More Than Medicine. Jennifer Nelson
from this particular woman’s need for prenatal health care: “I went into a shack out in the country on one [prenatal] visit today and found the ceiling was made of cardboard boxes and the roof leaked badly. What a sight! I did the prenatal exam as if this situation was a daily occurrence. ‘We’ll fix it when it stops raining,’ says the husband as he sweeps the water through the cracks in the floor.”100
Through her letters written home to her convent sisters, Simpson provided a detailed overview of the persistent and basic health problems confronted by poor African Americans who were served by the Tufts-Delta Health Center. Within days of her arrival in the Mississippi Delta, Simpson learned that ob/gyn care was not enough to improve the lives of the women and children she treated. As Geiger, Barnes, and Dorsey had already noted, Simpson found she needed to supply a nexus of health-related provisions such as sanitation, screens on windows to keep out mosquitoes, other basic housing improvements, clothing, nutritional information, and food. Without these vital necessities, the provision of any medical care was pointless.
Persistent problems recorded by Simpson were lack of food, inadequate housing, and inadequate clothing. In one letter she wrote, “The last place I visited was the worst ever. The dogs and cats go and come through the walls. It has a high front porch and an old washtub turned upside down for a step. I was scared stiff to put my weight on it, but it held. The mother and daughter were wearing rags held together by safety pins and had bare feet.”101 The lack of basic necessities was so profound that health center doctors, nurses, and nurse-midwives spent much of their time helping to find food and clothing, repairing screens on windows, pressuring landowners to provide better housing, and connecting patients with welfare entitlements such as food stamps.
Women also lacked basic health education, which compromised the health of their children. Although the health center midwives and physicians, including Sister Simpson, encouraged breast-feeding, few women practiced it at first. Physicians at Taborian, the local Mound Bayou hospital, discouraged women from breast-feeding their children because it was viewed as inconvenient (for the hospital that had to support women who breast fed, not the mothers). This left women with no option but to use formula, which required sterilizing bottles and finding clean water. Many homes on the white-owned plantations and farms in the region were without running water or a well. Some families used water from the bayou until it dried up in the summer. Some families were also without the means to boil water, and women often didn’t know that a bottle could not be rinsed and reused. Because of the unsanitary conditions, diarrhea was a constant problem with small children and a major cause of high infant mortality.102 In 1960 the infant mortality rate in the Mississippi Delta was more than sixty deaths per thousand live births, more than twice as high as the rate for white infants.103 This number was high compared to the national rate in 1960, which was about forty-five deaths per thousand live births for African Americans and just over twenty for whites.104 Although both white and black infant mortality rates had been declining nationally since the mid-1930s, the rate of decline for whites was 3.2 percent annually, while the rate of decline for black infants was only 2.6 percent.105
The women in Mound Bayou and Bolivar County were very enthusiastic about breast-feeding when they were given some coaching as to how to get started. Because good mothering is something that is learned and not instinctual or natural, new mothers often need to be shown how to breast-feed their babies.106 In the past it had been grandmothers and granny midwives who passed on this knowledge. Without these traditional health care providers, however, women in Mound Bayou and surrounding areas were often reliant on indifferent physicians and hospital staff until the community health center was founded. Sister Simpson recorded the enthusiasm for breast-feeding she witnessed among the new mothers:
We are starting to see results! Breast-feeding is beginning to catch on. We hope to have 100 percent of our mothers feeding this way before the year ends. The mothers enjoy our classes, too. . . . We seem never to get away from the sessions. . . . They ask questions for hours! One of the mothers delivered her baby only a few days before the next class. She didn’t want to miss it, so we went to her home and had class there!107
For many of these patients, a home visit by a nurse midwife was their first encounter with a health care practitioner. Many women had received no prenatal care, had never had any sort of medical care as children, and bore their children without any medical support. Simpson also confirmed reports that some doctors and hospitals in the area that did provide care for poor African Americans were neglectful or inadequate for the population. In one case a mother took her eleven-month-old baby who would not eat to two different doctors before Simpson helped her to get her child into a hospital that would feed the child intravenously. Another eighteen-year-old patient was due to deliver her baby any day and was experiencing preeclampsia. She had extremely high blood pressure and protein in her urine but had never been seen by a doctor.108 Simpson also cared for a child whose hand had been badly burned and had healed into a fist—the child would remain handicapped for the rest of his life—because a neighborhood doctor had neglected to treat him properly.109 Sister Simpson noted that prenatal care was seldom the only care given on a home visit: “If the prenatal exam was the only thing we did on such visits, they wouldn’t take so long. But when you see a little one with impetigo all over his face, you doctor him, which often takes a couple of hours.”110 As Barnes pointed out, “Medicine may be the way we got in the door, but medicine is not the number one priority. There are other priorities; food is number one and then a way to make a living.”111
The clinic quickly transformed the health of the population in the area served by the Tufts-Delta Health Center. When the health center was first established, clinic services and training for community staff occurred in an abandoned church parsonage and in an old movie theater in town. After about a year, a new building was built for the health center. By 1969, the clinic was able to provide hospital equipment to patients in their homes when there was not enough space to accommodate patient needs at Taborian Hospital. Prenatal and postnatal care both improved dramatically over the first three years of the clinic’s existence. Thelma Walker reported that ob/gyn care had grown from almost nothing in the community to a majority of pregnant patients attending the clinic before the fifth month of their pregnancies. Many of these women gave birth at the hospital or at home with a midwife in attendance and were then followed up postpartum at the health center. Their infants received care from birth onward. Walker explained that it was “quite a change . . . from the days when Sister Mary Stella and Aase [sic] Johansen saw many mothers for the first time when they were ready to deliver—or had delivered—and from the time when little children never saw a doctor or nurse until they were so ill with diarrhea or pneumonia that it was touch and go to save them.” She added that the “two nurse midwives have helped in prenatal care or delivery of over 100 babies, all living, many at home, but now most mothers have their babies in the hospital.”112
Ultimately, the Tufts-Delta Health Center brought poor blacks in the Delta the basic and preventive health services that were available to most other populations in the United States by 1966. But, unlike with most other hospitals serving the poor in America, in Mound Bayou the poor provided and managed much of their own health care. The health center workers, many of whom were drawn from the local population, including the physicians, nurses, nurse-midwives, nurse’s aides, sanitarians, and health outreach educators, were black women and men who understood that African Americans had been neglected and even abused by mainstream (white Jim Crow) health provision in the past. Clinic staff also addressed fundamental factors contributing to ill health that few people had defined previously as legitimate to a medical practice. As Dorsey explained, they had created a farm collective because they believed that the only antidote to hunger was food.113 Lack of food was a medical issue. Geiger pointed to the success of the cooperative farm: “In one spring and summer, they have grown one million pounds of food, enough to end hunger in Northern Bolivar County—sweet potatoes, Irish potatoes, snap beans, butter beans, black-eyed peas, collard greens and the like.”114
Certainly, a targeted focus on funding and delivery of health care to address health problems among the poor helped bring medicine to many patients never before seen by a doctor. But money is not the only reason many of these programs succeeded. According to Dr. Joseph English, administrator at HEW, some federal health care programs were unsuccessful despite targeted funds. He noted that $.5 billion a year went to fund grant-in-aid programs in Alaska but did