This article originally appeared in Southern Exposure Vol. 6 No. 2, "Sick for Justice: Health Care and Unhealthy Conditions." Find more from that issue here.
A meeting held the night of Friday, March 10, 1978, at Meharry Medical College in Nashville, Tennessee, was delayed for over an hour because of a bomb threat. Those attending were then warmly welcomed by Lloyd Elam, MD, President of the College.
What kind of medical college gets bomb threats? What kind of meeting does it hold which precipitates a bomb threat? What kind of college president gives a rousing statement supporting the students for holding that meeting? What kind of Friday night event attracted persons so used to bomb threats that, once evacuated from the building, they stood outside and burst into group singing — the commonest word heard being “Freedom”?
The meeting was the opening session of a Conference on International Sports, Politics, Racism and Apartheid, held to express solidarity with the suffering black people in the ghettos and mines of South Africa, to back the United Nation’s condemnation of the racist South African government, to demand cancellation of the Davis Cup tennis matches between the South African and US teams to be held in Nashville at Vanderbilt University, March 17-19. The demonstrations and protests that next weekend were the greatest outpouring of US and world protest against the hypocritical racist policies of the South African government in recent years.
Meharry faculty and housestaff provided health services during the protests and in so doing demonstrated agreement and involvement.
Dr. Elam attended every session of that weekend conference, and spoke clearly and movingly of its importance. He recounted the insults he had personally experienced during a recent official trip to South Africa. He welcomed the official United Nations representatives who informed most of us for the first time of the numerous General Assembly Resolutions opposing the quasi-slavery (Apartheid) of South Africa, including the importance of expelling South Africa from international sports events. In 1977, Vanderbilt University earned $1.4 million from its investment in corporations doing business in South Africa, where whites are paid on the average seventeen times more than blacks. The meeting was thus particularly critical of Vanderbilt University for its persistence in hosting the tennis matches despite world-wide shock and protest.
Was this event a freak? How did a medical school, from its president on down, get involved in protesting racism in South Africa? How had the school, its students and faculty responded to the challenges of segregation, impoverishment and discrimination in the past?
Meharry’s president, Lloyd Elam, and the life of his institution gives us much insight into the answers to these questions. Dr. Elam is Afro- American, the son of a Little Rock, Arkansas, carpenter. His mother taught him at an early age that the family should walk whenever they went anywhere, rather than ride on the city’s segregated street cars and buses.
Dr. Elam, like Meharry, had battled racist odds to survive through the years. In 1976, he reflected on the Meharry mission as the college celebrated its hundredth year of operation: “Meharry Medical College enters its second century with a tempered confidence. So long as poor and sick people are denied care that means health and life, we know how steep the climb will be. We can help meet the vast and complex need only by learning how better to deploy skills equal to the tasks.
“We have come through the worst of times. We inherit the tradition that trained emancipated slaves to be physicians and dentists.”
A Need For Healers
Black people called doctors have been identified in the United States as early as the seventeenth century. By the 18th century, slaves, especially males, were forbidden the healer role by law in most states. The reasons were political, cultural and simple fear they would poison their masters.
Whites also knew that healers’ mobility among the black populace might aid potential slave insurrection. For example, the Tennessee Court ruled in 1844 that slaves could not practice medicine because “such doctors might foment insurrection,” and fined a plantation owner for allowing such a practice.
When the Civil War broke out, Union troops occupied Nashville and remained there until the war was ended in 1865. The emergency needs of the sick, malnourished and war injured, combined with yellow fever, cholera, smallpox and other epidemics. Endemic diseases such as malaria, typhoid and dysentery continued unabated. As the decade wore on, these conditions helped some whites recognize the need for blacks to receive medical training.
Meharry Medical College grew out of an unusual set of post-Civil War circumstances. George W. Hubbard, a white Northern Army Medical Corpsman, stayed in Nashville after the war ended and attended Nashville Medical School, which later became Vanderbilt Medical School. He was offered the opportunity of adding a Medical Department to Central Tennessee College, a college for freed slaves begun in 1866, by the college’s president, John Braden.
In October, 1876, Hubbard joined with W.G. Snead, a former Confederate Army Surgeon, and seven parttime white doctors, under the sponsorship of the Methodist Episcopal Church. Financial assistance for the project came from the Meharry brothers, five Midwestern abolitionists of Irish ancestry. The school began educating former slaves and children of slaves. Meharry’s early graduates returned to the disease-ridden city streets and the impoverished countryside of the post-Civil War South.
