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

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Moderator: Welcome to Conversations on Healthcare, 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 futur e .

This week Mark and Margaret speak with Dr. Mona Hanna - Attisha , the Flint,
Michigan, pediatrician who expose d the Flint water crisis which brought l ead
poisoning to so many children living in that city. She is the author of What the
Eyes Don’t See : A sto ry of Crisis, Resistance and Hope in an American city.

Lori Robertson, also checks in, the Managing Editor of FactCheck.org, looks at
misstatements spoken about health policy in the public domain, separating
the fake from the facts. And we end with a brigh t idea that’s improving
health and wellbeing in everyday lives.

If you have comments, please email us at [email protected] or find
us on Facebook or Twitter, iTunes or wherever you listen to podcast. And y ou
can also hear us by asking Alexa to play the program Conversations on
Healthcare. Now stay tuned for our interview with D r. Mona Hanna - Attisha ,
on Conversations on Healthcare .

Mark Masselli: We are speaking today with Dr. Mona Hanna - Attisha, pediatrician, who
exposed the Flint water crisis to the public. She is 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 P E N America. Her 2018 book on the Flint water
crisis , W hat 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 Master’s in Pub lic Health from
the University of Michigan and her M.D. at Michigan State. Dr. Hanna - Attisha ,
welcome to Conversations o n Healthcare .

Mona Hanna - Attisha: It is great to be with you guys, thank you.

Mark Masselli: Yeah and I know you like to be called Dr. M ona, so -- .

Mona Hanna - Attisha: That would be great.

Mark Masselli: That’s wonderful. A couple of years ago you found yourself really at the
center of this incredible public health crisis at Flint , Michigan . S tate and local
officials that switch ed the Flin t water supply from a source, from Lake Huron
to the Flint River and local residents started to complain . But it was really
your public news conference that alerted everyone to the dangers that were
being foist up on Flint’s most vulnerable residents, espec ially children who
were being harmed by these extreme high levels of lead in the water . I am
wondering if you c ould just share with our listeners the scope of the crisis
and what did it take to get people's attention .

Mona Hanna - Attisha: Well, Flint was in the near bankruptcy state and in Michigan if you are
in really poor financial conditions, the state can swoop in and take over the

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city . I n 2011, Flint lost democracy and was under state appointed financial
emergency management with really the goal of aus terity , i t was that, how do
you save money with no regards to public health or environment al health, it
was just how do you balance the books. And i t was decided to save money by
switching our drinking water source from the Great Lakes, which we had
been d raw ing water from for over a half of century. I t was decided to switch
to th e Flint River , until a new pipeline was to be built . Flint is literally in the
middle of the Great Lakes, which is also the largest source of freshwater in
the world.

I n 20 14 , we s tarted drawing our water f rom the local Flint River . T he water
was not being treated properly , i t was missing an important ingredient called
corrosion control , which was federally mandated to prevent whatever is in
the pipe, its coming out of the pipes and going into our drinking water. So
without th ese ingredients the water was about 20 times more c orrosive . I t
was so corrosive that actually it just have few months after our water switch,
General Motors, which was born in Flint and still has a plant in Fli nt stop ped
using this water because i t was corroding the engine part s of the plant. T hey
were allowed to 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 the clinic and asking me , is this water, okay ? S hould I
would be mixing my baby’s formula with this water ? Most of our children in
Flint are not b reast fed. S hould I would be g iving my kid this water and should
I would be bathing my kids in this water ? And for over a year I was also telling
my patients that, yeah of course I think it’s okay, like how can it be that when
you turn on tap your water is not okay, like because this is America and there
is a rules and laws. M y eyes were also ver y much close d, we had heard
complains obviously about color and odor and taste and bacteria and there
was boiled advisories and all th ese other red flags. But I was also reassuring
my patients until I heard the word Lead, Lead being in the water . T hat’s wh en
my life change d, you don’t mess around with lead, even the possib ility of
lead, any pediatrician would tell you that. And that’s really what kind of
started my quest to see i f that lead w as really in our water and if it was
getting into the bodies of ou r children.

Margaret Flinter: Well, Dr. Mona, your experience so much stands as a testament to the
essential role that primary care clinicians pla y as really as f rontline warriors in
public health . A nd your clinical data and your observations showed the
si gnificant spike in lead levels in the blood of children. I know that you
enlisted Dr. Mar c Edwards, a scientist from Virginia Tech University and
somebody who we ha ve had the pleasure of having on the show to verify
what specific toxins including lead w ere now flow ing from every tap in the
city. What did you learn from his research and how did this collaboration help
mobilizing get the support to move forward and make an impact ?

