As it had for so many immigrants over the centuries, the promise of America worked for my family. We’d left a country that was broken, unsafe, unpredictable, and oppressing its own people for a country that allowed us to thrive. My parents didn’t have much when they arrived in the United States, but they were able to use their educations to find good-paying jobs, buy a house in a safe neighborhood, and educate Mark and me at Michigan’s excellent public schools and universities. The American Dream—buoyed, backed, and underwritten by the choices of the American people, expressed through their democratically elected government— worked for us in so many ways that it no longer works for my kids in Flint—and maybe was never meant to.
* * *
—
MY MOM NEEDED A LOT of convincing before she retired. She finally took a buyout from the school district, which was a big relief to me. She did it just in time, right before the state legislature began limiting pensions and benefits for teachers who had retired during the Great Recession, which started earlier, hurt more, and lasted longer in Michigan than in the rest of the country.
I needed her. We all did. Elliott was now fully immersed in the world of school health while also overseeing a mobile medical program that treated kids in Detroit. And the jobs I wanted were intense and required a significant time commitment. From our point of view, the more time Nina and Layla spend with my mom, the better. She speaks to them in Arabic. She teaches them to cook and knit, when they are interested. She brings the culture of old Iraq and our family stories into their lives. She is even willing to deal with the logistical hassles of carpools and field trips and school volunteering. After I took the job at Hurley, Elliott and I bought a house just ten minutes away from my parents—halfway between Flint, where I worked, and Detroit, where Elliott did. This was, I recognized, another privilege our family enjoyed.
Bebe. That’s what the girls call her. The love between them is immeasurable and precious. She makes every sleepover an adventure—with Audrey Hepburn movie festivals, card games, baking adventures, and craft projects. She doesn’t just look after Nina and Layla. She helps us raise them. And she looks after Elliott and me too.
As for my dad, or Jidu, as the girls call him, he never really stopped working. The layoffs and reorganizing that hit the assembly lines of Flint so hard in the 1980s slowly worked their way to Warren and my dad’s fantastic space-age office. The economic crisis in 2008 began waves of layoffs. In one day, hundreds of engineers and scientists were fired—instructed to empty their desks and leave the building where they’d worked their entire lives.
The layoffs sometimes seemed random to my dad, and sometimes unfair. My dad would come home with sad stories of having to say goodbye to people he’d worked alongside for decades. He believed in GM, perhaps too much. As the stock price went down, he bought more GM stock. With the company bankruptcy in 2008, the “old GM” stock literally disappeared, and so did quite a bit of his 401(k). Yet he continued to have faith in the company that had put food on our table.
When he survived the layoffs in 2008 and 2009, we rejoiced. After he survived more cuts in 2010 and 2011, it became a family joke that he was on some sort of “safe list.” What did Daddy have on GM? Why was he still there? Finally, just a few months back, after thirty-one years, he retired and began a new life with new kinds of work, from obsessively researching our ancestral history to indulging Nina and Layla as well as Mark’s two boys, Theodore and Zachary, with expressions of love and affection that had been largely absent during my own childhood.
I chalked it up to the softening that comes with age and time, the ability of love to heal, and the mysteries of being a grandparent.
His activism hadn’t died or faded. It morphed. His view shifted. He embraced what was in front of him—his love of his family, his realized dreams for Mark and me, his hopes for our kids—rather than holding on to what was behind him or across the sea. His transformation grounded me, nourished me, and gave me hope. Time and love had brought out the best in my dad, buffering the trauma of his past. Resilience, I knew firsthand, could be learned.
* * *
—
“HOW WAS THE BARBECUE?” Bebe asked me. Over the years, she and my dad had managed to charm and semi-adopt many of my friends, but Elin was a particular favorite. My mom had always been impressed by how academically and musically accomplished she was. When my mom visited D.C., she always made food for Mark and his family—and for Elin too. Later, when Elin moved back to Michigan, my mom gave her cooking lessons. The fact that Elin’s dad and mine had both worked at the GM Tech Center for years created even more shared history.
“Oh, it was fun,” I said. “It was nice to be together.”
“What did you serve?” she asked.
I described the meal briefly, knowing that whatever I said, my mom wouldn’t think it was enough food. She hasn’t quite given up on my domestic skills, but she was already turning her attention to Nina and Layla, hoping they might be more receptive to her cooking lessons than I was.
“Everybody seems good,” I said. “Elin says hi.”
I was careful to say nothing about the Flint water. I have always kept pretty quiet about my work, wanting to savor my family time, focus on the girls, and maintain boundaries. My parents and Elliott are used to it. My dad was the same way about his job at GM. But that morning, my sense of privacy, or boundaries, whatever you call it, was heightened. My mom is a chronic worrier. She worried that I might speed on my way to work or use my cellphone and become distracted while driving. She worried that I worked too hard, or that I didn’t have enough fun or days of vacation. She never sheltered Mark and me from the bad news coming from Baghdad when we were little, yet in many ways she was the prototypically overprotective immigrant mom. She enforced early curfews and banned slumber parties, dating, and watching violent movies. A few broken curfews aside, I never really gave her cause to worry. And when I did give her cause, I felt guilty.
