What the Eyes Don't See

Introduction

In 2014, the city of Flint, Michigan changed its water source from Lake Huron to the Flint River in an attempt to save money. This decision set off a chain of events that would lead to one of the worst public health crises in recent American history. Dr. Mona Hanna-Attisha, a pediatrician in Flint, became an unlikely hero when she uncovered the devastating effects of lead poisoning on the city's children and fought to bring the truth to light.

"What the Eyes Don't See" is Dr. Mona's gripping account of how she used science to prove Flint was being poisoned by its own water supply. It's a story of environmental injustice, government negligence, and the power of persistence in the face of denial and intimidation. But it's also a deeply personal story about family, activism, and the immigrant experience in America.

This book takes us behind the scenes of the Flint water crisis, revealing how a city was poisoned and how one doctor rallied a community to fight back. It's a tale of crisis, resistance, and hope that reminds us of the importance of standing up for what's right, even when powerful forces stand in opposition.

Dr. Mona's Family Legacy of Activism

Dr. Mona Hanna-Attisha's story begins long before the Flint water crisis. Her family history is steeped in a tradition of activism and resilience that would shape her own path as a crusader for public health.

Born in Sheffield, England in 1976, Mona was the child of Iraqi immigrants who had left their homeland in search of better opportunities. Her parents always hoped to return to Iraq one day, and they regaled young Mona with stories of Baghdad's rich history as a center of learning and scientific advancement.

But the Iraq of her parents' memories was far different from the reality under Saddam Hussein's oppressive Ba'athist regime. Mona's family had a long history of standing up against injustice, even in the face of grave danger.

Her grandfather Haji was a beloved figure known for his generosity and inclusiveness. When his perfume factory burned down, the entire community came together to help him rebuild, demonstrating the power of community support in times of crisis.

Even more influential was Haji's cousin Nuri, a lifelong activist who fought against imperialism and fascism. Nuri's dedication to his principles, even when it meant exile or imprisonment, left a lasting impression on the family. His unwavering commitment to fighting injustice would later inspire Dr. Mona in her own battles.

This family legacy of activism and resilience laid the foundation for Dr. Mona's future work. It instilled in her a sense of duty to stand up for what's right and to use her skills and knowledge to help others, especially those most vulnerable.

Flint: A City of Struggle and Resilience

Dr. Mona's connection to Flint began during her medical training, but the city's story of struggle and resilience stretches back much further. Once a thriving industrial center, Flint's history is intertwined with the rise and fall of the American auto industry.

The city's fortunes were closely tied to General Motors, which established major manufacturing facilities there in the early 20th century. Flint became known as "Vehicle City," a symbol of American industrial might. But this prosperity came at a cost, with workers facing dangerous conditions and exploitation.

In 1936, Flint workers staged a historic sit-down strike at GM's Fisher Body Plant. For 44 days, they occupied the factory, enduring harsh tactics from management. Their perseverance paid off, leading to the recognition of the United Auto Workers union and improved conditions for workers across the country. This event, known as "The Strike Heard Around the World," exemplified Flint's spirit of resistance and collective action.

However, Flint's challenges were far from over. The city struggled with deep-seated racial inequalities that persisted for decades. As African Americans moved north during the Great Migration, seeking better opportunities, they faced discriminatory housing policies and segregation in Flint.

The post-war economic boom largely bypassed Flint's Black residents, who were often confined to substandard housing near polluting factories. Attempts at integration were met with racist resistance, and "white flight" to the suburbs further exacerbated racial and economic divides.

The 1980s brought more hardship as GM began closing plants and moving jobs overseas. Flint's economy, so dependent on the auto industry, was devastated. The failure of misguided revitalization efforts like the AutoWorld theme park only added to the city's woes.

By the time Dr. Mona arrived in Flint for her medical training, the city had become a poster child for post-industrial decline. Yet amid the challenges, she found a community of resilient people determined to persevere and rebuild their city.

