A Mighty Purpose (8 page)

“This organization is a two-hundred-thousand-ton vessel,” he said fervently. “It’s an oil tanker, and you’re driving it like a speed boat.”

As soon as he said it, he realized he shouldn’t have. The nautical image elicited a charge from Grant, a glint in his eyes. Grant “saw himself at the helm of an oil tanker, throwing the throttle, changing up a gear, watching the prow rise up in the water, taking off across the high seas,” Adamson later wrote in an essay that was included in
Jim Grant: UNICEF Visionary
, published by UNICEF.

“I had pressed entirely the wrong button,” Adamson says now.

Adamson and Williams lost their argument. Adamson set about rewriting the report. Grant quickly made preparations. It was as if, Williams offers, Grant was running a hurdle race by his own rules. “He would arrive at the end first,” he says. “He might have knocked over most of the hurdles, but he could go back and put them up later, whereas everybody else was running a normal race.”

Had Grant taken the advice to hold off and solicit more feedback, the child survival revolution might never have gotten off the ground, suggests Stephen Joseph. “Jim wasn’t so stupid,” he says. “Here, he was dealing with the UN bureaucracy … Imagine if he had called all UNICEF together, with representatives from the UNDP and [other agencies] and said, ‘We’re going to do this.’ … He might never have gotten it done.” Joseph adds:
“There are people who achieve things that could not be achieved by the traditional manner, because the traditional manner is part of the reason why they ain’t being achieved. And that was Jim Grant.”

As the word spread of Grant’s designs, fears and confusion uncoiled. What was this revolution? How could such a preposterous plan possibly go anywhere? Would UNICEF survive Grant’s reign? He soon earned a new nickname: the Mad American.

Adamson knew he had to take sides. Finally, he made his choice. No matter how ill-advised the timing, no matter how much it slashed against the grain, Grant’s reasoning could not be dismissed. Some critics had charged that the eager new head of UNICEF was focusing only on the “symptoms”—mass child deaths, malnutrition, and pervasive ill health—and was therefore neglecting the fundamental causes of poverty and the complex, long-term, “bottom-up” solutions that were necessary to effectively combat it. But as Adamson came to appreciate, and would later write in a speech for his boss, these “symptoms of poverty help to crush the potential of the poor, to reduce their control over circumstance, to narrow choices available to them, and to undermine the long-term process of development.”

He realized that, ultimately, what Grant was trying to do was “take up the slack.”

That “slack” was an appalling daily toll of death and misery that didn’t have to happen. At the time, an estimated fourteen million children were dying every year of causes that had long ago been banished to the medical history books in the
industrialized world. The means to save these children existed; they were cheap, readily accessible—yet they were not being used. “It was as if a cure for cancer had been found, and no one was doing anything about it,” Adamson says. “Because they were poor and had no voice.”

Jim Grant had decided he would do something about it.

Adamson resolved that he would join the Mad American. “I decided this is worth a go,” he says. “I threw myself in.”

It was on his way to school on frigid winter mornings, peddling his bicycle through the kinetic, imperial labyrinth of Peking, that he would see the bodies. They lay in the street. What surprised him most was that passersby did not seem at all alarmed. They did not stop. They just stepped over the corpses or around them, as if they were heaps of snow or garbage. Whether these people had starved or frozen to death the night before, their bodies had simply become yet another part of the teeming, motley urban landscape. Peking (now Beijing) in the late 1920s and early 1930s was a city of opium dens and prostitution and commerce of all kinds, a dense metropolis surrounded by ancient walls and living under the crumbling legacy of two thousand years of dynastic rule (the last dynasty, the Qing, had fallen in 1912). The threat of invasion from Japan hung menacingly in the air. It was also a place where awesome grandeur mixed with pernicious poverty.

Commenting on the frozen bodies in the street years later, Grant would say that “it was virtually unthought of at that
time that all these people would ultimately read and write and have access to health services.” They were dispensable, insignificant—acceptable casualties for a society, not unlike many societies at the time, where the benefits of life and health and education were organized disproportionately for the few, and not the many. The visual imprint of these lifeless souls, and the morally vexing questions that came with them, would flicker in Grant’s mind, on a continual loop, for the rest of his life.

