This is longer than a 140-character Tweet, but I respectfully ask that all who participated in exchanges over a statement I made on Twitter on February 4, 2021 concerning #PureReparations, that aroused a firestorm of responses, please read this from start to finish.
This is longer than a 140-character Tweet, but I respectfully ask that all who participated in exchanges over a statement I made on Twitter on February 4, 2021, concerning #PureReparations, that aroused a firestorm of responses, please read this from start to finish. Some of the responses to my statement were serious, thoughtful, and critical, but others were so hostile. I am convinced many of them were written by people who only had, at best, second- or third-hand knowledge of the content of my message.
Let me be clear, I remain steadfast that African American reparations in the United States should be designated specifically for black Americans who are descendants of persons enslaved in the United States. It is a position that I have maintained for upwards of 20 years, first articulated with the eligibility criteria I presented in an article published with Dania Frank in 2003 in the American Economic Review.
The criteria expressed at the time were twofold: 1. An American citizen would have to demonstrate they have at least one ancestor enslaved in the United States. 2. An American citizen would have to demonstrate that for at least ten years before the adoption of a reparations program they self-classified as black, negro, or African American. The first criterion is a lineage standard; the second is an identity standard. Both standards must be met to merit receipt of reparations payments.
In our recent book, From Here to Equality (FHTE), Kirsten Mullen and I modify the identity standard to lengthen the time to at least twelve years (two Senatorial terms) and to include the adoption of a study commission for reparations as one of two events that would trigger the time count on self-classification.
The core objective always has been to include all persons, and their descendants, who have been subjected to the cumulative, intergenerational effects of slavery, legal segregation and white terrorist violence, and post-Civil Rights Era mass incarceration, police executions of unarmed blacks, and ongoing discrimination in the justice claim. This is the community whose ancestors were denied the promised 40 acres as restitution for the years of bondage and as a material springboard for entry into full citizenship in the United States.
Kirsten and I argue further, in FHTE, the best economic indicator of the combined effects of these atrocities is the racial wealth gap. We propose that elimination of the gap yields the baseline value for a reparations plan—demanding a federal government expenditure of $10 to $12 trillion. It is a key aspect of our project to generate a research-based standard for determining the size of the bill that is due. We do not identify an upper bound for the bill.
We also insist that priority be given to mobilization of the funds in the form of direct payments to eligible recipients, whether cash transfers, trust accounts, other types of endowments, or some combination thereof.
The two eligibility criteria necessarily exclude many Americans. The lineage standard will exclude all blacks in the United States who migrated to the United States and became citizens after the end of the Civil War. Their descendants also will not be eligible, in the absence of a parent’s or grandparent’s intermarriage with black Americans having ancestry anchored in US slavery. Counting among blacks excluded would be the relatively small group that migrated to the United States during the Jim Crow years (estimated to be, according to a Smithsonian study, to the right of the decimal point). Also excluded is a much larger group of black immigrants (now approaching ten percent of the nation’s black population) who arrived after 1964, especially coming in large numbers from the 1980s onward.
The identity standard excludes all persons who self-identified as non-black, inclusive of all white Americans, at a point where there was no apparent financial benefit from classifying oneself as black.
Meeting the lineage standard necessitates serious genealogical research. As a result, in FHTE, Kirsten Mullen and I recommend the federal government establish an agency with genealogists with expertise in African American ancestry to provide free services to all persons seeking to establish their reparations claim. Despite that recommendation, we continue to get substantial push back from those who say many black Americans with ancestors enslaved in the US will hit a wall in getting past the 1870 Census to identify their particular ancestors who were held in bondage before 1865. Therefore, I have been giving more thought to modifications in the criterion that would make it easier for all black American descendants of U.S. slavery to be assured of inclusion.
One possibility that seemed reasonable is the one I advanced that stirred the pot to a boil—include black immigrants who came during the Jim Crow years on the eligibility list. Let me emphasize, I advanced this to prompt discussion. I even referred to this in a later post as a “trial balloon,” which left me open to the somewhat humorous charges that the balloon popped or, quite the opposite, the balloon was made of lead.
Here is the thinking that I pursued: Allowing pre-1950s black immigrants onto the reparations roll eases genealogical proof required of black American descendants of U.S. slavery to establish their lineage claim. You necessarily have a tradeoff between letting a small number of otherwise excluded black folk in the door versus keeping the strong genealogical standard that will demand going past the 1870 “wall.” Under the former case, with the relaxed lineage standard, a person would have to demonstrate, say, that they have at least two black ancestors who were citizens of the USA before 1950 or 1960.
Then, eligibility would be much easier to establish for all black American descendants of U.S. slavery at the “price” of including a small number of black immigrants who arrived during legal segregation. Let a few in who do not meet the original lineage standard to ensure that all make it in who meet the original lineage standard.
No Mission Creep
I reject the “slippery slope” argument that has it that making this exception opens the gates for every other group to piggyback onto the reparations’ claim. Conditions can be drawn so precisely that no additional groups will become eligible.
Nevertheless, I do take seriously, the following critical response to my “trial balloon”: The limitation of African American reparations to black American descendants of US slavery is a matter of principle that should not be compromised. America’s history of racial injustice has targeted this community so consistently and with such ferocity that we should brook no modification in the criteria, even it remains more difficult for each individual to establish eligibility for the merited compensation.
In fact, I take it so seriously, in a later message, I indicate that I would not advance as an option the proposal any longer, and I will stand committed solely to the original criterion. Unlike what is suggested in a number of messages on Twitter, I never proposed that recent black immigrants should be eligible for reparations from the U.S. government. Nor do I anticipate reneging on that position. . . ”
Image above: Portrait of Mollie Williams (Mississippi), taken as part of the Federal Writers’ Project
This article was published online on February 9, 2021.
On a rainy Thursday afternoon in November, I stepped inside the National Museum of African American History and Culture, in Washington, D.C. On past visits, I’d always encountered crowds of tourists and school groups, a space bursting with movement and sound. But on this day, the museum was nearly empty. It seemed to echo with all the people who had been there but were no longer. For the few of us inside, social distancing was dictated by blue circles scattered on the floor.
I made my way down to the bottom level, which documents the history of slavery in America. Masks were mandatory, and something about the pieces of cloth covering everyone’s mouths seemed to amplify the silence and solemnity of what surrounded us.
I walked past the statue of Thomas Jefferson standing among bricks bearing the names of people he’d enslaved, past a cabin that enslaved people had slept in, and past the stone auction block upon which enslaved people had been sold and separated from their families.Toward the end of a long corridor was a dimly lit room with sepia-toned photos on the walls. Photos of enslaved people holding their own children, or their enslaver’s children. Photos of fresh wounds on the backs of those who’d been beaten. Photos of people bent over fields of cotton that hid their faces.
But what was most striking about the room was the voices running through it. The words of people who had survived slavery were running on a six-minute loop. Their voices floated through the air like ghosts.
“My father was not allowed to see my mother but two nights a week,” said a woman in the voice of Mary A. Bell. “Dat was Wednesday and Saturday. So he often came home all bloody from his beatings.”
“I had to wok evva day,” said a woman in the voice of Elvira Boles. “I’d leave mah baby cryin’ in the yard, and I’d be cryin’, but I couldn’t stay.”
“My mudder word in de field,” said Harrison Beckett. “Sometimes she come in 9 or 10 ’clock at night. She be all wore out an’ it be so dark she too tired to cook lots of times, but she hafter git some food so we could eat it. Us all ’round de table like dat was like a feast.”
When I’d first encountered these floating voices years before, I was fascinated by how ordinary their stories were. These were not tales of daring escapes like those of Henry “Box” Brown, who in 1849 contorted his body into a wooden crate for 27 hours as it was delivered from the slave state of Virginia to abolitionists in Pennsylvania—mailing himself to freedom. Nor were they the stories of Frederick Douglass, who as a teenager, in 1833, fought his white slave breaker with such force that the man never hit Douglass again. Nor were they the stories of Harriet Jacobs, who, in an attempt to escape the physical and sexual abuses of slavery, hid in an attic for seven years.
Brown became a global celebrity who turned his escape routine into a one-man show that traveled throughout the United States and England. Douglass and Jacobs wrote autobiographies that became best sellers, and that today are staples in classrooms around the world. Theirs are the stories I learned as a child, and there’s great value in teaching kids stories of resistance, of Black people not being passive recipients of violence. But I remember how, after reading them, I found myself wondering why every enslaved person didn’t just escape like these famous figures did. The memory of that thought now fills me with shame.
The stories swirling about the room weren’t famous accounts of extraordinary people; rather, they were the words of all-but-forgotten individuals who bore witness to the quotidian brutality of chattel slavery. These stories were the result of the Federal Writers’ Project—a New Deal program that was tasked with collecting the oral histories of thousands of Americans. From 1936 to 1938, interviewers from the FWP gathered the firsthand accounts of more than 2,300 formerly enslaved people in at least 17 states. The members of the last generation of people to experience slavery were reaching the end of their lives, and so there was an urgency to record their recollections. In scale and ambition, the project was unlike any that had come before it. The Federal Writers’ Project ex-slave narratives produced tens of thousands of pages of interviews and hundreds of photographs—the largest, and perhaps the most important, archive of testimony from formerly enslaved people in history.
While many of these narratives vividly portray the horror of slavery—of families separated, of backs beaten, of bones crushed—embedded within them are stories of enslaved people dancing together on Saturday evenings as respite from their work; of people falling in love, creating pockets of time to see each other when the threat of violence momentarily ceased; of children skipping rocks in a creek or playing hide-and-seek amid towering oak trees, finding moments when the movement of their bodies was not governed by anything other than their own sense of wonder. These small moments—the sort that freedom allows us to take for granted—have stayed with me.
When I first came across the narratives, I was confused as to why I had never, not once in my entire education, been made aware of their existence. It was as if this trove of testimony—accounts that might expand, complicate, and deepen my understanding of slavery—had purposefully been kept from view.
For many black americans, there is a limit to how far back we can trace our lineage. The sociologist Orlando Patterson calls it natal alienation: the idea that we have been stripped of social and cultural ties to a homeland we cannot identify. I have listened to friends discuss the specific village in Italy their ancestors came from, or the specific town in the hills of Scotland. No such precision is possible for Black Americans who are the descendants of enslaved people. Even after our ancestors were forcibly brought to the shores of the New World, few records documented their existence. The first census to include all Black Americans by name was conducted in 1870, five years after slavery ended. Trying to recover our lineage can be a process of chasing history through a cloud of smoke. We search for what often cannot be found. We mourn for all we do not know.
But the descendants of those who were interviewed for the Federal Writers’ Project have been given something that has been denied to so many Black Americans: the opportunity to read the words, and possibly see the faces, of people they thought had been lost to history.Because these narratives are not often taught in school, many people come across them for the first time later in life. Several historians told me that their encounters with these stories had shifted the trajectory of their personal and intellectual lives. Catherine A. Stewart, a historian at Cornell College, in Iowa, and the author of Long Past Slavery: Representing Race in the Federal Writers’ Project, remembers sitting in the basement of the university library as a graduate student, making her way through reels of microfilm. “I will just never forget this sensation I had of these stories—of these life histories of these individuals, personal stories and experiences of enslavement—just leaping off the page,” she said.
For years, the collections had been largely ignored. As Ira Berlin, Marc Favreau, and Steven F. Miller note in Remembering Slavery, an edited volume of selected narratives, historians throughout the mid‑20th century came up with a range of reasons not to take them seriously. Some argued that because the people who were interviewed, in the 1930s, had been children when slavery ended, their memories were unreliable. Others claimed that the narratives couldn’t be trusted because they weren’t an adequate statistical sample: Those who were interviewed represented approximately 2 percent of the formerly enslaved population still alive in 1930.
Perhaps the most insidious reason to dismiss the narratives came from the historian Ulrich B. Phillips, whose conception of slavery as a civilizing institution for the enslaved shaped many Americans’ understanding of it in the early-to-mid-20th century. Phillips complained of “Negro bias,” believing that Black Americans were “too close” to the subject of slavery and thus unable to be objective about it—a criticism that has been used to undermine Black writing and research on issues of racism since the earliest days of Black life in America.That view began to change with the civil-rights movement of the 1960s, when historians, intellectuals, and activists came to see slavery as the root cause of racial inequality. Interest in the Federal Writers’ Project narratives grew.
