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The evolving role of SBAS – We’re getting in but we’re not going on

2020; Elsevier BV; Volume: 219; Issue: 4 Linguagem: Inglês

10.1016/j.amjsurg.2020.01.029

1879-1883

Malcolm V. Brock,

Nursing Education, Practice, and Leadership

It has been my distinct pleasure to serve as your President over this past year. The salient tradition of a SBAS Presidency has been to leave the organization just a little better than when inaugurated, and to make some lasting contribution. It has been truly a group effort. I have had help from a great many people this year especially the tireless work of the central office. Lovie Brown and Molly Britain – would you stand please. I received tremendous support from many officers on the Executive Committee such as Drs. Pugh, Karpeh, and Stewart who were on fast dial, the selflessness of so many of the past Presidents who gave so freely of their time (immediate Past President Dr. Stallion called me every two weeks to discuss strategy maintaining a tradition that Past President Turner gave him; Past Presidents Vickers, Higgins, Cornwell, Kirton and Stain started giving me high-octane advice and constant advocacy even before my Presidency started), our Executive Director who made it always clear that he would be a text away and he was, our historian, Dr. Fred Cason who gave me constant air cover so that I could take the risks that this position demands, Committee Chairs and Committee members who did a lot of the yeoman work, and most importantly, you the members of SBAS who have been energetic and vocal with suggestions, praises, and of course, like all vibrant organizations, with criticisms. I want to acknowledge the support and tolerance of family, especially the love of my wife of 30 years, Ronae, my parents who gave love and guidance, my two sisters – Arlene and Michelle, and niece, Tsilala, all who are in the audience as well as our three children – Maquira, Meleina, and Mayalen. Children truly do enrich one’s life, and as everyone in this organization is a testament, giving them a solid education is a solemn responsibility of every parent. When our oldest child, Maquira, was born, we found an elementary school with a great reputation in Baltimore but we didn’t have much money and we were living quite a distance away “on the proverbial wrong side of the tracks”. The school gave a “ride sharing” handout to all new families so that you could contact those who lived nearby and carpool. Even on the other side of the tracks, there was one family close by. So, that first year Rebecca and Maquira often car-pooled to school and here is a photo of them at the end of that first year. Even though Rebecca and her family were living near us well away from the best neighborhoods of Baltimore, Rebecca’s family had been in Baltimore for generations, and in fact, her great, great grandfather was rather famous around town, as well as in all American surgery, as he was JMT Finney, the first President of the American College of Surgeons. In Chicago, IL, on November 13, 1913, Dr. JMT Finney found himself during his Presidency presiding over a particular contentious meeting of the Board of Reagents. It was the last meeting to discuss the admission of candidates to the very first class of Fellows for the American College of Surgeons, during which the name of the first woman Florence West Duckering MD from New England Deaconess was read and confirmed, along with Dr. Daniel Halle Williams. Dr. Williams was on the staff of St. Luke’s Hospital and highly regarded by all who had observed him in the operating room. He was born in 1856 in Hollidaysberg, Pennsylvania in a free negro family but had to move to Baltimore, MD and discontinue his schooling after his father died when Daniel was just ten years old. He was apprenticed to a cobbler but left after two years of “pushing needles through smelly hides” and persuaded a rail man to give him a pass to go west to find his mother who was then living in Rockford, IL. His mother later remarked, “anyone with so much spunk could easily take care of himself.” By 17 years old, he was running his own barbershop in Edgerton Wisconsin, and through numerous coincidences and connections through customers, he eventually met and convinced Dr. Henry Palmer, a prominent, highly skilled surgeon and ex-major to take him on as an apprentice. Williams then went on to study at the prestigious Chicago Medical School where he graduated in 1883. On January 23, 1891, using his position on the Illinois State Board of Health and connections to philanthropists, he founded the Provident Hospital and Training School Association to fulfill a need for a place where young black nurses could train. His operative skills became widely known and, on July 9, 1893 when a young black expressman, James Cornish, was stabbed in a saloon not far from Provident hospital, Dr. Williams, against the medical opinion of the day, made the decision to explore the chest, and alleviate what was undoubtedly a cardiac tamponade. Mr. Cornish outlived his surgeon dying 50 years later in 1943. At that Board of Reagent Meeting as the names of the initiates were read out Dr. William Haggard, a Regent from Nashville TN, interrupted the meeting to discuss Dr. Daniel Halle