Amid politics, pediatrician stands out as trusted advocate in Flint water crisis

As blame, debate and federal investigations continue into the water crisis in Flint, Mich., Mona Hanna-Attisha, M.D., M.P.H., FAAP, remains focused on the care of the city’s children.

The pediatrician who proved Flint’s water system was contaminated with lead was named director of the Pediatric Public Health Initiative (PPHI) at Michigan State University (MSU) and Hurley Children’s Hospital. The initiative will provide comprehensive services for 9,000 Flint children under age 6 with probable lead exposure.

A study by Dr. Hanna-Attisha’s team, published in the February American Journal of Public Health (http://bit.ly/1PKk9VJ), provided evidence to refute doubts that Flint’s water supply was raising children’s blood lead levels. Since Dr. Hanna-Attisha went public with the data last September, she has become a familiar face in the news. She refused to stand down even as public officials questioned her findings.

At the PPHI, she will see patients, gather data, track their health and ensure they receive services in a medical home. As the PPHI follows the children over the next two decades, it also will serve as a model public health program.

The collaborative brings together experts from pediatrics, child development, psychology, epidemiology, nutrition, toxicology, geography and education and includes the Genesee County Health Department, Michigan Department of Health and Human Services and the MSU Extension.

The consequences of lead exposure are multigenerational, and in some cases the children’s blood lead levels may have peaked before they were screened, said Dr. Hanna-Attisha, director of pediatric residency at Hurley and assistant professor of pediatrics at the MSU College of Human Medicine. Because of lead’s short half-life, every intervention will be made available to every child.

“We have this moral, professional obligation to these children. They did nothing wrong,” she said. “If we don’t throw every single resource at these kids now, we’ll see those long-term consequences.”

Continued advocacy

In late January, Gov. Rick Snyder signed off on $28 million in supplemental funding from the state to support immediate interventions in health, nutrition, education and literacy. At press time, the governor was asking for $195 million more in his 2017 budget proposal.

“We know the benefits of early education, early literacy, universal preschool,” said Dr. Hanna-Attisha. “We’re advocating for improved nutrition access, expansion of WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children), behavioral health services, a lot of these evidence-based interventions that we know will help.”

The AAP Michigan Chapter was instrumental in gathering information from its 1,300 members and sending alerts asking them to contact their legislators to support the supplemental bill. The chapter also coordinated messages with medical societies and early childhood agencies, said chapter Executive Director Denise Sloan.

A registered lobbyist, Sloan has worked closely with Dr. Hanna-Attisha, a member of the chapter’s board of directors, and Lawrence Reynolds, M.D., FAAP, past president of the board. Both pediatricians were appointed by Gov. Snyder to a three-year term on the 17-member Flint Water Interagency Coordinating Committee.

Nearly two years after Flint starting getting its water from the Flint River, which corroded pipes and caused lead to leach into the drinking water, nobody knows exactly when the problem will be fixed.

Medical home a must

Flint is fortunate in that the medical community was already working to meet the needs of the 58% of children who live below the poverty level. The Hurley Children’s Center opening this spring in the heart of Flint across from MSU will serve as a medical home and bolster those efforts.

One focus will be on nutrition, which can help counter lead’s effects. The clinic is located above a farmer’s market that accepts Supplemental Nutrition Assistance Program benefits. Weekly cooking demonstrations are offered in the market to teach families how to prepare meals that are high in iron, calcium and vitamin C. The city does not have grocery stores, so locating the clinic above a farmer’s market was purposeful. “We give out nutrition prescriptions,” said Dr. Hanna-Attisha.

The new clinic also is a pilot site for the Michigan Caries Prevention Program, and all Flint children are eligible for dental care.

The clinic also will have space for 21 MSU medical residents. Residents and medical students participating in the MSU teaching clinic so far have learned a great deal from the crisis. AAP Resident Member Allison M. Champney Schnepp, M.D., was co-author of the American Journal of Public Health study. Dr. Hanna-Attisha also has a medical student who in his first two days on rotation met U.S. senators, the mayor, Environmental Protection Agency Administrator Gina McCarthy and attended multiple press conferences.

“If they (residents and medical students) can work in this environment and espouse these values, then they will go on and practice in perpetuity espousing the same,” she said.

Public trust

Dr. Hanna-Attisha represents credibility and trust in a city where residents are understandably suspicious. When the government began handing out free water filters, the public was wary. Only after pediatricians made public service announcements to let the community know they should use the filters did people listen.

Dr. Hanna-Attisha said she remains “apolitical,” working with everyone regardless of their position. Sloan admits having to push aside her feelings about the crisis. “I don’t want to do finger-pointing. I just want to get services to kids and get our members what they need to try to mitigate some of the impacts of this poisoned population.”

She urges chapters to be proactive and use the Academy’s emergency preparedness recommendations and resources to develop their own plans (see Resources).

Despite the patient care, research, national press interviews and meetings with federal officials, Dr. Hanna-Attisha remains grounded by her family, especially her two daughters who occasionally remind her to put down the laptop and spend a little time with them. She and her husband, Elliott Attisha, D.O., FAAP, don’t expect life to continue at such a frenetic pace, but they’re aware there’s still a lot to be done.

“It is our job to be the voice of children, especially in underserved communities where they are essentially voiceless,” said Dr. Hanna-Attisha. “People are congratulating me and calling me a hero, but this is our job. This is what we signed up to do as pediatricians.”

See related Letter from the President.