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FLINT, Mich. — Uncertainty haunts the mothers and fathers of Flint.

No one can tell them how much toxic lead their children may have ingested from polluted drinking water over the past two years.

And no one can say for certain what health effects might stem from that exposure. Is the lead to blame for this headache? For that bald spot? For a sudden spate of violent tantrums? Might a child who seems fine now have suffered subtle brain damage that could affect his grades and behavior down the road?


“When I think about my kids and what might happen to them, I can’t sleep,” said Laura Darch, a Flint native who checks her three boys, ages 9, 7, and 5, each day for rashes.

Darch has recently sought treatment for intense anxiety and depression. She feels guilty that she let her sons drink from their school water fountains. She can’t stop thinking of how those sips might set back their development.


“I don’t feel safe,” she said. “I have never felt so unsafe in my life.”

Recognizing the fear pervading this community, physicians and school officials are offering residents tests for lead exposure. But those tests aren’t likely to reveal much.

Many families have been drinking bottled water since discovering last year that there was lead in the city’s water; results will reflect that. Lead, a neurotoxin, doesn’t circulate long in the blood before it’s absorbed into bones and other organs or excreted. So a test taken today won’t show how much lead a child ingested a year ago, or what her peak exposure might have been. 

Flint, Michigan
Volunteers and inmates in a work detail hand out cases of bottled water to residents of Flint. Fabrizio Costantini for STAT

Nor is there any way to definitively link an individual’s exposure to a specific health concern — past, present, or future. All that’s known is that lead exposure can damage multiple organs and the brain, even at very low doses. Children are particularly vulnerable and once harm has occurred, the impact cannot be reversed.

“When a child presents with attention deficit hyperactivity disorder, behavioral problems, or intellectual deficits five years from now, I’ll never be certain if it was from the lead or another reason,” said Dr. Mona Hanna-Attisha, a pediatrician whose research on children’s blood lead levels helped call attention to Flint’s water crisis.

“When I look into a mom’s eyes,” she said, “that uncertainty is a great cause of anxiety.”

The entire community is suffering from toxic stress, Hanna-Attisha said, and needs mental health first aid to cope with this crisis. But services are few and far between, especially for children.

Flint, Michigan
A water tower in Flint, where life was hard even before the spate of lead poisoning. Fabrizio Costantini for STAT

A hard life, made harder

Life in Flint was already hard before the city’s switch in April 2014 from Detroit’s water system to the Flint River exposed residents to lead, E. coli bacteria, and a cancer-causing byproduct of chlorine.

More than 41 percent of the city’s nearly 100,000 residents are impoverished, unemployment is endemic, 15 percent of homes are boarded up or abandoned, and the murder rate is one of the highest in the nation. Dilapidated buildings and overgrown lots abound.

Now, evidence of government negligence has raised residents’ distress to an even higher level. Officials failed to add anticorrosive agents to water from the Flint River; as a result, old pipes throughout the city began to leach lead into the water supply. For 18 months, residents’ complaints about discolored, foul smelling, and strange tasting water were dismissed or ignored. Officials assured people repeatedly that the water was safe.  

Though Flint returned to Detroit’s water system in October, the damage to the city’s aging infrastructure — and its sense of trust in government — was extensive. The US Justice Department, the Environmental Protection Agency, and the Michigan Attorney General are conducting investigations

“Our lives are already so hard. Why would they do this to us?” asked Bethany Hazard, 59, breaking into tears. Hazard lives alone and is disabled by painful osteoarthritis, which she said has become much worse over the last year and a half. “It’s like they just don’t care.”

“We screamed at the top of our lungs that the water was hurting us, and they called us crazy, irrational, fear mongerers,” said Florlisa Stebbins Fowler, 37, a single mom who became a community activist after her three children suffered inflamed skin after showering and diarrhea after drinking the water.

Fowler’s 19-year-old son, Jared, has autism; her 12-year-old, Taylor, is deaf. “My kids had it tough to begin with and to think that they’ve fought so hard to do well only to be poisoned by this water and possibly face additional damage — it’s unimaginable,” she said.

Hanna-Attisha’s research found that 4.9 percent of Flint children under the age of 5 had elevated blood lead levels after the city began drawing water from the Flint River, compared with 2.4 percent before that switch.

In one ward, nearly 16 percent of young children had elevated lead levels, compared to just under 5 percent previously.   

It was a stunning finding, which garnered immediate attention — and a backlash from state officials — when Hanna-Attisha presented the results publicly last September. But she believes it almost certainly underestimates the problem. 

FLINT - Elizabeth Tramble
Elizabeth Tramble worries about the long-term effects of Flint’s water on her children. Fabrizio Costantini for STAT

In part, that’s because blood tests don’t capture the extent of past exposure to lead. Also, available data exclude even more vulnerable populations — pregnant women, infants in utero, and babies who are fed formula, typically mixed with tap water, in the first few months of life.

