Hookworm, a disease of extreme poverty, is thriving in the US south. Why?

Exclusive: in America, the countryare rampant, the first study of its kind in modern times Reveals

Children playing feet away from open pools of raw sewage; drinking water pumped beside cracked pipes of untreated waste; human faeces flushed back into kitchen sinks and bathtubs whenever the rains come; people testing positive for hookworm, an intestinal parasite that thrives on extreme poverty.

These are the findings of a new study into endemic tropical diseases, not in places generally associated with them in the growing world of sub-Saharan Africa and Asia, but in a corner of the richest nation on earth: Alabama.

Scientists in Houston, Texas, have raised the lid on one of America’s darkest and deepest secrets: that concealed under fabulous wealth, the US tolerates poverty-related disease at levels comparable to the world’s poorest countries. Over one in three people sampled in a bad region of Alabama tested positive for traces of hookworm, a gastrointestinal parasite which was believed to have been eradicated from the US decades ago.

The long-awaited findings, revealed by the Guardian for the first time, are a wake-up forecast for the world’s only superpower as it grapples with growing inequality. Donald Trump has promised to “Make America Great Again” and handle the nation’s crumbling infrastructure, however, he has said very little about enduring chronic poverty, particularly in the southern countries.

The study, the first of its kind in modern times, was carried out by the National School of Tropical Medicine at Baylor College of Medicine in conjunction with Alabama Center for Rural Enterprise (ACRE), a non-profit group seeking to tackle the root causes of poverty. In a survey of people living in Lowndes County, an area with a long history of racial discrimination and inequality, it found that 34% tested positive for genetic signs of Necator americanus.


The parasite, better known as hookworm, travels around the body until it attaches itself to the small intestine where it proceeds to suck the blood of its host, and enters the body through the skin through the soles of feet. Over years or months it causes iron deficiency and anemia, weight loss, fatigue and mental function, particularly in children, helping to trap them.

Hookworm was rampant in the south of the US in the 20th century, sapping the energy and educational accomplishments of both white and black kids and helping to make the stereotype of the lazy and lethargic southern redneck. As public health improved, most experts assumed it’d disappeared altogether by the 1980s.

But the new study reveals that hookworm survives in communities of Americans lacking even basic sanitation, but does so on a breathtaking scale. Not one of the people had travelled outside the US, yet as was shockingly waste treatment, parasite exposure was found to be widespread.

The peer reviewed research paper, published in the American Journal of Tropical Medicine and Hygiene, focuses on Lowndes County, Alabama — the home state of the US attorney general, Jeff Sessions, and a landmark region in the history of the nation’s civil rights movement. “Bloody Lowndes”, the region was called in reference to the violent response of white residents towards attempts to reverse racial segregation in the 1950s.

It was through this county which Martin Luther King led marchers from Selma to Montgomery in 1965 in search of voting rights for black citizens, More than half a century later, King’s dream of what he called the “dignity of equality” remains elusive for many of the 11,000 residents of Lowndes County, 74 percent of whom are African American.

Raw sewage is transported through a PVC pipe to be dumped only a few yards away from a nearby home. Photograph: Bob Miller for the Guardian

The average income is just $18,046 (#13,850) a year, and almost a third of the population live below the official US poverty line. The most basic waste disposal infrastructure is.

Some 73 percent of taxpayers included in the Baylor survey reported that they had been exposed to sewage washing back as a result of faulty septic tanks or waste pipes becoming overwhelmed in torrential rains.

The Baylor study was inspired by Catherine Flowers, ACRE’s founder, who invited the Houston scientists to carry out the review after she became concerned about the health consequences of having so many sewers in her home county. “Hookworm is a 19th-century disease that should by now have been addressed, yet we are still struggling with it in the United States in the 21st century,” she said.

“Our billionaire philanthropists like Bill Gates fund water treatment around the world, but they don’t fund it here in the US because no one acknowledges that this level of poverty exists in the richest nation in the world.”

Flowers took the Guardian on a tour of Lowndes County to witness the states in. One stop was in a group of homes outside Fort Deposit that illustrated the crisis.

An eight-year-old child was sitting on the stoop of one of the trailers. Below him a pipe ran out of his house, into a copse of pine and sweet gum trees, and across the yard a couple feet away from a basketball hoop.

The color of oil was cracked in many places and stopped just inside barely 30ft from the house, the copse, dripping ooze. Directly over the sewage pool, a separate narrow-gauge pipe ran up to the house, which turned out to be the main channel.

The sewer was festooned with mosquitoes, and a cordon of rodents could be seen trailing along the waste pipe. In the dappled sunlight the treacly fluid was glistening at the end of the pool nearest the house — a closer look revealed that it really moved, its human effluence churning and heaving with thousands of worms.

