More Than Medicine. Jennifer Nelson
Freedom Project, organized for summer 1964 by civil rights groups in Mississippi such as the Student Non-Violent Coordinating Committee (SNCC), was as much an attack on southern Jim Crow culture as it was a drive for voter registration. The project brought hundreds of college students to Mississippi to help register black voters and to lend their support in the often overwhelming and exhausting effort of sustaining southern blacks to keep up the fight against embedded traditions of segregation and racial inequality.18 Over the course of the summer, white northern college students spread out across Mississippi to teach in freedom schools, register black voters, and lend a hand in local voter registration and community projects sponsored by SNCC and the Congress for Racial Equality (CORE).19
Accompanying the college students were groups of professionals, including lawyers, law students, ministers, and physicians who also traveled south but often for shorter terms—sometimes just for a week or two—to lend their professional skills and services to the movement. One group of New York physicians traveled to Mississippi for the 1964 Freedom Project with the Medical Committee for Human Rights (MCHR) to provide first aid and basic medical care for civil rights workers. Some of these physicians also felt it was imperative to help end discriminatory health practices in Mississippi. This perspective formed the basis for extending their medical contributions beyond a single freedom summer.20
The mid-1960s was a pivotal time in the civil rights movement as organizations sought strategies to energize activists increasingly skeptical about the movement’s continued progress. The 1964 Summer Project was a formidable effort that succeeded in channeling new energy into the movement and also drew national attention to continued southern resistance to civil equality. Organizers gambled correctly that by bringing elite and white northern college students to Mississippi, they would attract new national attention to the fight for racial justice. The deaths of two white middle-class volunteers, Andrew Goodman and Michael Schwerner, and one black Mississippi civil rights worker, James Chaney, brought home the high cost of that gamble; but the deaths of the volunteers also focused the attention of the nation on Mississippi and the movement for racial equality. Beyond the deaths of these three young men, 1964 was a summer of severe violence, including lynchings, beatings, bombings, and the burning of buildings. Yet, activists also began to see a transformation in the political orientation of the movement. With the passage of the Civil Rights Act of 1964 and the Voting Rights Act of 1965, many people around the nation believed the movement had achieved its goals. Of course, blacks in Mississippi knew that racial justice was still not a reality as white Mississippians mounted fierce resistance to the new federal laws. Organizations like SNCC became increasingly frustrated with the promise of integration and nonviolence and, as a result, began to focus on Black Power and Black Nationalism.21 The turn to Black Power also renewed interest in building black community control over local institutions. Demands for community control originating from civil rights and Black Power activists would be influential on NHC programs funded by the federal government.
According to historian John Dittmer, individuals with two different sets of goals contributed to MCHR work in Mississippi during the summer of 1964. Their health care work and objectives were compatible but not identical. One group focused on the narrower goal of providing medical and immediate emergency care to the civil rights workers. The other group came to Mississippi with the broader and long-term goal of eradicating and replacing the southern segregated and discriminatory health care system with an egalitarian one. The second group, led by physician activist H. Jack Geiger, who, at the time, was the Mississippi field coordinator for MCHR, extended their stay in Mississippi and in other southern states after other northern civil rights activists returned home. By the fall of 1964, MCHR activists in Mississippi had established projects to provide health care to poor African Americans and had made plans to extend the program nationally. This group of MCHR activists played a pivotal role in the transformation of health care access for the poor in the South and elsewhere in the country in the 1960s.22
As the goals of the civil rights movement shifted away from gaining the vote and ending legal segregation in the South, MCHR physicians like Geiger channeled War on Poverty funds into medical clinics in both the North and the South to help empower poor African Americans—and poor Americans in general—to become involved in their own health care improvement and delivery.23 Experience in the civil rights movement convinced Geiger that any real changes to health care delivery needed to fundamentally involve those who would benefit from the services. Thus, a few members of MCHR, founded to provide limited emergency aid to civil rights workers, expanded their goals when President Johnson’s War on Poverty offered financial support for the transformation of health care delivery to the poor.
The most successful Neighborhood Health Centers brought local residents and patients into the planning and implementation of the institutions from the very beginning. NHCs also employed residents, who often lacked a college education or even basic skills, to take paid positions as day care workers, in after-school programs, as employment counselors, in outreach programs, or as health aides. Thus, residential staff could gain skills and professional experience and even advanced degrees through the NHCs (some of whom partnered with local community colleges) that would help them to direct or manage programs within the NHCs or use their skills to find professional employment elsewhere. The goals of the NHCs surpassed the simple distribution of medical care in commodity form—to be exchanged within a marketplace that at best lowered the cost for the poor. Instead, the NHCs were designed to empower the least powerful members of society and to radically transform a deeply anti-egalitarian culture that had embedded inequalities within institutions such as clinics and hospitals.24
Although there is not one individual responsible for the creation of Neighborhood Health Centers, Dr. H. Jack Geiger was pivotal to the creation of a nationwide system of NHCs. He promoted a vision of medicine as not only a tool for individual health care but also a tool for community transformation.25 He also believed that health care could be used to promote empowerment if members of the community were given an “assured role in the design and control of their own health services.”26
Geiger imported the seeds for the community medical center that was built in Mound Bayou, Mississippi, from Pholela, South Africa, where he had traveled in the 1950s while in medical school on a Rockefeller Foundation grant to investigate a health center also funded by the Rockefeller Foundation.27 Physicians Sydney and Emily Kark had created the Pholela Health Center in 1940 to serve a Zulu “tribal reserve” that suffered from desperate poverty. The emphasis at the clinic was not merely on individual health but on promotion of health for the entire community. Kark and other health care providers at the Pholela Health Center were principally attentive to environmental factors, including sanitation, as major contributors to the community’s ill health. They also focused on nutrition and basic preventive care. Everyone in the community was considered a patient regardless of his or her ability to pay for health services elsewhere. This model was so effective that Kark exported it to other South African health centers, including one at Lamontville, a housing project outside of the city of Durban. Kark and his colleagues targeted communities with “high birth rates, high death rates, a heavy burden of both infections and chronic disease, low levels of employment, low literacy, substandard housing and nutrition, and limited medical care resources.”28
In June 1964, as a participant in the Mississippi Freedom Project, Geiger connected his experiences with the health centers in South Africa to the desperate poverty he found in the southern United States. Geiger traveled to Mississippi in 1964 as a member of MCHR, taking time off from his new position on the faculty of the Harvard School of Public Health. During his month-long stint as a doctor-activist in Mississippi, Geiger found that African Americans lived in communities that were as poor and unhealthful as those he had seen in the tribal reserves of South Africa. He wrote that he “took a long, close look at the poverty, misery, and deprivation—and, inevitably, illness—in the sharecropper shacks and small-town black slums of the Deep South.” He recognized that he didn’t have to go to Africa to find poverty, as “there was a third world in the United States.”29 Geiger and several other physicians from MCHR, together with the Delta Ministry, a Mississippi civil rights organization, committed to staying in Mississippi once the Freedom Project had ended to continue providing health services for poor African Americans.30 Several nurses also came south for the Freedom Project and remained in Mississippi to provide health care services with MCHR and the Delta