When Meharry began, it consciously rejected the goal of merely training what we now think of as licensed practical nurses or lower level health workers. Meharry’s early striving for both equality and excellence grew out of the expression attributed to W.E.B. Dubois that black people should be able to do anything as well as white people. Meharry’s mission focused on enabling black people to become both community leaders and medical practitioners. The founders hoped that the religious aspect of healing would be expressed; as a result many of the graduates were ministers or highly religious physicians.
Meharry graduates later confronted head-on the dilemma posed by the debate between W.E.B. Dubois and Booker T. Washington concerning the proper role for blacks in changing a racist white society. Every activity in a black doctor’s life presented the challenge: whether to compromise with white society or stand for civil rights. White doctors would not see black patients in their offices, except perhaps during segregated hours and in a separate, undersized waiting room. Hospitals would either not admit black patients or have a special ward in the basement for blacks, obviously inferior to the services and facilities for whites. In these circumstances, the black doctor had to be willing to suppress many normal attitudes of self-respect and independence. To get through medical training required financial and other kinds of support from white men with power in the community. And those allowed to graduate were expected to play the role of the educated “pacifier,” to insure that lynchings, beatings, robbings, and various other misdeeds done to the black community did not elicit reprisals.
Black doctors patched the walking wounded and did their best to keep society stable to avoid conflict and trouble. Technological knowledge and skills were stressed at Meharry. Hard work with no relief became the lot of the college’s graduates. In the cities, they developed Negro hospitals to counter the segregated wards of the white hospitals. Many Meharry graduates were never able to obtain hospital privileges in white health care institutions. But black people in the South were in desperate need of health care services and they proudly embraced their own providers.
In 1877, the South’s long dreamt of black medical college graduated its first class. By 1882, the graduating class numbered eight, and among them was Robert F. Boyd, perhaps the greatest Meharry graduate of the nineteenth century. Dr. Boyd was the first black doctor to open a private practice in Nashville. He helped found the National Medical Association (NMA), the first organization of black physicians in the United States, and became its first president in 1895. The NMA was founded because the American Medical Association (AMA), and almost all state and county societies persistently banned black physicians from membership. As Meharry’s first professor of hygiene, Boyd wrote an important paper entitled, “What are the Causes of the Great Mortality Among the Negroes in the Cities of the South, and How is that Mortality to be Lessened?” — a question which our present medical establishment has yet to answer. Boyd invoked the goddess of health (Hygeia) and pointed to overcrowding, unsafe working conditions, impure milk, spitting in public, improper diet and lack of health education as the answers to his question. This was the best public health thinking of his time.
In addition to his medical practice and health education activities, Dr. Boyd headed the Nashville Anti- Tuberculosis Association, a chapter of the first voluntary health association in the United States. In responding to the challenge laid down by W.E.B. Dubois, Dr. Boyd did not eschew politics. Even during the dark days of the Ku Klux Klan and racist power, Boyd ran for mayor of Nashville in order to bring the needs of the black community to the public eye.
By 1910, the waves created at Meharry and its sister school, Howard in Washington D.C., were rippling across the South. There were now seven black medical schools including Flint in New Orleans, the University of West Tennessee in Memphis, the National Medical College in Louisville and Shaw Medical College in Raleigh. During that year, Abraham Flexner published his widely touted report on medical education in the United States, with the support of the Carnegie Foundation. The Flexner Report had many important insights, but it also sounded the death-knell for the growing black medical education network and laid the groundwork for consolidating Southern medical education in the hands of a small number of elite white medical schools closed to black students. Only Meharry and Howard survived, as the number of black doctors dropped dramatically.
In spite of the glimmer of hope created by Meharry’s stubborn survival, its efforts in health care delivery and medical education were but a drop in the bucket, as all health indicators continued to reveal the South’s and the nation’s shameful neglect of black people.
Black Health Today
Practically all major indicators in health, health service and health personnel are much worse for blacks than for whites. Infant mortality, that inescapable indicator of the public health status of a population group, remains strikingly adverse for black Americans. The American Public Health Association’s Health Chartbook shows the 1971 black infant mortality rate as 30.3 deaths per thousand live births, almost double the rate for the white population.
Black youth is similarly ravaged. Today’s violent urban environment subjects black people to a disproportionately high risk of death from homicide or suicide. High unemployment and dead-end ghettos breed and spread devastation from drug addition, theft, juvenile delinquency and unwanted pregnancies.
Statistics on black participation in the health care system are equally dismal, in spite of the progress that has been made. Although over 350,000 black people worked in health-related jobs during 1970, two thirds of them worked in lower paying positions as orderlies, attendants, nursing aides and practical nurses. That same year, there were only 16,000 black physicians to serve the country’s 22,000,000 blacks.
