Keith Smalls has taken his heartbreaking life experiences and turned them into a force for good

April 26, 2022
Keith Smalls, wearing a red striped jumpsuit next to the words making sense of tragedy
Keith Smalls, violence intervention advocate for MUSC Health, speaks at 2022 TEDx Charleston. Photo provided by TEDx Charleston

Keith Smalls was just 12 years old at the time, but he knew exactly who the man was. After all, he had seen him around the neighborhood riding his bike, talking with friends. But it was the arguments he had seen him have that etched the face into Smalls' memory forever.

He was walking into the grocery, head down, counting change; the man was walking out. It was just a small bump, but to understand the man Keith Smalls is today, that collision was seismic. For the briefest of moments, they locked eyes – Smalls’ synapses connecting the dots immediately; the man in front of him not showing the slightest hint of recognition – and then it was over. No words were exchanged. No gestures. Nothing. 

Think about how tough that must be. Not to be recognized by your own father. 

And so Smalls made a choice – probably not right then; this isn’t Hollywood, and he was just a kid after all – that he would never be that kind of man. He would never raise his voice to the mother of his children. He’d be an involved dad. A family man. 

But as is often the case, life can get in the way. And that’s just what happened.

And his story took a totally different path. 

The devil inside

Super Bowl Sunday. 1994. Cowboys versus Bills. 

A diehard Raiders fan, Smalls didn’t have a dog in the fight that year, but he loved football, and there was no way he was going to miss the game. That part, he remembers vividly. What he doesn’t remember is how the game went. Because, as it turns out, he would never see a single play.

Smalls’ childhood was defined by bad role models and unhealthy environments. He grew up in a house with an absent father and a mother who used drugs recreationally – right in front of her kids. Bad choices and lawlessness were normalized under his roof.

Naturally, Smalls followed a similar path. He fell in with the wrong crowd. Sold drugs. Ran the streets. Eventually his bad decisions would get him kicked out of school and shipped off to New York to live with his aunt and uncle. 

A household with strict rules and high expectations saw an outward transformation in Smalls. He started getting straight As. He joined the chess club. He played sports. But inside, nothing really changed. He was still that same kid who felt most comfortable with the laws of the streets. 

A series of three photos showing Smalls stepping out of his striped jumpsuit during his TEDx presentation. 
Smalls wore a bright red striped jumpsuit during his TEDx talk. Midway through the presentation, he stepped out of it, saying that when he got out of prison he was a changed man. Provided by TEDx Charleston

Occasionally he would come back down to visit his old friends in Charleston. It was during these visits that he would fall back into the same rhythms, finding himself selling drugs. And that’s when an idea hit him: There were so many more drugs in New York than Charleston. Why not bring them down and make some real money?

Not long after, the idea became a reality. He’d load up his car, drive down, sell them, hang out for a few days and then head back. And for a while, it worked. 

Until one day, it didn't.

Text that said 45,222. The number of people who died from gun-related injuries in the U.S. in 2020 

That day was Jan. 30, 1994. A childhood friend of Smalls had set up a huge deal for the pair. Smalls just needed to show up with the drugs. His friend would do the rest. 

As they left the hotel room where they were staying that day, Smalls’ buddy pulled out of the parking lot and onto Rivers Avenue in North Charleston.

“Then, it was just like a movie,” he said. “Cop cars came from every direction, lights flashing, sirens blazing. We were surrounded.” 

His “friend” had cut a deal with law enforcement in exchange for setting up Smalls. He’d get a reduced sentence for a previous charge, and Smalls would take the fall. The next morning, Smalls – who back then was known on the streets as “Kilo” – was on the front page of the newspaper, cited for possession of crack and cocaine with intent to distribute. He was given a five-year prison sentence. 

“That was the beginning of my life in the criminal justice system,” he said.

For the better part of his early 20s, he would serve time at nearly a half dozen correctional institutions across the state. Allendale. MacDougall. Walden. His last stop was Lieber Correctional Institute, one of the hardest, meanest facilities in South Carolina.

Three years and seven months later, the 23-year-old would finally walk free.

The very next day he would be back selling drugs. 

