STRAIGHT TALK

Dr. Joycelyn Elders, a living monument to the black experience in
Arkansas, may be retired, but she's not retiring about the issues
that made her a controversial surgeon general.

Fourteen years after President Bill Clinton fired her as surgeon
general of the United States for uttering one final impolitic remark,
Dr. Joycelyn Elders is long into retirement, but hers is not a repose
that the meek would envy or her many old critics would cheer.

And if you were wondering, no, she never shut up or took up mincing words.

Straight talk made Joycelyn Elders famous, earned her a legion of
enemies and finally got her fired, but she does not wish that she had
substituted a single euphemism for any of it, not even her mention of
masturbation at a world AIDS conference at the United Nations in
December 1994 that brought an angry telephone call from Clinton
demanding her immediate resignation.

She returned to her teaching and clinical career at the University of
Arkansas for Medical Sciences and retired there in 1998, but
retirement may not be an apt word for it. Not counting talks to
groups around Arkansas, Dr. Elders made more than 50 speeches in 20
states last year, which was well off the pace of even her retirement
years and a tacit acknowledgement that, at 75, she's tapering off a
bit. Although no longer engaged in clinical or laboratory work, she
managed the past four years to publish seven articles in national
medical journals or books. She is on nine boards, eight outside
Arkansas and the other at her alma mater, Philander Smith College.

She still carries the title professor emeritus of pediatrics at UAMS
but she works now from the study of the ranch-style home south of
Little Rock that she and her husband, the legendary basketball coach
Oliver Elders, bought in 1987. The terrain but not the culture would
have reminded her then of the piney woods of Howard County, where she
grew up in a three-room sharecropper's cabin with seven younger
brothers and sisters under conditions that offered slim prospects for
even a way out of the cotton patch much less an eminent career in science.

The subjects of her speeches and papers are mostly but not altogether
those that lifted her from relative obscurity as a medical scientist
and public health administrator 20 years ago to be the nation's top
physician, chief health educator, children's tribune and public
scold. The subjects are human sexuality and its effect on health and poverty.

You would think that getting fired from the biggest job you ever had
by the president of the United States and having it reported on the
front pages of newspapers across the country would hang like doom
over her existence but she speaks of it cheerfully, even proudly. For
that humiliation she harbors no anger for Clinton.

"I never thought at all that Bill Clinton was the reason I was
leaving Washington," she said the other day. It occurred at a
particularly low point for Clinton and his administration.
Republicans had swept the congressional elections a month earlier, he
was largely blamed for it, and a New York Times poll showed that only
28 percent of the people trusted him on economic issues. The White
House had gone into a defensive crouch when Dr. Elders went to New
York on Dec. 1, 1994, to address a global HIV-AIDS conference at the
United Nations.

Dr. Elders was already a lightning rod for the administration owing
to her defense of abortion and her advocacy of sex education and
contraception. Because she said youngsters should be taught to use
condoms to prevent pregnancy and AIDS, conservative groups labeled
her "the condom queen."

She had finished her lecture at the U.N. and the discussion turned to
blunting the AIDS epidemic by breaking down the taboo of talking
frankly about sex. A psychiatrist suggested that encouraging other
forms of release besides sex might be one way to prevent risky sexual
activity that led to AIDS and teen pregnancies. "What do you think
are the prospects for the discussion and promotion of masturbation?" he asked.

She recalls that she squirmed a little but answered that she believed
in comprehensive health education and that children should be taught
what they needed to know in ways that were appropriate to their age.
It seemed vague but she later said she was not trying to be coy and
that she thought masturbation was a part of human sexuality and
perhaps should be included in comprehensive sex education discussions.

Nothing was reported about the remark but it got back to Donna
Shalala, the secretary of Health and Human Services, who had never
been a fan of the Arkansas doctor. A year earlier, Shalala had
scolded her for a remark at the National Press Club. Someone asked
her if legalizing drugs would lower the crime rate. Dr. Elders
answered that it would do that but she did not know all the other
consequences of legalization. Perhaps it ought to be studied, she said.