The Black Lives Matter movement has further pushed historians to revisit these stories. The past several years—and particularly the months since last summer’s racial-justice protests—have prompted many people to question what we’ve been taught, to see our shared past with new eyes. The FWP narratives afford us the opportunity to understand how slavery shaped this country through the stories of those who survived it.
My mammy Martha an’ me we ’longed ter Mister Joshua Long in Martin County, an’ my paw, Henry, ’longed ter Squire Ben Sykes in Tyrrell County. Squire Sykes lived in what wus called Gum Neck, an’ he owned a hundert slaves or more an’ a whole passel of lan’.
Noah lewis had been doing genealogical research for years, trying to learn as much as possible about his family history, when he discovered that his great-great-grandfather, a man named William Sykes, had been interviewed as part of the Federal Writers’ Project ex-slave-narrative collection. He wanted to see the original documents himself, so he traveled from his home in Philadelphia to Washington, D.C., to visit the Library of Congress.
“It was an amazing experience,” he told me. “I had never seen photographs of him before … That was just mind-blowing all by itself.”
In the black-and-white photograph of William Sykes that accompanies his narrative, he is 78 years old and facing the camera, his eyes hidden behind a pair of dark glasses. He has a white mustache that stretches over his mouth and a long goatee that hangs from his chin. He appears to be furrowing his brow.
“He kind of reminds me of my older brother, Jimmy,” Lewis said.
Lewis had read books that detailed the physical and psychological violence of slavery; he had seen photos of enslaved people and understood the brutal conditions in which they worked. But there was something different about reading the narrative of his direct ancestor—someone from his own family who, only a few generations earlier, had been in chains.
In his narrative, William Sykes describes being a child in North Carolina and seeing the soldiers of the Union Army make their way into Confederate territory. Sykes’s enslaver, fearful for his own life and worried that the Union soldiers might confiscate his human property, escaped with his enslaved workers into the mountains.
While we wus dar one day, an’ while Mr. Jim Moore, de Jedge’s daddy am in town de missus axes my cousin Jane ter do de washin’.
Jane says dat she has got ter do her own washin’ an dat she’ll wash fer de missus termorrer. De missus says “you ain’t free yit, I wants you ter know.”
“I knows dat I’s not but I is ‘gwine ter be free’ ”, Jane says.
De missus ain’t said a word den, but late Sadday night Mr. Jim he comes back from town an’ she tells him ’bout hit.
Mr. Jim am some mad an’ he takes Jane out on Sunday mornin’ an’ he beats her till de blood runs down her back.
Sykes was a child; the detail of blood running down Jane’s back stayed with him the rest of his life.
Lewis said that, like me, he’d grown up with an incomplete understanding of slavery. “As a young child, I remember thinking to myself, You know, hey, if slavery was so bad, why didn’t my people fight harder to try to get out of it? ” Jane’s story showed that it wasn’t so simple.Lewis himself was born in 1953 on an Army base in Heidelberg, Germany, where his father was stationed. His family returned to the U.S. when he was just 10 months old. When he was 13, they moved to Aldan, Pennsylvania, a suburb of Philadelphia. As far as Lewis knows, his was the first Black family in Aldan, and he says they were not welcomed with open arms.
“A couple days after we moved in, we woke up that morning, and somebody had written on our car windshield i hate niggers.” His father came out of the house with a shotgun and yelled loud enough for everyone in the neighborhood to hear: “I don’t care if you don’t like me, but if you start playing with my property, there will be trouble.”Lewis said that while the FWP narratives can be emotionally difficult to get through, he’s also found “a certain joy” in reading them. “This is your relative, and it’s them speaking, and it brings them to life. They remind you that they were a person, not a stat, not a little side note, not a little entry in a genealogical chart. They were a real, living, breathing human being. That’s what that document kind of really hits you with.”
But not everyone feels the way Lewis does. Six years ago, he attended a family reunion in New Jersey and decided to share what he’d discovered. Standing in front of about 30 people in folding chairs in a relative’s backyard, Lewis read Sykes’s words. Some of those present were old enough to have known Sykes when they were children—and some felt deeply hurt, and embarrassed, by parts of what Sykes was portrayed as having said.
For example, some sections of his narrative implied that life under slavery was good:
I knows dat Mister Long an’ Mis’ Catherine wus good ter us an’ I ’members dat de food an’ de clothes wus good an’ dat dar wus a heap o’ fun on holidays. Most o’ de holidays wus celebrated by eatin’ candy, drinkin’ wine an’ brandy. Dar wus a heap o’ dancin’ ter de music of banjoes an’ han’ slappin’. We had co’n shuckin’s, an’ prayer meetin’s, an’ sociables an’ singin’s. I went swimmin’ in de crick, went wid old Joe Brown, a-possum huntin’, an’ coon huntin’, an’ I sometimes went a-fishin’.
Read one way, these sorts of details might be seen as softening the horrors of slavery, making the gruesome nature of the institution more palatable to readers who aren’t prepared to come to grips with what this country has done. Read another way, though, they might reveal the humanity of those who were enslaved, and show that despite circumstances predicated on their physical and psychological exploitation, they were still able to laugh, play, celebrate, and find joy.
Other sections of Sykes’s account, however, are more difficult to reconcile. Toward the end of the narrative he’s depicted as having said:
We ain’t wucked none in slavery days ter what we done atter de war, an’ I wisht dat de good ole slave days wus back.
Dar’s one thing, we ole niggers wus raised right an’ de young niggers ain’t. Iffen I had my say-so dey’d burn down de nigger schools, gibe dem pickanninies a good spankin’ an’ put ’em in de patch ter wuck, ain’t no nigger got no business wid no edgercation nohow.
After Lewis finished, some of his relatives told him that he shouldn’t have read the narrative to them. They felt that Sykes’s words reflected poorly on them as a family and on Black people in general. But they didn’t just blame Sykes; they blamed the white person who’d interviewed him, who they believe must have manipulated Sykes or changed his words. “A typical example of white people trying to make us look ignorant,” they told him.
This issue of manipulation in the interviews is something historians have had to wrestle with. The narratives were rarely verbatim transcriptions. Many interviewers altered their subjects’ dialect to make it seem more “authentically” Black. As Catherine Stewart writes in her book, “FWP decisions about how to depict [dialect] on the page reveal more about how the black vernacular was used to represent black identity than about the actual speech patterns of ex-slave informants.” And historians have worried that in a violent, segregated society, when white interviewers showed up on a Black person’s doorstep, the formerly enslaved might have told the interviewers what they thought they wanted to hear, rather than what had actually happened.
The project did employ some Black interviewers, but the majority were white southerners. Some were the descendants of slaveholders—in certain cases, descendants of the families that had enslaved the very same people they were sent to interview—or members of the United Daughters of the Confederacy, an organization known for pushing a narrative of slavery that was sympathetic to the Confederate cause.
When Stephanie Jones-Rogers, a historian at UC Berkeley and the author of They Were Her Property: White Women as Slave Owners in the American South, showed early portions of her book to friends, some questioned why she hadn’t changed the language of the interviews. They worried that the narratives portrayed formerly enslaved people as uneducated and illiterate. “There may have been some manipulation,” Jones-Rogers told me, and that should be accounted for and taken seriously. Still, she felt that changing the language would risk changing the specific meaning behind how these individuals wanted to tell their story. And it would ignore the fact that, unfortunately, many of them were, by nature of circumstance, uneducated and illiterate—a reflection of the way the insidious legacy of slavery had continued to shape their lives.
Daina Ramey Berry, the chair of the history department at the University of Texas at Austin, told me that there is no source a historian can use that isn’t compromised by bias in some way, and the notion that we should ignore the narratives because of their imperfections would mean applying a standard to them that is not applied across the board. “The big excuses that people have as to why they push back against them is that they’ll say, ‘Well, they’re biased,’ ” she said. “And I’m always like, ‘I don’t understand why you can read a plantation owner’s letters, or his journal—or her journal—and not even question that.’ ”
Lewis understood his relatives’ concerns. Still, he couldn’t help but feel disappointed that they didn’t appreciate how remarkable it was that this narrative existed at all. For Lewis, it was a piece of history, a piece of them. It was like finding treasure—even if the jewels aren’t cut as cleanly as you’d like, they’re still worth something.
Lewis’s interest in history would ultimately change the course of his life. As he was doing his genealogical research, he went all the way back to the American Revolution, trying to discover whether he had relatives who had been enslaved in the British colonies. He came across the book Black Genealogy, by the historian Charles L. Blockson. There, Lewis encountered the story of a man named Edward “Ned” Hector, a Black soldier who fought in the Revolutionary War, one of thousands of Black people to fight on the side of the Americans. During the Battle of Brandywine, in September 1777, Hector and his regiment were under attack and ordered to abandon their guns and retreat for safety. Hector, however, seized as many abandoned guns as he could, threw them in his wagon, and warded off British soldiers to salvage the only equipment his company had left.
Learning about Hector was transformative for Lewis. He thought this history of Black contributions to the American project should be taught in his children’s classrooms—but not just through books or lectures. The history had to be brought to life. It had to be made real. “So I figured it would be a much better way of getting across to the kids about Hector if I came as Hector,” he said.
His first presentation was in his daughter’s fifth-grade classroom, in a makeshift costume that he still laughs about today. His pants were blue hospital scrubs, with a pair of long white socks pulled over the bottoms of the legs. He wore a yellow linen vest, a souvenir-shop tricornered hat, and a woman’s blouse. “It was very bad, extremely bad,” he said. Still, the teachers and students loved his presentation, and he was asked to come back again. And again. “After a while, one of the teachers said, ‘You got something really good here. Maybe you might want to consider taking this more public, out to other schools and places.’ I thought about that. And I said, ‘You know, that’s not a bad idea.’ ”About three years later, Lewis decided to leave his full-time job running an electronics-repair shop so he could dedicate more time to his reenactment work, which he had begun getting paid to do. Since then, he’s performed as Ned Hector in classrooms, at memorial sites, and at community festivals and has become a staple of the colonial-reenactment community.
In a video of one performance, he’s dressed in a blue wool jacket—typical of those worn by American soldiers during the Revolutionary War—and a matching tricornered hat with a large red feather. In his hands, the musket he holds is not simply a musket, but an instrument that helps him transport the audience back more than two centuries. It becomes a paddle, rising and falling in front of his chest as he tells the story of Black soldiers helping other American troops cross a river during battle. He places it just below his chin as if it were a microphone amplifying his story, or a light meant to illuminate his face in the darkness.
In another video, Lewis stands in front of a school group. “How would you like to have your families, your loved ones, dying for somebody else’s freedom, only to be forgotten by them?” He pauses and scans the crowd. “If you are an American, you share in African American history, because these people helped you to be free.”Watching Lewis, I was impressed by how he brought the Revolution to life in ways that my textbooks never had. How he told stories of the role Black people played in the war that I had never heard before. How in school—except for Crispus Attucks’s martyrdom during the Boston Massacre—I don’t think I had ever been made to consider that Black people were part of the American Revolution at all. It reminded me of how so much of Black history is underreported, misrepresented, or simply lost. How so many stories that would give us a fuller picture of America are known by so few Americans.
The horn to git up blowed ’bout four o’clock and if we didn’t fall out right now, the overseer was in after us. He tied us up every which way and whip us, and at night he walk the quarters to keep us from runnin’ ’round. On Sunday mornin’ the overseer come ’round to each nigger cabin with a big sack of shorts and give us ’nough to make bread for one day. I used to steal some chickens, ’cause we didn’t have ’nough to eat, and I don’ think I done wrong, ’cause the place was full of ’em.
In the photograph accompanying the interview of Carter J. Johnson, he stands in front of a wooden cabin in the town of Tatum, Texas. He wears denim overalls and a collared shirt. His head is cocked, his brow furrowed. On the porch behind him is a woman in a patterned dress.
Janice Crawford had never seen a photo of her mother’s father. When she saw this picture, she told me, it was listed under the name Carter J. Jackson, but Crawford couldn’t find a Carter Jackson in the census records for that area. She recognized some of the names he mentioned in his narrative from her genealogical research, and showed the photo to her mother, who immediately recognized her father. Carter J. Jackson was in fact Carter J. Johnson. The interviewer must have made a mistake.
