Dr. Shirley was the first black doctor to do his residency at the University of Mississippi Medical Center. For a decade, he worked at the Delta Health Center in Mound Bayou, which was one of the only hospitals in Mississippi where black people could go. He was trailed by the State Sovereignty Commission, which began spying on black people shortly after Brown v. Board of Education, and in 1964 he went to Atlantic City with the Mississippi Freedom Democratic Party to challenge the Democratic Party to recognize black candidates. He did things that don’t end up in history books, too, such as build wells for poor black people when they didn’t have clean drinking water; travel throughout rural areas to treat malnourished babies; fight for federally qualified health centers and welfare rights and Medicaid. He was, by all accounts, a take-no-shit kind of guy. “When Aaron was doing his residency, he was the only black resident, and one day a black soldier came in with a head injury,” said Dr. Jack Geiger, who worked with Shirley. “He was sitting in a back room, and the doctor’s attitude was ‘Oh, just another drunk nigger,’ you know, we’ll just leave him back there. Well, Aaron heard this and walked right out and called the Pentagon. And soon enough there was a general or a colonel or whatever he was standing in the emergency room, demanding to know what was going on with his soldier. That’s Aaron.”
When I visited him, Dr. Shirley was working at the Jackson Medical Mall, his name emblazoned on a wall inside the building. For decades, the Mall was an actual mall, with a JCPenney and a Gayfers, but the mall and the area around it began to depreciate as whites fled integration for whiter, suburban areas such as Brandon and Madison and Pearl. Historic downtown Jackson emptied out altogether, and Capitol Street, the bustling avenue that Medgar Evers boycotted in 1962, looked shuttered and ghosty, a Lott Furniture collecting dust on its desks. Entire industrial mills, warehouses, and office buildings had been abandoned just minutes from the capitol building, and it was hard not to be embarrassed by the naked deterioration of this American city, as if seeing a guy who’d accidentally left the house without his pants on. The Mall was just five minutes from downtown and business was ailing, so Dr. Shirley and others decided to buy it and turn it into the kind of place they knew would generate business among poor black people for quite some time: a health care mall for the sick.
Dr. Shirley, then seventy-nine years old, had observed for the last two decades a dispiriting development. The millions of dollars that poured into Mississippi every year—federal funds, Kellogg grants—had disappeared into wells of political and economic dysfunction. In fact, he said, in order to remind his guests that none of these problems would necessarily be fixed by the election of a black president, Dr. Shirley hung a COLORED sign above the doorframe of the entrance to one of his office rooms, which you had to walk under on your way to his bathroom. The implication was that Obama’s historic election wasn’t enough to transform people’s circumstances. Dr. Shirley had gray curly hair and a sad face, but he laughed when he talked about the other signs he made, including DON’T NEED NO TEA PARTY, MISSISSIPPI ALREADY HAS A KLAN and YOU CAN BE A CHRISTIAN AND A COWARD TOO and MUSLIMS DIDN’T ENSLAVE MY ANCESTORS, SO-CALLED CHRISTIANS DID.
“Look, Head Start was also once treated like a Communist conspiracy,” he told me one day, “like they’re doing with Obamacare. The anger against Obama reminds me of the reactions to JFK. When Kennedy was shot the white elementary and middle school children cheered. And you call yourself a Christian? It’s the same attitude. They don’t say it’s because he’s black, but you just listen to the rhetoric. Ninety percent of the whites in Mississippi, if it were Obama versus Sarah Palin, they will vote for Sarah Palin. I mean, this woman is dumb, this man is not! He’s got a family, he’s never been divorced! He represents all the values you cry about! And you’ll vote for Gingrich!
“I’m proud of Obama,” he continued. “But when he was trying to accommodate the Republicans, I became anxious and thought, When is he going to recognize that you can’t.”
Dr. Shirley had more reason for conveying his sympathy for Islam ever since 2009, when he heard about Iran’s rural health care model and realized it might be transplanted to Mississippi. He had worked outside of the system his entire life. He didn’t share the assumptions of American exceptionalism that many others did; namely, that the most advanced nation in the world didn’t take tips from poor countries, never mind a poorer country whose leaders regularly challenged American power. He did not think the American system, as it existed, could produce real change in people’s lives.
“I’ve been coming here for forty years,” he said one day after a trip to the Mississippi Delta, “and nothing has changed.”
Mississippi was the poorest state in the nation. A Mississippi black man’s life expectancy was lower than the average man’s expectancy was in 1960. Sixty-nine percent of adult Mississippians were obese and a quarter of households didn’t have access to decent, healthy food, so Mississippians were dying from diabetes, hypertension, congestive heart failure, asthma, and chronic obstructive pulmonary disease. It was common to hear a sick person offhandedly mention that their thirty-nine-year-old cousin just had a stroke, or their thirty-two-year-old diabetic sister just lost a toe. In the 1960s people starved; now they died from cheap, terrible food.
The South was also the epicenter of the HIV epidemic in the United States, and Mississippi had one of the highest HIV acquisition rates of all. African Americans in Mississippi were dying from AIDS at a rate 60 percent higher than the nation’s average. In the Delta, which stretches north and west of Jackson like a diamond, AIDS was a full-blown but silent crisis. Waiters got fired because restaurant owners didn’t want them handling food; dentists refused to serve patients with HIV. Half of HIV-positive Mississippians didn’t seek or receive treatment, because the vast majority of the people didn’t have health insurance. Forty percent of the people in the Delta were illiterate. Often, people didn’t even understand the words the doctors were using when they treated them.
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ONE APRIL MORNING, I accompanied one of Dr. Shirley’s nurses, Claudia Cox, who was driving far from Jackson’s empty downtown to visit a patient named Vonda Wells. “The rural people are the worst,” she said. “‘Come to the oak tree.’ Well, hell, I’m from the city, I don’t know what no oak tree is. I know magnolia. I know pine trees.” Cox referred to her seven-year-old Ford Freestyle as her “office,” but it had the ambience of a video arcade: the petulant ding-ding-ding of her unused seat belt, the whir of a phone charger stuck in the cigarette lighter, a Galaxy S that rang with the opening of Cheryl Lynn’s disco hit “Got to Be Real.” Cox, a forty-five-year-old divorced mother of three, juggled phone calls and patients’ charts and cigarettes like some serene octopus, always catching the steering wheel just before the truck veered onto the grass. After twenty minutes, she pulled into a pebbly country driveway to suss out why Vonda Wells kept returning to the emergency room.
Ms. Wells’s large figure filled the doorframe of the tiny old house. She was jovial despite the oxygen tubes running from her nose. “Is that yours?!” Cox exclaimed, pointing to the baby in Wells’s arms. “That’s my grandbaby!” Wells laughed and passed off the child to a teenager who disappeared behind a closed door. The two women sat down in a dark, damp living room crammed with couches.