DID THIS WOMAN SAVE THOUSANDS OF BABIES’ LIVES?
Pearl Tang, an Arizona health-care pioneer.
The battles are familiar to her. She knows about the struggles to get funding for public-health programs, especially the ones that help the poor and vulnerable.
Back in the late 1950s and early ’60s, Pearl Tang fought to get schoolchildren vaccinated, to get women screened for uterine cancer and to get pregnant women checked to make sure they were on track to deliver healthy babies.
Those programs — which seem commonplace now — didn’t exist in Phoenix before Tang created them. Half a lifetime ago, Tang became a crusader for health care for the indigent. And she quickly found that would mean a fight to get tax dollars out of politicians.
“It’s always difficult trying to get money for public-health programs,” Tang, 92, said in an interview at her Paradise Valley home. “It primarily affects the underprivileged population who may not be voters.”
Tang sees familiar arguments as state lawmakers debate whether to expand health-care cov- erage for the poor as part of the federal Affordable Care Act, often called “Obamacare.” Spending money on health care always seems difficult for
local governments, she said, noting that major changes in health care always seem to come from the federal level.
That could be because programs such as the ones she started at the Maricopa County Public Health Department don’t pay off right away. The benefits show up over long stretches of time, as diseases are eradicated and infant death rates level off.
Politicians in state and county offices don’t have that kind of time, Tang said.
“If they spend money, they want instantaneous results so they can tell their voters, ‘Look what I did for you,’ ” she said. “When you’re in politics controlling money, this is what you’ve got to do.
“But we can’t do that because it takes time to catch up and show the statistics.”
For Tang, statistics are on her side.
They show a drop in the infant-mortality rate of more than 75 percent from the 1920s to the 1970s. The rate dropped most dramatically from the 1950s through the ’70s, reflecting Tang’s work.
To take a sample year: In 1970, there were 19,695 births in Maricopa County, according to state statistics. Under the old rate, 819 would have been expected to die before the age of 1. But, under the new rate, that number was down to 270, a difference of 549 babies.
Not to mention the women whose uterine cancer was caught through screenings. And the tens of thousands of children who avoided deadly diseases because of her immunization programs.
Undoubtedly, there are people alive in metro Phoenix today because of Tang’s work. She just can’t say who. Preventive care doesn’t work that way.
As a public-health worker, Tang had to look at statistics to justify her expenses.
“What I did prove (is) that if you take care of the poor, it saves the taxpayer money down the line,” Tang said.
But she knew those numbers represented patients.
“Sometimes when you hear about these arguments about health care, or not wanting to support the cost of expanding Medicaid, people don’t realize we’re taking care of people who are really in need of it,” Tang said. “Health care is really a basic need.”
*** Pearl Mao was born in China. She met her future husband, Thomas Tang, while he was with the U.S. Army in Shanghai during World War II. After the war, he went to finish his degree in Santa Clara, Calif., while she went to Canada and took her residency in obstetrics and gynecology at a hospital in Quebec City.
The two kept in touch during their time apart and, after they both completed their educations in 1947, married and moved to Phoenix. But Pearl Tang discovered her medical degree was no good here. Graduates of foreign medical schools could not take the licensing exam.
Tang went on to study microbiology at the University of Arizona, while her husband, who had gotten a law degree from UA, argued against the licensing policy before the state medical board. He won, allowing his wife to take the exam and become the first Asian female doctor licensed in Arizona. Thomas Tang, who also served in the Korean War, went on to become a judge on the Maricopa County Superior Court and the first American of Chinese descent named to the federal judiciary.
The Maricopa County Public Health Department hired Pearl Tang in 1954 to start an immunization program in elementary schools to prevent an outbreak of diphtheria. She told them she was relatively new to the area.
“They said, ‘Don’t worry, we have nurses who will drive you,’ ” she said.
Tang crisscrossed the county’s 9,200 square miles visiting the schools. She saw the gap between urban and rural areas. She saw places with little access to health care.
And when the immunization program was over, she was asked to stay on with the county health department.
The decision wasn’t just altruistic. At the time, in 1955, the county had only one pediatrician, and he was based in Phoenix. Working for the county, she wouldn’t have to be on call 24 hours a day to deliver babies.
“In obstetrics, I had to get up at night,” she said. “This was a 40-hour job.”
But the job had its own challenges. Arizona’s infant-mortality rate remained stubbornly high. The number had come down slightly since territorial days, said Mary Melcher, a historian who has studied the state’s public-health systems and Tang’s career.
“It was obvious more needed to be done,” Melcher said. “Especially among families of color, there was such a high infant-mortality rate.”
Melcher said she found comments from Valley health officials in the 1920s that suggested race was at the root of the problem: Officials cared only about White families.
“The people who ran public health didn’t care about others, basically,” Melcher said.
In 1950, approximately 41 out of 1,000 children in Phoenix would die before their first birthday. It was the highest of any city in the U.S. with a population of more than 250,000.
Tang looked at those numbers and figured something had to be done. “It’s a red flag,” she said. After studying the data, she saw that most infant deaths happened in outlying areas. Recalling her time vaccinating children in the rural parts of Maricopa County, she knew those areas had few if any health-care opportunities.
