Leaden hearts

Six-year-old Taaraz Tashdeed Khan loves to get tucked into his mother's lap. Running fingers into his curly, black hair, his mother lets out a sigh that the child has not called her "ma" yet.

But, Taaraz has his own way of expressing emotions for his mother. Every day, he cleans a photo of his where he, a toddler Taaraz, is wrapped in his mother's arms. The photo and its frame have already got a worn-out look as he rubs off the colours after every wash.

"This one is his favourite," said Farhana Islam, Taaraz's mother, explaining why the photo frame had been kept above a shelf out of the reach of the child.

There is another motive. Taaraz may feel incited to speak to demand the photo. For the same reason, all his favourite toys are displayed at the top of a rack in his room.

Taaraz spoke on so rare occasions that Farhana recalls them as fleeting moments of something unbelievable.

"Once we were standing for a car probably in Malaysia… All on a sudden, he called out 'car'. The pronunciation was very clear but that was it."

The child has been going through treatment since September last year to flush out lead from his body. The heavy metal is to take the blame for a delay in development of his brain's frontal lobe that controls speech and expression of emotions among other cognitive skills.

Taaraz has begun to demonstrate good results and is expected to gain the ability to speak as he receives injections flown in from Singapore.

His condition is called lead toxicity. An excess amount of lead in the body impairs growth of intelligence and learning abilities and may have visible signs like weight loss, seizures and abdominal pain.

How much of the metal would be a threat for a person or a child depends highly on how his health reacts to it. This is why researchers say no amount of lead is safe. In children, development disorders and behavioural problems may occur at relatively low levels.

Environmental pollution and unregulated disposal of industrial waste could result in an infusion of lead into our food cycle and thus into our bodies.

However, this health concern remains still unaddressed in Bangladesh due to a lack of scope for diagnosis and awareness among physicians, according to experts.

Agonising days of a mother

And even if a parent like Farhana Islam, by any chance, digs out the root cause behind her child's suppressed growth, there is no way to get the treatment in the country.

Farhana, who herself is a doctor, was unaware of her son's condition until he was four. Living away from home in Indonesia for her husband's job, she was getting more and more alarmed when the child fell behind the developmental milestones in terms of communication, picking up words and expressing emotions.

Doctors here and abroad ruled out the possibility of Taaraz's autism and, instead, suggested them to share more time with the child.

Farhana dedicated all her time and attention to her son alone. But, there was no sign of change.

Taaraz's symptoms put forth lots of questions before her. She was tormented as she found no answer to them. Time elapsed but Farhana was at sixes and sevens on how to solve that puzzle.

Then internet and a friend came to her help from where she learnt about the impacts of heavy metals like lead and mercury on children.

Taaraz was taken to Bangkok where a mineral test of his hair confirmed for the first time that he had a toxic level of lead in his body.

Thai physicians did not prescribe any treatment for him other than a specific diet, socialisation, more mother-son interaction and pre-schooling to follow.

It was after insistence of an educator at a chain specialised school in Indonesia that Farhana flew to Singapore with Taaraz and got his blood tested.

The results showed the lead level in Taaraz's blood at 3.3 micrograms per decilitre while it should not cross two micrograms per decilitre, according to the report.

This time, doctors recommended a chelation therapy in which oral or intravenous medicines are administered to remove toxic metals from the body.

Taaraz takes injections every week in the process of speeding up his recovery from the damages inflicted by lead. It is a cycle of his getting cranky, aggressive, calming down and then preparing for another dose.

Watching the child going through such a medication cycle regularly is quite aching, but Farhana has accepted it. Because, she is hopeful of her child's recovery as she can see changes in him which seemed a miracle even a few months back.

The boy now responds to calls or instructions, takes interest in toys and mingles with other children, Farhana said.

Taaraz is not the only child suffering from lead poisoning.