Mona Hanna - Attisha: I n medicine, we tend to become hyper specialized and so oft en we

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live in our little siloes and as a pediatrician, as a doctor, I didn’t think that
anybody cared about kid more than we did. M y experience with Professor
Edwards and so many other folks in the story, proved me wrong time and
time again. Here was an en vironmental engineer from thousands of miles
away, who probably cared about children more than I cared about children.
When he heard from a mom in Flint, about the possibility of lead in the
wa ter , he literally packed his minivan ove rnight with gra d studen ts and with
supplies and drove up to Flint to work hand - in - hand with the people of Flint,
in 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.

You know we are blinded to o ther people , in other disciplines who are ,
couldn’t be more different than us, who actually are working towards the
same goal and that’s what this lesson has taught me, working with Professor
Edward, who really proves scientifically that there was lead in water. His
research should have been enough. And in lead, you are supposed to practice
something that we call on public health Primary Prevention, children are
never supposed to be exposed to lead, it’s a irreversible toxin, there is no
safe level. When we detect it in a child, it’s too late, like the only treatment is
prevention.

T his crisis never should have started and it should have stopped when he
reported on the lead levels in the water. And those 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 p art - per - billion , which is also
extremely high, it’s not health based. American Academy of P ediatric s has set
the actionable for school that one part - per - b illion . W e ha d home and school s
in thousands and thousands of parts - per - billion . I know, I remember a home
had a lead level 22,000 parts - per - billion of lead in water. There were th ese
exceedingly high er results that he was sharing , yet just like everybody out in
the st ory, his science was often being attacked and denied and dismissed .
An d unfortunately it took my science, which never should have happened, he
never should have needed evidence of children being poisoned , but
unfortunately it took that proof of impact to r eally change the tide .

Mark Masselli: Dr. Mona, your role in this story w as so powerful that you wrote a book
about it, What the Eyes Don’t See, which reads like a, who done it, only in
this case the culprits were those who were supposed to be responsible for
the health and well - being of Flint citizens both the state EPA level and the
governor’s office . W hen you a re speaking truth to power , power starts to
come at you and you we re certainly a ttacked for doing so . And eventually
they started to supply bottle d water to the hardest hit neighborhoods . B ut
tell us , what this type of exposure does to children ?

Mona Hanna - Attisha: When I heard about the possibility of lead in the water , I freaked out
and as would any pediatrician. Lead is probably the one of the mo st well
studied poison as the no neurotoxin, and we now know through incredible
science that there is a no safe level of lead. Levels that were okay, decades

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ago, we now know are no longer okay. Lead impacts who you are, it impacts
cognition, it drops IQ l evels, it impacts behavior, leads to developmental
disabilities , h as been linked at things like ADHD and positional disorder. We
also know that le ad is a form of environmental racism, it’s a known
environmental injustice . My kids in Flint already has highe r lead levels just
like kids in Detroit and Chicago and Philadelphia and Baltimore ; o ur countr y’s
children who are already burdened with so many toxic stresses .

O ur Flint kids already had every obstacle s of development -- ; 60% p overty
rate for our childre n. One of the most violent cities in America and no full -
service grocery stores , crumbling school s all these impacts the health
outcomes of our children, so much so that a child in Flint, actually has a 15
year less life expectancy. F lint is an example , wh ere the zip code of your birth
is the greatest predictor of where you end up , even more so than your
genetic code . And then added burden of lead exposure which is entirely
preventable, which is all created by kind of a man - made policy decision s. It’s
heart breaking , it is saddening, I mean that’s really kind of what spurred my
anger into action. What I continue to do, is all in my job description a s a
primary care physician. I literally took an oath as a doctor to standup, to
protect , to be the voice of chil dren and I continue to be doing exactly what I
am supposed to be doing as a physician.

Margaret Flinter: But Dr. Mona, I have often thought back to my early career years as a
public health nurse in a rural area. This goes back to the 70s . We were
screening for lead. We were getting people out of houses that were le a d
toxic. We knew it was a devastating toxin in the 1970s 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 ha ve 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 water crisis.

Mona Hanna - Attisha: You know from the moment that we recognize that we had this
population wide lead exposure. We knew that our next step was secondary
prevention ; you know we failed at preventing this exposure, but we were
working around the clock, to make sure that we didn’t see the consequences
of this exposure. We also had [inaudible] [ 00:11:57 ] le ad generis disease , we
have massive skin issues, but by and large, it was a cr isis of betrayal and lot of
t rust and anger and stress and all of th ose em otion s also can led to poor
outcome , there are all th ese added toxic stresses.

