MH - Community Health Services/*/New York City MH - New York City MH - Students, Health occupations/*// KW - 20C CN Greater New York Student Health Project//// CN Albert Einstein College of Medicine//// CN Montefiore Hospital and Medical Center//// CN United States. Division of Regional Medical Programs//// Ti The:Student Health Project of Greater New York, summer 1968./G IM [Bethesda, Md.]/Health Services and Mental Health Administration/[19691 CO viii 155 p. GN - S@onsors: Albert Einstein College of Medicine of Yeshiva University and Montefiore Hospital and Medical Center. GN Project supported in full by the Division of Regional Medical Programs, Contract no. 43-68-1515. CP 02NLM,08HMS,01SSY:WA 546:AN7:G5s::1969 CA WA 546 AN7 G5s 1969:02NLM,08HMS,01SSY Yl S/1969/ LP Eng LA Eng MT CORPORATE NAME MAIN ENTRY RO O:MED RO C:MED RO M:KRC DA 710614 MR 831204 LR 831222 RI rev EL FULL LEVEL IT MONOGRAPH Ul 1267146 I& AIVIA AW GREATER NEW YORK STUDENT HEALTH PROJECT summer 1968. THE STUDENT HEALTH PROJECT OF GREATER NEW YORK Summer 1968 Sponsors Albert Einstein College of Medicine of Yeshiva University Montefiore Hospital and Medical Center This report does not necessarily represent the views of the Public Health Service U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service The Division of Regional Medical Programs Health Services and Mental Health Administration This project was supported in full by Contract No. 43-68-1515 FOREWORD While medicine in this country advances by giant steps in the area of increasing scientific and technical knowledge, it plods along in extending the fruits of these benefits to all Americans. Today comprehensive com- munity health care is an idealistic pipedream, compared with the realities of a stopgap system of health care which is scanty, episodic, and frag- mented. A major reason for these deficiencies and inadequacies is the lack of incentive and interest among health professionals in attacking these problems. In their formal curriculum the vast majority of students in the health professions do not gain an appreciation of the needs of the medically underprivileged or the difficulties that are faced by health practitioners and health facilities in poverty areas. The patient is observed by the student merely as a disease or clinical entity-as a fragment of his society being distinct and separate from his environment. The health Stu- dent by spending his long years of training isolated from the community which he will serve loses his social idealism and remains blind to many of the basic causes of ill health: environmental deprivation, loss of income and jobs, and poor housing. Tomorrow's health practitioners must under- stand these causes if there is to be any large scale improvement in stand- ards of health care. First hand experience with the urban community and the urban health problem is the best way to gain this understanding. The purpose of the Student Health Project of Greater New York was twofold: to increase the education and understanding of health profes- sionals by providing experience in dealing with the social problems and health needs of the poor, the social conditions which engender these prob- lems, and the difficulties in alleviating them; and,to engage students in beneficial projects that will have immediate and long term effects on the community, on the educational process, and on themselves. Such long term effects can be achieved only through the fostering of resources within the community and through encouraging flexible student attitudes necessary to develop the new health models needed to define and improve the delivery of health services. PREFACE This report represents a distilling of the hundreds of thousands of words written as biweekly or final reports or transcribed from tape-rec- orded meetings and interviews during the course of the 1968 Greater New York Student Health Project. The 1967 Bronx Student Health Project report and similar reports of other Student Health Organization summer projects have tended to be compendia in the truest sense of the word, with essays by the participants printed in their entirety or organized in such a way that the reader has had to search through pages and pages of information, impressions, and opinions for specific points he may have been seeking. An effort has been made here, through judicious editing and organization of the excerpts into specific categories of discussion, to provide a more useful source book of information about the summer experience for future planning of Stu- dent Health Projects or similar efforts. Although perhaps less "readable" than previous reports because essays have been fragmented and stripped of most of the "poetic impres- sionism" that students tend to write, the format of this report should, it is hoped, enable the reader to go straight to a caegory of interest and get a sampling (but not a random one) of student and community co-worker experiences and opinions on that topic without having to read the entire report. Of course, breaking down the material into so many categories produced the disadvantage that some categories overlap in content. We tried to assign excerpts as precisely as possible, but in some of the larger excerpts (especially where the writer's flow links several related topics), it was necessary to assign the category on the basis of the "main thrust" of the entire excerpt rather than its specific points. (Many of these papers will appear at the front of discussions as "position papers" that set a tone for the rest of that section.) Thus, the reader should be aware that although he may be primarily interested, for example, in student views on "patient advocacy," he should also cross-reference himself to related categories such as "white students in black communities" for perspectives on the problem that may be stated in a different context. The "main thrust" criterion was applied also to several excerpts whose significance seemed, upon further consideration, to be more relevant to a category other than the general grouping in which it would seem to belong at first glance, e.g., BW's description of his f und-raising activities for Newark's New Well addict rehabilitation program was finally placed under "Student Health Project Role in Agencies and Hospitals" rather than under "Agencies" or "Drug Addiction" because it seemed a better example of a suitable (and successful) student role than a description of either . e agency or the problem of drug addiction. Another thing that has to be pointed out is that much of the material finally used in the report reflects a mood of dissatisfaction that pervaded v the project throughout the summer, and which caused participants to focus on their problems in meetings, reports, and interviews. Not all the partici- pants were unhappy with their summer experience or with the Student Health Project in general, but it appears that they were -not as moved to write about their successes and satisfactions as were those who had bitter bones to pick. Thus, the report is biased in the sense that "usable" material came primarily from the latter group. Overall, however, the editors feel that the report does reflect the conflicts in and among participants as to the meaningfulness of the summer. It should be noted here that those Greater New York area health science students who constitute the regional Student Health Organization "steering committee" voted recently not to sponsor any more Student Health Projects of this kind. They concluded that any future summer projects will have to be locally planned and ad- ministered projects growing out of on-going activities of the Student Health Organization or other groups at each medical, nursing, or dental school. Our apologies to those who may feel that what they had to say has been distorted by quoting out of context, and to those whose observations and opinions could not be used. Even after careful selection of what we felt was the best of the material submitted, the first draft of the four major sections of the report was almost 500 typewritten pages and had to be further cut in a somewhat merciless fashion. Anyone who feels strongly about his views being distorted or slighted is encouraged to consider sub- mitting his ideas to one of the SHO publications such as Current. Profuse appreciation goes to all those who helped pull this report together, especially to, Mrs. Marylyn Gore, Project Director, for many helpful suggestions after reading the ponderous first draft, to Miss Jody Williams of Albert Einstein College of Medicine (who handled much of the project's cumbersome administrative work during the summer) for invaluable advice and efficient liaison with,, the funding agency, to Mrs. Joanna McDonough, our excellent editorial assistant, and Mrs. Ruby Hough, our manuscript typist, who stuck with us through the long winter months and showed patience and understanding even when our demands became overbearing. W. M. SMITH, Amy T. SMITH, March 1969. vi Contents PART 1:' THE DREAM The Task ---------------------------------------------- 1 The Motivation ---------------------------------------- 4 PART 2: THE REALITY Introduction -------------------------------------------- 9 Views of the Community -------------------------------- 10 Health Care Delivery ------------------------------------ 18 Attitudes ---------------------------------------------- 29 Medicaid, Medicare -------------------------------------- 33 Dental Health ------------------------------------------ 33 Lead Poisoning ---------------------------------------- 34 Drug Addiction ---------------- ----------------------- 34 Family Planning ---------------------------------------- 37 Housing ----------------------------------------------- 38 Legal Services ----------------------------------------- 40 Agencies ---------------------------------------------- 41 PART 3: ROLES IN CONFLICT Introduction ------------------------------------------- 45 Students as a Force for Change -------------------------- 45 The Student Health Project and the Community ------------ 52 White Students in Black Communities -------------------- 54 Community Education and Training Programs -------------- 66 Community Organizing ---------------------------------- 70 Student Health Organization Service Projects -------------- 72 Patient Advocacy -------------------------------------- 77 Student Health Project Role in Agencies and Hospitals ------ 84 The Neighborhood Youth Corps --------------------------- 92 Community Workers ------------------------------------ 96 Faculty Advisors --------------------------------------- 99 PART 4: OPINIONS ON THE ORGANIZATION Introduction ------------------------------------------- 101 Greater New York Student Health Project Structure -------- 101 Local Project Structure ---------------------------------- 104 Funding ----------------------------------------------- 107 Student Fellow Selection -------------------------------- 109 Interdisciplinary Team ----------------------------------- 112 PART 5: EVALUATION Introduction ------------------------ 115 ------------------- The Student Health Project as a Learning Experience ------ 121 vii What Next?-Suggestions for the Future ------------------ 129 Recommendations -------------------------------------- 134 APPENDIXES A. Listing of Participants ------------------------------ 139 B. Health Resources in the Harlem Area ------------------ 143 viii Part 1: THE DREAM THE TASK This section contains the project proposals school health referral activities due to less distributed to prospective participants at the than enthusiastic cooperation by some Depart- Orientation session. They were used by many ment of Health administrative and school students to determine which area they finally health program personnel. chose to work in. It should be noted that "concrete task fulfill- Although most of the statements suggest ment" as a measure of project success may not that substantial project planning and precep- be a valid criterion to judge project achieve- tor arrangements had been worked out, in fact ment since considerable disagreement existed much of the foundation laying remained to be from top to bottom in all the project areas as done in several projects at the time students to what the Student Health Project task was were expecting to "go to work." That the sum- supposed to be: providing an educational expe- mer thus turned out to be a "use your own ini- rience in community medicine for health sci- tiative" opportunity was extremely frustrating ence students versus helping a finite number of and discouraging for many students who had persons get better health services versus bring- expected otherwise, as well as community ing about changes in health care delivery sys- workers and Neighborhood Youth Corps teen- tems in the area. Certainly, however, each pro- agers, who were probably even more job action ject was both successful and unsuccessful to oriented than the students. some degree in each of these objectives. In general, those projects in which specific Some subprojects were judged sufficiently task definition and firm preceptor arrange- successf ul on a programmatic basis that at- ments had been made before the summer began tempts were made to continue them year- (e.g., Brooklyn's King's County Hospital and round. At the end of the summer, the students St. Mary's Hospital physician assistant pro- requested that several thousand dollars of sur- jects, and Harlem's school health referral pro- plus funds be reappropriated for distribution ject) were most successful in terms of concrete to the Bronx project to continue the Unwed achievements, whereas more open-ended pro- Mothers project storefront, to the Newark pro- jects in which students had to "feel their way" ject to keep their advocacy storefront office proved less successful (e.g., Brooklyn's Model open, and to support a benefit show for the Cities project, Harlem's pediatric care center New Well, a narcotics addiction rehabilitation advisory committee, Lower East Side Medicaid agency, and to the Harlem project to buy black cutback study). children's books for clinic waiting rooms, and But even good advance planning was not al- to pay salaries to three of the community ways sufficient, as evidenced by difficulties ex- mothers who had been trained to do school perienced in Brooklyn's Youth In Action -Pro- health referrals (the Harlem project leaders e entually obtained a $43,000 grant from the ject and Newark's frustrating relations wi@h v ' the Martland Hospital and medical school au- Ford Foundation to keep their program going). ministrations. Even in Harlem, where good The Lower East Side Project pre-project planning had enabled an early Students working with the Lower Fast Side start a month before everyone else began, Stu- Project will be placed with members of the dent Health Project workers experienced sev- North East Neighborhood Association, its dele- eral weeks of frustrating slowdowns of the gates or subcommittees and the NENA clinic 1 GREATER NEW YORK (a total health care clinic to be run jointly by sumed the controland management of this hos- the medical and Lower East Side communi- pital. The College's goal is to improve the ties). As consultants to community members health care delivered by the hospital. The Ne- concerned with the problem of health. care on wark Project will attempt to upgrade local the Lower East Side, students will gain a health care and community opinion of the hos- knowledge of community attitudes about pital through (1) "patient advocacy," (2) health care as well as of existing facilities clinics, and (3) improved student understand- serving health needs and related areas. There ing through exposure to the needs of the com- will be no door-to-door interviewing as factual munity. material can be obtained from the various (1) Patient Advocacy: Emergency Ro-om- agencies serving the area. Outpatient Department: Community attitudes will become apparent Students will work here (a) assisting the as students develop working relationships with patients who are receiving health care and community members. Students and community other social services which may be available; people will @develop a program of health educa- (b) helping achieve total patient care which tion responsive to community needs and priori- may not always be immediately possible be- ties vis-a-vis health services in the area. The cause of the mechanics or the attitude of the structure of the program and the type of hospital operation; (c) obtaining complete, health education needed to improve health care meaningful records of accidents and the condi- in a poor community will be determined by Stu- tions which produced them. dents and community members during the (2) Clinics: Student Health Organization summer' The program will stress the role of Evening Clinic for Chronic Diseases: the professional student as a consultant whose Members of the Student Health Organiza- activities are to be directed by the communi tion have already organized an evening clinic Specific activities will be determined by I at the NCH outpatient department. It is staffed needs of the community and prevailing circum- by five internists and two surgeons as well as stances. Particular assignments will be made several students who do the initial history-tak- on the basis of knowledge of the individual ing and screening and also necessary lab work. student gained during Orientation. Students This will be expanded during the summer to a will participate as fully as possible in commun- nightly or weekly schedule. ity life, and housing will be obtained in the (3) Student Exposure: Community Ob- area for those students who so desire. stetrics Interplay between students with discussion Development and use of a questionnaire for about roles, impressions, and difficulties will be maternity patients at Newark City Hospital. encouraged and the importance of the project Prenatal death rate in Newark is three times as a groupactivity will be stressed. By the end that of the State of New Tersey-some of the of the summer, each student will have a good reasons are: (a) Out-of-wedlock children get knowledge of health problems and community less care; (b) Care may be unavailable. life on the Lower East Side, of the community The questionnaire will investigate: members they will work with, and of, each family size, other. living conditions, The NeWark Project problems of pre-na care, During this past summer's 1967 disorders, nutritional problems. Newark City Hospital had the distinction of In conjunction with the information ob- being the only hospital in the United States to tained by the questionnaire, the students will be fired on by snipers. These shots were indica- focus on environmental problems. An outcome tive of the general dissatisfaction with the care of this might be establishment of a storefront given Newark citizens by the hospital. The prenatal clinic or some realistic health-care :a- New Jersey College of Medicine has just as- cility. 2 ' SUMMER 1968 The Brooklyn Project ant, Crown Heights and Brownsville neighbor- The Brooklyn project for this summer in- hoods is contemplated, in addition to other volves working through five different agencies functions. or institutions. Participants on the project may be able to work with more than one of these The Harlem Project agencies. On the basis of last summer's program at (1) Pediatric Outpatient Clinic of Kings Public School 175, a plan for this summer's County Hospital: Harlem Student Health Project has been de- Students will act as physician-assistants to signed, incorporating the knowledge gained help save physician time. Specific duties will and cooperation began with community resi- dents last summer. The new project will in- include: (a) Interpretation of instructions for troduce an adequate, readily financed, referral patients; (6) relaying of information on nutri- program. Harlem is an area noted for large tion, hygiene and accident prevention to the numbers of inhabitants unconnected.with any patients; (c) performing routine medical pro- cedures; (d) history-taking, with the aid of a health agency and for the f ui 'of school questionnaire to determine the entire medical health programs even to recognize the health problems of the students. The 1968 Student status of each family. A major responsibility Health Project will train community people to will be the training of community persons for paramedical positions. function on a year-round basis as health workers in the schools and as referral experts (2) St. Mary's Hospital: within the school community. The backbone of Students will act as physician-assistants as the project is the establishment of small in (1). In addition, they will work with the groups of parents who will meet with the Crown Heights Health Council in developing a health worker to discuss health care as a vital Health Rights and Resources Handbook for community issue. These health-conscious par- the community residents. ent groups will.begin to deal with redefinition (3) Bedford-Stuyvesant Youth In Action: of health germane to local community needs, With the assistance and supervision of the will establish babysitting and escort services, organization's professional staff, students will will act as a nidus for further community edu- interview clients with problems related to jobs, cation in nutrition, birth control, and pre- and medical care, legal aid, housing, job training, postnatal care. and nutrition. They will help secure the neces- Several local elementary schools and their sary services from existing agencies and per- Parent-Teacher Associations will serve as the form follow-ups on all patients. Involvement in project population. The PTA's with their ac- family counseling and group discussion ses- tive participation will be the sources for the sions will also be an integral function of this community contacts, for health worker train- project. Tutoring and homework study pro- ees, for homes to be used as meeting places, as grams are also planned. guides for answering pertinent health ques- (4) Brownsville Communitly Council: tions, as health committees to evaluate health Students will assist doctors in counseling on problems, as guides for SHP workers, and to contraceptive techniques, showing films and serve as an advisory group for the Pediatric conducting discussion groups. With the aid of Comprehensive Care Center. Cooperation with Neighborhood Youth Corps teenagers, pro- the original PTA group has been expanded grams of hygiene instruction in the commun- during the academic year and additional PTA's ity, a health cleanup program, and a survey of have pledged their participation. existing medical facilities are anticipated. The project will be. introduced at school (5) Central Brookly?i Model Cities Program: teacher-project staff meetings with the cooper- Details still to be worked out, but a compre- ation of the principal of each school. An evalu- hensive survey of health needs and resources ation of the role of the school health nurse- available to the residents of Bedford-Stuyves- her problems and needs-will be undertaken GREATER NEW YORK with her participation. Communication, with student and one nursing student, will organize an eye toward improving school health-care a child health survey in cooperation with four programs, will be maintained with the head of neighborhood day care centers for children School Health Programs of the New York City ages 6 to 16. Project fellows will be responsible Department of Health. for arranging discussion groups and films on Thus, health science students working in the health issues for community residents and Harlem SHP will work in the community with their children. They will also teach first aid to families, will deal with the referral problems, the Day Care Center counselors. The health and will develop with community support the survey will be made with the help of third and year-round bases for the project. A large pro- fourth year medical students. portion of the project staff will be housed (3) Mental Retardation: in Central Harlem. Two student fellows will work with a com- The education of the health science student munity organization which hag been given a will come from a door-to-door, person-to-per- grant for a summer day camp for mentally re- ' involvement in the problems tarded children. They will help organize com- son summer Harlem's health care system, and his contribu- munity support for submitting a larger grant tion will be his effort to deal with these prob- proposal for a permanent mental retardation lems in a short-term sense and to help create a center. long-range plan to solve these problems in (4) Unwed Mothers: ways that will be useful to the community. The Two student fellows will work with a cQm- opportunity to work and live in the Harlem munity worker at the Neighborhood Medical area should lead toward a contribution to Care Demonstration to organize a group of creating a better level of health in the com- unwed mothers for the purpose of obtaining munity. legal rights in housing, education, health prov- Participating institutions include Knicker- isions; obtaining good health care for them- bocker Hospital, the Harlem Health Center, selves and their children; gaining confidence to Harlem Hospital, members of the Columbia function as dignified human beings; and fur- University School of Public Health and Ad- thering educational opportunities. The student ministrative Medicine, and the Harlem Health fellows will work closely with salaried com@ Council. munity preceptors in motivation, guiding, and The South Bronx Project teaching. (1) Patient Advocacy: THE MOTIVATION Eight student fellows will work closely with The application essays of students who community organizers from four storefronts in wanted to work in this summer's project were defining the health needs of a circumscribed important criteria in the selection process. In slum neighborhood in the South Bronx. The reviewing the application essays (as well as fellows will make home visits, accompany pa- final reports) of accepted students after the tients to local clinics, monitor followup care, project ended, it could be seen that students distribute information on health care facilities, came to the project with many different moti- and prepare a Health Rights and Resources vations. Handbook. Each fellow will be accompanied in Although most students expressed more than his daily work by a member of the Neighbor- one reason for wanting to participate, by far hood Youth Corps. Special assignments will in- the largest essay category, consistent with clude a supervised study of medical patients, what seems to have been a primary objective and planning a biology and medical science of the SHP leadership, comprised those Stu- course in the newly organized Morrisania Com-. dents, who expected the summer to provide a munity College., learning experience, a chance to understand (2) Child Health: the people of the ghetto -and their problems, as Four project fellows, including one dental an extension of their professional educations. 4 SUMMER 1968 The second largest category consisted of stu- the only one. I want to do something that will dents who desired to offer specific service-ori- be of service to the community.- K.B., Medi- ented skills (e.g., health education programs) cal Student, Bronx. or just had an undefined desire "to help poor The experience will help me becomea better people get better health care." individual and perhaps enable me to under- Other motivation categories included those stand my environment better. I will learn from who expected to achieve some degree of self-ac: working with other members of the team as tualization by "giving of themselves," and those who hoped to compensate for the failings well as with the individuals I am trying to of our society vis-a-vis the pooi (or to assauge help. This will help me in deciding whether I their guilt in this regard). want to go into the field of public health after I graduate.-J.L., Nursing Student, Lower Interestingly enough, only a few of the ac- East Side. cepted applicants indicated in their application essays an interest in effecting changes in Besides bringing to the people my back- health care delivery systems and institutions ground and knowledge, I will be learning much through politically oriented activism. Yet, this from them. I will learn much about myself and. surfaced as a burning issue early in the sum- others. It is one thing to read and hear some- mer that split many of the projects right down thing, but another thing to actually know what the middle, and was the cause of much of the it's like to be poor. It will be quite an experi- frustration experienced by project participants ence and the personal satisfaction I hope to get that was expressed at the Final Conference out of it will be exactly why I went into nurs- and in their final reports. Only one applicant ing-not for the money, but to help people.- mentioned a need for the $900 stipend, but this J.0., Nursing Student, Newark. too turned out to be a matter of considerable Working in such a project should be very concern to many of the students as I e summer progressed. valuable in formation of my personality- broadening my understanding of life and The following excerpts illustrate not only awareness of problems of others. My primary the variety of motivations, but also the range goal is having some effect on the poor living of sophistication regarding the summer's possi- conditions and inequality problems.of the peo- bilities that participants brought to the pro- ple on the Lower East Side. ject. * * * I believe there is a great need for Participation in a Student Health Project showing people how to help themselves, rather seems to me to be crucial in my education than taking the attitude of condescension by * * * a unique opportunity to learn what I "helping" them, which has been proven unsuc- otherwise never could. cessful. I * * * I would hope to learn a new perspec- Aside from the vast intangible benefits, the tive on health care: a little insight into what financial aid would be of great assistance in life is like for the urban poor, some under- the coming school year.-B.G., Nursing Stu- standing of where health fits into the priorities dent, Lower East Side. of the community. I want to build my education during medical My main reason is to learn-about the school along relevant lines * * * and I want to ghettos and the people there, about the power work closely with a community before profes- structures presently in existence and ways to sionalism puts too much distance between us change those structures, about health services * * * I want to make sure that community in the city (or lack thereof ), and how those health is the foundation of my education, not served would like to see health care changed. the capstone. -I.B., Medical Student, Bronx. My own education is the primary reason I I felt the job afforded one of my last oppor- want to work on a project this summer, but not tunities for a "dose of liberalism," so to spea c. 5 GREATER NEW YORK It potentially offered insight into the problems our societyand try our hand at curing our itso- of the disenfranchised that a hospital setting cial disease." My goal was to give of myself will never offer. The desirability of working as and in doing so find out what I was really part of a community health team also caught made of. I wanted people to tell me how I could my imagination. I felt that the role of a medi- be of some use; I wanted to understand the cal student in o. project might, in some small people of the community and wanted them to way, differ from that of a nurse, social worker, understand and believe in me.-D.Y., Medical lawyer, etc. This too, I thought, would broaden Student, Brooklyn. my outlook concerning possible solutions to There is nothing worse than a hypocrite or community health problems. A third lure of martyr in the ghetto. Bad enough I'm white the position was the opportunity the job of- and middle class. I'm enthused by the idea of fered for community contact, though I must really offering these people something con- admit that my concept of my role in commun- crete, of doing something they can't now do for ity interaction was nebulous even before I be- themselves, or working with them to begin gan.-J.R., Medical Student, Brooklyn. something that won't end with the summer.- I have not had the experience to know P.G., Sociology Student, Harlem. what real poverty is. I feel that I should have I like working with people and caring for the experience of working in a poverty area -and becoming more familiar with what cul- the sick. However, I feel that hospital nursing tural and racial factors prevent individuals is too confined for the kind of care many peo- from living a healthful life. I want to come to ple require. * * * By going into a perso-n's the level of these people to see their problems home you can see the type of problems he has more clearly, discuss these problems with the to face every day. * * * I would like to try to people and other members of the health pro- help in finding a solution to a few of these problems and I feel I could be of some service ject, and work on possible solutions to the because I want to help. On the selfish side, problems. I think I will be able to have a fuller working with people in poverty areas would understanding of how I, as a nurse, can help benefit me. It would enable me to once again these people achieve the standard o iving see the nursing profession as I did before I they deserve. * * * I would be able i share my experience with my classmates in nursing chose to enter it. Finally, as a Negro, I have a strong desire to help my own people.-A.C., school when I returned in September, so they Nursing Student, Newark. too could learn more about how to help the poor with their health problems.-L.D., Nurs- It has long been my goal to assist less for- ing Student, Newark. tunate persons in obtaining human dignity by helping them to secure equal-justice under law Medicine is a full-time job in its strictest and a decent standard of living, which includes sense. Yet, to turn away from the full man all -necessary medical care as a right not a pri- (i.e., in and affected by his society) is too strict vilege. a definition of medicine. Consequently, I wish * * * I consider this project an opportunity to study, observe, and "get the feel of" what to help and not a job or a t@k.-N.W., Law affects man. This, I believe, will enable M6 to Student, Newark. diagnose the cause and alleviate the effect.- J.C., Medical Student, Lower Ecut Side. When I found out that I had been accepted for a second summer with the Student Health The Orientation had impressed on us the im- Project, I was both excited and optimistic portance of the job. We couldn't even call it a about the summer to come. I was anxious to job; it was more of a mission in understanding. build upon last summer's experiences, using Our goals were many. Some of us wanted to my knowledge to accomplish something defi- find out what life in the slums was really like. nite. Last summer I had not expected to accom- Some of Us wanted to find out what was ailing plish anything, and I was pleased with what 6 SUMMER 1968 little I was able to do. In contrast, this summer the curriculum to include instruction and expe- l had higher expectations, partly because of . rience in community medicine. my experiences last semester in leadership and * * -,': I am concerned with health problems group dynamics *-V.V., Nursing Stu- of the poor and uneducated. SHO asserts the dent, Bronx. right of every man to comprehensive health Working in the SHP last summer was an e service; I completely support that assertion and I consider it my duty * * * to do every- lightening and exciting experience for me. i thing to provide effective health programs for learned more about the reality of medical care all people.-L.B., Medical Student, Harlem. as it exists for the majority of Americans in those few short weeks than in my 2 years of My experience would also enable me medical school. to encourage Stanford to set up an SHO sum- * * * I felt that perhaps this summer, with mer program of its own to serve the needs of some of the initial learning process * * * be- the Palo Alto community.-B.W., Medical Stu- hind me, I might be able to do a lot more than dent, Newark. last year.-M.M., Medical Student, Brooklyn. * * * I feel the commitment to offer assist- I have a brother-in-law who is a "social ance to that part of the population which has work" minister * * * and who has e.:ee ed generally gotten the nation's digested food- significant change * * * through similar stuffs as daily fare. * * * The experience I grass-rootsactivities * * * would get from this project is of the sort that I I feel that the SHO projects are significant would be able to use in my day-to-day contacts efforts to bring about important changes in the with other fellow students and attack their health care people in these communities have motivations and purposes and try to interest been receiving. I want to be a part of this ef- the great uncommitted. In my professional role fort.-W.S., Medical Student, Halrem. I believe this summer's experience would be a big step in defining for me exactly what I want I think I should be a part of this project, -not to do in the health. field.-D.T., Student Coor- because I am any more qualified than other ap- dinator, Newark. plicants to do community organizing, or to work with poor and minority groups in the so- As a white person, I share with my society lution of their particular problem, but because the guilt of having manipulated the "poor." as a law student I am trained in "social engi- * @ * * I want to give all the life I've got to un- neering"-the ordering of institutions of soci- ravel the. tangled mess that exists.-B.M., ety under the law. I want to do more than sim- Nursing Student, Bronx. ply alleviate suffering for a summer. I want to * * * I felt quite hypocritical since my po- change the institutions that have so far been litical and social convictions were distant from unable to do the job. our nation's practices and I was not doing any- * * * I want to hasten the day when such thing to express my dissent. projects are no longer necessary, and working * * * SHO filled this discontent that was on this project will provide me with invalu !@le growing more and more in me. The work Iam practical experience, which I hope I can utilize -1 - to help bring about long-run changes in the aoing seems to be at least a step in the right law@R.H., Law Student, Brooklyn. direction.-L.K., Medical Student, Brooklyn. 11 For me, working directly with the underpri. The present medical curriculum at Corneii vileged would be one small way of putting good places little emphasis on ghetto problems ana intentions into action.-V.S., Dental Student, solutions, so as an SHO participant I would be filling a gap in my medical education. Further- Bronx. more, I might be so affected by the program I am aware of the sad fact that my profes- that I could work effectively toward changing sion has devoted its energy almost entirely to 7 GREATER NEW YORK middle class patients, and as a psychologist I I have long been disturbed by the relegation hope eventually to move things out into the of the individual to a mere cog in society's gar- communities where he lp is most needed. gantuan machine. Indeed, in .4n age when we * * * The main reason for my wanting to tend to appreciate humanity only as an amor- be part of this program is simply that I would phous mass, medicine should reassert the need like to do something worthwhile this summer for appreciation of the individual's worth. Yet, * * * I have not felt particularly effective this it appears to me that organized medicine has year, sitting in the library studying while so often lost sight of this goal. Poverty may be an much immediate concrete work has to be done. abstraction, poor people are real. Med'l%--"'. I also cannot help but feel totally frustrated school can be a terribly discouraging enter- with the condition of this country today. At a prise for a student who sees medicine as more than a mere "profession." I would like time when positive action is needed I would be medicine to be a means for deepening my un- particularly grateful to get out and do some derstanding of people and for my rendering a tangible and helpful work.-M.I., Psychology genuinely useful social service.-D.S., Medical Student, Harlem. Student, Lower East Side. 8 Part 2: THE REALITY INTRODUCTION lost almost all of its neighborhood practition- After 3 days of "Orientation" to the summer ers. ahead (held at an upstate New York resort), The South Bronx, which is just a short drive the SHP student fellows and community from down-town Manhattan, has traditionally workers officially arrived in the five ghetto been a rapidly changing community of immi- communities of Greater New York City on grants. At present, it is a Negro and Puerto June 27, 1968, eager to begin implementing Rican area which has few private medical their formidable task proposal. practitioners. Its hospitals and health centers Bedford-Stuyvesant, typical of the communi- are overcrowded. There s a high in an mo a - ties in which the Brooklyn SHP was located, ity rate in many health districts, and lead poi- has soning of infants, rat bites, and drug addiction a population of 190,000, 85 percent of whom are black. The median family income is are great community problems. far below that for the city as a whole and the Health.services in the South Bronx are pro- unemployment rate of 7.2 percent is more than vided by ambulatory care centers in Morri- double the national average. The usual slum sania Hospital, Lincoln hospital, and by many pattern of inferior, inadequate housing, new neighborhood service centers for mater- schools, sanitation, and recreation facilities nity care and mental health. Most inpatient prevails. The majority of inpatients are seen in services are provided by the hospitals men- the massive, 3,000-bed Kings County Hospital, tioned above. One of the great innovations in outpatients using any of the hospital's 32 over- primary medical care for this medically indi- crowded clinics. There are woeful shortages of gent area is the Neighborhood Medical Care community practitioners, dentists, and home Demonstration (NMCD), funded by OEO as a care services. Essentially similar statements demonstration project. This center as een a could be made for the Brownsville community, great help in changing the pattern of health served by Brookdale Hospital, and the Crown care delivery. North of Central, Park, New Heights community, served by St. Mary's Hos- York City changes its complexion. It becomes a pital. teeming ghetto of closely packed houses, lit- Newark, a city of 405,000, can claim the tered streets, and alienated citizens-Harlem. highest of any national crime rates, the high- Summer in this neighborhood means the swel- est national incidence of tuberculosis, alcohol- tering humidity and scorching heat of poorly ism, venereal disease, and drug addiction. Its ventilated apartments forcing youth into their health profile reflects the ignorance, bitterness, playgrounds on the streets. The freedom of and despair of a -large segment of the city's summer turns into an endless ballgame or wad- ]population which had hoped to escape the ing pool filled by gushing water hydrants. blight of the decaying rural South. Newark Although Harlem has the high unemploy- has proven, instead, to be a blind alley whose ment and crime rates characteristic of other only exit is often through inward self-destruc- depressed areas, one of the most troubling as- tion of explosive violence of varying degree. pects of life is the inability of youth to im- Health services in Newark are provided prove their fate. They receive few aids to im- mainly by Newark City Hospital (Martland), pro%-ement and have many chronic health prob- which lies in the center of the Central Ward, lems, some of which are direct results of their one of the city's largest ghettos. The area has environment. GREATER NEW YORK Harlem is served by Harlem Hospital, these views have not been changed but, rather, K-nickerbocker Hospital, private practitioners, reinforced. I have come to consider the urban and practitioners of folk medicine. This area ghetto -another country: an isolated colony of has one of the highest infant mortality rates in the United States, dependent upon the U.S. New York City. Lead poisoning and rat bites economy for its essential needs, at the same have traditionally been health hazards for time not being a part of the mainstream of so- those who live in the ancient housing of this ciety nor sharing on an equal basis the wealth predominantly Negro community. existing in this great Nation. The Lower East Side has traditionally been Like most colonies, Bedford Stuyvesant is the home of immigrants. Puerto Ric-ans and economically underdeveloped; furthermore, it Chinese now makeup the larger part of the is exploited by those who have control over its community but there are still many Jews, Ne- existing economy. This economy is one which is groes, Ukranians, and Italians. The median setup in such a way that it takes the small grcss income is approximately $2,000 less than monetary resources which do exist and drains the average for the city. Drug addiction, alco- them from circulation in the community. Like holism, and crime are the main problems in other economies of the world, the affluence of this neighborhood, where many inhabitants the people in an urban community depends speak little or no English. The public schools upon how much money enters the community hat-e been abandoned by those families who and how many times that money exchanges can afford to do so. As much as 10 percent of hands within the community. Money can enter the total labor force many be unemployed at in the form of payment for goods and services, any one time. wages, interests, and rents. Health services are provided by 106 private For the most part, communities like Bedford practitioners, more than 40 of whom work in Stuyvesant are unproductive: no industries the Wall Street area and in effect do -not pro- exist and no goods are manufactured in the vide medical care to the inhabitants of the community. Therefore, money does not enter Lower East Side. In recent years the Gouver- for payment of goods. On the contrary, money neur Ambulatory Care Unit of Beth Israel leaves in the form of payment for essential Hospital and the Judson Health Center have goods produced outside of the community by delivered the bulk of primary medical care. In- nonresidents. The obvious solution to this patient services are provided by Beth Israel problem is to bring more industry into the Hospital,and the mammoth Bellevue Hospital. community. Such industries should be owned Although many of the SHP workers had and run by residents and should provide essen- some prior understanding of The Reality of the tial goods for residents and/or nonresidents. health care delivery deficiencies in these com- (This is presently being done on a small scale munities (at least from a professional point in the clothing industry.) of view), the awakening of many participants In the case of interest, we see another vehi- to the realities of life in a ghetto environment cle for the exit of money from the community. and the circumstances of health care delivery There are few creditors, if any, in Bedford from the patient's side of the admitting desk Stuyvesant; there are, however, a great many constituted the first stage of the "learning ex- debtors. perience"'that was, perhaps, the most signi@fi- cant of the summer. Rents represent a large drain on the com- munity's monetary resources. I, for one, think VIEWS OF THE COMMUNITY that rents should,be taxed away, thus abolish- ing landlords from the face of the earth. Brooklyn Rents in the pure economic sense are money At the beginning of the summer I had certain paid in return for which no goods or services ideas about the problems existing in the Bed- are given. (A perfect example of this are rents ford Stuyvesant community. For the most part, paid by Nebraskan farmers to individuals or 10 SUMMER 1968 corporations completely removed from the ter paying jobs. "To get a good job, get a good land.) The land was here long before any land- education." Education and vocational training lord came into existence; furthermore, the represent major tools for improving the econ- land will be here long after the last of the land- omy of any economically underdeveloped area. lords has turned back into dust. I believe that The rendering of services represents a po- no mortal being has the right to claim that he tential means of keeping money circulating owns so much as 1 square inch of soil on the within a community. But this is another area face of the earth. Rents and the ownership of which represents a drain on the community re- land is purely a European concept. In Asia and sources. One of the larger services provided is Africa people live on and work the land but the sale and distribution of essential goods in the landlord-tenant relationship is unheard of. the community-food and clothing. This serv- Slumlords are the same type of landlords ice is provided by large corporations and mer- as those who rent land to tenant farmers: they chants who are, for the most part, nonresi- accept rents; they provide essentially no ser- dents. These are the men who drive down'from vices; they don't keep the buildings in good the suburbs in the morning and leave at night, condition; often they don't provide heat or hot often exploiting the community residents by water, proper garbage disposal, or elimination selling poor quality goods at high prices. of rats, roaches, and other health hazards. The In recent years, programs have been started few services their tenants do receive are pro- to encourage community residents to enter into vided by the city, not by the landlords to whom small businesses, largely in the merchant field. they pay rent and from whom they should re- Such programs, however, will continue to have ceive services for said payment. limited success unless residents are provided Article 7A is a law which has been setup in with the knowledge necessary to run a small New York to deal with this problem. It prov- business. Once again, the issue is the need for ides for the withholding of rents from land- adequate education. lords who fall to supply required services. At the present time there is an attempt The rents withheld are used by the city to being made by residents to provide themselves provide the services to which the tenants have with a service once rendered by nonresidents, a right and which the landlords have not seen often in a discriminatory manner: taxicab serv- fit to give. At the present time, however, this ice. The medallion cabs are licensed by the po- law is not being applied on the scale necessary lice department-the gypsy cabs are licensed to deal with the problem. by the people' "Black Pearl means Black Wages are the major route for the entrance Power." Indeed, if Black Pearl, the private.cab of money into the Bedford Stuyvesant com- service association, wins its fight to exist, it munity. The problem is that these wages are , will have a beneficial effect on the economy. not enough to support the economy of the com- The existence of the gypsy cabs serves to keep munity. One reason is high unemployment, an- money circulating among residents of the com- other is the type of employment available. The munity. jobs which are available to the population, for In this report, I've concerned myself with the most part unskilled and uneducated, are problems other than health problems existing usually low-paying. in Bedford Stuyvesant which, when solved, If the economy of the community is to be will elevate the community into the main- strengthened, more money must enter. One stream of American society. I cannot deny that way of doing this is to raise the total wages of health-care delivery is a problem in the com- the community, which can be done by creating munity. However, its solution will not upgra' de new jobs to meet the level of knowledge and the status of residents of the community. They skill already in existence. At the same time, if realize this, and therefore health care h@'low education and vocational training are 'im- priority. I recognized this at the beginnin@g@'of proved, residents will be able to move into bet- the summer and chose to work in the Youth In GREATER NEW YORK Action education program rather than in a day night you will see people having fun. In health problem area. Brownsville people walk along depressed with The students working in the YIA homework their heads held low, many nodding from their study program were criticised for devoting last fix. There is little spirit in this community their full time to this program. The basis of and that is why working here is difficult. There this criticism was that the project was not ori- are no chapters of CORE, SNCC, or other na- ented toward health. I trust that the people tional organizations Thus these people are not who felt this way are now beginning to realize aware of much more than their immediate that health is not of high priority among the personal needs.-D.K., Medical Student Brook- problems of the urban ghetto, justas it is not lYn. in other economically underdeveloped parts of the world. Brooklyn in such areas the problems to be solved first For too long we have been satisfied with are economic ones. Western countries have often charity where rights are involved. The legal solved the health problems of undeveloped coun- profession has been a major offender in this tries long before they have even begun to think area, but there is reason for optimism in recent about socioeconomic difficulties. One result has decisions of the courts. The problem of the been a population explosion which makes it poor is that they do not have enough money. that much harder to solve economic probleIms. That is not their only problem, but their other Indeed, in most instances the economic progress hangups are shared with their more affluent has been nullified by the population explosion. brothers. The solution is not to provide the Another solution offered by the Western poor with goods and services, food stamps, wel- countries has been foreign aid, charity and fare, or free medical care at special clinics, but handouts, all of which have no positive effect to get money into their hands. They should whatsoever on the economic development that have the same opportunity to squander their would eventually eliminate the need for aid money on what many would deem less benefi- and reduce the dependency of the undeveloped cial services as anyone else, for who is compe- areas on the Western world. tent to tell another what is worthwhile and The same sort of Christian ethic which has what is not? It is paternalistic for the affluent shaped the relationship of the West to the un- society to decide what is good for those who are not affluent. The poor are not free, for derdeveloped areas of the world has shaped their only choice is between starvation and ac- the approaches the Federal Government has cepting largess with strings attached. Our wel- chosen to solve the problems of the ghetto. fare laws date back to the Elizabethan Poor Such programs as medicaid, welfare, and other assorted handouts are all very beautiful ideas, Laws, when being poverty stricken was akin to but in the end they don't even scratch the sur- being a criminal. face of the problems which exist. If all the Paternalism in society has the same conse- health problems of the urban ghetto were quences as paternalism in the family-the son solved tomorrow, the only significant change must rebel against the father before he can would be that there would be a lot of 'health feel himself a man. We are seeing the results . y of this policy in the rising crime -rate and people throwing bricks and bottles at police- urban riots, at a tremendous monetary cost to men and firemen.-R.J.,Medical Student Brook- society. Those who do not rebel become depen- lyn. dent, docile, unwilling to change, lest they some- In working in Brownsville, one must take how run afoul of some welfare regulation into consideration something not found in and have their relief check reduced. As for the other ghetto areas; Brownsville is a very unor- rest of society, it gets its money's worth in the ganized community; there are many deserted psychological satisfaction of moral indigna- houses all over that were burned out. and are tion, and retains its ability to discriminate waiting to be demolished. In Harlem on a Fri- against the poor. They are kept in ghetto 12 SUMMER 1968 areas, in public-housing projects. They do not without having the qualities of the product or have access to the same professional, educa- the terms of the contract fully disclosed. Such a tional, and. social opportunity as their affluent statute is fully consistent with modern theories neighbors. The legal aid society, the county of tort liability, in which the risk of liability is hospital, and all other agencies which require placed upon the party most able to insure a means test are separate from the agencies or against the risk. facilities used by those with money. The Su- The problem is not with the poor, it is with preme Court has held that separate is inher- the institutions and the laws. People, even poor ently unequal in regard to education and race. people, can see what is in their own best inter- Perhaps the same reasoning applies to poverty. ests. No one else can do that for them. What Discrimination on the basis of rich and poor one can do is try to educate, persuade, and may violate the equal protection clause of the make available. Certainly there is less need for 14th amendment. public health services if everyone can afford Furthermore, abolishing this discrimination his own doctor.-R.H., Law Student, Brooklyn. may save tax dollars. If everyone had money, I don't imagine community people feel very then everyone could be sued and would be in- much about health care one way or the other. surable, and many crimes could be converted It's a sort of episodic thing. You go when'you into torts. A burglar, arsonist, or murderer need to go. Some people are regulars, according could be sued for damages by the victim, thus to the nurses. They come to the hospital like killing three birds with one stone: the "crimi- some people go for walks or play mah-iong or nal-tortfeasor" would be punished, the victim go to the movies. That is not to say that they would be compensated, and society would be are malingerers, but only that St. Mary's Hos- saved the expense of keeping the man in pital is as much a part of their daily existence prison. The few really dangerous people could as anything else in the Brooklyn communi . continue to be dealt with by custodial treat- People want care and do, for the most part, ment, but with more due process guarantees- have confidence in doctors as a breed W10 preferably as mental patients. There are other know their business, but they do not often per- costs that would be saved. The waste involved ceive the professional's ideas on better health in relocating slums by urban renewal, sending care as being great improvements. Taking the city dwellers to the suburbs, building freeways time to answer questions on a. medical history to bring them to and from the city, then hav- form may help the doctor, but it is not always ing to deal with the resulting smog problem, welcome to the patient who has to 90 home to and then watching the same thing happen over the other kids.-M.H. Sociology Student, again in another place is costing more than an Brooklyn. outright gift of a minimum standard of living rp e basic problem I found this summer in to every poor person. And the human cost in Lh -- 'Brooklyn is that the medical problems from terms of physical health, and emotional in:3e- which the poorer communities suffer are less curity is difficult to calculate. important to them than problems of survival. Just how this minimum amount of money is A toothache isn't important if you're starving. provided is a decision for the legislature. It @ Even with medicare and medicaid it is costly may be done through a negative income tax, or for a ghetto mother to obtain care for her kids. through recognition of a right to employment, Often babysitting' services are needed and either with government or indirectly with pri- transportation to the hospital is time-consum- vate enterprise. The latter should include the ing. Accounting for the costs of a babysitter or choice of quitting and taking another job. An a taxi can be a big order for many families. additional means would be to enact legislation The result is that medical care is neglected requiring full disclosure by merchants, loan until a serious problem arises. . companies and landlords, and granting treble In poverty areas, where people are more, con- damages to any person who deals with them cerned about money for food and clothes and GREATER NEW YORK things like that, health care has to take a sec- munity which has a defensive shield around ondary position because it is not as immediate it? P.D., Medical Student, Neivark. a need. This is the problem in Brooklyn. We The people are on the verge of a major re- find that to a lot of the residents, health care is volt. Right now, they are awaiting the election equated with emergency room care. There is very little concern for preventive medicine.- year, but if Newark does not have a black W.S., Stttdent Coordinator, Brooklyn. mayor and a black majority council in 1970, Newark will burii. Newark's blacks are not Newark only tired of poor health care but also of the What is this community that we were to whole political system.-D.B., Com reach? They did not respond to radio appeals, Worker, Neivark. personal appeals, or flyers. The "leaders" we Newark-born, I never realized how badly in attempted to integrate within our local organi- need my people are. I never knew how disinter- zation did not "produce." A person suggested ested they are in their surroundings, that. ey as a leader by our community worker promised don't care to come out and help themselves or to reach "different folks with different to take part in building a better place in whid i strokes," but when we failed to move our or- they could get a better outlook on life. ganization into his domain he evaporated. To I never knew that a community of people the outsider, the New-ark "community" is apa- could stand to be content where there are so thetic and hardened against any type of appeal many disadvantages, not only with housing, to join and march. They generally fear and clinics, welfare, and schools, but with many dislike the treatment that they have received other everyday things. from the city at Martland Hospital, but they As a community worker in Newark, I hope, will not rally with the white liberals to upset during the next 10 years, that the people will the status quo. What is the community? They come outand be willing to take part in trying are a disparate group of leaders jockeying for to build a better community in which they can power and, perhaps, money, within a cross-sec- live. It will take time to give the black people tion of distorted values (by white middle-class back their confidence in any new organization, standards). To "them" we are richer, different health or otherwise. The needs are far too deep outsiders who in many eases don't belong. for a mere 10 weeks of SHP to help them help These are things I feel very strongly about: themselves. They don't know who to listen to: apathy and what is the community here, who for too many years black people have been lied represents the community, who are the com- to by all kinds of so-called do-gooders. I pray munity leaders? I don't think anybody knows. that the services that SHP has offered the peo- We ran into problems with the administration ple of the ghetto area in Newark have not been of the hospital and the administration of the a total loss, but only a start for better under- medical school because they thought we were standing between the hospital and the black upsetting the community, but I think they community.-K.C. Community Worker, New- were entirely wrong. I don't think they know ark. who the community is (though they think they do) and I don't think we know. The adminis- Newark tration doesn't feel that these people are repre- * * * The newest and most popular weapon sentative, these mothers who have been wait- in the war on poverty's arsenal is an attempt ing four hours in a clinic or the factory to change a common feeling in the ghetto or. workers who have to be dragged to a meeting. despair and powerlessness into one of hope and Another thing is the tremendous disappoint- a sense of power over one's life by giving the ment you get when you think you've got com- community control of decentralized local pro- munity involvement and -no one shows 'up at grams and institutions. This approach may have the meeting, which was pretty -normal for us. some validity as a line of communication and a The question is, how do you reach this com- peaceable channel for protest which forestalls 14 SUMMER 1968 or helps to prevent ghetto insurrections. How- Harlem community was, "who is the commun- ever, the experience I have had in observing ity?" Here I was really stumped. Out in the the United Community Corporation Area Midwest where I grew up, communities were Boards in Newark suggests that the commun- pretty homogeneous. But in an area such as ity approach is not very effective in alleviating central Harlem, community is almost indefin- hard-core poverty. These Area Boards are fail- able. The community of Lenox Terrace (high- ures because they do not reach significant num- income housing) is infinitely different from the bers of the real poor. In large part, the real community of the middle and low income hous- poor include those without the time, energy, ing project across the street, and both differ knowledge, or hope to go to the meetings of the greatly from the community of brownstone Area Boards, to speak up to and not be intimi- tenements they face. The community of well- dated by the clique who run the meetings. The kept brownstones in the block of West 137th United Community Corporation spends vast Street out of which we were working was very sums on rent and office equipment, and very lit- different f rom the run-down brownstones on tle, if any, money or material goods gets to the same street across Seventh Avenue. Not to those who need them the most. mention the multiplicity of self-anointed com- Much better than this approach would be an munity leaders and ad hoc community groups individual approach to the universal problem working independently toward the same objec- of poverty, for example, low income. This tives.-W.S., Medical Student, Harlem. would involve an overhaul of the welfare sys- Harlem Hospital was presented to me as a tem to provide something like a guaranteed minimum income and other features designed place where people go to die. Columbia Univer- get off wel sity and its students were portrayed as an in- to make it possible for persons to fare, for example, enough babysitting stations stitution that had in some way or another so that a mother of dependent children (70 created the woes and hardships of the people in Harlem. The city fathers have been neglect- percent of all welfare cases) can leave her ing Harlem, I was told, and a most impressive children and work. If a welfare recipient does start making money or inherits some, he illustration of this is the beautiful, ultramod- should not have to give it all back to the Gov- ern but too long unfinished Harlem Hospital- ernment and thus have to remain on welfare. a structure which seems to tantalize the peo- There must be an incentive to welfare recipi- ple. I was told that community control was the only way out and to get this it was necessary to ents to get off welfare; it should be riiade possi- demonstrate. It seems, however that many a ble to earn more by working than by being on I welfare by providing that money earned is not demonstration had gone for nought in the past. deducted from the welfare check. The present As I passed our neighbors day after day, I welfare system provides no such incentive. In could sense their confusion, frustration, and contempt. They were vexed.-E.M., Law Stv, fact, the existing welfare system is producing dent, Harlem. second and third generations of welfare recipi- ents by such features as requiring children re- Harlem ceiving aid to dependent children to give what- The attitudes that people have about facili ever money they earn to the family who then have that amount deducted from the welfare ties, without even using them, are subtle and difficult to document. Nevertheless, there were check. Neither the mother or the child have any incentive to get a job because it is almost a "Te things that came up over and over again foregone conclusion that neither can get a job which had little to do with the actual health which pays much more than the welfare check. care delivery facilities, but which kept people -N.W., Law Student, Newark. away. Health is not a high priority issue for many Harlem people who live in Harlem; health care often The biggest problem I felt in working in the means the alleviation of a medical emergency, 15 GREATER NEW YORK not preventive care or the treatment of prob- Going in and among the people, through lems that aren't causing immediate, severe some dirty hallways to-almost always-the pain. We ran across numerous cases of people topmost floor, seeing the undelivered -garbage who had not taken their children to treatment, on the landings and around the buildings made even after referral, simply because they didn't me wonder why it is that the city does not do think it was important enough. something about it all. This left me with an Lack of knowledge about health and health impotent feeling when I realized that we have facilities is one of the reasons for the low came and will be going and leaving these peo- priority; people may not know that a hernia pie in the same conditions and knowing full can strangulate and become a serious problem well that what we have done hardly began to very quickly, or they may not know that there scratch the surface. are specialty clinics for problems such as obe- It seems to me that SHP, and through no sity. People seem to think that if a problem fault of our own, is really powerless to effect isn't causing immediate discomfort then it any meaningful change in the lives of these probably isn't very serious. If someone does @eople, except that we can bring the needs of impress on them the seriousness of the prob- the whole community to the attention of the lem, or if a mother is seared because she @owers-that-be with the hope that some social thinks the problem might be serious but isn't cliange will be effected which will lessen some sure, we found that she would usually take the medical problems encountered in the commun- child to a treatment facility. The lack of knowl- edge about facilities 'available was noted but Let's face it. The incidence of poor eye sight, was sometimes an excuse rather than a serious TB, and rheumatic heart disease bears a direct hindrance. relationship to the socioeconomic conditions of Perhaps the major reason why health does the environment in which they are found.-J.H. not have a very high priority in Harlem is that Medical Student, Harlem. there are so many other problems facing peo- In terms of health-care delivery, the most ple who live there that have more to do with important differences I discerned in Harlem simply keeping food on the table and keeping a are matters of priorities. Residents of Har- decent apartment. Rather than try to describe lem's Lenox Terrace, and the middle-class ori- the galaxy of social problems that afflict people ented mothers with whom we worked, can af- living in Harlem, I will outline a few: Health ford to be concerned about preventive medi- care is expensive; not only does treatment at a, cine, dental care, and the like, because their clinic or a doctor's office cost a lot, but it may physical and psychological environments are mean the loss of half a day's salary to go to more in order than those of the slum tenement an appointment. Added to this may be the cost families across the street. of a babysitter to take care of a mother's other Some of the mothers whom I visited had an children, and transportation costs to get to the entirely different hierachy of priorities, and relatively centralized health facilities in Har- preventive medicine was far down on their lem. As a result', checkups or non-emergency lists, below housing, food, and crisis medical problems are often prohibitively expensive. care, their major concerns were matters of Moreover, people who live in Harlem may be day-to-day survival in a hostile, uncaring, un- more interested in getting a job with a steady responsive world. salary than in attending to health problems. I found it very difficult to convince myself, Housing conditions or keeping up With Pay- much less a tired, distraught mother of several ments on merchandise may come before health. children, that one of her kids needed a general Preventive medicine.may be impossible in a sit- checkup "just because" when they were sleep- uation where there is a general lack of a fu- ing three to a bed in a dark, smelly, roach-in- ture orientation.-R.C., Student Coordination, fested two-room hovel for which she paid $90 a Harlem. month. 16 SUMMER 1968 I felt that I was in no position (strange out- help them if they have health problems.-M.G., sider, inexperienced student) to address myself Community Worker, Bronx. to her real problems and that even if I turned Bronx her case over to one of our law students, there There is mixed opinion in the community was little he could do for her either. Should we have come more prepared to direct ourselves to about the health care they are receiving. It is those needs that the people in the community obvious, however, as you go from home to consider more pressing than non-crisis health home, which family does its best for its chil- care? If so, what can we really offer at all ex- dren -and which do not even try to secure the cept a body willing to do legwork or babysit? care available to them. Mothers are often ne- (Actually, we don't have that much more to glectful except when it comes to themselves. offer!)-W.S., Medical Student, Harlem. Children are dirty and unclothed and receive no medical attention. Other mothers of equal- Bronx sized families in the same area do not live ela- The mothers' classes in the Bronx were not borately, but the home and children are clean attended because the mothers did not see at- and they do their best. They are the ones who tending classes as a priority need. When a do not complain too much if asked about medi- mother has unsolved problems with welfare -cal care, although everyone has some gripes and housing, she really is not too concerned about hospitals such as Morrisania. The ne- about what happens to her body during preg_ glectful mothers are more dissatisfied, but nancy. I am not suggesting that there is not a. again are primarily uninterested or despairing. need for such classes, but more immediate -P.E-, Nursing Student, Bronx. needs should be taken care of first. A better ap- I really couldn't state in words the feeling of proach to providing health classes may be to disgust and the "I don't give a-" attitude that work through welfare rights or housing the people in the South Bronx have toward the groups. There is a need for individual health hospitals and clinics.- counseling for people facing specific health H.H., Nursing Student, Bronx. problems, but hoping to form a group for the sole purpose of health classes is unrealistic.- Lower East Side V.V., Nursing Student, Bronx. Much of our information concerning the I felt out of place forcing the issue of health Lower East Side community's view of the care when the tenants had many other things health care in the area was collected by means they wanted first, especially housing repairs, of random canvassing throughout the commun- full welfare benefits, and better police protec- ity. As with most methods of canvassing, there tion. The health care I heard about sounded are no real instruments to measure the validity like all the cliches-poor quality, fragmented, of expressed opinion and experience. There- inaccessible, without regard for the dignity of fore, after sifting through generalities, in- the patient, in the control of external institu- dividual misfortunes, etc., we focused upon a tions. On the whole, I think the real lack was number of problems that appeared to be repre- in preventive measures. The housing code on sentative of the community as a whole. The two hazardous and unhealthful conditions is not problematic areas to which our group initially enforced, garbage is not collected, walls and directed most of our time and energy were: (1) ceilings let rats and roaches through, diets are The recently instituted medicaid and medicare often skimpy.