What the Eyes Don't See

by Mona Hanna-Attisha

  Greedy real estate agents colluded to control neighborhoods in what came to be called “blockbusting.” Real estate agents would go door to door, frightening whites with warnings of plummeting home values—and offering to put their homes on the market quickly, often below market prices. The agents then sold the homes to African Americans at a large markup above market prices. The scam continued at the banks, which charged blacks a higher interest rate. The upward mobility that white Americans took for granted in the second half of the twentieth century was denied to most blacks, but blockbusting—which continued into the 1970s—kept it out of reach even longer.

  Worried about the city’s future vitality and population, some city leaders, institutions, and entities, from GM to the UAW and the Mott Foundation, backed a 1968 referendum to bind the city and its suburbs to a regional government. The first effort had been made prior to white flight, as far back as 1958. Cities in the South and the West grow geographically by annexing suburbs, as in metropolitan Los Angeles, where suburban expansion didn’t jeopardize the tax and economic base of downtown. But the residents in Flint’s new suburbs, happily ensconced in their new houses and all-white neighborhoods, voted overwhelmingly against the referendum. The ramifications of this missed opportunity were grave and enduring. Flint was left isolated and abandoned, comprising only a bit more than its urban core.

  Attempts to desegregate Michigan’s public schools met with even more white voter anger—and violence—throughout the 1960s and ’70s. The school busing wars raged, culminating in the bombing of school buses in Pontiac in 1971. Finally in 1974 the Supreme Court issued a decision that kids couldn’t be bused across city lines. That decision, if it had gone the other way, could have integrated my hometown of Royal Oak with kids bused in from Detroit. Justice Thurgood Marshall wrote in his dissent to Milliken v. Bradley that the “Court’s refusal to remedy separate and unequal education” leaves “little hope that our people will learn to live together and understand each other.”

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  THE DOWNWARD TRENDS CONTINUED in Flint after the failure of AutoWorld in 1984. Leaders came and went. More GM plants closed. Many people left, seeking jobs and warmer climates. As an urban center, Flint has been in a man-made state of emergency for forty years.

  Today pockets of old-money affluence remain in Flint, but you can also buy a house here for less than $30,000. And I’m talking about a decent house, similar to the Royal Oak home where I grew up. The national poverty rate is about 16 percent, but in Flint, almost 60 percent of children live in poverty, some in extreme poverty. Unemployment, unheard of in the city’s glory days, is now epidemic. Violence has also taken a toll: there were 48 killings in Flint in 2015, including 42 gun deaths, and an additional 147 nonfatal shootings.

  The population of Flint peaked at 200,000 but is now less than half that, which means thousands of abandoned homes, plummeting property values, and far less tax revenue. When the state of Michigan cut revenue sharing, the city starved even more. When I returned to Flint to work at Hurley in 2011, a new glimmer of revitalization was under way, with a few new restaurants, an enhanced downtown, and a new program of blight removal. But given all the city’s challenges, it was just that—a glimmer.

  Even as a girl I had guessed that places are more complicated and nuanced than a sentence or one explanation can offer. That has proven true. No single bad decision or unfortunate event created modern Flint. The greatest forces working against the city were racism and the corporate greed of GM, which pulled out of Flint, the city that birthed and nurtured it, to satisfy financial problems caused by a lack of imagination. But halfhearted, weakly enforced policies like desegregation, and the premature end of the Great Society, also played a role, along with deindustrialization and real estate greed.

  What drew me to Flint—and has kept me here—was something else I saw. Something that made me think of my dad and mom, of the family stories I’d heard. It was the tenacity and endurance of its people, the passion of its strikers and workers, and its legacy of steel-plated grit and resilience.

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  WHEN RICK SNYDER DECIDED to run for governor in 2010, Flint was bleeding money, just as it was bleeding people and taxpayers. He campaigned as a moderate and a can-do guy. A former businessman, he had been the chief operating officer at now-defunct Gateway computers. When Acer acquired Gateway in 2007, he left the company and kept busy as a venture capitalist, selling a healthcare firm for $200 million to Johnson & Johnson.

  With his practicality and financial know-how, Snyder vowed to make Michigan government work like a business. While his focus on metrics and calls for “relentless positive action” always sounded creepy and vaguely cultish to me, there was definitely hope when he was elected that he might join the ranks of other successful Republican moderates, like George Romney and William Milliken, who’d governed Michigan fairly and successfully.

  But almost from the start, a sinking sense of disappointment in Snyder set in. He wasn’t a moderate at all—or at least he didn’t govern like one. Almost immediately the Tea Party started pushing him to the right, and then he just kept going in that direction.

  Governor Snyder’s enthusiasm for the emergency manager law seemed totally genuine and unforced—not something he was pushed to do by the Tea Party or anybody else. One of the first bills he signed was Public Act 4, a beefed-up version of a prior EM law that allowed him to take over a municipality that was beset with financial problems. Even though Michigan voters shot down Public Act 4 in a referendum, the ideologues in the legislature ignored the voters and passed the law again, one month later.

