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'Waste' Activist Digs Into The Sanitation Crisis Affecting The Rural Poor

Nov 23, 2020

Hookworm is an intestinal parasite often associated with poor sewage treatment and the developing world. It was long thought to have been eradicated from the United States — until a 2017 study revealed otherwise.

According to the study, more than one in three people in Alabama's Lowndes County tested positive for hookworm infection.

Hookworm spreads when people walk or play in soil contaminated with feces and the larvae of the worms penetrate their skin.

"This is not something that we test for in the U.S. because people don't anticipate that we have it," says activist and author Catherine Coleman Flowers.

It was Flowers' activism that spurred scientists to conduct the hookworm study. For 20 years, she's worked with advocacy organizations, philanthropists, business leaders and elected officials to shed light on the gaps in access to basic sanitation in rural America.

An Alabama native, Flowers has been awarded a MacArthur fellowship for her work on behalf of rural Americans living without proper sewage treatment. She says the hookworm study was a "smoking gun," that highlighted the sanitation and environmental problems the rural poor face.

Lowndes is a predominantly Black community, but Flowers notes that sanitation issues — and the health problems that tend to accompany them — are as much about class as they are about race.

"It's very hard to get people to pay attention to rural poverty because most people don't understand it," she says. "In Lowndes County, for example, a lot of it is about race, but poor white people are having the same problems."

Flowers writes about her life and the battle for universal sanitation in the new memoir, Waste: One Woman's Fight Against America's Dirty Secret. She is also the founder of the Center for Rural Enterprise and Environmental Justice.


Interview highlights

The New Press

On why sanitation is a particularly bad problem in these rural parts of Alabama

First of all, there's no municipal system. Usually when people visit or especially if they call me and they've never been to a rural community, they ask, "Why don't they connect to a municipal system?" In a lot of rural communities and suburban communities around the United States, people own on-site septic systems. And the on-site septic systems are something that the homeowner, at least in Alabama, the homeowner, has to to purchase and put it in place.

Recently, we were working with a family who ... needed [an] on-site septic system, and we had the engineering done. You have to have a perc test done in the state of Alabama. A perc test is when they are checking the percolation rate or the rate in which water drains to the soil. And that can determine whether or not what type of septic system is needed in that location. Lowndes County has dense clay soils. It holds water, so it makes it harder.

The other factor that we have found to be a problem is the water table. The water table is high, and the water table is getting higher because of sea level rise. A lot of people do not account for that when they are talking about on-site sanitation.

This particular family that we were trying to help, they went down 25 feet and struck water. That's how high the water table was. ... So that means that there's a need for a different type of system. ... The system needed to treat wastewater from the home would have taken a close to two thirds of the [half acre] property. And it would have cost $28,000, and most families — not just poor families, but middle-class families in Lowndes County and other places in Alabama — could not afford that.

On how climate change affects how these septic systems work

We're still using technologies that were developed before we had the type of rainfall that we have, before we had the type of conditions that we have with climate change in having all these storms coming ashore and we get more rain or we get deluges of rain at one time.

Even before now, when I was growing up in Lowndes County and my family had a septic system, the sewage would come back into the homes and sometimes come back into the bathtub, and we thought it was a plumbing problem. But because my organization did a house-to-house survey and we went to over 1,000 homes in Lowndes County and we kept hearing the same problems over and over again, and under the same conditions, we realized there was a pattern. And it's not just that they're not being maintained.

We have to find something that's going to work. And now I'm hearing from people around the country that are saying the same thing. We have to get the people that are designing these systems to listen so they can change them and make them work, hopefully, or we need to create something new and different.

On how the health department in Lowndes County issued citations if residents didn't have permits for septic systems

What was happening in Lowndes County at the time, people were being cited ... and [the health department] said because the problem was so prevalent throughout the state, we were told that at that time that their stance was to only act if somebody reported it. So when it was reported to [the health department environmentalist], he would go see the situation and then he would send them a citation giving them so many days to get it corrected. And after they didn't get it corrected within whatever that period of time was, they would go to court and the judge could issue an order for them to correct it, and when they were being arrested was when they apparently violated the order.

