Health Woes Run Rampant in Mississippi Delta : Rural South: Numbing poverty, social structure and lack of education are blamed. In some cases, blacks are forced to choose between food and medicine.

On a spring afternoon seven years ago, a man arrived at Dr. Anne Brooks’ clinic near the Tutwiler, Miss., post office with a sore back. He’d been chopping cotton in a nearby field--moving methodically up and down the rows, digging weeds with a hoe. Like most of Tallahatchie County’s residents, he was black.

As a matter of principle, Brooks, a Catholic nun who trained as an osteopath, likes to suggest ways for patients to help themselves. In this case, her instinct was to recommend that the man spend the weekend in bed, putting hot towels on his back now and then. She thought for a moment, then asked if he had hot water.

“No ma’am, I don’t,” he told her. “But I can heat the kettle.” How? she asked. “I’ll go outside, haul the water and chop some wood,” he said, “then start a fire.” Brooks told him to rest in bed, and perhaps ask a friend to rub his back.

I had gone to Tutwiler, a town of 1,176, in the hope of learning why black Americans, in Mississippi and across the rural South, are less healthy and dying younger than their white neighbors--what physicians call excess morbidity and excess mortality.

For two weeks, I crisscrossed the Delta in search of doctors, nurses and public-health officials who might provide answers. I could as easily have gone to any of seven other Southern states, from North Carolina to Louisiana, that make up the so-called stroke belt and have the highest infant mortality rates in the United States. But in the Delta, where blacks constitute about 70% of the population and many are desperately poor, the problems are the most concentrated of any region in the country.

For more than 400 miles, from New Orleans to Memphis, U.S. Highway 61 roughly parallels the Mississippi River and passes within 20 miles of all but one of the towns I visited. It was my lifeline, the road to which I constantly returned, for most of these towns are too small and too poor even to have a motel of their own.

Time and again I discovered situations as complex and frustrating as Brooks’ attempt to treat her patient’s aching back. In the Delta, health and medicine are linked inextricably to numbing poverty, lack of education and a social structure in which many blacks remain fundamentally powerless, unable to control their own lives. All of these forces are as entwined in local culture as the ivy that overwhelms abandoned buildings scattered across the landscape. If the pain of Brooks’ patient cannot entirely be attributed to race, neither can race be absolved: White people do not chop cotton, and most white people do not live in houses without stoves and running water.

I learned, most of all, from the stories I heard. One nurse told me about a man who stood at the edge of a field waving a white flag to let a crop duster know where to spray, wearing only a T-shirt and jeans to protect him from raining poison. A physician described a patient hospitalized with massive gastrointestinal, urinary tract, liver and skin ailments after a spring wind soaked him with herbicide he was pouring into a container.

In Mound Bayou, I heard about a man who lost his manufacturing job because he missed work to get X-rays, and one doctor told me of women whose employers “don’t want them to go to a doctor even if they’re half-dead.” I heard of people forced to choose between food and heart medicine, because they didn’t have money for both.

When black people in the Delta seek medical care, it’s not in an integrated health-care system but a haphazard patchwork assembly--one held together by too few physicians and fewer specialists. Their efforts are undermined by employers who fail to provide insurance, and Medicaid and Medicare systems that inadequately reimburse doctors and leave many patients uninsured.

“I’m not sure that the medical problems we face here in the Delta are a whole lot different from the medical problems any place in our country,” Brooks said. “I think people are sicker longer before they get help, because of lack of money and transportation. When we finally get them in the hospital they’re much worse off.”

Poverty is the most overwhelming cause of poor health among black people in the Mississippi Delta: They are ill because they don’t have to the resources to remain well. “Your wealthier people, with cars, they can travel to Clarksdale, to Memphis, to Oxford,” said Dr. Marilyn Aiello. “But your poor become very sick and die. I can’t tell you how many people come into the clinic who have never seen a doctor, and are seriously sick--not so much any more, because I’ve been here almost 10 years. But in the beginning it was very commonplace. They just wouldn’t go, because it was so hard for them to go.”