A pediatrician in Flint, MI faced a torrent of criticism and official denials when she discovered her patients were being poisoned by dangerously high levels of lead in their water. Here's the inside story of how she fought back.
The right person, in the right place, at the right time.
That’s how Mona Hanna-Attisha’s describes herself when discussing her decision to sound the alarm regarding the contaminated water crisis in Flint, MI. But Hanna-Attisha, MD, MPH, FAAP (pictured, left), director of the pediatric residency program at Flint’s Hurley Medical Center, did more than simply raise a red flag. She carried that flag into battle.
In April of 2014, the City of Flint switched to a new water source as a temporary solution before a new water service came on line. Almost immediately, residents complained the new water was brown and smelly. Local and state officials dismissed the concerns, but Hanna-Attisha decided to look at the evidence. She was shocked by what she saw: Vastly elevated lead levels in the blood of local children. She double-checked the results. Then she went public.
“This was our job,” she says of the decision to release her research. “And if it wasn’t going to be done by the state health department, we had an ethical, moral and professional obligation to do so.”
Hanna-Attisha is a first-generation immigrant. Her family is from Iraq, but she was born in the United Kingdom where her father was studying to obtain his PhD. The plan was for the family to return to Iraq. But it was the late 1970s and Saddam Hussein had just come into power. Going back was not an option.
“We moved here for the American dream,” Hanna-Attisha says of her family’s uprooting when she was age 5. “My family emphasized the importance of education and of service to community—wherever that community may be. So I think the work I do was influenced by my family and the struggles they had gone through.”
It may seem unusual for a hospital physician to become an advocate for large-scale public health, but Hanna-Attisha says that everything in her past training, and in her current role at Hurley Medical Center, prepared her for the water crisis in Flint.
“My job is to train the next generation of pediatricians,” she explains. “The focus of our training program is pediatric public health. We tell our future pediatricians that they are advocates. This is their job. They are the voice of children, especially in underserved communities.”
So when she and her staff routinely screened children for lead and found that the percentage of children with elevated levels doubled across the entire city, even tripled in some neighborhoods, she was resolute.
“I had no hesitation on what to do next.”
Peer-reviewed journals, not press conferences, are the typical venue for releasing medical research. But time was of the essence, and far too much time had already slipped away.
“As physicians we know the consequences of lead,” Hanna-Attisha says. “We know what it has done and will do to our community. We had no choice.”
Almost immediately after the press conference health officials from the state of Michigan attacked Hanna-Attisha and her colleagues.
Brad Wurfel, a spokesman for the state’s Department of Environmental Quality, accused Hanna-Attisha of contributing to “near-hysteria” in Flint, calling her “an unfortunate researcher” and dismissing her data, according to Crain’s Detroit Business.
“I wouldn't call them irresponsible. I would call them unfortunate," Wurfel said, in September, more than a year after the water switch. “Flint's drinking water is safe in that it's meeting state and federal standards. The system has an aging portion that needs to be addressed. They haven't had meaningful maintenance for four decades or more."
The criticism was physically jarring, Hanna-Attisha said.
“When the state with its team of 50 epidemiologists tells you that you’re wrong, how can you not second-guess yourself?” she recalls. “However, that lasted maybe two to three hours. We knew our numbers were accurate, so we went on the offensive.”
Lead is an irreversible neurotoxin that impacts cognition and behavior. It affects every organ system, and can cause a child’s IQ to drop due to the inability to focus and handle schoolwork. That’s well known. But with state officials refusing to acknowledge the connection between elevated lead levels and the change in water service, it was up to Hanna-Attisha to turn that knowledge into action.
“We are flipping the story,” she says. With the help of Michigan State University and Hurley Children’s Hospital, she launched a comprehensive pediatric public health initiative. “We want to show the nation that, yeah, Flint has this (crisis), but we’re not going to sit back and do nothing. We are going to throw every single evidence-based intervention at these children now to mitigate the impact of the exposure.”
The Power of Hope
Hanna-Attisha says the Flint community has been “absolutely traumatized.” Each day she sees the fear and trauma in families’ eyes. It’s trauma born out of two years of government betrayal, she says, but also the unknown. Parents ask, “What is going to happen to my child?” Hanna-Attisha and her colleagues actively assure them that not every child will experience every potential problem.
“If we can build the support of a nurturing environment, those wrap-around services, the early education, the healthcare access and nutrition access, we can bring back hope into our community,” Hanna-Attisha says. “They need that hope. They need that resilience. Because there’s so much fear and despair right now. It’s absolutely heartbreaking.”
Hanna-Attisha says the community has not stopped fighting since the water service change first raised concerns in April 2014. She says the heroes in this story are the Flint residents.
“We are a resilient community, with so much history and pride,” she says. “Flint put the world on wheels. There’s such incredible history. We’ve been through a lot, and we’re hoping that this is just a speed bump and that we can turn lemons into lemonade and have an even brighter future for our children.”
A Call to Physicians
Hanna-Attisha says children are foremost in Hanna-Attisha’s mind. If she’s not focused on the health and wellbeing of the children in the community, she’s spending time with her own—two daughters, ages 9 and 7.
“They are my absolute number one priority,” she says. “They’ve obviously been a little neglected recently, but they understand. And we’ve been blessed with so much family support.”
Meanwhile, Hanna-Attisha continues the fight. She was recently invited by Nancy Pelosi (D-CA), minority leader of the US House of Representatives, to come to Washington and speak about the challenges the residents of Flint face. And now she’s calling on other physicians to make their respective voices heard within their own communities.
“There’s evidence that as physicians go through training for medical school, residency, their careers, they get jaded and they lose their focus of why they went into medicine,” Hanna-Attisha says. “Physicians get consumed by EMRs and ICD-10 and reimbursements, and have lost the realization that they are valuable members of their community. Physicians need to realize their voice is powerful. And that wherever they are, in whatever they are doing, they can have a tremendous impact in their community.”