As a Certufied Industrial Hygienist and Certified Safety Professional for a Fortune 500 company with nearly 25,000 employees throughout the Eastern U.S., many of the topics covered by these chapters are issues that deal with every day.

Part of what I really enjoy about my job is that sometimes, I get to play detective and solve a mystery. Often we have an employee present with symptoms and we have to investigate to determine what may be causing those symptoms and whether or not they are a result of workplace exposure. For this assignment, I'm going to let you play occupational health detective with me. Read through the cases and pick one. Start a new thread in Discussion Board #6 and tell me which case you chose and then tell me how you solved the case.

Case #1: He thought it was an insect bite.

Ousmane immigrated to the United States from West Africa when he was just 20. Now living in Washington, DC, he has a thriving business making and repairing traditional West African drums as well as teaching workshops and playing around the city with his performance troupe or with friends in drum circles.

As a young boy living in Guinea, Ousmane learned how to make drums from his father, a skill he hoped to pass on to his son someday. The drums Ousmane makes, djembe drums, are carved from hardwood and the drumhead is made from animal hides that are air-dried until they are brittle enough to crack.

Ousmane typically travelled to New York City to buy goat hides from importers. However, he recently returned from a 3-week trip to Guinea where he attended a relative's wedding. While abroad, he purchased two hard-dried goat hides and brought them back to the U.S. wrapped in a plastic bag.

After returning from his trip, Ousmane went to work crafting two new drums in his basement workshop. To make the drumheads, he soaked the new hides he purchased in Africa for 1 hour in water, stretched them over the drum body, then scraped and sanded hair from the hides with a razor. It was an unusually hot and muggy June day in Washington, DC so Ousmane wore only a short sleeve shirt and no gloves or eye protection. While sanding the drums, he felt a sting on his left forearm. Thinking nothing of it, he proceeded to finish sanding and then sweep up the hair and dust from the floor before calling it a day. He then went upstairs to wash the dust off his hands and arms.

Two days later, Ousmane noticed an itchy bump on his left forearm. Later, the little bump turned into a bigger blister and the area around the sore became red and swollen. Ousmane decided to go see his doctor in case he had an infection.

Remembering the sting he felt, Ousmane told the doctor he might have been bitten by an insect or cut himself a few days earlier while in his basement. The doctor confirmed Ousmane's suspicion and said that it was probably a spider bite that had become infected. Ousmane's doctor prescribed an antibiotic for 7 days to stop the infection.

After taking all his medicine, the sore had still not gone away. In fact, it got bigger and the center of it turned black. Ousmane noticed his lymph nodes were swollen and that he was also running a temperature.

What could be causing Ousmane's symptoms?

Case #2:It was just a routine well child exam.

A simple blood test showed 13 micrograms per deciliter (µg/dL) of lead in two-year-old Sarah's blood; 8 µg/dL more than the 5 µg/dL the U.S. Centers for Disease Control and Prevention (CDC)recommends as a reference level for determining if a child's blood lead level is much higher than most children's levels. This serves as a warning that the child may be exposed to lead at home or in the environment, and may require case management. It also allows parents, doctors, public health officials, and communities to take action earlier to reduce the child's future exposure to lead.

Sarah's mom, Michelle, was in shock. "How could this be happening?" she thought to herself. Michelle had heard of kids being exposed to lead through crumbling paint in old houses, but their home was built in 1975 and was in good condition. The couple had even just finished a do-it-yourself renovation project, transforming the dated ‘70's kitchen into something a little more modern.

Michelle and her husband Ted bought their house three years ago when Michelle found out she was pregnant. They had been living in a tiny one bedroom apartment and had scraped together enough money from their jobs for a down payment on a house-Michelle worked as an art teacher at a neighborhood charter school and recently started teaching an evening community education course on the art of stained glass. Ted worked at a nearby e-scrap recycling facility crushing cathode ray tubes from discarded TVs and computer monitors.

The family's house was located in a part of the city that had been redeveloped a few decades earlier. Older dilapidated homes from the turn of the century were torn down to make way for a handful of new homes as the neighborhood underwent revitalization. The only aspect of the house Michelle didn't like was its location on the last block before the interstate highway. The constant hum from the thousands of cars that passed by each day could be unnerving at times, especially when she was outside playing in the yard with Sarah.

Sarah's pediatrician referred the family to the local health department's childhood lead poisoning prevention program. A certified risk assessor conducted a lead risk assessment of their home to determine the presence, type, severity, and location of lead hazards that might be in the paint, dust, and soil.

What do you think might be the source of Sarah's elevated blood lead level?