I ii N I I @ol *1 MH -Chicago MH -Community Health Services/*/Chicago MH - Students, Health Occupations/*// KW - 20C PN - Ballance, Lee///// CN - Chicago Student Health Project//// CN - Presbyterian-St. Luke's Hospital//// CN - Student Health Organization of Chicago//// CN - United States. Division of Regional Medical Programs//// Ti Chicago Student Health Project, summer 1968/G TC . Student director: Lee Ballance. IM [Bethesda, Md.,/Health Services and Mental Health Administration,/l 9701 CO viii, 129 p.:illus. GN Sponsored by Student Health Organization of Chicago and Presbyterian-St. Luke's Hospital. GN Project supported in full by the Division of Regional Medical Programs, Contract no. 43-68-1534. CP 02NLM,08HMS:WA 546:AI3.2:C5S9c:: 1 970 CA WA 546 A13.2 C5S9c 1970:02NLM,08HMS Yl S/1970/ LP Eng LA Eng MT CORPORATE NAME MAIN ENTRY RO O:MED RO C:MED RO M:CN1 DA 710309 MR 831204 LR 831220 RI rev EL FULL LEVEL IT MONOGRAPH Ul 1254501 i -F CHICAGO STUDENT HEALTH PROJECT summer 1968 v am imm , CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Sponsored by STUDENT HEALTH ORGANIZATION OF CHICAGO and PRESBYTERIAN-ST. LUKE'S HOSPITAL Student Director ------------ Lee Ballance Faculty Advisors ------------ Joyce C. Lashof, M.D. Adrian Ostfeld, M.D. Research Director ------------ Philip Rushing Project Coordinators --------- Peter Bonavich Terry Fonville Elizabeth Butters George David George Donna Karl Lynnae King Gerald Kirk Leith Mullings James Pinney Patricia Rice Marsha Steinberg Joseph Thornton Intern Coordinators ----------- Pamela Duncan Carlos Moore Pat Peterson Emerson Lenoir Executive Secretary ---------- Rosalie Ross US. DEPARTMENT OF HEALTH, EDUCATION AND WELFARE Public Health Service Health Services and Mental Health Administration This project was supported in f ull by The Division of Regional Medical Programs rop" e8 -no nece8san r PREFACE The Chicago Student Health Project-Summer, 1968-was carried out under a contract with the Division of Regional Medical Programs (PH-43- 68-1534) and was administered by the Section of Community Medicine of Presbyterian-St. Luke's Hospital. The faculty advisors were Dr. Adrian Ostfeld who, at the beginning of the Project, was Professor and Chairman of the Department of Preventive Medicine of the University of Illinois College of Medicine, and Dr. Joyce C. Lashof, Professor of Preventive Medicine, the University of Illinois, and director of the Section of Com- munity Medicine of Presbyterian-St. Luke Hospital. Explanation of the structure of the Project and preparation of the report is in order here. The Project was devised, organized and directed by members of the Student Health Organization. The student coordinating staff consisted of a project director Lee Ballance, a third-year medical student at the University of Chicago Pritzker College of Medicine, and 12 coordinators. Each area coordinator was responsible for the selection of sites in the geographic area and for students located at these sites. In addition, there were coordinators responsible for the high school interns and the law students. The student staff was assisted by a research director, Mr. Philip Rushing, formerly administrative assistant at a junior college in Mississippi, who also had experience as a community organizer and youth worker in both Chicago and the rural South. He aided in the develop- ment of questionnaires which were used in some of the surveys under- taken by the students that will be reported in the following. He also served as an adviser and "troubleshooter" when problems arose. The preparation of this final report has been primarily the responsibility of Mrs. Irene Turner, Research Associate in the Section of Community Medicine. All students submitted site reports, research reports or personal essays at the completion of their assignments. All of these have been read; some are reproduced here in their entirety, others have been quoted and some abstracted for this text. Due to the lack of space some student's reports have not been included. The format of this report is as follows: There is an introduction written by Mr. Lambert King, a fifth-year M.D.-Ph.D. candidate at the University of Chicago's Pritzker College of Medicine and chairman of the Chicago chapter of the Student Health Organization. It concerns the implications of the project for the students. Mr. Lee BaRaiice, the project coordinator, has written a statement giving background information and discussing the implications of the summer's work for the Regional Medical Programs. r. ip s research director, has described his overview of some of the problems faced by the project, dealing in d with the blac, i-w. ii co@ ron CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The body of the report consists of two sections, the first composed of reports on the community sites where the students worked and the second an analysis of the work performed at a number of hospital sites. Mrs. Ann . Prosten, a member of the Section of Community Medicine, assisted in the preparation of the Community Sites Section. The final section presents a brief analysis of some selected charac- teristics of the participating students and was prepared by Mrs. Turner. The report of each student represents the work and thinking of that student alone, and its publication here indicates neither approval, or dis- approval of any other individuals, institutions or other students. A final editorial word: I hope that when the students read this final report they will realize that they accomplished more than many of them thought they had. They have indicated how much they learned and profited from their summer's experience in their reports. I offer them my congratu- lations. JOYCE C. LASHOP, M.D. Director, Section of Community Medicine. IV ACKNOWLEDGMENTS We wish to especially thank the following individuals for their instrumental support of the 1968 Chicago Student Health Project: Dr. Robert Q. Marston, Dr. Richard Manegold, and Dr. Herbert Mathewson of the Division of Regional Medical Programs for their support and guid- ance; Dr. Wright Adams of the Illinois Regional Medical Program for his sense of innovation; Dr. James Campbell and Dr. Mark Lepper of Presby- terian-St. Luke's Hospital for their unstinting dedication to health pro- fessions education and to the highest standards of community health care-, Dr. Joseph English and Mrs. Edna Rostow of the Office of Economic Op- portunity for their creative support of the Student Health Projects during the past 3 years; Dr. Jeremiah Stamler of the Chicago Health Research Foundation and Pierre de Vise of the Hospital Planning Council of Metro- politan Chicago for their substantial assistance in designing our major research efforts. v AGO COMMITTEE ON URBAN OPPORTUNITY INNER CITY POVERTY ZONES E-EDUCA'rION-NCUSING'WELPME-DELINQUENCY) 13 14 CONCENTRATION OF POVERTI LEGEND' M A- i.t@ GREATEST CONSE.I.Al.. -@CNE I T- F- 161 0.2@OKATEST CONUNTRATION'ZONE I C. 3,0. $NEATEST CONSEKTRATION Z-1 I mu MAWS OL 23 63 _42 70 4 - @73 _ - 63 C6MMUNITY AREAS AND CENSUS TRACTS 19leO CENSUS OF HOUSING AND POPULATION TABLE OF CONTENTS Page PREFACE ------------------------------------------------- III ACKNOWLEDGMENTS ------------------------------------ v MAP OF CHICAGO COMMUNITY AREAS ------------------- VI Section I. INTRODUCTION "The Health Science Student Experience on the 1968 Chicago Student Health Project" by Lambert King ------------------------------------- 1 "Background Information and Implications for Regional Medical Programs" by Lee Ballance --------------------------------------- 5 "The Black-White Confrontation" by Philip Rushing ------------------------------------- 8 References --------------------------------------------- 10 Section II. COMMUNITY SITE REPORTS The North Side ------------------- I --------------------- 11 Uptown --------------------------------------------- 11 Lincoln Park ---------------------------------------- 23 The Latin American Defense Organization -------------- 34 Erie House ------I------------------------------------ 35 The West Side ----------------------------------------- 38 The Valley -------------------------------------------- 41 Pilsen ------------------------------------------------ 43 Lawndale ------------------------------------------- 47 Martin Luth er King, Jr. Neighborhood Health Center - - 47 Lawndale Association for Social Health @ -------------- 48 Drug Abuse ------------------------------------------ 49 St. Leonard's House ---------------------------------- 50 The South Side ---------------------------------------- 53 Abraham Lincoln Center ------------------------------ 53 The Robert Taylor Homes and Clinic -------------------- 56 Woodlawn ------------------------------------------- 62 The Southwest Side ------------------------------------- 65 Benton House ---------------------------------------- 66 Garfield Civic Association ------------------------------ 68 vii CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Page 69 South Lynne -------------------------------- 73 Englewood ----------------------------------------- 76 The Englewood Mental Health Center ------------------ 77 The Englewood Clinic ------------------------------- 82 Other Reports ----------------------------------------- 82 The Chronic Disease Detection Program ---------------- Proposed Amendments to the Illinois public Aid Co 91 Relating to the Illinois Medical Assistance Program ---- 97 Bibliography ------------------------------------------ pITAL SITE REPORT Section III. HOS 99 Cook County Hospital -------------- 101 presbyterian-St. Luke's Hospital ------------------------ 103 ospitals and Clinics ---------------- University of Chicago H 105 Woodlawn Hospital ------------------------ 106 - - - - - - - - - - Michael Reese Hospital ------------------------- 107 Provident Hospital ------------------------------------- 108 Emergency Rooms -------------------------------------- 108 Mercy and Billings Hospitals -------------------------- 109 St. Bernard's Hospital -------------------------------- 110 Student Reaction ----------------------------- ill summary 112 ----------------------- Tables -------------------------- 119 E STUDENTS ------------------------------ Section IV. TH 119 The Health Science Students ----------------------------- 123 chool Interns --------- ----------- The High S ICIPANTS AND SITES Section V. LIST OF PART 127 ---------------- Participants --------------------------- ----------- 129 ----------------- Sites ---------------------- Vill Section'l. INTRODUCTION The Health Science Student Experience on the 1968 Chicago Student Health Project by Lambert King (Medicine) The Student Health Projects (SHPS) were that is a salient change in the social orienta- conceived more than 3 years ago by students in tion of health professions students. the health sciences as a primary step in their The implications of the 1968 Student Health efforts to enhance the quality of their educa- Project in Chicago should be analyzed first for tional experience. Initiated and designed by the central similarities of the 1968 student ex- Student Health Organization members and cos- perience as compared with the experience of ponsored by leading medical schools and health students on SHPs during the. 2 preceeding care institutions, 12 major Student Health years; the commonality of the goals and res- Projects have taken place-one in 1966, three ponses of the students to their experience in all in 1967, and eight in the summer of 1968. The of the projects during the past 3 years reflects burgeoning growth and the striking results of some of the most consistent and important these projects have been unprecedented in qualities of the new generation of health stu- health professions education in the United dents. But proceeding beyond the areas of Simi- States. The energy, momentum, and creativity larity in the past and more recent projects, one necessary to mount these projects are indica- should also examine the distinct evolution that tive of major change in the goals and attitudes has occurred in the attitudes of each succeed- of.a broad sector of contemporary health pro- ing group of student project participants. It is fessions students. An analysis of the experi- in the evolution of the student experience that ence of the hundreds of students across the the most important trends for the future may country who have participated in these pro- be found and directed toward other health sci- jects is likely to yield implications of vital im- ence students, teachers and administrations of portance for the future of health science edu- health professions schools, and the other orga- cation and health care. nized representatives.of the health -professions. The Student Health Projects are best consid- The implications of the experience of these ered as an integral component of the more gen- deeply committed progressive health science er-al student health movement that has ini- students must be heard and acted upon with a tiated -the SHPS. Within only 3 years the atti- constructive spirit of renewal and reform. tudes and goals of the students involved in or- During the past 3 years health professions ganizing these projects have undergone a, dis- students have been the prime initiators of the tinet evolution. The socio-political-psychologi- Student Health Projects; they have recruited Cal evolution of the students participating in fellow students, negotiated for substantial the projects reflects their response to a com- funding, and have determined the location and plex array of societal-wide issues and condi- nature of their own project experiences. tions. Indeed the very flexibility of their res- T e third distinguishing characteristic of Ponse to the problems they have confronted is our @program involved a large amount of indicative of a capacity for self reappraisal autonomy permitted@encouraged-in the I i CHICAGO STUDENT HEALTH PROJECT SUMMER IUUZS student participants. This intentional min- We focus around community health imization of its structure was intended to because we are dismayed at the re- permit students to'exercise their own ini- treat of the health professions schools tiative in identifying and pursuing activi- from contact with the clients of our ties in po entially fruitful areas within professions. We are concerned not the broad context of their own particular only with the basic science view of summerplacements * * * (1) health, illness, and therapy; we are Generally the quality of student leadership outraged by the lack of education in which has initiated and organized the SHPs the area of socioeconomic determi- has provided a convincing demonstration of nants of health and disease. student capability and creativity in determin- (2) ing the nature of a sizeable segment of their Students foresaw two major'goals for the educational experience. In the case of the Stu- participants; personal experience on the pro- dent Health Projects, this experience has cen-, jects as distinguished from the equally impor- tered around the focus of action and research- tant results of the students' work. First the oriented multidisciplinary community health projects were intended to result in basic programs. Each of the projects has brought changes in the sociopolitical viewpoints and at- students together for a previously uitavailable titudes of the largely middle and upper middle interaction between students of all health dis- class student participants. Second it was in- ciplines, community workers - tended that the b , community or ody of student participants ganizations, and established health agencies. would in the coming years constitute an experi- The impact of this somewhat loosely struc- enced and united corps of young health profes- tured yet uniquely'challenging experience for most of the students involved has led many of sionals dedicated to reform of the United the student participants to compare the project States health care system. experience with their own conceptual model of Perhaps the problem of changing a "free university of health." society is insoluble, but after one summer of immersion in the frustra- Throughout the 3 first years of the Student tion of the South Bronx, I believe Health Projects, student participants have con- realities must be challenged and cluded that the projects have demonstrated changed, ho .efully with the coopera- p that the health professions students them- tion of the full resources of our soci- selves are far more capable of determining the ety. For the cancers that infect our -nature of their own educational process than society, only radical change offers any the present organization and structure of their hope schools permits. My summer's experience leads me As students we have no voice in de- to conclude that students must create termining our educational process. a new health profession concerned Except for a minimal amount of time with the real problems of society. An devoted to a narrow range of elec- organization which responds to the tives, we are not allowed to plan our -needs of the people and which ration- courses; nor are we allowed to judge ally utilizes and provides for health our professors or examine the qualifl- manpower is needed.* We have not cations for admission or promotion of changed the places we worked in this our peers. In each of these functions summer, nor was it realistic to think the student has as much at stake as that we would. But we have changed faculty personnel to promote the ex- ourselves-our aspirations, actions, cellence of the university. Both fac- our beliefs..In this departure from ulty and students are subject to simi- the lack of involvement with social lar errors of judgment. problems shown by the past genera- 2 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tion of health students lies the catalyst sacrifice of life and disruption of cul- for making our dream of a vibrant ture for the sake of unjustifiable mili- American health profession a reali- tary and political priorities. (5), ty.* * * (3) At the inception of the 1968 Student Health Consistently the student participants on this Projects, many of the student participants felt year's and on previous Student Health Projects that such statements as the preceeding one have viewed their project experience as bridg- were highly relevant to the goals of reform- ing an all important gap in their formal health minded and progressive health science stu- science education. This experience has led dents. Indeed the writing of the student parti- them to verbally and organizationally commit cipants on the 1968 Chicago project reflect a themselves to life styles and career orienta- more sophisticated and well-documented un- tions centeredabout contemporary biosocial is- derstanding of such socially critical subjectsas sues. Black Power, war and the health profession, I have looked and, perhaps I have political dissent in medicine, and consumer found. I have been a member of the control of health care planning. Student Health Project, I have met The 1968 Student Health Projects wit- people who made my former "liberal nesseda widespread conclusion among student views" pale by comparison * * * participants that the focus of their work must Most of all, I h-ave been given the op- be broadened to include not only direct action portunity to spend 10 weeks during in poverty communities but to encompass re- my years of medical training thinking formation within their own schools and health about riots and open housing and the care institutions. Many students on the Chi- welfare system as medically and so- cago project felt that their experience in black cially significant entities which di- communities striving to develop their own rectly pertain to me and for which I leadership was detrimental to the eventual so- must attempt a solution. (4) lution of problems of such relatively powerless Following the 1967 Student Health Projects, communities. The students' study and analysis both the Student Health Organization of Chi- of the shortcomings of health care in ghetto cago and other Student Health Organization areas often lead them to conclude that the groups across the country began to seriously prime cause of this poor health dare lies not in examine the larger issues confronting them as the black community but in the lack of signifi- a result of their 2 prior years of involvement cant commitment on the part of powerful insti- in the community and in the development of tutions, schools and government agencies to their own projects. Health science student ac- the solution of these problems. Seven students tivists articulated a challenging conception of who worked attempting to set, up an evening the obligations of health professionals. Their medical clinic in the Robert Taylor Homes area broader definition of their own future role led on the 1968 Student Health Project concluded. them to confront issues and problems that * * * This student venture may be in- deeply affected the reform of health care and strumental in adding another incident health science education. in a long series of disappointments, as The defining purpose of the Student well as acting as a channel to divert Health Organization is the achieve- energy from places where it may be ment of human welfare, good health in more effectively placed. Fortunately, a total sense. A commitment -to human through a combination of coinci- welfare must lead to concern with dences, the Taylor project is at least relevant political affairs. We consider functioning. Students do not need to the involvement of the people in the organize in poor communitie's-Appa- United States in the war in Vietnam lachian white, Spanish or Black-to to be inimical to human welfare in its learn about the problems that affect 8 CHICAGO STUDENT HEAL'EJ:I rxlvir,%jx the poor. Middle class whites are for- stitutions, and more broadly, in affluent, white eigners to the poor and always will be. America. As students, they concluded that they Contact with middle class whit@s, must concentrate upon obtaining more freedom SHOs own constituency, can teach -the in their schools to redesign and broaden the same classic lessons. nature of their educational experience; as f u- ture health professionals, they concluded that The student participants on the 1968 Chi- they must work to bring change within health cago SHP involved themselves deeply in the care system under the control of the impover- difficult problems and issues underlying most . I euphemistically isned communities that have been most deel- what has come to be known the crisis in health care delivery. For most of mated by the lack of a humane, rational health the student participants, their experience was care. of crucial importance-it was an experience The report which follows contains not only a that their own schools were either unwilling or description of the work of the students, their unable to provide. A brief 10 weeles immersion findings and impressions but gives clear evi- in the milieu of poverty led some students to dence in their personal essays that they are conclude that the "crisis in health care deliv- moving toward nothing less than a long term ery" had deep and intimate roots in the policies commitment to a new health profession based ols, health care in- upon both science and social justice. and attitudes of health scho 4 Background Information and implication for Regional Medical Programs by Lee Baliance (medicine) The 1968 Student Health Project was some background information which should be funded by the Division of Regional Medical helpful in tying things together. Programs of the Health Services and Mental The planners of 'Student Health Projects Health Administration of the Department of have been troubled since the beginning with Health, Education, and Welfare. It is impor- the dichotomy between education and service. tant that all parties concerned take some time It soon became clear that the goal which could out to lookat what has been learned from the be most regularly and satisfactorily attained summer's experience. First it is important to and quantitated was that of education of the note that by giving 124 students from various student participants. It was equally clear that health science fields the opportunity to work in using the medically deprived community as a and with community groups towards solution summer teaching laboratory without providing of community health problems, the project and a fair amount of service to that community its sponsors contributed to the growing pool of ranked with the worst forms of exploitation. It interested, aware, and vitally concerned stu- was the thesis of the planners of this project dents dedicated to the solution of Americ-a's that one could learn a great deal without pro- health problems. It afforded 75 high school viding a bit of service, but that one could not student "interns" the opportunity to work make a serious attempt at serving the com- within their own communities towards solution munity without learning a lot as a result. of their own problems. The project also gave one intern the motivation to become a doctor, But what kind of meaningful service can a another the insight that the solutions to his group of nursing, preelinical medical, law, so- community's problems lie largely within that cial work, and high school students provide in community itself, and a good many the faith 9 weeks time? This was a question which that things can be changed for the better. could only be answered by the community or- These immeasureable contributions are proba- ganizations and groups with which the student bly the most important result of the summer's eams would work. In order for any communi- expe ience, but the RMP's also gained the not ty-oriented project to be maximally effective in insignificant reports which make up the bulk defining and attaining its goals, it must be con- of this volume. Some of these report events ceived and planned with the full cooperation of and insights which we think others should all people directly affected by it. For this rea- share. Others contain the results of the numer- son much of our energies during the planning ous and diverse research projects carried out stage of the project were devoted to discussions with the members and leaders of the communi- by the intern-student teams last summer. In introducing this volume, no attempt will ties in which students were to work. Thus the individual site-projects evolved over the winter be made to force its contents into a series of and spring. neat generalizations. In putting it together out of the multitude of reports, questionnaires, Some students were assigned to doing com- and other documents which were left at the end of munity health resources surveys and drug the summer, an attempt has been made to leave price surveys which the community groups -ry in the words of the stu the summer's sto could use to help their constituents get better dents who experienced it. It would be insulting health care. Other students found themselves for anyone to try to tell the reader what it all working with the two community-sponsored means. Rather the reader is left to read the clinics which grew out of last year's project. book through and find in it his own meaning. Still others found themselves working on hous- This introduction will serve only to provide ing, urban renewal, and lead poisoning prob- 5 CHICAGO STUDENT HEALTki ri--vir,',' lems which, while not strictly medical, were -as the students learned this summer-but considered essential to the health of the com- while it may be difficult it is most rewarding. munity. The concept of re "onal medical programs gi On a different level, many students worked appears to be a limited one. More appro- on more conventional.research projects. The priately the concept should be that of regional focus for most of these was the attempt to un- health programs. The word, medical, implies derstand the current health care system of the 'curing' or 'caring for' when actually RM'P city of Chicago. The majority of these projects must concern itself with the health of a region took place in various hospitals and out-patient not the medicine or medical care provided in clinics in the city. that region. Yet, as will rapidly become clear to the This might mean that elimination of air pol- reader, the focus of the reports from these di- lution, implicated in the etiology of lung can- verse placements is confrontation: confronta- cer, may well be as important as sophisticated t.ion between health science student and intern, research into its chemotherapy or building and between community members and project equipping intensive care units for post-pneu- workers, between students and politicians, be- monectomy patients. Resolution of the social tween students and staff, between old concepts stresses, implicated in hypertension, may be as and ideas and -new ones.'It seems as if no one important and economical as designing cornpu- went through the summer without having at terized link-ups of cardiac care units. least one of his actions or ideas seriously chal- The goal of prevention of disease must be- lenged. Our research director, Rev. Philip mportant as the goal of curing dis- come -as i Rushing, has analyzed the reasons for many of ease. If RMP is to be concerned with such ap- these confrontations in an accoml>anying proaches, then community involvement at paper. It seems also that these challenges were every level in its various programs is essential. a significant part of the summer for most of RMP can help a community achieve power and the students. Reading their detailed reports, importance by allowing the community to one can gain a great appreciation for many Of make its own decisions, or be involved in deci- the major issues which confront anyone who sion making, on its own terms. By doing so, it tries to work with the community in solving its can create a climate in which many problems health problems. The reports are also a valu- central to the total health needs of the com- able record of success and failure in attempt- munity can be solved. RMP can become a cat- ing to meet these challenges. alyst in the process of social change rather With this as a background let me -next dis- than another organization in a plethora of or- cuss the implications for RMP as I see them. ganizations planning a surfeit of programs- most of which will have no lasting impact on RMP is not involved in the actual provision the health of whole segments of the popula- of medical care. Further, they are prohibited from "changing the existing organization of tion. These broad definitions of the appropriate medical carell-a somewhat ambiguous provi- sion since RMP's very existence changes the role of RMP may be very difficult of accept- organization of medical care. The major prem- ance, let alone achievement. Perhaps, change is . dicated in RMP's enacting legislation to per- ise, as well as the initial etus for RMP's in- in mit it to broaden its approaches and deal with ception, is their potential to raise the health earth problems involving whole status of American communities by regional very real h -solving communities. planning and regional problem The best method of attaining this goal, is to work it is probably easier for students to embrace with and through community groups who have these approaches than it may be for RMP similar interests, i.e., improving the health planners. Students have little or no vested in- conditions of the community. This is -not simple terest in defending the present medical care 6 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 system since it is not "ours" yet. But RMP ing scene will not be as easy as it was for the planners are part of that medical care system. students-although it was not easy for them It is "theirs." Students are prepared to be, and either. indeed are, highly critical of that system, but However, the demands of community groups criticisms of that system by members of the for the right to govern their own lives will Establishment-as are most people in control continue to escalate. This is attested to by the of local RMP'@is less likely to be forthcom- increasing demand for community control by ing. Students are without power. The medical such disparate groups as the Black Panthers, school deans, hospital administrators, an the Dissident Democrats and the American n- medical society representatives who administer dependence Party and also by the increasingly local RMP planning have a substantial amount common provisions for consumer and commun- of power. Resisting the temptation to wield ity control in Federal legislation. RMP will, as this power as a club over the heads of con- will many other American organizations, need sumer and community groups will not be easy. to hear these demands and bring creativity and People in control of local RMPs will have to inventiveness to meet the challenge they offer. guard against their own, quite natural, tend- The students heard them and have been pro- ency to defend and enlarge their own "em- foundly influenced by them. This will be evi- pires." They will need to sublimate their own dent as their reports in this volume are read. needs for power and prestige to the. total We hope that these experiences will be of value health needs of the community and to the need in offering RMP new insights and avenues for social change. Therefore for local RMPs to through which it can more effectively fulfill its come to grips with. some of the new and chang- promise. 7 The Black-White Confrontation by Philip Rushing The project encountered several problems was a valuable experience for both student and that caused some degrees of frustration for al- intern. Both realized the difficulty involved in most all of the students. First, many students learning to relate to people who are ethnically were perturbed by the ambiguity of their roles and culturally different. Both seemed to realize and complained that they did not know exactly that by working together for a common con- what to do. Part of this uncertainty was due to cern a meaningful affinity can develop between the deliberate attempt of the staff to avoid sti- people in spite of their differences. At the close fling students' creativity by a strict guidelining of the project, relations between students and of their roles, thinking the summer's experi- interns were decisively improved. Between ence would be more productive were students some at the wrap-up conference, there were in- independent to design their own activities. dications that this would continue. Addresses However, the students "syndrome" of having were being exchanged, interns were leaving functioned more or less within a prescribed each other to sit and dine with students and framework and of having their work proce- vice versa. dures defined for them probably played a part. Though these problems had some signifi- Second, organizational logistics-many stu- cance , the overriding problem through-out the dents complained about poor communication be- summer was that of the black-white confronta- tween themselves and staff. This situation was tion. The effect upon the students stands out in the result of the wide area over which the pro- almost all the individual essays, as will be seen ject extended and the inconvenience of not hav- in the reports that follow. The essence of the ing ready access to a telephone. The project problem was poignantly described by one stu- was officed in Presbyterian-St. Luke's Hospital dent as follows: on a new floor of an unfinished building and was without telephone service (due to the Into the church where we worked Brotherhood of Electrical Worker's strike). walked Black Power. They told us in Offi no uncertain terms that we were un- ce personnel had to go from the 10th floor of this building to the third floor of an adjacent welcome in their "hood" and that we building to make calls. This situation not only should leave immediately' A concen- limited staff-student communication but also sus of white opinion was taken and it impeded effective coordination and administra- was our most "noble" hour when it tion of the project's activities. was conditionally decided that we would stay, at least until we had Third, the attitudinal confrontation between found out who the youths were, and the health science students and the black high whom they represented. In a few days school interns-initially, some students had following the incident, our physical difficulty relating to their interns. Different at- stake was pulled and we left the titudes, value patterns, and goal objectives neighborhood. My emotional stake re- created a communication and social barrier be- mained, however, and I continued tween student and intern. Both brought to the throughout the summer to wor or project preconceived expectations and were an- the Clinic. noyed when those expectations were not ful- I worked because I wanted to see a filled. Students expected mature behavior from lot of work come to fruition, and I the interns while the interns expected an un- worked because I didn't want frustra- derstanding "big-brother" type -of behavior tion and finally despair to overcome from students. Analytic-ally, this confrontation the indigenous committee of women 8 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 who had been with this project from hanced the summer's learning experience. This the beginning. What was wrong with learning occurred on two levels-individual and all of -this? community. First, 1, and probably many others, 1. The individual level-Th-e militants' po- ,assumed our jobs without a real un- sition provoked students to really see, hear and derstanding of the past relationship feel the pathos, dynamics and mentality of between the white and black people in ghetto life for the first time. In contradis- the area. Of course we know things tinction to Negro passivity of previous decades, were bad and could spout words like disciplined to deceive white liberals in order to white racism and neocolonialism but incur paternalism, black.militancy "told it like I, for one, didn't really understand it was." Initially shocked by this raw mili- how these phrases could apply to our tancy, students began to probe their own well-meaning effort. I didn't realize motives and intensified the on-going debate on until a few weeks after the beginning the moral right of white students to interject of the project that all our efforts at themselves in the life of ghetto communities at organizing the community were a time when these communities were strug- impeded by the belief of many that gling for esp?it de corps. This direct personal the Student Health Project was just encounter with militant segments of ghetto another extension of the mistrusted leadership, the introspection it precipitated, University of Chicago. Also, I didn't enlarged students' understanding of ghetto know that because many other white problems, increased their appreciation for poor liberals had come into the area before black people and inspired students to a creative us and had changed nothing, we were search fora redefinition of their role as health judged either guilty or impotent by professionals seeking change in a health sys- association. And lastly, I didn't real- tem that is not responding to the health needs ize until much later that what I of the poor. thought was our greatest asset-our 2. Community level-That the ghetto is un- organizational skills and abilities- dergoing radical ideological and organizational was one of our greatest liabilities. transformation was readily observed by stu- (Stephen P. Rand.) . dents. New attitudes are forming and new Militants precipitated situations that created manhood is developing as the infiuence of a constant problem for students and at times Negro passivity is waning while that of black threatened to submerge the projecVs achieve- militancy is increasing. The emerging black ments. Articulate, sometimes raw, and often man is unwilling docilely to accept roles pre- provocative young militants spewed their rhe- scribed for him and is resolute in his commit- toric as they evinced their position, stressing ment to master his right to self-determination. their determination to organize their own conf- Consequently, militants are moving for control munities, accusing some students of being tools of ghetto institutions and the Negro power of the "Establishment" dispatched to safe- structures and they rationalize their activity guard the Establishment's "colonial" interest, on the premise that these structures are mere and challenging white students "go organize extensions of the "system" and are therefore Your own community and leave ours to us." On illegitimate. Concluding whites are the true the premise that liberalism perpetuated rather owners of Negro power, and reasoning that out than solved ghetto problems, Black Power re- of self-interest whites support and perpetuate jected it, maintaining that effective solution a Negro elite, these blacks want whites out. must be built into black ownershipand control "Get out, Whitey, and leave the driving to us," of ghetto institutions. was the cry often heard by white students. @, In addition to presenting some very -serious Currently, the Black Power confrontation is problems, the black-white confrontation en- basically a conflict between powerless young 9 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 militants and old line conservative Negroes concerned about the plight of poor blacks. who occupy positions of power. These militants They were, but only as the blacks' problem was are dissatisfied with the way the affairs of a syndrome of a much larger problem. It is at their community are being conducted, and are this level students and militants part. Mili- pressing for change. Militants hold whites res- tants are committed to the rectification of ponsible for the conflicts, thinking whites by ghetto ills to the exclusion of other considera- means of liberalism deliberately keep the black tions; students are committed to a rectification community divided. Not having a constructive of the ills of the total society. strategy for achieving their goal, young mili- (b) Students' inclination to underrate their tants roam their community seething with dis- own effectiveness was probably a rationaliza- content. Like a powder keg, they can be set off tion of -an emotional "hangup" that inhibited with the slightest provocation. Provocations their capacity to grapple "head on" with the are often provided in the form of exploitative challenge presented by the confrontation. business practices, excessive police forces or (c) Students tendency to devalue their com- whites controlling ghetto institutions. Mili- munity contribution was probably influenced tants feel black unity is a first priority to solv- ing ghetto problems and ridding the commun- by unresolved feelings of paternalism-stu- ity of whites would facilitate this unity and dents felt the need to measure success and help thus control of community' Militants really n terms of "doing something for poor people" want power over their lives to control their to the exclusion of "being something to poor community, to rebuild it, to withdraw into it as people." It was difficult for students to under- they attempt to escape the frustration and stand that "just being there" (emotionally as complexity of an engulfing society. They want well as physically) had positive value. a place for blacks to develop their resources Finally, solutions to ghetto problems require and "peoplehood" competent to function on a the participation of student health projects. level equalling other ethnic groups. Lacking These projects bring to the community a sense the means to achieve this within the context of of dedication and expertise desperately needed. the "system" drives them to struggle for it out- However, future involvement in ghetto areas side the system. Sometimes impetuous and must consider the historical frustrations and often unseasoned, they maneuver without care- disappointments sustained by ghetto people at ful design, often alienating would-be support- the hands of well-meaning.liberals. ers and incurring repressive measures for both themselves and their community. REFERENCES 3. Students' assessment of the black-white (1) Report of the 1966 California Student Health Pro- confrontation-In their assessment of the con- ject. frontation students tended to be overly critical (2) Peter Schnall, Lew Rosenbaum i'n Encounter, the of themselves. Three influences probably un- Bulletin of the Student Health Organizations, derlie this tendency to demean their personal Summer, 1967. eff activeness: (3) Robert Cohen, 1967 Report of the South Bronx (a) Solution to ghetto problems per se was . Student Health Project. (4) Claire Wittenmeier, Report of the 1967 Chicago not an overriding consideration underpinning Student Health Prbject. student liberalism and desire for change' This (5) Resolution passed by the Student Health Organiza- is not to imply that students were not seriously tion of Chicago on Feb. 5, 1968. Section 11. COMMUNITY SITE REPORTS More than half of the over 40 sites where Southwest area at Trumbull Park (105th summer of '68 Student Health Project teams Street South). were assigned can be defined broadly as com- munity organizations. These are the settlement THE NORTH SIDE houses or special project centers sponsored by neighborhood churches, private agencies, or in- Uptown digenous self-supporting community associa- The area: A strip that runs from 4000 tions. Many of these have come into being in North (Irving Park Road) to 5600 North an effort to cope with community needs which (Bryn Mawr Avenue) and from Lake Michi- society, or the appropriate government agency, gan on the East (about 400 West at that point) may occasionally acknowledge, but which are to beyond Clark Street (about 1600 west at not met with the requisite facilities, funds and this location). It is a portion of Community personnel, nor with programs and policies nec- Area 3. essary to assure their effective utilization. The population: A mixture of Appalachian Several sites were community health clinics, whites, American Indians, Spanish-speaking in some cases established and functioning par- Americans, these groups are mainly recent in- tially as a result of student health project par- migrants; a Japanese population which has ticipation, or where the students acted as cat- been there since the end of World War II; a alysts enabling the community to establish few blocks of predominantly black population; such clinics. Common to all the community and a substantial number of mostly single, in- sites to which SHP teams were assigned was digent, elderly white people, many of whom the community's unmet needs for accessible, have been located in Uptown by social service quality health care and education. departments of mental and chronic disease in- In some instances, the teams continued work stitutions. In 1964, the estimated white popula- begun by their predecessors during the sum- tion of the whole of Community Area 3'was mer of 1967. In every assignment the work 93,000, while the nonwhite population was es- was health oriented, if not directly health fo- timated to be 2,225 (2.4 percent). (1) cused. The projects were defined through joint The only data available as to income and site-sponsor, SHP discussion and the execution housing is based on 1960 census tabulations of the project was subject to the guidance of and the area has Changed since then with,more the sponsoring group. poor people moving in. However, even at that This section summarizes the SHP commun- time the percentage of families with incomes ity experiences as the students and interns re- below $3,000 per year ranged from 16.6 per- ported them. In some cases the students' essays cent to 30.1 percent in seven out of the 21 cen- will constitute the entire report on the site; in sus tracts in the area. In these same tracts the others, a precis of their experiences with quo- percentage of substandard housing ranged tations from their reports will be the mode of from 25 percent to 60.5 percent with only one description. A number of reports and commen- having lower than 23 percent poor housing. taries are reprinted in full for the quality of (2) work and thought which they reflect. Uptown is ranked as a zone 3 poverty area The presentation is in general geographic se- (the third greatest concentration of poverty in quence; from the Uptown community bordered the 24 poverty zones as determined by the Chi- by !Bryn Mawr Avenue (5600 north),'to the cago Committee on Urban Opportunity). In CHICAGO STUDENT HEALTH PROJECT SUMMER 1.968 ranking five mortality and morbidity factors, which had been started by SHP teams the pre- the section of Uptown in which the students vious summer. worked ranks in the 2d (highest) quartile for numbers of deaths due to influenza and pneu- The teams followed up the surveys with monia both for infants and noninfants; it is in "test" projects, introducing residents to local clinical resources. They also participated in the 2d quartile for deaths due to cervical can- screening children from the Indian community cer and 2d also for new cases of tuberculosis; for a lead poisoning detection program con- it is in the first quartile (the highest) for ducted jointly with the Montrose Urban Prog- deaths due to unknown and ill defined causes. ress Center. (The diagnosis, "ill defined causes" on a death certificate frequently reflects the extent or lack The American Indian Center team notes of medical care preceeding death.) (1). among its accomplishments: SHP teams operated at three Uptown sites: The health survey will leave a perma- The American Indian Center; the Tri-Faith nent record for use by the Center and Employment Service; and United People, a other concerned agencies, including neighborhood organization concerned with the the Commission on Health Planning impact of urban renewal in their area. and Model Cities. It was impossible to determine the adequacy of health care Medical student James Drake, working in for the American Indians from pre- the American Indian Center team, describes vious studies, since the Indians were Uptown in these words: never considered as a distinct ethn c The Uptown area of Chicago boasts group. fine apartment buildings just off the There were 133 personal interviews in the [lake] shore, modern hospitals scat- survey, yielding information for 620 individu- tered throughout, and thriving busi- als. The essay, "Indian Summer" describes one nesses on all the major streets. One's such interview, and a more detailed report on first impression is that this must be a the over-all survey will be found in the report, progressive and promising part of "Health Care in the Indian Community". Chicago; in fact, a fine place to begin Some of the specific accomplishments of the a career, invest in a business-even American Indian Center team of students in- rear a family. But it doesn't take a cluded: sharp observer too long to see Up- Preparation of a two-fold plan, adopted by town's moire typical streets and dis- the Montrose Urban Progress Center, for cover its "other face": the face of the treatment and prevention of lead pois- poverty, slum housing high density oning, now a widespread phenomenon a- living, dirt, disease and ignorance. As mong Uptown children: one finds street after street in the Establishment of a North Side Treatment same deteriorated condition, one be- Center at the Montrose Urban Progress gins to realize that this is indeed an Center. (Children have had to go to the area with grave urban problems. Municipal Contagious Diseases Hospital on The 'other face' of Uptown, is described in the southwest side of the City-a consid- greater detail by Lynnae King, SHP coordina- erable distance). tor for the area. Her report is printed in its en- 0 Creation of a central file at the Montrose tirety. Center which lists dangerous buildings Health science students and interns, at both where lead poisoning cases have been iden- the American Indian Center and at the Tri- tified, and distribution of this list to the Faith Employment Service sites, undertook community and to the renting agencies. surveys of health needs and facilities and com- This team's survey of drug prices in Uptown pleted a comparative study of drug prices discovered some interesting pricing practices 12 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 in the 14 drug stores involved. For at least one costs to the Indian and non-Indian investiga- of the prescriptions tested, 12 of the 14 drug tors. stores charged Indians higher prices for the Number of drugstores in Uptown item than they did non-Indians. The variation in prices between drug stores however indicate that all residents of the area are victimized to some degree by the pricing practices of the surveyed stores. 3 Prescription Tota ;$ ,-a Description and results of the survey follow: Penicillin --------- 14 5 5 4 1 Chlor-Trimeton --- 14 12 0 2 As members of the Student Health Project, Ortho-Novum ----- 8 2 4 2 we have been working this summer in the Up- town area. Our sponsor, the American Indian The increase in prices for penicillin ranged Center, knows of all our activities; and with its from 4 percent to 100 percent more charged consent, we have undertaken a drugstore sur- Indians as compared with non-Indians in the vey. From the results of this project, we have five stores where this occurred. The price vari- compiled information which we wish to relay, ations were even greater for filling the Chlor- in the hope that you will save both time and Trimeton prescription. Indians paid from 1 per- money. cent to 195 percent more than non-Indians. The drug survey was conducted by six people, Only one store had the low price differential of three Indians and three non-Indians. Six pre- 1 percent. Eight of the 12 stores charging Indi- scriptions were obtained from reputable doctors ans higher prices for this drug charged from 30 to 195 percent more. The two stores charging in the Chicago area. The six individuals in- Indians more for Ortho-Novum charged them volved in -the price survey proceeded separately 12.5 percent and 66 percent more respectively. from one drugstore to another, asking the charge for filling each prescription. There was also a wide difference in prices charged between the different drugstores for Many factors could have influenced the re- all three prescriptions, as follows: sults of the survey. One possible variable is Cost of JiUing penicillin preemptions that the pharmacists may have realized what Number of stores To Indians Number of stores To non-lndians the purpose of our investigation was, after I ------------- $2.40 2 $2.50 being asked to quote prices to six individuals 1 ------------- 2.50 5 3.00 on six different occasions. In addition, different 5 ------------- 3.00 4 8.50 Pharmacists may have misquoted prices from I ------------- 3.50 1 4.00 memory, but would have checked more accur- I ------------- 3.65 2 6.00 2 ------------- 4.00 --- ---- ately if the investigators had paid atthat mo- I ------------- 4.95 --- ---- ment. However, in analyzing our results, we 2 ------------- 5.00 --- ---- have made the necessary assumption that all The variation in prices for filling Chlor-Tri- the prices quoted were given in good faith, meton prescriptions is as follows: With the expectation that the investigators really intended to buy the drugs. Costs of flUing C@Trime@ P-rescriptiom Number Of Charged There were 14 drugstores inuptown where Number of drug stores drug stores non-India= the six investigators brought their prescr' 2 -------------- $2.00 1 $1.76 ip- 1 -------------- 2.75 1 1.95 tions at separate times and requested informa- 2 -------------- 3.00 1 2.00 tion from each store as to the cost of filling the 3 -------------- 8.26 1 2.20 prescriptions. There was a wide variance in 2 -------------- 8.75 1 2.25 costs for each of the prescriptions both be- I -------------- 4.50 4 2.50 tween prices charged Indians and non-Indians 1 -------------- 4.75 1 2.65 1 -------------- 5.00 2 2.75 and between prices of the different stores. The 1 .............. 6.50 1 3.45 following are the data relative to differences in 1 8.50 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Costs of filling Ortho-Novum prescriptions that community * * * the people for Indians was only obtained for eight drug.! * * * the idea of a cooperative vil- stores but for non-Indians all 14 stores prices lage that will provide low income are presented: housing, while being at the same time Coots of filli,4g Orao-Now7n pre8@-vt@ an economically as well as racially in- Number of Charged Number of Charged non- tegrated community. drug stores Indians drug stares Indians Community policy dictates the es- 3 -------------- $2.00 1 $1.35 4 -------------- 2.25 1 1.50 tablishment of three types of hous- I -------------- 2.50 3 2.00 ing: private ownership by resident 1 2.10 landlords, condominium, and owner- 4 2.25 ship by non-profit corporations or vil- 3 2.50 lage cooperative. I 3.00 Community medical facilities will Only one drugstore of the 14 charged Indi- include a combined neighborhood ans consistently higher prices than non-Indi- adult and juvenile clinic. ans for all three prescriptions. There was no Hank Williams Village model pro- discernible pattern of pricing for the other poses a method of rebuilding and re- stores. They seemed to charge randomly re- newal in the urban community, that gardless of the prescription or whether or not will lessen the dangers of changing the prospective purchaser was Indian or non- existing community patterns. Indian except in the filling of Chlor-Trimeton where Indians were charged higher prices in United People, joined by private building 12 of the 14 stores. and financial groups who support the proposal, will present its plan to the Department of The Tri-Faith Team reports: Urban Renewa . Local community organizations hope to use our report to support their ar- The following three students reports sum- gument[s] for the need for better marize the problems and solutions as they saw them. health facilities. [In] individual cases [they] were able to use our informa- It willnot be helped as long as current policies, tion to improve the health of their PHorities, and values pervade decisions affect- families. ing the peoples' lives.-by Lynnae King (Nurs- Working with United People, architectural ing) student Barry Williams of SHP team reports: Uptown is a general poverty area-gb-for I built a model for urban change, a RMP purposes. ADC, general assistance and physical alternative to meet the di- some help from friends are often the main verse cultural and economic needs of means of support for many residents. Jobs are the disabled rural and indigenous hard to find: often both older and young men people living in Uptown. The model is must compete at day labor places. Mothers a cardboard product of intangible rarely work@specially among the Appa- ideas made tangible initially gener- lachian. Generally the blacks, whites, and Indi- ated by community people and later ans face many of the same basic problems as translated and amplified into physical poor health, no work, no money, poor hous- form by concerned professionals. The ing, sick kids, alcoholism, transiency, and the Hank Williams Village model (as it overall cultural problems of poverty. . owever, has been named) is a statement of each group (and add to that the elderly resi- community purpose* and com- dents) has unique cultural qualities and needs munity hope The model is, in that must be considered for the effective insti- fact, a physical explanation of com- tuting of one overall scheme for health care. munity needs from the very gut of Each group must be contacted and involved in .14 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 the planning of any facility or service or else girl continues to be anemic, weak, depressed the service may not be useful or utilized by and prone to illness. them. The men coming into the city are soon de- Health needs.-There is essentially no real moralized by the brutality and lack of home health care given to the people in poverty in life qualities. Many resort to alcoholism, drug Uptown. Existing facilities as Infant Welfare abuse, violent crimes, etc., after day labor Station Number One, private physicians, hospi- places and other unfair employment agencies, tal clinics and emergency rooms are makeshift, plus other living conditions 'torture' them. patch-up operations offering nothing to con- Mi- tribute to the purveying of decent care to any- ilfie children suffer. Protein deficiency pre- one and everyone. natally and post natally causes many cases of borderline mental retardation. Combined later The elderly are chronically ill, malnour- ished diabetic, alcoholic, I depressed and poor. with sensory deprivation, unfair and cruel ex- periences in school, and the problems of frus- Assistance comes from friends, small social se- tration, many of these children develop behav- curity checks and sometimes welfare. Many ior disorders. Some are frankly psychotic but are immobile, confined to room or hotel. Wel- most are unable to do simple school tasks and fare checks are frequently stolen. Few under- fulfill expectations of teachers. They are stand the use of food stamps-besides the poorly dressed, malnourished, usually suffering stores honoring food stamps usually overcharge with upper respiratory infections, middle ear for very low quality food. Many elderly are infections and ugly cuts or open wounds. Head robbed by young boys in the area. Housing is injuries are common. Lead poisoning is a large, poor; chronic diseases with complications are real danger. Much more must be done to detect not treated by nearby institutions (Weiss Me- and treat it immediately. Dental care is nil. morial Hospital's clinic won't handle a poor Folk medicine is often used in preference to person with a chronic disease), and, of course, humiliation at an emergency room, doctor's doctors do not make home visits. Public health office, or clinic. nurses are likewise unavailable. The Ameiican I@ns in Uptown have a The Appalultia;n whites are often transient similar plight. Discriminated against, inarticu- and therefore disqualified from public assist- late, shy, afraid, and demoralized, these people ance. The men who head the family do not are getting just as poor care. They too have a want their women receiving aid; case workers large number of lead poisoned children, in- are remarkably overworked and unable to be fected babies, mentally ill men and so forth. efficient. Job opportunities are poor, even if better than in the rural South. 