The RW Interview
Dr. Tolbert Small: Journey of a People’s Doctor
Revolutionary Worker #1139, February 17, 2002
Posted at http://rwor.org
The RW Interview is a special feature to acquaint our readers with the views of significant figures in art, theater, music, literature, science, sports and politics.
The views expressed by those we interview are, of course, their own, and they are not responsible for the views expressed elsewhere in the Revolutionary Worker and on this website.
Dr. Tolbert Small runs the Harriet Tubman Medical Clinic in East Oakland. The Clinic is located in an old Victorian in the middle of a low-income residential neighborhood. On the walls in the clinic are pictures of Frederick Douglass and Harriet Tubman, African American art, posters from the civil rights and Black liberation movements. In the waiting room, medical magazines and information share the tables with radical literature. On the walls are also some old signs from the days of Jim Crow. “Colored waiting room” one sign reads, a reminder of the overt racism of that time. Most of the patients in the waiting room are African Americans and know that racism is not a thing of the past but confronts them in every aspect of their lives, including health care.
Last October, the RW sat down to talk with Dr. Tolbert Small, who first talked about some of his own personal history. He was born in a shack without plumbing or electricity in Coldwater, Mississippi. His great grandfather was a former slave. His grandfather was a “crack shot” and one day put seven shots into a member of the local Ku Klux Klan. His father moved to Detroit to look for work and Dr. Small described the racism he experienced growing up in the ghetto community of Black Bottom. A teacher told his mother, “We’re not trying to educate these kids. They’re all going to jail anyway. We just want to teach them some discipline.”
Dr. Small went to college and medical school at a time when Northern medical schools would only admit one token Black student while the Southern schools were “white only.” It was a time when hospitals had quotas on the number of Black patients, and pregnant women were turned away from hospitals with empty beds if the quota was full. “I was a very good student in school. I would usually score the highest mark in the classroom,” Dr. Small remembered. “The teachers would stand behind me and watch me when I took every exam because Black folks weren’t supposed to be smart. I used to jokingly say to myself, ‘Who the hell can I be copying from? I’m scoring the highest damned mark in the room.'”
“My experiences with racism are not unique,” Dr. Small told the RW. “I have the same experience as my patients. …You could literally walk down the street and talk to any Black senior citizen, anyone, and they would tell you their experience with racism. So nothing I say is unique. It’s just the way things were in this country.”
RW: Why did you decide to become a physician?
Dr. Small: When I was an undergraduate student in college, it was in the early ’60s, and I was involved with SNCC–the Student Non-violent Coordinating Committee. We were interested in developing our skills to either take to some other country that was more interested in providing the things necessary for survival for its citizens, like education and health care, or using it in this country. And so I went into medicine, because I thought it would be a useful skill to have, not only to bring a service that served the needs of the people of our community, but also because our government has a long history of neglecting the health care of its citizens. We spend more money than any other country in the world on health care. We spend 16% of our gross national product on health care. But, when the World Health Organization ranked us [for health care] we were ranked number 37.
RW: How did you come to set up the clinic?
Dr. Small: I came to Oakland in 1968. And I did a lot of different things before I finally opened up an office. I ran a free clinic for the Panther Party for three years. I was their physician for four years. I worked at the West Oakland Health Center for three years. I did emergency room work for nine years. I was doing house calls in West Oakland in the early ’70s, and in North Oakland.
I felt the physician should be in the community. There were enough physicians on Pill Hill, where all the hospitals and doctors are in Oakland. We wanted to be in the community where the people lived.
“Healthcare” for Profit
RW: What do you think about the health care system in this country?
Dr. Small: The basic problem is when you hand people a lot of money and you tell them “If you deny care you’ll make money,” they deny care… The head of one HMO sold his interest in the company for $1 billion. In 1995 the government spent, public and private, $1.4 billion on AIDS research. But the top six CEOs of insurance companies–they made $2.4 billion. So it was more than the entire government spent on AIDS research.
The head of HealthNet was given a $220 million stock option. When QualMed and HealthNet merged, the person who was head of HealthNet was given $100 million for agreeing to close these [HMO] companies down.
You have lots of money being spent on health care, but it doesn’t go to provide health service. It goes into people’s pockets. So you can have a poor country, like Cuba, which can have a better infant mortality rate than the United States. It basically depends on what you do with the funds.
