It’s the 21st Century—Alabamans Shouldn’t Have to Worry About Hookworms

In Lowndes County, raw sewage is backing up into homes, flooding yards, and giving rise to long-eradicated parasites.

Carlos Rush, 12, stands near the pipes that carry sewage from a relative’s trailer home into the woods, approximately thirty feet from the back door, in Lowndes County, Alabama.

Credit: Bob Miller/Redux

UPDATE: On October 3, 2023, the U.S. Environmental Protection Agency opened a federal civil rights investigation to examine whether the Alabama Department of Environmental Management (ADEM) has discriminated in its distribution of funding for wastewater infrastructure and withheld resources from communities of color that lack adequate sanitation access. This announcement comes in response to a Title VI civil rights complaint filed against ADEM by the Center for Rural Enterprise and Environmental Justice and NRDC, represented by Southern Poverty Law Center.

Raw sewage has been backing up into Ruby Rudolph’s central Alabama home for about a decade. The waste comes up through her bathtub drain, toilet, and sinks. Rudolph assumed her septic tank was full, but after twice calling a service to empty it—and twice having to pay for a half-full tank to be cleaned out—she learned that the situation was much more serious. The septic tank was sinking. “Each time it rains, it sinks a little more,” says Rudolph, noting that the tank has dropped nearly two feet since it was installed. “And I’m not the only one,” she adds. “Lots of people are having problems. It’s a bad thing here.”

Indeed, raw sewage issues have long plagued residents across Lowndes County, a majority-black rural area located about 25 miles southwest of Montgomery. Nearly a third of the county lives in poverty, and the United Nations Special Rapporteur for extreme poverty and human rights has compared the conditions there to those of much less developed nations. Here, where the Civil Rights movement took off some 60 years ago, people are again speaking out, this time about environmental justice―thanks in part to advocate and Lowndes County native Catherine Flowers. “It’s such a personal issue, and for years people were shamed into not talking about it,” Flowers says.

Living with raw sewage is bad enough, but the resulting unsanitary conditions have the community now dealing with an epidemic of parasitic hookworm infections—something that was thought to have disappeared from the U.S. South decades ago. Out of 55 stool samples taken from Lowndes County residents for a November 2017 study, 19 of them, or 34.5 percent, tested positive for the parasite, which burrows into a person’s skin (typically a bare foot) before lodging itself in the intestines, potentially causing diarrhea, fatigue, and anemia as well as developmental problems in children.

Rudolph’s septic system and others are failing because the rich, claylike soil in this part of the country, known as the Black Belt for the color of this geological trait, can’t accommodate them. Working septic tanks retain sludge and allow liquid to escape to a drain field, where the soil acts as a filter. But Alabama soil cannot absorb the liquid, and as a result, septic tanks get too heavy and sink. In the economically depressed and unincorporated parts of Lowndes County, where municipal sewer systems aren’t available, many households can’t afford an expensive on-site tank anyway. Instead they “straight pipe” waste into their yards, ditches, or pastures.

Flowers knows all about Lowndes County’s sewage issue; raw waste used to back up into her childhood home, too. But when she learned that police had been arresting people (legally but unethically, she says) for not having on-site septic systems, she decided to tackle the issue through her work at the Alabama Center for Rural Enterprise (ACRE), an environmental justice organization she founded in 2002.

Flowers and Alabama Senator Doug Jones visit Lowndes County to speak with families and see the problem first-hand on March 26, 2018.

Credit: Walter Farrow for ACRE

The desire to help people is in Flowers’s blood: Her parents were well known in Lowndes County during the height of the Civil Rights movement, and everyone went to them when they had a problem, she remembers. People trusted them and, in turn, have come to trust their daughter. “The people who were having these issues, especially those who had invested in [septic tanks], felt like it was something they did wrong,” but that’s untrue, she says. “They did everything right and it still didn’t work.”

Because the raw sewage issue cuts across a wide variety of concerns, including engineering, health, and social justice, Flowers has enlisted many allies in her years fighting for her community. About four years ago, she reached out to NRDC and connected with Sara Imperiale, an environmental justice attorney who has been helping Flowers develop a potential legal strategy regarding the disproportionate prosecution of poor people of color for not having a working sewage system and the failure to expand municipal systems into those same communities. Imperiale says, “Lowndes County is illustrative of the unique challenges facing rural communities of color around the country, where environmental injustices are compounded by a lack of economic opportunity, inadequate infrastructure, and deep-rooted histories of racism.”

After Imperiale’s recent visit to Montgomery, NRDC agreed to partner with ACRE to conduct a survey that will help uncover the scope of the sewage problem. For optimal results, Flowers will need a high response rate and access to people’s property. She plans to train and hire Lowndes County residents to go door-to-door conducting the survey.

Flowers also connected with Erika Weinthal, a professor of environmental policy at Duke University, to help explore possible solutions to the malfunctioning septic systems and to elevate the issue to get political attention and mobilize people and resources. Meanwhile, at Columbia University, Kartik Chandran, a professor of environmental engineering and a 2015 MacArthur Fellow, is looking at the technological side of the county’s sewage woes. He says the area needs self-sufficient, decentralized systems that can run on their own energy and are compatible with Black Belt soil. “We need to make sure that they’re doing more than just holding the waste,” he says. “We need to make sure that they’re also treating the waste.”

Lowndes County’s circumstances present an opportunity for innovation in the way communities handle waste—something that will become increasingly important as climate change fuels more extreme weather, including increased precipitation, and causes sea levels to rise. Across the country, heavy downpours are already triggering massive municipal sewage overflows, and oversaturated soil will cause septic systems outside of the Black Belt to start failing as well. What’s more, as the climate gets warmer and wetter, more tropical parasites may start creeping their way into vulnerable communities. Flowers says her hometown county “could be a bellwether for the rest of the nation.”

Whatever the solution will be, Flowers is determined that it will take into account all the needs of those living in Lowndes County. “Sustainability doesn’t mean forcing people to buy technology they can’t afford that’s going to break down over and over and over again,” she says.

Raw sewage is carried through a PVC pipe to be dumped only a few yards away from a nearby home in Lowndes County, Alabama on July 10, 2017.

Credit: Bob Miller/Redux

Ruby Rudolph knows that all too well. “You do what you can to try to make your septic system work—and that’s hard,” she says. “Especially for me, because I’m by myself.” When the sewage backs up into Rudolph’s home, her brother comes over to help get it flowing again, but her three grown children have left these problems behind. “We have the land, but they are afraid to move back because they don’t want to be bothered with this—and I understand that. But at my age,” says the 69-year-old, “I don’t need to move anywhere.”

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