MH - Students, Health Occupations/*// MH - Community Health Services/*/Pennsylvania MH - Pennsylvania KW - 20C CN - Philadelphia Student Health Project CN - Student Health Organization in Philadelphia CN - United States. Division of Regional Medical Programs Ti Philadelphia Student Health Project, summer 1968./G IM [Bethesda, Md.]/Health Services and Mental Health Administration/[19691 CO - vi, 133 p. GN - Sponsored by the Student Health Organization in Philadelphia. GN - Project supported in full by Contract no. 43-68-1533 with the Division of Regional Medical Health Programs, Health Services and Mental Health Administration. CP 02NLM,01SSY:WA 546:AP4.2:P4S9p::1969 CA WA 546 AP4.2 P4S9p 1969:02NLM,Ol SSY Yl S/1 969/ LP Eng LA Eng MT CORPORATE NAME MAIN ENTRY RO O:MED RO C:MED RO M:NMC DA 710322 LR -780426 EL - FULL LEVEL IT - MONOGRAPH Ul -1255573 PHILADELPHIA STUDENT HEALTH PKOJI=t;l summer iuoo U.S. Department of Health, Education, and Welfare Public Health Service Health Services and Mental Health Administration Division of Regional Medical Programs This project was supported in full by (Contract No. 43-68-1533) This report does not necessarily represent the vieivs of the Ptiblic Health Service PHILADELPHIA STUDENT HEALTH PROJECT 1968 FOREWORD The reports included in this volume describe the variety of experiences available to health professional students during the summer of 1968. Al- though some accounts of activities are more complete than others, some far more sophisticated than others, and many are naive, the impact of all these experiences on the reader is profound. Young professionals, at the threshold of their careers, have had a real opportunity to observe the complexities and inequities of our health and welfare delivery systems, and to record their impressions of these experiences. The interest expressed by Regional Medical Programs in service deliv- ery systems has been served well in that the participants were enabled to observe at first hand the current problems in the delivery of services. It can be predicted that none of these students will be content, in the future, blindly to accept the status quo. These students have worked conscientiously and maturely in accom- plishing their goals. I consider it a privilege to have been associated with them and with the Student Health Project, Philadelphia, 1968. ROBERT L. LEOPOLD, M.D., Associate Professor of Clinical Psychiatry and Director of Division of Community Psychiatry, Department of Psychiatry, University of Pennsylvania Director, West Philadelphia Community Mental Health Consortium Director, Student Health Organization Preface and Acknowledgments The Philadelphia Student Health Organization Summer Health Proj- ect wag funded by the Division of Regional Medical Programs (Contract #PH-43-68-1533), and the work-scope of the contract indicated that the purpose of the project was to collect information relevant to the following categories: 1. Descriptions of new kinds of cooperative arrangements. 2. Descriptions of features of community organizations; how they facilitate and/or block attainment of RMP objectives. 3. Description of the health status of poor populations. 4. Evaluation of the present adequacy of health care programs. 5. Estimation of health attitudes of poor populations. 6. Descriptions of new and creative methods for obtaining informa- tion relevant to the above questions. This report is, therefore, primarily a response to the contractual agree- ment with the Regional Medical Programs. The papers of the project workers are collected in sections II and III together with comments by the research directors, Miss Karen Lynch and Mr. Jon Snodgrass. These sections are the core of the report and contain the material relevant to the stated purpose of the project. Section I provides some background information to help orient the reader to the papers that follow. Section IV presents an evaluation of the educational and attitudinal impact. of the project on student participants as well as some general comments on the significance of the project as a whole. The various research instruments designed and used by the re- searchers in obtaining their information are contained in the appendixes of Section V. A list of the projects and project participants appears in Section V also. In addition to Drs. Richard F. Manegold and Herbert 0. Mathewson of the Division of Regional Medical Programs, other individuals and groups who were instrumental in making the project possible are the following: George Silver, M.D., Joseph English, M.D., Mrs. Edna Rostow and Mrs. Carol Simons, who helped with negotiations in Washington dur- ing the winter and spring of 1968; Leo Molinaro, I. Milton Karabell, and members of the Board of Directors of the West Philadelphia Corporation, who approved the arrangement whereby the corporation acted as the grantee and official administrator of the funds of the project; Gaylord P. Harnwell, who was instrumental in providing for use of University of Pennsylvania funds by the project, later to be reimbursed by the government on presentation of vouchers; and, finally, Robert L. Leopold, M.D., and almost the entire staff of the West Philadelphia Community Mental Health Consortium, on whom the project depended for counsel and support throughout, its course, beginning in the fall of 1967 when organizational work began. These people and many others-students, school administrators, secretaries-helped with the many little steps which ultimately lead to the project becoming a reality. Patrick Storey, M.D., acted as liaison between the Division of Regiona Medical Programs and the Philadelphia SHO's during the crucial period in May when agreement was essentially reached. This Report was edited by Jon Snodgrass, Karen Lynch, and Paul Frame. iv Table of Contents FOREWORD, Robert H. Leopold, M. D . ......................... PREFACE AND ACKNOWLEDGMENTS ............................ SECTION 1. BACKGROUND TO THE PROJECT, Ron Blum ... ........ SECTION II. PROBLEM PAPERS, Karen Lynch ............I...... 3 Studeiit Health Organization in the Community ............ 3 Gray's Ferry, Summer 1968 ......................... 4 1400 Block, South Taylor Street ..................... 8 10 The Pocket ........................................ Health-A Priority Item ................................ 12 Complex Problems in Ludlow ........................ 13 Eastwick Survey Report ............................ 13 Report on Community Work With The Paschall ....... 15 Betterment League ....................... Welfare Rights Organization ......................... 17 Community-"Establishment" Relations ................... 18 Community Pharmacies in North-Central Philadelphia 19 Philosophical Conflicts of the Temple Community 20 Mental Health Center's Day Program ................ 21 The Saga of Fidel Cruz .............................. Presbyterian-University of Pennsylvania Medical. 22 Center (I) ........................................ Presbyterian-U-niversity of Pennsylvania Medical 27 Center (II) ...................................... Student Health Organization, and Health Professionals ...... 33 The Unexplored: SHO Working in Poor White Communities ........................ ......... .... 34 The Effect of Inappropriate Reinforcement System. on Program Establishment: A Case Study ............ 35 Professionals' Values and Their Consequence on ........ . 39 Serving Clients ............................ 40 Eagleville ......................................... Mantua and Mantua Community Planners (1) ........... 41 Mantua and Mantua Community Planners (II) ........ 43 45 Various Mental Health Problems ......................... 45 Organizing Mental Health Services ........... Proposal: Summer Training Program for Medical 46 School Students .................................. v The Recreation Project for One Psychiatric Service: Two Points of View (I) ........................... 47 The Recreation Project for One Psychiatric Service: Two Points of View (II) ........................... 49 Horizon House ..................................... 50 Planning and Developing Programs ...................... 51 Changing Direction at Southwest Center City Community Council: From Survey to Proposal .................. 51 What is Public Health? (Delaware County) ............ 56 The Wee-Care Babysitting Service .................... 60 The Photography Club at St. Christopher's ............ 62 Some Other Interesting Experiences ...................... 63 Hawthorne-Viewed by a Staff Member, a Student, and a Community Worker ......................... 63 Teaching Sex Education Classes at Hartranft Community Corporation ............................ 65 Preparing a Community Health Booklet at Houston Community Center ........................ 67 Working With Pernet Family Health Service .......... 67 Holmesburg Prison Project .......................... 68 Drama as a Means of Changing Health Professionals' Attitudes ....................................... 69 Misericordia Hospital ................................ 69 SECTION III. PROJECT WORKER PERSONAL CONTACTS, Jon Snodgrass 77 St. Christopher's Child and Youth Comprehensive Care Center ........................ 78 Spring Garden Community Center .................... 82 SECTION IV. SHO'S SHOW: AN EVALUATION OF THE PHILADELPHIA STUDENT HEALTH ORGANIZATION SUMMER PROJECT, Jon Snodgrass ........................................... 85 Background Characteristics of the Health Science Students ........................................ 87 Student Education .................................. 93 Students' Ideology .................................. 95 Attitude Change ................................... 96 Student Accomplishments and Student Perceptions of Philadelphia Student Health Organization ........ 102 Penn Medical Student and PSHO Medical Student Comparison ...................................... 104 SECTION V. APPENDIXES ........................ I............. 113 Appendix 1. Pre-Test Background Questionnaire ...... 113 Appendix 2. Post-Test Background Questionnaire ...... 114 Appendix 3. Attitude Scales .......................... 117 Appendix 4. Guidelines for Problem and Community Papers ........................................ I ... 127 Appendix 5. Personal Contacts ....................... 130 Appendix 6. Project List: Project Sites and Participants ..................................... 131 vi Section I BACKGROUND TO THE PROJECT Ron Blum The genesis of the Student Health Organiza- grant proposalg-modeled after the other proj- tio-ns in Philadelphia can be traced to the at- ects, but with important major revisions and tendance at the Second National Assembly of alterations based on the experience and ideas the Student Health Organizations held in New of those on the steering committee, which bv York in February 1967, of about half a dozen early winter was steadily expanding in size. interested medical students from Philadelphia At the same time proposals were being written, In 1966 the first summer project was con- many community groups, agencies, and indi- ducted in California aXid two medical students viduals were approached, both as prospective from Philadelphia participated. After the New project sites, and in some cases as possible York assembly, citywide meetings were held financial resources. Committees worked also in in Philadelphia, at which plans for a Philadel- seeking support of faculty members and the phia Student Health Organization were dis- deans of the medical schools. cussed and the prospects for a summer project The individuals involved in setting up the in 1967 were considered. Though this project Philadelphia Summer Project 1968 attend the did not materialize, local activities did begin, six area schools of medicine (one osteopathic), as the SHO philosophy became dispersed to several nursing schools, and various graduate the student -bodies. The interest generated at schools, representing a coordinated effort that, some of the schools waned as the school year in itself, was an experience in interscholastic ended, but several more students from Phila- cooperation. The project was designed to ex- delphia schools participated in the California, pose health science students to the patient as New York, and Chicago summer projects in a social being. At 35 community and agency 1967. project sites, 74 students, 21 community work- During the summer of 1967, some students ers, and 20 high school interns worked under who remained in Philadelphia made important selected preceptorg. The sites were predomi- inquiries toward establishing a summer proj- nantly in lower socioeconomic level communi- ect, and promoted with increasing enthusiasm ties that included Caucasian, Puerto-Rican, and the considerations of such a program in Phila- Negro slums. Placements were selected that delphia. In September 1967, at a meeting held had potential to provide a good learning expe- to report on SHO experiences, an unantici- rience while offering students opportunities to pated surge of interest forced standing room develop judgment and initiative in construt- only. Full efforts were thereafter directed to tive community action. The freedom to direct establishing SHO chapters at the Philadelphia their activities was left with the project fel- schools and directing full strength toward or- lows and the preceptors. Summer project staff ga,nizing a summer project. A Student Health were oriented to support, not direct. Steering Committee evolved that made the The philosophy of managing the student necessary contacts and wrote and rewrote health project might best be refle@d in part 1 by a brief consideration of the roles and strue- The five area coordinators were each responsi- ble for a given number of project sites. They tures involved: a. The project fellow was a health science met the workers regularly and served as com- student in the fields of medicine, -nursing, den- munication channels to the project office for all tistry, law, social work, pharmacy, or psychol- personnel. ogy. He worked for a 10-week period. Multiple means were provided by the proi- b. Community workers were individuals who !et staff for workers to become involved and resided in the immediate community of the Informed. Weekly meetings were held for project site where they were hired to work. groups of 12 to 14 people, led by individual They were adults working shoulder to shoulder 'taff members, to consider problems and sub- jects of interest or concern to the group. These with students. They served as liaisons with the pr portunity for worker community and now remain as vital contacts ovided an op s at diff6r- for continued community programs. ent sites to share experiences and exchange c. Youth interns were high school students ideas. Another major educational aspect who fit similar criteria as the community planned by the staff and committees of project workers. These students worked closely with people were the orientation, the midsummer, their health science student counterparts and and the final conferences. Also, one evening in the proIcess developed, it is hoped, an inter- each week for most of the summer, a special est in health science careers. program was held for the project participants d. The project site was the organization, and friends, bringing in speakers and films on agency, or office where the project participants pertinent local and .general issues. Through- worked. Health science students were allowed out the summer various work groups evolved to indicate preference of job site, and disposi- that allowed people with similar interests to tions were made on the basis of request when- consider action in such areas as Summer Proj- ever possible. ect 1969, admissions of blacks into health sci- ence professions, the SHO Fourth National As- e. The preceptors were individuals, usually sembly, and other issues. professionals, who were responsible for the Biweekly meetings were held with staff, in- activities of the project workers (a, b, c) at terested project workers, and the advisory that site. They met with the workers regularly council, the latter consisting of four Philadel- to provide guidance and assistance if needed. phia professionals: two physicians, one in city f. The summer project staff included three government, and one in medical education, a student directors, five area coordinators, two full-time community organizer and a group research directors, two office staff, and a physi- trainer. Policy decisions were reviewed and cian project director. made at these meetings. The staff met weekly The part-time project director is affiliated also with training consultants who assisted in with the West Philadelphia Community Mental developing leadership skills and an understand- Health Consortium, a subsidiary of the grantee, ing of group processes. the West Philadelphia Corporation. The proj- The goal of the extensive programming for ect director is also on the faculty of one of and by the staff and project workers was a the medical schools. He advised the student total involvement experience. Individuals had directors in overseeing the entire project. The the opportunity to pursue any area of interest student director was responsible for adminis- as it related to community health and their own trative duties and organizational liaisons. The education. The results of their involvement in two associate directors coordinated project the student health project are reflected, in part, sites and the educational aspects of the project. in the following pages. 2 Section 11 PROBLEM PAPERS Karen Lynch Introduction Since the Student Health Organization's pat- other topics. They should be read as cases tern of sponsoring summer projects and pub- which present problems and possible ap- lishing reports of the projects seemed on the proaches to solving them. verge of becoming an inviolable tradition de- spite SHO's resistance to adopting routinized, STUDENT HEALTH ORGANIZATION IN institutionalized activities, the attempt was THE COMMUNITY made to orient the reports of the sites away from a narrative "this-is-my-summer" account What Happens When SHO Workers Step In? toward a more critical isgue-oriented examina- At 25 of 37 sites, approximately 80 project tion of the health care delivery system. workers were cooperating with local commu- Thus, early in the summer a brief outline of nity groups, some digrags-rootst' organizations, plans and expectations about the summer was some settlement houses, and some other types collected from all the project workers. These of organizations. reports were then used to distribute three dif- With all of these organizations the SHO ferent guidelines for problem papers and one workers were planning with the community guideline for describing local communities. to do a variety of things. With Pernet Family These forms are included in appendix 4. Each Health Service, Spring Garden Community site was different and I ran the risk of asking Services Center, and Young Great Society, irrelevant questions of a site's activities. SHO workers were , directly meeting health Yet the resulting articles present a critical needs. At other sites, for example, Hawthorne, point of view on a number of issues which the Ludlow, and Hartr'.anft, SHO workers were .project workers experienced first hand. In serving their communities directly by sponsor- future projects this approach may be used in ing recreational activities and leading classes. a more'directed way, asking specific questions Others, among them Fairmount, "The about specific problems. This summer, how- Pocket" and Taylor Street projects of Univer- ever, such an approach would have been totally sity Settlements, and Gray's Ferry, were help- at odds with the philosophy of the Philadelphia ing communities attack environmental health project. problems or community needs. The articles which follow concern experi- Others were identifying problems in such a ences with community groups, health and non- way that other organizations, political bodies, health agencies, attempt to solve various public agencies, and planning boards would health and environmental problems and many become aware of them. SHO workers at Dela- 3 ware County's Citizens for Better Public yet even high motivation cannot be sustained Health, Eastwick Community Organization, without cooperation where communities need Welfare Rights Organization, North City Con- the assistance of, for instance, the Sanitation gress, and Southwest Center City Community Department, the Housing Authority, or other Council were working on these problems. agencies. Bill Robinson saw this in his work Still others were setting up or planning for with Taylor Street residents. The environ- programs. SHO workers at Mantua Commu- mental problems there could not be effectively nity Planners, Citizens Concerned for Welfare solved without the help of the City Sanitation Rights, CEPA (Consumers' Education and Department. Protective Association), Houston Community Perhaps Art Pressman found one of the so- Center, and Spruce Hill Community Associa- lutions to inaction: as an outsider he aimed at tion were involved in designing and getting personal vested interests of residents in order programs started. to build interest in Clean-Up Day at the Tot In short, SHO was working with a wide Lot and interest in preparing a house for the variety of community groups this summer in a nursery school. vast range of activities. All three of these projects were confronted Out of these experiences a number of dif- with the problem of working with their com- ferent issued were raised. Similar questions munities rather than working for them. The were asked in different situations. The most project workers built on issues which the com- prevalent were these: How can SHO Iwork ef- munities wanted to work on and on issues fectively with local communities'? Why aren't which personally affected the residents. It calls health problems priority issues in these com- for a great deal of sensitive probing and for munities? What can be done to improve rela- identification by workers with the community. tionships between local communities and health Looking at these three accounts of attempts to institutions and health professionals? work with communities with an eye for the The three papers in this section describe at- approach to problems at each site will point tempts to work with local communities. The out the successes related to working with the four papers in the next section describe at- communities and the failures related to work- tempts to identify health issues in communities, ing without them. the problems involved and the explanation for the apparent unimportance of health prob- Gray 's Ferry, Summer 1968 lems. The project workers in Gray's Ferry, on Richard Bonano and Rhoda Halperin Taylor Street and in "the Pocket" were all confronted with similar problems. There were To those who do not live there, Gray's Ferry obvious improvements which the communities is a community located 1.5 miles southwest of wanted, but action depended on the approach City Hall. It is clearly defined and cut off from the project workers and others made. As Rich- the rest of Philadelphia by the Schuylkill ard Bonano and Rhoda Halperin observed as River on the north, west, and southwest, the they worked in Gray's Ferry, an independent railroad highline on 25th Street to the cast, and survey team failed in their community to make Morris Street, to the south. The presence of use of informal ways of gaining access to com- these natural boundaries provides one with a munity residents. They also noticed that com- sense of physical enclosure and thus unity. In munity fears and distrust keep some families reality, Gray's Ferry exists as many social, from cooperating with other families even on economic, racial, religious, and ethnic frag- the same block. ments. Each group has @ own way of per- Action also depended on the spirit of the ceiving things, and its own way of doing community to move. The contrast they found things. In this sense, Gray'g Ferry is not a between the white community of Gray's Ferry single community. and the black community of Gray's Ferry are While geographical factors act to unify the clear examples of the consequences of motiva- community on the one hand, geography con- tion'and lack of motivation. tributes to the fragmentation of the Gray's '4 Ferry area. Wharton Street, which runs east- An additional element in the Gray's Ferry west, is viewed by many members of the com- situation is University Settlements. The Com- munity as a barrier which cannot be crossed munity Council originally contracted with from the south side by whites, and which University Settlements for social -workers to should not, although it is, be crossed from the explain the renewal plan to the people north north side by the blacks. The black community of Wharton Street. The hope of the council is referred to as that area "north of Wharton was that this would serve to gain the support Street." of the black community for the plan. Instead, The people in the white community "south the black community has begun to become of Wharton Street," are primarily of Irish or aware of the reality that their homes have been Italian descent. Some of the older citizens can scheduled for renewal. This means, in essence, barely speak English; some families have lived black removal. As a result of the realization of in Gray's Ferry for six or seven generations the plan's inequalities for the black commu- and would never consider living anywhere else. nity, the people north of Wharton Street are Some members of the younger generation, older beginning to mobilize themselves against it. teenagers primarily, cannot wait to get out of The black leadership has taken the position Gray's Ferry. Practically all the residents are that if the redevelopment plan does not change Catholics; most belong to St. Gabriel's Parish. to accommodate their wishes, the plan must The Church is a highly influential force in the be thrown out. This has created a great deal community. Most of the working people are of friction in the community and the Commu- employed in the surrounding factories as weld- nity Council has for the first time been forced ers, placeworkers, etc. There are a few small to take the demands of a semiorganized black businesses owned by the residents of the area. community into account. Their proprietors are often looked to for advice The problem of redevelopment, and the gen@ or funds for the few community projects. Some eral situation in Gray's Ferry has been exacer- families own three and four houses on a block- bated by the requirement for a diagnostic gur- These people consider themselves better off vey of the community's needs. Transeentury than the majority of people in Gray'g Ferry. Corporation has been contracted with by the One lady told us that the reason people kept Community Council first, to conduct a diag- this property was "to keep the community nostic social survey in Gray's Ferry, and sec- nice." What she really meant was that the peo- ond, to relate to the community's immediate ple wanted to keep the blacks and other "un- needs. Because of the position it has taken as desirables out." "Right behind this block," she an establishment organization, and because of said, "is a family who live like pigs." The a series of blunders, Transeentury has been white community itself, is by no means a single unable to gain the support of the black corn- social, economic, or cultural milieu. munity. That is, the black community has The Gray's Ferry Community Council is the barred the surveyors from their homes. Trans- official representative structure of community century has relied upon the formal structure, organization. The total membership on the the Community Council, without taking into council includes some 400 citizens. The Execu- account many informal structures. For ex- tive Committee, however, is the main policy ample, Transcentury hag set up a referral making body. It is composed of businessmen, service without taking into account the fact most of the religious leaders in the community that such a service exists in the community. and residents, a few of whom are black. Transcentury's major fault has been that it has The Community Council has primarily been tried to impose itself upon the community concerned with the urban renewal and rede- rather than to work with community people. velopment which has been planned for Gray's Transcentury has set up a series of topics to Ferry. A full-time Community Relations Rep- be surveyed. Some of these are health, employ- resentative of the Redevelopment Authority ment, and recreation' Education, specifically works with the Community Council. The Coun- the issue of the building of a new school in Cil claims to represent the entire Gray's Ferry what the community considers to be a danger- community on the redevelopment issue. ous industrial area, is of primary concern to 5 the people in Gray's Ferry. Yet, the survey has children walking through the Italian section. no section to deal with educational problems. That people are primarily concerned about Since Transcentury has been unable to gain what immediately and directly affects or threat- the support of the black community in carry- ens them is particularly evident in the field of ing out the survey, additional tension between health. Most people in the white community the Redevelopment Authority and the black have their own private physicians. When asked community has grown up. Action to the benefit about health problems in the community, they of the community has been f urther delayed. usually told us about a relative who had been In progress now are negotiations between the sick recently. Similarly, the doctors in the com- various parties involved. The issues have by no munity were only concerned with their private means been settled. patients. When asked about community health It is in the context of this tense situation problems, responses were: "Well, I can tell you that some of the problems of community or- right now mumps are goin , around," Or, "The ganization and community action must be problems are not here. They are in the clinics." viewed. Our job now was to find an issue which Our decision had been to concentrate our would have a direct, immediate, and positive efforts primarily in the white community. How- impact upon at least a f ew people in Gray's ever, we soon discovered that this presented us Ferry. We learned that the residents of Earp with many unanticipated problems. The most Street, a small street between 27th and 28th striking of these is the prevailing attitude in Streets, had participated in a series of organi- the white community towards change and im- zational meetings to discuss plans for building provement. For example, a pharmacist told a play area on a vacant lot on the block. At us that it would be impossible to organize a one time, we were told, the residents had been group of people on a given block to do some- quite enthusiastic about this project. Now, thing about a particular issue because "no one for a number of reasons, interest had waned cared." He agreed that conditions needed and the various authorities involved were under changing, but was certain that, in fact,.there the impression that the people were no longer was little or no chance of implementing interested in obtaining a Tot Lot from the change. He was not pleased with the status city. quo; he merely accepted it and the problems it It seemed only logical to us, however, that presented to him on a day to day basis. "Peo- parents would rather have their children play ple here are lazy," he said. He gave ug the on grass than in the dirty streets. Since interest impression that a definite inertia existed in in the project had been quite substantial at Gray's Ferry. People are prone to complain, one time, why would it not be possible to but do not move to act. In this sense, they revitalize the initial enthusiasm? We were soon seem to accept.their fate as it is. to see why there would be no Tot Lot on Earp An Italian woman expressed concern to us Street. about the plans for a new elementary school. It soon became evident that there, too, people Her concern, however, was based on the fear were willing to act in their own self interest, that her house might be taken in order for the and only in their own self interest. One woman school to be constructed. The white people in said, "Why should I give my time and money the southeast section of Gray's Ferry, in fact, when Mrs. X across the street will not. Her have formed a separate community council. The children will play on the lot the same as mine." purpose of this organization is to oppose the Another great concern was connected with how building of the school in their neighborhood. the residents of Earp Street would be able to This woman wants the school to remain where prevent the children from "over there," mean- it is. "That school has been there for years ing the black children from across 28th Street, and years," she said. The school she is refer- from using their play lot. There seemed to be ring to is the Benson Elementary School which no understanding or acceptance of the idea that was built in 1888. Now it serves primarily action which would be in the interest of the black children. The presence of a public school entire community would also benefit one's own in this neighborhood would necessitate black self interest. 6 In fact, to the people on Earp Street, the Recreation, by avoiding it completely. A group use of the lot by "outsiders" posed a threat to of black youths rented a garage to house their them, What would they do if a fight occurred own recreation center. They are very concerned on the lot? Who would be responsible for break- about doing constructive things for "the f ellas" ing it up? Who would be responsible for keep- who have nothing to do in the evenings. They ing it clean? The fact that the city would pro- are not afraid to attack monumental problems vide the facilities if the residents would take with imaginative solutions. A group of the on some responsibilities for taking care of them teenagers set up a film program which they was incidental. The people wanted the authori- run themselves. In addition to securing the ties to take care of everything, or nothing at films, this project involved printing leaflets to all. advertise the program, obtaining chairs from a The Tot Lot was voted down by the residents church, and selling refreshments to replenish of Earp Street. Given the racial situation and f und5. People in the black community have also the attitudes of the people towards change, realized that the so-called establishment can be positive action was virtually impossible. used to their own advantages. In direct con- At the Vare Recreation Center, located in an trast to the inaction of the people on Earp Italian neighborhood, we were to see an n- Street, a group of black residents, after one stance in which people will move to eliminate meeting with the people from the Department that which is negative or detrimental to them, of Licenses and Inspection, began to collect but will not tax their energies to create the money for their play lot. Children from the positive. Programs at Vare are designed to area were consulted with regard to what keep kids off the streets, not to provide new, equipment would be put on the lot. er 'eative activities. The staff hired by the De- On a somewhat larger scale, the communi- partment of Recreation run everything. Those ty's desire to move on its own is manifested in charge find sufficient gratification in contain- in the formation of the King's Village Asso- ing the youths within the confines of the recrea- ciation in a section north of Wharton Street. tion center. It is great for rough teenage boys This group has helped to stir people out of to sit and play cards all day. This keeps them their apathy towards accomplishing meaning- out of trouble. ful social change. We have sensed a different attitude towards These attitudes toward change have largely change among many of the black people we determined the course of our action in Gray's have met. Although they are not militant, Ferry. We had originally been contacted by many clearly have decided that certain things the Community Council to strengthen the will not be accomplished in their community Health and Welfare Committee, with the hope unless they do it themselves. They will not of eventually getting up a heaJth center in accept the premise that "the establishment" Gray's Ferry. We soon learned, however, that will do it for them. In f act, they have come to strengthen the Health and Welfare Corn- to distrust establishment organizations. mittee was impossible on several counts. First, A segment of the black community success- this committee did not exist as a f unctioning fully organized and carried out a clean-up cam- body. It hardly even existed on paper. Second, paign in the area north of Wharton Street. The the community had other priorities. Because designated purpose of this effort was not the people were concerned about their homes simply to clean the street, but to develop a being demolished by the Redevelopment Au- sense of unity among the people and to get thority, there was little interest in establishing people together for the purpose of confronting such a committee. the,egtablishment. The press was there to wit- We then discovered that, although recrea- ness and report that these citizens had cleaned tion was not such an urgent concern as urban the streets and were in the process of sending renewal, it did represent a concern of the com- the city the bill for the job the Sanitation munity which held higher priority than health. Department was supposed to have done. Our task was to find someone or some organi- The youth of the community dealt with the zation in the community with which to work. establishment, in this case, the Department of Fortunately we have been able to work with a 7 black woman who is probably the person most 1400 Block, South Taylor Street concerned about the activities of the com- munity's youth. Her activities reach far be- Bill Robinson yond her responsibilities as director of the Summer Urban Day Camp. One of her chief The 1400 block of South Taylor Street is A concerns has been lack of indoor space which single block in South Philadelphia. The resi- is essential for carrying out a winter program dents are all black and generally of low in- of any sort. come. Most houses are rented. Approximately We became aware of the urgency of th is five to seven are owned by residents. Five need, and realized that the city agencies could houses in the block are vacant. The street is not be relied upon to f urnish this space in any very narrow. The residents have a large num- reasonable amount of time. With the com- ber of teenage and pre-teenage children. munity people we began to investigate other Sei-t7ices to the Sti-eet ways to obtain space and facilities. We were fortunate enough to be given the There is no public transportation through Tavlor Street or on adjacent streets, but it is name of a socially minded architect who Would iairiv accessible to residents. work with the community people. He willingly offered his services in drawing up plans for a Shopping and schools are also not immedi- cost estimate on a new center for Gray's Ferry- ately available, but they are accessible without Our idea is to take his plans to private indus- major inconvenience. try with the hope of finding a sponsor for the Rubbish and trash are collected once weekly project. on Monday (usually in the morning). The major problem for residents is the failure of In the meantime, we have obtained a vacant city workers to clean alleys of trash and building on the corner of 30th and Wharton garbage. Streets to house the Gray's Ferry Workshop, as it will be called, on a temporary basis. Evi- Police protection is adequate, at best. Resi- dence of community support for this project dents generally do not hold police in high re- has taken many forms. One businessman in gard. Police are slow to respond to residents' the community has donated a kiln for ceramics calls. and paid for the first month'g rent. A group Recreation is another major problem for of youth have planned a paint party and gen- concern of residents. A public square is ap- eral fix-up weekend. Attendance at planning proximately one block away but parents feel meetings has been extremely good. the area is not safe for their children. Parents Our aim with this project, from the begin- have tried unsuccessfully to get a vacant lot ning has been to help the community set things . the block converted to a Tot Lot. No other up in such a way that they would in no way be facilities are available. Children play in the dependent upon us for the project's continu- street. ance. We have tried to act as a stimulus to Residents have little concern for the health the people so that they would respond in an care system. They prefer to concentrate on active way to their own needs. Now they are realities of: (1) No play area for children; beginning to become aware of and use re- (2) danger .of traffic to children playing in' sources outside of Gray's Ferry. street; (3) fire hazard from - children playing We believe that any project of this sort must in open vacant houses; (4) rats in homes; and be initiated, planned, and carried out by people (5) trash accumulating in alleys. from the community. Outsiders, like ourselves, The major community health problems is the can be most effective as advisors and as re- social well-being of the block.residents. Prob- source people. To go to a community with the lems associated with their environment have idea of doing things for and to the community been under primary consideration. In 'light rather than with the community would prob- of this, the Taylor Street Residents Association ably prove to be highly detrimental and possi- has been working on all of the problems de- bly disastrous. scribed above. 8 When the people of the block have decided to day, it has a high degree of car and truck act on a problem, they: (1) Decide on a chan- traffic. This presents an obvious danger to the nel for action; (2) contact city official or other large number of children who play in the power and register complaint by phone and/or street. They attempted 'to get signs reading letter; (3) repeat action if needed; (4) con- "No Through Trucks" and "Slow, Watch Chil- tact Congressman William Barrett for assist- dren." ance for the city related problem; (5) consider The presence of five vacant houses in the other actions if needed. block has caused more concern for the resi- Environmental Problems dents. They had become depositories for trash and garbage 'for people from other neighbor- The central movement of the Taylor Street hoods, and thus havens for rats. But more Residents Association was a multi-faceted at- important to the residents, they were open tack on problems associated with their en- invitations for children playing with matches. vironment. From the health standpoint, their Many fires had resulted in previous months aim wag to improve their own social well-being and years. by acting on their own community. This was This problem was presented by letter and the position presented to me by the residents phone calls to Mr. S. at the Complaint Depart- themselves. They wanted to take action in the ment at Licensing and Inspections at City Hall. specific areas described below, and wanted me After many months, only one of the five houses to help them. has been properly cleaned and sealed. Again One major area of concern for the residents the residents have talked with feeling that was to try to convert a vacant lot on the block this attitude prevails because they are black. into a Tot Lot, on which their children could play. Contacts were made with the Depart- The final major problem voiced by the resi- ment of Recreation, Land Utilization, Univer- dents concerned the presence of rats in their sity Settlements, Congressman William homes and backyards and the accumulation of Barrett's office, et. al., to attempt to achieve trash and garbage in their alleys. The rat prob- this. lem seemed to be caused or at least enhanced by the trash problem, so emphasis wag placed The stumbling block was presented when on removing trash and garbage. A representa- one of the property owners, Mrs. X, said that tive from the City's extermination unit was she could grant permission for the group to contacted, but he felt that it would be futile use her property if she were insured against to place poisoned bait where rats had so much any liability charges from parents whose chil- other debris and food to eat. dren might be hurt playing on the Tot Lot. At least ten complaints and probably more Attempts to seek this insurance through the were registered with the Mayor's Office for City of Philadelphia, University Settlements Complaints because the City'g sanitation work- and others were rebuffed and the action has ers would not clean the alleys. The alleys were been stymied. oximately the first Monday last cleaned on appr At present the property is tax delinquent in June. Since then they have become deplor- according to Mr. M. of the city's Land Utiliza- able. It is a,fact that the people of the block tion Office. In this case, the land will be placed could clean the alleys themselves, but again it available for sheriff's sale in approximately 8 is a point,that their taxes help pay for this months. At this time the city can purchase the service and if they were more affluent,. or property and effect the conversion to a Tot white, they would not have to be subjected to Lot. A major consequence of the delay through this treatment by the City. "red tape" and negotiations has been waning The concern of the residents of Taylor Street interest and skepticism on the part of the resi- for their own improvement, through uplifting dents that anything will improve their situ- their environment, has.been suppressed. The ation. City has shown in various areas to be imper- Another situation which the residents.saw sonal and unresponsive to their needs. They as a problem was the fact that although the have gone "through proper channels" to affect street is very narrow, at various times of the changes, but the results have been negligible. 9 Their interest in helping themselves is waning, thony's Parish has a school; there also is a as their confidence in those who make change public elementary school, but pupils there are is reaching a new low. mostly black; most Pocket children go to St. . I identify very closely with the residents in Anthony's. Police protection is good during general, and have not, and will not try to con- the day, but there are complaints of its being sole them or attempt to reconcile them with almost nonexistent at night. the systems of the "establishment." If some- Since most Pocket women are Catholic, one one with a more militant approach revives would not imagine many to be practicing birth their interest in helping themselves, they will control, but most are. Three blocks from the be much more receptive to an attitude of Hospital of the University of Pennsylvania "damn the establishment!, we'll change things and Philadelphia General Hospital, the people our own way!" use the clinics quite often. St. Agnes Hospital is also frequented. No complaints were heard The Pocket of these institutions other than waiting time and the Filipino doctors who don't understand Art Pressman what is wrong with the people. There has been almost no community action. "The Pocket" is the area within Taney "The Pocket" expects the community organ- Street, Webster Street, Catherine Street, and izer to do everything. They sit and talk, but South 26th Street. are mysteriously absent when the time comes This is an all white community. One black for the work to be done. This sounds presump- family was driven out about a year ago. Once tuous but I just spent today trying to round mostly Irish, now some Italian, but still over- uP 45 men to work for two hours this week- whelmingly Irish, most men work at Philadel- end in the nursery and got a most negative phia Electric, half a block away. There is a response. At this stage, the next thing to do large incidence of interrelation among fami- is incense the men individually about their col- lies. Many residents have lived their entire lective weakness. Maybe some will come out lives in "The Pocket." A few are really large that way. The women are fairly industrious- families with eight or 14 children but most some are notorious laggards, others are bundles f amilies have about three to four kids. One of energy. very rarely sees any teenagers, therefore the Before anything can be accomplished in a impression exists that only young children are community, the community must desire the end around, butteenagers mysteriously surface in result. For an outsider to enter a neighborhood Most people marry from within and identify and remedy certain problematic the evening. "The Pocket." It is rare for someone to bring conditions is a condescending gesture. Certain a stranger in (stranger: more than 10 blocks circumstances cannot equal a problem unless away). "The Pocket" is completely surrounded the community sees a problem from their per- by black communities.. There are no other spective. No doubt many conditions exist in whites for blocks. There has been hostility the pocket that warrant immediate attention, for years with the power shifting to the blacks but I feel that it is not my place to identify more and more every year'. Eight vacant them. This is not to say that I blissfully ignore houses stay vacant; no one wants to move into them. Questioning of a random nature during "The Pocket." Their most difficult problem is a friendly.conversation generally produces one realizing that they live in a poor white ghetto. of two possible results. "How long have those "The Pocket" is convenient to public trans- three abandoned cars been on the block?" portation; garbage collection is regular; South "Two years" or "Two years . . . I sure wish Street "business" district is very close; there we could get rid of them." If the people af- is a swimming pool at 26th and South (in ter- fected by the problem recognize iti then the rible shape, and the community is disgruntled community organizer and the community reach about the Marian Anderson Center being so the first plateau-a problem exists. Without nice) ; University Settlement House has day this recognition, the community organizer is camps, day schools, a gymnasium, etc.; St. An- nothing more than an officious intermeddler. 10 Once there comes this recognition and, there- in that self-appointed kings are constantly be- fore, identification of the problem as their ing deposed. Even if a leader is "democrati- own, the mobilization of the community into cally" elected by the community, the commu- some form of functioning political entity can nity refuses to look upon him as a leader. Dis- be attempted. (N.B., atte@pted rather than trust, envy, and backseat driving immediately accomplished.) set in. A feeling of community is the only alter The organization process is the most dif- native to the leader problem. This can be ac- ficult. The two major issues of the summer complished through total involvement of the entire group in an issue with pointed relevance helped facilitate this process in that both is- sues affected a major part of the community. to all. The Tot Lot was one of these. By making A digression into the background of these is- the Tot Lot's condition each person'g problem, sues is necessary at this juncture. In conjitnc- rather than the vague general community's tion with Unive?,sity House and the commit- problem (and therefore no one's problem), we nity, the Land Utilization Depa?-tment of Phila- were able to wage a successf ul campaign to delphia consti-2tcted a Tot Lot last fall. Reread clean up the Tot Lot. "When's the last time this sentence because here is where the basic your child cut his foot in the Tot Lot?" problem lies. The community did not con- "When's the last time your neighbor's kid came into your home and bled all over your struct, but Land Utilization constructed. Cer- ug, because no one was home at his place?" tainly men and women of "The Pocket" con- tributed valuable man hours of labor and cer- is effective rather than "Let's clean it up be- tain materials, but the end result was not "The cause it's a mess." One must touch each per- Pocket's" project. The fact that the Tot Lot son's vested interest, whether it is his child, resembles a first year architecture student's his rug, his hatred for the sight of blood, to nightmare, which indeed it turned out to be, mobilize a group of individuals into a func- does not matter. Merely, this project, because tioning body. There was excellent attendance of the great stake the City of Philadelphia on C-lean-Up-Day and heretofore disinterested persons took an active role. The beauty of this had in it, was not allowed to fail. By this I project was that it was a one time affair- do not mean to imply that it was a success- the lot has remained in excellent shape for 6 not at least to the people in "The Pocket." weeks -now. One lady hoses it down every other They use it, play in it, and gather in it, but day or so and takes care of the hose that oper- it is almost as if they have borrowed it from ates the sprinkler for the kids. Because of their someone else. For Land Utilization it was a involvement in the initial clean-up, the moth- success, but, alas, only a hollow one ("The ers, when present, impress upon the children Pocket" strikes back!) Within the space of six unattended months, the Tot Lot became a ttie need to keep it clean. Play-Street, a Uni- mass of broken glass and litter. No commu- versity House afternoon recreation project, a . instills this attitude. For a period of about nity responsibility existed for its condition and !so .1 ttiree weeks after clean-up day, the mothers indeed, none should have for the Tot Lot dia took turns supervi.sing the lot, keeping out the not belong to "The Pocket." bottle breaking older kids, and watching out Once "The Pocket" recognized the hazard for the saf ety of the younger ones. While it the Tot Lot presented, we were back at the lasted, this scheduling of mothers wag very organization process. No strong leadership ex- effective, but its breakdown is directly linked ists in this neighborhood, as I am sure it does with issue No. 2-the nursery school. not exist in many other ghetto areas. Many reasons for this exist-general complacence, The University House and "The Pocket" had the individual's desire to drink his beer in long considered opening a nursery in "The peace, and lack of confidence to lead, much Pocket" for the Pre-schoolers. University less influence, the opinions of others. If one House negotiated for a vacant house and had is able to overcome these obstacles, another an option to buy the building. The Board of more serious barrier presents itself-the corn- Education had promised to furnish a teacher munity's reluctance to accept anyone as their and some equipment, if the school met their leader. "The Pocket" resembles a petty duchy standards. Through a raffle, "The Pocket" was able to raise about $100 that acted as consid- the nursery. Discrimination by geography was eration for the option contract. Paint was pur- one thing-only people from within the boun- chased and the community began to fix up the daries were eligible-but we would not support building, which was in a state of terrible dis- any other type. After about three weeks the repair. Scrubbing on hands and knees came mothers decided-with the empty half-painted first and the women eagerly pitched in and the school on their block serving to remind them place began to take shape. It was looking too of their foolishness-that something really good to be true and was. The Board of Edu- ought to be done one way or the other, so a cation required a minimum of 18-20 children meeting took place. Somehow they miracu- enrolled for them to sponsor a school and pro- lously came up with three other children from vide a teacher. Since "The Pocket" is teeming within the boundaries; independent action on with children, no one had ever considered the their part because they finally realized that possibility that maybe "The Pocket" could not they really wanted the nursery. Or did theyl come up with enough children. After long Whatever the answer, work begins anew on arduous searching, we only came up with 16. Monday and hopefully the school will be ready The big question was where Nvould others come to go by the middle of September. from. If two more children could not be found, These two projects, the Tot Lot and the the nursery would fail. Because of its unique nursery, were the major issues of the summer; position in relation to the surrounding com- but in order to substain overall interest, nu- munity, "The Pocket" was in the hole. "The merous secondary, easily remedied issues were Pocket's" unbelievable antagonism for their worked on. Boarding up a vacant house, fixing black neighbors surfaced when we asked them the fireplug that had eroded half the street, to consider the possibility of getting the other and having one vacant house condemned pro- two children from the adjoining neighbor- vided a type of day-to-day incentive system hoods-all of them black. Spoken to individ- that kept the community's interest intact for ually, a scant few of the mothers who had the major issues. already enrolled their children in the nursery indicated that they would have no objection HEALTH-A PRIORITY ITEM? to an integrated school. Even though we de- scribed the nursery in terms affecting their in- At a few of the sites this summer, project terests, i.e., getting rid of the children five worke?