The Generational Health Toll of Excluding Black Americans in Healthcare

Cassandra and Cootie sat under a large tree watching a car or two occasionally fly by along Springfield Road, a two-lane country passage connecting Middle Georgia’s old Negro Log Cabin Community and State Route 22.

They’d settled into lawn chairs outside of Cassandra’s home, a single-wide trailer she shared with her husband, Michael. Surrounded by rusty grilles, tires, and plastic trash cans, the pair waved me into a gravel driveway. As I pull up on their property, I offered a head nod and one-finger lift from behind the wheel of my rental car. It was a sign that our brief impending fellowship had been baptized and confirmed by southern tradition and was now understood to be safe.

The soles of my sneakers crunched through the gravel as I introduced myself. Cassandra looked to be in her late fifties, while Cootie, a family friend, was a bit older, maybe late sixties. He seemed frail, with a warm smile that was overshadowed only by the brim of his trucker’s cap. They were both chocolate, their skin kissed by a Georgia sun that would soon disappear behind the clouds.

Cassandra and Cootie scooted to the edge of their seats as I started the speech I’d practiced in the car. I lifted the brim of my own ball cap and stuffed my hands in my pockets while I started telling them why I’d come from the outskirts of Atlanta to the sleepy rural town on this sticky, humid day in mid-May 2025.

This article is adapted from The Price of Exclusion: The Pursuit of Healthcare in a Segregated Nation by Nicole Carr, copyright © 2026. Reprinted by permission of Dey Street Books, an imprint of HarperCollins Publishers (The Xylom illustration; courtesy of Nicole Carr)

Before my visit, I explained, I’d sat in the office of my suburban home and pulled up a map of Georgia on my laptop, along with a state physicians database organized by race. I jotted down notes to list the counties with the highest percentage of Black residents. Then I paired them with the counties reporting the fewest number of Black doctors. With zero Black doctors and a 71 percent Black population, Hancock County earned a place in my top three potential landing spots.

I had hoped to use Hancock County to illustrate a problem that the United States had since it met its first Negro doctor in the late 1830s. Dr. James McCune Smith could not attend medical school in the U.S., since no institution would train a Black doctor. And it would be nearly another two decades until Dr. David Peck completed studies at Rush Medical College in Chicago, thereby becoming the nation’s first Black medical school graduate, and about three decades before Dr. Rebecca Lee Crumpler followed as the first Black woman to earn the degree from the New England Female Medical College (now part of the Boston University School of Medicine). It is at this time, when a great need for doctors arises from the ashes of Civil War battlegrounds, that the first Black medical schools begin to open their doors to train most of the race physicians in the United States. My great-grandfather would become a product of the medical school that would go on to produce the most Black doctors: Howard University School of Medicine.

Racism impacted the ability of all these doctors to become educated and serve patients in even moderately equipped facilities, and we as a nation continue to pay a steep price — roughly 5 percent of doctors in the United States are Black today, compared to the 14 percent of African Americans living in the nation. It’s a ratio that has barely budged in more than a century.

Researchers have drawn direct ties between the workforce demographic and its adverse impact on patients who distrust a system in which they do not see themselves. I wanted to know the history behind the price we all pay for excluding these doctors, and the proverbial debt America owes for their resilience and fight for basic human rights.

Roughly 5 percent of doctors in the United States are Black today, compared to the 14 percent of African Americans living in the nation. It’s a ratio that has barely budged in more than a century.

As I began peeling back the layers of my own family history, I realized that my great-grandfather had been a part of largely untold and significant events — shaping attitudes toward race, patriotism, public service, and civil rights. I knew I could use his journey to introduce people to some of the forgotten Black physicians who’d made extraordinary contributions to a system that never seems to tilt in our favor.

So here I was in the middle of the week and in Middle Georgia, looking for Black folks to talk about their chances of finding and keeping a good doctor, one that looked like us.

“Hold on a minute,” Cassandra said before climbing the wooden steps and disappearing through the front storm door of the trailer.

Once considered a thriving and innovative center of Black rural life, Hancock County is nestled in what’s known as America’s Black Belt region. This is where the midnight-colored soil along a 300-mile stretch between Alabama and Mississippi is fertilized with the blood, sweat, tears, and hope of the formerly enslaved. Today it is 60 percent Black, facing an inordinate number of hospital closures and lacking a robust pipeline for African American physicians — an issue that extends beyond the confines of the country.

