Pubdate: Thu, 05 Feb 2009
Source: Arkansas Times (Little Rock, AR)
Copyright: 2009 Arkansas Times Inc.
Contact:  http://www.arktimes.com/
Details: http://www.mapinc.org/media/583

STRAIGHT TALK

Dr. Joycelyn Elders, a living monument to the black experience in 
Arkansas, may be retired, but she's not retiring about the issues 
that made her a controversial surgeon general.

Fourteen years after President Bill Clinton fired her as surgeon 
general of the United States for uttering one final impolitic remark, 
Dr. Joycelyn Elders is long into retirement, but hers is not a repose 
that the meek would envy or her many old critics would cheer.

And if you were wondering, no, she never shut up or took up mincing words.

Straight talk made Joycelyn Elders famous, earned her a legion of 
enemies and finally got her fired, but she does not wish that she had 
substituted a single euphemism for any of it, not even her mention of 
masturbation at a world AIDS conference at the United Nations in 
December 1994 that brought an angry telephone call from Clinton 
demanding her immediate resignation.

She returned to her teaching and clinical career at the University of 
Arkansas for Medical Sciences and retired there in 1998, but 
retirement may not be an apt word for it. Not counting talks to 
groups around Arkansas, Dr. Elders made more than 50 speeches in 20 
states last year, which was well off the pace of even her retirement 
years and a tacit acknowledgement that, at 75, she's tapering off a 
bit. Although no longer engaged in clinical or laboratory work, she 
managed the past four years to publish seven articles in national 
medical journals or books. She is on nine boards, eight outside 
Arkansas and the other at her alma mater, Philander Smith College.

She still carries the title professor emeritus of pediatrics at UAMS 
but she works now from the study of the ranch-style home south of 
Little Rock that she and her husband, the legendary basketball coach 
Oliver Elders, bought in 1987. The terrain but not the culture would 
have reminded her then of the piney woods of Howard County, where she 
grew up in a three-room sharecropper's cabin with seven younger 
brothers and sisters under conditions that offered slim prospects for 
even a way out of the cotton patch much less an eminent career in science.

The subjects of her speeches and papers are mostly but not altogether 
those that lifted her from relative obscurity as a medical scientist 
and public health administrator 20 years ago to be the nation's top 
physician, chief health educator, children's tribune and public 
scold. The subjects are human sexuality and its effect on health and poverty.

You would think that getting fired from the biggest job you ever had 
by the president of the United States and having it reported on the 
front pages of newspapers across the country would hang like doom 
over her existence but she speaks of it cheerfully, even proudly. For 
that humiliation she harbors no anger for Clinton.

"I never thought at all that Bill Clinton was the reason I was 
leaving Washington," she said the other day. It occurred at a 
particularly low point for Clinton and his administration. 
Republicans had swept the congressional elections a month earlier, he 
was largely blamed for it, and a New York Times poll showed that only 
28 percent of the people trusted him on economic issues. The White 
House had gone into a defensive crouch when Dr. Elders went to New 
York on Dec. 1, 1994, to address a global HIV-AIDS conference at the 
United Nations.

Dr. Elders was already a lightning rod for the administration owing 
to her defense of abortion and her advocacy of sex education and 
contraception. Because she said youngsters should be taught to use 
condoms to prevent pregnancy and AIDS, conservative groups labeled 
her "the condom queen."

She had finished her lecture at the U.N. and the discussion turned to 
blunting the AIDS epidemic by breaking down the taboo of talking 
frankly about sex. A psychiatrist suggested that encouraging other 
forms of release besides sex might be one way to prevent risky sexual 
activity that led to AIDS and teen pregnancies. "What do you think 
are the prospects for the discussion and promotion of masturbation?" he asked.

She recalls that she squirmed a little but answered that she believed 
in comprehensive health education and that children should be taught 
what they needed to know in ways that were appropriate to their age. 
It seemed vague but she later said she was not trying to be coy and 
that she thought masturbation was a part of human sexuality and 
perhaps should be included in comprehensive sex education discussions.

