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

by Mona Hanna-Attisha

  I started elementary school in Michigan when I was four, after my parents mistakenly wrote my birth date in European style on the school forms; it was misunderstood as September 12 rather than December 9, which meant I was always the youngest in my class. Just before Christmas at Mama Evelyn’s, I turned five. Thanks to the cartoons I watched on TV and my kindergarten class at Houghton Elementary, when my parents asked me a question in Arabic, I did a new thing.

  I answered in English.

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  WE WERE DRIVING THROUGH Gaylord, just fifty miles south of the Mackinac Bridge, when our car hit a patch of black ice. Before I could react or even call out, the Monte Carlo began swerving and sliding. It slammed into the metal guardrail and spun away, crossing the lines in the middle of the road and veering onto the opposite lanes of the highway, where it smashed into another guardrail and kept spinning.

  I was flying, as if I were weightless, from one side of the car to the other. Our car kept grinding against the guardrail until the guardrail ran out and there was nothing left to break our slide. The unstoppable Monte Carlo fell headlong into a ravine, crashing and crushing trees on its way down.

  I have a faint memory of flashlights and an ambulance. My mom was crying and pulling me into the front seat, onto her lap. I saw blood on my dad’s forehead. I blacked out.

  The next morning I woke up in the pediatric wing of a hospital in Traverse City. I couldn’t move my neck. I couldn’t really move at all. The pain was terrible, but I remained silent, afraid to make a noise. My mom was trying to communicate with the hospital staff in her limited English, which did not include any medical terms. She was worried about my mouth. Something didn’t look right to her. My face seemed crooked.

  A young woman in a white coat quietly entered the room. She listened closely to my mom. Then she came to the side of my bed and looked at me. She had brown skin and dark hair, like me. She smiled a big smile. She held my small hand firmly in hers. She told me I was going to be okay.

  It took a while for me to get better. A spinal injury. A broken jaw. I had some operations. My neck was in some sort of brace. My top and bottom teeth were wired together. My mom slept with me at the hospital. Once back home, she put rice and stews, timen wa maraca, in a blender and turned them into smoothies that I could drink through a straw. I missed a month of kindergarten. The sturdy Monte Carlo was totaled. But I was okay.

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  —

  SOME THIRTY-PLUS YEARS LATER, I’m wearing the white coat. I’m smiling at the beautiful brown girl in front of me and firmly holding her hand. She’s going to be fine, I tell her. She was mixed up in an accident. A lot of kids were. The accident wasn’t her fault. And it is my job to make sure she is okay.

  THIS IS THE STORY of the most important and emblematic environmental and public health disaster of this young century. More bluntly, it is the story of a government poisoning its own citizens, and then lying about it. It is a story about what happens when the very people responsible for keeping us safe care more about money and power than they care about us, or our children.

  The crisis manifested itself in water—and in the bodies of the most vulnerable among us, children who drank that water and ate meals cooked with that water, and babies who guzzled bottles of formula mixed with that water. The government tried hard to convince parents the water was fine—safe—when it wasn’t. But this is also a story about the deeper crises we’re facing right now in our country: a breakdown in democracy; the disintegration of critical infrastructure due to inequality and austerity; environmental injustice that disproportionately affects the poor and black; the abandonment of civic responsibility and our deep obligations as human beings to care and provide for one another. Along with all that—which is a lot already—it’s about a bizarre disavowal of honesty, transparency, good government, and respect for scientific truth.

  Those are demoralizing realities to face. But there is another story, another side of Flint. Because it is also a story about how we came together and fought back, and how each of us, no matter who we are—a parent, an activist, a schoolteacher, a pediatrician—has within us a piece of the answer. We each have the power to fix things. We can open one another’s eyes to problems. We can work together to create a better, safer world, a place where all children can develop without obstacles and barriers, without poisoned water or callousness toward their dreams.

  There are lots of villains in this story. A disaster of this scale does not happen completely by accident. Many people stopped caring about Flint and Flint’s kids. Many people looked the other way. People in power made tragic and terrible choices—then collectively and ineptly tried to cover up their mistakes. While charges have been brought against some of the individuals who were culpable, the real villains are harder to see.

  Because the real villains live underneath the behavior, and drive it. The real villains are the ongoing effects of racism, inequality, greed, anti-intellectualism, and even laissez-faire neoliberal capitalism. These are powerful forces most of us don’t notice, and don’t want to. These villains poisoned Flint with policy—with decisions that were driven by lack of hope in government. If we stop believing that government can protect our public welfare and keep all children safe, not just the privileged ones, what do we have left? Who are we as a people, a society, a country, and a civilization?

  For all the villains in this story, there are also everyday heroes: the people of Flint. Each one has a story to tell—100,000 stories in all—about months of pain, anger, betrayal, and trauma, along with incredible perseverance and bravery. Flint fought hard, never gave up, and turned a devastating crisis into a model of resilience. But this book is only my story, told from my narrow perspective, as a doctor and as a brown immigrant in a majority-black city. It cannot attempt to do justice to all the stories that need to be told. No one book could.

