Courtesy of Ijeoma Opara

To Maame-Owusua Boateng SPH ’23, on-the-ground work is the only way to get things done in public health. 

Boateng was recently in Jackson, Mississippi, where she and five other public health students saw first-hand the devastating effects of the country’s worst water crisis in recent history. Floods in October damaged the city’s already-troubled water treatment system, leaving as many as 150,000 residents without safe drinking water for over two months.

“It made me cry a little bit listening to other people who were volunteers in the community, and then meeting new people and seeing their life perspectives,” Boateng said. “How they came to be and how they’re impacted by these issues [including] the water crisis and incarceration.”

Research alone, Boateng explained, cannot address a population’s immediate, individual needs — community engagement is key. 

That’s the ethos Rukia Lumumba, a prominent community activist from Jackson, flew in for the Yale School of Public Health’s first Change Talk by activist-in-residence Angelo Pinto. After speaking with students at the event, Lumumba felt it was necessary for students to “see with their own eyes” what was happening in communities affected by the water crisis. Lumumba, on behalf of the Mississippi Rapid Response Coalition, arranged for six students to visit Jackson on Nov. 1, accompanied by Pinto and the School of Public Health assistant professor of social and behavioral sciences Ijeoma Opara.

“I think that this was a great opportunity for the university to do something different, to show up and participate in the process of recovery and not just write about it,” Lumumba said. 

Lumumba leads the Mississippi Rapid Response Coalition, which was started in 2020 and encompasses over 30 organizations. These organizations work together to respond to disasters caused by issues such as failing infrastructure and climate change. 

The water crisis in Jackson has left over 150,000 residents under boil advisories, with water line breaks, contamination hazards and low water pressure threatening access to clean water in an 82 percent Black city. 

“Unfortunately, it is often the urban, predominantly Black and Brown cities that are impacted by something as simple as access to clean water,” Opara said. “It shouldn’t be happening in America. We need to uplift this more so that our politicians who have the power to fund this stuff can actually take this seriously.”

Opara noted that activism is not just protesting — it encompasses campaigning and highlighting the importance of social change. She handpicked most of the students based on their participation in her Community-Based Participatory Research class or their attendance at the Change Talk. The students included Boateng, Nassim Ashford SPH ’23, Rosa Gonzalez Juarez SPH ’23, Katie Soden SPH ’24, Eryn Pawluk SPH ’24 and postdoctoral researcher Sitara Weerakoon. 

Her goal for this trip was to work closely with the Jackson community to devise solutions as public health researchers, students and activists. 

“When the community members saw us coming, they were extremely excited,” Ashford said. “They were like ‘Yale’s here!’ It shows them that other people actually care about what’s going on, and it gives them the fight to keep going.”

Knocking door-to-door

The coalition conducts “wellness checks,” which consist of calling residents and performing door-to-door surveys to assess peoples’ needs. Last year alone, they performed 10,000 wellness checks. The first wellness checks were implemented in 2021, during which the city was struck by a winter storm and had been without water for nearly six weeks. 

Students conducted wellness checks at a senior home which had 152 units and was government-run, inhabited mainly by people over 65 on Medicare. According to Opara, many of the seniors had comorbidities, including diseases like cancer, diabetes or heart disease which put them in an especially vulnerable population. 

The students surveyed residents, asking how they were dealing with the water crisis, what their needs were and how they felt about the government’s response. Based on their needs, the students offered water filters, water tests and basic necessities like cleaning supplies.

Sitara Weerakoon, a postdoc in Opara’s lab, asked one woman how she was coping with the water crisis. The first thing the woman said was that she was hungry and dying of cancer. All she wanted was for someone to get her food. She was on a breathing machine, had medications to take and did not have the strength to cook. After talking with Weerakoon, Pinto and Opara brought food to her doorstep.

“If we hadn’t knocked on her door and asked her that question, we would have never known that she needed that,” Weerakoon said. “She might not have gotten food that day, who knows what could have happened. To me, the biggest takeaway from this was how important it is to be in the community and figure out what their individual needs are.”

Weerakoon is a self-professed “quantitative person” used to the process of analyzing data, writing reports and then publishing them. Her public health research naturally falls at the population level. Compared to canvassing, she felt that research could not help individuals or have impact in the short term because of the years it takes for research to be translated into practice.

Community involvement contextualizes research, and reveals the larger story of which publications are “just one tiny fraction,” Weerakoon explained. While these crises often point to a systemic cause, she viewed empowerment at an individual level as key to propelling long term systemic change.

“If you look at public health as promoting the health of the public, research is really insignificant, and that is because it takes 10, 20, 30 years to translate research into practice,” Weerakoon stated. “So to really do public health, you need to be in the community, fighting for change to make sure that everybody has equitable health in every possible way.”

Ashford emphasized the need to understand lived experiences when conducting research to figure out “what it is that you’re doing” and avoid bias. 

Opara conducts and teaches community-based participatory research, which seeks to bridge the gap between academic institutions and community members. While the community teaches researchers about their experiences, the researchers teach them how to understand data on their situation and utilize the research for their benefit. 

“It’s a co-learning process that allows researchers to come into a community and remain humble,” Opara said. “People in Jackson are the experts of their lived realities. I may be an expert on health disparities and health equities and using research to inform practices and policy, but I’m not the expert of their lived experiences — they are — so I’m learning from them.”

