Editor’s note: In honor of Black History Month, INSIDE is publishing this article on the history of African-Americans at Duke. It was originally published in the Duke University Medical School’s Alumni News. Watch for other articles in March about Duke University Health System’s diversity initiatives.
In 1963, Duke was among the last medical schools in the country to open its racially cloistered campus to African-American students, setting in motion a long and arduous commitment to diversification that continues to evolve.
Currently, the percentages of minority representation in the faculty and students surpass national diversity averages. While the affront of racism remains an ugly stain in American culture, many praise Duke for the progress it is making toward racial equality across the medical spectrum.
“If you look at where Duke has come from 1963 to now, it has eclipsed everybody in the country on these issues,” says Brenda Armstrong, M.D., a pediatric cardiologist and dean of admissions at the Duke University School of Medicine. Her life at Duke began in 1966 as one of the few African-American undergraduates in the third year of integrated classes. Socially, it was a difficult four years, she says.
Today, Duke is known for embracing diversity and gets calls for advice from top-tier medical schools across the country. The 2005 incoming medical school class contained 30 under-represented minorities (African- Americans, Hispanic-Americans and Native-Americans) in a class of 101. This is the highest percentage in the nation, which averages 11 percent minority enrollment in private medical schools. Duke Medicine’s minority faculty rate of 10 percent far surpasses the national average of 4 percent, based on figures from the Association of American Medical Colleges.
“We are very fortunate at this institution that we have a powerful triumvirate of people with a common, shared vision about Duke being great, and who aren’t afraid to step out and do what is right,” Armstrong says. This leadership team includes Chancellor for Health Affairs Victor J. Dzau, M.D., Duke University President Richard H. Brodhead, Ph.D., and School of Medicine Dean R. Sanders “Sandy” Williams, M.D. “They shape the discourse of Duke in a way that puts them far ahead of just about everyone else in the country.”
Closing the Gaps
Duke is working to close the gaps that still exist. More minorities are needed in tenured and leadership positions and as residents, interns and fellows to better reflect the population the medical system is serving.
“Duke has made broad strokes. But the last holdout is not seeing enough faces in the hospital that reflect mine,” says School of Medicine senior Staci Arnold, who is double majoring in medicine and business.
The need for a heterogeneous physician base in the U.S. is crucial to quality health care. That fact was acutely re-emphasized with the 2002 report by the National Institute of Medicine that linked minority patients’ disproportionately high levels of mortality and disease to the lack of physician diversity. Having more minority physicians will directly elevate the level of health of minorities, it concluded.
“It brings an additional degree of understanding and sensitivity,” says former vice chancellor for health affairs and current faculty psychiatrist Jean G. Spaulding, M.D., who was also the medical school’s first black female student. “I’m impatient to make sure that our pool of doctors and professors represents what the United States looks like,” she says.
Slow Growth
Since the 1960s, each administration has ratcheted up the call for racial diversity and justice, allowing Duke to slowly ascend to the pedestal upon which some schools have put it today.
Delano Meriwether, M.D., pioneered the way as Duke’s first black medical student in 1963. During his entrance interview, he easily could have been jaded by hypocrisy: the university finally was integrating its medical student body, but the hospital still had segregated wards and bathrooms. “I was very put off. In fact, upset,” Meriwether recalls. “I was surprised they wanted me to come back south when it hadn’t changed a bit.”
When Meriwether arrived that fall for classes, the hospital bathrooms were integrated. It wouldn’t be until his third year that the rest of the hospital would follow suit. Not fighting for quicker ward integration is something Meriwether regrets. “I did not demand it at any point, and that is a mistake,” he says. “But my primary goal was to get an education. Some buddies of mine at other schools would have created a huge uproar.”
Recruiting black students was a challenge. Even by 1969, only 3.2 percent of American medical school students were African-American, and 75 percent of those were at historically black Howard University and Meharry Medical College. By the end of the decade, Duke medical school had matriculated just six black students.