-K.B., Medical Student, Bronx. sliding-scale classifications for clinic fees; and -- (2) the transportation problem wherein people When SHP comes back, please do not ask the found it an inconvenience to travel to and from community how you can help them because you the Bellevue outpatient clinics.-E.C., Medical will hear everything but health problems. Student, Lower East Side. They will tell you welfare, housing, play streets. Just let them know you are willing to If we in the Lower East Side SHP regard YORK GREATER NEW ourselves as healers of a chronically ill system made worse by the scarcity of taxicabs cruis- of health care delivery, then our treatment of ing the Lower East Side and the absence of it this summer can best be described as symp- subway facilities in the area. tomatic. I do not believe that the health care Bellevue is a huge, impersonal institution; a problems of the Lower East Side are related to very easy place to get lost in. The structure is the methods of health care delivery per se. It is too large, the passageways too cavernous, and unfortunate, for example, that a patient may the directional signs are abysmally inadequate. have to wait a long time at an allergy clinic for These features are especially formidable obsta- his turn to see a doctor; but if we find that the cles to patients lacking a firm command of the patient"s allergy responds remarkably well to English language. moving him from his dirty, roach-infested ten- * * * We regarded our group as a commun- ement to a clean and airy apartment house, ity-located action organization working with mustn't we admit to ourselves that the prob- Bellevue to effect changes that would improve lem, really, is in the housing? I believe that the delivery of health services to the Lower future Student Health Projects will make more East Side. Early in the summer we developed a enduring and important changes in the health productive liaison with the department of pedi- of the communities they work in if they con- atries, whose director served as advisor to our cern themselves more with social, economic, group throughout the summer. We had in- and political activism, and less with estab- tended to focus our efforts on the pediatrics lished medical facilities or health-oriented com- clinic, but discovered that this department of munity organizations which are, afterall, dedi- Bellevue was very sensitive to the -problems of cated to the maintenance of the status quo. Im- the community it was treating and was already proved health care in the Lower East Side area attempting to solve problems that other clinics in the future depends more on providing more didn't even realize existed. In comparison to and better jobs, better housing, and improved other Bellevue clinics, Pediatrics is a paragon. education in the community than in cleaning Therefore, we decided to involve ourselves up the wards at Bellevue or making doctors be- with problems of the institution as a whole, come nice people. Not that these latter factors are unimportant but they are luxuries that we and not with the particular problems of the de- can deal. with after the basic problems have partment of pediatrics. been solved.-J.A., Medical Student, Lower .To define the existing problems, we first met East Side. with doctors at Bellevue and viewed the work- ings of the clinics. We went to the community HEALTH CARE DELIVERY to. speak to organizations and residents. We Lower East Side followed up patients who were known to use It is! difficult to generalize about Bellevue the services at Bellevue. We knocked on doors, Hospital. The enormity of the physical planIt, spoke to people on the street, and met with community organizations. Our relationships the complexity of its organizational structure, with these people were informal and unstrue- and the heterogeneity of the hospital's staff .ured, and our conversations were very sponta- defy simple categorization. However, a general t impression of the hospital has been imprinted neous. Certain problems were consistently ex- in my mind through certain experiences that pressed by the people, and we chose those that tended to recur and through attitudes that we thought we could work with. seemed to be ever-present. An illustrative example of our experiences is The physical structure is not well-suited for our work with the fee system at Bellevue. The the delivery of good medical care to the resi- predominant myth at Bellevue is that there is dents of Manhattan's Lower East Side. The no problem paying hospital bills: "Medicaid hospital .is inconveniently located and is diffi- and welfare pay all their bills"; "They never cult to get to by public transportation. The pay their bills anyway"; "They fool us by giv- problem of transportation to the hospital is ing us a wrong address"; "If they don't pay 18 !" ' SUMMER 1968 nothing happens to them" etc. Quite a different but who were not admitted and had to return perspective on this situation can be gained by to the Lower East Side during the night. We anyone talking to residents of the Lower East did not think that improving the bus service Side about this: "I'm afraid to go to Bellevue would eliminate these problems because we did because I have no money"; "Eleven dollars is not think it sound medical procedure for ill too much to pay, I can't afford it"; "Medicaid adults and children to walk several blocks to a used to pay for my medical care, but doesn't bus stop and then wait a long time for a bus to since the Government took the Medicaid money arrive, particularly in bad weather or late at away"; and "If I don't pay my bill the clerk night. We thought that either a hospital or will embarrass me in front of everyone the community-based car service would contribute next time I go to the hospital." to solving these problems. We hope that our ef- As of July 1, 1968, a new sliding scale of forts iti the study of this problem will lead to a fees went into effect for all city hospitals. De- greater utilization of a Medicaid-financed pri- pending on income and the size of the family, vate car service by patients unable to reach people were to be billed from $3 to $11 for Bellevue by conventional modes of transporta- visits to Bellevue's clinics. Most patients from tion.-J.A., Medical Student, Lower East Side. the Lower East Side were in the $3 to $5 cate- Another area we worked in points up the gory, but they did not know this. The signs at problem of poor communication between hospi- Bellevue still described the old $11 fee for tal administration and staff even more. After weeks after the system had been abandoned, talking with the administrator of Gouverneur and little effort was made to notify the com- Hospital, which runs its. own transportation munity of the reduction in fees. (I was told the service for those who can't use public transpor- newspapers carried this inform@ation as a tation, we decided to propose that such a ser- public service. I missed the story, and I sup- vice be instituted by Bellevue. Gouverneur pays pose many others did, too.) As a result of our for private cars but it also uses the services of prodding of the administration of the hospital cars paid for by Medicaid for the use of eligible and the office of the commissioner of hospitals, Medicaid recipients. The patient's eligibility new signs in English and Spanish were posted for such a service is determined by the pa- throughout the hospital explaining the new fee tient's doctor who fills out a request for it; so- system. In addition, we obtained a pamphlet, cial service handles the rest. Naturally, the also in English and Spanish, that described the funding of the cars and the drivers' salaries new fee system and distributed it to everyone was the main issue. As far as the admini - on the streets of the Lower East Side. We also tion at.Bellevue knew, that hospital had never placed signs in'loc-al storefronts. used and didn't know that such a service was We developed the transportation problem available under Medicaid. with the advice of various community organi- A trip to the central Medicaid office at 34th zations, particularly the North East Neighbor- Street revealed that Bellevue did indeed avail hood Association, the United Neighbors Asso- themselves of these services-at least, the re- ciation, the Fifth Street Mothers, and Movi- habilitation and orthopedic clinics did. When cluded informed of this the administrator was, of mientos Puertoriqueftos Unidos. We con I that patients in acute crisis were adequately course, greatly surprised that. his initial inves- transported to the hospital via the ambulance tigation hadn't indicated that Bellevue used emergency service. However, we thought that such a service; he said he would make further adequate facilities for transportation were inquiries. A few days later he reported to us lacking for clinic patients, for patients want- that a supervisor at the same medicaid office ing to use the emergency room services during insisted -that medicald provided no such ser- the night but'who did not consider themselves vice! Thus, we have a case of a phantom car sick enough to call the ambulance, and for pa- service which neither Bellevue or medicaid tients brought to the hospital by ambulance knows about, which Bellevue uses and medi- 19 GREATER NEW YORK caid provides!-J.M., Nursing Student, Lower gent. I would say that the people seek care in East Side. equal numbers at Bellevue, Beth Israel, and We found Bellevue's administration to be Gouverneur. Many had no complaints about very receptive and helpful to us. However, it Bellevue. Many heated it. The reasons they ex- matters little what one supervisor or one in i- pressed most often for using facilities other vidual says, since the hospital's rules and than Bellevue were: Spanish-speaking staff ; chains of command are so extensive and com- more courteous treatment; not as long a wait, munication is so poor. therefore a day's wages didn't have to be lost. In the beginning of the summer we had seri- For those people who missed appointments ous misgivings about being connected with at Bellevue whom we followed up and visited, Bellevue, especially since the Lower East Side it appeared the reasons were usually an inabil- community is trying to cut the cord with Belle- ity to find a place to keep their kids or an in- vue by establishing its own comprehensive ability to travel to Bellevue' For many of the health center. An end of the dependence that patients, the problem is what I believe is the Lower East Side residents have long had on first problem in health-care delivery-they Bellevue, and which, to a certain extent, has can't afford it. They know the hospital will send a bill and they don't like not paying bills allowed poor hospital conditions to continue, so they don't come for help. In one case in will probably be the best thing that could be which the woman neglected going to the hospi- done both for the community and for Bellevue. tal because she couldn't afford the fee, I as- People who have a choice will go to the health sured her the hospital would never refuse her facility that offers them the best care. service, money or no. She finally came to the Bellevue should not make the mistake of hospital and it was found that she zibeded sur- supposing that Lower East Side residents are gery, which she has now had.-J.M., Nursing too unsophisticated, too irresponsible, or even Student, Lower East Side. too stupid to know the difference between good and bad health care' For . what, after all, is The idea for the NENA health center arose good health care? Does it matter if a doctor because of the mistreatment of community res- has won a Nobel Prize if his patient's bed is 'dents at other institutions and the lack of suf- roach-infested? Or, if a doctor's language ficient health facilities on the Lower East Side. "doesn't happen to be Spanish," yet Spanish is From my own experience, doing clinical prac- all the majority of people in this area can tice in a municipal hospital, I find many of speak? These people are extremely capable of their criticisms are valid. judging the quality of health care they receive. One complaint that I can support, having This is obvious because many of them, though worked in a city hospital, is the one of deper- complaining about Bellevue's clinics, have sonalization that takes place in these large in- nothing but praise for the pediatric clinic. In stitutions. People are not treated as individu- this clinic there are Spanish-speaking com- als. They are forced, for example, to see differ- munity workers who help with translation, ap- ent doctors all the time even when a familiar pointments are made for further visits (and face would make the situation less embarrass- they are kept), and, if a patient has a problem 'Ilk and perhaps less painful. The doctors that at home, the community health workers, see these patients in a clinic do not have time nurses (and occasionally doctors) will make to study the background of each patient, such home visits to see if further help can be pro- as the number of people in a family and the vided. Bellevue personnel must stop thinking conditions they live under and if they do get that a person's sensitivity to true human con- 'this information it is not always passed on to cern is dulled because his income is low. If the next doctor.-4.L., Nursing Student, anything, it is heightened. Lower Ewt Side. * * * In our contact with the community, I do not believe that the residents of the the opinions we heard were many and diver- Lower East Side community feel that they are 20 SUMMER 1968 not getting good medical care. Most people do Newark is ranked at least second in infant not think about medical care at all until they mortality, drug addiction, and TB deaths. Peo- are acutely ill, and it has been my impression ple fired on this hospital during the 1967 re )e - that the residents of this community have lion. They hate it. They hate the 3-hour waits found places to be treated that they regard as in clinics; being turned away from clinics adequate. The pediatric clinic at Beth Israel without treatment; being misseheduled for Hospital and the.pediatric clinic at Bellevue clinics; the lack of hum-an concern and the are widely regarded as excellent medical facili- abuse received from all levels of staff; the lack ties. of anaesthesia for delivery; inadequate social Some patients prefer private or union doc- services; families being notified 2 to 3 days tors, others prefer Columbus Hospital because after a patient has died, or finding out when of the large number of Spanish-speaking per- visiting; filthy and uncomfortable waiting fa- son,nel there. Some prefer Beth Israel because cilities; lack of followup, etc., etc.-A.H., Med- it is near, clean, and they don't have to wait ical Student, Newark. long, and some prefer Bellevue because they like the medical care they get there. Certainly I particularly don't like Martland Hospital. I 'ek once when I was pregnant with my there are complaints, especially about Belle- was si vue: the long-waiting hours in the clinics, rude litle boy. Used to have nerve tantrums, and had and impersonal hospital staff, dirty and de- to get a shot. When my mother took me to the pressing surrounding, etc. I believe, however, hospital, those people put me on the 10th floor, that the people have accepted these faults as the psychiatric ward, and I was not allowed to inherent and inevitable aspects of the system leave until I was examined. My mother told. of delivery of health care, and are not espe- those people I just had to have a shot, and they cially concerned with complaining or changino, kept me there and made me go through all this the present situation.-J.A., Medical Student, red tape. I just wouldn't take my dog there. I Lower East Side. take my children to Beth Israel in Newark. At Beth Israel, people act like they are concerned. Newark You don't hear smart remarks. The hospital is Martland, formerly City Hospital, is better clean, you don't even know iVs a hospital, known in Newark's Central Ward as "Butcher doesn't have that funny smell, and the food is Shop on the Hill." This hospital is under- not food for animals. It's nice, it's so much dif- staffed, underspaced and underfunded, 90 per- ferent, the people there are so nice and when cent of its patients are on welfare. The Board you leave they give you a questionnaire to of Health in Newark is inactive, ineffective, write what you like about the hospital. and unconcerned. Not many people from this area go to Beth City Hospital was run on a minimum budget Israel because it is a private hospital. When I for years. Jobs were political plums and, be- was pregnant I had to pay $6 for every visit fore the New Jersey College of Medicine took for an examination, and I had to pay for my over recently, only a portion of the @ff ac- pills, and it was $300 or something like that to tually worked, others just collected checks. De- have my baby and I.had to have the cash first. partments, clinics, and emergency room ran in- But a lot of people around here don't have that dependently with no communication between money. I didn't have it either, but I just had to administration and medicine, nursing, dietary, get that money because I wasn't going to the etc. Even good @ff became bogged down and City Hospital.-G.J., NYC, Newark bitter in the medical morass. Result: patients suffer from bitter, tense staff, uncoordinated The delivery of health care to the commun- medical care, failure to be directed to existing ity was ineffective and insufficient. Many of the facilities. I have seen patients wake up in the hospital departments are undermanned. The hospital, realize where they were, and run out majority of their present staff is grossly un- of the door dripping blood fron stab wounds. productive. This stems from many causes: @the 21 GREATER NEW YORK jobs were under city civil service, many of the dirty; the floors look as if they've never been political appointees are unqualified for their mopped, and there was a lot of useless junk positions; many of the staff believe that good lying around which was finally removed about health care is a privilege and not a right. Con- 24 hours after I called and made the request. sequently, the people administering health care The patients have to wait to see the doctor have corruptive attitudes about the Newark in these surroundings from 2 to 4 hours, de- black community. One of the hospital adminis- pending on how early they arrive at the clinic. trative staff was quoted as saying: "These Peo- Everyone is given an 8:30 a.m. appointment. ple are all the same, you have to treat them The doctors arrive around 9:00 a.m. to begin like,animals." seeing -new patients, but do not see returning Hospital records were out of order; cases patients until 10:00 a.m. Some of this waiting and files were misplaced and lost, record rooms time is needed by the P.H.N.s to take weights, were open only six hours a day and four days a blood pressures, etc., but not 3 hours. However, week, and doctors had no way of getting any since there are so many patients and so few histories or X-rays during off-hours or off- nurses, the nurses seem to be very busy all days. morning. The patients are served on -a "first Clinic patients were forced to wait anywhere come, first served" basis, so many arrive very from 2 to 7 hours before they could be seen; early. If a returning patient arrives at 7:00 many were even turned away without being a.m., then she will be one of the lucky "firsts" rescheduled. The people were forced to wait in to see the doctor at 10:00 a.m. filthy, hot rooms, with no restrooms or water All the patients seem to be treated equally, facilities. Many of the clinics are located near except sometimes I have seen certain nurses food service garbage rooms, which present giving the Puerto Rican patients a bad time be- problems with flies and the smell of decaying cause they cannot speak English.-L.D., Nurs- waste.-D.B., Community Worker, Newark. ing Student, Newark.' In the prenatal clinic at Martland I found The lack of facilities for good health care many positive things but mostly negative are not isolated to Martland Hospital and its things. The nursing care the patients receive in clinics. Most of the programs offered by the the clinic is very good. The clinic is staffed by Board of Health and its drug dispensary are public health nurses who want to give each pa- plagued by similar problems. The problems tient individualized care as much as possible. range from improper followup of cases (which Most of the nurses' attitudes seemed good and eventually become chronic ailments) to useless they appeared to be interested in the patienVs and cursory initial treatment. Medical people problems. However, there are only seven use "lack of supplies" as their excuse. But the P.H.N.s and approximately 125 patients per fact is that they don't make proper use of the day. Most of the time the nurses got tied little they do have. As with other services down with paperwork and assisting doctors, found in the context of our society, the health and were unable to do as much health teaching delivery system in Newark are corrupted by an as they wanted to do. The nurses do make inherent disrespect for and unconcern for the home visits to try to do some of the health poor, nonwhite peoples. teaching the patients often miss in the clinic. There are many members of, the Newark The physical setting in the clinic is awful. community who would rather die than subject The patients are packed into a very small area. themselves to the health care offered by the They sit on hard, wooden church pews. For a city. Those who can afford health care pri-, while there were no fans in the clinics and pa- vately would much rather do so. For the ma- tients would frequently faint from waiting so jority of the people, however, there are no op- long in that hot stuffy room. However, after tions available. Community people are not as enough patients had fainted, someone was able ignorant as many suppose them to be. They to procure fans for the clinic. The clinic is very judge the value of their health care only after 22 SUMMER 1968 years of experience. Newark SHP has numer- ulation of the area. It seems that more imagi- ous accounts of conversations with community native means of communicating the checkup, people in which they usually expressed dissat- such as a sound truck, would have brought a isfaction with their health care. Their most great many more persons. Another problem of useful parameter is a measure of discomfort. the checkups and the free clinics is that the They will usually tell you that a visit to one of older males almost never come. Women of all Newark's health. centers results in an aggrava- ages and children, yes, but hardly ever any tion of discomfort rather than an easing of it. males over high school age. This comment re- In general, the Newark population is repulsed fers to city-run checkups lasting until 7 or by its health care-repulsed to the point of 8:00 p.m., and free clinics run by Queen of An- hostility.-R.P., Community Coordinator, Ne- gels Church between 5 and 9:00 p.m. wark. Another problem I was told about was that While working in the Martland Clinic, I ob- it is almost impossible to geta doctor to make served that the people who came to the clinic a house call in Newark. For this reason, people received good care, but I might add that the who are not in an actual emergency state but community people were very reluctant to come. do need the services of a doctor call the city They often would come to the hospital days, ambulance to take them to Martland Hospital. weeks, or even years after they developed med- Those who have had a very bad experience with the hospital and do not wish to return ical problems. An example was a boy about 11 have nowhere else to go if they are on wel.fare. years old who came into the emergency room 3 The no-house-call problem undoubtedly will days after he had cut his head on a piece of continue, but since the college took over Mart- glass. The doctor told me he could not adminis- land Hospital it is possible that maybe 5 or ter the proper medical care to the patient be- even 10 percent of the people who have sworn cause a wound of this type must be closed never to return to Martland may give it an- within 8 hours of the occurrence. There were other chance after learning it has changed many similar cases where people neglected to hands, and, hopefully, they won't be disap- come to the hospital promptly. pointed again. I found out by administering a questionnaire I did note two other major problem areas in to the women in the maternity ward at Mart- which improvements should be made. One was land that in many instances they had neglected the abominable state of dental care of almost their health. They did not know about birth all the persons in Newark's Central Ward. I am control methods; they had dental problems but unaware of what, if any, dental clinics are never went to the dentist; and the same was available. A second more general problem is true of many other medical problems they had. finding and helping the real poor-the igno- Some women complained of long waiting pe- rant, despairing, almost helpless person who is riods in the prenatal clinic, and other patients hardly being touched by the health and wel said they had received rough treatment in the maternity ward and delivery room. The mai fare programs. Some referrals to these people may come through the emergency room. A far answer I got from these women when I askeci them why they did not go for medical care better source is through. people who know when they needed it were, "they didn't kno them in the community. One such case was a :w 71-year-old guardian of five great-nieces and why they didn't go." or, "they were afraid to nephews and the two children of the oldest come to the hospital."-Anony , Newark. niece whose welfare check was going to be There are many problems of health care de- cut. This woman's only contact with the so- livery in the central ward of Newark. One cial services and agencies set up to aid people problem is neighborhood health examinations. was an unsympathetic welfare worker. We I assisted at one such checkup organized by the were referred to her by a neighbor who was city health department. The turnout was not one of our NYCs.-N.W., Law Stvdent, N small, but it wasn't near a majority of the pop- wark. 23 GREATER NEW YORK Brooklyn Hours of waiting in the emergency room, half- hearted treatment given to welfare patients as The population of the Crown Heights area of Brooklyn is estimated at 225,000 people, opposed to those who could pay, that children most of whom are either black or Puerto aren't cared for unless their parents are there Rican.. These are the patients that use St. (try to explain the "law" to people who have Mary's Hospital. seen a child refused service when he needed St. Mary's can be seen as a white fortress in it), that white children get dental care at a black forest. It is a voluntary hospital with a Brookdale Hospital a few weeks after they capacity of 237 beds, administered by the Cath- apply whereas black children must wait for olic Medical Center of the Diocese of Brooklyn. months-all this has been told to us again and In my opinion, it is a 4th-rate hospital in an again. Many people claim they wouldn't go to area where there is tremendous need. Until Brookdale if their lives depended on it. The several years ago, the hospital refused to prov- community resident have been asking for bet- ide outpatient services for the residents of ter services-a better emergency room, a nar- Crown Heights. During the last few years, the cotics program- and Brookdale has been deaf. forest has crept in. There is still a good deal of -E.B., Medical Student, Brooklyn. resentment by staff and employees of the hos- Health care delivery services in the Browns- pital who represent the "old guard," having ville section of Brooklyn are far from ade- such attitudes as: people who receive free med- quate. ical treatment (the Medicaid fiasco has Brookdale Hospital has two new programs changed this) should not care whether it is ad- Comprehensive child care, and multiphasic ministered with dignity or not.-W.B., Medical screening-both of which in format appear ex- Student, Brooklyn. cellent. From contact with the programs, it seems evident that the staff is attempting to Those of us who have observed the workings deliver total health-care services to the com- of the pediatric clinic at St. Mary's Hospital munity- The programs have not been success- have noted the cursory care given the patients. ful and the services are under-utilized because, We identified this not simply as a function of (a) the community did not participate in plan- disinterest or lack of thoroughness on the part ning the program, and (b) Brookdale has had of the doctors, or as simply a crush of patients a reputation for many years of giving second- in a short time, but rather that the patient class treatment to Brownsville residents.- does -not enjoy what we are accustomed to L.K., Medical Student, Brooklyn. seeing as the.proper doctor-patient relation- Through activities in the clinic, I found out ship. The'patient is not seen by the same doc- tor at each visit, although an attempt is made how many people felt about the health care af- to some extent to do this. There is no appoint- forded the community at Kings County Hospital ment system at the present time and the pa- in Brooklyn. Most people readily admitted that tients and parents must wait an hour or more. the doctors were quite competent and that they Most important, however, the doctor sees an felt their children were in the best of hands. incomplete chart on each patient. He is ex- One common complaint had to do with the lack pected to treat the symptoms of the episode of understanding that the doctors showed con-. rather than the cerning the day-to-day problems of the ghetto .patient as an individual. Often ther. First of all, most doctors did not fully the value of knowing past facts about the med- mO ical history of the patient proves essential to comprehend the conditions that these people adequate patient care.-M.H., Sociology Stv- live under. This was one of the reasons why dent, Brooklyn. the role of the patient advocate was instituted. We attempted to show the doctors how serious The most common community complaints the problem of peeling plaster and lead poison- were about the service in the emergency room ing was. In most cases the doctors never in- and the attitudes of doctors toward patients: quired about the living conditions of the family 24 SUMMER 1968 being treated. They didn't think to ask state complaining of poor treatment at King's whether there was any loose plaster in the County Hospital, and he undertook to bring house or whether any of the children ingested the suit. The suit, Moore v. Terenzio, et al., the stuff .-D.Y., Medical Student, Brooklyn. Index no. 12459/68, was filed with the Manhat- I was pleasantly surprised at the excellent tan Supreme Court on August 6, 1968, by Mr. quality of medical care the people receive at Hanft, an extraordinary lawyer on the Lower the Kings County Hospital pediatric outpatient East Side. There will probably be a hearing on department. Before beginning the job there the order to show cause sometime in the Fall. _R.H., Laiv Student, Brooklyn. this summer, everyone was telling me what a "hell hole" it was. I found it quite the opposite. Bronx The only major problem that I noticed was the A young boy in that neighborhood had been very long wait encountered by the patients in treated at Morrisania Hospital in the Bronx the after-noon hours, whereas those patients for a puncture wound of the knee, caused by a arriving around nine in the morning usually rusted iron bar. His treatment had consisted of had little or no wait at all. What most people X-ray and a damp bandage; no antibiotics or fail to realize is that with many private physi- cians, an hour's wait is not uncommon, and tetanus shots had been given. He came back with the tremendous volume of patients seen to our storefront complaining of pain. His knee was red and swollen and he could bend it or daily at Kings County Hospital, an hour and bear weight on it. I took him back to A-lorri- one-half wait should not be unexpected. . any sania and spoke to the head doctor. It took 15 of the people I have spoken to had very little minutes of arguing and debate about who I complaint about Kings County Hospital. Their was and whether or not I had any medical au- main complaints were usually against the thority before the doctor consented to treat the smaller neighborhood hospitals and private boy.-M.J-., Nursing Student, Bronx. physicians. Invariably many patients first went to these two before coming to Kings County Many feel that though health care may not Hospital.-S.P., Dental Student Brooklyn. be perfect, it is good enough to be a major rea- l found the poor delivery of health care in son for staying in New York rather than re- New York City to be well-documented, and the turning to rural areas. Everyone mentions the people painfully aware of it. The question was, long waiting periods before the doctor gets to what could be done about it. I believe I found a see them. I found no agreement in the partial solution, legally. Bronx about the quality of health care. The most common accusations were against the ob- I found a newspaper clipping which related stetrics ward of Morrisania; no one who had that some months earlier the Commissioner of been there once wanted to return. Bronx-Leba- Hospital had testified before the State Investi- non Hospital was felt to treat patients conde- gation Commission that none of the city's 21 scendingly; there was a fair amount of bad municipal hospitals met the requirements of the feeling towards it from Medicaid patients.- Federal Medicaid law or the State Hospital N.A., Medical Students, Bronx. Code, with respect to physical facilities. I went to the Investigation Commission office in Man- The health care which the residents of the hattan, read the 200-page manuscript, and we Bronx receive does not seem 'as bad as some decided we had a case under article 78 of the would believe. Fordham Hospital, while not New York civil practice law and rules, which the most luxurious spot in the city, seems to Provides for the issuance of a court order give effective service. The hospital is, of course, against any public official to compel him to per- plagued by the problem of all the city hospitals form a duty to see that the city hospitals meet -over-crowding, too much red-tape, and not the requirements of the law. enough personnel. But stories that it was a I described the case to a 21 year-old black butcher shop seemed from my point of view to man who had come to the SHO office at Down- be unfounded. The people in the community will 25 GREATER NEW YORK all say that the care is horrible and degrading, delivery and insults received from the medical but many have had actually no specific reasons personnel, especially the initial contact at the for feeling this way. Either they have heard sto- main desk, in order to press for reform' Stu- ries which may or may not have been exagger- dents can do nothing in one summer because ated, or they feel they will get the bad side of these institutions put up a front of cooperation things wherever they go. Upon taking a survey for the 10-week duration of the SHP. Educat- of 60 Head Start mothers and talking to them ing the residents is necessary.-B.B., Student more and more, many conceded that their Coordinator, Bronx. health care, while not ideal, is adequate.- The people would rather go to private doc- J.W., Nursing Student, ronx. tors in the area, any place but Morrisania, Lin- Health care attitudes were determined from coln, and Bronx Hospitals. The people describe a questionnaire administered to 60 Head Start these hospitals as the "dog pounds." Three mothers and from a sampling of communityat- women I know delivered their own children be- titudes. Since Fordham Hospital was serving cause Morrisania and Bronx Hospitals doift our area of the Bronx, most of our responses have enough clean sheets for the patients dealt with this hospital. so the people feel they can keep them- A majority felt that Fordham was -not a de- @elves cleaner at home.-M.G., Commun-ttV sirable place to seek care. Long waits, poo.r Worker, Bronx. care, disinterested doctors, etc., were given as The delivery of health care to the commu-n- reasons. Sentiment ran the gamut from mild ity residents of the South Bronx ranges from endorsement (usually from those who had had excellent to poor. I feel if people really want to the least involvement), to outright anger. get good healIth care, it can be found with. a lit- Women expressed feelings that they'd sooner tle effort on their part, but unfortunately many have babies at home than suffer the indignities people are not motivated to try. If they hear at Fordham. Several complained of mi-gcar- rumors that this city hospital or that clinic is ri@ages due to poor obstetrical care. Many not doing the job, they fail to complain or avoided health care for all but emergencies be- search out better medical care. Laziness is cause of such unfortunate experiences.-V.S., much of the problem. It is easy to blame it on Dental Student, Bronx. discrimination or lack of money, but if some of The people in the Bronx community in the population can get good care and they have which I worked receive health. care that is un- the same problems, why can't others? The pro- believably bad. Some,.of them said that they jects I worked on showed that there are many would rather die than go to Morrisania Hospi- service being offered to the slum areas if peo- tal or to Bronx-Lebanon because, once they go ple are willing to ask for it instead of shrug- there, the substandard care, the abuse from ging their should.ers and saying nobody cares. staff, and the interminable waiting would -E.F., Communtty Worker, Bronx. probably kill them anyway. Besides these two Harlem hospitals, Monteflore Hospital's Neighborhood After working for 9 weeks on school health Medical Care Demonstration Health Center also offers service to the area. This facility is referral problems, we can draw some conclu- highly regarded by community residents but sions about why people don't use the health fa- cilities available in Harlem. unfortunately it canIaccommodate only a lim- The most obvious and most frequently cited ited number of patients and it has definite geo- reason for not using outpatient facilities at graphical boundaries which exclude many of Harlem Hospital and other clinics in the area the residents in the area. I services. is that the time spent waiting in line is often I feel that the community residents who go prohibitively long. Most of the clinics are open to Morrisania and Bronx-Lebanon Hospitals only during the daytime andappointments can- should document each case of poor health-care not be made: the waiting time varies but can -26 SUMMER 1968 be as long as 4 hours. People simply cannot found gross inadequacies in coverage. All the afford to take time off from work or leave other facilities in-and-out of the Harlem area had children and their homes unattended for that long delays before diagnosis and even longer long. Also, sitting and waiting in noisy, un- delays before treatment could be started. comfortable waiting rooms is -not a very * * * An important reason why people pleasant way to prepare oneself or one's child don't avail themselves of facilities bears di- to see a doctor. rectly on Harlem Hospital; the reputation of Compounded with the long waits, the clinic the hospital in the community is abysmal. Peo- procedures and personnel are often insensitive ple say that they have heard nothing but bad to the needs of the people who use the facili- things about the treatment people get there ties,. We found that the procedure for register- and refuse to put anyone in their family ing at a clinic and for Medicaid was often con- through it. fusing and exasperating, particularly when Part of this reputation comes from a time questions were asked in front of a long line of when Harlem Hospital was one of the two or other people waiting to register. We found one three worst in the city. Many doctors appear to clinic for eye and ear problems where the staff have cared very little for the people who use was downright rude and hostile to the patients the hospital and left it to others to improve waiting. Another frequent complaint was that services. The house staff had been largely for- doctors did not take time to explain to the pa- eign-trained and this led to problems of com- tient or the mother what actually was wrong munication with the patients. The list of griev- and what prescribed medicine was supposed to ances is long and familiar for large urban hos- do. It seems that the feeling that health care is pitals with poor facilities. The significant a right that people are entitled to is just not op- changes and improvements that have taken erative. Health personnel seem to consider place recently have not been communicated to their work a nine-to-five job, and patients, the people who might use the hospital. The im- especially, lots of patients, are a hindrance to provement in quality of the house staff since the many bureaucratic duties they may have the Columbia University affiliation (the fact rather than people to be, dealt with in an that all the interns are now American trained, efficient, gracious way. for example) has not filtered down to the peo- A problem that was a result of the Medicaid ple -and the reputation continues to be just as legislation last spring was the institution of bad as it ever was. The efforts of all the dedi- the $11 clinic fee for any visit. This was a cated doctors (not just the results of the hardship until a sliding scale was set up for affiliation) in recent years should be made non-Medicaid patients, but it still represents known in the community. Demonstrations of another obstacle: the patient must again tell community frustration and dissatisfaction like how much he earns. Needle@s to say, the people the one that took place this summer following who were covered by Medicaid before the cut- the death of a child who was misdiagnosed backs are now getting less adequate health care need not occur. than they were getting when they were covered. Whether or not these community attitudes We found that most Medicaid patients pre- are fair or even rational is not the issue; the ferred going to a private doctor to waiting in fact is that they are real. The challenge to the the clinics; many non-Medie-aid patients would doctor, black or white, is -to understand the rather risk paying a higher fee to a private mentality and life styles of his patients and to doctor for a non-emergency problem than hav- deal with them as they are, not as he wishes ing to go through the inconveniences of a clinic them to be. visit. I will list our recommendations for improv- A significant problem is the lack of adequate ing health facilities in the I4arlem area which Psychiatric facilities for the people of Harlem. we think would lead to more frequent and In a survey of child psychiatric facilities, we more satisfactory use by patients: 27 GREATER NEW YORK (1) Clinics in the Harlem area should be sionals in Harlem. One school nurse must serve made more convenient for the people up to five schools or more; some schools have a who use them; there should be appoint- doctor only 1 day a month; school children are ments made, waiting rooms should be commonly not examined between first grade made more comfortable, and babysitting and high school; there would appear to be vir- should be provided. Clinic hours day tually no specialists in private practice in Har- and evening should be scheduled for the lem. Parents are concerned. When informed convenience of the patients, not the their children need care they endure long @ff. waits, dreary waiting rooms, rude clerks, and (2) There should be health workers hired frequent double standards for paying custom- from the community who can do case- ers versus Medicaid and welfare patients. finding and home visits, and who can What seems to be lacking is proper preven- act as patient advocates in the hospitals tive medicine. Harlemites tend to wait until or large clinics. they are noticeably ill before seeking medical (3) Attitudes of doctors and staff should be care. This is due, to a great extent, to the peo- screened and standards of courtesy and ple's mistrust of the medical institutions. cooperativeness should be maintained. Harlem Hospital has a terrible reputation in Patient complaints should be solicited the community. The building is old and over- and acted upon. crowded, while a new building stands next (4) The New York State Medicaid program door, unfinished, overdue many years, and should be reinstated in full. many months short of completion. One won- (5) There should be an attempt to establish ders whether the city is giving the new build- more psychiatric and counseling facili- ing the priority it deserves. I suspect a similar ties immediately; the need is especially project in the East Sixties would have been critical in the area of child psychiatry. completed on time. The people of Harlem (6) Health education through all the com- agree. munication media and with community The people of Harlemare not blind. They re- groups should be continued actively and alize that decent housing, proper nutrition and new bases should be sought. adequate jobs are necessary for health. Is the (7) Harlem Hospital should establish a American system as presently constituted able community relations department on a to deliver these? Doubts are multiplying. formal basis which would concern itself It is to belabor the obvious to say that to im- with more than just the writing of prove health care more doctors are needed- press releases; it should actively try to young people from Harlem who will return reach the people in the community and there must be trained as doctors, nurses, etc. involve them in the hospital. Pediatric screening programs in the schools (8) Community participation in the setting could be expanded; hospitals can be made more of priorities for health and the running relevant to the community by placing them of health facilities should be institution- under community control. It is stupid to speak alized. Responsiveness of health facili- of anything short of billions of dollars spent in ties to the needs of the community can all areas .of human life when considering and should be guaranteed in this way. health care.-L.B., Medical Student, Harlem. These recommendations may not solve all of At present, the most important way to im- the health problems in Harlem, but unless prove care in the. Harlem area is to lobby for these eight points are addressed,, we see no the speedy opening of the new Harlem Hos- chance for an improvement in the health care pital. Also, I would try to get more board- delivery situation.-R.C., Student Coordinator, certified group practices involved in the area. Harlem. At present there are only two.-J.H., Medical There is an acute shortage of health profes- Student, Harlem. -28 SUMMER 1968 There is need for a followup service as an Gladys is an 18-year-old girl who has a little extension of health facilities in Harlem. People boy and is expecting her second child. Gladys often do not return for appointments or seek made an appointment to visit the Morrisania referred treatment. By having individuals go prenatal clinic and I decided to accompany her. out into the community to follow up school She misunderstood, or was not told, that she health referrals, we have managed, temporar- would not see a doctor at this time. The pur- ily, to deal with part of this problem. In order pose of this visit was to obtain a clinic card to secure a more permanent solution, on a and to have the preliminaries before seeing an small scale, we are in the process of funding obstetrican. During her interview with the permanent jobs for our five community clerk, Gladys said that she had been going to workers. In these positions they will function the N.M.C.D. and that they had referred her to as extensions of the school nurses and will fol- Morrisania. She said that she was told that she low up the school health referrals year-round. no longer lived in the N.M.C.D. district. The -S.G., Medical Student, Harlem. patient had never been seen prenatally. An ap- pointment had been made for Gladys, but she ATTITUDES did not keep the appointment. With this bit of Brooklyn information the clerk asked Gladys why she The doctors must know the community. that had not seen a doctor sooner. Gladys appeared they serve. They must be acquainted with the very hurt by this question because she said customs and beliefs of the patients. They must she had seen a doctor. The clerk told Gladys know their patients and respect them as fellow that she was old enough to be her grandmother human beings. In order to treat someone with so she shouldn't try to tell her that she had compassion, one must understand this person seen a doctor when she hadn't. I was irritated and look on this person as a comrade in pain, with the clerk for making a judgment without not as a stranger who cannot be understood. trying to clarify with Gladys as to how she There are a variety of problems about com- saw the situation. It is possible that Gladys munication bet ween the patient and the physi- saw a medical doctor and thought that she had cian. The patient or the mother of the patient seen an obstetrican. Gladys did say she didn't often viewed the doctor as competent but un- keep an appointment to have some blood concerned. They often felt that the doctor' drawn. This one encounter left Gladys with an didn't care about them. On the other hand, the unfavorable first impression. doctors viewed the patients as being hostile Gladys was told, or rather I was told, to take and unreceptive to the care they were deliver- her to have blood drawn, her teeth checked, a ing. chest X-ray, and, finally, to see a social worker. There is a definite lack of communication be- The lab technician did not say anything to tween the members of the community and the Gladys when she 'went to have her blood hospital as an institution and as a representa- drawn. The technician was very hurried and a tive of the white man's world. bit gruff. Gladys was frightened and did not re- What is needed is more community involve- ceive any psychological support or instruction, ment in the running of the city hospitals. and such as to look away or to grasp something to more effort on the part of the hospitals to make the.experience easier for her. make their services known to and accepted Our next visit was to the dental clinic. At graciously by the community.-D.Y., Medical Student, Brooklyn. the registration desk I had tried to tell the clerk that she had seen a dentist within the Bronx last 6 months,,and that maybe it wasn't neces- The following two experiences illustrate the sary to see a dentist.again since it was so close problem' of routine medical care delivered to the time of her delivery. At the dental sta- without concern for the patient and his specific tion I was told that the X-ray machine was needs. broken and that she would have to make an ap- 29 GREATER NEW YORK pointment for another day. At this point I said problems she was having with her leg. Th that it was hard for this woman to get to the nurse explained that elevating her legs woul( clinic and unless.it was absolutely necessary help. She suggested that Gladys elevate he that she see a dentist at this time, that I pre- legs while reading a good book. I had to chuckl ferred a new appointment not be made. The at this because Gladys only has a 9th grad clerk, somewhat confused, called the nurse. education and has difficulty reading and writ The nurse checked the records and found that ing. The nurse did some diet counseling whicl Gladys had seen the dentist at the end of was very inadequate for this patient. Slit March. She arranged for Gladys to see the den- handed the patient a diet sheet and said t, tist without coming back to the clinic. avoid salt and greasy foods. No inquiry wa: Next we went to the X-ray department. made into Glady's eating habits. After waiting about half an hour Gladys was Rebecca is a 64-year-old Negro lady who wa: seen. The technician did not smile and ap- referred to me by a dental student because hi peared very tired and bored with what she was felt that she needed more comprehensive car, doing. She made no effort even to acknowledge than just seeing that she get some dentures. the patient's presence. I decided to take Rebecca to Morrisania t( Our last visit that afternoon was to the have a checkup. This was to be my first ex social service department. She was the only per- perience with registering a new patient. I firs son we met that day who appeared interested, asked a clerk processing new patients what th( and we felt she had the time to speak with us. procedure was for bringing an elderly patien- We came back that evening for the prenatal to the clinic who hadn't seen a doctor in som( clinic. The doctor started asking questions, and time. She said to bring the lady to the emer Gladys became confused and appeared fright- gency room. I replied that there was nothinj ened. He got irritated because she was not re- acutely wrong with this lady and asked if ther( sponding to his questions. The nurse then in- wasn't some other procedure. "No, you mux formed me that I was not supposed to be with take her to the emergency room". I didn't ac- the patient while she was with the doctor be- cept this as being the solution so I asked at th( cause I was violating her privacy. I did not information desk on leaving the hospital. ShE leave so she sent in another nurse to inquire if suggested that I speak with the nurse at thE I was translating for this woman. Even though screening clinic. The -nurse said that the screen- the head nurse did -not object the other nurses ing clinic was perhaps the best solution. did not want me there speaking with the doc- We returned to the clinic the next day. WE tor. It was not their routine. arrived at 8:15 and were seen by the. clerk by The doctor also followed his routine. He did about 9:00. Shortly thereafter we were seen by not interject any personal comments at all. In the doctor at the screening clinic. the examining room I could hear him bawling The first question he asked was, "What's thE her out for using salt because of her high matter, why did you come." After a pause with blood pressure. I'm not sure any doctor had no answer he said, "Well, whaVs wrong with was this ly At thi told her this before. He then told her she you, you know that is a hospital. IC to have a Pap smear. I could hear Gladys say- oint I answered by saying, "Nothing is thE p ing that she had just had a Pap smear, and I matter with this woman in particular. She just know she had because I had read the letter she hasn't seen a doctor for some time, and I think received stating that the results were negative. it is advisable. She had poor vision, she is hard Maybe the doctor did have reason to doubt of hearing, she needs dentures, and has had Gladys, but he didn't take much time to listen to problems with her .heart in the past." By this her. time I was disturbed by the lack of dignity and Our last visit was with the nurse. The nurse respect the doctor showed this patient. After a was very pleasant, and did not appear to be very brief examination, he discovered high rushed. Gladys did speak up to ask about the blood pressure and decided she needed a car- .30 SUMMER 1968 diae series. He was very impatient with Re- repetition of a few common complaints about becca. He would get irritated when she did not Bellevue's services. It would be a conservative understand his questions. He even tried to tell estimate to say that 90 percent of those per- -her how to talk. Rebecca answered some of his sons we asked cited the lack of courtesy to be questions with a "ya." He told her to say yes, their main complaint about Bellevue. Medical not "ya." What particularly irritated me was care, they say, is fine, but "the clerks are rude his being more interested in my being a student and we're treated like dirt." nurse than in Rebecca. I think it would have Bellevue must refocus its attention from been much more beneficial for the patient if his medical education to that of service to the com- interest had been directed toward her. The doc- munity. This is, of course, difficult to do. I was tor said to make an appointment for the medi- told by a resident in pediatrics at Bellevue that cal clinic for Rebecca. I asked him about the he cares about his patients and their continu- eye clinic. He did not mention the E.N.T., den- ing welfare, yet if Bellevue's census continued tal or G.Y.N. clinics., This would seem to indi- dropping as it had in recent years, and the "in- cate that this doctor is not providing compre- teresting cases" no longer were seen there in hensive care, or is even considering preventive such quantity, he would promptly leave and so medicine.-V.V., Nursing Student, Bronx. also would most of his colleagues. "Let's face Lower East Side it," he said,. "what I'm most concerned with at The biggest obstacle to the delivery of good Bellevue is my education. Sure I care about my medical care at Bellevue Hospital is the perva- patients, but that's not what I'm here for; pri- sive atmosphere of what I have heard referred marily I'm here to learn." As long as the pa- to as "Bellevue Paranoia." It is an attitude tient remains in this secondary position in the composed of varying degrees of lassitude, o physician's list of priorities, no amount of new stinacy, and covert hostility. It is personifier buildings, equipment, or famous names will by the elevator operator who will not tell yoi lure patients to Bellevue Hospital. what floor a certain clinic is on because it is Bellevue 9s pediatric clinic has serious "com- not his job to give information; by the clerk petition" from Beth Israel Hospital's "I Spy Pt who will not admit you for a clinic appoint- clinic, which also handles children. There, the ment because it is 10:10 a.m. and registration doctors speak Spanish, as do all the health-aid for the clinic @ps at 10:00; by the perverse workers on the floor. These health workers administrator whose decision it was to man the make regular home visits and followup care on information desks with personnel who do not their own patients. The "I Spy" clinic does ac- speak any Spanish; and by the physician who tual soliciting and canvassing in its area, ac- can just walk away from patients waiting to tively trying to get people to come. see him in a specialty clinic because he thinks This active community action on behalf of it's time to go. These attitudes are accounted the health care facility is the essential feature. for in many ways: overworked doctors who It is what's lacking at Bellevue and seems to be must see too many patients in too little time, what Bellevue still refuses to do. More than frustrated clerks frozen in positions with little one doctor has said to me, "I don't know what upward mobility, etc. Regardless of the excuse, our job is in respect to the community any it is an attitude which exists throughout the more; should we go out and get them, or hospital and which the hospital has failed to should we let them come to us? I don't know." deal with. For a hospital whose census has dropped in re- Bellevue has, for too long, enjoyed the posi- cent years and which faces an estimated 75 tion of being the only center in the area offer- percent loss of its outpatient department pa- ing extensive facilities. That it has also. been tients to the new NENA health center, is there one of the most notorious is often not consid- much of a choice? They must reach out ae- ered. It was interesting to observe, in the pro- tively to the community if they expect to see an cess of speaking with community people, the increase in their patient load. A new building 31 GREATER NEW YORK alone isn't the answer.-J.M., Nursing Stu- changes are necessary fast, but I didn't ac- dent, Lower East Side. complish them and SHP didn't accomplish Newark them.-K.S., Nursing Student, Newark. Generally, postpartum patients felt their People do not like being treated. like dogs at prenatal care was satisfactory; their one com- city hospitals; they do not like to be kept wait- mon complaint was the long waiting time. ing for hours at a clinic; drug addicts do not * * '- It is not unusual to see 150-200 prek- like to be considered criminals when they seek nant women come to prenatal clinic at Mart- medical attention. In short, the people of Ne- land Hospital in one morning, nor to see them wark's Central Ward are just like people every- wait 3 or 4 hours to see a doctor who gives where-they want to be treated with respect them only 5 minutes. There is little personal- and dignity. This does not seem to be an unrea- ized attention because there is no time to give sonable request, but in Newark it is far from a reality.-B.W., Medical Student, Newark. it with such inadequate staffing. Little wonder that mothers wait until their delivery date or The hospital is contracting a psychology in- near before coming to the hospital. stitute to begin sensitizing staff to needs of the Many of them were dissatisfied with the patient, and to coordinate and improve com- treatment they got from the nurses in the de- munications between various levels of supervi- livery room; they felt that the nurses were sion. This idea for a sensitization program was giving them very little emotional support; that sold to the administration by speaking with en- the nurses conveyed an "I don't care" attitude. lightened members of the administration on all I quote a young mother: "I delivered the baby levels. It is hoped that @ff will begin to func- all by myself; they (the nurses) only stood tion as a whole towards patient care. there watching." The general complaint about An in-service sensitivity training program the postpartum floor was the attitude of the now running in the nursing department will staff; many patients felt they were rude.- continue weekly until I leave in October. I am J.Q., Nvrsi?W Student, Newark. using tape recordings of community people talking about the hospital and working with Besides the decrepit, dirty, and dingy staff reactions to this stimulus material. This conditions of community health facilities in program is serving in the interim preparatory Newark and the poor quality of health care ad- to the more general program.-A.H., Medical ministered, the ultimate crime is the complete Student, Newark. insensitivity of most health care personnel to the patients whom they have supposedly dedi- Harlem cated their lives to serving. The patients are We received many complaints about the treated like cattle,. herded in, thrown out if "nasty attitudes" of the personnel in the clinics they dare to speak or question, and herded out, at Knickerbocker Hospital, poor treatment, usually with a few harsh words of condescen- long waiting periods and frequently a lack of sion. The obvious reasons for the conditions communication between the patient and doctor are lack of funds, lack of staff, and ultimately due to a Ian guage barrier. The Harlem com- lack of concern. Hopefully SHP fostered con- munity feels that the comprehensive pediatric cern if nothing else. health center that Knickerbocker is trying to The people of the community are completely establish is fine but that it will be some time disgusted with the deplorable health care of- before the center is completed. They would like fered them. However, only an exceptional few to use Knickerbocker's facilities since it is in will speak up to the hospital staff. The major- their vicinity, but generally refuse, except in ity of the community people I've had contact the case of dire emergency, to tolerate the with feel like puppets on a string-if they treatment they presently receive from person- don't jump when the hospital personnel says nel at this hospital.-P.J., Nursing Student, jump, they get no health care. Obviously Harlem. 32 SUMMER 1968 MEDICAID, MEDICARE and trouble-shooters for the people of this The pharmacies are another bone of community.-JH, Medical Student Ha-riem. contention in the Harlem community. The peo- DENTAL HEALTH ple on Medicaid feel that they are not being Nowhere was poor health care brought home given the same kind of service that non-Medi- to me more than in the dental clinic at the caid people are getting, especially if their health station. Being a dental student, I was cards are not "filled out properly." Also there able to observe and question the dentists as is no drugstore in Harlem which is open 24 they treated the Head Start youngsters I hours, or even late in the evening.-J.H., Med- brought from St. Joseph's. From the equip- ical Student, Harlem. ment which was antiquated, to the techniques We've run a couple of experiments on a Har- used which were criminal, to the attitudes lem drugstore: we got prescriptions for the which were racist, to the ability which was same drug for Mrs. X. who has a Medicaid low, to the knowledge which was minimal, the card and Mrs. Y. who doesn't have a card. The entire service epitomized the worst in health store gave about the same service to each cus- care. I will not proceed further into a detailed tomer in terms of time. The drugs sold were analysis of the care here but I can summarize different, the Medicaid drug being generic, and what I saw by saying that, by comparison, Mrs. Y. had to ask for a bag to carry it in. Fordham Hospital was a model of health care, Also, when Mrs. X. asked how much the drug and that the city has no justification for allow- was going to cost Medicaid she was told, in ef- ing outright malpractice to exist within its ser- fect, that it was none of her business.-R.C., vice. At the conclusion of the program, I rec- Student, Coordinator, Harlem. ommended that this health station be boycotted It takes longer for a Medicaid patient to get by the Bronx community.-V.S., Dental Stu- his prescription filled. There seem to be legiti- dent, Bronx. mate reasons, or are they legitimate? Many A particular deficiency of health care deliv- are clerical in nature and could be avoided. One ery on the Lower East Side can be seen in den- wonders if these professionals are excessively tal health services. There is no dental clinic in jealous of their independence and excessively, the neighborhood and the people are oblivious almost cruelly, preoccupied with resisting a to the effects of poor dental hygiene on overall "government takeover." And who finally suf- health of body.-B.G., Nursing Student, Lower fers if the prescription is left unfilled?-L.B., East Side. Medical Student, Harlem. Since one child out.of eight gets dental ser.- These past 2 weeks revealed a problem vice in the community, the need for dental edu- which was not entirely surprising. We found cation for the parents and children, and also that most holders of Medicaid cards regarded the need for more and better dental services, is themselves as recipients of a gratuitous act absolutely imperative in the Lower East Side from any agency, doctor, or pharmacist that community. delivered services to them. They felt as if they The parents frequently said that they can't were obligated to put up with any indignity. find good dental services in the community (no However, this does not derive from the fact of dentist or clinic was apparently satisfactory) Medicaid, but from a general feeling on the and others told me they could not afford it. part of many of the community of being see- Morally, I feel this is one of the most terrible ond-class citizens. The situation is compounded things that could happen in the wealthiest when the person slighted does not know how to country in the world. Everyone I talked to was have redresses made, or does not have any disgusted with the lack of dental services and Place to appeal. I see the role of SHP as mid- financial aid for the underprivileged. Some- dlemen between the community and the deliv- thing must be done in these two respects and I erers of health care, acting both as advisors to will certainly try to do what I can in the fu- 33 GREATER NEW YORK ture to alleviate such a situation.-G.L., Dental Brooklyn has the highest incidence of lead Student, Lotver East Side. poisoning, and it is increasing. A lot of people don't know that children can die or get perma- LEAD POISONING nent brain damage from it. Say there are 600 In the course of our survey of lead poisoning cases of lead poisoning a year found in the incidence in the South Bronx (and, to a limited city: well, if these 600 cases were diphtheria extent, in Harlem), we came in contact with a or polio, everyone would worry about it be- wide range of community institutions, most of cause it would spread. But lead poisoning is which were of an Establishment-type nature. just in the poverty areas, and does not First reactions to our requests were guarded "spread," so no one is concerned about it. until we had explained our purpose and our Our purpose is to get the community inter- procedures, at which point we found people ested, to get them to realize that no one is lis- most willing to aid us. We found, for the most tening to their problems.-W.S., Student Coor- part, that dealings on a personal level were dinator, Brooklyn. more profitable than when we were forced into a head-on encounter with a bureaucracy. The Brooklyn Community Council SHP In terms of concrete results, our group came workers coordinated the Brownsville and East in contact with 1,200 households and informed New York activities of a campaign throughout them of lead poisoning dangers. We collected Brooklyn against lead poisoning. This invo ve and analyzed 500 urine samples from small contacting parents whose children had had children, and our results will soon be made lead poisoning in the past 21/2 years, distribut- available to the general public. ing flyers and posters, and speaking to com- We found that a good many asymptomatic munity organizers and workers, in order to en- lead poisoning cases had not been to a hospital courage attendance ata mass meeting we were recently, -nor received medical care, nor sought holding' A door-to-door canvas was conducted it out.-I.B., Medical Student, Bronx. explaining the effects of lead poisoning and how it was related to poor housing conditions. Two suits were filed this summer having to A bus was arranged to take area people to the do with lead poisoning. Acting on a suggestion meeting. from Paul DuBrul, Mr. Hanft asked for the The meeting was attended by approximately court, under article 78, to order the New Yor r' 80 people, 10 of them from Brownsville. In the City Health Department to compel the remo- estimations of most people involved, the meet- val, pursuant to section 173.13 of the health ing was successful. However, the effectiveness code, of lead-based paint from the walls of two of communication techniques, which involved apartments in which children have suffered so many man-hours and netted such a small at- lead poisoning from eating chipped paint and tendance, can be questioned.-L.K., Medical plaster. In one of these families, three children Student, Brooklyn. have been treated for lead poisoning, one seven times. One suit asks that the court order the DRUG ADDICTION removal of lead-based paint from all apart- In taking steps to establish a narcotics cen- ments in New York City.-R.H., Law Student, ter in the Brownsville section of Brooklyn, we Brooklyn. met with people from the Governor's Office, The Central Brooklyn Coordinating Council Ramirez, Narcotics Addiction Community Cen- and our group are working on the problem of ter and C.C.V.N. This meeting was quite en- lead poisoning. The hope is that we can get a lightening: the State people couldn't account group of people from all over Brooklyn-par- for the placement of funds and had no idea ents, doctors, and people in other fields-inter- where the appropriated money went; . e ested in the problem to meet after SHP is gone, money that was appropriated to private ad- and maybe take some action or at least make diction rehabilitation centers was never given demands. to the centers. Moreover, the ae programs ,34 SUMMER 1968 weren't servicing the real addict population: dicts into detoxification and rehabilita- 75 percent of the addicts in the city are black, tion programs run by the State. but only 15 percent of the addicts in the (3) Interfaith Hospital, owned by Ramirez program are black. N.E.G.R.O. and located in Queens. The We found that Model -Cities had money for hospital maintains a twenty-one day de- health facilities and that the Multi-Service toxification program. Most addicts come Committee, which was supposed to make the in from ref erral from other organiza- funding decisions, was not functioning. We tions, but any addict can walk into the acquired the directions on how to write a pro- center. Some minimal rehabilitation posal, and spent several days at the Addiction work is done. Rehabilitation Center in Harlem with our (4) Brookdale Hospital, whose psychiatric NYCS, speaking with ex-addicts and addicts. service has a newly formed narcotics They helped us in writing the proposal for a program. They are doing some metha- Brownsville narcotics center. We presented the done treatment; they.liav.e.no preven- proposal to model cities and the leaders of tive program. Brownsville. The response has been very fa- (5) Brownsville Community Council Nar- vorable.-E.B,, Medical Student, Brooklyn. cotics Committee, a group of interested community people who want better The narcotics problem is a big one with no treatment and preventive facilities in good answers at present. Everyone in the Brownsville. They have attempted to Brownsville community knows people that are improve the effectiveness of police con- "shooting" and that kids at nine years of age arrests of addicts, and th trol and ey are or younger are turning on by glue sniffing, presently undergoing some training reefers, and goof balls. In talks with two of the with the addiction services agency. NYCs working with us, it became evident that None of these groups really reaches the they were interested in working perhaps in a youngsters or does anything with the glue sniff- preventive sense with youngsters and drugs. In ing problem, so we decided to canvas all stores order that we would not duplicate other pro- which would possibly sell glue, carbona, or grams, and to avoid some of the previous mis- other toxic substances. We visited 80-100 takes,.we contacted and spoke with all groups stores, informed the owners of the law and dis- working with drug abuse in Brownsville, in- cussed the problem with them. We presented cluding - them with a copy of the law against the sale of (1) Addiction Services Agency, (ASA), part glue for the purpose of sniffing, and attempted of the Phoenix Program of New York to get them to attend a meeting we had City. They have a storefront which is planned. (We were surprised that so many Of an induction center and meeting place the storeowners were. Puerto Rican, and re- for A.W.A.R.E and R.A.R.E. gretted not having copies in Spanish.) The (2) Narcotics Addiction Community Center meeting was conceived as a way to make a (NACC). They have a fairly formal small attempt to change attitudes, rather than and traditional approach as part of the just forcing people to comply with demands or New York State program. Their preven- rules. At the most, we had expected five sto- tive measures consist primarily of reowners to come, that would have been a sue- films which can be loaned to any group, cess-but -none showed. and staff members occasionally will an- Shortly after this meeting, we had a discus- swer questions with film showings, or sion with three NYCS, who were requested to go to the schools. Unfortunately, none do some protesting at stores selling glue. They of the films are directed towards the discussed the drug problem and'fairly freely "ghetto" children or towards children described various encounters they had had with around the age of nine years. The drugs. One in particular, who is a gang mem- NACC takes a limited number of ad- ber, had very strong feelings about drugs since 3.5 GREATER NEW YORK he had seen two of his uncles and a cousin buy glue. Happily, our earlier campaign seems hooked. The NYCs noted that most of the drug to have had some effects: only one store that usage is in the evening: the kids either work we visited was still willing to sell glue. We re- or hustle all day and then get high at night. It turned to this store 2 days later with 20 not- is more or less the thing to do. From the discus- so-eager pickets, and left about a half-hour sion emerged the idea of organizing some even- later with the druggist's total supply of Duco ing activities, an idea which will be further Cement. Picketing is apparently a very effee- developed.