Mercury poisoning - Indonesia

Indonesia's gold mines are causing birth defects. More than a million small-scale miners in this island nation are poisoned, which is leaving children with crippling birth defects. Child "I" is 16 months old and suffering his 3rd seizure of the morning. His head is too large for his body, and his legs are as thin as sticks. He arches his back, and his limbs stiffen. He cries out in pain. His mother tries to comfort Child "I," but there's not much she can do. A dukun, or shaman, says his soul was invaded by the spirits of the monkey, bat, and octopus. On his advice, the mother and her husband, changed the boy's name from "Child I one" to "Child I" and fed him tiny rice balls mixed with octopus. "The dukun says this is why Child I's legs look like a monkey's legs," his father says. "Actually, I don't believe that, but I will try anything." Doctors say the real culprit is more down to earth: mercury poisoning. His parents are small-scale miners who used the heavy metal to process gold for years before "Child I" was born, including while his mother was pregnant. Millions of people in 70 countries across Asia, Africa, and South America have been exposed to high levels of mercury as small-scale mining has proliferated over the past decade. The United Nations Environment Programme estimates that at least 10 million miners, including at least 4 million women and children, are working in small "artisanal" gold mines, which produce as much as 15 percent of the world's gold. More than a million miners scratch out an illegal living digging for gold in at least 850 hot spots, says Yuyun Ismawati, a 2009 winner of the Goldman Environmental Prize who has conducted extensive research on small-scale mining. Many of them fall prey to corrupt authorities who take a share of the gold rather than enforcing a law that bans mercury use. Indonesia, an archipelago of 17 500 islands with the world's 4th largest population, has one of the worst mercury problems, according to Stephan Bose-O'Reilly, a children's health expert who volunteers at the Indonesian environmental group BaliFokus Foundation. "Indonesia is a real global hot spot," Bose-O'Reilly said during a recent trip to Indonesia examine miners in the gold fields. "I haven't seen anything worse than here." "Child I" is one of at least 46 suspected victims of mercury poisoning identified by doctors in impoverished southwestern Lombok, a tourist island next to Bali. Another 131 people with mercury poisoning have been found on the islands of Java, Lombok, and Sulawesi, according to Ismawati. Many more victims likely remain undiscovered in remote villages across Indonesia. Nationwide, Ismawati estimates that 100 000 to 200 000 people are suffering from mercury poisoning and another 10 000 to 20 000 children have birth defects from exposure in the womb. Some of the miners heat mercury in their kitchens, where the vapors can reach concentrations that are quadruple the amounts considered safe under World Health Organization standards. High doses of mercury, which is a neurological poison, are a well-documented cause of birth defects, including crippling deformities and nervous system disorders. The most notorious episode of mercury poisoning occurred in Japan in the 1950s when a factory dumped the heavy metal into Minamata Bay. More than 2000 people were poisoned by the bay's seafood, killing some, and dozens of children suffered severe birth defects. [Cats on the dock who ate the fish scraps were some of the 1st victims and unintentionally became the sentinel in the 1950's incident. - Mod.TG] In Indonesia, child labor is common in the gold fields, with boys as young as 8 digging the ore and as young as 12 burning the mercury-gold amalgam. "Youth M" 14, who lives in the West Lombok village of Luang Baluk, says he began torching mercury 2 years ago. "I burn the amalgam 2 or 3 times a week," he says. "I never wear protective clothing." The smoke, he says, simply "disappears." Doctors have identified 24 children in mining villages in the Sekotong district in southwestern West Lombok with birth defects or ailments caused by mercury. Among them is "Baby L", who was born in September [2015?] without a left hand. Like "Child I", she suffers frequent seizures. Six-year-old "Child A" was born with deformed fingers on both hands. "Child N", who suffered from an enlarged skull and other serious deformities, died earlier this year [2016] at the age of 8. She was in a near-vegetative state all her life. "Mercury vapor is very toxic to the brain, especially during development, and exposures may therefore be detrimental to pregnant women and small children," says Harvard environmental health professor Philippe Grandjean, one of the world's leading experts on the effects of mercury exposure. Small-scale gold mining began to take hold in Indonesia after the 1998 fall of Suharto, its longtime military ruler, and has flourished in an ensuing era of lax governance. Nearly all artisanal miners use mercury to extract gold, even though the practice has been banned by the government since 2014. Indonesia's small-scale miners produce 5 billion dollars in gold a year, according to Atmadji Sumarkidjo, special assistant to Luhut Pandjaitan, coordinating minister for security and political affairs. That's about 7 percent of the country's total gold