Health Center News

Book Review: Out in the Rural, A Walk Back In Time

Few may realize the remarkable history behind the Civil Rights Movement and its role in launching Community Health Centers.  The narrative of how this happened is eloquently told in a new book, Out in the Rural: A Mississippi Health Center and its War on Poverty (the title is borrowed from a short film of the same name produced in 1969).  Author and history professor Thomas J. Ward vividly deconstructs how a small group of medical students and young physicians from far-flung parts of the country organized to provide health and triage care to activists who descended onto rural Mississippi during Freedom Summer. The group, among them H. Jack Geiger, MD, called themselves the Medical Committee for Human Rights (MCHR). It was their small but fierce coalition that launched what one activist called “the medical arm of the Civil Rights Movement.”

Though initially immersed in fighting voter suppression during Freedom Summer, Ward describes MCHR’s shift from engaging in civil rights activities to improving the shocking conditions of African Americans living in Bolivar County, MS. Ward writes, “They became convinced of the inability to truly bring about racial equality without dramatic improvements in the health care of the state’s black population.” Scores of people went without medical care and struggled under poor living conditions —   living in dilapidated homes without toilet facilities or plumbing, and suffering from malnutrition. The infant mortality rate for African American children was 54.4 deaths per 1,000 live births, more than twice the rate for white children. Bob Smith, MD, a physician with MCHR, recalled:

“I understood for the first time what it truly meant to be black in Mississippi and underprivileged, and poor and without medical care, and saw people by the hundreds, and really by the thousands, go without medical care… Saw what I call a Third World Country…People had been denied benefits under Social Security… Thirty to 40 percent of children had intestinal parasites…The maternal mortality rate was out of this world.”

Image courtesy of Dan Bernstein, Southern Historical Collection, University of North Carolina at Chapel Hill.

The story of how Geiger joined with other pioneering activists, including John W. Hatch, L.C. Dorsey, and Andrew B. James, to start a Community Health Center and address the health needs of the medically underserved in Bolivar County is well established. We know the health center in Mound Bayou, now known as the Delta Health Center, was one of the nation’s first two Community Health Centers, along with urban Tufts-Columbia Point Health Center in the Dorchester neighborhood of Boston. Lesser known are the struggles, large and small, that took place on the ground, including no small amount of skepticism from the white and African American residents as these dedicated activists attempted to launch a program that reached beyond addressing basic health needs and become, as Dr. Geiger put it, “an instrument of social change.” This was the boldest effort yet to not only treat illness but to directly intervene against the root causes of it – poverty, lack of food and jobs, and poor drinking water.

“To treat symptoms, and then to send patients back, unchanged in knowledge, attitude, or behavior, to the same physical and social environment – also unchanged—that overwhelmingly helped produce their illness and do so again, is to provide antibiotics for cholera and then send patients back to drink again from the Broad Street pump.”

Programs began to take shape in Mound Bayou to target the environmental conditions affecting the community. An agricultural co-op was established to fight food scarcity, and Dr. Geiger regularly prescribed groceries from the health center’s pharmacy for malnourished families, explaining, “The last time I looked in my textbook, the specific therapy for malnutrition is food.”

Geiger and the team at the Tufts-Delta Health Center also labored to resolve the problem of unclean drinking water and sewage disposal, the hallmarks of poverty and disenfranchisement that, until that time in history, had been the status quo.  Ward offers up a rich narrative that is instructive in demonstrating how entrenched local communities and public officials can be when it comes to resisting progress.  Bureaucracies needed to be unraveled and stubborn civic leaders needed to be coaxed. History writ large can often fool us into thinking that change is immediate when people mobilize, yet this is hardly the case.  Ward provides the context, the small skirmishes, the obstructionism, and the exhaustive effort required to empower people used to being forgotten.

More than 50 years later, original mission of MCHR and  Tufts-Delta Health Center to address the social determinants of health continues to this day in the Community Health Center Movement. There are nearly 1,400 health centers across the country in rural and urban areas providing not just excellent care, but local solutions that improve population health, create jobs, and empower communities.  “That is what we do: make a road out,” explained Dr. Geiger. “We work with people to build a road out of their circumstances, out of the inequity, out of poverty.”