@ I I i MH Community Health Services/*/California MH Students, Health Occupations/*// MH California KW 20C PN - Weiner, Tess CN - California Student Health Project CN Los Angeles CoUnty-University of Southern California Medical Center. Dept. of Pediatrics CN United States. Division of Regional Medical Programs CN United States. Social and Rehabilitation Service CN University of Southern California. School of Medicine TI - California Student Health Project, summer 1968/G TC - Department of Pediatrics, Los Angeles County-University of Southern California Medical Center. Report written by Tess Weiner. IM - [Bethesda, Md.,/Health Services and Mental Health Administration,/l CO x, 84 p.:illus. GN - Project supported in full by U. S. Division of Regional Medical Programs (Contract no. 43-68-1532) and Social and Rehabilitation Service (Grant no. 53-5132-5437) and the Rosenberg Foundation. GN Sponsored by the University of Southern California School of Medicine. CP 02NLM,08HMS,01SSY:WA 546:AC2:Cl4c::1969 CA WA 546 AC2 C14c 1969:02NLM,08HMS,01SSY Yl S/1 969/ LP Eng LA Eng MT CORPORATE NAME MAIN ENTRY RO O:MED RO C:MED RO M:NMC DA 710317 LR -780426 EL - FULL LEVEL IT - MONOGRAPH Ul -1255501 I i i f I i i I I I -A lmmm;i; 'A I CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 DEPARTMENT OF PEDIATRICS LOS ANGELES COUNTY-UNIVERSITY OF SOUTHERN CALIFORNIA MEDICAL CENTER Report W@tten By: Tess Weiner, M.A. Director of Education, Student Health Project, Summer, 1968 FacWty Director: S. Douglas Frasier, M.D. Student Health Project, Summer, 1968 Associate Professor of Pediatrics and Psysiology Student Director: David Snyder, M.D., Paul F. Wehrle, M.D. Faculty Advisor: Student Health Project, Summer, 1968 Chief Physician and Chairman, Division of Pediatric and Communicable Disease Service Hastings Professor of Pediatrics This project was supported in full by U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Services and Mental Health Administration Division of Regional Medical Programs (Contract No. 43-68-1532) and Social and Rehabilitation Service (Grant No. 53-5132-5437) and The Rosenberg Foundation This report does not necessargy represent the view8 of the Public Health Service "An ideal medical center would give to physicians and students a direct contact with the whole spectrum of these (biomedical and social) sciences, from the most abstract knowledge to its ultimate practical applica- tions. Such a center would provide a suitable environment for the birth of an idea, the establishment of its validity, the shaping of it in the form of a usable concept, the testing of its practical utility and limitations, the teaching of its theory and practice, the con- cern of -the moral and ethical problems that inevitably arise whenever technological innovations are applied to human beings, and finally the discriminating application of the new knowledge for the benefit of a particular human being as well as of the community as a whole. Ideally, the medical center should recapture the intimate relationship with the patient, symbolized by the traditional picture of th-. family physician; it should cultivate the rational approach to disease that has grown out of scientific medicine; it should be a forum of the soul, and the needs of society are inte- grated into a new science of human and social engineering." -RENE DUBOS, Man Adapting PREFACE The following report has been prepared by Mrs. Tess Weiner an experienced sociologist, who served as the Director of Education for the 1968 Summer Student Health Project. Her background in medical care administration, particularly at the Mount Sinai Hospital Child and Family Study Center and as the Director of Health and Welfare for the Los Angeles County Headstart Program (EYOA) provided an excellent basis for appraisal of this program. Her inherent sensitivity and perceptive nature, together with her close but "nonadministrative" involvement with the project has provided an unusual perspective for a different form of evaluation for this project than was done in prior years. She has captured the essence of the successes and failures, and the many poignant vignettes included bring to the reader a measure of sharing in the experiences and frustrations of their authors. As this report is reviewed, the dis cerning reader will recognize the resistance of the "over-organized" health science student to a structured and regimented experience during the "vacation" months. He will also see the greater interest in what is now called community medicine, evidence of increased student political activism and, as in prior years, the individual expression of student attitudes toward various social problems. There is also clear evidence of the present unwillingness of many students to speak for their colleagues; its counterpart, the lack of clear definition of those the group wishes as its representatives, is also shown. The project was mounted with an aura of great expectation born of success during prior years. The philosophical divisions and changes in attitudes within the sponsoring agencies, the students and the preceptors were not clearly recognized. Those between law and medicine further complicated the plan. The year 1968, itself, marked by political conventions and campaigns, civil disturbances, and assassinations of prominent leaders with the understandable emotional reactions, added further problems to the successful pursuit of the project. Perhaps the most important lesson to be learned from this report is the need for organizations contemplating the sponsorship of such programs to develop, - in advance, a central organization with the needed experienced staff who can participate with students in defining the reasonable goals and methods of achieving them and an organizational structure which will withstand the sudden and often unexpected pressures to be encountered. These comments a.re not intended as an apology for less than optimal performance by an organization composed almost entirely of dedicated and altruistic individuals, but as an introduction to a detailed and thought- ful report, best described by a truly involved participant who has given much of herself to the successes of the project. She has provided herein a valuable and perceptive account of the program itself and insight into many of the social forces which influenced its ultimate form. S. DouGLm FRASIER, M.D. Faculty Director, Student Summer Health Project, 1968. Associate Professor of Pediatrics and Psychology. PAUL F. WEHRLE, M.D. Faculty Advisor, Student Summer Health Project. Chief Physician and Chairman, Division of Pediatric and Communicable Disease Service. Hastings Professor of Pediatrics. v Contents Page PREFACE ------------------ ------------------------------ ACKNOWLEDGMENT --------------------------------------- vii PERSPECTIVE ------------------ -------------------------- ix THE STUDENT HEALTH PROJECT ------------------- I Background --------------------------------------------- I Summer 1968 - ---------------------------------------- 2 Excerpts From Application@WhSr They Came 3 SELECTION OF PARTICIPANTS ------------------ 7 Health Science Students ---------------------------------- 7 Law Students' Selection ----------------------------------- 7 Distribution of Students by Discipline and Race ------------ 8 List of Student Participants ----------------------------- 8 THE PRECEPTORS 12 Background ------------- I -------------------------------- .12 Planning of Projects - - @ ------------ I ----------------------- 18 Student Selection from the Preceptor's Point of View -.. - ...- - .- .- 14 Student-School Relations -------------------------------------- 14 Student-Community Relations -------------------------- 15 Distribution of Preceptors by Organization and Specialty 16 FUNDING SPONSORSHIP7AND STAFF --------------------- 18 ADMINISTRATION AND - ORGANIZATION 20 Description ------------------- ;-------------------------- @-20 Some Administrative Decisions - - - 22 A LOOK AT GOALS ------- I- - - - - - - - - - - - - - - - - - - ----------- 24 THE ROLE OF THE UNIVERSITY -. 26 EDUCATIONAL PROGRAM ---------------------------------- 27 THE PROJECTS ------------------------------------------- 80 Los Angeles County ----------------------------- I ---------- 30 Venice ----------------------------------------------- 30 East Los Angeles Child @ and Youth Clinic ------ ;32 Bio-Medical Careers Project-Minority Group Admissions ---------------------------------- 34 Los Angeles County-University of Southern California Medical Center ---------------------------- 36 El Monte --------------------------------------------- 35 Willowbrook Volunteer Health Center --------------------- 36 South Central Los Angeles-The Watts Project, 37 Ventura County-Oxnard -------------- 39 v THE PROJECTS-Continued Page South Monterey County-Rural Health Project ------------- 43 Kings County Community Action Organization ------------- 44 .Tulare County Community Action Organization-Visalia 45 Fresno County-The Fresno Project 45 Kern County-Bakersfield 47 San Francisco County 47 Imperial County-Imperial Valley Project 48 The Law Projects - ----------------------------------------- 49 Background 49 The Law Projects by Steve Bingham 51 Blacklash and Backlash Blues ------------------I---------- 65 PROBLEMS MOST FREQUENTLY MENTIONED BY STUDENTS -------------------------------------------- 58 Personal Problems 58 Health Problems ------------- ----------------------- - 58 Community Problems ----------------------------- 58 RECOMMENDATIONS ------------------------ I ------------------ 59 Bibliography --------------------------------------- 62 APPENDIXES A. Preceptor Evaluation-South Monterey 63 B. Preceptor Evaluation-Tulare County ------------ 65 C. Recommendations by Students on Project Placements for the Future -------------------------- 68 D. Some Questions from the Black Caucus ---------- 69 E. The Black Students and the Student Health Project-A Position Paper -------------------- 70 F. A Letter from the Dean, Roger 0. Egeberg, M.D. 71 G. Goals and Directions, S. Douglas Frasier, M.D - ------ 72 I-I. Identity (Abby Krowitz's Diary) -------------------- - @73 1. Martha Jackson's Letter ---------------------------- 74 J. Suggestions for an Education Program from the Northern California Educational Committee 75 K. Major Activities Conducted by Students , -------------- 77 L. Institutions and Groups Contacted by Students. 79 M. Organizations and Institutions Contacted by Students ----------------------------------- 81 N. Final Conference Program and Workshops, August 28-30, 1968 --------------------------------------- 82 0. Renascence (Mike Albertson's Letter) --------- ------ 84 ,VI ACKNOWLEDGMENT This case study on the student health project of 1968 is a departure from former years when students wrote and edited the final report. Their fresh, sensitive style, unhampered by analytic jargon, reflected tne honest excitement of discovering their own strengths, and the pain of experienc- ing the pain of others. In a very different vein, this report is being compiled both as a de- scription of the Summer 1968 project activities, and as an analysis of some of the problems the organization faces in the ever, increasing tur- bulence of student activism. It will be neither as subjective nor as poetic in its compassion as the reports of former years. This is by way of an apology, since dispassionate analysis sometimes cools the passion that moves us to action. To the social researcher, diagnosis and prognosis are no less important to the achievement of health than to the physician. If the report appears to focus on shortcomings, if it reflects frustration, perhaps it is because we recognize that self-criticism is necessary now so that we might better understand how to define and pursue our objectives later. But, more im- portantly, the students who will be called upon in a few years to make fateful policy decisions need to expand their judgments. There will be a significant influx of students active in the process of change joining the ranks of professionals within the next 10 years. To strengthen their com- mitment to improving the profession which they are about to enter is the challenge and privilege of those teachers also interested in modifications in the health services. For the Project Directors, S. Douglas Frasier, M.D., for the faculty, and David M. Snyder for the Student Health Organization, and Paul F. Wehrle, M.D., faculty advisor, who entrusted the writing of this study to me in spite of our differences, I feel sincere admiration. It would have been infinitely more reassuring for them to have authorized a descriptive study of the Student Health Project experience rather than a substantive analy- sis. Somewhere in their decision must have been a similar thought that prompted John W. Gardner's statement: "Many Americans have a sentimental and undiscriminating view of change. They think it is, without qualification, a good thing. But death is a form of change. So is deterioration. A society must court the kinds of change that will enrich and strengthen it, rather than the kinds that will fragment and de- stroy it * * * "Renewal is not just innovation and change. It is also the process of bringing the results of change into line with our "I (15) purposes. I also wish to thank Mrs.' Joan Bolt6 for help in preparing this manu- vii script, and for the many hours spent in analyzing student reports. To her Brian, 6 months old, a special thanks for contributing the warmth of his trust. My very special gratitude to my husband, -Beryl Weiner, for his stimulating editorial comments and painstaking assessments during the process of writing this study. And, of course, a special word of thanks to those students, faculty members, and preceptors whose thinking is brought together in this study. For those among you who remain dedicated to the cause of improving health care institutions, I hope this proves of some value. TF.ss WEINER, M.A., Los Angeles, Calif., May 1969. PERSPECTIVE This report is being written as a protest of scientists is occurring at MIT which may quickly spread to science departments in other major universities. The protest consists of a 1-day research stoppage by a group of students and faculty while they discuss their involvement in govern- ment-related research used for military purposes. They question whether their talents could not be put to better use in the solution of the major problems of the cities, such as water and air pollution, education, health, and welfare. Within the last 10 years, student involvement has had an exuberant rebirth after the dormant period of the 1950's when political conservatism victimized the Nation's intellectuals while it promised rewards to youth for aggressive mastery of technology and uncompromising excellence in research. However, their research was not to be used so much to investi- gate the social institutions as to serve an abundant consumer-producing economy. Universities sanctioned a competitive search for knowledge with ever-heightened standards of independent scholarship. But the system of extending education, with practice deferred until later, delays achieve- ment of autonomy. It fosters dependency. Talcott Parsons, in the 1962 edition of Daedalus (24) "Youth, Change, and Challenge," traces the change in the concerns of youth from its pri- mary field of social justice at the turn of the century to that of meaning- fulness in the 1960's. The desire to exert some influence on the decisions which affect their lives has been the demand of students in the mid- sixties. It invariably has been. called The Identity Crisis. By the late sixties, youth movements have become more organized. They have focused their attacks on a social system which they perceive to be inequitable and punitive to disenfranchised segments of the population-minorities, stu- dents, and the poor. As a lesson in the rapidity of social change, it is surprising to note that as late as 1962, Kenneth Kenniston was still concerned with and deploring the political apathy of students. In an effort to stimulate some participation, he stated: "Young people, by exaggerating their own powerlessness, see the system, whether at work in politics or in international af- fairs, as far more inexorable and unmalleable than it really is. In short, an alienated generation seems too great a luxury in the 1960's." (18) Kenniston, though concerned about general student apathy, called attention to the fact that even scholarly elites were defecting from the mainstream of tradition: "A surprising number of these young men and women, despite their efforts to get good scholarships and good grades so that ix they can get into a good medical school and have a good practice, nonetheless view the world they are entering with a deep mis- trust. ay is partly manifest in the sanity of young people tod their awareness that their world is very different from that of their parents." (18) To that small but growing group of vociferous students, society has again and again violated the trust and values so necessary to achieving maturity. Erik H. Erikson puts the case of youth and its need to trust in community: "In youth, ego strength emerges from the mutual confirmation of individual and community, in the sense that society recognizes the young individual as a bearer of fresh energy and that the individual so confirmed recognizes society as a living process which inspires loyalty as it receives it, maintains allegiance as it attracts it, honors confidence as it demands it." (11) quest for a revitalized society continues, as does the quest for a The "philosophy" to guide action. In that tortuous quest some choose to opt out, some to "cop out," and some to search for new models of behavior and service to mankind. Only 6 years later, in 1968, Daedalus published another issue on youth, titled "Students and Politics." By this time, student movements had become prime news for every kind of media and countless observers of the scene, whether educators, journalists, or political analysts. Not a day or evening's cursory glance at the ubiquitous tube omits reports of student activism, variously alluded to as revolt, riot, or mutiny. Some- times students have been denied their share of self-determination by those still believing in the theory of conspiracy, of 'goutside agitators", or com- muni@. This occurs in spite of the Kerner Report statement to the con- trary. What is not understood is that students historically have had enormous courage in pushing for social change all over the world: in anticolonial struggles, in the spread of republican and radical ideas in India, Indonesia, Asia, and Africa, and, more recently, in France where students successfully involved a sluggish labor movement in a general strike. Seymour Lipset, in the 1968 issue of Daedalus referred to above, states that: "Students were often the carriers of modern ideas of liberty, socialism, industrialization, and equality of opportunity." (19) Now new voices are being added. For the first time in. modern history, young Sisters of Catholic orders are signing the same political petitions as minority group students attending local colleges. By Vatican report, one thousand priests a year are requesting a change in the celibacy lawsi Students, black, brown, and white, are pushing. for black studies departments and student representation on faculty committees. Although mistakes in .strategy occur it is hoped that through or- ganizational experiences like the Student Health Organization more ap- propriate strategies will be developed. THE STUDENT HEALTH PROJECT BACKGROUND and biological warfare, urban vio- The history of the Student Health Project lence, drug addiction, and war were, has been adequately documented in the 1966 in large part, omitted from their cur- and 1967 reports of the University of Southern ricula. Lack of this subject matter California and the 1967 Student Health Pro- symbolized to them the failure of ject of the South Bronx and Chicago. The their teachers to come to grips with three reports describe the birth of the organi- the biosocial issues of the day."(35) zation in June, 1964, in Los Angeles, at,th , ! On those campuses where the organization University of Southern California Schooi oi took hold, they developed a pattern of student- Medicine. All sum up the inadequacies of i)re- sponsored meetings at which important speak- sent medical education in similar statements: ers were invited, followed by lively debate on the confinement of health science students to .. I tne crucial issues of the time. There was parti- teaching hospitals with concentration entireiy I .. , cuiar emphasis on the relevant health issues, on clinical theory and methodology separating such as fragmentation of medical care and the the students from the community. The reaiiza- need for widely based neighborhood health ser- tion of many health science students that the .ces responsive to the needs of individual com- social aspects of medicine are largely ignored vl in the medical school curriculum, and the in- munities. terest in these problems that studIents acquired In the summer of 1965, concerned health during their undergraduate years, plus their student leaders met in Chicago to discuss possi- motivation to find solutions,Icombined to bring bilities of formalizing the organization and, by about the nationwide Student Health Organi- 1966, plans were under way to submit a pro- zation. In the Chicago report of 1967, the case posal to the Office of Economic Opportunity for a more extensive program during that summer. is stated: Support came from faculty in various medical "Within the past three years, the schools and from the Office of Economic Op- students active as undergraduates in portunity, which awarded a grant of $204,000 campus organizations and service pro- to the University of Southern California-Stu- grams have begun to arrive at health dent Medical Conference Project in Commun- science schools. They have been un- ity Health Resources for the poor. In 1966, fel- willing to drop their concern for so- lowships were provided for 90 medical, dental, cial change upon their entrance to nursing, and social work students from 40 in- medicine. Many of these students stitutions in 11 States. Fifteen community chose medicine with a conscious de- workers received the same stipend and helped sire to study man rather than disease guide the students through their communities. alone. They soon became aware that The 1966, University of Southern California the course offerings at health science Medical School Student Health Project report schools failed to reflect the contempo- states: rary ferment in medicine. What they had hoped would be a broad and pro- "Concomitant with educational tean experience promised, they were values, placement of health science sure, to be narrowing and restricting. students in such communities also is They were disappointed that topics seen as a stimulus to public health such as abortion, population -control, and welfare agencies to review and poverty, -racism, euthanasia, chemical carefully evaluate traditional meth- CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 ods of provision of public health and dents began to question the relevance of the medical s'ervices found in urban and private practice of medicine, the social distance rural poverty areas. Manpower shor- of faculty from community problems. They tages frequently prevent or delay sys- questioned.the separation of different profes- tematic reappraisal of existing pro- sional schools for health professionals who grams." (38) would be required to work together at a later period. The whole structure of medicine as pri- During the summer of 1966, the project pro- vate enterprise was the subject of constant dis- vided an educational experience to see at first cussion, in view of the need for public access to hand how the system of health services works the human services. and the degree to which health has become -Si-immer 1968 specialized and bureaucratized. As students guided patients through the maze of welfare In 1968, 93 students came to California from and hospital departments, they noted that the many areas and universities in the United interest and responsibility of the latter were States. The distribution by school and geo- focused not so much on the study of the person graphic orgin is recorded on pages 8-11. It as the study of his isolated problem; the stu- should be noted that the political climate had dents began to identify with the patients changed since the first students came in 1966 whose life chances gave them no alternatives. and 1967. "On strike, shut it down" had be- The literature of the students reflects their come a familiar organizing slogan on campuses frustration with the unplanned system of med- across the Nation. Authority-rejecting stu- ical care, a system which spawns more and dents, increasingly violent police actions, and more bureaus sensitive to the convenience of rising student militancy undoubtedly affected the profession, rather than to the needs of the members of the Student Health Organization. patients. To the students, continuation of the war in The interr ationship of health and illness to Vietnam is a clear example of the illegitimate other urban social problems was a powerful use of power to manipulate people and the in- learning experience for most of the health sci- stitutions which serve them. Many see a paral- ence students. Many of the students began to lel in the use of power to control service insti- realize that we are not applying our existing tutions in the cities. While some student health knowledge to people's most basic needs in plan- people saw their role to be patient-advocates, er than social change agents, there was a ning for the general welfare. We laminate lay- r@th significant number who aspired to the role of ers of opaque veneers onto antique foundations, radical reformer in support 'of oppressed knowing that the structure will never serve ghetto minorities. modern technological requirements. For manyIEven medical students, who usually are students the times call for a set of ethics res- identified with some of the more conservative ponsive to human welfare, not to a welfare sys- members of the health professions, have begun tem. Rather than utilizing intermittent stop- to question the posture of many of the profes- gap measures which provided more and more sional associations, medical schools, -hospitals, specialized clinics or departments to fill the and welfare organizations which do not take holes in the system, it was necessary to coordi- an agressive s,;and in solving the health prob- nate and perhaps reorganize so new solutions lems of the Nation. could be found for old and new problems. As And so 1968 brought a curious mixture of McLuhan stated, we attempt to apply new con- students to California, not unlike previous tent to old forms and the malady lingers on. mixtures of students except that the objective Constant assaults on emotional health, se- conditions called for more clarity of purpose cure and trusting relationships, and ego-fulfill- than ever before. In 1968, it was not possible ment, forces people into the despair which ac- for students to have widely disparate goals, companies poverty. In their own context stu- from low to reasonably high levels of political 2 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 understanding, varying levels of investment in becoming better professionals, whatever their organizational success, and wide differences in specialty. One student explained it this way: knowledge about their profession-all shel- tered under the matrix of one organization. "Being only a first-year student, I These differences, coupled with lack of interest still look at the medical profession as in being either leader or follower@r in estab- a means of helping humanity by lishing an ad hoc hierarchy for purposes of de- treating people. As I consider the at- cision making-gave rise to one emergency titudes of my classmates, this seems after another. Structure was considered synon- to be a major philosophy behind a ymous with authority and control. Students good majority of them. Compare this brought different definitions of program, dif- to the junior, or senior students: The ferent expectations of their summer work, and stimulus in most cases has become a high degree of individual anarchy. money and the method has become Excerpts from Application-Why They Came treatment of disease. The institu- tional efficiency of our physician as- A review of student applications bears out sembly line called medical school, iso- the above-mentioned variety of interpretations lates us from patients our first 2 of student health project goals but, more par- years, and fails to emphasize any- ticularly, the variations in individual goals. thing about them but their diseases Some who came were primarily interested in during our clinical years." CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 Hoping to improve her skills, a third-year tiously stated: nursing student says: "I can offer my sensitivity to people "I believe that the project will pre- inasmuch as I am aware that my indi- sent a challenge for educational vidual insensitivities interfere with the understanding of theirs." growth, personal- development and also a better preparation for future In an intense personal statement, one third- work in community health." year medical student: Some of the students felt that involvement in "Medical objectivity comes from the project would help them in reorganizing experience in suffering and can be the medical school curriculum. To that end gained with or without genuine con- they discussed the need for change: cern for patients. But concern feeds "What is amazingly pathetic espe- my strength. I will make personal cially in a large city like mine is that contacts with patients in my educa- an effective program in community tion. Without these my humanity will medicine has never been established wither. There is nothing so self-de- at my school. I know what medicine is structive as an unvented soul. about and I know too that when the only sick person I can see all year is A young nursing student attending an eastern myself, then I've been living a very college measured her present resolve against her earlier background: sheltered existence. It's about time the medical com- "I was born and raised in a South- munity quits kidding itself about the ern white family and all my life my excellent medical care given to the contacts with Negroes and minority American people, as one can see from groups were almost nil. Three years the most cursory look at any hospital ago I moved to New York. Here I emergency room.ty have been allowed to attend an inte- grated nursing school without being There were others who spoke with poetic com- passion and, though their goals were not well ostracized. This association plus my defined, they wanted very much to be a part of work in the South Bronx project has change. A student interested in the mental been an eye opener for me * * *Pt health field observed: ss "implicit" in inte- Not satisfied by the progre "Last summer I visited a State grated education, the young woman is quick to discern that institutions have to be reinforced mental hospital. In the children's ward were 10 black boys and one by operational philosophy. She goes on to say: white boy. The ward room consisted "The nursing school I attend of one wooden floor and four walls, 'prides' itself on being a patient-cen- completely empty: no toys, no equip- tered school and many lectures are ment. The windows were cracked and devoted to the 'whole patient'. How- there was an open terrace. The 'pa- ever, when we are on the hospital tients' were locked in there for most wards, we are cautioned against get- of the day with nothing to do and ting too involved in our patients' pri- were then diagnosed 'aggressive, ac- vate affairs (and to our instructor, ting out behavioral problems.' The in- this means their socioeconomic prob- stitution functioned to hide these chil- lems.) They tell us that this is the so- dren from sight and remove them cial service department's concern- from public . schools which could not not ours. I th.ink it is our problem be- meet their needs." ursing should involve more cause n A third-year occupational therapy student cau- than ministering to a patient's physi- 4 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 Cal needs for the time he is hospital- white liberal adults and students who have not ized, only to send him back out into yet decided how to make the fight for social the same situation that was responsi- justice their fight. One summed it up: ble for his hospitalization in the first "I am asking for the opportunity to place." work with the Student Health Pro- There were those for whom the Student Health ject this summer to experience first- Project offered an outlet for political action: hand the conditions confronting the disadvantaged. I would like the "I have to learn how to approach practical social problems so that as a chance to work with people in the mi- doctor I can be an asset to the com- nority community on an individual munity not jiis4' as an individual basis, and to show by my presence healer, but as a trained organizer in that there is some concern for their the solution of sociomedical prob- problems in the white community and lems." thus dispel some of the general antip- athy towards whites that seems to be Another: growing in the ghetto." "It is the type of action SHO or- Though some of the objective factors of class, ganizes that strikes me as the only age, and socioeconomic indicators were the way health workers and community same for the black students as the white, there members can effectively combine their was one major difference- The black students experience to provide medical care had an unequivocal sense of identification with and community action at a grassroots blackness. The white students chose to identify meaningful level." vicariously with blacks, migratory workers, Chicano farm labor organizers, or many of the For many students, self-fulfillment was a goai. other descriptive terms used for the poor-dis- Among this group were those whose expression advantaged, deprived, or emotionally handi- of their own autonomy superseded project capped. But the black students were eager to needs or community cooperation. One student, make their positions known. Witness the state- in the course of describing his own motivation, ment of one first-year black medical student: states: "It is a well-known fact that the "I find the Student Health Organi- number of existing Negro health sci- zation project especially appealing be- ence students is very small. Realizing cause it appears that the only limit to one's accomplishments .are his own this, I feel that I cannot any longer initiative and resourcefulness." rely on others to do this work." Another medical student: A first-year social work student who felt well- endowed with, the power to solve life's prob- "I think it is imperative that those lems confidently stated: Black Americans who have had more "Not only do I have the basic good fortune than most, must begin to knowledge of the growth and develop- provide the remainder of the black mental process of human beings, but community with whatever is needed to continue the movement to free- also the techniques to precipitate dom. change." (Veni, vidi, sed non vici!!