Joycelyn Elders: From Sharecropper's Daughter to Surgeon General of the United States of America.

Up From

Arkansas

Jocelyn Elders, M.D. grew up in a 1930s Arkansas African- American sharecropper family so desperately poor that few would expect such a child - whose skin color legally marginalized her - to surmount the formidable barriers in front of her. It would have been a major achievement if Elders had just survived, worked as the store clerk she originally aspired to be, married, raised a family, and lived a God-loving decent life.

Elders did a lot more than that, however, and not just for herself. Her most significant accomplishment was her victorious battle to expand health care for Arkansas's poor while state director of health services in the late 1980s. Then President Clinton appointed her Surgeon General of the United States, the first African American to hold the post. As the nation's top doctor, Elders's plain-spoken manner stirred up one storm too many for the Clinton administration during her 15 months in the office. First, Elders suggested studying what impact the legalization of drugs might have on crime. Then she said that masturbation is a "part of human sexuality, and perhaps it should be taught" The latter statement was too much for Clinton, still reeling from the Republican Party victory in the mid-term congressional races, so he fired Elders in December 1994. Now a pediatric professor at the University of Arkansas, Elders has not spoken with Clinton since.

Elders says she harbors no anger toward Clinton. She accepts what happened to her in Washington as the fate that awaits all who occupy high-profile political positions and are impolitic enough to say what they genuinely feel and believe. She never claims to be more than a physician who saw the worst of rural poverty and racism and put it all behind her to become a committed health care advocate for the many neglected children of our nation.

All of this can be learned from Elders's easily read autobiography. She credits her strong-willed mother for all of her success. Haller Jones, to whom the book is dedicated, passed on to Elders four bits of wisdom that could serve well any child in any American circumstance today.

"If you want to get out of the fields, get something in your head.

"Recognize the truth and speak out against wrongdoing.

"Don't use up your future trying to recapture the past.

"Do your best; that's good enough."

Elders's account of how she rose out of the rural hamlet of Schaal, population 98 ("ninety-nine when I'm home"), provides a textbook formula for others who would follow her. If Jones had not died in her eighties in 1995, she could tell us in one word, as she told Elders six decades ago, the secret to Elders's success: education.

Haller Jones had an eighth grade education, a considerable achievement for a southern, rural black woman in the early part of this century. At 18, she married 19-year-old Curtis Jones, who also had made it through the eighth grade. Through the birth of her eight children, Haller Jones "held tight to the conviction that if we ever wanted to `be something,' we had better get educated," Elders writes.

Elders was her mother's first born, and one of her earliest childhood memories is of her mother teaching her to read, using a switch to add painful emphasis to Elders's errors. By the time Elders entered school in 1938, she was reading. Jones taught each of her children to read with the same fierce determination and a collection of switches.

As Haller Jones's children grew, house and farming chores were added to their school lessons. But never were the children allowed to use the hard work all of them did as an excuse to slack off on their school work. Jones and her switches saw to that. So when opportunities expanded in Arkansas for African Americans, Elders and most of her siblings were prepared to take advantage of them. Since the mid-1980s, I've studied several families trapped in intergenerational poverty. One consistent element within all of them is the absence of any understanding that a solid academic education can be a ticket out of their dire circumstances.

Elders certainly faced dire circumstances. There were no hospitals for black people in the area around Schaal, and, if by chance you cut your foot while doing farm work, you put coal oil (the equivalent of kerosene) on it. If you stepped on a rusty nail, you prayed that you didn't get lockjaw and put coal oil on the wound. And if you were bit by a dog, you might put coal oil on the punctures, watch to see if the "dog had had rabies in its bite," and hope you didn't get hydrophobia.

Elders gives a poignant description of her father carrying her very ill younger brother, Bernard, in his arms early one morning as he rode off on Old Jim, the family mule, to see the nearest doctor. Curtis Jones did not return with his son until late that night.

