What the Eyes Don't See

by Mona Hanna-Attisha

  Yet in Flint, everybody else who had gone up against the state had been attacked, so why was I so stunned? My brother, Mark, the whistle-blower lawyer, had warned me this could happen.

  A rush of doubts began to overwhelm me.

  The state employs dozens of epidemiologists with decades of experience. They were looking at their data, exactly the same kind of data as mine but more of it, and they were telling the world I was wrong. What if I was?

  I worried that I’d thrown everything away on a hunch.

  I worried that the results weren’t peer-reviewed.

  I worried that I was in way over my head.

  I worried, most of all, that I was doing exactly what the state accused me of: creating a problem where none existed and adding anxiety to the already stressed lives of my patients and our city.

  Elliott walked home alone from Layla’s school that night. I heard him enter the house, then rush upstairs. As soon as he found me, he tried to comfort me and even to coax me out of bed.

  I broke down, sobbing. “I just told all of Flint to stop drinking the water and that all their children are being poisoned.”

  “You did the right thing,” he said.

  “I don’t know.”

  “The kids of Flint needed you at that podium today.”

  “I don’t know.”

  He tried to distract me. “Scandal is premiering tonight,” he said.

  I had been waiting months for the new season—I’d even put the date down on the calendar.

  “Come on,” he said. “It’s just about to start. It might help get your mind off things.”

  “I don’t care.”

  “Mona.”

  I said nothing.

  “Mona.”

  Nothing.

  I felt defeated and so unbelievably small. In the coverage of the press conference, the media referred to me as a “local pediatrician.” Not a scientist, not an authority, not an academic. Local pediatrician. It was true. That’s what I was. But every time I read those words, I felt smaller and smaller, like a clueless quack, a know-nothing. What had I been doing holding a news conference? I had wandered out of my league—and was now being ridiculed. I couldn’t imagine feeling good again, ever.

  SOMEHOW I FELL ASLEEP, A COLLAPSE from total exhaustion. A good six hours passed, and I barely stirred. At three in the morning, I woke up. The house was dark and quiet. I sat up and took a deep breath. I found my glasses and put my hair up in a knot. I grabbed my phone and laptop and went downstairs.

  A new feeling was growing inside me. My despair was being replaced with something else—a sense of strength and certainty. This fight wasn’t about me. It had nothing to do with me. It was about Reeva and her sweet smile, that look of trust on her face. It was about the way Nakala’s fuzzy head felt in my hand.

  And it was about Jalen, who had pinkeye. And Macy, who told me at her four-year checkup that she wanted to be five years old.

  And Tyler, who sprained his ankle.

  And Sasha, who always asks if she can use the stethoscope to listen to my heart.

  And Brandon, Jasmine, Chanel, and Nevaeh.

  All the Flint kids I knew and saw, all the kids that I’d ever known and seen, were pushing me forward, lifting me up. This war of numbers and data was really about children. Each number on my spreadsheet was a child, a patient I’d seen and cared for. I knew their faces. I’d patted their heads, held their hands, hugged them tight. And for them, I’d keep fighting and never stop. Sure, I was a local pediatrician. But I was also a scientist, an advocate, and now an activist. Nothing was going to make me back down. Let the state “experts” come after me, try to destroy me with all their lies. They were scared and negligent and arrogant. They were incompetent, not me. In less than a few minutes awake, I was in high gear, making plans for my next move.

  * * *

  —

  OTHER THINGS KEPT ME GOING. Earlier in the night, Bebe had called. I prepared myself for the kind of backlash only my mom can deliver. So I didn’t let on how I was feeling or say anything about news stories or things being said by the state. I wondered what she knew but pretended everything was just fine and I wasn’t upset or troubled.

  “Shlonke?” It means “How are you?” in my mom’s soothing Baghdadi colloquial. Non-Iraqi Arabic speakers don’t understand it and sometimes make fun of it, but I find it comfort food for my ears.

  “Zayna.” “I’m fine.” Oops. Not my usual “super” or “awesome,” but surprisingly she didn’t catch on.

  “I watched the press conference on TV,” she said, then went on to say that my father woke up in the middle of the night in China to watch online. Afterward they Skyped and talked about it.

  I waited for that sound to come into her voice, the fear and panic, the aeb.

  I waited, but that night it didn’t come.

  “Mona,” she said. “You were so brave, mumtaz—excellent.”

  * * *

  —

  IN THE DARKNESS OF early morning, the room glowed from the laptop screen. I began to fight back.

  Science was on my side. Numbers don’t lie. Jenny and I had checked, double-checked, and triple-checked our findings. We had scoured the literature and replicated previous studies. We had controlled for seasons, used the appropriate age range, removed duplicates, analyzed for the highest lead level for each kid, and just to be sure, anticipating pushback, we had analyzed the first lead level too.

  No matter which way you ran them, the numbers came out the same. The conclusion was the same: they showed an increase in the percentage of children with elevated lead levels. But we knew that even this conclusion was a gross underestimation of exposure. The lead levels across the nation, the state of Michigan, and the city of Flint had been decreasing for the last several decades. An increase was highly unusual—an anomaly. If the percentage of children with elevated levels had stayed the same, or plateaued, it would still have been a red flag. But this was much worse.