I went to court at the invitation of the environmentalist. That's how I knew they were in court that day. The health department's environmentalist was concerned that the person, a young man, would lose his job if he was arrested that day, if he was placed under arrest because he could not afford to put in his septic system. Apparently he had been trying to work with this young man, but it was just so expensive.

And so when I went to court, I did explain to the judge that he couldn't afford it. I also explained that we were trying to help understand the problem and try to help families that were facing potentially being arrested for not having septic systems. So she eventually let him go. But there was also another person in the courtroom and she had spent the weekend in jail and had been arrested for not having a septic system.

On finding new solutions to sewage treatment problems

My next phase in this is to partner and work with people to establish new technologies that could work, because I'm understanding that this problem is not just a Lowndes County problem. This is a problem all over rural America — and it's also a global problem. So we have to develop the type of technologies that [are] going to work.

To give you an example, going outside of Lowndes County, in the Miami-Dade County area, I saw an article that said that they had an over billion dollar septic tank problem because of sea level rise. They're not working. We have to acknowledge that a lot of these systems are not working and we have not understood that it's time for us to develop green wastewater treatment that takes into account climate change.

And until we do that, the infrastructure will continue to fail over and over and over again. And there shouldn't be another Catherine Flowers 20 years from now saying what I'm saying. If we can treat wastewater to drinking water quality and outer space, why can't we do it here on Earth?

Heidi Saman and Seth Kelley produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Carmel Wroth adapted it for the Web.

Copyright 2020 Fresh Air. To see more, visit Fresh Air.

DAVE DAVIES, HOST:

This is FRESH AIR. I'm Dave Davies, in for Terry Gross. In 2017, many were shocked to read of a study that found that more than 1 in 3 people in a poor area of Alabama tested positive for traces of hookworm, an intestinal parasite long thought to have been eradicated in the United States. The findings were not a surprise to our guest, Catherine Coleman Flowers. She's an Alabama native who, for years, worked to bring attention to the problem of people living without sewage treatment so that human waste collects in their yards and sometimes backs up in plumbing pipes and seeps into their homes. Hookworm spreads when the larva of the worms penetrate the skin of people walking or playing in soil contaminated with feces.

As you'll soon hear, the hookworm study was a direct result of Coleman Flowers' activism. For 20 years, she's worked with advocacy organizations, philanthropists, business leaders and elected officials on the issue of basic sanitation. She's testified before Congress and a United Nations panel in Geneva. And earlier this year, she was awarded a MacArthur Foundation fellowship to continue her work.

She's written a new memoir about her life and the battle for universal sanitation. It's called "Waste: One Woman's Fight Against America's Dirty Secret." Catherine Coleman Flowers is the founder of the Center for Rural Enterprise and Environmental Justice and since 2008 has been the rural development manager at the Race and Poverty Initiative of the Equal Justice Initiative, founded by Bryan Stevenson. She joins me from her home in Montgomery, Alabama. Catherine Coleman Flowers, welcome to FRESH AIR.

CATHERINE COLEMAN FLOWERS: Thank you. Thank you for inviting me.

DAVIES: You've been active on this issue for a long time and have brought a lot of people - philanthropists, reporters, elected officials - to rural areas to see for themselves poor people living with this problem of simply not having sanitary disposal of human waste. I'd like you to describe the experience of just one of these tours and the reaction of those who saw what you showed them.

FLOWERS: Well, one of the persons whose reaction was, I think, sums it up was Dr. Philip Alston. Dr. Alston was the U.N. special rapporteur on extreme poverty. And when he was invited to Lowndes County, as part of his official tour, he went to see areas where people were living amongst raw sewage. One of the homes that we went to, it was a compound with a number of mobile homes that sat off of a dirt road.

And one could see the water lines that carried water into the home going above what looked like a ditch full of raw sewage. And nearby was a basketball goal where children, apparently, played basketball. And when he saw it - there were reporters with us on his tour. And one of the reporters ask him, have you seen this before? And he said, this is uncommon in the developed world. And I thought that that spoke loudly of what I had felt for all of these years that I had seen this.

DAVIES: And so what people would see - and you've taken so many people to this and observed their shock at what they saw - was often, you know, a piece of (ph) pipe running from a home or a trailer to, you know, a hole in the backyard. And then, when you get closer, what do you see there?

