I have finally started my clerkships and it’s amazing. Each day I come home and plop down so quickly you’d think years of clinics had taken its toll on me — it’s tiring. Yet every day, my limited medical knowledge quickly reminds me that that is the farthest thing from the truth — I’m definitely a newbie at all of this. Today, as usual, I was a sponge. I stared in awe as my attending cited p-values when referencing literature to bolster his suggestion for the continuation of a particular medication. I made my medical student status obvious as I aggressively took down notes on all of the pathophysiologies and mechanisms of action I needed to look up tonight. I soaked up everything I could.
As usual, I also washed my hands innumerable times. I left the room of a patient placed in isolation for a potential infection and immediately placed my hands under a faucet. As I paused in the chaos of rushing to present my findings to my resident, I found relief in the warmth of the water and the scent of the soap. In that moment, I was grateful for cleanliness.
Then, the images of water from Flint, Michigan water came into my mind and I lingered at the sink a few minutes too long. I became heartbroken for the children whose bodies may have been irreversibly and negatively impacted. I became enraged at a system that would prioritize saving pennies over properly protecting its citizens from preventable harm. Governor Rick Snyder, his appointed “emergency financial managers” and other leaders allowed this crisis to develop over years as they mistreated Black citizens through racist policies, violated the public trust, and endangered lives. A significantly poor and majority black city was told it was okay to use polluted water to prepare their children’s dinners. Families washed their dishes in what could be mistaken for urine. They scrubbed their pearly whites with toxins to avoid cavities. Despite reports in 2011 that water from Flint River would require treatment upon traveling through the city’s pipes in order to be approved as safe for consumption, governing agencies took no steps to ensure this process happened when switching to the problematic water supply in 2014. Moreover officials quelled the crowd instead of taking action when the people started to raise suspicion.
But, why would citizens use water if they thought there was something wrong with it? Well, they were paying water bills among their electricity bills, their car notes, their mortgages, their internet fees, their gas and their groceries. They were trying to make ends meet. Buying bottled water was burdensome for strict budgets, and local officials happily drank this water on television; perhaps the water was actually okay? As citizens of the United States, we participate in a social contract and expect that our governing bodies will protect us from harm, which can be interpreted as not intentionally poisoning us.
Furthermore, in June 2015, an expert within the Environmental Protection Agency (EPA) declared the water had unsafe levels of lead, but upper level officials slandered his credibility and belittled concerns from the citizens of Flint. The organization failed to be transparent with its constituents and appropriately demanded a change on behalf of the state government. Then, in September, a Virginia Tech professor shared his research results with the community, confirming residents’ suspicions and declaring that the city’s reports regarding lead water levels could not be trusted. This same month, pediatrician Dr. Mona Hanna-Attisha and her research team revealed that pediatric blood lead levels of Flint residents had more than doubled since the water change. Government officials dismissed her statistics and continued to mislead Flint’s citizens. Thankfully, Dr. Mona rechecked her p-values, re-evaluated her data, enlisted help and most importantly — remained persistent. In October 2015, Flint’s citizens had had enough and justifiably felt the need to petition our government for clean water. Finally, they were taken seriously, and the President stepped in and labeled this catastrophe “a federal state of emergency.”
When I got home, as eager as I was to better understand the jargon heard today, my first search in the medical world’s Bible, Uptodate, was about lead poisoning in the youth. In the 1970s, the United States intentionally and aggressively attacked the prevalence of lead toxicity via preschool screening programs, increased public awareness and the removal of lead from gasoline and paint products. Studies have shown that there are no safe blood lead levels for the pediatric population, and that children under the age of six are the most susceptible to the consequences of lead poisoning. All children exposed are at risk for more immediate neurocognitive effects, and later down the road, at risk for nephropathy and a host of other medical problems.
I find it hard to believe that a government responsible for the well-being of a community could ignore significant data and not be labeled as mal-intent. In January 2016, I am once again reminded of the need for physicians like Dr. Hanna-Attisha because historically, politicians have turned a blind-eye to the living conditions of the poor and those who identify as black. Vulnerable citizens lacking political and economic power have been pushed into polluted environments or their previously clean neighborhoods have been the recipients of intentional toxic dumps. Incidents like these cannot be solely blamed on financial capital, because majority black suburban environments are not immune to becoming dump sites either. Studies have shown that some health problems disproportionately found among black citizens and poor people may be linked to the burden of environmental pollution endured by these populations. In fact, the EPA is currently leading an initiative to address the disproportionate numbers of diagnoses and deaths among black youth due to asthma, since this is one of the most common disorders associated with poor environmental health.
It is extremely important for me to know the pathophysiology, pharmacology and latest literature so that I can one day serve my patients to the best of my ability. However, I am doing a disservice to my patients if I end my education there, as diseases do not begin or end with the human body. Were Flint physicians washing their hands in foul smelling water before performing the physical exam? Did they avoid drinking the water their patients were forced to consume while enjoying the luxury of bathing in properly treated water in their suburban homes? Like Dr. Hanna-Attisha, a student of public health and doctor who addresses health disparities, we must address more than the body, but also the environment that our patients live, work and play in. If we sincerely want to be great medical providers who take care of our communities, we need to understand why some patients can’t just return to their neighborhoods and run at the local parks. We need to know why telling them to eat more fresh fruits and vegetables isn’t necessarily accomplished with a quick stop on the way home. We need to consider the costs of medications we prescribe to treat their illnesses. We need to acknowledge and understand the problems our poor and minority patients face and advocate on their behalf so that our knowledge and expertise will do more than provide symptomatic relief. We should be willing to get our hands dirty in the murky water of politics and bureaucracy, analyze how it is tainting the lives of our patients and facilitate the change to making it a cleaner and reliable resource that promotes good health for everyone.