Flint Water Crisis Whistle Blower Dr. Mona Hanna-Attisha on the Aftermath of the Poisoning of a City

Dr. Mo na Hanna - Attisha

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Female : Welcome to Conversations on Health Care with Mark Masselli
and Margaret Flinter , a show where we speak to the top
thought leaders in health innovation, health policy, care
delivery, and the great minds who are shaping the healthcare
of the future. This week, Mark and Margaret speak with Dr.
Mona Hanna - Attisha , The Flint Michigan Pediatrician who
exposed The Flint Water Crisis which brought le a d poisoning
to so many children living in that city. She is the Author of the
What the Eyes Don’t Se e: A Story of Crisis, Resistance and
Hope in an American City.

Lori Robertso n also checks in , the Managing Editor of
FactCheck.org , looks at misstatement spoken about health
policy in the public domain, separ ating the fake from the facts .
W e end with a bri ght idea that's improving health and well -
being in everyday lives. If you have comments please e - mail us
at [email protected] or find us on Facebook or Twitter,
i T unes or wherever you listen to podcasts . Y ou can al so hear
us by asking Alexa to play the program Conversations on
Health Care . Now stay tune for our interview with Dr. Mona
Hanna - Attisha , on Conversations on Health Care.

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Mark Masselli: We're speaking today with Dr. Mona Hanna - Attisha ,
pediatrician who exposed the Flint Water Crisis to the public.
She ’s a Professor and Director of the Pediatric Public Health
Initiative at Michigan State University and Hurley Children’s
Hospital . Dr. Hanna - Attisha was awarded the Freedom of
Expression Courage Award b y PEN America . Her 2018 book on
the Flint Water Crisis, “What the Eyes Don’t See: A Story of
Crisis, Resistance and Hope in an American City,” has won
numerous distinctions including a notable book award by the
New York Times. She earned her m aster ’ s in Pu blic Health
from the University of Michigan and her M.D. at Michigan
State. Dr. Hanna - Attisha , welcome to Conversations on Health
Care .

Dr. Mona Hanna - Attisha : It is great to be with you guys. Thank you .

Mark Masselli: Yeah, and I know you like to be call ed Dr. Mona so –

Dr. Mona Hanna - Attisha : That would be great.

Mark Masselli: That’s wonderful . And you know, a couple of years ago, you
found yourself really at the center of this incredible public
health crisis at Flint, Michigan . A state and local offici als had
switched the Flint Water Supply from a source from Lake

Dr. Mo na Hanna - Attisha

Huron to the Flint River and t he local residents started to
complain . B ut it was really your public news conference that
alerted everyone to the dangers that were being foist upon
Flint’s most vulnerable residents, especially children who are
being harm by these extreme high levels of lead in the water .
I’m wonder ing if you can just share with our listeners the
scope of the crisis, and what did it take to get people’s
attention ?

Dr. Mona Hanna - Attisha: Flint was in this near bankruptcy state and in Michigan, if you
are in really poor financial conditions, the state can swoop in
and take over the city . I n 2011, Flint lost democracy and was
under state appointed financial emergency management with
really the goal of austerity. It was just how do you save money
with no regard to public health or environmental health, it was
just how do you balance the books. I t was decided to save
money by switching our drinking water source from the Great
Lakes whi ch we had been drawing wa ter from for over a half
of century. It was decided to switch to the Flint River until a
new pipeline was to be built and Flint is literally in the middle
of the Great Lakes which is also the largest source of fresh
water in the wo rld.

In 2014, we started drawing our water from the local Flint
River . T he water was not being treated properly. It was
missing an important we then called corrosion control, which
was federally mandated to prevent whatever is in the pipe
from coming out o f the pipes and going into our drinking
water. W ithout this ingredient, the water was about 20 times
more corrosive. It was so corrosive that actually just a few
months after our water switch General Motors, which was
born in Flint and still has a plant in Flint, stop using this water
because it was corroding the engine parts of the plant . T hey
were allowed a bypass to go back to the Great Lakes water.
Yet the people of Flint were told that everything was okay and
that they could essentially “relax.”

