What the Eyes Don't See: A Story of Crisis, Resistance, and Hope in an American City (One World Essentials)

by Mona Hanna-Attisha

O MAKE SURE MAYOR WALLING KNEW the deadline had passed, somebody in Senator Ananich’s press office called him to double-check. Sure enough, we were told that there would be no cooperation from the mayor’s office. So we moved ahead without him.

Marc Edwards gave his EPA buddies, especially Miguel Del Toral, a heads-up and told his trusted media contacts that my team had been able to produce the final piece of the puzzle that was missing in the D.C. crisis. Blood data. Proof of impact. “This is a game changer,” Marc kept saying.

Down deep, something else was eating away at me. Aeb. It was difficult to describe without using the imprecise word shame. It was not just an Iraqi thing; it was an Arabic thing. It was the idea that you were never acting independently of your family or larger community. You always had a connection to a larger group, and there were always repercussions. If you behaved badly, or strayed even a little bit from the accepted norm, you would bring shame not only upon yourself but on your people. There was nothing worse.

Even small and seemingly insignificant things could be considered aeb. If you offered someone chai, for instance, and they said no, you still had to bring them chai. Because it didn’t matter what they said—it would be aeb not to.

Even though my family lives on the edges and outside the norms of the Chaldean community—we are progressives, political dissidents, and nonchurchgoers—the concept of aeb was deeply ingrained in us. My mom still talked about aeb. My dad did too. Aeb is the reason I started eating meat, so I wouldn’t insult Elliott’s mom with rude and ungrateful behavior. It’s serious in our culture—and hard to ignore.

My brother emailed too, striking the balance of encouraging me while leaving me alone, something he’d calibrated over a lifetime of big-brothering. He didn’t mention that he’d explained the entire Flint water saga to Bebe—how it had happened, and how wrong it was that nobody was doing anything about it. He told her that I was doing the right thing, the only thing I could do—advocate for the kids of Flint.

ALMOST EVERY YEAR when Mark and I were growing up, my parents sent out Christmas cards. They did them in newsletter style, like a PR bulletin that covered all the year’s accomplishments in a classic American way.

News from Iraq was a bit better, or so we thought: “Saddam is still in power, but his end looms near, which will bring great relief to the people of Iraq.”

The situation under Saddam Hussein is getting progressively worse. This is very disheartening to us. After the war, the embargo has strangled the Iraqi people while Saddam is living in luxury. The suffering has triggered another exodus to the United States, especially to the Detroit area where there is an established Middle Eastern community.

At home, my dad was a man of Vulcan-like stoicism and restraint—he never even hugged us—but every year his Christmas tone grew darker and sadder, like the sound of a mournful trumpet.

As for us, the message was clear: The Hanna family had once lived in Iraq. We loved that place in the deepest part of ourselves. And we were living with its loss—with homesickness, with disturbance, with injustice.

Some five thousand American soldiers died in the Iraq War, tens of thousands were injured, and an entire generation of soldiers will live with lifelong trauma.

“Every year we mention the situation in Iraq,” my dad wrote in his Christmas letter of 2004, the year Elliott and I married—and the year my father produced a PowerPoint presentation called “Mass Graves Symphony” about the atrocities in his homeland. “The occupation was bungled,” he wrote. “A civil war loomed. And the final bonds between ethnic and religious groups that once lived alongside each other in peace are now broken….Besides the removal of Saddam, it’s hard to find anything positive to say.”

In every picture, every radio voice, every video image, I felt the pain of Iraq. And I saw it in me, in my family, and in my children.

JUST TWENTY-EIGHT DAYS BEFORE, I had known very little about water treatment, anticorrosives, service lines, and lead leaching. I hadn’t known much about lead exposure beyond paint and paint dust and bullets. I hadn’t met Marc or Senator Ananich or Andy. I couldn’t have told you the names of the directors in charge of the MDHHS or MDEQ. It was hard enough to keep track of the revolving door of EMs in Flint.