Twelve days after the AIDS conference, Shalala summoned her to her
office and asked whether she had said masturbation should be
discussed in sex education. Dr. Elders recalled that she had said
something like that. Shalala said it was a real problem and that she
was not sure Dr. Elders could be saved.

Back at her office later in the morning, she received a call from
Clinton's chief of staff, Leon Panetta, who said he wanted her
resignation on his desk by 2:30 p.m. She told him she was not
resigning until the president himself asked her to resign. The White
House had already leaked word to the media that she had resigned and
it was on the radio. Clinton telephoned from Florida and in an angry
tone said he was sorry but her remarks made it impossible for him to
keep her. He wanted her resignation immediately. She wrote it out,
took it to the White House, cleaned out her desk and her house and
headed back with Oliver to Little Rock.

Never would she talk to Clinton again, but she said Oliver saw him
several years ago and he said he was sorry about all of it and that
she had been right. You might expect some contrition from a man whose
tawdry contributions to the public dialogue on sexuality would make
her remarks sound like a Sunday school homily.

Dr. Elders still doesn't blanch talking about the subject. Why should
masturbation be taboo, a topic only of locker-room jokes? In fact,
she set out several years ago to write a book about the subject with
Dr. Barbara Kilgore, a retired United Methodist minister. They have
got off track, she said, "but I intend to finish it and get it
published before I die."

Clinton could not have been surprised by her remark. Unflinching
candor and the biting epigram were her trademarks after he appointed
her state director of public health. "These people should get over
their love affair with the fetus," she said of anti-abortion groups
that were fighting her efforts to establish school-based health
clinics in Arkansas. The phrase inflamed religious conservatives, who
would picket her appearances for the next six years.

Before his inauguration in 1993 Clinton invited her to the Governor's
Mansion, where he asked her to be surgeon general. She was reluctant
and she recalls telling him, "Governor when you asked me to be your
health director you didn't know anything about me. But if you do
this, you will know exactly what you're getting," adding "You know I
tend to say what I think."

"I know that for sure," he said.

Back at Little Rock three weeks after her firing she returned to her
job as professor of pediatric endocrinology at UAMS, from which she
had had a leave of absence for seven years. She went back to teaching
and clinical practice, but she didn't entirely shed the political
intrigues of her public health years. Arkansas Right to Life, a
nemesis of those years, made a freedom of information request for a
daily account of her activities, her comings and goings. Until
shortly before she retired, she recorded her arrival times,
departures and speaking engagements with the secretary for the
Endocrinology Division for a monthly report to the group.

Dr. Harry P. Ward, the chancellor, told her that several Arkansas
legislators with whom she had crossed swords called to say that she
should not be restored to the medical faculty. "He said they told him
I would contaminate the minds of the bright young medical students."

Sexuality, sex education, abortion, condoms, HIV-AIDS ­ those were
topics to which Dr. Elders had given little systematic thought before
she became director of the Department of Health in 1987. As a
pediatric physician and scientist she had seen enough teen
pregnancies and childhood victims of sexual abuse and the terrible
consequences of both, "but I looked at them as individual cases," she
said recently. She had not extrapolated those experiences into a
systematic view of the problem.

She still remembers, poignantly, one of the early cases when she was
a pediatric resident at UAMS. For two weeks, she treated a
13-year-old girl from the Ozarks who came to the hospital with severe
hyperthyroidism. With the thyroid problems under control the girl was
to be released but she begged Dr. Elders not to let her go home,
finally explaining "Saturday nights my daddy and my brother and my
uncles use me and my sister."

Dr. Elders wanted to report the case but the hospital social worker
told her that she, not the men, would be punished. This was six years
before the state toughened its child-abuse laws. She spoke to the
girl's mother delicately, but the mother did not think there was a
problem. The girl returned to the hospital some months later,
pregnant by her father.

