Alumni Profile: Stuart Hamilton'74

By Julia Hickey González

When pediatrician Stuart Hamilton returned to his apartment in Washington Heights after a trip to Chester, South Carolina, a hate letter was waiting in his mailbox.

“You won’t like it here,” it said. The writer warned Dr. Hamilton and his wife against buying a home in the Chester neighborhood they had toured just weeks before. It was 1976, the year he finished his residency at Babies Hospital in New York City. He had joined the U.S. Public Health Service and was now assigned as the only pediatrician in a rural county in South Carolina that—he later discovered—still had separate waiting rooms for white and Black patients.

“Oh, brother. This is going to be a little tougher than I thought,” he remembers thinking. But he reminded himself: “Deny yourself and pick up your cross. You are here for one purpose. And that purpose is service to people who don’t get it.”

The letter writer was correct that Dr. Hamilton would not find living in Chester easy. At one point, someone chased him with a car. Someone killed his dog. The other doctors refused to cross-cover his night or weekend calls, so for two years he had no true days off.

But Dr. Hamilton was also correct about his life’s purpose. Today, 47% of people at or below the poverty level in two counties of the midlands of South Carolina are served by Cooperative Health, the system of compassionate nonprofit primary care centers that he went on to create. According to the Health Resources & Services Administration, Cooperative Health continues to rank in the top 50 of the nation’s 1,200 community health center systems for volume of patient visits. Patients are able to make payments on a sliding scale, and no one is turned away for inability to pay. Today, Cooperative Health operates 20 clinical sites with 80 full-time physicians and nurse practitioners and additional services, including dentistry, podiatry, pharmacy, and family counseling. The network recently opened a dedicated women’s health center.

While Dr. Hamilton’s influence grew over the years, the racism he experienced never entirely disappeared. For example, a patient’s parents made calls to verify that Dr. Hamilton graduated from Trinity College and Columbia University’s Vagelos College of Physicians and Surgeons. They did not appreciate that his Columbia training, especially the grueling rigor of residency, prepared him to provide them with the best of care.

“I always remembered from training, an attending physician said that one of the things that separates the good doctors from the not good doctors is the quality of the patient note at 3 a.m. If you can do a good workup at 3 a.m. that looks just like your workup at 3 in the afternoon, then you have arrived,” he said.

In 2007, South Carolina Gov. Mark Sanford awarded Dr. Hamilton the Order of the Palmetto, recognizing lifetime achievement and service. That same year, the City of Columbia presented him with keys to the city. These recognitions are especially significant because of, or perhaps despite, the aggressions Dr. Hamilton experienced while pressing for transformation of the primary care landscape in communities that had been languishing, awaiting local access to primary care.

Pediatrics in practice

As a pediatrician, alleviating fear must become a specialty. First, there are babies to be immunized. Dr. Hamilton and a nurse positioned the babies facing away from him so he could inject them, run out of the room, and re-enter again unexpectedly to soothe their tears.

“Next time the child came in, they weren’t afraid of me at all. It worked every single time except when the nurse was off. That was a disaster,” he says.

 Then there were the brave children facing extensive treatments, such as a 9-year-old boy undergoing chemotherapy for leukemia during Dr. Hamilton’s residency. Dr. Hamilton noticed that “Green Acres” and its familiar jingle came on TV during their time together. He arranged to arrive and search for IV sites while the program was on, which calmed the boy down.

“It was like visiting your neighbors,” he remembers, adding that pediatric practice appealed to him for its collegial atmosphere. “You rotate through adult medicine, and it’s very cerebral. You stand around and hypothesize about what the patient may have, what that means, and what you will do about it. I enjoyed that. In pediatrics, you do the same thing—except the staff were much warmer, more congenial, and more laid back.”

This warmth also aids in dealing with concerned parents.

“A parent might say of their child, ‘He gets headaches.’ But their real concern is, ‘I think my child has a brain tumor,’ and you have to prove he doesn’t.” So, Dr. Hamilton took to thinking out loud to include parents in his process of deduction. He verbally eliminated as many causes as possible while completing the exam before presenting a treatment plan. Only if the medicine didn’t work would they begin the testing. “And nine times out of 10, it works, and you do not have to do the big hunt,” he says. “Once they get it, parents are on board.”