But Peking was also a wondrous place for a young boy, a great domain to explore, which is something his parents apparently liberally allowed. “It was a boyhood of freedom,” he would say years later. He bicycled everywhere, weaving between the rickshaws and street merchants. With his friends, he built tree houses and clambered aboard rooftops. Many of the roofs were connected, and the boys could roam above the city, from block to block, for up to half a mile, as occupants cursed them from below. Grant knew that, as a foreigner, he was not subject to the same laws as the Chinese, “so there was the additional element of freedom.”

Curious and adventurous, he played tennis and basketball, collected stamps, and joined the local Boy Scout troop. He got into skirmishes. During one fight, a boy grabbed his arm and hoisted it roughly behind his back, until his elbow snapped. It was the third time he had broken it in the same place; the first was after rolling down a hill. He fell a lot, and, by his own estimation, his forehead was stitched up twenty times.

By far his favorite activity was reading. He read the entire
World Book Encyclopedia
, from A to Z. He claimed to have checked out
War and Peace
from the school library and to have
read it in a few days. He liked
The Hardy Boys
series and
The Swiss Family Robinson
. The book that seems to have made the biggest impression on him as a young reader was
The Forty Days of Musa Dagh
, Franz Werfel’s 1933 novel about the 1915 Armenian genocide. Based on real events, the book “powerfully affected” Grant.

He lived with his parents and sister, Betty, who was two years older, in a large, enclosed compound in the middle of the city that included the hospital and medical college where his father worked. His mother, Charlotte Hill Grant, was a “true homemaker” who looked after Jim and Betty attentively, with the help of a Chinese nanny. Her hobby was buying and collecting broad robes and pieces of art from the imperial court, which was selling off the items, and the Grant household became filled with elegant artifacts from ancient China. A perfectionist who “loved beautiful things,” she also liked to sew and was often heard humming. Grant remembered “a light and happy atmosphere” permeating the home, seemingly due to his mother’s warmth and positive aura; he credited her with largely forming his own upbeat and optimistic outlook. The family took weekend excursions together, venturing into the countryside to visit temples; over the summer, they sometimes spent several months at a resort. In one photo taken when he was six, he and his sister are standing with their nanny, who is holding their hands. They are both wearing shorts and long boots and are standing rigidly straight. Jim is staring into the camera, his eyes wide, looking surprised or perhaps bewildered. His ears protrude underneath neatly combed hair.

Like his son many years later, Grant’s father worked long hours, traveled frequently, and “was gone half the time.” When Grant was eleven, his parents divorced, and he and his sister lived with his mother.

He went to a school in the medical college compound, where he estimated that about half of the two hundred students were Chinese, a quarter were American, and a quarter were European and Japanese. Several of his closest friends were Chinese, and his first girlfriend was Scottish-Chinese. “I always grew up feeling that China was one of the greatest civilizations in the world,” he recalled, “and that the disorder they were in was a temporary phenomena …, that the Chinese would regain their status as one of the world’s leading civilizations during this century.”

Growing up in China and regularly associating with Chinese, he later claimed, had spawned in him a “complete lack of race consciousness.” Whether or not this was true or a rare burst of braggadocio, Grant’s ability later in life to quickly establish a rapport with people from other cultures was undoubtedly influenced by spending his formative years as a minority resident in a developing country.

Grant’s China roots began with his grandfather, a Baptist medical missionary from St. Stephen, New Brunswick, Canada, named James Skiffington Grant. After graduating from medical school at the University of Michigan, James S. Grant joined a university-sponsored volunteer program to open a health clinic
in China. He was supported by the Baptist Foreign Mission Society. Dr. Grant went to the seaport town of Ningpo in 1889, and his son John Black Grant was born there on August 31, 1890. The clinic Jim Grant’s grandfather helped found would become a major hospital. Dr. Grant was known for his deep personal commitment. He made house calls and skipped summer vacations to tend to patients. When hospital beds were filled up, he would sometimes invite patients into his home and reportedly even once offered one his own bed. He remained in China during the violent Boxer Rebellion in 1900, when foreigners and Christians were targeted and many fled. He knew the horror of disease intimately—he lost a brother to appendicitis and a son, John Grant’s younger brother, apparently to dysentery.

