A pediatrician who exposed the flint water crisis shares his "story of resistance"

In August 2015, Dr. Mona Hanna-Attisha was having a glass of wine in her kitchen with two friends, when a friend, water expert, asked her if she was aware of what was happening in the house. water in Flint, Michigan.

Hanna-Attisha, a pediatrician in Flint, knew that the city had changed sources of water the previous year. Instead of channeling water from the Great Lakes, residents were now drinking water near the Flint River. She had been aware of some problems with bacteria after the change, but she thought that everything had been cleared up.

Her friend told her, "Mona, the water is not treated properly, something is missing that is called corrosion control … Without this corrosion control, there is will have lead, "recalls Hanna-Attisha.

The possibility that drinking water in the city was tainted with lead triggered alarms at Hanna-Attisha; lead exposure can lead to long-term cognitive and behavioral problems, especially in children.

When Hanna-Attisha began to review the medical records of her patients, she noticed that the percentage of children with high levels of lead had increased after the change in water. But when she shared her data at a press conference at the hospital, government officials tried to discredit her.

"The state said that I was an unfortunate researcher, that I was causing near-hysteria, that I was cutting out and cutting out numbers," says Hanna-Attisha. "It's very difficult when you present science and the facts and figures for the state to say you are wrong."

But Hanna-Attisha refused to give up. Instead, she led efforts to publicize and resolve the water crisis in Flint. She writes about her experiences in the book What the eyes do not see.

"It's a story of resistance, activism, citizen action, awakening and opening eyes and making a difference in our community," she says. "I wrote this book to share the terrible lessons that happened at Flint, but more importantly, I wrote this book to share the incredible work we did, with our community, for that our community takes care of our children. "

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Highlights of the interview

On how the Flint water crisis began

Flint was in a state close to bankruptcy, suffering really crisis for years, even decades before this water crisis. In Michigan, if you are in a desperate financial situation, the state can come in and really usurp democracy. Thus, in 2011, Flint became under the control of the state-appointed financial emergency management, and the work of this emergency manager was austerity. It was ostensibly save money, no matter the cost.

They decided that the water we had been receiving for half a century from the Great Lakes – from the pristine Lake Huron fresh water we had bought in Detroit – was too expensive. We would begin to draw water from the local Flint River until a new pipeline is built in the Great Lakes. The move to the Flint River had to be temporary. …

All this has been done to save money, to reduce costs, without regard to public health or children's health. People who grew up in Flint know the story of the Flint River. We are an inherited industrial community. The Flint River has already caught fire twice in the past. Corrosion or the impact of the water crisis was not the fault of Flint River. The Flint River would probably have been OK, not ideal, if it was treated properly. The biggest irony is that the chemical treatment, the control of corrosion, would have cost only 80 to 100 dollars a day. That's all it would cost to properly treat this water. Yet, this has never been put in this water. The pump to install this treatment has never been installed, so there has never been any intention to treat this water properly.

On how lead is a "silent pediatric epidemic"

The consequences of exposure to lead are something that we do not easily see. This has an impact on cognition at the population level, and therefore drops the IQ of a population of children, moving this IQ curve to the left where you have more children who have need special education services, less talented children. It influences the behavior – increasing the likelihood of things like deficit disorder of attention. It has been linked to impulsivity. It has been linked to violence and even crime. Exposure to lead therefore has permanent cognitive and behavioral consequences that you do not see right away.

On his approach to treating children exposed to lead

Our response to Flint has been very proactive and preventative because we can not wait morally to see the consequences of lead poisoning and lead exposure. We have therefore implemented multiple interventions that promote the brain development of children and limit the risks. impact of this crisis. We can not remove lead – I wish I could prescribe a magic pill or antidote to remove lead poisoning; there is no such thing. But we can do a lot to limit the exposure of children in order to mitigate the impact of this crisis.

On if people from Flint can bathe safely in the water

Many people had concerns, especially at first, with bathing and showering. We had bacteria in the water, then we had a lot of chlorine in the water, which irritated the skin and the eyes of people. People had rashes and hair loss and they took a bath and up to the water line, their kids were bursting into rashes. We did not really know why people had these rashes. Lead in itself does not cause skin problems. the [Centers for Disease Control and Prevention] In fact, they came in and did a huge survey of the rashes and they noted that yes, people had more skin problems, but we do not know why. There were a lot of things in this water that could have irritated people's skin. So, it's case-by-case, decide if you can swim, if you can take a shower. For some people, that's fine. for some people, it always causes irritation.

On the quality of Flint water today

Flint is still in a state of public health emergency. Flint people are always recommended to drink filtered water or bottled water. The quality of our water has improved considerably since the beginning of this crisis. however, Flint launches into something that no other city does: we replace our damaged lead pipes. We were on this untreated corrosive water for 18 months and it devoured our infrastructure. So these pipes are replaced and it takes time. We have replaced about 6,000 damaged lead pipes, but there are still about 9,000 that still need to be replaced. Until then, if people have not had their pipes replaced, they must be [drinking] filtered or bottled water. …

[Flint is] one of the poorest cities in the country. Until recently, the state was paying for bottled water, and that ended a few weeks ago, so now it is supported by churches and nonprofits as United Way.