'Often the The blacks living up on Leland, Winthrop, money earned cannot begin to cover city living etc. are, of course, better off than those on the expenses. Stores often take. advantage of the West Side. They.stay to themselves and gener- "hillbilly" and young people are soon in debt ally do not interact in the community. They too with no merchandise to show for the expendi- are poor, in need of health care facilities and ture. Housing is remarkably poor; rents are hit by the same problems of poverty. unfair; living conditions in general are subhu- Organizations- man. Young couples-16 years old-marry and have a child soon afterwards. The girl rarely American Indian Center gets Prenatal care, a decent diet or proper Tri-Faith Employment is management. More often than not, no care United People rece' Join Community Union ived because of fear, embarassment, or Thresholds husband's orders until delivery. (The infant welfare station waits for clients to 'come in. Welfare Recipients Demand Action Give' Voice of the Poor People n the cultural problem here this is negli- medical care!) After pregnancy th6 young There is an Urban Progress Center at 901 15 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 West Montros -e and Infant Welfare Station #I Problems.-Our project did not attack any near 4600 North Sheridan. one problem. We should have. If SHP works in Uptown during the year and next summer the ,Thresholds serves mentally ill people re- issues of lead poisoning o leased from mental institutions to live in half- r clinic admissions way houses in Uptown. The Urban Progress Policies or pediatric care-including guidance, training residents etc. or prenatal care or hos- Center and Infant Welfare Stations function as others do in the city. pitals-real estate-urban renewal are all The Ameiican Indian Center is excellent. It worthwhile. There is no reason for SHP to enter Uptown again unless they mean business is controlled by the Indian community, has about one main problem and intend to stay many programs and reaches many people. Do until it is over. We must begin to struggle for contact them for any health planning. They change within our institutions, having formed care and can act effectively, given the opportu- nity. alliances and allegiances with indigenous com- munity people. All of these issues present that The United People ofrice is currently en- challenge. gaged in an urban renewal struggle, but is in- We learned that what is wrong with the terested in health issues. The United People leadership is an effective link between the peo- health care delivery system in Uptown is what ple and businessmen in the area. is generally wrong with our society, legisla- Some Uptown leaders see the problems, the tion, and institutions. causes and effects of poverty, racism, exploitive The system operating there excludes, manip- financial practices and selectively negligent ulates, ignores and often punishes people una- health care. They should be contacted when ble to "buy in" or present the problem at the Regional Medical Program@at least -nation- emergency room in an acceptable, middle class way. We were appalled at the insensitivity and ally-is serious about setting up a different racism of men who are in their own and oth- model for health care. ers' judgment "responsible." They are, but not Up until now such leaders have not been in- to those whom their decisions affect by exclu- corporated into planning commissions. We sion. have heard doctors and administrators in Up- The poverty community of Uptown is in crit- town Say: "Poor people donpt know how to Plan a clinic"-"we'll let them in later"-or .Cal need-and it will not be helped in the im- even "we aren't servicing area 3b, so why?" mediate future as 'long as current policies, priorities and values pervade decisions affect- What Uptown needs is a neighborhood ing the peoples' lives. health center-designed to serve anyone- Can RMP fulfill the promise of its legisla- whether or not they can buy into current health care delivery system. No serious at- tion? Does it believe in consumer control-the tempt is being made at this time to do this. poverty consumer, too? Is it willing to put its Agencies recently surveyed by a local hospital money onto the streets and into the controlling were not even remotely responsible or respon- forces for the poverty community to be sive to the ' served? Does RMP wish to serve poverty poverty consumers in thearea. The -al Prog-ram-stimulated current Regional Medie areas? If so, several. things must be done: planning commission, voted not to include 1. Abolish the current "local control" of the consumers-and only one man objected. medical school deans. Therefore it is clear that no responsible, hon- 2. Strictly demand indigenous community est health care planning is being done for, consumer control-and that does not mean the with, or by the poverty consumers. And none local banker. seems to be foreseeable. If some effort were to 3. Put money into grassroots resources- be made, the agencies and their leadership hire community people to do work organizing, 'would be excellent participants. planning. -16 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 4. Listen to, accept, and act upon commun- stairs to answer her call. "Who was that" he ity health needs. asked. This would mean.the end of playing politics, "Marilyn," she said. "My older sister," she of allowing commissions to halfheartedly plan added for my benefit. "She lives on the South when indigenous people could do much of the Side." work, and of delaying the development of de- "Did she ask how I was?" asked the father cent system of health care for a poverty area. anxiously. RMP could be a pioneer of sorts !despite legis- lative controls and an insensitive electorate. "Yes, I told her you hadn't had any weak Resources must be allocated to areas and peo- spells for a couple of days," replied the young ple of greatest need. Geographic and institu- mother. She was 8 months pregnant with her tional boundaries will have to be disregarded third child. She had not yet seen a doctor. in favor of responsiveness to cultural qualities, When I urged her to do so, she said, "Oh, it the problems and implications of poverty in doesn't'matter. I can't take care of it, since I America, and all the complicating aspects separated from my husband 3 months ago, so found in Uptown. The people in the area must I'm going to adopt it out." This she told me have a voice in and the control of any facility with almost no show of emotion, as though this entering their area. is just something that happens to some people, RMP people must know that health care is a and one should not feel sorry for himself if he basic human right which people in a free soci- happens to be the victim. (I later found that ety inherently have and must therefore, have this idea is inaccurate. All the Indian parents I the power to control as well as to receive it. met seemed very affectionate towards their The residents cannot do that now. And they children. I have never seen any Indian strike a are being excluded in current plans designed to child.) serve 3a. Health professionals participating in Her father suffered a stroke, the illness he current plans declaring men free to control mentioned, and still suffers from the after-ef- their own lives are negligent by this systematic fects. His right side is partially paralyzed; his exclusion of those. in the most need. This is im- speech is a little thick. He probably drinks a moral, and unprofessional; it must change. lot; his eyes have the peculiar bluish glaze of alcoholics' eyes, rather than being clear and 1-ndian Summer.-by Laura J. Simon (Medi- bright. Since he has no private insurance or cine) Medicaid, he has not seen a doctor for over a The old man sighed, "I have 24 grandchil- year. He knows that his general assistance dren. My wife and I had eight boys and girls. I check is too small for his needs and'realizes have all kinds of grandchildren-Indians, that he is eligible for aid to the aged, blind, Swedes, Italians, Spanish and disabled; but when he went to apply, the "Irish, too," put in his daughter from the mounting bureaucracy of question upon ques- next room. Her husband was Irish. tion, form after form, and repeated interviews with different people discouraged him from He lit a cigarette, -his right hand weak and pressing on. He gave up and never went back. trembling, and held it in his left hand to flick He recalls having applied to welfare in Wis- ashes out the tiny unscreened kitchen window. consin, when he had just come out of the hos- "I've been married 35 years. When I got sick a pital. He has never received any aid from that Year and a half ago, I had to quit work. I was office. "The doctor had ordered me to drink a ill the hospital in Wisconsin. After that, I went certain amount of wine every day, to improve BUY with my sister for a while. We didn't my strength," he told me. "When the young I came down here to stay with my man came from the welfare office, I wasn't drunk-I remember talking to him-but he rang, and his daughter ran down- could see that I'd had a few. Maybe. he, got 17 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 angry and destroyed my papers." I tried to as- cago area, about three times as many as there sure him that this should never happen, but I wereat the time of the 1960 census. They in- am really not sure of this myself. Once this clude members of about 140 different nations, summer I was trying to help a young married from Apache to Zuni, and the largest Eskimo woman apply for emergency assistance at the settlement in the country outside of Alaska. central welfare offices. I watched her go The Indian community in Uptown has been es- through a series of interviews, one with a fat, timated at 6,000 people. This is possibly the rude, cigar-smoking social worker. I asked the third largest group in the area. The black pop- next interviewer how we could go about mak- ulation is probably a little smaller than the ing a complaint against this person@nly to Indian community; the Spanish-speaking peo- discover that the little client was almost too ple are the second largest group in the neigh- timid to tell the sympathetic office supervisor borhood; and the Appalachian whites form the that the man had talked to her loudly and largest group in Uptown. The American Indian roughly, the way people talk to deaf people, to Center provides social activities, youthgroups, people who do not understand English, or to clubs, sports teams, and social services like idiots. I had to start the story. Finally she said family service and counseling for these Indi- shyly, "It was almost-"she hesitated a long ans. It is the first such agency in the country to tim@',almost as though he didn't like Indi- be founded and run exclusively by the Indians ans." That was all she would say. But if she themselves. It is totally independent of the Bu- had had enough experience with people who reau of Indian Affairs, which the staff and "don't like Indians" to think she saw some- directors feel encourages Indian people to be thing of the sort in the intake interviewer, dependent, rather than helping them make it then maybe the old man's fears were justified. on their own to autonomy in the city. Only two The old man spoke once more of his mar- people on the permanent staff are non-Indians, riage. His wife, whom he apparently loved and one of these men is a student married to an very much, is ,still alive. "She lives over there," Indian girl. The importance of such an organi- he said, indicating a spot four or five blocks zation can scarcely be overestimated. City life north of the window with a wave of his ciga- must come as a tremendous shock to a family rette. "When I got sick, I couldn't wor.,i:, so I. that arrives in Chicago on -the Bureau of Indian told her to find a man who could take care of A'ffairs Relocation Program. They have been her. I hear she's living with a fellow who gets Promised decent jobs and a nice place to live, a her everything." he said wistfully. life that is better than the reservation life they are leaving. Often they find that the apart- The old man and his daughter were the first ments available to families with 10 children people I interviewed in a survey which thIe are at beat no better than the places they lived team at the American Indian Center ran on in before, while the job hardly pays enough to health problems among Indians in Uptown. take care of the rent, let alone food and clo- They made a great impression on me, as did thing at higher city prices. Worst of all, with- many of the other people I met. Most suffer out the Indian center, there would really be no from the deficiency disease the whole summer project has tried to deal with: poverty, the place where they could meet other members of lack of money. Some also suffer from physical their own nation socially, and indeed only onc- other agency, St. Augustine's Center, where illnesses, like alcoholism, tooth decay, and vari- they could go for help in a family crisis. ous other ailments which require treatment they cannot afford. We learned quite a lot The people I met at the Indian Center were about the problems these people have in find- quiet and gentle, and above all, generous. Gen- ing medical and dental care when they need it, erosity is one of the chief virtues recognized ir but we also learned a great deal about the peo- the cultures of many of the nations, along witt, ple themselves. courage, loyalty, and compassion. Strengthane There are some 10,000 Indians in the Chi- dignity are inherent in the manner of doin@ 18 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 things at the Center. I think I have learned nated his ancestors in the Blackhawk War gave much from the people I met: how to do three refuge to mine. Many times in the course of the or four different dance steps in a pow-wow; summer I was reminded of the differences be- how to say good morning in Chippewa; and tween the experience of Indians in the city and perhaps how to look at the city through the my own experience. eyes of a tribal person, to see it as an insane Such a reminder came one day when I was place where people are stranded and cut off plunking idly on an old piano in the youth from each other in a mad scramble for money, room. One of the teenage boys came up to lean which is admittedly important, but not worth on the piano and watch my hands. the isolation. "You're really educated, aren't you" Joe At the beginning of the summer, I had the asked. imp .ression that my own experience in growing I replied that I tried to learn things in col- up in a somewhat tribal and matriarchal Jew lege. ish family was somehow similar to the experi- ence of some of the young Indian people. How- "Yes, but you're really well educated," he ever, the matriarchy to which I belong has persisted. "I can tell by the way you wear your been an urban culture for centuries; the re- hair, by your earrings, even by the way you semblance to a truly tribal existence is only su- move your hands. Now take us," he gestured perficial. A member of the Center staff sug- towards a group of teenagers who were setting gested to me the distinction between the urban up a rock band behind me. "We're just a bunch man and the tribal man. The urban man is es- of poor, ignorant, low-down Indians. We're sentially a product of European culture, an in- born losers!" dependent person who merely happens to be- I wondered if the situation is as completely long to certain groups which have more or less hopeless as Joe must feel sometimes. A few influence over him, as he chooses. The tribal weeks later, while serving as my navigator on man, like many of the Indians, is primarily a some errands for the Center, Joe gave me evi- member of a group and defines his existence dence that there is much hope for Indian peo- and main responsibilities in terms of this ple. group membership. As I came to realize th, error I had made by equating others' experi- "Are you going to be a doctor?" Joe asked. ences with my own, I realized that there are "Yes, eventually," I said. really two kinds of prejudice. One kind denies "I wanted to be a doctor once, but now I that people are similar; the other denies that don't any more." they are different. No one on the project fell into the trap of assuming that people of a dif- "What made you change your mind?" ferent race or nationality from his'own have "I want to be a lawyer. I think I can help my different basic needs. But we "liberals" are people more that way. Look at the kids at the perhaps all too prone to lapse into the fallacy Center: most of 'them are so trapped that that lies at the other extreme, the error of as- they'll never get anything done. I think I can suming that people are not different.Certainly do something for my people." . everyone needs food, clothing, shelter, someone "What would be your strategy?" I asked. to love them, and a place where they can feel "First I'll get the best education I can and that they belong. These 'are almost biologic 90 to a good law school. Then I'll get my peo- needs, and in these respects people are similar. ple behind me, and I'll come forward to do But not everyone sees society in the same way. what needs to be done." It is unreasonable to expect a Sauk Indian to see American history in the same light as I do, "Then you might end up in a legislative posi- ere his nation once living in northern Illinois wh tion?" I pursued. @ped. The same government that extermi- "Yes, probably," Joe said. 19 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 If Joe thinks there is room for a person population itself and to health care in the pop- within the traditions of his nation to speak to ulation. One hundred and thirty-three inter- the white community about the needs of Indi- views were conducted, with single peop e an ans, he will probably succeed in doing it. I representatives of families, giving information' think there is also room for the converse ex- about a total of 620 individuals. Of the people change: a sincerely concerned white person interviewed 113 had children, for an average can help the Indian community tackle white of 3.4 children per family (a family is defined society and the problems it poses. Our summer in this studyas a unit consisting of at least one at the American Indian Center was a start. adult and the children for whom the adult is responsible). Some 67.8 percent of the families Health Care in the Indian Communit-y.-by go to the American Indian Center occasionally, James Drake (Medicine) Laura Simon (Medi- while 32.2 percent reported no direct contact cine), Rosalyn Netzky (Nursing), Ellyn Mill- with it. The ages of 91 individuals, mainly man (Medicine) adults, were not determined, but the majority In the past, several studies have reported on of the remainder were under 21 years of age, patterns of medical and health care in the Up- and the median age for the group : ell etween town neighborhood as a whole. Most notable of 6 and 10 years. Only 15 of the families had these is the Lepper-Lashof report of 1965, been in Chicago less than a year, while 48 had which proposed a system for establishing com- been in the city more than 10 years. The me- prehensive clinics like the Mile Square project. dian time in Chicago was 7 years, but this does However, although the American Indian popu- not reflect real stability of the population, lation of Uptown has increased greatly in the since many of these families do not regard the past 5 to 10 years, none of the studies has yet city as their true home. They look instead to distinguished the Indians as a separate group; the reservation or town they came from, and and indeed no one knew just what does happen many who have been here a long time still talk to Indians as a group. At the request of the about returning home as soon as they can af- staff of the American Indian Center, we have ford it. Some of these families live under ex- tried in this survey to describe patterns of tremely crowded conditions, with an average o medical and health care among the Indians in four people in three rooms. Families of more the Uptown area. than five people are more crowded, with an av- Indian families in the Uptown area, and a erage of eight people in five rooms. Thirty per- few in Lakeview, were located from a list of cent of the families have private telephones, the names and addresses of families sending while 70 percent do not have them. their children to the Indian Center day camp, Data on the characteristics of the population families using the family services at the Indian tell only half the story. The other half, the Center, and families who are members of the half we set'out to discover in the beginning of Indian Center. House-to-house surveying was the study, concerns where these 620 people, also used; each family was asked where its half of whom are children, get medical care Indian neighbors on the block lived, and build- when they need it. Of the individuals repre- ing managers were asked whether any Ameri- sented in the survey, 34.8 percent have a family can Indian families were renting apartments. dentist while 65.2 percent of the individuals A responsible member of each family, usually have no regular dentist. Physical illness re- the mother or the father, was interviewed ac- c6ives more attention than dental problems: cording to an interview protocol, the Health 55.8 percent of the individuals in the survey Questionnaire. The six interviewers on the pro- have some private physician, while 29.3 per- ject included three white medical students, one cent depend on clinics, and the remaining 14.9 white nursing student, and two American percent have no regular doctors. Indian high school students. Of the families surveyed, 60 percent report Major findings of this survey relate to the having contact with a clinic in Chicago, while 20 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 40 percent have not had any contact with clin- bly too high. The Medical Assistance-No ics for any family member. Of those using any Grant (MA-NG) program, known as "the clinics, 88 percent said they would go back to medical card" or "the green card", takes care the clinic they had used, while 12 percent did of the expenses for a very small number and a not like their experiences with the clinic and number have medical coverage under Aid to would not go back. The clinics most used were Dependent Children or other public assistance the Maternal and Infant Welfare Station (35 programs for a total of about 30 percent. The interviews), Children's Memorial Hospital (20 Blue Cross-Blue Shield plan insures another interviews), Arvey Clinic of Weiss Memorial 20.1 percent of the individuals; while the Bu- Hospital (six interviews), and the Argyle reau of Indian Affairs, the Army and unspeci- Clinic, a private clinic run by a physician (five fied private companies provide for the remain- interviews). Hospital experience was quite der. similar to clinic experience. Some 66.4 percent When we asked where people go to get all of the families had a member in the hospital in the medical and dental treatment they may Chicago at some time in the past, while 33.6 need, certain patterns became apparent. Nearly percent had no experience with in-patient ser- one-quarter of the individuals represented in vices in the city. Of the families that had some contact with in-patient service 84.8 percent the survey have both a family doctor and a pri- vate dentist. Another 8.1 percent have a pri- would return to the hospital where they vate dentist and a medical clinic where they go ceived care if necessary, while 15.7 percent ctia fairly regularly. The private doctor is the sole not like the care they received and would not medical contact for almost one-third of the in- return if they could possibly avoid it. The hos- dividuals; a clinic serves as sole contact for pitals mentioned most often were Children's 21.2 percent; and a dentist is the only regular Memorial (23 interviews), Cook County (17 medical contact for 1.7 percent of the individu- interviews), American Hospital (15 inter- als. Of the people represented in this survey views), Cuneo Memorial (eight), Illinois Ma- 13.2 percent are medically isolated, having no sonic (six), Weiss (five), and Ravenswood regular contact at all with any medical or den- (five). Most of the visits to Cook County, tal facilities. American, Cuneo, and Illinois Masonic Hospi- tals were related to the birth of children, just No survey can be more accurate than the re- as most of the clinic contacts reported were search technique used in gathering the infor- with the Maternal and Infant Welfare stations. mation, and the present survey is limited in its Next in importance, in both clinic and hospital accuracy for several reasons. Most serious of experiences, was Children's Memorial Hospi- the limitations is the biased nature of the sam- tal. Apparently the birth and subsequent ple of people: although 'we found some people health of children receive more attention than who were not on the Indian Center day camp the health of their parents. or family service lists by going door-to-door, Of the individuals in the survey, 59.2 per- most of the families contacted were on the day cent, a little over half of the population, are camp list. Thus there may be more small chil- covered by some medical insurance. Thirty- dren in our survey population, and fewer old people among those contacted, than are really eight percent have no insurance at all; the in- present in the Indian community. We me.t no surance status of the remaining 2.8 percent is one over the age of 65, and no one on Medi- unknown. Of those who have any insurance, care; but old people may form a higher pro@or- 31.8 percent of the individuals are represented tion of the real community than they do of our by interviews which mention some unspecified small sample. A related difficulty is that of find- form of group insurance at the father's place ing working families during -the brief timIes 'of work. Since some of these plans do not cover when they are at home: most of the surveying the @ children, the figure for the proportion of was done during the day, and many people Population covered by insurance is proba- were at work. Since the survey was conducted 21 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 during the summer, it probably also missed a tor twice. We realized in talking to people that number of families who spend their winters in some children-and adults, too-had not re- the city and their summers "back home." A ceived adequate followup care for the problems further -difficulty with our survey is the lack of that first brought them into the clinic, partly experience of the interviewers in conducting because there was no continuity o doctors such a project. Often our lack of experience led from one visit to the next. We suggest that a us to accept imprecise statements without ask- family service clinic, such as the small service ing for more details. As a result, our notation now being organized by Illinois Masonic Hospi- as to the number of people in each family who tal, might help meet this need. The clinic need are actually covered by the father's insurance not be associated with any particular hospital, policy, the number of people in the family who but it must have cooperation from the institu- actually go to the same clinic as the mother, or tions in the area. Each family should have its the number who have actually been in the hos- own private, or, to use the fashionable jargon, pital themselves, is not accurate. Some family "primary" physician within the clinic. ' e histories were allowed to remain incomplete should have specialists available in a referral because we did not notice the gaps in our infor- service, but the primary physician should be mation. In general, the white students did not the family's main Contact with the clinic and feel that racial fear or prejudice were affecting should take the major responsibility for all the interviews they conducted, so that problem their medical problems. If a dental service probably has not affected our results. could be associated with such a clinic, a truly Within the limitations of non-random sam- flexible and comprehensive health service pling and errors introduced by a lack of expe- might be available. Such services might be rience, we feel that this survey points up some financed partly by contributions from private of the urgent health needs of the community. charities or by the government, although Almost two-thirds of the people lack dental efficient consolidation and use of expensive care, both by their own report and by the ob- equipment like X-rays might cut the expenses servation of the interviewers who noticed that to a point where a pay-as-you-can plan could many had very bad teeth. Besides lack of edu- enable the patients to support much of the cation on the necessity of dental care, a major clinic cost. factor in the lack of such care seems to be A person who is ill and unable to work can- economic: teeth just are not worth the money not afford medical expenses; and the medical one has to spend to go to the dentist. We there- aid programs of the city welfare system, while fore suggest that a low cost dental clinic be es- they do help many people, still do not meet the tablished, on a plan similar to that used by needs of all the medically indigent. Since it some private-hospital clinics of scaling the fees was apparent to the interviewers that some to the patient's ability to pay, to provide dental people did not quite know the uses of medical care for Indians as well as for others in the insurance or of the medical card, we suggest Uptown neighborhood. Vigorous education that a public education project in these techni- may help encourage people to use the existing calities, as well as in the intricacies of getting facilities more;.but when expense is a barrier, service from existing medical and dental clinics, the only facility in the area is the McCormick might help people take fuller advantage of the Boy's Clinic for children; and a public facility resources available to them now. A long-term of some sort could provide adequately for their goal that might be useful would be to establish parents. a major medical insurance plan at low cost for Many people who had rather casual contact People who need some insurance coverage and with large out-patient clinics, like those at Ili_ who do not qualify for the MANG program or nois Masonic and Children's Memorial hospi- other public funds. tals, complained that they had to wait for long Improvement of health care for Indian peo- periods and that they never saw the same doc- ple in Uptown seems to rest ultimately on two 22 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 cornerstones which have been repeatedly men- It ranked in the 3d quartile for deaths from tioned, economics and education. Low-cost cervical cancer and for newly discovered cases medical and dental care and insurance should of tuberculosis. '(l) certainly be available for people who need them; perhaps such facilities are already Therefore, while Lincoln Park is not one of available in the city and could be attracted to the inner-city's deepest poverty zones, it pre- set up agencies in Uptown. This study has not sents many health problems to which the stu- delved into the available facilities, although dents in the SHO project addressed them- some fragmentary information about them is selves. available from previous student health pro- The students conducted a health survey of jects. But even the best facilities will stand residents of the community; they reviewed the idle if people are not helped and educated to area's hospital out-patient and emergency fa- use them. We think it is important for the cilities; and they arrived at several conclusions community to establish a health committee and recommendations. The entire report which could do research on the available facili- (which also describes the ethnic composition ties, help educate.the people in the use of these and other parameters of the population) is pre- facilities, keep track of complaints about bad sented. treatment, and serve as advisors to educate the "Just Getting Bij'@an Analysis of Health Care clinic personnel on how they could serve the in Lincoln Park.-by Susan Soboroff (Medi- Indian community better. In the long run, the cine), George Spinka (Medicine) only clinics that will really succeed in Uptown or any other community will be those in which Lincoln Park is a community made up of the people of the community themselves deter- many different kinds of people. Compared with mine and control clinic policies so the clinic the rest of the North Side, its population has a functions to serve them best. We believe, from relatively low median income. Yet it has our encounters with various clinics in Uptown, within and near it a variety of health institu- that it is just as important to educate the doc- tions and many practicing physicians. I tors to this aspect of the running of clinics as true, then, that everyone is receiving good it is to educate patients to other aspects of clin- health care, regardless of their income? Do ics. It is a job which only people from the com- barriers exist that keep certain people from munity can do. getting the best possible medical care? Are there problems unknown to city health depart- Lincoln Park ments that do not appear in incidence of dis- Community area 7, Lincoln Park, has been ease statistics or mortality rates? Are there subdivided into 7A and 7B. Median family in- needs, especially among minority groups, that comes for all the census tracts in 7 ranged have not been recognized or adequately dealt with by health professionals, who are devoted from a low of $5,344 to a high of $7,088. How- -to "serving the people"? ever, the percentage of families with incomes under $3,000 varied from one with 7.3 percent To answer these questions we asked the peo- to the highest with 29.1 percent of its families ple of Lincoln Park who are directly involved earning incomes under poverty levels. (2) Area in health care problems. A survey was taken 7 is considered a zone 3 poverty area by CCUO among a sampling of the lower income resi- criteria. However, area 7A was not considered dents and among hospital administrators. a Poverty community while 7B was considered Their answers point to the need for better com- to be a Poverty area. munication between these two groups. Area 7B was ranked in the 2nd quartile for The purpose of the questions asked of the numbers of deaths from pneumonia and in- people was to find out: fluenza for infants and non-infants and also for 1. How the people went about meeting their deaths due'to unknown and ill-defined 'causes. health needs. 23 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 2. If they thought these means were ade- just as the individual examples illustrate the quate for their needs. If not, why were they reality much better than the statistics can. We not adequate and how could they best be irn- did not wish to document the state of health of proved. the people, though many diseases were found. 3. How well hospitals and other health faeil-. Rather, we want to consider the social, psy- ities in the area were being used. chological, and economic problems that are in- 4. What the people thought of the treatment volved in getting medical care. they received at these institutions. The questions asked of five hospital adminis- 5. How the health attitudes and needs of the trators were not systematized. Specific ques- people related to their social and economic sit- tions about their available facilities were de- uations. signed to bring out their awareness of the com- The method of inquiry was a questionnaire munity's needs and their willingness to meet in interview form designed to document certain them. Planning for the future was an impor- facts, but also leave room -for as much informa- tant area of concern. We have tried to evaluate tion about health care as people wished to give. from these answers, the hospitals' attitude to- The questions tried to bring out the attitudes ward the Lincoln Park community and what and opinions of those who answered, as well as their role will be in future planning for the facts and figures. community. A total of 176 people were interviewed The total number of people interviewed was within an area bounded by Larrabee, Fremont, 176. They frequently will be broken down by of ethnic groups:w jte 88; Spanish 70; blacks Armitage, and North Avenues-a total 18. about 16 city blocks. A smaller area in north- ern Lincoln Park was also covered between Or- The types of health care received by all chard, Halsted, Diversy, and Wrightwood, and roughly fell into three general categories. The Lill between Seminary and Racine-together first was the most secure, in which the people about six blocks. Usually, 10 families per block had hospital insurance and a family doctor, a were interviewed. private physician whom they see regularly. The sampling is not random, for we spoke The second group of people were "just getting only to the people who were home during the along" in their health needs. The type of care day and who were willing to answer our ques- they received was usually fragmented, crisis- tions. On many blocks this biased our resi)on- oriented, and often too costly for their incomes. ses toward the large Spanish families in which Th!y sometimes held hospital insurance, but the mother was most likely to be home and could not afford large hospital bills. They often most receptive to us. cited a private physician,- but saw him only when they were ill. Many in this group used The southwestern part of Lincoln Park was clinics and might be on welfare. Those in the chosen as a sampling area deliberately, because third group either have no knowledge about the population is the most varied socially and health facilities available or no concern about economically. Thus it was' thought the main them. They had no private physician or health health problems would be concentrated here. insurance, or hadn't seen a doctor in many That these problems occur in other parts of years. The breakdown of those interviewed Lincoln Park is shown by the interviews from into the three groups are: the northern areas. PereeW Many of the statements made below, other 2otd Whites Sva-nish Ulacks Have family doctor and than the statistics, are subjective impressions. ,n,,urance ------------ 81 45 16 12 They come out of personal contact with the Just getting along ------ 60 48 72 76 people and with their surroundings. We feel No knowledge or concern - 9 7 12 12 that this can only add to the figures, however, Total ------------ loo 100 100 100 24 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The majority of the people interviewed fall Percent into the second group. Total Whit" Spanish Blacks A. significant number fall into the third Have a family doctor ---- 50 70 36 18 Use a private doctor ---- 26 12 36 41 group. Use no private doctor --- 24 18 28 41 The whites are fairly evenly distributed be- Total ------------ 100 100 100 100 tween the first and second groups, but the Spanish and blacks fall mainly into the second. One half of the people have a family doctor. To some extent, length of time in the com- One quarter see some private physician, and munity determines the kind of health care re- nearly one quarter see no private doctor at all. ceived. Familiarity with services available and A large majority of the whites have a family positive experience with them often lead to doctor, though a significant number have none. better care. The dynamics of the population The majority of Spanish and blacks do not ,are: have family doctors. The blacks have the hig& Percent est percentage udthout a private doctor of any Total White8 Spa-nish Blacks kind. In area I year or less ---- 20 12 25 41 In area 1 to 5 years ----- 36 24 49 41 Dental care is the least health concern. Most In area over 5 years ----- 44 64 26 18 people who see, a dentist go only when they Total ----- - have trouble; many others do not go, even ------- 100 100 100 100 . when they have trouble with their teeth, for a The majority of white are well established variety of r.easons-money, time, discomfort in the community. among them. Many of the Spanish are relatively new and Percent nearly a quarter are very new. Total Group I Groupll Group III The blacks are the newest to the area, few See a dentist ------ 94 (53) 44 15 18 having lived there over 5 years. Do not see a dentist - 68 (39) 46 82 82 Health insurance is an indication of income Use a dental clinic - 14 (8) 10 8 -- Total -------- 176(100) 100 100 100 level and of attitude about health needs. Percod NoTE-Numbers in parentheses are percentages of Total Whit" Spani8h Blacks total. Have insurance --------- 60 73 51 50 Most of those who have seen a dentist fall Self-paid --------------- 25 12 40 25 into group I. Welfare and Medicare --- 15 15 9 25 Total ------------ 100 100 100 100 Those who are "just getting along" in group 11 usually do not see a dentist. A slight majority of the people have insur- Use of private doctors and clinics show some ane-e; with welfare and Medicare, 75 percent of the patterns for attaining medical care. The are covered by third party payment of some heavy use of clinics is evident. kind. Tota This leaves'25 percent of the people who Use private doctor only -------------------- 1 4 must pay for all health expenses themselves. Use private doctor and clinic -------------- 64 (40) The distribution of insurance among the eth- Use clinic only --------------------------- 20 (12) nic groups differs significantly. Use no doctor or clinic -------------------- 4 (4) Having a private physician and seeing him Total ------------------------------- 159(100) regularly is the ideal form of health care in NOTL-Numbers in parenthftm are pemntages of toW. Our society. This is our definition of a family Nearly half of the people see a private doc- or. He must have an interest in the health tor only; the majority of these are family doe- ase as the disease of the whole family. tors. 25 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Almost as many use both clinic and private medical grant, or prepaid union clinics. Third doctors. they are knowledgeable about the existinj health care facilities in the community. Fi More than half of the people use a clinic. nally, they see the need and i ortance of goo( MP Answers relative to emergency care show medical care and are conscientious in attempt knowledge of and confidence in the area hospi- ing to obtain such care. tals. A profile of a typical group I subject woul, Had experience at hospital named Percent include the following characteristics: White ------------- 60 Had no experience at hospital named ----------- 19 well-established in the neighborhood-ofte Named clinic or private doctor ----------------- 8 having lived there more than 5 years-steadil Didn't know where to go ----------------------- 13 employed as a white or blue collar workel Total ---------------------------------- 100 businessman, or professional; has a famil A substantial percentage of the respondents doctor, very often located outside of the Lir have had previous experience at a hospital and coln Park area; tends not to use out-patiel would rely on its emergency room. clinics; if he does use a clinic it is most like] to be Children's Memorial, Augustana, ( 13 percent did not know where they would go Northwestern University; has a dentist; h. in an emergency. health insurance; knows of a local hospital Use of the area!s hospital out-patient and go to in an emergency, most likely Grant emergency facilities. The totals for emergency Augustana. room are the number of times it was men- Group I families are more likely to tioned, not necessarily used. smaller' with fewer pre-teen children th. Hospitd Cli@ Emergemyroom group II or group III families. There are al Children's Memorial ----------- 40 25 many senior citizens within the group, who a Grant ------------------------ 13 26 likely to be taking advantage of or relying Illinois Masonic --------------- 12 18 Medicare when theyare ill. In conclusion, t' Northwestern ----------------- 8 5 most significant fact about the group I subje( County ----------------------- 5 10 St. Joseph -------------------- 8 7 is that they are only 32 percent of the tot Augustana ---------------I---- 8 15 sample. Alexian Brothers ------------------------------ 5 Henrotin, Roosevelt Memorial ------------------ 2 Group II: Many different types of people e American, Columbus --------------------------- 8 in the category of those who are "just getti along" in health care. They have neither Total ---------------------------------- 116 family doctor nor health insurance, our c Clinics used most frequently are Children',g teria for being medically secure. Most of th( Memorial, Grant and Illinois Masonic. have had some experience and have soi Heavy use of Children's indicates an empha- knowledge of health facilities in the area, I sis on child, rather than adult care. would like to know more. Two definite pattei Hospitals such as St. Joseph and Augustana do appear within this group, one for the Sp: are mentioned more frequently for emergencies ish and another for the black population. than clinic usage. general description of each as well as spec examples from the survey follows: Group I: Those people classified in group I in general have their medical needs well taken The Spanish-speaking Americans are rE care of. They meet four basic criteria. First, tively new to the area; most have lived th they receive preventive medical care, usually less than 5 years. Some adults speak no, from a family doctor to whom they go for reg- very little English. Families tend to be lai ular checkups. Second, they are able to finance with many young children. Almost all of extended sick care treatment either through men work, usually as factory workers or f, private health insurance, Medicare, a welfare own small businesses. Very few are on welf. 26 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 About half of the people can afford health the community 9 years. She normally goes to insurance; the others must pay all their medi- one of the Spanish-speaking doctors first when cal expenses themselves. They prefer to see a she is ill. A school nurse suggested that she private doctor who speaks Spanish and who is take her children to St. Joseph's eye clinic for geographically close when they are ill; few of glasses. When she registered three children these physicians are their regular family doc- there they received complete physical exams. tors. She has gone to the infant welfare station and The Spanish utilize clinics whether or not to hospital clinics for prenatal care. Her den- they have a private doctor. Those with chronic tist is in the area, and her husband has Blue conditions are especially likely to use a clinic, Cross insurance from work. In an emergency, they would go to St. Joseph. and families with young children very often go to Children's Memorial. The infant welfare 3. Mrs. C. has nine children and has lived in station on Halsted and the clinics at Illinois the area for 3 years. Her husband works as a Masonic and Grant hospitals were also well laborer and must pay for all medical expenses used. They would turn to these in emergencies. himself. He goes to one of the Spanish-speak- Most of the Spanish people do not have a ing physicians only when he is ill, but the chil- dentist, but some wanted to find inexpensive dren are seen regularly at the Children's Me- ones. Children.had received immunizations el- morial clinic. These visits cost only $1, but there is a long wait. Mrs. C. received prenatal ther at the clinics or in school. On the whole, care at the infant welfare station and was de- their attitude toward health care is conscien- tious, but few can afford the cost of a regular livered at County. They used to see a dentist at family doctor or even insurance. Language Casa Central, but can not afford it now. In an barriers also keep them from dealing with emergency they would go to Children's Memo- large, unfamiliar institutions and from obtain- rial or to county and not to Augustana, where ing more information about available facilities. the expense, they said, is too much. lVomen with many small children and working 4. Mrs. H. has seven children. She does not husbands have difficulty getting to doctorsand speak English and has lived in the area for 5 clinics, even when they are very ill. They Years. She brings her father to a Spanish- Would benefit by having a neighborhood clinic speaking doctor when he is ill. These visits that offered a comprehensive and personal, cost between $5 and $8. Her children were family-oriented approach to health care. born at County and Illinois Masonic hospitals. They do not use a clinic, and she would like to Some examples of the Spanish interviewed: know more about clinic facilities in the area. I. Mr. S. has seven children and has lived in They have no dentist, and she does not know the area 2 years. His take home pay comes to where she would go in an emergency. One child about $80 a Week. They have no family doctor, had stitches taken at Grant where, since they but he brings the children to two frequently have no insurance, the cost was too high. named Spanish-speaking physicians when they Although conscientious, the health picture are ill. One child with a heart condition is of the average Spanish family is a confused About to be operated on at Children's Memo- one. One or two private doctors, sometimes a rial- Mr. S. must take the child to the clinic number of clinics, different hospitals for deliv- each week. His insurance will cover the boy's eries, emergencies, and chronic conditions, and hospitalization, but it does not pay for private no place for regular care. Neither private phy- ofn visits. His wife delivered at County Hos- sicians or hospitals are concerned about the Pi The family has no dentist. In an emer- welfare-healthy and diseased-of the whole uld call their doctor. Mr. S. family. Even small emergency costs areoften a see more convenient clinic facili- burden, and extensive hospitalization is impo.s- sible for them to afford. Government pro r-a five children and has lived in such as Medicaid do not pay for these ambul a- CHICAGO STUDFNT RFALTH 'PR03ECT SUMMFR 1968 rs. B. is on welfare and has'O and their low, but regular in- have io dentist. M 11 travel to Count@ tory service ineligible for poverty edical card but wold sti Her experience come usually makes them and clinic Hospital in an emergency. grants. In addition, these programs panisb. there in the past was 'not good. facilities were.often unknown to the S ost 2. Mrs. L. is a young mother of three anc 11 live, for the m has lived ill the area 2 years. At present hei The @lacks in group to the have n( part, south of Willow. They are newer husband is looking for a job. They the Spanish'. very few have lived family doctors but do have hospital insurance area " 'an Families tend to be She had experience at St. Joseph clinic wher there more than 4 years.. clinic sent her there as a occupations range from laborers to the board of Health small and laid-off. A number are on welfare. high risk pregnancy. For the delivery she ,ve,,: mailman to e a family to Pass-ava'n and was treated well. She does-n", The average person does not hav jan. More t area or of a clini( doctor or even see a private physic know of adentist in the shots. Sh( often they turn to a clinic when they are ill, where her older children can get likely to be Cook County has used Children's Memorial clinic in a' and the clinic is very Hospital clinics or Children's Memorial. For emergency, but would rely on Cook County prenatal and infant welfare the Board of the f uture. Health clinics are used. S. Mr. L. has lived in the area for 2 year with his wifea-nd two small children. His wif, Most of the families are covered by some . When ill, he goes to - -hospitalization or welf are now supports the family form of insurance most often on County physician on Chicago Avenue or a to a medic-9 medical grant. They rely center on Division. His children were born a Hospital in an emergency. The only other hos- ital and his wife received no pr,- n and Roosevelt, both County I-IOSP pitals used are Henroti icies, Iand anatal care. Ile does have health insurance. known for the integrationist Pol en wher -S On the near north side. would go to Renrotin in an emerg eY few private clinic injuries in the past. They usually do not see a dentist because of he has been treated f or dren. He the cost. 4. Mrs. S. is the mother Of two chil sister has Supported her for the 2 years the, From the brevity of their health care de have no health in -ks do not seem to have have lived in the area. They ne t scriptions, the blae sur-ance and no family doctor. She has go much. experience with the different health fa- nty 'HosPi- a doctor on Clybourn and to clinics at Count cilities in the community. Cook Cou ho als. Her vailable, and, though many are and Children's Memorial st'Oit tal is always a continue to use it. dren were born at County and !hey would prof dissatisfied with it, they ney. The private doctors they see are mostly wel- ably go there in anemerge fare physicians located near the Cabrini Hous- Some of the whites in group 11 might best b inl-r Project who see far too many people a day described by a few examples. For them, th to be rae-ticing good medicine. On the whole, main problem in getting good health car p gned one, then, their attitude seems to be a resi seems to be expense. care a lower priority and getting thern Lincoln Park wit giving health 1. A family in nor help wherever they can when sickness or in- two- children has been in the area for 3 year@, of the jury develops. Some typical examples ion work. The ir The husband does construct blacks interviewed are; gets regular care at the Diversy Clini fant ed on Burling 1 year with , @l is seen at Illinois Masoni I. Mrs. B. has liv ana ine older one her one small child. She has no family doctor, clinic. For the last delivery at Illinois Masoni( her child to Childrees Me- sarean section, their insuranc but she does take ild has been which was a ce' s itai bill. The morial clinic once a month. Her ch covered $200 of the $1,100 ho p seen at the infant welfare station also. For would go to Illinois Masonic in an emergenc@ prenatal care she went to the Cook County Hospital clinic and was delivered there. They 2. Mrs. S. has a family Of six in norther 28 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 incoln Park. They had a family doctor until 3. Mr. C. is white and has lived in the area tcently, but can't afford one now. She takes for 18 months. He is unmarried and works as a ,,r children to Children's Memorial clinic. Her teacher. He does not see any -doctors, nor does ,st three were born at home, and they do not he know of any in the area. He doesn't use, or ave a dentist, both because of the expense. know of, any clinic although he does have he family is covered by Blue Cross, but it health insurance. His problem is not a financial oes not pay for all of their -medical costs. She one, nor is it really a lack of knowledge. It is rould like to have more low cost and conven- simply an indifferent attitude towards medical ,nt clinic facilities and to know more about e-are-a belief that it is unnecessary and unde- he health facilities now available in the area. sirable to guard his health through regular Group III: Subjects in group III are the visits to a private doctor or clinic. aast well taken care of. They receive little or 4. Mrs. D. is white and has been living in the lo regular medical care. They are often new area for 1 year. She has three children ages 2, Lrrivals in the community. They are usually 3, and 5. She and her family do not see any pri- )panish and speak little English, or black. vate doctors for the reason that they cannot af- Chey have -no family doctor, although they ford to. They do not have insurance for the -nay know of a doctor whom they can go to same reason. The only medical facility which 6vhen they are sick. They generally have no her family uses is the infant welfare station on @ealth insurance and do not know of a place to Clark Street. This family is obviously in need go in an emergency. Most do not know of, or of information about the available clinic faeili- use, any outpatient clinics. Finally, they re- ties that are designed to serve low income fam- ceive no dental care. ilies. Some specific examples may shed some light in conclusion, the people in group III receive on the special problems of the group III peo- inadequate medical care for one or a combina- ple: tion of the following reasons: They cannot af- 1. Mrs. A. is Spanish. She has two children ford adequate care; they do not know what fa- ages 6 and 7 and has been in the area only cilities are available to them within their in- months. She has no regular family doctor, come range; they fail to see regular care as im- but takes her children to a doctor on Clark and portant or necessary; they are reluctant or Division in time of illness. She doesn't know of afraid to use institutions that are unfamiliar to any clinics in the area, nor does she know them. where she would go in an emergency. She is on There are seven hospitals in or very close to welfare and has a medical card. Her problem is Lincoln Park. They range in size from Roosev- basically lack of knowledge of the existing elt Memorial with 125 beds to Illinois Masonic medical facilities in the area, for she is new in Medical Center with 544. They range greatly the area and has difficulty with the language. in origins and in the kinds of services pro- 2. Mrs. B. also is Spanish and has five chil- vided, thus in character. Columbus, for exam- dren between the ages of 9 and 16. Her hus-. ple, has no out-patient clinic, but Grant has band is a painter, and they have lived in the been providing clinic services for many years. area fo' Does a private hospital have an obligation to r 2 years. They have no family doctor, and do not use any clinics; they do visit a doc- change its character to fit the changing needs tor on North Avenue for minor illness or inju- of the community around it? We believe that it ries. They have no insurance. Their-problem is does, and we have evaluated the answers of Primarily financial. The husband is worldng hospital administrators within this context. and earning too much to qualify for welfare For the most part, the. hospital is run by a grants. Yet his income is still too low to cover board of directors who are representative of of a family doctor or health'insur- wealthy business interests on the North Side. An exception is St. Joseph whose board is 29 CHICAGO STUDENT HEALTI-I PROJECT SuMMrR 1969 III Park Hog- e advised by aefficient way. The Lakeyiew-LincO made up of nuns but,they ar on pital Planning Council is meeting now and owhere ity businessmen. N' ion of services ariaOng board of commun ps are the lower trying to avoid duplicat o has the pO- these boards or advisory grou s represented. the area hospitals. The council als incorine people or their interest 0 plan an efficient health delivery Sys- An exception is the model clinic run by Chil- tential t drenys Memorial at the Cabrini Homes. UP tem that would reach everyone in the Lincoln until now, however, the advisory board of Ca- Park area, but has few plans like this. They s had only a minor role in the should be discussing how the hospital can par- brini residents ha ticipate in community affairs and how the cOm- clinic functions and do not have the legal res- ipate in hospital affairs ponsibilities or interest of a true board. As amunity can partic etween thE result, is having serious Problems in through free interchange of ideas b the clinic council and the people. An awareness of their relating to the community. out needs and a willingness to listen to their sug- The private hospital can avoid looking gestions and deal with them should be an inte- retext that its -medical 'I's activities. the window under the p of its clientele or gral part of the counel staff determines the makeup Illinois Masonic.-The administration 0-@ inpatients. The results of this and other stud- large, recently named, medical center i,, ies, however, point to the pressing need for the itment a nd involvement witl more and comprehensive ambulatory or out-pa- alone in its comm is in direct corn tient services. Five of the seven hospitals offer the community around it. It emunication with Lakeview organizations an( out-patient services in varying degrees. Th ol( three largest are open every day all dayp al- agencies, and the hospital takes a leading r though one still works on the old no-aPPoint- in community affairs by serving the needs. rnent system. The two others operate for a lim- Some examples of the wide array of service ited time with volunteer staff s. This is an out- it provides are: an extensive outpatient clini moded, charity-clinic way of offering service. that emphasizes personal care, and which ol It has no place in a health delivery system that fers both sick and well care; a free PaP smea must move toward more ambulatory, compre- program; Physical exams for public schoo- hensive care provided to all that need it at the children; psychiatry courses for local clergy hospital level. Spanish and English courses for hospital pel . open 24 hours a day sonnel. The emergency room is rk hospitals and to In the near future Illinois Masonic Plans t in each of the Lincoln Pa anyone who needs it. A few of these are ser'- build a large addition devoted mainly to ambl cialiv after clinic latory services. it will include a family pra( ously overcrowded, espe ospitals that are which int rns will be respons hours; these are the same h, tice program in . e well known and trusted for their outpatient ble for the health of five clinic families froi nity physicians, and v. In this way general pract facilities, staff of commu the communit. - acceptance of minority groups. Much Of the Ov- tioners on the staff can teach the lost art.