What the eyes don't see A story of crisis, resistance, and hope in an American city

Review by New York Times Review

on A cool spring day in April 2014, Dayne Walling, the mayor of Flint, Mich., entered an old water-treatment plant and, amid cheers from a crowd of city officials and engineers, pushed a small black button on a cinder-block wall. With that gesture, the mayor switched Flint's water supply from a tested and reliable source provided by the city of Detroit to a cheaper and untested one, the nearby Flint River. City officials defended the move as necessary cost-cutting for a bankrupt city. Like his colleagues, Walling - a Rhodes scholar who had a master's degree in urban studies - believed that Flint, by deciding to rely on its own river for water, was taking control of its destiny. He called it "a historic moment." He was certainly right about that, although probably not in the way he foresaw. By changing the source of the city's water, Walling and other local and state officials touched off a chain of events that led to one of the biggest public-health disasters of our time. The water from the Flint River turned out to be highly corrosive, causing the city's old pipes to leach lead into the drinking water. Lead has been known for decades to cause irreversible damage to human brains and nervous systems, especially children's. Yet in Flint, a predominantly African-American city, nobody worried too much about it. City officials ignored laws requiring that anti-corrosion agents be added to the water to reduce the risk of lead buildup. Water tests were done haphazardly. Officials rigged data and intimidated activists. Thousands of kids drank water that may have permanently harmed their brains. This "is the story of a government poisoning its own citizens, and then lying about it," Mona Hanna-Attisha writes in her gripping memoir about the crisis, "What the Eyes Don't See." "ft is a story about what happens when the very people responsible for keeping us safe care more about money and power than they care about us, or our children." If there is anyone well positioned to make this argument, it's Hanna-Attisha, the director of the pediatric residency program at Hurley Medical Center, a teaching hospital affiliated with Michigan State University. Hanna-Attisha's analysis of Flint residents' blood tests proved indisputably that they were being poisoned and exposed the official denials and obfuscation as a crime of tragic proportions. She is disarmingly modest about her role. "1 was just the last piece," she writes near the end of the book. "The state wouldn't stop lying until somebody came along to prove that real harm was being done to kids. Then the house of cards fell." Hanna-Attisha's book covers a monthlong period in the middle of the crisis, roughly from the moment she learned about lead in Flint's water to a news conference she held announcing test results showing high lead levels in residents' blood. Hanna-Attisha is a chatty and entertaining narrator. And while Fm not sure 1 needed to hear about her mother's crepes with "gooey Nutella on top," or to eavesdrop on her pillow talk with her husband about the emotional drama of the day, these are minor sins. Her book has power precisely because she takes the events she recounts so personally. Before she knew Flint's water was contaminated, Hanna-Attisha encouraged mothers who came to her clinic to mix baby formula with tap water; the guilt she later feels is heart-rending. As a mother and a pediatrician, she also understands the vulnerability of children in a city like Flint, where, she points out, the life span of the average child is 15 years shorter than that of a child born in a neighboring suburb. "When 1 found out that a group home for abused and neglected kids near the hospital had a water-lead level over 5,000" parts per billion, she writes, "1 was the maddest and saddest I'd ever been in my life." (The federally mandated action level for lead in drinking water is 15 parts per billion.) For Hanna-Attisha, Flint's water crisis was not just a personal tragedy but a betrayal of the American dream. Her mother and father were born in Iraq and watched with horror from abroad as their country was overtaken by the fundamentalist regime that eventually led to Saddam Hussein. "The promise of America worked for my family," she writes. "We'd left a country that was broken, unsafe, unpredictable and oppressing its own people for a country that allowed us to