A Defining Moment
Racial tensions on campus were so high in 1969 that Armstrong and other black students believed “there was no hope for Duke. We felt we were dying here,” she says. So they took matters into their own hands. In February, nearly 75 undergraduate students in the Afro-American Society " which Armstrong chaired " occupied the Allen Administration Building and issued the administration a list of demands for equality. “We didn’t think we had any other choices,” Armstrong says.
Despite protests from dissenters and the confrontations that followed, the takeover proved to be a defining moment in Duke’s history. The black students received broad support from white faculty and students during the takeover, proving that “our impression that Duke was one-sided wasn’t true. It gave us hope,” Armstrong says. Several of the students’ concerns were swiftly addressed by the administration, including issues of harassment on campus, racism in the classroom, and the need for increased allocation of effort and money to recruiting black students and faculty.
As the 1970s dawned, Duke pushed to increase its minority population across the board. Then chair of Medicine Eugene A. Stead, Jr., M.D., recruited Charles Johnson, M.D., as the first black faculty member. Johnson stayed at Duke until retiring in 1996 and is credited by many as being a key mentor, recruiter and friend to the black community, as well as an effective champion of racial equality.
The medical school also formed an advisory committee that urged the recruitment of interns and residents from predominantly black medical schools. Certainly, having Johnson on staff had a tangible impact, as did Meriwether’s post-Duke success, which included performing award-winning sickle cell disease and leukemia research. Still, recruiting black students to the South was no easy task.
Steady Steps
By 1975, there were 161 African-American applicants to the Duke School of Medicine. Twenty-two were accepted, and 11 enrolled. It also marked the year that Armstrong, who had accepted a full scholarship to earn a medical degree at St. Louis University, returned to Duke for a pediatric residency and fellowship. She was named to the faculty in 1979 as an assistant professor and in 1996 was appointed associate dean and director of admissions.
Keith H. Brodie, M.D., was an “extraordinarily important” player in the diversity cause, according to Spaulding. As chancellor from 1982-85 and university president from 1985-93, “he was always interested in being color blind,” she says. In 1988, he and the President’s Committee on Black Affairs adopted the Black Faculty Initiative, which called for each university department to hire more black faculty. It wouldn’t be until 1996, however, that every department had at least one minority faculty member.
University President Nannerl O. Keohane arrived in 1993 and made it clear that diversification was a top priority. “She didn’t back down from that,” remembers Armstrong. “She was such a strong individual and said to all the schools that this is what she expected. It was a signal appointment” in the history of Duke diversification.
Then-Chancellor for Health Affairs Ralph Snyderman, M.D., rallied behind Keohane’s edict and in 1996 convened a mandatory three-day retreat for all medical department chairs and administrative heads to discuss how to continue building on progress and to learn about ongoing concerns from the African-American community. “It was a response to the fact that it was taking a long time to increase the number of under-represented minorities,” says Snyderman.
During 1996-97, 14 percent of the Duke first-year medical students were minorities. The national average at medical schools at the time was 9 percent. The number shot up to 20 percent the following year. Snyderman signed the Institutional Commitment to Diversity in 1997, pledging Duke’s continued efforts to further establish a diverse workforce and a welcoming environment. Sandy Williams followed this by appointing two African-American chairs: Haywood Brown, M.D., became chair of Obstetrics-Gynecology in 2002, and Danny O. Jacobs, M.D., M.P.H., took the chair of Surgery in 2003.
“For Duke to hire its first African-American chair of a major department speaks highly of the desire to have diversity,” says Brown. “Duke is far ahead of the institution that I was previously affiliated with. Its record of diversity is at the top. Can we do more? Sure, but right now we’re already getting the cream of the crop.”
This is an impressive feat considering the fierce competition between medical schools striving to attract the best minority students. Since Durham is a small metropolis, it loses students to larger cities based merely on its size, according to Arnold, a self-described big-city girl who initially did not consider Duke because of Durham’s size. Fortunately, Duke’s rich resource of dedicated faculty tipped the scales. Armstrong won her over.
Williams says that the commitment to increasing diversity has paid other dividends as well: “As we have become more diverse, many of the other numerical metrics by which medical schools evaluate themselves " selectivity in admissions, peer evaluation by deans, National Institutes of Health grants for example " have improved as well.”
