Lee County, Arkansas, is 200 square miles of flat farmland on the bank of the Mississippi River in the mid-South Delta. Seventy miles to the northeast, across the river, is Memphis, Tennessee; 120 miles to the west, Little Rock.
Of Lee County’s 18,000 inhabitants, over half are poor and about sixty percent are black. About a third of the population-lives in Marianna, the county seat and only settlement with more than 300 residents.
On the outskirts of Marianna, in a field near an okra shed, stands a low square brick building — the Lee County Cooperative Clinic. An unusual health-care facility, it primarily serves the poor, and is one of only a handful of American rural health centers which attempts to provide comprehensive services. It is also unusual because it has been controlled from its inception entirely by the people it serves. But it is perhaps most unusual because of the central role it has played in changing the political and social outlook of Lee County.
The clinic exists, in large part, because of a pilot VISTA (Volunteers in Service to America) health project assigned to the county in August, 1969. As a doctor fresh out of internship, and the only physician in VISTA, I joined the project, along with my wife, Janet (a child psychologist), a nurse, and four other volunteers who had been given some basic training in health or community development-related areas.
We had no specific assignment when we arrived in Lee County, other than to learn our way around and meet some of the prominent citizens. We found an area largely bypassed by the civil rights movement. Ten years after Little Rock, de jure school segregation persisted in Lee County. Nearly two years after Dr. Martin Luther King had been gunned down only seventy miles away in Memphis, there was no evidence of his movement in Lee County. There was no SCLC chapter. There was, to be sure, an NAACP chapter, at least on paper, but it was all but invisible. It had been three years since Winthrop Rockefeller, a moderate Republican, had replaced Orval Faubus as governor of Arkansas, thus making the state a charter member of the “New South.” But in Marianna, County Judge Haskell “Hack” Adams led an all-white county government that kept Lee County squarely in the ranks of the Old South. Adams, who once indicated to a visiting journalist that he thought blacks were genetically indolent and irresponsible, most symbolized the attitudes of the ruling whites.
As we drove around the county, we viewed a scene archetypical of rural poverty in the cotton South. Outside of town, there were scattered plantation houses, usually large, brick ranch-style structures owned by white gentlemen farmers. Down the road from a plantation house was, typically, a collection of tumbledown wooden shacks inhabited by the black field hands. Sometimes, instead of wooden shacks, there were small whitewashed cement-block houses.
The homes of the black farmers who owned or rented a small piece of land were generally indistinguishable from those of the field hands. Living in similar shacks were the elderly blacks and poor whites too old to farm and too unschooled to do anything else, who lived on social security checks or on food stamps or, seemingly, on nothing at all. Typically, their houses were located on dirt roads that became impassable when it rained. Paved roads were few. Indoor plumbing was a rarity.
In Marianna, blocks of middle-class white homes alternated with blocks of blacks’ unpainted shotgun houses which could have been moved in from the country. The few middle-class black houses were often owned by workers at the Douglas and Lomason auto seat-cover factory, the county’s only industry. A statue of General Robert E. Lee, after whom the county was named, watched over the courthouse square.
Health care in Lee County was not plentiful, even for those who could afford it. Of the four doctors in Marianna, all general practitioners, one was in his mid-sixties, another in his mid-eighties. Counting all four, the physician-population ratio in the county was about a fifth of the US as a whole. The new twenty-five bed Lee Memorial Hospital had been built largely with federal funds. A county health department, staffed by an elderly public health nurse and a younger part-time public health nurse, provided wellchild and prenatal care, and VD treatment. The nearest “charity” hospital and clinic for the poor was across the state line in Memphis.
Dr. Dwight Gray - one of the four doctors, and a prominent citizen taught me what Lee County was about. When I first met him, he leveled with me as a fellow Southern doctor, one of the clan. “Feller from Pennsylvania was visiting down here a couple of weeks ago,” he said. “Wanted to know why I’ve got segregated waiting rooms. I told him it was because that’s what the colored folks want.” He paused. “He just didn’t understand,” he added with a wink. I was beginning to understand.