FLOWERS: When you get closer, you'll probably see human feces and toilet paper or whatever was flushed in the toilet that day. The one place that we went that was - that stands out in my mind is that it was full of - it was a pit full of raw sewage. As you said, the person had a PVC pipe. But there was a lot of ingenuity that's involved in this. They - the PVC pipe was buried underground. And it went to a pit. And in that pit, again, it was full of, you know, raw sewage. And you could see the eyes of a frog that was embedded in the sewage and was peeping out from it. And oftentimes, depending on the time of the year - and now that the days - we have longer, warmer seasons. There are mosquitoes sometimes congregated on top of the sewage.

DAVIES: Right. And those animals will spread this stuff to wherever they go.

FLOWERS: Exactly.

DAVIES: You grew up in Lowndes County, Ala. It's an interesting place in the history of the civil rights movement, isn't it?

FLOWERS: Yes, it's a very interesting place in the history of the civil rights movement. Most people know about Lowndes because of its fight for voting rights and the establishment of the Lowndes County Freedom Organization, which was the original Black Panther Party and that the Black Panther was chosen because a lot of the sharecroppers had not been afforded the opportunity to go to school. So they wanted to use a symbol that people could understand.

And it also - you know, I think one of the slogans from that time was pull the tail for the Panther when they organized their own political party and ran candidates on that party, because at that time, it was not - Black people running as candidates wasn't accepted on either the Republican or the Democratic Party in Lowndes County. So that, itself, was a great accomplishment on the side of sharecroppers, former sharecroppers, who had been kicked off the property just because they sought the right to vote.

DAVIES: And that was the Lowndes County Freedom party that preceded the Black Panther organization, right?

FLOWERS: Yes.

DAVIES: And it's also - is this area on the route of the famous march from Selma to Montgomery that Dr. King led?

FLOWERS: Yes. Most of the Selma to Montgomery march route goes through Lowndes County. Lowndes County is actually between Selma and Montgomery.

DAVIES: You want to describe some of the rural poverty there, what distinguishes life there that brought you back there? You'd moved away and had done lots of interesting things with your life. But, I guess, in your middle age, you came back because you felt like the county needed help. Why did it need help?

FLOWERS: Well, I had always been involved as an activist in Lowndes County. And even when I didn't live in the county, no matter where I was, I would always go back and always stay connected to things that were happening. So when I came home, I was very surprised at what I saw. You know, I grew up in Lowndes County before we had telephones or before we had a lot of the services that people take for granted today. And it was very - it was striking to me to see that some things had changed, and some things had not.

A lot of people were living in mobile homes. And a lot of these mobile homes were in serious disrepair because they charged a lot of money for these homes. But the homes were very hard to maintain. And as it got warmer, you know, you can see the mold and mildew on the outside of the homes and, in some cases, on the inside of the homes. We saw homes that were falling apart, where people had to step over boards on the floor because the floors were weak. You know, the homes just were not sustainable.

And a lot of people that are living in that type of poverty also have food insecurity. And because there are no grocery stores and not - no access to fresh food, there are lots of diabetes, so much diabetes, in fact, that there are, in some cases, buses that provide - vans that provide transportation for people to go to dialysis two or three times a week. So it's that type of stark poverty, I believe. And some of these people are working. But they're working in jobs that are not paying a lot of money. They're not paying a living wage. And as a result, they are unable to have the type of access to health care and other kinds of things to improve their quality of life.

DAVIES: When you first came back to Lowndes County, you were working in economic development in a job with the county. Your attention was drawn to this problem of a lack of sanitation. And I think I want to talk about - just a little bit about why this happens. You know, I think most of our listeners have never thought about what happens when they flush the toilet, right? We flush it, and it disappears because we're connected to a public, you know, sanitation and water system. What is it about these rural homes that make this problem particularly bad for them?

FLOWERS: Well, first of all, there's no municipal system. Usually, when people visit or they - especially if they call me and they've never been to a rural community, they ask, well, why don't they connect to a municipal system? Well, in a lot of rural communities and suburban communities around the United States, people own onsite - it's called onsite septic systems. And the onsite septic systems are something that the homeowner - at least in Alabama, the homeowner has to purchase and put it in place.