-L.K., Medical Student, Brooklyn. tive prod.-J.T., Medical Student, Brooklyn. As a part of the Brownsville project, we can- My feelings and views about the problems of vassed the area to inform storeowners of the the ghetto have changed sinc . e summer dangers inherent in glue sniffing. We handed began; I am less optimistic and more depressed them literature concerning a meeting at which over it all. storeowners would confront members of the Tuesday afternoon an addict walked into Ac- community and discuss this topic. It is of inter- tion Center 3 in Brooklyn; he had two friends est to note what transpired in one hardware with him who had agreed to drive him to In- store in the area, where a man behind the terfaith Hospital. He has been an addict for 8 counter claimed: "I hope kids continue to sniff years. A girl friend who was maybe willing to glue; they will get sick and die and stay off the marry him, and a growing fear that the next streets. * * * You are stupid to think that rock he tossed through a shop window would these kids don't know it's dangerous. be the last, had convinced him to call Inter- will continue to sell it to them." faith on his own and make an appointment to The next week, in conjunction with the be admitted on Wednesday morning. From us Brownsville Community Council, a plainclothes he wanted pajamas, soap, and eigaretes, since narcotics officer waited outside the store as two he had no possessions of his own. We took him young children entered to ask for glue and to Action Center 5 since I'd heard that they bags. After the man sold them, the policeman had a good program there. The lady there came in and issued him a summons, which he called the welfare center, then informed him refused to accept. The policeman called a squad that he could not get pajamas and soap and car and he was arrested. cigarettes until the following afternoon. She Perhaps if this incident were made public, asked him why he had waited until the after- through news media, a greater public aware- noon to come in, since he must know that "in ness of the problem would follow, and the peo- offices things have to be done in the morning." ple of the area would pressure storeowners not He.walked out. I followed and begged him to to sell glue and the police to make more ar- go the Interfaith anyway with his friends, and rests. The problem at present is so great that promised to get pajamas and soap and ciga- you cannot walk down the streets without rettes to him the next day if he couldn't get seeing young kids -sniffing glue. them through the hospital. He wasn't so sure The meeting on glue sniffing was a failure he wanted to go anymore, and after 2 hours of because not one of the 100 storeowners in- waiting around for nothing was quite angry formed about it showed -up. At the meeting the and confused. So was I. I begged him some topic digressed from glue sniffing to gun-con- more, shook his hand and wished him luck. On trol legislation, etc., and members of the com- Wednesday afternoon, Interfaith Hospital had munity claimed that glue sniffing was not such no record of his arrival.-J.T., Medical Stv, an important problem that such priority dent, Brooklyn. should be given it. Our activities were, in es- sence, called useless.-D.K., Medical Student, The official Newark City narcotics bureau is Brookl,yn. a division of the Police Department. Lt. Ken- ney of Newark's Narcotics Squad was friendly We spent 2 days driving our NYCA around and informative but I was horrified at his atti- Brownsville from store-to-store,.attempting to tude toward drug addiction. He and his staff 36 GREATER NEW YORK under her circumstances has stamped on her and personal motivation. If total rehabilitation record, "13P", which means out-of-wedlock is to take place, their families must become in- pregnancy. The stigma follows her throughout volved. Society has spent thousands of dollars her life. The final decision to accept a girl back to help rehabilitate the drug addict, high into school is left up to the individual school school dropouts, and people coming out of our principal; for reasons cited previously, the penal institutions. Why hasn't something been principal is usually not anxious to have such a done for the unwed teenage mother? Perhaps girl in the school, and permission to return it's because she is not seen as a threat to soci- to the girl's original school is often denied. ety like the drug addict and ex-criminal! If the girl tries to remove the social stigma M.J., V.V., Nursing Studeiztso Bronx. of her out-of-wedlock pregnancy by marriage, Mornings weren't too busy in the emergency she is denied an education because she is now room any more so I began to give a question- considered a married woman. naire (concerning prenatal care) to patients on There are only seven centers in all of New Martland's postpartum floor. The actual ques- York City that offer educational facilities for teenage mothers; three in Brooklyn, three in tion and answer session was slow, but in talk- Manhattan and one in the Bronx. These cen- ing with these women I was appalled to learn ters offer both educational and health facilities that: (1) Most of the women had very little prenatal care, partly because they dislike the while the young mother is out of school and long waits in the prenatal clinics and partly living at home. However, they can only accom- because they didn't think that prenatal care odate 40 to 70 girls at one time, which means was very important; (2) too many were un- that 85 percent of the unwed mother popul-a- married and under 16, and very few (young or tion is not being reached and is therefore not old) knew much about birth control-they re- being educated. ceived pamphlets for family planning, but most Other resources offering educational and had not bothered to read them; (3) most of medical facilities are "shelters for unwed these women accepted their poverty, ignorance, mothers." These shelters only accept girls who and degrading surroundings (24-bed wards are planning to give their babies up for adop- with paint falling from the ceilings) because tion, or girls who have no home or can-not cope they knew of no other existence or did not with their home situation. These shelters range know to whom to protest; (4) most impor- ,from $40 a week, up. Ninety percent of the tantly, many of these women could not read or Negro and Puerto Rican girls do not go to the speak above a grammar-school level, even shelters because, either, they live at home, those who had graduated from high school, are unwilling to give up their babies for adop- and some could not even construct complete tion, unable to afford the shelter, or lack infor- sentences or understand words like abortion. mation about such shelters. That lack of ability to communicate was not I found that in certain instances these cen- just a problem of the black mothers; it also ap- ters and shelters were not able to fulfill the ed- plied to many of the white mothers I inter- ucational needs of the girls either: most of the viewed.-K.O., Nursing Stitdent, Newark. educational facilities already set up do not have full-time teachers; and subjects such as HOUSING advanced math, languages, and commercial Article 7-A is a "tent strike: law passed in subjects are not taught because they require 1965. It is the most effective means of getting special teachers and equipment. This means slum dwellings repaired ever passed in New that it is only token education; and the girl York. It provides that if specified conditions may also require classes in child care and nu- dangerous to life, health or safety exist for trition, personal hygiene, social services, fam- more than five days in an apartment building, ily counseling, and psychiatric counseling. then one-third of the tenants can sue to get an These girls usually lack parental support administrator appointed to collect the rents 38 SUMMER 1968 and make the needed repairs from the rent detrimental to the welfare of the occupants money. The law is not a flawless piece of legis- that these conditions cannot be allowed to con- lation. Among other things, it requires an ar- tinue for one more day. One of the flaws of the chiteet's estimate of the cost of repairs be program is that certain conditions that could made at the .expense of the tenants bringing be disastrous to the health of the children are the,suit. not deemed emergency repair. Despite the In connection with various community or- threat of lead poisoning, the presence of fall- ganizations, an extraordinary lawyer'on the ing or loose plaster is not now considered a Lower East Side, Mr. Hanft, has brought reason for emergency repair. Our studies on about 75 article 7-A suits in the last year or the incidence of lead poisoning from ingestion two, and has had adverse decisions in only two, of loose plaster and paint have shown us that and in those two cases the repairs had been this condition leads to a sick and often criti- made by the time the decisions were made. cally ill child in too many cases. I The law has received little publicity, and Even though Project RESCU is a city Mr. Hanft believes it has been downright ce-n- agency that is part of the superagency, the sored in the press. For instance, on May 27, Housing and Development Agency, it has man- 1968, the New York Times wrote a long article aged to cut out a lot of the red tape that was on slum problems including tenant legal rem- formerly involved in getting needed housing edies, without mentioning article 7-A; the repairs. It has shown many people that repairs New York Post wrote a feature on a slum can be done without having to go through the building in which Mr. Hanft had an article entire "mishmosh" of housing agencies and ad- 7-A suit pending, and failed to mention that ministrators, and it has gained the confidence fact; when picket lines were organized to of the community. This was clearly shown in picket large department stores which advertise the demonstration for RESCU in the fall of in these papers, the television stations refused 1967, when the agency was threatened with a to cover the story.-R.H., Law Student, Brook- funding cutback: 1,,500 people attended a rally on behalf of the agency.-D.Y., Medical Stu- dent, Brooklyn. We found that the Crown Heights Neighbor- The "channels" we had expected to set up hood Improvement Council was very quick to for the follow up on housing complaints discov- respond to our report of dangerous housing ered through our hospital social history are be- conditions. In one instance, they sent out an inspector the same Inight that the complaint coming bogged down in red tape. By trial and error, we have nearly reached the end of all was called in to them. the agencies who have passed the buck. T e One of our complaints was at 1018 Park latest system for housing and health violations Place in the Crown Heights section of Brook- is to type up a resume of each case separately lyn, where there was loose plaster falling from on a memo. One copy is sent to the Department the walls and garbage and dead vermin in the of Buildings for the Borough of Brooklyn. A alleyway between'their building and the next. The pressure that was put on the landlord by carbon is sent to the health commissioner. The our organization and the Crown Heights Im- third is kept for our files. A cover letter with provement Council resulted in a new plaster the seven memo cases was sent out today to and paint job for three apartments in the. each agency. The question is now what to do if building, and a thorough cleaning of the no answer to received.-M.H., Sociology Stv- way. alley- dent, Brooklyn. We found the RESCU agency to be the most The real problem is housing. The community -cooperative and productive of any of the or- knows that housing is not only an urgent prob- ganizations dealing with housing conditions. lem, but is also a central one; many other The role of this agency is to make emergency problems, particularly health, are dependent !repairs in cases in which the conditions are so on it. 39 GREATER NEW YORK My first approach in handling housing prob- lar court actions to be taken against landlords lems in the Bronx was to work with each per- in all the buildings on the same block of Mon- son individually; call the landlord about the terey Avenue. These efforts may contribute tenants' complaints; help a tenant look for a more to the good health of the community than new place, and so on. It's the wrong technique, all of the screening, physicals, and referrals but the right problem. One-to-one work is that could be made for this same neighbor- probably the only way of doing good patient hood.-J.G., Medical Student, Bronx. advocacy, but it's not a productive technique for improving housing. Housing is much more LEGAL SERVICES directly a community problem than health is: Legal services are about as adequate as med- all the tenants in a building are inherently a ical services. The Legal Aid Society is an es- group with common problems.-K.B., Medical tablishment organization that will really fight Student, Bronx. like ---- to get you a divorce but if you want to sue a landlord, look elsewhere. They do an I worked as a community organizer in a di- excellent job on family problems. I don't want lapidated apartment building on Monterey Av- to downgrade the importance of this, but they enue in the Bronx. After working as a patient by no means offer a full range of capable legal advocate for four of the families in the build- services. As far as the criminal division goes, ing, I had decided that an effort should be they are a fine outfit if you are guilty. The made to confront the landlord and to make him criticism has been leveled that they plead pay for his negligence. We held two meetings, everyone guilty. From my summer contacts at which the tenants chose a captain and trea- with them, I believe this to be true. This prob- surer, and during which tenants' rights and vi- lem is compounded by the fact that The Legal olations were itemized. A lawyer was recom- Aid Society is the only organization offering mended to us by a representative of "Little legal counsel on a wide base to persons in- City Hall," and the tenants decided to hire volved in crimes. him. The treasurer was able to collect a $5 fee The legal services provided by the NAACP from nine of the 13 tenant families. During the are mostly (if not exclusively) for what they last week of the project, an architect who consider landmark cases. If you can't get into a works with the lawyer in a group called the trade union, they might take your case, but if 7-A Associates made a systematic inspection of you are a petty thief they won't. Most of the eight of the worst apartments. Article 7-A other organizations are interested in rendering specifies the following 'sequence of action: aid in those cases that will bring publicity to (1) Landlord summoned to court for apart- the organization. If there are other legal ser- ment violations. Specific repairs or- vices available, I am unaware of them. (which dered. - doesn't mean that they don't exist or that they (2) Landlord obtains one week adjourn- haven't had much impact on the community). ment, during which he must indicate As far as community attitudes about the specific progress on repairs orders. quality of the legal care that they receive go, (3) If these repairs are not initiated during they are resigned. They have come not to ex- a prescribed period, the building owner- pect it, so they don't miss it. They are unaware ship is transferred to a court adminis- of the role of the lawyer and exactly what he trator and rent is payable only to this can do for them. (In this respect, I don't think administrator. Harlem's attitudes differ from those of the (4) The landlord does not receive ownership lower economic groups across the country.) back until major repairs requested are The concrete legal services that the project on the way to completion. rendered were limited by several factors: only I intend to be present during the first court two law students; lack of experience on the action in September. Arrangements have been part of the law students; the very nature of made with a community organization for sim;.- law insofar as it takes a long period of time to 40 SUMMER -1968 not truly representative, and pr indle a case. In terms of people reached and fggrams are he needs of tses handled, I would say that they come to V,,,,erefore do not speak directly for t bo.ut a dozen. That, as far as I am concerned, tkP. people. In setting up the Riverside Corn- i disgraceful. It was so because the project 'rjr;@unity Health Council, existing community ac- ras entirely unstructured for law students. I tion groups were contacted and each was asked @ink that it was an error to hire us without t/,, send a representative. This group then be- ny real idea of what we were going to be c@me the Health Council. oing or of whether there was any real need While this system of selection may not be or us in a project like this. The other big rnis- perfect in that only those people already in- volved in community programs were eligible ake was the assumption that law students would, on their own, know what to do. Law f (,r the Council, use was being made of the peo- chool has almost no relation to social prob- fJ.e who would be using the facility. According erns. They don't teach us about these things. t(,, 0,E.O. policy, the Community Council is not ,4alaried. This is to insure against the position 'We knew that we didn't know, but the project I I)c,@oming one of status rather than of concern. lirectors didn't know that we didn't know.) (Funds were provided, however, for transpor- If it is within the goals of the SHP (and I'm tation, babysitting, or for time lost from the riot saying it should be), law students should job while Council meetings were takin place.) be assigned to work with a lawyer in the corn- 9 munity itself. Most of the good work is being The Council meets on a biweekly basis. Its done by private, non-funded lawyers. These f unctions are concerned with the hiring of peo- guys are really doing some exciting things, but ple to staff the health facility-making sure they are shorthanded. It would be to the bene- that people hired are from the community and fit of the community to assign a law student representative of it. The Council also deter- with a lawyer like this. I don't know whether mines that people hired have the proper atti- this would fit into the conception of SHP that tudes needed to work with the community.- its leaders have, but it would be more effective. J,A.,,Medical Stqtdent, Harlem. -F.V., Law Student, Harlem. E3rooklyn AGENCIES One of the main accomplishments of Project ITESCU (a program set up by the City Hous- Harlem ing and Development Agency to facilitate it seems as though someone has finally speedy repairs following complaints) has been begun to understand what is meant by corn- to prove to the white power structure that the munity participation. The phrase used to mean blacks can do much for themselves. that you'd have a black Ph.D. from Scarsdale For example, the head of Bedford-Stuyves- on your planning board to approve of ideas atit's RESCU is a black man who was raised in from the" community" point of view. Well, yes, the area. He has much knowledge about the he was black. needs of his fellow blacks and can communi- But the Riverside Health Clinic in Manhat- cate with them. He is very responsive to the tan is something different. The Department of complaints that are filed with the agency. He is Health, backed by St. Luke's Hospital, has set hindered by a lack of funds and by the lack of up this comprehensive health facility, working good investigators, especially black ones. There closely with a Community Health Council are, according to this man, not enough black which actually is made up of people living in inspectors. The connotation of the housing the neighborhood, people who will be the con- inspector is still one of disgust and mistrust in sumers of the health care. the community. When the people see a black man coming to inspect their homes and help Since the Clinic was to be funded by O.E.O., them, they are more responsive and also filled some sort of community participation was - re- with a sense of pride.-D.Y., Medical StuIdent, quired in the planning of the facility. Often, though, community people involved in such Biooklyn. 41 YORK GREATER NEW I came to the conclusion that the basic prob- wouldn't let a copy of the proposal out of sight lem with Youth In Action was lack of money. for fear that Bedford-Stuyvesant might steal It seems that the Government has managed to the idea. give just enough for the middle-class Negroes Some degree of protective self-interest is to set up a bureaucracy; these funds, however, reasonable, but it would seem that if each area have not been sufficient to permit the bureauc- had -a certain amount of funds allocated for re- racy to function. newal, health care, new construction, etc., each The funding is on a year-to-year basis, thus year (or 5 years), there would be less competi- causing a great deal of insecurity and a high tion, more sharing of ideas and perhaps even turnover rate in the administration; and since less Federal and local red tape. Each commun- the administration is constantly changing, ity would be assigned funds depending on their good relationships with the regular staff never needs and local conditions. On the Federal have a chance to materialize. Furthermore, a level, fewer agencies with overlapping func- great number of the administrators and super- tions would be needed. Perhaps the existing visors are members of the middle class, profes- Model Cities areas could be used as a start. sionals who, for the most part, are more inter- Each local Model Cities office would know how ested in using the programs to further their much money was available to its area. The ex- own personal careers than to eliminate pov- penditure of these funds could be decided by a erty. joint action of Model Cities and other existing If the Federal Government would supply community agencies.in the particular area. sufficient funds on a long-term basis, many of The Model Cities program has so far ignored YIA's problems would cease to exist. It would existing community agencies in the area, and seem that the Federal Government really isn't therefore any planning proposals drawn up serious about eliminating poverty but is perpe- were probably staff-oriented and not communi- trating an immense fraud.-R.J., Mediral Stu- ty-oriented, as decreed by the philosophy of the dent, Brooklyn. program. This could probably be remedied by I was struck by the immense bureaucracy hiring community people to staff the commit- tees, thus eliminating meetings which end wi: that is Youth In Action, and by the apparently "we'll have to find out more about that"; and it large gap between administrators and working would give the communitya real, -not just ap- staff. The workers, who are community people, Darent, say in the planning. make up for a lack of formal education with a - Much resentment exists because local anti- great deal of understanding and ingenuity, and poverty agencies feel that their funds will be are on the whole impressive.-J.T., Medical cut due to the creation of this superagency, Student, Brooklyn. Model Cities. They also feel, and rightfully so, Some of the problems with the community that -all 'their work and planning is being ig- antipoverty agencies is that they are in a sense nored since this new ageney's committees du- competitive with each other for Federal funds. plicate and have preference over their own Year to year funding, common in many Fed- committees (which seem to have more com- eral programs is a hindran ce to good rapport munity experience). It seems that for any ac- between different local agencies. Agencies don't tion to be taken these days much preliminary communicate to each other about programs planning, studying and investigation is neces- they,are conducting or applying for since they sary. Many of the local agencies have been don't want to chance losing anything to the doing this for the last few years and now a other agencies. An example of this in Brooklyn new agency comes to do more planning, ignor- was seen when the Brownsville Community ing any previous studies of the area. It appears Council was, with our .help, writing up a pro- to many people that this is a way to make pov- posal for a narcotics center in. Brownsville erty programs ineffective: keep them financed through the Model Cities Program. They as long as they are just studying the situation, 42 SUMMER 1968 but once they start to do something about the After attending one meeting of the Tremont status quo, give the funds to someone else so Community Council early in the summer, and they can plan some more.-W.S., Student Coor- having become acquainted with several of its dinator, Brooklyn. permanent members, I could only conclude that it was thoroughly infiltrated by nuns, priests, Newark and policemen, and that its lay members were Our office was located in Area Board No. 2 of neither representatives of, nor interested in, the United Community Corporation in Ne- basic efforts to confront and combat the causes wark. Our relationship with the UCC proved of Poverty, sickness, and crime in the neigh- @to be detrimental to our services-patient ad- borhood. The major preoccupations of the Tre- vocacy and community organization and partic- mont Community Council during this past ipation. Many community residents were skep- summer appeared to center around the mainte- tical, even bitter, about any organization that nance of a good self-image in the neighbor- dealt with UCC, as it is known throughout the hood. Attempts to achieve- this included numer- community that UCC is part of the degenerate ous block parties, parades, recreational out- political power structure that has a strangle- ings, cleanup caml>aigns, visits by political and hold on the Newark community. Any attempt church leaders (including the Archbishop), of theirs to service the people would be viewed and organization buttons. as a move to subjugate the community into the The summer recreation program was run by power structure. UCC has also been involved a Vietnam war veteran who was biding his in a few scandals. When Newark had its riots time until he could apply for a job in a Man- and fires, UCC was designated as a distribution hattan business. After some fruitless attempts point for food, clothes, and furniture. Before anything was distributed, the staff of each area to question the basic goals and motives of the board took what they wanted. Working in Tremont Community Council, I decided to Area Board No. 2 handicapped SHP because adopt a position of peaceful coexistence. The community people were reluctant to come to Uouncil did, after all, provide four students, our office for services or organizational meet- two community workers and three NYCs with ings.-D.B., Community Worker, Newark. office space, phone, and clerical facilities. The Tremont Community Council had been bought Bronx out by O.E.O. and the church; SHP members, During the summer, I worked with two com- in turn, were bought out by the Tremont Com- munity organizations in the Bronx: the Tre- munity Council. It was a cozy arrangement: a mont Community Council and the St. Joseph's priest offering his buddy the cop a salami sand- School Head Start program. The former or- wich, while a Vietnam veteran shooed the ganization is -a summer, O.E.O.-funded group; pesty natives out of the storefront. SHP the latter, a parochial school affiliated with the workers maintained, in true style, a conspiracy large and powerful Roman Catholic parish of of silence.-J.G., Medical Student, Bronx. St. Joseph's on Bathgate Avenue. 49 Part 3: ROLES IN CONFLICT INTRODUCTION seem endless and unproductive? We have not For a multitude of reasons, highlighted in decided whom we should support, the medical the categories comprising this section of the schools or the community; we have tried to be report, the summer experience for most of the all things to all men. SHP participants was memorable more for its We have failed to respond to the real prob- frustrating role conflicts (both real and imag- lems in health-the need for change in schools ined) rather than for any specific task accom- and health institutions. This summer, we did plishment that may have occurred. There was much that was stop-gap. We helped, as advo- little disagreement as to what needed to be cates and organizers, but these roles provided done during the summer ("improve health care few innovations; they merely reformed bad sit- delivery") but agreement as to how best to uations in a hospital system which the'com- achieve this highly desirable objective was munity detests. We should have devoted our never reached on any level of the project or- entire efforts to helping the community gain ganization. Furthermore, approaches to a control of its hospitals and to helping commun- given problem suitable for one area or area ity organizers challenge the inequities of the subproject often turned out, because of basic existing health establishment. But we were differences in the communities and health care still trying to protect the health establishment, delivery systems involved, to be inappropriate project our middle-class values, and preserve or ineffective for other areas or area subpro- our image as a "liberal" organization. jects. Particularly where strong project leader- We have chosen to "sensitize" ourselves, t o ship and firm preceptor arrangements did 'not educate health students. But we are Still acting exist, the necessity for modification of many of as "good" whites in the poor community., The the original task proposals and the develop- problem, however, is not being educated at the ment of new subprojects throughout the sum- expense of the community. This SHP was mer required that SHP workers constantly doomed from the beginning since it chose to be re-evaluate and redefine their roles in the pro- educational. It chose to cooperate with the ject. health establishment, but failed to listen to the The diversity of views in the excerpts that needs of - the community. The community follow illustrate the resulting confusion and wanted people who would help it help itself to frustration experienced by project participants organize area health councils and who would as they faced the realization of their limita- give the community organizers ways they could tions, lack of power, or failure to deal with the challenge the long waits and poor care of the summer's various problems most effectively, second-class hospitals. They wanted picket ranging from broad questions of SHP/SHO lines of sincere white students and the black philosophy versus SHP/SHO practices, to deal- community around these hospitals, if that ings with community groups, institutions, and would help the struggle. Eventually, SHO agencies, to relations within the SHP "family" would have to realize that it must work,:'or itself. first-class health for all, not just for the rich. To do this, health students would have to take STUDENTS AS A FORCE FOR CHANGE a position favoring community control. In fail- Why do many in SHO feel frustrated after ing to do this, we only served to further erode summer projects? Why does our bickering the pride and self-esteem of the poor. 45 GREATER NEW YORK What is SHP? SHP itself does not know. cated to community control, which would bring Our project lacked participatory democracy; needed information about health institutions we never met as a whole to decide upon any- and their politics to community groups inter- thing. Prior to the project, we failed to build ested in health care, and which would actively proper ties to the community, especially in the fight for sweeping changes in health schools. Bronx. Thus, in many instances, we did not Health professionals of the future must begin have well-planned projects; they just fell to- to face the realities of our society now, and gether. I think SHO's leadership let a sinking should begin to force changes by militant reso- boat flounder by not constantly re-evaluating lute actions.-R.C., Medical StvWvit, Bronx. the project and by not providing for direct Before one can relate to a "task" it is neces- participation, or even revolt in the ranks. In sary to develop an idea of what the "task" is. essence, we did not learn from the failures o! The SHP leadership has not clearly defined the previous SHPs and we were doomed to repeat SHP "task." At the beginning of the summer them. there was talk about sensitization, and in the The thing which haunted me most during outline for the final report they ask "how the the summer was an expression from the Deople in your community feel" or "evaluate French student revolt this May: "The walls o ided." It is too have Oars and your ears have walls." I wanted the concrete service you pr v bad they were not able to develop their leader- to help the Bronx community I worked in, but ship beyond scurrying about trying to get I also wanted to listen to them. But people people to do their individual tasks. It is even a wanted action and results. They were tired of greater pity that they were not able to think more white faces. In the inquisitorial darkness beyond a "task" to be performed or a contract of their eyes, I could sense the deep resentment to f ulfill to the point where they quickly lost the my skin had aroused. The community was not moral leadership of SHP and never gained the a wall. It did respond to sincerity, but it conceptual leadership which they had the wanted its own leaders. Advocacy, or doing potential to attain. things for the community, would solve noth- What are the conceptual goals which should ing; helping the community's leadership guide one's efforts? Perhaps they should be to would. I laid some groundwork for a commun- educate doctors and students to the medical, so- ity health council, but much of my work organ- cial and political aspects of health problems- izi-ng tenants to protest a garbage pile in their why they exist and what can be done to correct courtyard, and poor housing conditions, did lit- them on a long term, fundamental basis. The tle for the whole community. question is not, how many will return, but, I think the experience did much for me. I how can the health system from the national to have a clearer idea of what the blacks want the city level be changed for all people so that and what I need to do to help re-educate communities are not dependent on a few white whites; white students must become more raili- doctors who are kind enough to return to work tant in their own communities. in patchwork, pilot project clinics. Student power is desperately needed in the The orientation to the type of education is health schools. We must begin to build a base key-it should be intensely political. Change in within our own society to attack what it has health system, and the people who rule them, been doing to the black and white communities, will only be achieved through political action. in hospitals and in teaching institutions. Stu- The A.M.A. has effectively known this for dents should begin to fight for: (1) A student years. Task-oriented service projects or paying veto in all areas of student life and studies; the salary of NYCs to "sensitize" white medi- (2) student-faculty control of school decisions; cal students to black people gives a minimal (3) more social orientation of courses-, (4) political orientation. The overall tone of the more responsibility of schools and hospitals to New York SHP has been intensely a political. the community; and (5) a militant SHO, dedi- It is difficult to decide what makes medical 46 SUMMER 1968 people political. The present approach of gov- politics, and still be effective in both areas, at ernment funds for service projects and sensiti- least, not this early in the game when our com- zation is not the answer. That a national SHO petence in either of these areas is so limited' convention is afraid to come out strongly (or We can no longer afford to keep winning the at all) against the war in Vietnam or that the small skirmishes (for example, patient advo- SHP is organized around fulfilling Government cacy) while losing the war (for example, little contracts retards meaningful political activity. or no change in the health care delivery insti- Students must obtain a degree of autonomy tutions -with which we worked this summer). from their medical school faculties before they -NV.S. Medical Student, Harlem. can even begin. One approach which the Col- Because I have not succeeded in making umbia SHO is planning to take is to build a many grievances known to the people who c@ hard core of politically active students and doc- trol the health care delivery system, I feel the tors to start with, and to -attempt to slowly project should be organized to put pressure build from this. We hope to extend our base to where it is -needed. Perhaps SHP should not be other medical professions and perhaps to form funded if it is not going to provide a systematic some communication with the hospital unions means of working within the system to exert eventually. This will be attempted through the -nressure. Stop-gap measures will not suffice to continuation of the Liberation School "Politics appease the f rustrations of the patients At- of Health" classes at Columbia's College of tended to by the student, and SHP will lose all Physicians and Surgeons, meetings of the coa- meaning to the community if it accepts in prac- lition of community doctors, house staff, and . alth delivery medical students at Harlem Hospital, and tice the wrongs of the present he through the involvement of these people in po- system.-R.F., Medical Student, Bronx. litical actions' on health issues at all levels. The lack of sophistication of some of the This blend of education and political action is leadership and most of the fellows-I include something which can be pursued on a year- myself-in the SHP is a principal issue. I sus- round basis without costing money. pect all of us learned this summer, but I ques- If medical people are asked to work on a vol- tion whether, other than sensitizing ourselves unteer basis, they will begin to develop ways Of to community health needs so we might be handling the medical responsibilities of being more effective in the distant future, we accom- politically active doctors; once they are profes- plished very much. For that I do not think the sionals, they can then fall back on these ap- structure of people of SHP, or the communities pro,aches with confidence. Because this an- with which we worked, are at fault. We are proach does not involve money, instead @f not capable of implementing vast changes m wasting nine months of effort gaining grant health care in poverty areas. People suffer money and then three months of "activity", from poor health -not only because the city hos- leaders could spend the whole year actively pital system does not meet their needs; not working politically.-K.C., -Medical Student, only because the average physician is self-seek- Harlem. ing; not only because the average medical school is more concerned about research than A question with which we all have to wres- people; they suffer because their children eat tle: do I serve each suffering individual on a lead paint off the walls; because their apart- person-to-person basis and reach only a few of ments are inadequately heated in winter and the many needing assistance, or do I direct my too warm in the summer, and overcrowded in energies at solving broader problems which winter and summer. SHP might cause a eatest number of. persons? landlord to repair an apartment, but in one could benefit the gr To my view, where medical politics are con- summer SHP is not going to begin to attack cerned, there just isn't time to split one's atten- the causes of poor health in poverty areas. We tion and energies between medical practice are unsophisticated and we are not revolution- (for example, service projects) and medical aries; we work within an establishment. We 47 YORK GREATER NEW may serve to improve that establishment with commitment. I never understood the rationale what we have learned this summer. With the that gave lowest priority in the selection of structure of SHP as it now is, we probably will students for this year to people who had pre- not contribute to revolution, but only to evolu- vious SHP experience. If students are willing tion. to come back after one summer's experience, How can we become revolutionary in our ac- they must be committed.-J.P., Medical Stu- tions as well as in our words? We would have dent, Lower East Side. to begin accepting more sophisticated people I was confused about the role of SHP in gen- into SHPS. People who were not idealistic the eral. It was not clear to me whether it was sup- way we were. People not afraid to offend the nosed to be a service project or a political pro- health establishment. People unwilling to fit As a -result, I did into existing community organizations, if those ject for better health care. ek of not know which way to go. There was a la organizations. might have goals with which we communication in the local Newark project as disagree. People willing to accept a subsistence to which direction everyone was headed; every- wage for the summer, to live in the community one seemed to be doing his own thing. So it with the people, to work with them day ind turned out that I acted mainly in the service night. Most people accepted into the SHP were role because it is too difficult to make any at- not like this. For the most part, they were so- tack on organization without cooperative sup- cially concious but not dedicated, concerned but s o the 'dministra- port. When any movement n a not committed. J.W., Medical Student, Lower tion of the hospital were planned, I think med- East Side. ical students became fearful of being thrown There was little threat to the Establishment out of medical school.-L.D., Nursing Student, made this summer. This, of course, brings up Newark. the question that SHO has been struggling Turning to the cold, hard facts, how do we with for as long as I've been associated with it, assist in providing good medical care for the and from what I can tell from the literature, most people? This, I feel, is almost an impossi- from its inception. It is the same question that bility for students. We do not have the knowl- caused two New York SHO leaders to resign edge or power to provoke the radical changes before the summer began. Is the SHP to con- that are drastically needed. The whole philoso- cern itself with political issues, or is ft a phy of doctors and nurses, must be analyzed service and educationally-oriented organiza- and evaluated, and this is a task that must be tion? I believe that any local SHP is doomed to accomplished individually by every person who failure unless the students and community peo- enters these professions and is responsible for ple are in agreement on this question. One of the quality o.f care they give. In one's mind, our major problems was that even the students there must be no distinction between race, could not agree among themselves as to pur- creedi or nationality, but each must be treated pose. Those of us who had been working and as an important person, "my patient," and I preparing for the project during the year had must do my best to assist "my patient" with difficulty understanding and were angered by his every n'eed-physical, psychological, socio- the lack of commitment -displayed by some of economic, etc. Our job is not finished when we the people who came in June. They, in turn, have handled the priorities, such as medica- were angered by our attitude, which at times tions, yet patients are damn lucky if they get must have seemed more dogmatic than ra. even their immediate utmost needs attended to. tional. It was never really stated, either in the I think we can talk and talk about how an in- application or at orientation, that the SHP dividual may assist in providing better care, wasn't "just a job," and that people who wer- but we had better ask just what everyone else en't really willing to commit themselves were is doing-including the people in influential not wanted. For that reason, it was, wrong of positions-to change health care delivery some of us to expect (and often to demand) systems.-P.B., Nursing Student, Bronx. 48 SUMMER 1968 I see the role for next summer's SHP healing, but it doesn't remove the glass from as working directly to change institu- the streets to prevent further cuts.-V.V., tions. The latter, I know from last summer's Nursing Student, Bronx. experience, is extremely difficult to do. I think it is a necessary step for SHO to take if it I don't know anything about heart, stroke, wants to provide any other service than ban- or cancer, and I don't know anything about the daging a festering wound. Changing an institu- enabling legislation behind regional medical tion is a slow process, and student fellows planning, but if we're interested in future should realize this, but not let this realization funding we might look at SHO under two discourage them. To illustrate how difficult lights; first, enviormental health; second, com- change is one just has to ask the chiefs of each munity participation. service. If the chief has been on a service for If the people in the Division of Regional any length of time, and if he has just a little Medical Programs are serious about good sensitivity, he will tell you exactly what is health, they've also got to be serious about wrong with his service. Ignorance isn't the environmental health. They've got to care reason. This doesn't mean that fresh eyes and about good housing, safe streets, good trans- uncluttered minds will -not bring about new portation, and decent incomes. At this stage, ideas for change. they're probably not committed enough to Changing the institution is directly involved stake anything on those goals; but they may with what the community asks of us. The com- be willing to keep us tootling along for a few munity feels that if we have no power to summers. At the very least, we can keep re- change, then why are we offering to help' This minding them that they can't set up routines statement was made during Orientation. Alone for testing and treating people without know- it is hard for the community to change a sys- ing how their patients live. We could feed tem, but united with the forces of people who them ideas on how to make their programs will someday be a part of the system, it should accessible, acceptable; we could point out be possible to start changes. things they should study, such as the par- I think the project should strongly emphas- ticular stresses of poverty and their relation ize being of service to the community. Unfor- to heart disease. Somebody has got to re- tunately, medical schools have a bad reputation mind them that good ambulance service and of taking from the community without giving good telephone service is as important to the anything in return. Medical and nursing stu- proper care of patients as a good surgical suite. dents study the ghetto so they can better treat I think SHO can act as a source of new ideas in poor people. What do they do to change the environmental health; and act as a small force conditions that cause ghettos? What good is it fighting for good housing and decent living to know that poor housing adversely influences standards. health if no effort is going to be made to Community participation can tie RMP to change these conditions? The same applies to SHO. Project fellows-students and particu- the realization tha:l city hospitals give poor larly community people-are better able to care. This has been known for a long time,. but identify the people and groups that RMP the situation still remains. I believe that with should be in contact with to set up local com- education comes the responsibility to make use mittees. of new ideas and information. If the responsi- As far as I can tell, RMP has no access to bility was taken there would be no conflict on the community. SHO can't honestly function as the issue of who was benefiting from SHP, be- that entree, but it can steer RMP towards the cause both the student and the community right people. And SHO can keep lines of com- would benefit. munication going both ways by telling RMP I think that, as health professionals to-be, who to contact and by telling the community we should be concerned with prevention. that RMP is moving in.-K.B., Medical Stu- Cleansing a cut and bandaging it promotes dent, Bronx. 49 GREATER NEW YORK Outside of the community, SHP can play a REPORT very important role. One of their major tasks I proposed an elaborate freshmen orienta- should be to work within the medical and other tion scheme with a flyer, talks at orientation professional schools to change the curriculum about the SHO project and community medi- and to get more ghetto youth admitted to these cine, a siminar program with many of the schools. Since the students are part of these parties involved during the summer, and a con- schools, they can have a strong voice and exert tinued advocacy program. Through a variety pressure for change.-K.D., Medical Student, of intimidating tactics, my efforts (and those Lower East Side. of a number of others) were squashed. Our The white medical student must go back to first flyer, dangerously honest and filled with his own area and make vital changes come what the administration considered half- about. He must work to get more blacks in- truths, was not approved. We revamped the volved in the health sciences and in community flyer and sent it to the incoming frosh, along health. One way to do this would be to get with a bibliography of books about the com- medical schools to admit more black students munity they will enter. The administration and to start programs to get black students in- has refused to give us time at orientation be- terested in going to medical school. Medical cause they doubt. our credibility and demand a schools are going to have to make a special ef- sponsor and acceptance by the medical school's fort to seek out qualified blacks and encourage student council. This is hardly feasible because them to enter the health sciences.-D.Y., Medi- the council won't be meeting for another cal Student, Brooklyn. month or so, and the administration thinks we INTERVIEW have been "put off." Hardly! The community Q: What direction do you think SHP medicine department likes our ideas and will should take. Should it continue to try to edu- integrate a tour of Newark for entering fresh- men into the biostatisties curriculum. It now Cate the medical student to the needs of the community or try to help the community? depends on our organizing the means for this Or program. The seminars must be planned and should students focus on working througii the structure for an advocacy program devel- their schools? oped. What we have proposed is student-family A: It was a good sensitization experience advocacy, some emergency room advocacy, and for me, but there's a limit on how much you need. You could supplement this experience by community doctor-student interaction. Much of having medical students work through the this will depend on the support of incoming freshmen.-P.D., Medical Student, Newark. medical schools trying to get them to change their orientation. We're going to continue SHO To go out and try to be a revolutionary into the year, working through our Community group cannot be done through an organization Medicine department. We tried this summer to like SHP. These people who are going to try to revolutionize from the inside, and really didn't take over the Health Department, who are do it. This is the question to consider: whether going to go down there and force change, we can do more from within the white middle- that's okay, but-that's a different group of peo- class structure as concerned medical students. I ple, not us. If we did that we'd antagonize peo- think continuing SHPs would be good here, but ple and it would be detrimental to our using they would have to be restructured; there have certain facilities. to be different guidelines. Something has to If someone were to tell me that we shouldn't keep going during the summer, whether have an office on Springfield Avenue in Ne- through SHPs or the medical school. It's going wark, and maybe we should work in the hospi- to be the same people anyway. But if it does tal, I'd really want to know why. I understand come through the medical school, right now is in a basic way the concept of black pow er, the wrong time because medical schools are too where a group of people has to get to a certain reactionary to be objective. level of power to meet the white money estab- 50 SUMMER 1968 lishment on equal economic and psychological After the initial phase of orientation to grounds. I don't think the SHps are keeping Martland Medical Center, I limited myself to anyone down; I think we are helping the working with individuals of the Newark com- NYCs and some of the little kids around here, munity who had some specific health problem, talking to them, also assisting the people attempting to procure good medical care for through the advocacy program. Anyone who them and, through this, to effect some changes says that we shouldn't come in is hung up in for better health care in general.. This led to his own thing which doesn't seem to be rele- constructive criticism of and suggestions for vant to what we're doing. We're not putting the facilities I came in contact with such as ourselves in a position of power, we're putting clinics, social service and welfare. I found my ourselves in a position of asking the commun- suggestions usually received with much hostil- ity, "What do you want us to do?"-D.T, Stu- ity and also a sense of hopelessness. But I dent Coordinator, Newark. found most health and social service profes- sionals agreed that the city of Newark must The community-oriented projects were more improve existing health and social services, as successful in educating student fellows, but well as create better facilities. Unfortunately, they weren't as successful in getting things by the time this relationship of trust and mu- done. A lot of the time we got wrapped up in tual concern for the community was developed, the bureaucracy of these different agencies, it was time for me to write this report and and that shortens your summer greatly. * * * leave. In actuality, nothing was accomplished. If the students were more radical * * * you -K.S., Nursing Student, Newark. would get a lot less done. You would make a lot * * * I go to Columbia Liberation School to more noise and you would get a lot more of the the seminar on hospitals to' hear the "radicals" hospitals and medical schools angry with you. * * * I think in our situation the best thing is hold forth. I describe the suit (against the city to get something done by working with these hospitals) and ask for assistance on a future people. In a place like Newark where they get suit against Harlem Hospital to obtain better nowhere with the administration, you canpt health care for the community. I am stunned work within the existing structure because by the apparent indifference and even hostility they won't hear you, so maybe there you have of the group, and come away very troubled.- R.H., Law Student, Brooklyn. to become more radical. It probably depends on eac situation. Too many times during the course of this I think the health system as it is today has summer I have seen highly idealistic and well- to be changed, but when people talk about re- motivated SHP workers try to attack too large volution, about scrapping the system and mak- a problem (example, the poor health care given ing a new system, I don't know. There has to by City Hospital). Frustrated in their attempts be a radical change and maybe a revolutionary to accomplish anything tangible, their energy change, but it has to come through what exists. becomes channeled into hypercriticism. Even- -W.S., Student Coordinator, Brooklyn. tually, this criticism leads to antagonism and ill will, and the SHP worker gets discouraged, I perfectly agree with attempting to reor- throws up his hands and quits.-B.W., Medi- ganize the entrenched, oppressing superstruc- cal Student, Newark. tures in America that are the source of so much agony. However, I think it is a mistake Unfortunately, I. and many other student fel- to ignore the immediate stopgap measures, lows came to the project with the psychologi- especially if one is involved in the delivery of cal orientation that something could be done health services. I think that the above two are about the political problems through our ser- not mutually exclusive and it would be wrong vice activities. As the summer progressed, it to focus on one to the exclusion of the other.- became obvious that a different focus is re- B.F., Medical Student, Brooklyn. quired. Getting out of my psychological "seV' GREATER NEW YORK and into another bag proved to be difficult and We had one subcommittee which perhaps frustrating, since little can really.be accom- would have functioned better if there wasn't plished by individuals in the area of political such a temptation to let the students do the activism, especially twenty or so students, work. They were very helpful, but I think that without any power base, attempting political the community resident who was the chairman activism directed at intransigent health estab- of the committee would have felt more of a res- lishment professionals.-W.S., MedicaZ Stu- ponsibility to draw together Puerto Rican and dent, Harlera. Negro neighbors on that committee, if those four students hadn't been there functioning as THE STUDENT HEALTH PROJECT a good substitute In a less organized commun- AND THE COMMUNITY ity, if there's a vacuum, then you can put to- INTERVIEW gether your leadership-whether it's chairmen In terms of basic directions for SHP in the of social clubs or ministers of churchs; put to- future, and one of the limitations of this sum- gether a coalition and talk to them. This argu- mer's project, it seemed to some of us residents ment that "we don't know who the community in the community who're struggling with the is, so we can't talk to anybody," doesn't go, be- basic problems of inadequate care, could be cause you could put together a coalition of who giving more attention to developing substan- it is. tive positions on how better care could be de- * * * The basic maturity level of students veloped. We feel that even while students are varies. Some of them are very happy to play a involved with problems of personal practices neighborly role, to help someone do something. and intergroup relations for example There are others whose need for a role is so how they can relate to other groups such as great that they have to go in and do it for the Neighborhood Youth corps-they still them. It might be that communities ought to have a basic responsibility to think about the develop screening processes and use certain problems of institutional change, taking reso- kinds of students in certain projects. Some stu- lutions and making their positions known, dents might be more ready than others for a thinking through these things. highly confidential or difficult community stra- * * * Different communities are at different tegic problem. You wouldn't want to talk about stages of evolution. On the Lower East Side, those things to students who are toddling when where there's already some substantial com- it comes to being able to relate in a comforta- munity control, you have a different situation ble way to community people. Maybe we could than in a totally unorganized community, develop programs for students which are basi- where the basic leadership which is there has cally immersement programs. In other words, to be discovered and put together in a coalition. maybe there could be a subcommittee of some I was surprised'to find that (some of the com- community organization concerned with just munity people at the final conference) did not taking students around, showing them what know anything about.hospital affiliations pro- misery is, and how people are struggling. That grams and who's controlling the development way they could get a first-hand understanding of care in their own areas, because all summer of why things need to be changed. long there has been no discussion of this.I I think there's a line between commitment think that if the students, who really do have and accomplishment; it's something we haven't substantive knowledge or can get it in a hurry, given enough thought to. Just because a stu- don't make this knowledge available to com- dent is committed and deeply concerned about munity residents, they're losing a very great giving better health care doesn't mean he's opportunity to do the very things they say they going to be able to use his time in a way that's believe in, going to accomplish that. Then there's the One of the problems in an organized com- question of how to hook that concern up to an munity is the danger of subverting the com- awareness of the constrictions of the medical munity leaders who are already in operation. systems: the medical power structure, the 52 SUMMER 1968 questions of State policy and city policy, and experiment on them and then leave when their the planning mechanisms, and how these interest flags. I don't even think it is our deci- things to which we had very little access as a sion as to whether we have succeeded or failed. community were impinging upon us. In what If we leave while they are still willing to ac- way were -the students addressing themselves cept, or tol erate, our presence we are being de- to this? In order to understand that, the stu- structive by once again reinforcing their cyni- dents, perhaps, would have to go from an im- cism about outsiders. From what I've seen, the mersement experience in the community into a community people are honest rather than po- seminar, the kind that Robb Burlage runs. lite, and will tell us to get the hell out when Frankly, the students have a lot of power, they want us to go.-J.P., Medical Student, within the medical institutions and on a policy Lower Ea-st Side. level, if they want to put their energy in that Though we did accomplish some things in direction. the Harlem area, I hope that there is a more * * * Perhaps if their contributions'in com- efficient way to spend the fifteen to twenty munities were judged programmatically -neces- thousand dollars that went into just the sala- sary, then let those students be funded, but ries for the project personnel. I am not at all let's not just pay them to come in and sit down sure that we were justified in, first, going into and decide what they want to do. I think if you're really trying to develop deep contact be- their community as we did, without an invita- tween community people and middle-class ppo- tion, and then in leaving after doing our 10- ple, you don't do it by putting a glob of people week thing. True, we have left some perma- down in a storefront and letting them be there nent accomplishments, but they are really the from nine-to-five. You do it by placing individ- results of the work of a very few people who had been working independently of SHP be- uals carefully into situations where they . get fore the summer and who will continue to do involved in family life and become aware, in a so after the summer. There were just too many visceral way, of what life is, as in the Peace people getting too much money to accomplish Corps and American Friends Service pro- what, for the most part, amounted to little grams. * * * more than a temporary and insignificant ser- We have to be humble about trying new vice for the community and a sensitizing expe- models. We ought to experiment and if one rience for themselves.-S.G., Medical Student, thing doesn't work let's try another. I think Harlem. you have a beautiful element here among these students who are dedicated, and they ought to We are surprised to find kindness and con- have an opportunity to do something 'basic, cern for us among these people in Harlem who whether or not they can bring the rest of their seemingly do not care about anything. On the structure along with them. Two@ or three are other hand, there is no way for the members of going to live in the community now. Of course, the project to become acquainted with the com- the Lower East Side is a neat place to live, and munity as a whole, and so the work that can be I think a lot of people come because 'of that, accomplished is small. We remain outsiders but as they become community residents they who come and go, like the summer.-A.G., may play a completely different role.-S.D., Nursing Student, Harlem. Community Worker, Lower East Side. One main complaint I have is that our pro- I believe that there is no place for an SHP ject should have been more involved with com- on the Lower East Side next summer unless munity groups or institutions. In that way, o ur the students maintain a continuing relation- presence would have become known to the peo- ship with the community. This means that the ple of Harlem and there would have been less projects started must not be dropped during of an aura of "here's a bunch of college' kids the rest of the year. The community is justifia- coming in for the summer." I don't know if the bly cynical about "outsiders" who come in and community was aware enough of our existence GREATER NEW YORK to have felt this way, but individuals in the does not cover a third of the people who are in group were self-conscious lest this be the ap- need of help. It's a waste of time for everyone. pearance we present.-M.I., Psychology Stu- You have students who think they have done a dent, Harlem. great job, but it's because they filled their own need to "help poor people."-M.H., Community When I began work in this project, I knew nothing about SHP. I knew that I was sup- Worker, Bronx. posed to be a liaison between the project stu- The main goal of the Student Health Project dents and the community. I became more. I did is to help the people of the community. At first, everything from house-calling on unwed people were reluctant to accept any outside as- mothers to cleaning and removing garbage at sistance, but gradually they began to realize the project office in the South Bronx. that sooner or later they would need someone In the beginning, I merely performed my du- to help them, and they began to assimilate tie@appointed and volunteered-without much with the so-called "foreigners." Now, at the thought to the reasons for being of this project. end of the summer, when things are really Then I began to think. I questioned; I was getting on their feet, everyone is packing his answered; I was disgusted. bag and saying "goodbye." Once again, the According to the project fellows and SHO community is hit with the hard truth-no one literature, the main goal was "sensitization" of really cares.-C.B., NYC, Bronx. white, middle-class, medical students. A per- Ideally, I think a project such as this one fectly rational idea-from the white medical should strive to make -itself obsolete; the goal student's viewpoint. But from the moral point should be to help the people become more in- of view, this is an horrendous injustice to the terested and show them how to gain more community! How can SHP invade a ghetto (to power to solve those problems which continu- "help," of course) with an army of white medi- cal students, and for ten weeks perform acts of ally afflict their daily lives.-I.B., Medical Stu- charity and fellowship, but simultaneously dent, Bronx. have the anguish of the ghetto as a secondary It is just that you have to decide what SHO reason for justifying the existence of SHP? is out to do. If it is to educate students, then The makeup and foundation of SHP must be the community is a good place, but if it is to changed In fact, it had better be changed, or it help the community then maybe there are bet- will get kicked from one ghetto to another ter places than out with community groups.- until there are no ghettos left. (And then its W.S., Student Coordinator, Brooklyn. only alternative will be Scarsdale and similar WHITE STUDENTS IN BLACK communities.) COMMUNITIES SHO must have total commitment to the community, but not a pIaternal commitment. It SHAWANGA WORKSHOP: THE ROLE must help train black, Puetro Rican and all mi- OF THE WHITE STUDENT IN THE nority groups to help their brothers and sisters BLACK COMMUNITY. in a meaningful manner. By meaningful, I Position Papers Presented By Willard Finderson, mean meaningful from the community,point of Leslie Clarke, Mrs. Altanese Maxwell, and Peter view, not the interpretation of the community Dorsen (Moderator). point of view by the white medical students.- I believe that there is a place for white Stu-' C.R., Community Worker, Bronx. dents in a non-white community to a certain The health care in my community is very extent, but just because you're in the medical poor' It's the worst possible care anyone could profession does not mean that you don't need get. This is why people stay away from the NYCs to serve as your contact to the commun- hospital until the last minute. Having students ity. If you were to'go out into the community come in the summer is not helping. The num- and try to run your program by yourselves, her of people reached by SHPs this summer you'd be rejected. Someone was saying yester- 54 SUMMER 1968 day that he would like to run the show him- seemed a bit more dedicated to what they were self, but for too long we've been dependent on doing. I don't care if you call me Uncle Tom or the whites to tell us about ourselves. For in- traitor or any other such names, my first con- stance, whites run the school system for us, and cerii is with the welfare of my people. What I this means that our children learn about them- want is black sincerity, and whether you be selves through whites, and that shouldn't be. black or white you can have that. I saw dedi- We should have our own school systems, our cated black students this summer and I also own television and radio stations, things like saw the other ones. I'm not saying there are that. This way we can express ourselves, we not white students who b.s. I just didn't come can tell our children about themselves without across any this summer. For this reason I don't the help of whites who distort history. care who comes into the community, any color, As far as having a lot of white students as long as he is sincere-black sincere. I noticed come into nonwhite communities, they do no that all some of the militants did was call for help. They should go to their own communities "Black Power;" they didn't do anything.- and express to their own people how we feel. L.C., Nursing Student, Brooklyn. It's easier for you to talk to your own people. The bias of this report is that of a white, Of course, you have to come here to find on middle class medical student. Perhaps as a rep- what it's like for yourself, but it's very difficult resentative of this group, I derived a lot more for you to tell me how I should live. The non- from Newark's Central Ward than I could con- white community needs help from just about everybody. I'@ just trying to say you can9t tribute. My skills were certainly limited, and my credibility often questioned. I definitely come into this community and say you're going could be of better service as a physician, as a to do it on your own, because you can't. If you lawyer, as a nurse, for example, once my train- want to help, you can go back to your own ing was completed, if I were assigned to a spe- community and express how we feel and what cific task. And particularly, I think, if the pe- we need. We should let you know what we riod of time in which I was involved in the need, and this way you can try to open the eyes community was longer. But again, I think this of your brothers and sisters, and maybe we can period of sensitization, and perhaps even the get along together in this world.