production. Indonesia's gross domestic product was about USD 873 billion in 2015. Miners have released hundreds of tons of mercury into the water, soil, and air, often in poor, remote areas, contaminating food and wildlife. In some villages, families use mercury-laced mine waste as the foundation for their homes or to surface their yards and walkways. [It is likely cheap and an available material for building. - Mod.TG] In the central Java regency of Wonogiri, where small-scale gold miners have operated for more than 15 years, residents were alarmed 2 years ago when the local environmental agency tested guavas, cassavas, papayas, and bananas grown in the area and found them to be highly contaminated with mercury. "Children in the mining areas have been exposed to mercury since they were in the womb, and some are born with deformities," Ismawati says. "When they grow up, they inhale contaminated air, drink contaminated water, and eat contaminated rice." Miners flock to newly discovered gold fields in Indonesia, often in national parks or on other public land, where they operate without required permits. They dig deep mine shafts, dredge rivers, destroy forests, and poison the environment. Stephan Bose-O'Reilly, a pediatrician and environmental health expert, examines 2-year-old "Child R", who lives in the village of Cisitu, for symptoms of mercury poisoning. "Child R" was in good health until his 3rd month when he began losing motor control. "Child R's" mother, who lived in Cisungsang, a nearby mining community, said her home there was surrounded by gold processing centers. Mercury poisoning is "a serious health problem" for children in Indonesia, Bose-O'Reilly says. [caption for a photograph] Noisy tumblers known as ball mills operate almost continually in mining communities, often next to homes, grinding the ore along with mercury and water to extract the gold. As the tumblers rattle and spin, the rock breaks down and flecks of gold bind to the mercury. Afterwards, the miners drain off the liquid and recover some excess mercury, but much of it becomes vapor and pollutes the air or flows onto the ground and into waterways. In the final stage of extracting the gold, the miners typically heat their mercury and gold with a blowtorch, sending poisonous mercury vapors into the air. Inhaling the vapors produced by burning the amalgam is the most dangerous form of exposure, doctors say. "Adult P", 67, lives with his family in the placid hills of Wonogiri in a wooden, Javanese-style house with a high peaked roof and a large living area. The family has tunneled about 50 feet into the hillside below the house to find ore, which they process with mercury in their ball mill in the garden. After many hours of labor, "Adult P" has produced a small lump of mercury and gold, which he takes to the kitchen at the far end of the house. The room has a dirt floor, woven bamboo walls and a rudimentary woodstove with no chimney. Two large pots of soup simmer on the fire at midafternoon. "Adult P" brings out a piece of pipe, which is about 18 inches long and closed at one end. He slips the mercury-gold amalgam into the sealed end of the pipe and places it in the fire. He rests the other end of the pipe in a small dish of water on the floor. His daughter, "Adult Y", 33, and grandson, "Child G", 9, squat nearby to watch. As the pipe heats up, the mercury melts and most of it flows into the dish. But some evaporates, and the fumes escape into the room. Krishna Zaki, of the group BaliFokus, has lugged a portable vapor analyzer into the kitchen and tests the air. He detects about 4000 nanograms (ng) of mercury per cubic meter, 4 times the World Health Organization's safety threshold of 1000 ng. Ismawati immediately tells the family members that the air in the kitchen is unsafe, so they should all go outside. But none of them -- including the child -- heed her advice. When the process is complete, "Adult P" retrieves a hot 2-gram pellet of gold, which he can sell for the equivalent of about USD 75. Outside, "Adult P's" wife, "Adult D", 55, has been complaining of headaches and difficulty breathing. Ismawati gives her simple coordination tests, including touching her nose with her finger and moving her wrists simultaneously. She does poorly, and Ismawati recommends she get tested for mercury exposure. "Adult D" is shocked. She and her husband had no idea mercury was harmful. "Now I know," "Adult P" laments. "But before today I didn't know, and I cooked the mercury in the kitchen." Inside a bamboo hut in Rau-Rau, a small girl named "Child D" lies rigid on the bare bamboo-slat floor. The girl's bone-thin legs convulse, drawing up, then stretching out reflexively. Her feet are pointed and trembling. "Child D" is a victim of neurological and physical abnormalities that afflict people in parts of Sulawesi where small-scale gold mining is common. Her mother, "Adult K", 43, says "Child D" was a normal little girl until she was about 3 years old. Then she began to have trouble walking, and suffered seizures. Doctors couldn't figure out what was wrong with "Child D", and, her mother said, offered nothing to help her. When "Child D" was 7, her symptoms suddenly worsened. She lost control of her arms and legs. Her limbs contorted and became rigid. Her hands and fingers curled shut. She stopped talking. And still no one, "Adult K" says, knew what was wrong with her daughter. Doctors say these symptoms are associated with exposure to mercury. They suspect that she suffered mercury intoxication after she was born. She died in August [2015?]