Recently, we were working with a family who wanted or needed a onsite septic system, and we had the engineering done. You have to have a perc test done in the state of Alabama. A perc test is when they are checking the percolation rate or the rate in which water drains through the soil. And that can determine whether or not - what type of system, septic system is needed in that location. Lowndes County has dense clay soils. It holds water, so it makes it harder.

The other factor that we have found to be a problem is the water table. The water table is high. And the water table is getting higher because of sea level rise. A lot of people do not account for that when they are talking about onsite sanitation. And with that being a problem, this particular family that we were trying to help - they went down 25 inches and struck water. That's how high the water table was. I've been in situations where they've gone down 6 inches and struck water. So that means that there's a need for a different type of system.

And the system designed for that property was designed in such a way - the owner owned - it was a half-acre of property. The system needed to treat wastewater from the home would have taken up close to two-thirds of the property. And it was - would have cost $28,000. And most families, not just poor families, but middle-class families in Lowndes County and other places in Alabama cannot afford that.

DAVIES: We're going to take a break here. I'm going to reintroduce you. Catherine Coleman Flowers' book is "Waste: One Woman's Fight Against America's Dirty Secret." We'll be right back after a short break. This is FRESH AIR.

(SOUNDBITE OF ANAT COHEN'S "NIGHTMARE")

DAVIES: This is FRESH AIR. And we're speaking with Catherine Coleman Flowers, an activist based in Alabama who has spent years advocating to get basic sanitation to poor communities, particularly in rural areas where many families live without sewage treatment, so human waste may collect in their properties. Her new memoir is "Waste: One Woman's Fight Against America's Dirty Secret."

You know, you write about how when you got involved in this issue of a lack of sanitation, you met an environmentalist with the state Health Department who - he went to a meeting, and people got kind of angry at him. And so he wanted to connect with you. He invited you to his office to kind of see what the health department was doing to deal with this. Tell us about that. What did you learn from him?

FLOWERS: Well, he and I had a lot in common, and that's why we were able to connect. And he showed me that - you know, what the permitting process was, how they maintain their records. It was all in a file. But he knew based on the number of permits that they had on file that most of the citizens were not permitted. And while I was there, someone came to see him to ask him about a woman who lived in the community of Mosses and asked whether or not she had a permit for her septic system. And of course, when they looked and there was no permit there, he asked me, would I ride with him?

He took me over to her house and rode around the house. And we could see not only was there raw sewage on the ground. It was almost coming up the back of her wooden home. And her bathroom was pretty much sitting - that part of her house was sitting on the ground. So he took that time to also drive me around and show me other areas where he could tell just from the road that they had raw sewage on the ground because the grass was greener in that area.

DAVIES: Right. You develop an eye for it, right?

FLOWERS: Yes.

DAVIES: You know, you mentioned that while you were in there with this health department official, that this guy had come in who was actually a builder, a contractor, right? And he wanted to know about this woman. Does she have a permit? Went over, discovered, no, she didn't have a permit for a septic tank. And then you realized that there was probably a reason that this contractor was looking for this information. What was going on here?

FLOWERS: Because she would be cited. And when she was cited, she was put in a position where she had to get - she had to get it repaired.

DAVIES: And then he could do the work and make money from it.

FLOWERS: He could do the work, yes.

DAVIES: It was astonishing to me to read that a lot of people that are in this situation, where if they are in a circumstance where the health department inspects, and they do not have a permitted - an effective septic system, that they can be noticed and eventually arrested for failing to provide this?

FLOWERS: Well, what was happening in Lowndes County at the time - people were being cited. And this is one of the things that this environmentalist explained to me - that they were cited, and they generally - they said because the problem was so prevalent throughout the state, we were told that - at that time that their stance was to only act if somebody reported it. So when it was reported to him, he would go see the situation, and then he would send them a citation giving them so many days to get it corrected. And after they didn't get it corrected within whatever that period of time was, they would go to court, and the judge could issue an order for them to correct it. And where they were being arrested was when they apparently violated the order.

DAVIES: You actually went to court a few times where people were facing arrest and explained to the judge, look. You're asking this family to do something it doesn't remotely have the resources to do, right?

FLOWERS: Yes. I was actually invited to - when I went to that - went to court, I went to court at the invitation of the environmentalist. That's how I knew they were in court that day.

