Marc had hacking stories too and warned us against communicating in email and texts. Partly worried and partly amused, Jenny and I kept our new study on an encrypted USB only, and drove it back and forth between our offices at Hurley and Rick’s office at MSU.
We used code names for each other in emails too, to protect our identities—and to allow us to be cynical and use expletives liberally. I have to confess that I found this kind of exciting; it reminded me of the noms de guerre of my uncle Nuri—“Anwar”—and many other dissidents at the time. (Even Haji had a code name, “Faris.”) Jenny was Red Panda. Allison was Little Bird. Rick was DikDik, which had something to do with his summer camp nickname as a boy. I was Fire Ant. I liked that.
Working quickly, with the tight, all-consuming focus that was becoming habitual for us, we finished the paper by late October and gave it to Elin, Marc, and Nigel Paneth, a pediatrician, epidemiologist, and distinguished professor at MSU, to review. They all gave us critical feedback and suggested revisions. Then we submitted it to the Journal of the American Medical Association, one of the most prestigious medical publications around, but it responded that it offered a rapid review process only for drug trials. Jenny quickly found that The American Journal of Public Health was willing to peer-review it as soon as possible. “Elevated Blood Lead Levels in Children Associated with the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response,” coauthored by all four of us, was accepted for publication on November 21 and went online a month later, right before Christmas.
Having the study peer-reviewed and published protected me from further criticism and laid the groundwork for more serious recognition of the crisis. It also gave me leverage when time came to talk about long-term care and prevention.
* * *
—
BUT MEANWHILE THE STATE was still playing catch-up and making some very stupid moves.
For starters, the governor’s office still seemed to downplay the health risk of lead to children, even after eighteen months of exposure. I guessed the staff was trying to make the crisis, and therefore their own complicity, seem less awful. And of course, money was a factor. The state had no budget yet to make a real response, and the scope of the liability for the harm caused was a big unknown. Lawsuits were being filed daily, a mix of class-action suits and individual cases, some by lawyers for the ACLU and the Natural Resources Defense Council on behalf of Flint residents. Some sought damages. Some sought immediate relief, like enforceable commitments to replace the lead pipes and to provide services for kids.
The intense panic in the governor’s office and the two agencies involved, the MDHHS and MDEQ, became obvious at a press conference on January 11, 2016. The plan was for Governor Snyder to come to Flint and meet with Karen Weaver, the new mayor, for the first time. (Dayne Walling had lost his bid for reelection on November 3, one of many political casualties of the water crisis.) Hoping to marshal support, the governor’s office called and asked me to attend.
I was conflicted about going. I didn’t want to be used—or become a Flint water crisis trophy for the same state government that had ignored the complaints of residents all these months and that would have continued to ignore them in perpetuity. And besides, I didn’t really know what the press conference was about. At the same time, I didn’t want to miss an opportunity to advocate for Flint kids. When I called Andy for his opinion, he said he didn’t know what it was about either, but he and Senator Ananich planned to be in the audience.
The initial meeting place was in the basement of Flint City Hall, where cabinet members and the new mayor gathered before the press conference. Eden Wells saw me and said she wanted to share something with me—preliminary graphs of the deaths from Legionnaires’. A quick glance said it all—there had been a huge spike in Legionnaires’ after the water switch. While I was processing this terrible news, which I hadn’t known much about previously, Nick Lyon appeared, glanced at the graphs, and said, “Can’t we just say this is due to seasonality too?”
I raised my eyebrows. Is he serious? Instantly I had a really bad feeling. I was in a room full of the people who had poisoned a city to save money. I was behind enemy lines. What was I doing with these people, and what was coming next?
Then the governor arrived. He had just left a heated meeting with the Flint pastors and something traumatic must have occurred there, because he was visibly shaking. I had never met the guy before, even though he’d been planted in my brain for weeks now. We greeted, exchanged niceties, Thank you for coming. Thank you for inviting me….