This complex history of struggle, resistance, and resilience forms the backdrop for the water crisis that would soon engulf Flint. Understanding this context is crucial to grasping the full scope of the injustice that unfolded and the community's determination to fight back.

The Seeds of Crisis: Flint's Financial Troubles and the Emergency Manager Law

The roots of the Flint water crisis can be traced back to the city's dire financial straits and a controversial Michigan law that allowed for the appointment of emergency managers to oversee struggling municipalities.

In 2011, facing severe budget deficits, Flint came under the control of an emergency manager appointed by the state governor. This effectively stripped power from the city's elected officials, including the mayor. The emergency manager's primary mandate was to cut costs, with little regard for the long-term consequences of those cuts on residents.

The use of emergency managers in Michigan had a disproportionate impact on communities of color. By 2013, over half of the state's African American residents lived in cities under emergency management, compared to just two percent of white residents. This disparity highlighted the racial undertones of the policy and its implementation.

It was in this context of financial crisis and loss of local control that the fateful decision to change Flint's water source was made. In an effort to save money, state-appointed officials decided to switch the city's water supply from Lake Huron (via Detroit's water system) to the Flint River.

This decision, made without adequate study or preparation, would prove catastrophic. The Flint River had long been polluted by industrial runoff, and its water was known to be more corrosive than that from Lake Huron. Crucially, officials failed to add necessary anti-corrosion treatments to the new water supply.

The switch was made on April 25, 2014, marking the beginning of the crisis. Almost immediately, residents began to complain about the water's color, smell, and taste. Many reported health issues they believed were related to the water.

Despite these complaints, state officials repeatedly assured residents that the water was safe to drink. They dismissed concerns and manipulated water quality tests to hide the growing problem. This pattern of denial and deception would continue for months, even as evidence of lead contamination began to mount.

The Flint water crisis thus emerged from a perfect storm of factors: a city in financial distress, a loss of local democratic control, short-sighted cost-cutting measures, and a systemic disregard for the wellbeing of a predominantly low-income, minority community.

The Dangers of Lead and the Vulnerability of Children

To understand the full impact of the Flint water crisis, it's crucial to grasp the severe health risks posed by lead exposure, particularly for children. Dr. Mona, as a pediatrician, was acutely aware of these dangers, which made the crisis all the more alarming to her.

Lead is a potent neurotoxin that can cause wide-ranging and irreversible health effects. Even low levels of exposure can be harmful, especially to developing brains and bodies. There is no safe level of lead in the human body, particularly for children.

The effects of lead poisoning can be devastating and long-lasting. In children, lead exposure can cause:

• Developmental delays
• Learning difficulties
• Behavioral problems
• Reduced IQ
• Hearing and speech problems
• Stunted growth
• Damage to the nervous system and kidneys

What makes lead particularly insidious is that its effects are often not immediately apparent. Symptoms can take years to manifest, by which time significant damage may have already occurred. This "silent" nature of lead poisoning makes it all the more dangerous.

Children are especially vulnerable to lead poisoning for several reasons:

1. Their developing brains and bodies absorb lead more readily than those of adults.
2. They are more likely to ingest lead through normal hand-to-mouth behavior.
3. Their smaller body size means that even small amounts of lead can have significant effects.
4. The impacts on their developing brains can have lifelong consequences.

In Flint, the risk was particularly acute for infants consuming formula mixed with contaminated tap water. These babies were essentially being fed a daily dose of lead, potentially setting them up for a lifetime of health and developmental challenges.

Dr. Mona understood that the stakes couldn't be higher. Every day that passed with children drinking lead-contaminated water meant more potential for harm. This urgency drove her determination to uncover the truth and push for action, even in the face of official denials and pushback.

The Flint water crisis wasn't just about dirty water – it was a potential public health catastrophe that threatened to impact an entire generation of the city's children. This understanding fueled Dr. Mona's relentless pursuit of justice and her efforts to not only expose the problem but also to develop long-term solutions to support affected families.