- Ed.) A second-year nursing student included the fol- lowing essay in her application: Whatever the individual goals refiected,,they all sought personal involvement. Many of the "I think I should be a part of this students' applications expressed the guilts of project because I know what it is to 5 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 go through half of my life thinking tually identify with me,. this will be that all white people were smarter my greatest reward." and a much better person than I was, that white is good and black is bad. Another nursing student stated: But then one day, in my last year of "I am convinced that my unique ex- high school, I realized that the lowest periences as an Afro-American have mark in my report card is an 85 and I played a decisive part in the formula- tion of this desire to work in under- didn't study because of the noise that privileged communities. I truly desire five little children can make in a to help my people in time of crisis." three-room apartment. Can you imag- ine the shock and surprise that it A black law student makes clear that his goal must be for an 18-year-old to wake up is to reinforce what he is and who he will be, and see that I'm not inferior and stu- and perhaps points up the major goals of the pid and being black isn't the worst black students who participated: thing in the world? "I also know that the fight for life "There are various reasons why I in the ghetto is a 365-day-and-night feel that I should participate in this struggle. Your guard must never be program. All of them, however, are let down, or else. I consider myself wrapped up with a continuous effort lucky because I had someone behind to be black in a constructive way -, to me, pushing me on. I had someone to emphasize and relate that blackness identify with. I hope through this to one's interactions with people and summer project to show all the chil- things, e.g., institutions. dren that I come in contact with, that "I have been trained at educational it can be done, it's not an impossible institutions that reflect the best that dream, I am a living, breathing exam- white America can offer. Too often, ple. This is one of the somethings black people of similar experience that are lacking in the black commun- have used it to escape f rom their ity, identity. The kids of the ghetto blackness. This history is clear, I from time they can remember have won't go into it. We have ended up nothing more to identify with than with black leaders who are largely dope pushers, junkies, and number extensions of the white culture, who runners. These are the only people on are psychologically and socially dis- the block who have clothes, a Icar, and tant from their own constituency. a decent place to live in. But I hope to 'Captive leaders' they have been show them that this isn't all the called', world has to offer, that pushing dope gg* * * The orientation here at law and number running aren't the only school is toward big business and cor- professions that are open to them. porations and money and Wall Street. With just a little more effort on their The talk is of fine . cars and big part, a whole new world can open to houses. The rich get richer and the them. It may not be as easy as becom- poor get poorer. And for the blacks ing a dopepusher or number runner, who follow the traditionally-dire@d but no one is 'promised a rose gar- routes here, the roads toward the pov-. den.' erty and ghetto-stricken are hardly on the map. "I know what it is to have someone gl* * * It i the effort to make new to look up to and count on. If I can maps that motivates me to work with get just one kid, this summer, who relating my life to such experiences will really build a trust and can even- as this summer project offers." 6 SELECTION OF PARTICIPANTS tually shared, and set the tone for the pattern Health Science Students of behaviors to which students would be ex- As in the previous year, the application form pected to comply. It was to be an intense per- for the 1968 Student Health Project was sonal experience validated by a summer of ser- mailed in an imaginative, aesthetic brochure, vice. describing the various projects throughout the Law students were screened by the advisor country. Again, too, the student response to the and cordinator who are contemporaries, the essay question "Why Do You Think You advisor having graduated from law school in Should be a Part of the Project?" was used as 1967. The relevancy of that fact is merely that a major criterion in choosing the participants the advisor's youth lent acceptance to the rule by the selection committee, composed of medi- that all law students must live and play in the cal, dental, and nursing students. The commit- poverty community to which they were as- tee looked for several attributes in their selec- signed. Hence, though he was both authority tion: and intern, the advisor also became comrade (1) Students with some previous experience in community organization, poverty pro- grams, and health related agencies, who had developed a commitment to the goals of the student health project, and therefore were able to "jump right into the job." (2) Students with relatively little past expe- rience but eager to learn and displaying, in their application, some intention and promise of using the experience for self development. (3) In @ order to ensure heterogeneity all minority group applicants were accepted and a balance was sought between a wide -range of disciplines of medical, dental, nursing, and social sciences. In additio pref erence was given to students from Calif ornia. Law Students' Selection The philosophy of the law student project very much dictated the kind of students who would finally be a part of it. Early in the spring the faculty law advisor and law coordinator developed a central philos- ophy which prescribed the quality of student community relations, the style of life to be mu- 7 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 and advocate. Perhaps the many roles he oc- These were essentially the qualities ascribed cu@ied O'ffered greater strength to his position, to law students who were selected by the law but they might have weakened his leadership screening committee. had he not shared in the daily life of the com- munity with students and been less sure of Distribution of Students by Discipline and Race what he hoped to accomplish during the sum- Out of 250 applications, 93 students were se- mer. lected for the 1968 Student Health Project. Al- The law project will be dealt with at greater though this information is not complete for the length in another section of this report, but in law student groups, the record shows that at terms of the selection process, the fact that all least 59 students were from California and 56 students were to share in the life of the cOm- attended California Schools. Of the 93, there munity gave support and cohesion to the were 65 male and 28 female participants. The group. average age was 23.6. All applicants were personally screened, by the faculty advisor and law-student coordina- Distribution by Discipline tor, and though this method of screening is largely subjective, there were very specific ob- Number Percent jective criteria by which students were judged. Medicine 37 39.7 The project judged a student by: Law 19 20.4 Nursing 14 15 (1) The extent of his political awareness; Social sciences 6 6.4 Pharmacy ---------------- 2 2.1 (2) The degree to which he understood that Dental hygiene 2 2.1 his technical skills were second to his Optometry I 1 ability to work with established and rel- X-ray technician I I evant community agencies; and, Occupational therapy I I Total --------------- 93 100.4 (3) The degree to which he understood that autonomy and decisionmaking rested with the community people, not,the stu- Distribution by Race dent. Number Percent The students who were chosen were those who Caucasian: the two interviewers felt could trust in the White -------- --- 67 72. community and build trust for the student pro- Mexican-American .... 6 6.4 Black 18 19.3 ject. They were to function as counselors and Oriental 2 2.1 friends to the local young people and as ex- Total T3 @.8 pediters to experienced community organizers. List of Student Participants Student Home School Medicine William Bauer -------------- Brooklyn, N.Y - ----------- New York State University William Boyd ---------------- @ Denver, Colo - ------------- University of Colorado Lionel Bodzin --------------- -I Oak'Park, Mich - ---------- Wayne State University Robert Buker --------------- @ '.Mount Vernon ------- 7 ---- UCLA Joe Capell ------------------ Fresno, Calif - ------------- University of Southern California Noel Drury ------------------ Los Angeles, Calif - -------- University of Louisville 8 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 Student Home School Michael Duchowny ----------- Bronx, N.Y - -------------- Yeshiva University Andrew Fisher --------------- Bartlesville, Okla - ---------- University of Oklahoma ,John Gambin --------------- Los Angeles, Calif. University of California, at Irvine Jerry Ginsburg -------------- Los Angeles, Calif. University of Southern California Lloyd Gordon --------------- Paramus, N.J - ------------ New York State University Michael Halperin Fresno, Calif - ------------- University of Southern California Kirk Holloman --------------- Los Angeles, Calif. Stanford University Duane Iverson --------------- Kent, Wash - -------------- Northwestern University Robert Jones ---------------- lienver, Colo - ---------- University of Colorado Phyllis Klein --------------- Bronx, N.Y.. Yeshiva University Alvin Larkins ------ New York, N.Y. Meharry Medical College Joseph Lee ------------------- Los Angeles, Calif. Meharry Medical College Edward Liu ---------- Detroit, Mich. Wayne State University John Long ----------------- Beaver, Pa - -------------- University of Oklahoma Robert Lundstrom Los Angeles, Calif. - UCLA Bill Mason ------------------ N. Hollywood, Calif. University of California, at Irvine Walter Maynard Los Angeles, Calif. - Meharry Medical College Robert Montoya ------- ------ Los Angeles, Calif. - University of Southern California Lovell Mosley ------------------ Oakland, Calif - ------------ Howard University Robert Peoples -------------- Los Angeles, Calif - -------- University of Southern California Don Peterson --------------- Los Angeles, Calif. University of Southern California Arthur Raehels ------------- Los Angeles, Calif - -------- Meharr'y Medical Co' Ilege Barry Rand ---------------- New York, N.Y - ---------- Yale University Don Rogers ---------------- Los Angeles, Calif - -------- UCLA Robert Slama --------------- Los Angeles, Calif. Temple Universitk- Semeon Tsalbins ------------ Brooklyn, N.Y. Yale University Lauren Welch ---------------- Kansas City, Kans - --------- University of Kansas Albert Wilburn Los Angeles, Calif - -------- UCLA Bernard Wilkins ------------ Los Angeles, Calif. - Meharry Medical College Michael Witte --------------- Fullerton, Calif - ----------- Marquette University David Wren .---------------- San Francisco, Calif - ------ University of California, at San Francisco Law John Calmore ------------- Pasadena, Calif - ---------- Harvard University Diana Chapman ------------- San Joaquin, Calif. University of California, at Davis Stephen Cline ----------- Sacramento, Calif.,'@. University of the Pacific Bartley Deamer San Francisco, Calif. Harvard University Martin Eich 'er --------- Palo Alto, Calif.;@ ----------- Stanford University Steven Hei -------------- Palo Alto, Calif - ----------- Stanford University 9 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 Student Home School Peter Janiak .@-. ------ ------- * University of California, at -- ----------------------- * Davis Nanette Kripke ------------------------ University of California, at Berkeley Theodore Lakey * -------------------------- University of California, at Davis Stephen Lindfeldt Sacramento, Calif. University of the Pacific * Keith Lesar -------- ------------- ----------- University of California, at Berkeley * Leroy Miller ------------------ ------------------------ Stanford University Philip Nicholson ------ * ------------------------ Stanford University Alan Rader ------------ * ------------------------ Stanford University Ron Romines ---- -----------* ------------------------- Stanford University Greg Sager .. --------------- * ---------------------- University of California, at Davis Sheldon Sarfan * ------------------------ University of California, at Berkeley Jon Steiner ----------------- Los Angeles, Calif. University of California, at Berkeley Jacob Weisberg Los Angeles, Calif. University of California, at Berkeley *Information not available. Nursing Maria Gonzalez -------------- Los Angeles, Calif ---------- L.A. Valley College Ruth Hassell ------------ --- Chicago, III --------------- Wesley Memorial Hospital, Chicago Catherine Hunter ------------ Vancouver, British Columbia University of British Columbia, Canada Martha Jackson ------------- Charleston, South Carolina Bronx Community College Leona Judson --------------- San Francisco, Calif - ------- San Francisco State College Norma Kent ---------I------- San Francisco, Calif - ------- University of California, at Berkeley Betty Labastida Los Angeles, Calif - --------- Cal-State, Los Angeles ---------- Claire McCamman ----------- Los Angeles, Calif ---------- Cal-State, Los Angeles Anita Roper ---------------- New York, N.Y - ----------- Bronx Community College Toni Tayjor ------------------ San Diego, Calif - --- ------ San Diego State College Fae Thomas ------------- Vancouver, British Columbia University of British Columbia, Canada Brenda Thompson ------ Los Angeles, Calif - -------- UCLA Patricia Wiley -------------- Los Angeles, Calif - -------- UCLA Bonnie Zagon ------------ Flushing, N.Y - ------------ Bronx Community College Dentistrly, Frederick Collins ------- San Francisco, Calif. University of California, at San Francisco 10 H PROJECT SUMMER 1968 CALIFORNIA STUDENT HEALT Student Home School Maria De Marco ------------- San Francisco, Calif - ------ University of California, at San Francisco Richard Deatherage ----------- Manhattan Bch.9 Calif University of Southern California Dick DiBartolomeo ---------- Santa Cruz, Calif - --------- University of California, at San Francisco Roy Fogelman Los Angeles, Calif. University of Southern California Richard Fuentes Los Angeles, Calif ---------- Northwestern University Don Graham -------------- Los Angeles, Calif ---------- University of Southern California Steve Mascagno ------------- Manhattan Bch., Calif University of Southern California Stephen Sanders - ---------- Los Angeles, Calif University of Southern California John Trego ------------------ Santa Ana, Calif - ---------- UCLA So@Z Sciences Margaret Carter (behavioral sciences) ----------------- San Jose, Calif ------------- San Jose State Jane Hirschmann (social work) -------------------- Los Angeles, Calif - -------- UCLA Alice Krowitz (clinical psychology) --------------- Brooklyn, N.Y - ------------ University of Colorado Marta Steiner (political Los Angeles, Calif. -@ -------- UCLA science) ------------------ Deborah Tarnapol (social psychology) --------------- Cleveland, Ohio ----------- Case Western Reserve Judith Varni (sociology) ---- Watsonville, Calif - --------- University of San Francisco Pharnw,y San Francisco, Calif - ------- University of California, at Eddie Boyd ----------------- Berkeley Robert Zeiger --------------- Los Angeles, Calif -------- I-- Universityof Southern California DentaZ hygiene University of -Hawaii Sherry Plumb --------------- N. Hollywood, Calif - ------- Sally Westrick ---------------- - Van Nuys, Calif. optmdry John Bruce es, Calif ---------- L.A. College of Optometry --------- Los Angel X-ray technician Melo Woodville, Calif ------------ L.A. County General Hospital dye Tunis ------------- occupational therapy Jos Dale Kawagoye -------------- Gardena, Calif -- ------------ San e State 11 THE PRECEPTORS in one in- ple and real problems. ,ONever, ed students where a preceptor encourag . et, BACKGROUND tance, r own survey proje and s crea- possible s@s to develop and execute thei olvementi During the spring of 1968, site se- dents felt a.sense of inv ptors were.sought:'by the stu onplishtnent. appropriate prece f medical, den- tivity, -and ace- lectio'n committees con'PosecL.n southern,, and unirner, the 13receptors stude,nt@ I At the close of the 8 evaluation of tal, and nursing ing to a committee a letter requesting all Student northern California. AccorcL vith community were sent est to the 11 Only conferred particular subjects of inter niversity. rner,aber, they nitY action oriented groups, and organizatiOll and 'rJ replied. Subse- ers, coTnTnu In the -main, Health 2 preceptors lead heal les. three of the 3 ailed some established th ag'c ished -n interview was n" o attach students to establ tly, a request for a f acuity, and Stu- the effort was t od and quen f prereptorso munity organizers who underlItO dent to a sample o felt would represent a varl- coTn c with the goals of the Stu 8, who, it was were syrnpgtheti been involved in dent opinions. out of those preceptors 'Who nd ,Vho had d. -t a ety of y interviews Health Proj ee revious years. 12 %vere personall eats the Project in iated by -theirs replied, displeasure 'with stud or schools to in spite of .some. jous overiden- The precel unt of undisciplined behavior and vicar areas of ey-I d the arnO with Tninoritiesp and despite sonie which they More influential tifle-ation the validity Of nonhealth-related E their doubts about Student 'how closely projer rthy interest th the hoice was ts, the preceptors hung on to the Of in affecting ilosopbies dovetailed with those . ations' ideal as one wo individual 'oh Health Orgailiz one said: committee members- . As Of site selection ed their jobs to be perpetuating Son,ie p-receptors interpret be available when iiin the I g run YO get a new advisors or facilitators, to supervi- On c breed and they respond to something needed; sorae Ollsidered themselves e needs at currently sors; while others, more in tune with th that is different from 'vvh e -permitted oined students as problem solvers exists, but Only if they ar of students, i - As f ew students had - y in a mutual enterprise .iiatilig activities in to deviate from what is currentl the bad the experience of ini ex prob- norrn-iset that where we're at?" ul v on cornPI any comniunity, partic arl@ and would ey inter- predated their entry ered .@,that the only constituen lerns which exit, preceptors who Off it was felt , the postdate their s were fying the health services is ructure to project ested in mOdi I o fnd Ways to skills and st group, and we have t teaching sful than others %vhO did not Tnaln- student 5 ears. The more succes during the next 10 or I Y rsonal contact, attitudes help them al preeeptors agreed thatthere is no tain close p se diff erent rnoreliber animation Dedicated to As a con e preparations made by other formal health org an be a part of, toward the varied. Somewelcorned change which the students C Organiza- preceptork; on student therefore, the Student Health plans, depending and, in some form. But it them with spee Stu- Maintained and der. standing; Others felt tion must be a health sciences orggll- acceptance e their own projects raust be maintained as rless SDS-' dents ought to structur eptoy; and still ization rather than a "weak, leade pending approval frora the pree. on-going rou- -nital-affiliated preceptor stated: others appliqued students onto little oppor- A hos. tine surveys which afforded them s ppedi-- ity for inspiration Or exposure to real peo- tun CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 "The students provide a fresh, formed of the student health project's expecta- sometimes anarchistic, sometimes tions of the summer experience and be involved nihilistic attitude, which gives the in planning; that student health project mem- preceptor and establishment persnn a bers should be oriented to the individual com- reminder that he has accepted a set of munities prior to the summer; that, no matter conditions based upon the flimiest of how capable students are, in a short 2-month foundations." project, they are usually unable to make effec- tive contributions; that it took too long for stu- This.same preceptor, who had guided a group dents to understand both the agency and the in a large teaching hospital, continued on the community; and that white students have to issue of leadership: understand that the black and brown commun- ities are only willing to accept them as techni- "I think there should be extremely cians, not leaders, in their revolution. On this dedicated leadership, with guys who last subject, two of the responses of preceptors know wl%ere it's at and who are pre- are appended at the end of this section. Mr. Ri- pared to work their tails off on a chard Unwin is a special assistant in Tulare weekly basis up until the time when County Community Action Agency. Miss the project is ready-whatever the Eleanor Foster is the director of the Child form, I still think the project is very Care Education 'Center in Tulare County's De- necessary. But the Student Health partment of Education, Visalia. Organization is not the place for com- In summation, the general feeling of precep- munity action projects. It is a crimi- tors was that there can be no change unless nal waste of funds to dissipate the en- there is some influence, some kind of systematic ergies of these students away from way of influencing the present arrangements changin%r the health system." to become part of the past. The reactions of preceptors can be divided Some preceptots made the point that people into subject areas of : don't expect a great deal from a demonstration 1. Planning of projects; project the first year, but after 4 years, they 2. Student selection from the preceptor's had hoped that the student health project point of view; would exhibit more organizational sophistica- 3. Student-school relations; tion. The charismatic student leadership who ini- 4. Student-community relations. tiated the program was frequently given as a Planning of Projects reason for its early success and the present lack of that leadership the reason for, the cur- All preceptors 'agreed that students and pre- rent frustrations. However, in reading the ceptors must plan the contents of the projects 1966 and 1967 Student Health Project reports, earlier and with greater specificity. Preferably, it is evident to the author that lack of organi_ projects would continue year-round. Continuity would be maintained through rotating fellow- zational structure was and has continued to be a problem. ships after a given period of time, when stu- From the interviews, several other thought- dents either go on to other projects or gradu- ful reactions and suggestions emerged. With ate. Regular channels of communication would the exception of the black preceptors, who su- be established for preceptors so that they pervised black students in ghettos and who might stimulate each other's thinking. we're reluctant to discuss the positive and nega- A special year7round committee should be tive.aspects of either the projects or the stu- formed, composed of preceptors willing to meet dents assigned to them, all preceptors felt stu- with students on a regular basis to plan and dents should be more carefully matched to the analyze projects and develop a sense of per- jobs assigned; that preceptors should be,in- sonal involvement. CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 People in the communities chosen for stu- tivity training, one consultant to the education dent assignments should be involved in the program offered the advice that the medical preplanning phase. There are -certain kinds of- school administration must assume the respon- projects which would interest particular sibility foreducating the students to social and groups in the community-planned parenthood economic problems which affect the distribu- programs, prenatal programs, dental health, tion of medical care services. One of the con- health education-and many others which sultants who participated in a communications would give students experience in organizing, workshop stated that the universities should in health needs and in working with communi- assume some responsibility for helping stu- ties. They could also be involved in programs dents become "aware of the gaps in their social relating to middle-class health problems, such awareness". as drug addiction and alcholism. It would seem that a program less vulnera- ble to quick starts and stops such as the sum- Student Selection From the Preceptor's Point mer program, might be more possible if the of View school administration would actively seek joint There was unanimous feeling that the value sponsorship with the community in a pro- of the Student Health Project is really in its gram of community education for health sensitizing effect and, therefore, any student science students. The university as an institu- who evinced an interest in working in a com- tion has allowed itself to become so frag- munity health program should be accepted, mented that it does not even take advantage of whether or not he has any degree of social its own departments or the experience of the awareness, If he has, he will probably bring a community which surrounds it. To be made more sophisticated attitude toward learning; if aware of the possibilities of collaborating with he has not, he will be stimulated to learn. In the departments of social work, sociology, neither case can the project lose. public administration and education, in con- Student-School Relations junction with truly representative grass roots community organizations, would offer students Two questions which continue to be of parti- less restricted and more useful educational cular interest to faculty and students are: tools. For example, the department of pediat- (1) Would it be well for students to confine ricts might enjoy some benefits from cooperat- their activity to "their own communi- ing with the teacher corps or other title I pro- ties," of which the basic unit is the med- grams under the Economic Opportunity Act ical school? which affect the physical and emotional (2) Is the Student Health Organization ha v- growth of thousands of youngsters. These ex- ing an. effect upon medical school curri- POsures might offer the nation a greater cula? chance than we now have to develop young sei- entists guided by their humanistic as well as There was general agreement that the stu- scientific interests. To those students who are dents can have an impact on school policies demanding this kind of social education, it through participation in curriculum and policy .would offer a direct route. committees of the schools. But, although most Perhaps, then, a young doctor could see him- faculty people felt that preceptois should come self delivering health care in revolutionary from the faculty, all were in agreement that ways. student activities should not be confined to the A practical measure recomniended by one medical schools. Whether this was in self-de- f aculty person was that medical schools pro- fense we could not tell, but their feelings that vide medical care for a defined segment of the @students could best learn by working in struc- population, 20,000 to 30,000 people, by . develop- tured projects in the community seemed genu- ing a model health service administered by the ine. medical school faculty and the students. After being involved with students in sensi- Almost all preeeptors thought the project 14 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 could be immeasurably improved if there was a participation in the community should not be f ull-time person administering student-com- the responsibility of the university nor should munity programs. That person should be uni- it be regarded as related to their health educa- versity based but have a background in the so- tion. The Student Health Organization should cial as well as health sciences, in order to un- be concerned with the community aspects of derstand both the educational and the com- medicine. mu-nity aspects of the program. In contrast to most faculty people, there It was suggested that preceptors might be were a few who felt strongly that preceptors paired off-one knowledgable in the health should be community agency people, with the field and the other in community skill@work- latter having some informal relationship to the ing with a group of students around specific faculty. As one member put it: projects. "Faculty people hang in the ivory Student-Community Relations tower-they're part of academia. It's' With the exception of four, all faculty pre- a lot different being in the commun- ceptors believe that the preceptors should be ity.'f university-attached rather than community- based people. One professor in the School of This same preceptor said: Public Health stated: you had effective preceptorships "I would think that any preceptors at the community level and the black who are selected, if they do not have students said 'Go to hell', no matter a university appointment, should be what was said, an effective preceptor very carefully reviewed and approved would be responsible for working by appropriate faculty of the univer- things out and coordinating the sity, if it is to be a university spon- work." sored program." One preceptor from dentistry stated: To show the variations in the faculty opinions, one physician connected with a medical center I'Students frequently resent the in- in San Francisco, commented: stitutional rigidity of institutions such as health departments or infor- "I do not believe the Project should mal community agencies., and precep- be used to educate educators in any tors from these agencies are some- didactic way. I believe university fac- times fearful of the students, but one ulty should serve as preceptors only if of the important experiences gained they work in conjunction with com- from this type of exposure is that this munity preceptors. I believe commun- rigidity is what is preventing prog- ity preceptors do not necessarily need ress.)? to work with faculty. If a student has . "Under these circumstances, what a community preceptor, that work re- the students do is not nearly so im- lationship alone will be educational." portant that they be frustrated in the doing of it, because nothing could be In response to a general question about stu- more misleading than success in a dents involved in nonhealth related community summer project." agencies, several faculty members stated that the distinction must be made between their ed- -The degree of community involvement in pre- ucation as professionals in the health fields planning came up frequently, and as mentioned and their interest in community life. Students .previously, all concerned were adamant that should -be given every encouragement, but their -the community should be involved in preplan- 15 C LIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 ning. One community organizer in the San Joa- had a highly successful program in 1967, but quin Valley, in answering general questions was dissatisfied with the 1968 relationships, about student-community relations, went so far states: as to state: "No project will, come into Visalia "We're kidding ourselves if we again, unless there is a committee of think that inexperienced students local people from the barrio who have who in many cases are still under- a say in what that project will be and graduates, can come into a ghetto who will participate. Students should community and establish a rapport be chosen by a panel of community and deal effectively with the system members plus faculty and students- -that's just a little too much. We but the community should have the have to realize the students are going final say about a student worldng in to be gaining most of the knowledge, its community. I see a change coming and the community is the one that is about in the barrios." going to be supplying it-the invest- ment might come out 4 or 5 years A black preceptor in northern California, who later." Distribution of Preceptors by Organization and Specialty Rural Name Orgaulation Specialty or urban Counties: Jacqueline Campbell ----------- Private ---------------------------- Dental hygienist -------- Urban. Max Schoen ------------------ U.S.C. School of Dentistry ---------- F, B-------------------- Urban. El Centro: Jeff Ghelardi ------------------ Economic Opportunity Corporation -- C----------------------- Rural. Fresno County: James Aldridge --------------- Model Cities, Fresno ----------------C---------------------- Urban. Joe Tee ----------------------- North Avenue Community ----------- C---------------------- Urban. Harold Williams -------------- Community Medical Planning Pro- c---------------------- Urban. gram, Fresno General Hospital. Kern County: Gary Bellow ------------------ Western Center for Law and Poverty, D,F -------------------- Rural. U.S.C." California Rural Legal As- sistance. Jerry Cohen ------------------ Farm Workers Organizing Committee-D---------------------- Rural. LeRoi King ------------------- Rural Development, Bakersfield -----C----------------------- Rural. Jackie Wallace --------------- Multi-Service Center, Bakersfield C---------------------- Urban. Kings County: Angelo Alessandro ------------ Hanford Community Action Organiza-D---------------------- Rural. tion. Larry Lezak ------------------- Hanford Community Action Organiza-D---------------------- Rural. tion. Los Angeles County: James Bates ------------------ South Central Multi-Purpose HealthC----------------------- Urban. Center. Thomas Brod ----------------- USC-L.A. County Medical Center --- E----------------------- Urban. Jay Friedman ----------------- UCLA School of Public Health - - @. - - -B---------------------- Urban. Arnold Kisch ----------------- UCLA School of Medicine ----------- E, F ------------------- Urban. Raymond Kivel --------------- South Central Multi-Purpose HealthE---------------------- Urban. Center. 16 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 Rural Name Specialty or Organiation urban Tony Salazar ----------------- El Monte Teen Post ----------------A----------------------- Urban. Arthur Stein ----------------- USC-L.A. County Medical Center ----C----------------------- Urban. Lou Smith -------------------- Operation Bootstrap ----------------A---------------------- Urban. Merced County: Rural. Art Jenkins ------------------- Economic opportunity Corporation, c ---- ------------ Merced. Mae Lopez - ----------------- California Rural Legal Assistance A-- ------------------- Rural. Denny Powell ------- ---------- California Rural Legal Assistance ---- D Rural. Oakland: Nelson B. Smith --------------- East Oakland Neighborhood ServicesC Urban. Center. Oxnard: Urban. Armando Lopez --------------- Grass Roots Operation A San Francisco: Urban. Arnold Gilbert ---------------- Comprehensive Care Program for Chil- E, F -------------------- dren and Youth, Mount Zion Hos- pital. Southern Monterey County: Rural. Stuart Allen ----------------- Rural Health Project c Tulare County: David Brooks ----------------- Salud Clinic, Woodville --------------E ---------------------- Rural. Chuck Gardinier -------------- AFSC-Farm Labor Project ---------A ------------------ Rural. Eleanor Foster ---------------- Child-Care Center, Visalia ----------c ---------------------- Rural. Leon Mirviss ----------------- AFsc ----------------------------- E ---------------------- Rural Richard Unwin --------------- Tulare Community Action Agency --- c---------------------- Rural. Code: A@mmunity organizer. B-Den C-Admi tor. D-Lawyer. F-Physii F-Professor or teacber. 