NAKALA CAME TO THE CLINIC FOR her eighteen-month checkup in October 2016. Reeva spotted me in the hallway while her baby sister was being weighed. “Dr. Mona! We saw you on TV!” I waved her over, lifted her up, and squeezed her tight. Holding her hand, we walked over to the bookshelf and looked at newly stocked Reach Out and Read books. We grabbed a couple, and a Richard Scarry classic for Nakala.
Back in the exam room, I smiled at Grace, their young mom. She seemed more grown up, more confident somehow. She and I had more of a relationship than I have with most of my patients. I met her when Nakala was just four months old, the week I learned about the Flint water, and somehow those memories are seared together in my mind. When I thought of the babies of Flint, I always thought of sweet Nakala, who was now a chubby, happy, walking-and-talking toddler.
I had done a lot of apologizing to Grace a year earlier. “I told you the water was fine for Nakala’s formula, and it wasn’t,” I had said. “I’m so sorry. I had no idea.” Moms are always right. Every parent should listen to that primal instinct to protect their kids.
“I knew it wasn’t fine,” Grace replied, much to my relief. “My auntie told me. She’s Nakala’s godmother, and her water was brown and smelled. My water seemed okay, but my auntie told me not to use it. I said, ‘I can’t afford bottled water,’ so she bought it for me.”
Allison and I had seen Nakala for her checkups when she was six, nine, twelve, and fifteen months old. Over the year, Grace mixed her formula with bottled water that she got from her auntie, then from her church, the food bank, and the National Guard. She cooked Reeva’s meals with it too.
The medical assistant came to take Reeva for her blood draw. She was getting her lead level checked. Her first lead level, taken the year before, was high—26 μg/dl—and now she was getting it checked again. After that, she’d have her hearing and vision checked, and get a ten-dollar prescription for fruit and veggies at the Flint Farmers’ Market, which becomes twenty dollars with the Flint expansion of Double Up Food Bucks.
As soon as they left, Grace let down her guard and gave me an all-too-familiar look of fear, anxiety, and guilt. “Is she going to be okay?” she asked. “Both of them. Are they going to be okay?”
Reeva was three years old that autumn. She had been drinking contaminated water most of her life, during the most critical period of brain development. And even though Nakala was spared the water in her formula, Grace had drunk it during her pregnancy.
A year before, their water at home had been checked and found to be 150 ppb, something Grace would never have known on her own, because lead in water is colorless, odorless, and tasteless. At their auntie’s house, it was 3,000 ppb, and a neighbor down the street had a level of 13,000 ppb. Putting this into perspective, 15 ppb is the federal action level (and that’s set too high)—and 5,000 ppb is the hazardous waste level. Drinking Flint water after the water switch was like drinking through a lead straw. You never knew when a piece of severely corroding lead scale would break off and fall into the drinking water and into the bodies of our children. When I found out that a group home for abused and neglected kids near the hospital had a water-lead level over 5,000 ppb, I was the maddest and saddest I’d ever been in my life. These kids literally had every adversity possible. It was like the world was conspiring to keep them down.
Grace worried a lot. And there were days when she looked terrorized and down. I couldn’t blame her. Every day in Flint, our families had been waking up to a nightmare of water contamination, betrayal by every governmental agency charged with protecting them, and years of neglect and poverty. Many of the families who want to call it quits and leave Flint can’t sell their homes, because the home values have tanked. Those who remain feel angry at everyone almost every day. It is community-wide PTSD. The mental health problems are now just as serious as the physical ones.
MY FAMILY CAME TO the United States basically as refugees fleeing oppression, in search of a peaceful and prosperous place for my brother and me to grow up. The American Dream worked for us.
But sitting with Nakala in my lap, I realized that America has changed a lot since I was a little girl. Yes, people are still running to America, or at least trying to. It remains the epitome of prosperity for the entire world, the richest country that ever was. But there really are two Americas, aren’t there? The America I was lucky to grow up in, and the other America—the one I see in my clinic every day.
In that other America, I have seen things I wish I’d never seen. The things you run from, not toward. Things that would never be part of any dream. And for too many people, this nightmare is taking place right outside their front door.
Sometimes I joke that I was born an activist. But it’s not really a joke. I was born into a family that was on the move toward something better, and I was born into a life knowing there is injustice in the world—and the importance of fighting it. And that’s exactly what my babies in Flint are born into—sweet little ones like Nakala. For them, life is a struggle from the very beginning. That can make a baby a fighter. Because for Nakala and Reeva, every little thing—sometimes things as simple as a meal or clean water or a bath—can require a fight.
Where is the American Dream in this scenario? It’s not there. It’s not even talked about. It is becoming so out of reach. Income and wealth inequality make mobility tough. Stagnation is now the norm. At the end of their lives, most children wind up where they started. Not just Flint’s kids but children in Detroit, and Los Angeles, and Chicago, and Baltimore, and all over rural America. Black, brown, and white. Too many kids are growing up in situations stacked with insurmountable toxic stresses and every barrier imaginable. Too many kids are growing up in a nation that does not value their future—or even try to offer them a better one.
That’s not how it’s supposed to be. The Dream shouldn’t have to come by way of a miracle. It should come fairly to all and be big enough for everybody to achieve. The environment shouldn’t be stacked against anybody, especially our kids. We owe it to them and to one another.
As a doctor, what can I prescribe for our sons and daughters of the other America?
This is what I thought about that day with Grace, when she asked me about her girls, and if they were going to be okay. Nakala was still snuggling on my lap.
“What can I do?” Grace asked.
“Keep doing everything you are already doing. Love them, talk to them, sing to them, read to them, give them great food,” I replied. I encouraged her to fill the “nutrition prescriptions” downstairs at the farmers’ market for fresh produce, and urged her to sign up for WIC. There is a special Medicaid expansion and universal early-intervention development support offered to Flint kids. “You have also been getting the home delivery of kids’ books every month, right?” Mental health support is nothing to be ashamed of, I said, “so here is the number to the trauma crisis line if you need it. Don’t forget about the mindfulness workshops—they have them in the schools now too. Parenting support classes are being held on Tuesdays, and they even do home visits.” I took a breath and said, “And make sure you come visit me often.”
Grace applied for a preschool aide job at Flint’s new childcare center, one that pays well, more than $17.50 an hour, with healthcare benefits and a 401(k). It was a new position made available with state money. She was sticking with Flint. This “intervention” of a good job, a living wage job, is one of the best I can think of. And these recovery jobs, the return of the Grand Bargain, will be critical for Flint and places like Flint everywhere.
“Nakala and Reeva are growing so fast right now,” I went on. “Their brains are growing so much. And no matter what badness they may have been exposed to, we can overcome it with all this goodness. We are trying to tip the scale. And we will.”
The most important medication that I can prescribe is hope.
Nakala moved around in my lap, a little restless. Her eyes were wide open, and she followed my voice and my every move. Her fingers were tightly wrapped around mine. I lifted her up and told her she was going to be fine. She was mixed up in an accident—a lot of kids were—but it wasn’t her fault. And it’s my job to make sure she and her sister—and all the kids in Flint—are okay. Actually, it’s my job to make sure they have every chance in the world to be better than okay—to be great.