I got better at protecting Bebe once I was an adult. She is anxious about the unknowns, the hundred things that can consume a woman who has lost everything of her youth and has decided she is not going to risk losing anything more.
* * *
—
LAYLA SMELLED BREAKFAST AND rushed downstairs, dressed, alert, and ready for another day of Skull Island.
“Layla oumree!” my mom called out, a term of endearment that means “Layla, my life!” and wrapped her arms around my youngest daughter before handing her a plate of crepes with gooey Nutella on top. Several minutes later, after multiple calls of Yalla!—“It’s time to get up!”—Nina finally appeared, groggy and quiet. She was slow to get going in the morning. She hugged and kissed my mom, then sat at the counter with her plate of crepes, piled high with strawberries and cream.
“Did you get enough sleep?” Bebe asked me.
“No, not really,” I said distractedly, immediately regretting having said it.
Luckily, Elliott popped into the kitchen, his arm in the sling and his hair disheveled. He was the perfect distraction. I grabbed my go-cup of coffee, kissed everybody goodbye, and called out, “ ’Bye, habebtees! I love you. Have fun at camp!” And I headed straight to the garage.
It was another chilly morning, and damp. On I-75, the same road where I had been in that car accident all those years ago, I drove to Flint, my usual commute, feeling obsessed and stressed. My mind had focused narrowly on one thing and one thing only.
* * *
—
FIVE OF US WERE sitting around the large oval conference table, down the hallway from my office at Hurley Hospital, in what used to be the old pediatric psych wing. The room felt too big with so many empty chairs and dead space. For the meeting with the guy from the Genesee County Health Department, I was joined by three residents, all of us in white coats.
The guy from the county health office was in his thirties and dressed in
the business-casual style of someone who does restaurant inspections half of the time. He had recently come to Genesee from a nearby county’s health department, he said, with twice as much funding and only half the population. That was annoying to hear. As soon as we started talking, he complained about how few resources he had for lead remediation in Genesee. He said his main focus was on trying to build a stronger and better public health program.
I had no argument with that goal. Funding for public health is inconsistent in Michigan, which has a weird system that just doesn’t make sense. In the past, the state took on more responsibility for county and local expenses, but especially under Governor Snyder, there were major cuts in revenue sharing to local governments. Consequently, counties and municipalities relied on their own tax bases, mostly from property taxes, to maintain services.
The result was wild disparities in how effectively the health of Michigan residents was protected. When money was tight, public health budgets were often the first to be reduced. In Genesee County, for instance, where the crime rate was considerable and the sheriff wielded immense power, most of the resources went to the sheriff’s department, for better offices and more staff, guns, uniforms, and squad cars. The health department got less.
It made no sense that communities with the most struggles and most poverty—and therefore the most health issues—were always allocated the least amount of money, but that was how it worked, since the property tax revenue was smaller in poor counties. A similar dynamic affected school funding in Michigan, allowing the richest school districts to spend more per student, especially on capital improvement or school buildings. Everyone in government knew about this inequity—in fact, it was the legislature’s choice to set up the system like that—but the unfair situation was passively accepted with a “well, life isn’t fair” shrug. And the state government’s cuts to local revenue sharing made things much worse. In Flint, despite years of state oversight of the city and its services, the budget deficits had never been closed, not even by the parade of EMs.
When a city doesn’t generate enough tax revenue because property taxes don’t bring in enough money, the poor people who live there are punished with higher utility bills. It’s very regressive thinking, asking poor people to pay a higher share of their income than other residents for basic public health protections like water or adequate plumbing. Flint had miles and miles of old pipes underground that needed repair and replacement. In 2014 the city pipes were leaking between 20 and 40 percent of their load, which meant residents and business owners had to pay for those water losses. The average annual Flint residential water bill in 2015 was $864—about $300 more than in any other city in Michigan. In fact, it was the highest in the nation.
The guy from the health department and I moved on to talk about making sure the families with children who tested for high levels of lead would have easy access to the cleaning supplies. Lead poisoning from old paint and paint dust was an ongoing concern in Flint, due to the ancient housing stock that was often in disrepair. What these houses really needed was a serious inspection and total lead abatement, but that was more money than the government wanted to spend. So instead, we offered mops and cleaning supplies.
I felt a pang of frustration but held my tongue and waited until the end of the meeting to raise the subject of the Flint water. First I brought up the recent newspaper articles about the leaked EPA memo.
“Do you know what’s being done about that?” I asked.
He looked puzzled.
“You’ve heard about the water problems in Flint—the lead?”
He shook his head.
“Testing has been done by a drinking water expert at the EPA,” I went on, “and the water shows high levels.”
My residents all nodded. They had read the articles I sent them early that morning.
The health guy looked away, as if anxious to leave, then turned to me and said, “Water is not under the jurisdiction of the health department.”
