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Shoalwaters' 'catastrophe' confirmed
Tribe gets grants to study miscarriages
Monday, March 6, 2000
By PAUL SHUKOVSKY
TOKELAND -- Government scientists have confirmed what the frightened band of Indians living here already knew: Their babies are dying in the womb at an alarming rate, and nobody knows why.
Epidemiologists from the federal Centers for Disease Control and Prevention descended a year ago on this impoverished, southwest Washington reservation where the Tokeland Peninsula points into the Pacific Ocean. Their report, released last week by the tribe to the Seattle Post-Intelligencer, pegs the Shoalwater Bay Tribe's miscarriage rate at a stunning 50 percent to 67 percent.
The government has given the Shoalwaters a few hundred thousand dollars in grants and left it up to them to find out what is killing their future.
"It is frustrating that after seven years, all we get is a CDC report that says we've got a problem," said Herbert "Ike" Whitish, chairman of the 200-member tribe. "I don't know how much more of a catastrophic situation it could be."
Calls for comment to a lead member of the CDC team were not returned.
But the cause has remained a mystery, and the clinic has made no apparent difference in the fetal death rate. Of nine pregnancies on the reservation during the study period of 1997-98, six ended in miscarriage, according to the CDC.
And the bad news may not be limited to the tribe.
Neighbors at risk
In Pacific County, where the Shoalwater reservation is located, there is concern that the high miscarriage rate might be a countywide problem. The concern, based on years of anecdotal reports, has led the county and state health departments to begin a special tracking program there this month.
Health professionals who provide obstetric care to Pacific County women are being contacted and asked to provide information beyond fetal death certificates without identifying the patients involved.
That surrounding white populations might be at risk makes Whitish seem prescient.
Whitish has often said the Shoalwaters "are like the canary in the cage" carried by coal miners of old to warn if the air in the mine shafts turns toxic.
Although no one knows why the tribe's future is dying in the womb, many people assume there are environmental causes.
For example, "everybody around here eats a lot of shellfish," Whitish said. "But nobody is willing to make that leap from ingesting shellfish to an adverse outcome."
Whitish is not saying the mollusks are the cause, just one of many factors that should be investigated.
"It's going to take a cooperative look by everyone in this area to find out what is going on. Putting chemicals into this environment is not good for any of us."
One of the CDC's recommendations is that the tribe evaluate any "preventable genetic or environmental components" to the miscarriage crisis. The tribe last week applied for a $600,000 grant from the federal Department of Health and Human Services to undertake an extensive program of environmental testing around the reservation.
"If there is something out there, let's find it," said Gary Burns, the tribe's environmental director. "If there isn't, let's put it to rest so people can get on with their lives."
The fear that environmental toxins might be responsible for the health crisis is widespread.
Traumatic pregnancies
Kim Zillyett, who has had two miscarriages, is pregnant again. Due in May, she said she "didn't eat or drink anything" near the reservation the first months of her pregnancy.
Zillyett, like many people on the reservation, is traumatized by the plague of miscarriages.
"What a lot of people don't understand is when a woman becomes pregnant, not only does her body change, she changes emotionally, physically and spiritually," she said. "When you get pregnant, you feel this sense of success. When a woman who is pregnant suddenly loses this being that is inside her, she -- or at least I -- felt a sense of shame. Why couldn't I carry this baby? What is wrong with me? I felt I had let down my husband as well."
Though most miscarriages happen early in pregnancy and Zillyett is now carrying a viable fetus, she is still scared. In her two miscarriages, she had lived a healthy lifestyle.
"I take care of myself -- no drinking, no drugs."
The Shoalwaters have convened a committee of health care advisers that include scientists and medical professionals from the Indian Health Service, the University of Washington, the state departments of Health and Ecology, and the U.S. Environmental Protection Agency.
The committee suggested that the Shoalwaters create a tissue bank and collect saliva samples so that tests can be run to determine the presence of environmental toxins and hormone levels. It is an open question whether there will be enough money to conduct such tests, Whitish said.