"I knew that her life was over and that I, the medical profession,
had failed her," Dr. Elders said.

As the chief pediatric endocrinologist (one who studies disorders of
the hormone system and the body's chemistry), she would treat
hundreds of cases of children with diabetes and growth disorders and
she wrote or co-authored more than 100 medical articles, most of them
on children's hormone problems. She was particularly distressed at
the high rate of teen-age girls who were diabetic, sexually active
and often pregnant, a grave peril to the girl and the baby. The
girls' bodies were not ready for pregnancy and they were not ready
for parenthood. She always got the diabetic girls to promise her that
they would not be sexually active or if they were that they would
avoid pregnancy at all cost.

Her first months on the job as state health director were an
epiphany. She spent much of the time in county health clinics around
the state, seeing patients and following home health nurses to the
ramshackle homes to see pregnant and obviously sexually abused
children. In one county they paid a visit to a 13-year-old girl for a
six-week postpartum checkup who they suspected was pregnant again.
She was living with six men, and one of them told the nurse that he
thought she was giving them all an infection of some kind.

Then the magnitude of the problem became clear. She had seen the
reality behind the statistics. The United States had the highest
rates of teen-age pregnancy and out-of-wedlock births in the
industrialized world and Arkansas had the highest rates in the United
States. She would write about the epiphany in her autobiography in 1996:

"Seeing these places was taking me right back to where I had come
from. I could identify with all of it. I wasn't looking at these
scenes and saying, 'Oh, my goodness gracious isn't this just
terrible?' I had lived through it. I didn't have to think, How in
God's name do these people survive? I knew how they survived. They
survived the same way we had survived. Ignorant and without help."

So began her crusade to save a generation of children by confronting
head-on the great tension of the times, the sexual revolution and the
culture of not talking frankly to kids about sex. She set out to open
a public dialogue, in the schools, health offices, churches, the home
and any other forum, on the most prevalent subject in America ­ sex ­
but on a level that was largely taboo. It began with school-based
health clinics, improvement of local health offices and expansion of
the home health program, sex education and, almost incidentally, a
defense of abortion.

She opposed the repeated efforts to restrict abortions, not so much
because women should have dominion over their own bodies, though she
believed that, too, but because it gave youngsters more freedom to
choose their own destinies, including education, and because it meant
fewer babies who came into the world unhealthy and doomed to the
plight of their mothers who were unprepared to parent children.

She believed and still believes that teenage births were the largest
cause of poverty in America.

"It's not just my belief," she said. "It's been proven. Children get
pregnant, fall behind in school or drop out, they don't get an
education and they can't get a job. They don't do well in life. When
you look at the prisons, a very large percentage of young people in
prison were born to teenagers who weren't ready to be parents. Many
are there because they killed their mom's boyfriend. The cost of
teen-age pregnancy is just incalculable."

The teen-age pregnancy rate has been declining since she began her
campaign in 1987, by 36 percent for black teen-agers, but it began to
rise again in 2006 and 2007, she said.

The Guttmacher Institute, on whose board she sits, found that 70
percent of the reduction in teen pregnancy was related to the use of
condoms. Twenty-five percent was related to abstinence, a product of
the AIDS panic of the late '80s and '90s, she believes.

She fought the abstinence-only education advocates, and studies as
late as last month, including one by the Bush administration, have
shown that she was right, that abstinence-only education and a pledge
of abstinence until marriage makes no difference in the sexual
activity of youngsters.

"They may delay for five or six months, but what happens when they do
become sexually active is that they don't use condoms. They are
greater risk takers and they get sexually transmitted diseases,
including HIV," she said last October. A report making precisely
those conclusions was published in January.

All the battles were at bottom about poor children, mostly
African-American, getting an education. Early pregnancy nearly always
blocked girls' path out of poverty and dependence. It was not an
altogether popular stand among African-Americans. Black ministers in
her own community, Dr. Elders said, accused her of aiding a campaign
of racial extermination by pushing contraception.