( ercrowding could be relieved by other hospitals -family doctoring while whole f anilies receii inic hours into e hosp d by extending cl thorough and personal Care. If all of th in the area, an for non- . iii d weekends. The need tals in the area participated in a program the evening an e after clinic hours is, a much more significant Part of the low( emergent ambulatory car 00 pa- th was shown by the fact that out Of 8,2 income population could be reached. tients seen at the St. Joseph emergency rooiny St. josephi-The hospital was founded ar only 26.6 percent of these were trauma or ur d by a Catholic order, t] gent cases. Similar stories were told at each of is administers whose goal was orig the other hospitals. Daughters Of Charity he attractive ne one method for lowering hospital e aiiy to "serve the poor." T Osts is ton include a clinic with a wide rani coordinate services with other institutions so facilities do that expensive facilities are used in the most of specialty services, but its hours are limit( 30 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 nd its existence is little known. The Board of schools, etc., and take a leading role in com- lealth also runs a referral clinic there for high munity affairs. Better communication and un- jr,k pregnancies and very ill infants. Its loca- derstanding will lead to better utilization of ion,.however, has kept it out of reach of the the clinics and, of course, to better health. leople who need it. Better public relations and The medical staff at Grant is representative ,each-out programs would help to make it of many ethnic groups, and includes a number tiore widely known and used. of physicians who practice in the Lincoln Park The administrator is head of a long-range area. The hospital also trains many paramedi- )Ianning committee to define the hospital's role cal personnel, technicians, and nurses. It is n health care of the city. Nowhere do com- very active in future planning on the Lincoln nunity organizations, churches, schools, or in- Park-Lakeview Planning Council. iividuals appear on this committee to partici- Augustana.-Since it is owned by the Lu- pate in the planning. However, the council is theran Church, Augustana serves patients reeking the people's involvement in a referral from a wide area. Only one-half of the hospi- iervice that was suggested for the Cabrini tal's inpatients come from Lincoln Park or con- Homes. They want to improve medical care by tiguous zones. Today it offers little to the lower sending patients to existing facilities and thus making the best use of these resources. Sister income people of the Lincoln Park area. Its new clinic operates on a referral basis for ob- Vincent hopes to find interested members of stetrics and medical problems. The clinic is not the. community to participate in this project. being used to capacity, and the emergency ChitdreWs Memorial.-Children's is a pedia- room is not crowded. tric hospital that serves the entire North Side. Its major service to the community is a large Augustana plans a large expansion program outpatient clinic that is widely used. Long and has already acquired much land from Urban Renewal agencies. The hospital has waits and only daytime hours are complaints purchased and torn down "slum housing" to that theadministration is aware of and trying put up more inpatient facilities. According to a to improve, though slowly, Hospital Planning Council report, no more beds The hospital also operates a neighborhood are needed on the North Side. According to us, clinic on the near North Side that offers both more ambulatory, low-cost services are needed. sick and well care without charge, unlike the Clearly, Augustana is not moving to meet the hospital clinic. The clinic claims a community needs. advisory council, but the residents have little real say in how the clinic is run. On the basis of interviews with people of -the conununity and with local hospitals, the fol- In this sense, the administration of Chil- lowing conclusions and recommendations are dren's seems only slightly open to ideas of com- offered. munity participation in or even community 1. The ideal of good medical care is . in a communication with the hospital. It is aware large measure defined by the concept of prev- of s ome of the problems, but has taken few entive medicine. Preventive medical care in- steps to improve the situation. volves safeguarding the health of the individ- Grant.-Grant has a history of providing ual and the family through regular visits to a outpatient services to the community. It is qualified physician who is familiar with the Planning to expand these facilities in a new medical history and special medical problems building and even now is equipped to take of the family members. The results of the sur- A problem for the hospital is vey show that comprehensive care of this kind the people more aware of the fa- is not a reality for many of the people inter- e available. We suggest that they viewed. Only one-half of these people have a elves, as Illinois Masonic has, family doctor.' Roughly one-fourth have con- nity organizations, churches, 'All emphasis, the students. CHICAGO STUDENT.HEALTH PROJECT SUMMER 1968 e doctor, but only go to him County hospital, some reason-be it discrimi- tact with a privat when they are ill or injured. Finally, one- natory policies, unfamiliarity, or simply force fourth of those interviewed have no contact of habit-has kept them from taking full ad- with a private physician and must receive all vantage of the health facilities available in their medical care at clinics, emergency rooms, Lincoln Park. or not at all. 4. The kind of dental care received is an- 2. Economics obviously play an important other index of the quality of general health role in the kind and quality of health care re- care. Among the people interviewed, regular ceived. Those most seriously affected by their dental care was rarely reported and occasional ability to pay are not the indigent or unem- care was received by only half. Roughly 40 ployed whose medical needs are paid for by the percent received little or no dental care. t of government, but rather they are the people in 5. It must be emphasized that 10 pereen the lower middle income range. These people the people interviewed made up group 3, and earn too much to qualify for any kind of gov- received little or no medical care at any time. ernment assistance, and in some cases to be el- 6. On the basis of hospital interviews, it is igible to use outpatient clinics. Yet they cannot obvious that a general lack of communication afford the cost of a private physician, dental exists between the hospitals and the community. care, or extended hospitalization. Even when True grassroots community representation or these individuals have health insurance, the hospital policymaking and planning boards iE policy usually does not pay for preventive, am- nonexistent. As a result, hospitals have tg- bulatory, or dental care, and it does 'not P9,Y nored the immediate area or are attempting t( the entire cost of hospitalization. Moreover, adefine its needs without consulting its needi quarter of the people do not have health insur- people. A number of the hospitals are movin@ ance of any kind. To sum up, most of the peo- ahead with expansion and building planE ple in group 2 are "just getting along" because which at this time are not the most effectiv( of their inability to pay for good medical care, solutions to the communitY@s health problems and their situation applies to more than half of On the basis of the preceding conclusions, f the peopleinterviewed. number of recommendations for future course,, 3. There are differences in the quality fof action aimed at improving medical care car medical care received according to racial and be made. c groups. For instance, 43 percent of. the 1. Hospitals should expand their existinE whites interviewed fall into group 1, while 16 percent of the'Spanish and only 12 percent of clinic facilities; all future building and expan. wjor- sion planning should include provision fol the blacks are in this group. The large r more ambulatory, low-cost services. The lea@ ity of Spanish and blacks fall into group 2. The reasons for these differences are in part in this area has already been taken by Illinoik Masonic Hospital, which is planning a $5 mil- s generally find fi-nancial; the minority group lion addition devoted mainly to ambulatory themselves in the lower income brackets. An- clinic care. other reason is that white people are more knowledgeable about the facilities which are 2. Hospitals should take steps to enable morE available in the community for they have lived people to use clinic facilities. This would in- there longer on the average. A third reason in- volve extending clinic hours into the evenings volves attitude and cultural f actors. Many of and weekends, so that people who work or the Spanish people are isolated from the white have small children can make use of them. society by their language and unfamiliarity 3. Hospitals must reach out to the comTnun. with Amerie-an'life. They are frightened and ity and assume an active responsibility in per- embarrassed by large institutions, and may be suading the public to take advantage of their reluctant to seek help unless they are very ill. facilities. As a first step they can make their For the black people who rely heavily on services known through Community newspa- 32 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 @rs and by distributing information directly 6. Doctors should be more personal and give community organizations and agencies. They the patient more information about his illness. LOuld also work to remove the psychological 7. Hospitals bills are too expensive. irriers which keep people away by hiring A school-community representative who is .ore Spanish speaking, Oriental and black deeply involved in the medical problems of the ,edical personnel. The impersonality of the children at Arnold and their families and is a inic could also be improved by assigning eacii mother herself gave these suggestions: atient to his own doctor. 1. Where to go when the children are handi- 4. Hospitals must undertake more imagina -capped and are turned away from school. .ve programs aimed at low-cost preventive iedical care for the community. Illinois Ma- 2. How important it is for family to have DDIC is again leading by developing a family TB X-ray once a year. @ractice program. All teaching hospitals in the 3. Where to go when your child is retarded. rea could and should experiment with similar 4. How important it is to have a diabetic irograms. test. 5. Hospitals in the area must build and ex- 5. How important it is for younger girls and )and true channels of communication with the women to get prenatal care as early as possi- @ommunity if they are to serve its needs. This ble. loes not mean talking only with associations of 6. Whom to get information for psychiatric ocal businessmen or professional people. It.help. neans dealing with organizations that have di- r-ect contact with the average person. In Lin- 7. Our neighborhood needs to know where -loln Park these would include the Northside to go for Alcoholics Anonymous help. Action Group, Neighborhood Commons C2rp., 8. How important children!s eyeglasses are Concerned Citizens of Lincoln Park, C.B.C.A. for them in and out of school. Where to go and find out if parents also need glasses. block clubs, churches such as St. Teresa's ana 9. Need for more dental care. Mt. Olivet, welfare unions, P.T.A.'s, settlement houses such as Christopher House, Wright- 10. Medical care for fathers who are along wood Center, J.Y.D.C.'s, boy's club, etc. It is with children or grandparents also (i.e., clinic only through such dialogue that the health hours open after -regular working hours). needs of the community can be accurately as- 11. Health Fair should be in the community sessed and appropriate solutions developed. centers at least 2 days before moving to an- Only through dialogue and direct participation other center until all centers in the community of the people in planning and implementation are covered for 1 or 2 weeks at least. can projects aimed at improving health care 12. Cab service for people who are alone and have any hope of success. can't travel by themselves. The above are steps that -can be taken now This community representative's suggestions for improving medical care. In response to the emphasize the need for more information about 'questionnaires specific suggestions and com- available resources and educating people to ments were made that bring out the needs of take advantage of them. Psychiatric help has the community. Some of those mentioned are: not been dealt with in this report, but the need 1. A general neighborhood clinic for the for @Ore and better facilities has come up fre- whole family. quentiy. The Health Fair sponsored by the J.Y.D.C. last spring was successful in helping 2. Homes for retarded and delinquent chil- dren. to educ-ate the people as well as screening them S. School nurses and visiting doctors. for a number of diseases and disabilities. How- ever, its effect on the community was limited 4. A referral service for medical problems. by its single location and short duration. 5. Better housing. Longer and more widely distributed fairs of 33 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 this sort would have a greater influence on the In each case, howeverIthese programs hav( health of all of Lincoln Park. been begun by a corporation or government with a great deal of organizing power. A cor( Other communities and groups have worked of compulsory subscribers has been necessar3 toward better health care through more exten- to provide enough initial capital for setting ul sive and long-range projects, such as prepaid the clinics and operating them. The plai group practices and neighborhood health cen- should be a serious possibility in health car( ters. Some information concerning these fol- planning for Licnoln Park. lows,as well as our evaluation of their applica- Comumer Participation.-For a successfu bility to Lincoln Park. Neighborhood Healt@ Center, a strong com In any discussion of long-range solutions to munity organization interested in health car( improve the health of an entire community' and a willing hospital staff are needed. prepaid group practice plans or health insur- ance offering direct medical services should be Our gratefulacknowledgments to the follow explored. Essential to such a plan are: (a) The ing people: Phil Bredine, Sherry Levin, Pa people who subscribe pay a set monthly fee Devine, Jim Reed, Jerry Needem, Mrs. Jose into a common fund, in return they receive Phine Aragon, and special thanks to Alic( medical service from a group of doctors who Cruz. are paid from the common fund; (b) these ser- vices include preventive care ambulatory sick The Latin American Defense Organization care and intensive sick care9with hospitaliza- (LA DO) tion; (c) the physicians who render care are This organization came into being approxi paid a fixed salary, instead of fee-for-service; mately 2 years agoafter rioting in the Puert( and (d) they may render service in their own Rican community had sharply focused atten. private offices, but more likely use a special tion on some of the problems besetting th( clinic facility set up for the subscribers of the Spanish speaking people in Chicago. It ha,@ plan. been a service organization in the sense that ii Advantages to the subscriber are that tries to aid people and families with problem,. through a reasonable monthly rate, like an in- but it is basically attempting to organize thE surance rate, the patient is relieved of the costs Spanish-speaking community around the issue,, of most preventive and ambulatory medical of welfare, health, housing, and jobs. It is nol care as well as possible extensive hospitaliza- specifically a community organization sinCE tion expenses. The salaried physician is freer Latin Americans live in a number of different to give the patient more thorough and personal communities located in poverty zones of th( attention. Advantages to the doctor are that he city. As a result of urban renewal programs or is relieved of the paper and clerical work in- Chicago's near west side, large numbers ol volved in billing patients, and he is spared the Puerto Ricans and Mexican Americans werE expense of maintaining an office. displaced and moved to different communities, Group practice plans similar to the one just north and south of the near West Side. above are operating successfully in a number Three health science students and two higl, of places in this country and Canada. The Kai- school interns were assigned to work witl-@ ser insurance plan in California and the health LADO in setting up two projects. One was the organization and staffing of a day care center insurance plan in New York have resulted in and nursery for children of Spanish-speaking better health planning for the insured through families and the second was a program tc more efficient and effective medical service. screen. children for intestinal parasites, q Studies show that for families enrolled in the Kaiser plan, the total cost of health care is 'neatth problem in the Spanish community. only 70 to 80 percent as much.as employees Between 15 and 20 families responded to thE under another plan. day care and nursery center. Approximately 34 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 DO stool specimens were collected and sent to lures, etc. were divided among the three of us. f Health for analysis. It was hoped Much of my SHP salary was set aside for pur- ,ie Board o I might be a step to- chases of equipment and materials. At the pre- , at this latter program lard the construction and maintenance of asent time, the writing and taping tasks as- arasite detection and treatment center. signed to my husband and I have been com- One of the health science students, reported pleted, in addition to a brief bibliography of ,n her suminer's experiences, in part, as fol- available references. Miss Tatman will complete the film strips when her position with LADO :)Ws: becomes less demanding. She anticipates coop- in edvcational system which strips them of eration from neighborhood groups and perhaps @heir cultural heritage.-by from public -school officials in trying out our Mrs. Terry MeMurry (Sociology) materials in the fall. From our combined experience among Span- It may be asked how "Medically relevant" [sh-speaking youth in the Southwest, in New our siimmer's work has been. Admittedly, our York City, and in Chicago, we recognized the work will not reduce the chronic physical ail- crying need for such materials, and set out to ments of the Spanish-speaking poor in Chi- fill this "informational vacuum" as best we cagoi nor ameliorate the discriminatory treat- could with our limitations of time and money. ment they receive from the medical "establish- The first few weeks of the summer 'were ment." We hope, however, that it will ulti- it ' for ailable materials mately foster emotional and psychological spent on a snipe hunt' av well-being among students who are presently on the history and culture of Spanish-speaking being harmed by an educational system which groups in this country. We contacted such in- strips them of their cultural heritage, and de- stitutions as the Chicago Board of Education nies them the right to self-respect and pride in and the University of Chicago Lab School and their specialness. The importance of teaching found no materials whatsoever. Afterward we ,Black History" to our school children has outlined the relevant topics which might be finally been recognized by the educational hi- discussed under the heading of "Problems, Is- erarchy. Likewise, we feel, the importance of sues, and Answers of the Spanish-Speaking educating our youth to appreciate all minorities Population." They included: must be seen in the near future. 1. General history of the three major groups of Spanish-speaking people in the United States-Spanish Americans, Mexican Ameri- Erie House can, Puerto Ricans. This is a settlement house on the near North- 2. Discussion of the problems of Spanish- west Side. In addition to sponsoring a number speaking people in both urban and rural set- of social and welfare programs, it houses an tings. and their relation to problems of other outpatient clinic staffed mainly by Northwest- minorities. ern University medical students. 3. Treatment of the contemporary move- The'community it serves is bounded on the ments among Spanish-speaking people to de- east by Halsted Street (800 west) ; on the west mand equality and justice as citizens of the by Ashland Avenue (1600 west); its northern United States-Reies Tijerina's Land Grant boundary is Chicago Avenue (800 north) and Movement, Cesar Chavez's Farmworkers' its southern boundary is Grand Avenue (530 Union' Corky Gonzales's struggle against the north). urban establishment, et. al. The population residing in this section of It was decided at this point that film strips community area 24 is mixed. It is composed of and tapes would be the most appropriate Spanish-speaki.ng peoples including Mexican means to illustrate these topics. Americans, Puerto Ricans and Spanish Ameri- The tasks of writing, taping, shooting pic- cans; white immigrants from Appalachia and 35 R 1968 CHICAGO STUDENT HEALTH PROJECT SUMME white Polish and Italian residents, usually * * * [they are] less concerned with older people; and a small Negro population. subtle or nonobservable problems There are probably about 10,000 people in the which do not interfere with their iM- area. Median family incomes in these census mediate, every day activities. Thus, tracts was between $4,000 and $5,000 per year they seek [a] doctor when symptoms in 1960. interfere with their work or other ac- I The students reported that the health r@ tivities * * * Still health receives sources most frequently used by residents of less attention than (1) food; (2) this part of the community include St. Mary of housing; (3) employment; (4) recre- Nazareth (the nearest geographically), Chil- ation; (5) education; and (6) health. dren's Memorial and Cook County Hospitals, The students worked primarily in the EriE the Northwestern Medical Clinics and Hospi- Settlement House Clinic. This clinic is rur tals and Presbyterian-St. Luke's Hospital. jointly by Erie and Northwestern University',- The utilization of health resources seemed to Medical School. It is staffed mostly by -medical students from that school and is open twc be affected by a number of factors unrelated -co times a week. About '50 patients are seen ir health itself. Quoting from one of the reports: those two clinic sessions. It is a free clinic and Many claim to have private doctors, the students indicated that some patients at- often because they seek doctors with tend it because they have been rejected b@ whom there is no language barrier other clinics, particularly because they are un- (Spanish); [and] also as a matter of able to pay for care. The students felt the clin- pride rather than accepting public aid. ic's program was limited and needed to be ex. tended and enlarged. They were critical of thE A large percentage Of the people attitudes of the staff of the house insofar as hesitate to use doctors and hospitals the community was not, in their view, suffi- because of language barriers, money, ciently represented or involved with the plan- negative experiences, long waiting pe- ning of any of the social welfare or-health pro- riods, rushed [and] impersonal con- grams. They thought the community had very tacts. little to say about the programs currently And from the same report the health know- available at Erie House or about what pro- ledgeability in the community was described as grams that might be more responsive to their being at the individual level only, as follows: needs and initiated. These people do not see health The students described their activities, as problems as community problems re- follows: quiring community action [but] * * * the project tried to meet rather as their own individual family some immediate health needs, e.g., problems, e.g., mental retardation. discovery and treatment of parasites, They have not seen good health care teaching mothers [health] skills and have no concept of what we term developing awareness among quality care.' Therefore, they are the Spanish community of their grateful for what we consider to be health problems and encouraging fragmented health care. In addition, cooperating in solving these prob- there is a great reliance on, and faith lems. Stimulation of fellow profes- in, folk medicine. These people ac- sionals * * * to consider the com- tually constitute a rural society that munity and their responsibility to the is merely existing in an urban setting. community. Health concerns pertaining to chil- dren have much higher priority than The students believed that there were nega- those pertaining to the adults/parents tive features to their presence and their work; 36 CHICAGO STUDENT EALTH PROJECT SUMMER 1968 H More pacification of an al- is racism. All summer I was torn between the ready apathetic community; leaving knowledge that although unity comes from a without adequate education as to group identity, power comes only after accul- where to complain and how to get ac- turation-in a sense, a giving up of ethnic tion on problems; creating concern values and group identity. For example, was I over inadequate health care and facil- to encourage the community health facilities to ities without providing proper chan- hire for staff Spanish interpreters (therefore neling for these concerns to the ap- decreasing the community's need to learn the propriate people * * *. dominant culture's language, English,) or was When asked what they would have done, I to assume that it was better (in terms of @sing hindsight, if they were starting the power access) not to encourage the hiring of ,,ier project again, the site report said: sum- interpreters (thus accelerating the accultura- We would reassess the priorities Of tion process by forcing the people to learn En- the community and work with hous- glish) ? Furthermore, I knew that the group of ing problems before moving to health people with whom I was working was not even problems. We would maintain the representative of the larger Spanish-speaking he group I became close with had same long term goal of increased level population. T of [health] in the community. already accepted much of the Anglo culture, as evidenced by their very participation in the Individual students echoed these sentiments: white Erie Neighborhood House. So was I I am pleased to report that the really changing anyone? families I have contacted have been It's true that the health classes we sponsored most receptive and listened atten- may have taught some of the mothers skills, tively to what I had to say. Whether may have given them information with which they were stimulated by what I said to function more independently and more con- about diets remains to be seen and de- fidently. But the group we probably affected pends greatly on their being able to most was not the Spanish themselves, rather it fit my suggestions into their incomes was the group of health science students from Northwestern University Medical School who This is mainly because our came to Erie every Thursday night to run a first goals in lif@better heath for free clinic for the community. After a few instance-are not necessarily their early confrontations with the Northwestern first ones. (We have found that people which did nothing but alienate them housing is several times more impor- from our more community oriented ideas, the tant than health in this Spanish com- four of us in SHP calmed down, backed off and munity. tried working with the Northwestern [stu- The students assigned to Erie House were dents.] We planted seeds of question, pointed ambivalent about the project. A partial text of out workable ways in which the community an essay which indicates this ambivalence could be involved in the clinic's structure with- sharply follows: out presenting a threat to the students' self-in- terest. As long as we have a way out, we are not peers My guess is that any change which is was of the ghetto inhabitant.-by Sandi Berkowitz possible for us to effect in Northwestern's phi- (Nursing) losophy was because there at least, we felt we There is a huge cultural barrier be- had a right to be talking. It was understood tween the Spanish and Anglo communities that we were their peers. Obviously, -this was which perpetuates separation from the domi- not, and could.never be, true in the ghetto com- nant culture and consequently denies the Span- munity. We should have known that as long as ish-speaking community access to power. This we have a way out, we are not peers of the 37 ghetto inhabitants. As long as we have that taught "challenging " Jewish students cannot dime, we have no right to be talking to them. understand the anger and educational apathy When I am asked, then, what the value -of of black children. And black children cannot this Summer's experience offers me convincing understand the middle class, white approach to proof that as a health professional committed supposed learning about their poor, black envi- to trying to change the present health care de- ronment. A vicious cycle thus creates and per- petuates itself. livery system in the United States, my first responsibility lies in radicalizing my own pro- The greatest percentage of residents there fessional community. do not set health care at the same priority level * * * The ghetto communities will organize as does the middle class. There are too many and radicalize their own people. more pressing problems to be dealt with- like the clogged toilet that hasn't worked for 2 weeks, like a $125 rent payment for the three- THE WEST SIDE room apartment without properelectrieity, or On the West Side of Chicago students like the son who got "busted" for being black worked in the West Side Medical Center hospi- and standing on a corner. All of these things tals (see Hospital Sites section), with commun- indeed fit into health care if not medical care. ity organizations; in neighborhood health cen- But it becomes quite obvious why medical care ters and clinics, and in settlement houses. A facilities may not be freely used. few students worked independently in a special Health to many people on the West Side program dealing with drug abuse conducted by means functioning. The concept of preventive, a church agency. sometimes diagnostic treatment services does not become a part of their thinking. Illness is The West Side of Chicago is succinctly ae- when one can't work or take care of her kids scribed by the SHP Area Coordinator whose or make it out of bed to the neighbor's house. report follows: Illness is when normal, routine activities are No one has any power over his environment.- stopped. Health care is not fixing cavities or by Donna Karl (Nursing) drinking a quart or milk a day or getting a The West Side of Chicago is a massive land Pap smear. It is going to the Cook County area populated primarily by poor, black people. Emergency Room when the pain gets so bad Once a thriving, Jewish settlement neighbor- you can't pull on your cotton socks, or when hood with wide handsome boulevards and the baby is hot and shakes every once in a p while, or the bleeding won!t stop and runs well-tended townhouses, it has become an over- down your leg. flow pond for poor blacks forced from southern farms for lack of work and pushed from other Many people on -,the West Side used the areas of Chicago by economically hind-sighted emergency room of Cook County Hospital. urban renewal. It has become a stagnant pool Dangerously over utilized, it sees about 1,200 of wasted humans. And it stinks. patients daily, 75 percent of whom are "seen and advised," i.e.,-seen and sent home without Twice the number of people live here now as further treatment at that time' Many of the the area was originally constructed to house. small hospitals in the area will not or do not The population density in some places, for in- take welfare patients. Physicians are generally ance, is 150-250 residents per residential acre old, or specialists,. or foreign educated, or which compares to the Lake Shore Drive area, part-time, or leaving, or have already left. characterized by many high-rise apartment buildings. In some places it is over 300 per There are however two OEO funded eom- munity health centers which are attempting acre. comprehensive care to ghetto residents in a Education standards have deteriorated along community-based, self-determining hea th cen- with population change. Teachers who once ter. 38 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The West Side is not a community if one de- college/high school students with the commun- fines a community as a group of residents ity aspects. For several reasons the plans as within one geographical area with similar conceived failed. First, the two white students goals and some degree of group identification. (medical) on the nine-member team appeared It is a transient, brewing mixture of people to dominate the project from the beginning thrown together. Many came North in search and stifled others speaking out. The black Stu- of "the land of milk and honey" and green dents, not being from that community, were bread. Unable to cope with the disillusioning too inhibited to get into it. Prematurely and reality of Madison or Sawyer Street, their without true community contact, the group im- dream has become scraping together enough mediately began setting up a screening and re- money to return "home" to the South. They ferral clinic. The clinic objectives were to do a don't have roots here. They merely float. And simple series of diagnostic tests for chronic there is little interest in the urban affairs by diseases, e.g., hypertension, diabetes, tubercu- which they see themselves hopelessly strangu- losis, lead poisoning, heart pathologies, ane- lated. mia, vision difficulties, etc. Their plan was to The streets are strangely surrealistic. (Sear- refer diagnosed patients to medical clinics' and ing breezes, brown and curl Hershey wrapper also to use the data gathered in approaching edges that blow the ashes down a side street the medical center to get more complete serv- ices for the people of the Valley, a hideously and into the gutter.) People there cling to I things for identification. A little girl holds her deprived area within walking distance of the popsickle stick close. Old men play checkers. medical complex. But no one has any power Over his environ- At first the community was not included in me-nt. And there is little organization within it. the group thinking. The students having con- And people remain pawns of a power structure tact with the leaders of the "Y" thought that which serves only its own ends. this leadership was that of the community and Students working this summer on the West when these men spoke they were representing Side were primarily attacking a common prob- the community. In reality they represented the young, more militant section only. They lem-the disorganization of a society that ha. seemed to alienate many of the older persons been herded into this state of mind. With no who also need medical care and representation power, people react defensively and refuse to in decisions made about such matters. be a part of the structure. They project apathy to outside observers. And it grows, nurtured on When the idea of community representation the manna of nonexistence, into psychological did finally filter into the student's thinking, the disorganization that stunts any community en- clinic had been physically set up. The students deavor or collective action. felt that until they could.give the Valley r i- One team of students worked at the Medical dents something, these people could not orga- center YMCA, which is located on Roosevelt nize. The assumption, in many. ways fallacious, Road at the northern edge of the Valley (North, partially goes back to the white man's pater- Roosevelt Road; south, railroad tracks, run- nalism and need to give the black "native" ning from 16th Street on the east to 13th on something. The Robert Taylor Clinic on the the west; east, Ashland; west, Western.) South Side of Chicago was planned from the Their task was to examine the health needs beginning by the community working with Of the Valley area and work with the ddypp in medical students, and thus avoided some of the an attempt to meet these needs. The team was pitfalls which seemed to be inherent in the conceived and set up as a dual group-black medical clinic. and white, with each respective group doing its But one significant happening came out of thing. The medical students were to deal the project. There were several meetings of medical aspects and the black many different people, each with a common in- 89 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 terest in the future of the Valley and the per- are marginally poor, e.g., there are many sec- sons living there. Representatives from the ond-hand and wholesale stores. People have Halsted Urban Progress Center, the Circle- enough to buy used furniture but not enough to Maxwell YMCA, the University of Illinois, the buy new. Most go to Cook County or Mother Medical Center YMCA, and the community Cabrini Hospitals with the distinct emphasis (six community ladies) all sat down and dis- on the former. Among 38 physicians in the cussed the future of the Valley and how it area about half are GP's, 35 percent are over could be shaped now by community interven- 60 years old, and 50 percent were educated out- tion. The meeting demonstrated that, given the side of the United States. Residents complain opportunity the extremely poor, black com- of much exploitation, high medical fees and munity can be interested in itself and its fu- drug charges. But no one does anything about ture. The medical people associated with the the conditions. Many people in this area, being clinic now have the job of helping to educate within a marginal income bracket, are inelizi- the community about its health rights so that ble for MANG but do not have enough money it may become more sophisticated and articu- for medical bills above and beyond their nor- late concerning its medical rights and demand mal living costs. these rights. Students working in this community did a The clinic is quite limited and its services in- health survey of the types and numbers of adequate. If fur ther community activity does medical problems facing people there and how not continue, it will have been a failure. It will they see, understand, and deal with them. The have been only another in a series of "summer data collected is going to be given to the com- things" that @ghettos are the victim of every munity to use in negotiating with Cabrini Hos- ,June to August. But it has the potential, hav- pital to possibly set up a peripheral clinic in ing organized a community health committee, the Howell House area. of activating the Valley and helping it grow The two medical students assigned to the into a community. St. Leonard's Drug Abuse Program defined Spanish-speaking people live in the same their experience primarily as educational, disorganized kind of apathy as many black without a great deal of "direct" community communities. contact. But their original goals were realized. To deal with this problem a team of health Many preconceived ideas were destroyed. The science and Spanish-speaking high school stu- "junkie" became a human being. The stereo- dents worked at Howell House (neighborhood types fell away. They have been able to exam- service center). Their work concentrated ine and evaluate their original ideas about "junkies" and modify them to more reality ori- within the realm of welfare recipient rights ented ones. For them the summer has been al- and organization . around this issue. They most pure learning and reacting and broaden- worked with a leader of the Latin American 9 of mind. Defense Organization who has had a degree of success in organizing Spanish-speaking people Students working in the tutorial program at on Chicago's Northwest Side. The ultimate the East Garfield Park Mental Health Clinic goal is forming a permanent welfare reci- (a ity board of health facility) dealt with the Pients' union in the Howell House area . for common problem of community disorganization Spanish-speaking people ther at an early level-with grammar school reme- e. dial readers. Students at Lawndale Association The community in that area is composed of for Social Health (LASH) participated more primarily Spanish speaking but also a small directly by becoming a part of the staff of this number of older Czechoslovakian residents social-action agency dedicated to redirecting who have remained in their life-long neighbor- normal anger of repressed people into paths hood, and a few blacks from across the rail- productive for them, to encouraging black con- road track (the Valley area). The people there sciousness, to promoting economic gains 40 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 through a co-op grocery store and trades train- (near West Side). Roughly, it is bounded by ing program. The students learned about com- Ashland Avenue on the east (1600 west), njunity responses and how they as white pro- Western Avenue on'the west (2400 west), and fessionals of the future could fit into the by Grenshaw Street on the north (1100 south) scheme of providing medical services to such and 15th Street on the south (1500 south). A groups of people. relatively large proportion of the land is de- The students involved in this project gener- voted to industrial use and railroad tracks ally agree that their main accomplishment crisscross its southern and western bounda- during the summer was not really in dealing ries. This factor, to some extent, has created a directly with community disorganization but in psyhological, as well as a physical, separation educating themselves. of the community known as the Valley from its I would, however, object to the project in the near West Side neighbors. Between 12,000 and future as it was conceived and implemented '@5,000 people live in this community. Four cen- this summer. The Kerner Commission made it sus tracts in the area, when enumerated in quite clear that the problems facing the ghetto 1960, showed that each had more than a 90 are, in fact, based in the white, middle-class Dercent black population. There is no reason to communities and the white institutions. The believe that this magnitude has changed except place for students, especially white students to become greater. The median family income, then, ranged from $3,828 for the tract with the concerned about the black ghetto, is some- where outside of those ghetto boundaries, work- iowest median to $5,014 for the tract with the ing 'to help them "behind the scenes." highest median income. Two of its four tracts reported the percent unemployed of the male For 10 weeks I've looked and seen and tried labor force as standing at 13 and 17 percent, to understand and to digest and to emerge with respectively. It is not possible to determine something tangible and significant. And now whether these unemployment and income data I'm tired. I've exhausted my thought processes. have changed significantly from the 1960 cen- But I can say that for me the summer experi- sus for this small area. One-third to one-half ence has been most enlightening. I came into of the housing in the four tracts was classified the program this summer with the same ideal- as substandard. (2) No change appears to have istic misconception as last summer. I came say- taken place in this respect either since there ing that the ghetto had given me much last has been no new building in the area and 8 summer and that I was tired of testimonials years have elapsed with subsequent deteriora- about "How I changed" or "What I learned." I - came saying that I had a debt to repay to the tion. This community is probably one of the deepest poverty areas in the city of Chicago. community and that I wanted to use this sum- While it is not possible to refine the mortality- mer to repay it for my experience the summer morbidity indicators for this small section of before. But as I look back, I can see that again community area 28, these data for the entire I have gleaned much more from the ghetto area undoubtedly reflect the conditions within than I could have ever given or ever will. the Valley as well. Again I've changed or been changed by my summer. It hs again been a summer of the Community area 28 ranks in the first (the SRO-W, with me the receiver. highest) quartile for all five mortality-morbid- itv indicators. This includes deaths due to in- But I have learned one thing; that is how to fluenza and pneumonia for infants and nonin- deal with communities and not for them. I have iants; deaths from cervical carcinoma; deaths learned that they have as much or more to give due to unknown and ill defined causes and new me than I them, I have learned that it is a two- cases of tuberculosis discovered. (1) way street. The students assigned to the Valley under- The Valley took the development of a screening clinic at The Valley is part of community area 28 the Medical Center YMCA "Outpost." A most 41 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 important question concerning the future of That step was the creation of a community the clinic was raised by one of the students health clinic on the West Side of Chicago. This (.Jon Trefil) in his final report. clinic began as the back room of a YMCA * * * The main problem facing the building which was converted from an old cas- clinic is urban renewal. At our first ket factory. meeting where we had gathered to- How did this clinic come into existence? gether all the community leaders we * * three medical and six high school and were asked how we, as representa- undergraduate students met with the young tives of the medical center, could es- black director of "The Outpost"-a branch of tablish a clinic when that same medi- the Medical Center YMCA serving a black cal center was planning, in the next community * * * in the heart of Chicago's few years, to tear down the entire near West Side. Here we learned that this com- neighborhood and build middle class munity, although only a few blocks from the housing and thereby displace all the world's largest medical center, had no perma- people living there. Of course we did nent health facilities (with the exception of a not have any answer. But this pointed few private doctors). The director's answer to to the real problem. What is the pur- our question of what the community needed in pose of building a clinic when it will the way of health care was, "everything." be torn down in a few years. The Thus, given a free and supportive hand from problems that these people are. really the YMCA we decided to build a medical clinic. concerned about are not medical but where they will go once they are We could not operate a complete treatment kicked out of their homes. They have clinic but we could run a screening and several other problems which are referral clinic where medical students could do more important than medical care simple diagnostic tests under guidance of a such as good education for their chil- physician, and then refer patients to a hospi- dren, getting good jobs, and the con- tal. Thus, a person off the street could come to stant police harassment. Our medical the clinic and undergo a 15-minute examina- commitment began to seem more and tion by a medical student.* * * If a chronic more nearsighted. * * * disease was suspected, he would be personally A report describing the organization and assisted to a hospital for confirmation and functioning of the clinic follows for a more treatment.. The screening would be provided at complete discussion of the students' work. no cost and treatment costs would be on a slid- ing scale with welfare recipients having free The clinic was converted from an old casket treatment.* * * factory.-by Robert J. Tanenberg (Medicine) Our problems, and they were numerous, can be considered as those involving medical When I sit down and think about S.H.P. and the summer of 1968, two thoughts come to know-how and equipment and those involved with "catalysis" of the community. In essence mind immediately. First, I think of how wor we came a long way toward sIolving the former ing in a black community has enriched my life 1. and fell far short in tackling the latter. Con- and rekindled embers of youthful idealism to tacts were made with a medical supply com- meet the challenge of changing our socioecon- omic system which perpetuates the etto pany and an examining table and scale were through racism and bigotry. Second, I feel donated. A valuable contact with the Preven- much satisfaction in the realization that I as tive Medicine Department of the University of 7 Illinois enabled us to borrow another examin- part of a small group of black and white sTu- ing table and scale, two electrocardiographs, a dents whose labors bore fruit-a small but spectrophotometer, and other medical supplies. concrete step toward righting the many wrongs committed against the black man in America. After a week of painting, scrubbing and 42 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 other types of hard labor, we placed our sup- tor to the clinic once a week for lead poisoning plies in the room. Sheets hung from wires tests. We -also arranged for an agency to skin partitioned the room so that there was a gen- test area children for tuberculosis. We at- eral,admitting area where ease histories could tempted to contact infant welfare stations to be taken and [there were) two examining refer for vaccinations. We unsuccess- rooms. Meanwhile, several doctors had been fully tried to get a chest X-ray [unit] sta- contacted and we had standardized our screen- tioned at the "Y." ing procedure. In brief, we were doing simple Despite these efforts, the community res- urine, blood, and physical tests for diseases ponse was poor. We -next tried to motivate the such as diabetes, anemia, heart disease.* * * community by forming a community health We mimeographed a form for each patient committee. More flyers and personal letters which contained questions for a case history, a were sent and finally 20 people from the com- list of medical tests with room for results and munity came to the "Y" and we talked about a legal release form signed by each patient or health problems and the clinic. Many ideas his parent, if under age. The medical students were brought forth a president was elected learned the use of the instruments from a lab and plans were made. After a second meeting, technician and, in turn, taught the high school the committee was for all practical purposes and undergraduate students how to take the -nonfunctional, yet its existence was necessary various tests [there were] lectures on since it symbolized the clinic belonging the body and the diseases for which the clinic to the community it was the first step of was screening.* Contacts were made at S.H.P. [in] fading out of the picture-aii two hospitals so that our patients would have original goal of the group. some priority.* * * Many doctors were con- Attempts to publicize and promote the clinic tacted and one volunteered to act as a perma- included mailing of letters to all adult resi- nent medical adviser to the clinic. Essentially, dents in the area; dedication of the clinic; and we were [now] prepared as far as the medical other methods, all of which met with limited aspects of the clinic were concerned. Now all success. Probably the method with the greatest we needed were some patients. potential was word of mouth from The Student Health Project incorporated the treated patients. * * * idea of including black high school students as In order to insure that the clinic would con- interns into the program to act as liaison be- tinue in the fall, the medical students enlisted tween the white medical students and the black the help of the student AMA and other stu- community. Thus, we had hoped that our in- dents of the medical college to volunteer 1 or 2 terns, along with two black undergraduate stu- hours a week. When word came that the Uni- dents and one black medical student, would go versity of Illinois 'might build a modern facil- out to "their" community and bring people to ity in the community, plans were temporarily the clinic, Unfortunately, these students, al- suspended, and it is presently hoped that all though black, were not from the community medical students will * * * have an opportu- [the Valley] and were therefore strangers to nity to work in this community clinic. the people we hoped to serve. If they do, then hopefully, others like myself Nevertheless, flyers were distributed and will commit themselves to the cause of better community leaders were approached to an- health care-not only for the wealthy but for nounce that the clinic existed and would be the poor too, since health care is not a privi- open two evenings a week. This brought some lege, but a basic human right. response and we began testing. The YMCA ar- ranged for us to test * * * over 100 children Pilsen from a summer day camp.* We arranged Howell House is a settlement house adminis- for the Chicago Board of Health to send a do@ tered by United Christian Charities Service 43 L;17ilCA(iU STUDENT HEALTH PROJECT SUMMER 1968 and is located at 1731 South Racine. Predomi- purposes, no new construction has been done in nantly now a Spanish-speaking community Pilsen for more than 50 years. (most Mexican, but a small number of Puerto This area, with a fairly large and heteroge- Ricans as well), the area is also home for neous population, has no hospitals located in it older Czechoslovakians and some Negroes. It at all and only one recently established com- was originally known as the Pilsen Neighbors munity mental health center located in a store- so named by the Czech immigrants who settled front. The one infant welfare station which there earlier. used to serve the area was moved out a few The SHP team consisted of two health sci- years ago. We found that there were 27 private ence students and two Spanish-speaking high doctors in Pilsen, of whom only 17 practice in school interns who live in the community. Pilsen full time. More than half are foreign Their project included a survey of community trained, six are over 60 and six have been out health needs; participating with the Latin of medical school for 30 years or more. American Defense Organization in working The 1965 report of the Chicago Board of with welfare recipients; and assisting individ- ual families on welfare in securing health care. Health recommended that community health centers be set up in each of the 24 poverty The major report of their project concerns areas in Chicago. To date, two such centers their experiences with the health care survey have been set up in some of the worst poverty in Pilsen. A summary of the students' report areas of the city. Our impression was that describes this activity, and follows: since Pilsen was located in a poverty area of Health Care in Pilsen.-by Joseph Enderle the lower West Side and since the existing (Intern), James McCulloch (Medicine), Jose medical facilities seemed to be fairly sparse Molina (Intern), Lewis Resnick (Medicine and relatively expensive, perhaps a community health center could be established in the area When our group of medical and high school to its great advantage. students was assigned to Howell House by the We were aware that, given the existing po- Student Health Project for the summer of liti,-al and economic conditions in Chicago, no 1968, we felt a need to do something which such center would be started unless significant might be relevant to the community. Our pur- pressures were brought to bear. Since we our- pose in being there was to somehow improve selves could@ not organize the community to the health care of the neighborhood. We form such an interest group in one summer, we thought that, logically, in order to improve its thought that perhaps we could function by health care, we should first determine the na- gathering information to be used by any such ture of the health care facilities in the area and then find out what kind of health care the groups when they did form. To do this, we people of the area were receiving. made a survey to assess the health needs of the community. Through this, we thought we could In answering these questions, we found that find what kinds of health care the people of Pilsen, the area in which we were working, the area were receiving and what their health was a zone 2 (intermediate type) poverty area needs would be. with a population of about 30,000. The area is now predominantly Mexican and PuertoRican The questionnaire we used was taken pri- although there are still remnants of its origi- marily from one developed by Philip Rushing, Student Health Project Research Directo , al- nal eastern European population and a fairly r though we felt a need to modify and add to it small Negro population. Most of the people liv- questions, the re- ing there are lower income workers and there slightly. It consisted of 48 are a good number of welfare recipients also. sults of which are, presented in the next sec- tion. The housing is for the most part old and in various states of disrepair-for all practical We talked to 150 people during the months 44 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 of July and August, usually on weekdays be- courage freedom in answering questions. For tween the hours of 10 a.m. to 8 p.m. similar reasons, no socioeconomic information Our interviewing was done in the Pilsen was gathered. Such studies have been done in area, from Ashland Avenue on the west to the the past and our interest was only in building Chicago Canal on the east and from 16th a picture of the health care needs of this com- Street on the north to 22d Street on the south. munity. our method of selecting people to be inter- Like the poverty level of the area itself, the viewed can only be described as chance and results of this survey seem to be intermediate haphazard. We would walk through the streets in nature. Pilsen residents (interviewed) are of the area and approach anyone we saw who by no means suffering from a complete lack of was out on the sidewalk or on their front medical care; an overwhelming majority (82 porch and appeared not to be doing anything percent) are receiving some sort of medical at- pressing at the moment. We would then pre- tention during a year's time. On the other sent ourselves and ask permission to interview hand, there are definite indications that the them in something like the following manner. health care is not all that it should be. Good afternoon, Sir. Perhaps you Almost one-third (30 percent) of the people could help us, I'm a medical student interviewed had no family doctor and thus working this summer at Howell were dependent on public and private institu- House. Because I'm a medical student, tions along with occasional visits to neighbor- I'm interested in the medical facilities hood doctors for their primarily crisis-oriented in this area and the way in which health care. This means that carefully super- people who live in this area receive vised followup care would probably not be their medical care. What we're doing available to or used by this group to any large is making a survey, asking people extent. questions such as if they have a family In addition, almost one-fifth (18 percent) of doctor or what hospital they use. We the people interviewed are not receiving medi- were wondering, would you mind if we cal attention of any sort. asked you these questions? This would seem to indicate that while most Using this approach, only 10 to 20 people de- of the people interviewed receive some sort of clined to be interviewed. Our reasons for not medical care there is a significant group of using a more rigorous sampling procedure -neople whose medical care is vastly inadequate. were bur inexperience and our reluctance to ii we ask why this group is not receiving ade- engage in house-to-house canvassing. Because quate health care, we seem to find that one of of this, our results may not achieve a rigorous the causes is, not unexpectedly, that of po'v- definition of statistical accuracy. However, we erty. Previous studies (1965 report of the Chi- are of the opinion that the people interviewed cago Board of Health and a study done by the roughly comprise a representative cross section 1967 Student Health Project, among others) of the people living in the area. Since our in- have shown that poor health care is associated terviewing teams were for the most part bilin- with poverty, and even this study, which did gual, both English- and Spanish-speaking peo- not specifically concern itself about socioecon- Ple were included. Also, when the interviewing omic problems, illustrates some relationships was done, we made an attempt to cover all the between inadequate health care and poverty. streets in the area fairly equally. Although many of our respondents were women between The reason given most often for why people didn't have family doctors, why people didn't the ages of approximately 25 and 50, our sam- go to doctors when they had medical problems Ple included both men and women, the elderly and some older teenagers. and why people didn't go to dentists when they had dental problems was that of money.,Also, The interviews were kept anonymous to en- in their choice of hospitals, the most fre- 45 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 quently used were Cook County and other com- ics which of necessity caused them to go out- paratively free clinics such as those at Presby- side the community since there are no hospitals terian-St. Luke's and Illinois Research and Ed- in Pilsen. The average outpatient clinic visit ucation. Even in -an important matter such as required a 40-block round trip and about a 1 emergency care, the hospitals which were used hour wait at the clinic. According to these followed the same general distribution. People measures, more medical facilities would thus who used Cook County and other such hospi- seem to be indicated. tals for their emergency care reported that But there are other measures which also de- they went there because these places wouldn't serve attention. In relation to dental care, more charge them -and implied that they couldn't af- than half (57 percent) of the people inter- ford to go any place else. Even when faced viewed had not seen a dentist in the past year, with the prospect of waiting for up to 5 hours even for a checkup. In addition, one-third of which most people considered unfavorably, the people interviewed had dental problems in more people went to Cook County Hospital for the past but had not gone to a dentist. When their outpatient visits than anywhere else. asked why, lack of money was reported to be a Thus we can see that for people in Pilsen as prime factor by most of the people involved. In well as in other places, poverty seems to have a a casual search through the telephone boo c-, we decided influence on the choice and amount of found only 10 dentists practicing in the entire medical care. An alarming consideration in re- area. This seems to indicate a severe lack of I-ation to this is that most of the complaints for dental services and dental care in the Pilsen which 28 percent of the people did not consult area and appears to be one of the more press- doctors were or could be quite serious. This is , ing health needs of the community. group of people, therefore, who need prompt medical attention but are not getting it. In relation to mental health, it is fortunate Another aspect of the area's health care is that the Pilsen Mental Health Center has been the way in which Pilsen residents utilized med- established. We found that 30 percent of the ical services. Although 73 percent said that a people interviewed reported that they had had yearly checkup was necessary, only 58 percent some sort of nervous (emotional) disorder at actually had one. And of the visits that people some time. About 10 percent of the people in- of the area made to doctors for any reason at terviewed reported having emotional disorders all, only 28 percent were for checkups. From at the present time, and another 5 percent re- these results it would seem that, although the ported emotional difficulties within the past yearly checkup is important in theory, in prac- year. This seems to be somewhat higher than tice people only go when something serious ap-- the national average one out of every 10 Amer- icans and, if it is a valid figure, might be due in tually occurs. It is this kind of crisis-oriented health care that is one of the characteristic part to the conditions of poverty in the area features of the inadequate health care received and the conflict arising out of rapidly changing in poverty areas. cultural backgrounds. A similar incidence (32 percent) of emotional maladjustments was re- Another important aspect of the health care ported for children in the area. When asked picture in Pilsen is the apparent inadequacy of what they would do if faced with an emotional its existing health care facilities to provide for problem. in themselves, only 47 percent of the the total needs of the community. To receive people interviewed would see a doctor. Of the their ordinary medical care, almost one-half people who actually had an emotional disorder, (48 percent) of the people interviewed went about the same Dereentage (44 percent) ac- outside the Pilsen area. The picture is even tually did see a doctor. Of the parents who re- worse in regard to emergency care where fully ported having a maladjusted child, only 28 per- 58 percent of the people had to go outside the cent sought medical attention. This is probably area. In addition, more than one-third (37 per- not a significant difference$ however, since at cent) of the people made use of outpatient clin- least 46 percent of the parents attempted to in- 46 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tervene somehow in the child's problem, in- There are about 125,000 people living there. cluding medical care. Thus, there seems to be a The median family income in 1960 was $4,981 i definite mental health problem in Pilsen and it 10 percent of the male labor force was unem- is fortunate that it has its own community ployed; 25 percent of the families had incomes mental health center to deal with it. of less than $3,000 per year; 14 percent of the Perhaps the most significant result, how- housing was substandard. (2) There has been ever, was the overwhelming 91 percent of the virtually no new construction in this commiin- people who voiced their desire to have a com- ity since 1930 (when the population was about munity health center established in the area. 112,000) with the exception of a small Chicago Most of these reaffirmed that a community Housing Authority unit with 136 apartments. health center was badly needed. Repeatedly, (3) North Lawndale was in the first quartile the comment was made that it would help the (the highest) ranking for all of the five mor- people of the area and a few were in favor of it bidity-mortality factors. (1) only if it did and only if it were inside the Pil- Martin Luther King, Jr. Neighborhood Health sen area itself. Center.