What the Eyes Don't See_A Story of Crisis, Resistance, and Hope in an American City

by Mona Hanna-Attisha

  As a mom and a pediatrician, my heart ached for her. I wondered when we were going to learn from our past mistakes, when our policies would finally catch up with science. Science tells us that there is no safe level of lead. All the federal lead exposure standards are out of date. Rulemaking for something so crucial should not take almost a decade. Every day children are trapped and held hostage by bureaucratic governmental processes.

  We know the right policies and practices to eliminate lead exposure for all children. And we even know the economic benefit. But we continue to kick the can down the road, putting the future of our most vulnerable kids at risk.

  As Marc and I walked on, I kept thinking about that activist mom. And I knew that years from now Flint moms would surely wonder the same thing: How much lead was my child exposed to, and what did it do to her?

  At the hearing, the EPA allowed us to make a case for a stronger Lead and Copper Rule in two-minute allotments. A bunch of us were there—Representative Kildee, Senator Ananich, LeeAnne Walters, Curt Guyette, and others. After the testimony, Marc and I headed to Capitol Hill to continue our advocacy. We first went to Kildee’s office for a meeting, where we ran into the legendary water warrior Erin Brockovich, and then we went on to see Senator Gary Peters before going our separate ways. Marc had a class to teach remotely.

  I had a meeting with Senator Stabenow, who had kept her promise and, in record time, paved the way to make ready-to-feed formula available for all Flint babies, like Nakala.

  Just before we parted, Marc said, “Can I speak to you?” and pulled me into a small room in Senator Peters’s office. During the day, I had noticed he seemed a little strung out and preoccupied. Aside from his two-minute testimony to the EPA, he had been quiet. Was it hard for him to be back in D.C., I wondered, where he undoubtedly had so many bad memories?

  “You are amazing at this,” he said as soon as we were alone. “Do you know that?”

  I was embarrassed and wanted to stop him, deny what he was saying, be humble, dismiss it, change the subject, and remind him that this was part of my job. This was what pediatricians were supposed to do, what we take an oath to do.

  But I’ll confess, it also felt good to bask in the sunshine of this compliment, coming from a man who had been in the trenches, been an activist for kids, fought harder and longer than I had—and put more on the line. What he was saying, really, was that I could do things he couldn’t: spread hope, bring people together, control a room. His heart and his science were in the right place, but he wasn’t an organizer or an optimist.

  It wasn’t really what I had achieved that impressed him. It was what we had all achieved together. We were, as he said, “a dream team.”

  It wasn’t lost on either of us that we were lucky to be able to speak out—that we had the support and academic freedom of the public land grant universities where we taught and did research. Both Michigan State and Virginia Tech had our backs and urged us on.

  Marc continued, probably sensing how much it meant to me. I connected with audiences, he said. I connected emotionally—I made people feel engaged and angry and ready to help, ready to fight. “You are a force of nature,” he said.

  Not long afterward he gave me a necklace made from a slice of lead pipe that came from a D.C. home where a child had high lead levels—and the city kept denying that any plumbing in the house contained lead until the pipe was dug up. When he gave it to me, plated in gold, he said he hoped it would be a constant reminder of my commitment to all kids.

  I keep it with me always, wherever I go.

  * * *

  —

  ELIN AND I ORDERED our lunch and chatted in that casual old-friends way about parents, kids, schools. Sitting across from her, I noticed she seemed lighter. Her manner was easier. She was more like her younger self, her high school and college self. Her years in D.C.—the dismay, the disturbing realization that “environmental protection” can mean all kinds of things, including butt-covering, pointless exercises, and pro-industry agendas—had left her burdened and puzzled. She had carried around a sense of disappointment in life, a kind of existential dissatisfaction. But now, that heavy air around her had cleared.

  Eight months had passed since the noisy barbecue at my house where she cornered me to tell me about the water in Flint. It seemed like a lifetime ago. It almost felt like we were both new people now, older and wiser, but also younger and more hopeful. I had spent the better part of these months in meetings, giving interviews and speeches. I had seen Marc many more times over the winter and spring, at hearings, Flint water meetings, and various functions where we shared our accounts of the Flint story. Time magazine cited us in its annual list of the world’s most influential people, and, most memorably for Mama Evelyn, I received a Detroit Pistons jersey with my name on it during a halftime show.

  All the recognition was largely awkward. I often feel like a broken record, always repeating that I was doing my job, adhering to an oath I had taken when I became a doctor. And that my activism on behalf of Flint and the kids of Flint is a privilege, full of its own rewards that have nothing to do with awards. Although I wouldn’t wish the state’s attack machine on anyone, my woes are nothing compared to the daily deprivations inflicted on the people of Flint, who, at this time, still do not have drinkable tap water. They are the heroes of this crisis.

  What I liked most was the chance to explain, to share the latest developments in Flint, to tell the stories—and to track the lessons. I hope that somehow what happened—the resistance, the science advocacy, and the coalition building—inspires others to fight the injustices around them.

  “I told you,” Elliott liked to say. “I told you that you could do it—that you’d find a way to fight for Flint kids. And you did.”

