Hookworm, an intestinal parasite believed to have been eradicated in the U.S. decades ago, has made a comeback in the south with at least one in three people in Alabama’s Lowndes County testing positive for infection, according to a 2017 study.
The parasite is often associated with poor sewage treatment and is common in the developing world such as Africa and Asia, where access to clean water, sanitation and hygiene is low.
Infections happen when people walk or play barefoot in places prone to open defecation. That’s a breeding ground for hookworm larvae which penetrate the skin and use the bloodstream to attack different parts of the body including lungs, skin and small intestine.
While hookworm infection may not be fatal, the blood-sucking parasites could cause anemia, which can contribute to heart failure in severe cases. It can also cause slow growth and slow mental development in children.
The re-emergence of hookworm infections in the U.S. point to growing inequality in the world’s top superpower, indicating that beneath America’s fabulous wealth lies a dark secret of poverty-related illness comparable to the world’s poorest countries.
Hookworm was rampant in the south in the earlier 20th century, sapping the energy and educational achievements of both white and Black children and helping to create the stereotype of the lazy and lethargic southern redneck.
The parasite was believed eradicated by 1980s as public health improved but the 2017 study proved otherwise. The study was carried out by the National School of Tropical Medicine at Baylor College of Medicine in conjunction with Alabama Center for Rural Enterprise (ACRE), a non-profit group seeking to address the root causes of poverty.
Researchers found that hookworm was rampant in communities in the south due to a lack of basic sanitation in some cases in areas where people had not traveled outside the U.S.
The state of Alabama mandates that anyone who is not on a municipal sewer line must invest in a private waste-management system. However, the dense soil in the region makes it hard for conventional septic tanks to work properly. They store sewage until it can be filtered by the earth and consumed by microbes.
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Lowndes County is a Black American civil right hallmark. Dr. Martin Luther King, Jr. led marchers across the county more than five decades ago from Selma to Montgomery in 1965 in search of voting rights for Black citizens. But it seems Dr. King’s dream of “dignity of equality” remains elusive for many of the 11,000 residents of Lowndes County, 74 percent of whom are African American.
Catherine Coleman Flowers, an author and activist for wastewater-infrastructure justice, makes the case for investment in America’s rural population in her new book “Waste” (2020, New Press). Flowers grew up in Lowndes County, where she said about 90 percent of septic systems are failing or inadequate. Raw sewage backing up into homes and yards led to the hookworm outbreak in 2017, she said.
“Indisputable connections emerge between our nation’s history of slavery and sharecropping and the current inaccessibility, for some, of ‘the right to flush and forget,'” according to a book review in the New Yorker.
