MH    - Community Health Services/*/New York City
            MH    - New York City
            MH    - Students, Health occupations/*//
            KW    - 20C
            CN    Greater New York Student Health Project////
            CN    Albert Einstein College of Medicine////
            CN    Montefiore Hospital and Medical Center////
            CN    United States. Division of Regional Medical Programs////
            Ti    The:Student Health Project of Greater New York, summer 1968./G
            IM    [Bethesda, Md.]/Health Services and Mental Health Administration/[19691
            CO    viii 155 p.
            GN  - S@onsors: Albert Einstein College of Medicine of Yeshiva University and
                  Montefiore Hospital and Medical Center.
            GN    Project supported in full by the Division of Regional Medical Programs, Contract
                  no. 43-68-1515.
            CP    02NLM,08HMS,01SSY:WA 546:AN7:G5s::1969
            CA    WA 546 AN7 G5s 1969:02NLM,08HMS,01SSY
            Yl    S/1969/
            LP    Eng
            LA    Eng
            MT    CORPORATE NAME MAIN ENTRY
            RO    O:MED
            RO    C:MED
            RO    M:KRC
            DA    710614
            MR    831204
            LR    831222
            RI    rev
            EL    FULL LEVEL
            IT    MONOGRAPH
            Ul    1267146


                            I&

               AIVIA
               AW

       GREATER NEW YORK STUDENT HEALTH PROJECT
                      summer 1968.


                                      THE STUDENT HEALTH PROJECT

                                                                     OF
                                                  GREATER NEW YORK
                                                         Summer 1968

                                                                Sponsors
                                           Albert Einstein College of Medicine
                                                      of Yeshiva University
                                              Montefiore Hospital and Medical
                                                                  Center

            This report does not necessarily represent the views of the Public Health Service

                          U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
                                                          Public Health Service
                                             The Division of Regional Medical Programs
                                        Health Services and Mental Health Administration
                                                This project was supported in full by
                                                       Contract No. 43-68-1515


                                                  FOREWORD

                        While medicine in this country advances by giant steps  in  the  area  of
                   increasing scientific and technical knowledge, it  plods  along  in  extending
                   the fruits of these  benefits  to  all  Americans.  Today  comprehensive  com-
                   munity health care is an idealistic pipedream,  compared  with  the  realities
                   of a stopgap system of health  care  which  is  scanty,  episodic,  and  frag-
                   mented. A  major  reason  for  these  deficiencies  and  inadequacies  is  the
                   lack of  incentive  and  interest  among  health  professionals  in  attacking
                   these problems. In their formal  curriculum  the  vast  majority  of  students
                   in the health professions do not gain an appreciation  of  the  needs  of  the
                   medically underprivileged  or  the  difficulties  that  are  faced  by  health
                   practitioners and health facilities in poverty areas. The patient is  observed
                   by the student merely as a disease or clinical entity-as  a  fragment  of  his
                   society being distinct and separate from  his  environment.  The  health  Stu-
                   dent by spending his long  years  of  training  isolated  from  the  community
                   which he will serve loses his social idealism and remains  blind  to  many  of
                   the basic causes of ill health:  environmental  deprivation,  loss  of  income
                   and jobs, and  poor  housing.  Tomorrow's  health  practitioners  must  under-
                   stand these causes if there is to be any large  scale  improvement  in  stand-
                   ards of health care. First  hand  experience  with  the  urban  community  and
                   the urban health problem is the best way to gain this understanding.
                        The purpose of the  Student  Health  Project  of  Greater  New  York  was
                   twofold: to  increase  the  education  and  understanding  of  health  profes-
                   sionals by providing experience  in  dealing  with  the  social  problems  and
                   health needs of the poor, the social conditions  which  engender  these  prob-
                   lems, and the difficulties in alleviating  them;  and,to  engage  students  in
                   beneficial projects that will have immediate and  long  term  effects  on  the
                   community, on the educational process,  and  on  themselves.  Such  long  term
                   effects can be achieved only through the fostering  of  resources  within  the
                   community  and  through  encouraging  flexible  student  attitudes   necessary
                   to develop the new health models needed to define  and  improve  the  delivery
                   of health services.


                                                  PREFACE

                       This report represents a distilling  of  the  hundreds  of  thousands  of
                   words written as biweekly or final  reports  or  transcribed  from  tape-rec-
                   orded meetings and interviews during the  course  of  the  1968  Greater  New
                   York Student Health Project.
                       The  1967  Bronx  Student  Health  Project  report  and  similar  reports
                   of other Student Health  Organization  summer  projects  have  tended  to  be
                   compendia in the truest sense of the word, with essays  by  the  participants
                   printed in their entirety or organized in such a  way  that  the  reader  has
                   had to search through  pages  and  pages  of  information,  impressions,  and
                   opinions for specific points he may have been seeking.  An  effort  has  been
                   made here,  through  judicious  editing  and  organization  of  the  excerpts
                   into specific categories of discussion, to provide a more useful source  book
                   of information about the  summer  experience  for  future  planning  of  Stu-
                   dent Health Projects or similar efforts.
                       Although  perhaps  less  "readable"   than   previous   reports   because
                   essays have been fragmented and stripped  of  most  of  the  "poetic  impres-
                   sionism" that students tend to write, the format of this  report  should,  it
                   is hoped, enable the reader to go straight to a caegory of interest  and  get
                   a sampling (but  not  a  random  one)  of  student  and  community  co-worker
                   experiences and opinions on that topic without  having  to  read  the  entire
                   report. Of course,  breaking  down  the  material  into  so  many  categories
                   produced the  disadvantage  that  some  categories  overlap  in  content.  We
                   tried to assign excerpts as precisely as possible, but in some of the  larger
                   excerpts (especially where the writer's flow links several  related  topics),
                   it was necessary to assign the category on the basis  of  the  "main  thrust"
                   of the entire excerpt rather than its specific points. (Many of these  papers
                   will appear at the front of discussions  as  "position  papers"  that  set  a
                   tone for the rest of that section.) Thus, the reader  should  be  aware  that
                   although he may be  primarily  interested,  for  example,  in  student  views
                   on "patient advocacy," he should  also  cross-reference  himself  to  related
                   categories such as "white students in  black  communities"  for  perspectives
                   on the problem  that  may  be  stated  in  a  different  context.  The  "main
                   thrust" criterion was applied also to  several  excerpts  whose  significance
                   seemed, upon further consideration, to be more relevant to a  category  other
                   than the general grouping in which it would seem to belong at  first  glance,
                   e.g., BW's description of his  f  und-raising  activities  for  Newark's  New
                   Well  addict  rehabilitation  program  was  finally  placed  under   "Student
                   Health  Project  Role  in  Agencies  and   Hospitals"   rather   than   under
                   "Agencies" or "Drug Addiction" because  it  seemed  a  better  example  of  a
                   suitable (and successful) student role than  a  description  of  either  .  e
                   agency or the problem of drug addiction.
                        Another thing that has to be pointed out is that much  of  the  material
                   finally used in the report reflects a mood of dissatisfaction  that  pervaded

                                                                                                          v


                            the project throughout the summer,  and  which  caused  participants  to  focus
                            on their problems in meetings, reports, and interviews. Not  all  the  partici-
                            pants  were  unhappy  with  their  summer  experience  or  with   the   Student
                            Health Project in general, but it appears that  they  were  -not  as  moved  to
                            write about their successes and satisfactions as  were  those  who  had  bitter
                            bones to pick. Thus, the report is biased in the sense that  "usable"  material
                            came primarily from the  latter  group.  Overall,  however,  the  editors  feel
                            that the report does reflect the conflicts in  and  among  participants  as  to
                            the  meaningfulness  of  the  summer.  It  should  be  noted  here  that  those
                            Greater New York area health  science  students  who  constitute  the  regional
                            Student  Health  Organization  "steering  committee"  voted  recently  not   to
                            sponsor  any  more  Student  Health  Projects  of  this  kind.  They  concluded
                            that any future summer projects  will  have  to  be  locally  planned  and  ad-
                            ministered  projects  growing  out  of  on-going  activities  of  the   Student
                            Health Organization or  other  groups  at  each  medical,  nursing,  or  dental
                            school.
                                 Our apologies to those who  may  feel  that  what  they  had  to  say  has
                            been distorted by quoting out of  context,  and  to  those  whose  observations
                            and opinions could not be  used.  Even  after  careful  selection  of  what  we
                            felt was the best of the material submitted, the first draft of the four  major
                            sections of the  report  was  almost  500  typewritten  pages  and  had  to  be
                            further cut  in  a  somewhat  merciless  fashion.  Anyone  who  feels  strongly
                            about his views being distorted or slighted  is  encouraged  to  consider  sub-
                            mitting his ideas to one of the SHO publications such as Current.
                                 Profuse appreciation goes  to  all  those  who  helped  pull  this  report
                            together,  especially  to,  Mrs.  Marylyn  Gore,  Project  Director,  for  many
                            helpful suggestions after reading the  ponderous  first  draft,  to  Miss  Jody
                            Williams  of  Albert  Einstein  College  of  Medicine  (who  handled  much   of
                            the  project's  cumbersome  administrative  work   during   the   summer)   for
                            invaluable advice and efficient liaison with,,  the  funding  agency,  to  Mrs.
                            Joanna  McDonough,  our  excellent   editorial   assistant,   and   Mrs.   Ruby
                            Hough, our manuscript typist,  who  stuck  with  us  through  the  long  winter
                            months  and  showed  patience  and  understanding   even   when   our   demands
                            became overbearing.
                                                                                   W. M. SMITH,
                                                                                   Amy T. SMITH,
                                                                                           March 1969.

                vi


                                                Contents

                 PART 1:'  THE DREAM
                      The Task  ----------------------------------------------             1
                      The Motivation   ----------------------------------------            4

                 PART 2:  THE REALITY
                      Introduction        --------------------------------------------     9
                      Views of the Community         --------------------------------   10
                      Health Care Delivery       ------------------------------------   18
                      Attitudes ----------------------------------------------          29
                      Medicaid, Medicare       --------------------------------------   33
                      Dental Health        ------------------------------------------   33
                      Lead Poisoning   ----------------------------------------         34
                      Drug Addiction   ----------------       -----------------------   34
                      Family Planning  ----------------------------------------         37
                      Housing         -----------------------------------------------   38
                      Legal Services        -----------------------------------------   40
                      Agencies  ----------------------------------------------          41

                 PART 3:  ROLES IN CONFLICT
                      Introduction        -------------------------------------------   45
                      Students as a Force for Change       --------------------------   45
                      The Student Health Project and the Community       ------------   52
                      White Students in Black Communities        --------------------   54
                      Community Education and Training Programs        --------------   66
                      Community Organizing         ----------------------------------   70
                      Student Health Organization Service Projects     --------------   72
                      Patient   Advocacy       --------------------------------------   77
                      Student Health Project Role in Agencies and Hospitals    ------   84
                      The Neighborhood Youth Corps        ---------------------------   92
                      Community Workers          ------------------------------------   96
                      Faculty   Advisors       ---------------------------------------  99
                 PART 4:  OPINIONS ON THE ORGANIZATION
                      Introduction        -------------------------------------------   101
                      Greater New York Student Health Project Structure      --------   101
                      Local Project Structure      ----------------------------------   104
                      Funding   -----------------------------------------------         107
                      Student Fellow Selection       --------------------------------   109
                      Interdisciplinary Team      -----------------------------------   112

                  PART 5:  EVALUATION
                      Introduction  ------------------------                            115
                                                                  -------------------
                      The Student Health Project as a Learning Experience      ------   121

                                                                                                    vii


                             What Next?-Suggestions for the Future     ------------------   129
                             Recommendations       --------------------------------------   134

                         APPENDIXES
                             A. Listing of Participants    ------------------------------   139
                             B. Health Resources in the Harlem Area    ------------------   143

               viii


                                           Part 1: THE DREAM

                                                   THE TASK
         This  section  contains  the   project   proposals   school health  referral  activities  due  to  less
        distributed  to  prospective  participants  at  the   than  enthusiastic  cooperation  by  some  Depart-
        Orientation  session.  They  were  used   by   many   ment   of   Health   administrative   and   school
        students  to  determine  which  area  they  finally   health program personnel.
        chose to work in.                                      It should be noted that "concrete  task  fulfill-
         Although   most   of   the   statements    suggest   ment" as a measure  of  project  success  may  not
        that  substantial  project  planning  and   precep-   be a valid criterion  to  judge  project  achieve-
        tor arrangements  had  been  worked  out,  in  fact   ment  since  considerable   disagreement   existed
        much  of  the  foundation  laying  remained  to  be   from top to bottom in all  the  project  areas  as
        done in  several  projects  at  the  time  students   to  what  the  Student  Health  Project  task  was
        were expecting to  "go  to  work."  That  the  sum-   supposed to be:  providing  an  educational  expe-
        mer thus turned out to be  a  "use  your  own  ini-   rience  in  community  medicine  for  health  sci-
        tiative"  opportunity  was  extremely   frustrating   ence students versus helping a  finite  number  of
        and  discouraging  for  many   students   who   had   persons get better health services  versus  bring-
        expected   otherwise,   as   well   as    community   ing about changes in  health  care  delivery  sys-
        workers  and   Neighborhood   Youth   Corps   teen-   tems in the area. Certainly,  however,  each  pro-
        agers, who  were  probably  even  more  job  action   ject  was  both  successful  and  unsuccessful  to
        oriented than the students.                           some degree in each of these objectives.
         In  general,  those  projects  in  which  specific    Some   subprojects   were   judged   sufficiently
        task  definition  and   firm   preceptor   arrange-   successf ul  on  a  programmatic  basis  that  at-
        ments  had  been  made  before  the  summer   began   tempts  were   made   to   continue   them   year-
        (e.g.,  Brooklyn's  King's  County   Hospital   and   round. At the end  of  the  summer,  the  students
        St.  Mary's  Hospital  physician   assistant   pro-   requested that several thousand  dollars  of  sur-
        jects, and Harlem's  school  health  referral  pro-   plus  funds  be  reappropriated  for  distribution
        ject) were most successful  in  terms  of  concrete   to  the  Bronx  project  to  continue  the   Unwed
        achievements,   whereas   more   open-ended    pro-   Mothers project storefront,  to  the  Newark  pro-
        jects in which students had  to  "feel  their  way"   ject to  keep  their  advocacy  storefront  office
        proved  less  successful  (e.g.,  Brooklyn's  Model   open, and  to  support  a  benefit  show  for  the
        Cities  project,  Harlem's  pediatric  care  center   New Well,  a  narcotics  addiction  rehabilitation
        advisory  committee,  Lower  East   Side   Medicaid   agency, and to the Harlem  project  to  buy  black
        cutback study).                                       children's books for  clinic  waiting  rooms,  and
          But  even  good  advance  planning  was  not  al-   to  pay  salaries  to  three  of   the   community
        ways sufficient, as evidenced by  difficulties  ex-   mothers  who  had  been  trained  to   do   school
        perienced  in  Brooklyn's  Youth  In  Action  -Pro-   health  referrals  (the  Harlem  project   leaders
                                                              e entually  obtained  a  $43,000  grant  from  the
        ject  and  Newark's  frustrating   relations   wi@h   v  '
        the  Martland  Hospital  and  medical  school   au-   Ford Foundation   to keep  their  program  going).
        ministrations.   Even   in   Harlem,   where   good   The Lower East Side Project
        pre-project   planning   had   enabled   an   early     Students  working  with  the  Lower  Fast   Side
        start a month  before  everyone  else  began,  Stu-   Project  will  be  placed  with  members  of   the
        dent  Health  Project  workers   experienced   sev-   North East  Neighborhood  Association,  its  dele-
        eral  weeks  of  frustrating   slowdowns   of   the   gates  or  subcommittees  and  the   NENA   clinic
                                                                                                               1


                                                      GREATER       NEW  YORK

                 (a total health care clinic to be  run  jointly  by   sumed  the  controland  management  of  this   hos-
                 the  medical   and   Lower   East   Side   communi-   pital.  The  College's  goal  is  to  improve   the
                 ties).  As   consultants   to   community   members   health care delivered  by  the  hospital.  The  Ne-
                 concerned with  the  problem  of  health.  care  on   wark  Project  will  attempt   to   upgrade   local
                 the  Lower  East  Side,  students   will   gain   a   health care  and  community  opinion  of  the  hos-
                 knowledge    of    community    attitudes     about   pital   through   (1)   "patient   advocacy,"   (2)
                 health care  as  well  as  of  existing  facilities   clinics,  and  (3)  improved  student   understand-
                 serving  health  needs  and  related  areas.  There   ing through exposure  to  the  needs  of  the  com-
                 will be no  door-to-door  interviewing  as  factual   munity.
                 material  can  be   obtained   from   the   various      (1)   Patient   Advocacy:    Emergency    Ro-om-
                 agencies serving the area.                                    Outpatient Department:
                   Community   attitudes   will   become    apparent      Students  will  work  here  (a)  assisting   the
                 as  students  develop  working  relationships  with   patients  who  are  receiving   health   care   and
                 community   members.   Students    and    community   other  social  services  which  may  be  available;
                 people will @develop a  program  of  health  educa-   (b)  helping  achieve  total  patient  care   which
                 tion responsive  to  community  needs  and  priori-   may  not  always  be   immediately   possible   be-
                 ties vis-a-vis health services  in  the  area.  The   cause of the  mechanics  or  the  attitude  of  the
                 structure  of  the  program   and   the   type   of   hospital   operation;   (c)   obtaining   complete,
                 health education  needed  to  improve  health  care   meaningful records  of  accidents  and  the  condi-
                 in a poor community  will  be  determined  by  Stu-   tions which produced them.
                 dents   and   community    members    during    the      (2)   Clinics:   Student   Health   Organization
                 summer'   The  program  will  stress  the  role  of           Evening Clinic for Chronic Diseases:
                 the professional  student  as  a  consultant  whose      Members  of   the   Student   Health   Organiza-
                 activities are to be directed by the communi          tion  have  already  organized  an  evening  clinic
                   Specific activities will be determined by I         at the NCH outpatient  department.  It  is  staffed
                 needs  of  the  community  and  prevailing  circum-   by five internists and  two  surgeons  as  well  as
                 stances.  Particular  assignments  will   be   made   several students who do  the  initial  history-tak-
                 on  the  basis  of  knowledge  of  the   individual   ing and screening  and  also  necessary  lab  work.
                 student   gained   during   Orientation.   Students   This will  be  expanded  during  the  summer  to  a
                 will participate as fully as  possible  in  commun-   nightly or weekly schedule.
                 ity life, and  housing  will  be  obtained  in  the      (3)    Student    Exposure:    Community     Ob-
                 area for those students who so desire.                        stetrics
                   Interplay  between   students   with   discussion      Development  and  use  of  a  questionnaire  for
                 about roles, impressions, and difficulties will  be   maternity  patients  at   Newark   City   Hospital.
                 encouraged  and  the  importance  of  the   project   Prenatal  death  rate  in  Newark  is  three  times
                 as a groupactivity will be  stressed.  By  the  end   that  of  the  State  of  New  Tersey-some  of  the
                 of the  summer,  each  student  will  have  a  good   reasons  are:  (a)  Out-of-wedlock   children   get
                 knowledge  of   health   problems   and   community   less care; (b) Care may be unavailable.
                 life on the  Lower  East  Side,  of  the  community      The questionnaire will investigate:
                 members  they  will  work  with,   and   of,   each        family size,
                 other.
                                                                            living conditions,
                 The NeWark Project                                         problems of pre-na   care,
                   During  this  past   summer's   1967   disorders,        nutritional problems.
                 Newark  City  Hospital  had  the   distinction   of      In  conjunction   with   the   information   ob-
                 being the only hospital in  the  United  States  to   tained by  the  questionnaire,  the  students  will
                 be fired on by snipers. These  shots  were  indica-   focus  on  environmental   problems.   An   outcome
                 tive of the general dissatisfaction with  the  care   of this might  be  establishment  of  a  storefront
                 given  Newark  citizens  by   the   hospital.   The   prenatal clinic or some realistic  health-care  :a-
                 New  Jersey  College  of  Medicine  has  just   as-   cility.

                 2 '


                                                 SUMMER  1968
       The Brooklyn Project                                  ant,  Crown  Heights  and   Brownsville   neighbor-
         The  Brooklyn  project  for   this   summer   in-   hoods  is  contemplated,  in  addition   to   other
       volves  working  through  five  different  agencies   functions.
       or institutions. Participants on  the  project  may
       be able  to  work  with  more  than  one  of  these   The Harlem Project
       agencies.                                               On  the  basis  of  last  summer's   program   at
         (1)  Pediatric   Outpatient   Clinic   of   Kings   Public  School  175,  a  plan  for  this   summer's
             County Hospital:                                Harlem  Student  Health  Project   has   been   de-
         Students  will  act  as  physician-assistants  to   signed,   incorporating   the   knowledge    gained
       help save  physician  time.  Specific  duties  will   and  cooperation   began   with   community   resi-
                                                             dents  last  summer.  The  new  project  will   in-
       include: (a)  Interpretation  of  instructions  for   troduce an  adequate,  readily  financed,  referral
       patients; (6) relaying  of  information  on  nutri-   program.  Harlem  is  an  area  noted   for   large
       tion,  hygiene  and  accident  prevention  to   the
                                                             numbers   of   inhabitants   unconnected.with   any
       patients;  (c)  performing  routine  medical   pro-
       cedures; (d) history-taking,  with  the  aid  of  a   health agency and for the f       ui   'of   school
       questionnaire  to  determine  the  entire   medical   health  programs  even  to  recognize  the   health
                                                             problems  of  the  students.   The   1968   Student
       status  of  each  family.  A  major  responsibility   Health  Project  will  train  community  people  to
       will be  the  training  of  community  persons  for
       paramedical positions.                                function  on   a   year-round   basis   as   health
                                                             workers in the  schools  and  as  referral  experts
         (2) St. Mary's Hospital:                            within  the  school  community.  The  backbone   of
         Students  will  act  as  physician-assistants  as   the  project  is   the   establishment   of   small
       in (1).  In  addition,  they  will  work  with  the   groups  of  parents  who   will   meet   with   the
       Crown  Heights  Health  Council  in  developing   a   health worker to discuss health  care  as  a  vital
       Health   Rights   and   Resources   Handbook    for   community  issue.   These   health-conscious   par-
       the community residents.                              ent groups will.begin  to  deal  with  redefinition
         (3) Bedford-Stuyvesant Youth In Action:             of  health  germane  to  local   community   needs,
         With  the  assistance  and  supervision  of   the   will establish  babysitting  and  escort  services,
       organization's professional  staff,  students  will   will act as a  nidus  for  further  community  edu-
       interview clients with problems  related  to  jobs,   cation in nutrition, birth control,  and  pre-  and
       medical care, legal  aid,  housing,  job  training,   postnatal care.
       and nutrition. They will  help  secure  the  neces-     Several  local  elementary  schools   and   their
       sary  services  from  existing  agencies  and  per-   Parent-Teacher  Associations  will  serve  as   the
       form follow-ups on  all  patients.  Involvement  in   project  population.  The  PTA's  with  their   ac-
       family  counseling  and   group   discussion   ses-   tive participation will  be  the  sources  for  the
       sions will also be an  integral  function  of  this   community  contacts,  for  health   worker   train-
       project.   Tutoring   and   homework   study   pro-   ees, for homes to be used  as  meeting  places,  as
       grams are also planned.                               guides  for  answering   pertinent   health   ques-
         (4) Brownsville Communitly Council:                 tions, as  health  committees  to  evaluate  health
         Students will assist  doctors  in  counseling  on   problems,  as  guides  for  SHP  workers,  and   to
       contraceptive   techniques,   showing   films   and   serve  as  an  advisory  group  for  the  Pediatric
       conducting  discussion  groups.  With  the  aid  of   Comprehensive   Care   Center.   Cooperation   with
       Neighborhood   Youth    Corps    teenagers,    pro-   the  original   PTA   group   has   been   expanded
       grams  of  hygiene  instruction  in   the   commun-   during  the  academic  year  and  additional  PTA's
       ity, a health cleanup  program,  and  a  survey  of   have pledged their participation.
       existing medical facilities are anticipated.             The  project  will  be.  introduced  at   school
         (5)  Central  Brookly?i  Model  Cities   Program:   teacher-project staff  meetings  with  the  cooper-
         Details still to be worked  out,  but  a  compre-   ation of the principal of each  school.  An  evalu-
       hensive  survey  of  health  needs  and   resources   ation of the  role  of  the  school  health  nurse-
       available  to  the  residents  of  Bedford-Stuyves-   her   problems   and   needs-will   be   undertaken


                                                    GREATER       NEW  YORK

               with  her   participation.   Communication,   with   student and  one  nursing  student,  will  organize
               an  eye  toward   improving   school   health-care   a child health  survey  in  cooperation  with  four
               programs, will be  maintained  with  the  head  of   neighborhood  day   care   centers   for   children
               School  Health  Programs  of  the  New  York  City   ages 6 to 16. Project fellows will  be  responsible
               Department of Health.                                for  arranging  discussion  groups  and  films   on
                  Thus, health science students  working  in  the   health   issues   for   community   residents   and
               Harlem  SHP  will  work  in  the  community   with   their children. They will also teach first  aid  to
               families, will deal with  the  referral  problems,   the  Day  Care  Center   counselors.   The   health
               and  will  develop  with  community  support   the   survey will be made with  the  help  of  third  and
               year-round bases for the  project.  A  large  pro-   fourth year medical students.
               portion  of  the  project  staff  will  be  housed      (3) Mental Retardation:
               in Central Harlem.                                      Two  student  fellows  will  work  with  a  com-
                  The education of  the  health  science  student   munity  organization  which  hag   been   given   a
               will  come  from  a  door-to-door,  person-to-per-   grant for  a  summer  day  camp  for  mentally  re-
                             '  involvement   in   the   problems   tarded  children.  They  will  help  organize  com-
               son  summer
               Harlem's health care  system,  and  his  contribu-   munity  support  for  submitting  a  larger   grant
               tion will be his effort to deal with  these  prob-   proposal  for  a   permanent   mental   retardation
               lems in a short-term sense and to  help  create  a   center.
               long-range  plan  to  solve  these   problems   in      (4) Unwed Mothers:
               ways that will be useful  to  the  community.  The      Two  student  fellows  will  work  with  a  cQm-
               opportunity  to  work  and  live  in  the   Harlem   munity   worker   at   the   Neighborhood   Medical
               area  should  lead  toward   a   contribution   to   Care  Demonstration  to   organize   a   group   of
               creating a better level  of  health  in  the  com-   unwed  mothers  for  the   purpose   of   obtaining
               munity.                                              legal rights in housing,  education,  health  prov-
                  Participating  institutions  include   Knicker-   isions;  obtaining  good  health  care  for   them-
               bocker  Hospital,  the   Harlem   Health   Center,   selves and their children;  gaining  confidence  to
               Harlem   Hospital,   members   of   the   Columbia   function  as  dignified  human  beings;  and   fur-
               University  School  of  Public  Health   and   Ad-   thering  educational  opportunities.  The   student
               ministrative  Medicine,  and  the  Harlem   Health   fellows  will  work  closely  with  salaried   com@
               Council.                                             munity  preceptors  in  motivation,  guiding,   and
               The South Bronx Project                              teaching.
                  (1) Patient Advocacy:                                          THE MOTIVATION
                  Eight student fellows will  work  closely  with      The   application   essays   of   students   who
               community  organizers  from  four  storefronts  in   wanted  to  work  in  this  summer's  project  were
               defining  the  health  needs  of  a  circumscribed   important criteria in  the  selection  process.  In
               slum  neighborhood  in  the   South   Bronx.   The   reviewing  the  application  essays  (as  well   as
               fellows  will  make  home  visits,  accompany  pa-   final  reports)  of  accepted  students  after  the
               tients to local clinics,  monitor  followup  care,   project ended,  it  could  be  seen  that  students
               distribute information on health care  facilities,   came to  the  project  with  many  different  moti-
               and  prepare  a  Health   Rights   and   Resources   vations.
               Handbook.  Each  fellow  will  be  accompanied  in      Although  most  students  expressed  more   than
               his daily  work  by  a  member  of  the  Neighbor-   one reason  for  wanting  to  participate,  by  far
               hood Youth Corps.  Special  assignments  will  in-   the  largest  essay   category,   consistent   with
               clude a  supervised  study  of  medical  patients,   what  seems  to  have  been  a  primary   objective
               and  planning  a  biology  and   medical   science   of  the  SHP  leadership,  comprised   those   Stu-
               course in the newly organized Morrisania Com-.       dents,  who  expected  the  summer  to  provide   a
               munity College.,                                     learning  experience,  a   chance   to   understand
                  (2) Child Health:                                 the people of the ghetto -and  their  problems,  as
                  Four project fellows, including    one   dental   an  extension  of  their  professional  educations.

               4


                                                   SUMMER  1968

          The second largest  category  consisted  of  stu-    the only one. I  want  to  do  something  that  will
       dents who desired  to  offer  specific  service-ori-    be  of  service  to  the  community.-  K.B.,   Medi-
       ented  skills  (e.g.,  health  education   programs)    cal Student, Bronx.
       or just  had  an  undefined  desire  "to  help  poor      The  experience  will  help  me   becomea   better
       people get better health care."                         individual  and  perhaps   enable   me   to   under-
          Other  motivation   categories   included   those    stand my  environment  better.  I  will  learn  from
       who expected to  achieve  some  degree  of  self-ac:    working  with  other  members   of   the   team   as
       tualization   by   "giving   of   themselves,"   and
       those who  hoped  to  compensate  for  the  failings    well  as  with  the  individuals  I  am  trying   to
       of our society vis-a-vis the  pooi  (or  to  assauge    help. This  will  help  me  in  deciding  whether  I
       their guilt in this regard).                            want to go into the field  of  public  health  after
                                                               I    graduate.-J.L.,    Nursing    Student,    Lower
          Interestingly enough,  only  a  few  of  the  ac-    East Side.
       cepted applicants  indicated  in  their  application
       essays  an  interest   in   effecting   changes   in      Besides  bringing   to   the   people   my   back-
       health  care  delivery  systems   and   institutions    ground  and  knowledge,  I  will  be  learning  much
       through politically  oriented  activism.  Yet,  this    from them. I will learn much about myself and.
       surfaced as  a  burning  issue  early  in  the  sum-    others. It is one  thing  to  read  and  hear  some-
       mer that split  many  of  the  projects  right  down    thing, but  another  thing  to  actually  know  what
       the middle,  and  was  the  cause  of  much  of  the    it's like to be poor. It will be  quite  an  experi-
       frustration  experienced  by  project   participants    ence and the personal satisfaction  I  hope  to  get
       that  was  expressed   at   the   Final   Conference    out of it will be exactly  why  I  went  into  nurs-
       and in  their  final  reports.  Only  one  applicant    ing-not  for  the  money,  but  to   help   people.-
       mentioned a need for  the  $900  stipend,  but  this    J.0., Nursing Student, Newark.
       too turned  out  to  be  a  matter  of  considerable      Working  in  such  a  project   should   be   very
       concern to many  of  the  students  as  I  e  summer
       progressed.                                             valuable   in   formation   of    my    personality-
                                                               broadening   my   understanding    of    life    and
          The  following  excerpts  illustrate   not   only    awareness  of  problems  of   others.   My   primary
       the variety  of  motivations,  but  also  the  range    goal is  having  some  effect  on  the  poor  living
       of  sophistication  regarding  the  summer's  possi-    conditions  and  inequality  problems.of  the   peo-
       bilities  that  participants  brought  to  the  pro-    ple on the Lower East Side.
       ject.                                                     * *  *  I  believe  there  is  a  great  need  for
          Participation  in  a   Student   Health   Project    showing  people  how  to  help  themselves,   rather
       seems  to  me  to  be  crucial   in   my   education    than  taking  the  attitude  of   condescension   by
       *  *  *  a  unique  opportunity  to  learn  what   I    "helping"  them,  which  has  been   proven   unsuc-
       otherwise never could.                                  cessful.                            I
          * * * I  would  hope  to  learn  a  new  perspec-      Aside  from  the  vast  intangible  benefits,  the
       tive on health care:  a  little  insight  into  what    financial  aid  would  be  of  great  assistance  in
       life  is  like  for  the  urban  poor,  some  under-    the   coming   school   year.-B.G.,   Nursing   Stu-
       standing of where health fits  into  the  priorities    dent, Lower East Side.
       of the community.
          I want  to  build  my  education  during  medical      My main reason           is  to  learn-about   the
       school along relevant lines * *  *  and  I  want  to    ghettos  and  the  people  there,  about  the  power
       work  closely  with  a  community   before   profes-    structures  presently  in  existence  and  ways   to
       sionalism  puts  too  much   distance   between   us    change  those  structures,  about  health   services
       *  *  *  I  want  to  make   sure   that   community    in the city  (or  lack  thereof  ),  and  how  those
       health  is  the  foundation  of  my  education,  not    served  would  like  to  see  health  care  changed.
       the capstone.                                           -I.B., Medical Student, Bronx.
          My  own  education  is  the  primary   reason   I      I felt the job afforded  one  of  my  last  oppor-
       want to work on  a  project  this  summer,  but  not    tunities for a "dose of liberalism," so to  spea  c.

                                                                                                                  5


                                                             GREATER NEW  YORK

               It potentially  offered  insight  into  the  problems    our societyand try our hand at curing our       itso-
               of  the  disenfranchised  that  a  hospital   setting    cial  disease."  My  goal  was  to  give  of   myself
               will never offer.  The  desirability  of  working  as    and  in  doing  so  find  out  what  I   was   really
               part  of  a  community  health   team   also   caught    made of. I wanted people  to  tell  me  how  I  could
               my imagination. I felt  that  the  role  of  a  medi-    be  of  some  use;  I  wanted   to   understand   the
               cal student  in  o.  project  might,  in  some  small    people  of  the  community   and   wanted   them   to
               way, differ from that  of  a  nurse,  social  worker,    understand   and   believe   in   me.-D.Y.,   Medical
               lawyer, etc.  This  too,  I  thought,  would  broaden    Student, Brooklyn.
               my   outlook   concerning   possible   solutions   to      There  is  nothing  worse  than  a   hypocrite   or
               community  health   problems.   A   third   lure   of    martyr  in  the  ghetto.   Bad   enough   I'm   white
               the  position  was  the  opportunity  the   job   of-    and  middle  class.  I'm  enthused  by  the  idea  of
               fered  for   community   contact,   though   I   must    really   offering   these   people   something   con-
               admit  that  my  concept  of  my  role   in   commun-    crete, of doing  something  they  can't  now  do  for
               ity  interaction  was  nebulous  even  before  I  be-    themselves,   or   working   with   them   to   begin
               gan.-J.R.,   Medical   Student,   Brooklyn.              something  that   won't   end   with   the   summer.-
                         I have  not  had  the  experience  to  know    P.G., Sociology Student, Harlem.
               what real poverty is.  I  feel  that  I  should  have      I  like  working  with  people   and   caring   for
               the  experience  of  working  in   a   poverty   area
               -and  becoming   more   familiar   with   what   cul-    the sick.  However,  I  feel  that  hospital  nursing
               tural  and   racial   factors   prevent   individuals    is too confined  for  the  kind  of  care  many  peo-
               from living a healthful  life.  I  want  to  come  to    ple  require.  *  *  *  By  going  into  a  perso-n's
               the level of  these  people  to  see  their  problems    home  you  can  see  the  type  of  problems  he  has
               more  clearly,  discuss  these  problems   with   the    to face every day. * * *  I  would  like  to  try  to
               people  and  other  members  of   the   health   pro-    help  in  finding  a  solution  to  a  few  of  these
                                                                        problems and I  feel  I  could  be  of  some  service
               ject,  and  work  on  possible   solutions   to   the    because  I  want  to  help.  On  the  selfish   side,
               problems. I think I will be able  to  have  a  fuller    working  with   people   in   poverty   areas   would
               understanding  of  how  I,  as  a  nurse,  can   help    benefit  me.  It  would  enable  me  to  once   again
               these  people  achieve   the   standard   o     iving    see  the  nursing  profession  as  I  did  before   I
               they  deserve.  *  *  *  I  would  be  able  i  share
               my  experience  with   my   classmates   in   nursing    chose to enter it. Finally, as  a  Negro,  I  have  a
                                                                        strong  desire   to   help   my   own   people.-A.C.,
               school  when  I  returned   in   September, so    they   Nursing Student, Newark.
               too  could  learn  more  about  how   to   help   the
               poor  with   their   health   problems.-L.D.,   Nurs-      It has long  been  my  goal  to  assist  less  for-
               ing Student, Newark.                                     tunate  persons  in  obtaining   human   dignity   by
                                                                        helping  them  to  secure  equal-justice  under   law
                 Medicine  is  a  full-time  job  in  its  strictest    and a  decent  standard  of  living,  which  includes
               sense.  Yet,  to  turn  away  from   the   full   man    all -necessary medical care as a  right  not  a  pri-
               (i.e., in and affected by his society) is too  strict    vilege.
               a  definition  of  medicine.  Consequently,  I   wish      * *  *  I  consider  this  project  an  opportunity
               to  study,  observe,  and  "get  the  feel  of"  what    to  help  and  not  a  job  or   a   t@k.-N.W.,   Law
               affects man. This,  I  believe,  will  enable  M6  to    Student, Newark.
               diagnose  the  cause  and  alleviate   the   effect.-
               J.C., Medical  Student,  Lower  Ecut  Side.                When  I  found  out  that  I  had   been   accepted
                                                                        for  a  second  summer  with   the   Student   Health
                The  Orientation  had  impressed  on  us   the   im-    Project,  I   was   both   excited   and   optimistic
               portance of the job.  We  couldn't  even  call  it  a    about  the  summer  to  come.  I   was   anxious   to
               job; it was  more  of  a  mission  in  understanding.    build   upon   last   summer's   experiences,   using
               Our  goals  were  many.  Some   of   us   wanted   to    my   knowledge   to   accomplish   something    defi-
               find out what life in  the  slums  was  really  like.    nite. Last  summer  I  had  not  expected  to  accom-
               Some of  Us  wanted  to  find  out  what  was  ailing    plish  anything,  and  I  was   pleased   with   what

               6


                                                    SUMMER  1968

       little I was able to do.  In  contrast,  this  summer   the curriculum  to  include  instruction  and  expe-
       l had higher expectations, partly because of .          rience in community medicine.
       my  experiences  last  semester  in  leadership   and      * * -,': I  am  concerned  with  health  problems
       group dynamics           *-V.V.,     Nursing     Stu-   of  the  poor  and  uneducated.  SHO   asserts   the
       dent, Bronx.                                            right  of  every   man   to   comprehensive   health
          Working in the SHP last summer was an e              service;  I  completely   support   that   assertion
                                                               and I consider it  my  duty  *  *  *  to  do  every-
       lightening  and  exciting  experience   for   me.   i   thing  to  provide  effective  health  programs  for
       learned  more  about  the  reality  of  medical  care   all people.-L.B., Medical Student, Harlem.
       as  it  exists  for  the  majority  of  Americans  in
       those  few  short  weeks  than  in  my  2  years   of             My  experience  would   also   enable   me
       medical school.                                         to  encourage  Stanford  to  set  up  an  SHO   sum-
          * * *  I  felt  that  perhaps  this  summer,  with   mer program  of  its  own  to  serve  the  needs  of
       some of the  initial  learning  process  *  *  *  be-   the  Palo   Alto   community.-B.W.,   Medical   Stu-
       hind me, I might be  able  to  do  a  lot  more  than   dent, Newark.
       last   year.-M.M.,   Medical    Student,    Brooklyn.      * * * I feel  the  commitment  to  offer  assist-
          I  have  a  brother-in-law  who   is   a   "social   ance to  that  part  of  the  population  which  has
       work"  minister  *  *  *  and  who   has   e.:ee   ed   generally  gotten  the   nation's   digested   food-
       significant   change   *   *   *   through    similar   stuffs as  daily  fare.  *  *  *  The  experience  I
       grass-rootsactivities * * *                             would get from this project is of the  sort  that  I
          I feel  that  the  SHO  projects  are  significant   would be able  to  use  in  my  day-to-day  contacts
       efforts to  bring  about  important  changes  in  the   with  other  fellow  students   and   attack   their
       health  care  people  in   these   communities   have   motivations  and  purposes  and  try   to   interest
       been receiving. I want to  be  a  part  of  this  ef-   the  great  uncommitted.  In  my  professional  role
       fort.-W.S., Medical Student, Halrem.                    I  believe  this  summer's  experience  would  be  a
                                                               big step in defining for  me  exactly  what  I  want
          I think I should be a part of this  project,  -not   to do in  the  health.  field.-D.T.,  Student  Coor-
       because I  am  any  more  qualified  than  other  ap-   dinator, Newark.
       plicants  to   do   community   organizing,   or   to
       work  with  poor  and  minority  groups  in  the  so-      As a  white  person,  I  share  with  my  society
       lution  of  their  particular  problem,  but  because   the  guilt  of  having   manipulated   the   "poor."
       as a law  student  I  am  trained  in  "social  engi-   * @ * * I want to give all the life I've got to  un-
       neering"-the  ordering  of  institutions   of   soci-   ravel   the.   tangled   mess   that   exists.-B.M.,
       ety under the law.  I  want  to  do  more  than  sim-   Nursing Student, Bronx.
       ply alleviate suffering  for  a  summer.  I  want  to      * * * I felt  quite  hypocritical  since  my  po-
       change  the  institutions  that  have  so  far   been   litical and social  convictions  were  distant  from
       unable to do the job.                                   our nation's practices and  I  was  not  doing  any-
          *  *  *  I  want  to  hasten  the  day  when  such   thing to express my dissent.
       projects  are  no  longer  necessary,   and   working      *  *  *  SHO  filled  this  discontent  that  was
       on this project will provide me with invalu      !@le   growing  more  and  more  in  me.   The   work   Iam
       practical experience, which  I  hope  I  can  utilize   -1 -
       to  help  bring  about  long-run   changes   in   the   aoing seems to be at  least  a  step  in  the  right
       law@R.H., Law Student, Brooklyn.                        direction.-L.K., Medical Student, Brooklyn.
                                                          11      For  me,  working  directly  with  the  underpri.
          The  present   medical   curriculum   at   Corneii
                                                               vileged would be  one  small  way  of  putting  good
       places  little  emphasis  on  ghetto   problems   ana   intentions  into   action.-V.S.,   Dental   Student,
       solutions, so  as  an  SHO  participant  I  would  be
       filling a  gap  in  my  medical  education.  Further-   Bronx.
       more,  I  might  be  so  affected  by   the   program      I am aware  of  the  sad  fact  that  my  profes-
       that  I  could  work  effectively   toward   changing   sion has  devoted  its  energy  almost  entirely  to

                                                                                                                  7


                                                   GREATER       NEW  YORK

               middle class patients, and  as  a  psychologist  I     I have long  been  disturbed  by  the  relegation
               hope  eventually  to  move  things  out  into  the   of the individual to a mere cog in  society's  gar-
               communities where he   lp is most needed.            gantuan  machine.  Indeed,  in  .4n  age  when   we
                 *  *  *  The  main  reason  for  my  wanting  to   tend  to  appreciate  humanity  only  as  an  amor-
               be part of this program is  simply  that  I  would   phous  mass,  medicine  should  reassert  the  need
               like  to  do  something  worthwhile  this   summer   for appreciation of the  individual's  worth.  Yet,
               * * * I have not felt particularly effective  this   it  appears  to  me  that  organized  medicine  has
               year, sitting in the  library  studying  while  so   often lost sight of this goal. Poverty  may  be  an
               much immediate  concrete  work  has  to  be  done.   abstraction,  poor  people  are  real.  Med'l%--"'.
               I also cannot help  but  feel  totally  frustrated   school  can  be  a  terribly  discouraging   enter-
               with the condition of this  country  today.  At  a   prise for a  student  who  sees  medicine  as  more
                                                                    than a mere "profession."            I  would  like
               time when positive action is  needed  I  would  be   medicine  to  be  a  means  for  deepening  my  un-
               particularly grateful  to  get  out  and  do  some   derstanding  of  people  and  for  my  rendering  a
               tangible  and   helpful   work.-M.I.,   Psychology   genuinely  useful  social  service.-D.S.,   Medical
               Student, Harlem.                                     Student, Lower East Side.

               8


                                           Part 2: THE REALITY

                      INTRODUCTION                            lost almost all of  its  neighborhood  practition-
          After 3 days  of  "Orientation"  to  the  summer    ers.
       ahead  (held  at  an  upstate  New  York   resort),      The South Bronx, which is  just  a  short  drive
       the   SHP    student    fellows    and    community    from  down-town   Manhattan,   has   traditionally
       workers  officially  arrived  in  the  five  ghetto    been  a  rapidly  changing  community   of   immi-
       communities   of   Greater   New   York   City   on    grants. At present,  it  is  a  Negro  and  Puerto
       June  27,  1968,  eager   to   begin   implementing    Rican  area  which   has   few   private   medical
       their formidable task proposal.                        practitioners. Its hospitals  and  health  centers
          Bedford-Stuyvesant,  typical  of  the   communi-    are overcrowded. There s a  high  in  an  mo  a  -
       ties  in  which  the  Brooklyn  SHP  was   located,    ity rate in many health districts, and  lead  poi-
       has                                                    soning of infants, rat bites, and  drug  addiction
            a  population  of  190,000,  85   percent   of
       whom  are  black.  The  median  family  income   is    are great community problems.
       far below that for the city  as  a  whole  and  the      Health.services in  the  South  Bronx  are  pro-
       unemployment rate  of  7.2  percent  is  more  than    vided  by  ambulatory  care  centers   in   Morri-
       double  the  national  average.  The   usual   slum    sania Hospital,  Lincoln  hospital,  and  by  many
       pattern   of    inferior,    inadequate    housing,    new  neighborhood  service  centers   for   mater-
       schools,  sanitation,  and  recreation   facilities    nity  care  and  mental  health.  Most   inpatient
       prevails. The majority of inpatients  are  seen  in    services  are  provided  by  the  hospitals   men-
       the  massive,  3,000-bed  Kings  County   Hospital,    tioned above. One  of  the  great  innovations  in
       outpatients using any of the  hospital's  32  over-    primary medical  care  for  this  medically  indi-
       crowded clinics.  There  are  woeful  shortages  of    gent  area  is  the  Neighborhood   Medical   Care
       community   practitioners,   dentists,   and   home    Demonstration  (NMCD),  funded   by   OEO   as   a
       care  services.  Essentially   similar   statements    demonstration  project.  This  center  as  een   a
       could  be  made  for  the  Brownsville   community,    great help  in  changing  the  pattern  of  health
       served  by  Brookdale  Hospital,  and   the   Crown    care  delivery.  North  of  Central,   Park,   New
       Heights  community,  served  by  St.  Mary's   Hos-    York City changes its  complexion.  It  becomes  a
       pital.                                                 teeming ghetto  of  closely  packed  houses,  lit-
         Newark,  a  city  of  405,000,  can   claim   the    tered  streets,  and  alienated   citizens-Harlem.
       highest of any  national  crime  rates,  the  high-    Summer  in  this  neighborhood  means  the   swel-
       est national incidence  of  tuberculosis,  alcohol-    tering  humidity  and  scorching  heat  of  poorly
       ism, venereal  disease,  and  drug  addiction.  Its    ventilated apartments  forcing  youth  into  their
       health profile reflects the ignorance,  bitterness,    playgrounds  on  the  streets.  The   freedom   of
       and despair of  a  -large  segment  of  the  city's    summer turns into  an  endless  ballgame  or  wad-
       ]population  which  had   hoped   to   escape   the    ing pool filled by gushing water hydrants.
       blight  of  the  decaying   rural   South.   Newark      Although   Harlem   has   the   high   unemploy-
       has proven, instead, to  be  a  blind  alley  whose    ment  and  crime  rates  characteristic  of  other
       only exit is  often  through  inward  self-destruc-    depressed areas, one of  the  most  troubling  as-
       tion  of  explosive  violence  of  varying  degree.    pects of life is the inability  of  youth  to  im-
       Health   services   in    Newark    are    provided    prove their fate. They receive  few  aids  to  im-
       mainly  by   Newark   City   Hospital   (Martland),    pro%-ement and  have  many  chronic  health  prob-
       which lies in  the  center  of  the  Central  Ward,    lems, some of which are direct  results  of  their
       one of the city's largest  ghettos.  The  area  has    environment.


