The Book of Gutsy Women

by Hillary Rodham Clinton

  Rebecca faced intense racism and sexism from her colleagues in the South. Her fellow physicians snubbed her, and pharmacists ignored her. She couldn’t fully take care of her patients if prescriptions went unfilled. She moved back to Boston and continued her career while also working on a book about good medical care for mothers and children. When, in 1883, she published A Book of Medical Discourses: In Two Parts, Rebecca may have been the first black American to have a medical textbook in print. It was notable for its focus on children at a time when most medical tracts focused solely on adults. Her book is dedicated to “mothers, nurses, and all who may desire to mitigate the afflictions of the human race.” Her legacy lives on in the Rebecca Lee Society, one of the first medical societies for black women.

  Through our explorations, Sara and I also found Dr. Mary Edwards Walker, the only woman in her medical school class at Syracuse Medical College in 1855. She was a practicing physician when the Civil War broke out. She desperately wanted to enlist in the Union Army as a surgeon but wasn’t allowed to because she was a woman. Initially, she was called a nurse, since women generally weren’t considered doctors. Because women were not allowed to enlist, Mary had to volunteer, working for free at a temporary hospital, first in Washington and then in Virginia, where she traveled to Union field hospitals across the commonwealth. Mary watched other surgeons routinely perform dangerous, unnecessary amputations on soldiers suffering from fractures and other injuries. She began discreetly advising soldiers against the procedures when she thought they were not warranted. After the war, she would receive thank you letters from patients whose limbs had healed. When her medical credentials were finally accepted, she moved to Tennessee and became a War Department surgeon—a paid position that was the equivalent of a lieutenant in status.

  “Let the generations know that women in uniform also guaranteed their freedom.”

  —DR. MARY EDWARDS WALKER

  During the war, she crossed enemy lines to treat the wounded and was arrested by Confederate forces as a spy. She was held for several months before she and some of her colleagues were exchanged “man for man” for Confederate medical officers. After her release, she was contracted as a surgeon—the first female surgeon ever commissioned in the army—and served through the end of the war.

  Mary was not only a surgeon; she was also an activist. One of the causes close to her heart was for women to be able to wear clothes that actually allowed them to move freely. Born in 1832, in Oswego, New York, Mary worked on her family’s farm from a young age, wearing boys’ clothing, which was much better suited to physical labor than the tight corsets and full skirts that women were expected to wear. Years later, when she married one of her medical school classmates, she wore trousers and a dress coat. (She also struck “to obey” from the marriage vows, and she kept her own name.) Throughout the Civil War, she famously sported “bloomers,” or a combination of a dress and pants. During her time in Virginia, though she was not yet officially credentialed by the military, she designed her own uniform: blue with a green sash, similar to the clothing worn by male physicians on the battlefield. The New York Tribune described her in an article: “Dressed in male habiliments… she carries herself amid the camp with a jaunty air of dignity well calculated to receive the sincere respect of the soldiers.… She can amputate a limb with the skill of an old surgeon, and administer medicine equally as well. Strange to say that, although she has frequently applied for a permanent position in the medical corps, she has never been formally assigned to any particular duty.”

  After the war Mary traveled the country, lecturing on dress reform, and was even elected president of the National Dress Reform Association. She sported men’s pants, a top hat, and a bow tie and was arrested several times for “impersonating” a man. (Keith Negley’s wonderfully titled children’s book, Mary Wears What She Wants, tells her story and is a favorite in our house!) She used her public platform to campaign for equal rights for women for the rest of her life, including advocating for a woman’s right to vote. In 1865, Mary was awarded the Congressional Medal of Honor, the first woman to be so recognized. As hard as it is to believe, she is still the only woman ever to be deemed worthy of this honor. In 1917, Congress rescinded her medal—along with hundreds of others—citing a lack of combat experience. Dr. Walker refused to return the medal. Instead, she wore it every day until her death. Decades later, President Jimmy Carter posthumously reinstated the award.

  These are just a few of the many women who felt called to be physicians before most medical schools admitted women. They are part of a global sisterhood of women whose impact continues to this day—women like Kadambini Ganguly, who in 1886 became the first Indian-educated woman doctor; and Yoshioka Yayoi, who in 1892 became the first woman physician in Japan and later founded the Tokyo Women’s Medical School. All of them fought not just to break down barriers for themselves but to advocate for their peers and the women who would come after them.

  Betty Ford

  Hillary and Chelsea

  Hillary

  Betty Ford was not only an influential first lady in the last half of the twentieth century, she was also a transformational American. Aside from being gracious, humble, and welcoming, she was fierce. She advocated passionately for the Equal Rights Amendment, which would guarantee all Americans equal rights regardless of sex—and which still hasn’t passed. She never shied away from expressing her views. “I believe the Equal Rights Amendment is a necessity of life for all citizens,” she said. “The Cabinet sometimes felt that I shouldn’t be so outspoken.”

