Rain has made mud soup of the clay driveway leading to the offices of the National Black Women`s Health Project in Atlanta. Inside, water from a leaky roof drips into the foyer of the blue frame Victorian, forming a pool on the hardwood floor.
Byllye Y. Avery, the project`s co-founder and executive director, wades undaunted through the wet obstacle course. The 51-year-old activist has overcome more formidable challenges in her efforts to elevate the self-esteem and health status of black women.
Her perseverance, in fact, has enabled her to transform many a ”wild idea” into practical reality.
Six years ago, the fledging organization was working out of cramped space in a local community center when Avery spotted the 85-year-old, two-story house during a drive through the city`s West End. The home went on sale shortly thereafter and Avery tendered a successful bid, even though she had only $1,000 toward the down payment. The group organized a fund-raising campaign to net the balance.
The project has expanded from a local, shoestring operation into a respected national organization. It conducts health education programs, holds weekend retreats, and disseminates health information. It also operates a wellness center in cooperation with the Southern Christian Leadership Conference and conducts an Avoidable Mortality Cancer Project with the Morehouse School of Medicine and the National Cancer Institute.
But the backbone of the project remains its small self-help groups, where ”women stand up and talk out loud about what`s happening to them,” said Avery, who shuns the chair behind the formal desk in her wood-paneled office, opting instead for a seat in a casual corner of the room.
”They talk about being beaten. They talk about being passed around sexually as little girls. They talk about all of that, and how it feeds into a negative self-image, and how we carry that with us. We`ve heard some incredible stories.”
Avery sees the development of self-esteem as the starting point for fighting debilitating social and health conditions. According to the project, black women are murdered at four times the rate of white women and are twice as likely to die from diabetes between the ages of 45 and 64. Black women die from cervical cancer at three times the rate of white women; black infants die at twice the rate of whites in their first year of life. Alcohol abuse contributes to the deaths of twice as many black women as it does white women. ”First, it has to start in the head,” said Avery. ”As we start to feel better about ourselves, and when we know who we are, we start doing more of the things that we want to do. When we as women feel empowered, we start taking better care of ourselves. We go for our Pap smears. We examine our breasts.”
The National Black Women`s Health Project is the only national organization that focuses on self-esteem as an integral part of black health care. Its success is an outgrowth of each one of the self-help groups,
”whether it`s three ladies meeting on the 14th floor of a federal housing project in Washington or 200 women in a hall in St. Croix,” said Virginia Davis Floyd, M.D., Ph.D, director of the Georgia Health Dept.`s Division of Maternal and Child Health.
”These groups are doing all kinds of things-making films, helping senior citizens in nursing homes, talking to teens-doing for themselves and for their own local community,” Floyd said. ”The success of the project isn`t the grants it`s gotten, it`s these black women who realize that their health is not an outcome of efforts by the federal government. It`s a matter that is in their own hands.”
Last July, Avery`s pioneering efforts were recognized by Chicago`s John D. and Catherine T. MacArthur Foundation, which awarded her a ”genius” grant of $310,000, to be paid in quarterly installments. The fellowship is designed to allow exceptional individuals the freedom to develop new ideas without the pressure of having to account for how their time and money are spent. Fellowship winners are nominated without their knowledge by members of a national panel and are selected after a lengthy and confidential evaluation process. (The awards range from $30,000 to $75,000 annually, depending on the age of the recipient.)
Upon learning of the award, Avery said she ”screamed and screamed and screamed.”
Then, in October, Avery was named one of seven outstanding black women in the nation by Essence Communications Inc., publishers of a national black women`s magazine. The recipients were selected for having a major impact on American society. Avery was honored for achievements in health, science and technology.
Floyd, a professor at Morehouse School of Medicine in Atlanta, observed that in Atlanta ”you can`t talk about black mothers and black babies without talking about Byllye Avery and the health project. They just go hand in hand.”
She met Avery seven years ago and is one of the activist`s most ardent admirers. ”If the problems that plague black women were just part of a medical model, we would have solved them a long time ago. But it`s really more than just a medical model,” Floyd explained. ”It really comes down to how a woman feels about herself and how she feels about her life and about taking control of it.
”You name the parameter and I can give you the statistic that shows we are dying of it at higher levels than anyone else. But it`s Byllye`s belief that it doesn`t have to be that way. We don`t have to have this mentality. We can change it.”
