When Loving Your Neighbor Means Fighting Hookworm in Alabama

In the Black Belt—once cleared for cotton plantations—rural black communities suffer the consequences of poor land stewardship.
When Loving Your Neighbor Means Fighting Hookworm in Alabama
Image: Lidor Akavia / EyeEm / Getty

In 2013, the septic system at Jesus Christ Church of God the Bibleway failed and sewage began leaking into a neighbor’s yard—not uncommon for rural Alabama, an area plagued by sewage problems and a related upsurge in hookworm cases. A warrant was issued for the arrest of the church’s pastor, Bishop Ira McCloud.

The public health department accused McCloud of failing to fix the problem after multiple warnings. But McCloud had actually been trying to resolve the problem for months by connecting the church to a city sewer line; it would be cheaper and easier than buying a new septic system. The city, however, wasn’t making it easy.

When McCloud heard there was a warrant for his arrest, he immediately turned himself in. “I walked into the station and didn’t know what to do, so I put my hands up,” he recalled. “I had tears in my eyes when they took my picture.”

McCloud, fortunately, didn’t have to spend a night in jail. The sheriff’s department told him to go home; they weren’t in agreement with the state’s orders to make the arrest. With the problem unsolved, the city later threatened to shut off the church’s electricity and take the property away.

Leaking sewage systems—and the subsequent legal problems they cause—aren’t unique to Alabama and can be understood with a deeper “reading of the landscape,” an exercise recommended by ecologist Kristen Page, a faculty member at Wheaton College. She references Job 12: “… speak to the earth, and it will teach you.” It can help us understand our role as a part of creation and our connection and responsibility to our neighbors, she explained.

“Christ will return to reconcile all things,” Page said. “But before that, he left us as stewards of creation. To love creation and care for it is an extension of living like him.”

Page, who is particularly interested in how diseases can spread when humans alter landscapes, first encountered the story of rural Alabama’s sewage crisis when she met Catherine Flowers, rural development manager for the Equal Justice Initiative, who shared her story at a global health and environment symposium at Wheaton College in 2018.

At the symposium, Flowers recalled visiting a young pregnant woman in Lowndes County, Alabama—a county of about 10,000 people some 30 miles southwest of the state’s capital, Montgomery.

With no major city or municipal sewer line nearby, their small, single-wide mobile home was unconnected to a city wastewater system. Instead, the woman managed by piping the family’s waste straight into her backyard.

A large pit of raw sewage sat just steps away from their backdoor, swarms of mosquitoes silently stalking across the raw waste. In the warm and sticky subtropical atmosphere of Alabama, the stench was impossible to ignore—but Flowers wasn’t shocked; she had seen this before. Cesspools of waste sat bubbling in the yards of many homes in Lowndes County, where she grew up.

Standing nearby in a summer dress, Flowers left the home with several rising welts where the mosquitoes had fed. Days later, her body broke out in a rash that would last for months. Tests for infections and other diseases came back negative, and it appeared as though she was healthy. The doctors were stumped.

Then Flowers recalled how mosquitoes had crawled across the wastewater—“I asked my doctor if I could have something that American doctors don’t typically test for and she told me it was possible,” Flowers said.

Eventually, the rash went away. Several years after her illness dissipated, Flowers came across a New York Times opinion piece by Peter Hotez, a medical researcher who described how poverty in the US was giving rise to diseases previously unheard of in America.

A lightbulb went off. Flowers said a quick prayer and then shot Hotez an email.

He quickly responded with interest and sent a team of researchers from Baylor College of Medicine to conduct an official study. Their findings would shock the scientific world.

Hookworm, a disease of the world’s poorest countries, was found in multiple residents in Lowndes County. The microscopic worm is notorious for persisting in regions with poor sanitation and open defecation. Individuals are primarily infected when their bare feet or skin come in contact with contaminated feces and the worm latches on, burrowing into the body.