Science was denied in this crisis, ultimately it was our science [inaudible]
[00:12:21] and we have bee n committed to using the science of child
development , of brain plasticity, of resilience to buffer t he impact of this
crisis. And that’s what this Pediatric Public Health Initiative is all about is this
holistic approach to mitigating the impact of th is c risis and using everything ,

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we know t o promote the development of children . W e put into place things
like Expansion of Home Visiting Programs , t wo brand new childcare center s,
literacy promotions, breastfeeding services and Medicaid expansion,
behavioral h ealth services, trauma informed car e , mindfulness in our schools,
breastfeeding, nutrition services and the list goes on and on, all these things
that we already know, promote the development of children.

We have also just launched something called The Fli nt Registry which is
m odeled after the World Trade Center registr y another large - scale registr y ,
it’s not just to track folks, we are actually serving as a public health authority
for the CD C . The goal of this registry is to identif y those exposed, but mos t
importantly to get them connected, to these development promoting
interventions, to improve their outcomes. And this is one of the ways in a
very data - driven way, where we hope to share what we are doing with 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 toxic ities of lead
exposure, or poverty, or injustice, a lost democracy or austerity or violence or
you name it. And what we want to share is how, we have been able to turn
the story around and improve the outcomes of our children.

I am just going to share one quick example of how this is really being
modeled. In our clinic which is on the second floor of a Farmers Market ,
where we see most of our Flint kids, every single kids comes in and get the
prescription for nutrition, which they f ill at our Farmers Market , prescriptions
for fruits and veggies . Our U . S . Senator knows th e success of that program in
terms of improving food security and food acce s s. A nd she included that
Nutrition Prescription program in the Farmville, which was signed by the
President. And now that’s a national program. So Flint is now beginning to
export our awesomeness and -- interventions that we are doing, in terms of
our recovery .

Mark Masselli: We are speaking today with Dr. Mona Hanna - Attisha, a pediatrician and
public health activist who expose d the Flint water crisis to the public. She is
the founder of the Pediatric Public Health Initiative at Michigan State
University . Her 2 018 book on the Flint Water Crisis: What The Eyes Don’t See
comes out and paper back in F ebruary. You know Dr. Mona, I was thinking as
you were saying that you took this oath as a doctor to advocate for your
patients. And you are more than a cl inician, you are this clinician as activist.
And I am wonder ing what message do you have for other clinicians, who are
on the precipice of a crisis like that . What’s your advice for that?

Mona Hanna - Attisha: As a doctor we wear many hats . , I have always seen my many h ats as
a clinician, as a researcher, as an activist and as an educator. The story
enables me to wear all these hats and just to know that you are all trained to
have all of th e skill set. And you know I spend a lot of my time now working
with other communi ties, interacting with so many other doctors, who are
facing similar issues. T he advice that I always give is to build a team . O ne of

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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” Ma rc Edwards and so many other
folks. So often we think we are alone in th ese fight, but really there is a lot of
folks who care about the same things as we do . I also tell folks that I was the
right person, the right place with the right training and it was n’t the first time
that I talk ed to a legislator and it wasn’t the first time that I had an interview
and talk ed to media. So take advantage of all those opportunities and often
those opportunities are in your own medical societies, for example, the
Americ an Academy of Pediatric s , I was able to do things like media training
and legislative advocacy days , before all th is I remember when my officer
would ask, you know does anybody want to talk about the Rotavirus
epidemic and you know visit local TV crew and I was like, okay I will do it.

But I am so glad, I had done that, you know every year I take my residents to
the state capital and we just meet with legislators and before that we do
advocacy training and you know how would you interact with this legislato r.
So this was all part of my training and the training that I had been giving to
my medical students and my residents. So because you never know when
these skills will come in handy, like I never would have anticipated that one
day I would have 17 intervi ews in one day. So you have to be prepared for
these kinds of things.

Margaret Flinter: While you were handling th ese environment al and public health
disaster, I am sure you also were taking care of the very full paneled of your
pediatric patients. And I u nderstand you were running the Pediatric
Residency Program at your hospital , at the same time . You know I think your
book is a incredible resource for all people coming into healthcare , really a
primer for them on the importance , I think of data , seeing em erging trends of
listening , to what people are saying . And I a m really curious if there ha s been
some new take - home lessons you know even five years ago , I am not sure
our Electronic Health Records were h elping us look for trouble . How has
practice change d because of the availability perhaps of this kind of data and
is it helping to r eally dissolve that border in some ways between primary care
and public health ?

Mona Hanna - Attisha: Yeah, I think one of the lessons was definitely that they need to have
more integration between primary care, medicine and public health . So often
in medicine, we are very myopic, we only see what’s in front of us because
we don’t have access to that often larger surveillance, population level data.
And that is one of the lessons and kind of re wards of this crisis, is that,
hopefully more folks are able to kind of open the ir eyes and recognize that ,
oh you know this could be part of something larger . M y goal of writing this
book , is that folks become more curious and ask more quest ions and dig
deeper and don't kind of drink the Kool - Aid .

