Lowndes County, Alabama, which sits between Selma and Montgomery, was once called Bloody Lowndes for its central role in the struggle for civil rights. Today people in Lowndes are fighting for another basic right: access to sewage treatment. By some estimates more than half the impoverished, rural residents have raw sewage running into their yards and even their houses. Catherine Coleman Flowers, a White House adviser and MacArthur Genius Grant recipient, is turning a spotlight on this long-standing public health failure. She says it's a problem, found in other parts of Alabama and all over the country, which even the millions of dollars in new infrastructure spending are unlikely to fix. Flowers brought us home to Lowndes County to see what she calls America's dirty secret. We warn you, it can be hard to watch.
Lowndes County is in one of the most neglected corners of the country. The poverty rate in this majority-Black county is double the national average. Cell phone service is a luxury and so, incredibly, is sewage treatment. Like most states, Alabama requires sanitary sewage disposal. But outside a handful of small towns here, sewage treatment is not provided and for many people, private systems, usually a septic tank, are unaffordable.
It's a public health crisis, one community advocate Catherine Coleman Flowers has been raising hell about for 20 years.
Catherine Coleman Flowers: We don't expect this to be a U.S. problem.
Bill Whitaker: Is it just the woods behind your house?
Catherine Coleman Flowers: Yes, sir.
She took us to Emma Scott's home deep in the woods, where even light rain can create pools of fetid waste. When we arrived, the smell of raw sewage hung heavy in the air.
Bill Whitaker: This is the runoff from your house?
Emma Scott: Yes, sir.
Bill Whitaker: And it just empties right into this little drainage area in your backyard?
Emma Scott: Yes, sir.
Catherine Coleman Flowers: this is straight piping. And when one flushes the toilet, and it goes to a pipe. Instead of going into a sewage treatment plant, or an on-site septic system for the sewage to be treated. It just ends up on top of the ground.
Bill Whitaker: I have seen things like this in Haiti. And parts of Southeast Asia. I have never seen anything like this in the United States.
Catherine Coleman Flowers: That's why we call it "America's dirty secret."
And it's not something most people here care to talk about, especially with outsiders. A little embarrassed and a lot nervous, Scott explained to us why she has no proper waste disposal for her mobile home.
Bill Whitaker: How many hours a week do you work at the chicken plant?
Emma Scott: I work-- eight or nine hours, work six days a week.
Bill Whitaker: So you work six days a week?
Emma Scott: Six days.
Bill Whitaker: And you can't afford to put in a septic tank?
Emma Scott: No, sir.
Scott just told us she was laid off after ten years at the chicken processing plant, due to automation. It's expensive to be poor in Lowndes - septic tank systems can cost as much as $25,000. That's one reason straight piping is so common around here, but the state of Alabama considers this a crime.
Bill Whitaker: The state says it's your responsibility to have a sewage system.
Emma Scott: I can't afford any. With my income, I can't afford no septic tank.
Bill Whitaker: So, what, you have no choice but to break the law?
Emma Scott: Don't have no choice but to break the law. And I'm sorry, but I ain't got no choice.
Catherine Coleman Flowers: If this was a community of more affluent people, this would have made headlines 20 years ago when I first started doing the work. The reason that the situation has continued for so long is because of the type of benign neglect that has happened to Black communities, poor communities and rural communities across the United States.
Bill Whitaker: What I have witnessed this week-- is not benign. It's-- it's-- it's horrible.
Catherine Coleman Flowers: It is horrible. But the-- but the neglect is obvious, that somewhere along the way that there's been a serious disconnect in terms of who should have access to sanitation and who shouldn't.
Bill Whitaker: Why did you choose to focus on this problem?
Catherine Coleman Flowers: Because it's so basic. We all go to the bathroom, so we all should have access to sanitation. I've had people that tell me, "Oh, it's-- it's not sexy. The media's not gonna be interested in that."
Bill Whitaker: It's difficult. It's difficult to discuss, it's difficult for us to cover.
Catherine Coleman Flowers: But somebody has to do it.
Flowers knows about this problem firsthand. The 63-year-old took us to the site of her childhood home.
Catherine Coleman Flowers: When we first moved to Lowndes County, we didn't have indoor plumbing, we had an outhouse.
She says this fight is about basic human rights - a long tradition in Lowndes County. The march from Selma to Montgomery passed through here; Flowers' parents registered Black voters; their home was a meeting place for civil rights activists.
Bill Whitaker: Did they encourage you to speak up when you saw something wrong?
Catherine Coleman Flowers: You know, when you grow up in a situation where your parents are constantly speaking up, you don't learn to be quiet (LAUGH) so.
To make sure the voices of the marginalized are heard, Flowers founded the Center for Rural Enterprise and Environmental Justice.She has testified before Congress…
Catherine Coleman Flowers testimony before Congress: Rural communities should no longer be left behind…
...brought in politicians, anyone she thinks can help. The state doesn't know exactly how many people have this problem. So, Flowers went door to door in Lowndes County to try to find out.
Catherine Coleman Flowers: Of the 3,000 or so homes that we surveyed, at least 2/3rds of them had failing systems or no systems at all. And the difference between the failing systems and the straight pipe systems is-- are that the straight pipe systems take it away from the home. When the systems fail, it brings it back into the home.
Septic systems often fail because of the same rich soil that made this region perfect for growing cotton.
Catherine Coleman Flowers: This is clay-like,
Bill Whitaker: Look at that. So it's hard for water to seep through?
Catherine Coleman Flowers: Yes I mean if you look at it it looks like Play-Doh.