Unfortunately, not all his patients were so amenable. Adults could be difficult. One night, when Dr. Hamilton was serving two weeks of emergency room duty with his Army Reserve unit at a Southern base, the staff was aggressively confronted by a drunk, broad-shouldered sergeant who had been cut up in a bar fight. While blood poured from his deep facial lacerations, he cursed and yelled that he didn’t want anybody Black to touch him.

Because the entire staff that night was Black, all eyes were on Dr. Hamilton for direction.

“The reptilian part of my brain screamed, ‘This is the embodiment of evil.’ The cortex whispered, ‘You have to calm the staff, approach the patient empathetically, and start the care. There’s a way to diffuse this without pouring gasoline on it.’

“For 15 minutes, I told him every off-color joke I could. By the third joke, he was visibly relaxed and waiting for the fourth. Twenty minutes into it, he was totally calm.” Dr. Hamilton used a thread the diameter of an eyelash to deliver 65 carefully placed stitches. Eventually, the sergeant fell asleep.

Serving the underserved

“I grew up with a strange sense of diplomatic immunity,” says Dr. Hamilton, who always managed to evade schoolyard bullies while growing up in Lakeview, Long Island. Maintaining composure in the face of challenge—no matter how unfair—is a skill Dr. Hamilton learned early on. He was 13 years old when his father, a police officer in Brooklyn, died of an aneurysm. Instead of panicking, the boy prayed and received an assurance that he would be okay.

“If at the center of your little being, you know you will be OK, what does that allow you to do? To put yourself at risk. It takes the fear away,” he says.

He also exhibited, quite early, a sense of social empathy. He noticed that other first graders in his class had holes in their shoes that were bigger than the holes in his shoes. They wore the same clothes every day, and their bicycles needed repair.

“They were wounded. They weren’t as happy. Some were angry. There were fights. I just felt badly because every kid should have a measure of stability,” he says.

He realized he was blessed because he and his two siblings had their material needs met, and his parents’ relationship was “steady as the tides.” Later he would find his own love, meeting his wife, Barbara, when the two were undergraduates in Connecticut. He was at a concert when his blind date left unannounced and didn’t return. Barbara, who was taking tickets, approached him to chat. They talked until sunrise.

“By then, you could see your unborn children in her eyes. The rest is history,” he says. They married three days before his first pharmacology exam, and she attended NYU Law School. Barbara gave birth to their first child five months into their eye-opening assignment at Chester.

After Chester, the family moved 50 miles to Columbia, South Carolina, where Dr. Hamilton had a much warmer welcome as a chief pediatrics resident at Richland Memorial Hospital. But ever eager to assist those at the margins, he went on to serve as medical director for the South Carolina Department of Juvenile Justice’s youth prison. He and one psychiatrist cared for nearly 400 boys and girls from all over the state. He advocated for basic safety measures for prison occupants, such as relocating a child with hemophilia from the yard where he was repeatedly beaten or diagnosing a boy’s congenital heart disease that could result in sudden death from exertion on the playground.

At the same time, he had a job performing recruitment physicals for an Army enlistment processing center. It was a busy time. “First thing in the morning, recruits would fib to me about how healthy they were. Later, I would go to the youth prison, and they would fib to me about how sick they were,” he says. The imprisoned youth loved coming to the infirmary because it was air-conditioned, and they were treated well.

From no-profit to not-for-profit

In 1981, Dr. Hamilton moved on from the prison to open the private practice, Eau Claire Pediatrics, named for the low-income neighborhood of Columbia that it served. For more than 10 years, Eau Claire Pediatrics provided a health safety net to residents of local and neighboring communities, regardless of economic status. Dr. Hamilton also created a mobile health outreach unit in a 35-foot RV to provide well-child exams and immunizations up to 150 miles away. But despite all the much-needed work that Dr. Hamilton and his team performed, he couldn’t make ends meet. He could pay the staff and the junior doctor, but he couldn’t pay himself. And at this rate, he would never retire.

