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Eduardo Arias waiting for a bus recently outside his apartment building in Panama City.
PANAMA — Eduardo Arias hardly fits the profile of someone capable of humbling one of the world's most formidable economic powers.
A 51-year-old Kuna Indian, Mr. Arias grew up on a reservation paddling dugout canoes near his home on one of the San Blas islands off Panama's Caribbean coast. He now lives in a small apartment above a food stand in Panama, the nation's capital, also known as Panama City.
But one Saturday morning in May, Eduardo Arias did something that would reverberate across six continents. He read the label on a 59-cent tube of toothpaste. On it were two words that had been overlooked by government inspectors and health authorities in dozens of countries: diethylene glycol, the same sweet-tasting, poisonous ingredient in antifreeze that had been mixed into cold syrup here, killing or disabling at least 138 Panamanians last year.
Mr. Arias reported his discovery, setting off a worldwide hunt for tainted toothpaste that turned out to be manufactured in China. Health alerts have now been issued in 34 countries, from Vietnam to Kenya, from Tonga in the Pacific to Turks and Caicos in the Caribbean. Canada found 24 contaminated brands and New Zealand found 16. Japan had 20 million tubes. Officials in the United States unwittingly gave the toothpaste to prisoners, the mentally disabled and troubled youths. Hospitals gave it to the sick, while high-end hotels gave it to the wealthy.
People around the world had been putting an ingredient of antifreeze in their mouths, and until Panama blew the whistle, no one seemed to know it.
The toothpaste scare helped galvanize global concerns about the quality of China's exports in general, prompting the government there to promise to reform how food, medicine and consumer products are regulated. And other countries are re-examining how well they monitor imported products.
Lost in this swirl of activity was the identity of the person who started it all — Mr. Arias. Until The New York Times tracked him down with the help of the Panama City mayor's office, his name had not been known, even to some people working on the case. "We haven't been able to find him," said Julio César Laffaurie, the Panamanian prosecutor pursuing the case of the contaminated toothpaste.
In looking back over events of the past year, Dr. Jorge Motta, director of the Gorgas Memorial Institute, a prominent research center in Panama City, said he was grateful that some good had come from the national trauma brought on by the toxic cough syrup.
"The whole questioning about Chinese goods began in Panama with our deaths," he said, putting a twist on an old Chinese saying by adding, "A little butterfly in Panama beat her wings and created a storm in China."
Mr. Arias, who lives alone and does not own a car, went to buy blank CDs on May 5 at Vendela, a discount store where he had heard prices were so low that street vendors bought supplies there. Stepping into the store, a large display of toothpaste caught his eye.
"Without touching the tube, the letters were big enough for me to read: diethylene glycol," Mr. Arias said.
A year ago, those words would have meant nothing to him. "Nobody had ever heard of this stuff," Mr. Arias said. But a steady drumbeat of news about poison cough syrup had engraved the words in his mind.
"It was inconceivable to me that a known toxic substance that killed all these people could be openly on sale and that people would go on about their business calmly, selling and buying this stuff," said Mr. Arias, who has a midlevel government job reviewing environmental reports.
Mr. Arias thought about alerting the store clerk but figured nothing would come of it. Instead, he bought a tube with the plan of turning it over to the health authorities. It was not easy.
Since government offices were closed on the weekend, he said, he used a vacation day on Monday to walk the tube to the nearest Health Ministry office. But that office refused to accept it, directing him to a second health center.
Mr. Arias walked there and found himself in a crowded office. "It's always filled with people who are seeking medical attention," he said. The clerk there directed him to another section of the building where he spoke to another official.
"I said, look, here is this toothpaste I bought on the pedestrian mall," he said he told the official, "and it says right here — it's got diethylene glycol."
The official told him he needed to take the toothpaste to a third health center, this one much farther away. "I said, wait, wait, do I have to walk all the way over there?" he recalled. "Can't I give it to you and make the complaint here?"