On how the Flint water crisis exacerbates the "toxic stress" that the city's inhabitants are already facing

Growing up in poverty is a toxic stress. Being exposed to violence, lack of nutrition, dangerous places to play – all this is toxic stress. And now, with the incredible science of brain development, we have learned that all this stress and repetitive trauma for children is affecting their entire life course in a very gradual and predictable way.

The more adversities you have – especially very early in life during this critical brain development period, this prenatal or preschool period – the more toxicity you have, whether it's lead exposure or poverty or the separation of the family, that you will grow up to be unhealthy and have more chronic diseases.

In the original study on [adverse childhood experiences]it has actually shown an impact on mortality. If you have had six or more of these ACEs, these negative experiences in your childhood, your mortality has dropped by 20 years. Your life expectancy has dropped by 20 years. Our Flint children already had a reduced life expectancy. Their life expectancy in Flint postal code is 15 years lower than the life expectancy of an adjacent postal code. So we were a community that was already shaken by these toxic stresses.

Sam Briger and Mooj Zadie produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Scott Hensley have adapted it for the Web.

TERRY GROSS, HOST:

It's FRESH AIR. I'm Terry Gross. My guest is proof that science and facts can defeat political lies and cover-ups on the environment and public health. But his story also speaks of irreversible medical damage. Mona Hanna-Attisha is a pediatrician in Flint, Michigan, who proved that Flint's children were exposed to lead in tap water. How she discovered that lead was in the water and how she proved that it is the subject of her new memoir "What the eyes do not see".

She writes (reading) this is the story of a government poisoning its own citizens and lying about it. It's a story about what happens when the very people responsible for keeping us safe worry more about money and power than about their interest for us or for our children. She adds (read) that it is also the story of a breakdown of democracy, the disintegration of critical infrastructure, due to inequality and austerity, and of environmental injustice that disproportionately affects the poor and the blacks. Dr. Mona, as he is called, is a pediatrician at Hurley Medical Center, a Flint public hospital, and professor of pediatrics at Michigan State University. His parents are Iraqi immigrants.

Dr. Mona, welcome to FRESH AIR. As a pediatrician and immigrant – the daughter of parents who immigrated from Iraq, what are your concerns about children who have been separated from their parents after illegally crossing the border? And what are the long-term effects that separation could have on them?

MONA HANNA-ATTISHA: The science of this separation – it's a trauma. It inflicts trauma to children that can cause irreparable damage to their development. It is not different to be abused or neglected. It's a trauma. And that's exactly the kind of things that pediatricians need to protect children.

GROSS: You are referring to something in your book – an acronym called ACE, which represents the adverse experiences of children. These are toxic stresses.

HANNA-ATTISHA: Absolutely.

GROSS: And you quote a historical study that has shown that the more the child has negative experiences on him, the more likely he is to have long term physical and behavioral health problems. And you say that resilience is something that is learned.

HANNA-ATTISHA: Yes. So ACE is – and the concept of toxic stress, I think, is the most important thing in pediatrics and public health right now. Our trauma in Flint – the water crisis and the resulting trauma – is also a toxic stress. And so it is that we have framed the whole crisis – one of the added difficulties for children who are already suffering from so many adversities and obstacles to their development. The separation of their children and their families is a toxic stress. Growing up in poverty is a toxic stress. Being exposed to violence, lack of nutrition, dangerous places to play – all this is toxic stress. And now, with an incredible brain development science, we have learned that all this stress and repetitive trauma for children is affecting the trajectory of their life cycle in a very gradual and predictable way.

The more adversities you experience – especially at the very beginning of life during this critical period of brain development – this type of prenatal or preschool period – the more toxicity you have – either exposure to lead or poverty or the separation of the family – the more likely that you will grow up to be unhealthy and have more chronic diseases. And in fact, in the original study on CEA, it actually showed an impact on mortality. If you have had six of these ACEs or more – these negative experiences of childhood, your mortality has dropped by 20 years. Your life expectancy has dropped by 20 years. And our Flint children already had a reduced life expectancy. Their life expectancy in Flint postal code is 15 years lower than the life expectancy of an adjacent postal code. So we were a community that was already shaken by these toxic stresses.

GROSS: So what is the quality of Flint tap now? And do you drink it?

HANNA-ATTISHA: It's a great question. So, Flint is still in a state of public health emergency. Flint people are always recommended to drink filtered water or bottled water. Our water quality has improved considerably since the beginning of this crisis. However, Flint embarks on something that no other city does. We replace our damaged lead pipes. We were on this untreated corrosive water for 18 months, and that devoured our infrastructure. So these pipes are replaced, and it takes time. We replaced about 6,000 of these damaged lead pipes. But there are about 9,000 of these pipes that have yet to be replaced. Until then, if people have not had their pipes replaced, they must be on unfiltered or bottled water.