DAVIES: The Health Department environmentalist, right?

FLOWERS: Yes. The Health Department's environmentalist was concerned that the person, a young man, would lose his job if he was arrested that day, if he was placed under arrest because he could not afford to put in his septic system. And apparently, he had been trying to work with this young man, but it was just so expensive. And so when I went to court, I did explain it to the judge and explained to her that he couldn't afford it. I also explained that we were trying to help, you know, understand the problem and try to help families that were facing potentially being arrested for not having septic systems. So she eventually let him go. But there was also another person in the courtroom, and she had spent the weekend in jail and had been arrested for not having a septic system.

DAVIES: Wow. You know, I mean, the county is obliged to ensure, you know, that there aren't dangerous and unhealthy conditions. That's why there's a permitting system. That's why they act. But it just doesn't make any sense to expect people to do what they cannot do, right?

FLOWERS: It doesn't make any sense. I agree with you.

DAVIES: You know, in the book, one of the things we learn is that you are a woman who - you do a lot of networking. You make a lot of connections. And you've been effective in getting business leaders, philanthropists, activists together. And you've helped a lot of people to resolve their problems. Is it harder to get people to pay attention to rural poverty than urban poverty, do you think?

FLOWERS: Yes, it's very hard to get people to pay attention to rural poverty because most people don't understand it. Most people don't understand the way rural communities are organized because I'll often get questions like, why do they not have this, or why do they not have that? When people come to visit, I have to tell them, write down the directions because there may come a time when you may not have a phone signal, and you can't rely on GPS. So - or in a case where people will look at an address and say, oh, that person lives in Tyler, Ala., and assuming that Tyler, Ala., is in Lowndes County because it's part of the address. Tyler, Ala., is actually in Dallas County and that's where the post office is located, where their mail comes from. So that is - it's those kinds of things that we have to teach people that are not familiar with rural communities. And because they're not familiar, a lot of things they just don't see.

DAVIES: How much of this is about race, this kind of poverty?

FLOWERS: It depends on where it's located. I think it's about race and class. I think that in Lowndes County, for an example, a lot of it is about race, but poor white people are having the same problems. If - I've gone to areas outside of Alabama. I've gone to Appalachia as part of the new Poor People's Campaign. I've seen it there, too. The only difference were the people were white. Or if one goes to Indigenous communities, you see the same thing - Latinx communities. And now with COVID, the communities that are most vulnerable, that are probably having the higher death and infection rates, are those communities that are living in extreme poverty and also do not have access to working infrastructure.

DAVIES: When you look at this problem of these individual poor homeowners, some in trailers, some of them in small homes that aren't connected to county systems - and septic systems are expensive, not particularly well-suited to the clay soil and high water tables that you have there - is there a big fix? What would it take to really resolve this issue for people that are suffering?

FLOWERS: What it's going to take is, first of all, using technology that works. This problem is not just a Lowndes County problem, this is a problem all over rural America, and it's also a global problem. To give you an example, going outside of Lowndes County, in the Miami-Dade County area, I saw an article that said that they had an over billion-dollar septic tank problem because of sea level rise. They're not working. Now we're finding that wastewater - the way wastewater is treated in some places create more contamination. In some cases, leaks from wastewater is contaminating the drinking water. Leaks from wastewater is causing fish kills, algae blooms. And we have not understood that it's time for us to develop green wastewater treatment that takes into account climate change.

DAVIES: We're going to take another break here. Let me reintroduce you. Catherine Coleman Flowers' book is "Waste: One Woman's Fight Against America's Dirty Secret." She'll be back to talk more after this short break. I'm Dave Davies, and this is FRESH AIR.

(SOUNDBITE OF ALLEN TOUSSAINT'S "BLUE DRAG")

DAVIES: This is FRESH AIR. I'm Dave Davies, in for Terry Gross. We're speaking with Catherine Coleman Flowers, who's been awarded a MacArthur Fellowship, a so-called genius grant, for her work calling attention to the problem of people living, mostly in rural areas, without sewage treatment so that human waste collects in yards and seeps into homes. Coleman Flowers grew up in Lowndes County, Ala., where the problem is particularly acute. Her new memoir is called "Waste: One Woman's Fight Against America's Dirty Secret."