Dr. Mona's Discovery and Initial Research

Dr. Mona's involvement in uncovering the Flint water crisis began almost by chance. In August 2015, at a casual barbecue with friends and family, she had a conversation that would change everything. Her friend Elin, who worked for a Washington D.C. think tank, asked if she had heard about problems with Flint's water.

Elin shared information about a leaked memo from the Environmental Protection Agency (EPA) that suggested dangerously high levels of lead in Flint's water. This revelation shocked Dr. Mona, who had been reassuring parents that the city's tap water was safe to use, based on official statements from state authorities.

Disturbed by this information, Dr. Mona immediately began investigating. She started by looking at blood lead levels in children before and after the water source change. What she found was alarming: there was a significant increase in the percentage of children with elevated blood lead levels after the switch to Flint River water.

This initial finding spurred Dr. Mona to dig deeper. She expanded her research, gathering more data and analyzing it carefully. She was determined to build a solid, scientifically rigorous case that could withstand scrutiny and potential pushback from officials.

Key aspects of Dr. Mona's research included:

1. Comparing blood lead levels in Flint children before and after the water switch
2. Analyzing data from a broader age range and larger sample size
3. Accounting for seasonal variations in lead levels
4. Collaborating with other experts to verify her findings

Throughout this process, Dr. Mona faced numerous challenges. She had to work quickly, knowing that every day of delay meant more children potentially exposed to lead. She also had to navigate the complex politics surrounding the issue, aware that her findings would likely be contested by state officials.

Despite these obstacles, Dr. Mona pressed on. She was driven by a deep sense of responsibility to her patients and the Flint community. Her medical training and family history of activism had prepared her for this moment, and she was determined to use her skills to protect Flint's children.

As her research progressed, Dr. Mona became increasingly certain that Flint was facing a major public health crisis. The data was clear: lead levels in children had increased significantly since the water source change. Armed with this evidence, she prepared to bring her findings to the public, knowing that doing so would likely spark controversy but believing it was necessary to protect the health of Flint's residents.

Going Public: The Press Conference and Immediate Backlash

On September 24, 2015, Dr. Mona took the bold step of presenting her findings to the public in a press conference. This event marked a turning point in the Flint water crisis, bringing the issue into the national spotlight and setting off a fierce battle over the truth of what was happening in the city.

Dr. Mona's presentation was clear and compelling. She laid out the evidence showing a significant increase in blood lead levels among Flint children following the water source change. To drive home the human impact of the crisis, she concluded by holding up a baby bottle, a poignant reminder of who was most at risk.

The immediate response to the press conference was mixed. While some, including Michigan Senator Jim Ananich, voiced support for Dr. Mona's findings, others were quick to dismiss or discredit her research.

The backlash came swiftly and forcefully:

1. The Michigan Department of Health and Human Services (MDHHS) claimed that Dr. Mona's report merely showed normal seasonal fluctuations in lead levels.

2. Officials from the Michigan Department of Environmental Quality (MDEQ) accused her of "slicing and dicing" data to make the situation appear worse than it was.

3. State officials continued to insist that Flint's water was safe, attributing any lead issues to problems with individual home plumbing rather than the water supply itself.

4. Even the governor's office worked to discredit Dr. Mona's findings.

This pushback took a toll on Dr. Mona. She faced public ridicule and felt the weight of standing alone against powerful state institutions. There were moments of doubt and despair, where she questioned whether she had done the right thing by going public.

However, Dr. Mona's resolve quickly returned. She reminded herself that this fight wasn't about her – it was about the children of Flint and their right to safe, clean water. She stood firm in the face of criticism, confident in the validity of her research and the importance of her message.

In the days following the press conference, Dr. Mona continued to speak out, giving interviews to local and national media outlets. She tirelessly explained her findings, defended her research methods, and emphasized the urgent need for action to protect Flint's residents.