thrive." A great virtue of her book is the moral outrage present on every page. "There are lots of villains in this story," she says with refreshing bluntness, and she goes after many of them, from the (white) mayor of Flint to the public-health officials who claimed that ensuring safe drinking water was not their responsibility. Brad Würfel, the spokesman for the Michigan Department of Environmental Quality during the crisis, who frequently reassured Flint's citizens about their water's safety - "Anyone who is concerned about lead in the drinking water in Flint can relax," he said early on - gets particularly venomous treatment. For better or worse, there are no clear villains in "The Poisoned City," by Anna Clark. A journalist based in Detroit, Clark takes a broader, more measured approach to the Flint crisis, keeping herself out of the story and aiming for what she has called "a collective narrative" of the local community. She is a smart, hard-working reporter who knows she has a great tale to tell, and if the narrative gets lost in bureaucratic minutiae at times (who knew that Genesee County had a drain commissioner?), it's easy to forgive because you admire her passion and her sweat. Clark is particularly good at describing the importance of infrastructure in a functioning democracy: "Public water systems are one of this country's most heroic accomplishments, a feat so successful that it is almost invisible." In "The Poisoned City," you will learn that the average water main in Flint is more than 80 years old; that the drinking-water supply system is made up of 15,000 lead service lines; that the only way to figure out where these lines are is to sort through a file box containing 45,000 index cards scrawled with notes in smudged pencil; and that, as a result of leaky old pipes laid when Flint was a much larger city, residents' water bills averaged $149 a month, compared with $58 a month in neighboring Burton. Clark writes powerfully about the environmental consequences of a shrinking city, about how Flint's financial decline drove the decision to switch drinking-water sources. She also discusses an outbreak of Legionnaires' disease, related to the water crisis, that led to 12 deaths. But she's most effective describing the racism that shaped Flint, especially under the influence of General Motors. In the 1920s, G.M. built thousands of houses for workers, but these could not " be leased to or occupied by any person or persons not wholly of the white or Caucasian race." As Clark points out, "the apartheid approach to city building wasn't just tolerated by the federal government; it was exacerbated by it." Black neighborhoods were redlined for federal mortgages, cutting off their residents from home loans and a path to middle-class prosperity. Of the nearly 6,000 houses built in Flint in the early 1950s, fewer than 100 were open to AfricanAmericans. City officials performed in blackface in minstrel shows, and black children were allowed in the local pool only on Wednesdays. Is it any surprise that more than 50 years later, when black kids were being poisoned by the city's drinking water, nobody took action? In the end, many of the officials involved in the Flint crisis were fired or indicted on criminal charges ranging from obstructing an investigation to involuntary manslaughter. But there are no whistle-blowers in Clark's book, no single bureaucrat who decided to poison the children of the city in order to save a few bucks in the budget. In a way, that's her point. As she writes, "Neglect, it turns out, is not a passive force in American cities, but an aggressive one." For Hanna-Attisha, the story of Flint is about the loss of the American dream, and the importance of community bonds and family life. "The most important medication 1 can prescribe is hope," she writes, sounding a bit too much as if she's auditioning for "The Oprah Winfrey Show." But perhaps the best way to read these two worthy books is as a preview of America's future. Many of the factors that led to tragedy in Flint - the disregard for environmental law, the unwillingness to invest in rotting infrastructure, the distrust of science, the lying officials and, above all, the racism that still shapes many state and federal policies - are the guiding principles of the Trump administration. The sad truth is that we are all living in versions of Flint now. JEFF goodell is a contributing editor for Rolling Stone and the author of "The Water Will Come."