  As part of the state’s counterattack, it released a tally sheet of total numbers of children in “City of Flint” zip codes with elevated lead levels by month for the past few years. It was a one-page PDF—not the raw numbers I had been pleading for—and was meant to be “proof” that I was wrong. It was basic and crude. The tally sheet showed monthly counts, used a large age range (up to sixteen), and looked only at first-time lead levels. At first glance, it didn’t show an increase in the raw numbers of children with elevated blood-lead levels. But honestly, it was so unsophisticated and unscientific, Jenny and I didn’t know what to make of it. There were no graphs or statistical analyses, which you would expect for something like this.

  Pulling my thoughts together, I quickly wrote an email to my team and to Ron Fonger, articulating why my science was solid and why the state’s numbers were different. Our studies were not even comparable, in an apples-to-apples way. And even if the state had done its analysis the same way and found numbers that were still not consistent with mine, it didn’t mean my numbers were wrong. Expecting that we might be in for a years-long fight, as in D.C., I tried to look ahead. I wasn’t going to give up on my faith in good science, but my focus had to be on marshaling irrefutable evidence of harm.

  We were in a numbers war.

  But the numbers were kids—real kids.

  Suddenly an idea came to me—a way to prove the state wrong and at the same time improve my own work. It involved the use of zip codes. For our study, Jenny and I had discovered that even if a child had “Flint” in her address, it didn’t necessarily mean that her house was receiving Flint water. Flint zip codes included kids who were not getting Flint water, and if they were included in a study, it diluted the harm.

  What if we looked at the blood data again, I thought, using geographic information systems (GIS) software to sharpen the exact neighborhoods in the city w
here the water was received? We could create maps of Flint—like John Snow’s maps of his London neighborhood during the cholera epidemic! And if the blood-lead levels of children in neighborhoods that only received Flint water still tested higher, the impact would be even more conclusive.

  As an undergraduate in environmental science classes, I had worked with GIS. But that was long ago and the software had evolved and improved. I wondered if my friend Rick Sadler, the nutrition geographer at MSU’s public health program in Flint, could help us. He usually maps grocery stores in urban areas to help identify “food deserts,” places where there was nowhere to buy real food. I knew he’d have the latest GIS software down cold. I emailed him, and he quickly agreed to help.

  * * *

  —

  THE WORDS “SPLICE AND DICE” were repeated throughout the next day and night, as the news cycle continued to run Flint water stories. Later on, in studies of the media coverage and its impact on the Flint crisis, Thursday, September 24, would mark a high point. The state showed no signs of backing down or even checking its facts. But good things were starting to happen too—important shifts, small and large.

  On Friday morning, the day after our press conference, the mayor’s office issued a “lead advisory.” I had no idea what that meant, but it was a good start. Finally, people would be informed. And I was thrilled to hear that the brand-new superintendent of the Flint Community Schools had unilaterally decided to stop allowing the kids to drink the water in school. When it comes to protecting kids, pediatricians and educators are almost always on the same page.

  In constant communication with Jenny and me, Rick began geomapping the kids with elevated blood-lead levels in Flint—and within a day, we had new findings. The more precise mapping technique increased the percentage of kids with elevated lead levels to more than double. And it allowed us to pinpoint hot spots in certain wards and neighborhoods with the most elevated blood-lead levels. Any doubts vanished, but while it was gratifying to know my work held up, it was also devastating.

  The same day, I spoke with Kristi Tanner, a statistician with the Detroit Free Press who had been assigned to review the tally sheet released by the state. I shared my study with her, describing how we had carefully designed the work, factored for seasonality, and still found rising blood-lead levels.

  Tanner and reporter Nancy Kaffer reviewed my research and did their own analysis of the state’s ridiculous data release. The next day the Free Press ran their story. It not only backed me up, it called for action. This time, rather than referring to me as a “local pediatrician,” I was a “hospital researcher.”

  Data that the State of Michigan released last week to refute a hospital researcher’s claim that an increasing number of Flint children have been lead-poisoned since the city switched its water supply actually supports the hospital’s findings, a Free Press analysis has shown.

  Worse, prior to the water supply change, the number of lead-poisoned kids in Flint, and across the state, had been dropping; the reversal of that trend should prompt state public health officials to examine a brewing public health crisis.

  Yes, you read that right. The state’s single-minded mission to distract and deny had caused it to miss the fact that its own summary data—made public—confirmed my study rather than undermined it. The newspaper ran a hard-hitting editorial by Kaffer that took on Governor Snyder directly: “It’s hard to understand the resounding yawn that seems to have emanated from the governor’s office, following news that an increasing percentage of Flint kids have been lead poisoned after a switch in the city’s water supply.”

  The Detroit Free Press carried weight, and people would pay attention. Would Governor Snyder?

  * * *

  —

  WHILE WE WAITED AND pushed and insisted, our first priority was to get clean water to the kids and their families. I shared my updated analysis highlighting the hardest-hit neighborhoods with other members of my team, and they made those places our priorities. They began grappling with logistics of water and filter distribution while I was consumed with my Flint kids.