As our first activity, the VISTAs organized four Neighborhood Action Councils (NACs), local grass-roots organizations that would represent the area in OEO* programs which had just become available to the county. One of the NACs was to be centered in Marianna, the others in small communities in three corners of the county. Knocking on doors, making announcements in churches, putting signs in store windows, we recruited people to NAC meetings which discussed local problems and their possible solutions. Talk at our meetings generally turned to health, not because it was necessarily the most important problem faced by the county’s poor, but because a VISTA team was now available to attack it. The leading health problem, it was generally agreed, was the lack of a place where poor people could go when they were sick.
Stories abounded of people turned away from the hospital or doctors’ offices because they lacked the means to pay for their care. Most people, however, knew better than to seek medical attention when they had no money. At one NAC meeting, I asked how many people had ever needed medical care but failed to go to the doctor because they could not afford it. Virtually all of the fifty or so people in the room raised their hands.
The VISTAs had been discussing health issues among ourselves, and we were committed to the idea of a community-controlled clinic. The legislation establishing OEO had called for “maximum feasible participation” of the poor in projects sponsored by the agency, but there was no consensus as to what this meant. “Community control” often existed more on paper than in reality. Now that the demand for a clinic in Lee County was apparent, we began to discuss at NAC meetings how such a facility should be planned and run by the people it served.
Why community control? There were several reasons. The first had to do with insuring the appropriateness of the services to be provided. The rural poor understood their own needs and priorities better than we, a group of urban professionals and middleclass college graduates, possibly could.
A second reason related to breaking the “cycle of poverty” in which perhaps half the citizens of the county were trapped. Generations of blacks in the Delta had depended on the charity of wealthy whites for much of their livelihood. If they were field hands, they lived in shacks provided by the plantation owner. Their kids wore his children’s discarded clothes. If they needed to see the doctor badly enough, the plantation owner would pay the bill or the doctor would take on a “charity case.” More recently, this patronage had become institutionalized as welfare and food stamps. The poor survived, but just barely, and only at the sufferance of the rich.
If people were ever to escape from poverty, we thought, they needed to get control of their own lives. It would not be enough simply to have health care, or other services, available; people needed to gain some of the self-esteem that accompanies the ability to dictate one’s own destiny. Poor people needed broader political power, the chance to elect public officials, the opportunity to have a voice in the operation of the schools, the ability to direct public services, the power to have a meaningful voice in the daily affairs of the county. An organization built around health care could, we hoped, tackle other issues; it could serve as the basis for a successful political organization. If people saw that they could work together to gain control of one aspect of their lives—if they could develop and run their own health care facility then they could take collective action in other areas as well.
The idea that the people who used a clinic should dictate such matters as hours of operation and fees to be charged made sense to the NAC members. By November, the four NACs had each elected two representatives to the eight-member Board of Directors of the unborn Lee County Cooperative Clinic. The board applied to OEO for an operating grant for the clinic, but the chances of approval appeared no better than fifty-fifty. The board, therefore, launched a community fund-raising effort to start the clinic on a shoestring if necessary.
In the meantime, we had begun running a “clinic” from my car, making house calls. This helped us develop relationships of mutual trust between the VISTAs and the poverty community. I had also applied for membership in the four-member Lee County Medical Society, because membership carried with it staff privileges at Lee Memorial Hospital. But by now, the local doctors no longer considered me a member of the clan. By majority vote, I was refused medical society membership and the use of the hospital, including its laboratory and x-ray facilities.
By mid-November, 1969, the story of the rejection hit the papers. “Medical Society Locks Out Physician To Poor,” read a headline in the Memphis Commercial - Appeal. “Dr. Mac McLendon, a Marianna physician, said the medical society refused Dr. Blumenthal admittance partly because he had ‘agitated’ local Negroes to demand more rights.” In a subsequent newspaper story, Dr. Gray explained, “We object to a group financed by the federal government coming into the community and, in effect, practicing medicine as a group.”
