Surrounded by Sewage
Catherine Coleman Flowers
Meet Catherine Coleman Flowers, the “Erin Brockovich of Sewage”
In Episode 1 of The Heart of Healthcare Podcast, I interview Catherine Coleman Flowers, the founder of the Center for Rural Enterprise and Environmental Justice. She is the author of Waste: One Woman’s Fight Against America’s Dirty Secret. Catherine has been called the “Erin Brockovich of Sewage” for bringing about awareness of the crumbling infrastructure causing toxic sewage spills in backyards of poor, rural communities.
In 2019, she testified to Congress to address the diseases associated with poverty in the United States. And in 2021 she was appointed a member of the White House Environmental Justice Advisory Council.
As I always say, most healthcare problems have a root in social justice and today we’ll talk about Catherine’s work investigating the structural inequalities impacting access to sanitation and clean water.
Below is an abbreviated transcript from the interview.
Halle: When and how did you first become aware of the problem of inadequate human waste disposal, which you call “America’s dirty secret”? When did you realize this was a major environmental health and social justice issue?
Catherine: I realized it was a problem in 2000 when I moved back to Alabama, and found out that people were being arrested because they could not afford on-site septic systems. And consequently, I learned about street piping, which I had never seen before. When I grew up, we didn’t straight pipe, we actually had an outhouse and you went to the outhouse and there wasn’t a toilet, it was called a night pot that was used in the house or a slop jar that was used for the purpose of taking it out to the outhouse. But regulations change and people started switching to cesspools as they call them. These other iterations of on-site septic were very expensive, and a lot of poor families could not afford them, and consequently, they were straight piping.
Halle: So what’s the magnitude of this problem? How many families within your county and then your state nationwide? How prevalent is this?
Catherine: In the county itself? I would say that over two thirds of the county are having problems with treating wastewater where they are paying a wastewater treatment fee with a small treatment plant that this decentralized or if they’re on on site, septic, they’re having problems statewide. I found out back in the early 2000s that it was in all 67 counties in the state of Alabama.
Since that time, we found out that this is quite a problem throughout the US. And it’s in every state. The reason it’s America’s dirty secret is because we have not given ourselves permission to talk about it, plus there are regulations in place to silence people if they speak out because they feel they can be cited.
Halle: So why isn’t water and sewage a public utility for all Americans?
Catherine: That’s a great question, because I believe it’s a human rights issue. But apparently, we’ve gotten to the place where we don’t think about the public good anymore. We’re only concerned about profit making schemes, even when the profit making schemes are not in the best interest of the entire public. I was told recently that water utilities are more concerned about selling water because it’s profitable, then they are about wastewater treatment, because it’s not. So as long as we have those type of mindsets influencing policy around who gets wastewater treatment and who doesn’t, then of course, the public will always be in jeopardy of the next potential pandemic, coming from disease because we’re not treating human waste adequately.
Halle: I’d love to talk about hookworm, the intestinal blood feeding parasite that we thought had been eradicated in the United States. But you found hookworm infections were extremely prevalent in Lowndes County due to the inadequate waste disposal. Talk to us about how you uncovered this problem.
Catherine: Well, simply by listening to the local folk, I think that that’s part of why we keep having these issues, because… we don’t listen enough. But I listened to local people because I grew up listening to people that were elders and seeking guidance from folk who probably knew a lot more than I did, because wisdom was so important. So in listening to people, when we did the house to house survey, we realized that people were also complaining about potential illnesses.
And we noticed that a lot of people were sick and we couldn’t figure out why.
… I was called to a site where there was wastewater on the ground just outside the home and this pit of sewage was covered with mosquitoes. I had on a dress. Mosquitoes bit my legs. So much so [that] I had hosiery on and you can see through my hosiery the bloodstains where they drew blood. And I was concerned because I could see them sitting on top of human feces and whatnot, and they came out of the toilet. It was after that my body broke out in the rash. And I went to my doctor and I asked her [for a] blood test to make sure that nothing was wrong with me. And the test came back negative. And that’s when I start asking the question, is it possible? And I asked her, is it possible that there’s something that … American doctors are not trained to look for? Because we don’t even acknowledge that we have this problem?
Halle: The test was negative because it was the wrong test.
Catherine: It was the wrong test. And then from that, I read an op ed in the New York Times that was written by Dr. Peter Hotez. And I googled him, found his email address, wrote him and told him about my experience. And that’s how we did the hookworm study. He sent scientists to Lowndes County, and we collected fecal, soil, water, and blood samples. And in those samples, we came back with evidence of hookworm and other tropical parasites. And hookworm basically is an infection that is associated with inadequate wastewater treatment.
Halle: We all face naysayers in health care. Can you tell me about the biggest roadblock that you faced in your work?
Catherine: … One is the historical inequities that are baked into our system that discriminates against people of color, it discriminates against poor people, and it discriminates against rural communities. People just feel like rural people should choose to move to a city so they wouldn’t have to deal with on-site problems. But they’re also taxpayers and a large part of the US is incorporated and rural.
One is the historical inequities that are baked into our system that discriminates against people of color, it discriminates against poor people, and it discriminates against rural communities.
I’ve also found that wastewater more often than not, in many areas, has inequity baked into it, that was inspired by racial covenants about where black people and people of color or Jewish people could settle at the time. And those lands is folk that were trapped there and couldn’t move, because they were not the best places to live, are the ones that are having a lot of the infrastructure issues, and there was never real sustained investment in building a resilient infrastructure in those places.
Then of course, the other problem is what I what I’m seeing now are people that are not accountable who design these failing systems and sell them to people that don’t have a lot of influence, that are forced into situations to get these, this infrastructure that they know is going to fail because they lived through it before and nobody listens to them.
… And until we solve those issues, we’re going to always be forced to accept so called solutions that don’t work without any kind of input from the community themselves. Because they’re the ones that ultimately have to deal with the failures. And they’re not making any money off of it. But the owners have maintained it as is put there is passed on to them.
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