GROSS: Does this include baths and showers?

HANNA-ATTISHA: Many people have had concerns, especially at the beginning, with bathing and showering. We had bacteria in the water. Then we had a lot of chlorine in the water, which irritated people's skin and eyes. People had rashes and hair loss. And they would take a bath. And up to the waterline, their children burst into rashes. So it was very – we did not really know why people had these rashes. Lead in itself does not cause skin problems. The CDC came in and did a huge investigation. And what they noticed was that, yes, people had more skin problems. But we do not know why. There were a lot of things in this water that could have irritated people's skin. So it's case-by-case – decide if you can swim or if you can take a shower. For some people, that's fine. For some people, it always causes irritation.

GROSS: Do you treat children now that you are treating for the long term effects of lead poisoning?

HANNA-ATTISHA: Absolutely. So our position, since the beginning of the recognition of the crisis, is to treat everyone as if they were exposed. Lead exposure is known as a silent pediatric epidemic. We do not see the consequences of lead poisoning right away. I wish we did. I wish that if a child was exposed to lead, they had, like, bright yellow bumps. And we could immediately identify that they were exposed and that they needed treatment. But we do not see the consequences. And there is often a gap between exposure and when we see potential consequences, such as school problems or behavioral problems.

So, our response to Flint has been very proactive and preventative because we can not wait morally to see the consequences of lead poisoning – from lead exposure. We have therefore implemented multiple and multiple interventions that, as we know, will promote the brain development of children and limit the impact of this crisis. We can not remove the lead. I would like to be able to prescribe, like, a magic pill or antidote to remove lead poisoning. There is no such thing. But we can do a lot to limit the exposure of children – to mitigate the impact of this crisis.

GROSS: How did you first recognize that there was a problem in the water?

HANNA-ATTISHA: So it was not at the clinic. It was not seeing patients. It was not in the hospital. It was at my place. It has happened to me to have two more high school girlfriends. We were hanging out with our children – lots of little kids running around. And one of my high school girlfriends happens to be a water expert. She worked for the EPA. And she – with glasses of wine in both hands, she's like, hey, Mona, did you hear about Flint's water? I'm like, yeah, you know, there were bacteria. But, you know, this has been cleared up. And then there were other problems. But that has been clarified. I mean, I tell my patients that the water is fine. They keep asking me. But, you know, the state says that everything is fine. Everything must be OK. And she turned to me. And she said, Mona, the water is not treated properly. Something is missing called corrosion control. And I had no idea what she was talking about. And she said, without this control of corrosion, there will be lead in the water. And it was the first time – at home, in my kitchen, a glass of wine in hand – that I heard about the possibility of lead in the water.

GROSS: And your friend knew that because she had worked at the EPA and that she had seen a memo from the EPA. Tell us about this memo.

HANNA-ATTISHA: Yes, so my friend used to be with the EPA. And she was with the EPA a decade ago in Washington, DC, when Washington, DC, had a very similar lead in the water crisis. She was therefore very aware of the consequences of lead in the water. And she had seen a memo published by one of his former colleagues – Miguel Del Toral of the EPA in Chicago. And in this memo, he warned that Flint was on the brink of a water disaster, and that they had to act.

GROSS: So, was it the EPA memo that allowed you to make a connection between lead in water and the symptoms you saw in children? you treat?

HANNA-ATTISHA: So I did not see any symptoms in the children I was treating. Lead has no symptoms. I therefore like to take my medical students and my residents – like, how does a child with lead poison it? And it's asymptomatic. They have no symptoms. So we have to be alert and do a screening to see if there is an exposure. So when I heard about the possibility of lead in the water – when I read this EPA note, I tried to see if the lead levels in the blood of our children had changed since the change of source of water.

GROSS: Oh, it's so interesting that you do not see any symptoms because the symptoms are – what? – cognitive, other symptoms related to the brain over a long period of time.

HANNA-ATTISHA: Yes. And that's one of the reasons why the title of my book is "What the eyes do not see". So our eyes do not see any lead in the water. So, literally driving in the water is invisible. It is odorless. It's tasteless. But also, the consequences of exposure to lead are something that we do not easily see. It has an impact on cognition at the population level. So it drops the IQ of a population of children, moving this IQ curve to the left, where you have more children who need special education services, Children less gifted. It has an impact on the behavior, increases the likelihood of things like deficit disorder of attention. This has been linked to impulsivity. He has been linked to violence and has even been linked to crime. Exposure to lead therefore has permanent cognitive and behavioral consequences that you do not see right away.

GROSS: Once you realized that there was lead in the water, or that you suspected that there was lead in the water, you had to do some research scientists to prove that something was happening. What do you need to do to create the kind of study you could bring to the authorities and say, look what's going on?

