LOWNDES COUNTY, AL (WSFA) - Scientists are reigniting health concerns in rural Alabama with new research.
A recently published study found that some Lowndes County residents exposed to raw sewage in their homes are suffering from intestinal parasites, including hookworm.
The impact of improper sewage methods on rural communities in the Black Belt has been highlighted by local and national media outlets for years and this new study has activists once again calling for better wastewater technology for health reasons.
The peer-reviewed study published in the American Journal of Tropical Medicine and Hygiene is titled "Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama."
Lowndes County was chosen as the study site "given previous high hookworm burdens, degree of poverty, and use of open-sewage systems."
The research was carried out over the course of several years by the National School of Tropical Medicine at Baylor College of Medicine in conjunction with Alabama Center for Rural Enterprise (ACRE), a non-profit organization that works to address the root causes of poverty.
In that area, some people have no sewer system at all or they have onsite septic systems that are failing with the soil, causing raw sewage to back up into their businesses, homes and yards when it rains.
"We took fecal, soil, water and blood samples from people from living around raw sewage to determine whether or not there's a possibility of tropical parasites being here because with the intersection of this environmental injustice issue and climate change, it was very likely and the study bared fruit," said Catherine Coleman Flowers with the Alabama Center for Rural Enterprise.
She's listed as one of the authors on the study.
Of those tested, 35 percent were positive for hookworm, thought to be long eradicated from the United States. The parasite enters the body through the skin usually through the soles of bare feet and travels through the body until it attaches itself to the small intestine where it sucks the blood of its host. It causes iron deficiency, anemia, weight loss, tiredness and impaired mental function.
Other parasites were also found by scientists.
Dr. Rojelio Mejia, Assistant Professor of Infectious Diseases and Pediatrics at Baylor, another author, said researchers looked for nine parasites, and ended up finding four people and one in the environment.
"We found that, among 24 households, 42.4% reported exposure to raw sewage within their home, and from 55 stool samples, 19 (34.5%) tested positive for N. americanus, four (7.3%) for Strongyloides stercoralis, and one (1.8%) for Entamoeba histolytica," the study states.
Flowers says evidence of the tropical parasites shows the need for additional studies.
"We need a larger sample to determine whether or not there are even more that we missed. In addition to that, there are other areas throughout the Black Belt that have the same problem," she added.
In Wilcox County, she indicated that more than 50 percent of the septic systems are failing.
"We have found that some of the people who showed evidence of these parasites had paid for technology that doesn't work because it raw sewage runs back into their homes. There's also people who have raw sewage on the ground," Flowers stated. "There hasn't been the type of investment in rural communities to find on site technology that works for residents as well as businesses, especially when it rains."
The high clay content of the soil in the Black Belt doesn't lend itself very well to water absorption. Therefore, on-site septic systems don't work well in it at all.
Conventional systems cost around $3,000, but many residents need engineered systems, which can cost anywhere from $7,000 to $20,000.
"The ground and the soil will only take so much water. This is a water and sanitation issue and when the ground takes this water and you have a septic system, it can back up into the house or business and that's unhealthy. It's coming back through people's bathtubs," Flowers said.
Perman Hardy lives on County Road 9 in Collirene, a community in Lowndes County. She's been there for 30 years and has been forced to replace her septic system four times.
"I just had to get a plumber back at our house to flush it through so it wouldn't come into the house and to try to get the flow working again," she said.
When there's heavy rains, she dreads what happens at her home.
"I've had it come into the house and I've had to replace everything in it, take up all of the carpet. It's a huge problem and a health issue too," she said.
Her family couldn't celebrate Christmas one year because the money needed to go towards repairs to the septic system. Hardy says that might happen again this year because she's been spending money on ongoing issues.
"A lot of people in Lowndes County don't have a sewer system and they're dealing with this problem. I have a sewer system and still have problems. So what is the solution," she asked. "I keep fighting because I have grand kids growing up in this community so I am going to keep on to make things better. You can't give up."
She hopes the parasite study helps shed more light on the problem.
"I really feel like if they could come up with a solution of a sewer system that works and you don't have so much a problem with the sewage backing up, it could get better," Hardy added.
ACRE is working with Engineers Without Borders and other universities to develop better wastewater technology that works with the soil. ACRE has called for a wastewater challenge, asking entities from across the country and around the world to get involved in the effort.
"People find it very, very shocking that in rural communities in the United States this problem has not been addressed. This is the richest country in the world," Flowers said.
"I have traveled all of the world to some of the most resource-limited settings, but I would of never expected to see these conditions in my own country. The duty of decreasing exposures to infections and having clean water, good sanitation falls to all Americans, as we must help out neighbors," added Dr. Mejia.
At the Center for Rural Enterprise, ACRE wants to investigate and find technologies that work and test them in the soil so that residents aren't throwing more money away.
"We want something that people can go to their Home Depot or Lowe's and purchase and get installed in their homes to treat the wastewater. That way, it would probably even eliminate the government being involved or having to seek government funding to do this," Flowers explained.
The Alabama Department of Public Health (ADPH) says it's aware of the study and has reviewed it results. Officials said ADPH was actively involved in the development of the surveillance study design.
The study was approved by the Baylor and ADPH Institutional Review Boards. Survey and testing activities were conducted in 2014.
"The study did not obtain statistical significance. The ADPH has offered assistance for additional testing to this community and remains available to do so per established protocols," a spokeswoman said in a statement from the agency.
ADPH added that there continues to be no evidence of a higher incidence of gastrointestinal disease in Area 7 (which includes Lowndes, Dallas, Hale, Perry, Wilcox, Marengo, Choctaw, and Sumter), including hookworms.
Flowers says the research calls attention to a major water and sanitation issue in impoverished areas.
"Hopefully, out of this study, we can inspire the kind of drive to find on site wastewater technology that works with our current environment and that's sustainable and resilient and can deal with our climate conditions," she said.