-s tvere a-sked by their sites' organi@ mornings a week as well as improved educa- tion-s to conduct surveys or investigations into tional backgrounds and easier adaptability to the health needs of their communities. The the first grade, the community acted in accord- startling result of these investigations is that ance with their emotional needs. At a com- health is not a priority item. Although the munity meeting with 100 percent attendance, SHO workers began by asking about health the unanimous decision was . . . no nursery needs, environmental problems and recreation of black children. To circumvent the,problem, were more visible and more urgent issues than rather than drop the entire plan for the nur- health problems. sery, the community developed their own op- In this section the process of setting up the tions: get the Board of Education to lower the studies, the results of the studies and the con- limit of children to be involved; rent a build- -.equent action at four'sites is presented. ing from University House and staff it with The first article about attempts in Ludlow mothers; have University House extend the to set up a community blood bank, teach sex geographical boundaries that the nursery education classes, and show a cancer detection would service in order to take in areas with film points out the fact that health problems some white children. No one really worked on are obvious, but they have to be met in the these options and work on the half-painted order of their priority to the community. If school stopped. Tot Lot supervision also ceased you are faced with rats, shabby housing and as a sort of protest. "Lethargic limbo" was unpaid food bills, as Jerry Braverman points where "The Pocket" found itself. We made it out, you haven't got time to worry about can- clear that in no way would we help to segregate; cer, give blood, or learn about sex. 12 Both Eastwick and Paschall community or- which does not directly attack these problems ganizations requested a survey of their neigh- is destined to meet with limited success. Our borhoods in order to gather evidence to bring basic programs, sex education and blood bank, to bear on government authorities and also to are prime examples. Although worthwhile, identify for themselves where the needs and these were indirect efforts to remedy some priorities of their community were. Unlike the comparatively minor community problems, and report from Ludlow, the results of surveys in consequently, did not stimulate any community Eastwick and Paschall indicate that their real support. health needs are not as fundamental and basic A more illustrative example was our attempt as the needs found in Ludlow. Attention was to show to the women of Ludlow a short film placed on recreation facilities in Paschall and concerning breast and uterine cancer. Despite on a variety of environmental prolalems in leaflets, posters, sidewalk solicitation and an- Eastwick. These findings suggest that it is very nouncements in the local churches, only three difficult to deal with the underlying health or four women showed up. problems in ten weeks and that attention is They do not have cancer now and are not likely to be diverted to easier projects like worried about it; they have never needed bloo recreation programs, blood banks and visible in the past so why give now; academic mat- environmental health problems. The basic, un- ters about sex do not interest them. NOW are derlying problems are obvious to residents and rats, shabby, overcrowded housing, and food those concerned with meeting health needs, bills. and they are vast. Concern for the less visible Further, I do not feel that a SHO person problems of cancer and other chronic diseases should initiate an attack against these prob- can only be stimulated and can only interest lems. They are the problems of the people who residents of these communities when other live here, and when these people come to more pressing needs have been met. recognize these themselves as community prob- The final report in this section describes the lems (without having been told) and begin experience of SHO workers who provided tech- their own action, then would be the time to Dical competence to the Welfare Rights Organi- enter with funds and personnel to provide im- zation in designing a survey at WRO's request, petus to their movement. training WRO members to do the surveys, and Our problem is a complex one and I do not then examining survey results. have an answer. These experiences suggest that health needs are obvious and pressing. Communities' priori- Eastwick Survey Report ties are also obvious, even though it may take unsuccessful programs to show it. Health serv- Paul Frame, Bill Woods, Andrea Benn, ice producers must be aware of community Renee Edwards, and Eileen Fair demands and meet these in order for their programs to be effective. The Eastwick Community Organization is a fairly new organization. The Eastwick area Complex Problems in Ludlow has been an urban redevelopment area since 1958. A large number of families have moved Jerry Braverman from the area and public services have dimin- ished since then. The Eastwick Community Or- The Ludlow community extends from ganization felt that a survey could better de- Girard Avenue to Montgomery Avenue be- termine the needs of the community and could tween Fifth Street and Ninth Streets. It is be used as a working paper to get better serv- approximately 50 percent Negro, 40 percent ice into the area. Puerto Rican, and 10 percent White; it has The survey is to be used by the Community been described as one of the ten worst slums. Organization to put pressure on various agen- in Philadelphia. cies and institutions, especially City Govern- The health problems are obvious, most of all ment and the Redevelopment Authority. The to those who live there, and any program survey was commissioned by the Community 13 Organization and the survey committee of the twice in the evening before writing it off as organization is in charge of carrying it out. A "No Answer." community worker with the Methodist Service Stti-vey Findings Center who works in the Eastwick area is also We are presently in th.e process of evaluat- interested in the survey and has been working with us on some of the individual followups. ing the survey findings. Some of the main The Community Organization received a grant problems which have developed are: from the Philadelphia Council for Community 1. Problems caused by redevelopment. Advancement which allowed them to hire a A. Lack of stores in the area. community resident, Mrs. T., to work with the B. Weeds which have not been cut in SHO students and survey committee on the many fields. This poses a traffic and rodent survey. This grant also paid for the incidental hazard. expenses of the survey. C. Poor public transportation. The actual survey was drawn up by several II. Problems the city should deal with. people, including Community Organization A. Lack of mosquito control. members, SHO workers, an urban planner B. Lack of an adequate sewage system. working with the West Philadelphia Mental C. Lack of street repair and cleaning of Health Consortium, and a community worker gutters. with the Consortium. A rough draft was III. Problems peculiar to the Larchwood formed from a list of problem areas the com- Gardens Apartments. mittee thought important to work on. Subse- A. Bad relations with the landlord. quently there was much of the cutting, re- B. Noisy kids in the nearby schoolyard writing, and changing which goes with pre- at night. paring any finished paper. The final version It will be noticed that health problems are contained questions on demography, mobility, not included. This is partly due to the fact that health needs, employment, and social and phys- other problems are more pressing and also be- ical environmental conditions. The final version cause the health problems which do exist are had to be cut down f rom a 45-minute ques- individual problems and were handled on that tioning time to a more workable time of 25 basis. minutes. We tried to make all our questions The survey was useful in determining the ones which could conceivably lead to meaning- overall and specific needs of Eastwick. The ful followup and eliminate those which were subsequent follow-up has taken two basic of purely sociological interest. directions: helping individual members where Our aim was to survey as many of the 500 help was needed, and attempting to strengthen homes in the area as possible. One week in the Community Organization and help it deal advance we distributed flyers to each home with the Redevelopment Authority and City describing the organization and explaining why Governmen . we were doing a survey. This advance pub- The first of these directions has probably licity proved to be very important as it alerted involved the most successful part of the sum- people to our presence and we were not total mer. Needs of specific persons were identified strangers when we knocked on their door to as the survey progressed and handled on an interview them. In general, people reacted co- individual basis. For example, several recipi- operatively or apathetically to us. A few were ents of public assistance were informed of a suspicious, thinking we were from the city or program whereby they could obtain much the Redevelopment Authority, and of course needed dentures free of charge through the there were a few refusals and hostile people. University of Pennsylvania Dental School, and Our refusal rate, however, was less than 10 two have actually begun to be fitted for den- percent. One problem which is common to any tures. Several persons in need of financial help survey attempting to reach a total population were found eligible for Pennsycare and Food is that some people are not home when called Stamp Programs. Other persons seeking jobs on and cannot be reached. We usually tried were directed to various training centers to visit a given house twice in the daytime and throughout the city. One man who lived on 14 the f ringe of the community was even helped munity get-together. The SHO workers will in his effort to obtain a telephone. It was sur- also work with the Or@anization to obtain bet- prising to discover how many people in the ter mosquito control, set up a possible sex edu- lower income brackets had no knowledge of the cation course, and assist where we can in many programs available for all types of as- f urther dealings with the Redevelopment Au- sista-nce, and we gladly supplied the needed in- thority. formation. We are presently preparing a Other than the problems already discussed "Where to turn" type booklet for general dis- above, no major health deficiencies were found. tribution in Eastwick as a continuation of this The most pressing problem would probably be eff ort. the general lack of periodic checkups. Most The second part of our effort, that of at- people are either quite healthy or have ade- tempting to form a more effective Community quate health care. One area in the health field Organization, is presently the concern of the was improved, however. It was discovered that community. It is an important issue because a receiving ward type of clinic was recently the community is in need of an effective force established by St. Luke's Hospital at Interna- to handle its many problems-mainly public tional Airport only 8 minutes from the center transportation, more stores, effective mosquito of Eastwick. The community,,however, is un- control, street repairs and dealing with the aware that this facility exists. Plans are being Redevelopment Authority. The Redevelopment made with St. Luke's to publicize the clinic Authority began its operations in Eastwick and there is also a possibility that it can be over 10 years ago and has planned the project used as the site for a Public Health Service so that it is the largest urban renewal site in Clinic in the future. the country. However, due to ineffective plan- ni-ng Eastwick today has many overgrown Report on Community Work With the fields where homes have been torn down but nothing has been built to replace them. Also, Paschal Betterment League Redevelopment has not always dealt straight- forwardly or fairly with the residents of the Renell Burden, Larry Budner, Dudley area. Goetz, and Chris White The problem of forming a strong, repre- sentative Community Organization is a pri- Our major concern at the Paschall Project mary problem since it is the community, and site was a comprehensive survey of the neigh- not outside SHO workers, who should be deal- borhood, made at the request of the Paschall ing with the City and Redevelopment Author- Betterment League. Problems concerning ity. It is also a difficult problem. The present health care and municipal services were cov- organization has a nucleus of dedicated people ered in the study. With demographic material but does not have the widespread participation and attitudes toward the neighborhood in- it needs. Many people are quite bitter over the cluded, the survey was undertaken to deter events of the last 10 years. They stood up and mine whether the residents had any interest in were "bulldozed over" by redevelopment once their community and what specific community and don't feel like standing up and being run problems exists. over again. In Larchwood Gardens Apart' As a result of the survey!s findings, many ments, the people are more transient and many problems concerning environmental health don't feel they have enough of a stake in the were made evident. These included lack of: community to get involved. street lights, traffic lights, fireplugs, recreation, The survey was itself a first step in the at- a day care center, adequate police protection, tempt to strengthen the Community Organiza- and adequate shopping facilities. In addition tion. The confidence of many people was gained to the above, abandoned houses, inadequately in the process of door-to-door canvassing and functioning sewers and unfit housing condi- a fair number of people showed a willingness tions were reported to the respective city agen- to work with the organization. The next step cies. No significant personal health problems includes the planning of a cook-out and com- were brought to light, however. 15 ounded ice, such as a car accident victim dying in the The Paschall community is roughly b hospital because of too long a wait f or a on the East by 63d Street, on the South by Grays Avenue and on the North and West by needed operation. There is no community in- Cobbs Creek Parkway. This community is volvement on the planning or administrative quiet, lower class (and some middle class), boards of any health facility in the area, that and integrated, although mainly black. we are aware of. Generally, community services, except those In order to obtain immediate community pertaining to shopping and recreation, are con- services from the city, we: confer with the sidered adequate by the residents. Trolley Paschall Betterment League President, as to route 11, running from Darby through whom in the City Bureaucracy to notify about Paschall to Center City, is the only direct the problem; call up other voluntary groups, transportation into the city. There were rela- such as North City Congress; and work tively few complaints about the No. 11 in our through the City's published reference guides survey, but frequently of service is signifi- to municipal departments. After a phone call cantly lower than other nearby lines. Municipal to the appropriate city office, most of our re- response to residents' complaints about city quests are followed up by a letter to the same services appears to be prompt and at times office and a copy to Mayor Tate. Complaints efficient. There are two hospitals in the area, by the neighborhood residents were also ob- Mercy Douglas at 50th and Woodland, and tained in the PBL's storefront office. The two Misericordia at 53d and Spruce. These hos- project fellows and two students aides assigned pitals appear to be used by the residents only to the Paschall Betterment League, 7039 in case of emergency. For non-emergencies Woodland Avenue, undertook a survey of the and/or for sustained treatment, the residents Paschall neighborhood at the request of the go to the Hospital of the University of Penn- PBL president. The survey site had been se- sylvania or the Philadelphia Ge'neral Hospital. lected on the basis of PBL's conception of its Although the neighborhood borders the city "neighborhood." Of approximately 500 fami- limits, very few residents travel into Darby, a lies, 195 families were selected and interviewed nearby suburb (literally across the street) for during various times of the day. Supervision hospital or clinic care. A large number of re- and "overall responsibility" for the survey re- spondents in our survey said that they go to mained with SHO students. their private doctor or dentist for treatment. The PBL president considered the survey This response cut across economic, racial, and necessity in order to provide estimates of the age lines. The use of public transportation for neighborhood population density; child popula- obtaining medical care is time consuming but tion; knowledge of PBL and any other neigh- reliable (except when snow falls, then the No. borhood organization; "pressing". neighborhood ll doesn't run regularly). One respondent problems; complaints about city services; complained about the necessity of taking three racial composition; age composition; mobility; buses to travel to a public clinic. There are number and types of dwellings; employment almost no taxicabs cruising in the neighbor- histories; and neighborhood development possi- hood. Over half of the respondents said they bilities. The large number of questions on did not own a car. health care and services were of less interest The major community health need that we to the PBL. encountered is the lack of recreation facilities The survey design was not drawn up by in the area. Both a large number of small chil- either the SHO staff or PBL but came from dren in the area and the adults suffer from an outside source. The PBL president added i 4nothing to do." This deficiency includes a a page of questions to the schedule. Each SHO lack of: swimming pools, athletic fields, and staff member tabulated his own survey re- equipment and recreational centers. sponses in conformity with a master schedule Both Mercy Douglas and Misericord ia Hos- devised by the entire staff. Many questions pitals have very poor reputations in the area. were discarded as being either too inconclusive Several residents have accused the hospitals ("How much money did you spend -on cloth- of various forms of malpractice and poor serv- ing in the last 6 months?") or of little value 16 ("What does the word neighborhood mean to not provide adequate money for the basic needs you?") Some of the statistics are being used in of life. Provisions in welfare regulations, such a day care center proposal being written by the as that which states the recipient must pay SHO staff. back all of the money "loaned" to him by wel- The large majority of the respondents were fare when he finally gets off assist ance, stifles quite responsive to the survey takers. The sur- motivation to become independent. But even vey demanded at least 20 minutes of the re- more central to this issue is the fact that the spondents' time. The noncooperators tended to people who administer and deliver welfare be older, white, long-term residents who ap- services cheat, insult, degrade, or simply don't peared to distrust any individual or organiza- care about the people receiving the services. tion connected with their changing neighbor- These and other indignities were identified hood. The area residents tend to be poor and by the consumers themselves. The central issue black, although poor whites continue to move is how these consumers have been effecting into the area. changes in the services they are receiving. By far the main finding was the residents' They have done this by banding together in a desire for recreation facilities for their chil- self-controlled and directed group, independent dren. At this time, the few recreation sites are of the influence of nonconsumers. Utilizing quite overcrowded, inadequate and beset by publicity and political and legal sanctions, they racial tensions. have attacked the structure which holds up Other problems, but which were not as uni- the welfare system. versally cited as recreation, included lack of The Philadelphia Welfare Rights Organiza- shopping facilities. and transportation and the tion (PWRO) is a truly grassroots organiza- need for a Child Day Care Center. Although tion of welfare recipients. The SHO's rela- over half of the respondents were aware of tionship to the organization was to help WRO PBI!s existence, very few were members. Only in their fight against the Department of Public 15 percent of the respondents wanted to live Assistance. We were well accepted as helpers "in the same area." and extra staff people. After the survey was completed, SHO staff Our first activity of the summer was to con- members began to attempt to obtain needed duct a cost of living survey. The PWRO asked city services for the area. Attention was drawn the Student Health Organization to help them to these needs by the survey respondents and construct, administer, and evaluate a cost of noted by the surveyors, although emphasis was living survey. The survey's purpose was to not put on the reception of complaints by re- determine the actual cost of food, clothing, and spondents. On the whole, municipal reaction shelter as compared to the allotments recipients to SHO requests, made in the name of PBL, receive from the Department of Public Assist- was quite good.@ However, with the SHO staff's ance. In addition to the food, clothing, and assistance, the Paschall Betterment League, shelter items the survey included items such has begun action on the need for recreation as furniture, home upkeep, personal care, edu- sites. cational and recreational expenses. The results of the survey will be presented in Harrisburg Welfore Rights Organization to the Governor and members of his cabinet. It is hoped that the Public Assistance payments Marpha Crafton, Shirley Fischer, Gene Schat@ will be raised from their present level of 71 Jon Bonano, and Jean Wilkerson percent of the 1957 standard. to 100 percent of 1968 standards. The central issue with which we have been The questions to be used in the survey were concerned this summer is the power of con- determined in the following way. The SHO stu- sumers to affect the services they are receiving. dents prepared a preliminary . questionnaire. This is, a central issue because the welfare This preliminary questionnaire was presented system, as it presently functions, is inadequate to the 18 local chapters of PWRO for their cor- and insensitive to the needs of, the consumers, rections and revisions. These revisions were the recipients. The present welfare grants do incorporated into the final survey. On Monday, 17- July 16, and Tuesday, July 17, a training ses- tiorial disputes. Much experience was gained Sion was held for the 18 community workers from the consumer viewpoint. This, Nve think, who would administer the survey. The first by the students in battling the establishment training session consisted of reviewing the 'has been a valuable experience for future deal- questions to iron out any last minute problems. ings with the medical establishment in the The second training session consisted of a trial role of patient advocate. interview. The 18 community workers were split into teams of two - one interviewer and COMMUNITY-"ESTABLISHMENT" one interviewee. In the afternoon the roles were RELATIONS reversed. In this way a thorough familiarity with the survey was obtained. Karen Lynch Each community worker was responsible for Where there is concern and action by local interviewing 11 people. These people were to communities to improve neighborhoods and by be taken from the following categories of individuals to make use of available health Public Assistance, seven Aid to Dependent Chil- services, the "establishment" must respond dren, two Old Age, one General, and one Dis- with similar concern and action. Effective re- ability. This distribution corresponds approxi- sponse by hospitals, city agencies, and clinics mately to the percentages given by the Depart- today, means changing from present proce- ment of Public Assistance. A total of 216 sur- dures and adopting new philosophies an pro- ve ys were distributed. As of now (August 14) grams and even new goals in light of changing about half have been returned. About 20 per- needs and priorities of individuals and com- cent of those surveys returned were incom- munities. plete, i.e., one or more vital questions were The six articles in this section present experi- not filled out completely or correctly. ences, problems, insights and potential solu- The only difficulty expressed by the com- tions to community-establishment relation- munity workers was the problem of obtaining ships. people for interviews in either the disability, The project workers at Fairmount were old age, or general assistance categories. The confronted with much "red tape" in working interviewers have reported very cooperative on problems of abandoned houses and in trying responses from the people that they have inter- to set up discussions of family planning. Their viewed. experience points out the problems and the in- At the present time -no analysis of the data ability of communities themselves to straighten has been undertaken. out communication paths from neighborhood to After the survey was launched our main City Hall, to the Bureau of Licenses and In- function was to assist the organization with spections, and with the Board of Education. some of their other activities. The main one Solutions to these problems must come from the was helping the women staff WRO booths in agencies themselves. the district Public Assistance Offices. The re- Solutions are being suggested for another cipients have a right to be represented by any- problem of the resident of the inner city. Steven one they want when they go down to the Public Marder's investigation of the adequacy of Assistance Offices. The -women assumed I the pharmacies to meet the needs of poor people role of client advocates. The reaction of the pointed out the pressing need for young phar- establishment was both hostile and abusive. macists and the possible ways of meeting this Their main objections were that while they need. The article printed here is an abstract were being checked by the women they could of a much longer, more detailed report which -not function properly. A great part of the he prepared during the summer. summer was also spent sitting around the WRO The remaining articles in this section deal office, learning the problems of a grassroots with the difficulties of providing service within organization. These were problems of building large organizational structures. Differences in and arousing a membership, keeping outside philosophy between the Day Care Program of institutions and groups from influencing the the Temple Community Mental Health Center organization, and just simply intraorganiza- and the Department of Psychiatry at Temple 18 Medical School led to strain in running that opinion. Conversations with the Human Re- program. "The Saga of Fidel Cruz" shows sources Standing Committee indicated that in- vividly how one man "battled" with an ear, formation which I could compile would be nose, and throat clinic and will never return. A useful in the action programs they are pres- few incidents like this one may result in an eiitly planning. The Health Department based entire community losing trust in the clinic. The Model Cities Staff provided the expertise and proposed position of patient advocate at Pres- influence that would guarantee that I could find byterian Hospital, reported by Frank Greer maximal involvement in the medical-pharmacy and Jerry Lozner, is another possible solution establishment. to this problem. Especially useful in evaluating community The two extensive articles by Lozner and opinion was a report by the Human Resources Greer about their work at Presbyterian-Uni- Standing Committee entitled, "Barriers to versity of Pennsylvania Medical Center Good Health," and meetings with the Commit- (PUPMC) are models of the changes which tee. The report indicated that the community can be planned for a hospital in order to make viewed deficiencies in pharmacist services as it more responsive to its community. These being closely allied to deficiencies in the services articles present, in detail and occasional d'upli- of other health professionals. The report as- cation, the results of an imaginative coopera- serts that there is, 'ta lack of quantity and tive effort of students, community workers, quality of doctors, dentists, druggists, visiting and hospital staff to improve the relationship nurses, and other health specialists." The com- of PUPMC with its neighborhood. These munity indicated that pharmacies are often not papers should be read very closely. open when the people need them and that they The problems discussed in these articles are are often inconveniently located. It was also not new. These articles are significant, however, recommended that a system should be developed since they report real experiences and real which would provide necessary health services, attempts to meet problems and they are not including drugs at prices that people in the editorials. They should be read for insight community could afford. into the complexity of the problems and for When interviewed, the pharmacists disclosed the potential of the solutions. an image of a profession which was more or less falling apart. Of a total of 102 pharmacies Community Pharmacies in North-Central located in the Model Cities Target Area in Philadelphia 1960, only 57 remain open for business today. Indications are that this decline will continue. Steve Marder At least 10 of the 43 pharmacists interviewed already had definite plans for closing. - This The encounter between a black ghetto resi- marked decrease is not unique to the black dent and a white professional takes place in a ghetto. There is an overall tendency in Phil- number of different institutions. This summer I adelphia for the total number of pharmacies studied the encounter at its primary source in to decrease at a rate which is not too dif- the community-namely, the community phar- ferent from that in the Model Cities Target macy. The purpose of the study was to evalu- Area. The difference lies in the fact that in ate how well existing pharmacies were meeting most areas of the city, small "one-man" phar- the expressed needs of the poor people whom macies have been replaced by larger, more they serve. To do this, the opinions of the modern stores. This has not been the case in black community were evaluated and integrated North-Central Philadelphia. into a questionnaire for pharmacists. In this The survey indicated that the problem lies manner, the health professional would, by ne- as much with the pharmacist, himself, as it cessity, be responding to the -opinions of the does with the economics of the area. The community. pharmacist in the Model Cities Target Area For the purposes of this study, the areawide is rarely a young man. He is almost always Citizen's Council of Philadelphia's Model Cities older than his middle fifties and is often in Program was used as a source of community his sixties and seventies. He has usually owned 19 30 years and he con- filled. Discussions with the community have his store for more than the only already brought up several possibilities which tinues to run his store with himself as estigated. These include coopera- pharmacist. The North-Central Philadelphia are being inv pharmacist has probably not remodeled his tive drug stores replacing pharmacies which store in any rhanner in the past few years. have closed, pharmacies in District Health Cen- Instead, he has allowed it to deteriorate until ters, and Neighborhood Health Centers, and today it is often small, depressing, and di:ty programs to keep hospital pharmacies open with a rather scanty inventory available on the during the evening. shelves. The most important factor preventing the Philosophical Conflicts of the Temple North-Central Philadelphia pharmacist from providing the kinds of services the community uommunity Mental Health Center's wants lies in the attitudes he has towards his business. He very rarely has any ambition to Day Program improve and expand his pharmacy. Rather, he is quite content to manage whatever profit he Bess Aronian can from his business until he retires. In or er to detect what flexibility there might be in the system, I spoke to several of the pharmacy The day program of the. Temple Community leaders in Philadelphia, including representa- Mental Health Center is an experiment in com- tives of pharmacists and the pharmacy schools. munity psychiatry. The philosophy of the From these men I obtained several ideas of how program was defined largely by its director, pharmacists in the area might alter their busi- Dr. Frederick B. Glazier, who used Day Top nesses to better serve the community and in- Village of New York as his model. Because of crease their profits. The idea included stores the highly innovative nature of the program, merging to form larger, more modern pharma- Dr. Glazier has had many problems to face cies and prepaid drug programs which are im- since its inception last September. I will first proved over today's Public Assistance plans. discuss one of these problems and then briefly It is interesting that when questioned, pharma- explain the philosophy of the day program. cists showed little enthusiasm for any of these One of the major problems faced by the pro- proposals. . gram is its validation as therapy technique All of these results were taken to indicate and thus its potential as a model for the estab- that if we use the consumer's needs as our lishment of future day programs. This involves basis for evaluating the services being rendered bringing about its acceptance by the main- by pharmacists, the present personnel are like- stream of psychiatry. At the present time, the ly to continue to fail. The character of th Temple University's Department of Psychiatry has not considered the day program especially business and the age of the pharmacists would suitable training ground for its medical Stu- seem to serve as a good basis for inflexibility. dents and residents. It helps to understand this The problem in this case lies not so much with when we realize that the frame of reference of the fact that pharmacists are unable to solve the day program and that of traditional psy- their problem, but more with the f act that most chiatry are so different that comparison be- did not have any great hope or ambition for comes very difficult. Psychoanalysis and other their businesses. Freudian based therapy techniques face many Probably the most important conclusion barriers when considered as treatment methods which comes f rom the survey is that new in community psychiatry, especially when the sources of pharmacists must be found to serve community is the black ghetto. First, there is North-Central Philadelphia. The obvious solu- the problem of sheer numbers. Temple Com- tion which comes to mind is increasing dra- munity Me ntal Health Center is the only psy- matically the number of black pharmacy stu- chiatric facility servicing an area of North dents. There is also a necessity that the gaps Philadelphia with a population of approxi- left by pharmacies which are closing should be mately 215,000. The verbal facility normally 20 required for successf ul psychiatric treatment The Saga of Fidel Cruz would be a barrier with this population, as would the medical terminology usually em- Tom Fiss ployed. Also, the crisis orientation of this popu- lation makes it unlike the middle class from which psychiatry has traditionally drawn its The following is an attempt to illustrate the clien tele. As a rule, people in the ghetto are problems of the clinic system as encountered approaching or are at the breaking point be- in a midcity hospital in this area. The system fore they seek help-many do not voluntarily is a mire, bogging down, and hindering those seek help, but are brought to the center by the who administer it, those whom it claims to police or their families. Generally, middle class serve, and those who attempt to reform it. The people seek help before a crisis is incipient. administrator too often becomes frustrated and It is significant that the stress psychoses pro- overwhelmed by the system. The patient be- duced by ghetto living have been likened to comes a unit of the system frequently proc- those observed in combat veterans. essed but seldom treated. The reformer becomes quickly disillusioned. He's told that change These are some of the problems which Dr. must be slow but too often slow movement Glazier has had to consider while evolving his becomes complete halt. program; into a working treatment center. He incorporated many ideas into his program, Tuesday morning, July 16, Fidel Cruz, 72, probably the most significant of which is his walked into the community center complaining conception of the behaviorally oriented thera- of dizziness and marked auditory dysfunction. peutic community. The device used to imple- It was discovered that the patient could not ment the formation of this community is that hear with his right ear because it was impacted of multiple, interlocking group therapy. There with wax. The Rene-Weber test showed that is virtually no one-to-one therapy between the the ossicles were functional. The physician-in- patients, or members as they are called, and charge called the ear, nose, and throat clinic the staff. Basically, the therapeutic community (ENT) at the hospital for an appointment so depends upon the responsible behavior of each that Mr. Cruz should be there at 11 a.m. When member towards himself andevery other mem- Mr. Cruz was told of his appointment, he pro- ber. Responsible, mature behavior is encour- tested vehemently. He wanted no part of the aged by the staff and "sick" behavior is dis- hospital-he'd been there before too many couraged. The community is a democracy in times. They had X-rayed him, palpated him, which the traditional authoritarian role of the hooked him up to wires but nothing had ever staff members is relinquished. Dr. Glazier is been done for him. But Mr. Cruz was per- known as Fred, and his opinion, which counts suaded that things would go better this time. equally with each of the members as one vote, Mr. Cruz walked the three fourths of a mile to can be overruled. The members, themselves, the hospital, was on time for the supposed jap- are the therapeutic agents for each other, and pointment, but was told the doctor would not be present until 1 p.m. Mr. Cruz went home the openness of the community accounts for and returned, by foot, at 1 p.m. At 3:30 p.m. the fact that a person like myself, who is Mr. Cruz was told that the doctor would not neither member nor staff, can function with be in that day. the group. Wednesday, July 17: In the case followup, Although the National Institute of Mental staff member, Santo Smith, encountered a Health evaluation report recently issued states rather aggravated Fidel Cruz. He vowed never in reference to this program, "It is our opinion to return to the clinic. that this day program constitutes the model Thursday, July 18: To prevent a repeat of of what a therapeutic type of day program Tuesday's fiasco the day's activity was planned should be," Temple's Department of Psyphi- carefully and precisely. The ENT clinic was atry remains doubtful, and maintains at best called and it was discovered: 1. that although a tenuous relationship with the Day Program. the doctor does not arrive at the clinic until 2 1 p.m. the patients are told to report at 11 a.m. Presbyterian-University of Pennsylva nia so that they would be on hand at the doctor's Medical Center (1) arrival; 2. the doctor would be present today. Santo Smith would act as patient advocate and Frank Greer translator (Mr. Cruz spoke only Spanish) to insure a successful outcome. With some diffi- "Proposed projects include a Child Health culty Santo convinced Mr. Cruz that it was Project and developing roles for community best for his health if he went to the clinic aids to reach people not now covered. Home today. Santo guaranteed Mr. Cruz that the out- visits, group sessions at the hospital and place- come would be diff erent this time. Santo and meiit in the Family Planning Clinic, birth con- Fidel arrived at the clinic at 1 p.m.-"ahead trol education, or in the receiving ward." of the doctor." At 2:30 p.m. Mr. Cruz wanted It was about 10 weeks ago that I read the to leave because the doctor is not coming." above words in a massive publication by SHO Santo inquired and was told that the doctor describing the various summer work sites in would be delayed until 3:30 p.m. Santo calmly Philadelphia. I suppose the words "Child informed Mr. Cruz that the wait would be Health Project" attracted my attention, and worth his while. At 4:30 they were informed I made the work site at Presbyterian-Uni- that: 1. the doctor was detained in surgery and versity of Pennsylvania Medical Center would not be in that day; 2. clinic hours were (PUPMC) my first choice as a work site. over for the week. Santo reported that Mr. Arriving here in Philadelphia, I hesitantly Cruz was extremely agitated. decided to live with a black family in Mantua. Friday, July 19: Needless to say, by this Though I went through some traumatic ex- time Fidel Cruz had become a legend in his periences, it was an invaluable part of my own time. Interest was taken in his case by summer. When the people of the community the physician at the community center who learned I worked at PUPMC they immedi- called the hospital for Fidel's file. In the past ately wanted to "fill me in" on what they few months Mr. Cruz had had an X-ray, EKG, knew about the hospital. I got many reactions PPD, and various other tests to satisfy an from community people about the hospital, intern's academic curiosity. There was only one most of them negative. For example, consider remark concerning Fidel's hearing "right ear- that case of Mrs. B., who lived across the drum not visible." street from me this summer. On Sunday, June Monday, July 22: The hospital ENT Clinic 23, she had stomach pains and Went to was called. The clinic may have hours Thurs- PUPMC. After a long wait, which she didn't day. seem to mind, she saw the doctor in the re- ceiving ward (RW). He gave her some pills Wednesday, July 24: ENT Clinic still uncer- and told her to call the hospital on Monday tain about hours. Call 12:00 tomorrow. for an appointment for Tuesday's Medical Follow-Up Clinic. So, at 9 a.m. on Monday, she Thursday, July 25: The doctor -will be in at called and was told by the admission clerk 12:30 p.m. but will leave at 1 p.m. if not enough that clinic was in session and to "Please call pi people are present. Mr. Cruz was not able to back at I p.m. At 1 p.m. she called back and be contacted. No clinic hours until next week. was told "The book (appointment book) hadn't come back yet-please call back at 3 p.m." Tuesday, July 30: Mr. Cruz visited the cen- Calling back at 3 p.m. she was told that she ter today. He felt much better. He still had no couldn't get a clinic appointment bef ore July hearing in his right ear but his morale was 9. She tried to explain that the doctor had good. Mr. Cruz had not unreasonable doubt told her to come on June 29. Ultimately, she concerning the value of his clinic visits and received a clinic appointment for July 9. Mrs. B. was the victim of a great deal of run-around. expressed a desire that they be terminated. As she did not have a telephone, this cost her The physician in charge complied with his very 30 cents. When asked why she had gone to reasonable wishes and dismissed him. PTJPMC in the first place, she gave as a reason 22 the fact that her brother had been treated 2. Many of the community people could re- ,,just swell there." In general, however, despite member, or were told, about the former segre- her treatment, she described things at PUPMC gationist policy of the hospital. They felt un- ,is "pretty nice." welcome at PUPMC as people from a black, As another example, take the case of a economically deprived community. Indeed, one neighbor, Mrs. S, She related how a nephew woman boasted about the fact that her teen- had been treated at PUPMC two years ago. age son was the first black baby born at Pres- Having received third degree burns, he re- byterian. ported to PUPMC on Monday, only to be told 3. Community people were afraid of the to come back on Wednesday. Instead, he went research" going on in the hospital, particu- to the Veterans Hospital that very same day larly after its affiliation with the University and was admitted immediately. Mrs. S. ex- of Pennsylvania. Many older people expressed pressed disgust with PUPMC, not being able the fear of being used as guinea pigs. If one to understand why her nephew had not been died at PUPMC, then his kidneys, eyes, etc. admitted. were removed for transplants, and even the Mrs. W., also from the community and who corpse was given to the medical school. was employed by PAAC, expressed the be- Thus, as a result of our first two weeks lief that PUPMC was just too "high and experience, both in and out of the hospital, mighty." She recalled the time when no black our point of focus became directed at hospital- patients were accepted at PUPMC-and a spe- community relations. This problem can be at- cific case where a black nurse had sued the tacked on two different levels as is exemplified hospital for the.right to work there. A friend by programs at several area hospitals. On the of hers had told her that the Bookkeeping De- one hand, one can work towards the improve- partment was "bad" at PUPMC. The friend ment of community relations with the idea of had been billed repeatedly for a service for improving health services to community peo- which she had paid before leaving the hospital. ple already making use of the hospital's facili- Surprisingly enough, Mrs. W. thought that the ties. Such programs are being conducted at hospital turned away Department of Public Temple and Jefferson Hospitals. On the other Assistance patients. hand, one can work towards improving the Taking another case, Mrs. E. said that she hospital's image with the community at large. and her family used the hospital regularly. Her This approach could not include the specific son was employed there. But she did mention in-hospital tasks required of the first level. the fact that she had a great deal of difficulty Rather, it would involve close contact between in making clinic appointments. When she tele- hospital and community so as to keep the hos- phoned, the extension was always busy and she pital informed of the community health needs. was asked to' "hold" or to "call back later." The hospital would also be kept in close touch Having no phone, she found it less expensive with other community institutions and cooper- to spend 50 cents carfare and to make the ate with them when asked to do so. This would appointment in person at the hospital. probably involve the hospital in community ac- Finally, take the case of an old white woman tivities not often considered a part of "health" living in Mantua. She reported that "Presby- except under the broadest definition of the terian was a good hospital, but I wouldn't touch word. Such a program is currently underway it with a 10-foot pole." at Misericordia Hospital. After having heard such comments about Our approach to the problem of hospital- the hospital, I and my colleagues felt that there community relations has been on both levels was a serious schism between the hospital and this summer, though our daily emphasis has community. We attributed this to three basic been on the first level, the theory being that factors: by improving hospital services, patients will 1. Patients Were generally dissatisfied with act as catalysts to improve relations with the long waits in the Receiving Ward and felt community at large. that there was discriminating behavior on the Invited into the hospital initially by Dr F., part of the RW personnel. we began first to investigate his Pediatrics and 23 Well-Baby Clinics. He had expressed concern it is to be expected that such patients would that his Pediatrics Clinic had not been grow- not make any extra efforts to receive immuni- ing appreciably in the past years and that a zations. The hospital would be doing a favor very high percentage of clinic appointments for themselves as well as the community by were broken. We noted one fault immediately supplying these indigent patients with the nec- in the appointment system for the Pediatric essary immunizations. Jerry Lozner and I Clinic-patients were admitted only after they made the trips for these immunizations this had first been seen in Receiving Ward. Thus, summer and have worked out a plan with the a mother with a sick child could not simply Volunteer Department for their continuance call up and make an appointment for the child, this fall. being required first to bring her child into RW, Other suggestions for the Pediatrics Clinic which automatically meant a long and incon- included providing some sort of entertainment venient wait. Now appointments for the Pedi- for the children. As patients are instructed by atrics Clinic can be made directly by telephone. the clinic admissions desk to register at 12 Turning to the problem of broken appoint- noon for a 2 o'clock clinic, it is not unf air to ments, I began to call on all of the patients ask the hospital to provide the children with signed up for Pediatrics Clinic, on a given day, on the morning of the afternoon appoint- some sort of amusement. To make matters worse, many patients feel that if they register ment. About one-third of those patients whom before 12 noon, they will be seen earlier. Of 1. was able to contact, admitted they had in- course the obvious solution would call for a deed forgotten the afternoon appointment. Of supply of toys for the Pediatrics Clinic, but those who said they would not keep the ap- then several objections were raised to this pro- pointment, about two-thirds stated that the posal. It was pointed out that such toys would child had improved significantly and that it quickly become dirty and serve as germ car- was felt that the appointment was no longer riers. However, it is also -noted that toys can necessary. The other one-third said that cir- be purchased which can easily be cleaned by cumstances had arisen making it impossible the Housekeeping Department, and besides, to keep the afternoon appointment. It is inter- many of the children's personal habits spread esting to note that I met with very little hos- so many germs around the clinic that a few tility on these calls in the black community. more would not make much difference. An- Many people expressed surprise that PUPMC other objection to the proposal was that in should be so concerned about them. many cases the children would raise a fuss if In another project in the Pediatrics Clinic, unable to take the toys home with them. This we found that many patients unable to afford objection can be answered easily. It is all a immunizations were being referred to the Dis- matter of discreet selection of the toys. These trict 4 Health Center at 44th and Haverford are indeed toys which children would not ex- Avenue. At one time, someone from the hos- pect to take home with them, i.e., a set of pital had picked up free immunizations sup- wooden blocks or a black board mounted on plied by the city and brought them to pUpMC the wall. Or, inexpensive toys could be supplied for administering. However, it was felt that which could be taken home by all children. this was not worth the time of a paid employee Such items can be bought wholesale at half- so it was discontinued. We felt that this was price, and the necessary funding can be made bad policy on the hospital's part, as many available through organizations such as the patients referred to the Health Center would Ladies Aid Society, etc. never bother to make the extra trip. Of course, After the Pediatrics Clinic, we turned to an it was argued that this was not any fault of examination of the Emergency Room. The the hospital's; but such an attitude showed Emergency Room at PUPMC, like many others genuine lack of understanding. People in Man- across the country, is becoming a sort of com- tua are faced with many other priorities which munity doctor on call 24 hours a day. Thus, they usually place above thaf of good health in addition to non-ambulatory emergency pa- care. The only time they would bother to come tients, many patients come in with dog bites, to the institution was when they are ill. Thus, colds, earaches, indigestion, etc., and they man- 24 age to keep the waiting area filled at all times. Turning to the out-patient waiting area in it is nothing f or a patient with a dog bite to general, we have noted the need for a number sit from 9 p.m. to 3 a.m. waiting for a tetanus of changes and have been able to effect them shot. To be sure, the long wait could not be in some cases. blamed on the nurses and interns who are First, during the summer heat spells, the always working to capacity. What is dearly out-patient areas are unbearable. Temperatures needed is additional employees for the Emer- near the 100 degree mark have been reci)rded gency Room, not to say anything about addi- this summer. The entire waiting area is served ,tional facilities. It is hopeed that paramedical by two small fans. Air conditioners should be personnel can be hired to screen out those installed; (the nurses who have air-condi- patients who can be treated without the aid tioned cubby hole, responded to this sugges- of a doctor. tion sharply: "Well, what did people do before It was unfortunate to observe that several you had electricity?") It is realized that the interns assigned to the Emergency Room were circuits in the out-patient areas are being apathetic towards the patients. They would utilized to capacity, but something should be often verbally compare the patients to a herd done about the situation. It is certainly not a of cattle and administer inappropriate care. very healthy condition as it exists now. They openly expressed disgust with patients Secondly, lighting is extremely poor in the they saw repeatedly. This exemplifies a prob- out-patient areas. One would think the hospital lem not only for the hospital but of medical was trying to drum up business for the Eye education in general which turns out such Clinic. If the overloaded circuits negate the products. In one case in particular, an intern addition of more lights, then either the ceiling refused to become legally involved in what or the lights could be lowered. was clearly a case of child abuse. Fortunately, Thirdly, unlike the waiting room in the this attitude was not characteristic of all the ground level of the Private Wing, out-patient interns. areas are not supplied with magazines. We There are several obvious faults in the opera- instituted the placement of magazines in these tion of the Emergency Room which can easily areas this summer and hope the project will be corrected. For instance, at night the Emer- be continued by the Volunteer Department. gency Room handles compensation patients. Still needed, however, is a selection of maga- They are given first consideration and their zines which circulate almost exclusively among names are placed ahead of all other waiting. black people-Jet, Ebony, etc. persons. The unf ortunate part is that most of Fourth, at the beginning of the summer, the these compensation patients are white. Thus, restrooms in the out-patient area were very to the black patients, it appears that white unsatisf actory. At times they were so filthy patients receive preferential treatment, as they and smelled so badly, that it was an insult to do not have to wait. This situation does noth- use them. After dropping a few hints in the ing toward improving the hospital's image in right places, we are happy to note that con- the eyes of the community. ditions have improved considerably in the past Another hang up in the Emergency Room is month. the "temporary" appointment cards which are Fifth, a program, which has been instituted dispensed to patients referred to a daytime at.Jefferson Medical Center and is planned at clinic. Patients se e the date filled in on the Temple, is a milk and juice service in clinic card (if they are able to read) and-think they areas during peak hours. At Jefferson no already have an appointment. You can imagine charge is made to the patients, but it could be their chagrin when they show up for clinic only instituted for a small fee if necessary. Proceeds to find that it is closed or that the date written from the sale could be used .for a scholarship in on the card is an incorrect one. The appoint- fund, etc. Many patients arrive in Ithe hospital rne,nt must be confirmed by a telephone call, without breakfast, not realizing the long wait and as we have already noted, this simply adds ahead of them. to the critical telephone line shortage in the Sixth, one aspect of the clinic admissions morning hours at the clinic. desk which bothered us was the fact that 25 numbers and letters diate community compete for the positions patients were called by certainly which require one to be on the job five days a rather than by their names. This was eek from 10 to.3. If it can be done at Temple, a very dehumanizing experience on the part of w eeded the patient. Recently, we have cooperated with it can be done at PUPMC. All that is n the clinic admissions desk in instituting a sys- is a little initiative. tem of registration whereby the patient's name Consider the case of R.obert P., a black 14- is used, not his number or letter. We hope that year-old who lives about two blocks from this procedure will be continued in the fall. PUPMC. Robert was one of two students rec- We have also done some work on the second ommended by Salzberger Junior High School level of hospital-community relations-improv- for volunteer work at PUPMC. Having spent ing the hospital's image with the community at some time here last year as a patient, he was large. We first considered the possibility of excited about working in the hospital. As a putting more community people into the hos- matter of fact, I talked with several of his pital, either on a salaried or a volunteer basis. friends who said that all he ever talked about Looking first at the employment situation, we was hospitals and doctors. Robert reported to found room for improvement. For instance, the Director of Volunteers and was told that there were 80 vacant positions for nurses in he might be placed in one of the laboratories. the hospital in July. Forty of these were for A few days later, he received a letter f rom R.N.'s. Twenty were for senior nurses' aides PGH saying that he had been recommended and 20 were for junior nurses' aides. To qual- to them by the Volunteer Director at PUPMC. ify as a senior nurses' aide at PUPMC, the He worked at PGH this summer, and the labo- candidate must have two years of previous ex- ratory jobs at PUPMC were given to white perience as a senior nurses' aide, yet there is boys (probably sons of doctors) of about the no program here where the necessary 2 years' same age. As many positions as PUPMC has experience can be gained. Also, the hiring prac- open for volunteers, Robert P., a student from tices of the hospital are very much open to the community, was recommended to PGH. In criticism. Applicants for employment are often mid-July, Robert, who still wanted to work at rejected because they wear "large, dangling this hospital, applied for employment, only to earrings" or "too much eye shadow." We were be rejected on account of his age. That same never able to procure the necessary informa- week, another 14-year-old was hired by the tion to determine the percentage of employees Dietary Department as part of some sort of from the immediate community, as there was Youth Corps Program. But, this same hospital, no way of finding out that information, so we several days before, bad no place for a boy were told. of the same age and of a very enthusiastic We also were interested in recruiting more -nature. black volunteers at PUPMC. During the sum- Still another aspect of hospital-community mer months, PUPMC, a hospital in the midst I relations on this level is the cooperation be- of a black community, had no black volun- tween hospital and other community institu- teers. During the remaining months of the tions. We have successfully opened up a chan- year, PUPMC has only one black volunteer. nel betwen PUPMC and Drew School located The Volunteer Director admitted that no at- about two blocks east of the hospital, through tempt has been made to organize an active re- discussions with the principal. As the same eruitment program. As a matter of fact, the families make use of both institutions, there neighborhood Presbyterian Churches have not is certainly value in mutual cooperation. In the even been approached. It is thought by the fall, both institutions are beginning commu- director that the most reliable volunteers from nity advisory committees on which a repre- the black community are just not dependable. sentative from each institution will sit. An Though this may be the case in some instances, agreement is in the works between Hematol- and it may be true that most black people ogy and Drew School. Hematology plans to test from the community cannot afford to volunteer, the school children for anemia in return gain- the fact remains that at Temple University ing data for its research on sickle-cell anemia. Hospital, black candystripers from the imme- It is presumed that PUPMC could cooperate 26 similarly with the community institutions- Indeed,the impatient advocate" will come under schools, churches, YGS Health Clinic, etc. a great deal of pressure from members of the Another way the hospital could serve the establishment who will feel threatened by this community-at-large is in the area of family new approach of the hospital. To prevent this, planning or sex education. A representative it will probably be necessary that the "patient from Mantua City Planners met with us and advocate" be contracted through a third party, discussed the great need for service of this type such as diversified university settlements. in Mantua. The SHO group at PUPMC this Though this will certainly be a difficult step for PUPMC to take, I believe that it is neces- summer has attempted to get an unwed moth- ers' group going. It is felt that these young sary to assure that what happened to hospitals girls who face so many problems would find in Newark and Rochester does not occur here. it of value to share their experiences with one another. We have also met with a clinical teach- Presbyterian-University of Pennsylvania ing nurse at PUPMC. Out of this meeting came Medical Center (11) a number of suggestions and ideas, including a possible sex education program to be set up Jerry Lozner by Drew School to be taught by student nurses at PUPMC. As a medical student, I have become in- The white man can only play a secondary creasingly aware of many of the shortcomings role in improving the lot of the people in the in the health care delivery system. I joined the black ghettos. It is these people who must Student Health Organization and became in- become cohesive and work together to enact volved in the Philadelphia Summer Project, the necessary changes. Fortunately, the corn- because many of SHO's goals, as I interpreted munity of Mantua is showing signs of this them for myself, have been extremely mean- new cohesiveness, especially through such or- ingful for me. The ideas behind SHO and the ganizations as Mantua Community Planners. Summer Project were many: It is easy to put a few magazines in out- 1. To orient the health science student to the patient areas or to roll a juice cart through patient as a social being; to look beyond the the clinic areas, but these changes by them- patient to his environment; the nature of pov- selves will accomplish little in the field of hos- erty and its effect on the patient is often neg- pital-community relations. Unless the people lected. The products of such an education are of Mantua have a voice in enacting changes physicians and nurses who are skilled in the in PUPMC's policies, such changes will not techniques of their professions, but who are be appreciated. Without this community voice, woefully ignorant of the sociological factors the hospital can make no positive moves in the which affect the .lives of their patients. direction of improving the rapport between 2. To develop a new model of health science the hospital and community. I believe that the education, with a high degree of student ad- time has come when the consumer should have ministrative leadership and new ties Nvith com- a voice in defining the policy of the hospital munity groups, which could be applied to medi- which provides community health care. One cal training programs throughout the country. method of instituting this new community 3. To demonstrate an active interest in com- voice would be by filling the position of "pa- munity medicine, a-nd.change in health science tient advocate" with a Black American from education; to recognize failure of curricula the community. Hopefully, this person will be to come to grips with the biosocial issues of the able to set up acommittee of community lead- day . . . abortion, population control, poverty, ers which will function together with a par- racism, euthanasia, drug addiction, war, etc. allel committee of hospital personnel in mak- 4. To become personally involved with the ing new policy as well as redefining existing social issues, so our understanding can be in- policy. creased and our opinions become informed and To be sure, there is the imminent danger vital. that this individual will be absorbed and be- 5. To implement a multidisciplinary ap- come an additional organ of the establishment. proacb to health care. 27 foliated with the UniversitY of Pennsylvania new breed of health ago really implied some kind Of 6. To help develop a new pri- several years to this particular Olnmun'ty' ho is prepared to adopt courage porflnitment of economically de- professional W l lif e and en elp but ,coniprised Principally d downwardly-mo- orities in his professions his cannot h prived Afro-Arnericans all . outsiders do likewise. T iective his fellows to ed patterns of health ericans.11 As ob. -th the ely to irnprov bile White-Anl be concerned WI lead ultiTnat looking in, we were to v and hospital- Why care. year's Chicago it@ -nt? Why Irorn last rapport between commun lionexiste student nted, 44Today's rnedi- most sed only to A Ynedica was such a rapport al .sbeing u Summer Project cOrIlm r diseases were several of the e-"D'c e Pediatric Clinic? cine man tries to Put P( s of the ited extent, especially th that we would @..F in context; to see alcOl ill te @ 1,T we agreed t the the ghetto; ch create Anct from the outset, some despair of. al injustice go beyond just becoming aware ot wha of the soel or hostile pa- were, to also set the seeds for "the slum housing; to see a which society problems . It was hoped that we, kers tient in terms of the a man who concrete solutions community wor doctor 's a student fellows, and the fosters. The new breed medical help is , right congruent enough to hear would be personally were saying, considers that receiving ct of niedi- ,vhat persons in the community ough to onsiders that the only aFpe medicine." be personally congruent ell and who cis a privilege is practicing nd, I set and would . g to each other." This cine that -range goals in mi hear what we were BaY'n o the institution With these long some realistic short-term precaution and commitment t id be leaving ir down for myself .ect which and to the community we wou er a 'rnOrl the summer and f or a Pro' ake the sumrn goals f or ly health !cience students, but 10 weeks would help Mxperience for all in involved not On @,, high school students valid and worthwhilee .ty workers a . 4. a col,,Triuni volved. carae to was th as well: seeds for students to start The first ;realization Inipose their value 1. To plant the achieve their long-range white people can no longer i thinking how to best ple. The black people have a ver on black P@O - of their own goals. conln-Lunity rap- e and tradition To implement in any Way strong cultur ud, along with a grown comynunity rapport Tis or xhich they can be )ro is realization port with institute need to help themselves. With th cus of Tned with health science 13erso'nnel- the people ol recalled the words of a black cau ogether @ith this vearg 6'lf whi 3. To arrive at) t eecis for better serv- dents from earlier munity, concrete n cal Stu rojects do 'not have tb the com stitute these.needs as prac- students on ,ulnrner Pthe projects again tu: dto help in improving the health care understanding, aternalis'@ ices an kind Of mer of white P tices in specifically nce system. into yet another sum re rnindlessy. self ness sei delivery and grieva poverty area high school another sumriier whe 6vert palliation, anOt@ 4. To encourage into the ard in c jgg( ts to continue their education ice finds its rew the n studen summer in the sun learning how prof essions. some of mv aspirations as live.@@ These then were Hospital sorie Hospital personnel were inf ormed of c -n working at Presbyterian 1) consisted of through a letter asking f Or tl' I bega eks go. our working grou, elf, presence i icisrns. Community peo lo we a_ nts, Frank Greer and MYs suggestions and er t' y word of mouth @ two medical stude. y workers, both of Nvhorn learned of our presence b unity m@ two corninunit ity of the hos- ithin the so-called corntnull through attendance at ,everal COMM and inning to make initial c live wWe were f ortunate enough to have two ings. We were beg pital. to assist and guide very interested preceptors, tacts al was thro, ,to the hosPit . 