Thursday, November 19, 2009

Book Review: Susan L. Smith - Sick and Tired of Being Sick and Tired

The following review was originally published in 2003 on the now defunct site (publishing reference). It was the first piece of writing we ever had published and it was such a defining moment, that it feels right to re-publish it.

Author: Susan L. Smith
Publisher/Year: University of Pennsylvania Press, 1995

No matter how many books I read, it never ceases to amaze me how the one book that I would never pick up voluntarily always seems to be the one I prominently display on my bookshelf. Such is the case with Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890-1950 by Susan L. Smith (University of Pennsylvania Press, 1995). I read this book as a requirement for a seminar on the history of women and health conducted by the author herself. I can honestly say that the seminar topic did not set my soul ablaze with interest; I was basically looking to finish up my last senior-level credits for graduation. But I had already taken two other courses with the author and even though my interest was minimal, I knew her energy and enthusiasm would get me interested. And indeed it did.

My interest was especially piqued when I realized one of the required readings would be Smith’s own book. Always intrigued by professors who assign their own work for study, I half expected the course to have the aura of shameless self-promotion. This was not the case; in fact, quite the opposite. Smith let her book do the talking and I for one was completely fascinated. I may not have believed that black women’s health activism in the United Studies had any bearing on my current health care situation when I started the book. At its conclusion however, I was well aware of how indebted Americans in particular, and everyone else in general, are to the spirit and determination of all the women Smith so lovingly writes about. If I ever doubt the power of sisterhood in the face of political indifference and racial discrimination, I need only look at the plethora of notes littering every page of my copy of this book.

Taking her title from a rallying cry put forth by black civil rights leader Fannie Lou Hamer in the early 1960s, Smith presents a sensitive yet critical study of the history of the health care activism undertaken by black women in the first half of the twentieth century. Winner of the American Association of Women’s History Sierra Book Prize in 1996 and the American Association for the History of Nursing Lavinia L. Dock Award in 1997, Smith’s book places black women squarely at the front of the black health care movement:
Black health care reform was gendered to the extent that men held most of the formal leadership positions and women did most of the grassroots organizing. Much like the black civil rights movement of the 1950s and 1960s, ‘men led, but women organized’. Black men played an important role in the black health movement as doctors, ministers, journalists, businessmen, and educators. Yet, men’s leadership often came and went, while women’s grassroots activity persisted.
Smith keenly demonstrates throughout the book that it was this persistence at the grassroots level that afforded black women the opportunities to navigate the intricately intertwined political machinery of the health care movement for the betterment of the entire black community. As she states:
Despite the fact that male leaders like Booker T. Washington and Dr. Roscoe C. Brown received credit for creating a black health movement, laywomen and female health professionals were the ones who pioneered grassroots health organizing. Whether as volunteers or paid workers, black women were the vital links between health initiatives and poor African Americans. They were integral to the implementation of black health programs at the local level, and they sustained black communities in the face of institutionalized racial discrimination and government neglect.
Black women carried the initiatives of the health care movement to poor black communities across the United States and translated them into active services. These women were the nurses, teachers, club members, sorority sisters, and midwives that formed the heart and soul of the push for better and greater health care reform for African Americans. Smith aptly illustrates that black women created their own solutions to health care issues. They learned how to skillfully move within and around political, gender and class barriers in order to increase the quality of health care for their communities. Their determined work led to numerous milestones within the history of American health care such as organized community health work, the development of a National Negro Health Week and the Alpha Kappa Alpha Mississippi Health Project.

While gender played an important role in the structure of the black health care movement, so did class. Class politics played a major, if not the critical, role in the health care movement. Smith uses specific case studies, such as the role of black club women in ‘spreading the gospel of health and cleanliness’ in the name of public health work and the prestigious positioning of black midwives in rural communities, in order to paint vivid pictures of the close ties between class welfare and political warfare.

One such case study is the Tuskegee syphilis experiment. Smith is especially sensitive in discussing the devastating effects of this experiment on the African American community and the role of the Public Health Service in carrying out this experiment. The Tuskegee syphilis experiment was carried out from 1932 to 1972 and implicated 400 black men in its directives. The object of this experiment was to study the long-term course of syphilis until death. Unfortunately, as Smith states, the men who joined this study did so without knowing that they had syphilis, and without knowing that they were not receiving any treatment. This experiment is a key example in demonstrating how destructive any reliance on government health initiatives to take care of African Americans could be for poor African Americans. It is also grimly representative of how wanting to act in the best interests of poor black people, as Eunice Rivers, the public health nurse involved with the experiment strongly believed she was doing, sometimes forced black women to make risky bargains in the pursuit of better health care.

Smith’s overlying theme for the book is that the black health care movement was closely tied to the black civil rights movement:
Furthermore health reform was a cornerstone of early black civil rights activity. As the history of black women’s health activism demonstrates, from 1890 to 1950 black social welfare activity was indistinguishable from racial uplift work. In an era of legalized segregation, health improvement was not necessarily tied to the struggle for social change. Focusing on health issues permitted black women an authoritative voice in the realm of political organizing. They exploited the identification of health needs with the domestic realm in order to take on very public roles and engage in a little-recognized form of civil rights work.
Health care reform was a major foundational component for the much larger black civil rights movement. Both movements were inherently tied together through the struggle for social and political change, and both were greatly indebted to the work of black women like Eliza Farish Pillars and Dr. Dorothy Boulding Ferebee in sustaining and advancing the agendas of both movements.

The struggle of black women to bring proper health care to their communities was definitely part of an even greater effort to get recognition and funding from the federal government for the basic care of black people. As such, Smith correctly argues that the work of these women needs to be recognized as being as political in nature as any other more visible activities carried out in the pursuit of improving the political, social, cultural and medical conditions of the African American community.

Sick and Tired of Being Sick and Tired fills an enormous gap in the history of health care in the United States. Smith’s carefully documented investigation of the health care work carried out by black women provides valuable insight into the intersection of gender and class in American health care history. She provides a nuanced and sometimes thoughtful account of how black women’s grass roots activism, no matter how small, could put critical pressure on the right points to bring about desired change.

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