"When we went out to see, there was Daddy sitting on Old Jim holding Bernard in his arms, still bundled up in the blanket. Bernard looked the same as when he had left, huge-eyed and silent as death. But when we took the blanket off, I saw a big tube sticking out of his stomach. The doctor told Daddy Bernard's appendix had burst. He put the big red tube in there to drain the poison out of him. Then he sent him home. There were no hospitals around there for any black children."

Elders was the valedictorian of her high school class, and fortune stepped in with a full-tuition Methodist scholarship for Elders to attend Philander Smith College in Little Rock. But Curtis Jones needed his oldest daughter in the fields chopping the weeds coming up around the cotton and corn. "What going to college might mean for the future wasn't that obvious to Daddy," Elders remembers. But he was certain he'd be losing his work leader if Elders went off to Little Rock. Haller Jones was desperate for her husband to let Elders go, and they bickered about it. But as strong-willed as her mother was, Elders knew if her father decided he needed her on the farm, Haller Jones would not be able to convince her husband otherwise. Elders resigned herself to staying home. She'd be picking the family's cotton crop come late September. But Elders hadn't counted on her paternal grandmother, the woman she was named after, Minnie Jones. Elders never learned what Grandma Minnie said to her father, but in early September, her grandmother told her to get ready to go. The only problem now was money: The family didn't have the $3.83 bus fare to Little Rock. So at dawn, the entire family waded out into the cotton patch, searching for and collecting bolls that might have ripened early. Toward nightfall, Elders's five-year-old brother Chester, stooped over after working since sunup, looked up at his sister and asked, "Min, do we have enough yet?" They were able to sell the cotton they picked for $5, enough to get Elders to Little Rock "with a dollar and change left to spare."

Elders, who adopted the name Joycelyn in college, married briefly after graduation, joined the U.S. Army's Women's Medical Specialist Corps, and entered the University of Arkansas Medical School in 1956 with financial support from the GI Bill. Elders and the two other black medical students could not eat in the medical school's white lunchroom. They ate in a separate cafeteria with the black hospital staff. "We understood that the aim of this game was to get through medical school," writes Elders about her reaction to the segregated facilities. "Right from the start we were far more concerned with that than we were with something like where we ate."

In Elders's fourth year of medical school, she met Oliver Elders when she had to give physical exams to the players on the high school basketball team he coached. Elders and her second husband had their share of personal pain and trauma. A young white foster daughter and the young woman's fiancee were both killed in an unsolved double murder. Oliver Elders experienced several long bouts of such deep depression that Elders considered leaving him. Kevin, the younger of the couple's two sons, has had serious problems with alcohol and cocaine addictions, and was arrested (and eventually convicted) for the sale of cocaine when Elders was surgeon general.

These travails and years of medical research on childhood diseases occupied Elders up to her appointment by Governor Bill Clinton as director of the moribund state health service in 1987. For more than a month, Elders traveled around Arkansas visiting the state's 106 health clinics in its 75 counties and quickly determined what their needs were.

"Between the poor whites and blacks there was no difference," she writes about what she saw. "Large families, teenage pregnancies, incest, abuse, lack of nutrition, scant medical care. No hopes and no horizons. It was all the same. One was like a photo negative of the other."

"Seeing these places was taking me right back to where I had come from," Elders says. "I had lived through it. I knew how they survived. They survived the same way we had survived. Ignorant and without help. Like my father riding off on the mule with Bernard in his arms."

Elders's proposal to establish school-based health clinics set off storms of protest in Arkansas, with anti-abortionists accusing her of trying to set up programs that would take away parents' rights to teach their children about human sexuality. With the help of Arkansas legislators, Elders won some of the battles around school-based clinics, the professional legacy of which she is most proud.

Elders feels the opposition she stirred up in Arkansas followed her to Washington, where her stint was too short to let her make any lasting accomplishments. And indeed, the section on Washington is the most boring in the book. The most compelling part of Elders's life is her childhood of rural poverty, and her overcoming that to rise to a position in Arkansas to help those in similar circumstances. How to help people out of poverty has perplexed and occupied this nation for many years. Elders is an example of what is possible, but on the national level, she was hardly given the opportunity to share with us how it can be done. We are all the poorer for her absence.

Leon Dash is a reporter for The Washington Post.