Will We Ever Change the World?
“You unbelieving and perverse generation,” Jesus replied, “how long shall I stay with you? How long shall I put up with you?”
This quote from Matthew 17 rang in my ears as I finished Out in the Rural, an account of the early years of the Tufts-Delta Health Center, the first community health center in Mississippi, written by Thomas Ward, Jr. The book describes the herculean efforts of Dr. Jack Geiger and John Hatch, as well as others, to build a new kind of health center to improve the lives of African-Americans living in the Mississippi delta, whose agricultural livelihoods, such as they were, had disappeared with the mechanization of local plantations. As Hatch noted in a 1970 video of the same name:
While the plantation manager or owner had a vested interest in the survival of the people he needed to grow his crop, [after mechanization] this is no longer true.
Dr. Geiger had apprenticed with Drs. Sidney and Emily Kark in South Africa, learning about the “community-oriented primary care” model they pioneered there. He saw a similar opportunity in the U.S., among poor and indigent populations, to use health care as a platform for social change, empowering and elevating long-suffering communities whom the established authorities had neglected.
The expansive and overlapping nature of the Tufts-Delta clinic’s activities in the early years, which were funded by the Johnson Administration’s Office of Economic Opportunity (OEO), forces historian Thomas Ward to retrace some of his steps as he slices and dices the center’s history in different ways. As a result, the book reads less as a page-turner than it does as an almost encyclopedic gospel (in both senses of the word) of what is possible when a team of committed people acts fiercely to engage communities in their own advancement, against the unbelieving and perverse opposition of the day.
The Tufts-Delta staff formed health associations in which local residents identified their most urgent needs. To the leaders’ surprise, what locals needed most was food, water, sanitation, education, and employment, very little of which could be provided within the walls of an outpatient clinic. As a result, the health center’s physicians, nurses, and other staff took action in the homes, schools, and broader community of the patients they served.
They hired and trained local people to build privies and dig wells. They provided healthy food and taught mothers how to care for sick children. They put screens on doors and windows to keep the mosquitoes out. They showed people through a microscope all of the nasty critters that lived in the water they were drinking in order to undermine the local belief that “clear water is good water.” They created a food co-op on which community members grew their own vegetables in order to end the paradox of people starving atop some of the world’s most fertile soil.
Of course, Geiger and his team ran into plenty of opposition. The state’s White power structure claimed that the health care their African-American residents received was sufficient, and if not, then any new federal money should go to the state’s existing institutions, which, of course, were the same institutions that had neglected those residents all along. In fact, the involvement of Tufts University was key to Tufts-Delta’s feasibility, since, according to the legislation creating the OEO, state governors could veto any OEO projects in their states unless the grantee was an academic institution.
But some Black groups also opposed the center, primarily the Black middle-class that controlled the businesses and the two ailing hospitals in Mound Bayou, the town where the center was located. According to Ward, they too wanted the federal money to come to them, and in some cases they resented the fact that Tufts-Delta, with its federal funding, paid their staff the minimum wage, which was much higher than the prevailing rate.
Geiger recounted an incident in which a gun-toting local man, obviously intoxicated, stormed into the health center demanding to see “Mr. Tufts,” who had “stolen his woman.” The woman in question had been his maid who had quit her job and escaped the sexual exploitation that came with it when she was hired at the health center.
The center’s early successes, however, did not last long, raising the larger question of whether sustainable social change is even possible. Even the noblest efforts seem to succumb in relatively short order to political interests and vicissitudes. In this case, Ward’s epilogue describes how the Nixon administration, and then the Reagan administration a decade later, reduced or eliminated funding for community health centers and other activities born out of the War on Poverty, despite the fact that these programs had contributed to a halving of the U.S. poverty rate from 1964 to 1974. Ward writes:
Despite Ronald Reagan’s infamous statement, “In the sixties we waged a war on poverty, and poverty won,” in many ways, most Great Society programs did not fail, as much as they were cut off at the knees and forced to move away from their current roots.
Thus, as I finished the book, the scripture quoted earlier came to mind. Ward’s book left me both encouraged by what the Tufts-Delta team was able to achieve, and discouraged by how quickly it all fell apart. As funding decreased under Nixon, governance transitioned to the local Black elites who had been against the center from the beginning. The food co-op quickly shifted from fresh vegetables for local residents to cash crops for export; it was eventually turned over to a local college as a research farm. Geiger, Hatch, and other key players moved on to other projects and ambitions. Looking back, they may have measured their biggest impact in the career opportunities some local residents found through their involvement with the health center project.
Jack Geiger proudly recounts the education success of the people touched by the health center and the long-term impact of the center on the Delta. “There are five black Ph.D.s from that initial crew. Two Ph.D. clinical psychologists from Alligator, Mississippi, population 900. Three others in other fields… There are at least seven physicians out of that initial crew. There are about fifteen social workers. There are about twelve RNs,” Geiger recalled in a 1992 interview. “That’s all a consequence in the main of our original intervention.”
I am sure that those numbers brought Dr. Geiger a certain satisfaction up until his death this past December, along with his many other achievements in life, which included founding two separate organizations that each received the Nobel Peace Prize. He likely also found pleasure in his subsequent involvement with Delta Health Center, which the Tufts-Delta project became, following its revitalization in the late 1980s under CEO L.C. Dorsey, who was a remarkable woman in her own right and someone with whom Geiger had worked in the early days.
At the same time, when we look at the experience of the Tufts-Delta Health Center’s early years as described by Thomas Ward, we must face that hard question: Will we ever change the world in a way that finally settles these profound challenges that Geiger, Hatch, Dorsey, and many others have spent whole lifetimes addressing? And if not, what then?