  “You never said that,” I liked to respond, as stubbornly as possible. And it always made him laugh.

  In early March, he’d had another operation on his shoulder—to repair the mistakes made in the botched first surgery—and he was recovering quickly this time, and making plans to build a tree house in our backyard.

  Nina and Layla still complained that I was gone too much—and traveling too much—but they were happily obsessed with Simba, an emotionally needy rescue cat that followed them all over the house, never leaving them alone.

  Marc stayed with us during his frequent pilgrimages to Michigan, where he served on various committees and continued water sampling. By then, he wasn’t just my close friend; he was a good friend to my entire clan—my brother, the girls, Simba—and was carefully monitoring Elliott’s progress on his treehouse plans.

  And even though the road to clean tap water in Flint would take years, and the people of Flint still had a lot of suffering ahead, Marc always says that what happened here—in contrast to D.C.—was a “miracle,” something he would never have believed possible.

  Doctors aren’t really supposed to be mystical, but sometimes the whole thing had a “meant to be” feeling, starting with the wild coincidence that Elin had been right there at the EPA throughout the D.C. crisis.

  Water treatment engineers aren’t supposed to be mystical either. “Before Flint, my career was a total mystery to me,” Elin confessed at lunch. “None of it made sense. So many times I have looked back at my choices and career moves and wondered, What was I thinking? But now I see that each move was a piece in the puzzle, so that I could be standing right there in your kitchen at exactly the right time. It all makes sense to me now. There was a point to all those twists and turns.”

  This was a daunting revelation coming from a woman so confident and strong. But the more I thought about it, the more I realized that Elin’s description really described my own life. Like lots of young people, I was drawn to advocacy, but the chance to really do something meaningful had come by accident. I was the right person in the right job, with the right set of skills, with the right team, who saw a chance
to make a difference. For me to push through and succeed, many random aspects of my life came into play and helped me, from the resilience of my long-dead ancestors and the courage of my progressive family to my many mentors who fostered my environmental activism, which started in high school and grew in college, and my background in hard-core science.

  The Flint water crisis never should have happened. It was entirely preventable. And when the water supply was switched and not properly treated, it should have ended when the residents raised their voices and their jugs of brown water. I certainly wasn’t the most important piece of the Flint puzzle. So many others—LeeAnne, Miguel, Elin, and Marc, the dozens of tireless Flint activists and local journalists—were instrumental and critical.

  I was just the last piece. The state wouldn’t stop lying until somebody came along to prove that real harm was being done to kids. Then the house of cards fell.

  * * *

  —

  I FINALLY HAD A chance to talk to Bunyan Bryant, the environmental justice pioneer, when I received the Michigan Environmental Council’s Distinguished Service Award, named after environmentalist and former Michigan governor William Milliken. The last time I’d seen Bunyan was more than a decade earlier at my brother’s wedding to Annette, an environmental lawyer who’s even closer to Bunyan.

  * * *

  —

  PRESENTING AN AWARD TO BUNYAN BRYANT, FLINT ENVIRONMENTAL JUSTICE SUMMIT, MARCH 2017

  Bunyan’s family is still in Flint, and his lifelong fight for justice buzzed through my mind as I talked a mile a minute about the Flint water crisis with him. He is suffering from Parkinson’s now. His wife tells me he has good days and bad. I had the great fortune of seeing him on a good day. Always the professor, he had some keen observations to share. I knew he was thinking about all the places plagued by ongoing environmental injustice—including the many communities with lead contamination much worse than Flint’s. He couldn’t quite respond a mile a minute, but I knew his sharp mind was taking everything in. Bunyan’s lifetime achievements and contributions in environmental justice gave me, and all of us, a way to see the Flint crisis through his eyes, and a framework and language to understand it—truly an enduring legacy.

  Mostly, I wanted to thank him. Throughout the Flint crisis, I stood on the shoulders of giants—incredible giants I intimately worked with, like Marc Edwards, and giants who walked a long time ago, like Alice Hamilton and John Snow, who paved the way. Bunyan Bryant is definitely one of them.

  NAKALA CAME TO THE CLINIC FOR her eighteen-month checkup in October 2016. Reeva spotted me in the hallway while her baby sister was being weighed. “Dr. Mona! We saw you on TV!” I waved her over, lifted her up, and squeezed her tight. Holding her hand, we walked over to the bookshelf and looked at newly stocked Reach Out and Read books. We grabbed a couple, and a Richard Scarry classic for Nakala.

  Back in the exam room, I smiled at Grace, their young mom. She seemed more grown up, more confident somehow. She and I had more of a relationship than I have with most of my patients. I met her when Nakala was just four months old, the week I learned about the Flint water, and somehow those memories are seared together in my mind. When I thought of the babies of Flint, I always thought of sweet Nakala, who was now a chubby, happy, walking-and-talking toddler.

  I had done a lot of apologizing to Grace a year earlier. “I told you the water was fine for Nakala’s formula, and it wasn’t,” I had said. “I’m so sorry. I had no idea.” Moms are always right. Every parent should listen to that primal instinct to protect their kids.