  The appointed EM had one job: extreme austerity. (Someone called Snyder’s EM scheme “austerity by dictator.”) The EM had to balance the books, no matter the cost. The EM law has so many miserable aspects, it’s hard to know where to start. City employees and their pensions and benefits were a primary target.

  The extreme austerity—which was also behind the water switch—decimated Flint’s police force. Between 2008 and 2016, it shrank from 265 sworn personnel to 98.

  Selling off city resources was also part of the grand plan. The EM law also allowed for the privatization of public institutions, even possibly Hurley Medical Center. By the time I got deep into the water crisis, three different Flint EMs had come and gone, each lasting only a short while.

  It didn’t really matter who they were anyway. The governor’s office in Lansing was calling the shots.

  THE LACK OF RESPONSE FROM THE state, specifically the health department, sent me into a dark hole. I just didn’t get it.

  Just as I began to fall into despair, Elin wrote to me with good news. For the last week, she had been working behind the scenes quietly, like a spider spinning a web. The first strand in her trap was marshaling political support. Elin was working as a water policy analyst for a Washington-based nonpartisan think tank, the Northeast-Midwest Institute, where she was finishing up a massive report on fracking, a project that had kept her in regular communication with members of Congress, including the office of Dan Kildee, who represented Flint. She got in touch with Kildee’s office to share her concerns about Flint water and passed along my name and number to a staff member.

  Elin’s view all along was that the D.C. crisis had been prolonged and worsened because the District lacked congressional representation. For all Flint’s problems, we at least had congressional representation. If Representative Kildee could be brought in, made aware of the lead levels in Flint, we’d have more clout and more options.

  I didn’t know much about Kildee, except that he’d succeeded his uncle, Dale Kildee, who had been the congressman for the Flint area for almost four decades and had been an old-school New Dealer. Even if the nephew had gotten into office by trading on his locally famous name and had nothing else going for him, any congressman who represented and lived in Flint would surely have to
help. The controversy over the water switch had been bubbling for a while now. Some of his constituents were definitely mad, and hopefully they were also contacting his office with concerns.

  Sure enough, after a brief email exchange, Jordan Dickerson, Kildee’s legislative director on Capitol Hill, called me to talk. He sounded young, earnest, and thanks to Elin, already well-informed. He knew about the Del Toral memo, the pushback from the EPA, the lack of a response from the state agencies, and that I was looking at my kids’ blood-lead levels. He asked what I knew so far and what I needed.

  Quickly, I spelled out my request. The county and state collected children’s blood-lead levels for all of Flint. Could Representative Kildee’s office help me get them? To do the science right, we needed that large sample.

  After so much silence and feeling like I was shouting into the wind, I was greatly relieved to hear excitement in Jordan’s voice. He was on board and had the complete support of his boss. Better yet, he couldn’t wait to get started.

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  ELIN SENT ALONG NEWS of another big development: Marc Edwards and his Virginia Tech research team had more results posted online from extensive citizen water testing in Flint. In case there was any doubt about the urgency of the city’s water situation, the headline of Edwards’s report was bold and in all caps. If it were spoken, it would have been yelling:

  “FLINT HAS A VERY SERIOUS LEAD IN WATER PROBLEM.”

  The numbers were pretty dramatic. “Forty percent of the first draw samples are over five parts per billion. That is, 101 out of 252 water samples from Flint homes had first-draw lead more than 5 ppb.” The report went on to say that “several samples exceeded 100 ppb, and one sample that was collected after flushing exceeded 1000 ppb.” No level of lead is actually safe, but this meant a significant number of households had levels above the federal action level of 15 ppb.

  Those are scary numbers, sure to shock anybody with any knowledge of the consequences of lead as a neurotoxin. “Until further notice,” Edwards recommended that Flint water be used for cooking and drinking only if filtered first or after the tap was run for a full five minutes at a high flow rate.

  Elin and I texted back and forth, horrified by the numbers and wondering how the state would react. Can they really keep ignoring this? Both Dean Dean and Elin wrote with the news, according to MLive, that Edwards was returning to Flint the following week and was scheduled to appear at a town meeting on the evening of September 15, at Saints of God Church on Forest Hill Avenue. I added the town meeting to the calendar for my Community Pediatrics residents.

  Then I wrote to Elin, “I think we should meet him.”

  She called immediately, something she did only when she had too much to say and didn’t have the patience to type out her response. “All the water people are afraid of him,” she said.

  “Should I be?”

  Elin used words like “too intense” and “radioactive” to describe Edwards, saying that he didn’t play nice and seemed willing to attack almost anyone. If we wanted to convince state authorities to get on the right side of this issue, any connection to him could backfire. His battles with the EPA, the CDC, WASA, and the D.C. government were notorious in water circles and had sparked continuing investigations, hearings, and court cases. It had been a long and painful decade fighting governments and water utilities to root out lead from their water, an uphill battle that had left Edwards, according to things Elin had heard, emotionally and psychologically damaged.