Nothing was reported about the remark but it got back to Donna 
Shalala, the secretary of Health and Human Services, who had never 
been a fan of the Arkansas doctor. A year earlier, Shalala had 
scolded her for a remark at the National Press Club. Someone asked 
her if legalizing drugs would lower the crime rate. Dr. Elders 
answered that it would do that but she did not know all the other 
consequences of legalization. Perhaps it ought to be studied, she said.

Twelve days after the AIDS conference, Shalala summoned her to her 
office and asked whether she had said masturbation should be 
discussed in sex education. Dr. Elders recalled that she had said 
something like that. Shalala said it was a real problem and that she 
was not sure Dr. Elders could be saved.

Back at her office later in the morning, she received a call from 
Clinton's chief of staff, Leon Panetta, who said he wanted her 
resignation on his desk by 2:30 p.m. She told him she was not 
resigning until the president himself asked her to resign. The White 
House had already leaked word to the media that she had resigned and 
it was on the radio. Clinton telephoned from Florida and in an angry 
tone said he was sorry but her remarks made it impossible for him to 
keep her. He wanted her resignation immediately. She wrote it out, 
took it to the White House, cleaned out her desk and her house and 
headed back with Oliver to Little Rock.

Never would she talk to Clinton again, but she said Oliver saw him 
several years ago and he said he was sorry about all of it and that 
she had been right. You might expect some contrition from a man whose 
tawdry contributions to the public dialogue on sexuality would make 
her remarks sound like a Sunday school homily.

Dr. Elders still doesn't blanch talking about the subject. Why should 
masturbation be taboo, a topic only of locker-room jokes? In fact, 
she set out several years ago to write a book about the subject with 
Dr. Barbara Kilgore, a retired United Methodist minister. They have 
got off track, she said, "but I intend to finish it and get it 
published before I die."

Clinton could not have been surprised by her remark. Unflinching 
candor and the biting epigram were her trademarks after he appointed 
her state director of public health. "These people should get over 
their love affair with the fetus," she said of anti-abortion groups 
that were fighting her efforts to establish school-based health 
clinics in Arkansas. The phrase inflamed religious conservatives, who 
would picket her appearances for the next six years.

Before his inauguration in 1993 Clinton invited her to the Governor's 
Mansion, where he asked her to be surgeon general. She was reluctant 
and she recalls telling him, "Governor when you asked me to be your 
health director you didn't know anything about me. But if you do 
this, you will know exactly what you're getting," adding "You know I 
tend to say what I think."

"I know that for sure," he said.

Back at Little Rock three weeks after her firing she returned to her 
job as professor of pediatric endocrinology at UAMS, from which she 
had had a leave of absence for seven years. She went back to teaching 
and clinical practice, but she didn't entirely shed the political 
intrigues of her public health years. Arkansas Right to Life, a 
nemesis of those years, made a freedom of information request for a 
daily account of her activities, her comings and goings. Until 
shortly before she retired, she recorded her arrival times, 
departures and speaking engagements with the secretary for the 
Endocrinology Division for a monthly report to the group.

Dr. Harry P. Ward, the chancellor, told her that several Arkansas 
legislators with whom she had crossed swords called to say that she 
should not be restored to the medical faculty. "He said they told him 
I would contaminate the minds of the bright young medical students."

Sexuality, sex education, abortion, condoms, HIV-AIDS ­ those were 
topics to which Dr. Elders had given little systematic thought before 
she became director of the Department of Health in 1987. As a 
pediatric physician and scientist she had seen enough teen 
pregnancies and childhood victims of sexual abuse and the terrible 
consequences of both, "but I looked at them as individual cases," she 
said recently. She had not extrapolated those experiences into a 
systematic view of the problem.

She still remembers, poignantly, one of the early cases when she was 
a pediatric resident at UAMS. For two weeks, she treated a 
13-year-old girl from the Ozarks who came to the hospital with severe 
hyperthyroidism. With the thyroid problems under control the girl was 
to be released but she begged Dr. Elders not to let her go home, 
finally explaining "Saturday nights my daddy and my brother and my 
uncles use me and my sister."