Although advocacy is a duty of a children’s hospital, it almost never means holding a press conference.

I don’t think they were actively trying to discourage me. It was more nuanced than that. Dean Dean wanted me to understand that I was stepping out of my lane and into a role that would threaten people. He was a military man and probably saw things in terms of a rigid chain of command.

I think Aron was just caught off guard—and didn’t have much information about what was going on. His initial response, before he digested the whole story, was the classic risk-averse turtle move. Duck into your shell. And maybe it would have been easier for him and everybody else if I did that and stayed a good little pediatric residency director and waited for the proper authorities to come to their senses. But that’s not how I see things.

The world shouldn’t be comprised of people in boxes, minding their own business. It should be full of people raising their voices, using their power and presence, standing up for what’s right. Minding one another’s business. That’s the world I live in. And that’s the world I want to live in.

I wondered if part of the pushback was about the $270 million the state government approves for MSU every year. The power of money can’t be underestimated, ever. As Karl Marx said, “It transforms fidelity into infidelity, love into hate, hate into love, virtue into vice, vice into virtue, servant into master, master into servant, idiocy into intelligence, and intelligen...

I took Liam’s baby bottle out of my bag. I walked out into the hallway, to a small bathroom across from my office. I filled the bottle with Flint water. It looked okay, pretty clear. But that wasn’t the point. The point was what our eyes couldn’t see.

I recognized LeeAnne Walters, the tough Flint mom and military wife who’d started it all—who’d gone to town meetings, called the EPA, tracked down Del Toral, and gotten in touch with Marc Edwards. Her life over much of the last year had been about the water and was given over to activism on behalf of her kids and all Flint kids.

For the last month, every second that had gone by without an announcement about the water was agony, knowing Flint kids were still drinking it, Flint babies were still being fed formula mixed with it. It was an awful secret to hold inside me—and it had taken a toll.

Those first few minutes of euphoria were wonderful; I’d later wish I’d held on to that feeling for a little longer. But it didn’t last. The truth was out, but—just as I’d been warned—it would awaken new enemies.

Even before bothering to analyze my findings, the governor’s office and the state agencies launched a systematic effort to undermine and discredit me.

Now it was my turn. As soon as the news conference ended, his ugly statements began popping up online—not just in the local outlets but, by the next day, in state and national media. My conclusions weren’t just “irresponsible,” Wurfel said, dripping with condescension. “I would call them unfortunate….Flint’s drinking water is safe in that it’s meeting state and federal standards.” I was an unfortunate researcher.

There was no getting around the fact my focus on the water crisis was taking an emotional toll on the family.

Senator Ananich urged him not to reflexively discredit the data or “the doctor.” The sensible approach would be for the health department, which had a staff of epidemiologists, to check the numbers themselves. Lyon assured him—yes, yes, of course, there was no point in going after the doctor.

This implicated another scientific sin, one I was nakedly guilty of: my research had not been peer-reviewed, which was highly unusual. Peer review is both an ancient and modern procedure, a way to legitimize research by independent experts prior to publication. But peer review can take months. So I knowingly skipped that step. It was academic disobedience and a risk to my reputation. But urgency called for it. The research was too important to wait another day.

You don’t necessarily hear this part of the story often, but when you’re in the middle of a backlash, the psychological stress is extraordinary. The emotions are big, overpowering. And they come as a total surprise.

I worried, most of all, that I was doing exactly what the state accused me of: creating a problem where none existed and adding anxiety to the already stressed lives of my patients and our city.

In the coverage of the press conference, the media referred to me as a “local pediatrician.” Not a scientist, not an authority, not an academic. Local pediatrician. It was true. That’s what I was. But every time I read those words, I felt smaller and smaller, like a clueless quack, a know-nothing. What had I been doing holding a news conference? I had wandered out of my league—and was now being ridiculed. I couldn’t imagine feeling good again, ever.