HANNA-ATTISHA: Yes. So I knew that I needed proof of impact. I needed to know if this lead in the water was entering our children's bodies. As pediatricians, we regularly check children for lead exposure. We do this at the age of 1 and 2 years for high-risk groups, especially children on Medicaid because Medicaid serves as a proxy for poverty, and these are some of the most exposed groups to lead . So, I knew that in my clinic, we watch children for lead. And I knew that in other clinics in Flint, they also examined children for lead. But I have also realized that blood lead levels are part of state and county level surveillance programs. So we have a number of programs to track epidemics, monitor rates of influenza and HIV rates. And lead is one of those things. We have surveillance programs already designed for lead levels in the blood. So I tried to get blood data from both the state and county health departments, but there were roadblocks in all directions.

GROSS: Why?

HANNA-ATTISHA: So, I do not know why. I'm trying – you know, there was so much denial in Flint's story. So much information was hidden from those who were trying to get information. I would have liked it to be easily shared and I would have liked to know that even at that time, even when I was asking for this information, the state-level health department had already examined children's lead levels and had already seen a spike in children's lead levels. I would like it to be there; I would like this to be shared; I would have liked it to be transparent because our crisis would not have lasted as long as it would have been.

GROSS: So some authorities knew and did nothing.

HANNA-ATTISHA: Absolutely. And that 's why we have so many criminal charges right now.

GROSS: How many people are accused?

HANNA-ATTISHA: More than 15 people have been charged with criminal charges, including negligent homicide charges. Not only was it a lead exposure crisis, but we also had one of the biggest outbreaks of Legionnaire's disease. It's a pneumonia that older people have. At least 12 people died of this. There was also a slight increase in deaths due to pneumonia in general, probably due to legionnaires' disease. And because of that, there have been accusations against people from the Department of Health and the Department of Water, one of the emergency managers for negligent homicide.

GROSS: So let's pause in this story, then we'll come back and talk more. If you have just joined us, my guest is Dr. Mona Hanna-Attisha. She is the pediatrician who exposed that lead poisoned children in Flint, Michigan in 2015 and warned against lead in tap water. His new brief is called "What the eyes do not see". We will take a short break. We will be back right away. It's FRESH AIR.

(SOUND OF SLOWBERN "WHEN THE WAR WAS KING")

GROSS: It's FRESH AIR. And if you just joined us, my guest is Dr. Mona Hanna-Attisha. She is the pediatrician who has exposed lead plummeting children in Flint, Michigan, through tap water in 2015. Her new book is a memoir entitled "What Eyes Do not See." It is the water crisis, the politics and the racism that led to the crisis and the role it played in solving it. It's also a personal memory about being the daughter of Iraqi immigrants. She is a pediatrician at Hurley Medical Center, a public hospital in Flint, Michigan, and a professor of pediatrics at Michigan State University.

So when you discovered that there was no corrosion measures in the flint water, what did it mean?

HANNA-ATTISHA: So when I discovered that there was no control of corrosion, I had no idea what that meant. I – you know, I actually have environmental health training. I am trained in public health. But until that moment, I did not even know that our plumbing had lead in it. For years, I was looking after children who were intoxicated with lead, and I always asked them if they were exposed to lead paint, lead or lead dust, or, you know, toys that might get into it. if children drank water that could have been contaminated with lead. And it shows my blindness to the knowledge of this risk to environmental health.

So when I heard that there was no control of corrosion, I had to ask – I'm like that, OK, so what does it want say? And my good friend Elin, the water expert, said well, if there is no control of corrosion, the lead that will come out of the plumbing will sink into the water. ;potable water. And that was all new information for me. And I would have liked to know, and would have liked to know the history of lead in the water. And in this book, it plunges into a lot of history because Flint is not the first time we have a lead problem in the water. Washington, DC, ten years ago is not the first time.

We have had lead problems in the water, for example, since we started putting lead into our plumbing. The Romans put lead in their plumbing, and they also put in a lot of their food. And in fact, many people assume that the end of the Roman Empire is because they have used so much lead in their plumbing and everything else. So, I wish people open their eyes and learn from history. And a lot of this story is in this book so we do not repeat those same mistakes.

GROSS: So you said you treated a lot of kids for lead poisoning. I guess there is a difference between lead poisoning and lead exposure.

HANNA-ATTISHA: Of course. So, there is – lead is a poison. We now know that there is no safe level of lead, so any exposure can be considered poisoning. Children need medical care – for example, they have to be admitted to the hospital when their lead level exceeds, for example, 40, 45 micrograms per deciliter, which we have not seen in Flint. And that's when they have to be chelated. So, an agent takes the head out of their bodies. However, chelation does not alter the neurodevelopmental outcome of a child. The only treatment for lead exposure – lead poisoning – is prevention because it is an irreversible neurotoxin with no safe exposure level. So the only treatment is prevention.

GROSS: So when you said you've been dealing with kids with lead poisoning for years, was it based on just seeing what levels of lead in the blood were?