We’ve spent a lot of money, but we don’t spend it on health care. You will see this when you go to the emergency room. You will wait five hours to be seen. It used to be we had six or seven hospitals in this area… Many of these hospitals had emergency rooms. They provided care. But the hospitals have all folded, because you have the government, through Medicare and Medi-Cal, and the HMOs — the health maintenance organizations — stealing all the money. All the hospitals are in the red. So they’re all folding and merging. They are cutting services.
The politicians are all in the pocket of the blood barons of insurance and the HMOs’ directors. Both the Democrats and the Republicans. I think we have a system in which you basically have blood barons stealing money, and health care is not being provided.
RW: How does all this affect your patients? I understand that you used to run a blood-drawing lab here, and you had to close that because you couldn’t get the HMOs or the government to reimburse you.
Dr. Small: If I have someone who has weakness in their legs, back pain, numbness radiating down their leg, obviously they need an MRI to rule out a herniated disk. If I order an MRI, the HMO will not allow me to order it. The radiologists are paid, capitated. Capitation is where they will pay them so many dollars for each patient that signed up whether they are treated or not. So the radiologists don’t want the primary care doctors to be able to order MRIs, because they’ll order “too many” appropriate MRIs. So I have to refer the patient to a neurologist, to a neurosurgeon, orthopedic specialist so they will order MRIs so the insurance company will pay for it.
We had a lab here for 19 of the last 21 years. We were providing a service for our patients. After Medicare cut their reimbursement rate about five years ago, the lab was always in the red, but we still did it as a service for our patients. The HMOs told us that we could draw blood for them free, and they would be happy for us to do any test we wanted for them, free, on our patients. But they would pay for a CBC. Then Medicare told us that it was “illegal” for us to do a blood sugar on a patient who was diabetic or to do an EKG on someone who had chest pains.
Oakland has the highest rate of prostate cancer in the world. The state of the art is that every man over 50 should get a blood test for what we call a PSA, or Prostate Specific Antigen–which goes up in two-thirds of the people with prostate cancer. And for Blacks, we’re supposed to do this test in people over 40. I’d have someone come in with an enlarged prostate, or blood in their urine, and we would do a PSA on them. Medicare told us that was illegal. They audited us, and essentially denied all our appropriate lab tests. They actually did their best to close us down. They said, “Well, you’ve done these lab tests illegally.” Also, Medicare does not allow you to do an annual history and physical on people who are over 65. They have it in their rules. But they are supposed to allow you to do it if someone has coronary artery disease.
I had one patient who had colon cancer and leukemia. I did a physical on him. They denied it, and said it wasn’t indicated. It was a routine history and a physical. So they went to my records and they said, “You’ve done physicals on people, done lab work that’s inappropriate, you spend too much time taking care of your patients, you owe us $7,000.” Then they said, “Plus you’ve got to multiply by four and a half to punish you for all the people we didn’t audit. So you owe us $38,000. Then we got to charge you $800 a month interest on it.” We didn’t have $38,000. We had to borrow and beg to give them $38,000, so we wouldn’t get charged $800 a month interest.
Of course we appealed. I wrote a 60-page appeal. And it turned out that the doctor who audited me didn’t even read it. He actually put it in writing that he wasn’t going to read it because he said he was fair with me the first audit.
Then I did a second appeal, which was a 62-page appeal, which also they didn’t read. We actually ended up having to go to court, and they admitted that they hadn’t read it. Eventually we won in court, and we got all our money back. That gives you some idea of specific examples of how the government has gone out of its way to hinder someone who wants to practice medicine in the community, wants to provide a service to people who live in the community.
Inspired by Revolutionary China
RW: You showed me some of the pictures from when you went to China in 1972 with the Black Panther Party–back when China was a socialist country under Mao Tsetung. And I also read a poem you wrote that was printed in the Black Panther Party newspaper titled “Serve the People.”
Dr. Small: I wrote that in China. Yeah. What happened was Huey [Newton] went to China and met Chou En-lai, and Huey suggested that the BPP send a delegation to China and Chou agreed. We were actually supposed to be over there right before Nixon left. But the CIA didn’t want us over there at the same time. When Kissinger was arranging Nixon’s trip, he told Chou En-lai that he wanted the Chinese to leave the American leftists alone. Masai Hewitt and Elaine Brown went to Canada to get our visas. There was no Chinese embassy, of course, in the United States. The Canadian government wouldn’t let them into Canada until after Nixon had come back.