Dr. Elders wanted to report the case but the hospital social worker 
told her that she, not the men, would be punished. This was six years 
before the state toughened its child-abuse laws. She spoke to the 
girl's mother delicately, but the mother did not think there was a 
problem. The girl returned to the hospital some months later, 
pregnant by her father.

"I knew that her life was over and that I, the medical profession, 
had failed her," Dr. Elders said.

As the chief pediatric endocrinologist (one who studies disorders of 
the hormone system and the body's chemistry), she would treat 
hundreds of cases of children with diabetes and growth disorders and 
she wrote or co-authored more than 100 medical articles, most of them 
on children's hormone problems. She was particularly distressed at 
the high rate of teen-age girls who were diabetic, sexually active 
and often pregnant, a grave peril to the girl and the baby. The 
girls' bodies were not ready for pregnancy and they were not ready 
for parenthood. She always got the diabetic girls to promise her that 
they would not be sexually active or if they were that they would 
avoid pregnancy at all cost.

Her first months on the job as state health director were an 
epiphany. She spent much of the time in county health clinics around 
the state, seeing patients and following home health nurses to the 
ramshackle homes to see pregnant and obviously sexually abused 
children. In one county they paid a visit to a 13-year-old girl for a 
six-week postpartum checkup who they suspected was pregnant again. 
She was living with six men, and one of them told the nurse that he 
thought she was giving them all an infection of some kind.

Then the magnitude of the problem became clear. She had seen the 
reality behind the statistics. The United States had the highest 
rates of teen-age pregnancy and out-of-wedlock births in the 
industrialized world and Arkansas had the highest rates in the United 
States. She would write about the epiphany in her autobiography in 1996:

"Seeing these places was taking me right back to where I had come 
from. I could identify with all of it. I wasn't looking at these 
scenes and saying, 'Oh, my goodness gracious isn't this just 
terrible?' I had lived through it. I didn't have to think, How in 
God's name do these people survive? I knew how they survived. They 
survived the same way we had survived. Ignorant and without help."

So began her crusade to save a generation of children by confronting 
head-on the great tension of the times, the sexual revolution and the 
culture of not talking frankly to kids about sex. She set out to open 
a public dialogue, in the schools, health offices, churches, the home 
and any other forum, on the most prevalent subject in America ­ sex ­ 
but on a level that was largely taboo. It began with school-based 
health clinics, improvement of local health offices and expansion of 
the home health program, sex education and, almost incidentally, a 
defense of abortion.

She opposed the repeated efforts to restrict abortions, not so much 
because women should have dominion over their own bodies, though she 
believed that, too, but because it gave youngsters more freedom to 
choose their own destinies, including education, and because it meant 
fewer babies who came into the world unhealthy and doomed to the 
plight of their mothers who were unprepared to parent children.

She believed and still believes that teenage births were the largest 
cause of poverty in America.

"It's not just my belief," she said. "It's been proven. Children get 
pregnant, fall behind in school or drop out, they don't get an 
education and they can't get a job. They don't do well in life. When 
you look at the prisons, a very large percentage of young people in 
prison were born to teenagers who weren't ready to be parents. Many 
are there because they killed their mom's boyfriend. The cost of 
teen-age pregnancy is just incalculable."

The teen-age pregnancy rate has been declining since she began her 
campaign in 1987, by 36 percent for black teen-agers, but it began to 
rise again in 2006 and 2007, she said.

The Guttmacher Institute, on whose board she sits, found that 70 
percent of the reduction in teen pregnancy was related to the use of 
condoms. Twenty-five percent was related to abstinence, a product of 
the AIDS panic of the late '80s and '90s, she believes.

She fought the abstinence-only education advocates, and studies as 
late as last month, including one by the Bush administration, have 
shown that she was right, that abstinence-only education and a pledge 
of abstinence until marriage makes no difference in the sexual 
activity of youngsters.

"They may delay for five or six months, but what happens when they do 
become sexually active is that they don't use condoms. They are 
greater risk takers and they get sexually transmitted diseases, 
including HIV," she said last October. A report making precisely 
those conclusions was published in January.

All the battles were at bottom about poor children, mostly 
African-American, getting an education. Early pregnancy nearly always 
blocked girls' path out of poverty and dependence. It was not an 
altogether popular stand among African-Americans. Black ministers in 
her own community, Dr. Elders said, accused her of aiding a campaign 
of racial extermination by pushing contraception.