Crawford’s mother was born to two unwed parents. They lived nearby, but the man she called Papa, the man she always thought of as her father, was Carter Johnson. Johnson, a deacon in the local church, and his wife, Sally Gray Johnson (whom Crawford called Big Mama, and who is the woman on the porch in the photo), took her in and raised her as their own. Crawford never knew her grandfather—he died nine years before she was born—but his presence was still in the air as she grew up.
Crawford’s mother didn’t have a photograph of her father, and it meant a great deal to Crawford to be able to give her one. “It was very emotional to me,” she said.
She remembers her mother telling her a story, long before she read it in the narrative, about how Johnson and other enslaved people had been forced to walk from Alabama to Texas while guiding their owner’s cattle and horses and a flock of turkeys the entire way. She couldn’t understand how someone could make other people walk so far, for so long.In the narrative, Johnson says that his mother, a woman named Charlotte from Tennessee, and his father, a man named Charles from Florida, had each been sold to a man named Parson Rogers and that he’d brought them to Alabama, where Johnson was born.
What Johnson describes was not uncommon. Despite the Emancipation Proclamation, enslavers throughout the Confederacy continued to hold Black people in bondage for the rest of the war. And even after General Robert E. Lee surrendered, on April 9, 1865, effectively signaling that the Confederacy had lost the war, many enslavers in Texas and other states did not share this news with their human property. In the narratives, formerly enslaved people recount how the end of their bondage did not correspond with military edicts or federal legislation. Rather, emancipation was a long, inconsistent process that delayed the moments when people first tasted freedom.
Johnson’s narrative opens and closes with stories of separation. Near the beginning he says:
I had seven brothers call Frank and Benjamin and Richardson and Anderson and Miles, Emanuel and Gill, and three sisters call Milanda, Evaline and Sallie, but I don’t know if any of ’em are livin’ now.
Then, toward the end, he speaks about the last time he saw his mother:
Me and four of her chillen standin’ by when mammy’s sold for $500.00. Cryin’ didn’t stop ’em from sellin’ our mammy ’way from us.
“The fact that his mother and several of his siblings were sold away, and he was standing there watching this happen,” Crawford said, her voice cracking. “That’s just—that’s just heartbreaking.”
I asked Crawford about the first line of Johnson’s narrative, a line striking in how direct it is:
If you’s wants to know ’bout slavery time, it was Hell.
“Well, you know, it’s just kind of gut-wrenching, isn’t it?” she said. “It was hell. And that’s the word. When my mother saw that word she just kind of jumped. Because she said she’d never heard him curse. And to her, he wasn’t talking about heaven and hell, in the way that, you know, a preacher or minister might. And it was jarring to her.”
Crawford’s genealogical research was driven in part by a desire to trace her biological lineage, because her mother had been adopted. But she also began searching for those who had enslaved her family. In the census records, she found a Rogers who matched her grandfather’s description of “Massa Rogers.” Then, in a Texas newspaper, she found an article written by one of Rogers’s descendants that celebrated the family’s local history, despite all that that history included.“These folks are proud of their heritage,” Crawford told me. “Even though it includes the fact that their people enslaved other people.”Crawford wrote to the newspaper, which put her in touch with the article’s author. She didn’t say that his family had enslaved hers. She simply said that, based on her research, the two families were “connected.” But she believes he understood. It was a small town, and the names she mentioned should have made the nature of the connection obvious.
I wondered what Crawford had been hoping to get from these exchanges. Did she want an apology? A relationship? Something else?
She told me she’d been looking for information about her family, trying to recover names of ancestors that had never entered the public record. The man promised to send her some documents from his family members but never did. More important, she added, “I was hoping that they’re acknowledging our humanity. And that just like he is interested in and proud of his ancestry, so am I.”
“I would like to say that I’m an observer, and that I can be emotionally detached,” she said, but “it just brings tears to my eyes, how they were treated.” One of the things that left Crawford most unsettled was that the Rogers family back then had claimed to espouse the principles of Christianity. “The people that enslaved my ancestors were ministers, pastors, preachers.”
For Crawford, reading Johnson’s words was the entry point into an entire world of ex-slave narratives. “They really weren’t fed well. They weren’t housed well. They were just required to work from sunup to sundown. They were whipped,” she told me. “It is horrendous. But still, in all, I feel so blessed to have found that document.”
“Why is that?” I asked.“Because it’s a link to our shared history,” she said. “We existed. We conquered. We overcame.”
My mammy said dat slavery wuz a whole lot wusser ’fore I could ’member. She tol’ me how some of de slaves had dere babies in de fiel’s lak de cows done, an’ she said dat ’fore de babies wuz borned dey tied de mammy down on her face if’en dey had ter whup her ter keep from ruinin’ de baby.
Lucy brown didn’t know her age when she was interviewed for the Federal Writers’ Project on May 20, 1937, in Durham, North Carolina. She had no birth certificate, no sense of what year she’d come into this world. Brown’s testimony is shorter than many of the others, in part because she was so young—perhaps only 6 or 7—as slavery entered its final days.
“I wuz jist a little thing when de war wuz over,” she said.
We belonged to John Neal of Person County. I doan know who my pappy wuz, but my mammy wuz named Rosseta an’ her mammy’s name ’fore her wuz Rosseta. I had one sister named Jenny an’ one brother named Ben.
The narrative is a mix of small memories she carried with her from her early childhood and memories that had been passed on to her from her mother.
Gregory Freeland, like both Lewis and Crawford, came across the narrative of his great-great-grandmother while researching his family history. He was raised just outside Durham, where he lived with his mother and his great-grandmother—Lucy’s daughter. He found the narrative only after she had died.
When Freeland was a child, his family members would tell stories about their lives, but he wasn’t interested in hearing them. “I was sort of ready to get away from that, that slavery thing,” he told me. “So I never paid attention. It seemed like schoolwork.”
Now he wishes he’d asked his great-grandmother about her life, and her mother’s life. He felt grateful for having stumbled onto this narrative, and for how connected it made him feel to a history that he’d previously taken for granted. “This is the link to the past,” he said.Freeland was drafted in 1967 to serve in the Vietnam War. He was stationed in Korea when Martin Luther King Jr. was assassinated, and according to Freeland, the Army worked to “keep the temperature down” after King’s death so that Black soldiers—who were fighting a war for a country that still didn’t afford them basic rights—wouldn’t get too upset. The strange dissonance of being sent to the other side of the world to fight for a country that had just killed the leader of your people stayed with Freeland long after he came back to the U.S.
The GI Bill paid for him to go to college, and covered most of graduate school, where he studied political science. For the past 30 years, he’s been a professor at California Lutheran University, where he teaches courses on race, politics, and the civil-rights movement—subjects he feels are urgent and necessary for students at this college with a tiny Black population.
He told me he’s “trying to keep this history alive, because it’s getting further and further away.”The Durham of Freeland’s childhood smelled of tobacco. He remembers the ubiquity of chicken noises, mixed with music from people’s houses as they sang while they cooked or listened to the radio on the porch. His family grew fruits and vegetables in their yard, and Freeland helped kill the chickens and hogs they raised. “I had to go out and wring the chickens’ neck,” he told me. “I don’t know if you’ve ever seen it happen, but you grab the chicken by the neck and wring it, wring it, wring it until the body pops off. And when the body pops off, it flops around for a while.”
“My students,” he said, “they can’t fathom that life was like that.”
Freeland grew up in the same town where his great-great-grandmother had settled after the Civil War. Known then as Hickstown—named for a white landowner, Hawkins Hicks—the community had begun as an agricultural settlement for the formerly enslaved on the western edge of Durham. Over the course of several decades, it became a self-reliant Black community where the formerly enslaved, their children, and their children’s children all lived together. This history is reflected in Lucy Brown’s narrative:
I can’t tell yo’ my age but I will tell yo’ dat eber’body what lives in dis block am either my chile or gran’chile. I can’t tell yo’ prexackly how many dar is o’ ’em, but I will tell you dat my younges’ chile’s baby am fourteen years old, an’ dat she’s got fourteen youngun’s, one a year jist lak I had till I had sixteen.
As nearby duke university grew, so too did Hickstown, which became known as Crest Street. Residents served as food-service workers, housekeepers, maintenance staff. By the 1970s, the community had more than 200 households, and more than 60 percent of residents worked for the university, according to the Southern Oral History Program at the University of North Carolina. This included Freeland’s mother, who walked every day from the dirt roads surrounding their home to the paved streets near Duke. And though many of the jobs available did not pay much, it was a tight-knit community of people deeply invested in one another, and in the history of the community their ancestors had built.
Crest Street came under threat in the 1970s with the planned expansion of the East-West Expressway, which would slice directly through the center of this century-old Black community. The residents decided to fight the plan. They hired a team of lawyers and filed a complaint with the U.S. Department of Transportation, citing Title VI of the 1964 Civil Rights Act, which prohibits discrimination “under any program or activity receiving Federal financial assistance.” In 1980, the U.S. Department of Transportation ruled that the highway project could not move forward as proposed, because it would disproportionately affect Black residents.
Representatives from the North Carolina Department of Transportation and members of the Crest Street community began meeting to see if they could come to an agreement. Crest Street residents invited officials to visit their homes, so that they could see what the construction project would have demolished. Ultimately, a compromise was reached in which the residents would all move to an area that was adjacent to their original neighborhood, keeping the community largely intact.
Listening to Freeland tell this story, I thought about how remarkable it was that in this same place where formerly enslaved people had built a community for themselves after generations of bondage, Black people once again had to defend themselves against a government that was attempting to take away a sort of freedom.
For Freeland, stories of towns like Crest Street, and the activists who kept the community together, are just as essential to document as the stories of his formerly enslaved great-great-grandmother. “I’d like to interview people who lived through the segregationist era,” he told me. “And I’d like to interview those people who participated in making change—Black people who are maybe my age, who grew up in this kind of community—before we pass on.”
“Who is going to remember,” he said, “if nobody’s there to tell it?”
Freeland is right. There are other stories of the Black experience that should be collected—and soon. Recently, I’ve become convinced of the need for a large-scale effort to document the lives of people who lived through America’s southern apartheid; who left the land their families had lived on for generations to make the Great Migration to the North and West; who were told they were second-class citizens and then lived to see a person who looked like them ascend to the highest office in the land. Their stories exist in our living rooms, on our front porches, and on the lips of people we know and love. But too many of these stories remain untold, in many cases because no one has asked.
What would a new Federal Writers’ Project look like? How could we take the best of what the narratives of the 1930s did and build on them, while avoiding the project’s mistakes?
When I raised the idea with the historians I interviewed, their voices lit up with energy as they imagined what such a project might look like.
“Historians would definitely need to be in charge,” Stephanie Jones-Rogers told me. Specifically, Black scholars should lead the project. “There’s a way in which to not only center the Black experience, but also to privilege Black intellect, Black brilliance,” she said. “It would be a project like none we’ve ever seen.”
Daina Ramey Berry thought family members should conduct the interviews. “Almost like a StoryCorps on NPR,” she said, “because I think you’re going to get a more authentic story about what life was like.” Berry thought that even well-intentioned strangers might re-create some of the same dynamics in place in the 1930s. She worried about the implications, again, of having federal workers going into older Black folks’ homes and asking them deeply personal questions about what may have been a traumatic time in their lives.
Catherine Stewart believes that there would be important benefits to having such a project led by the federal government: “Funding, first and foremost, at a level other agencies and nonprofit organizations simply don’t have.” She added that the federal government already has the infrastructure this sort of project would require—in places like the National Archives and Records Administration, the National Museum of African American History and Culture, and the Library of Congress. The government also has the ability to ensure that the public has access to it.
When I began reading the Federal Writers’ Project ex-slave narratives, I thought about my own grandparents. I thought about my grandfather, and how his grandfather had been born into bondage. About my grandmother, and how the grandparents who raised her had been born just after abolition. About how, in the scope of human history, slavery was just a few moments ago. I thought, too, of everything my grandmother and grandfather have seen—born in 1939 Jim Crow Florida and 1930 Jim Crow Mississippi, respectively, and now living through the gravest pandemic in a century and watching their great-grandchildren, my children, grow up over FaceTime.