Over the next few years, similar situations would emerge in places such as Epes, Alabama; Holmes County, Mississippi; and Franklin, Louisiana. Southern rural doctors were concerned about shortages of health services in their communities, but they were more concerned about maintaining the existing health care delivery system and the existing political power structure. Government-financed doctors and clinics controlled by poor people, particularly by blacks, were not welcome. Organized medicine, which maintained control of hospital privileges and licensure, and which could often veto federal projects at the local level, could erect formidable roadblocks to innovative health care programs, if not destroy them altogether.
National media coverage of the Lee County situation soon led to rapid polarization of the community. The pharmacists, the minister of the First Baptist Church, some of the large farmers, and other white establishment figures lined up publicly against the VISTA project and the proposed clinic. The black community, on the other hand, solidified its support. The fund-raising drive produced nearly $2,000, mostly in one and two dollar donations contributed at church functions. Attendance at NAC meetings grew. The poor, who had for so long been recipients of paternalism and the beneficiaries of occasional charity, began to realize that the Lee County Cooperative Clinic would not come into existence of its own accord, the way other government programs had. A struggle would be required.
The board of directors of the clinic appointed a committee to negotiate with the board of directors of the Lee Memorial Hospital and the medical society for staff privileges for me and future clinic doctors. When it became apparent that the negotiations were at an impasse, a class action suit was filed in federal court, with the patients of the Lee County Cooperative Clinic as plaintiffs.
The Clinic Opens
OEO granted initial funding for the Lee County Cooperative Clinic (a relatively miniscule $39,875) in December, 1969, after three board members and three VISTAs went to Washington for a day to lobby the agency’s officials. We were pleasantly surprised and speculated that perhaps OEO thought things could be kept quiet in the Delta by infusing a bit of health money. If that was the reasoning, the agency could not have "been more mistaken.
In February, 1970, the board of directors selected as clinic administrator Oily Neal, Jr., a twenty-eight-year- old black who had been born and raised in Lee County. With only three years of college and no formal training in health administration, he appeared, on paper, less qualified than the other applicants for the position. But none of the others had ever lived in Arkansas, and Neal knew Lee County and its people; he could learn administrative functions quickly, and he was an incredible organizer.
Like other young blacks with ability or ambition, Neal had left Lee County years before to seek his fortune in the city. And like others, he had become disillusioned with urban life. But there were few opportunities in the country — one could become a teacher, a preacher, or a farmer. So, Neal had become part of the rural “brain drain.” The job as administrator at the Lee County Cooperative Clinic gave him a chance to come home. He quickly became a major force in enabling the clinic to survive and make an impact on the county.
The clinic opened in March, 1970, with a staff of seven employees in addition to the VISTAs. It attempted to provide “comprehensive” services — more than medical care — for it was clear that malnutrition, poor sanitation, inadequate housing, lack of transportation and poverty itself caused the poor health of the low-income population as much as did the inaccessibility of doctors. To combat malnutrition, the clinic assisted people in registering for the food stamp program, despite an often apparent desire by the local food stamp office to reduce its rolls. In addition, the clinic provided outreach and home care through three “neighborhood health aides” (local women trained by the clinic); transportation via a single van and driver; and assistance in constructing sanitary privies and doing home repairs from a VISTA experienced in this area. At the same time, I saw about thirty to forty patients a day in the clinic.
The volume of services we could provide was minute compared to the need, but it established the principle of providing comprehensive care. We specifically wanted to start small, to begin with a facility that could be effectively governed by a board of unsophisticated community people. Other OEO health centers, rural and urban, were multimillion dollar facilities run by universities or health departments with community “advisory boards” which were to be phased in as governing boards when and if they gained the necessary expertise to run a large center. We thought it far preferable for the community to govern fully a small facility from the beginning and for the clinic to grow as the board and the community grew in sophistication.
The clinic’s bylaws defined it as a cooperative, with each registered patient a member of the cooperative and a part-owner. At an annual membership meeting, the administrator and medical director would report on the clinic’s progress, plans, and financial status, and elections for the board of directors would take place.
Neal’s commitment to this approach was total, and his organizational efforts on its behalf, tireless. He talked to people about the clinic - what it was, and what it could be — in his office, at NAC meetings, at board meetings, and in the little country bars that dotted the county. And sometimes there was a political message in what he said: if the county officials did not support this clinic, then perhaps replacing them would have something to do with health.
