Caring for all

By Bryant Boutwell and Charles M. Balch 

The mandate was clear. The State of Texas had created a new cancer hospital in 1941 to treat all Texans, regardless of ability to pay. The emphasis was on “all.” During the hospital’s early years, Bertner and Clark focused on indigent care and those Texans less able to afford cancer treatment. Blacks and Hispanics composed the largest proportion of the new hospital’s patients. Clark was determined to provide equal opportunity care.  

The Jim Crow laws and segregation did not make his task easy. They made life difficult and unfair for Houston’s growing Black population, who largely settled in in Houston’s Third Ward, not far from MD Anderson’s temporary quarters at the old Baker estate. Keeping the hospital’s doors open to all regardless of race, gender or nationality was a priority. Not every hospital in Houston at the time could say the same. As with all challenges, Clark sought creative solutions. 

Consider the numbers. In 1940, Houston had a population of nearly 385,000. Census data shows Houston’s Black population was approaching 90,000, or about 21% of the population. Hispanics represented about 37% of the city’s population, and throughout Houston’s pre- and post-WWII years, Black and Hispanic populations increased. Like all Texans, Black and Hispanic citizens deserved the best cancer care available — yet they were most often among the least able to afford it.  

Clark’s inclusive position was described in a 1949 letter to Dr. R. O’Hara Lanier, president of the Texas State University for Negros: “We feel that it is our privilege, as well as our duty, to extend consideration to all citizens of Texas regardless of race or station in life…. We also feel that it is our responsibility to give graduate doctors and nurses of the state an opportunity to learn more about detection and treatment of cancer, and we plan to make some such instruction available to Negro doctors and nurses as well as other groups.”   

While MD Anderson had in those early days a small number of patient beds at Hermann Hospital (22) and the Houston Negro Hospital (10), most patients were treated on an outpatient basis. They were ambulatory in need of housing in the city while they returned to the hospital for treatment. For patients coming from all parts of Texas, hotels were rarely the answer, given the cost and the Jim Crow laws of the day. Compounding the patient housing problem, local hotels rarely accepted cancer patients, of any race, because of the common misconception that cancer was contagious and bad for business.   

Clark further explained in his letter: “As you know, the services of the M.D. Anderson Hospital are entirely medical, and we have no funds to provide either transportation or maintenance for a patient outside the hospital.” 

To address the need for housing for ambulatory Black and Hispanic patients, Clark went to work. There’s an old saying in public health that it’s not what health care professionals do for a community, but what they do with a community. That small distinction has big implications for long-term success, and nobody understood it better than Lee Clark. High on his 1947 list of to-dos was to find someone who could work with the community and lead the hospital’s new medical social service department. He found her in Arkansas.  

Edna Wagner, during her long, three-decade tenure at MD Anderson, became an international name in social work circles, with ample national awards to prove it. She had a heart of gold and a spirit of determination to find solutions for her cancer patients’ needs while teaching a new generation of social workers the art of serving the special needs of cancer patients and their families. She developed model training programs for physicians and nurses that, in time, became standards in cancer care circles. She also found time to address those housing needs for Black and Hispanic patients that were high on Clark’s priority list.  

 In Arkansas she had addressed polio needs among the poor. In Houston she joined Clark at the Oaks to address the cancer care needs of indigent, underserved populations. Working directly with Houston’s Black and Hispanic communities, two MD Anderson housing annexes were successfully established. Here’s how. 

Ernst Bertner had first leased that handful of beds at Houston’s Negro Hospital and Hermann Hospital in 1942. Some background is in order. The Houston Negro Hospital was built in 1926 when an earlier hospital known as the Union-Jeramiah Hospital could no longer meet needs. Civic leaders wanted a new hospital for their Black community, and oilman Joseph Cullinan (founder of Texaco) stepped up to help fund the new 50-bed hospital. The city provided 3 acres, and by 1931, the hospital added a nursing school adjacent to the hospital. In 1961, a new wing was built and the name changed to Riverside General Hospital.  

Shortly after arriving in Houston, Wagner met with the hospital’s board to explain MD Anderson’s commitment to helping all citizens and to stress the housing needs of Black patients receiving outpatient treatment at MD Anderson. The need was acute ─ with 24 Black patients in 1945, the year before Clark arrived, the number increasing to 100 his first year as director and 200 by 1949.  

Riverside General Hospital’s board agreed to convert one of its nurses’ homes into a domiciliary unit if MD Anderson would help raise funds. In 1948, Wagner and Clark teamed with community leaders bringing together 150 black churches to produce a musical drama in the Sam Houston Coliseum. 