HANNA-ATTISHA: Yes. So, it was like a pediatrician at a time – mainly in Detroit where I had done my training. You know, we would have kids coming in with high levels. And we did not even know that they would have a high level until we get tested because there are no acute symptoms.

GROSS: So you managed to get hold of the medical records of many children in Flint and to show that there was an unusually high number of children with lead in their blood. Your search has been discredited. How was he discredited?

HANNA-ATTISHA: Yes. We therefore found that the percentage of children with high levels of lead increased after the change in water, which was contrary to all that was happening nationwide, in the world. all of the state and city. Publicly shared this data, which is very atypical of a doctor. In academia, you are supposed to present your research in publications and journals. And it was a kind of academic disobedience, but our kids did not have another day. This process is time consuming. So we publicly shared this data at a press conference at the hospital, warning families and children to take precautions and not to use this water, especially for the youngest and most vulnerable in development. And just as Marc Edwards was attacked, I was also attacked. So the state said that I was an unfortunate seeker, that I was almost causing hysteria, that I was splicing and cutting out numbers. And that their numbers – the big data set, this set of surveillance data – did not fit my numbers.

It is therefore very difficult, when you present scientific and factual data, to ask the state to say that you are wrong and that it is difficult not to guess you. When I wrote this book, I relived those emotions that were going through me during this time. You know, I was – at that time, I was – I just wanted to hide under a blanket. I'm like, you know, all this state – you know, their health department, their team of epidemiologists, and the people who have even more numbers than me say I'm wrong. And maybe I'm wrong. You know, maybe I should not have spoken. Maybe I should not have done this job. But finally, you know, despite this kind of setback and discredit, the research being discredited, I realized, as a researcher, that these figures were part of my research – the facts – all the numbers of my the research was a child. And that is by realizing that they were kids we were playing with and that it was their future that was on the line that really gave me this fight to say, hey, no these numbers are right. We checked and checked three times. And we did not even need to have any evidence from children with an increase in lead in their blood. It should have stopped when we knew that there was lead in the water. And that's sort of what pushed me and gave me my fight to keep going.

GROSS: My guest is Dr. Mona Hanna-Attisha. She wrote a new memoir on Flint's water crisis and her crucial role in proving that there was lead in the tap. The book calls "What the eyes do not see". After a break, we will talk more about Flint and be the daughter of Iraqi immigrants. And our TV critic David Bianculli will review Paul McCartney's appearance on James Corden's feature film, "Carpool Karaoke". I am Terry Gross, and it is FRESH AIR.

(SOUND OF THE COURAGE OF JOSHUA REDMAN (ARIA ASYMMETRIC)

GROSS: It's FRESH AIR. I'm Terry Gross back with Dr. Mona Hanna-Attisha, the pediatrician who helped prove that there was lead in the drinking water of Flint Michigan and that the kids who drank it had levels high lead in their blood. Her research was challenged by the government, but she refused to back down. She wrote a new memoir entitled "What Eyes Do not See: A Story of Crisis, Resistance and Hope in an American City". Her book also talks about being the daughter of Iraqi immigrants.

This Flint water crisis has been so expensive in every way – in terms of children's health, parents' anxiety about their children, real dollars that are still needed to change all the pipes (laughs) …

HANNA-ATTISHA: Yes.

GROSS: … Flint, medical treatment costs of children. And it will last a long time – for years.

HANNA-ATTISHA: Yes, it's a long-term problem.

GROSS: And everything has happened to try to reduce costs. So…

HANNA-ATTISHA: Absolutely.

GROSS: … Explain a bit about the emergency managers that Governor Rick Snyder set up in cities like Flint that were in debt.

HANNA-ATTISHA: Yes. So Flint was in a state close to bankruptcy, really suffering from the crisis for years, if not decades, before this water crisis. And in Michigan, if you are in a desperate financial situation, the state can come in and really usurp democracy. Thus, in 2011, Flint became under the control of the state-appointed financial emergency management, and the work of this emergency manager was austerity. It was essentially, save money, no matter the cost. And they decided that the water we had been receiving for half a century from the Great Lakes – the pristine and fresh Lake Huron water we had bought in Detroit – was too expensive and we would begin to draw the local Flint water. River until the construction of a new pipeline to the Great Lakes.

The move to the Flint River was therefore temporary until a new pipeline was built. And all this has been done to save money, to reduce costs without regard to public health or the health of children. And people who grew up in Flint, like, know the story of the Flint River. I mean, we are an inherited industrial community. The Flint River has already caught fire twice in the past. But it was not actually corrosion – or the impact of the water crisis was not because – it was not Flint River 's fault. The Flint River would probably have been OK – not ideal – if it was treated properly. And the biggest irony is that the chemical treatment, the control of corrosion, would have cost only 80 to 100 dollars a day. This is all that would have cost to properly treat this water, but this has never been put into this water, and the pump to install this treatment has never been installed. So, there had never been any intention of treating this water properly.