Louis W. Sullivan, M.D., Secretary of Health and Human Services, first met Avery about seven years ago when he was president of Morehouse School of Medicine. ”I sought her out because I was intrigued by the organization and its purpose-that is, to empower black and low-income women with knowledge about health issues so they can improve their health and maintain a sense of independence and self-sufficiency,” he said.
Sullivan praised Avery, the daughter of a rural schoolteacher, for
”empowering poor people, who oftentimes feel they don`t have power and influence.
”I know of no other group that has developed into a national organization that addresses this problem,” he said. ”She is a national treasure and a national resource because of what she is doing.”
Mora McLean, a program officer at the Ford Foundation in New York City, said that health programs are not ordinarily funded by the philanthropic organization, but Avery`s group was an exception. The project is receiving a two-year, renewable grant of $220,000. ”What she is doing is unique,” McLean explained.
Two years ago, the foundation also donated $110,000 to the group to cover the cost of promoting and distributing a film: ”On Becoming a Woman: Mothers and Daughters Talking Together.” The film explored issues of sexuality and reproduction from the perspective of black women. (It`s available on videotape.)
The group has also produced a documentary on infant mortality, prenatal care, and teen pregnancy.
”Byllye Avery is a trailblazer in the area of grassroots women`s self-help groups,” said McLean. ”She takes a holistic approach to health and is not involved in just the physical dimension. She looks at racism as an additional source of stress, which can impact an individual`s ability to live a fulfilling life.”
The project`s genesis was personal tragedy. At 33, Avery`s husband died of a massive heart attack, leaving her with two small children and many unanswered questions. (Daughter, Sonja, 23, now works for the project; son, Wesley Jr., 27, lives in Gainesville, Fla.)
”I hadn`t thought much about health until Wesley died in 1970,” said Avery, who had earned a master`s degree in special education and was working with autistic children at the time. ”Wesley had never been sick a day in his life. He was what we in the black community call, `in the picture of health.` It was actually a picture of death.”
A child of rural poverty, Avery`s husband was the first in his family to earn a college degree. He was within four months of receiving his Ph.D. in sociology when he died.
”His daddy never made more than $2,400 a year in his life,” Avery said. ”He came from a family that respected education, but they were strapped by their poverty and culture. So they ate all of the wrong things-like too much fat and too much salt. I can remember Wesley insisting on having butter on the table all the time. Some of that is what killed him.”
Later, Avery realized her husband`s death had been foreshadowed 10 years earlier during an Army physical when he learned his blood pressure was too high. However, after he rested for 20 minutes and it was taken again, the reading was normal, she said.
”The act of laying him down and picking him up, and saying everything was okay, made it seem as if it wasn`t a big deal. This was in 1960 before the massive education campaign about hypertension. And in the black community, everybody had high blood pressure, or `bad nerves,` and we didn`t know there was anything to be alarmed about.”
Avery then turned to the women`s movement, where she became active in health issues. In the mid-1970s, she co-founded the Gainesville (Fla.) Women`s Health Center and Birthplace, a Gainesville alternative birthing center.
Then, in 1981, while researching a grant in Washington, Avery was stunned by two simple sentences buried in a health atlas. A survey reported that more than half of black women 18 to 35 years old rated themselves in psychological distress, she recalled.
”Their distress was rated higher than that of diagnosed mental patients,” she said. ”I was blown away. I wondered what was this distress that black women were feeling?”
A board member of the National Women`s Health Network at the time, Avery proposed a conference on the special concerns of black women. Her idea was well-received. ”We believed that the issue should be given priority and that it had been long neglected,” said Sybil Shainwald, who was president of the National Women`s Health Network at the time.
Avery pulled together a group of 21 women to plan the meeting-the first National Conference on Black Women`s Health Issues, which was held in June 1983 at Spelman College in Atlanta. She had anticipated attendance by 200 black women, but about 2,000 showed up.
”It was remarkable,” said Shainwald, who attended the conference. Black women came by bus, they came by car. They came however they could get there. It was truly a conference by and for black women.”
Years later, in North Carolina, Floyd witnessed firsthand Avery`s remarkable organizing abilities.
”We traveled together to do a speech in Raleigh-Durham,” she said.
”When I came back to the hotel, there were about 50 women on the floor. I asked her what was going on. She said: `We`re going to organize. No one has done any organizing around here.`
”She asked the women: `Can`t you pick up the phone and call someone up, and tell them to come over?` ” Floyd recalled. ”A chapter of the National Black Women`s Health Project was started in the hotel that night.”
