Catherine Flowers examines an overflowing septic tank in Lowndes County, Ala.
Photo: Catherine Flowers

Paul pulls the cigarette again.

It dangles precipitously from his bright-red lips, almost defying gravity, the orange glow from its tip dancing a jig as he laughs at the podcast playing in my car about Donald Trump’s “shithole country” remarks.

“You wanna see a shithole? I’m finna show you a shithole,” he bellows as the smoke wafts from his mouth. “That man needs to come down here. He’ll see that he’s the president of a shithole! But it seems like everybody forgot about Lowndes County ... even God.”

We are standing at a gas station near the intersection of Highway 80 and Starks Road in Lowndesboro, Ala. Paul points north, toward the Montgomery County line. “When you go down the road a little bit, you’ll start to see big ol’ houses,” he tells me. “When you cross the county line, it’s almost like you’re in another America. It even smells different. ... Oh, this smoke doesn’t bother you, do it?” he asks.

Paul does not live across the county line. He is one of the roughly 10,000 residents of Lowndes County, one of the poorest counties in all of America. Here, the manicured lawns and sprawling brick homes are nonexistent. In Lowndes County, poverty is a natural resource. The ground is infected with death. And Paul is right: You can smell it.

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Over the last three months, I have spent countless hours in Paul’s neck of the woods. I initially came to Lowndes County after reading a story about United Nations officials who toured this region of Alabama and concluded that it has the worst poverty in the developed world. The Root thought it was important to cover the health crisis in the area after The Guardian shed light on the prevalence of a parasite usually found in developing nations.

“You need to hear my story,” Paul told me the first day we met. He requested that his last name not be printed, but he has served as my de facto tour guide during each visit.

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But after I met Paul and spent countless hours in his stomping grounds, it became increasingly apparent that Paul’s story has very little to do with a microscopic worm. Paul’s story is the story of Lowndes County, and the tale of Lowndes County is a fascinating, ongoing tragedy that stretches farther and wider than I could have ever imagined.


Lowndes County sits southwest of Alabama’s capital city of Montgomery. There is no clear consensus on why this area of the state is called the “Alabama Black Belt.” Some say it is because of the dark fertile soil that holds water and nutrients so well, it beckoned South Carolina slave owners to the area in the 1800s to expand their cotton empires into Alabama.

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Other say the area gets its name from the high percentage of black residents in the region. Seventy-three percent of the county’s population is African American, a vestige of the former slaves who stayed in the area after the Civil War and became sharecroppers.

Whatever the case may be, this section of the state has a history as dark as its name, and Lowndes County has a legacy of death as rich as its coffee-colored soil, prompting another, more apt description of this place:

“Bloody Lowndes County.”

In 1900, a mob murdered a black man in the small Lowndes County township of Letohatchee, Ala. When Jim Cross, a black man, objected, the mob quieted him by lynching Cross and his entire family.

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People visit the Viola Liuzzo memorial on the side of U.S. Highway 80 on March 7, 2015, in Lowndes County, Ala.
Photo: Justin Sullivan (Getty Images)

In 1917, two more black men were lynched for talking back to a white farmer. Viola Liuzzo, a white woman, was murdered by Ku Klux Klansmen on Highway 80 as she drove protesters during the 1965 Selma-to-Montgomery “Bloody Sunday” march.

Later that same year, after the passage of the Voting Rights Act, a civil rights worker named Stokely Carmichael heard that there were zero registered voters in the county. He became so fed up with the white landowners who terrorized black citizens in the county, he organized the Lowndes County Freedom Organization. Two like-minded California activists asked Carmichael if they could use the LCFO’s mascot to start a similar organization. The two men, Bobby Seale and Huey P. Newton, named their group in Oakland, Calif., after the LCFO symbol of freedom, calling it the Black Panther Party.

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As the population of this nation increases in size, Lowndes County is one of the few places in America experiencing a stark population decline. In the early 1900s, more than 22,000 people lived in Lowndes County. The 2000 census recorded 11,289 residents. By July 2017, the population was barely above 10,000.

