

One reason for that, simply enough, is that greta works, at least at first, and at least if taken as directed. Greta is powdered lead salt, and it comes from one major source: Mexican ceramic shops, where it's used to glaze pottery. Although no one knows who started using it for empacho, generations of Mexican families are now used to stopping at regional ceramic factories to buy bags of the substance.

Although it's illegal in the United States, smuggling in a baggie of greta is simple. An enterprising parent can also find it in flea markets, a few herb stores and the local curandera's. And while the treatment is akin to dropping a bomb on an ant, there's no doubt it partially works. It's not for nothing that the loyalty to the curandera tradition is so fierce: both its faith healing component and herbal remedies have an excellent track record, one in which the use of a toxic remedy is a distinct, if deadly, aberration.

"We're talking about a different world-view, a situation where people traditionally get their health care from curanderas," says Bremer. "They trust them; they go to them. And they get better. Then we come along and say no, no, no, you shouldn't do that. We have to build the level of trust in the community that the curandera has, and I don't think we can easily do that over the radio or television."

For a case of empacho, seasoned curanderas will estimate the body density of a patient before handing out a dose. They know that a judicious pinch of greta halts diarrhea, and a larger amount has a violent purging effect. But while adult bodies can rid themselves of small quantities of lead, even a few pinches of greta will linger inside a child. If it's not cleared out, or if it's augmented by other lead sources, it eventually makes its way to the brain.

For Angel Faz, today a shy four-year-old with doll-like brown eyes and a scab on his nose, the effects of lead intake won't be known for awhile. "I try to be an optimistic person, but I hope to God he will recover, that I didn't do anything permanent," his mother says. She has reason to worry -- a routine school blood test a few months ago showed Angel had 45 micrograms of lead per deciliter of his blood. Now, after treatment at Ben Taub, Angel's level hovers at 29. Anything above a level of ten is considered dangerous.

Today, it seems, for every parent who learns about greta and pitches it out like a bad batch of tortillas, another newly arrived or returning immigrant is somewhere on a bus, confidently carrying his own sack of lead powder. Sometimes he's on his way to Los Angeles, sometimes to Florida. Greta use even has been documented as far away as Wisconsin. But in part because of the city's aggressive screening techniques, the greatest number of greta users are showing up in Houston.

Last March, a two-paragraph report from the Harris County Health Department describing the situation here caught the eye of Texas Health Department epidemiologist Teresa Willis. The note mentioned only four greta-linked lead poisonings, but it was enough to make Willis wonder if the state was doing all it could to warn people of the consequences of greta. "If it's happening in Houston, [high greta use] could be happening elsewhere," Willis says. "It's really hard to know who's being tested, and if we're capturing all the events." To find out, this week she'll meet with several other divisions of the state health department to plot out wider-reaching public awareness strategies.

Key to her efforts will be reaching people such as Orlanda Faz, who lives in a far-flung North End barrio and has little contact with Anglo Houston. Although she's lived in Texas since she was nine, Faz mainly speaks Spanish. Her schooling stopped in the sixth grade, and when she watches TV, it's not the news she clicks to, but telenovelas.

Still, it was an announcement on Channel 45 that alerted Faz about greta, inspiring her to dump her remaining supply. That points to one of the advantages of education where greta and similar cures are concerned: unlike with some environmental toxins, exposure to this poison can easily be cut off if a family chooses to do so.

Standing near her small wooden house, surrounded by dozens of cans filled with begonias, Faz voices a pragmatism that may be health workers' best ally. Recalling her road trip to Monterrey to smuggle the greta, Faz observes, "When someone's sick and you think something will help them, you do whatever you have to.


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