“What do you mean?”
“Water isn’t our department. We deal with lead paint and lead dust,” he said. “When it comes to water, that’s another department. It’s under public works.”
“Excuse me, it’s a public health issue,” I said, suddenly becoming aware of how short my fuse was. Public works? What was that? “I understand the focus on lead paint and lead dust, which, don’t get me wrong, is a serious problem. But lead is lead, no matter the source. How can lead in the water not be under the jurisdiction of the health department?”
He shifted in his chair.
“Doesn’t your office collect all the blood-lead-level data for the county?” I asked.
He nodded.
“What about the lead levels of kids? Have you noticed any changes in the levels over the last year? Has anybody noticed?”
“I don’t know if anyone has looked,” he said.
I wasn’t getting anywhere, I could see that. The guy had no power, and he didn’t plan to shake the cage or step beyond the confines of his job description. The meeting ended pretty quickly after that.
I soothed myself with a new plan. I would fire off an email to his bosses at the county health department. I didn’t really know them, but I knew their names. Surely somebody there knew something and could help.
YOU CAN BE DRAWN TO THE field of public health as a humanitarian, a mathematician, a statistician, or a health provider. It can be a religious calling, or it can spring from a passion for pure science. For me, except the religious business, it’s a combination of all those things, along with my love for a bit of suspense. Addressing a public health crisis or curing a disease is like solving a mystery, usually with just the right mix of instinct, insight, footwork, solid data, strategy, and pure luck. The history of public health is loaded with incredible stories and puzzles, which is why so many books are written about contagions and outbreaks. Even zombie stories are metaphors for epidemics.
Before public health departments became part of government, responsibility for people’s welfare fell on their families and communities. It’s been only fairly recently, over the last couple of centuries, that governments became involved in protecting the health of citizens. As a field of science, public health rose up with the cities that formed around the time of the industrial revolution. As people crowded into smaller geographic spaces, disease spread faster. Wood and coal fires polluted the air. Human waste ran into the streets. Running water was very rare, sewers even rarer.
My favorite sleuth is John Snow, a nineteenth-century physician, inventor, scientist, advocate, and founding father of public health. The son of laborers who worked his way through school, Snow first made his name as an anesthesiologist, before that was even a discipline, by inventing new ways to ease the pain of patients during surgery. He was even called to Queen Victoria’s bedside in childbirth. Snow published dozens of papers on a wide range of public health and medical issues, including lead poisoning. But more than anything, Snow loved systems, networks, demographics, and, most of all, epidemiology—the branch of medicine that deals with the spread and control of disease.
A century ago the biggest threat to life wasn’t cancer or heart attacks—it was infectious disease. Nothing surpassed his obsession with preventing cholera.
The effects of cholera are devastating. In a healthy person, the small intestine absorbs more water than it secretes, which keeps the cells of the body hydrated. But an invasion of Vibrio cholerae reverses that balance. A victim experiences sudden diarrhea, vomiting, and severe dehydration—quickly evacuating all fluid from their body. In a matter of hours after contracting the disease, the victim often dies. In the nineteenth century, the fluids left behind contaminated the sewage systems, then the drinking water, and spread the disease.
In London’s first outbreak, Snow’s own records show that 4,736 lives were lost. Seventeen years later, in 1849, a second outbreak in London clai
med another 14,137. When cholera struck yet again, in the summer of 1854, victims in the crowded neighborhood of Soho began dying—eventually 10,530 of them.
A combination of luck, location, hard work, and brilliant instincts led John Snow to a major scientific breakthrough. Learning from his work and experiments with various anesthetics, all inhalants (primarily ether and chloroform gas), Snow doubted the prevailing “miasma” theory that cholera was spread by breathing stagnant air. He argued that people working in all kinds of smelly places weren’t getting sick. He suspected that the disease was spread by unsanitary drinking water instead. Snow conducted research, published papers, and gave presentations to the London Epidemiological Society. But few doctors in London at the time felt comfortable bucking consensus. And politics played a part.
Miasma was the established theory—and had the support of the entire medical establishment and public health community, including the persuasive reformer Edwin Chadwick, who had led a charge to clean up the foul and stinky air in London by creating a drainage system for under-house cesspools, a predecessor of sewage systems. But the expensive new system relied on an ancient drainage network underneath the city that led straight to the River Thames, the source of the water that South London used for cooking, bathing, and drinking. Chadwick’s new drainage system actually left the population far more vulnerable to disease.
When the 1854 cholera outbreak occurred in Snow’s own Soho neighborhood, he once again made his case, this time to the Board of Guardians of St. James’s Parish. He argued that the Broad Street pump, where many people in the parish got their water, was contaminated—and was spreading the disease. As far as the eye could see, the water seemed clean, with no smell or any other sign of danger, but it could kill you if it had enough cholera in it. The board doubted Snow, but the pump handle was removed (just in case). By then, most people had fled the neighborhood or were using water from clean wells nearby. The outbreak was stayed.
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