0 eff orts. My first insight iet which -is given to all UF us in ur , that the @ledical informed its welcome PamPhl following The preceptors d about the sig- S. on the first pagey the iallY concerne ent 4eare for the Center was espec .es for the Corn- Pat' d. "Founded in 1871 to ance of its health servic state . no patient excluded fl" nific s decision to re- s ed, with The hospital' af- and di abl munity at large. phia when it became main in West Philadel ry or color,' coffee would be dangerous as far as the safety benefits by reason of creed, count The Center has built its reputation on medical of the babies was concerned. and surgical aid, nursing care and the 'spiritual From the Pediatrics Clinic, we expanded our consolation' provided its patient." This state- observations to the Pre-Natal, Post-Natal, ment, of course, wa@ highly inconsistent with Family Planning Clinics, and the Receiving the feedback we were getting from community Ward. The community workers began to get people about the hospital. It was felt that the together a group of unwed mothers for the Medical Center, since it once catered to a cer- purpose of having a meaningful interchange tain class of white people, had remained high in the discussion of common problems and baby and mighty. Only now that this class of people care. Frank and I began looking into the ap- was gone, were community people welcome. It pointment system. I began to look into the was felt that the hospital was using the com- nature of the appointment card which is rather munity. The research and experimentation go- confusing, especially for patients who receive ing on here at the hospital instilled fear in it after 5 p.m. The card indicates that the pa- many of the community people. They feared tient is referred to one of the specific clinics organ transplants or losing blood for sickle on a particular day, but few patients remem- cell anemia studies. Many people didn't know her that they must call in the next day to make that DPA was recognized by the hospital. One their actual appointment. The small print at person believed that the first black baby born the bottom of the card reminding them of this in the hospital was delivered only 5 years ago. can often be overlooked. The card should state Others said that they would rather go to Phila- at the top in large letters, "THIS IS NOT AN delphia General Hospital for their own reasons. APPOINTMENT; FOR CLINIC APPOINT- The basic problems seemed to be a poor rap- MENT CALL EV 2-4200, EXT. 308, BE- port, poor communications, and a poor under- TWEEN 9-10 A.M. Provision should be made standing on both ends. so that when they do call there is more than Still other people we talked to discussed the one open telephone line to receive their calls. confusion in the out-patient areas and the long Too often the lines are busy for such a long waits. Others didn't understand the Glover time that patients give up and forget about Clinic and its heart surgery. We found that their appointments or come in at the printed many of the people who came to clinic were tentative time only to. find that they cannot really not the ones who needed medical care be taken. most. Preventive medicine was something that This problem can be solved in several ways. many people either were ignorant of or con- The most obvious solution would be to move sidered unimportant. The major concerns were the appointment books down to the Receiving the day-to-day affairs, and a laceration or gush- Ward at night. It is not necessary to move all ing blood would be one of those. of the clinic books. We spent our first 2 weeks at the hospital Among the people we came into contact with finding out more about each other and meet- were the Director of Public Relations, the Di- Ing many people in the hospital, both in Ad- rector of the Volunteer Service, the Director ministration and on the medical staff. We were of Personnel, Director of Admissions, and becoming increasingly. aware and sensitive to many others. All of these people were very the problems, and we started discussing what willing to help us, although some did not seem we could do about them. aware of what the problems were or that prob- We Worked out of the Social Service Depart- lems even existed, me,nt, and we received a lot of help from the I took care of getting together a Hospital- staff of that department. We attended Pedi- Community Newsletter. The purpose of this atrics and Well Baby Clinics and spoke to the newsletter 'was to let the community people mothers as they waited for the physician. As know what. facilities were being offered to we talked, we observed. We thought at first them here at the hospital, what job and vol- that it might be a good idea to serve coffee unteer opportunities were available, and most to@th re important, how to go about making an ap- I ege mothers as they waited, but we we advised that because of the er owded space, hot pointment. There was no pamphlet of any kind 29 how to all about. And I could hardly find words to available to the out-patient to tell him answer the intern who called these people ani- use the clinics. Pertinent telephone -numbers, als and looked at our future as extremely nts could be directed in suggestions, and complai Perhaps futile. When the 4-year-old male came in with to the Social Service Department. tracted from a 6-year-ola then, by working together, we could attempt gonorrhea con ss could and would "to bridge the gap between institution and com- female, I knew that progre munity." come through education. I hoped that it wasn't The followup on the newsletter brought sev- true that the United States could be compared eral interesting responses. Major response to a poker game in the Old West; when a cow- from the community is yet to come, but many boy was caught cheating he would either be people were no doubt pleased to learn about 'Killed by the others at the table, or his win- the hospital's interest. Several nurses from the nings would be split up among them. Our racial Receiving Ward commented on one particular Problem has been compared to that poker statement in the newsletter, "The Medical game. The blacks have found that the whites Center through the Receiving Ward tries to have been cheating them, and either we'll have function as the family doctor for the commu- to shoot it out with each other, or be prepared nity, 24 hours a day, 7 days a week." The to share what we have. We must be prepared community had been informed of a constant now to dispel the idea of white racist institu- service; the Receiving Ward was staffed only tion. Now that communities are demanding sufficiently to supply an adequate emergency relevance, institutions must stop ducking be- service. Here arose another incongruity in com- hind elegance. The hospital must be prepared to listen to the needs of the community. And munications which demands evaluation. if sex education is an important need, then Frank and I looked into the areas around the steps should be taken to fill that need. I hospital where our out-patients come -fr M. have given the clinical nursing instructor re- About 3,500 patients used the clinics during source material from the large-scale health the month of April, and we plotted their geo- education program being carried on at Lanke- graphical distribution on a map. It was indeed nau Hospital. Miss H. has contacted a family difficult to define the community of the hos- planning registered nurse who would be glad pital. Mantua wasn't the hospital's community; to take the program under her auspices, al- in fact, there was a proportionately small num- though she would have little time for actually ber of people coming from the Mantua area. running it. Mrs. S. has indicated that Drew Powelton Village had been torn up by reloca- School would be an excellent source of young tion, another sore spot in community discus- people. So, this then is one program, the corn- sion of. the -hospital, and there were many pone-nts of which can easily be put together. patients coming from miles away. We also were concerned with the fact that With the start of the Young Mothers' group few people from the community were actually and the availability of cafeteria rooms for employed by the hospital at levels above kitchen legitimate community meetings in the evenings, and maintenance staff. We did realize that we realized that the hospital's commitment to many people from the community could not the community fell within the definition of present the necessary qualifications. Yet, the health in its broadest terms. We contacted a clinical nursing instructor about the possibil- hospital could use 20 more senior nurses' aides. ity of involving the student -nurses in a sex The problem is that to be a nurses' aide one education or health education program. This must have 2 years' experience as a nurses' was something that members of the commu- aide. An aides training program possibly run nity had expressed a need for. by the nursing school would be a valuable asset It wasn't until the first night that I spent in to hospital and community. the Receiving Ward that. I became impressed Our main focus, then became closing the with how cruel and brutal life can actually gap between institution and community and be. After seeing a gunshot wound and several what might be done to improve the rapport. lacerations, I felt my stomach sort of turning we began seriously investigating the area of over inside. I even asked myself what it was patient relations. We found that several pro- 30 grams in patient relations and community re- tee would consist of community leaders drawn lations were already in existence at other hos- together by the patient advocate; the other and pitals in Philadelphia. parallel committee would be composed of ad- The assistant director of ambu a y serv- ministrative and medical staff of the hospital. ices at one near-by hospital, was on of the Together, these two committees could function people we got in touch with. There he has es- to work on new policy, as well as improve on tablished both a patient relation coordinator existing policy. In other words, for the hos- and a community relations coordinator. Their pital to be really accepted by the community, main intent is to make the patient's stay more the community must be involved in desicion- comfortable. Small overtures-juice and milk making. for patients who have to wait, magazines, clean Another valuable resource person we came toilet facilities, furniture and toys for the pedi- in contact with was the Assistant Director of atrics playroom, etc.-receive quite a favorable University Settlements. He introduced us to response. In poverty areas particularly, favor- his "Design for Service Delivery that Rein- able, as well as unfavorable, impressions move forces Constructive Tension Between a Health quickly by word of mouth. He has been aiming Center and Its Consumer and Supports Com- to add the humanistic touch to the services ren- munity Power." He emphasizes the following dered in the out-patient area. premises: The Community Relations Director at an- "1. Individuals within a residential area other hospital, which is white, Catholic, has need their own effective community organiza- quite a difficult task for himself. As the only tion structure if they are to deal meaningfully black person on an administrative level at this with the problems they are experiencing. hospital, he faces the impossible or rather, ex- "2. A geographic area needs a broad based tremely difficult job of helping.a white Catholic community association that proceeds in a demo- institution relate to a predominantly black cratic manner and is controlled by residents. Protestant community. He hopes to have serv- "3. A citizen organization is representative ices rendered by the hospital which not only of a community as long as it remains unchal- keep the community healthy, but happy as well. lenged. He has organized a dance for the teenagers, "4. Public and private service institutions study areas for the students in the community, that are truly accountable to their consumers and an enrichment program for the youngsters. will choose to support rather than undermine community structures. At still another hospital the director of pa- tient relations has done an admirable job. In "5. Institutions that desire horizontal rela- response to a noise, dirt, and confusion letter tionships need to provide independent funds for a community organization service." drawn up by several physicians in the hospital, He has come into contact with PUPMC's As- she organized a committee to look into some of the inadequacies of the hospital as far as pa- sistant Administrator and hopefully their con- tient relations, and to try to respond to the versation will be ongoing. Patients' needs. The head of each staff in the hospital is always ready to address himself to Proposal For Position of Patient a problem as it comes up. The hospital quickly Advocate recognized the usefulness of her work, and her department has now expanded to four people. Goals: Here at PUPMC, we have presented a pro- 1. To be a human link between'the institu- posal for the position of patient advocate. This tion and the immediate community, so that the is a community person who could function in care of patients will acknowledge their human- the field of patient relations and actually be a ity and affirm their dignity as persons; hope- human link between the hospital and the corn- fully, this will make the patients' hospital visits MunitY. This step of course would only be like as comfortable as possible. Placing a foot in the . door toward a solution 2. To work imaginativel with professional y to the pr oblems we are confronting. Two com- personnel in the continuing evaluation, re- rnittees would have to be formed. One commit- shaping and development of health services. 31 the So- social dimensions of their medical problems as Departmentally, working out of either -it might be. In other words, the hospital has cial Service Department or the assistant ad ilable to the com- be the most suitable resources which it makes ava re not ministrator's ofrice would munity but, because these resources a context. many of whom are limitless, it wishes to make the most economic 3. To advise patients, cedure, of the steps use of them. At the same time, while the com- confused by hospital pro unity is not equipped to treat its Own ill- to be followed in gaining admission to, locat- in ing and using the clinic facilities in the Medical nesses, it does know what its illnesses are and Center; to be the patients' advocate with the could help the hospital identify needs to help hospital in reporting grievances about serv- facilitate and economize in the delivery of serv- ices, and to carry out in depth followups on ices. If channels for informing the community specific patient problems, as well as specific about medical services could be opened up and tasks related to making the patients' stay more if channels for listening to the needs of the comfortable. community could be developed, delivery of med- 4. To continue to inform the hospital of com- ical care could be greatly simplified. munity health needs by facilitating communi- PUPMC has been struggling to define its cation between community leadership and this relationship with the community f or many institution. This would involve setting up ayears. Now that it finds itself placed in an area committee of community leaders which, func- comprised principally of Black Americans, the tioning together with a parallel committee of Medical Center which held itself aloof from hospital personnel, could work on new policy the community bears the stigma of discrimina- formation, as well as making needed changes tion against the community. This makes the in existing policy. practice of good medicine difficult. Turning 5. To be a liaison between this institution now toward the black community, little has and the other institutions serving the commu- been done to acknowledge or deal with the nity. hostility generated out of a history of unf or- Since the goals outlined above will probably tunate community relations. prove too much for one person, we conceive Affiliation with the University of Pennsyl- of handling these goals in two phases or vania was a function of the hospital's decision through two people. For instance, initial focus to stay in the community and, at the same time, might be on the first three items, which pri- a kind of commitment to the community-to marily affect community people already mak- Our recently acquired us it and to be used by it. ing use of the hospital's facilities. Items 4 and '4research" image sometimes gets in the way, 5 represent a second phase in the project's generating fear in many of the people living development. This phase would not include the in the immediate area. Nor are we as aware of specific in-hospital tasks required in the first the ego destruction of the Black American as phase, but would deal with the hospitals rela- we might be, which makes it difficult for him tions with the community-at-large. This phase to cross the threshold of a predominately white might possibly involve the hospital in activi- institution. ties which fall within the definition of "health" The position being proposed would begin to in its broadest terms. open up some channels for conversation with the community. Of course, by providing a per- Rationale son to fill such a position, we by no means feel PUPMC is becoming increasingly aware of that this negates the entire hospital staff's re- the need for cooperation between institution sponsibility to be always listening for the con- and community for the efficient delivery of cerns of patients and to be interpreting the health services. The hospital feels frustrated hospital to them. Furthermore, it is our hope because a medically unsophisticated commu- that, in his language and presence, the advocate nity often overlooks, misuses, or does not make will be performing a teaching function for the the best use of the services available; many hospital personnel and will be affecting their community people feel frustrated because the attitudes towards community persons in a posi- hospital does not seem to be as sensitive to the tive, healing way. 32 It is significant that the hospital's decision Perhaps this experience of observing health to stay in the community was made in the professionals, the health delivery system, and absence of any serious conversation with com- the local communities which receive services munity leaders. It seems clear that hospital- will, in the long run, have the greatest impact community relations could be improved im- on these students, more than any formal facts measurably if the hospital were to take the and skills which were picked up during the community into its confidence regarding plans summer. already made for renovation and development The following six.articles present observa- of facilities. It might also prove useful for the tions on health professionals. Articles in other hospital to seek further conversation with corn- parts of this report present indirect observa- rnunity leaders in the ongoing task of decision- tions on health professionals: comments about making. Granted, there are ways of defending the Jefferson Mental Health Program, the Con- the monolithic stance of a medical center, but sortium's recreation project, the philosophy of these can only be posted with complete disre- the Temple Day Care Center, Gray's Ferry gard for the need to involve community persons community, and the "Saga of Fidel Cruz," all in decisions which have to do with the life and relate to this topic. In the articles of this sec- f uture of the community. tion, students address themselves straight for- wardly to health professionals and their fellow Possible C?,edentials students. Bill Halperin discusses a forgotten group in 1. The person should reside in the immediate Philadelphia, the poor whites, a group which community and have an in-depth understand- previously had been excluded from SHO's con- ing of the community surrounding the hospital. cern. How to relate to this group remains prob- 2. The person will need to be especially sen- lematic for SHO and it is one which all health sitive to the feelings of other persons and able professionals and reformers will have to face. to perceive, on many levels, the nuances in Both Jefferson Mental Health workers and human relationship. Temple Mental Health workers were person- 3. The person should be a Black American, ally involved in organizational probleriis. Phil preferably between 25 and 45 years of age. Harber and Anne Sheehan discuss the dual re- 4. The person will understand or have the ward system which is common to organizations ability to learn hospital procedure. which deliver services. Responsibility to client 5. The person will be articulate enough to and responsibility to the serving organization, communicate verbally both with patients and in theory, coincide and produce no conflict for professionals. the serving professional. In actuality, however, 6. The person will acknowledge a dual re- conflicting goals and expectations abound. An- sponsibility: to community and to hospital- other common problem of service professions and will possess the personal resources to work is the determination of the appropriate mode within this tension. of service and the development of appropriate attitudes in the practitioner toward the client. SHO AND HEALTH PROFESSIONALS This problem is accentuated when practitioner and client are characterized by not only differ- Karen Lynch ent needs but also different values and social backgrounds. Bart Butta and Robert Lewy About 80 of the project workers were stu- make some observations on this conflict area dents who will someday flnd themselves in as a result of their work at the community roles similar to those of the health profes- "Trouble Clinic of the West Philadelphia sionalg with whom they came in contact dur- Mental Health Consortium." ilig the summer. Through the summer project The experience reported by Darryl Robbins they have been able to examine the role of as a summer staff member of Eagelville points health professional differently from their usual out the importance of personal feelings and vantage point as students and prospective relationships to others within and outside of health professionals. professional roles. 33 t Mantua rnigrant of 20 odd years had been robbed in- The article by project workers a numerable times. rnniunity escribeg another alter- One cannot consider this a poor co community Planners d-community relations- e residents would see native to professional ides technical compe- or call it low class. Th euphem- This organization prov on of community this as an insult. They demand other problems tence in the design and executi del of the isms-lower income. Howevery the e effort is a MO remain the same: a high drop out rate-1 per plans. This cooperativ ida ed anO, potential alignment of community people nd college; mayiY dilaP t Ken Logan and Phil cent 90 On to block or skilled professionals. vacant homes; uiemployment. One Graiteer present a vignette of the comlnul"ty which I helped a resident try to orgailize and MCP projects. Tot Lot had only two Of 13 families supporte( A difficult problem in any human situation is arriving at ai, understanding of the effects by wage earners. just beginning to per,-ei,:, -nd behavior on others. Stu- The community is - It is beginning to under of one's attitudes a point out the sometimes that it has problems ust be badgered int, dents' comments here ssional atti- stand that the police ril ople a]: ces of profe ab doned cars. The pe deleterious consequeri the organizations which towing away an rs are not abandoniii, tudes on clients and ders about the effect of realizing that outside their neigl they serve. One won students themselves, as and stripping all the cars, but that these experiences on - bors are responsible. A late model Pontiac wit they begin to assume the role of health pro a flat tire and a smashed f ender was t,,rnE days later. I watche fessionals. into a worthless shell 2 ove tl a -neighborhood youth Of 12 or 11 rem The Unexplored: SHO Working in Poor radio. A public parking lot on Moyer StreE tial street, is abandoned by the ci' o munities a residen not used. A woman told me tb White C rn because it is your battery would be stolen by your next do, William Halperin iieighbor. She was not angry. She merely as quite normal. it is a ghetto cepted such behavior broadly defined. For Fishtown has been left out. al behavior is bounded by the Delaware River, Norris Ave- Norm oholis'rn is not perceived as a prc nue, and Front Street. Front Street is the stance, alc t all who drink ieed , "demilitarized zonepy across which -no black or lem. Most believe tha ady themgeIN Puerto Rican people move into Fishtown. Fish- other shot in the morning to Ste are thOu@ f white, lower income Arneri- to get their shoes on. Black-outs town is a ghetto 0 St- to be normal for those who drink. A sOciOIc) cans. Many are white Anglo-sax0l' Prote graduate student is presently attempting ants; there are Irish, Polishp Slovaks, and information on the residents' knowle( others. Some are recent immigrants, others collect olism, mental health and other welf; rica five, six, and seven gen- of alcoh p have been in Arne problems. But it would be quite reasonable little knowledge about these arE erations is a combination of old brick expect this area. The community There are no health agencies in ries, and small stores. Resi- left out. Fishtown is i row houses, facto e. Philadelphia Ps Fishtown has been v. It was dents are working class peopl outside the model cities boundar trucking industry, for example, is centered in choosing. To'@e imPlis this area. In a sense, things are -not changing included by its own homes-model ci no new Fishtown has vacant y-no new housing, housing. 0 for the communit. means rehabilitation and open s, little mobility either acks and Puerto Ricans. public works program r themselves housing means bl econotnle- raphically fo in this community that a true race riot ally or geog sense the community is . it; ildren. In a occurred in recent years. This was precip or their ch are becoming iz in. More recently ebanging-motorcycle gangs by a black family movin- attempting ue sniffing is more prevalent; more popular; gl black kids were "Cut UP" when ner candy vacant homes are set afire. in one cor go swimming in the Fishtown pool. Black f and grocery store which was crowded with erceived as a major problem. A local custoixiers in it, a Polish irri- are p more than three QA dent employed by the state explained this fear they are bigoted. Working in poor white com- as a defense mechanism. Fishtown residents munities is just coming into vogue for the have very little except their patriotism (one social activist. of the highest Marine enlistment rates) and On another level, some modicum of aid is their supposed white superiority. Integration now directed towards the black community be- of poor blacks who, by most criteria (income, cause of pressure from that community in the education), are the Fishtown residents' equals form of lobbies and insurrection. The children would destroy their last defense, that irrational of the white poor can be playing in dangerous belief of white superiority. Therefore, in fact, housing shells, but there is no urgency for the Fishtown leaves itself out of many programs city to act. When our leaders talk of poverty, which could prove to be beneficial. But there they mean black people who have been left out are other reasons it is left out. because of white racism. The community is "solid" in a negative sense. The government responds to pressure. The It acts together to keep blacks out. Community War on Poverty once was earnestly concerned solidarity does not work in positive directions. with poor whites, urban and rural. Urban A very eager, unselfish shift worker was asked blacks have now gained most of the war on how much he was being paid to help better poverty's attention. Blacks may appreciate the the community. The only community worker, efforts of white people in getting the civil who is also my preceptor, was accused of hav_ rights movement moving. Now their problem ing real estate interests. But then again the is to determine the path of their own commu- accuser thought that two major evils are the nities. international Communist menace and the Poor white communities continue to exist teaching of Darwinism in the schools. The and grow. People live in despicable conditions. community does not seem either worried or Perhaps in addition to facing our own institu- astonished that the Delaware Expressway not tions, we must catalyze the reaction of poor only has demolished many homes, but will run white America by building a new human rights on a graded mound through the community. movement there. The Fishtown Civic Association with its 88 members is trying to face some problems. It is investigating trying to gain a mini-school The Effect of Inappropriate Reinforcement like the one in Mantua and trying to have the abandoned homes in the expressway's path System on Program Establishment torn down before they burn. Fishtown is left out because it hag never gotten itself "together" Anne Sheehan and Philip Harber for constructive purposes. The third reason that Fishtown is left out is A Case Study that the government and other establishments leave it out. Miss Anne Sheehan and Mr. Phillip Harber, There are several possible explanations. The students in the Health Sciences, participated most obvious is exemplified by SHO's summer in the Philadelphia Student Health Organiza- Project. Letters were sent to agencies, com- tion's Summer Projec't of 1968; they I were as- munity groups, and I roughout the signed to the Temple Community Mental eaders th city. Since, there is only one social service Health Center to work and learn under the agency and one embryonic civic association, preceptorship of the Chief of the Community chances were not good that there would be Organization, Section of the Mental Health a response to SHO's offer. The proliferation Center. Their prime activity.,for the summer of community groups and projects in the black was the establishment of a Child Care Service community is not paralleled in the white com- for the West Nicetown-Tioga Neighborhood . munity. Family Health Center. This Neighborhood @Fishtown does not even attract the most Health Center is an Office of Economic Oppor- Sir-nple-minded do-gooders. Fightowners are tunity Healthright community medical center dismissed from our social concern because serving a population of about 30,000 persons. 35 opening Neighborhood Health Center, were called to Throughout the summer of 1969, its meeting with Miss S. and the PSHO persons. the mid-a ved by date was delayed from early July to At this meeting, the project was appro dle of August- Dr. C. for presentation to the Executive Com- The SHO participants attended a tour of the mittee and to the Neighborhood Board of Di- Neighborhood Health Center which included rectors for approval. A final revision of the meeting Miss S., Director of the Social Work proposal was prepared in consultation with Department. At her invitation, they attended Miss S. The proposal was approved by both a staff meeting at which numerous staff mem- groups; Mr. J,, Assistant Director of the Pro- bers presented the problem of the desire, and gran-1, was to present the proposal to the Phila- funds, for summer employment of high school delphia Antipoverty Action Council and to the students being present, without any ideas of ffice of Economic Opportunity for approval. how to utilize these individuals. At the close of0 the meeting, the SHO participants presented Miss W., acting Director of PAAC delayed the idea of establishing a service to care for approval. Dr. C. presented the proposal for children while a family member is receiving unofficial approval to a visiting OEO official. Id Health After a delay of about a week, Miss W. ap- medical attention at the Neighborhoo proved the proposal. The implementation of Center.; this Child Care Service would be the program then began. staffed by area high school students, who will also participate, in a training program to This paper will attempt to analyze one of qualify them to act as recreational leaders the causes for the difficulties encountered in and to facilitate establishment of good cornmu- gaining approval of the program. The imple- nity relations for the Neighborhood Health rnentation of the program will not be described; Center. The idea of working with a group of nor will other causes of difficulties be consid- high school students had been suggested by ered. No attempt is being made in writing this Miss S. to the PSHO participants on the pre- paper to provide a comprehensive view of the vious day. Dr. C., Director of the Neighbor- SHO participants' activities during the sum- hood Health Center, stated that the idea repre- mer of their placement at the Temple Com- sented a sound solution to the problem and he munity Mental Health Center. Since the cause agreed that the Child Care Service would be of the problem lies primarily in the medical a useful part of the services to be offered by establishment" ostensibly engaged in deliver- the Neighborhood Health Center. He author- ing medical and social services to the poor of ized the PSHO students to write a proposal for North Philadelphia, the paper will focus on itestablishment," rather than "community." the Child Care Service with the guidance of Miss S. When she was contacted, she agreed Since the "private entrepreneurship" form to provide the guidance and suggested that the of medical service does not function in North .students write a proposal to be presented to her Philadelphia, service is provided (when it is in a week's time. The students then wrote the provided) by relatively large institutions. This proposal. Upon its completion, the proposal results in a separation of the recipient of a was presented to her; she carefully read it service from the purveyor of the service; this and made certain revisions. There, was some separation may be temporal (it was difficult to lack of clarity as to the next step to be taken; produce enthusiasm for the proposal since en- it was decided that the proposal must be thusiasm lor action at the early stages would approved by the groups along the lines of au- bring no immediate benefit) ; physical (most of blems evolved; these in- the "high" administrators do not live in the thority. Numerous pro eluded inability to find a reasoInable location area they serve; their offices' walls and air for the Child Care Service, question as to the conditioners separate them from the people date that the Neighborhood Health Center they are.mandated to serve) social (many of ot identify would open, resistance to the idea by certain the 'professional" employees cann staff members, and many details such as insur- with the problems of those they serve) ; bu- an6e. The relationship. between the PSHO stu- reaucratic (the duties of many prevent them dents and Miss S. became appreciably strained; from meeting the people they serve), or of finally, Dr. C. and Mi. 0, Administrator of the another nature. 36 This separation produces an inappropriate munity, although it has been said that only reward system. Because the employee in an ad- three of the 15 positions on the Board to be rninistrative position receives rewards from filled by community residents are actually filled other administrators, rather than the "commu- by people residing in the area served by the nity" to be served, he acts to please the admin- Center; more importantly, the Board and ad- istrator, rather than to deliver real service. ministration associated with it are highly de- There are two determinants of the nature of fensive; their greatest reward is lack of any the reward system: the individual's responsive- form of opposition. This naturally leads to fear ness and the structural design for operation. of change. The former of these determinants is largely An example of the way in which fear of in- determined by the latter; to the extent that it novation operates to delay service is provided is not determined by the latter, it is extremely by the Child Care Supervisor. One of the first difficult to manipulate. The latter reason, the tasks assigned to her by the Director of the structural design, is artificial and, therefore, Social Work Department was to write herself subject to manipulation. a job description. Later, she was able to rely There are several structural causes of the on that document to justify her delays in the separation of recipient of a service from the establishment of the Child Care Center, stating purveyor thereof; the most significant of these that her job description precluded her from is the role definitions for employee positions. doing some of the things necessary for easy Also contributing to the separation is the in- establishment thereof. crease in the proportion of time spent on non- Factionalism is another result of responsive- service administrative work as the group de- ness to something other than the quality of livering service increases in size. Furthermore, service provided. When one can receive rein- racial and social barriers accentuate the bar- forcement only from within one's "unit" and riers between patient and health services can increase one's bureaucratic status by in- personnel. crease in the size of one's "unit," it is natural The inappropriateness of the reward sys- that there is more interest in the "unit" than tem reduces the quality of care delivered and, the community. This was evident in several perhaps more significantly, reduces the possi- ways. bility for meaningful change in the methods The Mental Health Center and the Neigh- of health care delivery. While the West Nice- borhood Health Center, do not now cooperate town-Tioga Neighborhood Family Health Cen- to any significant degree, while it would ap- ter is itself, an experiment in health care de- pear logical and even necessary according to livery and incorporates several innovative ap- OEO Guidelines* that the two cooperate. proaches on a broad level, its staff shows a In providing psychiatric services, the Neigh- marked reluctance to experiment with, or even borhood Health Center is seeking to establish think about, changing the way they do their its own psychiatric service. There is a basic individual jobs. "Job Description" for each mutual distrust and dislike between the two employee is quite sacrosanct; employees are organizations which became quite evident at a bound to their specific tasks as with the most staff meeting of both centers. It has been said stringent labor contract. Since the Neighbor- that at a meeting of the Neighborhood Health hood Health Center is seeing a minimal num- Center's Social Work Department, the director ber of patients, the staff has no real contact explained her reservations about the establish- with those to be served; many administrative ment of the Child Care Service Program on the officers stress plodding along without "caus- grounds of a fear that the Director of the ing any trouble." This probably results from Mental Health Center would attempt to direct ,the fact 'that they are in no way responsive one of "her" programs through the SHO par- to the 'needs of the community; they Ire re- ticipants. sponsive to an Executive Comm tee, com osed it p @rFelY@ of.@administrative medical personnel, Healthright funds are to be used only as aI"last dollar" wife and to s.@y no other service or support is available: Ne.ighborhood Health . a "Neighborhood Board of Director Centers are to cooperatd with, and utilize, the services of ether This last body supposedly represents the com- community service groups wh never Possible. e 37 ture might be reduced since the structure wol'Icl Temple elevant to the individuals gratifl- ,so animosity between the acy are There is a the Neighborhood be wholly irr isadvantages of bureaue-r tic ini-: cation. The d University Hospital and the reac- is summer, the btireaucra ,lines Health Center. This is evident fro, iversity" wil kiionvn; til LT established ,taff to including "Teraple U-n portaiice of working along bvious. Maytifac- tions Of F f authority" became quite0 ut as a oil their sign. itive serv-0 iid resistance came abo tured delays a 8s the established ssity to have one's POs , 1 The -nece of the i 4unit results result of attenPts to bypa ice viewed as a service services which would lines of autho"ty' the Proposal for the in the exclusiOll Of many,, product. A possible A, Iescribed earlier, taff not be visible as a "unit ring for Care Service was presented at a F al to even consider ca reason for refus merni)er visits an OPD Child ng. The Director of Social Work might children,kvhile a family the Neigh- meeti clinic at any other hospital (before ervice it- have suspected a "conspiracy?y between the opens fors SHO participants and. the Director of the borhood Health Center e latter self) may have been the consequent lack of Neighborhood Health Center when th ion of the service as one of the Neigh- approved the idea without first consulting her. identificat ealth Centel:. While the nature of @'Vhile the above e-,ample is concerned wity borhood H a-.v in part account f or nes of authority , tb( the f unding situation m- that 94serv- assumed (informal) lines. Afte- this answer, it is interesting to note following is concerne Neighbor o the community,@ was not considered. the proposal was al e ice t nl, other problems are hood Health Center approval 0 Besides f actionalis ard system. oned earlier caused by the inappropriate reNv f responsi- PAAC, CAC, and 0 OFO office', one of these is a great diffusion 0 the proposal was prese se administrators at led on it. it has been sui bility. This occurs becau v themselves before PAAC had ri the Social Work Depar all levels are not required to justif- rovide. gested by a member of elay resulted from tb s of the actual benefit they P ment that Miss N'V.'s r in term to personally the "proper channels It is, therefore, riot necessary an avoid- f ailure to work through make any real contribution. Hence, in the absence of more appropriate rei onsibility for any projectI are forced to set ance of personal res establishment iorcement, many persons t of their occuP develops. The resPo ego satisfaction as a resul hild Care SE red by Many, tional status. This may in part account f Or t of the C e follow al listing: Di- inflexibility concerning job descriptions. PI of whom tb Direc- freque exploit rector of Neighbor] Department, I orhood fessional distinctions are ntly tor of Social Work to increase the professionals' sense of wor Board of Directorsy SRO participants, Execu- In conversations with persons at both i tive Committee, Program Development and Mental Health Center and the Neighborhc I'Ljnit, Patient Care Coordination 0 participants detec Evaluation it, Child Care Health Center, the SH d to mental hea Committee Administration TJn erty Action a sense of inferiority atta S. I Supervisor, Philadelphia AntiPOv Area assistants and to family y he, Commission, Community Action Councileexample, the names of in( s of ce of Economic opportunity. All of thes workers do not appear i B, Offi v in establishing the Pro- as do the names o all ot have been invO.1 ed delay it was staff meetings d. Mental health as, graM. Since at the time of anIY if individuals who atten s equal,- impossible to Pinpoint the responsible parti, ants seem to be considered more a s impossible -to speed action. per- prof essiolials than are the family health w( it wa -natural outcome of the lack of any ers. It appears that the Neighborhood 'He A itment to a projer-t is a great indif - tant to dest sonar Comm Center personnel are more regis ference to one's work. in North Phila- tion of Professional superiority than are Medical and social services staff members of the Mental Health Cent( complex bureau- - eni of establishing respongiVE delphia are pro ed by fairly rele- The probl were made eeds of the community cratic structur, tendency to for- to the wishes and n egtablishniei vant to one's r struc- not been answered with the nialize relatioi reaucratic tioned cannot the "Neighborhood Board of Directors." It has do what many of the aforemen been said that 80 percent of the positions do. a- It is unfortunate that those who are closest allotted on this body for community represent tly most re- tion are held by outsiders. Furthermore, one to the community and consequen may question if the Board members do truly sponsive to its needs are those who cannot represent the community; one may question if communicate well in the language the "admin- the "poor poor" are really inarticulate in Board istration" has chosen. This problem is perhaps affairs. Many persons (social workers partic- related to that of status, since exclusion of ularly) claim to represent the community; that one's "underlings" on the grounds of their lan- they do often appears doubtful. guage may be used as an ego-builder by many. The system is such that the persons closest It is natural for the real interests of the to the community-mental health assistants. community not to be served when the service system refuses to speak the community's lan- family health workers, some nurses, etc.- really have the least voice. When the proposal guage. In general, one gets the impression that was first presented, enthusiastic reactions came interest in the commuriity's reactions is nega- from some members of this group. However, tive in character: only a fear of community the fate of the proposed Child Care Service was disapproval leads to a solicitation of the com- in no way dependent on their reactions; rather, munity. The phrase "getting a proposal it depended on the wishes of high admini§tra- through the Board of Directors" was too fre- tion officials. While their support was hearten- quently used. ing, it was really insignificant in comparison Despite these problems, it appears that the with the power afforded by Dr. C.'s interest. Mental Health Center is making valid beneficial contributions to the community and that the Many of the persons who could be most valu- Neighborhood Health Center will do so when it able in instituting beneficial changes in the sys- finally begins to provide f ull-scale service. tem are prevented from doing so due to a lan- The organizational plan of the Neighborhood guage problem. To institute change within the Health Center is a fine step in the direction of i@system," it is necessary to speak the "sys- responsiveness to service rather than to the tem's language. The "system" speaks a bu- i 4administration" of the "system." It is unfor- reaucratic language of its own. tunate that it is not implemented to allow this The SHO participants encountered difficulty actually to occur. Several questions should be in talking the language of the Neighborhood answered. Why should administrative positions Health Center. Such terms as "philosophy," (e.g. Director of Social Work) carry more re- I'goal," "objective ... .. staffing patterns ... .. pro- ward than service positions (e.g. social work- cedtiral steps" have very specific meanings er) ? Why should a physician not really listen which are, in some cases, different from the to what a Family Health Worker has to say? generally accepted meaning. Why must the organization rely on token com- Besides the terms developed by each organi- . munity representation to justify their intru- sion into the community? Why are "appear- zation to be used internally only, there is a ances" rather than real service the basis for prejudice against improper grammar and mon- osyllabic words. In writing an acceptable Pro- reward? Why is health care in North Phila- delphia inadequate? posal, it was necessary to use quite formal con- structions and language. The need to write in a sophisticated manner leads to the exclusion Profession'als' Values and Their of many family health workers, mental health Consequence on Serving assistants, and others who have quite valuable Clients ideas, from the rank of those who can develop a Program. These persons are stymied when Robert Lewy and Bart Butta ie-ate on the language level they cannot commun established by the 'high" administration. Only The main problem of the West Philadelphia the SHO students' academic high school and Mental Health Consortium is the preoccupa- college education placed them in a position -to tion on the part of the staff with their roles 39 al. It is unfortunate that such ople in gener dt) by obtaining are "ethically" Obli-p come itcertifle . e Pro- a, white professionals Who _class get of valuesP al training in order to r's .- ce a middle P,yhological submit that such formal train gated to enfor oriented middle-class r whom nity fo and MMU 11 redu( their effectiveness. bers of the co Ing w n our opinion, is lot to, as is theory on mem ,old- this is totally inappropriate. ed on The solution,1 adually force olit Consider an interchange which transpir present procedure, gr -.tionalists aid e- d requested a Psy-h'- lineup professionals and tracti- 13eople.11 As August 12. A student ha sortium place them piecemeal with "Young - imply atric evaluation of an alcoholic by a co" the new arrivals are s The psychiatrist's response ,vas amentioned above, d UP as their guilt be- psychiatrist. and , profes- d is a corn- pathY, indignation, isolated and swallowe mixture of a . f that his prof ound zed. What is require , cilities so sional-trainiII6,-bred belie a fellow comes mobili I of the CoDsortiurn f a .ely and Id only be meaningf ul to plete overhau sionals are irnraediat insights cOu illing to 4. at white profe, tionally compe- member of the guild. He ,vas not w th esponsible to enlo procedure ruits of his training with "Mr- invariably r oiess,onals.,, Such a share the f tent ,noypr egsio-nals at the Con- Temple Student-t@ cornmor, at the West would release those prof Instances like this are Mental Health COn- sortiuln whose originality and dissatisfaction y e been, by virtue of Philadelphia COmmun't g people become con- with present methods hav ofessio-nals, sub- sortium. Even the youn nd tradi- their responsibility to other such of discipline a d point t vinced of the value ed, classroorn-oriente merged. It is a MoOt r, o are tiorial, bilhly structur aik of flexibility, re- a iireleage" would occu seek groupwork methods. Tility and innovation incapable of it should be tradi- mu an institut' sponsi,veness to the corn ost cynical. the safety Of from such individuals is alm with ne@ tionally oriented. ho enter the Consortiun' People w Ls of indifference anci met with feelin- ideas are dermined, isolated and their ideas Eagieville are subtly un ,laeks who lack the s ed to death. B are discu S re of -lass origin seem "property values by natu ofessiorial Debbie Finkelstein and Darryl Robbins . the course Of Pr a treatment center to acquire them in em with the enthusiasm training and prof els th Although Eagleville is d that alco- of a convert. Certain Professionals at the Con- for alcoholism, it must be realize mple, 0 this aP- mntom of more co are not totally committed t hoiisiu is orly 11 Sy - hich is the in sortiuln confide their doubts pri- in living, part of w .cate. We fee proach, but will only or s ch behavior is not, problems iduals to coramuni empha vatelY. The reason fu iob; rather@ ability of indiv ugt a- cohol f ear of losing the that the F- vleville SRO project ria isril bLi realistically, ciently guilt-ridde-n that size lot only the problems Of ai ople 'are suffi ance of being aware o such pe eff ectivelY silenced. roach is that also stress the import d they are bus our project expaii A fallacy in this entire apP n tional our own feelings. T of human awar( the,@peuti effectiveness and eve eTnO from alcoholism to the area project, v c professional training. iiess. Therefore) as a part Of our gleville. 01 adequacy depends upon 'E' areas of nonverbal Corn- I Recent work in the rapy (e.g. the have brought several groups to - e ups was the Soul ty and ZU municat,ion and cross-cultural th it clear that of these gro gangs tb: ank) made two North PhiladelPlI work of Jerome Fr Nation, nteraction with an emotion iiswing together." what heals is all I dual. The Pro- or the gangs coming mpetent persuasive indivi looks: 1. The Arrangements f ekend of July 19-21, 19 ally co prejudice over ille for the we mbers of t fessional training of lionprofessi0yals@ 2. the Faglev two staff me s parents were riade through ration. Memb, adequacy a as parents of many professionals, liartranft@ Conmunity Corpo- up thera inadequacy ations of therapists, anft staff sat in on a gro and 3. our own observ e Hospital who of the Ilartr Ile and, being impressed wi former alcoholics, at Fagl'evill re highly eff ec- session at Eaglevi itnessed in tl have -no formal training but 11 ir patients and the group therapy techniques w tive in their, dealings with the A in group and in the SHO groups, realized that Mantua and Mantua Community these techniques would be applicable to work- Planners (1) ing with the gangs. A great deal of gang war- ring was going on in the community and it was Ken Logan and Philip Graitcer felt that a talking out of hostilities and an honest expression of feelings would be of some The Mantua community is an underdevel- benefit. Furthermore, the community workers oped residential area located in West Philadel- were concentrating on a $250,000 Federal grant phia. It is a community of about 22,000 people for building and maintaining clubhouses and most of whom are of Afro-American descent. saw the weekend as a time for the gang mem- The geographical boundaries of Mantua are bers to evaluate their roles as clubhouse mem: 31st to 42d Streets on the east and west, and bers and to suggest clubhouse leaders a-nct Hamilton Street to Mantua Avenue and the administrators. Penn Central Railroad tracks on the north and The gang weekend was successful as far as south. The income, health, education, and hous- the gangs themselves were concerned. How- ing levels are far below the City's average. ever, the weekend highlighted the divergent There are over 400 abandoned houses in this opinions and approaches of the Hartanft staff. 90 block area, and over one-quarter of the A great deal of intra-organization conflict habited homes are considered substandard and emerged. It was suggested to the Hartianft overcrowded. Statistically, Mantua presents staff that they put themselves into a group one of the bleakest pictures of a ghetto in the session. city. On Friday, July 26, 1968, a member of the As is true in all aspects of life, the poor are Temple Graduate School in Group Dynamics provided with the least services. Mantua is led an all day group session with members of served by the 16th District of the Philadelphia Police. Patrol cars are generally seen only the Eagleville and Hartranft staffs. A list of along 33d, 34th, Lancaster, Haverford, and suggestions for more constructive youth week- ends resulted from the day's discussion. How- Spring Garden Streets. The police are slow ever, the Hartranft rift only widened. It was to respond to emergency calls and complaints- revealed that when the clubhouse money would if they respond at all. It is generally assumed be received and when the clubhouses would be that the police want to get involved as little as built had not yet been established. If the money possible with the community. There are com- is delayed, and because of the emphasis placed munity relations meetings at the Police Depart- on the clubhouses by the Hartrauft staff, -not ment at which attendance is good - about 30. only would the relationship between the com- Nothing seems to come out of these meetings, munity workers and the gang be endangered and the establishment's answer is generally, but the gang's resentment might also extend "Of course we'd like to help in this matter ... to the community at large. if only we could get a larger appropriation ... already we are 2,000 complaints behind . . . When Hartranft left Eagleville that Friday why don't you people use your 'political pull' night, the problems within the organization by banding together." were still unresolved. Although Eagleville is The PTC runs the 31 bus through Mantua; willing to continue working with the,Hartranft its schedule is sufficient, but its route avoids organization and although gang weekends had much of Mantua. Few in Mantua have auto- been proposed as a continuing program at Eagleville, Eagleville has not been contacted mobiles. Trash and garbage collection is but by Hartranft for any futher action. once a week and is totally inadequate for such a densely populated area. (Most areas of the city Eagleville has resources in the forms of staff, have one trash collection and two garbage col- residents, and group t.echniques. The Eagleville lections in a week.) staff has shown itself to be adaptable in work- Stores for the most part are marginal owner @W ing@ ith SHO, camp counselors, and Philadel- operated corner grocery and variety stores. P@l'a@ gangs. We have found that resident par- There is one large, clean, moderately priced ticiPiatiOn is invaluable in a group situation. Thriftway on Haverford Avenue. - There are 41 venereal disease) mental healthg physica@health Tnating Mantua on comprehensive medical care), alcoholism' several large stores proxi Lancaster Avenue. addictions, tuberculosis. Unless education the west. These are on antua, most of Nvhich drug. iiditions improve at the same tirne@ There are many bars in IVI ners by local bar- and living co it in health care ',,ill be mini- are run f or absentee ow any irnproveme tenders. ill Mantua. The mal and temporary. problems Of health There are several schools An eff ective attack on the us and chool is the largest elementary ible without a simllitaneo d eco- McMichael S ast. There are also a Cath- care is imPOSS 11 the social an school in the East CO the Belmont Elemen- comprehensive attack on a overty and ill- olic School for the Deaf, nomic conditions which breed P t com- and the Ma,tlia-powelton Mini ness. It is perhaps f or this reason tha tary School, unity involvement in the planning of Com- School. al facilities are provided b citym y Recreation These are prenensive health care services has been mini operated playgrounds and Tot Lots. rnal - a more pressing need is shown in the in fairly poor shape and unsupervised except assault on the problems that bring about Pov- -nd.Mantua Community for McAlpin playgrou erty. We have been involved Nvith legal, hotis- tw city parking lots e have done some Planners has converted 0 ing, and zoning matters. W into basketball courts. MCP runs several research in the planning of V.D. clinics@. mental basketball leagues on these courts. Several health clinics, and physical health clinics, but the process of being 1)art from the community- pocket parks are in e Mantua this has been a- we think may be built by the Mantua Workshop and th we are writing proposals that community. MCP and Young Great Society and ective in Mantua. Haverf ord- Center all maintain recreational eff . onl one way I can see as a viable programs for Mantua youths. There is y done - that is by in Mantua there are three general praction- means of getting things e in the form of of whom take DPA pa- direct action. This may b ers and one dentist all harrassment, picketing or by doing it your- tients, but they have very limited hours of self. Whatever the tactic7 in an underdeveloped practice. (Each averages about four hours per community it is impractical for one to believe day.) The community turns to these men only that either the city or the grass roots members in emergencies. of the community will undertake action without on June 1, Young Great Society established a slight amount of encouragement. a medical center on 33d Street. Though it After a discussion with a member of the o give very adequate emergency serv- community I realized that the inei- appears ts not used by the majority of the Mantua ase in Mantua was un- ices, it i - loca- dence of venereal dise to lack of health community due to: I. lack of publicity; 2 usually high. This was due ssociated with the name crowded living conditions, and lael, tion; 3. the stigma a edu ation, , YGS. In essence, YGS Medical Center is just Of ae-n adequate treatment facility. (The closest what it says -a YGS facility. It can not be facility is' at 500 South Broad Street.) considered a community project or facility. with Dr. L., thE Mantua is also served by District 4 Health A meeting was arranged at hiF head of V.D. Control, and I proposed th already burdened in its (V.D. control) establish a clini( Center. This center is located quite department . district of 200,000 people, and is in the Mantua area. Dr. L. felt that this wa@ far in walking distance from Mantua. District impractical sinceIpeople do not want to b( 4 is not served by public transportation con- alking into a "V.D. Center." An alter District 4 does not seem seen W was proposed - part-time facili venient to Mantua. he community nate solution t 4400 RaIv interested in reaching out to t ties should be set ul) in District 4 a this center is not i' either. health is not erford Avenue. Though As much as I hate to admit it? ' a ched by walking. Also, I jobs, educa- Mantua, it c ii be rea publi the major priority in Mantua - the city supply was suggested that tion, housing, anci the elimination of Police health educators in Mantua to provide hygier brutality certainly are much more essential to cize the new V.D. clin: ntua. Some of education and to Publi improving the daliv life in Ma ict 4. at Distr the health problems are (in order of priority A9 it was asked that the President of Mantua of helping Mantua plan and develop com- Community Planners write a letter officially re- munity services for the people of Mantua. The -D. Mantua Workshop is the community ingtitu- questing that the city establish more V s the active facilities. This was completed in the middle tion doing the planning, serving a liaison between the people of Mantua and the of July. roviding the The next move was up to the Health De- City, directing the research, p partment-once a week I received a call from technical skills - and harnessing white energy the Senior Public Health Officer who informed and concern. It is within this community orga- me that he brought the matter of establishing nization that our work has been done. The a V.D. clinic in Mantua to a meeting of such legitimacy and credibility of the planners and and so and that he felt quite sure that a facility the workshop as effective community organiza- would be established shortly. tions largely rest on their indigenous character. I have been receiving this run-around for Hence, SHO students have assumed an "in- f our weeks now - I've received calls of en- visible" role, behind-the-scenes and supportive, couragement that it %vas only a matter of a developing proposals rather than a "visible" short time, I've received letters ("We are role on the streets doing anything like active currently dealing with this request"), and I've community organizing. even been visited by the coordinator for several From the outset, SHO, as a matter of prin- health districts. But results are all that counts ciple, has consciously placed itself in a subordi- ; . . and there is no V.D. facility at District nate position to community groups. The pre- 4 yet. ceptor, speaking for the community, raised the A community mental health program has issues, identified the problems and directed also been devised. This was originated by a SHO workers' activity. Thus, SHO attempted psychiatrist at District 4, and has since been to prevent still another white middle class modified by work done this summer. Ideas for organization from flooding the ghetto with modifleation of the original proposal arose its own values. However, our preceptor's from discussions with psychiatrists from first question was, "What do you want to do Temple Community Mental Health Center, the this summer?" "What are you interested in?" City Department of Health, and several psychi- In reality, the process of defining issues has atrists in private practice. The proposal as it been somewhere between these two positions. stands now is an amalgamation of their ideas It is f air to say that the community wanted that have been modified to fit the community's action in various areas, although the preceptor needs as I see them. and SHO workers really verbalized the issues Basically the source of patients for this cen- and defined the problems. Our preceptor sug- ter comes from many "informers" in Mantua. gested ideas. Our process of research was These may be -neighbors, block captains, bar- tenders, gang workers, civic leaderg, or corner essentially one of gaining an overall apprecia- tion and sensitivity within the problem areas, store owners. They advised the troubled person to seek further help at the mental health center. then focusing on one aspect and narrowing our At the center there are several indigenous inquiry. Our object was to produce concrete, functional, empirical statements for communi- workers and a staff psychiatrist who shall ty action rather than general theoretical select out those patients who need intensive i 4 analyses." treatment, sending them to f acuities that exist in the city. The remaining patients will'be Our projects have varied f rom individual to dealt with at the center using group and/or individual. Most of our research has been individual methods. done separately. The students have communi- cated more than the community worker and youth intern. Our work has been tailored to Mantua and Mantua Community our individual skills and interests. Again, much Planners (11) of our effort has gone into preparing feasibility proposals for specific projects. The projects SHO workers in the Mantua Community will be implemented by the people of Mantua I miners project have grappled with the issue and for the people of Mantua. Much of our 43 entire bail "business" to be dirty and a com- ggresearch" has involved talking with key resi munity bail bondsman a good idea for the f u- dents of 'Alantua. Another large part of the ture - 4 or 5 years away - rather than f or research has been establishing contact and then negotiating with city officials - both in public now: As an alternative, a plan was designed health and in other fields such as housing, the to integrate the Philadelphia Bail Project into police and elected officials. A third part of Mantua's needs. The Bail Project attempts to our inquiries took us to useful resource per- release defendants on their own recognizance sons outside Mantua and outside the web of in lieu of bail. The process requires close city government - to health professionals, community connections to speed up the verifi- lawyers, and other experienced people. Only cation of information obtained from the de- a small part of our research took place in the fendant at the Detention Center and House of library. Correction. Thus, a system was devised using The following is a brief run-down of our block captains as the persons to contact to start projects. In some our part is completed; in the verification process. others it is just beginning. 