The clinic opened in a rented fiveroom house. Finding a place to rent had been difficult. Several vacant white-owned houses and offices, and even the abandoned Missouri-Pacific railroad depot, had suddenly become unavailable when the VISTAs had attempted to rent them as a clinic building. The five-room house belonged to the town’s black funeral parlor director, one of the few wealthy blacks in Lee County.
In July, 1970, I had to leave Lee County to serve in the US Public Health Service, an obligation I had incurred in order to avoid the draft. Our major anxiety was alleviated when Dr. Ralph Wolf — a young physician recruited through a poster displayed in in a New Orleans hospital — replaced me. In September, when OEO increased the budget to $120,000 for the next year, the Neighborhood Action Councils voted on what new services should be added.
The summer of 1970 also marked the appearance of the Concerned Citizens of Lee County, a political organization whose leadership largely duplicated that of the Neighborhood Action Councils. As its first effort, the new organization sponsored a slate of seventeen black candidates for Marianna and Lee County offices in the November elections. It was the first such slate to appear on a Lee County ballot since Reconstruction, and excitement ran high at the clinic — at least until election day. All but four of the black candidates lost, and those four were elected to Justice of the Peace seats (similar to county commissioner), the least powerful of the positions sought. The black candidate for County Judge had lost by 400 votes out of 6,600 cast. The election was marred by some intimidation by whites of black voters at the polls while the sheriff looked the other way, but while these incidents left a bad taste in the mouths of black voters, they probably had little effect on the outcome of the election.
Despite the losses, signs of black political power were evident. The Concerned Citizens’ candidates had run as Republicans in order to avoid a primary contest with the Democratic incumbents. The black Republican vote, combined with the votes of ticket-splitting whites, had enabled the Republican Winthrop Rockefeller to carry Lee County in his race for reelection as governor. It was one of the very few counties he carried, as Democrat Dale Bumpers won in a landslide.
The appearance of a black slate of candidates kindled racial fears in the whites of this majority-black county; at the same time it gave the black community a feeling of some potential political muscle. Then, in April, 1971, the white power structure suffered another jolt when the Lee Memorial Hospital Board agreed to an out-of-court settlement of the clinic’s suit demanding hospital staff privileges for clinic doctors. The hospital consented to the agreement when it realized it would lose its suit if it went to trial.
Three months later, Quincy Tillman, a young black social worker employed by the county welfare department, got into an argument with a white counterman over what flavor of pizza she had ordered. The dispute grew heated and Tillman was arrested. In days gone by, the incident might have been overlooked, but now the black community, particularly the Concerned Citizens, was in no mood to ignore further injustices. The Concerned Citizens proclaimed a boycott of all white-owned downtown Marianna businesses and declared that the boycott would continue until a list of forty-one demands, mostly for more jobs in both the private and public sectors, was met.
By January, 1972, a dozen stores, a third of the downtown business district, had closed. Racial tension ran high and spilled into the school system when black students in the newly integrated high school demanded of the white superintendent of schools that the birthday of Dr. Martin Luther King, Jr., be declared a school holiday. Refused, the black students — eighty percent of the enrolled students — walked out of school en masse and began a protest demonstration. The police and fire departments arrived, turned a fire hose on the students in sub-freezing weather, and arrested one hundred of them. With injury added to insult, the black students declared a school boycott that lasted the rest of the term.
For the first time since the organized black political activity had begun in Lee County, violence reared its ugly head. County Judge Adams, driving a pickup truck, narrowly missed running over two black boycott picketers on the sidewalk in downtown Marianna. (Later, he testified that his brakes had failed.) When the two picketers went to the county courthouse to file charges, Adams threatened them with a pistol. Cooler heads restrained the County Judge and he was eventually arrested, convicted of assault and carrying a prohibited weapon, and fined $100.
