When Dr. Hanna-Attisha, a pediatrician in Flint, Michigan, sensed that there might be a problem with the city’s water, she pursued it herself, despite coming under scrutiny and criticism.
Flint, Michigan was hit particularly hard by the great recession. The state appointed an emergency manager to try to stabilize the city’s fiscal crisis. One of the cost-saving measures he undertook in April of 2014 was to switch the city’s water supply from the Detroit water system to the Flint River.
The change did not go unnoticed. People in Flint began to complain that the water had strange colors and odors and tasted bad. A General Motors engine plant stopped using Flint’s water when they noticed engine parts were corroding. Health officials reassured the community that the water was safe. We know now that they were wrong.
Dr. Mona Hanna-Attisha is a pediatrician who directs the pediatric residency program at Hurley Medical Center in Flint. She is a life-long Michigan resident and the mother of two daughters. Over the summer she hosted an old friend for dinner. This friend had worked for the EPA and told her how the District of Columbia in 2003-2004 changed their water treatment procedures, causing lead to leach from connector pipes linking water mains to indoor plumbing in some older homes. Hearing this caused Dr. Hanna-Attisha to wonder if this could be happening in Flint. She knew how to find out.
The American Academy of Pediatrics (AAP) guidelines recommend checking lead levels in children at ages 1 and 2 years if they are enrolled in Medicaid or have risk factors for lead exposure, such as living in older housing. Dr. Hanna-Attisha had access to the lead test results of the children followed at the Hurley Medical Center. So she compared the lead levels of 1 and 2 year olds seen at Hurley in 2013, before the switch over, and in 2015, after the switchover. What she found was a doubling of the number of children with elevated blood lead levels. In some neighborhoods, a tripling was observed.
Dr. Hanna-Attisha went public with her findings. Her results were dismissed, labeled “unfortunate” and she was accused of spreading groundless hysteria. She was so shaken by this she felt ill. Going over her data repeatedly she confirmed her results and persisted in pushing public health officials until they reviewed their own data more closely and confirmed she was right.
How had they missed it? Their data was accrued at the county level and included areas that were not exposed to the Flint River water. This diluted the impact of the water change. When they looked only at children exposed to the Flint River water they saw the same rise in lead levels that Dr. Hanna-Attisha had noticed. Now Dr. Hanna-Attisha has been asked to head a multidisciplinary task force, the Pediatric Public Health Initiative, to use educational, nutritional and other interventions to mitigate the long-term effects of the lead exposure on the children of Flint.
This was not Dr. Hanna-Attisha’s first foray into environmental activism. When she was a high school student she belonged to a group called Students for Environmental Awareness. Group members helped shut down an incinerator in Madison Heights, Michigan.
Thanks in part to Dr. Hanna-Attisha’s investigation, Darnell Earley is in the hot seat. The Flint emergency manager from September 2013 to January 2015, Earley oversaw the change in Flint’s water supply from Detroit to the Flint River. After leaving Flint, he was appointed emergency manager of the troubled Detroit Public schools but is stepping down from that position February 29 after controversial decisions made there led to “sick-outs” by Detroit teachers dissatisfied with his leadership.
Michigan governor Rick Snyder has faced heavy criticism for his failure to act fast enough in the Flint water crisis. He is now being called on to testify before a House committee.
EDs are somewhat uniquely positioned to see what is going on in the community through our interactions with patients of every age group and consultants of almost every specialty. We can sometimes be the first to notice a problem or trend. How can we use this power for good? We would be wise to pay attention to how one person, standing up for what she thinks is right, can lead the way and change the shape of the future.