Flint's Water Crisis and Its Fight for the American Dream (Adobe Stock) 1500 × 993

When Mona Hanna-Attisha took the stage at TedMed 2016, I assumed she would start out by telling the story of how she discovered that children in Flint, Michigan were being poisoned by lead after cost-cutting measures led the city to use the filthy Flint River as the primary water source for its citizens. But that is not how Mona started her talk. Instead, she talked about how her experience growing up as the daughter of Iraqi refugees made her a stronger person—one who is passionate about helping everyone in her community have a chance to live the American dream. In the aftermath of a brutal presidential campaign filled with immigrant-bashing and threats of mass deportations, I thought, thank you, Mona, this is exactly the right way to frame a story that at its core is about government neglect and denial at both the state and local levels and how one person, shaped by her immigrant experience, helped to make a difference.

 

Mona’s immigrant story

In 1980, four-year-old Mona and her brother were living with her parents in Iraq under the brutal dictatorship of Saddam Hussein. It was the beginning of the Iran-Iraq war that would eventually kill more than a million people. Her parents, “progressive, secular, left-wing, pacifists believed in the country Iraq that could have been—diverse, tolerant, modern and free.” But what they found instead was the rise of fascism. Even worse, they could foresee the country’s bloody spiral into anarchy. So, they fled with their children to the United States “in search of the American dream.”

Once settled in Michigan, her Dad became an engineer at General Motors and her Mom, a teacher of English as a second language to recent immigrants. They earned a good living and were able to ensure their children got a good education. “For my family,” she said,

“the American dream became a reality.”

Mona went to medical school, became a pediatrician and, eventually, the Director of the Pediatric Residency Program at Hurley Medical Center in Flint, Michigan.

 

A bit about Flint

Flint, Michigan was the birthplace of General Motors. It was also the site of the 1936 “sit down strike” that led to the recognition of the UAW as the bargaining agent for GM’s workers. The strike lasted 44 days and eventually ended in favor of the workers after the personal intervention of Michigan’s governor and President Roosevelt. The settlement between GM and the workers became known as “the grand bargain.” It provided the workers with a living wage as well as benefits, such as healthcare and pensions. It helped people rise up from poverty into the middle class. Mona pointed out that,

“For the first time, people had access to the American dream”

Flint was something special, she said, it was hailed as one of America’s great industrial cities—a promised land for people migrating from the South during the Great Migration and for immigrants all over the world.

However, this part of the dream didn’t last and Flint began its descent into poverty after decades of “disinvestment”—including the closure of the GM factories that provided employment to many of the city’s workers. The aftermath of the closures is poignantly chronicled in Michael Moore’s famous 1989 documentary, “Roger and Me.” The decline has continued to the present. A recent Sanjay Gupta story on CNN describes Flint, a city of about 100,000 people, like this:

“The past three decades have been rough for the blue-collar city, which has experienced a drop in population and rise in violent crime since the auto plants began closing in the 1980s. Local officials say about 40% of residents live in poverty. Fifteen percent of homes are abandoned. The city doesn’t even have a grocery store.”

Today, she says, Flint is where our inequality and injustice problems are most striking. The life expectancy in Flint is 15 years less than the life expectancy in a neighboring zip code. Fifteen years! “This is no one’s dream,” she continued, “the America I wake up to has changed a lot since I was a little girl. Now, there are two Americas—the one that I grew up in and the one that I see every day in my clinic.”

“I have seen things you would never want to see…things that are part of a nightmare not a dream.”

 

Lead in the water

Flint’s financial difficulties led to the city being taken over by the State Emergency Management group led by Ed Kurtz, Flint’s Emergency Manager. In 2014, in a cost-cutting move, the city decided to quit using the clean, clear waters from the Detroit Water and Sewerage Department to fill their pipes, switching instead to the contaminated waters of the nearby Flint River. After the switch, the water that came from the taps was cloudy, brown, and smelly and, almost immediately, people in the town began complaining about rashes and eye irritations. They were advised to boil their water because it was contaminated with E. coli and other bacteria known to cause human disease.

One evening, while having dinner with a friend who told her that Flint water was 19 times more corrosive than water from Lake Huron, Mona freaked. She knew that meant that lead could be leaching out of the old lead-based pipes and into the drinking water of the town. And, as a pediatrician, she knew all too well the devastating effects of lead on the developing brains of children. Lead, you see, is a potent neurotoxin even in small amounts. The results of lead poisoning include learning disabilities, behavioral problems, and even mental retardation. As Mona said in her talk,

“There are no safe levels of lead.”

In order to determine if Flint’s children had been exposed to lead as a result of changing the water source, she began testing their blood lead levels and comparing the results with levels found before the switch. What she found was shocking, lead levels had doubled from 2.1% of children 5 years old and younger to 4.0% afterward. In one neighborhood, the percentage of kids with lead poisoning went from about 5% to almost 16% of the kids that were tested. It directly correlated with where the water lead levels were highest.

She said,

“Our mouths were ajar, and we couldn’t believe that in 2016, in the middle of the Great Lakes [the largest group of freshwater bodies in the world], we couldn’t guarantee a population access to good drinking water.”

Realizing the profound implications of her findings, she held a press conference to announce the results. The response of officials in the city and the state was to attack her results, calling her an “unfortunate researcher and accusing her of ‘causing hysteria’.”

Despite this, she persisted because the children’s futures were at stake. As she said in her TedMed talk,

“You don’t mess around with kids. You don’t mess around with lead. And, you don’t mess around with pediatricians, especially this one.”

Eventually, Mona learned from a state health official that her results were consistent with what they had found as well. This was when “the house of cards began to fall” and the government neglect and denial at both the state and local levels that put so many kids at risk of neurologic problems—one that for some will last a lifetime —was exposed for all to see.

In October 2015, Flint’s water system was switched back to Detroit’s system in October 2015. In April 2016, Michigan’s attorney general filed criminal charges against nine individuals involved in the tragedy and its coverup.

 

A prescription for hope

Mona closed her talk by saying that now the people of Flint are focused on tomorrow. She said, “We are working towards hope, forged with hard work and sweat.” Although there is no magic bullet for lead poisoning she notes, she is working with others in the community to build what she describes as a model public health program—one that will surround the children of Flint with every evidence-based intervention that can promote their development to mitigate the effects of the toxic exposure. But, she concludes, to fix Flint—and Flint’s everywhere—it will take rebuilding the American dream. This is because the most potent medicine that we can prescribe is to lift our families out of poverty. Mona is a public health hero and an inspiration

Mona is a public health hero for physicians and others who are passionate about the health and well-being of our communities. I hope you found this story inspirational and one that will motivate you to stand up when you see social injustice in your own communities. Thanks to Shirley Bergin and TedMed for inviting Mona to talk and for sharing access to the livestream with me.

Patricia Salber MD, MBA (@docweighsin)
Patricia Salber, MD, MBA is the Founder and Editor-in-Chief of The Doctor Weighs In. She is also a physician executive who has worked in all aspects of healthcare including practicing emergency physician, health plan executive, consultant to employers, CMS, and other organizations. She is a Board Certified Internist and Emergency Physician who loves to write about just about anything that has to do with healthcare.

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