Better man or better criminal

Smalls, now 48 years old, sits at a conference room table in the Medical University of South Carolina’s Clinical Sciences Building, where his office resides. As a violence intervention advocate for MUSC’s Turning the Tide Violence Intervention Program, Smalls commands respect. Not because of his demeanor or stature. He’s the least intimidating ex-felon you’ll ever meet. He’s soft spoken, with a gentleness in his eyes that makes it almost impossible to believe his past. No, that respect – his near effortless ability to connect with local youth who are trying to break the cycle of violence and lawlessness in their own lives – comes from having been exactly where they are. 

But above all else, it’s his openness. His pure honestly and self-awareness is what makes him so intoxicating. His message so powerful. Warts and all.

“These are my bad decisions. I take ownership of them. There’s no reason to deny them,” he said.

But it’s just that – that willingness to say, “I screwed up. You don’t need to make the same mistakes I did,” that makes Smalls such a good mentor and an even more compelling human being.

“The penitentiary can either make you a better man or a better criminal.
In that moment, I chose to be a better man."


Keith Smalls

Just two years after being released from prison, Smalls – now a father of four: three daughters and a 1-year-old son – found himself staring at an even bigger charge. It was April 4, 2000, and he was busted for carrying over 10 grams of cocaine, which constitutes trafficking. A seemingly small amount – roughly three packs of sugar, he said – but legally, a very big deal. 

The judge didn’t go easy on Smalls. He would spend the next 15 years of his life in prison. 

What made the sentence even harder to swallow was, in the previous two years, he had actually started to become the kind of father he never had. Now, if he were lucky, he might see his kids twice a year.

Months passed before he got his first visitor. His mother brought his son to see him. Smalls will never forget how the toddler kept pinching his face. 

“He couldn’t believe I was real,” he said. 

Statistic that reads 79. Percentage of U.S. murders in 2020 that involved a firearm. Source Centers for Disease Control 

It was a painful moment for Smalls. “That moment was life-changing for me,” he said. “I knew right then I had to be better for him."

Tears run down Smalls’ face as he recalls that visit.

“The penitentiary can either make you a better man or a better criminal,” he said. “In that moment, I chose to be a better man.”

For the next decade and a half, Smalls occupied his time reading as much as he could. He consumed so many legal books that he could recite the Miranda rights by heart. Some weeks, he spent nearly two hours every single day in the prison library. Others, he was fortunate if he got one visit. But it was through reading all of those legal texts that he realized something critically important: He wasn’t one of those people. 

“When you’re in prison you hear so many voices. Voices of people who doubted you. Voices of people who believed in you. You hear them all. Which ones you choose to listen to? That’s up to you.”

So he thought back on the handful of people who believed in him when he was a kid. And he let those voices dominate. They inspired him to improve. To better himself. He sought out any learning program the prison offered. From financial literacy to family roles and relationships to job interviewing techniques, he took them all. Slowly, he sensed a real change was happening. 

“I wasn’t just saying it to try to convince myself anymore,” he said. “As my time to get out got closer and closer, I might not have known what the world had in store for me, but I certainly knew what kind of man I was.”

A better man, for sure, but also a man who had spent 19 of the last 21 years behind bars. 

A new rock bottom

Life outside of prison was an adjustment. But not once did Smalls consider going back to breaking the law as a means of making ends meet.

By then his mother was in a better place, so he moved back in with her. His son, now 16 years old, moved in with them, too. 

“I had no money and no job,” Smalls said, “but I was cool with that. I had my son.”

The two were inseparable for the next year. His son, Amarai, was never more than two steps away from his dad. He wore his dad’s clothes, copied his movements. He even tried to talk like his father. 

stack of two photos, at top smalls and son when he was young and below smalls and son when he's a teenager 
Smalls with his son, Amarai, as a toddler (above) and then as a 16-year-old (below). Smalls spent the 15 years between photos in prison. Provided

Reenergized by his newfound relationships with mother and son, Smalls enrolled at Trident Tech, taking classes to become a computer programmer. He got a job as an electrician. He was finally living a normal life.

And then, just as things seemed to be finally going his way, he got a phone call that completely altered his interpretation of “rock bottom.” 

Amarai was dead. He had been shot in the back three times. 

The very next day, Oct. 18, 2016, Smalls stood in front of a microphone at a press conference and made his voice heard publicly for the very first time. He was speaking out, not against the person who shot his son but rather against senseless violence. 

“We have to take a stand in our community. We know better than this. This is not who we are. We have got to be better,” he said. 