Ruby Dee Rudolph, 66, noticed her septic tank was gradually sinking unevenly into the ground. Photograph: Bob Miller for the Guardian

“This is the definition of ‘Make America Great Again’,” said Aaron Thigpen, 29, a community activist who helped with the hookworm study. “This is the reality of how people are being forced to live.”

Thigpen’s cousins live in the trailer park, and he has talked to them about the perils of piping sewage from their homes and dumping it in the open just a few feet away. “They are disgusted about it, they’re sick and tired of living like this, but there’s no public help for them here and if you’re earning $700 a month there’s no way you can afford your own private sanitation.”

He added that people were afraid to report the problems, given the spate of criminal prosecutions which were launched by Alabama state between 2002 and 2008 against taxpayers who were open-piping sewage from their homes, not able to afford proper treatment systems. For failing to get a tank than her annual income, one grandmother was jailed.

“People are scared. They don’t like to speak out as they’re worried the health department will come round and cause trouble,” Thigpen said.

The challenge to places like Lowndes County is not to restore public infrastructure, as Trump has promised, since there’s absolutely no infrastructure here to begin with. Flowers estimates that any municipal sewerage system uncovers 80 percent of the county, and in its lack people are expected — and in some cases legally forced — to provide their own.

Even where folks can afford up to install a septic tank the terrain is against them. Lowndes County is located within the “Black Belt”, the southern sweep of loamy soil that’s ideal for growing cotton and consequently spawned a great number of plantations, each worked with a large enslaved population.

The same thing that made the land good for cotton — its properties makes it a hazard to the thousands of African Americans who still live on it. When the rains come, the soil becomes overwhelming waste systems, saturated and providing a breeding ground for hookworm.

Ruby Rudolph lives beside the main Selma to Montgomery road where King led the protest walk. On the opposite side of the road there’s a history placard to mark the spot where her grandmother, Rosie Steele, ran a campsite for the weary marchers.

The campsite was cleared and after they moved on, Rudolph said, her grandmother’s grocery store was set on fire in an arson attack. She was 13 at the time, and can remember the flames.

Rudolph, now 66, does have her own septic tank in the back of her house, which she shows us in the sweltering 41C (105F) heat. But it does not function properly and if it rains the tank spills over, spreading waste all around the yard. “That’s better than when it flushes back into the house, and I’ve had that too,” she said.

She has been told a replacement system would cost. She runs through her financing: she gets up to perform an early shift at a Mapco convenience store, which earns less than $1,200 a month. When it’s hot and there’s the electricity bill that may be more than $ 300 a month from that amount she has to pay $ 611 for her mortgage and the air conditioning is busy. There’s not.

Perman Hardy, 58, stands with her grandson Carlos near the pipes that carry sewage from a relative’s nearby trailer home into the woods, approximately 30ft from the back door. Photograph: Bob Miller for the Guardian

Perman Hardy, 58, lives in nearby Tyler at a selection of seven single-storey houses all occupied by members of her extended family. Two of them have septic tanks, the rest just pipe waste into the forests and creeks.

Hardy is one of the lucky ones with a treatment system of her own, but like Rudolph’s it is overwhelmed with faeces washed back into her home. The stench was so bad she had to vacate the property for 2 weeks over Christmas while it was cleaned.

Hardy has traced her family back to slaves held on the Rudolph Bottom plantation about five miles off. The road that leads to the farm from her house is still called to this day by white neighbors “Nigger Foot Road”, she said, though she and other African Americans call it Collerine Cutoff Road.

As a young child, Hardy worked in the cotton fields after college and, mindful of her family’s slave history and that, she is determined to find a future for her grandchildren. “I don’t want the same for my boys. But it’s still a struggle. It’s the 21st century and we shouldn’t be struggling like we still are today.”

The daily hardship faced by Hardy, Rudolph and fellow inhabitants of Lowndes County is reflected in the Baylor study’s glaring statistic of 34. The sample size was low — 67 people participated giving samples, all of whom were African American — but the results are so stark that the Houston scientists now need to conduct a survey.

“We now need to find how widespread hookworm is across the US,” said Dr Peter Hotez, dean of the National School of Tropical Medicine, who led the research team combined with Rojelio Mejia. Hotez, who has estimated that as many as 12 million Americans might be suffering from neglected tropical diseases in poor parts of the south and midwest, told the Guardian the results were a wake-up call for the country.

“This is the inconvenient truth that nobody in America wants to talk about,” he said. “These people live in the southern United States, and nobody seems to care; they are poor, and nobody seems to care; and more often than not they are people of color, and nobody seems to care.”

Read more: http://www.theguardian.com/us