17 FUNDING SPONSORSHIP AND STAFF The University of Southern California tion. The area coordinators screened, selected, School of Medicine sponsored the Student and developed the sites where students were Health Project of California. Funds came from placed. This process of development necessar- the Social Rehabilitation Services and the Divi- ily had to be done early in the year with those sion of Regional Medical Programs of the De- people in the areas who would be served, and partment of Health, Education and Welfare. therefore, could not involve the students who The University of California at @ Angeles were to eventually work in those areas. This is Medical School supported four students in the a matter of logistics and cannot be helped at project. the present stage of planning, but it would be In addition, there was a small grant from well to consider how individual students might the Rosenberg Foundation awarded to the law be helped to determine their own placements. students who participated in a rural legal as- The odds are that there would be a better mar- sistance program and focused their attention riage of student and community objectives. on a variety of legal problems related to health The State was divided into regions, northern and welfare. and southern, for administrative purposes, but The faculty adviser was Paul F. Wehrle, major policy and financial decisions were made M.D., professor of pediatrics and chairman of from the Los Angeles office. the Department of Pediatrics. The faculty Because the project was funded directly director was S. Douglas Frasier, M.D., assist- from Washington, neither Dr. Donald Brayton ant professor of pediatrics and physiology, De- nor Dr. Donald Petit, areas IV and V directors partment of Pediatrics. Other members who of Regional Medical Programs, respectively, were temporarily attached to the summer pro- were engaged in the planning for funding the ject as faculty advisors were Peter Haberfeld, Student Health Project. However, they did LL.B., law faculty advisor, and Tess Weiner, have more than a peripheral interest in it. M.A., educational director, and Harriet From time to time, the student staff ap- Sprouse, R.N., P.H.N., educational director. proached Dr. Petit for advice and support, edu- The administrative assistants, Kathleen Bren- cational material, and resource people. In every nan and Barbara McClaurin, were a part of instance, there was genuine cooperation. How- the permanent staff. ever, in the main, the local Regional Medical The basic student staff consisted of the Program offices had little daily contact with the director, David Synder, a fourth-year medical project and, therefore, their reactions were student at the University of California at Los largely dependent on secondary sources. Angeles, the educational director, Robert Vi- In an interview, Dr. Petit agreed fundamen- netz, a third-year medical student at the Uni- tally with other faculty members that student versity of Southern California, and seven pro- projects should be health oriented, and if jectIcoordinators, Barbara Hastings, R.N., funded by Regional Medical Programs, should John Prueitt, John Bruce, Steve Bingham, be pertinent to heart, cancer, and stroke dis- Norma Kent, Hugo Ferlito, and Helen Salazar. eases. He mentioned that the . Comprehensive Unfortunately, the administrative assistant, Health Care Act would be a more flexible vehi- Karen Chappel, and one of the coordinators cle for student research and activity since the who had been instrumental in the early organi- act makes provisions for demonstrations of zational phases of the project had to leave new models of health care, methods of elimi- early. nating duplications, and Mling-in gaps in The project was organized and directed by service. the members of the Student Health Organiza- Dr. Brayton, at UCLA, had less contact with 18 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 the summer students, as the SHO headquarters ious kinds of unorthodox community resources were at the University of Southern California which might be useful in the solution of health Medical School. However, immediately after the problems, the gathering of data for the devel- summer project, Dr. Brayton reported an in- opment of new guidelines for health care sys- creasing interest of the UCLA students in tems and the building of community relation- some closer relationships with the RMP organ- ships which would afford RMP deeper insights. ization. Dr. Brayton reacted by suggesting that Some of the basic incongruities between area IV RMP (UCLA) would be able to lend RMP and SHO were discussed at that meeting. itself to a certain degree of student training in The students found RMP's commitment to the the coming years, but any plan would amount present structure of medicine incompatible to "an RMP preceptorship wherein the student with their own goals of modifying those struc- would be exposed to the organizational and tures; students believed that RMP should iden- planning problems inherent in the development tify and build networks of relationships with of Regional Medical Programs." Adequate and community groups who were not particularly suitable skilled staff would have to be made iTi the mainstream of health care, and students available for organizing such a program. were unwilling to be officially tied to any gov- In July 1968, two communications were sent ernment group which might threaten their or- from the training consultant in the Washing- ganizational autonomy or acceptance in the ton office of RMP. The first indicated that the poverty communities. most significant contribution of students would In consideration of the above, it would seem be to gather information about urban commun- that if RMP's purpose is to more effectively ity organization problems pertinent to RMP spread knowledge of new modalities in health programs. These would include the present ef- care, it would be well advised to involve the fectiveness of voluntary and public agencies students in a jointly sponsored RMP-commun- now operating in the inner city. The memo ity preceptorship program, while at the same stated: time strongly protecting SHO's rights to make independent judgments and affiliations. A well "From the students we should be planned year-round program might be devel- able to learn which of these have oped by a committee of the two groups. problems, what the problems are, and Through the establishment of this kind of a which organizations are effective. cooperative relationship, both organizations Further, we should learn the reasons might satisfy their own needs and the needs of for certain agencies' ineffectiveness." the communities for education and service. Although the Regional Medical Programs in The second communication was an invitation to Washington funded the Student Health Organ- a joint 1-day RMP-SHO Conference in Chi- ization directly in 1968, there would appear to cago in'July. At this meeting, Dr. Manegold be an advantage in involving the local RMP or- reiterated RMP's concerns about the disparity ganizations in support of the above mentioned between accumulated knowledge in the tech- year-round planning. Surely in the geographic nology of medicine and the imperfect, unsyste- areas where they function, the recognition that matic distribution of that knowledge. It was problems of local origin need local solutions his judgement that if it could be worked out, would be a determining influence in the deci- RMP and SHO might share certain informa- sion to work with students who are a part of tion. The information included a survey of var- those same local areas. 19 RGANIZATION ADMINISTRATION AND 0 sistant and secretary, all other staff members Description were summer workers. The project directors, The summer 1968 project terminated in suc@ educational directors, law project directors, a state of disorganization that many partici- and coordinators did not take an active role in pants, students, staff, and preceptors came to the project until the middle of May. Routine question the legitimacy of the project itself- decisions were attended to by the two perma- Nonetheless, as mentioned in the section deal- nent oflice people with occasional supervision ing with preceptor reactions, despite the disap- projects persists. from one of the project directors. Day-to-day pointment, hope for future decisions, which didn't seem crucial when Faced frankly, it is a moot point whether this weighed individually, became cumulatively ir- hope should be nourished or quietly smothered. ritating when consistently handled in a casual Perhaps the best way to begin a description man-ner. Complicating matters was the fact of the administration is with an anecdotal that the project office was located at the 'Uni- story. It describes the last hours of the final versity of Southern Calif ornia while the stu- conf erence held in Santa Barbara late in Au- dent director and several coordinators were en- gust. Days and weeks were spent in finalizing rolled on other campuses. Students who called the . genuine emergencies were al- physical arrangements and program for .the office with 200 people expected to attend. However, nei ways met with warmth and concern. The office ther students uninvolved in the arrangements staff were often helpful to those who arrived nor the staff who did the planning, felt obliged without money or lodging, but little was ever either to -adhere to the program or to subst'- done to dispel their sense of impotence. Groovy tute another more meaningful. On the last af- promises were made with groovy hopes and a ternoon, the final full group meeting at the oroovy ,wow !,,-and months after the project v in total frustration, and s were still dan- conference dissol ed terminated, many loose end the students began departing en masse. While gling. the project directors were quietly leaving, ap- A good part of the problem was lack of demoralized as the confused stu- know-how and curiosit about ordinary office parently as ally confused members of the 'y ful for dents and equ procedures which have proven success staff, the project secretary was busily reprod- years. Material was frequently undated so that ucing the position paper of the black a retrospective look at the project through students 11 in the temporary hotel office. Corn- written material becomes difficult. The office mu-nic-ation and coordination has been so lack- was a vast reservoir of rniscellanea-hundreds ing that she was unaware that the students to of copies of outdated memos and equipment whom she planned to distribute the paper were that had long ago outlived its usefulness were already leaving in disillusionment. The sum- being saved at the expense of scarce space mer program terminated in quiet despair-like needed for current staff use. a routed army in disarray, its wounded devoid Staff meetings became another instrument of of the courage supported by their cause, and aargument and confrontation. As a consequence searching in vai-n for an expla- structure for vent- few stragglers the organization provided a nation. ing individual psychological needs. Vulgarized This story typifies the daily misadventures up techniques, repeated ques- sensitivity gro -al staff . With of the blithe but ineffectual centr tioning of individual motives ,precluded adher the exception of the f ulltime administrative as- ence to simple -agendas. The differences were never neutralized. Nor were they channeled See Appendix E, "A Position Paper." 2 .0 CT S-UMMER 1968 CALIFORNIA STUDENT HEALTH PROJE Positively to optimize the objectives. General their relations must develop through mutually problem solving techniques might have taken acceptable sanctions, no matter how loosely ap- into consideration the weighing of alternatives plied. We could carry this out to the logical de- and deciding on priorities. terminants of a bureaucracy-the most com- And thus, while the well-intentioned staff plex form of groups within groups, with many was highly motivated, they were too inexperi- goals, hierarchies, systems of communication, enced to man-age a project of such magnitude and patterns of authority. Whatever the form and complexity. As a result, they reacted de- all these take, one of the most basic require- fensively to suggestions or requests for infor- ments common to all groups is that responsibil- mation as if an orderly approach smacked of ity must be assumed or delegated to someone or the "establishment" and violated the spirit of a group of someones. The most simple group re- the project. quires some patterned division of labor. In Other general meetings, having to do with larger organizations, job descriptions serve the planning educational programs, the opening purpose of explaining what is expected. Other and closing conferences or matters of policy 'requirements are the built-in authority that were held when necessary. Probably the most must accompany responsibility and some form consistently constructive meetings were held of feedback or accountability for purposes of before the summer program started. At the in- evaluation and continuity. All of these ideas stigation of the project directors many discus- can safeguard the rights of individuals if ap- sions were held about the educational policy plied in a flexible, commonsense way. It's what and program. For a variety of reasons which sociologists call structure. will become evident in the report, students did The exercise of authority posed another not respond favorably to the program, but none- problem. Unf ortun'ately, neither the @ff, theless, a good deal of thought had preceded whose position gave them authority, exercised the summer project. it, nor did the larger group reognize the staff's Some of the faculty and advisory board authority as legitimate. Without the former, a members behaved toward the student health vacuum is created and without the latter, no project more like parents of unwanted children leader can function. -acknowledging their parentage but unable to If a short-term project is to have any cope with their own feelings or the character strength, it cannot tolerate this vacuum; nor is of the 'children who developed. Perhaps the there time to correct major administrative mis- analogy would be more suitable if it were takes. Direction not only implies coordination, drawn of the parent, who unable to see the but the ability to arbitrate between opposing child grow up, forever infantalizes him. Both and competing factions and securing the coop- comparisons are variations on the same theme. eration of the group in setting standards. The whole concept of group process is at There is no question that the combination of stake here. There is a difference between -a the black-white confrontation and the demoral- group and an aggregate. The smallest group, izing effects of;guilt and nihilism would miti- two, four, or six, has the same basic require- . gate against -the. success of the strongest of ments as a larger one. A bunch of people leaders. But the misfortune of the summer was standing on a street corner is an aggregate. that problems heaped upon others, and lack of They might all walk into a department store or organizational stability precluded the ability to waiting room, but are still an aggregate. Some- take the blows-and respond with a new strat- thing has to happen to make them a group. Aegy for survival. form of communication, no matter how simple, There was an ideal of participatory democ- must occur. They have to acknowledge some racy. Everyone spoke the words, and nobody relation to each other. Someone has to assume seemed to say that the prerequisites to partiei- leaders hip. Some issue must mold them into apatory democracy are a highly disciplined group. Some form of social control to govern group of individuals able to focus sharply on 21 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 interests and issues, with sufficient control emphasis than that geared to urban problems. mechanisms to insure participation. Some The educational program will be discussed mechanism for making decisions and making more f ully in another section. them stick is also essential. Another area of concern was the relation be- Whether from the East, Middle West, or tween preceptors and students. The decision West, students seemed to perceive structure as was that flexibility in judging each problem on restrictive and authoritarian, rather than in- its own merits would be the rule of thumb, and strumental to cooperation and coordination. independent solutions were to be arrived at be- They conf used participation in decisions with tween preceptor and student. It was hoped that the implementation of them, which require del- serious disputes could be mediated by coordina- egation in order to achieve minimal goals. As a tors whose f amiliarity with communities and result it would have been easy to predict that rapport with preceptors provided them with everyone would make unilateral decisions, and special insights. all the King's horses and all the King's Other major decisions -reached during the men planning stages, were: (1) That any unfilled places would be filled by black or brown stu- Some Administrative Decisions dents, and (2) the orientation program should emphasize the organization of medical care .systems, provisions of various categorical aid Considering that health science students have programs, and an analysis of community little free time and are forced into rigid pat- health resources in areas where projects sites terns of curriculum and long hours of concen- trated study, it was difficult to establish regular were located. oaeeting times. .Against the backdrop of increased national- ism and racial pride in the Mexican-American Student leaders and faculty had held meet- community, on April 15 the staff invited a ings devoted to developing proposals and re- Mexican-American member of the Los Angeles quest for funds. But by spring, it became nec- County Commission on Human Relations to essary for students to anticipate problems of discuss methods of working in East Los An- organization on the assumption that funds geles, an area largely populated by Mexican would eventually be made available. people. He cautioned against the effects of stu- In March of 1968, 45 people responded to an dents who try to organi in invitation to a special meeting of students and ze ' an area unfamil- advisory board members. The purpose was to iar to them, particularly in view of their lack arrive at some general agreements about site of community organization skills. He warned selection, student selection, the education and that community trust takes longer to build than one summer and by inference suggested orientation program, methods of relating the that students confine their activities to their San Joaquin Valley and northern California, of and the advisability of involving the Neighbor- special health science skills in support oth- hood Youth Corps as trainees. Based on the ers who were indigenous to the community. unsuccessful experience of the previous year, At another staff meeting a highly respected the students decided not to include the,Youth and much admired black community organizer Corps students. Committees were formed for and advisor to the Student Health Organiza- each of the other tasks. tion suggested that the orientation meeting and a good deal of the time of the educational In that same month an educational task program should be devoted to black-white sen- force was formed to respond to the requests of sitivity sessions of "telling it how it is" and both urban and rural educational committees. "finding out where it's at." Due to the naivete Because many students were active in the rural of the staff, including both faculty and stu- San Joaquin Valley, inhabited mainly by Mexi- dent members, there was not real understand- can-American farm laborers, students felt the ing of how much an issue this would become as educational material might have a different the summer went on. 22 R 1968 CALIFORNIA STUDENT HEALTH PROJECT SUMME Faculty advisory people who were interested b. Attendance at the weekly educational in didactics were pushing for their positions, programs shall be mandatory for all community organizers for encounter groups student health project students. and confrontation as a method of education, 3. Students are invited to attend Joint Pre- and the students and staff were uncertain ceptor-Staff Policymaking Committee about which way to go in a short summer pro- meetings. gram. Those who were present approved the minutes During the orientation session in Yucaipa,2 with the exception of Dr. Brod." from June 23 to June 26, the black and brown Student Health project students formed a cau- Preceptors Staff cus to challenge the organizational structure, David Swimmer, M.D. David Snyder particularly the ratio of white to minority staff Arnold Kisch, M.D. Tess Weiner positions and the ratio of minorities on policy Max Schoen, D.D.S. Robert Vinetz committees. On July 11, a meeting was called Jacqueline Campbell Hugo Ferlito to im lenient an important demand of the June Jay Friedman, D.D.S. . p 23 Yucaipa meeting of the black-brown caucus Tony Salazar -this provided that preceptors were to be in- Thomas Brod, M.D. cluded on the board where staff decisions were made' At the July 11 meeting, the following At this point in an already explosive situa- decisions were made: tion, an action was taken by the student and 411. A joint preceptor-staff policy-making faculty directors that turned out to be more in- committee is hereby established for the flamm-atory than illuminating. They changed Los Angeles Region. the word "decision" to "proposal" in the min- a. The membership of this committee utes on the grounds that the northern Califor- consists of all Los Angeles preceptors nia group had to agree to any decisions before and Student Health project staff they could be made binding. Their premise was members. that all decisions must be uniform throughout b. Voting powers shall be distributed the State. Since the northern California group equally between black, brown, and was never asked to act on the proposals, those white preceptors and staff according involved in the original meeting felt that they to the 1/3, 1/3, i/3 principle. had been stripped of their power through the c. Formal meetings shall be held once a illegitimate use of it by the directors. It was week for the next 3 weeks; thereaf- unfortunate that by that act the directors ren- ter, every other week. dered the new policy committee impotent and 2. The Joint Preceptor-Staff Policymaking lost the good will of some of the preceptors. Committee hereby instructs the staff to The reason the last meeting is recounted is institute an educational program com- merely to describe in some historical way, if mencing forthwith. a. The educational program shall consist not exactly in chronological order, the enor- of ekly meetings, the content of mous amount of conflict situations which the we which shall be the responsibility of- staff had to face during that.summer. Hope- the educational committee. fully, this le'ngthy analysis can be 'Used to See Appendix F, letter from ROgir 0. Egeberg. dean, University thwart any repetition, if and when another of Southern California Medical School. project is launched. 23 A LOOK AT GOALS About three-quarters of the way into the vice organization. And though that recurrence summer, the faculty director, Dr. Douglas Fra- only indicates how difficult a problem it is, the sier, became alarmed by the many problems implicit assumption that it was possible to in- which remained unresolved. The perturbing tegrate difficult' ideologies of students, com- frictions between staff members, conflicts in munity, and funding agencies is a Utopian no- goals, and inadequate communication between tion. By Utopian, we mean that a situation is coordinators and students in the field, contrib- incongruous with the historical and social real- uted to mounting dissatisfaction. There were a ity which exists in a given present. As Mann- series of interminable, indecisive meetings to heim once said of 18th century values, "The which the students reacted with belligerent idea of Christian brotherly love for instance, criticism and faint support. No new leadership in a society founded on serfdom, remains un- developed. By their own assessment, students realizable." (20) experienced a slowdown-some were angry, There are many organizations which suc- some guilty. The cohesion of former years cessfully serve the goals of more than one seemed to give way to -an immobilizing para- group. Many have made important contribu- 'noia. tions to science and industry and have used It was at this point that the faculty director their multipurposes to stimulate growth. The felt compelled to pose the question "Who high-quality hospital ,vhich serves the triple should set the goals ?" 3in a paper sent to all functions of teaching, research, and medical participants. In substance, he stated that, if care is more often superior to the hospital the three interest groups (students, community which only gives medical care. The demonstra- groups, and funding agencies) would reconcile tion school is frequently a better educational their goals, the organizational problems might institution than the ordinary school. The prob- be lessened. Further, that the goals of Stu- lem with measuring success solely by achieve- dents, community groups, and funding agen- ment of goals is that goals become subjectively cies, if not polarized, were surely not inte- defined, idealized symbols, and cannot readily grated. It was the director's suggestion that if lend themselves to dependable social analysis. students had independent interests from com- Perhaps that is why so m-any students and fac- munity and funding agencies, it was urgent ulty felt unable to cope with the reality of the they recognize that fact. It was equally urgent Student Health Organization summer 1968 that the Student Health Organization work to- project. ward common objectives with these agencies. Implied in the director's search for satisfac- The only reference to goals by a sponsoring tion of mutual goals is consensus. But in the group had been issued earlier in the year by wish for congruity and consensus, the contri- the Washington office of regional medical pro- grams. It.was an unspecific, too comprehensive butions of conflict to change are overlooked. paper called "Work Scope" which summed up Consensus and conciliation are certainly Ac- t ceptable and easier methods of settlement, but the goals of Regional Medical Programs, the not often possible. Conflicts produce organized achievement of which would require high level subgroups from which power ploys become in. medical and community organizational skills -and months of planning and training. evitable. If successful, they frequently shift Actually, .the theoretical question of congru- the organization in another direction. In that case, several alternatives open up for the less ity of goals comes up for analysis in every ser- organized groups. They may form other groups 2 See Appendix, Douglas Frasier M.D., "Goals and Directions." retaining the old objectives, develop tangential 24, CALIFORNIA STUDENT HEALTH PRQJECT SUMMER 1968 ones, or cease to exist. But what is important is With these factors in mind, our analysis of that the conflict suc ceeds in forcing a new pla- whether an organization has succeeded or teau-whether or not it satisfies the needs of failed should not be based solely on attainment the members or contributes to a better situa- of idealized goals. Rather, evaluation might be tion, obviously is not always predictable. But based on reality factors such as cumulative ac- the recognition of the value of conflict to prog- complishment in education and service over ress is important. time, evolution of organizational structure, a In the case of the student health project, it subjective evaluation by the members of their seems that there has been a shift in interest own effectiveness, attitudes and value changes and emphasis from the 1965, 1966, and 1967 by objective and subjective indices, or other projects from identification with established measurements or combination of measurements health agencies toward more militant commun- the group agrees to. Such changes woul prov- ity action groups. This has paralleled the ide inputs and resources for conversion to still growth of student militancy against the politi- higher levels of adaptation. cal and military institutions in the nation. From the foregoing it must be api>arent that Some of the health-science students have been the organization was bombarded by problems deeply touched by these movements. The major on all sides. There were internal administra- problem of the summer 1968 program was that tive problems and external political pressures. -no one was sufficiently skilled to convert the It was -an election year of intense political con- conflicts into positive accomplishments. The fusion with four candidates polarized on dif- United States was born in conflict and unfor- ferent issues, the assassination of two national tunately is still settling major disputes by heroes, and widespread campus protests. To armed conflict. Yet we expect rational prob- top it off, the student health project's final con- lem-solving to find mature expression in con- ference was being addressed by Eldridge sensus. We continue to look for agreement be- Cleaver as the radio and TV blared out the tween ideas and conduct and fail to understand treachery of the Chicago police during the that conflict is the fulcrum for the balance to Democratic convention. Put in this context, it be achieved. Because the author feels that we have too is not difficult to understand why things did long neglected the role of conflicts -and have not go as smoothly -as they had in previous not given enough study to the art of negotia- years. tion, this paper takes issue with the search for goal consensus as commendable as it may be. "The word progress is ex This is strictly the author's bias but raises im- tremely ambiguous. It means, of portant questions for accomplishing social course, moving forward on a certain Change. The paper takes issue not because road, but not necessarily the right there were not real differences in the goals of road. It denotes a continuous expan- the three interest groups, but because the sion of knowledge, but is almost director poses their incompatibility as the rea- meaningless with regard to better- son for failure. Perhaps it would be more real- istic to start out knowing incompatibility ex- ment of the human condition, unless ists and going on from there. Accepting handi- the goals to be reached are stat- caps is a good way of starting a game if you ed." (8) acknowledge they exist. -RENF, DUBOS. 25 THE ROLE OF THE UNIVERSITY In all likelihood, the University viewed the terested in promoting change. That means the student health project as a maturing organiza- University would have to invest more imagina- tion then in its fourth year. It assumed there tion in planning their sponsorship. The stu- had been learning from negative as well as dents too would have to accept the charge of positive experiences, and this was not an un- planning projects with reasonable judgment warranted assumption considering that the and follow through. It is not an unwarranted students had been active for 2 to 3 years. Per- assumption to expect that students will be in haps the University failed in not making its conflict with universities, health institutions own objectives clear to itself or students. In in- and other groups from time to time. That in terpreting its role as one of a facilitator rather and of itself should not mitigate against the than a change agent, it staodapart rather than Student Health Organization seeking alliances become involved in a mutual enterprise. Under with those professional and nonprofessional ordinary circumstances people have a chance groups who offer the best solutions for health to test out their learning before taking over a care delivery. leadership role. But the objective political,con- Nineteen sixty-nine and the seventies will ditions in 1968 were quite different from other no doubt produce some forms of student-com- years, and consequently conditions for leader- munity relationships. What is to be hoped for ship were also different. are thoughtful and more refined models of No one at the University or elsewhere could community education and service which will have predicted the events of the summer. Even permit the university and students to have a if the University had stepped in with creative constructive experience in community develop- and imaginative shock troops, the probability nity medicine. ment and commu is that they could not have changed the direc- m the wounds of When people are so fresh fro tion very much. But sensitive and resourceful a moving experience, it limits the implications supervision might have responded to the as- that can be drawn, but in retrospect, some of saults on the organization, handled the @e- the positive elements come through. This resi- destrian needs of students, and offered secu@ty liency is now being exhibited in the initiative of to -a badly battered staff. Organizations, ilice 4t-hose students who have decentralized the local people, have a life and death cycle. If an or- organization into three separate organizations ganization is to prosper, it must be given pro- attached to the major medical schools in the per nutrients and a chance to mature through area, the University of Sou. ern California, learning opportunities and successful coping. As to the coming years, it matters not who University of California at Los Angeles, and sponsors the students in the future-whether the University of California at Irvine. it be departments of community medicine, vol- Already they have begun to make contribu- untaky or government agencies. Discipline and tions to the number of minority group student control must reside in both sponsor and Stu- admissions and to define other objectives di- dents. If the sponsor is the University, it has rectly related to the original objectives of the to make itself accountable to students in their student health projects of the past several acceptance of students as developing adults in- years. 26 EDUCATIONAL PROGRAM During the previous summer, the faculty ad- the three educational directors were to be visors, preceptors, and students had expressed available resources to preceptors and students. concern over the lack of an organized educa- Beyond their own limited knowledge, they tional program to supplement the field experi- were expected to develop a bank of additional ence. resource people who could be called on to sup- At the March 1968 Student Health Organi- ply information when needed. They were to be zation meeting, the minutes show that the stu- from a large variety of fields such as connnun- dents agreed that this year special attention ity organizing, child care experts in education would be given to the study of the organization and health, and physicians, dentists, and public of medical care institutions, the f unding pro- health nurses familiar with the organization of cesses, Federal, State, and local health care ju- public health programs. risdictions and responsibilities, and the various That the program did not come off satisfac- kinds of health careavailable to, as well as the torily was due to the general problems men- gaps, in services to the poor. In addition, the tioned earlier: disinterest in formally striie- educational committee gradually refined its tured programs, which is understandable con- scope to include workshops in communication sidering the overly structured life health stu- skills, a study of community organization dents lead, and the inability of students to dis- methods, plans for a session on racism, and tinguish between authority and authoritar- later, sensitivity training groups if monies ianism. The lack of authority of the educa- were available and there was sufficient need tio-nal directors was another major barrier to and interest. success. Individual volition was the only au- Three educational directors were attached to thority but a mobilizing force was absent. the project: one was from the field of medical Attendance at educational sessions was vol- sociology, another was from nursing education, untary, and needless to say, summer is a good and the third was a third-year medical student. time to go to the beach or to explore new vis- It as unfortunate that the three people were tas. If a didactic program is to be included in never able to work out a unified program. Each the student health experience, it would appear had autonomy and seemed unable to relinquish one day a week should be set aside for that some of it. The intent was that the educational purpose. person from the field of sociology would add To mix a metaphor, the staff was snowed to some knowledge from the behavioral and social the point where it lost its own volition and the sciences, and together with the student direc- snowball effect took over. Rather than recog- tor, contribute a balanced program of readings, nizi-ng the boycott of the educational program films, discussion groups, role play, and other as another evidence of protest, and therefore techniques suited to the particular educational terminating the program, those of us who were goal. The educational person from the field of involved became lemmings and went quietly to nursing education was to use her knowledge to our demise. The author, who was involved as give support and guidance to student nurses one of the educational directors, shares the res- who have long suffered from a low self-image ponsibility for not shifting gears quickly in relation to physicians. The hope was that enough to either termi nate the educational pro- behavior would change as we upset the tradi- gram or drastically modify it. With some de- tional roles which institutions foster in physi- fensiveness, it must be stated that the project cians, dentists and nurses. directors and the educational directors fre- In addition to organizing formal programs, quently attempted to seek suggestions from 27 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 students, who were really disinterested in project has many potential advantages and ob- any formal program. To the degree that we did vious built-in disadvantages, what is crucial is not respond to their capacities and interests, to focus on the process of education in all its the goals of the educational .program failed. forms. Otherwise we may only finally achieve a The students, however, also failed in their con- less committed, partially defeated student ,vho sistent lack of response either to the program perceives the problems as so enormousas to be or requests for program suggestions. Conse- insurmountable. To some degree the future be- quently, part of their confusion on projects re- havior of the student will be conditioned by the sulted from their ignorance of simple answers outcome of the conflicts between his principles to what appeared to be large insoluables. Per- and his self-interest. If the Student Health Or- haps what it indicates is that the concept of ganization can help in unifying the struggle measurable education in sequential steps is ir- between these two pulls, it will make a signifi- relevant'for the summer-just as the summer cant contribution. Camus(5), in explaining program is no longer relevant. If students are that reasons for revolutions are inbedded in required to use their own potential in dealing the conditions of their times, and in modern with persons and problems, and if possible, times in western educated man, reflects: offer solutions within a reasonable time, the "Actual freedom has not increased development of those skills also constitutes a good basic education. But there remains the in proportion to man's awareness of fact that without some basic knowledge about it. We can only deduce from this ob- servation that rebellion is the act of how to approach some of the problems they en- an educated man who is aware of his counter, the students can only stumble blindly own rights. But there is nothing which onto solutions. In so doing they quickly incur justifies us in saying that it is only a the wrath of the communities in which they question of individual rights. * * * work and insure defeat for themselves. It is ev- what is at stake is humanity's gradu- ident from student reports that students who ally increasing self-awareness as it were better prepared, either from past summer pursues its course." experiences or intellectual interest, had more realistic expectations of themselves and the In the interests of documentation, though none summer experience. Of the educational programs were well at- Since a project such as the student health tended, some of the sample programs follow. Sample Educational Programs-1968 June 13 --------------- Staff meets at Urban Training Center with four community organizers from minority communities. June 15 --------------- Communications Skills Workshop.