Williams who had been recommended by Dr. Albert J. Oschner from Chicago (Slides projected show the original documentation of the Thursday, November 13, 1913 Board of Regents Meeting minutes from the ACS Archives courtesy of Archivist Meghan Kennedy). Dr. Haggard: Does the American College of Surgeons take in negroes? I notice the name of Daniel H. Williams on the list and understand that he is a colored man. Dr. Ochsner: We recommended him because everybody respects him. He is a first classman in every respect. I think that if a negro makes good scientifically, and is ethical in every way, we have no business to debar him. Dr. Haggard: It is a new thing in this country absolutely. Dr. Cotton (orthopedic surgeon from Harvard): How are we going to straighten it out? Dr. Haggard: There will be an enormous number of negroes who will apply for membership in the College. Dr. Ochsner: That does not make any difference. Dr. Finney as Chair: I appreciate the objection raised by Dr. Haggard. Every tub must stand on its own bottom, but I do believe we should rise above everything except the consideration of professional fitness for Fellowship in this College. Personally, I do not believe we really ought to consider that. I may be wrong, but I want to go on record to that effect. Dr. Cotton: May I speak to this question?... the number of Negroes who would be competent to become Fellows of this College is so small that we are throwing away a good deal to get a little. Dr. Haggard: You will be surprised at the notoriety that will be taken of this. It will be heralded all through the newspapers that this Negro has been elected a Fellow of the American College of Surgeons, and a great deal of advantage will be taken of it in our section of the country…when we take a man of this race at this time in our history into an association of this sort, it seems to me, brings a long train of evils which, at the present time, cannot be cured. I do not see any reason for it and there are a great many reasons against admitting such a man to Fellowship. It is a serious question where we live. Take Mississippi, where there are twelve negroes to one white man, and all through the South, we cannot give these people social recognition, and there is no gainsaying this, that while this is scientific recognition, it is more than that. I feel very strongly about it, and there is no reason why we should take in colored men at the present time. Personally, I am strongly opposed to it.” Dr. Ochsner then exhibited what today we refer to as “sponsorship” or advocating for someone even when they are not in the room to defend themselves and doing so at one’s own detriment. Dr. Ochsner threatens to resign twice: Dr. Ochsner: I will resign from this College at once if this man is not accepted. He is absolutely straight. Dr. Haggard: I never saw the man. I submit the question to you gentlemen. There is a principle involved here. Dr. Finney then asks if this should be considered now or later and another Regent suggests postponing the vote on Williams. Dr. Ochsner: I shall resign instantly if that is done. He is an absolutely square man, and there is no better man in this or any other association. I shall be proud to have him as one of our members. As we read this discussion, Dr. Drew’s words start to ring in our ears, “Excellence in performance will eclipse any artificial barriers imposed by man”, and after more back and forth, Dr. Williams was secured in the first class of 1059 Fellows of the American College of Surgeons in 1913. But, between 1913 and the next Black Initiate, there was a long pause of over 20 years before a name was even brought before the Board of Regents for consideration as a Fellow. This was not due to the lack of African American surgeons trying to submit their names for membership. Most were blocked at the state level, such as Dr. William A. Warfield from Washington DC, who applied in 1914 but was rejected by the state credentialing committee because he was colored. Finally, Dr. Louis Wright was actually approved by his state board of New York, and in 1935, his name came up for a vote in the Board of Regents Meeting. Dr. Franklin Martin who is widely recognized as the single most responsible person in the establishment of the American College of Surgeons and its first Director-General remarked as he presented Dr. Wright, “…we knew (when we received his name from the state) he was a negro and we tried to find every reason why he shouldn’t be admitted. I will admit that. But we could find no flaw anywhere.” As with the previous nomination of Dr. Williams, as Regents from the southern states poised to rebel, a sponsor who knew Dr. Wright made an impassioned stand. Dr. John Jennings of New York: “I know this man, and I know his reputation. He is considered one of the most brilliant surgeons of the city. His work has been striking and remarkable. His chest work and work on blood vessels has been considered outstanding. I consider him as a man representing in the highest way the ideals of the College among his own people. I think it would be too bad to turn him down.” Dr. Martin: “I move that the resolution be adopted.” Again, the SBAS motto rings true, “Excellence of performance will transcend artificial barriers created by man.” Contrary