Marilyn Gaston, M.D.

Sickle Cell Disease Pioneer and Public Health Advocate

Marilyn Hughes Gaston, M.D. is lauded for her contributions to the sickle cell and public health communities. As the first African American woman director of the Bureau of Public Health Care in the U.S. Health Resources and Services Administration, Gaston’s career is marked by success and determination.[1] And it is such resolve that propelled her career in medicine.

Born on January 31, 1939 to Myron and Dorothy Hughes, Gaston was raised in the public housing projects of Cincinnati, Ohio. Myron worked as a waiter, and Dorothy secured a job as a medical secretary. [2] Gaston’s led an enjoyable childhood despite the Hughes’ limited financial means. As Gaston recalls, “We were poor financially, but not in terms of love and happiness.”[3]

At nine years old, Gaston witnessed her mother lose consciousness in the living room. Gaston was frightened, unsure of how to help or notify others to that she need immediate assistance:

“One day I was in the living room with my mother… and that day she fainted in the living room. And I had no idea what was wrong. It was very frightening to me, and back then we didn’t have 911 and so I didn’t really know what to do… she had cancer of the cervix.”[4]

Gaston soon learned that her mother suffered from cervical cancer, and her loss of consciousness was the direct result of internal bleeding.[5] Gaston understood that inadequate healthcare impeded her mother’s ability to receive the medical attention she needed and deserved: “We were poor, we were uninsured, she was not getting health care, …and that’s why she fainted. And from that point on, I knew that I wanted to do som[e]thing to change that situation.”[6]

Three years later, the Hughes’ vacated the public housing projects of Cincinnati, and Gaston entered a college preparatory school, where she was discouraged from pursuing a career in medicine.[7] For a poor African American woman, medical school was deemed impossible.[8] The Hughes’, however, encouraged their daughter to pursue her ambitions, reminding Gaston that “[y]ou can be whatever you want to be.” The Hughes’ believed in the notion of the self-fulfilling prophecy, often quoting former President Henry Ford: “[T]here are people who believe that they can and people who believe that they cannot.”

Gaston was further influenced by “fierce black women,” or African American women deemed “self-confident and determined to succeed.” Gaston refers to author Maya Angelou when discussing these role models: “We live in direct relation to our heroes and ‘sheroes.’” Of these “fierce black women,” Gaston’s mother and godmother were of particular importance. To Dorothy Hughes, racism was not an excuse for failure, and she often told Gaston: “Don’t give in, give up, or give out.” Gaston’s godmother became a prominent influence to Gaston, challenging racist sentiments by taking neighborhood children, including Gaston, to a local “Whites Only” pool every Saturday. Gaston’s godmother succeeded in desegregating the pool, demonstrating the power of perseverance.[9]

Gaston later enrolled in Miami University, where she studied zoology. Miami University faculty and advisors continued to dissuade her from pursuing a medical degree, and Gaston graduated in 1960 with a certain ambivalence toward a career in medicine. One physician, however, encouraged Gaston to pursue medicine: “He told me that if I really wanted to be a physician, I would never be satisfied with the nursing duties I was then performing…He told me to go for it, and I did.” Gaston enrolled in the University of Cincinnati School of Medicine, where she was one of six women and the only African American woman in her class. Gaston graduated in 1964 and began her internship at Philadelphia General Hospital.[10]

Gaston developed an interest in sickle cell disease (SCD) as an intern at Philadelphia General Hospital. One evening, Gaston admitted an infant with a swollen hand and struggled to determine the underlying cause. The supervising resident suggested that the infant may suffer from SCD, and these suspicions were confirmed with blood work. Gaston was disconcerted that she was unable to diagnose the infant, in turn seeking to gain further SCD knowledge. Gaston developed an interest in SCD that would later change the standard of care in infants born with SCD. Gaston completed her training as a pediatrics resident at Cincinnati Children’s Hospital Medical Center and began to practice medicine in Lincoln Heights, Ohio, an all African American suburb of Cincinnati.[11]