P atien ts were coming to clinic and asking me, is this water
okay? Should I mixing my baby’s formula with this water?
Most of our children in Flint are not breastfed, should I be
giving my kids this water ? S hould I be bathing my kids in this
water? F or over a yea r, I was also telling my patients that yeah
of course, everything is okay like how can it be that when you
turn on your tap your water is not okay like because this is
America and there ’s rules and laws. M y eyes were also very
much closed.

We’ve heard comp laints obviously about color and odor and

Dr. Mo na Hanna - Attisha

taste and bacteria and there was boiled advisories and all
these other r ed f lags. But I was also reassuring my patients
until I heard the word lead, lead being in the water, and that’s
when my life changed . You don ’t mes s around with lead even
the possibility of lead. Any pediatrician will tell you that , and
that’s really what kind of started my quest to see if that lead
was really in our water and if it was getting into the bodies of
our children .

Margaret Flinter: Well Dr. Mona, your experience so much stan ce as a
testament to the essential role that primary care clinicians play
as really as frontline warriors in public health . Y our clinical
data and your observations showed the significan t spike in
lead levels in the blood of children . I know that you enlisted
Dr. Mark Edwards, a Scientist from Virginia Tech University
and somebody who we’ve had the pleasure of having on this
show to verify what specific toxins including lead were now
flowing from every tap in the city. What did you learn from his
research and how did this collaboration help mobilizing , give
the support to move forward and make an impact?

Dr. Mona Hanna - Attisha: Yeah. I n medicine we tend to become hyper specialized and so
often we live in our little silos . A s a pediatrician, as a doctor, I
didn’t think that anybody cared about kids more than we did.
M y experience with Professor Edwards and so many other
folks have started prove me wrong time and time again. He
was an environmental engineer from thous ands of miles away
who probably cared about children more than I cared about
children . When he heard from a mom and friend about the
possibility of lead in the water, he literally packed his minivan
overnight with grad students and w ith supplies and drove up
to Flint to work hand in hand with the people of Flint and it is
something called citizen science to prove that there was lead
in the water. I could not have done my work if it was not for
his work.

W e a re blinded to other people and other discipline s w ho
couldn’t be more different than us, who actually are working
towards the same goal . T hat’s what this lesson has taught me
working with Professor Edwards, who really proves
scientifically that there was lead in the water. His research
should have been en ough. The lead you’re supposed to
practice something that we call on public health primary
prevention. Children are never supposed to be exposed to
lead. It's a potent universal toxin , t here is no safe level. When
we detect it in a child, it's too late lik e the only treatment is
prevention.

Dr. Mo na Hanna - Attisha

T his crisis never should have started and it should have
stopped when he reported on the lead levels in the water .
T hose lead levels in the water are mind boggling. They were in
the thousands and thousands of parts per b illion. The EPA has
an action level of 15 parts per billion which is also extremely
high, it's not health based. The American Academy of Pediatric
has set the action level for school at one part per billion. W e
had home and schools in th ousands and thousan ds of parts
per billion.

I remember a home had a lead level of 22,000 parts per billion
of lead in water. There were these exceedingly higher results
that he was sharing yet just like everybody else in the story ,
his science was also being attacked and den ied and dismissed .
U nfortunately , it took my science which never should
happen ed , we never should have needed evidence of children
being poisoned. But unfortunately , it took that proof of impact
to really change the tide.

Mark Masselli: Dr. Mona, your role in this story were so powerful that you
wrote a book about it, What the Eyes Don’t See , which reads
like who done it . O nly in this case the couplers were those
who were supposed to be responsible for the health and
wellbeing of Flint citizens also state E PA level in the governor's
office . W hen you're speaking truth to power, power starts to
come at you and you were certainly attacked for doing so .
E ventually , they started to supply bottled water to the hardest
hit neighborhoods, but tell us what this ty pe of exposure does
to children?

Dr. Mona Hanna - Attisha: When I heard about the possibility of lead in the water , I
freaked out as w ould any pediatrician . Lead is probably the
one of the most well studied poison that's a known neurotoxin
and we now know throu gh incredible science that there is no
safe level of lead. Levels with that we're okay decades ago, we
now know are no longer okay. Lead impacts who you are, it
impacts cognition, drops IQ levels, impacts behavior, leads to
developmental disabilities has b een linked to things like ADHD
and oppositional disorders.