GROSS: Was it a function of ignorance or austerity, financial austerity?

HANNA-ATTISHA: It's a great question, and I think that's why we have so many investigations. People are trying to get to the base of why. Why has this water not been treated properly? And I have no idea why. Many people point to this as an environmental justice problem, that it is because of the demographics of the population that this crisis has occurred and has continued and that these people have been neglected during so long. I do not know if it was laziness. I do not know if they just wanted to jump in until this new pipeline was built, you know, nobody would notice it was not processed properly. But, you know, I'd love to find the answer, and I'm waiting for even more investigations on why.

GROSS: When Governor Rick Snyder appointed an emergency manager to take over Flint, who replaced? Has this replaced the mayor, the municipal council?

HANNA-ATTISHA: Yes, it replaced everyone, but essentially, the mayor and the city council. The city council voted to return to the Great Lakes because of all the citizens' complaints. People were complaining about the smell and, you know, about the quality of water and bacteria in the water. And the city council voted for Flint to return to the Great Lakes water, but the emergency director said no, it is not possible. So, there was no democracy in Flint. There was no responsibility.

GROSS: Yes. You write that in 2013, half of Michigan's black citizens lived under an emergency manager, compared with 2% of white residents. So, that's half of all black citizens, 2% of white residents, which, according to you, meant that half of Michigan's black population had no elected representatives managing their cities. The cities had actually been colonized by the state.

HANNA-ATTISHA: Grossly undemocratic.

GROSS: Is water coming out of Lake Huron now again?

HANNA-ATTISHA: Yes, just – in fact, a few weeks after our press conference, we returned to treated Great Lakes water. However, during the 18 months we spent in this corrosive and untreated water, the infrastructure was so damaged and that is why people had to stay in the filtered and bottled water until that that the pipes are replaced.

GROSS: So, you are a pediatrician in Flint, Michigan, where people are always under surveillance to drink filtered or bottled water. What about those of us who are not a counselor – under a notice? What advice would you have for us regarding tap water?

HANNA-ATTISHA: Oui, j'ai l'impression d'avoir suivi un cours accéléré sur la chimie de l'eau et la qualité de l'eau potable au cours de ces dernières années. Et ce que j'ai appris, c'est que les règlements sur les livres ne protègent pas complètement les enfants. La règle du plomb et du cuivre, qui fait partie de la Loi sur la salubrité de l'eau potable, n'a pas rattrapé la science que nous connaissons maintenant, où il n'y a pas de niveau de plomb sécuritaire qui soit permis. Donc, pour les enfants de Flint et pour les enfants du monde entier, surtout si c'est une maman enceinte ou un enfant jusqu'à l'âge de 5 ans, je recommande l'eau filtrée si vous voulez vraiment protéger cet enfant. Jusqu'à ce que nous ayons des investissements massifs dans l'infrastructure pour prendre la tête de notre plomberie, jusqu'à ce que nous ayons un renforcement de la réglementation, je recommanderais aux gens de prendre des précautions supplémentaires.

GROSS: OK (rires), donc ça ne sonne pas très bien. Ainsi, vous seriez en train de boire de l'eau en bouteille ou filtrée, peu importe où vous viviez aux États-Unis.

HANNA-ATTISHA: Oui. Nous étions obstinément lents en tant que nation à restreindre le plomb dans notre plomberie. Nous n'avons pas limité le plomb dans nos lignes de service, qui sont les conduites d'eau qui vont de la conduite d'eau à votre maison, jusqu'en 1986. Mais nous n'avons pas restreint le plomb dans nos appareils en laiton jusqu'en 2014. Ainsi, les écoles Flint Il n'y avait pas de lignes de plomb, mais ils avaient certains des niveaux de plomb les plus élevés, et cela parce que les appareils étaient du plomb de lixiviation. Et presque chaque semaine, nous entendons parler d'une autre communauté ou d'un autre district scolaire de tout le pays qui fait des tests et trouve du plomb dans son eau parce qu'il y a du plomb dans son eau. Donc, ce sont quelques-uns des grands effets d'entraînement positifs sur l'histoire de Flint – c'est que, vous savez, les gens pensaient que nous prenions soin de la terre; les gens pensaient que c'était un problème d'hier, mais c'est un problème d'aujourd'hui, et c'est un problème de demain. Et nous sommes chanceux que les gens y prêtent attention.

GROSS: Alors, quelle est l'efficacité des filtres à eau en vente libre que vous achetez …

HANNA-ATTISHA: Alors si …

GROSS: … Quand il s'agit de plomb? Yeah.

HANNA-ATTISHA: Oui. Vous devez donc avoir un filtre spécifique pour l'élimination du plomb. C'est un filtre NSF – National Science Foundation (ph) – n ° 53. Donc, tous les filtres ne libèrent pas de plomb. Vous pouvez obtenir un filtre qui s'attache à votre robinet de cuisine, ce que nous avons dans Flint, ou vous pouvez obtenir un filtre de pichet, mais il doit être désigné comme un filtre de plomb.

