‘All scraped up’ inside: Maui fire survivors grapple with health effects

LAHAINA, HAWAII — Every morning before she drives to see her students at Lahainaluna High School, Kailini Ross smears a thick lotion across her skin, so the soot that has gotten into her lungs, and remains in the air, does not “fill her pores.”

She then slowly climbs the three flights of stairs between her classrooms, budgeting enough time to sit at the top and rest her wheezing lungs.

She's "all scraped up" inside, she said.

Ross is far from alone. In west Maui, thousands of people are living in the burn zones — in or near homes that absorbed heavy amounts of toxic smoke from the most deadly wildfire in U.S. history. Many residents say their health is compromised or declining due to exposure to ash, debris, and smoke, according to a health report provided to The Washington Post.

Conducted by University of Hawaii researchers and grass-roots organizations, the Maui Wildfire Exposure Study surveyed and tested 679 people, most of whom lived in Lahaina at the time of the blaze, as well as others from the Upcountry area, where another fire burned. While it was not a randomly controlled trial, researchers found that “exposure to smoke, ash, and debris is strongly associated with worse physical health outcomes and reported symptoms.”

About 74% of these residents had elevated blood pressure levels, indicating a heightened risk of cardiovascular disease, and up to 60% “may suffer from poor respiratory health,” researchers said.

In their report, the researchers noted the study’s limitations, including the fact that it may not be “broadly representative of all individuals affected by the wildfires” and lacks some pre-fire baseline data for comparisons. The study also depended on self-reported findings, which could introduce bias into the result, “with participants potentially offering responses they perceive as more socially acceptable rather than their true experiences.”

Even so, researchers say the study is the most comprehensive effort yet to understand the health and social impacts of the Maui wildfires. Over time, they say, it will help researchers see if people’s health conditions are the result of exposures, through regular testing of those who agreed to participate — up to 2,000 people over 10 years. It also comes at a time when scientists, especially in North America, are working understand the short- and long-term effects of being exposed to wildfire smoke.

“You can see it in the data. We are capturing a broad insight into exposures and issues that no one has done before,” said Ruben Juarez, a professor of health economics and one of the lead researchers in the study. He added that in addition to detailed questionnaires, participants are being screened for lung damage, blood pressure, and mental health conditions, with access to healthy services that many in west Maui lack.

“We are following people over time to see how these issues exacerbated,” he said. “We want to mitigate and prevent these problems from occurring in the future.”

Fed by dry grasses and fanned by ferocious winds, the Maui blaze demolished much of Lahaina, killing more than 100 people. It tore through thousands of old homes and commercial buildings, incinerating batteries, electrical equipment, cars, and other pollutants. Ever since, trade winds have been stirring up and blowing that debris into neighborhoods that survived the fire.

Yet questions remain about the degree that local residents are exposed to toxic contaminants. Last week, the Hawaii Department of Health released a statement concluding that it had found no evidence of widespread exposure to toxic lead from the fires, based on a screening of about 557 people at community events between December and February. “With lead as an indicator of exposure, we do not expect to find health impacts caused by toxins in the wildfire ash,” it said.

Experts and environmental health scientists, including an independent adviser to the Maui exposure study, expressed concerns that the state made such a sweeping conclusion made so quickly.

“There is robust scientific evidence of both the short- and long-term harmful health impacts of air pollution exposure, and air pollution that results from wildfire that burned buildings and other structures may be particularly toxic,” said Alison Lee, a National Institutes of Health-funded physician-scientist who specializes in the health effects of wildfire and air pollution exposures. “More research is urgently needed to better understand these health impacts.”

In response, a state Department of Health spokesman acknowledged there are elevated levels of copper, cobalt, antimony, lead, and arsenic in the ash.

“What the Lead Screening Report results showed is that lead (which can be used as an indicator for contaminant monitoring) is not being found in clinically significant levels in people,” Stephen J. Downes, the department’s director of communications, said in an email. “This is reassuring … the contaminants are not getting into people’s bodies in concerning amounts.”

In Ross’s case, she had been living at home in the Leiali‘i neighborhood right at the edge of the burn line. During the fire, flames destroyed part of her back patio. After six weeks, she started having trouble breathing, her nose and throat always burned, and she was lightheaded.