We also know that lead is a form of environm ental racism. It's
a known environmental injustice. My kids in Flint already had
higher lead levels, just like kids in Detroit and Chicago and
Philadelph ia and Baltimore . Our countr y’s children who are
already burdened with so many toxic stresses, so our Flint kids
already had every obstacle to development , give us 60 %
poverty rate for our children . O ne of the most violent cities in
America, no full servic e gr ocery stores, crumbling schools, all

Dr. Mo na Hanna - Attisha

of these impact the health outcomes of our children so much
so that a child in Flint actually has a 15 - year less life
expectancy.

Flint is an example where the zip code of your birth has -- is
the greatest predictor of where you wind up even more so
than your genetic code. T hen added burden of lead exposure,
which is entirely preventable, which is all created by kind of
manmade policy decisions. It's heartbreaking , it is saddening ,
and that's really kind of what spur red my anger into action.
What I continue to do is all in my job description as a primary
care physician, I literally took an oath as a doctor to stand up
to protect, to be the voice of children . I continued to be doing
exactly what I am supposed to be doi ng as a physician.

Margaret Flinter: Dr. Mona, I've often thought back to my early career years as a
public health nurse in a rural area, and this goes back to the
70s . W e were screening for lead , we were getting people out
of houses that were lead toxic. We knew it was a devastating
toxin in the 19 70s and even before that, and long before that .
Here we are, it's 2019 and the Flint Water Crisis still isn't over.
Some of the pipes had been replaced, but free water delivery
has ended for many residents . Y ou'v e got to help patients deal
with the aftermath of physical consequences, the trauma. Talk
to us a little bit about the clinical response, particularly
perhaps the Pediatric Public Health Initiative which you
created to mitigate the impact of the Flint Wate r Crisis .

Dr. Mona Hanna - Attisha: F rom the moment that we recognize that we had this
population wide lead exposure, we knew that our next step
with secondary prevention . W e failed at preventing this
exposure, but we were working around the clock to make su re
that we didn't see the consequences of th ose exposure. We
also had an upwards of Legionnaires' disease , w e had massive
skin issues . B ut by and large it was a crisis of betrayal and lo ss
of trust and anger and stress and all of those emotions also
can le ad to poor outcomes. There are all these added toxic
stresses.

Science was denied in this crisis, ultimately , it was our science
that spoke truth to power . W e have been committed to using
the science of child development of brain plasticity of
resilience t o buffer the impact of this crisis . T hat's what this
Pediatric Public Health Initiative is all about , i t's this holistic
approach to mitigating the impact of this crisis and using
everything we know to promo te the development of children.

A s we put into pl ace things like an expansion of home visiting
programs , tw o brand new childcare centers, literacy

Dr. Mo na Hanna - Attisha

promotion, breastfeeding services , Medicaid expansion ,
behavioral health services, trauma informed care, mindfulness
in our schools, breastfeeding , nutrition services and the list
goes on and on . A ll these things that we already know
promote the development of children. We have also just
launched something called the Flint Registry , which is modeled
after the World Trade Center registry and other large scale
re gistries, not just to track folks . W e are actually serving as a
public health authority per the CDC. The goal of this registry is
to identify those exposed, but most importantly to get them
connected to these development promoting interventions to
improve their outcomes. Th is is one of the ways in a very data
driven way where we'd hope to share what we are doing w ith
other communities.

O ne of the reasons I wrote this book is because the story of
Flint is not isolated. There are kids everywhere waking up to
the same toxicities of lead exposure or poverty or injustice or
lost democracy or austerity or violence or you name it . W hat
we want to share is how we've been able to turn the story
around and improve the outcomes of our children . I'm just
going to share one quick example of how this is really bei ng a
model. I n our clinic, which is on the second floor of a F armers
M arket where we see most of our Flint kids.

Every single kid comes in and gets a prescription for nutrition,
which they fill at our F armers M ark et. A prescription for fruits
and veggies , our US s enator knows the success of that
program in terms of improving food security and food access .
S he included that nutrition prescription program in the farm
bill which was signed by the president and now tha t's a
national program . F lint is now beginning to export our
awesome ness and all the interventions that we are doing in
terms of our recovery .