-The Lepper-Lashof report (1) issued In summary then, it seems that: there is a in 1966 recommended that 24 neighborhood significant number of people who are not get- health centers be established in the poverty ting full health care, one of the principal rea- communities of Chicago to provide quality sons being its relatively prohibitive cost for health care to defined populations of these them; a good number of the people in the area areas. To date, only two have been established receive their health care in a crisis-oriented and the Martin Luther King Center is one of fashion, rather th-an allowing for more thor- these. ough, followup types of care; and emergency Two health science students and three high and dental services are especially deficient, school interns were assigned to this site. They causing most of the people either to go out Of worked in the day-to-day routine of the health the area, for emergency care, or not have any, in relation to dental care. center and with the community health aides so As our recommendation, then, these findings they had some exposure to both the center and would lead us toi believe that a community the community which it serves. The students worked individually by conscious decision so health center, located inside the Pilsen area, they could function best in assisting in the would act admirably to furnish all these addi work of the center and still work in areas of tional services at costs low enough so that al their particular interests. The three high would benefit. school interns plan to continue working with Lawndale programs during the com.ing year. The area known as Lawndale is actually two As stated so commonly throughout most of community areas; one is North Lawndale, the the reports the students felt that they had been Other is South Lawndale. They are community the recipients of the benefits from the sum- areas 29 and 30, respectively. No two commu - mer's experience. Selected quotations indicate n- ities could be more different even though they this. are geographically contiguous. North Lawn- Raymond Zablotny a health science student, dale is considered a zone 2 poverty area; South said in his midoroject evaluation, Lawndale is not a poverty area. North Lawn- My main goal in the SHO project dale is more than 90 percent Negro while the this summer is to learn: * * * When other is more than 90 percent white. I speak of learning I do not necessar- SHP teams worked in North Lawndale and ily mean from the careful collection this report will deal only with that community of statistics but rather knowledge area ', No. 29. from the mouths and lives of the peo- 47 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ple with whom I come in contact in the patient. LASH treats people in my work.* their usual setting, and in doing so I have made a special effort attacks the environment The at- to try and understand the problem of tempt is not made, as is usual, to re- community control of the center. I move disturbed people from the have spoken for many hours with stressful situation and treat their * * * the community organizer of the problems in an alien context. Center, and have attended meetings Instead, the orientation of LASH is of the Community Health Council. to cure and prevent mental illness by * * * I think my role as a student helping people to alter those environ- in this site is one that will enable me mental conditions which contribute.to to become a better, more aware health their mental illness.* * * professional.* * * This description of the ageney's orientation is Unlike some of the criticisms of the summer by one of the medical students, Howard Fenn. project which revolved around difficulties in His reaction to his site assignment is presented relationships between health science students in the following essay. and the high school interns, health science stu- dents at this site did not have this experience. I see myself in the role of an observer and a This seemed to be the feeling of the high changer.-by Howard Fenn (Medicine) school interns as well since in describing what When I began the Student Health Project of all five students -thought were the short and 1968, the goals I foresaw for the summer were long term positive effects of the project, their directed toward two areas: myself and the report said, community. With regard to the community, I We have helped things to run a little envisioned the possibility of perhaps slightly smoother in some areas, to actually altering the sense of futility among the popu- get a little more done, and to add to lace. The despair and hopelessness so apparent the convenience of the patients. * * * in a poverty neighborhood are linked closely Our chief contribution here seems to with so many other terrible characteristics of lie in the area of human relations and a poverty zone: high unemployment, low edu- a rather good spirit of working and cational level, political disenfranchisement, al- being together. coholism, and substandard living conditions. It is true that a partial cause of all these factors Lawndate Association for Social Health.- is the capitalist system and a disinterest of the Two health science students and two high establishment toward the poor. However, also school interns joined this 3-month-old pri- at fault in perpetuating these conditions is the vately subsidized agency, staffed with psychia- mental state of the inhabitants of the poverty tric and. social work professionals. A new con- area. In order to alter the physical health of cept about some forms of mental illness is em- these people, which is hampered by the poverty braced by this agency, i.e., state in which they live, the mental health * * * The concept that mental ill- must also be improved. And this was my origi- ness is often * * * a normal, under- nal goal for the community: by attempting standable adaptation to an intolera- various self-help projects, the hopelessness and ble, stifling environment is a strong despair present would be alleviated, improving assumption at LASH. And so this As- mental health and thereby working against the sociation is unique among mental poverty conditions. Unfortunately, the prog- [health] institutions in that it deals ress I have accomplished in this area has been with the environment of the patients minimal. But the goals with regard to myself rather than merely the symptoms of are being reached through my attempts to that environment as manifested by alter the community. 48 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The goal for myself has always been to learn prived community. But in my attempts toward more about the "Culture of poverty," the condi- change in the neighborhood, I am gaining the tions which bring it about, and what methods skills and knowledge for future, more success- there may be too combat it. This I am slowly be- ful attempts, when my higher academic level Corning acquainted with. will also add to my degree of effectiveness. So The site at which I am working coincides for the present, I see myself in the role of an well with my projected goals for the summer. observer and a changer, with the emphasis on The Lawndale Association for Social Health is the former so that eventually my ability in the committed to the concept that the mental health latter will be increased. of the Lawndale community can best be im- Drug abwe.-Elsewhere in this report we proved through direct social action taken to have occasion to note the frequency with which better conditions in that community. Several SHP teams felt their 10-week effort had prod- projects are already underway in order to ef- uced little change or had "failed" entire y -;o fect such betterment: adult education, a coop- meet the goals they had set. This reaction was erative business, vocational training, and psy- less evident where teams were taking up the chiatric workshops are just a few of the pro- unfinished SHP projects of the previous sum- jects. mer. Following is the report of a student who returned in the summer of 1968 to continue I have been engaged in helping and observ- work she had begun in the Summer Health ing several of these programs. In addition, I Project of 1967. have been involved in a tutoring program in the local Lawson Elementary School, which is Joint Community Program on Drug Abuse.- gaining speed. I have, with the help of a clini- by Jeanie Snodgrass (Nursing) cal psychologist from Madden Zone Center, been formulating a course in psychosocial de- As this summer draws to a close and the pro- velopment to be perhaps presented to possible ject ends, people are going home, back to dropouts at Farragut High School. This pro- school or whatever; most are leaving Chicago gram is to be initiated on July 29, on an exper- behind-leaving the project with an education imental basis. and with observations they'll never let sUp While engaging in these efforts I have in- their minds. For me the 10-week project (my deed learned much of the neighborhood prob- second affiliation with the SHO Summer Pro- lems and the possible solutions. But as for di- ject) was really a renewed beginning, or rectly affecting the people of the community I maybe just a continuation of the commitment I'd found the summer before. must admit that this gain is not visible. How- ever, it is hoped that in the next few weeks of Last summer I left the project after 10 the summer these projects will begin to take weeks, having made not so much as a minimal hold and continue as permanent scenes in the contribution to the health center where I had neighborhood. The psychosocial development worked: of course I gave nothing to the larger course, in 'Particular, will be initiated in this community of Lawndale. last half of the summer and will make a con- I did come away pondering many new tinuing contribution to the mental health of thoughts, my world of experience and exposure high school age youngsters. In addition, my much expanded, which was of no lasting value goals with regard to myself will be attained as to anyone but myself. I felt that I had taken I see projects take form and achieve small ef- something from the community, leaving noth- fects on the community. ing of value behind; what's more I had used And this, indeed, is my major role as a other people's money to do it. health student in the community. For at my I couldn't leave with a record like that. That @@present status and educational level, -there summer only whet my appetite for community to be little effect I can have on a de-. involvement, and I just couldn't leave-so I 49 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 stayed. I continued to work with the preceptor much-needed contribution to the community, at the health center, who was in the process of and a contribution with long-lasting effects. I planning the mental health services for the will be continuing my work with the program center. I took on the role of his "Girl Friday," for the coming year, as the paid "Coordinator" and I learned more and more. of the program; but within one year I hope I became interested in one particular mental that the program will have become a successful health problem that was plaguing the Lawn- integral part of the programs of each agency dale community as it does so many other com- nd institution involved. munties; this was the problem of drug abuse The ramifications of this program extend far among the youth. I undertook an exploratory beyond the treatment of youthfu g users. study to find out the true scope of the problem. The program involves communication and co- ordination of activities among more than forty During November and December I visited agencies, raising the level of interaction and youth agencies, law agencies, health facilities intercommunication to a new level. and many individual persons serving the Lawndale area. I was taken by surprise by the Needless to say this work has defined a fu- findings that the problem was apparently so ture role for me; more than that, it has clear great, yet no one really knew how great, and uncovered a new way of life for me. I feel -now, no one was making any effort to curb or deal too, that I have paid back the money and expe- with the problem. rience debt I had accumulated that first sum- With the results of this study, my role for mer, and I'll be continuing to repay it the rest f my life. this summer became more clearly defined as I 0 discussed the findings with many persons- some of whom I had interviewed during the St. Leonard's House study-involved in youth work on the West This site is a halfway house administered by Side. the Episcopal Diocese of Chicago. The @ff in- By June I had several people interested in cludes physicians, psychologists, social workers, doing something about the problem. No one and priests. Its purpose is to act as a re- had yet defined what type of action should be habilitation and support center for ex-conviets taken, but gradually throughout the summer a and for narcotics addicts. It is located on Chi- specific program has taken shape. This had cago's west side but accepts guests from all been done through combined efforts of over 40 over the city. However'!it is closely related to community agencies who have banded together i wh ch it is physically 10- the community n i for the first time to combat the rising problem. cated; namely, the Mile Square. There is an ad- At the present time, the actual program is visory council composed of leaders from this about to begin, training programs for the po- community as well as therapists and others lice and youth legal agencies, and the treat- from the addict Community. ment center workers taking place in early Oc- Private contributions, church charity funds, tober. In the total comprehensive program, we and Federal moneys support the work of this are involving over 40 community agencies, 45 agency. A special program for rehabilitation of schools of five school districts, and 10 youth narcotics addicts is funded by the Office of "Treatment" centers, plus the police Youth Di- - visions of four districts, and the juvenile k;conomic Opportunity. courts. Actual referrals of youths involved in The agency is currently planning a program drug abuse will begin November 1. focused upon juvenile delinquency and drug abuse. It was in this area that the two students I feel that my first summer was not wasted - assigned to this site did the greatest amount of now, for it laid the foundation for me for a their work. whole future's lifetime work, and has truly been the catalyst for a program which is a They interviewed directors of about 20 Wes 50@@ CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Side agencies. Their intent was to determine the students is beautifully expressed in the fol- what kinds of programs, if any, these agencies lowing essay. sponsored that had to do with juvenil6 delin- I did not know my own ideas. by quency or drug abuse. * * * We found that there are Emily Gottlieb (Medicine) many and varied programs for juven- It seemed perfectly obvious to me: all iles on the West Side, all of them at these emotional arguments presented by the least indirectly affecting juvenile de- more militant speakers at the orientation ses- linquency. However, there were very sion were nothing more than illogical ha- few programs which were directed rangues directed at antagonizing the white au- specifically to help kids who were in dience. I was all for civil rights and integra- trouble with the law, though most of tion, but the leaders of SHP seemed a little too the programs took care of these cases enthusiastic in their desire to be liberals- when they came across them. these speakers were one case in point, another As far as drug abuse was concerned, being the pictures of Malcolm X which decor- all agencies were aware of drug use ated the meeting hall. Granted a small minority of one kind or another, but almost may think these militant ideas, but I know none had programs of any kind on that it certainly didn't speak for most Negroes. drugs, and almost all stated that they Anyway, these militants were so illogical and would like to know of a referral disorganized, they would never be able to col- agency or resource for further infor- lect any sizeable following, much less accom- mation on these problems. * * * plish anything concrete, since their modes of Their learning experience was again thinking were so obviously immature. stressed, as is common throughout the report: The interns I met at orientation were of a At two of the agencies we visited, more sensible nature, able to think in terms of we encountered some hostility which Negroes and whites working together in a resulted in very poor communication brotherly fashion within the ghetto to help Ne- our interviews with these two groes better themselves. They were certainly agencies were "good for us" in that more mature in their ideas than certain of . e we were able to get a broader view of speakers I had listened to-and since they are the spectrum of attitudes in commun- the youth of the ghettos, do not they speak for ity agencies, especially their feel- the future? I was sure most of them didn't ings and reactions toward white really like Rap Brown any more than I did. He liberals. * * * is all right, but a little too radical, and he Short term effects on ourselves doesn't seem to want-any of the assistance of- consist mainly of broadening our out- fered him by white liberals today. look on the problem of drug addle- The above is an approximation of the atti- tion, and equally important, becoming tudes with which I began the summmer. They acquainted with the people and their -were not changed by the few days of lectures feelings in the ghetto. In the long during orientation. But perhaps the orientation run, the experience of this summer provided the initial confrontation which was to will help us to evaluate both our cap- force me into a reevaluation of my attitudes abilities and our desire to work in throughout the summer. As I rode home from community, medicine. If we should Camp Reinberg, I felt that, on the whole, I was eventually end up in community medi- in tune with the young Negroes of today-that cine, we will perhaps be able to make I understood them, and that we shared com- a better contribution in light of the mon goals. Yet, there were some disturbing insight gained this summer. ideas that came to mind occasionally: some of The impact of the site assignment on one of the speakers seemed very hostile toward the 51 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 white liberal in general, and suggested that Within a few days, I discovered an interesting whites had no business in the ghetto. I was thing happening to my conversations with able to dismiss these memories easily, however, James; I was scraping the ground to make this when I thought of the many people I had man like me, but the way in which I did this heard who had reinforced my own views on the was quite fascinating. Knowing James to be of problem of discrimination-I didn't let the militant leanings, I mouthed to him the very words of the militants stay in my mind long ideas which I had heard at orientation, and enough to bother me. with which I had so much disagreed. I do not My summer assignment was to work at S!. know whether James believed me, but for a Leonard's House, a halfway house for drug aa- while I succeeded in convincing myself. dicts and ex-offenders coming out on parole. St. Soon enough I realized what I was doing, Leonard's is located on the near West Side of and for the first time, I admitted that I did not Chicago, just off -Madison Street. Many of the know my own ideas, much less understand buildings in the area were gutted by fire last those with which I disagreed. It is difficult to April, but they are still "inhabited" by addicts, describe the subsequent process in which I winos, and little kids during the day, sitting on reevaluated my opinions, and at the same time the doorsills or empty window frames, watch- sought to gain insight into the ideas which I ilig Madison Street move by. A layer of pulver- had thus far rejected on the premise that they ized glass covers the sidewalks and trash is ev- were insignificant. Given the ideas to which I erywhere. had been more than superficially exposed at orientation, I was able to appreciate and bene- Storefront businesses that are still in opera- fit from various experiences at St. Leonard's. tion are fortified by iron grillwork. The local Walgreen's has replaced all its plate glass win- There were several instances in which I felt dows with obviously durable paneling. The I was discriminated against because of the schools in the neighborhood are easily recog- white color of my skin. I once thought I had nized by the large number of broken windows. been able to talk meaningfully with a woman ailing at St. Leonard's. But the next day, I ov- Occasionally, there is a vacant lot, of bricks and rubble, with a sign designating it as )art erheard her talking with a person of her own ce (black), and she seemed a different per- of some plan for urban renewal, Richard J. ra Daley, mayor. Two blocks from St. Leonard's son. What I thought I had been talking to was is a very large, dirty building that exudes dust, an act she had contrived because I was white. the public aid office. Whenever this type of thing happened, I felt very depressed. At the same time, I was begin- At St. Leonard's, I was introduced to the ning to experience, though on an extremely re- staff members who are black and white. On my duced scale, some of the frustration, even own I got to know most of the people living at anger, over events determined solely by skin St. Leonard's most of them black. My coworker color. No longer did "the race problem" remain and I both were astonished at the intellects of a rather intellectual phenomenon to be read the people we met-people who had been on about, and mulled over in discussions; it was drugs, or who had been doing time for armed real to me in emotional terms. robbery. And reluctantly we realized and ad- During the summer, I believe I was able to mitted the subtlety'of our own racism-that sense a feeling that hangs on everybody and we were surprised that blacks were intelligent. everything in the ghetto. It is almost as if the One man, I shall call him James, we got to ghetto is a forgotten part of the city. One sees know and like very much. James had just the forgetters every day driving down Madison kicked his habit a few weeks before we met to the L6op-they never seem to notice what him. He could talk for hours on all sorts of life lies between their jobs and their secure topics, ranging from Malcolm X to jazz to Op- suburban ranch homes. What bothered me eration Breadbasket to the Communist Party. was a seeming apathy on the part of the people 52 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 in the ghetto-didn't they know that nobody and church-supported or church-related agen- cared? Why didn't they do anything and de- cies. inand to be remembered? It wasn't apathy I saw-it was an acceptance of the ghetto as Abraham Lincoln Center their only way of life. What had the black man This site is a settlement house which has ever seen to suggest that black men should ex- been in existence for 50 years. It offers a wide pect more? Who'has ever proved to a ghetto variety of programs and services for all age child that a schoolteacher makes out better in groups. The community is serves is located in life than a good hustler? area 38, also known as Grand Boulevard. Its The more I seemed to be learning about the population is about 99 percent Negro and it is ghetto, the more I realized that to understand considered a zone I poverty area (greatest con- the feelings of blacks, one has to be black. Per- centration of poverty). (1) About 83,500 peo- haps I knew what it was like to be judged on ple reside in the entire community area. The skin color, but I will never know what it is to median family income in 1960 was $4,329 but be judged on black skin color. Along this same 32.6 percent of the families had incomes below line, I slowly began to understand black objec- $3,000 per year; 12 perce.nt of the male labor tions to whites in their neighborhood. First of force was unemployed. (2) The community all, whites had plenty to do in terms of clean- area was ranked in the first quartile (the ow- ing up their own communities, spiritually if est levels of health) for all five mortality-mor- not physically. Secondly, the black man is tired bidity factors. (1) of saying thank you to the white man for the There were three health science students few crumbs that are swept his way. Lastly, and two high school interns assigned to the blacks are starting to throw off their warped Abraham Lincoln Center. Their project goal self-images of second rate human beings, and was to help launch a community health com- are taking pride in themselves and their com- mittee. The team reported briefly. "It did not munity-and it is they who will make the de- succeed," ascribing the failure to "community cisions about thmeselves and their community apathy," and predicting that, "no one else can from now on. succeed here." I am repeating ideas probably already quite Yet the essay that follows emerges as the familiar to many, and even accepted by many most outstanding personal commentary on stu- -but they are -reproduced here to illustrate my dent's experience during the summer. It sums own change of attitude through the summer. I up the continual theme of "learning" for SHP am grateful to St. Leonard's and the people of participants, black as well as white, during the the neighborhood for enabling me to see the in- summer's confrontations. flexibility of my original attitudes; and for having provided me with the opportunities to 94if you can't appreciate a tootkpick, a yard reshape my ideas, which, I hope, will continue full of golden lumber won't do you no good." to change and not stay fixed by disregarding -by Roscoe Woosley, Jr. (Premedicine) any opinions contrary to my own @ as they al- "Rocky?" * * *,He was coming toward me most did at the start of the summer. with a huge blade now. He wanted, it seemed, THE SOUTH SIDE to cut my throat and the razor blades he had used before weren't good enough. My skin has Students were assigned to a variety of or- a number of long slits that are bleeding quite ganizations and agencies on Chicago's South- freely * * * "Rocky! It's 7:30" * * * He's east and Southwest Sides. In addition to their advancing now. Slowly, every slowly, he moves experiences in several hospitals (see Hospital with the blade raised high overhead. His black Sites section), they also worked with outpatient skin glistens with sweat. His face looks so clinics, civic associations, health associations, hard and fixed it seems to have been carved community organizations, settlement houses - from black ebony. His face is expressionless - 53 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 save the slight hint of a smirk, eyes glazed, old brown color and t he heels were worn down and not a twitch of nervousness. He stops as a so much they made him appear to walk with a cat stops before he lunges at his prey. He rocking gait. His head was covered with a bat- rushes * * * "Rocky GET UP!" tered gray felt hat whose crown had been I abruptly but thankfully awoke and slowly 7iolded so much, it looked like it had collapsed climbed from bed. With a sigh of relief and irom exhaustion. Beneath this hat was a warm twinge of remorse I vividly remembered last face. His eyes were black and penetrating, but night's dream. Why? they held a warm glow as a coal holds fire. His eyes darted from me to the street as we walked What day is it? Oh yeah, today is Monday. toward each other on the sidewalk. When we The beginning of the week and work and met he stopped me and asked if I was in col- mindful confusion. lege. I put my clothes on and went downstairs to "Was it that obvious," I thought to myself, I wash up. don't want to look like that. It wouldn't be too "See you later, Mom. Have a nice day at healthy around here." work." I said I was and he told me to stay there. "You too, Rocky Eat a good breakfast be- Then he told me something, he said: "Always fore you leave." remember, if you can't appreciate a toothpick, 490K.ff a yard full of golden lumber won't do you no I turned on the stero to have a little music good, son." He told me he had graduated from with my cold ceral. I should have fixed some Fisk University in 1937. I wondered under what circumstances he came to live in this bacon and eggs but I just didn't feel like cook- neighborhood. ing. "Well, I guess I better get going. It's already I remember my first impression of the nine o'clock." "houses." Some were painted in a vain attempt to make them presentable to society. Some The people have all learned the game every- were just left to die a natural death. Some of one plays on the bus. Everyone keeps a the people tried to keep the grass growing, if straight, impersonal face so no one may hurt there was any to begin with, to give the old you, or think you're crazy, or make a pass at places some new life. One house, in particular, you. Everyone puts their masks on when they was nicely, but rather gaudily painted in my enter the bus. The sad part of this game is that estimation. This two flat was painted blood red even the young children have learned to play on the face brick from the roof to the porch and in the morning when they get on the bus and down the cement stairs to the sidewalk. going to day camp they don the faceless mask The storm window frames, door and down the of unconcern! Even more tragic to me is the middle of the steps were painted a deep, mossy, realization that I too, have a mask, or is it a moody green. It had a shiny new, aluminum God-sent gift? storm door and window awnings, and the grass Well the next stop is mine'. was green and rich. I- liked it and silently com- "Oakwood! Oakwood Boulevard, next stop." plimented the owners that first day. As I look I remember my first day getting off at this at it again today I get a sick, depressed feeling stop. Apprehension and the fear of physical inside. Another house farther down the street harm cluttered and clouded my mind. I remem- caught my eye, also. It had no windows ' they her meeting the old man. He was a short, had been broken out, the door@ stood wide open elderly, potbellied man. He wore a pair of old, off its hinges with at least six dogs lying in the faded purple, blue pants that shined from dirt in the front of the house. An old black wear. His coat was black and white checked woman with big gnarled hands, muscular and grayed with dirt. He wore a light blue arms and shoulder; sat with a child in her arms shirt, opened at the neck. His shoes were an on the wooden porch. I felt guilty the first day 54 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 because she turned my stomach. I couldn't look "I feel fine." her straight in the eyes. I steppe up my pace "Then what's wrong, Karen?" with head bowed in order to escape her seem- "I don't want to go home right now." ingly stone gaze. Today, as I walk down this A beautiful black girl with deep dark eyes street, I find myself moving at a slower more and a razor-sharp mind would rather get shots relaxed pace. I still cannot look her in the face than go home. There was nothing I could say but I know now why, and how, and I under to console her.-Her younger brother lay crying stand her. I feel no pity for her, just a deep un- at home in bed because the gnats and mosqui- derstanding and a knowing frustration. toes, so abundant in the dirty two flat apart- The center stands on the next corner. It's an ment building where they lived, had bitten him imposing structure. My first impression was of so much he had broken out in hives all over his a warehouse. It's red brick, dirty, old, and body. looks very tired. "I'm hungry." The elevator doors opened onto the fifth "Didn't you eat this morning, Karen?" floor and my office is room 5-B. "I just had a sandwich before you came to About 3 weeks after I first arrived there the get me." telephone rang. My mother's words came racing back to me. "Hello, Roscoe Woosley, Student Health Or- "Eat a good breakfast before you leave." But I ganization." was too lazy to eat. What could I do? If I "Hi, Rocky, This is Mrs. Hill. I'm down- bought her anything she may realize the des- stairs. I have something for you." perateness of her station in life because she "OK) I'll be right down." was black. But would that be good or bad? After what seemed to be an endless ride on Who knows? My lunch sat cold and untouched the outdated, 5 m.p.h. elevator, "Hi, what's in front of me that afternoon. ti up. "I want you all to start a diabetes program "Well, Mrs. Parker, here came in with her in the neighborhood." four children. One got bitten by a dog last Sun- "We want a clinic." day and she brought her here because she has "What about all the children with tetanus no transportation or babysitter and the child's that won't be admitted into school this fall un- leg is swollen up, See?" less it is cleared up?" "Oooh damn! We better get her to a clinic. "The main objective of this project at this Let's go." particular site is to effectively organize the That went on for 2 weeks. Ron and I picked community so that they may control their own up 7-year-old Karen and took her to the clinic lives." for rabies shots. Karen, as most girls her age, "What are you doing here that KOCO doesn't was a slim gamely child. Her face, though, was already do?" not the face of child of seven. She had a beau- "You're just a fixture, you're not effective tiful full face that contained an unnatural and nothing concrete has happened." awareness. She, seemed more self-reliant and mature than other girls her age. She wore This is what was asked, demanded, and said clothes that were too small for her and some- to us by members of'the Student Health Or- times soiled but she was probably fuller of life ganization, the Concerned Parents Group of than other children. On the fifth day, after we Ida B. Wells which consists of no more than had gained her trust, she seemed to have lost 200 people whereas Ida B. Wells accommodates her easygoing, Sunday disposition. She seemed thousands, and other people who had been in troubled and we asked her what was the mat- the neighborhood for about 5 years. How could ter. I organize or help organize any community 55 IIJDZL"In rnvjrju'i' 6UMMER 1968 when I didn't have an organized mind. I didn't pieces are beginning to fit and a pattern is pre- know what all the problems were, where they senting itself, it is up to me and all black peo- stemmed from, or how to effectively cope with ple to begin to try to put the puzzles together them. I was unorganized and confused in my which are themselves. Then, and only then, thought in terms of my identity, and in terms may we advance. For me there lie other pieces of what my role in life is to be. I didn't know to be fit together and now is the time to re- why I thought the way I did. group and advance. Before this summer, all of In terms of benefiting the community, I was this was unknown to me and I am deeply a total failure. In terms of myself and how the @rateful to the Student Health Organization ior making this realization possible. For with project benefited me, however, it has achieved this realization and a great amount of determi- one goal. It has made me aware and has made nation and action there is hope and an answer me change mentally. for the "Karen's" of the world and all the I realize now and understand why I had that "Classes of 37." dream. I was afraid of my own people. I had been brainwashed into believing my people The Robert Taylor Homes hated me and anyone else who tried to get The Robert Taylor Homes is a giant housing ahead and, therefore, I feared them. What was project, the largest one administered by the not drummed into my head was that the only Chicago Housing Authority. It is located on 92 reason my people dislike others who tried to acres of land between 39th and 54th Streets on get ahead was because they seemed to always State Street, running about 2 miles in length forget or disown their own kind. The fear the and two blocks deep. (3) They are high rise first day at work is now as understandable as units, most of which are located in community the feeling of remorse after the dream. area 38, just described; however, some spill The confusion my mind was assaulted by at over four blocks in community area 40. The the beginning of the summer has been con- parameters for 40 are similar to those for area quered, I understand, now, the cord which 38. joins together the old man on the street to the The Taylor Homes have become a commun- woman on the porch to the little girl named ity unto themselves, isolated from the sur- Karen to me and the rest of the black people. rounding South Side. Even branches of schools No more will I be able to think and act as the operate in apartments within.the housing pro- people in the gaudy house who disregarded ject. It is an extremely young community with their neighbors and their people. No more will 20,300 of its 27,200 residents below the age of I be able to strive to think and act as a white 18 years. The average number of children is man. For now I know what besets my people, 4.7 per family. (3) and how, perhaps in a feeble way, to help them The median family income at the end of and myself. Now I am able to understand the 1967 was $4,860 per year and 48.7 percent of proverb that was told to me a black, perse- all the families were supported by one or more cuted old man. If you cannot appreciate the public assistance grants. Of the families with smallest thing or the seemingly smallest per- assistance grants, 75 percent were supported son, a whole college education with an infinite by the Aid to Dependent Children category. understanding of the universe is worthless. Racial occupancy is 100-percent Negro. (3). How could I before, do anything to help the Ten health science and high school students people in my site if I was as unorganized and were assigned to work with the Robert Taylor as in need of help as they were. Now, at least, IHomes Health Committee and the Robert Tay- am able to see more than before. The Demo- lor Homes Health Clinic. The former is com- cratic National Convention was also a revela- posed of residents of the project who are con- tion. I had not before fathomed the power Em- cerned with health issues in their community. peror Daley possessed. Now that some of the Mostly women comprise its leadership. The lat- 56 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ter has been a goal of the Health Committee housing project in the world, are "high-rise since its inception. Student Health Organiza- concentration camps" (Dick Gregory) that tion members have been working with the pack 30,000 black people into' a one-block Health Committee since the summer of 1967 stretch along 2 miles of South State Street. assisting them in attempts to open a Health The city of Chicago built "Taylor Homes" with Clinic in the Taylor Homes. The clinic finally Federal funds during Mayor Daley's second was opened in the summer of 1968. Students term and planned into the project such defects participated in the opening and the staffing at as totally inadequate playground and recrea- first. However, the Taylor Home site was one tional facilities, two small and often inoperable of the most trauma ridden for the students. elevators for each building (1,100 people), and, The best description of the student involve- most devastatingly, the swept-aside feeling ment this summer at this site is their own re- that comes from being stacked into a 16-story port. The text of this report follows. prison. "Depressing"-that is the word most commonly used by people caught in Taylor Taylor Hom es Area Site Report.-by Pamela Homes. Osbourne (Nursing), Suzan Simons (Psychol- In June 1967 the one black and three white ogy), Grace Dammann (Social Sciences), Steve ience students of the Student Health Rand (Medicine), Mary Anne Caswick (Medi- health se cine), Andrea Gay (Biology) Vinc6nt Torna- Organization went into Taylor Homes and im- p mediately saw that the Humane Society had bene (Medicine) little real contact with the community. They In the process 'of writing this report, it be- then proceeded to conduct a survey of the came evident that the report could be written health needs of the community by interviewing from any one of three points of view: that Of about 40 parents at great length. The Taylor the ladies of the health committee, that of the residents told of the lack of health care facili- e c whit health scien e students, that of the black ties in their area. Several mothers said, "I need health science students. In view of the consti- a place where I can take my children when tuency to which this report is directed, all stu- they are sie-k." After hearing statements like dents at the site agreed to write the report this the SHO students decided that it was pos- from the point of view of the white health sci- sible to set up a clinic to serve the Taylor ence students. Student efforts in the Taylor Homes area. The Infant Welfare Station at story include two Student Health Projects (the 47th and State Streets seemed to be a logical summers of 1967 and 1968) and the efforts of place where a Taylor mother "could take her the Student Health Organization during the in- children." The Infant Welfare Station, like all tervening school year (1967-68). In this report the Taylor Homes buildings, is owned by the the name "SHO (Student Health Organiza- ubiquitous Chicago Housing Authority. Taylor tion) is used to include all the students who residents and other "project" people of Chi- contributed to the Taylor story. cago hold a special resentment for the Chicago pp - What drives a college student who really Housing Authority, their "keeper. Their jus knows nothing about a black ghetto to enter tifiable rage seethes when a baby falls 13 sto- that ghetto? "I want to help these people," ries because Chicago Housing Authority hasn't said one SHO member who worked in Tayjor repaired a balcony fence, as happened again in Homes on the 1968 summer project. "I thought September 1968. The Chicago Board of Health I could learn a lot," said another. With these leases the Infant Welfare Station in Taylor attitudes and all the ignorance and paternal- Homes from the Chicago Housing Authority. ism behind these statements, SHO, in 1967, This station, like the others in Chicago' does sought its contact with the Taylor community not serve sick children but only well babies and ended up with the Illinois Humane Society who get routine checkups and immunizations. which has an, office in the Taylor area. At the suggestion of one of the SHO mem- The Robert Taylor Homes, the largest public bers. several of the ladies who had been inter- 57 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 viewed met at a local church and decided that mitment the ladie set out with the strong help they themselves could indeed improve their from SHO to open their clinic. neighborhood health situation. They com- Opposition from the black doctors at 51st plained about their health problems to each other and asked why these problems existed. and State Streets was strong. These doctors This was enough to motivate the ladies to form saw the Taylor Clinic as another attempt by the Taylor Residents' Health Committee. They the University of Chicago and Michael Reese elected Mrs. Shirley Collins, one of the ladies Hospital to continue white dominance of health present at the meeting, chairman, and they di- care facilities on the South Side of Chicago. cided to seek better health care through the es- The presence of white students from the Uni- tablishment of a low cost clinic that would versity of Chicago at all Taylor Residents' serve Taylor Homes and would be under their Health Committee meetings only confirmed own control. their suspicion, despite earnest disclaimers by students. Besides this, the doctors were con- Now, 1 year later, that clinic is operating. fronted with a -new phenomenons group of The Taylor Residents' Health Committee con- black women who had familiarized themselves trols the operations and there are finally no with new developments in Chicago like the SHO people in any positions of authority. The Neighborhood Health Centers and who had or- doctors who practice in the Taylor area have ganizea themselves solely around the health is- met with the Taylor residents on friendly sues. These ladies were demanding a measure terms. The young men of the Taylor Homes, of real control in the delivery of health care in potentially the strongest power in the area, their own area-a concept new to Chicago and have forced changes in the structure of the to all its doctors. Taylor Clinic. The removal of the white stu- dents, whom the Taylor ladies came to depend The conflict came to a head on January 25, on, gives the Taylor Clinic a chance to be a 1968, when the Taylor ladies, three SHO stu- constructive force in the black community. dents, the doctors, and some city health profes- sionals clashed in a stormy meeting. The doc- The Taylor Clinic revolves around Mrs. tors tried to explain the long history of dis- Shirley Collins and about seven other black crimination against them which each physician women who make up the Taylor Residents' knew well from bitter experience. They de- Health Committee. Their determination over- scribed the sorrowful but common phenomenon came huge obstacles that would have stopped of a black man preferring a white doctor over any average group of people-obstacles like a a black doctor of equal or better training and city that makes discrimination - against the ability because of the unremitting brainwash- poor an avowed policy (i.e., the building of ing that blacks had received. "During my resi- Taylor Homes), a history of calculated dis- dency," said one of the doctors, "a white resi- crimination against black doctors that left dent and I walked onto a ward filled with black them alienated from their own communities, patients and they wanted him, not me, to care and lastly the obstacle of the white paternal- f or them." The chairman of the meeting was ism of city health officials, hospital administra- one of the nine black doctors who had filed suit tors,' and SHO that fostered dependency upon in 1961 against a number of defendants includ- white institutions and catalyzed splits among groups of black people. ing 40 Chi,-ago hospitals charging them with systematic exclusion of black doctors from On September 12, 1967, Samuel Andelman, their staffs. (An out-of-court settlement was then Commissioner of Health, said in a letter to reached by which the hospitals agreed to admit Mrs. Collins, "We are glad to approve this re- physicians to their staff without regard to race quest (to use the Infant Welfare Station), and and the doctors reserved the right to reopen we will look forward to working out the de- the suit if the hospitals did not comply.) The tails with you at the time you are able to im- physicians at the meeting expressed the view plement your program." Armed with this com- that the proposed clinic would be another inad- 58 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 equate and unrealistic response to the commun- -neighborhood. The health science students ex- ity's needs. In the end not one of the approxi- plained as best they could. rnately 25 doctors present spoke in favor of the One 19-year-old black youth told the whites clinic. to leave Taylor Homes. He said he represented If the ladies and the SHO students didn't ap- 3,000 others like himself who resented the fact preciate the positions of the battle-weary doc- that SHO "sneaked into Taylor without telling tors, neither did "the doctors seem to appreci- anybody they were there." The rest of his ar- ate the significance of this effort and how im- guments are worth quoting directly: portant it was to the ladies of the Robert Tay- This is a ghetto. We are trying to lor Homes" (from a letter written the next day by a witness to the meeting). SHO, instead of make it a community. The reason it is relieving tensions, only widened the gap be- a ghetto is that the people here have tween the Taylor ladies and the doctors. The -no control. People like you can sneak t SHO students were unaware of the fact tha in and out. In a community the people many of these black doctors have been at- control their lives. tempting to improve the health conditions of When asked about how the ghetto's Prob- their people for many years. lems would be solved, he answered, As long ago as 1956 the building of a new You're the problem. If you go, we'll community hospital on Chicago's South Side solve the problem. You people are had the support of several of the black physi- here to experiment on us. The only cia-ns. In 1965 they endorsed the concept of thing you can do is give us your Neighborhood Health Centers and Provident money and leave. Hospital submitted a letter of intent to cooper- The black youths objected to h-aving any ate in the establishment of such a center. (1) whites in positions of authority, which, obvi- All of these efforts came to naught. ously, they still held in the Taylor Clinic. The students were surprised to learn that, These young men were justifiably angered over due to discrimination in medical schools and the atrocities perpetrated by the whites staff appointments, there are only 7,000 black against blacks. They objected to anything that doctors in the United States' In Chic-ago, 50 fostered dependency on the white man. They percent are over the age of 50 and 25 percent didn't want their women undressing in front of are over 65. The number of black physicians white doctors or a perpetuation of the situation practicing in Chicago today is no greater. than of black school children who saw nothing but it was 20 years ago; indeed, it is believed to be white teachers. To a white clergyman who was slightly smaller, while the black population present they said, "Get out, we don't want no has almost doubled in the same period of time. more Father Groppis." His answer, "I am stay- The SHO people didn't understand the doc- ing," only angered them more. tors nor did they understand the devastating Despite warnings that they would hear implications behind whites "helping" blacks "Whitey, go home," the health science students organize and the subtle damage --lia, - is "help" can do to black efforts to organize were unprepared f or this confrontation. Some themselves into a position of strength,. began to leave immediately but most of them just sat bewildered. Who were these guys? Did Several young men from a black youth or- they really represent 3,0,00 other youths? ganization clued SHO in. Upset about the Were they even from the Taylor area? The whites coming unannounced into their neigh- questions were understandable, but regretta- borhood, they walked into an early July 1968, ble. They didn't understand what the guys meeting of the 12 Student Health Project peo- were saying, i.e., that the 800 years of brutal Pie assigned to Taylor Homes for the- 1968 oppression of blacks by whites has to stop. So Summer and asked what they were doing in the rather than concentrating on the content of the CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 blacks' message, the SHO people could only what the committee did. One said, "It seemed say, "Who are these guys?" Malcom X had to me the residents weren't doing anything," reached the blacks but not the whites. indicating complete ignorance of what had Realizing that the whites couldn't compre- happened in Taylor. hend what was happening, the young blacks The drive and stamina of the Taylor Resi- from Taylor resorted to threats of bodily harm dents' Health Committee was, and still is, the which the whites did understand. The SHO central reason for the existence of the Taylor members decided to leave the church because it Clinic, even considering the great amount of was not safe to remain, but they vowed to con- work done by SHO. During the incredibly hard tinue to work on the clinic. year-long struggles against Chicago's political This decision to continue working on the machine, opposing doctors, and indifferent hos- clinic was very much in keeping with the his- pital officials, the SHO representative to the torical approa committee during the 1967-68 school year said, eh of whites to black communi- ties. At best, the students assumed that the "I felt like quitting many times, but the ladies small group of people that they had made con- just would not quit." tact with were the voice of the community; at During their 1968 Summer Project orienta- worst, they -assumed that this decision was tion the students got the impression that black theirs to make and not the community's. students only, and not the whites, would have In their naivete, the students could not im- contact with the black community. The whites mediately understand that giving health care were to gather supplies, raise funds, and per- could ultimately damage the community. The form other tasks that had to be done if the decision to stay was made from their own per- clinic was to run. Above all, no whites would sonal bias. It was facilitated by the opinion of do any "organizing" in the black community. the ladies of the committee, but the ladies re- All this sounded fine but things didn't wor present only a segment of the community. this way. Whites did contact the community. They were present at all clinic meetings, and One student, who had had previous exper!- they definitely influenced policy decisions. ence working in black communities, was ai- ready familiar with the problems engendered There were other sites in the Taylor area by her presence. Consequentlyi she was more where the SHO people could have worked, but concerned with pinpointing the ultimate causes they seemed "so unstructured" that the health behind the health care problems than with set- science students rejected them. At one site a ting up a single clinic. To her the important medical student was expected "to cure a re- question concerned the point at which they tarded child," which understandably scared could most effectively apply pressure to ame- her away. So, it was a case of too many SHO liorate the entire situation. She "felt guilty for people knowing -too little about the enslave- getting into a situation like this because she ment of the blacks which still continues to ay had been in a similar situation before," and and about the resulting present-day black said,"I should have known better." drive for freedom. By the end of the summer, The early confusi 1968, when the vestiges of white student con- on of the eight health sci- ence students and the six high school students trol were being eliminated one admittedly naive health science student could nevertheless assigned to the Taylor Homes area for the 1968 Summer Project added enormousl to the say, "I don't think we should have been there y in the first place." problems. As a result of communication prob- lems between the groups of 1967 and 1968, the By September 1968, things had changed. students, including the area coordinator, did The clinic was operating -two xiights a week not clearly understand the background of the with the number of patient visits, then num- Taylor story. They did not know the members bering about 15 per night, increasing each of the Taylor Residents' Health Committee or night as the clinic became more widely known. 