When Diane Wilson complained of headaches and coughs after an oil pipeline ruptured in Mayflower, Ark., her doctor treated her for allergies.

When Genieve Long came down with nausea, rashes and a fever, her doctor couldn't provide a diagnosis.

When Ann Jarrell's 6-month-old grandson began wheezing, a doctor sent him home with asthma medication.

All three families live within a few hundred yards of the March 29 oil spill that sent more than 200,000 gallons of heavy Canadian crude oil through Mayflower. Their experiences offer a snapshot of the confusion surrounding the health impacts of the spill, an uncertainty created by limitations in the science, physicians' lack of training in environmental health and a communication gap between local health officials and the people they are meant to serve. Like families who lived near two other large oil spills—the June 2010 spill in Salt Lake City, Utah and the July 2010 spill in Michigan's Kalamazoo River—they are still searching for answers.

Because the three families weren't among the 22 households in the North Woods subdivision that state officials deemed to be most affected by the spill, they weren't evacuated or contacted directly by health officials. Instead, they stayed put, enduring foul odors and a host of health problems they believe were caused by the chemicals found in crude oil. Not only were their physicians unable to provide clear answers, but in some cases they also seemed unwilling to consider the spill as a possible culprit.

Long said she had to persuade her doctor to add chemical exposure to her medical history. Jarrell said she provided a printout of the petroleum chemicals detected by air monitoring equipment, but the doctor refused to look at it.

Health experts say it's virtually impossible to prove that a particular symptom was caused by the chemicals released during an oil spill. Respiratory problems, for instance, can be blamed on springtime allergies, and headaches explained by the stress of living through a spill. Some people are also more sensitive than others, so two residents could be exposed to the same level of chemicals, yet only one will show a response.

Howell Foster, director of the Arkansas Poison Control Center, said he has no doubt that Mayflower residents are experiencing real health problems. But "causation is very, very hard to prove...There isn't a smoking gun. It's not that simple."

Some of the tests, such as analyzing benzene levels in urine, are expensive and rarely used by primary care physicians, he said. In addition, most doctors have little training in diagnosing or treating chemical exposures. Physicians who specialize in that field tend to live near industrial hot zones such as the Texas Gulf Coast.

One of the few chemical health experts in Mayflower is Dr. William Mason, a pulmonologist and chief of emergency response at the Arkansas Department of Health (ADH), the agency responsible for public health after the spill. Before joining the ADH, Mason worked in private practice for 20 years and treated many people who were exposed to chemicals in the workplace.

Mason said local doctors can call him any time for advice, but he has received only one call so far. Like Foster, Mason said it's difficult to connect health problems with the spill. "You want to consider the entire symptomology, because you may overlook something that's unrelated to the spill. So we trust our physicians...[and] we think they've done a really good job."

Children Still Sick

Long, a 28-year-old college student and a mother of four, lives next to a cove of Lake Conway where the oil eventually collected. Within days of the accident, she said her five-year-old asthmatic son began wheezing and needed a machine to help him breathe at night. Her eight-year-old daughter developed stomach problems.

But when Long asked ExxonMobil—the company responsible for the spill—to help pay for a hotel room, she said her claim was denied because ongoing air monitoring showed that the levels around her house were safe.

"We did not have the funds to move unless we were helped by Exxon," she said. "So we've had to sit here and deal with it."

Long said the children are still experiencing those symptoms, more than three months after the spill occurred.

When InsideClimate News told the health department about Long's experiences, Shirley Louie, the deputy state epidemiologist, said she couldn't comment on a private matter between Long and Exxon. "I don't know what [Long] asked for. We're not in any way, shape or form qualified to answer that."

Since April 2, four days after the spill, the ADH has reported that contaminants in the air were "below levels likely to cause health effects" for the general population.

But as InsideClimate reported last month, some health experts believe the agency's air quality standards for benzene—a known carcinogen—aren't strong enough to protect the public. Those experts were also concerned that the agency didn't issue health warnings for pregnant women and young children, two groups who are considered especially vulnerable to chemical exposure.

Agency spokesman Ed Barham said the staff spent many "long nights and weekends" monitoring air quality and residents' concerns. They've held public meetings, distributed flyers and posted online news releases, he said.

Mason, the emergency response chief, said the agency urged people to report their symptoms to the Poison Control Center at the University of Arkansas for Medical Sciences. The call center is staffed 24/7, and he said the ADH publicized the number on paper flyers and at public meetings.

But their efforts haven't reached everyone.

Long said she saw the poison control number only once, on an Exxon flyer. Because she assumed the number led to a company line, she called the ADH directly to report her family's health problems. But Long said she was transferred back and forth between the agency and Exxon, "and in the process of being batted around, nothing [got] taken care of."