Mark Masselli: We ’re speaking today with Dr. Mona Hanna - Attisha
Pediatrician and Public Health Activists to expos e the Flint
W ater C risis to the public. She's the founder of the Pediatric
Public Health Initiative at Michigan State University. Her 2018
book on Flint W ater C risis , What t he E yes D on't S ee comes out
in paperback in February. Dr. Mona, I was thinking as y ou were
saying that you took this oath as a doctor to advocate for your
patients . Y ou're more than a clinician , y ou're this clinician a s
activist . I'm wondering what message that you have for other
clinicians who are on the precipice of a crisis like that. What's
your advice for them?

Dr. Mona Hanna - Attisha: As a doctor w e wear many hats. I've always seen my many

Dr. Mo na Hanna - Attisha

hats as a clinician, as a researcher, as an activist, and as an
educator. The story enabled me to wear all these hats and just
to know that you're all trained to have all of these skill sets . I
spen d a lot of my time now working with other communities,
interacting with so many other doctors who are facing similar
issues . T he advice that I always give is to build a team. One of
the reasons I did not want to write this book is because, hey,
it's not about me, it's about a team that came together, Mark
Edwards and so many other folks . S o often we think we are
alone in these fights, but really there's a lot of folks who care
about the same things as we d o.

I also tell folks that I was the right person at the right place
with the right training and it wasn't the first time that I talked
to a legislator , and it wasn't the first time that I had an
interview and talk to media . T ake advantage of all those
oppo rtunities and often those opportunities are in your own
medical society. For example, the American Academy of
Pediatrics, I was able to do things like media training and
legislative advocacy days before all this. I remember when my
hospital would ask, does a nybody want to talk about the
Rotavirus epidemic and visit local TV crew. I was like, oh, okay,
I'll do it. B ut I'm so glad I had done that.

Margaret Flinter: Right.

Dr. Mona Hanna - Attisha: Every year I take my residen ts to the S tate capita l and we just
meet with legislators and before that we do advocacy training
and how would y ou interact with legislator. This was all part of
my training and the training that I had been giving to my
medical students in my residen ts, b ecause you never know
when these ski lls will come in handy . L ike I never would have
anticipated that one day I'd have 17 interviews in one day. You
have to be prepared for these kinds of things .

Margaret Flinter: While you ’re handling this environments on p ublic h ealth
d isaster sure you also are taking care of a very full panel ed of
your pediatric patients . I understand you are running the
pediatric residency program at your hospital at the same time.
I think your book is a incredible resource for all people coming
into healthcare . R e ally a p rimer for them on the importance I
think of data, seeing emerging trends of listening to what
people are saying.

I'm really curious if there's been some new take home lessons,
even five years ago, I'm n ot sure o ur electronic health records
were helping us look for trouble. How h as practice changed
because of the availability , perhaps, of this kind of data and is
it helping to really dissolve that border in some ways between

Dr. Mo na Hanna - Attisha

p rimary c are and p ublic h ealth?

Dr. Mona Hanna - Attisha: Yeah, I think one of the les sons is definitely that the y need to
have more integration between p rimary c are m edicine and
p ublic h ealth. Often in medicine we're very myopic , w e only
see what's in front of us because we don't have access to that
often larger surveillance population lev el data. That is one of
the lessons and kind of rewards of this crisis is that hopefully
more folks are able to kind of open their eyes and recognize
that, oh, this could be part of something larger.

My goal of writing this book is that folks become more c urious
and ask more questions and dig deeper and don't kind of drink
the Kool - A id. One of the attacks after I released my research
from the state, they said that I was splicing and dicing
nu mbers and because of that E pic , which is one of the largest
electr onic medical record platforms , released a new feature
called Splicer Dicer , which enables you to ask questions of data
and to be able to dig deeper.

Mark Masselli: We've bee n speaking today with Dr. Mona Hanna - Attisha
Pediatrician, Public Health Activists , Founder and Director of
the Michigan State University and Hurley Children's Hospital,
Pediatric Public Health Initiative, and the author of W hat t he
E yes D on't S ee : A S tory of C risis , R esistance and H ope in
American City. You can learn more of her incredi ble story by
reading her book, w hich you can find at
monahannaattisha.com or you can follow her on twitter. Dr.
Mona, thank you so much for your integrity, your
perseverance, and for joining us today on Conversations on
Health Ca re.