-W.F., NYC, small amount I did accomplish, was impor- Brooklyn. tant for what I might be able to give later to At the beginning of the summer, I raised a medicine and to the community. Perhaps also big stink about why a white student would our impatience, because we were only working want to come into a black community. I said if for ten weeks, was quite important because we they want to help the black cause so much they were more demanding of change and cutting ought to give their own communities the word. red tape. Now it is the end of the summer, and I'm going On the one hand, the student already has el- to reverse my previous position. ementary knowledge of his profession and his This has come about by much experience, skills, so that he can be a liaison for those much thought, and a little bit of ink on paper. less informed about what quality of health The place of the white student, if he is sincere, care they should be getting-what is adequate, is in the black community doing what he and what their rights are in terms of health knows best. There is no way of knowing if a care. I think the white medical student could student is sincere, that is up to him. In my ex- get the ball rolling, as we did in many cases perience this summer, the black man did noth- this summer. But I think it's up to community ing but b.s. Once they got a title and $20,000 a health councils staffed with community person- year, the black bourgeoise in all the top posi- nel to replace him. This suggests, I think, a tions forgot their roots. Give a black man that definitely political approach. title and his money and you don't see him any- I also think it's awfully important that the more. The white students I worked with "volunteers" continue into the winter if they 55 SUMMER 1968 only time my kids will get a chance to get cation" of working in the community. I'm very something better is if a group of white people ashamed of myself, and very disgusted with get together and say, okay, we're going to do myself, and I would never, ever get into any- this for you. thing like this again * * * Are you suggesting that we do not have a Whenever anybody from SHP took some- place, that we're making a mistake by coming body to the hospital, they got better care that in? day, but the day that you couldn't be there to Right, you do not have a place! Besides, and take them, they got the run-around, they got this has been getting me angry all summer the same old thing. SHP isn't going to be here you've been getting involved in personal, deep all the time, I don't think. What's going to problems, and all you can really do is go to happen after SHP is gone? Welfare with them, or take them to the hospi- If SHP was able to get a few people in, was tal, and then you've got a file of everybody's able to get services for them, I think that when personal sex life and everything like that, and SHP moves out, these people will get so angry, then you leave. I don't believe that your mind they will get together and try to organize in is so together that you're not going to discuss the way in which SHP tried to get them ser- these things that you're not going to have an vice. So SHP, I feel, did something, even idea of "this is how they live" kind of thing. I if * * * only to get them angry. They're really believe that this plays in your mind going to be angry if they can't get it any more, after you leave. There were very fevr white so I think we did something. students this summer who didn't have that I think it's ridiculous to assume that every typical attitude-maybe they can't help it. But white man that comes into the black commun- you don't understand how the system has made ity is there just to take advantage of the peo- us this way-you just say, well, this follows up ple, is there not to give anthing, just to be do- with things I have been taught all my life, and gooders. I think many students that went into this makes you feel superior. * * * the black communities this summer really were Can I put it to you and ask, why ate you interested and wanted to change the situation here with us now if you don't believe in of the people. We have our hangups in the it. * * * white community, but I think the blacks have I'm angry at myself the whole summer, be- too-the fact that some black people distrust cause someone told me, I think you'll like this all white people, this is something that's job because you're outgoing and you sincerely wrong with our society. We're heading towards have a feeling for people, and you might really an all-black and an all-white society. This is enjoy doing this kind of work. When I went to terrible. If we're going to stay out of the black orientation I got an impression that a lot of community, all you're going to head for is two things were going to be done for my people. I separate communities. The fact that white pgo- resented the idea that white people would have ple give a dam n about what's going on in the to be there to keep doing it, damn it; but all black community is a. very good thing, and I do right, I thought there was still going to be think we have something to offer; I think some something done. And then all of the things you people really care about what goes on and can said you weren't going to do, such as, you wer- go into a black community and ask people, en't coming in with microscopes, and you wer- "how would you like us to help?" and then do en't going to write books, and stuff like that. for these people exactly what they want us to You came in and started doing the same damn do. I think this is performing a service, and I things you said you weren't'going to do. And think the white person does have such a place that made me disgusted * * '-' that made me a in the black community. And you say it would part of your sneaky, underhanded way of get- be better if we had black students going into ting what you want. I think the only ones who the community, but we don't have them now. got anything out of this were the students who What are we going to.do, wait around for 10 to maybe will get a credit in school, or the "edu- 20 years until they come? 57 GREATER NEW YORK are accepted in the community. I'm thin-king in another white student. We didn't have any terms of the structure of the welfare rights NYC's with us and we were accepted in Har- program where there are outsiders present, but lem. We got a few wisecracks, sure, but that community people must administer and pursue was minor. We had health services to 'give to claims themselves. these people and we went out and gave it to I think it really should depend on the local them. Just because we were white they didn't climate of the particular area, as to just how refuse help; they wanted it. much a student does become involved. On the Do you think if there had been just black one hand, he can live, work, and sleep in the students, do you think they'd have been more area as VISTA workers do, or he can merely effective ? work out of a storefront and return to his I don't know, it just worked out in Harlem. I white middle-class neighborhood for reasons of don't know the situation in Brooklyn. safety or convenience. He can also choose to I think as a community person, you can iden- work in an emergency room or agency and tify more with a black student than a white never enter certain parts of the community. student. Of course, if you have some services to Certainly, the community is cynical about offer, the people would be stupid if they didn't 10-week do-gooders. It is cynical about ques- take advantage of it. I'm just saying they're tiorinaire makers and posters. It is cynical more inclined to accept a black person than a about photographers and bookwriters who white. They'll still accept the services, but in many times catch the people's misery on their different degrees. films or in their books, which only supports I worked in the South Bronx area, and I got the distortion whites already may have. I a chance to talk to a lot of the people. In my think the question is: Is this worth the time, community, you always see white people pick@ effort, and money involved?-P.D., Medical ing up our kids; you see white people taking Student, Newark. our kids to camp; you see white people teach- ing them during the winter months. Why can't The students working with the community we have black people being taught to do these during the summer in the Harlem project were kind of things? very helpful and they really worked very hard A person who needs help isn't going to say, in our community to help our children and to "I'm not going to accept it because he's white"; serve their health needs. They seemed so dedi- a person won't do that. But we get .. the feeling cated. If there was any question we workers wanted answered, or whatever systems and that we always have to be led by whites, medical terms -needed explaining they did it. I whites have to take us to the hospital, etc. I think their being here was great as ong as really reject this thing of patient advocacy. All they provide a service to help the community right, it's one thing for me as a black person to do what was needed. And if they didn't (although I feel kind of uncomfortable) taking reach but ten children and did a very good a 60-or 70-year-old woman to the hospital just thing for those children, then they belong. And like she's a baby but for a white person to do it that goes for all white students. I think more makes them feel a continual dependence on whites, I've even met some black people who of this work should be done, but not on the wouldIrather a white student would do some- basis of color, or what the community is, or thing for them than a black student. You know whether you belong. You belong wherever why? Because white society has taught - there is a need for dedicated people.-A.M., "don't trust your own kind of people"; it's a Community W&rker, Harlem. sick thing that they would prefer to be taken Open Discussion by a white student. * * * You're not letting I was just wondering if WF's argument them grow, you're keeping them down by con- could be a counterattack, because you feel the stantly coming in and leading them. NYCs have been attacked so far. -I worked in I don't want you coming in to take'my kids Harlem, and I worked for a few weeks with to the park, or on hikes. It would seem that the 56 GREATER NEW YORK The thing about black self-esteem, and tak- that's sick about our society, in supposing that ing something away from a black person by community people don't know what good being white and having to do something for health care is, or how to get it. These people them, that's really beautifully expressed in have learned over the course of many years Carmichael and Hamilton's book, Black Power what bad health care is. And if you go up to and the Politics of Liberation. It's really a very any one of these people in the clinics, they will good document on this. To get to the things tell you why their treatment is bad. They you were talking about, how would you re- might say, my discomfort is aggravated by structure SHO, so that it would do what is the going to the hospital, rather than being eased. most important thing, to train community peo- Rather than having their problems alleviated, ple to do what medical students think they can their situation has become chronic through bad do. I think SHO at Yale in New Haven has health care. done the best thing along this line, which is, What you need is outspoken, militant peop e they have as many community workers as who gather people around them and make students. * * * Maybe SHO should just be a themselves more assertive to demand certain sort of enabling force, so that we can enable things. If you are a powerless body, and you community people to do things for themselves. demand from a powerful body, you're not I think what we should have been doing was going to get anything, which is the case in Ne- giving our expertise, what we know about the wark. The Newark City Hospital is a very hospitals, to community organizations, and this powerful body, very bureaucratic, very much is the pattern we can take for next summer. in the system. They know they're very power- We should go in and work with these commun- ful, and they don't have to "sit down" to real- ity groups during the year, so that we would ize their power. But the community people, have some plan of going in next summer. Then often, have only one recourse open to them: we could say, OK, you know we've learned how they have to Bogart, they may have to close the welfare system works, and we know how a down a hospital, they may have to burn it hospital system works, and now we're going to down. And there are plenty of people in Ne- work with a group of five or six people from wark right now who would rather die in the your community organization; we're going to streets than use that Newark City tell them all we know about health and wel- Hospital * * * fare systems. * * * I think that's where we What you need for white students, first of can work, and eventually we'll work ourselves all, is to get away from this thing of coming in out; that's what we should work for. * * * to learn about us. Whites always want to be I think black people are all trying to reach a one jump ahead of not only what we're think- level of pride, esteem in themselves and things ing, but of how we're going to go about doing like that, so that, when they reach this level, it. More than that, they want to be able to give they can communicate with the white people, their suggestions and exercise control over with the white power structure. So they're all how and what we're going to do. There are going towards this one aim, to communicate. plenty of black people in Newark, and in other What you're doing down on the bottom is irrel- black communities around the Greater New evant. We need help, in all kinds of forms. York area, who have plenty of ideas about how The whole concept of white students going they're going to change things. The whites are into a black community to offer what they have very curious about this; they can't.stand to sit to offer-some mysterious type of expertise back and work in their own communities. Some which I have yet to see-is totally bogus, be- of the really liberal whites realize how deca- cause what took place in Newark this dent their own society is, so they reject work- summer * * * I could have gotten twenty-five ing in their own society; they want to come high school kids to do the exact same thing. down and leech off the black society. And they I think you're being very naive, very conde- can do it with the Student Health Organiza- scending very racist, and everything' else tion the same way they've done it with all 58 SUMMER 1968 these anti-poverty programs, across the board. the administration didn't want SHO people to You've got to -get away from this thing of inform freshmen about how there should be not rehiring even the few whites who perform more involvement with community people as well in the project during the course of the part of their medical school education-some- summer, who get beyond this learning experi- thing as simple as that. Some of this experi- ence, who finally realize what they can offer, ence is vital if white people expect to practice and who can then come in and differ with it. in black areas. The second summer, these kids aren't even As far as providing an immediate service for hired by SHO; SHO's intention is to bring in people in a community like Newark, that is more leeches, to suck and learn off the black vital, because these people really don't want to community. This is what these kids do, and be bothered with you if you can't do something when they go back to their own medical definite for them. And white kids can do this. schools, they can't do a damn thing. They They can come with a clear mind as to exactly aren@t going to Bogart their way into those where they stand. A lot of them are just too buildings, they aren't going to do the very mixed up, because in a place like Newark things they're demanding of black people. I'm' there's always talk about violence, and when not saying we want to make -a parallel health such talk hits the fan, where are you going to system, I don't think that -a lot of blacks be? I remember that at all the meetings, just today want to see a parallel of the white before the project got under way, they kept society. We don't want to have black folks talking about what are you going to do in case doing to their own folks, what white folks of violence. And I just sat there and said, man, have been doing to us for so long. What you you people should know what you're going to have to have is creative people who will do. If you've arrived at a certain point, either help develop totally new methods in health you get the hell out or you know which side of delivery systems. If whites are going to a gun you're going to stand on. It seems stupid come into a black neighborhood, the black peo- that they would worry about it since they ple in that neighborhood should determine who would have been working at the hospital all the whites are who will return. The white stu- summer. The first thing you would do is go dents who worked in the Newark community the the hospital, because people are going to be should submit themselves to evaluation if they coming in there, all banged-up and shot-up, or want to work the next summer. The black peo- whatever, so you could be the most help there. ple they worked with should say which ones of That's the way they can be the most help now, them should come back. when there are no riots, in the city hospital. I think that white students could definitely Patient advocacy is a beautiful and meaning- serve a role in a black community. Maybe not ful thing. We didn't drop it, we got hustled out make up a black community health council, but of the hospital. The hospital is seared of the they can certainly educate their own folks as community, and some of the medical students to what's going on by working from out here. are even seared of the community, though I We can get more done that way. We have three think quite a few of them got over that. But or four kids who go to the New Jersey College the immediate service, the advocacy, is ex- of Medicine. They have been more effective by tremely important. Even if this project was all associating themselves with community people, black, if they did not offer an immediate ser- with the high school kids, and with the -non- vice to people, it would be useless and stupid; hospital people, rather than doing it the they wouldn't be able to help anybody. other way around. If they did it the other There could be a place for SHP 'next summer way around, they'd get co-opted, they'd get in Newark. Apart from antagonizing people in softened.- A lot of the health science students Martland Hospital, student fellows only antag- have seen how really desperate the situation onized each other this summer. I would drop is' Two or three of them have been threatened the policy that former student fellows not be, with being kicked out of school, just because hired the following year. This should be based 59 SUMMER 1968 mer in the ghetto.-L.C., Nursing Student, Ne- worker on Gouveneour Place, a short block ,wark. which offered ample opportunity for being or- There is a certain core of adults in Newark ganized around housing, sanitation, and health issues. who have really had it. They don't believe any- The first three weeks were spent planning body, or anybody in a position of power, or the and executing a block cleanup and block party city government. They are also struggling for -the accepted way of getting the residents their own living, and because we're college "fired up" for tenant council meetings set up graduates, they aren't going to believe us. by the LABOR staff. While discussing code We're too clean and too "Establishment." v- iolations with tenants, I was able to uncover We're not living and sharing their experiences very few medical problems, but heard a bar- with them. You can be white and share the rage of complaints against the sanitation de- experiences and get accepted by doing the same partment and the police who have failed to thing, by being a day laborer. I really think come through with a play street for three you have to break that economic barrier and do summers. The block swarms with kids, from the same type of work to reach them. toddlers to teenagers, and no one hears the e; it was so,+ I've had one negative experienc . . angry parents' protests against speeders and of funny. One of the student fellows who didn't have his name tag on was talking to a guy the dirty streets. I decided, therefore, to ex- from the African place across the street. Then plore the possibility of closing off the street to through traffic. While the cleanup and I came in with my name tag on and broke in on block party were successful as stopgap meas- the conversation; the guy took one look at me ures, neither provided the expected induce- and said, "Are you a medical student from the ment to organize tenant councils. Nor were medical school?" When I said, "Yes", he just the petitions signed by all residents or meet- got up and walked out. He didn't say anything, ings with police successful in getting through he just got up and walked out of an elaborate city bureaucracy and around uncooperative conversation.-D.T., St-ztdent Coordinator, Ne- tenants to get the street closed. wark. I had questioned the merit of such measures Those non-black people who are selected as a means of getting to the people and helping should be more carefully screened for attitudes them work together. It was explained to me and grasp of the problem. An upper middle- that this mostly black-inhabited block had not class student who honestly sees nothing wrong @esponded to past organization efforts despite with taking photographs of human suffering tne vast need for the attention from city agen- with his Nikon-F is a mistake. His presence 'cies which group effort initiates. I felt that and his blundering are too expensive. Let him this community was apathetic because all out- learn'elsewhere. Asking to be shown through side agencies had failed to use the manpower someone's home for the purpose of seeing just potential already there. Even LABOR operated how bad it is is too much. Is he going to fix it? by importing black organizers from other -A.M., Nursing Student, Newark. areas. Were the people unresponsive because I ap- I was assigned to be a patient advocate out peared to have initiated efforts to get the street of a poverty program storefront, the League of closed off? I think it naive to settle on such a Autonomous Bronx Organizations for Renewal simple answer, but I did begin to realize how (LABOR). The office was located in the middle these people feel about whites coming into of an old tenement area with both black and their homes, exposing their dilemma of apathy Puerto Rican residents. The assignment at first and an unresponsive system controlling their seemed to be a challenging approach to the ad- lives. Appearing to know more about the SYS- vocacy work because LABOR's primary con- tem and how to apply pressure, the whites are cern is organizing tenants around housing code expected to do for them what they have been violations. I was to work with a community unable to do. I was told by many of the outspo- 61 GREATER NEW YORK on performance and comparability with the tified till a couple of days later; how people non-white community. Community people who were in a coma were operated on without should not be "used" to train liberal white permission from the family. * * * It would leeches, or even to help them become more well have brought back a lot of bad memories and informed. Only those who know what they can would have really been a mess.-L.J., NYC, offer and how they can offer it should be hired. Newark. SHO could possibly split its forces for the summer project into two forces' Those who I agree that getting "sensitized" is a good will work in non-white, for example, black idea, but I don't think three months are needed communities, and those who will talk to their if it is to be done in the manner we tried. My own folks.-R.P., Community Worker, Ne- Philosophy is all-or-nothing; we should move wark. in completely or we should have a "detached" attitude, as many of us had. We returned to INTERVIEW our white middle-class suburbs like clockwork. Q: Do you think the health students related I think it important for white middle-class stu- to the Newark community well? dents to re-evaluate the ghetto. They'll find A: Yes, they fitted in very nicely, they wer- that the residents are some of the finest and en't too anxious, they were understanding, most decent of people and that there are rea- very pleasant-they weren't formal. The peo- sons why they act in the manner they have or ple around here don't like people to be formal. feel as repressed as they do as denizens of an They like down-to-earth people. The . students involuntary ghetto. But it is curious that fitted in all right. If they hadn't, they wouldn't many of us are victims of a white involuntary be here this long. ghetto imposed on us by bigots and opportun- * * * A number of things would have hap- ists in our own families and communities, in pened if we'd cut into the hospital the way we many cases of the worst kind, the silent bigots wanted to. There probably would have been a who are the hardest to weed out and the most riot, I know that. SHP really wanted to protest dangerous to our society. Being sensitized- against the hospital for the people there. The which I admit to be of some value-we must hospital people don't treat the patients re-enter our own communities and shatter the right. * * * 'If we had really pushed com- fears of integration and the myths of black ig- plaints as hard as we wanted to, and had had norance and irrationality that are perpetuated the people protesting, it would have been a in the white communities as they are -now. We huge mess. In a round-about way it was best must also remember in the future, when we are to do as much as we could, but not to do it too doctors and nurses and lawyers, to be nonsub- strongly. * * * scribers to the hypocrisy of our milieu.-P.D., You see, community people never really stop Medical Student, Newark. to think about how they're used to being I think that inducting a lot of white kids to treated. The people know they're being treated come and work in a black ghetto for the sum- mean, they know they're not being treated fair, 'thout some type of screening or inter- but. they never stopped to realize what they mer wi could do about this until the health students viewing is simply a newer and better means of came here. That's when they stopped to think, legalized exploitation. For years we've been why should we be treated this way? Before pushed around and used and now when whites they had said, "Oh well, we're going to be start feeling guilty, they want to rush right treated like dogs, let's get used to it," and they into the ghetto with their righteous attitudes never tried to do anything about it. If the and change the world. And when the summer health students would have come in- and started is over, they can go back to their family and protesting, then the people would have remem- friends with news of how they've redeemed bered how the riots worked; how our people themselves through the great community ser- were killed and their families weren't even no- vice they rendered the "poor folks" this sum- 60 GREATER NEW YORK ken residents that seeing the white students in found that medical students are, on the whole, this role only aggravates the wounds they have inconsiderate and self-centered. With the excep- suffered. They wondered why more isn't being tion of three, I found that they are interested done to train the community people to do my only in what they can gain and how far it can work. They argued that if I do know the sys- get them. The attitude of most medical stu- tem better, I should be demanding reform and dents is one of condescension. They act as working within to change it. If I as a health though the community should be on its knees student am committed to helping these people praising them. Most of them seem to be saying, get the services they deserve, in their eyes my "Look, you should be glad that I'm giving up place is not in their community, but in the clin- my precious time to work in your poverty- ics and hospitals.-R.F., Medical -Student, stricken ghetto area." This feeling is not Bronx. voiced, but felt instinctively by the community. it is often said that a person acts the way he The subject of health is very touchy. Most feels. people won't discuss it openly. I feel that you To being with, it's bad enough that people must have the quality of being able to talk to a have to live in conditions such as these (rats person in a way that will make him or her feel and roaches crawling all over the place), but at ease. You can't expect to knock on a person's you don't have to remind them and make them door and have them tell you, in detail, what is feel bad about it. After all, they don't like it wrong with them physically, especially, if you're a white person. any more than you do. If someone were to come to my door with that kind of attitude and tell I am black and I know when a white person me that they wanted to help me, I'd tell t.hem comes to my door I'm a bit skeptical. I know if where to go and how to get there fast.-C.B., a white person comes to a black person's door NYC, Bronx. to ask about health, the black person will think he's crazy or tell him to get the hell out This comment is an attempt to respond to the of there. Despite the fact that many white stu- position supported by most militant black or- dents have stated that people in the community ganizations (for example, the Black Caucus of didn't receive them that way, I know for a fact the Chicago SHP) that the "very presence (of that nowadays that's what you'll get.-H.H., white middle class health students) is destruc- Nursing Student, Bronx. tive and you cannot make yourself relevant to The question has often been asked, "What us at all." Two crucial issues are raised here: are white medical students doing in a black what kind of "presence" is destructive, and and Puerto Rican community?" Naturally, what is "relevant" involvement for SHP mem- this question arouses fear and guilt feelings in bers? I propose the concept of the "relevant some of the community. As a black person, I absence" of white SHP members in the black feel that no one black person can safely say community. How is this "relevant absence" to what the community feelings are about this be implemented. By (a) tutoring and job matter. Luckily, the SHP has -not had to face advocacy of community teenagers and adults this problem because when people'are in need for entry into the health professions; (b) sup- or want help they don't care about the color of port for organizations for control of local the person who is giving them this help. If one health facilities; and (e) supporting construc- were to look at the question of black vs. white, tive union demands for professional advance- they would realistically see that there are more ment and higher salaries among hospital slave labor groups. white medical students than black. Therefore, All of this implies that Whitey must with- Student Health Projects cannot consist Of all draw from the destructive summer colonial out- black medical students.-M.'J., Nursing Stu- posts called storefronts and confront the injus- dent, Bronx. tices of his own mother country (medical From my experiences this summer, I have schools, hospitals, clinics). If he does not make 62 SUMMER 1968 his confrontation peacefully, his black SHP col- older people meet and work on equal ley- leagues will have to do it violently. As in the els.-N.W., Community Coordinator, Brooklyn. present systematic oppression, the future in- I believe that being black is becoming daily surrection against inadequate health care will more and more of a criterion for working in the unfortunately leave its deepest scars on the black community. However, it should be noted poverty-stricken patient.-J.G., Medical Stu- that all it does is get one into the community; it dent, Bronx. does not make the job in the community any I think that in most cases of a black person easier after you are there. and a white person working together, the white The fact of my having worked in Youth In person doesn't really expect too much from the Action since February was more of an asset non-white, and the non-white knows this and than was the color of my skin.-E.C., Medical therefore doesn't do any more than is expected Student, Brooklyn. of him. The white student, if he comes in the area What I mean is, you only get what you expect with the right attitude (that of being willing to out of most people. If you expect very little, work for the wishes of the community, not to that is just what you ge@very little. So if You dictate to the community what must be done), intend to have a project next summer, don't can do much good for his brothers-black and fool yourselves, as one student said, that you white. He can give his black brothers the tools are all things to all people, because you cer- needed to carry on the fight for better health tainly are not fooling the people in the ghettos care. He can help them organize and give them or the community people you are working with. information about the white power structure The people that I worked with this summer I that can be used to change it. He can align him- believe were sincere and in most cases hard- -self with the members of the black community working, honest people. Some of them I liked in demanding reforms and revolution. He can and worked well with, but others I felt were show the medical world that whites must work just curious to see what life in a nonwhite com- together with blacks in order to make a better munity was like, not because they really cared,, society for all.-D.Y., Medical Student, Brook- but just because it was an opportunity to sat- lyn. isfy their curiosity and get pretty good pay, too. The project director and I talked about the Another thing I feel about this project is appropriateness of medical and nursing Stu- that the white students are feeling guilty about dents working in these communities this sum- the wrongs that have been done to black people mer. Just where do we fit into the scheme of for so long and are trying to make amends, so things already going on. I feel very strongly they say to us, "What can we do for you, what that our role should be support, not leadership. can we give you to makeup and let you know we Black people should be doing their own orga- are sorry now?" Well, this may be great, but I nizing, not only because it is likely to be more don't want you to give me anything, not as a effective, but because of the need for a black gift, not as charity. If white people want to identity and solidarity. We're really just an- help black people, don't give handouts; don't other group of absentee philanthropists who treat grown men and women as children that come in for ten weeks and do our thing and have to be taken care of. First ask and find out then leave. The only things that will have last- if Your help is wanted, then give the help that ing significance are projects that speak directly is asked for, don't try to shove your way of life to the needs of the community and which have down our throats. I really think that the big- the interest and support of the people. for whom gest help you can give us is in teaching and they're intended. To that end, we can try to en- showing us how to help ourselves; show our list support for a project, but the real leader- Young people how to get into colleges, what to ship must come from the people who are inter- do to'get grades that are college level. Let us ested in it, not the health students. 63 GREATER NEW YORK Also, in the words of Malcolm X, we might only that which he found expedient. He criti- fruitfully spend our energies "organizing our cized other Negroes (excuse me, I mean black) own people" and trying to make them cognizant historians and branded them "Toms" because of and responsive to the expressed needs of the they had the intellectual honesty to tell history community. This refers mainly to the hospitals as they saw it, even if a different telling would we'll be dealing with, but also to our medical be a better demagogic tool. I was really in- schools and some of the city agencies we deal censed. I came to work on this project because with. We can perform a unique function in that I am tired of white lies and hypocrisy, and I we are health science students and can talk to will not now accept black lies. After rejecting doctors and nurses in a somewhat knowledge- "Establishment" propaganda, I won't fall prey able way. I think we should look for ways in to radical black propaganda. which we can serve as intermediaries between I have spent too long at academic institutions the community and the health providers and and will not willingly cast off respect for intel- use our position not to be apologists for the lectual honesty and truth, even though it's cur- health providers but as advocates for the unre- rently in vogue to do so. It has become fashion- presented. Hopefully, as decentralization and able to class these terms under the column community control becomes a reality, the need headed "bourgeois educational system" and re- for this function will wither away also. The ject them, and that is a great pity. At any rate, name of the game is participatory democracy as history I found the talk a failure. It was, and we should try to facilitate that. These re- marks apply more to the white health science however, useful in that much of his approach students than to the blacks, but it's unfortun- to history exemplifies what we're seeing today in the new trends the Negro movement is tak- ately true that some blacks are only slightly ing-namely, over-reaction. more effective than whites.-R.C., Student Coordinator, Harlem. When I began working here ten weeks ago, the words "Black Power" really frightened me. It's late Tuesday -night, and I've had a full 24 They conjured up images of burning buildings, hours to go over the black history talk. I had shattered storefronts, and gun-point confronta- really looked forward to the Monday night tions of black and white. It wasn't the immedi- black history class: first, because I thought it acy of riots that was frightening, but rather would be interesting and, second, because I had the future prospects of the black movement- heard the speaker praised. I was disappointed where is it all leading? The idea of black con- on both counts. trol of the schools and hospitals had been men- tioned at various meetings and discussions, and The topic for the class was something about the transition from African to slave. The I refused to accept it because I inseparably speaker began with a glowing exhortation of linked it to a total rejection of the white com- the "rich" African culture and religion, and munity by the black. I could see recurrences of moved on to talk about the life of the plantation the Ocean Hill-Brownsville school incident in slave. I don't know much about the African all the situations where blacks were suddenly heritage, but I found this discussion of it given control of the local institutions. I could neither enlightening nor pertinent. It was see the firing of white ljeople, not on the basis pitifully one-sided, filled with half-truths, of their competence, but on their whiteness totally lacking in historical perspective and, at alone. What was particularly disturbing is times, a complete perversion of the past to suit that it appears to be a rather unsatisfying the speaker's own present needs. In the course culmination of black discontent both for the of my own studies on the Civil War and Ante- white community and the black as well. Whites bellum South, I had read the same authors to control the money and power structure of the which he made reference (and a great many country, and it seemed like the black man was others as well), and I honestly believe he judi- hurting his own struggle by permanently re- ciously edited everything he read and presented jecting Whitey. These considerations led me 64 SUMMER 1968 to write off the Black Power movement as defense against the wretchedness that sur- irresponsible and immature. rounds him? Can he help but try to close out I interpreted the Afro cult as the natural the ugliness? Consider the incidence of hard- complement to the Black Power movement. The drug addiction in Harlem-the needle o ffers stress upon things Afro is easily seen and felt relief: escape. The same for the bottle-it too around here-all along Lenox and Seventh promises escape. How can the black man an- Avenues boutiques have sprung up where Afro swer the question: who am I? Is he the stag- clothes are sold and the "natural" hairstyle be- gering drunkard, the unwed mother, the comes more popular daily. I didn't like the Afro bastard son, or the local whore? The reality rennaissance for a number of reasons. It has all of the nightmare is too much to bear-a new the earmarkings of a fad, and like other fads it identity must be found. The Negro tried to flourishes on conformity and is steeped in hy- adopt white middle-class values and was pocrisy. The artificiality of the whole thing was doomed to failure, because he can never be particularly disturbing. While the American white and is not now middle-class. Afro was Negro obviously does have an African heritage, seized upon because at least it is compatible the Afro rebirth, as it appears now, seemed to with being black. Unfortunately, that is the have little meaning for him in 20th-century only relevance I could find for the cult, Harlem. It all appeared so inane. I had no diffi- and it is for this reason that I saw it too culty calling it "just a lot of people swept up by as a blind alley, a fad, a foster ethos. Yes, the ethnic mongers." Of course, the black man black man once was African, but 250 years of should be conscious of his black heritage; it slavery followed by another 100 years of mock would be a crime to disavow it-he can no freedom and urban poverty living have far re- more deny it than he can deny his blackness. moved him from the 16th-century African. But the whole thing seemed so unreal-a re- Whatever African he had in him has long since treat. What I came to realize slowly was that died and cannot now, in the 20th-century Amer- the need which forces him to seek out this ica, be brought back to life. The Afro cult African cult is very real. There is a void as seemed to me a backward-looking sham. It ap- to the identity of this black man-just who peared that the Negro had taken up the cult for is he? The question is not how he appears to no other reason than his denial of white the world but rather how he appears to him- middle-class America-a denial born out of self. 350 years of frustration and hate. On my way to and from our office I walk past From the mid-fifties to the early sixties, the southwest corner of Eighth Avenue and Civil Rights looked as if it were going some- 137th Street-past the crap game in pmtetua, and the old men sitting on the stoops and stand where: Supreme Court decisions and picketing appeared to be gaining ground. But the proe- ing at the corner; past the tired faces with eyes the first still bloodshot from the last night's cheap whis- ess was much too slow and after key; past the panhandling junkies, century of "almost-freedom," every year was coming harder to take. The Negro of that period down and looking for their next shot; past pur- appears to have f allen into the trap of think- ple pants and old yellow Cadillacs. The side- walks themselves are speckled with the trodden ing that because he could now ride in the remains of chewing gum, tar, spittle, and urine. front of the bus his blackness would pass un- On hot afternoons, the south side of 137th noticed. But as the slow years rolled on he Street is in the shade-and it teems with name- soon realized that no matter how close he less black life. gets he's never going to be white. Out Of Harlem is a nightmare, and it is against that the old and new frustrations came the propo- background of the all too real ugliness that sition that "Black is Beautiful." The politi- must come to terms with Black Power and the cal adjunct to this is. that Black can run things Afro cult. The question of identity looms up without Whitey, and if we don't give him the again, can the black man help but build up a chance, he'll seize it for himself. The Negro, 65 GREATER NEW YORK unable to become white middle class, makes the gering job of revitalizing his institutions, he psychological defense of rejecting it. must come to terms with himself. When his I've spent a whole summer listening to black personality development is complete he can leaders, at times working with them, and each then look to his sociological ills, and therein the day walking around Harlem, always trying to Black Power phase will have to end or at least put Black Power and the Afro movement in the sufficiently alter itself to allow acceptance of proper perspective. If you listen to black white support and aid. The white sector has too leaders you get the impression that this is the much of the broader political power, too much end-the final step in the evolution of the Civil of the money, and too much of the professional Rights movement. They seem to say now all personnel for the Negro to ignore it-the black that's left is for the black community to get man would be a fool if he did. fully behind it, and the final assumption of I've asked myself where the white man fits in power is imminent. This is what always threw now, and the only answer I can come up with me off about Black Power-the proposition that is that he doesn't. He can support the move- it is the matured product of black unrest. ment to give the black communities the power it would be unfair to Black Power and the they demand, but that is all. It is the black man Afro cult were I to leave the impression that himself who must struggle with that power. they are useless socio-psychological defenses, Until he's ready to ask for and accept, . e because, for all their superficiality and imma- white man's help, all Whitey can do is watch turity, they serve an absolutely vital function: *-B.G., Medical Student, Harlem. they make being black something acceptable, not to the white man, but rather, to the black COMMUNITY EDUCATION AND man himself. The trouble I have had with TRAINING PROGRAMS Black Power is that it disguises itself as the This summer I think the community asked to end, when in reality it is the means-the vehi- be able to do for itself what is now neces- cle by which the black man can regain his self- sary for outsiders to do. The community wants respect and pride. I seemed to fear Black Power to know how to obtain the knowledge necessary because of its finality-the black-community is to meet its own needs. This was clearly stated given control of its schools and responds by during orientation, but I've seen little evidence firing all of its white teachers. The crime in of any action. I think it would be extremely ad- that is that by disregarding competence, the visable for the health science students in - e black community can destroy what institutions future to act as tutors. There is no question as it has. I do believe it should determine policy to who would benefit from the service. Part of and make decisions, but not on the basis of our work this summer with the NYCs was to black and white. provide educational programs. I saw very little If the black leaders were given control now, evidence of this taking place. A few poorly or- as they demand, white heads would roll, and if ganized classes were given but no ongoing pro- the matter were left at that, Black Power gram seemed to exist. would be an insidious creation. But I don't be- Our knowledge could be applied by having lieve it can be left at that. In the beginning community workers and health students teach there will be abuses of power which will Arise the community how to do advocacy. If one for two reasons: (1) The immediate psycholog- health science student spent his time teaching ical need of the black man (the very need patient advocacy to a group of community peo- which prompted the birth of Black Power) will ple, he then could work himself out of a job. demand that for once black be on top; and (2) Health advocates from the community should the black community itself will have to learn be taught as much as possible about the hospl- the responsibility of power (a lesson it cannot tal and other health facilities. I see the role of learn until it is given the exercise of power). the health science student as that of setting up These things will happen-they must happen relationships making it possible for the com- -for before the black man can tackle the stag- munity advocates to function. A thorough in- 66 SUMMER 1968 troduction to the hospital is necessary. I found to contribute. Why wait for the disease to hap- that in my dealings with Morrisania Hospital pen and then fret about the cure. Get ahead of very few of the hospital staff had been in- the problem.-A.M., Nursing Student, Newark. formed about SHP and patient advocacy. At the Health care in Newark would be greatly im- beginning of the summer, we were introduced proved if medical people could be sensitized to to some of the staff, but apparently this was not respect and have compassion for the people effective. they are being paid to serve. I feel strongly One drawback I can see to having community that many people are too hardened by now, and advocates is that of status. The reason that stu- the answer, I think, is to be found in the imme- dent patient advocates are effective is because they represent a group which puts them on a diate training of community people in medical higher level than the patients. If patient advo- fields so that they can replace bad personnel. cates were people who used the clinics them- This should occur at all levels. People who re- selves, the institutions may not feel they have fuse to be responsive to the desires of the com- to pay any attention to them. munity should be removed from their jobs.- Therefore it would be very important for a R.P., Commitnity Worker, Newark. thorough saturation of the institution on pa- I find that in Newark, at least, a major rea- tient advocacy.-V.V., Nursing Student, Bronx. son for poor medical care is that people do not Instead of literally taking people by the hand know what they are entitled to, or even what to welfare, de artment of buildings, and hospi- adequate health care is. Therefore, since New tals, SHP should direct its goals more toward Jersey College of Medicine and Dentistry is showing the people of the community how to new in the Newark community, we must first help themselves. By this, I mean forming wel- act in an observational capacity, conjoined fare rights groups, showing people how to put with much communication with the residents in complaints which deal with housing, sanita- of the community, in order to create a plan for tion, and health, directing them toward job actions that we can take. We should also act in training programs, SEEK (college discovery), an educational capacity, relaying our informa- and tutoring junior and senior high school stu- tion and suggestions to the community. dents to prepare them for college or health ca- I believe that this is our most important reers.-M.i. Nursing Student, Bronx. function in the community, for if we stand If there was nothing we could do in the hos- only as a small group of students against a pital in the existing milieu, there was a more large political organization, we can expect to positive path open: the community might have make little or no impression. From my experi- e-nee this summer, I can see that the large been spared the indignities.of that facility if iiist, like machines which we are fighting aga the people's knowledge of health matters had Martland Hospital, are deathly afraid of the been more sophisticated. There should and could be much more profit from an emphasis on community and its wrath and would bow to the prevention. This could be accomplished via lec- demands of a coherent community group much tures, demonstrations and discussions about more readily than they would to us. maternity, first aid, dietary patterns, contracep- The majority of the people in the Newark tion, abortions, etc. The personnel for this en- community are unaware of their rights and the deavor could come from at least two sources: injustices imposed on them, and are not orga- SHP members (out of all the education we have nized into any protest organization. Therefore, we must educate the community through agen- among us it struck me as ironic how little we cies, schools, PTAS, meetings, advocacy, and were able to utilize) -, and the health profession- I als already in the community. There are local aoor-to-door soliciting, and whatever other Physicians, nurses, and nursing students who methods become necessary.-K.O., Nursing are Possessed of varying amounts and types of Student, Newark. knowledge. They should be contacted and asked It was realized that new and totally different 67 GREATER NEW YORK methods of health care delivery were needed in vice Department of the clinic, who would be light of the doctor shortage and population responsible for gathering feedback informa- rise witnessed in America. Functions that tion and informing the physician-assistant as classically have been the sole domain of the to what has been done and what the physi- physicians would necessarily be taken away ei-an-assistant should do next. This worked from him and given to persons lower down on with great success. the health professional scale, thus freeing him Patients that we have seen (over 300) ex- to see more patients. As a result, such func- pressed pleasure with the fact that someone at tions as history-taking, blood pressures, pulse, last was concerned with their total health situ- immunizations, and vaccination were consid- ation and not just with the episodic treatment ered possible areas whereby a dent could be of whatever condition their children were made in the solid but perhaps rusting armor of brought in for. the physician, without too much fuss being Kings County Hospital Pediatric Clinic, made. Included in the role of "physician-assist- which was already held in high regard by the ant" were other functions, such as dissemina- patients (for they honestly receive excellent tion of nutritional, health, and safety informa- care there) received an extra boost by this con- tion to visitors to the clinic. cern on the clinic's part. Patients, upon revisits Now, many months after the conception of to the clinic, looked for the physician-assistant the above idea, what we finally have is very -and relayed to him any problems that arose different from the origin-al seed. During this since they last saw each other. The use of phy- time, we molded and remolded our concepts so sician-assistants not only gave 100 percent bet- that a meaningful and realistic position would ter medical care because they concerned them- be established. No longer are the various func- selves with the total health problem of the pa- tibns mentioned above a part of the physician- tient, but also served to minimize the tedium of assistant's role. The history-taking is now the the long waiting period. primary function of the physician-assistant. Now, what about continuation of the pro- ject? The Pediatrics Clinic is funded by a gov- The questionnaire (history-taking) ernment grant under rigid stipulations as to was considered a total success by health sci- hiring of employees. With this straightjacket I ence students, NYCS, and especially by the doc- am in the process of negotiating five new posi- tors of the clinic who found the screening his- tions for physician-assistants under the social tory an invaluable aid. But a question arose as service department, beginning next July ist. to what to do with the social pathology that Why next July Ist? After careful considera- was detected by the history. The answer to tion, it was concluded that it would be much that, we all agreed, had to be part of the physi- wiser, -and more realistic and meaningful to cian-assist-ant's role, for example, it would be have a 40-week training program that not only his function, and a major one, to do followup .. includes on-the-job training, but gives accred- work on the patients he thought required such ited courses in English, math, science, sociol- attention. With this in mind, we set out enthu- ogy, etc. The benefit of such a program is that siastically to do home visits. After a number of someone with a minimal education (6th grade weeks of a split regimen-clinic hours and home and up) can acquire skills that will enable him visits-we groped with the problem of the ex- to have some upward mobility, rather than to tent of followup care to be indulged in by the place him in a position that he has no hope of physician-assistants, in light of the fact that ever rising above or moving from.-B.F., Med- 95 percent of the patients seen needed fol- ical Student, Brooklyn. lowup, and it would be impossible, physica y and realistically to do so. We decided that the My experience is proving to be quite social worker role of the physician-assistant interesting. * * * I learned the art of taking would be limited to getting in touch with the case histories, and the task of learning all of proper agencies and notifying the Social Ser- the names of the diseases was easier than I 68 SUMMER 1968 expected. The doctors working with us proved public school health programs. The atmo- to be very patient. * * * The medical students sphere at the beginning was one of beholdeness. in our group are very friendly and always try -people did not know their rights. Many to help us in any way that is possible. They. thought that because they were Medicaid re- have patience with us and are always around cipients they were obligated to the various to assist if we need their help. treatment facilities. Others felt that they could The best time is when we are given the op- only go to a clinic and not on a private physi- portunity to go out in the waiting room and cian. Our job was to educate the community to call our own patients. Even though I was quite think differently.-J.H., Medical Student, Har- nervous at first, I greeted the people with lem. friendly smiles -and all of the fright went away Halfway through the summer referrals from from me. The parents are more than willing to Public School 175 were running out and I re- come and talk with us because we not only took quested some from Public School 100. Along an interest in the patient, but also in the rest ed the opportunity of the family -and in the conditions in whi with the referrals we -acquir the school. ch to train 10 "parent assistants" from they live. We figure that we are showing the These community mothers were in training for parents that we too are concerned about the 6 weeks in various aspects of education, and welfare of their children and also -about the - two of us met with them for 3 weeks to explain conditions in which they are living. This the departments and procedures of health fa- makes the parents feel that the health organi- cilities, and to give them experience in field zation has a strong concern for the welfare of work on referrals. We used Public School 100 their child, and for the people living in the referrals and covered nearly all of them. Feed- community. Speaking with these people about back from the parent assistants and the school their children's health, and the rest of the administration was favorable.-C.W., Medical family, gets the feeling of fright out of their Student, Harlem. system because they feel that they are talking. to community people, being us, who are faced I started the project thinking that all with the same problems.-L.J., NYC, Brook- my job would entail would be getting people lyn. started and somewhat oriented to Harlem and I don't think there was that much resistance the goals of our project. After that, I hoped to be able to get into some projects of my own from the doctors to the idea of physici-an-as- and simply be around to give suggestions and sistants, because when it got started the. @oc- help other people by being a resource. It has tors' main complaint was-that the question- naire didn't have this in it, or it didn't have turned out that there was a lot more supervi- that, and they wanted more on it, which was a sion involved and I had to dream up things for good sign. * * people to do simply to keep them from sitting * The St. Mary's group has had around the office doing -nothing. I needn't bela- one person working fora month or so, and just recently they've got another person that we bor this but I have found it the biggest disap- hired, and they're scheduled to have two more pointment in the project for me personally. People hired by the time we leave in Septem- The reason I mention this is that the Public ber. Thus, four community people will be School 100 part of our project is an example of working in St. Mary,s after we leave.-W.S., the way I hoped things could work; the two Student Coordinator, Brooklyn. guys who went over to Public School 100 to see about referrals found out about the training I saw the SHP workers in Harlem this sum- program there for community mothers and mer as a liaison between the community people then worked out an arrangement whereby they and Harlem Hospital and the various other could be useful as advisors. This had the dou- agencies involved. We served to help people ble advantage of supporting an already exist- take the best advantage of services rendered by ing program and working in a roleas advisor, the Harlem Hospital clinics, other clinics, and not an organizer of a new project. There are 69 GREATER NEW YORK enough projects going in Harlem, already; we this themselves. It is going to be year-round, don't need to go organize any more, especially and they're going to try and get funded. There ten-week ones.- (Incidentally, lots of people in seems to be a consensus that this is the kind of Harlem have told us this, too) At any rate, I thing that SHP's should focus on, but there think these two workers did exactly what we can only be so many health councils.-D.T., should be doing and the point is that they found Student Coordinator, Newark. the job on their own initiative in the process of When we first arrived -at Martland Hospital working on referr-als.-R.C., Student Coordi- nato.r, Harlem. in Newark, either the staff was unaware of our function or they pretended to be. During the Another means of attacking the problems of first weeks, we were given a lot of "busy work" health care delivery, however, may not involve to keep us out of the way. During this time, working in poverty areas but rather in the however, we compiled a list of criticisms and upper levels of American society. Perhaps edu- recommendations which we offered to help cation of middleclass America is more impor- carry out. Eventually, this list was presented tant than working in poverty areas in the long to the hospital administrators, who did noth- run. This task is much harder to undertake ing. After repeated attempts to get some sort and, -as of yet, the mechanisms of such an oper- of action, followed by repeated failures, we re- ation are out of sight. The task is to get the sorted to other means in the form of trying to unconcerned, unknowing, and uncommitted develop a community health council. This coun- people concerned with the problems the coun- cil, if it becomes functional, will be the biggest try faces. This, perhaps, is what SHP's in the achievement of the summer because it should future should direct their energies to.-W.S., make the hospital receptive and sensitive to Student Coordinator, Brooklyn. the requests of the black community. We, as COMMUNITY ORGANIZING health science students, can meet with admin- istrators for the next ten years and get abso- Newark lutely nothing accomplished, because they feel It's so difficult to have any kind of political that we'll only be there for a certain length of gathering in a community such as Newark. time and then they'll be rid of us. However, the The Leroi'Jones approach is probably going to hospital will be forced to listen to organized be the most productive, because it is going to community people because they aren't going let these people speak for themselves. Just or- anywhere and mean business. This council, g,anizing and bringing a group in to sit in the composed of community and professional peo- hospital is not going to work the way you ple, will be able to make demands of the hospi- might want it to. Ultimately, though, I think tal with no excuses accepted.-A.C., Nursing it's the best thing, because when you surround Student, Newark. an administrator with five or six big black cats I believe that if the community health coun- and seare him personally to death, then have cil fails, one of the proposed major accomplish- some little guy come in and mediate, talk ments of this summer fails. It must be said calmly to him- and make him see that he p that the grass roots in the Newark community doesn't have to be afraid, then something will took -no interest whatsoever in our efforts, and be done that both sides will like. The basic ob perhaps such a council must evolve some other jectives of the administration of all hospitals, way. I honestly feel that community involve- really, is to serve the community: they just ment in the medical school development could want to do it their own way. , We got a group of people together and help create the type of environment for in- they're working on a community health council struction and health care delivery that would on their own. It is going to be black and Puerto be in the forefront of medical accomplishments Rican; they're going to try to advocate, to let -P.D., Medical Student, Newark. people know what is available. They decided on Our most important project is to organize 70 SUMMER 1968 the community, and to get them to work for tapping them for personnel, for exam- themselves and realize that they can do some- ple. thing if they're organized. (2) My personal relations with LABOR do We tried to do this in the beginning. We ar- have strains in them. Mostly I try to ranged to have a meeting with the community work them out by clearing with them and sent the health science students around to what I want to do, and talking things different churches. I think about three or four over as much as possible. It's amazing students were interested enough to go; three- how effective just talking is in working quarters of them didn't even bother; this as- things out. signment wasn't important enough for them. it (3) I've made some bad mistakes, especially would be naive to suppose that white people missing followups, but luckily the real can organize a black community. strength is in the tenants. The most im- portant thing I can do is keep an effec- There's much to be said for focusing on one tive relationship going between the ten- objective. It makes a lot of sense, but the im- ants, LABOR, and the rent-strike law- portant thing is that it's not a silly objective, yer. But if I try to make it mV rent that it's an objective which is -at the basis of a strike, and judge success and failure in council made up of community people. I those terms, then inevitably I'm manip- couldn't see focusing the manpower on getting ulating the tenants and inevitably I'm everybody to health examinations: they get a doomed to failure since they're the only health examination, so what; they still live in ones who can pull it off.-K.B., Medical those shitty houses; so now they know they're Student, Bronx. sick they still don't have enough health clinics to take care of them and when they do go to Brooklyn the clinics they get treated badly One of the major goals of this summer was anyway. *-R.P., Community Worker, to help get a narcotics center established in Newark. Brooklyn. Since it is too amorphous to expect Bronx that mass community meetings would somehow end in an actual center, we worked with a few I have begun to help the tenants of one interested community people who were moti- building with a rent strike; I happened to be vated toward action and interested in getting the only one in the office when a tenant came in results. After these people formed a concrete and asked for help. LABOR is understaffed plan and structure for their narcotics center, and gave me pretty much a free hand to do the community was asked if it wanted such a what I thought best. I have reservations about center by circulating a petition. my role for several reasons:. (1) Should I, as Initially we had hoped to get people 'in an outsider, be organizing? (2) Will my han- Brooklyn mad about the problem of drug ad- dling this rent strike puta strain on my rela- diction, to get massive community concern and tions with LABOR? (3) Can I actually cope action. We soon learned that it is next to im- with the problem.? possible to get community people to a mee I've worked out some partial answers: or to get them active. This is not too surprising (1) No, I shouldn't be organizing. Luckily when you realize that most people work, are the tenants organized themselves very struggling to feed and support their family, quickly, and I can carry out their spe- are asked to attend scores of meetings that cific wishes-write letters for them neveraccomplish anything. with their demands to the landlord, get * * * How is any progress made within the a lawyer to answer their questions, get community? Usually there are a few commun- a survey of the building done. And I ity leaders who are motivated and are very ef- have a worthwhile goal in helping fective. It is these people who make most of LABOR be a good resource for them, the positive changes. Unfortunately, what 71 GREATER NEW YORK some people call the "community"-the person To prepare the group for participation in who works, comes home and doesn't give a - the mothers clinic, a bibliography of required -is not going to accomplish anything. The few reading was prepared and group discussions community people who are effective must re- were held, in order to help the students iden- present the whole community; they can't know tify their feeling about unmarried mothers and what every person in the community wants, their associated problems. but they are the only people who are taking In addition, group participants located and the responsibility and must make the decisions. visited some of the various agencies, such as -E.B., Medical Student, Brooklyn. adoption centers, shelters for unmarried mothers, etc., in order to find out how these STUDENT HEALTH ORGANIZATION services may be utilized in procuring assistance SERVICE PROJECTS for our anticipated clients. Bronx The group was aware that even though as The original purpose of the South Bronx many as one in three pregnancies in the South project unwed mothers clinic was to provide Bronx area is out-of-wedlock, obtaining clients quality comprehensive professional services to for our clinic would be a difficult task. In order young unmarried mothers in the South Bronx to reach these people, we sought assistance Bathgate Avenue area. This goal was to be ae- from the various community organizations and complished through individual counseling ses- neighborhood groups. Key persons in prenatal sions, group and family counseling sessions, clinics and public health agencies were con- classes in mother and baby care, grooming, t-acted. As a result, we were permitted to inter- personal hygiene, family planning and family view patients during clinic visits to encourage living. Home visits where indicated were to be their participation in the mothers clinic. an integral art. One of the big problems was that community p Our objectives for the Mothers Clinic were: groups did not offer much encouragement since (1) To improve prenatal care of young they felt that there were far too many tempo- mothers; rary -agencies in their community already. Be- (2)'To promote quality health of mothers cause of this attitude, a file of at least 80 candi- and their children; dates for the mothers' clinic, which we had (3) To reduce fear of the birth process been told was available, became unavailable through education; due to "confidentiality." (4) To help pregnant teenagers gain an un- Flyers were distributed, signs posted, letters derstanding of themselves-, written, telephone calls made, schools visited, (5) To facilitate the appropriate use of com- and door-to-door canvassing was carried out as munity resources; additional, efforts for procurement of clients (6) To help bring about community aware- for the mothers clinic. (Even so, project direc- ness of the needs of pregnant teenagers; tors said that this was not enough.) These ef- (7) To assist in the rehabilitation of preg- forts yielded a very few young mothers who nant teenagers; may benefit from the quality counseling and (8) To provide an accredited continued edu- teaching availableat the mothers clinic. cation program for pregnant teenagers. As a result, we became involved in housing Those persons involved in the mothers clinic and welfare problems. Because of this involve- consisted of three student nurses who had com- ment, we became acutely aware of the critical pleted a course in the nursing care of mothers 'need for educational facilities for pregnant and children, and a physical therapy student teenagers, especially in the South Bronx area. who was to serveas a translator since many of We learned. from the people of the community our clients were expected to be Spanish-speak- that pregnant teenagers are dismissed from ing. My job was purported to be faculty advi- school as soon as the school officials discover sor to this group of students. that they are pregnant. Secondly, if they are 72 SUMMER 1968 able to return to school following the birth of established so that these efforts may be contin- the baby, they are rarely permitted to return ued. Persons from various cooperating health to the same school. Thus, a minimum of 18 agencies and community participants comprise months may be lost prior to the continuation of the committee. their education. The storefront office has remained open This problem seemed to take priority and through funds made available by one of the the group then set out to. discover how we participating committee groups. What shall ul- could possibly help the community to meet this timately become of this project remains to be need. We were aware that there was a very seen, but, thanks to our interested cooperating small educational facility for pregnant teen- groups, the mothers' clinic has acquired a most agers in the South Bronx. Key persons in this vital aspect, time. program, as well as the few other programs of I feel that this project could have made this sort in New York, were contacted. Visits greater strides had the group's request for cov- were made to each of theseagencies. Our pur- erage by the newspapers been supported. We poses for these meetings were manifold, were made to feel that this could be accom- though mainly we hoped to obtain some help- plished simply by a telephone call, but for ful information about setting up such an edu- some reason this call was not made either. cation-al facility. Based on my observations and participation The group was informed that the best way in this summer's SHP, I do not feel that I to proceed was to locate a suitable facility and could in good conscience encourage future par- obtain a commitment for medical services. ticipation by student nurses in this project.- These tasks were accomplished. We were then F.L.M., Program Advisor, Bronx. faced with two additional problems: first, the formal writing of a grant proposal, and sec- Some of our project members were working ondly, finding a sponsoring agency. on a clinic which was supposedly for unwed Recognizing that these were problems that mothers. Because they could find no patients we could not handle alone, the group sought and had trouble finding a place in which to help from those persons who were supposed to hold classes, they expanded their program to be -able to help us. Yes, there is someone who any mother desiring birth control information, can help you with the writing of a grant pro- and any pregnant woman, married or not, liv- posal; where are they? Surely, you can get ing with her husband or not. money from the children's bureau; how, under It was my understanding at the orientation what circumstances? This suggestion was that we were to work with existing facilities in made just as one might tell a child that he can the community, offering constructive criticism shake all of the money that he may need for. where necessary. This would hopefully bring candy from his piggy bank. Yes, there is medical inadequacies to the attention of the money available from the children's bureau, powers-th-at-be and changes would be imple- but not the way it was suggested to us. mented accordingly. Should a community need We were also told that a mere phone call exist which was not being met, an attempt was all that was needed to gain the cooperation' would be made to create an agency to meet said of the Board of Education in our pursuit for need. educational facilities for pregnant teenagers. With this in mind, I could see no purpose for Isn't it interesting that the whole summer the formation of this clinic. One of my advo- passed and this phone call was never made? cacy patients, while at the Fulton Street Despite the lack of cooperation by SHP ad- Health Station, mentioned that she would like visory personnel, the group persisted in its ef- to - obtain birth control pills. The prenatal fort to setup this much-needed program. As a clinic at the health station gave me a referral result, a Committeee on Education for Preg- slip for the new family planning clinic in' the n-ant Teenagers in the South Bronx area was area which had just opened the month before, 7 SUMMER 1968 the research and illustration end of the book, Our Community Coordinator was not sur- which will be distributed through Martla-nd prised and advised us again to direct ouratten- Hospital and our newly formed Community tion to parents' groups. With the help of the Health Council.