Intermediary Medicine in Charleston
Medical Intermediaries
Between
the field of clinical medicine, centered in urban Charleston, and the field
of traditional folk medicine, prevalent especially in the rural low country,
operated a group of dedicated medical professionals and institutions referred
to here as "medical intermediaries." Among them were medical doctors
who practiced in rural clinics, licensed nurse-midwives, and the outreach staff
of the Penn Center on St. Helena Island. Their mission was to share the benefits
of clinical knowledge with the black population of the low country. Their challenge
was to avoid frightening or alienating them. Success required respect for the
spiritual and therapeutic power found in traditional medical practices.
Traditional medicine was based in a centuries-old world view and belief system that travelled with African slaves
to American shores. Though adapted to accommodate new surroundings and influences, the traditions remained strong
and viable in the lives of the transplanted Africans and their offspring. To attack those traditional beliefs and
the medical practices they supported would have been both harmful and foolish.
The Penn Center
One
of the most successful intermediary agencies operating in the low country was
the Penn Center. Sensitive to
the value, practical knowledge, and traditional community status of the "granny
midwives", the agency developed a program to retrain and certify them.
The program's goal was to discourage traditional midwifery practices that were
sometimes harmful (such as the use of cobwebs to dress
a newborn's naval) and to introduce sanitary techniques to the grannies without
alienating or discrediting them.
In
the 1930s, in conjunction with the State Board of Health, licensed nurses began
regular courses of training for granny nurses at the Penn Center. The grannies
received sterile dressings and equipment to sterilize their scissors and other
instruments. They learned new procedures to supplement their basic skills and
also when to seek professional from a doctor or a licensed nurse.
The agency held periodic meetings for the grannies which were conducted with dignity and usually opened with
prayer and singing of a spiritual. By showing respect for the grannies and their tradition, the agency earned their
trust and their cooperation in spreading knowledge about hygiene and sanitation within their spheres of influence.
The County Public Health Nurse
From the 1920s on, public health nurses, the great majority black, travelled the South Carolina low country
from village to village, home to home, providing a compassionate link between clinical and traditional medicine.
Employed by county health departments, they covered territories hundreds of square miles in size, supplementing
the work of the far-too-few county doctors. Among them were a small but vital number of trained nurse-midwives,
whose education included the full course required of all registered nurses, plus public health training and at
least six months training in obstetrics. One of these nurse-midwives, Maude Callen, was profiled in a 1951 Life
Magazine picture essay that described her as a combination doctor, dietician, psychologist, bailgoer and friend
to ten thousand clients.
County public health nurses taught the rural population about sanitary procedures and watched for signs of communicable
disease while showing respect for their clients' traditional medical practices. These intermediaries offered the
benefits of clinical medicine to clients who, because of their traditional self-reliance, marginalization due to
economic and racial factors, or physical isolation, would otherwise have been denied them.
Rural Physicians
Those few physicians, predominantly black, who practiced in the rural low country
faced formidable challenges. They encountered suspicion and lack of trust from
the rural population because their procedures and prescriptions were so different
from the traditional folk medicine that was practiced in the low country. Also,
the physicians threatened the traditional status and authority of the "root
doctors", or herb doctors, who for generations
had dispensed herbal remedies and charms to cure their patients.
If the black physician directly confronted the authority of the herb doctor,
he confronted an entire folk tradition. He might lose the confrontation and
any foothold he had gained among the population, because the herb doctor often
knew the best cure for his patients. In the tradition
of low country blacks, the doctor did not receive payment unless he effected
a cure, so each time the herb doctor got credit for a cure, the physician received
no fee for his services, no matter how beneficial they had been. It was difficult
for a physician to make a living in the rural low country.
To succeed in his practice, a rural physician often worked with and through
a granny midwife, sometimes certified, who was well positioned in the local
population. One such doctor, Joseph Hoffman, had the
good fortune to be sponsored in his practice on Johns Island by a prominent
farmer who built an office for him. He worked there one day a week during the
Depression until his Charleston practice became too demanding. He served about
six patients and dispensed his own medicine, charging fifty cents for office
visits and a dollar for house calls and delivering babies when summoned by a
local midwife. He maintained a good relationship with the midwives by tactfully
accommodating their traditional practices, and at
a time when the rural population had difficulty travelling to Charleston, his
presence on Johns Island was welcomed.
Even with today's modern roads and bridges, access to Charleston from rural or island locations is not guaranteed
for many area residents. Some are too old to drive, some are too poor to own a car, and some are intimidated by
"establishment" medicine in the city. For them, the work of intermediary public health professionals
and the outreach of religious and educational institutions remains critical to their health and well being.