About a year ago, I decided to interview them. I spoke with them each individually, an audio recorder sitting on the table between us, and listened as they told me stories about their lives that I had never heard. My grandfather and his siblings hid in the back room under a bed while white supremacists rode on horseback through their community to intimidate Black residents. As my grandmother walked to school on the red-dirt roads of northern Florida, white children passing by on school buses would lower their windows and throw food at her and the other Black children. For as much time as I’d spent with them, these were the sorts of stories I hadn’t heard before. The sorts of stories that are not always told in large groups at Thanksgiving while you’re trying to prevent your toddler from throwing mac and cheese across the room.
My children will, in a few decades, be living in a world in which no one who experienced the passage of the Civil Rights Act of 1964 or the Voting Rights Act of 1965 will still be alive. What happens to those people’s stories if they are not collected? What happens to our understanding of that history if we have not thoroughly documented it?
Some of this work is already being done—by the Southern Oral History Program and the National Museum of African American History and Culture, for instance—but not on a scale commensurate with what the Federal Writers’ Project did. That requires financial and political investment. It requires an understanding of how important such a project is.
Imagine if the government were to create a new Federal Writers’ Project. One committed to collecting, documenting, and sharing the stories of Black people who lived through Jim Crow, of Japanese Americans who lived through internment, of Holocaust refugees who resettled in America, of veterans who fought in World War II and the Vietnam War. And stories like those of the people in Freeland’s great-great-grandmother’s town, who fought to keep their community together when the state wanted to split it apart. There are millions of people who experienced extraordinary moments in American history, and who won’t be around much longer to tell us about them. Some of these moments are ones we should be proud of, and some should fill us with shame. But we have so much to learn from their stories, and we have a narrowing window of time in which to collect them.
I keep thinking of something Freeland told me, and how his words speak to both the stakes and the possibility of this moment.
“We survived,” he said. “And I’m still around.”
This article appears in the March 2021 print edition with the headline “We Mourn for All We Do Not Know.”
In a time of racial reckoning, a new film looks at a very personal attempt to address racial injustices in this country.
“Ashes to Ashes” are the final words in typical African American funeral services. Many of those who were murdered by the Klan to maintain the reign of white supremacy never received their “Ashes to Ashes”.
Ashes to Ashes, the film, is an endearing portrait of Winfred Rembert, an avid Star Wars fan and master leather-work artist who survived an attempted lynching in 1967. This moving short documentary showcases the incredible friendship he has forged with Dr. Shirley Jackson Whitaker, as she creates and establishes an interactive art exhibit to memorialize the more than 4,000 African Americans who were lynched during the Jim Crow era. Taking all of her experiences from her love of medicine, art and people, Dr. Shirley J. Whitaker, MD, created the Ashes to Ashes program that will provide for a real memorial (funeral) service for the over 2 million lost during the Middle Passages.
FROM 1882-1968, 4,743 LYNCHINGS OCCURRED IN THE UNITED STATES. OF THESE PEOPLE THAT WERE LYNCHED 3,446 WERE BLACK (72%). THE MAJORITY OCCURING IN THE SOUTH (79%). This too is Black History.
The goal of the project by Dr. Shirley Jackson Whitaker is to acknowledge and mourn the African Americans who were racially terrorized during the Jim Crow era after the Civil War and until this very day. Some endured lynching and other forms of brutalization and therefore, they never received a proper burial. The ceremony was a celebration of thousands of African Americans. As we must. #BlackHistoryMonth2021
Dr. Whitaker will join us this week. Mr. Rembert is unable to join us tonight. We will host him soon.
Dr. Whitaker is the seventh child of Eddie and Charlie Mae Jackson from Waycross, Georgia. Dr. Whitaker attended Clark Atlanta University completing a BS degree with honors in Biology. She attended Yale University School of Medicine-Department of Public Health and obtained her medical degree form Emory University School of Medicine, the only female African American in her class. A kidney specialist by trade, an artist trained under Leonard Baskin, and a healer by passion, her Ashes to Ashes project was developed to provide hope for a better American future, one in which races of varying color and heritage can understand the importance of each other’s American history, empathize with each other’s sacrifices and tragedies, realize the legacy of impacts from suffered injustices and accept that healing is a process as much a cure, and recognize and lay to rest the 4,000 victims of vigilante justice perpetrated against a predominantly black population for simply desiring the most basic of American rights of obtaining an education, ownership of land, fair competition in commerce, the uniquely American right of voting for our governing institutions and for an equal stake in the American experience. She is currently working on the second phase of A2A: The Noose: Tread of Hate and Resilience. This will center on American history through the lens of lynching and will include an International Speak My Name Day to speak the names of the lynched.
Mr. Rembert grew up in rural Georgia, in a farm laborer’s house and later in the small town of Cuthbert. Raised by his great-aunt, Rembert worked with her in the cotton fields during much of his childhood, and received little formal education. As a teenager he got involved in the 1960s Civil Rights Movement. Jailed for fleeing for his life in a stolen car, nearly lynched and then cut down to serve as an example to others, Rembert was sentenced to 27 years in the Georgia Penal System. Despite the cruel prison circumstances, Rembert learned to read and write and managed to meet and write letters to his would-be wife Patsy as well as to congressmen, with the hope of gaining early release. He also learned the craft of hand-tooling leather from a fellow-prisoner. After seven years, most of which was spent on chain gangs, Rembert was released from prison, but it wasn’t until 1997, at the age of 51, that he began to work more seriously with leather as his artistic medium, creating tooled and dyed canvases that tell the stories of his life. His paintings have been exhibited at galleries across the country—including the Yale University Art Gallery, the Adelson Galleries New York, and the Hudson River Museum—and have been profiled in The New York Times and elsewhere. Rembert is the recipient of a 2017 USA Fellowship, and in 2015 was an honoree of Bryan Stevenson’s Equal Justice Initiative. Rembert’s full-color memoir, Chasing Me to My Grave: An Artist’s Memoir of the Jim Crow South, is forthcoming from Bloomsbury in 2021.
“I’ll Be Listening for You”
Join us for the OUR COMMON GROUND BHM Special
“A History of Black Political Movements in America”
The Post-ReConstruction, Civil Rights, Black Power, and “unnamed” Black struggle movements grew out of each other and have steadily gained momentum through 2020. Some were not a formal movement, however, these movements marked a turning point in the meaning of Black struggle in the United States and also in how Black people saw themselves, generation to generation. All of the many Black movements are hailed as significant struggles of Blacks to achieve full equality. They were complex events that took place at a time when society and culture were being transformed throughout the United States, and their legacy reflects that complexity. But what of the interplay and relationship of all Black legacy political movements that occurred since Emancipation? They were all building blocks, learning opportunities, and a continuum of victories for our people. What we do know is that the descendants of American chattel slavery have waged the most successful and effective protests in American, indeed, world history. Our greatest achievements include teaching America the real meaning of justice, freedom, and resistance.
We need to know and understand the networks that compose the many Black struggles and movement that brought us to our current political struggles. It is how we measure our worth and etch out our future
This course of study will review the history of the many Black struggle movements and events that brought us to the election of Barack Obama resistance that brings us to the white supremacy insurrection and riots on January 6, 2021. What we see happening in America, the growth of white supremacy and confederacy politics become clear through the understanding of our journey toward freedom. This lecture series will provide knowledge of where we have been, Black achievement in how Black people have transformed America.
Series Schedule Thursdays, 8-10 pm EST
February 4, 2021
Session 1: Overview of significant Black political movements and events.
Black Politics and the Reconstruction Era
Black Politics of the Jim Crow Era
Black Politics creating the Civil Rights Era
Black Political development during the Black Power Era
February 11, 2021
Session 2: Review of Syllabus Examine why certain sources are most helpful to us to understand the continuum and projection of history forming new generations of struggle. How history informs strategic directions of each of the major movements.
February 18, 2021
Session 3: Black political diversities and ideologies. Examining class, economics, religion, spirituality, art, gender, sexuality, and how they have factored in Black movement history.
February 25, 2021
Session 4: Practical Strategies for 21st Century Black and Peoples’ movements.
About Dr. James L. Taylor
Professor James Lance Taylor is the Chair of the Department of Politics at the University of San Francisco and is from Glen Cove, Long Island. He is the author of the book “Black Nationalism in the United States: From Malcolm X to Barack Obama”, which earned 2012 “Outstanding Academic Title” – Choice: Current Reviews for Academic Libraries. (Ranked top 2 percent of 25,000 books submitted and top 8 percent of 7,300 actually accepted for review by the American Library Association). Rated “Best of the Best.” The hardback version sold out in the U.S. and the paperback version was published in 2014.
He is a former President of the National Conference of Black Political Scientists (NCOBPS), an important organization of African American, African, and Afro Caribbean political scientists in the United States, 2009-2011. Taylor also served as Coordinator of the African American Studies Program for 2015-2017 at the University of San Francisco. He served as the Chair for the “Committee on the Status of Blacks” in Political Science for the American Political Science Association (APSA), 2016-2017.
The Black Power movement grew out of the CIVIL RIGHTS MOVEMENT that had steadily gained momentum through the 1950s and 1960s. It was not a formal movement, however, the Black Power movement marked a turning point in Black-white relations in the United States and also in how Black people saw themselves. Both movements were hailed as significant struggles of Blacks to achieve full equality. They were complex events that took place at a time when society and culture were being transformed throughout the United States, and its legacy reflects that complexity. But what of the legacy political movements that occurred right after the Emancipation of slavery? We need to know and understand the networks that compose the many Black struggles and movement that brought us to our current political struggles.
This course of study will review the history of the many Black struggle movements and events that brought us to the election of Barack Obama resistance that brings us to the white supremacy insurrection and riots on January 6, 2021. We hope that you will join us.
February 4, 2021
Session 1: Overview of significant historical Black political movements and events.
Black Politics and the Reconstruction Era
Black Politics of the Jim Crow Era
Black Politics creating the Civil Rights Era
Black Political development during the Black Power Era
February 11, 2021
Session 2: Review of Syllabus Examine why certain sources are most helpful to us to understand the continuum and projection of history forming new generations of struggle. How history informs strategic directions of each of the major movements.
February 18, 2021
Session 3: Black political diversities and ideologies. Examining class, economics, religion, spirituality, art, gender, sexuality, and how they have factored in Black movement history.
February 25, 2021
Session 4: Practical Strategies for 21st Century Black and Peoples’ movements.
About Dr. James L. Taylor, Ph.D.
Chair, Department of Politics, former President of the National Conference of Black Political Scientists (NCOBPS), an important organization of African American, African, and Afro Caribbean political scientist community in the United States, 2009-2011.
Professor James Lance Taylor is from Glen Cove, Long Island. He is the author of the book “Black Nationalism in the United States: From Malcolm X to Barack Obama”, which earned 2012 “Outstanding Academic Title” – Choice: Current Reviews for Academic Libraries. (Ranked top 2 percent of 25,000 books submitted and top 8 percent of 7,300 actually accepted for review by the American Library Association). Rated “Best of the Best.” The hardback version sold out in the U.S. and the paperback version was published in 2014.
He is a former President of the National Conference of Black Political Scientists (NCOBPS), an important organization of African American, African, and Afro Caribbean political scientists in the United States, 2009-2011. Taylor also served as Chair of the Department of Politics at the University of San Francisco from 2012-2015, and Faculty Coordinator of the African American Studies Program for 2015-2017. He served as the Chair for the “Committee on the Status of Blacks” in Political Science for the American Political Science Association (APSA), 2016-2017.
Professor Taylor is currently writing and researching a book with the working title, Peoples Temple, Jim Jones, and California Black Politics. He expects the book to be completed with a 2018-2019 publication range. The book is a study of the Peoples Temple movement and African American political history in the state of California.
His teaching and research scholarly interests are in religion and politics in the United States, race and ethnic politics, African American political history, social movements, political ideology, law and public policy, Black political leadership, and the U.S. Presidency. He lives with his family in Oakland, California.
The doctor put up billboards in the Mississippi Delta.
Amputation Prevention Institute, they read.
He could save their limbs, if it wasn’t too late.
The Black American Amputation Epidemic
by Lizzie Presser
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.