We spent seven weeks in China. We went up to Yenan, and we met the peasants who were living there when Mao was living there, who knew Mao, and who knew the People’s Liberation Army. And so we actually met with them.
The group was about 22 people. Everyone was very enthused about what China had done. TB was under control, schistosomiasis — a parasite that infects people through snails — was under control.
We met the first surgeon in the world who had sewn a hand that was chopped off, back on. He had also sewn a foot back on. They had an 80% success rate in sewing hands, and a 60% success rate in sewing fingers back together. This was in Shanghai, and he was a child of peasants and was probably the first person in his family to have a higher education.
We were also very impressed by the integrity of people at that time. You know the saying was you couldn’t throw an old shoe away. You’d throw it in a waste paper basket, or something, and someone in another town would say “Oops, you forgot! You lost it!”
People were very enthused about building socialism, and there seemed to be warmth and fervor. In fact, I remember when we left, we were getting on the train to go back to Hong Kong, not only were the people in our group in tears, but our translators were in tears. It was just the warmth of the relationship. They were sad to see us go.
RW: After Mao’s death, capitalism was restored in China and today, the health care system in China, like in the U.S., puts profit above meeting the needs of the people. But you actually saw how under socialism the health care system is run in order to serve the people.
Dr. Small: Well, you know, China in 1972 was a different country than China in 2001. But at that time they were sending “Barefoot Doctors” — they had over a million Barefoot Doctors who were going into the community, providing health care. Whereas in this country, the first thing they ask you when you go into the emergency room is “Do you have insurance?” Medicine in this country is not to provide a service for its citizens, but it’s used for insurance companies and HMO directors to make money, whereas in China in 1972 medicine was supposed to be of service to the people, you know; if you’re a citizen of the country we’ll provide you with an education, we’ll provide health care, we’ll provide all the things necessary for life.
RW: At the time acupuncture was illegal in the U.S. and was not considered “legitimate medicine”–but you learned acupuncture in China and then came back to the U.S. and continued to practice it.
Dr. Small: We got started doing acupuncture in China. I wound up seeing three operations, I think, at the Workers, Peasants and Soldiers Hospital in Peking. We’d be sitting there watching someone get his eye muscle operated on, and he’d be talking while he was having the operation. Someone was having surgery on the larynx, there’s a nerve called the recurrent laryngeal nerve, which if the surgeon cut, the patient would lose their ability to talk, and they would be talking to people while they were having the operation, thus insuring that they did not cut the nerve. So we realized, there’s got to be something to this.
So when we got into Shanghai, I had a stiff neck, and I thought I’ll get acupuncture for it. The point was gall bladder 20, and I remember the numbness shooting up into the head.
I think the Chinese were kind of concerned that we would be sticking needles into each other, so they wanted us to learn correctly. And so they had Dr. Wu, who was a traditional professional acupuncturist in Shanghai, come and lecture to us two days in a row.
When you would go to the Children’s Palaces, there would be 5-year-old kids who would be doing acupuncture on simple points on themselves — large intestine four or LI4 or stomach 36. And so, when I got back, I was very interested in acupuncture. I was working at the West Oakland Health Center and we used to meet once a week to do the points on ourselves. In China, when you learn how to do acupuncture, you do the points on yourself. And that’s how the Barefoot Doctors, that’s how the people learn it. But we wound up doing all the basic acupuncture points on ourselves. When the needle is inserted in the right area, stimulating the non-pain-carrying nerves, and you feel this numbness, dull ache, distention, or swelling. And so we took the principles that I picked up in Shanghai and we put it into concrete practice when I got back, based on simply doing all the points on myself.
In fact, I actually was very interested in how it worked, and I did a couple of articles–one on the neurophysiological basis of acupuncture, and the other one’s on acupuncture anesthesia.
Serving the People
RW: How did you get involved with the Black Panthers?
Dr. Small: I had been working with SNCC and the Mississippi Freedom Democratic Party (MFDP) while I was in medical school and when I came out here to intern at Highland Hospital in 1968, I did some work with the Oakland Direct Action Group.
After finishing two years at Highland Hospital I remember going by the Panthers’ office on Grove Street. And I drove by there and June Hilliard was outside, in front of it, so I just gave her my name and phone number and said if you ever need a doctor, give me a call.