6. Landlord-Tenant Pi-oblems: 1. Ment(ti Health: Development of a pro- A. Individual Cases: Individual cases were posal for a "Trouble Clinic," a walk-in clinic referred to the SHO law student by various utilizing indigenous workers - bartenders, community workers-seven or eight cases al- cornerstore owners, _varig workers, barbers, together. Each case involved expediting the community leaders, and recreation workers- problems ivith rather than for the individual as "listeners" and as counselors to handle involved. The cases concerned landlord prob- threshold problems and as liaisons to the store- lems, insurance fraud, problems with the city front clinic. These "listeners" would operate Water and Tax Departments and problems in the community and refer individuals to the with realtors. The cases led to good coopera- clinic. Within the clinic would be located ation from Community Legal Services and iso- psychiatrist, medical services, a lawyer, voca- lated individuals within the City government- tional services, and experienced community and apathy and hostility from the "establish- personnel. ment" as a whole. 2. Compi-ehensive Medical Facility: A pro- B. Community Escrow Agent: Pennsyl- posal is being written for a community medical vania's rent withholding statute allows a ten- facility, hopefully serving all of Mantua. Lo- ant to divert rent from his landlord to an cated in a rowhouse it would break down the escrow agent when the city certifies the tenant's barriers-transportation, size, whiteness, im- dwelling "Unfit for Human Habitation." A personality - between Mantua and the sur- proposal was prepared to facilitate rent with- rounding medical institutions. holding using the Mantua Community Plan- 3. TB Examinations: On two occasions, SHO ners as an escrow agent. The plan involves close coordination with L & I (not very easy workers scheduled the City's TB mobile unit for visits to Mantua. Sites were selected, pub- to obtain), immediate contact of tenants whose licity was prepared and distributed and recruit- dwellings are "unfit" and negotiations with ing was done a personal basis. The target landlords to prevent the cost of repairs being group was composed of persons bypassed by transferred to the tenant in the form of higher other TB checks, i.e., those not in school and rent. While L & I has been reluctant to do- on jobs where periodic TB tests are scheduled. operate, the plan will go into effect this fall. Approximately 200 such tests were given. C. Housing Clinic: A proposal.is being pre- 4. Social Disease: With community pressure pared for a Community Housing Clinic to a Venereal Disease Program was instituted at which residents with housing problems can the District 4 Medical Center. come for advice and action. The clinic would 5. Bail: A feasibility proposal was prepared provide a variety of services, e.g., directing an for establishing a community bail bondsman to emergency repair unit, providing legal advice, serve Mantua. This would be a-black business- running educational programs for tenants, man working to serve the community and. in action as an escrow agent for Mantua, giving business for a profit. The proposal found the advice on establishing credit and mortgage op- 44 portunities, providing a list of dependable con- though they developed plans for an interesting, tractors from Mantua to do repair work and feasible project. rehabilitation and finally acting as a real estate The entire mental health system of Philadel- agent f or Mantua-locating vacant apartments, phia isn't disorganized, as the reports of two arranging home purchases, etc. PSHO workers on one psychiatric service of 7. Community Parks: The community has Philadelphia General Hospital show. Harry started construction of several parks. Legal re- Hirsch and Rich Bernstein present comple- search has been done in the area of structuring mentary points of view on their work with the effective community control and maintenance Neighborhood Youth Corps on the recreation of the parks. project. This is only a quick summary; much has Jim Padget and Steve Ager present an inter- been left out. It would be tiresome to describe esting account of their experience at Horizon individual encounters with the "establishment" House, a residence within the community for and not really very illuminating. Not surpris- recently discharged mental patients. Their ingly, the establishment has been lethargic. insight into motivations and the apparently Several individuals within the establishment simple problems facing these patients may lead such as Walter Lear, individuals on the City to greater sensitivity in working with these Planning Commission and individuals within patients. Community Legal Services have been invalu- None of these problems is new; the ap- able. On the whole, however, the city's atti- proaches in confronting them are new and tude has been one of "disposing" of problems serve here as examples for future programs. rather than "resolving" them. Organizing Mental Health Services VARIOUS MENTAL HEALTH PROBLEMS Michael Geha and Gail Jones Karen Lynch When we arrived at our project site, we At five sites, SHO project workers were deal- found a complete state of chaos. The entire ing with problems of mental health. Three of mental health set-up in Philadelphia was being these sites are represented in this section. Re- reorganized with a new program taking effect ports of the other two, Temple Community July 1, 1968. Changes in the physical plant Mental Health and the Trouble Clinic of the as well as in the personnel were in high gear. West Philadelphia Community Mental Health Needless to say, little thought had been given Consortium, are presented in other sections of to the PSHO project After meeting with Mr. the report, J. it was obvious that the only real planning These articles discuss various aspects of the was that which produced a letter to Ron Blum complex processing of mental patients from and an arrangement for -a two o clock appoint- the point where they are first identified as ment with Dr. W. at Philadelphia General i 4mental patients" to the psychiatric wards Hospital. When we arrived there, we waited and then eventually back to their communi- hours for him to show up. As it turned out ties. The experiences of PSHO workers not chaos existed at the Philadelphia General Hos- only showed them the intricacies of adminis- pital too. The entire Jefferson Hospital service tering this process and the problems of staffing, had been moved from the seventh to the sixth maintaining, providing, and coordinating serv- floor along with a complete shift of the staff, ices, but also involved them in the present re- including a new nurses staff and new interns. organization of mental health services in and residents. By the weekend we had little Philadelphia. in the way of a project. Everyone was very in- Michael Ge,ha was not simply involved in terested with words only, including sugges- that process of reorganizing services in Phil- tions as to whom, except themselves, would adelphia, but suffered the consequences of that be best suited to help us with our project. ,,,,reorganization process. The Jefferson project All we needed wag someone to spend a few never really got underwa for the summer, al- hours giving some direction. On Tuesday of 45 There was little planning and thought Put into d someone who was ott?, project. Gail and I tried, but we know much the second week we f oun him we work or f or that interested, Richard S., Ph. D. With tructure too little about community set up a structure for a project. This s ended matter even what it Consisted of, to kiow the proposal which is aPP and as we tried we could get is described in Once this war, done, ,ve began which way to 90, going on and which to this paper. no one to tell us what was s may have been t . t. Three weeks later direction we should take (thi o cook with our projec is that ted, depressed,and very unhappy really knew) - MY Opinion we were defla to find tnvo Or three because no one c mental health election this fall because we were only able structure. As I look unless the publi tstand- patients who fit into our g. The and Jr. Corps Service at PGH proves ou roject realize what went wron is fall, the p back now, I ing for Jefferson students th eet next most crucial point, because there are many, is site should be abandoned as a proi f work t our ideas were molded into a it is not dropped, a lot 0 the fact tha d just arrived at the summer. If at the start of the project pre- man who ha hould be done project by a bout thes ational data for the PMHC, and who knew less than I a s going paring some type of inform is in the Jefferson catchment area and what wa roject worker so that the know what I Hospital. We knewp es provided by the on at Philadelphia Genera HosPi- community and the servic what the ward at Philadelphia General tal was supposed to have in the way of patients, agencies. t it actually had. if the mental for but not wha it is de- proposal: Summer Training Program health community was operating as I i al S hool Students signed to operate, our project would have Med c c worked. What I fail to understand is why Dr- M. and Mr. J., both of whom knew exactly Goals d to give students an what was going one failed to realize Nvhat would This program is designe tal P a- happen if we tried this type -of project. opportunity to study a series of men n eight week period during which What I'm trying to -gay is that the idea we tients over a readjust- cellent, but not resolute with respect time these patients will be making aes follow- had was ex nds of patients are in the Psychi- ment to their families and communiti to what ki phia General Hospital- ing release from a mental hospital. A secondary atric Ward at Philadel us to me is that most goal is to gain some f eedback from the stu- What has become obvio of the Jeffer- ed to be going On, dents regarding two subdivisions people know what is suPPOs economic ek of communication so,, catchment area: the low sOcIO e but there is such a total la s what is Negro ghetto (area B) and the low sOc'o co- between People that 110 one know te ghetto (area C) - really going on anywhere but right where they nomic whi themselves work. Thug, Dr. M. had no idea we ng in the first place, Mr. J. didn't Procedure sted tnat Dr. Mock at PGH, or were coTni situation was-at PGH it is reque know what the patient his staff, refer to the summer stu- and poor Dr. S. had not been in the community members of long, enough to know anything but what he had dents a total of 20 patients who are preparing read about it in the appropriation for the staff -to return to their homes. Hopefully this sample ing grant. The lack of communication came out of 20 patients, ten in the two designated sub- even more sharply when he attended a staff divisions of the catchment area can be located meeting of people from all the different agen- one week prior to their anticipated release from cies involved in community mental health in the hospital. Students then will review the case the Jefferson catchment. No one knew about records of each patient in regards to demo- anything in the other agencies. Service was graphic characteristic personal history, pre- being unnecessarily duplicated, resources un- vious alienations and s@mptoms of present psY- h patient to used in one agency were needed badly by an- chosis. Students will interview eac other, but because no one was "aware" they get acquain@d with the patient and to learn were unused. his plans for leaving the hospital and for re- entry into the commu'll - Students will also I don't think there is any way to sumniarize visit each f amilY prior to the return of the except to say that everything just "happened." 46 8pects to be maintained throughout the ye3r- patient to the family homes. The interview nterests of the patients, with the families will be directed towards The widely varying i vious experi- who ranged in age from 10 to 80 years pre- learning about the family's pre lanning an ences with the patient, their expectancies in sented a challenge to anyone p regard to the patient, and their areas of ac- activity program. ceptance or rejection of the patient. In addition to a description of the family situation, stu- Resou?-ces dents will complete items 22-30 of the Freeman The Mental Health Consortium had engaged and Simmons questionnaire. They will also five supervisors (of whom three were SHO study the community setting to which the pa- workers) to work under Christine Westfall in tient will be returning and in addition to aplanning and executing the recreation program. description of the community in terms of rele- Thirty high school students from the West vant variables, also describe the relationship of Philadelphia area, working in the Neighbor- the family to this community. hood Youth Corps, were paid $1.40 an hour by Following the return of the patient to his the Youth Corps to serve as recreation aides. family, the student will interview the patient All but two of the recreation aides were female. in the family setting, one, three, five, and seven A Consortium sociologist led semiweekly in- weeks after his arrival there. The interview service training seminars for the five super- will consist of items 1 to 21 on the Freeman visors and preceptor. He also served as a valu- and Simmons scale. Relevant items will be ad- able advisor and consultant on sundry prob- ministered to the patient and also to the sig- lems arising during the summer. The seminars nificant family member. In addition, the pa@ dealt with the background of mental illness tient will be rated on the MAAC scale and and practical problems encountered in group the Overall-Gorham Scales. wor . At the end of the seventh week, after all In addition to these human resources, the interviews have been completed, the students physical facilities available proved to be ade- Will summarize the changes over time that he quate for the program needs. Several grassy has noted in the patient and also his impres- fields on the hospital grounds were used for sions of the barriers to further growth, wheth- outdoor activities. The PGH recreation depart- er they derive from the patient himself, from ment and a small budget from the Consortium the family or from the community setting. This provided athletic and indoor game equipment. last item hopefully, will give feedback to the JeffersonyCommunity Mental Health Center The Consortium bus was used for trips to the regarding community factors in areas B and zoo, Phillies games, and weekly swimming ex- C which influence the mental health of the cursions at League Island Pool (Philadelphia Recreation Department). A request to use a residents. beautiful indoor pool in the nearby PGH nurses' residence was turned down by the The Recreation Project for One Psychiatric ,matron"-in-charge. Service: Two Points of View (1) Oi-ganization Harry Hirsch Each of the five supervisors worked directly Problem with a team of recreation aides. Because the Prior to this summer, no program of recre- need for recreation activities is, in fact, great- ation therapy existed for the 80 in-patients in est on evenings and weekends, when hospital Penn@s Psychiatric Service located in Philadel- routine is at a minimum, the program operated Phi General Hospital. Patients were able to on a seven-day week: 1 to 9 p.m. Monday spend their time watching TV or staring at through Saturday; 9 a.m. to 9 p.m. on Sunday. the wall-neither of which is particularly Two teams of recreation aides and two super- therapeutic. As part of a series of moves de- visors were on at any given time within that signed to upgrade the quality of psychiatric schedule. These arrangements resulted, for care at PGH, a pilot recreation program was supervisors, in a week of approximately 35 suggested for the summer, with succesgf ul as- hours and 2 days off out of every seven. 47 schedule resulted in conflicts between site obli- gations and Sllo meetings conferences, and Activities mprised one aspect of le I generally placed MY allegi- Structured activities co go, picnics, programs. Whi that towards These . included bin e to the project site above the program. softball, trips for @ill ed in movies, bowling, volleyball, and OHO, the other two SHO workers tend swimming, museum, zoo, .baseball games, arts and crafts. Poetry readings and psycho- the opposite direction. ere, f or the drama were Used a few times. Much of the Pro- Relations with the PGH staff w Is and -ng to the most part, extremely cordial. The R.N gram consisted of unstructured relati P.N.'s were very cooperative and often assisted patients. Card games, checkers, ping-pong, and in urging patients to participate in recreation above all, discussions among patients and rec- ndly reation workers filled out the unstructured activities. Male attendants were very frie and often participated in the activities them- time slots. selves. The female attendants, on the other Sitccess in Confi-onting Pi,obte?n hand, were usually both lazy and insolent to The recreation program succeeded fairly well patients and were often uncooperative. Interns in supplyin a varied schedule of recreation and residents seemed pleased with the program 9 provided and were willing to confer with supervisors activities. Moreover, the program fie pa- enormous opportunities for patients to partici- about problems in dealing with speci pate in social interaction and. thus facilitate tients. Some initial conflict arose between the their recoverv. Because of common socioeco- student nurses and recreation aides. Some stu- d Youth I (and perhaps jeal- nomic backgrounds, the Neighborhoo dent nurses were resentfu ' Corps workers were able to -relate quite well ous) of the rapport which the NYC workers and without inhibitions towards many of the had struck with the patients. The student patients. nurses, despite or because of, their psychiatric The success of the NYC workers in this proj- training, often f elt less confident in dealing ect is significant in terms of meeting person- with the patients than did the NYC recreation nel needs in health care delivery. The success- aides. By mid-summer, however, this conflict f ul employment of inexperienced recreation had been resolved. Whenever possible, super- aides (and supervisors) in the recreation Pro- visors attempted to involve hospital staff in the gram suggests that people lacking formal train- recreation activities. These efforts paid off in ing in medical fields may, nevertheless, be able dividends of enthusiastic cooperation from to free trained personnel for more efficient use most of the staff - of manpower. The patients tended to refer to the recre- A major criticism of the recreation program ation aides as "volunteers." This term suggests is the failure to establish a routine activity that patients perceived the youth Corps as schedule. Supervisors Planned activities on the people who enjoyed relating to the patients spot, An activity schedule would have provided rather than workers who put UP with drudgery a structure on which supervisors could f all in order to collect a pay check. Patients appre- back on when in doubt of what to plan, and ciated the presence of People who: (1) took he monotony would have insured a more varied array of time to stop and listen; (2) broke t ctually offered. of a hospital stay, with planned activities; and programs than was a .er to manipulate than Closer communication between SHO and (3) were, at first, easi project receptors would have been-helpful in other hospital staff. Patients vvere particularly p e in off -the- ascertaining the role of SHO workers at the glad for opportunities to participat de, project sites. The 7-day working week was ward activities. Some effort should be ma both a basis and subject of conflict. SHO work- however, to decrease their dependency upon the uel and un- nly source of organized ers were not prepared for the "er recreation staff as the o usual" summer work schedule which was not recreation and help patients to organize their ance publicity or project own recreation programs. suggested in SHO adv descriptions. The schedule was handed to super- Conclusions ning of the summer as visors at the begin nfront any ,what hod to be", and was accepted largely due Although this project failed.to co to a lack of viable alternatives. The working major injustices of the health care system, the pilot recreation program tients who were not physically repulsive nor establishment of the within the verbally hostile. On the whole, the patients succeeded in filling a major gap ed the greatest amount of attention, present system. This site afforded me the expe- who receiv rience of relating to: (1) psychiatric patients, were under 30, black, and white males, extro- (2) "hard-core" ghetto youth, and (3) the bu- verted or passive men who were receptive to reaucracy of a large city hospital. Finally, the and thankful for the attention of the girls. problem of transferring the program into the Thus, almost a third of the patients received hands of the year-round staff remains to be a lot of direct attention from the NYC. It confronted between now and the summer's should be noted that this is only a generaliza- end. tion, for certain members of the Youth Corps felt very much at ease with the less sociable View 11 men and women of all ages. Richard H. Bernstein If an index of success for the recreation pro- gram was direct, personal contact between The group which our recreation program Youth Corps and patient population, our pro- gram has failed. While it was hoped that, as came into contact with was the Neighborhood the students became more at home on the Youth Corps. This group of underprivileged wards they would socialize more freely, this black high school students was a constant never materialized to any large extent. Even source of fun and difficulty. Formally, the 25 young people (two of wIhom were boys) were at the end of the summer, it was somewhat divided into five teams, each headed by a white common to find three recreation aides (i.e. supervisor (three of whom were in SHO). NYC members) and only one patient playing Each supervisor was supposed to encourage his cards together or to observe three or four rec- team to get the patients involved in some out- reation aides watching TV or sitting alone door activity or, if we were on the ward, to without patients nearby. engage in quiet indoor games. Talking to the Despite this fact, I was very interested to patients and relating to them spontaneousl hear that an experiment in Europe indicated y that wards in which there were community was very much encouraged by most of the adolescents present had a higher rate of dis- supervisors. charge and absence from in-patient services for Despite the admonitions of black nationalists all ages of patients than control groups. There- and militants, we found virtually all of the fore, it might well be that even if the recre- NYC people receptive to our friendship and ation aides dance and talk among themselves, our leadership. Even when actual resentment sit alone, socialize only with the men, or just toward certain supervisors did arise, the black generally do their thing, the old ladies and students candidly denied any feelings that a sick old men are absorbing the atmosphere, given supervisor was condescending or taking which simply radiated with life and health and advantage of his authority, they were quite surprised to hear and quickly dismissed the youth. Possbility that the supervisor was expressing Health Problems a white supremacist attitude. After discussing with others, it seems that Regarding the effectiveness of the NYC, the fundamental problem with the health care I have mixed feelings. Relating to patients is delivery system as far as I saw it (on the difficult. it is very easy to Ask people to "just eighth floor of the Mills Building run by Penn), talk to anyone who looks alone." But these was that Penn is much more concerned with Young men and women have had no previous educating its interns and residents than with experience in a psychiatric setting. Further- treating patients. The treatment aspect is not more, they find it very difficult to carry on absent, of course, but various conditions on the a conversation with adults in their own com- ward indicate that Penn is educationally ori- munity, let alone in a community of emotion- ented. Most critically, it is clear that there is ally disturbed adults. As a result, the NYC hardly any semblance of a team approach to students tended to gravitate toward the young.; patient treatment. If the medical staff in charge er patients, and more particularly, to those pa- of the ward were truly interested in helping 49 patients, they would institute, as early as P03- Resoul'ces endation I have is sible, a team approach. This would involve The most obvious recomm I cementing the nurses, student nurses, attend- to encourage the Consortium to put pressur.e On recreational and occu- .University of Pennsvlvania Medical SchOO to ants, social workers, and working group to institute a team approach to dealing with Pa- pational therapists into a of the tients. This would mean coordinating the eff orts serve as the surrogate eyes and ears ing, ward nursing, above staff should be informed of the heads of student nurs e recreation arid doctors. The y and, more impor- social service department, th that all about the patients, histor ccupational therapy department. so f, and have some say to both' romote ed tantlY, should be aware o 0 ther in order p u- 4 6strategy" for each working toge aximum care for the in determining the staff's ore observations in cational instruction and m more and in . gh a team effort). Furthermore, patient. As ings are made) the strategy may patients (throu sychiatrists working various sett vent, the doctors ought Penn ought to get more Pabout 90 percent of be altered. But in any e . tion with the rest of on the ward. At present, and residents, who to have some communica ake the most efficient the doctors are interns to three-quarters of the staff if they are to in 'n resources latent spend about two-thirds. onferences. and prudent use of the huma clinical c their time in classes or in Consortium should in the staff LastlY, it seems that the schools' the doctors consulted with ct as a consortium of several medical In the ward setup, sure howa far as I could ascertain, there was the social workers, although I am not services. As urces be- tors, time was spent no coordination of efforts and reso different often. Over half the doc achers and rs (each run by learning about patients from their te notes tween the various flOO ents. Doctors read the -nurses' local medical schools). Apparently, the known fellow resid harting was only done political rivalry among schools has been al- on patients; however, c ramatic changes lowed to be expressed within the rubric of the when there were some fairly d autono- in the patients' physical or emotional or behavi- 'gconsortium' " Each floor is a perfectly t conversations or ob- mous unit, totally segregated from the others. oral condition. Pertinen our recre- to inefficient use of servations made by attendants or -This must inevitably lead services to ation teams or supervisors were not discour resources and poorer delivery of aged but never really encouraged. We, the rec- the community- felt very much alienated reational Drog-ram, giving our from the urslg staff in so far as personal opinions. While nothing was said, I Horizon House felt my observations were listened to but not openly welcomed. I should say, howevery that Steve Agar and Jim Padgett several nurses did spend some time with the rs, informing them about patients. Can you imagine yourself being away f or supervise 5 months, 3 years, or even your life time from Perhaps one of the most illustrative exam- the society that you've been'used to? I can't ples of the attitude prevalent this summer either, but several people whom I have met this among the staff was demonstrated at the very summer have faced this problem.. What are first -meeting we supervisors had with the ward these new buildings thev see? The strange new staff - We five met with the head of nursing, the dress? The changing political and social world? meone from Can you put yourself in their places? head of student 'nurses, and so social service. They made it quite clear to us This has been the plight of most of America's that the recreation program was our baby and mental patients. Our system of mental health that we could not expect and should -not expect care has been what we thought was quite pro- any help from the staff, because of the terrible fessional and indeed it was for its time, but th other things. This is a now the situation is no lonLrer the same. A step burden they had wi striking example of the way communication is back into the co,)nraunity must be made in the u @i@ discouraged, resulting in a fractionating of a clinical treatment of the mental Patient. He shipped out of his home potential team effort, and ultimately in causing should no longer be .poorer care to the patient. territory into an impersonal, factory-like envi- 50 ronment from which he will eventually emerge@ mental health program until this summer. Now somewhat a stranger to his former situation. we can see. A recent research project in which we have been involved deals with the product of such PLANNING AND DEVELOPING PROG.RAMS a system. We are trying to motivate ex-patients (called "members" at Horizon House) to learn Karen Lynch about and search out their communities. We have divided a low-functioning class of mem- Each project and each new program which bers into three groups of 10. One group is a is developed in an attempt to achieve that long- control. With both of the other groups, we range goal of improving health services is discuss various activities, such as the Franklin unique. Yet, the successes and failures of the Institute. One group of people is urged to go past are brought to each new project and these to these community activities by itself (client- experiences should guide future plans. Four led) while one of the PSHO students takes the such experiences are included in much detail other (staff-led). In this manner, we may be here. They should be read not so much for the able to show whichi if any, is the bett er method case history of one proposal or one program as to get: the clients involved in the community. for the successes and f ailures which each one As the project has just begun, we have no faced along the way and the action which was results as of yet. But the ultimate knowledge taken in each case. gained will not be concerned with which meth- At Southwest Center City Community Coun- od is better. The result of this project will aid cil, project workers and community people members treated under the present mental knew the general needs of the area, but worked health system; but the.final question is, "Is in several different directions until the finally y this system adequate?" We think not. decided to write up a proposal. The Delaware Thus, we have a difficult time getting J.R. County project involved two students prepar- even to go with the staff-led group. J. wants to ing for the November election and the county go in order not to hurt our feelings, but his health department issue which was on the convenient sore feet,early rising hours, various ballot. duties, etc., prevent him from joining the poor- These two sites were involved in planning. ly attended group trip. The project workers at Citizens Concerned for Therefore, our duty of motivating these peo- Welf are Rights were setting up a babysitting ple becomes a very difficult and trying job. Are center and then presenting proposals to various we convincing enough while telling them of our organizations for funding. At St. Chris, a pho- exciting trip the following day? Should we tography club was set up with a dual objec- pressure them into coming? These questions tive: it educated children during the summer and this research project wouldn't be as neces- and it was a means of entering the community. sary if these chronically ill people had been A caref ul reading of these papers should pro- hospitalized short term in their own commu- vide both information and a feel for the effec- tive approach to establishing -new community nities. In addition, a series of social functions for programs. male and female ex'-Mental patients was estab- Changing Direction at SWCCCC: From lished at the Horizon House residence, which was very successful. TJ-nfortunately, a proposal Survey to Proposal to initiate a concomitant series of sensitivity groups to enable the boys and girls to better Ed Pisko understand each other's motivations was squashed by the powers that be for irrelevant There are two health science students now reasong. working with the Southwest Center City Com- This whole new field of community mental munity Council (SWCCCC) at present, Carla health is finally beginning to take shape and Oswald and Edward Pisko. A member of results are coming forth. We never realized SWCCCC and its Health Committee is work- the consequences of our country's antiquated ing closely with these students. 51 The Initit&t Rote of SHO Worke?-s search was done into comprehensive health care The initial agreement to bring in the stu- in general. This decision was also based on changing concepts about what is considered dents was made between Mr. C., representing good quality medical care. SWCCCC, and the SHO. This agreement was made with the knowledge and approval of the These are changes which can be seen right Health Committee and the Executive Board in this community. To begin with, one reason that the two hospitals are going to leave the of SWCCCC. Mr. C. was to serve as preceptor, defined by SHO as "an individual, usually a @rea in the next few years, is the belief in a professional, who is responsible for the activi- he.alth center complex as the best way to ad- ties of the project workers at the project site. minister hospital health care. To the Univer- He will meet with the workers regularly and sity of Pennsylvania, who owns the two hos- offer guidance and assistance, while not direct- pitals, there is a great deal of value in putting ing the actual activity of the workers." the two hospitals with others. Some of the ad- The roles of the workers were not clearly vantages of this system are the close proxim- defined by SHO or SWCCC. At first, it seemed ity of a large number of physicians for con- sultation, centralization of facilities, and prox- that their role was to do a health survey of the SWCCCC area west of 19th Street. The !Mity of the medical school to its associated nospitals. Temple University has a similar pro- reason for this was to help in obtaining a chil- zram with a large health center complex being dren's clinic and program similar to the one the anticipated end result. It is of interest that in existence in the eastern SWCCCC area, the Temple has also established a comprehensive Rebound Program. health center in the community of North Phila- After discussion, a questionnaire was com- d.elphia. piled using many of the same questions that Group practice is considered a model of Dr. L., Director of Research, had used to obtain quality in the field of medical care. Its emphasis information about the persons Rebound was on having many specialists see a patient guar- serving. Other questions were added that antees high quality care. In combination with seemed pertinent, and the questionnaire was a good hospital for in-patient services, a per- submitted to the Health Committee and ap- son can be assured of the highest quality treat- proved after suggestions were made. ment for illness under the group practice sys- However, before they started surveying the community with the questionnaire, they de- tem. The comprehensive health care program cided to see if this was the best way possible in cooperation with a good hospital provides to deal with the problem of obtaining health this same model of care, but with even more facilities. Dr 'L. revealed that her question- services than the group practice hospital model. naire wag used to gather information that would help administer and evaluate the pro- The Present Health Care System in the gram that was already funded. But in order to SWCCCC Area obtain a grant for new facilities, the proposal There are many means of obtaining health should contain statistics from the Census Bu- care in the SWCCCC area. These include pri- reau, the Philadelphia Department of Public vate physicians and hospital clinics. However, Health, Philadelphia School District, Depart- at present the main concern is the services that ment of Public Assistance, and police records. Graduate and Children's Hospitals provide. Therefore, a health survey would not be of These services include in-patient (hospital bed) great value at this time. and outpatient (clinic and emergency) care. Health Care System 1. In-Patient Care: Children's Hospital has The next move was to see how one goes always provided quality in-patient care, and about obtaining a health clinic for an area, with their moving to new facilities these serv- since it became evident that a health survey ices will probably improve. It would be ex- was not the answer. Since the original goal of pected, then, that many people would continue the project was comprehensive children's to go there despite the distance. The alterna- health care, the idea was expanded and re- tive is the erection of a new hospital in the 52 SWCCCC area, or renovation of Children's. into the program including training of COM- The advantages of such an institution would munity people as nurses and health workers. be many. If the hospital were community con- trolled, the hospital could employ many local Present Philadelphia Comprehensive Health residents and train them as nurses and other Care P?-ogi-ams health personnel. Funding would be a prob- lem. Mercy-Douglas and the University of There are presently two comprehensive Pennsylvania has been mentioned as possible health care programs in the city of Philadel- sponso rs of the hospital. The city could also be phia. Mr. Robert Fishman wrote the proposal approached as a sponsor, but community con- for the project sponsored by Pennsylvania Hos- trol would then be difficult. The City Depart- pital, and the proposal is available for anyone ment of Public Health is still mainly concerned to read in his office. Mr. James Snipe, of the with preventive medicine and not with treat- Temple Comprehensive Health Program, com- ment, although this philosophy might change pleted the proposal for the comprehensive when fund-, are available. health program there and he may still have 2. Oti,t-patient Services: The present system copies of his proposal available. The students of waiting for hours in a hospital clinic is have talked to both of these gentlemen and faulty. The service is very often impersonal certain things were emphasized. and the followup is poor. If the community de- Mr. Fishman spoke of two alternatives for cides to have its own hospital, and it wishes obtaining a comprehensive health care pro- to incorporate out-patient services into that gram. One alternative is for the community hospital, it is important that the unsatisfac- to write a proposal and submit it to the OEO tory qualities of hospital out-patient clinics be office to obtain a grant. The United Neighbors eliminated. The alternative is an out-patient Settlement House tried this in 1965 and they facility which would provide emergency and failed to obtain a grant. This year Mr. Fish- treatment facilities and be housed apart from man wrote the proposal for the community in the hospital. The Federal Office of Economic affiliation with Pennsylvania Hospital and ob- Opportunity funds comprehensive health care tained the grant. s, and the program could be set up to program serve all the people in the SWCCCC area. Mr. Fishman's suggestions on obtaining a Advantages of Comprehensive Health Care health center were -first to interest an institu- The acceptance of the Rebound Program tiori in the area and then to work closely with that institution in writing the proposal for the which provides comprehensive services to chil comprehensive health program. The existing dren in the eastern SWCCCC area demon- Health Committee or a subcommittee of the strates the value of this service to the com- Health Committee could be the agent working munity. The Rebound Program could be in- corporated into the larger program that serves with the institution. Mr. Fishman mentioned everyone. The comprehensive health program that the SWCCCC area falls in the boundaries is a combination of two concepts in the prac- of the Jefferson Hospital Mental Health Pro- gram. Therefore. a comprehensive health pro- tice of medicine. The program provides for a ion of thos.e primary physician who acts as a family doctor. gram would be a logical extens services. But Children's Hospital, as a part of In addition, there are other specialists on call also involved the University of Pennsylvania is and this provides the advantages of group prac- in the area with the Rebound Program. There- tice. Arrangements would be made with a hos- fore, they should also be approached as a pos- Pital for in-patient care when these services sible sponsor. Hahnemann, Mercy-Douglas, and are needed. The program provides for a great the City Department of Public Health are also deal of involvement of the community in the possible sponsors. planning and running of the program. The present Pennsylvania Hospital program pro- Mr. Snipe confirmed what Mr. Fishman said. vides for complete community control after He added that from the very beginning it was three years. Therefore, whatever programs important to work with the Area H Anti- the community wished could be incorporated Poverty Committee and Community Action 53 Council, since proposals will have to be ap- Table I.-l96O Population Characteristics for SWCCCC proved and submitted by these groups. Also in Census Tracts and Philadelphia. his proposal he mentioned . the importance Of 3o-B 30-C delphia working ,yith city agencies concerned with health and welfare and state agencies of health Total population .... ....... 7,220 9,240 7.067 2,002,512 and ;8.4 26.4 and welfare, and community physicians Percent Negro ...... 96.8 82.8 dentists. Percent white ........ 2.7 16.9 1.4 73.3 Percent other races 0.5 0.3 0.2 0.3 Wi-iting a Pi-opos(tl Income: Employment, Education, Occupation Initially a health survey was going to be done to establish the need for a comprehensive The income level of the area is extremely low. Over a third of the families in the area have health program. However, if a proposal for a yearly incomes of less than $3,000. Over half health center is written, existing statistics are usually used. The following section shows sta- earn less than $4,000 annually. tisticg demonstrating the need for a health center. These figures could be expanded with Table 2.-1960 Income for SWCCCC Census Tracts and Philadelphia. Philadelphia Department of Welfare, School District, and Police Records. iFa- SO-A SO-B 30-C delphia So,ui,ces Number of families ........ 1,562 2,056 1,537 500,515 Percent under $3,000 40.0 36.9 47.9 17.1 Although the members of the Southwest Percent between Center City Community Council (SWCCCC) $3,000 and $3,999.. 19@l 15.3 15.2 9.6 over ..................... @-. 40.9 47.8 36.9 73.3 and other residents of the SWCOCC area are Percent $4,000 and generally familiar with the characteristics and Median family income.... $3,526 $3,854 $3,139 $5,782 problems of the area, a statistical description better documents the needs and makes it pos- The median family income for the area is sible to objectively cornpare the SWCCCC area over $2,000 below that for Philadelphia as a with the rest of Philadelphia. The original whole. The average family size is 4.6 persons. boundaries of SWCCCC-South Street to the These facts alone declare the need for low- north, Broad Street to the east, Washington cost, high-quality medical facilities in the area. Avenue to the south, and the Schuylkill River Part of the reason for this low income is cer- to the west-simplify this task. These bound- tainly unemployment. Unemployment rates for aries almost exactly correspond to the outlines both men and women in the labor force in the of the three census tracts which comprises this SWCCCC area are double those for the whole area-30-A and 30-C in the eastern SWCCCC city. area and 30-B in the western part. Table 3.-1960 Unemployment for SWCCCC Census Thus, the census data from 1960 can be used Tracts and Philadelphia. for general information about the population characteristics, income, employment, and hous- 30-A 30-B 30-C d ing. Although this information may have Percent of male civilian changed to some degree since the 1960 census labor force unemployed ...... 12.2 13 .3 17.0 6.4 was taken, it is presumed that it still repre- Percent of female civilian sents the area to a great extent. Health sta- labor force unemployed ...... 12.1 12.6 8.5 6.5 tistics data are available from the preliminary Further reason for the low income level can Philadelphia health statistics for 1967. be found in the educational level and occupa- Population tions of the SWCCCC residents. The area as a whole has a median of less than ten school The population of all three census tracts is years completed for persons.25 years or older. redominantly Negro. The percentage of Negro Overall, there are more than 300 blue-collar p persons in the area is over three times the workers for every 100 employees on white- percentage for the city as a whole. collar jobs in the SWCCCC census tracts. This 54 he number of blue-collar jury for these infants is substantially higher is more than double t he city. The percentage of these in- to white-collar workers for the city as a whole. than for t Housing fants born illegitimately is drastically higher in the SWCCCC area than for the entire city. 'While only 36.1 percent of the households This fact may suggest the need for sex educa- in the entire city rent their dwellings, over tion and/or planned parenthood programs in half of the residents in the SWCCCC area rent the community. their homes. This places an additional strain Many of the mothers in the SWCCCC area on the already very low income. Moreover, less have inadequate medical 'care before the birth than two-thirds of the housing units in the of their children. A mother's care is consid- three SWCCCC census tracts are considered ered inadequate when she has no care until sound. Worthy of note is area 30-B in the west- the last three months of her pregnancy or no ern part of the SWCCCC community where prenatal care at all. The percentage of birth 14.7 percent of the homes are dilapidated (de- in the SWCCCC area preceded by inadequate fined by Census Bureau as not providing safe medical care for the mother is nearly twice and adequate shelter; requiring extensive re- that for the city as a whole. This lack of care pair or rebuilding). Furthermore, over 10 per- to the mother contributes greatly to the pos- cent of all SWCCCC residences are over- sible immaturity, birth defectg, and birth in- crowded with more than one person in the jury of the infants. house for each room. Table 4.-1960 Housing for SWCCCC Census Tracts and Table 5.-1967 Birth for SWCCCC Census Tracts and Philadelphia. Philadelphia. 30-A 30-B SO-C delphia 3A-A 30-B 30-C delphia Percent of housing units Number of births .. .............. 100 142 125 36,112 owner occupied . ....... ......... 17.5 40.7 18.9 58.7 Birth rate per 1,000 Percent of housing units (1960) population .- 13.9 15.4 17.7 18.0 renter occupied .................. 75.6 54.3 72.6 36.1 Pe. reent of live births Percent of housing units immature .................. 17.0 13.4 15.2 11.6 judged sound ...... ........ 47.3 62.2 62.8 87.3 Percent of live births Percent of housing units congenitally deteriorated ........................ 44.7 23.1 35.1 10.6 malformed ................ 1.0 .7 4.0 1.1 Percent of housing units Percent of live births dilapidated .. ........ ............... 8.0 14.7 2.1 2.1 with birth injury ... ... .... .... 1.6 .4 Percent of housing units Percent of live births with 1.01 persons per illegitimate ................ 37.0 38.7 56.0 17.0 room or more ...... ......... ..... 10.2 12.8 12.3 7.0 preceded by inade- quate pre-natal care .... 31.0 20.6 36.8 16.8 Health Death rates for 1967 are also substantially More important than these facts are th'e ob- higher in the SWCCCC census tracts than in vious health needs of the people of the all of Philadelphia. Moreover, a greater per- SWCCCC census tracts. With the poverty im- centage of deaths in the SWCCCC area is posed on the residents already shown by all caused by preventable and -infectious disease the above information, health problems place than in the city as a whole. a further strain on incomes that have no room left to stretch. Health status is indicated below Table 6.-1967 Deaths for SWCCCC Census Tracts and by statistics on birth, deaths, and incidence Philadelphia. Of preventable disease for 1967. The live-birth rate in the SWCCCC census 3A-A SO-B 30-C delphia tracts is about the same or slightly lower than Number of deaths ................ 137 149 109 24,443 for Philadelphia as a whole (based on 1960 Death rate per 1,000 Population figures). Although the birth rate (1960) population .... 19.0 16.1 15.4 12.2 is lower, the incidence of immaturity (weigh- Percent of deaths from i tuberculosis .............. 2.2 .7 .... .6 119 5 lbs. 8 oz. or less at birth), congenital Percent of deaths from Inalformations (birth defects), and birth in- syphilis ...................... .7 ... .... .07 55 1. Protecting you against disease, both Table 6-Continued chronic and contagious. SO-A 30-B 3@C delphia 2. Controlling the environment so that the Percent of deaths - conditions under which you live, work, and from influenza play are healthful. and pneumonia ---------- 3.6 2.7 1.8 2.8 Percent of deaths 3. Finding those who need treatment and from nephritis and arranging for their care, if they would not nephrosis (kidney otherwise receive it. disease) .............. .7 .7 .9 0.6 At the present time, public health services Percent of deaths disease of early in Delaware County are administered by a infancy ............... 1.6 2.0 4.6 3.6 multiplicity of governmental units and levels, in addition to the numerous voluntary agencies. These f acts show that the SWCCCC area is Boroughs, First-Class Townships, and the City a very impoverished area in its general char- of Chester receive the majority of services acteristics and an area very much in need of from municipal health boards and health of- more and better health care. The fact of Chil- ficers (38 in all). Second-class Townships and dren's Hospital's relocation in 1971 has been the two boroughs which have surrendered their established. This presents a vast decrease in programs to the State, are serviced by the the health services available to the SWCCCC State Health Department from its Chester of- community, while all evidence shows need for fice and the regional office in Philadelphia. In an increase. All the facts taken together indi- addition, the State consults with the municipal cate a critical situation in which the residents boards to aid in the problems when necessary, of the SWCCCC area must make some move and has directed supervision over certain types to acquire an additional health facility in their of programs, which are primarily State re- area before 1971. There are various possible sponsibilities. channels the community can take to reach that end but they all require action Now. In,t?-oditction It is an incontrovertible medical fact that What Is Public Health7 in our complex society public health is a vital (Delaware County) governmental service. The question remains, Jan L. Baxt and Sheldon A. Halpern however: "Why should public health be admin- istered on a countywide basis in Delaware Positive physical, emotional, and social well- County? We already have a State Department being, not just the absence of disease. In the of Health Center and 38 municipal boards of simplest terms, "public health" is people band- health, as well as numerous voluntary agen- ing together-primarily under governmental cies. Why do we need a County Health De- auspices-to solve health problems which they partment.?" cannot solve alone. First, it must be emphasized that a county- Whenever two or more persons are affected wide administration of health services is not a by the same disease, this becomes a public new, untried experiment. Rather, it is the norm health concern in the broadest sense. Public throughout the country. Eighty percent of the health services are directed towards the pre- counties in' the country are served by county vention of disease for all members of the com- health department. Delaware County, like munity, while private health care is concerned many other counties, is undergoing changes with curing a specific illness in an individual. which make the establishment of a county Private medicine and public health complement department both possible and more important: each other. The family doctor treats an indi- 1. A population boom is altering the nature vidual case of hepatitis, while the Public Health of our community by: Department traces down the source of con- (a) Quickly turning the eastern end of the tamination and eradicates it. county into a single densely populated unit In brief, the responsibility of a Public Health with all of the problems which normally occur Department includes: in areas of this type, and 56 (b) Accelerating the rate of development in nonresidents, The obviousness of the answers the semirural western portion of the county. implies that everyone must be concerned about Both areas require sound planning and com- the quality of the restaurant inspections, com- prehensive health programs to cope with these municable disease control, etc., all over the problems, but neither is possible under the ex- county-not just to be a public spirited citizen, isting fragmented municipal structure which but to be sure of his own and his family's bears little relation to patterns of work, trade, health. or recreation. 3. Untrained health officers: Experience has 2. Increasing mobility of population, with clearly shown that public health work is a people moving in and out of the county at in- highly professional undertaking. There is no creasing rate. substitute for professional and technical com- 3. The accelerating pace of change and dis- petence. As the Stebbins Report said: "Cheap covery in public health practices which re- public health is expensive-failure to provide quires the combined efforts of a team of trained adequately for the professional guidance of specialists. All of the services and programs health programs results in inestimable waste." administered by a modern public health depart- With that in mind, consider the fact that ment are interdependent-when one portion of there are no professionally trained and experi- the cortiprehensive program is missing, all of enced public health directors operating in the the other programs become less effective. Pro- county. The present municipal health officers viding the full range of public health services range from salesmen. or retired policemen to in a professional manner is beyond the scope nurses, santiarians, and physicians, with vary- of an untrained, part-time municipal health ing backgrounds in public health. However, officer, and the fiscal ability of any one munici- none of these have qualifications the State pality. mandates for the Director of a County Health Department, namely, a physician who has Inadequacies of Municipal Health Departments taken postgraduate public health training, in- Let us now look at some specific reasons cluding a master's degree and a residency in why municipal health officers, regardless of public health and who is certified in the spe- their diligence, cannot adequately serve the cialty of public health and preventive medicine. county's health needs. It would seem that having a physician or 1. Fragmented programs: In Delaware nurse listed as a municipal health officer would County approximately 75 administrative units guarantee a sound public health. However, this are involved in the provision of official health has not been the case. Upon consideration of services, including: 38 municipalities which the following facts, the reasons will become have health officers and/or boards; the State obvious: Health Department, which serves the county 1. Each of the 16 doctors who acts as a through its Chester office and its regional municipal health officer does so on a part-time office in Philadelphia; the various local school basis; none is trained in public health work, districts; county government, which adminis- which differs greatly from private medicine. ters a variety of services; and 11 other State Each is heavily involved in big own practice departments engaged in various regulatory and is thus hard to reach in emergencies. Also, and supervisory activities. Thig is a cumber- he is not usually available to participate in some administrative structure without any day-by-day planning and coordination of pro- central point for the coordination or integration grams with other public and private agencies. of these closely related services. Finally, by virtue of his office, he is potentially 2. Uneven quality: When there is great vari- subject to serious conflict. If he is fearless, he ation among local boards of health, nobody is is likely to lose some of his private practice. really protected, because health problems over- If he is timid, he cannot be a succssf ul health lap the boundaries of our small municipalities. officer. How many Delaware County citizens spend no 2. None of the 12 nurses employed as health time outside their own municipality? Is there officers are graduates of accredited public any municipality which prohibits entry to all health nursing programs. As registered nurses, 57 all are trained primarily for clinic and bedside Meaningless Boundaries small municipalities not for public health work in the corn- The boundaries of our nursing, drance where public health prob- munity, especially sanitation. al boards act as a hin erned. pollution, disease, and rate 3. Since the programs of niunicip lems are conc e township line, but a of health are concentrated largely in the area do -not turn back at th st. To combat public of sanitation, they rarely utilize the medical municipal health officer mu skills of the 28 doctors and nurses employed health problems, the entire county must count as health ofricers. Their skills and training as one "community." Moreover, adjacent full- would have much greater relevance in a well- te more rogram which included time county departments can coopera rounded public health p effectively than part-time local officials. the planning and administering of personal health services. Small Range of Services Pa)-t-time Health Office@)-s Many problems, such as rat infestation, lael, of health education, and communicable disease, Public health has reached a degree of com- require a combination of professional disci- plexity in which the part-time local health of- plines and services. A county health depart- ficer is not able to discharge his duties as the ment normally supports a range of these serv- executive officer of the local board of health ices. A brief description is given below, along adequately. It is impossible for him to acquaint with the problems caused for Delaware County himself with the many technical advances in by the lack of a County Department to run public health and still find time to carry on these services. his normal gainful occupation. Nevertheless, at 1. Vital statistics and communicable diseas@ the present time there are only four full-time, cont?,ol: Under the present system, we have lit- municipal health officers in DelaNvare County. tle reliable data on the incidence of commurii- Of the 39 municipalities with health boards in cable disease or of chronic diseases, accidents 1966, only four were paying their local health or environmental hazards. There are many officers $2,000 or more in salary, six were pay- points at which the current reporting systeir ing between $1,000 and $2,000, eight between falls down. This is not a reflection on eithei: $400 and $1,000, and 18 under $400. Three doctors or health officers, but on an incredibly reported no salaries at all tinder the local health complicated reporting system, which could bE officer category. corrected by a County Department. Spokesmen for municipal health interests a. Morbidity statistics, including communi- herald their availability for nighttime emer- cable diseases, are reported by doctors to thE gencieg. This obscures the difficulty of reach- municipal health officers, a time-consuming ing many of these officials during daytime task since a doctor's patients come from many hours, when most people would avail themselves municipalities, and their postal addresses ofter of their services. Besides, how beneficial is the confuse, rather than help, in determining theii presence of a public officer at midnight, if he residences. is untrained? Few real public health problems b. The municipal health officer sends emerge or can be dealt with on an emergency weekly report to the state office in Chester. Th( basis during these hours. statistics are then forwarded to Harrisbur@ for analysis. Eventually, they are returned t@ Poo?- Financial Base the municipal health officer, by which time ani A modern public health program is composed epidemic on which he would act might well bf of many interrelated, highly complex, techni- over. cal services which can be provided only by a c. A breakdown in reporting from a fev trained staff of specialists. According to the municipalities could create a great distortion Stebbins Report, an adequate financial base and in the prevalence of any disease-and raan minimum population of 100,000 or more are municipalities do not file annual reports o. essential to provide these services efficiently. communicable disease tvith the state. No municipality in the county could aff ord to This breakdown in comunicable diseas; provide the program and staff necessary. reporting is potentially quite dangerous. Al 58 ready, Delaware County is lagging behind more inspect, and how often. Almost none take the progressive counties in communicable disease initiative to report more than the barest out- control. For example, in 1960, Delaware County line of activity to the public. experienced 12 cases of meningitis, more than Other aspects of environmental sanitation, tnvice the rate of the state as a whole. Also, such as clean water, clean air, and radiation there were over 500 cases of measles reported programs are almost nonexistent under the during 1966. Since 14 municipal health boards current setup. filed no annual communicable disease report, While state law mandates municipal action health boards filed no annual communicable disease report, the actual incidence of measles in sewage disposal, many municipalities in the county have failed to even appoint a responsible may have been much higher. In those parts of official. Recent surveys by the Citizens Council the nation where strong public health leader- in Delaware County have revealed widespread ship exists, this disease is close to extinction. pollution in the county's four small watersheds, In addition, there is a soaring V.D. rate among even though none of the streams is more than Delaware County teenagers-the, rate is three a dozen miles long. The county's streams gen- times greater than the neighboring counties erally flow along the boundaries of numerous and almost twice the state average. boroughs and townships. This makes it im- 2. Chi-6nic illness coizt?