Foster, the Poison Control Center director, said his office received 25 spill-related complaints from residents. He advised those with persistent symptoms to contact their primary care doctors.

The data gathered at the poison control center will be shared with the health department, Foster said. The agency "has been as much above board as they can be," he added.

A Fruitless Search for Help

Ann Jarrell is also frustrated by her experience with the health department.

Jarrell lives with her daughter, Jennifer, and her six-month-old grandson in a house behind the North Woods subdivision, about 350 yards from the oil. The ADH never contacted her after the spill, she said, and she didn't know that benzene and other dangerous chemicals were in the air until about three weeks after the spill, when she attended a town hall meeting held by the Faulkner County Citizens Advisory Group, a nonprofit that advocates for community health. Alarmed, Jarrell called her daughter and told her to pack her bags.

Jennifer and her son moved to Jennifer's brother's house, five miles away. Jarrell, who often travels for work, tries to arrange her schedule so she's rarely at home.

Jarrell is especially concerned about her grandson, who was three months old at the time of the spill. She said he had always been in good health, but began coughing and wheezing after the accident. One doctor prescribed asthma medication. Another doctor recently diagnosed him with a severe upper respiratory infection and put him on antibiotics.

When Jarrell called the health department to report her family's problems, she was transferred seven times and finally ended up on an Exxon company line. Jarrell said the receptionist took down her symptoms and promised to report her case to the ADH, but she never heard back.

Jarrell and Long say the ADH should have been more proactive after the spill and conducted door-to-door surveys. The agency is based in the city of Little Rock, about 20 miles from Mayflower.

Barham, the ADH spokesman, said the agency participated in numerous public meetings organized by Exxon, state and federal agencies. But Long said officials from Mayflower and Exxon told her the events were restricted to the 22 evacuated families. Jarrell didn't learn about the meetings until they were over.

Diane Wilson, who lives near Long, also feels that the health department has let her down. Her house is so close to the oil-stained part of the lake that hundreds of cleanup workers spent weeks working on and around her property.

Wilson wonders why the ADH didn't bring in out of-town experts who understand chemical exposures. And she wished the agency had reached out to her after the spill.

Louie, the deputy state epidemiologist, acknowledged that the agency didn't send its employees to individual homes, but said they were "always available for people to contact."

"Dr. Mason has expressed at many meetings that he was available, and that the health department was available. The poison control center is the best number" for people to call, she said. "We were hoping they would take advantage of it. How much clearer could we have made it?"

Spill Triggers Activism

April Lane, a community health advocate who works with the Faulkner County Citizens Advisory Group, says there's an "epic communication gap" between the agency and local residents. In the first two weeks after the spill, Lane, a self-described "conservative Republican," went door to door in and around the North Woods subdivision, conducting air sampling and checking on local residents.

At one house, a woman who mistook Lane for a health department official flung open the door and said, "'It's about time!'" Lane said the woman described her family's problems—wheezing, coughing and diarrhea—and asked if they should evacuate. Lane told her to follow her instincts, and the family left soon after.

"That was just one of 10 or 12 people I met in the first couple of days who were completely surprised they hadn't been contacted by the health department," Lane said. "We need the agency to go to the people...If I went to 30 homes in a week, they can definitely do it. They have the resources and equipment to do it much more quickly."

The oil spill has turned Long, the mother of four, into an activist. In May, she traveled to Washington, D.C. to speak out against the Keystone XL, a proposed Canada-to-Nebraska pipeline that would carry the same type of oil that spilled Mayflower. She also runs a Facebook page about the spill and is considering changing her college major from office supervision and business management to environmental studies.

Above all, Long wants local officials to investigate the spill's short-term and long-term impact on human health.

"As far as I see, that should be an Arkansas Department of Health issue," she said. "What are we supposed to do if we can't get help from [government] agencies?"

Lori Simmons, chief of environmental epidemiology at the ADH, said the agency will publish a post-spill health report in the next few months. The report will include "health conclusions" based on data such as air and water monitoring results and common health complaints, she said.

The agency has no plans to track residents' health in the long term. Experts say these types of studies are crucial for a better understanding of how oil spills affect the general public. But because cancer and other possible effects may not appear for years or decades, such studies are expensive and rarely conducted.

Someone who develops a headache and a cough may not develop long-term symptoms, said Foster, the poison control center director. "It doesn't mean you couldn't, but these two things aren't necessarily related."

After the 2010 oil spill in Michigan's Kalamazoo River, county officials petitioned the federal Agency for Toxic Substances and Disease Registry (ATSDR) to conduct a long-term study. But ATSDR denied their request.

The Arkansas health department has asked the Centers for Disease Control, which oversees ATSDR, about conducting a potential long-term study, but Simmons said the CDC told them the Mayflower spill was "not appropriate" for that type of research.