  “I knew it wasn’t fine,” Grace replied, much to my relief. “My auntie told me. She’s Nakala’s godmother, and her water was brown and smelled. My water seemed okay, but my auntie told me not to use it. I said, ‘I can’t afford bottled water,’ so she bought it for me.”

  Allison and I had seen Nakala for her checkups when she was six, nine, twelve, and fifteen months old. Over the year, Grace mixed her formula with bottled water that she got from her auntie, then from her church, the food bank, and the National Guard. She cooked Reeva’s meals with it too.

  The medical assistant came to take Reeva for her blood draw. She was getting her lead level checked. Her first lead level, taken the year before, was high—26 μg/dl—and now she was getting it checked again. After that, she’d have her hearing and vision checked, and get a ten-dollar prescription for fruit and veggies at the Flint Farmers’ Market, which becomes twenty dollars with the Flint expansion of Double Up Food Bucks.

  As soon as they left, Grace let down her guard and gave me an all-too-familiar look of fear, anxiety, and guilt. “Is she going to be okay?” she asked. “Both of them. Are they going to be okay?”

  Reeva was three years old that autumn. She had been drinking contaminated water most of her life, during the most critical period of brain development. And even though Nakala was spared the water in her formula, Grace had drunk it during her pregnancy.

  A year before, their water at home had been checked and found to be 150 ppb, something Grace would never have known on her own, because lead in water is colorless, odorless, and tasteless. At their auntie’s house, it was 3,000 ppb, and a neighbor down the street had a level of 13,000 ppb. Putting this into perspective, 15 ppb is the federal action level (and that’s set too high)—and 5,000 ppb is the hazardous waste level. Drinking Flint water after the water switch was like drinking through a lead straw. You never knew when a piece of severely corroding lead scale would break off and fall into the drinking water and into the bodies of our children. When I found out that a group home for abused and neglected kids near the hospital had a water-lead level over 5,000 ppb, I was the maddest and saddest I’d ever been in my life. These kids literally had every adversity possible. It was like the world was conspiring to keep them down.

  Grace worried a lot. And there were days when she looked terrorized and down. I couldn’t blame her. Every day in Flint, our families had been waking up to a nightmare of water contamination, betrayal by every governmental agency charged with protecting them, and years of neglect and poverty. Many of the families who want to call it quits and leave Flint can’t sell their homes, because the home values have tanked. Those who remain feel angry at everyone almost every day. It is community-wide PTSD. The mental health problems are now just as serious as the physical ones.

  * * *

  —

  MY FAMILY CAME TO the United States basically as refugees fleeing oppression, in search of a peaceful and prosperous place for my brother and me to grow up. The American Dream worked for us.

  But sitting with Nakala in my lap, I realized that America has changed a lot since I was a little girl. Yes, people are still running to America, or at least trying to. It remains the epitome of prosperity for the entire world, the richest country that ever was. But there really are two Americas, aren’t there? The America I was lucky to grow up in, and the other America—the one I see in my clinic every day.

  In that other America, I have seen things I wish I’d never seen. The things you run from, not toward. Things that would never be part of any dream. And for too many people, this nightmare is taking place right outside their front door.

  Sometimes I joke that I was born an activist. But it’s not really a joke. I was born into a family that was on the move toward something better, and I was born into a life knowing there is injustice in the world—and the importance of fighting it. And that’s exactly what my babies in Flint are born into—sweet little ones like Nakala. For them, life is a struggle from the very beginning. That can make a baby a fighter. Because for Nakala and Reeva, every little thing—sometimes things as simple as a meal or clean water or a bath—can require a fight.

  Where is the American Dream in this scenario? It’s not there. It’s not even talked about. It is becoming so out of reach. Income and wealth inequality make mobility tough. Stagnation is now the norm. At
the end of their lives, most children wind up where they started. Not just Flint’s kids but children in Detroit, and Los Angeles, and Chicago, and Baltimore, and all over rural America. Black, brown, and white. Too many kids are growing up in situations stacked with insurmountable toxic stresses and every barrier imaginable. Too many kids are growing up in a nation that does not value their future—or even try to offer them a better one.

  That’s not how it’s supposed to be. The Dream shouldn’t have to come by way of a miracle. It should come fairly to all and be big enough for everybody to achieve. The environment shouldn’t be stacked against anybody, especially our kids. We owe it to them and to one another.

  As a doctor, what can I prescribe for our sons and daughters of the other America?

  This is what I thought about that day with Grace, when she asked me about her girls, and if they were going to be okay. Nakala was still snuggling on my lap.

  “What can I do?” Grace asked.

  “Keep doing everything you are already doing. Love them, talk to them, sing to them, read to them, give them great food,” I replied. I encouraged her to fill the “nutrition prescriptions” downstairs at the farmers’ market for fresh produce, and urged her to sign up for WIC. There is a special Medicaid expansion and universal early-intervention development support offered to Flint kids. “You have also been getting the home delivery of kids’ books every month, right?” Mental health support is nothing to be ashamed of, I said, “so here is the number to the trauma crisis line if you need it. Don’t forget about the mindfulness workshops—they have them in the schools now too. Parenting support classes are being held on Tuesdays, and they even do home visits.” I took a breath and said, “And make sure you come visit me often.”