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, that served both local residents and migrant farm workers trained locals to perform x-rays and provide physical therapy as well as make home visits in Spanish.86 One example from the Martin Luther King Health Center in New York City, another OEO-supported NHC, illustrates the importance of these home visits. A five-year-old boy had appeared at the clinic six times in three months. A home visit revealed that his “apartment lacked heat, and the winter cold was leaking through a broken window. The family was also short on food and badly needed more clothing.” The outreach worker helped the family access welfare benefits that allowed them to heat the apartment and acquire clothing and food. The five-year-old could only get well after these linked socioeconomic problems were addressed.87
L. C. Dorsey’s interaction with the Tufts-Delta Health Center characterizes the way community involvement in medical services could help transform black people’s lives beyond simple health care provision. Dorsey was born on a plantation to sharecropper parents (just a generation removed from slavery) in Washington County, Mississippi. She grew up in neighboring LeFleur County without access to education or job experience except in the fields. As a teenager, Dorsey was a social activist—a self-described civil rights field worker—with the Council of Federated Organizations (COFO), the Student Non-Violent Coordinating Committee (SNCC), and the Southern Christian Leadership Conference (SCLC). From her involvement in the civil rights movement, Dorsey heard about the Tufts-Delta Health Center and was intrigued because she wanted to become engaged with a project that would be sustainable. She explained that she was hired to be a part of community health outreach with the center. Dorsey said that Hatch, at that time director of Community Health Action at the health center, wanted to give young people the chance to grow in the organization, so he hired people with little or no work experience. After a stint as an outreach worker, Dorsey applied to direct the community farm associated with the clinic. Again, she noted she had no direct experience but was given an opportunity to develop her skills on the job. She also utilized Delta Health Center resources to complete her high school degree at the local junior college. Dorsey made clear that her work with the health center helped build her confidence to the point that she eventually completed an undergraduate degree and attended SUNY–Stony Brook for her master’s in social work. Ultimately she completed a Ph.D. at Howard University and returned to the center to become its executive director in 1988.88
Most of the Delta Health Center patients were women, children, and elderly men. Because there was so little paid labor in the South, many young men migrated north to find jobs. As a result of out-migration, the average age of Mound Bayou residents was only about fifteen, and the average age of men in the community was about fifty. Thus, women and their children were very much at the center of the Tufts-Delta Health Center as both patients and workers.89 With so many women in the community, obstetrics and gynecology were essential specialties at the health center. Two white nurse midwives, one a nun, Sister Mary Stella Simpson and Asa Johansen, both of whom joined the clinic when it opened its doors, worked in this area. The first black female obstetrician/gynecologist to practice in Mississippi, Dr. Helen Barnes, also joined the center in 1968. When she arrived at Mound Bayou, Barnes set up a program for prenatal care, delivery, and contraceptive services, which was supported after 1970 with federal funds accessed through Title X, a program created by President Nixon to promote family planning among poor Americans.90 Born in Mississippi, Barnes left the state to earn her medical degree from Howard University in Washington, D.C. After completing her degree in 1958, she returned to the Mississippi Delta to serve as one of the few black general practitioners in Greenwood, Mississippi. After returning north to complete specialty training in ob/gyn at Kings County Hospital in Brooklyn, New York, she joined the Tufts-Delta Health Center.91
Like Geiger, Barnes discovered that she could not address ob/gyn or infant health without addressing the larger environmental and economic problems that faced the community. She recalled that “[w]e had pediatrics and surgery, but I also found out that it’s all right to practice medicine and deal with sanitation and feed people—write a prescription for evaporated milk.” Like general health care, ob/gyn and child health services could not be limited to a narrow conception of medical practice. The practice of medicine necessarily expanded to embrace the environmental and economic problems of the Mississippi Delta community. Barnes continued, “I delivered babies every day and night and the nurse midwives would go out to do home visits—take care of the babies. [They would] look and see if they had screens and if they didn’t have running water they would dig a well.”92 Thelma Walker, another local woman who became the nursing administrator of the center, added,
If a nurse in the field finds a home without a water supply—out go the sanitarians and engineers with the well digger invented right here at the center and they dig a well in half a day. If there are rats coming through the floor, we exterminate them. A leaking roof? A privy falling down? Out go workers from the center—and these are local people—to patch the roof, build a new privy or take healthy adults tools from the tool bank we’ve scrounged together so they can make their own repairs.93
Although there was no women’s health movement in the late 1960s in the Mississippi Delta, there is abundant evidence that African American women responded positively to contraceptives when they were made available. Dr. Barnes distributed large numbers of contraceptives as part of a “community health improvement program” supported by federal Title X funds. Barnes explained that for many poor black women this was the first time they had been introduced to any kind of family planning. For the most part, she said, black women responded positively to the idea that they could limit their fertility using contraceptive measures. She recalled that women also came to her to be sterilized when they felt they no longer wanted to bear children. Her experience confirms other evidence that African American women wanted to control