                                                       GREATER NEW  YORK

               Harlem   is   served   by   Harlem    Hospital,   these views have not  been  changed  but,  rather,
             K-nickerbocker Hospital,  private  practitioners,   reinforced. I have  come  to  consider  the  urban
             and practitioners of  folk  medicine.  This  area   ghetto -another country:  an  isolated  colony  of
             has one of the highest infant mortality rates  in   the  United  States,  dependent  upon   the   U.S.
             New York  City.  Lead  poisoning  and  rat  bites   economy for  its  essential  needs,  at  the  same
             have  traditionally  been  health   hazards   for   time not being a part of  the  mainstream  of  so-
             those who live in the  ancient  housing  of  this   ciety nor sharing on an  equal  basis  the  wealth
             predominantly Negro community.                      existing in this great Nation.
               The Lower  East  Side  has  traditionally  been     Like  most  colonies,  Bedford   Stuyvesant   is
             the  home  of  immigrants.  Puerto  Ric-ans   and   economically   underdeveloped;   furthermore,   it
             Chinese  now  makeup  the  larger  part  of   the   is exploited by those who have  control  over  its
             community but there  are  still  many  Jews,  Ne-   existing economy. This economy  is  one  which  is
             groes,  Ukranians,  and  Italians.   The   median   setup in such  a  way  that  it  takes  the  small
             grcss income is approximately  $2,000  less  than   monetary  resources  which  do  exist  and  drains
             the average for the city. Drug  addiction,  alco-   them  from  circulation  in  the  community.  Like
             holism,  and  crime  are  the  main  problems  in   other economies of the  world,  the  affluence  of
             this   neighborhood,   where   many   inhabitants   the  people  in   an   urban   community   depends
             speak little or no English.  The  public  schools   upon  how  much   money   enters   the   community
             hat-e  been  abandoned  by  those  families   who   and  how   many   times   that   money   exchanges
             can afford to do so. As much  as  10  percent  of   hands  within  the  community.  Money  can   enter
             the total  labor  force  many  be  unemployed  at   in the form of payment  for  goods  and  services,
             any one time.                                       wages, interests, and rents.
               Health services are  provided  by  106  private     For the  most  part,  communities  like  Bedford
             practitioners, more  than  40  of  whom  work  in   Stuyvesant   are   unproductive:   no   industries
             the Wall Street area and in effect do  -not  pro-   exist  and  no  goods  are  manufactured  in   the
             vide medical  care  to  the  inhabitants  of  the   community.  Therefore,  money   does   not   enter
             Lower East Side.  In  recent  years  the  Gouver-   for payment  of  goods.  On  the  contrary,  money
             neur  Ambulatory  Care  Unit   of   Beth   Israel   leaves  in  the  form  of  payment  for  essential
             Hospital  and  the  Judson  Health  Center   have   goods  produced  outside  of  the   community   by
             delivered the bulk of primary medical  care.  In-   nonresidents.  The  obvious   solution   to   this
             patient services  are  provided  by  Beth  Israel   problem  is  to  bring  more  industry  into   the
             Hospital,and  the  mammoth   Bellevue   Hospital.   community.  Such  industries   should   be   owned
               Although  many   of   the   SHP   workers   had   and run by residents  and  should  provide  essen-
             some prior understanding of The  Reality  of  the   tial  goods  for  residents  and/or  nonresidents.
             health care delivery deficiencies in  these  com-   (This is presently being done  on  a  small  scale
             munities (at  least  from  a  professional  point   in the clothing industry.)
             of view),  the  awakening  of  many  participants     In the case of interest, we  see  another  vehi-
             to the realities of life in a ghetto  environment   cle for the exit  of  money  from  the  community.
             and the circumstances  of  health  care  delivery   There  are  few  creditors,  if  any,  in  Bedford
             from the patient's side  of  the  admitting  desk   Stuyvesant;  there  are,  however,  a  great  many
             constituted the first stage of the "learning  ex-   debtors.
             perience"'that was, perhaps, the  most  signi@fi-
             cant of the summer.                                   Rents  represent  a  large  drain  on  the  com-
                                                                 munity's monetary resources.  I,  for  one,  think
                  VIEWS OF THE COMMUNITY                         that rents should,be  taxed  away,  thus  abolish-
                                                                 ing  landlords  from  the  face  of   the   earth.
             Brooklyn                                            Rents  in  the  pure  economic  sense  are   money
             At the beginning of  the  summer  I  had  certain   paid in return for  which  no  goods  or  services
             ideas about the problems  existing  in  the  Bed-   are given. (A perfect example of  this  are  rents
             ford Stuyvesant community.  For  the  most  part,   paid  by  Nebraskan  farmers  to  individuals   or

             10


                                                 SUMMER  1968
      corporations   completely    removed    from    the   ter paying jobs. "To get a  good  job,  get  a  good
      land.) The land was  here  long  before  any  land-   education."  Education   and   vocational   training
      lord  came   into   existence;   furthermore,   the   represent  major  tools  for  improving  the   econ-
      land will be here long after the last of the  land-   omy  of  any   economically   underdeveloped   area.
      lords has turned back into  dust.  I  believe  that     The  rendering  of  services  represents   a   po-
      no mortal being has the  right  to  claim  that  he   tential   means   of   keeping   money   circulating
      owns so much as  1  square  inch  of  soil  on  the   within  a  community.  But  this  is  another   area
      face of the  earth.  Rents  and  the  ownership  of   which  represents  a  drain  on  the  community  re-
      land is purely a  European  concept.  In  Asia  and   sources. One of  the  larger  services  provided  is
      Africa  people  live  on  and  work  the  land  but   the sale and  distribution  of  essential  goods  in
      the landlord-tenant  relationship  is  unheard  of.   the  community-food   and   clothing.   This   serv-
        Slumlords  are  the  same   type   of   landlords   ice is  provided  by  large  corporations  and  mer-
      as those who rent  land  to  tenant  farmers:  they   chants  who  are,  for  the  most   part,   nonresi-
      accept rents;  they  provide  essentially  no  ser-   dents.  These  are  the  men  who  drive   down'from
      vices;  they  don't  keep  the  buildings  in  good   the suburbs in  the  morning  and  leave  at  night,
      condition; often they don't  provide  heat  or  hot   often  exploiting   the   community   residents   by
      water,  proper  garbage  disposal,  or  elimination   selling poor quality goods at high prices.
      of rats, roaches, and  other  health  hazards.  The     In  recent  years,  programs  have  been   started
      few services their  tenants  do  receive  are  pro-   to  encourage  community  residents  to  enter  into
      vided by the city, not by  the  landlords  to  whom   small businesses, largely  in  the  merchant  field.
      they  pay  rent  and  from  whom  they  should  re-   Such  programs,  however,  will  continue  to   have
      ceive services for said payment.                      limited  success  unless  residents   are   provided
        Article 7A is a  law  which  has  been  setup  in   with  the  knowledge  necessary  to  run   a   small
      New York  to  deal  with  this  problem.  It  prov-   business. Once again, the  issue  is  the  need  for
      ides  for  the  withholding  of  rents  from  land-   adequate education.
      lords  who  fall  to  supply   required   services.     At  the  present  time   there   is   an   attempt
      The  rents  withheld  are  used  by  the  city   to   being  made  by  residents  to  provide   themselves
      provide the services  to  which  the  tenants  have   with  a  service  once  rendered  by   nonresidents,
      a right and  which  the  landlords  have  not  seen   often in  a  discriminatory  manner:  taxicab  serv-
      fit to give. At the  present  time,  however,  this   ice. The medallion cabs  are  licensed  by  the  po-
      law is not being applied  on  the  scale  necessary   lice  department-the   gypsy   cabs   are   licensed
      to deal with the problem.                             by the  people'    "Black    Pearl    means    Black
        Wages  are  the  major  route  for  the  entrance   Power." Indeed,  if  Black  Pearl,  the  private.cab
      of  money  into   the   Bedford   Stuyvesant   com-   service association, wins its  fight  to  exist,  it
      munity.  The  problem  is  that  these  wages   are , will  have  a  beneficial  effect  on  the  economy.
      not enough to  support  the  economy  of  the  com-   The existence of  the  gypsy  cabs  serves  to  keep
      munity.  One  reason  is  high  unemployment,   an-   money  circulating  among  residents  of  the   com-
      other is the  type  of  employment  available.  The   munity.
      jobs which are available  to  the  population,  for     In  this  report,  I've  concerned   myself   with
      the  most  part  unskilled  and   uneducated,   are   problems  other  than   health   problems   existing
      usually low-paying.                                   in   Bedford   Stuyvesant   which,   when    solved,
        If  the  economy  of  the  community  is  to   be   will  elevate   the   community   into   the   main-
      strengthened,   more   money   must   enter.    One   stream of  American  society.  I  cannot  deny  that
      way of doing this is to raise the  total  wages  of   health-care  delivery  is  a  problem  in  the  com-
      the  community,  which  can  be  done  by  creating   munity. However, its solution  will  not  upgra'  de
      new  jobs  to  meet  the  level  of  knowledge  and   the status  of  residents  of  the  community.  They
      skill already in existence. At the  same  time,  if   realize  this,  and  therefore  health  care  h@'low
      education  and   vocational   training   are   'im-   priority. I recognized this  at  the  beginnin@g@'of
      proved, residents will be able to  move  into  bet-   the summer  and  chose  to  work  in  the  Youth  In


                                                              GREATER NEW  YORK

               Action   education   program   rather   than   in    a   day  night  you  will  see  people   having   fun.   In
               health problem area.                                     Brownsville   people   walk   along   depressed    with
                 The   students   working   in   the   YIA   homework   their  heads  held  low,  many   nodding   from   their
               study   program   were   criticised    for    devoting   last fix. There is  little  spirit  in  this  community
               their  full  time  to  this  program.  The  basis   of   and that  is  why  working  here  is  difficult.  There
               this criticism was  that  the  project  was  not  ori-   are  no  chapters  of  CORE,   SNCC,   or   other   na-
               ented  toward  health.  I  trust   that   the   people   tional  organizations  Thus  these   people   are   not
               who  felt  this  way  are  now  beginning  to  realize   aware   of   much    more    than    their    immediate
               that  health  is  not  of  high  priority  among   the   personal   needs.-D.K.,    Medical    Student    Brook-
               problems  of  the  urban  ghetto,  justas  it  is  not   lYn.
               in  other   economically   underdeveloped   parts   of
               the world.                                               Brooklyn
                 in such  areas  the  problems  to  be  solved  first      For  too  long   we   have   been   satisfied   with
               are  economic  ones.  Western  countries  have   often   charity  where   rights   are   involved.   The   legal
               solved  the  health  problems  of  undeveloped   coun-   profession  has  been  a   major   offender   in   this
               tries long  before  they  have  even  begun  to  think   area, but  there  is  reason  for  optimism  in  recent
               about  socioeconomic  difficulties.  One  result   has   decisions  of  the   courts.   The   problem   of   the
               been   a   population   explosion   which   makes   it   poor  is  that  they  do   not   have   enough   money.
               that  much  harder  to   solve   economic   probleIms.   That  is  not  their  only  problem,  but  their  other
               Indeed,  in  most  instances  the  economic   progress   hangups   are   shared   with   their   more   affluent
               has  been  nullified  by  the  population   explosion.   brothers.  The  solution  is   not   to   provide   the
                 Another   solution   offered    by    the    Western   poor  with  goods  and  services,  food  stamps,   wel-
               countries  has   been   foreign   aid,   charity   and   fare, or free medical  care  at  special  clinics,  but
               handouts,  all  of  which  have  no  positive   effect   to  get   money   into   their   hands.   They   should
               whatsoever   on   the   economic   development    that   have   the   same   opportunity   to   squander   their
               would  eventually   eliminate   the   need   for   aid   money  on   what   many   would   deem   less   benefi-
               and  reduce  the   dependency   of   the   undeveloped   cial  services  as  anyone  else,  for  who  is  compe-
               areas on the Western world.                              tent  to  tell   another   what   is   worthwhile   and
                 The  same  sort  of  Christian   ethic   which   has   what is not?  It  is  paternalistic  for  the  affluent
               shaped  the  relationship  of  the  West  to  the  un-   society  to  decide  what  is  good   for   those   who
                                                                        are  not  affluent.  The  poor  are   not   free,   for
               derdeveloped   areas   of   the   world   has   shaped   their  only  choice  is  between  starvation  and   ac-
               the   approaches   the    Federal    Government    has   cepting  largess  with  strings  attached.   Our   wel-
               chosen  to  solve  the   problems   of   the   ghetto.   fare  laws  date   back   to   the   Elizabethan   Poor
               Such  programs  as  medicaid,   welfare,   and   other
               assorted  handouts  are  all  very  beautiful   ideas,   Laws,  when  being  poverty  stricken   was   akin   to
               but in the  end  they  don't  even  scratch  the  sur-   being a criminal.
               face  of  the  problems  which  exist.  If   all   the     Paternalism  in   society   has   the   same   conse-
               health   problems   of   the   urban    ghetto    were   quences  as   paternalism   in   the   family-the   son
               solved   tomorrow,   the   only   significant   change   must  rebel  against   the   father   before   he   can
               would be that there would be a lot of 'health            feel  himself  a  man.  We  are  seeing   the   results
                                                                .   y   of  this  policy  in  the  rising   crime   -rate   and
               people  throwing  bricks  and   bottles   at   police-   urban  riots,  at  a  tremendous   monetary   cost   to
               men   and   firemen.-R.J.,Medical    Student    Brook-   society.  Those  who  do  not   rebel   become   depen-
               lyn.                                                     dent, docile, unwilling  to  change,  lest  they  some-
                 In   working   in   Brownsville,   one   must   take   how   run   afoul   of    some    welfare    regulation
               into   consideration   something    not    found    in   and  have  their  relief  check  reduced.  As  for  the
               other  ghetto  areas;  Brownsville  is  a  very  unor-   rest of society, it  gets  its  money's  worth  in  the
               ganized   community;   there   are    many    deserted   psychological   satisfaction    of    moral    indigna-
               houses  all  over  that  were  burned  out.  and   are   tion,  and  retains   its   ability   to   discriminate
               waiting  to  be  demolished.  In  Harlem  on  a   Fri-   against   the   poor.   They   are   kept   in   ghetto

               12


                                                     SUMMER  1968
         areas,  in  public-housing  projects.  They  do   not   without  having  the  qualities  of  the  product  or
         have  access  to  the   same   professional,   educa-   the terms of the contract  fully  disclosed.  Such  a
         tional, and. social  opportunity  as  their  affluent   statute is  fully  consistent  with  modern  theories
         neighbors.  The  legal  aid   society,   the   county   of tort liability, in which the risk of liability  is
         hospital,  and  all  other  agencies  which   require   placed  upon  the   party   most   able   to   insure
         a means  test  are  separate  from  the  agencies  or   against the risk.
         facilities  used  by  those  with  money.   The   Su-      The problem is not  with  the  poor,  it  is  with
         preme  Court  has  held  that  separate   is   inher-   the institutions and  the  laws.  People,  even  poor
         ently  unequal  in  regard  to  education  and  race.   people, can see what is  in  their  own  best  inter-
         Perhaps  the  same  reasoning  applies  to   poverty.   ests.  No  one  else  can  do  that  for  them.  What
         Discrimination  on  the  basis  of  rich   and   poor   one  can  do  is  try  to  educate,   persuade,   and
         may  violate  the  equal  protection  clause  of  the   make available. Certainly  there  is  less  need  for
         14th amendment.                                         public  health  services  if  everyone   can   afford
           Furthermore,   abolishing    this    discrimination   his  own   doctor.-R.H.,   Law   Student,   Brooklyn.
         may  save  tax  dollars.  If  everyone   had   money,      I  don't  imagine  community  people   feel   very
         then  everyone  could  be  sued  and  would  be   in-   much  about  health  care  one  way  or  the   other.
         surable,  and  many   crimes   could   be   converted   It's a  sort  of  episodic  thing.  You  go  when'you
         into  torts.  A  burglar,   arsonist,   or   murderer   need to  go.  Some  people  are  regulars,  according
         could  be  sued  for  damages  by  the  victim,  thus   to  the  nurses.  They  come  to  the  hospital  like
         killing three  birds  with  one  stone:  the  "crimi-   some  people  go  for  walks  or  play  mah-iong   or
         nal-tortfeasor"  would  be   punished,   the   victim   go to the movies.  That  is  not  to  say  that  they
         would  be   compensated,   and   society   would   be   are  malingerers,  but  only  that  St.  Mary's  Hos-
         saved   the   expense   of   keeping   the   man   in   pital is as much a  part  of  their  daily  existence
         prison.  The  few  really  dangerous   people   could   as  anything  else  in   the   Brooklyn   communi   .
         continue  to  be  dealt  with  by  custodial   treat-   People  want  care  and  do,  for  the   most   part,
         ment,  but  with   more   due   process   guarantees-   have  confidence  in   doctors   as   a   breed   W10
         preferably  as  mental  patients.  There  are   other   know their business,  but  they  do  not  often  per-
         costs  that  would  be  saved.  The  waste   involved   ceive  the  professional's  ideas  on  better  health
         in  relocating  slums  by  urban   renewal,   sending   care  as  being  great   improvements.   Taking   the
         city  dwellers  to  the  suburbs,  building  freeways   time  to  answer  questions  on  a.  medical  history
         to bring  them  to  and  from  the  city,  then  hav-   form may help  the  doctor,  but  it  is  not  always
         ing  to  deal  with  the  resulting   smog   problem,   welcome  to  the  patient  who  has  to  90  home  to
         and  then  watching  the  same  thing   happen   over   the    other    kids.-M.H.     Sociology     Student,
         again in  another  place  is  costing  more  than  an   Brooklyn.
         outright  gift  of  a  minimum  standard  of   living      rp e  basic  problem  I  found   this   summer   in
         to  every  poor  person.  And  the  human   cost   in      Lh
                                                          --     'Brooklyn  is  that   the   medical   problems   from
         terms  of  physical  health,  and  emotional   in:3e-   which the poorer communities        suffer  are  less
         curity is difficult to calculate.                       important  to  them  than   problems   of   survival.
           Just  how  this  minimum   amount   of   money   is   A  toothache  isn't  important  if  you're  starving.
         provided  is  a  decision  for  the  legislature.  It    @ Even with  medicare  and  medicaid  it  is  costly
         may  be  done  through  a  negative  income  tax,  or   for a ghetto mother to  obtain  care  for  her  kids.
         through  recognition  of  a  right   to   employment,   Often   babysitting'   services   are   needed    and
         either  with  government  or  indirectly  with   pri-   transportation  to  the  hospital   is   time-consum-
         vate  enterprise.  The  latter  should  include   the   ing. Accounting for the  costs  of  a  babysitter  or
         choice  of  quitting  and  taking  another  job.   An   a  taxi  can  be  a  big  order  for  many  families.
         additional  means  would  be  to  enact   legislation   The  result  is  that  medical  care   is   neglected
         requiring  full   disclosure   by   merchants,   loan   until a serious problem arises. .
         companies  and   landlords,   and   granting   treble      In poverty areas,  where  people  are  more,  con-
         damages  to  any   person   who   deals   with   them   cerned  about  money  for  food   and   clothes   and


                                                    GREATER       NEW  YORK
              things like that, health care has  to  take  a  sec-    munity  which  has   a   defensive   shield   around
              ondary position  because  it  is  not  as  immediate    it? P.D., Medical Student, Neivark.
              a  need.  This  is  the  problem  in  Brooklyn.   We      The people  are  on  the  verge  of  a  major  re-
              find that to a lot of the residents, health care  is    volt. Right now,  they  are  awaiting  the  election
              equated  with  emergency   room   care.   There   is
              very  little  concern  for   preventive   medicine.-    year,  but  if  Newark  does  not   have   a   black
              W.S., Stttdent Coordinator, Brooklyn.                   mayor  and  a  black  majority  council   in   1970,
                                                                      Newark  will  burii.   Newark's   blacks   are   not
              Newark                                                  only tired of poor  health  care  but  also  of  the
                 What is this community that we         were    to    whole  political  system.-D.B.,  Com
              reach? They did not respond to radio        appeals,    Worker, Neivark.
              personal  appeals,  or  flyers.  The  "leaders"   we      Newark-born,  I  never  realized  how   badly   in
              attempted to  integrate  within  our  local  organi-    need my people  are.  I  never  knew  how  disinter-
              zation  did  not  "produce."  A   person   suggested    ested they  are  in  their  surroundings,  that.  ey
              as  a  leader  by  our  community  worker   promised    don't care  to  come  out  and  help  themselves  or
              to   reach   "different   folks    with    different    to take part in building a better place  in  whid  i
              strokes,"  but  when  we  failed  to  move  our  or-    they could get a better outlook on life.
              ganization  into  his  domain  he   evaporated.   To      I  never  knew  that   a   community   of   people
              the  outsider,  the  New-ark  "community"  is   apa-    could  stand  to  be  content  where  there  are  so
              thetic and  hardened  against  any  type  of  appeal    many   disadvantages,   not   only   with   housing,
              to  join  and  march.  They   generally   fear   and    clinics,  welfare,  and  schools,  but   with   many
              dislike  the  treatment  that  they  have   received    other everyday things.
              from  the  city  at  Martland  Hospital,  but   they      As  a  community  worker  in   Newark,   I   hope,
              will not rally with  the  white  liberals  to  upset    during the next  10  years,  that  the  people  will
              the  status  quo.  What  is  the   community?   They    come outand  be  willing  to  take  part  in  trying
              are a  disparate  group  of  leaders  jockeying  for    to build  a  better  community  in  which  they  can
              power  and,  perhaps,  money,  within  a  cross-sec-    live. It will take time to  give  the  black  people
              tion of  distorted  values  (by  white  middle-class    back  their  confidence  in  any  new  organization,
              standards).  To  "them"  we  are  richer,  different    health or otherwise. The  needs  are  far  too  deep
              outsiders who in many eases don't belong.               for a mere  10  weeks  of  SHP  to  help  them  help
                 These are things  I  feel  very  strongly  about:    themselves.  They  don't  know  who  to  listen  to:
              apathy  and  what  is  the   community   here,   who    for too many  years  black  people  have  been  lied
              represents  the  community,   who   are   the   com-    to by all kinds  of  so-called  do-gooders.  I  pray
              munity  leaders?  I  don't  think   anybody   knows.    that the services that  SHP  has  offered  the  peo-
              We  ran  into  problems  with   the   administration    ple of the ghetto  area  in  Newark  have  not  been
              of  the  hospital  and  the  administration  of  the    a total loss, but only a  start  for  better  under-
              medical  school  because  they   thought   we   were    standing  between  the  hospital   and   the   black
              upsetting  the   community,   but   I   think   they    community.-K.C.     Community      Worker,      New-
              were  entirely  wrong.  I  don't  think  they   know    ark.
              who  the  community  is  (though  they  think   they
              do)  and  I  don't  think  we  know.  The   adminis-    Newark
              tration doesn't feel that these  people  are  repre-      *  *  *  The  newest  and  most   popular   weapon
              sentative,  these  mothers  who  have   been   wait-    in the  war  on  poverty's  arsenal  is  an  attempt
              ing  four  hours  in  a  clinic   or   the   factory    to  change  a  common  feeling  in  the  ghetto  or.
              workers  who  have  to  be  dragged  to  a  meeting.    despair and  powerlessness  into  one  of  hope  and
                 Another  thing  is  the  tremendous   disappoint-    a sense of power  over  one's  life  by  giving  the
              ment  you  get  when  you  think  you've  got   com-    community  control  of  decentralized   local   pro-
              munity  involvement  and  -no  one  shows   'up   at    grams  and  institutions.  This  approach  may  have
              the  meeting,  which  was  pretty  -normal  for  us.    some validity as  a  line  of  communication  and  a
              The  question  is,  how  do  you  reach  this   com-    peaceable  channel  for  protest  which   forestalls

              14


                                                   SUMMER  1968
         or  helps  to  prevent  ghetto  insurrections.  How-   Harlem  community   was,   "who   is   the   commun-
         ever,  the  experience  I  have  had  in   observing   ity?"  Here  I  was  really  stumped.  Out  in   the
         the    United     Community     Corporation     Area   Midwest  where   I   grew   up,   communities   were
         Boards  in  Newark   suggests   that   the   commun-   pretty  homogeneous.  But  in  an   area   such   as
         ity approach is not very  effective  in  alleviating   central  Harlem,  community   is   almost   indefin-
         hard-core  poverty.  These  Area  Boards  are  fail-   able.  The  community  of   Lenox   Terrace   (high-
         ures because they  do  not  reach  significant  num-   income housing) is  infinitely  different  from  the
         bers of the real  poor.  In  large  part,  the  real   community  of  the  middle  and  low  income   hous-
         poor  include  those  without  the   time,   energy,   ing project  across  the  street,  and  both  differ
         knowledge, or hope to go  to  the  meetings  of  the   greatly   from   the   community    of    brownstone
         Area Boards, to speak  up  to  and  not  be  intimi-   tenements  they  face.  The   community   of   well-
         dated by  the  clique  who  run  the  meetings.  The   kept  brownstones  in  the  block  of   West   137th
         United    Community    Corporation    spends    vast   Street  out  of  which  we  were  working  was  very
         sums on rent and office  equipment,  and  very  lit-   different  f  rom  the   run-down   brownstones   on
         tle,  if  any,  money  or  material  goods  gets  to   the  same  street  across  Seventh  Avenue.  Not  to
         those who need them the most.                          mention  the  multiplicity  of  self-anointed   com-
          Much  better  than  this  approach  would   be   an   munity  leaders  and   ad   hoc   community   groups
         individual  approach  to   the   universal   problem   working  independently  toward   the   same   objec-
         of  poverty,   for   example,   low   income.   This   tives.-W.S., Medical Student, Harlem.
         would  involve  an  overhaul  of  the  welfare  sys-     Harlem  Hospital  was  presented  to   me   as   a
         tem  to  provide   something   like   a   guaranteed
         minimum   income   and   other   features   designed   place where  people  go  to  die.  Columbia  Univer-
                                               get  off   wel   sity and its  students  were  portrayed  as  an  in-
         to make it possible for persons to
         fare,  for  example,  enough  babysitting   stations   stitution  that  had  in   some   way   or   another
         so  that  a  mother  of   dependent   children   (70   created  the  woes  and  hardships  of  the   people
                                                                in Harlem.  The  city  fathers  have  been  neglect-
         percent  of  all  welfare  cases)  can   leave   her   ing Harlem,  I  was  told,  and  a  most  impressive
         children and  work.  If  a  welfare  recipient  does
         start   making   money   or   inherits   some,    he   illustration of this  is  the  beautiful,  ultramod-
         should not have to give it  all  back  to  the  Gov-   ern  but  too  long  unfinished   Harlem   Hospital-
         ernment  and  thus  have  to  remain   on   welfare.   a  structure  which  seems  to  tantalize  the  peo-
         There  must  be  an  incentive  to  welfare  recipi-   ple. I was  told  that  community  control  was  the
                                                                only way out and to get this  it  was  necessary  to
         ents to get off welfare; it should be riiade  possi-   demonstrate. It seems, however that        many    a
         ble to  earn  more  by  working  than  by  being  on                                      I
         welfare  by  providing  that  money  earned  is  not   demonstration had  gone  for  nought  in  the  past.
         deducted  from  the  welfare  check.   The   present   As  I  passed  our  neighbors  day  after   day,   I
         welfare  system  provides  no  such  incentive.   In   could  sense  their  confusion,   frustration,   and
                                                                contempt.   They   were   vexed.-E.M.,   Law    Stv,
         fact,  the  existing  welfare  system  is  producing   dent, Harlem.
         second and  third  generations  of  welfare  recipi-
         ents by such  features  as  requiring  children  re-   Harlem
         ceiving aid to  dependent  children  to  give  what-      The  attitudes  that  people  have  about  facili
         ever  money  they  earn  to  the  family  who   then
         have  that  amount   deducted   from   the   welfare   ties,  without  even  using  them,  are  subtle  and
                                                                difficult  to  document.  Nevertheless,  there  were
         check.  Neither  the  mother  or  the   child   have
         any incentive to get a job because it  is  almost  a   "Te  things  that  came  up  over  and  over   again
         foregone conclusion  that  neither  can  get  a  job   which had  little  to  do  with  the  actual  health
         which  pays  much  more  than  the  welfare   check.   care delivery  facilities,  but  which  kept  people
         -N.W., Law Student, Newark.                            away.
                                                                   Health is not a  high  priority  issue  for  many
         Harlem                                                 people  who  live  in  Harlem;  health  care   often
            The biggest problem I  felt  in  working  in  the   means  the  alleviation  of  a  medical   emergency,
                                                                                                                   15


                                                 GREATER       NEW  YORK
             not preventive care  or  the  treatment  of  prob-      Going  in  and   among   the   people,   through
             lems  that  aren't   causing   immediate,   severe   some   dirty    hallways    to-almost    always-the
             pain. We  ran  across  numerous  cases  of  people   topmost  floor,  seeing  the  undelivered  -garbage
             who had not taken  their  children  to  treatment,   on the  landings  and  around  the  buildings  made
             even after referral, simply  because  they  didn't   me wonder why it is  that  the  city  does  not  do
             think it was important enough.                       something about  it  all.  This  left  me  with  an
              Lack  of  knowledge  about  health   and   health   impotent feeling  when  I  realized  that  we  have
             facilities is one  of  the  reasons  for  the  low   came and will  be  going  and  leaving  these  peo-
             priority;  people  may  not  know  that  a  hernia   pie  in  the  same  conditions  and  knowing   full
             can  strangulate  and  become  a  serious  problem   well  that  what  we  have  done  hardly  began  to
             very quickly, or they  may  not  know  that  there   scratch the surface.
             are specialty clinics for problems  such  as  obe-      It  seems  to  me  that  SHP,  and  through   no
             sity. People seem  to  think  that  if  a  problem   fault of our own, is  really  powerless  to  effect
             isn't  causing  immediate   discomfort   then   it   any  meaningful  change  in  the  lives  of   these
             probably  isn't  very  serious.  If  someone  does   @eople, except that  we  can  bring  the  needs  of
             impress on  them  the  seriousness  of  the  prob-   the  whole  community  to  the  attention  of   the
             lem,  or  if  a  mother  is  seared  because   she   @owers-that-be  with  the  hope  that  some  social
             thinks the problem  might  be  serious  but  isn't   cliange will be effected  which  will  lessen  some
             sure, we found that she  would  usually  take  the   medical  problems  encountered   in   the   commun-
             child to a treatment facility. The lack of  knowl-
             edge about facilities  'available  was  noted  but      Let's face it. The incidence of poor eye  sight,
             was sometimes an  excuse  rather  than  a  serious   TB, and rheumatic  heart  disease  bears  a  direct
             hindrance.                                           relationship to  the  socioeconomic  conditions  of
              Perhaps  the  major  reason   why   health   does   the  environment  in  which  they  are  found.-J.H.
             not have a very high priority in  Harlem  is  that   Medical Student, Harlem.
             there are  so  many  other  problems  facing  peo-      In  terms  of  health-care  delivery,  the  most
             ple who live there  that  have  more  to  do  with   important  differences  I   discerned   in   Harlem
             simply keeping food on the  table  and  keeping  a   are  matters  of  priorities.  Residents  of   Har-
             decent apartment.  Rather  than  try  to  describe   lem's Lenox  Terrace,  and  the  middle-class  ori-
             the galaxy of social problems that afflict  people   ented  mothers  with  whom  we  worked,   can   af-
             living in Harlem, I will  outline  a  few:  Health   ford  to  be  concerned  about   preventive   medi-
             care is expensive; not only does treatment  at  a,   cine, dental care,  and  the  like,  because  their
             clinic or a doctor's office cost a lot, but it may   physical   and   psychological   environments   are
             mean the loss of half a  day's  salary  to  go  to   more in order  than  those  of  the  slum  tenement
             an appointment. Added to  this  may  be  the  cost   families across the street.
             of a babysitter to take care of a  mother's  other      Some of  the  mothers  whom  I  visited  had  an
             children, and transportation costs to get  to  the   entirely  different  hierachy  of  priorities,  and
             relatively centralized health facilities  in  Har-   preventive  medicine  was   far   down   on   their
             lem.  As  a  result',  checkups  or  non-emergency   lists, below  housing,  food,  and  crisis  medical
             problems are    often   prohibitively   expensive.   care,  their  major  concerns   were   matters   of
             Moreover,  people  who  live  in  Harlem  may   be   day-to-day survival in  a  hostile,  uncaring,  un-
             more interested in getting a  job  with  a  steady   responsive world.
             salary  than  in  attending  to  health  problems.      I found it very difficult  to  convince  myself,
             Housing  conditions  or  keeping  up   With   Pay-   much less a tired,  distraught  mother  of  several
             ments  on  merchandise  may  come  before  health.   children, that one of her  kids  needed  a  general
             Preventive medicine.may be impossible  in  a  sit-   checkup  "just  because"  when  they  were   sleep-
             uation where there is a  general  lack  of  a  fu-   ing three to a bed in  a  dark,  smelly,  roach-in-
             ture  orientation.-R.C.,   Student   Coordination,   fested two-room hovel for  which  she  paid  $90  a
             Harlem.                                              month.

             16


                                                  SUMMER  1968

          I felt that I was in no  position  (strange  out-   help  them  if  they  have  health  problems.-M.G.,
       sider,  inexperienced  student)  to  address  myself   Community Worker, Bronx.
       to her real problems  and  that  even  if  I  turned   Bronx
       her case over to one  of  our  law  students,  there     There  is  mixed   opinion   in   the   community
       was little he could do for  her  either.  Should  we
       have come  more  prepared  to  direct  ourselves  to   about the health care they  are  receiving.  It  is
       those  needs  that  the  people  in  the   community   obvious,  however,  as  you   go   from   home   to
       consider  more  pressing  than   non-crisis   health   home, which family does  its  best  for  its  chil-
       care? If so, what can we really  offer  at  all  ex-   dren -and which do  not  even  try  to  secure  the
       cept a  body  willing  to  do  legwork  or  babysit?   care available  to  them.  Mothers  are  often  ne-
       (Actually,  we  don't  have  that   much   more   to   glectful  except  when  it  comes  to   themselves.
       offer!)-W.S., Medical Student, Harlem.                 Children  are  dirty  and  unclothed  and   receive
                                                              no  medical  attention.  Other  mothers  of  equal-
       Bronx                                                  sized families in the same area do  not  live  ela-
          The mothers' classes in   the  Bronx   were   not   borately, but  the  home  and  children  are  clean
       attended  because  the  mothers  did  not  see   at-   and they do their  best.  They  are  the  ones  who
       tending  classes  as  a  priority   need.   When   a   do not complain  too  much  if  asked  about  medi-
       mother   has   unsolved   problems   with    welfare   -cal  care,  although  everyone  has  some   gripes
       and  housing,  she  really  is  not  too   concerned   about  hospitals  such  as  Morrisania.   The   ne-
       about  what  happens  to  her  body   during   preg_   glectful  mothers  are   more   dissatisfied,   but
       nancy. I am not suggesting  that  there  is  not  a.   again are  primarily  uninterested  or  despairing.
       need  for   such   classes,   but   more   immediate   -P.E-, Nursing Student, Bronx.
       needs should be taken care of first.  A  better  ap-     I really couldn't state in words the  feeling  of
       proach  to  providing  health  classes  may  be   to   disgust and the "I don't  give  a-"  attitude  that
       work   through    welfare    rights    or    housing   the people in  the  South  Bronx  have  toward  the
       groups.  There  is  a  need  for  individual  health   hospitals and clinics.-
       counseling  for  people   facing   specific   health   H.H., Nursing Student, Bronx.
       problems,  but  hoping  to  form  a  group  for  the
       sole purpose  of  health  classes  is  unrealistic.-   Lower East Side
       V.V., Nursing Student, Bronx.                            Much   of   our   information   concerning    the
          I felt out of place forcing the issue  of  health   Lower   East   Side   community's   view   of   the
       care  when  the  tenants  had  many   other   things   health care in the  area  was  collected  by  means
       they  wanted  first,  especially  housing   repairs,   of  random  canvassing   throughout   the   commun-
       full welfare benefits,  and  better  police  protec-   ity. As with  most  methods  of  canvassing,  there
       tion.  The  health  care  I  heard   about   sounded   are no real instruments  to  measure  the  validity
       like  all  the  cliches-poor  quality,   fragmented,   of  expressed  opinion   and   experience.   There-
       inaccessible, without  regard  for  the  dignity  of   fore,  after  sifting  through  generalities,   in-
       the patient, in the  control  of  external  institu-   dividual  misfortunes,  etc.,  we  focused  upon  a
       tions. On the whole,  I  think  the  real  lack  was   number of  problems  that  appeared  to  be  repre-
       in  preventive  measures.  The   housing   code   on   sentative of the community  as  a  whole.  The  two
       hazardous  and   unhealthful   conditions   is   not   problematic areas  to  which  our  group  initially
       enforced,  garbage  is  not  collected,  walls   and   directed most of our  time  and  energy  were:  (1)
       ceilings let rats and  roaches  through,  diets  are   The  recently  instituted  medicaid  and   medicare
       often   skimpy.-K.B.,   Medical   Student,    Bronx.   sliding-scale classifications for clinic fees;  and
                                                         --   (2)  the  transportation  problem  wherein   people
          When SHP  comes  back,  please  do  not  ask  the
                                                              found it an inconvenience to  travel  to  and  from
       community  how  you  can  help  them   because   you   the  Bellevue  outpatient  clinics.-E.C.,   Medical
       will   hear   everything   but   health    problems.
                                                              Student, Lower East Side.
       They  will   tell   you   welfare,   housing,   play
       streets. Just let  them  know  you  are  willing  to     If  we  in  the  Lower  East  Side   SHP   regard


                                                                        YORK
                                                       GREATER     NEW
              ourselves as healers of a chronically  ill  system    made worse by the  scarcity  of  taxicabs  cruis-
              of health care delivery,  then  our  treatment  of    ing the  Lower  East  Side  and  the  absence  of
              it this summer can  best  be  described  as  symp-    subway facilities in the area.
              tomatic. I do not believe  that  the  health  care     Bellevue is a huge,  impersonal  institution;  a
              problems of the Lower East  Side  are  related  to    very easy place to get lost in. The structure  is
              the methods of health care delivery per se. It  is    too large, the  passageways  too  cavernous,  and
              unfortunate,  for  example,  that  a  patient  may    the directional signs are  abysmally  inadequate.
              have to wait a long time at an allergy clinic  for    These features are especially  formidable  obsta-
              his turn to see a doctor; but if we find that  the    cles to patients lacking a firm  command  of  the
              patient"s  allergy  responds  remarkably  well  to    English language.
              moving him from  his  dirty,  roach-infested  ten-     * *  *  We  regarded  our  group  as  a  commun-
              ement  to  a  clean  and  airy  apartment   house,    ity-located  action  organization  working   with
              mustn't we  admit  to  ourselves  that  the  prob-    Bellevue to effect  changes  that  would  improve
              lem, really, is in the  housing?  I  believe  that    the delivery of  health  services  to  the  Lower
              future Student  Health  Projects  will  make  more    East Side. Early in the  summer  we  developed  a
              enduring  and  important  changes  in  the  health    productive liaison with the department  of  pedi-
              of the communities  they  work  in  if  they  con-
                                                                    atries, whose director served as advisor  to  our
              cern  themselves  more  with   social,   economic,    group  throughout  the   summer.   We   had   in-
              and  political  activism,  and  less  with  estab-    tended to focus our  efforts  on  the  pediatrics
              lished medical facilities or health-oriented  com-    clinic, but discovered that  this  department  of
              munity organizations which  are,  afterall,  dedi-    Bellevue was very sensitive to the  -problems  of
              cated to the maintenance of the  status  quo.  Im-    the community it was  treating  and  was  already
              proved health care in the  Lower  East  Side  area    attempting to solve problems that  other  clinics
              in the  future  depends  more  on  providing  more    didn't even realize  existed.  In  comparison  to
              and better  jobs,  better  housing,  and  improved    other Bellevue clinics, Pediatrics is a  paragon.
              education  in  the  community  than  in   cleaning    Therefore,  we  decided  to   involve   ourselves
              up the wards at Bellevue  or  making  doctors  be-    with problems of  the  institution  as  a  whole,
              come nice people. Not that  these  latter  factors
              are unimportant but  they  are  luxuries  that  we    and not with the particular problems of  the  de-
              can deal.  with  after  the  basic  problems  have    partment of pediatrics.
              been   solved.-J.A.,   Medical   Student,    Lower     .To define the existing problems,  we  first  met
              East Side.                                            with doctors at Bellevue  and  viewed  the  work-
                                                                    ings of the clinics. We  went  to  the  community
                      HEALTH CARE DELIVERY                          to. speak  to  organizations  and  residents.  We
              Lower East Side                                       followed  up  patients  who  were  known  to  use
                It is! difficult to  generalize  about  Bellevue    the services at Bellevue. We  knocked  on  doors,
              Hospital. The  enormity  of  the  physical  planIt,   spoke to people  on  the  street,  and  met  with
                                                                    community   organizations.   Our    relationships
              the complexity of  its  organizational  structure,    with these  people  were  informal  and  unstrue-
              and the  heterogeneity  of  the  hospital's  staff    .ured, and our  conversations  were  very  sponta-
              defy simple  categorization.  However,  a  general    t
              impression of  the  hospital  has  been  imprinted    neous. Certain  problems  were  consistently  ex-
              in  my  mind  through  certain  experiences   that    pressed by the people, and we  chose  those  that
              tended  to  recur  and  through   attitudes   that    we thought we could work with.
              seemed to be ever-present.                             An illustrative example of  our  experiences  is
                The physical structure is  not  well-suited  for    our work with the fee  system  at  Bellevue.  The
              the delivery of good medical  care  to  the  resi-    predominant myth at Bellevue  is  that  there  is
              dents  of  Manhattan's  Lower   East   Side.   The    no  problem  paying  hospital  bills:   "Medicaid
              hospital .is inconveniently located and  is  diffi-   and welfare pay all  their  bills";  "They  never
              cult to  get  to  by  public  transportation.  The    pay their bills anyway"; "They fool  us  by  giv-
              problem  of  transportation  to  the  hospital  is    ing us a  wrong  address";  "If  they  don't  pay

              18


                                                 !" ' SUMMER  1968
        nothing happens  to  them"  etc.  Quite  a  different    but  who  were  not  admitted  and  had  to   return
        perspective  on  this  situation  can  be  gained  by    to  the  Lower  East  Side  during  the  night.   We
        anyone  talking  to  residents  of  the  Lower   East    did  not  think  that  improving  the  bus   service
        Side about  this:  "I'm  afraid  to  go  to  Bellevue    would  eliminate  these  problems  because  we   did
        because  I  have  no  money";  "Eleven   dollars   is    not  think  it  sound  medical  procedure  for   ill
        too much  to  pay,  I  can't  afford  it";  "Medicaid    adults and children to  walk  several  blocks  to  a
        used  to  pay  for  my  medical  care,  but   doesn't    bus stop and then wait a long  time  for  a  bus  to
        since  the  Government  took   the   Medicaid   money    arrive, particularly  in  bad  weather  or  late  at
        away";  and  "If  I  don't  pay  my  bill  the  clerk    night.  We  thought  that  either  a   hospital   or
        will  embarrass  me  in   front   of   everyone   the    community-based   car   service   would   contribute
        next time I go to the hospital."                         to solving these problems.  We  hope  that  our  ef-
          As  of  July  1,  1968,  a  new  sliding  scale  of    forts iti the study of this problem will lead  to  a
        fees went into effect for  all  city  hospitals.  De-    greater  utilization  of  a  Medicaid-financed  pri-
        pending  on  income  and  the  size  of  the  family,    vate  car  service  by  patients  unable  to   reach
        people  were  to  be  billed  from  $3  to  $11   for    Bellevue  by  conventional  modes   of   transporta-
        visits to  Bellevue's  clinics.  Most  patients  from    tion.-J.A.,  Medical  Student,  Lower   East   Side.
        the Lower East Side  were  in  the  $3  to  $5  cate-     Another  area  we   worked   in   points   up   the
        gory, but they  did  not  know  this.  The  signs  at    problem  of  poor   communication   between   hospi-
        Bellevue  still  described  the  old  $11   fee   for    tal  administration  and  staff  even  more.   After
        weeks  after   the   system   had   been   abandoned,    talking  with  the   administrator   of   Gouverneur
        and  little  effort  was  made  to  notify  the  com-    Hospital,  which  runs   its.   own   transportation
        munity of the reduction in  fees.  (I  was  told  the    service for those who  can't  use  public  transpor-
        newspapers   carried   this   inform@ation    as    a    tation, we decided  to  propose  that  such  a  ser-
        public service.  I  missed  the  story,  and  I  sup-    vice be  instituted  by  Bellevue.  Gouverneur  pays
        pose many others  did,  too.)  As  a  result  of  our    for private cars but it also uses  the  services  of
        prodding  of  the  administration  of  the   hospital    cars paid for by Medicaid for the  use  of  eligible
        and the office  of  the  commissioner  of  hospitals,    Medicaid  recipients.  The   patient's   eligibility
        new  signs  in  English  and  Spanish   were   posted    for  such  a  service  is  determined  by  the   pa-
        throughout  the  hospital  explaining  the  new   fee    tient's doctor who fills out a request for  it;  so-
        system.  In  addition,  we   obtained   a   pamphlet,    cial  service  handles  the  rest.  Naturally,   the
        also in  English  and  Spanish,  that  described  the    funding  of  the  cars  and  the  drivers'  salaries
        new  fee  system  and  distributed  it  to   everyone    was the main issue. As far as the admini           -
        on the streets  of  the  Lower  East  Side.  We  also    tion  at.Bellevue  knew,  that  hospital  had  never
        placed signs in'loc-al storefronts.                      used  and  didn't  know  that  such  a  service  was
          We    developed    the    transportation    problem    available under Medicaid.
        with  the  advice  of   various   community   organi-      A trip to the  central  Medicaid  office  at  34th
        zations,  particularly  the  North   East   Neighbor-    Street  revealed  that  Bellevue  did  indeed  avail
        hood  Association,   the   United   Neighbors   Asso-    themselves  of  these  services-at  least,  the  re-
        ciation,  the  Fifth  Street   Mothers,   and   Movi-    habilitation  and  orthopedic  clinics   did.   When
                                                       cluded    informed  of  this   the   administrator   was,   of
        mientos Puertoriqueftos Unidos. We con                                      I
        that  patients  in  acute  crisis   were   adequately    course, greatly surprised that. his  initial  inves-
        transported  to  the  hospital  via   the   ambulance    tigation  hadn't  indicated   that   Bellevue   used
        emergency   service.   However,   we   thought   that    such a  service;  he  said  he  would  make  further
        adequate   facilities   for    transportation    were    inquiries. A  few  days  later  he  reported  to  us
        lacking  for  clinic  patients,  for  patients  want-    that  a  supervisor  at  the  same  medicaid  office
        ing  to  use  the  emergency  room  services   during    insisted  -that  medicald  provided  no  such   ser-
        the  night  but'who  did  not   consider   themselves    vice!  Thus,  we  have  a  case  of  a  phantom  car
        sick enough  to  call  the  ambulance,  and  for  pa-    service   which   neither   Bellevue   or   medicaid
        tients  brought  to   the   hospital   by   ambulance    knows  about,  which   Bellevue   uses   and   medi-
                                                                                                                   19


                                                   GREATER       NEW  YORK

              caid   provides!-J.M.,   Nursing   Student,   Lower   gent. I would say that  the  people  seek  care  in
              East Side.                                            equal  numbers  at  Bellevue,  Beth   Israel,   and
                We  found   Bellevue's   administration   to   be   Gouverneur.   Many   had   no   complaints    about
              very receptive  and  helpful  to  us.  However,  it   Bellevue. Many heated  it.  The  reasons  they  ex-
              matters little what one supervisor  or  one  in  i-   pressed  most  often  for  using  facilities  other
              vidual  says,  since  the  hospital's   rules   and   than  Bellevue  were:  Spanish-speaking   staff   ;
              chains  of  command  are  so  extensive  and   com-   more courteous  treatment;  not  as  long  a  wait,
              munication is so poor.                                therefore a day's wages didn't  have  to  be  lost.
                In the beginning  of  the  summer  we  had  seri-     For  those   people   who   missed   appointments
              ous   misgivings   about   being   connected   with   at  Bellevue  whom  we  followed  up  and  visited,
              Bellevue, especially  since  the  Lower  East  Side   it appeared the reasons  were  usually  an  inabil-
              community is trying to cut  the  cord  with  Belle-   ity to find a place to keep their kids  or  an  in-
              vue   by   establishing   its   own   comprehensive   ability to travel to Bellevue'  For  many  of   the
              health  center.  An  end  of  the  dependence  that   patients, the problem is  what  I  believe  is  the
              Lower  East  Side  residents  have  long   had   on   first   problem   in   health-care    delivery-they
              Bellevue, and  which,  to  a  certain  extent,  has   can't  afford  it.  They  know  the  hospital  will
                                                                    send a bill and they don't like  not  paying  bills
              allowed  poor  hospital  conditions  to   continue,   so they  don't  come  for  help.  In  one  case  in
              will probably be  the  best  thing  that  could  be   which the  woman  neglected  going  to  the  hospi-
              done both  for  the  community  and  for  Bellevue.   tal because she couldn't  afford  the  fee,  I  as-
              People who have a choice  will  go  to  the  health   sured her  the  hospital  would  never  refuse  her
              facility that offers them the best care.              service, money or  no.  She  finally  came  to  the
                Bellevue  should  not   make   the   mistake   of   hospital and it was found  that  she  zibeded  sur-
              supposing  that  Lower  East  Side  residents   are   gery,  which  she  has   now   had.-J.M.,   Nursing
              too unsophisticated,  too  irresponsible,  or  even   Student, Lower East Side.
              too stupid to  know  the  difference  between  good
              and bad health care'    For . what, after  all,  is     The  idea  for  the  NENA  health  center   arose
              good health  care?  Does  it  matter  if  a  doctor   because  of  the  mistreatment  of  community  res-
              has won a Nobel  Prize  if  his  patient's  bed  is   'dents at other institutions and the lack  of  suf-
              roach-infested?  Or,   if   a   doctor's   language   ficient health facilities on the Lower  East  Side.
              "doesn't happen to  be  Spanish,"  yet  Spanish  is   From  my  own  experience,  doing  clinical   prac-
              all  the  majority  of  people  in  this  area  can   tice in  a  municipal  hospital,  I  find  many  of
              speak?  These  people  are  extremely  capable   of   their criticisms are valid.
              judging the quality of health  care  they  receive.     One  complaint  that  I   can   support,   having
              This  is  obvious  because  many  of  them,  though   worked in a city hospital, is  the  one  of  deper-
              complaining   about   Bellevue's   clinics,    have   sonalization that takes place in  these  large  in-
              nothing but praise for  the  pediatric  clinic.  In   stitutions. People are  not  treated  as  individu-
              this  clinic  there   are   Spanish-speaking   com-   als. They are forced, for example, to  see  differ-
              munity  workers  who  help  with  translation,  ap-   ent doctors all  the  time  even  when  a  familiar
              pointments  are  made  for  further   visits   (and   face  would  make  the  situation  less  embarrass-
              they are kept), and, if a  patient  has  a  problem   'Ilk and perhaps less  painful.  The  doctors  that
              at   home,   the    community    health    workers,   see these patients in a clinic  do  not  have  time
              nurses  (and  occasionally   doctors)   will   make   to study  the  background  of  each  patient,  such
              home visits to see if  further  help  can  be  pro-   as the  number  of  people  in  a  family  and  the
              vided.  Bellevue  personnel  must   stop   thinking   conditions they live  under  and  if  they  do  get
              that a person's  sensitivity  to  true  human  con-   'this information it is not  always  passed  on  to
              cern is  dulled  because  his  income  is  low.  If   the    next    doctor.-4.L.,    Nursing    Student,
              anything, it is heightened.                           Lower Ewt Side.
                *  *  *  In  our  contact  with  the   community,     I do  not  believe  that  the  residents  of  the
              the  opinions  we  heard  were  many   and   diver-   Lower  East  Side  community  feel  that  they  are

              20


                                                 SUMMER  1968

       not getting good  medical  care.  Most  people  do     Newark  is  ranked  at  least  second  in  infant
       not think about medical care  at  all  until  they   mortality, drug  addiction,  and  TB  deaths.  Peo-
       are acutely ill, and it  has  been  my  impression   ple fired on this hospital during the 1967 re )e  -
       that  the  residents  of   this   community   have   lion. They hate it.  They  hate  the  3-hour  waits
       found places to be treated  that  they  regard  as   in  clinics;  being  turned   away   from   clinics
       adequate. The  pediatric  clinic  at  Beth  Israel   without   treatment;   being    misseheduled    for
       Hospital  and  the.pediatric  clinic  at  Bellevue   clinics;  the  lack  of  hum-an  concern  and   the
       are widely regarded as excellent  medical  facili-   abuse received from all levels of staff;  the  lack
       ties.                                                of  anaesthesia  for  delivery;  inadequate  social
         Some  patients  prefer  private  or  union  doc-   services; families  being  notified  2  to  3  days
       tors,  others  prefer  Columbus  Hospital  because   after a patient  has  died,  or  finding  out  when
       of  the  large  number  of  Spanish-speaking  per-   visiting;  filthy  and  uncomfortable  waiting  fa-
       son,nel there. Some  prefer  Beth  Israel  because   cilities; lack of followup, etc.,  etc.-A.H.,  Med-
       it is near, clean, and they  don't  have  to  wait   ical Student, Newark.
       long,  and  some  prefer  Bellevue  because   they
       like the medical care they  get  there.  Certainly     I particularly don't like  Martland  Hospital.  I
                                                                  'ek  once  when  I  was  pregnant   with   my
       there  are  complaints,  especially  about  Belle-   was si
       vue: the long-waiting hours in the  clinics,  rude   litle boy. Used to have  nerve  tantrums,  and  had
       and  impersonal  hospital  staff,  dirty  and  de-   to get a shot.  When  my  mother  took  me  to  the
       pressing surrounding,  etc.  I  believe,  however,   hospital, those people put me on  the  10th  floor,
       that the people  have  accepted  these  faults  as   the psychiatric ward, and  I  was  not  allowed  to
       inherent and  inevitable  aspects  of  the  system   leave  until  I  was  examined.  My  mother   told.
       of delivery of health  care,  and  are  not  espe-   those people I just had to have a  shot,  and  they
       cially concerned  with  complaining  or  changino,   kept me there and  made  me  go  through  all  this
       the  present  situation.-J.A.,  Medical   Student,   red tape. I just wouldn't  take  my  dog  there.  I
       Lower East Side.                                     take my children  to  Beth  Israel  in  Newark.  At
                                                            Beth Israel, people act like  they  are  concerned.
       Newark                                               You don't  hear  smart  remarks.  The  hospital  is
         Martland,  formerly  City  Hospital,  is  better   clean,  you  don't  even  know  iVs   a   hospital,
       known  in  Newark's  Central  Ward   as   "Butcher   doesn't have that funny  smell,  and  the  food  is
       Shop  on  the  Hill."  This  hospital  is   under-   not food for animals. It's nice, it's so much  dif-
       staffed,  underspaced  and  underfunded,  90  per-   ferent, the people  there  are  so  nice  and  when
       cent of its patients are  on  welfare.  The  Board   you  leave  they  give  you  a   questionnaire   to
       of Health  in  Newark  is  inactive,  ineffective,   write what you like about the hospital.
       and unconcerned.                                       Not  many  people  from  this  area  go  to  Beth
         City  Hospital  was  run  on  a  minimum  budget   Israel because it is a  private  hospital.  When  I
       for years. Jobs  were  political  plums  and,  be-   was pregnant I  had  to  pay  $6  for  every  visit
       fore the  New  Jersey  College  of  Medicine  took   for an  examination,  and  I  had  to  pay  for  my
       over recently, only  a  portion  of  the  @ff  ac-   pills, and it was $300 or something  like  that  to
       tually worked, others just collected  checks.  De-   have my baby and I.had  to  have  the  cash  first.
       partments, clinics, and  emergency  room  ran  in-   But a lot of people around  here  don't  have  that
       dependently   with   no   communication    between   money. I didn't have it either, but I just  had  to
       administration  and  medicine,  nursing,  dietary,   get that  money  because  I  wasn't  going  to  the
       etc.  Even  good  @ff  became  bogged   down   and   City Hospital.-G.J., NYC, Newark
       bitter in the  medical  morass.  Result:  patients
       suffer from  bitter,  tense  staff,  uncoordinated     The  delivery  of  health  care  to  the  commun-
       medical care, failure to be directed  to  existing   ity was ineffective and insufficient. Many  of  the
       facilities. I have seen patients wake  up  in  the   hospital   departments   are    undermanned.    The
       hospital, realize where they  were,  and  run  out   majority of their  present  staff  is  grossly  un-
       of the door dripping blood fron stab wounds.         productive.  This  stems  from  many  causes:  @the