Copyright (c) The New York Times Company [January 31, 2019]

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Review by Booklist Review

*Starred Review* Despite complaints from Flint, Michigan, residents, the city's emergency manager and state government insisted that the city's municipal water switch from Lake Huron to the Flint River hadn't caused any problems. However, the city did not use corrosion control, and soon lead from the old pipes began leaching into the water at extremely high levels. When she learned in August 2015 that the water wasn't safe, author Hanna-Attisha, a pediatrician and researcher, first thought of her patients. Knowing the devastating effects of lead on childhood development, she began organizing a study of lead levels in children's blood before and after Flint switched its water source. Despite resistance from the state to share data, her research became key to proving the Flint water was unsafe and that the government had been denying the crisis for more than a year. Hanna-Attisha infuses her story with context from her own family history, the development of public health as a field, and background on political changes in Michigan. Told with passion and intelligence, What the Eyes Don't See is an essential text for understanding the full scope of injustice in Flint and the importance of fighting for what's right.--Chanoux, Laura Copyright 2018 Booklist

From Booklist, Copyright (c) American Library Association. Used with permission.

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Review by Publisher's Weekly Review

This powerful firsthand account from Hanna-Attisha recalls her efforts to alert government officials to the public health disaster caused by lead in the water supply of Flint, Mich. In April 2014, as a cost-cutting measure, Flint switched its water source from Lake Huron to the Flint River, which had been a "toxic industrial dumping site for decades." Hanna-Attisha, who directs the pediatric residency program at Hurley Medical Center, where many of Flint's poor children are treated, received a tip about lead levels and realized her patients were particularly vulnerable to lead poisoning. She recounts how state and local government officials ignored her requests for data, deflected responsibility, downplayed the threat, and tried to discredit the findings of her study, conducted with help from a corrosion expert, which found that the percentage of children with blood-lead elevations had doubled after the switch. That study eventually proved to be the "game-changer" that resulted in the state's declaring a public health emergency and switching the water source back to Lake Huron. Hanna-Attisha's empathy for her patients and the people of Flint comes through, as do her pride in her Iraqi roots and her persistent optimism. It's an inspiring work, valuable for anybody who wants to understand Flint's recent history. (June) © Copyright PWxyz, LLC. All rights reserved.

(c) Copyright PWxyz, LLC. All rights reserved

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Review by Library Journal Review

Hanna-Attisha, a pediatrician at the city hospital in Flint, MI, recounts vividly the events leading to the 2015 press conference at which she held a clear baby bottle filled with water from the Flint River saying, "This is what our babies are drinking.... Lead-tainted water during the period of most critical brain development." Hanna-Attisha risked her reputation as a researcher when she went public with data showing elevated lead blood levels in the children of Flint, the scientific proof something was wrong with the city's water, which many parents and community leaders had been saying for months. The children were being poisoned by a neurotoxin that hinders development for years to come. Hanna-Attisha, an immigrant whose Iraqi parents were social and political activists, weaves her personal stories with the history of Flint and the racial undercurrent in government policies that led to the water crisis. Hanna-Attisha's narration underscores her passion for science and children, but there were moments when the program was off the mark: either too much or too little emotion, or too fast or too slow in delivery. Still, her story is so compelling that the hiccups in narration, including some choppy editing, could be overlooked. -VERDICT Hanna-Attisha's debut work offers a dramatic firsthand view of what happens when government fails to serve the public good, sacrificing public health for the sake of saving municipal dollars. ["Essential for all readers who care about children, health, and the environment": LJ 6/1/18 starred review of the One World hc.]-Gladys Alcedo, Wallingford, CT © Copyright 2018. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

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Review by Kirkus Book Review

"There are lots of villains in this story": An Iraqi immigrant and pediatrician recounts the epidemiological sleuthing that uncovered the lead crisis in the drinking water of Flint, Michigan.The story begins with people turning up sick. But more, longtime Michigander and physician Hanna-Attisha's story begins in a political moment, when a tea party-dominated state legislature and a former business executive elected governor declared a state of fiscal emergency over the city of Flint. As she notes, Flint was not alone in having its democratically elected government replaced by a technocrat imposed from outsideand those that shared the distinction were far likelier to be areas where African-Americans lived, "effectively colonized by the state." A budgetary shortcut was to change Flint's source of drinking water from Lake Huron to the Flint River, long used for dumping industrial waste. Bacteria was one thing, but high concentrations of lead quite another. Drinking Flint River water was "like drinking through a lead painted straw," with resulting developmental delays and cognitive damage that will plague Flint for generations. Hanna-Attisha combined a background in environmental science and medicine to expose a multilayered conspiracy of crony capitalism involving the lead industry, which she likens to big tobacco in greed and damage, and allies in government and business. Along the way, she notes that medicine itself is not blameless, since older pediatricians in particular have assumed that the old problems of lead poisoning that plagued previous generations have gone away with regulatory changes. Not so, she writes, particularly if you are poor and a member of an ethnic minority. Making this story known proved a challenge, but the author and her allies were methodical in approaching professional journals, the press, and finally federal authorities with their evidence. In the end, writes Hanna-Attisha, this is "the story of a government poisoning its own citizens, and then lying about it"and it demands greater justice than has been served.An important contribution to the literature of environmental activismand environmental racism. Copyright Kirkus Reviews, used with permission.