IT WAS A FRIDAY EVENING in the hospital after a particularly grueling week when Dr. Foluso Fakorede, the only cardiologist in Bolivar County, Mississippi, walked into Room 336. Henry Dotstry lay on a cot, his gray curls puffed on a pillow. Fakorede smelled the circumstances — a rancid whiff, like dead mice. He asked a nurse to undress the wound on Dotstry’s left foot, then slipped on nitrile gloves to examine the damage. Dotstry’s calf had swelled to nearly the size of his thigh. The tops of his toes were dark; his sole was yellow, oozing. Fakorede’s gut clenched. Fuck, he thought. It’s rotten.
Fakorede, who’d been asked to consult on the case, peeled off his gloves and read over Dotstry’s chart: He was 67, never smoked. His ultrasound results showed that the circulation in his legs was poor. Uncontrolled diabetes, it seemed, had constricted the blood flow to his foot, and without it, the infection would not heal. A surgeon had typed up his recommendation. It began: “Mr. Dotstry has limited options.”
Fakorede scanned the room. He has quick, piercing eyes, a shaved head and, at 38, the frame of an amateur bodybuilder. Dotstry was still. His mouth arched downward, and faint eyebrows sat high above his lids, giving him a look of disbelief. Next to his cot stood a flesh-colored prosthetic, balancing in a black sneaker.
Fakorede explained that he wasn’t the kind of doctor who cuts. He was there because he could test circulation, get blood flowing, try to prevent any amputation that wasn’t necessary. He hated that doctors hadn’t screened Dotstry earlier — when he’d had the stroke or lost his leg. “Your legs are twins,” he said. “What happens in one happens in the other.”
Dotstry needed an immediate angiogram, an imaging test that would show blockages in his arteries. He also needed a revascularization procedure to clean them out, with a thin catheter that shaves plaque and tiny balloons to widen blood vessels. His foot was decaying, fast. Though Fakorede ran an outpatient practice nearby, when doctors consulted him on inpatients at Bolivar Medical Center, the local hospital, he expected to use its facilities.
He asked his nurse to schedule the procedures. But by the time he had driven home to his ranch house on the northern edge of town, he hadn’t received an answer. Nor had he when he woke up on Saturday at 3:30 a.m., as he did every morning. By sunrise, he was restless at his kitchen counter, texting the hospital’s radiology director, explaining the need for an intervention on Monday, Martin Luther King Jr. Day. Within a few hours, he got a response: “I don’t have the staff or the supplies. I’m sorry.”
Now Fakorede was mad, walking briskly into his office, dialing friends on speaker phone, pacing around his conference room. He’d been raised in Nigeria, moved to New Jersey as a teenager and had come to practice in Mississippi five years earlier. He’d grown obsessed with legs, infuriated by the toll of amputations on African Americans. His billboards on Highway 61, running up the Delta, announced his ambitions: “Amputation Prevention Institute.”
Nobody knew it in January, but within months, the new coronavirus would sweep the United States, killing tens of thousands of people, a disproportionately high number of them black and diabetic. They were at a disadvantage, put at risk by an array of factors, from unequal health care access to racist biases to cuts in public health funding. These elements have long driven disparities, particularly across the South. One of the clearest ways to see them is by tracking who suffers diabetic amputations, which are, by one measure, the most preventable surgery in the country.
Look closely enough, and those seemingly intractable barriers are made up of crucial decisions, which layer onto one another: A panel of experts decides not to endorse screening for vascular disease in the legs; so the law allows insurance providers not to cover the tests. The federal government forgives the student loans of some doctors in underserved areas, but not certain specialists; so the physicians most critical to treating diabetic complications are in short supply. Policies written by hospitals, insurers and the government don’t require surgeons to consider limb-saving options before applying a blade; amputations increase, particularly among the poor.
Despite the great scientific strides in diabetes care, the rate of amputations across the country grew by 50% between 2009 and 2015. Diabetics undergo 130,000 amputations each year, often in low-income and underinsured neighborhoods. Black patients lose limbs at a rate triple that of others. It is the cardinal sin of the American health system in a single surgery: save on preventive care, pay big on the backend, and let the chronically sick and underprivileged feel the extreme consequences.
Fakorede grabbed his car keys and headed to the hospital. He walked straight to the lab. As he suspected, it had all the supplies that he needed. Why won’t they give me staff? he wondered. They wouldn’t do that to a surgeon.
He has little tolerance for this kind of transgression. He is militaristic, to an extreme. To him, nonhealing wounds are like heart attacks. “Time is muscle,” he repeats. He calls huddles when nurses forget to check a patient’s ankles: “If you haven’t assessed both legs, I don’t want to walk into that room.” He considers each of his procedures an act of war. When people stand in his way, he sends a barrage of text messages, punctuated by exclamation marks. And he uses his cellphone to collect evidence that the system is working against his patients, and his efforts.
He pulled out his iPhone and photographed the hospital’s wires and catheters, IVs and port protectors. He shot the images over to the hospital’s radiology director. Fakorede’s private practice was closed for the holiday weekend. He calculated that he had only a few days to carry out some plan before Dotstry’s remaining leg was amputated.
TWO MAPS EXPLAIN why Fakorede has stayed in the Mississippi Delta. One shows America’s amputations from vascular disease. The second shows the enslaved population before the Civil War; he saw it at a plantation museum and was stunned by how closely they tracked. On his phone, he pulls up the images, showing doctors, or history buffs, or anyone who will listen. “Look familiar?” he asks, toggling between the maps. He watches the realization set in that amputations are a form of racial oppression, dating back to slavery.
Fakorede was initially tempted to move to the Delta while practicing in Tennessee. He befriended a medical device sales rep named Maurice Hampton who had grown up in the Mississippi region. Hampton talked about how black families were leery of local hospitals and how few black doctors in the Delta specialized in vascular work. “It’s the norm to go to Walmart and see an amputation or a permacath in the neck,” he’d told Fakorede. “If you don’t see one, then you didn’t stay but two minutes.”
Then, a little over a year into his Tennessee job, Fakorede found himself at loose ends. He’d raised concerns that he was being billed for expenses that weren’t his and asked for an audit; though the audit later found that the clinic where he worked had claimed over $314,000 in improper expenses, he was quickly terminated. Fakorede sued the clinic for retaliation under the False Claims Act and lost. (The clinic’s lawyer said his client had no comment, but there were “numerous” reasons for Fakorede’s departure.) In the spring of 2015, he had a mortgage, a quarter of a million dollars in student debt and four months of severance pay. He also had an impulse to understand the Delta.
Fakorede spent four days driving through its long, flat stretches of farmland dotted with small towns and shotgun houses. The wood-slat homes and bumpy roads reminded him of his grandparents’ village in the Nigerian state of Ondo, where he’d spent summers as a kid. He drove scores of miles on the Mississippi highways without seeing a single grocery store; fast-food chains lit the busiest intersections. He was startled by the markers of disease — the missing limbs and rolling wheelchairs, the hand-built plywood ramps with metal rails. He thought of amputees like “an hourglass,” he said, “that was turned the day they had their amputation.” Mortality rates rise after the surgeries, in part, because many stop walking. Exercise improves circulation and controls blood sugar and weight. The less activity a person does, the higher the risk of heart attacks and strokes. Within five years, these patients were likely to be dead.
Fakorede weighed taking a lucrative job up north, near his parents, who had both been diagnosed with diabetes. He had professional connections there; he’d gone to Rutgers Robert Wood Johnson Medical School and done a residency at NewYork-Presbyterian Weill Cornell Medical Center. But the South, he felt, needed him. About 30 million people in America had diabetes, and Mississippi had some of the highest rates. The vast majority had Type 2; their bodies resisted insulin or their pancreas didn’t produce enough, making their blood sugar levels rise. Genetics played a role in the condition, but so did obesity and nutrition access: high-fat meals, sugary foods and not enough fiber, along with little exercise. Poverty can double the odds of developing diabetes, and it also dictates the chances of an amputation. One major study mapped diabetic amputations across California, and it found that the lowest-income neighborhoods had amputation rates 10 times higher than the richest.
The Delta was Mississippi’s poorest region, with the worst health outcomes. Fakorede had spent years studying health disparities: African Americans develop chronic diseases a decade earlier than their white counterparts; they are twice as likely to die from diabetes; they live, on average, three years fewer. In the Delta, Fakorede could treat patients who looked like him; he could find only one other black interventional cardiologist in the entire state. A growing body of evidence had shown how racial biases throughout the medical system meant worse results for African Americans. And he knew the research — black patients were more responsive to, and more trustful of, black doctors. He decided after his trip that he’d start a temporary practice in Mississippi, and he rented an apartment deep in the Delta.
He fantasized about building a cardiovascular institute and recruiting a multidisciplinary team, from electrophysiologists to podiatrists. But as he researched what it would take, he found a major barrier. Medical specialists with student debt, who graduate owing a median of $200,000, generally could not benefit from federal loan forgiveness programs unless they got jobs at nonprofit or public facilities. Only a few types of private practice providers — primary care, dentists, psychiatrists — qualified for national loan forgiveness. The Delta needed many other physicians. Though Bolivar County was at the center of a diabetes epidemic, there wasn’t a single diabetes specialist, an endocrinologist, within 100 miles.
Fakorede leased a windowless space in the Cleveland Medical Mall, a former shopping center that had been converted to doctors’ offices. People came to him with heart complaints, but he also asked them to remove their socks. Their legs alarmed him. Their toes were black and their pulses weak. Their calves were cold and hairless. Some had wounds but didn’t know it; diabetes had numbed their feet. Many had been misdiagnosed with arthritis or gout, but when Fakorede tested them, he found peripheral artery disease, in which clogged arteries in the legs limit the flow of blood.
This is what uncontrolled diabetes does to your body: Without enough insulin, or when your cells can’t use it properly, sugar courses through your bloodstream. Plaque builds up faster in your vessels’ walls, slowing the blood moving to your eyes and ankles and toes. Blindness can follow, or dead tissue. Many can’t feel the pain of blood-starved limbs; the condition destroys nerves. If arteries close in the neck, it can cause a stroke. If they close in the heart, a heart attack. And if they close in the legs, gangrene.
Within a month, Bolivar Medical Center had credentialed Fakorede, allowing him to consult on cases and do procedures in the hospital. His most complicated patients came in through the emergency room. Some arrived without any inkling that they had gangrene. One had maggots burrowing in sores. Another showed up after noticing his dog eating the dead flesh off the tips of his toes. Fakorede took a photo to add to his collection. “It was a public health crisis,” he told me. “And no one was talking about amputations and the fact that what was happening was criminal.”
On weekends, Fakorede had been driving back to his five-bedroom home in Tennessee, but in August of 2015, he decided to go all-in on Bolivar County. He sold his house and black Mercedes G-Wagon, and applied for funding to build a practice in the Delta: Cardiovascular Solutions of Central Mississippi. He pitched himself as a heart guy and a plumber, removing buildup in the arteries. Four banks denied him loans, so he borrowed money from friends. He gave himself a two-year window to reduce amputations and publish his outcomes.
THE DELTA FLOOD PLAIN runs 7,000 square miles along the northwestern edge of the state, with sweet-smelling, clay-like soil cordoned between bluffs and the banks of the Mississippi River. By the 19th century, the primeval forests had been transformed into a cotton empire; at the start of the Civil War, more than 80% of people in many Delta counties were enslaved. Sharecropping emerged after emancipation, and black farmers cultivated small plots in return for a portion of their crop. They lived on credit — for food and feed and clothing — until the harvest, but even then, their earnings rarely covered their expenses.
For decades, African Americans in the South struggled to find and afford health care. The American Medical Association excluded black doctors, as did its constituent societies. Some hospitals admitted black patients through back doors and housed them in hot, crowded basements. Many required them to bring their own sheets and spoons, or even nurses. Before federal law mandated emergency services for all, hospitals regularly turned away African Americans, some in their final moments of life.
Fakorede was drawn to Bolivar County, in part, because of its history. He’d run out of gas there when he was first scouting the region, and later that evening, he’d Googled its background. For a brief moment, Bolivar was the center of a movement for public health care, driven by the conviction that racial equality was not possible without justice in health. In 1964, when a group of physician activists traveled to the Delta, Robert Smith, a black doctor from Jackson, saw rocketing rates of intestinal parasites and maternal death. “I understood for the first time what it truly meant to be black in Mississippi,” he told a magazine. Under President Lyndon B. Johnson’s War on Poverty, a Boston doctor secured funding to open a community health center in Bolivar, which he grew with the help of Smith. Clinicians worked with residents to take on housing, sanitation, exercise and nutrition. Its success spawned a national project of more than a thousand Federally Qualified Health Centers for the underserved. But funding shrank under President Richard Nixon, and the centers’ initiatives were scaled back to basic primary care.