  But I will share with you a few stories of my Flint kids. They are my inspiration. To protect their privacy and dignity, I have changed or modified their names and identities. In some cases, composites have been created that are based on real patients and real encounters. They are strong, smart, beautiful, and brave—and so resilient.

  Resilience isn’t something you are born with. It isn’t a trait that you have or don’t have. It’s learned. This means that for every child raised in a toxic environment or an unraveling community—both of which take a terrible toll on childhood development and can have lasting effects—there is hope. This is another way we can come together and each be a piece of the answer, not just for Flint and places like Flint, but for children anywhere who bear the brunt of life’s hardest blows, and live with poverty, violence, and hopelessness. Resilience is the key, the deciding factor between a child who overcomes adversity and thrives and a child who never makes it to a healthy adulthood.

  Just as a child can learn to be resilient, so can a family, a neighborhood, a community, a city. And so can a country. A country can endure trauma and neglect and become a place where people are cared for, where democracy and equality and opportunity are once again encouraged and advanced. Where poverty is silenced instead of people. Where we nurture one another and create stable and safe environments for all children to grow up.

  This is where healing begins.

  IT WAS COLD AND RAINY ON the summer morning of August 26, 2015—that predictably unpredictable Michigan weather. I dropped my two daughters off at Skull Island, an ominously named summer camp they were trying out for a few days, and got to Hurley later than usual. Once inside, warm, musty air greeted me, that old-hospital smell wafting through the brightly lit corridors of glossy tile.

  I reached my office on the pediatrics floor and immediately felt behind the door for my white coat. Wearing the coat always made me feel better, stronger, protected—it was my armor. Then I swung a stethoscope around my neck, completing my transformation from civilian to doctor. />
  At my desk, I read the local news online for a few minutes—just a quick scan—and noticed another story about the tap water in Flint. Residents were complaining, authorities were explaining. This had been going on for so long, more than a year already. It had become a loop of white noise. Turning my attention to the multicolored grid of my online calendar, I got a handle on the day ahead. It was packed—a crush of meetings, four, five, six of them, for research projects, curriculum changes, faculty recruitment. Somehow, wedged between the meetings, I had to answer emails and read other material, mostly prep for more meetings.

  On the home front, a barbecue was beginning to materialize for later that night—a spontaneous, last-minute gathering. I’d discovered that my high school friend Annie Ricci was in town for a few days, and we’d decided to get together with another old friend, Elin Warn (now Betanzo). We had all been friends since our freshman year at Kimball High School in Royal Oak, the inner-ring working-class Detroit suburb where my family had landed after my dad was hired by General Motors. Annie is an opera singer in New York City now. Elin is an environmental engineer who moved back to the Detroit area after many years in D.C. They were both in my wedding, but not as bridesmaids in matching dresses. I didn’t have any of those. Elin and Annie were both serious musicians, so I asked them to perform—and they did.

  I reached into the pocket of my white coat for a pen and felt the plastic tip of an otoscope, that pointy tool that doctors use to look inside a child’s ear. The coat may have been my soft cotton armor, but as far as I can tell, the real reason doctors wear white coats is for the pockets. Otherwise there’d be no place to store all our pens, pagers, cellphones, reference cards, tongue depressors, penlights, mints, Chapstick, and otoscope tips.

  My fingers felt a scrap of paper, and I pulled it out. The paper was covered in crayon scribbles. A memento. I remembered where it had come from and smiled. Reeva had given it to me. She was a watchful two-year-old who had been coming to our clinic since she was born at Hurley Medical Center.

  The week before, Reeva’s four-month-old baby sister, Nakala, had been in the Hurley Children’s Clinic for a routine checkup. One of my pediatric residents, Allison Schnepp, was seeing Nakala; I was the supervising physician. Nakala’s mom, Grace, a young African-American woman with a steady gaze and hair pulled under a loose cap, told us she wanted to stop breastfeeding. I urged her to continue, but she said she’d made up her mind. Breastfeeding took too long and was a hassle—plus, she had to go back to work. She was a waitress, and there was no place to pump in the restaurant except the restroom that all the customers used. She couldn’t afford to do anything that jeopardized her job. As it was, she wasn’t getting enough hours to make ends meet.

  She planned to switch to powdered formula mixed with water but had some concerns. “Is the water all right?” she asked, looking skeptical. “I heard things.”

  Reeva walked toward me with her hand out. Kids love to distract a doctor who is giving total focus to a younger sibling. So I turned my full attention to Reeva, and she placed the torn scrap of paper in my open hand. She had a sheepish smile, as if she were handing me a secret message, and we shared a conspiratorial look.

  “Thank you, Reeva,” I whispered. “I’m going to keep this right here in my pocket.” Then I sat her down on my lap.

  The water. I’d been asked about it before.

  “Don’t waste your money on bottled water,” I said, nodding at Grace with calm reassurance, the way doctors are taught. “They say it is fine to drink.”

  Inches away, Reeva watched me carefully. I smiled at her again, gave her an extra squeeze, and then put her down.

  I patted Nakala’s fuzzy little head and touched her fontanel, or soft spot, out of habit, to check its size. It was my chance to explain to Grace that her baby’s skull was open because her brain was still growing. This was the time to stimulate her baby by singing, talking, and reading. Then I gave Grace another nod.