60 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Doctors and nurses, all but one of them black, man "was like hanging out their dirty laundry were volunteering their time steadily. (Taylor in front of whites," as one observer put it. black youth, in their efforts to make the clinic viable in their own community,'would not Unfortunately there are still residuals of y whites to work in the clinic and this white intervention which still cause bitterness. allow an For example, the ladies. when faced with get- included white doctors. Once the clinic had tiiig gome technical job done immediately have opened and functioned under these conditions, a tendency to turn to the long-standing depen- the youths, because they did not want to deny dency on white students rather than to black the community medical services, voted to allow people who may, with admittedly more diffi- up to five white persons to work in the clinic culty, be able to accomplish the same thing. each night.) Procedures for culture taking and This artificial dependency upon whites, which hospital referrals were still not smoothed out. doesn't have to exist, weakens the black com- But the Taylor ladies were carrying the. bur- munity. That dependency is exactly what, the den of the work. Local black doctors who origi- young blacks hate most. The black volunteers nally opposed the clinic were offering their now working with the Taylor Committee to in- time. (The young men from Taylor were es- crease the power of the black community must corting black nurses from the bus stop into the now surmount an extra obstacle placed there clinic and protecting the clinic.) The ladies unintentionally by white students. The depen- themselves were obviously proud of their dency relationship fostered by white people work. working in the black community slows the co- What had happened? What brought the la- hesiveness of the black people working in the dies, the young men, and the local black doc- clinic. Until these splits between the various tors together? The real answer is simple to segments of the community are bridged, the state, but the meaning is profound: everybody black community will not be organized enough working in the clinic was a member of the to resist the encroachment of a Model Cities black community. The Taylor ladies, 10 local program or neighborhood comprehensive care black doctors, representatives of three other center that may not be in their best interest. community organiaztions, and two black No one can judge now what will be the long nurses met on July 30, 1968, and for the first term value of the Taylor Clinic in the black time they calmly discussed their mutual prob- community. Mrs. Collins has always main- lems and the future of the clinic. It is most sig- tained that "politics is our real problem." Her nificant that no whites were present. Whites committee waged an incredibly hard political were not invited. The doctors, seeing that no battle with an insensitive, if not oppressive, outsiders were strongly influencing or control- city administration. But th ling the clinic's policies, agreed for the first e fight is just begin- time to work for the Taylor Residents' Health ning. Other battles are coming. Committee in the clinie. These community The lessons of the Taylor story are classic. groups themselves went a long way toward re- First of all, there is the power of the black pairing the splits among themselves. This was community embodied especially in the women facilitated, to some,extent, by the efforts of the of the Taylor Residents' Health Committee and black SHO students to contain any destructive in the Taylor youth. They created something white influence. "In my mind," said .one of the that didn't exist before despite tremendous ob- black students, "the July 30th meeting was the stacles. beginning of the clinic and the end of the con- SHO made some big mistakes. It's tempting struct of some white man's mind." The earlier to say that knowing the black man's view Of meetings between these groups were stormy history could have kept the SHO people from partly because, with outsiders present, there making these errors, but that's too easy. How was a constant undertow of feelings. Blacks does a white get this knowledge or appreciate differing with each other in front of a white its meaning? One thing for sure-it's very 61 CHICAGO STUDENT HEALTH PROJECT SUMMER-1968 hard, but not impossible, for one man to under- and South Parkw@ay (400 east) on the west. stand another, especially if one is black and (This latter street has just been renamed the the other white. This takes a constant, monu- Dr. Martin Luther King, Jr. Drive) mental effort. Today the burden of that effort Woodlawn is 'community area'42 and the is on the white man because he has to change. population reported in the 1960 census was It would be presumptuous to lay down direc- 89.1 percent black. (2) Approximately 77,000 tives for SHO based on the Taylor story. But people were estimated to be living in Wood- one question does deserve an answer: How is it lawn in 1964, 93.4 percent of whom were possible for whites to come to a knowledge of black. (1) In 1960, 27.0 percent of the families the black man? Definitely not as the whites in in Woodlawn had incomes below $3,000 per. the Taylor story did. Some of them learned year while the median family income was things that will change their lives decisively, $4,797 per year. In that year 11.5 percent of but the black community paid a high price for the male labor force was unemployed and 30 that knowledge. On one hand, the Taylor pro- percent of the housing was substandard. (2) ject appears to be functioning. On the other No new housing has been built in Woodlawn hand, the clinic is not yet funded and there are since that time, although such housing is now serious problems in persuading practitioners being contemplated. If there have been any -black or white-to regularly give their time changes since 1960 in the parameters of this in a volunteer situation. In their process of community, they have been f or the worse, not learning, SHO attempted to treat a symptom the better. rather than the cause. Since concerned black Woodlawn is considered a zone 2 poverty people made a concerted effort to prevent the area. It ranks in the first quartile (the highest clinic from becoming an issue that would fur- rates) for all five morbidity-mortality fac- ther divide the community, the black commun- tors. (1). ity did not suffer from this "learning process" Two SHP teams were assigned to Woodlawn as much as it might have. But this student ve-n- projects this summer. One of these was a sex ture may be instrumental in adding another in- education program conducted at a neighbor- cident in a long series of disappointments, as hood center. (This same center also offered a well as acting as a channel to di energy variety of programs, including arts and crafts, from places where it may more effectively be physical education and tutorial work.) placed. One health science student and one high Students do not need to organize in poor school intern participated in the sex education communities-Appalach.ian white, Spanish or program. It offered girls, between the ages of black-to learn about the problems that affect 12 and 19, sex education including information the poor. Middle class whites are foreigners to about basic anatomy and physiology, the repro- the poorand always will be. The real problem ductive organs, personal hygiene, venereal dis- lies in the white community and must be dealt ease control, birth control, and nutrition. with there. A number of community organizations Woodlawn (Woodlawn is a more highly organized com- munity than many others), cooperated with Woodlawn is another almost all black com- the program. The team felt the program was munity on Chicago's South Side. It is - geo- successful and are hopeful that it will be the graphically adjacent to the University of Chi- beginning of an ongoing educational tool for cago with it's massive resources. the community. Woodlawn's boundaries are the Midway The medical student on the team wrote: (6000 south) and 67th Street (6700 south) ex- I now feel that the time remaining in cept for a small strip that goes to 71st Street medical school should be focused on (7100 south); and Lake Michigan on the east gaining the quality of medical train- 62 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ing which will enable me to be a good experimental school project, and several others doctor as well as a concerned and were brought together in a meeting to discuss hopefully aware doctor in an inner- possible ways of meeting the sex education city ghetto clinic. needs. The team's "Final Report," is reproduced, A discussion of effectiveness of attempted and describes this experience. means of publicizing classes; bibliography and revised pamphlet list; course outline; and a re- Sex Education Program in Woodlawn.-by view of available films including an evaluation Dorothy R. Davies (Medicine), Georgia L. of their usefulness is available from the Chi- Houston (Intern) cago Student Health Organization. The project has involved exploration and work at several levels: Woodlawn Child Health Center 1. Meeting with representatives of a number The University of Chicago, founded by the of community service agencies in the Wood- Children's Bureau, has established a compre- lawn neighborhood to obtain their .opinions of hensive child care center in Woodlawn. Free (a) the central needs in reproductive care edu- medical care and social services are provided to Ca'tion in the community; (b) most effective Woodlawn children up to age 18 years. . means of meeting those needs; and (c) what Three high school interns and one health services their agencies might be able to con- science student were assigned to this center. tribute to an educational program. Their duties included acquainting the commun- 2. Teaching sex education el-asses to three ity with the danger of lead poisoning and as- groups of teenage girls, exploring several sisting Woodlawn residents in finding screen- ferent techniques and media, as well as more ing and treatment sources for lead toxicity. and less effective means of publicizing classes. They went door to door in the community with a pamphlet dealing with lead poisoning that 3. Surveying available films, books, and was produced by last year's SHP team in pamphlets pertinent to such a course. Woodlawn. They also worked with a specia 4. Writing a permanent course outline for a committee on lead poisoning established by -the 10-session sex education program based on the alderman who represents Woodlawn in Chi- information and understanding gained from cago's City Council. 1-3, as well as work done in the spring quarter The following portion of a student's report to write a course outline for prenatal care describes this experience. classes. 5. Working with various resource agencies Guess one can learn about a bureaucracy only and individuals to establish an ongoing pro- by dealing with it.-by David S. Sargent gram which will be carried out primarily by (Medicine) community people, and available to whatever My efforts eventually came to focus on the community groups are interested. lead poisoning problem in Woodlawn. During There -has been an effort made to share as the first few weeks of the summer I made nu- much as.possible of the information and under- merous visits to the homes of lead poisoned standings gained with individuals who, while children who had been seen at the clinic. One not directly involved in the program outlined of these cases, a girl who was hospitalized at in the attached grant proposal, are likely to be Wyler Children's Hospital with lead encephal- involved in sex education in the course of their opathy, dramatized to me how senseless and responsibilities. Perhaps most gratifying along potentially tragic this disease can be; I had these lines was the dialog which took. place followed the purely medical aspects as well as when a street-worker from Youth Action, a the social aspects of this case. representative of TWO, of the TWO-U. Of C. Nearly all of the buildings I visited had bla- 63 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tant violations of the city building code. To landlord. Who knows how long the court action satisfy my own curiosity I decided to find out lasts? The landlord may eventually have to why the building code had not been enforced in pay a small fine, an'amount considerably less these instances. My approach was to phone the than the cost of building repairs. He pays, but building department and ask what violations supposedly still has to fix up the building. they found in specific buildings and what was After more inspections, more processing and being done about them. This sounds easier more court action, the building might eventu- than it actually was. ally be boarded up. While all this is going on, My first call lasted about 1 hour; 45 minutes the paint continues to flake, the plaster contin- of this time was how long it took them to put ues to crumble, and young children continue to eat both the paint and plaster. Massive -num- me in contact with the person who could give me the desired information. I talked with eigh ners of substandard buildings are presently in- habited by families with children, but the different people altogether, all of whom, excep-c building department will not move. for the last one, sounded equally vague about how I could get this information. The eighth There is a more practical side to my efforts fellow I talked to said he would check their on the lead poisoning problem. I have been files for the status of the building I was asking working with a group called the Chicago Com- about. Although subsequent calls to the )e- mittee Against Lead Poisoning, which was partment required less time, since I then knew started during the summer by Alderman just who to talk to, still, I was amazed by how Despres. Although its overall goal is to erad- completely nonchalant and impersonal -some of icate lead poisoning in the Chicago area, a more the people sounded. Guess one can learn about immediate goal is to amend the city housing a bureaucracy only by dealing with it. code such that it will be more enforceable with A few conclusions can be drawn from this respect to the elimination of peeling paint and "investigation" which required a large amount broken plaster in Chicago housing. Petitions of time both on the phone and in the neighbor- have been circulated by members of the group, hood. The building department seems to be a and these will be sent to the mayor as a show very slow, inefficient bureaucracy, completely of support of the amendment proposed by Al- apathetic about the living situation of the derman Despres. The amendment is to be in- thousands of slum dwellers in Woodlawn. troduced at the city council in September. Hang ups in the enforcement of the building , All in all, my work with the Chicago Stu- code appear to fall into two 'groups. In one dent Health Project has been very enlighten- case, violations somehow slip by "unnoticed"; ing for me and somewhat productive for the substandard buildings are given a clean bill of community I worked in. I consider these sum- health. An example of this situation was mer projects very valuable with respect to pointed out by one very good newspaper article broadening the views of students in the health which came out'during the summer. Why 1 oc- sciences. Service to. e community is ideally an curs is unexplained; I was told bv the building equally valuable goal; however, it presently ap- department that it is "being looked into." pears to be more of an incidental thing. In the other group, violations have been Despite the fact that Woodlawn is so highly found in a building and the case is presently organized and that a well-known youth gang being "processed." Unfortunately, in numerous considers Woodlawn "their turf," there was no cases, this processing apparently lasts a num- report by the students assigned here of diffi- ber of years. The inspector's report of viola- culties in working in the community. When tions slowly makes its way to a secretary's asked if there were negative effects of their ' iter, on to the Compliance Board, and work this summer the typewr Y answered that there eventually to the Corporation Counsel which were none. They did not appear to become en- submits the case for court action a gainst the meshed in black-white confrontations and did 64 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 t decry the possibility of SHP students which are one notch better have not been -ex- working in Woodlawn again in the future. amined. Even the community organizations in the area tend not to recognize health care as an issue. THE SOUTHWEST SIDE A number of student health projects were Do the people on the Southwest Side pay a involved with communities on the Southwest higher percentage of their income for care Side of Chicago. Most of this area is still pre- which is less adequate than that received in other sectors of the society? At the same time dominantly white. However, there are all black are working people subjected to more harmful communities scattered throughout this part of physical conditions than the executives who Chicago, Students assigned to projects in this can more easily afford good medical care? part of the city worked in both black and What percent of their income do working peo- white communities. A brief overview of the ple pay and how adequate is their health care? Southwest Side as seen by several students What is the effect of working conditions to (David and Elizabeth George and Robert which they are subject? How are community Geohegan) is presented as an introduction to health standards influenced in an area of tran- this part of the report. sition? Why do housing and therefore health The Southwest Side has been characte@zed as standar ds decline in such an area? How can suffering from the problem of mass paranoia decline be prevented without an appeal to ra- and mass denial cism? What are the particular health needs of different ethnic groups? How can greater The Southwest Side was roughly defined as awareness of these problems be created so that the area from Lowe (632 West) west to the the people of the area can demand what they city limits between Archer and the city limits- need? The ethnic composition overall is predomi- nantly Irish, Polish, and other European The Southwest Side has been characterized groups, especially Lithuanian, although in as suffering from the problem of mass para- fewer numbers. There are small pockets of Ap- noia and mass denial. To what extent is this palachians and Mexicans. Its eastern edge bor- situation caused by social, economic, and politi- ders on the black ghetto and it is undergoing cal factors as compared to individual and psy- racial transition. It is a low to middle income chological factors. How, for example, does ra- working class area. Men work in factories in cial fear and hostility contribute to the situa- construction trades or in lower level white col- tion? How are these fears and hostilities built lar jobs. Income is lowest in black, Mexican, up? Are they simply a matter of individual at- and Appalachian areas. Generally speaking, in- titudes? To what extent are they the product come rises as one travels west. of institutional forces? For example what part do politicians, news editors, and realtors play The health needs of the people in this area in causing racism, through the exploitation of should be viewed in the context -of this envi- racial fear in order to gain votes, sell papers, ronment in which they arise. The type and ade- or make profits on the sale of property? What quacy of health services should be analyzed in influence does the ethnic factor have? For ex- terms of the broader social, economic, and po- ample., how did Right from communism, or loss litical forces at work on the Southwest Side. of status and property upon coming to the This is important in the areas of both physical United States, influence the mental health of and mental health. immigrants? What special generational prob- Little public attention or awareness has been lems have arisen? How does community pow- focused on the health needs of an area like the erlessness via the political machine and other Southwest Side. The ghetto and hard-core poor special interests influence the development of areas have received a lot of attention (at least alienation and apathy'? Lastly how does the in the form of studies) but areas like this factory or industrial situation undermine men- 65 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tal health? How is a man influenced when he prise a description of the students' work on has a lack of major decisional power over the Chicago's Southwest Side. purposes and directions of his.daily work, or when he is just a cog in the machine monoto- Benton House nously repeating the same tasks? What solu- tions are required to the problem of mental The student's report that follows includes a health on the Southwest Side? Will individual brief description about the neighborhood that and group therapy provide a long range solu- this settlement house serves. tion or is basic societal change necessary? I have come to feel, as have many others, that The communities are almost exclusively I belong in only one place if I want to change white, except for a housing project on Ciceo the world, and that place is in trying to change at the edge of Garfi'eld Ridge. The area is a my own communitv.-by John Vogel (Medi- working class neighborhood. The largest eth- eine) nic groups are Polish, Italian, Irish, and Bohe- mian, and many of the people are third genera- Coming from 4 days of orientation in Pala- tion. Few of the middle-aged people completed tine, I was all set to get into the work of my high school. The values of these people reflect site. I had chosen to work in a Mexican-Ameri- their educational level; thus, a couple will con- can area, less than a mile from Mayor Daloy's sider a new car or a well-kept lawn more im- home. Nominally, this site was included in the portant than a college education for their chil- Southwest Side group, but in reality was sepa- dren. Many parents suffered from authoritar- rated from the Southwest Side both geographi- ian upbringing; hence they often fail to dem- cally and ethnically. This subsequently proved onstrate love in the home. They have been suc- to be disadvantageous because we found it very cinctly described by one of the local clergymen difficult to relate to the rest of the Southwest as "relatively affluent dropouts." Side group. The other 20-25 people in the I group, although working at different sites, These people feel alienated. They feel t@at often were able to interact with each other be- most of the public money being spent for 'Te cause they all were working, basically, in the welfare of the city's citizens goes to the blacks, same community. the influx of whom they greatly fear. Commun- Susanna Roberts and I worked at the Neigh- ity spirit is notably absent. This is reflected in the fact that the only centers of any kind cur- borhood Resources Center (NRC) of Benton rently in existence are church-sponsored af- House, which is a settlement nearby in Bridge- fairs; and the few community organizations port, a white ethnic area. The NRC is a store- that do exist were established largely in res- front at 27th and Normal. Our preceptor was ponse to the race problem. The fact that the the unit director of the NRC, Dick Hall. He people do relatively well materially, with rela- and four neighborhood workers made up the tively little education, tends to make them indi- staff of the NRC. vidualistic. It is also highly significant that the Add to this the Lati - Kings, a loosely knit n youth problem is recognized by everybody but gang of neighborhood teenagers, whose main the parents. This denial of personal problems activities consist of (a) hanging around the is in general manifested by a failure to recog- NRC in the daytime; and (b) nighttime recre- nize the need for change. ational activities-drinking, window-breaking, glue sniffing, etc. A really good bunch of kids In the foregoing the students have not pre- but with nothing to do. I sometimes wonder if sumed to set forth "answers" but rather to for- we who do have something to do are any better mulate basic questions that must be dealt with off, pursuing a structured existence which we in finding approaches to the communities' might not choose in a less rigid society. health problems and needs. Within this context To top it off, throw in about 30 (sometimes the following reports on individual sites corn- they appeared to be 30,000) kids between the 66 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ages of 2 and 14. Some of them were in the 1000 people (mostly parents of kids in the day NRC's day camp, others just hung around be- camp) and about eight or nine women showed ,cause they, too, had nothing to do. All these up at the meeting. (The men rarely attend uii- people thrown together added up to one BIG less they are pulled in by their wives.) Several happy family. things were discussed, including what to do The immediate community itself, is not one about a run-down building across the street of abject poverty. Most of the people are from NRC, the teenagers, and our proposed poor, but most are employed (usually underem- health fair. The idea of a health fair was well receiv ployed) and are eking out a fairly dignified ex- ed, and at the end of the meeting it a@ istence. One of the biggest problems in the peared that the neighborhood women had de- area is that, having no established community cided to have a health fair, whereas they had organization and no militant spokesman, it suf- really been presented with the idea and said, fers in terms of municipal services. Trash cans "OK." Although I was not cognizant of it at on corners are rarely seen, there is always bro- the time, I was, in effect, acting in a somewhat ken glass in the rarely cleaned streets, etc. The racist manner by going into someone else's rest of Bridgeport, well organized and very community, messing it up with something that vocal, receives almost all of the ward's ser- they had not proposed, and learning from it ' In vices. the long run, this health fair will probably have had little effect on the neighborhood, one The adults in the community have been too way or another. But in a more conscious com- preoccupied with the teenagers-the vandal- munity (e.g., the black community) this type ism, the drinking, etc. Dick saw that this had of "messing up" can and does have disastrous to be eliminated, as a first step in buildings consequences. more viable community. Somehow, the kids In any case, Susanna and I then began ac- have to be turned in a more constructive direc- quiring the services necessary to hold the tion, at the same time that issues are raised on health fair. We received, in general, excellent which the adults can focus-the more funda- service from the Board of Health. We were not mental issues, such as housing, education, and able to obtain chest X-ray mobile units, but we health. Therefore, Susanna and I could be used did get them to send a diabetes detection unit to help people to begin thinking about these is- for a fair on a Saturday, and the diabetes units sues by doing something in the field of health generally do not work on Saturdays. Much of to bring it to their attention. At the same time, our success at the board of health was thanks we all agreed that whatever we did, it should to Dr. Jeremiah Stamler. My impression is be something that the area people could partic- that the Board of Health, partly because of ipate in so that they could@ convince themselves their stormy experiences with SHP last sum- that when they set out to do something, they mer, and partly becaust of their general desire could succeed. The. next logical step after this to keep things quiet in poor neighborhoods, de- would be the formation of some sort of com- cided this summer to give SHP people what munity organization so that the neighbors they wanted, as long as nothing interfered could have a permanent base from which they with ultimate city control of poor communities. could work whenever they set out to do any- thing, including demanding their rights with We also persuaded the Salvation Army to regard to city services and other city obliga- send one of its dentists to our health fair tions. (teeth are a big problem in this area), and the After Susanna and I had been there for Urban Progress Center at 19th and Halsted about a week, there was a meeting of the supplied a Board of Health physician with neighborhood's "Policy recommending commit- equipment for doing lead poisoning testing on tee." This group had done various isolated children under six. things in the past, but was basically a nonfune- In the neighborhood, various people were tional entity. Dick sent out a notice to about busy making arrangements for the fair. Some 67 CHIC4kGO STUDENT HEALTH PROJECT SUMMER 1968 made posters, others ordered hot dogs and pop, stituted. What have we been doing other than etc. The local priest, Father Peter, gave us per- messing up other' people's communities and mission to hold the fair in the basement of St. learning from them? I have come to feel, as Anthony's School. Several times we showed have many others, that I belong in only one movies on first aid, diabetes, etc., which we ob- place if I want to change the world, and that tained from the Chicago Public Library and place is in trying to change my own commun- the American Medical Association. ity, that is, my medical school. I must try to make my medical school change in ways which As the day of the fair approached, the teen- w!ll move it toward becoming an institution agers got into the act. They helped in various itiich serves all of the people, not just a few. activities, and on the day before the fair, did w most of the work as we built the wooden frames which were to house the booths. Garfield Civic Association The fair itself was a huge success. Everyone This community organization serves an area from the Board of Health showed up with their between Halsted' and Racine Avenues (800 mobile units. The Salvation - Army dentist west to 1200 west) and between 51st and 55th showed up. The hot dogs and pop showed up. Streets (5100 south and 5500 south). The Pop- The fair made a net profit from the games ulation is almost all white with a few black booths we had set up. And lots of people showed and Puerto Rican families. It however borders up and were screened for diabetes, tooth decay, the black ghetto east of Halsted and south of and lead poisoning. There were hundreds of 55th Street. kids, who spent almost all of their time play- The area is part of community area 61. This iiig and eating. is a nonpoverty area with a median family in- come reported in 1960 as being $6,500 per year. Our aim of using.the health fair as a cat- alyst to get the neighbors to take action on However, 10..4 percent of the families earned their own proved to be at least somewhat sue- less than $3,000 per year, and 6.1 percent of the male labor force was unemployed in that cessful. About a week following the fair, an- year. Also, 18.3 percent of the housing was in other meeting of the Policy Recommending Committee was held. About 25 people showed substandard condition. up..The landlord of the run-down building It is predominantly a white working class- across the street had been invited, but sent the low middle income area with some problems building's manager instead. A heated discus- very similar to those of their black neighbors sion.evolved, in which the people there formed to the south and east. a special committee to guard the building There were seven health science students against vandals, i.e., the neighborhood teen- and five interns working on the develo.pment of agers. The group as a whole was becoming a teenage youth center and the organization of very enthusiastic about everything going on in a parent cooperative recreational and educa- their neighborhood. This is the latest informa- tional program for preschool children. tion that I have on what is going on in the The need for a teenage center was clear, neighborhood. SHP students reported: Looking back I feel that although I enjoyed In an area with many teenagers, the summer thoroughly, and got a real kick out there was no movie theater, no soda of working with the people in the neighbor- fountain, no teen social center o any hood, there remains the unavoidable question: kind. In the summer, neighborhood Did I do anything to change the basic health teens spent their time in Sherman picture in that community, or to change the Park, on Garfield Blvd., on Halste , basic socioeconomic picture? The answer to the and on front stoops. In the winter, question is definitely no. And it has made me they played cards. Teenage drinking, question the value of SHP as it has been con- drug abuse, venereal disease, and 68 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 unwed pregnancies are major prob- break the present pattern in which lems. The high school dropout rate is the brightest kids often drop out of high; college attendance is very low. school from lack of interest. Such projects as the newspaper and the li- The students polled adult opinion on their brary, if successful, could do much to projected teenage center. augment the inferior education many . Most people I talked to considered of the kids receive in the public and the youth center a fine idea, but many parochial schools. saw problems * * * They thought we The plans for dealing with the would have trouble controlling fights health and social problems of the and drinking, that parents would be neighborhood teenagers are also pos- too lazy to help, that we wouldn't be sible, if the center is a success. But able to finance it. But' the problem such programs would require the sus- raised by nearly everyone was tained effort of the interested health whether the center would be for science students. A 10-week summer whites only. Many claimed blacks and project would almost certainly not be Puerto Ricans would be sure to come enough. and start fights. The site report by student Polly Young re- Of the parents' cooperative preschool center lates how the dangers of an "exclusivist" cen- student Pam Zumwalt writes: ter, and of "Outside" control were averted, to We were constantly forced' to re- bring the community, at the end of the 10- think our roles and tactics, and to week SHP involvement, to the threshold of question whether we should be spend- realizing its teen center. ing our time helping communities Following is Miss Young's report: build needed and eommunity-con- The center may never really get off trolled institutions if these then be- came yet another tool to perpetuate the ground. Lack of community inter- white racism *All of us increased est and support, shortage of funds, or th fights between rival gangs could close our own knowledge of e breakdown it. There is a possibility that it comes which occurs in the white community to worse than just failing- it could when threatened by racial change, of become a white power group. Even the moral and tactical questions now, it is dangerous for black people which ust be faced in attempting or- to walk in this community after dark. ganizational work in such an area. More than 50 small children had White teenage gangs frequently beat black and Puerto Rican youths. The summer fun and creative experiences community as a whole seems unified at the preschool centek, and the hand- only in its desire to keep nonwhites ful of mothers interested in maintain- from moving in. The kids and the ing the program in the fall found out for themselves how the city of Chi- community could decide to keep non- cago curtails the development of coin- whites out, by force if necessary. munity controlled activities of poor SHO would have no power over any and lower class people. While we such trends in the youth center. didn't make any impressive and last- At best, the youth center could ing changes,, in these respects our really have some positive effects on project was successful. these teenagers. They are as locked into their social positions as those in South Lynne the ghetto. It would take expert coun- The only other predominantly white com- munity in which SHP students work 8 seliniz starting with young teens to ed wa the 69 F,CT SUMMER 1968 CHICAGO STUDENT HEALTH PROJ South Lynne area. This community extends prise involving Some parents as well as chil- from Ashland (1600 west) to Wood Streets ' dren, serving mental and physical health needs (1800) and from 59th Street (5900 South) to through recreational opportunities. 67th Street (6700 South). Title Search and Real Estate Survey.-The it is part of community area 67. While the students report that results of their survey population in the entire area was almost 12 were given to the organization under whose di- percent Negro in 1960, the particular portion rection they worked. A notable by-product of called South Lynne is about 99 percent white this team's activity is their paper on "the of Irish, Polish, and European descent. There changing community," which follows. Here the are small groups of Appalachian white and- students have explored their topic in depth, examining and explaining social economic, Mexican Americans. The eastern edge borders I the black ghetto and is, itself, undergoing ra, psychological, and cultural facets of their sub- cial transition now. Median family income re- j ect. ported in 1960 for the entire area was $6,695 Their paper leaves no aspect of the anatomy per year, with the South Lynne section reflect- of South Lynne untouched, revealing it as the ing this same median. The percent of families very prototype of the "sickest" areas of urban earning less than $3,000 per year for the entire. life in U.S. cities today-the communities in area was 12.5 percent population. The percent transition from segregated white to ghetto of unemployed in the male labor force was 5.2 black. percent. The area is considered to be a non- poverty area and is composed predominantly of Spe@tors, slumlords, and real estate agents a low to middle income working class popula- have a heyday.-by Marilyn Stanek (Psychol- tion. ogy), Peggy McQuade (Law), Karen 'Kaye There were three student teams worldng on (Social Work), Katie Sawallisch (Intern) separate projects. These projects included: To describe a "changing community" as an 1. A study of the location and availability of area changing from all white to all black is in- medical services and the identification of complete and therefore inaccurate. Rather the unmet health care needs in the area. definition should include consideration of the title economic and psychological factors involved in 2. Aid to the community council's search and Teal estate survey in a 30-block the process of racial turnover. area, for the purpose of tracing down "block- We can make such an analysis of South busting" real estate brokers. Lynne, especially the area from Ashland to 3. Aid in the establishment Of the South Wood between 59th and 67th Streets. The spec- Lynn day camp-a summer project "to give ter of inundation has haunted South Lynne foi the children of the area something more to do several years. About 2 years ago the commun. than wander around the street." ity was transferred from the police district t( Medical Servzces and Health Care Survey. the west (all white) to the Englewood polic4 -The team of four health science students department. This not only seemed to mar] compiled a directory of health services availa- South Lynne as the next area to undergo racia ble to residents. The students also conducted change; but also heralded the switch from peo extensive interviews with residents and local ple-oriented police protection to property-ori physicians to learn their assessment of health ented law enforcement. (This is a common Pal care facilities and needs. tern, however, it is difficult to estimate to wha South Lyn?w Day Camp.-Without indicat- extent it affects South Lynne.) ing the number of children w io were in- The real estate industry has also marke volved, the students report this as a successful South Lynne for change. The "Down's Rei undertaking, within the narrow limits of the Estate Report" cited South Lynne as becomin objective: a strictly inner community enter- all black in 2 years. Real estate speculator 70 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 started Ibuying property in the area in 1967. But when whites in a changing neighbor- The activity among the real estate dealers hood decide to sell, they find it difficult, if not might have been delayed a few more years ff impossible, to put their home on the open mar, South Lynne did not have a reputation for ket. Banks do not usually give mortgages to being "soft," that is, they would not bomb a those wishing to move to neighborhoods desig- house blacks moved into. nated as "changing," "high risk" neighbor- Being a "soft" community is certainly a hoods. The owner must sell on contract. For credit tG the people of South Lynne. Unfortun- the private owner as opposed to the real estate ately, this area, with the potential for becom- speculator, this is a losing proposition. The ing a stable, integrated community will proba, buyer puts down a relatively small amount- bly be an extension of the ghetto within the not nearly enough for a down payment in the decade. (It is true that South Lynne has its higher cost all white area the seller is proba- share of bigots-, but effective ties and/or econ- bly moving to. Therefore, the latter must bor- omic necessity override prejudice in many resi- row, possibly in the form of a second mort- dents. "I'm staying until it turns 50 percent gage. Thus his housing market becomes some- blacle' is often heard.) what limited and he must contend with added interest. One of the main forces pushing for complete Most homeowners find it easier to deal racial turnover is the real estate industry. through a real estate broker. If they are among Since the early part of the 20th century the the first two or three to sell in a block about to real estate industry has made conscious efforts be "busted" they usually get a fair price. But to maintain two housing markets-one black then comes the rush of selling, the housing and one white. Considering the law of supply market is glutted, and according to the law of and demand on which our economy is based the supply and demand the prices drop. Specula- existence of two housing markets is exceed- tors, slumlords and real estate agents have a ingly profitable. That is, if the rea "Ors can manage to limit the housing available to the heyday. They are free to sell to the black mar- population or one segment of the population, ket at inflated prices. Contract selling is again they can demand higher prices from those peo- the most common method, but somehow it is ple. The great influx of blacks from the 1920's far more profitable for the realtor. Maybe.this through the 1960's has provided that popula- is due to the realtor's willingness to foreclose. tion. For, unlike the mortgage in which the debtor owns a substantial interest in the property, the In turn, realtors prey on the prejudices contract buyer pays the interest first. In other and misconceptions of whites to obtain dwell- words, for possibly the first 10 years he is pay- ings at a reduced price. This phenomenon is ing nothing but interest. If he is even 24 hours termed "panic peddling." It ranges from bla- late his contract can be forel'osed. It would be tant appeals to -racial prejudice (i.e. "colored as if he had been paying rent for all those are moving in down the block.") now outlawed years, Thus the realt,or has the down payment by the fair housing ordinances, to more subtle and all the contract payments for as long as 10 forms (such as sending a black man to the peo- years plus the option to sell again on contract. ple living next to a house that is up for sale). Economics plays a part in another facet o Realtors also try to make the neighborhood un- the deterioration of neighborhoods like South Pleasant to live in. They may rent to a mother Lynne-the movemen of small businesses out with 12 children. No judge, in conscience, of the neighborhood and the subsequent decay would evict them; yet, black or white, 12 un- of the shopping area. The reasons shopkee ers @ p Watched children can be a nuisance. Coupled give for leaving the community are varied, but ment over the telephone and other three factors stand out most. ir small , busi- the least prejudiced will consider nesses are closing all over the country because they cannot compete with large firms. See- 71 EALTH PROJECT SUMMER 1968 CHICAGO STUDENT H ondly, a small business depends on regular cus- being integrated are slim. The organizer must tomers from the neighborhood. The shopkee- look to another source of support. Young per deals with them on a personal basis. Many mothers often prove invaluable in this context. Of these people are leaving; yet white shopkee- In South Lynne this group is angry. They are pers find it difficult to form the same type of angry that their kids come home with their relationship with members of the black com- clothes in shreds. They are angry they cannot munity. Lastly, the problem of getting i-nsur- send their children to the grocery store with- ance is often the last straw-the shopkeeper out fear that the child might be robbed. They leaves. We can well understand his distress. are angry and fearful for their children when The small business operates on a small and not they hear of both white and black gangs-girls too stable margin of profit; when an area is and boys. However, anger and fear do not pre- designated "high -risk" the shopkeeper can af- suppose action. Yet the potential is there and it ford neither the insurance nor the risk of cuts across the lines that separate renters and broken windows. homeowners. The loss of these businesses not only gives Still inaction plagues South Lynne. Father the shopping area a shoddy, decaying visage; Lawlor's racist block clubs have promised sta- but also makes it difficult for the old people bility. They promised to bring whites into the who remain. What was on.ce a 5-minute walk is neighborhood, to stop urban renewal and the now a trip to Ford City, requiring two bus extension of the "L," to regain racial "bal- transfers-that could put both a physical and ance" in the schools' located in South Lynne. monetary strain on the aged. Also when aThey have reneged on each of these promises; person shops out of the community, shopping but still they are a source of hope for a desper- becomes a task, not another occasion to talk ate poeple * * * to one's neighbors. * * * Lack of organization in the area has Yet these old people can be among the com- not only contributed to the feeling of aliena- munity organizer's greatest -resources. They tion, but has also heightened suspicion of each have lived in the community 39, 40, 50 years- other. A man who has lived down the block their friends are here. Their mortgages are from you can be your friend or can be a poten- paid off and they can live off their pensions. tial seller-to blacks. In South Lynne he is the They are not ready to start again. And many latter. Such lack of, trust is a fertile bed for of them simply can not afford to move. Con- panic peddling. If you do not know the man on tract selling does not supply a homeowner with the corner, you don't know if the real estate enough immediate cash for a down payment on dealer is telling the truth-has he really sold a home in suburbia. Yet if they sold through ahis home, are blacks moving in at night? realtor they would not get their price and he Suspicion also reduces the possibility of con- would sell to blacks. This would constitute an fronting group fears and problems. They can- act of treason to the people that remained. not confront the real estate brokers and slum- ,Also many of those in late middle age have lords who fleece both white and blacks * * * moved from other neighborhoods that have We hope that we have presented a clear ex- gone all black. Some of these people are fear- ful to the point of paralysis. Others are willing planation of the economic reasons for complete to stand their ground. They axe aware of the racial turnover in a neighborhood. We do not scare tactics of some real estate firms and wish to discount blatant racism as a force in sometimes can even name the worst offenders. the community. There are John Birchers, However, to stabilize a neighborhood young white supremacists and Nazis in some -neigh- whitk families are needed. Take South Shore, borhoods. But most of the people subscribe to for example: technically it is integrated; but the tried and true racial misconceptions perva- in some sections all the whites are old. So sive in America. The roots of these are emo- within 10 years the chances of these areas tional and economic. For the community organ- 72, CHICAGO STUDENT HEALTH PROJECT SUMMER 196 izer to try to reverse 40 or 50 years of indoctri- The active organizations in the Englewood nation is difficult if not impossible. The most area include: he can do is play on whatever sane and just The Englewood Civic Organization-for- sentiments they do hold to mobilize around is- sues that are related to though not directly merly the Action Center confronting the institution of racism. That (a) Englewood Citizens Housing Commit- task is left to the young. tee (b) Englewood Health Committee Englewood The Englewood Community Organization The Englewood Businessmen's Association Englewood is located in community area 68. The Green Street Association Its boundaries are 55th Street on the -north Youth Action (5500 south) ; 75th Street on the south (7500 Urban Progress Center south); a jogging boundary which runs be- Miscellaneous Block Clubs. tween State and Stewart Streets on the east (O to 500 west) and Racine Avenue on the west These organizations, their relationships to (1200 west). It was estimated to have a popu- one another, their major concerns, and their lation of approximately 97,500 people in 1964. involvement in fiealth-related activities are de- At that time, 83.6 percent of the population scribed. was nonwhite, a change from 69 percent of the (a) The Englewood Community Organiza, population in the 1960 census. tion, located in the Englewood Terrace Apart- The median fam' ments at 64th and Lowe shares office space ily income in the community reported in 1960 was $5,579 with 8.4 percent of with the Businessmen's Association and repre- the male labor force unemployed in that year. sents business and professional interests. Both Over 14 percent of the housing in the area was hospitals located in Englewood are represented substandard at that time. (2) A part of this in this "community organization." community is currently in the process of urban (b) Englewood Businessmen's Association is renewal. a coalition of business interests located in the In a ranking of poverty community areas 63d and Halsted shopping district. Their m or interest currently is the Englewood Central for mortality, morbidity indicators Englewood Renewal Project involving creation of aI een- was in the first quartile (highest rates) for in- fant and noninfant deaths from influenza and tral mall with peripheral parking lots and re- routed traffic patterns for the 63d-Halsted pneumonia; and in the first quartile also for shopping area. This project was responsible for newly diagnosed cases of tuberculosis. It was the demolition of many homes, among them the 'in the second quartile for deaths from cervical homes owned by members of the cancer and deaths due to unknown and ill-de- fined causes. (1) (c) Green Street Association. Originally like a block club, the Green Street Association was While there are two private hospitals in the developed to fight urban renewal plans calling area, @35.5 percent of its residents needing in- for condemnation of homes along Green Street, patient admission went to Cook County HOBPI- tal, about 9 miles distant from the community. irom 63d Street south. This part of the urban (1) renewal plan was necessary to make room for An overview of the community, its organiza- the traffic bypass and peripheral parking lots. tions, its problems, and the activity of the stu- Originally the Green Street people attempted dents prepared by the area coordinator, fol@ to identify areas of mutual interest with the @usinessmen's Association and E.C.O. "We lows: wanted a better community and a nice shop- Englewood Area Report.-by Patricia Rieb ping area, too!" Eventually they took their (Nursing) case to court and lost. Some of these people are 73 CT SUMMER 1968 CHICAGO STUDENT HEALTH PROJE their contracts sis upon Positive self-evaluation and the devel- still paying out the balance of opment of cultural pride and'self-help pro- f or homes they've lost. grams through youth action workers in other (d) The Englewood Civic Organization- communities. Mirninial relationships have. been formerly the Action Committee. The group no the efforts of one of the longer has headquarters, but operates with aestablished through young women at the Englewood Clinic. Some president and several active committees. of the boys have done volunteer work (paint- (1) Englewood Citizen's Housing CoixL- i@g) at the clinic. Others have been treated mittee is collecting data on disnossessed fami- there on clinic night. An attempt was made to lies, especially those relocated by, the Depart- Englewood ment of Urban Renewal, re: quality and cost of encourage relationships with the nity resi- Mental Health Clinic when comlnu new location as compared to previous quarters, dents complained about the gangs at a mental and whether suitable relocation is, in fact, ac- health meeting. complished for these people. There is an at- tempt to document individual cases. (f) The Urban Progress Center is engaged in a variety of educational programs including Followup is undertaken on buildings @r! a lead-poisoning screening program that prov- viously reported to the building department to ides transportation to and from the 'U.P.C for see if an inspector has visited and whether ap- children to be tested. Home visits are made in propriate recommendations were ever made or an attempt to encourage screening and to fol- followed. In terms of lead poisoning, Engle- lowup the positive tests@ Seldom is action ever wood is second highest in the city in the @u@- taken against owners of buildings where hous- ber of coroner-confirmed deaths from lead Po': ing violations are reported and where poisoned Boning for the last 7 years. A list of suspecT, children are found. housing is obtained and followed up. ( ) Relatively inactive block clubs exist 9 , (2) Englewood Health Comnuttee was es- throughout Englewood. There is hope, how- tablished in the summer of 1967 with the pur- ever, that they may reactivate in support of ng positive action to improve the unity Clinic through the pose of taki the Englewood COMM health of the residents of Englewood. R in- encouragement of some community women on cludes in its membership representatives of th! Z@e Board of Directors of the Clinic. Englewood Civic organizations Englewooa Community Organization, The Green Street As- The Englewood Health Committee is the one sociation, the Salvation Army, St. Bernard's group currently involved in health planning. gy and profession- This planning revolves -around the major Hospital, several of the cler ity, namely the als in the area, community .members served by health issue in the cOmmun the clinic, and SHO.!rhis committee has worked provision of ongoing, comprehensive health ns of Englewood. (Last year's to open the Englewood community Clinic, now care to the citize ity of health care operating two evenings weekly out of the Sal- SHP report showed the paue vation Army facility at 62d Street. facilities and the fragmented, crisis-oriented (e) Englewood Youth Action is composed of services available -to the residents.) Questions currently are raised regarding the advisability a group of young men actively engaged in li . ed basis, in an - the youth groups in the- area. of a "free clinic," open on a mit working with . health care facilities. Does the Major concerns seem to be the young men and area so poor in women of the community and the social organ- provision of yet another fragmented service izations they build. overt concern with health oblige the group beyond the limit of the care issues has thus far been limited to tentative de- they are capable Of Providing? Suggested di- velopment of a V.D. control and treatment pro- rections include: gram which is emerging in cooperation with a (a) Liaison with Cook County Hospital to representative of some other agency. Less ap- provide easier access to county f acuities for rent, but perhaps more important to the Englewood residents; (b) liaison with com- pa ty hospitals and private practitioners in health of the community, has been the erilpha- Muni 74 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 order to weave a more comprehensive network ence of a strong relationship between heal th of services available locally; (c) purchase of a rights and housing rights in this community. building that once housed a hospital (now Unfortunately, specific information,was not ob- moved to another community) for the purpose tained about hospital land ownership practices, of expanding into a clinic-community hospital even though requested. organization that will exist independently of Attempts were made to place students at other community' services; (d) use of the both hospitals in Englewood; we were success- health committee and the clinic as an organiz- ful only at one. Here students explored the re- ing focus from which the Englewood citizens lationship between the hospital and the com- can pressure the city and county to implement munity by working in the emergency room and the proposed Board of Health Community interviewing patients during and after the Clinic in Englewood, and soon! visits to the emergency room. The hypothesis While these larger, directional issues are was that Englewood residents would tend to being discussed, the community representatives utilize the emergency -room as a source of ongo- also consider details of clinic operation and ing health care. This was shown to be true; policy: but the extent to which followup care was pro- (a) The application of a means test" of vided or encouraged and the quality of care re- sorts in an attempt to weed out those patients ceived depended largely upon the efforts or who can afford ordinary sources of health care. lack of effort on the part of those individuals This was overruled by the community repre- on duty in the emergency room at the time of sent-atives on the board who seemed to thor- the patient's visit (described more fully in hos- oughly dislike the introduction of the paper- pital site section). work and the techniques of prying used by Students at the Englewood Clinic worked to other institutions in their community. (This provide the goods and services necessary for issue was raised by community professionals the maintenance of a volunteer clinic on a one- on the board who feel that more cooperation to two-night-a-week basis. After several weeks with community physicians will be obtained if the students visited families se.rved by the they have some guarantee that patients will'not clinic and encouraged participation on the En- be "spirited away" by the lure of a "free glewood Health Committee. Those residents be- clinic." Sears Foundation's investigators asked coming active voiced their feelings about the clinic representatives what precautions had quality of care avaialbe through already exist- been taken to insure that those treated in the ing community facilities, including the two clinic would be truly poor people and not hospitals. They seemed to use their own experi- merely those unwilling to pay for private ences as background for establishing policy for care.) their clinic. (b) The ladies are considering selling Students working for the Housing Commit- chicken dinners through their block clubs in tee brought information regarding the treat- order to raise money for the clinic. ment area residents had received from the city, -The major health problem is the lack of specifically D.U.R.,, and at the hands of the available health facilities other than the cri- community power structure, namely, the Busi- sis-oriented emergency rooms in the commun- nessmen's Association. Information about con- ity. The lack of coordinated health care and tract buying practices was compared with data comprehensive care facilities was really the gathered by students in Ashland-to-Western basis for the activity at almost all sites in the Avenue strip whose residents were currently area. The two hositals existing in the commu- being "blockbusted" by unnamed realtors. It nity seem to behave more like businesses than was apparent -that in terms of housing, both service institutions. Hospital participation in the white and black communities were victim- the land ownership, clearance, and develop- ized; in terms of health, the white community nient activities in Englewood indicates exist- seemed to be better off. 75 CHICAGO STUDENT HEALTH PROJECT sUMMFiR 1968 Thus, the agency director requested the white Information gained at the Mental Health student assigned to the Mental Health Center ow- attempts were being made art of the Clinic showed h o work in the West Englewood P to unite communities around a rtiental health site t jurisdiction. facility. Unfortunately, Clinic progrms are cur- -ate rently limited to curative-restorative effortst He was assigned to develop and dissemin ipulation of the information about the center's programs. He whereas evidence of mass man er of leaders in the corn- communities in question suggests a need for interviewed a numb tive ms stressing self-determina- mu-nity, including ministers and leaders ac preventive progra munity organizatons. tion for the people of Englewood. It was inter- in the major com esting to note that when white people from the His interviews and discussions with these western section of Englewood declined invita- people focused around the following questions: tions to use the Englewood Mental Health Cen- (1) What are the problems facing your corn- ter the staff of the center were unable to for- @unity; (2) can the Mental 'Health Center be p "outrea - While es the mulate an ch" type of program oi value to your community; (3) what do imbued with appropriate values in terms of the community know about the center. The student on between the white rtant contacts in the need for positive interacti e community, that felt he had made imPo by the staff at and black segments of th area which would be pursued staff seems unable to recognize the fact that the center. He felt there might be long range epresented in the the different factions r ther's enemies. positive results in the development of relation- community are not truly one anO ships with the white community in West En- Th i instead, the ag" take advantage e'r mutual enemies are, 9 situation, the de- glewood that would enable it to cies that control the housin the center's facilities and programs. livery of services to the community and the 0, cilities to the peo- He summed up his recommendations in the availability of health care fa following report which was submitted to the ple of Englewood. staff of the center. The work the students were involved in at the specific sites just described follows. Soitth Lynne-Reflectiom and Recommenda- The Engle-wood mental Health Center.