to earlier thoughts in the College leadership that there were only a few Black surgeons qualified to apply for Fellowship in the College, the requests for membership in the nation’s premier surgical society kept coming furiously from innumerous Black surgeons including those in the military. After Dr. Martin’s death in 1935, Dr. Bowman Crowell became Co-Director of the ACS and handled these application requests. In a Board of Regents meeting in 1940, the record reads, “Dr. Crowell presented a subject which has been before the Board previously – applications for fellowships from members of the colored race. These are applicants who from all professional standpoints are well qualified for fellowship in the College. Dr. Crowell said that he had talked very frankly with a number of these men and they have been very courteous about postponement of consideration of their applications. It is becoming increasingly difficult to continue excuses for postponement, and it is brought to the attention of the Board for instructions…” In this barrage of letter writing from all quarters about qualified Black surgeons who should be admitted to the College, the name of our Society’s own namesake, Dr. Charles Drew appears, with various sponsors asking for clarification about his application. Charles L. Scudder wrote to Dr. Crowell on November 5, 1943, “Perhaps you would give me a little more definite idea of the existing reasons for not approaching Dr. Drew at this time in the membership of the A.C.S. I expect to attend his surgical clinic at Howard and I should like to be able intelligently to avoid embarrassing conditions. I will swear to absolute secrecy and will destroy your letter.” Three days later, Dr. Crowell responded quite frankly, “Dr. Drew’s embarrassment at present is purely one of color. Our Regents at the present time will not admit colored surgeons. We have a large group of Fellows in the South who have yet not come around to it. That is all that I can say now, and I am sure you will have a good time at Dr. Drew’s clinic and find him in every way an able surgeon.” It is interesting that we have this letter today. Apparently, Dr. Scudder did not destroy it as he had promised. One year later, the pressure to act had become palpable with threats of exposure in the news media. Dr. Wright, as the only Black Surgeon member, actually wrote a scathing editorial in the New York edition of the Pittsburgh Courier, “…Many doctors, white and black, fail to see any justification for prejudice on the part of the greatest fraternity of surgeons in the world. I am firmly convinced that the college has a large number of members who are ashamed of this injustice to competent fellow surgeons and would welcome its immediate correction. It is not in accordance with the change in American and world opinion and is harmful to the health of the American people, also to the morale of millions of our soldiers. As a fellow of the American College of Surgeons, I take this time to protest this attitude which is un-American in spirit and fact. The removal of this racial ban on the part of the American College of Surgeons would go a long way to causing the colored doctor to think that the majority of his white professional brothers believes in democracy, and that racial distinctions cannot be justified in the art and science of surgery.” Shortly thereafter, the results of a survey of all members of the ACS confirmed Dr. Wright’s beliefs, and quietly, black surgeons’ requests for membership became to be approved. This included the first African American woman approved by the Board of Regents in 1950, Dr. Helen Octavia Dickens, who spent an illustrious career as a Professor of Surgery at the University of Pennsylvania from 1965 to 1985. Dr. Drew was also approved for admission at the ACS convocation in 1950, and then in a rare gesture, posthumously in 1951 by the Board of Regents itself. A mere thirty-odd years later, our society, SBAS, was founded, born out of this long history of resilience of black surgeons confronting barriers to entry to American Surgery. Our co-founder, Dr. Claude Organ, was well aware of this history, and in fact, in the early spring of 1987, just months before the infamous October Marriott hotel room first “brainstorming” meeting where the idea of SBAS was conceived, he published, “A Century of Black Surgeons” which chronicles much of the history that I’ve reviewed today. We will never fully know, but some of his thoughts about the necessity of an organization like SBAS must have been formulated during those long, hard hours writing his two volume history. My mentor, the late Dr. Levi Watkins who spent his entire career at Johns Hopkins, early in his tenure worked tirelessly to increase the number of black medical students and residents at our institution. Here is his copy of Dr. Claude Organ’s book dated April 10, 1987 just before SBAS began, and this book has been handed down to me (I held it up), a testament that no-one in this room is too far from this history. But the ACS has evolved and in the three years before Dr. Watkins untimely death in 2015, approximately 6% of ACS inductees were African Americans. As our Executive Director and past president, LD Britt, who became the first African American chair of the Board of