The dense soil can't absorb liquids drained from septic tanks, causing waste to pool in yards and back up into homes.
Charlie Mae and Willie Holcomb say raw sewage has flooded their property for the last 30 years.
Charlie Mae Holcomb: All these years we've been here, my kids have never-- name a year, been able to go out there and play in the yard. And even when it wasn't flooded, let me tell you something. The ground stays so soft, you could walk out there and like you sinkin'.
Bill Whitaker: It's mushy?
Charlie Mae Holcomb: Yes It's mud and waste.
The retired couple live on a fixed income in Hayneville – the county seat. Incredibly, they pay monthly sewage fees to have waste from their septic tank empty into this municipal lagoon – roughly eight football fields of sewage.
Bill Whitaker: So, where's the lagoon?
Willie James Holcomb: The lagoon's across the road over there.
Charlie Mae Holcomb: Right behind those houses right there.
Charlie Mae Holcomb: Everybody smells it. I got central air. You can have the windows down and the central air on. And the smell will wake you up. Did you hear me?
Bill Whitaker: The smell will wake you up.
Charlie Mae Holcomb: Yes.
When it rains, they tell us, sewage frequently backs up into their house. Catherine Flowers asked a team of doctors to check out the unsanitary conditions.
Charlie Mae Holcomb: They tested my husband and my grandson for some kind of parasite. Both of them came out positive with it. Man, it's like a horror movie.
Bill Whitaker: It's like a horror movie--
Charlie Mae Holcomb: A horror movie.
Dr. Rojelio Mejia: The conditions were very similar to very poor countries that I travel to in-- in-- in Latin America and even Africa.
Dr. Rojelio Mejia is a tropical disease specialist at Baylor College of Medicine who's studied infectious diseases in 34 countries. He and his team collected stool and soil samples from the Holcombs and other residents. Using a PCR test – like those used to detect COVID-19 - they found small amounts of DNA from hookworms, a parasite that can cause stomach problems, anemia and developmental delays in children.
Dr. Rojelio Mejia: So our study in Alabama was a small study, about 55 patients. And the results were we found over 30% of people in at-risk situations with poor sanitation had hookworm
Bill Whitaker: Were you surprised by these findings?
Dr. Rojelio Mejia: We were very shocked and we actually had to run the sample several times to prove to ourselves that we found these numbers.
Dr. Mejia's 2017 findings are controversial. Hookworm was long thought eradicated in the U.S. The Alabama Department of Public Health couldn't confirm Mejia's results. The CDC and the University of Alabama are now following up - testing hundreds of children in the state for hookworm.
Bill Whitaker: Have you gone to the county to ask for help? Have you gone to the state--
Charlie Mae Holcomb: Sir, I have been to the county. I been to the board of education. I wrote Washington D.C.
Bill Whitaker: Why do you think nothing's been done?
Charlie Mae Holcomb: Because we Black. That ain't no secret. Do any of y'all really think if this had've been a White neighborhood, all of this would've went on all these years with your children around here? No. Oh, Jesus, have mercy. Mm. I get upset, even just talking. It's-- it's a mess.
We tried to find who in Alabama is responsible for fixing this public health mess. Lowndes County officials told us they don't have the money. The governor and the head of the state department of public health declined to speak with us. But someone else at the department did. Sherry Bradley's office regulates septic systems in rural areas among other things. She said it's not the department's job to build infrastructure.
Bill Whitaker: Who is responsible?
Sherry Bradley: I can tell you who's not responsible, and that's the Department of Public Health. We're not responsible.
But, the U.S. Department of Justice has some questions. Last month, just days after we spoke with Bradley, the DOJ launched an unprecedented civil rights investigation into whether the Alabama Department of Public Health is discriminating against Black residents in Lowndes, denying them access to proper sanitation.
The department says it's cooperating.
We couldn't find a single state program devoted to remedying the sewage problem in rural areas. This year, Sherry Bradley started a pilot project on her own, seeking outside grants and donations for septic tank systems that can work in the soil here. The governor and the state health department coughed up about $450,000.
Bill Whitaker: So why are you doing this?
Sherry Bradley: Because nobody else stepped forward, that's the reason I'm doin' it.
Bill Whitaker: This is not technically a state-funded project?
Sherry Bradley: It's not even-- it's not even a state project, it's state-supported. I have-- (LAUGH) I have begged money from a whole lotta people.
Bill Whitaker: This is a big problem, Why is the state not taking the reins on this to solve a statewide problem?
Sherry Bradley: I don't know.
Bill Whitaker: Would you like the state to step in and solve this problem--
Sherry Bradley: I would like to see Lowndes County, the people there, the majority, say, "I'm not gonna put sewage on the ground. I rather put a outhouse out there."
Bill Whitaker: So these people should put up outhouses?
Sherry Bradley: Yeah, they can, and it's approved.
Bill Whitaker: You do know this is 2021?
Sherry Bradley: It's 2021, but do you want sewage on the ground or would you rather dispose of it properly?Until I can get to you with a system there's nothing wrong with a outhouse.
Bill Whitaker: Could you handle everybody in the state who needs help?
Sherry Bradley: No. No, I can't do that, and not-- and not work my job.
Bill Whitaker: What do you say to people who say, "Just clean it up. Why do you live like this"?
Emma Scott: We just try. Did the best you could. That's all I can tell them. I do the best I could.
Bill Whitaker: You feel forgotten?
Emma Scott: Yes sir.
Produced by Nichole Marks and David M. Levine. Broadcast associate, Emilio Almonte. Edited by Matthew Lev.