- tiom.-by Robert Geohegan (Medicine) This center has four programs which include ait would be easy for the staff of this Mental day treatment program, a program for adoles- Health Center to dismiss the South Lynne com- cents, an aftercare program and a school Pro- munity as a lost cause. South Lynne people are r grain for parents and tachers. it is a Chicago afraid to come into Englewood to visit. the cen- Board of 'Health facility whose jurisdiction is ter. Also, it is very likely that the South Lynne broader than the Englewood community area area will change from awhite neighborhood to 68. it is suppose provide services to the a black neighborhood in the next several years. population west of Ashland Avenue as well as The staff feels an outpost cannot be estab- east, going up to Western Avenue (2400 west). almost lished in South, Lynne. The center simply does That portion of the jurisdicti n is an +,IF not have themanpower at the present time to all white community located in communist develop separate Programs at an outpost in area 67, known as West Englewood. lower middle income South Lynne. that setting up an This is a working class, of the some of the staff also feel area, threatened by the expansion outpost would be catering to a bigoted com- black ghetto to its cast (See "The Changing munity. Community"). As pointed out in the -area coor- uth Lynne should not dinator's report, this Part of the jurisdiction I personally think SO ity. To does not utilize the Englewood Mental Health written off as an unreachable commun Center but the center is interested in extending call the situation in South Lynne hopeless is to st position. This kind of response its services into this part of the community. take a defeati 76 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 is the easy way out. But it also would represent made to get South. Lynne teachers and parents the center's shirking. of its responsibilities. involved in the school development program This is especially true since the staff has made which can effectively reach the community in a little effort to get to know the people and the relatively short time. Through this program, mental health problems in South Lynne. more individuals can be made aware of the My first suggestion is that the staff should center. The seminars and discussion groups decide immediately whether the center has ',a might also encourage a dialogue between black commitment in South Lynne. If a commitment and white people. is to be made, I think it should be undertaken The Englewood Clinic.-This clinic was as soon as possible and wholeheartedly. The begun as a result of the efforts of three groups community is already changing and time is an in the summer of 1967. These included the Stu- important factor. In spite of the attitudes of dent Health Organization, The Englewood some South Lynne people, the fact remains Civic Organization and a local branch of the that some of them need help. The community Salvation Army. The best description of this deserves attention and understanding of the clinic and its participants is contained in the center. following document prepared by the Engle- The recommendations I make for this com- wood Health Committee. This committee in- mitment are as follows. cludes health science students who were, and 1. The center should send a staff member are, participating in the Englewood Clinic. into South Lynne during the week to do intake The Area Involved.-The Englewood Clinic work (e.g., at a church). The people of the is located at the point at which the south Chi- community will more readily go to an intake cago communities of Englewood, Washington worker stationed in their own community than Park, and Greater Grand Crossing meet. All to one stationed -at the center. three are classified as poverty areas by the In performing intake work with South. Chicago Committee on Urban Opportunity; all Lynne residents, the center can get a better three are Negro ghettos with low levels of in- idea of the primary mental health needs of the come and education, poor housing, large pro- portions of the population on public assistance, community. Through personal contact, the staff member and high unemployment and juvenile delin- quency rates; in all three, the quality of health might also be able to more effectively convince care avail-able to the population is low. residents to come into Englewood to the center. If necessary, the Intake worker could per- Statistical evidence of the poor state, of sonally accompany an individual to the center. health prevalent in these communities is pro- This intake worker would also engage in anv vided in the Chicago Board of Health Medical follow up activities with people who have Care Report published in Sptember 1966. Some dropped out of programs, etc. of the pertinent data from this report is in- cluded on the table on the following pag.e 2. The possibility of having a community organizer working in South Lynne was sug- Other data in this report demonstrate that gested. A community organizer could p both Englewood and Washington Park are erform several valuable functions. He could establish among the poorest of Chicago's poverty com- further contacts in South Lynne and make ar- munities with respect to health care. Greater rangements for staff members to meet with in- Grand Crossing, while faring better than these dividuals and organizations in the community. two communities by many criteria, still suffers He also could play an important role in setting greatly f rom inadequate medical care. UP workshops with groups in South Lynne Available health facilities in this area of @i such as the clergy. Chicago are remarkably scarce. There are few I would recommend that every effort be physicans in private practice in Englewood. Of 7 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 the two private hospitals in Englewood and For a great many residents of these three ,one in Greater Grand Crossing, none provides areas-perhaps a majority-the only available an outpatient facility and none serves over 10 source of medical care is the emergency room percent of its community's hospitalized pa- or the outpatient clinic at Cook County Hos- tients. pital. These facilities are overcrowded and may require up to 2 hours to reach by public trans- Public facilities include three Infant Wel- portation. fare Stations, one in Greater Grand Crossing and two in Englewood, which provide only rou- The Englewood Health C&mmittee.-The tine prenatal and well baby care. An additional Englewood Health Committee was established Infant Welfare Station in Englewood provides in the summer of 1967 with purpose of taking specialized care for some types of infant disor- positive action to improve the health of the ders on a referral basis. There is, in addition, a residents of Englewood. It includes in its mem- Mental Health Center in Englewood. bership representatives of the Englewood Civic Co,mparative Health Statistics: Englewood. Organization, the Englewood Community Or- Washington Park, Gr ganization, the Green Street Association, the eater Grand Crossing, Poverty and Nonpoverty Areas of Chicago Salvation Army, the Englewood Mental Health (1965) Center, the Student Health Organization, and several of the Englewood clergy as well as other residents of the area. The Clinic Site.-The clinic is located in the uilding, at 140 West 62d Salvation Army B coo PI Street, where there is a furnished clinic facil- ity which was not in use. Use of this facility is Birth rates 32.9 26.6 22.6 28.9 19.0 being donated by the Salvation Army to the Mother under community; it is emphasized, however, that it 2011 --------- 19.7 23.3 18.6 20.0 10.1 Illegitimacy --- 27.7 28.6 23.2 25.0 5.1 is a community clinic operated by the com- Prematurity --- 14.4 14.3 15.0 12.8 6.1 munity. Infant death rate:" The facility contains three furnished medi- Under 28 days 25.8 33.1 30.3 25.6 17.0 28 days to 1 cal examining rooms, an office, a conference year ------ 15.3 12.7 9.7 12.9 5.1 room, a waiting room, and two washrooms. Causes of infant The clinic possesses most of its needed labora- death: tory equipment and there is additional space Influenza and pneumonia 9.8 9.0 6.0 7.9 2.2 for a laboratory and storage of medical sup- Gastroenteritis plies. Additional rooms are available in the and colitis - 2.0 --- --- 1.8 --- building for use as offices or examining rooms Percent of can- as needed. cer deaths from cervi- Staff.-The clinic will employ a full time cal cancer - - 2.1 4.0 8.1 4.4 1.8 director who will be responsible for the coordi- Broncho- pneumonia 1.0 --- --- 0.5 --- nation and direction of all clinic services and Syphilis ------- 2.8 4.2 2.2 2.6 --- programs. The director will be selected by the Gonorrhea ---- 21.3 27.8 14.2 14.3 1.4 board of directors of the clinic and wil I be di- Tuberculosis - - 0.9 1.4 ---, 1.1 --- rectly responsible to them. A part time secre- I Nonpoverty and pove@ are combined toWs for all the city's tar will be employed to assist the director in I y nonpoverty and povert3r areas, respectively. keeping records, handling correspondence, and I Birth rate and infectious diseases are num@ Per i,ooo Popu- lation. mailings. "Mother under 20, inegidmacy and Prematue" are percent of live births. Volunteer staff present at each clinic session 4 infant death rate and causes of infant deaths lper 1,000 live tir@. will include one licensed physician, two regis- 78 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tered nurses, two senior medical students to patients; it is felt, however, that it will per- perform histories and physicals, two junior form a needed service for those people in the medical students for laboratory work, one so- area affected most severely by the present shor- cial worker, and a receptionist. Additional vol- tage of facilities: Those at the lowest levels of unteer personnel will include lawyers, pharma- poverty. cists and nutritionists. 2. To demonstrate that a neighborhood Se,rvices.-For clinic patients there is a health facility can best be directed and its charge of 50 cents per clinic visit. Services to priorities established by the community people be provided encompass the spectrum of basic which the facility serves. outpatient care including routine examinations, 3. To furnish health science students and treatment of general medical problems, immu- health prof essionals direct contact with the nizations, lead poisoning screening, and eventu- health problems of a ghetto community and ally general dental care. Diagnostic studies in- promote in them an. understanding and an clude routine blood counts, U'rinalysis, tubercu- awareness of these problems. losis skin tests, and electrocardiograms. Sam- Ref errals.-One of the accomplishments of ples for further laboratory evaluation are sent the clinic may be to increase the involvement to the Board of Health and cooperating hospi- of the community's hospitals in the communi- tals (lead poisoning screening, Pap smears, cultures, etc.). ReferralIa for hospitalization tyos health. St. Bernard's Hospital and Engle- wood Hospital-the two hospitals in Engle- and more complex diagnostic workup are made wood-have agreed to accommodate patients to cooperating hospitals and to Cook County referred from the clinic for hospitalization Hospital. under Title 19 or Medicare. Similar arrange- Hours.-The clinic has been open every ments will be sought with other area hospitals. Wednesday night from 6 to 9 p.m. since May Presently, reluctance of these hospitals to treat 29) 1968. This schedule will be extended to patients requiring payment from Department other nights of the week as resources become of Public Aid, or from Title 19 funds, contrib- available and the clinic program expands. utes greatly to their isolation from the com- Ad,ministration.-The policymaking body for munity. the Englewood Clinic is a Board of Directors Patients who cannot be hospitalized at one established by the Englewood Health Commit- of the community hospitals are, of necessity, tee. The board is composed of representatives referred to Cook County Hospital. Whenever of the health professionals involved in the possible, referrals for certain types of diagno- clinic operation and members'of the commun- sis or care are made to existing agencies such ity (who constitute the majority of the board). as the Board of Health Infant Welfare Stations Of the nine community representatives on the (prenatal and well baby care), Veneral Disease board, six of these positions will be occupied by Treatment Centers, Municipal Tuberculosis consumers of the clinic services. Upon payment Sanitarium Clinics, and the Tuberculosis Insti- of the clinic fee, a patient's family is regis- tute X-ray detection facilities. tered as a "stockholder" in the clinic. This en- ed.-The clinic serves Patients To Be Serv titles the family to attend regular meetings of patients from the Englewood district and those the board and to elect representatives to serve sections of the Washington Park and Greater as board members. Grand Crossing communities which are near Objectives a/nd Philosophy.- the clinic site. To as great an extent as possi- 1. To help MI, in a small way, the critical ble, patients wll be seen on an appointment need for medical facilities in the Englewood- basis. Walk-ins will, of course, also be seen. -Washington Park-Greater Grand Crossing Patients may be referred to the clinic from the area. It is recognized that this facility will be churches, public schools, and from the Engle- able to serve only a relatively small number of wood Urban Progress Center when they are 79 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 y discovered to require medical care at these in- tion by their presence and concern that the stitutions. had achieved no positive results for the com- munity. Indeed, in m-any cases, they felt they Future Fundin6a.@The Englewood Clinic had no right to be in the community at all. will, in the future, attempt to become self-sup- However, there was a cautious note of opti- porting. There are at least two routes by which mism in the reports by the Englewood students this may be accomplished: that perhaps, just perhaps, they had made 1. Many of the patients seen at the clinic some positive contribution this summer. A few will be eligible for payment of their medical quotations from their reports describe their expenses through public aid, Title 19, or Medi- reactions: care. Eventually, it may be possible to finance the clinic entirely through these sources. There I feel that my summer was well are a great number of difficulties, however, in spent * * * I became aware of health collecting money from the agencies involved problems in the ghetto plus I have including vast amounts of secretarial work, de- learned techniques and means of react- lays in payment by the agencies involved, and ing to these problems. The Englewood Clinic is the kind of project that is in many cases, payments inadequate to cover the expenses of the care involved. Thus, for at ideal for SHP students and does not least the first year, the clinic will have to be necessarily scuse" the black ghetto for supported by nongovernmental funds. the learning experience of whites. 1 2. The city of Chicago has tentative plans predict a- tough future for the clinic to build a comprehensive outpatient facility on but if it does survive it will hasten the south side of the city. When these plans the infusion of governmental money reach fruition-probably in the next few years into the Englewood area to improve -the clinic may be able to become affiliated the health f acuities available. with this facility and derive its support from My participation in the SHO the city. summer project left me with mixed feelings about its merits. * * * Un- Summar,y.-The Englewood Health Commit- doubtedly, the greatest benefits de- tee is seeking to establish a low cost medical rived from my activities this summer clinic in anarea nearly devoid of medical facil- were those which I received in,terms ities. In addition to providing medical services of education and insight gained about to some of the area's indigent population health problems in -this city, and the which would otherwise be hard pressed to ob- myraid factors affecting its [un] tain other than crisis-oriented health care, the equal distribution. The knowledge Clinic will provide for community control in that I gained from talking to com- order to demonstrate that the consumers of f om newly medic-al services may best direct their own munity members r health facility and determine their own health acquired friends, from relevant read- priorities; it will help to increase the involve- ing rnaterial, and from personal expe- ment of existing community hospitals in the riences has deeply affected my think- ing and -attitudes-both profession- care of community residents; and it will help ally and personally.* * * to introduce participating health science stu- The worst aspect of the project was dents to the medical problems of a poverty the fraud that I gave as a white per- area. son acting as a representative of a The students working in the various Engle- 4 4community" clinic. * * * I was pain- wood sites generally felt that the projects were fully Aware of this fact in all my useful but, in their essays, highlighted again dealings with the community. * * * their fears of "imposing" themselves on the Despite the amount of personal community, "inhibiting" community participa- warmth and interest that a white per- 80 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 son shows, he cannot help but ini- up day camps, planning preschool, or teenage, tially represent an authoritarian or senior citizen centers. figure and all its ensuing evils. * * * Recording the impact of her experience at I plan to work with the clinic dur- the American Indian Center, medical student ing the school year and therefore Laura J. Simon writes in the report she has ti- ,avoid the problem of abandonment tled "Indian Summer": that is so often inherent in this type of * * * I realized that there are project, but I still have not resolved really two kinds of prejudice. One the serious problem of fraud. * * * I kind denies that people are similar; can only rationalize that I am offer- the other denies that they are differ- ing a service to the clinic that they ent * * *. We are perhaps all too can use until they can find a true com- prone to the fallacy that lies at -the munity person to honestly represent other extreme, the error of assuming their clinic. that people are not different. * * * A sense of the in-adequacy of their accom- it is unreasonable to expect a Sauk plishment, an impatience with the role, as one Indian to see American history in the student describes it, of "parachutist mission- same light as I do living in northern ary," a sense of despair over the community's Illinois where his nation once unmet health needs, is common to almost all of carnped. The same government that the team reports. Studied together, their re- exterminated his ancestors in the ports both affirm and refute the students' con- Blackhawk War gave refuge to mine clusions. * * *. M-any times in the course of Affirmed, through survey findings and expe- the summer I was reminded of the differences between the experience of riences with bureaucratic, or lethargic, or out- moded "establishment" agencies and proce- Indians in the city and my own expe- rience. dure, is the tragic disparity of health care needs and their fulfillment in every poverty Substitute "enslaved" for the word "exter- community. Denied, by the evidence in these minated" (although they were often synony- same reports, is the students' frequent conclu- mous), and we have an insight into.the differ- sion that their effort "didn't change any- ences between black and white in the United thing." States that validate the need to vest control of If we recognize that awareness is a precondi- the community project in the hands of black, or Indian, or A-rn6rican of Mexican or Puerto tion for change, then SHP's teams awakened Rican descent, urged in so many of the stu- the beginnings of change for hundreds of -per- dents' reports. The SHP reports tell us, in ef- sons in whom their activity created an aware- fect, that groups with such different, and bit- ness: ter, memories of official mishandling cannot be 1. Of their own health care problems, by expected to trust "usti-the dominant white so- having to discuss them with an interviewer in a ciety-until we have demonstrated that we health survey. trust "themt' to the point of accepting their 2. Of fa.cilities to serve their health needs, ability and their right to make policies and exe- the "tests" that could help determine their cute them. state of health, through health fair demonstra- There is one commonly assumed difference tions, lead poisoning and parasite screening among the poor, however, which we must note programs, TB and dental checks in preschool a number of the SHP reports repudiate. It is centers, etc. the assumption that the black community suf- S. Of the possibility of working with others fers more than its socioeconomically equivalent to secure care for mental as well as physical nonblack community from the phenomena Of health, in organizing the health fairs, setting dislocated youth and hopeless, apathetic adults. CHICAGO STUDEN T HEALTH PROJECT SUMMER 1968 Teenage drinking, drug abuse, ve- Since 1967, the Division of Adult Health and nereal disease, and unwed pregnancies Aging of the Chicago Board of Health, under are major problems. The high school the. direction of Jeremiah Stamler, M.D., has dropout rate is high; college attend- conducted a number of disease detection pro- ance is very low. grams. In two public housing projects, the Many (adults) saw problems Dearborn and Lathrop Homes, over 500 per- They thought we would have trouble sons were screened in a 14-month program. A controlling fights and drinking, that followup study on the persons who were re- parents would be too lazy to help, ferred to sources of health care because of ab- that we wouldn't be able to finance it. normal results was undertaken by two medical The description easily fits the stereotype students as part of the Student Health Project concept of all-black communities like Lawndale in cooperation with the Board of Health's Di- or Woodlawn. In fact, it is student Polly vision of Adult Health and Aging. Young's account of the all-white Garfield Park The reports of the two students who Worked area in which her team worked to establish a in the project are presented first as an over- teenage center. view of their work, followed by a description The SHP experience in the communities con- of their findings. firms, with the dimension of reality which per- This seems to suggest that medical practice in sonal eyewitness alone, can add, what "cold" poor neighborhoods has been substantially statistics have long indicated: That poverty abandoned by graduates of the medical schools has the same impact everywhere. It suggests of the United States.-by Jack E. Berger that while the need for health care services (Medicine) may be greater in the black community be- My summer placement was at the Chicago cause its deprivation and poverty embr@ce more people, the need is no less serious in tne Board of Health's Division of Adult Health impoverished or economically "marginal" non- and Aging. The project we (Charlie Bass and black area. I) undertook was,a research effort to evaluate the effectiveness of the Board of Health's It suggests, finally, that a publicly subsi- chronic disease detection screening survey. dized, universal health care system for the This program involves multiphasic testing for poor and "marginal" communities, predicated indications of chronic disease processes. The on community control that observes the spirit object of the program is to elevate the level of and letter of equal rights incumbent legally as ic health by catching chronic diseases .publ well as morally upon such a system, can serve (which are now the large public health prob- to conquer racism, along with the other sick- lems, rather than the infectious diseases) be- nesses that poverty nurtures. fore they reach crisis proportions in a given in- dividual. The program provides subsequent re- Other Reports ferral for those requiring further investigation to existing medical care structures. There were several students working with agencies and groups not directly affiliated with Several types of testing facilities are oper- a single community. These were sites whose ated under this program, such as the station- work affdcts the lives of residents of the city of ary and mobile diabetes testing units. Our at- Chicago. tention in this project, however, was confined to the multiphasic screening done at the per- These included students working on special manent testing locations in the Lathrop and projects with the Board of Health and with re- Dearborn Homes housing projects. The testing gard to the welfare laws in the. State of Illi- done at these two locations takes 2 hours of the nois. screenee's time, and includes the following . The Chronic Disease Detection Program.- tests: (1) Blood pressure (taken twice), (2) -82 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 weight, (3) hematocrit, (4) tonometry for ther medical care actually contact a doctor or glaucoma, (5) urine protein, (6) urine sugar, other source of care about the findings of the (7) ECG, (8) serum cholesterol, (9) glucose screening survey? (2) Did this contact result tolerance test, (10) Pap smear, (11) VDR L, in the diagnosis of a hitherto unsuspected dis- and (12) chest X-ray (optional). In addition, a ease process? (3) What type of treatment was short medical history was given by the scree- instituted? (4) Did the doctor's diagnosis con- nees. The history gathered data pertinent to firm the findings of the screening survey? (5) chronic disease such as smoking habits and the Were the patients actually followed for any presence of any signs and symptoms of cancer. length of time? Were they actually receiving After the results of the tests are available, continuing" care? patients with abnormal tests are designated as The answers to these questions were made "refer for care." Those with serious problems all the more interesting by the fact that a simi- are sent a letter immediately, informing them lar followup study of the Chicago Heart Asso- of the findings and urging them to see their ciation's Adult Screening in Industry program doctor. Subsequently, the medical social was being done in DuPage County. In this pro- worker phones them to see that they have gram, only the tests pertaining to diabetes and sought care. If the person has no source of heart disease were done, but nonetheless, a val- care, she arranges one for them. The less ur- uable comparison could be made between the gent cases are f ollowed up after a lag of sev- practice of preventive medicine in DuPage eral months to allow the screenee time to seek County as compared with the city of Chicago. medical care. It might be pointed out that virtually all seg- Although the multiphasic testing program ments of the urban population were seen in the was initially confined to the residents of the multiphasic screening program. Most of the above-mentioned housing projects, in the last 3 people seen at the Dearborn site were blacks, years this free testing service was made availa- whereas most of those seen at Lathrop were ble to anyone who is over 35 years of age and whites. Financially, the persons screened cares to call the Board of Health for an ap- ranged from welfare to affluence, but with pointment. The program is currently operating lower incomes prevailing. without public relations of any sort, finding After some initial delay in defining the pro- that word of mouth advertising alone is suffi- ject, the research began by examining the pop- cient to.fill the program with screenees. Some ulation selected for our study. The sample con- 2,000 persons are currently screened per year. sisted of all persons screened by the Lathrop i- and Dearborn Homes sites during the months Initially, there were fears by local phys cians that the program would constitute a gov- of November and December, 1967, and January ernmental invasion of the traditional preroga- . of 1968. This population was chosen so as to be tives of the private medical practitioner. With comparable to the population being studied by the passage of time the tension has cooled, per- the Chicago Heart Association as a followup to haps ameliorated by the physicians' realization its Adult Screening in Industry program. This that the program was actually providing more program is similar to the multiphasic testing grist for the "fee for service" mill. program with the exception that tests for indi- The object of our research, then, was to de- cations of heart disease and diabetes are the termine whether the chronic disease screening only tests performed. @ program was actually resulting in the delivery The folders containing the history and.test of preventive medical care, on a continuing results of each of the 506 screenees in our sam- basis, to those who gave indications of chronic ple were first gone through case by case. We disease processes. In our research we at- retained the following information on all those tempted to answer these questions: (1) Did the who were referred for care: Case number, screenees who were classified as needing f ur- name, address, code numbers of abnormal 83 JECT SUMM CHICAGO STUDENT HEALTH PRO ER 1968 tests, name and address of their source of med- rected to some vacant desk where I could look ical care. Out. of the 506 in the sample some at them without benefit of help. The secre- 186, that is about 37 percent were referred for taries knew little more about the charts than I care. Of these, 5 indicated that they received did and were no better at trying to decipher care from both a private physician and a the writing. Only an interview with the treat- clinic; 31 claimed a clinic for a medical center; ing doctor could give us the accurate informa- 20 gave no source of care; and the remainder tion we needed. (130) listing private physicians. The following This presents a real problem with following plan was developed to determine the medical ii-n persons visiting a clinic or medical center, fate of these persons. Each referree would be in that the patients have been treated by a sent a questionnaire through the mail with a number of different doctors (all with equally self-return envelope. Each private physician i)oor handwriting), no one of whom would be would be sent a letter explaining our project familiar with all aspects of the treatment and informing him that he would soon be given a particular patient. The real solution called for an interview. A considerable amount here is to have well kept, neatly written or of time went into finding and verifying the typed records. doctors' addresses and zip codes. Many doctors Once we were identified as being f rom the had to be dropped from the study as we could Board of Health, very few clinics gave us trou- not find their names or addresses in the tele- ble about releasing the information. Our policy phone directory. Others were also dropped for was to bring the release signed by the patients interviews because they practiced outside the on screening only when it was requested. city. For those screenees who listed clinics, all While making a visit to one clinic, one of the of the names of screenees for each clinic were doctors became quite suspicious when he saw compiled and sent to the respective clinics me going through some records. He gave me along with a letter requesting that we be al- the third degree until I showed him a sample lowed to see their charts. Subsequently we of the release form and promised I would send phoned the clinics for appointments to @ook the copies of the releases for the patients over their records. I found that the medical re- -whose charts I had examined. The releases cord librarian was the best person to contact concerning this matter. were mailed the next day. This particular doc- tor had more on his mind than the technical- We had some 24 clinics with one or more ties of maintaining confi ential information. screenees listing them as their source of care. He was very interested in the attitudes of med- The clinic personnel were almost always very ical students. He proceeded to probe me with cooperative. The real problem here was that such questions as "How would you characterize instead of talking with the doctor who was fa- yourself politically?" and "Are, you a Catho- miliar with the patient, we had only a chart at lic?" and "What is it with you guys with long which to look. In one exceptional case (Mercy hair?" I did my best to give straightforward Hospital Clinic) this was no drawback. In honest answers to his questions. For the record other cases it was very difficult to glean infor- my hair covers neither my ears nor my collar. mation from the chart. Most of the charts were It soon became apparent that the ma.n was a poorly organized and nonsequential, but most rock-ribbed conservative who enjoyed having a importantly they were handwritten and practi- little fun at the expense of a "pinko" student. cally illegible. Much of the crucial informa- After carefully disassociating myself and my tion, such as treatments and medication given views from the Board of Health, we had about was abbreviated or coded. In our cover letter to 45 minutes worth of discussion and/or argu- the clinics we asked that a person familiar ment in which we could agree on approxi- with the charts be available to go over them mately nothing. He would not believe that black with us. This rarely was the case. - Usually the people had any trouble getting to Cook County charts were pulled and waiting, but I was di- Hospital. He said, "The police take them there 84 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 for free all the time." He denied that black mainly on the South and Near West Side-the schools in Chicago were inferior to white black and the "Poor white" neighborhoods. schools. On a more fundamental level he said Here it seemed that at least one-half of the that, "The trouble with the damn niggers is doctors were foreign born. As I began to work that they are genetically inferior." I told him on the North Side I found that few, if any, that he was misinformed and blatantly racist. were foreign born physicians. This seems to He cited his 20 years of experience in working suggest that medical practice in poor neighbor- with the "niggers" as ample evidence to sup- hoods has been substantially abandoned by port his views. He would not listen to the idea graduates of the medical schools of the United that environmental forces had a profound ef- States. This observation seems to be supported fect on development of personalities. He felt by the f act that my partner who worked that "genetics determine 95 percent of every- mainly on the North Side saw few foreign thing." The whole conversation is not worth born doctors, and the two medical students reproducing here except to show the extent of doing the interviews for the Chicago Heart ignorance and racism in some of tke practi- Association in DuPage County saw almost tioners of medicine. This man was neither se- none. nile nor southern. He held a teaching position One of the most revealing experiences of the in one of Chicago's medical schools. summer was hearing the experiences of the As far as the physician interviews were con- two medical students working on the pre- cerned there was good cooperation in all cases. viously mentioned survey. Just in listening to Many of the doctors were a little wary or de- their problems I could tell that inner city rned- fensive. Some of this disappeared once they un- icine was in a different ball park. They were derstood what we were doing and that we had working on the level of finding out what meth- the written permission of the patient to obtain ods were favored by physicians for lowering the information,we wanted. Some of the defen- serum cholesterol. I had only two cases that I siveness on the part of the doctors was proba- can recall in which a followup serum choles- bly due to the nature of the questionnaire it- terol was even done. They noted that almost all self. There was simply no way to disguise the of their doctors had group practices with plush probing nature of the questions and conse- surroundings and further that many practi- quently no way to avoid feelings of guilt or tioners had their own laboratory facilities. I defensiveness on the part of the doctors. talked to doctors in modest to ramshackle At the time of the interview almost all of offices, none of whom had laboratory facilities the doctors had the record to be reviewed be- on the premises. In addition the students work- fore them on their desk. A good many of the ing in DuPage County were quick to point out records that I saw consisted of 3 x 5 or 5 x 7 that they saw very thick charts on their pa- cards writte to- tients, most of which were neatly typed, the n on both sides and stapled gether in the corner. A few other doctors had .doctors having dictated them to a secretary. their records on official looking forms. Only This brings up one of the critical issues that one or two maintained their records on full the summer's work touched upon, namely the 81/2 x 11 sheets. Most of the doctors referred difficulty of getting testing done on low income to the records consistently throughout the in- people. Many doctors were quick to point out when I asked if they had had some . articular terview, but in one notable exception the doc- p tor answered all of my questions without ever test done, that they wished they could have looking at the record although it was right be- had it done but, (1) the patient didn't want to fore him. bother with it because he was currently An initial impression that stuck with me asymptomatic, or (2) the patient had neither very markedly was that a high percentage of the time to make another appointment in a the doctors I interviewed were foreign born. In testing lab to have it done, nor the money to' the initial weeks of interviewing I Worked pay for it. Thus, if the practice of preventive 85 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 medicine requires testing, the real failure lies I was left to find a project within the Divi- not with incompetent doctors, but rather with sion of Adult Health and Aging that would at the entire socioeconomic framework that dic- least be of Value to someone, or some project tates that: (1) Poor people do not think on a that seemed of value to my partner, Jack Ber- "preventive" basis but rather on a "crisis" ger, and myself. The two interns on our site basis, (2) that they have -no money to spend on were concerned with the service and the labo- testing that they see little value in, (3) that ratory facilities that the Board of Health oper- they frequently do not take the time to go to a ates. They thus went their own way to do what separate facility to have testing done, and (4) they could at the sites where they were al- that the doctor who practices among the poor lowed to participate. We talked with them only either will not or can not make the financial in- infrequently for the rest of the summer. vestment in laboratories that would help to The Board of Health is involved in a chronic ameliorate this situation. One offshoot of this disease screening program which works out of problem is reflected in the fact that several two stationary sites, one on the Near South doctors mentioned that they would rather have Side and one Near Northwest. This screening a patient put on welfare so that at least he can seemed like a very important project as it is a have his testing done. Another consequence Of first step toward effective preventive medicine. the lack of laboratory testing among the poor Though the screening is on a small scale, it is is that the Board of Health screening tests at least an attempt at a beginning. It was take on the role of diagnostic tests on some oc- within this project that Jack and I decided to casions. On other occasions the diagnostic test do our research. ordered by the physician is a poorer test than the screening test. That is, a referral based on If the effectiveness of one system ultimately a glucose tolerance test, for example, is fol- depends upon the functioning of another inde- lowed up with a urine sugar, or perhaps a fast- pendent system, that one system must check ing blood sugar only. It seems to me that the beyond itself to determine its validity for exist- problems mentioned here are going to have to ence. In this case the Board of Health's effec- be dealt with in a massive and radical fashion titness is dependent upon the total medical Miiieu in which it functions. As effective a de- before we can expect to see great improvement in the health of the poor. Certainly this will be tector as the screening may be, if for economic, true as far as preventive medicine is con- social, or psychological reasons a person does cerned. not get care, the detection is a waste. Our pro- ject this summer went beyond the Board of In this case the Board of Health's effectiveness Health into a part of the medical care system, ts dependent upon the total medical milieu in the hospitals, clinics, and private M.D.'s in an Which it fumt@.-by Charlie Bass (Medi- attempt to determine the ultimate effectiveness cine) of the screening program. My summer's placement at the Chicago Without going into the details of the project, Board of Health at first seemed like an excel- I am left at present with only general impres- lent opportunity to study a structure to deter- sions gained from physicians I've talked to and mine the powers that be. I was told by my pre- the records I've examined. The most dominant ceptor that the project would take a great deal impression I have -is of the extreme guarded- more time that I had, and that the power ness of the M.D.'s and even their nurses. This structure was a great deal more complicated attitude is very understandable from merely than I could imagine. As it turned out, all I the point of view of an invasion of privacy by a learned concerning the Board of Health's strue- young individual who doesn't look exactly ture was what I was told about the rudimen- clean-cut, but it is even more understandable tary formalized structure and what I saw of its when one discovers the type of care that is daily operation. This part of my "radical sum- given. Most of the M.D.'s had a great many ra- mer" turned out to be a bust. tionalizations to explain the type of patient 86 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 d for care because of abnormal re- sons referre care given, most of them probably containing a great deal of validity; nonetheless, these sults in the Chronic Disease Detection Pro- M.D.Is did find it necessary to give excuses gram of the Chicago Board of Health. It was thus acknowledging their knowledge that the conducted by two medical students as part of treatment was less than ideal. the Student Health Project with the coop.era- About one-third of the-caseg I investigated tion of the Chicago Board of Health, especially seemed to show some effective degree of fol- the Division of Adult Health and Aging. It was lowup which ranged from retesting for the an attempt to answer three basic questions: suspected disease with the finding of normal re- 1. What percentage of the persons referred' sults, thus not confirming the Board of actually contacted a physician? Health's findings, to treatment for the disease 2. Is the examinee under care for the abnor- suggested by the screening procedure. The mal condition (s) ? other two-thirds can be accounted for by pa- 3. What is the response of physicians and ex- tients having seen their doctors but not telling aminees to followup efforts? them about the screening results, patients hav- Two parts to this survey, one concerning ing not seen their M.D.Is in the 6 or more months since the screening, and the whole Persons screened 6 months prior to followup range of rationalizations given by M.D.'s. and the other, persons 2 to 3 years before fol- These explanations ranged from "this Person lowup, allowed us to compare the answers for couldn't afford a new test .... .. I don't consider two time periods. these results abnormal," "she is too unreliable The major population under consideration to treat the way I would like," to "you know was that tested in the time period between No- this type of people" and a whole range of vember 1, 1967, and January 31, 1968, at the pleasant conversation to avoid giving specific Dearborn and Lathrop Homes sites. A total of answers to questions. 508 people were screened during this period Nothing really new can be gotten from this with 186 referred for care. For this group of study that hasn't already been shown in much 186, data were gotten from both examinees and more conclusive, dramatic, and meaningful medical care sources. The examinees were all ways. It can be seen that any system to im- mailed questionnaires with a letter of explana- prove health which depends upon the present tion and a stamped return envelope enclosed. system for dispensing medical care is going to The sources of medical care were sent an intro- be very severely handicapped and possibly re- ductory letter which Was followed by a phone duced to total medical-economic ineffectiveness. contact asking either for an interview with the The two general and oversimplified solutions to examine the medical physician or a chance made -obvious from this study are that the records. All sources Of care who could not be health care delivery system must be radically personally contacted (primarily physicians changed or a separate independent system with unusual schedules or those on vacation) must be set up. were mailed a questionnaire with a letter of Report on Follov)up on a Sample of Screening explanation and a stamped return envelope. Program Examinees Referred for Medical In the second part of the survey, 460 exarni- Evaluation and Care: 6 Months and 2 to 3 Years 'nees (of whom 152 were referred for care) After Screening.--by Charles Bas.s and Jack were chosen at random from older files rang- Berger ing in time of being screened from December This study was designed to followup on per- 10, 1965, to November 10, 1966. For this popu- lation, both examinees and medical care 'Under the direction and with assistance of Willie rmalities Cain, R.N., R. Raphaelson, Rose stamler, M.A., and The criteria for referial for the major abno Jeremiah' Stamler, M.D., for the Chicago Health Re- discussed were: (1) Diastolic blood pressure of 95 mm. search Foundation and the Division of Adult Health Hg. or greater (2) An abnormal modified glucose toler- and Aging, Chicago Board of Health. ance test, and (3) A specific abnormality on the ECG. 87 CHICAGO STUDENT HFALTH PROJFCT SUMMFR 1968 (An additional small precentage-2.2-an- .estionnaires with explana- this question negatively. It is assumed sources were sent q return envelopes. swered share of the Sq.2 percent tory letters and stamped as likely that a large Copies Of all forms are available. not answering the questionnaire did not report The tables below summarize the findings.'3 to a physician after the tests.) The three most es-Reporting frequent bases for referral-elevated blood Follo@P of Recent Eza'min" ucose (after oral imately 59 percent of those pressure, elevated plasma 91 all seemed for Care.-Approx eported that they had seen a load), specifil- FCG abnormality referred for care r tests (table 1) about equally compelling to examinees as rea- physician after the screening sicians. About 60 per- sons for reporting to Phy i gs -reported 3 Where information was not obtained bY the survey cent of persons with these find n available from the social workers hysician. of those with other abnor- techniques but was d as indicated in the tables. seeing a p . report it was include 186 examinees referred for abnormal test results: Was physician seen2 TABLE 1,FollowuP on a samPle Of M.D. L-er IV Didn't answe-r Didlet see M. D,sc,iPtiun Of uestionnaire ezami-nee 89 20 4 109 (47.8) (10.8) Test findings: ------------ 73 (2.2) (58.6) All --------------- - - (39.2) (N 2-186) @--------------- 12 d pressure 95 mul. 15 (46.2) (11.5) Hg. or> -------------------- 10 (3.8) (57.7) (38.5) (N-26) ---------- .2) 3) (63.9) 11 2.5) --- (45.0) (35.0) (10.0) referrable (55.0) ---- (N=40) ------------------- 6 35 29 107) Sex, 18 3 62.5) (51.8) (5.4) 60 14 Male -------------------------- (32-1) 1 74 (10-8) (N=56) ----------- 55 (56.9) (46.2) Female ----------------------- (42-3) (0.8) (N-130) ----------------- 8 67 69 (7.2) Race: 42 2 (60.4) (53.2) 12 White ------------------------ (1.8) 42 so (16.0) ------------ (37.8) 2 (40.0) (N=lll) --------- 31 (2.7 (56.0) Nonwhite --------------------- - (41-3) (N-75) ----------- 24 20 (8.2) Age: 24 (49.0) (40.8) 8 30 to 39 ---------------------- (49-0) (2.0) so 22 (15.4) (N=49) ---------------------- 20 2 (57.7) (42.3) 5 40 to 49 ---------------------- (3.8) 25 (9.8) (N - 52) ---------------------- (38-5) 1 30 (49-0) 3 50 to 59 ---------------------- 20 (2.0) (58.8) 22 ------------ (39.2) ---- 25 (64.7) (8.8) (N,51) ---------- 9 (73.5) 60 to 64 ---------------------- (26.5) (N - 34) ---------------------- in prentheses IL percentages. 1 Exaniinee ciu- naire. t finding grOuP- 2 some examinees Lre in more than I tes 88 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 TABLE 2.-FollowuP on agarapte of 186 exami,- rialities 45 percent indicated they bad seen anees referred for abnornml test results: Are ource of medical care .4 e'xamnees who saw Physician following his rec- .. Males in this sample reported seeing a phy- oramendations? ,)Ician in a slightly higher proportion of cases ;ban did female examinees (62.5 percent ver- ;us 56.9 percent, respectively) - The proportions of whites and nonwhites re- ported as seeing a physician were only slightly respee- 60.4 percent and 56 percent different tively). As would be expected, considerably more older examinees reported they sought Number ---- 61 10 19 19 77 care when compared to those in the younger Percent of all age groups (73.5 percent for 60 to 64 year olds examinees who saw versus 49 percent for those 30 to 39). It may be M.D - ----- 56.0 9.2 17.4 17.4 --- that the older examinees had more symptoms Percent of all as a result of the abnormalities, or it may be referred that their older age has made them more fre- examinees (N = 186) 32.8 5.4 10.2 10.2 41.4 quent and regular visitors to the physician. e@tio,ns rom examinee question.aiies. in a Is examinee following the rec&mm social worker followup. of the physician? The maj ority (56 percent) of those report- care) (table 3). Actually, the percentage of physicians cooperating in followup was ing that they had seen the physician also re slightly higher (63.4 percent), since requests port they are following all or part of his rec- for such information went to Physicians in 164 ommendations (table 2). These 61 persons con- f the 186 cases. In the remaining 22 cases, it ne-third (32.8 percent) 0 i stitute approximately 0 al percentage was not possible to locate the doctor ndicated of all those referred. (The actu as being the source of care. following M.D. recommendations is probably Of the 104 persons for whom information higher than this one-third. However, there is was obtained from a source of medical care, 79 no way to know what percentage of nonrespon- were reported as having been seen (table 3),. dents actually received followup care). out one-quarter of the reporting cases They represented 76 percent of those for whom In ab there is an M.D. report, and 42.5 percent of all (26.6 percent), examinees stated that the phY- those ref erred f or care. The doctors report sician made no recommendations for treat- that 68 of the examinees were under long term ment. No explanation is given in 17.4 percent care and that 40 of these were receiving treat- of the cases, but in 9.2 percent, the absence of ment as a result of the screening referral; i.e., recommendations is based on the physician's 38.5 percent of those for whor-i there was an decision that the examinee was normal. (In 5 M.D. report, and 21.5 percent of all those re- of those 10 cases, the repeat test given was as i stringent as the initial screening test. In 6 oth- ferred. One word of caution is needed in nter- ers, the test was less sensitive@.g., urine test preting the report. that 68 of the examinees for diabetes versus initial modified GTT@R no (65.4 percent of those reported on, and 36.6 test was made). percent of all referred) are "under long term care." Apparently, physicians in responding to Physician Report. Information from the 11 . - estion stated that persons were under source of medical care was received for 104 ex- tnis qu aminees (55.9 percent of those referred. for their long term care even though they were not treating them for any of the abnormalities 'Such abnormalities include suspicious findings on found in the screening tests. The more realistic cervical examination, suspect glaucoma, low hematocrit. estimate of the number under care is the 40 re- 89 CHICAGO STIJDENT HEALTH PROJECT STJMM-ER 1968 ported specifically as receiving treatment as alowup requests is great, and this inter eres ing referral. with any accurate assessment. Only 31.6 per- result of the screen ent of examinees and 53.3 percent Of M.D.'s Ilow,ap.-Table '4 indicatesc . estionnaires (as contrasted Lona Term Fo ge salutary ef_ e,ponded to the qu that there is probably a long ran h 60.8 percent and 63.4 percent, respee- 4.61 oTe recently re- wit feet of such a screening proaramp since 2tive y, for the followup Of In percent of those for whom there is an M.D. re- ferred cases) - port a-re described as under treatment for the Despite the lapse of 2 to 3 years, 58.3 per- screening abnorrjaalities. it also indicates, how- e responders reported them- ever, that the attrition in response rate to fol- cent of examine t for the screened F, 3.-Followup on a sample of 186 exaini.- selves to be under treatrnen TABL eabnormality (table 4). This compares favora- nees referred for abnormal test results: Ar bly with the 54.8 percent of the more recently examinees receiving treatment as a result of 0 also reported them- 191 referred examinees -wh screening referra selves as under treatment. Sumraary and Conclusion.-A sizable per- au ez Numbcr m centage of examinees recently referred for fol- - - 104 100.0 55.9 lowup medical evaluation and ea-re (59 per- M.D. report 3 79 76.0 42.5 selves as having sought such M.D. saw exi --- cent) report them Examinee under M.D.'s 65.4 36.6 care. one-third (33 percent) Of all examinees long-term care ---- 68 referred report that they were under treat- Examinee receiving treatment as result Of 21, Tnent and following all or at least part of the screening referral 40 38.5 5doctor's advice 6 -months after referral. (This ich percentage is higher-55 percent-if one uses 2 IS of these exa the abnormalities for wb the number responding to the questionnaire as they were referred known although not under , usly un- eferred.) Phy- control. 22 indeed tt these gLbnormalities were pre'no the base, rather than all those r known. s of examinees, ist group, 6 months after re- TABLF, 4.-C&mParison of followup results in 2 group ferral; 2d group, 2 - 3 'Years after referral to in sample -------- 508 ------------------------------- 460. Persons examiul 186: 36.6 percent of examinees ------ 152 i33.0 perment of examinees. Referred for test abnormalities 186: ioo percent of referred -------- 147- 96.7 percent of referred. Examinee questionnaires sent Examinee questionnaires completed 48: 31.6 percent of referred. and returned. 113- 60.8 percent of referred ----- Examinee reports himself to be under 61: 28: 58.3 percent of responders. 54.8 percent of responders ----- ed. treatment following referral. 18.4 percent of referr 32.8 percent of referred -------- .4 percent of referred. physicians receiving follow-up request 164: 88.2 percent of referred ------ 107: 70 67: physicians -responding -------------- 104- 63.4 percent of M.D.Is queried 53.s percent of M.D.Is quer- ied. 37.6 percent of referred. 55.9 percent Of referred -------- 40: 14:' physician reports examinee under 38.5 percent of examinees with 24.6 percent of examinees treatment --------------------- with M.D. reports. M.D. reports. f referred. 