Copyright (c) Kirkus Reviews, used with permission.

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Chapter 1 What the Eyes Don't See It was cold and rainy on the summer morning of August 26, 2015--that predictably unpredictable Michigan weather. I dropped my two daughters off at Skull Island, an ominously named summer camp they were trying out for a few days, and got to Hurley later than usual. Once inside, warm, musty air greeted me, that old-hospital smell wafting through the brightly lit corridors of glossy tile. I reached my office on the pediatrics floor and immediately felt behind the door for my white coat. Wearing the coat always made me feel better, stronger, protected--it was my armor. Then I swung a stethoscope around my neck, completing my transformation from civilian to doctor. At my desk, I read the local news online for a few minutes--just a quick scan--and noticed another story about the tap water in Flint. Residents were complaining, authorities were explaining. This had been going on for so long, more than a year already. It had become a loop of white noise. Turning my attention to the multicolored grid of my online calendar, I got a handle on the day ahead. It was packed--a crush of meetings, four, five, six of them, for research projects, curriculum changes, faculty recruitment. Somehow, wedged between the meetings, I had to answer emails and read other material, mostly prep for more meetings. On the home front, a barbecue was beginning to materialize for later that night--a spontaneous, last-minute gathering. I'd discovered that my high school friend Annie Ricci was in town for a few days, and we'd decided to get together with another old friend, Elin Warn (now Betanzo). We had all been friends since our freshman year at Kimball High School in Royal Oak, the inner-ring working-class Detroit suburb where my family had landed after my dad was hired by General Motors. Annie is an opera singer in New York City now. Elin is an environmental engineer who moved back to the Detroit area after many years in D.C. They were both in my wedding, but not as bridesmaids in matching dresses. I didn't have any of those. Elin and Annie were both serious musicians, so I asked them to perform--and they did. I reached into the pocket of my white coat for a pen and felt the plastic tip of an otoscope, that pointy tool that doctors use to look inside a child's ear. The coat may have been my soft cotton armor, but as far as I can tell, the real reason doctors wear white coats is for the pockets. Otherwise there'd be no place to store all our pens, pagers, cellphones, reference cards, tongue depressors, penlights, mints, Chapstick, and otoscope tips. My fingers felt a scrap of paper, and I pulled it out. The paper was covered in crayon scribbles. A memento. I remembered where it had come from and smiled. Reeva had given it to me. She was a watchful two-year-old who had been coming to our clinic since she was born at Hurley Medical Center. The week before, Reeva's four-month-old baby sister, Nakala, had been in the Hurley Children's Clinic for a routine checkup. One of my pediatric residents, Allison Schnepp, was seeing Nakala; I was the supervising physician. Nakala's mom, Grace, a young African-American woman with a steady gaze and hair pulled under a loose cap, told us she wanted to stop breastfeeding. I urged her to continue, but she said she'd made up her mind. Breastfeeding took too long and was a hassle--plus, she had to go back to work. She was a waitress, and there was no place to pump in the restaurant except the restroom that all the customers used. She couldn't afford to do anything that jeopardized her job. As it was, she wasn't getting enough hours to make ends meet. She planned to switch to powdered formula mixed with water but had some concerns. "Is the water all right?" she asked, looking skeptical. "I heard things." Reeva walked toward me with her hand out. Kids love to distract a doctor who is giving total focus to a younger sibling. So I turned my full attention to Reeva, and she placed the torn scrap of paper in my open hand. She had a sheepish smile, as if she were handing me a secret message, and we shared a conspiratorial look. "Thank you, Reeva," I whispered. "I'm going to keep this right here in my pocket." Then I sat her down on my lap. The water. I'd been asked about it before. "Don't waste your money on bottled water," I said, nodding at Grace with calm reassurance, the way doctors are taught. "They say it is fine to drink." Inches away, Reeva watched me carefully. I smiled at her again, gave her an extra squeeze, and then put her down. I patted Nakala's fuzzy little head and touched her fontanel, or soft spot, out of habit, to check its size. It was my chance to explain to Grace that her baby's skull was open because her brain was still growing. This was the time to stimulate her baby by singing, talking, and reading. Then I gave Grace