GROSS: Et ça dit ça sur l'étiquette.

HANNA-ATTISHA: Oui. Il a une désignation spécifique, NSF 53. Et il y a d'autres choses que les familles peuvent faire – par exemple, le rinçage de l'eau. Comme, vous le savez, si vous n'avez pas utilisé votre eau pendant six heures, pendant la nuit ou si vous êtes sorti de la ville, vous devez toujours vider votre eau. Donc, vous ouvrez votre eau froide, vous la faites fonctionner pendant quelques minutes jusqu'à ce qu'il fasse vraiment froid, et ensuite vous savez que vous avez reçu l'eau de la conduite principale, et cela vous débarrasse de tous les résidus dans les sédiments. D'autres choses que les familles peuvent faire, juste des précautions de base – vous n'êtes jamais censé utiliser l'eau chaude de votre robinet. Comme, ma belle-mère me l'a toujours dit, mais je me demande pourquoi elle me le dit? Mais c'est vrai. Vous n'êtes jamais censé utiliser de l'eau chaude, car cela augmente la lixiviation du plomb provenant de votre plomberie, ce qui est une autre raison pour laquelle les enfants ont des niveaux de plomb plus élevés en été, car ils s'échappent de la chaleur. Donc, vous n'êtes jamais censé utiliser de l'eau chaude pour cuisiner ou pour boire. Ce genre de problème a trait à notre crise parce que nous avions eu tellement d'avis d'ébullition à Flint à cause des bactéries. Et en fait, l'ébullition est l'une des pires choses que vous pouvez faire quand il y a du plomb dans l'eau, car le plomb qui se trouve dans l'eau se concentre dans tout ce que vous cuisinez.

GROSS: Faisons une pause ici, et nous en parlerons un peu plus. Si vous venez de nous rejoindre, mon invité est le Dr Mona Hanna-Attisha. Elle est le pédiatre qui a exposé que plomb empoisonnait les enfants à Flint, au Michigan, en 2015 et a mis en garde contre l'eau. Son nouveau livre «Ce que les yeux ne voient pas» traite de la crise de l'eau, de la politique et du racisme qui ont conduit à la crise et de son rôle dans la résolution de ce problème. C'est aussi un mémoire personnel sur le fait d'être la fille des immigrants irakiens. Nous parlerons d'immigrant après une courte pause. C'est de l'AIR FRAIS.

(SONORE DE MARIO ADNET "EXCERTO NO 1")

GROSS: C'est de l'AIR FRAIS. Et si vous venez de nous rejoindre, mon invité est le Dr Mona Hanna-Attisha. Elle est la pédiatre qui a exposé ce plomb dans l'eau du robinet à Flint, au Michigan, empoisonnait les enfants là-bas en 2015. Son nouveau livre est un mémoire intitulé "Ce que les yeux ne voient pas". C'est à propos de la crise de l'eau. C'est aussi un mémoire personnel sur le fait d'être la fille des immigrants irakiens. Elle est née en Angleterre et a ensuite déménagé avec ses parents aux États-Unis.

Enfant, vous étiez exposé à l'activisme politique. Tes parents avaient prévu de retourner en Irak après que ton père ait obtenu un diplôme supérieur. Il a fini par obtenir un bon travail chez GM et avait – quoi? – comme, 43 brevets en son nom parce qu'il était – quoi? – un chimiste.

HANNA-ATTISHA: Il était ingénieur métallurgiste. J'ai donc grandi avec la table périodique.

GROSS: C'est vrai. Mais tes parents viennent d'Irak.

HANNA-ATTISHA: Correct.

GROSS: Est-ce que c'est pendant la guerre Iran-Irak qu'ils ont décidé de ne pas revenir?

HANNA-ATTISHA: Ils sont partis juste avant. Je suis née au Royaume-Uni quand mon père a obtenu son doctorat. Et le plan était, quand il a été fait en 1979, 1980, pour nous de retourner en Irak – de rentrer à la maison. C'est là que toute notre famille était. But that's when Saddam Hussein was rising in power. My parents were hearing stories about friends that had gone missing. And of the rise in fascism and tyranny and oppression. And they had two small children at the time. I was just born. My brother is a year older. And they knew that they could not raise their two children there. So we immigrated to Metro Detroit. We immigrated to the States, where already there was beginning kind of the diaspora of Iraqis who were leaving Iraq.

GROSS: So your father became very obsessive in following the news out of Iraq. He used to listen to the shortwave radio every night to find out the news. What impact did it have on him emotionally to be away from Iraq but to have friends and family that were still there – and to be obsessed with how Saddam was, you know, imprisoning people, torturing people – people were living in fear.