  Chelsea

  Betty was born in Chicago in 1918 and spent her childhood in Grand Rapids, Michigan. She took dance lessons from the time she was eight years old and, after graduating from high school, briefly pursued a dance career. As a student at Bennington College in Vermont, she studied with modern dancer and choreographer Martha Graham—someone who, Betty later said, shaped her life “more than anyone else.” After college, she moved to New York City to dance as part of Graham’s company. She then moved back to Grand Rapids where she worked in fashion and taught dance to children with disabilities. She married a childhood friend and cared for him as he struggled with alcoholism and poor health; after five years, they divorced. Betty later met and married a World War II veteran and lawyer named Gerald Ford.

  “I do not believe that being First Lady should prevent me from expressing my ideas.… Why should my husband’s job or yours prevent us from being ourselves? Being ladylike does not require silence.”

  —BETTY FORD

  Hillary

  I felt Betty’s influence throughout my life, especially her work around breast cancer. It was very personal to me; my mother’s best friend, who lived across the street from us in the 1960s, was diagnosed with breast cancer, and at the time no one talked about it. I knew my mother was over there every afternoon, but I had no idea what was wrong with her friend. It was only after she died that I learned what she had been going through. But then along came Betty Ford. She talked about her ordeal, even sharing a photo of herself in her hospital room after surgery in 1974. It was reassuring and invigorating to have an important person, let alone our first lady, be so open and honest and personal about her cancer. She explained that “maybe if I as First Lady could talk about it candidly and without embarrassment, many other people would be able to as well.” She also campaigned for early detection and screening, research, and better access to treatment, and blew away the stigma that had kept countless women from even getting examinations. We’ll never know how many lives she saved, both directly and indirectly, because of her courage in facing up to her own illness.

  After she left the White House Betty was equally open about her successful battle against substance use disorders and addiction. I visited the Betty Ford Center with her years ago, and was stunned by the dignity with which patients were treated; there was no place for stigma at the Betty Ford Center. She could have just given her name to the facility and left it at that;
but of course she didn’t. She knew the names of every staff member and every patient. (When I expressed my awe, she brushed it off, explaining that she only knew their first names. Still!) To me, Betty has always embodied grit and guts.

  Chelsea

  In addition to her campaign to destigmatize breast cancer and addiction, and expand treatment for both, Betty also championed the Equal Rights Amendment and gender pay equity. She was vocally pro-choice; while her husband suggested Roe v. Wade went too far, Betty publicly celebrated the landmark Supreme Court decision that legalized abortion. Time magazine named her the “Fighting First Lady” for her unapologetic political, social, and public health stances. That steeliness continued throughout her life. Her support for full equality under the Constitution and a woman’s right to make her own reproductive health decisions never wavered, even as the party her husband had led moved further away from them both.

  Mathilde Krim

  Chelsea

  In high school, I read And the Band Played On, Randy Shilts’s extraordinary book about the early days of the AIDS (acquired immune deficiency syndrome, caused by HIV or human immunodeficiency virus) epidemic. Shilts detailed the painful toll of AIDS on the gay community in San Francisco and New York in the early 1980s, exacerbated by those in the medical world and government at all levels who ignored the suffering because AIDS was seen as a “gay disease.” Shilts also wrote movingly about the heroic doctors and researchers who did the opposite, throwing themselves into caring for AIDS patients and diving into research to find the cause of the disease and how to stop it. One of those doctors was Mathilde Krim.

  As a young scientist in the 1950s, Mathilde studied cancer-causing viruses in Israel. She also studied cytogenetics and was part of the team that developed prenatal testing to determine the sex of a fetus. After she moved to New York, she was a researcher at Cornell Medical College and Memorial Sloan Kettering Cancer Center. Throughout the 1960s and her life, Mathilde supported the civil rights movement, the gay rights movement, and the women’s movement in the United States, as well as the independence movement in Zimbabwe and anti-apartheid movement in South Africa. She was also a strong supporter of Israel, then a relatively new country. Mathilde was clearly not one to shy away from controversial issues or scientific challenges; her character was shaped as a child growing up in Switzerland during World War II. In an interview, she described the experience of watching the liberation of the Nazi death camps: “I confronted the reality that racism is murderous.” She would later realize that bigotry in any form can kill.

  Early in the AIDS epidemic, Mathilde was one of the first scientists to recognize that AIDS was a new disease with possible catastrophic consequences. In 1983, she and others started the AIDS Medical Foundation to raise money to fund research. Her efforts were particularly important at the time because the American government was largely ignoring AIDS, with the exception of a few notable heroes at the Centers for Disease Control and the National Institutes of Health.

  “Most people start with this idea that they can’t do anything because ‘I’m only a little guy and I can’t have an effect on public policy.’ It’s not so. Everybody can do something.”

  —MATHILDE KRIM

  In addition to raising research dollars, Mathilde pushed New York City and the federal government alike to invest more in AIDS; to name AIDS; and most important, to treat AIDS patients with dignity. She pushed her medical colleagues to do the same. When asked by a New York Times reporter why she had gotten involved, she answered, “Because I was incensed! So many young men were dying.… And many would be dying abandoned or alone because they were afraid to contact their families.” She made it her personal mission to provide compassion, good medical care, and hope.