With the advent of a treatment, hygiene education, and sewage systems, scientists had assumed that hookworm no longer existed in the US. The discovery sparked international attention: How could a disease of developing countries exist in America?

In the 1800s, Americans flocked to the Black Belt region of the US for its fertile soil. Slaves labored to sow fields and build plantations for Alabama’s thriving cotton industry. But with poor farming practices, the land failed and the region’s cotton boom didn’t last long.

“Overuse of resources creates situations where diseases can emerge,” said Page, who offered to help translate the Hotez study and its findings into non-scientific terms for the community, policymakers, and others to understand the environmental health crisis and its causes.

For Page, this human misuse of the environment is partially to blame for today’s problems. And unfortunately, the legacy of that misused land impacts mostly black communities in the rural Black Belt today. “Caring about our environment translates to loving our neighbors,” Page said. “The way we use land impacts our neighbor and if [we] mistreat the soil, [we] indirectly mistreat and harm people.

“For example, hookworm responds to deforestation—eroded soil is a good habitat for the worms—and historically, this region was a forest, but we cut it down to plant large cotton fields,” said Page.

Loss of forests makes the land prone to flooding—the ideal home for hookworms, which thrive in moist landscapes with warm climates. The landscape alteration is still having ramifications years later. Today, heavy rains and flooding are overwhelming the Black Belt’s septic tanks and causing them to malfunction.

Small unincorporated communities have no access to city-maintained sewage systems because they are too far away from sewer lines. To make do, some devise their own sewer lines with PVC piping. Manmade ditches hold the waste temporarily, but rain causes the pits to overflow, spreading raw sewage across yards and even up to people’s front doors.

Residents with more means invest in septic systems—underground tanks that contain and treat sewage—but they often fail, too. The region’s flood-prone soil often pushes sewage up piping and back into individual’s toilets, sinks, and bathtubs.

“People think it’s personal failing; they didn’t know that others are having the same problems,” Flowers said. “Who discusses, ‘Oh, my toilet overflowed’?”

Today, Flowers visits homes in Lowndes County to observe and document the extent of the sewage crisis.

“It’s my faith that pushes me onwards,” said Flowers who grew up under a Baptist mother and a Methodist father. “Even though there’s a possibility of getting bitten, getting sick again, at the end of the day, I think this is what God wants from me.”

That is, to bring Lowndes County’s darkness—its secret sewage problem—to light and help bring change.

Since hookworm’s discovery and the international media attention, Flowers and her organization, the Alabama Center for Rural Enterprise, have been approached by multiple partners to help find a solution. Ideas include waterless toilets or the development of affordable septic systems that can operate in the Black Belt’s nonporous soil.

And even though the local government has not stepped in to offer help, Flowers said, “God is moving,” and America’s dirty secret is being laid bare.

Flowers approached McCloud after hearing about his warrant on the news. She had seen dozens of situations like McCloud’s, where sanitation problems are twisted into a way to promote inequality and injustice. And it’s not just a problem in Alabama, she said, it’s happening across the US in other small, rural communities.

The bishop was in a state of despair. “Pastors live off of their reputation,” he said. “One of the first things people do is Google you and now it was online that I was arrested. It hurt.”

About a year into his ordeal, McCloud remembers walking to the back of his church where the leak was and crying out to God. “I started crying and praying in the woods. I said, ‘How long will I have to go through this? Lord, I want to fix this but they have cut off my hands.’”

That’s when Flowers showed up. She was convinced the state was using the leak as an excuse to take his property. Flowers connected McCloud to two lawyers who would take on the case pro bono.

They won and the bishop’s name was cleared. Today, his church is connected to the city sewer line.

“The Lord sent me Catherine Flowers and the lawyers,” McCloud said. “They were my angels.”

Nadia Whitehead is a freelance journalist and science writer. Her work has appeared in Science, The Washington Post and NPR. Find her on Twitter @NadiaMacias.

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