Her own unlikely life convinced her that education was the ticket to
everything for African-Americans and that the paramount job of anyone
in public service like herself was to try to remove anything that impeded it.

Born Minnie Lee Jones (she changed her name in college to Joycelyn,
the name of her favorite peppermint candy), she was the eldest of
eight children, which made her the foreman when each of them got old
enough to help in the cotton fields that her daddy sharecropped. He
also trapped raccoons and she helped him skin them. They ate the
raccoons and he saved the money from the skins to buy swatches of
land for himself, eventually accumulating 80 acres.

School for blacks was a two-room house at Bright Star (the one in
Howard County, not the one farther south in Miller County), where
there were benches but no desks, no workbooks and few books. School
was held when there was no work to be done in the fields. The school
bus was an old truck chassis with a flatbed covered by a big plank
box with chicken wire nailed over the window openings so the children
wouldn't tumble out. High school was the training school for black
children still farther east at Tollette although few went to high school.

But there was a reasonable semblance of education going on both
places. In 1944, she got a better chance. Her father got a wartime
job in the Richmond Shipyards on San Francisco Bay and she and her
mother and the smallest baby joined him for two years. For the first
time she attended school with whites. The school tested her and
placed her two grades ahead of her age group. She excelled for two
years and she got the idea that she was as bright as white kids and
might do something more than work in the cotton fields or even clerk
in a dime store at Nashville, which had been her farfetched ambition.
Only whites were store clerks in Arkansas in the 1940s.

The family was reunited at Schaal after the war and she went to the
training school for blacks at Tollette, graduating in 1949 at the age
of 16. A Methodist official announced at the graduation that the
church was giving a scholarship at Philander Smith College at Little
Rock to the valedictorian, which was she. She had never heard of
Philander Smith or been to Little Rock, but she wanted to go. Her
father did not want her to go because she was needed for the cotton
harvest in late September, but her grandmother persuaded him to let
her go. When fall came the family did not have the $3.82 bus fare
from Nashville to Little Rock. All the children turned out to pick
early cotton until they had the fare.

It was at Philander Smith where she met Edith Irby, the first black
medical student at the University of Arkansas, who was invited to
speak at chapel. Irby, later Dr. Edith Irby Jones, professor of
medicine at the University of Texas, ended by reciting a poem about
taking the high road. Minnie Jones was spellbound and decided that
she would be a doctor, too. After college, she joined the Women's
Army Medical Corps, received training as a physical therapist and
finished as a second lieutenant and with eligibility for the GI Bill.
Together with her Army savings, that enabled her to go to medical
school. She would excel as a student, an intern and a resident and
finally as a medical scientist.

She still marvels at the constellation of events that allowed her to
escape the cotton fields and the ignorance and poverty that were the
nearly certain fate of black children of that era and culture.
Education did it. Partly out of recompense for their help in raising
the $3.82 for her bus fare to Little Rock that early September day,
she saw to it through example, encouragement and financial help that
all her siblings except one got to college. A sister earned a Ph.D.
All her medical training and expertise in childhood disease and
development came to be directed at clearing away the health obstacles
to an education.

Dr. Elders sits for the second time on the Board of Trustees at
Philander Smith, which she says gave her an education as fine as
Harvard would have given her. While a film crew was filming her at
Philander Smith in November for a documentary on her life that AETN
Channel 2 is preparing, two men students saw her and wanted to shake
hands. They said they wanted to tell their mothers they had met her
and thank her for paving the way for them.

She smiled but the scold returned. "How are your grades?" she asked.
"Are you studying or just trying to slide by?" They said they were
working pretty hard. Good, she said, because she had been to the
penitentiary and it was full of young men who hadn't. It's
discouraging sometimes, one said, but they were going to persevere to
graduation.

"Promise?" she asked each.