Regents, has remarked, “The evolution of the American College of Surgeons, the world’s largest organization for surgeons, and its growing partnership with the Society of Black Academic Surgeons needs to be recognized, underscored, and continually enhanced.” Another of the co-founding members and past President of SBAS, Dr. Eddie Hoover, commented, “The hero of academic African American surgeons, Dr. Charles Drew, adorns the shield of SBAS as much for his defiance of ACS for refusing to accept other well-qualified African American surgeons in the 1940s as for his scientific contributions…(But) With strong ACS support, SBAS has been stunningly successful over the past 27 years...” Despite these achievements of SBAS during our first 30 years, a couple of months before his death, Dr. Watkins told me how concerned he was that so few African American surgeons were progressing up the academic ladder to professor. In vintage Levi he said, “We’re getting in, but we’re not going on”. The data support these assertions. Our Executive Director along with SBAS member Dr. Paris Butler pointed out the deficit in numbers in tenured black surgical professors highlighting that majority whites comprised about 86% of these positions. Although SBAS has undoubtedly had successes since 1987, with over a dozen chairs and 5 deans in majority schools, there is still room for SBAS to grow in its vision and leverage its influence to become a clearinghouse for division chiefs and department chairs. For example, as women chairs have proliferated, most have been majority women with no African Americans. This year under the leadership of the Chair of the SBAS Women in Surgery Committee, Dr. Cherisse Berry and the Association of Woman’s Surgery President, Dr. Sareh Parangi, an exciting collaboration has begun, focused on diversity and inclusion of women in surgical leadership. This includes a proposal to sponsor an AWS-SBAS visiting professorship for SBAS mid-career women to give them exposure to leading majority institutions across the country. Just last summer, Past President Higgins, as Director of the SBAS Leadership and Faculty Development Institute, pitched an innovative idea to the American Surgical Association (ASA) - the establishment of a shadowing experience for SBAS mid-career members with department chairs, Center Directors, Deans, CEOs or equivalent. This year working with SAAS, AWS, and the SUS, and with the support of ASA President, Dr Christopher Ellison, these four organizations collaborated to share the limited time and resources of ASA leaders by forming a joint ASA Surgical leadership Fellowship in which Associate or Professor members will visit two academic institutions for experiential leadership mentoring for one week each. The Fellowship was unanimously approved by the ASA Council on April 10, 2019. During the even years of the fellowship beginning in 2020, the AWS and SAAS will each submit three names to the ASA Council. For the odd years of the fellowship, beginning in 2021, SBAS and SUS will each submit three names. As we grow and increase these collaborations, SBAS will be expected to share in the cost and carry its own weight. Without funding, there is no mission. This year, we started the SBAS Foundation and I am proud to say that we received $110,000 in pledges including 100% commitment from all of our Past Presidents. This foundation will have a renewed focus on mid-career SBAS members and help to pay for some of our collaborative leadership opportunities. Other organizations, such as the AWS, have utilized their Foundation over the years in this way, and as we have seen, have been tremendously successful in promoting leaders. Our recent growth in the last 2–3 years, has also this year highlighted our need to supplement our existing partnerships with academic institutions by embracing new long-term partnerships with Industry. This year we have a host of industry partners who are supporting SBAS. But, they are not interested in just a one off sponsoring of a single meeting, but instead a long-term partnership which would be mutually beneficial to both parties. They spoke to us about setting up travel bursaries, research scholarships, and awards while they would like to harness the “energy in the room “and engage the significant brain trust of SBAS members about value-based medicine especially as it pertains to the health of the minority community. As we continue to grow and evolve, I encourage all of us to remember the lessons of our resilient history especially the one that says that any ascendance to leadership must first be built on a foundation of academic excellence, and only then (as we saw in the Board of Regents meeting about 100 years ago) can active sponsorship really be effective. The year 2019 marks 30 years since our inaugural conference at Duke University in 1989. The mentorship and sponsorship of SBAS remains relevant, our annual meeting continues to be vibrant with new workshop offerings, and our organization has proven nimble. Moreover, SBAS is up to the challenge of serving the needs of our members for many years to come. Acknowledgements to Meghan Poepping Kennedy the Archivist of the ACS for providing free access of all original documents. I have no conflicts of interest related to this talk.