                                                                                                             21


                                                   GREATER       NEW  YORK
             jobs were under city civil  service,  many  of  the    dirty; the floors look as  if  they've  never  been
             political  appointees  are  unqualified  for  their    mopped,  and  there  was  a  lot  of  useless  junk
             positions; many of  the  staff  believe  that  good    lying  around  which  was  finally  removed   about
             health care is a privilege and not  a  right.  Con-    24 hours after I called and made the request.
             sequently, the  people  administering  health  care      The patients have  to  wait  to  see  the  doctor
             have  corruptive   attitudes   about   the   Newark    in these  surroundings  from  2  to  4  hours,  de-
             black  community.  One  of  the  hospital  adminis-    pending on how early they  arrive  at  the  clinic.
             trative staff was quoted  as  saying:  "These  Peo-    Everyone  is  given  an  8:30   a.m.   appointment.
             ple are all  the  same,  you  have  to  treat  them    The  doctors  arrive  around  9:00  a.m.  to  begin
             like,animals."                                         seeing -new patients,  but  do  not  see  returning
                Hospital  records  were  out  of  order;   cases    patients until 10:00  a.m.  Some  of  this  waiting
             and files were misplaced  and  lost,  record  rooms    time is needed by  the  P.H.N.s  to  take  weights,
             were open only six hours a  day  and  four  days  a    blood pressures, etc., but not  3  hours.  However,
             week,  and  doctors  had  no  way  of  getting  any    since  there  are  so  many  patients  and  so  few
             histories  or  X-rays  during  off-hours  or   off-    nurses,  the  nurses  seem  to  be  very  busy  all
             days.                                                  morning. The  patients  are  served  on  -a  "first
                Clinic patients were  forced  to  wait  anywhere    come, first served"  basis,  so  many  arrive  very
             from 2 to  7  hours  before  they  could  be  seen;    early. If  a  returning  patient  arrives  at  7:00
             many  were   even   turned   away   without   being    a.m., then she will be one of  the  lucky  "firsts"
             rescheduled. The people  were  forced  to  wait  in    to see the doctor at 10:00 a.m.
             filthy, hot  rooms,  with  no  restrooms  or  water      All the patients  seem  to  be  treated  equally,
             facilities. Many of the clinics  are  located  near    except  sometimes  I  have  seen   certain   nurses
             food   service   garbage   rooms,   which   present    giving the Puerto Rican patients  a  bad  time  be-
             problems with  flies  and  the  smell  of  decaying    cause  they  cannot  speak   English.-L.D.,   Nurs-
             waste.-D.B., Community Worker, Newark.                 ing Student, Newark.'
                In the  prenatal  clinic  at  Martland  I  found      The lack  of  facilities  for  good  health  care
             many   positive   things   but   mostly    negative    are not  isolated  to  Martland  Hospital  and  its
             things. The nursing care the  patients  receive  in    clinics.  Most  of  the  programs  offered  by  the
             the clinic is very good. The clinic is  staffed  by    Board  of  Health  and  its  drug  dispensary   are
             public health nurses who  want  to  give  each  pa-    plagued   by   similar   problems.   The   problems
             tient individualized  care  as  much  as  possible.    range  from  improper  followup  of  cases   (which
             Most of  the  nurses'  attitudes  seemed  good  and    eventually  become  chronic  ailments)  to  useless
             they appeared to  be  interested  in  the  patienVs    and  cursory  initial  treatment.  Medical   people
             problems.   However,   there   are    only    seven    use "lack of supplies" as  their  excuse.  But  the
             P.H.N.s  and   approximately   125   patients   per    fact is that they don't  make  proper  use  of  the
             day.  Most  of  the  time  the  nurses   got   tied    little  they  do  have.  As  with  other   services
             down  with   paperwork   and   assisting   doctors,    found in the context of  our  society,  the  health
             and were unable  to  do  as  much  health  teaching    delivery system  in  Newark  are  corrupted  by  an
             as  they  wanted  to  do.  The   nurses   do   make    inherent  disrespect  for  and  unconcern  for  the
             home visits  to  try  to  do  some  of  the  health    poor, nonwhite peoples.
             teaching the patients often miss in the clinic.          There   are   many   members   of,   the   Newark
                The physical setting in  the  clinic  is  awful.    community  who  would  rather  die   than   subject
             The patients are packed into  a  very  small  area.    themselves  to  the  health  care  offered  by  the
             They  sit  on  hard,  wooden  church  pews.  For  a    city.  Those  who  can  afford  health  care  pri-,
             while there were no fans in  the  clinics  and  pa-    vately  would  much  rather  do  so.  For  the  ma-
             tients  would  frequently  faint  from  waiting  so    jority of the people, however,  there  are  no  op-
             long  in  that  hot  stuffy  room.  However,  after    tions  available.  Community  people  are  not   as
             enough  patients  had  fainted,  someone  was  able    ignorant  as  many  suppose  them   to   be.   They
             to procure fans for the clinic. The clinic is  very    judge the value of their  health  care  only  after

             22


                                                 SUMMER  1968
       years  of  experience.   Newark   SHP   has   numer-   ulation of the  area.  It  seems  that  more  imagi-
       ous  accounts  of   conversations   with   community   native   means   of   communicating   the   checkup,
       people  in  which  they  usually  expressed  dissat-   such  as  a  sound  truck,  would  have  brought   a
       isfaction  with  their  health  care.   Their   most   great  many  more  persons.   Another   problem   of
       useful  parameter  is  a  measure   of   discomfort.   the checkups  and  the  free  clinics  is  that  the
       They will usually tell you that a visit  to  one  of   older  males  almost  never  come.  Women   of   all
       Newark's health.  centers  results  in  an  aggrava-   ages  and  children,  yes,  but  hardly   ever   any
       tion of discomfort rather  than  an  easing  of  it.   males  over  high  school  age.  This  comment   re-
       In  general,  the  Newark  population  is   repulsed   fers  to  city-run  checkups  lasting  until  7   or
       by  its  health  care-repulsed  to  the   point   of   8:00 p.m., and free clinics  run  by  Queen  of  An-
       hostility.-R.P.,    Community    Coordinator,    Ne-   gels Church between 5 and 9:00 p.m.
       wark.                                                   Another  problem  I  was  told   about   was   that
        While  working  in  the  Martland  Clinic,  I   ob-   it is almost  impossible  to  geta  doctor  to  make
       served that  the  people  who  came  to  the  clinic   a house call in  Newark.  For  this  reason,  people
       received  good  care,  but  I  might  add  that  the   who  are  not  in  an  actual  emergency  state  but
       community  people  were  very  reluctant  to   come.   do need the services  of  a  doctor  call  the  city
       They  often  would  come  to  the   hospital   days,   ambulance  to  take  them  to   Martland   Hospital.
       weeks, or  even  years  after  they  developed  med-   Those  who  have   had   a   very   bad   experience
                                                              with  the  hospital  and  do  not  wish  to   return
       ical  problems.  An  example  was  a  boy  about  11   have nowhere else to go if  they  are  on  wel.fare.
       years  old  who  came  into  the  emergency  room  3   The   no-house-call   problem    undoubtedly    will
       days after he  had  cut  his  head  on  a  piece  of   continue, but since  the  college  took  over  Mart-
       glass. The doctor told  me  he  could  not  adminis-   land  Hospital  it  is  possible  that  maybe  5  or
       ter the proper  medical  care  to  the  patient  be-   even  10  percent  of  the  people  who  have  sworn
       cause  a  wound  of  this  type   must   be   closed   never  to  return  to  Martland  may  give  it   an-
       within  8  hours  of  the  occurrence.  There   were   other  chance  after   learning   it   has   changed
       many  similar  cases  where  people   neglected   to   hands,  and,  hopefully,  they   won't   be   disap-
       come to the hospital promptly.                         pointed again.
        I  found  out  by  administering  a   questionnaire     I did  note  two  other  major  problem  areas  in
       to  the  women  in  the  maternity  ward  at   Mart-   which  improvements  should   be   made.   One   was
       land that  in  many  instances  they  had  neglected   the  abominable  state  of  dental  care  of  almost
       their  health.  They  did  not  know   about   birth   all the persons  in  Newark's  Central  Ward.  I  am
       control  methods;  they  had  dental  problems   but   unaware  of  what,  if  any,  dental   clinics   are
       never  went  to  the  dentist;  and  the  same   was   available.  A  second  more   general   problem   is
       true  of  many  other  medical  problems  they  had.   finding  and  helping  the   real   poor-the   igno-
       Some  women   complained   of   long   waiting   pe-   rant, despairing,  almost  helpless  person  who  is
       riods in the prenatal  clinic,  and  other  patients   hardly  being  touched  by  the   health   and   wel
       said  they  had  received  rough  treatment  in  the
       maternity  ward   and   delivery   room.   The   mai   fare  programs.  Some  referrals  to  these   people
                                                              may  come  through  the  emergency   room.   A   far
       answer  I  got  from  these  women  when  I   askeci
       them  why  they  did  not  go   for   medical   care   better  source   is   through.   people   who   know
       when  they  needed  it  were,   "they   didn't   kno   them  in  the  community.  One  such  case   was   a
                                                          :w  71-year-old  guardian  of  five   great-nieces   and
       why they  didn't  go."  or,  "they  were  afraid  to   nephews  and  the  two  children   of   the   oldest
       come to the hospital."-Anony            ,    Newark.   niece  whose  welfare  check   was   going   to   be
         There  are  many  problems  of  health  care   de-   cut.  This  woman's  only  contact  with   the   so-
       livery  in  the  central   ward   of   Newark.   One   cial services and agencies  set  up  to  aid  people
       problem   is   neighborhood   health   examinations.   was   an   unsympathetic    welfare    worker.    We
       I assisted at one  such  checkup  organized  by  the   were  referred  to  her  by  a  neighbor   who   was
       city  health  department.  The   turnout   was   not   one   of   our   NYCs.-N.W.,    Law    Stvdent,    N
       small, but it wasn't near a  majority  of  the  pop-   wark.
                                                                                                                 23


                                                      GREATER  NEW  YORK
                  Brooklyn                                              Hours  of  waiting  in  the  emergency  room,  half-
                                                                        hearted  treatment  given  to  welfare  patients  as
                   The population of the Crown Heights           area
                  of  Brooklyn  is  estimated  at   225,000   people,   opposed  to  those  who  could  pay,  that  children
                  most  of  whom   are   either   black   or   Puerto   aren't cared for  unless  their  parents  are  there
                  Rican..  These  are  the  patients  that  use   St.   (try  to  explain  the  "law"  to  people  who  have
                  Mary's Hospital.                                      seen  a  child  refused  service  when   he   needed
                    St. Mary's can be seen as  a  white  fortress  in   it),  that  white  children  get  dental   care   at
                  a black forest. It is a voluntary hospital  with  a   Brookdale  Hospital   a   few   weeks   after   they
                  capacity of 237 beds,  administered  by  the  Cath-   apply  whereas  black   children   must   wait   for
                  olic Medical Center of  the  Diocese  of  Brooklyn.   months-all this  has  been  told  to  us  again  and
                  In my opinion, it is  a  4th-rate  hospital  in  an   again.  Many  people  claim  they  wouldn't  go   to
                  area  where  there  is   tremendous   need.   Until   Brookdale  if  their  lives  depended  on  it.   The
                  several years ago, the hospital  refused  to  prov-   community  resident  have  been  asking   for   bet-
                  ide  outpatient  services  for  the  residents   of   ter  services-a  better  emergency  room,   a   nar-
                  Crown Heights.  During  the  last  few  years,  the   cotics  program-  and  Brookdale  has   been   deaf.
                  forest has crept in. There is still a good deal  of   -E.B., Medical Student, Brooklyn.
                  resentment by  staff  and  employees  of  the  hos-     Health  care  delivery  services  in  the  Browns-
                  pital  who  represent  the  "old   guard,"   having   ville  section  of  Brooklyn  are  far   from   ade-
                  such attitudes as: people  who  receive  free  med-   quate.
                  ical   treatment   (the   Medicaid    fiasco    has     Brookdale   Hospital   has   two   new    programs
                  changed this) should not care  whether  it  is  ad-   Comprehensive   child    care,    and    multiphasic
                  ministered  with  dignity  or  not.-W.B.,   Medical   screening-both  of  which  in  format   appear   ex-
                  Student, Brooklyn.                                    cellent.  From  contact  with   the   programs,   it
                                                                        seems  evident  that  the  staff  is  attempting  to
                    Those  of  us  who  have  observed  the  workings   deliver  total  health-care  services  to  the  com-
                  of the pediatric  clinic  at  St.  Mary's  Hospital   munity-  The  programs  have   not   been   success-
                  have noted the cursory  care  given  the  patients.   ful and the  services  are  under-utilized  because,
                  We identified this not  simply  as  a  function  of   (a) the  community  did  not  participate  in  plan-
                  disinterest or lack of  thoroughness  on  the  part   ning  the  program,  and  (b)  Brookdale   has   had
                  of the doctors, or as simply a  crush  of  patients   a  reputation  for  many  years  of  giving  second-
                  in a  short  time,  but  rather  that  the  patient   class   treatment   to    Brownsville    residents.-
                  does  -not  enjoy  what  we   are   accustomed   to   L.K., Medical Student, Brooklyn.
                  seeing  as  the.proper   doctor-patient   relation-     Through activities in  the  clinic,  I  found  out
                  ship. The'patient is not  seen  by  the  same  doc-
                  tor at each visit,  although  an  attempt  is  made   how many people  felt  about  the  health  care  af-
                  to some extent to do this.  There  is  no  appoint-   forded  the  community  at  Kings  County   Hospital
                  ment  system  at  the  present  time  and  the  pa-   in  Brooklyn.  Most  people  readily  admitted  that
                  tients and parents  must  wait  an  hour  or  more.   the doctors  were  quite  competent  and  that  they
                  Most  important,  however,  the  doctor   sees   an   felt their children  were  in  the  best  of  hands.
                  incomplete  chart  on  each  patient.  He  is   ex-   One  common  complaint  had  to  do  with  the  lack
                  pected  to  treat  the  symptoms  of  the   episode   of  understanding  that  the  doctors  showed  con-.
                  rather than the                                       cerning  the  day-to-day  problems  of  the   ghetto
                                   .patient as an  individual.  Often      ther. First of all, most doctors  did  not  fully
                  the value of knowing  past  facts  about  the  med-   mO
                  ical history of the  patient  proves  essential  to   comprehend  the   conditions   that   these   people
                  adequate   patient   care.-M.H.,   Sociology   Stv-   live  under.  This  was  one  of  the  reasons   why
                  dent, Brooklyn.                                       the role of the  patient  advocate  was  instituted.
                                                                        We  attempted  to  show  the  doctors  how   serious
                     The    most    common    community    complaints   the problem of  peeling  plaster  and  lead  poison-
                  were  about  the  service  in  the  emergency  room   ing  was.  In  most  cases  the  doctors  never  in-
                  and  the  attitudes  of  doctors  toward  patients:   quired about the living  conditions  of  the  family

                  24


                                                   SUMMER  1968

     being   treated.   They   didn't    think    to    ask    state  complaining  of  poor   treatment   at   King's
     whether  there  was   any   loose   plaster   in   the    County   Hospital,   and   he   undertook   to   bring
     house  or  whether  any  of  the   children   ingested    the  suit.  The  suit,  Moore  v.  Terenzio,  et  al.,
     the stuff .-D.Y., Medical Student, Brooklyn.              Index  no.  12459/68,  was  filed  with  the   Manhat-
        I  was  pleasantly  surprised  at   the   excellent    tan  Supreme  Court  on  August  6,   1968,   by   Mr.
     quality  of  medical  care  the  people   receive   at    Hanft,  an   extraordinary   lawyer   on   the   Lower
     the  Kings  County   Hospital   pediatric   outpatient    East  Side.  There  will  probably  be  a  hearing  on
     department.   Before   beginning   the    job    there    the  order  to  show  cause  sometime  in  the   Fall.
                                                               _R.H., Laiv Student, Brooklyn.
     this  summer,  everyone  was   telling   me   what   a
     "hell hole" it was. I found  it  quite  the  opposite.    Bronx
     The  only  major  problem  that  I  noticed  was   the      A  young  boy  in   that   neighborhood   had   been
     very  long  wait  encountered  by  the   patients   in    treated  at   Morrisania   Hospital   in   the   Bronx
     the   after-noon   hours,   whereas   those   patients    for  a  puncture  wound  of  the  knee,  caused  by  a
     arriving  around   nine   in   the   morning   usually    rusted  iron  bar.  His  treatment  had  consisted  of
     had little  or  no  wait  at  all.  What  most  people    X-ray  and  a  damp   bandage;   no   antibiotics   or
     fail to realize  is  that  with  many  private  physi-
     cians,  an  hour's   wait   is   not   uncommon,   and    tetanus  shots  had   been   given.   He   came   back
     with  the   tremendous   volume   of   patients   seen    to  our  storefront  complaining  of  pain.  His  knee
                                                               was  red  and  swollen  and  he  could  bend   it   or
     daily  at  Kings  County   Hospital,   an   hour   and    bear weight  on  it.  I  took  him  back  to  A-lorri-
     one-half  wait  should  not  be  unexpected.   .   any    sania and  spoke  to  the  head  doctor.  It  took  15
     of the  people  I  have  spoken  to  had  very  little    minutes  of   arguing   and   debate   about   who   I
     complaint   about   Kings   County   Hospital.   Their    was  and  whether  or  not  I  had  any  medical   au-
     main   complaints    were    usually    against    the    thority before  the  doctor  consented  to  treat  the
     smaller    neighborhood    hospitals    and    private    boy.-M.J-., Nursing Student, Bronx.
     physicians.  Invariably  many  patients   first   went
     to  these  two   before   coming   to   Kings   County      Many  feel  that  though   health   care   may   not
     Hospital.-S.P., Dental Student Brooklyn.                  be perfect, it is good  enough  to  be  a  major  rea-
        l  found  the  poor  delivery  of  health  care  in    son  for  staying  in  New  York   rather   than   re-
     New  York  City  to  be   well-documented,   and   the    turning  to  rural  areas.   Everyone   mentions   the
     people  painfully  aware  of  it.  The  question  was,    long  waiting  periods  before  the  doctor  gets   to
     what could be done about  it.  I  believe  I  found  a    see   them.   I   found   no    agreement    in    the
     partial solution, legally.                                Bronx  about  the  quality   of   health   care.   The
                                                               most  common  accusations   were   against   the   ob-
        I found a newspaper     clipping   which    related    stetrics  ward  of  Morrisania;   no   one   who   had
     that  some  months   earlier   the   Commissioner   of    been  there  once  wanted   to   return.   Bronx-Leba-
     Hospital  had  testified  before  the  State  Investi-    non  Hospital  was  felt  to  treat  patients   conde-
     gation  Commission  that  none  of   the   city's   21    scendingly;  there  was   a   fair   amount   of   bad
     municipal  hospitals  met  the  requirements  of   the    feeling   towards   it   from   Medicaid    patients.-
     Federal   Medicaid   law   or   the   State   Hospital    N.A., Medical Students, Bronx.
     Code, with respect  to  physical  facilities.  I  went
     to  the  Investigation  Commission  office   in   Man-      The  health  care  which  the   residents   of   the
     hattan,  read  the   200-page   manuscript,   and   we    Bronx  receive  does  not  seem  'as   bad   as   some
     decided  we  had  a  case  under  article  78  of  the    would   believe.   Fordham   Hospital,    while    not
     New  York  civil  practice  law   and   rules,   which    the  most  luxurious  spot  in  the  city,  seems   to
     Provides  for  the   issuance   of   a   court   order    give effective service. The hospital  is,  of  course,
     against any public official  to  compel  him  to  per-    plagued by the  problem  of  all  the  city  hospitals
     form a duty  to  see  that  the  city  hospitals  meet    -over-crowding,   too   much   red-tape,    and    not
     the requirements of the law.                              enough  personnel.  But  stories   that   it   was   a
        I  described  the  case  to  a  21  year-old  black    butcher  shop  seemed  from  my  point  of   view   to
     man  who  had  come  to  the  SHO  office   at   Down-    be  unfounded.  The  people  in  the  community   will

                                                                                                                   25


                                                    GREATER  NEW  YORK
                  all say that the care  is  horrible  and  degrading,   delivery  and  insults  received  from  the  medical
                  but many  have  had  actually  no  specific  reasons   personnel, especially the  initial  contact  at  the
                  for feeling this way. Either they  have  heard  sto-   main desk, in order to press for reform'        Stu-
                  ries  which  may  or  may  not  have  been  exagger-   dents  can  do  nothing  in   one   summer   because
                  ated, or they feel they will get  the  bad  side  of   these institutions put up  a  front  of  cooperation
                  things  wherever  they  go.  Upon  taking  a  survey   for  the  10-week  duration  of  the  SHP.   Educat-
                  of  60  Head  Start  mothers  and  talking  to  them   ing  the  residents  is   necessary.-B.B.,   Student
                  more   and   more,   many   conceded   that    their   Coordinator, Bronx.
                  health  care,  while  not   ideal,   is   adequate.-   The  people  would  rather  go   to   private   doc-
                  J.W., Nursing Student,  ronx.                          tors in the area, any  place  but  Morrisania,  Lin-
                  Health   care   attitudes   were   determined   from   coln,  and  Bronx  Hospitals.  The  people  describe
                  a  questionnaire  administered  to  60  Head   Start   these  hospitals  as   the   "dog   pounds."   Three
                  mothers  and  from  a   sampling   of   communityat-   women  I  know  delivered  their  own  children  be-
                  titudes.  Since   Fordham   Hospital   was   serving   cause   Morrisania   and   Bronx   Hospitals   doift
                  our  area  of  the  Bronx,  most  of  our  responses   have  enough   clean   sheets   for   the   patients
                  dealt with this hospital.                                   so  the  people  feel  they  can   keep   them-
                  A  majority  felt  that  Fordham  was  -not  a   de-   @elves    cleaner    at    home.-M.G.,    Commun-ttV
                  sirable  place  to  seek  care.  Long   waits,   poo.r Worker, Bronx.
                  care, disinterested doctors,  etc.,  were  given  as   The  delivery  of  health  care  to   the   commu-n-
                  reasons.  Sentiment  ran   the   gamut   from   mild   ity  residents  of  the  South  Bronx  ranges   from
                  endorsement  (usually  from  those   who   had   had   excellent to poor. I feel if people really  want  to
                  the   least   involvement),   to   outright   anger.   get good healIth care, it can be found  with.  a  lit-
                  Women  expressed   feelings   that   they'd   sooner   tle effort on their  part,  but  unfortunately  many
                  have babies at  home  than  suffer  the  indignities   people are  not  motivated  to  try.  If  they  hear
                  at   Fordham.   Several   complained   of   mi-gcar-   rumors that this city hospital  or  that  clinic  is
                  ri@ages  due  to   poor   obstetrical   care.   Many   not  doing  the  job,  they  fail  to  complain   or
                  avoided health care  for  all  but  emergencies  be-   search  out  better  medical   care.   Laziness   is
                  cause   of   such   unfortunate   experiences.-V.S.,   much of the problem. It  is  easy  to  blame  it  on
                  Dental  Student,  Bronx.                               discrimination or lack of  money,  but  if  some  of
                   The   people   in   the    Bronx    community    in   the population can  get  good  care  and  they  have
                  which I worked receive  health.  care  that  is  un-   the  same  problems,  why  can't  others?  The  pro-
                  believably  bad.  Some,.of  them  said   that   they   jects  I  worked  on  showed  that  there  are  many
                  would  rather  die  than  go  to  Morrisania  Hospi-   service being offered to  the  slum  areas  if  peo-
                  tal  or  to  Bronx-Lebanon  because,  once  they  go   ple are willing to ask  for  it  instead  of  shrug-
                  there,  the  substandard  care,   the   abuse   from   ging  their  should.ers  and  saying   nobody   cares.
                  staff,   and   the   interminable   waiting    would   -E.F., Communtty Worker, Bronx.
                  probably  kill  them  anyway.  Besides   these   two   Harlem
                  hospitals,   Monteflore Hospital's       Neighborhood
                                                                           After  working  for  9  weeks  on  school   health
                  Medical    Care    Demonstration    Health    Center
                  also offers service to the area.  This  facility  is   referral  problems,  we  can   draw   some   conclu-
                  highly   regarded   by   community   residents   but   sions about why people  don't  use  the  health  fa-
                                                                         cilities available in Harlem.
                  unfortunately  it   canIaccommodate   only   a   lim-    The  most  obvious  and  most   frequently   cited
                  ited number of patients and  it  has  definite  geo-   reason  for  not  using  outpatient  facilities   at
                  graphical   boundaries   which   exclude   many   of   Harlem  Hospital  and  other  clinics  in  the  area
                  the residents in the area. I services.
                                                                         is that the time spent  waiting  in  line  is  often
                    I  feel  that  the  community  residents  who   go   prohibitively long. Most of  the  clinics  are  open
                  to   Morrisania    and    Bronx-Lebanon    Hospitals   only  during  the   daytime   andappointments   can-
                  should  document  each  case  of  poor   health-care   not  be  made:  the  waiting  time  varies  but  can

                  -26


                                                  SUMMER  1968
      be  as  long  as  4  hours.  People  simply   cannot   found  gross  inadequacies  in  coverage.   All   the
      afford to take time off from  work  or  leave  other   facilities  in-and-out  of  the   Harlem   area   had
      children  and  their  homes  unattended   for   that   long  delays  before  diagnosis   and   even   longer
      long.  Also,  sitting  and  waiting  in  noisy,  un-   delays before treatment could be started.
      comfortable   waiting   rooms   is   -not   a   very      *   *   *   An   important   reason   why   people
      pleasant way  to  prepare  oneself  or  one's  child   don't  avail  themselves  of  facilities  bears   di-
      to see a doctor.                                       rectly  on  Harlem  Hospital;   the   reputation   of
        Compounded  with  the  long  waits,   the   clinic   the  hospital  in  the  community  is  abysmal.  Peo-
      procedures and   personnel  are  often   insensitive   ple  say  that  they  have  heard  nothing  but   bad
      to the needs of  the  people  who  use  the  facili-   things  about  the   treatment   people   get   there
      ties,. We found that  the  procedure  for  register-   and  refuse   to   put   anyone   in   their   family
      ing at a clinic and  for  Medicaid  was  often  con-   through it.
      fusing   and   exasperating,    particularly    when      Part  of  this  reputation  comes  from   a   time
      questions were asked in front  of  a  long  line  of   when  Harlem  Hospital  was  one  of   the   two   or
      other people  waiting  to  register.  We  found  one   three worst in  the  city.  Many  doctors  appear  to
      clinic for eye and  ear  problems  where  the  staff   have  cared  very  little  for  the  people  who  use
      was downright  rude  and  hostile  to  the  patients   the  hospital  and  left  it  to  others  to  improve
      waiting.  Another  frequent   complaint   was   that   services. The  house  staff  had  been  largely  for-
      doctors did not take time  to  explain  to  the  pa-   eign-trained  and  this  led  to  problems  of   com-
      tient  or  the  mother  what  actually   was   wrong   munication with the  patients.  The  list  of  griev-
      and  what  prescribed  medicine  was   supposed   to   ances is long  and  familiar  for  large  urban  hos-
      do. It seems that the feeling that  health  care  is   pitals  with   poor   facilities.   The   significant
      a right that people are entitled to is just not  op-   changes   and   improvements    that    have    taken
      erative.   Health   personnel   seem   to   consider   place  recently  have  not   been   communicated   to
      their  work  a  nine-to-five  job,   and   patients,   the people  who  might  use  the  hospital.  The  im-
      especially, lots of patients,  are  a  hindrance  to   provement  in  quality  of  the  house  staff   since
      the  many  bureaucratic   duties   they   may   have   the  Columbia  University   affiliation   (the   fact
      rather  than  people  to  be,  dealt  with   in   an   that  all  the  interns  are  now  American  trained,
      efficient, gracious way.                               for example)  has  not  filtered  down  to  the  peo-
        A problem  that  was  a  result  of  the  Medicaid   ple -and the  reputation  continues  to  be  just  as
      legislation  last  spring  was  the  institution  of   bad as it ever was. The  efforts  of  all  the  dedi-
      the $11  clinic  fee  for  any  visit.  This  was  a   cated  doctors  (not  just   the   results   of   the
      hardship until  a  sliding  scale  was  set  up  for   affiliation)  in  recent   years   should   be   made
      non-Medicaid  patients,  but  it  still   represents   known   in   the   community.    Demonstrations    of
      another  obstacle:  the  patient  must  again   tell   community  frustration   and   dissatisfaction   like
      how much he  earns.  Needle@s  to  say,  the  people   the  one  that  took  place  this  summer   following
      who  were  covered  by  Medicaid  before  the   cut-   the  death  of   a   child   who   was   misdiagnosed
      backs are now  getting  less  adequate  health  care   need not occur.
      than they  were  getting  when  they  were  covered.     Whether   or   not   these   community    attitudes
      We  found   that   most   Medicaid   patients   pre-   are fair or even  rational  is  not  the  issue;  the
      ferred going to  a  private  doctor  to  waiting  in   fact is that they are  real.  The  challenge  to  the
      the  clinics;  many  non-Medie-aid  patients   would   doctor,  black  or  white,  is  -to  understand   the
      rather  risk  paying  a  higher  fee  to  a  private   mentality and life styles  of  his  patients  and  to
      doctor  for  a  non-emergency  problem   than   hav-   deal  with  them  as  they  are,  not  as  he  wishes
      ing to go through the  inconveniences  of  a  clinic   them to be.
      visit.
                                                               I  will  list  our  recommendations   for   improv-
       A significant  problem  is  the  lack  of  adequate   ing health  facilities  in  the  I4arlem  area  which
      Psychiatric facilities for  the  people  of  Harlem.   we  think   would   lead   to   more   frequent   and
      In a survey  of  child  psychiatric  facilities,  we   more satisfactory use by patients:

                                                                                                                27


                                                                  GREATER NEW  YORK

                     (1)  Clinics  in   the   Harlem   area   should   be   sionals  in  Harlem.  One  school  nurse   must   serve
                          made   more   convenient   for    the    people   up to  five  schools  or  more;  some  schools  have  a
                          who  use  them;  there   should   be   appoint-   doctor  only  1  day  a  month;  school  children   are
                          ments   made,   waiting   rooms    should    be   commonly   not    examined    between    first    grade
                          made   more   comfortable,   and    babysitting   and  high  school;  there  would  appear  to  be   vir-
                          should   be   provided.   Clinic   hours    day   tually no  specialists  in  private  practice  in  Har-
                          and  evening  should  be  scheduled   for   the   lem.   Parents    are    concerned.    When    informed
                          convenience   of   the   patients,   not    the   their   children   need   care   they    endure    long
                          @ff.                                              waits,  dreary  waiting   rooms,   rude   clerks,   and
                     (2)  There   should   be   health   workers    hired   frequent   double   standards   for   paying    custom-
                          from   the   community   who   can   do   case-   ers versus Medicaid and welfare patients.
                          finding  and   home   visits,   and   who   can      What  seems  to  be  lacking   is   proper   preven-
                          act  as  patient  advocates  in  the  hospitals   tive  medicine.   Harlemites   tend   to   wait   until
                          or large clinics.                                 they  are  noticeably  ill   before   seeking   medical
                     (3)  Attitudes  of  doctors  and  staff  should   be   care. This is due, to  a  great  extent,  to  the  peo-
                          screened  and   standards   of   courtesy   and   ple's mistrust of the medical institutions.
                          cooperativeness    should    be     maintained.      Harlem  Hospital  has  a  terrible   reputation   in
                          Patient   complaints   should   be    solicited   the  community.  The  building   is   old   and   over-
                          and acted upon.                                   crowded,   while   a   new   building    stands    next
                     (4)  The   New   York   State    Medicaid    program   door,   unfinished,    overdue    many    years,    and
                          should be reinstated in full.                     many   months   short   of   completion.    One    won-
                     (5)  There  should  be  an  attempt   to   establish   ders  whether  the  city  is  giving  the  new   build-
                          more   psychiatric   and   counseling   facili-   ing the priority  it  deserves.  I  suspect  a  similar
                          ties  immediately;  the  need   is   especially   project  in  the   East   Sixties   would   have   been
                          critical  in  the  area  of  child  psychiatry.   completed   on   time.    The    people    of    Harlem
                     (6)  Health   education   through   all   the   com-   agree.
                          munication    media    and    with    community      The  people  of  Harlemare  not  blind.   They   re-
                          groups  should  be   continued   actively   and   alize  that  decent  housing,  proper   nutrition   and
                          new bases should be sought.                       adequate  jobs  are  necessary  for  health.   Is   the
                     (7)  Harlem    Hospital    should    establish     a   American   system   as   presently   constituted   able
                          community    relations    department    on    a   to deliver these? Doubts are multiplying.
                          formal  basis  which   would   concern   itself      It is to belabor the obvious  to  say  that  to  im-
                          with   more   than   just   the   writing    of   prove   health   care   more   doctors   are    needed-
                          press  releases;  it  should  actively  try  to   young   people   from   Harlem    who    will    return
                          reach  the  people   in   the   community   and   there  must  be  trained  as  doctors,   nurses,   etc.
                          involve them in the hospital.                     Pediatric   screening   programs   in    the    schools
                     (8)  Community   participation   in   the    setting   could  be  expanded;  hospitals  can   be   made   more
                          of  priorities  for  health  and  the   running   relevant   to   the   community   by    placing    them
                          of health  facilities  should  be  institution-   under  community  control.  It  is  stupid   to   speak
                          alized.  Responsiveness   of   health   facili-   of anything short  of  billions  of  dollars  spent  in
                          ties  to  the  needs  of  the   community   can   all  areas  .of    human    life    when    considering
                          and should be guaranteed in this way.             health    care.-L.B.,    Medical    Student,    Harlem.
                     These  recommendations  may   not   solve   all   of      At  present,  the  most   important   way   to   im-
                  the health problems in Harlem,           but     unless   prove  care  in  the.  Harlem  area  is  to  lobby  for
                  these  eight  points  are   addressed,,   we   see   no   the   speedy   opening   of   the   new   Harlem   Hos-
                  chance  for  an  improvement   in   the   health   care   pital.  Also,  I  would  try   to   get   more   board-
                  delivery    situation.-R.C.,    Student    Coordinator,   certified  group  practices  involved  in   the   area.
                  Harlem.                                                   At  present   there   are   only   two.-J.H.,   Medical
                     There  is  an  acute  shortage  of  health   profes-   Student, Harlem.

                  -28


                                                SUMMER  1968
         There is need  for  a  followup  service  as  an    Gladys is an 18-year-old  girl  who  has  a  little
         extension of health facilities in Harlem. People    boy and  is  expecting  her  second  child.  Gladys
         often do not return  for  appointments  or  seek    made  an  appointment  to  visit   the   Morrisania
         referred treatment.  By  having  individuals  go    prenatal clinic  and  I  decided  to  accompany  her.
         out into  the  community  to  follow  up  school    She  misunderstood,  or  was  not  told,  that  she
         health referrals,  we  have  managed,  temporar-    would not see a  doctor  at  this  time.  The  pur-
         ily, to deal with part of this problem. In order    pose of this visit was  to  obtain  a  clinic  card
         to  secure  a  more  permanent  solution,  on  a    and to have  the  preliminaries  before  seeing  an
         small scale, we are in the  process  of  funding    obstetrican.  During   her   interview   with   the
         permanent   jobs   for   our   five    community    clerk, Gladys said  that  she  had  been  going  to
         workers. In these positions they  will  function    the N.M.C.D. and that  they  had  referred  her  to
         as extensions of the school nurses and will fol-    Morrisania. She said that she  was  told  that  she
         low up the school health  referrals  year-round.    no longer  lived  in  the  N.M.C.D.  district.  The
         -S.G., Medical Student, Harlem.                     patient had never  been  seen  prenatally.  An  ap-
                                                             pointment  had  been  made  for  Gladys,  but   she
                       ATTITUDES
                                                             did not keep the  appointment.  With  this  bit  of
         Brooklyn                                            information  the  clerk  asked   Gladys   why   she
         The  doctors  must  know  the  community.   that    had not  seen  a  doctor  sooner.  Gladys  appeared
         they serve. They must  be  acquainted  with  the    very  hurt  by  this  question  because  she   said
         customs and beliefs of the patients.  They  must    she had  seen  a  doctor.  The  clerk  told  Gladys
         know their patients and respect them  as  fellow    that she was  old  enough  to  be  her  grandmother
         human beings. In order  to  treat  someone  with    so she shouldn't try  to  tell  her  that  she  had
         compassion,  one  must  understand  this  person    seen a doctor when  she  hadn't.  I  was  irritated
         and look on this person as a  comrade  in  pain,    with  the  clerk  for  making  a  judgment  without
         not as a stranger who cannot be understood.         trying  to  clarify  with  Gladys  as  to  how  she
         There are  a  variety  of  problems  about  com-    saw the  situation.  It  is  possible  that  Gladys
         munication bet ween  the  patient  and  the  physi- saw a medical  doctor  and  thought  that  she  had
         cian. The patient or the mother of  the  patient    seen an obstetrican.  Gladys  did  say  she  didn't
         often viewed the doctor  as  competent  but  un-    keep   an   appointment   to   have   some    blood
         concerned. They  often  felt  that  the  doctor'    drawn. This  one  encounter  left  Gladys  with  an
         didn't care about them. On the other  hand,  the    unfavorable first impression.
         doctors viewed the  patients  as  being  hostile     Gladys was told, or rather I  was  told,  to  take
         and unreceptive to the care they  were  deliver-    her to have  blood  drawn,  her  teeth  checked,  a
         ing.                                                chest X-ray, and, finally, to see a social  worker.
         There is a definite lack  of  communication  be-     The  lab  technician  did  not  say  anything   to
         tween the  members  of  the  community  and  the    Gladys  when  she   'went   to   have   her   blood
         hospital as an institution and as a  representa-    drawn.  The  technician  was  very  hurried  and  a
         tive of the white man's world.                      bit gruff. Gladys was frightened and  did  not  re-
         What  is  needed  is  more  community   involve-    ceive any  psychological  support  or  instruction,
         ment in the running of the city  hospitals.  and    such as to look  away  or  to  grasp  something  to
         more effort on the  part  of  the  hospitals  to    make the.experience easier for her.
         make  their  services  known  to  and   accepted      Our next visit  was  to  the  dental  clinic.  At
         graciously  by  the   community.-D.Y.,   Medical
         Student, Brooklyn.                                  the registration desk  I  had  tried  to  tell  the
                                                             clerk that  she  had  seen  a  dentist  within  the
         Bronx                                               last 6 months,,and  that  maybe  it  wasn't  neces-
         The following  two  experiences  illustrate  the    sary to see a dentist.again since it was  so  close
         problem'  of  routine  medical  care   delivered    to the time of her delivery.  At  the  dental  sta-
         without concern for the patient and his specific    tion  I  was  told  that  the  X-ray  machine   was
         needs.                                              broken and that she  would  have  to  make  an  ap-
                                                                                                               29


                                                     GREATER         NEW  YORK
                  pointment for another day.  At  this  point  I  said   problems  she  was   having   with   her   leg.   Th
                  that it was hard  for  this  woman  to  get  to  the   nurse  explained  that  elevating  her  legs   woul(
                  clinic and unless.it   was   absolutely    necessary   help.  She  suggested   that   Gladys   elevate   he
                  that she see a dentist at this  time,  that  I  pre-   legs while reading a good  book.  I  had  to  chuckl
                  ferred  a  new  appointment   not   be   made.   The   at  this  because  Gladys  only  has  a   9th   grad
                  clerk,  somewhat   confused,   called   the   nurse.   education  and  has  difficulty  reading  and   writ
                  The  nurse  checked  the  records  and  found   that   ing.  The  nurse  did  some  diet  counseling  whicl
                  Gladys  had  seen  the  dentist  at   the   end   of   was  very  inadequate   for   this   patient.   Slit
                  March. She arranged  for  Gladys  to  see  the  den-   handed  the  patient  a  diet  sheet  and  said   t,
                  tist without coming back to the clinic.                avoid  salt  and  greasy  foods.  No   inquiry   wa:
                  Next   we   went   to    the    X-ray    department.   made into Glady's eating habits.
                  After  waiting  about  half  an  hour   Gladys   was    Rebecca  is  a  64-year-old  Negro  lady  who   wa:
                  seen.  The  technician  did  not   smile   and   ap-   referred to  me  by  a  dental  student  because  hi
                  peared very  tired  and  bored  with  what  she  was   felt  that  she  needed  more   comprehensive   car,
                  doing.  She  made  no  effort  even  to  acknowledge   than just seeing that she get some dentures.
                  the patient's presence.                                 I  decided  to  take  Rebecca  to   Morrisania   t(
                   Our  last  visit  that   afternoon   was   to   the   have  a  checkup.  This  was  to  be  my  first   ex
                  social service department. She  was  the  only  per-   perience with registering  a  new  patient.  I  firs
                  son  we  met  that  day  who  appeared   interested,   asked a  clerk  processing  new  patients  what  th(
                  and we felt she had  the  time  to  speak  with  us.   procedure  was  for  bringing  an  elderly   patien-
                   We  came  back  that  evening  for   the   prenatal   to the clinic who  hadn't  seen  a  doctor  in  som(
                  clinic. The doctor  started  asking  questions,  and   time. She  said  to  bring  the  lady  to  the  emer
                  Gladys  became   confused   and   appeared   fright-   gency  room.  I  replied  that  there  was   nothinj
                  ened. He got  irritated  because  she  was  not  re-   acutely wrong with this  lady  and  asked  if  ther(
                  sponding  to  his  questions.  The  nurse  then  in-   wasn't  some   other   procedure.   "No,   you   mux
                  formed me  that  I  was  not  supposed  to  be  with   take her  to  the  emergency  room".  I  didn't  ac-
                  the patient  while  she  was  with  the  doctor  be-   cept this as being the solution so I  asked  at  th(
                  cause  I  was  violating  her  privacy.  I  did  not   information  desk  on  leaving  the  hospital.   ShE
                  leave so she sent in another  nurse  to  inquire  if   suggested  that  I  speak  with  the  nurse  at  thE
                  I  was  translating  for  this  woman.  Even  though   screening clinic. The -nurse said that  the  screen-
                  the head nurse did  -not  object  the  other  nurses   ing clinic was perhaps the best solution.
                  did  not  want  me  there  speaking  with  the  doc-    We  returned  to  the  clinic  the  next  day.   WE
                  tor. It was not their routine.                         arrived at 8:15 and  were  seen  by  the.  clerk  by
                   The  doctor  also  followed  his  routine.  He  did   about 9:00.  Shortly  thereafter  we  were  seen  by
                  not interject  any  personal  comments  at  all.  In   the doctor at the screening clinic.
                  the  examining  room  I  could  hear   him   bawling     The first  question  he  asked  was,  "What's  thE
                  her  out  for  using  salt  because  of   her   high   matter, why  did  you  come."  After  a  pause  with
                  blood  pressure.  I'm  not  sure  any   doctor   had   no  answer  he  said,  "Well,   whaVs   wrong   with
                                                                   was                        this                ly  At  thi
                  told her this before. He then told her she             you, you know that         is a hospital.          IC
                  to have a  Pap  smear.  I  could  hear  Gladys  say-    oint I  answered by saying, "Nothing is           thE
                                                                         p
                  ing that she  had  just  had  a  Pap  smear,  and  I   matter with  this  woman  in  particular.  She  just
                  know she had because  I  had  read  the  letter  she   hasn't seen a doctor for  some  time,  and  I  think
                  received stating that  the  results  were  negative.   it is advisable. She had poor vision,  she  is  hard
                  Maybe  the  doctor  did   have   reason   to   doubt   of  hearing,  she  needs  dentures,  and   has   had
                  Gladys, but he didn't take much time  to  listen  to   problems with her    .heart in  the  past."  By  this
                  her.                                                   time I was disturbed by  the  lack  of  dignity  and
                    Our last visit  was  with  the  nurse.  The  nurse   respect the doctor  showed  this  patient.  After  a
                  was  very  pleasant,  and  did  not  appear  to   be   very   brief   examination,   he   discovered   high
                  rushed.  Gladys  did  speak  up  to  ask  about  the   blood  pressure  and  decided  she  needed  a   car-

                  .30


                                                SUMMER  1968
     diae  series.  He  was  very  impatient   with   Re-   repetition  of  a  few   common   complaints   about
     becca. He would  get  irritated  when  she  did  not   Bellevue's services.  It  would  be  a  conservative
     understand his questions.  He  even  tried  to  tell   estimate to  say  that  90  percent  of  those  per-
     -her how to  talk.  Rebecca  answered  some  of  his   sons we asked cited  the  lack  of  courtesy  to  be
     questions with a "ya."  He  told  her  to  say  yes,   their  main  complaint   about   Bellevue.   Medical
     not  "ya."  What  particularly  irritated   me   was   care, they say, is fine, but "the  clerks  are  rude
     his being more interested  in  my  being  a  student   and we're treated like dirt."
     nurse  than  in  Rebecca.  I  think  it  would  have     Bellevue   must   refocus   its   attention   from
     been much more beneficial for  the  patient  if  his   medical education to that of  service  to  the  com-
     interest had been  directed  toward  her.  The  doc-   munity. This is, of course, difficult to do.  I  was
     tor said  to  make  an  appointment  for  the  medi-   told by a resident in pediatrics  at  Bellevue  that
     cal clinic  for  Rebecca.  I  asked  him  about  the   he cares  about  his  patients  and  their  continu-
     eye clinic. He did  not  mention  the  E.N.T.,  den-   ing welfare,  yet  if  Bellevue's  census  continued
     tal or G.Y.N. clinics., This  would  seem  to  indi-   dropping as it had in recent  years,  and  the  "in-
     cate that  this  doctor  is  not  providing  compre-   teresting  cases"  no  longer  were  seen  there  in
     hensive care,  or  is  even  considering  preventive   such  quantity,  he  would  promptly  leave  and  so
     medicine.-V.V., Nursing Student, Bronx.                also would  most  of  his  colleagues.  "Let's  face
     Lower East Side                                        it," he said,. "what  I'm  most  concerned  with  at
       The biggest obstacle to the delivery of       good   Bellevue is my  education.  Sure  I  care  about  my
     medical care at  Bellevue  Hospital  is  the  perva-   patients, but that's not what  I'm  here  for;  pri-
     sive  atmosphere  of  what  I  have  heard  referred   marily I'm here  to  learn."  As  long  as  the  pa-
     to  as  "Bellevue  Paranoia."  It  is  an   attitude   tient remains in  this  secondary  position  in  the
     composed of varying degrees of lassitude, o            physician's list of priorities,  no  amount  of  new
     stinacy, and covert hostility. It is personifier       buildings,   equipment,   or   famous   names   will
     by the elevator operator who will not tell yoi         lure patients to Bellevue Hospital.
     what floor a certain clinic  is  on  because  it  is     Bellevue 9s pediatric  clinic  has  serious  "com-
     not his  job  to  give  information;  by  the  clerk   petition" from Beth Israel Hospital's "I Spy      Pt
     who  will  not  admit  you  for  a  clinic  appoint-   clinic, which  also  handles  children.  There,  the
     ment because  it  is  10:10  a.m.  and  registration   doctors speak Spanish,  as  do  all  the  health-aid
     for  the  clinic  @ps  at  10:00;  by  the  perverse   workers  on  the   floor.   These   health   workers
     administrator whose  decision  it  was  to  man  the   make  regular  home  visits  and  followup  care  on
     information  desks  with  personnel   who   do   not   their own patients. The  "I  Spy"  clinic  does  ac-
     speak  any  Spanish;  and  by  the   physician   who   tual soliciting and  canvassing  in  its  area,  ac-
     can  just  walk  away  from  patients   waiting   to   tively trying to get people to come.
     see him in a  specialty  clinic  because  he  thinks     This  active  community  action   on   behalf   of
     it's time  to  go.  These  attitudes  are  accounted   the health care facility is the  essential  feature.
     for   in   many   ways:   overworked   doctors   who   It is what's lacking at Bellevue  and  seems  to  be
     must see too  many  patients  in  too  little  time,   what  Bellevue  still  refuses  to  do.  More   than
     frustrated clerks frozen in  positions  with  little   one doctor has  said  to  me,  "I  don't  know  what
     upward mobility,  etc.  Regardless  of  the  excuse,   our  job  is  in  respect  to  the   community   any
     it  is  an  attitude  which  exists  throughout  the   more;  should  we  go   out   and   get   them,   or
     hospital  and  which  the  hospital  has  failed  to   should we let  them  come  to  us?  I  don't  know."
     deal with.                                             For a hospital  whose  census  has  dropped  in  re-
       Bellevue has, for  too  long,  enjoyed  the  posi-   cent  years  and  which  faces   an   estimated   75
     tion of being the only center  in  the  area  offer-   percent  loss  of  its  outpatient  department   pa-
     ing extensive facilities. That  it  has  also.  been   tients to the  new  NENA  health  center,  is  there
     one of the  most  notorious  is  often  not  consid-   much  of  a  choice?  They  must   reach   out   ae-
     ered. It was interesting to  observe,  in  the  pro-   tively to the community if they  expect  to  see  an
     cess  of  speaking  with   community   people,   the   increase in  their  patient  load.  A  new  building

                                                                                                              31


                                                    GREATER  NEW  YORK
                alone  isn't   the   answer.-J.M.,   Nursing   Stu-   changes  are  necessary  fast,  but  I  didn't  ac-
                dent, Lower East Side.                                complish   them   and   SHP    didn't    accomplish
                Newark                                                them.-K.S., Nursing Student, Newark.
                  Generally,   postpartum   patients   felt   their     People do not like being treated.  like  dogs  at
                prenatal care  was  satisfactory;  their  one  com-   city hospitals; they do not like to be  kept  wait-
                mon  complaint   was   the   long   waiting   time.   ing for hours at a  clinic;  drug  addicts  do  not
                * * '- It is  not  unusual  to  see  150-200  prek-   like to be  considered  criminals  when  they  seek
                nant  women  come  to  prenatal  clinic  at   Mart-   medical attention. In  short,  the  people  of  Ne-
                land Hospital in  one  morning,  nor  to  see  them   wark's Central Ward are  just  like  people  every-
                wait 3 or  4  hours  to  see  a  doctor  who  gives   where-they  want  to  be   treated   with   respect
                them only 5  minutes.  There  is  little  personal-   and dignity. This does not seem  to  be  an  unrea-
                ized attention because there is  no  time  to  give   sonable request, but in Newark it  is  far  from  a
                                                                      reality.-B.W., Medical Student, Newark.
                it with such  inadequate  staffing.  Little  wonder
                that mothers wait  until  their  delivery  date  or     The hospital  is  contracting  a  psychology  in-
                near before coming to the hospital.                   stitute to begin sensitizing staff to needs of  the
                  Many  of  them   were   dissatisfied   with   the   patient,  and  to  coordinate  and   improve   com-
                treatment they got  from  the  nurses  in  the  de-   munications  between  various  levels  of  supervi-
                livery  room;  they  felt  that  the  nurses   were   sion. This idea for  a  sensitization  program  was
                giving them very  little  emotional  support;  that   sold to the administration  by  speaking  with  en-
                the nurses conveyed an  "I  don't  care"  attitude.   lightened members  of  the  administration  on  all
                I quote a  young  mother:  "I  delivered  the  baby   levels. It is hoped that @ff will  begin  to  func-
                all  by  myself;  they  (the  nurses)  only   stood   tion as a whole towards patient care.
                there  watching."  The  general   complaint   about     An  in-service   sensitivity   training   program
                the  postpartum  floor  was  the  attitude  of  the   now  running  in  the   nursing   department   will
                staff;  many  patients  felt   they   were   rude.-   continue weekly until I  leave  in  October.  I  am
                J.Q., Nvrsi?W Student, Newark.                        using   tape   recordings   of   community   people
                                                                      talking  about  the  hospital  and   working   with
                         Besides the  decrepit,  dirty,  and  dingy   staff reactions to  this  stimulus  material.  This
                conditions  of  community  health   facilities   in   program  is  serving  in  the  interim  preparatory
                Newark and the poor  quality  of  health  care  ad-   to  the   more   general   program.-A.H.,   Medical
                ministered, the  ultimate  crime  is  the  complete   Student, Newark.
                insensitivity of  most  health  care  personnel  to
                the  patients  whom  they  have  supposedly   dedi-   Harlem
                cated their lives  to  serving.  The  patients  are     We   received   many   complaints    about    the
                treated like cattle,.  herded  in,  thrown  out  if   "nasty attitudes" of the personnel in  the  clinics
                they dare to speak or  question,  and  herded  out,   at   Knickerbocker   Hospital,   poor    treatment,
                usually  with  a  few  harsh  words  of  condescen-   long waiting  periods  and  frequently  a  lack  of
                sion.  The  obvious  reasons  for  the   conditions   communication  between  the  patient   and   doctor
                are lack of funds, lack of  staff,  and  ultimately   due to a Ian  guage  barrier.   The   Harlem   com-
                lack  of  concern.  Hopefully  SHP  fostered   con-   munity  feels  that  the  comprehensive   pediatric
                cern if nothing else.                                 health  center  that  Knickerbocker  is  trying  to
                  The  people  of  the  community  are   completely   establish is fine but that it  will  be  some  time
                disgusted  with  the  deplorable  health  care  of-   before the center is  completed.  They  would  like
                fered  them.  However,  only  an  exceptional   few   to use Knickerbocker's facilities since  it  is  in
                will speak up to the  hospital  staff.  The  major-   their vicinity, but  generally  refuse,  except  in
                ity  of  the  community  people  I've  had  contact   the  case  of  dire  emergency,  to  tolerate   the
                with  feel  like  puppets  on  a   string-if   they   treatment  they  presently  receive  from   person-
                don't  jump  when  the  hospital   personnel   says   nel  at  this  hospital.-P.J.,   Nursing   Student,
                jump,  they   get   no   health   care.   Obviously   Harlem.