This period was a crucial test of Dr. Mona's determination and resilience. Despite the intense pressure and criticism, she refused to back down. Her persistence in the face of official denials would prove crucial in eventually forcing acknowledgment of the crisis and spurring action to address it.

Turning the Tide: Building Support and Forcing Action

As Dr. Mona continued to advocate for Flint's children, the tide slowly began to turn. Several factors contributed to shifting public opinion and forcing officials to acknowledge the crisis:

1. Media Coverage: Dr. Mona's press conference and subsequent interviews generated significant media attention. Journalists began investigating the story more deeply, helping to keep the issue in the public eye.

2. Community Activism: Flint residents, armed with Dr. Mona's findings, became more vocal in their demands for clean water and accountability. Protests and community meetings put pressure on local and state officials.

3. Support from Experts: Other scientists and public health experts began to corroborate Dr. Mona's findings. This included Marc Edwards, a Virginia Tech professor with experience exposing lead contamination in Washington D.C.'s water supply.

4. Flaws in the State's Response: The state's attempts to discredit Dr. Mona's research began to backfire. Their own data, when properly analyzed, actually supported her conclusions.

5. Political Pressure: As the story gained national attention, politicians at various levels began to call for investigations and action.

A key turning point came when Dr. Mona had a productive conversation with Dr. Eden Wells, Michigan's chief medical officer. Despite initial skepticism, Dr. Wells came to support Dr. Mona's findings, providing a crucial voice of reason within the state government.

Gradually, official denials began to crumble:

• On October 1, 2015, state officials held a press conference acknowledging problems with Flint's water, though they still downplayed the extent of the crisis.

• The Genesee County Health Department declared a public health emergency, and water filters began to be distributed to Flint residents.

• On October 8, 2015, Governor Rick Snyder announced that Flint would switch back to Detroit water, supplied from Lake Huron.

• In January 2016, President Obama declared a federal emergency in Flint, freeing up additional resources to address the crisis.

Throughout this period, Dr. Mona continued her work on multiple fronts:

1. She refined and expanded her research, leading to a peer-reviewed study published in the American Journal of Public Health.

2. She developed a comprehensive public health program to address the long-term impacts of lead exposure on Flint's children.

3. She advocated for policy changes and funding to support Flint's recovery and prevent similar crises in the future.

4. She continued to speak out, ensuring that the story of Flint remained in the public consciousness even as other news events threatened to overshadow it.

Dr. Mona's persistence, combined with growing public awareness and support from other experts and activists, finally forced meaningful action to address the Flint water crisis. While the battle was far from over, these developments marked a crucial shift from denial to acknowledgment and the beginning of efforts to remedy the situation.

The Deeper Roots of the Crisis: Systemic Issues Exposed

As the immediate crisis in Flint began to be addressed, investigations and public scrutiny revealed deeper, systemic issues that had allowed the disaster to unfold:

1. Environmental Injustice: The crisis highlighted ongoing environmental racism in the United States. Flint, a majority-Black city with high poverty rates, had been subjected to environmental hazards for decades. The water crisis was a stark example of how marginalized communities often bear the brunt of environmental risks.

2. Governmental Failures: Investigations revealed multiple levels of governmental failure:

   • The emergency manager law, which prioritized cost-cutting over public safety
   • The Michigan Department of Environmental Quality's lax enforcement of water quality standards
   • The EPA's slow response to early warnings about lead contamination
   • A culture of dismissiveness towards residents' complaints and concerns

3. Lack of Transparency: Freedom of Information Act requests revealed that officials had hidden or downplayed evidence of problems with Flint's water. There were instances of data manipulation and deliberate attempts to mislead the public.

4. Infrastructure Neglect: The crisis exposed the dire state of water infrastructure in many American cities, particularly in older, industrial areas like Flint.

