Truth Like a Hippo

Hippopotamuses are not native to Cambodia. But if you’re relentless—if you have a bit of Sisyphus in you—you may push one there. Keep in mind, however, that heavy things don’t care for uphill journeys. And what refuses to budge in one direction is a threat to pitch and roll in another.Gatch graduated from NWU in 1953, eager to make a difference.

Once it started moving, the force that pushed and overturned Dr. Donald E. Gatch’s (’53) jeep in Cambodia back in 1980 could not be stopped. The jeep rolled with Dr. Gatch inside. And when it finally did stop, the loudest mouthed country doctor to ever practice medicine in the state of South Carolina fell quiet and died.

Dr. Gatch died 32 years ago on a trip to Cambodia to treat refugees. But that’s not the work he’s most remembered for. Gatch made his reputation—or, some would say, destroyed it—as a young physician in the late 1950s and ’60s working in and around Bluffton, S.C., a small town on the state’s southern coast.

That’s where he first stepped behind an especially foul and stubborn hippo and started pushing.

Gatch’s rural patients near Bluffton included many destitute African Americans. He witnessed among them alarming signs, not just of malnutrition, but of starvation. And he saw parasites at levels redolent of the Third World.

What’s good about going into a dirty shanty and delivering a baby on newspapers spread out on the floor?

He described one case to Esquire’s Bynum Shaw in a June 1968 article (“Let Us Now Praise Dr. Gatch”, from which Gatch’s quotes here, unless otherwise noted, are taken). Not yet 30, Gatch made an emergency house call to the isolated home of a woman on remote Daufuskie Island. He found her near death on her filthy bed. “Her arms, her legs—her entire body was full of maggots,” Gatch remembered. “Medical books don’t cover that condition, not the complete infestation of the body. How do you treat maggots?”

The woman died, and her grisly image stayed with the young general practitioner.

In 1962, Gatch led a group of physicians from the Public Health Service’s National Institute of Allergy and Infectious Diseases in a study of the prevalence of roundworm and whipworm cases in Bluffton. He walked down Bluffton’s Goethe Lane and collected 212 stool samples from residents. Results, which Gatch published in the January 1963 issue of Public Health Reports, revealed an infection rate above 80 percent among children under 5.

Not everyone found these results worrisome. “People say, ‘Worms? What’s so bad about that? Everybody has worms, one time or another,’” Gatch said. “Sure they do. Treated, worms are no problem. White kids, kids in families with just a little money, get treatment. The kids I’m talking about don’t get treated. Or the adults. And nobody knows how many there are, and nobody’s trying to find out.”

Gatch saw that willful ignorance as nothing short of lethal. Shaw wrote, “[Gatch] personally had presided at eight deaths which he could honestly attribute only to hunger… [all of whom] were Negroes whose strength had been sapped by worms.”

His outspoken reaction to these conditions—his willingness to push the issue—was just one of the things that set Gatch apart from his professional peers.

[The county health officer] denied that any death in Beaufort County... had been the result of malnutrition.... Gatch, he all but explicitly stated, was lying.

Gatch, a liberally educated young physician from a farm near McGrew, Neb., a few miles southeast of Scottsbluff, did not fit into South Carolina’s medical establishment. “Gatch is not the ordinary member of the medical profession,” Shaw wrote. “[H]e regards even the poor or illegitimate Negro as a human being; he reads books and listens to music of every beat; and gradually he came to be regarded as a medical troublemaker.”

Gatch didn’t reserve his criticism for the white mainstream’s disinterest in whatever might be living in the guts of poor blacks. He also criticized the out-of-hospital delivery system through which the majority of the state’s black babies were born—the same system that a colleague had called “one of the best-organized and most closely supervised midwife programs in the entire U.S.A.”

Gatch questioned the entire notion of home deliveries in squalid conditions. “What’s good about going into a dirty shanty and delivering a baby on newspapers spread out on the floor?”

While Gatch was adamant such deliveries should take place in clean and equipped hospitals, he was nonetheless eager to support midwives and mothers when deliveries grew complicated. Jennie Kitty was one such midwife and nurse working in Bluffton in the 1960s. She remembered one delivery where she saw what no midwife wants to see first: a tiny foot.

Kitty called Dr. Gatch. “I wouldn’t have called anyone else,” she said. “He was doing God’s work, helping people whether they had any money or not.” Gatch arrived and was able to slide and turn the baby around, avoiding a dangerous breech delivery.