-ol: Other than the possible for even conscientious municipal county's operation of Fair Acres, the field of health officials to control pollution. chronic disease prevention and control is virtu- In Delaware County, there is no overall local ally unserved by the official health agencies. air pollution control service. With the increased The volunteer agencies are active only on popluation of the county, the problem of air certain aspects of the problem and could be far pollution is of great significance. more effective with the aid which would be In 1965, a study of air pollution in Delaware provided by a professional health department. Valley by the Drexel Institute of Technology Since chronic illness represents the major com- estimated that nearly 2,500 tons of pollutants munity health problem, this lack of any overall a day were being emitted in Delaware County official program is a serious gap in health serv- alone. Of that, more than one-third was due to ices, In 1966, the mortality rate for breast and pollutants from transportation sources. This lung cancer in Delaware County exceeded the averages out to nearly eight and a half pounds state average. This is highly significant as edu- of air pollutant per person per day. This is cation and early detection can effectively con- nearly tivice that of Philadelphia County pei- trol both of these types of malignancies. person. 3. Envii-onmental health services: Virtually Another problem is that people have the all of the roughly 100 personnel employed by mistaken notion that air pollution occurs only municipal boards of health function primarily when it is associated with odor. There should as sanitation or plumbing inspectors. This be available a local service which is constantly aspect of environmental sanitation, therefore, at work protecting the public against potential is often carried out with diligence, though air pollution hazards and cooperating with standards vary widely. There is some question, surrounding counties on these problems. too, whether an untrained officer can bring to There is no countywide program of radia- this job the needed range of knowledge about tion protection despite the fact that over 300 solutions to the sanitation problems that he county users of radiation producing machines finds. Without such knowledge, the official may or material have registered with the State De- have no choice other than to ignore the prob- partment of Health. Continuous monitoring lem or fine the owner, neither alternative being and enforcement is necessary to protect the good public health practice. public against the potential hazards of radia- Also, it is almost impossible to ascertain the tion. thoroughness of their inspections. Municipali- 4. Maternal and child health services: No ties are not required to report the results of programs in maternal and child health are food sanitation inspections to the state. They sponsored by local .municipalities. A limited need only state how many establishments they program of the State Department of Health is 59 available to a relatively small portion of the The Wee-Care Babysitting Service county's mothers. In a 1966 State Report on natality and mortality statistics, the poorer Ida E. Floyd, Kathryn Dunbar, and communities in Delaware County exceeded the Dorothy S. Federman state average in every category of maternal and infant death rates including natal, infant, This project proposal describes our major and neonatal and in the percentage of imma- focus of the summer-the establishment.of a ture live births. Immature birth@those under free babysitting service in Mantua. However, 5 pounds-are usually premature. One of the two areas deserve emphasis. major reasons for premature births is the lack 1. Piti-poses: a. Parents in the community of prenatal care. According to the State's d@tal have a great need for babysitting services at the children in our poor neighborhoods !are low cost or free. The incentive to seek jobs little better if they survive birth and the first and maintain them, keep appointments, go to few months of infancy; while the state aver- the hospital, or take courses, is often killed age mortality rate for "certain disease of early because of the difficulty of affording babysit- infants" is 24.1, the rate among Delaware ting services. This service will provide mobil- County's poor is 52.8. ity f or parents as well as the security that their 5. Health education: Presently, only a hand- children are taken care of in their absence. No ful of county municipalities regularly inform such service exists now; all child care pro- their residents on health matters, and there grams charge about $2.50 per child per day is little educational use made of annual reports. and impose restrictions regarding DPA status, Health education is largely in the province of income, age, etc. voluntary agencies, acting independently- b. It is proposed that the service grow to Most municipalities, for example, d@ no@ provide health services: (1) For the children have organized programs for the control anct in the nature of examinations, immunizations, prevention of accidents. The State health de- etc. (2) For the parents in the nature of pub- partment has provided limited programs in licity concerning family planning services, or Delaware County, but these have had little programs involving such topics as nutrition or community impact. There is no local agency re- consumer fraud. sponsible for poison control. c. If the service is funded, jobs will have been created for community members. Health education in Pennsylvania schools d. An essential objective is to provide a has improved during the past decade. How- broad program for preschool children. ever, in the 'absence of vigorous public health 2. Q2testions to face and problems to solve: leadership, the necessary parent and commu- a. Question of legitimate use of this service. nity involvement remains very limited. This is What did we consider good reasons for using indicated by the failure of school advisory the service, who was to judge (if anyone health councils, permitted under a 1962 law, to should), how to.deal with the individual who catch hold in Delaware County. had no other commitment and would not offer 6. Labo?,ato?-y services: Almost all Delaware time helping to babysit, how do you deal with arents whom we know could afford to pay a County municipalities contract separately and ip, -abysitter. privately for the bulk of these services. This Question of whether to penalize the child results in a less well coordinated and efficient because the parent took advantage of the public health program. service. 7. Planning: Public health planning on a Decision: We decided to deal with the parents county level is now almost nonexistent. The on a case-by-case basis, personally interview- situation will not change until public health ing each parent, seeking an honest answer as programs are administered by qualified, full to why they used the service, explaining the time professionals. In short, the situation will reasons for having established the service, re- not change until Delaware County has a county questing help if they, could give any, etc. No health department. major conflicts have risen so far; we have 60 limited the age to 5 years old or younger, have The project grew out of prolonged discus- d parents to sion and personal contact throughout the requested donations, have urge p neighborhood, including door-to-door contact, send lunch, beverage, and a sheet if they can discussion with businessmen, politicians, po- and we have been able to recognize extenuat- ing circumstances Nvithout causing resentment lice, schcol coordinators, etc. among other parents. Pit)-pose.-a. To provide free babysitting to c. Question of survival potential on a vol- enable parents to seek and maintain jobs, take unteer basis. About a dozen mothers have given courses, go to the hospital, keep appointments, some time this summer, some more consistently enter training programs, etc., to provide mo- than others. What seems to be essential, given bility f or parents and the security of knowing that the interest in helping is already present, that their children are cared for. is frequent communication with all volun- b. To provide health services (1) for the teers before and after they work. The success children i.e. immunizations, eye and ear testing, of a volunteer organization rests in the mutual and (2) for the parents, i.e. family planning sense of responsibilit felt by all workers. This services publicity, programs of an educational y can only be conveyed through personal contact nature on such topics as consumer fraud, nutri- and a genuine invitation that all workers par- tion, rat control. ticipate in policy decisions regarding the serv- c. To create jobs for community members. ice. The volunteers are also aware of the con- d. To provide a broad program for preschool stant efforts being made to become funded in children, i.e. group activity, arts and crafts, order to make the transition to a paid staff. trips, films, music. Many existing programs do id. Question of black or white source of fund- not accept the child younger than three years ing. Funding is the major hurdle; attached to old, or they require $2.50 per child per day, or the Proposal is a list of contacts made and they make some restriction regarding income, possibilities still unexplored. DPA status, employment status, etc. e. Question of any funds leading to the hir- What has t?-anspired since JulV I St.-I. Prior ing of community people. This is the stipula- to Opening on July 15th: tion we decided must be made in accepting a. Obtained rent-free facilities at Haverford any f unds-that the community people involved Center, Lutheran Social Mission Society at 39th in the service make decisions regarding hiring. and Wallace Streets. Room is f urnished with f. Question of charging a fee. This decision small tables and chairs, refrigerator, toys, etc. is being worked out now with the desire being b. Publicized for a meeting to arrange se,hed- to maintain a free service, perhaps encourag- ule of volunteers. ing steady cash donations as parents see fit. c. Planned painting party with the teenagers g. Question of organizational structure, and cake and hot dog sale to raise f unds and working within an existing community organi- publicize Opening. zation with ongoing policies and programs. d. Solicited for donations for babysitting service and the sale. Response was uniformly Project Proposal generous from the community, businessmen, police, suburbs, Board of Education. Title.-Wee-Care Babysitting Service. 11. Operating of the Service: Brief description.-Free, daily babysitti-ng a. Publicity. for children 5 years old or younger. Hours of b. Ironing out of details (1) programs and operation: 8 a.m. to 3:30 p.m. Proposed hours: routine, (2) registration forms, (3) meals. 8 a.m. to 6 p.m. Parents are asked to supply lunch and sheet. Geographical area.-West Mantua (1) III. Present focus: Boundaries for publicity on door-to-door basis: a. To stabilize service on volunteer basis. 42d Street to 38th Street and Haverford Ave_ b. To seek f unds (see attached list of pos- nue to Ogden Street. (2) Newspaper publicity: sibilities) - citywide. (3) Boundaries of use: 56th Street Problems encountered.-a. Regulations of to 32d Street and Spring Garden Street to'Og- the Department of Welfare which may be im- den Street. possible to comply with in present facilities. 61 Avenue Businessrneii's Associ nature of workers, difficulty Of 2. Lancaster b. Volunteer lity of schedule. ation; ensuring stabi f legitimate use of the Service; 3. PAAC; delphia Mental Health Con- c. Question 0 on the part of the 4. West Phila demand of some reciprocity sortiUM; parents. 5. Public Health Service Research grants. d. Question of charging a fee to ensure some income for the Service. Possibility of asking The Photography Club at St. for regular donations, Christopher's which an independent ser .vice is e. Situation in zation set up within another community organi Richard Ragg6 and Richard Baines with ongoing Program and policies. Morrison Possible Budget.-Staffing: 1- One individ- f ommurlity children is an im- ual engaged in planning programs for children. Education 0 c Group nsible for schedules portant concern of the Comprehensive 2. One individual,respo s (CGHS). They felt the estab- and contact with volunteers- related Health Service would serve to edu- 3 One individual coordinating health- lishment of a camera club - cate as well as to OCCUPY a number of chil- aspects as stated above. verview; ie. mainte- ing the summer. This is what was 4. One individual to 0lity for registration, dren dur orientation as a possibility for a nance, finances, responsibi es: $7,- presented at correspondence, etc. Estimated salari project. 2 w ooo to $10,000. Maintenance $2,000. The first eeks consisted of obtaining Space.-Haverford Center all year round; if facilities, financing, equipment, a list of poten- expansion seems necessary, possibilities lie +.,.al club members, and advice from people with the Department of Recreation, Friends working in programs of this type. Social Order Committee, Mantua Community Facilities consisted of a converted eye ex- Planners. amination room from the health center as a Eqttipraent.-Already obtained but in fair temporary residence for the darkroom of the condition: cots, cribs, small tables and chairs, club. toys. Toilet and sink and play yard adjoin Financial support came from the SHO pho- main room. tography allotment and from donations from Needs.-First aid supplies, disposable di- one f oundation, Food Fair Stores and 14 area apers, bathinette, record player, toys, etc. stores. ting from nt ' Recreation has a Estimate of funds required if star The city's Departme of scratch: (not including salaries) $6,500 to program called PIX which helps to supply $7000. photo clubs with film and cameras. We could Contact re: Funding.-I. Black Coalition; not use this because (1) we were too late in 2. Philadelphia Coordinated Community applying, and (2) they were dealing generally Services; with a diff eront age group (13-19) and most of 3. MIC (Maternal and Infant Care Pro- our club members were be,tween 10-14; but I gram) ; feel if they were. approached early enough, 4. Episcopal Diocese; something could be worked out. 5. Friends Social Order Committee; A list of children (ages 10-15 years) was 6. Redevelopment Authority; gathered from the personnel of the health ce-n- 7. Model Cities; ter. Some were recommended for special rea- 8. Department of Recreation; rons such as difficulty in school. Approximately 9. RMP (Regional Medical Program); 20 children were in the club's summer portion. 10. Smith, Kline, and French, Merck, Sharp The club has offered a good opportunity to and Dome; get to know the community, especially some 11. Philadelphia Foundation; of the children from it; and to work with 12. Department of Welfare. these children to make ourselves more aware Unexplored possibilities.-l. Presbyterian of some of the problems that exist in a poor Hospital; community. 62 The reports, however, TNvo Projects for the children evolved, one during the summer. cooperation in conjunction with the social services at point out the importance of SHO's CGHS, For this service the Camera and Youth staffing by students and local people in Studio (C&YS) has in three cases supplied Hawthorne. pictures of specific housing problems they were The other articles in this section describe a dealing with. The other project was supplying wide range of activity. Project workers at Per- the Hartranft Corporation with pictures of net Family Health Service, Houston Commu- various lots in the community which were in nity Corporation dealt with significant issues bad condition, also pictures of the community for their communities. The two project work- crews that were cleaning them up. We are ers at Holmesburg Prison report a totally dif- also supplying several groups with sets of ferent experience. pictures of conditions in the Hartranft area. Each of these articles should be read indi- It has been the opinion of several of the com- 'dually for each presents still another view- vi munity leaders we have met that many people point on the summer 9s experience. in the community do not realize the extent or the degree of the problems some people face. Hawthorne Viewed by a Staff Member, a These projects are only a fenv of the things Student and a Community Worker we have done as a club during the summer. We are -flow making arrangements to continue the Cha)-les Floyd, Staff: The SHO personnel as- club on a year-round basis. signed to this particular site have been with One of the biggest hangups with "the estab- us now approximately four weeks as of this lishmeilt" was a contact with a local Business writing. The problems we have encountered Association. Speaking with the past president of the association about support for the pho- thus far have been minimal and I feel we have solved them to each person's satisfaction. How- tography club, we found that the association ever, of these problems, I feel the greatest has a means of handling such requests for has been lack of proper orientation of the stti- support. Community people would have to save dents, prior to their commitment. I recognize sales slips from participating stores and then turn them in to the association. The people that this was done on purpose to some extent, would then receive 2 percent of the total as but I personally feel it was, perhaps, too gen- the contribution. She said that almost no one eral in scope and too fragmented. I think that had availed himself of the plan. In our opinion, in order for an orientation to be beneficial to the students, it must be specific as to the par- the plan has worked well in keeping the com- . I munity from receiving anything, yet the Busi- ticuiar site. I also feel that if this job is han- ness Association can say that they tried. dled prior to the commitment, it can alleviate To end on a positive note, our relationship other related problems, e.g. what to work with, where to work, etc. with the CGHS has been a friendly and cooper- An example of the above problem as it re- Rtive one. The relationship it has with the com- lates to this particular site is as follows: mun@ity is a very good one which would make the center a good place to educate medical stu- SHO personnel assigned here (Miss Oster, dents on communit Mr. Sesso and Mr. Williams), were handi- y relations. capped, so to speak, due to lack of proper ori- SOME OTHER INTERESTING- entation. Although Mr. Sesso is from the adja- cent neighborhood, it was nevertheless, a EXPERIENCES problematic situation. They were not given Karen Lynch proper information as to the age group they would work with, where the base of operation @@@@A few of the papers written about the sum- would be, and the resources they would have periences stand alone. These are at their disposal. Some may feel that this is the or convenience. responsibility of the preceptors who are actu- s of the Hawthorne experience are ally in the programs and the community. How- Each highlights a different aspect ever, regardless of where the responsibility gram and the difficulties encountered should f all, I feel the timing of this is more 63 important. Whether it is done by SHO or the upon the opening of the Hawthorne Annex, preceptors, to me, is beside the point. The which I felt took too long to open anyway. We point, as I see it, is to help the students to be couldn't do many tangible things during the aware of the community they will serve, and first week. As a result, I felt that perhaps I the mechanics involved in the serving. Now was possibly remiss in my efforts. In fact, I if it is decided this is really a job that belongs didn't declare the compensation which I was in the realm of the preceptors' responsibility, it to receive for an extra day's work, prior to nevertheless should be executed before the stu- my arrival at Hawthorne. dents are assigned and employed in the com- During the first week, we arranged a meet- munity. Failure to do so will only add to their ing with the teens. Fifty guys and girls partici- f rustrating situation and it could stifle the cre- pated. Many valuable ideas and suggestions ativity and imagination they bring as part of were given by the teens. The kids were a bit their offering services. leery or cautious; after all, we are white In this particular site, the focus for the SHO strangers. Fortunately, we had Nate as a co- personnel has been recreation' in the Haw- worker. Nate commanded the respect of the thorne Area. Utilizing such activities on ateens; "Nate is cool," and so a rapport with group basis such as bus excursions to distant the community began. points (Atlantic City; Hershey, Pa.; Dorney During the next weeks, we attended staff Park; etc.), picnics, Phillies games, etc., afford and community meetings. It is a sad com- the students the opportunities of beginning amentary, but we went to many sessions and working relationship with the teens. Once this only a few of them were significant, in my relationship is formed, they are then able to opinion. get into the more personal and often specific As our first outing we planned a trip to the problems which can be worked upon on an in- Phillies game. We considered this a moderate dividual, but more ideally, on a group basis. success, but since we had to get there on our Most important in this program, originated own by public transportation, no girls came. by United Neighbors Association is the tie It was at the end of the second week that the it has to the Jeff erson Hospital Children and Deux ex machine, appeared in the form of ex- Youth Services. Referrals are made here for cursions sponsored by PAAC. This generated teen problems. much interest and enthusiasm from everyone, The relationship of this program to non- and it served as a focal point for our future health agencies has been most encouraging. activities. We went into the community to meet Collaborating with the PAAC (Philadelphia and recruit the kids. According to our commu- Anti-Poverty Action Committees) they were nity worker, this went over big, because it able to work out bussing schedules fof trips or showed we were interested in associating with excursions. The same is true with the Board of everyone. The trips provided us with the oppor- Education and their Operation "Green Grass." tunity to talk seriously about health, education, Arrangements were made with the staff at the or social concerns. We are hoping that these Children and Youth Center to have physicals opportunities will increase in number during performed. Work was also done with the Hous- the future weeks. Rapport takes time, espe- ing Authority as they were made aware of cially since we were dealing with such a large certain hazards in the Housing Projects and number of people, many (most) of whom "go surrounding grounds. The latter was an out- and come" from day to day. I must mention growth of a survey done by the SHO personnel. the relationship that we've developed with our Don Sesso, student: Much of our first week ficaptain," Tom Bradley. He is a great.guy who was devoted to becoming oriented and sets an example for big friends. acquainted with community j)eople and serv- Much of our time in the passing weeks was ices. This first week was challenging in that spent in writing to, or contacting, people asso- we were "wetting our feet." I was somewhat ciated with recreation or things which would disappointed by the lack of a pivot point or interest the community. We helped to staff the structure" upon which we could begin to de- Annex, and also aided in setting-up Tot Lot". v'elop our projects. Most of our activities hinged Tot Lot started nicely, but seems to have 64 interested in recruiting In conclusion, urban development programs ,Waned. I also became on coach aare essential, and I hope that our contribution youth and helping Jim Washingt the at Hawthorne was meaningful. We would like track team. Results are OK so far, but to express our gratitude to our preceptors for verbal affirmations and support greatly out- weighed the actual number of teens who par- their guidance. ticll)ated.However, this is understandable; it's Nate Williams, Commitnity Worker: I would pretty tough to run in 95 degree heat. like for the recreation and education program Also in the past few weeks I've become ato continue through the fall, because I think it friend with a group of about 10 boys, who are is a wonderful program for the children of the 12 and 13 years old. They had been uninter- Hawthorne community. As for problems, I have ested in day camp, and I guess felt young f or had none except for when we went to Atlantic our PAAC excursions. They are nice City. The PAAC staff were ignorant to the fact guy" tiTt we were dealing with children and not docile and willing to learn. We've gone on trips with adults. Nvhich were planned to be both educational and fun. I knew I would encounter difficulty get- Some of the projects we worked with are not ting them to leave their boats at the Schuylkill too good. And the children are old enough to River, but was I amazed when I had to "drag" know in addition to recreation they must learn four boys from the Logan Library. We also other things, like visiting more important went to New York, visited science centers, and places and doing more important work at the medical school labs. centers. In that way it would be much easier Our efforts during the remainder of the sum- for the ones that are there to help them. I en- mer will be to continue at the Hawthorne An- joyed working with the children and maybe nex,, to contact local business and perhaps next summer it will be better. news media in reference to assistance; to set up a film series. Teaching Sex Education Classes at In answer to the research question of, "What Hartranft Community Corporation is your central problem?" I can make supposi- Forest Lang: There was no direction at Hart- tions. I must first state that my analysis is ranft. The first problem was finding the right meant to be constructive, and I hope it will be construed as such. bag. The anatomy and physiology of sexuality is one of our few areas of expertise. Sexuality A. How important was it to have health s@ transcends racial and ethnic groups. Inadequate ence students since the teens are predominately and erroneous sex education is the rule. V.D. interested in recreation? There was a group, control is among the four priorities of Hart- however, interested in more than recreation ranft health committee. V.D. and prenatal mor- and we are trying new ways to arouse the tality are serious medical problems in the area. interest in the others who are the majority. Our first problem in planning was to dis- B. There are times when I question the nec- cover the amount of sex information among .essity of three of us as staff on a permanent area youth and their interests. A teaching plan basis. Definitely all three were needed at vari- progressing along a course envisioned through ous occasions for the proper relationships to the analytical mind of the medical student occur. would fail. We solved the problem by allowing The answer to this dilemma might come anatomy and physiology to grow naturally out about if there were much educational interest of discussion on V.D., intercourse, birth con- from the teens, but we were there to help in- trol, and birth instead of vice versa. still this in the first place. In addition there To research and plan a relevant course.ran must be added financial support for equipment us face to face with institutions entrenched in and materials to implement any program we out-dated mores. Building up a birth control attempt. kit for educational purposes was a real prob- Another answer might be a surge of in- lem. Planned Parenthood decided to loan us, creased creativity on my part; heaven kiiow's for one day, their birth control kit. They dis- I'm trying. pense thousands of I.U.D. and diaphragms, yet 65 to loan one to a medical student for more than tions at any time- The length of each class a day became a serious problem. It was only varied depending upon the amount of material through a personal contact at the health center to be covered and class interest. that we acquired these materials for the We found team teaching most effective. summer. Forrest Lang and I felt that we could present Also, the films at the Philadelphia Public a more honest and accurate picture of the top- Health Department were often inadequate. ics together than separately. My presence may They were poorly described in their catalog. have helped the boys learn to communicate We had to personally screen out the moralistic better with a woman, Forrest's helped accus- and threatening movies related to sex and V.D. tom the girls to deal with male doctors more The "Innocent Party" is an example of such a easily. movie. Other movies (Boy to Man) were in- We also felt it important that we were young adequate for the white community and inappro- and not authority figures. We think that the priate for the black. Most characteristic was classes found it easier to ask questions they the attitude of the Narcotics Addiction Center. might be reluctant to ask their teachers, clergy, They would not lend us a film on dope addic- parents, etc. tion for fear of putting ideas in the "little Good visual aids are of paramount impor- minds" (our boys have been on grass for tance. Films should be previewed beforehand years). since catalog descriptions can be misleading to The same problem occurred with films on say the least. If material presented in the film childbirth. Jefferson Hospital would not lend us is new it must be discussed before the film is its film because the boys were too young. shown. Otherwise the best presented movie Hahnemann allowed its birth film out only makes little sense. Many of the films require with a physician. Childbirth.Education Asso- discussion afterwards, especially those dealing ciation has a great film. But the rental is $10 with sexual attitudes. because they are a private institution. Clay models of the female reproductive sys- Finally Hartranft would not financially back tem-simple to make-are invaluable. Concep- the necessary expenditures because they did tualizing the uterus, vagina, ovaries from not approve of our sex education on their drawings is practically impossible even for facilities. the medical student. Models were made Ito scale. These problems exemplify the need for SHO A female pelvis was brought in to show how and all future doctors to push for realistic re- the organs were situated in the body. A model sources in youth education. pelvis was also useful in describing childbirth. Yvonne Butte?,field: Members of the sex edu- Whenever possible examples of tampons, cation classes were recruited from preexistent napkins, deodorants,' and powders should be groups-clubs, gangs, baseball teams. We felt used when explaining menstruation to either that in this way classes would feel more com- boys or girls. Classes should be directly in- fortable if all were already friends, that infor- volved by allowing them to open the boxes, us.e mation would b a e more efficiently retained and the powder and sprays, talp part the napkins, passed from one to another, that attendance place the tampons. in water. This same ap- would be better if a leader of a group could be proach is necessary when discussing birth con- interested in coming himself, This recruit- trol. We purchased examples of foams, jellies, ment tactic seemed to work well. Attendance suppositories and borrowed diaphragms, IUD'S, remained a problem as gang fights, baseball and pills. We inserted IUD's into the clay model games, and trips conflicted with scheduled of the uterus to show how it is done by the doc- classes. We tried to remain as flexible as pos- tor, squirted foams into the clay vagina. Every- sible in scheduling to allow for these occur- one was allowed to handle everything. If pos- rences. If possible, community recruitment is sible, material was presented by question and best. We Used this whenever possible. answer to encourage class participation. This Classes were kept @ small (less than six) to was particularly effective with birth control encourage questions and discussion. All , mate- since classes usually had some idea of a meth- rial was presented informally, allowing ques- od. The idea of "corking" the vagina to sepa- 66 covered by United Health Services rate sperm and egg leads easily to the idea of paper was foams and jellies. A rubber for a woman is a(an agency of United Fund), and the cover's diaphragm. cost was paid by SHO. With each subject, particularly venereal dis- We distributed the booklet ourselves going ease and birth control, classes must be told door-to-door to 1,500 households. The people's ,,vhere to go for advice and treatment. response was in the main, positive; people were In summary, classes were encouraged to par- glad to have a convenient source explaining ticipate themselves as much as possible, by ask- what things are and how to get them. Some ing questions, handling materials, selecting people accepted them passively. Others said movies, and making models. they couldn't read. Southern Philadelphia will hopefully have a Preparing a Community Health Booklet at Community Health Center Service within 5 Houston Community Center years. Such centers act as a central point for health information and referrals as well as for Zack Pinkney, Mike Rutberg, Lynn Sullivan, health care. Booklets such as ours, written on and Pat Witherspoon a community format, can act as a central source of information until the centers are Our project was the writing of a community formed and active. It is our recommendation, health booklet. The booklet contains articles on therefore, that booklets be written for all areas health services available and how to go about of Philadelphia. They can be informative and getting them. Included topics are: Medical So- convenient based on a community or geo- graphic basis. Booklets could be sponsored by cial Service; Community Information and Re- city agencies interested in health-United ferral Service; finanical helpIthrough Public Assistance, Medical Assistance, health insur- Health Services, Health and Welfare Council. ance Blue Cross and Blue Shield, Medicare; These agencies could be approached to organ- Health Center District 2; Chest X-Ray Service; ize and write the booklets themselves, or per- haps health students could be employed on a Venereal Disease; Help for the Alcoholic and part-time job basis to write them. Distribution Drug Addict; Poison Information Center; or could be handled by (political) Committeemen, Ambulance Service, Police Red Car, Cabulance, working on a Ward basis. Wheels for Welfare; Dental Care; Community Mental Health Center; Rehabilitation Center; Working With Pernet Family Health Service Planned Parenthood; Senior Citizen's Center; and a health director of area hospitals and practicing physicians, dentists, optometrists Joan Gomeg and chiropodists in the area. I would like to begin this paper by a brief We decided on writing the booklet on our description of the Pernet Family Health Serv- own. We wanted to do something tangible so ice with which I have been working this that people would be able to see that we had summer. done something. Our work group was two The Family Health Service is a voluntary health science students and two youth interns. nonprofit home health agency, staffed conjoint- We were responsible to our preceptor, a corn- ly by the Little Sisters of the Assumption and munity organizer at Houston Community lay personnel. Their work with the families, in Center. either a crisis intervention situation, or with We got information for the booklet by inter- the more long-term multi-problem complex, viewing people in the areas previously listed. seeks the overall aim of the agency which is We started with Public Assistance, Medical the preservation of the values of family life. Assistance, Public Health, the Community In- The 'Optimum level -of the family's physical formation and Referral Agency, and Medical and emotional health is encouraged and fos Social Service. We were further referred by tered through the rendering of direct services these people. We then wrote the articles and which seek to identify and alleviate the health typed, stenciled and mimeographed the book- and social problems that threaten the family let ourselves at Houston Center. The cost of structure. These services are: 67 difficult as the community has no provision for Nursing Care; 2. Maternal and o requires custodial care. I also Skilled Care; 3. Homemaker Home the patient wh the Sisters to limit Child Health ; 4. -Referral Service; believe it is important for West Health and Aid Service and Instruction. the dimension of the area of service to nt and 5. Health Promotion r serv- Philadelphia; otherwise too much time is spe Everyone who applies is evaluated fo limited travelling. ice. Admission criteria are necessarily In my interpersonal relationship with the ographical area and to: acuteness of need, ge rred to Sisters and other people involved with the availability Of staff. Families are refe gency there was good communication with ional anda the agency through numerous profess coworkers as well as with the patients I have nonprofessional sour,-es. The only problem encountered in satellite tried to help nal limitation. Being The Sisters have recently opened a MY work was my professio nt had to be limited office in our Mot-her of Sorrows Social Cen- only a student, my assignme ter-where l,loo children from the neighbor to patients who did not require professional hood are registered for day camp. The office skilled nursing. But, by Penerating the hones a first aid station where the chil- of several patients, I feel that I have had a has become or minor injuries or are brought unique experience arid an occasion to observe dren come f jous prob- rty creates and that there by their counselor for more ser many problems that pove lems, including infected wounds, ring worms- create poverty. or suspected battered child syndrome. The many of these cases problem there is that Holmesburg Prison Project should be closely followed up but the lack of personnel does not permit them to 'do so at the present time. The Sisters hope to be able Lawrence Krony Alan Cohler, and nter is 10- N. Joblon, M.D., Preceptor to penetrate the area where the ce cated, an underprivileged area with a predomi- nantly Negro populatiion. They have pledged We have been involved this summer with the their individual and State Maximum Security Forensic Diagnostic themselves to combine -ngths to re- Hospital at Holmesburg Prison. This hospital group efforts with community stre e in soci- deals primarily with court committed offenders. store families to their rightful plac P chi- ety, and to do something about the conditions The bosi)ital serves to give a complete sy which create poverty. atric Evaluation of its inmates, which is subse- with the quently reported to the court. Our function at A problem I have noted in working Work- Sisters is the geriatric patient. Many times re- this institution is that of Mental Health ferrals are made for elderly patients who re- ets. in this capacity, we deal with the compil- quire custodial care in their home. The aging ing of social history and character evaluations n is s of spouse, of the patients. In addition, we have been in- perso surrounded with loss: los volved in numerous Fact Finding research family, health, independence, mental capacity, This sense of loss is a profound human experi- projects concerned with both followup and reness of isolation, of therapeutic studies. ence. It causes an not belonging, of uselessness. In trying to re- S,ince.the hospital deals with an incarcerated spond to their needs the Sisters have burdened population there is little room for flexibility, themselves with a heavy cage load of geriatric i.e., the regimented structure is necessary for that til atients. it seems to me ey should con- functional utility. It is this highly organized p centrate their efforts in working with families, environment that we found ourselves in, and especially with multiproblem families, where within which we must function effectively and the underlying cause of their problems could educationally. It.is apparent that our primary problem was learning to deal with the strict- be explored in an intimate in-depth family contact. ness of the environm.ent. I have discussed this problem with the Sis- There.ig no typical character type here, but ave -tried to a general appraisal of the people we work with w of it and h ters who were a are disebar e some 'geriatric patients in order to is in order. The majority of these patients are 9 o work with families.but it is very poor, deprived, and considerably socially dis- be free t 68 roducts of broken homes, work he chooses. One's daily work experience turbed. They are the p the most profound molding influ- little education, and even less motivation. The is probably main problem in our dealing with these men ence that is allowed to operate on an individu- has been the difficulty in establishing interper- al's psyche. Therefore, in "The Disaster Drill," son@l communications of a meaningful nature. a short, one act play, I wished to not only intro- We presented ourselves to the patients as duce people to and impress them with the gross both confidant and therapist. Therefore, to- inadequacies of the existing health-care deliv- together with the administrative and psy- ery system, but to confront health profession- chiatric staff, we endeavored to provide the als with a situation that they themselves might courts with concrete detailed information, as be in someday, and to depict characters that well as beginning therapeutic and motivational could very well be themselves. My primary aim programing. is to make health professionals begin to ques- In summary, the vastness of the problems tion their educational experience, their work which give rise to the personalities we have environment, their attitudes toward those they seen is incalculable. Therefore we have striven treat, and their feelings about the very type to work within the structure of this institution of life they are leading. to provide a service to both the prevailing ju- Of all the groups to whom I would like to dicial system and, in a limited capacity, the in- present the play, medical, dental, and nursing mates and their families. Obviously, there are students, and beginning students, are first on sufficient problems to deal with for a long time. my list. These young people must be forced to We, theref ore, feel this to be a continuing f unc- question their most basic assumptions and am- tional project for the Student Health 0 rgarliza- bitions, as well as to see as lucidly as possible tion. Both the insight one derives from this the huge problems now existing in the health experience, and the opportunity to be produc- care system. In addition, I definitely do see tive, more than justify this project's existence. possibilities for presenting it to any group which is either directly medically oriented or Drama as a Means of Changing Health peripherally related. Professionals' Attitudes The best chances for the play being widely circulated would come from the Student Health Lucia Siegel Organization's sponsorship of it as a packaged program, the play being followed by small dis- cussion groups led by people trained in "sensi- I came to my experience with the Student tivity" techniques. A permanent cast is yet to Health Organization having a f airly well con- be assembled and the possibilities of obtaining ceived idea of the kind of project in which a director have not yet been explored. The play I wanted to work. Coming from graduate shall have its first rehearsed reading on Au- school of Social Work and having spent sev- gust 28, 1968, at the Philadelphia Student eral summers working with residents of the Health Orgariization's final conf erence. ghetto in various capacities, I recently have made a decision to devote an increasing amount Of my time to understanding and exploring Misericordia Hospital what I consider the white economic and politi- cal Power structure, responsible for the major At the beginning of the summer of 1968, rep- decisionmaking in this country. It is only resentatives of the Philadelphia Student Health through influencing this power structure by Organizations and Misericordia Hospital Divi- Many methods-"educational'@ efforts, protest sion of the Mercy Catholic Medical Center dis- movements, and mass civil disobedience, ete.- cussed the desirability and feasibility of devel- that individuals can- work for creative change, oping and carrying out a 10-week program de- @id the issues that are best suited as rallying signed to expose health science students to the for initiating change are those which patient as a social being. It was proposed that, -the individuals personally. Nothing is the health science student -who may eventually personal to an individual than what hap- serve lower class patients lacked an under- him as a result of the type of life- standing of the problems that beset them'. @ It 69 The Cei'vical Caacer Detection Pha-se was also proposed that patients of the lower class (ghetto) usually do not receive health operating with a grant from the cancer con- urate with their needs. After trol division of the Department of Health, Edu- services commens nd with the cation, and Welfare of the Federal Government weighing the pros and cons a con- sent of the hospital administrator and medical and under the direction of Dr. J. Edward ram was begun. r of the Department of Ob@ director the prog Lynch, the directo stetrics and Gynecology, the hospital estab- Pui-pose of the Prog?,am lished a cervical cancer detection program for women, which is designed to detect cancer of The purposes of the program were as fol- the cervix in its earliest stages. lows - steff orts to recruit and involve lower class 1. To make known to the community the Pa health service programs offered by the hospital. community people in programs designed to 2. To reduce the gap of communications and make available and improve the health care understanding between community people and services they receive revealed that this par- hospital staff. ticular segment of the community did not re- 3. To pin-point problem areas and make rec- spond readily to traditional methods of corn- ommendation§ for their resolution. mu-nication, i.e. the news media. Therefore, it 4. To demonstrate how health services may was decided that new methods of recruitment be improved and made more available to the' should be developed for the Pap smear pro- entire community. gram. 5. And finally, to give the health science stu- dent the opportunity to develop an awareness App?,oaches and Results of the problems of those individuals living in aThe community health aides decided that the lower class area. best way to augment the recruitment effort was through direct and personal contact and estab- Structu?-al Design lished the following objectives: The program was composed of the following 1. To recruit women who had not had a Pap components: smear test within the past 6 months. 1. A cervical cancer detection phase; 2. To inform all women in the area serviced by the hospital of the existence and availability 2. A recruitment phase f or the hospital's of the test. Neighborhood Health Center; 3. An emergency room out-patient depart- The program was initiated by conducting ment survey phase; interviews with the mothers of children who 4. A cultural enrichment phase for neigh- were selected to attend the cultural enrichment borhood children (Operation Create). program Operation Create (see section below). Having completed the initial interview, the Personnel interviewer discussed the Pap smear test with the child's mother; due to the rapport estab- The program was carried out by the follow- lished through the interview pertaining to the 'n i g individuals- child, the reception to the idea of the Pap smear 1. Three health science students; test was favorable. Moreover, through this con- 2. Three community health aides; tact the interviewer was able to get referrals of 3. One art education major (teacher) ; and a. 4. Two Sisters of Mercy of the teaching families, friends and neighbors in the are The use of a familiar name for introductory vocation. sibility of favorable purposes increased the pos reception. The interviewers continued using Preceptorship y referrals until they were finally these secondar in order to develop a smoothly operated pro- scheduled for appointments or "disposed of" gram and to .handle problems as they arose, (i e. some referrals were outside of the hos- ho met pital, s service area and therefore referred to the aides were assigned to preceptors w closer places for treatment) with them periodically. 70 Extending the concept of direct contact, the "At (blank) church we were told by the sec- interviewers canvassed door-to-door and con- retary that their members were not the type dlicted interviews in the hospital's clinics. Be- we were looking for. First she said, that her cause of the high percentage of working wom- congregation was too old, and when this was en in the area, contact was made with about 'answered by the fact that cervical cancer has only one-fourth of the women in the blocks a higher incidence among older women and canvassed. that this indeed would be a substantially bene- The door-to-door technique provided very ficial program for these women, the secretary interesting insight as to the attitudes of some abruptly said that most of their women were of the neighborhood residents. The following from the suburbs and that she would not see us. statements were taken from reports submitted "In another incident Reverend (blank) of by the interviewers: (blank) Baptist Church, who is an elderly "A few women, mostly elderly, would not cleric, said he would be embarrassed to make listen at all. Others listened but were totally the announcement. He did refer us to a woman disinterested. Some reacted with a negative who was very active in the parish activities attitude and a fear of cancer. 'If I have cancer, and who handled our program as well as could I don't want to know it' was one of the com- be expected." ments recorded. Avoiding the impulse to hurry the ten-week "Most of the superstition and misconception period of operation to a close, the aides, throug about cervical cancer was deeply entrenched. cerebral gymnastics, decided to recruit block This convinced us of the need and importance chairmen and to encourage them to solicit their of a program such as this. An attitude held by block members. They reported the following: a woman on the 5300 block of Larchwood Ave- "Astonishing returns resulted. For example, nue, concerned her seeming immunity, because in one block, 45 women responded and have she was white and middle class. This lady sai made appointments for Pap smears. The rea sons are that these block chairmen know when that neither she nor the other women on that to contact their neighbors and they do not run street would be interested, and that what we into the obstacle of suspicion. We fully edu- really wanted were the 'black streets.' " cated these women to our program and an- The door-to-door contacts were effective but swered any of their questions so that they, in they consumed a great deal of the interviewers' turn, could act as health educators to the rest time; therefore, efforts were concentrated o@ of the block. It must be emphasized that these working through community organizations anci block chairmen must be fully educated and churches. understand their task so that they may not Almost immediately the community health only carry out their tasks and convince the aides discovered that the vast majority of the- women in their block to take preventive . meas- community organizations in the West Phila- ures against cervical cancer, but to guard delpbia-Misericordia Hospital area were dis- against any misrepresentation and perpetu- organized, that they existed only on paper and ation of misinformation." in name, and had registers of nonparticipating The aides found out as a result of following members' However, those organizations that up unkept appointments, that people were were contacted promised to publicize the cancer often scheduled for appointments without a detection program. realistic assessment of the time factor. For Moving on to the area churches, the aides example, some were scheduled for appointments were able to get several priests and ministers to anno unce the existence of the program dur- only a day or two after they received their an- ing Church services, in fact, at one Roman nouncements and after they had already. made Catholic Church the aides, with the assistance other commitments. In addition, some received of a church group, solicited registrants for the their appointment cards 4 or 5 days after they test at the end of each Mass on a given Sunday. had been scheduled (via Pony Express). While most of the clergymen were coopera- Recommendations tive the aides recorded the following incidences 1. That appointment be confirmed by tele- which are worth relating: phone call before assuming that the woman 71 has received information about the appoint- diate area of the clinic to a dinner at the hos- ment. pital for the purpose of seeking their advice 2. That the postcards be sent out after con- and ideas. firming the appointment and about a week in The director of the council, furnished a list advance of.the appointment time. of the neighborhood organizations for the invi- 3. That consideration be taken of the pa- tation list. Also, invited were: chairman of the tient, i.e. certain arrangements may have to be West Philadelphia Chamber of Commerce, rep- made in order to keep an appointment, i.e. resentatives of the American Cancer Society, babysitter, transportation, etc. head of the local school district, and the area 4. That the backlog of women'which were representative of PAAC. Representing Miseri- recruited be scheduled for appointments as cordia were: Alisericordia Hogpital's adminis- early as possible, even if it would entail an trator, director of the clinic, director of the extra day a week for appointments. social service department and the director of 5. That a community health aide be hired. the public relations department. This health aide, as a member of the indigenous area, be assigned certain tasks. Among them: Appi-oaches and Results (1) Continue the program which has al- In spite of a logical and sequential approach ready proved successful. to establishing and publicizing the clinic, re- (2) Since the regular secretary canno maiKe turns f rom client appointment files were not evening calls to schedule the women for eve- favorable. ning clinics, the community health aide would i assume the task. Considering hat As mentioned above, it became obvious to the fact t the Health Aides that the community (for there are many women iTi this area that work wnich the clinic was established) did not re- during the day (as has been proven by can- spond to traditional methods of communication, vassing and mentioned earlier in this report), i.e., the mass media. Therefore, the following the evening service is essential. obpectives were established: (3) Consider that this health aide may in- 1. To visit meetings of community organiza- deed be an essential feature of instituting a tions for the purpose of explaining the fune- program of preventive medicine in this corn- tion of the clinic. munity with its base at Misericordia Hospital. 2. To make door-to-door contacts in order to Rec?-uitment fo?- the Hospital's Neighbo?,hood explain how community women could use the Health Center clinic. The health aides made numerous visits to The site of the Neighborhood Clinic (52d and Community meetings and churches. They no- Thompson Streets, some 2 miles from the hos- ticed that those in attendance represented a pital) was chosen because no hospital actually segment of the community which was articulate serves the area and because hospital records and knowledgeable of existing health care serv- showed that a relatively small number of pa- ices. Moreover, this particular group of people tients from this area had seen a doctor prior to maintained very little contact with the "grass admission. Since the majority of cases from roots" people and had personal physicians at this area were maternity patients, the pilot hospitals other than Migericordia (primarily program, under the department of obstretrics/ Mercy Douglas Hospital). gynecology, offered prenatal and gynecological Ijuring the month of July 1968, the health care and free cervical cancer detection tests. aides made door-to-dbor recruitment contacts. Working closely with the West Area Health According to Mr. James McGee, director of the and Welfare Council, the Public Relations De- out-patient department, the clinic served the partment discovered that merely establishing a greatest number of patients for any given clinic in a giv3n community does not guarantee month since its opening (see July statistics a a its acceptance, no matter what services are of- below). fered or for how little. Therefore, it was de- As a result of the door-to-door contactg, the a. cided to invite the chairmen and leaders of health aides discovered that the "community" various community organizations in the imme- was not aware of the existence of the clinic 72 and its purpose. In addition, racial and relig- ing hospital-community relations, a health sci- ious misconceptions were evident. "Most of the ence student was assigned to the department. black people that I contacted felt that the clinic Appi@oacit and Obse?-vatioits was for Catholics.only and they thought that you had to be white to receive service. Most of The health science student first oriented him- the whites living in the area were Italian and self (through consultation with staff) to the they thought the clinic was for blacks and that function and operation of the E.R. after which it was degrading f or them to go there" was he attempted to define existing problems and the comment of one health aide. to relate them to the developing concept of hospital-community relations. The orientation Neiglibo?,hood Clinic, July 1968 Statistics included direct observation of the E.R.'s per- sonnel and procedures as well as interviewing I. Health services rendered: Nui)iber pe)-,gons patients to determine their general background, Gynecology ............................... ...................... 14 i.e. economic status and health service orienta- Pap Smear ........ .............. ...... ........... l 6tion. Pediatrics ........................................ ........4Of the two hundred (200) respondents inter- Prenatal .......... ..................................5viewed, the following percentages were calcu- late: * 39 (A) 80 percent were employed 7 percent p II. Information contacts: retired, 8 percent on public assistance, 2 per- By telephone ...... ...... ...... .................. 21 cent on social security benefits related to the In person --- ................................. ............ 12 death of husbands, and 3 percent received their 33 support from the divorce courts. (B) 60 percent had family physicians, 23 Total I and II ....... ................................ ... 72 percent relied on Misericordia Hospital for health care, 5 percent relied on Philadelphia Recommendations General Hospital and Hospital of the Univer- In an effort to increase the utilization of the sity of Pennsylvania, the remaining 12 percent clinic, the health aides recommended the fol- represented Mercy Douglass Hospital, St. lowing. Christopher's Hospital, Police Welfare clinics 1. That a black and a white receptionist be and union clinics. on duty on alternate days. (C) 2 percent had periodic physical exami- nation every 6 months, 29 percent every year, 2. That a full-time health aide be hired to 12 percent every 2 years, and the remainder promote the clinic and other hospital projects. (57 percent) only when they were' ill. Emei -Out Patient -gencli Room (D) Less than 5 percent had 'chronic illness Department Su?,vey in their family. The Emergency Room Out-Patient Depart- (E) 56 percent of the patients had never ment represents the point at which most com- used the clinics at Misericordia, while the re- munity people have their first contact with the maining 44 percent had used the clinics once hospital. In instances where there are racial or more. and cultural differences, the community per- The student observed the following situa- son often gets a negative impression of hospi- tions and occurrences which are submitted as tal's staff and its policy; racial prej.udice and possible areas of concern as they may affect bigotry are often claimed. patient and hospital staff relationships: First, situations which usually created con- if a hospital is to serve effectively the com- fiict between the patient and hospital staff were @unity in which it is located, there must be those in which that patient felt that he suffered a reasonable amount of mutual understanding and tolerance of differences by both the patient from a f atal disease or a grave physical in- and hospital staff. . . * 'No'ice is here given to the fact that this survey is, skewed In an effort to pin-point problem areas and and therefore v.lid only insofar as it helped the Health Science student to get some very general in4ight into the background c-f to recommend changes directed toward improv- the E. R. patient). 