5. Public Health Preparedness: The slow response to the crisis revealed weaknesses in public health systems and their ability to detect and respond to environmental health threats.

Several key investigations shed light on these issues:

• The governor-appointed Flint Water Advisory Task Force (known as the "Five Guys Committee") produced a scathing report that linked the crisis to the emergency manager law and failures at multiple levels of government.

• A Michigan Civil Rights Commission report explicitly cited racial discrimination as a factor in the crisis, noting that it was unlikely to have occurred in a wealthier, whiter community.

• Congressional hearings and criminal investigations led to charges against several officials involved in the crisis.

These revelations sparked broader conversations about environmental justice, the importance of government accountability, and the need for investment in public infrastructure and health systems.

Dr. Mona used her platform to advocate for addressing these root causes:

1. She pushed for changes to the emergency manager law and other policies that had contributed to the crisis.

2. She advocated for increased funding for public health and environmental protection agencies.

3. She emphasized the need for greater diversity in decision-making roles to ensure that marginalized communities' voices are heard.

4. She called for a renewed focus on environmental justice and the elimination of disparities in environmental risk exposure.

The Flint water crisis thus became a catalyst for examining and addressing deeper societal issues. While the immediate focus was on fixing Flint's water system and helping affected residents, the crisis also sparked important conversations about equity, justice, and the responsibilities of government in protecting public health.

Long-Term Impacts and Ongoing Challenges

While the switch back to Lake Huron water and the distribution of filters and bottled water addressed the immediate crisis in Flint, the long-term impacts of lead exposure and the challenges of rebuilding trust and infrastructure remained significant:

1. Health Impacts: The full extent of health effects from lead exposure may not be known for years. Children exposed to lead during critical developmental periods could face lifelong challenges, including cognitive impairments, behavioral issues, and increased health risks.

2. Mental Health: The crisis took a severe toll on the mental health of Flint residents. Many experienced anxiety, depression, and post-traumatic stress related to the water crisis and its aftermath.

3. Economic Consequences: The crisis had significant economic impacts on Flint, including decreased property values, business closures, and increased costs for healthcare and social services.

4. Infrastructure Challenges: Replacing Flint's aging water infrastructure, including lead service lines, is a massive and expensive undertaking that will take years to complete.

5. Ongoing Water Quality Concerns: Even after the switch back to Lake Huron water, many residents remained skeptical about water safety, continuing to rely on bottled water and filters.

6. Trust in Government: The crisis severely eroded trust in government institutions, making it challenging to implement recovery efforts and address other community needs.

To address these ongoing challenges, Dr. Mona and others advocated for comprehensive, long-term solutions:

1. Health Monitoring: Dr. Mona helped establish programs to monitor the health of exposed children over time and provide interventions as needed.

2. Early Childhood Support: Recognizing that early intervention is crucial, programs were developed to provide additional educational and developmental support for Flint's children.

3. Nutrition Programs: Given that good nutrition can help mitigate some effects of lead exposure, efforts were made to improve access to healthy foods in Flint.

4. Mental Health Services: Increased resources were directed towards mental health support for residents affected by the crisis.

5. Infrastructure Investment: Significant funding was secured to begin the process of replacing lead service lines and upgrading Flint's water infrastructure.

6. Community Engagement: Efforts were made to involve Flint residents in decision-making processes about recovery and rebuilding efforts.

7. Policy Changes: Advocacy continued for policy changes at the state and federal level to prevent similar crises in the future and to address environmental justice issues more broadly.

Despite these efforts, recovery in Flint remains an ongoing process. The crisis exposed deep-seated issues of inequality and neglect that will take years, if not decades, to fully address. Dr. Mona and other advocates continue to push for sustained attention and resources for Flint, emphasizing that the story didn't end when the national spotlight faded.

The Flint water crisis serves as a stark reminder of the importance of vigilance in protecting public health, the need for responsive and accountable government, and the ongoing struggle for environmental justice in America.