On most visits, I usually rendezvous with Paul at a Montgomery Walmart where he makes the 72-mile round-trip every day to earn $11.26 an hour. Although his salary might seem meager, it is higher than the county’s per capita income of $18,434.

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There are very few jobs in Lowndes County. Nearly a third (31.7 percent) of the people who reside within its borders live in poverty, two-and-a-half times the national average. The infant mortality rate is twice the national average. Lowndes County’s population has likely fallen to four figures because of poverty, lack of opportunity and a long history of white supremacy

And also, because people keep dying.


Paul straight-pipes.

He lives in a double-wide mobile home on a parcel of land he shares with three other mobile homes, all owned by his family. In 1993 he took out a loan for $65,354 for the home at 9.6 percent interest. He pays $560 per month and splits another $180 per month for the land.

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Unlike what is the case for many of the homes in Lowndes County, Paul’s leased land has a septic tank that disposes of the sewage from his home. But as with too many residents of the Black Belt, his septic tank began to overflow a few years after he connected the two other homes on his property to the same septic tank.

County laws do not allow more than one tank on a piece of property unless it is surveyed and cut into smaller parcels. Because he does not own the land, this was not an option for Paul. Even if the county allowed him to install a second and third septic tank, it would have cost Paul his yearly take-home pay to install each separate tank.

“I don’t remember when it started backing up,” Paul explains, trying to recall when he noticed sewage backing up into his home. “Probably ... like seven or eight years ago, I said ‘Fuck it,’ and dug me one [for] myself.”

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What Paul is referring to is that he and his brother spent one weekend digging a hole near the back of their property, essentially fashioning a makeshift septic tank for themselves. They ran pipes, above the ground, from their homes to the pit, allowing the sewage from their homes to fill the hole.

This system of dealing with sewage is common in Lowndes County, and commonly called “straight-piping.” Many of the residents don’t bother to dig pits for the sewage, simply rigging pipes to transport their sewage a few yards from their homes.

The soil holds so much water that regulation, licensed septic tanks often malfunction. Even sewage systems run by the municipalities in the county suffer from similar problems. The poverty, the high cost of septic tank installation and the lack of sewage maintenance mean that wastewater and sewage often leak into the soil. The ground then becomes infected with parasites and disease, leading to environmental contamination that spreads to the people who live in the county.

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No one can say for sure how many people have been sickened by the sewage in the soil, likely because the problem stretches back for years and partly because there is no hospital in the entire county.

But the story of how the world discovered that sickness springs from the Black Belt soil is a tale of the unlikely convergence of all the problems in this region, including poverty, the lack of resources, the sewage problem and even the history of lynching in Lowndes County.


White supremacy is a disease.

Over the last few days, media outlets everywhere have written about the recently opened National Memorial for Peace and Justice in Montgomery, Ala. The “lynching memorial”—as it is called—is a project of Bryan Stevenson and the Equal Justice Initiative, a nonprofit “committed to ending mass incarceration and excessive punishment in the United States, to challenging racial and economic injustice, and to protecting basic human rights for the most vulnerable people in American society.”

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Aside from fighting to end the inequalities embedded in the justice system, the EJI fights to expose the problems that plague places like Lowndes County that have been plagued by economic and systemic injustice for more than a century. One of the widespread injustices that EJI was forced to address was the criminalization of Lowndes County’s poor residents as it related to the sewage problem.

For years, authorities in Lowndes County imposed a draconian practice of arresting the mostly black citizens who skirted the county health regulations by straight-piping or creating their own solutions for the sewage problem. The county’s solution was to lock up the poor people who couldn’t afford to pay for sewage and fine them, causing an infinite circle of criminality.

Catherine Coleman-Flowers, a native of Lowndes County, works for the EJI as a rural development manager, advocating for poor, rural communities in Alabama’s Black Belt. She traveled around the area fighting this phenomenon and trying to help residents find answers to this problem.