  Her work and advocacy, along with the work of other researchers and health care providers, yielded real results. In 1985, Congress significantly increased AIDS research funding. In 1987, the American Medical Association declared that doctors have an obligation to care for people with AIDS, including asymptomatic patients. Throughout the 1980s, Congress allocated more and more funding for AIDS research. In 1990, Congress passed the Ryan White Comprehensive AIDS Resources Emergency Act, which was then and remains the largest federal program for people living with HIV/AIDS.

  Alongside the doctors who were waging a research battle were advocates like Elizabeth Glaser, who contracted HIV in 1981 from a blood transfusion while giving birth to her daughter, Ariel. Elizabeth later passed on HIV unknowingly to Ariel through breastfeeding, and to Jacob, her son, in utero. The Glaser family raced against time to fight for access to treatment. Tragically, it was too late for Ariel. Galvanized by Ariel’s loss, the Glasers started a foundation to raise funds for pediatric AIDS research. Elizabeth’s work, like Mathilde’s, helped save other lives, including her son’s. A few years before Elizabeth’s death in 1994, she wrote about her family’s struggles with HIV/AIDS in In the Absence of Angels. As my Grandma Ginger would have said, both Elizabeth and Mathilde were engaged in God’s work—and, I think she would say, closer to angels than most people would ever be.

  Larry Kramer, the great playwright and LGBTQ rights activist, once said of Mathilde: “One can only be filled with overpowering awe and gratitude that such a person has lived among us.” I agree. I was proud to honor her in 2011 at an event for amfAR, the Foundation for AIDS Research, a successor organization to the one she started in the early 1980s. I talked that night about how grateful I am to live in a world with real heroes like Mathilde, who saved countless lives through her resolve, adaptability, curiosity, intelligence, and heart. I believe Mathilde would be appalled, but not surprised, by current efforts to diminish HIV/AIDS research, prevention, and treatment funding in the United States and around the world. We must protect the progress she, Elizabeth, and many others fought so hard for and keep fighting until every patient with HIV/AIDS is treated with dignity and receives the treatment they need, while continuing the search for a vaccine and cure.

  Dr. Gao Yaojie

  Hillary

  Back in 1996, in the midst of the exploding global AIDS crisis, a retired Chinese gynecologist, Dr. Gao Yaojie, consulted on the case of a forty-two-year-old woman who was not improving after ovarian surgery. After examining her, Gao demanded an HIV test because, based on her own practice, she knew that AIDS was present where she lived, in Henan Province. Her colleagues could not imagine how a peasant farmer could have contracted HIV, a “foreign disease” they perceived to only affect drug addicts and sex workers. The test came back positive, sending Gao on a hunt to find out what had happened. She discovered that the woman had contracted AIDS from a transfusion that used blood from a government blood bank. Gao immediately understood that if the government was supplying the blood, much of the supply could be tainted, and many more people could be infected both from transfusions and from selling their own blood and plasma.

  Gao traveled across rural China, finding high rates of infection and little understanding by the people affected about how they had become infected and why they were sick and dying. She also discovered that corrupt local government officials were complicit in turning a blind eye to poor farmers selling their blood, creating the “plasma economy” between 1991 and 1995.

  Gao and other doctors urged the government to warn people about the risk of contracting AIDS from blood donations and transfusions, and to stop the system. When that didn’t happen, Gao began making speeches and distributing written warnings. She even began speaking to the press, an especially courageous move given how closely the Chinese government monitored the media. After a few years, the story about the Chinese government’s complicity in the blood scandal started being covered in both the Chinese and the international media. The negative global press finally forced China to ban unlicensed plasma and blood collection centers, but it was too late for the thousands of people already infected.

  Gao burned with righteous anger at the deadly injustice done to vulnerable people, and kept pushing the government fo
r legal rights and compensation for victims. She gave financial help to children orphaned because of AIDS. She was nicknamed “AIDS Granny” and “Grandmother Courage.” Her relentless campaign to raise the profile of victims and hold the government accountable enraged local officials, many of whom had profited from the blood centers. They threatened her and her family but failed to stop her.

  It was not the first time she suffered under the Communist Party regime. As an educated doctor, she was accused of being an elite counterrevolutionary and spent a year in a forced labor camp. She and her family were finally reunited in 1973, and she returned to her medical practice.

  The first time I heard of Dr. Gao Yaojie was early in 2007. She had been invited to the United States to receive an award for her AIDS advocacy from Vital Voices, an organization that I helped start as first lady. When the local authorities in China learned about the award, they put her under house arrest. When I heard that she wasn’t being allowed to travel, I wrote a letter to President Hu Jintao and Vice Premier Wu Yi asking that they permit her to come. Vice Premier Wu Yi, the highest-ranking woman in the Chinese government at the time, also Health Minister and a politburo member, played an instrumental role in getting Gao released and granting her permission to come to the United States.

  I met Dr. Gao at my senate office for a long talk in March 2007 and saw for myself how formidable this diminutive woman was. Her walk was hobbled from her feet having been bound as a child, but she was an unstoppable energy force.