On our way to the press conference, in another room of City Hall, I could hear protesters chanting both outside and inside the building. I would have given anything to join them. But instead, I paraded in with the rest of the suits and landed in the second row directly behind the podium. A sea of reporters, microphones, and TV cameras spread out before us, but weirdly, the only people sitting in the auditorium were Senator Ananich and Andy.
I was a trophy—and captive.
AT FLINT CITY HALL, DURING THE GOVERNOR’S PRESS CONFERENCE, JANUARY 11, 2016, WITH EDEN WELLS (FAR LEFT), GOVERNOR SNYDER (AT PODIUM), KAREN WEAVER, AND NICK LYON (AT RIGHT)
The onslaught of misinformation and lies began. First, MDEQ blamed the high water-lead levels in the schools on the school fixtures. Then Nick Lyon stepped up to the podium and stated unequivocally that since October 1, 2015, forty-three kids had been exposed to lead.
He had a number.
It was forty-three.
I couldn’t believe what I was hearing. Had he really said forty-three? How had he arrived at that wholly inadequate number? Who had given it to him?
It was outrageous—medically ridiculous—to announce that only a few dozen kids had been exposed. The time frame was way, way off. By October 1, 2015, the exposure had been going on for eighteen months—and it was two weeks after my big press conference, when the word had already gone out to parents not to drink the water.
What about all the kids who had had elevated lead levels before October 1?
Another thing: only kids on public assistance had mandatory screenings for lead exposure, and less than half of those kids even got them. What about all the others? There were thousands of kids in Flint under six. And on top of that, the number didn’t account for pregnant women, newborns, or infants who drank the Flint water while MDEQ authorities were declaring how safe it was. Babies and children under one were not even tested, and when they were, it was well after the exposure was realized, and often too late for the lead to show up in their blood.
Every kid had been exposed.
Or, 8,657 had, to be exact, according to the census.
The state said it wanted to earn back the residents’ trust and make amends. But it didn’t want to admit the obvious: that the entire city of Flint and all its kids had been exposed to lead in the water—whether it was at home, at school, at Grandma’s house, or in a neighbor’s kitchen. Lead was in the water that had been mixed with formula and powdered lemonade and other drinks. Lead was in the water that had been used to boil macaroni and vegetables, to cook instant ramen. And when a child turned on the water fountain at a Flint school, lead had been in that water too.
I don’t have a poker face. This is why I can win at Konkan, because it isn’t a game of bluffing. But this time, my lack of reserve worked for me. In a matter of seconds after Nick Lyon opened his mouth, a dozen TV cameras could see that I wasn’t on board: I was shaking my head, shaking and shaking it. And every time Lyon said another stupid thing, I shook it again, visibly and actively and forcefully protesting. The governor’s office had invited me, but that didn’t mean I had to toe their line and smile like a fool. I caught a glimpse of Andy and Senator Ananich in the audience. They seemed despondent, kept looking at the ground. They were just as angry as I was.
As soon as the press conference ended, I shot an email to the gove
rnor’s office explaining that yes, the fixtures in the Flint school had lead, but it was released when they came in contact with untreated corrosive water. And saying that only forty-three kids in Flint had been exposed to lead was bogus. Next, I contacted the media, protesting the state’s weak understanding of population-wide exposure. To properly address the public health crisis in Flint, every child under six years old—8,657 kids—should be considered exposed to lead.
I worried that if I didn’t protest loudly and persistently, the downplaying and misinformation would live on. And indeed it did. The number forty-three was picked up again and again, even cited by The New York Times, to discuss the extent of the problem. But worst, in my mind, was the Kettering University president who used “forty-three” in a letter to students, staff, families, and alumni in an effort to keep Flint’s water from adversely impacting enrollment. When I heard about his letter, I contacted the president, who quickly posted a correction, removing the blood-lead data. But he stayed in damage control mode. Kettering was again living up to its namesake.
