Advocates for children

Advocates for children

The autumn of life

By Judith Asch-Goodkin

From the migrant camps of New York and California to thecommunity health centers that serve New England's rural poor, this pediatrician'slife of service has been a grand adventure. And it's not over yet.

"Advocates for children" is an occasional series highlightingthe accomplishments of pediatricians who have given extraordinary amountsof time, talent, and energy to the betterment of children's lives.

John Radebaugh, MD, is in his mid-70s, in what he describes as "theautumn of a life that is far from over." He stopped practicing medicinefive years ago, when the lack of malpractice insurance forced him out ofhis volunteer position at the Good Neighbor Health Center, a free clinicin White River Junction, VT. He still serves as a preceptor in a coursefor second year students at Dartmouth Medical School called Problem BasedLearning.

He and his wife Dotty have "entwined lives," he says: "Dottythe anchor and I the visionary, each dependent on the other." They'veanchored in many different places over the years, but their present homeis in Norwich, Vermont--a house with a serene view across a valley to theNew Hampshire mountains. The gardens (his vegetables, her flowers) are putto bed at this time of year, covered with a blanket of compost from a lovinglytended compost bin. ("We have a neighbor who keeps donkeys, and hegives us the manure.") Dr. Radebaugh gave up playing ice hockey withThe Slapsticks ("a bunch of derelicts like me") when his heartstarted beating erratically during a game a few years ago, but a pacemakerhas kept him in good shape since then. He has more time now, for a fly-tyinghobby, for playing the harmonica and singing in a senior chorus. Time, too,for looking back over an extraordinary life as a physician for whom thepoor and the dispossessed have always been the central concern.

The driving forces

When John Radebaugh tries to define what it is about medicine that ledhim to enlist in so many causes, he's likely to reach for a volume by doctor-poetWilliam Carlos Williams, MD. Williams practiced pediatrics and family medicineamong poor immigrant families in Paterson, NJ, in the bleak years of theDepression, and wrote in his autobiography that the "actual callingon people, at all times and under all conditions, the coming to grips withthe intimate conditions of their lives" was the source of his poeticinspiration. Radebaugh, too, has come to grips with the lives of the poor.

A man's heroes tell you a great deal about his inner life. Most of Radebaugh'sare doctors:

* Robert Coles, MD, the psychiatrist and writer who coaxed black schoolchildren in the thick of the battle for school integration to tell him theirremarkable stories. Dr. Coles is an old friend and colleague.

* Robert Haggerty, MD, Dr. Radebaugh's chairman at the University ofRochester, who "turned the medical school outward to the community"and allowed his faculty to spend some of their time providing care for themigrant workers who came to pick apples, cherries, and cabbages in upstateNew York

* Nobel Peace Prize winner Albert Schweitzer, MD, about whom Dr. Radebaughsays, "I read about him extensively and wished to emulate his work,if at all possible, in my lesser career."

* Dr. Radebaugh's grandfather, a Congregational minister who visitedhis parishioners in their homes, listened to their troubles, and sharedtheir poverty. For more about Dr. Radebaugh's early years, see "Roots"(below).

* Cesar Chavez, founder of the United Farm Workers (UFW), whose cause(La Causa) Dr. Radebaugh joined in 1973, for what he still regards as "themost meaningful, challenging period of my life."

Discovering a calling: The Rochester years

Like William Carlos Williams, John Radebaugh has never been comfortablewith "a money practice." Still, a better income was what he wasafter when he and Dotty left his pediatric residency at Massachusetts Generalfor the more lucrative prospects of private practice in Bangor, ME. Theyhad three children by then, and a resident's salary just didn't cut it.

The fees Bangor patients could pay were low; $3 for an office visit,$5 for a house call. Some patients couldn't afford to return for a follow-upvisit, and then Dr. Radebaugh might just find himself in the neighborhoodand drop by, making no charge, to check up on the child's progress. Volunteerwork at the nearby Penobscot Indian reservation and in the local crippledchildren's clinic didn't make up the slack. The Radebaughs found themselvesnot much better off than they'd been in Boston.

So when, after three years in Bangor, the offer of a spot in a three-personpediatric practice in Rochester, NY, came along, Dr.Radebaugh accepted.He found the challenges of private practice appealing, but worried aboutpatients who had to be referred to university clinics because they couldn'tafford the practice's fees. The years in practice, later followed by a full-timefaculty position at the University of Rochester School of Medicine, provideda hiatus in which John and his wife were able to bring up their childrenin a secure, middle-class lifestyle.