The first priority for the money the tribe does have is to create a high-risk pregnancy program that will ensure that all pregnant woman get the best possible prenatal care, Whitish and Taylor said.
The CDC also recommended that the tribe closely track pregnancies, in part to get better data on the number of miscarriages.
That is more difficult than it sounds because women who have miscarriages frequently mistake it for a late menstrual period because they do not know they are pregnant, said Dr. Angela Zechmann, a Department of Health epidemiologist.
Zechmann said the state collects information from fetal death certificates that are filed only after the 19th week of a pregnancy. No data are collected on miscarriages in the first trimester, when they are far more common.
"We don't have a standardized way to collect information on miscarriages," she said.
A healthy baby
At the Shoalwater Tribal Center, 10-month-old Kaylee Shipman is treated like a princess.
"It is like she is everybody's baby," said her mother, Lisa. As grateful as she is to have a healthy, happy baby, the smile on her face quickly dissolves when she thinks about her pregnancy -- a nine-month battle with fear. The last time Shipman was pregnant, nine months passed and her baby was born dead.
This time when she discovered she was pregnant, Shipman was so traumatized, she could not eat or sleep. She was hospitalized. "I was put on anti-depressants and sleeping pills."
Kaylee's great-aunt, Joan Shipman, said that if not for miscarriages, she would have seven more grandchildren.
"So many of our young people are afraid of having babies," said the 63-year-old elder. "I don't know what's going to become of us."
Whitish and Taylor are grateful for the money they get from the government. With the $267,000 a year, "now we can tell the women that we can do more for them than just cross our fingers," Taylor said.
As Zillyett walked past Taylor's office door, Taylor glanced at her round belly. "Everyone around here just loves the fact that she looks so pregnant. We are all running around here on pins and needles looking at her for reassurance.
"If she comes into work 15 minutes late, everyone is unnerved. I told her we are going to have to rent a bus to go watch the ultrasound."
P-I reporter Paul Shukovsky can be reached at 206-448-8072 or paulshukovsky@seattle-pi.com
SEATTLE POST-INTELLIGENCER REPORTER
The CDC report suggests further study and surveillance of the problem. But it doesn't speculate on what might be causing a tribal miscarriage rate that is at least triple the national average.
Joan Shipman, a Shoalwater Bay tribal elder, has had two miscarriages. Her daughter has had one and her daughter-in-law six. "So many of our young people are afraid of having babies," she said. "I don't know what's going to become of us."
Rick Giase/P-I
The Shoalwaters first began to worry that they might have a problem in 1992, when they realized that 10 of 19 pregnancies since 1988 had ended in miscarriage, ectopic pregnancy, stillbirth or the death of the baby within a year of birth. Since then, some segments of the environment have been tested, and the Shoalwaters have built a health clinic with federal dollars.
See related story:
Study reveals troubling data on pregnancies in five counties
The tribe is surrounded by land and water that has been routinely sprayed with pesticides. Chemicals are applied to the north on cranberry bogs and to the east on timberlands. Even on Willapa Bay, the state sprays pesticides directly onto the water to protect oysters from a parasite.
Kim Zillyett's fear of a miscarriage lingers despite carrying a viable fetus. After two miscarriages, the Tribal Center worker says many women feel shame after miscarrying.
Rick Giase/P-I
The CDC alluded to possible causes by making several recommendations such as examining environmental concerns, providing optimal health care, monitoring pregnancies and conducting health education programs to reduce behavioral risks such as consumption of alcohol or drugs. There are no data that justify a conclusion that the problem is related to substance abuse.
Tribal health director Gale Taylor, a non-Indian who has also had a miscarriage while working at Shoalwater Bay, is responsible for trying to stretch a $267,000 annual appropriation from Congress to provide quality care for pregnant women and try to solve the miscarriage mystery.
Michael Shipman sings tribal songs to his 10-month-old daughter Kaylee in the family's home. "It is like she is everybody's baby," said her mother, Lisa, who had a stillbirth before Kaylee.
Rick Giase/P-I
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