The next day, the FBI called a doctor at Highland Hospital, and told him “One of your physicians has agreed to work with the Black Panther Party.” Fortunately, the FBI were not so astute those days and they called the wrong doctor [not my boss]!
That’s how I got involved working for the Panther Party. A couple of years ago a gynecologist asked me “I heard you were the doctor for the Panther Party. What was it like?” And I said, “Well, you know, practicing medicine is very labor intensive; it’s very hard work. And basically, when I was their physician for four years, it was like practicing medicine anywhere else. It was very labor intensive and it was very hard work.”
I was thinking about that the other day. I was looking at my itinerary from 1971. I used to keep records on what I did, because I didn’t want to pay any tax money to go into the war in Vietnam. And I just realized how many miles and miles I did, people I took care of going in and out of prisons. I was actually going to San Quentin to see George Jackson and Panther soldier Charles Bursey and Rodney Williams, David Hilliard in Folsom. Angela Davis in Marin and San Francisco. This is all very labor intensive; it was a lot of hard work!
When you’re trying to change society for the better, you can’t sit in your chair and read a book to do it. As Mao said, you cannot tell the taste of a pear unless you bite into it. It was very labor intensive, it’s lots of long hours involved.
I think it was kind of an embarrassment for the Oakland chapter of the Black Panther Party that although the Party had free clinics — they had eight or nine free clinics in 44 chapters — they didn’t have one in the Oakland area. So actually we got together with the Berkeley branch of the Panther Party and we opened the Berkeley clinic.
And at the time Bobby [Seale] got hold of the fact that sickle cell anemia was being neglected, and I went on a speaking tour, visiting various Panther chapters talking about sickle cell anemia. We used an article by Dr. Robert Scott, who I think was from the University of Virginia. He documented the neglect of sickle cell anemia. Sickle cell anemia is a disease in which 98% of those affected are Black folks, where cystic fibrosis was 98% white folks. And he showed that the United States spent less than $50,000 on sickle cell anemia, and $7.9 million on muscular dystrophy and $1.9 million on cystic fibrosis. Yet people with sickle cell anemia have a greater morbidity, spend more time in the hospital than the other two diseases.
We used this to document the lack of public policy of the United States government in dealing with sickle cell anemia. The Panther medical clinics were screening and testing for sickle cell anemia in all the chapters. And this put tremendous pressure on the government. In fact, Children’s Hospital in Oakland is now on the cutting edge of sickle cell anemia research work. If you talk to the doctors there, they’ll say the reason they were able to get funds for sickle cell anemia was because the Black Panther Party lit a fire under the government and embarrassed them for their shameless, racist neglect of the disease. And that’s why most major cities have sickle cell anemia foundations, counseling, and that sort of thing.
RW: How did you set up and run the free clinics in the community? I know they didn’t get a lot of government funding.
Dr. Small: Well, we relied tremendously on volunteers. When I originally set up the clinic, I was working there Monday, Wednesday and Friday, and I’d get other doctors to volunteer on the other days. We would get volunteers from the community.
I was very good at getting drug samples, so we had a very complete pharmacy. There was a guy who went to medical school and was in the Panther Party who used to do our hemoglobin exoploresis, an electrical screening for sickle cell. We got the Berkeley Public Health to do our gonorrhea cultures free. There was an optometrist who would make glasses for people for free. We would get certain specialists who would agree to see people free.
There was a need in the community for health care, and the government was not going to provide it. We felt that until we had an appropriate government that would provide health care, that would be a service we would provide.
There were multiple survival programs: bus transportation for families to visit relatives in prison, a free plumbing program, the free breakfast program, a free school, we were trying to set up a pre-school program. There was a whole galaxy of things that the Panther Party was trying to set up.
I actually wasn’t a member of the Panther Party. Everyone thought I was, but I was just their doctor for four years.
RW: The last question I wanted to ask is, what keeps you going? After 30 years, with the government going after you, trying to prevent you from doing your work, going after you financially, working like 12-hour days, 7 days a week. What is it that motivates you and keeps you going?
Dr. Small: When I was younger, I think it was anger that motivated me. I think that people who oppose racism and oppression, it’s psychologically uplifting for them to oppose it. And I think as you develop principles in life where you want to serve the needs of your community, that you can also get your satisfaction and your energy off of the positive things you see in life… Even though you work long hours, you can get some energy out of the positive things that you do in society. You know, I’m almost 60 now and so I’m not quite yet ready to give up!
