More Than Medicine. Jennifer Nelson
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trained locals to perform x-rays and provide physical therapy as well as make home visits in Spanish.86 One example from the Martin Luther King Health Center in New York City, another OEO-supported NHC, illustrates the importance of these home visits. A five-year-old boy had appeared at the clinic six times in three months. A home visit revealed that his “apartment lacked heat, and the winter cold was leaking through a broken window. The family was also short on food and badly needed more clothing.” The outreach worker helped the family access welfare benefits that allowed them to heat the apartment and acquire clothing and food. The five-year-old could only get well after these linked socioeconomic problems were addressed.87
L. C. Dorsey’s interaction with the Tufts-Delta Health Center characterizes the way community involvement in medical services could help transform black people’s lives beyond simple health care provision. Dorsey was born on a plantation to sharecropper parents (just a generation removed from slavery) in Washington County, Mississippi. She grew up in neighboring LeFleur County without access to education or job experience except in the fields. As a teenager, Dorsey was a social activist—a self-described civil rights field worker—with the Council of Federated Organizations (COFO), the Student Non-Violent Coordinating Committee (SNCC), and the Southern Christian Leadership Conference (SCLC). From her involvement in the civil rights movement, Dorsey heard about the Tufts-Delta Health Center and was intrigued because she wanted to become engaged with a project that would be sustainable. She explained that she was hired to be a part of community health outreach with the center. Dorsey said that Hatch, at that time director of Community Health Action at the health center, wanted to give young people the chance to grow in the organization, so he hired people with little or no work experience. After a stint as an outreach worker, Dorsey applied to direct the community farm associated with the clinic. Again, she noted she had no direct experience but was given an opportunity to develop her skills on the job. She also utilized Delta Health Center resources to complete her high school degree at the local junior college. Dorsey made clear that her work with the health center helped build her confidence to the point that she eventually completed an undergraduate degree and attended SUNY–Stony Brook for her master’s in social work. Ultimately she completed a Ph.D. at Howard University and returned to the center to become its executive director in 1988.88
Most of the Delta Health Center patients were women, children, and elderly men. Because there was so little paid labor in the South, many young men migrated north to find jobs. As a result of out-migration, the average age of Mound Bayou residents was only about fifteen, and the average age of men in the community was about fifty. Thus, women and their children were very much at the center of the Tufts-Delta Health Center as both patients and workers.89 With so many women in the community, obstetrics and gynecology were essential specialties at the health center. Two white nurse midwives, one a nun, Sister Mary Stella Simpson and Asa Johansen, both of whom joined the clinic when it opened its doors, worked in this area. The first black female obstetrician/gynecologist to practice in Mississippi, Dr. Helen Barnes, also joined the center in 1968. When she arrived at Mound Bayou, Barnes set up a program for prenatal care, delivery, and contraceptive services, which was supported after 1970 with federal funds accessed through Title X, a program created by President Nixon to promote family planning among poor Americans.90 Born in Mississippi, Barnes left the state to earn her medical degree from Howard University in Washington, D.C. After completing her degree in 1958, she returned to the Mississippi Delta to serve as one of the few black general practitioners in Greenwood, Mississippi. After returning north to complete specialty training in ob/gyn at Kings County Hospital in Brooklyn, New York, she joined the Tufts-Delta Health Center.91
Like Geiger, Barnes discovered that she could not address ob/gyn or infant health without addressing the larger environmental and economic problems that faced the community. She recalled that “[w]e had pediatrics and surgery, but I also found out that it’s all right to practice medicine and deal with sanitation and feed people—write a prescription for evaporated milk.” Like general health care, ob/gyn and child health services could not be limited to a narrow conception of medical practice. The practice of medicine necessarily expanded to embrace the environmental and economic problems of the Mississippi Delta community. Barnes continued, “I delivered babies every day and night and the nurse midwives would go out to do home visits—take care of the babies. [They would] look and see if they had screens and if they didn’t have running water they would dig a well.”92 Thelma Walker, another local woman who became the nursing administrator of the center, added,
If a nurse in the field finds a home without a water supply—out go the sanitarians and engineers with the well digger invented right here at the center and they dig a well in half a day. If there are rats coming through the floor, we exterminate them. A leaking roof? A privy falling down? Out go workers from the center—and these are local people—to patch the roof, build a new privy or take healthy adults tools from the tool bank we’ve scrounged together so they can make their own repairs.93
Although there was no women’s health movement in the late 1960s in the Mississippi Delta, there is abundant evidence that African American women responded positively to contraceptives when they were made available. Dr. Barnes distributed large numbers of contraceptives as part of a “community health improvement program” supported by federal Title X funds. Barnes explained that for many poor black women this was the first time they had been introduced to any kind of family planning. For the most part, she said, black women responded positively to the idea that they could limit their fertility using contraceptive measures. She recalled that women also came to her to be sterilized when they felt they no longer wanted to bear children. Her experience confirms other evidence that African American women wanted to control their fertility as long as they could do so voluntarily.94
At the same time, in the late 1960s and early 1970s, many African Americans, including black nationalists, but also other women of color involved in the burgeoning feminist movement, viewed federally sponsored birth control programs as genocidal. Federally funded family planning programs were often associated with ideas of population reduction and population control rather than with notions of creating healthy communities. Black women were particularly adamant that birth control and abortion services needed to be accompanied by other health services that allowed black families to bear and raise the healthy children they wanted. Any emphasis on population reduction as a solution to black poverty made many African Americans very suspicious.95 As Barnes noted when I asked her why blacks were suspicious of white health care providers, “You can get kicked in the shins only so many times before you decide that you won’t trust people anymore.”96 To gain the trust of the populations she worked with, Barnes explained, we “set up a clinic in a community and found more people came to the clinic year after year after year because we were proving to the community that we were going to stay and do what we said.”97
A collection of letters written by Sister Mary Stella Simpson, one of the nurse-midwives at the health center, serves as a particularly cogent example of how women’s health, in particular, needed to be understood in conjunction with larger community development needs. Simpson arrived in Mississippi in 1966 from Evansville, Indiana, to work at the newly opened Tufts-Delta Health Center. As a native of rural Arkansas, Simpson said she “was very familiar with the kind of poverty . . . found in Mound Bayou.” Her letters paint a vivid picture of health conditions in the Mississippi Delta during this decade.98
One letter reveals the extent to which African Americans in the Mississippi Delta lacked even basic necessities such as adequate shelter, food, and clothing, as well as health care and access to education. Simpson recognized these as fundamental problems that could not be separated from her primary task of providing ob/gyn care to poor women:
Today was my first day for [obstetrical/gynecological] home visits. . . . On the very first one I had to come back to town to get milk for a baby. He had finished his last bottle. It had gotten really cold, and the 14 people in that family all congregate in one room around a small wood burning stove. . . . The children were all barefoot, therefore could not go to school. The parents have no way of getting shoes for them since they have no income. . . . A year old baby was very ill with diarrhea—had it for a week. So I had to drive the mother with all [her] six children to the clinic. The baby had to be hospitalized.99
Another letter addresses the extraordinarily poor housing occupied by Delta