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In collaboration with writer Chanoff (a visiting scholar at Brandeis Univ.), whose labors are happily invisible, Elders tells an inspiring story of a child born to an Arkansas sharecropper in 1933 who 60 years later became the first black woman surgeon general of the US. Family and church instilled in her early a commitment to education and a high moral sense. With a college scholarship, good role models, hard work, the GI Bill, and strong mentors, she rose swiftly. When she became chief resident at the University of Arkansas Medical School in 1963, it was an unheard-of honor for a black woman, and with the help of an NIH fellowship grant in biochemistry, she was soon Arkansas's resident expert in pediatric endocrinology. Elders's story is much more than a brilliant career résumé. She shares details of her personal life—her strong marriage, her husband's deep depression, the loss of a child, and her younger son's problems with cocaine—and her introduction to public life. In 1987, Arkansas governor Bill Clinton asked her to direct the state's health department. With this appointment, Elders—a pragmatist, not a politician—battled "antichoice, antieducation, anticondom fundamentalists" outraged by her plans for distributing condoms in school clinics. Six years later, when Clinton picked the outspoken Elders as his surgeon general, he knew exactly what he was getting. Her account of her brief tenure, only 15 months, is restrained, but it's clear that relations with her boss, Donna Shalala, were rocky, and she blames Shalala and Leon Panetta, not Clinton, for her dismissal after the masturbation flap.
Now back in Arkansas teaching pediatrics, Elders says she has no regrets. She knows who she is and what she stands for. After reading this absorbing autobiography, readers will too.
In my six years as director of Arkansas's health department, I had become a lightning rod on these issues. That was ironic in a way, because for the quarter century before that as a professor of pediatric endocrinology what I mainly saw was the inside of my laboratory, my classroom, and my clinic. In that whole time I probably hadn't ever spent more than five minutes at a stretch thinking about public health. The biggest controversy I ever got into might have been over whether we could get someday care started at the medical school. But once I moved over to the health department I landed in the middle of a national debate on values that looked more like a war than an argument.
While that debate had different components, near its heart was how people think about sex: how to teach children about it, what sexual responsibility means, and the consequences of unmarried and unprotected sexual activity for public health. Swirling around in this mix were issues like AIDS, abortion, homosexuality, and sexual abuse, which meant there was never anylack of people who were seriously disturbed about something.
The fact that I was the one at the center of these sex wars was ironic in another way too. When I was growing up in Schaal, Arkansas, sex was so secret that no adult ever mentioned it, period. Somewhere in the United States there might have been a child more ignorant about sex than I was, but you'd have been hard pressed to find her. By contrast, later on, when I be came a doctor, part of my job was to treat all the really severe problems of sexual development in Arkansas, from babies born with ambiguous genitalia to children who never went into puberty. At one time I had more experience talking to parents and children about sex than any doctor in the state and probably as much as anyone in the country. In those days there weren't more than a handful of specialists who knew much about these things.
Maybe it was because of my background that I never stopped being exasperated by all the commotion over condoms and sex education. I knew firsthand what it is like to be ignorant, and I also knew how vital it is to be informed. When I was health director, we were seeing frightening increases in AIDS cases and an epidemic of pregnancy among unmarried teenagers that was eating at the country's social fabric. But hysteria about sex was disabling our primary means of prevention, which is of course just as true today. No health professional can really tolerate that. My predecessor as surgeon general, Antonia Novello, couldn't any more than Koop or I could, although we each had our own ways of trying to contend with it.
Maybe even worse was that by focusing attention on subjects like abortion and sex education, the loud right-wing groups were distorting and politicizing health issues generally. What I hated as much as anything about my confirmation debate was that most of the other side was so preoccupied with sex issues that they didn't care in the slightest what I might have actually done for public health in Arkansas, most of which had nothing to do with sexuality.
While I was director there, we had raised our childhood immunization rate from 34 to 60 percent—96 percent for first graders. Our early-childhood health screening was twelve times what it had been. We set up sickle-cell anemia screening and a comprehensive women's health program. Our prenatal care rate went way up, as did the numbers of qualifying women getting food supplements for their children. We built a major in-home health service to care for our frail and elderly, and we made a lot of headway in attracting doctors to rural areas that didn't have any. We established home hospice care and got the churches involved in that. We built twenty-eight new public health clinics, renovated fourteen more, and opened twenty-four clinics in schools. I was proud of what we had accomplished. I thought the health department had improved the lives of a lot of Arkansans. But none of that made a whit of difference to people who were fixated on abortion and couldn't bear the thought of sex education.
Of course I have to admit I didn't make it easy for them. I had been up on the barricades a long time, and when I thought strong language was needed, I didn't shy from it. I wasn't a stealth candidate for surgeon general. A lot of what I had said was public record, and a few of my comments had really lodged in some throats. During the confirmation debate those were the ones that got repeated over and over again, most often out of context and twisted.
In one speech I had said that we've taught teenagers what to do in the front seat of cars, now we have to teach them what to do in the back, meaning that if we were instructing them on traffic safety, we surely ought to be teaching them how to protect themselves from AIDS and other sexually transmitted diseases (STDs) and pregnancy. I had said that girls going out on prom dates should carry condoms in their purses, meaning that if there was any chance they weren't going to be abstinent, they should be ready with contraception. Senators Trent Lott and Don Nickles and a couple of others believed comments like those showed I was advocating immorality. They seemed to think, like Pat Buchanan did, that I saw teenagers mainly as "rutting animals whom we expect to do a good deal of fornicating."
Worse, I had taken to calling the extremist right-to-life groups "very religious non-Christians," and more than once I had said they should "get over their love affair with the fetus." The first time Senator Coats brought those up to me, I told him that in Arkansas the groups I was talking about "fight against health education, they fight against welfare, they fight against Medicaid. They always want to have the children born, but they don't want to support them after they're here. That's an affair," I told him. "That's a short-term commitment, whereas with children that's forever. In my state," I said, "I have not seen these people out working for programs to help poor children and mothers. If we had a society where everybody was provided health care, a decent place to live, and adequate education, then, Senator, we would be taking care of people. But in my state I don't see these kinds of commitments." That was pretty much the tone of the whole debate. It was tense and confrontational.
My opponents said they were outraged by the language I used. They were offended. Even some of my supporters thought I might do well to tone it down. Senator Nancy Kassebaum of Kansas, who was a voice in my corner, said maybe I needed to work on my bedside manner, and David Pryor, one of Arkansas's two wonderful senators, mentioned that I had a number of diplomas but I didn't have one from the school of diplomacy. But others said that in their opinion, using plain, unvarnished English was a virtue, and they wished more government people would do it. My favorite was Barbara Boxer, who said she wasn't offended by my language. What she was offended by was that the infant mortality rate in the United States was higher than in nineteen other countries and that the black infant mortality rate was higher than in thirty-one other countries, including Cuba and Bulgaria. She was offended that we ranked thirty first in low-birth-weight babies and seventeenth in polio immunization and that the American preschool death rate was twentieth in the world. With that kind of record, she didn't have time to be offended by someone's language.
Copyright ) 1996 by Dr. Jocelyn Elders and David Chanoff