And from the pain came purpose. 

Though he had done his share of bad things, Smalls had never shot anybody, much less even fired a gun in his entire life. So to lose his son that way was unthinkable to him. 

“There was so much promise in our relationship,” he said as tears streamed down his face. “I will never get that back.”

Heartbroken and 42, he embarked on a new mission to speak out against community violence. To provide programs to help youth to make better decisions. He became a vocal advocate. For all the worst reasons, Smalls had become wise beyond his years, often finding himself the youngest man in the room by several decades. 

But he had a plan and a belief. And he had energy. While still in prison, he had started a mentor group. Years later, he knew he could do the same thing again, only this time he could reach people before they ended up in jail. 

His pain was his fuel. Now, there was no stopping him.

A link with Hink

In 2018, after two years of speaking out in the community against violence, Smalls was tapped to join the Charleston County Criminal Justice Coordinating Council, a group focused on improving justice reform and enacting public safety initiatives. During that same timeframe, Smalls became a certified juvenile arbitrator, an executive board member for South Carolina for Criminal Justice Reform, a member of the Tri-County Gun Violence Coordinating Council and a frequent speaker on community issues, including gun violence prevention, criminal justice reform and grassroots community improvement. 

Ashley Hink MD 
Dr. Ashley Hink

Meanwhile, another force looking for change in the community was MUSC Health trauma surgeon Ashley Hink, M.D. Hink’s passion, much like Smalls’, came from a place of hurt. In college, a classmate of hers was murdered, and it shook her to the core. It was only then that she realized how few resources were available for people affected by violence. And so began a decade-plus crusade to provide that framework for a community. Inevitably, the two advocates’ passions intersected. And she knew immediately that Smalls would be a perfect fit for a program she was trying to get off the ground. 

So in July of 2021, when MUSC Health launched its Turning the Tide Violence Intervention Program, Hink tapped Smalls to serve alongside local activist Donnie Singleton as one of the program’s two violence intervention client advocates. 

“The people are incredibly important to the success of this program, and we’re so lucky to have the right ones,” Hink said. “Keith is able to connect with our patients – having lost a son of his own to gun violence – in a way that other people just can’t. Most of us have no idea what that’s like. Keith does. And our patients really connect with that.” 

Smalls and his program director talk with a nurse in the hospital 
Smalls, center, alongside program director, Ronald Dickerson, Ph.D., left, chats with a nurse in University Hospital. Photo by Sarah Pack

Hink said walking down the halls of the hospital with Singleton and Smalls is kind of like being with two celebrities. 

“They’re friends with everyone. They’re so charismatic and loving toward our patients and families and staff. So many people just light up when they enter a room because they know they get it. They actually understand what they’re going through,” she said. 

Smalls’ role in the program is to work with teens and young adults experiencing injuries from community violence as well as providing mentorship and support, with the goal of ultimately breaking the cycle of violence. It was something that came naturally to him, and he quickly gained a reputation as a mentor.

Just nine months into the program and Smalls already has 18 patients, all of whom he sees or talks to on nearly a daily basis. He takes some to lunch, plays basketball with others and occasionally, he’ll drive one to work. But one thing they all share is his cell number. A couple even call him “Pops.” 

Take the young man who had always dreamed of being a fireman until one day, when trying to break up a fight between his mom and her boyfriend, he got shot in the head. Though his outlook was bleak at the beginning, he went to the intensive care unit where he slowly began to get better. Next, he did therapy. After that, he linked up with Smalls, and their connection was immediate. There was a mutual respect – a shared narrative that brought them close. The relationship flourished. And in January, after more than a year of wondering if life would ever be the same, he finally became a firefighter for Charleston County. 

The man and his mother give Smalls a lot of the credit for his turnaround. Of course, he plays down his role: “I’m just here for him. He did all this.”

With his new job has come a higher profile. In March, he spoke at the Charleston TEDx event, and earlier in April, he served as a keynote speaker for the 28th Annual Thomas A. Pitts Memorial Lectureship, which focuses on ethics in medicine – this year’s theme was gun violence and public health. 

But even with all the newfound success and prominence, Smalls never forgets who he is or where he came from. Through all the ups and downs, Smalls believes deep down that his mistakes, his tragedy, have inspired the triumph. 

From despair has come hope. 

And as long as people like Keith Smalls exist in this world, there will always be hope.