Lessons Learned and Call to Action

The Flint water crisis offers numerous lessons and calls to action for public health professionals, policymakers, and citizens:

1. Importance of Scientific Integrity: The crisis underscores the critical role of rigorous, independent scientific research in protecting public health. It highlights the need for scientists to speak truth to power, even in the face of political pressure.

2. Environmental Justice: Flint exemplifies the disproportionate environmental risks faced by low-income communities and communities of color. It calls for a renewed commitment to addressing these disparities and ensuring equal protection for all.

3. Government Accountability: The crisis reveals the dangers of prioritizing cost-cutting over public safety and the importance of transparent, accountable governance at all levels.

4. Infrastructure Investment: Flint's story is a wake-up call about the state of aging infrastructure in many American cities and the urgent need for investment in these critical systems.

5. Community Engagement: The crisis demonstrates the importance of listening to and involving community members in decisions that affect their health and well-being.

6. Preparedness and Response: It highlights the need for robust public health systems capable of quickly detecting and responding to environmental health threats.

7. Long-term Commitment: Addressing the impacts of environmental disasters requires sustained attention and resources long after the immediate crisis has passed.

Dr. Mona's work during and after the crisis provides a model for engaged scholarship and advocacy. She emphasizes several key points for those seeking to make a difference:

1. Use Your Voice: Professionals have a responsibility to speak up when they see injustice or threats to public health.

2. Build Coalitions: Effective change often requires working across disciplines and sectors, building alliances with diverse stakeholders.

3. Empower Communities: Lasting change comes from empowering affected communities to advocate for themselves.

4. Persist in the Face of Adversity: Change often requires facing opposition and setbacks. Persistence and resilience are crucial.

5. Focus on Solutions: While exposing problems is important, it's equally vital to work towards constructive solutions.

6. Think Long-term: Addressing complex issues like those exposed in Flint requires sustained effort and a long-term perspective.

The book concludes with a call to action for readers to become engaged in their own communities, to stay informed about environmental and public health issues, and to use their skills and voices to fight for justice and equity.

Dr. Mona's story serves as an inspiration, showing how one person's dedication and courage can spark a movement and bring about meaningful change. She encourages readers to see the Flint water crisis not just as a tragedy, but as a call to action – a reminder of the ongoing work needed to ensure safe, healthy environments for all communities.

Conclusion

"What the Eyes Don't See" is more than just an account of the Flint water crisis. It's a powerful testament to the importance of scientific integrity, community activism, and the relentless pursuit of justice in the face of systemic failures.

Dr. Mona Hanna-Attisha's journey from concerned pediatrician to public health crusader illustrates the critical role that individuals can play in exposing injustice and driving change. Her story is a reminder that the most significant threats to public health often lurk beneath the surface, requiring vigilance, expertise, and courage to bring them to light.

The book paints a vivid picture of Flint – its rich history, its struggles, and the resilience of its people. It shows how the water crisis was not an isolated incident, but the result of decades of disinvestment, racial discrimination, and governmental neglect. In doing so, it connects Flint's story to broader issues of environmental justice and equity in America.

Perhaps most importantly, "What the Eyes Don't See" is a call to action. It challenges readers to look beyond the surface, to question authority when necessary, and to stand up for the health and well-being of their communities. Dr. Mona's example shows that one person, armed with facts and driven by compassion, can make a profound difference.

The book ends on a note of cautious hope. While the challenges facing Flint and many other communities remain significant, the response to the water crisis demonstrated the power of collective action and the possibility of positive change. It serves as a reminder that the fight for clean water, healthy communities, and environmental justice is ongoing – and that it requires the engagement and commitment of all of us.

In the end, "What the Eyes Don't See" is not just about what happened in Flint. It's about what can happen anywhere when we fail to protect our most vulnerable citizens. And it's about the change that's possible when we open our eyes, raise our voices, and take action to create a more just and equitable world.