Breaking the Bedside Barrier: The Legacy of Black Hospitals

Charles Brown:
I want to kick off this episode with some exciting news. Many of you may not know, but I’ve been working on a very special book that will be released this spring. It is called Arrested Mobility: Overcoming the Threat to Black Movement. If you’d like a signed copy, please contribute to our Patreon or pre-order by contacting me at charlesbrown@equitablecities.com. More on that at the end of the episode. The town of Mound Bayou, Mississippi was once called the Jewel of the Delta by President Theodore Roosevelt. It was founded by freed slaves in 1887. It was known across the South of being a place where black Americans took care of themselves. In 1942, the Taborian Hospital opened in Mount Bayou. At a time when most hospitals segregated black from white patients or turned black patients away, the Taborian Hospital provided equal treatment and care for all. Here is long-term resident, Myrna Smith-Thompson.

Myrna Smith-Thompson:
So many people traveled from other parts of the state to get medical treatment. That set the catalyst for a new economic base in the community. This was 1942. So when the hospital opened, there was a gas station and there were restaurants and there was stores, and there was a drug store, a pharmacy, and there was a hotel, and people coming to the hospital supported those businesses. Most of the people who lived in the community worked at the hospital. This was something new that was added to the community, and it was healthcare, something that black folks didn’t have, don’t have.

Charles Brown:
The Taborian Hospital closed its doors in the 1980s, and as a result, the economy of the town suffered greatly. Those who had worked at the hospital moved away, and businesses in town declined as patients and their families no longer visited. Today, Bolivar County where Mount Bayou is located is one of the poorest counties in the nation. The life expectancy there is 10 years less than the national average. The Taborian Hospital accepted patients of all backgrounds, but it was known as a black hospital. It was a massive source of pride for the community. It had black doctors, black nurses, and black patients.
Today, there are just over 1 million black people living in Mississippi, but there are fewer than 600 black doctors. There is no question that desegregation and the Civil Rights Movement improved access to healthcare for black Americans. But today, rural hospitals increasingly face closure and healthcare disparities continue to negatively impact black Americans. I believe there is something to be learned from studying the history of black hospitals in the communities they served. My name is Charles T. Brown, and this is Arrested Mobility. We are going to start with a history lesson. Dr. Ezelle Sanford III is a historian and assistant professor at Carnegie Mellon University. He gave me the rundown about the first black hospitals in the country.

Ezelle Sanford III:
In Chicago in the 1890s, you have a nurse named Emma Reynolds who tries to enroll in a nurse training program. Nurse Emma Reynolds was an African-American woman, and the nurse training program that she applied to rejected her because of her race, and so she went to a very famous black physician, Dr. Daniel Hale Williams, explained the racial tensions. They raised money, educated the public, the black public especially, and they created the first black-established hospital in 1891 in Chicago, which was named Provident Hospital. And this really begins to open up a doorway for black communities to begin to cobble their resources together to establish small clinics, particularly in the South.

Charles Brown:
Mound Bayou’s hospital was funded by the efforts of a fraternal organization called the Knights and Daughters of Tabor. Anyone who donated or contributed was able to receive care at the Taborian Hospital. For Myrna Smith-Thompson, the memory of the hospital is still something to be proud of.

Myrna Smith-Thompson:
It was more monumental than anything I’ve seen in my lifetime. Given the climate of the state of Mississippi, the environment, for them to be able to raise enough money to construct a hospital. As simplistically as I can put it, the whole of the Mound Bayou community thrived and existed because of our coming together with all of the different systems, the institutions that we built for ourselves. A major one was the healthcare. We were the mecca for healthcare for 30 years. If you’re from Mound Bayou, if you say that phrase, “I’m from Mound Bayou,” then that spirit that is us that is so powerful, that is so resilient, that is so strong, and that is so very, very smart.

Charles Brown:
Dr. Vanessa Northington Gamble is the preeminent scholar on the history of black hospitals in the United States. She wrote the definitive book on the subject titled, Making a Place for Ourselves. Dr. Gamble is a physician herself, and she echoes the importance of the pride and dignity felt by patients and doctors in the black hospitals.