A study done between 2016 and 2017 found that 55.1 percent children receiving treatment at Dhaka Shishu Hospital and Bangabandhu Sheikh Mujib Medical University bore toxic level of lead – at or above five micrograms per decilitre – in their blood.

The blood samples were tested at Atomic Energy Commission to quantify the amount of lead in them. Because anywhere else in the country, there are no diagnostic facilities that can measure lead in blood or other body tissues.

The children aged eight and above, who were covered in the study, were all physically fit and did not have any chronic or communicable diseases. But, they were at risk of developmental delays, deficits in behavioural functioning and diminished hearing acuity.

"A continued close observation of the children would have helped us to understand the impact of the toxic metal on their physical and psychological being," said Kinkar Ghosh, an epidemiologist of the Shishu Hospital and one of the two researchers who conducted the study.

A shortage in funds did not let them expand their work to reach a substantive conclusion over lead toxicity in children, he added.

Another study in 2018 found that more than 85 percent of nearly 400 children in Munshiganj had lead concentration in blood above the reference level [5 micrograms per decilitre] issued by the United States Centre for Disease Control and Prevention. The children were all between two and three years.

Who or what the sources are

How these children got lead in their bodies remains largely unexplored. But a big contributor was their mother.

A pregnant woman passes on lead to her child, which has been accumulated in her body over the years or even decades. Therefore, the adverse impact of lead toxicity on the child is greater than that on the woman.

The research in Dhaka pointed out two contributors of lead toxicity – industrial areas and truck or bus stands. Nearly 33 percent children with toxic levels of lead lived in and around industrial areas compared to 18 percent in non-industrial areas.

Again, about 37 percent children living close to truck or bus stands in the capital had an alarming level of lead in blood whereas children with a similar condition from other areas constituted 18 percent.

Children in rural areas also face the threat of lead poisoning.

One of the major factors might be lead acid batteries. Researchers and experts expressed concern that the rising use of batteries in rickshaws and "easybikes" outside Dhaka might give rise to lead contamination in air, water and soil.

A recent report by The Business Standard also shed light on the severity of the situation. About 20,000 tonnes of lead acid batteries are recycled every month, and hundreds of clandestine and illegal recycling plants are being operated across the country with least regard for environmental safety. 

More research would help to unravel the gravity of lead toxicity; how lead is creeping into our food cycle and how harmfully it influences neurological development, said Prof Sharfuddin Ahmed from the community ophthalmology department at BSMMU and the other researcher of the study conducted in Dhaka.

Bangladeshi children are worse off in Asia

An observation about Bangladeshi children compared to other Asian children by a Canadian expert paints a grimmer picture.

Dino Trakakis, who has been working for two decades in Asia providing educational therapies to children with autism, said one of the major factors behind autism is lead toxicity, and the condition of the children here is worse than that in other Asian countries.

He has been closely working with a school for special children in Gulshan named Inner Circle for three years by providing training to the staff and supervising the programmes. Taaraz is a student there.

"The children are suffering because they live in the most toxic environment in the world," Dino said.

Explaining how lead can hamper intellectual growth, he said, "For every microgram of lead in your body, you lose 10 IQ points. After seven years, that IQ loss becomes permanent."

With the reduced intellectual ability, children will be able to live their life but without reaching their potential.

That is where children need help. Biomedical intervention coupled with educational therapies can reverse the toxic effects to the extent that some children recuperate fully, Dino said.

A child will have the best chance to get rid of toxic effects at the age between two and four years, he said, adding that children suffering from lead poisoning with or without autism, like Taaraz, would be able to reap benefits of treatment and therapies at a later age as well.

That is the answer Farhana, the mother of Taaraz, had been looking for all along. The family has been undergoing a financial drain by the expensive treatment that has cost around $14,000-15,000 so far, but the mother is happy that she has got a solution.

Taaraz has recently started attending a normal school and has been enjoying classes too. There are more developments to see as his treatment promises.