Beneath the Surface

“Something, someday, will happen in your community where your skills are needed. You have to listen to that call and answer it.”

Author | Amy Spooner

Walter Barkey (M.D. 1979) initially was drawn to the visual orientation of dermatology. "Unlike other medical specialties, dermatology relies on visual skills," says Barkey. "With a trained eye, I can see problems in a unique way."

Recently, Barkey trained his eye on two headlines involving rashes — one during the Flint water crisis, the other at a prison. He knew he could see things that a non-dermatologist might not.

Barkey, a lifelong Flint-area resident, gets emotional when he talks about a 2016 Time cover featuring a Flint child with a rash. "I never met him, but I knew he had eczema." The story shone a spotlight on the troubles caused by the city switching the source of its drinking water. Many citizens had elevated lead levels; others developed rashes. When a state alert in February 2016 asked area physicians to look out for patients with rashes, Barkey saw trouble. "Diagnosing rashes is hard, especially in general clinics where most were seeking treatment."

Shortly after receiving the alert, he volunteered to assess people for what he figured would be a few afternoons but quickly realized it was a far bigger problem. "We were easily talking hundreds of people." He recruited three other dermatologists in Genesee County, where Flint is located, and then worked with state and federal public health officials to create a questionnaire, call center, and appointment-scheduling system; provide transportation; and see patients.

Community distrust of government amplified the problem. "This disenfranchised population had barriers to health care and repeatedly was lied to by officials saying they would help." Barkey's status as a volunteer, specialist, and resident helped him build trust — and provided new perspective.

"I went from solving problems one-on-one in my office to studying a whole community."

The team's work began after the city returned to its original water source. While they found no correlation between the rashes and lead, data from before the switchback — when the rashes began — showed elevated chlorine levels and a spike in water hardness, both known to exacerbate eczema. The October 2015 outbreak correlated with low ambient humidity, which also exacerbates eczema. Furthermore, people took measures to avoid the water, like using wipes and reducing washing.

Working with state and federal officials to write a report based on their findings was a learning experience. "They wanted to whitewash the findings," says Barkey, recalling one high-level EPA administrator he met while she was in town for just one day for a press conference. He next saw her six months later when she tried to rewrite his report. "People want the whole story. Because the government needed my credibility to validate the report, I felt empowered to strike revisions and ensure we weren't glossing things over."

In 2018, when Barkey learned about a mysterious rash outbreak at Women's Huron Valley Correctional Facility, "the same alarm went off": a disenfranchised population saying something was wrong; officials saying not to worry. The cases presented as scabies, but Michigan Department of Corrections doctors had supposedly ruled this out. Barkey, however, saw a problem: no dermatologist had done an assessment.

"The physicians trying to figure out a rash were led by a psychiatrist and an occupational medicine physician. Just like Flint, I knew this wasn't going to work."

Prison officials were reluctant to accept his offer of help until a high-level state official he worked with on the Flint investigation vouched for him. He brought his microscope to the prison and proved that, of the 24 inmates he examined, 22 had scabies. "They were doing their best, but it's an argument for access to specialty care," Barkey says.

Like the Flint residents unaware they were vulnerable to eczema flare-ups, the inmates couldn't fully access the health care system. "In the real world, if your PCP hasn't fixed your problem, you see a specialist. The inmates couldn't," Barkey says. "They could try to build awareness, but how much clout do appeals from inmates have?"

Unlike Flint, this issue had a definitive solution. Barkey worked with officials on a treatment plan for all 2,200 inmates and helped rewrite a new treatment protocol. The message stuck: State officials recently called Barkey about a nascent outbreak elsewhere, and "we nipped it in the bud," he says.

Barkey insists that any dermatologist could've done what he did, and that all doctors similarly can find ways to serve. "Something, someday, will happen in your community where your skills are needed. You have to listen to that call and answer it."

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