Dr. Mona Hanna - Attisha: Mark and Margaret, thank you so much for having me.

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Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about health care
reform and policy. Lori Robertson is an award - winning
jou rnalist and Managing Editor of FactCheck.org, a
nonpartisan, nonprofit consumer advocate for voters that aim
to reduce the level of deception in US p olitics. Lori, what have
you got for us this week?

Lori Robertson: In the national address President Donald Trump called on
c ongress to provide $5.7 billion for a border wall to address
what he called a crisis at the border. In his remarks, he
suggested that 20,000 children were illegally brought into the
country in one month by “ vic ious coyotes and ruthless ga ngs .”

Dr. Mo na Hanna - Attisha

B ut there ’s no evidence of that in the available statistics. The
President said that , “ these children ar e used as human
ponds .”B ut his 20,000 figure is equal to all children
apprehended on the southwest border in December , a
number that includes both those traveling in a family unit and
unaccompanied children. We wrote about the issue of adult
trafficking children to the border in June when DHS con firmed
to us that there were 191 suspected fraudulent cases in the
first five months of fiscal 2018 . T hat was 0.61% of the total
family unit apprehensions in that time period.

As for unaccompanied children, they are referred to the O ffice
of R efugee R esettlement in the Department of Health and
Human Services . The children are screened for visible health
issue s when they arrive at customs and border protection
facilities which have medical staff on site. The children must
be deemed fit to travel before being moved to HHS ’s c are .
O nce at an O ffice of R efugee R esettlement S helter , t hese
children get a more thorou gh medical screening , vaccinations
if they don't have documentation for vac cine and treatment if
need be for communicable diseases. The CDC has said there is
little risk that these children would spread infectious diseases
to the US p ublic . T hat's my fact check for this week. I'm Lori
Robertson, Managing Editor of F act C heck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country's major political players and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fact that you'd like checked, email
us at chcradio.com . We’ll have FactCheck.org's Lori Robertson
check it out for you here on Conversations on Health Care.

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Mark Masselli : Each week Conversations highlights a bright i dea about how to
make wellness a part of our communities and everyday lives.
Pregnancy is normally an exciting time for most women, but
according to the research, an estimated 10 % of prenatal
women experience some kind of depression during their
pregnancy . M any are reluctant to treat their depression with
medication for fear of harming the fetus.

Dr. Cynthia Battle: In fact, a higher percentage are experiencing lower grade
depressive symptoms so they might not meet full criteria for a
major depressive episo de . B ut they're having significant
symptoms that are getting in the way of feeling good and
those mild to moderate symptoms can progress , in some cases
lead to a more serious postpartum depression.

Dr. Mo na Hanna - Attisha

Mark Masselli: Dr. Cynthia Battle is a P sychologist at Bro wn University. She
and her colleagues decided to test a cohort of pregnant
women to see if a targeted prenatal yoga class might have a
positive impact on women dealing with prenatal depression .

Dr. Cynthia Battl e: It was a typical kind of Hath a y oga that w ould include physical
postures, breathing exercises, meditation exercises . W e
enrolled 34 women who are pregnant , who had clinical levels
of depression and they would come to classes and we
measured their change in depressive symptoms over that
period of t ime.

Mark Masselli : Not only were women able to manage their depressive
incidents, they also bonded with other pregnant women
during the program and found additional support from their
group .

Dr. Cynthia Battl e: The initial signs from this research are rea lly encouraging. We
found that women on average were reporting that they were
reporting much less. Women who are depressed during
pregnancy unfortunately do often have less ideal birth
outcomes. One thing we're interested in seeing i s when w e
provide prena tal yoga program, candid improved mood, and
then can we even see some positive effects in terms of the
birth outcomes.

Mark Masselli : A g uided non - medical yoga exercise program designed to
assist pregnant women through depression symptoms, helping
them suc cessfully navigate those symptoms without
medication , e nsuring a healthier outcome for mother and
baby. Now , t hat's a bright idea.

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Mark Masselli: You've been listening Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Marga ret Flinter.

Mark Masselli: Peace and health.

Female : Conversations on Health Care is recorded at WESU at
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or wherever you listen to podcasts. If you have comments,
please e - mail us at [email protected] , or find us on Facebook
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