According to Opara, when they met with residents in Jackson, almost all of them said that the water crisis was not their biggest issue. Some people were dealing with food insecurity and did not have access to healthy food. Others needed access to doctors who could address their comorbidities. 

Opara also noticed a rift between the local and state government, with residents unsure where to direct their frustration. While blame would often target the local government, there was also the issue of the state controlling the distribution of funding necessary to address the water crisis. 

“The water crisis exacerbates all the other issues that Jackson residents are facing,” Opara said. “If we’re not working with policymakers to figure out how to get more funding to low income people in the community that need it, the water crisis is an added issue that’s going to further push them into multiple states of crisis.”

The status of the crisis 

Pinto found that many people use an average of 16 to 20 bottles of water a day. While people are beginning to use the water again for bathing, they still do not trust it for drinking, cooking or even brushing their teeth. Conscious of the hazards, Lumumba likewise chooses not to drink water from the pipes in Jackson.

“They’ve never trusted the water,” Pinto said. “They continuously boil their water or they use water bottles to shower or to brush their teeth. They’ve been forced to kind of have that be their everyday reality, but it doesn’t hide the fact that there’s so many other things that are compounded.”

The students continued their day by volunteering at one of the coalition’s six water distribution sites. The coalition distributes water five days a week to areas all over Jackson. Lumumba wanted the students to experience the act of passing out water “in a massive way,” to people who had lined up for hours to get bottled water to drink. 

“A lot of times you’re sending in all this money or you’re saying people need water, but to actively be there and to put water in somebody’s car, and know that this person actually needs water is a really humbling experience,” Ashford said.

According to Lumumba, while water is largely restored and flowing through pipes in Jackson, boil water notices remain in many parts of the city. Though the EPA claims that the water is safe to drink, the issue lies in the infrastructure. Water coming out of processing plants may start out safe, but many homes still have pipes made out of lead, copper and other contaminants that mix with water as it travels from the plants to homes. Many pipes across Jackson still need to be replaced, but the funding is sparse and the problem is widespread.

Residents may not even know that their property’s pipes require replacement, according to Lumumba. Many homes in Jackson were built in the 1960s, with private pipes that the city does not track. The coalition handed out water tests and water filters to help residents diagnose their own water for potential contamination.

Opara spoke to coalition volunteers who worked at the water distribution site ‘day and night.’ Many expressed their love for the city of Jackson, a community that raised them. Bringing their “full selves” to the site every day, they put aside their own struggles to serve their community. Opara called them the real heroes of Jackson.

“It’s not easy work,” Opara reflected. “When you’re distributing water and canvassing, you’re hearing really hard stories. You’re seeing people that are struggling, that are literally depending on you to give them free water and free supplies […] I commend them for doing this work.”

Reflections

Pinto admitted to being surprised by “how good” the students were at administering surveys and navigating the needs and challenges of the residents they encountered. But all of them had some type of experience working on-the-ground in communities. A nontraditional student, Rosa Gonzalez Juarez spent ten years doing community organizing work before coming to Yale.

“I miss being back in community, I miss working with them, I miss hearing their stories,” Gonzalez Juarez said. “I miss being an advocate for them and with them, and teaching them about their rights.”

From her last two years as a student, Gonzalez Juarez said she merely learned the academic, professional terms for what she had already been doing as an organizer. One term was “community-based participatory research,” Opara’s field of research. It is a process Gonzalez Juarez loved doing as a community advocate, conducting needs assessments and collecting data directly from people. This process, observed too in the canvassing done in Jackson, was important to build trust and partnerships within communities.

Through the academic knowledge of public health work, Gonzalez Juarez envisions shifting her advocacy work to focus on project proposals and project funding in support of disadvantaged communities. Opara hopes that this experience was life-changing for the students, and that it inspired them to be more engaged in community-level work as they graduate and move on in their careers.

The students ended their trip at city hall, meeting policy decision makers and municipal government members, including Chief of Staff Safiya Omari, who Zoomed into the previous Change Talk. Omari gave the students historical context on the city of Jackson.

While Ashford’s coursework typically involved reading studies and research that were decades or years old, he valued having an activist show the urgency of current issues and the need for an active team of researchers to figure out how to remediate specific situations. 

“As a Black man from the South … and also a political activist, one of the most impactful things for me was just being in the presence of people like Rukia and hearing the history behind the fight and the struggle for rights in Mississippi,” Ashford said.

Lumumba’s coalition is aiming to complete wellness checks on at least 60,000 residents this year. They are also requesting that the state and federal government fully fund a rebuild of Jackson’s water and sewage infrastructure, which Lumumba estimates will cost close to $1.5 billion.

Boateng recommended that public health students connect with local community members and use their academic knowledge to write op-eds. Using Yale’s name could help attract public attention to these issues and create better funding opportunities for them.

“Water is important, infrastructure is critical,” Lumumba said. “We hope that from the experience of the students that came that they will be inspired to find some way big or small to help heal us here in Jackson to overcome this water crisis and our water infrastructure issues.”

Pinto and Opara hope that future trips can be arranged to bring students to other states, or even inspire work within the local New Haven community. Ashford wants the master’s program to create an ‘activism’ track, similar to the tracks dedicated to Global Health and U.S. Health Justice, because “public health is activism.”

Donations to the Mississippi Rapid Response Coalition can be made here.