Welcome to 2026 where the threats to public health remain the same as 1923.
Sure, there are certainly far fewer occurrences of hookworm, syphilis, and maternal and infant deaths. But our enemies in the United States remain eerily similar: inadequate nutrition and limited access to health care.
But a different year – 1951 – offers insight into combatting these persistent plagues. At the time, South Carolina’s public health system—segregated as it was—saved countless lives due to nurses who lived in the communities they served. That year, Life magazine sent two reporters to the outskirts of Hell Hole Swamp in Berkeley County. They came, in part, to document the state’s health system that then drew national envy.
These reporters stumbled upon Maude Callen, one of those public health nurses. My new book, Maude Callen: Legendary Nurse-Midwife of South Carolina, shows Callen in context of the blossoming-to-withering public health system in the state.
Part of why Callen needs to be remembered is the context in which she lived.
Callen moved to Pineville as an Episcopal missionary nurse on Oct. 1, 1923. Tapped by church leadership to come to the impoverished area, she found her life’s work.
“I can never do too much along any line for our poor, unfortunate ones here,” Callen wrote for The Spirit of the Missions, the publication chronicling Episcopal mission work. “One cannot realize what a rural nurse does unless they have had the opportunity to see the work. I have no special hours, no special place, to be about my duties attending the sick.”
What she discovered was a need for cooking classes. Folks would eat boiled or roasted corn since that’s what grew in the fields to support the moonshine industry. But nutritional deficiencies reigned. Pellagra, a niacin deficiency caused by eating mostly corn, causes the four D’s: dermatitis, diarrhea, dementia and death.
Callen’s other early initiatives focused on prenatal care and early identification of communicable diseases such as tuberculosis. She hosted the county’s first-ever prenatal clinics and the county’s first midwife training class using state instructional materials.
So, Callen already had boots on the ground when the state began investing in county-level public health departments. Berkeley County’s public health department was wise enough to tap the tireless missionary in Pineville.
As Callen’s responsibilities grew, she also gained access to more education and vaccines, though not much more in support or pay. She retained her church position, which helped fund medical supplies. Churches around the county continued to host prenatal and vaccination clinics.
It became a cycle: as Callen’s patients knew more about nutrition, pregnancy and disease became less of a death sentence. And because Callen knew them and saw them frequently, she could catch problems earlier when they were treatable.
What Life magazine photographer W. Eugene Smith captured on film in 1951 was, unfortunately, a fleeting moment. Already, the state was cutting public health spending, kowtowing to the private medical professionals who claimed it was socialized medicine that threatened their practices. In reality, Callen’s poor patients were never going to drive the 27 miles into Charleston for sickness, health ailments or prenatal checks.
By the 1960s as lay midwives disappeared and public health departments began scaling back services, Callen told her trainees to hold strong. Stick to the state rules. Mind your P’s and Q’s. Why?
“Your patients have more confidence in you than they do in their doctor. They’re going to tell you more than they’re going to tell their doctor.”
But when Callen finally retired from public health in the 1970s, rural communities were already amid medical desertification. Berkeley County’s public hospital shuttered. If patients needed care, they had to drive to the city.
Today, like then, when medical care is far away, patients begin opting out, skipping routine prenatal visits and other doctor visits that can prevent or catch diseases early enough to treat. And even when they get to medical services, the rapport is lacking and care is often siloed.
Now, 75 years after Smith left Berkeley County, federal and state policies could lead to more hungry people this year, as reported by Statehouse Report’s Jack O’Toole in December. One in eight South Carolinians already faces food insecurity. It’s worse in rural areas.
Maternity deserts also continue to plague the state. When women don’t live close enough to maternity care, they miss appointments. When they finally get there, the doctors and nurses don’t know these women, and these women are more reluctant to share potentially harmful issues.
Callen is called a saint by those who remember her service in Pineville. But her legacy remains just one generation away from obscurity. With her legacy under threat, so too is the reminder that we once got healthcare (somewhat) right.
Lindsay Street is a former correspondent for Statehouse Report and the Charleston City Paper. Her book, Maude Callen: Legendary Nurse-Midwife of South Carolina,will be released through the History Press on Feb. 24. Follow Street’s book events and updates on her Substack: gatheringplace.substack.com.
Help keep the City Paper free.
No paywalls.
No subscription cost.
Free delivery at 800 locations.
Help support independent journalism by donating today.