Kitty recalled another case where severe hemorrhaging required Gatch's quick intervention. With the hospital too far away, Kitty was able to whisk the patient to Gatch’s clinic. “It wasn’t the blood that got to me,” she recalled, “but there was something about the click-clack sound of his instruments working. I can still hear it, just like I can still hear his voice. I got all woozy and he told me, ‘Go to the door and get some air and come back.’” She did so, but the metallic sounds of Gatch’s work trying to stop the bleeding still left her faint. Kitty laughed at the memory. “He told me, ‘Damn, Kitty! Can’t you stand a little blood?”

The friendly familiarity between white doctor and black nurse wasn’t exactly typical at that time and place. Nor was Gatch’s integrated waiting room. Many local whites found the absence of segregated waiting rooms unpardonably offensive. “It never occurred to me to segregate the sick,” he said.

All of it was too much for local physicians and whites. Beaufort County Health Officer Dr. H. Parker Jones began a campaign to discredit the young Nebraskan. “I have been in public health for more than 15 years,” Jones said, “and I have never seen a case of starvation or extreme malnutrition.” He denied that any death in Beaufort County in the preceding year had been the result of malnutrition or intestinal parasites. Gatch, he all but explicitly stated, was lying.

Jones, or any physician who remained inside the bounds of the county hospital, could very well traverse their entire careers without seeing the squalor or desperation Gatch had seen. But the anomalousness of Gatch’s perspective didn’t make it false. “These patients don’t get to large medical centers,” Gatch said. “They die before they get there.”

Gatch’s outspokenness created enemies in Beaufort County. It also earned him fiercely loyal friends. Among nurses, Gatch’s popularity extended beyond Jennie Kitty. “My mother was one of the few black licensed practical nurses in those days,” said Thomas Barnwell, Jr., of Hilton Head Island, S.C. “She told me, ‘Junior, you’ve got to meet this doctor. You need to get involved and help him.’”

Barnwell followed his mother’s advice and began a friendship that would last the remainder of Gatch’s life. “That man got my head in the direction of health care needs.” Barnwell’s head would remain fixed in that direction throughout his career, and he went on to form what is known today as Beaufort Jasper Hampton Comprehensive Health Services (BJHCHS). “Don and I would talk about these issues—about clean water and access to care. I was able to articulate that and put it into place because of him,” he said. “They never made another like him again.”

Friends like Kitty and Barnwell would see Gatch through his growing conflicts within and without the white medical establishment. Joining Dr. Jones in the effort to discredit Gatch were the county’s 14 other physicians. They claimed in a statement released by Beaufort County Memorial Hospital’s chief of staff that the cases Gatch decried were “rare” and primarily caused by black mothers’ “parental inexperience, indifference or gross neglect.”

Gatch’s reaction: “Whose indifference? Whose neglect?”Photo by Edward Hausner/The New York Times/Redux

Forty-four years later, those four words struck Associate Professor of Biology Angela McKinney as quintessential Nebraska Wesleyan questions. “Our students realize it’s important to know more than just the science,” she said. “They need to know how to make connections.” Hearing his story, McKinney said it was clear that Gatch had that ability to connect—“that ability to see the roles that small parts play in a larger whole.”

While any med student can tell you that the whipworm relies on its host’s diet, a liberal arts education helps students see that the same whipworm feeds also on public apathy. Without willful blindness, the parasite running rampant then in the intestines of black children in Bluffton, S.C., would fare no better than it would have in those of middle class white children in Lincoln, Neb.

Recognize the connection between this worm and that blind eye, McKinney said, and the cure becomes something more than a simple regimen of medication. “The cure is education. The cure is advocacy. The cure is relentless service.”

Six decades after Gatch’s graduation, Nebraska Wesleyan’s Biology Department continues to work instilling that same kind of vision and dedication in its students. Associate Professor of Biology Cody Arenz coordinates Nebraska Wesleyan’s chapter of the biology honorary Tri Beta. He has implemented a volunteer requirement for all NWU members. The message that requirement sends to biology students is clear: Being a leader in this department requires doing more than just your homework. It requires involvement and service.

McKinney said the department’s international trips are equally important in equipping students to draw essential connections. “When we take students to Costa Rica or Honduras to study marine biology,” she said, “they see more than the reefs. They see industry. They see tourism. They see the local population. They see how all these things overlap to shape an interconnected environment. The value of that kind of firsthand look is just tremendous.”