“I wasn’t getting paid two-thirds of the time, period. The money just wasn’t there.”

He joined the Army Reserves for comradery and a retirement plan. When the Army activated his service during the Gulf War, he found unexpected peace of mind at the Georgia base’s pediatric clinic.

“It doesn’t matter whether you are seeing a corporal’s child or a major’s child or a sergeant’s child. Economics have no bearing. You can order whatever is appropriate and do whatever you have to do without worrying about money. I considered staying in the Army just because you don’t have to worry about patient economics.”

Ultimately, he and Barbara decided to stick it out in South Carolina, where the community still needed him. But something extraordinary happened soon after Dr. Hamilton returned to his private practice in Eau Claire.

One afternoon, two men arrived at the office and asked, “Have you considered becoming a non-profit community health center?” They outlined the many steps required to launch a federally qualified health center and to compete for grant support.

He ran with the suggestion.

As it turns out, a local hospital was hemorrhaging money by treating uninsured emergency room patients from one rural town with a sizeable migrant population and a high poverty rate. It also happened to be the regional headquarters of the Ku Klux Klan and the epicenter of South Carolina’s methamphetamine production. The hospital supported Dr. Hamilton’s cooperative by constructing and donating a customized medical office facility to provide treatment for low-income patients in a new not-for-profit setting.

Dr. Hamilton was delighted.

“We were more than happy to get rid of the for-profit model, dump it, and pick up the not-for-profit model,” he says. The nonprofit community health center launched in 1993, and with the help of grant funding, community fundraisers (including help from Yvonne Thornton’73), and local donations of paper products, the practice bloomed.

In time, the Eau Claire Cooperative took over two additional private practices and four hospital practices operating in the red, transitioning them into thriving federally qualified health centers. Dr. Hamilton also became medical director of Select Health of South Carolina, the state’s first and largest Medicaid-managed care provider for low-income individuals.

“I learned it all the hard way,” says Dr. Hamilton, who describes himself as “not a businessperson. I have one buttock bigger than the other because of all the chunks that have been taken out of it.”

Compassion projects

Dr. Hamilton taught himself oil painting while a medical student. After decades of creating African American history paintings of protest marches, Civil War troops, and African themes, he enjoys painting landscapes on his porch.

“It idealizes the world,” he says. “Especially now.”

Dr. Hamilton is retired as an Army lieutenant colonel. He maintains ties with Cooperative Health as a consultant, mentoring youth, serving global communities on mission trips, and advising his children about his four grandchildren’s health.

Notably, in 2019, he helped fly a blind 9-year-old he met in American Samoa to South Carolina, where surgeons removed her two dense, milky cataracts and restored perfect vision in both eyes.

But of all the clinics he has opened and maintained, his most potent achievement, he believes, is the 8,000-square-foot Kwa- Zulu-Natal community primary clinic that opened in 2007 in the township of Esikhawini, South Africa.

“I thought the clinic there was the mountaintop of things we had done, simply because there was so little there. There were no medical facilities in the area. The nearest hospital was quite distant on a road that would shake most cars to pieces. We asked the people what it was that they needed. Their answer was simple. They said, ‘We have nothing.’”

A local woman stepped forward to offer six acres of land to house the clinic. Then she looked at Dr. Hamilton and said, “What are YOU going to do?”

 “Oh no, she is throwing down the gauntlet,” he recalls. “It is the widow’s mite story in real life. When that happens, you have to say what you are going to do. I told her I would help get the money. And then I gulped.”

 Dr. Hamilton spearheaded the process by raising the initial $50,000 that the local government said was needed to kick-start the project, mostly with money from family and friends. The initial collection was used to leverage a much larger commitment from a Japanese company operating a nearby titanium mine.

He obtained assurances from the South African government that the local province would staff, equip, and provide operating funds. Dr. Hamilton gave them the operational blueprint. The government followed through, and today, the clinic serves a population area of around 9,000. “

All they needed was a kick-start. It was a set-it-and-forget-it,” Dr. Hamilton says of the clinic—a modest summary of just one in a long list of contributions to public health that will be difficult to forget.