                32


                                              SUMMER  1968
              MEDICAID, MEDICARE                           and  trouble-shooters  for  the  people  of   this
             The  pharmacies   are   another   bone   of   community.-JH, Medical Student Ha-riem.
      contention  in  the  Harlem  community.  The  peo-              DENTAL HEALTH
      ple on Medicaid  feel  that  they  are  not  being   Nowhere  was  poor  health   care   brought   home
      given the same  kind  of  service  that  non-Medi-   to me more  than  in  the  dental  clinic  at  the
      caid  people  are  getting,  especially  if  their   health station. Being  a  dental  student,  I  was
      cards are not "filled out  properly."  Also  there   able to  observe  and  question  the  dentists  as
      is  no  drugstore  in  Harlem  which  is  open  24   they  treated  the   Head   Start   youngsters   I
      hours, or even late  in  the  evening.-J.H.,  Med-   brought  from  St.  Joseph's.  From   the   equip-
      ical Student, Harlem.                                ment  which  was  antiquated,  to  the  techniques
       We've run a  couple  of  experiments  on  a  Har-   used  which  were  criminal,  to   the   attitudes
      lem  drugstore:  we  got  prescriptions  for   the   which  were  racist,  to  the  ability  which  was
      same  drug  for  Mrs.  X.  who  has   a   Medicaid   low, to  the  knowledge  which  was  minimal,  the
      card and Mrs. Y. who  doesn't  have  a  card.  The   entire service  epitomized  the  worst  in  health
      store gave about the same  service  to  each  cus-   care. I will not proceed further into  a  detailed
      tomer in  terms  of  time.  The  drugs  sold  were   analysis of the care  here  but  I  can  summarize
      different, the Medicaid drug  being  generic,  and   what  I  saw  by  saying  that,   by   comparison,
      Mrs. Y. had to ask for  a  bag  to  carry  it  in.   Fordham Hospital  was  a  model  of  health  care,
      Also,  when  Mrs.  X.  asked  how  much  the  drug   and that the city has no justification for  allow-
      was going to cost Medicaid she was  told,  in  ef-   ing outright malpractice to exist within its  ser-
      fect, that it  was  none  of  her  business.-R.C.,   vice. At the conclusion of  the  program,  I  rec-
      Student, Coordinator, Harlem.                        ommended that this  health  station  be  boycotted
       It takes longer for a  Medicaid  patient  to  get   by  the   Bronx   community.-V.S.,   Dental   Stu-
      his prescription filled. There seem to be  legiti-   dent, Bronx.
      mate  reasons,  or  are  they   legitimate?   Many    A particular deficiency  of  health  care  deliv-
      are clerical in nature and could be  avoided.  One   ery on the Lower East Side can  be  seen  in  den-
      wonders if  these  professionals  are  excessively   tal health services. There is no dental clinic  in
      jealous of  their  independence  and  excessively,   the neighborhood  and  the  people  are  oblivious
      almost  cruelly,  preoccupied  with  resisting   a   to the effects of poor dental hygiene  on  overall
      "government  takeover."  And  who   finally   suf-   health  of  body.-B.G.,  Nursing  Student,   Lower
      fers if the prescription is  left  unfilled?-L.B.,   East Side.
      Medical Student, Harlem.                              Since one child  out.of  eight  gets  dental  ser.-
       These   past   2   weeks   revealed   a   problem   vice in the community, the need  for  dental  edu-
      which  was  not  entirely  surprising.  We   found   cation for the  parents  and  children,  and  also
      that  most  holders  of  Medicaid  cards  regarded   the need for more and better dental  services,  is
      themselves  as  recipients  of  a  gratuitous  act   absolutely  imperative  in  the  Lower  East  Side
      from  any  agency,  doctor,  or  pharmacist   that   community.
      delivered services to them. They felt as  if  they     The parents  frequently  said  that  they  can't
      were obligated  to  put  up  with  any  indignity.   find good dental services  in  the  community  (no
      However, this does not derive  from  the  fact  of   dentist or  clinic  was  apparently  satisfactory)
      Medicaid,  but  from  a  general  feeling  on  the   and others told  me  they  could  not  afford  it.
      part of  many  of  the  community  of  being  see-   Morally, I feel this is one of the  most  terrible
      ond-class citizens. The  situation  is  compounded   things  that  could  happen  in   the   wealthiest
      when the person slighted  does  not  know  how  to   country in the world. Everyone  I  talked  to  was
      have  redresses  made,  or  does  not   have   any   disgusted with the lack  of  dental  services  and
      Place to appeal. I see the role  of  SHP  as  mid-   financial  aid  for  the  underprivileged.   Some-
      dlemen  between  the  community  and  the   deliv-   thing must be done in these  two  respects  and  I
      erers of health care, acting both as  advisors  to   will certainly try to do what I  can  in  the  fu-
                                                                                                           33


                                                     GREATER  NEW  YORK
                ture to alleviate such  a  situation.-G.L.,  Dental     Brooklyn  has  the  highest  incidence  of   lead
                Student, Lotver East Side.                            poisoning, and it is increasing. A  lot  of  people
                                                                      don't know that children  can  die  or  get  perma-
                             LEAD POISONING                           nent brain  damage  from  it.  Say  there  are  600
                  In the course of our  survey  of  lead  poisoning   cases  of  lead  poisoning  a  year  found  in  the
                incidence in the South Bronx  (and,  to  a  limited   city: well, if  these  600  cases  were  diphtheria
                extent, in Harlem),  we  came  in  contact  with  a   or  polio,  everyone  would  worry  about  it   be-
                wide  range  of  community  institutions,  most  of   cause  it  would  spread.  But  lead  poisoning  is
                which  were  of   an   Establishment-type   nature.   just  in  the   poverty   areas,   and   does   not
                First  reactions  to  our  requests  were   guarded   "spread," so no one is concerned about it.
                until  we  had  explained  our  purpose   and   our     Our  purpose  is  to  get  the  community  inter-
                procedures,  at  which  point   we   found   people   ested, to get them to realize that no one  is  lis-
                most willing to aid us.  We  found,  for  the  most   tening  to  their  problems.-W.S.,  Student   Coor-
                part,  that  dealings  on  a  personal  level  were   dinator, Brooklyn.
                more profitable  than  when  we  were  forced  into
                a head-on encounter with a bureaucracy.                 The    Brooklyn     Community     Council     SHP
                  In terms of  concrete  results,  our  group  came   workers  coordinated  the  Brownsville   and   East
                in  contact  with  1,200  households  and  informed   New  York  activities  of  a  campaign   throughout
                them  of  lead  poisoning  dangers.  We   collected   Brooklyn against lead poisoning. This invo ve
                and  analyzed  500   urine   samples   from   small   contacting   parents   whose   children   had   had
                children,  and  our  results  will  soon  be   made   lead poisoning in the past 21/2  years,  distribut-
                available to the general public.                      ing  flyers  and  posters,  and  speaking  to  com-
                  We  found   that   a   good   many   asymptomatic   munity organizers and  workers,  in  order  to  en-
                lead poisoning cases had not  been  to  a  hospital   courage  attendance  ata  mass  meeting   we   were
                recently, -nor received medical  care,  nor  sought   holding' A  door-to-door   canvas   was   conducted
                it out.-I.B., Medical Student, Bronx.                 explaining  the  effects  of  lead  poisoning   and
                                                                      how it was  related  to  poor  housing  conditions.
                  Two  suits  were  filed  this  summer  having  to   A bus was arranged  to  take  area  people  to  the
                do with lead  poisoning.  Acting  on  a  suggestion   meeting.
                from  Paul  DuBrul,  Mr.  Hanft   asked   for   the     The  meeting  was   attended   by   approximately
                court, under article 78, to order the  New  Yor  r'   80 people, 10 of  them  from  Brownsville.  In  the
                City  Health  Department  to   compel   the   remo-   estimations of  most  people  involved,  the  meet-
                val, pursuant  to  section  173.13  of  the  health   ing  was  successful.  However,  the  effectiveness
                code, of lead-based paint from  the  walls  of  two   of   communication   techniques,   which   involved
                apartments  in   which   children   have   suffered   so many man-hours  and  netted  such  a  small  at-
                lead  poisoning  from  eating  chipped  paint   and   tendance,   can   be   questioned.-L.K.,    Medical
                plaster. In one of these families,  three  children   Student, Brooklyn.
                have been treated for  lead  poisoning,  one  seven
                times. One suit  asks  that  the  court  order  the                DRUG ADDICTION
                removal  of  lead-based  paint  from   all   apart-     In taking   steps to establish a  narcotics  cen-
                ments  in  New  York   City.-R.H.,   Law   Student,   ter in the  Brownsville  section  of  Brooklyn,  we
                Brooklyn.                                             met  with  people  from  the   Governor's   Office,
                  The   Central   Brooklyn   Coordinating   Council   Ramirez,   Narcotics   Addiction   Community   Cen-
                and  our  group  are  working  on  the  problem  of   ter  and  C.C.V.N.  This  meeting  was  quite   en-
                lead poisoning. The hope  is  that  we  can  get  a   lightening:  the  State  people  couldn't   account
                group  of  people  from  all   over   Brooklyn-par-   for  the  placement  of  funds  and  had  no   idea
                ents, doctors, and people  in  other  fields-inter-   where   the   appropriated   money   went;   .    e
                ested in the problem to meet  after  SHP  is  gone,   money that was appropriated       to  private   ad-
                and  maybe  take  some  action  or  at  least  make   diction  rehabilitation  centers  was  never  given
                demands.                                              to the centers. Moreover, the       ae     programs

                ,34


                                              SUMMER  1968
     weren't  servicing  the  real  addict   population:         dicts into  detoxification  and  rehabilita-
     75 percent of the addicts in the  city  are  black,         tion programs run by the State.
     but  only  15  percent  of  the  addicts   in   the    (3)  Interfaith    Hospital,     owned         by
     Ramirez program are black.                                  N.E.G.R.O.  and  located  in   Queens.   The
       We  found  that  Model  -Cities  had  money   for         hospital  maintains  a  twenty-one  day  de-
     health  facilities  and  that   the   Multi-Service         toxification  program.  Most  addicts   come
     Committee,  which  was   supposed   to   make   the         in  from  ref  erral  from  other  organiza-
     funding  decisions,   was   not   functioning.   We         tions, but any  addict  can  walk  into  the
     acquired the directions on  how  to  write  a  pro-         center.    Some    minimal    rehabilitation
     posal, and spent  several  days  at  the  Addiction         work is done.
     Rehabilitation   Center   in   Harlem   with    our     (4) Brookdale   Hospital,   whose    psychiatric
     NYCS,  speaking  with   ex-addicts   and   addicts.         service  has  a   newly   formed   narcotics
     They helped  us  in  writing  the  proposal  for  a         program.  They   are   doing   some   metha-
     Brownsville  narcotics  center.  We  presented  the         done   treatment;   they.liav.e.no   preven-
     proposal  to  model  cities  and  the  leaders   of         tive program.
     Brownsville.  The  response  has  been   very   fa-     (5) Brownsville    Community    Council     Nar-
     vorable.-E.B,, Medical Student, Brooklyn.                   cotics  Committee,  a  group  of  interested
                                                                 community    people    who    want    better
       The narcotics  problem  is  a  big  one  with  no         treatment  and  preventive   facilities   in
     good  answers   at   present.   Everyone   in   the         Brownsville.   They   have   attempted    to
     Brownsville  community  knows   people   that   are         improve the  effectiveness  of  police  con-
     "shooting" and that  kids  at  nine  years  of  age                  arrests of addicts, and th
                                                                 trol and                            ey   are
     or  younger  are  turning  on  by  glue   sniffing,         presently    undergoing    some     training
     reefers, and goof balls. In talks with two  of  the         with the addiction services agency.
     NYCs  working  with  us,  it  became  evident  that     None  of  these  groups   really   reaches   the
     they  were  interested  in  working  perhaps  in  a   youngsters or does anything with the  glue  sniff-
     preventive sense  with  youngsters  and  drugs.  In   ing problem, so we decided to  canvas  all  stores
     order  that  we  would  not  duplicate  other  pro-   which  would  possibly  sell  glue,  carbona,   or
     grams, and to  avoid  some  of  the  previous  mis-   other  toxic   substances.   We   visited   80-100
     takes,.we  contacted  and  spoke  with  all  groups   stores, informed the owners of the  law  and  dis-
     working  with  drug  abuse  in   Brownsville,   in-   cussed  the  problem  with  them.   We   presented
     cluding -                                             them with a copy of the law against  the  sale  of
        (1)  Addiction  Services  Agency,  (ASA),   part   glue for the purpose of  sniffing,  and  attempted
             of  the  Phoenix  Program   of   New   York   to  get  them  to  attend   a   meeting   we   had
             City.  They  have  a  storefront  which  is   planned.  (We  were  surprised  that  so  many  Of
             an  induction  center  and  meeting   place   the  storeowners  were.  Puerto  Rican,  and   re-
             for A.W.A.R.E and R.A.R.E.                    gretted  not  having  copies  in   Spanish.)   The
        (2)  Narcotics   Addiction   Community    Center   meeting  was  conceived  as  a  way  to   make   a
             (NACC).   They   have   a   fairly   formal   small attempt to  change  attitudes,  rather  than
             and traditional approach  as  part  of  the   just forcing people  to  comply  with  demands  or
             New  York  State  program.  Their   preven-   rules. At the most,  we  had  expected  five  sto-
             tive   measures   consist   primarily    of   reowners to come, that  would  have  been  a  sue-
             films which can be  loaned  to  any  group,   cess-but -none showed.
             and staff  members  occasionally  will  an-     Shortly after this meeting,  we  had  a  discus-
             swer  questions  with  film  showings,   or   sion  with  three  NYCS,  who  were  requested  to
             go  to  the  schools.  Unfortunately,  none   do some protesting at stores  selling  glue.  They
             of  the  films  are  directed  towards  the   discussed  the  drug  problem  and'fairly   freely
             "ghetto"  children  or   towards   children   described various encounters  they  had  had  with
             around  the  age   of   nine   years.   The   drugs. One in  particular,  who  is  a  gang  mem-
             NACC  takes  a  limited   number   of   ad-   ber, had very strong feelings  about  drugs  since
                                                                                                            3.5


                                                       GREATER        NEW  YORK
                  he  had  seen  two  of  his  uncles  and   a   cousin   buy  glue.  Happily,  our  earlier   campaign   seems
                  hooked.  The  NYCs  noted  that  most  of  the   drug   to  have  had  some  effects:  only  one  store  that
                  usage  is  in  the  evening:  the  kids  either  work   we visited was still willing to  sell  glue.  We  re-
                  or hustle all day and then  get  high  at  night.  It   turned to this  store  2  days  later  with  20  not-
                  is more or less the thing to  do.  From  the  discus-   so-eager  pickets,  and  left   about   a   half-hour
                  sion  emerged  the  idea  of  organizing  some  even-   later  with  the  druggist's  total  supply  of  Duco
                  ing  activities,  an  idea  which  will  be   further   Cement.  Picketing  is  apparently  a   very   effee-
                  developed.-L.K.,    Medical    Student,     Brooklyn.   tive prod.-J.T., Medical Student, Brooklyn.
                   As a  part  of  the  Brownsville  project,  we  can-     My  feelings  and  views  about  the  problems   of
                  vassed  the  area  to  inform  storeowners   of   the   the   ghetto   have   changed   sinc   .   e   summer
                  dangers  inherent  in  glue   sniffing.   We   handed   began;  I  am  less  optimistic  and  more  depressed
                  them  literature  concerning  a  meeting   at   which   over it all.
                  storeowners   would   confront   members    of    the     Tuesday  afternoon  an  addict  walked   into   Ac-
                  community and discuss this topic.  It  is  of  inter-   tion  Center  3  in  Brooklyn;  he  had  two  friends
                  est  to  note  what  transpired   in   one   hardware   with  him  who  had  agreed  to  drive  him  to   In-
                  store  in  the  area,  where   a   man   behind   the   terfaith Hospital.  He  has  been  an  addict  for  8
                  counter claimed:  "I  hope  kids  continue  to  sniff   years.  A  girl  friend  who  was  maybe  willing  to
                  glue; they will get sick and die  and  stay  off  the   marry  him,  and  a  growing  fear  that   the   next
                  streets.  *  *  *  You  are  stupid  to  think   that   rock  he  tossed  through   a   shop   window   would
                  these kids don't know it's dangerous.                   be  the  last,  had  convinced  him  to  call  Inter-
                  will continue to sell it to them."                      faith  on  his  own  and  make  an   appointment   to
                   The   next   week,   in   conjunction    with    the   be   admitted   on   Wednesday   morning.   From   us
                  Brownsville   Community   Council,   a   plainclothes   he  wanted  pajamas,  soap,  and   eigaretes,   since
                  narcotics officer waited outside  the  store  as  two   he had  no  possessions  of  his  own.  We  took  him
                  young  children  entered  to   ask   for   glue   and   to  Action  Center  5  since  I'd  heard  that   they
                  bags.  After  the  man  sold  them,   the   policeman   had  a   good   program   there.   The   lady   there
                  came  in  and  issued  him  a   summons,   which   he   called  the  welfare  center,   then   informed   him
                  refused to  accept.  The  policeman  called  a  squad   that  he  could  not  get  pajamas   and   soap   and
                  car and he was arrested.                                cigarettes  until  the   following   afternoon.   She
                   Perhaps  if  this   incident   were   made   public,   asked  him  why  he  had  waited  until  the   after-
                  through  news  media,   a   greater   public   aware-   noon to come in, since he must know that          "in
                  ness of  the  problem  would  follow,  and  the  peo-   offices things have  to  be  done  in  the  morning."
                  ple  of  the  area  would  pressure  storeowners  not   He.walked  out.  I  followed  and   begged   him   to
                  to  sell  glue  and  the  police  to  make  more  ar-   go  the  Interfaith  anyway  with  his  friends,  and
                  rests. The  problem  at  present  is  so  great  that   promised  to  get  pajamas   and   soap   and   ciga-
                  you   cannot   walk   down   the   streets    without   rettes to  him  the  next  day  if  he  couldn't  get
                  seeing young kids -sniffing glue.                       them  through  the  hospital.  He  wasn't   so   sure
                   The  meeting  on  glue  sniffing   was   a   failure   he wanted  to  go  anymore,  and  after  2  hours  of
                  because  not  one  of   the   100   storeowners   in-   waiting  around   for   nothing   was   quite   angry
                  formed about  it  showed  -up.  At  the  meeting  the   and  confused.  So  was  I.   I   begged   him   some
                  topic  digressed  from  glue  sniffing  to   gun-con-   more, shook his hand and     wished  him   luck.   On
                  trol legislation,  etc.,  and  members  of  the  com-   Wednesday   afternoon,   Interfaith   Hospital    had
                  munity  claimed  that  glue  sniffing  was  not  such   no  record  of  his   arrival.-J.T.,   Medical   Stv,
                  an   important    problem    that    such    priority   dent, Brooklyn.
                  should be given  it.  Our  activities  were,  in  es-
                  sence,   called   useless.-D.K.,   Medical   Student,     The official Newark City narcotics bureau         is
                  Brookl,yn.                                              a division  of  the  Police  Department.   Lt.   Ken-
                                                                          ney  of  Newark's  Narcotics   Squad   was   friendly
                    We  spent  2   days   driving   our   NYCA   around   and informative but I  was  horrified  at  his  atti-
                  Brownsville   from   store-to-store,.attempting    to   tude  toward  drug  addiction.  He  and   his   staff

                  36


                                                    GREATER        NEW  YORK
                under  her  circumstances  has   stamped   on   her   and personal  motivation.  If  total  rehabilitation
                record,   "13P",   which    means    out-of-wedlock   is to take place, their  families  must  become  in-
                pregnancy.  The  stigma  follows   her   throughout   volved.  Society  has  spent  thousands  of  dollars
                her life. The final decision to accept a girl  back   to  help  rehabilitate   the   drug   addict,   high
                into school is left up  to  the  individual  school   school  dropouts,  and  people  coming  out  of  our
                principal;  for  reasons  cited   previously,   the   penal  institutions.  Why  hasn't   something   been
                principal is usually not anxious  to  have  such  a   done  for  the   unwed   teenage   mother?   Perhaps
                girl  in  the  school,  and  permission  to  return   it's because she is not seen as a  threat  to  soci-
                to the girl's original school is often denied.        ety like the drug addict and ex-criminal!
                  If the girl tries to  remove  the  social  stigma   M.J., V.V., Nursing Studeiztso Bronx.
                of  her  out-of-wedlock  pregnancy   by   marriage,     Mornings  weren't  too  busy  in   the   emergency
                she is denied  an  education  because  she  is  now   room any  more  so  I  began  to  give  a  question-
                considered a married woman.                           naire (concerning  prenatal  care)  to  patients  on
                  There are  only  seven  centers  in  all  of  New   Martland's  postpartum  floor.  The   actual   ques-
                York City that  offer  educational  facilities  for
                teenage  mothers;  three  in  Brooklyn,  three   in   tion and answer  session  was  slow,  but  in  talk-
                Manhattan  and  one  in  the  Bronx.   These   cen-   ing  with  these  women  I  was  appalled  to  learn
                ters offer both educational and  health  facilities   that:  (1)  Most  of  the  women  had  very   little
                                                                      prenatal  care,  partly  because  they  dislike  the
                while  the  young  mother  is  out  of  school  and   long  waits  in  the  prenatal  clinics  and  partly
                living at  home.  However,  they  can  only  accom-   because  they  didn't  think  that   prenatal   care
                odate 40 to 70  girls  at  one  time,  which  means   was  very  important;  (2)   too   many   were   un-
                that  85  percent  of  the  unwed  mother  popul-a-   married  and  under  16,  and  very  few  (young  or
                tion is not being  reached  and  is  therefore  not   old)  knew  much  about   birth   control-they   re-
                being educated.                                       ceived  pamphlets  for  family  planning,  but  most
                  Other   resources   offering   educational    and   had  not  bothered  to  read  them;  (3)   most   of
                medical  facilities   are   "shelters   for   unwed   these  women  accepted  their  poverty,   ignorance,
                mothers." These  shelters  only  accept  girls  who   and    degrading    surroundings    (24-bed    wards
                are planning to give  their  babies  up  for  adop-   with  paint  falling  from  the  ceilings)   because
                tion, or girls who have no  home  or  can-not  cope   they  knew  of  no  other  existence  or   did   not
                with their home  situation.  These  shelters  range   know  to  whom   to   protest;   (4)   most   impor-
                ,from  $40  a  week,  up.  Ninety  percent  of  the   tantly, many  of  these  women  could  not  read  or
                Negro and Puerto Rican  girls  do  not  go  to  the   speak   above   a   grammar-school    level,    even
                shelters  because,  either,  they  live  at   home,   those  who   had   graduated   from   high   school,
                are unwilling to give up  their  babies  for  adop-   and  some  could   not   even   construct   complete
                tion, unable to afford the shelter, or lack  infor-   sentences  or  understand   words   like   abortion.
                mation about such shelters.                           That  lack  of  ability  to  communicate   was   not
                  I found that  in  certain  instances  these  cen-   just a problem of the black  mothers;  it  also  ap-
                ters and shelters were not able to fulfill the  ed-   plied  to  many  of  the  white  mothers  I   inter-
                ucational needs of the girls either:  most  of  the   viewed.-K.O., Nursing Stitdent, Newark.
                educational  facilities  already  set  up  do   not
                have  full-time  teachers;  and  subjects  such  as                      HOUSING
                advanced   math,    languages,    and    commercial      Article 7-A is a  "tent  strike:  law  passed  in
                subjects  are  not  taught  because  they   require   1965. It is the  most  effective  means  of  getting
                special  teachers   and   equipment.   This   means   slum  dwellings  repaired   ever   passed   in   New
                that it is  only  token  education;  and  the  girl   York.  It  provides  that  if  specified  conditions
                may also require classes  in  child  care  and  nu-   dangerous  to  life,  health  or  safety  exist  for
                trition, personal hygiene,  social  services,  fam-   more  than  five  days  in  an  apartment  building,
                ily counseling, and psychiatric counseling.           then one-third of the tenants  can  sue  to  get  an
                  These  girls  usually   lack   parental   support   administrator  appointed  to   collect   the   rents

                38


                                                   SUMMER  1968
       and  make   the   needed   repairs   from   the   rent    detrimental  to   the   welfare   of   the   occupants
       money. The law is  not  a  flawless  piece  of  legis-    that  these  conditions  cannot  be  allowed  to  con-
       lation.  Among  other  things,  it  requires  an   ar-    tinue for one more  day.  One  of  the  flaws  of  the
       chiteet's  estimate  of  the  cost   of   repairs   be    program  is  that  certain   conditions   that   could
       made at the  .expense   of   the   tenants    bringing    be disastrous  to  the  health  of  the  children  are
       the,suit.                                                 not   deemed    emergency    repair.    Despite    the
        In   connection   with    various    community    or-    threat  of  lead  poisoning,  the  presence  of  fall-
       ganizations,   an    extraordinary    lawyer'on    the    ing  or  loose  plaster  is  not  now   considered   a
       Lower   East   Side,   Mr.    Hanft,    has    brought    reason  for   emergency   repair.   Our   studies   on
       about 75  article  7-A  suits  in  the  last  year  or    the  incidence  of  lead  poisoning   from   ingestion
       two, and  has  had  adverse  decisions  in  only  two,    of  loose  plaster  and  paint  have  shown  us   that
       and  in  those  two  cases  the   repairs   had   been    this condition  leads  to  a  sick  and  often  criti-
       made by the time the decisions were made.                 cally ill child in too many cases.
       I  The  law  has  received   little   publicity,   and     Even    though    Project    RESCU    is    a    city
       Mr.  Hanft  believes  it  has  been  downright   ce-n-    agency  that  is  part   of   the   superagency,   the
       sored  in  the  press.  For  instance,  on   May   27,    Housing  and   Development   Agency,   it   has   man-
       1968,  the  New  York  Times  wrote  a  long   article    aged to cut out  a  lot  of  the  red  tape  that  was
       on  slum  problems   including   tenant   legal   rem-    formerly   involved   in   getting   needed    housing
       edies,   without   mentioning   article    7-A;    the    repairs.  It  has  shown  many  people  that   repairs
       New  York   Post   wrote   a   feature   on   a   slum    can  be  done  without  having  to  go   through   the
       building  in  which   Mr.   Hanft   had   an   article    entire  "mishmosh"  of  housing   agencies   and   ad-
       7-A  suit  pending,  and  failed   to   mention   that    ministrators,  and  it  has  gained   the   confidence
       fact;   when   picket   lines   were   organized    to    of  the  community.  This   was   clearly   shown   in
       picket  large  department   stores   which   advertise    the  demonstration  for   RESCU   in   the   fall   of
       in  these  papers,  the  television  stations  refused    1967,  when  the  agency   was   threatened   with   a
       to  cover  the  story.-R.H.,   Law   Student,   Brook-    funding  cutback:  1,,500  people  attended  a   rally
                                                                 on  behalf   of   the   agency.-D.Y.,   Medical   Stu-
                                                                 dent, Brooklyn.
         We  found   that   the   Crown   Heights   Neighbor-     The  "channels"   we   had   expected   to   set   up
       hood   Improvement   Council   was   very   quick   to    for  the  follow  up  on  housing  complaints  discov-
       respond   to   our   report   of   dangerous   housing    ered through  our  hospital  social  history  are  be-
       conditions.  In  one  instance,  they  sent   out   an
       inspector the same     Inight   that   the    complaint   coming  bogged  down  in  red  tape.  By   trial   and
                                                                 error,  we  have  nearly  reached  the  end   of   all
       was called in  to  them.                                  the  agencies  who  have  passed   the   buck.   T   e
         One   of   our   complaints   was   at   1018   Park    latest  system  for  housing  and  health   violations
       Place  in  the  Crown  Heights   section   of   Brook-    is to  type  up  a  resume  of  each  case  separately
       lyn,  where  there  was  loose  plaster  falling  from    on  a  memo.  One  copy  is  sent  to  the  Department
       the  walls  and  garbage  and  dead  vermin   in   the    of  Buildings  for  the   Borough   of   Brooklyn.   A
       alleyway  between'their   building   and   the   next.
       The  pressure  that  was  put  on  the   landlord   by    carbon  is  sent  to  the  health  commissioner.   The
       our   organization   and   the   Crown   Heights   Im-    third is kept for  our  files.  A  cover  letter  with
       provement  Council   resulted   in   a   new   plaster    the  seven  memo  cases  was   sent   out   today   to
       and  paint  job   for   three   apartments   in   the.    each agency.  The  question  is  now  what  to  do  if
       building, and a thorough cleaning of the                  no   answer   to   received.-M.H.,   Sociology    Stv-
       way.                                            alley-    dent, Brooklyn.
          We  found  the  RESCU  agency  to   be   the   most      The  real  problem   is   housing.   The   community
       -cooperative  and  productive  of  any  of   the   or-    knows  that  housing  is  not  only  an  urgent  prob-
       ganizations   dealing   with    housing    conditions.    lem,  but  is  also  a   central   one;   many   other
       The  role  of  this  agency  is  to   make   emergency    problems,   particularly   health,    are    dependent
       !repairs in cases  in  which  the  conditions  are  so    on it.
                                                                                                                     39


                                                     GREATER         NEW  YORK
                 My  first  approach   in   handling   housing   prob-   lar court  actions  to  be  taken  against  landlords
                lems  in  the  Bronx  was  to  work  with  each   per-   in all the  buildings  on  the  same  block  of  Mon-
                son  individually;  call  the   landlord   about   the   terey   Avenue.   These   efforts   may    contribute
                tenants'  complaints;  help  a  tenant  look   for   a   more  to  the  good  health  of  the  community  than
                new place,  and  so  on.  It's  the  wrong  technique,   all  of  the  screening,  physicals,  and   referrals
                but   the   right   problem.   One-to-one   work    is   that  could  be  made   for   this   same   neighbor-
                probably  the  only  way   of   doing   good   patient   hood.-J.G., Medical Student, Bronx.
                advocacy,  but  it's  not   a   productive   technique
                for  improving   housing.   Housing   is   much   more                LEGAL SERVICES
                directly  a  community   problem   than   health   is:    Legal  services  are  about  as  adequate  as   med-
                all  the  tenants  in  a  building  are  inherently  a   ical services.  The  Legal  Aid  Society  is  an  es-
                group    with    common    problems.-K.B.,     Medical   tablishment  organization  that  will  really   fight
                Student, Bronx.                                          like ---- to get  you  a  divorce  but  if  you  want
                                                                         to  sue  a  landlord,  look  elsewhere.  They  do  an
                  I  worked  as  a  community  organizer  in   a   di-   excellent  job  on  family  problems.  I  don't  want
                lapidated   apartment   building   on   Monterey   Av-   to  downgrade  the  importance  of  this,  but   they
                enue  in  the  Bronx.  After  working  as  a   patient   by no means offer  a  full  range  of  capable  legal
                advocate for  four  of  the  families  in  the  build-   services. As  far  as  the  criminal  division  goes,
                ing,  I  had  decided  that  an   effort   should   be   they are  a  fine  outfit  if  you  are  guilty.  The
                made  to  confront  the  landlord  and  to  make   him
                                                                         criticism  has   been   leveled   that   they   plead
                pay  for  his  negligence.  We  held   two   meetings,   everyone   guilty.   From    my    summer    contacts
                at  which  the  tenants  chose  a  captain  and  trea-   with them, I believe this  to  be  true.  This  prob-
                surer,  and  during  which  tenants'  rights  and  vi-   lem  is  compounded  by  the  fact  that  The   Legal
                olations  were   itemized.   A   lawyer   was   recom-   Aid  Society  is  the  only   organization   offering
                mended  to  us  by   a   representative   of   "Little   legal  counsel  on  a  wide  base  to   persons   in-
                City  Hall,"  and  the   tenants   decided   to   hire   volved in crimes.
                him. The treasurer  was  able  to  collect  a  $5  fee     The  legal   services   provided   by   the   NAACP
                from nine  of  the  13  tenant  families.  During  the   are  mostly  (if  not  exclusively)  for  what   they
                last  week  of   the   project,   an   architect   who   consider landmark cases. If  you  can't  get  into  a
                works  with  the  lawyer  in  a   group   called   the   trade union,  they  might  take  your  case,  but  if
                7-A  Associates  made  a  systematic   inspection   of   you are  a  petty  thief  they  won't.  Most  of  the
                eight   of   the   worst   apartments.   Article   7-A   other  organizations  are  interested  in   rendering
                specifies the following 'sequence of action:             aid in those  cases  that  will  bring  publicity  to
                   (1)  Landlord  summoned   to   court   for   apart-   the organization.  If  there  are  other  legal  ser-
                        ment   violations.   Specific   repairs    or-   vices  available,  I  am  unaware  of  them.   (which
                        dered. -                                         doesn't mean that  they  don't  exist  or  that  they
                   (2)  Landlord    obtains    one    week    adjourn-   haven't  had   much   impact   on   the   community).
                        ment,   during   which   he   must    indicate     As   far   as   community   attitudes   about   the
                        specific progress on repairs orders.             quality of the  legal  care  that  they  receive  go,
                   (3)  If these  repairs  are  not  initiated  during   they  are  resigned.  They  have  come  not  to   ex-
                        a  prescribed  period,  the  building   owner-   pect it, so they don't  miss  it.  They  are  unaware
                        ship  is  transferred  to  a  court   adminis-   of the  role  of  the  lawyer  and  exactly  what  he
                        trator  and  rent  is  payable  only  to  this   can do for them. (In  this  respect,  I  don't  think
                        administrator.                                   Harlem's  attitudes  differ   from   those   of   the
                   (4)  The  landlord  does  not   receive   ownership   lower economic groups across the country.)
                        back  until  major   repairs   requested   are     The  concrete  legal  services  that  the   project
                        on the way to completion.                        rendered  were  limited  by  several  factors:   only
                   I intend to  be  present  during  the  first  court   two  law  students;  lack  of   experience   on   the
                action   in   September.   Arrangements   have    been   part  of  the  law  students;  the  very  nature   of
                made  with  a  community   organization   for   sim;.-   law insofar as it takes a  long  period  of  time  to

                40


                                            SUMMER  -1968
                                                                         not   truly    representative,    and
                                                            pr
      indle a case. In terms  of  people  reached  and      fggrams are                       he   needs    of
      tses handled, I would  say  that  they  come  to      V,,,,erefore do not speak directly for t
      bo.ut a dozen. That, as  far  as  I  am  concerned,   tkP. people. In setting  up  the  Riverside  Corn-
      i disgraceful. It was  so  because  the  project      'rjr;@unity Health Council, existing community ac-
      ras entirely unstructured for  law  students.  I      tion groups were  contacted  and  each  was  asked
      @ink that it was an error  to  hire  us  without      t/,, send a representative. This  group  then  be-
      ny real  idea  of  what  we  were  going  to  be      c@me the Health Council.
      oing or of  whether  there  was  any  real  need      While  this  system  of  selection  may   not   be
      or us in a project like this. The other big rnis-     perfect in that  only  those  people  already  in-
                                                            volved  in  community   programs   were   eligible
      ake  was  the  assumption  that   law   students
      would, on  their  own,  know  what  to  do.  Law      f (,r the Council, use was being made of the  peo-
      chool has almost no  relation  to  social  prob-      fJ.e who would be using  the  facility.  According
      erns. They don't teach us  about  these  things.      t(,, 0,E.O. policy, the Community Council  is  not
                                                            ,4alaried. This is to insure against the  position
      'We knew that we didn't know,  but  the  project
      I                                                     I)c,@oming one of status rather than  of  concern.
      lirectors didn't know that we didn't know.)           (Funds  were  provided,  however,  for   transpor-
      If it is within the goals of the  SHP  (and  I'm      tation, babysitting, or for  time  lost  from  the
      riot saying it should be), law  students  should      job while  Council  meetings  were  takin  place.)
      be assigned to work with a lawyer in  the  corn-                                            9
      munity itself. Most of the good  work  is  being      The  Council  meets  on  a  biweekly  basis.   Its
      done  by  private,  non-funded  lawyers.   These      f unctions are concerned with the hiring  of  peo-
      guys are really doing some exciting things,  but      ple  to  staff  the  health  facility-making  sure
      they are shorthanded. It would be to  the  bene-      that people  hired  are  from  the  community  and
      fit of the community to  assign  a  law  student      representative of  it.  The  Council  also  deter-
      with a lawyer like this. I  don't  know  whether      mines that people  hired  have  the  proper  atti-
      this would fit into the conception of  SHP  that      tudes  needed  to  work   with   the   community.-
      its leaders have, but it would be more effective.     J,A.,,Medical Stqtdent, Harlem.
      -F.V., Law Student, Harlem.                           E3rooklyn
                      AGENCIES                               One  of  the  main  accomplishments  of   Project
                                                            ITESCU  (a  program  set  up  by  the  City  Hous-
      Harlem                                                ing   and   Development   Agency   to   facilitate
      it   seems    as    though    someone    has    finally speedy  repairs  following  complaints)  has  been
      begun  to   understand   what   is   meant   by   corn- to prove to the white  power  structure  that  the
      munity  participation.  The   phrase   used   to   mean blacks can do much for themselves.
      that  you'd  have  a   black   Ph.D.   from   Scarsdale For  example,  the   head   of   Bedford-Stuyves-
      on  your   planning   board   to   approve   of   ideas atit's RESCU is a black  man  who  was  raised  in
      from the" community"  point   of   view.   Well,   yes, the  area.  He  has  much  knowledge   about   the
      he was black.                                         needs  of  his  fellow  blacks  and  can  communi-
       But   the   Riverside   Health   Clinic   in   Manhat- cate with them.  He  is  very  responsive  to  the
      tan  is  something   different.   The   Department   of complaints that are filed with the agency.  He  is
      Health,  backed  by  St.  Luke's  Hospital,   has   set hindered by a lack of funds and  by  the  lack  of
      up  this   comprehensive   health   facility,   working good investigators, especially black  ones.  There
      closely    with    a    Community    Health     Council are, according  to  this  man,  not  enough  black
      which  actually  is  made  up  of  people   living   in inspectors.  The  connotation   of   the   housing
      the  neighborhood,  people  who  will   be   the   con- inspector is still one of disgust and mistrust  in
      sumers of the health care.                            the  community.  When  the  people  see  a   black
                                                            man  coming  to  inspect  their  homes  and   help
        Since  the  Clinic  was  to  be  funded  by   O.E.O., them, they are more  responsive  and  also  filled
      some  sort  of  community  participation  was   -   re- with a  sense  of  pride.-D.Y.,  Medical  StuIdent,
      quired  in  the  planning  of  the   facility.   Often,
      though,   community    people    involved    in    such Biooklyn.
                                                                                                             41


                                                                            YORK
                                                    GREATER         NEW
                 I came  to  the  conclusion  that  the  basic  prob-   wouldn't let a copy of  the  proposal  out  of  sight
                 lem  with  Youth  In  Action  was  lack  of   money.   for  fear   that   Bedford-Stuyvesant   might   steal
                 It  seems  that  the  Government  has   managed   to   the idea.
                 give  just  enough  for  the  middle-class   Negroes    Some   degree   of   protective   self-interest   is
                 to set  up  a  bureaucracy;  these  funds,  however,   reasonable, but it  would  seem  that  if  each  area
                 have not been  sufficient  to  permit  the  bureauc-   had -a certain amount  of  funds  allocated  for  re-
                 racy to function.                                      newal, health  care,  new  construction,  etc.,  each
                 The  funding  is  on  a  year-to-year  basis,   thus   year (or 5  years),  there  would  be  less  competi-
                 causing a  great  deal  of  insecurity  and  a  high   tion,  more  sharing  of  ideas  and   perhaps   even
                 turnover  rate  in  the  administration;  and  since   less  Federal  and  local  red  tape.  Each   commun-
                 the   administration   is    constantly    changing,   ity  would  be  assigned  funds  depending  on  their
                 good relationships  with  the  regular  staff  never   needs  and   local   conditions.   On   the   Federal
                 have  a  chance  to  materialize.   Furthermore,   a   level,  fewer   agencies   with   overlapping   func-
                 great  number  of  the  administrators  and   super-   tions  would  be   needed.   Perhaps   the   existing
                 visors are members  of  the  middle  class,  profes-   Model  Cities  areas  could  be  used  as  a   start.
                 sionals who, for the  most  part,  are  more  inter-   Each local Model Cities office would know         how
                 ested  in  using  the  programs  to  further   their   much  money  was  available  to  its  area.  The  ex-
                 own  personal  careers  than   to   eliminate   pov-   penditure of  these  funds  could  be  decided  by  a
                 erty.                                                  joint action  of  Model  Cities  and  other  existing
                 If the    Federal    Government     would     supply   community agencies.in the particular area.
                 sufficient funds  on  a  long-term  basis,  many  of    The  Model  Cities  program  has  so   far   ignored
                 YIA's  problems  would  cease  to  exist.  It  would   existing  community  agencies  in   the   area,   and
                 seem  that  the  Federal  Government  really   isn't   therefore   any   planning   proposals    drawn    up
                 serious about  eliminating  poverty  but  is  perpe-   were  probably  staff-oriented   and   not   communi-
                 trating  an  immense   fraud.-R.J.,   Mediral   Stu-   ty-oriented, as decreed  by  the  philosophy  of  the
                 dent, Brooklyn.                                        program.  This  could   probably   be   remedied   by
                 I   was   struck   by   the   immense    bureaucracy   hiring  community  people  to   staff   the   commit-
                                                                        tees, thus eliminating meetings which end wi:
                 that is Youth  In  Action,  and  by  the  apparently   "we'll have to find out  more  about  that";  and  it
                 large  gap  between   administrators   and   working   would  give  the  communitya  real,  -not  just   ap-
                 staff.  The  workers,  who  are  community   people,   Darent, say in the planning.
                 make up for  a  lack  of  formal  education  with  a   - Much  resentment   exists   because   local   anti-
                 great  deal  of  understanding  and  ingenuity,  and   poverty  agencies  feel  that  their  funds  will  be
                 are   on   the   whole   impressive.-J.T.,   Medical   cut  due  to  the  creation  of   this   superagency,
                 Student, Brooklyn.                                     Model Cities. They  also  feel,  and  rightfully  so,
                 Some   of   the   problems   with   the    community   that -all 'their  work  and  planning  is  being  ig-
                 antipoverty agencies is that they  are  in  a  sense   nored  since  this  new   ageney's   committees   du-
                 competitive  with  each  other  for  Federal  funds.   plicate  and   have   preference   over   their   own
                 Year  to  year  funding,   common   in   many   Fed-   committees   (which   seem   to   have   more    com-
                 eral programs is a hindran   ce  to   good   rapport   munity  experience).  It  seems  that  for  any   ac-
                 between different  local  agencies.  Agencies  don't   tion  to  be  taken  these  days   much   preliminary
                 communicate   to   each   other    about    programs   planning,  studying  and  investigation   is   neces-
                 they,are  conducting  or  applying  for  since  they   sary.  Many  of  the   local   agencies   have   been
                 don't  want  to  chance  losing  anything   to   the   doing  this  for  the  last  few  years  and  now   a
                 other agencies.  An  example  of  this  in  Brooklyn   new  agency  comes  to  do  more   planning,   ignor-
                 was   seen   when    the    Brownsville    Community   ing any previous studies  of  the  area.  It  appears
                 Council was, with our  .help,  writing  up  a   pro-   to many people that  this  is  a  way  to  make  pov-
                 posal  for  a  narcotics  center   in.   Brownsville   erty  programs  ineffective:   keep   them   financed
                 through   the    Model    Cities    Program.    They   as long as they  are  just  studying  the  situation,

                 42


                                                SUMMER  1968
       but once they  start  to  do  something  about  the    After  attending  one  meeting   of   the   Tremont
       status quo, give  the  funds  to  someone  else  so   Community  Council  early   in   the   summer,   and
       they  can  plan  some  more.-W.S.,  Student   Coor-   having  become  acquainted  with  several   of   its
       dinator, Brooklyn.                                    permanent  members,  I  could  only  conclude   that
                                                             it was  thoroughly  infiltrated  by  nuns,  priests,
       Newark                                                and  policemen,  and  that  its  lay  members   were
        Our office was located in  Area  Board  No.  2  of   neither  representatives  of,  nor  interested   in,
       the   United   Community   Corporation    in    Ne-   basic efforts to  confront  and  combat  the  causes
       wark.  Our  relationship  with   the   UCC   proved   of  Poverty,  sickness,  and  crime  in  the  neigh-
       @to be  detrimental  to  our  services-patient  ad-   borhood.  The  major  preoccupations  of  the   Tre-
       vocacy  and  community  organization  and   partic-   mont   Community   Council    during    this    past
       ipation.  Many  community  residents   were   skep-   summer  appeared  to  center  around   the   mainte-
       tical, even bitter,  about  any  organization  that   nance  of  a  good  self-image  in   the   neighbor-
       dealt with UCC,  as  it  is  known  throughout  the   hood. Attempts  to  achieve-  this  included  numer-
       community  that  UCC  is  part  of  the  degenerate   ous  block  parties,  parades,   recreational   out-
       political power  structure  that  has  a  strangle-   ings, cleanup caml>aigns, visits  by  political  and
       hold  on  the   Newark   community.   Any   attempt   church   leaders   (including    the    Archbishop),
       of theirs to service the  people  would  be  viewed   and organization buttons.
       as a move  to  subjugate  the  community  into  the     The  summer  recreation   program   was   run   by
       power  structure.  UCC  has  also   been   involved   a  Vietnam  war   veteran   who   was   biding   his
       in a  few  scandals.  When  Newark  had  its  riots   time until he could  apply  for  a  job  in  a  Man-
       and fires, UCC was  designated  as  a  distribution   hattan  business.  After  some  fruitless   attempts
       point for  food,  clothes,  and  furniture.  Before
       anything was distributed, the staff  of  each  area   to question the  basic  goals  and  motives  of  the
       board   took   what   they   wanted.   Working   in   Tremont   Community   Council,    I    decided    to
       Area  Board   No.   2   handicapped   SHP   because   adopt  a  position  of  peaceful  coexistence.   The
       community  people  were  reluctant   to   come   to   Uouncil  did,  after  all,  provide  four  students,
       our office for  services  or  organizational  meet-   two  community   workers   and   three   NYCs   with
       ings.-D.B., Community Worker, Newark.                 office space, phone, and  clerical  facilities.  The
                                                             Tremont   Community   Council   had   been    bought
       Bronx                                                 out  by  O.E.O.  and  the   church;   SHP   members,
         During  the  summer,  I  worked  with  two   com-   in  turn,  were  bought  out  by  the  Tremont  Com-
       munity  organizations  in  the  Bronx:   the   Tre-   munity  Council.  It  was  a  cozy  arrangement:   a
       mont  Community  Council  and  the   St.   Joseph's   priest offering his buddy the  cop  a  salami  sand-
       School  Head  Start   program.   The   former   or-   wich,   while   a   Vietnam   veteran   shooed   the
       ganization  is  -a  summer,  O.E.O.-funded   group;   pesty   natives   out   of   the   storefront.   SHP
       the latter, a parochial school affiliated with  the   workers maintained,  in  true  style,  a  conspiracy
       large  and  powerful  Roman  Catholic   parish   of   of silence.-J.G., Medical Student, Bronx.
       St. Joseph's on Bathgate Avenue.

                                                                                                               49


                                      Part 3: ROLES IN CONFLICT

                       INTRODUCTION                            seem  endless  and  unproductive?   We   have   not
          For  a  multitude  of  reasons,   highlighted   in   decided  whom  we  should  support,   the   medical
        the  categories  comprising  this  section  of   the   schools or the  community;  we  have  tried  to  be
        report,  the  summer  experience  for  most  of  the   all things to all men.
        SHP  participants  was  memorable   more   for   its     We have failed  to  respond  to  the  real  prob-
        frustrating role  conflicts  (both  real  and  imag-   lems in  health-the  need  for  change  in  schools
        ined) rather  than  for  any  specific  task  accom-   and  health  institutions.  This  summer,  we   did
        plishment  that  may  have   occurred.   There   was   much  that  was  stop-gap.  We  helped,  as   advo-
        little  disagreement  as  to  what  needed   to   be   cates and  organizers,  but  these  roles  provided
        done  during  the  summer  ("improve   health   care   few innovations;  they  merely  reformed  bad  sit-
        delivery")  but  agreement  as  to   how   best   to   uations  in  a  hospital  system   which   the'com-
        achieve  this   highly   desirable   objective   was   munity  detests.  We  should   have   devoted   our
        never reached  on  any  level  of  the  project  or-   entire  efforts  to  helping  the  community   gain
        ganization.    Furthermore,    approaches    to    a   control of its hospitals  and  to  helping  commun-
        given  problem  suitable  for  one  area   or   area   ity organizers  challenge  the  inequities  of  the
        subproject  often  turned  out,  because  of   basic   existing  health   establishment.   But   we   were
        differences  in  the  communities  and  health  care   still trying to protect the  health  establishment,
        delivery  systems  involved,  to  be   inappropriate   project  our  middle-class  values,  and   preserve
        or ineffective  for  other  areas  or  area  subpro-   our image as a "liberal" organization.
        jects. Particularly  where  strong  project  leader-     We have chosen to "sensitize" ourselves, t      o
        ship  and  firm  preceptor  arrangements  did   'not   educate health students. But we  are  Still  acting
        exist, the necessity for  modification  of  many  of   as  "good"  whites  in  the  poor  community.,  The
        the  original  task  proposals  and   the   develop-   problem, however, is  not  being  educated  at  the
        ment  of  new  subprojects   throughout   the   sum-   expense   of   the   community.   This   SHP    was
        mer   required   that   SHP    workers    constantly   doomed from the beginning  since  it  chose  to  be
        re-evaluate and redefine their  roles  in  the  pro-   educational.  It  chose  to  cooperate   with   the
        ject.                                                  health establishment, but failed to listen  to  the
           The diversity  of  views  in  the  excerpts  that   needs   of   -   the   community.   The   community
        follow  illustrate  the  resulting   confusion   and   wanted people who would  help  it  help  itself  to
        frustration  experienced  by  project   participants   organize  area  health  councils  and   who   would
        as they  faced  the  realization  of  their  limita-   give  the  community  organizers  ways  they  could
        tions, lack of power, or failure to  deal  with  the   challenge the long  waits  and  poor  care  of  the
        summer's   various   problems   most    effectively,   second-class   hospitals.   They   wanted    picket
        ranging   from   broad    questions    of    SHP/SHO   lines of  sincere  white  students  and  the  black
        philosophy  versus  SHP/SHO  practices,   to   deal-   community   around   these   hospitals,   if   that
        ings  with  community  groups,   institutions,   and   would   help   the   struggle.   Eventually,    SHO
        agencies,  to  relations  within  the  SHP  "family"   would  have  to  realize  that  it  must  work,:'or
        itself.                                                first-class health for all, not just for the  rich.
                                                               To do this, health  students  would  have  to  take
        STUDENTS     AS     A     FORCE      FOR      CHANGE   a position favoring  community  control.  In  fail-
           Why  do  many  in  SHO  feel   frustrated   after   ing to do this, we only  served  to  further  erode
        summer   projects?   Why    does    our    bickering   the pride and self-esteem of the poor.