-Part of staff and volunteers take 1-day training workshop to learn discussion leadership techniques in order to build cadre of leaders. Led by Paula Menken, UCLA specialist in com- munications. June 21-24 ----------- Orientation program at Yucaipa, P' Calif. *See Ap endix for program. July 14 - - L ----------- Infor=Z Su@j Evening "Problem Clinic".-Dinner and beer (The "Pro- blem Clinic" was a gimmick developed to give students a place to share problems, to ventilate anxieties, and erhaps to pool solutions to mutual p problems.) July 28 The Political and Social Forces in Health Care: Who Has the Power?- Evening with three experts: Lester Breslow, M.D., president, American Public Health Association, professor, UCLA School of Public Health 28 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 David Solomon, M.D., chief of medicine at Harbor General Hospital Austin Chinn, M.D., project director of Rehabilitation, Research and Train- ing Center, University of Southern California School of Medicine. July 20 -------------- Trip to Salitd Clinic, Woodville, Calif.-David Brooks) M.D., director; an independent health clinic near Visalia, a small farm labor community inhabited by mixed ethnic groups, poor whites, Mexican-American, and some black families. August 11 ------------ Community Organization and Development.-John Davis, sociologist and representative of the Black Congress; Jerry Inglis, Community Service Department, Los Angeles County. August 18 ------------ New Career.- in Health-Legal and Attitudinal Barriers to The Use of Semi-Professionals (canceled because of lack of Attendance at previous sessions). August 23 ------------ Racism-FuU-day Session.-Open discussion between students, preceptors, faculty-Nathan Cohen, dean, UCLA School of Social Welfare; Harold Jones, M.D., black psychiatrist from Youth Development Center -, rep- resentative from United Mexican-American Students; and all student health project fellows. (Cancelled because of threat of boycott by black SHP students.) Suggested Alternative Program.- (These education-the relation of complex social prob- were discussed for future programs if SHP lems to individual health problems. should consider year-round activity.) The Concept of Community as a Process.- The Development of Alternative Systems What are its functional borders? What are the and ModeU For Health Care Facilities through factors in its togetherness? What are the ob- the Case Study Method With Role Play Tech- stacles to change? What would accelerate its niques. -Students to develop the cases out of progress? their experiences. The alternatives are listed here for the re- The R@tiowhip Between Law and Health cord. They may be suitable for study in a -Legal Barriers to Health.-Members of the year-round program on community medicine. UCLA and U.S.C. School of Law. There were many pieces of important litera- The Responsibilities of Public Health Insti- ture sent to students or given as handouts. tutions in 1968.-State Department of Public They covered a variety of subjects such as Fi- Health and Child and Youth Clinic, Los An- nancing Health Care, The Economic Opportu- geles County Department of Public Health. nity Act, The City, material on New Careers in The Urban Condition.-Population shifts, the health professions, community organizing black capital, white exodus tax rates, land methods. There were others too numerous to rate, automation, jobs, industry, housing and mention. 29 THE PROJECTS omissions, it is due to those reasons enumer- Introduction ated, plus the fact that the projects in the In some parts of the country, the projects Black ghettoes did not report. There was an planned in advance for the publication of their attempt to collect data at the beginning and reports. A staff historian or evaluator was end of the summer. Questionnaires were dis- made a part of the staff at the beginning which permitted an objective evaluation to be kept tributed at the orientation session at Yucaipa, and later compared to the subjective logs of and at the closing session in Goleta. Some of students. While the project was in process the the students cooperated, but many rejected the instruments as irrelevant. As a result, any con- historian was able to investigate individual clusions based on the analysis of the question- communities and -relate demographic material naires would be unreliable and incomplete. to deficiences in health care in these communi- The f ollowing summaries attempt to report ties. Whether this information was gathered some of the salient impressions, and sometimes only for the official student health project re- hopeful and sometimes poignant anecdotes port or was used to enrich the understanding about the summer projects. The excerpts are of student fellows, we do not know. If it in fact from synopses of project goals written prior to was used to supplement the students' knowl- the summer by the area coordinators and from edge about the areas in which they worked, it final reports of students who worked in the would have added much meaning to their jobs. projects during the summer. Thirty-nine re- f In former years, the California area coordi- -nators summarized their own perceptive feel- ports representing 46 students were submitted out of a total of 93 participants. There were 16 ings about the various ways the students lived health-science projects and 10 law projects in in the communities in which they worked, a d n California. t the intensity of some of the relationships a o matter how exhilarated or weary, joyous developed; how some of the teams worxea or despondent, the message that comes gallop- along well as a part of the community, and i.ng through all of the student reports is suc- how in some communities, students were too uncomfortable to weave themselves into the cinctly stated by one Yale medical student: life of the community. Characteristically, there "I DID NOTHING, BUT, I LEARN- is a description of the sharp contrast between ED A LOT." the students' ability to deal with complex intel- Los Angeles County lectual concepts, and their inability to under- stand the complexities involved in the perpe- There were seven projects in the following tuating cycle of poverty. six areas in Los Angeles County: Venice, East ious problems such Los Angeles, El Monte, Watts, Willowbrook, This year, because of var as replacements in area, coordinators, illness, University of Southern California Medical the fact that one coordinator had to leave Center. early, and other problems mentioned in the Venice s were received body of this text, no summarie from coordinators. Unfortunately, no one was Venice is a poor beach community on the assigned in advance to plan for the preparation west side of Los Angeles Coun@y. There have of this report. Therefore, we are writing this been some tensions between the Negro, Mexi- retrospectively, without the possibility of ver- can-American, and poor whites who live in sep- ifying material with participants who have de- arate parts of the ghetto. A hippy community, parted.. If there are gross errors or serious a small group of university students, and a 30 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 group of elderly Jewish residents also live in to include provision for operating at a Venice. It has been a retirement community for loss in spite of patient fees, with the elderly Jewish people long before World War hope that any such loss could be un- 11 and has remained so to this day. derwritten by sympathetic local com- Three students, two in medicine, and one in panies." dentistry, worked in Venice during the sum- "Other features of the clinic were mer. One law student, a student health project to include medical students furnish- fellow, worked on a separate project which he organized. The goal of the students was to es- ing transportation and 'patient ad- vocacy' for patients, as well as fol- tablish a Venice Health Clinic in cooperation low-up visits to those treated at the with the UCLA Medical and Dental Schools. clinic in their homes. Treatment itself The ground work for this project had been laid would be administered solely by den- the previous summer. The Venice project was a tists and physicians, however. It was prime example of effective preceptor support combined with constructive experiences for the understood that Venice residents students. The project was well defined and pro- would be selected preferentially for any staff positions at the clinic." vided consecutive challenges which were met by consistent faculty and community involve- "A biproduct of our summer was ment. an extensive list of over 50 important With the help of three faculty preceptors, resource people in t e nice commu- Arnold Kisch, M.D.; James Freed, D.D.S- and nity. This also has been submitted to Jay Friedman, D.D.S., the students wrote and the student health office for any fu- submitted a proposal for the dental clinic to ture workers in Venice." the Regional Medical Programs Area IV Divi- John Trego, the dental student assigned in sion at UCLA. While in the process of develop- Venice states: ing additional support for the clinic, the stu- "We have support of the Health dents were able to build a good rapport with antipoverty agencies. The Venice State Service Council, the Service Center, and most Center offered office space for the project and everyone we have talked to in Venice. We have dental equipment donated to the Venice public library cooperated in publi- cizing and making space available for evening install in the clinic. We have a com- meetings. Probably the single most important mitment from UCLA to make this a contribution students made was in bringing to- satellite facility. We have funds avail- able through a state grant. We are gether the University (UCLA), the Los An- now waiting on word from the Serv- geles County Health Department, and commun- ice Center director in Sacramento to ity people who formed the Venice Health Coun- allow us free rent on a room in the cil. That the'project had sufficient momentum Service Center. These last two items to carry on from year to year, indicates that -funds and space, will decide whether it is possible to build the kind of bridges be- the clinic can be started and. when." tween the community and the institutions who serve it, which will permit them to consummate I know this summer has attuned projects beneficial to both. -This sense of my opinions of myself, my profession, achievement was reported in the statements of and of people in poverty situations. I some of the students. Bob Buker, third-year don't think I will ever forget the ex- periences I have had and the concepts medical student with a sense of personal urgen- I have learned this year. I hope to sat- cy worked in the program in former years and isfactorily incorporate these 'ideas' stated: into my future goals in dentistry, to "Ultimately, the model (dental please myself and to help the people clini@Ed.) we proposed was forced that need it." 31 CALIFORNIA STUDE.NT HEALTH PROJECT SUMMER 1968 The law student, Jon Steiner, who was placed The community needs training programs for in Venice because he had previously worked auxiliary health personnel, and a cheap shuttle at the Venice public library in a tutorial pro- service to and from clinics. t, was fully justified in complainiii- that According to one student who lived in the .Jec he had no preceptor nor any project. How- community, it needs sanitation services too: ever, his familiarity with the community "My apartment costs $80 a month, helped him to flounder less than most students has 13 broken windows, and houses might have, and after a period of searching, he the U.S. headquarters for the Interna- attached himself to the local Venice branch of the Los Angeles Neighborhood Legal Services tional Termite Command." office. With the cooperation of that ofnce, he was able to organize a series of classes on legal The East Los Angeles Child and Youth Clinic problems which affect the poor, such as land- East Los Angeles is a sprawling area east lord-tenant relations, garnishment/attachment I I and north of the center of Los Angeles and problems, consumer fraud, and welfare rivnts. composed predominantly of poor Mexican- He was encouraged by how much could be gone by students if a plan had been implemented American families. The Child and Youth Clinic before the summer: is -t demonstration project which represents a joint responsibility and collaborative effort of "Many times, a phone call to a the Los Angeles County Department of Health collection agency could serve to re- and the Children's Division of the Los Angeles lease a garnishment of wages and County-Univei-sity of Southern California save a possible lost job." Medical Center. It opened early in 1968, and is a new clinic model for Los Angeles. It provides For the projected Venice Community --%Iedical comprehensive services for children under 19. Center, it is hoped the clinic will incorporate Some of the original data to substantiate the three basic personnel elements: residents of need for the clinic was collected by project fel- the Venice area, interested physicians, and in- lows in the summer of 1967. Great impetus was terested medical students. given to the establishment of the clinic tin 0 32 CALIFORNIA STUDENT HEALTH PROJECT SUMAIER 1968 through the combined efforts of the adminis- Steiner, conducted a survey of families in the trator of the Los Angeles County General Hos- area through the use of a questionnaire devel- pital and the Los Angeles County Health De- oped at Children's Hospital. They chose' a partment. group of families who had been seen once at Five students, from the fields of medicine, the clinic and had been rejected for future care dentistry, psychology, social work, and politi- for one of several reasons; either they did not cal science were assigned to the clinic with two meet the poverty criteria, had other health general objectives: (1) To develop meaningful coverage, or were not in the catchment area. educational experiences for four high school Thirty-eight families were interviewed for the students participating in the project; and study. The researchers wrote an excellent (2) to communicate their perceptions of the paper on their findings which they presented community's needs to the staff of the clinic. to the clinic and their preceptors at the close of Three of the students worked throughout the summer. the summer with the high school teenagers. The two girls had many reactions to their They conducted classes on sex education, biol- experience: ogy, anatomy, and mathematics. They made use of slides, films, and medical and dental equip- "Located in the heart of a pov- m-.nt. They took the teenagers on field trips and erty pocket and making efforts to re- encouraged them to ask questions. A special spond to the community's real needs, the clinic is bringing health services understanding was established: closer to the people. "But the important thing was that The clinic personnel must re- they asked, and we listened, and re- main constantly aware that they are worked the rest of the program working in an area where social path- along with their desires. I had hoped ology, as well as medical pathology, that this would happen, but we really is a problem. It is the responsibility had to wait until they were ready to of the professional staff to recognize talk to us. As it was, it was like pull- and respect the cultural differences be- ing teeth to get them to talk about tween themselves and their patients." what they wanted." "Those interviewed saw the clinic July 23d.-"Pat started the session. only as a place to bring children for We talked about lung dieseases, su'ch emergency treatment. From these re- as asthma, emphysema, cancer., We sponses, we question the adequacy of discussed pneumonia and TB, then the explanation of the services being the mechanics and symptons of left offered by the clinic. To these people, heart failure. We showed a film about a referral slip is the carte blanche to smoking and they know the danger health care. This is evidenced by the signals of cancer. Then we got into a fact that thirty-two of our cases came discussion of the common cold. From to the clinic by a referral from either there we went to viruses and then the County Hospital, public school, DNA, and then the structure and Health Department, or Project Head function of RNA in the cell (DNA- Start. Many times an interviewee RNA-Protein). We also had a discus- would question ff she could return to sion of coding, computers, and binary the clinic without a referral slip." numbers' They can compute in binary JANF, HmsciiMANN. numbers now." MAP.TA STEINER. BILL BAUER. "People in East Los Angeles are To achieve the second goal of the project, poor, yet this is the only thing they two students, Jane Hirschmann and Marta' know. How can they lift themselves 33 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 up without power when even we @Vith this information, the team prepared who are not poor, cannot buck the sys- recommendations for a minority group recruit- tem? N@lhat's the answer?" ment program at three medical schools: U.S.C, iNIARTA STEINER. Stanford, and the University of California Medical Center in San Francisco. They submit- Bio-medical Careers Pro@ect-Minority ted several models of their suggested program Group Admissions to the Admissions Departments and Deans of medical schools' and disseminated information This project was aimed at laying the about the program to students in the three gi@oundwork for increasing minority group schools. The model programs would permit mi- admissions into medical and other health sci- nor@ty group students at various levels of ence schools, and for the establishment of an achievement to enter medical school. In order organization to encourage high school students' to compare their methods of approach, they in poverty areas to enter the biomedical ca- contacted Student Health Organizations in reers field. Boston, Chicago, and Detroit, who had already Three students, two medical, one sociology, made some progress in facilitating minority worked on the project throughout the summer. group admissions. They gathered two classes of statistical infor- The students felt encouraged by the response mation from nine California medical schools: to their efforts during the summer. 1. The number of minority group applica- In the past year, minority group applications tions and admissions in the nine schools at UCLA have risen f rom nine to 35, from in the past 3 years. which eight will be admitted. At U.S.C. 15 mi- nority group students have fulfilled admissions 2. The number of minority group students requirements. admitted since 1960. Though progress is slow, the evidence contin- 34 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 ues to indicate that pressures from students medical staff and become patient advo- do have some impact. cates. Los Angeles County-University of Southern The students on this project had much to say California Medical Center about about SHP in general: The Los Angeles County-U.S.C. Medical "The most obvious deficiency is Center is the largest medical institution in the the project's lack of leadership. It United States. had been difficult to identify the staff Four medical students were assigned to the because of the shunting of responsi- hospital with the goal of making some rough bility from one persoh to another. appraisal of the medical care received by some Confusion and indecisiveness in the selected groups of patients. leaders about goals and methods has The students, who had relative autonomy, led to confusion in the project. * * * decided to walk through with patients from Absence of direction prevents effec- moment of arrival, to treatment by a doctor, to tive leadership in the present and receipt of prescription drugs. In their survey, prevents development of project sites they interviewed patients, doctors, nurses, and that can be maintained into the fu- administrators. After compiling their findings, ture. An organization cannot exist they made valuable recommendations for im- only for the present. It needs a sound provements about relatively simple, but p.roba- sense of the future to be able to grow bly very useful aids to dispel the usual confu- and become more effective as it sion felt by patients in such an enormous fa- grows. cility. They suggested a brief pamphlet be pub- BILL MASON. lished in English and Spanish describing the Walk-In Clinic, its procedures and the care it El Monte provides. They also suggested the placement of El Monte is a city of approximately 65,000 bilingual personnel in those areas of the hospi- residents in the San Gabriel Valley in the east- tal where there is a large amount of patient ern portion of Los Angeles County, with about contact with hospital personnel, such as the In- 55 percent white, over 40 percent Mexican- formation Desk, Walk-In Clinic desk, and the American, and the balance Oriental. clinic Registration Desk. Two students were assigned to the El Monte They found treatment in Unit I ' the Acute Teen Post to attempt to establish a Dental Ward, was excellent. They suggest that in ad- Clinic for the area. Although they tried very mitting rooms, medical wards, and out-patient hard and, in fact, made some headway in in- clinics, the following changes would enhance volving local residents and a local dentist, the personal service: students were unable to achieve their aim. The 1. Screening of patients should be done by San Gabriel Valley Dental Society is a conserv- an RN or P.H.N. ative organization which has, in the past, op- 2. That there be a special area set aside for posed other antipoverty or government subsi- the refilling of prescriptions. (Average dized programs. The students received prom- wait for a large number of patients was 3 ises of help from dental supply houses and a hours, 13 minutes.) local real estate agent, but without the den- 3. A bilingual pamphlet in English and in tists, could go no further. They feli very disil- Spanish describing Unit 1, its procedures lusioned and bitter, and their experience in El and the care it provides, and in general Monte tended to dramatize the need for greater what patients may expect. SHP activity. What they found fortified their 4. Nursing personnel should pay more at- belief s. tention to the human factors in nursing The two students made many efforts to in- rather than be task-oriented. Nurses volve local people, but not only were they unfa- should be invited to attend rounds with miliar with the area, but they also lacked su- 35 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 pervasion from health professionals who could joy-at first. It was he who first have guided them. Their preceptor was either swayed our clinic to its present objec- too busy or unable to direct them to adequate tives, but he was the first tonight to professional or community resources. The local try to cut our project to ribbons along Health Center dentist feared socialized dentis- with the school nurse. And the people try, the PTA was squeamish about supporting themselves (six women) disliked the a Dental Health Clinic if they did -not have the project because the community was support of the Health Department, the area asked to help the project through coordinators were not able to teach any special participation and financial help-as I organizing skills, and to top it off, no one ever already expected, these people are circularized any representative groups in the lazy slobs that want everything community before the decision was made about handed them on a silver platter and organizing a Dental Health Clinic. f or f ree." According to their reports: Esperanza Gonzales, a SHP community worker "Four out of 13 dentists we invited at the El Monte Teen Post, after a meeting showed up. We had a community with some of the local dentists wrote: meeting and five people showed up." "I also know that these dentists Don Graham, the dental student, wrote about lie to you in your f ace. I only wish his deep resentment: I had the nerve to tell them; although "We finally seem to know where we I did try. Dr. Kean says, 'I'm sure are going-at least where we are at that the dentist and myself would for sure-nowhere! We've gotten some gladly like to work on poor people good leads and are on the track and and ease them of their pain. Mrs. have appointments to make appoint- Gonzales seems to give the impression that there are a lot of little youngsters ments to find where we will be re- going around in pain. If so, he says, ferred to next. Primarily, we need bring them to us and we'll take care dental health statistics and are pre- pa@ed to make any sacrifices or at- of them. We have always done a lot tacks to remove or lift these facts out of charity cases, the doctor and I.' Well, all I can say is, they must have of the 'system'. gone to jungle,land for charity cases, "I f eel as if I am being used for a cause I never heard of one." purposeless purpose and resent the arrogance or ignorance (probably Willowbrook Volunteer Health Center both) of the SHO coordinators. You Three students were assigned to the Volu-n- may rationalize by saying we planned teer Health Center in the ghetto community of these meetings with Dr. Schoen's Willowbrook, which is adjacent to Watts in office to let you explore more avenues South Central Los Angeles. They were not as- of possibilities, but it was all an acei- signed any specific task or given any particular clent. Just as I believed we were get- goal other than working with Dr. David Swim- ting somewhere, I learned that I am deeper in nowhere. I don't know where mer, the director of the Health Center and 'I am at' what I have done, or which their preceptor "in doing whatever is needed to way to turn, or what to do next. I make the Health Center work." This they en- know I am not at all pleased with thusiastically began to do, teaching NYC what I have done so far, however. youths to take temperatures, blood pressures "At our meeting to form a den- and pulses, and on occasion, the students tal council, the only dentist was Dr. pitched in on the maintenance work. They Kean, which was a great shock and made great efforts to enlist outside support for 3G CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 the Health Center and achieved some measure to have them in our games, of success. but you replied.: In their final report, these students detailed problem areas in the Center and made sugges- They are only wind-up birds tions and recommendations for the improve- who strut on scarlet feet ment of its health care delivery system. How- so hopelessly far ever, the unexpected consequences of a summer from our curled finger. with this kind of involvement are often mani- fested in the sudden awareness that one must I had moved to warn you, experience one's self and one's values before he but you only adjusted your hair can truly experience others. and ventured: .Their wings are made of glass and gold "This summer's experiences and we are fortunate has me more confused than ever. I not to hear them splintering honestly don't know how it is going to against the sun. affect my 'career'. I am torn over just how involved I should get, or whether Now the hollow nests there is really a cause to be involved sit like tumors or petrified blossoms in. I get the feeling that people must between the wire branches first face themselves before jumping and you, an innocent scientist, into a 'movement' or any cause." question me on these brown sparrows: JOHN GAMBIN. whether we should plant our yards with John Gambin and Steve Sanders, the two stu- breaderumbs dents, felt this was an exceptionally or mark them with the black, persistent crows good placeIment, and that they received constant whom we hate and stone. friendly support and advice from Dr. Swim- mer, a resident interist at Harbor General Hos- But what shall I tell you of migrations pital. But their awakening to problems was not when the dimmest flutter of a coloured wing without cost to their peace of mind: the precige ghosts of departed summer birds still trace old signs; "I feel that individuals seeking or of desperate flights a large chunk of the 'capitalist pie' when the dimmest flutter of a coloured wing exploit their 'brother' with calls for excites all our favourite streets unity and identity while really pri- to delight in imaginary spring. marily concerned with personal ad- vancement. -LEONARD COHEN Selected Poems, 1956-68. "Possibly we disrupted the lives of the boys our age by trying to be South Central Los Angeles- friends with them and then leaving The Watts Project them stranded at the end of the sum- Thousands of words have been written about mer." Watts by people "in the system" and people THE SPARROWS doing battle with the system. There have been descriptions, explanations, and lamentations Catching winter in their carved -nostrils from all shades of opinion. Watts as Harlem the traitor birds have deserted us, has countless numbers of Federal, State, and leaving only the dullest brown sparrows local measures meant to reduce the symptoms for spring negotiations. of poverty, to tranquillize the pain, and to tnaesthetize the anger. I told you we were fools Watts, a community in South Central Iks 37 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 Angeles, was the center of the 1965 Los An- The two preceptors who planned the pro- geles revolution, usually referred to as "The gram and gave tight supervision were: James Watts Riots." The people of Watts know some Bates, community organizer for the South Cen- of the things they want. Jobs that go some- tral Multi-Purpose Health Center, an OEO where, a good education and day care centers Health facility, and Lou Smith of Operation are just a few of the things that are high on Bootstrap, an aggressive voluntary self-help their priority list. organization dedicated to the development of So much has been written about the char- black-owned and operated businesses. Accord- acteristics of Watts, that this report will re- ing to one student, tempers in the summer de- frain from the usual comparisons of eastern manded tight supervision and self-disciplined and western ghettos or from giving an aval- workers. anche of statistical data on infant mortality, It is not possible to report the' students' in- morbidity and unemployment rates, school dividual reactions to the project since none of dropout rates, life expectancy charts, average them submitted a final report to SHP and only income, or number of AFDC families. one responded to the request for an interview. There were five project sites in South Central John Bruce, an area coordinator in the South Los Angeles, with a total of 10 students, seven Central and El Monte areas is a man who can black, two Mexican-American and one white. make many objective observations by reason The purpose of the projects was to establish of his African heritage. He talked about his re- voluntary medical disaster stations for treat- cent identification with the black man's strug- ment of injured persons in case of tensions gle in the United States: erupting in the area. Important to the estab- "The differences I notice in South lishment of these stations was the plan to Central from most of the countries of utilize doctors and nurses and health science Africa and Europe where there are students to teach first aid skills to community ghettos, is that in those places there is residents and thereby build up a corps of hope-there are ways of getting out trained first aid technicians in the commu- and here there is not." -nity. In the course of training, the community people would be brought into contact with When he discussed the method used to gain ac- available health resources and learn how to ceptance and trust with community people, make use of them. Teenagers were also in- Bruce stated: cluded with other residents. "It helped, of course, to have the The plan was carefully conceived and doc- same color. Also there had been some umented before the student health project peo- involvement before the project began. ple arrived. Groundwork had to be laid. De- We had meetings with the people in cisions about the most strategic locations for the community, with the woxnen, Black disaster stations, transportation of both work- Congress, and other groups. By the ing peronnel and possible victims had to be time we came, they were waiting for arranged, and cooperation was sought from us-we met originally with older peo- related social agencies, health agencies, ple, for we realized that younger ones churches, community organizations, and indi- were much more militant than we by viduals. Channels of communication were middle-class standards." worked out and dry runs were made with SHP Later on he mentioned that it was important fellows after they arrived. that the people in the community realized the It was understandable that professional per- students were interested in their survival. sonnel as well as community people.might feel Bruce was adamant that faculty people and the antagonistic to young, bright, privileged black universities in the area represent special local students and, therefore, the roles of student interests and therefore cannot relate well to health members were carefully limited. community needs, although he sees no reason 38 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 the federal government cannot support local tically of the Wedneday sessions when he and programs. students would "sit around and rap" about "I don't think universities and sim- books, their projects, the people in the commu- ilar institutions can provide the type nity, about strategies and political imperatives of person we need as a preceptor who related to the Black Revolution. As is the case understands and can be receptive to of most teachers, Bates felt that he learned as the community. But there is a role for much from the students as they learned from these people. Dr. Kivel and Dr. Lieb- each other and the community. According to erman, both white physicians at the John Bruce and -Bates, the spirit of trust and Health Center, worked with us last exploration set a tone which encouraged stu- summer by providing technical advice dents to accelerate the process of their per- when we needed it, and it was a very sonal growth as well as deepen their philosophi- valuable service." cal commitment. Attendance on Wednesday afternoon was expected. In a totally pragmatic way, Bruce stated that There is no question that the project served the black person aware of the urgency for a critically important purpose for the black change will realistically face the fact that students. Most aspiring professionals leave im- there 'are not enough black professionals to poverished areas as soon as they are -financially solve the problems. But he attempted a defini- able to leave. Watts is no exception. The SHP tion of what the relationship ought to be. The offered a way for the community to be visible white professional has to provide services again to some of the younger, more aware stu- against the background of dealing with a sub- dent professionals who hopefully might return culture on its own terms. He has to accept the once they have graduated. fact that he is in a culture partially strange In addition to changes in specific individuals, to him, and that he is going to have to work there was the effect of pride in group identity with the people in the way the people present which captured the black students and offered their problems, not the way the professional them a chance to work within a ghetto com- predetermines it. munity in a cooperative working relationship. As to the integrative aspects of the black Al Wilburn, a third-year UCLA medical stu- power movement in helping to strengthen the dent, who was one of the student fellows in self-definition and self-determination of black Watts last summer, is currently involved in people, Bruce stated: the faculty-student committee on admissions "The black students saw their role policies at the UCLA medical school. The com- more or less as a mission. They were mittee is working hard to increase the appli- involved and sensitive and took Watts cants from minority group students and there- on as their community." by to increase the number of black and brown students who are admitted. As a result of the Bates in another way stated that the black work of this committee there has been a sharp students were more politically sophisticated increase in the number of applications this than the whites, that the whites really didn't year. UCLA had 35 applications, out of which understand the fact the black students were not eight people qualified for admission, as against permitted to keep logs and that the request for 10 applicants last year. USC has had a corre- them was interpreted as counterrevolutionary sponding rise. by the black community. With the amount of surveillance and police interference, anyone Ventura County-Oxnard with a pad and pencil is personna non grata, Oxnard is the center of a rich agricultural according to Bates. area in Ventura County, about forty mi es The catalyst in the Watts project was the north of Los Angeles. There are a large num- bull sessions held every Wednesday with Jim her of poor Mexican-American families in the Bates and the students. Bates spoke enthusias- area, conservative land owners with large 39 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 holdings, and many lower-middle class families drones who did not know what, where, 'Oxnard is sufficiently from the Middle West. or how to do much of anything." distant from the Los Angeles urban complex to But, as indicated in the introduction to this retain some of the authenticity of old Mexico. section, the contradiction between how stu- Parts of it are still struggling to remain rural. dents perceive themselves as against what they Seven students, two medical, two nursing, learned was of constant interest to any re- one dental, one clinical psychology, and one porter. Though all seven students in Oxnard social psychology, were assigned to this area- ieit thwarted and anxious the whole summer, four in Oxnard, and three in the small town they report sensitive insights. Slama states of Santa Paula, 9 miles to the east. Their goals of the high school students: were: 1. To aid the community in on-going pro- "We of the SHP were originally as- grams-to fill community-perceived needs. signed two crash kids. Supposedly, these two high school pupils were 2. To provide students with educational ex- somewhat interested in health-related posure to the problems of ghetto com- fields. My original two counselors were munities. girls; one wanted to be a teacher, the 3. To begin an alliance between students, other a hairdresser. health professionals, and community peo- "The spark and enthusiasm which ple to improve conditions and fill gaps these kids had was tremendous." in community needs. The students were perceptive and analytical in The intent of the Site Development Committee centralizing the responsibility for services. was to allow for the greatest latitude and de- Claire McCamman a nursing student working cision making on the part of the students, as in Santa Paula, pinpointed some of the prob- reflected in their description of their aims, lems and partial solutions: written prior to the summer. Though there was "No health center, no dental care, some minimal suggestion of suitable projects, no recreation facilities. There is the students still felt unanimous in their opin- no documented evidence of the need ion that they had not received enough guidance The Health Department uses from the SHO Staff. the lack of documentation as a 'cop Robert Slama, a medical student who dis- out'. The SHP, by documenting the cussed his team's problems at a few student need, would provide some leverage for meetings, wrote: getting these services. A major prob- had little to do with health lem is terror of the growers. Politi- part of my disillusionment cally, the poor Chicano is disenfran- was due to illusions which I chised. The mayor of Santa Paula is a had about what we would be doing. 