  “The tap water is just fine.”

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  I WANTED TO BE a doctor as far back as I can remember, maybe from obsessively watching M*A*S*H reruns growing up. Or it could’ve been the story about my grandfather Haji that my mom used to tell me, when he fell out of a tree and doctors took care of his broken leg. Or maybe it was the car accident and my early experience with a caring physician who made it seem like everything was going to be okay. My parents are both scientists who raised us to love the multiplication and periodic tables and the majestic order of the natural sciences, so the prospect of biology, chemistry, and math courses never put me off.

  In high school, I had some powerful experiences as an environmental activist, so I created an environmental health major at University of Michigan’s School of Natural Resources and Environment, merging environmental science and premed courses. My passion for activism, service, and research was solidified there, followed by four years of medical school at Michigan State University; my last two clinical years were in Flint.

  It wasn’t a tough call which specialty I’d go into. As a medical student, you have to do rotations in a variety of fields, and as soon as I got to pediatrics, I felt like I was at home. Kids are usually looking for fun, and everything’s new to them. No matter how sick they are, they still want to laugh and play. I was briefly tempted by obstetrics but noticed that as soon as my patients gave birth, I tended to forget about them: my attention suddenly shifted to their newborn babies.

  I may not be quite as much of a baby-whisperer as my husband, Elliott, who’s a pediatrician like me but with the supernatural power to soothe any child. I can hold my own, though. With patience and empathy, and sometimes with stickers, bubbles, and penlight tricks, I can get that sulky five-year-old to tell me where it hurts. A nonverbal teenager will talk to me if I take her seriously and listen carefully and let her know that I am her doctor and not her parents’. Even when a baby is wailing and making those supersonic ear-piercing sounds, I know that it just takes a soft voice, a gentle sway, and eye contact to calm them.

  A crying baby gives me a sense of mission. Deep inside I have a powerful, almost primal drive to make them feel better, to help them thrive. Most pediatricians do. For some of us, that sense of protectiveness becomes much more powerful when the baby in our care is born into a world that’s stacked against her and her needs aren’t being met—a world where she can’t get a nutritious meal, play outside, or go to a well-functioning school, all of which will diminish her health. I am a fanatic when it comes to protecting all kids, but when I see a child in danger through no fault of her own, I go a little mad. She’s a baby like any other, with wide eyes and a growing brain and vast, bottomless innocence, too innocent to understand the injustice of her circumstances. She can’t see what I can.

  A baby who is properly fed and loved and kept healthy, and surrounded by people and communities that value and protect her, has the best chance of becoming a healthy adult. This is what drew me to pediatrics—we pediatricians are at the pivotal intersection of clinical care and prevention. Every aspect of my job—from immunizations to emphasizing the importance of bike helmets—is not just about ensuring kids are healthy today. It’s about tomorrow, next year, and twenty years from now. We see life at its beginning, when it can be shaped for good. As Frederick Douglass said, “It’s easier to build strong children than to repair broken men.” Walk into the adult floor of a hospital any day, and you’ll see beds of patients with problems like diabetes or heart disease that can’t be fixed, because to do that you’d have to time-travel back to their childhoods and fix those too.

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  AS MUCH AS I love spending time with kids and seeing one little patient at a time, I wanted to have as much impact as I could—on as many lives as I could—so right from the beginning, I made a tactical decision to be a medical educator rather than a pediatrician in private practice. That way, ov
er the course of my career, I could share my passion for children’s health and proven interventions with hundreds of new doctors who would go on to treat thousands of young patients, caring for them as I would and hopefully even better.

  And in 2011 I became the director of the pediatric residency program at Hurley Medical Center, a public teaching hospital affiliated with Michigan State University; with more than four hundred beds and almost three thousand employees, it’s a place where new doctors are trained and most of the children in Flint are treated.

  The hospital was given to the city of Flint by a soap and sawmill businessman, James J. Hurley, in 1905. And like many public hospitals, it serves a poor and minority population with high levels of Medicare/Medicaid patients and uncompensated charity care. That means budget cuts from the state or federal government hit Hurley hard, in ways they would not hit a private hospital.

  When I first took the job in 2011, the pediatric residency program was in tough shape and coming up short in lots of ways, large and small. Morale was low. The sixty-year-old program was at risk of losing accreditation, which meant it could close altogether. Its clinic, where Flint kids came for routine appointments, was in a depressing old building with low ceilings and little sunlight.

  The first things I did were to increase the number of our residents and faculty and to overhaul our programs and recruitment practices to attract better trainees. We worked hard to improve residents’ curricula and schedules—and soon we received a full ten-year accreditation. When the lease was up on our old clinic location, we moved our pediatric center into a one-of-a-kind building with soaring ceilings and spectacular sunlight, built above a year-round farmers’ market—and just a few steps from the central bus stop. It was a dream location: the light, the fresh produce, the beauty of the building itself. It was a chance to give the kids of Flint a glimpse at what a healthy environment might look like—but also to show them that they deserved nothing less.