                                                                                                                45


                                                  GREATER         NEW  YORK
               What   is   SHP?   SHP   itself   does   not   know.   cated  to  community  control,  which   would   bring
               Our   project   lacked   participatory    democracy;   needed   information   about   health    institutions
               we  never  met  as  a  whole  to  decide  upon  any-   and  their  politics  to  community   groups   inter-
               thing. Prior to the  project,  we  failed  to  build   ested  in  health  care,  and  which  would  actively
               proper ties to  the  community,  especially  in  the   fight  for  sweeping  changes  in   health   schools.
               Bronx.  Thus,  in  many  instances,   we   did   not   Health  professionals  of  the  future   must   begin
               have  well-planned  projects;  they  just  fell  to-   to  face  the  realities  of  our  society  now,  and
               gether. I  think  SHO's  leadership  let  a  sinking   should begin  to  force  changes  by  militant  reso-
               boat  flounder  by  not   constantly   re-evaluating   lute actions.-R.C., Medical StvWvit, Bronx.
               the  project  and  by  not  providing   for   direct    Before one can relate  to  a  "task"  it  is  neces-
               participation, or  even  revolt  in  the  ranks.  In   sary to develop  an  idea  of  what  the  "task"  is.
               essence, we did  not  learn  from  the  failures  o!   The  SHP  leadership  has  not  clearly  defined  the
               previous  SHPs  and  we  were   doomed   to   repeat   SHP  "task."  At  the   beginning   of   the   summer
               them.                                                  there  was  talk  about  sensitization,  and  in  the
               The   thing   which   haunted   me    most    during   outline for  the  final  report  they  ask  "how  the
               the   summer   was   an    expression    from    the   Deople  in  your   community   feel"   or   "evaluate
               French  student  revolt   this   May:   "The   walls                                  o  ided."  It  is  too
               have Oars  and  your  ears  have  walls."  I  wanted   the concrete service you pr v
                                                                      bad they were  not  able  to  develop  their  leader-
               to  help  the  Bronx  community  I  worked  in,  but   ship   beyond   scurrying   about   trying   to   get
               I  also  wanted  to  listen  to  them.  But   people   people to do their individual tasks.  It  is  even  a
               wanted  action  and  results.  They  were  tired  of
                                                                      greater  pity  that  they  were  not  able  to  think
               more white  faces.  In  the  inquisitorial  darkness   beyond  a  "task"  to  be  performed  or  a  contract
               of their eyes, I could  sense  the  deep  resentment   to f ulfill to the point where they quickly lost  the
               my  skin  had  aroused.  The   community   was   not   moral  leadership  of  SHP  and  never   gained   the
               a  wall.  It  did  respond  to  sincerity,  but   it   conceptual   leadership   which    they    had    the
               wanted  its  own   leaders.   Advocacy,   or   doing   potential to attain.
               things  for  the  community,   would   solve   noth-     What  are  the  conceptual   goals   which   should
               ing;    helping    the    community's     leadership   guide  one's  efforts?  Perhaps  they  should  be  to
               would.  I  laid  some  groundwork  for   a   commun-   educate doctors and  students  to  the  medical,  so-
               ity health council,  but  much  of  my  work  organ-   cial  and  political  aspects  of  health   problems-
               izi-ng tenants to protest a garbage  pile  in  their   why they exist  and  what  can  be  done  to  correct
               courtyard, and poor  housing  conditions,  did  lit-   them  on  a  long  term,   fundamental   basis.   The
               tle for the whole community.                           question  is  not,  how  many   will   return,   but,
                I  think  the  experience  did  much  for   me.   I   how can  the  health  system  from  the  national  to
               have  a  clearer  idea  of  what  the  blacks   want   the city level be changed  for  all  people  so  that
               and  what  I  need  to   do   to   help   re-educate   communities  are  not  dependent  on  a   few   white
               whites;  white  students  must  become  more  raili-   doctors  who  are  kind  enough  to  return  to  work
               tant in their own communities.                         in patchwork, pilot project clinics.
                Student  power  is  desperately   needed   in   the     The  orientation  to  the  type  of  education   is
               health schools.  We  must  begin  to  build  a  base   key-it  should  be  intensely  political.  Change  in
               within our own  society  to  attack  what   it   has   health  system,  and  the  people  who   rule   them,
               been doing  to  the  black  and  white  communities,   will  only  be  achieved  through  political  action.
               in hospitals  and  in  teaching  institutions.  Stu-   The   A.M.A.   has   effectively   known   this   for
               dents should begin  to  fight  for:  (1)  A  student   years.  Task-oriented  service  projects  or   paying
               veto in all  areas  of  student  life  and  studies;   the  salary  of  NYCs  to  "sensitize"  white   medi-
               (2) student-faculty  control  of  school  decisions;   cal  students  to  black  people  gives   a   minimal
               (3)  more  social  orientation  of   courses-,   (4)   political  orientation.  The  overall  tone  of   the
               more responsibility  of  schools  and  hospitals  to   New  York  SHP  has  been  intensely   a   political.
               the  community;  and  (5)  a  militant  SHO,   dedi-      It is  difficult  to  decide  what  makes  medical

               46


                                                  SUMMER  1968
         people political.  The  present  approach  of  gov-    politics, and still be effective in both areas,  at
         ernment funds for  service  projects  and  sensiti-    least, not this early in the  game  when  our  com-
         zation is not  the  answer.  That  a  national  SHO    petence in either of  these  areas  is  so  limited'
         convention is  afraid  to  come  out  strongly  (or    We  can  no  longer  afford  to  keep  winning  the
         at all) against the war  in  Vietnam  or  that  the    small  skirmishes  (for  example,   patient   advo-
         SHP  is  organized  around  fulfilling   Government    cacy) while losing the  war  (for  example,  little
         contracts retards  meaningful  political  activity.    or no change in the  health  care  delivery  insti-
         Students  must  obtain   a   degree   of   autonomy    tutions  -with  which  we  worked   this   summer).
         from their medical  school  faculties  before  they    -NV.S. Medical Student, Harlem.
         can  even  begin.  One  approach  which  the   Col-    Because   I   have   not   succeeded   in    making
         umbia SHO  is  planning  to  take  is  to  build  a    many  grievances  known  to  the  people   who   c@
         hard core of politically active students  and  doc-    trol the health care delivery system,  I  feel  the
         tors to start  with,  and  to  -attempt  to  slowly    project  should  be  organized  to   put   pressure
         build from this. We hope  to  extend  our  base  to    where it is -needed.  Perhaps  SHP  should  not  be
         other  medical  professions  and  perhaps  to  form    funded if it is not going to provide  a  systematic
         some  communication  with   the   hospital   unions    means  of  working  within  the  system  to   exert
         eventually. This  will  be  attempted  through  the    -nressure. Stop-gap measures will  not  suffice  to
         continuation of  the  Liberation  School  "Politics    appease the  f  rustrations  of  the  patients  At-
         of  Health"  classes  at  Columbia's   College   of    tended to by the student, and  SHP  will  lose  all
         Physicians  and  Surgeons,  meetings  of  the  coa-    meaning to the community if  it  accepts  in  prac-
         lition  of  community  doctors,  house  staff,  and    .                                  alth    delivery
         medical   students   at   Harlem   Hospital,    and    tice the wrongs of the present he
         through the involvement  of  these  people  in  po-    system.-R.F., Medical Student, Bronx.
         litical actions' on health issues  at  all  levels.     The  lack  of  sophistication  of  some   of   the
         This blend of education  and  political  action  is    leadership  and  most  of  the  fellows-I   include
         something  which  can  be  pursued   on   a   year-    myself-in the SHP is  a  principal  issue.  I  sus-
         round basis without costing money.                     pect all of us learned this  summer,  but  I  ques-
          If medical people are asked  to  work  on  a  vol-    tion  whether,  other  than  sensitizing  ourselves
         unteer basis, they will begin to  develop  ways  Of    to  community  health  needs   so   we   might   be
         handling  the  medical  responsibilities  of  being    more effective in the  distant  future,  we  accom-
         politically active doctors; once they  are  profes-    plished very much. For that  I  do  not  think  the
         sionals, they can  then  fall  back  on  these  ap-    structure of people  of  SHP,  or  the  communities
         pro,aches  with  confidence.   Because   this   an-    with  which  we  worked,  are  at  fault.  We   are
         proach  does  not   involve   money,   instead   @f    not  capable  of  implementing   vast   changes   m
         wasting  nine  months  of  effort   gaining   grant    health  care  in  poverty  areas.   People   suffer
         money  and  then  three   months   of   "activity",    from poor health -not only because  the  city  hos-
         leaders  could  spend  the  whole   year   actively    pital  system  does  not  meet  their  needs;   not
         working   politically.-K.C.,   -Medical    Student,    only because the average  physician  is  self-seek-
         Harlem.                                                ing;  not  only   because   the   average   medical
                                                                school  is  more  concerned  about  research   than
          A  question  with  which  we  all  have  to  wres-    people; they  suffer  because  their  children  eat
         tle: do I serve  each  suffering  individual  on  a    lead paint off  the  walls;  because  their  apart-
         person-to-person basis and  reach  only  a  few  of    ments  are  inadequately  heated  in   winter   and
         the many needing assistance,  or  do  I  direct  my    too  warm  in  the  summer,  and   overcrowded   in
         energies  at   solving   broader   problems   which    winter   and   summer.   SHP    might    cause    a
                              eatest  number  of.   persons?    landlord  to  repair  an  apartment,  but  in   one
         could benefit the gr
         To  my  view,  where  medical  politics  are   con-    summer  SHP  is  not  going  to  begin  to   attack
         cerned, there just isn't time to split one's atten-    the causes of poor  health  in  poverty  areas.  We
         tion  and   energies   between   medical   practice    are unsophisticated  and  we  are  not  revolution-
         (for  example,  service   projects)   and   medical    aries;  we  work  within   an   establishment.   We
                                                                                                                  47


                                                                      YORK
                                               GREATER        NEW
             may  serve  to  improve  that  establishment  with   commitment.  I  never  understood  the   rationale
             what  we  have  learned  this  summer.  With   the   that gave lowest  priority  in  the  selection  of
             structure of SHP as it now is,  we  probably  will   students for this year  to  people  who  had  pre-
             not contribute to revolution, but only  to  evolu-   vious SHP  experience.  If  students  are  willing
             tion.                                                to  come  back  after  one  summer's   experience,
             How  can  we  become  revolutionary  in  our   ac-   they must be committed.-J.P.,     Medical     Stu-
             tions as well as  in  our  words?  We  would  have   dent, Lower East Side.
             to  begin  accepting  more  sophisticated   people    I was confused about the  role  of  SHP  in  gen-
             into SHPS. People  who  were  not  idealistic  the   eral. It was not clear to me whether it  was  sup-
             way we were.  People  not  afraid  to  offend  the   nosed to be a service project or a political  pro-
             health  establishment.  People  unwilling  to  fit                                As a -result,  I  did
             into existing community  organizations,  if  those   ject for better health care.               ek   of
                                                                  not know which way to go. There was a la
             organizations. might  have  goals  with  which  we   communication  in  the  local  Newark  project  as
             disagree. People willing to accept  a  subsistence   to which direction  everyone  was  headed;  every-
             wage for the summer,  to  live  in  the  community   one seemed to  be  doing  his  own  thing.  So  it
             with  the  people,  to  work  with  them  day  ind   turned out that I  acted  mainly  in  the  service
             night. Most people  accepted  into  the  SHP  were   role because it is too difficult to make  any  at-
             not like this. For the most part,  they  were  so-   tack  on  organization  without  cooperative  sup-
             cially concious but not dedicated,  concerned  but                              s  o  the   'dministra-
                                                                  port. When any movement   n         a
             not  committed.  J.W.,  Medical   Student,   Lower   tion of the hospital were planned,  I  think  med-
             East Side.                                           ical  students  became  fearful  of  being  thrown
              There was  little  threat  to  the  Establishment   out  of  medical  school.-L.D.,  Nursing  Student,
             made this  summer.  This,  of  course,  brings  up   Newark.
             the  question  that  SHO   has   been   struggling     Turning to the  cold,  hard  facts,  how  do  we
             with for as long as I've been associated with  it,   assist in providing  good  medical  care  for  the
             and from what I  can  tell  from  the  literature,   most people? This, I feel, is almost  an  impossi-
             from its inception. It is the same  question  that   bility for students. We do  not  have  the  knowl-
             caused  two  New  York  SHO  leaders   to   resign   edge or  power  to  provoke  the  radical  changes
             before the  summer  began.  Is  the  SHP  to  con-   that are drastically needed.  The  whole  philoso-
             cern itself with political  issues,  or  is  ft  a   phy  of  doctors  and  nurses,  must  be  analyzed
             service   and   educationally-oriented   organiza-   and evaluated, and this is a  task  that  must  be
             tion? I believe that any local SHP  is  doomed  to   accomplished  individually  by  every  person  who
             failure unless the  students  and  community  peo-   enters these professions and  is  responsible  for
             ple are in agreement  on  this  question.  One  of   the  quality  o.f care they  give.  In  one's  mind,
             our major problems  was  that  even  the  students   there  must  be  no  distinction   between   race,
             could  not  agree  among  themselves  as  to  pur-   creedi or nationality, but each  must  be  treated
             pose.  Those  of  us  who  had  been  working  and   as  an  important  person,  "my  patient,"  and  I
             preparing for the  project  during  the  year  had   must do  my  best  to  assist  "my  patient"  with
             difficulty  understanding  and  were  angered   by   his every  n'eed-physical,  psychological,  socio-
             the lack  of  commitment  -displayed  by  some  of   economic, etc. Our job is  not  finished  when  we
             the people  who  came  in  June.  They,  in  turn,   have  handled  the  priorities,  such  as  medica-
             were angered  by  our  attitude,  which  at  times   tions, yet patients are damn  lucky  if  they  get
             must  have   seemed   more   dogmatic   than   ra.   even their immediate  utmost  needs  attended  to.
             tional. It was never really stated, either in  the   I think we can talk and  talk  about  how  an  in-
             application  or  at  orientation,  that  the   SHP   dividual may  assist  in  providing  better  care,
             wasn't "just a job,"  and  that  people  who  wer-   but we had better  ask  just  what  everyone  else
             en't really  willing  to  commit  themselves  were   is  doing-including  the  people  in   influential
             not wanted. For that  reason,  it  was,  wrong  of   positions-to   change   health    care    delivery
             some  of  us  to  expect  (and  often  to  demand)   systems.-P.B., Nursing Student, Bronx.

             48


                                                SUMMER  1968
        I   see   the   role   for   next   summer's    SHP    healing, but  it  doesn't  remove  the  glass  from
        as      working   directly   to   change   institu-    the  streets   to   prevent   further   cuts.-V.V.,
        tions.  The  latter,  I  know  from  last  summer's    Nursing Student, Bronx.
        experience, is extremely difficult to do.  I  think
        it is a necessary  step  for  SHO  to  take  if  it    I  don't  know  anything   about   heart,   stroke,
        wants  to  provide  any  other  service  than  ban-    or cancer, and I  don't  know  anything  about  the
        daging a  festering  wound.  Changing  an  institu-    enabling  legislation   behind   regional   medical
        tion  is  a  slow  process,  and  student   fellows    planning,  but  if  we're  interested   in   future
        should realize this, but not let  this  realization    funding  we   might   look   at   SHO   under   two
        discourage  them.  To  illustrate   how   difficult    lights; first, enviormental  health;  second,  com-
        change is one just has to ask the  chiefs  of  each    munity participation.
        service. If the chief has been  on  a  service  for    If  the  people  in  the   Division   of   Regional
        any length of time, and if he  has  just  a  little    Medical   Programs   are   serious    about    good
        sensitivity, he  will  tell  you  exactly  what  is    health,  they've  also  got  to  be  serious  about
        wrong  with  his  service.  Ignorance   isn't   the    environmental   health.   They've   got   to   care
        reason. This  doesn't  mean  that  fresh  eyes  and    about  good  housing,  safe  streets,  good  trans-
        uncluttered  minds  will  -not  bring   about   new    portation,  and  decent  incomes.  At  this  stage,
        ideas for change.                                      they're   probably   not   committed   enough    to
         Changing  the  institution  is  directly  involved    stake  anything  on  those  goals;  but  they   may
        with what  the  community  asks  of  us.  The  com-    be willing to keep us  tootling  along  for  a  few
        munity  feels  that  if  we  have   no   power   to    summers.  At  the  very  least,  we  can  keep  re-
        change, then why are we offering to help'      This    minding  them  that  they  can't  set  up  routines
        statement  was  made  during   Orientation.   Alone    for  testing  and  treating  people  without  know-
        it is hard for  the  community  to  change  a  sys-    ing  how  their  patients  live.  We   could   feed
        tem, but united  with  the  forces  of  people  who    them  ideas  on  how   to   make   their   programs
        will someday be a part of  the  system,  it  should    accessible,  acceptable;   we   could   point   out
        be possible to start changes.                          things  they  should  study,  such  as   the   par-
         I  think  the  project  should  strongly   emphas-    ticular stresses  of  poverty  and  their  relation
        ize being  of  service  to  the  community.  Unfor-    to  heart  disease.  Somebody  has   got   to   re-
        tunately, medical schools  have  a  bad  reputation    mind  them  that   good   ambulance   service   and
        of  taking  from  the  community   without   giving    good telephone  service  is  as  important  to  the
        anything  in  return.  Medical  and  nursing   stu-    proper care of patients as a good  surgical  suite.
        dents study the ghetto so  they  can  better  treat    I think SHO can act as a source  of  new  ideas  in
        poor  people.  What  do  they  do  to  change   the    environmental health; and  act  as  a  small  force
        conditions that cause  ghettos?  What  good  is  it    fighting  for  good  housing  and   decent   living
        to know  that  poor  housing  adversely  influences    standards.
        health  if  no  effort  is  going  to  be  made  to     Community   participation   can   tie    RMP    to
        change  these  conditions?  The  same  applies   to    SHO.   Project   fellows-students   and    particu-
        the realization  tha:l  city  hospitals  give  poor    larly   community   people-are   better   able   to
        care. This has been known for  a  long  time,.  but    identify   the   people   and   groups   that   RMP
        the situation still remains. I  believe  that  with    should be in contact with  to  set  up  local  com-
        education comes  the  responsibility  to  make  use    mittees.
        of new ideas  and  information.  If  the  responsi-     As far as  I  can  tell,  RMP  has  no  access  to
        bility was taken there  would  be  no  conflict  on    the  community.  SHO  can't  honestly  function  as
        the issue of  who  was  benefiting  from  SHP,  be-    that entree, but  it  can  steer  RMP  towards  the
        cause  both   the   student   and   the   community    right people.  And  SHO  can  keep  lines  of  com-
        would benefit.                                         munication  going  both   ways   by   telling   RMP
          I think  that,  as  health  professionals  to-be,    who  to  contact  and  by  telling  the   community
        we   should   be   concerned    with    prevention.    that  RMP  is   moving   in.-K.B.,   Medical   Stu-
        Cleansing  a  cut   and   bandaging   it   promotes    dent, Bronx.
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                                                GREATER  NEW  YORK
               Outside  of  the  community,  SHP   can   play   a   REPORT
               very important role.  One  of  their  major  tasks   I   proposed   an   elaborate   freshmen   orienta-
               should be to work within  the  medical  and  other   tion scheme with  a  flyer,  talks  at  orientation
               professional  schools  to  change  the  curriculum   about  the  SHO   project   and   community   medi-
               and to get more ghetto  youth  admitted  to  these   cine,  a  siminar  program   with   many   of   the
               schools. Since the  students  are  part  of  these   parties involved during  the  summer,  and  a  con-
               schools, they can have a strong  voice  and  exert   tinued  advocacy   program.   Through   a   variety
               pressure  for   change.-K.D.,   Medical   Student,   of intimidating  tactics,  my  efforts  (and  those
               Lower East Side.                                     of  a  number  of  others)   were   squashed.   Our
               The  white  medical  student  must  go   back   to   first flyer, dangerously  honest  and  filled  with
               his  own  area  and  make   vital   changes   come   what   the    administration    considered    half-
               about.  He  must  work  to  get  more  blacks  in-   truths,  was  not   approved.   We   revamped   the
               volved in the health  sciences  and  in  community   flyer and sent it  to  the  incoming  frosh,  along
               health. One  way  to  do  this  would  be  to  get   with  a  bibliography  of  books  about  the   com-
               medical  schools  to  admit  more  black  students   munity  they   will   enter.   The   administration
               and to start programs to get  black  students  in-   has refused to give  us  time  at  orientation  be-
               terested  in  going  to  medical  school.  Medical   cause they doubt.  our  credibility  and  demand  a
               schools are going to have to make  a  special  ef-   sponsor and  acceptance  by  the  medical  school's
               fort to seek out qualified  blacks  and  encourage   student council. This is  hardly  feasible  because
               them to enter  the  health  sciences.-D.Y.,  Medi-   the  council   won't   be   meeting   for   another
               cal Student, Brooklyn.                               month or  so,  and  the  administration  thinks  we
               INTERVIEW                                            have  been  "put  off."   Hardly!   The   community
               Q:   What   direction    do    you    think    SHP   medicine  department  likes  our  ideas  and   will
               should take. Should it continue  to  try  to  edu-   integrate a tour  of  Newark  for  entering  fresh-
                                                                    men  into  the  biostatisties  curriculum.  It  now
               Cate the medical  student  to  the  needs  of  the
               community or try to help the community?              depends  on  our  organizing  the  means  for  this
                                                               Or   program.  The  seminars   must   be   planned   and
               should  students   focus   on   working   througii   the  structure  for  an  advocacy  program   devel-
               their schools?                                       oped.  What  we  have  proposed  is  student-family
               A:  It  was  a   good   sensitization   experience   advocacy,  some  emergency   room   advocacy,   and
               for me, but  there's  a  limit  on  how  much  you
               need. You  could  supplement  this  experience  by   community  doctor-student  interaction.   Much   of
               having   medical   students   work   through   the   this  will  depend  on  the  support  of   incoming
                                                                    freshmen.-P.D., Medical Student, Newark.
               medical schools  trying  to  get  them  to  change
               their orientation. We're  going  to  continue  SHO    To  go  out  and  try  to   be   a   revolutionary
               into  the  year,  working  through  our  Community   group  cannot  be  done  through  an   organization
               Medicine  department.  We  tried  this  summer  to   like SHP. These people who  are  going  to  try  to
               revolutionize from the inside, and  really  didn't   take  over   the   Health   Department,   who   are
               do it. This is the question to  consider:  whether   going  to  go  down   there   and   force   change,
               we can do  more  from  within  the  white  middle-   that's okay, but-that's a different group  of  peo-
               class structure as concerned medical  students.  I   ple, not us. If we did that  we'd  antagonize  peo-
               think continuing SHPs  would  be  good  here,  but   ple and  it  would  be  detrimental  to  our  using
               they would have to  be  restructured;  there  have   certain facilities.
               to  be  different  guidelines.  Something  has  to     If someone were to  tell  me  that  we  shouldn't
               keep   going   during    the    summer,    whether   have  an  office  on  Springfield  Avenue  in   Ne-
               through SHPs or the  medical  school.  It's  going   wark, and  maybe  we  should  work  in  the  hospi-
               to be the same  people  anyway.  But  if  it  does   tal, I'd really want  to  know  why.  I  understand
               come through the  medical  school,  right  now  is   in  a  basic  way  the   concept   of   black   pow er,
               the wrong time because  medical  schools  are  too   where a group of people has to  get  to  a  certain
               reactionary to be objective.                         level of power  to  meet  the  white  money  estab-

               50


                                                 SUMMER  1968

       lishment  on  equal  economic  and   psychological     After  the  initial  phase  of  orientation   to
       grounds.  I  don't  think  the  SHps  are  keeping   Martland  Medical  Center,  I  limited  myself  to
       anyone  down;  I  think   we   are   helping   the   working  with  individuals  of  the  Newark   com-
       NYCs and some of  the  little  kids  around  here,   munity  who  had  some  specific  health  problem,
       talking  to  them,  also  assisting   the   people   attempting  to  procure  good  medical  care   for
       through   the   advocacy   program.   Anyone   who   them and, through this,  to  effect  some  changes
       says that we shouldn't  come  in  is  hung  up  in   for better health care in general..  This  led  to
       his own thing  which  doesn't  seem  to  be  rele-   constructive  criticism  of  and  suggestions  for
       vant  to  what  we're  doing.  We're  not  putting   the facilities I came  in  contact  with  such  as
       ourselves in a position of  power,  we're  putting   clinics, social service and welfare.  I  found  my
       ourselves in a  position  of  asking  the  commun-   suggestions usually  received  with  much  hostil-
       ity, "What  do  you  want  us  to  do?"-D.T,  Stu-   ity and  also  a  sense  of  hopelessness.  But  I
       dent Coordinator, Newark.                            found  most  health  and  social  service  profes-
                                                            sionals  agreed  that  the  city  of  Newark  must
         The community-oriented    projects   were   more   improve existing health and  social  services,  as
       successful  in  educating  student  fellows,   but   well as create better  facilities.  Unfortunately,
       they  weren't  as  successful  in  getting  things   by the time this relationship  of  trust  and  mu-
       done. A lot of the  time  we  got  wrapped  up  in   tual concern  for  the  community  was  developed,
       the  bureaucracy  of  these  different   agencies,   it was time  for  me  to  write  this  report  and
       and that shortens  your  summer  greatly.  *  *  *   leave. In  actuality,  nothing  was  accomplished.
        If the students were  more  radical  *  *  *  you   -K.S., Nursing Student, Newark.
       would get a lot less done. You would  make  a  lot
                                                             * * * I  go  to  Columbia  Liberation  School  to
       more noise and you would get a  lot  more  of  the   the seminar on hospitals to' hear  the  "radicals"
       hospitals and  medical  schools  angry  with  you.
       * * * I think in our situation the best  thing  is   hold forth. I describe the suit (against the  city
       to  get  something  done  by  working  with  these   hospitals) and ask  for  assistance  on  a  future
       people. In a place  like  Newark  where  they  get   suit against  Harlem  Hospital  to  obtain  better
       nowhere  with  the   administration,   you   canpt   health  care  for  the  community.  I  am  stunned
       work  within  the   existing   structure   because   by the apparent indifference  and  even  hostility
       they won't hear  you,  so  maybe  there  you  have   of  the  group,  and  come  away  very  troubled.-
                                                            R.H., Law Student, Brooklyn.
       to become more radical.  It  probably  depends  on
       eac situation.                                        Too  many  times  during  the  course   of   this
        I think the health system  as  it  is  today  has   summer I have seen  highly  idealistic  and  well-
       to be changed, but  when  people  talk  about  re-   motivated SHP workers  try  to  attack  too  large
       volution, about  scrapping  the  system  and  mak-   a problem (example, the  poor  health  care  given
       ing a new system,  I  don't  know.  There  has  to   by City Hospital). Frustrated  in  their  attempts
       be a radical  change  and  maybe  a  revolutionary   to  accomplish  anything  tangible,  their  energy
       change, but it has to come  through  what  exists.   becomes  channeled  into   hypercriticism.   Even-
       -W.S., Student Coordinator, Brooklyn.                tually, this criticism  leads  to  antagonism  and
                                                            ill will, and the  SHP  worker  gets  discouraged,
        I  perfectly  agree  with  attempting  to   reor-   throws  up  his  hands  and   quits.-B.W.,   Medi-
       ganize  the  entrenched,  oppressing   superstruc-   cal Student, Newark.
       tures  in  America  that  are  the  source  of  so
       much agony. However,  I  think  it  is  a  mistake    Unfortunately, I. and  many  other  student  fel-
       to  ignore   the   immediate   stopgap   measures,   lows came to  the  project  with  the  psychologi-
       especially if one is involved in the  delivery  of   cal  orientation  that  something  could  be  done
       health services. I think that the  above  two  are   about the  political  problems  through  our  ser-
       not mutually  exclusive  and  it  would  be  wrong   vice activities.  As  the  summer  progressed,  it
       to focus on one to the exclusion  of  the  other.-   became obvious  that  a  different  focus  is  re-
       B.F., Medical Student, Brooklyn.                     quired. Getting  out  of  my  psychological  "seV'


                                                  GREATER  NEW  YORK
                 and into another bag  proved  to  be  difficult  and   We    had    one    subcommittee    which     perhaps
                 frustrating, since little can really.be        accom-  would  have  functioned  better   if   there   wasn't
                 plished by individuals  in  the  area  of  political   such  a  temptation  to  let  the  students  do   the
                 activism,  especially   twenty   or   so   students,   work. They  were  very  helpful,  but  I  think  that
                 without  any  power   base,   attempting   political   the  community  resident   who   was   the   chairman
                 activism  directed  at  intransigent  health  estab-   of the committee would  have  felt  more  of  a  res-
                 lishment    professionals.-W.S.,    MedicaZ     Stu-   ponsibility  to  draw  together  Puerto   Rican   and
                 dent, Harlera.                                         Negro  neighbors  on   that   committee,   if   those
                                                                        four  students  hadn't  been  there  functioning   as
                 THE STUDENT HEALTH PROJECT                             a  good  substitute  In  a  less  organized   commun-
                       AND THE COMMUNITY
                                                                        ity, if there's  a  vacuum,  then  you  can  put  to-
                 INTERVIEW                                              gether   your   leadership-whether   it's    chairmen
                 In  terms  of  basic  directions  for  SHP  in   the   of social clubs or  ministers  of  churchs;  put  to-
                 future, and one of  the  limitations  of  this  sum-   gether a coalition  and  talk  to  them.  This  argu-
                 mer's project, it seemed to  some  of  us  residents   ment  that  "we  don't   know   who   the   community
                 in  the  community  who're   struggling   with   the   is, so we can't talk to  anybody,"  doesn't  go,  be-
                 basic  problems  of  inadequate   care,   could   be   cause you could  put  together  a  coalition  of  who
                 giving  more  attention   to   developing   substan-   it is.
                 tive positions on  how  better  care  could  be  de-   *  *  *  The  basic  maturity   level   of   students
                 veloped.  We  feel  that  even  while  students  are   varies. Some  of  them  are  very  happy  to  play  a
                 involved  with  problems   of   personal   practices   neighborly  role,  to  help  someone  do   something.
                 and intergroup relations           for       example   There  are  others  whose  need  for  a  role  is  so
                 how  they  can  relate  to  other  groups  such   as   great  that  they  have  to  go  in  and  do  it  for
                 the    Neighborhood    Youth    corps-they     still   them.  It  might  be  that   communities   ought   to
                 have a  basic  responsibility  to  think  about  the   develop   screening   processes   and   use   certain
                 problems  of  institutional  change,  taking   reso-   kinds of students  in  certain  projects.  Some  stu-
                 lutions   and   making   their   positions    known,   dents  might  be  more  ready  than  others   for   a
                 thinking through these things.                         highly  confidential  or  difficult  community  stra-
                 *  *  *  Different  communities  are  at   different   tegic  problem.  You  wouldn't  want  to  talk  about
                 stages  of  evolution.  On  the  Lower  East   Side,   those  things  to  students  who  are  toddling  when
                 where  there's   already   some   substantial   com-   it comes to being  able  to  relate  in  a  comforta-
                 munity  control,  you  have  a  different  situation   ble  way  to  community  people.   Maybe   we   could
                 than   in   a   totally    unorganized    community,   develop  programs  for  students  which   are   basi-
                 where  the  basic  leadership  which  is  there  has   cally   immersement   programs.   In   other   words,
                 to be discovered and put together  in  a  coalition.   maybe  there  could  be  a   subcommittee   of   some
                 I was surprised'to  find  that  (some  of  the  com-   community   organization    concerned    with    just
                 munity people  at  the  final  conference)  did  not   taking   students   around,   showing    them    what
                 know  anything  about.hospital   affiliations   pro-   misery  is,  and  how  people  are  struggling.  That
                 grams  and   who's   controlling   the   development   way  they  could  get  a   first-hand   understanding
                 of care in  their  own  areas,  because  all  summer   of why things need to be changed.
                 long  there  has  been  no   discussion   of   this.I    I  think  there's   a   line   between   commitment
                 think that if  the  students,  who  really  do  have   and  accomplishment;  it's   something   we   haven't
                 substantive knowledge or can  get  it  in  a  hurry,   given  enough  thought  to.  Just  because   a   stu-
                 don't  make  this  knowledge   available   to   com-   dent  is  committed  and   deeply   concerned   about
                 munity  residents,  they're  losing  a  very   great   giving  better  health   care   doesn't   mean   he's
                 opportunity to do the  very  things  they  say  they   going to be able to use his  time  in  a  way  that's
                 believe in,                                            going  to   accomplish   that.   Then   there's   the
                  One  of  the  problems   in   an   organized   com-   question of  how  to  hook  that  concern  up  to  an
                 munity  is  the  danger  of  subverting   the   com-   awareness  of  the  constrictions  of   the   medical
                 munity  leaders  who  are  already   in   operation.   systems:   the   medical   power    structure,    the

                 52


                                                 SUMMER  1968
     questions  of  State  policy  and  city  policy,   and   experiment  on  them  and  then  leave   when   their
     the    planning    mechanisms,    and    how     these   interest flags. I don't even think it  is  our  deci-
     things to  which  we  had  very  little  access  as  a   sion as to  whether  we  have  succeeded  or  failed.
     community   were   impinging   upon   us.    In    what  If we leave while  they  are  still  willing  to  ac-
     way   were   -the   students   addressing   themselves   cept, or tol erate,  our  presence  we  are  being  de-
     to  this?  In  order  to  understand  that,  the  stu-   structive  by  once  again  reinforcing  their  cyni-
     dents,  perhaps,  would  have  to  go  from   an   im-   cism  about  outsiders.  From  what  I've  seen,  the
     mersement  experience  in   the   community   into   a   community  people  are   honest   rather   than   po-
     seminar,   the   kind   that   Robb   Burlage    runs.   lite, and will tell us  to  get  the  hell  out  when
     Frankly,  the  students   have   a   lot   of   power,   they want us to     go.-J.P.,    Medical     Student,
     within  the  medical  institutions  and  on  a  policy   Lower Ea-st Side.
     level, if they  want  to  put  their  energy  in  that     Though   we   did   accomplish   some   things   in
     direction.                                               the  Harlem  area,  I  hope  that  there  is  a  more
       *  *  *  Perhaps  if  their  contributions'in   com-   efficient  way  to  spend  the  fifteen   to   twenty
     munities   were   judged   programmatically    -neces-   thousand  dollars  that  went  into  just  the  sala-
     sary,  then  let  those  students   be   funded,   but   ries for the project  personnel.  I  am  not  at  all
     let's not just pay  them  to  come  in  and  sit  down   sure that we were justified  in,  first,  going  into
     and  decide  what  they  want  to  do.  I   think   if
     you're really  trying  to  develop  deep  contact  be-   their  community  as  we  did,  without  an   invita-
     tween   community   people   and   middle-class   ppo-   tion,  and  then  in  leaving  after  doing  our  10-
     ple, you don't do it  by  putting  a  glob  of  people   week  thing.  True,  we   have   left   some   perma-
     down  in  a  storefront  and  letting  them  be  there   nent  accomplishments,  but  they  are   really   the
     from nine-to-five.  You  do  it  by  placing  individ-   results  of  the  work  of  a  very  few  people  who
                                                              had   been   working   independently   of   SHP   be-
     uals carefully into situations where they       .  get   fore  the  summer  and  who  will  continue   to   do
     involved  in  family  life  and  become  aware,  in  a   so  after  the  summer.  There  were  just  too  many
     visceral way,  of  what  life  is,  as  in  the  Peace   people  getting  too   much   money   to   accomplish
     Corps    and    American    Friends    Service    pro-   what,  for  the  most  part,   amounted   to   little
     grams. * * *                                             more  than  a  temporary   and   insignificant   ser-
       We   have   to   be   humble   about   trying    new   vice  for  the  community  and  a  sensitizing  expe-
     models.  We   ought   to   experiment   and   if   one   rience   for   themselves.-S.G.,   Medical   Student,
     thing  doesn't  work  let's  try  another.   I   think   Harlem.
     you  have  a  beautiful  element  here   among   these
     students  who  are  dedicated,  and  they   ought   to     We  are  surprised  to  find  kindness   and   con-
     have  an   opportunity   to   do   something   'basic,   cern  for  us  among  these  people  in  Harlem   who
     whether or not  they  can  bring  the  rest  of  their   seemingly  do  not  care  about  anything.   On   the
     structure  along  with  them.  Two@   or   three   are   other hand, there  is  no  way  for  the  members  of
     going  to  live  in  the  community  now.  Of  course,   the  project  to  become  acquainted  with  the  com-
     the Lower East Side is  a  neat  place  to  live,  and   munity as a whole,  and  so  the  work  that  can  be
     I think  a  lot  of  people  come  because  'of  that,   accomplished   is   small.   We   remain    outsiders
     but  as   they   become   community   residents   they   who   come   and   go,   like    the    summer.-A.G.,
     may   play   a   completely   different    role.-S.D.,   Nursing Student, Harlem.
     Community Worker, Lower East Side.
                                                                One  main  complaint  I  have  is  that  our   pro-
        I believe  that  there  is  no  place  for  an  SHP   ject  should  have  been  more  involved  with   com-
     on  the   Lower   East   Side   next   summer   unless   munity groups or institutions. In that way, o      ur
     the   students   maintain   a   continuing   relation-   presence  would  have  become  known  to   the   peo-
     ship  with  the  community.  This   means   that   the   ple  of  Harlem  and  there  would  have  been   less
     projects  started   must   not   be   dropped   during   of an aura  of  "here's  a  bunch  of  college'  kids
     the rest of  the  year.  The  community  is  justifia-   coming in for  the  summer."  I  don't  know  if  the
     bly  cynical  about  "outsiders"  who  come   in   and   community  was  aware   enough   of   our   existence


                                                 GREATER        NEW  YORK
                 to have felt this way, but  individuals  in  the   does not cover a third of the  people  who  are  in
                 group were self-conscious lest this be  the  ap-   need of help. It's a waste of  time  for  everyone.
                 pearance  we  present.-M.I.,   Psychology   Stu-   You have  students  who  think  they  have  done  a
                 dent, Harlem.                                      great job, but it's because they filled  their  own
                                                                    need  to  "help   poor   people."-M.H.,   Community
                 When I  began  work  in  this  project,  I  knew
                 nothing about  SHP.  I  knew  that  I  was  sup-   Worker, Bronx.
                 posed to be a liaison between the  project  stu-    The  main  goal  of  the  Student  Health  Project
                 dents and the community. I became  more.  I  did   is to help the people of the community.  At  first,
                 everything   from   house-calling    on    unwed   people were reluctant to  accept  any  outside  as-
                 mothers to  cleaning  and  removing  garbage  at   sistance,  but  gradually  they  began  to  realize
                 the project office in the South Bronx.             that  sooner  or  later  they  would  need  someone
                 In the beginning,  I  merely  performed  my  du-   to  help  them,  and  they  began   to   assimilate
                 tie@appointed   and   volunteered-without   much   with  the  so-called  "foreigners."  Now,  at   the
                 thought to the reasons for being of this project.  end  of  the  summer,  when   things   are   really
                 Then I began  to  think.  I  questioned;  I  was   getting on their  feet,  everyone  is  packing  his
                 answered; I was disgusted.                         bag  and  saying   "goodbye."   Once   again,   the
                 According  to  the  project  fellows   and   SHO   community  is  hit  with  the  hard  truth-no   one
                 literature, the main goal was "sensitization" of   really cares.-C.B., NYC, Bronx.
                 white, middle-class, medical  students.  A  per-    Ideally, I  think  a  project  such  as  this  one
                 fectly  rational  idea-from  the  white  medical   should strive to make -itself  obsolete;  the  goal
                 student's viewpoint. But from  the  moral  point   should be  to  help  the  people  become  more  in-
                 of view, this is an horrendous injustice to  the   terested  and  show   them   how   to   gain   more
                 community! How  can  SHP  invade  a  ghetto  (to   power  to  solve  those  problems  which   continu-
                 "help," of course) with an army of  white  medi-
                 cal students, and for ten weeks perform acts  of   ally afflict their daily lives.-I.B., Medical  Stu-
                 charity  and  fellowship,   but   simultaneously   dent, Bronx.
                 have the anguish of the ghetto  as  a  secondary     It is just that  you  have  to  decide  what  SHO
                 reason for justifying the existence of SHP?        is out to do. If it is to  educate  students,  then
                 The  makeup  and  foundation  of  SHP  must   be   the community is a good place,  but  if  it  is  to
                 changed In fact, it had better be changed, or it   help  the  community  then  maybe  there  are  bet-
                 will get  kicked  from  one  ghetto  to  another   ter  places  than  out  with   community   groups.-
                 until there are no ghettos left. (And  then  its   W.S., Student Coordinator, Brooklyn.
                 only alternative will be Scarsdale  and  similar
                                                                         WHITE STUDENTS IN BLACK
                 communities.)                                                     COMMUNITIES
                 SHO  must   have   total   commitment   to   the
                 community, but not a  pIaternal   commitment.   It SHAWANGA         WORKSHOP:         THE         ROLE
                 must help train black, Puetro Rican and all  mi-        OF    THE     WHITE     STUDENT     IN     THE
                 nority groups to help their brothers and sisters         BLACK COMMUNITY.
                 in  a  meaningful  manner.  By   meaningful,   I   Position Papers  Presented  By  Willard  Finderson,
                 mean  meaningful  from  the  community,point  of   Leslie Clarke, Mrs.  Altanese  Maxwell,  and  Peter
                 view, not the interpretation  of  the  community   Dorsen (Moderator).
                 point of view by the  white  medical  students.-     I believe that there is a place for  white  Stu-'
                 C.R., Community Worker, Bronx.                     dents  in  a  non-white  community  to  a   certain
                 The  health  care  in  my  community   is   very   extent, but just  because  you're  in  the  medical
                 poor' It's the worst  possible  care  anyone  could profession  does  not  mean  that  you  don't  need
                 get. This is  why  people  stay  away  from  the   NYCs to  serve  as  your  contact  to  the  commun-
                 hospital until the last minute. Having  students   ity. If you  were  to'go  out  into  the  community
                 come in the summer  is  not  helping.  The  num-   and  try  to  run  your  program   by   yourselves,
                 her  of  people  reached  by  SHPs  this  summer   you'd  be  rejected.  Someone  was  saying  yester-

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                                                  SUMMER  1968

      day  that  he  would  like  to  run  the  show   him-   seemed  a  bit  more  dedicated  to  what  they   were
      self, but  for  too  long  we've  been  dependent  on   doing. I don't care  if  you  call  me  Uncle  Tom  or
      the whites  to  tell  us  about  ourselves.  For  in-   traitor  or  any  other  such  names,  my  first  con-
      stance, whites run the  school  system  for  us,  and   cerii is  with  the  welfare  of  my  people.  What  I
      this  means  that  our  children  learn  about  them-   want  is  black  sincerity,   and   whether   you   be
      selves  through  whites,  and  that   shouldn't   be.   black  or  white  you  can  have  that.  I  saw  dedi-
      We  should  have  our   own   school   systems,   our   cated  black  students  this   summer   and   I   also
      own  television  and  radio  stations,  things   like   saw  the  other  ones.  I'm  not  saying   there   are
      that.  This  way  we  can   express   ourselves,   we   not  white  students  who  b.s.  I  just  didn't  come
      can  tell  our  children  about  themselves   without   across any  this  summer.  For  this  reason  I  don't
      the help of whites who distort history.                 care  who  comes  into  the  community,   any   color,
        As  far  as  having  a  lot   of   white   students   as long as he  is  sincere-black  sincere.  I  noticed
      come  into   nonwhite   communities,   they   do   no   that all some  of  the  militants  did  was  call  for
      help.  They  should  go  to  their  own   communities   "Black   Power;"    they    didn't    do    anything.-
      and  express  to  their  own  people  how  we   feel.   L.C., Nursing Student, Brooklyn.
      It's easier for you  to  talk  to  your  own  people.      The bias  of  this  report  is  that  of  a  white,
      Of course, you have to come here to find on             middle  class  medical  student.  Perhaps  as  a  rep-
      what it's like for yourself, but it's very  difficult   resentative of  this  group,  I  derived  a  lot  more
      for you to tell  me  how  I  should  live.  The  non-   from  Newark's  Central  Ward  than   I   could   con-
      white  community   needs   help   from   just   about
      everybody.  I'@  just  trying  to   say   you   can9t   tribute.  My  skills  were  certainly   limited,   and
                                                              my  credibility   often   questioned.   I   definitely
      come  into  this  community  and  say  you're   going   could be of  better  service  as  a  physician,  as  a
      to do it on your  own,  because  you  can't.  If  you   lawyer, as  a  nurse,  for  example,  once  my  train-
      want  to  help,  you  can  go  back   to   your   own   ing was completed,  if  I  were  assigned  to  a  spe-
      community  and  express  how   we   feel   and   what   cific task. And particularly,  I  think,  if  the  pe-
      we  need.  We   should   let   you   know   what   we   riod  of  time  in  which  I  was  involved   in   the
      need, and this way you  can  try  to  open  the  eyes   community  was  longer.  But  again,  I   think   this
      of your  brothers  and  sisters,  and  maybe  we  can   period  of  sensitization,  and   perhaps   even   the
      get  along  together  in   this   world.-W.F.,   NYC,   small   amount   I   did   accomplish,   was    impor-
      Brooklyn.                                               tant for what  I  might  be  able  to  give  later  to
        At  the  beginning  of  the  summer,  I  raised   a   medicine  and   to   the   community.   Perhaps   also
      big  stink  about   why   a   white   student   would   our  impatience,  because   we   were   only   working
      want to come  into  a  black  community.  I  said  if   for  ten  weeks,  was  quite  important   because   we
      they want to  help  the  black  cause  so  much  they   were   more   demanding   of   change   and    cutting
      ought  to  give  their  own  communities  the   word.   red tape.
      Now it is the  end  of  the  summer,  and  I'm  going      On the  one  hand,  the  student  already  has  el-
      to reverse my previous position.                        ementary  knowledge  of   his   profession   and   his
        This   has   come   about   by   much   experience,   skills,  so  that  he  can  be  a  liaison  for  those
      much thought, and a  little  bit  of  ink  on  paper.   less   informed   about   what   quality   of   health
      The place of the white student,  if  he  is  sincere,   care  they  should  be   getting-what   is   adequate,
      is   in   the   black   community   doing   what   he   and  what  their  rights  are  in  terms   of   health
      knows  best.  There  is  no  way  of  knowing  if   a   care.  I  think  the  white  medical   student   could
      student is sincere, that is up  to  him.  In  my  ex-   get  the  ball  rolling,  as  we  did  in  many  cases
      perience  this  summer,  the  black  man  did   noth-   this  summer.  But  I  think  it's  up  to   community
      ing but b.s. Once they got  a  title  and  $20,000  a   health  councils  staffed   with   community   person-
      year, the black  bourgeoise  in  all  the  top  posi-   nel  to  replace  him.  This  suggests,  I  think,   a
      tions forgot their  roots.  Give  a  black  man  that   definitely political approach.
      title and his  money  and  you  don't  see  him  any-      I  also  think  it's  awfully  important  that  the
      more.   The   white   students    I    worked    with   "volunteers"  continue  into  the   winter   if   they

                                                                                                                  55


                                                   SUMMER  1968
        only  time  my  kids  will  get  a   chance   to   get   cation"  of  working  in  the  community.  I'm   very
        something  better  is  if  a  group  of  white  people   ashamed  of   myself,   and   very   disgusted   with
        get  together  and  say,  okay,  we're  going  to   do   myself,  and  I  would  never,  ever  get  into  any-
        this for you.                                            thing like this again * * *
         Are  you  suggesting  that   we   do   not   have   a    Whenever    anybody    from    SHP    took     some-
        place,  that  we're  making  a   mistake   by   coming   body to the  hospital,  they  got  better  care  that
        in?                                                      day, but the  day  that  you  couldn't  be  there  to
         Right,  you  do  not  have  a  place!  Besides,   and   take  them,  they  got  the  run-around,   they   got
        this  has   been   getting   me   angry   all   summer   the same old  thing.  SHP  isn't  going  to  be  here
        you've  been  getting  involved  in   personal,   deep   all  the  time,  I  don't  think.  What's  going   to
        problems,  and  all  you  can  really  do  is  go   to   happen after SHP is gone?
        Welfare  with  them,  or  take  them  to  the   hospi-    If SHP  was  able  to  get  a  few  people  in,  was
        tal,  and  then  you've  got  a  file  of  everybody's   able to get services for  them,  I  think  that  when
        personal  sex  life  and  everything  like  that,  and   SHP moves  out,  these  people  will  get  so  angry,
        then  you  leave.  I  don't  believe  that  your  mind   they  will  get  together  and  try  to  organize  in
        is so  together  that  you're  not  going  to  discuss   the  way  in  which  SHP  tried  to  get  them   ser-
        these  things  that  you're  not  going  to  have   an   vice.  So  SHP,   I   feel,   did   something,   even
        idea of "this is how  they  live"  kind  of  thing.  I   if  *  *  *  only  to   get   them   angry.   They're
        really  believe  that  this   plays   in   your   mind   going to be angry if they  can't  get  it  any  more,
        after  you  leave.  There   were   very   fevr   white   so I think we did something.
        students   this   summer   who   didn't   have    that    I think it's ridiculous to   assume    that    every
        typical  attitude-maybe  they  can't  help   it.   But   white  man  that  comes  into   the   black   commun-
        you  don't  understand  how  the   system   has   made   ity is there just  to  take  advantage  of  the  peo-
        us this  way-you  just  say,  well,  this  follows  up   ple, is there not to give anthing,  just  to  be  do-
        with things I  have  been  taught  all  my  life,  and   gooders.  I  think  many  students  that  went   into
        this makes you feel superior. * * *                      the  black  communities  this  summer   really   were
          Can  I  put  it  to  you  and  ask,  why   ate   you   interested  and  wanted  to  change   the   situation
        here  with  us   now   if   you   don't   believe   in   of  the  people.  We  have   our   hangups   in   the
        it. * * *                                                white  community,  but  I  think  the   blacks   have
          I'm  angry  at  myself   the   whole   summer,   be-   too-the  fact  that  some   black   people   distrust
        cause someone  told  me,  I  think  you'll  like  this   all  white   people,   this   is   something   that's
        job  because  you're  outgoing   and   you   sincerely   wrong  with  our  society.  We're   heading   towards
        have a  feeling  for  people,  and  you  might  really   an  all-black  and  an  all-white  society.  This  is
        enjoy  doing  this  kind  of  work.  When  I  went  to   terrible. If we're going to stay  out  of  the  black
        orientation  I  got  an  impression  that  a  lot   of   community, all  you're  going  to  head  for  is  two
        things  were  going  to  be  done  for  my  people.  I   separate  communities.  The  fact  that  white   pgo-
        resented  the  idea  that  white  people  would   have   ple give a dam  n  about  what's  going  on  in   the
        to be there  to  keep  doing  it,  damn  it;  but  all   black community is a.  very  good  thing,  and  I  do
        right,  I  thought  there  was  still  going   to   be   think we  have  something  to  offer;  I  think  some
        something  done.  And  then  all  of  the  things  you   people  really  care  about  what  goes  on  and  can
        said you weren't  going  to  do,  such  as,  you  wer-   go  into  a   black   community   and   ask   people,
        en't  coming  in  with  microscopes,  and   you   wer-   "how  would  you  like  us  to  help?"  and  then  do
        en't going  to  write  books,  and  stuff  like  that.   for  these  people  exactly  what  they  want  us  to
        You  came  in  and  started  doing   the   same   damn   do. I think this  is  performing  a  service,  and  I
        things  you  said  you  weren't'going   to   do.   And   think  the  white  person  does  have  such  a  place
        that made  me  disgusted  *  *  '-'  that  made  me  a   in  the  black  community.  And  you  say  it   would
        part  of  your  sneaky,  underhanded   way   of   get-   be  better  if  we  had  black  students  going  into
        ting  what  you  want.  I  think  the  only  ones  who   the  community,  but  we   don't   have   them   now.
        got  anything  out  of  this  were  the  students  who   What are we  going  to.do,  wait  around  for  10  to
        maybe will get  a  credit  in  school,  or  the  "edu-   20 years until they come?
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                                                   GREATER        NEW  YORK
                  are accepted in the community. I'm  thin-king  in    another  white  student.  We  didn't   have   any
                  terms of the  structure  of  the  welfare  rights    NYC's with  us  and  we  were  accepted  in  Har-
                  program where there are  outsiders  present,  but    lem. We got a  few  wisecracks,  sure,  but  that
                  community  people  must  administer  and   pursue    was minor. We had health  services  to  'give  to
                  claims themselves.                                   these people and we  went  out  and  gave  it  to
                  I think it really  should  depend  on  the  local    them. Just because  we  were  white  they  didn't
                  climate of the particular area, as  to  just  how    refuse help; they wanted it.
                  much a  student  does  become  involved.  On  the    Do  you  think  if  there  had  been  just  black
                  one hand, he can live, work,  and  sleep  in  the    students, do you  think  they'd  have  been  more
                  area as  VISTA  workers  do,  or  he  can  merely    effective ?
                  work out  of  a  storefront  and  return  to  his    I don't know, it just worked  out  in  Harlem.  I
                  white middle-class neighborhood  for  reasons  of    don't know the situation in Brooklyn.
                  safety or convenience.  He  can  also  choose  to    I think as a  community  person,  you  can  iden-
                  work  in  an  emergency  room   or   agency   and    tify more with  a  black  student  than  a  white
                  never enter certain parts of the community.          student. Of course, if you have some services  to
                  Certainly,  the  community   is   cynical   about    offer, the people would be stupid if they  didn't
                  10-week do-gooders. It  is  cynical  about  ques-    take advantage of it.  I'm  just  saying  they're
                  tiorinaire makers  and  posters.  It  is  cynical    more inclined to accept a  black  person  than  a
                  about   photographers   and    bookwriters    who    white. They'll still accept the services, but  in
                  many times catch the  people's  misery  on  their    different degrees.
                  films or in  their  books,  which  only  supports    I worked in the  South  Bronx  area,  and  I  got
                  the  distortion  whites  already  may   have.   I    a chance to talk to a lot of the  people.  In  my
                  think the question is: Is this  worth  the  time,    community, you  always  see  white  people  pick@
                  effort,   and   money   involved?-P.D.,   Medical    ing up our kids;  you  see  white  people  taking
                  Student, Newark.                                     our kids to camp; you  see  white  people  teach-
                                                                       ing them during  the  winter  months.  Why  can't
                  The   students   working   with   the   community    we have black people being  taught  to  do  these
                  during the summer  in  the  Harlem  project  were    kind of things?
                  very helpful and they  really  worked  very  hard    A person who  needs  help  isn't  going  to  say,
                  in our community to  help  our  children  and  to    "I'm not going to accept it because he's  white";
                  serve their health needs. They  seemed  so  dedi-    a person won't do that. But  we  get .. the    feeling
                  cated. If  there  was  any  question  we  workers
                  wanted  answered,   or   whatever   systems   and    that  we  always  have  to  be  led  by   whites,
                  medical terms -needed explaining they did  it.  I    whites have to take us to the  hospital,  etc.  I
                  think their  being  here  was  great  as  ong  as    really reject this thing of patient advocacy. All
                  they provide a  service  to  help  the  community    right, it's one thing for me as  a  black  person
                  to  do  what  was  needed.  And  if  they  didn't    (although I feel kind  of  uncomfortable)  taking
                  reach but  ten  children  and  did  a  very  good    a 60-or 70-year-old woman to  the  hospital  just
                  thing for those children, then they  belong.  And    like she's a baby but for a white person to do it
                  that goes for all white students.  I  think  more    makes  them  feel  a  continual   dependence   on
                                                                       whites, I've  even  met  some  black  people  who
                  of this work should  be  done,  but  not  on  the    wouldIrather  a  white  student  would  do   some-
                  basis of color, or  what  the  community  is,  or    thing for them than a  black  student.  You  know
                  whether   you   belong.   You   belong   wherever    why? Because white society has taught -
                  there  is  a  need  for  dedicated  people.-A.M.,    "don't trust your own kind  of  people";  it's  a
                  Community W&rker, Harlem.                            sick thing that they would  prefer  to  be  taken
                  Open Discussion                                      by a white student. *  *  *  You're  not  letting
                   I  was   just   wondering   if   WF's   argument    them grow,  you're  keeping  them  down  by  con-
                  could be a counterattack, because  you  feel  the    stantly coming in and leading  them.
                  NYCs have been attacked  so  far.  -I  worked  in     I don't want  you  coming  in  to  take'my  kids
                  Harlem,  and  I  worked  for  a  few  weeks  with    to the park, or on hikes. It would seem that  the