'brown-Anglo' who has sold out his "We had no experience ourselves; people. Unionism seems to be a rea- sonable start at the solution of the as first-year medical or dental stu- migrant workers'problems." dents, we were very much in a posi- tion of having a lot to learn." Claire's job was to work with the Community "We saw a community that had as Action Agency in the Summer Youth Program little idea of what it should do itself to develop a Girls' Club. She and two other stu- as a community, as we had of what we dents, Cathy Hunter and Alice Krowitz, taught should do 'ourselves on the Student classes on sex education, developed informa- Health Project. tion on consumer education, publicized their ','Together, we made up a group of classes, worked on health education with high idealistic, enthusiastic (sometimes) school dropouts, and helped the La Raza Com- 40 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 mittee for Education, a group committed to in- two community workers with SHO, to creasing Mexican-American college admissions. the home of one of his friends, and The reports from these students all indicate we discussed our ideas with him. We the Yucaipa o rientation would have been far encouraged him to have a house meet- more useful if students could have been cued ing and invite sortie of his friends into the workings of the communities before over to discuss the ideas we had pre- they went out. However, they all felt Ventura sented to him. Thus, we arranged our County is an excellent place for SHO to work first house meeting with little diffi- because as Bob Montoya, a medical student, culty and proceeded to the house of stated: another friend to try for another "It is isolated geographically and meeting." is small enough so that there is not a DEBORAH TARNOPOL. great big bureaucracy to face." Although the proposal was not completed Deborah Tarnopol, social psychology student, when the students left, enough enthusiasm was after trying in vain to work with young chil- created f or the proposal that the work hope- dren in various centers and nursery schools, fully continues. taught reading readiness to Head Start chil- "The next day I met with John dren in Oxnard with two NYC youths. The lat- and he was in great spirits and re- ter, under Deboyah's tutelage, were able after sponded immediately to my concern a few weeks to teach the children themselves about replacements for Ricardo and and became quite involved with the concepts of me. He was sure of himself and quite reading readiness. However, Deborah was not clear about his plans for La Raza entirely happy with the whole experience: Committee's near future. His strong feelings about this make me feel that "The next day, Wednesday, the e understood the situation much bet- supervisor of the Oxnard Head Start ter. I felt that I had indeed fulfilled observed Armando and Lupe doing an honorable intention: to leave, or to their lessons with the children. I help leave something behind in Ox- think. she was pleasantly surprised nard." both by the skill of my two kids and DFBORAH TARNOPOL. the excited participation of the four- Deborah also helped a Mexican-America-n lady year-olds. She told me to feel free to with the written section of the California driv- train any interested volunteers to do similar things in the classrooms. This er's test, and ends her final report with sort of passive cooperation was frus- this: trating because, as an outsider I "So I said goodbye to Oxnard the couldn't leave behind any leadership next day and left behind Mrs. T. (with for this sort of Head Start program, a driver's license), John and Ricardo and with only 21/2 weeks of Head (with La Raza Committee). I had Start left, the time for training vol- learned much about techniques of com- unteers had long passed." munity organizing." Deborah also became involved in helping a Again and again, students reflected their committee of La Raza write a proposal for strong convictions that they "did nothing, but higher education for Mexican-Americans. They learned a lot". Richard Fuentes, a dental stu- encouraged local residents to have house meet- dentwho tried hard to involve Oxnard dentists ings to discuss ideas for establishing a sebolar- in private .practice in a volunteer dental pro- ship fund. gram, reported: "I went with John, one of the@ "I do not believe we helped the com- 41 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 munity. Some individuals may have explained the others were away on an been personally affe@d by us, but we emergency meeting in @ Angeles, did not get rid of any problems or im- and heard what they had to say. Then prove their ability to get health treat- I brought up my own project and got ment." a slow response at first. They didn't trust me. However, after 10 minutes, However, he goes on to say: we really got going-ideas, experi- "I have made up my mind to do ence, suggestions, offers to help per- the best in order to get Mexican- sonally, and lots of literature. It was Americans and Negroes into dental a valuable and productive meeting. schools, either by giving them infor- Second week of summer: mation, or later monetary help. This year my school accepted two Negro "Visited homes today. Walked for students, the first time a Negro has hours and hours tracking down un- gone there in over 20 years." wed mothers. One moved, three were Robert Montoya worked with community peo- out, saw two others. Of the girls ple in the Colonia area and helped form a I saw, the fi-rst, Betty, was in some Brown Beret Chapter. kind of a stupor. I got the impression The three students in Santa. Paula decided to she was doing nothing with herself or form a Young Mother's Club for unwed her life. mothers. One of the problems was finding the Third week: young women without imposing a feeling of "My project's coming along really being special or different. well. Contacted four girls today- The Club was started with a small number Of young mothers, and classes were held on sex all coming. With some kids, the de- spair is so obvious, and with others education, first aid, and discussions about gen- you can see the strength. It's beauti- eral problems. The team provided transporta- ful. I have great hope that the kids tion many times for the girls and visited them ' I wants constantly to encourage them to attend the will help each other. One gir to go back to high school, another club. wants work. I sent the NYC director The combination of a profound sense of em- out there to talk to her (Alice). Alice pathy, love, anxiety, and loneliness which is 17, lives in a labor caxnp at Sespe. comes through in the following excerpts, Ten little kids hanging a-round, all makes one feel Holden Caulfield's ghost has dirty, 'ragged and nonsmiling. One risen again. This time it is Abby Krowitz, older thing about poverty kids that rips me and wiser, female clinical psychology student up is the vacant eyes, and the don't- from New York. hit-me look-the fear. "Marty McKeever, of Family Coun- Fourth week: seling in 'Ventura, is so great-alive young, interested, and the possessor Of "When interest in talking lagged, a rare working combination of mind I switched to the club as a purpose- and feelings. I think we shall become f ul get-together. I told them no matter good friends. Marty delivered me to how small it was, it was their club and the Health Department where I met I had done my share and they had to two public health nurses. Man, they do theirs. They looked dumbfounded. were prepared for a whole meeting I offered several alternatives, and.said and were so disappointed that I I couldn't believe three girls had no was alone. I really was scared at first ideas about doing things. Betty spoke and gave a 15-minute talk on SHP, up and said one meeting a week wasn't 42 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 enough. I said fine, when do you want Two students, one in medicine and one in a second one? They said Thursday nursing, were assigned to the project directors would be good and it was settled. Then of the existing health team to ascertain another girl suggested a beach party whether private medicine in that area could and I said it was O.K. with me, but provide good medical care for the indigent. they had to plan everything. They took The nursing student, Martha Jackson, lived me up on it, and we are having.it Sat- with Mexican-American families for the dura- urday. They also said they would bring tion of the project, working in the fields, eating, any unwed mothers to the next meet- sleeping, laughing, and participating in the ing and their other friends to the daily life problems. She observed and talked beIach party. I was very happy about to people about their health problems. She then this meeting. related her findings to the doctors in the rural "There were times during the health project. She describes her experience: meeting when the group was really "My job was to 'educate the out of control. I was so personally ov- doctors' to the Mexican way of life. erwhelmed by the stories they told None of them in the group are Mexi- that I couldn't direct it anywhere. can, yet a large percentage of their Also, once the problems really began patients are. This has posed some to become real, everyone got de- problems in rendering effective medi- pressed, and although I focused on cal care. Aides from the target area the positive, the negative and hell are used as interpreters. I was also to that they had each been living became identify health problems and other too much. I wanted to break through problems that might be indirectly re- the defensive laughter and did so, but lated to health, such as housing condi- when I did, it was a hard trip back tions, working conditions, and the from the dumps. I can see now that like." this approach, maybe groovy with psychological problems, just won!t At the end of the summer Martha submitted make it when it's a real baby, a real lengthy reports to her preceptor, Stuart Allan. marriage that fell through, and a real She felt the summer had been very worth- mess that they have to live with." while, but was not sure to what extent she had affected the doctors' attitudes. But we want to Part of Abby's report is appended at the end of share a letter she wrote to the project's direc- this section. In spite of its length we took the tor at the end of the summer in lieu of a re- liberty to include it for those who might be in- port. We think it has the special flavor of terested. If moneys for this project could ever someone who has lived poor. Her sense of real- be justified by the degree of personal growth ity, her refusal to romanticize the poor, her and education added, this kind of searching is recommendations for the future, and her in itself perhaps one of the best examples Of doubts about her own effectiveness in changing self-discovery, and who knows what kind of attitudes of physicians, gives her letter a kind commitment, and to what, may result? of Pinter-esque quality. Therefore, we include it at the end of this section, following AbbY's South Monterey County-Rural Health Project report. Jerry Ginsburg made a study of how the The rural health project in King City, south rural health project served the needs of the Monterey County, offers comprehensive health community, and found to his satisfaction that services, social aid, education and retraining to they did indeed. approximately 10,000 indigent people, mostly Mexican-American farm workers, in King City "We have proved that local initia- and its surrounding areas. tive and autonomy can develop a 43 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 good working plan that provides good cess * * * if the programs which services. we initiated are continued in our ab- "The rural health project has also sence. This was my joy in selection by proven that first-class, readily access- the KCCAO of Clarence Gutierrez as ible medical care with proper facili- a grassroots worker. It is felt he will ties, and located where they are be well able to carry on programs needed, can give the indigent a per- that have already been initiated." sonalized, humanized, nondiscrimi- Robert also initiated a health screening clinic, natory or segregatory treatment com- and one day was set aside for examinations of pletely different f rom the one they the Indians with participation from volunteer have traditionally received." doctors from Fresno: Kings County Community Action Organization "The clinic ran both smoothly and KCCAO is the delegate agency for the OEO effectively through the afternoon and programs directed toward the estimated 25,000 evening. The turnout was surprising low-income people in Kings County. The popu- in the fact that over three-quarters lation increases by approximately 10,000 dur- of the reservation's population got ing the summer agricultural season with the complete physical and eye examina- influx of migratory workers. tions." The three medical and one nursing student Another student, Michael Witte, associated associated with the Community Action Agency himself with the Kettlemen City Child Devel- were fortunate because, either by design, or opment Center, and after defining the health the omission of one, they encouraged the stu- care and educational problems among the farm dents to define their own projects, and in this laborers, reduced his interests to nutrition and instance some interesting things happened. transportation. Very quickly he made contacts Robert Jones, who worked with the Tache with a drug company in an attempt to obtain a Indians on the Santa Rosa Indian Reservation, demonstration supply of vitamins to distribute defined existing health problems and worked to the children. The local public health nurse toward the establishment of a recreational fa- cooperated in their distribution. cility for the Indians. Although the facility In the area of transportation, he hoped to was not completed by the end of the summer, obtain funds to establish a small scale bus sys- Robert was assured that the work would be tem to transport people to the various clinics continued by the Community Action Agency. operated by the Public Health Department. Robert worked with the Tribal Council and Again, as with Robert Jones, Michael Witte was instrumental in bringing together and ob- stated: taining assistance from many institutions, both public and private. The local Naval Air Sta- "I will consider this summer suc- tion, Standard Oil Co., and local Catholic cessf ul only when we can create a Church, and the U.S. Government Soil Conser- viable proposal and obtain a sponsor vation Service all cooperated. Grounds were for it. There must be. someone to razed by the Standard Oil for the recreation carry this project on once the summer has elapsed * * * Perhaps an agency facility and the Catholic Church was helping such as CCAA, who seems enthusias- in making-plans for it. Robert recognized the tic." problem of half-finished projects and was par- ticularly gratified that the community worker Robert Jones, in his lament to the Indian who employed to carry on the project was a resi- is locked in: dent of the Santa Rosa Indian Community and "To children poverty is the dark niarried to a Tache Indian woman. rider encompassing them before their "This summer will only be a suc- senses can acknowledge its presence. 44 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 It springs from everyday life and yields acceptance. For with the chil- dren of the poor, there is -no aware- ness of another standard until their environment has made them a captive of their own." Tulare County Community Action Agency-Visalia Two nurses -worked in the Earlimart Child Care Center, which had opened 4 -,veeks prior to their arrival. This was part of the Tulare County Community Action Agency. They set up a dental health program for the children and held first aid classes. They instructed teachers how to be aware of and treat such things as impetigo, ringworm, and minor abra- sions so the teachers could continue this health program after the nurses had left. "The assistant teachers were able to carry out these procedures quite well. They acquainted themselves with the first aid cabinet and all of the sup- plies on hand." BONNIE ZAGON. The nursing students also arranged for an im- munization clinic to administer DPT, polio, measles shots, and tuberculin tests to all pre- school children. They maintained health record files on each child so that the public health nurse serving the area would not have to -re- gather the information. In spite of her own personal satisfactions, Bonnie Zago-n's final report cautions about loosely defi-ned summer projects: time have been sensitized to many "This would not be a good site problems that I was unaware of be- placement for an SHO student next fore entering the community. The summer @' * * I feel that in deciding health care I have given has been on future site placements, emphasis taught to community people and is should be placed on plugging in stu- most definitely an on-going project." dents to very structured projects." Fresno County-The Fresno Project She again poses the same paradox of the bene- The Fresno project was probably rated high- fits of negative experience to personal growth: est in lowest rewards to students, preceptors, "I have spent a very beneficial and community. summer in working with a rural com- Though one member of the student staff had munity and feel certain that I will come to an agreement with one of the three continue to give service in this type of preceptors, apparently there were many fuzzy area. I have served and at the same areas never spelled out. These fuzzy areas con- 45 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 cerned the actual tasks, the methods of inter- was communication, or an almost weaving students in staff projects and defining total lack of it. I believe that this ex- the limits of summer expectations. The lack of isted with the Community Health job specificity and content of tasks were obvi- Planning Project, the Student Health ously a detriment to the establishment of any Organization, as well as with the Stu- good relationships. dents themselves. Through this, unex- The project consisted of four preceptors; pressed complaints, misinformation, three of these connected with the city of and personality conflicts were allowed Fresno Community Health Planning Project in to build up to a point where no one the Fresno General Hospital, a part of the person trusted the other, and resolu- model cities plan; and one preceptor in the tion of problems was not attempted." North Avenue Community Center, a neighbor- FAE THOMAS. hood settlement house fulfilling the needs of black residents. However, Miss Thomas ends her report on a Nine students were assigned to the general more optimistic note: area. They were representatives of almost all "Despite the problems this summer, of the health professions: medicine, dentistry, I feel that I have learned a tremen- social work, health education, public health, dous amount. One of the major things and nursing. There were also indigenous com- is the various blocks that exist to munity workers attached to the projects by the giving comprehensive health care. preceptor. This will affect me when I am work- The only value at this point in describing ing as a public health nurse. I have the ineptness of the project end the uncomfort- also had some practical experience in able personal relationships which resulted, is innovation (although unsuccessful). because it indicates again that noble intent and I hope that I can learn from my mis- high spirits cannot forever make up for takes' My understanding of some of lack of sequential systematic steps in the plan- the problems of the poor and minor- ning process. ity groups has greatly increased since The students were to explore new and ex- I have had no previous exposure to panded methods of providing comprehensive this." care by taking a look at, the family medicine Another student vividly describes the diffi- training program, a neighborhood health cen- culties of the project: ter, and. a variety of training programs for health workers in the allied health professions. "My placement was with the Com- Contrary to every purpose of SHP, the pre- munity Health Planning project of ceptors attempted to reenact that situation the Fresno General Hospital. This which causes some of the most serious prob- was a most unfortunate placement. lems in health care institutions-the secondary The SHP members worked in a team role of the nurse was again reinforced by plac- approach with other members of the ing the student physician.at the head of the planning project who were given mis- student team. A student -nurse comments on the informed ideas of the SHP workers problems of the project: before we arrived. We were to have "Thus far I have attempted to de- led the teams, been full of many ideas scribe only what we did this summer. for Fresno (which we were to have Obviously, this does not sound like too discussed at Yucaipa), and have had much. I should now like to attempt to the power to fire other team mem- describe what I feel happened this bers! Unfortunately, none of these summer and why. prejudices was brought out into the The one major block to success open until the sixth week of the sum- 46 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 mer. It was at this time that project Kem County-Bakersfield' workers from both SHO and Fresno Bakerfield is situated in one of the largest began to express their dissatisfaction. cotton producing areas in the world. It is in Our chief complaint was that our pre- Kern County, a county oozing with the earth's ceptor had not strictly defined the rich bounty, cultivated and tended by thou- goals of the Fresno project, had sands of Mexican farmworkers. It stretches for claimed that he could easily obtain miles of green, black, purple, and orange. The grants and bend the ears of influen- colors sometimes obscure the fertile black tial people, and that he communicated exclusively with SHP members, ig- earth's cotton, grapes, citrus, artichokes, toma- noring most of the Fresno workers toes, and melons. Bakersfield is insular. It sits * * * It' was decided by the SHP comfortably in the vast San Joaquin Valley. members at this time (end of August) Five students, two in medicine, two in nurs- to continue their work in their re- ing, and one behavioral scientist, were as- spective communities with the com- signed to the area with the Economic Opportu- munity contacts they had made, but nity Cooperation as their base of operation. to disaffiliate themselves from the They were assigned to two preceptors, the Community Health Planning Project. rural area program supervisor, and the director I felt personally relieved by this be- of the Multiservice Center. cause I thought that I could do more The medical students worked mainly in the good for Del Rey working f or Sal Gon- town of Wasco near Bakersfield-. By working zalez than by bullshitting my time through an existing semiactive Women's Club, away with the Fresno project." they were able to stimulate enough interest to MIKE DucHOWNY. form a Welfare Rights Organization, which be- came affiliated with the National Welfare Duchowny concludes: Rights Organization. The students hoped the group would be able to maintain itself after "I cannot yet say how this sum- their departure. In order to offer greater assur- mer will influence my future ca- ance of that, the students attempted to enlist reer. I do know that the experiences I commitments from local residents to continue had this summer form a part of me their support of the Welfare Rights Organiza- that cannot express themselves very tion. well on paper. I am returning to med- One of the medical students established a ical school with many new ideas and free medical clinic in the Wasco labor camp. it with my old ideals reinforced." opened every Monday and Thursday evening the latter part of the summer. One out of the In summary, the Fresno projects, which are six physicians in Wasco volunteered his time to only briefly touched here, suffered from the the clinic. same deprivation as other projects-a lack of One of the nursing students, a Mexican- definition. But it is interesting to note that American herself, became involved in promot- some of the students found they were able to inga program of interest in their own heritage use their skills at the North Avenue Commun- among the Mexican-Americans. She arranged ity Center in developinga Girl's Club, whereas for films and speakers and trained two NYC ,some remained at the hospital and aided in a girls to involve people from the community in survey on transportation needs. A few held the project. meetings with the Kings County group on the Possibility of a county-wide transportation sys- San Francisco County tem to public health clinics. What is pointed up In San Francisco, six students from the San here is the amount of innovation that charac- Francisco Medical Center operated a program terizes some of the student groups. in conjunction with the Office of the Dean to 47 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 enable economically disadvantaged high school Other difficulties resulted from the pro students to gain employment in health care gram (SHP-NYC) being primarily stu agencies. Fifty teenagers were placed in vari- dent-administered. The Medical Cente ous hospitals, including the Veterans' Adminis- SHP students were frequently unfamilia tration and San Francisco General Hospital. with campus policy and how the adminis The teenagers worked 26 hours per week for trators operate. This inadequate commu 10 weeks and were paid from the Neighbor- nication caused misunderstanding an( hood Youth Corp's funds. The work experience delays. was supplemented with educational and social However, in spite of the problems most o: activities such as a film on childbirth, a drug the NYC students felt very positive a@out theii information program, a film on former SHP experience. In a questionnaire distributed at summer projects, a meeting with black students the end of the summer, they responded well t( and medical students devoted to minority re- their jobs and supervisors. A number of there cruitment and admissions policies in co eges asked to remain during the fall. Since funding and universities and a picnic and a dance. p for the NYC program was severely cut, this wa, "Throughout the program we tried not possible for all who wished it, but several to make sure the students were have been absorbed. Many department heads learning from their jobs. and not were very enthusiastic about the potential and spending all their time on routine du- ability of the NYC groupand specifically asked ties. Through the use of counselors that the same student be retained on the job in and small group discussions, we en- the fall. couraged them to discuss their jobs The SHP students felt this was certainly an and to indicate when they were dis- important step in opening the Medical Center satisfied." to employees in new careers. Following are some of the problems the San Imperial County-Imperlal Valley Project Francisco project encountered: Imperial Valley is a large agricultural area 1. Although the medical students had antici- in Imperial County near the Mexican border. pated hiring students interested primar- There is a large Mexican-American population ily in the health sciences, and had been with a small Negro population scattered -assured by the Unified School District throughout the Valley. that the students would be screened with The previous summer, SHP had a project this in mind, the screening was not dom- operating out of El Centro, which is located in pleted, and they were merely assigned a the rich Imperial Valley. The students docu- randomly chosen group of 50 NYC stu- mented the need for a dental clinic for low-in- dents. come children and had laid the foundations for the location and personnel. The Imperial Val- 2. The many delays and confusion in the ley Community Dental Clinic had sent a letter paying of salaries: in October'of 1967 to the Imperial County Den- "The students never knew when their tal Association, reiterating the need for the checks were coming and consequently felt most insecure about the entire situ- dental clinic and expressing their interest in ation." participating. The Site Development Committee of SHO 3. Lack of preparation of supervisors in the felt that with such interest on the part of the departments. The supervisors did not local dentists, and the groundwork that, was know what was expected of them, nor done by students the year before, this project were they given sufficient orientation could be carried to a successful conclusion in about the NYC students or the objectives 1968. of the program which involved 'them. Three students, one from medicine, one den- 48 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 tal hygienist, and one occul3,ational therapist The Law Projects were assigned to the Economic Opportunity Corporation in El Centro. The director of that Background agency was their preceptor. The law projects were exceptionally well The students submitted a joint final report summarized by Steve Bingham, the law coordi- in which no mention was made of previous ar- 'nator, and therefore, his report is reproduced rangements for the dental clinic. They de- here in toto. It follows the discussion of the re- scribed existing conditions of poverty in the lationships between the law and medical stu- Valley, of local citizens' groups, of the possibil- dents. ity of future projects with these groups, and of As to be expected, feelings about the contri- "waiting to be given things to do." butions of the law students differ. The faculty "We did not accomplish anything. director, when asked about the role of the law What we did find was a movement students, stated: which can show students how a com- 14I think the law students were munity can help itself. This was a on o a good thing, they might have major find. done well for themselves, but I don't "The trouble was there was little think they worked. well with the med- we could contribute. Perhaps this ical students. In large part, they ig- was because of our situation, but nored health science students. From more likely it can be remedied by giv- the first appearance of the law Stu- ing the community several months in dents on the scene, they were destruc- which to decide how students can best tive. They made a contribution to add to their overall plan." their thing, not the Student Health The three end their report: Project, which is to say let them find their own funds." "Finally we can say that the sum- mer was a vital experience in our On the other hand, Chuck Gardinier, a well- f health accepted community organizer in the San Joa- understanding o . problems, in the structure of the functioning of quin Valley, whole heart6dly approved of the this country, in ourselves. The sum- law student project. When -asked "What was mer was like intensive sensitivity the most important thing the law students training, self-analysis, people watch- did?" Gardinier tells it from his point of view: ing, and group process. It is a major "The most important service was experience to see a woman crying be- taking cases to court and they beat cause she cannot get money from wel- four of them in jury trials. And fare because her daughter needs a they had a licensed attorney right special diet; it is frightening to see a here. They did a lot of work with ju- county (poor farm) hospital run by venile hearings and set up an OR (On frightened and/or sadistic doctors their Own Recognizance) Program who pride themselves on the cheapest for prisoners. Those are in just legal care in the state; it is horrifying to terms. The other service they provided see polio victims come crawling was being in the community and across the border when vaccine is 15 available twenty-four hours a day- cents. they related very well with the guys "Perhaps we learned something this from the barrio-the law center be- summer." came a place for guys to drop in and rap.tt BARRY RAND DALE KAwAGoYE Gardinier explained why he felt the law stu- SALLY WESTRICK. dents were able to develop that re a lionship: 49 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 "They were here earlier-a couple To strengthen the convictions of some toward of weeks. Peter (Haberfeld) had been a career of social action, they indulged in ex- making continual contacts for several coriating lectures, challenged the students to months and already was acquainted shape up and reject their flaccid political Stan- with the guys, so when the project dards. In loosing "their cool" they also lost started, they already knew Peter." their humility. They arrogated to themselves Apparently from the community's point of the authority to set moral standards of behav- view, the law students were effective, and our ior for all. At Yucaipa they almost appeared to set up a Kangaroo Court, where people were observations and the reports which follow judged guilty or innocent by their knowledge s out. Their realistic would certainly bear thi of the political process. To their credit, some of appraisal of the productive use of their time, the medical students addressed their attention their ability to face limitations in their own to their own interests and skills. The resolve of skills, and their decision to confine their asso- those who were already politically sophisti- ciations to on-going community based Chicano cated was strengthed by the law students. organizations imposed functional as well as geo- There were others who stood apart in the Yu- graphical limits on them. In addition, the fact caipa countryside hoping to be rescued from that law students were expected to share the life style of the community by living, working their discomfort. A further explanation of the apparent in- and playing in it, imparted a special integrity compatibility might be found in the different to the project and solidarity to the group. It kinds of personalities who are attracted to was an intense personal experience-Spartan medicine and law. Steve Bingham, the law at times-but one in which living with the peo- ple and sharing their frustrations increased coordinator, explained that in the beginning he the possibility of being accepted by them. did not see any difference between the students of law and medicine. But later he realized how But their relations with the medicals Stu- self-selective the different professions are. dents left much to be desired. Many of the "Lawyers are argumentative and medical students echoed the faculty director's very verbal. Medical students have a statement. One who is very aware of the con- much more humanitarian attitude- scienceless society spoke for many others in de- in the positive sense, in the project scribing his anger at the law students: sense-missionary. The law students have more of a political way of deal- "As a group, they were more de- ing with things. Socially concerned structive than contributory. I think law students make a different kind of they thought we were all lost in our analysis than socially concerned med- Ivory Tower and didn't know what ical students. I think we see evil mo- was happening and they were going tivations on the part of people in to be the ones to show us the light. power in terms of what they do- The letter they read to us in the judge, ranch, legislator-conscious wind-up conference about being emo- tional Mongoloids and being entirely design-we tend, as political human beings, to look at a situation and an- askew was very vitriolic and made me alyze it in those terms, and I think a ip very angry. medical student tends more to look at To find an explanation of what happened be- the situation and say "it's unfortu- nate that man has to live like that and tween the two groups of students is difficult. what can I do to make that situation The law students fell ii" the trap many mili- tants fall into, and it is that confinement which better. gives them comfort but robs them of their This is merely to emphasize that law and medi- vision. cine do operate out of a different set of inter- 50 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 ests and frames of reference, although both the participants grew tremendously, are involved in advocacy. the question which 'remains una-n- It remains for interested law schools and swered is whether the projects had medical schools to work out projects which a beneficial effect on the communities, permit mutual interests to become better inte- or possibly a harmf ul effect. It was the grated. After the summer experience Bingham possibility of a tension between these recommended that a great deal of pressure be two objectives which was constantly put on medical and law schools to get them to raised last summer." incorporate community law and community The Law Projects by Steve Bingham health courses in the curriculum. Gary Bellow, attorney and preceptor, for- The San Joaquin Valley Legal-Medical pro- merly with the California Rural Legal Assist- ject was an amalgam of individual assignments ance . program and presently with the USC throughout the San Joaquin Valley. It is easi- Western Institute for Law and Poverty, stated est to explain what it was and what it at- that "most of the law students learned very tempted to accomplish by discussing each loca- few of the insights medical students could have tion separately. Preparatory to that, however, given them." Bellow suggested that supervi- the following introductory remarks are neces- sors who could themselves relate the two disci- sary: plines would be part of the answer. Bellow felt that the law students suffered as much as the 1. The overall project was intended to place medical students from disorganized goals. law students and medical students side by side in widely varied experimental "There was a real conflict of goals programs, all hooked in to "releva-nV', -whether it was to provide service "community-based", and "on-going" Chi- for as many people as could be cano (Mexican-American) organizations. reached or whether it was to produce The reasons for these requirements change or whether it was to radical- were: ize the students. These are different concepts. The early meetings polar- (a) Summer projects cannot succeed where they attempt to set up their ized youths depending on their con- own structure goals, programs, and cept t ,S.$, attempt complete them in 10 Peter Haberfeld, the faculty law advisor in weeks. large part responsible for the structure of the (b) "Anglo" urban-oriented students are law project, and the leader in the Visalia pro- incompetent to sally forth into the ject, had some second thoughts about the early world of the poor and work indepen- polarization of the law and medical students, dently. but in a letter received from him after the (c) Because of a well-founded suspicion summer he evaluates the program positively: of so many poverty programs, espe- "I came away from the final gath- cially federally sponsored ones, we ering with satisfaction. What had insisted that we offer our limited seemed to be complete disorientation skills to people and organizations had finally begun to crystallize. The which enjoyed wide-spread commun- conflict perhaps blasted people into a ity support because of the nature of new realm, stripped naked of former what they were doing. The initial cliches and grappling for a new un- evaluations were based on extended discussions with recognized commun- derstanding. In short, I came away with a good feeling, but little specific ity leaders throughout the Valley. analysis. (d) Our decision to work primarily with "Though there is little doubt that chicanos grew out of a feeling that 51 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 their oppressed condition is extreme a credit union. A couple of initial meetings and also a hesitancy to try, in a sum- were held during the summer. in addition he mer, to work with anglo poor who worked with a chicano community organizer would be initially hostile. In addition, on problems of working conditions in the virtually every organization in the fields. Because of the late harvest season in the Valley at this time is working on chi- northern San Joaquin Valley, it proved very cano problems. difficult to operate in this area though some 2. The medical-legal partnership was sue- meetings were held. The most successful out- growth of this effort was a program to include cessful in the limited areas where it was farm worker legal problems and solutions in attempted. Because of a general lack of the training of adult education persons, work- interest in what we wanted to do by the ing for the Central California Action Agency. medical students at the orientation con- Jack's wife taught English to Portuguese can- ference, we took only those few (four) nery workers in Livingston. who shared our enthusiasm. The others were looking more for clinic-type experi- (Madera)-Semeon Tsalbins (medical Stu- ence. It is interesting, however, that jur- dent, Yale), Ted Lakey (Davis, law) and Leroy Miller (Stanford, law) worked under Mac ing the course of the summer, severai oi Lopez (a local community worker paid by our the separate medical student projects de- project). This team was given much assistance veloped along the same lines as ours. by the Madera California Rural Legal Assist- S. While many of the final placements dif- ance Office. Their emphasis was on the legal vi- f ered from those originally planned, the olations of farm labor contractors, who are re- underlying thinking remained the same. quired to provide toilets, washing facilities, Our reasons for choosing different pro- etc., which the grower would otherwise prov- ject sites were varied but generally, we ide were he hiring workers directly. A very felt on the basis of further study after complete 'declaration form' was prepared. The our first proposal was written, that the intent was to document violations and hope criteria in No. 1 required us to select that a few individuals would be willing to seek other places. legal help from C.R.L.A. in filing complaints. The following projects were undertaken: Due to an extreme reluctance to sign anything (fear of losing job, ete.), few declarations were (Merced)-Jack Weisberg (first-year Boalt gotten initially. This led to setting up 'house Hall). Jack initially assisted a budding black meetings,' small informal gatherings where student group (some high school, other junior workers could get together and discuss their college) who were attempting to organize problems. This is a technique which Cesar blacks in Merced around the issue of police Chavez has used extremely effectively in his brutality. This issue arose following a police union organizing work. The students spent a invasion of a black dance, resulting in many few days actually in the fields working, and arrests. Jack and several law students at- then making declarations themselves as well as tached to the Merced County. Legal Services meeting workers. In the future, this should be office (two from Boalt but not under our pro- a major part of the work. By the end of the gram) provided.what legal help they could as summer, a number of complaints had been Med law students. Jack found, however, that the with the Labor Commissioner in Fresno and student group was too new to really take ad- the C.R.L.A. office may be able to use the infor- vantage of him, and the black -organizer for mation gathered. This group got off to a very whom he was working had little time to work slow start and suffered some lack of enthu- out a summer program for him. Therefore, he siasm because they did not live where they spent part of the summer helping a community were working and thus never became a part of group in South Dos Palos, an incredibly poor, the chicano community. very southern-looking town of blacks, to form (Del Rey)-Sheldon Sarfan (Boalt), worked 52 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 with Sal Gonzalez, a highly respected organ- without all the stereotyped attitudes which izer attempting to get the town of Del Rey most poverty legal services programs have. incorporated. Presently, with a population 85 The office very quickly became a focal point for percent chicano, it is ruled by an anglo Com- community activities. Chuck Gardinier, known munity Service District Board appointed by throughout the Valley for his organizing the Fresno County Board of Supervisors. Shel- skills, had already laid some groundwork and ley did some legal work in connection with the the Center was able to become part of that. incorporation and was most useful in helping The result of taking several cases (narcotics, to formulate the feasibility arguments (suffi- drunkenness, etc.) was that more people began cient tax base, etc.) to be presented to the to come by. The style of the office had en- Local Agency Formation Commission, which couraged young people to drop in and rap. This must initially approve every such request. Very resulted in a high degree of trust being estab- recently, this Commission approved the re- lished, a very rare thing for anglo outsiders to quest. This was considered a very surprising, achieve in a short time. - major victory. In many ways, Shelley's assign- The defense work in court caused the "estab- ment was the ideal model we would hope, to lishment" to become very "uptight" and a good build on in the future. His special (legal) deal of hostility was apparent. The office even skills' were put to use by an organizer who became the object of a County Bar Association knew how to use a law student effectively. financed investigation. Living alone in Del Rey (population 800), Besides the criminal work, other results of Shelly became a part of the community he was the summer included an experimental "O.R. working with. Except in Visalia (see below), Project," that is a project designed to enable one of the consistent personal failures of al- prisoners to be released on their own recogniz- most all of the students-law and medical- ance without putting up bail, pending trial. was their isolated living situations and with- Local youths are currently running this pro- drawal from their communities during week- ject themselves, conducting interviews and ends. In addition to Sarfan, two local women making recommendations to the local judge were given half-time support from our project who has agreed to release the first 100. In ad- funds for organizing work they were doing dition, a not-so-successful attempt was made under Gonzalez' direction in a packing house. to improve the juvenile court procedures by (Visalia Youth Law Center)-Peter Haber- having a law student work with the over- feld (Boalt 1967, member California Bar), staffed officials there. Keith Lesar (Boalt, Law Review), Steve Heiser The Youth Law Center additionally served (Stanford, law), Marty Eichner (Stanford, as project headquarters' for all the law stu- law), Jim Romero and Jim West, local com- dents and medical students in the San Joaquin munity workers, Jeannie Eichner and Marilyn, Valley. secretaries. The Youth Law Center was (Porterville)-Phil Nicholson and Ron Rom- financed by the Rosenberg Foundation (all ines (both Stanford, law) had 'originally in- other projects were funded by the Social Reha- tended to work under two field workers for the bilitation Services and Regional Medical Pro- Tulare County Community Action Agency. Ron gram of the Department of Health, Education, was going to work in Dinuba with a recently and Welfare). This project was the most ex- formed community group, probably on labor perimental and probably the most exciting in camp Health and Safety Code Violations. Phil terms of its potential as a model for radical was to work in Porterville.on a variety of com- lawyers seeking meaningful roles in poverty munity issues-credit unions, irregularities in law. the registration and voting laws, etc. Because The office was set up in an old church build- they were unable to work under the two ing on the north side, where Visalia chicanos TCCAA workers, Phil and Ron worked with and blacks live. The purpose was to provide Jose Aguilar, who had done some farm worker legal assistance to people there but to do so organizing. In addition. to helping to solve a 53 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 number of individual problems people were a wide variety of legal problems. This job, having with government agencies, they did a while somewhat useful to CRLA, was more in very effective and comprehensive job at docu- the nature of a typical legal services office as- menting "field violations" in southern Tulare signment and thus was not the kind of experi- County. Using a detailed map they made of mental project most of the other locations land holdings, they would visit . different were. Some field work was done by them. ranches during the harvesting of grapes. (Hospital Project) -Bart Deamer (Harvard, Through a variety of techniques (such as pre- law) and John Long (Oklahoma, medical), tending they were looking for someone), they spent a few weeks developing a comprehensive were able to visually observe lack of toilets, questionnaire designed to uncover different handwashing facilities, and so forth. Affidavits types of legal violations in the 'health care de- were prepared and presented to the Industrial livery systems' of the Kern General and Tulare Welfare Commission and the Labor Commis- County Hospitals. This project had the most sion. potential as an effective medical-legal job but In addition, they were able to be helpful to suffered because John arrived in California 2 the United Farm Workers' Organizing Com- weeks late and. Bart had to leave a month early. mittee, which at the time was interested in About 30 interviews with former patients of knowing who was engaged in health violations these hospitals were completed and the in the vineyards. Phil and Ron made a,very ef- groundwork laid for successful followup next fective team and provided much useful detailed summer. The reason for documenting these vi- information for different people working in olations is to put pressure on the hospital sys- Tulare County. Both UFWOL and CRLA were tems to change their practices and, failing to pleased with the work they did. do so, to hope affected patients will sue. (Hanford)-Steve Linfeldt (McGeorge, (United Farm Workers Organizing Commit- law) and Lonnie Bodzin (medical school, De- tee (UFWOC), D-elano)-Ala-n Radar (Stan- troit), worked under a young lawyer and ford, law), Nan Kripke (Boalt), and Pete Jan- former social worker, who were both employe,-' iak (Davis), did a combination of office re- by the Kings County Community Action Or- search and fieldwork under the direction of ganization. A plan was conceived to organize a UFWOC staff attorneys Jerry Cohen (Boalt, county-wide welfare rights organization. Steve 1965) and Dave Averbuck (Boalt, 1966). This and Lonnie spent the first couple of weeks legal work was useful. These assignments, learning in great detail about how the entire much like the Del Rey job, fit in most closely to welfare system works, who qualifies for how our concept of what law students should be much aid, etc. The laborious task of contacting doing. Feeling that UFWOC is an extremely people, finding leadership, and explaining what important social movement in the valley, the the advantages to su ch an organization were, chance to place three students in their law took most of the summer. A budding organiza- office working under close supervision, gave us tion finally evolved, and both were hopeful the opportunity to make maximum use of our that it would become permanent. Compared to legal skills for the benefit of a 'relevant' com- some of the other projects this one had the ad- munity organization. vantage @of being directly organized by two poverty workers who had sufficient skill, and (Lamont)-Diana Chapman (Davis, law), knew how to use the summer students. It was and Lloyd Gordon (med), began on a housing deficient in that the welfare rights group survey in Arvin, t try to get .migrant housing 0 really should have been organized more by condemned, because it housed scab migrants, local people. But by the end of the summer, it being brought in to break UFWOC strikes. was in their hands. This work did not get very far however, bet (California Rural Legal Assistame Office, cause it was impossible to get into people's McFarlatW)-Steve Cline (McGeorge) and homes to ask them questions which they knew Greg Sager (Davis, law), did office research on might lead to tearing down of their own 54 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 houses. Most of the summer, therefore, was city of good organizations and good organizers spent doing a variety of jobs for the Lamont suggests that the summer project should not office of UFWOC. This included strike work, restrict itself to the Valley but should look field investigations, and some legal research. anywhere organizers are. There are many. (Once more the adage was borne out that one areas where we did not look-Stockton, Mays- must hook in to a group already functioning ville, Salinas, and the urban areas as well. The that is doing something worthwhile, rather than chicano students who seem most interested in attempt to create something new.) carrying on the program at this point have This completes the list of individual pro- Probably more interest in the urban areas. jects. It is apparent in a number of cases that On balance, however, I think the summer the students began on one thing and then had projects was extremely valuable as a way to to move on to something else. As a result of experiment with new models. The Visalia.law this shifting, if was difficult in a 10-week pe- project, especially, has been the subject of tiod to accomplish a great deal. It is now ap- much discussion in the law schools this fall; a parent that the original project selection must number of students are talking seriously about be more thorough and be definite when the stu- this kind of community law practice after law dents arrive. Many of the problems we faced, school. such as the difficulty of obtaining affidavits in The students who participated this summer Madera and interviewing migrants in Arvin, have by and large remained active. The Stan- could possibly have been anticipated with more ford contingent has organized the campus contact work in the beginning. Furthermore, it around the grape strike issue. We at Boalt have is always risky to attempt to do anything inde- been working on different Boalt Hall Commun- pendently. This had been, in fact, a basic prem- ity Action projects and have some contact with ise to our whole program but in a number of the Mexican-American students Confederation. cases, we in fact did just that (e.g. Porter- In spite of all the administrative and program- ville). (I am now convinced that a project on matic problems we faced this summer, I think this scale must employ a person from the Val- the overall project was exceedingly valuable ley, who knows generally the people who are and should be continued. doing things and can set up projects with them during the spring. Such a job would not be Statistics full-time but could be on a consultant-day (a) Project ran from June 24 to Augst 30. basis.) (b) Number of volunteer students partici- In addition, as many students as possible pating. should be chicano. If anglo, they should speak 5 Boalt students Spanish. They should be willing to live in the communities where they work and not live a 6 Stanford students 4 Davis students campus-type existence in an air-conditioned apartment. Their summer must be lived in the 2 McGeorge students I Harvard student community where they work so that the di- (c) Impossible to measure the number of chotomy of time spent on the job and time persons served by the project. spent at home cannot develop. The $800 sti- Pend can only be justified on the basis that stu- Llillacklash and Backlash Blues dents have to earn money for school. If this is $6, the best way to administer it is to keep $500 There was the confrontation at Yucaipa at for the student to give him at the end of the the beginning of the summer and it went on all mnier. He can easily live on $30 per week. summer. Whites overreacted to blacks, and more people like Sal Gonzales and blacks defined every ine pt move of white stu- nizations like UFWOC will be the dents as white liberalism, tokenism, or coun- ingredient to a really cohesive and ter-revolutionary. The lack of leadership from evant summer program. The se-ar- either black, brown, or white -was apparent 55 MMER 1969 CALIFORNIA STUDENT HEALTI-I PROJECT SU organized meeting from the start. At any well- many dis arate opinions, it is- where there are pto integrate the crucial for someone to be able s and knowledge, Put the issues clearly in fOcu level of action. Instead of that agree on some it attitude, a Petu- course there was a you do i-Vt dity that did not allow for a lance and rigi absence of humor modicum of good will. The was frightening. ess there are two When people feel powerl athy, or paths open: either resignation and aP revolt. The politics of confrontation isevidence that those who use it so not feel powerless any- .nt that viO- more. Frantz Fanon makes the pol 0 lence is therapeutic and creative for th se de- nels of redress, and history ree- nied other chair en ri ng expecta- s of ords that violence occurs wh Si le want mentioned earlier in this report, the goal tions and levels of education make peop the black students were much clearer than er students. The brown stu- more of both- of the minority groups2 the ero- those of any oth that they didn't On the part power dents were in such a minority Sion of trust in the promises of the tcomes, but they did identify with generally affected minority com- affect the ou structure has Iminority group students. it has the black students. munities and nsify their demands, and in the Black students were welcomed in ghetto led them to inte udents affiliated with the Stu- communities as advocates and teachers, a role case of those St ated as tok ' - dent Health Proect, to use the project as a ve- understandably design enism if un 3 . The black students hicle for their own anger aff and dertaken by white students. But the realistic conspiracy in every move of the St fact is that the black students could do things saw ,,loped a kind of sick gym- ate for whites to do in 1968. students. There d St unani- that are inappropri e into communities in bio s -wherein white students almO e black students cam ere more hi sessive guilt and Th ghly with ob which thev did not live, w mously responde as the fact that than most residents, were self-doubt. A simple example w trained and skilled nity for educa- a inistrative decision, the refusal to used by-and used-the commu a Sloppy dm the Watts project, im- ice, and to our knowledge left the provide a telephone for c proportions tion and se'rv. At this ities when the project ended. mediately took on giant symbol' commun whether provisions and was used as evidence of racism. The whole is not known o $4. The fa 't is that writingg it es for com transaction amounted t were made for continuing the class the telephone was among countless other er- munity first aid workers or the disaster sta- as standing on a prin- Granting that its a totally different rors in lo-gic. Someone -w is moment tions. lack students than White students@ ,,iple which escapes the writer at th scene with b about short-term projects probably any other moment. However, its from what is known Pro- or immediately COitrasted to the ex- the question remains whether this kind of denial was travel or sensitivity groups, ject is not damaging to the community what- penditures on ny bearing at all on the neither of which had a ere a last ever the color of the student, s, in their effort t( telephone. The sensitivity groups w situa- Minority group preceptor on of thei@ to ease the very tense fully control the design and executi ditch stand to try described here. protecting theinselve tions which have been -class own projects while ear to measure thei The project was also a Way for middle usion, app ed a otribution on the againt illtr independence they fok black students to make residents. As success by the degree of streets and identify with ghetto 56 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 tered in the black students. Gary Bellow and Clinic, few students achieved the goals pro- Douglas Frasier, both independently inter- jected for their projects. It is quite clear that viewed, felt that white students should fight to even seasoned community organizers would work in every community. Bellow was clearly have not been able to accomplish such over- in favor of facing up to the conflicts and using whelming objectives in so short a time. By the them to develop some positive outcomes. Fras- same token, no seasoned organizer would have ier felt the project was used effectively by the approached the problems with such naivete. law students and the black students for their The area coordinators, in establishing the pro- own purposes of seeking power rather than ject goals grasped the seriousness of the prob- seeking education about health Institutions lems, but their inexperience and lack of thor- or in giving service. oughness combined to produce unattainable There is no doubt that the preceptors of the ends and ill-defined means which for many black students succeeded in politicizing the stu- people spelled built-in failure. This lack of dents, If 'the SHP helps to turn the tide for careful planning led them into grandiose vi- black professionals and attracts them back to sions of potential accomplishments which no ghetto communities or public health medicine, one could have achieved. The summer experi- much will be gained. What the long term ef- ence led David Snyder, student project direc- fects of the summer will be upon some of the tor, to comment: other young health science students, we have "During the summer, and now no way of knowing. But in 1968, the efforts of every once in a while, I stand back the white middle class students (and SHP and look at the situation and think members are characteristically that) evapo- that no matter how incompetent I am rated in angry accusations of white liberalism or how little understanding I have, it -to militant whites and for blacks, the equiva- lent of poison. For some students, the self-im- is statistically almost impossible that age of the confused white liberal will be rein- we were always wrong, so something forced. For others, there will be a more accel- else is going on and I am still too erated search for social justice. No doubt for bound up in it to really separate gen- some, the charge of white liberalism will be- uine mistakes I made and where it come a challenge and for others the charge was impossible to do the right thing, will be dropped in'favor of a more comfortable either because there was no right retreat. thing or because nothing was accepta- The majority of the health science projects ble. By the end of the summer, I felt have been reported in humanist terms rather you couldn't win even if the leader- than analytical terms. Most students found ship were all black. If this revolution themselves anxious and sometimes frustrated isn't consummated, everything else is by their inability to accomplish their expecta- just going to crumble. Our society has tions. With the exception of the Venice Dental to solve this problem." 57 NTS PROBLEMS MOST FREQUENTLY MENTIONED BY STUDE Personal Problems 2. Inaccessibility and inadequacy of health 1. interpersonal relations. resources when they do exist. 3. In rural and urban areas, absence of 2. Problems of suddenly finding oneself in a no personal attach- transportation to and from health centers. new, community with ment. 4. Ignorance of the existence of health re- 3. The inability to connect the means to the sources by the poor. There is no program to educate them to the existing programs goals. 4. The lack of knowledge about interviewing orresources. and survey techniques, how to interview, 5. Health manpower shortage. what questions to ask, who to ask. 6. Dearth of preventive medicine programs 5. Ambivalence between personal autonomy -immunization, health education, family and organizational structure-viewed by planning. participants as the difference between 7. Inadequate clinical facilities for narcotics freedom and restraint. users. 6. Insufficient supervision by the preceptor, 8. Inadequate medical care in health depart- et between preceptor ments. inconsistent conta and student. 9. Disinterest of private physicians and den- 7. Insufficient knowledge or orientation of tists in health problems of the poor. participants to sites or comniunities in which sites were located. Community Problems 8. The multiple Student Health Project goals 1. The co-optation of minority group people were never clearly spelled out beforehand to either preceptor or student, both of into the power structure with subsequent whom complained of the other's lack of harassment and rejection of their own people best described by one student as the understanding. I 9. Little advance preparation for arrival of 'Brown Anglos." students in the community. 2. The wide variations in interpreting pol. 10. Inadequate knowledge about community icies of community action agencies. resources.and how to find them (on part 3. Repeated hiring and firing of personne of students). creates confusion and makes on-going re lationships impossible. Health Problems 4. No recourse to legal protection for farn 1. Insufficient health professionals in rural workers who are not covered for welfar@ areas and urban poverty areas. benefits. 58 RECOMMENDATIONS As in an act of faith, the single theme be- 5. Preference should not be given to students yond all others which thrums its waythrough on the basis of their political sophistica- the reports and personal interviews is that the tion or prior experience, but on the basis Student Health Organization should and must of their commitment. continue. There are many variations in opinion 6. Some self-education should be a require- as to how the organization could function best ment for student participants. A reading and what it might do to maximize its potential. list should be sent prior to the summer. Nowhere and by no one was it said that the or- 7. Students assigned to projects in a Mexi- ga-nization has ceased to serve a purpose or can-American or Puerto Rican community that it could not serve its purposes better if it should know Spanish. Other students did thus and so. As is evident from Michael Al- should be assigned to non-Spanish speak- bertson's letter, (see Appendix) there were ing projects. students, disappointed from the summer expe- 8. Priority should be given to minority group rience, still eager to mend the disabled orga-ni- students. zation. To some degree this has occurred. At 9. The present balance of medical, dental, this writing there are three student health or- nursing, with a few behavioral science ganizations operating in the local medical students should be maintained. schools of UCLA, USC, and the California Col- 10. Students assigned to rural areas should be lege of Medicine, recently transferred from prepared by a special orientation program. Los Angeles to the University of California 11. Students neither have the time, nor are campus at Irvine, Calif. they in school long enough to develop loca- The recommendations which follow are a tions for projects or to evaluate them over distillation as well as a condensation of many time. Therefore, though students should views. They are divided into subjects for the participate in finding suitable locations, ease of the reader and for those who might be they should not have sole jurisdiction. in position to work with one or more aspects of 12. Each student should receive a packet de- the project at some future date. Because of the scribing what SHP has accomplished in subject matter the divisions are arbitrary and the past. This should be broken down by in some instances overlap. No effort was made area, giving pertinent information and to make them discrete categories nor are they names of contacts made. This would de- arranged according to any priority. velop some continuity in the projects. A central file should be maintained with this Students information. 1. Students should live in the community The Health Science Schools-Recommendations where they work. 2. Student exchanges with other areas of the 1. The study of community health and com- country do not work because it does not munity law should be required subjects in build community trust or enduring pro- all professional schools. Medical and Law jects in which the community can expect schools should jointly sponsor courses for some follow-through. both disciplines so each has an opportune Students should be selected by a commit- to work on problems of mutual interest. tee consisting of faculty, students, and 2. Community medicine departments should community people. include courses in group work techniques Students should be selected by personal in- and sensitivity training. terview. 