9.2 percent 0 21.6 percent of referred -------- CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 published in the June 1968, issue of inquiry icians independently report that 39 percent Of of "Medicaid in Cook der treat- magazine under the title hose they saw after referral were un .County." These legislative amendments are de- aent. This constitutes 22 percent of all re- signed to revise the Illinois Medical Assistance erred examinees. The discrepancies between examinee and physician report can be ac- Program in such a manner that it may more -ounted for partly by the fact that some exami- adequately serve the needs of those Illinois res- ian other than the one idents who are unable to meet their medical ex- .iees reported to a physic ,isted at screening time, and this listed physi- penses. -i,ian (the one contacted for followup) counted It should be understood from the outset that this examinee as "not reporting." Even after 2the authors are not altogether certain the cur- to 3 years a sizable portion of examinees re- rent welfare system is the proper f ramework port themselves as still under treatment (58 for an adequate and effective health care plan. percent of those responding, although Only 18 Patching up the existing system 'May do little percent of the referred,since the response rate good. In f act, it May help further entrench is low after such a time lapse.) One-quarter of what should really be discarded. But with the those with M.D. reports are stated to be still prospects for a total rethinking of the problem under care (again, with a low response rate very dim indeed, it is perhaps prudent now to over time, this accounts for only 9 percent of consider those changes in the current program those originally referred.) which will be most beneficial. at at least a third of The conclusion is th II. Defects in the Current Program those recently examined (and possibly UP to 55 percent) do end up under medical care they The basic f ramework of the current Illinois sought, for the treat- gram is quite simple. might not otherwise have Medical Assistance Pro ment and control of major chronic diseases. Two classes of people qualify for free medical improved methods of followup (including a sistance: cash grant recipients of public aid, built-in plans for intermittent or periodic fol-8 lowup) would increase ability to assess and those persons whose incomes are sufficient whether the salutary effect lasts over the (by Public Aid standards) to meet daily needs but insufficient to meet medical needs. Cov- years. erage by the program is evidenced by a card It is clear that this type of study did not and which signifies to medical vendors that reim- could not assess in depth the type of care and bursement for various medical services ad- treatment received following referral. It is im- ministered to the holder will be paid by the portant to register, however, that the screen- ing program is a valuable first step in bringing State of Illinois. under early control those chronic diseases Through this system it could be possible to prevalent in a significant Proportion of the provide necessary health care in a dignified middle-aged ancl older population. manner to those unable to pay. Unfortunately this is not the case. Specifically, the program: Proposed Amendments to the Illinois Public (1) Fails to set reasonable standards and Aid CoAe Relating to the Illinois Medical As- categories of eligibility thereby ex- sistance Progran@Lawrence S. Bloom (Law), cluding from coverage broad ranges Ralph McMurray (Law), Margaret Stapleton Of deserving persons; (Law) (2) Fails to include major axeas of preven- tive care within the services for which I. Introduction vendors may be reimbursed thereby This report suggesting specific amendments depriving program eligibles of. an es- to the Illinois Public Aid Code represents the sential element of good health care implementation of research begun during the and, in the large run, adding to the 1967 Chicago Student Health Project and taxpayers' supporting burden; 91 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 (3) Fails to provide convenient efficient surance) would not be included in the methods for procuring coverage under computation of income. Families eligi- enying a large ble on -the basis of income under the the program, thereby d segment of our state's population standards set out in l(B), above, quick access to the medical treatment would retain their eligibility status afforded them by law,,as well as de- so long as their liquid assets (savings, priving them of any measure of medi- stocks, insurance, etc.) do not exceed cal security; 50 percent of the maximum income (4) Fails to provide financial incentives allowable for their family classifica- and administrative efficiencies to med- tion. Necessary assets such as a home, ical vendors thereby alienating the one car and a limited amount of life, medical vendors and discouraging health, accident and property insur- their practice in povertv areas. ance would be totally exempt from the computation of assets. In a broader scope, the program: Example: Using the family of four (1) Reinforces the degrading image of hypothesized earlier. that family charity medicine, and be excluded from eligibility would (2) Takes little advantage of its oppor- for medical assistance only if their tunity to integrate publicly supported nonexempt assets in the form of patients into the health care delivery stocks, savings, etc., exceeded system of the community as a whole. $2,400, i.e., 50 percent of $4,800, the 111. Proposed Medical Assistance Program maximum income allowed for a family of four. The proposed statutory amendments would (4) Applicants who do not qualify on the revise the medical assistance program to take basis of need would nonetheless have the following basic form. the assurance that when their calcu- A. Eligibility lated excess income is exhausted for (1) All persons and families falling below medical expenses, the State of Illinois the HEW "poverty line" for their would be committed to grant coverage particular family classification would for subsequent medical expenses. This be eligible for basic maintenance cash would be accomplished by the Depart- grants and hence free medical assist- ment's keeping an accurate record of ance. all "rejected" applications, with a no- (2) All individuals and families (here- tation of the calculated excess income after refered to as "families") whose or assets availabl'e for medical needs. incomes do not exceed 133 percent of The applicant would then submit re- the maximum basic maintenance cash ceipts of medical expenditures to the grant allowable to families of similar Department and if, within a pre- constitution would be eligible for free scribed period, these exceed his excess medical assistance. income, a medical assistance . card Example: If a family of four with no would automatically be issued and f ull income whatsoever would be eligible eligibility granted for the duration of for a cash grant of $3,600 covering the time his initial application would basic needs, a similar family of four have covered had it been granted. The which fails to qualify for a cash Department of Public Aid would be grant on the basis of need would encouraged to devise a plan whereby still be eligible for free medical care those found ineligible for medical as- if its income does not exceed $4,800. sistance on the basis of need could be (3) Assets (such as a car, savings, life in- given State financial aid in meeting 92 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 a percentage of their medical costs, the responsibility of a separate agency without first having to totally deplete solely concerned with this task. their excess income. (2) For each individual or family found Example: If the family of four sug- eligible for medical assistance, the De- gested above were found to have an partment of Public Aid would each income of $5,000 and assets of month deposit with this payment $2,400, eligibility for medical assist- agency an amount computed to be the ance would initially be denied. How- average expected monthly cost of pro- ever, if this family were to incur viding medical services to each person medical expenses in excess of $200 covered. Such funds would be irrevoc- during the 6-month period for ably commited to the payment of which eligibility is now granted, it Medical Assistance bills. would then be eligible for coverage (3) Persons eligible for medical assis ce for the duration of the 6-month would be allowed to have such monthly period. Of course, eligibility would payments transferred to private medi- be regranted if the family's financ- cal insurance of group care plans to ial status remained the same at the cover the cost of premiums required by end of the 6-month period. such plans. From that point on, the Comment: The purpose of these changes is medical relationship would be safely two-fold. First, they increase the -num- between the patient and his chosen ber of people eligible for medical assi@ medical care dispenser. ance and grant some measure of medical security to those just beyond the eligi- (4) Vendors who continue to submit bility limits. Second, with an enlarged vouchers to the State reimbursement group of potentially "fully paid" patients agency would be entitled to interest on whose eligibility can be quickly ascer- vouchers unpaid after a month's tained, more and better physicians and period of time. institutions might be encouraged to serve (5) The State reimbursement agency poverty communities. would be authorized to make advance B. Medical Services Covered payments to medical institutions which on the basis of past billing can Those services for which medical vendors reasonably be expected -to submit sub- could be reimbursed would be expanded to in- stantial payment claims. Specifically, clude preventive dentistry, physical check-ups institutions which in the past - have and psychological counselling. submitted vouchers over a year period Comment: Aside f rom the necessity of in excess of $300,000 could receive in these items to provide comprehensive advance 50 percent of an average es- medical care, effective preventive atten- timated monthly reimbursement. tion may in the long run reduce the costs Comment: These changes would take the Of the Medical Assistance Program job of vendor reimbursement out of the through a reduction in costly remedial make it Department of Public Aid and services. the responsibility of 6 professional pay- C. Administration of the Medical Assistance ment institution. This, along with the Program interest and advance payment provi- (1) While determination of eligibility for sions, could help restore vendor cooper- medical assistance would remain the ation with the Medical Assistance Pro- function of the Department of Public gram. Allowing persons covered by the Aid, the administration of vendor bill- Medical Assistance Program to transfer the funds set aside for their medical ing and reimbursement would become 98 i CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ions has several Amend Section 5-4 to read as follows: needs to private institut "Subject to the subseqvent pro- advantages. It allows greater control visions of this Section 5-4, the over the management of an individual's amount and nature of medical as- own medical care. It enables him to be- sistance shall be determined by come part of the health care delivery the County Departnlnts in ac- system of the general community. it cordance with the standards, @s gives an added push to the development and regulations of the Illinois De- of group care plans in Illinois. And, partment, with date regard to the incidentally, this P'rOvision may enlist requirements and conditions in the support of the powerf ul insurance each case, including contributions lobby in support of the entire legislative from legally responsible relatives. renovation. itin no event, however, shall the Illinois Department establish in- IV. Proposed Amendments to the Illinois Pub limitations for lic Aid Code. (Note: Statutory additions indi- come eligibility d in Article V, persons designate cated by italic) Sec. 5-2 (,o), Article V (new) A. Declarationof Purpose See. 5-2 (4), and Article V (re- Amend Sec. 5-1, second paragraph to numbered) See. 5-2(5) of this read: "Preservation of health, Code of less than 1337'0 of the prevention of disease, alleviation maximum basic maintenance * * 11 allowed the most needy of sickness, * grant lar classificatiola ic preventive care recipient of a sirai comraents: For specif nt shall der Articles IIIY IVY and VI of services for which reimburseme un be made see amendments to See. 5-5 in this Code. tment shall devise IV (E) of this report. $'The Depar Classes of Persons Eligible methods of income evaluation that B. sub- take into account seasonal and Amend See. 5-2 to include as new other fluctuations in income with sections. 3 and 4: 0 eligible for basic the ai?n of issuing medical assist- ,'S. Persons oth@ gra,nts under Article once Coverage to all those who inaint&wnce ould qualify IV but who fail to qualify there- over a ye-ar period w un&r on the ba@ of the full e@ on the basis of need for swh as- plo,y,ment of a falnity wage earner. sistaace. "4. persons othe@e eligible f&rmed- e under section 5- 'edeterraination of income u@ ical assistanc OM Of this Section 2(2) of this Article V but who fail der the provisi to qualify thereunder on the ba@ 5-4 shall include no consideration of the full employment of a f@Iv of the assets Possessed by the aP- ,Wage earner.)I pacant. The Illinois Department Current subsections 3 and 4 should be may set standards limiting eligi- renumbered '5 and 6 respectively. bility for medical assistance on Corame,nt: These amendments are design- he basis of value, of assets P03- ed to include within the Medical Assist- t ed. Provided, however, that families now denied sees ance Program those because of the full no applicant shall be denied eligi-. ADC-U cash grants ell as those bility for medical assistance, on employment of a father as w ly re- the basis of assets Possessed un- families now denied categorical less the value Of those assets ex- lated medical assistance eligibility for ceeds 509'o of the mlxllll the same reason. income allowed any person or C. Amount and Nature of Medical Assistance CkA CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 family of a similar classification his application. Each re- for medical assistance eligibility port of a disapproved under this code. Provided further, application shall be ac- that the following assets shall be companied by a writ- excluded from consideration: ten statement setting homestead property, one automo- forth the re-mom for bile, and such amounts of life, disapproval. If eligibility health, accident, property and is disallowed on the other insurance as the De@ grounds of excess -tn- ment shall determine to be suffi- come or assets, such cient for the various classifica- statement shall specify tions of persons and families the nature and amount eligible for medical assistance of the excess. under this code. (3) All approved and disap- "The Department may devise a proved applications shall plan or plans whereby individvals be kept on file for five or families found ineligible under years by the County De- the income and asset requirements partinent to which it was promulgated pursuant to this submitted. Section 5-4 may nonetheless re- (4) The Department shall ceive financial assistance toward recompute eligibility for payment of a percentage of medi- medical assistance upon cal expenses imurred." submission by a diop- proved applicant of re- D. Application and Eligibility Determination ceipts for medical ex- Procedures penses incurred. If with- Amend the Public Aid Code to pro- in the standard period of vide as new Sec. 5-5, the following: eligibility granted ap- "Sec 5-5 Application and Eligi- proved applicants the bilit,y Determination procedures. disapproved applicant "The Illinois D@ment shall shall have expended for by appropriate rules and regula- medical care fun& in tiom establish procedure-& for excess of his computed processing and determining the excess income or assets, eligibility of applicants for medi- he shall automaticau .y cal assistance. Such procedures be declared eligible, for wM take any reasonable form but medical assistance for in any event shall include the fol- the duration of the lowing provisions: period, and shall be, is.- (1) Application for medical sued a medical "sist- assistance may be made ance card so indicating." at any time regardless Note: All subsequent. sections of of the medic4d condition the existing Public Aid Code of the applicant. should be renumbered to ae- (2) Each applicant shall be count for the insertion of this notified within thirty new Section 6-5. days of the receipt of his E. Medical Services application of the ap- val or disapproval of Amend the Public Aid Code to provide pro 95 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 as renumbered Section 5-6 the fol- (3) Payments to the Medical Pay- lowing: ment Fund-I-Iow Computed-Month- "Section 5-6. Medical Services. ly Medical Capitation Payments "The Illinois Department, by Amend Section 12-6.2 to provide as rule, shall determine the quantity follows: tment shall de- and quality of the medical assist- "The Illinois Depar te,rmine the per capita amount neces- ance for which payment will be sary to meet the estimated monthly authorized, and the medical serv- needs of each person duly authorized ices to be provided, which shall to receive medical assistance under this include all or part of the follow- Code for such services and supplies as ing: (1) inpatient hospital serv- shall be authorized by the Illinois De- ices (13) other diagnostic, partment pursuant to Section 5-6 of this Code. Such per capita amounts screening, preventive, and reha- may vary with the age and classifica- bilitative services; (14) psycho- tion of the eligible recipient. The Illi- logical counselling; (15) trans- nois Department shall designate for portation * * * (16) any other payment into the Medical Payment healing. Fund the monthly per capita amounts so computed and such payments shall "In determining those services be known as monthly medical capita, for which payment will be author- tion payments.'f ized, the Department shall wher- (4) Disbursements From Medical Pay- ever possible include those -pre- ment Fund ventive services such as diagnos- Amend Illinois Public Aid Code to in- tic physical examinations, pre- clude the following new Section ventive dentistry, psychological 12-6.5: counselling authorized above Section 12-6.5. Disbursements from ,which are most likely to reduce Medical Payment Fund. the possibility of later remedial "Disbursements shall be made treatment. from the Medical Payment Fund "The Illinois Department -2." solely by the Medical Payment Secti n 5 Bureau upon authorization by the F. Administration Director of Medical Payments. The Director of Medical Pay- (1) Medical Payment Fund ments shall authorize disburse- Amend Section 12-6 to provide at the ments only for the payment of end of the current section the fol- duly submitted medical vendor lowing: claims for services rendered or for "The Medical Payment Fund shall the payment of medical premiums be administered y a Medical Payment as hereafter authorized. Duly sub- Bureau under the direction of a Di- rector of Medical Payments to be ap- ?atted medical vendor claims pointed by the Governor. The Medical shall be pat'dwithin thirty days of Payment Bureau shalt perfor7n Such their receipt by the Medical Pay- duties as are further designated in this Bureau. All clairtW not so Code." ment (2) Payment to Medical Payment Fund- paid shall accumulate interest at the rate of 1 glo per month or Amend Section 12-6.1 to provide as fraction thereof. Each person or follows: family for whom a monthly medi- "Fr&m State appropriations for this cal capitation payment shall have purpose, the Illinois Department shall been credited to the Medical Pay- provide for payment into the Medical Payment Fund ment Fund may request that such 96 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 capitation payment be paid to any ments is authorized to disburse corporation, partnership or other funds in advance of billing to association licensed by the State hospitals and other institutions of Illinois to provide medical or which during the past year sub- hospitalization insurance or to mitted valid claims for reimburse- any association of physicians au ment in excess of an average of thorized by the State of Illinois $25,000 each month. Such advance to provide medical services upon disbursements may not exceed in payment of a set premium. Such amount 50'7o of the imtitution's requests shall be automatically past year average monthly bill- granted by the Medical Payment ings. Bureau and the appropriate funds Note: Current Sections 12-6.5, 12-6.6 and so disbursed. No medical vendor 12-6.7 should be renumbered 12-6.7, 12- claims shall subsequently be paid 6.8 and 12-6.9 respectively. for medical services rendered to those for whom monthly medical BIBLIOGRAPHY capitation payments are so dis- (1) Mark H. Lepper, M.D. and Joyce C. Lashof, M.D., bursed." "Preliminary Report on Patterns of Medical and (5) Advance Disbursements to Hospitals Health Care in Poverty Areas of Chicago and Amend Illinois Public Aid Code to in- Proposed Health Programs for the Medically clude the following, new Section 12- Indigent," 1966. ,6.6: (2) Evelyn M. Kitagawa and Karl E. Tauber, eds., Local Community Fact Book, Chicago Metropol- Section 12-6.6. Advance Dis- itan Area, 1960, Chicago: Chicago Community bursements to Hospitals. Inventory, 1963. "The Director of Medical Pay- (3) Chicago Housing Authority Report, 1967. REPORTS Section Ill. HOSPITAL SITE Eight hospitals were sites of activity for on one in the Fantus Clinic for residence, Student Health Project participants. These in- age, sex, a: d race. These data are presented in cluded the four major purveyors of ambulatory table 1. (These patients had all been accepted health services in the city of Chicago and four for continuing care at Fantus; patients receiv- other hospitals. These latter four ranged from ing crisis care in the admitting and emergency small to medium-sized institutions. area were -not interviewed.) was based One of the major hospitals, Cook County, is Geographic residence in the study the city and county's only public hospital and on the 75 community areas in Chicago. The was established to care for the indigent. The concept of community areas within the city Of remaining hospitals were all privately co-n- Chicago was first delineated more than 30 trolled, voluntary institutions. All of them years ago, through the work of the Social Sci- were general hospitals. Most of them were lo- ence Research Committee of the University of cated in, or directly adjacent to, predominantly Chicago, with the Cooperation and concerted Negro, poor communities. effort of many local agencies and the United The types of activities in which the students States Bureau of the Census. (2) engaged at the various hospitals included col- The data in table 1 indicate that on the day lection of data, interviews with patients, obser- of the survey, patients came to Fantus Clinic vations of health care delivery systems and, in from 60 of Chicago's 75 community areas. some cases, participation in the daily work However, patients from only seven community routine of specific departments. areas accounted for 55.7 percent of all the pa- The work the students did will be described tients seen th-at day. Four of these seven Areas in this section. Their reactions to their experi- were on the West Side, geographically close to ences in the hospitals will be discussed at the the hospital and three were on the South Side. end of this portion of the report. As might be expected, since this hospital is primarily established to render care to the in- Cook County Hospital digent, these seven communities are poverty areas, as defined by the Chicago Committee on This public institution is the largest general Urban Opportunity. (1) hospital in the city of Chicago'with 2,747 beds. In addition to the survey of geographic It provides care to the indigent primarily, but origin, the students conducted interviews with has been characterized in certain press articles patients- selected at random, from among per- as "the physician to the Negro" in Chicago. It sons sea@ed in several w.aiting rooms of about a provides ambulatory services at its Fantus dozen clinics in Fantus. Approximately 60 pa- Clinic and the students assigned there worked reent of them tients were interviewed; 86 pe only in this area. were black and all of them had limited econ- The emergencyand Admissions area of this omic resources. Less than 10 percent of the hospital sees approximately 1,200 patients each respondents were past age 65 years and the re- day. About 200 of these are admitted to the mainder were predominantly under 45 years of hospital, about, 200 are referred to Fantus age. Clinic and the remainder are seen and ad- When asked why they came to Fantus Clinic, vised." (1) a majority of the patients interviewed re- The students reviewed all the patients seen .sponded that they had known about the clinic 99 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 all their lives or had been "referred" to it. Ten work. However, apparently patients accept this percent came because their care was free. The as inevitable since, upon interview, few per- most frequently stated reason given by pa- sons included cuts. in waiting time as one sug- tients who only used Fantus Clinic and no gestion for improving services. other source of medical care was that they When queried about suggestions for improve- lacked money. ment of health services only about half of the A question probing the patient's knowledge patients had such suggestions. These included: of the MA-NG 11 program revealed that 93 per- all night emergency services in the neighbor- cent of the patients queried about MA-NG had hoods; better methods of transporting emer- never heard of this program for the medically gencies to hospitals (there is no public ambul- indigent. Only one-third of the patients who ance service in the second largest city in the are on public aid rolls were aware that their United States); making information about 94 green card" entitled them to seek care at pri- costs at various hospitals available to the vate hospitals or from private physicians if public; and cooperative programs with outly- they so desired. ing clinical laboratories so that great travel Over 90 percent of the Fantus patients rated and time would not be required for tests that the personal attention they received and the only take a few minutes. Other improvements medical competence and continuity of care at that were suggested related more specifically to the clinic as "good" rather than "generally Cook County Hospital itself. These included good or poor." About 85 percent of the respon- better food, air conditioning, better parking fa- dents thought that physicians at Fantus were cilitiesand a time payment plan. really interested in taking care of the poor and The students, in their report, quoted a num- a high positive response was also elicited as their perception of the physicians' intere . 'Her of individual comments made by respon- St l@ dents. They ranged from critical to complimen- taking care of Negroes. About two-thirds of tary and a few of them are repeated here: the respondents felt that conditions at Fantus On the surface, they're making Clinic were improving and that steps were every effort, but still there's not much being taken to improve conditions. Only 17 being done to improve. Why do people percent thought that nothing was being done to improve conditions there. have to come all the way here-20 When queried as to their preference if they miles? Why don't they have services there? They pay taxes. Mayor Daley had a choice of free care at neighborhood doesn't even say why. These people health centers or continued attendance at Fan- come and sit after coming 25 miles tus Clinic, about two-thirds responded that they would prefer to go to a n.eighborhood and sit all day. Maybe don't get any health center. (This is a different response service all day. Why do you have to than the one elicited -at Presbyterian-St. Luke's do it all day? People in pain * * * Hospital to a similar question.) To get admitted to the hospital takesa long tirAie unless you have po- The length of time patients had to wait prior litical connections, even if you have a to being seen was probed. Waiting time varied doctor's note. I went and got a note from about 1 hour to as much as 8 hours, with from my alderman and got admitted 4 hours -appearing to be an average waiting pe- right away. The system of admissions riod. The length of waiting time posed a major makes people die. Wait a long time- problem for those patients who were employed 2 or 3 weeks. Some people suffer. since they usually lost an entire day from They are people. They're sick. 2Medical Assistance-Non Grant which. provides pay- No place to go,'only the County. Po- ment for eligible patients from public funds even lice have failed. They won't touch you though they are not on public assistance rolls. without a statement from family doc- 100 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ata for making it Possible to extrapolate these d tor. I know one woman who died. But the clinic population as a whole. The card of ink it's Political- proximately every 15th patient in the active again I th get me to COM- ap 15,000 in total) was selected and No * * * never files (about this card. These plaii'l, they've treated me nice. information recovered from But you do wait, cards are filed by unit (chart) number and as- C-an't be no better. , completely random. it,s so crowded. I don t mind waiting; signinent of number is _, to the hospital or it's a good hospital. Each new patient, presentin- e next interviewed at Fantus the health center for caret is assigned th In comparing patients hospital number from the pool. T) interviewed at another e 1,000 ith a grou, ity of Chicago clinics) The information retrieved from th @,ee section on Univers e emerged. The stu- ic resid- interesting differene cards selected included the geograph on this difference, -as atient, the aget sex, race, clinic of ants report commented ence of the Psion, and source of payment for :)Ilows: derable difference initial admis Thus we have collsi medical care. oject students recov- between Fantus and Billings Popula- The information the pr c origin is presented tio.ns, the maj oritY of the former corn- ered relative to geographi ref erred to ing because they "have to", the latter in table II. (This table will be forma- seeking Out a source of care thought again since it also includes the same in tobesuperior. * ** tion for FaltuE, Clinic and the University Of While it is not valid to make -a scientific corn- Chicago Clinics.) arison between the groups interviewed the The out-patient services of Presbyterian-St. p pression the students gained, as de- pital are utilized by patients living @.ii-nical im appears to have merit. Luke's Hos . Chicago. the quotation, in 64 of the 75 community areas in e scribed in However, slightly more than 50 perent of all e f rom'four c_omnunity areas. one Presbyterian-St. Luke's Hospital patients com the hos- of these four areas is the one in which This is the third largest general hospital in lid the other three are Chicago with about 850 beds. It has a long tra- pital itself is located aSt west and southwest in-patient close to the hospital ju dition of providing ambulatory and services to populations of limited means, as of it. well as all other means and groups. its out-pa- The next largest number of patients from a to as the health center) single community area come from a tient clinics (referred visits last .e city. As can e seen in served approximately gg,ooo patient on the south side of th year. When visits to its recently opened neigh- table 11, the patients served at this hospital borhood health center are added (approxi- tus Clinic tend to come from the mately 35,000 this past year), it becomes the and at Fan . These areas are consid- rvices among same community areas . ies and their largest purveyor of ambulatory se ered to be deep poverty communit the private hospitals in Chicago. populations are predominantly black. The students at this site worked solely in the r Presbyte- -The distribution Of variables fo health center physically located at the hospi-rian-St..Luke's Hospital clinic population is de- tal. They were not involved with its neighbor e active pa- community ad- scribed in table Ill. Almost half th hood health center located in a -tients are under age lg. Almost 75 percent of j,acent to the hospital. These students under nd two-thirds of them are took a survey of the out-patient clinic popula- them -are nonwhite a tion and they interviewed some patients at the female. Greatest utilization is in the pediatrics end of this survey. and OB-GYN clinics$ although the medicine of admission for almost The survey of the health center population clinics were the clinic was based on a sequential sampling technique 20 percent of the population. 101 @CAGO STUDENT HEALTH PROJECT SUMMER 1968 Almost half of the population (42.8 percent) nine patients used other hospitals occasionally. had their health services paid for by public Twenty-one said they had not used any other funds, i.e., categorical.assistance, Medicare or source of care in the past and 21 stated they MA-NG. Fifty-four percent paid for their own knew of no other sources of care. (A number care based on a low proportion of the actual of these patients lived nearby other major hos- costs since their financial resources were lim- pitals in the city.) Nine patients indicated they ited. Approximately 0.5 percent paid for their preferred to use this particular hospital. own care in full. The remainder had other The responses dealing with their attitudes sources for payment of their medical care. toward, and perception of, their own and gen- In summary, patients cared for in the health eral health care obviously are biased. When center of this hospital are for the most part they are seated in the institution from which poor, in great proportion black, and while they they seek care and when they are approached come from all over the city, the majority come by people they consider to represent that insti- from areas very close to the hospital. tution, their answers may well be guarded or After completing the survey of patients' may represent what they believe the institu- cards, the students proceeded to interview pa- tion wishes to hear. In that context, the follow- tients, selected at random, with a questionnaire ing are the responses dealing with attitudinai similar to that used in Cook County. Forty-one and perception questions. patients were interviewed by the two high Thirty-seven of the respondents thought the school students working at the site. Twenty- care they received at this hospital was good and one of these were male, 19 of them were fe- two said it was generally good. The other two male, and for one, sex was not recorded. While did not respond to the question. A similar re- the utilization of the clinics is higher among sponse was elicited to the question pertaining females, the fact that more males were inter- to their attitudes about the quality of the physi- viewed probably reflects the fact that the stu- cians. Thirty-five thought the physicians we're dents were both young males, and possibly good, two said generally good, and four did not more comfortable in discussion with other respond. males. This may also partially account for the They were asked whether they thought phy- fact that 37 of the people interviewed were sicia-ns were really interested in taking care Of black, as we-re the students. The other four the poor and of Negroes. TheTe,was positive were white and two of them were Spanish- response to these two questions with 31 re- speaking. sponding that they thought doctors were really Nine of the respondents were born in Illinois interested in caring for Negroes. Only two thought they were not interested in ' for and 23 were born in southern States. One pa- care tient was born in Cuba, a second in Puerto the poor wi.th seven holding no opinioii, and Rico, and the other seven were born in differ- one not responding. None of the respondents ent states. Eighteen of the patients had been said physicians were not interested in caring receiving care at this clinic for less than 6for Negroes but seven held no opinion and one months while nine had been coming here for did not respond. more than 3 years. The remaining patients had They were then asked if they thought this been coming for periods between these times' particular hos.pital was interested in caring for Forty-four percent of them said they came to the poor and the positive responses dropped to this institution because it had good doctors and 24, with 14 holding no opinion and three not 19 percent came because a friend had recom- responding. To the question did this hospital mended it. take interest in caring for Negroes, 26 re- Thirty used no other source of medical care sponded affirmativelyp one said he thought it presently, while two used the neighborhood did not, 10 held no opinion and four did not re- health center of the hospital. The remaining spond. 102 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The positive responses dropped even more the Billings Hospital emergency room. They vhen they were asked if they thought private also conducted interviews with randomly se- Lospitals in general were really interested tak- lected patients using the same questionnaire as ng care of the poor or of Negroes. To the that used at Cook County Hospital. ormer 16 said yes, seven said no, 12 had no review of The period of time for which the ,pinion and six did not respond. Seventeen said records was undertaken was not described in hey thought private hospitals were interested the students'. report. They reviewed the records n caring for Negroes, five said they thought of 346 patients who received care in the fol- iot, 16 held no opinion and three did not an- lowing clinics: Medicine, OB-GYN, pediatrics, iwer the question. eye, E.N.T., plastic surgery, urology, or- When asked if they would have a preference thopedic surgery, psychiatry, general surgery, f the choice were offered them of care in their and neurosurgery. They collected information ieighborhood or at this institution, 33 said about the geographic residence of these pa- -,hey would prefer Presbyterian-St. Luke's tients, their age, sex, race, and source of pay- Flospital. When the question was refined to ask ment for medical care. Table II presents the if they had a choice of free care in their neigh- data for geographic residence. borhdod or care at this hospital, 32 still re- The largest single group of patients (22.5 @ponded that they would prefer Presbyterian- percent) surveyed came from outside the city St. Luke's Hospital. of Chicago. The remainder were from 55 com- These patients were also asked if they had munity areas of Chicago's 75, and five of these any suggestions for improving care or service community areas accounted for 30 percent of in the health center. Eleven patients indicated the total number of patients reviewed. These that cutting down waiting time would be an five areas are all on the south side of the city, improvement. (More than half said they had to directly adjacent to, or relatively near the hos- wait between 1 and 3 hours for care.) Twenty- pital. Two of them are considered poverty two said they,could "think of no way" to im- areas and three are nonpoverty areas. prove the services. They were finally asked The distribution of variables for all the pa- ether there were any improvements in wh tients are presented in table IV. Unlike the two health care they would like to see in their other hospitals described so far, 71 percent of neighborhoods. Seventeen -responded they the patients pay for their own care. Only 15 would like to see more physicians in them; 22 percent are paid for by public funds, including had no suggestions for improvements. Medicare. The sample of 1,000 patients, initiated by The distribution of variables by clinic is pre- the students, is being explored in greater depth sented in table V. The largest number of pa- for diagnoses and other information, that will tients use the medicine clinics, with OB-OYN enable the planners in the institution to deter- being the second most utilized clinic. The dis- mine more effective and efficient methods of de- tribution by race varies from the patients at- livering health care to selected populations. tending the medicine clinics, the majority of whom are white as compared to the OB-GYN University of Chicago Hospitals and CliniCS and pediatrics clinics where the majority are This facility is located on the south side of Negro. Patients utilizing all other clinics are Chicago and the clinics are part of the fourth also predominantly white. The out of city pa- largest hospital complex in the city (661 beds). tients probably account for this since the five It is located directly adjacent to one of the community areas with the greatest utilization most densely populated Negro communities in for Chicago patients are either all black or have the city. large Negro populations. Students working there conducted a survey After completion of their survey the Stu- of utilization of the out-patient clinics and of dents conducted interviews with patients, se- 1 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 lected at random, f rom among those seated in tution for emergency care or for other medical the waiting rooms of the medicine, surgery, reasons regardless of its distance from their OB-GYN, and pediatrics clinics. The inter- homes or other factors. viewers ap roached the patients, without in- p The attitudes of the patients were probed troduction by clinic staff personnel, and de- relative to their perceptions of the hospital's in- scribed themselves as working for the Student terest in caring for poor people, and Negro Health Organization and the Hospital Plan- people. About 20 percent of the patients ning Council (collection of data in the Univer- thought that physicians were not really inter- sity of Chicago clinics was supervised by the ested in taking care of the poor and 20 per cent research director of that agency). They de- thought that physicians in their neighborhoods scribed these two organizations as being inter- were not interested in caring for people living ested in knowing how patients felt about dif- in their neighborhood. About 40 percent ferent hospitals in Chicago. They especially at- thought that private hospitals were not inter- tempted to assure the patients that they did ested in taking care of the poor or in Negroes. not represent a particular hospital, -newspaper, When the question was refined as to whether school, or doctors' group. this particular hospital at the University of There were 66 patients interviewed. Twen- Chicago was interested in taking care of the ty-five of these were members of families with poor, all but six responded they thought it was incomes below $5,000 per annum, 31 had in- so interested and only two felt that the hospi- comes between $5,000 and $10,000 and 10 had tal was not interested in taking care of Ne- incomes above $10,000. There were 44 Negro groes. patients and 21 white patients. The students selected several comments on About 10 percent of the patients were sup- these latter subjects from the people who were ported by public assistance sources. However, interviewed that are worth repeating there as in all the interviews about 90 percent had they project an interesting variety of attitudes. never heard of the MA-NG program or Medic- * * * I can afford medical care and aid, per se. The few who had heard about it if it's free it should serve the people knew no more than its -name. who can't afford to pay for it. Fifty-five percent of the patients used no Too much attention paid to poor other health resources besides the University of blacks now. They (the poor) don't Chicago Clinics for themselves or their fam- know the difference. Too many (Ne- ilies. More than 50 percei-it of the patients groes) but they have to live, too, I -stated that they attended Billings because it guess. had been recommended to them or because it * * * They (the welfare patients) had "good doctors." shouldn't be here if they cannot pay. Waiting time in the clinics varied between Public aid should set up a place es- clinics. The longest waits were in the medicine pecially for those people. It's unfair to and surgery clinics while there were only short let those welfare people come here. I delays in seeing, patients in pediatrics and don't think transportation is too bad obstetrics clinics. Those who generally waited and there are all the health stations. longer than 1 hour were the ones who stated The fees are too high. The govern- that a way to improve the service was to cut ment shouldn't regulate prices but down the waiting time or add more staff. How- everybody should be able to get good ever, a number of people did not appear to care and the government should pay object to the waiting periods. for schooling of more doctors. Their loyalty to the institution appeared to As the survey indicated, not only are there be on a high level; approximately 40 per- major differences between the patients who cent indicated they would depend on the insti- utilize the University of Chicago hospitals and 104 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 the other two described, in terms of income, ary 1965 were from that area and in 1968 37.5 race, etc., there are also differences in attitudes percent were from that area, an increase of 29 of patients toward key social and health ques- percent. tions. The students reported that they felt the major reason for this change resulted from Woodlawn Hospital changes in payment policies of the welfare de- This is a small hospital (145 beds) located in partment. They said: the heart of a Negro community on the south Until 2 years ago the attending physi- side of Chicago. There are no out-patient clinic cian was not paid for his services to services and the work performed by the as- welfare in-patients although the hos- signed students included a survey of in-patient pital did receive payment for hospital and emergency room utilization. costs. With the change in payment policy that occured in 1966, the hospi- The data for in-patient utilization, by com- tal staff physicians began to refer munity of residence, is described in table VI. welfare recipients to the hospital. The data are for 1 year's experience. Three community areas account for 37.7 percent of They felt other f actors were: the patients admitted in this 1 year. These are An increase in the resistance of Cook the communities in which the hospital itself is County Hospital toward admitting located, the one directly north and the one di- patients transferred from other hos- rectly south of its physical plant. One of these pitals and an increased reluctance of (Woodlawn) is a poverty area, the other two the emergency room physicians to are not. transfer border line cases has re- Five other community areas account for 18.5 sulted in a rise of admissions to percent of the annual admissions. Three of Woodlawn Hospital from its emer- these are further south of the hospital and two gency room. * * * of them are north of it. None is far away geo- The final point they make as to reasons for graphically. Four of these are poverty areas the change, is: and one is not. Another 17 percent of the patients come An administrator with a greater from nine community areas. There were 50 or awareness of a need for a responsible attitude toward the community, as- more patients from each who were admitted sisted by a hospital staff with a that year. Four of these were poverty areas changing outlook, may also have con- and five were not. tributed substantially to bring about Patients from outside the city accounted for the increase in admissions from the an additional 8 percent of the patients. community surrounding the hospital. There has been a change in the geographic The study of emergency room patients con- distribution of admissions from 1965. Medical- sisted of observations of the functions of the surgical services admissions to Woodlawn Hos- emergency room and telephone interviews of 30 pital in February 1968 compared with that in patients who had been treated thIere. The reac- February 1965 revealed that admissions from tion of the students was that there were two the Woodlawn area (where the hospital is lo- major problems in emergency room function. cgted) increased by 70.7 percent from 196@ First, a large percentage of the emergency 8.2 percent in that year and 14.0 percent in room visits were not genuine emergencies and 1968 admitted from the area. The change for secondly the inability of many of the patients the rest of the southeast section which Wood- coming to the emergency room to pay for their lawn serves was not as dramatic. In this case, medical care resulted in problems for the pa- 29 percent of the patients admitted in Febru- tients. 105 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The first observation is, of course, one that Michael Reese Hospital many emergency rooms in urban centers are This hospital is the largest private hospital concerned about, i.e., their utilization as a phy- (933 beds) and second largest hospital in Chi- -sician to the nearby community(ies), instead cago. Its out-patient clinics serve approxi- of their utilization as true emergency centers. mately 115,000 patient visits per year. In their second observation, the students The hospital is located on the edge of a black noted that the great majority of emergency and poor community. Indeed, at one time the room patients were either on public assistance hospital itself was part of such a community. or were unable to pay for their care. In the lat- However, urban renewal changed the character ter case, if a patient was not on categorical as- of the neighborhood immediately surrounding sistance or Medicare, a financial deposit was the hospital. Now much of the land is used by required prior to admission unless he was ex- educational and medical institutions, including tremely ill and absolutely could not be trans- Reese's expanded facilities, and the remainder ported. In less extreme cases, patients'without of the immediate community consists of high a source of payment, were generally trans- rise apartment buildings for middle and upper ferred to Cook Country Hospital if the trans- middle income population. fer was accepted (as it usually is). Here'again, this situation is repeated many times in hospi- Students at this site reviewed data on clinic tals around the city, and doubtless in other cit- utilization by community area. They also ies around the country. worked in the pediatric out-patient clinic The students conducted telephone interviews where a new mode of delivery of health care with 30 patients. had been instituted in the immediate past. (New, in the sense that it was a change from Twenty-two of the 30 questioned. chose to their previous mode of delivery.) In addition come to Woodlawn because it was closest to they surveyed charts in the emergency room, their homes. Twenty-five thought it was a good again reviewing for utilization data by areas of hospital. Nineteen patients stated that they residence. had private doctors, while 11 did not. Eleven The students undertook a review of 500 of the 19 said that they went to their private physicians regularly. charts of patients seen in the outpatient clinics (excluding pediatrics) in June of 1968. Unfor- They were also asked for their opinions as to tunately, they did not conduct a citywide tabu- the best place for health care and 12 thought lation of the clinic's population. Instead, they Woodlavm Hospital was, five thought. Cook collected the information pertinent to the num- County was and only seven thought a private bers from four community areas close to the physician was the best source of health care. hospital. Their figures indicated that 205 (41 Four of the remaining six had no opinion on percent) of the 500 charts represented people the subject. living in those four areas. A separate survey of Thirteen of the patients reported they pai 217 charts in the pediatrics clinics showed that 91 (42 percent) of these patients came from for their medical care themselves and three hact insurance coverage for such costs. The remain- the same four areas. In 485 emergency room ing 14 were eligible for public funds including records 274 (56.5 percent) patients were from Medicare. i@e four areas. It is apparent that an impor- tant segment of the population served by the Apparently, loyalty to the health purveyor ambulatory facilities of this hospital reside in of choice, even when the choice is made pri- the four community areas adjacent to the site marily by geographic location, remains high. of the hospital. One of them is the one in This appears to be true for this small hospital which the hospital itself is peripherally lo- as well as for the major ones referred to pre- cated; the other three are just southeast and viously. southwest of it. 106. CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The students also reviewed in-patientadmis- background of a staff which is accus- sions for the community areas from which tomed. to working within a frame- they came. They reported that of 1,791 dis- work of administration-centered med- charged patients, only 10.2 percent came from ical care when the new orientation the four community areas discussed. and structure of the clinic is patient- The students who worked in the pediatrics centered* * * however, the persist- clinics described changes m@ade by the hospital ance of the old attitudes in the staff administration which emphasize the delivery prevents there being any significant of preventive care as well as continuing to de- change in the attitudes of the patients liver crisis or symptom-oriented care. being served * * * there hasn't been The new organization of the pediatrics clin- a tremendous change in the parts of ics was described as based on an appointment the system which the patients find ir- system. Patients were screened and referred to ritating, e.g., waiting time, hurried the appropriate source of care. They were then care by doctors, treatment by the assigned a specific physician whom they are staff, bewilderment and lack of supposed to see each time they come. Blocks of communication * * *. Much of the time in the appointment system are left un- discontent remains because the new scheduled so that physicians may also see system is a new stone in the same old walk-ins. A telephone service (TOT line) is setting. Patients must still wait for now available to parents. The parent may call lab reports, X-ray results, shots, in at any time of day or night. A nurse moni- pharmacy services * * *. torg this telephone and acts as a screening However, the strengths of the new officer. She determines the nature and serious- approaches are also described: ness of the problem, acts in a reassuring fash- "There are at least three great ion, if indicated, and makes a judgment as to virtues * * *. First, the clinic is ca- the disposition of the problem. pable of and is providing better and more dignified care to more people be- Another innovation for this unit is a termi- cause of increased manpower, longer nal collection of fees system. Previously, pa- hours, and the physical changes tients paid for each service at the point where Second, the clinic provides an ex- or when the service was rendered. If more perimental milieu in which not only than one service was rendered the patient paid new methods of providing care can more than one time. The current system per- be studied, but also the fairly new mits the patient to pay once at the termination concept of studying methods in phy- of all his clinic services. sician education * * * finally, this The physical environment has been made clinic, and in particular, the new com- more attractive and comfortable; more equip- prehensive care clinic provides an ment is available; and additional nonprofes-,. excellent model * * * of some of the sional staff --have been employed to expedite new concepts in private or rather gen- processing of patients.. eral practice * * *. While this learning experience seemed to be All of the students at this site were compli- mentary to the staff and administration of'this a positive one for the students nonetheless they were critical of problems that still remained to institution as being a progressive, enlighte be solved. Several quotations from their re- group who were seriously concerned with e- Ports would be in order: livery of health care to poor populations. * * * One of the greatest diffi- culties that this program began with Provident Hospital and is constantly hampered by is the This is a hospital with a predominantly 107 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Negro staff and almost all Negro patients. It is emergency rooms of Mercy and Billings Hospi- located in the heart of one of Chicago's largest tals. Billings has been described previously in Negro ghettoes. It is a small hospital with 204 the section on the University of Chicago Hospi- beds which has been struggling for many years tals. Mercy is a church-related (Roman Catho- to maintain itself. It has had to close its out- lic) institution of 355 beds. It has out-patient patient facilities for lack of funding as well as clinics as well but no students were placed having been forced to close its nursing school there. It is located on the near south side of and internship and residency programs. De- Chicago in what was a poor Negro community. spite many obstacles and lack of support it Urban renewal has changed some of the char- continues to provide care for a substantial seg- acteristics of the community but the hospital is ment of the black population. still most closely adjacent to all black, generally The students at this site were involved in poor communities. service roles as well as observation and data At Mercy Hospital, during one week in Au- collection. The health science student worked gust, 1968, every third patient who used their in the blood bank facilities and occasionally emergency room was tabulated for community assisted the technicians when they had heavy area of residence, age, sex, race, source of re- work loads. The high school students partici- ferral, time of arrival, diagnosis, disposition, pated in a number of unskilled jobs in the hos- and source of payment for care. Similar data pit@l were gathered for the Billings emergency room using one week in April, 1968 as the )ase. The students also worked in an educational program in the community disseminating in- Data for area of residence of patients using formation about lead poisoning. The residents both f acuities are described in table VII. Data of this particular community are involved in a relative to variables appear in table VIII. cami)aign for passage of an amendment to the The largest numbers of patients from any city housing code that will provide some safe- one community area using Mercy were from guards against lead poisoning. However, no the community of Bridgeport. This part of the major involvement on the part of the hospital city is composed of people of different ethnic f or a lead toxicity detection program was feas- backgrounds but is all white. It is primarily a ble. working and middle el-ass community and is lo- The suggestions for closer relationship of the cated slightly south and west of the hospital. A hospital with its surrounding community. are large proportion of its residents are communi- quoted from the student's report: cants in the Roman Catholic Church. (It is I know only to give it enough money also the home of the mayor of the city of Chi- to expand its facilities, reopen its cago). The next largest number came from the clinics, reestablish its nursing school, all black communities of Grand Boulevard (CA attract residents and interns and then 38) and Douglas (CA 35) both of them to the younger doctors * * * put residents south of the hospital. of the community on its board and on Unlike the population utilizing the Univer- its policy determining committees sity of Chicago clinics, the largest number of patients coming to Billings emergency room EMERGENCY ROOMS were from Woodlawn (25.5 percent), the area directly south of the hospital (across'the Mid- Mercy and Billings Hospitals way). The second largest group came from While students actively participated in inter- Hyde Park just north of the hospital. It would views with patients using emergenIey rooms in appear that in the utilization of these enier- six of the hospitals, specific data about some of gency rooms, geography is still a major factor. the parameters of the populations was recov- That many patients use the geographically ered for only two of them. These were the convenient emergency rooms as doctors' offices 108 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 is supported by the data relative to diagnoses They elected not to use a structured ques- of patients, disposition of cases, and time of ar- tionnaire for the latter task since they felt rival at the facility. (See table III.) In both there were too many forms a patient had to fill hospitals' emergency rooms, the majority of out in the course of hospital routine without patients were treated for general medical prob- adding another. Some patients were inter- lems and sent home. The next largest group was viewed in the emergency room area but others referred for care to the hospitals' out-patient were interviewed by telephone or at their clinics and the third largest group were re- homes. This latter technique was selected to f erred to other hospitals or doctors. In both determine reactions after the stress situations hospitals, fewer than 10 percent of the patients that brought the patient to the hospital had seen were admitted to the hospital for care. been removed or ameliorated. When the stu- Time of arrival at the emergency room indi- dents conducted interviews in the hospital area cates that their experience is the same as that they sometimes wore white uniforms and per- in many urban emergency rooms. The peak mitted the patients to view them as hospital staff. However, in some cases they simply de- load is after 5 p.m.. and prior to midnight. This scribed themselves as.Student Health Organi- would seem to support the contention that pa- zation students with no vested interest in the tients tend to come to such facilities when hospital. Their feeling was that their image in transport is more readily available at the end of a work day or when some source of care is the patient's view did little or nothing to more readily available for children left at change the nature of the responses. home. The patients interviewed in the hospital were The source of payment for medical care was quietly -accepting of the interview and coopera- not available for the Billings patients. It would tive. One of the employees pointed out subse- have been interesting to note whether the quently that the patients were very " humble source in Billings emergency rooms, with its and fearful while in the hospital setting. How- substantial numbers of patients from Wood- ever, once the site of the interview was the lawn, was different from the source of payment home of the patient, the students met with for patients who use the University of Chicago -great suspicion and distrust and had much dif- clinics for ambulatory care. ficulty in locating and interviewing the pa- tients. The majority of the patients seen at Mercy The students at this site also acted as "pa- (59 percent) were insured and the second larg- tient advocates." This was defined as assisting est group paid for their own care. Only 19 per- the patients in any way they could. They cent were supported by public funds. helped patients find their way to the services needed; they intervened with an administrator St. Bernard's Hospital on behalf of a patient who felt he should be re- This hospital is a 229 bed Roman Catholic f unded a fee since no service was rendered him; Church related institution located on the south and they helped a patient to another source of side of Chicago further south than the others care when he was referred to it. Having reported on so far and slightly west of them. learned some things themselves about how to Students working in their emergency room move through the maze of a hospital system, described themselves as "participant observ- they were able to ease the 'Paths of patients ers." The major objective as they defined it without similar knowledge. was to observe and gain impressions of W.Ilat There was one other emergency room in a happened in the emergency room. A second ob- hospital in Chicago which was not originally jective was to interview patients to determine selected as a site. However, a student was there the patients' impressions of what happened in on the night shift to informally observe their an emergency room. emergency room procedures. This was a hospi- 109 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tal which contracted with a corporation to em- the area and that the hospital is much con- ploy physicians to staff the emergency room. cerned with its public image. While some of these agencies provide -good emergency room staffing, it was the observa- Student Reaction tion of this individual student that this parti- At the end of the summer's work each stu- cular one did not. dent wrote a report on his activities during the The student felt that with the difficulty of project. There was a uniformity of reaction obtaining qualified physicians, most of those among the students at all the hospital sites. In working a night shift did so as a second posi- each case the students reported that they had tion. Therefore, in his opinion, they are fre- had an important learning experience per- quently very tired and there is an underlying sonally; in almost -all cases the students ques- hostility to patients, especially those whom tioned whether they had contributed anything they feel are not genuine emergencies. He to their site or to the project as a whole. Even- thought that there was no ongoing relationship those who felt they had made some contribu- between such a physician and his patient and tion considered it to be a negligible one. An ob- that this -affected the type of care rendered the jective review of all the report, indicates how- patient. ever, that their microcosmic, subjective view is In the observer's view: not wholly accurate. It is understandable, but "The staff never attempts to deal not accurate. with problems considered outside its As has been. stated elsewhere, this was a 10- province. It is only interested in week project. In almost all of the hospital reaching decisions about the follow- sites, a period of from 1 to 3 weeks was de- ing * * * (1) Discovering the chief voted to orientation of the students. The last complaint of the patient; (2) render- week was a windup week. This left 6 or . 