At the core of Avery`s work is what she calls ”breaking the conspiracy of silence” that prevents black women from discussing their personal and health problems. ”We give women the permission to talk about it,” she said. ”Once we start to talk, it ends the isolation.
”There`s no shame in being afraid, in saying, `Come hold my hand.` ”
Avery hopes that by tearing down the invisible wall of silence the next generation will be spared its predecessors` psychological and physical ills.
”Why do you think our babies are dying?” she asked, raising her voice.
”It`s because their mommas are dying. They`re in dead relationships. They`re dead inside. They feel empty. Most black women function as an empty well.
”We are expected to take care of our children. We`re expected to take care of our husbands. And most of us get very little in return. If you go to a well and keep drawing water, and there isn`t a spring to refill it, then the well will become empty.”
Avery has tried to refill that spring through dialogue, advocacy and grassroots education. She believes that self-help groups that deal only with physical problems are not effective. ”They have to combine the physical and the emotional,” she said.
A motivational speaker, Avery delivers about 60 speeches a year to women`s groups, medical students and health leaders.
”There`s a whole way of thinking about how you take care of your body,” she said. ”If you`re in a relationship with a man who is beating you, do you think you`re going to remember to get your Pap smear? You`re going to spend most of your time worrying about him and his actions and whether you can get out of this situation.”
That approach has won Avery considerable respect among health providers, including Sandra MacDonald, executive director of Outreach Inc. in Atlanta, an AIDS education program that focuses on minority substance abusers. ”There is a tendency to look for someone else to come along and provide leadership,”
MacDonald said. ”Byllye actually does something.”
One of the things she tries to do is influence physicians to assume greater responsibility for breaking down communication barriers. ”As a community, they don`t take input from the consumer,” Avery said. ”We have the greatest medical system in the world, but I want it to be available for everybody. I will always be the one who will demand that. Right now, there`s no commitment to making it available. Medical care is a commodity that is bought and sold.”
Sullivan said he shares Avery`s concern about getting health information out to the public, especially to underserved communities. ”As a physician and as head of a medical school which trains physicians, I was concerned that oftentimes health professionals have knowledge about health matters, but have difficulty transmitting it in a way that makes it understandable and creditable in the eyes of poor people,” he said.
”She has a particular knack for translation. She has a lot to offer us about how we can be more effective in training doctors to carry the message of preventive health care.”
Avery, whose delivery alternates between rapid-fire and Southern slow, is a composite of opposites. Her voice ranges from soft to impassioned. Her movements are at times subdued, then animated.
”She is a laid-back person” who works hard, Floyd said. ”I`ve worked with her at three o`clock in the morning on grant proposals. I`ve seen her holding someone`s hands through a crisis. I`ve seen her trying to get someone`s electricity turned back on. She is a tireless, hard worker.”
Her special gift is an ability to get people to believe in her vision
”and to buy into it,” said Loretta Ross, who left the National Organization for Women to work for Avery. Ross became the project`s national program director last July.
”It`s hard to keep Byllye focused on the present, because she`s always in the future,” Ross said. ”We`re talking about what we`re to do to get funded this year, and she`s thinking about what we are going to do 10 years from now.
”If it`s a drawback, it`s the drawback of a visionary. But that`s where the leadership comes from. How else would you know what goals to go after, if someone isn`t thinking in the future and taking you there?”
The challenge now is in formalizing the grassroots project and making it more structured. ”Our success is actually outpacing our growth,” Ross said. ”We don`t have all the staff in place to support our programs, and we don`t have a lot of operational systems in place. We also have to change our funding base-right now we`re largely foundation-dependent. We have to become more self-sufficient.”
The project subsists on membership dues, about a half-dozen foundation grants and small donations. It has an annual budget of more than $800,000. The wellness center, which serves women in a local public housing development, operates on a separate grant from the Kellogg Foundation.
Avery plans to withdraw from day-to-day project business in early July to begin using her MacArthur fellowship. She said she plans to locate near a first-rate medical library and write. Her 13-member staff has been learning to get along without her. Shainwald said the transition should be smooth because Avery ”doesn`t need to control.”
In fact, Avery`s lack of ego is the basis for much of her success, say her friends and associates.
”She`s a very calming, positive person with inward beauty,” said MacDonald. ”Her short Afro, her natural look-she`s a healthy example of how we can be.”
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For more information about the National Black Women`s Health Project, contact the group at 1237 Gordon St. SW, Atlanta, Ga. 30310, 1-404-753-0916.
