Scientists think Alabama's sewage problem has caused a tropical parasite. The state has done little about it.
Raw sewage–soaked lawns are a common sight in and around Lowndes County.
“It's an infectious disease nightmare,” said one parasitologist.
LOWNDES COUNTY, Alabama — On one of the first cool days in October, Catherine Flowers parked her SUV in front of a beige-paneled mobile home with aqua window shutters. She got out and hugged its owner, 63-year-old Alabama native Walter McMeans, and introduced him to the two scientists who’d followed her there.
“We’re here today just to test some of the water and the soil,” said one of the researchers, Megan McKenna, an infectious disease specialist at Baylor College of Medicine in Texas. “We will notify you, and let you know about any particular parasites. Everything will remain confidential.”
Then, McMeans took the researchers behind the trailer, to show them what they’d come to see, and couldn’t help but smell:
a four-foot-long puddle of raw sewage, seeping from a failing septic system.
“You have too much rain, you've got problems. You do too much washing, you got problems,” McMeans said, as the researchers took water and soil samples. “The ground is just not suitable for this.”
Raw sewage–soaked lawns are a common sight in and around Lowndes County, where more than
70 percent of the area’s 10,000 residents are black and 26 percent live in poverty. Close to a third of Lowndes households report having sewage back up into their homes or pool in open areas in the past year, according to a small survey of residents conducted in May by the Alabama Department of Public Health. And the problem isn’t limited to Lowndes; a quarter of the state’s 850,000 private onsite septic systems are failing, according to a 2015 infrastructure report by the American Society of Civil Engineers.
That probably explains the presence of the parasite the researchers were there to investigate: the blood-sucking hookworm.
Until recently, there was little reason to suspect that hookworms could pose a risk for Lowndes County residents; the gut parasite is
usually found in developing countries. But in 2017, McKenna and her partner, parasitologist Rojelio Mejia, published a study that revealed that,
out of a small group of county residents, 34 percent were infected, a finding that contributed to a United Nations official calling out the United States for the persistence of “extreme poverty” within its borders.
Now, the same research team is performing a follow-up study that will investigate the link between open sewage, hookworm infections, and any potential negative health impacts.
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McMeans’ yard, which is located just outside Lowndes County, is in bad shape, but he’s actually better off than some of his neighbors. Those who can’t afford septic tanks resort to “straight-piping,” a term that refers to plastic pipes that collect raw sewage from people’s homes and unceremoniously discharge it on the ground nearby. That’s what the scientists found at the second mobile home Flowers led them to that day.
“In the summertime, it smells and stuff,” said Lowndes County resident Pamela Rush, the mother of two who lives there.
Rush can’t afford a septic tank at all, so she copes by avoiding the sewage when she can, she explained. “There’s a certain part of the yard we don’t go out in.”
After surveying the yard, Mejia didn’t mince words. “It's an infectious disease nightmare,” he said.
A PIPE DISCHARGES RAW SEWAGE IN THE WOODED AREA NEAR RUSH’S HOME. PHOTO: ARIELLE DUHAIME-ROSS.
The CDC estimates that as many as 740 million people are infected with hookworm worldwide, but today few Americans would consider themselves at risk. In the research and medical community, it’s known as a “neglected tropical disease” that’s associated with poor communities in developing countries.
People with hookworm release eggs through excrement; in areas with poor sanitation or open sewers, they end up on the ground, where they turn into microscopic, infectious larvae that dig into human skin when people walk by. Once inside the body, the hookworm gets in a person’s veins, and travels up past the heart and into the lungs.
When the parasite makes the jump from the vascular system to a person’s airways, it climbs up the trachea to get to the esophagus, where its human host swallows it — finally giving the hookworm access to its favored mating environment, the digestive system. “It's a human-to-soil, soil-to-human infection,” Mejia said.
Hookworms feed on the blood of their host, so people who have a lot of them in their gut can suffer from diarrhea, abdominal pain, anemia — causing fatigue — as well as intestinal inflammation.
Hookworm can have particularly devastating effects in children, Mejia said, including malnutrition and cognitive impacts. And all of that begins with poor sanitation.
