Doctors to be educated on nitrates in Lower Valley water

Yakima Herald-RepublicJune 15, 2014 

— Federal environmental health experts and a team of pediatricians from the University of Washington will arrive in the Yakima Valley this summer to train local health care providers in recognizing the health hazards associated with nitrate contamination in groundwater.

High levels of nitrates in the water can cause health problems, especially for pregnant women and young children. Given the large population in the Lower Valley dependent on well water, health officials are anxious to prevent future problems by educating local doctors and, by extension, their patients.

“This is a complicated topic — you can’t see nitrates, you can’t smell them, you can’t taste them in your drinking water,” said Tom Eaton, director of the Washington Operations Office for the Environmental Protection Agency, Region 10. “We have been working with the county for quite a while on education programs.”

EPA is partnering with the Pediatric Environmental Health Specialty Unit (PEHSU) at the UW to provide the technical training. Exact dates and the size and duration of the training sessions have not yet been determined, Eaton said. The Northwest PEHSU is based in the School of Medicine and the School of Public Health at the UW and serves Washington, Oregon, Alaska and Idaho.

Dr. Catherine Karr, professor of pediatrics at the UW and director of the PEHSU, said medical school training does not typically prepare health care providers to deal with environmental health issues, making a joint outreach with EPA a rare opportunity to reach an audience that’s dealing with a variety of health concerns, from nitrate contamination to asthma and pesticides.

“I don’t get that many opportunities to sit down with health care providers in the Yakima Valley, so we will take the opportunity to talk about other important environmental concerns in the area,” said Karr, who is conducting research on asthma in the Valley.

While the specific educational material has not been nailed down, the training is meant to put nitrate-related health concerns higher on the radar, so health care providers are more aware of who is at risk, how to recognize symptoms and how to treat patients.

The health risks posed by nitrate-contaminated water can be extreme. Blue baby syndrome, the common name for “methaemoglobinemia,” occurs mainly in newborns up to 4 months old who are exposed to high levels of nitrates. The nitrates decrease the capacity of the body’s red blood cells to carry oxygen, which, in the more severe cases, cause babies’ skin to show a bluish-brownish color around the hands, feet and mouth.

Affected children may also have trouble breathing and experience vomiting and diarrhea, according to the World Health Organization. In extreme cases, there is significant lethargy, an increase in the production of saliva, loss of consciousness and seizures. Some cases may be fatal.

Other health effects following fetal exposure to elevated levels of nitrates in drinking water include a slowing of intrauterine growth, increased incidence of Sudden Infant Death Syndrome, cardiac defects and increased risk of nervous system defects, according to a toxicity summary by EPA.

With darker-skinned babies, the blue color may be harder to detect, so parents and providers within the Latino community need to be especially vigilant, said Carol Taylor, a supervisor and dietician with Yakima Valley Farm Workers WIC clinic in Grandview, which works to educate and support mothers and young children.

“At WIC, we ask all our clients: How do you drink your water? Is it bottled; is it filtered; do you have a well?” Taylor said. “It’s important for pregnant women; some studies have shown higher rates of spontaneous abortions or certain defects for women with higher rates of nitrates in the water.”

Concern about nitrates has come up in discussions of the Valley’s unusually high rates of anencephaly, a fatal neural tube defect.

Not much research exists on the topic, but some studies have shown a connection between nitrate contamination and increased rates of the defect.

Municipal water systems are regularly tested for nitrates and other contaminants; federal regulations mandate that nitrate levels be under 10 milligrams per liter for drinking water to be considered safe. For residents on private wells, however, the onus for testing is on the homeowner or landlord.

EPA has concluded that the major sources of nitrate pollution are the overapplication of cow manure by dairies on crop fields, commercial fertilizer, failing septic tanks and drain fields, and use of sludge and other biosolids on cropland. Those sources, combined with often-shallow wells, mean as many as 20 percent of the wells relied upon for drinking water in the Lower Valley are contaminated, according to the EPA.

Programs that offer free well-water testing, such as one that the Yakima Health District held over the past two months, aren’t utilized as much as health officials would like, so officials view the training as another way to raise awareness in the community.

The EPA/PEHSU training project was inspired by a “New Mom” nitrate education initiative from the education and public outreach committee in the Lower Valley Groundwater Management Area (GWMA). Materials explaining various nitrate risks have not yet been approved by the committee, but the EPA training is separate and will move forward without needing approval.

Margo Young, with the EPA’s Children’s Health program in Region 10, said the goal of the training this summer is to use their partners in the local health care community because they have established trust with patients and will be the ones to care for them if health problems arise.

“It’s just going to be an ongoing challenge that we just need to stick with it, and do it over the long term and not think that a one-shot education program is going to be good enough,” Young said.

“It’s probably a job that, as long as there are groundwater contamination problems there, it’s one we should continue to do.”

Editor's note: Dr. Catherine Karr's name has been corrected

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