By Charles Zackary King|Changing Trends and Times|Healthcare Series, Part 4
The night was July 9, 1893. The city was Chicago, Illinois. A man named James Cornish, a laborer, an ordinary working man, was brought into Provident Hospital with a stab wound that had penetrated within a fraction of an inch of his heart. His physician was Dr. Daniel Hale Williams. And what Dr. Williams did next changed the recorded history of medicine: he operated. He sutured the pericardium, the fibrous sac surrounding the heart itself, in what has been documented as the first successful open-heart surgery in recorded medical history. Think about what that means for a moment. The first successful open-heart surgery in recorded human history. And it happened at Provident Hospital, an institution Dr. Williams had helped found just two years earlier, in 1891, for a specific and infuriating reason: no hospital in Chicago would grant admitting privileges to Black physicians. When the door was closed, Dr. Daniel Hale Williams did not stand outside it and wait for someone to let him in. He built another door. He built the entire building. And then, inside that building, he performed one of the most consequential medical procedures in human history. This is the tradition Part 4 of the Changing Trends and Times Healthcare Series is asking you to remember, carry, and continue. Not as nostalgia. As architecture.
When We Were Told No, We Built Yes
The history of Black medical self-determination in America is one of the most remarkable and fundamentally under-told stories in the entire sweep of American history. It is a story of extraordinary construction under extraordinary constraint and it did not begin with Dr. Williams, though his legacy is as vivid as any single moment in it.
After the Civil War, the Freedmen’s Bureau established hospitals, dispensaries, and medical infrastructure across the South specifically to serve formerly enslaved Black Americans who had been entirely excluded from antebellum medical care, except as unwilling subjects of it. At its peak, more than forty Freedmen’s Bureau hospitals were operational across the South, training Black physicians and nurses and building the groundwork for a public health infrastructure that the nation had never previously extended to Black Americans. When Reconstruction ended and the Bureau was dismantled, much of that infrastructure was deliberately destroyed or allowed to collapse. But the institutional determination that had built it could not be dismantled as easily. What survived was the will to keep building.
In 1867, Howard University was established in Washington, D.C. Its College of Medicine became one of the primary pipelines producing Black physicians for over a century, training the doctors who would serve communities that private, white-run medical institutions routinely refused. In 1876, Meharry Medical College was founded in Nashville, Tennessee. Together, Howard and Meharry trained the vast majority of Black physicians in America for generations during the era when white medical schools maintained policies of racial exclusion as official institutional practice. In 1895, just four years before the turn of the twentieth century, the National Medical Association was founded, because the American Medical Association had closed its doors to Black physicians. The NMA became not merely a professional organization but an advocacy institution: it fought for civil rights, for hospital integration, for healthcare equity policy, and for the recognition of Black medical professionals across more than a century of American history.
The pattern is so consistent that it becomes its own kind of evidence. Exclusion produced institution-building. Denial produced construction. Closed doors produced new buildings entirely. This is not a story of victimhood. This is a story of extraordinary, sustained, documented genius under pressure. This is heritage. This is the blueprint.
The Blueprint That Already Exists: What Works Right Now
Let me be direct with you, because this series has always been about telling you the truth straight. We do not have a knowledge problem. We do not have a solutions problem. What exists in this country, right now, as a working, evidence-based, replicable model of community-anchored primary healthcare for underserved communities is extraordinary and it is called the Federally Qualified Health Center.
Federally Qualified Health Centers (FQHCs), are the most documented, most studied, and most proven model of primary care delivery in underserved communities operating in the United States today. There are more than 1,400 FQHC organizations operating approximately 15,000 service delivery sites across all fifty states and U.S. territories, collectively serving more than 30 million patients annually. The majority of those patients are uninsured, low-income, or covered by Medicaid. No patient is turned away for inability to pay, that is not a policy choice at individual centers; it is a statutory requirement of the federal program. A sliding-fee scale is applied based on income, so that the cost of care is tied to what a patient can actually afford to pay.
But here is the structural feature of FQHCs that I want you to sit with, because it is unlike almost anything else in American healthcare: by law, the governing board of a Federally Qualified Health Center must be composed of a majority of patients, the people being served. The community being served has structural governance power over how the center operates, what services it provides, what languages it speaks, what hours it keeps. This is not a suggestion. This is not a diversity initiative. It is the law. The community runs the clinic. And when the community runs the clinic, the clinic serves the community’s actual needs.