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                                                     GREATER       NEW  YORK
                   The thing  about  black  self-esteem,  and  tak-    that's sick about our society,  in  supposing  that
                ing  something  away  from  a   black   person   by    community   people    don't    know    what    good
                being  white  and  having  to  do   something   for    health care is, or how  to  get  it.  These  people
                them,  that's  really  beautifully   expressed   in    have  learned  over  the  course  of   many   years
                Carmichael  and  Hamilton's   book,   Black   Power    what bad health care  is.  And  if  you  go  up  to
                and the Politics of Liberation. It's really a  very    any one of these people in the clinics,  they  will
                good  document  on  this.  To  get  to  the  things    tell  you  why  their  treatment   is   bad.   They
                you  were  talking  about,  how   would   you   re-    might  say,  my   discomfort   is   aggravated   by
                structure SHO, so that it  would  do  what  is  the    going to the hospital,  rather  than  being  eased.
                most  important  thing,  to  train  community  peo-    Rather  than  having  their  problems   alleviated,
                ple to do what  medical  students  think  they  can    their situation  has  become  chronic  through  bad
                do.  I  think  SHO  at  Yale  in  New   Haven   has    health care.
                done the best thing  along  this  line,  which  is,      What you  need  is  outspoken,  militant  peop  e
                they   have   as   many   community   workers    as    who   gather   people   around   them   and    make
                students.  *  *  *  Maybe  SHO  should  just  be  a    themselves  more  assertive   to   demand   certain
                sort of enabling  force,  so  that  we  can  enable    things. If  you  are  a  powerless  body,  and  you
                community  people  to  do  things  for  themselves.    demand   from   a   powerful   body,   you're   not
                   I think what  we  should  have  been  doing  was    going to get anything, which is  the  case  in  Ne-
                giving  our  expertise,  what  we  know  about  the    wark.  The  Newark  City   Hospital   is   a   very
                hospitals, to  community  organizations,  and  this    powerful  body,  very   bureaucratic,   very   much
                is  the  pattern  we  can  take  for  next  summer.    in  the  system.  They  know  they're  very  power-
                We  should  go  in  and  work  with  these  commun-    ful, and they don't have to  "sit  down"  to  real-
                ity groups  during  the  year,  so  that  we  would    ize  their  power.  But   the   community   people,
                have some  plan  of  going  in  next  summer.  Then    often,  have  only  one  recourse  open  to   them:
                we could  say,  OK,  you  know  we've  learned  how    they  have  to  Bogart,  they  may  have  to  close
                the  welfare  system  works,  and  we  know  how  a    down  a  hospital,  they  may  have  to   burn   it
                hospital system  works,  and  now  we're  going  to    down.  And  there  are  plenty  of  people  in  Ne-
                work with a  group  of  five  or  six  people  from    wark  right  now  who  would  rather  die  in   the
                your  community  organization;   we're   going   to    streets   than     use   that    Newark        City
                tell  them  all  we  know  about  health  and  wel-    Hospital * * *
                fare systems.  *  *  *  I  think  that's  where  we      What  you  need  for  white  students,  first  of
                can  work,  and  eventually  we'll  work  ourselves    all, is to get away from this thing  of  coming  in
                out; that's what we should work for. * * *             to  learn  about  us.  Whites  always  want  to  be
                   I think black people are all trying to  reach  a    one jump  ahead  of  not  only  what  we're  think-
                level of pride, esteem  in  themselves  and  things    ing, but of how  we're  going  to  go  about  doing
                like that, so that, when  they  reach  this  level,    it. More than that, they want to be  able  to  give
                they  can  communicate  with  the   white   people,    their  suggestions  and   exercise   control   over
                with the white  power  structure.  So  they're  all    how  and  what  we're  going  to  do.   There   are
                going  towards  this  one  aim,   to   communicate.    plenty of black people  in  Newark,  and  in  other
                What you're doing down  on  the  bottom  is  irrel-    black   communities   around   the   Greater    New
                evant. We need help, in all kinds of forms.            York area, who  have  plenty  of  ideas  about  how
                   The whole concept of white students        going    they're going to  change  things.  The  whites  are
                into a black community  to  offer  what  they  have    very curious about this; they  can't.stand  to  sit
                to  offer-some   mysterious   type   of   expertise    back  and  work  in  their  own  communities.  Some
                which I have  yet  to  see-is  totally  bogus,  be-    of the really  liberal  whites  realize  how  deca-
                cause   what   took   place    in    Newark    this    dent their own society is,  so  they  reject  work-
                summer *  *  *  I  could  have  gotten  twenty-five    ing  in  their  own  society;  they  want  to  come
                high school kids to do the exact same thing.           down and leech off  the  black  society.  And  they
                   I think you're being  very  naive,  very  conde-    can  do  it  with  the  Student  Health   Organiza-
                scending  very   racist,   and   everything'   else    tion  the  same  way  they've  done  it  with   all

                58


                                                SUMMER  1968

       these anti-poverty  programs,  across  the  board.   the administration  didn't  want  SHO  people  to
         You've got to  -get  away  from  this  thing  of   inform  freshmen  about  how  there   should   be
       not rehiring  even  the  few  whites  who  perform   more  involvement  with   community   people   as
       well in the  project  during  the  course  of  the   part  of  their  medical  school  education-some-
       summer,  who  get  beyond  this  learning  experi-   thing as simple as that.  Some  of  this  experi-
       ence, who finally realize  what  they  can  offer,   ence is vital if white people expect to  practice
       and who can then  come  in  and  differ  with  it.   in black areas.
       The  second  summer,  these   kids   aren't   even     As far as providing an  immediate  service  for
       hired by SHO;  SHO's  intention  is  to  bring  in   people  in  a  community  like  Newark,  that  is
       more leeches, to suck  and  learn  off  the  black   vital, because these people really don't want  to
       community.  This  is  what  these  kids  do,   and   be bothered with you if you  can't  do  something
       when  they  go   back   to   their   own   medical   definite for them. And white kids  can  do  this.
       schools,  they  can't  do  a  damn   thing.   They   They can come with a clear  mind  as  to  exactly
       aren@t  going  to  Bogart  their  way  into  those   where they stand. A lot  of  them  are  just  too
       buildings,  they  aren't  going  to  do  the  very   mixed  up,  because  in  a  place   like   Newark
       things they're  demanding  of  black  people.  I'm'  there's always  talk  about  violence,  and  when
       not saying we want  to  make  -a  parallel  health   such talk hits the fan, where are  you  going  to
       system, I  don't  think  that  -a  lot  of  blacks   be? I remember that at  all  the  meetings,  just
       today  want  to  see  a  parallel  of  the   white   before the  project  got  under  way,  they  kept
       society.  We  don't  want  to  have  black   folks   talking about what are you going to  do  in  case
       doing to   their  own  folks,  what  white   folks   of violence. And I just sat there and said,  man,
       have been doing  to  us  for  so  long.  What  you   you people  should  know  what  you're  going  to
       have  to  have  is  creative   people   who   will   do. If you've arrived at a certain point,  either
       help  develop  totally  new  methods   in   health   you get the hell out or you know  which  side  of
       delivery  systems.  If   whites   are   going   to   a gun you're going to stand on. It  seems  stupid
       come into a black  neighborhood,  the  black  peo-   that  they  would  worry  about  it  since   they
       ple in  that  neighborhood  should  determine  who   would have  been  working  at  the  hospital  all
       the whites are who will  return.  The  white  stu-   summer. The  first  thing  you  would  do  is  go
       dents  who  worked   in   the   Newark   community   the the hospital, because people are going to  be
       should submit themselves  to  evaluation  if  they   coming in there, all banged-up  and  shot-up,  or
       want to work  the  next  summer.  The  black  peo-   whatever, so you could be the  most  help  there.
       ple they worked with  should  say  which  ones  of   That's the way they can be  the  most  help  now,
       them should come back.                               when there are no riots, in the city hospital.
         I think that  white  students  could  definitely     Patient advocacy is a  beautiful  and  meaning-
       serve a role  in  a  black  community.  Maybe  not   ful thing. We didn't drop it, we got hustled  out
       make up a  black  community  health  council,  but   of the hospital. The hospital is  seared  of  the
       they can certainly  educate  their  own  folks  as   community,  and  some  of  the  medical  students
       to what's going  on  by  working  from  out  here.   are  even  seared  of  the  community,  though  I
       We can get more  done  that  way.  We  have  three   think quite a few of  them  got  over  that.  But
       or four kids who go  to  the  New  Jersey  College   the  immediate  service,  the  advocacy,  is  ex-
       of Medicine. They  have  been  more  effective  by   tremely important. Even if this project  was  all
       associating  themselves  with  community   people,   black, if they did not offer  an  immediate  ser-
       with the high school  kids,  and  with  the  -non-   vice to people, it would be useless  and  stupid;
       hospital  people,  rather  than   doing   it   the   they wouldn't be able to help anybody.
       other  way  around.  If  they  did  it  the  other     There could be a place  for  SHP  'next  summer
       way  around,  they'd  get  co-opted,  they'd   get   in Newark.  Apart  from  antagonizing  people  in
       softened.- A lot of the  health  science  students   Martland Hospital, student  fellows  only  antag-
       have  seen  how  really  desperate  the  situation   onized each  other  this  summer.  I  would  drop
       is' Two or  three  of  them  have  been  threatened  the policy that former student  fellows  not  be,
       with being kicked  out  of  school,  just  because   hired the following year. This  should  be  based
                                                                                                           59


                                                    SUMMER  1968
        mer  in  the  ghetto.-L.C.,   Nursing   Student,   Ne-      worker  on  Gouveneour  Place,   a   short   block
        ,wark.                                                      which offered  ample  opportunity  for  being  or-
          There  is  a  certain  core  of  adults  in   Newark      ganized around  housing,  sanitation,  and  health
                                                                    issues.
        who have  really  had  it.  They  don't  believe  any-      The  first  three  weeks   were   spent   planning
        body, or anybody  in  a  position  of  power,  or  the      and executing a  block  cleanup  and  block  party
        city  government.  They  are   also   struggling   for      -the  accepted  way  of  getting   the   residents
        their  own   living,   and   because   we're   college      "fired up" for  tenant  council  meetings  set  up
        graduates,  they   aren't   going   to   believe   us.      by  the  LABOR  staff.   While   discussing   code
        We're   too    clean    and    too    "Establishment."      v-
                                                                    iolations with tenants,  I  was  able  to  uncover
        We're  not  living  and  sharing   their   experiences      very  few  medical  problems,  but  heard  a  bar-
        with  them.  You  can   be   white   and   share   the      rage of  complaints  against  the  sanitation  de-
        experiences  and  get  accepted  by  doing  the   same      partment  and  the  police  who  have  failed   to
        thing,  by  being  a  day  laborer.  I  really   think      come  through  with  a  play  street   for   three
        you  have  to  break  that  economic  barrier  and  do      summers.  The  block  swarms   with   kids,   from
        the same type of work to reach them.                        toddlers  to  teenagers,  and  no  one  hears  the
                                             e;  it  was  so,+
          I've had one negative experienc                 .  .      angry  parents'  protests  against  speeders   and
        of funny.  One  of  the  student  fellows  who  didn't
        have  his  name  tag  on  was   talking   to   a   guy      the dirty streets. I decided,  therefore,  to  ex-
        from  the  African  place  across  the  street.   Then      plore the possibility of closing  off  the  street
                                                                    to  through  traffic.  While   the   cleanup   and
        I came in  with  my  name  tag  on  and  broke  in  on      block  party  were  successful  as  stopgap  meas-
        the  conversation;  the  guy  took  one  look  at   me      ures,  neither  provided  the   expected   induce-
        and  said,  "Are  you  a  medical  student  from   the      ment  to  organize  tenant  councils.   Nor   were
        medical school?" When I said,       "Yes",   he   just      the petitions signed by  all  residents  or  meet-
        got  up  and  walked  out.  He  didn't  say  anything,      ings with police  successful  in  getting  through
        he  just  got  up  and  walked  out  of  an  elaborate      city   bureaucracy   and   around    uncooperative
        conversation.-D.T.,   St-ztdent    Coordinator,    Ne-      tenants to get the street closed.
        wark.                                                       I  had  questioned  the  merit  of  such  measures
          Those   non-black   people    who    are    selected      as a means of getting to the  people  and  helping
        should  be  more  carefully  screened  for   attitudes      them  work  together.  It  was  explained  to   me
        and  grasp  of   the   problem.   An   upper   middle-      that this mostly  black-inhabited  block  had  not
        class  student  who  honestly   sees   nothing   wrong      @esponded to  past  organization  efforts  despite
        with   taking   photographs   of    human    suffering      tne vast need for the attention  from  city  agen-
        with  his  Nikon-F  is   a   mistake.   His   presence      'cies which group effort initiates.  I  felt  that
        and  his  blundering  are  too  expensive.   Let   him      this community  was  apathetic  because  all  out-
        learn'elsewhere.   Asking   to   be   shown    through      side agencies  had  failed  to  use  the  manpower
        someone's  home  for  the  purpose  of   seeing   just      potential  already  there.  Even  LABOR   operated
        how bad it is is too much. Is  he  going  to  fix  it?      by   importing   black   organizers   from   other
        -A.M., Nursing Student, Newark.                             areas.
                                                                    Were  the  people  unresponsive  because   I   ap-
           I  was  assigned  to  be  a  patient  advocate  out      peared to have initiated efforts to get the street
        of  a  poverty  program  storefront,  the  League   of      closed off? I think it naive to settle on  such  a
        Autonomous    Bronx    Organizations    for    Renewal      simple answer, but I  did  begin  to  realize  how
        (LABOR).  The  office  was  located  in   the   middle      these  people  feel  about  whites   coming   into
        of  an  old  tenement  area  with   both   black   and      their homes,  exposing  their  dilemma  of  apathy
        Puerto  Rican  residents.  The  assignment  at   first      and  an  unresponsive  system  controlling   their
        seemed  to  be  a  challenging  approach  to  the  ad-      lives. Appearing  to  know  more  about  the  SYS-
        vocacy   work    because    LABOR's    primary    con-      tem and how to  apply  pressure,  the  whites  are
        cern  is  organizing  tenants  around   housing   code      expected to  do  for  them  what  they  have  been
        violations.  I  was   to   work   with   a   community      unable to do. I was told by many  of  the  outspo-
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                                                    GREATER        NEW  YORK
                on   performance   and   comparability   with    the   tified till a  couple  of  days  later;  how  people
                non-white      community.      Community      people   who  were  in  a  coma  were  operated  on   without
                should  not  be  "used"  to  train   liberal   white   permission  from  the  family.  *  *  *   It   would
                leeches, or even  to  help  them  become  more  well   have  brought  back  a  lot  of  bad  memories   and
                informed.  Only  those  who  know  what   they   can   would  have   really   been   a   mess.-L.J.,   NYC,
                offer and how they can offer  it  should  be  hired.   Newark.
                 SHO  could  possibly  split  its  forces  for   the
                summer project into two forces'       Those      who     I  agree  that  getting  "sensitized"  is  a  good
                will  work  in   non-white,   for   example,   black   idea, but I don't  think  three  months  are  needed
                communities,  and  those  who  will  talk  to  their   if it is to be done  in  the  manner  we  tried.  My
                own    folks.-R.P.,    Community     Worker,     Ne-   Philosophy  is  all-or-nothing;   we   should   move
                wark.                                                  in  completely  or  we  should  have  a   "detached"
                                                                       attitude,  as  many  of  us  had.  We  returned   to
                INTERVIEW                                              our  white  middle-class  suburbs  like   clockwork.
                 Q:  Do  you  think  the  health  students   related   I think it important  for  white  middle-class  stu-
                to the Newark community well?                          dents  to  re-evaluate  the  ghetto.  They'll   find
                 A: Yes, they  fitted  in  very  nicely,  they  wer-   that the  residents  are  some  of  the  finest  and
                en't   too   anxious,   they   were   understanding,   most decent  of  people  and  that  there  are  rea-
                very  pleasant-they   weren't   formal.   The   peo-   sons why  they  act  in  the  manner  they  have  or
                ple around here don't  like  people  to  be  formal.   feel as repressed as  they  do  as  denizens  of  an
                They like down-to-earth people. The     .   students   involuntary  ghetto.  But   it   is   curious   that
                fitted in all right. If they hadn't,  they  wouldn't   many of  us  are  victims  of  a  white  involuntary
                be here this long.                                     ghetto  imposed  on  us  by  bigots  and   opportun-
                  *  *  *  A  number  of  things  would  have   hap-   ists  in  our  own  families  and  communities,   in
                pened if we'd cut  into  the  hospital  the  way  we   many cases of the  worst  kind,  the  silent  bigots
                wanted  to.  There  probably  would  have   been   a   who are  the  hardest  to  weed  out  and  the  most
                riot, I know that.  SHP  really  wanted  to  protest   dangerous  to   our   society.   Being   sensitized-
                against the  hospital  for  the  people  there.  The   which  I  admit  to  be  of   some   value-we   must
                hospital   people   don't   treat    the    patients   re-enter  our  own  communities  and   shatter   the
                right.  *  *  *  'If  we  had  really  pushed   com-   fears of integration and  the  myths  of  black  ig-
                plaints as  hard  as  we  wanted  to,  and  had  had   norance  and  irrationality  that  are   perpetuated
                the  people  protesting,  it  would  have   been   a   in the  white  communities  as  they  are  -now.  We
                huge  mess.  In  a  round-about  way  it  was   best   must also  remember  in  the  future,  when  we  are
                to do as much as we could, but  not  to  do  it  too   doctors  and  nurses  and  lawyers,  to  be  nonsub-
                strongly. * * *                                        scribers  to  the  hypocrisy  of  our  milieu.-P.D.,
                  You  see,  community  people  never  really   stop   Medical Student, Newark.
                to  think  about   how   they're   used   to   being      I think that inducting a lot  of  white  kids  to
                treated.  The  people  know  they're  being  treated   come and  work  in  a  black  ghetto  for  the  sum-
                mean, they know  they're  not  being  treated  fair,          'thout  some  type  of  screening  or  inter-
                but.  they  never  stopped  to  realize  what   they   mer wi
                could  do  about  this  until  the  health  students   viewing is  simply  a  newer  and  better  means  of
                came  here.  That's  when  they  stopped  to  think,   legalized  exploitation.  For   years   we've   been
                why  should  we  be   treated   this   way?   Before   pushed  around  and  used  and   now   when   whites
                they  had  said,  "Oh  well,  we're  going   to   be   start  feeling  guilty,  they  want  to  rush  right
                treated like dogs, let's get used to it,"  and  they   into  the  ghetto  with  their  righteous  attitudes
                never  tried  to  do  anything  about  it.  If   the   and  change  the  world.   And   when   the   summer
                health students would  have  come  in-  and  started   is over, they  can  go  back  to  their  family  and
                protesting,  then  the  people  would  have   remem-   friends  with   news   of   how   they've   redeemed
                bered  how  the  riots  worked;   how   our   people   themselves  through   the   great   community   ser-
                were killed and  their  families  weren't  even  no-   vice  they  rendered  the  "poor  folks"  this  sum-

                60


                                                     GREATER         NEW  YORK
                 ken residents  that  seeing  the  white  students  in    found  that  medical  students  are,  on   the   whole,
                 this  role  only  aggravates  the  wounds  they  have    inconsiderate  and  self-centered.  With   the   excep-
                 suffered.  They  wondered  why   more   isn't   being    tion  of  three,  I  found  that  they  are  interested
                 done  to  train  the  community  people  to   do   my    only  in  what  they  can  gain  and  how  far  it  can
                 work.  They  argued  that  if  I  do  know  the  sys-    get  them.  The   attitude   of   most   medical   stu-
                 tem  better,  I  should  be  demanding   reform   and    dents  is   one   of   condescension.   They   act   as
                 working within  to  change  it.  If  I  as  a  health    though  the  community   should   be   on   its   knees
                 student  am  committed  to   helping   these   people    praising  them.  Most  of  them  seem  to  be   saying,
                 get the services  they  deserve,  in  their  eyes  my    "Look,  you  should  be  glad  that   I'm   giving   up
                 place is not in their community,  but  in  the  clin-    my   precious   time   to   work   in   your   poverty-
                 ics   and    hospitals.-R.F.,    Medical    -Student,    stricken   ghetto   area."   This   feeling   is    not
                 Bronx.                                                   voiced,  but  felt  instinctively  by  the   community.
                                                                          it is  often  said  that  a  person  acts  the  way  he
                 The  subject  of  health   is   very   touchy.   Most    feels.
                 people won't discuss  it  openly.  I  feel  that  you    To  being   with,   it's   bad   enough   that   people
                 must have the quality of being  able  to  talk  to  a    have to  live  in  conditions  such   as   these   (rats
                 person in a way  that  will  make  him  or  her  feel    and  roaches  crawling  all  over   the   place),   but
                 at ease. You can't expect  to  knock  on  a  person's    you  don't  have  to  remind   them   and   make   them
                 door and have them  tell  you,  in  detail,  what  is    feel bad  about  it.  After  all,  they  don't  like  it
                 wrong   with   them   physically,   especially,    if
                 you're a white person.                                   any  more  than  you  do.  If  someone  were  to   come
                                                                          to  my  door  with  that  kind  of  attitude  and  tell
                 I  am  black  and  I  know  when   a   white   person    me that they wanted  to  help  me,  I'd  tell  t.hem
                 comes to my door I'm  a  bit  skeptical.  I  know  if    where  to  go  and  how  to   get   there   fast.-C.B.,
                 a  white  person  comes  to  a  black  person's  door    NYC, Bronx.
                 to  ask  about  health,   the   black   person   will
                 think he's crazy or tell him  to  get  the  hell  out     This  comment  is  an  attempt  to  respond   to   the
                 of there. Despite  the  fact  that  many  white  stu-    position  supported  by   most   militant   black   or-
                 dents  have  stated  that  people  in  the  community    ganizations  (for  example,   the   Black   Caucus   of
                 didn't receive them that  way,  I  know  for  a  fact    the  Chicago  SHP)  that   the   "very   presence   (of
                 that   nowadays   that's   what   you'll   get.-H.H.,    white  middle  class  health  students)   is   destruc-
                 Nursing Student, Bronx.                                  tive  and  you  cannot  make   yourself   relevant   to
                 The   question   has   often   been   asked,    "What    us  at  all."  Two  crucial  issues  are  raised  here:
                 are  white  medical  students  doing   in   a   black    what   kind   of   "presence"   is   destructive,   and
                 and    Puerto    Rican     community?"     Naturally,    what   is   "relevant"   involvement   for   SHP   mem-
                 this question arouses  fear  and  guilt  feelings  in    bers?  I  propose  the   concept   of   the   "relevant
                 some  of  the  community.  As  a  black   person,   I    absence"  of   white   SHP   members   in   the   black
                 feel  that  no  one  black  person  can  safely   say    community.  How   is   this   "relevant   absence"   to
                 what  the   community   feelings   are   about   this    be   implemented.   By    (a)    tutoring    and    job
                 matter.  Luckily,  the  SHP  has  -not  had  to  face    advocacy   of   community    teenagers    and    adults
                 this  problem  because  when   people'are   in   need    for  entry  into  the  health  professions;  (b)   sup-
                 or want help they  don't  care  about  the  color  of    port   for   organizations   for   control   of   local
                 the person who is  giving  them  this  help.  If  one    health  facilities;  and   (e)   supporting   construc-
                 were to look at the  question  of  black  vs.  white,    tive   union   demands   for   professional    advance-
                 they would realistically  see  that  there  are  more    ment  and  higher   salaries   among   hospital   slave
                                                                          labor groups.
                 white  medical  students   than   black.   Therefore,      All  of  this  implies   that   Whitey   must   with-
                 Student  Health  Projects  cannot  consist   Of   all    draw  from  the  destructive   summer   colonial   out-
                 black   medical   students.-M.'J.,    Nursing    Stu-
                                                                          posts  called  storefronts  and  confront  the   injus-
                 dent, Bronx.                                             tices   of   his   own    mother    country    (medical
                   From   my   experiences   this   summer,   I   have    schools, hospitals,  clinics).  If  he  does  not  make

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                                                 SUMMER  1968
       his confrontation peacefully, his  black  SHP  col-   older  people  meet   and   work   on   equal   ley-
       leagues will have to do it  violently.  As  in  the   els.-N.W.,    Community    Coordinator,    Brooklyn.
       present  systematic  oppression,  the  future   in-    I  believe  that  being  black  is  becoming  daily
       surrection  against  inadequate  health  care  will   more and more of a  criterion  for  working  in  the
       unfortunately  leave  its  deepest  scars  on   the   black  community.  However,  it  should   be   noted
       poverty-stricken   patient.-J.G.,   Medical    Stu-   that all it does is get one into the  community;  it
       dent, Bronx.                                          does  not  make  the  job  in  the   community   any
         I think that in most  cases  of  a  black  person   easier after you are there.
       and a white  person  working  together,  the  white     The  fact  of  my  having  worked  in   Youth   In
       person doesn't really  expect  too  much  from  the   Action  since  February  was  more   of   an   asset
       non-white,  and  the  non-white  knows   this   and   than  was  the  color  of  my  skin.-E.C.,   Medical
       therefore doesn't do  any  more  than  is  expected   Student, Brooklyn.
       of him.
                                                               The  white  student,  if  he  comes  in  the  area
         What I mean is, you  only  get  what  you  expect   with the right attitude (that of  being  willing  to
       out of most people.  If  you  expect  very  little,   work  for  the  wishes  of  the  community,  not  to
       that is just what you ge@very  little.  So  if  You   dictate  to  the  community  what  must  be   done),
       intend  to  have  a  project  next  summer,   don't   can  do  much  good  for  his   brothers-black   and
       fool yourselves, as  one  student  said,  that  you   white. He can give  his  black  brothers  the  tools
       are all things to  all  people,  because  you  cer-   needed to carry  on  the  fight  for  better  health
       tainly are not fooling the people  in  the  ghettos   care. He  can  help  them  organize  and  give  them
       or the  community  people  you  are  working  with.   information  about   the   white   power   structure
         The people that  I  worked  with  this  summer  I   that can be used to change it.  He  can  align  him-
       believe  were  sincere  and  in  most  cases  hard-   -self  with  the  members  of  the  black  community
       working,  honest  people.  Some  of  them  I  liked   in  demanding  reforms  and   revolution.   He   can
       and worked  well  with,  but  others  I  felt  were   show  the  medical  world  that  whites  must   work
       just curious to see what life in  a  nonwhite  com-   together with blacks  in  order  to  make  a  better
       munity was like, not because  they  really  cared,,   society  for  all.-D.Y.,  Medical  Student,   Brook-
       but just because it  was  an  opportunity  to  sat-   lyn.
       isfy their curiosity and get pretty good pay,  too.     The  project  director  and  I  talked  about  the
         Another  thing  I  feel  about  this  project  is   appropriateness  of   medical   and   nursing   Stu-
       that the white students are  feeling  guilty  about   dents  working  in  these  communities   this   sum-
       the wrongs that have  been  done  to  black  people   mer. Just  where  do  we  fit  into  the  scheme  of
       for so long and  are  trying  to  make  amends,  so   things  already  going  on.  I  feel  very  strongly
       they say to us, "What  can  we  do  for  you,  what   that our role should  be  support,  not  leadership.
       can we give you to  makeup  and  let  you  know  we   Black  people  should  be  doing  their  own   orga-
       are sorry now?" Well, this  may  be  great,  but  I   nizing, not only because it is  likely  to  be  more
       don't want you  to  give  me  anything,  not  as  a   effective, but because  of  the  need  for  a  black
       gift, not as  charity.  If  white  people  want  to   identity  and  solidarity.  We're  really  just  an-
       help  black  people,  don't  give  handouts;  don't   other  group   of   absentee   philanthropists   who
       treat  grown  men  and  women  as   children   that   come  in  for  ten  weeks  and  do  our  thing   and
       have to be taken care of. First ask  and  find  out   then leave. The only things  that  will  have  last-
       if Your help is wanted, then  give  the  help  that   ing significance are projects  that  speak  directly
       is asked for, don't try to shove your way  of  life   to  the  needs  of  the  community  and  which  have
       down our throats. I  really  think  that  the  big-   the interest and support of  the  people.  for  whom
       gest help you  can  give  us  is  in  teaching  and   they're intended. To that end, we  can  try  to  en-
       showing  us  how  to  help  ourselves;   show   our   list support for a project,  but  the  real  leader-
       Young people how to  get  into  colleges,  what  to   ship must  come  from  the  people  who  are  inter-
       do to'get grades that are  college  level.  Let  us   ested in it, not the health students.

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                                                    GREATER        NEW  YORK
                 Also,  in  the  words  of  Malcolm  X,   we   might   only  that  which  he  found  expedient.  He   criti-
                 fruitfully  spend  our  energies  "organizing   our   cized  other  Negroes  (excuse  me,  I  mean   black)
                 own people"  and  trying  to  make  them  cognizant   historians   and   branded   them   "Toms"    because
                 of and responsive to the  expressed  needs  of  the   they had the intellectual  honesty  to  tell  history
                 community. This  refers  mainly  to  the  hospitals   as they saw it, even if  a  different  telling  would
                 we'll be dealing with,  but  also  to  our  medical   be  a  better  demagogic  tool.  I  was  really   in-
                 schools and some  of  the  city  agencies  we  deal   censed. I  came  to  work  on  this  project  because
                 with. We can perform  a  unique  function  in  that   I am  tired  of  white  lies  and  hypocrisy,  and  I
                 we are health science  students  and  can  talk  to   will not  now  accept  black  lies.  After  rejecting
                 doctors  and  nurses  in  a   somewhat   knowledge-   "Establishment"  propaganda,  I   won't   fall   prey
                 able way. I  think  we  should  look  for  ways  in   to radical black propaganda.
                 which  we  can  serve  as  intermediaries   between    I have  spent  too  long  at  academic  institutions
                 the  community  and  the   health   providers   and   and will not willingly cast off  respect  for  intel-
                 use our position  not  to  be  apologists  for  the   lectual honesty and  truth,  even  though  it's  cur-
                 health providers but as  advocates  for  the  unre-   rently in vogue to do  so.  It  has  become  fashion-
                 presented.  Hopefully,  as   decentralization   and   able  to  class  these   terms   under   the   column
                 community  control  becomes  a  reality,  the  need   headed  "bourgeois  educational   system"   and   re-
                 for  this  function  will  wither  away  also.  The   ject them, and that is a great  pity.  At  any  rate,
                 name  of  the  game  is   participatory   democracy   as history I  found  the  talk  a  failure.  It  was,
                 and we should try to  facilitate  that.  These  re-
                 marks  apply  more  to  the  white  health  science   however,  useful  in  that  much  of   his   approach
                 students than to the  blacks,  but  it's  unfortun-   to  history  exemplifies  what  we're  seeing   today
                                                                       in  the  new  trends  the  Negro  movement  is   tak-
                 ately true  that  some  blacks  are  only  slightly   ing-namely, over-reaction.
                 more   effective   than    whites.-R.C.,    Student
                 Coordinator, Harlem.                                    When  I  began  working   here   ten   weeks   ago,
                                                                       the  words  "Black  Power"  really   frightened   me.
                  It's late Tuesday -night, and I've had a  full  24   They  conjured  up  images  of   burning   buildings,
                 hours to go over the  black  history  talk.  I  had   shattered  storefronts,  and   gun-point   confronta-
                 really  looked  forward   to   the   Monday   night   tions of black  and  white.  It  wasn't  the  immedi-
                 black history class: first, because  I  thought  it   acy  of  riots  that  was  frightening,  but   rather
                 would be interesting and,  second,  because  I  had   the  future  prospects   of   the   black   movement-
                 heard  the  speaker  praised.  I  was  disappointed   where is it all  leading?  The  idea  of  black  con-
                 on both counts.                                       trol of the  schools  and  hospitals  had  been  men-
                                                                       tioned  at  various  meetings  and  discussions,  and
                  The  topic  for  the  class  was  something  about
                 the  transition  from   African   to   slave.   The   I  refused  to  accept  it  because   I   inseparably
                 speaker  began  with  a  glowing   exhortation   of   linked it to a total  rejection  of  the  white  com-
                 the  "rich"  African  culture  and  religion,   and   munity by the  black.  I  could  see  recurrences  of
                 moved on to talk about the life of  the  plantation   the  Ocean  Hill-Brownsville   school   incident   in
                 slave.  I  don't  know  much  about   the   African   all  the  situations  where  blacks   were   suddenly
                 heritage,  but  I  found  this  discussion  of   it   given control of  the  local  institutions.  I  could
                 neither  enlightening   nor   pertinent.   It   was   see the firing of white ljeople,  not  on  the  basis
                 pitifully  one-sided,  filled   with   half-truths,   of  their  competence,   but   on   their   whiteness
                 totally lacking in historical perspective  and,  at   alone.   What   was   particularly   disturbing    is
                 times, a complete perversion of the  past  to  suit   that  it  appears  to  be   a   rather   unsatisfying
                 the speaker's own  present  needs.  In  the  course   culmination  of  black  discontent   both   for   the
                 of my own  studies  on  the  Civil  War  and  Ante-   white  community  and  the  black  as  well.   Whites
                 bellum South,  I  had  read  the  same  authors  to   control  the  money  and  power  structure   of   the
                 which  he  made  reference  (and   a   great   many   country,  and  it  seemed  like  the  black  man  was
                 others as well), and I honestly  believe  he  judi-   hurting  his  own   struggle   by   permanently   re-
                 ciously edited everything  he  read  and  presented   jecting   Whitey.   These   considerations   led   me

                 64


                                                SUMMER  1968
      to  write   off   the   Black   Power   movement   as   defense   against   the   wretchedness   that    sur-
      irresponsible and immature.                             rounds  him?  Can  he  help  but  try  to  close  out
      I  interpreted  the  Afro   cult   as   the   natural   the  ugliness?  Consider  the  incidence   of   hard-
      complement  to  the   Black   Power   movement.   The   drug addiction in Harlem-the needle o           ffers
      stress upon things  Afro  is  easily  seen  and  felt   relief:  escape.  The  same  for  the  bottle-it  too
      around   here-all    along    Lenox    and    Seventh   promises  escape.  How  can   the   black   man   an-
      Avenues  boutiques  have   sprung   up   where   Afro   swer  the  question:  who  am  I?  Is  he  the  stag-
      clothes are sold  and  the  "natural"  hairstyle  be-   gering    drunkard,    the    unwed    mother,    the
      comes more popular daily.  I  didn't  like  the  Afro   bastard  son,  or  the  local  whore?   The   reality
      rennaissance for a number  of  reasons.  It  has  all   of  the  nightmare  is  too  much   to   bear-a   new
      the earmarkings of a fad,  and  like  other  fads  it   identity  must  be  found.   The   Negro   tried   to
      flourishes  on  conformity  and  is  steeped  in  hy-   adopt   white    middle-class    values    and    was
      pocrisy. The artificiality of  the  whole  thing  was   doomed  to  failure,  because   he   can   never   be
      particularly   disturbing.   While    the    American   white  and  is  not  now   middle-class.   Afro   was
      Negro  obviously  does  have  an  African   heritage,   seized  upon  because  at  least  it  is   compatible
      the Afro  rebirth,  as  it  appears  now,  seemed  to   with  being  black.  Unfortunately,   that   is   the
      have  little  meaning   for   him   in   20th-century   only  relevance  I   could   find   for   the   cult,
      Harlem. It all appeared so inane.  I  had  no  diffi-   and  it  is  for  this  reason  that  I  saw  it  too
      culty calling it "just a lot of people  swept  up  by   as a blind alley, a fad, a  foster  ethos.  Yes,  the
      ethnic   mongers."   Of   course,   the   black   man   black  man  once  was  African,  but  250  years   of
      should  be  conscious  of  his  black  heritage;   it   slavery  followed  by  another  100  years  of   mock
      would  be  a  crime   to   disavow   it-he   can   no   freedom  and  urban  poverty  living  have  far   re-
      more  deny  it  than  he  can  deny  his   blackness.   moved   him   from    the    16th-century    African.
      But  the  whole  thing   seemed   so   unreal-a   re-   Whatever  African  he  had  in  him  has  long  since
      treat.  What  I  came  to  realize  slowly  was  that   died  and  cannot  now,  in  the  20th-century  Amer-
      the  need  which  forces  him  to   seek   out   this   ica,  be  brought  back  to  life.  The   Afro   cult
      African cult  is  very  real.  There  is  a  void  as   seemed  to  me  a  backward-looking  sham.   It   ap-
      to  the  identity  of   this   black   man-just   who   peared that the Negro  had  taken  up  the  cult  for
      is  he?  The  question  is  not  how  he  appears  to   no  other   reason   than   his   denial   of   white
      the  world  but  rather  how  he  appears   to   him-   middle-class   America-a   denial   born    out    of
      self.                                                   350 years of frustration and hate.
       On my way  to  and  from  our  office  I  walk  past     From  the  mid-fifties  to   the   early   sixties,
      the   southwest   corner   of   Eighth   Avenue   and   Civil  Rights  looked  as  if  it  were  going  some-
      137th  Street-past  the   crap   game   in   pmtetua,
      and the old men  sitting  on  the  stoops  and  stand   where:  Supreme   Court   decisions   and   picketing
                                                              appeared  to  be  gaining  ground.  But   the   proe-
      ing at the corner; past the  tired  faces  with  eyes                                             the   first
      still bloodshot from the  last  night's  cheap  whis-   ess was   much too slow and after
      key; past the panhandling junkies,                      century  of   "almost-freedom,"   every   year    was
                                                     coming   harder  to   take.   The   Negro   of   that   period
      down and looking  for  their  next  shot;  past  pur-   appears  to have f allen  into  the  trap  of  think-
      ple  pants  and  old  yellow  Cadillacs.  The   side-
      walks  themselves  are  speckled  with  the   trodden   ing  that  because  he  could   now   ride   in   the
      remains of chewing  gum,  tar,  spittle,  and  urine.   front  of  the  bus  his  blackness  would  pass  un-
      On  hot  afternoons,  the   south   side   of   137th   noticed.  But  as  the  slow  years  rolled   on   he
      Street is  in  the  shade-and  it  teems  with  name-   soon  realized  that   no   matter   how   close   he
      less black life.                                        gets  he's  never  going  to   be   white.   Out   Of
        Harlem is a  nightmare,  and  it  is  against  that   the  old  and  new  frustrations  came   the   propo-
      background  of  the  all  too  real   ugliness   that   sition  that  "Black  is  Beautiful."   The   politi-
      must  come  to  terms  with  Black  Power   and   the   cal adjunct to this is. that  Black  can  run  things
      Afro  cult.  The  question  of  identity   looms   up   without  Whitey,  and  if  we  don't  give  him   the
      again,  can  the  black  man  help  but  build  up  a   chance,  he'll  seize  it  for  himself.  The  Negro,
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                                                     GREATER  NEW  YORK

               unable to  become  white  middle  class,  makes  the    gering job  of  revitalizing  his  institutions,  he
               psychological defense of rejecting it.                  must  come  to  terms   with   himself.   When   his
                  I've spent a  whole  summer  listening  to  black    personality   development   is   complete   he   can
               leaders,  at  times  working  with  them,  and  each    then look to his sociological ills, and therein  the
               day  walking  around  Harlem,   always   trying   to    Black Power phase will  have  to  end  or  at  least
               put  Black  Power  and  the  Afro  movement  in  the    sufficiently alter itself  to  allow  acceptance  of
               proper  perspective.  If   you   listen   to   black    white support and aid.  The  white  sector  has  too
               leaders you get the  impression  that  this  is  the    much  of  the  broader  political  power,  too  much
               end-the final step in the  evolution  of  the  Civil    of the money,  and  too  much  of  the  professional
               Rights  movement.  They  seem   to   say   now   all    personnel for  the  Negro  to  ignore  it-the  black
               that's left  is  for  the  black  community  to  get    man would be a fool if he did.
               fully  behind  it,  and  the  final  assumption   of      I've asked myself where  the  white  man  fits  in
               power  is  imminent.  This  is  what  always   threw    now,  and  the  only  answer  I  can  come  up  with
               me  off  about  Black  Power-the  proposition   that    is  that  he  doesn't.  He  can  support  the  move-
               it is the matured product of black unrest.              ment  to  give  the  black  communities  the   power
                  it  would  be  unfair  to  Black  Power  and  the    they demand, but that is all. It is  the  black  man
               Afro cult  were  I  to  leave  the  impression  that    himself  who  must   struggle   with   that   power.
               they  are  useless   socio-psychological   defenses,    Until  he's  ready  to  ask  for  and  accept,  .  e
               because, for  all  their  superficiality  and  imma-    white  man's  help,  all  Whitey  can  do  is  watch
               turity, they serve  an  absolutely  vital  function:        *-B.G., Medical Student, Harlem.
               they  make   being   black   something   acceptable,
               not to the white  man,  but  rather,  to  the  black        COMMUNITY EDUCATION AND
               man  himself.  The   trouble   I   have   had   with              TRAINING PROGRAMS
               Black Power is  that  it  disguises  itself  as  the      This  summer  I  think  the  community  asked   to
               end, when in  reality  it  is  the  means-the  vehi-    be  able  to  do  for  itself  what  is  now  neces-
               cle by which the black  man  can  regain  his  self-    sary  for  outsiders  to  do.  The  community  wants
               respect and pride. I  seemed  to  fear  Black  Power    to  know  how  to  obtain  the  knowledge  necessary
               because  of  its  finality-the  black-community   is    to meet its  own  needs.  This  was  clearly  stated
               given  control  of  its  schools  and  responds   by    during orientation, but I've  seen  little  evidence
               firing all of  its  white  teachers.  The  crime  in    of any action. I think it  would  be  extremely  ad-
               that  is  that  by  disregarding   competence,   the    visable for the  health  science  students  in  -  e
               black  community  can  destroy   what   institutions    future to act as tutors. There  is  no  question  as
               it has. I do  believe  it  should  determine  policy    to who would  benefit  from  the  service.  Part  of
               and  make  decisions,  but  not  on  the  basis   of    our  work  this  summer  with  the   NYCs   was   to
               black and white.                                        provide educational  programs.  I  saw  very  little
                  If the black  leaders  were  given  control  now,    evidence of this taking  place.  A  few  poorly  or-
               as they demand,  white  heads  would  roll,  and  if    ganized classes  were  given  but  no  ongoing  pro-
               the  matter  were  left   at   that,   Black   Power    gram seemed to exist.
               would be an insidious  creation.  But  I  don't  be-      Our  knowledge  could   be   applied   by   having
               lieve it can be  left  at  that.  In  the  beginning    community  workers   and   health   students   teach
               there will be  abuses  of  power  which  will  Arise    the  community  how   to   do   advocacy.   If   one
               for  two  reasons:  (1)  The  immediate   psycholog-    health  science  student  spent  his  time  teaching
               ical  need  of  the  black  man   (the   very   need    patient  advocacy  to  a  group  of  community  peo-
               which  prompted  the  birth  of  Black  Power)  will    ple, he then  could  work  himself  out  of  a  job.
               demand that for  once  black  be  on  top;  and  (2)    Health   advocates   from   the   community   should
               the  black  community  itself  will  have  to  learn    be taught as  much  as  possible  about  the  hospl-
               the responsibility of  power  (a  lesson  it  cannot    tal and other health facilities. I see the  role  of
               learn until it is  given  the  exercise  of  power).    the health science student as  that  of  setting  up
               These   things   will   happen-they   must    happen    relationships  making  it  possible  for  the   com-
               -for before the  black  man  can  tackle  the  stag-    munity  advocates  to  function.  A   thorough   in-

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                                               SUMMER  1968
    troduction to the hospital  is  necessary.  I  found    to contribute. Why wait for  the  disease  to  hap-
    that  in  my  dealings  with   Morrisania   Hospital    pen and then fret about  the  cure.  Get  ahead  of
    very  few  of  the  hospital  staff  had  been   in-    the   problem.-A.M.,   Nursing   Student,   Newark.
    formed  about  SHP  and  patient  advocacy.  At  the     Health  care  in  Newark  would  be  greatly   im-
    beginning  of  the  summer,   we   were   introduced    proved if medical people  could  be  sensitized  to
    to some of the staff, but apparently  this  was  not    respect  and  have  compassion   for   the   people
    effective.                                              they are being  paid  to  serve.  I  feel  strongly
      One  drawback  I  can  see  to  having   community    that many people  are  too  hardened  by  now,  and
    advocates is that of status. The  reason  that  stu-    the answer, I think, is to be found  in  the  imme-
    dent patient  advocates  are  effective  is  because
    they  represent  a  group  which  puts  them  on   a    diate  training  of  community  people  in  medical
    higher level than the  patients.  If  patient  advo-    fields so that  they  can  replace  bad  personnel.
    cates  were  people  who  used  the  clinics   them-    This should occur at all  levels.  People  who  re-
    selves, the institutions  may  not  feel  they  have    fuse to be responsive to the desires  of  the  com-
    to pay any attention to them.                           munity  should  be  removed   from   their   jobs.-
      Therefore  it  would  be  very  important  for   a    R.P., Commitnity Worker, Newark.
    thorough  saturation  of  the  institution  on   pa-     I find that in Newark,  at  least,  a  major  rea-
    tient  advocacy.-V.V.,   Nursing   Student,   Bronx.    son for poor medical care is  that  people  do  not
      Instead of literally taking  people  by  the  hand    know what  they  are  entitled  to,  or  even  what
    to welfare, de  artment  of  buildings,  and  hospi-    adequate  health  care  is.  Therefore,  since  New
    tals,  SHP  should  direct  its  goals  more  toward    Jersey  College  of  Medicine  and   Dentistry   is
    showing  the  people  of  the   community   how   to    new  in  the  Newark  community,  we   must   first
    help  themselves.  By  this,  I  mean  forming  wel-    act  in  an   observational   capacity,   conjoined
    fare  rights  groups,  showing  people  how  to  put    with  much   communication   with   the   residents
    in  complaints  which  deal  with  housing,  sanita-    of the community, in order to  create  a  plan  for
    tion,  and  health,  directing   them   toward   job    actions that we can take. We  should  also  act  in
    training   programs,   SEEK   (college   discovery),    an  educational  capacity,  relaying  our  informa-
    and tutoring junior  and  senior  high  school  stu-    tion and suggestions to the community.
    dents to prepare them  for  college  or  health  ca-     I  believe  that  this  is  our   most   important
    reers.-M.i. Nursing Student, Bronx.                     function  in  the  community,  for  if   we   stand
      If there was nothing  we  could  do  in  the  hos-    only  as  a  small  group  of  students  against  a
    pital in the  existing  milieu,  there  was  a  more    large political  organization,  we  can  expect  to
    positive  path  open:  the  community   might   have    make little  or  no  impression.  From  my  experi-
                                                            e-nee  this  summer,  I  can  see  that  the  large
    been spared  the  indignities.of  that  facility  if                                            iiist, like
                                                            machines which we are fighting aga
    the  people's  knowledge  of  health   matters   had    Martland  Hospital,  are  deathly  afraid  of   the
    been   more   sophisticated.   There   should    and
    could be  much  more  profit  from  an  emphasis  on    community and  its  wrath  and  would  bow  to  the
    prevention. This  could  be  accomplished  via  lec-    demands  of  a  coherent   community   group   much
    tures,   demonstrations   and   discussions    about    more readily than they would to us.
    maternity, first aid, dietary  patterns,  contracep-     The  majority  of  the  people   in   the   Newark
    tion, abortions, etc. The  personnel  for  this  en-    community are  unaware  of  their  rights  and  the
    deavor  could  come  from  at  least  two   sources:    injustices imposed  on  them,  and  are  not  orga-
    SHP members  (out  of  all  the  education  we  have    nized into  any  protest  organization.  Therefore,
                                                            we  must  educate  the  community   through   agen-
    among us it  struck  me  as  ironic  how  little  we
                                                            cies,  schools,  PTAS,  meetings,   advocacy,   and
    were able to utilize) -, and the health  profession-    I
    als  already  in  the  community.  There  are  local    aoor-to-door   soliciting,   and   whatever   other
    Physicians,  nurses,  and   nursing   students   who    methods     become     necessary.-K.O.,     Nursing
    are  Possessed  of  varying  amounts  and  types  of    Student, Newark.
    knowledge.  They  should  be  contacted  and   asked     It was realized that  new  and  totally  different

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                                                        GREATER         NEW  YORK
                    methods  of  health  care  delivery  were  needed  in    vice  Department  of  the  clinic,   who   would   be
                    light  of  the   doctor   shortage   and   population    responsible   for   gathering    feedback    informa-
                    rise   witnessed   in   America.    Functions    that    tion  and  informing   the   physician-assistant   as
                    classically  have  been  the  sole  domain   of   the    to  what  has  been  done   and   what   the   physi-
                    physicians   would   necessarily   be   taken    away    ei-an-assistant   should   do   next.   This   worked
                    from  him  and  given  to  persons  lower   down   on    with great success.
                    the  health  professional  scale,  thus  freeing  him    Patients  that  we   have   seen   (over   300)   ex-
                    to  see  more  patients.  As  a  result,  such  func-    pressed  pleasure  with  the  fact  that  someone  at
                    tions  as  history-taking,  blood  pressures,  pulse,    last was concerned  with  their  total  health  situ-
                    immunizations,   and   vaccination    were    consid-    ation  and  not  just  with  the  episodic  treatment
                    ered  possible  areas  whereby  a   dent   could   be    of   whatever   condition   their    children    were
                    made in  the  solid  but  perhaps  rusting  armor  of    brought in for.
                    the  physician,   without   too   much   fuss   being    Kings    County    Hospital     Pediatric     Clinic,
                    made. Included  in  the  role  of  "physician-assist-    which  was  already  held  in  high  regard  by   the
                    ant"  were  other  functions,  such   as   dissemina-    patients  (for  they   honestly   receive   excellent
                    tion of  nutritional,  health,  and  safety  informa-    care there) received an  extra  boost  by  this  con-
                    tion to visitors to the clinic.                          cern on the clinic's part.  Patients,  upon  revisits
                    Now,   many   months   after   the   conception    of    to the clinic,  looked  for  the  physician-assistant
                    the  above  idea,  what  we  finally  have  is   very    -and  relayed  to  him  any   problems   that   arose
                    different  from  the  origin-al  seed.  During   this    since they last saw  each  other.  The  use  of  phy-
                    time,  we  molded  and  remolded  our   concepts   so    sician-assistants not  only  gave  100  percent  bet-
                    that  a  meaningful  and  realistic  position   would    ter  medical  care  because  they   concerned   them-
                    be established.  No  longer  are  the  various  func-    selves with the  total  health  problem  of  the  pa-
                    tibns  mentioned  above  a  part  of  the  physician-    tient, but also served  to  minimize  the  tedium  of
                    assistant's  role.  The  history-taking  is  now  the    the long waiting period.
                    primary function of the physician-assistant.              Now,   what   about   continuation   of   the   pro-
                                                                             ject? The Pediatrics  Clinic  is  funded  by  a  gov-
                            The      questionnaire       (history-taking)    ernment  grant  under  rigid   stipulations   as   to
                    was  considered  a  total  success  by  health   sci-    hiring  of  employees.  With  this  straightjacket  I
                    ence students,  NYCS,  and  especially  by  the  doc-    am in the  process  of  negotiating  five  new  posi-
                    tors of the  clinic  who  found  the  screening  his-    tions  for  physician-assistants  under  the   social
                    tory an invaluable  aid.  But  a  question  arose  as    service  department,   beginning   next   July   ist.
                    to  what  to  do  with  the  social  pathology   that    Why  next  July   Ist?   After   careful   considera-
                    was  detected  by  the   history.   The   answer   to    tion,  it  was  concluded  that  it  would  be   much
                    that, we all agreed, had to be  part  of  the  physi-    wiser,  -and  more  realistic   and   meaningful   to
                    cian-assist-ant's role,  for  example,  it  would  be    have  a  40-week  training  program  that  not   only
                    his  function,  and  a  major  one,  to  do  followup    .. includes on-the-job training,  but  gives  accred-
                    work  on  the  patients  he  thought  required   such    ited  courses  in  English,  math,  science,  sociol-
                    attention. With this  in  mind,  we  set  out  enthu-    ogy, etc. The benefit  of  such  a  program  is  that
                    siastically to do home  visits.  After  a  number  of    someone  with  a   minimal   education   (6th   grade
                    weeks  of  a  split  regimen-clinic  hours  and  home    and up) can  acquire  skills  that  will  enable  him
                    visits-we  groped  with  the  problem  of   the   ex-    to  have  some  upward  mobility,  rather   than   to
                    tent of followup  care  to  be  indulged  in  by  the    place him in a  position  that  he  has  no  hope  of
                    physician-assistants,  in  light  of  the  fact  that    ever  rising  above  or   moving   from.-B.F.,   Med-
                    95  percent  of  the  patients   seen   needed   fol-    ical Student, Brooklyn.
                    lowup,  and  it  would  be  impossible,   physica   y
                    and realistically to  do  so.  We  decided  that  the      My experience            is  proving  to  be  quite
                    social  worker  role   of   the   physician-assistant    interesting. * *  *  I  learned  the  art  of  taking
                    would  be  limited  to  getting  in  touch  with  the    case histories, and  the  task  of  learning  all  of
                    proper  agencies  and  notifying  the   Social   Ser-    the  names  of  the  diseases  was  easier   than   I