HANNA-ATTISHA: Yeah. So that that is how I recall my entire childhood – my father smoking cigarette after cigarette in a backroom, reading Amnesty International, trying to find out any news about what was happening back home, listening to the shortwave radio, trying to learn about what was happening to his home country. And he would turn that anger – his knowledge of the injustice into action. So he wrote papers. He contacted legislators. And this was a time when nobody knew about Saddam Hussein. Nobody knew about his evilness. And the U.S. was actually supporting that regime at that time.

And I clearly recall – I was about 11 or 12. And he showed me – from Human Rights Watch – he showed me a picture of a child – of a baby who was killed – who was poisoned in Halabja. So Halabja is in northern Iraq. And it was a city that had the largest chemical weapons attack. Saddam Hussein poisoned this Kurdish city of Halabja. And over 5,000 people died. And I remember seeing this beautiful baby in a pink blanket who was just, you know, coddled with her father. And both of them were on the ground poisoned to death.

It was that picture and that moment that haunted my dreams – but also made me realize how lucky I was to grow up here in this country and how lucky I was to be free, to speak freely and to have the opportunities that I had. But we were never shielded from injustice. We were never shielded from the realization of what evil leaders could do to their own populations – especially vulnerable populations.

GROSS: You as a child were in a terrible car crash.

HANNA-ATTISHA: Right, yeah.

GROSS: And what happened?

HANNA-ATTISHA: So when we first came to the States, we actually moved to the Upper Peninsula of Michigan, which is a full 12 hours away from the Detroit area. And I don't think my parents knew that when they came to Michigan. They knew that there were – was many Arab Americans in Michigan. But I don't think they knew that it would be 12 hours away from most Arab Americans. So we moved to Michigan Tech University, where my father did a postdoc. He continued his research in the metallurgical sciences.

And we were traveling back-and-forth to the Detroit area to see our family. And on one trip back to the Upper Peninsula, our car hit a patch of black ice. And it swerved and swerved back-and-forth. And I was weightless. Nobody was wearing seatbelts at that time. And I flung back-and-forth to either side of the car. And then the car eventually went into a ditch. I broke my neck. I fractured my jaw. My teeth were braced together for months. My face was crooked.

And what I remember from that time – we were then transported to a hospital. And my mom had limited English. Nobody knew anything about medicine. And I just remember being reassured by a doctor. I can still see her face. She had dark hair. She had dark skin. She held my hand. And she sat down with me and my mom. And she said, you were in a terrible accident, but you are going to be OK. And it was one of my most vivid memories. And from that moment on, I was always interested in medicine. I felt it was probably the most intimate – is the most intimate form of service and healing. And in 30 years after that accident, I found myself in that exact same position where I am literally holding the hands of my kids in Flint, telling them that they were in this terrible accident that wasn't their fault. And now it's my turn to make sure that they're going to be OK.

GROSS: So that accident had a lot to do with you becoming a pediatrician?

HANNA-ATTISHA: Absolutely.

GROSS: So, you know, you had described how your father showed you a picture of a dead baby to show what had gone on in Iraq when Saddam Hussein poisoned people in his own country through a chemical attack. He wanted to show you what was going on in the country that your parents could no longer return to and how lucky were to be living in America. What do you tell your two children about the country their grandparents are from? And what do you expose them to? What do you protect them from…

HANNA-ATTISHA: Yeah. So…

GROSS: …Especially during this period when you're trying to reassure them that in spite of President Trump's opposition to Muslims – and I know your family isn't Muslim, but for the outside world, like, if you're from Iraq people are just going to assume you're Muslim – and his – also his opposition to immigrants?

HANNA-ATTISHA: Yeah. So my husband and I, we're not exactly showing our children pictures of dead babies. But we are absolutely carrying forward the oral stories, the traditions, letting them know where they came from, where their roots are, telling them about stories about my grandfather. We love telling them about my great-uncle, who's in the book, Nuri Rafael (ph), who was a progressive in Iraq in the 1930s who actually left Iraq to fight in the Spanish Civil War as part of the International Brigade. He was one of two people who left Iraq to fight against Franco, to fight against fascism.

So we reiterate that no matter where you are, you come from folks who believed in a borderless cause, who believed in a just society. And that just like they did and just like your mom and dad do, we expect that you also, you know, use your education, use your skills and use your voice to make wherever your community may be a better place.

GROSS: Dr. Mona, thank you so much for talking with us.

HANNA-ATTISHA: Terry, thank you so much. It is, like I said before, an honor to be here – on here with you.

GROSS: It's an honor to have you on the show.

HANNA-ATTISHA: Thanks a lot.

GROSS: Dr. Mona Hanna-Attisha's new memoir is called "What The Eyes Don't See." After a break, TV critic David Bianculli will review Paul McCartney's guest shot on "Carpool Karaoke," James Corden's popular "Late Late Show" feature. This is FRESH AIR.

(SOUNDBITE OF PATTI SMITH'S "WITHIN YOU WITHOUT YOU") Transcript provided by NPR, Copyright NPR.