Subsequent incidents were more serious. The house of one of the boycott leaders was fire-bombed; shots were fired at another boycott leader. In January, the headquarters of the Concerned Citizens was burned; the fire spread, destroying ten businesses, seven black-owned, three white-owned. Another white-owned store burned a few weeks later. A white deputy sheriff was shot at and his house fire-bombed. A shot was fired at the president of the school board. Miraculously, despite the numerous incidents, there were no deaths, no serious injuries.
White attention focused on the Lee County Cooperative Clinic, and on Oily Neal, Jr., in particular, as the moving force behind the boycott. Said a white shopkeeper, whose store had been put out of business by the boycott, “I’ve been in this business thirty years in this one building, and we never had any trouble until they (the clinic) came in here.” The head of the Lee County Farm Bureau added, “Oily Neal is involved in a lot of racial things. He headed the boycott, led people to school board meetings and he was instrumental in the store burnings, although I can’t accuse him individually of doing it.”
As a clinic administrator, Neal was more than a paper-pusher. He was an organizer and an articulate spokesman for the black cause. But Neal did not have to head the boycott, lead people to school board meetings, or burn buildings. The black political organization did exist largely because of Neal’s organizational efforts on behalf of the community-controlled clinic, but the organization thrived in response to the opposition of the white establishment to the clinic. The boycott had been called as a result of years of bitterness on the part of blacks over their denial of entry into the county’s political and economic system. And the violence stemmed from that bitterness, and from the whites’ reaction to the sudden threat to their dominance.
The white establishment complained to Washington about the clinic’s assumed role in the boycott and the county’s politics, and Washington responded by investigating and auditing the clinic and its funds, the VISTAs, and Neal. No wrongdoing was found.
The clinic, meanwhile, expanded its staff and patient load. In 1972, OEO approved a funding request for $1.2 million for eighteen months. The grant would be enough to buy some land and construct a new building; to make the transition from clinic to comprehensive health center; to provide a volume of services more commensurate with the need. The white establishment was appalled that this thorn in its side would suddenly acquire a budget larger than that of the county government itself.
The Lee County White Citizens Council filed a suit in federal district court to block the grant. The suit focused on the VISTAs, charging that, “Because of the clinic’s association with...VISTA, it has shown what appears to be a subversive attempt to overthrow or replace the presently constituted Lee County government with that of one controlled by blacks. In the past, VISTA has, by encouraging blacks and whites to participate in psychodelic [sic] parties and other mixed racial social events, fomented and disturbed racial relations in the county.”
Meanwhile, State Representative J. B. Smith and School Board President Lon Mann pressured Governor Bumpers to exercise his power of veto over the HEW grant, or to approve it only on the condition that the clinic board be reconstituted to give the whites control. Bumpers temporized, trying to strike a compromise in the politically volatile situation. He summoned Neal and several members of the clinic Board to Little Rock and explained to them that he might be forced to cut off clinic funding if they would not consent to reconstitute the Board. Mrs. Emma Glaspy - a frail, middle-aged black woman from the tiny Lee County community of Brickeys, who might have been voted “the Board Member Least Likely to Stand Up To the Governor of Arkansas” — responded for the Board. “Mr. Governor, we understand your position, and we sure do need that money, but we just can’t give our clinic away.” It was a position that could only have been taken by a clinic board that had started penniless and knew it could go back to being penniless if it had to.
Besides, there were, perhaps, other resources, albeit small. As a start, Joan Baez accepted a clinic request to give a benefit concert in Memphis and raised about $6,000. Then in the spring of 1972, Bumpers finally managed a compromise: the clinic board would be enlarged by five members, giving the county fathers a minority interest in the facility. The bargain enabled the Governor to approve the grant without completely losing face. At the same time, he declared that “I wholeheartedly support the clinic,” provided there was no “agitation” and no violation of federal requirements. Of the five new white board members, only one - a maverick who actually supported the clinic - participated in board affairs.
The summer of 1972 brought a resolution to what had seemed an interminable struggle, and marked the beginning of a new chapter in the history of Lee County and the clinic. The school boycott ended as school let out. Moreover, the superintendent of schools resigned, removing a focal point of the boycott. The economic boycott of the downtown businesses, after sputtering for several weeks, was officially terminated on July 26 by the Concerned Citizens. The forty-one demands had not been met. The administrator of the Lee Memorial Hospital resigned and was replaced by Ken LaMastus, a white moderate who immediately set about repairing relations with the clinic. And the clinic began construction of its new 7,000 square-foot building.