                    68


                                                SUMMER  1968
     expected.  The  doctors  working   with   us   proved   public   school   health    programs.    The    atmo-
     to be very  patient.  *  *  *  The  medical  students   sphere at  the  beginning  was  one  of  beholdeness.
     in  our  group  are  very  friendly  and  always  try   -people   did   not   know   their    rights.    Many
     to help  us  in  any  way  that  is  possible.  They.   thought  that  because   they   were   Medicaid   re-
     have  patience  with  us  and   are   always   around   cipients  they  were   obligated   to   the   various
     to assist if we need their help.                        treatment facilities. Others  felt  that  they  could
      The  best  time  is  when  we  are  given  the   op-   only go to a clinic  and  not  on  a  private  physi-
     portunity  to  go  out  in  the  waiting   room   and   cian.  Our  job  was  to  educate  the  community  to
     call our  own  patients.  Even  though  I  was  quite   think  differently.-J.H.,   Medical   Student,   Har-
     nervous  at  first,  I  greeted   the   people   with   lem.
     friendly smiles -and all  of  the  fright  went  away     Halfway   through   the   summer   referrals   from
     from  me.  The  parents  are  more  than  willing  to   Public  School  175  were  running  out  and  I   re-
     come and talk  with  us  because  we  not  only  took   quested  some   from   Public   School   100.   Along
     an interest in the patient,  but  also  in  the  rest                                 ed   the    opportunity
     of the family -and in the conditions in whi             with the referrals we -acquir          the    school.
                                                        ch   to train 10 "parent assistants" from
     they  live.  We  figure  that  we  are  showing   the   These  community  mothers  were   in   training   for
     parents  that  we  too  are   concerned   about   the   6  weeks  in  various  aspects  of   education,   and
     welfare  of  their  children  and  also  -about   the   - two of us met with them  for  3  weeks  to  explain
     conditions   in   which   they   are   living.   This   the  departments  and  procedures   of   health   fa-
     makes  the  parents  feel  that  the  health  organi-   cilities,  and  to  give  them  experience  in  field
     zation has  a  strong  concern  for  the  welfare  of
                                                             work  on  referrals.  We  used  Public   School   100
     their  child,  and  for  the  people  living  in  the   referrals and  covered  nearly  all  of  them.  Feed-
     community.   Speaking   with   these   people   about   back  from  the  parent  assistants  and  the  school
     their  children's  health,  and  the  rest   of   the   administration    was    favorable.-C.W.,     Medical
     family, gets the  feeling  of  fright  out  of  their   Student, Harlem.
     system  because  they  feel  that  they  are  talking.
     to  community  people,  being  us,  who   are   faced            I started  the  project  thinking  that  all
     with   the   same   problems.-L.J.,    NYC,    Brook-   my  job  would  entail  would   be   getting   people
     lyn.                                                    started  and  somewhat   oriented   to   Harlem   and
       I  don't  think  there  was  that  much  resistance   the goals of our project.  After  that,  I  hoped  to
                                                             be  able  to  get  into  some  projects  of  my   own
     from  the  doctors  to  the  idea  of  physici-an-as-   and  simply  be  around  to  give   suggestions   and
     sistants, because when it got started the.       @oc-   help  other  people  by  being  a  resource.  It  has
     tors'   main   complaint   was-that   the   question-
     naire didn't have this  in  it,  or  it  didn't  have   turned  out  that  there  was  a  lot  more  supervi-
     that, and  they  wanted  more  on  it,  which  was  a   sion involved and  I  had  to  dream  up  things  for
     good sign. * *                                          people  to  do  simply  to  keep  them  from  sitting
                      *  The  St.  Mary's  group  has  had   around the office doing  -nothing.  I  needn't  bela-
     one  person  working  fora  month  or  so,  and  just
     recently  they've  got   another   person   that   we   bor this but I  have  found  it  the  biggest  disap-
     hired,  and  they're  scheduled  to  have  two   more   pointment  in  the   project   for   me   personally.
     People  hired  by  the  time  we  leave  in   Septem-   The  reason  I  mention  this  is  that  the   Public
     ber.   Thus,   four   community   people   will    be   School 100 part of  our  project  is  an  example  of
     working  in  St.   Mary,s   after   we   leave.-W.S.,   the  way  I  hoped  things  could   work;   the   two
     Student Coordinator, Brooklyn.                          guys who went  over  to  Public  School  100  to  see
                                                             about  referrals  found  out   about   the   training
       I  saw  the  SHP  workers  in  Harlem   this   sum-   program   there    for    community    mothers    and
     mer  as  a  liaison  between  the  community   people   then  worked  out   an   arrangement   whereby   they
     and   Harlem   Hospital   and   the   various   other   could be  useful  as  advisors.  This  had  the  dou-
     agencies  involved.  We   served   to   help   people   ble  advantage  of  supporting  an   already   exist-
     take the  best  advantage  of  services  rendered  by   ing  program  and  working  in  a   roleas   advisor,
     the  Harlem  Hospital  clinics,  other  clinics,  and   not  an  organizer  of  a  new  project.  There   are
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                                                      GREATER         NEW  YORK
                  enough  projects  going  in   Harlem,   already;   we   this  themselves.  It  is  going  to  be   year-round,
                  don't  need  to  go  organize  any  more,  especially   and  they're  going  to  try  and  get  funded.  There
                  ten-week ones.-  (Incidentally,  lots  of  people  in   seems to be a consensus  that  this  is  the  kind  of
                  Harlem have  told  us  this,  too)  At  any  rate,  I   thing  that  SHP's  should   focus   on,   but   there
                  think  these  two  workers  did   exactly   what   we   can   only   be   so   many   health   councils.-D.T.,
                  should be doing and the  point  is  that  they  found   Student Coordinator, Newark.
                  the job on their own initiative  in  the  process  of    When  we  first   arrived   -at   Martland   Hospital
                  working   on   referr-als.-R.C.,   Student    Coordi-
                  nato.r, Harlem.                                         in  Newark,  either  the  staff  was  unaware  of  our
                                                                          function  or  they  pretended  to   be.   During   the
                  Another  means   of   attacking   the   problems   of   first weeks, we  were  given  a  lot  of  "busy  work"
                  health  care  delivery,  however,  may  not   involve   to  keep  us  out  of  the  way.  During  this   time,
                  working  in  poverty  areas   but   rather   in   the   however,  we  compiled  a  list  of   criticisms   and
                  upper  levels  of  American  society.  Perhaps   edu-   recommendations   which    we    offered    to    help
                  cation  of  middleclass  America   is   more   impor-   carry  out.  Eventually,  this  list   was   presented
                  tant than  working  in  poverty  areas  in  the  long   to  the  hospital  administrators,   who   did   noth-
                  run.  This  task  is   much   harder   to   undertake   ing.  After  repeated  attempts  to  get   some   sort
                  and, -as of yet, the  mechanisms  of  such  an  oper-   of action,  followed  by  repeated  failures,  we  re-
                  ation are out of  sight.  The  task  is  to  get  the   sorted to  other  means  in  the  form  of  trying  to
                  unconcerned,     unknowing,      and      uncommitted   develop  a  community  health  council.   This   coun-
                  people  concerned  with  the   problems   the   coun-   cil, if it becomes functional,  will  be  the  biggest
                  try faces.  This,  perhaps,  is  what  SHP's  in  the   achievement  of   the   summer   because   it   should
                  future  should  direct   their   energies   to.-W.S.,   make  the  hospital   receptive   and   sensitive   to
                  Student Coordinator, Brooklyn.                          the  requests  of  the   black   community.   We,   as
                         COMMUNITY ORGANIZING                             health  science  students,  can   meet   with   admin-
                                                                          istrators  for  the  next  ten  years  and  get  abso-
                  Newark                                                  lutely  nothing  accomplished,   because   they   feel
                   It's so difficult to  have  any  kind  of  political   that we'll only be  there  for  a  certain  length  of
                  gathering   in   a   community   such   as    Newark.   time and then they'll  be  rid  of  us.  However,  the
                  The  Leroi'Jones  approach  is  probably   going   to   hospital  will  be  forced  to  listen  to   organized
                  be the  most  productive,  because  it  is  going  to   community   people   because   they    aren't    going
                  let these  people  speak  for  themselves.  Just  or-   anywhere   and   mean    business.    This    council,
                  g,anizing and bringing a  group  in  to  sit  in  the   composed   of   community   and   professional    peo-
                  hospital  is  not  going  to   work   the   way   you   ple, will be  able  to  make  demands  of  the  hospi-
                  might  want  it  to.  Ultimately,  though,  I   think   tal   with   no   excuses   accepted.-A.C.,    Nursing
                  it's the best  thing,  because   when   you   surround  Student, Newark.
                  an administrator with five  or  six  big  black  cats      I  believe  that  if  the  community  health  coun-
                  and  seare  him  personally  to  death,   then   have   cil fails,  one  of  the  proposed  major  accomplish-
                  some  little  guy   come   in   and   mediate,   talk   ments  of  this  summer  fails.  It   must   be   said
                  calmly  to  him-   and   make   him   see   that   he
                                  p                                       that  the  grass  roots  in   the   Newark   community
                  doesn't  have  to  be  afraid,  then  something  will
                                                                          took -no  interest  whatsoever  in  our  efforts,  and
                  be done that both  sides  will  like.  The  basic  ob   perhaps  such  a  council  must  evolve   some   other
                  jectives of  the  administration  of  all  hospitals,   way.  I  honestly   feel   that   community   involve-
                  really,  is  to  serve  the  community:   they   just   ment  in  the   medical   school   development   could
                  want to do it their own way. ,
                    We   got   a   group   of   people   together   and   help  create  the  type   of   environment   for   in-
                  they're  working  on  a  community   health   council   struction  and  health  care   delivery   that   would
                  on their own. It is going  to  be  black  and  Puerto   be  in  the  forefront  of   medical   accomplishments
                  Rican; they're going  to  try  to  advocate,  to  let   -P.D., Medical Student, Newark.
                  people  know  what  is  available.  They  decided  on      Our  most  important   project   is   to   organize

                  70


                                                      SUMMER           1968
        the  community,  and  to   get   them   to   work   for           tapping   them   for   personnel,   for    exam-
        themselves  and  realize  that  they   can   do   some-           ple.
        thing if they're organized.                                  (2)  My   personal   relations    with    LABOR    do
          We  tried  to  do  this  in  the  beginning.  We  ar-           have  strains  in  them.   Mostly   I   try   to
        ranged  to  have   a   meeting   with   the   community           work   them   out   by   clearing   with    them
        and  sent  the  health  science  students   around   to           what  I  want  to   do,   and   talking   things
        different  churches.  I  think  about  three  or   four           over  as  much   as   possible.   It's   amazing
        students  were  interested   enough   to   go;   three-           how  effective  just  talking  is   in   working
        quarters  of  them  didn't  even   bother;   this   as-           things out.
        signment  wasn't  important   enough   for   them.   it      (3)  I've  made   some   bad   mistakes,   especially
        would  be  naive   to   suppose   that   white   people           missing  followups,   but   luckily   the   real
        can organize a black community.                                   strength  is  in  the  tenants.  The  most   im-
                                                                          portant  thing  I  can  do  is  keep  an  effec-
          There's  much  to  be  said  for  focusing   on   one           tive  relationship  going   between   the   ten-
        objective. It  makes  a  lot  of  sense,  but  the  im-           ants,   LABOR,   and   the   rent-strike    law-
        portant thing is  that  it's  not  a  silly  objective,           yer.  But  if  I  try  to  make   it   mV   rent
        that it's an objective which is  -at  the  basis  of  a           strike,  and  judge  success  and   failure   in
        council   made    up    of    community    people.    I           those  terms,   then   inevitably   I'm   manip-
        couldn't  see  focusing   the   manpower   on   getting           ulating   the   tenants   and   inevitably   I'm
        everybody  to   health   examinations:   they   get   a           doomed  to  failure  since  they're   the   only
        health  examination,  so  what;  they  still  live   in
                                                                          ones  who  can  pull   it   off.-K.B.,   Medical
        those  shitty  houses;  so  now   they   know   they're           Student, Bronx.
        sick  they  still  don't  have  enough  health  clinics
        to  take  care  of  them  and  when  they  do   go   to   Brooklyn
        the     clinics    they     get     treated       badly      One  of  the  major  goals   of   this   summer   was
        anyway.         *-R.P.,        Community        Worker,   to  help  get  a   narcotics   center   established   in
        Newark.                                                   Brooklyn.  Since  it  is   too   amorphous   to   expect
        Bronx                                                     that   mass    community    meetings    would    somehow
                                                                  end  in  an  actual  center,  we  worked  with   a   few
           I  have  begun  to   help   the   tenants   of   one   interested   community    people    who    were    moti-
        building  with  a  rent  strike;  I  happened   to   be   vated  toward   action   and   interested   in   getting
        the only one in  the  office  when  a  tenant  came  in   results.  After   these   people   formed   a   concrete
        and   asked   for   help.   LABOR    is    understaffed   plan  and  structure   for   their   narcotics   center,
        and  gave  me  pretty  much   a   free   hand   to   do   the  community  was  asked   if   it   wanted   such   a
        what  I  thought  best.  I  have   reservations   about   center by circulating a petition.
        my  role  for  several  reasons:.  (1)  Should  I,   as      Initially  we   had   hoped   to   get   people   'in
        an  outsider,  be  organizing?   (2)   Will   my   han-   Brooklyn   mad   about   the   problem   of   drug   ad-
        dling  this  rent  strike  puta  strain  on  my   rela-   diction,  to   get   massive   community   concern   and
        tions   with   LABOR?   (3)   Can   I   actually   cope   action.  We  soon  learned  that  it  is  next  to   im-
        with the problem.?                                        possible to get community people to a mee
           I've worked out some partial answers:                  or to get  them  active.  This  is  not  too  surprising
              (1)  No,  I  shouldn't  be  organizing.   Luckily   when  you   realize   that   most   people   work,   are
                the   tenants   organized    themselves    very   struggling   to   feed   and   support   their   family,
                quickly,  and  I  can  carry  out  their   spe-   are  asked   to   attend   scores   of   meetings   that
                cific    wishes-write    letters    for    them   neveraccomplish anything.
                with  their  demands  to  the   landlord,   get      *  *  *  How  is  any  progress   made   within   the
                a  lawyer  to  answer  their   questions,   get   community?   Usually   there   are   a    few    commun-
                a  survey  of  the   building   done.   And   I   ity  leaders  who  are  motivated  and  are   very   ef-
                have   a    worthwhile    goal    in    helping   fective.  It  is  these  people   who   make   most   of
                LABOR   be   a   good   resource   for    them,   the    positive     changes.     Unfortunately,     what

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                                                  GREATER        NEW  YORK
             some   people   call   the   "community"-the   person      To  prepare  the  group   for   participation   in
             who  works,  comes  home  and  doesn't   give   a   -      the mothers clinic,  a  bibliography  of  required
             -is  not  going  to  accomplish  anything.  The   few      reading  was  prepared   and   group   discussions
             community  people  who   are   effective   must   re-      were held, in order to  help  the  students  iden-
             present  the  whole  community;   they   can't   know      tify their feeling  about  unmarried  mothers  and
             what   every   person   in   the   community   wants,      their associated problems.
             but  they  are  the  only  people  who   are   taking      In  addition,  group  participants   located   and
             the  responsibility  and  must  make  the  decisions.      visited some of  the  various  agencies,  such  as
             -E.B., Medical Student, Brooklyn.                          adoption   centers,   shelters    for    unmarried
                                                                        mothers, etc., in order  to  find  out  how  these
                 STUDENT HEALTH ORGANIZATION                            services may be utilized in  procuring  assistance
                         SERVICE PROJECTS                               for our anticipated clients.
             Bronx                                                      The  group  was  aware   that   even   though   as
                 The original   purpose   of   the   South   Bronx      many as one in  three  pregnancies  in  the  South
             project  unwed  mothers   clinic   was   to   provide      Bronx area is  out-of-wedlock,  obtaining  clients
             quality comprehensive   professional   services    to      for our clinic would be a difficult task. In order
             young  unmarried   mothers   in   the   South   Bronx      to  reach  these  people,  we  sought   assistance
             Bathgate  Avenue  area.  This  goal  was  to  be  ae-      from  the  various  community  organizations   and
             complished   through   individual   counseling   ses-      neighborhood  groups.  Key  persons  in   prenatal
             sions,  group   and   family   counseling   sessions,      clinics  and  public  health  agencies  were  con-
             classes  in   mother   and   baby   care,   grooming,      t-acted. As a result, we were permitted to  inter-
             personal  hygiene,   family   planning   and   family      view patients during clinic  visits  to  encourage
             living.  Home  visits  where  indicated  were  to  be      their participation in the mothers clinic.
             an integral  art.                                          One  of  the  big  problems  was  that   community
                         p
                 Our  objectives  for  the  Mothers  Clinic  were:      groups did  not  offer  much  encouragement  since
                 (1)   To   improve   prenatal   care   of   young      they felt that there  were  far  too  many  tempo-
                     mothers;                                           rary -agencies in  their  community  already.  Be-
                 (2)'To  promote   quality   health   of   mothers      cause of this attitude, a file of at least 80 candi-
                     and their children;                                dates  for  the  mothers'  clinic,  which  we  had
                 (3) To  reduce  fear   of   the   birth   process      been  told  was  available,   became   unavailable
                     through education;                                 due to "confidentiality."
                 (4) To  help  pregnant  teenagers  gain  an   un-      Flyers were  distributed,  signs  posted,  letters
                     derstanding of themselves-,                        written, telephone calls  made,  schools  visited,
                 (5) To facilitate the  appropriate  use  of  com-      and door-to-door canvassing  was  carried  out  as
                     munity resources;                                  additional, efforts  for  procurement  of  clients
                 (6) To  help   bring   about   community   aware-      for the mothers clinic. (Even so,  project  direc-
                     ness of  the  needs  of  pregnant  teenagers;      tors said that this was  not  enough.)  These  ef-
                 (7) To assist  in  the  rehabilitation  of  preg-      forts  yielded  a  very  few  young  mothers   who
                     nant teenagers;                                    may  benefit  from  the  quality  counseling   and
                 (8) To  provide  an  accredited  continued   edu-      teaching availableat the mothers clinic.
                     cation  program   for   pregnant   teenagers.      As  a  result,  we  became  involved  in   housing
                 Those persons  involved  in  the  mothers  clinic      and welfare problems.  Because  of  this  involve-
                 consisted of three student nurses  who  had  com-      ment, we became  acutely  aware  of  the  critical
                 pleted a course in the nursing  care  of  mothers      'need  for  educational  facilities  for  pregnant
                 and children,  and  a  physical  therapy  student      teenagers, especially in  the  South  Bronx  area.
                 who was to serveas a  translator  since  many  of      We learned.  from  the  people  of  the  community
                 our clients were expected  to  be  Spanish-speak-      that  pregnant  teenagers   are   dismissed   from
                 ing. My job was purported  to  be  faculty  advi-      school as soon as the  school  officials  discover
                 sor to this group of students.                         that they are  pregnant.  Secondly,  if  they  are

                 72


                                                  SUMMER  1968

       able to return to school  following  the  birth  of   established so that these efforts  may  be  contin-
       the baby,  they  are  rarely  permitted  to  return   ued.  Persons  from  various   cooperating   health
       to  the  same  school.  Thus,  a  minimum   of   18   agencies  and   community   participants   comprise
       months may be lost prior  to  the  continuation  of   the committee.
       their education.                                         The  storefront   office   has   remained   open
          This  problem  seemed  to  take   priority   and   through  funds  made  available  by  one   of   the
       the  group  then  set  out  to.  discover  how   we   participating  committee  groups.  What  shall  ul-
       could possibly help  the  community  to  meet  this   timately become  of  this  project  remains  to  be
       need.  We  were  aware  that  there  was   a   very   seen, but, thanks  to  our  interested  cooperating
       small  educational  facility  for  pregnant   teen-   groups, the mothers' clinic  has  acquired  a  most
       agers in the  South  Bronx.  Key  persons  in  this   vital aspect, time.
       program, as well  as  the  few  other  programs  of      I  feel  that  this  project  could  have   made
       this sort  in  New  York,  were  contacted.  Visits   greater strides had the group's  request  for  cov-
       were  made  to  each  of  theseagencies.  Our  pur-   erage  by  the  newspapers   been   supported.   We
       poses   for   these   meetings    were    manifold,   were  made  to  feel  that  this  could  be  accom-
       though  mainly  we  hoped  to  obtain  some   help-   plished  simply  by  a  telephone  call,  but   for
       ful information  about  setting  up  such  an  edu-   some reason this call was not made either.
       cation-al facility.                                      Based  on  my  observations  and   participation
          The  group  was  informed  that  the  best   way   in  this  summer's  SHP,  I  do  not  feel  that  I
       to proceed was to locate a  suitable  facility  and   could in  good  conscience  encourage  future  par-
       obtain   a   commitment   for   medical   services.   ticipation by  student  nurses  in  this  project.-
       These  tasks  were  accomplished.  We   were   then   F.L.M., Program Advisor, Bronx.
       faced with  two  additional  problems:  first,  the
       formal  writing  of  a  grant  proposal,  and  sec-      Some  of  our  project  members   were   working
       ondly, finding a sponsoring agency.                   on  a  clinic  which  was  supposedly   for   unwed
          Recognizing  that  these  were   problems   that   mothers.  Because  they  could  find  no   patients
       we  could  not  handle  alone,  the  group   sought   and  had  trouble  finding  a  place  in  which  to
       help  from  those  persons  who  were  supposed  to   hold  classes,  they  expanded  their  program   to
       be -able to help us.  Yes,  there  is  someone  who   any  mother  desiring  birth  control  information,
       can help you with  the  writing  of  a  grant  pro-   and  any  pregnant  woman,  married  or  not,  liv-
       posal;  where  are  they?  Surely,  you   can   get   ing with her husband or not.
       money  from  the  children's  bureau;  how,   under      It  was  my  understanding  at  the  orientation
       what    circumstances?    This    suggestion    was   that we were to work with  existing  facilities  in
       made just as one might tell a  child  that  he  can   the  community,  offering  constructive   criticism
       shake all of  the  money  that  he  may  need  for.   where  necessary.  This   would   hopefully   bring
       candy  from  his  piggy   bank.   Yes,   there   is   medical  inadequacies  to  the  attention  of   the
       money  available  from   the   children's   bureau,   powers-th-at-be  and  changes   would   be   imple-
       but not the way it was suggested to us.               mented  accordingly.  Should   a   community   need
          We  were  also  told  that  a  mere  phone  call   exist  which  was  not  being   met,   an   attempt
       was all that was needed  to  gain  the  cooperation'  would be made to create  an  agency  to  meet  said
       of the  Board  of  Education  in  our  pursuit  for   need.
       educational  facilities  for  pregnant   teenagers.      With this in mind, I could see  no  purpose  for
       Isn't it interesting that the whole          summer   the formation of  this  clinic.  One  of  my  advo-
       passed and this phone call was never made?            cacy  patients,  while   at   the   Fulton   Street
          Despite the  lack  of  cooperation  by  SHP  ad-   Health  Station,  mentioned  that  she  would  like
       visory personnel, the group persisted  in  its  ef-   to -  obtain  birth  control  pills.  The  prenatal
       fort  to  setup  this  much-needed  program.  As  a   clinic at the health station  gave  me  a  referral
       result,  a  Committeee  on  Education   for   Preg-   slip for the new family  planning  clinic  in'  the
       n-ant  Teenagers  in  the  South  Bronx  area   was   area  which  had  just  opened  the  month  before,

                                                                                                            7


                                                  SUMMER  1968
        the research  and  illustration  end  of  the  book,    Our   Community   Coordinator    was    not    sur-
        which  will   be   distributed   through   Martla-nd   prised and advised  us  again  to  direct  ouratten-
        Hospital   and   our    newly    formed    Community   tion to  parents'  groups.  With  the  help  of  the
        Health   Council.-K.O.,   Nursing    Student,    Ne-   supervisor  for  the  district  of  the  Head  Start
        wark.                                                  programs, we did  organize  a  series  of  presenta-
                                                               tions for the mothers  of  the  young  children  in-
        Brooklyn                                               volved  in  the  Head   Start   programs.   We   had
          I  think  we  did  meet  favorable  reaction.   Of   one  meeting  with  about  ten  mothers,   most   of
        course, a  lot  of  what  we  were  doing  was  ser-   whom  were  Puerto  Rican,  who  were   the   family
        vice-oriented, like in the  hospitals.  *  *  *  The   representatives for  the  different  public  schools
        people  felt  someone  was  taking  an  interest  in   that  were  having  Head   Start   programs.   Their
        them,  because  someone   was   sitting   down   and   response  to  the  idea  of  available   information
        talking  to  them  for  15  minutes,  while  usually   about  family  planning  and   sex   education   was
        they would be sitting there  and  waiting  for  half   very enthusiastic. Some  of  them  also  felt  thata
        an hour, 2 hours,  whatever,  ignored.  This  was  a   program  directed  at  their  children  was  a  very
        positive sign. A lot  of  these  people  invited  us   good  thing.  They  did  admit  that  the   subjects
        to  their  homes  to  inspect  housing   violations,   were  ones  that  Puerto  Rican  parents   did   not
        and on some  we  got  results,  so  there  again  we   discuss with  their  children;  however,  they  felt
        met with favor. I don't think we  tried  to  do  too   that  their  children  should  be  aware  of   these
        much  in  which  we  might  have  failed  and   thus   things  so  that  they  would  not  face  the   same
        angered   people.   We   weren't   promising    much   problems  that  their  parents  had  to   face.   In
        that we couldn't deliver.                              other   words,   these   mothers   were   expressing
          In  Brooklyn  we  had   a   group   working   with   the  desire  for  more  information   concerning   a
        Youth-In-Action.  At  first,   we   had   hoped   to   very  important  aspect  of  health  care  that  was
        work  on    family   counseling,   birth    control,   at  present  impossible  for  them  to  give   their
        homework  study  (which  is  like   a   Head   Start   children  and  which  the  public  health  care  in-
        program),  etc.,  but   it   degenerated   just   to   stitutions did not provide.
        homework   study  and  we  had  three  people   act-     When  we  gave   these   presentations   to   par-
        ing as  teachers  or  tutors.  I  personally  didn't   ents'  groups,  we  felt  that   the   people   were
        feel that  this  was  the  best  way  for  a  health   really not terribly  interested;  yet  we  were  in-
        student  to  spend  his  summer.  But  they  thought   vited  back  to  give  more  information.  The  fact
        they  were  doing  something   that's   their   bag.   was  that  the  women  were  very   interested   but
        You  can't  tell   them   it's   not-W.S.,   Student   they  were  inhibited  about  discussing  such   ma-
        Coordinator, Brooklyn.                                 terial in front of  strangers.  We  were  told  that
        Lower East Side                                        after  we  had  left  they  had  a  very  open  talk
                                                               about a subject that had  'not  been  discussed  be-
          From the very      beginning     our     Community   fore.  We  had  acted  as  'a  catalyst  for   these
        Coordinator  objected  to  the  sex  education  pro-   mothers.
        gram  on  the  basis  that  a  Puerto   Rican   com-
                                                                 Another  idea  that  we  tried  to  work  on   was
        munity would  not  accept  it,  especially  for  the
        younger  people.  We  were  advised  that  it  might   an    educational     program     for      community
        be possible to  work  out  a  program  for  mothers,   workers  from  local  action  groups.  Some  of  the
        but  thata  program  aimed  at  the   younger   peo-   groups  were  polite  and  refused   openly,   while
        ple was doomed to  failure.  At  first  we  did  not   others said  that  they  were  interested  and  then
        heed  the  advice  and  we  attempted   to   educate   the  women  didn't  show  up  for   the   appo   nt-
        the  two  Puerto   Rican   girls   (NYC's)   working   ments  with  us  or  they  claimed  that  they  were
        with us.  We  tried  to  have  them  partially  take   too  busy  that  day.  We  wanted  to  leave   some-
        over  some  presentations   to   other   groups   of   thing  of  more  permanent  value.  We   wanted   to
        @Neighborhood    Youth    Corps;    however,    they   give the  women  the  tools  to  help  other  women,
        were not able to do so.                                but the groups we visited rejected the idea.

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                                                  GREATER       NEW  YORK
              and  arrangements  were  made  for  Mrs.   M.   to   pertaining  to  local  health  care  delivery;  (3)
              visit it. I found  the  faciliti@  at  the  Fulton   making  referrals  where  indicated;  (4)   provid-
              Street  Health  Station  adequate  and  the  staff   ing information on existing  local  health  facili-
              cooperative, and they encouraged us  to  bring  in   ties; (5)  establishing  a  working  file  on  each
              any problems  we  encountered  in  the  course  of   family for  subsequent  use  by  medical  students.
              our work.                                              * * * Results: Of 60  children  enrolled  in  the
                In -all fairness to the community, I do not  see   Head  Start  program,  56  children  were  seen  at
              the point of setting up a  clinic  which  probably   Fordham,  and  four  children  were  seen  by  pri-
              will  not  endure  past  the  summer.  There   was   vate  doctors.  Twenty-one  children  had  physical
              trouble getting the rent approved for  the  build-   examinations   and   accompanying   test    results
              ing, and  since  most  of  the  workers  are  stu-   that  were  entirely  within  normal  limits.   The
              dents, I wonder at  the  likelihood  of  its  sur-   following   abnormalities   were   diagnosed    and
              vival,                                               acted  upon:   three   underweights;   two   upper-
                What I am trying ta say  here  is  that  I  feel   sites;   two   functional   heart   murmurs;    two
              the SHP clinic is  duplicating  existing  agencies   minor  umbilical  hernias;  one  inguinal   hernia;
              with no assurances  that  it  will  survive  after   one  kidney  infection;  one   urinary   infection;
              the summer. Therefore,  I  feel  a  personal  lack   one  vaginal  infection;  one  sickle-cell   trait;
              of support for it in terms of the interest of  the   three subelinical a nemias;   eight    eosinophilia
              community.-C.B., Nursing Student, Bronx.             results;  12  albuminuria  results;   one   ectopic
                                                                   eczema;  one  asthma;  two  positive   Tine   tests
              The  following  description  of  the   Bronx   SHP   (X-rays negative).
              Head Start health program  was  used  as  part  of     The results of  the  questionnaires  (40  returns
              a grant proposal  for  the  continuation  of  this   out of 56) have not yet been  analyzed  in  detail,
              program:                                             but  quick  sampling  indicated  clearly  a   deep-
                During  the  summer,   the   Bronx   SHP   oper-   seated dissatisfaction  with  existing  health  fa-
              ated, in  cooperation  with  St.  Joseph's  Summer   cilities, and  a  willingness  to  organize  around
              Head  Start  program  and  Fordham   Hospital,   a   the  issues  of  Fordham  Hospital  and  a   neigh-
              complete  physical  exam  and  screening   program   borhood  health  clinic.-J.G.,   Medical   Student,
              for sixty children, ages four to  six.  Under  the   Bronx.
              leadership of a medical student, one  dental  stu-
              dent,  two   nursing   students,   two   community   Newark
              workers,   and   three   NYC's   implemented   the     *  *  *  My  other  activities  at  Martland  in-
              following:  (a)   English-Spanish   letters   were   cluded  drawing   pictures   for   the   pediatrics
              sent to all  Head  Start  parents  explaining  the   emergency  room,   and   helping   to   alphabetize
              program  at  Fordham  Hospital,  with   a   choice   the files for the medical and surgical clinic
              .of  participating  either  through   Fordham   or   also observed the  functioning  of  several  o  er'
              private  doctors.  (b)  From  July  23  to  August   hospitals and city clinics to  see  how  Martland's
              16, five children per day were  taken  with  their   could  be  improved.  As  you  can  see,  most   of
              parents  to  Fordham  Hospital.  At  the  hospital   these  tasks  were  just  little  service  projects
              they  were  registered,  given  complete  physical   that  did  not  change  too  many  lives  or   make
              exams, urinalyses,  blood  tests,  and  Tine  T.B.   any   radical   improvements   in   health    care.
              tests.  Health  students  and  community   workers   These   experiences   were   rewarding   but    not
              were responsible for seeing to it  that  followups   really satisfying. This  does  not  spell  failure,
              were  made  for  any  abnormal  findings  in   the   but I suggest th-at  SHO  must  make  a  more  con-
              tests. During the  week  of  August  19  to  August  crete stand on what its place and  service  to  the
              23, home visits to all Head  Start  families  were   community should and will be.
              made for five purposes:  (1)  Explaining  the  re-     I think that the  most  positive  and  beneficial
              sults of the examinations and  tests;  (2)  admin-   thing that I did this  summer  was  to  work  on  a
              i@ri-ng  a  two-page  questionnaire  containing  a   health  rights  handbook   which   we   will   soon
              family health survey and  a  survey  on  attitudes   have  published  and  distributed.  I   worked   on

              74


                                                  GREATER       NEW  YORK
                We  are  going  to  try  to  continue  with  this   winter isn't possible.  (The  above  from  an  un-
                program in the fall though  I  am  not  sure  ex-   dated by  weekly  report;  the  following  from  a
                actly what we will do. We  certainly  could  con-   Final Report.)'
                tinue to provide the limited  service  of  giving    When our job  began  this  summer,  I  felt  that
                presentations to various parents' groups  in  the   there would  be  a  tremendous  amount  of  direc-
                schools. We  also  may  try  to  work  with  some   tion needed on my part in order to  find  out  ex-
                younger   people    through    local    community   actly what contribution I could make.
                groups.  I  am  more  interested,   however,   in    I feel that  if  more  work  had  been  done  be-
                working  out  some  way  of  involving  community   forehand  to  decide   exactly   where   we   were
                women  in  providing  the  education.  One   idea
                                                                    -needed,  our  projects  might  have   been   more
                that we have is to look into the  possibility  of   fruitful. We didn't  realize  that  the  community
                creating jobs  for  women  through  the  services   in general was not  ready  to  accept  information
                in Bellevue  Hospital.  These  women  could  work   about  sex  education  and  contraception.   There
                in the hospital and in  the  Community  providing   are   no   community    organizations    presently
                much  needed  information  about   family   plan-   involved  in  sex  education,  and  any  organiza-
                ning  and  sex   education.-P-S-,   Medcal   Stv'   tions  that  were  approached  to  see   if   they
                lent, Lower East Side.                              would be interested  in  having  us  hold  discus-
                In order to educate ourselves  in  the  field  of   sions were polite  to  us,  but  inevitably,  when
                birth control, sex education, and  venereal  dis-   the time came for the talk  or  discussion,  dates
                ease,  we  visited  a  number  of'  organizations   were cancelled or  groups  didn't  show  up@r,  if
                such   as   Planned   Parenthood,   SEICUS    and   they did, they politely listened to  what  we  had
                various drug  companies.  Most  people  tried  to   to  say  but  showed  no  enthusiasm  in   joining
                be helpful and encouraging but  those  of  actual   into discussions with us.
                value to us were  the  workers  at  planned  par-    I feel that we  did  make  one  positive  contri-
                enthood who put us in touch with  the  only  per-   bution by arranging for  discussions  to  be  held
                son on  the  Lower  East  Side  who  is  actually   and a film  to  be  shown  throughout  the  public
                working  directly  with  the  community  teaching   schools.
                birth  control.  This  convinced  us  that  since     One of the  most  helpful  people  on  the  pro-
                there is not an excess of  people  on  the  Lower   ject, I found, was our  community  coordinator.  I
                East  Side  dispensing  such   information,   our   felt that if we  had  heeded  her  warnings  about
                services were definitely needed.                    the  subject  with  which  we  were  dealing,   we
                 We  decided  that  our  best  approach  was   to   wouldn't have run into  as  many  difficulties  as
                read as much as possible  on  our  own  and  hold   we  did  this   summer.-S.R.,   Medical   Student,
                discussions among ourselves  so  as  to  acquaint   Lower East Side.
                the  NYC's  with  human  anatomy,  the   mech-an-
                ics of reproduction, etc. We found that  even  if   Harlem
                the girls we are  working  with  are  not  poised     The basic  structure  of  our  project  revolved
                and confident enough to give  lectures  and  hold   around  the  school  health  referrals.   We   in-
                discussions  on  their  own  during  the  winter,   tended to work  at  two  schools,  Public  Schools
                they are still interested  and  willing  to  work   175  and  133  in  Harlem  and  then  branch   out
                along with US.                                      from there to  more  referrals  at  Harlem  Hospi-
                 We  have  had   several   speaking   engagements   tal.  This  was  viable  in  the  case  of  Public
                and have felt that these  have  been  successful,   School 175 only because  we  had  previously  done
                depending on our ability to sense  the  needs  of   a health study there  and  already  had  over  250
                the group we were talking with.                     referrals to work on.  At  Public  School  133  we
                 On the whole, I  feel  a  sense  of  accomplish-   got virtually  no  co-operation  from  the  school
                ment so far, and  see  the  rest  of  the  summer   health people-, mostly  because  the  director  of
                spent  in  increasing  community   'contact   and   school health for the city  of  New  York  refused
                trying to see  if  continuing  work  through  the   to release any but  a  few  nonessential  referral

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                                                SUMMER  1968
     cases. She  claimed  that  we  had  enough  to  work    patient. The student learned  about  the  different
     on from our previous summer.                            agencies  that  the  poor   must   confront.   This
      Other   institutions   we    worked    with    were    practical  knowledge,  which  enables  the   health
     equally  frustrating;  the  Department   of   Health    professional to  give  comprehensive  care,  cannot
     at all but the highest levels is staffed  by  defen-    be  learned  any  way  other  than  by  direct  ex-
     sive,   uncooperative   people   who   seemed   more    perience.  Most  medical  and  nursing  schools  do
     intent  on  giving  us  the  runaround  or  refusing    not provide these  experiences  in  their  curricu-
     to  give  information  than  anything  else.   Other    lum. The  patient  was  able  to  confront  bureau-
     groups   we   worked   with   rather    successfully    cratic institutions, whereas  before  he  had  been
     were    Ministerial    Interfaith        Association    confused and discouraged.
     (M.I.A.),   a   very   cooperative   private   group     My  feelings  toward  the  benefits   of   patient
     health  facility,  Harlem   Teams   For   Self-Help,    advocacy  after  last  summer  and  at  the  begin-
     which arranged  for  a  job  in  the  Harlem  HosPi-    ning of  this  summer  were  very  favorable.  Now,
     tal  playroom  for  outpatients'  children,   Harlem    at the conclusion  of  my  second  summer,  I  have
     Consumer    Education    Board,    a    member    of    quite different feelings. At this point, I  am  not
     which  came  to  a  lunch  meeting  at  our   office    sure where either  party  benefits.  To  substanti-
     which  was  very  interesting,  Public  School  100,    ate this feeling  I  will  present  incidents  from
     where  we  helped  in   a   training   program   for    my experiences with three families.
     school    assistants,    Knickerbocker     Hospital,     My first example is Rebecca, a 64-year-ol
     where  we  tried  to  organize  a   health   council    'Negro  lady.  My  first  introduction  to  Rebecca
     around   a   proposed   community   health   clinic,    was  through  a  -dental  student  working  on  the
     and  the  Puerto  Rican   Guidance   Center,   where    project.  Rebecca's  toothless  smile  had   caught
     we  helped   with   research   on   the   Washington    his attention.  After  a  brief  conversation  with
     Heights   community'mental   health    center    and    her, the dental student  discovered  that  she  had
     ran  an   education   program   for   a   group   of    not seen a doctor in several years. With  this  in-
     N.Y.C's. In  general,  our  relationship  with  cOm-    formation, in addition to  the  fact  that  Rebecca
     munity   organizations   was   successful   and   we    is elderly and quite heavy, it  seemed  very  prob-
     tried to put ourselves at their disposal.               ably  that  she   might   have   medical   problems
       We  provided  specific  referral  help  for  about    warranting  treatment.  He   suggested   that   she
     150 of the Public  School  175  cases  from  a  year    be taken for a checkup. I decided  that  since  she
     ago.  We  also  worked   on   about   25   referrals    did  not  have  Medicaid  or  financial  means   to
     from  two  clinics  at  Harlem  Hospital,  and   an-    pay for  treatment,  our  only  recourse  was  Mor-
     other 25 from  Public  School  100.  We  got  a  nu-    risania  Hospital.  Not  knowing   which   of   the
     cleus of six persons interested  in  the  pediatrics    clinics to go to first, we went  to  the  screening
     clinic  at   Knickerbocker   Hospital   and   worked    clinic.   From   there   went   to   the    medical
     on several ceases  from  the  department  of  social    clinic twice, the eye clinic twice.  Also,  Rebecca
     services there.  Other  assorted  services  included    had  blood  work  done  twice,  an  X-ray,  and  an
     providing  black  childrens'  books   for   doctors'    E.K.G. The results  up  to  this  time  reveal  hy-
     offices  and  clinics.-R.C.,  Student   Coordinator,    pertension,  diabetes,  degeneration  of  the   re-
     Harlem.-                                                tina,  a  positive   V.D.R.L.,   and   longstanding
                                                             leftsided heart disease.
                PATIENT ADVOCACY                               At  first  glance,  and  without  much   thought,
       Last  summer  the  concept  of  patient   advocacy    an initial reaction to the discoveries is  that  it
     evolved. The student  fellow  functioned  as  a  li-
     aison between the  patient  and  the  health  facil-    was  a  good  thing  that  Rebecca  went   to   the
     ity.   As   our   awareness   of   health   problems    clinic. After studying  the  situation,  I  am  not
     broadened, our  concept  of  the  role  of  the  pa-    sure  this  is  so.   Rebecca   does   not   follow
     tient  advocate  grew  to  include   dealings   with    through  with  her  edical  treatment;   she   can-
     many   institutions.   We   saw   patient   advocacy    not remember to take  her  pills  even  after  con-
     as valuable for both  the  student  fellow  and  the    stant reminders; she  refuses  to  90  on  a  diet.

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                                                   GREATER        NEW  YORK
               There  are  several  other  reasons  why   I   think    mistake  because  she  will  have  to   assume   the
               patient  advocacy  for  Rebecca  may  have  been   a    responsibility herself when I am gone.
               mistake. First of -all, there  is  a  problem  about    There  is   still   another   form   of   dependency
               getting to the clinic: Rebecca  does  not  seem  ca-    that  Rebecca  has  developed  in  the  clinic  set-
               pable of taking two buses to get to  the  clinic;  I    ting. She feels that she  will  be  taken  care  of,
               have  always  accompanied  her  so  I  do  not   ae-    so pays no attention to  the  proceedings  and  sits
               tu.ally  know  how  well   she   would   manage   on    back  and  takes  cat  naps.  I  tried  to  overcome
               her  own.  I  have  always  gone  with  Rebecca  be-    this  by  always   telling   her   where   we   were
               cause at first it  was  necessary  for  me  to  make    going  and  what  was  going  to  take   place.   On
               sure that  she  found  her  way  too  the  different    our last  visit  I  deliberately  left  her  at  the
               clinics, -and that she had all the tests  that  were    pharmacy to  fill  her  prescription.  All  she  had
               medically indicated; later  it  was  necessary  that    to  do  was  wait  for  her  number  to  flash,  and
               I go with her to follow up on  the  results.  I  had    then  walk  up  to  the  desk  and  hand  the  phar-
               thought  of  the  possibilities  of  an  NYC  taking    macist  her  prescription.  When  I  returned,   she
               my place, but decided against  this  because  I  did    was sitting in -a chair staring off into  space  and
               not  have  accessibility  to  the  NYC's  and   also    her  number  had  gone  by.  My  attempt   at   mak-
               my  medical  knowledge  was   needed.   (For   exam-    ing her participate had  failed.  Also,  the  clinic
               ple, I was able  to  cl-arify  questions  concerning
                                                                       environment  is  not   conducive   towards   promot-
               Rebeeca's  high  blood  pressure  and  poor   vision    ing independence  in  people  like  Rebecca.  It  is
               which  an  NYC  probably   would   not   have   been    geared for expediency,  and  slow  people  like  Re-
               able  to  do.)  My  going  with  Rebecca  to   every    becca just bog  the  system  down,  so  it  is  much
               Clinic  appointment  did  not  enable  her  to   de-    easier for the staff to  direct  all  comments  con-
               velop her -ability to be  independent'                  cerning Rebecca's  care  to  me,  which  just  rein-
                This  case  points  up  a  crucial  factor  of  pa-    forces her dependency on me.
               tient  advocacy,  which  is  time.  It  took  me  45     Is  medical  care  without  followup  better   than
               minutes  to  come  to  the  Bronx  from   Manhattan,    no  medical  care   at   all?   Would   this   woman
               which means that if  we  planned  to  go  by  bus  I    have  been  just  as  happy  having  never  seen   a
               had to leave my  apartment  at  6:45  a.m.  to  pick    doctor?  Looking  back,  I   feel   that   Rebeeca's
               Rebecca  up  for  a  9:00   a.m.   appointment.   By    real  priority   need   was   attention.   She   was
               the  time  we  finished  in  the   afternoon   some-    lonely, and by going to the clinic with  her  I  in-
               times it was 2 o'clock.                                 creased  her   personal   interactions.   Would   it
                The  logical  solution  to  this  predicament   was    have been better for her if  I  had  spent  my  time
               to find  someone  who  can  assist  Rebecca  to  the    just  visiting  her  and  fulfilling  her  need  for
               clinic.  She  is  living  with   her   granddaughter    companionship  rather   than   dragging   her   from
               who  seems  to  be  the  likely  person  to   assume    one clinic to the jaext? Even if  I  acted  only  as
               this responsibility, but  they  do  not  get  along.    a companion, there  would  still  have  been  a  de-
               The  granddaughter  has  tried  repeatedly  in   the    pendency   on   my   company.   Maybe    the    best
               past to get  her  grandmother  to  go  to  the  doc-    thing  for  Rebecca  would   have   been   to   have
               tot; she very clearly told me  that  she  had  tried    found her a frien .
               and  was  fed  up  with  Rebecca,  and  that  if   I     Gladys  is  an  18-year-old  girl  who  has  a   3-
               wanted to take her to  the  clinic  that  was  fine.    year-old son, and  is  expecting  another  child  at
                 Rebecca  was  also   economically   dependent   on    any time. At  the  time  I  met  her,  she  had  not
               my  services.  She  does  not  have  the   resources    followe  up  with  her  prenatal   care.   She   saw
               for  cab  fare  as  she  only   receives   a   small    doctor once  early  in  pregnancy,  but  after  mov-
               amount  from  Social  Security.  I.  started  paying    ing  had  not   gone   back.   I'made   arrangements
               the cab fares because the first  time  she  told  me    for Gladys to  register  at  Morrisania  clinic  and
               she had no money to  get  there.  I  -paid  for  all    accompanied  her,  there.  But  after  straightening
               transportation   since,   which   was   probably   a    things out for  her  at  the  clinic,  I  no  longer

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                                                SUMMER  1968
       went  with  her  for  her  appointments.  She   man-    with  Mildred  was  my  role  as   patient   advocate
       aged fine by herself.                                   and  my  limitations.  Just  as  in  Gladys'  case  I
       Gladys'    dependency    needs    became    apparent    had  decided  that  my  role  was  not   a   shopping
       through  our  dealings  with  the  welfare   depart-    assistant or a real  estate  agent,  with  Mildred  I
       ment.  The   rapport   between   Gladys'   familyand    decided I was not a social worker.
       the  investigator  was  very  poor;  the  investiga-    Mildred  is   a   14-year-old   pregnant   girl   who
       tor  was  extremely  nasty,  making   all   dealings    ran  away  from  home  8  months  ago  and   is   now
       with  welfare  difficult  for  the   family.   Being    living with  a  29-year-old  man.  She  is  5  months
       aware  of  this  poor  relationship,  I  went   with    pregnant and  came  to  us  to  find  out  where  she
       Gladys  to  welfare  to  help  her  obtain  a  check    could  receive  prenatal  care.   We   decided   that
       for a layette.  Because  of  my  presence,  the  in-    because  of  her  age   and   social   problems   the
       vestigator  gave  Gladys  the   check   immediately.    prenatal  clinic   at   Morrisania   health   station
       But what  will  happen  after  I  leave?  The  rela-    would be the  best  for  her.  We.  also  have  co-n-
       tionship  between  Gladys   and   the   investigator    tacts  with  the  Social  Service   department   from
       will still be poor.  With  Gladys  I  had  more  re-    which  we  can  be  sure  that   she   will   receive
       sources  available  to  me,  so  hopefully  my  ser-    good followup care.
       vices will not just  act  as  a  temporary  bandage.    At  the  clinic  during  the   interview   with   the
       Welfare   Rights   works   with   people   to   help    social  worker,   several   problems   became   imme-
       them  deal  with   the   welfare   department,   and    diately  obvious.  The  man  she  was   living   with
       hopefully this group  will  take  over  my  role  as                                           t.o   the   psy-
                                                               had been admitted the night before
       an advocate. Also  I  referred  Gladys  to  the  So-    chiatric ward of Bellevue Hospital.    Also,  he   is
       cial  Service  department  which  will  follow   her    married. His  being  in  the  hospital  left  Mildred
       case.                                                   in a  desperate  situation;  he  did  not  leave  any
        The  most  important  point  I   have   made   con-    provisions  or   money,   and   Mildred   has   none.
       cerning  patient   advocacy   in   relationship   to    Her  mother  is  on  welfare  and  receives  anallot-
       both  Gladys  and  Rebecca  is  that  the   individ-    ment for  Mildred,  but  Mildred  has  not  seen  her
       ual's resources must  be  utilized  to  the  fullest    mother  for   8   months.   Considering   that   both
       extent. To be able to develop  the  patient's  inde-    the girl and her mother are  in  the  Bronx,  it  ap-
       pendence a critical analysis  of  the  situation  is    pears that the  mother  hasn't  tried  very  hard  to
       needed,  and  with  that  information  the   patient    find her  daughter.  Mildred  did  not  express  con-
       advocate  should  carefully  define  his  role.  For    cern about her situation. I  asked  her  if  she  had
       example,  I  decided  that  my  role   with   Gladys    food to eat  in  the  apartment,,and  she  said  that
       was to see that  she  received  good  medical  care,    she  had  two  porkehops,  a  pound   of   hamburger,
       but  what  was  not  my  function,  I  decided,  was    and  some  cabbage.  When  I  asked  her   what   she
       shopping -with her  for  baby  clothes  and  looking    was going to do when  the  food  ran  out,  she  gig-
       for  an  apartment.  I   carefully   reviewed   with    gled, rolled  her  eyes  at  the  ceiling,  and  said
       Gladys what  she  needed  for  the  baby,  but  told    that she  didn't  know.  She  made  these  same  res-
       her that  she  was  perfectly  capable  of  shopping    ponses  to  other  questions  concerning   her   wel-
       without  me.  She  would  have  liked  me  to   help    fare.  From  her  behavior  she  appears  to   be   a
       her with the  shopping,  but  this  was  not  neces-    very   immature   14-year-old.   The   problem   that
       sary  and  there  would  be  no  one  to  help   her    the  social  worker  and  I  faced  was  what   imme-
       shop in the future.  The  same  was  true  of  find-    diate  arrangements  would  be  made  for  the  girl.
       ing her  an  apartment.  I  am  sure  that  with  my    Being  a  minor,  she  could  not  go  to   her   boy
       higher  level  of  motivation  I  would  have   been    friend's   apartment   because   she    would    have
       able to  make  greater  progress  than  Gladys,  but    been  picked  up  by   the   police.   (Mildred   had
       this  would  not  have  helped  Gladys   to   become    written  her  mother  a   letter   which'her   mother
       an independent adult.                                   had just received, and  she  had  -notified  the  po-
         The  last  patient  I  would  like  to  diseu.ss  is  lice.) It was  too  late  in  the  day  to  make  ar-
       Mildred.  The  important  concept  in  my   dealings    r-angements  with   welfare   concerning   a   foster
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                                                       SUMMER  1968
              home or a maternity shelter,  so  the  only  solu-   the advocate should  use  his  skills  to  help  the
              tion  appeared  to  be  to  take  Mildred  to  her   patient become as independent as possible.
              mother's  apartment.  The  social   worker   asked     Also, a critical an-alysis of the purpose  of  pa-
              if I would take  her  there  myself,  but  I  said   tient advocacy is  needed,  and  a  decision  should
              that  r  would  like  someone  to  come  with  me.   be made as  to  whether  it  should  be  a  part  of
              Looking back, this was a  wise  decision;  what  I   the SHP services.  If  the  decision  is  made  that
              was to encounter  in  the  home  would  have  been   patient  advocacy  is  valuable,   then   how   much
              a lot for me to cope  with.  When  we  arrived  we   time should be spent  in  this  area.  In  my  opin-
              were met by  a  very  upset  mother  who  did  not   ion, patient advocacy is  a  stop-gap  service.  The
              speak  English.  The  confrontation  between   the   real  problem  lies  with  the  system  that  causes
              mother -and the daughter  was  very  tense.  After   the need for  an  advocate.  I  would  like  to  see
              the initial confrontation, we had difficulty  get-   SHP's  energy   directed   at   the   institutions.-
              ting  any  other  direct   communication   between   V.V., Nursing Student, Bronx.
              the  mother  and  daughter.  Mildred   said   that     Aside   from   supervising   a   restricted   play
              she had only come  to  see  her  mother  and  that   area with  the  help  of  four  NYC'S,  the  remain-
              she was not going to stay,  and  the  mother  cer-   der of my time was  spent  taking  patients  to  the
              tainly did not want her to stay. The  mother  fin-   nearby    Fulton    Avenue    (Morrisania)    Health
              ally  accepted  the  fact  that  Mildred  was  her   Center,   and   disseminating   information    about
              responsibility,  whether  she  remained  at   home   the avail-able health services. It was in  this  re-
              or not. Mildred also accepted the  fact  that  she   gard that I felt  most  qualified  to  work  in  the
              could not return to her  boy  friend's  apartment,   community.
              -and decided to stay. After both  parties  finally     I  was  involved  with  two  families  I  had  met
              made a decision, the social  worker  and  I  left.   while   discussing   housing   problems.   One   21-
              The  social  worker  returned  the  next   morning   year-old  mother  of  three   was   desperately   in
              to make more permanent arrangements.                 need of medical  help  and  will  require  the  sup-
               This  whole  incident  made  me  very  aware   of   port  of  the  advocate  program   in   the   coming
              my limitations.  Not  being  a  social  worker,  I   months.   This   woman   had   neglected   her   own
              had  not  come  across  such  complicated   situa-   health and did not expect to  get  relief  from  her
              tions  that  demanded   immediate   decisions.   I   chest  pains  and  dizzy  spells  by  going  to  any
              might have, in  a  moment  of  confusion  and  in-   city clinic. At first, I was  more  optimistic,  but
              decision, decided  to  take  the  girl  home  with   soon  became  frustrated  upon  finding  how  diffi-
              me.  This  obviously  would  not  have  been   the   cult it is to get  good  care  even  when  one  know
              way  to  have  handled  the  situation.  (I  think   how   to   maneuver   through   the   administrative
              that  patient  advocates  should   always   remem-   labyrinth.  This  woman  has   now   been   to   the
              ber  that  in  situations  where   a:   dependable   medicine,  opthalmology,   and   neurology   clinics
              agency  is  involved,  we   should   have   enough   without  getting  a  satisfactory   history   taken.
                                                                   The  fragmention  of  her   condition   into   unre-
              common  sense  to  let  the  agency   handle   the
              problem.)  I  know  of  situations  where  patient    ,,ted problems, as seen by  each  clinic  physician
                                                                   and generally  a  new  face  each  time  she  visits
              advocates  have  gotten  themselves  into  a  bind
              because they have tried  to  make  decisions  they   each  clinic,  works  against  any  hope  that   she
                                                                   might have of getting  better.  Despite  her  diffi-
              did  not  have  the  background  or  knowledge  to   culty in  getting  a  diagnosis  and  therapy,  how-
              make, or the resources to carry through.             ever,  there  have  been  positive  aspect  to   her
                To summarize, I believe  that  the  patient  ad-   trips  to  Fulton  Avenue:  she  is  more  aware  of
              vocate needs  to  thoroughly  analyze  situations,   her own  needs  and  realizes  that  her  children's
              and before  making  any  decision  he  should  as-   welfare  depends  on  her  health;  the  Fulton  Av-
              sess his capabilities. Included in his analysis  a   enue clinic  staff  knows  herand  are  more  atten-
              realistic   appraisal   of   manpower   and   time   tive  because  of  my  intervention;  she  has  been
              should  be  considered.  With  this   information,   given  medication  for  insomnia  and  a   prescrip-

