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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.