On a sunny day, the Flint River sparkles as it meanders through the concrete-banked, park-like setting in downtown Flint, its calm surface belying the turbulence it now symbolizes.
This temporary source of drinking water for Flint-area residents also is the source of lead poisoning for many, including children, and it now serves as an example of primary public health prevention gone wrong.
“Just announced: Mona Hanna-Attisha MD to head up team to assess, monitor and treat those exposed to elevated lead”
The Flint water crisis – and various actions and reactions related to it – also served as a living educational example in community health, ethics, public policy, and patient advocacy for medical students and resident physicians.
Allison Schnepp MD, a second-year pediatric resident at Hurley Medical Center, worked with one of the principal investigators who helped to bring attention to the problem: Mona Hanna-Attisha MD MPH, who also happens to be the director of Schnepp’s pediatric residency program at Hurley, which is affiliated with Michigan State University College of Human Medicine.
“I have learned so much,” said Schnepp, who helped the Flint water research team primarily by conducting a thorough review of the literature to discover known health effects of elevated lead levels in blood, what to do about it, and how other similar situations have fared. “Dr. Hanna has been a great mentor in terms of learning how to navigate the world of medicine and politics. I also learned that we truly can make a difference – and that is pretty inspiring.”
It began when Mona Hanna-Attisha MD MPH, director of Hurley’s Pediatric Residency Program, heard about Virginia Tech engineering professor Marc Edwards’s research findings, showing elevated lead levels in Flint drinking water after Flint switched from Detroit water to the Flint River as its water source. The switch was intended to be a temporary, cost-saving measure – until Flint could connect to a new Lake Huron water source, currently under construction. Edwards’ findings were disputed by various public officials, but Flint residents also complained about water quality and health problems that began after the drinking water source was switched to the Flint River.
After talking about the water issues over dinner with a friend who is a water expert, Hanna decided to take a look at the lead levels in the blood of the young patients from Hurley resident physicians’ Pediatric Clinic, most of whom have routine lead testing under age 5 because they live in areas with older housing stock, thus are at higher risk of lead poisoning. Initial results with a small number of patients showed a clear increase in blood levels after the time point that the water source was changed. Hurley Research Coordinator Nicolas Lecea suggested expanding the investigation to all blood-lead samples collected by Hurley’s Laboratory, which processes blood samples for most medical facilities in the Flint area, capturing around 65% of all blood-lead testing in the region.
Teaming up with public health researcher Richard Sadler PhD from the Flint Campus of Michigan State University College of Human Medicine Division of Public Health, Hanna, Schnepp, Lecea and Hurley Research Coordinator Jenny LaChance MS analyzed a much larger data set: samples of 3675 children under age 5, including samples from pre- and post-water source changes. The findings in blood levels mirrored the findings in the water itself: Flint area residents were being poisoned by lead. The study mapped blood lead levels to geographic location and water sources (some from Flint, some from outside of Flint). The team’s research paper describing the findings eventually appeared online in the Dec. 21, 2015, edition of the peer-reviewed American Journal of Public Health.
Before publishing the paper, Hanna informed city and state officials of the health crisis caused by the lead-poisoning. At first, officials ignored the concerns, disputed Hanna’s findings, and questioned her competence. Frustrated that the water situation was not changing, Hanna and other local physicians and health officials held a press conference at Hurley Medical Center Sept. 24 to bring attention to the issue in order to inform and educate city residents, so they would stop drinking the contaminated water and seek treatment.
“We have a professional responsibility to our patients and families to tell them if we know something is harmful to their health,” said Hanna. “Lead poisoning can cause irreversible damage.”
According to the U.S. Centers for Disease Control and Prevention, blood lead levels above 5 micrograms per deciliter are categorized as “elevated,” though recent evidence shows that no lead in blood is safe. Lead poisoning has been shown to increase learning disabilities, attention deficits, behavioral problems, hearing loss and other chronic health conditions in children, with lifetime consequences. The Flint blood-level research team found that blood-lead levels increased significantly, from 2.4% before the water-source change to 4.9% afterward. In some areas, blood-lead levels tripled.
The press conference helped to accomplish the first goal, to attract attention to the issue. Since the press conference, the Flint water crisis has been a near daily headline somewhere in the world, and Hanna has personally testified before U.S. Congress and has been interviewed on national television and by news organizations from around the world, including Al-Jazeera, the New York Times, the Washington Post, National Public Radio, the BBC, and The Rolling Stone magazine, to name a few.
But many are still working on the second goal: preventing further damage from the elevated lead levels. While the state helped to pay for Flint to reconnect to the Detroit water source, the corrosivity of the Flint water has already damaged the aging plumbing infrastructure in the Flint area and likely won’t be safe to drink for several months. The Flint River water caused chemical reactions with lead in the piping, causing physical pieces to fall off and to pour through kitchen faucets. While local media helped to spread the word and various organizations offered free bottled water and free water filters (some of which, in the beginning, were the wrong type to filter out harmful lead), there was no door-to-door campaign to distribute appropriate kitchen faucet filters or to educate people on how to eat the right foods and at the right times to help their bodies eliminate as much lead as possible.
“Secondary prevention measures should be the highest priority now,” said Hanna. In the long run, extra services will be needed to help affected children learn, help with more frequent health issues, and to continue to make sure that the water is safe and families have knowledge about and access to nutritional foods and other methods to stay as healthy as possible, despite lead exposure. And the families exposed to lead need to be monitored over time. Adults, too, can be affected by lead exposure, which can cause high blood pressure, join pain, memory loss, and fertility issues, according to the Centers for Disease Control and Prevention.
For Schnepp, the entire experience was invaluable in her quest to become the best pediatrician she can be. But it’s more than that, said Schnepp, who was born in Flint.
“I grew up in Genesee County,” she said. “This has been my home and my husband’s home since day one. To know that there is such an injustice going on so close to home was alarming to me, especially when it was in a vulnerable population that cannot represent themselves. I think that is one of the most important roles of a pediatrician: to be the voice of the children we treat. Pediatrics involves much more than the office visit or hospital stay.”
And that shows that a third goal may be in the works: The education of the next generation of physicians who also will try to make a difference in the their community’s health, no matter where they end up practicing medicine in the future. They now know how to advocate for changes when needed – even when “officials” say they’re wrong.
This “has made our education stronger; it has taught us the role of public health first hand,” said Schnepp.
Photos at top: Mona Hanna-Attisha MD MPH (left) and Allison Schnepp MD.