At this point, Mr. Arias said he was given a form to fill out. He left wondering what if anything would come of his complaint.
Mr. Arias got his answer three days later when the nation's top health official, Dr. Camilo Alleyne, announced that toothpaste containing diethylene glycol had been found by an unidentified shopper in Panama City.
The news set off alarms. In 2006 the government had mistakenly mixed mislabeled diethylene glycol into 260,000 bottles of cold medicine, and Panama was still coping with its aftermath. The day before Dr. Alleyne's announcement, a front-page newspaper article here reported the finding by The Times that the diethylene glycol in the cold medicine had come from a Chinese company not certified to sell pharmaceutical ingredients, and that it had been sold under a false label.
Over the years, counterfeiters have used diethylene glycol as a cheap substitute for its more expensive chemical cousin, glycerin, a common ingredient in medicine, food and household products.
Could the suspect toothpaste have come from China as well, investigators wanted to know? And how did it enter the country unnoticed?
"Under no circumstances were we ever going to let another incident such as happened last year happen again," said Eric Conte, a top drug official at the Panamanian Health Ministry.
The label did not list its origin. "There was stuff in English, how to brush your teeth, and there was a list of ingredients," Mr. Conte said. Markings suggested that it came from Germany, but the authorities were skeptical.
"We had a good idea where it came from," said Reynaldo Lee, director of the national food protection agency. He suspected China, and shipping records proved him right.
The toothpaste had entered Panama through the Colón Free Trade Zone on the Atlantic side of the Panama Canal. One of the world's biggest free zones, with 30,000 workers and 2,500 businesses, it is a place where billions of dollars in goods are unloaded, stored and either sold or reshipped free of tariffs. From there, 5,000 to 6,000 tubes slipped into the Panamanian market, without proper certification, mixed in with animal products, investigators said. A much larger number of tubes were reshipped from the free zone to other Latin American countries.
But it was not until the United States disclosed June 1 that tainted tubes had penetrated its borders that the hunt intensified, a task that grew more difficult when investigators discovered that some contaminated toothpaste did not list diethylene glycol on the label.
Even two well-known brands, Colgate and Sensodyne, got caught up in the sweep when counterfeiters were found to be selling toothpaste with antifreeze under their names. Some fake Colgate tubes also contained potentially harmful bacteria, according to a statement from Health Canada, the national health agency.
"Consumers should seal the tube and put the tube in a sealed bag," Canadian officials advised. Investigators told The Times that both counterfeit brands came from China.
As the complaints mounted, China's government defended legitimate manufacturers that used diethylene glycol as a thickening agent in toothpaste, saying it had caused no health problems among Chinese consumers.
Officials outside China took a different view. "They should apologize to the world, and not say that it is not dangerous" said Dora Akunyili, who runs the National Agency for Food and Drug Administration and Control in Nigeria. "This is ridiculous."
Like Panama, Nigeria had its own lethal encounter with diethylene glycol when dozens of children died in 1990 from medicine that also contained the poison.
In laboratory tests, Canadian authorities found diethylene glycol concentrations of nearly 14 percent in Chinese toothpaste — about twice the level of poison detected in the deadly Panamanian cough syrup.
"While toothpaste is not meant to be swallowed, it is often swallowed by young children," Health Canada warned. Action against Chinese toothpaste is continuing. In late September, Brunei and Australia announced bans on toothpaste containing unacceptable levels of diethylene glycol.
As reports from around the world mounted, Chinese officials showed they were not immune to the criticism. When the makers of Sensodyne tracked counterfeit toothpaste through the Dubai Free Trade Zone to a factory in Zhejiang Province in China, regulators there shut it down, a spokesman for Sensodyne said. The government also closed the chemical company that made the poison used in the toxic Panamanian cough syrup.
And in July, China ordered its manufacturers to stop using diethylene glycol in toothpaste.
The decision generated news coverage around the world. The name Eduardo Arias was nowhere to be found. He did not seem to mind.
"At least I contributed something," he said.