73 case the patient sie-jans either do not hear their page or ignore jury. As a result of either ition it.,, was emotionally upset. To him, his cond appeared critical and immediate attention was Reco)li))ieiidations required. To compound the situation he may 1. An extensive effort be made to acquire have been accompanied by members of his re black and white American physicians. ds who were also emotionally MO . ity over confer- family or frien 2. That patients have prior involved. in the E.R. is often ences which require the presence of on duty In addition, this situation at the hospital is residents. be developed which ex- compounded by the fact th unity as a "white 3. That a booklet f the F,.R. and that it ex- known throughout the Comm plains the function 0 Catholic hospital". Consequently, the NegroIlain the need for delays. patient becomes concerned about the possibilityp . t him because he Opei,atiolt Create (Citititi'al En?,ichment for of discrimination agains vironmp,-nt (credi- Ne-igliborhood Ciiildi-en) doesn't trust this alien en bility gap). The short-range objective of the program a rewarding and meaningful Secondly, as is the case in E.R.'s in general, was to provide for neighbor- patients are treated on the basis of the serious- 49cultural enrichment" experience riess of their conditions and often those who are hood children, through stressing the creative less ill are required to wait several hours. The aspects of learning rather than, the mechanical. The long-range objectives of the i3rogram were ften interpreted by d the priority of service was 0 y. Also, to develop community interest, rapport an the black patient as being discriminator hospital itconflict occurred when patient sought emer- expertise with the hope of making the the gency treatment for a nonemergency problem. a more meaningful institution sensitive to wait while patients needs of the community in which it is located. As a result of having to re were served, the "Operation Create') consisted of 7 weeks, who needed immediate Ca Forty children par- black patient seemingly felt that he was being divided into two sessions. conducted Mondays discriminated against." ticipated. The program was Next, "situations which did not produce im- through Fridays. the following activi- mediate conflict, but which were not conducive The program included the hospital staff and ties: Choral singing, physical education On to good rapport between ped when the doctor records, reading book corner, finger painting, community People devel.0 te with the patient murals, collages, interpretive Painting, sewing, was unable to comrnunica ed Cross volunteer worker gave because of a lack of command of the English etc. Also, a R rnplete with films of language to say nothing of the vernacular of 5 hours of instruction, co e home, child care the black patient." instruction,'On safety in th dition, the children s involved in improv- and personal hygiene. In ad how to In addition, the problem elations are greatly were given practical suggestions on ing hospital-community rlong waiting periods handle fires and burns by the local fire chief. increased as the result of n were taken on field trips to the before the patients received medical attention. The childre Hood Dell (the chil- to the following pla'es- Robin "In one case a patient was admitted c H.ospital to see the s and 40 minutes later dren's concert), Lankenau accident ward and 8 hour Health Museum Exhibits, St. Joseph's College- he was admitted to the hospital to have a for- moliere's comedy "The Patient Pretends" eign object removed from his ear." r juvenile audiences, the Art Mu- Finally, several cases which required the at- adapted fo tention of a resident physician were delayed seum, Abbotts Dairy, the Philadelphia Evening because either "the residents on duty were in Bulletin And other sites of interest. Recreation rough trips to the conference or because the residents had left the was provided for them th hospital without informing the telephone op- Westtown camps and the Sherwood Recreation erator or a responsible person in the depart- Center. ied and interesting rnent which they were covering; where they As a result, of the var navail- activities provided for the children, tremen- were going, thus making themselves u dous community interest was generated by the able." Also, "it was observed that some phy- 74 the center mp-ncement exercises for the group. A program program, Many parents visited was pre- their children be included entitled "A Message Through Song" and requested that am war, continued. sented after which certificates of merit were next year if the progr given by the hospital administrator. "Operation Create'3 was concluded with cOm- 7 Section III PROJECT WORKER PERSONAL CONTACTS ion Snodgrass introduction discussion among the researchers, the From the outset the research phase f aced siderable Ith professionals, the idea two major questions: (a) how to evaluate the staff and a f ew hea th delivery system as a effect of student activities on the institutions of viewing the heal and organizations with which they dealt, and process within which there were presently vari- p- ous points of friction came to mind. The idea (b) how to collect relevant information hel ashington Conference of ful to concerned agencies of the Federal gov- was taken to the W June 8- as favorably received by ernment who -might realistically begin to re- 9 where it w form the health system in the future. several of the social science consultants. Later, their recommendations as to how the projects The very diversity and complexity of PSHO included the'notion of peri- ted easy answers to these questions. For might be evaluated s which would reflect the preven planned to introduce 80 odic contact report health care process was example, PSHO had unity workers points at which the health science students, 20 comm poor or inoperative. and 20 youth interns to 40 different project Basically, the idea was to view the con- sites. The number of persons at each site would sumer at one end of a dimension of health vary, the function of each at the sites would service and the institutions of delivery at the vary and, of course, the nature of each individ- other. Theoretically@ it was thought that at cer- ual would vary. At first and for a considerable tain points along this dimension, health care period of time, the project appeared to be too was quite highly developed or at least adequate diverse and complex for any evaluative re- in comparison to other points in the process to be c,onducted. It was impossible, for extremely poor or completely search at which care is example, to develop a standardized reporting absent. Student placements in PSHO would procedure for feedback because the pro3ects be involved with community organizations or were so diverse that no common questions perti- official institutions which dealt directly or re- nent to all participants could be asked- Pre- latedly with the health status of the consumer. vious research bad asked students to prepare In this capacity we felt that it was possible to a log r diary to be reported periodically from consider students as participant observers of 0 which data could be collected. However, these to the health delivery system, in a position researchers had learned that students soon lost report on which aspects seemed adequately de- interest in maintaining a personal account of veloped, inadequately developed or completely their activities so that by the close of the overlooked. In an effort to systematically un- ority had made consistent n this area, the researchers project only a min cover information i and valuable reports. reasoned that if students were able to make An answer tIo the first question was never brief reports on the nature and purpose of each oten_ individual with whom they came into contact, found by the present research, but one p tial answer to the second came to light during a picture of the points of consumer grievances the presummer research planning. After con- Iand satisfactions would come to light. ;: @ 77 The research, however, did not have the re- below is a description of the variety, nature sources or the personnel to carry out this plan and outcome of contact made by these project at every site. Consequently it was decided to workers. The report is organized according to experiment with the idea of personal con- the type of contact made by each project work- tacts revealing the health system deficiencies at er, such as city official, community resident, two sites for a 2-week period. If this approach and medical professional. to the investigation of medical services proved The reader can judge how valuable these successful, then it might be improved and em- descriptions are in the collection of information ployed in future SHO research. helpful to the Federal Government in improv- Appendix 5 is a copy of the Philadelphia ing the health care system. However, in the Student Health Organization "Personal Con- final section the researcher has commented on tact Sheet," It contains a checklist by which the value of the "Personal Contact Sheet" as a the respondent can quickly give the biographi- research instrument in collecting such informa- cal characteristics of the person contacted, how tion, and its potential as a research device for the contact was established, the purpose of the future SHO research. contact and a means for reporting the conse- St. Christopher's Child and Youth quences of the contact. The reporting form Comprehensive Care Center was designed to be brief enough so that Stu- dents would not be reluctant to complete it Fii-st Healtit Science Stttdent following each personal contact, yet substan- 1. City Officials: During the 2-week period, tial enough to indicate whether the outcome of a contact revealed a complaint or a compli- there were 15 contacts with Philadelphia city ment for the health care system. officials, a total of eight different Philadelphia governmental officials. Two sites for the exploratory use of the The contacts were all associated with cases personal contact sheet were chosen, the St. of lead poisoning in renovated public housing Chn'stopher's Child and Youth Comprehensive units. The health science student stated that a Care Center and the Spring Garden Community specific accomplishment as a result of these con- Center, both located in North Philadelphia, St. tacts was: "The presence of lead poisoning and Christopher's C & Y Center employed all three the need for immediate relocation of f amilies types of PSHO participants, three health sci- with lead poisoning was brought to the atten- ence students, one community worker and one tion of the health department." Also an ap- youth intern. This site was chosen in the hope pointment to meet personally with a responsible that by multireporting, the three varieties of city official to examine the issue of lead poison- project worker would shed light on the de- ing was made. There was no indication that livery system at this institution. Unfortunate- the student was successful in relocating a spe- ly, the youth intern at this site was not respon- cific family which was the victim of the lead sive to our request and did -not file contact poisoning within the two-week period. reports. 2. Community Leaders: One contact with a The Spring Garden site also had a variety community leader in person in effort to obtain of project workers; one male and one female information and advice on how to approach the health science student and two youth interns. health and housing departments concerning Here again, however, we did not receive the co- the cases of lead poisoning. operation -of the youth interns and their con- 3. Health Professionals: Three contacts with tacts and perspectives of the health delivery health professionals were established in order system remain unknown. to obtain inf ormation on the relocation of the The project workers at these two sites were cases of lead poisoning. asked to complete a contact sheet for a 2-week 4. Community Residents: The health science block of time, (August 12-16 and August 19- student bad contact with three community 23) on each person contacted either by phone residents during the 2-week period. One con- or in. person. The results were collected during tact was with the woman involved in the lead the final conference and subsequently analyzed poisoning mentioned above. In a second con- and collated. The analysis which is presented tact, the worker collected information for a 78 ,,voman's Public housing application and in the with other PSHO project workers on a number third, discussed the career opportunities and of issues. health sci- further education of a 14-year-old Negro male 1. He established contact with a on the verge of quitting school. The health ence student at another site and pursued the science student remarked that he was success- possibility of developing a sex education course. in investi- Several films were later reviewed for their pos- ful in getting the contact interested Lances for further education before sible incorporation into the course. gating c dropping out of junior high school. 2. He was in contact with a variety of other 5. State Government Officials: A personal PSHO workers at his site placement, a neigh- contact was initiated with the Department of boring site, and Nvith PSHO staff in order to Public Assistance which was successful in hav- discuss the admission policies of various Phil- ing the allotment of a welfare recipient in- adelphia medical schools and to discuss what creased to include a dependent child. action and contributions they might collectively 6. Community Groups: The health science make toward improving these policies. student met with one high school drill team 3. The health science student called several composed of both male and f emale teenagers meetings of other members of the child and and one Puerto Rican boy's social organization youth site to discuss, outline and write their to show and discuss a film on venereal disease site problem paper. and sex education. 4. The health science student initiated a Adult community workers of two different meeting with three other members of PSHO community organizations were shown the film who were also enrolled in the same medical which was also followed by discussion sessions. school to discuss the possibility of creating a Health Pi-ofessionals: There were several "humanitarian program" for their medical contacts with health professionals for num_ school in the fall and to investigate this par- erous reasons. ticular school's black admissions policy. 5. He attended a sensitivity training session Second Health Science Student with other student participants and institu- 1. The director of St. Christopher's Children tional residents at Eagleville Hospital. and Youth Center was seen personally to discuss NonHealth Pi-of essionals: A personal contact and revise the informal review clause practiced with the head of social work department at St. by the Patient Care Review Board. Christopher's Children and Youth Center was 2. Later in the week, a personal contact was made and a time arranged for the social work- made with a professor at Hahnemann Medical ers to view the childbirth films. College from whom two films, "Labor and De- A going-away party for a nonhealth profes- livery" and "Natural Childbirth" were bor- sional was held one after-noon at which the rowed. health science student had contact with 'num- In a third instance, the health science stu- erous doctors, social workers and other person- dent personall,y contacted a female official of nel of the St. Christopher's Children and Youth St. Christopher's Children and Youth to set up Health Center. an on-going sex education course in the fall. Medical Technicians: The health science stu- He offered to her a resum6 of our class mate- dent met in person with one medical technician rials and resources." The student indicated that of St. Christopher's Children and Youth Center the. official was very interested and coopera- after having shown the childbirth film and tive, but he personally had some reservations discussed her attitude toward childbirth and about the complete success of the contact. The toward sex in general. same individual was contacted several days Comraunity Youth: The health science stu- later and, through her, arrangements were visited the home of a female community resi- made to show a film on childbirth to a group dent in an eff ort to find her son, the leader of a of nurses. teenage gang. The son was in St. Christopher's Other PSHO Project Workers: Over.the Hospital recovering from a gunshot wound re- course of the 20-week period, this particular ceived from another gang member. The health health science student made several contacts science student visited the gang leader at the 79 hospital and had him select the sex education of the Hartranft Community Corporation after movies to be shown to his gang. The following an in-person contact and request were made. week the gang leader was seen in his home to The health science student telephoned the discuss a date f or the films. At this meeting Childbirth Education Association requesting A the health science student reported that they film on childbirth and asking that the central talked about retribution against another gang fee be waived. The contactee responded that that shot him 2 weeks ago. the film committee would look into the possi- Several days later, a group of about 10 bility of using the film. There is no notation gang members met at the branch of the Public by the student as to whether he was eventually Library for 3 hours with several health science Successful or unsuccessful in this request. students and a physician from Hahnemann Another community leader, the organizer of Medical College in which the films on childbirth a drill team, was contacted in person to arrange were shown, models of the uterus and pelvis for a meeting with the team to show films and were discussed and questions answered. discuss sex education. As described below the This same format was followed with three meeting of the team was held a few days later. other local gangs during the cours6 of the 2- The health science student had previously week period, a total of about 35 gang mem- established a relationship with the members of bers. On the whole, the health science studefit a local teenage baseball team, so that at the reported that the members of the gangs felt outset of the 2-week reporting period, sex the experience to be interesting and sucessful. education classes were held with this group. At the outset of the 2-week reporting period, He played a f ew innings of baseball with the the Health Science Student conducted sex edu- team after which the players participated in cation classes with a local teenage baseball sex education classes. Over the 2-week period, team. There was more extensive contact with four classes were held at which a total of five this particular group than with the others. The films were viewed, each of which was followed health science student had previously estab- by a discussion session. lisbed a relationship with the local baseball The sex education films and discussion ses- team. sions were also conducted with other groups Cominit?zity Leade)-s: The health science stu- and associations. On one day, the film was seen dent was contacted over the telephone by a by three different groups, Negro, and Puerto community leader who was the chairman Of Rican females, and on another day six family the St. Christopher's Children and Youth health workers from St. Christopher'g Chil- Health Center Advisory Board. They agreed dren and Youth Health Center saw and dis- that a suggestion box was needed for the griev- cussed the films. The film was also shown to ance committee in the health center. Approxi- eight members of a local girl's club.'On another mately a week later, the health science stu- occasion, the student took the film to a biology dent contacted the leader and together they class at Gwynedd Mercy College and presented sawed the pieces of wood neessary to make a it to a group of 25 students and faculty. complaint box. Later, the box was actually Third Health Science Student built and sanded by the health science student. The third health science student was in- On several occasions between these two meet- volved mainly in the establishment of a camera ings, the committee leader was seen twice per- - club at St. Christopher's Children and Youth sonally; once to investigate the bylaws con- Center. During the 2-week period, he reported cerning the Patient Care Review Board and, repeated contacts with young high school stu- secondly, to invite him to attend an evening dents interested in learning about photography meeting of PSHO's Committee for Black and establishing a permanent camera club. His Admissions. activities were in association with four Negro The health science student personally con- male and two Negro female teenagers and three tacted the pastor of Holy, Cross Lutheran Puerto Rican male teenagers. Also: involved Church who "refused to lend his take-up reel were an 11-year-old Puerto Rican girl and a for our films on sex education." The'take-up 10-year-old Puerto Rican male. The health reel was borrowed later that day from a leader science student carried out a number of dif- 80 all of which phone number or address at which the priiei- ferent projects with each of them) ound the instruction Of pal could be reached. seemed to center ar they designed a pho- The health science student was also in cOn- photography. In addition) h the director of educational services tographic display for the waiting room of the tact wit nd Montgomery County community health center, and worked on aof the Philadelphia a s intere picture story of PSHO. Equipment for the TB and Health Commission who wa ' sted permanent club was sought and a name for the in obtaining prints of housing and lot condi- club, "Camera & Youth Studio" was decided tions to be used to display to persons with upon. whom he officially comes into contact. The student was in contact with two adult Other PSHO Students: The health science members of the community who he hoped would student met with two PSHO workers from an- like to take charge of the club and see that it other site and discussed in general PSHO plans continued after the close of the summer. for the f all of the year. He later talked to Another community resident was contacted different area coordinators about the plans for in her home in order to take pictures. The the final conference. Another telephone contact involved one of the PSHO directors and the health science student reported-that, "The pic- pians to show the Children and Youth Center tures would be used in an approach to city to out_of-town visitors. This health science stu- agencies to have the house fixed." dent was also in frequent contact with the Preceptors: The health science student had youth intern at the site and numerous conver- several personal contacts with his preceptor in sations covering a wide range of subject mat- an effort to obtain the -names of persons who ter. Finally, on one occasion, the health science might be interested in continuing the camera student along with the PSHO committee went club in the f all. One other preceptor was brief ed into the neighborhood to take photographs of on two occasions about the nature of the final the housing conditions. conference at which his attendance was urged. Coramunity Worker: The community worker Healtib Professionals: Three different health f contact sheets; however, I completed a series o professionals at St. Christopher s Children and some of them were incomplete or else too vague Youth Center were contacted in an effort to to give a complete picture of her 2-week con- provide for the continuity of the camera club. tae-ts. She was primarily in contact with Corn- During the 2-week period no solution to the munity residents and community leaders in problem was obtained. reference to a number of issues centered around The health science student also came into ahousing conditions and welf are rights. wide variety of health science personnel at aCommunity Residents: On one case she took farewell party conducted at the institution one a Puerto Rican female to a welfare agency afternoon. Approximately 40 people of all races where she was successful in having the welfare and from a wide variety of occupational status grant increased to include a dependent child. were present. In two other instances she obtained permission City Government Officials: A group of teach- from two community residents to take photo- tour of the St. graphs of urifit housing conditions. She con- ers were contacted while on th Center. The tacted dents by tele- several community resi Christopher's Children and You health science student discussed with the prin- phone to give information concerning hearings cipal of Hartranft School about the further which the residents were unable to attend. In development and continuity of the camera club. two other cases, she went to the homes of com- e the munity residents to learn the status of the In an effort to f ollow up th possibility, health science student attempted twice by tele- residents' applications for public housing. She phone to contact the ' incipal of the Hartranft also attended several 'local meetings as re- Pr School in order to describe the camera club sources to further her work with housing con- activities and status and to possibly work out ditions. a solution of its continuity." In both cases, he Community Leaders: The community worker was not able to get beyond the principal's sec- also met with several community leaders, par- retary, who twice refused to provide a tele- ticularly ministers, to arrange meetings to or7 81 ganize community members to obtain improved and then would have to open it to someone housing conditions. else." Com,mit??ity 07-ganiza,tio,@is: During the 2- The next contact with Mrs. R. by the health week period, the community worker became science student was the following day in which -an associate member of the Welfare Rights they had discussion about selling Mrs. R.'s Organization and worked with them to organize radio-record player. The contact sheet does not for the improvement of housing conditions. disclose whether the radio-record player was in Health P?-ofessionals: The community worker connection with the funds needed to visit the came into contact with a number of health pro- public housing or not. The student reported fessionals in the 2-weeIk period; in some cases that "I have the feeling that Mrs. R. will not made arrangements via telephone for dental find anyone to buy her record player and will services for community residents; in other continue making the payments on it which she cases she made contacts in person or by phone really does not want to, because of being on with officials responsible for public health and welfare." public housing. She also attended a lecture on Approximately 1 week later, Mr. R. came to environmental health delivered by a health pro- the center and informed the health science stu- fessional, and a lecture on housing at the dent that she could not attend a clinic at a University of Pennsylvania. nearby hospital by herself because of the many other problems she has. "She asked me to go Spring Garden Community Center along - I explained the value of going alone and reporting back to me how she feels it This female health science student noted went." At that time the student did riot think that the contacts which are summarized below Mrs. R. would attend the clinic. "ivere made at the end of oLir project period, After Mrs. R. left, the student telephoned a when the clinic had closed for the month of nurse at the clinic and informed her of Mrs. R's August; they are not necessarily typical of reluctance to come to clinic and clarified that those contacts with community people we had since she is in the maternal and infant care pro- been making in the beginning." gram, she need not be there until 12:30, al- In reporting the results of this student's con- though the appointment card reads 11:15. The tacts, the material has been organized in terms student also asked that the interpreter be on of the person contacted rather than the type of the lookout for Mrs. R. The health science stu- person. Most of the contacts were of a patient- dent also noted that the clinic had become more advocate nature. cooperative with her and had followed some of Mrs. R: Mrs. R. is a 36-year-old Puerto her suggestions oii specific patients since the Rican living in the neighborhood of the Spring time the student had personally accompanied Garden Community Center, who came to the them to the clinic earlier in the summer. In center with a letter from the Philadelphia spite of this, the student believed that the ob- Housing Authority. The health science student stetrics clinic process needs a total revision for translated the letter into Spanish, which ap- all patients. parently stated that housing was available. An hour or so later, the student again called From the contact reports it is unclear; either the nurse at the clinic concerning Mrs. R. and the housing required a $25 deposit or Mrs. R. learned that she had just been seen by the phy- felt that she needed this sum in order to make sician. The student noted "this was the first arrangements to inspect the housing and secure time to my knowledge that Mrs. R. was seen so it. The health science student telephoned the quickly in the clinic." city official who had written the letter to Mrs. Mrs. R. stopped by the community center af- R. and found that the official was away for a ter her visit to the clinic and talked to the week. The health science student then spoke health science student. The student suggested to another official and "explained to her that that "Mrs. R. had proved to herself that she Mrs. R. did not have the $25 to cornIe and see could go to the clinic alone regardless of the the house now. The official replied that they language and cultural -barriers she might en- could only hold the apartment for a short time counter there and on the way." 82 contacts reports witll The following day the health science student There are no further ek period. Whether she visited the L.'s home to discuss the results of lvlrs. R. during the 2-we housing is the appointment with the mental health clinic. was successful in obtaining Public possibility unknown. At that time they also discussed the pital. dent called of having his wife admitted to the hos Officer S.: The health science stu The health science student later spoke to a the community relations ofFicer of the Philadel- medical secretary to learn how Mrs. L. might be phia Police Department and learned that they admitted to the hospital for surgery. The secre- had no record of a letter written by the.student tary offered to contact a doctor who could ex- asking for an officer to speak about the police plain admission procedures. A doctor from the and community relations, to a meeting of P'SHO hospital called later and "suggested that Mrs. students. L.'s other medical problems be handled before An officer of the community relations office her oral surgery." The health science student -returned her call later that day to let it be explained Dr. R.'s deferral of her oral surgery. known that he could not speak on the day re- Her possible admission was to be discussed with quested. A health science student told the officer another doctor. The health science student she would find out what other date might be stated that she had arranged to page Dr. S. the scheduled for the SHO students. following day to find out what doctor would The following day, Officer S. called the health perform Mrs. L.'s surgery and when she might science student to ask whether a definite date be admitted, but there is no indication whether had been arranged. It had not, so the student this was done or whether Mrs. L. received the promised to call back as soon as the date was surgery. established. After discussing the problem with Several days later the health science student the area coordinator, a date was established and received a telephone call from the doctor at the Officer S. was informed. mental health clinic with whom she discussed Several days later the student again tele- Mr. L.'s case. phoned Officer S. to confirm the date and the On the same day Mr. L. came by the Spring topic and 2 days following, the officer spoke at Garden Community !Center "to thank me for the Hahnemann Medical School Auditorium to ahaving helped him and his family. The fact that group of SHO students. iNh-. L. sought me out to say goodbye I feel was Mr. and Mrs. L.: The health science student significant-apparently he feels our contact had been in continuous contact with the L. with him this summer has been on @ person-to- family during the summer. During the 2-week person basis and that he has made some prog- reporting period, she was involved in obtaining ress." -year-old Negro at aMrs. M.: "Mrs. M. (a 30-year-old Puerto treatment for Mr. L a 30 mental health clinic and oral surgery for Mrs. Pican) called me over when she was waiting -week period in clinic. She asked me to in- L. The first contact during the 2 with.her son at the regard to the L. family was to telephone a pub- quire when her son would be seen, since she had lic health nurse to brief her on the L. family in been waiting 2 hours already (she did not speak order to provide continuity of care once the English). When I explained this to the nurse, health science student completed her summer she and her son were seen immediately so that assigrunent. she co.uld get home to her other children before She next went to the L.'s home and informed it got too late. Actually this is not much of an Mr. L. personally of an appointment she had set accomplishment (the intervention of a health up with the Community Mental Health Clinic. science student) because it is not remedying the She also discussed his progress in obtaining situation of long waits that almost all patients public housing and informed him that she at the clinic must endure." woulld be leaving soon and that the public Mrs. C.: A 28-year-old Puerto Rican came health nurse would take over his case. to the Spring Garden Community Center seek- She then called the mental health clinic, ing health care for her son. The community cen- 'de ',,he care thanked the nurse for setting up the appoint- ter could not provi , so the health ment for Mr. L. science student called the pediatric clinic at a 83 nearby hospital and obtained information on science student were done in a perfunctory and how Mrs. C.'s son might receive treatment. The cursory fashion so that it is difficult to establish student informed Mrs. C. of the procedure and the purpose and accomplishments of his work referred her to the hospital clinic. activities. During the first week, he apparently This health science student had numerous worked closely with health professionals of a other contacts durn-ig the 2-week period aside mobile X-ray unit, although the specific tasks from those associated with patient advocacy. remain vague. He also had frequent contact She worked with a mobile X-ray unit working in with a female Puerto Rican over the 2-week the Spring Garden area, attended a sex educa- period who was a community worker although tion seminar with other PSHO students which the reasons for contact are not spelled out. He explained how one hospital is teaching this topic was in continuous contact with two other P'SHO in the Philadelphia public schools, toured a hos- pital museum and worked with several other students of another project to discuss and help PSHO members to develop a schedule of meet- carry out a project survey. Other than these ings and speakers for the final convocation. issues, the other contact reports filed by this Second Health Science Student particular student are not especially valuable in understanding points of grievance in the health The contact reports filled in by this health care delivery system. 84 Section IV SHO'S SHOW: AN EVALUATION OF THE 1968 PHILADELPHIA STUDENT HEALTH ORGANIZATION SUMMER PROJECT ion Snodgrass introduction a grand success or dis- The title, ,SHOIS Show," @rnay imply that the whether the attempt is 1968 Philadelphia Student Health Organization mal failure. pSHO's relevance to larger socie- a'ludicrous carnival, or it in locating ost outstanding and Summer project was tal trends, one of the m may imply that it was a remarkable deriionstra- curious features of the project was the nature tion in social rP-f Orm- Possibly it implies both, financial support and the character of its perhaps neither. In any case, the title is left of its inistrators sufficiently ambiguous to allow the reader of participants. The adm and partici- this report to come to his own conclusions by pants were almost entirely youth, While those critically examining the data in this section. funding the project were primarily adults. It is The report can be read on two different levels. this fact, it seems to the researchers, which The reader can view it as factual, empirical ma- contains PSHO's relevance to the broader so- terial about the 1968 PSHO project. Or the ciety. It struck the researchers time and time reader can view it as a specific example of larger again throughout the summer that the relation- historical trends in society. ship between the adults and youth in PSHO was On an empirical level PSHO was composed of somehow only a reflection of a larger trend in 74 health science students, five area coordina- society. A trend in which it seems that adults tors, three directors, 21 community workers and not only identify strongly with youthful life 20 youth interns who worked with a total of 34 styles, dress and ideology, but place great hope community .organizations and health and wel- in the present generation to attain a conflict- fare institutions within the city of Philadelphia. free society and secure the basic rights of men. On a general level PSHO was composed of a This is not the "generation gap." The genera- group of individuals in an attempt to improve tion gap is an old phenomenon, widely covered the social conditions of relatively few victims (but never bridged) by the media and generally of the 20th century. acknowledged by the public. Even 170 -years On an empirical level the evaluation reflects ago de Toequeville, the French scholar, was that PSHO had mixed results-successful and aware of the generation gap when he stated unsuccessful. that in the United States, "The tie that unites On a general level the actual results appear one generation to another is relaxed or broken', insignificant in comparison to the attempt. The every man there readily loses all trace of the importance of PSHO lies in the attempt to mi- ideas of his forefathers or takes no account of prove the conditions of less privileged men them." But the contemporary relation between caught up in the human race, regardless of the generations as reflected by PSHO seemed 85 by adults. This means that the burden of social to indicate that we have moved beyond the gen reformation rests heavily on the shoulders of eration gap to what we can only describe as the Within the field of medicine it invers@ion." De Tocqueville saw youth alone. he passing generation of medical "generational sical relationship between adults eanS that tremain inactive observer that the clas in s as and youth would be fractured, but not that they professionals can tempt to improve might be totally inverted_he did not foresee their youthful successors at the possibility that the forefathers might imi- the field of medicine. tate the traditions and ideas of their offspring. if PSHO is a representation of a general There presently is much debate over the societal trend in which adults rely on Youth, meaning of active and protective movements of then one has in this report, on the general level, youth. On the one hand the vast majority of material which would indicate -,vhether the so- people overtly claim that this is the undisci- cial reforms so urgently needed have been dis- plined response of the permissive generation covered by Youth. If the generational inversion constrained to act out of the boredom of its pen-nits acquiescence by adults, we fear that the eath this mented, but held in affluence. On the other hand, but ben reforms will not be inlple general assessment, there seems to be a mi- abeyance awaiting the initiative of youth. nority, but growiny number of individuals, who Whether all youth will take up the initiative is of hope; the h youth alone can claim that this is the generation ent solu- doubtful; whether enoug its is at least generation which can achieve perrnan match the expectations of the adu mplex problems which t eff ' ts by both either independ- tions to the many ind co uncertain. Bu or increasingly plague modern civilization. There ent or in unison, seem far more prornasing. With- appears to be a subtle and gradually emerging out broader, transgenerational efforts in social belief @that youth are prodigies who can ingeni- refon-n, the generations may not continue to ously resolve the social Pathologies of co'ntem- invert, but both dissolve amidst the crises in porary society. society. The generation inversion is seen, for example, ments are not restricted to the ret Mead, the well- These com search but apply to the in a statement by Marga ,What's hap- empirical aspect of the re known anthropologist, who said, total evaluation-the qualitative portion 're- pening now is an immigration in time with the ported by Miss 'Karen Lynch in section 11 and people over 40-the migrants into -the present .'the qualitative portion in the present section. age, and the children born in it-the natives." e comment by an OfF'- As to the empirical aspect of the research, it It is also evidenced in th social-bio- e-ial of the U.S. Department of State who re- has been directed toward, first, a "Th,ese kids are all trying to tell us graphical description of student participants, marked, or project something-a'nd we better damn well figure out and second,--the impact PSHO summ what it is Similarly, an eminent fashion de- has on student attitudes, student education and "It used to be that careers. of these three, the signer recently quipped that, student f uture has received the the son Who sneaked in to borrow his father's change in student attitude more than tie, now the father is sneaking in to borrow his greatest study, out of 'necessity son's turtleneck." And also by a housewife w.ho choice. The impact of PSHO on student future reflected, "I believe this whole generation of careers was beyond the individual ability of the young people is saying to us, in eff ect, 'Look, researchers, beyond the financial resources of -ly things; beyond the capacity of you use beautiful words and do U. uty out of the project and perhaps its present we'll take ugly words and make bea social science research, at least in them.' stage of development. To learn whether a 10- altered students' career Should the exchange be simply one of clothes, week work experience as new virtues, state- direction would rniiiimally require a longitudinal or but old vulgarities seen ments of precaution would be improper. How-. study with a carefully matched control group- ever, the inversion permits the older generation a very ambitious undertaking. The most the to resign its responsibility for building a better researchers have been.able to doin this regard society. The reliance and expectation placed on is ask students to project the direction of their youth imply a resignation, if not acquiescence future careers and to subjectively estimate 86 what influence PSHO has had in shaping that tude from pre-test to post-test occurred on only direction. a limited number of questions.' The present re- To know what effect the project has had in search has attempted to rely on this past re- increasing student knowledge and broadening search, using their experience as a guide as to their education assumes that one knows before what pitfalls to avoid and what errors to cor- hand what will be learned and can devise meth- rect. Both limitations of the California 1966 ods to measure the quantity and quality of project have been improved upon but not com- learning. Since PSHO has been organized pre- pletely resolved. dominantly by students of medicine, there has In the following pages then is the empirical been a great interest is discerning what stu- portion of the evaluation of the 1968 Philadel- dents have learned with regard to subjects phia Student Health Organization Summer within the field of medicine. Unfortunately, pre- Project. It is composed of several parts: vious research has not been able to devise The background characteristics of the 74 means of measuring the quality and quantity health science participants and the eight staff of knonvledge gained and thus has had to rely members. primarIily on students' subjective estimate of The influence that PSHO has had on student the amount learned; as, for example, by askin- education and careers. "how much did you learn about health care in The results of the administration of several an urban setting," "health problems of the attitudinal tests to the participants, both before poor," "politics and health care" and so on. and after the summer-work experience. While certainly students' judgments are reliable A few of the accomplishments of the students indications of learning these estimates are not over the course of the summer and their reac- conclusive in themselves. Unfortunately how- tion to PSHO as an organization. ever, the present research has.not been able to A comparison of the attitudes of 39 medical avoid this dilemma and students have therefore students in PSHO with 38 medical students not been asked to judge the amount and type of participating in PSHO, as they were measured learning provided by PSHO. both at the beginning and conclusion of the Out of default then, rather than enthusiastic project. disposition, the present research has attempted to evaluate the impact of the PSHO experience Background Characteristics of the Health on student attitudes. The measurement of atti- Science Students tudes has also been attempted by previous SHO research largely without success. The 1966 Cali- Introduction fornia SHO research, the most highly developed Presented here is a description of the back- in this regard, attempted to measure the change ground characteristics of PSHO participants in student attitude toward a variety of @edical along with a modest comparison of what is and social issues." known about the background characteristics of The two major limitations of that research, members in other students' movements. Also (a) the absence of a control group with which 'a few notes of comparison on the composition to compare attitude change, and (b) the absence of the Philadelphia 168 project with previous of a technique by which to control for or at least SHO projects in other cities. account for student selection procedures which tend to choose students already favorably pre- Methodology disposed toward the attitude in question, have During the initial orientation held June 21- both been partially corrected in this research. In 23, 1968, at Eagleville State Hospital and Re- the following year, 1967, the California evalua- habilitation Center near Norristown, Pa., a tion also concerned itself with attitude change. questionnaire consisting of biographical items No conclusions could be drawn in this case be- and a battery of five attitudinal tests contain- g keys were not available. Item an- ing 185 questions were given to the majority of ver, indicated that a change in atti- students on the first day immediately after reg- Health Project, USC-SMC Stude"nt Health Project 'Evaluation of the California 1967 Student Health Project, unknown, December 1966. mimeo., n.d., p. 24. 87 class and whose f ather is a medical prof es- 1 and 3). For those who arning on the aver- istration (see app. sional or a businessman e arrived at orientation late, the questionnaire age over $15@000 yearly. describe the charac- was given to them to a,,snver as soon as pos- The data which follow . tation, 62 and staffs and their sible. By the conclusion of the orle'nly to par- teristics of the students tail. of the 74 students who Nvere eventual background ii greater de ticipate in the projects had completed the ques- a7@ticipation ts who were not sarn- Reason fo"P ing Ori- tionnaire. The 12 studen or were not were asked both at the open pled are those who did not arrive, Students at the closing conference to rank hired until after orientation, or were either un entation and participation in PSHO. willing or neglectful in completing the ques- three major reasons for tionnaire during orientation. A decision was In all, there were four dominant interests: (1) made not to follow up the unsarnpled 12 since to learn about corflrnunity medicine; (2) to the orientation period contained a great deal learn about urban slurn conditions; (3) to of activity and discussion which might Pro- bring about social change; and (4) to help the rnote attitudinal change. it was felt that any- poor. In the beginning,. almost one-half selected one not present at orientation would not be ex- either the opportunity to learn about cornrnu- posed to the complete range nor the f ull in- nity medicine or the opportunity to learn about tensity of the summer project and might e-on- urban sitirn conditions as their major reasons sequently tend to neutralize attitudinal changes for participation. These were also the first and. should their responses be compiled along with second choices respectively of over one-third of those exposed to the orientation. the students. This would indicate that students data on the background perceived the summer project mainly as a On the other hands one-third of all 74 student participants is available. Alearning experience. Approximately word of explanation, however, is needed con- also selected two altruistic reasons, creating cerning the total 'number of students: of the social change and helping the poor, as among original 74 students to begin work at project the three primary reasons for participation. sites, four dropped out during the course of the These two were among the 'highest first and summer for various personal reasons or be- second individual choices- initially then, stu- joined primarily for the cause of illness. Below are described 73 of the dents seemed to have , humanita- original 74 project fellows, Plus One individual educational value, and secondly for who was employed as a replacement very early rian interest in community welfare. Personal in the summer. Also described Separately are reward such as earning $900 and living in priority originally- the background attributes of the five area co- Philadelphia took lower s who are The response to the reason for participation ordinators and three student director jointly reported under the heading of "staff." changed somewhat, however, by the time of the -closing conference. The emphasis on learning The term "health science student" is some what of a misnomer in describing the field of and creating social change remained relatively study of the participants. Roughly 65 percent constant but the interest in helping the poor d medical students, and an dropped from the fourth most frequently men- are osteopathic an t additional 12 percent encompass nursing and tioned to the ninth position. This shift is no there are also representa- readily explicable. It may, perhaps, indicate a dentistry. However academi.c disciplines change in the expectations of what realistically tives of a wide variety of 'ks. Moreover, only indirectly related to Physical health such can be accomplished in ten wee as communications, counseling, Psychology and twice as many students in the closing session anthro ology. The term "health science Stu- indicated an interest in income as being among p the under- r participation than dent" is used for convenience with the three major reasons fo - s f a is that cOn- context to all did originally. Another curiou et standing that it refers in this s was amonP students participating in the project. cern With advancing civil right -the lowest justifications for participation origi- The model response of health science partici nally, and while this increased slightly over tb( pants indicates that they have their origin in . ed a minor reason for Stu the Philadelphia area from Jewish families summer, it remain n the whole. which are predominantly middle and upper dent participation 0 The data concerning reason for participation constant over the summer with the exception both before and after the summer project are of interest in helping the poor which declined shown in table 1. In general, students initially and personal interests which increased gave educational and altruistic reasons for par- slightly. ticipation; for the most part, this remained Table l.-Student's Reasons for Participation, Before and After. R,@son Percent Percent Percent Percent Percent Percent Percent Percent The opportunity to: Learn about community medicine ... ............ 34.4 27.6 21.3 19.0 9.8 17.5 21.9 21.4 Learn about urban slum conditions . ...... .... 19.7 19.0 36.1 15.5 13.1 15.8 23.0 16.8 Help bring about social change ... ... .... ..... 14.6 20.7 16.4 15.5 18.0 10.5 16.4 15.6 Help the poor .-. ..................... ......... ....... 11.5 1.7 11.5 8.6 24.6 3.5 15.8 4.6 Associate with health science students ...... 3.3 5.2 4.9 6.9 8.2 14.0 5.5 8.7 Earn $900 .................. ....................... ...... 1.6 6.9 6.6 10.3 8.2 15.8 5.5 11.0 Help advance Civil Rights movement .... .... 3.3 1.7 .... 8.6 8.2 8.6 3.8 6.4 Live and work in Philadelphia ...................... 3.3 10.3 1.6 5.2 4.9 7.0 3.3 7.5 Work with a practicing health science professional ..... .......................... .............. 3.3 1.7 ... 6.9 3.3 5.3 2.2 4.6 Other ...... ........ .............. ......... ........ ............... 4.9 5.2 1.6 3.4 1.6 1.8 2.7 3.5 Total ... ... ....... .................................... 99.9 100.0 100.0 99.9 99.9 99.8 100.1 100.1 efore= . O),igin of the Students: The majority of the Table 2.-Students and Administrators. student participants considered Pennsylvania, ge tudents particularly Philadelphia or its surrounding NP.,e@i suburbs, to be their home. Most attended a Up to 19 years ......... 45.4 .... .... university or medical school in the city of 19 to 20 years ....... ............ 68.1 .... .... Philadelphia. There were, however, some whose 20 to 21 years .................... 22.7 1 12.5 home and school of attendance were quite dis- 21 to 22 years .................... 15 20.3 .... .... tant. For example, four nursing students came 22 to 23 years ...... ............. 17 23.0 2 '25.0 23 to 24 years ............. ..... 16 21.6337.5 from San Jose, Calif., one medical student from 24 to 25 years .................... 19.4 ... .... Milwaukee, Wis., and one nursing student from 25 to 26 years .... .............. 45.4 1 12.5 Rochester, N.Y. In a few instances, students 26 to 27 years ..... .............. 22.7 .... ....I who considered Philadelphia to be their home 27 years and older ............ 11.4 1 12.6 ie a universities outside the State and ISex and Race: The student participants were had returned to the city for the summer to predominantly white males. The sex and race Participate in the project. of the staff and students are shown in the table below. Age: The age of the great majority of stu- dents was concentrated in a very narrow range Table 3.-Sex and Race of Students and Staff. of 3 years. Almost 65 percent were between the ages of 21 and 24 years. The most fre- 11 quently reported age was 22 years and when this is broken down categorically into mon Male ............. ................... 51 68.9 6 76.0 thSt Female ................................ 23 31.1 2 25.0 mmon age is closer to 23 years. The Total ........................4100.1 ject administrators too were ap- the same age as fellow partici- -Percent N Percent e 2 following reflects the distribu- White ... ............ ................... 70 94.6 7 87.5 4 5.4 1 12.5 Of ages of the 74 health science students Negro ................................. the eight members of the staff. Total ........................4100-C 89 30 percent have a background in studies other Religion: Students were asked to provide in- ir-al and -natural sciences. Table 6 religion. Table 4 de- than the phys of study as under- formation on their family is, the displays the major area picts the religion of their family, that they gradua@es. type of religious background in which were reared rather than their own personal Table 6,-Undergraduate Major of Students and Staff. belief Staff Table 4.-Family Religion of Students and Staff. 17 Natural sciences, Religion - 28 37.8 3 47.5 ereen Percent Biology ....................... 5 62.5 Pre-med ........................3 4.0 1 12.5 .... other (chemistry, 10.8 2 25.0 3 37.5 zoology) .................. Total ........................ orrnon ----- ............ ........ 1 1.4 .... ---- Physical sciences: Quaker ------ ----------------------11.4 ... Engineering .-@ -------------1 1.4 .... .... Russian Orthodox --------------1 1.4 .... Total ........................ Eastern Orthodox @--- ---------1 1.4 .... Atheist ...................... ...... social sciences: 1 1.4 .... psychology ...... .........5 6.8 Unknown ............................ 3 4.0 1 12.5 Total ........ ......... Philosophy ................ 4 5.4 .... .... Sociology ....... ..............1 1.4 1 12.5 Educational Experiences: Eighty-one percent History ------------------------2 2.7 .... ... nrolled in professional Political scieice ----- of the students were e Total ........................I schools, either medicine, osteopathic, dental, law or nursing. Approximately 10 percent were Humanities: 1 1.4. German ........................ ... in various graduate schools and 10 percent English ------------------------3 4.0 .... .... were undergraduates. Table 5 below reflects the French .@ ........... ............1 1.4 .... .... variety of professional and graduate schools Art --------------------------------11.4 .... .... which the students attended. Total ------------------------6 8.2 ... ---- and Staff. Other: 7 9.5 Table 5.-Field of Study of Students Nursing ------------------------ Pharmacy ....................3 4.0 .... .... Field -f rldy NPercen Physical therapy --------3 4.0 .... .... 8 100.0 Total --------------- -------- 13 i7.6 .... ---- Medicine ------------------------------ 39 52.7 Total ........................7 100-0 8 Nursing --------------------------------7 9.6 .... .... Osteopathy ..........................9 12.2 ---- .... Dentistry ----------------------------2 2.7 .... F(&mily Background: A well-known technique 2.7 .... .... Law .. ..................... ............2 .... for determining social class 3 reveals that most Social work ------------------------2 2.7 Anthropology ----------------------1 1.4 .... .... of the PSHO participants are from either the Communications ................ 1 1.4 ... .... upper or middle class. This technique estimates Counseling ....... ..................1 1.4 .... .... 1.4 .... ... an individual's social class position based on Education ............................1 psychology .., ------------------- - -1 1.4 .... ... the amount of esteem accorded by the general Undergraduate --------------- 7 9.5 public to the father's occupation. Tablo 7 re- --- 74 99-0 100-0 flects the distributions of students according Total ----------------- to social class. Over 75 percent of the students were en- d to health its the prestige rolled in disciplines directly relate 3The North-Hatt occupational Prestige Scale and den- accorded by the g@ner 1 public to some 90 cecup care-medicine, Osteopathy, nursing a Hatt scale was divided into four equal parts eac tistry. upper iddle, working and low classes. A stude a par@iemular class based on his father's occupat The undergraduate majors, however, show provided on.the ,ious equivalent occ pation is a much wider variety of scholarship. Here, an estimate was made on the basis of the amount of skill an education required. see Delbert C. Miller, HaAdbook of Resea?,ch there is a greater representation of the social Design and Social Measurement (David McKay Co.: New York, 1964 sciences and humanities indicating that almost pp. 106-110.) 90 Table 7.-Social Class of Students and Staff. Table IO.-Occupation of Mothers of Students and Staff. Stu e rcent P.,-cet Upper ---------------------------------- 23 31.1 225.0 Professional medical .......... 3 4.1 2 25.0 30 40.5 460.0 Professional nonmedical -. 11 14.9 1 12.5 Middle -------------------------------- 1 1.4 .... .... Working .@ ............................ 17 23.0 225.0 Proprietors and managers 2.7 .... Businesswomen .................. 1 1.4 .... .... Lower ....................... ............ 2 Clerks and kindred ............ 9 12.2 3 37.5 Unknown .... ........................ 2 2.7 .... .... Manual ......... ......................1 1.4 .... .... 8100-0 Total ..................... 74 100 Protective and service ...... 4 5.4 .... .... House@-if e ............................ 44 59.5 2 25.0 Family Income: Combined parental income Total ---------- ............. 74 100.3 8 100-0 of students averaged $15,195, while that of staff was $9,312. These figures indicate that Pi-eviotis Expeiience: Students were asked me from the whether they previously had any ex erience the students for the most part co @ p more affluent sectors of the economy. with sccial action programs. Only 39 percent of the students, but 75 percent of the staff, had Table 8.-Family Income of Students and Staff. previously participated in at least some form of community work. Students were also questioned as to whether Up to 2,999 ........... .......... 3 4.1 1 12.5 they had taken coursework in comprehensive 3,000 to 5,999 ......... .......... 1. 3 4.1 1 12.@ medical care or community medicine. Here ap- 6,000 to 8,999 .... ................. 16 20.3 2 25.u proximately 15 percent of the students and 25 9,000 to 14.999 ..... ............ 17 23.0 3 37.5 15,000 to 19,999 ........ ....... 8 10.8 1 12.5 percent of the staff had had this sort of aca- 20,000 to 24,999 ................ 13 17.5 .... .... demic preparation. 25,000 and over .................. 13 17.5 ... .... Unknown .... .................... I., 2 2.7 .... .... Combining these two as indicators of an Total ........................ 74 10 0.0 interest in social activism reveals that, alto- gether, approximately 50 percent of the stu- Father's Occupation: Classifying father's oc- dents had either practical experience or aca- cupation into several broad cateLyories shows a demic coursework that might prepare them to wide range of occupational types as indicated carry out their summer work projects. in table 9 below: Pi-evious SHO Compc&rison: It is difficult to compare the members of PSHO with previous Table 9.-Occupation of Fathers of Students and Staff. SHO projects since the past method of report- ing is considerably different or in many cases, N ereen severely limited. This is possible in a few in- Professional medical ........ 17 23.0 1 12.5 stances; however, the composition of Philadel- Professional nonmedical .. 9 12.2 1 12.5 phia 1968 in terms of percentage of medical Proprietors and managers-. 2 2.7 .... .... students is identical to that of Bronx 1967 and Businessmen ...................... 15 20.3 1 12.i) Clerks and kindred .. ........ 11 14.7 2 25.0 Chicago 1967; all three had 65 percent medical Manual ................................ 12 16.2 1 12.6 student participation.. The students of Phila- Protective and service ...... 3 4.1 .... .... delphia 1968 also reported fewer Protestants Deceased ........... ..................4 5.4 2 25.0 and Atheists and more Catholics and Jews than Unknown ... ...... ...... .............1 1.4 .... .... previous projects. However, this may be ac- Total .... ................... 74 100.2 8 100-0 counted for by the fact that Philadelphia 1968 students noted their family religious back- Mother's Occupation: Most of the students' ground rather than their personal faith. Addi- mothers were occupied as housewives, very few tionally, Philadelphia 1968 had fewer black were professionals in the health science field, health science students than any previous proj- and only about 40 percent worked outside the ect (5.4 percent) except possibly Chicago 1967, home. which made -no report on its racial composition. 91 d Characteristics: a heterogeneous group whose level of Social Disciission of Backgroun . ce in social recon- Using the most frequently reported character- awareness, previous experien widely. Certain- istics as an indication of the typical health sci- struction and background vary ence student, one finds a 22-year-old, white, ly some members of PSHO were deeply com- Jewish, male, student of medicine, who minored mitted to the improvement of social conditions, in biology as an undergraduate. He has his others were as unseeing and indifferent as the origin in the upper middle class and his father career-bound normal student, and others yet is a medical professional. On the average he began to emerge as among the concerned. It has had no previous experience in social action seems reasonable to state that students in programs nor substantial academic preparation PSHO had many characteristics in common for medical work in the community. with students in dissent groups with one not- There is a growing body of research being able exception. The major fields of study of conducted concerning student social activism most activists are the humanities or more and the student protest movement. One of the commonly the social sciences.6 PSHO partici- most f requently reported observations is that pants are mainly medical students and even in the vast majority of college students are not their undergraduate careers majored in the activists. Most students across the country natural sciences. Also, student activists tend to seem to uncritically accept society as it is pres- be more intellectually or esthetically oriented ently established, see college as an extension of and not concerned with specialization in a tech- high school and as a vehicle to a comfortable nical field which more or less guarantees a career. Rarely are they apparently deeply con- secure and durable position in society. PSHO cerned with political and social issues or per- students are overwhelmingly oriented toward ceptive of disturbing social conditions in this a professional career particularly in medicine. country or abroad. Student dis@ent seems to As mentioned, over 80 percent of PSHO health SC occur predominantly among a minority of Stu- science students were enrolled in hools of dents in large, urban universities either in the professionalization, either law, dentistry, nurs- North or Far West which are well-known for ing, medicine or osteopathy. The moderateness their academic standing.4 Two recent studies by of the students of professions, including those one social scientist investigated the background of medicine in the United States, is not typical of 50 activists in Chicago area colleges and 65 in other parts of the world. Lipset reports that students who sat-in at the Administration medical students in Latin America and south- Building of one university in protest against ern Europe are historically more leftist in ori- the administration's cooperation with the Selec- entation, while in northern Europe and the tive Service System. The findings disclosed that "Anglophonic" world they have a traditionally studentsIinvolved in protest activity generally conservative orientation .7 In Holland and Ger- are from upper status families which are Jew- many, for example, medical students' participa- ish or irreligious and whose head of the house- tion in reformative groups is a rarity.8 The hold is an affluent professionals comparison of PSHO students with -protest One would like to be able to compare the groups is basically a comparison between two attributes of PSHO students with the members student groups and not a comparison between of activist groups to discover whether there two protest groups. The activities of PSHO stu- are similarities and dissimilarities. Unfortu- dents over the summer were more in the.tradi- nately, no tabulation of the biographical fea- tion of moderate casework-like improvement of tures of Student activists is available. Impres- social conditions rather than strong dissent and sionistically it seems that PSHO and members demand for radical change in the existing social of student movements generally may have com- structure. parable traits in some cases and remarkably different traits in others. PSHO students were 6 Trent, op. cit., p. 42. And Seymour Martin Lipset, "Student and Politic6 in Comparative Perspective"; Daedalus (Winter 1968) 'J. W. Trene and J. L. Craise, "Commitment and Conformity pp. 1-20. in the American College," Journal of Social Issues 23 (July 1967) 7Lipset, op. cit., P. 17. P. 35. "Richard Flacks, "The Liberated Generation: An Exploration of 8 Frank E. Pinner, "Tradition and Transgression. Western Euro- the Roots of Student Protest", Ibid., P. 66. Pean Students in the Postwar Period", Daedalu3, op. cit. p. 144. 