She went to the doctor, who found particulates in her lungs and sent her home with an armful of medications. An inspector for her insurance company found “high levels of lead, arsenic, and low levels of asbestos” inside her home, according to records The Post reviewed.

For Ross and many other survivors, it has been strangely hard to see the progress the town has made while they have lost their jobs and homes, with many still living in hotels.

In Lahaina, green grass has mostly covered the burn scar, growing around and out of the few rusted, burned-out cars still waiting to be collected. Tall, black fabric walls surround much of the charred neighborhoods, largely hiding them from view. New housing projects have broken ground. The shopping center is revamped and freshly painted, with stores selling sunscreen and key chains to tourists, who are again enjoying happy hour on Front Street.

Yet for many, the safety net that existed before the fires is much smaller.

As the Maui Wildfire Exposure Study details, the fire crippled the island’s health-care infrastructure, with a particularly heavy impact on Native Hawaiians, Latinos, Pacific Islanders, and Filipinos.

More than 4 in 10 people reported challenges in accessing medical care, compared with about 1 in 10 before the fire. More than 13% of respondents currently don’t have health insurance, the study said. Nearly 38% of Hispanic participants reported that they were now uninsured, compared to just 5% for west Maui as a whole.

For many residents, housing is a constant worry. Even before the fire, affordable housing was scarce, and now rent for a two-bedroom apartment has jumped to $5,000 to $8,000 a month, residents and community advocates said. Insurance payouts have also been slow, leaving them unable to fix their homes or pay for those high rents. Nearly half of the study’s participants said they were struggling to secure food and housing.

According to researchers, rates of depression and anxiety “are very concerning,” having spiked post-fire and stayed that way. More than half of participants showed depressive symptoms — higher than before the fire, when a survey showed that third of Maui residents reported such symptoms.

In February, around the six-month mark when researchers began surveying residents, the Maui Community Mental Health Center saw a big uptick in people seeking help. Some were unable to sleep, still hearing screams in their dreams, having panic attacks when a siren wails, or feeling guilt they had survived while so many others did not, said John Oliver, a program manager.

Before she started therapy, Ross said she would “cry all night long.” It was as if, she described, the entire town was “screaming.”

“That sorrow lasted every day, every night,” she said. “It is thicker at night. When you are alone, you can feel it — it is so thick, the sorrow. It’s there when I drive through town. … It’s there when I see the crosses and the leis and the faces of those who died. So many people I know who died.”

Often, their emotion seeps out unexpectedly. Sitting in front of Federal Emergency Management Agency employees and aid workers at Lahaina’s recovery center, residents grew visibly frustrated by the paperwork they had to submit and resubmit to get assistance. Some complained about how their insurance company doesn’t return calls. Some started to cry.

“Everyone is so tired and ready to give up,” said Maria Linz a coordinator with the Kako‘o Leiali‘i Recovery Center and also a burn zone resident and participant in the Maui exposure study. Linz has been helping dozens of her friends and neighbors navigate the exhausting maze of red tape while also going through it herself.

“There is no light at the end of the tunnel at this point because the tunnel is so far ahead,” she said. “We can’t even see the beginning of the tunnel at this point.”

Emily Archangel, Linz’s neighbor, feels this way. Her job is to smile and greet tourists at the same hotel she’s been living in with her sick husband since the fire. But she recently got to the point “of why wake up?” she said.

“There is no guidance, no parameters on how to handle this kind of stress,” she said.

Archangel, 63, reached out to her doctor, who urged her to talk to people about how she was feeling and told her she was not the only survivor with thoughts of ending her life. The researchers found that, too: In the past month, about 30 other people in the burn zone have contemplated suicide, “which is notably higher than the 0.8% of the respondents living on Maui” who filled out a survey a few months before the fire.

Despite such findings, researchers added there is a bright note to the survey results. Many participants said they felt a powerful connection with their community and with grass-roots groups, despite the challenges they face.

Ross sees this in her students, at the Native Hawaiian-run food distribution center that operates out of a park, next to a tent where volunteer chiropractors are trying to eliminate pain where they can.

And sometimes, to remind herself how light she felt before the fire, how easy it was to breathe, she floats in the ocean after school, imagining the “the ions taking away all the negative energy out of my body.”

If you or someone you know needs help, visit 988lifeline.org or call or text the Suicide & Crisis Lifeline at 988.