another nod. "The tap water is just fine." I wanted to be a doctor as far back as I can remember, maybe from obsessively watching M*A*S*H reruns growing up. Or it could've been the story about my grandfather Haji that my mom used to tell me, when he fell out of a tree and doctors took care of his broken leg. Or maybe it was the car accident and my early experience with a caring physician who made it seem like everything was going to be okay. My parents are both scientists who raised us to love the multiplication and periodic tables and the majestic order of the natural sciences, so the prospect of biology, chemistry, and math courses never put me off. In high school, I had some powerful experiences as an environmental activist, so I created an environmental health major at University of Michigan's School of Natural Resources and Environment, merging environmental science and pre-med courses. My passion for activism, service, and research was solidified there, followed by four years of medical school at Michigan State University; my last two clinical years were in Flint. It wasn't a tough call which specialty I'd go into. As a medical student, you have to do rotations in a variety of fields, and as soon as I got to pediatrics, I felt like I was at home. Kids are usually looking for fun, and everything's new to them. No matter how sick they are, they still want to laugh and play. I was briefly tempted by obstetrics but noticed that as soon as my patients gave birth, I tended to forget about them: my attention suddenly shifted to their newborn babies. I may not be quite as much of a baby-whisperer as my husband, Elliott, who's a pediatrician like me but with the supernatural power to soothe any child. I can hold my own, though. With patience and empathy, and sometimes with stickers, bubbles, and penlight tricks, I can get that sulky five-year-old to tell me where it hurts. A nonverbal teenager will talk to me if I take her seriously and listen carefully and let her know that I am her doctor and not her parents'. Even when a baby is wailing and making those supersonic ear-piercing sounds, I know that it just takes a soft voice, a gentle sway, and eye contact to calm them. A crying baby gives me a sense of mission. Deep inside I have a powerful, almost primal drive to make them feel better, to help them thrive. Most pediatricians do. For some of us, that sense of protectiveness becomes much more powerful when the baby in our care is born into a world that's stacked against her and her needs aren't being met--a world where she can't get a nutritious meal, play outside, or go to a well-functioning school, all of which will diminish her health. I am a fanatic when it comes to protecting all kids, but when I see a child in danger through no fault of her own, I go a little mad. She's a baby like any other, with wide eyes and a growing brain and vast, bottomless innocence, too innocent to understand the injustice of her circumstances. She can't see what I can. A baby who is properly fed and loved and kept healthy, and surrounded by people and communities that value and protect her, has the best chance of becoming a healthy adult. This is what drew me to pediatrics--we pediatricians are at the pivotal intersection of clinical care and prevention. Every aspect of my job--from immunizations to emphasizing the importance of bike helmets--is not just about ensuring kids are healthy today. It's about tomorrow, next year, and twenty years from now. We see life at its beginning, when it can be shaped for good. As Frederick Douglass said, "It's easier to build strong children than to repair broken men." Walk into the adult floor of a hospital any day, and you'll see beds of patients with problems like diabetes or heart disease that can't be fixed, because to do that you'd have to time-travel back to their childhoods and fix those too. As much as I love spending time with kids and seeing one little patient at a time, I wanted to have as much impact as I could--on as many lives as I could--so right from the beginning, I made a tactical decision to be a medical educator rather than a pediatrician in private practice. That way, over the course of my career, I could share my passion for children's health and proven interventions with hundreds of new doctors who would go on to treat thousands of young patients, caring for them as I would and hopefully even better. And in 2011 I became the director of the pediatric residency program at Hurley Medical Center, a public teaching hospital affiliated with Michigan State University; with more than four hundred beds and almost three thousand employees, it's a place where new doctors are trained and most of the children in Flint are treated. The hospital was given to the city of Flint by a soap and sawmill businessman, James J. Hurley, in 1905. And like many public hospitals, it serves a poor and minority population with high levels of Medicare/Medicaid patients