7 questions with a pediatrician in the thick of Flint's lead poisoning crisis

While under state financial management in 2014, Flint, an industrial town near the base of Michigan's 'thumb,' began pulling its water supply from the notoriously grimy Flint River.

The water was sourced there rather than from Lake Huron through Detroit's water system in an effort to cut costs. The decision was reversed in October 2015, but not before it resulted in hundreds of lead poisoning cases in children due to toxic levels in the Flint River. In December, Flint's mayor declared a state of emergency, which has drawn national attention to the small town. The National Guard arriving on the scene early Wednesday to distribute clean water and other supplies.

Mona Hanna-Attisha, MD, director of Flint-based HurleyMedicalCenter's Pediatric Residency Program, was one of the first to notice the trend of toxic lead exposure cases. She has fought denial of the crisis from Michigan officials while working to save the lives of poisoned children in an underserved population already short on resources.

Dr. Hanna-Attisha spoke with Becker's Hospital Review about how she became involved in the crisis and HurleyMedicalCenter's efforts to provide treatment and resources to Flint residents.

Editor's note: This article has been lightly edited for clarity and style.

Question: When did you first become aware of the crisis?

Dr. Hanna-Attisha: In late August, we were hearing about lead in the water and a team led by Marc Edwards, PhD, [a professor of civil and environmental engineering at Virginia Tech in Blacksburg], was investigating. They had been alerted by a family who had elevated lead levels in their water, and they reported lead throughout the Flint water system. When I heard about lead in the water, we got mobilized. Pediatricians know lead — it's a well-known neurotoxin. The CDC and the AmericanAcademy of Pediatrics recommend no safe level of lead in a child. Lead should never be in contact with a child. So when we heard about lead in the water, we wanted to see if that was getting into the bodies of children.

Q: How were your results first received?

Dr. Hanna-Attisha: We released our research findings at a press conference on Sept. 24. Medical research isn't intended to be released at press conferences, it's intended to be released in peer-reviewed journals, which it now is but at the time we had an ethical and moral obligation to share what we saw with the community.

And what we saw was that in Flint, the percentage of children with elevated lead levels doubled and in some neighborhoods it actually tripled. In one of the city's wards, the rate went from 5 percent to almost 16 percent of kids tested showing elevated lead levels. We had to share this information. There was a good week and a half, two weeks of the state disputing our research findings, but after we spoke with them and after they really looked at their numbers, they saw their findings were consistent with ours.

Q: How many cases have there been?

Dr. Hanna-Attisha: Since the water switch happened, there have been over 200 children with elevated lead levels. However, this grossly underestimates the exposure. We screen for lead at 1 and 2 years of age as per Medicaid and CDC mandate, however lead in water affects different age groups differently. We screen between the ages of 1 and 2 because that's when children have hand-to-mouth activity, that's when they're crawling and getting lead paint from their house and their soil. But lead in water affects a different age group — utero babies and babies on formula. Young infants who are drinking lead-tainted water mixed with powdered formula. And lead has a short half life, it only lasts in your blood about 28 days, so when we screen those kids at the ages of 1 or 2, we have missed their peak and their level is no longer elevated.

This is a population-wide exposure. Anybody who drank this water or cooked with this water (because cooking actually concentrates lead in your water) from April 2014 until end date not set, because the water was still unsafe, is still exposed.

Q: Beyond treating poisoning cases, what has the hospital done to take on the crisis?

Dr. Hanna-Attisha: I direct our pediatric residency program, so I train residents and medical students on becoming pediatricians. We've always had kind of an advocacy and public health focus. People come to Flint to do their training because they want to work with underserved communities and make a population health impact. So it's kind of an untold story, but this has all been about education. We are training the next generation of physicians to do this kind of work — residents have been involved with the meetings with the mayor since the beginning. At the very first meeting when we disclosed our findings, there was a resident nervously sitting next to him. It's our obligation to train that future workforce who looks beyond the one patient in that one exam room.

Hurley also has a robust research department as an academic medical center affiliated with Michigan State University. We've been doing research for quite some time, so they continue to be actively involved. In conjunction with our pediatric department, we also have a department that focuses on the community's wellness. My pediatric clinic is actually on the second floor of a farmer's market — it's the only clinic in the country that we know of that is co-located with a farmer's market — and that is purposeful to address the social determinants of health. There are no grocery stores in Flint, our patients have limited access to nutrition and there are other social determinants of health that impede their health outcomes. We're across the street from a central bus stop in the middle of downtown Flint to address our patients' transportation barriers. So we have been and continue to be proactively addressing the non-medical issues our patients have to optimize their health and outcomes.

In our wellness department, we're offering cooking lead-focused classes to help mitigate exposure risk through nutrition and we've created a recipe book in collaboration with Michigan State University where we demo a certain lead-focused recipe each week.

Q: Have you noticed any changes in Flint since the switch back to the Detroit water system?

Dr. Hanna-Attisha: The water switch happened Oct. 16, but the water is not safe yet because the corrosive water with a lack of corrosive control significantly damaged our infrastructure. So it aged our pipes and we also lost that protective seal that was in our pipes, so that's why we're still in this public health state of emergency. People should still be using water filters and cold water and so on. The water is a lot better than it was before we switched, but it's still not entirely safe.

Q: What measures are you taking to make sure that hospital water is clean?

Dr. Hanna-Attisha: We have a hospitalwide filter system, and the hospital does routine testing of its water and then for very vulnerable populations — infants for example. We just used ready-to-feed formula, so we've been taking proactive measures from the onset. But our hospital is about 120 years old and the damage to our infrastructure is still unknown, so there's a lot of investment that needs to happen in terms of continued monitoring and remediation.

Q: What are people following the crisis in Flint missing out on when they just read the headlines?

Dr. Hanna-Attisha: We have a community with a populationwide trauma, so we're really trying to convey a message of hope. Not every kid is going to have every problem related to lead exposure, and I feel that this really is a state of emergency now because if we can throw every evidence-based intervention at these children from early education to nutrition to healthcare, we have a chance to build a model public health program that can really mitigate the impact of exposure. I'm hoping we can turn lemons into lemonade and help our children, who are already dealing with so many toxic stresses from poverty to unemployment to violence, to get the interventions they need to overcome this exposure as well.

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