Vanessa Northington Gamble:
When we think about these hospitals, we cannot just think of them as healthcare institutions. Hospitals were also places of pride that this is an institution that we have built against all odds, against the lack of resources. To this day, when I go to Chicago and mention Provident Hospital, people say with a sense of pride, “I was born at Provident Hospital,” and so these institutions have transcended just being places where people got healthcare.
I’m writing a biography of a black woman physician by the name of Virginia Alexander and Dr. Alexander had a very small hospital. It was only like a three-bed hospital in Philadelphia, and many of her patients came to her because they knew they would be treated with respect and dignity, that they would not be poorly treated because of the color of their skin. They would not be in the basement or by the furnace because of segregated wards in hospitals. And so what these hospitals did was allow black patients and black healthcare professionals to go about their personal and professional lives unimpeded by racism or unimpeded by people thinking that they were less than, that when I was in medical school that someone thought I was the maid. That still happens. Langston Hughes has this great poem called Intern at Provident, and in this you see the pride of the brown skin in the white coats. And so these hospitals allowed black patients and physicians to live their lives unimpeded by racism.

Speaker 5:
Brown hands, black hands, golden hands in white coat, nurses’ hands on suture, miracle maternity. Tears of joy and Coca-Cola twinkle on the rubber gloves he’s wearing. A crown of sweat gleams on his forehead. Nurses turned glass doorknobs opening into corridors. A mist of iodine and ether follows the young doctor. Cellophane’s his long stride, cellophane’s his future.

Charles Brown:
There were not many of these black hospitals in the country, but you can see that for patients and communities who could access them, it was profound to have a place in the healthcare system free from racism. Then desegregation happened and things changed. The Civil Rights Act of 1964 declared that public funded hospitals could not segregate their patients. This was the beginning of the end for black hospitals. Here is Dr. Gamble.

Vanessa Northington Gamble:
One of the things that I found intriguing when I was looking at hospitals in the black community after World War II was that there was this optimism when desegregation happened that black physicians and patients would go into white hospitals and white physicians and patients would go into the black hospitals. So there was this optimism, we might even say naivete, thinking that integration was going to be a two-way street, but it did not turn out to be the case.

Charles Brown:
Most black hospitals closed by the end of the 1980s. One key reason why this happened was that healthcare increasingly focused on patient financing via private insurance. Here’s Dr. Sanford.

Ezelle Sanford III:
What happens is the middle class patients who have insurance, who have been borrowed from white hospitals in many ways now are sort of flocking to those institutions. They have the funds to do it. These institutions want them. They have the money that’s coming along with their patient care. So in St. Louis, for example, black residents could go to Barnes Jewish Hospital, which for decades barred black patients and for decades barred black doctors, black nurses and in 1960s, you as a black middle class patient could go to that hospital. Now again, the question is for a hospital that has historically segregated you, placed you in the basement or said you couldn’t come in at all, how are they going to interact with you now?

Charles Brown:
There’s contradictory research on the impact of desegregation on healthcare for black Americans. Generally, it is accepted that greater access to hospitals was a net positive, but then and now there are obvious disparities in health outcomes for black and white Americans. Here’s Dr. Vanessa Gamble.

Vanessa Northington Gamble:
I teach a course on the history of race and racism in American medicine and public health. I have students look at infant mortality today and infant mortality in the early 20th century. Infant mortality in the black community in the early 20th century was two to three times the rate of white Americans, and in 2024, it’s two to three times the rate of white American. So one of the things is that these inequities in healthcare have been tenacious.

Charles Brown:
Black Americans face higher rates of maternal mortality, diabetes, hypertension, and heart disease than white Americans just to name a few. COVID-19 also hit black communities much harder than white communities. In some cases, the pandemic was a stark reminder that not everything has changed since the days of Jim Crow. Here’s Dr. Sanford again.

Ezelle Sanford III:
As a historian of segregation in hospitals, I was extremely disturbed to hear reports that African-Americans were being refused admission to hospitals. Of course, hospitals were overpacked, but there were several stories that really disturbed me. One being that of David Alexander Bell, who was a 35-year-old black man in the suburbs of St. Louis who tried to get access to hospital facilities three, four times and actually passed away in the parking lot of one of the satellite facilities of Barnes-Jewish Hospital. And this is an institution that, again, segregated patients, held them in the basement. And the question is if there were another choice for a hospital to go to, Bell’s wife did not want him to go back to Barnes-Jewish after their repeated attempts to get access to this institution, but he went back and again, lost his life because of the refusal to be admitted.