92 There were of course vague goals that vari- Student Education ous staff members held such as reforming the health care system) improving conditions Of e the poor) effecting social change. But thes. Tite Goals of PSHO tract, almost bordering on the trans- Ith Project Proposal for were abs The Student Hea sized the edu- cendental,and not intended for actual imple Philadelphia Summer 1968 empha -mentation unless a tinited movement in this cational importance of the project. The pro direction naturally developed out of the sum- e Summer Health Project periences. Staff and students did not posal stated that th from various mer's ex ajor goals of PSHO, aside ,,will provide 80 health students ew and vital f ully agree on the in ation, and on particular sectors of the country with a n would hope- f rom the goal of educ educational experience." ") Students in issues, opinion Was fragmented. f ully learn about Problems of health care If one had to define the goals of the PSHO entive solutions to health project, its goals were what each i-ndi- indigent areas, prev approach to summer problems, a multidisciplinary rticipant defined as his goal on a per- health care, the economics of health delivery vidual pa systems and community medicine among other sonal basis. If individual goals coincided and issues. they desired to join together, initiate a reform- ative movement within the organization and Aside from education, the goals of the Stu- draw in other members, then the structure -%vas dent Health Organization summer projects are flexible enough to permit this to occur. a complicated mattter. Primarily, the philoso- Education, then, was the primary empha- phy of the staff was to allow students to expe- sis-betterment of the poor and social ref orm rience the multifaceted problems of health and were incidental, if not serendipitous. In regard the urban poor on an individualistic level, to education, it was believed that should there through a decentralized organizational struc- be no reformative movement as an outcome, at ture with nondirective leadership. There were, least students had personally witnessed the im- then, no ubiquitous, definitive goals. The or- poverished conditions of the urban lower class; ganization did not establish goals for student and students could learn how the educational participants to achieve other than self -edifica- institutions might be altered in order to ad- tion through firsthand experience, PSHO was dress themselves to the medically indigent and designed to allow students to Witness alone or how students themselves, once they had in small teams the social conditions of the poor, achieved positions of influence in the medical particularly health conditions in industrial so- or professional field, might from that statiire ciety, and from this experience create and ini- be successful in bringing about, constructive tiate new and hopefully practical reforms. The change. staff itself and the office materials were avail- The research collected some data on the heur- able as resources to the students. The directors istic effects of PSHO which are presented in could be contacted for advice and recommenda- detail in the following paragraphs. tio-ns on how students might approach the re- form of particular problems, but the directors PSHO as an Educational Expe?,ience did not feel it their task to select specific goals, make strategy decisions and outliiie the aim of As mentioned in the section concerning stu- all project members for the total summer. The dent characteristics, roughly 50 percent of the leadership did not conceive of itself as leaders students joined the summer projects in antici- but as coordinators. The organization did -not pation of a learning experience. When asked have formal organization, but was flexibly or- specifically during the introductory orientation ganized so that students could follow their own "how much do you think your summer work individually conceived courses of action and it experience will add to your professional educa- tion," over 40 percent thought it would con- did not designate major purposes for the total tribute a "great deal" and an additional 42 project. percent thought it would make a "considerable" contribution. However, by the close of the sum- 9 Student Health Project Proposal for Ph@elphia, Surnmer 1968, mer, 10 percent fewer students in each of these n.d., Tnimeo, p. 2. 93 atched staff thought general knowledge was acquired. categories felt that the summer had m roups (80 percent their expectations. Moreover, almost twice as A lesser percentage of both g many (30.5 percent vs. 17.7 percent) thought and 87.5 percent) felt that specific skills helpful were gained. In both the cases, the summer provided only a moderate learning to their career experience in the end as they expected in the the experience was judged to be more valuable beginning. Also, while no one thought the proj- in the acquisition of knowledge than in the ect would have "little or no" educational value acquisition of skills. In f act, 20 percent of the prior to the actual work experience, 10 percent students thought the summer was not helpf ul felt this way at the closing conference. at all in terms of skills as contrasted with only As for the staff, all but one member expected 5 percent who felt this way in terms of knowl- the summer to have a great deal of educational edge. The distribution of student responses are value before the project began, but only five presented below in table 12. felt this way after the project closed. Table 11 reveals students' and staff's before and after Table 12.-Judgment by Students and Staff of Knowledge and Specific Skills Acquired. responses to the question, How much do you think your summer work experience will add nts (has added) to your professional education?" percent percent percent percent Table II.-Judgment of Students and Staff on PSHO's Very helpful ............... 35.6 18.6 75.0 25.0 Educational Value. Moderately helpful .... 44.1 32.2 12.5 50.0 Slightly helpful .......... 13.6 28.8 12.6 12.5 Not helpful at all ...... 5.1 18.6 .... 12.5 Ye f o-r, Detrimental ................ 1.7 1.7 ))e7,cert I)erce7it percent pment Total ................ 100.1 A great deal .............. 40.3 28.8 87.5 62.5 'N Stud.,,tl-59- Considerably ...... .... 41.9 30.@ 12.5 12.5 N Staff=8. 25.0 Moderately .................. 17.7 30.5 .... Very little .......... ........ .... 10.2 .... .... "Rcnald Miller, "The Project Evaluated:, The Student Health Nothing ................ ....... .... .... .... .... Project of the South Bronx Suntrier 1967. ed. S. Fisch & J. Wil- Total ..@ ............. 99.9 100.0 liams, publisher unk., n.d. p. 188. N Students before=62. Estimating the value of the PSHO in terms N Students after=69. of student education is a difficult matter, and N Staff before and after@g. Students X2=10.6, df=4, p=0.05. the above figures should be used only as rough In general, both staff and students reported indicators. It may be that the projects had a decline in education enrichment in compari- more educational impact than students recog- son to their original expectations. Chi.Square nize or were willing to report during the imme- calculated for students indicates that this de- diacy of the closing conference. It is also pos- crease is probably not a chance occurrence, but sible that educational value may only material- rather a significant decrease in judged educa- ize over a more extended period of time. In any tio-nal value. The only source of comparison is case, it can be fairly stated that on the whole the Bronx 1968 project which asked the same a great majority of students and staff did sub- question. In that project, 53 percent thought jectively estimate that the summer program that the work experience contributed a great was helpful to a varying extent in acquiring deal to their professional education as con- knowledge relevant to their future careers. trasted with 29 percent for Philadelphia 1968.10 Students were also questioned as to what One should bear in mind, however, that follow- they saw as the "major benefits" of participa- ing the summer experience, 90 percent of the tion in PSHO.-The major benefit agreed upon students and all of the staff believed it to be of by 20 percent of the students was the oppor- some educational enhancement. tunity to learn about urban slum conditions As to what was learned, students and staff firsthand. Here again, self-education is the both were asked to what extent the summer point most heavily emphasized by students. experience contributed knowledge and specific Approximately the same percentage, one may skills helpful to their future careers. Over '93 recall, stated that they joined the program for percent of the students and 100 percent of the this specific learning opportunity (see p. 88). 94,- ous facts stand out-over Students' Ideology However, several curi 20 percent of the students joined for the oppor- A major question in previous SHO evalua- tunity to learn about community medicine, but ch reports has been the degree to listed this among the top tive resear tudents has a bias built less than 4 percent ticipation. Likewise, some which the selection of s ts with views three benefits of par tunity to help in which naturally selects studen S. Students 16 percent joined for the oppor idered this an already favoring particular attitude the poor, but only 5 percent cons cted on the basis of their interest in- advantage to participation. On the other hand, are sele 20 percent joined to learn about urban slum gaining insights into community health prob- conditions and approximately the same nuin- lems and their previous participation in com- ber agreed that this was a ma or advantage. munity involvement projects. As a result, pre- Similarly, creating social change was equally vious research has been unable to discern considered to be a major reason for participa- whether students are converted to liberal views tion and a major benefit. Other advantages as a result of project participation or whether most frequently mentioned were: earning $900, the summer simply reinf orces liberal attitudes working with a practicing health professional, previously established. and associating with fellow health science stu- Consequently before measuring student at- dents. Data concerning the major advantages titudes on more specific issues such as compre- of participation are shown in table 13 below. hensive medical care and socialized medicine, a technique for learning an individual's degree of liberalism and conservatism was employed. Table 13.-Rank Judgments of Students on Major Benefits Milton Rokeach has devoted a considerable Resulting From PSHO Partid'ipation. amount of his career to the measurement of belief systems. This research utilized Rokeach's It 2, Opinio-nation Scale, 40 item test, designed to The opportunity to: uncover an i-ndividual's degree of left opiniona- Learn about urban tion, right opinionation, total opinionation and slum conditions ...... 30.9 14.8 13.0 19.0 conservatism/liberalism." Rokeach claims that Help bring about the Opinionation Scale is meant to measure social change ... ....... 16.4 10.7 14.8 16' lu it of a series of Earn $900 ..................... 9.1 1.11 22.2 14.1 general intolerance". It consists in orien- Work with a practicing 20 statements prejudged to be leftist . health professional.. 12.7 11.1 13.0 12.3 tation politically and 20 statements indicating Associate with health a rightist political position. Within each of science students ...... 5.5 14.8 14.8 11.7 these two positions are 10 questions indicating Live and work in Philadelphia ............ 3.6 13.0 5.6 7.4 either an acceptance or a rejection of the par- HEID the poor ............ 1.8 7.4 5.6 4.9 ticular political stance. The Rokeach Opiniona- Hel-P advance civil 3.7 5.6 4.3 tion Scale appears in appendix 2. rights -. ...................... 3.6 Total opinionation indicates how strongly an Learn about commu- - 0 OYIS 5.6 3.7 3.7 individual responds to both Political P siti Tilty medicine .......... 1.8 Other ----------------------- 14.5 1.9 1.9 6.1 combined. Left opinionation is the degree to Total .... ............ 9.9 10 0.1 which an individual accepts those statements indicating a left orientation. Right @opiniona- tion is the strength of agreement with state- Any conclusions concerning the total heuris- ments associated with rightist political views. tic effect of PSHO must remain tentative. Stu- Liberalism/Conservatism is the difference be- dents joined mainly for the educational advan- nation and left opinio-nation; tages offered. The outcome, however, did not tween right opinio conservatism, a fulfill their complete expectations and students a positive score indicating in Philadelphia SHO felt they learned less than negative score indicating liberalism. students in the Bronx 1967 projects In spite of Although Rokeach's scale is undoubtedly this it bears reiterating that over 90 percent filled with flaws, and dated, if not questionable, ely to greatly help@- e open and The Closed Mi,,d. (New York, felt the project was ?noderat la Rokeach, milton, Th f ul in educating them for their future careers. Basic Bocks, Inc., 1960.) PP. 80-97. 95 atti- score for all student participants. The sub- content, it is the most highly researched verage left opinionation score tudinal scale of this nature available, and by sample had an a all indications the most accurate. There has of 84.2, while all students scored 84.7. The been a great body of research to test its valid- Penn medical students were not as far left in .ity and reliability. For these reasons it was opinionation, scoring 72.81. Rokeach has also selected in this research. (For a f urther dis- administered this scale to. groups of students: cussion of this scale see pp. 105-106 of this in 1955, 186 Michigan State University under- report.) graduates had an average left opinionation In the experimental study (pp. 106-108) one score of 61.2 .12 The comparison of PSHO par- can compare the political stance of PSHO medi- ticipants with the Michigan sample reveals cal students with Penn medical students who that PSHO was considerably more left in ori- attended school during the summer. As noted entation. Also, however, the Penn medical stu- there, PSHO medical students are significantly dents had a more leftist opinionation than the more left in orientation than are medical stu- Michigan students. Table 14 below, shows the dents who attended school. The mean score for the subsample of PSHO various sample scores on left opinionation. The medical students is almost identical to the mean higher the score, the more left opinionation. Table 14.-Left and Right Opinionation of Students. p PSHO students ... ............. 60 84.7 20.031 63.8 10.01 Michigan State ...... ............. 186 61.2 11.9 5 8.4 0.0005 180.8 II. Difference ................................... 23.5 i udents ....... Penn Medical students .. . . ....... 36 72.8 10.1 5 68.8 1 Of Difference -. ........................ ......... 11.4 6.0 In terms of right opinionation, PSHO stu- students are significantly more liberal than the dents in general during the initial orientation Penn medical students who were sampled. were less right oriented than Rokeach's sample, Since PSHO students average liberalism scores and the subsample of SHO medical students are very similar to that of the PSHO medical less right than Penn medical students. Table student subsample, one would be led to believe 14 above shows the sample scores on right that PSHO students on the whole came to the opinionation. The higher the score the more project with a tendency toward liberalism right the opinionation. greater than that of students in general. There- In general, the PSHO students have a sig- fore, it would seem likely that PSHO health nificantly greater left orientation than students science students would tend to come to the proj- sampled by Rokeach and a sample of medical ects predisposed to favor certain liberal atti- students attending school. tudes. The difference between the right and left opinionation results.is a measure of liberal- Attitude Change ism-conservatism. PSHO students average score on this index placed them in a liberal The data above tends to indicate that PSHO position. There are no Rokeach scores with participants in general have liberal attitudes. which to compare PSHO students on this di- Thus, the PSHO project, rather than an agent mension. However, the reader is again referred to convert conservative students to liberals, to the section concerning a comparison of would appear to be geared toward. carrying PSHO medical students with Penn medical stu- liberal attitudes to more liberal positions, or dents. There it is shown that PSHO medical at least reaffirming liberal positions already held. At the beginning of the summer only 11 @Rokeach, op. cit., p. 95. students (18 percent) held a conservative view 96 very mildly and this change was sufficiently large to affect and the majority of these were conservative. At the close of the summer, seven liberalism scores; therefore, staff members ap- or 11.6 percent still held conservative views so parently became less right in opinionation and that, at most, only four students moved from also moderately more @liberal. Total opiniona- a conservative to a liberal position. tion, that is, how emphatically students reject Tables 15, 16, 17, and 18 compare students' one political stand and accept the other, or in and staff's scores both before and after the this case the degree of leftism, remained con- summer experience on left opinionation, right stant from pre-test to post-test. opinionation, total opinionation and liberal- In terms of liberalism there was no signifi- ism/conservatism. In each case, a higher score cant change in attitude; students maintained means a greater acceptance of the attitude in approximately the same degree of liberalism question. On the left and right opinionation from pre-test to post-test. The staff on the scales scores can range from 20 to 140; on total whole moved considerably more to the left; opinionation, from 40-200; and on liberal- in fact, their average liberalism score more ism/conservatism, from @l to @140. As can than doubled over the course of the summer. be seen from a glance at all tables, there was On the whole, however, there was little apparently a change only in right opinion change in the ideological position among the among the students. That is, students did not student participants in PSHO. This finding become more left in opinionation (table 15), would tend to support the assertion that th'e but less right (table 16). This, however, did experiences operate to reinforce opinions and not significantly affect their general scores on beliefs already held and does not result in sig- liberalism. The staff as well became less right nificant attitudinal shifts. Table 15.-Left Opinionation of Students and Staff. t p Before .... .......................................... 84.67 20.031 0.66 N.S. 86.38 16.531 0.59 N.S. After ....... ............ ........... 87.00 18.34 191.88 18.04 5 Difference ................ .............................3-1.69 Table 16.-Right Opinionation of Students and Staff. Before ..... ............................................. 63.83 10.021 3.19 0.005 5 70.13 0.0251 2.25 0.025 Af ter .... ................ ................ ........ 57.83 10.44 154.12 9.20 5 'Difference ......... .................................I... .00 .42 -16.01 -7.27 Table 17.-T(>tal Opinionation of Students and Staff. - Staff t t p Before ................ ........ ........... ........ 143.83 17.761 i 155.25 23.581 After ............................................... ..... 144.08 17.67 0.08 N.S. 1 146.00 17.46 0.84 N.S. Difference .......... ............. ................... .25 -.09 -9.25 -6.lz Table 18.-Liberalism of Students and Staff. staff t p Before ....... .......................................... 23.33 24.8.4 5 16.38 16.921 After ... ......... ........... ....................... 24.51 24.51 0.26 N.S. 137.75 22.12 S 2.03 0.025 Difference .. .................................. ......... .18 -.33 21.67 6.ZU 97 majority of the proach in medical treatment, it was an exce - Medical Attitudes: Since the odel for the present research. Three of students were pursuing careers in the field of lent in health science, the research was interested in the five scales in Boswell and Newman instru- learning whether there were changes in medi- ment were used: (a) Attitude toward compre- cal attitudes over the course of the summer. hensive medical care; (b) attitude toward the Considerable research was conducted by the team approach in medicine; and (c) attitude University of Colorado School of Medicine in toward preventive medicine. The three scales the 1950's when they introduced a physician's in combination are compiled as a total medi- educational program which emphasized com- cal attitude scale. A brief description of each prehensive medical care. That research com- of the scales is given below along with the re- pared two groups, one exposed to a traditional sults of the pre- and post-test administration educational program and the other exposed to to the PSHO students. the innovative comprehensive care program .13 In an attempt to evaluate the newer and Comp2-ehensive Care: This scale measures a broader program's effect on medical students' subject's attitude as a physician toward taking 'ng, the researchers responsibility for the patie-nt's total health, the traini used Boswell and Newman's "Medical Attitudes Test. Since the general health of other family members, and purpose of the comprehensive coursework at the environmental and social factors which Colorado was much like the purpose of PSHO, enter into an individual's health status. The that is, cultivating a broader approach to treat- before and after results on this scale f or both ment rather than concern with the narrow or- the staff and student workers is presented in ganic disorder, interest in the prevention of table 19 below. Scores can range from 1 to 50; disease rather than the curative process only, the higher the score, the more favorable the and the development of a multidisciplinary ap- attitude toward comprehensive care. Table 19.-Attitude of Students and Staff Toward Comprehensive Medical Care. Before .................................................... 36.97 3.621 0.09 N.S. 5 40.38 2.74 N.S. After ........ ........ ............................ ...... 37.03 3.56 141.75 2.16 Diff erence ........................................... .06 - .06 37 -.68 The table shows that students' and Staff is at- suiting and working xith other nonmedical titudes did not become more favorably disposed professionals and such as social worker, psy- toward comprehensive medical care but re- chologists, and the benefit of a team consulta- mained remarkably constant from pre-test to tion among all treatment personnel such as post-test. technician, therapist and nurse. Table 20 re- Team Approach: This scale measures the flects the test results on this attitude scale. subject's opinion concerning the value of con- Table 20.-Attitude of Students and Staff Toward the Team Approach in Medicine. x p Before ... .......................... ...................... 37.30 @ 4 29 40.13 2.93 1.10 N.S. 2.01 0.025 After . .................................................... 36.50 3.56 36.25 4.18 Difference .............................................. 80 -.73 1.25 Is Kenneth R. Hammond and Fred Kern, Teaching Co))tprehensive Medical Care (Cambridge, Mass.: Harvard Univ. Press 1959.) 98 Table 2i.-Attitude Of Students and Staff Toward Preventive Medicine. 0.72 N.S. 4. This table shows that the staff became sig- Table 21 contains the results on this scale. nificantly less in favor of a multidisciplinary There was no attitude change for the stu- approach to medical treatment over the course dents on this measure; however, the average of the summer. If this finding is not spurious, staff score was less in the post-test than in the one would be led to interpret that the inter- pre-test. The difference between the two is not action of staff with persons of other disciplines sufficiently large to indicate anything more and in many diff erent roles, resulted in a de- than random variation, however. c,line in proteam approach in medicine. As for students in general, there was no attitude Total Medical Attitude: This is a combination change on this scale whatsoever. of all three scales and is an indication of an Preventive Medicine: This scale measures individual's overall opinion on these three opinion concerning the need for and impor- medical issues in general. There is no signifi- tance of preventive medicine as opposed to a cant change either for students or for staff concentration on curative medicine alone. as the following table summarizes. Table 22.-Total Medical Attitude of Students and Staff. dents Before .... ........ ........................... 114.17 8.60 0.45 N.S. 121.88 4.311 1.13 N.S. After ....... ......... ..................... --- 113.42 9. 117.13 Difference ................... ..................... 4 6.15 In summary, the findings in regard to atti- Scales f or the Measurement of Attitudes. 14 In tude toward various medical issues f or students the original scale Mahler used the terms "com- indicate that there was no change over the pulsory health program" and "compulsory length of the summer. As for staff, the one health insurance" to refer to a medical sys- change was a shift from a more favorable to tem supervised by the Federal government. In a less favorable view of the team approach in this research these terms were replaced by the medicine. To be noted too was the downward phrase "socialized medicine" to avoid confusion shift, although not statistically significant the and ambiguity. attitude toward preventive medicine and in Both among the staff members and the total medical attitude for the staff. PSHO students there was a more favorable Socialized Medicine: Another attitudinal view of socialized medicine after the summer scale administered to students concerned their work experience, although the significance opinion on the issue of socialized medicine. level in both cases leaves open to doubt the The scale was developed by R. A. Mahler in possibility that this change occurred by chance. 1953 and is reproduced in Shaw and Wright's The findings for socialized medicine are re- flected in the Table below. Here the higher "Marvin E. Shaw and Jack M. Wright. Scates jor the Hea5ure- the score the more favorable the attitude to- raent of Attitudes. (New York- McGraw-Hill Book Co., 1967) PP. ward socialized medicine. 152-154. 99 Table 23.-Attitude of Students and Staff Toward Socialized Medicine. nts x SD t p Before ............... -------- ------------------ -------- 50.17 17.93 1.55 0.10 49.25 8.50 1.39 0.10 After -------------------------------------------- ........ 54.83 14.53 55.38 7.97 Difference -------------------------------------- 4.66 -3.39 6.13 -.53 Attt'tude Toiviw)-d the Pooi-: A great number the assertions made by the two authors after of the site assignments were to indigenous com- having been exposed to the poor. It was as- munity . organizations or to health and welfare amil- sumed that students would become more f institutions which serve the citizens of impov- iar with this group's qualities and, thereby erished neighborhoods. Consequently, it was gain sufficient firsthand knowledge to reject or felt appropriate to discover whether student accept the statements more decidedly. Any opinions about the poor Nvere altered signifi- change in attitude assumedly would be based cantly as a result of their contact with the on actual field experience. Thirty-eight of the urban poor. The researchers were dissatisfied questions are drawn from the Riessman refer- with the types of tests already available to ence, 28 from Lewis and the remaining four measure individual's opinions about the poor. from other sources. They primarily deal with As a result a Likert scale, the "Philadelphia factual matters which could be empirically ver- Student Health Organization Opinions About ified such as the amount of illegitimacy and the Poor" test was constructed. There are 70 family conflict, nature of political opinion and qIu orks of the economic outlook of indigent persons gen- estions derived primarily from the w Miller and Riessman 15 and Lewis .16 Miller and erally. Riessman in their article describe the life style This instrument must be viewed as com- of the working class in the United States. It pletely exploratory at this point. No work has includes working class attitudes toward the been done here to test its reliability and valid- family, children, employment, politics, educa- ity although this may be forthcoming. tion and numerous other issues. Lewis, on the Student attitudes toward the poor did change other hand, describes the lower class subcul- significantly over the course of the summer as ture of Puerto Ricans both in San Juan and in table 24 indicates. Staff attitudes were not Sig- New York City. Both of these sources were nificantly different. However, this would be used to obtain statements that might be true expected since the staff was mainly concerned or not true of the urban poor in the United with administrative matters which provided States. The research here is not concerned little contact with the urban poor. In this table, with whether Riessman and Lewis' statements the higher the value the more agreement the about the social classes are accurate or not, but students have with the Riessman & Miller de- only whether students agree or disagree with scriptions. Table 24.-Opinion of Student and Staff About the Poor. Stud,@t. SD t p x Before .... ................. ........... 327.83 21.761 2.40 0.01 5 331.25 22.331 0.52 N.S. After .... ....................... .......... 338.00 24.24 5 1330.13 33.00 Difference ..................... --------- 10.17 2.38 7.88 10.67 Segregation: Since many of the students citizens than had been their custom in the past, would be working in black ghQttos and ge-n- a test in attitude change in terms of racial erally coming into closer contact with black prejudice was deemed appropriate. Quite an extensive search of the literature for attitudes 11 S. M@ Miller and Frank Riesi;man, "The Working Class Subul- ture: A New View," Social Problems, 9 (Summer 61), pp. 86-97. toward Negroes was made. Most of the-scales "I Oscar LewiE;, La Vida (New York: Random House, 1954). encountered were far too simplistic to measure 100 d prejudice that might itern scale which asks respondents for their subtle, unacknowledge out racial integration of schools. be held among educated white students. No feelings ab completely satisfactory measure was located, Table 25 below reflects the before and after g the most sophisticated appeared to responses to the issue. The higher the score, but arnon be Rosenbaum and Zimmermanis "Attitude the more prointegration the response. Toward Segregation Scale." 11 This is a 25- Table 25.-Attitude of Students and Staff Toward Segregation. Bef-r@ @ ....................... -------- ...... 12.69 0.79 0 N.S. Af ter ....... -------------------------- ...I........ --- 120.33 Diff erence ........... --------------------------------- -1.75 1.22 There was no significant change in attitude for the most part this decision is arbitrary, a toward segregation either by the staff or by review of the students and their involvement the students. scores indicates from personal experience, that Involvement a,,nd Attitude Change: One pos- this is -not an unreasonable point at which to sible reason for the absence of attitude change draw the demarcation line between involve- might be the assertion that attitude change oc- ment and uninvolvement. curred only among students who became deeply The contingency tables in which a significant involved in the summer project and attitudes relationship exists between involvement and remained relatively constant for those who attitude change are presented below. were uninvolved. In order to test this hypothe- sis, that attitude change depends upon degree Table 26.-Student involvement and Opinionation. of involvement, the research has correlated these two factors. On the whole, attitude change is not related Increased right opinionation ..... @@. 23 16 to involvement, except for two instances. In Increased left opinionation ............ 6 14 these two cases, however, the attitude becomes Total ...................................... 29 30 less favorable among the involved and more Table 27.-Student involvement and Opinions About the favorable among the uninvolved. The follow- Poor. ing paragraphs explain these findings. In the questionnaire of the closing confer- involv ence, students were given a list of PSHO ac- More empathic ---------------------------------- 14 25 tivities, such as lectures, work-groups, confer- Less empathic ....... .......... ............... 15 5 ences, social outings and weekly meetings (see Total ----- ....... ......................... @9 app. 2). They were asked to check which of these they participated in or attended. From this list was constructed an index of involve- In these two cases, there is an association ment, the greater the number of activities in between involvement and attitude change, but which one participated, the greater the involve- in both cases those involved rp-flected attitude me,nt. The possible range extends from par- changes in a direction opposite that expected ticipation in no activities to 19 activities. The by the project. That is, the involved moved actual range was participation in one, to par- more to a rightist and the uninvolved to a left- ticipation in 19 activities. In the date presented ist orientation politically and the involved to a below, involvement has been defined as par- less emphatic and the uninvolved to, a more ticipation in five activities, or more, and unin- emphatic orientation toward the poor. volvement in four or fewer activities. While There is no significant association between involvement and attitude toward comprehen- i7 Marvin E. Shaw and Jack M. Weight, Scales for the Measure- sive medical care, total medical attitudes, lib- meta of Attitudes, op@ cit., pp. 168-177. 101 ine and attitude to- continue to work in the ensuing year with the socialized rnedic community organization or the institution with eralisrn, which they were placed, 56 percent had no such ward integration then is that, while ncertain. The surprising fin d in 9 lans, and 16 percent were u f or the most part there is no contingency be- p nt iiidi- and project involve- C,,,,-iculo, Reform: Thirty-nine perce tween attitude change .sts, it is cated that they had specific plans for attempt- ment, where such a contingency ex' ng curricula reform or faculty education in antithetical to the project's intentions. i sional school in the following aca- A note of caution should be interjected, how- their profes ereent were uncertain and 30 ever, concerning the relationship between opin- dernic year, 27 p ions about the poor and involvement. It is quite percent had no definite plans. of the sum- possible that those who came into intimate poverty Practice: At the close ly prac- contact with the poor learned that one cannot mer, 22 percent had plans to eventual make sweeping generalizations about the poor tice their profession in a poverty area, 61 per- and consequently lowered their score on this cent were undecided and 17 percent did not scale of indicating uncertainty or making have such plans. agreement or disagreement with less.definitive- council ia Medicine: During the course of the ness than initially. As mentioned previously, summer, 26 students counseled 87 individuals this is the first usage of this scale, and until about a career in medicine. No effort was made Its remain arch to elicit in what depth this it has been validated, the test resu in the rese open to question. counseling took place, nor whether some indi- Concl@on: The results of the administration viduals, particularly the youth interns, %vere of a total of eleven attitudinal scales gives the recipients of rnulticounseling. evidence of change only on two of these for Active Reform: Students were asked if as a students (right opinionatioli and opinions result of their participation in PSHO, they had about the poor) and on four for the staff become active and 59 percent were not. (team approach in medical treatment, right The section on problem papers by '.%Iiss opinionation, liberalism and possible socialized Lynch reflects a great deal of information medicine). Testing whether the lack of change relevant to the perceptions of PSHO. Only a is a result of noninvolvement in the project few items on this topic were covered b@, the reveals that involvement and attitudinal change questionnaire method. In general, however, it are not generally related, except in two cases appears that there is a considerable discrep- where the noninvolved had significantly more ancy between what students expected to ac- positive changes in attitude than the involved. cornplish and what they felt actually was ac- complished. This discrepancy holds true both Student Accomplishments and Student at the individual level and for PSHO as an Perceptions of PSHO organization. Students were asked at the open- Student Acco?nplishment: Very little of the ing orientation "how effective do you think research effort has been devoted to evaluating your summer activities will be in improving the the impact of PSHO on the community or on conditions of the poor.: At the closing confer- institutions in which students were placed. ence the same question was repeated with only While highly desirous of obtaining information a change in wording, that is, dHow effective about specific accomplishments, it is practically do you think your activities were ... 11 Results impossible to measure the collective influence on the pre-and post-question show a sharp de- of 80 health science students dispersed cline in estimated effectiveness. Originally, al- throughout a city of 2 million people. Informa- most all students felt that they as individuals tion in other sections of the report reveals in would be to varying degrees effective, and only descriptive fashion the efforts and attainments 5 percent thought they would have no effect. of specific projects. Here mention can only be However, by the closing conference, over 50 made to several minor indices of accomplish- percent thought they personally had no effect ment. and only 33 percent thought they had been to Continuity of Projects: Twenty-seven per- some extent effective. Moreover, only one in- cent of the students indicated they planned to dividual originally thought he personally might 102 in an effort to determine what might be the be ineffective; nine individuals felt this way at source of dissatisfaction, an open-ended ques- the close of the summer. In general terms he projects asked "what then, there was a considerable downward shift tion at the close of t with the major problem if any, dQ you see in effectiveness judged by students from the al organization of PSHO." Below are beginning to the end of the summer. Table 28 intern reflects these facts. the classified results. Table 28.-Judgment of Students and Staff as to indi- Table 30.-Judgment of Students on Major Internal vidual Effectiveness in improving Conditions of Poor, Problems of PSHO Before and After. Degree of effectiveness (percent) Lack of formal organization .................... ......... 25.4 After Lack of clear-cut goals .......................................... 15.3 Lack of leadership . ....................... ....................... 13.6 Exertmely effective ..... 1.6 Lack of communication ............................. ............ 5.1 Very effective ................ . 1.6 .... .... Moderately eff ective ...... 30.6 8.3 ... 12.5 Overly theoretical .............................................. 5.1 li9.7 25.0 Inadequate site development .............................. 5.1 Slightly effective 25.4 ---- No eff 6ct @...................... 4.8 50.8 50.0 62.1 Inadequate area coordination ................... .......... 3.4 Slightly ineffective ....... .... 1.7 .... Absence of community personnel on staff ........ 3.4 Moderately ineffective .. 1.6 3.4 .... .... Inadequate preceptors ...................................... Very effective .... ....... .... 5.1 .... ...IInadequate representation of nonmedical Extremely ineffective 5.1 25.0 12.5 students ....... .................................... ............ ...... 1.7 99.8 loo. 100.0 Inadequate office management ............................ 1.7 Total .............. ..... 9.9 No answer-none ... ............................................. .. 18.6 S Stud@nlr b,-f.@1-62. N Students after@59, Total ............ ............................................... o@0.1 N Staff =S. N=5 XI=49.9; df=8; p=0.001. Students were asked at the final session to Students and staff were a so asked both at indicate how satisfied they felt in general about the orientation and final conference "how e-ff ec- their role in PSHO. In table 31 below, one can tive do you think the PSHO project as a whole see that 58 percent indicated that they were will be (was) in improving conditions of the very or somewhat satisfied and 32 percent were poor." There was here also a significant de- very or somewhat dissatisfied. crease iyi students judgment of organizational Table 31 -Satisfaction of Staff and Students With Role effectiveness. At the outset, over 90 percent in PSHO. felt the organization would be effective to some extent, whereas in the end this had decreased (Pe to about 53 percent. Only one individual judged Very satisfied .................................... 15.3 12.5 the project would be ineffective during orienta- Somewhat satisfied .. ........................ 42.4 50.0 tion, but 13 held this judgment at the final Uncertain ...... ................................... 10.2 convocation. Data on this question are shown Somewhat dissatisfied ........ .......... 25.4 37.5 in table 29. Very dissatisfied ........................... 6.8 ---- Total ...................................... @ou 0 Table 29.-Judgment of Students and Staff as to Effective- tudant tiveness of PSHO in Improving the Conditions of the Poor, Before and After. While it seems probable that there would D,,@e f always be a percentage of student discontent (percent with their position no matter what its -nature, efore A the fact that one-third of the students indi- Extremely effective ........ 1.6 .... .... .... cate dissatisfaction and another 10 percent un- Very effective .... 1.6 .... .... certainty may be disproportionate. Also, only Moderately effective ...... 38.7 3.4 12.5 .... 15 percent responded as being "very satisfied." Slightly effective ........ 50.0 49.2 50.0 25.0 No eff ect ......... ........ 6.5 25.4 25.0 75.0 From this tabulation it would seem that the Slightly ineffective ...... 1.6 6.8 .... administration of the project in the eyes of the Moderately ineffective 1.6 5.1 .... --- students wag lacking. The lack of formal or- Very ineffective 6.9 .... .... ganization, goals and leadership all involve the Extremely ineff ective .... .... 3.4 12.5 .... basic structure of the organization. As men- Total ............... .... TO 0 O-- -Stu, tioned earlier, however, the project was inten- 103 centralized in order Cal and social attitudes of the project workers. tionally designed to be de It attempted to learn whether this experience that students themselves might establish their provoking attitude change. This own goals on an individual basis rather is successful in than be handed guidelines and directions from previous PSHO research, however, has been be- t show set by two major limitations: (a) the absence a central authority. These findings migh of a control group by which comparison in at- that students were displeased with an unstruc- might be made, and (b) the in- tured program and would be desirous of more titude change rongly student par- ization. In any case, ability to determine how st direction and formal organ ipants identified with the attitudes in it should be made explicit that student dissat- tic ques- isfaction may result from other sources in ad- tion prior to their participation. The small ex- dition to the internal organization, and in fact, perimental comparison reported here has at- this conceivably may not be the primary source tempted to correct these limitations. Herein of dissatisf action. is presented a comparison of second year medi- Finally, students were asked if they would cal students both before and after the summer participate in PSHO if it were repeated in the with the medical student participants of PSHO f uture: 32 percent stated that they would, 22 at the same time periods. percent that they would not, and 46 percent were uncertain. Methodology: 'ble to make any definitive state- It is impossi The Dean of the medical school of the Uni- ments about student perceptions of PSHO; however, it would seem reasonable that stu- versity of Pennsylvania permitted the re- dents were somewhat less than enthusiastic searchers to record the names and addresses about the summer project. There appears to of 61 second-year medical students attending have been a decided change in their anticipated classes and working in hospitals during the effectiveness both individually and organiza- summer. The same questionnaire given to tionally, two out of five were uncertain about PSHO medical students during orientation was or dissatisfied with their role, and only three mailed to Penn students during the first week out of ten were readily willing to reparticipate of the project. The questionnaire was coded for in a future project. anonymous replies and contained background data questions and four attitudinal tests: atti- tudes towards the poor, socialized medicine, Penn Medical Student and PSHO Medical general medical attitudes, and the Rokeach Student Comparison opinionation scale. The entire instrument re- quired approximately one hour to complete. Int?-oduction Most of these students were telephoned in ad- This report compares the attitudes of medi- vance and informed that they had been selected Cal students who attended school during the as a member of the control group and that a summer with those of medical students partici- questionnaire addressed to them was being pating in PSHO. Within PSHO there were in- placed in the mail. No student objected to re- itially 3 individuals, both male and female, at- ceiving the questionnaire. tending medical schools. The remaining 35 Originally, the researchers wanted to Corn- PSHO participants were students of numerous pensate the Penn students for their effort and other disciplines ranging from nursing and funds that could be devoted to this purpose dentistry to social work and law. This report were available. It was known that medical stu- compares the 39 @PSHO medical students with dents were exceptionally busy, both attending a group of nonparticipating medical students courses and working long hours, often at night, who were actuallv attending medical school and consequently seldom had free time. Some during the summer. monetary compensation for the time required The Problem: to fill out the questionnaire, it was felt, might insure a larger and more adequate return, par- PSHO research in the past has been interested ticularly since the researchers were asking for in learning what effect actual participation in a return at two diff erent times of which the community work projects has on both the medi- absence of either would make the participants' 104' Members of the medical pro- as to be an insult when answered by intelligent, results unusable- unseleed that payment sensitive individuals. with fiaws, fession, however, CO ed that most This test, although certainly filled would be 4 iunethical." They suggest is designed to uncover how intolerant an in- medical students would be willing to contribute ng points of view and to a research project voluntarily since it cOn- dividual is of OPPOs' accepts his own view. ion-students would be how dogmatically he cerned their profess Ilows in the Failing to agree strongly with one's own POSI- willing to participate freely as fe pletely tion and failing to reject strongly alternative medical community- This was not corn positions theoretically gives evidence of one's the case. tolerance level. At the same time the mild naires mailed to the stu- @s political stance. The of the 61 question e by the post acceptance reveals one requires dents, three were undeliverabl returned at Rokeach instrument unquestionably office and 38 were completed and erefinement and greater sophistication. in the ,imer. This is a return rat interest of overcoming the limitations of pre- the start of the sun to know the of 67 percent. As for the po@t-test mailing vious studies, namely the inability dents prior which began when the projects closed in late ideological position Of PSHO Stu August 1968, only 32 or 54 percent of the total to the entry in the project, the Rokeach scale students fully cooperated with the research was used. its validity and reliability have been completed questionnaires. oth in this country and effort by returning most of those heavily researched b is developed, When contacted by telephone, eabroad. Until an improved scale who did not cooperate explained that they WI the Rokeach scale will probably continue to be to devote time to the re- th apologies. simply f ar too busy reacted v'ehe- used wi to plan suf search. A few other students the researchers been able of the questionnaire, how- Had mently ficiently in advances a matched control group to the content ever, claiming that it was highly biased. would have been selected. Not only a lack of The content of the questionnaire, actually time, but other difficulties as well, prevented was determined by the nature of the PSHO sibilitY. For example, we did not know e attitude scales were those this pos eteristics Of PSHO partici- project, that is, th was interested some of the chara relevant to the attitudes PSHO basis pants until after orientation in June 1968. Ap- in changing. They were selected on the plication forms do not ask for characteristics of the goals PSHO was attempting to attain. race and religion, two attitudes which There was -no implicit interest by the research- such as e controlled in an experiment of this ers in demonstrating that PSHO students were should b o medical students at- nature. Secondly, a delay by the medical school in any way superior t tending school. While no social science research in granting permission to review student char- is ever successful in being completely value acteristics to choose matched pairs, even on free, the research was not out to prove that attributes such as sex and age, precluded a PSHO participants were the socia-Ily concerned matched control group. In fact'the use of the term "control group" is dubious. Actually, this reformers and the medical students attending school, the unconcerned conservatives. The re- report simply draws a comparison between search simply required a base group by which medical students in school and medical stu- Comparisons in attitude shifts could be made, dents in PSHO. A full report is provided be- and the Penn medical students were a con- low as to what changes in attitude occurred -nd available group. among PSHO medical students compared with venient a the Penn medical students, the difference in A major criticism by the Penn students cen- attitudes between the two groups and, finally, tered around the Rokeach OPinionation Scale parison of the social background fea- 11 pp. 95-96). This scale at-a (gee app. 3 anu corn tempts to measure an individupLI's political I)OSI- tures of both groups. tion by asking for agreement or disagreement The samples are small and the returns by with brief, opinioned statements. The state- Penn medical students limited, so that the re- ments admittedly are dated, concerning politi- search should be viewed as an exploratory at- cal issues and personalities no longer contem- tempt to extend PSHO research with the hope porary, and the items are so blunt and naive that future projects of this nature might come 105 as a result Of the summer experience. on the to more decisive findings, left opinionation portion of the Rokeach scale, the PSHO medical students maintained almost Findings: from pre-test to Post- ily that little attitu- identical average scores so re- The findings are genera students test. Penn medical students' attitudes al dinal change occurred among PSHO e were mained constant over the summer. There was, from pre-test to post-test, but that ther rence between the n the two groups at however, a significant diffe strong distinctions betwee two groups at both time periods, PSHO tend- both time periods. ing to be more leftist in outlook. Table 32 below describes the before and after results on this Ideology: medical scale. The higher the score, the more left the The results indicate that the PSHO titudes opinionation. students did not alter their political at Table 32.-Mean Left Opinionation Scores, PSHO and Penn Medical Students. ical Differen p for, ------------ .......... ...... ...... After ....... ............. ...................... 84.6 36 72.5 30 12.1 3.8 0.0005 Difference ...... ........................ ............ .4 -.3 t .14 p ................................... --------- ......... N.S. N.S. On the right opinionation scale PSHO medi- as to whether the PSHO project is -necessarily cal students tended to become less and Penn effecting attitude change. Quite possibly, -na- medical students more, rightist in orientation tional and international events, particularly in over the summer. In the pre-test the difference an election year, could be influencing student in scores between PSHO and Penn medical scores. Whatever the source, however, both students was 5.4 (p=0.05) while at the close groups appear to have changed position during of the summer the difference had increased to the summer months. Table 33, below, reflects 13.8 (p=0.0005). It is then open to question these findings. Table 33.-Mean Right Opinionation Scores, PSHO and Penn Medical Students. x Before ..... ............ ..................... 62.8 39 68.2 36 5i4 1.9 0.05 After .............................. ........................ 59.1 38 72.8 30 13.8 4.7 .0005 Difference .......... ................................ -3.7 4.6 t ..... ....... ................ @:@ ...................... 1.4 1.4 p ------------------------------------------------------ .10 .10 One tail test. Neither group reflected a change in Total The right and left opinionation scores can Opinionation, that is, the combination of right be used to measure liberalism and conserva- and left opinionation, over the course of the tism, by subtracting right from left opiniona- summer. However, in the pre-test, PSHO stu- dents were significantly more opinionated than tion. Scoring high on right and low on left measures a conservative political orientation, the Penn students although this difference de- creased in the post-test in which both scored at while scoring high on left and low on right I approximately the same level. indicates liberalism. i @5 106 more liberal moved in contrary directions which leads the PSHO students did not become post-test results to show far greater differ- as a result of participation. Although the scores ences than the pre-test. Here also it would be move in this direction, they are not sufficiently at PSHO is the agent e than chance variation. difficult to assume th large to indicate mor responsible for the attitude change. Had the The Penn medical students in the pre-test Penn students score remained approximately scored slightly liberal and in the post-test less the same, while only PSHO students scores liberal, although here too the difference may changed, then there would be reason to con- be due to chance variation in scoring. The corn- tend that the PSHO experience induced the bination of these slight movements, however, change. The trend of Penn medical students adds up to large differences between the two "downward" and PSHO students "upward" groups. While the difference between the two may reflect the trend in the United States at the beginning of the summer was 14.5 generally toward a "Polarization" of liberal (P=0.01). it increased greatly by the end to and conservative attitudes. Table 34 surnmar- 26 . This is similar to the findings izes the findings on liberalism; the higher the .4 (p=0.0005) on the right opinionation: the two groups score the more liberal.the attitude. Table 34.-Mean Liberalism Scores, PSHO and Penn Medical Students. PS nn medical p Before ....... ---------- ------------------------------- 21.7 39 7.2 36 14.5 2.6 0.01 After ------- ........ -------------------------------------- 28.4 38 2.0 30 26.4 4.8 .0005 Difference . --------------------------------------------- 6.7 -5.2 t .......... ............. 1.2 1.0 p------------------------------------------------------ N.S. N.S. One tail test. Medical Attitudes: between the two groups, initially PSHO had a Both groups completed two sets of questions significantly higher average se-ore in favor of concerned with attitudes within the field of comprehensive care than Penn students; how- medicine. A more elaborate explanation of the ever, by August both groups average scores moved closer together, pSHO's slightly de- content of these atttiude scales can be found easing so that on pp 287. One was Boswell & Newman's creasing and Penn's slightly incr "Medical Attitudes Test" consisting of three no significant difference remained. subscales: attitude toward comprehensive -med- ical care, attitude toward the team approach Team Approach: in medicine, and attitude toward preventive Neither group's attitude toward the team ap- medicine. The second was Mahler's "Social- proach in medicine, that is favoring the use of ized Medicine Attitude Scale" (see app. 3, pts. nonmedical professionals such as psychologists 11 and V). and social workers and favoring conference- like discussions with medical specialists such -orap re: C i-ehensive Ca as nurses and technicians in the treatment of This scale concerns attitudes toward regard- a case, reflected a change over the summer. ing a patie-nt's total health as within the physi- However, PSHO students demonstrate a cian's purview, the willingness to assume re- more favorable attitude on this measure than sponsibility for additional family members do the Penn medical students in the beginning health care needs, and concern with social and of the summer, but not necessarily at its con- environmental conditions which might influ- clusion. The difference between the two groups ence health status. initially was 2.9 (p=:O.Ol) but only 1/5 PSHO students did not alter their attitude (p=0.10) after. The average score for Penn on this dimension. In regard to the differences slightly increased and the PSHO average 107 score, the more favorable the attitude toward slightly decreased thereby eliminating a signifi- preventive medicine. cant difference in the post-test. There was also a considerable difference be- Preventive Medicine: tween the two groups in both the pre- and post- PSHO students' attitude toward the impor- test; PSHO in both cases evincing a higher tance of preventive medicine as opposed to ntive medicine score than Penn students- curative medicine did refiect a significant posi- preve tion change. Table 35 below indicates that Total Medical Attitude: Penn medical students average score remained SHO students' and Penn students' averages relatively constant while that of PSHO stu- p dents increased. In this table, the higher the on a combination of all three measures refiects Table 35.-Mean Preventive Medicine Scores, PSHO and Penn Medical Students. -x Difference p Before ..................... ....... ....... 36.3 39 32.4 38 3.9 3.6 0.0005 After .. ................................... ----------------- 38.4 38 33.6 32 4.8 3.9 .0005 Difference ........ 6@ ............ --------- ----------- 2.1 1.2 t ----------- ................ 2.1 1.0 p ---------------------------------------------- 1-@ ... .025 N.S. no changes from pre- to post-test. There is, cral Government. The PSHO students' attitude however, a significant difference between the in this area was more in favor of a f ederally two groups at both stages of measurement. regulated medical system at the end of the PSHO students score higher than Penn stu- summer than at the beginning although the dents both at the beginning (t=9.7, P==O.0005) statistics indicate that possibly this change and conclusion (t=6.8, p--O.005). is due to random variation in responding to Socialized Medicine: the questions rather than an actual change in This test measures to what degree an indi- attitude. Table 36 below shows the pre- and vidual favors a health care system in the post-test results for PSHO students on this United States which is supervised by the Fed- index. Table 36.-Mean Socialized Medicine Scores, PSHO and Penn Medical Students. -x Differei p Before .................................... ------- ..... 49.6 39 35.6 36 14.0 3.4 0.0005 After .................... ----------- .......... 55.0 39 35.3 31 19.7 5.4 0.0005 Diff erence .................................. ........... 5.4 .3 t ------------------- 1.4 .05 p ------------------------------------------------------- .10 N.S. One tail @t. This table also shows that PSHO students Attitude T6,ward the Poor: are far more inclined to favor socialized medi- About two-thirds of the PSHO project sites cine than are Penn students. were with community organizations in urban 108 Table 37.-Mean opinions About the Poor Score, PSHO and Penn Medical Students. -x stu ents Difference t p 323.7 39 341.1 36 17.4 4.2 0.0005 Before .... ............................................ 333.4 38 327.3 31 6.1 1.2 0.10 After ......................................................- 9.7 - 13.8 Difference .............................................. 1.9 3.3 t............ ..........................I-----I --------- .025 .005 p..................... "I-,--, ......................... il test. ther factors. It may be that intimate slum areas and most of the remaining one- well as o third were with official institutions serving contact results in a lowering of overall score, such areas. Intimate exposure to the living con- since the respondent may come to feel that it ditions and problems of the poor were expected is inappropriate to generalize widely about the as a part of the summer activities. In order to poor after having personally observed their life find whether personal contact lead to changes conditions. in attitudes toward the poor, the research team The researchers feel that the attitude toward developed a 70-item test (see pp. 100-101 and the poor test developed by PSHO is an im- app. 3). It consists of statements to be ac- provement over existing tests, but requires cepted or rejected by the respondent concern- item analysis and additional study before it ing the political philosophy, family structure, is adopted by future research projects. economic views and other social matters, of the The findings indicate that both groups poor. The test was constructed hurriedly changed attitudes toward the poor. These facts shortly before the summer project was are illustrated in table 37 below. The higher the launched in June 1968 and consequently no score, the more familiar with the circumstances time was available to perform extensive pre- of the poor. testing, nor to establish its validity and reli- ability. The results show a great deal of atti- The table reveals that PSHO students sig- tudinal shifting both by Penn medical an nificantly increased scores while Penn students decreased in regard to the .,poor. While one PSHO medical students, so that its content might expect PSHO student scores to change needs to be very carefully investigated before it is used in the future. The basic problem is as a result of exposure to indigent community determining the scoring of the questions. For life, the change by Penn students is not readily the present research they were scored when a explicable. subject indicated agreement with the two Backgi-ound Comparison: major scholars, monographs from which the questions are drawn (see p. 100). However, As mentioned earlier in the research, a more one scholar describes the working class, not structured research design would have required the lower class, so that agreement with the a matched control group for the experimental items taken from his reference may not be ac- comparison. Time limitations prevented this curate in regard to the lower class. If, for possibility and, as a consequence, the research- example some of these items apply exclusively ers opted for what they hoped would be an to the working class, then answering in agree- acceptable matched group control. Thus' rather ment with his assertions is inaccurate in re- than matching pairs, it was hoped that the gard to the lower class and the scoring would, average background characteristics of the two therefore, need to be reversed. A second prob- groups would be sufficiently similar to allow lem concerns the wisdom of generalizing about group comparisons. What follows then is a de- the poor. Although the test is designed for at- scription of the background differences of the titudes about the urban poor specifically, this two groups. The groups were, of course, sim- Population's characteristics undoubtedly varies ilar in some traits on the average and consider- according to rate and geographical region as ably different in others. 109 Both groups consisted of 89 percent males, Table 39.-Social Class of PSHO and Penn Medical and approximately 95 percent of each group Students. was white. However, the Penn medical stu- dents were on the average significantly older and had significantly different religious back- Upper .................. ..... 38.5 15 35.1 1 grounds. The average age of PSHO medical Middle ........................ 38.5 15 56.8 21 students was 22.9 years, whereas the Penn stu- Working ........ ........... 20.5 8 8.7 3 dents were slightly over 24 years of age. (This Lower ........................ 2.5 1 .... 0. difference is statistically significant-X2 = 28.4 Total .............. 37 df@7, p=0.001.) The two groups also differed significantly in Family income of the parents of the two terms of family religious background. Almost groups does not vary significantly although half of the PSHO medical students come from Penn students come from families that earn Jewish families, whereas more than half of the more money on the average. The mean income Penn students have a Protestant family reli- of Penn students' parents was $18,776 whereas gion. This data is shown in table 38 below. PSHO was $16,664, a difference of over $2.000 annually. This does not amount to a statis- tically signiflcant difference, however (X2@5.6, Table 38.-Family Religion of PSHO and Penn Medical df=6, p=0.50). Students. In regard to educational experience which Religic-n Stu ents might have influenced the manner in which the two groups answered the questionnaire, Penn Protestant .... ........... 20.5 8 5(.8 21 students in general had significantly more aca- Catholic --. .............I--- 17.9 7 21.6 8 demic preparation by enrollment in courses Jewish ............ ...... 48.7 19 18.9 7 concerning community medicine. Twenty-seven Other .@.. ...................... 12.7 5 ... 0 percent of the Penn, but only 8 percent of the Total ...... ....... 9@8 PSHO students had coursework in this area. On the other band, however, PSHO students had significantly more actual experience in In terms of social class, PSHO students and community work. Over 38 percent of the PSHO Penn students differ, but not significantly. students had previous participation in social Most students in both groups come mainly from action projects, whereas less than 11 percent the middle and Upper classes (see p. XX for the of Penn medical students had this experience. method of determining social class). Table 39 Table 40 below reflects these differences be- gives the data on social clas,-,. tweerl the two groups. Table 40.-Community Medicine Coursework and Practical Experience of PSHO and Penn Students. Stu Per Yes ......... ...................... 7.7 3 27.0 10 38.5 15 10.8 No ................................. 92.3 36 73.0 27 61.5 24 89.2 33 Total -.. ..... ........ X2=5.00; df=l; P=0.05. XI=7.74; df=l; p=0.01. In summary, a comparison of the two groups characteristics; sex, race, social class and shows that Penn medical students are signifi- family income, the two groups are essentially cantly older, have had significantly more similar. course work in community medicine and less How much these background differences con- practical experience in social action programs tribute to the differences in responses to the than PSHO medical students. In terms of other attitude scales is purely a matter for specula- 110 tion. it is possible that age alone could account in the pre-test and on six in the post-test. In for the difference in answering. Therefore, we cases where the difference dissipated over the the summer summer, it is generally movement by both can only note the possibility that groups in the other group's direection. There experience is only one contributing factor to is no way to determine why there was no, dis- the differences in response to the questionnaire. tinction between PSHO and Penn students on conclusion: comprehensive care, team approach, totalopin- There was no change in PSHO medical stu- ionation, and attitudes toward the poor in the dents attitudes from pre-test to post-test in post-test as there' was in the pre-test. Quite terms of left opinionation, total opinionation, possibly events external to both groups were liberalism, comprehensive medical care, team creating a stimulus for opinion change. approach in medicine, and medical attitudes in Since the ten attitude scales have differenti- general. There is a possibility that PSHO stu- ated between the two groups, particularly in dents became less rightist in political ideology the initial testing, one is tempted to think that and more in favor of socialized medicine, but the tests are relatively accurate and there exist these changes may be due to random variation I -' other f actors to account for the absence of more The two measures on which there are definite, widespread attitudinal change within the significant changes are: more favorable atti- PSHO student group. The most apparent rea- tudes toward the poor and more favorable at- son would be the assertion that PSHO project titudes toward preventive medicine. on the whole is not a source of pervasive atti- As for the Penn medical students, there was no change in left opinionation, total opin- tude change. This would be corroborated by ionation, liberalism, comprehensive care, team the fact that there was little manifest atti- approach, preventive medicine, medical atti- tudinal change among the total SHO partici- tudes in general, and socialized medicine. There pants (see pp. 95-101). Whether this is the was possibly a more right-leaning political case or not, remains open to question and de- stance at the end of the summer, but here too bate. It should also be mentioned that the the resulting difference may be simply scoring California 1966 research project, using a com- fluctuation. Penn medical students became Sig- pletely different set of attitude scales found a nificantly less favorably inclined toward the change only in attitudes toward the poor .211 poor in the post-test. It should be stipulated very clearly, however, As to the difference between the two groups, that the absence of profound attitude change however, they are significant on all ten indexes is possibly not a just reason to question . the 29 USC-SMC Stu(lent Health Project, op. cit., P. 17. value of the total PSHO experience. Section V APPENDIXES APPENDIX 1 Pre-Test Background Questionnaire Philadelphia Student Health Organization The following questionnaire consists of six parts. Please read the instructions to each part and answer each one carefully. PART 1: BIOGRAPHICAL DATA 1. Name 2. Home address 3. School address 4. Age (months) 5. Field of Study 6. Undergraduate major 7. Race 8. Family religion 9. Family's annual income: up to $2,999 $15,000 to $19,999 $3,000 to $5,999 $20,000 to $24,999 $6,000 to $8,999 over $25,000 $9,000 to $14,999 10. Father's occupation: if deceased or retired list former occupation) (be specific. 11. Mother's occupation 12. Have you previously had any actual experience with social action programs in poverty areas such as SHO. If so please list locations and dates: 13. Have you ever had a course in comprehensive medical care or community medicine: yes no 14. Please rank in decreasing order of importance (from 1 to 5) your major reasons for par- ticipation in the Philadelphia SHO project for the summer: -the opportunity to learn about urban slum conditions firsthand. -the opportunity to live and work in Philadelphia. -the opportunity to help advance the civil rights movement. -the opportunity to earn $900.00. -the opportunity to associate with health science students. -the opportunity to learn about community medicine firsthand. -the opportunity to help the poor. -the opportunity to work with a practicing health professional. 113 -the opportunity to help bring about social change. -others (please list). I will be the biggest problem You face in carrying out your 15. Describe what You Presently fee ing the conditions of work activities this summer: summer activities will be in improv 16. How eff ective do you think your the poor: Slightly ineffective Extremely eff ective Moderately ineff ective Very effective Very ineffective Moderately eff ective Extremely ineffective Slightly eff ective improving the condi- No eff ect ou think the SHO project will be as a whole in 17. How eff ective do y tions of the poor: Slightly ineff ective Extremely effective Moderately ineff ective Very effective Very ineff ective Moderately effective Extremely ineffective Slightly effective No effect think your summer work experience will add to your professional edii- ig. How much do you cation: Very little A great deal Nothing Considerably Moderately APPENDIX 2 Post-Test Background Questionnaire Philadelphia Student Health Organization ons'sts of six parts. Please read the instructions to each part The following questionnaire c I and answer each carefully. PART -1: EVALTJATIONAL DATA 1. Name ork experience this summer has added to your profes- 2. How i sional education: -Very little @ great deal -,nothing -considerably oderately was the summer experience helpful in acquiring knowledge for your 3. To what extent, if any, future career: -not helpful at all -very helpf ul -detrimental -moderately helpf ul helpf ul -slightly the summer experience helpful @ in acquiring specific skills f or 4. To what extent, if any, was your future career. @ot helpful at all -very helpful -detrimental Moderately helpful -slightly helpful 114 5. Which of the following type of school do you attend: -professional -technical -graduate -Other (specify) -undergraduate 6. What was your grade point average (4 pt. system) for the last semester of school attended: 7. In terms of academic standing where do you rank: -top 10 percent of class -top 50 percent of class -top 25 percent of class -below the top 50 percent of class 8. Please rank in decreasing order of importance (from 1 to 5) your major reasons for par- ticipation in the PSHO project for the summer: -the opportunity to learn about urban slum conditions firsthand -the opportunity to live and work in Philadelphia -the opportunity to help advance the civil rights movement. -the opportunity to earn $900.00 -the opportunity to associate with health science students. -the opportunity to learn about community medicine firsthand. -the opportunity to help the poor. -the opportunity to work with a practicing health professional. -the opportunity to help bring about social change. -other (please specify) 9. Please rank in decreasing order of importance (from 1 to 3) the major benefits as a result of participation in the PSHO project, if any: -the opportunity to learn about urban slum conditions firsthand. -the opportunity to live and work in Philadelphia. -the opportunity to help advance the civil rights movement. -the opportunity to earn $900.00 -the opportunity to associate with health science students. -the opportunity to help the poor. -the opportunity to work with a practicing health professional. -the opportunity to help bring about social change. -the opportunity to learn abo ut community medicine firsthand. -other (please specify) 10. Describe what you presently feel was the biggest problem you faced in carrying out your work activities this summer: 11. Did you live in the area in which you worked: -yes, if yes was it a poverty area: -yes -,no -no 12. Did you attend the initial PSHO orientation session at Eagleville- -yes _no 13. Did you attend the PSHO picnic at Parvin State Park: -yes _no 14. Did you attend the PSHO midsummer conference at Eagleville: -yes _no 15. Please indicate how frequently, if at all, you attended the "Tuesday night group meetings:" -regularly -irregularly -somewhat regularly -not at all 115 indicate which of the following PSHO activities you attended or participated in, 16. Please if any: -Cherry's "The Jungle." -Woodruff's "A Black Analysis of Our Society." -Energies of @lantua -Communities Relations and the Police. -Rat Control and Health Problems in the Ghetto. -First Aid Course. -Friends Peace Committee Non-violent, Direct Action Course. -Workgroup on Curricula Reform. -Workgroup on Black Admissions. -Workgroup on Education (Elaine Hagen's planning group). -Workgroup on Communication & Publicity (Chip Smith & Joan Horan) -Workgroup on Project Continuity (Ron Blum) -Workgroup on the Newsletter (Dick Devereaux) -Workgroup on Lucia's Play. -Other (please specify) - 17. Do you presently plan to practice your profession in a poverty area: -yes _no -uncertain 18. Do you presently have any specific plans for attempting curricula reform or faculty education at your college in the fall: -yes -no -uncertain 19. Do you presently have plans to continue to work in the fall with the community organization or institution with which you were placed this summer: -yes -no -uncertain 20. Are you presently active in any group seeking social change as a result of your participa- tion in the PSHO summer project. -yes -no 21. During your summer activities did you counsel anyone about a career in medicine: -yes, if yes how many-. -no 22. How effective do you think your summer activities were in improving the conditions of the poor: -extrem v effective -silghtly ineffec e -very effective _moderately ineffective y @very ineffective -moderatel effective -Mightly effective -extremely ineffective -no effect 23. How effective do you think the PSHO project was as a whole in @ improving the conditions of the poor --extremely effective -Slightly ineffective atel ' ineffective -very effective -itoder y _moderately effective -very ineffective -extremely ineffective -slightly effective -no effect 116 24, Indicate how You feel in general terms about your role in the Summer project: -very satisfied -somewhat dissatisfied -somewhat satisfied -Very dissatisfied -Uncertain et in the future, would you participate: 25, Assuming'that PSHO repeated its summer proje -yes @o -uncertain al organization of PSHO: (,explain) 26. What major problem, if any, do you see with the intern Use the back of this page for other comments, criticism, observations, suggestions, etc. APPENDIX 3 Attitude Scales PART II: BOSWELL AND NEWMAN MAT Instructions: This is a study of what medical students and people in general think about a number of social and medical questions. The best answer to each question below is your personal opinion. We have tried to cover many different points of view. You will find yourself strongly in favor of some and disagree strongly with others. For some statements your opinions will not be as clear cut. Whatever way you feel about any of the statements you can be certain that a good many people feel the way you do. Be sure to answer every item. After all,'no knowledge, but only your opinion is involved. Think quickly: your immediate reaction to the statement is prob- ably the best one. Read each statement carefully. Below it are five possible answers numbered 1, 2, 3, 4, and 5. Circle the answer you think best represents the way you feel. 1. How important do you hink it is for the doctor to know the effect of the patient's illness on his family in order to provide adequate treatment? 1. Not important at all 4. Pretty important 2. Pretty unimportant 5. Very important 3. Not so important 2. The greatest service a physician can provide is in following longterm health and adjust- ment of patients and families rather than in concentrating only o n the treatment of immediate illness complaints of his patients. 1. Strongly disagree 4. Agree 2. Disagree 5.. Strongly agree 3. Undecided 3. In medical practice today there are sufficient specialists so that'a physician in general Practice should not assume long-term responsibility for his patients. 1. Completely disagree 4. Agree for the most part 2. Disagree 5. Agree completely, 3. undecided 4. The medical school should train students for specialties rather than general practice. 1. Disagree completely 4. Agree 2. Disagree 5. Agree completely 3. Undecided 117 5. Do you think that as a physician you would prefer to have for your patients all members . dividuals'? of a family rather than patients as in 4. Yes 1. Definitely not 5. Definitely Yes 2. No 3. Undecided the physician is to immediately relieve the suffering of 6. The most important function of the patient. 4. Agree 1. Strongly disagree 5. Strongly agree 2. Disagree 3. Undecided stress good health and promote disease pre- 7. In a general practice there is no reason to ay for the alleviation of his disease. vention since the average patient only wants to P 1. For practically no cases at all 4. For most cases 2. For very f ew cases 5. For practically all cases 3. For some cases I practice to take time to f Ollow UP 8. How practical do you think it is for a doctor in clinica provocative clues other than the presenting symptoms9 1. It is always impractical 4. It is usually practical 2. It is usually impractical 5. it is always practical 3. Undecided 9. Do you think medical training in the clinical years should concentrate most of the stu- dent's time on evaluation and treatment of specific disease processes9 1. Definitely not 4. Yes 2. No 5. Definitely yes 3. Undecided 10. A specialist such as an otologist, gynecologist, psychiatrist, etc., generally would be less effective on a routine home call than a general practioner. 1. Strongly disagree 4. Agree 2. Disagree 5. Strongly agree 3. Undecided 11. Do you think th at Iin a medical setting, the doctor should have all personnel involved in in case discussions regardless of their profession? the treatment of patients participate 1. Almost never 4. Usually 5. Almost Always 2. Not very often 3. Quite often 12. To what extent do you think a medical doctor in a clinical team should consult with the team members, such as social worker, psychologist, etc., before making ba'sic decisions in the management of the patient, such as discharge, referrals, or pronounced changes in therapy? 1. In none of his cases 4. In most of his cases 2. In some of his cases 5. In nearly all of his cases 3. In about half of his cases 13. How important do you think it is to have nonmedical specialists included on a treat- ment team in a medical setting? 1. Not important at all 4. Pretty important 2. Pretty unimportant 5. Very important 3. Not so important 14. The medical doctor in a clinical team consisting of psychologist, social worker, nurse, therapists, and technicians should take a decidedly directive rather than coordinating position if treatment is to be effective. 1. Strongly disagree 4. Agree 2. Disagree 5. Strongly agree 3. Undecided 118 actively participate in organized 15. How important do you hink it is for a physician to state public health programs 9 all 4. pretty important 1. Not important at 5. Very important 2. Pretty unimportant 3. Not so important ether or not he wants to accept the opinion Of a 16. A medical doctor is free to decide wh consultant. 1. Almost 'never 4. Qnite of ten 5. Almost always 2. Seldom 3. Undecided al social worker is unnecessary provided an experl 17. in general clinical practice a medic enced nurse is available. lv 4. Agree f or the most part 1. Disagree complete-, 5. Agree completely 2. Disagree 3. Undecided 18. A medical doctor should accept the opinion of a consultant without reservation. 1. Never 4. most of the time 2. Seldom 5. Al-Nvays 3. Undecided 19. After a physician has explained the medical diagnosis and prognosis of a patient to his relatives he refers the family to the social worker for further discussion of their reactions to. the patient's diagnosis and illness. How good a practice do you think this is" 4, A fairly good practice 1'A very poor T)ractice 5. A very good practice 2. A somewhat Poor practice 3. Undecided pay for medical services should not influence treatment given by 20. A patient's ability to the doctor. 1. Strongly agree 4. Agree 2. Disagree 5. Strongly agree 3. Undecided With curative medicine is uninteresting and unprofit- 21. Health supervision as compared able to the physician. 4. Yes 1. Definitely not 2. No 5. Definitely yes 3. Undecided 22. Hygiene, often defined as the science of health, is as much a science as internal medicine and pediatrics. 1. Disagree completer 4. Agree y 5. Agree completely 2. Disagree 3. Undecided state .of de- 3. Specific knowledge necessary for prevention of disease is so limited at this 2 velopment that the time of a practicing physician is much better spent in curative medicine. 4. Agree for the most part 1. Completely disagree 2. Disagree 5. Completely agree 3. Undecided 24. For a well-rounded medical education, work in pediatries'and surgery is decidedly more tive medicine. important than work in preven 1. Strongly disagree 4. Agree 5.' Strongly agree 2. Disagree S. Undecided '119 ne necessitates a degree of understanding of patient's attitude toward 25. Preventive medici e current practice of medicine. health and disease that is unusual in th 4. Agree for the most part 1. completely disagree 5. Completely agree 2. Disagree 3. Undecided p actice the demand for treatment of disease is so great that hardly any 26. in present day r ith prevention of illness. time can be spared to concern oneself w 4. Agree for the most part 1. completely disagree 5. Completely agree 2. Disagree 3. Undecided 0 you think it is for a physician to participate in programs of accident 27. How important d mportant prevention? 4. Pretty i I. Not important at all 5. Very important 2. Pretty unimportant 3. Undecided of disease is directly related to the properties of disease itself, there 28. Since prevention entive aspects in separate courses. is no special reason to teach the prev 4. Agree 1. Disagree completely 5. Agree completely 2. Disagree 3. Undecided s of disease prevention as personal habits of 29. There is little value in stressing principle of effecting more lasting Change is most adult patients are so firmly established that the possibility rather unlikely. 1. Disagree completely 4. Agree 2. Disagree 5. Agree completely 3. Undecided 30. Prevention of disease as a medical activity is primarily the responsibility of health de- partments rather than the responsibility of bedside physicians. 4. Agree 1 . Disagree completely 5. Agree completely 2. Disagree 3. Undecided PA'RT III: THE R-0 SCALE Instructions: The following are questions concerning what students, think and feel about a number of important social and personal questions. The best answer to each statement below is g points of view; you your personal opinion. We have tried to cover many different and opposin may find yourself agreeing strongly with some of the statements, disagreeing just as strongly with others, and perhaps uncertain about others; whether you agree or disagree with any state- ment, you can be sure that many people feel the the same as you do. Mark each statement in the left margin according to how much you agree or disagree with it. Please mark every one. Write +1, +2, +3, -1, -2, -3 depending on how you feel in each case. +I: I agree a little -1: I disagree a little + 2: 1 agree on the whole -2: 1 disagree on the whole -3: 1 disagree very much +3: 1 agree very much 1-1-2-3 (1) It's all too true that the rich are getting richer and the poor are +3 +2 + getting poorer. +3+2+1-1-2-3 (2) It is very foolish to advocate government support of religion. +3+2+1-1-2_3 (3), This much is certain: The only way to defeat tyranny in China is to support Chiang Kai-Shek. 120 (4) It's perf ectly clear that the decision to execute the Rosenberg's has +3+2+1-1-2-3 done us more harm than good. he believes that college be pretty short-sighted if (5) A person Must ial loyalty oaths. @+3+2+1-1-2-3 professors should be forced to take sPee ida put out by the real ly those who believe the propaga +1-1-2-3 (6) It,s main . st a federal slum clearance program, +3 +2 estate interests who are again member the Hoover days will tell +3 +2 +1-1-2-3 (7) Anyone who's old enough to re reelected. you that it's lucky thing Hoover was never roof that (8) The American rearmament program is clear and positive P +3+2+1-1-2-3 we are willing to sacrifice to preserve our freedom. will be better mostly the noisy liberals who try to tell us that we +3 +2 +1-1-2-3 (9) it's off under socialism. rs who talk about government owner- -1-2-3 (10) it's usually the troublemake +3 +2 +1 ship of public utilities. t is the private enterprise system which -1-2-3 (11) History clearly shows that i +3 +2 +1 is at the root of depressions and wars. that the way to solve our + 1-1-2-3 (12) It's perfectly clear to all thinking persons +3 +2 -financial problem is by soak-the-rich tax program. f ailure. t the United Nations is a (13) it's already crystal,clear tha ii that the only +3+2+1-1-2- 1-1-2-3 (14) Anyone who is really for democracy knows very we backward +3 +2 + way for America to head off revolution and civil war in countries is to send military aid. f air Deal pro- (15) There are two kinds of people who fought Truman's +3+2+1-1-2-3 gram: the selfish and the stupid. s who yell the loudest about +3+2+1-1-2-3 (16) It's the radicals and the labor racketeer labor's right to strike. that the Corn- t be pretty gullible if he really believes +3 +2 +1-1-2-3 (17) A person mus trated into government and education. munists have actually infil ould believe that the 'United States is uided idealist w +3+2+1-1-2-3 (18) Only a Mlsgt warmonger- an imperialis nse tells you that prejudice can be removed by +3+2+1-1-2-3 (19) Plain common se education, not legislation. the time about reds who keep yelling all +3 +2 +1-1-2-3 (20) it's the fellow travellers or civil Rights. st be pretty stupid if he still:@elieves in differences +3+2+1-1-2-3 (21) A person mu between the races. ant if he things that ROckef eller is going -1-2-3 (22) A person must be very ignor +3 +2 +1 to let the "big boys" run this country. you that Alger Hiss -2-3 (23) Anyone who knows what is going on will tel +3 +2 +1-1 ed his couDtrY- that it would be was , traitor who betray brain in his head knows +3+2+1-1-2-3 (24) Any person with even arv be run by men like General MacArthur. dangerous to let our count is not really ughtful persons know that the American Legion +3 +2 +1-1-2-3 (25) ThO interested in democracy. only a simple-minded fool would think that Senator Joseph Me- +3 +2 +1-1-2-3 (26) Carthy is a defender of American democracy. that the world (27) you can't help but feel sorry for those who believe +3 +2 +1-1-2-3.couldn't exist without the Creator. +3+2+1-1-2-3 (28) Any intelligent person can plainly see that the real reason America is rearming is to stop aggression. wants to +3+2+1-1-2-3 (29) The truth of the matter is this: it is big business thaIt continue the cold war. 'i2l +3 +2 +1-1-2-3 (30) History will clearly show that Churchill's victory over the Laboul: Party in 1951 was a step forward for the British people. +3+2+1-1-2-3 (31) Even a person of average intelligence knows that to defend our- selves against aggression we should welcome help-including Franco Spain. +3 +2 +1-1-2-3 (32) It's the agitators and left-wingers who are trying to get Red China into the United Nations. +3+2+1-1-2-3 (33) It's simply incredible that anyone should believe that socialized medicine will actually help solve our health problems. +3 +2 +1-1-2-3 (34) It's the people who believe everything they read in the papers who are convinced that Russia is pursuing a ruthless policy of aggression. +3 +2 +1-1-2-3 (35) It's mostly those who are itching for a fight who want a universal military training law. +3 +2 +1-1-2-3 (36) It's perfectly clear to all decent Americans that congressional com- mittees which investigate communism do more good than harm. +3 +2 +1-1-2-3 (37) It's just plain stupid'to say that it was Franklin Roosevelt who got us in the war. +3 +2 +1-1-2-3 (38) A study of American history clearly shows that it is the American businessman who has contributed most to our society. +3 +2 +1-1-2-3 (39) It is foolish to think that the Democratic Party is really the party of the common man. +3+2+1-1-2-3 (40) Make no mistake about it! The best way to achieve security is for the government to guarantee jobs for all., PART 1V: THE PSHO-OAP SCALE Instructions: In the following series of questions we are interested in your opinion about poor people in general. We are interested in your own personal opinion therefore there are no "right" or "wrong" answers. Please indicate how you feel about each statement by deciding if you agree or disagree, and the strength of your opinion. Then circle the appropriate number in front of the statement in the following fashion: +3: Strongly agree -1: Slightly disagree +2: Moderately agree -2: Moderately disagree +1: Slightly agree -3: Strongly disagree 0: Uncertain Many of the statements may seem absurd and impossible to answer by simply noting how strongly you agree or disagree. Nevertheless, answer every item even if you must guess at some. Keep in mind that the questions concern the URBAN POOR in general and not any spe- cific minority group. +3+2+1 0 -1-2-3 (1) Most poor people are poor because they are lazy. +3+2+1 0 -1-2-3 (2) There is little antagonism or conflict between poor parents and their children. +3+2+1 0 -1-2-3 (3) The poor are greatly concerned with gaining social status and pre tige. +3+2+1 0 -1-2-3 (4) Children in poor families are expected to obey parental authority immediately. +3+2+1 0 -1-2-3 (5) Wives of the poor frequently face the threat of desertion. +3+2+1 0 -1-2-3 (6) The poor generally resis t innovation in preference for traditional ways of doing things. +3+2+1 0 -1-2-3 (7) The poor would rather learn things from books than from other people. 122, (8) while desiring a good standard of living, the poor are not at- +3+2+1 0 -1-2-3 tracted to a middle class style of life,. rned with "getting by" +3+2+1 0 -1-2-3 (9) most poor families are dominantly conce rather than "getting ahead." +3+2+1 0-1-2-3 (10) The poor are compensated for their poverty by enjoying a more sensual lif e. difficult to have informal, comfortable -1-2-3 (11) The poor usually find it +3+2+1 0 relationships with other persons. +1 0-1-2-3 (12) The poor are not readily open to reason. f class diff er- +3+2 (13) The poor are -not class conscious, although aware o +3+2+1 0-1-2-3 ences. ally read very little and ineff ectively. +1 0-1-2-3 (14) The poor usu er- +3+2 -3 (15) in poor families there is a. great deal of f amilY discord and int +3+2+1 0-1-2 ersonal conflict. ii p of intellectuals as egg-heads." (16) The poor generally think +3+2+1 0-1-2-3 a considerable interest in encouraging a +3+2+i o-1-2-3 (17) Generally the poor have children. college education for.their such as movies to active +3+2+1 o-1-2-3 (18) The poor prefer passive entertainment entertainment such as parties and dances. one in a slow, +3+2+1 0-1-2-3 (19) The poor are able to build abstractions, but it is d physical fashion. not interested in planning for long-term +3+2+1 0-1-2-3 (20) The poor are usually immediate gratification of needs. goals, but rather prefer one of the major problems of the poor is unemployment and the +3+2+1 0-1-2-3 (21) threat of laYoff. (22) The poor generally judge a political candidate on the basis of per- +3+2+1 0-1-2-3 sonality rather than on qualifications or platform. +3+2+1 0-1-2-3 (23) The poor family is frequently "child-centered." -1-2-3 (24) The poor are largely uninterested in politics. in +3+2+1 0 efer I abstract planning to direct, concrete action +3+2+1 0-1-2-3 (25) The poor pr attaining goals. les, aunts and cousins of the poor usually +3+2+1 0-1-2-3 (26) The grandparents, unc rjaaintain close family ties. +3+2+1 0-1-2-3 (27) The poor view most Political leaders as corrupt "bigshots.." d to +3+2+1 0@1-2-3 (2s) The poor prefer voluntary associations to be loosely organize those with rflore structure. ant author- milies the husband is generally not the domin +3+2+1 0-1-2-3 (29) in poor fa ity figure. +.8+2+1 0-1-2-3 (30) The poor are quite well informed about most social and political issues. +3+2+1 0-1-2 (31) The poor prefer strong, directive leadership to that of nondiree- -3 tive leadership. +3+2+1 0-1-2-3 (32) The poor generally have sufficient contact with Most social insti- tutions such as the school. +3+2+1 0-1-2-3 (33) Humor among the poor often takes the form of physical acts such as "horseplay." e not sharply differentiated +3+2+1 0-'1-2-3 (34) The duties of husbands and wives ar in poor families. +3+2+1 0-1-2--3 (35) Usually the poor will accept jobs that provide moderate economic security as opposed to those involving risk but the possibility of high monetary return. 123 (36) Most poor people believe that the legiti- +3+2+1 0 -1-2-3 "insanity plea" is not a mate defense in a criminal trial. +3+2+1 0 -1-2-3 (37) The poor usually hold flexible opinions. +3+2+1 0 -1-2-3 (38) The outstanding weakness of the poor is a lack of education. +8+2+1 0 -1-2-3 (39) The poor rarely have firm convictions about such issues as re- ligion, morality and custom. +3+2+1 0 -1-2-3 (40) Physical punishment is the basic disciplinary technique for the children of the poor. +3+2+1 0 -1-2-3 (41) Most poor people are not willing to work even if given the oppor- tunity. +3+2+1 0 -1-2-3 (42) The poor are an outgoing, friendly and amiable people. +3+2+1 0 -1-2-3 (43) The poor rarely rely on such facilities as banks, hospitals and department stores. +3+2+1 0 -1-2-3 (44) There is a-considerable amount of preoccupation with sex among the poor. +3+2+1 0 -1-2-3 (45) The wives of the poor generally accept a tradtionally submissive role in relation to their husband. +3+2+1 0 -1-2-3 (46) Mothers in poor families tend to deprive their children of ma- tternal affection. +3+2+1 0 -1-2-3 (47) Even the poor who show initiative and industry are prevented from improving their lot by overwhelming circumstances. +3-'r2+1 0 -1-2-3 (48) Most poor people are concerned with the future rather than the present "here and now." +3+2+1 0-1-2-3 (49) There is a high incidence of common-law marriages among the poor. +3+2+1 0-1-2-3 (50) The poor tend to be narrow-minded and self centered. +3+2+1 0-1-2-3 (51) The poor are generally isolated and withdrawn from their own community. +3+2+1 0-1-2-3 (52) The poor have a low level of literacy. +3+2+1 0-1-2-3 (53) Children of the poor generally do not have long protected child- hoods. +3+2+1 0-1-2-3 (54) In most poor areas there is an absence of local community spirit. +3+2+1 0-1-2-3 (55) There is a good deal of metaphor and analogy used in the language of the poor. +3+2+1 0-1-2-3 (56) The poor are not easily capable of kindness, generosity and com- passion. 4 3+2+10-1-2-3 (57) The' poor are tough people who cope with problems that would overwhelm many middle class individuals. +3+2+1 0-1-2-3 (58) The poor tend to be provincial and ethnocentric. +3+2+1 0-1-2-3 (59) Children of the poor are initiated into sex late in life. +3+2+1 0-1-2-3 (60) The poor are members of few social organizations beyond that of the family. +3+2+1 0-1-2-3 (61) The poor live in areas in which there are numerous murderers, drug addi@, thieves and prostitues. +3+2+1 0-1-2-3 (62) The poor are quite impulsive iri their behavior. +3+2+1 0-1-2-3 (63) The poor usually belong to numerous voluntary associations. +3+2+1 0-1-2-3 (64) Most poor persons consider poverty to be their fate. (65) Most -poor persons have a feeling of helplessness, dependency and +3+2+1 0-1-2-3' inferiority. +3+2+1 0-1-2-3 (66) The poor have a basic distrust of the police. +3+2+1 0-1-2-3 (67) The language used by the poor is simple, direct and earthy. 124 class values and try to live by them. I 0 -1-2-3 (69) The poor are aware of middle Ilegitimate children among the poor. +S+2+ and adven- -3 (69) There is a high incidence of i new experience +3+2+1 0 -1-2 w a need for excitement, 1 0 -1-2-3 (70) The poor sho +3+2+ ture. PART V: THE SMA SCALE ink about a of what medical students and people in general th ,uctions: This is a study to each statement below is your per- Inst, uestions. The best answer number of social and medical q -ng these alternatives: sonal Opinion. your response to the following statements usi Please indicate -1: Disagree +2: Strongly agree -2: Strongly disagree + 1: Agree of private practice is 0: Undecided (1) The quality of medical care under the system +2+1 0 -1-2 superior to that under a system of socialized medicine. uctive PoPu- (2) Socialized medicine will produce a healthier and more prod +2+1 0 -1-2 lation. less incentive for Young -1-2 (3) Under the socialized medicine there would be test good to +2+1 0 men to become doctors. is necessary because it brings the grea +2+1 0-1-2 (4) Socialized medicine f people. the greatest number o ne would be rnechaniral and super- +2+1 0-1-2 (5) Treatment under socialized raedici ficial. ne of the true aims of a +2+1 0-1-2 (6) Socialized medicine would be realization of 0 democracy. between the +2+1 0-1-2 (7) Socialized medicine would upset the traditional relationship family doctor and the patient. +2+1 0-1-2 (8) 1 feel that I would get better care from a doctor whom I am paying than from a doctor who is beinLy oaid by the government. +2+1 0-1-2 (9) Despite many practical objectionsy I feel that socialized medicine is a real need of the American people. (10) Socialized medicine could be administered quite efficiently if the doctors '+2+1 0-1-2 would cooperate. and een doctors +2+1 0-1-2 (11) There is no reason why the traditional relationship betw patient cannot be continued under socialized medicine. +2+1 0-1-2 (12). If socialized medicine were enacted, politicians would have contr.ol over doctors. cal practice is the one best adapted +2+10-1-2 (13) The present system of private inedi to the liberal philosophy of democracy. +2+10-1-2 (14) There is no reason why doctors should not be able to work j ust as well under socialized -medicine as they do now. - +2+10-1-2 (15) More and better care will be obtained under socialized medicine. +2+10-1-2 (16) The atmosphere of socialized medicine would destroy the initiative and the ambition of voung doctors. eine upon the eople with- +2+10-1-2 (17) Politicians are trying to force socialized medi p out giving them the true facts. +2+10-1-2 (18) Administrative costs under socialized medicine would be exorbitant. + 10-1-2 (19) Red tape and bureaucratic -problems would make socialized medicine +2 grossly inefficient. pri acy of the indi- 1 , @ i @+10-1-2 (20) Any system of socialized medicine would invade the v vidual. 125 PART VI: THE ATS SCALE instructions: This last series of questions survey students opinion on the issue of segrega- tion. Please indicate your response to the statements using these alternatives: +3: Strongly agree -1: Slightly disagree +2: Moderately agree -2: Moderately disagree +1: Slightly agree -3: Strongly disagree +3+2+1-1-2-3 (I) Racial segregation is an effective and practical social arrangement which has no serious effect on the vitality of democratic ideals. -@3+2+1-1-2-3 (2) The Negroes' main concern is with equal educational opportunities. They have no intention of intei-ferring with the social patternIs of the white community. +3+2+1-1-2-3 (3) The best safeguard of a democracy is the solid stability of social tradi- tion such as is involved in the maintenance of segregation. -2-3 (4) Integration threatens one of the principles of democracy, the right of +3+2+1-1 each citizen to choose his own associates. +3+2+1-1-2-3 (5) The end of segregation would bring a continuing increase in social con- flict and violence. +3+2+1-1-2-3 (6) Although the IQ of Negroes in the South is on the whole lower than the IQ of whites, this difference in intelligence is mainly due to lack of opportunity for the Negro and will eventually disappear under an integrated school system. +3+2+1-1-2-3 (7) Since integration "-ill require some painful adjustments to be made in changing from segregated schools, the best solution will be to leave the races segregated. +3+2+1-1-2-3 (8) Equal educational exposures in integrated schools will help both the Negro and white students to profit from the best of two cultures. +3+2+1-1-2-3 (9) Desegregation can in most cases be accomplished without being fol- lowed by social conflict and violence. +3+2+1-1-2-3 (10) Improving Negro education via integregation will lead to a higher standard of living in the South accompanied by more and better jobs for everybody. +3+2+1-1-2-3 (11) The Supreme Court's decision on segregation was a politically inspired invasion of states' rights and represents a miscarriage of justice. +3+2+1-1-2-3 (12) The Negro race is physically and mentally inferior to the white race and integregation Nvould not help to erase the innate differences between the two races. +3+2+1-1-@ (13) Integregated and therefore better education for the Negro via ihtegra- tion is certain to result in increased feelings of responsibility and co- operation in his part. +3+2+1-1-2-3 (14) The successes of already completed integration attempts are clear evi- dence that the fears of extreme pro-segregationists are unfounded. +3+2+1-1-2-3 (15) Negroes who are given the opportunity to go to integrated schools are apt to become demanding, officious and overbearing. +3+2+1-1-2-3 (16) Although certain radical Negro leaders try to make people think other- wise, the majority of Negroes do not want integration and would be satisfied with "equal but separate" school facilities, +3+2+1-1-2-3 (17) Desegration will develop a false sense of power among Negroes and will move us closer to having a "Negro party" in America. +3+2+1-1-@ (18) The South has failed to adequately draw upon the resources of the Negro race and integrated schools will enable the Negro to make a greater contribution to the South eco-. nomically and socially than they have been able to make with segregated schools. 126 ou start letting Negroes attend the schools of whites they will +3+2 + 1-1-2-3 (19) Once y dating and demand complete social equality in all respects including club privileges. Ily unfair to the Negroes who will'nOw +3+2+1-1-2-3 (20) The'desegregation law is basica have to compete on equal terms with the whites. +3+2+1-1-@ (21) Negroes and whites will find it easier to get along together in the same school than most people think. +3+2+1-1-2-3 (22) In dealing with the problems of desegregation we should always act in terms of thechristian rule of brotherhood and justice for all and not in terms of social attitudes based on tradition. +8+2+1-1-2-3 (23) The practice of segregation cannot help but reduce our political influ- ence in international affairs. +3+2+1-1-2-3 (24) Desegrezation will lead to a permanent lowering of standards in the public schools. +3+2+1-1-2-3 (25) Desegregation is economically wise since the Soiith's poor economic state may in part be due to the double expense of segregation. APPENDIX 4 Guidelines for Problem and Community Papers MEMO TO: PRECEPTORS AND PROJECT WORKERS IN-VOLVED IN GROUP WORK, TEACHING CLASSES, LEADING RECREATION, AND OTHER KINDS OF ACTIVITIES WITH COMMUNITIES AND ORGANIZATIONS. FROM: KAREN LYNCH SUBJECT: PROBLEM PAPERS (YELLOW GUIDELINES 1) You should present your activities of the summer from several points of view. I would like you to focus on the problems and conflicts you have encountered in working with your group or community. You'll probably make the greatest impact by describing specific problems and specific ex- amples of the things which have happened this summer. Focusing on problems and conflicts will highlight the critical issues you've encountered. These may appear to be "personality prob- lems," or misunderstandings between you and community people or you and health producers. Examine these problems from the point of view of the process of getting services to people. These guidelines may help in thinking about your activities: 1. Groups. If you've been in contact with groups of people-through recreation programs, sex education classes, group therapy, day camp psychiatric followup, or other similar ac- tivity-describe your activities with these grou@s, your intentions or plans for the groups and the development of these activities. Speak in examples including time, names, and identifying information. 2. Health problems. If you have come across health problems, become involved with at- tempts to meet health needs, discovered gaps in information about health services, or mis- informed attitudes, describe these problems in detail and your attempts to deal with them. 3. Resources. If you have become aware of resources at your site-people, experience, orga- nizations, places-which can be effectively utilized in the delivery of health services, describe these, how you found them, and what potential they offer. The most vivid and striking approach to this is by presenting one incident or project activ- ity. This incident should point out a problem in the health care system or in community's re- sPonse to health issues. It should show how you decided to deal with it, what help, difficulty, or 127 indifference you received from the medical "establishment," and what help, difficulty, or indiffer- ence you encountered from communities. Be as specific as possible in your descriptions and analysis. RETURN THE PROBLEM PAPER TO KAREN LYNCH'SHO OFFICE, BY AUGUST 14, 1968 MEMO TO: PRECEPTORS AND PROJECT WORKERS INVOLVED IN THE DEVELOP- MENT OF SERVICES, COMMUNITY ORGANIZING, PLANNING WITH COM- MUNITIES, ACTING ON SURVEY FINDINGS. FROM: KAREN LYNCH SUBJECT: PROBLEM PAPERS (YELLOW GUIDELINE 2) 1. What is the central issue you've worked on this summer? 2. Why is this an issue, who identified it, and who wanted action on it? 3. Describe what you've been doing this summer, focusing on the problems and conflicts you have encountered. You may want to include a chronology of activities, including names, titles, and ways of contacting people of the community and of the "establishment." include a description of how the medical establishment (or nonhealth establishment) related to your summer's activities-the cooperation, conflicts, and problems you encoun- tered with them and how you dealt with them. Describe specific incidents. Include a description of the way health consumers, community, patients, clients re- lated to your activities. Were they resposive, hostile, cooperative? How did you deal with their reactions. Des@ribe specific incidents. RETURN THE PROBLEM PAPER TO KAREN LYNCH, SHO OFFICE, BY AUGUST 14, 1968 MEMO TO: PROJECT WORKERS INVOLVED IN SURVEY WORK AND STUDIES PRE- CEPTORS. FROM: KAREN LYNCH SUBJECT: PROBLEM PAPERS (YELLOW GUIDELINE 3) 1. Why did you, undertake the survey or study? What, in other words, is the rationale, justi- fication, or purpose of the survey or study? 2. What is the intended use of your survey or study? Who, what group, is involved? 3. Who asked that it be done? Who supervises or has overall responsibility for it? 4. How did you go about setting up your survey or study? Describe the planning and who was involved, the design of the study, sampling procedures, development of survey, and so on. Tell as much as you can about the problems of developing the study and working up the findings. 5. Did you follow through and use the instrument-survey9 Did you present (or are you presenting) a report? To whom? 6. Did you encounter hostile or cooperative responses by those interviewed or studied? Does this tell you anything about the attitudes of your population? 7. What are the descriptive findings of the survey or study? 8. What were your results in terms of problems to deal with and action on findings? If you have presented a report to your site or anyone else, please enclose a copy of that with your problem paper. If you acted on survey findings or undertook the development of services, use one of the yel- low guidelines for presenting those activities. If those guidelines are inappropriate, go ahead and explain in your own terms what happened after the survey or study was completed. 128, RETURN THE PROBLEM PAPER TO KAREN LYNCHP SHO OFFICE, BY AUGUST 14, 1968 WORKERS IN COMMUNITIES MEMO TO: PROJECT FROM: KAREN LYNCH COMMUNITY PAPERS (GREEN GUIDELINE) cerned with You know the local community where you are working this summer. Others con the delivery of health services don't know Your community. I would like you to use the questions on this green page as a guideline for writing a description of the local community you are work- ing in. This description of the local community should be written with the cooperation and ap- proval of your preceptor and organization. Nothing should be included which you or your com- munity would find objectionable. The purpose of these questions is to provide Philadelphia SHO and others interested in getting health care to local communities with information about your community so that they will be a better informed position in planning their programs with local communities. % 1. How is your community defined? Indicate geographical boundaries and characteristics of the people and -the area which are important. (Keep this description relevant, but brief.) 2. What services are provided your community and how adequate are these services? Some of the services you may wish to comment on are transportation system, shopping, schools, rubbish and trash collection, police protection, and recreation. 3. More specifically, what is the condition of the health care system in your community? What services are known and not known? What is the response of the community to present services. 4. What major community health problems have you encountered this summer? 5. Has the community been involved with health planning? Describe experiences you have been involved with and experiences you have heard about. 6. From your experience in the community, if you want to get things done, how do you go about it? If you have a plan or a grievance, for example, how do you go about acting on it in your community? As I mentioned above, these are only guidelines for presenting your community in such a way that those who haven't had the experience of working with it will have some idea of your community and health servic.es. I suggest that you keep the paper brief but accurate. RETURN THE PROBLEM PAPER TO KAREN LYNCH, SHO OFFICE, BY AUGUST 14, 1968 129 APPENDix 5 Personal Contacts PHILADELPHIA STUDENT HEALTH ORGANIZATION W-HHS-yl- SHEET Contactor ate PERSONAL CONTACTS State- nd Time: Begi 1. NAME OF CONTACT 4. CIRCUMSTANCES OF CONTACT Place of Contact Male n Home of contae, Female ri Community health center Puerto Rican Welfare Agency Negro On the street White Hospital Age Other Last lanned 2. YTATU: other activity community worker act with this Community leader H Health Prof essional person s'onal e follow-up contact with Nonhealth profes I There will not b Medical technician this person CT rl City government ofricial 5. PURPOSE OF CONTA rl other SHO worker investigate housing conditions tj Oth Self education "-ONT Self education 3. C rc for further work Pei in person Resou e Person contacted rl Patient advocacy Person contacted individually Referrals dical services Size of group o-ntacted in group- Providing me Names of others c other CTION BE BRIEFLY WHAT 6. DESCRI St contact with person Fir WAS TAKEN Contactor initiated meeting Contact initiated meeting Other initiated meeting 7. EVALUATION OF CONTACT ed 5 4 3 2 1 unsatisfied with the contact. cted seemed to be satisfi The person conta disinterested in the contact. The person contacted seemed to be interested 5 4 3 2 1 cooperative 5 4 3 21 uncooperative in the contact. The person contacted seemed to be success 5 4 3 2 1 a failure. The person contacted seemed to feel that the contact was a success 5 4 3 2 1 a failure. I think that the contact was a in terms of special accomplishments.-- state the results of the contact 8. If possible, please omments' 9. Additional c 130 the attempt by a removed person to integrate Contact Sheets as a Research Technique and summarize a second party's summer work For example, had the health science The purpose of asking project workers at activities. ChristoPher's used his own co'n- Spring Garden community center and St. student at St. ting teenage e tact sheets in regard to attrac ChristoPher's Child and comprehensive Car In classes, he would be able n their personal Contacts gangs to sex educatio essive and sensitive ac- Center to report 0 ting method to present a more expr uninvolved was to experiment with a repor count than can a researcher who is which might provide unique and previously activity first haid. untapped data regarding the deficiencies of with the t sheet" then seems to be the health care system and to help develop an The "contact repor ersonal accounting form evaluational technique for future SHO research most applicable as a p . t workers. onal contact sheet" has vari- for use by the individual projec projects. The "pers rits in this regard. Should this f orm be used in f uture research, ous merits and deme usage of the it should be modified to a certain extent and Probably the most suitable to, complete it student should be thoroughly briefed on its checklist would be for students s over the course of the purpose, The modifications should expand the on an individual basis, e to write. an on purpose of contact, action taken summer, and use it as a referenc sections omplishments of contact. An effort end-of-summer report. in this sense the con- and ace ourage a more elaborate tact report sheets are an adequate, quickly corn- should be made to eric s; otherwise, the re- which students can make reporting on these itern This might pleted format by etivities and use them as a maining data have no relevance. daily logs of their a a final report. The contact be accomplished by encouraging student, to personal record for uitable for the method used make more detailed notes rather than attempt- sheets do not seem s as a report to a cen- ing to develop additional questions. in this research-that is, unit is too dis- ask tral research unit. The central any future use of this form should tant from the daily activities to make a valu- Also, able report on health system deficiencies. if for the occupation of the person contacted and in the case of the present research, each proj- his title, and the specific name of the agency ect worker had utilized his own contact sheets or organization for which the person contacted as a reference to write a report on the health works. As a reporting technique to a central system, it would have been for more factual, researcher, however, its usage is not recom informative, specific, detailed and readable than mended. APPENDIX 6 Project List: Project Sites and Participants Black Summer Project workers: Ka ryne Dunbar (CW), Dorothy Federman (HSS), Ida Floyd (CW). Precel)tor: Lee Montgomery, Office of Urban Aff airs, Area coordinator: Jay Federman. Temple University. Delaware CountY Health and Welfare (Citizens for Project workers.: Mike Roth (HSS), Bob Sussman BetterIPublic Health) Area coordinator: Paul Fernhoff. Preceptor: Peter Brigham. CEPA-Consumer's Editcation and Protecti-ve Project workers-. Jan Baxt (HSS), Sheldon Halpern Association (HSS) - Area coordinator: Dick Devereux.. e tor: Max Weiner, 6048 ogontz Avenue. Eagleville Hospital s: Clarissa Cain (CW)'p Garland Demp- al Jane Friedman (HSS), Steve Marder Preceptor: Donald Ottenberg. M.D., Eagleville Hospit, and Rehabilitation Center, Fagleville, Pa. Project workers: Debbie Finkelstein (HSS), Darryl nator: Paul Fernhoff. en Concerned for Welfare Rights Robbins (HSS). 1 Fernhoff. receptor: Leona Thomas, 741 North Preston Street. Area coordinator: Pau 131 East,wick Community Organization Jefferson Community Mental Health Preceptors: Regina Eichinger, 8508 Harley Avenue; Preceptor: Jerry Jacobs, Junto Building, 12th and Joan Baker, 2816 South 81st Street. Walnut Street; John Mock, M.D., Philadelphia Gen- Project workers: Andrea Benn (YI), Clark Bird (YI), eral Hospital. Renee Edwards (YI), Eileen Fair (HSS), Paul Project workers: Mike Geha (HSS), Payle Jones Frame (HSS), Bill Woods (HSS). (HSS). Area coordinator: Dick Devereux. Area coordinator: Mary Lou Evitts. Experiment in Community Action Ludlow Community Association Project worker: Lucia Siegel (HSS). Preceptor: Marvin Lewis, 1233 North Franklin Street. Fai?-mont Community Council Project workers: Darlene Bredell (YI), Gustine Bre- Preceptor: Marion Hilliard, 3956 Pennsgrove Street. dell (CW.), Jerry Braverman (HSS), Carol Dinker- Project workers: Frank Ferri (HSS), Steve Fox lacker (HSS), Peter Eisenberg (HSS), Richard (HSS), Nathan Smith (YI). Lockett (HSS), Denise Smith (YI), Brenda Wil- Area coordinator: Jay Federman. liams (CW). Area coordinator: Cleve Dawson. Fishtown Civic Association Mantua Community Planners Project worker: Bill Halperin (HSS). Preceptors: Forrest Adams; John Ciccone; MCP Work- Area coordinator: Cleve Dawson. shop, 3625 Wallace Street. Gray's Ferry Project workers: Phil Graitcer (HSS), Frank Hart Preceptor: Velva Taylor, 1337 South 28th Street. (YI), Ken Logan (HSS), William Roundtree (CW). Project workers: Rich Bonanno (HSS), Rhoda Hal- Areea coordinator: Jay Federman. perin (HSS), Francine Lewis (CW). Mill Creek Area coordinator: Paul Fernhoff. Preceptor: Onna Parker, 709 June Court. Haddington Homes Project Worker: Claudia Mills (YI), David Stewart Preceptor: Mary Voughn, 5448 Aspen Place. (HSS). Project workers: Keith Hansen (HSS), Mary Rich Area coordinator: Jay Federman. (CW). Misericordia Hospital Area coordinator: Jay Federman. Preceptors: Henry Hunter, Department of Public Re- Ha?ltranft Community Corporation lations, 54th and Cedar Avenue; Dr. Lynch, Depart- Preceptor: Hector Rodriques, 3257 Germantown Ave- ment of OB GYN, 54th & Cedar Avenue; Dr. Hesch, nue. Outpatient Department, 54th & Cedar Avenue. Project workers: Yvonne Butterfield (HSS), Charles Project workers: Gwendolyn Anthony (CW), Richard Cook (YI), David Eisenberg (HSS), Natline Thorn- Bremer (HSS), Dan Brzusek (Hss), Willie Mae ton (CW), Van Williams (CW), Heidi Wolf (HSS). Harris (CW), Leonore Lee (CW), Susan Skulnick Area coordinator: Cleve Dawson. (HSS), Bettina Stronach (HSS). Area coordinator: Dick Devereux. Hawthorne Community Center Preceptors: Charles Floyd, 5215 Spruce Street; Caryl North City Congress Heimer, M.D., 235 South Third Street; Jefferson Preceptors: Alvin E. Nichols, Director; Steve Turner, C & Y, 1332 Fitzwater Street; Hawthorne Commu- Mr. Cameron, Tony Lewis, 1428 North Broad Street. nity Center. Project workers: Meredith Hand (HSS), Stanley Rey- Project workers: Susan O@r (HSS), Don Sesso nolds (HSS). (HSS), Nate Williams (CW)-. Area coordinator: Cleve Dawson. A-rea coordinator: Mary Lou Evitts. Ogden Civic Association Holmesburg Prison Preceptor: Mamie Weaver, 4117 Ogden Street. Preceptor: Norman Jablon, M.D., Holmesburg Prison, Project workers: Martha Arey (HSS), Alma McEl- Torresdale Avenue. roy (YI). Project workers: Alan Cohler (HSS), Lawrence Kron Area coordinator: Jay Federman. (HSS). Preceptors: Mike Simmons, 3702 Spring Garden Area coordinator: Paul Fernhoff. Street; Lou Ellen Williams, 7235 Paschall ue; Horizon House Rhoda Houston, 7225 Greenway Avenue. Project workers: Lawrence Budner (HSS), Renel Bur- Preceptors: Armin Loeb, M.D., Research Director, 1825 den (YI) ! Dudley Goetz"(HSS), Chris White (YI). Pine Street; Audrie Russell, Director of Case Work- Area coordinator: Dick Devereux. ers, 1823 Pine Street; Lee Booth, Director of Resi- Pernet Family Health Service (Little Sisters of the dence, 504-6 South 42d Street. Project workers: Steve Ager HSS), Jim Padget Assumption) (HSS). Preceptors: Sister Rita, Sister Marguerite, 1001 South Area coordinator: Mary Lou Evitts. 47th Street. 132 Project workers: Art Pressman (IISS), Bill Robinson Project worker: Joan Gomes (HSS)- (HSS) - Lou Evitts. Area coordinator: Dick DevereUX. Area coordinator: Mary Presbyterian Hospital Welfare Rights Organization Preceptor: Neville R. Vines, 51 North 39th Street. Project workers- Frank Greer (HSS), Garnette Hicks Preceptor: Roxanne Jones, 1520 Green Street; 1021 (CW), Jerry Lozner (HSS), Wilhelrnina Seamon South Fourth Street. (CW). Project workers' Marpha Crafton (YI), Shirley Area coordinator: Jay Federman. Fischer (HSS), Gene Shatz (HSS), John Zonano Southwest Center City Community Council (SWCC) (HSS), Jean Wilkerson (YI). Preceptor: Joseph Cooper, 1732 Catherine Street. Area coordinator: Dick Devereu)L Project workers: Isma Jackson (CW), Carla Oswald West Philadelphia Community Mental Health (HSS), Ed Pisko (HSS). Consortium Area coordinator: Mary Lou Evitts. spring Garden 1. Trouble Clinic. Preceptor: Pat Story, M.D., 1812 Green Street. Preceptors: Jacob Schuts, M.D.; Gordon Podensky, Project workers: Anita Costa (HSS), Tom Fiss 6001 Woodland Avenue. (HSS),Walley Pillich (YI), William Smith (YI). Project workers: Bart Butta (HSS), Robert Lewy Areea coordinator: Paul Fernhoff. (HSS). Spruce Hill Community Association Area coordinator: Dick Devereux. Preceptor- David E. Boyce, Department of City and 11. Recreation Project. Regional Planning, University of Pennsylvania, 4428 Preceptor: Christine Westfall, PGH. Pine Street, Project workers: Richard Bernstein (HSS), Harry Project workers: Stephen Terzian (HSS). Hirsh (HHS), Lucia Sosnowski (HSS). Area coordinator: Dick Devereux. Area coordinator: Dick Devereux. St. Christophe,?s Child and Youth Comprehensive Young Great Society Care Center Preceptors: Lillian Johnson; William Spotwood, 603 Preceptor: Evelyn B. Wilson, Director; Nina Perry, North 33d Street. Mrs. Kennedy. Project workers: Ivan Cohen (HSS-). Thomas Devlin Project workers- Dick Bagge (HSS), Forrest Lange (HSS), Freida Farlow (CW), Patricia Ford (YI). (HSS), Richard Morrison (YI), Hetherwich Ntaba Area coordinator: Jay Federman. (HSS). Area coordinator: Cleve Dawson. Project Staff Temple Community Mental Health Center Director: Robert L. Leopold, M.D. Preceptors: Stanton B. Felzer, Ph.D., Assistant Di- Student directors: Chip Smith, Ron Blum, Elaine rector; Alvin Thomas, Director, Community Organiza- Haagen tion, 1531 West Tio-ga Street. Research directors: Karen Lynch, Jon Snodgrass. Project workers: Bess Aronian (HSS), Philip Harber Area coordinators: Cleve Dawson, Dick Devereux, (HSS), Anne Sheehan (HSS). Mary Lou Evitts, Jay Federman, Paul Fernhoff. Area coordinator: Cleve Dawson. Secretaries: Carrolyn Morgan, Rita Boler, Edith Barn- University Settlements hill. Preceptors: Jerry Gardner, Mike Norris, 2601 Lombard Advisory council: Walter J. Lear, M.D., Sue Leslie; Street. Jim Shelton; William A. Steiger, M.D. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Philadelphia Student Health Project-Summer 1968 U@S. GOVERNMENT PRINTING OFFICE: 1969 0-355-229 133 I", ,ll"lllfl"iili