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In 2009, while working with the organization she founded, the Alabama Center for Rural Enterprise, Flowers was inspecting a site where sewage seeped into the ground. That day started a series of events that would eventually make Flowers the involuntary patient zero who exposed one of the biggest health scandals in the civilized world.

It started with a rash.

“It wouldn’t go away, I went to see a doctor, and nothing we tried would make it go away,” she told The Root. ”So I asked my doctor, could it possibly be something here that American doctors don’t test for?”

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After taking samples, Flowers’ physician was astounded to discover that she had contracted something that almost every doctor in America would never have thought they would encounter.

Hookworms.

Necator americanus is the scientific name of a parasite that attaches itself to a human host by entering the body, usually through the feet. It travels to the intestines and keeps itself alive by sucking the blood of the host. It can cause weight loss, nausea, anemia and mental illness. In many cases, hookworms can prove fatal by literally starving the victim to death.

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“You can’t blame the doctors,” said Karen Reynolds, a physician at the University of Alabama, Birmingham’s Cooper Green Mercy Hospital. After serving as an Air Force physician, Reynolds, a black doctor, has spent much of her life in the South treating people in poor and rural communities. “Most medical schools don’t even teach doctors about hookworms because it doesn’t really exist in America anymore.”

It is relatively easy to treat, but until recently, most medical experts thought the parasite had been eliminated from America sometime between the 1950s and 1980s. It still can be found in poor, tropical climates in the Caribbean and South America ... and in Lowndes County.

In the Black Belt, it is not just walking outside that is dangerous. It is possible to contract the parasite from walking with bare ankles or from walking barefoot on a floor where another person’s shoes have come in contact with contaminated soil.

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Flowers contacted researchers at Baylor University who teamed up with the Alabama Center for Rural Enterprise to study the prevalence of hookworms and other tropical-borne illnesses in Lowndes County.

After collecting stool samples from across the county, the scientists found that more than a third of the people (34.5 percent) tested positive for hookworms. Even more troubling, 44 percent of the people surveyed had been exposed to raw sewage. But hookworms were not the only problem. Researchers found a number of other tropical parasites crawling in the rich Black Belt soil.

The report garnered national attention and interested researchers around the world, including the Centers for Disease Control and Prevention and the United Nations. So how did they fix the problem?

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This is Lowndes County. The place even God forgot.

“Infrastructure is the answer,” Flowers told The Root. She is working with activists, nonprofits and politicians to solve the rampant poverty and illness in Lowndes County. “We are working on trying to find sustainable, affordable, long-term solutions. It’s just like truth and reconciliation, we first have to acknowledge we have a problem.”

Flowers believes policy changes at the federal and state level are needed to address the problem. She points to the “rural lexicon” of state and federal laws that prevent poor, rural communities from receiving funding and technology. Sen. Cory Booker (D-N.J.) and Sen. Bernie Sanders (I-Vt.) are scheduled to meet with her to address some of the surrounding issues.

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I give Paul a ride to the auto mechanic who is fixing the fuel pump on his truck. The truck has been repaired for more than a week, but Paul had to wait until payday to pay for his vehicle. I ask him if he worries about catching hookworm.

“Not really,” he explains. “If I think I got it, I’ll just go by the health department and get the pill,” he continues, referring to albendazole, the three-day treatment given to people who contract the parasite.

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I ask him if he thinks he will ever be able to afford his own septic tank. He tells me that, at $15,000, a working septic tank would cost more than his house is worth. Unless someone figures out a way to fix the soil in the county, it won’t matter anyway, Paul explains.

When I tell him that some people estimate that $15 million to $20 million could fix the sewage problem in the county, Paul laughs.

“You think white folks gonna give $20 million to Lowndes County?” he says, laughing. “Man, they don’t even come down here to look at the problem. They can’t even take the smell.”

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Just before he shakes my hand for the last time and climbs into his pickup to disappear into the horizon of his home county, Paul pulls on the cigarette again.

I do not mind.