Gaston received various offers to practice in wealthier neighborhoods, but her interest in providing superior care to underserved communities propelled her to practice in Lincoln Heights. Gaston secured a grant to open Lincoln Heights Health Center, the first community health center in Ohio.[12] The Lincoln Heights Health Center opened in 1967 in a four-room apartment, where the living room functioned as a waiting room, upstairs bedrooms served as exam rooms and nurse stations, and the kitchen and basement were occupied by lab services and volunteer dentists, respectively.[13] Gaston became the director in 1969, providing guidance and leadership over a three-year period. Lincoln Heights Health Center served an array of SCD patients, prompting Gaston’s interest in developing a superior means to treat the disease. Using grant money allocated by President Nixon for the study of SCD, Gaston left her position as director of the Lincoln Heights Health Center and opened the Sickle Cell Disease Center in 1972.[14] Lincoln Heights Health Center continued to thrive as a community health center and is now one of several sites operated by The HealthCare Connection.[15]

Gaston left Cincinnati in 1976 when husband Alonzo Gaston secured a teaching position at Howard University in Washington, D.C.[16] Gaston accepted a position as a medical expert in the Sickle Cell Center of the National Heart, Lung, and Blood Institute (NHLBI), one of the various branches at the National Institutes of Health (NIH). Gaston continued her work at the NIH for fourteen years and later became the deputy director of the Sickle Cell Center. [17] In 1979, Gaston entered the U.S. Public Health Service Commissioned Corps and, in 1990, was the second African American female to be promoted to Assistant Surgeon General and Rear Admiral.[18]

In 1986, Gaston published a study that revolutionized the treatment of infants born with SCD. As Smith and Kinney write, “The role of prophylactic penicillin as the cornerstone of management to reduce morbidity and mortality from S. pneumoniae [the bacterial agent responsible for pneumonia, meningitis, and septicemia] was defined by Gaston, Verter, Woods, et al. (1986).”[19] Gaston and her colleagues conducted a multicenter, randomized, double-blind, placebo-controlled clinical trial to assess whether the twice daily administration of oral penicillin would be effective in reducing the incidence of infection from S. pneumoniae in children with SCD under the age of three when admitted into the trial. Gaston, Verter, Woods, et al. (1986) reported “an 84 percent reduction in the incidence of infection […] in the group treated with penicillin,” prompting the study to be terminated 8 months prior to the anticipated end date. [20] At present, the American Academy of Pediatrics recommends twice daily administrations of 125 mg of penicillin V potassium in patients under the age of five, the same dosage used by Gaston, Verter, Woods, et al. (1986). With the implementation of routine newborn screening, infants can be diagnosed and treated early. [21] Forty states launched screening programs within a year of the study’s publication.[22]

By 1990, Gaston began to focus her efforts on public health, assuming the role of director of the Bureau of Primary Health Care (BPHC) in the U.S. Health Resources and Services Administration (HSRA).[23] As the first African American woman director of a Public Health Service bureau, Gaston worked with a $5 billion budget to improve health care services for underserved communities.[24][25] More than 12 million individuals in more than 4,000 sites received health care services throughout her administration.[26] In 1998, Gaston championed the “Movement Toward 100% Access and 0 Health Disparities,” a movement designed to “get community leaders and business groups to set and achieve clear goals of everyone having equal access to primary health care in their communities, free of disparities based on race, ethnicity, gender, age, sexual preference of income […]”[27]

Gaston retired in October 2001 but has nonetheless continued her contributions to the public health sector. Gaston worked in collaboration with clinical psychologist Gayle K. Porter to publish “Prime Time: The African American Woman’s Guide to Midlife Health and Wellness.” Gaston asserts that African American women neglect their own health in their efforts to care for others. As a result, Gaston notes “[w]e as Black women are dying at rates greater than any other group of women.” Many of these deaths, however, are preventable. The book discusses exercise and nutrition to emphasize “a lifestyle of prevention” and further aims to draw attention to a health care system that fails to promote preventive medicine. “Prime Time: The African American Woman’s Guide to Midlife Health and Wellness ”was published in May 2001, and Gaston used her early retirement to promote the book. [28] At present, Gaston serves as co-director of the Gaston and Porter Health Improvement Center, a non-profit with a mission “to empower women, especially women in mid-life, to prioritize and improve their physical and emotional health and reduce their health disparities.”[29]

Gaston has accrued manifold honors throughout her career. Gaston is the recipient of several prestigious awards from the National Medical Association, including the Scroll of Merit and Lifetime Achievement Award. The University of Cincinnati has named a scholarship in her honor and full funds for the medical education of two underserved minority students. Residents of Cincinnati, OH and Lincoln Heights, OH celebrate the annual “Marilyn Hughes Gaston Day.”[30] Gaston has left an indelible mark in the public health and sickle cell communities as she triumphed through tremendous obstacles.