The documented outcomes are compelling and consistent. FQHC patients demonstrate better management of chronic diseases including diabetes and hypertension. They have higher rates of preventive cancer screening. They have lower rates of avoidable emergency room utilization compared to uninsured patients who lack FQHC access. This model is not theoretical. It is not a pilot program. It exists, at scale, right now, in communities across America. It needs to be funded at the scale of the need it serves and that is where political will becomes the variable.
“The solution to the healthcare crisis in underserved communities is not waiting to be invented. It is waiting to be funded, expanded, and given the political will that its evidence base has earned.”
Community Health Workers: The Bridge Between Systems and People
The clinical encounter, the thirty-minute appointment in a doctor’s office, is a powerful tool. But it is not the only tool healthcare requires, and for millions of patients in underserved communities, it is not even the primary barrier. The barriers are navigational: How do I enroll in coverage? How do I understand what this diagnosis means in the context of my life? How do I get to this appointment when I don’t have a car and the bus doesn’t run to that part of town? Who will explain what the doctor said in terms I can understand, in the language I actually speak? These are the gaps that Community Health Workers fill — and they fill them with documented, measurable, cost-effective results.
Community Health Workers (CHWs), are trained community members who serve as culturally competent bridges between healthcare systems and the populations those systems routinely fail to reach. They conduct home visits. They help patients navigate insurance enrollment. They provide health education in culturally relevant and linguistically accessible ways. They connect patients to social services, accompany patients to medical appointments, and do the sustained relationship work that the formal clinical system neither has the time nor the cultural fluency to do at scale. They are, in the fullest sense of the term, the human infrastructure that healthcare requires to work.
The evidence base for CHW effectiveness is robust across multiple health conditions and populations. In diabetes management, maternal health, HIV prevention and treatment adherence, and chronic disease management across multiple conditions, CHW programs produce measurable improvements in patient outcomes. Cost-effectiveness analyses consistently find that CHW programs generate healthcare system savings that substantially exceed the cost of their employment. This is not anecdote. This is peer-reviewed literature. The problem is not evidence. The problem is scale: the CHW workforce in this country is far smaller than the evidence says it should be, constrained largely by funding instability and the absence of sustainable reimbursement models in most states. Medicaid reimbursement for CHW services, now authorized and operational in a growing number of states, is the specific policy lever that makes this model financially sustainable at the scale it deserves to operate.
What You Can Do — Starting Right Now
I want to speak directly to you, wherever you are reading or watching this, because Part 4 is the part of this series where we don’t just document the landscape. We hand you tools.
If you are an individual: Be an informed and assertive patient. Write your questions down before every appointment, bring a list and bring a friend or advocate with you when the stakes are high. Know your rights under the Patient Advocate Foundation framework. If you are uninsured or underinsured, find your nearest FQHC and use its sliding-scale care, you will not be turned away. The Health Resources and Services Administration maintains a public FQHC finder at findahealthcenter.hrsa.gov. Use it. That resource exists for you.
If you are a community leader, faith leader, or small business owner: Partner with your local FQHC. Host community health fairs. Bring health education and insurance enrollment resources directly into your space, your church, your community center, your business. If your state has not yet expanded Medicaid, contact your state legislators by name and on the record. Join or financially support the National Medical Association or your local health equity advocacy coalition. Use the platform you have already built to amplify the work that needs your amplification.
If you are a policy advocate, civic organization, or grassroots coalition: Study the ballot initiative strategy for Medicaid expansion. In Missouri in 2020, voters approved Medicaid expansion through ballot initiative when the legislature refused. In Oklahoma in 2020, voters did the same. In South Dakota in 2022, voters approved it again. Three states. Three ballot victories. Legislatures that said no became law because the people said yes. This is replicable. Know your state’s ballot initiative process, rules, and signature thresholds. Build the coalition now, before the next election cycle. The mechanism exists. The evidence is there. The only question is organization and will.
| This is Part 4. This is where we build the answer. Dr. Daniel Hale Williams didn’t wait for Chicago’s hospitals to change their minds. He built Provident. You have tools. Use them. Watch Part 4 of the Changing Trends and Times Healthcare Series. Share this post. Follow @ChangingTrendsAndTimes. The trends are changing because we refuse to accept the times. I’m Charles Zackary King. Let’s go. |
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