-K.O., Nursing Student, Ne- supervisor for the district of the Head Start wark. programs, we did organize a series of presenta- tions for the mothers of the young children in- Brooklyn volved in the Head Start programs. We had I think we did meet favorable reaction. Of one meeting with about ten mothers, most of course, a lot of what we were doing was ser- whom were Puerto Rican, who were the family vice-oriented, like in the hospitals. * * * The representatives for the different public schools people felt someone was taking an interest in that were having Head Start programs. Their them, because someone was sitting down and response to the idea of available information talking to them for 15 minutes, while usually about family planning and sex education was they would be sitting there and waiting for half very enthusiastic. Some of them also felt thata an hour, 2 hours, whatever, ignored. This was a program directed at their children was a very positive sign. A lot of these people invited us good thing. They did admit that the subjects to their homes to inspect housing violations, were ones that Puerto Rican parents did not and on some we got results, so there again we discuss with their children; however, they felt met with favor. I don't think we tried to do too that their children should be aware of these much in which we might have failed and thus things so that they would not face the same angered people. We weren't promising much problems that their parents had to face. In that we couldn't deliver. other words, these mothers were expressing In Brooklyn we had a group working with the desire for more information concerning a Youth-In-Action. At first, we had hoped to very important aspect of health care that was work on family counseling, birth control, at present impossible for them to give their homework study (which is like a Head Start children and which the public health care in- program), etc., but it degenerated just to stitutions did not provide. homework study and we had three people act- When we gave these presentations to par- ing as teachers or tutors. I personally didn't ents' groups, we felt that the people were feel that this was the best way for a health really not terribly interested; yet we were in- student to spend his summer. But they thought vited back to give more information. The fact they were doing something that's their bag. was that the women were very interested but You can't tell them it's not-W.S., Student they were inhibited about discussing such ma- Coordinator, Brooklyn. terial in front of strangers. We were told that Lower East Side after we had left they had a very open talk about a subject that had 'not been discussed be- From the very beginning our Community fore. We had acted as 'a catalyst for these Coordinator objected to the sex education pro- mothers. gram on the basis that a Puerto Rican com- Another idea that we tried to work on was munity would not accept it, especially for the younger people. We were advised that it might an educational program for community be possible to work out a program for mothers, workers from local action groups. Some of the but thata program aimed at the younger peo- groups were polite and refused openly, while ple was doomed to failure. At first we did not others said that they were interested and then heed the advice and we attempted to educate the women didn't show up for the appo nt- the two Puerto Rican girls (NYC's) working ments with us or they claimed that they were with us. We tried to have them partially take too busy that day. We wanted to leave some- over some presentations to other groups of thing of more permanent value. We wanted to @Neighborhood Youth Corps; however, they give the women the tools to help other women, were not able to do so. but the groups we visited rejected the idea. 75 GREATER NEW YORK and arrangements were made for Mrs. M. to pertaining to local health care delivery; (3) visit it. I found the faciliti@ at the Fulton making referrals where indicated; (4) provid- Street Health Station adequate and the staff ing information on existing local health facili- cooperative, and they encouraged us to bring in ties; (5) establishing a working file on each any problems we encountered in the course of family for subsequent use by medical students. our work. * * * Results: Of 60 children enrolled in the In -all fairness to the community, I do not see Head Start program, 56 children were seen at the point of setting up a clinic which probably Fordham, and four children were seen by pri- will not endure past the summer. There was vate doctors. Twenty-one children had physical trouble getting the rent approved for the build- examinations and accompanying test results ing, and since most of the workers are stu- that were entirely within normal limits. The dents, I wonder at the likelihood of its sur- following abnormalities were diagnosed and vival, acted upon: three underweights; two upper- What I am trying ta say here is that I feel sites; two functional heart murmurs; two the SHP clinic is duplicating existing agencies minor umbilical hernias; one inguinal hernia; with no assurances that it will survive after one kidney infection; one urinary infection; the summer. Therefore, I feel a personal lack one vaginal infection; one sickle-cell trait; of support for it in terms of the interest of the three subelinical a nemias; eight eosinophilia community.-C.B., Nursing Student, Bronx. results; 12 albuminuria results; one ectopic eczema; one asthma; two positive Tine tests The following description of the Bronx SHP (X-rays negative). Head Start health program was used as part of The results of the questionnaires (40 returns a grant proposal for the continuation of this out of 56) have not yet been analyzed in detail, program: but quick sampling indicated clearly a deep- During the summer, the Bronx SHP oper- seated dissatisfaction with existing health fa- ated, in cooperation with St. Joseph's Summer cilities, and a willingness to organize around Head Start program and Fordham Hospital, a the issues of Fordham Hospital and a neigh- complete physical exam and screening program borhood health clinic.-J.G., Medical Student, for sixty children, ages four to six. Under the Bronx. leadership of a medical student, one dental stu- dent, two nursing students, two community Newark workers, and three NYC's implemented the * * * My other activities at Martland in- following: (a) English-Spanish letters were cluded drawing pictures for the pediatrics sent to all Head Start parents explaining the emergency room, and helping to alphabetize program at Fordham Hospital, with a choice the files for the medical and surgical clinic .of participating either through Fordham or also observed the functioning of several o er' private doctors. (b) From July 23 to August hospitals and city clinics to see how Martland's 16, five children per day were taken with their could be improved. As you can see, most of parents to Fordham Hospital. At the hospital these tasks were just little service projects they were registered, given complete physical that did not change too many lives or make exams, urinalyses, blood tests, and Tine T.B. any radical improvements in health care. tests. Health students and community workers These experiences were rewarding but not were responsible for seeing to it that followups really satisfying. This does not spell failure, were made for any abnormal findings in the but I suggest th-at SHO must make a more con- tests. During the week of August 19 to August crete stand on what its place and service to the 23, home visits to all Head Start families were community should and will be. made for five purposes: (1) Explaining the re- I think that the most positive and beneficial sults of the examinations and tests; (2) admin- thing that I did this summer was to work on a i@ri-ng a two-page questionnaire containing a health rights handbook which we will soon family health survey and a survey on attitudes have published and distributed. I worked on 74 GREATER NEW YORK We are going to try to continue with this winter isn't possible. (The above from an un- program in the fall though I am not sure ex- dated by weekly report; the following from a actly what we will do. We certainly could con- Final Report.)' tinue to provide the limited service of giving When our job began this summer, I felt that presentations to various parents' groups in the there would be a tremendous amount of direc- schools. We also may try to work with some tion needed on my part in order to find out ex- younger people through local community actly what contribution I could make. groups. I am more interested, however, in I feel that if more work had been done be- working out some way of involving community forehand to decide exactly where we were women in providing the education. One idea -needed, our projects might have been more that we have is to look into the possibility of fruitful. We didn't realize that the community creating jobs for women through the services in general was not ready to accept information in Bellevue Hospital. These women could work about sex education and contraception. There in the hospital and in the Community providing are no community organizations presently much needed information about family plan- involved in sex education, and any organiza- ning and sex education.-P-S-, Medcal Stv' tions that were approached to see if they lent, Lower East Side. would be interested in having us hold discus- In order to educate ourselves in the field of sions were polite to us, but inevitably, when birth control, sex education, and venereal dis- the time came for the talk or discussion, dates ease, we visited a number of' organizations were cancelled or groups didn't show up@r, if such as Planned Parenthood, SEICUS and they did, they politely listened to what we had various drug companies. Most people tried to to say but showed no enthusiasm in joining be helpful and encouraging but those of actual into discussions with us. value to us were the workers at planned par- I feel that we did make one positive contri- enthood who put us in touch with the only per- bution by arranging for discussions to be held son on the Lower East Side who is actually and a film to be shown throughout the public working directly with the community teaching schools. birth control. This convinced us that since One of the most helpful people on the pro- there is not an excess of people on the Lower ject, I found, was our community coordinator. I East Side dispensing such information, our felt that if we had heeded her warnings about services were definitely needed. the subject with which we were dealing, we We decided that our best approach was to wouldn't have run into as many difficulties as read as much as possible on our own and hold we did this summer.-S.R., Medical Student, discussions among ourselves so as to acquaint Lower East Side. the NYC's with human anatomy, the mech-an- ics of reproduction, etc. We found that even if Harlem the girls we are working with are not poised The basic structure of our project revolved and confident enough to give lectures and hold around the school health referrals. We in- discussions on their own during the winter, tended to work at two schools, Public Schools they are still interested and willing to work 175 and 133 in Harlem and then branch out along with US. from there to more referrals at Harlem Hospi- We have had several speaking engagements tal. This was viable in the case of Public and have felt that these have been successful, School 175 only because we had previously done depending on our ability to sense the needs of a health study there and already had over 250 the group we were talking with. referrals to work on. At Public School 133 we On the whole, I feel a sense of accomplish- got virtually no co-operation from the school ment so far, and see the rest of the summer health people-, mostly because the director of spent in increasing community 'contact and school health for the city of New York refused trying to see if continuing work through the to release any but a few nonessential referral 76 SUMMER 1968 cases. She claimed that we had enough to work patient. The student learned about the different on from our previous summer. agencies that the poor must confront. This Other institutions we worked with were practical knowledge, which enables the health equally frustrating; the Department of Health professional to give comprehensive care, cannot at all but the highest levels is staffed by defen- be learned any way other than by direct ex- sive, uncooperative people who seemed more perience. Most medical and nursing schools do intent on giving us the runaround or refusing not provide these experiences in their curricu- to give information than anything else. Other lum. The patient was able to confront bureau- groups we worked with rather successfully cratic institutions, whereas before he had been were Ministerial Interfaith Association confused and discouraged. (M.I.A.), a very cooperative private group My feelings toward the benefits of patient health facility, Harlem Teams For Self-Help, advocacy after last summer and at the begin- which arranged for a job in the Harlem HosPi- ning of this summer were very favorable. Now, tal playroom for outpatients' children, Harlem at the conclusion of my second summer, I have Consumer Education Board, a member of quite different feelings. At this point, I am not which came to a lunch meeting at our office sure where either party benefits. To substanti- which was very interesting, Public School 100, ate this feeling I will present incidents from where we helped in a training program for my experiences with three families. school assistants, Knickerbocker Hospital, My first example is Rebecca, a 64-year-ol where we tried to organize a health council 'Negro lady. My first introduction to Rebecca around a proposed community health clinic, was through a -dental student working on the and the Puerto Rican Guidance Center, where project. Rebecca's toothless smile had caught we helped with research on the Washington his attention. After a brief conversation with Heights community'mental health center and her, the dental student discovered that she had ran an education program for a group of not seen a doctor in several years. With this in- N.Y.C's. In general, our relationship with cOm- formation, in addition to the fact that Rebecca munity organizations was successful and we is elderly and quite heavy, it seemed very prob- tried to put ourselves at their disposal. ably that she might have medical problems We provided specific referral help for about warranting treatment. He suggested that she 150 of the Public School 175 cases from a year be taken for a checkup. I decided that since she ago. We also worked on about 25 referrals did not have Medicaid or financial means to from two clinics at Harlem Hospital, and an- pay for treatment, our only recourse was Mor- other 25 from Public School 100. We got a nu- risania Hospital. Not knowing which of the cleus of six persons interested in the pediatrics clinics to go to first, we went to the screening clinic at Knickerbocker Hospital and worked clinic. From there went to the medical on several ceases from the department of social clinic twice, the eye clinic twice. Also, Rebecca services there. Other assorted services included had blood work done twice, an X-ray, and an providing black childrens' books for doctors' E.K.G. The results up to this time reveal hy- offices and clinics.-R.C., Student Coordinator, pertension, diabetes, degeneration of the re- Harlem.- tina, a positive V.D.R.L., and longstanding leftsided heart disease. PATIENT ADVOCACY At first glance, and without much thought, Last summer the concept of patient advocacy an initial reaction to the discoveries is that it evolved. The student fellow functioned as a li- aison between the patient and the health facil- was a good thing that Rebecca went to the ity. As our awareness of health problems clinic. After studying the situation, I am not broadened, our concept of the role of the pa- sure this is so. Rebecca does not follow tient advocate grew to include dealings with through with her edical treatment; she can- many institutions. We saw patient advocacy not remember to take her pills even after con- as valuable for both the student fellow and the stant reminders; she refuses to 90 on a diet. 77 GREATER NEW YORK There are several other reasons why I think mistake because she will have to assume the patient advocacy for Rebecca may have been a responsibility herself when I am gone. mistake. First of -all, there is a problem about There is still another form of dependency getting to the clinic: Rebecca does not seem ca- that Rebecca has developed in the clinic set- pable of taking two buses to get to the clinic; I ting. She feels that she will be taken care of, have always accompanied her so I do not ae- so pays no attention to the proceedings and sits tu.ally know how well she would manage on back and takes cat naps. I tried to overcome her own. I have always gone with Rebecca be- this by always telling her where we were cause at first it was necessary for me to make going and what was going to take place. On sure that she found her way too the different our last visit I deliberately left her at the clinics, -and that she had all the tests that were pharmacy to fill her prescription. All she had medically indicated; later it was necessary that to do was wait for her number to flash, and I go with her to follow up on the results. I had then walk up to the desk and hand the phar- thought of the possibilities of an NYC taking macist her prescription. When I returned, she my place, but decided against this because I did was sitting in -a chair staring off into space and not have accessibility to the NYC's and also her number had gone by. My attempt at mak- my medical knowledge was needed. (For exam- ing her participate had failed. Also, the clinic ple, I was able to cl-arify questions concerning environment is not conducive towards promot- Rebeeca's high blood pressure and poor vision ing independence in people like Rebecca. It is which an NYC probably would not have been geared for expediency, and slow people like Re- able to do.) My going with Rebecca to every becca just bog the system down, so it is much Clinic appointment did not enable her to de- easier for the staff to direct all comments con- velop her -ability to be independent' cerning Rebecca's care to me, which just rein- This case points up a crucial factor of pa- forces her dependency on me. tient advocacy, which is time. It took me 45 Is medical care without followup better than minutes to come to the Bronx from Manhattan, no medical care at all? Would this woman which means that if we planned to go by bus I have been just as happy having never seen a had to leave my apartment at 6:45 a.m. to pick doctor? Looking back, I feel that Rebeeca's Rebecca up for a 9:00 a.m. appointment. By real priority need was attention. She was the time we finished in the afternoon some- lonely, and by going to the clinic with her I in- times it was 2 o'clock. creased her personal interactions. Would it The logical solution to this predicament was have been better for her if I had spent my time to find someone who can assist Rebecca to the just visiting her and fulfilling her need for clinic. She is living with her granddaughter companionship rather than dragging her from who seems to be the likely person to assume one clinic to the jaext? Even if I acted only as this responsibility, but they do not get along. a companion, there would still have been a de- The granddaughter has tried repeatedly in the pendency on my company. Maybe the best past to get her grandmother to go to the doc- thing for Rebecca would have been to have tot; she very clearly told me that she had tried found her a frien . and was fed up with Rebecca, and that if I Gladys is an 18-year-old girl who has a 3- wanted to take her to the clinic that was fine. year-old son, and is expecting another child at Rebecca was also economically dependent on any time. At the time I met her, she had not my services. She does not have the resources followe up with her prenatal care. She saw for cab fare as she only receives a small doctor once early in pregnancy, but after mov- amount from Social Security. I. started paying ing had not gone back. I'made arrangements the cab fares because the first time she told me for Gladys to register at Morrisania clinic and she had no money to get there. I -paid for all accompanied her, there. But after straightening transportation since, which was probably a things out for her at the clinic, I no longer 78 SUMMER 1968 went with her for her appointments. She man- with Mildred was my role as patient advocate aged fine by herself. and my limitations. Just as in Gladys' case I Gladys' dependency needs became apparent had decided that my role was not a shopping through our dealings with the welfare depart- assistant or a real estate agent, with Mildred I ment. The rapport between Gladys' familyand decided I was not a social worker. the investigator was very poor; the investiga- Mildred is a 14-year-old pregnant girl who tor was extremely nasty, making all dealings ran away from home 8 months ago and is now with welfare difficult for the family. Being living with a 29-year-old man. She is 5 months aware of this poor relationship, I went with pregnant and came to us to find out where she Gladys to welfare to help her obtain a check could receive prenatal care. We decided that for a layette. Because of my presence, the in- because of her age and social problems the vestigator gave Gladys the check immediately. prenatal clinic at Morrisania health station But what will happen after I leave? The rela- would be the best for her. We. also have co-n- tionship between Gladys and the investigator tacts with the Social Service department from will still be poor. With Gladys I had more re- which we can be sure that she will receive sources available to me, so hopefully my ser- good followup care. vices will not just act as a temporary bandage. At the clinic during the interview with the Welfare Rights works with people to help social worker, several problems became imme- them deal with the welfare department, and diately obvious. The man she was living with hopefully this group will take over my role as t.o the psy- had been admitted the night before an advocate. Also I referred Gladys to the So- chiatric ward of Bellevue Hospital. Also, he is cial Service department which will follow her married. His being in the hospital left Mildred case. in a desperate situation; he did not leave any The most important point I have made con- provisions or money, and Mildred has none. cerning patient advocacy in relationship to Her mother is on welfare and receives anallot- both Gladys and Rebecca is that the individ- ment for Mildred, but Mildred has not seen her ual's resources must be utilized to the fullest mother for 8 months. Considering that both extent. To be able to develop the patient's inde- the girl and her mother are in the Bronx, it ap- pendence a critical analysis of the situation is pears that the mother hasn't tried very hard to needed, and with that information the patient find her daughter. Mildred did not express con- advocate should carefully define his role. For cern about her situation. I asked her if she had example, I decided that my role with Gladys food to eat in the apartment,,and she said that was to see that she received good medical care, she had two porkehops, a pound of hamburger, but what was not my function, I decided, was and some cabbage. When I asked her what she shopping -with her for baby clothes and looking was going to do when the food ran out, she gig- for an apartment. I carefully reviewed with gled, rolled her eyes at the ceiling, and said Gladys what she needed for the baby, but told that she didn't know. She made these same res- her that she was perfectly capable of shopping ponses to other questions concerning her wel- without me. She would have liked me to help fare. From her behavior she appears to be a her with the shopping, but this was not neces- very immature 14-year-old. The problem that sary and there would be no one to help her the social worker and I faced was what imme- shop in the future. The same was true of find- diate arrangements would be made for the girl. ing her an apartment. I am sure that with my Being a minor, she could not go to her boy higher level of motivation I would have been friend's apartment because she would have able to make greater progress than Gladys, but been picked up by the police. (Mildred had this would not have helped Gladys to become written her mother a letter which'her mother an independent adult. had just received, and she had -notified the po- The last patient I would like to diseu.ss is lice.) It was too late in the day to make ar- Mildred. The important concept in my dealings r-angements with welfare concerning a foster 79 SUMMER 1968 home or a maternity shelter, so the only solu- the advocate should use his skills to help the tion appeared to be to take Mildred to her patient become as independent as possible. mother's apartment. The social worker asked Also, a critical an-alysis of the purpose of pa- if I would take her there myself, but I said tient advocacy is needed, and a decision should that r would like someone to come with me. be made as to whether it should be a part of Looking back, this was a wise decision; what I the SHP services. If the decision is made that was to encounter in the home would have been patient advocacy is valuable, then how much a lot for me to cope with. When we arrived we time should be spent in this area. In my opin- were met by a very upset mother who did not ion, patient advocacy is a stop-gap service. The speak English. The confrontation between the real problem lies with the system that causes mother -and the daughter was very tense. After the need for an advocate. I would like to see the initial confrontation, we had difficulty get- SHP's energy directed at the institutions.- ting any other direct communication between V.V., Nursing Student, Bronx. the mother and daughter. Mildred said that Aside from supervising a restricted play she had only come to see her mother and that area with the help of four NYC'S, the remain- she was not going to stay, and the mother cer- der of my time was spent taking patients to the tainly did not want her to stay. The mother fin- nearby Fulton Avenue (Morrisania) Health ally accepted the fact that Mildred was her Center, and disseminating information about responsibility, whether she remained at home the avail-able health services. It was in this re- or not. Mildred also accepted the fact that she gard that I felt most qualified to work in the could not return to her boy friend's apartment, community. -and decided to stay. After both parties finally I was involved with two families I had met made a decision, the social worker and I left. while discussing housing problems. One 21- The social worker returned the next morning year-old mother of three was desperately in to make more permanent arrangements. need of medical help and will require the sup- This whole incident made me very aware of port of the advocate program in the coming my limitations. Not being a social worker, I months. This woman had neglected her own had not come across such complicated situa- health and did not expect to get relief from her tions that demanded immediate decisions. I chest pains and dizzy spells by going to any might have, in a moment of confusion and in- city clinic. At first, I was more optimistic, but decision, decided to take the girl home with soon became frustrated upon finding how diffi- me. This obviously would not have been the cult it is to get good care even when one know way to have handled the situation. (I think how to maneuver through the administrative that patient advocates should always remem- labyrinth. This woman has now been to the ber that in situations where a: dependable medicine, opthalmology, and neurology clinics agency is involved, we should have enough without getting a satisfactory history taken. The fragmention of her condition into unre- common sense to let the agency handle the problem.) I know of situations where patient ,,ted problems, as seen by each clinic physician and generally a new face each time she visits advocates have gotten themselves into a bind because they have tried to make decisions they each clinic, works against any hope that she might have of getting better. Despite her diffi- did not have the background or knowledge to culty in getting a diagnosis and therapy, how- make, or the resources to carry through. ever, there have been positive aspect to her To summarize, I believe that the patient ad- trips to Fulton Avenue: she is more aware of vocate needs to thoroughly analyze situations, her own needs and realizes that her children's and before making any decision he should as- welfare depends on her health; the Fulton Av- sess his capabilities. Included in his analysis a enue clinic staff knows herand are more atten- realistic appraisal of manpower and time tive because of my intervention; she has been should be considered. With this information, given medication for insomnia and a prescrip- 80 SUMMER 1968 tion for eye glasses which she knew were in.g clinics with patients. These teenagers, needed. however, were assigned to LABOR by the city .Because of this one experience I feel patient and were given housing assignments most of advocacy is a meaningful experience, both for the time. They would have done well as advo- the recipient and for the health student. There cates and certainly expressed enthusiasm over are objections to the present modus operandi the prospect of such a job in the future.-R.F., which should, however, be raised. Successful Medical Student, Bronx. advocacy often depends upon the student as- Patientadvocacy over a short term has out- serting himself on the -patient's behalf and de- lived its usefulness as a concept. True advocacy manding services which might not be contin- implies a continuing personal/professional re- ued after the student returns to school. Some- lationship, which students (especially those one must be available to see these families from out-of-town) are not able to build during after the students leave. One may -ask if advo- a 2-month period. The central hypocrisy of pa- cacy works only because the student represents tient advocacy is revealed by the conscious the system. It would be much more beneficial avoidance by students of further responsibili- to the community if students were working ties for their patients at the precise time when with community people who would continue they are promising these same patients guid- the advocacy work in their neighborhood after ance on referrals, and encouraging militancy the students leave. There is no question in my with respect to hospital malpractices. Further- mind that the student -advocate gains a special more, without careful preparation, the pres- perspective by seeing health problems in a so- ence of health science students in overly cial setting which places little value on good crowded urban health clinics usually only health; but the student would gain additional serves to reinforce health care fragmentation. perspective by working with community people Advocacy has served the useful role of edu- and thereby give more responsibility to the -ating a critical number of health science stu- community itself. Being realistic, however, I dents about the injustices and kinks in hospital realize that such a program would require and private medical care. Now it is time to dis- year-round supervision. If our efforts are to card this tool and develop one with a better have further significance, we must provide an cutting edge.-J.G., Medical Student, Br&=. ongoing program geared to involving More than just the student as advocate. Perhaps a The hospital and welfare will still be training program could be arranged through the same after SHP has gone. They will still agencies such as the NMCD (Neighborhood give bad service to the people. The only thing Medical Care Demonstration), which depends we did was geta little better service by saying for its success in large measure upon commun- who we were. Now the people don't have us to ity health workers. speak for them any more. All I've seen SHP do The needs for more organized pressure on is get involved in people's lives and then leave. the health-care delivery system and the orien- -M.H., C&mmunity Worker, Br&nx. tation of LABOR offices to housing problems After spending a week earlier in the project both lead me to argue in favor of having stu- distributing information on the Lower East dents work out of the clinics and maintaining Side about the new sliding scale for fees at city contact with LABOR only as a means of relat- hospitals, I was again faced with the problem ing health issues to LABOR's ongoing activi- of a person who fails to seek medical help be- ties. The dichotomy of roles was definitely a cause he has no money. Our group spent a day hindrance, in my opinion, as concentration on knocking on doors to find out what medical fa- housing problems did not allow enough time cilities were used by the community. When I for learning about different health facilities. knocked at Mrs. V's door she first refused to I found it most worthwhile to take some of speak with me because she was cleaning her the Youth Corps workers with me when visit- apartment and her small grandchild needed 81 YORK GREATER NEW care. I assured her I just wanted to ask a few hadn't knocked on her door.-J.M., Nursing questions and she agreed to speak with me. I Student,Bronx. discovered that Mrs. V, who had ceased men- One of the things which disturbed me deeply struating for several years, was once again was that many of the people who complained bleeding, but felt that she couldn't go to the about bad experience in the hospital took it all hospital because she couldn't pay the eleven very passively instead of fighting for better dollars the hospital always charged. I became care. I found two women who were told to go very concerned when I beard of her problem home from hospitals because they spoke no En- and urged her to see a physician. I offered to escort her to the hospital along with my com- glish. I find it alarming, of course, that this panion, a Spanish-speaking NYC who ex- should have happened, but what was equally pressed a wish to care for her little grandchild. larming was that they left. These people must I called Bellevue to find out the hours of the De taught to stand up and fight for their health gynecology clinic; I was told to come early rights; no one is going to give it to them and I that the clinic was open until noon. That was don't believe anyone should. If SHP really all I was told. wants to be effective, educating community workers to educate the people will be much We arrived at 10:10 a.m. the next day and more worthwhile in the long run than all the were told by the clerk at the information booth patient advocacy in the world.-J.W., Nursing that we would have to come another day be- Student,Bronx. cause registration ended at 10:00,a.m. Feeling exceedingly foolish and responsible for bring- Throughout the summer we visited the ing Mrs. V. to the hospital, I went to the clinic homes of families we met at the pediatric to speak with the head nurse. She told of clinic or in the community, and very often be- the necessity of the registration period so that came personally involved with the family -and sufficient time was allowed to send for the pa- were always welcome in their homes. In the tient's chart. This was reasonable. She also case of Mrs. B. and her one and a half year old said, however, that the doctors (three were sit- daughter, who had suspected milk and egg al- ting in the room where we were, obviously lergy and asthma, we were with her at all pe- amused by my appeals to the nurse) were leav- diatric appointments, assisted her in obtaining ing soon. Why, I asked, were the doctors leav- additional welfare allowance for her daugh- ing if it was only 10:10 a.m., when the clinic terps special diet, and visited her at home on a hours were until 12 noon, and there were still number of occasions. patients to be seen? Surely there was enough Although such successful advocacy was lim- time to send to the record room for the chart, ited to a small number of families, it neverthe- and besides, Mrs. V's proble'm seemed rather less provided us with better insight into com- immediate. I was told that "rules are rules,p' munity life and 'gave us the opportunity to con- and the head nurse asked me to leave her ofFice. tribute concrete services to individuals in the One of the doctors followed me out and sug- community. gested I take Mrs. V to the emergency room as I feel that patient advocacy work could be a long as we were at the hospital. As'a result of rewarding experience for medical students her visit to the emergency room on that day, during their first year of medical education. Mrs. V entered Bellevue the next week to have Providing an early exposure to physician- a hystereet(nny. t advocacy would af- patient relationship, patien Our group has discussed extensively the ford the student the opportunity to view the value of patient advocacy. What is accomplished side of a patient that is often overlooked, that qualitatively by helping a few individuals? of his home and community life. Too often, a What happens to the thousands of others? I patient is thought of just as he is in the hospi- don't know the answers but I do wonder tal setting, and the knowledge of his life as a what would have happened to Mrs. V if. I functioning individual is I-acking. The student 82 SUMMER 1968 health organizations in the various medical I tried to impress upon her the importance of schools should try to have some form of pa- her medication and follow-up care, but my in- tient advocacy incorporated into the curricu- structions fell upon deaf ears.-M.J., Nurst'ng lum for the first year or first 2 years of medi- Student, Bronx. cal study.-E.C., Medical Student, Lower East Side. A Mrs. J. had called our office in Newark, having heard a radio announcement telling lis- I found the emergency room to be a good teners to contact us if they had any health place for patient advocacy work, for the people problems or complaints. In handling the case I were a captive audience while they waited for learned that Mrs. J.'s -niece, a 22 year-old treatment or as I dressed their wounds. I told mother of two, was suffering from cancer of them of our SHP office, of our Community the cervix. Mrs. J. was making a valiant at- Health Council, and of the Family Health tempt to comfort her niece at home, but B.'s Clinic (just opened by New Jersey College of pain was constant and her cries kept the house- Medicine and Dentistry students) which prov- hold awake night and day. B. needed prompt ides health care for entire families, including medical attention. Conversations with our facul- physical examinations for all every 6 months, ty advisor at Newark City Hospital and with and medical treatment when necessary, in @n B.'s doctors finally resulted in her readmittance attempt to give more personal health care To to the hospital. families who can't afford a private doctor. I was able to refer quite a few people who came While B. remained in the hospital, I visited into the emergency room to places where they her daily. We became friends and I became fa- could get help with their problems.-K.O. miliar with the workings of City Hospital, its Nursing Student, Newark. facilities and staff. Although the wards were crowded and impersonal and equipment out- How much responsibility can or should SHP moded, more striking was the deplorable atti- workers have in order to get health care for tudes held by several of the attending physi- their clients? A community worker took it cians and nurses. In a short time after I began upon herself to take a young boy with a leg in- to visit B., the @ff began to accept me as one jury to a private physician, since his mother of them-perhaps because I was a medical stu- believes in herbs and roots and is quite igno- dent- and they soon "opened up." I heard sto- rant of health matters. A few days later I saw ries of the poor care and abuse they gave to the this same young boy playing with his friends; patients. I could feel an attitude of "second- his leg was starting to swell again and he did class citizenship" permeate the welfare wards. not have a dressing on as the doctor had or- It is not uncommon for a patient's cries for at- dered. When I -questioned him about this, he tention to be answered with "shut up woman, told me that his mother always hits him on his you're lucky to be getting as much as you are,ty infected knee when she getsangry. or, "for somebody who's not even paying you Another time, I had occasion to take his sure do expect a lot." More commonly, their mother to Bronx-Lebanon Hospital. She had pleas went unanswered. had breakthrough vaginal bleeding for 21/2 In B.'s case, that of terminal cancer, the years with the passing of clots. She was exam- nurses were particularly hard on her because ined by a gynecologist who gave her medica- of her low tolerance for pain; her incessant tion to stop the bleeding and told her to come groans and cries kept the staff and fellow pa- back in three weeks for a more complete exam- tients on edge. Her attending physician had no ination. The next day I saw this same woman idea of B.'s background or personality, and' on the street. She told me that she was tired of' neither did she care. Practically at the moment taking her medication because it made her sick of readmission, B's doctor had said that she and caused pain (she had only taken one pill). would keep B. in the hospital only if we would 83 GREATER NEW YORK in the meantime make arrangements to put her STUDENT HEALTH PROJECT ROLE in -a nursing home. IN AGENCIES AND HOSPITALS Now to B.'s nursing home problem. City Newark Hospital's social service department sends its Our situation in Newark is quite unique requests to the local community welfare office from all of the other areas in what changes we for placement of patients who need posthospi- realistically expect to effect this summer, for tal care in nursing homes. The placement pro- the tide is changing its direction here, and all cedure does not begin until the doctor actually things portend a new guard for this city. We discharges the patient, so there is often a long have tried to identify with infusion of renewed delay between discharge and placement. In the life, the momentary depressions from lack of interim, the doctor is unaware of the cause o! instantaneous dissolvement of malingering the delay and therefore cannot understanding evils are but. split-second flickering trips why "these -patients stick -around the hospi- through disillusioned reality. However, on the tal wasting valuable space-just a bunch of -whole, a sense of project is developed and func- good-for-nothing freeloaders." City Hospital's tional. social service department has no idea of the July 1, 1968, a new administration, the new, quality of nursing care given by the institu- New Jersey, College of Medicine and Dentistry tions to which the patients are sent. Occasion- I took over Martland Hospital and promised to ally a patient will return to City Hcispital with -'I- bed sores, dehydration, or malnourishment, but enange much in health care delivery both at there is no direct information as to what goes the hospital and in the city as a whole. Newark on in these nursing homes. SHP feels itself in the position of helping push When B. was finally placed, I visited her the college into doing what it said it would do, nursing home and found it dirty, crowded, and leading the college into areas where it has not utterly depressing. Maybe if B.'s doctor had yet gone, and developing dialogues and action been aware of this she might have been a little experiences between the community and the more sympathetic with her patient. health services. As I followed B.'s progress, I kept in touch At the hospital we have begun several direct with her aunt. Mrs. J. had given up her job for actions: (a) specific patient advocacy in the the last few months in order to care for her emergency room; (b) admistering a question- niece. Being 61 years old and with a heart con- naire in the emergency room; (c) advocacy of dition, Mrs. J. was physically and mentally fa- the several clinics, especially the prenatal tigued from the entire episode. She responded clinic. to the assistance I gave her with pra Less direct but more me ise and aningful and expee affection which I was at times embarrassed to tation laden actions include: (a) Talk with key receive. In my visits to her home I got to know hospital personal about specific immediate Mrs. J., to see her style of life, to discover changes in procedure-trying to be part of a some of her attitudes,,and to meet her friends. committee that will actually write up proce- Thus, beginning with the specifle problem of dures; (b) talks with key hospital personnel helping Mrs. J. get medical attention for ,her about basic changes in stEiff attitudes (devel- niece, it soon developed into a complex network oped during the city's administration) and of exposure for me-a]-] of which helped me plans to develop program for training staff better understand the health care problems of about "where it's at", (c) actual development Newark. This knowledge was beneficial for of a committee of hospital, SHP, and commun- others who would call us for help, for in han- ity persons to work on these points. dling this one case I had succeeded in making a At the area board we have tried to develop a lot of useful connections which would be valu- health advisory and information service. How- able in helping other clients of Newark's SHP. ever, as yet there has been a dearth of persons -B.W., Medical Student, Newark. wanting information, less than one per day. 84 SUMMER 1968 However, we are developing the body of NYC'S, and they tried for a while to assign us knowledge necessary to help anyone. to useless jobs, such as removing carbon pa- A community committee has been organized, pers from duplicate copies of patient's charts. with exceptionally fine, able, committed local They wanted to keep us busy so we wouldn't persons in charge. Their main focus is on or- "spoil those useless community people" by ganizing persons to be aware of what is hap- trying to give good service. pening on the local health scene; what is avail- We refused to do meaningless tasks. After able on the local scene, and what they can do to about a week, we made up a list of suggestions generally improve the care given,-to see about for changes in the emergency room and clinics. getting decent treatment for whomever comes The changes we suggested were not unrealis- to clinics.-D.T., Student Coordinator, Ne- tic; they were not changes which required ad- wa,rk. ditional funding; they were simply reasonable I worked primarily in the prenatal clinic change. The hospital administration greeted Martland Medical Center in Newark. My rela- us, smiled at us, promised us everything, but tionship with the institution can best be ex- gave us nothing. plained by my relationship with the clinic's su- It had been my experience in the past that if pervisor. In the beginning she was very suspi- you could not obtain satisfaction at one level cious of me and of the SHP in general, and she you sometimes could achieve what you wanted sought to control everything I .did. When I by going to higher authority. I went to the ad- asked about the hospital mortality statistics, ministrative assistant to the president of the she sent me to a doctor who abruptly told me college which runs the hospital. He found most not to question the nurses in the clinics. of our requests to be reasonable and granted As time went on, and the supervisor could them. The hospital administrators were en- see that I was interested in improving the raged. clinic and willing to help rather than merely Nothing really happened to any of us as a criticize, she became more open with me. She result of this, and I believe it was because they would sit down and talk with me about pr were not absolutely certain about the amount o@- of community support we had. Actually, we lems she was having in the clinic; althou @ll had very little. People in Newark generally we did not always agree, we seemed to De hate Martland Hospital, but are not unified able to share our feelings with each other. enough to do anything about it. Lack of knowl- She took the time to listen. edge of the community by the administration She disliked patients coming to SHP with was to our advantage this time; they thought problems they were having in the clinic. She prides herself in having a good relationship we had more power than we actually had. I have come to believe that it is useless to with the patients and wants them to come di- rectly to her with their problems. She is also play with a bad system. Nothing short of com- plete overthrow will bring about major against a community organization to help i)a- I tients with health problems; she seemed to be cna@ges. The black community must organize, fearful of giving the community power in the must seize control of the city and must bring hospital.-L.D., Nursing Student, Newark. about radical change in order to survive.- K.F., Medical Student, Newark. When I first started working in the emer- gency room at Newark City Hospital I dealt Briefly, the New Well is a community drug with patients, talking to them, calling their rehabilitation and prevention center located in families for them, helping them to contact so- the heart of Newark's Central Ward. It is a cial services, sometimes acting as an inter- storefront operation, open at all hours to all preter for the Spanish-speaking people. The people, and staffed voluntarily by several medi- hospital employees in the emergency room cal doctors and approximately 10 former ad- didn't know who we were. Some of them diets. No police supervision or intervention is thought' that we were hospital-employed present to scare off those who need and seek 85 GREATER NEW YORK help. Addicts pay a $10 registration fee, re- In all that I have done, I have tried to make ceive a physical examination and get a pre- sure that the help would be of lasting benefit. scription for Methadone, a drug which helps -B.W., Medical Student, Newark. them come off their heroin-induced "highs" The attitudinal study among postnatal pa- without going through withdrawal. This pro- tients was almost wholeheartedly rejected by cedure takes 4 days. The addict is then encour- the students in the project as something aged to attend the triweekly group therapy "mickey mouse." I was more interested in it sessions during which everyone talks of their because I had helped formulate the question- problems and encourages one another to stay isclean". I was impressed with the program and naire and realized it was one of the reasons the caliber and dedication of the staff. that the dean had let us enter the community with the good blessings of the medical school. As the New Well's director told our SHP Although it did not seem to be a constructive group, addicts and Newark youth who may be thing to many of the students, it was one way fooling around with drugs, often listen to him of getting close to individual people from the because he is himself a former addict, and a community in a medical and sociological con- member of the black community of Newark. text with the possibility of followup. Actually, A big problem at the New Well is lack of it proved to be a better means of meeting prob- funds. Since they only began regular opera- lems than did our storefront at the area board. tions in December 1967, they have not as yet Confined to bed, people were more receptive been funded, although they are now in the pro- and the questionnaire, if given properly, covers cess of applying for a grant. In the meantime, a wide range of problems and is a beautiful ef- they must rely solely on the $10 registration fort at public relations to show the medical fee and on scanty private donations to meet the school cares.-P.D., Medical Student, Newark. rent, repair their facilities, and keep their pro- gram running. Bronx To help alleviate their financial difficulties, I The members of the community organization organized a musical benefit whose proceeds from which we worked were most anxious to will all go directly to the New Well. I was able have SHP join them, but unfortunately had to obtain a large hall located in the Central not been prepared well enough in advance on Ward, in which to hold the show; I got Tom what SHP could or could not do in the com- McCray's African Heritage Dancers, Art Willi- munity; not enough thought was given as to ans' Jazz Trio, Larry Young's Organ Combo, the actual needs of the community. Perhaps if and Bill Testa's band to donate their time and representatives from SHP would come into the talent. In addition to money coming in from community in early spring and explain SHP the ticket sales, I sent letters to all the and give the leaders of the community a churches, doctors, and big industries in Ne- chance to go back to their people, then the wark asking for their contributions and sup- short time that SHP spends could be spent in port of our musical venture. In all, 1200 letters accomplishment rather than frustrations.- were sent out. The response was gratifying; E.F., Cominunity Worker, S&uth Bronx. about $40 poured in each day. Working out of the LABOR storefront has Not only is the money important, but so too proved to be the greatest setback so far 'in is the publicity which will come to the New terms of doing patient advocacy. This agency Well as a result of newspaper coverage of the supposedly has its fingertips on the pulse of event and plugs for our show on radio station the community, but both students assigned WNJR. Many of the doctors and other com- there have found organization and action al- munity leaders who received our letter called most totaly lacldng. The reasons for this we to ask for more information about the New need not elaborate here; suffice it to say that Well's program and several wanted to find out their problems of inertia have held us back. how they could be of help. Out of fear of usurping the staff's power, I 86 SUMMER 1968 have gone along with their suggestions, adding have been people willing to help solve the my own whenever possible, always looking for problems of an individual or of a community in any opportunity to get things going without general, but the problem could not be defined making it look as though we, the outsiders, are to the satisfaction of both groups. Having actually directing.-R@F., Medical Student, heard so often, during orientation, that SHP Bronx. workers must be sure they are working towar Because our instructions were to work with the betterment of the community in an area LABOR and because we did not wish to antag- that the community deems a problem, this onize LABOR, we ended up working for th summer has shown the biggest difficulty to be !!n' the definition of a "Problem." doing the work they wanted rather than tne On the Lower East Side, project leaders felt medically oriented service we had envisioned it would be impossible to work in the area un- at the beginning of the summer. This had the less a liaison had been established between the advantage that LABOR can follow up what we SHP and an established community group. The did. But it meant that we did not function in the way we were best suited; we were doing problem is that in a relatively small area there work which people from the community should exists a large number of community agencies have done. We ourselves learned great deal. which have notoriously vied for positions of a power rather than worked together. It did we served very little.-N.A., Medical Stvde-nt, seem to the project leaders, though, that one Bronx. organization, the Lower East Side Neighbor- Health students should consider themselves hood Association, was representative of the de- working for LABOR. They should submerge sires of a majority of the community. This or- SHO independence as much as possible and try ganization provided the Lower East Side pro- to work out within LABOR a suitable role for ject with its community advisors as well as themselves. serving as a base for communicating with I think we ran into a lot of trouble when stu- other organizations and their activities. I felt dents considered LABOR a parallel organiza- that they tried to help as best they could but tion and demanded independence. As far as I were too involved in their own ongoing activi- can see, LABOR is flexible about letting people ties to be of any great help. This is not a criti- do what they want to do, if good relations and cism, merely an observation, for lately they trust are established first. I think it's the stu- have been working out the myr .iad details in dents' job as outsiders to work hard to main- volved in setting up the North East Neighbor- tain good relations with the community organi- hood Association (NENA) comprehensive zation. health service, scheduled to open in January The alternative is rather paternalistic. It in- 1969. This activity is indeed invaluable to the volves, first, denying that LABOR represents community. SHP's connection with NENA, the community and, second, presupposing that however, was such that we could only request students know what the community wants or assistance if they had the time to spare. Un- needs. derstandably, they often didn't. I believe that I have not been impressed with suggestions any future SHP groups working in Manhattan that students "run their own program within must have a close alliance with an established the community." Underneath those sugges- group in order to be at all effective. The estab- tions, I think, are a lot of petty professional- lished group offers the greatly needed back- ism and a belief that the community doesn't ground information, actual experience and recognize its own needs.-K.B., Medical St7t- vital contacts without which a small group is dent, Bronx. lost trying to challenge the bureaucracy of Lower East Side New York's health care facilities.-J.M., Nursing Student Lower East Side. Too many times this summer, as I am sure. it must have happened in years before, there Our contact with the Lower East Side com@- 87 GREATER NEW YORK munity was exclusively through the NENA time, we did not reach as many as we had Health Council, a coordinating committee for planned. We found that there was no way grassroots groups in the area. It is not a grass- Puerto Rican nurses could -be licensed except roots group itself, and is not involved in organ- by taking the New York State examination.- izational activity. I feel that white students K.D., Medical Student, Lower East Side. have no business in such a neighborhood unless Those of us interested in fighting narcotics they are supportive in the eff-ort of poor people addiction decided to produce a skit using NYC to organize themselves politically. NENA is residents of the Lower East Side, speaking the past that stage; they are now consolidating the slang of their peers and interacting on stage in fruits of past organization and pressure. I think it was a basic mistake to work through a manner to which their audiences could relate. them. They served to insulate us from the com- We realized that in order to be effective we munity. The members of the council, through would have to associate ourselves with ex-ad- years of striving for a neighborhood health dicts. We began to attend daily sessions at clinic, 'have become very sophisticated about Daytop-SPAN, and remained there until the health and politics. I think they still represent end of the project. This association both helped the communit but they are not representative and hindered us in the fulfillment of our objec- , Y, of it.@.M., Law St@nt, Lower East Side. tives. Because of the close-knit group together- ness of Daytop-SPAN, the orientation of the I worked with four other health science stu- organization was necessarily different from dents in helping the North East Neighborhood ours. This situation created a certain amount Association'(NENA) Intergroup Health COm- of tension, which remained between the two mittee develop and write up a training pro- groups for the duration of the project. Daytop gram for paraprofessional personnel who expected us to immerse ourselves completely in would work in the health service; publicizing their therapy program while we were only the clinic in the community and asking the there to gather information, background, and community people for suggestions on how it atmosphere for the play, and to insure t at the should be run; and trying to find ways in portrayal maintained a certain amount of accu- which Puerto Rican nurses could be licensed by racy. Daytop, however, subjected our private the State of New York. * * * lives to their scrutiny and jurisdiction, and re- I found that the health science students were fused to accept that we had come only to seek accepted completely by the people at NENA advice and not to seek "salvation." Perhaps the who seemed very happy to have us working burden of the blame lay with us. We did not with them. Since the health service had just clarify our exact position and functions to been funded, there was a great deal of work to Daytop-SPAN and thereby melted too far into be done to get it set up and there were only two the organization. people working on the clinic when we first Once again, this emphasizes the rather seri- came. Thus we worked as a staff for the devel- ous lack of a clearcut identity on the part of opment of the clinic. The project director of the SHP. Having formulated its specific objec- the health service outlined what she thought tives, the SHP ought to have established its were the important jobs to be done and then let autonomy as an organization vis-a-vis the us develop our own methods and goals; thus other community organizations with whom it we worked mostly on our own. worked or from whom it sought advice. The I think the group was quite successful in ful- value of SHP as a link between the establish- filling two of its three objectives. We com- ment's health and social services and the pleted the training program, our top priority Lower East Side community is too great to task, and hopefully a grant will be obtained so allow SHP's dissipation into simply another that the program may soon begin; and we free labor supply for various neighborhood or- reached a good many people and informed ganizations.-D.S., Medical Student, Lower them about the clinic, although, due'to lack of East Side. 88 SUMMER 1968 We had a great deal of trouble fitting into SPAN. They are all ex-addicts, who, through SPAN: we supposedly had a double allegiance their program of self-help, have become in-. -to SHP and to SPAN. SPAN is a very struc- credibly self-aware and perceptive. I found it tured, rigid organization, as it has to be. As easy to work with them; more than that, I they say, "We are in the business of saving doubt that there could have been a play, or any lives; we can't afford to compromise or let our- meaningful conception of what we were trying selves slip." Coming into SPAN, we originally to do, without their help.-M.H., Nursi@g Stu- agreed that we would do everything that every- dent, Lower East Side. one else did, for example, help clean up and Harlem attend all meetings, seminars, and group ther- apy sessions. However, in some ways we were When I went out on referrals in Harlem I treated with leniency, and for the NYC's this did not feel that I was accomplishing anything, was bad because it decreased their sense of res- because I was not connected with a community ponsibility. It also caused SPAN to be upset organization. Once associated with the hospi- with itself and with us, because they felt they tal, however, I felt that my service was more were not living up to their own standards. organized and therefore more effective.-M.I., The second hangup was that no one knew Psychology Student, Harlem. what the students' role should be. We were - Referral work formed the body of my job treated as supervisors, and fell into that role for the summer. Personally, I met with little too easily. The play was almost entirely con- resistance from the community; most families ceived and laid out by the students, without it were cooperative and grateful for our ever being explained to the NYC'S. When our services. * * * Nonetheless, a sense of friction director finally straightened out the mess, the arose in dealing with the clinics. Although we pendulum swung in the other direction: the were well received and complimented by all students felt they had no authority at all. Once health facilities we used in Harlem, I believe the play got underway, the NYC's were the ac- there was some resentment of our arriving so tors and SPAN people the directors; the stu- eager and fresh to do a job which the clinics dents floundered for a purpose. Eventually we alone were not doing as best they could. An ex- settled on an administrative-organizing role; ample of this was the hypersensitivity of the we set up performance places, bought props, dental clinic staff in the Central Harlem phoned absent NYC'S, etc. But through this Health Center. I feel they were caught sitting long struggle toward a role, SPAN looked on on their hands and that we forced them to take annoyedly, not quite knowing why we were on the number of patients they were actua there or what their concern for us should be. equipped to take but had not been receiving. Generally, SHP seemed so disorganized and in- Goading clinics to give better service was one experienced an organization that SPAN de- of our goals, however, and in certain respects cided to try to ignore it, and to take us into we were successful.-C.W., Medical Student, their organization as individuals. Harlem. After many stops and starts, we got the play going and performed it three times, once for I was told by many of the health establish- the people at SPAN, once each for University ment professionals that they felt they were and Henry Street Settlement Houses; alto- doing the best they could under very trying gether we reached about 100 people. We expect conditions (for example, over-utilized and di- that it will continue through the year. The five lapidated facilities in Harlem hospital clinics), remaining NYC's who acted in the play are and they felt that we posed a definite threat of very enthusiastic about doing it in high schools trying to "expose their inadequacies," which, throughout the year, and about coming down although never stated, was implicit in our ide- to SPAN and participating in groups. alistically trying to "make things better in a It was a tremendously enriching experience hurry." Many of them, of course, aren't doing to meet and get to know the people from their jobs; however, it doesn't matter what we 89 GREATER NEW YORK think we're doing but rather how they inter- The Brooklyn SHP felt that the student fel- pret our motives which determines whether or lows' role in model cities would be to help the not they co-operate willingly. Our handling of multiservice committees prepare a health pro- this "domain infringement" problem often was posal by the September target date. We should not very tactful (and other projects reported have seen trouble ahead when, on our first similar problems), so this is one area we meeting at model cities, the supervisor pro- should give more attention to in future efforts posed that we learn Spanish for the first few to effect change from within institutions.- weeks in order to help recruit the Puerto Rican W.S., Medical Student, Harlem. community for the Model Cities program. Following a week of orientation to the Model Brooklyn Cities concept, we reported to work in Central I thought the nature of our involvement in Brooklyn's Brownsville office and were told the hospital setting was extraordinarily appro- that our job would involve an investigation of priate in effecting our original aims. Per- the health facilities in the Model Cities area. sonally, I do not believe that community in- We knew little of the area and started from volvement is necessarily the best way to im- scratch. prove health care. Recipients expect doctors to Investigating health facilities can involve act like doctors; that is, to render healing ser- anything from making a list to conducting a vices, and not to act as quasi-social workers or survey of patients' opinions' of the various priests.-M.H., Sociology Student, Brooklytk health services available. We tried to set a We had hoped that the Youth-In-Action pro- course somewhere in between, realizing that there was little time for in depth evaluation ject would bloom out, because they're a gigan- since the committee were being asked to sub- tic organization in Bedford-Stuyvesant, and mit tentative proposals by August 15th. they have many programs: social affairs, fam- ily counseling, unwed mothers, sport@you On July 9th, our second day in the Model name it. We thought it would be a good oppor- Cities office following orientation, we walked tunity. As it turned out, it was horrible. across the street to check on the activities of The bureaucratic problem we met is proba- the Ralph Community Center. We were curious bly typical of a lot of agencies, but even worse to see how community action was being han- at YIA. We made arrangements, really good dled on a storefront basis. * * * The Ralph arrangements,'with a couple of people at YIA Center is small, but it did have a group of wel- and then some of them left, and we were up in fare mothers in a remedial reading program the air. No one else had been told about these and we spoke to them for a few minutes to arrangements, so we had t sound out their ideas concerning possible o start from scratch. We were trying to get involved in one of their health programs such as child psychology, nu- other programs (I think it was the unwed trition, the psychology of drug addiction, etc. The women were only mildly enthusiastic but mothers or the family planning section) and we found that people over there never knew we we arranged to meet with a larger group for iater that week. * * * had been working in home family counseling. -W.S., Student Coordinator, Brooklyn. Model cities did not employ Neighborhood Youth Corps workers. Instead, some 78 college Most of the community groups in which the aides from the Brownsville, East New York, Brooklyn SHP was to operate had been con- and Bedford Stuyvesant communities were tacted several months before the project began. hired. Three of these aides had attended the Model Cities was a last-minute addition, and SHP Orientation. Since the two girls were the role of the SHP in it was rather unclear. black and the boy a native of Puerto Rico, I We were to work for the multiservices commit- asked our .supervisor if they could join us for tees whose social service interests stretched, as the hour or so w.e expected the Ralph Commun- our supervisor said, "from the womb to the ity Center meeting to last. Much to my aston- tomb." ishment, I was not only told that they couldn't 90 SUMMER 1968 join us, but I was forbidden to walk across the grossly understaffed and equally uninspiring. street! I was told that we had enough to do at We have spent too much time writing reports Model Cities; and when I protested that we felt that are never read onresources that are being we had time on our hands at this point the su- listed for the umpteenth time by the ump- pervisor told me not to get involved because teenth agency. Our job is to drown in burea uc- there will be much to do. racy. We had not expected this type of rebuff. It Frankly, I think the job stinks. It is stupify- had been our feeling all along that our role at ingly dull and nonstimulating. * * * There is Ralph Street Center would be one of coordina- no doubt that Model Cities will benefit in some tion only, and that the women themselves way by our work; there is considerable doubt would make the contacts and invite the speak- that we will benefit from four more weeks of ers. We felt that even should the program de- boredom."-J.R., Medical Student, Brooklyn. velop on a weekly basis, it would involve only a There were two important areas of the couple of hours a week and we could not antici- Kings County Hospital patient advocate pro- pate our ever being so busy as not to be able to afford 2 hours. In any case, the commitment gram that hadn't been touched on by the 4th had been made to meet the women and we con- week of the project. One was the problem of tacted an assistant to the director and he ar- how best to utilize the facilities of the pedia- ranged for us to go to the meeting with two tric clinic to educate the mothers that visited Puerto Rican college aides in the office. it, and how to make the clinic as enjoyable as The significance of this encounter lies in its possible to the other children that had to tag total misconception of our role in model cities along. We needed to make the hospital admin- that saddled and hindered us in all the weeks istrators aware that much more could be done we worked. We felt that our task to provide for the people who visited the clinic * * * health information to a planning agency de- The National Dairy Council let us use for 2 signed to improve community services in toto weeks a 6 foot by 4 foot electrical cow that was an important one. Given the scope of our could "talk". Along with this cow came posters research, this assignment did not demand a 40 about proper -nutrition; and the importance of hour week, We spent every Monday evening drinking plenty of milk. and one Tuesday evening trying to help the The cow served two purposes: the first thing Multiservice Committee of Brownsville and that it did was brighten up the entire pediatric East New York. The job involved a great num- clinic for all the children. You should have ber of phone calls, many meetings with directors seen the excitement in their eyes as the cow of health facilities, and an equal number of re- moved its head back and forth and mooed and ports for the Model Cities office. It did not, we wagged its tail. Many of the children had felt, involve a stranglehold on our time and in- never seen a cow up close and couldn't help terests by a supervisor ill-equipped to direct us touching the animal. Why the - couldn't the efficiently and an agency burying itself under people in the clinic, the administrators of the the weight of its own memos. The net result clinic, think of something like this? In order' was a gradual alienation between us and our to get the cow free for 2 weeks, in order to get supervisor, then the director, then ultimately the task itself. the posters and handouts for the people visit- I had written a rather stinging report ing the clinic, all I had to do was write a letter to the National Dairy Council. Can you imag- for the SHP. it was written at a rather low point in a day in what had been a rather low ine how much could be accomplished if the head of the department of pediatrics or some week. I will quote the final two paragraphs. "It is our feeling th-at, since a proposal must other person in authority tried to use his influ- be produced by September lst, the committee ence -with various agencies'in order to help im- will have little to do or say but rubberstamp prove conditions in the clinic?-D.Y., Medi@l ideas suggested by the staff. Model Cities is Student, Brooklyn. 91 THE NEIGHBORHOOD YOUTH CORPS terested in medicine or an allied profession. A tentative program was developed in which The other one I met before we hired him, and I health science students and Neighborhood spoke with him for a while and explained the Youth Corps would jointly structure a summer project and he seemed interested. So both of "experience." The objectives were : (a) To un- these NYC's were screened. A lot of the other dertake a program which would give the NYCs people we got were just given to us. We had re- a constructive and educational summer job quested that they have an interest in medical which in some way relates to health and to sciences, but in truth, when people assigned medicine; (b) to enable health science students NYC's to us, I don't think they took anything to become thoroughly acquainted with the like that into account. It was a real horror health needs and health services in the com- show for a while. munity; (c) to develop one-to-one relationships We had to get NYC's f rom three different with several adolescents, thereby hoping to areas, because we were working in Browns- have a positive influence on their further de- ville, Crown Heights, and Bedford Stuyvesant, and we had to get NYC's from different agen- velopment and goal expectations.-L.K., Medi- cies within those areas. In the beginning there cal Student, Brooklyn. were hangups in all of them-the kids didn't Working with the NYC's was both reward- get paid and they had to register and re-regis- ing and frustrating. They contributed a ter-but after 2 or 3 weeks, Brownsville and great deal and ran some of the projects en- Crown Heights straightened themselves out. tirely. However, some of them were too imma- Bedford-Stuyvesant Youth-In-Action has yet to ture and didn't want to work. They didn't want straighten out. We were calling and going to walk a few blocks when we were all going down there and seeing people, and we got no- door-to-door with health information; they where. And last week we sent them a telegram didn't give us suggestions when we asked them telling them, "We've been trying to get you, what was wrong with the summer work. They and the NYC's haven't been paid for 6 weeks, said they wanted to talk to their age-group and it's time something got done." Two NYC's about drug addiction, but when the opportu- stopped coming to the office. Last week we told nity came they were too embarrassed to talk. them we would followup the telegram and go Many times, we climbed walls in order to down there and sit there until someone did keep them busy. I don't think, however,, that something, so we went down and we had, I'd our project could have existed without them. say, about 10 or 15 people there in that little When they were interested in something, they crowded office, so they saw us and we got it were creative and tremendously active.