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Reporter describes how she uncovered an infectious disease nightmare Date: 01/14/20

By Bara Vaida

Hookworm is a parasite transmitted to people through the feces of infected people. Symptoms can include itching, diarrhea, anemia and brain development problems in children. It infects as many as 740 million people a year, mostly in developing countries with poor sanitation and extreme poverty.

Before indoor plumbing, hookworm also was prevalent in the southern United States. Successful efforts funded by John D. Rockefeller in the early 1900s led many to believe the parasite had been eliminated from the country by the 1980s. But a 2017 study published in the journal American Society of Tropical Medicine and Hygiene cast doubt on that perception. Researchers from Baylor College of Medicine’s National School of Tropical Medicine found evidence that people living in Lowndes County, Ala. — one of the poorest counties in the U.S. — were infected by hookworm. The infections appeared to be caused by inadequate sewage and drainage systems that residents were too poor to fix.

In 2018, Vice News reporter Arielle Duhaime-Ross decided to follow up on the study and learn whether Alabama’s department of health had done anything about it. Shockingly, the answer was no.

Duhaime-Ross shined a light on the lack of state action in her story, “Scientists think Alabama’s sewage problem has caused a tropical parasite. The state has done little about it,” which won the National Association of Science Writers (NASM)'s 2019 Science in Society Journalism Award.

She highlighted the ongoing work of Baylor College’s lead researcher on the study, Rojelio Mejia, to demonstrate the negative public health consequences of doing nothing about the infestation. The story offered “an unforgettable view on an entirely fixable yet devastating crisis of public health and environmental justice,” said NASM in its announcement.

Here, Duhaime-Ross talks more about how she reported on this groundbreaking work.

Q: How did you find this story?

A: From a colleague at Vice News Tonight, who had read about the work done by Rojelio Mejia at Baylor College. He reached out to Rojelio and we filmed a segment about his work for the HBO show. I also ended up writing a piece recounting the time I spent in the field during Rojelio’s follow-up study. The article also covered the state’s response to Rojelio’s initial study.

Q: What did you see when you went into the field with Rojelio?

A: In some rural areas [in Lowndes County] there aren’t sewers taking people’s waste from their homes and away. They just have PVC pipes from their mobile homes that lead to the backyard, so there are pools of human waste there. People come into contact with that, and then combined with the heat, it ends up being a perfect storm for the proliferation of hookworm.

Q: Had you written a lot about infectious disease before this?

A: Yes. I had written a few pieces about Ebola, for instance. But it was one of my first where I was reporting out in the field. I was there as the samples were being collected, and I saw [the researchers] doing it and working with the community and explaining why they were taking samples from people’s yards.

Q: What were some of your obstacles and how did you overcome them?

A: Maybe 40 percent of the reporting was done in the field, and 60 percent outside of the field. Being in the field helped me get a sense of place. But a lot of the fact-finding was done outside of that. Back in the office, it was hard to get in touch with the story subjects and connect with the people I had met [when I was out in the field with the researchers]. They live in a remote area and it can be hard to connect with them. Then, getting a sense of [what happened] to hookworm eradication [efforts] in the early 1900s was difficult as well. I had to do a lot of searching through old documents. The [Alabama] department of health wasn’t happy with me and it took them a while to respond to me. That isn’t the first time that has happened to me, so you just carry on and get others to tell me things So then I could call them and say, ‘I was told this is it true, so is it?’ then I got them to answer my questions.

Q: Any other obstacles?

A: I couldn’t truly verify [information about] Catherine Flowers, who had been trying to get the word out about [hookworm] for a long time. I wanted to have her story in the [article] because she cares [so much] about her community. She worked with the [Baylor] scientists and was the liaison to her community. Her own mother had a terrible [public health] experience. Catherine said her mother was sterilized without her consent in the 1960s — after she gave birth to [Catherine] — and that was hard to verify. I detailed my efforts to verify the information because I thought it was an important backstory. I tried to reach out to the John A. Andrew Memorial Hospital in Tuskegee, where she said her mom had been sterilized, but they closed their doors in 1987. And the few records that were kept after the hospital closed were destroyed in a renovation in 2003. That part was hard to take. But I decided to include it anyway because that story shaped Catherine and who she is today. She believed it happened, and she is still working with these scientists despite having a family history of being “burned” by scientists and the medical field. That seemed relevant to me.

Q: Go back to the obstacle you mentioned earlier. That the Alabama department of health stopped responding to your calls. I think all reporters have experienced some version of this, so what did you do?

A: One of the ways to get them talking again is going around them. For example, [as I working on this], Fox News published a piece that said the [department of health] had plans to launch a new wastewater project [for Lowndes County].  I asked the department of health about it and they didn’t want to tell me about anything further about the project. The [Fox] article said the health department got verbal approval [for the project] from the Alabama Department of Agriculture. So, I got in touch with the department. What they told me is that the agency hadn’t gotten a completed application from [the department of health] and they hadn’t approved any funding. So that is one way to verify things. You go to the other parties and double-check.

Q: How long did it take you to report this story?

A: It took weeks. The field reporting was three to four days, but, I was also a correspondent for a TV show, so I wrote the piece on the side, while also working for HBO’s Vice News Tonight.

Q: About the video component to this story, how did you do that along with the print version of this story?

A: People can find the TV segment on YouTube. The TV version of the story includes some of the reporting in the written piece, but the [print] article goes beyond the TV segment. The article has more extensive reporting and storytelling, from my time with Catherine Flowers, for instance. When it comes to the video part, I had two producers to help me out in the field. They did a substantial amount of work for the TV segment, so it wasn’t just me working on it.

Q: What were some of your favorite resources for this story?

A: I love looking at old studies. I get a kick out of trying to tell the story through the history of science. I am happiest in those moments. I had this large folder of old parasite studies from the 1940s, ‘50s and ‘60s.

Q: Where did you find those old documents?

A: Through PubMed and other sites. You can access various sites with peer-reviewed studies. It feels like a huge victory when you find something.

Q: Any other resources you’d recommend to other journalists?

A: I spoke to a number of researchers. More than those included in the story because I wanted their help [in understanding] how good the DNA testing was to identify the hookworm diagnosis. [Part of the story was the state’s questioning of the validity of the Baylor study because of the DNA tools they use.] The Alabama Department of Health tried to use that as a way to criticize [the research] and say it wasn’t valid. So, I spoke to seven or eight well-regarded researchers and everyone one of them said [the DNA test] was the best science that we have.

Q: What is happening today? Has there been any progress?

A: I will be keeping an eye on this. The University of Alabama [at Birmingham] is doing a study now. They have gotten $1.5 million in funding from the Centers for Disease Control and Prevention to look into infections caused by hookworm. So, it looks like there is some movement there. They are studying 900 children in [three] Alabama counties. I don’t think things have gotten much better in terms of sanitation in those rural areas, however.

Q: What advice do you have any journalists wishing to do a story like this in their community?

A: My biggest advice is that you cannot write a story without talking to folks who are impacted by the disease. It is hard to do that today because newsrooms don’t always have the budget, but if you can go to these areas and see that they are human and not a data point, that’s always better.