3. If the universities sponsor a project, they 59 JECT SUMMER 1968 CALIFORNIA STUDENT HEALTI-I PRO asis should be on year-round ,Dn-going interest in 6. The emph ven when students have to be should maintain some they should be projects. E rogram changes - In turn, rotated because of P it or lot sponsor it eir role in the Pro- n, year-round projects have held accountable for th graduatio ject. e for sensi- more validity. ols should be responsibl 7. Students should be given preference in 4. The schO in various where they f eel they have suit- tizing students to the differences projects is and will be more comfortable, ethnic and social class groups- through a able skil skiiis they 5. Schools should be responsible ant place- (Some students complained the arned few central office, for finding relev The office had were not used and they le rnents for interested students. d in the new ones.) -going agen- . 13erson traine should be staffed by a .well as health Pro- g. Projects should be part of on ardless of the Purpose of the behavioral sciences as cies reg agency. Students therefore would work in the capability Of con- fessions. ools, students and funding sources agencies which have 6. The sch organized by student longitudinal study would benefit from curs in the tinuing any work which would evaluate what Oc have workers. io al lives of students who of projects dealing with riid- profess n alth projects. 9. A new group should be devel- participated in student he begin to dle class health Problems All health science schools should , oped by some of the voluntary agencies. 7. ght eventually drug abuse, develop a program which mi nships Alcoholism, heart disease a-nginZ attitudes, relatiO home health care, and insurance plans are lead to ch tists and behavior between physicians, den g schools should initiate such examples. and nurses. Nursin , help nurses develop a 10. opinion was divided on whether SHP s v@ihich Wil evote its energies to nonhealth re- program e of pride in their profession by should d ere many Who felt greater sens lated prDjects. There w f-image. Ility was a neces- increasing their own sel that work ill the comTnu sary Part of every students education and Projects-Recomrnendations that in itself is enough. There were those d be scaled who felt that the whole structure of the 1. The content of projects shOul is in such bad shape feasible goals. They should have a medical care system down to that students should not dissipate their and ending. related to chang- beginning teams should be 0'rga- n projects not 2. working project mmer Projects energies 0 nized long before the Su earn can de- ing that system. begin so the morale of the tent in meth- tions velop and people can experim eptors Administration-Recommenda od of working together with pree The organization should be staffed by a s 1. n charge of and communities. full-time year-round director i 3. All projects should be aTefully planned. unity relations. alternatives should student-e-omm iv located in ghettos o not work, 2. if st. dents are prima-ri-. If plans d u where minority groups live, the be tested. or areas a member of on of project goals should be pro- 4. A definiti year-round director should be if they are not available those minority groups. vided to students oneof nning process. t be chosen With spe- for participation in the pla the projects S. The -Oordinators mus background Students should understand s- cific criteria. They must have a and should be given an opportunity to di in community organizing methods and ull- cuss methods of achieving the objective derstand how to work in communities. f the students and pree-ep- 5. At least 85% 0 Choice should not be.baseddn seniority, but tors requested that Projects be more strue- expertise. tured. 60 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 4. Coordinators must be selective in their projects in advance. Considering the time choice of sites. involved, it may be necessary to think of 5. Coordinators should be expected to orient some financial reward to those agencies student fellows and look after administra- who undertake preceptorships. tive problems affecting student perform- 5. Several faculty members were of the opin- ance, i.e. mileage, stipends, etc. ion that Departments of Community Medi- 6. Educational programs should be carried on cine could best administer preceptorships in all year by staff. conjunction with outside agencies. Preceptors-Recommendations 6. Federal and State agencies as well as pro- fessional societies are now offering ex- 1. Faculty people who are preceptors should panded programs for field study. The Bu- have a good understanding of the commun- reau of Health Manpower and the Califor- ity and the agencies in which the students nia Medical Association are but two agen- work. Though faculty people are liked by cies involved in sponsoring preceptorships. the students, faculty preceptors cannot be Recently enacted legislation enlarges the effective if they do not make an effort to possibilities of financial aid to students, make relationships in the community. thereby freeing them for more time in corn- 2. Preceptors from community agencies munity programs. We refer to such legisla- should be helped to bridge the gap between tion as Public Law 88-497, the Graduate student organizations, universities and Public Health Training Amendments of their own communities by being fully ori- 1964; Public Law 88-581, Nurse Training ented to the objectives of the universities Act of 1964; Public Law 89-290, Health and students. This would help them to as- Professions Educational Assistance Amend- sess whether their objectives coincide or ments of 1965; and Public Law 89-329, complement or are in conflict with those of Higher Education Act of 1965. the universities and students. "Medicine and public health do not 3. A new model of "faculty-community-pre- develop or function in a social void. ceptor-team" could probably provide excel- They provide the social adaptive me- lent support and stimulation to a team of chanisms that complement the biologi- students as well as cross-fertilize their own cal adaptive responses to the condi- knowledge, benefiting all concerned. 4. Preceptors should be carefully chosen on tions of life at a given time. They can the basis of their philosophy and the nature fulfill their purpose, to improve the of the projects they have to offer. An objec- people's health, only if they are fitted to the needs and resources of the com- tive and respected community organizer munity a.s well as to the special condl-' should be hired to evaluate community tions created by the total environ- leaders and potential preceptors in each ment." community. On the basis of these recom- mendations, preceptors should be chosen. RENE DUBOIS, Preceptors should be willing to plan the Man Adapting. 61 BIBLIOGRAPHY (1) Peter M. Blau and W. Richard Scott, "Formal (17) William H. Grier, M.D. and Price M. Cobbs, Organizations" (Chandler Publishing Co., M.D., "Black Rage" (Bantam Books, Inc., Jan- 1962). uary 1969). (2) Henrik L. Blum, M.D., M.P.H.; Fred Wahl, (18) Kenneth Kenniston, "Social Change and Youth M.S.W.; Genelle M. Lemon, P.H.N., M.P.H.; In Amerca", Daedalus (Winter 1962). Robert Jornlin, M.S.W.; and Glen W. Kent, (19) Seymour Martin Lipset, "Students and Politics M.D., M.P.H., 'The Multipurpose Worker and in Comparative Perspective", Daedalus (Win- the Neighborhood Multiservice Center: Initial ter 1968). Experiences and Implications of the Rodeo (20) Mannheim, "Ideology and Utopia" arcour , Community Service Center', "American Journal Brace, and World, Inc.) of Public Health and the Nation's Health," vol. (21) C. Wright Mills, "The Sociological Imagination" 58, No. 3 (March 1968) ' (Grove Press, Inc., 1959). (3) David Boesel and Associates, "White Institu- (22) Wilbert E. Moore, "Social Change" (Prentice- tions and Black Rage", Transaction (March Hall, Inc., 1963). 1969). (23) Daniel P. Moynihan, "The Professors and the (4) Jerome S. Bruner, "The Process of Education" Poor", Commentary vol. 46, No. 2 (August (Vintage Books, 1960). 1968). (5) Albert Camus, "The Rebel" (New York Vintage (24) Talcott Parsons, "Youth: Change and Challenge", Books, January 1954). Daedalus (Winter 1962). (6) Eldridge Cleaver, "Soul On Ice" (McGraw-Hill, (25) Mitchell Sviridoff, "Contradictions In Community 1968). Action", Psychiatry and Social Science Review, (7) James Drugoth, "Drugoth" (Skylight Press, vol. 2, No. 10 (October 1968 ) . 1965). (26) Diana Trilling, "Liberalism and the Revolution (8) Ren6 Dubos, "Man Adapting" (Yale University of the Young", Commentary, vol. 46, No. 5 (No- Press, 1965). vember 1968). (9) Roger 0. Egeberg, M.D.; S. Douglas Frasier, (27) Willard Waller, Ph. D., "The Sociology of Teach- M.D.; and Paul F. Wehrle, M.D.; Lewis Ira ing" (Science Editions, 1965). Rosenbaum, 'Student Health Organization (28) Melvin M. Webber, "The Post-City Age", Daeda- (SHO), A Faculty Appraisal, A Student Ap- lus (Fall 1968). praisal', "Medical Opinion and Review", Vol. (29) Norman Zinberg "In Our Image", PiTchiatry and 4, No. 11 (November 1968). Social Science Review, vol. 2, No. II (Novem- (10) Ralph Ellison, "Invisible Man" (The New Ameri- ber 1968). can Library, 1947). (30) "The American Underclass: Red, White, and (11) Erik H. Erikson, "Youth: Fidelity and Diversity", Black", Transaction (February 1969). Daedalus (Winter 1962). (30) "Community Values and Conflict, 196711, A con- (12) Amitai Etzioni, "A Comparative Analysis of ference report sponsored by: City of New York Complex OrganiziLtions" (The Free Press of Commission on Human Rights, Lemburg Cen- Glencoe, Inc., 1961). ter for the Study of Violence, Brotherhood-In- (13) Amitai Etzioni, "Modern Organizations" (Pren- Action. tice-Hall, Inc., 1964). (82) "Summer Education For Children of Poverty", (14) Frantz Fanon, "The Wretched of the Earth" a report of the National Advisory Council (U.S. (Grove Press Inc., 1968). Government Printing Office, 1966). (15) John W. Gardner, "Self-Renewal, The Individ- (33) 1966 Student Health Project'Report, University of ual and the Innovative Society" (Harper & Southern California. Row, 1965). (34) 1967 Student Health Project Report, University (16) Paul Goodman, "Growing Up Absurd" (Vintage of Southern California. Books, July 1962). (85) Chicago Student Health Project, Summer 1967. 62 A P P E N D I X E S APPENDIX A Preceptor Evaluation-South Monterey PROGRAM: South Monterey County Medical Group Rural Health Project. PRECEPTOR: Stuart Allan, administrator. STUDENTS: Martha Jackson (we paid stipend); Jerry Ginzburg (SHO stipend). A. The rural health project is one of about 50 Neighborhood Health Centers fun d by OEO. In this case, the grantee is the Monterey County Medical Society; the South Monterey County Medical Group is the delegate agency. (This is a private group of about 10 doctors with clinics in King City, Greenfield, and Soledad.) The project's aim is to provide completely integrated medical care to low-income folks in south Monterey County. We pay all medical costs; except for the first dollar per prescription. Poor folks use the Community Hospital and the Medical Groups clinics, and the three local pharmacies. The "student team" was one nursing student and, later, one medical student. Since our program is strictly one of providing medical care and, since the students couldn't do this, I assigned the nursing student to live with a number of families on the program and write a health analysis of the household. This is fundamentally aimed at educat- ing the doctors of the medical group into the environmental (health, job, financi , so- cial) facts of life of this new group of clients that they are seeing under the Rural Health Project. The Medical Student I asked to do much the same thing for a single- man labor camp or, if that proved impossible, for the field crews, by living and working with them. The students, therefore, were never really "part of" the program-they have served as a special project on their own. B. I have not yet decided whether my plan for educating the doctors is reasonable or not. The one report the nursing student completed was pretty good, included all sorts of things on diet and attitude towards health care, etc., which will be valuable to the doc- tors if I can persuade them to read it. Her other report is now being finished. The medi- cal student I have seen little of (he works with the field crews, then camps out in the mountains during the night). I am reluctant to attempt an evaluation of the students, since they have worked very largely on their own, with little guidance. The local poor community is "undevel- oped" as far as self-awareness or the "black-brown revolution" is concerned. There are stirrings in North County, still on the MAPA level, but nothing as yet here. For that reason, I did not want any fooling around on the "community organization" theme, and discouraged the students from doing that (i.e., because there was no group of poor folks well enough developed to use the students-our projects Consumer's Advisory Council will be able to use some next year, perhaps, but not yet). Therefore, I can only evaluate the finished product-the reports they write for the edification of the doctors-and only one is in yet. The community was not hurt, probably not helpedi At least it wasn't-- with, more than can be said for some projects. C. As to student selection-the nursing student had some questions about that; she told me that last year she applied and mentioned being from a low-income background and was not accepted; this year she didn't mention this, and was accepted. I wondered whether this were coincidence, or whether SHO felt that poor folks who have made it into professional schools have already left the category of being worthy of help and attention, and therefore concentrates on bringing hereditarily middle-class kids into con- tact with the poor. That might be reasonable, but I sort of felt it should be spelled out. On staff-is it a tacit agreement that if no one mentions beards and long hair, the poor will accept them? They don't. In our area, since it is, as I mentioned, "underdevel- oped," witchcraft is still a going business. When Jerry Ginzburg did magic for some 63 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 kids, their mother, already uneasy about his appearance, concluded he was a magician, which is to say, witch. (This is secondhand information, but I know the family and it figures.) Same goes for Tew Rosenbaum. Both very interesting and competent, etc., but in appearance, they might either alienate or charm the younger poor folks, but appall the older ones. That might be all right, the older ones have pretty fierce petit-bourgeois leanings of course. But SHO certainly ought to be aware of the choice. On improving the thing-the ideal would be a poor folk-student board making placements with a local poor folk group. But, of course, anybody can work up his own list of poor folks. You could get a very good looking crew of junkies and yet not really represent that part of the poor who will work for change, for example (the reverse Uncle Tom phenomenon, or, how-to-achieve-wealth-and-fame-catering-to-the-college- boy-urge-to-play-Che). I think you want to watch that. Another thing-stop sending all those memos. Or get someone else to write them. But, mainly, less paper in the mail. The Student Health Organization must bear a major share of responsibility in depleting the Nation's forests for pulp. Where you have a well-develdped group of poor folks who can use medical science students, or law students, fine. Where you don't, I think you are going to have to say that you are trying to expose students to poor folks in order that they will serve them better when they return as licensed professionals. That you want to do this as much as possible on the poor folks own terms-and here, I think, it is imperative that every student have some kind of poor folk preceptor, as the two students working for us did NOT have (my own fault for accepting them without having laid that groundwork). But I don't see what else you can realistically expect to do beyond that . I hope these remarks are received as'friendly criticism. I hope to make it to Goleta. STUART ALLAN, Administrator Rural Health Project, 210 Canal Street King City, Calif. 64 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 APPENDIX B Preceptor Evaluation-Tulare County PROGRAM: Tulare County Child Care Educational Program. PRECEPTOR: Eleanor Foster, director. Four SHO students with varying degrees of relationship to us worked in and around the Child Care program this summer. This program is by birth CAP and only recently moved to county schools. It is still much closer to community identification than this letterhead suggests. A community group primarily farm workers, initiates a child care center, hires for it and makes local Aecisions regarding its functioning. I believe child care is seen by the community as a just return for their efforts, a right long overdue. It is not a demeaning relation- ship, and perhaps there is, or should be, a consideration for SHO in the choice of spon- sors. This past summer, two student nurses, a medical student, and a student dental hy- gienist, through this and a related program, contributed directly to the communities in the area of their own science specialty. What they had to offer was needed in the com- munities: Some of their services, the screening of vision and hearing problems among the.children, the initiation of a dental clinic, the detection of a change in the anemia pattern of the low-income children following a diet change, will make a long range difference to health and even lives in the communities here. The students met directly with the parents in an area of mutual concern. Some of the re- sults of the summer will be a growth in the students themselves who will have changed because of a genuine meeting with other persons. Is this a small thing? Is SHO wanting to yank this out of its prograrii and pretend to be something it is not? We honor the farmworker for his skill in the field and we admire the integrity of his appearance and his speech and his spirit. Can't we give honor also to the student nurse for her skill, and admire her integrity of speech and her spirit and her appearance? As poor strung out imitations of Cesar Chavez, these students would -not have had validity. They could even seem contemptuous of a whole hard-working population who has earned the right to strike by showing it had a contribution to make. It took 34 years of a search for honesty to make,Cesar; now he's speaking loud and clear to his own people. But that these students should come in expecting to speak out about some- thing they have not experienced, to know the right way for others to go, to condemn the unsure? To speak for Cesar? Certainly if the students have any sense of social history they can't help but be caught up in the excitement and pertinence of the social revolution going on here-but they cannot make this particular history. . In answer to your question: Yes, we would again welcome students here if they were working out their own authenticity-sharing their own vitality as they did this summer-making their own contribution in the health sciences in return for a genuine meeting with others and an education not to be duplicated in any classroom. But they would not be welcomed as dogmatists, as organizers or as prophets. We need their help as health students-we do not wish it as the other. They would have too little to offer-it would be too dishonest a role. ErmNoR PosT=, Director, Child Care Educational Program, Tulare County Department of Education, 202 County Civic Center, Visal@ Calif. 93277 65 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 TULARE: COUNTY COMMUNITY ACTION AGENCY, INC. Visalia, Calif., July 18, 1968. DAviD SNYDER, Co-Director, California Student Health Project General Lab Building, Room 1G-24 1200 North State Street Los Angeles, Calif. 90033 DEAR MR. SNYDER: I am writing you in personal response to the current challenge before the California Student Health project to abandon its original concerns with the problems of the medically underprivileged in favor of a more inclusive involvement in the revolutionary aspects of community change. I am writing you also as a preceptor of the present project to take issue with your formal acceptance of certain of the de- mands made by a so-called "black and brown" caucus to SHO on the 23d of June. As you are probably aware, the 1968 student health project can trace its historical antecedents back to 1964 when several students in the health professions, concerned over gross deficiencies in general medical education, formed what became the Student Medical Conference. In the summer of 1965, SMC fielded 13 medical, dental, and nurs- ing students into the rural communities of California. Their purpose was two-fold: Ex- pand and explore the potentialities of increasing medical and health services to migrant farm populations; involve and educate future health professionals in the enormous penalties paid by the poor for a segregated system of medical care. Significantly, these students saw themselves as uniquely qualified by virtue of their specialized training, to involve themselves in health problems as health professionals. This was their bag@om- plete, entire, and sufficient to a ten-week tenure. Not surprisingly, it was a successful summer. In Tulare County, the evaluatory study of local health conditions done for this Agency by the SMC intern was subsequently used in planning poverty programs di- rectly related to the medical needs of low-income farm workers. The SMC himself is completing his medical training and intends to practice among the rural poor. Of course, this was 1965. By 1968, SMC had grown into a national confederation of Student Health Organi- zations, able now to secure funding from the public trust, obtain sponsorship from pres- tigious medical schools, and enlist the interest of many hundreds of students from across the country. It has remained, however, in its involvement and impact upon rural California communities, essentially a summer program.- By 1968, this agency had also grown into the largest and most respected rural pov- -ty organization in the State, operating 19 community action groups, 13 year-round Id care centers, 4 low-income credit unions, and a half-million dollar basic education ay. training program. This agency, of course, operates 12 months out of every year in -)unty, each year since 1964. It has to effective community organization is -not a 10-week show. Again, this year, SHO invited us to sponsor several students to work in Tulare County. As we can well use the type of specialized skills available through SHO, we agreed to sponsor. We submitted a proposal, approved by SHO and our board of direc- tors, and we officially became a preceptor. Our students, as intended, are now working on health problems, as health interns, and are proving to be sensitive and sympathetic to those whose resources traditionally isolate them from the mainstream of medical care, i.e. the poor. We hope that their experience this summer will generate commit- ment from concern, and that they will eventually use their medical skills in the service of the low-income community. That, at least in theory, I had always though to be one of the major objectives of the summer project. Apparently, the objectives have been radically redefined. To take the demands, already acceded to, made by the black and brown caucus: "1. The target communities being black and brown, it is therefore nec- essary in order to maximize the project's relevance and effectiveness that the decision-making staff be composed of one-third black, one-third brown, and one-third white* Such a step would improve such areas as site determi- nation and placement, applicant selection and recruitment, and orientation." Comment: You've got the base for a good blend here, all right. That 66 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 "one-third, one-third, one-third" bit is an excellent way to maximize your rele- vance. And certainly when it comes to an actual decision, a little color control really helps. However, I question the need for the one-third white. After all, the target communities are only black and brown. And you've already agreed that student vacancies "must be filled with black or brown", so why white? Having dealt with that "white one-third" myself on your staff, I'd say elimi- nate them. But then, I'd also shoot for something like "one-third intelligent, one-third articulate, and one-third aware" or maybe just "three-thirds compe- tent" would suffice. "2. The selection of applicants must be reflective of and responsive to radically oriented students, NOT missionaries and soul searchers;,i.e. these stu- dents should be oriented to the black and brown revolution-not merely their technical "thing" of health or law or social work." Comment: Now this strikes right at the root of the fern. Birth of a new breed-the "health radical". Recruitment poster reads: "WANTED- FOR SHO SUMMER STUDENT PROJECT-HEALTH RADICALS! IF YOU OWN A HIP-POCKET HUEY NEWTON READER, SEND SOUL NOTES TO THE NEGRO NEUROSURGEON ON PEYTON PLACE, AND GROOVE WITH ANGLO INTEGRATION OF THE LUNCH COUNTERS AT TACO TIAS, YOU MAY QUALIFY FOR A TEN-WEEK CONTRACT WITH THE REVOLUTION OF YOUR CHOICE-BLACK OR BROWN. REMEMBER OUR MOTTO@'IF YOU CAN'T BE A PART OF THE PROB- LEM, YOU MIGHT AS WELL STAY HOME." Of course it would be helpful to begin with a radical medical school to sponsor, a radical government agency to fund, and a raft of radical preceptors to find someting for the radical students to do, but then you can bridge that gap when you fall in it. The AMA isn't in a rush. "3. This summer's project should have present preceptors serving on the board where staff decisions are being made." Comment: "I'm sorry but that number has been disconnected. Could you hang up and dial again, please?" "4. Propriety commends tht John Bruce be transferred to @ Angeles immediately; he is married and it is ureasonably inconvenient to place him in Oxnard. Furthermore, it detracts from his effectiveness as a black medical stu- dent." Comment: Now this is the kind of gut staff decision that could cer- tainly cause a preceptor to think twice before disconnecting his number. I mean I wish I had been there, you know, for the actual, decision. Just, of course, in order to maximize its relevance. John's right about Oxnard, though, I've been there. You can go numb just from saying the name. "5. Present vacancies in the student project-or -new positions that open-must be filled with black and brown." Comment: Amen, I say. After all, who wants the kind that melt in your hand? To sum up: This agency feels that the current direction being taken by the student health project is a distortion of its founding ideology, and is most especially irrelevant to the medical needs of this county. Responding to those needs is, in my estimation, the. sole and exclusive concern of any student health interns admitted into rural communi- ties on summmer projects. Students who insist on a 10-week "involvement" in the com- plexities of community organization, end by interfering with the process of social change, at best, and may even destroy good work that has gone before them. We don't iire 10-week organizers and we don't accept them as volunteers, not from VISTA, the Boy Scouts, or SHO. Yours truly, RicH,uw UNwiN, SHO Preceptor. 67 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 APPENDIX C.-RECOMMENDATIONS BY STUDENTS ON PROJECT PLACEMENTS FOR THE FUTURE Recommended Site Preceptor Name of site Yes No Yes NO Madera ------------------------------------------ -- x x East Los Angeles Health Clinic (Pat Wiley) ------ -- x x El Monte Teen Post ------------------------------- -- x x Venice (Lawless) Legal Aid Services --------------- x Oxnard area -------------------------------------- x x Willowbrook Health Clinic ------------------------ x x -- Earlimart Child Care Center ---------------------- -- x x Venice Dental Clinic ----------------------------- x Los Angeles County-general ---------------------- x x Fresno General Hospital --------------------------- -- x x Imperial Valley ----------------------------------- x King City Rural Health Project -------------------- x x 68 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 APPENDIX D SOME QUESTIONS FROM THE BLACK CAUCUS 1. How do white Student Health Organization people 'perceive the so-called civil disturbances in black communities? Riot or insurrection? Nihilistic or an epi- sode in a continuing social struggle? 2. How do you look at "nonprofessional" health workers, e.g., aides, LPN's or- derlies, etc.-those black people who form the underpinnings of the huge hospi- tal bureaucratic and services structure and who are locked in at the bottom- 3. Do you favor unionization of hospital employees even if tfiis threatens tradi- tional authority relationships with health "professionals"? 4. Is there any useful thinking among you about creative methods to challenge and enlighten those black physicians who have been screwed in the past by the white medical guild structure and now stand a chance to be screwed by the white lib- eral establishment which condemns them for not being sufficiently community minded? 5. Are black project participants used as fronts or as escorts into black communi- ties? Members of the black caucus are concerned about SHO's lack of a theoretical per- spective on the appropriate role of white health science students in black communities. Generally we ask these questions: Are you responsive to the principle of community and consumer control of services? Are you aware of the extent to which Black Power is a viable concept in black communities? Are you going to be doing political organizing in black areas-probably not-who wants to get killed, but is this a reason derived from principle? You must have an understanding of why black people no longer can tolerate your presence in the ghettoes@ven spiritually- It is not that you are racists (which you very well may be), but that we blacks are struggling for a sense of identity, mutual, trust and control of our destinies as a group. It is a question of survival, the very ess- ence of which depends ultimately upon black initiative, black support, services, re- sources, skills, and action. Only in this way is there any hope for our salvation. So it really doesn't matter whether you identify with black militants, have a radical analysis, have good hearts, and are clean for Gene-your very presence in black communities is destructive and you cannot make yourselves relevant to us at all. Obviously, if these dicta were adhered to literally many SHO summer projects would collapse. As a compromise solution we offer the following: The only roles still available for white students with respect to the struggle for liberation of the dispersed black colony are those of the patient-advoca@ in the context of white service institu- tions, catalysts and liaison for community groups seeking participation on boards and councils which control community services, and research analysts. Ultimately, those of you who are sincerely committed to social change must examine, confront, and expose those white institutions (hospitals, medical schools, welfare) which by their very struc- tural nature insure and perpetuate oppression, racism, and deprivation. This is essen- tially the,white radical position. It allows an opportunity for alliance and solidarity with the black struggle. If white students on summer projects do not have this kind of understanding, the project is again into yet another summer of white paternalism, an- other summer where mindless, selfless service finds its reward in covert palliation, an- other summer in the sun learning how the niggers live. 69 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 APPENDIX E THE BLACK STUDENTS AND THE STUDENT HEALTH PROJECT A POSITION PAPER Final conference- August 30, 1968 In 1960, black infants were dying at a rate that exceeded the total population by 66 percent; the maternal death rate for black women was four times as high as that for whites; the life expectancy for nonwhites was 6 years less than for whites; approxi- rnately 30 percent more whites have health insurance than blacks; and only 2 percent of this country's physicians are black. In light of such dismal reality, we, as future black health professionals, cannot afford to continue playing polite parlor games ivith the stu- dent health project. For black students, SHP has served as a source of frustration and an exercise in f utility. We joined the project with the hope that our collective efforts, black and white together, would be responsive primarily to the'needs and desires of the communities we sought to serve. While possibly lacking understanding, we assumed that you at least had good will. We have been mistaken. The 1967 project's critical report has apparently gone unread b'y the staff. That report warned of the organizational pitfalls to be avoided-which they have not: "Res- istance to sweeping innovation; dependence on revokable funds; perpetuation of in- group ideals to the exclusion of ideological renewal; over-reliance on public relations work to compensate for a deficit new activity; and, particularly, disregard for the needs and feelings of clients when these are in conflict with the inertia of the organization." While thus plagued by the interworkings of the project, even the inertia pushes in the wrong direction. The SHP has fallen into the hands of a staff of ignorant, middle- class whites who have been exploiting the project to feed their own needs and egos. Supposedly moving away from establishment ties, the SHP staff has become as insensi- tive as the historical establishment that brought about the situation as it is today. Pockets are being generously filled on the pretext of helping to improve the health situ- ation in the ghetto. The rhetoric claims that we are responding to the needs of the ghetto people as perceived by those people, but behind the closed doors where the deci- sions are made there hangs on those doors a whites only sign. In reality, the project exists only as a stop-gap adventure for many white middle- class students, and a token number of blacks used for legitimating purposes. The pro- ject is nothing but a reflection of the tired liberal mentality-an effort to rage quietly with dignity, "to tell the poor what to do with their poverty" as Le Roi Jones would say. In terms of the communities, no basic changes are made, no new power is e3ier- cised. The summer ends and business as usual continues. Students return to school with new insights, cleansed consciences, and an easy $800. The ghetto was just a research project; and, like other cancers, there has been no cure found. This project has become an apolitical social movement. Prof. Richard Flacks of the University of Chicago has pointed out the danger here, which is that of irresponsi- bility; "of a search for personally satisfying modes of life while abandoning the possi- bility of helping others to change theirs; a situation in which one's personal needs and hang-ups are increasingly acted out in the large arena, and attempts at solution of these take precedence over more collective concerns." Thus the project can spend over $10,000 for resort conferences and orientations, over $400 for individual Spanish les- sons, over $1,000 for sensitivity sessions; but merely to obtain a $4 phone, the students in Watts had to organize and bargain. The question should b e asked whether a project can be fostered by institutions sub- stantially tied to a status quo interests and still be responsive to the needs of the ghetto. It should also be asked what role white liberals can play in this effort. White liberals characteristically embrace objectives, but shy away from militant means. It is a fact that when black voices grow militant most white liberals become reluctant. Para- doxically, some see this project forming a tighter alliance with community militants. Yet the community NYCs have been dropped, our preceptor, Lou Smith, has been deemphasized, the implementation of the black-brown demands is a farce, and many 70 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 white students fear that the project is becoming merely an extension of the black and brown revolutions. It must be clear to all of us that blacks and whites live in very different worlds. As Carmichael and Hamilton have stated, it cannot be overemphasized that "these two groups operate from different vantage points and different concepts of what constitutes legitimacy. We shall have to struggle for the right to create our own terms through which to define ourselves and our relationship to the society, and to have those terms recognized." And for those who need reiteration, Silberman echoes the point, "For the moment, at least, it is far more important that things be done by