Tell us about hookworm - what it does, how people get it.

FLOWERS: Oh, wow. Well, first of all, I have to qualify that by saying I'm not a doctor. But my understanding...

DAVIES: Fair enough.

(LAUGHTER)

FLOWERS: My understanding is that hookworm is an intestinal parasite that whenever a person uses the bathroom, their feces ends up in the soil. Those worms can thrive there under the right conditions, and people come in contact with it when they either walk or play or whatever in those areas. And it penetrates the skin and eventually ends up, you know, in the gut. So - but what it does is it can create malaise in terms of health. And in children, it can make them anemic, and it may impact their development.

And we've also been told that people that have illnesses, other kinds of, you know, health care disparities, it can make it worse and create malaise. And the worst part of it is that this is not something that we test for in the U.S. because people don't anticipate that we have it. It's more of a term - they call it a third-world illness. But Dr. Peter Hotez has coined the phrase neglected diseases of poverty, and hookworm falls under that category.

DAVIES: Right. It's typically not fatal. It is treatable, but it is harmful and thought to have been eradicated. Turns out it isn't. This was discovered, really, as a direct result of your own experience investigating a property with open sewage. You want to just tell us what happened here?

FLOWERS: Yes. I was actually called to the site by people from the health department - it was the regional environmentalists and the local environmentalists for the county - and told me that they wanted me to go to the site, and they had threatened to put this woman in jail. She was in her 20s and pregnant.

So I went there, and she lived in a single-wide mobile home, and in the back of her home was a pit full of raw sewage with mosquitoes sitting on top of it. And I had on a dress and had on stockings, and the mosquitoes were so attracted to me that they bit me through the stockings. I had a lot of bites, and afterwards my body broke out in a rash. And I never had this happen to me before. And I went to my doctor, and I asked her - I told her. I explained what happened. And she did all these blood tests, and they came back negative. And I asked her, was it possible that I had something that doctors couldn't diagnose because American doctors don't expect these conditions here in the U.S.? And she said yes.

So later I read an op-ed that was written in The New York Times, and it was written by Dr. Peter Hotez. I googled him, found his information, emailed him and told him about my experience. And it just so happened that he was going to be in Atlanta the next week. And I went over and met him, and we talked and he said, you know, I'm going to send my parasitologist there; we're going to look for hookworm. And that was my first time hearing about hookworm.

DAVIES: Right. And, in fact, a study was organized. You ended up actually carrying samples to - was it Baylor Medical School?

FLOWERS: To Houston.

DAVIES: To Houston, OK. Right. And what it found was pretty alarming, wasn't it?

FLOWERS: It was very alarming. I was actually shocked by it. And they found other tropical parasites, too. But I was very shocked by it. And we were all - we knew that this was kind of a smoking gun, if you will. But I didn't realize the impact of it on the American psyche once it was released, and I didn't realize that the attention it would cause internationally, in the wealthiest country in the world, to have diseases that are generally associated with extreme poverty.

DAVIES: You know, as you developed your campaign to deal with this, it was - one of the things that struck me was that you worked with lots of people who you didn't necessarily agree with. There's a guy named Bob Woodson, who was a conservative who worked on, you know, development in poor communities - not the most likely person that you might have connected with. Tell us a little bit about him and his role in any of this.

FLOWERS: Well, I met Mr. Woodson at a faith-based summit in Washington. I heard him speak, and I approached him afterwards, and I asked him, would he help me with Lowndes County? And he invited me to his office, and I brought people to his office. And later he came to Lowndes County himself.

And it just so happened on that first visit, we were - there was a detour because one of the county commissioners, a female, said, Catherine, you have to go and see this site; I want you to go visit this family. And I didn't understand what she was talking about, and that was the first time I encountered a family that was dealing with a raw sewage issue and had been threatened with arrest. I think the husband and wife had been arrested because they had a failing septic system.

And Mr. Woodson was deeply moved by this. He was - he's a person that's - was born and raised in Philadelphia, who turned himself a Jack Kemp Republican but had a lot of deep respect in the communities where he worked. And these were primarily poor communities. There's a part of Mr. Woodson that I think a lot of people don't know. They hear Black political conservative and they stop. But he himself was also a winner of the MacArthur Award because of the work that he does in communities.