Her own unlikely life convinced her that education was the ticket to 
everything for African-Americans and that the paramount job of anyone 
in public service like herself was to try to remove anything that impeded it.

Born Minnie Lee Jones (she changed her name in college to Joycelyn, 
the name of her favorite peppermint candy), she was the eldest of 
eight children, which made her the foreman when each of them got old 
enough to help in the cotton fields that her daddy sharecropped. He 
also trapped raccoons and she helped him skin them. They ate the 
raccoons and he saved the money from the skins to buy swatches of 
land for himself, eventually accumulating 80 acres.

School for blacks was a two-room house at Bright Star (the one in 
Howard County, not the one farther south in Miller County), where 
there were benches but no desks, no workbooks and few books. School 
was held when there was no work to be done in the fields. The school 
bus was an old truck chassis with a flatbed covered by a big plank 
box with chicken wire nailed over the window openings so the children 
wouldn't tumble out. High school was the training school for black 
children still farther east at Tollette although few went to high school.

But there was a reasonable semblance of education going on both 
places. In 1944, she got a better chance. Her father got a wartime 
job in the Richmond Shipyards on San Francisco Bay and she and her 
mother and the smallest baby joined him for two years. For the first 
time she attended school with whites. The school tested her and 
placed her two grades ahead of her age group. She excelled for two 
years and she got the idea that she was as bright as white kids and 
might do something more than work in the cotton fields or even clerk 
in a dime store at Nashville, which had been her farfetched ambition. 
Only whites were store clerks in Arkansas in the 1940s.

The family was reunited at Schaal after the war and she went to the 
training school for blacks at Tollette, graduating in 1949 at the age 
of 16. A Methodist official announced at the graduation that the 
church was giving a scholarship at Philander Smith College at Little 
Rock to the valedictorian, which was she. She had never heard of 
Philander Smith or been to Little Rock, but she wanted to go. Her 
father did not want her to go because she was needed for the cotton 
harvest in late September, but her grandmother persuaded him to let 
her go. When fall came the family did not have the $3.82 bus fare 
from Nashville to Little Rock. All the children turned out to pick 
early cotton until they had the fare.

It was at Philander Smith where she met Edith Irby, the first black 
medical student at the University of Arkansas, who was invited to 
speak at chapel. Irby, later Dr. Edith Irby Jones, professor of 
medicine at the University of Texas, ended by reciting a poem about 
taking the high road. Minnie Jones was spellbound and decided that 
she would be a doctor, too. After college, she joined the Women's 
Army Medical Corps, received training as a physical therapist and 
finished as a second lieutenant and with eligibility for the GI Bill. 
Together with her Army savings, that enabled her to go to medical 
school. She would excel as a student, an intern and a resident and 
finally as a medical scientist.

She still marvels at the constellation of events that allowed her to 
escape the cotton fields and the ignorance and poverty that were the 
nearly certain fate of black children of that era and culture. 
Education did it. Partly out of recompense for their help in raising 
the $3.82 for her bus fare to Little Rock that early September day, 
she saw to it through example, encouragement and financial help that 
all her siblings except one got to college. A sister earned a Ph.D. 
All her medical training and expertise in childhood disease and 
development came to be directed at clearing away the health obstacles 
to an education.

Dr. Elders sits for the second time on the Board of Trustees at 
Philander Smith, which she says gave her an education as fine as 
Harvard would have given her. While a film crew was filming her at 
Philander Smith in November for a documentary on her life that AETN 
Channel 2 is preparing, two men students saw her and wanted to shake 
hands. They said they wanted to tell their mothers they had met her 
and thank her for paving the way for them.

She smiled but the scold returned. "How are your grades?" she asked. 
"Are you studying or just trying to slide by?" They said they were 
working pretty hard. Good, she said, because she had been to the 
penitentiary and it was full of young men who hadn't. It's 
discouraging sometimes, one said, but they were going to persevere to 
graduation.

"Promise?" she asked each.
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MAP posted-by: Keith Brilhart