If Catherine Flowers ever received a calling to take on a career in environmental activism, it likely came in the form of mosquito bites.
In 2009, Flowers was doing economic development work in her hometown of Lowndes County, Ala., where raw sewage leaked into the yards of poor residents who lacked access to a municipal sewer system.
On one visit, she met a pregnant woman whose toilet waste flowed into a pit right outside her mobile home. The mosquitoes swarming the pit attacked Flowers.
Days later, her body had broken out in mysterious red blotches.
"I didn't think anything of it until I broke out in a rash," she said in an interview with Morning Edition host Noel King.
Flowers went to the doctor, who ran blood tests for infections and other diseases, which came back negative.
"I asked her, 'Is it possible that I have something that American doctors are not trained to look for?' Because they don't even acknowledge that there's a raw sewage problem in this country," she recalled.
Lowndes is one of the poorest counties in the U.S. Its weak sewage infrastructure, combined with poor soil drainage, has left the rural area's predominantly Black community vulnerable to diseases and infections like hookworm.
At the time, Alabama's public health department threatened 37 families with eviction or arrests because they couldn't afford septic tanks. Since then, Flowers has been raising the alarm bell on the largely overlooked issue.
She negotiated with state politicians, working with then-Sen. Jeff Sessions, to end such prosecutorial policies, and collaborated with the Environmental Protection Agency help secure funding for septic systems.
This month, Flowers won a MacArthur Foundation fellowship – also known as a Genius Grant — for her work by "bringing attention to failing water and waste sanitation infrastructure in rural areas and its role in perpetuating health and socioeconomic disparities." (Note: The MacArthur Foundation is a financial supporter of NPR.)
Flowers counts her MacArthur award, a $625,000 grant, as a win for the recognition it brings — and the conversations it's driving — around work that she says is "not in the least bit" glamorous.
"When I first started doing this work, I was told that this was not sexy and this was something that the media wouldn't cover," she said.
As founding director of the Alabama Center for Rural Enterprise, she advocates for sanitation and environmental rights, including working with federal agencies to produce affordable septic systems.
"But what success looks like is that now we're in discussion about developing technologies that can work. If we can treat wastewater in outer space to drinking water quality, why can't we do that here on Earth?" Flowers said.
Her testimony before Congress last year urged lawmakers to address diseases linked to poor communities and spurred the introduction of the Neglected Diseases of Poverty Act. She also serves as the only Black woman on the joint Joe Biden-Bernie Sanders climate change task force, co-chaired by Rep. Alexandra Ocasio-Cortez (D-N.Y.).
Studies have shown that rising sea levels as the result of climate change can also lead to groundwater pushing closer to the surface. These shallow groundwater tables, under pressure during storms and heavy rain, can aggravate flooding and trigger septic system failures, she said.
Septic tanks aren't equipped for such conditions, Flowers added, and the burden often falls on the residents.
"They've gotten systems that are just not dealing with the current conditions very well and can't be maintained — because that's always the narrative we're getting: 'Oh, they can't afford to maintain them.' Well, let's build something that they can maintain," she said. "Because the toilets not only are for getting rid of waste, but that's where a lot of viruses are deposited. And especially now that we know that raw sewage can emit COVID."
It's unclear whether Lowndes County residents living in close contact to raw sewage means they are more at risk to contracting the coronavirus, Flowers noted.
Despite the county's modest population of under 10,000, Lowndes has the highest per-capita infection rate and the highest per-capita death rate in Alabama.
Faulty sewage and sanitation are far from a local problem. Flowers is working to remedy issues that impact impoverished regions and communities of color across the country. She found that residents in Centerville, Ill., and Riverside County, Calif., also experienced raw sewage backing up into their yards. A Native Alaskan village, Kivalina, had no septic system at all.
The pandemic has hit Black and Latino populations particularly hard. It's one more reason, said Flowers, that there's never been more critical moment to rethink sanitation infrastructure nationwide.
"One of the things that COVID should teach us is that we cannot allow this to exist without addressing it," she said. "If we do not address it, then we're going to have more disease and we're going to have diseases that could be worse than COVID."
NPR's HJ Mai and Milton Guevara produced and edited this interview for broadcast.