Sure, I was a local pediatrician. But I was also a scientist, an advocate, and now an activist. Nothing was going to make me back down. Let the state “experts” come after me, try to destroy me with all their lies. They were scared and negligent and arrogant. They were incompetent, not me. In less than a few minutes awake, I was in high gear, making plans for my next move.

I waited for that sound to come into her voice, the fear and panic, the aeb. I waited, but that night it didn’t come. “Mona,” she said. “You were so brave, mumtaz—excellent.”

Science was on my side. Numbers don’t lie. Jenny and I had checked, double-checked, and triple-checked our findings. We had scoured the literature and replicated previous studies. We had controlled for seasons, used the appropriate age range, removed duplicates, analyzed for the highest lead level for each kid, and just to be sure, anticipating pushback, we had analyzed the first lead level too.

For our study, Jenny and I had discovered that even if a child had “Flint” in her address, it didn’t necessarily mean that her house was receiving Flint water. Flint zip codes included kids who were not getting Flint water, and if they were included in a study, it diluted the harm.

We could create maps of Flint—like John Snow’s maps of his London neighborhood during the cholera epidemic! And if the blood-lead levels of children in neighborhoods that only received Flint water still tested higher, the impact would be even more conclusive.

Later on, in studies of the media coverage and its impact on the Flint crisis, Thursday, September 24, would mark a high point. The state showed no signs of backing down or even checking its facts. But good things were starting to happen too—important shifts, small and large.

Tanner and reporter Nancy Kaffer reviewed my research and did their own analysis of the state’s ridiculous data release. The next day the Free Press ran their story. It not only backed me up, it called for action. This time, rather than referring to me as a “local pediatrician,” I was a “hospital researcher.”

Worse, prior to the water supply change, the number of lead-poisoned kids in Flint, and across the state, had been dropping; the reversal of that trend should prompt state public health officials to examine a brewing public health crisis.

The newspaper ran a hard-hitting editorial by Kaffer that took on Governor Snyder directly: “It’s hard to understand the resounding yawn that seems to have emanated from the governor’s office, following news that an increasing percentage of Flint kids have been lead poisoned after a switch in the city’s water supply.”

I tried to see down the road and consider what they would need. Thinking of the Flint sit-down strikers and other effective organizers, I decided we needed to compile a list of demands right away. I had learned that tactic back in Roberta Magid’s SEA club. A list of demands gives your advocacy mission focus and direction. Otherwise, you could waste all the time and energy you spent getting to the bargaining table.

To put it as simply as I can: early trauma and toxic stresses leave a mark on the brain and change neural pathways. Children exposed to adversity need to be soothed, loved, and taught how to cope and be resilient; they need to be properly nourished and surrounded by people who value them; they need policies that support them. With all these in place, they can cope and rebound; otherwise they may be living with the impact forever.

We needed what experts were now calling an “ecobiodevelopmental” approach, with short-term, intermediate, and long-term interventions that touched every level of a child’s life. Science had been ignored and denied in Flint, but it was science that was critical to uncovering the crisis. Our science spoke truth to power.

Doctors are trained to be calm and comforting. But this wasn’t a time for that. Now that I had a microphone in front of me, I was going to talk about the truly scary things we were facing, with no sugarcoating. Neurotoxicity. Epigenetic or multigenerational effects. Permanent cognitive impairment. Criminal behavior. All these were entirely preventable, literally man-made.

Over and over again, I was going to say, “There is no cure.” It was all true—and had the side benefit of being shocking and terrifying. I wanted people to hear me on the radio and see me on TV and come away as angry and freaked out as I was.

To make things easier, I told reporters to just call me what my patients did: “Dr. Mona.” Otherwise, I’ve got a long and unwieldy string of names, too foreign for some to pronounce. And when I’m Mona, the name Haji presciently gave me, or even Dr. Mona, I feel more relaxed.