KABWE, Zambia -- From the screaming children being tested for lead in this African city, to the clouds of toxic dust blown across soccer fields, streets and courtyards, this is one of the world's worst lead poisoning epidemics.
The lowest blood lead levels in nearly 300 children we tested in July were around 35 micrograms per deciliter -- six times above the acceptable level in the United States.
Many children tested above the limit of the electronic lead-testing machine we brought from the United States. These children should be treated in a hospital. But in Kabwe, toxic pollution has been a hidden legacy of mining and smelting lead.
This is not a story of numbers. It is a story of reduced intellect, neurological damage, inability to learn, stomach ailments and other problems.
"This is a public health crisis," said Professor Jack Caravanos of the CUNY School of Public Health at Hunter College in New York, who led an investigating team in July that tested children's blood and soil levels in Kabwe.
In crowded local clinics packed with anxious mothers and screaming children, his team found lead levels as much as 10 times above what is permissible in the United States.
"These are extraordinarily high levels not seen anywhere in the U.S. -- this poses an immediate threat to child health," said Caravanos, whose team was organized by the New York-based environmental group Blacksmith Institute, also known as Pure Earth.
"This is not fenced off -- it is right in front of their house where they play every day."
Peggy Na, 34, who brought her child to be tested, said children with lead "are not able to listen to what their parents advise."
One child showed how lead travels: he dropped candy on the floor and picked it up, wiping his hand across the dusty cement, and putting the sweet and his hand in his mouth.
The U.S. Centers for Disease Control lists 400 parts per million as the safe limit for lead in soil. But the Blacksmith team recorded hotspots up to 15,000 parts per million in areas where barefoot children played soccer.
Blacksmith Institute cited Kabwe in as one of the Top Ten Toxic Threats in its 2013 annual survey.
The World Bank in 2003 began a multi-million dollar effort to reduce and eliminate the damage from lead exposure in Kabwe. But the Bank admitted its project did not achieve its goals and once Bank funding ran out in 2011, lead levels that had begun to go down spiked back up.
Since finding the high lead levels this summer, Blacksmith is working with the World Bank to restart efforts to resolve the lead problem here, once and for all.
The source of the lead is clear -- a mothballed lead mine and smelter that operated for nearly 100 years until it shut down around 1990. It has left a legacy of toxic lead that is staggering.
Acres of tailings -- 50-foot tall hills of lead-rich mining wastes -- surround the old smelter and abut residential neighborhoods.
The mine may well reopen in the coming months. Zambia's exports depend on mining -- mainly copper but also lead, manganese, zinc and other minerals.
Gibson Chileshe, 62, was walking past the mine recently and said "some of us are against reopening production at the mine, but people want jobs." Many have registered to get a job if it reopens.
The World Bank, in its own internal report by Robert Mark Lacey, found that their project to end lead pollution failed. Some children's lead levels declined by a small amount for a short time. But when the project ended in 2011, there was a halt to the money, equipment, training, medicine, and nutritional supplements that block lead uptake.
"Unsatisfactory" was the rating given to the project by the Bank's Independent Evaluation Group.
Even the "Environment Public Information Centers" that counseled parents to wash their children's hands and wipe lead-rich dust off home floors and surfaces, "have scaled back their activated due to lack of funding," said the report.
And the milk and other nutritious foods supplied by the Bank project because they block lead from taking root in the human body have been ended. The Bank project ran out of money but Kabwe, a city of more than 200,000 people, remains choc-a-block full of toxic lead.
In fact, there is not even a single facility in Kabwe that can test blood for lead. Pediatric nurses at the city's leading hospital told me they must send blood samples to the capital Lusaka, a two hour drive to the south, to test for lead. (The nurses spoke without authorization so the name of their hospital is not being published.)
Lead is known to damage the intellectual capacity of children. One education official in Kabwe said that there are many children who cannot learn. "We tell them something and the next day they return and do not remember it," he said.
Teachers at the David Ramusho elementary and middle school said they don't know which students have high lead problems since no testing is done. When it was available, results were kept private. But they know many of the 3,000 boys and girls in neat blue uniforms have lead.
The teachers said that high-lead children have no appetite, are moody but not aggressive, have slim bodies and often have ringworm.
Lead also makes some children wild and un-controllable -- a finding that was first reported by Dr. Herbert Needleman in the 1980s. Needleman's work in Boston led to a U.S. ban -- over strong industry objections -- on lead in gasoline and paint - two steps that led to the steep decline in lead levels for millions of American children.
Some children respond to high lead by being depressed and sullen, said Kabwe residents.
The Ramusho School head teacher Lackson Mwanza said "dealing with lead will help improve mental capacity of the children."
And the pediatric nurses noted that lead may be the cause of a condition so serious it was posted on the wall of their office: "flaccid (floppy) paralysis" whose symptoms are "weakness, frequent falls, gait disturbance, cannot walk."
The nurses also are unable to provide chelation -- a somewhat risky method of using medicine to displace lead when levels are dangerously high.
"Especially in the rainy season, after the rains, we see white stuff come out of the ground that we think is lead," said one nurse.
"All the people in Kabwe are affected by lead," said the nurse. She noted that youngsters now 16 to 18 years old may also be damaged by lead but there is no way to test them.
Lead poisoning is often a silent disease -- symptoms can be subtle such as degraded ability to learn, stomach upsets and other less-than-catastrophic effects.
So people continue to build houses near the mine, literally in the shadow of the towering slag piles. In Makalulu and other neighborhoods where thousands of children and adults lack resources to relocate, health teams told parents to prevent the children from playing outside. This has been inadequate and ineffective.
"This is a public health crisis -- these are the highest blood lead readings I have ever seen," said Caravanos.
"Part of the population has acute lead poisoning, above the level that causes mental impairment."
A teacher in Kabwe, Wisdom Kuanda, wrote in a letter to the Zambia Daily Mail July 23 that "Kabwe is indeed one of the 10 most polluted towns in the world."
"As a teacher I have observed poor memory retention in most of the pupils who were born in Kabwe as compared to those who just come on transfer. I have personally linked this problem to lead poisoning."
People are so poor in Kabwe that they had resorted to taking the lead tailings into their houses to try and extract some lead for sale.
Possible solutions to the lead threat include: recover lead from slag heaps; remove or cover the slag piles; remove or cover soil at toxic hotspots; relocate the people living in the most polluted areas adjacent to slag runoff; provide nutrition and health care to affected children and adults.
Until some solution is found, the children of Kabwe will continue to pay the price.
note: Ben Barber is a communications advisor to Blacksmith Institute.