-E.B., straightened out as well as we could have ex- Medical Student, Brooklyn. pected@W.S., Student Coordinator, Brooklyn. The big problem for most of the people -on When the NYC's were working they did the project who were working with the NYC's work comparable to the work which was being was that they felt they were working to make done by student fellows in the SHP. This is an work for the NYC'S; that they were constantly interesting observation and may shed some worried about what these kids can do, and light upon SHP's place in the community. should do, and trying not to keep them bored. If Neighborhood Youth Corps workers are A couple of the health students expressed to capable of doing much of the work which was me that the kids are wasting their time and done by medical students this summer, then could be getting a better experience elsewhere. why not set up an SHP in which the majority Some of the kids worked out well. In Browns- if not all of the student fellows are teenagers ville we had two kids who were really great from the community. I'm sure with supervision and they were interested. We had known one from the Public Health Service and a few med- of them before this summer and we requested ical students such a project would work. Fur- him, as he had indicated to us that he was in- thermore, if the funding is through an estab- 92 SUMMER 1968 lished bureaucracy such as ours was, there my efforts. Relations between me and male would be no financial problems.-R.J., Medical NYC's were cordial but superficial. I cannot re- Student, Brooklyn. member one truly frank or constructive con- On the whole, I found that working with the versation between me and a male NYC. The NYC fellows to be a very worthwhile experi- boys are mostly high school students whose in- ence. Although they had much difficulty as far terests and capabilities are varied. I had more as receiving their pay checks went, they still friendly, frank discussions with the girls, al- continued to work with us throughout the sum- though these did 'not come until the last 2 mer. I discovered that these workers were very weeks of the project. Boys were more cynical' imaginative and as eager as we allowed them less interested, and less vocal; they just didn't to be. That is, when we showed enthusiasm for trust or like me and many other project mem- a project, then the NYC's showed the same bers, and I feel they had good reason. Some stopped coming to work other than to pick up eagerness to get involved. If they didn't ha@? Paychecks. such a problem about getting paid, then i-c Here's how we let them down, as I see it. We would have been an even more productive sum- have a kind of Cinderella complex about mer for us. These youngsters know the com- NYCS. That because they know their commun- munity. They helped us get acquainted with the ity best we presumed they have highly devel- area, the problems that the people had, and oped social interests and ideas. We did not tai- the problems that they faced daily in their own ior jobs to individuals carefully and, where lives in the ghetto.-D.Y., Medical Student, necessary, we did not provide well defined Brooklyn. tasks, thus giving NYC's a feeling of impor- It appears that two factors contributed tance and belonging; it has to be nurtured and greatly to the somewhat frustrating situation we weren't able to do this. I don't think they with the NYC'S. First, the unstructured nature felt important and necessary. We did not use of the work in the initial stages' the degree of them as consultants. One boy failed his sum- abstract thinking required, and the many mer school course, and we didn't know about it hours of rather uninteresting but necessary until after he got the grade. busy work. To do this busy work both effec- With proper direction and attention, the tively and with enthusiasm requires an under- NYC program could be productive for them standing of and dedication to the ideology. BY and us, but more attention must be given to it. utilizing a confrontation technique with the We must learn from our past mistakes.-A.H., NYC'S, some success was achieved in increas- Medical Student, Newark. ing their interest and participation. Secondly, the generalized confusion of the NYC program Neighborhood Youth Corps teenagers were hurt us-many youngsters were not hired until essential as a direct line into the community. quite late and the payroll mix-ups were numer- They did not turn out to be secret agents at all, ous.-L.K., Medical Student, Brooklyn. but were frequently direct lines to the real In the beginning it was said that the health poor who need help the most. I did not develop students and the NYC's were to be equal, but it as close a relation with the NYC's as I hoped didn't turn out that way. The NYC's were the to, but some of the talks I did have with a few slaves@ of the health students, because the of them were mutually b6neficial. A basketball NYC's didn't have the same responsibility as game the health science students played the health students. By this I mean the hea@th against them was a success, but it or a similar student did everything and the NYC did the activity should have been held earlier in the v" project when enthusiasm was still high. I sug slave work, the dirty work.-R.P., N..,,, gest intensive individual tutoring of the NYC's Brooklyn. two mornings a week with as many health sci- The NYC program was nearly a total fiasco, ence students as possible participating and a flop-the major failure of our project and of keeping daily records of each NYC's progress. 93 GREATER NEW YORK We never made operational a suggestion that ship. By the end of the first week, the role of instead of focusing our attention in the direc- the NYC's was set in the minds of the glory- tion of what we could find for the NYC's to do, craving, great white liberals as kids who were we instead charge the NYC's with the respon- to be dragged along. These "kids" are a lot sibility of informing us about what their more mature, open, truthful, and real than neighborhood and its people were all about and most middle class health science students. The bringing to us what persons they knew or NYC's are the most powerful organ of SHP. knew of who needed some help. I feel a keen They are the community and any student who sense of disappointment that we didn't make ignores or exploits them "to know what a our NYC's experience this summer nearly as ghetto person is like" is ignoring and exploit- valuable as I thought it should be. The most ing the entire community that SHP is sup- certain thing I can suggest to remedy this in posedly established for. I myself underrated the future is that in the first week or two when the potential of the NYC's initially. But for- enthusiasm is still high (assuming it begins tunately, through one NYC who was "showing high) each NYC is made to feel important by me the ropes", I realized their importance and doing something constructive and meaningful, worked much more effectively with them. and not just sitting around.-N.W., Law Stu- K.S., Nursing Student, Newark. dent, Newark. I feel the NYC's were the most important The problem we have is that NYC's and people in the project, and with most of them, health science students don't relate that much. especially the boys, we failed miserably. First The NYC's don't have a sense of the project of all, they were excluded from many of our like the health science students do. One, the meetings concerning hospital services, meet- health science students don't have the same ings which they should have attended as the problems, with day to day living, as the NYC'S, main speakers on poor medical care and bad at- so they don't have the same objectives. We titudes in the hospital. Secondly, many of the have more intellectualized, idealized objectives health science students went about their busi- of a better health service. The NYC's are con- ness without the NYC'S. They were regarded cerned with summer jobs, keeping busy, get- as little kids who had to tag along after you ting something interesting -to do, and in the and the biggest question seemed to be, "What winter having another job, getting more are we going to do with the NYCS. Nothing money. Their interest in a way is very impor- should have been done "with" the NYCS. They tantly, very basically, economic. They think of were all old enough to understand why we that more than we do. The most important were there and what we were doing, and they thing'we're doing is making them think-how should not have been treated as kids. I found many of these kids would otherwise be think- the girl NYC's to be the most genuine people ing about hospitals and health problems? on the project. They were intelligent, alert They never would have thought about this. If young ladies, more aware of the existing condi- they have a job and they have to think about it tions that they were often given credit for. because it's their job, they're not going to stop Had some of the health science students thinking when the job is over. One guy is stopped patting themselves on the back and be- maybe going to get interested and one guy can friended these boys and girls, they could have change ten people.-D.T., Student Coordinator, learned a lot. If the NYC's had been treated as Newark. equals they could probably have proven invalu- The most striking lack of communication able to the project goals.-A.C., Nursing Stu- was between health science students and the dent, Newark. NYC's.. It got to the point where one NYC was This summer the Lower East Side dental ed- assigned to each health science student. I ucational program was performed by only thought this absurd, but shamefully necessary NYC students. They wrote and directed their in most cases, to establish this forced relation- own play and have received tremendous praise 94 SUMMER 1968 for their performances. All the Head Start guidance.-M.H., Nu@sing Student, Lower East schools in District 1, daycamp schools, the Side. Poor People's Campaign, Junior High 71, the Boy's Clubs, Sloane Center, and many other You see, one of the things about agencies have all enjoyed and learned some- Neighborhood Youth Corps is that it's a syn- thing from the plays. This group of 15 NYC's thetic organization developed for a particular have reached about 3,500 children and young purpose. If you have two synthetic groups re- adults this summer. As well as supplying a ser- lating to each other, and the core of their expe- vice to their own community, they also had a rience is what happens between those two great time doing it. I have personally heard groups, I think the community's going to get that they are proud of what they are doing and left off in the cold somewhere. And there's hope to have an ongoing program during the question as to what extent these NYC's are re- school year. A few of them have come to e lated to the community: some of them are, T some of them aren't; in fact, the coordinator of and expressed their personal gratitude for the the whole Youth Corps was in just as much of summer. a hurry to move out of the community as he I am presently submitting a proposal for could be.* * * -S.D., Community Worker, funds so these NYC's can continue their activi- Lower East Side. ties during the course of the year. We hope to coordinate their activities with an exciting From my point of view, the SHP could have program at NYU Dental School, where they been more organized if the students had been will continue to perform, to rehearse, to make more thoughtful in their decisions. For the costumes and scenery, and to draft new plays most part, I think that the SHP accomplished after school. They will perform their plays for what was needed in the community. I think local agencies as part of the dental school pro- that we NYC's were very effective and very gram. The NYC's will also be offered a tutorial helpful to the work of the students because program to aid them through high school and since we were also from the community, the entrance to college' They also will attend den- people would be more attentive to what was tal educational classes where NYU faculty being said. members will talk to them about oral diseases. The students I worked with were, for the From my own experiences and observations in most part, very nice. They made me feel ma- this community for over a year and a half, and ture in what I said and what I did. They some- considering the recent summary of dental times disagreed on what was decided in meet- ings., but I think this showed that they were needs by the Public Health Department, I feel this group can provide a'fantastic service to really interested in what they were doing. their community, a service which is desper- I feel I got to know the community better be- ,ause I personally went around to them, talk- ately needed.-G.L., Dental Student, Lower c East Side. ing about the clinic. Yes, I really think that my experiences this summer may surely change We, as students, had a great deal of trouble my plans for the future in that now I know adjusting to working with the NYC'S. We al- what I would want to consider my life's work. ternated between our ignoring their abilities -N.R., NYC, Lower Ectst Side. and their ignoring our abilities. In the end, we, The NYC's in our office had not been hired the students, moved into a cooperative, super- by SHP, but by LABOR. The ones I worked visory role, and it worked well, Though it was with were very good and responsible. LABOR hammered into our heads that everyone was would like to hire them part-time after school $'equal," and that "no one bosses anyone," we to work as block organizers. My relation to finally realized that the NYC's were 5 to 7 them was primarily one of a teacher-how to years younger than us, much less experienced get complaints in a building, how to organize a in the responsibilities of working, and needed tenants' council, how to do a title search. They 95 GREATER NEW YORK were expected to work independently and come In short, I am grateful to the SHP for what it to us as resources, an excellent relationship for has taught rne.-F.M., NYC, Bronx. those who were capable and mature, a hopeless I hated every minute of it. It was the most responsibility for the others. I felt somehow boring and the dirtiest job at times. This pro- that NYCs should be treated as our equals, but ject was also very unorganized, confusing, and they seemed to want more direction than I ex- a lot of talk as to what to do. All I really did at pected. I think in a continuing relationship, times this summer was fuck off in this project equality would emerge. But NYC's really have because sometimes that was the only thing left to be selected for the work. Just hiring any- to do. SHP did not do much work on housing body off the street and giving him make-work problems in the community, for what I saw. is quite damaging.-K.B., Medical Student, Besides, there aren't enough workers for this Bronx. job anyway. Concerning the workers I worked with, well that wasn't much of a problem for This summer found me working for LABOR as a screening technician. It was not fun. First me, but for the medical students, yes, it was. of all, I don't get kicks out of going from door They should have taken the job more seriously to door asking for urine. We didn't help the but I don't really blame them because there families as far as housing and bills, etc. are was no one around to make them responsible. concerned. I think that that is something that for what they were supposed to do. SHP should have considered. The most important thing I,think I got out As far the other NYCs I worked with were of this summer job is knowledge of the poor concerned, they felt the same as I did. We all conditions the hospitals are kept in. They don't thought it was a big drag and we all knew that even look like hospitals to me. And also the we weren't doing it because we loved o@@ poor housing conditions some people live in. I neighbors, but because we were getting paid think there should be something done about $40 a week for what we were doing. Being a this problem, which some people don't even screening technician didn't give me an oppor- consider. The one thing I really liked about my tunity to get to know my community any better job was that I got to know some of the people because I wasn't working in my community, in the community which I worked in.-R.F., but I did get to meet new people. NYC, Bronx. . My summer experiences didn't help me as As far as the Bronx project is concerned, I far as the future is concerned, because I think that there was very little unity, if any at wouldn't want to do what I did in the summer all, between the older memb ers of the project for the future.-J.R., NYC, Bronx. and the NYC'S. Most of the young people felt as though they weren't part of the project, but To me, this past summer has been very help- more like an old shoe that someone found and ful and educational. (I know I speak for my just happened to need. It is here, I felt, . a:, fellow NYC's as well). For instance, I never the project began to fall apart. I think that the really knew how bad the slums are until I got . NYC's could have worked more harmoniously out there and worked in them. It was pretty with the community workers,'medical students, depressing but that's the only way of learning coordinators, etc, for a better understanding of about it. I was also blind to the fact that in- the community.-C.B., NYC, Bronx. terns work hard to become doctors and when COMMUNITY WORKERS they become doctors they work just as hard to help out the sick, the ignorant and the op- This past summer I was given a job that was pressed. How do they do this? By starting supposed to be as community coordinator. The community projects; or by opening public hos- reason I got this job was, I believe, because I'm pitals, clinics, etc. Yes, this summer was a black. I made a good salary and I could use it, summer I'll never forget, for I learned a little but I want a job not because I am black but be- about a lot. Or a lot about a little, whichever. cause I can do the job. 96 SUMMER 1968 1 may be a little old-fashioned, but I take in SHO community-worker relationships.- pride in doing a job well, and when I'm given a J.C., Medical Student, Lower East Side. job to do I try to do it well. If I don't know We found, unfortunately, that although one how, I ask someone who'does know how, and of our community workers prefaced many of then I try to do the very best I can at it. her statements with "the community wants But this particular job no one will ever be * * *" we were actually hearing what she able to say whether I can do well or not, be- wanted. We found that she often had as much cause I really didn't have anything to do. The difficulty in communicating with the Puerto NYC's could have done most of what I did, and Rican and black community people as the health this was not the fault of the people I worked science students themselves had. We were told with so much as the way the program was set by another community advisor (who also is a up. It was a sort of gentlemen's agreement member of the Health Council) that often, since thing -"We must have these people in our pro- the other community worker sounded so know- gram or we'll look bad, so keep them happy ledgeable on' such topics as city and state and we'll do the real work."-M.W., Commun- politics, the Health Council accepted her word ity Coordinator, Brooklyn. on faith. And we behaved no differently at first. As one of the community workers, I found Her self-assurance and seeming political know- working with other community workers very . ledge convinced us that even though we felt agreeable. In most instances, we were in com- insecure about going upstate to do political mon agreement as to how something was to be organizing to get Medicaid back, we would be doing the community disservice by refusing to carried out. This is not to say that our behav- iour was stereotyped, but that a somewhat try. In effect, she succeeded in removing us common outlook on the aims of the project led from the community for the whole summer. I to closely aligned methods of implementation. feel that I was deprived of a valuable learning Much of our camaradarie came about thro experience. Hopefully, however, the primary ugh o@ective of the SHP is not to parasitize off the a defense of the community and its legitimacy, community for our own enlightment. Consid- a defense provoked by the subtle attacks made by some white members of our staff.-R.P., ering that, the Medicaid project may contrib- Community Coordinator, Newark. ute more of a long-range "concrete service" to the community than those projects which were Our community colleagues were indispensi- more "community based."-J.P., Medical Stu- ble in a pr 'ect composed largely of white, dent, Lower East Side. oi upper middle-class students who have very The community workers were overall very little idea of what is happening in the ghetto, helpful. Our community coordinator seemed what it's like to live there, and what it's like less helpful than I hoped and expected. Her re- to be black. Individuals and personalities and luctancib to give advice before it was too late the abilities and commitment of the commu- caused many a mishap. Her explanation of nity people have a great effect on the success community feelings concerning our difficulties of any community-wide efforts, but not neces- was helpful, but I feel many mistakes could sarily individual projectg.-N.W., Law Stv, have been avoided had she interceded sooner. dent, Newark. Our other community worker, though involved Our two community workers were quite dif- in much power play, constantly provided much needed advice concerning the community's ferent people, and the way they came across needs and fears. was remarkably different. I believe that they Mobilization For Youth provided us with may not have completely understood their rela- one of our most valuable people, the crew chief tionship (power-wise) to project decisions. of the NYC'S. He assisted us in understanding This understandably difficult position to evalu- the NYC's and them in understanding us. ate may have contributed to a mutual distrust Without this help, our project would have col- 97 Liittia,l,.M.K IN.M w I U.K.M lapsed.-B.G., Nursing Student, Lower Eagt The most reactionary and self-seeking mem- Side. ber of the Tremont Community Council was a I feel very funny working with professional white, female community worker assigned to the SHP. She was a strong proponent of "com- people, perhaps because I think they're trying munity relations" (keep the niggers happy), to put something over on me; I just didn't and constantly showed preference for SHP in- want to work with them. Then I reconsidered volvements such as single-shot sex education, because of the fact that I was the only Span- narcotics, and dental education programs ish speaking coordinator in the whole project. which would reduce the envy of other co mmun- * * * Sometimes I am asked questions by the ity organizations for the concentration of our students and I say, "I don't know how to an- services in the T.C.C. This community worker swer you because I have not consulted the com- was very domineering, vocal, and argumenta- munity;" Then the project members would say, tive, and managed to control somewhat the "What do you mean, you can't answer me; range of action of two nursing students who you're part of the community."-H.K., Com- worked with us on the project.'In addition to munity Coordi?mtor, Lower East Side. being frequently late or absent from project There are community people who'll give you responsibilities, she was an expert at ducking snappy answers. Some of us have lived there her own share. At the end of the project, when long and worked with each other long enough nineteen Bronx SHP students, community to know that on policy questions, the snappy workers, and NYC's signed a petition to reallo- answer is not always the best answer. Like I'm cate funds from the extravagant Final Confer- sure Mrs. K. has very definite recommenda- ence to the continuation of the Unwed Mothers tions on certain technical things, but at the and Head Start programs, she was the only same time the students wanted snap answers project member who refused to sign. With col- on things like broad-range policy to function leagues like this, who needs enemies? On sev- on, to force someone into giving them an an- eral occasions, this woman openly slandered swer and then say, well so-and-so said that. two black community workers assigned to the Central Bronx storefront. Her influence over Well, we don't want to be used that way.-S.D., i Community Worker, Lower East Side. one nursing student was so strong that this student threatened to resign from the project In the Bronx we were fortunate in having two if one of these black community leaders were hardworking, intelligent and congenial women transferred to her part of the project.-J.G., as community workers. One, the mother of Medical Student, Bronx. seven, was white and active already in commun- We had flve community mothers working ity affairs. She served as an excellent liaison with us in Harlem. We were told it was to be between us and the Tremont Council. She also brought to the job strong ideas about 'our ef- our duty to "train" them to work with Public forts and a willingness to do a job. She related Schools 175 and 133 health referrals. Three of well to the group and became an integral, in- the ladies are experienced in the home-visit terested member of the team. The other com- type of work involved, and it was absurd for us munity worker was Puerto Rican. She was to presume to train them to function in their very congenial and, like her counterpart, be- own backyards, particularly when there were came a friend as well as' fellow worker. 20 of us where three or four would have cer- Through her we were able to understand some tainly been sufficient. 1, and I think many of of the problems the community faced, as well the other student fellows, overlooked the two as her serving as a link to the predominantly inexperienced ladies who could have benefitted Spanish-speaking community. Both women from accompanying us on home visits, to the were made to feel entirely equal on the.team, hospital, and on visits with local oi;Ecials. We and their opinions were respected and often spent the last 2 weeks trying to make up for taken as gospel.-V.S., Dental Student, Bronx. our earlier shortcomings, only partially suc- 98 SUMMER 1968 cessful, I am afraid. The two are still unsure municating to them whatever cautions are nec- of themselves, partly due to our inadequacies. I essary to prevent them from proceeding at a felt the mothers suffered somewhat from the pace which is unrelated to the sentiment in the decision to hold the orientation and final con- community. Student health projects are an im- ference far out of the city, they being reluctant portant two-way educational program, with to leave their families.-L.B., Medical Student, communities receiving valuable augmentation Harlem. of manpower and students receiving an indoc- trination and a sympathetic understanding of Our community workers were pretty good; neighborhood problems which will stand them they were better at making home visits than in good stead as professionals. The faculty ad- the medical and nursing students. Two of visor can and should play a key role in facili- the five were working mainly to get them- tating this whole process.-J.W., Faculty Ad- selves out of the kitchen for the summer visor, Brooklyn. and weren't ready to put out . The other three were quite resourceful and critical of One of our faculty advisors was almost-to- things in the project or in health facilities in tally removed from any contact with our pro- Harlem that needed criticizing.-R.C., Student ject. Her main concern was with a question- Coordinator, Harlem. naire which was given to postpartum women. If I had had more contact with this woman, I FACULTY ADVISORS could say more. In summary, her role was one Health science students coming to a new of irrelevance. community from all over the country for a 10- Our other faculty advisor served more as a week summer work experience must depend hindrance to our project than as a boon. He ad- heavily on the advice and the orientation pro- vised our project members as how to best be- vided them by faculty advisors and precep- come co-opted into the bureaucratic b.s. of tors who have long-term experience in the which he himself is part. He seemed highly re- sponsoring institution and the neighborhood. sentful of the fact that members of our project The faculty member must be able to work saw fit to approach the top of the Martla-nd equally successfully with citizens, represen- Hospital administration with suggestions for tatives, and institutions in the community and change, which we saw as deserving immediate with the students. The former are inclined attention. These proposals were based on com- to be suspicious of this invasion of largely munity sentiment.-R.P., Community Coordi- middle class workers, and the latter are us- nator, Newark. ually highly idealistic and very naive. The Our faculty advisor both expected and de- preceptors who have prepared the ground manded that we remain docile, quiet workers in the neighborhood must be extremely careful in the emergency room, and not make any to suggest and advise students without in any "waves." When he and the hospital administra- way dominating their project or making deci- tor learned of our visit to higher authorities sions for them. There are realistic risks, of and of the community organization we were students antagonizing community people, or their being discriminated against because of trying to form, we were screamed at accord- ingly, threatened, and invited to leave the hos- class, race, or as "carpetbaggers." Even their physical safety ma be involved at times. The pital. This invitation, we learned, wasn't to be y the last.-A.C., Nursing Student, Newalrk. faculty advisors should be available at all times and should be capable of facilitating the Our faculty advisors were virtually nonexis- planning and the carrying out of student pro- tent. Unfortunately, both are extremely busy jects, through a close-working relationship people and just couldn't put in much time at Particularly with the student directors. You project meetings; they both came to several must be able to relate sympathetically to the meetings at the start of the project, but not changing objectives of the students, while com- much later. One advisor taught the pediatrics 99 GREATER NEW YORK part of our training program for the mothers. was one of the parts of the project that would She came to weekly meetings at our office for have been nice but that it was really put in to that. In the future, we should try to get advi- satisfy Montefiore Hospital that we would be sors who have more time, I guess, but I'm not well supervised."-R.C., Student Coordinator, all that sure that we suffered from not having Harlem. faculty direction. I felt from the start that this 100 Part 4: OPINIONS ON THE ORGANIZATION INTRODUCTION level, with the central staff being essentially The administrative organization of the 1968 powerless and the policy making council too project reflected the spirit of community con- cumbersome for immediate decision and action. trol that was of great importance to the pro- GREATER NEW YORK STUDENT ject's student leaders and to many of the stu- HEALTH PROJECT STRUCTURE dent participants. The result was a structure Bronx that was both decentralized and chaotic. Each I felt that SHP was five separate projects of the five areas was directed by a health sci- ence student (student area coordinator) as- governed by a sincere but unresponsive leader- sisted by a local area resident (community ship. This leadership failed to bring the pro- coordinator) and advised by a faculty member ject together so that we could learn from each from the local area medical school. These five other before the summer ended; failed to act in student-community-faculty teams determined accordance with our wishes regarding funds what projects students would work on during for continuing programs, supplies, materials, the summer, who would work where, and how etc. (Billions for buttons but not a penny for day-to-day problems would be handled. books seems to sum up SHP wisdom and fore- Above them in the organizational hierarchy sight.) Our own Bronx project split into sev- were officers for the combined five-area pro- eral projects, the result of weak leadership. In fact, weak, unresponsive leadership seems to ject, two student codirectors, a studeit educa I - be a major fault of SHP. Policy was not deter- tional coordinator, and a faculty director re- mined early enough to give direction to our ef- presenting the sponsoring agency, Albert Ein- forts. Individuality is great, but we must real- stein College of Medicine. Their functions be- ize our limitations as individuals. came deflned as largely adminstrative (pay- I Thus, in summary, SHP was in actuality five checks, mail notices, purchases of supplies, SHP's without a central policy or theme de- conference arrangements, etc.), a role defini- tion which caused considerable consternation flned enough to guide. Central staff failed to to these individuals who perhaps should have bridge the gap between and within groups, and exercised a greater role in project affairs, as lacked both the leadership and wisdom to run well as to those project members who did not the organization effectively. SHP was a ship consider their administrative functioning be- without a captain or a compass. yond criticism. Finally, policy statements of SHP has no moral right to return to the broad project significance had to be developed community this fall, next spring, or next sum- mer unless it undergoes a radical change into a and approved by a policy making council con- sisting of the student-community-faculty repre- student-staffed but commun-ity-run and respon- sentatives from each of the five areas, the sive organization. It must be decentralized three student central office staff members, the down to each local area and must have definite faculty director, and ex officio, the director of plans for self-perpetuating programs. Other- Monteflore Hospital in the Bronx and chair- wise, its existence is unjustified and unaccepta- -na-n of the department of community medicine ble.-V.S., Dental Student, Bronx. at Albert Einstein College of Medicine. Lower East Side Given this administrative structure, project I feel that the student health project this decisions were usually made at the local-area summer tried to be all things to all those in- 101 GREATER NEW YORK volved; it cannot possibly be. It is foolish to who invented this job before and had it clear think that we can be successful on all levels of in their minds as to what we could do, what involvement. In the future, student health pro- we couldn't do, and where the mistakes would jects should be more carefully defined before- fall. None of this really came out.-R.P., Com- hand so that all those involved have some feel- munity Worker, Newark. ing of direction and yet at the same time the I feel there was somewhat of a problem in projects should be flexible enough for innova- project communication which was mostly the tions. fault of our student area coordinator, but I also feel that there should be some method which could have been remedied by the Central of screening NYC's so that those who are truly Office. The remedy would be a calendar of all interested (if this is possible) become involved. project events in advance, especially the This is not to say that students should not also weekly meetings. Meetings or events subject to be more carefully chosen change could be so labeled, and we could con- One further suggestion: in the future, more tact the area coordinator to learn of any of an attempt should be made to increase the changes. This lack of communication was interchange of ideas not only between projects partly where the participatory democracy we within the city, but also between those who began with broke down.-N.W., Law Student, have been involved with SHP's in the past and Newark. those who are presently working. I, for one, am sorry that more of us ivere not able to visit Any future project should not try to consoli- other projects, but perhaps this is unrealistic date five separate areas under one cover. Per- in light of the time factor.-L.C., Nursing Stu- haps application and selection of students dent, Lower East Side. would be facilitated by one mailing address, Newark but there should be complete and absolute com- munity decentralization (community-student The whole program suffered from lack Of NYCs community people-in any order). This structure. People are used to working in struc- will greatly increase the effectiveness of the tured conditions so I think they would be most project.-S.G. Educatz'on Director. effective working under structured conditions. I think it's very important that the NYC's SHP is leaning in the right direction but is work with health science students. Somebody not democratic enough (in the Grecian sense). said to me that they don't see a place for the The Policy Board is a good idea but should NYC's unless they work by themselves. There function as a communications center for the has to be structure somewhere, but not so it's benefit of individual project members. This going to put out the relationship between black year motions were made and voted at e same and white students. I think the project should meetings, therefore coordinators did not -dis- have some definite goals. White students and cuss their votes with NYCs and fellows. I feel nonwhite students should not be thrown that the following alternative would give mem- into a community and allowed to spend their bers a greater sense of participation without summer "finding themselves." The leadership necessitating their presence at endless meet- of the SHP, together with community workers, ings: (a) Any member can attend policy board should have specific guidelines as to where Stu- meetings; (b) Any member can make a motion dent fellows will work and what they will be at a policy board meeting; (c) Policy board expected to accomplish. members have the option only to second or not I want to know what the central office do-es. second the motion; any one member of the pol- * * As far as our project has gone, as a icy board can accept a motion, (d) Motions are meaningful thing, I don't think the central not to be voted on by the policy board at the office has had a damn thing to do with it. I same meeting that they are first made. Individ- figured that the people who were going to run ual coordinators should return to the area pro- the central office were going to be the people jects and present motions to all members who 102 SUMMER 1968 then vote. Each coordinator then reports ma- democracy. No generals, no officers. They now jority vote of his project by telephone into cen- have officers.)-W.S., Medical Student Harlem. tral @ff who tally and record it; (e) Central The structure of the Greater New York stu- staff has a vote equal to a community,project. dent health project this summer started on a -A.H., Medical Student, Newark. poor level. The project for a time seemed to be Harlem nonexistent. It had no headquarters, no rules, no election of officers, no nothing. I met an indi- The "New Left" democratic process stinks vidual who said he was one thing, then I met as a way of running an SHP. With thousands another who said he was what the first person of dollars of Government money to account for had said he was. In my specific project, I be- a contract to fulfill, well-defined bureaucratic lieve I encountered four persons each of whom structure is required, with a management hier- at one time or another said he was in charge. archy of responsible persons selected for Nearing the end of the project, however, leadership and managment capability' who can some structure seemed to have been in the accept the responsibility for policy and plan- making. Directive after directive began to flow ning (as well as day-to-day decisionmaking) without requiring interminable meetings into our local project. We read of the topics where everyone has the right to speak his discussed and passed. * * * Yes, some sort Of structure with a policy making body and vari- mind no matter how rapid or irrelevant his ous sanctions finally seemed to have evolved. opinions. There is no guarantee that Grecian At the end of the summer, the student health democratic vote is the best way to make deci- project had just been created -E.M., Law Stu- sions, especially in an organization whos. dent, Harle?n. members generally lack sufficient information, understanding, and experience in managing The central office staff (personalities ex- large sums of money or supervising people at cluded) served a dubious role. They seem to work. Every form of government has estab- have evolved, by appointment or election lished an executive wing to administer day-to- (though -not elected by the project staff), to a day matters as well as to make long-term pol- position of policy-making and surveillance. icy decisions. Bureaucracy may have many, Their only visible activities seemed primarily many faults (whether capitalistic or commu- to consist of floating from project to project, nistic) but AT&T runs a damned efficient tele- and rapping the day away. (The importance is phone business and they don't take a referen- not whether or not this is all they do, but this dum every time a decision is required. As long is the impression they give to many people on as some checks and balances exist (such as the project not otherwise informed.) open-door policy making) we need not fear Most policymaking council decisions were power placed in the hands of managers. reached without consulting the general project Sol next time, let's establish definite organi- staff, and although meetings were alleged to zational structure, with hire-and-fire power in have included representatives of the group, the hands of project leadership, and a definite these meetings were sometimes announced I or understanding that an employee-ernployer rela- 2 hours beforehand, when it was impossible to tionship exists between the project fellows and get these "representatives" together. Often we were not told the purpose of the meeting and the funding agency. Sure, people are going to object to doing things the way our fath- could make no provisions to attend. The cen- ers did them, but since somebody will gripe no tral office also saw fit to bless us with favors- picnics, educational programs. It might have matter how decisions are made, or how much been a better idea to consult the community structure there is or isn't, why not let them gripe about the most effective and efficient they inten ded to serve.-J.A., Medical Student, method of managing an organization! (N.B. Harlem. After the Revolution, the Russian army triedMy relationship with the central office staff 103 GREATER NEW YORK was one of frustration and anger. They tried to structural changes should be made. Some of pass this off as some sort of a participatory or- the frustration and feeling of being at "loose ganization and then they would send out an- ends" and not knowing how to direct our ener- other "order". It is not that what they wanted gies was due to the fact that SHP was new to was so unreasonable, but rather the way in the Lower East Side. However, much of the which they did it. For example, they asked for frustration and wasting of time could have biweekly reports without an explanation of been avoided if the project had been more care- why they wanted or needed them. In addition, fully organized before the summer began. It they imposed no penalty for not writing one, was fine to say wait and discuss community so those of us who did write them felt rather problems with people in the community such foolish. To make things run more smoothly, we as Neighborhood Youth Corps workers and should have been able to elect a representative other community preceptors, but this could with an equal vote to sit in on the policy-mak- have been done before the summer began. It ing meetings. The Central Staff members took many of us as long as three weeks, includ- should not take out their anger on the student ing orientation, to decide what we wanted to fellows because the response to something that do, organize material, and to begin doing some- the central staff is interested in was not shared thing. I also feel that placing us with already by the project members. The black history existing organizations or agencies provides a classes are a case in point. Furthermore, the structure which is essential at least in the central staff's penchant for trying to combine early stages. One must also consider that the business with pleasure is annoying at best. If Lower East Side is a highly sophisticated and and when I want my leisure time planned for well organized community in many ways, and me, I will send a request for such a service. If that for SHP to become merely another sepa- the NYC's want a vacation in upstate New rate organization is a poor idea. York, they can have it. But to foist this upon Many of us were also frustrated by the lack the rest of us is just not fair. If we have not of unity within the group. Perhaps it is unreal- done our job, fire us, but to threaten not to pay isti'c to think that twenty students plus Neigh- us if we do not attend a Final Conference that borhood Youth Corps teenagers could be ex- everyone knows is being held at an inconven- pected to work together as a team. Perhaps i ient place for many of us because the NYC's students were required to live in the commun- want it, is just economic blackmail of the ity and to become involved in as many aspects worst sort@F.V., Law Student, Harlem. of community life as possible, there would be Brooklyn more community concern over health care in the broadest sense. By this I mean that we One of the faults with the structure of the should be concerned with all aspects relating SHP was the lack of communication between to and influencing health care. One of the most the different areas of the project (i.e., Brook- valuable experiences I had was door-to-door lyn, the South Bronx). What was really needed work. Health care is a basic and nonthreaten- was a newsletter to inform the people in.the ing subject which can serve as an "in" into the different areas of what was happening. Per- family setting. Once into a home, we could dis- haps the program next year could include one cuss other areas, such as housing or education, day in each week in which each group went to with individual families and try to help the visit another group to see what other areas were doing.-D.Y., Medical Student, Brooklyn. family in whatever ways we could. It is more of an overall understanding of the many LOCAL PROJECT STRUCTURE factors influencing health. It is for this reason that I feel that future SHP workers should at Lower East Side least experience, first-hand, neighborhood and First of all, I feel there is a future for SHO family settings.-L.C., Nursing "er on the Lower East Side, but if it is to continue, East Side. 104 SUMMER 1968 There was no feeling of an SHP structure sources. Also, I think that there should be two this summer, either on a citywide or a neigh- student co-directors for each project area, so borhood level. There was only the SHP name, that they can share the responsibilities and and it interfered with our work. We were sup- lend greater objectivity in handling all mat- posed to feel allegiance to an organization that ters. Finally, I think more concrete community barely existed as such. The whole Lower East job placements should be made. I think more Side SHP met together once a week, mainly to of an effort should be directed towards work- criticize each other's work. These discussions ing within specific community organizations; were not very constructive, because none of us we have learned, maybe the hard way, that knew enough about each other's work to make community structure does exist.-L.G., Psy- meaningful judgements or suggestions. The chology Student, Lower East Side. meetings became a kind of free-for-all in which Newark one found oneself either attacking or defending. The only goals pronounced by the Lower East Project structure was not deficient in any Side SHP were goals that each one of us, as in- way that I noticed. I thought the lack of struc- dividuals, had: to sensitize ourselves to the ture in our Newark project was very beneficial needs, problems, and attitudes of the commun- as it allowed people to gravitate to or seize ity, and to produce some meaningful, immedi- upon that which they liked best and thought ate contribution to the community.-M.H., would be most beneficial. The only place where Law Student, Lower East Side. lack of structure was really detrimental was in the case of the NYC's who often sat around I think the Lower East Side had several doing nothing until the last couple weeks of the problems. First, each of the several separate project when, I suspect, the guys, at least, projects seemed isolated from the others, ex- didn't show up at all.-N.W., Law Student, cept for infrequent progress reports' Second, Newark. there existed an atmosphere of tension among the student fellows. As well-expressed by one The local project is basically a great idea. student, "I don't think we really want to get to We maintained our integrity as a group and know each other." I feel there is a place for were able to coordinte our efforts in several SHP on the Lower East Side next summer, but areas. We were able to put our heads together in view of this summer's events, it should be nearly every day. We all worked out of our better structured. Each student fellow should UCC office space. It facilitated communication be made aware, before being accepted, that he and kept morale higher than it would have is taking on a full-time job, not a nine-to-five been if we were separated. When we met with responsibility. If a student has other obliga- hospital personnel we had at least 15 to 20 peo- tions, he must either adjust them so they do ple there. The benefits of a cohesive group are not conflict with SHP activities, or not work many when operating in a resistive environ- on the project. ment. I think people had more confidence and a large fund of ideas and opinions were availa- All SHP members should live in the coni- munity in which they 'will work, preferably ble. We stimulated each other.-A.H., Medical nearby or together. This would help improve Student, Newark. interpersonal relations-we would get to know The structure of the project should have each other better and be more cognizant of been more carefully laid out and adhered to. I what each other was doing. There should be a went to Newark expecting to work as a nurse store-front which not only serves as a meeting in a clinic, in a storefront, in the emergency place for SHP, but which offers some service to room, anyplace; I wound up painting signs and the community. not at all utilizing the one sure skill I have. I If people in the community want informa- recognize some degree of unpredictability is in- tion about health care housing, etc., we should evitable, but we were almost totally without be able to offer @ it or direct them to the proper structure in pursuing the vanishing hope of 105 GREATER NEW YORK "Improved Medical Care." Several different As far as the leadership is concerned, I feel groups evolved, divided along racial lines, and that a better system might have been the ap- pursued what they thought was the goal of the pointment of provisional coordinators and Cen- project. This might even have been acceptable tral Office staff, and after the groups had be- if there had been some coordination, some feel- come acquainted with each other, elections ing of unity. There was not much among the could have been held, giving somewhat of a factions, just a sort of palid coexistence.- democratic structure to the "governing" body. A.M., Nursing Student, Newark. -i.A., Medical Student, Harlem. Bronx Although some of the nonhealth science stu- In addition to problems with cohesiveness dents didn't get properly integrated into the and communications, there were difficulties group right away because the whole thing was o unstructured, I think the Harlem group had with job descriptions. This seemed particularly S" evident in the Bronx unwed mothers' program. tne least group interaction problems of all the The community workers seemed the most con- projects. I don't think the inter-disciplinary fused. Since this is the first summer that there team question every really arose. We worked have been community workers, it is under- together as individuals-not "professionals" and since the mothers were adults rather standable that there was some confusion. An- - other reason for confusion was poor orienta- than NYCS, there was never a question of con- tion. descension between students and community One of the roles which I thought needed People. Some of us at first (myself included) clearer definition was that of the project coor were condescending toward some of the non- dinator. I see the project coordinator as a per: health science students because we felt that son who spends a lot of time visiting the vari- they didn't really care enough, but after the air was cleared on that I think things worked ous programs in the projects and setting up a well. rapport between institutions and community groups. Our coordinator spent most of her I think it was especially important that we time in the office, and I think she would have all worked out of the same house. We were been of better assistance if she would have able to maintain a much better group sense spent more time in the community. She also be- than some of the other projects that were came too much of a director instead of a con- spread around in different agencies, and we sultant. She seemed afraid to delegate respon- were all able to keep sufficiently in touch with sibility which inhibited our making plans and what everyone was doing so that we could lend decisions on our own.-V.V., Nursing Student, a hand when necessary. Because people were Bronx. always in touch, 'we didn't have the typical kinds of confrontation or sensitivity sessions Harlem (that some people think are essential in SHP Concerning the structure of the Harlem pro- projects) because things often got talked Out in ject, one important thing was overlooked. The small bull sessions before matters came to a students who organized it wanted a loosely head. There was a disadvantage to this, how- structured organization with abstract duties ever, in that some things concerning the phi- and responsibilities taken on by the individuals losophy of what we were doing and how we themselves, with no real power structure. This were going about it didn't surface until the would have been fine if the organization had end.-W.S., Medical Student, Harlem. consisted only of students, but in dealing with members of the community we were made Brooklyn aware that they demanded much more of a I feel that there were too many small groups structure. They wanted to know who the in the Brooklyn area, and that in the future leaders were,'what everyone's duties were, and these small groups should be incorporated into to whom they were responsible. larger area priority groups which need man- 106 SUMMER 1968 power, or have people "float" from group to be fulfilled. It is good to sit down and plan group as each group needs extra help for spe- what we are going to do; but it is unrealistic cific projects, e.g., the lead poisoning cam- for people with little knowledge of what it is paign. I would like to see an area such as possible to accomplish in one summer to. sit Brooklyn develop one or two priority goals and down and write something up in order to get spend the entire summer developing these funded. What they write up may often have ideas and then wind up with a concrete plan, little relevance to what they actually do. proposal, mass meeting, etc., so that these They then begin to feel that they are not ideas can be carried on by other than SHP peo- fulfilling their jobs and they have the tendency ple.-S.P., Dental Student, Brooklyn. either to get upset or to work harder towards their original goals, without sitting down to FUNDING evaluate whether or not their goals are realis- The structure of an organization can often tic. What I am trying to say is that people with make for success or lack of success of its activ- comparatively little experience should not ex- ities; there were many elements of this sum- pect themselves to accomplish very much in mer's SHP which I felt limited one's ability to two months. When they write up some impres- act effectively. By "structure" I mean any deci- sive goals they soon begin to expect themselves sion which is made regarding how the project to accomplish these goals and are not as flexible is to be run, who will run it, etc. Thus, any lack as they otherwise might have been. I feel that of organization Iis part of the structure of the Ives with students should first familiarize themse their community and then have tasks outlined SHP. The first bad decision made was for the Stu- by responsible community groups. it should be dents to be funded by a Government agency' up to these groups to decide whether or not the This put us in the position of another group students are performing effectively; this is hard vying for funds to "help the poor people," and to do if a proposal is on file with a Governnxent immediately set us apart as a group who was agency that is paying and therefore ultimately being paid to be in a poor community. It was at controls the students whether they like it or least fortunate that we did not get funds from -not. OEO, as we might then have been taking While we're on the subject of money, which money from other groups composed more of after all is what separates rich people from grassroots people. Our advantage in getting poor people, I feel that all salaries were too funds would have been that we were mostly high this summer. This prevents effective ae- middle class people with a good idea rather T'lon for several reasons.. First, community peo- than community people trying to get money to ple tend to be suspicious of white middle-class increase power over their own lives. students who are paid a very high salary to . Another problem that goes along with writ- ing up a grant for government funds is that we enter their community. There is very little that become responsible to the funding agent, and a student can actually do in two months and are no longer answerable strictly to the com- this increases hard feelings towards students munity. Several instances have come up where who "aren't doing anything." It is bad enough when people ask, "What are those students it was necessary to consult our funding agency doing, anyway?" But it is much worse when it as to whether or not we could undertake a spe- is discovered what their salary is. I feel that it cific project recommended by community con- sultants, or whether or not we could use funds was similarly wrong to pay community co- for various purposes not outlined in the grant. directors and workers such a high salary. R is This limits the degree to which we may use re- commonly known that one of the best ways for sources given us through funding. bright community people to- get ahead is There is also a problem inherent in writing through one of the antipoverty agencies, which up a proposal for Government approval in that actively seek community people as partici- we begin to think in terms of a task that must pants, but not as administrators. I think that 107 GREATER NEW YORK this system creates resentment among the rest NYC's were paid by a different organiza- of the community which is "left behind," and tion, which added another voice, at least poten- tends to separate good leaders from their com- tially, as to what could be done during the munities. I feel that all workers on the Project summer. Also, the NYC's should be paid the should be paid the same subsistence salary. In same salary as everyone else. Otherwise our this way it can be seen that the students are talk about being colleagues and being equals, not in the community for the money, but be- and the students' not being the NYCs' bosses, cause they really care. And community people is nonsense. The argument is sometimes raised will not be reluctant to work with us for fear that the NYCs are younger and don't have the of being resented by their fellow community same educational and job experience. If this members for sticking with the white people to is valid, then students should be paid less than get high pay. community workers who are twice their age. If It has become evident that with our present the argument about education is valid then we personnel and structure it is impossible to ac- are building inequality into our project, for complish the things we had hoped to do. As many poor and nonwhite people are denied a long as people are here for money, and are res- chance to compete with white middle class ponsible to some superstructure which rewards People on the basis of not having had enough or punishes them for their actions with a sa- ducation; furthermore, they are consistently lary, they cannot honestly tell people they are aenied the chance for a good education. If we here because they care about them. It seems to didn't learn that this summer, we may as well me that the same setup that denies people not come back. A project designed to overcome down here many opportunities (including the inequalities should put all its members on an opportunity for good health care) is the set up equal basis, answerable equally to one another. which gives us a more than equal chance to get @l of us should be colleagues, each with some- a good education, good pay, become doctors, tnlng different, and something valuable, to etc. offer for the common good. We must set one If we want to correct this situation as it per- standard for all of us to live up to, so that we tains to health care, we must resent ourselves all finish the race at the same time, not some p of us ahead and others behind.-Student Co- as concerned individuals who recognize that ordinator, Lower East Side. our advantages are the other side of the coin of others' disadvantages. If SHO fellows continue One ongoing argument that we have had in to benefit from this system by being paid a the Lower East Side project has centered large salary for "helping" the poor people, around the money that we have been paid this they are propagating the very set of inequali- summer as a major factor in the loose, unstruc- ties they want to destroy. They therefore must tured, and often unsuccessful project. In my decide to reject the benefits and make some opinion, the fact that we have been paid for sort of personal sacrifice, in order to be free to our work has little to do with how well our see other people's situations, and to be free to project proceeded. talk to them as people. I realize that my ideas * * * The other argument made about our are hard to explain in words, but I do feel earning so' much and the NYC's earning too strongly that this way of conceptualizing is a - little has also bothered me. The NYC's are . p propriate, and we must learn to conceptualize. young people, and when we were their age it I don't want to put across a sense of "guilt"- was also difficult for us to earn. The fact is just a recognition of our position. As members that we are not the equals of the NYC's in just of the SHO, paid $900 by a Government about every way, and the concept of treating agency, we are limited by being representa- them as if they were our equals has seemed to tives of a bad structure. We are distrusted by be one of the greatest farces. It is one thing to the people we wish to reach. respect someone's opinion and to give them an A final problem in this area was that the equal opportunity to express themselves; but it 108 SUMMER 1968 is another to expect the same maturity and the bogus play because the one area that com- same concentration from considerably younger plained the most about needing their own stu- people.-P.S., Medical Student, Lower East dents developed the least potential for com- mun.ity projects.) A'proximately half of the Side. p My suggestion is that student fellows should project participants were on the "reserve list". start at $60 per week, serve a probationary pe- Applications of out-of-city students and non- riod of five weeks, and after evaluation by the reserve New York City. students were read by staff and community workers, as well as area groups of our students and rated highly desira- coordinators, be given salary raises computed to ble, acceptable, and undesirable. The distillate bring their total summer's earnings to the allo- of these applications (the "highly desirable" cated $900. It is a hell of a bad situation group) was read to the entire group and rated. not to The highest scorers were phoned and asked to be able to control the miserable rabble who de- come to New York. Not all of these applicants cide that student health project is an easy way accepted so the lower scorers were called and to make money for the summer. Before I be- came involved with SHO a nursing student subsequently the "acceptable" group of appli- cations was delved into.-S.G., Education Di- said to me that "Student Health is a good way to earn $900 doing nothing I" Every effort rector. must be made to eradicate this idea and up- Interview root this attitude if the job is to be approached Someone told me the other day that the SHO with the honesty and dedication it needs and doesn't rehire the same students each year, deserves. There must be a method or device they have some policy where they want to give for firing people.-B.B., Student Coordinator, everyone a chance to come and see what com- Bronx. munity medicine should involve. That's stupid, SHO should strive for joint-funding with because the first time the medical students are community agencies such as LABOR and plan here they go through a lot of changes, a lot of a project based on the twin issues of health hangups, annoy a lot of people, and it may take and housing. SHP should also get funding them a long time to get straightened out. But from foundations to begin work on changing after they've reached that point, if you don't the institutions that project fellows come from, bring them back again, you're making a mis- specifically continuing programs to get ghetto take. The -new students have to start from residents into professional schools.-K.B., Med- scratch all over again. If you brought the expe- ical School, Bronx. rienced ones back, they wouldn't have all these hangups as to the.black-w,.ite issue, and they STUDENT FELLOW SELECTION would know what they could do, and start im- In late April 1968, twelve or so students mediately doing it. from the five Greater New York areas met and This policy indicates the student health or- read all of the goo applications received. We ganization's orientation to this thing. They agreed to accept as many black students as we want students to learn about black people- could, and accepted all the applicants from which would be for their benefit. And it would Howard and Meharry medical schools'. Ironi- make them feel good that they had done a little cally, as a recruitment device for black stu- something to help the cause, and these kids are dents, this did not work 100 percent. Two out supposed to go back and stir up other students of seven such students were white. We also ac- in their medical school. But that's a pile of cepted all other people who indicated that they rubbish because there's thousands more white were black or Puerto Rican. The students from medical students who haven't got the least in- the five areas were very concerned about conti- terest in coming here. And even if all of them nuity after the summer, so they were asked to had a chance to come here for the summer, draw up lists of students they wanted to "re- first of all they don't have to live like the peo- serve". (Subsequently this proved to be aple live here. They may be able to sympathize 4109 GREATER NEW YORK with these people, having seen the conditions I wish to take issue with the composition of and what people have to go through, but if you SHP. I sincerely wish to register a strong pro- don't come back again, if you don't stay, it's a test. Here are my feelings and recommenda- waste. All you do is understand the problems, tions: I think project comp.osition should be'as maybe, and you can go and talk to your friends close to 100 percent black students as possible. about them, verbalize the problems, but you At this point in black history in this country, won't be able to do anything. black people need black leadership to give I would say, based on one summer's experi- them any meaningful stimulation and incen- ence, that I don't think SHO is useful in the tive. In a situation where conditions are so ex- long run. Take these white people that work treme and time so short, the time spent batter- here in the summer, or work here all year ing down the color barrier between yourselves round, like these hospital people; they're here and that community is too dear.-A.M., Nurs- with this problem all the time, and they still ing Student, N&wark. offer bad medical service. They haven't learned I think SHP might work next summer if a damn thing. As a matter of fact, they're the project members are selected differently. There ones who're responsible for the bad service. must be more community people in the project. So you bring some white kids in here, and There should be at least one adult community they're going to see a few things. But when worker to every health science student and they go back to school they're going to start NYC. In selecting applicants, students from studying, they're going to fall for the set-up the surrounding area should be given first which was already set out for them, and priority so that SHP can be a continuing thing- they're going to say, "Well, I had the experi- Students should not be selected on the basis of ence." But they wGn't be able to do anything an essay on "why I should be a member of the about it. project." Every applicant should have a per- What SHO should do is see about getting sonal interview before final selection. programs for black people which will be black Selection of members for the project should run. One of the first things I noticed when I not be so final that once youtre in, you're in for came in here was that we need some more good. Members who do not want to work with black people in this thing.-R.P., Community and for the project should be fired and re- Coordinator, Newark. placed. It's fine and dandy if members want to Hiring: Not fair to ignore rejected applica- do their "own thing" but they must also spend a major part of their ti e with the entire p tions when first choices decide on other em- m ro- ployment. We hired one student about one ject on a United effort to improve health care. month into the project. He was the nephew of Doing your "own thing" may help to make Dr. Important. This guy did little, said noth- small improvements and give you personal sat- ing, and was rarely seen. isfaction, but no massive changes are going to Firing: In a project such as ours every free- occur unless the project members unite their dom should be given; an atmosphere of confi- efforts.-L.D., Nursing Student, Newark. dence and optimism is essential for any cre- There is a definite need for some changes in ative unfolding. People should never be fired policy so that SHP of 1969, if existent, can for failing, only not working, for not doing function more effectively with less wasted anything. If complaints are made against a money and energy. There should be a hiring member, the policy council should consider the policy that attempts to accept only those who complaints and vote to drop the complaint, or are sincere to the cause. Interviews would seem warn the individual in question, or request the to be more revealing (than essays) and perhaps individual to appear and explain his position. interviews with a member of the specific com- Where or how someone is working is irrelevant munity who is working on the project would be @nly if he is working.-A.H., Medical Stu- most productive' dent, Newark. A firing policy should also exist to rid the 110 SUMMER 1968 project of any phony liberals who are goofing for some of them to realize what's happening off or just there to exploit the community for goals. After all, it takes over half the summer their own gains.-K.S., Nursing Student, New- for some of them to realize what's. happening ark. in the community. The others never know. I The students who were assigned to this pro- feel that only students having at least a full j ect, with the exception of a few, should not year's experiences in a community can go and have been included in a program of this na- work there during the summer. Students who want to become aware of community health ture. Some of them came into the community only for personal advancement; the narrow- and needs can learn initially through seminars ness of their motivation limited the effective- and discussion workshops outside of the com- ness of their work. Two students in particular munity in their schools. Those who are still caused me great concern. They needed constant more concerned can apply for part-time jobs direction, not only about what to do, but how during the summer with a community agency. to do it, and at the end of ten weeks were just They would then be under the responsibility beginning to show anything that could be and authority of that agency. I would never called initiative and creativity. A short-term like to see another SHP go into a community project suffers when it is staffed with liabili- area where very few of the fellows personally ties. know what the hell to do and when to do it.- G.L., Dental Student, Lower East Side. . I Medical people who are usually far removed For next summer, it is important that the from grassroots community work -need to be SHP attempt to bring back people with experi- sensitized and attuned to the problems of the ence in community health in the areas they are urban poor areas, but not at the expense of the located. A single summer on the Lower East community they profess to serve. A . 10-week Side is no more than an introduction to the program cannot sustain the inconvenience Of problems of health care in this community. It being burdened with out-of-@te students Wlo is on-the-job training in community health, have to be taught how to communicate before with an emphasis on the training, not on the they can operate effectively. Students who come job. Involving students in programs this win- lacking skills in contact with the urban poor ter, or having them return to the SHP next should come in as volunteers in order to learn, summer, will enable students to use what they not as paid personnel in order to experiment. have learned for the benefit of the community. The experience they gain is pay in itself, for they certainly get more out of the exposure If this is not done, the summer will have been, than they can possibly contribute. in the words of the black caucus, "two months in the sun seeing how the niggers liVe."-4.A., Next summer if there is a project, students Medical Student, Lower East Side. and community people who worked effectively The majority of -the students chosen for the this summer should be given priority when SHP should be from the area in which they staffing begins. A project of this sort can func- will work in order to insure a transition staff tion more effectively if the same people corn- for year-round work. Allowances should be bine their efforts to identify the causes for iaii- made where necessary to preserve the interdis- ure and the reasons for success and make c@n- ciplinary approach. New students should not crete plans to restructure the program,-B,j5,' have to go through some of the basic, orienta- Student Coordinator, Bronx. tion for half of the summer in the areas where From the experiences and observations of projects have already existed. Structured. dis- this summer, I do not feel that there should be cussions and seminars with experienced another SHP like this summer's. Any health workers are suggested to help prepare them. It professional student not having a good deal of is advisable that the project be planned -so as involvement in the community doesn't have not to require needless repetition at the ex- any business in the community. Such students pense of the community.