Negroes than they be done for them * * *." Hence, what is needed is a project emanating from the ghetto, comprised of black studen@to be integrated from black to white if need be-and receptive to the needs, frustrations, and cries of the ghetto. This will be an alternative to the SHP, not a paid vacation for anyone merely to familiarize himself with the problems of the ghetto, but rather an opportunity primarily for potential black health professionals to start help- ing their own people help themselves. As Loren Miller put it, "To liberals a fond fare- well, with thanks for service rendered, until you are ready to reenlist as foot soldiers and subordinates in a black-led, black-officered army under the banner of Freedom Now." UNr&wiTy OF SOUTHERN CALIFORNU, Los Angeles, Calif., June 25,1968. APPENDIX F A LETTER FROM THE DEAN To the Participants in the Student Health Project: I was grateful for the opportunity to talk briefly to you on Sunday evening at Yu- caipa, but the discussions that followed, even though it only involved a relatively small group, seem to require some further clarifir-ation on my part. The aims to which this project has been devoted is probably three fold, and it would seem to me that if those aims are not kept paramount in your consideration this could well be the last year of your project. The purposes for which the government has been willing to finance these summer experiences are: (1) To help future doctors, nurses, dentists, social workers and others interested in the field of health to learn at first hand the present methods of the delivery of health care to the very poor; (2) to think about and discuss ways in which this could be improved; and (3) to show by their presence to these poor their interest in them and concern about their problems and through their efforts still as students to help correct them. Since many of the poor are black and in California brown, it would certainly follow that one should search out as much cooperation as one could get from the blacks and in California the Spanish-American through committees in the areas in which you will be working and through the encouragement of black and brown professionals to join in your project. A demand of 1/3, 1/3, 1/3, while it was ambiguous would seem to me to discard so many of the other qualities that might go into such an undertaking. Regar less of my own feeling in this matter, I could not have defended active student partici- pation in a grape strike, in organizing a protest against the war in Vietnam, and, by the same token, I doubt that I can help defend it if it becomes as militantly antiwhite as was expressed by a few people at that meeting. I am sure that when you start working on your various assignments your interests will deepen as you learn of the patterns of health care and find what you can do to improve them. The discussions you have had at Yucaipa will certainly take on a fuller meeting. I trust that your hopes for the unity of man and your feeling of love for other men that is such an impelling force in this effort continues to grow. I look forward to joining you in the fall and hearing of your experiences, what you have learned and what you recommend. I shall certainly be interested in your planned structure for the future, in your efforts to improve communication, but I would hope 71 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 that whatever structure you create is given some semblance of authority to carry throuzh the wishes of the group for the succeeding year. I hope that your activities do not risk the continuing promise of this organization. I wish you well. Sincerely, ROGER 0. EGEBERG, M.D., Dean. APPENDIX G GOALS AND DIRECTIONS Nineteen sixty eight marks the fourth year of the California summer student health project. As early as the orientation conference for this year's project considera- tion was given to the California Summer Student Health Project of 1969. The salient demand of the black-brown caucus dealt with the composition of a policy board to be organized by the end of this summer, presumably to plan and direct next year's project. Additional discussions regarding a 1969 project have taken place since orientation. This demand and these discussions ass ume a fifth California summer student health project. A project should be based on a decision, not on an assumption. Before a decision can be made for or against a project, basic questions regarding goals must be answered. Without goals there is no basis for determining the true purpose of a project or, equally important, whether a project is a success or a failure. Who Should Set.Goals? Are the primary goals to be those of the students, the community, or the funding agencies? This is the Student Health Organization. Students must define their own goals based on the fact that they have important and independent interests. If a project is useful in meeting student goals specific project proposals should be developed. These proposals must reflect these goals. The proposals should be presented to the community and funding agencies. If student goals are consistent with community goals the project is feasible. If student goals are consistent with agency goals the project is fundable. This suggests negotiations from a position of strength based on specific proposals which may result in acceptance of a project by the community and funding agencies. Since each group should know what is involved, such negotiations should bring students, the community and agencies together at the same time. A project cannot succeed if the stu- dents have one understanding with the community and another with the agency. Under these circumstances the community and the agency have no understanding of each other. If all three groups see a mutual advantage, the maximum realization of defined project goals is likely to result. What are Some Possible Goals? Is the major goal to be education of the student, the provision of services to the community or the performance of a task, such as the gathering of information, for the funding agency? Can these goals be compromised? If the major goal is student education it must be recognized that ghetto or barrio communities and funding agencies are being used by the project. The community will expect services in return and funding agencies will expect the performance of a specific task. Students must recognize and accept these community and funding agency goa I a project is to succeed. Services must fill community needs as perceived by the community and not by the students or the funding agencies. Although more difficult to achieve, the community must also recognize and accept both the student and funding agency goals if a project is to succeed. Funding agencies do not write blank checks. Although considerable latitude has been given thus far for projects of the Student Health Organization, it is unlikely that this freedom can continue. A return on funds expended will be expected. However, funding agencies must recognize and accept student and community goals if a project is to succeed. 72 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 Does the California Student Health Project have a Direction? The initial funded project in 1966 consisted almost entirely of placements with the providers of services-institutions and health agencies. Preceptors were members of the establishment. Through these placements the student came into contact with the recipi- ents of health care-the community. He frequently identified with the recipients and used the information obtained from his experiences in an attempt to influence the estab- lishment. lie provided some services in an attempt to fill needs as viewed by the estab- lishment. In the course of his work he became aware of the inadequacies of the present health care system and hopefully resolved to remove them. His initial attempt at prod- ucing change was directed at his school when he returned in the fall. This effort en- joyed significant institutional support as reflected in curriculum modifications and the spread of Student Health Organization activities to many other schools. In 1967 the project was a mix of placements in institutions, agencies and commun- ity organizations. An attempt was made to organize dual preceptorships for each place- ment, with one preceptor representing the established agencies and the other represent- ing the community. The importance of filling community needs rather than establish- ment needs was recognized. Community involvement was emphasized by the inclusion in the project of Neighborhood Youth Corps enrollees. The role of the student in agency placements was similar to that of the previous year. Placements involving NYC enrol- lees frequently dealt with the problems of interpersonal relationships which lessened the ability to provide services. Again the major effect of the project appears to have been that students became aware of inadequacies in the system. This recognition was not limited to the health care system. Efforts at producing change after the termination of this project were again directed at schools and students continued to enjoy considera- ble institutional support. In 1968 there has been further identification with community interests. A minority of placements are with providers of health services and the majority are with recipient groups. Identification of the project with the community has been enhanced by attempts at radicalization of the project by the black-brown caucus and the relatively indepen- dent action of law student project participants. An attempt has been made to involve preceptors (community representatives) in giving direction to the project as a w io , as well as to specific placements. This incomplete historical review indicates a trend toward community interest and away from agency and institutional interests; toward identification with anti-establish- ment groups and away from the establishment. 'The culmination of this trend would seem to be complete alliance with militant community organizations. This implies work- ing against rather than within the present system of health care. Indeed, it implies working against the system without necessarily direct reference to health at all. This may be an appropriate direction. However, it must be recognized that along the way the Student Health Organization and its project will lose support from within medical institutions, funding agencies and the health science student community as a whole. More importantly, how much have the students themselves controlled this direc- tion and is the present direction consistent with the interests and goals of the Student Health Organization? These questions cannot be answered until the interests are de- fined and definite goals determined. S. DOUGLAs FRASIER, M.D., Faculty Director, California Student Health Project. APPENDIX H IDENTITY (ABBY KROWITZ'S DIARY) I feel that things are finally falling into place.- I am,begin-ning to understand what the situation is, what the possibilities are and the necessity for political power to be given to the people. I am, for the first time, in touch with my own cultural heritage, of prejudice and persecution, and can grasp the significance of my childhood experiences and my.father's 73 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 total development. I can see how the Jews, through a long tradition of being in a hostile society, developed the values and structures that they did. Education is a way out of the alums, a way of being listened to; credentials which are possible to obtain if you are geared to do it from birth. I can't remember ever thinking I would not go to college, not do well in school, not be interested in learning things. My father made it a point of taking me to museums, and getting me to groove on things like how are atoms com- posed, how do fishes survive, what are the stars made of. There was consistent and con- stant encouragement, and I responded. Also the kinship organization of which my fam- ily was a member, when I was a child. Those who had would give to those who hadn't, and there was warmth, and concern, and a strong group which functioned to get the clan out of poverty. Now that we are out, there are no more meetings. So I am beginning to understand, to see, to learn. Every day is a memorable one, but my memories are of conversations, and feelings which are hard to relate. I also feel more that I want these people to know me, that I can trust them, not with my problems, but with my most personal thoughts about life, myself, other people, love, despair. And we can all dance and drink and you know they will be there tomorrow. There is so much to read. I am impatient. So long have I evaded issues, because of the fear that the truth would alienate me from my family, my own passivity, and my own desire to have some security that the world is not a horrible place to be. I couldn't tolerate it any more and am now reading about Vietnam. It's hard for me because the story it tells makes me want to climb the walls and scream at everyone who says the war is good. It makes me want to shoot Johnson, or hide all the planes and guns in my backyard where I can watch them and be sure that no one gets so crazy that they want to kill someone with them. War is so sick, especially colonial wars. So r read about 50 pages a day and take long walks. I often think how can I go back to my scholastic rut, now when I still have so much to learn. I want to be in on it. So, being my usual insane self, I decided to quit school and go somewhere new next year. It is difficult to explain how this is related to the summer. I do not feel turned on to VISTA work. More to life outside of school, more to people than to life, more to my own possibilities than people. I want to explore. Asia or Europe (actually the world but I can get to these continents free). How absurd it is- being alive. APPENDIX I MARTHA JACKSON'S LETTER D@ DR. FRAsiER: This is in response to your letter requesting student evalua- tions of projects. I am not sure if I can give you a cut and dry answer as to precisely what my project was for the summer, but I think I can tell you what I did and how I felt about it. You probably know by now what rural health project in King City is all about. In a few words, this project provides medical services to indigent patients, mostly Mexi- cans, by a private medical group. Costs are paid from OEO funds. The area covered is southern Monterey County. None of the doctors in the group are Mexican, yet a large percentage of their patients are. This has posed some problems in rendering effective medical care. Aides from the target area are used as interpreters. My job was to "educate the doctors" to the Mexican way of life. My preceptor, Stuart Allen, felt I could best do this by living in the homes of some Mexican families here, observing and participating in their daily life and writing about what I saw and heard. I was also to identify health problems and other problems that might be indi- rectly related to health, such as housing conditions, working conditions, and the like. I lived with two Mexican families in labor camps during the summer and have written detailed accounts- of these experiences. I also worked a few days in the fields which I also wrote about. T'he value of these papers remains to be seen. I do not know what the doctors they're supposed to educate think about them. My preceptor seemed to think they were worthwhile and good. 74- CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 for the on-going Project come to contain a specific type of "revolution-oriented" con- tent; and, that the process of conveying the material which involve the black and brown conscious people from the communities. 1. There will be compiled a reading list, tapes, films and prepared talks dealing %vith the more and more clearly formulated philosphy of the heretofore "colonized" peo- ples of this country. 2. Discussion groups will be held and the participants will include students and community people interested in adequately preparing themselves beforehand. 3. Some of the readings would be chosen from the following list: (a) Crisis in Black and White -------------- Charles Silberman Autobiography of Malcolm X------------ Manchild in a Promised Land ------------ Claude Brown Invisible Man -------------------------- Ralph Ellison Black Bourgeoisie ---------------------- Franklin Frazier Sex and Racism in America ------------ Calvin Hernton The Negro Revolution in America -------- Brink Soul on Ice ---------------------------- Eldridge Cleaver Negroes With Guns -------------------- Black Power -------------------------- Stokeley Carmichael and Charles Hamilton Delano (and a long list of others emphas- ing the "Brown Revolution") ---------- Wind-up Conference The proposal advanced by the group which met in Visalia is that this occasion be regarded as for the benefit of the community people who are to be invited in large num- bers. The funds available are to be devoted as much as possible to attracting spokesmen for the black and Brown Revolutions, whose function will be to contribute to the politi- cization of all participants. Relationshl' Between Preceptor and Participant p The preceptor, if he or she is not a person connected with organizing efforts in the community, is to surround himself or herself with persons so associated. This relation- ship, it is suggested, will serve to ensure that student participants are involved in activ- ities which directly contribute to the development of a power base in the particular pov- erty community. It is acknowledged that all communities differ as to degrees of organi- zation among the poor and it is understood therefore that the student's technique of relating thereto must vary accordingly; but the emphasis on this orientation is clear. The persons attuned to the organizational needs of the community are to determine the method of applying the technical skills possessed by the student. The student is to maintain such a group of advisors in order to safeguard the wisdom of the direction of his or her activities. IV. Relationship Between Preceptor and Community Based Persons Serving in Governing Capacity for the Student Health Project Because the definition of preceptor has been vague in the Past and because it ap- pears to satisfy different functions in different contexts, the governing board is to be considered one composed of "community people". Where a person known now as a "pre- ceptor" is also a community person, there is no problem. However, when the preceptor admittedly has little or no connection to persons engaged in some form of community organizing effort, this board of advisors, perhaps four or five will be invaluable in di- recting the activities of the student and the project. V. Train Students in Community Development An underlying assumption of all projects must be that preprofessional and profes- sional skills alone are not valuable to the poor community, they must be offered in con- junction with those people in the community doing community organizing Though students are not to be considered "community organizers," they are to understand 76 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 the function and problems of a community organizer in order that the application of their respective skills be as a supplement to such work. Students must be capable of examining what they are doing in order to be certain that their projects are contributing to the organizing effort in the community where they are working. The emphasis of the student's activities is towards basic institu- tional change, to contribute in a variety of ways to building a power base among the poor such that they become capable of paricipating in the decision-Making process which affects their daily lives. The assumption is that the development of a large body of enlightened professionals does not go far enough, that without power among the poor, the professional-patient (legal or medical) relationship reaffirms the latter's sense of inadequacy to deal with the problems affecting his life, that. it is inherently paternal- istic and thereby perpetuates the cycle of poverty. It is an understanding that there are good and bad ways to extend services, and that the delivery system which most corre- sponds to the needs of the poor is one which can be managed by those heretofore gtserved". Students are not to be organizers, but they are to perform organizing functions. The simple gesture of involving community people in the performance of the students "professional" tasks serves to promote continuity of that f unction, and thereby develops a power base within the poverty community, the objective of all "organizers". There are many other tasks essential to the organizing e,ffort which the students may perform, and by working closely with the local organizing effort, they can discover how best to serve that effort. ADDENDUM 1. Unknown Youth ---------------------------- Pat Heller 2. Health Needs of Mexican-Atnericans ---------- Berkeley Press S. Psychology of the Mexican ------------------- Samuel Ram4Ds 4. Labrynth of Solitude ------------------------ Octavio Paz 5. El Ser Todavia No Sier4pre ------------------- Leopold de Cea 6. Center for Study of Democratic Institutions ---- "Center" Magazine March, 1966 Artirle, Mexican-Am@can History "La Mula no es Asigap -------------------- Galarcia 7. Factoi*s in th6 Field ------------------ --- Carey MeWilliains 8. Merchants of Labor ------------------------- Ernesto GaZarza APPENDIX K MAJOR ACTIVITIES CONDUCTED BY STUDENTS Health-Oriented Identified health problems in rural areas. Discussions with doctors in local clinic on health problems from the patient viewpoint. Assisted in urban health clinic, teaching routine tasks, such as taking of blood pressures and temperatures to aides and doing general maintenance work at times. Drew up bilingual (Spanish-English) questionnaire for health clinic in urban area. Taught dental care to children at Child Care Center (rural); administered first aid to children and taught assistant teacher to do same; took health histories of the chil- dren; made home visits to encourage parents to bring their hildren to immunization Clinic; held meetings for same purpose. Made referrals to dentists for children and provided transportation to dentisVs office if needed. Completed a lengthy report and made recommendations for improvements on the services provided by two rural hospitals, interviewing patients, administrators, nurses, doctors, etc. Gathered dental health statistics from schools, held meetings with dentists, etc., in attempt to set up dental clinic in poor metropolitan suburb. 77 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 Encouraged dialogue between medical school deans and faculty to ha@n process of minority group students admissions. Conducted classes in biology and medical science for teenagers; conducted field trips to medical centers. Prepared proposal to Regional Medical Programs for health and dental clinic in poor suburb of Los Angeles; w6re instrumental in bringing together UCLA Dental and Medical Schools, Venice Service Center, Venice Library, and Public Health Department to work on clinic. Involvement of private and public organizations in support of health clinic. Intensive study of health care delivery at large metropolitan hospital, including in- vestigation of reasons for lengthy waits by patients, and recommendations for improve- ments in this and other areas. Intensive study of health care delivery on selected families serviced by metro- politan health clinic. Taught and administered first aid to organized groups of youths in metro- politan ghetto. Use of films on health and health education in various programs. Demonstration films of medical and dental equipment, sex education, birth control, etc., in various programs. Instituted Young Mother's Club in small town, with discussions, films$ etc., on health and health education. Nonhealth Oriented Set up meetings for Model Cities program. Picketed in Sacramento with farm laborers on behalf of AB-182 (unemployment compensation extended to farm laborers). Worked with La Raza committee to help write a proposal for higher education for Mexican-Americans. Helped form Brown Berets' chapter in Oxnard. Helped local bilingual people to understand Department of Motor Vehicle Code for driver's test. Taught reading readiness to Head Start children; trained two NYC assignees to do same. Group discussions with high-school children on various topics geared to motivate them educationally; use of slides, films, etc.; guest speakers on va ous pics-police relations, different cultures, etc. Conducted field trips to museums, beach, UCLA campus. Law Students Assisted in organizing blacks irf Merced around issue of police brutality. Helped black community form a credit union. Documentation of legal violations by growers and farm labor contractors who, by law, are required to provide toilet and washing facilities-Safety Code violations. Plan was to try to get a few people to file complaints, but as there was extreme reluctance to sign anything, the students sought and got jobs in fields and then made declarations themselves. Preparation of Affidavits to present to Industrial and Welfare Rights Com- mission on field violations. Taught local community workers to, file complaints on their own behalf. Aided in an attempt to incorporate a town now ruled by Anglo community service district. Set up Youth Law Center in Visalia which became a focal point for community activities. Organized Own Recognizance ptoject-prisoners released on, or without'having to put up bail. This project has continued by local youths after students left. Drew up questionnaire designed to uncover types of legal violations in health care in two rural general hospitals. I-rousing survey attempted in order to get migrant housing condemmed. Three students worked with United Fannworkers Organizing Committee, doing office research and field work, usIing their skills in relevant community organizations. : 78 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 Set up a Welfare Rights Organization countywide. Office research on various legal problems and some field work with California Rural Legal Assistance Office. APPENDIX L INSTITUTIONS AND GROUPS CONTACTED BY STUDENTS In contacting agencies and community groups, the students showed a preference for established institutions, in their attempt to forward or improve the program in which they were involved. Local health departments, hospitals, and medical societies were among the first to be contacted, usually for information on local health services and problems. Schools were used, mostly for data gathering purposes, and in the Los An- geles area, various departments of UCLA 'were used for specific information. Voluntary agencies and private enterprises were contacted frequently, and several students worked quite closely with them. For example, La Raza, in Oxnard, sev- eral students worked with a La Raza committee to formulate a proposal for higher edu- cation for Mexican-Americans. Dental supply houses and drug companies were sought out for equipment. Community action groups were contacted to a much lesser degree than either of the above categories and were not used as extensively when contacted, with the exception of the Venice State Service Center, which students, after consultation with the director, used as a base of operation in organizing the Venice Health Clinic. LIST OF GROUPS CONTACTED BY STUDENTS HEALTH PROJECT- SUMMER 1968 Children and Youth Services Adolescent Creative Enterprises, San Francisco Black Men For Youth, San Francisco Catholic ServicL- Organization Catholic Youth Organization El Monte PTA La Raza Youth For Service Community Action merican Citizens Club, Calexico A Community Improvement Union, Venice El Monte Community Center Kings County Community Action Organization Los Angeles South Central Volunteer Bureau Mexie,an-Americans For Political Action Project Action,.Venice Project Adventure, East Los Angeles Santa Rosa Community Center Various citizens' groups, Venice Venice Service Center VISTA Women's Club, Wasco Educational El Monte Schools Local elementary schools, Los Angeles City Schools-Offiee of Urban Affairs Public Libraries UCLA Law School CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 Employment Willowbrook Job Corp 'FamilY Welfare Services Department of Public Social Service Ventura Family Counseling Health Fresno General Hospital Hanford Health Department Harbor Hospital Heart Association Kern County Medical Society Los Angeles County Health Department Oxnard Health Department Red Cross San Gabriel Dental Society Santa Monica Health Facility Santa Monica Hospital Santa Monica Medical Aid Office Santa Paula Health Department UCLA Department of Preventive Medicine UCLA Inhalation Therapy U.S. Public Health Service University of Southern California Medical @Center Various dental Supply companies Various drug companies Venice Health Council Venice Family Planning Clinic Housing Kern County Housing Authority Indian Aftairs Bureau of Indian Affairs Private Entel-prise Standard Oil Company (in the Santa Rosa area) Recreation University Work Study Recreation Students U.S. Department of Forestry Religious St. Peter's Catholic Church 80 CALIFORNIA STUI)ENT HEALTH PROJECT SUMMER 1968 APPENDIX M ORGANIZATIONS AND INSTITUTIONS CONTACTED BY STUDENTS Education Elementary Colleges Community and and Public social Private action secondary universities Health agencies institutions Community Im- El Monte UCLA:Law Santa Paula Dept. Public So- St. Peter's Cath- provement Union, elementary School Health De- cial Services olic Church, Venice schools partment Lemoore. Venice Health L.A. city Department of 03inard Health Bureau of Indian Various drug Council. schools-Offices Preventive Department Affairs companies Venice Citizens of urban Medicine Group afflairs El Monte PTA Inhalation L.A. County Kern County Various dental La Raza therapy Health De- Housing supply houses meriean artment Authority MexicAn-A p Oil Political Assn. University work U.S .Public Public Libraries Standard American Citizens study students Health Service Company Club, Calexico (Santa Rosa) Santa Rose Com- Recreation Fresno General U.S. Department munity Center students Hospital of Forestry Women's Club, Santa Monica Red Cross Wasco Health Facility Black Men for Santa Monica Heart Associ- Youth, San Medical Aid ation Francisco Offices Youth for Service, San Gabriel San Francisco Dental Society Adolescent Creative Kern County Enterprises, San Medical Society Francisco Harbor General El Monte Com- Hospital munity Center Black Panthers South Central Black Congress Multi-Purpose Watts Festival Health Center Committee United Farm Work- er's Organizing Committee Venice Service Center Project Action, Venice Catholic Youth Or- ganization Catholic Service Organization 'o, Corps Willoarook Venice Family Planning Clinic Kings County Corn- idunity Action Organization VISTA Project Adventure East Los Angeles L.A. South Central Volunteers Bureau 81 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 APPENDIX N FINAL CONFERENCE PROGRAM AND WORKSHOPS. AUGUST 28-30, 1968 rning Afternoon Even g meeting. address: 7:30-Panel: The 10- stration. Michael McGravey, M.D. Revolution. Eliezer 2:00-5:30-Discussion groups: Risco, Paul Jacobs, "The Student and the Com- Eldredge Cleaver or munityll- Question: "Assum- Bobby Seale. ing outsiders can't accom- plish anything alone, can you structure a worthwhile summer program?" "If so, how do you choose the sites? the students? "If not, then .... ?" group reports at break- 2:30-5:30-Problem work- 7:30-E Teatro shops: See attached work- Campesino. 9:30-11:30- Discuss groups: shop descriptions. "The Professional and the Revolu- tion" Question: "Whatever you I think about the Black/Brown Rev- olutions, its a fact you have to deal with. As a student, and later on as a professional, how do you work for the liberation of Black and Brown people?" 0. Pan : "Past and Future Goals of Close. SHO" Response panel of cormnu- nity people. Followed by General conference: To vote on resolutions generated by workshops and discussion groups. Bre 8:00-9:00 am. Li 12:00-1:00 p.zr. D 6:.00-7:00 p.m. CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 fINAL CONFERENCE PROBLEM WORKSHOPS-THURSDAY AFTERNOON The problem workshops will discuss three broad topics: 1. SHP Site Development 2. Orientation and Education 3. Organization and Structure of SHP Each workshop will meet as a whole briefly to have the task introduced. They will break up into small groups to discuss the designated problems or others which may come up in the course of discussion. The Workshop will then reconvene to formulate specific recommendations to be presented to the whole conference on Friday morning. The outlines which follow specify problem areas which must be resolved in plan- ning future Student Health Projects. Meeting places for Workshops will be announced or posted. Workshop No. i-Student Health Project Site Development: A. How are the sites best selected? Who should select sites? B. What makes a "good" site? C. How structured should projects be? D. What kinds of tasks should students undertake? E. How should students be selected and assigned to projects? F. What should we expect of preceptors? G. Should projects be designed to be completed in ten weeks with minimal "with- drawal" effects on the community, or should we emphasize ongoing roles in communities in which we have projects? Workshop No. 2-Orientation and Education - A. Preceptors: How can SHP support preceptors so that preceptors can make the best use of students, and, in turn, how can preeeptors be used to maximize the goals of students in SHP? B. Staff What kinds of education experience and expertise should the staff be required to have in order to: 1. support students in the field; 2. provide educational programs; 3. carry on administrative tasks; 4. understand community resources. C. Students: 1. What kind of orientation, what kind of topics, both as to format and content would be most useful for preparing students to go into the community? 2. What sorts of educational programs would be most useful during the summer whether in the form of: a. A preplanned series of discussions, films, etc. b. Written materials on a variety of subjects related to: 1. health care facilities; 2. health care legislation; 3. health care planning; 4. community development; 6. the culture of poverty. Workshop No. S-Organization and Structure of the Student Health Project A. Relationship of Student Health Project to USC. . B. Relationship of SHP to Federal funding agencie@i.e. Regional Medical Pro- grams, Health Education and Welfare and Office of Economic Opportunity. C. Function, power and limitations of the Policy Advisory Board-What is their role in planning the project and on-going decisions? 83 CALIFORNIA STUDENT HEALTH PROJECT SUMMER 1968 D. Staffing patterns-Central and Regional 1. Faculty Advisors 2. Student staff 3. Community workers. E. Relation between San Joaquin Valley and Los Angeles projects-more unity or two projects? Advantages and disadvantages of both approaches. P. Inter-site communications, cooperation, exchange of information and problems. APPENDIX 0 RENASCENCE (MIKE ALBERTSON'S LETTER) The California Student Medical Conference is in an organizational crisis. The sum- mer projects have ended on a note of absolute confusion and disillusioned ideas. The gestaff" is loosely organized and can no longer function as a- unit in keeping things together. @ We have been told that the goals that were set up at the beginning of the summer are no longer adequate. There are some good concrete things that we can do as an organization. I bate to see them lost in a muddle of rhetoric and red tape. For that reason there is an organi- zational meeting to be held on September 25 at 7:00 in the lounge of Seaver Hall, at 1969 Zonal Avenue, on the USC medical campus. The purpose of the meeting is to set up a director for the coming year along with an executive committee that is willing to assume responsibility of correlating and coor- dinating the fragmentation that has hindered the working of Student Medical Conference. Also at that meeting there will be a discussion and possible decision on where we are going as an organization of student health professionals. It is time, finally, for functional limits as to what we can do as an organization of this type, apart from what we do as individuals. Hopefully, it will not be a battleground for the airing of personal philosophies for the sole purpose of hearing how good it sounds: but will be a definitive work up of a set policy that we can work with. Please come Wednesday evening. We are in desperate trouble. Michael Albertson, Editorial-Board-Encounter. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE U.S. GOVERNMENT PRINTING OFFICE: 1969 0-355-231 84 f i i U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service