Some things did not change. In November, a slate of black candidates once again ran and failed to capture any of the major county offices. Two years later, Oily Neal, Jr., ran for the State Legislature; he, too, lost.
But the threat to the white business and economic community was diminished, as was the threat to the clinic. With the lessening of the threats came a lessening of the overt racial tensions. In 1974, more moderate whites replaced County Judge Adams and Sheriff Courtney Langston, symbols of hard-line white dominance. And in 1975, the Memphis Commercial Appeal wrote, “The Lee County Cooperative Clinic, once clearly a symbol of racial strife and violence, is now as clearly an accepted part of (Marianna).” Perhaps symbolic of the clinic’s acceptance was the small sign in Neal’s office proclaiming the clinic to be a member of the Marianna- Lee County Chamber of Commerce. Neal himself, declaring that the now million-dollar facility required a more highly-trained administrator, resigned his position to become director of the clinic-affiliated Demonstration Sewer and Water Project which he had been instrumental in establishing to build sanitary water supplies and sewer systems for rural Delta homes.
Acceptance did not spell an end to the problems faced by the Lee County Cooperative Clinic. Foremost was the problem of recruiting and keeping physicians. Most doctors are trained and socialized in medical school to become private specialists in the suburbs, not salaried primary-care providers serving the rural poor. The new building had been constructed to accommodate four doctors, but at times staffing dwindled to as little as one doctor and one physician’s assistant.
Second was the problem of maintaining adequate funding. HEW, which had taken over OEO health programs, increasingly stressed private-practice medical models at its health centers, both urban and rural, cutting back on outreach services and on programs which attacked the health-related problems of sanitation, nutrition, transportation, and housing. Neal’s tenacity in dealing with federal officials (“You’ve just got to out-argue the sons of bitches”) played a key role in preserving support for the full range of services offered by the clinic. Still, the clinic became less comprehensive year by year.
Nor did the end of the racial conflict in Lee County and the end of the threats to the clinic’s existence signal an end to the problems of the county’s poor. No doubt, health care had improved markedly. Some inroads had been made into the health-related problems that the clinic’s broad range of services was designed to attack. But the poor were still poor.
When the VISTAs began organizing around the prospect of a clinic, we were engaged in a war on poverty. We were not running a poverty program; we were running an antipoverty program. Viewed from a distance, it is clear now that a community-controlled clinic in one county cannot lead to the elimination of health problems or poverty. But the clinic did far more than make the poor of Lee County a bit healthier. The clinic helped create a new psychology in the county, a change in the collective consciousness of the black and the poor community. By working together, the poor got something — a clinic — that they did not have before. In doing so, they had acquired enough power to make some changes in the county, enough to gain the respect of the establishment and, more importantly, enough to gain self-respect.
The white community, too, changed. No longer could the black majority be overlooked or dismissed with a glib, “We ain’t got no race problems here.” Whites gained, if nothing else, a new appreciation of what it meant to be a black in the Arkansas Delta. Even State Representative Smith, who had led the white effort to close the clinic in 1972, was able to say in 1975, “Our community is a lot better today because of the boycott and what we went through then.” It was an incredible statement.
I returned to Lee County for the first annual membership meeting of the clinic in November, 1971, and for the sixth annual meeting in November, 1976. The first meeting drew over 600 people. The clinic was under attack then, and the community was rallying to its support. In 1976, fewer than 100 people attended the meeting. To the outsider, the sparse attendance might have signaled a loss of support for or interest in the clinic. But the clinic had, by then, become an established part of the county, and a visible show of support was no longer needed. The clinic had served out its role as a focal point for change in Lee County. It was still more than just a health care facility to the community it serves, but it was no long an institution of social upheaval. The 1960s were finally over. Lee County, with the rest of the country, might or might not move further ahead in the 1970s, but it could never go back.
*the federal Office of Equal Opportunity