7 ing symptomatic relief as well as first weeks for the students to actually become in- aid and supportive care in true emer- volved in the work at their site. Some of the enders "ad- students recognized that this time dimension gencies; this facility r vanced first aid," (3) determining limited their effectiveness but others appeared whether it is absolutely necessary to to have had higher goals than might have been admit indigent patients. Most indi- realistic. gents are sent to Cook County * * *. Uniformly the students were critical of the In general, indigents receive an ab- modes of delivery of health care that they ob- solutely minimal amount of care." served in - the institutions in which they The student indicated that this hospital's pa- worked. (All of their experiences were limited tient area is in excellent physical condition and to ambulatory service areas.) Their comments on very busy nights the area is often filled ran.ged from friendly, respectful observations with patients. The atmosphere, at night, he to hostile declarations. found to be generally friendly. There appeared Some selected quotations from a few reports to be a rigidly structured relationship pattern might highlight the range of critical comment: with little or no overlap of function, between We choose not to evaluate the different strata of personnel, i.e., physi- such a * * * center on the basis and cian, nurse, technician. One of the reasons for in terms of its own inherent inade- this the student thought was that the physi- quacies however for we have not the cians were under the supervision of the outside medical, institutional, or practical re- contracting agency, while the hospital adminis- sources to justify such a discourse, nor trator supervises the other personnel. can we underestimate the professional He felt there was evidence that the adminis- competence and vigor with which trator is interested in improving efficiency of these inadequacies are now being at- 110 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 tacked. We choose rather to air a ally the case * * * The underlying at- more general commentary that re- titude of the night staff toward the lates these inadequacies to the more patients is one of hostility The general problems which confront med- staff is especially hostile toward pa- icine today and to those more per- tients who enter the facility without vasive ones deeply rooted in the whole true emergency needs fabric of our society * * * . One other comment: * * * We spent sometime trying The doctor's divorce from the to determine what forces constrain the emergency room to be inadequate. community is mirrored by the corn- This attempt has been generally un- munity's reaction to it. The mothers I talked to are adamantly opposed successful In retrospect, we to taking their children there have devoted our time to the most im- portant of the answerable questions, One statement, more general in nature, is a but it is the unanswerable questions creditable summation of the views of the stu- which are most interesting * * * we dents: have had complete cooperation from Health care planning seems to the hospital, and are on a friendly have rarely taken account of the basis with the administration and felt needs of the patients who are to emergency room personel. be served. When the patient popula- * * * We became aware of some of tion is generally white middle class the advantages and disadvantages there are fewer "problems"-the of the small inner-city hospital. health planners themselves being of Among the advantages were a greater this milieu, have the same expecta- feeling of "belonging" experienced by tions and concepts of health care, hospital employees and patients, and health and disease. When the patient an administration shielded bya mini- population is, for example, Appa- mal bureaucracy. Among the disad- lachian white, Mexican, Puerto Rican, poor urban black, middle class black, vantages were that many of the ser- at the vices were inefficient* * * * as they etc. it is entirely pcissible th involved expensive equipment infre- white middle class standards and ex- quently used, and the difficulty.in at- pectations of health care, concepts of tracting young physicians with larger disease, the role of the doctor etc.- all that which is built into the typical institutions nearby urban hospital or neighborhood There were several unfriendly comments. health cent'er-do not conform to Some of these were as follows: those standards, expectations, etc. of * * * If patients receive good med- the patient population. The result is ical care it isn't so much due to the very possibly a relative failure of the dedicated staff * * * but to the in- program." tervention of the administrator * * * We object to the fact that medical care Summary should depend on the humaneness of Students working in hospital sites acted as one individual. It is a right, not some- observers in emergency rooms and out-patient thing administered condescendingly clinics to learn how health care is purveyed to primarily poor, black populations. At a number The patients may wait up of sites, they collected data relative to patient to 3 hours on a busy night, especially utilization of clinics and emergency rooms for if the physician is tired, which is usu- area of geographic origin, race, sex, and other ill CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 variables. They acted as patient advocates in that they had successfully completed their as- some cases and.participated in service roles in signed tasks in most instances. They had made others. Uniformly, they Were critical of modes a contribution to several institutions in the of delivery of health care services to the popu- work they undertook. In all cases, they felt lation observed. They felt that there was little that their summer's experience in the Student or no impact resulting from their presence in Health Project had been a profound learning the summer project. one for them and that its impact upon them Actually, when they detailed their experi- would have important implications for their ences in their respective projects, it appeared future career goals. Table I.-Outpatients attending Fantv-s Clin'w, Cook County Hospital, by commu?dtY of r@dence, July 24,1968 sex Age Race Coimunity F-m-l- Under 15 15 to 44 45 to 64 66 and over White Negro Other 1ARogers Park A-------------- ------ 1------ ------ ------ 1 1------ ------ IB Rogers Park B------------- I------ ------ 1------ ------ 1------ ------ 2 West Ridge ----------------- ------ I------ ------ ------ 1 1------ ------ SA Uptown A------------------ I- ------ ------ I------ ------ ------ ------ 1 3B Uptown B------------------ 4 4------ 4 4------ 7 1------ 4 Lincoln Square ------------- ------ ------ ------ ------ ------ ------ ------ ------ ------ 5 North Center --------------- 2------ ------ I------ 1 1 1------ 6A Lake View A-------------- - ------ ------ ------ ------ ------ ------- ------ ------ ------ 6B Lake View B----------------1 4 4 1 4 1 2 8------ ------ 7A Lincoln Park A-------- ---- 1------ I------ ------ ------ ------ I------ 7B Lincoln Park B------- ------ 2 1------ 2------ I I 1 1 8A Near North A--------------- I------ 1------ ------ ------ I------ ------ 8B Near North B--------------- 17 11 4 15 6 a 7 20 1 9Edison Park ---------------- I------ ------ ------ 1------ ------ 1------ 10 Norwood Park --------------- ------ I------ ------ ------ 1 1------ ------ 11 Jefferson Park --------------- ------ ------ ------ ------ ------ ------ ------ ------ ------ 12 Forest Glen ----------------- 1------ ------ ------ ------ I I------ ------ 13 North Park ----------------- ------ ------ ------ ------ ------ ------ ------ ------ ------ 14 Albany Park ---- ----------- I 1------ 1 1------ I I------ 15 Portage Park --------------- 3----- 1 1------ 1 2 1------ 16 Irving Park ----------------- 1 1------ ------ ------ 2 2------ ------ 17 Dunning -------------------- I------ ------ ------ 1------ 1------ ------ 18 Montelare ------------ ------- ------ ------ ------ ------ ------ ------ ------ ------ ------ 19 Belmont Cragin -------------- ----I-- ------ ------ ------ ------ ------ ------- -- --- ------ 20 Hermosa -------------------- ------ ------ ------ ------ ------ ------ ------ ------ ------ 21 Avondale ------------------- 2------ ------ 2------ ------ 1------ I 22 Logan Square ---------------- 7 6 1 4 3 5 10 2 1 23 Humboldt Park -------------- 6 6 2 6 2 2 4 6 2 24 West Town ----------------- 12 10 ------ 9 9 4 16 4 2 25 Austin ---------------------- 11 5 3 8 5------ 7 9------ 26 W. Garfield Park - 25 28 16 27 5 5 3 50 ----------- 27 E. G@eld Park ------------- 32 40 23 34 8 7 4 67 28 Near West Side -------------- 67 50 26. 48 30 13 17 95 5 29 North Lawndale -------------- 62 47 45 88 19 7 6 103 1 30 South Lawndale --------------- 4 1------ 2 1 2 3 ------ 2 31 Lower West Side ------------ 3 3------ 2 2 2 3 2 1 32 Loop ------------------------ 6 1 1 2 1 4 2------ 112 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Sex Age Race Community Male Female Under 16 15 to 44 45 to 64 65 and over White Negro Other 33 Near South Side ------------- 2 3 2 1------ 2------ 5 34 Armour Square -------------- 2 1 1 2------ ------ ------ 8------ 35A Douglas A------------------ 1 1 1------ I------ ------ 2------ 35B Douglas B------------------- 15 19 8 16 7 3 2 31 1 36 Oakland --------------------- 12 8 3 8 7 2 1 19 ------ 37 Fuller Park ----------------- 3 7 2 5 3------ ------ 10 ------ 38 Grand Blvd - ----------------- 55 51 22 44 25 15 3101 2 39A Kenwood A------------------ I I 1 1------ ------ 1 1------ 39B Kenwood B------------------ 6 6 3 7 1 1 2 10 ------ 40 Washington Park ------------ 24 31 8 26 13 8 1 53 ------ 41A Hyde ParkA--------------- 1 1------ I------ I------ 2------ 41B Hyde Park B---------------- 1 5------ 4 1 1------ 6------ 42 Woodlawn ------------------- 24 20. 11 18 12 3------ 44 ------ 43ASouth Shore A-------------- 2 5------ 3 3 1------ 6 1 43B South Shore B--------------- 3 7 3 4 2 1 1 9------ 44 Chatham -------------------- 8 8 4 5 3 4 2 14 ------ 45 Avalon Park ---------------- 2 1 1 2------ ------ ------ 3------ 46 South Chicago --------------- 5 5 1 6 1. 2 2 7 1 47 Burnside -------------------- 1------ ------ ------ 1------ ------ 1----- 48 Calumet Heights ------------- ------ I------- 1------ ------ I------ ------ 49 Roseland -------------------- 4 4------ 3 3 2 2 6------ 50 Pullman -------------------- ------ ------ ------ ------ ------ - ------ ------ ------ ------ 51 South Deering --------------- ------ ------ ------ ------ ------ ------ ------ ------ 52 West Side ------------------- - ---- ------ ------ ------ ------ ------ ------ ------ ------ 53 West Pullman --------------- ------ ------ ------ ------ ------ ------ ------ ------ ------ 54 Riverdale ------------------- 8 6 4 7 2 1 1 13 ------ 55 Hegewisch ------------------ 1------ ------ ------ I------ ------ 1------ 56 Garfield Ridge --------------- ------ 2------ 2------ ------ ------ 2------ 57 Archer Heights -------------- ------ ------ ------ ------ ------ ------ ------ ------ 58 Brighton Park --------------- ------ 2------ ------ 2------ I 1------ 59 McKinley Park -------------- ------ ------ ------ ------ ------ -- ------ ------ ------ 60 Bridgeport ------------------ 3 2 1 2------ 2 4 1------ 6i New City -------------------- I 5 1 4------ 1 1 5------ 62 West Elsdon ---------------- I------ ------ ------ ------ 1------ ------ 63 Gage Park ------------------ ------ ------ ------ ------ ------ ------ ------ ------ ------ 64 Clearing -------------------- ------- ------ ------ ------ ------ ------ ------ ------ ------ 65 West Lawn ----------------- ------ 1------ I------ ------- 1------ ------ 66 Chicago Lavm --------------- --- 2 1------ 1------ I 1------ 67 West Englewood ------------- 15 11 8 14 4------ 4 22 68 Englewood ------------------ 26 47 11 42 15 5 6 66 69 Grand Crossing -------------- 17 13 7 12 5 6 2 27 70 Ashburn -------------------- ------ I ----- ------ 1------ I------ ------ 71 Auburn Gresham ------------ 7 7 8 3 2 1 2 12 ------ 72 Beverly --------------------- 2 ------ ------ ------ ------ 2 2------ ------ 73 Washington Heights ---------- 2 3 2 3------ 1 4------ ------ 74 Mount Greenwood ------------ ------ ------ ------ ---- ------- ------ ------ ------ ------ 75 Morgan Park ---------------- 3 6 2 3 3 1 ------ 9------ Total --------------------- 536 514 241 462 220 126 159 864 27 Total percentage ----------- ------ ------ 23 44 21 12 15.1 82.3 2.6 113 CHICAGO'STUDENT HEALTH PROJECT SUMMER 1968 TABLE II.@ommunity area of residence outpatients attending Fantus, University of Chicago and Presbyterian-St. Luke's Hospital Clinics 0 0 d Community area (number and name) 4 0 N H Community area (number and name) 41 I Rogers Park -------- 2 2 1 6 40 Washington Park --- 55 13 14 82 2 West ridge ---------- 1 3 0 4 41 Hyde Park --------- 8 29 1 38 3 Uptown ------------ 9 1 1 11 42 Woodlawn ---------- 44 27 18 89 4 Lincoln Square ----- 0 1 6 7 43 South Shore -------- 17 23 4 44 5 North Center ------- 2 0 0 2 44 Chatham ----------- 8 14 19 41 6 Lake View --------- 8 31 2 13 45 Avalon Park -------- 3 2 1 6 7 Lincoln Park -------- 4 0 6 10 46 South Chicago ------ 10 '6 1 17 8 Near North -------- 29 1 21 51 47 Burnside ----------- I 0 1 2 9 Edison Park -------- I 0 0 1 48 Calumet Heights ---- 1 7 5 13 10 Norwood Park ------ I 0 0 1 49 Roseland ----------- 8 9 7 24 11 Jefferson Park ------ 0 0 1 1 50 Pullman ------------ 0 0 2 2 12 Forest Glen -------- 1 0 0 1 51 South Deering ------ 0 4 0 4 13 North Park -------- 0 0 1 1 52 East Side ---------- 0 1 1 2 14 Albany Park -------- 2 2 3 7 53 West Pullman ------ 0 4 2 6 15 Portage Park ------ 3 2 2 7 54 Riverdale ----------- 14 1 2 17 16 @ng Park -------- 2 1 3 6 55 Hegewisch ---------- 1 0 1 2 17 Dunning ------------ 1 1 3 5 56 Garfield Ridge ------ 2 1 4 7 18 Montelare ---------- 0 0 0 0 57 Archer Heights ----- 0 0 1 1 19 Belmont Cragin ---- 0 0 2 2 58 Brighton Park ------ - 2 3 2 7 20 Hermosa ----------- 0 0 0 0 59 McKinley Park ------ 0 0 2 2 21 Avondale ----------- 2 1 2 5 60 Bridgeport ---------- 5 1 6 12 22 Logan Square ------ 13 0 14 27 61 New City ----------- 6 3 8 17 23 Humboldt Park ------ 12 1 14 27 62 West Elsdon -------- 1 2 1 4 24 West Town -------- 22 5 31 58 63 Gage Park ---------- 0 3 3 6 25 Austin ------------- 16 1 85 52 64 Clearing ----------- 0 1 0 1 26 W. Garfield Park ---- 53 0 92 145 65 West Lawn --------- I 0 1 2 27 East Garfield Park -- 72 1 137 210 66 Chicago Lawn ------ 2 5 4 11 28 Near West Side ---- 117 2 150 269 67 West Englewood ---- 26 4 20 50 29 North Lav;ndale ---- 109 3 123 235 68 Englewood --------- 73 6 40 119 30 South Lawndale ---- 5 1 12 18 69 Grand Crossing ------ 30 20 ' 15 65 31 Lower West Side ---- 6 0 17 ' 23 70 Ashburn ------------ I 5 1 7 32 Loop --------------- 6 1 4 11 71 Auburn Gresham ---- 14 9 14 37 33 Near South Side ---- 5 1 4, 10 72 Beverly ------------ 2. 2 0 4 34 Armour Square ---- 3 1 4 8 73 Washington Heights 5 7 6 18 35 Douglas ------------ 36 5 12 53 74 Mount Greenwood 0 1 0 1 36 Oakland ------------ 20 1 4 25 75 Morgan Park ------ 9 4. 6 18 37 Fuller Park -------- 10 0 4 14 Out of City -------- 0 78 40 118 38 Grand Boulevard ---- 106 6 81 143. 39 Kenwood ----------- 14 4 6 Total --------- 1,050 346 1,000 2,396 1 One day's experience, July 24, 1968. 2 Unknown time period. 11 Sequential sampling total active clinic population. 114 SUMMER 1968 CHICAGO STUDENT HEALTH PROJECT TABLE III.-Presbyte@n-St. Luke's Variables Number Hospital Clinic Population Medical assistance-no grant ------------ 9 Other sources - - -7- - - - - - - - - - - - - - - - - - - - - -18 Variables Number Age: Total -------------------------------- 1,000 0 to 5 years ---------------------------- 165 6 to 12 years --------------------------- 152 13 to 18 years -------------------------- 130 TABLE IV.-University of Chicago clinics 19 to 34 years -------------------------- 248 35 to 64 years -------------------------- 221 Number Percent 65 years and older ---------------------- 94 Age: Total -------------------------------- 1,000 0 to 16 years ------------------ 56 16.2 Sex: 17 to 40 years ---------------- 132 38.1 Male ----------------------------------- 339 41 to 64 years ----------------- 116 33.6 Female --------------------------------- 661 65 and over ------------------ 39 11.3 Not known -------------------- 3 .8 Race: Total -------------------------------- 1,000 Total ----------------------- 346 100 White ---------------------------------- 233 Race: Negro ---------------------------------- 722 White ------------------------ 193 55.7 Spanish-speaking ------------------------ 36 Negro --------- -------------- 139 40.1 Other ---------------------------------- 9 Other ------------------------ 12 3.5 Not known -------------------- 2 .6 Total -------------------------------- 1,000 Initial clinic of admission: Total ----------------------- 346 100 Medicine ------------------------------- 195 Sex: Pediatrics ------------------------------ 358 Male ------------------------- 135 39.1 Surgery -------------------------------- 106 Female ----------------------- 211 60.9 Surgery subspecialties ------------------ 81 Total ----------------------- 346 100 Obstetrics and gynecology ------------------- 216 Source of payment: Psychiatry (adult and child) ---------------- 41 Medicare ---------------------- 38 11 Other ---------------------------------- 3 Other public fund -------------- 15 4.3 Total -------------------------------- 1,000 Insurance --------------------- 26 7.5 Source of payment for medical care Self-payment ------------------ 247 71.3 Self (full pay) --------------------------5 Not known -------------------- -- 20 5.8 Self (part pay) ------------------------ 540 Total ----------------------- 346 100 Public assistance ------------------------ 428 TABLE V.-University of Chicago clinics: Dist@bution of variable by clinics Age Name of clinic Total 0 to 16 years 17 to 46 yean 41 to 64 years 65 years and ovei Not known Medicine ---------------- 107 0 28 52 26 1 Pediatrics --------------- 18 18 0 0 0 0 Obstetrics and gynecology - 62 11 37 14 0 0 Surgery ----------------- 16 0 7 7 2 0 Neurosurgery ------------ a 0 1 2 0 0 Plastic surgery ---------- 5 1 3 1 0 0 urology ----------------- 14 1 6 5 2 0 Orthopedics surgery ------ 24 3 14 6 1 0 Eye --------------------- 25 8 9 5 3 0 Ear, nose, and throat ---- 26 4 6 15 1 0 Psychiatry -------------- 22 1 16 5 0 0 Dermatology ------------- 13 1 2 41 6 0 Nutrition ---------------- 5 0 0 5 0 0 Unidentified ------------- 6 0 2. 4 0 0 Total ------------- 346 48 (13.1 131 (37.9) 125 (36.1) 41 (Il.E 1 (.3) CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Sex Name of clinic Male Female Medicine ------------------ 52 55 Pediatrics ------------------ 8 10 Obstetrics and gynecology --- 0 62 Surgery -------------------- 5 11 Neurosurgery -------------- 0 3 Plastic Surgery ------------- 4 1 Urology ------------------- 8 6 Orthopedic Surgery ........ 11 13 Eye ----------------------- 11 14 Ear, Nose and Throat ...... 11 15 Psychiatry ----------------- 15 7 Dermatology --------------- 7 6 Nutrition ------------------ 0 5 Unidentified ---------------- 3 3 Total ---------------- 135 (39.0) 211 (61.0) Race Name of clinic White Negro er Medicine -------- 61 38 8 Pediatrics ------- 4 14 0 Obstetrics and 18 42 2 gynecology. Surgery -------- 13 a 0 Neurosurgery --- 3 0 0 Plastic surgery --4 1 0 Urology --------- 7 7 0 Orthopedic 13 11 0 surgery. Eye ------------ 18 9 8 Ear, Nose, and 20 6 0 Throat. Psychiatry ------ 22 0 0 Dermatology ---- 10 2 1 Nutrition ------- 1 4 0 Unidentified ----- 4 2 0 Total ----- 193 (55.8) 189 (40.2) 14 (4.0) Source of payment Medicare Other public Insurance Self pay Unknown Medicine -------------------------------- 27 ------- ------- 80 ------- Pediatrics ------------------------------- -------- ------- -- ---- --------- 18 OB-GYN -------------------------------- -------- 15 26 19 2 Surgery --------------------------------- 2 ------- ------- 14 - ------- Neurosurgery ---------------------------- -------- ------- ------- 3 ------- Plastic surgery -------------------------- -------- ------- ------- 5 ------- Urology --------------------------------- 1 ------- ------- is ------- Orthopedic surgery ----------------------- I ------- ------- 23 ------- Eye ------------------------------------- 2 ------- ------- 23 ------- Ear, Nose and Throat --------------------- I ------- 1 25 ------- Psychiatry ------------------------------- -------- ------- ------- 22 ------- Dermatology ----------------------------- 1 4 ------- ------- 9 ------- Nutrition -------------------------------- -------- ------- ------- 5 ------- Unidentified ---------------------- - -------- ------- ------- 6 ------- Total ----------------------------- i 38 (11.0) 15 (4.3) 2C (7.5) 247 (71.4) 20 (5.7) 116 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 TABLE VI.-Woodlawn Hospital: Inpatient Number of admissions July 1, 1967 to June 30, 1968 Community area (number and name admissions Percent' 4 Number of 55 Hegewisch ------------ .1 Community area (number and name) admissions Percent 56 Garfield Ridge -------- 8 .2 57 Archer Heights -------- 2 .05 1Rogers Park ---------- 16 0.4 58 Brighton Park -------- 5 .1 2West Ridge ------------ 7 .2 59 McKinley Park -------- 1 .03 3Uptown --------------- 26 .7 60 Bridgeport ------------ 14 .4 4Lincoln Square -------- 1 .03 -- 48 1.3 61 New City ----------- 5North Center --------- 0 ---- 62 West Elsdon ---------- 1 .03 6Lake View ------------ 14 .4 63 Gage Park ------------ 3 .08 7Lincoln Park ---------- 11 .3 64 Clearing -------------- 9 .2 8Near North ----------- 13 .3 65 West Lawn ------------ 14 .4 9Edison Park ---------- 0 ---- 66 Chicago Lawn ----- !.-- 34 .9 10 Norwood Park -------- 2 .05 67 West Englewood ------ 62 1.6 11 Jefferson Park -------- 2 .05 68 Englewood ------------ 180 4.8 12 Forest Glen ----------- 1 .03 69 Grand Crossing -------- 143 3.8 13 North Park ------------ 3 .08 70 Ashburn -------------- 26 .7 14 Albany Park ---------- 3 .08 71 Auburn Gresham ------ 90 2.4 15 Portage Park ---------- 3 .08 72 Beverly --------------- 8 .2 16 Irving Park ---------- 4 .1 73 Washington Heights --- 45 1.2 17 Dunning -------------- 0 ---- 74 Mount Greenwood ----- 10 .8 18 Montclare ------------- 0 ---- 75 Morgan Park ---------- 24 .6 19 Belmont Cragin -------- 3 .08 Out of City ----------- 815 8.3 20 Hermosa --------------- 0 ---- Unknown ------------- 2 .05 21 Avondale -------------- 1 .03 22 Logan Square --------- 5 .1 Total --------------- 3,800 100.4 23 Humboldt Park -------- 3 .08 1 Rounded to next larger number. 24 West Town ------------ 7 .2 25 Austin ----------- ---- 12 .3 TABLE VII.-Community Areas Of Residence: 26 West Garfield Park ---- 3 .08 Patients Seen In Emergency Roms of Mercy 27 East Garfield Park ---- 10 .3 28 Near West Side -------- 13 .3 and Billings 29 North Lawndale ------ 10 .3 name) Billings Mercy 30 South Lawndale 3 .08 31 Lower West Side ------ 5 .1 23 Humboldt Park --------------- I 32 Loop ------------- --- 1 .03 28 Near West Side -------------- 2 1 33 Near South Side ------ 7 .2 29 North Lawndale -------------- I --- 34 Armour Square -------- 56 1.5 30 South Lawndale -------------- 1 2 35 Douglas -------------- 44 1.2 31 Lower West Side -------------- --- 2 36 Oakland -------------- 56 1.5 33 Near South Side -------------- --- 4 37 Fuller Park ----------- 60 1.6 34 Armour Square --------------- 1 8 38 Grand Boulevard ------ 117 3.1 35 Douglas ---------------------- --- 10 39 Kenwood -------------- 129 3.4 36 Oakland ---------------------- 3 1 40 Washington Park ----- 84 2.2 37 Fuller Park ------------------ 1 --- 41 Hyde Park ------------ 345 9.1 38 Grand Boulevard ------------- 6 12 42 Woodiawn ------------- 641 16.9 39 Kenwood --------------------- 4 4 43 South Shore ---------- 450 11.8 40 Washington Park ------------- 4 --- 41 Hyde Park ------------------ 10 --- 44 Chatham -------------- 93 2.5 45 Avalon Park --. ------- 58 1.5 42 Woodlavrn -------------------- 34 5 46 South Chicago -------- 133 3.6 43 South Shore ------------------ 6 2 47 Burnside ------------- 37 1.0 44 Chatham --------------------- 6 2 48 Calumet Heights ------ 31 .8 45 Avalon Park ------------------ 6 49 Roseland -------------- 88 2.3 48 Calumet Heights -------------- 2 1 50 Pullman -------------- 46 1.2 49 Roseland --------------------- 2 1 51 South Deering --------- so .8 50 Pullman ---------------------- 2 --- 62 East Side ------------ 22 .6 55 Hegewisch -------------------- --- 1 53 West Pullman --------- 21 .6 56 Garfield Ridge ---------------- --- 1 54 Riverdale ------------- 22 .6 57 Archer Heights -------------- 1 2 117 SUMMER 1968 CHICAGO STUDENT HEALTH PROJECT me BiUings mercy BiUings Variable Number Number Percent 58 Brighton Park ---------------- 1 59 McKinley Park --------------- --- Time of arrival at Emergency Room 9 a.m. to 12 noon ---- 10 22 16.5 60 Bridgeport -------------------- 1 10 12 noon to 5 pm. - - - - 27 25 18.8 61 New City -------------------- I 1 5 p.m. to 12 midnight 42 35 26.3 63 Gage Park ------------------- --- I Midnight to 9 a.m. - - 19 27 20.3 67 West Englewood -------------- 3 5 Unknown ------------ 2 24 18 68 Englewood -------------------- 9 3 69 Grand Crossing --------------- .6 4 Total ------------- 100 l@3 99.9 71 Auburn Gresham ------------- 6 2 Diagnoses: 72 Beverly ---------------------- 1 --- General medical prob- 57 77 57.9 Out of City ------------------ 4 4 lems. Unknown -------------------- 8 1 Lacerations ---------- 24 20 15 Total ---------------------- 133 100 Fever --------------- 8 3 2.3 Broken Bones ------- 3 4 3 Gunshot wound ------ I 1 .7 Dermatology --------- I 1 .7 TABLE VIII.-Emergency room:Distribution Psychiatric problem 0 3 2.3 of variable for emergency rooms. Mercy Drug reaction and Billings accident 0 1 7 Rape ---------------- 0 1 .7 Mercy Billing' Removal of sutures - - 0 2 1.5 Variable Number Number Percent Comatose ----------- I 0 --- Age: Obstetrics and 3 0 --- 0 to 16 years -------- 36 35 26.3 .gynecology. 17 to 40 years -------- 43 63 47.4 Dental -------------- 1 0 --- 41 to 64 years -------- 17 27 20.3 Unknown ----------- 1 20 15 65 years and older - - 4 5 3.7 Total ------------ 100 as 99.8 Unknown ------------ 0 3 2.3 Disposition: Total ------------ 100 123 100 Sent home ---------- 49 68 51.1 Sex: Referred to these hos- 30 24 18 Male ---------------- 50 55 41.3 hospital clinics. Female ------------- 50 78 58.6 Referred to other hos- 13 15 11.3 pital or M.D. Total ------------- 100 133 99.9 Admitted to hospital - - 3 is 9.8 Race: Left without being a 3 2.3 White -------------- 23 16 12 seen. Negro -------------- 35 117 87.9 Ieft against advice - - 0 2 1.5 Other --------------- I 0 --- Unknown ----------- 2 8 6 Unknown ------------ 41 0 --- Total ---------- 7- 100 123 100 Total ------------- 100 133 99'9 Source of payment for medical care: Source of referral: Insurance ----------- 59 Friend or relative ---- 56 67 50.3 Self ---------------- 19 Self ---------------- 15 48 36.1 Public funds -------- 15 Police or fire depart- 29 11 8.3 Medicare --- :-------- 4 .ment. Unknown ----------- 8 0 Unknown ------- --- 7 5.3 Total ------------ 100 133 100 Total ------------ 100 118 Section IV. The Students Participants in the Student Health Project Field of study: Percent of 124 students during the summer of 1968 included those in Health professions ----------------------- 59 college, in postgraduate study in the health Medicine (38 percent) Nursing (14 percent) professions, other graduate study and high Dentistry (2 percent) school students. For ease in reporting, the col- Allied health (5 percent) lege,and graduate students will be referred to Law ------------------------------------ 10 as the health science students; the high school Social sciences -------------------------- 9 students will be referred to as interns. Humanities --------- -------------------- 6 Social work ----------------------------- 5 Other professions ------------------------ 4 THE HEALTH SCIENCE STUDENTS Premedical programs --------------------- 2 Natural sciences ------------------------- 1 One hundred and twenty four health science Not specified ---- ----------------------- 4 students participated in the summer project. - This section will define some selected character- Total ---------------------------------- 100 istics of the students, their backgrounds and While the majority of the students attended some of their views to provide the reader with colleges and universities located in Chicago, a a few insights into the kinds of students who substantial number (36 percent) came from elected to participate in the summer project. schools around the country. That distribution Some of these characteristics are self-ex- is as follows: planatory and no comments are offered: Locations of coUegea or universities: Percent of 124 students Ch-ai-act@tic: Percent of 124 students Chicago --------------------------------- 55 Characteristic- University of Chicago (18 percent) Sex: University of Illinois (16 percent) Male ------------ ------------------- 56 Loyola University (10 percent) Female ------------------------------ 44 Chicago Wesley Memorial Hospital (School of Nursing) (3 percent) Total ----------------------------- 100 Roosevelt University (2 percent) Age (in years): Northwestern University (I percent) Under 21 -------------------------- 11 Chicago College of Osteopathy 21 to 23 ----------------------------- 59 (1 percent) 24 to 26 ----------------------------- 23 Kent College of Law (I percent) 27 and older ------------------------ 7 Other Chicago colleges (2 percent) Total ----------------------- I------ 100 Other Illinois ---------------------------- 2 Race: Other States and areas ------------------ 36 White --------------------------- : --- 83 California (6 percent) Black ------------------------------- 17 Michigan (4 percent) - New York (6 percent) Total ----------------------------- 100 Pennsylvania.(4 percent) Almost 60 percent of the students were pre- Tennessee (3 percent) paring for careers in the health Drofessions. Missouri (2 percent) Utah (2 percent) Another 2 percent were in premedical under- District of Columbia (I percent) graduate programs. Five percent were in social All other States (8 percent) work schools, some of whom will probably Not presently in school -------------------- 4 enter the field of medical social work. The re- Not specified ----------------------------- 4 maining one-third of the students were distrib- Total --------------------------------- 101' uted through a variety of related fields. I I)ue to rounding. 119 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 The students were queried as to their par- knowledge or perhaps a refusal to divulge this ents' religious preferences and their families' information just as a large percent did not an- annual income. A substantial number of them swer queries about religious pref erence. How- did not respond to either question even though ever for the 80 percent who did answer, it most of them had responded with some degree would appear that the students in the summer of faithfulness to a number of questionnaires. project could generally.be considered to come Whether they specifically chose not to answer from relatively affluent backgrounds. these two questions is not known. In questionnaires administered to the health Reli@ zwefereme.- Percent of 1$4 parents science students, a number of queries probed Protestant ------------------------------- 30 their attitudes on a variety of subjects related J6vn'sh ---------------------------------- 24 to health and health issues. They were also Catholic --------------------------------- 17 asked to describe their reasons for participat- Other preference' ------------------------ 7 No answer ------------------------------ 22 ing in the summer project and what, if any- thing, they learned from the summer. Total ---------------------------------- 100 Includes those whose parents preferences differ for each parent, Only 87 of the health science students re- as well as those with other or no religious preferences. sponded to the queries so that the data to be While it is not possible to determine the af- presented pertain to those students who re- fluence of the students' homes, since neither sponded and represent approximately 70 per- the size of their families nor the nature of cent of the participants in the summer project. their financial obligations are known, a cur- The reasons for their decision to participate sory review indicates that a majority were in the summer project are presented first, from homes where the family incomes cur- based on eight suggested reasons for them to rently are above those of the United States rank in order of importance to them. A point population as a whole. The following table pre- system was designed and their responses to sents the comparison between incomes of the this question were tabulated on that basis. Ac- students' families and income Of U.S. families. cording to the assignment of points, the follow- Percent Peromt ingare the reasons in order of primary impor- families of . U.S. tance as to why the respondents participated in st@ts in f'%-izies Annual ittcm" brackets bracket' i- bracket the summer project. Under $5,000 ----------------- 7 83 $5,000 to $9,999 -------------- 22 42 TABLE I.-Ranking of possible reasons (or $10,000 to $14,999 -------------- so 17 g@) for part@ting in the summer project $15,000 and over -------------- 41 8 according to most important reason Total ------------------ 100 100 198 students answered question, 26 did not. 1. To learn about health problems of the poor and The differences between the students' family the delivery of health services to them. incomes and U.S. families may be even more 2. To help poor people get better medical care and marked at the upper brackets. Data were not medical services. - ue political action for 3. To help initiate and contin available for U.S. families in specific categories social change in a poverty area. above $20,000 and $25,000 respectively. HOW- 4. To acquire a better understanding o:f welfare ever, this information was available for the problems. students' families. Of the 41 percent whose in- 5. To earn money. 6. To work in Chicago. comes were in a range above 15,000 per year, 7. To work with other health professionals. 16 percent were between 15,000 and $19,999, 8. To be with Mends. 14 percent were between $20,000 and $25,000 and 10 percent had incomes- over $25,000 per A desire to learn about the health problems year. Twenty percent of the students did not of the poor was by far the most important rea- respond to this question either from lack of son for student partic' ation. The point di: IP 120 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 ferential between that as the first reason and example, only 30 percent of those who an- the nex swered the ninth ranked item-innovations in t three reasons was substantial. Rea- sons two, three, and four, helping poor people health care for the urban poor-indicated they get better medical care, helping initiate action learned little or nothing about it. for change and acquiring a better understand- When specific health problems of the poor ing of welfare problems were fairly closely and their attempts to deal with them are con- clustered as the next major reasons for par- sidered, the percentage of respondents who ticipation. The last four reasons were of far learned a good deal or a great deal declines less importance and were relatively closely rapidly. Only 28 and 22 percent, respectively, clustered. felt they learned a good deal about lead poison- The students were asked whether they had ing and nonprofessional health carers. Only learned much, some little, or nothing about 16 13 percent indicated they learned much about variables as a result of their summer exper- malnutrition among the urban poor and only ience. 12 percent learned a good deal about folk medi- The responses to this question are shown on cine among the urban poor. The students felt table II, with the items eliciting the greatest they learned little or nothing about mental ill- degree of positive response listed first. ness, heart disease, and cancer respectively. It More respondents said they learned a good is probable that the small percentage of stu- or great deal about the quantity and quality of dents who learned a good deal about these par- health care and housing conditions of the poor, ticular disease entities worked at sit 'es whose 66, 61, and 58 percent respectively, than they major interest was in these areas. Learning learned about any other of the listed condi- more about the health problems of the poor tions. In fact, only 16, 13, and 15 percent, and delivery of health services to them was respectively learned little or nothing about ranked as the most important reason for par- these factors. ticipation in the summer project and the data Respondents also felt they learned a signifi- indicates that this goal was accomplished. cant amount concerning organization of medi- The fact that they learned little or nothing cal care services, professional practices and about specific disease entities (mental illness, community attitudes toward health care. For heart disease, and cancer) is probably to be ex- Percent of respondents who leamed- A good or Little or Total number Rank Item great d@ Some nothing equals 87 1 The qu@ntity of health care received by the poor ---- 66 18 16 87 2 The quality of health care received by the poor ------ 61 26 13 82 3 Housing conditions of the urban poor -------------- 68 27 16 78 4 The organization of health services for the poor m an urban setting. 56 22 22 77 5 What professional practice is like in poverty areas 49 24 27 86 48 6 Organizaiion and problems of city hospitals ----------- 19 33 86 7 Community attitudes toward health problems -------- 46 so 24 83 8 Community groups concerned with health issues ---- 43 31 26 81 9 New innovations in health care for the urban poor - - 39 31 30 81 10 Lead poisoning among the urban poor -------------- 28 23 44 83 11 New health careers for nonprofessionals ------------ 22 29 49 87 12 Malnutrition among the urban poor ---------------- 13 21 66 77 13 Folk medicine among the urban poor ---------------- 12 20 68 80 14 Mental illness among the urban poor --------------- 2 28 70 82 15 Heart disease and stroke among the urban poor ---- I 11 88 76 1 6Cancer among the poor ------------------------------ 1 4 95 74 121 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 pected. It would seem unlikely that health sci- assigned and the following is their ranking of ence students, most of whom spend their entire effective plans. academic year studying the etiology and effect of pathology would become involved in this ex- TABLE III.-Specific plain to Improve health perience-a community health project-for statvs of the poor that purpose. Answers to the question, "To what extent 1. Remove all economic barriers to health and medical -)It services. was your involvement a learning experience. 2. Create more medical care centers in poor neighbor- provided the information that 80 percent of hoods-in convenient locations. the respondents felt they learned a great deal 3. Improve the quality of health care actually given this summer. Another 10 percent said it was to poor people. something of an educational experience for 4. Increase the employability of poor people-provide them. Only 10 percent felt they learned little more jobs for them. or nothing as a result of their participation 5. improve housing conditions for the poor. in the summer project. 6. Raise the general level of education of poor people. The impact of their experience relative to Actually there was a small point difference their career objectives was probed. They were between the items they ranked first and second asked, "To what extent do you think this sum- as most effective plans for improving health mer's experience will relate to your career ob- status. The last four items were clustered not jective?" More than 90 percent said a great far behind the first two ways they considered deal or -some relationship existed between their most effective for changing the health status of summer's experience and their career objec- the poor. tives. Only 7 percent felt there was little or no relationship. TABLE IV.- Only 31 percent responded positively when Community priorities as the students perceived asked, "To what extent did your work increase them): the health consciousness of the community in 1. Increased employment opportunities. which you worked?" About the same percent- 2. Improved housing. age (34) felt that the community in which 3. Development of ethnic power. they worked during the summer had benefited 4. Enlargement of educational opportunities. 5. Liberalization of health care. some or a great deal from their presence. This The first four items were relatively closely clustered correlates with their responses to the question, in point values but the fifth item liberalization of "To what extent were you successful in achiev- health care, was considerably behind the first four ing your objectives this summer?" In this case,. in the view the students had of community priorities. only half of the students felt they had been In summary, the health science students successful in achieving their summer's objec- were mostly white, from affluent homes, and at tives. Since second and third in importance an advanced level of education. They appeared among their goals were to help poor people get to be idealistic, enthusiastic and eager to a better medical care and to help initiate action constructive role in assisting those they consid- for change in poverty areas, it would 'seem that ered less privileged than themselves and in they felt the summer had fallen short. of their learning more about them. hopes for accomplishing these goals. The summer's experience did not meet the . Six alternatives were given them as specific goals of some. For others, there was a feeling of ways of improving the health status of poor accomplishment. For almost all of them-the people. They were asked to rank these in order summer had been a valuable educational expe- of what they considered the most effective way rience. For many, it may have a substantial in- of improving such services. Points were again fluence on their lifetime goals. 122 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 THE HIGH SCHOOL INTERNS Probably, the most important single factor in- There were 74 high school students or 1968 fluencing difficulties was the racial difference. high school.graduates in the summer project. However, the high school interns who re- The information presented in the following is sponded to questions concerning their feelings based on questionnaires which they filled out. about the health science students on their indi- vidual projects showed highly selective reac- Characteristics of the high school interns are tions to the other students. In a few cases, par- almost completely the reverse of those de- ticular health science students were character- scribed for the health science students. ized as racist by the int erns. In a larger num- The age distribution of the students was dif- ber of cases, the interns were friendly but crit- ferent, obviously. Perhaps, some of the diffi- ical.of their health science coworkers. In the culties that existed can be attributed, in part majority of cases the interns indicated respect to a "generation gap" between teenagers an@ and affection for the health science students students in their mid-twenties. This thought with whom they personally worked, both black might provide a moment of amusement to and white. Since responses to the question- those past 30 years of age. naires were confidential, the high school Stu- Age (inyears) : Percent of high school students dents probably stated their opinions honestly. 14 -------------------------------------- 1 'It is worth discussing these relationships 15 -------------------------------------- 9 further since there were references in the text 16 -------------------------------------- 41 of the students' reports which highlighted dif- 17 -------------------------------------- 28 ficulties in specific areas. The following ex- 18 -------------------------------------- 11 cerpts from black interns' questionnaires are 19 -------------------------------------- 6 20 -------------------------------------- 3 quoted to describe their feelings about the health science students in several instances. Total --------------------------------- 991 1 Due to rounding. Two of the questions asked were: (1) What There were more females among the high did the intern like best about the health sci- ence student(s) with whom he worked, and school interns and fewer males, almost exactly (2) what did the intern like least about their the reverse of the ratio for the health science colleagues. The students comments below are students. grouped by interns who like their health sci- Sex: Percent of high school students ence partners; interns who liked them but Male ------------------------------------ 44 were critical of them as well; and interns who Female ---------------------------------- 56 disliked their health science partners, some- - times intensely. Each set of quotations is from Total ---------------------------------- 100 Racial and ethnic background were com- a.single intern's response: pletely different as well. Liked most: "Her sincerity in willing to do something about the infant mortality Race or ethnic back Percent of high school students cases in [name -of community]. Her Negro ---------------------------------- 86 sense of responsibility to do the job well White ----------------------------------- 5 and on time. Her hope to keep the pro- Spanish-speaking -------------------------6 American Indian -------------------------3 ject going rather than stop at the end of 100 the weeks of payable work." Liked least: "Nothing-And believe me I'd VVhil6 83 percent of the health science stu- tell." dents were white, 86 percent of the interns Liked most: "He was a very understand- were black. The differences in sex, race, and ing person. Treats you with respect. He age surely must have contributed some ele- doesn't act like he's any better than you. ments to the difficulties where students encoun- He's alright." tered them in their working relationships. Liked least: "Nothing." 123 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Liked most: "She was swell to get along Liked least: "One calling us niggers and with, a good worker and no problems the way they took leadership in hand arose between us. We worked practi- and pretended that we were still. cally hand in hand." slaves." Liked least: "No comment because there is Liked most: "Nothing!" nothing I didn't like about her. Liked least: "We wanted to work in the Liked most: "We all worked together as black communities where h elp is really a group. One didn't go any higher than needed. They (H.S.S.) worked in [name the other. Each of us did the same of area] and on the north side. This work." proved to me that they didn't care about Liked least: "Everything about the health the health care of black people and that science students was just wonderful. We they wouldn't make good doctors. Be- got along together, ate together and cause doctors are concerned about the fought together when the time came." health care of human beings BLACK The remarks of interns who liked their OR WHITE." [Emphasis the stu- health science students but were critical of dent's] them as well follow: Liked most: "She helped me to under- Liked most: "Their pleasing personali- stand the white race and all their little tricks better " ties, honest opinions, willingness, help- Liked least: ('l) She was a spoiled brat fulness, honesty, and most of all, con- that always wanted her way. (2) She sideration for others." thought that she was actually doing Liked least: "I think the whites should something in our community. (3) She learn to be more willing and ready to also was a terrible flirt. I don't have any learn from the blacks about their prob- more room to finish." lems and less domineering and supervis- ing in such instances. Take orders in- Finally, there was an amusingly ambivalent stead of giving them." response. Liked most: "At the [name of site] the Liked most: "I liked his ability to see H.S.S. were really'involved and I feel things from all sides before making a that they became aware of the real judgment or decision. His fairness was problems." also appreciated by me." Liked least: "There was one I really Liked least: "Personally, I couldn't didn't care for and he happened to be stand him though I think he believes I black. He would call me in the middle of like him. There was something about the night to find out what I had done him, which I haven't discovered yet that during the day." rubbed me the wrong way. We got along Liked most: "Some of the health science beautifully though." students were ready, the others weren't And a terse response: worth talking about. Some were willing Liked most: "Transportation." to help, the others just came to work." Liked least: "Temper." ' Liked least: "Some were lazy, self-con- And one different kind of criticism: cerned helpless, hopeless and dirty." Liked most: "They were all right, except These were the hostile comments: one in [name of community]." Liked most- "I only liked one of my three Liked least- "He was always thinking." health students and that one was black. The proportion of friendly, indeed warm and The reason why I liked him is because affectionate, comments was much higher than he is a very nice and considerate person the critical or hostile ones. Therefore, while with a wonderful personalityin my eye the race issue loomed large in some instances, sight." whether race was really the issue may be open 124, CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 to question, although it undoubtedly played a $5,000 and $10,000 per year is affluent, it seems part ' Rather, the human condition is present that black high school students in the summer and the individual personalities of the partici- project generally were somewhat better off pants is highlighted in the interns' comments. than their peers around the country. This may have been the factor which was most The last characteristic which will be men- important in any difficulties which existed be- tioned is that of the career aspirations of the tween the groups. interns. Almost all of them have career goa s The differences between family income of that require education or vocational training' high school students and health science stu- beyond the high school level. While their goals dents also are great. While 70 percent of the are undoubtedly subject to change, perhaps health science students came from families even a number of times, they worth describing whose incomes were over $10,000 per year only here. First the grade-level distribution of the 10 percent of the interns' families were in this interns indicates that more than 80 percent of category. And at the other end, 38 percent of the respondents are new in the junior and the interns' families had incomes below $-5,000 senior years of high school and 10 percent had per year while only 7 percent of the health sci- been accepted at colleges or junior colleges for ence students' family incomes were in this the fall. At this stage in their educational prep- bracket. aration they are probably thinking seriously about their f uture careers. There were also interesting differences be- tween income of U.S. families as a whole and Over half of the respondents (56 percent) families of the interns. These are as follows: said they intended to go on to college and an- Percent Percent other 14 percent said they planned to go to la 'et,,@l U.S. ollege. While some students were unde- -i" bl.A: in familin junior c Annual income brackets in bracket I in br-ket cided or did not respond to the question, only Less thau $3,000 ------------- 11 17 one student wrote that he did not plan to con- $3,000 to $4,999 -------------- 27 16 tinue his education beyond high school. Al- $5,000 to $9,999 -------------- 52 42 Over $10,000 ---------------- 10 25 most all of them planning for higher education 100' - stated they would have to receive financial aid 1 60 students answered qumgon, 14 did not. 'O' or would have to work to finance a college edu- cation. Only three of the interns indicated that Since 86 percent of the students were black, their parents would be responsible for fi-nane- family income data for only the Negro interns ing them through college. was compared with family income data for A first career choice was stated by 54 interns nonwhite U.S. families and again interesting differences are present. The comparison is as while the remaining nine who filled out the follow: questionnaires were either undecided or did not specify a career interest. The choices of the 54 Percent Percent are as follows: fa-iii" of @white black interm Annual income brackets in bracket I U&S-b,a.-@"eit- First Career CWce: Percent of students Less than $3,000 ----------- 10 37.3 Health professions ------------------------ 46 $3,000 to $4,999 ------------ 26 25.2 Medicine (24 percent) $5,000 to $9,999 ------------ 56 29.2 Nursing (13 percent) Over $10,000 --------------- 8 8.3 Allied health (9 percent) Teaching/education ---------------------- 15 100 100.0 Social work ------------------------------ 9 52 students answered question, 2 did noL Computer science technology -------------- 5 Other professions I ---------------------- 13 It would appear that the interns' family in- Other careers' --------------------------- 12 comes were not representative of nonwhite families in the United States as a whole. While Total ---------------------------------- 100 Other professions Includes law, engineering, sociology, etc. it can hardly be said that an income between 1. Other careers includes military, business, forestry, football, 125 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 As is apparent, almost half of the students questionnaire responses showed them to be said they planned to pursue a health career idealistic, enthusiastic, and eager to play a con- and half of these indicated a desire to become structive role in helping themselves, and their -physicians. What effect their summer experi- people, to achieve status and dignity in society. ence had upon their career choices is not pogsi- That their summer's experience had an impact ble to guess since comparable information was upon them cannot be stated with any certainty, not sought prior to the start of the summer however, a number of them plan to continue project. work on projects started this summer. Their exposure to health issues and health system has In summary, the high school interns were made them more aware of the important role mostly black, from lower middle income homes health plays in their everday lives and in the with high aspirations for the future. Their lives of the communities in which they reside. 126 -Section V. LIST OF PARTICIPANTS AND SITES PARTICIPANTS Health Science Students Stanley Aeschleman John H. Heiligenstein Lewis Resnick Patricia Bailey Joan R. Hilbrick Susanna H. Roberts Irene Baker Edwin C. Holstein David Sargent Sara Joan Bales Robert Holt Druce M. Scheff Charles Bass Charles M. Jenkins Carolynn Sehore Susan Bennett Leslie Johnson Sue C. Schulman Jack Berger Kathleen A. Johnston Michael Yale Schwartz Sandra Berkowitz Deborah Lee Kahn Laura J. Simon Ronald Berman Karen Kaye Mark Simons Temistocles Betancourt Marie G. Leaner Suzan Simons Reginald Blanks Charles Levitan Catherine Slade Lawrence Bloom Walter Lowe Jean E. Snodgrass William J. Bridbord Patricia A. Lowery Susan Soboroff Barbara Britts James Lowry George Spinka Ira Buchalter Jeanne I4wry Suzanne Stallings May Ann Caswick Paul Mansheim Marilyn Stanek Jeanne Corbett Irwin Miller Margaret Stapleton Grace Dammann Ellyn Millman Porter Stewart Ronda Marie Davis Margo A. Montry Ronald Stewart Troy Doetch Dean Morgan Hugh Stinnette James E. Drake Christopher Murlas Robert Tanenberg Carol Eckman James McCulloch John Trefil Karen Edwards Irene McDonough Sandra Vernardo Bruce G. Fagel P. MeGauley John P. Vogel Howard H. Fenn Ralph McMurry Kurt Wahle Andrea Gay Terry MeMurry Michael Wartrnan David R. Gendernalik Margaret A. McQuade David Lee Weiss Robert W. Geohegan Rosalyn L. Netzky Gerald Wilburn Jeffrey Neal Gingold Pamela J. Osborne Barry Williams Emily D. Gottlieb Dean Lee Overman Linda Williams Franklin B. Gowdy lAe Pernell Mary M. Williams Margaret Guertin Douglas D. Peterson Roscoe Woosley Michael J. Guice Larry K. Powe Jane Wuchinich Steven A. Hadland James Puryear Polly Young Nancy Hall Michael P. Ranahan Raymond Zablotny Theodore B. Handrup Stephen P. Rand Pamela Zumwalt High School Interns Emillo Acevedo Gerry Clark Sonia Henderson Danny Anderson Larry Craig Willie Hill Jessica Anderson Alice Cruz Georgia Houston Willie Barney James Easter Lee Irving Joseph Brown Lewis Edwards Raymond Johnson Pamela Brown Joe Lopez Enderle Charles Jones Midacrito Cano Sibyl M. Ferrell Debra Kelly Betha Carr Trude FuUman Barbara King Maryln Carter Robert Graham Dan King Yvonne Christman Marsha'Ann Hackner Lucy Lane Eliza Clark Juanita Harvey Christopher Latham 127 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Howard L. Lee Gwendolyn Ramsey Lucius Taylor Pearl Helen Martin Mavies Randle Paul Taylor Jose Manuel Molina Anthony Samuel Roberts Daniel Thompson Patricia Diane Morris Katherine Sawallisch Richard Tinsley Valerie McKenzie Bernard Seals Debra Wash Rachel Clark McKinzie Francine Shane Drexel Weathiersby William MeNary Gwendolyn Shane Veronica Weathersby Juliette Nelson Naomi Shine Janet Williams Gregory Norman Darryl Speer Sandra Williams Lorine Patterson Rose Marie Steward Ernest Winkfield Susan Peterson Carol Stewart Valerie J. Woods Lola Porter Leon Talbot Deborah Young Alfred Taylor SITES Abraham Lincoln Center Englewood Clinic 2067 West Roosevelt 700 East Oakwood Boulevard 140 West 62d Street Preceptor: Hosea Lindsay Preceptor: Mrs. Hilton Preceptor: Doug Peterson (Rev. Michael Reese Hospital American Indian Center Richard Lawrence President of 29th and Ellis 1630 West Wilson Englewood Action Committee) Preceptor: Dr. M. Creditor Preceptor: Tony Madiekoy Englewood Mental Health Center Neighborhood Service Center Benton House Neighborhood (Board of Health) (Howell House) Resources Center (Mexican 852 West 63d Street 1831 South Racine Outpost) Preceptor: Mrs. Adele Levine Preceptor: Jose Morales 2624 South Normal Erie Neighborhood House Olivet Community Church Preceptor: Mr. Dick Hall 1347 West Erie Street 1443 North Cleveland (Director) Perceptor: Evelyn Lyman, R.N. Preceptor: Charles Marz Black Women's Committee Garfield Civic Association Presbyterian-St. Luke's Hospital 4300 Cottage Grove 5600 South Racine Preceptor: Bruce Douglas, D.D.S. Preceptor: Jackie Robbins Preceptor: Mrs. Rita Skeffinton Provident Hospital Casa Central (East) Garfield Park Mental Health 426 East 51st Street 40 North Ashland Clinic Preceptor: Mrs. Cobb, Director of Preceptor: Reverend Alvarez 4458 West Madison Volunteers Chicago Board of Health Preceptor: Mrs. Moon Robert Taylor Health Clinic Chicago Civic Center Greater Lawn Family Care Center Ida Noyes Hall, University of Preceptor: Dr. Stamler 2701 West 68th Street Chicago Concerned Citizens of Lincoln Park Preceptor: Dr. Jim Reese St. Bernard's Hospital 2512 North Lincoln Avenue (Director) 6337 South Harvard Preceptor: Sherry Levine Hospital Planning Council Preceptor: Sr. M. Shephard, Cook County Hospital Out-Patient 79 West -Monroe Supervisor of Emergency and Clinic Preceptor: Pierre DeVise O.P.D. Preceptor: Dr. Bernstein Latin American Defense St. Leonard's House Dearborn Homes-Booth House Organization (LADO) 2100 West Warren 2961 South Dearborn 1306 North Western Preceptor: Earl Durham Preceptor: Mr. Cotten Preceptor: Obed Lopez South Lynne Community Council Drug-Abuse Program (Operating Lawndale Association for Social 1737 West 63d Street' out of Association House) Health (LASH) Preceptor: Mrs. Donna Scheidt 2150 West North Avenue 3346 West Roosevelt (Housing Chairman) Rev. Preceptor: Mary Williams James Scorgie (Youth Chair- Preceptor: Bob Taylor, Joe Englewood Action Committee of the McDonald, Dr. Eric Kast man) Englewood Civic Organization Marcy Center South Lynne Day Camp, Thoburn 140 West 62d Street 1539 South Springfield Methodist Church Preceptor: Rev. Richard Lawrence Preceptor: Mrs. Betty Dobbins 1708 West 64th Street (of the Action Committee), Martin Luther King Memorial Clinic Preceptor: Rev. James Scorgie Mrs. June Dolnick (of Engle- 3312 Grenshaw Tri-Faith Employment wood Citizens Housing Com- Preceptor: Dr. Snyder 1861 West Wilson @ mittee) Medical Center YMCA Preceptor: Chuck Geary, 128 CHICAGO STUDENT HEALTH PROJECT SUMMER 1968 Trumb-all Park Community Center Preceptor: Rev. George Morey Woodlawn Hospital 10530 South Oglesby Woodlawn Child Care Center 61st and Drexel Preceptor: Mrs. Tikalsky 936 East 63d Street Preceptor: Mr. Jacobs-Hospital United People Preceptor: Dr. Madden Administrator 1354 West Wilson U.S. GOVERNMENT PRINTING OFFICE: 1970 0-355-233 129