-L.K., Medical @ Stu- only hinder and screw up the projects and dent, Brooklyn. GREATER NEW YORK INTERDISCIPLINARY TEAM and two nursing students were familiar with I found that working with students from all the technique of group catharsis whereby per- sons who -work together under tension can get different fields was a very worthwhile experi- together for an hour a week after work to dis- ence. Each of the fellows had something unique to offer the project. The interdisci- cuss all their likes and dislikes about each plinary team at Kings County Hospital worked other and their work. Properly conducted, such very well together and used the combined tal- session can act as a real help in reducing ents of the members, with their individual con- Iriction in their work.-N.W., Law Stitde)zt, tributions, to a great extent.-D.Y., Medical Newark. Student, Brooklyn. The interdisciplinary team is a good The concept of an interdisciplinary team is a thought, but relatively meaningless once put sound one and in practice is both stimulating into operation. Personality problems can occur and enlightening. The availability of legal ad_ anywhere in the team. Having a law student vice was helpful on several occasions, and edu- on hand is worthless unless the student is al- cational. In the lead poisoning project and at ready familiar with urban politics and law. In the hospital-based projects, nursing, dental, the case of the city of Newark, the "team" and social work students, with their different loses even more relevance. People on the un- outlooks and approaches, complimented each dergraduate level could function just as well. other.-L.K., Medical Student, Brooklyn. They would spend less of their time trying to use clinical procedure; they wouldn't use the This aspect of the project was one of the project as hustle for medical or dental school.- most valuable factors for the success of the R.P., Community Coordinator, Newark. project. I felt, as a sociology student with a background in education, that I contributed I think the biggest problem among the much towards making y colleagues more health science students was lack of communi- aware of the importance of role relationships cation. Some of the health science students I and informal organization in the hospital.- barely saw all summer. I had vague ideas what M.H., So@logy Student, Brooklyn. they were doing, but did not know how, if at all, we could be of help to each other. Many The medical students whom I worked with times I felt there were hard feelings among were quite understanding and easy to get along the health science students and we were unable with. Anything which I thought would arouse to communicate these feelings to each other. any difficulty, I directed to the students I Many times a lot of people did a lot of talking worked with, and they'd explain it to me until and no one did any listening. I think the inabil- I was able to comprehend and direct it back to ity to listen on the part of many of the health them, They treated us as equals to them, and I science students created the big communication grew to respect them for it.-L.J., NYC, problem. A weekly sensitivity session might Brooklyn. have helped this problem. By sensitivity ses- The interdisciplinary team was helpful as it '9ions, I do not mean a meeting where people brought together a variety of skills and out- give their philosophies of life, tell about their looks that helped in solving or at least iecog- general gripes and throw a bunch of vague nizing causes of problems. An example is the nonsense at each other. By sensitivity, I mean highly charged atmosphere of the emergency the group should sit down together and express room where people were often treated as some- specific feelings about the project, individuals, thing less than people. One student had a Mas- their work, and problems they've encountered. ter's degree in psychology and recognized that This requires not only the ability to express it was the tension of their work which caused your feelings freely, but also the ability to lis- many of the employees in the emer ney room ten to others express their feelings.-L.D., ,ge to occasionally treat people without dignity. He Nursing Student, Newairk. 112 SUMMER 1968 My "working" relationship with our law It's a funny thing about the interdisci- student was not profitable. I could not seem to plinary team. We nurses are-very touchy crea- fit his work in with anything I was doing. I en- tures about getting @pped on by doctors, and countered a patient who had fallen downstairs often, since we are very dedicated to the idea in her apartment building for the second time of the "team", get very up-in-arms about doc- and hurt her back because the landlord would tors' attitudes. At the beginning of the summer not fix the stairs. I thought the law student before we started working, before we knew one might be interested in the case, but he seemed another, the situation was very tense, but once to think there was nothing he could do about work progressed, except for the "normal" jok- it. ing, we worked as one group, not as students of I think the other project members were able nursing or students of medicine. We did make to use me when they came up with a problem one mistake; because we worked as health sci- concerning prenatal care, postpartem care, ence students I wasn't always cognizant of the birth control, or anything else related to nurs- different disciplines, so when my group was ing.-L.D., Nursing Student, Newark. having some difficulties on a legal matter, we never thought to consult the law students My contact with the three medical students among us. We really didn't make the best use working on this project was constructive and of our team.-J.L., Nursing Student, LoweIr very enjoyable. I picked up much of the needed East Side. medical background on lead poisoning from them. This project was, of course, particularly The interdisciplinary team really did not well suited for interdisciplinary work. My ex- exist over the summer. None of us worked in periences with our NYCs were scanty, since any kind of professional capacity. Whatever I they were almost totally utilized for the medi- did, a nursing student or a law student could cal screening program. I liked what I did see have done. It was a good experience for the of the high school students, more or less in various health professional students to work passing. In short, relationships within the pro- together, though I don't think that it was as ject seemed very good, and I feel that we've necessary as finding competent people to work gotten quite a bit done with sufficient interac- on the project. tion but a minimum of mutual interference.- * * * One fault of some of the people on our A.K., Law Student, Bronx. project has been that they have not made an effort to work well with everyone, but rather I think that working with the various disci- they desire and seek the advice of their close plines was a good experience but one handled friends. It seems to me that one doesn't have to in a haphazard way. If some organized way Of be best of friends with Someone to work well displaying the "uniqueness" of each discipline with him and to respect him. Being in the SHO in- alleviating health problems and establishing has always seemed like being in a kind of total health care were available, I would have clique, especially at NYU. I believe that the at- felt elated. Nevertheless, the nursing students titudes that many of the students have devel- found out what makes medical students tick, oped over the summer of not caring and of and vice versa.-J.C., Medical Student, Lower feeling left out are derived from the "in" or East Side. "out" feelings that are so clear on our project. I found that the students I worked with had -P.S., Medical Student, Lower East Side. a disturbingly little amount of initiative, en- Overall, my feeling for my colleagues was thusiasm, or devotion to accomplishment of our one of high respect. I have never been asso- goal. To too many of us, the project was just ciated with any project in which I personally a job, and that accounts for at least some of liked and admired so many of the people con- our failures to accomplish our goals in and for nected with it. They impressed me as an intel- the community.-M.H., Nursing Student, ligent, dedicated group whose frustrations Lower East Side. were not the result of any inner shortcomings 113 GREATER NEW YORK but rather due to external factors. (There were that the work is reduced to the lowest common people here, however, that I felt should have denominator so that everyone can do the work. been fired, not only because they were not Therefore, I don't feel that the project capital- really doing anything, but because they were a ized on the individual talents of the partici- demoralizing influence on others in the pro- pants. In the long run, however, I think that it ject.) is difficult to overestimate the positive effect of The interdisciplinary team was a very good this interdisciplinary team approach. Profes- idea as far as interaction goes. I don't know sionals are so impressed with and caught up in what positive aid this was to the community, their own world that any contact with those but I felt that I personally gained something outside that world is a benefit to all.-F.V., from being involved in it. The real problem is Law Student, Harlem. 114 Part 5: EVALUATION INTRODUCTION groups interested in health care problems. In During the summer of 1967, slightly over essence, the only common ingredient in the pot fifty medical health science students partici- pourri of student activities was health-de- pated in the Student Health Project of the fined broadly enough to include the social and South Bronx, a federally financed summer pro- political interests of ghetto inhabitants. gram designed to involve students in . e The major focus of this evaluation will be to document the primary sources of satisfaction health problems of a Negro and Puerto Rican and dissatisfaction with the project (other poverty area in New York City. Almost every than administrative problems) and to offer member of the 1967 project finished the sum- some explanations for the change from a to- mer with a smile-students, faculty, and e!al- tally satisfactory experience in 1967 to the uator.1 Thus, it was not surprising that ciur- somewhat less satisfactory experience of 1968. ing the fall and winter of 1967 considerable ei- Most of the following discussion is based upon fort wa@ spent by students and faculty in se- self-completed questionnaires given to the 1968 curing funds for a "bigger and better" student project for the summer of 1968. These efforts project student participants immediately be- fore the project began in late June 1968, and were rewarded with success, as approximatel then again during the final conference held at $200,000 was granted by the Division o, the end of August. Interviews with project Regional Medical Programs of the U.S. De- personnel during the summer also contributed partment of Health, Education, and Welfare to this evaluation report. for a 1968 summer project. The 1968 Student Health Project of Greater The Student Fellows New York consisted of five separate projects - Table 1 below indicates the disciplines and the South Bronx, Harlem, the Lower East Side backgrounds of the seventy-six (76) students of Manhattan, the Bedford-Stuyvesant, who responded to both the June and August questionnaires .2 Clearly, the majority of stu- Crown-Heights, and Brownsville sections of dent fellows come from health science schools Brooklyn, and the Negro slums of Newark, in the New York City area, and from white New Jersey. In structure, each was modeled on middle and u per class backgrounds. The stu- the previous summer's Bronx project pattern p dents were not, however without experience of placing students in diverse settings and al- 9 lowing them considerable flexibility to pursue with poor patients before the summer program (or not pursue) their interests. Thus, the stu- began, although wide variation existed in this dents worked'on such varied programs as men- respect also. Thus, thirty-nine percent (399'o) tal retardation, narcotics addition, illegitimacy -See Ronald Miller, "The Project Evaluated," The Student Hedth and unwed mothers hospital services and pa- Project of the South Bronx: SurAiner 1967, e&. Stan Finh and p Jody Williams, previously pub@hed under a gmnt from the Office tient advocacy, medical services for school chil- of Economic Opportunity, pp. 181-97. dren, and various community action programs 31n general, the responses of thfte 76 students reffeew almost perfectly the responses of the 99 who responded to the fint ques- for health care improvement. Not only did tionnaire. Appendix I contains comparisons of the rapondents who answ'e ed both and those who only answered the first, and shows they work in traditional health settings (hos- inor differences. Attitudinal and infor=tlon compaMsons (not pitals, clinics, doctors' offices), but they also shown) also Indicated similarit3r Of responses. Thus, it Is felt'@t the analysis based upon these seventy-six respondents can be gen- worked out in the community, with action erlized to the total project membership. GREATER NEW YORK had no experience or just a little bit, twen- good deal or a great deal of experience with ty-nine percent (29@o) had had some experi- poor patients before the summer program ence, and thirty-one percent (317o) had had a began. Table l.-Student backgrounds. Discipline olo Religion @o Family income olo Medicine ------------- 54 Protestant ---------- 17 Under $5,000 yr. ---- 5 Nursing -------------- 24 Catholic ------------ 29 $5,000-$ 9,999 ------ 26 Dentistry ------------ 7 Jewish -------------- 42 $10,000-$14,000 ------ 29 Law ----------------- 9 Other --------------- 5 $15,000-$19,999 9 Social work, Sociology ----------- 4 None --------------- 5 $20,000 and over 26 Other ---------------- 3 No response -------- I No response -------- 4 Total -------------- 100 Total ------------ 100 Total ------------- 100 Race Sex School Caucasian ----------- 82 Male --------------- 100 New York City area 67 Spanish ------------- 3 Female ------------- 41 Non-New York area 33 Negro -------------- 12 Other --------------- 3 Total ------------- 100 Total ------------- 100 Total --------------- 100 I While percentages may not add to 100% because of rounding in these and subsequent tables. totals are always reported as 100 percent. AU 1968 table percentages are based upon 76 respondents. Finally, the students had different reasons for divided into 31 subareas after discussions with joining the 1968 project (table 2). Given this both faculty and students. Student fellows divergence in student backgrounds, experience, were asked in late June and then again in Au- and expectations, a major problem of the pro- gust to indicate how much they knew (almost ject's student leaders was to organize the pro- nothing, a little bit, some, a good deal, a great ject to satisfy the desires and expectations of deal) about each of the items. As table 3 indi- all student project members. cates for a selected sample of these informa- Table 2.-Reason students joined 1968 project. tion areas, the students learned a great deal Percent giving reason during the summer.4 Remon joined in June 1,968 For example, while only fourteen percent To help initiate and continue political action for social (147o) of the students said that they knew a change in a poverty area -------------------- 28 good deal or a great deal about the organiza- To help poor people get better tion of health services for the poor at the be- medical care -------------------------------- 42 ginning of the summer, seventy-two percent To learn about the health problems of the poor ---- 28 To learn about disease, health and (72,7o) said they.knew that much at the end of medical care during the summer -------------- 1 the summer. While similar results were ob- No response ----------------------------------- I tained for most of the information areas, a few Total ------------------------------------ 100 showed almost no improvement in knowledge. The Project as an Educational Exper- Two of them, cancer and heart disease among ience the poor, were the two major areas of interest The educational aspect of the summer pro- to the Regional Medical Programs Division, the ject, the sensitization of students to the health agency which granted the project funds. care problems of ghetto residents, was a prime Thus, in almost every one of these areas (with the exceptions noted) a definite increase consideration in the development of the pro- ject. The project was viewed, in effect as a con- in student knowledge was evident. Table 4 tinuation of the student's professional educa- I The other areas which are not shown but generally also Indicate tion, although qualitatively different in the increased knowledge are malnutrition, sex education among teen- agers, lead poisoning, prenatal care, p@iatric -care, geriatric care, process of learning. In order to measure this dental care, educational problems, family-domestic problems, folk learning experience, the potential educational medicine, Medicare and Medicaid, org nization and problems of city a] hospitals, new innovations In health care, and new health careers content of a course in community medicine was for non-professionals, 116 SUMMER 1968 summarizes this increase in knowledge by the Table 4.-Information index June and August, 1968. students as it combines all 31 areas into an in- Infor?nation @ex Score Junel968 August 1968 formation index.5 Low information ------------------ 44 12 Table 3.-Student learning experience during the summer. Medium information -------------- 46 51 Percent saying they know High information ----------------- 10 37 a good or great deal Total --------------------- 100 100 Area of Knowledge About the Poor about each area June 1968 August 1968 Additionally, the information level of the stu- Organization of health services ---- 14 72 Quantity of health care received ---- 22 76 dents was directly related to their membership Quality of health care received ------ 30 74 (or nonmembership) in the Student Health Or- What professional practice is like ganization (SHO), a loose amalgamation of for poor ------------------------ 12 41 Narcotics and drug problems ------- 33 61 medical and health science student organiza- Birth control --------------------- 29 54 tions which are especially concerned with the Illegitimacy and unwed mothers ---- 29 47 health problems of the poor (as.well as with Welfare services ------------------- 26 50 political-social issues such as community con- Rat bites --------------- ---------- 16 25 Housing conditions - - - -. @ --------- 47 80 trol and black admissions to medical schools). Job problems ---------------------- 37 61 SHO was largely responsible for the genesis of Community attitudes toward health these student projects, and much confusion has problems ----------------------- 17 66 existed for the past two summers over the rela- Community groups concerned with health problems - - 17 65 tionship of the student health organization and --- ---------- Mental illness -------------- ----- 20 25 the student health project. SHO membbrs (see Mental retardation -------------- @--10 17 table 5) had higher information scores in Cancer --------------------------- 8 7 Heart Disease -------------------- 9 9 June, 1968 than did non-members, and main- ' The information index was constructed by giving arbitrary scores tained this differential at the end of the sum- of 1,2,3,4,5 to the five information response response categories mer. While nonmembers became sensitized noted in the text. The total score for each respondent on the 31 items was then classified as either low (scores under 80), medium during the summer, organization members also (80-99), or high (scores over 100). No responses were counted as 3; increased their knowledge about the health if there were more than two no responses, the respondent was classified as no response. problems of the poor. Table 5.-Information index scores and membership in the student health organization. information Member Junel968 Not a Member August 1968 Nota index scare Of SHO member of SHO member Low information ------------------------------- 34 59 4 25 Medium information ------------------------- ---- 53 35 55 45 High information ------------------------------- 13 7 40 31 Total ------------------------------------ 100 100 100 100 (N m 47) (N = 29) (N = 29) (N - 47) Besides this objective data on the educational New York. In 1968, however, one must ask, "Is value of the summer project, the students also education enough?" felt subjectively that the summer had contrib- uted to their professional education. In August, . A Clash of Perspectives seventy-four percent (747o) said the summer The educational aspect of the summer pro- contributed a good deal or a great deal, seven- ject-the sensitization of students to the vari- teen percent (172'o) said some, and eight per- ous health care problems of the urban poor- cent (87o) said the summer contributed only was seen by the faculty members from Monte- little bit or something to their professional ed- fiore Hospital and the Albert Einstein College ucation. of Medicine (through which the grant was Thus, educational gains should certainly submitted and funded), and most of the faculty have contributed to the satisfactory nature of members concerned with the project, as the the Student Summer Health Project of Greater prime reason for the project. To them, educa'- 117 GREATER NEW YORK tion was of greatest importance. To the "edu- especially community control, made education cationalists," radical political action for re- a secondary (although still important) aspect form of health care services was an alien and of the project. threatening concept-and widespread impro.ve- Community Control and'Political ment of current health care services was im- Radicalism plicitly discounted as unrealistic. In fact, early The controversial issue of community con- in the spring of 1968 (during the project's +.rol-community control of education, com- formative stage) a direct confrontation of the education and political action perspectives re- munity control of welfare services, community sulted in the two then student leaders !both control of medical services-dominated the highly politically oriented) resigning their po- ideological interests of the students during the sitions as they felt the faculty sponsor was res- summer, especially the leaders and the (vocal) tricting their actions and redirecting the focus politically radical student fellows. Education of the project. As the faculty sponsor later was not their primary goal; the improvement noted in his reaction to a student manifesto of health services for the poor via control by about the political action necessary for the poor was their slogan. This is not meant to imply, however, that all of the health science improving health care, "With regard to the manifesto I noted that in the preamble there fellows favored community control. In fact, was no mention of education and as far as I wide disparity existed on . this issue during the ty summer, and was a major source of conflict was concerned it was an educational program. and internal project debate. The two new student codirectors felt com- Since the issue of community control was pelled to "give in" and accepted the educa- clearly important to the student leaders during tional philosophy formally. They noted, "Stu- the spring, several questions on community dent placements will be on the basis o e po- control were included in the June question- tentiaI educational value of the exper. ence to naire. The students were asked what relation- the student." However, the students also main- hip community people should have with medi- tained their interest in the reform of health s ,al personnel in making decisions at a neigh- services as they noted that the dual goals of the project were the education of the students borhood medical care center; they could and the reform of health care services. Infor- strongly agree, agree, disagree, or strongly dis- mally, however, the student leaders and the po- agree with each of the nine possibilities listed litically radical (and vocal) student fellows in table 6. stressed over and over during the summer the Table 6.-Student attitudes toward community control of need for radical political change to achieve medicine. health care reform-especially, community Percent strongly agree, or agree ivith each statement participation, community control, community, Community people should June 1968 August 1968 community, community! Witness some of their Advise medical personnel on statements at the end of the summer which ne- budget decisions ---------------- 76 72 gated the value of the project's educational Advise medical personnel on decisions about the scope and goals: practices of the center ---------- 78 79 The community should be served, not the students. . A di,, on the hiring and firing The project is educational, but does this validate of medical personnel ------------ 57 67 using ghetto residents? Have an equal vote with medical I don't think it should be the purpose of SHP the student health project to sensitize. I .don't approve personnel on budget decisions ---- 67 63 of parasitizing off the community for our enlighten- Have an equal vote with medical ment. personnel on decisions about the Thus, -while educational achievement may scope and practices of the center . 71 74 Have an equal vote on the hiring have been an accepted goal in and of itself in and firing of medical personnel --52 64 1967, it was not so accepted in 1968! Emphasis Have the final controlling vote upon political action for health care reform, on budget decisions @ ------------ 26 36 118 SUMMER 1968 Percent strongly agree, or by Columbia University students was agree with each statement Community people should Junel968 August 1968 justified by their cause and ideals; Have the final controlling 'vote on (3) The burning of draft cards by oppo- scope and practices decisions ---- 29 45 nents of the Vietnam war is morally Have the final controlling vote on justified; the hiring and firing of medical personnel ---------------------- 20 37 (4) The seizure of factories by French workers and the French general strike While the majority of students felt in June that should be emulated in the USA by poor community people should either advise or have an equal vote with medical personnel on people; and, budget, scope-practice, and hiring-firing deci- (5) Black militants are right in excluding sions, less than one-fifth of the students felt white newspapermen from press confer- that community people should have the final ences. controlling vote on these issues. Therefore, a Student responses became more radical (that I ch state- community control index was constructed by is, the percentage agreeing with' ea combining answers on these three final control- ment increased) from June to August. This is lining vote questions.6 As show in table 7, fifteen clearly shown in the Political Radicalism percent (157o) of the students were communi- Index, (table 8) which shows the same radical- ty control radicals in June, while another nine- izatio-n as on the issue of community control. 7 teen percent (199'o) were community control Table 8.-Political radicalism index. Cl"oiftcation June 1968 August 1968 moderates. 51 Political radical ------------------ 87 Table 7.-Community control index. Political moderate ---------------- 40 25 Community Control Scare Junel968 August 1968 Political conservative -------------- 21 16 Community control radicals -------- 15 36 No response ----------------------- 3 8 Community control moderates ------ 19 16 Community control conservatives ---- 65 45 Total --------------------- 100 100 No response ---------------------- 1 4 The debate over community control created Total --------------------- 100 100 serious problems for the project. Not only did By the end of the summer, however, many the call for community by some students op- more students had become advocates of com- pose the views of others: mu-nity control, based on their experiences dur- The community people are more important, in- telligent and trustworthy than the health science ing the summer and the proselytizing behavior students; versus. of the pre-summer community control advo- The "community" is a myth used, by those who are cates. Thus, community people were always afraid to make real changes, to stifle action. given a larger role in hiring and firing deci- but, the radicals resented the project's less sions (either in terms of advising, an equal than total commitment to the theme of 'com- vote, or a final vote); and, community people munity control: were seen as competent to have a final vote on It was sdt up, of, by and for students, not io really all decisions by an increased number of stu- help the community. It took more than it gave. It was too tied into the medical establishment and dents. This view of increased radicalism among the not to the community' SHO lacked a real commun- ity philosophy and failed to be militant enough for students as a result of the summer project is the community or to listen to it effectively. reinforced by data on political attitudes I Each respondent was scored 1, 2, 3,' or 4 on each question which was also incorporated into the two ques- corresponding to strongly agreed, agreed, disagrftd, or strongly tio-nnaires. Students were asked to express disagreed on the three final vote questions. Scores then classified as radical (1-6), moderate (7-8), or conservative (9 or more). No their opinions on five issues of current impor- responses counted as 2.5; no response to more than one question taiice to political radicals: resulted in the respondent being classified as no response. (1) Violence and rioting by Negroes in slum Respondents were given scores of 1-6 corresponding to very strongly agree, strongly agree. agree, disagree, stmngly disagree. areas are justified if they result in so- very strongly disagree with each itenL Added scores then classified cial change; gts radical (14 or less), moderate (16-19) and conservative (20 and over). No response counted as 6.5; If there was more than one no (2) The seizure of administrative buildings response, the respondent was cassified as no response. 119 GREATER NEW YORK SHO is a liberal, white service organization. Table 10.-Student attitudes toward recommending that As sueb, I don't think it should be in a black com- a roommate or friend apply for project munity at this point. the following summer. would student reeom7nend As such, the ideological involvement of some of room?nate-friend apply? 1961, 1968 the students in political radicalism and COM- Definitely yes -------------------- 79 33 mu nity control contributed to the undercurrent Probably yes ---------------------- 17 20 1 of tension which permeated the Student Health Not sure --------------------------- 2 22 Probably no ----------------------- - 9 Project of Greater New York, and contributed Definitely no ---------------------- - 14 to the feelings of discontent, dissatisfaction, No response ---------------------- 2 1 dismay and disappointment which many pro- Total -------------- ------- 100 100 ject members felt at the end of the summer. fifty-three percent (537o) said they would do Satisfaction: An Overall Evaluation so after this summer's project. Finally, one must assume that a satisfactory As noted in the introduction, almost all of project would have resulted in more students the student and faculty members left the 1967 wanting to work in poverty areas (when they summer project with smiles on their faces. become full-fledged professionals) after the Faculty members were enthusiastic about the summer than had wanted to work in poverty gains. of the summer, and worked diligently areas before the summer. However, this did with the students during the winter to prepare not occur in the 1968 student health project; for the next summer's project. The same can- no gain in the percentage of students who not be said now. In fact, thoughts of another wanted to practice their profession in a pov- erty area occurred. In fact, there was a very summer project are presently far from the slight negative shift from the seventy-two minds of the Einstein faculty members who Ik'4727o) who wanted to work in poverty areas supported the 1967 and 1968 projects. Student in June to the sixty-eight percent (689'o) with reactions to the two projects followed this pat- the same desire in August, 1968. In brief, the tern. As table 9 indicates, the 1968 summer 1968 Student Health Project of Greater New was a disappointing experience for project York cannot be considered an unqualified suc- members, when compared to the previous cess. year's project. The reasons for this less than totally satis- Table 9.-Student satisfaction with the summer projects. factory experience have been alluded to before, Project was August 1967 Augwt 1968 '&jut can be placed in proper perspective now. Highly satisf actory ---------------- 83 43 First, the positive aspects of the educational Slightly satisfactory --------------4 28 gains of the summer were minimized by the Slightly unsatisfactory ------------6 5 conflict over considering education as a pri- Highly unsatisfactory -----------4 18 mary project goal. Since the "education-lis'ts," No response ----------------------4 5 both student and faculty, were constantly as- Total ---------------------- 100 100 sailed by the vocal politically oriented stu- This shift in attitudes toward the summer pro- dents, this tension no doubt lessened the stu- ject from 1967 to 1968 is clearly shown, once dent's satisfaction with the knowledge gains of again, in the percentage of students who ]would the summer project. And, it resulted in many recommend that a roommate or close friend at faculty members feeling that the educational ains just were not worth the'aggravation. school apply to a similar project the following 9 summer. (Table 10). While ninety-six percent Second, the students were dissatisfied with the (96@o) said they would recommend a room- limited nature of those changes that were ac- mate-friend apply after the 1967 project, only complished during the summer. While more students reported that they had achieved some I The number of cases upon which percentages are based for the change in the community in 1968 as opposed 1967 project is fifty-three (53) ; as usual, the base for the 1968 project is seventy-six (76). to 1967 (67 percent said they accomplished 120 STJMMER 1968 hange in 1968 compared to 58 percent in C. Family income 967), almost all of these changes were either Under $5,000 ---------- 5 6 ndividualistic as they helped one patient or $5,000-9,999 --------- 26 25 $10,000-14,999 ------- 29 27 ne family, or they were temporary and of lit- $1510oa-19,999 -------9 10 le significance. Broad, widespread change was $20,000 and over ------ 26 27 Lot accomplished. In 1967 this was permissible; No response ---------- 4 4 n 1968 it was not. As several students noted, Total -------- l@o 0 100 'There should be no summer projects. They D. Race ihould be all year or not at all." Caucasian ------------ 82 79 Third, the controversy over community con- Spanish-speaking ------3 3 Negro ---------------- 12 15 ;rol (and political radicalism) and its relation- Other ---------------- 3 2 ;hip to the reorganization of medical services No response ----------- I @or the poor served to supply the tension Total ----------- 100 @oo needed to minimize the positive aspects of the E. Sex summer program. The Spring confrontation of Male ----------------- 59 61 education-oriented faculty and political ac- Female --------------- 41 39 Total --------- l@O 0 100 tion-oriented student leaders foreshadowed the F. School attended summer's conflict over community control, po- - -New York area ------ 67 66 litical radicalism, educational exploration of -Non-New York area --- 33 33 the ghetto, and "meaningless" piecemeal No response ---------- I change "with the system." Total --------- 100 0 What had been a highly successful project in 'The umber f respondents to the first questionnaire was ninety- 1967 had become a much less successful-even nine (99), while the number responding to both questionnaires was unsuccessful-project in 1968. Why? The rea- seventy-six. (76). The percentages given in this appendix are based on these numbers. The main text of the report using the data abased sons given above are part of the explanation; upon the rsponses of the 76 who responded to both questionnaires. but, they are only part. Perhaps it was the stu- dents, the faculty, the radicals Or, perhaps it was America in 1968 as compared to America THE STUDENT HEALTH PROJECT AS A in 1967. Perhaps it was not the Student Health LEARNING EXPERIENCE Project of Greater New York, at all. Perhaps Those of us who worked to develop a 1968 it was Vietnam, Lyndon Johnson, Hubert Student Health Project in New York City saw Humphrey, Richard Nixon, and Mayor Daley. the 1967 California project as a partial model Appendix /.-Student backgrounds: Comparison of those and tried to incorporate as m uch of it as we who answered both questionnaires and those could into the planning. A tacit assumption we who answered the first questionnaire. all made was that students would be brought to First First and second New York City to work in "medically disad- A. Discipline questionnaire questionnaire vantaged areas," for example, black and Medicine ------------- 54 58 Nursing -------------- 24 24 Puerto Rican ghettos. In this way the students Dentistry ------------7 6 would: Law -----------------9 8 Sociology, social work - - 4 4 (1) Learn about these communities, their Other' - - - - @ -----------3 3 sights, sounds and smells; but more im- Total ---------- 100 100 portantly, the students would realize, B. Religion from first-hand experience, how the Protestant ------------ 17 22 community environment determined the Catholic ------------- 29 27 people's life-style and their pereetion of Jewish ---------------- 42 39 all things, especially health. This Other ----------------5 5 proved to be one of the most invalid as- None -----------------5 5 No response -----------1 1 sumptions one could make. I realize now Total --------- 710-0 100 that it is grossly unfair to bring two- 121 GREATER NEW YORK month "summer trippers", most of NYC program was having its difficulties whom do not live in the community, and (as witnessed by the constant turmoil view their summer as nine to five job and 'investigations, but trying to deal exposures to poor people, into someone's with the confusion, inefficiency, and home and expect the people to unburden lack of understanding made it almost themselves to the student, relate to the impossible to have NYC youngsters in student in any other than a short term, the Bronx and Brooklyn projects. Many ad hoc manner and it is most reenforc- health students were interested in the ing to the student's subtle feeling that NYC'S, but could not treat the young- he can act in this role with poor people, sters as equals on the job. Maybe it was but would never dare go into his own that the students received $900 for the community and ask what he asks, or as- summer and the NYC's received $320 sume the role he answers in poor com- but probably it was that the health sci- munities.. ence students could not accept the idea (2) Help the community get better health that their summer problems required care. This goal was our number one creativity in setting up tasks compatible goal, but attached to it is the subtle idea with the community's needs, the NYC's that it is all right for a student, to act capabilities, and their own abilities. The as a "patient advocate" and take the best relationships between NYC's and community person to the hospital and students were in Brooklyn where soriie use his own knowledge of the systems to students encouraged the NYC's to take help the community person. Students an active. role, and the NYC's accepted were also supposed to work with some this involvement and functioned beauti- community organizations, either fully. through them (using their office and Unfortunately, much of what I have said phones to contact people) or to become a thus far, places pivotal emphasis on the per- summer apprentice to the community sonality of the student, NYC, and community grciup and offer specialized assistance person. Our project was set up this way under where possible-and where decided by the guise of "creativity" and "flexibility," but the organization. I am happiest about for these assumptions to hold, the parties con- the last type of task, where the student cerned must have some knowledge of what is works with a community organization, expected of them. One of the glaring faults of because it is the least condescending to this summer's program was poor project devel- the community people, and makes the opment. The project descriptions were reassur- most efficient use of the student's special ing, but what backed them up? In Harlem and knowledge of the system or of uniquely in Brooklyn, most of the problems and pre- medical matters (for example, dental ceptorial contacts were valid and existed. In the hygiene, birth control). other three areas (especially the Lower East (3) Work with a member of the Neighbor- Side), the students were constantly confused hood Youth Corps (NYC), making it and frustrated by a lack of direction and a easier to come into a community, finding paucity of personal contact who understood the out about a ghetto youngster, and Student Health Project or what they, as precep- maybe interesting the teenager in a ca- tors, were supposed to do. I can, however, offer reer in on of the bioscience's, but cer- a theory as to why this happened. We were not tainly helping the youngster with high sure of our funding until two weeks into May, school subjects. This was the most dis- after students had been accepted and plans for appointing aspect of my summer. -Work- Orientation set into motion. Being unsure of ing with the NYC organization was im- the status of our venture, or if we would have possible. I know that New York City an SHP at all, students probably found it diffl- 122 SUMMER 1968 cult to make firm commitments. When the con- ple bullshit and she was unhappy with their tract was finally agreed to, I'm sure that stu- deception (she gave me no particulars). On the dent coordinators in all the areas had to whole, Orientation had. given the group a tighten up loose arrangements, but in Newark, needed esprit de corps, and a very low-keyed The Bronx, and the Lower East Side the ar- introduction to the community health scene in rangements never jelled and remained amorph- New York City. This was not a radical Orien- ous for the better part of the summer. Through- tation, merely an easing into the summer PS out the summer new preceptorial arrangements problems. Some people resented the site of our were constantly being made. This was a Orientation and Final Conference sessions drastic mistake. If the supporting structure (both were held at resort hotels outside of had existed, and if the project staff from the New York City). The problems inherent in top down had felt more secure in our roles and finding a place to feed, provide meeting facili- was clearer about direction, much of the conf u- ties for, and house participants (which is not sion and frustration could have been avoided necessary, but we felt this would be optimal) and more would have been accomplished. at a reasonable price in the New York Area are As for the educational function I was sup- HUGE. This was one of the greatest stumbling posed to direct, this started with Orientation, blocks all summer. We were a large group and which was in two parts. From June 28-26 we needed large facilities. Bader's Hotel was ideal (even though it was not in the community) be- met at Bader's Hotel in Spring Valley, N.Y.; the remainder of the week was to be spent ori- cause we were the only group in the hotel for entingIthe five student groups (with NYCs the three days it was the hotel's off-season and where possible) to the five communities. In the price was right. general I thought the project Orientation ses- The educational programs per'se during the sion W.Q.S adequate and accomplished my inten- summer never really achieved my goals. I fast tions. The first full day was devoted to an over- realized that the project participants were re- all view of the communities SHP would be in luctant to travel very far to hear a speaker and during the summer. Films, speakers, discus- were not really bristling with ideas as to'the sions, and lots of free time were used to help kinds of speakers that would interest them. the students obtain an overview of community There were two lecture series, on black and feelings and problems in the Greater New Puerto Rican history, given by Mr. S. L. and York Area. One full afternoon was spent talk- Miss C. M. Mr. L. presented the problem of a ing about NYCs (the twenty or so NYCs who self-appointed black historian. His treatment of attended the Orientation spoke to the students black history was interesting but not extremely in a wonderful two-ho-ur open discussion). The substantive. He certainly knows quite a bit but second day brought health professionals who his digressions confused matters and took the had some notion about community health. The group away from the factual matters. Miss M. students and community people asked many re- was excellent. She not only knew a vast vealing questions and I think received a rea- amount about Puerto Rican History and Cul- so-nable superficial exposure to some of the cur- ture, but she was an eloquent example of the rent thinking in Community Health (none of second generation Puerto Rican in the United it was radical, however). The third morning States. In Newark, R. P. (the Community Co- was taken up by a great discussion of "Com- ordinator) arranged a discussion group with munity Control of Health Care Facilities"; his NYC'S. These groups met twice a week and this seemed to be the logical culmination of the discussed Before the Mayflower, a black history previous Orientation topics. However, this last text by Lerone Bennett Jr., and Bluk P&wer, discussion was all rhetoric. In fact, one of the by Carmichael and Hamilton. These were far community people spoke to me during August from militant discussions, but merely an at- and said that some'of the promises made at tempt to help the NYC's become more verbal Bader's by the health professionals were sim- and less afraid of expressing their ideas. These @@123 I GREATER NEW YORK books were chosen because they deal with the ways of a bureaucratic system, and our lack of one inescapable attribute felt by all black assurance as to which decisions we could make people in America-blackness, its origins, and and which decisions required a policymaking its consequences. council vote, this kept us in a very confusing The Bronx project attempted weekly tutorial and confused state of affairs until we were al- sessions. For health science students there was most through with the project (maybe we instruction in Spanish, and for NYC's there never got out of it). was instruction in science, mathematics, and The Final Conference relied almost exclu- music. However, many of the students did not sively on health science students and commun- have time for these afternoon sessions, and the ity people to lead discussions, present working NYC's could not always attend because of their papers, and determine the focus of the Confer- responsibilities. ence. Much of the discontent and frustration I am convinced that each area has to have its was vented at this Conference, as well as the own educational coordinator who is in constant crystallization of the issue that had been crop- contact with the area people and is acutely ping up throughout the summer: Reform?'Sts aware of their desires. I attended area meet- vs. Revolutiona?ies in the health care field. ings once a week but received little feedback as That is, should the SHP and SHO try to re- to the type of programs the people wanted. form a bad, though not unsalvagable, system The Final Conference was steeped in dis- or should the thrust be to work with any and agreement, good intentions, and subjectivity. all allies to totally revamp this system. This is Many students did not care to attend the final the major decision of any activist-minded per- conference (August 26-28) because they needed son and was coupled with a crisis in choosing a rest before starting school in the fall and they allies for health students. We asked each other wanted that week for part of their vacation; should students work in communities or should many people felt the conference should not they only serve as advisors to community or- have been held at the Sha-Wan-Ga Lodge in ganizations (someone suggested that our name upstate New York; indeed, many people felt should be Community Health Organization). very strongly that the final conference should The fallacy of the first assumption enumerated have been held in New York City, in one of the at the beginning of this report was exposed five communities SHP was working in. In and much introspection and soul searching fol- choosing a site for the final conference we were lowed. The Final Conference was not orderly, faced with many more problems than with ori- people complained about "to much talk," no di- entation. We felt that if people were to com- rection, and no continuation of projects mute each day to the Final Conference we throughout the year (however, three area pro- would be ending the sessions early and begin- jects have been funded through the winter). -ning late in the morning-the logistics would This was not unexpected and merely reflected be much simpler if everybody was in one'place the clashing of ideals, none 'of which have ab- for the entire three days. Sha-Wan-Ga Lodge solute worth and all of which might be tried. was far from the ideal location, but it was the We ran into a problem in our project because best we could find in terms of space, facilities, e areas and the participan s e a food, convenience, and price. If I seem to be times to be less important than the unified Stu- harping on seemingly trivial issues, it is only dent Health Project. We talked about auton- because much of my time this summer was omy and creativity, but were faced by poor spent worrying about just such details and pre- support on the local level, many willing stu- cious little time was spent in a nonbureaucratic dents but some not willing at all, much money, bag. Much of the "central staff's" time was and a bureaucratic structure second to none be- spent patching up situations that arose because hind the project (Montefiore Hospital runs a of poorly functioning area leadership, and sim- very efficient bureaucracy, and their staff was ple confusion caused by poor planning on our invaluable) which often did not function as part. Coupled with a student ignorance of the responsively as we would have liked. The ten- 124 SUMMER 1968 sion was between the five individual areas and everything without benefitting from anyone's what each thought was important, what could specific knowledge. By defining roles some be allowed to permit proper functioning of the needless overlapping can be eliminated.A clear project, and what Montifiore and Washington definition of a role does not limit initiative or were willing to allow. These three power creativity. It should enhance it. If the commun- groups were never at direct odds, but the com- ity worker knows how the welfare department munication between the three was not good functions, this in no way stifles his ability to and this lead to much ill will.-S.G., Education work with welfare clients. Coordinator. * * * It seems that if students were given If SHO does continue, which I hope they do, a specific orientation, a definition of their role, they should do some serious thinking about the and started the summer by defining their focus' summer's experiences. Unfortunately, many of then the level of frustration would be lowered the comments I have to make this summer are and the feeling of accomplishing higher.-V.V., the same ones I made last summer. Nursing Student, Bronx. First of all, Orientation should be more spe- My reaction (to orientation) was negative. cific. For example, those working in the Bronx Most students who go to work in projects like need to know about the Bronx, Mimeographed this already have some awareness of ghetto sheets of all community groups, health facili- problems. The resource people do little more ties and service agencies should be made avail- than tell us in more vivid detail what we al- able to each project member at the beginning ready know in general. Specific names of pro- of the summer. This summer, halfway through grams and people are lost on me, as I have no the project one list of medical facilities and way to connect them with their environment. community organizations was available in our The Orientation seemed to be trying to give office. This list should also include such things us a feel for the ghetto in a resort hotel at- as clinic hours, how to register, and who the mosphere. It should have concentrated on the heads of each department are. organization of the power structure , and the It is also important to know basic functions poverty organizations, and left the ghetto feel- of the community groups. Last summer there ing to a time when we could experience it. I was an excuse for not having this information want to become "sensitized," too, but not at available because it was the first summer for Bader's Hotel. It was like going to France to SHP. This year it was not excusable, and next learn German.-R.H., Law Student, BrookZyn. year we should not attempt a project without To me the orientation was unnecessary be- having this information readily available. It is cause I now how it is to live in a ghetto and I rather astounding to find out that -a student need no one to tell me how it'is. The only thing working one block from the N.M.C.D., can go the orientation did for me was to give me a half way through the summer without know- chance to know the people I would be working ing of its existence. Equally astounding is that with. Also to find out what their personalities a community worker in the last week of the were like so I would know how, to approach project can admit to not knowing about Wel- them.-W.F., NYC, Brooklin. fare minimum standards forms. My only criticism of the project was the pre- Orientation should also include a discussion and postsummer meetings. They seemed to of roles. For example', community workers have too much of the "party atmostphere." I should be told that they are to be involved with am certainly not one to dislike parties, quite welfare and housing problems. Part of their the contrary. But I prefer my parties to be introduction to their new role should include paid for by me and not out of funds allotted specific information about welfare. They need for the urban communities' problems.-B.W., to know the lines of authority, the rights of the clients, the procedures of the different cen- Medical Student, IVewark. ters, etc. This summer everyone did a little 'of In improving SHP for next summer, the 125 GREATER NEW YORK most apt suggestion I can make is that the stu- munity people as health workers can work. dents in each specific project familiarize them- "Sensitization" of student fellows had a low selves with the community and the project be- priority.-R.C., Student Coordinator, Hartem. fore the summer so that when June comes they I feel that we were also severely limited in can start work immediately without first designating ourselves as a project to "teach" spending a great deal of time learning about other students about poor communities. While the problems of the area. This of course would necessitate much time during the school year, this is an admirable and necessary task, many something medical students may not be able to of the more experienced of the students were do. not capable of structuring a project which I believe the orientation session at Baders could provide useful service to the community was most useful and should be continued; while giving uninitiated students first expo- though much of what was said there was per- sure. This is because most of the students who haps not necessary (for example, what is a set up the project didn't have very much expe- ghetto?). There were two films shown, one of rience themselves. I don't think that- in several SHP in California and one on the South Bronx, weeks or a month or even a year a health sci- both of which gave us an idea of ghetto life, ence student can be knowledgeable enough or and, perhaps more important, explained.@tti- accepted enough by the people he is working tudes we might face while working in these with to take it upon himself to bring other stu- areas.-D.K., Medical Student, Brooklyn. dents in to get a feel for what is going on. In my opinion, all projects which are beginning The orientation program at Bader's may for the first time should be composed on ly of have been costly to SHO and boring or useless local students with some experience, who share to old SHO members but to anyone newly ac- some attitudes about "health care as a right," quainted with the organization, it held three the economics of poverty, the poor educational opportunities: to learn a bit about SHO, its system, etc. Their goal should be: (1) To prov- goals, philosophy, etc.; to learn the exact plans ide themselves as consultants to the community and expectations of the various projects (with on whatever projects are underway-they chances to reconsider choices!); and to get a should not start their own projects; (2) to feel of some attitudes the next ten weeks might meet people in the community and become support or struggle against. knowledgeable about the special problems and Local area orientation, on the other hand, resources of that community; (3) to discuss, might have been a little more diligently done. say at the end of the summer, with the com- In the future, such proceedings could serve as munity people they have worked with, ways a guiding push into the summer's activities and in which more students and community people save the student fellow from wasting precious may work together in the fall. time learning what old project members could I do not think that students -new to an area easily pass on. Admittedly, some things will re- should identify themselves as SHO or SHP or quire a certain amount of time for each student anything else; this marks them as another to get on his own.-A.G., Nursinq Student, group with something to do. Their 'Only task Harlem. during the first summer should be to help out We found that our goals were somewhat dif- existing community groups. If this were the ferent from those of the citywide'SHP. In the case there would not be a city-wide SHO as far introductory remarks and the comments on the as community work goes. There might be some 1967 California SHP film the first night of ori- central staff to arrange seminars, confronta- entation, it became evident that much of the tions, etc., but it should not be concerned with purpose of the New York SHP was "sensitiza- individual projects, which at least at first tion." Our primary goal was to improve the would be directed strictly by the individual school health program in Harlem public schools community. I think that the central staff this by demonstrating that a model for'using com- summer was very ambivalent about its role- 126 SUMMER 1968 supervisor-director or facilitator-but this one has never spoken. Yet I feel frustrated be- would be eliminated if they did not decide cause I know that sympathy on my part does things for the individual projects. nothing for those people. I feel frustrated be- I should state here that the idea of bringing cause I see that the problems are so enormous out-of-state students to various project sites, that I can do almost nothing. I also feel frus- which goes along with the idea of educating trated because many of the limited goals that students and creating other SHOS, is overambi- we have established will not be achieved. But tious and hampers activities. Aside from the then I think about how I felt after the first difficulty of getting a group with such diver- time I sat with a group of Neighborhood Youth gent views together to do something, it is diffi- Corps teenagers, trying to make boys and girls cult to think in terms of ongoing projects when confront each other about their ideas on male 75 percent of the project staff leaves almost as and female anatomy in a sex education class. I soon as it arrives. This also rubs in the fact felt very good because I say that these young- that students can and will leave the -commun- sters could respond to me and that we could ity, but residents are stuck there. Along these work together; that I could bring Something lines we might also say that students should be new to their lives.-P.S., Medical St@nt, required to live in the communities in which LowerOast Side. they work.-S.D., Student Coordinator, Lower After 2 years of working as a student in East Side. Metropolitan Hospital I really cannot say I The first few weeks on the project have been learned anything new about the delivery of so full of,different kinds of experience that it health care. I spent the summer in another would take me many pages to relate all that area of New York City where most of the has happened. . . . One moment I feel as if problems were basically the same, but I did ex- there is real purpose to our work and then the perience more about the delivery of health care next hour I feel as if the entire effort is a and hear more of the actual feelings of the futile one. There is very little structure to my people. What I had learned before was learned, project other than that which I make. Nothing dressed in white, as part of the hospital struc- in my educational or work experience has been ture; what I experienced this summer was ex- this way. The past year at medical school, es- perienced as part of a community organization pecially, convinced me that it was unnecessary (NENA) fighting health rights issues on its to have to think and to be creative in on6's own grounds. I found this completely invaluable to my understanding. When a person is sick and work, but this summer has been as much the opposite of last year as possible. Every day is must go to a hospital, he comes to you (the different and is only as meaningful as the ef- nurse, the doctor) on your grounds:. you are fort which I put in. In some ways this is irooi, the controlling factor in the relationship; he I am learning how to work in a loosely struc- has no voice and does not say what he feels. tured job and how to create something of value When you go to him and meet him on his in the summer's work. grounds, you are a guest in his home; he has more authority and can meet you on a o-ne-to- I wonder, however, if we are actually going one basis.-M.L., Nursing Student, L.ower East somewhere as an organization of professional -Side. students who really do have talents and Imowl- edge to offer the community. I feel as if I am You fight a deadline because you don't want going to come away from a meaningful experi- to disappoint the community, and then they ence with a much greater understanding of the don't showup; you can understand it, but it problems of the poor and a feeling of sympa- doesn't help your feeling of that big come- thy for the people, a feeling acquired only by down. Now you know how the people of the walking the streets, by smelling the air that community must feel when they get promised people breathe, by seeing the homes in which things and don't get anything. I was too naive they live, and by talking to people with whom going into it; I didn't expect any hitches; we 127 GREATER NEW YORK kept our end great and this guy had promised on the wording of the question as it was to con- he would get the kids for the physical exams centrate on the way it was asked. These and I took him on his promise. I now know you mothers are not stupid. They can tell when can't do that. If we were to do this again, we someone is sincere and when someone really would arrange for the kids to come ourselves, cares about the well being and safety of their and leave nothing to anyone else. That is one children.-D.Y., Medical Student, Brooklyn. thing I have learned this summer; I've learned The huge Brookdale medical complex was to rely on other people a lot less.-W.S., Stu, considered not worth a damn and all I knew dent Coordinator, Brooklyn. about it was what I heard and all I heard was I have heard our SHP advisor say more than bad. Validity is not inherent in universality once that it is difficult and almost impossible to and because all of the gung-ho people from assess the effects of any community service. both SHP and the community had climbed Bearing this in mind, I think that the major aboard the "Bury Brookdale" bandwagon, I accomplishment of my summer's efforts has been my own education. didn't believe any of it. This education began in family counseling When the opportunity was presented to where I learned about welfare, housing, and work at Brookdale with complete freedom, I mental health problems that affect some ghetto secured the position. Seven weeks' of examin- residents. I also saw how these problems are ing programs, speaking ta patients, and quietly interrelated and how they affect ghetto resi- observing the procedures and handling of pa- dents' health and well-being. In the VD educa- tients' convinced me that the blowhards I'd- tion program, I learned about venereal disease heard at the summer's beginning did not know and also how little is known about it and its firsthand what they were talking about. In cure in the community. It also became evident fact, they had fallen prey to exactly what they that even though people had many misconcep- so staunchly warned against: the blind ac- tions about VD, they were well aware of the ceptance of stories which, as I later found out, social stigma involved with having contracted should have been either buried long ago or syphilis or gonorrhea.-E.C., Medical Student, never even begun.-J.G., Dental Student, Brooklyn. Brooklyn. There had been many arguments concerning . * * * I spent most of the time talking with the wording used in our questionnaire. For ex- the three boys, about my age, who work as ample, we wanted to know if the person was guards in the office. I quickly learned that they were quite as complex as I. I was interested living with his or her spouse. One could simply ask: "Are you living with your husband?" We and surprised to learn that the reality of the did not want to do this. These people have been ghetto, with its junk, crime, and imminent picked on too often.'They have been constantly death frightens them as much as it would me if questioned, often with too little compassion, I lived there. And these boys are by no means about their personal lives; questioned by people powder-puffs-one is an ex-addict, and all are fully in the midst of the Bedford-Stuyve'sant who have different value systems and different discene." I was very discouraged by their bland ife really is like. By ask- concepts about what I' ing the number of children in the house and acceptance of everything that occurs around the number of relatives, etc., we would figure them; the universal gambling, dope, and steal- ing from one another is a depressing reality out by a person's response to the question about the total number of people living in the that is acknowledged fully but left unchal- house whether she did indeed live with her hus- lenged in their thought or conversation.-J.T., band. Medical Student, Brooklyn. One of my first lessons learned was that all For people on the outside there is a feeling this beating around the bush was quite unnec- that the black community in Newark is dan- essary. It wasn't as important to concentrate gerously unified and ready for complete revolu- 128 SUMMER 1968 tion. When I walked into Newark this summer, become somewhat prejudiced against white I was afraid. My orientation had never before people, I meet one I really like. From past ex- been that of a revolutionary; I had always perience, however, I try not to forget that I am been a reformer. I didn't believe in violence as black and he or she is white. The other day I a solution to any problem. I didn't like the idea was walking down 125th Street with one of my of "black power" because all it meant to me coworkers. I noticed that some people were was separation. I believ'ed that everyone had to staring at us; then it hit me: "I'm black-she's get together to solve racial problems. After white." I had forgotten. Ivs much easier and about 2 weeks in Newark, I changed my opin- more comfortable to forget. I'll have to do it ions and my orientation.-K.F., Medical Stu- more often.-C.R., Medical Student, Harlem. dent, Newark. The people who came to work in the project Although I have lived just outside of Ne- should have already had a meaningful attitude wark for most of my life, I found myself toward the people they would be in contact spending the first few weeks of the SHP pro- with, for example, the community, before they gram getting familiar with the city-objec- went into the community. And if some students tively and subjectively. There were streets to didn't have these attitudes, or there was some know, bus lines to learn, names to memorize, doubt that they did, then the students should landmarks to note, people to meet, etc. There have been screened out. This is not the place to were also attitudes to recognize and to under- develop attitudes. This is the place to work for stand-mine, as well as those of the com- the community as a result of these attitudes.- munity in which I was to work. My pre- C.R., Community Worker, Bronx. vious life in the suburbs had not exposed me to the real working of Newark-, initially I was in WHAT NEXT? SUGGESTIONS' FOR a state of overwhelming ignorance. But as I THE FUTURE came to know more about Newark and its peo- I think there may be a place in ghettos for ple, I was able to participate in the SHP task white liberal medical and nursing students of improving the medical care offered to the next summer but it is a rather specific and con- people of this community.-B.W., Medical Stv- ditional one. I think students should only go dent, Newark. into a community at the request of a commun- ity group. I think the students should see their The problems of health care delivery change role as primarily that of support for groups al- quickly revealed themselves to me to rest more ready working on health, or who are trying to with the medical establishment of the hospital build an awareness of health issues in their and New York City health department, than in communities. community apathy, lack of sufficient informa- I would personally suggest that there be no tion about health services in the community, or more SHPs like the ones we have had for the lack of parental concern and cooperation. (I last 2 years in New York. It is just too expen- was surprised and pleased to discover how well sive and too exploitative of the community (we ghetto mothers do take care of their children's learn more from them than we provide) to jus- health needs, within their limited means,. even tify taking government funds. If we could fund though not up to middle class white America's a large number of community people, as they standards.)-W.S., Medical Student, Harlem. did in New Haven, that might be better. On I really didn't expect to re.ceive too much the other hand, I think it would be better if $(sensitization" as far as the community was SHO concentrated on what it could do year- concerned, since I was born in Harlem and round to raise significant issues in health in have spent several summers there recently. the community where the medical schools are. However, I was surprised to find that my rela- SHO should concentrate on providing human tionship with white people was greatly im- medical care that is responsive to the needs of proved. It seems that every time I manage to the community and at the same time should 129 GREATER NEW YORK turn other medical students on to the concept small group which may serve as the "cutting of medical care as a right, not a privilege. edge" to anything SHP can becoTne.-R.C., SHO should develop the attitude of standing on Student Coordimtor, Hat-le-m. the side of the consumer of care and criticizing I now believe that the best thing SHPs (or the facilities from that point of view, not from more appropriately year-round active SHO the point of view of the professional deciding campus groups) can do is to focus all availa- what is best for a community without consult- ble manpower on a single significant ground- ing them. . floor objective (as determined by the needs of The last thing I want to say relates to the the specific community through prior discus- people I have seen on the SHP this summer, sion with people in the community)-be it ser- These remarks fall into the "I love humanity vice-oriented (for example, a health rights and but I can't stand people" category, I guess. I resources community education campaign) or think that SHP is in a dilemma; it was started activist-oriented (such as assisting some spe- by a group of people who were much more rad- cific community group in forming a community ical (in the sense that they were willing to ad- health advisory council). Otherwise, we can do dress themselves to "root" problems) than the the most good working within the medical care people who have climbed on the summer pro- delivery institutions of which we are a part to ject bandwagon. For example, we've tal effect changes in practices and policies. about alternative structures that seem to get at Medical student activities (whether the problem of community control, but most of SHO/SHP or not) should be directed toward the SHP medical students are suspicious of two important and closely related objectives: community control. We've talked about the "politics of health" but most of the students in Communication: We can work to facilitate the summer projects are essentially apolitical; communication between health service estab- to wit, the Detroit SHO convention declined to lishment, professionals and community people take a stand on the war in Vietnam. So what (and vice versa), example, liaison with hospi- we have is a liberal service organization, tal administrators where community people the most part, that tries to sound radical for co idn't get a foot in the door, or working to b @t deuvelop formal hospital "community relations" that has no real sophistication or under@nct- programs so that the "real" public (not just i-ng of root causes. the news media reporters) can know what I think that there will probably be more SHP good and bad things are going on inside our summer projects, simply because there are a ivory towers. At present, as clearly demon- lot of liberal medical students who would like strated in Harlem, rumors about the hospital a chance to prove something by "doing their are allowed to run rampant in the community thing" in the ghetto. Dealing with realities, and rumors about the community run rampant then, we have to decide how to make the ser- in the hospital. vice projects as good as possible while leaving Responsiveness- We can work to convince the smaller group of more political students to health professionals of the pressing need to re- deal with the issues of decentralization to spond to community requests for information, neighborhood clinics, community control of cooperation, suggestions for services or modifi- health facilities, redesigning health care sys- cations of existin.g services, etc. (How long tems in ghettos so that they take into account must the community keep asking for evening the life styles of the poor, and the fact that clinic hours before someone listens'?) even if the New York City hospita system We also can work to increase community were run efficiently (an impossibility in a bu- awareness of the facilities and services availa- reaucracy wracked with union and personnel ble (community education programs) or oppo-r- problems) it couldn't provide decent medical tunities they should not let pass (available care because the budget allocation isn't big jobs or positions on advisory committees, etc.). enough. All these issues we have to leave to the Specific SHP service projects should only be 130 SUMMER 1968 initiated at the request of some responsible ele- entry into health professions and over health Tnent in the community which has existed long care delivery. enough to have some real feelin,,z for the com- Future SHPS, therefore, should develop au- munity's needs and desires (PTA's, health tonomous organizations to attack the problems councils' etc.). in each borough. Borough leadership should be Dropping twenty or so health science stu- shared equally by one militant student and one dents (and some unmotivated NYC's or com- experienced community-leader. Funding should munity workers) into as complex a situation as be entirely independent of either Federal Gov- exists in urban areas like those in New York to ernment or medical schools. The ultimate pur- tackle whatever problems can be found in ten pose of such an arrangement would be the weeks just can't go on. The idea of sensitizing ouster of the health science student leader and health science students to the urban health the assumption of complete control by com- care problem in this manner is too selfish an munity spokesmen. This is the strange political objective to justify spending several hundred dialectic that white health professionals will thousand dollars. It's immoral to use the com- have to learn to accept: Success means getting munity for our own educational purposes with- kicked out.