Lab Matters Winter 2019 - Page 14

ENVIRONMENTAL HEALTH Indiana Strategizes with Partners to Protect Vulnerable from Private Well Water Risks by Mary Hagerman, MS, chemistry division director, Indiana State Department of Health (ISDH) Laboratories and Sarah Wright, MS, manager, Environmental Laboratories Featured on the agenda were two nationally-known experts on the relationship between well water and health. Steve Wilson, an expert on private wells, explained the importance of health professionals in promoting water testing. Dr. Susan Buchanan, director of the Great Lakes Center for Children’s Environmental Health in Chicago, discussed children as “the canaries in the coal mine” of environmental health and addressed the effects of contaminant exposures in pregnancy and early childhood. In 2014, APHL partnered with the US Centers for Disease Control and Prevention (CDC) National Center for Environmental Health Environmental Hazards and Health Effects Division to provide funding for laboratories to develop and host a meeting of their environmental health system partners. In fall 2017, APHL issued a request for proposal for laboratories to apply for up to $15,000 for meeting support. Indiana was a funding recipient and hosted its meeting in October 2018. Indiana has over 600,000 private, unregulated wells used for drinking water, and most are not tested to determine if the water is safe. Arsenic is estimated to be found in more than 10 percent of private drinking water wells in the state with levels in excess of the US Environmental Protection Agency (US EPA) Safe Drinking Water Act limit of 10 µg/L. Maternal arsenic exposure has been linked to gestational diabetes, lower infant birth weights and infant mortality. In light of the high prevalence of naturally-occurring arsenic in Indiana’s well water, the Indiana State Department of Health (ISDH) laboratory was concerned about exposure of expectant mothers and small children to untested and untreated drinking water. Were healthcare providers asking expectant or new mothers about their drinking water source? Were clinicians recommending well water testing? From Meeting to Action The Indiana Public Health Laboratory For organizations planning similar events, the ISDH laboratory recommends early budgeting and partnership with a medical organization to secure continuing medical education (CME) units, which are expensive and time-consuming to obtain. In contrast, nursing continuing education units proved to be relatively easy to obtain and an incentive to participation. ISDH staff decided they needed answers. With APHL meeting support, the laboratory planned a meeting that brought together environmental health laboratory scientists, environmental health specialists and clinicians—public health nurses, OB/GYNs, pediatricians and others—to discuss actions to protect mothers and young children from the effects of contaminated well water. 12 LAB MATTERS Winter 2019 The meeting demonstrated the value of laboratory outreach to the environmental health community, and notably to clinicians. Participants contributed creative ways to reach mothers with information on well water testing. For example, they suggested that information be included on immunization schedules for young children and obstetricians’ checklist for safe pregnancy. The ISDH laboratory will pursue these leads with support from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Indiana section of the American Congress of Obstetricians and Gynecologists (ACOG). The ISDH laboratory is now working with the Indiana Health Commissioner to explore how the state can enlist pediatricians to promote well water testing for mothers and young children, thereby becoming a model for other states. Other plans include 1) an update to Indiana’s pregnancy mobile phone app to allow users to find recommended well water tests and testing schedules, certified laboratories and information on treatment of unsafe well water, and 2) a regular meeting of state environmental health representatives with private well water issues on the agenda. n PublicHealthLabs @APHL