Amna Nawaz:

A century ago, Black physicians built hospitals, clinics and medical schools across the South, only to see them dismantled by policy, segregation, and a single at the time influential report.

Investigative journalist Nicole Carr traces that history through her own family and found the consequences are still being felt today.

Geoff Bennett recently spoke with Carr about her book, "The Price of Exclusion: The Pursuit of Healthcare in a Segregated Nation."

Geoff Bennett:

Nicole Carr, welcome to the "News Hour."

Nicole Carr, Author, "The Price of Exclusion: The Pursuit of Healthcare in a Segregated Nation": Thank you for having me.

Geoff Bennett:

You open this book with the story of your great-grandfather Dr. Lawrence St. Clair Ferguson. How did his story draw you into this project?

Nicole Carr:

Yes, so I wasn't planning on writing a book. I was working in local television in Atlanta during the height of the pandemic, the COVID-19 pandemic.

And I got off air one evening. We had three kids, two in virtual school. I was four months postpartum, feeling the pressures of everything we were covering at the time. And I just had a moment one evening and asked myself, how did they get through this 100 years ago?

And I knew we had this ancestor who was a physician maybe during this time, but we didn't know a whole lot about him because of some family dramas, some issues in the family. But we carried a name, and I wanted to find him. I wanted to know how he lived during this time.

And I went to Howard University archives to kick this off, because he'd completed medical school there and I thought maybe they'd have some answers. They had just digitized a new collection of archive material using a Mellon Foundation fund. And one of the new assets was his medical school yearbook, The Morgue from 1925.

But I found out that he'd come to America from Jamaica during Red Summer after serving in the Great War and, during the pandemic, during the war coming here, during racial terror and strife, finishing premed during the week of the Tulsa Race Massacre, where one of the first casualties is a Black physician, and finishing med school studies and going to a place, to Harlem, when they're trying to integrate the hospitals there.

The same things happening 100 years ago, with socioeconomic and health equity questions, and this question of racial reckoning in America. We were going through the same thing here a century later. And so I just felt drawn to him.

Geoff Bennett:

And you approached his story with your skills and background as an investigative journalist.

Nicole Carr:

Yes.

Geoff Bennett:

The title of this book, "The Price of Exclusion," what is the price and who is paying it today?

Nicole Carr:

I think we're all paying for it today.

One of the things I remember, I remember being on a Zoom press conference with the heads of the Black medical schools, the four that we have here in the U.S.

And the American Medical Association at some point during this reporting in 2020 apologized for the role it had played in shutting down Black medical schools in the early 20th century. We know this as the price we paid for the Flexner Report.

So they commissioned this report. They're with the Carnegie Foundation and they're evaluating these medical schools for efficiency, effectiveness, and what we lose are all the Black medical schools except for Howard University's school and Meharry. And we're left with those until late '70s, early '80s when Morehouse School of Med comes to be, and then Charles Drew later on.

They were apologizing because we were feeling the effects of the shortage of Black physicians 100 years later from shutting down these schools. To this day, the majority of our Black physicians are still trained at Black medical schools.

Even with the few we have left, the majority, our supply is from historically Black institutions. And so it starts with that. It starts with that.

Geoff Bennett:

And to your point, Black folks make up 14 percent of the population roughly, Black physicians only about 5 percent.

Nicole Carr:

Across...

(Crosstalk)

Nicole Carr:

Yes, right.

Geoff Bennett:

Yes, and that ratio has not changed for over a century. What accounts for that?

Nicole Carr:

The education. It's the education and not the ability, but the access to it, which is very important in this time, especially as we approach July 1 and what we see baked into the Big Beautiful Bill and the loan limits for professional schools.

When you factor that into scholarship funds and endowments and things that are being challenged for racial discrimination, when you combine that with the racial wealth gap, when you combine that with how many institutions are training our doctors, we're effectively seeing the potential for these doors to be shut in a way that they were during what we recognize as a formalized Jim Crow America.

And so we're not waiting to see black and white water fountains or no people of this kind allowed in this school, no policy like that. But modern-day policy can effectively take us back to the same ratios we were dealing with 50 to 100 years ago. And that's scary.

Geoff Bennett:

Your reporting took you to places where hospitals have disappeared, where access to health care has become increasingly scarce. What did those communities reveal about the connection between health care access and representation?

Nicole Carr:

I really felt folks' loss of hope when they could not access basic care.

So the book opens up in Hancock County, Georgia. The hospital has been -- the county hospital has been shuttered for decades. It's almost scary to walk on the property. It's overgrown with vines. There's this silence, this energy. It's like, OK, once, we were getting somewhere and now there's no Medicaid expansion. There's -- the doors are shut on the hospital.

There's one Black physician. She's a Spelman graduate. She's in her 70s, Dr. Patrice Boddie, that I talk about. Everybody's trying to get an appointment with Dr. Boddie because she's culturally competent. She understands them. She's come back to her hometown. She's -- we're dealing with generations.

Her grandfather, father and uncle ran the practice that she's still holding together all these decades later, a Meharry graduate who comes back home. And she's dealing with the problems that we're always dealing with, high blood pressure, diabetes. She's trying to stabilize folks in a home hospital setting that her ancestors ran.

And they can't get to a quality hospital quick enough when there's an emergency. You meet a woman who had a brain aneurysm, a brain bleed. She took -- it took an hour-and-a-half to get her to Augusta, Georgia, to get the care she needed. And the consequences of that, I mean, it manifests in her face in a way that she's able -- her mobility.

But had they lived 100 years ago, the hospital that was serving Black folks was right around the corner. And so there's this question of, what did we lose with the idea of integration? The policies with integration was, it meant for us to have access to the things that we needed.

What was lost in integration? And what are the effects of it all these decades later? What went wrong with policies? And that is -- I mean, that's something we're exploring here.

Geoff Bennett:

The book is "The Price of Exclusion: The Pursuit of Healthcare in a Segregated Nation."

Nicole Carr, a real pleasure to speak with you.

Nicole Carr:

Thank you.