and uncompensated charity care. That means budget cuts from the state or federal government hit Hurley hard, in ways they would not hit a private hospital. When I first took the job in 2011, the pediatric residency program was in tough shape and coming up short in lots of ways, large and small. Morale was low. The sixty-year-old program was at risk of losing accreditation, which meant it could close altogether. Its clinic, where Flint kids came for routine appointments, was in a depressing old building with low ceilings and little sunlight. The first things I did were to increase the number of our residents and faculty and to overhaul our programs and recruitment practices to attract better trainees. We worked hard to improve residents' curricula and schedules--and soon we received a full ten-year accreditation. When the lease was up on our old clinic location, we moved our pediatric center into a one-of-a-kind building with soaring ceilings and spectacular sunlight, built above a year-round farmers' market--and just a few steps from the central bus stop. It was a dream location: the light, the fresh produce, the beauty of the building itself. It was a chance to give the kids of Flint a glimpse at what a healthy environment might look like--but also to show them that they deserved nothing less. On that August day, we had been in the new Hurley Children's Clinic for only a few weeks and were still settling in. But I was looking ahead already, to September 15, when applications would come in from next year's residents. Recruitment can be difficult when your program is in Flint. Top medical residents want to live in Chicago, San Francisco, Boston, or New York. Luring them to an economically troubled community like Flint takes powers of persuasion, finesse, and assurances that they will be bountifully rewarded, but in ways that are as spiritual and personal as they are practical. But it works. Each year the residents we attract are better, more competitive, and more committed. So while it's true that as a residency director, I don't get to care directly for kids as much as I want, I get to spend most of my days with a group of smart, compassionate young doctors who love kids--and believe in Flint--as much as I do. Pediatric residency takes three years. Each of those years is divided into four-week rotations called "blocks," and each block is focused on a different pediatric skill. I direct a rotation called Community Pediatrics, designed specifically to open the eyes of first-year residents to the powerful, but not always immediately apparent, environmental and community factors that affect the lives and health of their patients. There's an expression I have always liked, a D. H. Lawrence distillation: The eyes don't see what the mind doesn't know. The first time I heard that phrase was during my own pediatric residency, when it was uttered by Dr. Ashok Sarniak, a legendary pediatrician at Children's Hospital of Michigan in Detroit. He challenged residents to know every possible disorder or genetic syndrome under the sun and its underlying pathophysiology. When discussing a case and trying to figure out a diagnosis, he watched us run through our limited supply of options, and he always criticized us for not reading enough and therefore not knowing enough, for not seeing the whole picture. "How can your eyes see something," he'd say, "that your mind doesn't know?" Community Pediatrics is meant to widen the focus of pediatricians beyond whatever is immediately visible. Sure, a nosebleed is a nosebleed. An ear infection is an ear infection. But beyond the common fevers and colds, many children are facing other struggles. Compared to nationwide averages, Flint families are on the wrong side of every disparity: in life expectancy, infant mortality, asthma, you name it. Flint is a struggling deindustrialized urban center that has seen decades of crisis--disinvestment, unemployment, racism, illiteracy, depopulation, violence, and crumbling schools. Navy SEALs and other special ops medics train in Flint because the city is the country's best analogue to a remote, war-torn corner of the world. The city compares badly not just to the rest of the country but to neighboring communities. The median household income is half the Michigan average, and the poverty rate is nearly double. The more adversities a child experiences, the more likely she will grow up to be unhealthy in ways that are completely predictable. A kid born in Flint will live fifteen years less than a kid born in a neighboring suburb. Fifteen years less. Imagine what fifteen years of life means. In a country riven by inequalities, Flint might be the place where the divide is most striking. Excerpted from What the Eyes Don't See: A Story of Crisis, Resistance, and Hope in an American City by Mona Hanna-Attisha All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

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