It was a novel idea, an extravaganza production to be produced annually for three years with 1,500 singers and actors. The choir alone blended 1,000 voices, including 500 children. After months of practice, the first performance opened as a torrential Houston rainstorm doused the city. Clark sent MD Anderson employees into the streets offering free admission, with little success. Fortunately, subsequent performances were a hit, with the two shows that followed drawing 4,000 attendees. Anderson, Clayton and Company President Lamar Fleming Jr. and his wife, Clare, contributed.  Clare Fleming’s devotion to the project and community needs should not be forgotten as the Fleming gift and proceeds from the performances provided Clark $12,000 to support the new annex. The Holman Street Annex opened on Dec. 29, 1950. According to Wagner’s reports, it served over 500 patients a year with lodging and food. The annex was such a success it gained national media attention including a Time magazine story published Dec. 21, 1953.  

Likewise, Wagner and her staff worked with Houston’s Hispanic community to find a similar patient housing solution. In 1951, community leaders representing Hispanic organizations throughout the city purchased a building at 2702 Helena St. to serve MD Anderson’s Spanish-speaking patients. They named the new housing annex La Posada, which means a “place of refuge.” Dedicated members of the community, inspired by MD Anderson’s commitment to helping all in need of cancer care, raised operating funds through festive dinners, dances and even a special night’s program at the Rice Hotel’s Crystal Ballroom. La Posada allowed each patient to have a family member and interpreter. Family members cooked dishes that their patient knew and preferred over typical hospital fare. Cultural sensitivity to food mattered, and La Posada made an important difference. 

Wagner and her staff educated patients, families, communities and more. MD Anderson social workers became leaders in the nation, educating health professionals and lay public alike and helping cancer patients regardless of their race or financial status. Time magazine noted one tough question posed to Wagner by a skeptical community leader who asked, “Isn’t this program just perpetuating segregation?” Wagner, a native of Louisiana, responded the only way she knew — from her heart: “I’m not trying to solve the entire problem of the South. I’m not smart enough for that. I’m trying to help sick people.” 

Addressing fear  

Lee Clark also recognized early on that regardless of race or gender, Texans generally feared hospitals. Upon his arrival in 1946, up to 12% of patients seen at the Oaks refused treatment. In those days before antibiotics and post-World War II advancements in care, hospitals were often perceived as places where one goes to die rather than to live.  

Lee Clark suggested this was a challenge that needed immediate attention. 

“I said that if we failed to give a patient the treatment he needed, we might as well not know the best treatment,” he told historian Don Macon in 1975. “We would have failed as doctors, and as people, and as salesmen. We had to keep those people who refused to be treated, to talk to them about it and see why they wouldn’t be treated. …I said, ‘Let’s get a psychiatrist or a psychologist to come here … to find out why they refused treatment…’ I talked to all the patients for a while and just by doing that we reduced the number of people who refused treatment from 12% to 6%.” 

The first psychologist he brought did not work out, recalled Clark. “She was scared to death. She was just paralyzed. …She would get up and wash her hands every time she got close to patients…We gave up on her in about three months.” 

His second psychologist, a doctoral student from UT Austin named Beatrix Z. Cobb (known as BZ), was just the ticket. She established an advisory council of MD Anderson physicians, UT Austin psychologists and representatives of the Hogg Foundation for Mental Health. She brought in grant funding, designed patient surveys, created lecture series and generated national attention. Her presentation at an April 1953 American Cancer Society conference of science writers put a spotlight on MD Anderson’s groundbreaking work. 

James Olsen wrote in The Houston Review: “Beatrix Cobb’s career shot up like a bottle rocket on the Fourth of July.  …Prominent psychologists trekked to Houston to meet her and the American Cancer Society and National Cancer Institute took notice.” 

Admittedly, Clark noted, a number of faculty had a hard time with Cobb’s often brash manner and ego, but her pioneering work could not be denied. Within seven years Texas Tech recruited her to Lubbock as a full professor.  

“She did a lot of basic background work from 1950 to 1958,” Clark said during his Macon interview. “She did a fine job and I might say that right now we’re trying to revive this very program. We were sorry to see her go.”   

In the early 1990s, Clark’s successor, Dr. Charles LeMaistre, created MD Anderson’s Division of Cancer Prevention. Clark, always the educator, had had prevention on his mind from the day he took the job. He understood behavioral medicine drove not only early detection but also compliance and positive treatment outcomes as well.  

Clark cared about every patient and saw to their needs even in an era defined by segregation and Jim Crow laws. If he had to be creative and swim against the tide in the interest of patient needs, so be it. He set a standard for Making Cancer History® by giving each and every patient the very best care. That defined MD Anderson then and continues to do so now. 

Next article: A Lee Clark history lesson