-J.G., Medical Student, Bronx. out providing it with something enduring of I suggest that SHO ought seriously to consi- significant benefit. der making the relation between itself and the 'I don't see how we can continue bringing in community more explicit and formal so that a new group of students each summer to sensi- the team of community worker and health stu- tize them, each summer attacking the same dent could be developed more easily. For exam- problems tci no avail, repeating the previous ple, SHO could try to form an alliance with year's mistakes, alienating the same establish- LABOR for joi-nt-funding next summer; hous- ment functionaries (who soon come to view us ing and health problems go naturally together. as a joke), and leaving behind the same com- The basic idea would be that health advocacy munity disillusionment with student projects. is a good way to build up the number of ser- Not to mention the health professional at Har- vices LABOR can provide, and that LABOR is lem Hospital who commented that we should be a good entree for working in the community as paid no mind because we're just another bunch health advocates. The idea seems to me to have of mixed up kids having an identity crisis, who advantages over the present funding and or- all are in the bottom third of our class! ganizational structure: In the first place, most of the students se- (1) SHO would be clearly allied with the lected for SHP's are already somewhat aware community and not with the Establish- or they wouldn't be here, and a summer of ment. From what I've seen this summer, foul-ups and frustrations doesn't really have the SHP funding agency and policy sensitization value for them anyway. As . for making committee haven't made any the others, who do need such exposure: is a contribution to the project. If anything, 10-week SHP the right time and place to do they forced unnecessary compromises it? I agree with the Harlem community on us in the planning stages. A clear al- worker who told me that future SHP's should liance with the community would give consist of five committed students and twenty us a sound and practical basis for learn- mothers, rather than the twenty students and ing what community health will have to five mothers that we had.-W.S., Medied Stu- mean in the future, and for working out dent, Harlem. that meaning. The only SHP organization relevant to these (2) An alliance with LABOR based on distinctive problems is one which minimizes joint-funding would give project fellows city-wide student and faculty political infight- a larger role in defining how they will ing and which maximizes local student involve- work out of LABOR. The ambigui@'of ment in the issues of community control over the present relationship created prob- i3l GREATER NEW YORK lems this summer; joint planning of the small ones all over.-J.W., Nursing Student, project and joint training of project Bronx. members would give us a chance to I'd suggest that skeleton ideas for projects work out conflicts on a realistic basis be worked out long before summer, and that and strengthen our relationship with project fellows be asked to apply for particular LABOR. projects and, as part of their application, give (3) LABOR employees could provide better some idea of how they think the project might continuity after the summer is over. be organized and implemented. In this way, the (4) Joint-f unding with a community organi- Orientation session could get down to decisions zation would give SHO a good opportu- as to how each group of eight or ten student nity to get LABOR involved in health fellows was to operate, and discussion of un- issues and aware of the problems that derlying philosophy would take place in the must be solved. This opportunity to ex- most useful context of real alternatives and the pose and develop our thinking shouldn't effects they would have. I suspect one reason be lost. We simply cannot go on educat- why the lead poisoning project will leave con- ing ourselves, believing that when we crete results, aside from the nature of the pro- are the medical establishment, we'll ject, was that project fellows formulated goals make the needed changes. Nor can we and thought about methods before the summer continue to try to dream up community work began.-A.K., Law Student, Bronx. groups (i.e., by calling meetings) that we can then manipulate to support our I don't think that there should be an SHP positions on health care. We must begin next summer, in the form it took this summer. working on a mature, realistic alliance Rather, SHP should be a kind of liaison, or with community groups, with sharing coordinating body, to place health professional of power.-K.B., Medical Student, students and perhaps NYCs in various com- Bronx. munity organizations throughout a specific area of the city. I do not believe that SHP can There is definitely a place for SHP in my accomplish anything worthwhile (in terms of community. However, there would have to be immediate contributions to the community) if major changes made in many of the organiza- it tries to function as an autonomous body in tion's basic ideals. First, the program must be the community. Students simply do not have organized well in advance. The community the experience, the know-how, or the time to should give SHP certain ideas for the project, produce something in a 10-week period. We but SHP should also have its own ideas. And can become more aware of the needs and prob- be ready to act on them. The leaders of the lems of poverty-stricken people, and benefit project should be able to tell the student fel- them more, by offering our manpower services lows and other workers exactly what they will to organizations which the people themselves be doing. This was one of the main drawbacks. have created out of awareness of their own I.spent most of the month of July looking for needs. Perhaps that way we can also convince the things to do, then when I finally really got them that we are not flighty, well-meaning but started August was half over. Secondly, SHP do-nothing kids, who have come slumming for must have strong leadership. With an organi- the summer.-M.H., Law Student, Lower East zation as large and spread out as the Greater Side. New York Project, you must have leaders who A place for SHO in our community? I look are able to make a decision without taking a around Grown Heights and I say yes. Perhaps poll of all the workers. I would also suggest a coordinating employment project for biomed- that -instead of spreading the project all over ical careers and paramedical professions. Why the city, SHP should concentrate on one area not extend the patient advocate position to and try to have large successes there instead of other hospitals and other communities. We 132 SUMMER 1968 could establish some liaison with hospitals in round program is community trust and sup- the area and ask . them for their port. To merit community trust and support a opinions. program cannot pull out at the 'end of a 10- As lead poisoning cases in the area continue week period. To effect changes in health care to rise, we could make a project of checking on an organization must have community support. apartments that are serious enough to warrant Although part of the Newark project is con- immediate emergency attention by the city and tinuing in the form of planning a health advis- try to get loose paint and plaster on the city's ory council, made up of community people, this list of emergency conditions that must be taken is not enough. Although the students must re- -care of immediately.-M.H., Sociology Student, turn to their respective schools, communica- Brookl,yn. tions and activities could be continued through Thus far the student health project func- the work of the NYC'S, community workers, tions only during the summer months. This and faculty advisor, and possibly previous means that every summer a new relationship health science students who have completed has to be fostered all over again and that the their education.-K.S., Nursing Student, Ne- new students have to learn all over again how wark. to cope with the problems and the people of the I believe any future projects should seek to community; while the people of the community make themselves available to assist directly have to learn how to trust the new students. any already existing organizations in need of Wii@ll this type of short-term relationship, the help. This would provide us with the needed only ones who are benefitting are the students. background information to avoid trial and So far, nothing concrete has been left in the error learning which we had little time for. It community. Why can't student health projects also would serve as a lever to get us into the be run on a year-long basis so that there will be community quicker, and in an already respect- continuity of care, personnel, and trust?- able way. M.,J., Nursing Stttdent, Bronx. It was my feeling, in the beginning of the My most immediate suggestion in continu- summer, that I would be living right in the ance of the program throughout the year. The area. It was a mistake not to do so. Though a few individuals did, I think future project fel- success of this project has been in becoming aware of the health needs of an impoverished lows should try living in close proximity, man- community and in becoming so involved with aging the affairs of a home and job together. poor people and their unceasing problems that 'All money should be pooled to go for rent and food. Any leftovers would be divided up at the one's commitment to community medicine is end among the workers as salary. I believe this strengthened. However, these successes do not would really lead us to experience, first-hand, begin to initiate the radical reforms that are what it means to exist on a restricted budget. urgently needed in the administration of Granted, this is an idealistic view, but maybe health care to the indigent. Reforms will @come some of the ideas can be modified and put in only with constant pressure on the existing working order.-J.M., Nurss'ng Student, Lower system of health care. This point was illus- East Side. trated vividly in the Newark Project by ad- ministrators of Martland Medical Center, the Perhaps one person could be specifi- established center of health care for the indi- cally in charge of NYC activity for two to ,gent of Newark, constantly --iving evasive res- three weeks. This person might arrange for ponses to suggestions for better health care de- one or two NYCs to work alongside some per- livery, knowing they would only have to listen son in the community whose job they are inter- to these suggestions for a limited period of ested in learning or aspire to: surgeons, anes- time. thetists, X-ray technicians, attorneys, police, I Another factor illustrating the limitation @of firemen, etc. Another suggestion to ponder is a ten-week program and the need for a year- whether two community workers would be bet- GREATER NEW YORK ter than one because some competition might ual community since factors such as de- develop between them to see who could do the gree of organization and level of politi- better job. Or at least each might, out of a cal sophistication had to be considered. sense of pride, strive to accomplish a body of (4) There were some complaints that some acts which they can point to.-N.W., Law Stu- students become impatient working dent, Newark. with lay people and would revert back RECOMMENDATIONS to a reliance on other professionals de- spite the talk of equality. Recommendations From Community (5) It was unanimous that the project Worker Workshop should take responsibility to send to (1) Questioning of the concept in practice of every project staff member in advance the patient advocacy role: (a) A feeling of the program a list of what project that the outsider (usually middle class funds can and cannot be used for. white) is further deepening the psy- (6) Everyone should have job descriptions chologically debilitating dependency po- before starting the work. sition of the person being helped. Doing (7) Finally, community staff want, psychol- everything for, and failing in the teach- ogically, to know that students cared ing function which will enable people to and really are with us. "Even a student advocate for themselves; (b) The con- who goes back to California could send cept of confidentiality is frequently vio- a card to say 'I was thinking about lated. Isn't this a reflection of an uncon- you'.20 scious racism? Recommendations for Community (2) On the selection of community workers Control and coordinators: Selection should be At this morning's workshop on the role of done by a community screening group the white medical student in black communi- who reflect the highest aspirations of ties, an important question was raised but not that community. Priority should be resolved. It was mentioned that the only way given to those community workers who the health care delivery in ghetto areas could have worked with the project before be significantly improved would be for the and demonstrated their value. community to take control of the hospitals and (3) On the question of whether students health facilities and run them. A medical stu- have anything significant to offer, or dent suggested that that was impossible-it whether their presence is irrelevant, the takes ten or twelve years to become a doctor, group was split. For those who felt stu- how can community people do the things that dents had no place, reasons were: 1 doctors do? This completely missed the point, Their presence is a perpetuation of we think, and we would like to set out our white power; (2) they are not needed views on what community control means, how because when they leave the community it could be accomplished, and how SHP could is in the same bag. For those who felt relate to the movement toward community con- they had a place, it was believed that: trol that is taking place in so many areas these (1) Students could open up doors; (2) days. students did provide services where The philosophical basis of community con- none previously existed. But this group trol has its roots in this country at least as far still felt the issue was community con- back as Thomas Jefferson. The classic liberal trol, and believed that the proportions ideal of Jefferson, the faith in the individual between community staff and students and the commitment to participation in self- must be reversed. Following further government, is one of the foundations of our discussion, it was agreed that this ques- political system. What we have seen in the tion was best answered by each individ- United States is the rise of institutions which 134 SUMMER 1968 were immune from the political system and more important for the community than more were unaccountable to the people who were af- glamorous things like open-heart surgery or fected by them; hospitals in ghetto areas with sophisticated research' boards of trustees who didn't live in the com- B. Hiring and firing of medical and ancillary staff-the community group should be able to con- munity are a good example of this, because trol the hiring of medical personnel after they have they so often become unresponsive to the needs been screened for professional competence by the of the people they serve. The two chief benefits medical board or director and ancillary person- we see from community control of health facil- nel on the basis of interviews. In both cases, the ities, then are that they would be made res- community groups could concern itself with such things as the attitudes of the employees toward ponsive to the needs of the community and that the community from which the patients come, their by having elected health councils or boards sensitivity to people, and their dependability. Fir- they would be accountable to the people they ing could be done on the basis of staff and patient serve. complaints. We suggest the following ways to set'up a C. Control of the finances of the health facility community health council or board for either a -we contend that community control implies fiscal control. Administration of the finance could be in neighborhood health center or a community the hands of a comptroller or manager employed hospital - by the clinic or hospital, but decisions as to w iere 1. Make contact with a few active individuals the money wil be spent should be in the hands of in the community who are concerned about health the community group. and want to do something to improve the delivery. We feel that community control is where system. @@ings are headed these days and decentraliza- 2. Set a date for a mass meeting to discuss the -cion of health facilities in neighborhood health health situation and what can be done about 1+@., disseminate information about the meeting as clinics is one of the most significant trends in widely as possible, using radio, newspapers, leaf- medicine. SHP might involve itself precisely lets, and contact with community groups. The where these two trends meet; it might set it- community people could make the personal con- self up as a resource to community people who tacts and the initiating group could provide the want to develop health institutions that are funds and produce the leaflets. 3. At the mass meeting, suggest mechanisms responsive to community needs or who want to for electing a board or council and let the as- assume control of existing institutions. Stu- sembled group decide which method to use. Pos- dents might be able to research other facilities sible mechanisms would be representatives from that have been set up under control and find all community, organizations in the area, a one- out if they are working; they could help with third community, one-third professional, one-third organization representation, an election from a the organization of the first meeting; and they slate of all people who had submitted petitions of could know enough to get out when they are support, etc. not needed or when they are getting in the 4. While the board was being elected, assign a way. Indeed, if SHP is to have any relevance to group to explore means of funding the clinic or what's happening, and not be just a liberal ser- cooperating with the hospital system. vice organization where future doctors and We suggest the following powers for the nurses get sensitized, then it must embrace and community council or board; the obvious as- relate to the concept of community control. sumption is that community people do not nee to be doctors to control non-medical decisions From Workshop on the White Student about the health facilities: in the Ghetto A. Control setting of priorities-the com- 1. Black people have depended on whites munity groups should be the one to assess the needs of the community and set the priorities of too long. Any program has to create a care provided by the facility in orderto meet those black economic structure in a "together" needs. For example, if there is a serious narcotics community. Blacks don't want to be used problem in the community, the community groups any longer, to be studied, or to be filmed should be able to put narcotics treatment high on Especially to their own disadvantage. the list of priorities; also facilities for premature 2. White students can do more by going to babies, or screening for lead poisoning may be SUMMER 1968 effective means of approaching the goal residents who are interested in health is- (depending on project site, previous his- sues. The students would use their exper- tory of successes and failures, etc.) tise to get a grant and would support the 4.' Necessary sensitization should be pri- project by doing research on issues that marily in winter programs and only sec- the community workers raise. There ondary in the summer projects. Summer should be more community people than should be for doing work and accom- students in such projects. plishing project goals. 4. SHP fund-raising and research.-The as- 5. A special point in the winter program sumption is that SHP should try to get should be the recruiting of black and funding from private or local sources. Puerto Rican high school and college stu- Students or community groups who are dents who show inclination towards med- working on improving health services or ical and paramedical professions. raising political issues in health would Two types of project actions are recom- apply for funds for their projects. SHP mended: might work with law students or civil A. Working with independent agencies liberties groups to research legal implica- doing whatever they want (i.e., foot- tions of the projects. work, research, etc.) 5. A Live-in Project.-Students would live in B. Setting up projects whose aims are to be a community, at the request of a local continued by a community group. The na- group and do direct community organiz- ture of the project to be decided and ing around health, organizing neighbor- structured during the winter months. hood health councils, bringing direct ac- Summer projects: tion against hospitals, etc. The prototype 1. Structured service projects.-Summer for this is the Cleveland SHP. projects that are specific in design and 6. A Work-in Project.-Students would get are staffed by highly selected students jobs in hospitals or summer research sti- with similar ideological views. Students pends (in community medicine, if possi- could work in hospitals or with commun- ble) and would raise issues of inadequate ity groups where significant preparations health care. They would seek alliances have already been made. This would.. with community groups that could mobil- avoid th.e period of picking out a course ize support for improvement in health of action and working out of group dy- care provision. Year-round projects at namics problems which past SHP's have schools: had to go through. We feel that any projects should aim qt edu- Affiliation with a community organization.- cating fellow students about the inadequacies Projects which could be funded jointly of health care provision, especially in low-in- with a community organization so that come areas, and should try to correct injustices the health students are putting them- that exist in their own medical centers. Pro- selves at the direct disposal of the com- jects could include courses in the "Politics of munity. The project would have to be de- Health" or the "Crisis in Medical Care," hold- signed by students and community organ- . ing workshops for community people to build izations together from the start. an awareness of health as a right, and devising 3. Funding co?nmunity people.-Projects means of direct political action to bring about would be made up mostly of community change in the local health facilities. 137 GREATER NEW YORK their own white communities. If they tion to the community before working in want to be involved in the black commun- it. ity there have to be safeguards to guar- 2. Working relationships weren't estab- antee sincerity and loyalty to the com- lished because of health student atti- munity. tudes of superiority and lack of interest 3. White students are interfering with ex- in the NYCS. isting community structures. People 3. NYC's feel that if they are to be consider- don't want whites there all the time ed equal as stated at Orientation, they (especially on a summer basis) doing should be given the same wages as the what blacks should do for themselves. students. Opposition to this means that 4. SHP has initiated actions which can be orientation statement was idealistic and not worth a bag of beans. pursued by the community-legal suits, 4. Late wages discouraged NYC's from advocacy, patterns of reforming the working. structure. 5. The pattern of action may be reformist 5. Equalization of work between the NYC's and health students: Students shouldn't or revolutionary. The revolutionaries ask NYC's to do anything they wouldn't among us regard advocacy as patchwork. do, e.g., Bronx lead poisoning project There are health councils galore in a lot where NYC's had to collect urine speci- of communities, but what is -needed are mens from house-to-house; the students law suits, picketing. Medical, nursing, collected a few times but not to the ex- and law students may disseminate infor- tent that they made the NYC's collect. mation, but the community should take 6. Lack of constructive work initiated for over the hospitals. either NYC's or health students discour- 6. Perhaps the Student Health Organiza- aged NYCS. tion should be retitled the Community 7. Some NYC's feel that the students took Health Organization, run for and by advantage of them as individuals. black students. It is suggested that black 8. NYC's would like to have practical communities select the professionals who health education, such as first aid, artifi- will be trusted, using a greater number cial respiration, what to do in emergency of community people'rather than risking situations like strokes, heart ittacks, etc. getting insincere health students. It is 9. NYC's feel they would appreciate tuto- unfair to the community to send.in 'fresh rial programs involving their needs and troops' each year just so they can be sen- interests, done on a constructive basis. sitized, and then leave, returning to their 10. NYC's would like to have representation schools (to a white 'structure) where, in within meetings and have something fact, they will be coopted. done to abolish their dislikes. They want 7. Health professionals are needed because spokesmen to make project directors there aren't enough black doctors, aware of their gripes and take action. lawyers, nurses. In certain -ewes, Recommendations for Future Student organizations employ professionals they Health Organization Projects themselves respect. Health professional 1. Summer SHP's must be a direct continu- students know what good health care is ation of SHO activities that .exist during and can point the'injustices out to the the year. community, who, in turn, can do what- ever they want to do to correct them. 2. The main SHO objective should not be to sensitize or educate students or commun- Recommendations from NYCs ity, but rather to basically change the 1. Students need more experience as to com- structure of health care and delivery. munity happenings, i.e., better orienta- 3. Attack should be whatever is the most Appendix A:- LISTING OF PARTICIPANTS CENTRAL OFFICE STAFF Project Director: Marylyn Gore-Albert Einstein College of Medicine. Student Co-directors: Nivia Nives-Bronx Community College School of Nursing. Peter Bryson-Downstate Medical Center. Educational Coordinator: Simeon Grater-Albert Einstein College of Medicine. Faculty Sponsor: Martin Cherkasky, M.D.-Director, Montefiore Hospital and Chairman, Depart- ment of Community Medicine-Albert Einstein College of Medicine. SOUTH BRONX Student Area Coordinator: Bernice Baker-Bronx Community College School of Nursing. Community Coordinator: Marie Gallishaw Faculty Ad@or: Harry Becker-Albert Einstein College of Medicine. Medicine: Nora J. Avins-Woman's Medical College. Karen E. Benker-University of Southern California. Ingrid Buhler-Albert Einstein College of Medicine. Robert Cohen-Albert Einstein College of Medicine. Peter Cummings-Case Western Reserve University. Robert Ferrell-New York Medical College. Christopher Frantz-Albert Einstein College of Medicine. John Graves-Albert Einstein College of Medicine. Michael Pawel-Albert Einstein College of Medicine. Nursing: Iris Arroyo-Bronx Community College. Patricia Benson-Syracuse University. Harriet Hair-Bronx Community College. Madeline Jervis-Bronx Community College. Anna Lopez-Bronx Community College. Vicki Vernig-San Jose State College. Jean Whelan-Hunter College. Law Arthur Kaplan-Harvard University. Dentistry Victor Sternberg-Tufts University. Community Workers Miriam Feliciano Elizabeth Prole Mercedes Hunter Carmello Rodriguez Program Ad@or Fannie May BROOKLYN Student Area Coordinator Warren Sweberg-Downstate Medical Center. Coinmunity Coordinator 139 GREATER NEW YORK Marian Williams. Faculty Advisors June Finer, M. D.-Columbia University. Jeff Weiner-Downstate Medical'Center. Medicine: William Basta-Downstate Medical Center. Richard Berkowitz-Downstate Medical Center. Ernest Braasch-Downstate Medical Center. Eric Cameron-Downstate Medical Center. Benjamin Fass-Downstate Medical Center. Robert Johnson-Downstate Medical Center. Daniel Koblentz-Downstate Medical Center. Leslie Kriegman-Downstate Medical Center. Margo Mazur-New York University. Joseph Ryan-Downstate Medical Center. Jules Tanenbaum-Downstate Medical Center. Richardo Wilson-Downstate Medical Center. Daniel Yellon-Downstate Medical Center. Nurss'ng Leslie Clarke-Boston University. Ellen Pindus-Molloy College for Women. Law Roger Haines-University of California at Berkeley. De-ntigtry Jan Wade Gilbert-Meharry Medical College. Steven Parnes-Meharry Medical College. Sociology Marian Hyler-Tufts University. HARLEM Student Area Coordinator Richard Clapp-Columbia University. Community Coordinator: Mary Smalls. Faculty Ad@ors: Ezra Davidson, M.D.-Harlem Hospital. Doris Wethers, M.D-Knickerbocker Hospital. Medicine: Joan Adler-University of Cincinnati. Louis Bartoshesky-Cornell University. Ken Cousen@Columbia University. James Cowan-Meharry Medical College. Stephen Gluckman-Columbia University. Barry Goozner-Columbia University. John Hibbert-Howard University. John Obedzinsky-Columbia University. Colin Romero-Howard University. William M. Smith-Columbia University. Carter Willsey-Columbia University. Nursing Angela Gaetano-Hunter College. Patricia Jone&-Bronx Community College. Barbara McFadden-Bronx Community College. Law Ellsworth Martin-Howard University. Francis Vergata-University of Chicago. Psychology Marla Isaam-Columbia University. International Affairs: Janet Barre@olumbia University. 140 GREATER NEW YU.KM Ctii%ics scwuud dave Ext. *Endocrine & Obesity ------ Wednesday ----------------- I:oo-Soo pin. 715,717 *HematologY, -------------- Wednesday ----------------- 9:00-11:00 am. 715,717 *Neurology --------------- ist and Srd Mondays -------- 9:00-11:00 a.m. 715,717 *Pediatric Follow-UP ....... Monday, Tuesday and 2:00 noon 715,717 Thursday ---------------- 11:00-1 *Pediatric General -------- Monday through Friday ---- 8:00-4:00 pm. 715,717 *Physical Handicapped ---- 2nd Tuesday ---------------- 9:00-41:00 a.m. 715,717 sday ----------------- 1:00-3:00 pm. 715,717 *Premature --------------- Wedne --------- 9:00-11:00 am. 715,717 *Respiratory Follow-UP ---- Tuesday ---------- am. 715,717 *Seizare ------------------ Thursday ------------------ 9:00-11:00 *Surgical Follow-Up ------- Wednesday ----------------- 1: 3@3:30 pm. 715,717 *Urology ----------------- Tuesday ------------------- 9:00-11:00 am. 715,717 Surgery: *Breast ------------------- Wednesday ----------------- 1:30-8:00 pm. 414 Child ------------------ Monday, Wednesday and Friday ------------------- 9:00-11:00 am. 580 Diagnostic -------------- Monday and Tuesday -------- 1:00-3:00 pm. 580 Thursday ------------------ Female ------------------ Thursday and Friday -------- 9:00-11:00 am. 490 Ponowup --------------- Thursday ------------------ 1:00--B:00 PM. 580 Hand ------------------- Wednesday ----------------- 9:00-11:00 am. 580 Male ------------------- Monday, Tuesday, Thursday and Friday --------------- 9:0041:00 a-In- 689 *Plastic --------- 580 --------- Monday -------------------- 1:00-3:00 pra. - Thursday ------------------ 9:00-11:00 am. 414 *Podiatry ---------------- Tuesday ---------7 --------- 9:00-11:00 am. 408 Wednesday ------------ ---- 1:00-3:00 P.M. - 408 *Proctology --------------- Monday and Friday --------- 9:00-11:00 am. 580 *Thoracic ----------------- Monday and Thursday ------ 1:00-3:00 P.M. - - - 418 *Tumor, Head, & Neck ---- Wednesday ----------------- 9:00-11:00 am.. - - 490 *Urology-Adult ------------- Tuesday and Thursday ----- 9:00-11:00 am. -- 580 Infertility (Male) -------- Wednesday ----------------- 5:0@8:00 pni. 580 *Vascular ----------------- Tuesday and Friday --------- 1:00-8:00 pm. 418 Ear, Nose and Throat ---- Monday, Tuesday, Thursday and Friday ----- 1:00-3:oo PM. -490 Eye --------------------- Monday, Tuesday, Thursday, Friday --------- 1:00-8:00 P.M. Oral Surgery ----------- Monday through Friday ---- 8:00-4:00 p.m. 657 Others: Blood chemistry ----------- Monday, Tuesday and Thursday ----------------- 7:00-9:00 am. 408 Mental Hygiene- (Adult and Child) ---- Monday through Friday ----- 9:0":OO pm. 567 Adult ---------------- Tuesday, Wednesday and 567 Thursday ---------------- 6:80-9:00 pm. Rehabilitation Medicine @--Monday through Friday ----- 8:00-11:80 am. 584 Employees Health Service -Monday through Friday ----- 8:00-4:00 pm. 417 *Appointment clinics Central, Harlem Destrict Health Center 2238 Fifth Avenue (137th Street) AU 3-1900 1. Dental clinic 1. The patient must come from a public school within the health district School 189, 136, 175, 183, 197, 120),- but they do not have to be referred through the @ool@if a child attends one of the schools a p bring him to the clinic. 146 SUMMER 1968 Community Workers: Charlie Mae Jones. Nettie Knox. Maxine Livingston. Altamese Maxwell. LOWER EAST SIDE Student Area Coordinator: Steven Dubovsky-New York University. Community Coordinator: Helena King. Faculty Advisor: Alice Miller-New York University. medicine: Jerome Aronowitz-University of Maryland. Edward Charney-New York University. Joseph Colletti-Howard University. Kenneth Ducker-New York University. Judith Pleasure-New York University. Diana Post-New York University. Sharon Ruskin-Marquette University. Peter Sheckman-New York University. David Sternber@Tufts University. Joseph Willner-New York University. Nursing: Beryl Gifford-Hunter College. Marilyn Levine-Hunter College. Judith Levy-Hunter College. Joan Musaro-Hunter College. Law: Martha Halpin-Yale University- Jonathan Marsh-New York University. Bettina Plevan-Boston University. Dentistry: Gerald Low-New York University. Ps,yeh@gy - Linda Gunsber@Yeshiva University. Coinmunity Worker - Sharon Diaz. NEWARK Student Area Coordinator Daniel Tartaglia-New Jersey College of Medicine. Community: Reginald Peniston Faculty Ad@or John Seebode, M.DNew Jersey College of Medicine. Medicine Richard DeBlasi-New Jersey College of Medicine. James Davis-Howard University. Peter Dorsen-New Jersey College of Medicine. Karen Filkins-New Jersey College of Medicine. Andrew Hurayt-University of Rome. Dennis Massler-New Jersey College of Medicine. Bruce Wermuth-Stanford University. Walter Wiechetek-University of Maryland Nursing: Andra Cross-St. Mary's College. Laura Doner-O'Connor School of Nursing. Ann Maroney-Syracuse University. Joyce Quock-O'Connor Sc'nool of Nursing. Kathleen Sherdian-St. Joseph's College. 141 Law: Neal Wiener-Loyola University of Los Angeles. Co-?nmunity Workers: James David Branch Katherine Cunningham NEIGHBORHOOD YOUTH CORPS George Acosta Walter Fletcher Gwendolyn Page 'tl@-rna Alvarez Nellie Garcia Carlos Perez Louis Aquino Maria Gomez Raymond Perez Cathie Baker Mirella Gomez David Ravenell Alan Benton Jeffrey Goodson Tom Reynolds Shirley Beechem Elaine Hale David Rhabb Gail Bristol Walter Hall Jack Rivera Eugene Brown Nurseal Hill Naomi Robinson Alfred Burt Dwight Jackson Nilda Rodriquez James Canty Agnes Jacobs Leroy Rozus Joanne Challenger Alzrina Johnson Rodney Shepard Pat Carswell Gloria Jones Laverne Singleton Roscoe Carthen Lilly Jones Cassandra Smith Victor Castro Leonard Knox Joan Smith 'Nelson Cintron Eric Livsey Leon Terry '-Nlicbael Colden Michael McClamb Randolph Tomlin Earl Collins Frank Morales Mamie Towns Kevin Collins Josephine Morales Gabriel Vasquez Gregory Dabney Arthur Murphy Julio Vasquez Gregory Darby Mason Napir John Watson Bradley Davis Julio Nieves Norm Whitlow Vashti Davis Elizabeth Norwick Phyllis Whittiker Alvin Duggins Terry Ormand Marilyn Whittfield Rafael Figuera Doris Ortiz . Marilyn Wilder LaVell Finerson Martha Pacheco Denise Wills Will,ard Finerson Gladys Padilla Nina Yung Sociologist Evaluator: Ronald Miller-New York University. Administrative Assistant: Jody Williams-Albert Einstein College of Medicine. Project Secretary: *Richard Perez. 142 Appendix B: HEALTH RESOURCES IN THE HARLEM AREA HARLEM HOSPITAL OUT PATIENT DEPARTMENT Lenox Ave. and 137th St. AU 6-3300 People in charge Service Dr. Wesley --------------- Director ambulatory care Dr. Russell -------------- Director social services Mr. Watldns -------------- See for clinic problems Mr. Giddings ------------- Surgery clinics Miss Mebane ------------- TB clinic Mrs. Johnson ------------- Emergency room coordinator Mrs. Place ---------------- Pediatric clinic coordinator Dr. Kahn ---------------- Director Pediatrics Miss Richardson ---------- R.N. pediatric clinic Mrs. Williams ------------ Clerk, pediatric clinic Clinic procedure: I. New patient (never been to H.H. before) 1. Start at the initial screening desk 2. Screening area a. examination for the type of medical problem b. clinic card number is assigned c. medicaid application can be made d. blod and urine tests are ordered e. X-ray (required by state law) f. sent to a specific clinic window for the medical problem S. Specified clinic window a. medical records are completed and sent to be kept in the file room b. Now the patient -may be: (1) given an appointment for the correct clinic for his problem or (2) sent directly to the correct clinic when immediate service is possible or (3) sent to the emergency room if immediate treatment is needed but the clinic for his problem is dosed 4. When a patient goes to a specific clinic for his problem A. drop the clinic card into the box or hand it to the clerk b. clerk then either fills out medicaid form or makes out a bill for the patient c. patient then sits and waits to be called for treatment 11. Old patient (been to H.H. for that problem before) 1. If the clinic that the patient goes to is an appointment clinic, the patient goes straight there on the day of the appointment and drops the appointment card in the box or hands it to the clerk. The patienVs records will already be there. Ill. Old patient with a new problem 1. Patient must.first go to the screening desk for an examination for the type of medical problem 2. Then the patient may a. go directly to his specific clinic if it is a non-appointment clinic or b. get an appointment for his specific clinic if that clinic requires appoint- ments or c. go to the emergency room if immediate treatment is needed but the clinic !or his problem is closed IV. Obstetrical-Gynecological Clinic (Ob-Gyn) 1. It is on the 8rd floor of the K building 2. It requires a double registration@nce on the ground floor at the clinic registration desk, and then again on the Ob-Gyn floor (3rd). 143 GREATER NEW IL)nm 3. Ob-Gyn does its own screening and keeps its own records V. Emergency Room 1. Ambulance service is by police call only 2. All patients must be registered and screened at the emergency room registra- tion deslc. VI. Pediatric Clinics 1. They are on the 3rd floor of the pediatric building-patient goes directly there to register 2. These clinics see infants and children up to about 11-12 years of age. 3. Procedure a. Patient goes directly to the pediatric clinic b. New patients go to the clerk to register and to fill out a medicaid applica- tion: Old patients go to the clerk and give her the clinic card and the medicaid card (if they get medicaid). c. Now sit and wait to be called for treatment d. Note: to save time-if the child has a clinic card (any child who has been to H.H. before or was born there has one) the parent can call a day ahead so then his child's hospital records will already be at the clinic and will not have to be sent for when he comes. e. If there is any trouble ask for Mrs. Place. She is in charge of the clinic and is there to take care of a patient's problems VII. Oral Surgery Clinic 1. This is the only place in the Harlem area that one can go to get teeth pulled (except to a private dentist). 2. Must get there at 8:00 A.M. to have a general examination. This is required before they will give a patient the general anesthetic (gas). 3. Parent must accompany child the first time to register him, then the child can cozne with anyone the next time. VIII. Opthamology Clinic 1. Very poor clinic at H.H. Go someplace else like to MIA. XI. Psychiatric Clinic 1. All of the psychiatric facilities available to the Harlem. area are described on pages 14-18. Additional Remarks about Harlem Hospital: 1. The specialty clinics have anywhere from 3 weeks to 2 months waiting list. 2. A playroom will be opened in the pediatrics clinic at the end of the surmner. It will be staffed by a full time paid worker from the Domestic Peace Corps. It is there for the children who come to the clinic so that the waiting will be more bearable both for them and for the parents who bring them. 3. Payi-ng: a. The fees at H.H. are determined on a sliding scale; this means that a person pays an amount that is based on the income of his family. b. Patients do not have to Pay when they get the treatment; they can ask that the hospital send them a bill. c. The bills usually do not come for many months. d. If a person has medicaid, he only has to brinx the bill back to the hospital along with his medicaid card. That takes care of the bill. e. A patient should not worry about any billing problems. Treatment must be given for all, regardless of financial status. 4. If a patient has any difficulty in one of the clinics, he. should ask to see Mr. Watkins. *Appointment clinics cli@8 Scheduled days Time Gynecology *Cytology ----------------- Monday --------------------- 1:00-3:00 pin. 680 *Dysmenorrhea ------------ Thursday ------------------ 9:00-11:00 am. '-- 630 144 SUMMER 1968 Clinice Scheduled days Titr&e Eze. *Endocervicitis ------------ Wednesday ----------------- 9:00-11:00 a.m. 630 *Endocrine ---------------- Wednesday and Thursday --- 1:00-3:00 pm. 630 Wednesday ----------------- 9:00-11:00 a.m. 630 *Gynecology General ------ Tuesday ------------------- 12:30-3:00 p.m. 630 Gynecology General ------ Monday, Tuesday Thursday, Friday --------- 9:00-11:00 a.m. 630 *Infertility --------------- Wednesday, Thursday ------- 1:00-3:00 P.M. 630 *Menopausal -------------- Thursday ------------------ 9:00-11:00 a.m. 630 *Tumor Follow Up -------- Monday -------------------- 1:00-3:00 P.M. 630 Maternal Health --------- Saturday ------------------- 9:00-12:00 noon 628 *I.U.D - ------------------- Tuesday and Wednesday ----- 9:00-11:00 a.m. 628 *Oral Contraception ------- Wednesday and Thursday ---- 12:30-4:00 p.m. 628 MEDICAL CLINICS: *Allergy ------------------ Wednesday and Friday ------ 9:00-11:00 a.m. 408 *Cardiac ---------------- Monday, Wednesday --------- Thursday and Friday -------- 9:00-11:00 a.m. 639 *Chest & T.B.C - --------- Monday, Wednesday, Adult ------------- Thursday and Friday ----- 9:00-11 :00 a.m. 418 Children ----------- Tuesday ------------------- 9:00-11:00 a.m. 418 Dermatology ------------- Monday through Friday ---- 1:00-3:00 p.m. 639 *Diabetes ----------------- Tuesday and Friday --------- 1:00-3:00 p.m. 668 Diabetic Supply and Instruction -------------- Monday through Friday ----- 9:00-11:30 am. 408 *Gastroenterology --------- Consultations, Wednesday --- 1:00-3:00 P.M. 637 Hematology -------------- Wednesday ----------------- 1:004:00 P.M. 580 *Medical ------------------ Monday through Friday ----- 9:004:00 pm. 637,668 Medical Reception -------- Monday through Friday ----- 9:00-4:00 pm. 540 *Neurology --------------- Tuesday ------------------- 1:00-3:00 p.m. 580 *Thyroid ----------------- Tuesday ------------------- 9:00-11:00 am. 639 Venereal Disease- Male G.C - ----------- Monday through Friday ----- 9:00-11:00 am. 639 Syphillis ------------- Monday through Friday ----- 1:00-3:00 p.m. 639 OBSTETRICAL Antepartum (new cases) --Monday through Friday ----- 9:00-11:00 a.m. 681, *Antepartum (reviE;its) ---- Monday through Friday ----- 1:00-3:00 p.m. 631 *Antepartum Adolescent --- Friday --------------------- 1:0@ :00 P.M. 631 Family Planning General - -Tuesday, Wednesday and 5:30-7:30 pm. 631 -3:00 p.m. 631 Thursday ---------------- 1:00 Post partum ------------- Tuesday ------------------- 1:00-3:00 P.M. 631 Orthopaedic and fracture: *Fracture- Adult --------------- Tuesday, and Friday -------- 1:00-3:00 pm. 414 Child ---------------- Friday --------------------- 9:30-11:30 a.m. 592 *Fracture-End Results (Long term follow-up) --Thursday ------------------ 1:00-3:00 p.m. 414 *Orthopaedic-Adult Monday -------------------- 1:00-3:00 p.m. 592 Child ------------------ Friday --------------------- 9:30-11:30 am. 414 Pediateric: *Allergy ------------------ Wednesday and Friday ------ 9:00-11:30 am. 715,717 *Cardiac ------------------ Thursday ------------------ 1:00-3:00 pm. - 721 ----------- '715,717 *Dermatology --- Tuesday ------------------ @9:00-11:00 am. *Development ------------- Monday ------ ---------- 1:00-3:00 P.M. 715,717 *Deabetes ---------------- lst Tuesday ---------------- 9:00-11:00 a.m. 715,717 *Appointment clinie-s 145 GREATER NEW YORK Clitties Schauted days !rime Ezt. *Endocrine & Obesity ------ Wednesday ----------------- 1:00-3:00 p.m. 715,717 *Hematology -------------- Wednesday ----------------- 9:00-li:00 a.m. 715,717 *Neurology --------------- Ist and 3rd Mondays ---- --9:00-11:00 a.m. 715,717 *Pediatric Follow-up ....... Monday, Tuesday and Thursday ---------------- 11:00-12:00 noon 715,717 *Pediatric General -------- Monday through Friday ---- 8:00-4-00 p.m. 715,717 *Physical Handicapped ---- 2nd Tuesday ---------------- 9:00-11:00 a.m. 715,717 *Premature --------------- Wednesday ----------------- 1:00-3:00 p.m. 715,717 *Respiratory Follow-Up ---- Tuesday ------------------- 9:00-11:00 a.m. 715,717 *Seizure ------------------ Thursday ------------------ 9:00-11:00 a.m. 716, 717 *Surgical Follow-Up ------- Wednesday ----------------- 1:30-3:30 pm. 716,717 *Urology ----------------- Tuesday ------------------- 9:00-11:00 am. 715,717 Surgery: *Breast ------------------- Wednesday ----------------- 1:30-3:00 pm. 414 Child ------------------ Monday, Wednesday and Friday ------------------- 9:00-11:00 am. 580 Diagnostic -------------- Monday and Tuesday -------- 1:00-3:00 pm. 580 Thursday ------------------ Female ------------------ Thursday and Friday -------- 9:00-11:00 am. 490 Followup --------------- Thursday ------------------ 1:00-3:00 P.M. 580 Hand ------------------- Wednesday ----------------- 9:00-11:00 am. 580. Male ------------------- Monday, Tuesday, Thursday and Friday --------------- 9:00-11:00 am. 589 *Plastic ------------------ Monday -------------------- 1:00-3:00 P.M. - 580 Thursday ------------------ 9:00-11:00 am. 414 *Podiatry ----------------- Tuesday ------------------- 9:00-11:00 am. 408 Wednesday ----------------- 1:00-3:00 P.M. --- 408 *Proctology --------------- Monday and Friday --------- 9:00-11:00 am. 580 *Thoracic ----------------- Monday and Thursday ------ 1: 00-3 - 00 P.M. - 418 *Tumor, Head, & Neck ---- Wednesday ----------------- 9:00-11:00 am. 490 *urology-Adult ------------ Tuesday and Thursday ----- 9:00-11:00 am. 580 Infertility (Male) -------- Wednesday ----------------- 5:00-8:00 pm. --- 580 *Vascular ----------------- Tuesday and Friday --------- 1:00-3:00 p.m. --- 418 Ear, Nose and Throat ---- Monday, Tuesday, Thursday and Friday ----- 1:00-3:00 P.M. --- 490 Eye --------------------- Monday, Tuesday, Thursday, Friday ......... 1:00-3:00 P.M. Oral Surgery ----------- Monday through Friday 8:00-4:00 P.M. --- 657 Others: Blood chemistry ----------- Monday, Tuesday and Thursday ---------------- 7:00-9:00 a.m. 408 Mental Hygiene (Adult and Child) ---- Monday through Friday ----- 9:00-5:00 pm. 567 Adult ---------------- Tuesday, Wednesday and Thursday ---------------- 6:30-9:00 P.M. 567 Rehabilitation Medicine --- Monday through Friday ----- 8:00-11:30 am. 584 Employees Health Service -Monday through Friday ----- 8-00-4:00 pm. 417 *Appointment clinics Central, Harlem Destrict Health Center 2238 Fifth Avenue (137th Street) AU 3-1900 1. Dental clinic 1. The patient must come from a public school within the health district (Public School 189, 136, 175, 133, 197, 120), but they do not have to be referred through the school-"if a child attends one of the schools a parent may bring him to the clinic. 146 SUMMER 1968 2. To be eligible the child must be between the fifth grade through junior high school. 3. Parent must accompany child only on the first visit, when history and financial information are given and a consent form is signed. No treatment is given on the first visit; appointment will be made for a later date. Registration times are 9-11 a.m., 1-4 pm. Monday through Friday. a. Treatment appointments can be for the morning or the afternoon; parent need not be with the child on these visits. 4. Paying: Depends upon family income. If income is too high one is not eligible for the services, if the patient is eligible the services are free. 5. The dental clinic does everything but tooth extractions (must go to Harlem Hospital oral surgery or private dentist). 6. School dental chairs a. A number of schools have dental chairs. These are merely extensions of the dental clinic, and therefore function similarly and provide the same services. b. Locations: Public School 24-22 East 128th Street LE 4-2866. Public School 68-127 West 127th Street MO 2-1410. Public School 144-134 West 132 Street MO 2-3460. Public School 156-2960 Eighth Avenue AU 1-4847. Public School 194-242 West 144 Street WA 6-0580. Public School 13@2121 Fifth Avenue AU 3-3056. II. Social hygiene clinic 1. Dr. Bloom is in charge. 2. Person may receive free venereal disease examinations and treatment without appointment. 3. Hours: Monday 9-11. Tuesday 1-5 Wednesday 9-11. Thursday 1-7 Friday 9-11. III. Maternal and Child Health Station 1. Services: a. This facility is for well babies; One should not take a sick child here. b. Periodic physical examinations. C. Immunizations for DPT, polio, smallpox, and measles. (Monday and Friday, 9-11 a.m. come early). d. Parent can come ask a doctor or nurse advice, etc. e. When child enters school the records that are kept here will be sent to the school. 2. Children from birth to school age are eligible 3. Walkin (with parent) will be accepted th; first time, but afterwards must have an appointment. 4. Hours: Monday and Thursday AM and PM. Tuesday, Wednesday and Friday AM only. 5. Additional Locations: Morningside Health Center, 264 West 118th Street MO 3-3822. Upper Harlem Child Health Center,.231 West 151 Street TO 2-2640. Mt. Morris Park Child Health Center, 122 Street and Madison Avenue LE 4-4612. St. Nicholas Child Health Center, 281 West 127th Street UN 5-1300. Stephen.Foster Child Health Center, 50 Lenox Avenue EN 9-4610. IV. Chest clinic 1. Only location is the Morningside Health Center, 264 West 118th Street MO 3-3822. 2. At this clinic chest X-rays and other tests are given to find out if person has tuberculosis or other diseases of the chest. If disease is found, treatment is given. 3. Call for an appointment. 147 GREATER NEW YORK V. Eye Clinic 1. Persons up to 21 years of age are eligible for the eye examinations and prescriptions for glasses. 2. 'Patient is usually referred through a school nurse or through a child health station, but parent may call for an appointment. 3. There is an additional location at the Morningside Health Center. VI. Health Education Services 1. Dr. Monrose is the health education officer for the district. He is located in room 212. 2. Consultation services are offered in the planning of health committee activities and health programs for church groups, PTA's and other clubs and settle- ment houses. 3. Films and pamphlets on a wide variety of health topics are available. A minimum of three weeks notice is essential in booking films, although by special arrangement one may pick up the films at the NYC Department of Education Film Library at 305 Fifth Avenue, room 11D, within 34 of ordering. a. The order must be placed with the district officer. No more than 4 films may be ordered at once. 4. Speakers are also available with 4-5 weeks notice. VII. Other Agencies in Central Harlem District Health Center building. 1. Visiting Nurse Service of New York, room 215 AU 6-7210. 2. Family and Child Welfare Student Unit, room B36. 3. Pediatric Social Service, room 211. 4. Alcohol Unit, rooms 307, 308, 311. 5. Community organization for Social Service, room 318. 6. Rehabilitation Medicine, rooms 334, 335. Summary and Time Schedule of SERVICE IN CENTRAL HARLEM HEALTH CENTER DISTRICT (February 1968) Legend: A=9-12 a.m. P = 1-4 p.m. E = 4-7 p.m. *=First and third Tues- day of month Central Harlem District Health Center Build- ing, 2238 Fifth Avenue, NYC. 10037 283-1900. m T w T E Dental ---------------------------------- AP AP AP AP AP Social Hygiene --------------------------- AP p A PE A Maternal and Child Health ---------------- AP A A AP A Eye ------------------------------------- AP p A Morningside Health Center, 264 West 118 Street, NYC. 10026 MO 34822. Dental ---------------------------------- AP AP AP AP AP Maternal and Child Health ---------------- A A A AP A Eye ------------------------------------- p A A A A Chest ----------------------------------- AP A*PE* A AP AP Prenathan and Family Planning ---------- P p Upper Harlem Child Health Center ----------- A A A 231 West 151 Street, NYC. 10039 AU 3-1970. Mt. Morris Park Child Health Station --------- 122 Street and Madison Avenue, NYC. 10035 A A A A LE 4-4612. p Prenatal and Family Planning ------------ A A A A A St. Nicholas Child Health Station ------------- 281 West 127 Street, NYC. 10027 UN 5-1800. A A A A A Stephen Foster Child Health Station ---------- 50 Lenox Avenue, NYC. 10026 --N 9-4610. A AP A Alexander Hamilton Child Health Station ------ 2690 Eighth Avenue, NYC. 10030 862-8002. Dental Clinics in the Schools (See page 8) ---- A A A A@ A 148 SUMMER 1968 MINISTERIAL INTERFAITH ASSOCIATION (MIA) 110 East 125th Street Suite 204 427-5700 Clinics: Monday ------------ internal medicine --------------- 10-42 noon' Dermatology ------------------- 1-2:30 P.M. Tuesday ----------- Ear, nose and throat ------------ 9 a.m@2 m.p. Gynecology --------------------- 2-4 p.m. Allergy ------------------------ 10 a.m.-12:30 P.M. ophthamology ------------------ 10 a.m-l P.M. Wednesday --------- ..... 10:30 a.m-1:30 p.m. Thursday ---------- Pediatrics ----------------- Friday ------------- Internal medicine ------------- -- 10a.m.-I:SOP.M- Ear, nose and throat ------------ 9 a.m@l P-m- . Saturday ----------- optometrist -------------------- 1-30 p.m.-4 pm. 1. MIA.is a very pleasant place-it does not look like a clinic. The staff is courteous and thorough, and the wait tends to be the shortest of any clinic in the Harlem area. 2. It is best to call and make an appointment for one of the clinics in advance. 3. Get there early-30-45 minutes before clinic starting tim@or the shortest wait. 4. Paying: patient must pay from 8-10 dollars per visit. They accept medicaid. They will not send a bill as Harlem Hospital Clinics do. 5. For eye problems, go to the optometrist first. He will refer patients to the opthalmologist if it is necessary. 6. If there are any difficulties see Dr. Farkas, the director. MANHATTAN EYE AND EAR HOSPITAL 210 East 64th Street TE 8-9200 Cl@s: Eye clinic-First floor. Ear, nose, and throat clinic-Second floor. Allergy clinic-Second floor. Hearing and speech clinic. Laboratories-Second floor. Pharmacy-basement. 1. A modern, well-equipped facility. 2. Mrs. Benoit is the Outpatient Department Supervisor. 3. Mrs. Fernandez is the Registrar. 4. First visit is for registration and screening only; a parent must accompany a child. 5. Second visit is for a speciality clinic for which the patient has been given an A.M. or P.M. appointment (always on the same day of the same week as the first clinic visit). 6. For a foster child the BCW number and the case number are required. 7. Procedure for a new patient a. No appointment-arrive by 8:30 a.m. on any weekday. b. Patient gets number at the information desk and sits to wait for an interview. c. At interview the patient receives a clinic card and a chart number. ' d. Patient then gets in line and pays in advance for treatment (see Paying be- low). e. After paying the patient receives his chart and goes to the screening clinic where he gives the chart to the nurse and waits to be called. f. Doctor screens the patient and recommends either returning to the screening clinic or to a speciality clinic at a later date. g. Patient takes white slip to appointment window and there receives an ap- pointment slip which he mu8t not lose. 8. Paying: a. The first visit costs $5. b. All subsequentnsits cost $4.50. 149 GREATER NEW YORK c. X-rays, laboratory work, etc. all cost extra. d. Special fees may be reduced at the discretion of the payment desk, but pa- tient must always pay something unless Medicaid or insurance covers fees. e. There is no billing procedure-patient must pay (or present Medicaid card) on the spot. KNICKERBOCKER HOSPITAL 70 Convent Avenue, AU 1-4100 1. Pediatric clinic only. 2. A.M. on Monday and Friday. P.M. on Tuesday, Wednesday, and Thursday. 3. No screening is required; appointments can be made by phone. 4. Paying: a. The first visit costs $3. b. All subsequent visits cost $2. c. Patient does not have to pay at the time of treatment; the clinic will send a bill. d. Medicaid is accepted in full. ADDICT REHABILITATION CENTER 253 West 123d Street 1. A half-way house for individuals desiring to be cured of heroin addiction. 2. Persons desiring to enter must send a letter or call Mr. James Allen, the director. A personal interview follows this letter. 3. Has both inpatient and outpatient services. As of now women are only seen on an outpatient basis. 4. This is a realistically oriented facility which is run by a staff of ex-addicts. 5. Mr. Allen or one of his staff is also available to give illustrated talks on drug addiction. 6. One of their most important functions is the finding of jobs for the patients stay- at the center. One of their most important goals for a patient is the achievement of economic self-sufficiency and stability. CHILD PSYCHIATRIC SERVICES AVAILABLE IN THE HARLEM AREA Because of the increasing awareness of the need for child psychiatric treatment in the Harlem area and because of the difficulty in attaining such treatment, these facili- ties have been compiled separately. HARLEM HOSPITAL 2238 Fifth Avenue, District: 116th. Street to 155th. Street Inpatient service: there is no inpatient service. Outpatient service: handles ap- proximately 500 patients a year. A. Staff: 3 full-time psychiatrists 3 part-time psychiatrists I psychologist B. Diagnosis: waiting period is from three days to a month; diagnosis is done in a conference with a psychiatrist, a social worker, and a psychologist. C. Treatment: children are referred to Bellevue, social agencies, special schools, Rockland State Hosp., and the Bureau of Child Welfare for placement in special homes. Treatment at Harlem Hospital seldom exceeds one appoint- ment a week with a psychiatrist; occasionally, children are reate by a social worker. D. Special facilities: Harlem Hospital runs a special school for children aged 9 to 13. There are now 15 children in it and there are plans to expand it. ST. LUKE'S HOSPITAL 421 West 113th. Street, District: 86th. Street, to 125th. Street, Morningside to the river Inpatient service: no inpatient service. Outpatient service: handles approximately 500 patients a year. 150 SUMMER 1968 A. Staff: rotating staff of residents. B. Diagnosis: waiting period is about a month; the child does see a psychiatrist after he has gone through the pediatrics clinic. C. Treatment: waiting period is about 6 months; all treatment is by psychiatrists-appointments are seldom more frequent an one per week per child. PRESBYTERIAN HOSPITAL West 168th. Street and Broadway, District: 155th. Street to 181st. Street Inpatient service: there are 16 inpatient beds (in the New Psychiatric Hospital) which are used for teaching and research as well as treatment. Outpatient service: handles approximately 800 cases a year and accepts about 15-20 per cent for treatment. A. Diagnosis: waiting period is one to 3 months and all children must go through the pediatrics clinic before child psychiatry. B. Treatment: varies depending on the needs of the family-may be appointments with psychiatrist, family conuseling, or group therapy; may be as often as three times a week. Referrals are drawn from all sources. METROPOLITAN HOSPITAL 1901 First Avenue, District: 42nd. Street Inpatient service: there is no inpatient service. Outpatient service: Out-patient service: A. Staff: 7 full-time psychiatrists. 5 part-time psychiatrists. B. Diagnosis: a child can be referred from all sources to an intake social worker for initial screening; there is a one-week to 2 month wait for diagnosis by a psychiatrist. C. Treatment: there it a 2 month wait for treatment. MT. SINAI HOSPITAL 144 Madison Avenue, District: unlimited Inpatient service: there are 15 inpatient beds which are used for teaching and research as well as treatment; the service has 7 psychiatrists part-time and pa- tients are usually not accepted for more than three months. Outpatient service: A. Staff: 8 psychiatrists-part,-time 2 psychologists-full-time B. Diagnosis: children are referred from al Isources and are screened in the sum- mer; a doctor sees the child and a social worker sees the family. In September 25-30 cases are accepted for the year-no more are accepted. C. Treatment: here again, patients are accepted who will be good teaching material; children seldom see the therapist more than once a week. D. Special facilities: there is a NIFAST clinic (Non-intensive, Flexible, Adaptable, Short-term clinic) for "crisis intervention"; this clinic meets once a week and accepted 350 cases last year; it is staffed by 6 residents, 3 attending psychia- trists, I social worker, one assitant, and one community worker; it accepted all but neurological or brain-damage problems. Other & hospitals outside the Harlem area: Hospital for Joint Diseases-1919 Madison Avenue, Psychiatric Clinic, TR 6-7000 Belluvue Hospital-lst. Avenue and 30th. Street Mental Hygiene Clinic, OR 9-5000 Roosevelt Hospital-428 West 59th Street Psychiatric Division, 544-7000 Jewish Memorial Hospital-Broadway & 196th. Street, LO 9-4700 New York Infirmary-321 East 15th. Street Psychiatry Clinic (No district, but no emergency or inpatient facilities). CA 8-8000 New York Medical College-106th. Street & Madison Avenue Dept. of Psychiatry. Clinics in the Harlem area: NORTHSIDE CENTER FOR CHILD DEVELOPMENT 31 West 110th. Street EN 6-6464 -waiting list for treatment is over a year. 151 GREATER NEW YORK -the center does not take brain-damaged or handicapped children. A. Staff: therapists, psychiatrists, psychologists, social workers. B. Fees: sliding scale. JAMES WELDON JOHNSON COMMUNITY CENTER 2089 3rd, Avenue TR 6-3533 District: 96th. Street to 125th. Street from 5th. to the East River James Weldon Johnson Community Center-2089 3rd, Ave. TR 6-3533 District: 96th. St. to 125th St. from 5th. to the East River A. Staff: psychiatrists, psychologists, social workers. B. Diagnosis: there is a waiting list of about six families for screening and the clinic will not accept retarded or brain-damaged children. C. Treatment: the waiting period for treatment is about 15 families or three months; appointments can be made as often as twice a week; no fees. KAREN HORNEY CLINIC 329 East 62nd. Street TE 8-4333 A. Staff: psychiatrists, psychiatric social workers. B. Diagnosis: there is no waiting period for diagnosis or treatment. C. Treatment: usually "family-oriented" with appointments once a week with a psychiatric social worker; fees are adjusted but are not Medicaid eligible. Other clinic8 outside the Harlem area: Payne Whitney Psychiatric Clinic-525 East 168th Street, TR 9-9000, District: 34th. Street to 96th. Street, east of 5th. Avenue. Postgraduate Center for Mental Health-124 E. 28th. Street, MU 9-7700 all types of therapy; no Medicaid. New York Clinic for Mental Health-150 5th. Avenue, CH 2-3778. Catholic Charities Guidance Institute-122 East 22nd. Street open intake; I month wait, Staff: 1 psychiatrist, I psychologist; 4 social workers. Alfred Adler Mental Hygiene Clinic-333 Central Park West American Foundation of Religious & Psychiatry-3 West 29th. Street, MU-6138, Staff: ministers, priests, or rabbis in psychiatric training. Girls & Boys Service League-138 East 19th. Street GR 3-4300. Henry Street Settlement-265 Henry treet, OR 4-1100. Hudson Guild Counselling-436 West 27th. Street, 2@1400. Institute for Crippled & Disabled-400 First, Avenue, OR 9-0100. special groups for obese and neurologically damaged, no geographic limit. MEDICAID 1. Centers: 1. Main Center: 330 West 34th Street. 2. Local Centers: 451 Lenox Avenue (133rd Street). Harlem Hospital (Women's Pavilion Rm 103). 207 W. 151st Steret. 2384 7th Avenue (139th Street). 254 St. Nicholas Avenue, (123rd Street). 75 Lenox Avenue (114th Street). 11. To Apply You Need to Bring: 1. Social security number. 2. Lasteightwagestubsor,earningstatementfromemployer. 3. Name of bank and amount of savings. 4. Amount of @@ and bonds. 5. Health insurance: name of company, policy number, amount of premiums. 6. Life insurance policies. 7. Veteran's serial number, veteran's administration claim number. 8. Medicare card (if over 65). 9. List of any medical expenses for current year. 111. Medicaid Complaints: 1. Send letter to the mayor and.a copy to Mr. Hamp Coley, 330 West 34th Street, New Work, N.Y. 2. For a complaint about a drug store: a. Immediately call Elihu A. Gorelik, 790-3757. 52 SUMMER 1968 b. Send letter to Mr. Alex Green, Room 367, senior pharmacist, Bureau of Health Care Service 330 West 34th Street, New York, N.Y. -the complaint should state: (1) the name, address and phone number of the pharmacy. (2) the name, address and phone number of the patient. (3) the item (prescription) in question. IV. List of Medicaid Drug Stores in the Harlem Area: America Pharmacy, 1645 Lexington -------------------------------------- 876-9981 Ascione Pharmacy, 2268 Ist ------------------------------------------- AT 9-0811 Asbell Pharmacy, 1600 St. Nicholas ------------------------------------ WA 1-5994 Atwater Pharmacy, 1404 Madison ------------------------------------- AT 9-0400 Beta Pharmacy, 1960 7th -------------------------------------------- MO 3-5567 Bishop Pharmacy, 273 W. 125th ------------------------------------------ 864-0151 Black Rexall, 1882 3rd 5 ---------------------------------------------- EN 9-1350 Broadmoor Pharmacy, 2675 Broadway --------------------------------- AC 2-2914 Brown's Pharmacy, 159-06 Harlem River Dr - ---------------------------- AU 1-7242 Callipo, J., 2146 2nd -------------------------------------- ----------- 534-9455 Cardinal Drug Store II, 2338 2nd -------------------------------------- SA 2-0805 Cardinal Drug Store I, 935 Amsterdam ----------------------------------- 666-7039 Claremont Chemists, 3181 Broadway ---------------------------------- MO 2-0220 Clunie Pharmacy, 21 Convent ------------------------------------------- RI 9-6970 Cohen's Drug Store, 2101 Amsterdam ---------------------------------- LO 8-3763 Cohler's Block Drug Store, 1938 3rd ----------------------------------- EN 9-8533 Cohn, David, 1990 2nd -------------------- ---------------------------- TR 6-2451 Cohn, Nathan, 1596 Madison ------------------------------------------ LE 4-0151 Columbia Chemists, 1121 Amsterdam ---------------------------------- UN 4-3773 Co-op Drug Co., 376 Manhattan ---------------------------------------- AC 2-0668 D&S Farmacia Central, 2040 2nd ---------------------------------------- 722-7100 Delane Pharmacy, 586 Lenox ------------------------------------------ PO 8-3777 Delcina Pharmacy, 1741 Park ----------------------------------------- EN 9-6540 Dorris Pharmacy, 1450 Lexington ---------------------------------------- 289-8012 Drug Mart Pharmacy, 326 W. 125th ----- ------------------------------ RI 9-0313 Dumbar Drugs, 2802 8th ------------------------------------------------ 283-9055 Eighth Ave. Drugs, 2512 8th --------------------------------------------- 283-9636 Eldorado Drugs, 2647 Broadway -------------------------------------- MO 2-6030 Embassy Pharmacy, 2457 7th ---------------------------------------- AD 4-1800 Eureka Pharmacy, 2500 7th ------------------------------------------- WA 6-5546 Farmacia San Martin, 3340 Broadway ------------------------------------- 286-5853 Famous Pharmacy, 1837 7th ----------------------------------------- MO 2-2070 Fein's Ethical, 3586 Broadway -------- --------------------------------- 286-4344 Finldestein, L., 1863 2nd ------------------------------------------------ 722-9388 Forman Drugs, 2630 8th ------------------------------------------------ 281-1400 -4703 Friedlands Pharmacy, 574 Lenox ------------------------------------- WA 6 Globe Pharmacy, 3361 Broadway -------------------------------------- WA 6-8900 George's Gothic Pharmacy, 2180 5th ------------------------------------ FO 8-0600 Ganbarg Drug, 2810 Broadway ----------------------------------------- UN 4-0700 Godettes Pharmacy, 2000 Amsterdam --------------------------------- WA 7-9571 Gubins, J., 100 E. Ilith ------------------------------------------------- 534-9876 Harlem Cut Rate Drugs, 68 W. 116th -------------------------- ----------- 369-9766 Hart Pharmacy, 1661 Amsterdam -------------------------------------- FO 8-8867 Hartly Chemists, 1219 Amsterdam ------------------------------------- RI 9-8480 Heights Pharmacy, 701 St. Nicholas -------------------------------------- 234-9803 Idell Pharmacy, 302 E. 100th -------------------------------------------- 348-9880 Jaystone Drug Co., 104 Lenox ---------------------------------------- EN 9-3636 Jomel Pharmacy, 2069 2nd --------------r ----------------------------- TR 6-8071 Kenwood-Peters Pharmacy, 144 W. 125th --------------------------------- 865-1052 Kirschemer Pharmacy, 1711 3rd ---------------------------------------- 831-3786 Langer Drug, 3399 Broadway ------------------------------------------ AU 1-0500 Lasalle Drug, 3143 Broadway ---------------7- - - - - - - - - - - - - - - - - - - - - - - - -MO 2-6908 153 Lax Drug, 360 Lenox ------------------------------------------------- EN 9-0365 Las Marias Pharmacy, 6138 Lexington --------------------------------- SA 2-4627 Lato Drug Co., 2243 2nd ---------------------------------------------- AT 9-0030 Lenox Terrace Drugs, 20 W. 135th ------------------------------------- AU 6-2120 Lenox Pharmacy, 145 E. 125th ---------------------------------------- SA 2-9305 i,inchon Pharmacy, 2310 8th ------------------------------------------ MO 2-6915 Litvin Pharmacy, 2423 2nd -------------------------------------------- SA 2-2053 Majestic Pharmacy, 356 W. 145th -------------------------------------- AU 6-6780 Malach Pharmacy, 2185 8th --------------------------------------------- 864-8114 Mills Pharmacy, 2032 Madison ---------------------------------------- SA 2-3128 Mishkin, 1961 Amsterdam --------------------------------------------- U 6-0 Morningside Hts. Pharmacy, 1302 Amsterdam --------------------------- MO 6-4337 Morton Pharmacy, 1693 Madison --------------------------------------- 722-9527 Mt. Carmel Pharmacy, 2325 lat --------------------------------------- TE 1-9876 Mt. Morris, 1931 Madison --------------------------------------------- TR 6-4041 Pacific Pharmacy, 1821 Amsterdam ------------------------------------ AU 6-0960 Palmer Theresa, 2395 Broadway --------------------------------------- SC 4-4800 Pharmacraft, 3645 Broadway ------------------------------------------- AD 4-4528 Physicians Prescriptions Service, 2340 7th ------------------------------ AU84052 Pleasant Pharmacy, 363 Pleasant -------------------------------------- AT 9-5677 116 East Drug Corp., 116 E. 125th ------------------------------------ TE 1-1151 Raysol Pharmacy, 1870 Lexington --------------------------------------- 348-2117 Rexall Drug Store, 1350 Madison -------------------------------------- TE 1-2354 Rio Pharmacy, 3839 Broadway ---------------------------------------- LO 8-2880 Rico Pharmacy, 170 Manhattan ------------------------------------------ 749-8317 St. Nicholas Pharmacy, 840 St. Nicholas --------------------------------- AU 1-1700 S-0 Cutrate Drug Co., 1486 Lexington -------------------------------- AT 94120 Santos Pharmacy, 3419 Broadway ---------------------------------------- 9624298 Schaaf Pharmacy, 2149 8th ------------------------------------------ MO 2-6019 Schreier's Pharmacy, 1878 Lexington ---------------------------------- EN 94760 Sharff Inc., 350 W. 125th --------------------------------------------- UN 4-6300 Shirnat Rexall, 3559 Broadway --------------------------------------- AU 6-5790 Siegel's Drug Store, 111 E. 115th ------------------------------------- EN 94030 60 E. 125th Drug Corp., 60 E. 125th -------------------------------------- 427-6610 Snow & Yeoman's Pharmacy, 3661 Broadway --------------------------- AU 6-2940 Swan Pharmacy, 3645 Broadway ----------------------------------------- 281-9990 Taft Pharmacy, 1080 Amsterdam -------------------------------------- UN 4-8600 Terry Drugs, 3481 Broadway ------------------------------------------ WA 6-6910 Theresa Pharmacy, 104 Lenox ------------------------------------------ 369-9850 Theresa Pharmacy, 3901 Broadway ------------------------------------ WA 3-7617 Thomas, John, 2601 Broadway ---------------------------------------- UN 4-6600 Tosan Drug, 3419 Broadway ------------------------------------------ AU 3-6628 Trau Pharmacy, 2123 3rd --------------------------------------------- EN 94013 Unity Drug Co., 2621 Broadway ---------------------------------------- AC 2-4100 V&J Pharmacy, 2247 Ist ------------------------------------------------- 348-2548 Vim Drug, 3817 Broadway ------------------------------------------- WA 7-0220 Webster Drug, 2509 Broadway ----------------------------------------- RI 9-3063 West Side Drugs, 3524 Broadway ---------------------------------------- 926-5500 Whelan, 145th & Broadway ------------------------------------------- WA 6-3250 Whelan, 2802 Sth ------------------------------------------------------ AU 6--3590 Whitehouse Pharmacy, Amsterdam & 122nd ---------------------------- MO 6-7989 Williams Pharmacy, 2155 7th ----------------------------------------- MO 2-2876 ADDITIONAL IMPORTANT RESOURCES OF THE COMMUNITY Department of Health: Dr. Harris-Commissioner in charge of child and maternal health. Dr. Pitkin-Director of School Health (566-7082) Dr. Frederickson-Director of Harlem Health Center (AU 3-1900) Miss Ambrose-Central Harlem Director of Nursing 154 SUMMER 1968 Harlem Consulner Education: 2325 7th Ave. (926-5300) Harlem Self Help: 179 W. 137th St. Rm 12A 1. Qualifications: 17-21 years of age fill out application. 2. Functions: 21 weeks of basic education in math, science, and english. HARYOU ACT: Local Boards: No. 1 207 West 151st Street 368-7000. No. 2 2386 7th Avenue 862-3500. No. 3 451 Lenox Avenue 862-1166. No. 4 254 Saint Nicholas Avenue 666-6920. No. 5 Lenox Avenue 666-3935. Legal Aid Society: It is not used very much because results depend very much on the lawyer one gets, and because they will not handle any controversial cases. United Block Asso@tion '- 68 East 131st Street (281-6000, 234-3822) Mrs. Addie Patterson-Problem Broker Mrs. Testamark-Schools (20 West 128th Street 281-6307) Miss Brabham-Operator (6th floor) Urban League: 204 West 136th Street (AU 6-8000) Mr. Wingate-Director City,wid@ Coordinating Committee For Welfare Rights 514 West 126th Street (Amst. + Bdwy.) 3rd Floor Local: 2325 7th Avenue (131st St.) 926-5300 2430 7th Avenue (141-2nd) 286-9399 FOR EMERGENCY PHYSICIAN IN MANHATTAN CALL 879-1000 *U.S. GOVERNMENT PRINTING OFFICE,. 1969 0-355-232 U.S. DEPARTMENT OF HEALTH EDUCATION, AND WELFARE I Public Health Service