And he told me that he didn't have any experience in rural communities, but he was willing to learn. And that relationship - he was able to bring a lot of resources and was very effective in a state that is Republican-run.

DAVIES: Right. So you got some momentum in part with his assistance. And, you know, one measure of your pragmatism in this is that, at one point, you know, you had connected with Senator Jeff Sessions, the Republican representing Alabama, and wanted to get him interested. And to make sure he got interested, you actually organized a political fundraiser for him, right?

FLOWERS: Yes (laughter).

DAVIES: How did that go?

FLOWERS: It was very interesting because I knew that in order for him to take Lowndes County seriously, he had to see us differently because all - I was the economic development coordinator for the county at the time, and every time I would get in touch with someone, people would - some people would literally laugh at me and say, oh, there's - the only reason to go to Lowndes County is to get to Selma or to get to Montgomery. So in order to change that and to make sure that we had a champion - I had met Senator Sessions prior to then.

And he had town hall meetings, and I went to one of his town hall meetings and asked the question - he was talking about the grants that they had available. But the grants required a match, usually a 25% percent match. And the county had no tax base. There was no way for them to pay for the matches, so they couldn't get the federal monies to deal with those issues. So I thought that it was a good idea to do this fundraiser and to invite local business people to participate, people that were African American. And a local businessman did host it at his home, and a lot of people came.

And I was - I think that they were very, very shocked, Senator Sessions, people that - people came and they talked to him about various problems that they were facing and wanted to address, and he became an advocate for us.

DAVIES: Pamela Rush - you want to tell us her story?

FLOWERS: Yes. Pamela was a distant relative. I didn't know her, but I knew her family. One of her sisters reached out to me through social media and asked me, would I help her sister? And I did agree to go and meet Pamela. And when I met Pamela, I just couldn't get it out of my head, what I saw and what she shared with me.

Pamela was a - her family was a victim, and it was generational. It didn't just start with her. It actually - her brother and mother bought that mobile home, and Pamela was still paying for it. But the home wasn't worth what they paid for it. If they had bought a house or built a house for the amount of money that they invested in that mobile home, it would have grown in value. But that mobile home had seriously decreased in value and also wasn't providing the kind of protection that the family needed.

And she was struggling with an income of less than a thousand dollars a month, trying to maintain and also raise two children. And the home was full of mold and had a lot of other issues that exacerbated her daughter's condition. Her daughter had respiratory problems and slept with a CPAP machine. So Pamela was - she shopped at secondhand stores to try to make money, you know, go as far as it could. And she expressed that she was just concerned that there are a lot of things she could not get for her children because she couldn't afford it.

So one of the things that I asked her to do was - I said, I personally don't have the funds to help you. But I'd like to bring some people here, and I hope that someone would be moved to do so. And she agreed. And out of that, Pamela blossomed, not only to receive strangers - because she was very shy - but, ultimately, she herself testified in Washington about being poor and even hosted Senator Bernie Sanders at her home when he came as a presidential candidate at our invitation to see firsthand the type of poverty and the conditions that existed in Lowndes County.

DAVIES: And then this year, tragedy struck.

FLOWERS: Yes, she was - like all of us, was afraid of COVID. And COVID started to - when it entered Lowndes County, it really created a lot of devastation. A lot of people died. And Pamela ended up contracting - getting COVID and ended up on a ventilator and was unable to return home. And on July 3, she passed away.

DAVIES: Going to reintroduce you once again. Catherine Coleman Flowers' book is "Waste: One Woman's Fight Against America's Dirty Secret." We'll continue our conversation after a break. This is FRESH AIR.

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DAVIES: This is FRESH AIR. And we're speaking with Catherine Coleman Flowers. She's an activist based in Alabama who has spent years fighting to get basic sanitation to poor communities, particularly in rural areas, where many live without sewage treatment. Her new memoir is "Waste: One Woman's Fight Against America's Dirty Secret."

I want to talk just a bit about your earlier life. You were born in Birmingham, but you say your parents wanted to raise their family in the country. So you moved to Lowndes County. What were your parents like?