. Since Roman times, when slaves worked the cinnabar mines, mercury has been known to cause a wide range of symptoms, including headaches, tremors, drooling, difficulty walking, and eventually, death. But mercury poisoning can be difficult to diagnose because it has many symptoms in common with other ailments. The extent of mercury-related health problems in Indonesia is only now emerging as BaliFokus, volunteer doctors, and a few government officials search out victims and test for mercury in the air, food, homes, and water. Erick Gunawan, a public health service doctor in Sekotong on Lombok island, has held 2 screenings in mining communities with BaliFokus's help and found dozens of potential mercury victims. He believes there are many more who have been poisoned and hopes to hold more screenings. "It's like an iceberg," he says. "You only see what's on top, but you can't see what's below." -- Communicated by: ProMED-mail <promed@promedmail.org> [There are 3 forms of mercury: elemental mercury, inorganic mercury, and organic mercury. Elemental mercury is also known as metallic mercury, liquid mercury, liquid silver, and quicksilver and is an extremely heavy, odorless, silver-colored liquid. Mercury exists as a natural element in the earth's crust. Since this is the most likely form of mercury to which these children were exposed, this comment is confined to the toxicity of elemental mercury. There are several sources of elemental mercury in the home, including broken mercury thermometers, broken fluorescent light bulbs, dental amalgam fillings, mercury-containing latex paints, extraction of gold from ore using mercury, and contaminated clothing from workers in thermometer-making plants. Elemental mercury is also used as a Mexican folk medicine to treat "empacho," a chronic stomach disorder. Elemental mercury is the most commonly swallowed form of mercury, usually from a broken thermometer. Fortunately, elemental mercury is not absorbed from the stomach and will not cause any poisoning in a healthy person. The swallowed mercury is slippery, and will roll into the stomach, out into the bowels, and will be quickly eliminated without causing any symptoms. However, if the person has severe inflammatory bowel disease or a fistula (hole or opening) in their intestine, problems may result if the mercury is not all cleared out, resulting in prolonged exposure. Handling liquid mercury for a very short period of time usually does not result in any problems. An allergic rash is possible. Mercury is not well-absorbed through the skin, so skin contact is not likely to cause mercury poisoning, especially with a brief one-time exposure. Even if a person has cuts in the skin, mercury is too heavy to be contained by a cut. Merely washing the wound well will remove the mercury. Inhalation of elemental mercury vapors is the main cause of toxicity, as mercury is well-absorbed through the lungs. Problems from inhalation result either from a large one-time exposure or a long-term exposure. A small, one-time exposure is not likely to cause problems. The lungs are the primary target organ following a large, one-time inhalation exposure of mercury vapor. Other signs and symptoms may develop as well. Clinical signs develop within a few hours and include chills, metallic taste, mouth sores, swollen gums, nausea, vomiting, abdominal pain, diarrhea, headache, weakness, confusion, shortness of breath, cough, chest tightness, bronchitis, pneumonia and kidney damage. Long-term exposure of inhaled vapors is generally more dangerous, with the nervous system being the primary target organ of toxicity. Symptoms may occur within weeks but usually develop insidiously over a period of years. Neurologic symptoms include tremors, headaches, short-term memory loss, incoordination, weakness, loss of appetite, altered sense of taste and smell, numbness and tingling in the hands and feet, insomnia, and excessive sweating. Psychiatric effects are also seen after long-term exposure. Acrodynia (painful extremities) can result from repeated exposures to mercury-containing latex paint fumes. Acrodynia is usually seen in younger children. The symptoms include chills, sweating, body rash, irritability, sleeplessness, leg cramps, swelling of the cheeks, nose, hands and feet, light sensitivity in the eyes, and peeling skin layers on the palms of the hands and soles of the feet. People are regularly exposed to all 3 types of mercury, although the organic type is the most likely to cause adverse health effects because of its tendency to build up in the body. Mercury vapor is very dangerous. Symptoms of mercury poisoning are progressive. The 1st stage is paresthesia distinguished by a tingling or numb sensation in the fingers, toes, and face. Paresthesia may be followed by difficulty walking and speaking, impaired vision and hearing, fatigue and weakness, headache and trouble concentrating, and tremors. Methods of detoxification or treatment are limited. In this particular case, awareness of what mercury does and instituting safety procedures seem paramount. It would appear that a lot of education is needed.