Yet not far from Michael and Cassandra’s trailer — just three-quarters of a mile to the northwest — lay what was once a center of Black progress, wealth, and loyalty, which nearly a century ago, folks called the Log Cabin Community. It was here that the Hubert brothers — Zack, Floyd, and David — migrated from their enslaver’s Warren County plantation after Emancipation and purchased 165 acres of land to build a segregated farming community, with a public school, a grocery store, and a church. After Zack’s death, the Log Cabin Community Center was dedicated to him and his wife, Camilla, in 1932. One of their sons, Benjamin, served as president of what is now the historically Black Savannah State University. He would go on to ensure a legacy of Black entrepreneurship, self-sufficiency, and fellowship among the colored farmers and their families.

The remains of the Negro Log Cabin community in Hancock County, Georgia. Founded by the formerly enslaved Hubert family, the community was also home to a Black health clinic in the early twentieth century. Black physicians, most of whom commuted from Atlanta, operated the rural hospital on this property. The doctors tried to address rural Black health disparities. The date of the hospital closure is unknown, but the predominantly Black community does not have a local hospital today. (Courtesy of Nicole Carr)

At one point during the early twentieth century, Black folks owned 27,000 acres of land in Hancock County. Today, a change.org petition protesting the construction of a railroad notes that by 1990, our people had lost 90 percent of that property. These days, you’ll find more neighbors on fixed incomes renting homes like Michael and Cassandra’s than you’ll find Black folks owning hundreds of acres like the newly freed Hubert brothers of the 1860s. But land isn’t the only thing Black people have lost in Hancock County. They’ve lost the only hospitals they’ve ever had nearby — and on more than one occasion.

Before I pulled into Michael and Cassandra’s driveway, I’d visited the building that used to house the old Hancock Memorial County hospital, which was covered in ivy leaves and brush. I’d contemplated pulling open the emergency door, but couldn’t work up the nerve to tug on the rotted metal.

The building had been abandoned by state and local authorities for more than two decades, a casualty of medical debt, mismanagement, and the politics behind access to Medicaid. But inside, the physicians’ operating chairs, tables, and hypodermic needles had been photographed by a journalist some nine years earlier. The images give off a haunting energy that I’d grown accustomed to feeling as I’d walked the grounds of similar sites throughout my research. I can imagine the last hands that touched the tools and the bodies that occupied the space. It makes you wonder if these people ever thought that the work would soon come to an end, that it would all be for nothing.

But land isn’t the only thing Black people have lost in Hancock County. They’ve lost the only hospitals they’ve ever had nearby — and on more than one occasion.

But instead of daring to check out whatever remained inside, I walked the grounds, roaming across the hot, cracked concrete, looking at the ambulance parking spot and taking photos of the entrance signs. healthcare & service looking to the future, one sign read, like a cruel joke. The only noise to break the silence was the sound of ropes moved by wind beating a nearby flagpole. But no flapping symbol of Georgia or America had been raised along that pole in years.

Later that day, I found myself standing in knee-high grass and staring into the windows of the Huberts’ Log Cabin Community Center. I walked slowly from the edge of the highway where I’d. parked my car and scanned the fields for snakes. As I got closer, the silent energy felt stronger, as if trying to summon me to climb the steps of the front porch, but that was another move into a large, abandoned structure that I would not dare make alone.

Listening to an orchestra of cicadas in that humid air, I remembered a faded newspaper photo that showed hundreds of finely dressed Black women and men standing in front of the facility in the 1930s. They’d used it for a gathering of Negro educators, but it was also where Black state medical conferences had been held during the early twentieth century. Scanning the field, I wondered where another community hospital — once described by the Black press as “the only Health Center of its kind in the deep rural south to administer medical aid to the colored people” — had been built. That structure no longer remains on the land.

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From 1932 to at least 1939, the Log Cabin Community operated the Mary Otis Willcox Health Center. There Black physicians from across the state would take turns lending their general and specialty services for rural patients of all races, but primarily the Black folks who remained the majority of both the state and the county population. At least once a year, they’d run a state-wide clinic, drawing Black Georgians to trusted Negro physicians they’d otherwise need to travel to larger southern cities to see. The facility, a white gabled cottage considered to be one of the “most attractive and serviceable” of its kind in Georgia, had three private wards, an operating room, a consultation office and a waiting room. It was financed by and named for a white female suffragist whose husband was the president of the New York City Board of Education from 1916 to 1918. But a little more than a decade earlier, one of Willcox’s chief allies, a man named Abraham Flexner, was responsible for the closing of most Negro medical schools. Perhaps this was a gift to compensate for guilt by association.