  I googled Edwards while Elin and I talked. Wow, he even had a Wikipedia page. As soon as she and I said goodbye, I dug into it thoroughly. The page described the truly awful story of the D.C. crisis and listed Edwards’s various papers, awards, and accolades. I wasn’t really sure what a MacArthur Fellow was, so I clicked on the link to that website and found the page that described the genius award he’d received in 2007.

  Marc Edwards, a civil engineer, is playing a vital role in ensuring the safety of drinking water and in exposing deteriorating water-delivery infrastructure in America’s largest cities. An expert in the chemistry and toxicity of urban water supplies in the United States, he has made significant advancements in a broad array of areas, including arsenic removal, coagulation of natural organic material, and the causes and control of copper and lead corrosion in new and aging distribution systems. Melding rigorous science, concern for public safety, and dogged investigation, Edwards’s recent work focused on the identification and analysis of lead contamination in the Washington, D.C., area’s local water supply.

  I discovered that money came with a MacArthur award and wondered if Edwards had been able to pay off the second mortgage that Elin said he’d taken out to cover the costs of his own research in D.C. Who was paying for his work in Flint? It had to be pricey to travel five hundred miles with all these grad students time and time again.

  A few photos were offered at the bottom of his MacArthur Foundation page.

  MARC EDWARDS, IN THE PHOTO I SAW ON THE MACARTHUR FOUNDATION WEBPAGE

  There he was, Scary Marc. Except he didn’t look radioactive. Angular and chiseled, the guy was seriously handsome, as if he should be starring in a movie about water, not testing it himself.

  I couldn’t help but notice the bizarre necktie he was wearing. It was way too wide and had a couple of baby panda bears with really sad-looking faces on it. Who was dressing this man? Was he for real? How could you take a man in a panda tie seriously, much less find him scary? But apparently everybody in the water world did.

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  I FOCUSED AGAIN ON the blood-lead data from my clinic. Kay Taylor, the head of Hurley research, had answered my frantic email within an hour, with an equally urgent reply. Bless her. Kay has always been so supportive—and she epitomizes everything I love about working at Hurley, such a passionate, altruistic, and lean place to treat patients and train new doctors.

  Compared to other teaching hospitals, our research department isn’t that big—just a handful of staff—but we’re nimble and scrappy and always evolving to meet the research needs of my residents and faculty.

  Kay assigned a research coordinator, Jenny LaChance, to help me. Jenny and I had previously worked together on tight deadlines for grant applications and research projects, and had known each other since I was a medical student at Hurley. We were a good team. I love crunching numbers and trying to harness the power of data, but Jenny took that passion to a whole new level. Smart, logical, superscientific, and verging on obsessive, she loves nothing more than designing a foolproof study and figuring out the best way to collect and analyze data. Jenny could talk your ear off about power and sample size, positive predictive value, statistical significance, and absolute risk reduction, among other esoteric subjects.

  I left work early that day to take Elliott for another opinion about his shoulder. Along the way, as I weaved through Metro Detroit traffic, we talked mostly about the girls. They were in the middle of their first week of school and settling in fine. Homework was light. There was soccer practice, but no games yet. Other parents were helping with carpooling, and Elliott’s parents were bringing over the occasional meal. As we got deeper into the logistics of soccer and meals, I mentally checked out—thinking about a dozen other lead-related things. A pang of guilt brought me back to the car, and I forced myself to think about home life again.

  In the waiting room, I tried to catch up on the glut of half-ignored emails that were taking over my in-box—questions from my pediatric residents, scheduling dates for nutrition education meetings, motivational interview training, following up on a new resident from India who’d gotten in a car accident just a day after getting her driver’s license, and more back-and-forth banter with Roebuck about the new software tool that the IT folks were embedding in our EMR to help residents safely hand over patients between shifts. (“Your peeps are awesome,
give them a hug for me,” I wrote to Roebuck. He replied: “IT nerds don’t hug. Makes them uncomfortable. Instead we spread out fingers and either say ‘live long and prosper’ or ‘nanu nanu.’ ”)

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  I CALLED AN URGENT meeting for the next morning, September 9, with Jenny and my team of Community Pediatrics residents. I explained my hypothesis: that lead in the Flint tap water had ended up in the bodies of our children. Assembled around the rows of tables and chairs in our pediatric classroom, adjacent to my office, we pulled up the raw labs—the unfiltered data from patients’ charts—on the conference room screen.

  A quick glance at the numbers on the screen—before and after the water switch—appeared to show an increase. But I couldn’t give just a quick look and be certain, the way I might quickly look at the itchy bumps on a young patient’s legs and the miserable look in her eyes and immediately identify a rash as scabies—Look, here are the classic signs, the pathognomonic burrows.

  Analyzing data requires a nuanced approach and much more time. As I had learned as an undergraduate and later in medical school, a good study needs to take into consideration an array of factors to get the science right, then must be carefully designed for accuracy and clarity. Numbers may appear to be black-and-white and simple, but they have a way of hiding secrets if a study and analysis aren’t properly done. A lot of thinking goes into a study, and often there are many revisions, times when you have to start all over from scratch.