FLOWERS: (Laughter) My parents were very outgoing people. They didn't meet strangers. I think maybe that's where I got my networking chops from. But they didn't meet strangers. We always had people coming to our homes. And they were - local people would come to them whenever they had a problem, and I called them the jailhouse lawyers of the community. My father was a native of Lowndes County, so we were related to just about everybody. And he would put us in the car and take us to people's homes and tell us, these are your cousins.

And whenever people would come to visit and they were from Lowndes County, he would ask - the first question they ask is, who are your folks? And then they would start that oral history of going down that family tree (laughter) and making a connection. So we were surrounded by people that were activists who came from the outside and would always stop by to visit my family. And we were also surrounded by family, people that were blood relatives to us that were - that never left Lowndes County or those that would come back to visit would stop by. So there was a lot of constant activity.

And they were also activists. My mother was an activist and was part of the Welfare Rights Organization they had at the time. But she was also a woman who had been sterilized at a hospital in Tuskegee, where they were sterilizing Black women from the Black Belt who were poor, who were going there and giving birth. So my last brother was born at that hospital. And the doctor that sterilized her was on, of course, his birth certificate because he delivered him. My father, on the other hand, was a Korean-era veteran who flew a flag outside of our house. And he felt that he had fought as a person in the military, he would always tell us, five years, four months and 17 days. (Laughter) That was the amount of time he spent in the service. And he felt because of that - his service that he was entitled to all the benefits that went along with being an American citizen. And that's why he flew the flag, as a reminder.

DAVIES: You know, you mentioned your mom's sterilization in passing in the book. Did you find out more about the circumstances?

FLOWERS: I knew about this when I was younger because that was kind of how I - what propelled me into activism. I happened to be there when a team from BBC came to interview my parents. And she talked about this. And I knew that she had organized women because a lot of women didn't talk about it. It's just like the wastewater problem. It was something people whispered about but never talked openly about. So she organized women in the Black Belt, and primarily a lot of women in Lowndes County who had been sterilized, because there was a legal action that was taken to prevent this from happening again. And later, I found out more about it as an adult, that there were lots of women that had been sterilized. And it was paid for by the government.

DAVIES: You attended the Lowndes County Training School. You write that, you know, you realized you weren't getting a good education. And you wanted a real education. So you and your parents decided to do something about it. Tell us how it went.

FLOWERS: Well, what ultimately happened, we were able to remove the principal from the high school. And I had the opportunity to go to Washington the summer at the end of my junior year as a Robert Kennedy youth fellow with the Robert Kennedy Memorial Foundation and met Senator Kennedy. And we had the discussion about training school. And he was the one that told me that training school - didn't know it was outside of the South - was a school for delinquent children. So I was determined when I went back home that I was going to change the name of the school. So I talked to my parents about it because I was, you know, entering my senior year. And I didn't want that on my diploma.

So we went to the board meeting. And we talked about that and brought that up to the school board. And one of the school board members say, well, you should be proud to go to a school named for William Lowndes. And William Lowndes, of course, was one of the first persons to advocate for secession from the Union over slavery. We (laughter) ended up getting the approval of the school board to change the name. And when I graduated from high school, my diploma had Central High School, which had been the original name of the school before they changed it.

DAVIES: You know, as a young person, you went from Lowndes County to Washington, D.C. You know, you met Senator Ted Kennedy in person. I mean, what do you think that experience did for you or gave you, that experience in Washington at that young age?

FLOWERS: I think that experience in Washington showed me a world outside of Lowndes County. And it showed me possibilities. It showed me that the world was not just black and white. And in Washington, I saw women doing things that I did not see in Alabama. A lot of the people that I met would come up to me. In some cases, people would look at me, and they would assume that I was from another country. I never knew that about myself. I never knew that I looked like I could be from the Caribbean or could be from Ghana. You know, I never - that never occurred to me before spending time in Washington. And it gave me a sense of possibilities beyond Lowndes County. It had opened up my world.

DAVIES: Well, Catherine Coleman Flowers, thank you so much for speaking with us.

FLOWERS: Thank you. Thank you.

DAVIES: Catherine Coleman Flowers is the recipient of a 2020 MacArthur Fellowship. Her book is "Waste: One Woman's Fight Against America's Dirty Secret." Coming up, John Powers reviews a Romanian documentary about suffering and death among burn victims in a hospital that journalists connect to political and corporate corruption. This is FRESH AIR.

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