  What would their future hold?

  I tried to see down the road and consider what they would need. Thinking of the Flint sit-down strikers and other effective organizers, I decided we needed to compile a list of demands right away. I had learned that tactic back in Roberta Magid’s SEA club. A list of demands gives your advocacy mission focus and direction. Otherwise, you could waste all the time and energy you spent getting to the bargaining table.

  Where did we want to wind up? What should we hold out for?

  A list began appearing in my mind. There is no magic pill for lead exposure—no antidote, no remedy, no time-honored or easy solution. The treatment is prevention. With lead, public health people strive for primary prevention, but we were way beyond that. So the next step was secondary prevention, which is what you do when a population is already exposed to something but you want to limit the impact. Lead may have already harmed Flint children, but there were things we could do to help them.

  Fortunately, in the last decade, there’s been a lot of research on how to deal with the lasting impact of toxic stress. Some of the advances came from technological breakthroughs in neurology and the study of brain development. Other advances came from work in the fields of trauma and economics.

  To put it as simply as I can: early trauma and toxic stresses leave a mark on the brain and change neural pathways. Children exposed to adversity need to be soothed, loved, and taught how to cope and be resilient; they need to be properly nourished and surrounded by people who value them; they need policies that support them. With all these in place, they can cope and rebound; otherwise they may be living with the impact forever.

  And then it hit me. Lead was only one of many developmental obstacles that our children faced. We had to frame their population-wide lead exposure, the entire trauma of the water crisis, as an additional toxic stress to a community already rattled with toxic stresses. This would give us a playbook of sorts. Our knowledge of the plasticity of the brain, its ability to rebound despite adversity, gave us hope. There were things we could do, interventions that were known to mitigate toxic stress. We had a scale we could tip. The burgeoning neuroscience in this area gave us the answer: the treatment was to build resilience.

  There were tested ways to improve a child’s chances of a healthier life by investing in them, especially the youngest and most vulnerable—early education, family support, proper nutrition, school health, and quality childcare. We needed what experts were now calling an “ecobiodevelopmental” approach, with short-term, intermediate, and long-term interventions that touched every level of a child’s life. Science had been ignored and denied in Flint, but it was science that was critical to uncovering the crisis. Our science spoke truth to power. And now I wanted the science of child development to lead the way in our recovery.

  Kirk and I began formalizing a list of demands for Flint kids. I wanted a long list. I wanted a complete one. I wanted the most extensive and proven-to-work interventions available, regardless of expense. My Flint kids deserved this and more.

  * * *

  —

  I KNEW INSTINCTIVELY THAT I had to be strategic about the media. Almost as soon as I stepped away from the microphone at the press conference, I was drowning in interview requests. Sure, I could say the exact same thing every time. But what would have the most impact? Doctor-activist Alice Hamilton once again became my role model. I was going to make my case as loudly and clearly and scarily as possible.

  Doctors are trained to be calm and comforting. But this wasn’t a time for that. Now that I had a microphone in front of me, I was going to talk about the truly scary things we were facing, with no sugarcoating. Neurotoxicity. Epigenetic or multigenerational effects. Permanent cognitive impairment. Criminal behavior. All these were entirely preventable, literally man-made.


  I was going to talk about the GM engine parts that corroded. I was going to talk about the Flint residents and activists who had been dismissed and ignored. Over and over again, I was going to say, “There is no cure.” It was all true—and had the side benefit of being shocking and terrifying. I wanted people to hear me on the radio and see me on TV and come away as angry and freaked out as I was.

  Every day I had at least one interview. One day I knocked out fifteen—on TV, radio, and print. It was exhausting. Some days all I did was talk, talk, talk to reporters. It got to the point that Elliott and the girls saw more of me on TV than at home. The Hurley press office was overwhelmed with requests, and they tried to do their best but couldn’t keep up. They were used to preparing for one media event a month, like a prostate-screening fair. So I began organizing much of the media end of things myself.

  There were stories, and stories about the stories, most of them local and state outlets, but the Canadian Broadcasting Corporation, our friends in the north, had also found us. So had National Public Radio’s All Things Considered. After many months of national media inattention for Flint, I didn’t want to miss any opportunity to be heard. I didn’t want to grow tired of explaining—or become overwhelmed.

  To make things easier, I told reporters to just call me what my patients did: “Dr. Mona.” Otherwise, I’ve got a long and unwieldy string of names, too foreign for some to pronounce. And when I’m Mona, the name Haji presciently gave me, or even Dr. Mona, I feel more relaxed. It seems friendlier and more personal. I felt that way about the media—and really grateful. It was the day-in, day-out work of local reporters Curt Guyette and Ron Fonger, in print and online, along with Lindsey Smith from Michigan Radio, and others, that kept the Flint story alive.

  Wurfel stayed on message and continued to try to discredit me. With the release of my research, the water controversy in Flint was reaching “near-hysteria,” he said. There it was again, the sexist hysteria, the word used against Alice Hamilton. I wore the insult like a badge of honor.