By the time Fakorede moved to the Delta, in 2015, the state had the nation’s lowest number of physicians per capita. It had not expanded Medicaid to include the working poor. Across the country, 15% of African Americans were still uninsured, compared with 9% of white Americans. That year, Jennifer Smith, a professor at Florida A&M University College of Law, wrote in the National Lawyers Guild Review what Fakorede saw firsthand: “While the roots of unequal and inequitable health care for African Americans date back to the days of slavery, the modern mechanisms of discrimination in health care has shifted from legally sanctioned segregation to inferior or non-existent medical facilities due to market forces.”
Fakorede understood that to reach patients, he needed referrals, so he met primary care providers at hospitals and clinics. He asked them to screen for vascular disease, measuring blood pressure at the ankle and the arm. Many didn’t have the time; given the shortage of local physicians, some were seeing up to 70 patients a day. Others didn’t know much about peripheral artery disease or why it was important to diagnose. Some were offended by Fakorede’s requests. Michael Montesi, a family doctor, was grateful for the help, but he found it brash for the new doctor in town to start telling the veterans what to do. He recalled thinking, “Where were you the first 12 years of my practice, when I needed a cardiologist, when I needed an OB-GYN, when I needed a surgeon, when I had to do an amputation in the ER, or deliver a baby that was 23 weeks and watch the baby die because there was nobody there that could take care of him?”
The brushoffs disturbed Fakorede, but when he dug deeper, he realized that the doctors weren’t only overwhelmed; they had no guaranteed payment for this vascular screening. The Affordable Care Act mandates that insurers cover all primary care screenings that are recommended by the U.S. Preventive Services Task Force, an independent panel of preventive care experts. The group, though, had not recommended testing anybody without symptoms, even the people most likely to develop vascular disease — older adults with diabetes, for example, or smokers. (Up to 50% of people who have the disease are believed to be asymptomatic.) As specialists, cardiologists are reimbursed if they screen patients with risk factors. But by the time patients got to Fakorede, the disease was sometimes too far along to treat. Many already had a nonhealing wound, what’s known as “end stage” peripheral artery disease, the last step before an amputation.
When Luvenia Stokes came to Fakorede, she had already lost her right leg at the age of 48. Like many Delta residents, she grew up in a food desert, and without money for fresh produce, she’d developed diabetes at a young age. She said that a pedicurist nicked her toe, and the small cut developed an infection. Without good blood flow, it began bubbling with pus. Stokes told Fakorede that no doctor had performed an angiogram to get a good look at the circulation or a revascularization to clean out the arteries. A surgeon removed her second toe. Without cleared vessels, though, the infection spread. Within weeks, a new surgeon removed her leg.
Stokes lived in a single-wide trailer with her mother. Her wheelchair could not fit in the doorways, so she inched through sideways with a walker. Because she could hardly exercise, she gained 48 pounds in two years. The amputation hadn’t treated her vascular disease, and a stabbing pain soon engulfed her remaining leg, “like something is clawing down on you,” she said. When she finally made it to Fakorede, she told him that one doctor had prescribed neuropathy medication and another had diagnosed her with arthritis. “I’m not letting them get that other leg,” Fakorede told her. Stokes’ grandmother, Annie, who lives in a nearby trailer, had lost both her legs, above the knee, to diabetes. Her cousin Elmore had lost his right leg, too.
General surgeons have a financial incentive to amputate; they don’t get paid to operate if they recommend saving a limb. And many hospitals don’t direct doctors to order angiograms, the most reliable imaging to show if and precisely where blood flow is blocked, giving the clearest picture of whether an amputation is necessary and how much needs to be cut. Insurers don’t require the imaging, either. (A spokesperson for America’s Health Insurance Plans, a leading industry trade association, said, “This is not an area where there is likely to be unnecessary surgery.”) To Fakorede, this was like removing a woman’s breast after she felt a lump, without first ordering a mammogram.
Nationwide, more than half of patients do not get an angiogram before amputation; in the Delta, Fakorede found that the vast majority of the amputees he treated had never had one. Now, he was determined to make sure that no one else lost a limb before getting the test. This wasn’t a controversial view: The professional guidelines for vascular specialists — both surgeons and cardiologists — recommend imaging of the arteries before cutting, though many surgeons argue that in emergencies, noninvasive tests like ultrasounds are enough. Marie Gerhard-Herman, an associate professor of medicine at Harvard Medical School and a cardiologist at Brigham and Women’s Hospital, chaired the committee on guidelines for the American College of Cardiology and the American Heart Association. She told me that angiography before amputation “was a view that some of us thought was so obvious that it didn’t need to be stated.” She added: “But then I saw that there were pockets of the country where no one was getting angiograms, and it seemed to be along racial and socioeconomic lines. It made me sick to my stomach.”
Stokes wasn’t at immediate risk of losing her left leg when she met Fakorede, but pain prevented her from walking. She had a severe form of the disease, and Fakorede booked her for an angiogram and revascularization. He inserted a wire into her arteries and cleaned out the clogged vessels, letting oxygen-rich blood rush to her remaining foot. While she was recovering in Fakorede’s lab, she thought about her neighbors who had the same problems. “I really don’t like what’s happening to us,” she said to me. “They’re not doing the tests on us to see if they can save us. They’re just cutting us off.”
Patients didn’t know about vascular disease, or why their legs throbbed or their feet blackened, so Fakorede went to church. The sales rep, Hampton, introduced him to pastors, and several times each month, he stood before a pulpit. He told the crowds that what was happening was an injustice, that they didn’t need to accept it. He told them to get screened, and if any surgeon wanted to cut off their limbs, to get a second opinion. In the lofty Pilgrim Rest Baptist Church, in Greenville, he asked the congregation, “How many of you know someone or know of someone who’s had an amputation?” Almost everyone raised their hands.
At first, Fakorede took a confrontational approach with colleagues. Some seemed skeptical that he could “prevent” amputations; it’s a tall claim for a complex condition. Once, when a doctor had disregarded his advice, he’d logged it in the electronic health record, so the oversight would be on display for anyone who looked up his patient’s chart. Fakorede could fume when people questioned his authority; self-confidence carried him, but it sometimes blinded him to his missteps. Over time, though, Fakorede tried to rein in the arrogance. “You peel off a layer that may be comprised of: I’m from up North, I know it all, you should be thankful we’re here to provide services that you probably wouldn’t get before.” He picked up some Southern manners. Fakorede began texting doctors with photos of their patients’ feet along with X-rays of their arteries, before his intervention and afterward. Referrals picked up, and within a year, he’d seen more than 500 patients.
But Bolivar Medical Center, he learned, was turning away people who couldn’t pay a portion of their revascularization bill upfront. Several former employees told me the same. “It’s a for-profit hospital, it’s no secret, it’s the name of the game,” Fakorede said. “But a for-profit hospital is the only game in town in one of the most underserved areas. So what happens when a patient comes in and can’t afford a procedure that’s limb salvage? They eventually lose their limbs. They’ll present back to the emergency room with a rotten foot.” And a surgeon would have no choice but to amputate. (A hospital spokeswoman said that last year, it gave $25 million in charity care, uncompensated care and uninsured discounts. Asked if it turned away patients who couldn’t pay for revascularization, she did not respond directly: “We are dedicated to providing care to all people regardless of their ability to pay.”)
The practice was discriminatory, he reasoned, and also financially backward. At $237 billion in medical costs each year, diabetes is the most expensive chronic disease in the country; one of every four health care dollars is spent on a person with the condition. Left untreated, the costs pile on. Medicare spendsmore than $54,000 a year for an amputee, including follow-ups, wound care and hospitalizations; the government program is the country’s largest payer. Then come the uncounted tolls: lost jobs, a dependence on disability checks, relatives who sacrifice wages to help with cooking and bathing and driving.
By the time Carolyn Williams came to see Fakorede, in 2016, she’d been uninsured with diabetes for 20 years; she’d worked at a housing nonprofit and for a food assistance program, but neither had offered coverage. At the age of 36, she’d needed a triple bypass surgery, and at 44, she had three toes amputated. Untreated leg pain left her needing a wheelchair; she pulled out of Delta State University, where she was pursuing a degree in social work. Fakorede reconstituted blood flow in her legs and got her walking. But the diabetes was already destroying her kidneys. She joined the government’s disability rolls. She also went on dialysis, at a yearly cost to Medicare of $90,000.
On the days when Fakorede wanted to give up and leave, he drove to an Emmett Till memorial in Money, Mississippi. After 14-year-old Till was mutilated and murdered, in 1955, his mother had insisted on opening his casket. “Let the people see what I’ve seen,” she said, and his image brought national outrage to racist violence in the South. Fakorede thought often about how that decision sparked the Civil Rights movement. He thought about it as he exhibited his photos of rotten feet and limbless bodies, his own proof of what he considered a modern atrocity. He didn’t want to live by Bolivar Medical’s policies. He decided that in order to treat as many people as possible, irrespective of income or insurance, he needed to build a lab of his own.
THIS JANUARY, THAT LAB was now Dotstry’s best shot. The hospital’s consulting surgeon expected to amputate his leg below the knee. He had written that because Dotstry’s kidneys were impaired, the contrast dye in an angiogram would be dangerous. But Fakorede could replace the dye with a colorless gas, which wouldn’t jeopardize Dotstry’s health.
It would have made the most sense to perform the procedure at the hospital; Dotstry had been admitted and was occupying a bed. But after Fakorede opened his outpatient lab and hired away two techs and a nurse, a spokeswoman said the hospital stopped doing certain interventions. She told me it shouldn’t have surprised Fakorede that they couldn’t schedule Dotstry’s case, and that if he had been unable to treat a patient in his lab, the hospital could have worked with him to find another. Fakorede told me he’d never received such a message. When a doctor asks him to treat an inpatient with an acute condition, his responsibility, as he sees it, is to do it in the hospital. “If I don’t have a hospital that wants to coordinate,” he asked, “what do I do?”
The answer, at least this time, was to get his patient out of there. He called Dotstry’s doctor and convinced her to discharge him for the intervention. Then, at noon on Saturday, Fakorede walked back into Room 336. Dotstry’s sister, Judy, was standing by his bed. She wore tall leather boots over acid-washed jeans, with a thick, black wig in a braid down her back.
Fakorede handed over his card. “I called the hospital to see if we can do this case on Monday,” he said, “and they said no.”
Judy inhaled. “What now?”
Fakorede laid out the plan for a Monday morning angiogram in his own procedure room. He would open up as many vessels as he could. If he could get circulation to Dotstry’s foot, he might be able to save it. He wasn’t sure about the toes.
When Dotstry had suffered his stroke several years back, Judy had become his caregiver. She’d stopped taking jobs in home care and supported her brother without pay — shuttling him to doctors’ appointments, controlling his sugars, managing his medications. After his amputation, she’d helped him learn to walk again. In place of a salary, she’d drawn disability for an old work injury; she’d been electrocuted while operating a machine, and the nerves in her arm were damaged, making her hands tremble. But she couldn’t stay unemployed forever. This past fall, she had gone back to work, cleaning the local post office.
After Fakorede left, Judy looked over at her brother, who sat slumped over the side of the cot, a blue gown slipping off his bony shoulders. Their father had been a sharecropper, and Dotstry had dropped out of elementary school to help on the farm, harvesting soybeans, rice and cotton. Of 10 kids, he was the oldest boy, and he took care of the others, bringing in cash and cooking them dinner. They almost never saw a doctor. Instead, they’d relied on cod liver oil, or tea from hog hoofs, parched over a fire.
Dotstry had spent his career driving tractors, hauling crops and plowing fields, but he wasn’t insured and still rarely saw doctors. At 60, when he was diagnosed with Type 2 and prescribed insulin, he didn’t know how to manage the medicine properly; he had never learned to read. Insulin pumps were too expensive —more than $6,000. His blood sugar levels often dropped, and he sometimes passed out or fell on the job. Little by little, his employer cut back his duties. In 2015, he had a stroke; diabetes had raised his risk. A year later, his right foot blackened and was amputated at the ankle. The infection kept spreading, and soon, his lower leg went. He could no longer work.