But the times they were a changin', as the song goes. Dr. Radebaugh recallsthe 1960s as a time for "reevaluation of one's relationship to socialchange and inequalities of race." A black faculty colleague named NaomiChamberlain, an activist with what Radebaugh describes as "a finelytuned social conscience," took several members of their departmentto see migrant farm workers' camps in a nearby rural county. The workerswere brought to New York from rural Florida by crew bosses each year. Conditionswere appalling: families living in filthy shacks, outhouses overflowingwith human waste, one big, cement-floored shower, one faucet for drinkingwater, pitifully low wages eaten up by charges for rent and food until aweekly take-home check could be as miserly as 20 cents. "It was gettingto be fall the first time I visited a migrant camp," Dr. Radebaughrecalls, "and it was cold; there wasn't any heat."

Within a few weeks, under Chamberlain's tutelage, Radebaugh and somecolleagues recruited volunteers from the medical school and set up a clinicin donated space on the Martin farm in the town of Brockport. Sheets hangingfrom wires divided the space into cubicles; medical students, supervisedby Dr. Radebaugh and other faculty members, volunteered to see patientsthere in the evenings.

Setting up the Brockport clinic gave Dr. Radebaugh his first lessonsin how to create public sympathy and use political influence. He and othersinvolved in the project sought the cooperation of the Surgeon General, WilliamStewart,MD, producing a gruesome slide show they projected for Stewart on the backwall of a bar. They convinced State Senator Arthur Hardwick, Jr., to usethe conditions at the camps as an issue to galvanize his black constituentsin Buffalo, and arranged for Senators Robert Kennedy and Jacob Javits tovisit the camps. The eventual upshot of these efforts was the passage ofthe federal Migrant Health Act and a $37,000 grant for the Brockport clinic.It's still in operation there, as a federally funded community health center.

Brockport had another lesson to teach: when you challenge the local powerstructure, you have to be prepared to defend yourself. In a pattern Radebaughwould see repeated throughout his career, local physicians joined farm ownersin a campaign to have clinic physicians dismissed from the medical schoolfaculty. This time, Dr. Haggerty intervened, moving the program where Radebaughtaught into the Department of Pediatrics, under his protection.

Digging deeper into issues the Brockport experience raised, Radebaughwent to hear Cesar Chavez speak about the UFW and the national boycott oftable grapes the union was promoting. He went to Connecticut, to see forhimself the condition of migrant workers on the tobacco farms, and to Florida,to learn what drove farm workers there to seek employment on farms in NewYork. He traveled to California, to consult with Chavez and United AutoWorkers' President Walter Reuther, where he seriously pondered an invitationfrom Chavez to work with the UFW. But he was not yet ready to move his familyfrom Rochester and become immersed in a radically different environment.

California: Enlisting in La Causa

In time, Chavez' invitation to join his movement would prove irresistible.But Radebaugh's first stop in California was Brawley, where the successof a proposal for a federallyfunded migrant health center brought him anoffer of a staff position. Brawley is a metropolis of 15,000 or so, setdown in the searing heat of the Imperial Valley. There's a bar on almostevery corner, and the city is surrounded by feed lots where cattle are fattened--asight (and smell) so revolting to Radebaugh's daughter Susan, who was 16when the family arrived in Brawley, that she became an instant vegetarian.

With amazing swiftness, Radebaugh was embroiled in the same sort of uproarhe'd lived through in New York: accusations from growers that their workerswere contented until those radicals at the clinic arrived, and attemptsby local physicians to shut the clinic doctors out of privileges at thelocal hospital. Three of the physicians brought suit to have the clinic'sfunds cut off, but lost their case in a San Diego court.

Despite the opposition, Clinica de Salubridad de Campesinos opened andflourished. Most of the patients were farm workers, and Cesar Chavez cameby from time to time--to sign diplomas at graduation ceremonies for communityhealth workers, to round up support for ongoing boycotts and strikes, totry to convince John Radebaugh that what the workers really needed wasn'ta federally funded clinic but one they funded and ran themselves. One ofRadebaugh's most vivid memories of this time is the stark contrast betweenthe dignity of UFW members he worked with in California and the totallyintimidated and defeated migrant workers from Florida he had known in NewYork.

If, like Radebaugh, you enjoyed practicing medicine with migrant farmworkers, had felt the charismatic pull Chavez could exert, and were askedby Chavez for the third time to join La Causa, could you resist? John Radebaughcertainly could not. So he exchanged his job at Clinica de Salubridad fora staff position at a clinic the UFW was opening in Sanger, CA, 400 milesnorth of Brawley. The space was rented from the Electrical Workers' Union.Funding came from the Robert F. Kennedy Farm Workers' Medical Plan, supportedby a 10 cents/ hour/worker payroll levy built into the union's contractswith growers. The Sanger clinic, in line with UFW values, was self-sufficient,run by the workers and for the workers. It was located near the farms whereUFW members lived and worked and stayed open in the evenings so workerscould come by without losing pay. Lay familyhealth workers, as well acquaintedwith traditional folk remedies as with scientific medicine, helped providepreventive and clinical services.