Something else lived on and on: the clip of my head-shaking protest during the governor’s press conference. It was on the nightly news. It made the rounds on the Internet. And probably because Rachel Maddow has an incredible research team that doesn’t miss anything, the head-shaking clip found its way to her show, which was way out ahead on Flint with cogent analytical segments, a mix of anger and concern for the kids.
She smartly connected the crisis to the undemocratic EM law, which she labeled “radical change” from “the way we govern ourselves as Americans.” And she was the first to say that the kids of Flint had been “poisoned by a policy decision.” As for the head-shaking clip, she said I was “badass.” I can’t imagine a better compliment.
Within a week, the state finally capitulated, and I finally felt we were on the same page, using the same numbers and the same words. The turning point came when Eden Wells told the Detroit Free Press that lead exposure was population-wide in Flint and not limited to a few dozen children. From a public health perspective, she said it was important to “consider the whole cohort” who had been “exposed to drinking water”—especially kids six and under who had been consuming the water since April 2014. The number forty-three vanished as mysteriously as it had arrived. All the kids in Flint had to be regarded “as exposed,” according to Eden, “regardless of what their blood level is [today].”
That was a victory. The future for the kids in Flint came down to a few coded words: “whole cohort” and “regardless.” Without a shared understanding of the problem—that all children needed to be protected and treated, whether or not they had problems, or will ever have problems—we couldn’t hope to arrive at solutions that would help everyone.
* * *
—
SHORTLY AFTER TAKING OFFICE, Flint’s new mayor, Karen Weaver, declared a citywide state of emergency. She had no formal power to do it, but around a small room, many of us urged her on, including a newly hired emergency responder for the county—and it worked. The declaration had a ripple effect and caused a new flood of media attention, forcing Governor Snyder to declare an emergency in Genesee County a few weeks later, which got the National Guard on the ground to distribute bottled water and filters, and which prompted President Obama to declare a “federal” emergency in Flint on January 16, 2016.
Being declared a “disaster” would have been better—and freed up even more resources—but it turned out that would have required a natural disaster like a fire, flood, or earthquake. It made me mad, since the potential consequences of the lead exposure are far longer lasting. Nevertheless, the federal emergency declaration was a big deal. For the most part, the feds knew what they were doing. It was no longer amateur hour. They understood the scope of the impact, and I never had to explain what toxic stress was. They got it, and they tried. Dr. Nicole Lurie, a seasoned physician and a uniformed U.S. public health service officer, took charge and coordinated the response from every acronym agency imaginable—FEMA, HHS, SBA, EPA, CDC, HUD, SAMHSA, and more.
By then, Jenny, Kirk, and I had been working on a list of interventions for a couple of months. I had looked at studies, researched programs, and called national lead experts, child development experts, and toxic stress and resilience experts. We wanted to recommend programs that had been tested and were proven to work. We let science tell us the best ways to protect children, promote their development, and improve their outcomes. This is what kids need everywhere, but especially Flint kids.
Most important, we needed to get them better food and nutrition. A child fully loaded with certain nutrients—especially iron and calcium—is less likely to have ongoing lead absorption and lead settling long-term in their bones. We needed to make sure every child in Flint had a regular pediatrician or “medical home,” where they could be treated and their progress reported. This medical home could check children’s development and coordinate with all the other programs, and help direct families toward other programs, like home visiting, breastfeeding and parenting support, early literacy, mental health, and transportation access.
The list kept growing. Kirk and I polished it, rewrote it, looked it over and over. We got it down to seven pages, so it was easy to read, the interventions organized by category, then prioritized. We hoped that would make a difference.