Two of his sisters had died after complications of diabetes. Judy had stood over their beds like she was now standing over Dotstry’s. He’s still here, she reminded herself.
She pulled out her phone and called another brother. “They gonna amputate his foot, cause it’s bad,” she said. “Toe’s rotted.”
Dotstry looked up from the bed. “No!” he shouted. “They can’t take that off. Why?”
“Why you think your foot look like that? Why you think it smells? It stinks!” she said. Dotstry reached down to unwind the gauze. Judy wondered why he hadn’t told her that his foot was infected sooner. She lowered her voice. “You were doing pretty good. If you wasn’t, I could have tried to get back in there and do something.”
Her daughter, Shequita, ran into the room, huffing. She was loud and pissed off. “Whose foot is that?” she shrieked. She kneeled by the cot and helped Dotstry scoot up onto his pillow, stretching out his legs. He was usually a prankster, a hard-headed contrarian, the uncle who’d picked her up and spun her around like an airplane. She was thrown off by how quiet he’d become.
“Your daughter wants to know if you want to come stay with her, if you want to come to Texas,” Shequita told him.
Dotstry knew the offer was on the table, but he hadn’t yet accepted. A few days earlier, a tornado had torn the roof from his trailer, and he was, for the moment, without a home.
“She said it’s a lot better doctors up there,” Shequita continued, “and if she gotta stop working to take care of you, she can do that.” She gripped her hands around the frame of the bed and leaned over it, locking her eyes with his. “I need you to be thinking hard about this, sir. This ain’t you. I need you to get back to you.”
“He ain’t gotta go to Texas,” Judy interrupted.
Shequita shot back: “You gonna take care of him?”
Judy was silent. She knew that she couldn’t, not like before. She needed her paycheck for home repairs; a flood had warped her wooden floors. But Dotstry’s daughter was younger, and Judy thought that if she quit her job at Walmart, she’d get restless. Besides, Dotstry knew no one in Texas. She pictured him in a wheelchair, staring off, confused about where he was. Judy figured if he went, he’d go on and die.
She crossed her arms. “He’ll be all right if they don’t have to amputate that leg,” she said.
Shequita looked at her mother. She walked over to where she stood, by a shaded window, and threw her arms around her neck. Then, she left the room. Judy hoisted herself up onto the foot of her brother’s cot. She swung her legs up so that she faced him, and she laid herself down.
ABOUT EVERY FIVE YEARS, the doctors and researchers who make up the U.S. Preventive Services Task Force reassess their screening guidelines. In 2018, the members returned to peripheral artery disease and the blood flow tests that Fakorede had asked local primary care doctors to conduct. Once again, the panel declined to endorse them, saying there was not enough evidence that the tests benefited the average asymptomatic American.
In their statement, they acknowledged that public commenters had raised concerns that the disease “is disproportionately higher among racial/ethnic minorities and low-socioeconomic populations” and that this recommendation “could perpetuate disparities in treatment and outcomes.” In response, the panel said it needed better evidence. But as the National Institutes of Health has found, minorities in America make up less than 10% of patients in clinical trials.
Dr. Joshua Beckman, the director of vascular medicine at Vanderbilt University Medical Center, was an expert reviewer of the evidence base for the task force, and its final report struck him as irresponsible. It hardly noted the advantages of treatment after screening; the benefits were right there in the data that he saw. The panel discounted the strongest study, a randomized control trial, which demonstrated that vascular screening, for men ages 65 to 74, reduced mortality and hospital days. (The study bundled peripheral artery disease screening with two other tests, but in Beckman’s eyes, the outcomes remained significant.) He was confused about why the task force had published its evaluation of screening the general public, when it was clear that the condition affects specific populations. Several American and European professional society guidelines recommended screening people with a higher risk. “You wouldn’t test a 25-year-old for breast cancer,” he told me. “Screening is targeted for the group of women who are likely to get it.”
Dr. Alex Krist, the chair of the task force, repeated the group’s position in an email that the data was not strong enough to endorse screening, even for at-risk patients. “The Task Force does not do its own research, so we can’t fix these research gaps, but we can — and did — ring the alarm bell to raise awareness of this vital issue among researchers and funders.”
Vascular surgeons who have spent their careers studying limb salvage have come to see preventive care as perhaps more important than their own last-ditch efforts to open blood vessels. Dr. Philip Goodney, a vascular surgeon and researcher at Dartmouth and White River Junction VA Medical Center, made a name for himself with research that showed how the regions of the country with the lowest levels of revascularization, like the Delta, also had the highest rates of amputation. But revascularizations aren’t silver bullets; patients still must manage their health to keep vessels open. Now, Goodney believes his energy is better spent studying preventive measures earlier in the disease’s progression, like blood sugar testing, foot checks and vascular screening. Many patients have mild or moderate disease, and they can be treated with medicine, counseled to quit nicotine, exercise and watch their diet. “We need to build a health system that supports people when they are at risk, when they are doing better and when they can keep the risk from coming back,” he told me. “And where there’s a hot spot, that’s where we need to focus.”
Fakorede scrolled through the task force’s statement. “You want more data? Really? Who has the highest amputation rates in America?” he asked. “That’s your data.” He had taken to the national stage, speaking at conferences about what he’d witnessed in Bolivar. On behalf of the Association of Black Cardiologists, he testified before Congress, convincing U.S. Rep. Donald M. Payne Jr., a Democrat from New Jersey, along with U.S. Rep. Gus Bilirakis, a Republican from Florida, to start a Congressional Peripheral Artery Disease Caucus. The group is pushing for the task force to reevaluate the evidence on screening at-risk patients, for federal insurers to start an amputation prevention program and for Medicare to ensure that no amputation is allowed before evaluating arteries. Other groups are advocating for legislation that would require hospitals to publicly report their amputation rates.
In Bolivar, Fakorede had seen more than 10,000 cardiovascular patients from around the Delta. Dr. DeGail Hadley, a primary care provider in town, told me that before Fakorede arrived, he wasn’t sure what was best to do for patients with rotting feet. “It was always a process of transferring the patients to Jackson or Memphis, which can be difficult.” Both cities were two hours away. Now, Fakorede was performing about 500 angiograms annually in town. Last year, he published a paper in Cath Lab Digest describing an 88% decrease in major amputations at Bolivar Medical Center, from 56 to seven. (Fakorede did not provide me with all of his sources.) The hospital has different internal figures, which also reflect a significant decrease. Between 2014 and 2017, the hospital recorded that major amputations had fallen 75% — from 24 to six.
Fakorede couldn’t catch everyone in time, and he was haunted by the patients who got to him too late. A week before he’d met Dotstry, Sandra Wade had come in with an open sore on her right big toe. She came from a family of diabetics. Her mother had died after a diabetic coma. Her cousin had just lost a leg. Her oldest sister, who’d raised her, had given up on walking when a tired, burning, itching sensation consumed her legs. Now, Wade felt it, too.
“I don’t want to give up like that,” Wade had said, reclining in a cot in Fakorede’s pre-procedure room. “I want my toes. I don’t want to lose not one limb. I choose life.” She elongated her O’s. She was 55 and had a high, gentle voice, a wide smile and big, curled lashes under loose, curled hair. She had spent most of her career in food service and retail, recently managing a Family Dollar, but after diabetes took her eyesight, she’d had to quit. She wondered if the sodas and chips that had fueled her at the store had accelerated her disease. Or if she’d focused so much on her son, who was developmentally disabled, that she’d neglected herself. She didn’t like to offload blame onto her genes. “Somebody’s gotta try to change the cycle,” she’d said. “I really want to be the one.”
Fakorede inserted an IV into the top of her leg. He opened up each of her blocked arteries, one at a time, until he got to the most important one, which ran along her inner calf. It was supposed to supply blood to her open wound, and she needed it to heal. Without it, she’d likely lose her toe. If she didn’t control her sugars, she could lose her lower leg next. Fakorede was hopeful as he slid a wire through the vessel in her knee, and into that crucial artery in her calf. But then, about a third of the way down, it stopped. It was as if the vessel itself had evaporated.
UNDER A CRISP, WIDE SKY, on Martin Luther King Jr. Day, churches around town were opening their doors for services. Fakorede’s office was scheduled to be closed, but he’d called in his nurses and radiology technicians, even those out hunting deer, to staff Dotstry’s case.
“What’s up, young man?” Fakorede greeted Dotstry, who was slowly fading into his Ambien, and he handed Judy a diagram of a leg. “The prayer is that we can find this many vessels to open up,” he said, pointing to the paper. “As soon as I’m done, I’ll let you know what I find.”
In the procedure room, he put on his camouflage-patterned lead apron, and with an assistant, he inserted an IV near Dotstry’s waist. He wound a wire across Dotstry’s iliac artery, into the top of his left leg. The femoral artery was open, even though it had hardened around the edges, a common complication of diabetes. They shot a gas down the arteries in Dotstry’s lower leg so the X-ray could capture its flow. Fakorede looped his thumbs into the top of his vest, waiting for the image. Other than a small obstruction, circulation to the toes was good. “They don’t need to whack off the knee,” he said, staring at the screen. Dotstry would lose one toe.
After they’d cleaned out the plaque, Fakorede called Judy into the lab and pulled up the X-rays. Dotstry snored in the background. The doctor showed Judy a playback of the blood moving through the vessels. She could tell that his foot had enough flow. She folded over, running her palms along her thighs. “Y’all have done a miracle, Jesus.”
Dotstry would need aggressive wound care, help controlling his sugars and a month in rehab following his toe amputation. In the meantime, Judy and her daughter would have to learn to manage his antibiotics and find him an apartment. He’d still be able to tinker with his cars, as he did most afternoons. And as far as Judy was concerned, he wasn’t moving to Texas.
Fakorede scrubbed out. He sat at his desk to update Dotstry’s doctors. He called an infectious disease specialist, 35 miles south, to check on whether he could see Dotstry the following morning. Then, he dialed the hospital and asked for one of the nurses. He explained what he’d found: that Dotstry didn’t need a leg amputation.
“Oh, great,” the nurse replied. “The surgeon was calling and asking about that. He called and tried to schedule one.”
Fakorede had been typing up notes at the same time, but now he stopped. “He was trying to schedule it when?” he asked.
“He was trying to schedule it today.”
ABOUT THE REPORTING
For this story, Lizzie Presser spent over a month in Mississippi, in December and January, speaking with dozens of patients and shadowing doctors, in clinic and in procedures. She interviewed over a dozen medical professionals whose work has intersected with Fakorede’s, including nurses, limb-salvage specialists, primary care providers and the hospital’s consulting surgeon, Dr. Roger Blake, who corroborated all facts related to his treatment plan for Henry Dotstry. She asked Bolivar Medical Center if it believed it provided Dotstry with adequate care. Even with Dotstry’s permission, the hospital declined to comment on his case, citing patient privacy.
The scenes in the story are informed by her own observations and interviews with the subjects to fill in details, including their thoughts at the time.
To put her observed reporting into national context, she reviewed the salient medical research and interviewed more than a dozen experts in all corners of the health care system, from those who treat diabetic patients to those who inform and set policies around care.
Lizzie Presser covers health, inequality and how policy is experienced for ProPublica.
The inherited disadvantages of slavery and the inability to transfer wealth to ADOS descendants have been a significant contributor to the bottom class positionality of this ethnic group. This series is published to encourage study and dialogue. It is an instrument for personal empowerment. The guide creates a space for the civic engagement participation of Reparationist in national coalition-building, including petitioning for significant revision (or
replacement) of the bill H.R. 40 (S.1083) currently under consideration in the U.S. Congress.
Slave auction block, Green Hill Plantation, Campbell County, Virginia, Historic American Buildings Survey – Public Domain
Many Americans watched as Joe Biden marked his Inauguration Day celebration with a brief presentation before the statue of Abraham Lincoln, invoking the Civil War as an historical moment when the nation triumphed over deep division.
When recalling Lincoln, many New Yorkers may remember the famous speech he gave at Cooper Institute (aka Cooper Union) in February 1860 calling to limit the extension – but not the end – of slavery. It was a critical campaign speech that helped him secure the Republican Party nomination for President. In November, he was elected, and, in December, South Carolina was the first state to secede from the Union.