Charles Brown:
To this day, many black patients feel they’re not heard or treated seriously when they enter a hospital seeking care. It is also important to note that today black people are less likely to have private insurance, and their public insurance is likely to be more expensive. This has been a problem for decades.

Ezelle Sanford III:
So black hospitals are going away. By the 1980s, public hospitals largely are going away by the 1980s. And so for the indigent working class folks who became used to the black hospitals in the neighborhood, the community serving institutions, those are going away and they’re beginning to ask, “Well, where do we go?” Not only now are we talking about desegregation, but we’re talking about privatization of hospital facilities and where do people who are underinsured, uninsured, where do they go? Right? These are people who now have Medicaid, but even today, you have to go to a place that’s going to take that right?
And in fact, what we have now, we still have, I would argue, sort of a hierarchical system of hospitals. You have very wealthy institutions, those who are associated with academic medical centers, for example, level one trauma centers that thrive on private patients, that thrive on even these publicly funded patients, Medicare and Medicaid patients because they’re academic centers, they use these patients for teaching, but you also have these safety net underfunded under-resourced institutions still today. They’re not black hospital exclusively, but they’re still a part of this sort of economic system born of the 1960s. And for those institutions that are still in poor communities, still serving poor people, these are not the institutions that are well-resourced and well-financed. And these are also the institutions that much like the black hospitals of the 1980s are starting to close now.

Charles Brown:
Dr. Sanford has spent much of his career studying the Homer G. Phillips Hospital in Saint Louis. In many ways, the story of that hospital reflects a history of disinvestment in black communities.

Ezelle Sanford III:
So my study, which is deeply based within the history of medicine, is also linked to these larger trends in urban history. And when I’m thinking about Saint Louis, I have to see it in this context of the city and understand how the mobility of black Americans, their abilities to navigate various systems in the city, it was limited. I mean, how do you get to the hospital before ambulances, for example? Where are you living? How does that set up your health status, your experiences of good health, ill health when the hospitals desegregate? The closest hospital from the Ville neighborhood is two miles away. It’s Barnes-Jewish. How do you get there? Given the history of racial segregation in the city, how are bus routes designed? Is there public transportation? When it came to trying to figure out which institution the city of Saint Louis would save, it had two city hospitals, one for blacks, one for whites, the decision came down to access to highways and access to parking.
The black hospital, which was located in the community intentionally wasn’t close to highways, didn’t have adequate parking. The white hospital existed long before the interstate highway system, but famed urban planner, Harland Bartholomew, who was from St. Louis, made sure that that institution was located next to a variety of different highways, that it had access to parking. And so the city on that reason decided that the historically white hospital would be the one that should remain open. I mean, there are a variety of other reasons, but these were the predominant reasons in the age of automobile transportation. So these are planning decisions that were made that then have a direct impact on how the city’s public healthcare system would develop in the ensuing decades. And so that’s just one example. Health planning, urban planning, they are mutually constitutive and they have consequences on each other.

Charles Brown:
In Mound Bayou, Mississippi, the Taborian Hospital still stands, but it is vacant. Myrna Smith-Thompson is advocating for it to be reopened, not just to provide healthcare, but also to continue serving as a symbol of black excellence in the South.

Myrna Smith-Thompson:
I’d like to see it restored as a contributor to the community because that is its legacy, providing service to people in the Mississippi Delta who did not have it before and currently do not have it. I’m hoping that a lot of people would be inspired to help restore the spirit of that. If we can rekindle that spirit, the spirit that I talked about before of us doing stuff together, let’s do what we have to do. We are that kind of people because we have from Mound Bayou.

Charles Brown:
I want to thank my guests, Dr. Vanessa Gamble, Dr. Ezelle Sanford III, and Myrna Smith-Thompson. I also want to thank Lauren Saucer and KFF Health News for their work researching this topic. This is the end of season two of the Arrested Mobility Podcast, but we will be coming right back at you for season three shortly. As discussed earlier, if you want to support my work, please contribute on Patreon, and I’ll send you an autographed copy of my upcoming book, Arrested Mobility: Overcoming the Threat to Black Movement. It’s being published through Island Press.
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