More Than Medicine. Jennifer Nelson
Center in Mound Bayou expanded the traditional idea of health care by pointing out that food, jobs, and housing were fundamental requirements for good health. For Geiger and other organizers of the project, it was essential to the success of the clinic that local people identify health needs for themselves. That these were not always traditional health care needs was not a problem. The clinic founders believed that they needed to respond to health priorities set by the people themselves. By 1969, seven thousand black residents of Bolivar County were involved in implementing the services sponsored by the health center; these were services the community members had created for themselves.69 Geiger and Hatch also recruited black professionals from the North to work at the health center. These included ten doctors and ten nurses. Social workers, a psychologist, a nutritionist, and a pharmacist also counted among professionals recruited for the clinic.70
By attending to what local people needed and wanted, the community clinic improved upon more traditional medical provision in the rural South. Geiger wrote that the Mound Bayou clinic provided “the essentials of community-oriented primary care: family health care teams; community organization and health education; the training of local workers as family health aides, environmental sanitarians and health [educators].”71 Health care was much more than seeing a doctor for these community activists. It meant building a strong economic and social base for the community as a whole.72 A community vegetable garden became a 500-acre farm cooperative founded by twelve hundred families in the region. “The first farm co-op of people who don’t own farms,” Geiger commented, recognizing that the vast majority of Delta residents lived on some of the most fertile land in the country but did not produce food for their own consumption. The sharecropping system, shaped by deeply embedded and historical race and class hierarchies, fostered malnutrition in rural areas where local blacks had almost no control over what was grown on the land they inhabited.73 In just over seven months the co-op grew more than one million pounds of food and effectively ended hunger in the area. As Geiger explained, the most important lesson to impart from the Mound Bayou experiment to health care providers is that “your [health care providers’] priorities may not be those of the people you are concerned with. . . . People who are concerned with survival are going to be worried about that before they are concerned with tuberculosis. They are going to be concerned with housing, jobs, food, their kids, and some other things.”74
Survival had become a problem for Mound Bayou residents, particularly since mechanization of the cotton crop in the mid-1960s had left thousands of families with no income. A 1967 investigation of the health of Delta residents by a team of six physicians discovered widespread malnutrition among children. They reported that children were dying from hunger and malnutrition. Geiger wrote prescriptions for food to make the point that traditional public health measures such as vaccinations or treatment for tuberculosis would not cure a fundamental need for basic socioeconomic measures like food and income.75 Geiger explained,
We decided that we had to do something more than keep treating individual cases, and that the first problem we had to address was the lack of food. And so, in the absence of any other resources, whenever we saw a child suffering this combination of infection and malnutrition, we wrote prescriptions for food: RX, so much milk, so much meat, so many vegetables, so many eggs.76
By the 1950s and 1960s, as the cotton harvest mechanized and white plantation owners saw no economic incentive to provide medical care to blacks who lived on their land, many rural African Americans went completely without health services. Often they were also without basic transportation to get to a hospital even if one existed in their area.77 Few white physicians worked in rural black areas, and those who did often neglected poor blacks. Hospitals that did serve African Americans often turned poor patients away if they could not pay. Health insurance was largely unavailable to blacks because of discrimination by national insurance companies like Metropolitan Life.78 As Dr. L. C. Dorsey, civil rights activist and director of the Delta Health Center in the 1980s, explained, “Doctors on plantations found conditions so unpleasant they didn’t want to treat African Americans. Health care for poor people and poor black people was dependent on home remedies.”79 Richard Hall, a reporter writing about the Tufts-Delta Health Center for Life Magazine, observed that “blacks in the farm country outside Mound Bayou were accustomed to suffering the pain of their illnesses until it became unbearable. Only then would they seek out a doctor. Even if the doctor was black, he would frequently demand payment on the spot; and if he was white, he would often only talk to them across a desk, asking questions.”80
There were other social factors stemming from within black communities that also prevented Delta residents from accessing institutionalized health care even when it was available. Many African Americans expressed a strong personal preference for local black midwives over white physicians. This preference can be traced to the legacy of African American health care practices under slavery, which included traditions of lay midwifery among African American women. These traditions continued into the Jim Crow period as black lay midwives still provided the greater part of health care for their communities. The preference for midwifery eroded, however, in the first half of the twentieth century through a complex interaction between public health policymakers and physicians who barred local black midwives from medical practice through a system of regulation and forced “retirement.”81 African Americans in the Delta were also frequently distrustful of white health care providers because of medical abuses—particularly after the Tuskegee (Alabama) experiment (1932–1972) and the high incidence of involuntary sterilizations were revealed in the 1970s. Distrust of the medical establishment needed to be addressed before African Americans would use mainstream health services in large numbers. As Dorsey recalled of the 1970s, “Black people were suffering from the aftershocks of the Tuskegee experiment. . . . I thought it would be real easy to tell people, ‘you got free health care,’ but many of them were suspicious.”82
The Tufts-Delta Health Center example suggests that African Americans needed to become agents in the provision of their own health care in order for health care institutions serving poor blacks in the South to succeed and thrive. Community control over the health center fostered a strong sense of personal and community empowerment by providing the opportunity for local blacks to command the expansion of an entire nexus of interrelated health care services that embraced reproductive health, sanitation, housing, education, and jobs. Empowerment was linked to the creation of services by and for the community, rather than the imposition of services on the community by outsiders. Local blacks also capitalized on their involvement with the health center and with professionals who could help residents pursue opportunities well beyond the area served by the health center. An office of education associated with the health center helped local students apply to college and professional schools and helped find information on scholarships. Health center staff also offered high school equivalency and college preparatory classes at night; these courses were accredited by the local junior college. Many of those who attended and/or worked at the health center went on to further their education elsewhere. Staff could also get college credit by working at the health center if they attended the local junior college. Others trained for professional jobs at the health center, such as librarian or medical technician or assistant. A few local employees went on to attend nursing or medical school or to receive training in social work, psychology, pharmacy, or education. The health center fostered an environment that encouraged the pursuit of opportunities that had been markedly absent from black Delta residents’ lives up to that point.83
Other health centers in the country also brought community members into the medical field by training local residents for jobs. The Mile Square clinic in Chicago employed 271 people, three-fourths of whom were local community members. Many of these local employees, as at the Tufts-Delta Health Center, were outreach workers hired to accompany a public health nurse on home visits. These visits were meant to attract “people into the center who have difficulty understanding the importance of health care.” Training for community members cost money, of course, but architects of the community health centers believed that community involvement as well as jobs that provided a living wage fostered community health.84 In addition to explaining the need for health care to a local population often suspicious of health care professionals, outreach workers followed up on missed appointments, helped people understand the importance of nutrition to good health, and aided people with problems associated with their welfare payments, housing, or jobs.85 An OEO-supported health center in King City, California,