In response to the deteriorating health conditions of blacks in America and the continued strict segregation within the health care industry, Meharry was swept up by the inspired winds of the civil rights movement. Throughout the late 1950s and ’60s, many Meharry medical students and faculty joined in the sit-ins, freedom rides, desegregation of health services and other civil rights demands. In 1966-67, a faculty renaissance occurred on the Meharry campus with the appointment of Dr. Lloyd Elam as college president. “It is ironic, yet appropriate,” he said, “that out of a past stained by discrimination and poverty this college should emerge as a national leader in the movement to bring medical and technological excellence into an equitable balance with social needs.”
During this same year, Dr. Elam helped to convince me to come and help realize the new Meharry “mission”. Previously, I had worked with the United Mine Workers Welfare and Retirement Fund in north Appalachia developing a network of community health centers. My first autumn at Meharry was marked by a visit from Stokely Carmichael which resulted in racist counterattacks and severe police brutality, especially against blacks in the college and local community. Dr. Elam withstood many pressures and pressed ahead with Meharry’s commitment to innovation in both health service delivery and medical education. To combine this dual commitment, the faculty oversaw a far-reaching series of off-campus problem-solving learning experiences. Meharry students began to shift the focus of their educational experience by developing concrete community health projects throughout the South.
Community Medicine Leadership
In addition to the Neighborhood Health Center and an on-campus reorganization of clinics into a Comprehensive Health Center, medical students and housestaff also intiated other education efforts in the community. In Rossville, Tennessee, site of the famous “Tent City” during the ’60s, Meharry and Vanderbilt students worked and lived in the black community, held health fairs, and helped to start the Poor People’s Health Clinic. In Frostproof, Florida, Meharry students helped serve a family health plan for the migrant workers and their families. And in Philadelphia, Mississippi — right down the road from where civil rights workers Goodman, Schwerner and Cheney were murdered in 1964 - Meharry medical students and residents are working to support the Indian Health Service on the Choctaw Reservation. More recently, Meharry and Vanderbilt students and faculty have helped start an occupational health project with union members in the Nashville area. An outstanding consumer-sponsored community clinic, the Waverly-Belmont Clinic in Nashville, also relies on Meharry faculty and housestaff for its medical services. And the college provides prisoners’ health services for jails around Nashville, and rural primary care services in ten counties through health department centers — an innovation for these predominantly white counties.
The Ongoing Struggle
While poverty, pollution, hypertension and cancer have been the lot of all too many people in these communities, Meharry itself has recently been plagued by serious financial problems. The institution’s rapid growth has been necessary in order to survive and compete within the burgeoning Southern medical/industrial complex. Because of the school’s sizable $30 million yearly budget, Meharry has been carrying an annual debt of $2-3 million, mainly due to hospital costs. A “cash crisis” occurred during 1977, which was mollified with federal education “distress grants” and emergency funds from HEW. Because the Vanderbilt medical center has a monopoly on funds and salaries from both the Nashville Veterans Administration hospital and the Nashville City-County Hospital, Meharry gets the short end of the city’s financial stick, in spite of its excellent service to Nashville’s medically indigent population. While this arrangement appears unfair, Vanderbilt’s power depends in part on this economic dominance, which it will not relinquish willingly. Meharry is attempting to obtain regular, on-going special Federal monies by being designated a “national resource.”
As an institution born, bred and nurtured in conflict, the key to Meharry’s long life has been its ability to thrive, learn, and grow through struggles which constantly threaten its survival. After a century immersed in the struggle for justice, the question of Meharry’s current involvement in supporting South African freedom fighters can be seen as another hopeful chapter in the life of one of our country’s most innovative black education institutions.
As Dr. Elam remarked during Meharry’s hundredth anniversary celebration, “There is a compelling obligation to conduct our programs in an atmosphere of self-criticism, hospitable to the clash of ideas in the never-ending quest for better results.”
Leslie A. Falk, MD
Leslie A. Falk, MD, is co-author of a history of Meharry Medical College, now in manuscript form. He has been Professor and Chairman of the Department of Family and Community Health at Meharry Medical College since October 1, 1967. From 1948- 1967 he was Pittsburgh Area Medical Administrator for the United Mine Workers Welfare and Retirement Fund, working mostly in northern West Virginia, Ohio and Pennsylvania. Civil rights events, especially during 1964-65, and changes in the UMWA led him back to the South where he had originally worked with migrants in Atlanta during 1947-48. (1978)