Hookworm affects around 740 million people worldwide and thrives in regions of extreme poverty. However, a recent study traced the parasite to a very unlikely place – on the soil of one richest nations on the Earth.

More than 100 years ago Hookworm was rampant in the U.S. poor South due to the inability of families to afford proper outhouses and the rarity of sewer systems and, contrary to popular belief, it has never left. The Rockefeller Sanitary Commission for the Eradication of Hookworm Disease (RSC) set out to provide treatment and eradicate the disease from 1909-1914. Efforts spanned 11 southern states, where about 40% of the population was infected. Thanks to their three-pronged approach, that included mapping the disease, curing patients and educating the public, the RSC successfully reduced the disease.

Now, hidden beneath America’s remarkable wealth, The American Society of Tropical Medicine and Hygiene has uncovered a resurgence of the poverty-related illness at levels equivalent to the world’s poorest countries.

The predominately African American Lowndes County in Alabama is one of the poorest counties in the nation and is suffering from high rates of Hookworm infection. 66 people, all African Americans, participated in the study, which included samples of blood, stool, and soil as well as a health questionnaire. Stool samples, taken from 55 of the participants, showed that 23 had a parasite, 19 of which were Hookworm.

The parasite larvae live in soil and enter its host through the skin, usually through bare feet, and attaches itself to the small intestine where it feeds off of blood. Hookworm eggs are expelled through the stool of the carrier, re-contaminating the soil, and beginning the process again. The short term impact of the infection includes itchiness, abdominal pain and diarrhea. The long term complications includes anemia, protein deficiency and impaired mental function, especially in children.

The Alabama Center for Rural Enterprise (ACRE) has reported there are residencies in Lowndes County without adequate sanitation systems, increasing exposure to open sewage near dwellings. Many are unable to afford a septic system and residents often concoct their own sewer line using PVC pipes. And, instead of increasing public assistance to those who are unable to afford a proper sanitation system, criminal prosecutions were launched by Alabama state between 2002 and 2008 against residents who were open-piping sewage from their homes.

With a per capita income of $18,434 as of 2016, it is nearly impossible for families to pay for new septic systems that can cost as much as $30,000. This results in an increase of a culture of mass incarceration and adds to the amount of African Americans in shackles

Moreover, Lowndes County earned the nickname “Bloody Lowndes”, as a reference to white residents’ violent opposition to civil rights in the 1950s and the vestiges have lead to a long history of racial discrimination and inequality in the area. Located on the famous Selma March trail, environmental justice and poverty have intersected, producing an inequality that is often overlooked.

It is time that we realize that the level of poverty in Lowndes exists in one of the richest nations in the world and until the sewage problems are dealt with, Hookworm will never truly be eradicated.