Back in Bluffton, Gatch gave Shaw a firsthand look at the conditions of the county’s destitute black families. They walked through shanties and met the malnourished children living there. “Some of these kids won’t [survive],” he said. “They’ll die. Of pneumonia. Something like that. If they had decent food and decent shelter they wouldn’t get pneumonia. And that’s what I mean when I say people down here are starving to death.”

The cure is education. The cure is advocacy. The cure is relentless service.

He said, “The statistics call me a liar. ‘Not a single case of starvation.’ I call the statistics a liar.”

Gatch’s tenacity helped open the eyes of powerful people. “He built a trail from Bluffton to the state capitol,” Barnwell said. “He built a trail from Bluffton to Washington, D.C.”

He helped change powerful minds, including that of Ernest Hollings, South Carolina’s governor from 1959 to 1963 and U.S. senator from 1966 to 2005. “I know as a public official, I am late to the problem,” Hollings told the U.S. Senate Select Committee on Nutrition and Human Needs in 1969. “As governor, I had to put first things first…[I]ndustrial development plus state pride resulted in the public policy of covering up the problem of hunger…You don’t catch industry with worms—maybe fish, but not industry.”

Gatch’s advocacy pushed Senator Hollings to see firsthand what Governor Hollings had ignored. “There is hunger in South Carolina,” Hollings told the committee. “In Beaufort County, I visited a shack in which 16 persons lived and there was no light, no heat, no running water, hot or cold, no bath, no toilet. The entire store of food consisted of a slab of fatback, a half-filled jar of locally harvested oysters, and a stick of margarine…. In the same house one small child had rickets and another was recovering from scurvy.”

He described another area in the state where “38 families were required to use one toilet, the seat of which had been burned for firewood.”

For the remainder of his life, Gatch kept pushing for more and more people to see this truth. When called a liar, he kept talking about the Third World conditions around him. When pushed to resign, he kept on telling that truth. Through the blatantly fabricated accusations that he was a sodomite and a pederast, the relentless Gatch just kept telling the truth.

Unhappy with the attention Gatch brought to the ugly conditions in South Carolina, the Ku Klux Klan came calling. Gatch received threatening phone calls. Someone saw fit to fire a gun in his general direction.

Whenever Jennie Kitty needed help, she called on Dr. Gatch. Now, afraid for his life and the safety of his family, Gatch called Kitty. “I need your help,” he said.

At first, Kitty thought he must be swamped with patients and in need of an extra nurse. But she quickly got the picture. “He was going to spend the night at his clinic.” If the worst was coming, he didn’t want anything to happen to his family. “And I didn’t want anything to happen to Dr. Gatch. He told me, ‘You know who to call.’”

Kitty, now 81, has the tendency when speaking of the past to refer to herself in the third person. “Kitty said, ‘Say no more!’ It’s a good thing I had Dr. Gatch, and it’s a good thing Dr. Gatch had Kitty.”

Kitty called Barnwell, who in turn called nine or 10 other reliable friends. Shotguns in hand, Barnwell and the others formed a perimeter around Gatch’s clinic on that first night. “They hid in the trees, waiting,” Kitty remembered. Meanwhile, Gatch’s wife, Anita, and their two young sons, Rex and Eric, spent that first scary night at Kitty’s home. “I gave Mrs. Gatch my bed,” Kitty said.

“When the KKK got wind we were there, they didn’t come back,” Barnwell recalled. The family felt safe enough to return home the next day. For the next five or six nights, they slept there inside a ring of protective, watchful friends.

When the KKK got wind we were there, they didn’t come back.

The motivation to protect Gatch through those nights came easily. “We were mostly military folks. All of us black. All we had to do was kick it in gear!”

Thus protected, Gatch could continue practicing medicine and pushing for change. “The quality of service he provided allowed his patients to feel like human beings,” Barnwell said.

“He got it,” McKinney said in her Olin Hall office. “He understood.” She turned in her chair and began searching her cabinet for a file. As she looked, she spoke about how satisfying it is for a professor to see lights flash in students as they begin making those connections. “Here it is!”

She turned back to her desk with a packet of papers—an application one of her current students, Sarah Hotovy, submitted for an internship opportunity in Indonesia with the Humana Foundation for Social Research. “Listen to what she wrote: ‘You cannot improve someone’s health without addressing their access to education, and you cannot address issues of education without addressing someone’s living situation, and you cannot address issues of living without addressing the governmental policies which perpetuate low standards of living.’

“She gets it the same way Dr. Gatch did.” (Read more about Hotovy’s interest in public health.)

McKinney said a science education in the liberal arts advances this mentality that seeks connections leading to the root of complex problems. It gives smart and principled people the footing and the voice they need to push hard for difficult truths.