The Log Cabin doctors, while attracted to the housing and work opportunities they could pursue in bigger cities, understood that it was just as important to tend to the needs of those who had not chosen to join the Great Migration. While masses of Black folks packed up their families, carrying their most essential belongings along with hopes of escaping Jim Crow America, not everyone chose to flock from South to North or even rural to metropolitan. The physicians understood that improving rural healthcare would also lead to agricultural and economic prosperity. So they split their time between the city and Hancock County.

One of these doctors was Dr. C. W. Powell, who was chief surgeon at the Harris Memorial Hospital in Atlanta. Beyond traveling to Hancock County, he was operating the only private hospital for Negroes, named after his father-in-law. Several years after he was pictured tending to a patient in the Log Cabin Community, he came down with the flu. Working off of four hours of sleep, he left a patient in his Atlanta operating room for about half an hour before his staff came looking for him. They found him dead on the floor after knocking down the door. The sick and fatigued physician had suffered a heart attack while dressed in his white coat, tending to a patient.

While masses of Black folks packed up their families, carrying their most essential belongings along with hopes of escaping Jim Crow America, not everyone chose to flock from South to North or even rural to metropolitan. The physicians understood that improving rural healthcare would also lead to agricultural and economic prosperity.

Then there was Dr. Frederick Earl McLendon, who would go on to establish the McLendon Hospital, a 30-bed facility that opened its doors in Atlanta decades after Dr. Powell built his hospital. McLendon was the alternative to Grady Memorial Hospital, where neither Black doctors nor patients could enter the front doors for another three decades. When he opened the doors to the hospital in 1946, Dr. McLendon was one of just twenty-five Negro physicians available to treat any of the 100,000 Black Atlantans. At the time, the city boasted just forty-four hospital beds that weren’t considered “charity beds” for the poor. And so it was the middle-class Negro who risked dying because there was no access to a hospital.

Dr. R. S. Douthard was a prominent physician who had married one of Zack Hubert’s daughters. Douthard ran medical practices out of the couple’s Atlanta home on Boulevard Drive and in Decatur, where he led voter registration efforts. During the summers and while the doctor tended to patients, his daughter Cora taught young Black city girls how to swim, hike, and fish in the Log Cabin Community while her father tended to patients.

The outside of Hancock Memorial Hospital in Sparta, Ga. The county's predominantly Black population has been without a local hospital since the facility closed in 2001. Most residents turn to the care of Dr. Patrice Boddie, the only Black physician in the area, who is a third-generation Meharry Medical School graduate. She practices in two renovated houses, one of which is across from the abandoned hospital. The other is in Milledgeville, where her grandfather, father, and uncle tended to patients in the early to mid-twentieth century. (Courtesy of Nicole Carr)

These men and their colleagues made up less than 3 percent of the nation’s physicians of the time, while Black people made up nearly 10 percent of the country’s population. It was hard enough for them to tend to patients’ needs back in the city. But the rural hospital would shutter within a decade of opening, with no pipeline of Black doctors and no funding available to continue the work in the small community.

While the hospital itself may have been unlike anything else in the Deep South, the problem of providing healthcare to underrepresented people was not that much different from today. And their patients had needs, not unlike those of Michael, Cassandra, and Cootie.

When the trailer door swung back open, Cassandra waved me in. Inside, her husband, Michael, dressed in a dingy white tee and weathered denim pants, sat watching the news on a television that was the largest item in the neat, compact space. Not quite sixty, Michael told me that he’d moved back to Hancock County less than a decade prior after spending some time up north. A job bottling products at the old 1890s-era perfume factory in Sparta offered him some stability.

He was surprised to hear that some form of a hospital once existed in the nearby Log Cabin Community, where his mother — a soon-to-be centenarian — had attended high school. It was especially hard to imagine, because just a few years earlier, he had to drive Cassandra all the way to Augusta to reach a hospital where doctors could treat her brain aneurysm. The hour-and-a-half journey likely contributed to the severity of Cassandra’s stroke, the effects of which still lingered along the creases of her face.

“That’s why she walks like that,” he said, referring to his wife’s limp, which had slowed her earlier trek from the lawn chair to the front door. Had he been able to get her to a hospital quicker, Michael said, maybe there would not have been as serious a brain bleed.

“You’ll kick rocks before you get to a hospital around here,” Michael told me, adding that Black doctors seemed to listen to him and his wife more closely and with more care.

“And Dr. Boddie the only Black doctor you’ll find round here.”

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