___________________________________________________________________________

[1] “Dr. Marilyn Hughes Gaston.” Changing the Face of Medicine. U.S. National Library of Medicine, n.d. Web. Accessed 6 Apr. 2014. <https://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_124.html&gt;.

[2]”Marilyn Hughes Gaston.” Contemporary Black Biography. Vol. 60. Detroit: Gale, 2007. Biography in Context. Web. Accessed 8 Mar. 2014.

[3] Huggins, Amy. “Marilyn Hughes Gaston, M.D. (MSA SC 3520-14533).” Biographical Series. Maryland State Archives, 16 Aug. 2006. Web. Accessed 6 Apr. 2014. <http://msa.maryland.gov/megafile/msa/speccol/sc3500/sc3520/014500/014533/html/14533bio.html&gt;.

[4] Huggins, 2006.

[5]”Marilyn Hughes Gaston.” Notable Black American Women. Gale, 2002. Biography in Context. Web. Accessed 8 Mar. 2014.

[6] Changing the Face of Medicine, n.d.

[7]”Marilyn Hughes Gaston.” Notable Black American Women. Gale, 2002. Biography in Context. Web. 8 Mar. 2014.

[8] Contemporary Black Biography, 2007.

[9] Huggins, 2006.

[10] Ibid.

[11] Ibid.

[12] “The HealthCare Connection: Our History.” The HealthCare Connection, n.d. Web. Accessed 6 Apr. 2014. <http://www.healthcare-connection.org/about/our-history/&gt;.

[13] The HealthCare Connection. Annual Report: A Retrospective of our Fortieth Year. Cincinnati: The HealthCare Connection, 2007. <http://www.healthcare-connection.org/wp-content/uploads/2013/10/AnnualReport2007.pdf&gt;

[14]Notable Black American Women, 2002.

[15] “The HealthCare Connection: Our History,” n.d.

[16] Huggins, 2006.

[17] Notable Black American Women, 2002.

[18] Contemporary Black Biography, 2007.

[19] Smith, Jeanne A., and Thomas R. Kinney. Sickle Cell Disease: Screening, Diagnosis, Management, and Counseling in Newborns and Infants. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1993. Print.

[20] Gaston, Marilyn H., Kim Ritchey, John Kelleher, Charles Pegelow, Gerald Woods, Joel I. Verter, John M. Falletta, Frances M. Gill, C. Tate Holbrook, Steven Diamond, Jeffrey S. Lobel, Rathi Iyer, Elliott Vichinsky, Harold Zarkowsky, and Gerald Presbury. “Prophylaxis With Oral Penicillin In Children With Sickle Cell Anemia.” New England Journal of Medicine 314.25 (1986): 1593-1599. Print.

[21] Cober, PharmD, Mary Petrea, and Stephanie J. Phelps, PharmD. “Penicillin Prophylaxis in Children with Sickle Cell Disease.” Journal of Pediatric Pharmacology and Therapeutics 15.3 (2010): 152-159. Print.

[22] Changing the Face of Medicine, n.d.

[23]Contemporary Black Biography. 2007.

[24]Notable Black American Women. 2002.

[25]Contemporary Black Biography. 2007.

[26]Ibid.

[27] Hill, Kathleen, and Gerald N. Hill. Encyclopedia of Federal Agencies and Commissions. New York: Facts on File, 2004. Print.

[28]Notable Black American Women, 2002.

[29] “Gaston & Porter: Mission.” The Gaston and Porter Health Improvement Center, Inc., n.d. Web. Accessed 6 Apr. 2014. <http://gastonandporter.org/about-us/mission/&gt;.

[30] Huggins, 2006.

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