The reason Lowndes Country has so many failing or nonexistent septic systems is in part due to geology: The soil here has a clay-like consistency, which means it doesn’t absorb much water. Standard septic systems tend to back up and flood raw sewage in people’s yards, or even clog toilets and sinks.
To avoid this,
locals have to buy specialized septic tanks, which can run upwards of $10,000 — about twice the cost of a standard system. In Lowndes County, where the
median household income is just under $30,000, many residents can’t afford them.
“In a place like where we are now, they're going to need an engineered
system that could be anywhere from $15,000 to $16,000, upwards,” Flowers said. “And a lot of people are living in homes that are not worth $15,000 or $16,000 — so it doesn't make sense. It doesn't make sense at all.”
Some states have programs to help residents pay to repair or replace failing private septic systems. Harris pointed to a program that installs septic tanks for free. This program, run by the Alabama Onsite Wastewater Association, doesn’t receive state funding and operates on a $10,000 yearly budget, according to its executive director.
A spokesperson for the department declined to comment on a follow-up question on whether the state provides financial support to any septic assistance programs.
The Alabama Department of Public Health does, however, have a history of fining people for open sewage violations. Residents like McMeans and Rush live in fear of being reported to the authorities. In the past 15 years, the department fined about one person a year, on average, Harris said.
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To understand what’s going on in Lowndes County, you have to know the area’s history, she told me, leading me toward an exhibit. That’s how you’ll understand the intersection of civil rights and environmental justice, she said.
Amid displays recounting the county’s history of slavery, and its subsequent role in the birth of the Black Panther party, she told her own family’s history with scientific institutions — and medicine. Flowers said her mother, Mattie D. Coleman, had been among the black women in the South who’d been sterilized without their consent or knowledge in the 1960s. The procedure allegedly took place in 1965, right after Coleman gave birth to Flowers’ younger brother, her fifth and final child.
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For black Americans, the history of medicine — and medical studies, in particular — can be painful. In Alabama, many remember that for 40 years, scientists knowingly withheld treatment from black men infected with syphilis to observe the long-term effects of the disease, a study known as the Tuskegee Syphilis Study. .”
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Mejia and McKenna’s 2017 hookworm study got a lot of attention when it was first published, and it wasn’t all positive. Despite having played an initial role in approving the study’s methodologies,
the Alabama Department of Health contested its results upon publication, claiming in a letter published online that the study had “failed to prove hookworm infection.” .
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Flowers had hoped to see change for Lowndes County residents after the hookworm study was published. Instead, she was disappointed by the Department of Public Health’s reaction. To her,
it was a sign of its lack of interest in helping residents of color.
“I think they would have reacted differently if the participants were white,” she said, sitting on a picnic table outside McMeans’ home. “I think they would have found money right away to maybe address and remediate the problems with our onsite septic systems.”
Harris denied that his department would have acted differently had the study been conducted in a white community. “That’s not true,” he said.
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“Ultimately, it's about resources,” Harris said. “It’s a tremendous need for resources that we have, and
the response right now has been really incremental and, you know, frankly not adequate.” A press secretary for the governor’s office declined to comment.
In September, the nonprofit group Earthjustice filed a federal civil rights complaint against the state and Lowndes County health departments, stating that the public health department’s “rejection” of the Baylor Study’s findings “misled the public by incorrectly assuring residents there is no evidence of a hookworm outbreak.”
Now, the department is reportedly planning to launch an initiative called the Lowndes County Unincorporated Waste Water Project to get working septic systems to residents, Fox News reported in November. According to the article,
residents who wish to participate in the program would have to pay a one-time $1,000 fee for a specialized septic tank, followed by monthly $20 maintenance payments.
Flowers said those fees would be too high of a barrier for most Lowndes County locals. “
The residents that would need that can’t afford it, bottom line.” She also said she’d only heard about the program through the Fox News story; neither McMeans or Rush had heard of the program at all.
According to the article,
an Alabama Department of Public Health official said the United States Department of Agriculture “verbally” approved $2.5 million in funding to the project, and that the program would launch in January. The public health department declined to provide VICE News with information on the project’s goal, timeline, funding, or origins because a “filed federal complaint.” A USDA spokesperson said the agency had not received a completed application for this project yet, and hasn’t committed or approved any funding.
Scientists think Alabama's sewage problem has caused a tropical parasite. The state has done little about it.