Unfortunately, few American – and likely very few New Yorkers – will recall that Lincoln’s speech was strongly attacked by city business leaders and the Democratic Party, many assailing him with the racist slogan, “Black Republican.” More important, Lincoln’s election sparked a strong movement in the city, led by Mayor Fernando Wood, to join the South and secede from the Union.
This is one of the many important historical stories retold in an informative new book by Jonathan Daniel Wells, The Kidnapping Club: Wall Street, Slavery and Resistance on the Eve of the Civil War (Bold Type Books). Slavery was formally abolished in New York State in 1827, but the slave trade lived on in the city until the Civil War. Wells argues that the slave trade persisted in New York City in the decades before the Civil War because it was the capital of the Southern slave economy.
The city’s business community of major banks, insurance companies and shipping industry financed and facilitated the cotton trade. Many of the leaders of this community played a decisive role in city social life and politics, including control over the powerful Democratic Party. Together, they backed the authority of the Constitution’s “Fugitive Slave Clause” – and later Fugitive Slave Acts (1793 and 1850) — guaranteeing slavery. Equally critical, city police, leading lawyers and judges (state and federal), with the support of the growing Irish immigrant community, colluded with organized slave “kidnappers.”
The slave trade functioned in two complementary ways. First, northern free Blacks — including young children — as well as self-emancipated former slaves who fled to New York from the slave states lived in fear of being kidnapped by organize slave catchers (often city police officers) and transported south into slavery. Second, “slaver” ships regularly stopped in New York harbor with numerous African slaves hidden on board as cargo to be sold as part of a lucrative, if illegal, business.
In pre-Civil War New York, the police were underpaid and made money through accepting bribes as well as by securing lucrative rewards from seizing and sending alleged “fugitive” Black people to the South or a fee for the sale of a captured free Black person into slavery. Because the courts were run by the Democrats, graft and corruption were accepted judicial procedures. Any Black person could be seized — walking on the street, working on the docks, at home in the middle of the night and even kids on their way to school – and accused of being an allegedly run-away slave. Most judges were notorious racists who thought little of Black people and were eager to go along with police charges.
The city’s powerful pro-slavery movement based its support for Southern slavery and slave kidnapping on the Constitution’s “Fugitive Slave Clause” (i.e., Article 4, Section 2, Clause 3). It stipulated that “no person held to service or labor” would be released from bondage in the event they escaped to a free state, thus requiring northern free cities like New York to return the self-emancipated to their southern enslavers.
In 1793, Congress passed the Fugitive Slave Act that added more enforcement teeth to the original Clause, explicitly stating that owners of enslaved people and their “agents” had the right to search for escapees within the borders of free states. Henry Clay promoted what was known as the “Compromise of 1850” that strengthened the Fugitive Slave Act to forestall growing talk of Southern secession. The revised act compelled citizens to assist in the capture of runaways and denied escaped people the right to a jury trial, among other actions. The new act was met by fierce resistance in many anti-slavery states, including upstate New York. The new act was adopted as the Underground Railroad reached its peak as many self-emancipated former slaves fled to Canada to escape U.S. jurisdiction.
The author grounds much of his narrative around the life of David Ruggles, a courageous Black abolitionists and journalist. He was born in Connecticut in 1810 when the spirit of the Revolution still glowed. At age 16, he moved to New York and became an abolitionist activist. He was a prolific contributor to newspapers, including his own paper Mirror of Liberty, published numerous pamphlets and contributed to abolitionist papers like The Liberator. He named “The New York Kidnapping Club” and published a list those he believed participated in kidnappings. Going further, he boarded ships in the harbor in search of Black captives or for signs of participants in the illegal slave trade. He also hosted the wedding of Frederick Douglass and Anna Murray at his New York home after they fled Maryland.
Ruggles helped forge the Underground Railroad, thus assisting self-liberated fugitives to safety in the north or to freedom in Canada. He was joined by a small but activist antislavery community that included Horace Dresser, Arthur Tappan, Charles B. Ray and Elizabeth Jennings. He ran a bookstore and was physically attacked, his store burned; he was hounded by the police and even briefly jailed. Sadly, by his 30s, he was nearly blind and moved to Massachusetts.
In 1837, Ruggles helped found the New York Committee of Vigilance, a biracial organization opposed to the kidnapping of innocent Black residents as well as self-liberated former slaves. The abolitionists were a small but activities community that regularly protested when a Black person was kidnapped and petitioned for jury trials in the cases of those arrested as fugitives. Not unlike today’s supporters of Black Lives Matter, Black and white activists in pre-Civil War New York claimed that law enforcement was mostly little more than legalized racism.
The Kidnapping Club reminds readers that New York was a pro-slavery city even as the nation was engulfed in the Civil War. Wells recounts how the city’s leadership joined with the growing movement in the South to promote secession. While the South seceded and New York (white) citizen voted against Lincoln’s election, the city remained part of the Union.
However, built-up anti-abolitionist sentiments exploded in the 1865 Draft Riot that saw Union soldier from the recent Battle of Gettysburg march on the city to suppress the uprising in which the Negro Orphan Asylum burned, numerous churches destroyed and about 100 people died, many of them Blacks.
Without acknowledging the racial conditions of New York during pre-Civil War era, especially the horrors inflicted by the “kidnapping club” and the role of the police and judiciary, one cannot fully understand – nor can society truly address – the complaints raised by the Black Lives Matter movement today. Racial oppression and suffering leave a deep and enduring scar that only true social change can remedy.
After the Civil War, the United States searched for ways to redefine itself. But by the 1880’s, the hopes of Reconstruction had dimmed. Across the United States there was instead a push to formalize and legalize discrimination against African-Americans. The effort to marginalize the first generation of free black Americans infiltrated nearly every aspect of daily life, including the cost of insurance.
Initially, African-Americans could purchase life insurance policies on equal footing with whites. That all changed in 1881. In March of that year Prudential, one of the country’s largest insurers, announced that policies held by black adults would be worth one-third less than the same plans held by whites. Their weekly premiums would remain the same. Benefits for black children didn’t change, but weekly premiums for their policies would rise by five cents.
Prudential defended the decision by pointing out that the black mortality rate was higher than the white mortality rate. Therefore, they explained, claims paid out for black policyholders were a disproportionate amount of all payouts. Most of the major life insurance companies followed suit, making it nearly impossible for African-Americans to gain coverage. Across the industry, companies blocked agents from soliciting African-American customers and denied commission for any policies issued to blacks.
The public largely accepted the statistical explanation for unequal coverage. The insurer’s job was to calculate risk. Race was merely another variable like occupation or geographic location. As one trade publication put it in 1891: “Life insurance companies are not negro-maniacs, they are business institutions…there is no sentiment and there are no politics in it.”
Companies considered race-based risk the same for all African-Americans, whether they were strong or sickly, educated or uneducated, from the country or the city. The “science” behind the risk formula is credited to Prudential statistician Frederick L. Hoffman, whose efforts to prove the genetic inferiority of the black race were used to justify the company’s discriminatory policies.
You may unsubscribe at any time by clicking on the provided link on any marketing message.
Hoffman had plenty of bad science to work with. Most of the available data on African-American health statistics came from Civil War-era studies of black and white soldiers. Hospital administrator J.F. Miller and other researchers consistently claimed to have proof of the inherent weakness of the black race, reporting that the internal organs, including the lungs and brain, weighed less in blacks than in whites, making them more susceptible to diseases like pneumonia, tuberculosis, and syphilis. Since most white physicians held the common belief that enslaved blacks had been relatively healthy, this proved that the constitution of the black race was incompatible with freedom:
These laws affect him in the air he breathes, the food he eats, the clothes he wears and every circumstance surrounding his habitation. In the wholesale violation of these laws after the war…was laid the foundation of the degeneration of the physical and mental constitution of the negro.
Black Americans were more likely to live in poverty and often lacked access to medical care, among many other hardships. Still, little credence was given to the theory that environmental factors were the reason for the higher black mortality rate. Hoffman’s work received widespread coverage in respected journals, including that of the American Statistical Association, a professional society where Hoffman later served as president.
Hoffman predicted that African-Americans would eventually die off like the Native Americans before them. He surmised that they wouldn’t be able to survive in “civilized” society, outside the bonds of slavery. The theory didn’t gain any traction, but Hoffman’s broader work on the racialist science behind black mortality rates did have lasting effects. Discriminatory policies based on race were standard in the insurance industry well into the twentieth century. In a 1940 survey, over forty percent of companies did not accept black policyholders.
America doesn’t want unity. It wants absolution without restitution
Renee Graham, Boston Globe
Throughout his campaign, and especially during his first speech as president-elect, Joe Biden stressed the need for unity. “Our nation is shaped by the constant battle between our better angels and our darkest impulses,” he said. “It is time for our better angels to prevail.”
Abraham Lincoln first summoned “the better angels of our nature” in his inaugural speech in 1861. A month later, the Civil War began; we’ve been waiting ever since for these rumored apparitions of our nation’s inherent goodness to prevail.
America has never wanted unity. It prefers absolution over restitution.
When this nation’s leaders speak of unity, that often means, “We need to move on,” even though unchecked trauma leaching from one generation to another prohibits any such thing. For many of us, especially Black and brown people, unity is a five-letter word for “Shut up and get over it.” That is how this nation regards calls for repair of systemic disenfranchisement.
Unity first requires dismantling white supremacy, the scaffolding of every American ill from systemic racism to police violence. It demands recompense for those whose lives it has stalled, even crushed. It insists on a sharp understanding of how to eradicate the most virulent preexisting condition — racism — that has inevitably led to disproportionate COVID-19 deaths in Black, brown, and Indigenous communities.
Before accord, there must be an accounting — otherwise, it’s like leaving a tick’s head embedded beneath the skin. The problem is less visible, but the host body remains sick and unsound.
In his speech, Biden seemed to speak very specifically about the horrors imposed these past four years. (And they aren’t over.) Of course, what we witnessed during the Trump years was an amplification of the racism and other hatreds that plagued this country long before a failed businessman became a failed president.
“Every day we hear about how society is splitting apart — a polarized Congress, a fragmented media market, a persistent schism among Americans over social issues. But really, how bad are the divisions?” Bob Cohn (now president of The Economist), wrote in The Atlantic.His conclusion: “Pretty bad.”
That was seven years ago. Trump did not create the divisions; he exploited the hell out of them.
About 10 millionmore people voted for Trump in the 2020 election than in 2016. Again, most of them are white. This I believe: They want to be feared, not understood, and their only definition of unity is aligning against anyone who doesn’t think like them. They’re willing to tear this nation apart with baseless, anti-democracy conspiracies to slake one man’s flimsy ego and their own relevance in an increasingly multiracial, multicultural nation.
Fox News is even chiding Democrats for lobbing “angry rhetoric at those who have worked with and for, and even those who simply support, Trump.” For the president’s propaganda network, achieving unity is a burden to be borne only by those who oppose the president. I don’t hear many Trump supporters reckoning with why they still support the worst president in modern American history.
For its entire existence, America has mostly walked away. From nearly 250 years of Black people in bondage to the genocidal “Trail of Tears” that forced thousands of Indigenous people from their lands in the 1800s; from the 1921 Tulsa Race Massacre during which white people killed hundreds and destroyed that Oklahoma city’s “Black Wall Street” to every barbarity the current administration concocted to punish those who sought only a better life, this nation continually opts for historical amnesia over atonement.
As the Rev. Bernice King, daughter of Martin Luther King Jr., tweeted, “We can’t skip justice and get to peace.” Nor can we get there without equality.
Scars of this catastrophic presidency will lie alongside festering wounds long untended. There’s no shortcut to unity, a challenge in a nation that would rather be comfortable than truthful. This unfinished democracy will never be whole until all of its practitioners abandon the collective silence that cloaks their complicity. To move toward unity, white supremacy must first be demolished. America has shown no serious inclination to do that, and more than 72 million Trump voters serve as damning proof.
For the sake of this country, I wish Biden every success. I hope he understands that unity is not self-achieving. The most arduous labor must be done by those who have inflicted or benefited from the pain of so many others. Until then, do not ask me to forgive all this nation is too eager to forget.