“I noticed a lot of women did not get prenatal care, and the reason was there were no facilities for them or they couldn’t get into town,” she said. “I thought what we should do is set up clinics in low-income areas to take care of low-income mothers and children.”
She looked for buildings in rural areas that could be converted into makeshift clinics. She preferred American Le- gion halls because she could tap into the ladies auxiliary groups for volunteers. Those halls also had the setup she needed: a small space that could be an examination room and a large hall to function as a registration and waiting area.
The clinics in Glendale, El Mirage, Surprise, Queen Creek, Gila Bend and Buckeye were set up once or twice a month. When she had trouble getting doctors to work the long days for the meager pay-
ment she could provide, she started seeing patients herself.
“I thought, ‘It gives me a chance to get out of the office,’ ” she said.
It also let her understand her patients’ relationship with health care.
“There were people there who had never seen a doctor,” she said.
One man showed up armed. He sat outside the exam room with his rifle across his lap, wanting to make sure no one but Tang entered the room to touch his wife.
“He didn’t know what to expect,” Tang said. “He didn’t want a man fiddling around with his wife, but he had never seen a woman doctor before.”
Tang realized there was a language barrier. Her patients would respond to her English-language questions with one-word answers.
She and some of her nurses took evening Spanish classes to learn how to communicate better.
“When you talk to a mother in Spanish, they lighten up and you get so much more,” she said.
By 1960, the state’s rate of infant deaths had dropped 35 percent compared with 1950’s. By the 1970s, it was down 67 percent, Tang said.
A study by the U.S. Department of Housing and Urban Development in 1971 called the “plummet” in infant mortality in Phoenix “the most impressive” for metropolitan areas. But Tang wasn’t done.
*** Now that she had clinics set up across the county, she wanted them to start screening for uterine cancer.
Pap smears were common in Canada where she did her residency. To get the screenings started in Maricopa County, she would need to find the money to pay for them, and that was a problem.
“I tried to get money for that,” she said, “and I was a pest.”
County officials told her no. State officials told her no. But one day, the state health director called her and told her to come make her pitch to a federal official who was visiting the state.
The U.S. government wanted to start pilot programs that showed the effectiveness of Pap smears in cancer screenings. It wanted to start the programs in medical schools, but Tang made her pitch to have the screenings in her clinics.
“I wrote up a proposal and it went to Washington and, lo and behold, they wrote me and said they’ll fund us,” she said.
The screenings started in 1962. By 1968, 26,970 women had been screened and 240 cases of uterine cancer had been detected. According to news stories from the time, the average woman testing positive was a mother of four. Saving those lives, Tang said, might have prevented those children from becoming wards of the state.
Tang started a free dental clinic in central Phoenix after learning that dental problems were a leading cause of absenteeism among schoolchildren. She also continued her work in immunizations, expanding the county’s role in giving vaccinations at public schools. In 1956, the county immunized 35,205 children, according to a Republic article. Four years later, the number jumped to 111,909.
But she also worked with the Legislature to pass a law that required all schoolchildren to enter school with their shots up to date. The lawmaker who introduced the bill was Sandra Day O’Connor, who went on to become the first female U.S. Supreme Court justice.
Tang retired from the county in October 1982.
But her legacy continues in Maricopa County, said Bob England, the current head of the county health department, although most of the care programs are handled through the state’s AHCCCS program, which is partly funded by the federal Medicaid program.
Pap smears and prenatal care for indigent women, as well as school immunizations, have become an expected part of health care.
“It is the standard of care now,” England said. “The only problem we have is making sure people receive that standard of care and making sure people are eligible to receive that standard of care.”
People take such measures for granted, he said, and don’t realize they are the result of policy decisions and always are in danger of being taken away.
England said the state recently eliminated $10 million in vaccine funds, threatening the county’s program.
“We are on the edge of risking losing decades of progress in immunizations,” England said.
It’s an age-old problem, he said, of weighing the immediate spending of public money against the possible longterm benefits of improving care for poor patients.
“People don’t like to put it in those terms, but that’s exactly what it is,” England said. Policy makers “don’t think these people over here are deserving.”
Tang is retired now, living in the house she shared with her husband, who died in 1995.
At 92, she isn’t particularly interested in being drawn into public debates about health care. But she has opinions as she sees the federal expansion of health care buck up against the will of Arizona lawmakers.
“I think Governor Brewer is correct in wanting to expand Medicaid,” she said. “Many people have lost their jobs, and they need health care. The expansion of Medicaid is the proper thing to do.”
Like with the programs she instituted 60 years ago, Tang said, the benefit of expansion will be seen through the lens of passing time.
“It will show that there’s a differ- ence in the health of the population,” she said. “It really cuts down on the costs to taxpayers for low-income patients.”
But platitudes seem to matter more than the practical effects of policy, she said. Common sense tells us that preventing a disease is cheaper than curing one, but Tang said it’s a lesson politicians still don’t understand.
They also don’t understand that some of the poorest people in our community don’t have access to health care.
“People don’t realize we’re taking care of people who really need it,” she said.
“We think of America as being a country where everybody’s equal and you get equal opportunity,” she said, “and I think health care is so important.”