Kitty, for one, misses that voice in Dr. Gatch. “I’d give anything to hear him talk.” She squeezed and smoothed her own voice—an octogenarian South Carolinian playfully imitating the young Nebraskan she remembered. “‘How can I help you, Kitty?’” She laughed at her memories. “I could listen to him talk all day.”

The sound of that voice is lost to most of us. But the truth of his words is still there, and as striking today as it ever was.

“I used to think truth was like a flash of lightning,” Gatch said. “You couldn’t mistake it. I don’t believe that anymore.” He said, “Truth is like a hippopotamus. You’ve got to keep prodding it, or it won’t move.”

All these years after his untimely death, we’re left to wonder what Dr. Gatch would think about today’s South Carolina, Cambodia or Nebraska Wesleyan University. Would he be heartened by all that’s changed for the better, or frustrated by what remains undone? What connections would he draw between his past and our present?

He certainly wouldn’t find truth’s hippo still loafing in the mud where he left it. More and more people have since joined the push that was his legacy.

Dr. Gatch’s push remains a part of our shared inheritance as Nebraska Wesleyan alumni, whether or not we ever knew him. In that way, maybe the glimmers of Dr. Gatch that Prof. McKinney saw in one of her current students are real.

Maybe Gatch is there, too, in Scott Young (’01) as he directs the Food Bank of Lincoln and speaks, as loudly as he must, about ongoing hunger issues in Nebraska. We might glimpse Gatch again in Dr. Scott Shipman’s (’91) willingness to speak an uncomfortable truth to today’s medical establishment. He published a 2011 study that showed a disinclination among pediatricians and family physicians to work in the poor and rural areas where they’re needed most (see “Alumnus Studies Thick and Thin of Pediatric Care”, summer 2011).

In 1975, Gatch left South Carolina to treat patients on the Navajo Reservation near Rough Rock, Ariz. And Barnwell continued running Beaufort Jasper Hampton Comprehensive Health Services. “I recruited all these young black professionals to come back home,” Barnwell said. One of his recruits, Roland Gardner, would take the reins at BJHCHS after his retirement. He serves as its chief executive officer today.

While Gardner didn’t know Dr. Gatch well, he remembered taking his ailing grandfather to appointments with him. “We’d drive an hour to see him,” Gardner said. “It didn’t matter that other clinics were much closer. My grandfather was very fond of Dr. Gatch.”

When BJHCHS added a new facility in Hardeeville, S.C., shortly after Gatch’s death in 1980, Gardner said no one had to think for very long what to name the new clinic. The program from the Donald E. Gatch Medical Center’s dedication read in part that Gatch “asked only that we who complain amidst our abundance awaken our minds to the suffering around us. He showed us the path of service to our fellow man.”

Despite the hatred some whites had expressed just a decade earlier, Gardner said the medical center’s name was warmly received. “People recognized he was telling the truth. The community was embarrassed by it then.” Some people lashed out. But times change. People change. Even hippos move.

Jennie Kitty was initially reluctant to speak on the record for this article. “What if those people [who had threatened to kill Dr. Gatch] read this? My grandkids said, ‘Oh, Grandma, they’re all dead and gone.’ Yeah, but they have kids, don’t they? What about them? And my grandkids say, ‘They don’t know anything about this. And besides, they don’t think that way anymore.’

I used to think truth was like a flash of lightning…. Truth is like a hippopotamus. You’ve got to keep prodding it, or it won’t move.

“So I thought about it and I said I’ll do it. I’ll do it for Dr. Donald E. Gatch.”

Dr. Donald E. Gatch: certified mouth runner. Professional world changer. Licensed pusher of immovable hippos.

“The people who ostracized Dr. Gatch before,” Gardner said, “would be ashamed today.”

But that sense of shame isn’t the only thing to change in Beaufort County, Gardner said. “Beaufort County is now one of the healthiest in South Carolina.” He calmly listed the same factors that Gatch had shouted out 44 years earlier. The life-saving impact of better septic systems and cleaner water. The deaths avoided through safer obstetrics. The access to affordable and reliable childcare.

Gone today are the outdoor privies. The dirty wells. The shanty births over spread out newspapers. Daufuskie Island, where Gatch had watched a woman die of maggots, is known today, not for its health concerns, but for its white beaches and golfing. And the county’s infant mortality rate, Gardner said in his quiet, matter-of-fact voice, has dropped by more than two-thirds since the early 1970s.

These are truths worth shouting.