The money from the employers' fund didn't go very far; it stretched toa salary of $15 a week for JR, $10 for Dotty to keep medical records, plussome subsistence for food and shelter. The union expected sacrifice; Chavezbelieved that sacrifice was an inherent aspect of the non-violent strugglefor workers' rights. Complaints got little sympathy. The Radebaughs hada tiny apartment, where they often put up union organizers and strike leaders.Their car was falling apart. Clinic days were long, and staffers were expectedto join marches and demonstrations and provide care for strikers and boycottleaders in jail. Dr. Radebaugh wound up in jail himself once, after a demonstrationat which American Friends Service Committee members tried to get farm workersto leave the fields. He was attacked by a sheriff when he tried to intervenein an altercation with a young farm worker, and he fought back. Chavez refusedto bail him out, because he had transgressed the principle of nonviolence.Chavez was a disciple of Gandhi, and insisted that all UFW workers and volunteersemulate the Indian leader's nonviolent principles. Court proceedings inthe case dragged on for a year, but the charges were eventually dropped.

Dr. Radebough described the Sanger clinic in a 1976 article in the NewEngland Journal of Medicine. The great strength of the clinic, he wrote,was the ability to bridge the cultural gap between middle-class health-careproviders and poor, Hispanic consumers. Services were provided where andwhen they were most needed. Clinic personnel were--or soon became--bilingual.The union was able to compel growers to fund the health plan and to improveliving and working conditions. But, he also pointed out, the system hadmajor drawbacks. Poverty-level salaries and long hours demoralized and exhaustedthe staff, endless meetings sapped time and energy, union goals took priorityover medical decisions. Turnover was high.

What this meant in human terms was that when Dotty was being treatedfor breast cancer and stopped working, the Radebaughs couldn't pay theirbills. When they consulted Chavez, he suggested they go on welfare. It hadn'thelped Radebaugh's standing with the union to air his doubts publicly inthe New England Journal article, even if those doubts were mingled withmuch heartfelt praise.

So after three incredible years, physically and emotionally worn out,Dr. Radebaugh resigned. He didn't see Chavez again for 20 years, when Chavezspoke before a student group at Dartmouth and the two had a warm reunion.Dr. Radebaugh drove with Chavez to the Boston airport, playing union songson his harmonica to help Chavez relax. They never met again; Chavez diedunexpectedly ten days later, in the midst of a trial where he was expectedto testify in a suit brought by growers against the union. "The countrylost a charismatic leader who changed the lives of many workers," Radebaughsays, "and even the lives of volunteers like the two of us, for thebetter."

After La Causa

In the years after Sanger, John and Dotty became migrants themselves.They traversed the West, with stops at:
*Woodburn, OR, a federally funded migrant workers' clinic that lost itsfunding six months after the Radebaughs arrived

* Pueblo, CO, a neighborhood health center where there were familiarrun-ins with the local medical society, which tried to deny hospital privilegesto clinic doctors

* Greeley, CO, another place of feed lots and migrant camps, where Dr.Radebaugh's humane pace seemed inefficient to a market-oriented board ofdirectors, and hewas fired

* San Jose, CA, a staff position at a large, community-controlled clinicwith ties to Stanford University School of Medicine.

And then finally, a return to academic medicine, first in the familypractice program at Stanford and then back at Dartmouth, where Dr. Radebaughshared what he knows about community medicine with medical students assignedto practices in southern New Hampshire and Vermont.

One of those practices was in a remote town of Warren, NH, where Dr.Radebaugh put in three days a week at the Mount Moosilaukee Community HealthCenter. At Moosilaukee, he enlisted elderly patients as volunteers (theycalled themselves the Moosekiteers) to visit their neighbors and convincethese proudly independent New England farmers to use the services the clinicoffered. "The Moosilaukee clinic was what family medicine really shouldbe,"
he says.

Autumn

Some physicians mightnot know what to do with themselves when a 45-yearmedical career came to an end. John Radebaugh doesn't have that problem.Still a political activist, he campaigns vigorously for Bernie Sanders,Vermont's maverick socialist Congressman, every two years. He is much involvedin the work of the American Friends Service Committee and projects of hislocal Friends' meeting. But the overarching vision that propels this phaseof his life is of a world free of nuclear armaments. Most of last summerwas spent helping to organize the 91-mile Vermont Walk for Nuclear Abolition,part of a campaign to press the US government to negotiate treaties thatwould eliminate nuclear weapons throughout the world. He's also much occupiedthese days with a citizens' campaign to help pay the delinquent dues theUS owes the United Nations. The project, Fund the United Nations Deficit(FUND), is a grass roots effort to catalyze Congress to honor its long overduedebt to theUN.Readers who are moved to do so can send contributions--$2per person--to FUND at PO Box 865, Hanover, NH, 03755-0865. The life isfar from over.

By Judith Asch-Goodkin
THE AUTHOR is a senior editor on Contemporary Pediatrics.