The health impacts of racism and poverty
Slade remembers his public health clinic practice, serving poor residents and migrants. He began serving only black patients, but desegregation made it more acceptable for whites to seek treatment there. Slade also remembers migrants' unique set of medical needs that were tied to their socioeconomic status: they sought treatment for diabetes, hypertension, and ulcers, for example.
Citing this Excerpt
Oral History Interview with James Slade, February 23, 1997. Interview R-0019. Southern Oral History Program Collection (#4007) in the Southern Oral History Program Collection, Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Full Text of the Excerpt
- KAREN KRUSE THOMAS:
-
One thing we haven't covered is your public health
experience. What was it like to practice in those public health clinics
when you first started in '66?
- JAMES SLADE:
-
Initially, when we began to do those public health clinics, they were
state-funded. Now they pay you something like $20 an hour.
Initially, we saw fairly sick children. Many times, I would have to
refer a child from the clinic to the hospital. One thing I always tried
to do was not refer them to myself. But a lot of times they wound up
seeing meߞif they come to you, you have no choice. We tried to
be careful not to refer patients to yourself. Initially, practically 100
percent of the children we saw were black. With the advent of Medicaid,
and the passage of time, we began to see more white children come into
the clinics. Now, it's still more black than white, but
it's not unusual to have white children in the clinics these
days.
- KAREN KRUSE THOMAS:
-
Why do you think that changed?
- JAMES SLADE:
-
I suspect part of it was because of school desegregation, since they had
to go to school together.
- KAREN KRUSE THOMAS:
-
So you think it became more acceptable to go to a public health clinic
after school desegregation?
- JAMES SLADE:
-
I think so, because it's not that there weren't
poor whites, but they either did without care or some of the white
doctors saw them. As time went on, it became no longer a problem. Even
in the public health clinics, though, you had very few black nurses. I
can only remember one or two. The children who come are less ill. You
very seldom see a premature baby in the clinics anymore. I have seen
babies around three pounds in public health clinicsߞyou
don't see that anymore. I think again, it's
because hospitalization is not a problem for these children. The
midwives were very active in those early years, and they're
not that active now.
- CATHERINE SLADE:
-
Also, they have programs in the health departments now where they
provide formula.
- KAREN KRUSE THOMAS:
-
When did that start?
- JAMES SLADE:
-
It probably began in the early '70s. We used to have milk and
formula in the office. In addition to the public health clinics, I also
work in the migrant clinics. It's still through the public
health department, but it's a different division.
- KAREN KRUSE THOMAS:
-
When did this area start getting a lot of migrants in, and when did
those clinics start?
- JAMES SLADE:
-
It might have started before my time. It was well established in
'66 when we started going over there. They would have
probably 500 migrants or more in the area.
- KAREN KRUSE THOMAS:
-
Were those migrants African American at that time?
- JAMES SLADE:
-
Yes. No Hispanics back in the late '60s, early
'70s. Occasionally you would see a Caucasian, not very often
but once in a while. Most of the clinics were held in Pasquotank County,
we'd have to drive over there. A lot of times, they were
busy. There were two physicians when I started, one other physician and
myself, and sometimes my wife would work with us. We would both work
until one or two o'clock in the morning before we got
through, and we weren't just sitting around chatting, either.
- KAREN KRUSE THOMAS:
-
What were some of the problems that y'all saw that were
specific to migrants?
- JAMES SLADE:
-
A lot of epilepsy. Occasionally, we'd find tuberculosis. Part
of the epilepsy problem was due to lifestyle. There's a lot
of alcohol consumed among the migrants, I guess that's part
of the socio-economic status, and the pressures and all that.
Hypertension, diabetes, although not necessarily insulin-dependent. A
lot of rashes. With the diabetics, a lot of times you'd see
foot ulcers. Occasionally, you may run into someone with a cardiac
problem, but hypertension was the biggest thing. Sometimes some of the
ladies would be pregnant and we'd take care of the newborns.
That's what I'd like, when we had a baby to look
after. Makes you feel more at home.