Bill Dow co-founded the Student Health Coalition while in medical school at Vanderbilt University, in 1969. His larger-than-life role in the SHC origin story and beyond warrants special telling, which we attempt in the essay that follows.
Contributed by Margaret Ecker, compiled in collaboration with friends
Bill Dow energized a generation of student activists and a wide range of community leaders throughout the South, beginning in the late 1960s and for the next four decades. Like many visionaries before his time and after, he managed to make his mark both despite and because of an enormous ego. He worked from a deep well of kindness, an authentic concern for the underdog, and an intuitive sense of the dynamics of power. He could be singleminded to the point of abrasiveness, driven by a righteous and implacable impatience at injustices he saw around him, an impatience that hovered near the boundaries of annoyance. Love of Bill was not universal. But no one who knew him would deny that the people he inspired and the projects he crafted, including but not limited to the Student Health Coalition, became engines of enduring change for the better. “He gave us hope,” as J.W. Bradley, retired coal miner and union organizer put it bluntly, reminiscing about Bill in 2013.
William Watlington Dow was born February 15, 1945 in Middletown, Ohio, but did most of his growing up in Meridian, Miss., working with his two brothers to run the family farm. He arrived at Vanderbilt as an undergraduate transfer from Mississippi State in 1967. Professor Charles Scott, then chair of the Philosophy Department, remembers him as a student with an “inchoate political desire” to change things, a dissatisfaction with the status quo which was beginning to take hold among many Vanderbilt students at that time. Scott later characterized Bill as an “archetype of dissatisfaction.” Bill graduated with a bachelor’s degree in molecular biology and went on to graduate from Vanderbilt Medical school in 1972. He interned in pediatrics at Vanderbilt, and served in Vanderbilt’s pediatric residency program from 1973 to 1975.
In medical school, Bill’s desire for activism found full focus: the health care delivery system. In a prescient way, long before “social determinants of health” became common vocabulary, he held close the belief that health care systems ignored critical concerns of nutrition, environment, and preventive health. In 1969, he determined to change that by moving experiences from the classroom out into the community. He recruited fellow medical students, including his wife Beth Dow, Pat Maxwell, Todd L’Hommedieu, and nurses Janice Ambry and Jane Law. Together, with Bill in the lead, they crafted a plan. They envisioned a student-run project which would take services to medically underserved areas over the course of the summer, but even more importantly, they would ensure that local leaders were empowered to articulate their own perception of problems, and solutions. It did not end well that first summer, but it was only the beginning.
During that first summer, the fledgling group, with real (if quiet) support from Dr. Amos Christie, chair of Vanderbilt’s Pediatrics Department, conducted health screenings of children enrolled in Head Start in Williamson County, just south of Nashville. Within weeks, students could show that nearly three quarters of the children screened had severe dental caries. They reasoned that that lack of fluoridated water contributed to the poor dental health they were seeing and turned to a pediatric dentist at Vanderbilt who taught them how to apply topical fluoride. They proposed to the county health officer that, with parental consent, they would provide fluoride via house-to-house visits. The health officer rejected the plan outright. Bill and the crew did not take the rejection sitting down. Dr. Christie, ostensibly in charge of their project, later referred to the fallout from that venture as a Charlie Chaplin tragic-comedy:
“Instead of consulting with me during this phase, they went off by themselves, contacted the local newspaper, the District Attorney, and several citizens who more or less encouraged them to put the pressure on the elected and appointed officials. They became very critical of what they thought was inertia on the part of the Public Health Nurses…we have not heard the end of this story yet.”
Amos Christie Papers. Eskind Biomedical Library Special Collections, Vanderbilt University Medical Center, Nashville, TN.
Undaunted, by the end of the first summer Bill had already scoped out contacts with community activists at work in rural East Tennessee: Marie Cirillo, a former Catholic nun working on economic development projects near the Kentucky/Virginia border, and Martha Stucker, still a catholic nun in those days and an enterprising registered nurse running a clinic for pregnant women.
Marie and Martha had already helped to plant seeds for the concept of community-run health fairs. Other religious missionaries had conducted screening exams out of the trunks of their cars, events that had garnered respect from the communities. But Bill wanted to take those events even further, building them into catalysts for community organizing. He befriended local community leaders in coal mining country, including Byrd Duncan in Briceville, Kate and J.W. Bradley in Petros, and Odes McKamey in Stoney Fork. Together, they developed a vision of summer “health fairs” in which students from medical school, nursing school, undergraduates, and others would identify local health care needs, and then turn over their findings to local leaders to help shape local solutions to local problems. At the heart of their approach was an insistence on community leaders as drivers of all events.