The county health department doesn’t test lead levels in adults, either, though they, too, can suffer adverse health effects, including elevated blood pressure, altered kidney function, and declines in cognitive function.

On top of the lead, residents suspect other contaminants in the river. Ten people in Flint have died from Legionnaire’s Disease, a lung infection caused by bacteria that thrives in water, since the city began using the Flint River for drinking water. 

“We’re not just worried about the lead, we’re worried about everything that’s in the water, and they haven’t come clean about that yet,” said Bill Hammond, 58, a retired industrial hygienist who contracted two serious infections after the city changed its water supply.

A defiant 5-year-old raises alarms

Elizabeth Tramble, 27, drank Flint River water for seven months during a recent pregnancy, until her older sister Egypt convinced her the health risks were too great. While her baby Lorenna, now 5 months old, seems fine, Tramble doesn’t know if she’ll suffer long-term impacts from the exposure.

In the meantime, Tramble —a single mother with five girls under the age of 9 — is worried about her 5-year-old, Nevaeh.

“She’s very defiant for nothing,” Tramble said last week, sounding tired. “She throws stuff. She acts out real bad. If I tell her ‘No, you can’t hold the baby,’ she just screams. She’s not minding in school. It’s like her attitude has changed and something is wrong with her mentally.”

Tramble’s stepfather, Ronnie Wexler, said he noticed a change in Navaeh last summer. “She didn’t used to be like that,” he said.

Wexler is convinced that the city water has something to do with both Navaeh’s outbursts and the strange hair loss experienced by her 6-year-old sister, Tatinasia, who now has a softball-sized bald spot on the back of her head. A doctor told Tramble last year that the little girl had a fungus, but medicine didn’t help and she has to wear a scarf to school to cover it up.

FLINT - Elizabeth Tramble
Tatinasia Hall, 6, has patches of hair missing on her head; her family blames the polluted water. Fabrizio Costantini for STAT

No answers for parents

One of the most painful aspects of the crisis is that medical professionals have few answers for anxious residents.

The only treatment for lead poisoning, chelation therapy, is used only in the most severe cases and isn’t appropriate for people with lower blood lead levels, like those seen in Flint.

So people are left to watch for symptoms. And to worry.

Hanna-Attisha advises parents to make sure their kids are getting plenty of calcium, iron, and vitamins C and D; a diet rich in those nutrients can slow absorption of lead into bones and organs. But it can be hard to get a nutritionally balanced diet in Flint, which is so disadvantaged, it doesn’t even have a supermarket.

The doctor is also pressing for more investment in services: expanded Head Start programs for toddlers, universal preschool, more food aid for mothers and infants, and mental health counseling. “We cannot sit back,” she said. “We have to throw every evidence-based intervention at these kids now to mitigate possible damage.”

Under Hanna-Attisha’s direction, and in partnership with Michigan State University, a new Pediatric Public Health Initiative will follow 9,000 Flint children under age 6 who were exposed to the city’s tap water in the past two years. It’s likely that the children will be monitored regularly for years by pediatricians, psychologists, child development specialists, epidemiologists, educators, and other experts.

None of that’s enough to give locals confidence in the future.

FLINT - Tiffany Burene
Tiffany Burene and her 8-year-old son have had health problems she believes stem from the contaminated water. Fabrizio Costantini for STAT

Wishing for an escape

Tiffany Burene, 33, has lived in Flint all her life, but now wants to leave. She can’t, though, she said. She doesn’t have the money.

Like many people in this city, Burene started drinking bottled water a year ago, after the city told residents that the tap water contained elevated levels of total trihalomethanes, a carcinogenic byproduct of chlorine. 

But in August, she ran out of money and began drinking river water from the faucet again. Several days later, she awoke with her stomach cramping, rushed to the bathroom and found the toilet full of blood. An emergency room physician diagnosed colitis, a condition she hadn’t had previously.

“It scared me. And I still have stomach issues to this day,” said Burene, who also had a stretch of alarming hair loss last year.

Nothing, however, has worried Burene so much as what’s happened to her 9-year-old son, Gabe, who was diagnosed with attention deficit hyperactivity disorder and bipolar disorder at the age of 5.  

“That little boy is my everything and I don’t know what’s going on,” Burene said. “Within the last year and a half, his ADHD has gotten worse. He gets very agitated and aggravated very easily. His anger outbursts are getting more frequent.”  

It could be a new development stage Gabe is going through — or something else. Burene has no way of knowing.   

FLINT - Tiffany Burene
Tiffany Burene would leave Flint if she had the money. Fabrizio Costantini for STAT

“I can’t say 100 percent it’s the lead, but nothing has changed in our household except the water and, honestly, that’s the only way I can put two and two together,” she said. “No matter how many times I take my son to the pediatrician or a therapist, they never find anything.”

Echoing other parents across Flint, Burene blames herself for not protecting her son, even though she could not have known about the lead leaching into the water. “Our kids don’t deserve this,” she said, “and it makes me feel like a failure as a parent.”