And then I got the idea to add a registry to the list. A registry of everyone exposed to the crisis, like the one for the victims of the PBB contamination in 1973, when nine million Michiganders had been exposed to a toxic flame-retardant chemical that causes permanent hormone disruption. Another prime example is the World Trade Center Health Registry, used for victims of 9/11—now the largest registry in the United States to track health effects of a disaster. Like those, the Flint registry had to include people who had moved out of the city, but our focus would be improving outcomes and supporting victims, not just monitoring. It would be a way to make sure that everyone was able to benefit from the advantages and resources that I was going to fight for—and I hoped would come.
Our document wasn’t just a list of demands on behalf of Flint kids: it was also a road map to intervention, throwing together everything that we knew worked for kids. And with it in hand, we hoped to enable government and donors to know exactly what was at stake—and what could be expected. We were already almost two years behind for Flint’s kids: two years of critical brain development had passed while they were consuming lead regularly. Whenever I thought of that, a sense of urgency took over, and I became single-minded about getting these programs funded and in place.
As the media focus on Flint sharpened, and I had more chances to speak out, I saw an opportunity. As the saying goes, “A crisis is a terrible thing to waste.” It wasn’t enough for me to give interview after interview, explaining how horrible the state’s actions had been, how tragic lead is for children, and how scary the implications were. More could be accomplished with a slightly different perspective from these scare-and-doom tactics. And that was to provide a sense of hope.
And it was with hope—and a commitment to justice—that MSU and Hurley stood beside me and helped me create something new: a model public health program to bring hope and healing to Flint. Coming up with that plan was like building an airplane in midair. But without a moment of hesitation, MSU’s Dean Dean and Aron Sousa, along with Melany at Hurley, helped me put it together. MSU made it clear that they would spare no effort to tackle the crisis. Our list of interventions grew and came to include continued advocacy, robust evaluation, and a promise to share our best practices with other struggling communities.
By this time, the immense generosity of people in the United States had been directed at Flint. Truckload after truckload of bottled water was delivered—sent by Girl Scouts in Ohio, UAW locals in Chicago, a ballroom dance club in Ann Arbor. Union plumbers volunteered countless hours installing and replacing filters, and joined the campaig
n to replace our nation’s millions of lead pipes.
The outpouring was tremendous. But soon we’d need more than bottled water. We would need an investment in the tomorrows of our children. Knowing that some of the effects of lead exposure might not be seen for ten years or more, Representative Kildee started talking about setting up a health fund of some kind, separate from the interventions that we were recommending.
In a small meeting, we decided that the best and most transparent place to house this kind of fund would be a community foundation. Kirk and I drafted the framework for a “tomorrow fund” with a twenty-year time frame. We created an advisory committee, established at the Community Foundation of Greater Flint, and I became the founding donor. We called it the Flint Child Health and Development Fund (FlintKids.org), with a goal of raising $100 million.
In January, once Flint had gained “federal emergency” status, we officially submitted our comprehensive science-based list of recommendations to the Emergency Operations Center. That is, we literally put this plan in front of everybody—the city, the state, and eventually the governor. Then we put it in front of the federal government.
This is what Flint kids need, we said.
This is what has to be done.
IN EARLY FEBRUARY 2016, I WAS sitting in the clinic, trying to catch up on my backlog of work, when four Michigan state police officers barged in. They had earpieces and dark suits and said the governor was going to pay me a visit.
But before he arrived, a team of guys with wands and all kinds of security gizmos swept and examined every nook and cranny of the clinic. What the hell? Most of the staff was shocked, but Arabs are used to this special attention.
Governor Snyder didn’t come alone. He was joined by a posse—Lieutenant Governor Brian Calley, who was in Flint a few days a week by then, MDHHS director Nick Lyon, and two indistinguishable top-level aides. Hurley is a diverse place—lots of women, lots of people of color, and a lot of white doctor coats. Now my tiny office was suddenly very crowded with dark suits, worn by five guys who were very tall and very white. Somewhere, down near the floor, were me and my medical student Joe. I felt like Bilbo Baggins when the dwarves keep showing up for the Unexpected Party at the beginning of The Hobbit.
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