I enjoyed a fully-vaccinated coffee a few weeks ago with a long-time poverty activist with five decades of experience both on the ground and in the halls of national policy. He had read my book, Reframing Poverty: New Thinking and Feeling About Humanity’s Greatest Challenge, which as stated in its introduction seeks not to answer the question, “How do we eradicate poverty?”, but rather:
What am I, as a human being, to do, living as I do in a world where poverty exists?
He enjoyed the book, but he found it quite challenging to some of his core beliefs. He said it really made him think, and he flattered me with his copy’s many dog-eared corners and with the yellow Post-It notes sticking out every few pages. He opened the book to the last yellow sticky-note and read from the final paragraph, in which I offer my answer to the question quoted above. It begins with the phrase, “To accept the world as it is…” He asked me to say more about that. Should we do anything at all?
I elaborated in part by pointing him to a quote from activist Saul Alinsky that I use in an earlier chapter:
It is painful to accept the simple fact that one begins from where one is, that one must break free from the web of illusions one spins about life.
I was not making a case for complacency, but rather, for ensuring that any action taken reflects the actual circumstances rather than projecting one’s ideas, emotions, and biases. One of the actual circumstances, by the way, is that the human poverty rate, using the World Bank’s current definition, has fallen from eighty-four percent two hundred years ago to around ten percent today, which seems to suggest that progress is possible.
That was all well and good, but he was more concerned with how little the numbers had changed during the decades of his own professional life. I knew what question he really wanted to ask me, and I would have asked him had he not gotten there first. “Have I wasted my life?”
This is not a question I typically field. I sat back, thought for a moment, and then replied, “I don’t think so.” He told me, both jokingly and not, that that was the right answer, and that at the very least, he surmised, he had strengthened his muscles by pushing the rock up the hill, an allusion to the Greek myth in which Sisyphus, a king who had twice cheated death, is sentenced to an eternity of rolling the same boulder up a hill day after day, only to watch it roll back down just as he nears the top.
I asked him if he had ever read Albert Camus’s essay, The Myth of Sisyphus, the subject of which is the “relationship between the absurd and suicide, the exact degree to which suicide is a solution to the absurd.” Camus defines the “absurd” as the absence of any meaning of life, or “divorce between man and his life, the actor and his setting.”
In the context of our coffee discussion, “suicide” can be defined as just giving up, and the “absurd” refers to the overwhelming evidence, spanning from the authorities of Jesus’s time to the Mississippi governors of the 1960s to the powers that today oppose the expansion of health care and social services for poor communities, that systems do not change. This evidence, when conjured by my admonition “to accept the world as it is,” could lead any long-time activist to ask, “Have I wasted my life?”
Like me, Camus doesn’t think so. He writes:
Sisyphus is the absurd hero. He is, as much through his passions as through his torture. His scorn of the gods, his hatred of death, and his passion for life won him that unspeakable penalty in which the whole being is exerted toward accomplishing nothing. This is the price that must be paid for the passions of this earth.
That is, it is their love of life and their refusal to remain complacent in the face of such dire challenges that lead makers of social change to suffer.
But Sisyphus’s awareness of his ordeal gives him power over it. Camus recognizes the “melancholy [that] arises in man’s heart” when facing a Sisyphean task, “but crushing truths perish from being acknowledged.” In that moment of pause as he pivots to watch his rock roll back down the hill, Sisyphus has a choice: He can, like Sophocles’ Oedipus at the end of his own tragic life, declare that “all is well.” Camus continues:
All Sisyphus’ silent joy is contained therein. His fate belongs to him. Likewise, the absurd man, when he contemplates his torment, silences all the idols… The absurd man says yes and his efforts will henceforth be unceasing… [H]e knows himself to be the master of his days.
Like Sisyphus, those who seek to change the world have a good gig. They wake up in the morning knowing what they must do. Dr. Geiger knew what he must do, and he did it again and again, in many different contexts over the course of decades. And though I never met him, in my heart I believe he must have looked back on his life with pleasure and fulfillment. As Camus writes, “The struggle itself toward the heights is enough to fill a man’s heart.”
It is perhaps unsurprising that Jesus’s quote used above comes from a story about health care. A man asked Jesus to heal his son, who suffered from seizures. It is worth mentioning that at the Tufts-Delta Health Center (now called Delta Health Center) in Mound Bayou, Mississippi, or at any federally-qualified community health center today, that boy could have been seen by a healthcare provider. Community health centers accept Medicaid and other forms of insurance, and they use a sliding scale for those paying out-of-pocket. No one is turned away regardless of their ability to pay.
In Jesus’s time, however, no such health centers existed. Here is the full passage from Matthew 17:14-20:
When they came to the crowd, a man approached Jesus and knelt before him. “Lord, have mercy on my son,” he said. “He has seizures and is suffering greatly. He often falls into the fire or into the water. I brought him to your disciples, but they could not heal him.” “You unbelieving and perverse generation,” Jesus replied, “how long shall I stay with you? How long shall I put up with you? Bring the boy here to me.” Jesus rebuked the demon, and it came out of the boy, and he was healed at that moment. Then the disciples came to Jesus in private and asked, “Why couldn’t we drive it out?” He replied, “Because you have so little faith. Truly I tell you, if you have faith as small as a mustard seed, you can say to this mountain, ‘Move from here to there,’ and it will move. Nothing will be impossible for you.”
One day we may move the mountain. Until then, keep pushing those rocks.
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