Providing even these low-cost organizing events would require financial resources. At the suggestion of Dr. Christie, Bill traveled to New York City and knocked on the doors of several national foundations. One of the first to respond, the Josiah Macy Foundation, had fortuitously set it sights on encouraging medical students to address underserved communities and they stepped up right away. Others eventually responded as well, including the Field Foundation, the Robert Wood Johnson Foundation, the Ford Foundation, and even Tennessee Valley Authority.
An innovation in nursing, just then getting started in one or two academic settings in the US, caught Bill’s attention: the expansion of nursing practice to include independent skills in physical assessment and diagnosis. The Coalition iteration of the expansion that Bill promoted involved nurses as examiners at the health fairs. By embracing this innovation, the Coalition not only enlarged nursing skills, they enlarged the capacity of the health fairs to reach more people. The invitation to nurses to learn these new skills, make no mistake about it, represented high-risk crossing of professional and legal boundaries. But no one hesitated, least of all the willing nursing students. It was a typical Bill Dow move: inspiring but relentless, not oblivious to boundaries but without much respect for their legitimacy.
The health fairs, nomadic by design, served like pop-up clinics. They were set up in scores of communities around the South over the succeeding decades. Clinical providers would conduct assessments at one before moving on to the next site. Data collected from these health assessments would become instruments for local leaders who could translate it into a call for lasting changes, changes such as the community-operated primary care clinics that survive to this day. Besides health care providers, Bill also recruited undergraduate liberal arts students, engineering students, and law students whose role was to conduct local research about intractable problems, sometimes only tangentially related to health, but always with an eye for support of community organizing. A range of environmental and political spin-offs ensued, developed by scores of young people and community leaders, all inspired by Bill’s “cantankerous” imagination: the East Tennessee Research Corporation (ETRC), set up by young law school graduates to provide legal assistance to fledgling community organizations; Save Our Cumberland Mountains (SOCM), under the leadership of J.W. Bradley to empower communities with student research into tax records of absentee land owners; and the Solar Greenhouse Employment Project, designed to promote energy self-sufficiency on small and minority-owned farms.
Some of this work took place while Bill was still in medical school. As his activism increasingly consumed both time and energy, it inevitably compromised his educational progress. He graduated from medical school on time, but he never completed the Board certification process and eventually abandoned his career as a physician altogether.
Even as his options to practice medicine faded, however, his abiding concern for public health grew. By 1975, he was working with John Vlcek and Lindsay Jones to develop the Agricultural Marketing Project with the goal of setting up food fairs and farmers’ markets throughout Tennessee. The project successfully established farmers’ markets in Memphis, Knoxville, Oak Ridge, and other locations in the state. He applied this model to help set up a similar project (also called the Agricultural Marketing Project) at the University of Alabama. In 1978, working with Laura Heise, he founded the North Carolina Agricultural Marketing Project with the same goal. That project ultimately led to the formation of what is now the Carrboro (N.C.) Farmers’ Market.
In 1978, more for personal than professional reasons at the time, Bill moved to Pittsboro, N.C., near Chapel Hill. He conducted some academic work with faculty at the School of Public Health, funded by the Robert Wood Johnson Foundation. By 1979, he was at work on the Solar Greenhouse Employment Project with Paul Konover and Randy Hodges and continued with that project until 1984.
Around 1980, Bill decided to become a full-time farmer. He bought a 30-acre farm just outside of Pittsboro, naming it Ayrshire Farm. He had come full circle, to the roots of his Mississippi farming, but now, as with everything he touched, embracing a mission to change for the better. Ayrshire became the first certified organic farm in North Carolina and the home base for Bill’s focus for the rest of his life.
For access to the full interview, click here.
Bill served on the North Carolina Governor’s Waste Management Task Force and on the Chatham County Planning Board. He also helped start the Committee for Solar and Appropriate Technology for Orange County, N.C.