Jim Grant was five or six years old the last time he saw his paternal grandfather. He recalled in his oral history that the elder Grant “had a stubbie”—he had lost part of his middle finger somehow.

John Black Grant left China to attend Acadia College in Nova Scotia. As World War I enveloped Europe, he tried to volunteer for the Canadian Army but was turned down because of poor vision. “One of his great regrets was that he didn’t participate in the war at that time,” Jim Grant remarked. His father chose Jim’s middle name, Pineo, to honor one of his friends who died in the Great War.

After graduating from medical school at the University of Michigan in 1917, John Grant joined the Rockefeller Foundation’s International Health Division. He briefly worked in North Carolina on a rural health project and was then sent back to
China to take part in a Rockefeller-funded program to combat hookworm disease. With some real-world experience under his fingernails, he enrolled at the Johns Hopkins School of Public Health in Baltimore before returning to China in 1921. He was sent again by the Rockefeller Foundation, this time to become the first-ever professor of public health at the medical educational facility Rockefeller had funded and built in Peking. The sprawling, state-of-the-art, twenty-five-acre Peking Union Medical College was intended to be China’s answer to Johns Hopkins. It comprised a hospital, classrooms, laboratories, residences, and a school.

As a young man, John Grant found himself in a position of immense responsibility and influence. Thin and bespectacled, he eschewed small talk and projected an air of self-confidence “that could border on brashness,” according to a 2005 profile in
Johns Hopkins Public Health
magazine. Though he aroused idealism in his students and inspired many to devote themselves to public service, he was not demonstratively warm or effusive. As Jim put it, “he was not a man to talk a lot.” Several decades after his service in China, John Grant’s then graduate student Conrad Seipp would characterize the legendary doctor in the preface of a book of Grant’s collected writings: “Singleness of purpose is one of the outstanding characteristics of the man … There is in him a tenacity and a constancy, even an obsessive quality in the advocacy of his views on health care, but most of all there is a profound integrity.”

John Grant’s father had been wary of his son becoming a doctor. Practicing medicine in an impoverished community
in a developing country with limited resources placed you at the mouth of an unceasing torrent of disease and death. It was overwhelming, dispiriting, crushing. The Canadian Baptist had imparted his reservations to his son with this metaphor: treating patients in this sort of environment is like “trying to mop the water overflowing the sink while the tap is still on.”

This analogy resonated over several generations. John Black Grant and, later, his son Jim both resolved that they would try to turn off that tap.

For the elder Grant, this meant rethinking the way medicine was practiced and organized in the developing world. Exactly how to do this became clear through his social and medical experimentations in China and, later, India and Puerto Rico. But China was where most of this thinking crystallized. One of the first lessons was simple: Curative care and preventive care must be tied together. Doctors had to do more than simply treat disease; they needed to block it before it could strike. This sort of comprehensive health care should take place not just in urban hospitals, but also at health centers in remote rural villages. Grant believed that the government bore a responsibility to provide health care for all, but that the only way this could happen and be sustained was if members of local communities were trained and educated in basic health and hygiene techniques. Some doctors invariably felt threatened by this grassroots credo—it would take power away from the medical establishment and put it in the hands of the people. As he learned and evolved over the years, Grant came to the conclusion that public health was intrinsically linked to social and economic
development—you could not pursue one without the other. These views earned him the moniker “Medical Bolshevik.”

To begin putting his theories to the test, Grant teamed up with Peking’s police force in 1923 to create a “demonstration health station” in an area of the city near the hospital; it was designed to give students experience outside the classroom and to offer police, midwives, and public health professionals basic health training. The center also provided medical care to area residents. Grant later took the demonstration model into the countryside, where he and his student C. C. Chen established a health station in a rural county more than 120 miles southwest of Peking; it would eventually serve four hundred thousand people and offer training courses and supplies for village health workers. This program was developed in concert with the Mass Education Movement, started by the Chinese literacy champion and John Grant’s friend, Jimmy Yen; with better education comes better health, and vice versa. These novel approaches to extend medical care beyond the realm of urban and Western influence—and to equip local communities with the tools to stave off disease and malnutrition—inspired China’s barefoot doctor movement several decades later.