One of the attacks after I released my research from the state, they said that
was splicing and dicing numbers. And because of that Epic, which is one of
the largest electronic medical record platfo rms released a new feature called

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Splicer Dicer which enables you to ask questions of data, and to be able to dig
deeper.

Mark Masselli: We have been speaking today with Dr. Mona Hanna - Attisha, a pediatrician
and public health activists, founder and direct or of the Michigan State
University and Hurley Children’s Hospital, Pediatric Public Health Initiative.
And the author of , What The Eyes Don’t See: A Story of Crisis, Resistance and
Hope in American City. You can learn more of her incredible story by readi ng
her book, which you can find at www.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 Hea lthcare.

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

[Music]

Mark Masselli: At Conversations on Healthcare, we want our audience to be truly in the
know, when it comes to the facts about healthcare reform and policy, Lori
Robert son is an award - winning journalist and Managing Editor of
FactCheck.org, a non - partisan, nonprofit consumer advocate for voters that
aim to reduce the level of deception in U.S. politics. Lori, what have you got
for us this week?

Lori Robertson: At a rally in Orlando launching his re - election campaign , President
Donald Trump mentioned his administration s work on the opioid epidemic
and he touted some unsubstantiated statistic s. Trump said the administration
had "made so much progress on opioid and drug addi ction ” adding “ opioid
down 17 %, 18%, 19% and 21% in some places.” It’s not clear what specific
statistic Trump w as highlighting, however similar figures were presented to
the President at an opioid meeting , a few days prior that we suspect Trump is
thinkin g of overdose death . Those numbers however were for all drug
overdose deaths, not just those involving opioid .

In that meeting the Assistant Secretary for Health presented the latest
Centers for Disease Control and Prevention figures for overdose deaths fr om
any drug s which compared the past year ’ s predicted tally o f drug overdose
death as of November 2018 to the same figure in November 2017. The
largest decreases were for Iowa at 18.2%, Pennsylvania 18.5% and Ohio
23.3% . CDC's website includes a color - code d interactive map with the decline
or increase s marked for each state . But there is no equivalent map or a
complete set of state data for opioid - related over dose deaths.

Oklahoma saw a 24% drop while Washington DC saw a 17.5% decrease. The
next closest is the State of New York, which had an 11.2% decline. It’s
possible more locales have experienced significant drop in opioid - related
overdose death s and that th ose figures might more closely match what
Trump emphasized in his speech , but we are unaware of suc h data . We
reached out to the White House to find the source for Trump’s numbers and
did not receive a reply and that ’s my fact check for this week. I a m Lori

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Robertson, Managing Editor of FactCheck .org .

Margaret Flinter: FactCheck.org is committed to fact ual 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 would like
checked, email us at www.chcradi o.com , we will have FactCheck.org’s Lori
Robertson, check it out for you, here on Conversations on Healthcare.

Mark Masselli: Each week C onversations highlights a bright idea about how to make
wellness a part of our communities into everyday lives. Pregna ncy is normally
an exciting time for most women, but according to the research and
estimated 10% of prenatal women experience some kind of depression
during their pregnancy and many are reluctant to treat their depression with
medication for fear of harmin g the fetus.

Cynthia Battle : In fact, a higher percentage are experiencing lower grade depressive
symptoms so t hey might not meet full criteria for a major depressive episode ,
but they are having significant symptoms that are getting in the way a feeling
g ood and those mild - to - moderate symptoms can progress .

Mark Masselli: Dr. Cynthia Battle is a Psychologist at Brown University. She and her
colleagues decided to test a cohort of pregnant women , to see if a target ed
prenatal yoga class might have a positiv e impact on women dealing with
prenatal depression.

Cynthia Battle: It was a typical kind of Hatha yoga that would include physical
postures, breathing exercises, meditation exercises . And we enrolled 34
women who had clinical levels of depression and the y would come to classes
and we have measured their change in depressive symptoms , over that
period of time.

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

Cynthia Battle: A nd the initial signs from this research are really encouraging. So we
found that women on average were reporting much less. Women who are
depressed during pregnancy unfortunately do often have less i deal birth
outcomes. O ne thing we a re interested in seeing is when we provide Prenatal
Yoga program , can it improves mood and then can we even see some positive
effects , in terms of the birth outcomes .

Mark Masselli: A guided non - medical yoga exercise prog ram , designed to assist pregnant
women through depression symptoms, helping them successfully navigate
those symptoms without medication, ensuring a healthier outcome for
mother and baby ; n ow that's a bright idea.

[Music]

Mark Masselli: You have been liste ning to Conversations on Healthcare , I am Mark Masselli .

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Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Peace and health.

Moderator: Conversations on Healthcare is recorded at WESU at Wesleyan University,
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