Sadly, Bill died unexpectedly in December, 2012 at his home in Pittsboro, N.C. where he lived with his partner, Daryl Walker. He was suffering from early dementia at the time. Shocked friends remembered Bill at his memorial service with inevitable depth, calling him passionate, stubborn, impatient, politically savvy, driven. Many were caught off guard by how many new faces they were meeting for the first time at the service, people pulled together from multiple seemingly disconnected chapters of Bill’s eclectic journey. Many others have since left mementos on the Coalition website. These comments, collected over time, at least begin to capture the complexities that were Bill Dow.
From Rod Lorenz:
Email correspondence, July of 2019
Bill was wired to work best in situations that had little or no structure, in which he could operate with substantial if not complete independence. Can you imagine Bill Dow working for long in any modern corporate world, including those that claim to prize independent thought and lack of formal structure? One could hypothesize that one driving force was his need to operate where there was little or no structure, leaving him free of any constraints to invent something new. Thus, when medicine did not work out for him, and the SHC became institutionalized, he migrated to another empty landscape — organic farming and healthy food supply.
From Frank Pacosa:
Bill was literally always picking on something, hatching, planning, explaining. Hardly a thought went by that didn’t implicate the powerful pit against the poor. A cold, hardened steel analysis of institutions and how they dominated across all domains academic, business, government. No one escaped.
But for all the cantankerousness there was a deeply loving heart. I remember when he took me to visit J.W. Bradley’s father who had severe painful rheumatoid arthritis. Bill’s reverence for the man was stunning. As he pulled the grass stalk out of his mouth before we got in his truck he said, “That man has never once complained of pain.” And Bill shook his head.
Being with Bill was not like being with anyone else.
To read the full text of Frank’s story, click here.
From Rick Davidson:
Email correspondence, May of 2021
Even though Bill never completed the pediatric board certification process, he was a fine clinician. He had a tenderness with kids that allowed him to learn details about signs and symptoms that might have been invisible to a lesser clinician. He served as pediatric consultant for the fledgling Mountain People’s Health Council (MPHC) in the mid-1970s, even without certification. Bill was committed to excellent child care, and he was invaluable to our practice. I was an internist in the middle of my residency, and our three nurse practitioners had varying amounts of pediatric experience. We knew that we could call him at any time, or schedule a patient to return to see him in the clinic, and they would get the high-quality care they needed. It made all of us much less anxious about our patient population, and it set a standard of care that continued through the years.
From Maureen O’Connell:
He really fell in love with the people in the mountains. He would talk about J.W., or Odes, or Dorothy Burns, or Vada as his heroes…It was not ‘Oh, I’m a big doctor, I’ve got to remember to be respectful of these people, because this is my philosophy of organizing.’ He absolutely counted them as his heroes. It’s where he got his juices.
Click here to for more of Maureen’s commentary on Bill Dow.
From Becca Joffrion Ingle
In between health fairs in St Charles in summer 1974, we formed a baseball team and played against the community teams. I remember getting really peeved at Bill Dow, our physician and co-founder of the SHC, because he’d make me finish writing up my charts before I got to play ball.
From Joe Little
Excerpted from his profile, posted here.
I understood the stated mission of the project and on some level was politically in sync with the goals, but carried neither the conviction nor the depth of understanding to have any significant impact. I was naive and unfamiliar in any real way with the people, whose homes and communities we visited. As the summer moved along, Bill Dow made one of the few miscalculations during his long tenure with the SHC – he thought it might be a good idea that I would act as one of the co-leaders for 1971-72. Bill was not one to be denied…Time and reflection and experience have brought into better focus what those years with the Coalition had meant for me. Simply, I was fortunate to have had the opportunity to observe Byrd Duncan, Kate and J.W. Bradley, Tommie Phillips, and so many others to learn a little about their lives and communities.
From Ginnie Munford and Mary Mikell:
Email correspondence, June of 2019
Bill was a large personality, controversial among his peers as well as faculty members at the medical school. He was skeptical of academic pursuits without practical application. His community and political activism consumed more and more of his time and energy, complicating his academic progress through the demands of medical school.
From Dal Macon:
Bill was very firm and unyielding in how we were to see ourselves. Very different from this typical Vanderbilt student sort of thing. We were not there to bring things to the people. We were there to respond to what they said they needed. It just made so much sense to me. The solutions were going to come from what the people were asking for.
Click here for Dal Macon’s full commentary on Bill.