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                                                     SUMMER  1968
          tion   for   eye   glasses   which   she   knew   were   in.g  clinics   with   patients.   These   teenagers,
          needed.                                                  however,  were  assigned  to  LABOR   by   the   city
          .Because  of  this  one  experience  I   feel   patient  and  were   given   housing   assignments   most   of
          advocacy  is  a  meaningful   experience,   both   for   the  time.  They  would  have  done  well  as   advo-
          the  recipient  and  for  the  health  student.  There   cates  and  certainly   expressed   enthusiasm   over
          are  objections  to   the   present   modus   operandi   the prospect of  such  a  job  in  the  future.-R.F.,
          which   should,   however,   be   raised.   Successful   Medical Student, Bronx.
          advocacy  often   depends   upon   the   student   as-   Patientadvocacy  over   a   short   term   has   out-
          serting himself  on  the  -patient's  behalf  and  de-   lived its usefulness  as  a  concept.  True  advocacy
          manding  services   which   might   not   be   contin-   implies  a   continuing   personal/professional   re-
          ued  after  the  student  returns  to  school.   Some-   lationship,   which   students   (especially    those
          one  must  be  available   to   see   these   families   from  out-of-town)  are  not  able  to  build  during
          after the  students  leave.  One  may  -ask  if  advo-   a  2-month  period.  The  central  hypocrisy  of  pa-
          cacy  works  only  because  the   student   represents   tient  advocacy  is   revealed   by   the   conscious
          the  system.  It  would  be   much   more   beneficial   avoidance  by  students  of   further   responsibili-
          to   the   community   if   students   were    working   ties for their patients  at  the  precise  time  when
          with   community    people    who    would    continue   they  are  promising  these   same   patients   guid-
          the  advocacy  work  in   their   neighborhood   after   ance  on   referrals,   and   encouraging   militancy
          the  students  leave.  There  is  no  question  in  my   with  respect  to  hospital  malpractices.   Further-
          mind  that  the  student  -advocate  gains  a  special   more,  without   careful   preparation,   the   pres-
          perspective  by  seeing  health  problems  in  a   so-   ence   of   health   science   students   in   overly
          cial  setting  which  places  little  value  on   good   crowded   urban   health   clinics    usually    only
          health;  but  the  student   would   gain   additional   serves  to  reinforce  health   care   fragmentation.
          perspective   by   working   with   community   people    Advocacy  has  served  the  useful  role   of   edu-
          and  thereby   give   more   responsibility   to   the   -ating a  critical  number  of  health  science  stu-
          community  itself.   Being   realistic,   however,   I   dents about the  injustices  and  kinks  in  hospital
          realize   that   such   a   program   would    require   and private medical care. Now  it  is  time  to  dis-
          year-round  supervision.  If  our   efforts   are   to   card  this  tool  and  develop  one  with  a   better
          have  further  significance,  we   must   provide   an   cutting edge.-J.G., Medical Student, Br&=.
          ongoing   program    geared    to    involving    More
          than  just  the  student  as   advocate.   Perhaps   a    The hospital and welfare             will  still  be
          training   program   could   be    arranged    through   the  same  after  SHP  has  gone.  They  will   still
          agencies    such    as    the    NMCD    (Neighborhood   give bad  service  to  the  people.  The  only  thing
          Medical    Care    Demonstration),    which    depends   we did was  geta  little  better  service  by  saying
          for  its  success  in  large  measure   upon   commun-   who  we  were.  Now  the  people  don't  have  us  to
          ity health workers.                                      speak for  them  any  more.  All  I've  seen  SHP  do
           The   needs   for   more   organized   pressure    on   is get involved in people's  lives  and  then  leave.
          the  health-care  delivery  system  and   the   orien-   -M.H., C&mmunity Worker, Br&nx.
          tation  of   LABOR   offices   to   housing   problems     After spending a    week  earlier  in  the  project
          both  lead  me  to  argue  in  favor  of  having  stu-   distributing   information   on   the   Lower    East
          dents  work  out  of  the  clinics   and   maintaining   Side about the new sliding scale  for  fees  at  city
          contact  with  LABOR  only  as  a  means   of   relat-   hospitals,  I  was  again  faced  with  the   problem
          ing  health  issues   to   LABOR's   ongoing   activi-   of a person  who  fails  to  seek  medical  help  be-
          ties.  The  dichotomy  of  roles  was   definitely   a   cause  he  has  no  money.  Our  group  spent  a  day
          hindrance,  in  my  opinion,   as   concentration   on   knocking on  doors  to  find  out  what  medical  fa-
          housing   problems   did   not   allow   enough   time   cilities  were  used  by  the   community.   When   I
          for learning about different health facilities.          knocked  at  Mrs.  V's  door  she  first  refused  to
            I  found  it  most  worthwhile  to  take   some   of   speak  with  me  because   she   was   cleaning   her
          the  Youth  Corps  workers   with   me   when   visit-   apartment   and   her   small    grandchild    needed
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                                                                         YORK
                                                  GREATER       NEW
             care. I assured her I  just  wanted  to  ask  a  few   hadn't   knocked   on   her   door.-J.M.,    Nursing
             questions  and  she  agreed  to  speak  with  me.  I   Student,Bronx.
             discovered  that  Mrs.  V,  who  had   ceased   men-
                                                                     One  of  the  things  which  disturbed  me   deeply
             struating  for  several  years,   was   once   again   was  that  many  of  the   people   who   complained
             bleeding, but felt  that  she  couldn't  go  to  the   about bad experience in the  hospital  took  it  all
             hospital  because  she  couldn't  pay   the   eleven   very  passively  instead  of  fighting  for   better
             dollars  the  hospital  always  charged.  I   became   care.  I  found  two  women  who  were  told  to  go
             very  concerned  when  I  beard   of   her   problem   home  from  hospitals  because  they  spoke  no  En-
             and urged her to  see  a  physician.  I  offered  to
             escort her  to  the  hospital  along  with  my  com-   glish. I find it  alarming,  of  course,  that  this
             panion,   a    Spanish-speaking    NYC    who    ex-   should  have  happened,   but   what   was   equally
             pressed a wish to care for  her  little  grandchild.   larming  was  that  they  left.  These  people  must
             I called Bellevue to  find  out  the  hours  of  the   De taught to stand up and  fight  for  their  health
             gynecology  clinic;  I  was  told  to   come   early   rights; no one is going to give it  to  them  and  I
             that the  clinic  was  open  until  noon.  That  was   don't  believe  anyone   should.   If   SHP   really
             all I was told.                                        wants   to   be   effective,   educating   community
                                                                    workers  to  educate  the  people   will   be   much
               We arrived    at  10:10  a.m.  the  next  day  and   more  worthwhile  in  the  long  run  than  all  the
             were told by the  clerk  at  the  information  booth   patient  advocacy  in   the   world.-J.W.,   Nursing
             that  we  would  have  to  come  another   day   be-   Student,Bronx.
             cause  registration  ended  at  10:00,a.m.   Feeling
             exceedingly  foolish  and  responsible  for   bring-     Throughout   the    summer    we    visited    the
             ing Mrs. V. to the hospital, I went  to  the  clinic   homes  of  families  we   met   at   the   pediatric
             to  speak  with  the  head  nurse.   She   told   of   clinic or in  the  community,  and  very  often  be-
             the necessity of the  registration  period  so  that   came  personally  involved  with  the  family   -and
             sufficient time was allowed  to  send  for  the  pa-   were  always  welcome  in  their   homes.   In   the
             tient's  chart.  This  was  reasonable.   She   also   case of Mrs. B. and her one  and  a  half  year  old
             said, however, that the  doctors  (three  were  sit-   daughter,  who  had  suspected  milk  and  egg   al-
             ting  in  the  room   where   we   were,   obviously   lergy and asthma,  we  were  with  her  at  all  pe-
             amused by  my  appeals  to  the  nurse)  were  leav-   diatric  appointments,  assisted  her  in  obtaining
             ing soon. Why,  I  asked,  were  the  doctors  leav-   additional  welfare   allowance   for   her   daugh-
             ing if it was  only  10:10  a.m.,  when  the  clinic   terps special diet, and visited her  at  home  on  a
             hours were until  12  noon,  and  there  were  still   number of occasions.
             patients  to  be  seen?  Surely  there  was   enough     Although  such  successful   advocacy   was   lim-
             time to send to  the  record  room  for  the  chart,   ited to a small number  of  families,  it  neverthe-
             and  besides,  Mrs.  V's   proble'm   seemed    rather less provided  us  with  better  insight  into  com-
             immediate. I  was  told  that  "rules  are  rules,p'   munity life and 'gave us  the  opportunity  to  con-
             and the head nurse asked me  to  leave  her  ofFice.   tribute concrete  services  to  individuals  in  the
             One  of  the  doctors  followed  me  out  and   sug-   community.
             gested I take  Mrs.  V  to  the  emergency  room  as     I feel that  patient  advocacy  work  could  be  a
             long as we were at  the  hospital.  As'a  result  of   rewarding   experience    for    medical    students
             her  visit  to  the  emergency  room  on  that  day,   during  their  first  year  of  medical   education.
             Mrs. V  entered  Bellevue  the  next  week  to  have   Providing   an   early   exposure   to    physician-
             a hystereet(nny.                                                                    t  advocacy  would  af-
                                                                    patient relationship, patien
                Our   group   has   discussed   extensively   the   ford  the  student  the  opportunity  to  view   the
             value of  patient  advocacy.  What  is  accomplished   side of a patient that  is  often  overlooked,  that
             qualitatively  by   helping   a   few   individuals?   of  his  home  and  community  life.  Too  often,  a
             What  happens  to  the  thousands   of   others?   I   patient is thought of just as he is  in  the  hospi-
             don't   know   the   answers   but   I   do   wonder   tal setting, and the knowledge  of  his  life  as  a
             what  would  have  happened  to   Mrs.   V   if.   I   functioning  individual  is  I-acking.  The  student

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                                                    SUMMER  1968

        health  organizations   in   the   various   medical   I  tried  to  impress  upon  her  the  importance  of
        schools  should  try  to  have  some  form  of   pa-   her  medication  and  follow-up  care,  but  my   in-
        tient  advocacy  incorporated  into   the   curricu-   structions  fell  upon  deaf   ears.-M.J.,   Nurst'ng
        lum for the first year or first  2  years  of  medi-   Student, Bronx.
        cal  study.-E.C.,  Medical   Student,   Lower   East
        Side.                                                     A  Mrs.  J.  had  called  our  office  in  Newark,
                                                               having  heard  a  radio  announcement  telling   lis-
          I  found  the  emergency  room  to   be   a   good   teners  to  contact  us  if  they  had   any   health
        place for patient  advocacy  work,  for  the  people   problems  or  complaints.  In  handling  the  case  I
        were  a  captive  audience  while  they  waited  for   learned  that  Mrs.  J.'s  -niece,  a   22   year-old
        treatment or as  I  dressed  their  wounds.  I  told   mother  of  two,  was  suffering   from   cancer   of
        them  of  our   SHP   office,   of   our   Community   the  cervix.  Mrs.  J.  was  making  a  valiant   at-
        Health   Council,   and   of   the   Family   Health   tempt  to  comfort  her  niece  at  home,  but   B.'s
        Clinic  (just  opened  by  New  Jersey  College   of   pain was constant  and  her  cries  kept  the  house-
        Medicine  and  Dentistry   students)   which   prov-   hold  awake  night  and   day.   B.   needed   prompt
        ides health  care  for  entire  families,  including   medical  attention.  Conversations  with  our  facul-
        physical  examinations  for  all  every  6   months,   ty  advisor  at  Newark  City   Hospital   and   with
        and  medical  treatment  when   necessary,   in   @n   B.'s doctors finally  resulted  in  her  readmittance
        attempt  to  give  more  personal  health  care   To   to the hospital.
        families who can't afford a private doctor.        I
        was able to  refer  quite  a  few  people  who  came     While  B.  remained  in  the  hospital,  I  visited
        into  the  emergency  room  to  places  where   they   her  daily.  We  became  friends  and  I  became  fa-
        could   get   help   with    their    problems.-K.O.   miliar  with  the  workings  of  City  Hospital,  its
        Nursing Student, Newark.                               facilities  and  staff.  Although  the   wards   were
                                                               crowded   and   impersonal   and    equipment    out-
          How  much  responsibility  can   or   should   SHP   moded,  more  striking  was  the   deplorable   atti-
        workers  have  in  order  to  get  health  care  for   tudes  held  by  several  of  the  attending   physi-
        their  clients?   A   community   worker   took   it   cians and nurses. In  a  short  time  after  I  began
        upon herself to take a young  boy  with  a  leg  in-   to visit B., the  @ff  began  to  accept  me  as  one
        jury  to  a  private  physician,  since  his  mother   of  them-perhaps  because  I  was  a   medical   stu-
        believes in herbs  and  roots  and  is  quite  igno-   dent-  and  they  soon  "opened  up."  I  heard  sto-
        rant of health matters.  A  few  days  later  I  saw   ries of the poor care and  abuse  they  gave  to  the
        this  same  young  boy  playing  with  his  friends;   patients.  I  could  feel  an  attitude  of  "second-
        his leg was starting  to  swell  again  and  he  did   class  citizenship"  permeate  the   welfare   wards.
        not have  a  dressing  on  as  the  doctor  had  or-   It is not uncommon for  a  patient's  cries  for  at-
        dered.  When  I  -questioned  him  about  this,   he   tention  to  be  answered  with   "shut   up   woman,
        told me that his  mother  always  hits  him  on  his   you're lucky to be getting  as  much  as  you  are,ty
        infected knee when she getsangry.                      or,  "for  somebody  who's  not   even   paying   you
          Another  time,  I  had  occasion   to   take   his   sure  do  expect  a  lot."   More   commonly,   their
        mother to Bronx-Lebanon Hospital. She            had   pleas went unanswered.
        had breakthrough vaginal bleeding for           21/2     In  B.'s  case,  that  of  terminal   cancer,   the
        years with the  passing  of  clots.  She  was  exam-   nurses  were  particularly  hard   on   her   because
        ined  by  a  gynecologist  who  gave   her   medica-   of  her  low  tolerance  for  pain;   her   incessant
        tion to stop the  bleeding  and  told  her  to  come   groans and  cries  kept  the  staff  and  fellow  pa-
        back in  three  weeks  for  a  more  complete  exam-   tients  on  edge.  Her  attending  physician  had  no
        ination.  The  next  day  I  saw  this  same   woman   idea  of  B.'s  background   or   personality,   and'
        on the street. She told me that she  was  tired  of'   neither did  she  care.  Practically  at  the  moment
        taking her  medication  because  it  made  her  sick   of  readmission,  B's  doctor  had  said   that   she
        and caused pain  (she  had  only  taken  one  pill).   would keep B.  in  the  hospital  only  if  we  would

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                                                 GREATER       NEW YORK
               in the meantime make arrangements to put her        STUDENT HEALTH PROJECT ROLE
               in -a nursing home.                                   IN AGENCIES AND HOSPITALS
               Now  to   B.'s   nursing   home   problem.   City   Newark
               Hospital's social service  department  sends  its   Our   situation   in   Newark   is   quite   unique
               requests to the local  community  welfare  office   from all of the other  areas  in  what  changes  we
               for placement of  patients  who  need  posthospi-   realistically expect to  effect  this  summer,  for
               tal care in nursing  homes.  The  placement  pro-   the tide is changing its direction  here,  and  all
               cedure does not begin until the  doctor  actually   things portend  a  new  guard  for  this  city.  We
               discharges the patient, so there is often a  long   have tried to identify  with  infusion  of  renewed
               delay between discharge  and  placement.  In  the   life,  the  momentary  depressions  from  lack   of
               interim, the doctor is unaware of the cause o!      instantaneous dissolvement of malingering
               the  delay  and  therefore  cannot  understanding   evils  are  but.  split-second   flickering   trips
               why "these -patients  stick  -around  the  hospi-   through  disillusioned  reality.  However,  on  the
               tal  wasting  valuable  space-just  a  bunch   of   -whole, a sense of project is developed  and  func-
               good-for-nothing  freeloaders."  City  Hospital's   tional.
               social service department  has  no  idea  of  the   July  1,  1968,  a  new  administration,  the  new,
               quality of nursing care  given  by  the  institu-   New  Jersey,  College  of  Medicine  and  Dentistry
               tions to which the patients are  sent.  Occasion-             I
                                                                   took  over  Martland  Hospital  and   promised   to
               ally a patient will return to City Hcispital with   -'I-
               bed sores, dehydration,  or  malnourishment,  but   enange  much  in  health  care  delivery  both   at
               there is no direct information as  to  what  goes   the hospital and in the city  as  a  whole.  Newark
               on in these nursing homes.                          SHP feels itself in the position  of  helping  push
               When  B.  was  finally  placed,  I  visited   her   the college into doing what it said  it  would  do,
               nursing home and found  it  dirty,  crowded,  and   leading the college into areas  where  it  has  not
               utterly depressing.  Maybe  if  B.'s  doctor  had   yet  gone,  and  developing  dialogues  and  action
               been aware of this she might have been  a  little   experiences   between   the   community   and   the
               more sympathetic with her patient.                  health services.
               As I followed B.'s  progress,  I  kept  in  touch    At the  hospital  we  have  begun  several  direct
               with her aunt. Mrs. J. had given up her  job  for   actions:  (a)  specific  patient  advocacy  in  the
               the last few months in  order  to  care  for  her   emergency  room;  (b)   admistering   a   question-
               niece. Being 61 years old and with a  heart  con-   naire  in  the  emergency  room;  (c)  advocacy  of
               dition, Mrs. J. was physically and  mentally  fa-   the  several  clinics,  especially   the   prenatal
               tigued from the  entire  episode.  She  responded   clinic.
               to the assistance I gave her with pra                 Less direct but more me
                                                       ise   and                               aningful   and    expee
               affection which I was  at  times  embarrassed  to   tation laden actions include:  (a)  Talk  with  key
               receive. In my visits to her home I got  to  know   hospital   personal   about   specific    immediate
               Mrs. J., to see her style of  life,  to  discover   changes  in  procedure-trying  to  be  part  of   a
               some of her attitudes,,and to meet  her  friends.   committee  that  will  actually  write  up   proce-
                Thus, beginning with  the  specifle  problem  of   dures;  (b)  talks  with  key  hospital   personnel
               helping Mrs. J. get medical attention for   ,her    about basic changes  in  stEiff  attitudes  (devel-
               niece, it soon developed into a  complex  network   oped  during   the   city's   administration)   and
               of  exposure  for  me-a]-]  of  which  helped  me   plans  to  develop  program  for   training   staff
               better understand the  health  care  problems  of   about  "where  it's  at",  (c)  actual  development
               Newark.  This  knowledge   was   beneficial   for   of  a  committee  of  hospital,  SHP,  and  commun-
               others who would call us for help,  for  in  han-   ity persons to work on these points.
               dling this one case I had succeeded in  making  a     At the area board we  have  tried  to  develop  a
               lot of useful connections which  would  be  valu-   health  advisory  and  information  service.   How-
               able in helping other clients  of  Newark's  SHP.   ever, as yet there has been  a  dearth  of  persons
               -B.W., Medical Student, Newark.                     wanting  information,  less  than  one   per   day.

               84


                                                   SUMMER  1968
          However,   we   are   developing   the   body    of     NYC'S, and they tried  for  a  while  to  assign  us
          knowledge necessary to help anyone.                     to  useless  jobs,  such  as  removing  carbon   pa-
          A   community   committee   has   been   organized,     pers from  duplicate  copies  of  patient's  charts.
          with  exceptionally  fine,  able,  committed  local     They  wanted  to  keep  us  busy  so   we   wouldn't
          persons in charge.  Their  main  focus  is  on  or-     "spoil   those   useless   community   people"    by
          ganizing persons  to  be  aware  of  what  is  hap-     trying to give good service.
          pening on the local health scene;  what  is  avail-     We  refused   to   do   meaningless   tasks.   After
          able on the local scene, and what they  can  do  to     about a week, we  made  up  a  list  of  suggestions
          generally improve  the  care  given,-to  see  about     for changes  in  the  emergency  room  and  clinics.
          getting  decent  treatment   for   whomever   comes     The  changes  we  suggested   were   not   unrealis-
          to   clinics.-D.T.,   Student   Coordinator,    Ne-     tic;  they  were  not  changes  which  required  ad-
          wa,rk.                                                  ditional  funding;  they  were   simply   reasonable
          I worked primarily in the prenatal clinic               change.   The   hospital   administration    greeted
          Martland  Medical  Center  in  Newark.   My   rela-     us,  smiled  at  us,  promised  us  everything,  but
          tionship with  the  institution  can  best  be  ex-     gave us nothing.
          plained by my relationship with  the  clinic's  su-     It had been  my  experience  in  the  past  that  if
          pervisor. In the  beginning  she  was  very  suspi-     you could  not  obtain  satisfaction  at  one  level
          cious of me and of the  SHP  in  general,  and  she     you  sometimes  could  achieve   what   you   wanted
          sought to control everything I    .did.   When    I     by going to higher authority.  I  went  to  the  ad-
          asked  about  the  hospital  mortality  statistics,     ministrative  assistant  to  the  president  of  the
          she sent me  to  a  doctor  who  abruptly  told  me     college which  runs  the  hospital.  He  found  most
          not to question the nurses in the clinics.              of  our  requests  to  be  reasonable  and   granted
          As  time  went  on,  and   the   supervisor   could     them.   The   hospital   administrators   were   en-
          see  that  I  was  interested  in   improving   the     raged.
          clinic and  willing  to  help  rather  than  merely     Nothing  really  happened  to  any  of   us   as   a
          criticize,  she  became  more  open  with  me.  She     result of this, and I believe it  was  because  they
          would sit down and talk with me about pr                were  not  absolutely  certain  about   the   amount
                                                          o@-     of  community   support   we   had.   Actually,   we
          lems she was having in the clinic; althou       @ll     had  very  little.  People   in   Newark   generally
          we  did  not  always  agree,  we   seemed   to   De     hate  Martland  Hospital,  but   are   not   unified
          able  to  share  our  feelings  with  each   other.     enough to do  anything  about  it.  Lack  of  knowl-
          She took the time to listen.
                                                                  edge  of  the  community   by   the   administration
          She  disliked   patients   coming   to   SHP   with     was  to  our  advantage  this  time;  they   thought
          problems  they  were  having  in  the  clinic.  She
          prides  herself  in  having  a  good   relationship     we had more power than we actually had.
                                                                  I have  come  to  believe  that  it  is  useless  to
          with the  patients  and  wants  them  to  come  di-
          rectly to her with  their  problems.  She  is  also     play with  a  bad  system.  Nothing  short  of  com-
                                                                  plete   overthrow    will    bring    about    major
          against  a  community  organization  to  help  i)a-     I
          tients with  health  problems;  she  seemed  to  be     cna@ges.  The   black   community   must   organize,
          fearful  of  giving  the  community  power  in  the     must seize  control  of  the  city  and  must  bring
          hospital.-L.D., Nursing Student, Newark.                about  radical  change   in   order   to   survive.-
                                                                  K.F., Medical Student, Newark.
          When  I  first  started  working   in   the   emer-
          gency  room  at  Newark  City  Hospital   I   dealt     Briefly,  the  New  Well   is   a   community   drug
          with  patients,  talking  to  them,  calling  their     rehabilitation  and  prevention  center  located  in
          families for them,  helping  them  to  contact  so-     the  heart  of  Newark's  Central  Ward.  It  is   a
          cial  services,  sometimes  acting  as  an   inter-     storefront operation,  open  at  all  hours  to  all
          preter  for  the   Spanish-speaking   people.   The     people, and staffed  voluntarily  by  several  medi-
          hospital   employees   in   the   emergency    room     cal  doctors  and  approximately   10   former   ad-
          didn't   know   who   we   were.   Some   of   them     diets. No  police  supervision  or  intervention  is
          thought'    that    we    were    hospital-employed     present  to  scare  off  those  who  need  and  seek
                                                                                                                     85


                                                            GREATER NEW  YORK

               help.  Addicts  pay  a  $10  registration  fee,  re-      In all that I have done,  I  have  tried  to  make
               ceive  a  physical  examination  and  get   a   pre-   sure that the  help  would  be  of  lasting  benefit.
               scription  for  Methadone,  a   drug   which   helps   -B.W., Medical Student, Newark.
               them   come   off   their   heroin-induced   "highs"      The  attitudinal   study   among   postnatal   pa-
               without  going   through   withdrawal.   This   pro-   tients  was   almost   wholeheartedly   rejected   by
               cedure takes 4 days.  The  addict  is  then  encour-   the   students   in   the   project   as    something
               aged  to  attend   the   triweekly   group   therapy   "mickey  mouse."  I  was  more   interested   in   it
               sessions  during  which  everyone  talks  of   their   because  I  had  helped   formulate   the   question-
               problems  and  encourages  one   another   to   stay
               isclean". I  was  impressed  with  the  program  and   naire  and  realized  it  was  one  of  the   reasons
               the caliber and dedication of the staff.               that  the  dean  had  let  us  enter  the   community
                                                                      with  the  good  blessings  of  the  medical  school.
                 As the New Well's director told        our     SHP   Although  it  did  not  seem  to  be  a  constructive
               group,  addicts  and  Newark  youth   who   may   be
                                                                      thing to  many  of  the  students,  it  was  one  way
               fooling around  with  drugs,  often  listen  to  him   of  getting  close  to  individual  people  from  the
               because  he  is  himself  a  former  addict,  and  a   community  in  a  medical   and   sociological   con-
               member of the black community of Newark.               text with  the  possibility  of  followup.  Actually,
                 A  big  problem  at  the  New  Well  is  lack   of   it proved to be  a  better  means  of  meeting  prob-
               funds.  Since  they  only   began   regular   opera-   lems than did  our  storefront  at  the  area  board.
               tions  in  December  1967,  they  have  not  as  yet   Confined  to  bed,   people   were   more   receptive
               been funded, although  they  are  now  in  the  pro-   and the  questionnaire,  if  given  properly,  covers
               cess of applying  for  a  grant.  In  the  meantime,   a wide range of  problems  and  is  a  beautiful  ef-
               they  must  rely  solely  on  the  $10  registration   fort  at  public  relations  to  show   the   medical
               fee and on scanty  private  donations  to  meet  the   school   cares.-P.D.,   Medical   Student,    Newark.
               rent, repair their facilities, and keep  their  pro-
               gram running.                                          Bronx
                 To help alleviate their financial difficulties,  I     The   members   of   the   community   organization
               organized   a   musical   benefit   whose   proceeds   from  which  we   worked   were   most   anxious   to
               will all go directly to the New  Well.  I  was  able   have   SHP   join   them,   but   unfortunately   had
               to obtain  a  large  hall  located  in  the  Central   not  been  prepared  well  enough   in   advance   on
               Ward,  in  which  to  hold  the  show;  I  got   Tom   what  SHP  could  or  could  not  do  in   the   com-
               McCray's  African  Heritage  Dancers,   Art   Willi-   munity;  not  enough  thought   was   given   as   to
               ans'  Jazz  Trio,   Larry   Young's   Organ   Combo,   the  actual  needs  of  the  community.  Perhaps   if
               and Bill Testa's  band  to  donate  their  time  and   representatives  from  SHP  would   come   into   the
               talent.  In  addition  to  money  coming   in   from   community   in   early   spring   and   explain   SHP
               the  ticket  sales,  I  sent  letters  to  all   the   and   give   the   leaders   of   the   community   a
               churches,  doctors,  and  big  industries   in   Ne-   chance  to  go  back  to  their  people,   then   the
               wark  asking  for  their  contributions   and   sup-   short  time  that  SHP  spends  could  be  spent   in
               port of our musical venture. In  all,  1200  letters   accomplishment     rather     than     frustrations.-
               were  sent  out.  The   response   was   gratifying;   E.F., Cominunity Worker, S&uth Bronx.
               about $40 poured in each day.
                                                                        Working   out   of   the   LABOR   storefront   has
                Not  only  is  the  money  important,  but  so  too   proved  to  be  the  greatest  setback  so  far   'in
               is  the  publicity  which  will  come  to  the   New   terms  of  doing  patient   advocacy.   This   agency
               Well as  a  result  of  newspaper  coverage  of  the   supposedly  has  its  fingertips  on  the  pulse   of
               event and  plugs  for  our  show  on  radio  station   the   community,   but   both    students    assigned
               WNJR.  Many  of   the   doctors   and   other   com-   there  have  found  organization   and   action   al-
               munity  leaders  who  received  our  letter   called   most  totaly  lacldng.  The  reasons  for   this   we
               to  ask  for  more   information   about   the   New   need not elaborate  here;  suffice  it  to  say  that
               Well's  program  and  several  wanted  to  find  out   their  problems  of  inertia  have  held   us   back.
               how they could be of help.                             Out  of  fear  of  usurping  the  staff's  power,   I

               86


                                                    SUMMER  1968

       have  gone  along  with  their   suggestions,   adding   have  been  people   willing   to   help   solve   the
       my  own  whenever   possible,   always   looking   for   problems  of  an  individual  or  of  a  community  in
       any  opportunity   to   get   things   going   without   general,  but  the  problem  could  not   be   defined
       making it  look  as  though  we,  the  outsiders,  are   to   the   satisfaction   of   both   groups.   Having
       actually     directing.-R@F.,     Medical     Student,   heard  so  often,   during   orientation,   that   SHP
       Bronx.                                                   workers must be sure they are working towar
         Because  our  instructions   were   to   work   with   the  betterment  of   the   community   in   an   area
       LABOR  and  because  we  did  not   wish   to   antag-   that   the   community   deems   a    problem,    this
       onize LABOR, we ended up working for th                  summer  has  shown  the  biggest  difficulty   to   be
                                                         !!n'   the definition of a "Problem."
       doing  the  work   they   wanted   rather   than   tne      On  the  Lower  East  Side,  project  leaders  felt
       medically   oriented   service   we   had   envisioned   it would  be  impossible  to  work  in  the  area  un-
       at  the  beginning  of  the  summer.  This   had   the   less  a  liaison  had  been  established  between  the
       advantage  that  LABOR   can   follow   up   what   we   SHP  and   an   established   community   group.   The
       did.  But  it  meant  that  we  did  not  function  in
       the  way  we  were  best   suited;   we   were   doing   problem is that  in  a  relatively  small  area  there
       work  which   people   from   the   community   should   exists  a   large   number   of   community   agencies
       have done. We ourselves learned         great    deal.   which  have  notoriously   vied   for   positions   of
                                             a                  power   rather   than   worked   together.   It    did
       we  served  very   little.-N.A.,   Medical   Stvde-nt,   seem  to  the  project  leaders,  though,   that   one
       Bronx.                                                   organization,   the   Lower   East   Side    Neighbor-
         Health   students   should    consider    themselves   hood  Association,  was  representative  of  the   de-
       working    for    LABOR.    They    should    submerge   sires  of  a  majority  of  the  community.  This  or-
       SHO  independence  as  much  as   possible   and   try   ganization  provided  the   Lower   East   Side   pro-
       to  work  out  within  LABOR  a  suitable   role   for   ject  with  its  community   advisors   as   well   as
       themselves.                                              serving   as   a   base   for    communicating    with
         I think we ran into  a  lot  of  trouble  when  stu-   other  organizations  and  their  activities.  I  felt
       dents   considered   LABOR   a   parallel    organiza-   that they  tried  to  help  as  best  they  could  but
       tion  and  demanded  independence.   As   far   as   I   were  too  involved  in  their  own  ongoing   activi-
       can  see,  LABOR  is  flexible  about  letting  people   ties to be of any great help. This  is  not  a  criti-
       do what  they  want  to  do,  if  good  relations  and   cism,  merely  an   observation,   for   lately   they
       trust are established first. I  think  it's  the  stu-   have been working out the myr        .iad  details   in
       dents'  job  as  outsiders  to  work  hard  to   main-   volved  in  setting  up  the  North   East   Neighbor-
       tain  good  relations  with  the   community   organi-   hood      Association       (NENA)       comprehensive
       zation.                                                  health  service,  scheduled   to   open   in   January
         The alternative  is  rather  paternalistic.  It  in-   1969.  This  activity  is  indeed  invaluable  to  the
       volves,   first,   denying   that   LABOR   represents   community.     SHP's     connection     with     NENA,
       the   community   and,   second,   presupposing   that   however,  was  such  that  we   could   only   request
       students   know   what   the   community   wants    or   assistance  if  they  had  the  time  to  spare.   Un-
       needs.                                                   derstandably,  they  often  didn't.  I  believe   that
         I  have  not   been   impressed   with   suggestions   any   future   SHP   groups   working   in   Manhattan
       that  students   "run   their   own   program   within   must  have  a  close  alliance  with  an   established
       the    community."    Underneath     those     sugges-   group in order to be  at  all  effective.  The  estab-
       tions, I think,  are  a  lot  of  petty  professional-   lished  group  offers   the   greatly   needed   back-
       ism  and  a  belief   that   the   community   doesn't   ground    information,    actual    experience     and
       recognize   its   own   needs.-K.B.,   Medical   St7t-   vital  contacts  without  which  a  small   group   is
       dent, Bronx.                                             lost  trying   to   challenge   the   bureaucracy   of
       Lower East Side                                          New    York's    health     care     facilities.-J.M.,
                                                                Nursing Student Lower East Side.
         Too many  times  this  summer,  as  I  am  sure.  it
       must   have   happened   in   years   before,    there      Our  contact  with  the  Lower  East   Side   com@-

                                                                                                                    87


                                                    GREATER       NEW  YORK

               munity   was   exclusively   through   the    NENA   time,  we  did  not  reach  as  many  as   we   had
               Health  Council,  a  coordinating  committee   for   planned.  We  found   that   there   was   no   way
               grassroots groups in the area. It is not a  grass-   Puerto  Rican  nurses  could  -be  licensed  except
               roots group itself, and is not involved in  organ-   by  taking  the  New   York   State   examination.-
               izational activity. I  feel  that  white  students   K.D., Medical Student, Lower East Side.
               have no business in  such  a  neighborhood  unless      Those of us  interested  in  fighting  narcotics
               they are supportive in the eff-ort of poor  people   addiction decided  to  produce  a  skit  using  NYC
               to  organize  themselves  politically.   NENA   is   residents of the  Lower  East  Side,  speaking  the
               past that stage; they are  now  consolidating  the   slang of their peers and interacting  on  stage  in
               fruits  of  past  organization  and  pressure.   I
               think it was  a  basic  mistake  to  work  through   a manner to which  their  audiences  could  relate.
               them. They served to insulate  us  from  the  com-      We realized that in order  to  be  effective  we
               munity.  The  members  of  the  council,   through   would  have  to  associate  ourselves  with  ex-ad-
               years  of  striving  for  a  neighborhood   health   dicts.  We  began  to  attend  daily  sessions   at
               clinic,  'have  become  very  sophisticated  about   Daytop-SPAN,   and   remained   there   until   the
               health and politics. I think they still  represent   end of the project. This  association  both  helped
               the  communit  but  they  are  not  representative   and hindered us in the fulfillment  of  our  objec-
                             , Y,
               of it.@.M., Law St@nt, Lower East Side.              tives. Because of the  close-knit  group  together-
                                                                    ness  of  Daytop-SPAN,  the  orientation   of   the
                  I worked with four other  health  science  stu-   organization   was   necessarily   different   from
               dents  in  helping  the  North  East  Neighborhood   ours.  This  situation  created  a  certain  amount
               Association'(NENA)    Intergroup    Health    COm-   of  tension,  which  remained   between   the   two
               mittee  develop  and  write  up  a  training  pro-   groups for the  duration  of  the  project.  Daytop
               gram   for    paraprofessional    personnel    who   expected us  to  immerse  ourselves  completely  in
               would work  in  the  health  service;  publicizing   their  therapy   program   while   we   were   only
               the  clinic  in  the  community  and  asking   the   there  to  gather  information,   background,   and
               community  people  for  suggestions  on   how   it   atmosphere for the play, and to  insure  t  at  the
               should  be  run;  and  trying  to  find  ways   in   portrayal maintained  a  certain  amount  of  accu-
               which Puerto Rican nurses  could  be  licensed  by   racy.  Daytop,  however,  subjected   our   private
               the State of New York. * * *                         lives to their scrutiny and jurisdiction,  and  re-
                  I found that the health science  students  were   fused to accept that  we  had  come  only  to  seek
               accepted  completely  by  the   people   at   NENA   advice and not to  seek  "salvation."  Perhaps  the
               who  seemed  very  happy  to   have   us   working   burden of  the  blame  lay  with  us.  We  did  not
               with them. Since the health service     had   just   clarify  our  exact  position  and   functions   to
               been funded, there was a great  deal  of  work  to   Daytop-SPAN  and  thereby  melted  too   far   into
               be done to get it set up and there were  only  two   the organization.
               people  working  on  the  clinic  when  we   first      Once again, this  emphasizes  the  rather  seri-
               came. Thus we worked as a  staff  for  the  devel-   ous lack of a clearcut  identity  on  the  part  of
               opment of the  clinic.  The  project  director  of   the SHP.  Having  formulated  its  specific  objec-
               the  health  service  outlined  what  she  thought   tives,  the  SHP  ought  to  have  established  its
               were the important jobs to be done  and  then  let   autonomy   as   an   organization   vis-a-vis   the
               us  develop  our  own  methods  and  goals;   thus   other  community   organizations   with   whom   it
               we worked mostly on our own.                         worked  or  from  whom  it   sought   advice.   The
                  I think the group was quite successful in  ful-   value of SHP  as  a  link  between  the  establish-
               filling two  of  its  three  objectives.  We  com-   ment's  health  and   social   services   and   the
               pleted the  training  program,  our  top  priority   Lower  East  Side  community  is   too   great   to
               task, and hopefully a grant will  be  obtained  so   allow  SHP's  dissipation   into   simply   another
               that  the  program  may   soon   begin;   and   we   free labor  supply  for  various  neighborhood  or-
               reached  a   good   many   people   and   informed   ganizations.-D.S.,    Medical    Student,     Lower
               them about the clinic, although,  due'to  lack  of   East Side.

               88


                                                SUMMER  1968
        We had a  great  deal  of  trouble  fitting  into   SPAN.  They  are  all  ex-addicts,  who,   through
      SPAN:  we  supposedly  had  a   double   allegiance   their  program  of  self-help,  have  become  in-.
      -to  SHP  and  to  SPAN.  SPAN  is  a  very  struc-   credibly self-aware and  perceptive.  I  found  it
      tured, rigid organization, as  it  has  to  be.  As   easy  to  work  with  them;  more  than  that,   I
      they  say,  "We  are  in  the  business  of  saving   doubt that there could have been a  play,  or  any
      lives; we can't afford to compromise  or  let  our-   meaningful  conception  of  what  we  were  trying
      selves  slip."  Coming  into  SPAN,  we  originally   to do,  without  their  help.-M.H.,  Nursi@g  Stu-
      agreed that we  would  do  everything  that  every-   dent, Lower East Side.
      one else  did,  for  example,  help  clean  up  and   Harlem
      attend all  meetings,  seminars,  and  group  ther-
      apy  sessions.  However,  in  some  ways  we   were     When  I  went  out  on  referrals  in  Harlem  I
      treated with  leniency,  and  for  the  NYC's  this   did not feel that I  was  accomplishing  anything,
      was bad because it decreased their  sense  of  res-   because I  was  not  connected  with  a  community
      ponsibility.  It  also  caused  SPAN  to  be  upset   organization.  Once  associated  with  the  hospi-
      with itself and with us,  because  they  felt  they   tal, however, I felt  that  my  service  was  more
      were not living up to their own standards.            organized  and  therefore  more   effective.-M.I.,
        The  second  hangup  was   that   no   one   knew   Psychology Student, Harlem.
      what the students' role should be. We          were   -  Referral  work  formed  the  body  of  my   job
      treated as supervisors, and  fell  into  that  role   for the summer.  Personally,  I  met  with  little
      too easily.  The  play  was  almost  entirely  con-   resistance  from  the  community;  most   families
      ceived and laid out by  the  students,  without  it   were   cooperative   and    grateful    for    our
      ever  being  explained  to  the  NYC'S.  When   our   services. * * * Nonetheless, a sense  of  friction
      director finally straightened  out  the  mess,  the   arose in dealing with  the  clinics.  Although  we
      pendulum  swung  in  the   other   direction:   the   were  well  received  and  complimented   by   all
      students felt they had no authority  at  all.  Once   health facilities we used  in  Harlem,  I  believe
      the play got  underway,  the  NYC's  were  the  ac-   there was  some  resentment  of  our  arriving  so
      tors  and  SPAN  people  the  directors;  the  stu-   eager and fresh to do  a  job  which  the  clinics
      dents  floundered  for  a  purpose.  Eventually  we   alone were not doing as best they  could.  An  ex-
      settled  on  an   administrative-organizing   role;   ample of this  was  the  hypersensitivity  of  the
      we  set  up  performance  places,   bought   props,   dental  clinic  staff  in   the   Central   Harlem
      phoned  absent  NYC'S,  etc.   But   through   this   Health Center. I feel  they  were  caught  sitting
      long  struggle  toward  a  role,  SPAN  looked   on   on their hands and that we  forced  them  to  take
      annoyedly,  not   quite   knowing   why   we   were   on the number of patients they were actua
      there or what  their  concern  for  us  should  be.   equipped to  take  but  had  not  been  receiving.
      Generally,  SHP  seemed  so  disorganized  and  in-   Goading clinics to give  better  service  was  one
      experienced   an   organization   that   SPAN   de-   of our goals, however,  and  in  certain  respects
      cided to try to ignore it,  and  to  take  us  into   we   were   successful.-C.W.,   Medical   Student,
      their organization as individuals.                    Harlem.
        After many stops and  starts,  we  got  the  play
      going  and  performed  it  three  times,  once  for     I was told by  many  of  the  health  establish-
      the  people  at  SPAN,  once  each  for  University   ment  professionals  that  they  felt  they   were
      and   Henry   Street   Settlement   Houses;   alto-   doing  the  best  they  could  under  very  trying
      gether we  reached  about  100  people.  We  expect   conditions (for  example,  over-utilized  and  di-
      that it will continue through the  year.  The  five   lapidated facilities in Harlem hospital  clinics),
      remaining  NYC's  who  acted  in   the   play   are   and they felt that we posed a definite  threat  of
      very enthusiastic about doing it  in  high  schools   trying  to  "expose  their  inadequacies,"  which,
      throughout  the  year,  and   about   coming   down   although never stated, was implicit  in  our  ide-
      to SPAN and participating in groups.                  alistically trying to "make  things  better  in  a
         It  was  a  tremendously  enriching   experience   hurry." Many of  them,  of  course,  aren't  doing
      to  meet  and  get  to   know   the   people   from   their jobs; however, it  doesn't  matter  what  we

                                                                                                            89


                                                          GREATER NEW  YORK

               think we're  doing  but  rather  how  they  inter-      The Brooklyn SHP  felt  that  the  student  fel-
               pret  our  motives  which  determines  whether  or    lows' role in model cities would be  to  help  the
               not they co-operate  willingly.  Our  handling  of    multiservice  committees  prepare  a  health  pro-
               this  "domain  infringement"  problem  often   was    posal by the  September  target  date.  We  should
               not very  tactful  (and  other  projects  reported    have  seen  trouble  ahead  when,  on  our   first
               similar  problems),  so  this  is  one   area   we    meeting  at  model  cities,  the  supervisor  pro-
               should give more attention to  in  future  efforts    posed that we learn  Spanish  for  the  first  few
               to  effect  change  from   within   institutions.-    weeks in order to help recruit  the  Puerto  Rican
               W.S., Medical Student, Harlem.                        community for the Model Cities program.
                                                                       Following a week of  orientation  to  the  Model
               Brooklyn                                              Cities concept, we reported  to  work  in  Central
                 I thought the nature of our     involvement   in    Brooklyn's  Brownsville  office  and   were   told
               the hospital setting  was  extraordinarily  appro-    that our job would  involve  an  investigation  of
               priate  in  effecting  our  original  aims.   Per-    the health facilities in the  Model  Cities  area.
               sonally, I  do  not  believe  that  community  in-    We knew  little  of  the  area  and  started  from
               volvement is  necessarily  the  best  way  to  im-    scratch.
               prove health care. Recipients  expect  doctors  to      Investigating  health  facilities  can   involve
               act like doctors; that is, to render healing  ser-    anything  from  making  a  list  to  conducting  a
               vices, and not to act as quasi-social  workers  or    survey  of  patients'  opinions'  of  the  various
               priests.-M.H., Sociology Student, Brooklytk           health services  available.  We  tried  to  set  a
                 We  had  hoped  that  the  Youth-In-Action  pro-    course  somewhere  in  between,   realizing   that
                                                                     there was little  time  for  in  depth  evaluation
               ject would bloom out,  because  they're  a  gigan-    since the  committee  were  being  asked  to  sub-
               tic  organization   in   Bedford-Stuyvesant,   and    mit tentative proposals by August 15th.
               they have  many  programs:  social  affairs,  fam-
               ily   counseling,   unwed    mothers,    sport@you     On  July  9th,  our  second  day  in  the   Model
               name it. We thought it  would  be  a  good  oppor-    Cities office  following  orientation,  we  walked
               tunity. As it turned out, it was horrible.            across the street to check on  the  activities  of
                 The  bureaucratic  problem  we  met  is   proba-    the  Ralph  Community  Center.  We  were   curious
               bly typical of a lot of agencies, but  even  worse    to  see  how  community  action  was  being   han-
               at  YIA.  We  made   arrangements,   really   good    dled on a  storefront  basis.  *  *  *  The  Ralph
               arrangements,'with  a  couple  of  people  at  YIA    Center is small, but it did have a group  of  wel-
               and then some of them left,  and  we  were  up  in    fare  mothers  in  a  remedial   reading   program
               the air. No one else had  been  told  about  these    and  we  spoke  to  them  for  a  few  minutes  to
               arrangements, so we had t                             sound  out   their   ideas   concerning   possible
                                          o start  from  scratch.
               We were trying to get involved  in  one  of  their    health programs  such  as  child  psychology,  nu-
               other  programs  (I  think  it   was   the   unwed    trition, the psychology of  drug  addiction,  etc.
                                                                     The  women  were  only  mildly  enthusiastic   but
               mothers  or  the  family  planning  section)   and
               we found that people  over  there  never  knew  we    we arranged  to  meet  with  a  larger  group  for
                                                                     iater that week. * * *
               had  been  working  in  home  family   counseling.
               -W.S., Student Coordinator, Brooklyn.                  Model  cities   did   not   employ   Neighborhood
                                                                     Youth Corps  workers.  Instead,  some  78  college
                 Most  of  the  community  groups  in  which  the    aides  from  the  Brownsville,  East   New   York,
               Brooklyn  SHP  was  to  operate  had   been   con-    and   Bedford    Stuyvesant    communities    were
               tacted several months before  the  project  began.    hired. Three  of  these  aides  had  attended  the
               Model  Cities  was  a  last-minute  addition,  and    SHP  Orientation.  Since  the   two   girls   were
               the role of the SHP  in  it  was  rather  unclear.    black and the boy  a  native  of  Puerto  Rico,  I
               We were to  work  for  the  multiservices  commit-    asked our .supervisor if they could  join  us  for
               tees whose social service interests stretched,  as    the hour or so w.e  expected   the   Ralph   Commun-
               our  supervisor  said,  "from  the  womb  to   the    ity Center meeting to  last.  Much  to  my  aston-
               tomb."                                                ishment, I was not only told  that  they  couldn't

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                                                     SUMMER  1968
        join us,  but  I  was  forbidden  to  walk  across  the   grossly   understaffed    and    equally    uninspiring.
        street! I  was  told  that  we  had  enough  to  do  at   We  have   spent   too   much   time   writing   reports
        Model  Cities;  and  when  I  protested  that  we  felt   that  are  never  read  onresources   that   are   being
        we had  time  on  our  hands  at  this  point  the  su-   listed   for   the   umpteenth   time   by   the    ump-
        pervisor  told  me  not   to   get   involved   because   teenth agency. Our job is to drown in burea          uc-
        there will be much to do.                                 racy.
         We  had  not  expected  this  type   of   rebuff.   It     Frankly, I  think  the  job  stinks.  It  is  stupify-
        had been our feeling all   along  that  our   role   at   ingly  dull  and  nonstimulating.  *  *   *   There   is
        Ralph  Street  Center  would  be   one   of   coordina-   no  doubt  that  Model  Cities  will  benefit  in   some
        tion   only,   and   that    the    women    themselves   way  by  our   work;   there   is   considerable   doubt
        would  make  the  contacts  and   invite   the   speak-   that  we  will  benefit  from   four   more   weeks   of
        ers.  We  felt  that  even  should  the   program   de-   boredom."-J.R.,     Medical      Student,      Brooklyn.
        velop on a  weekly  basis,  it  would  involve  only  a     There   were    two    important    areas    of    the
        couple of  hours  a  week  and  we  could  not  antici-   Kings   County   Hospital    patient    advocate    pro-
        pate our ever being so  busy  as  not  to  be  able  to
        afford  2  hours.   In   any   case,   the   commitment   gram  that  hadn't  been   touched   on   by   the   4th
        had  been  made  to  meet  the  women   and   we   con-   week  of  the  project.   One   was   the   problem   of
        tacted  an  assistant  to  the  director  and  he   ar-   how  best  to  utilize  the  facilities  of  the  pedia-
        ranged  for  us  to  go  to  the   meeting   with   two   tric  clinic  to  educate  the  mothers   that   visited
        Puerto Rican college aides in the office.                 it,  and  how  to  make  the  clinic  as  enjoyable   as
          The  significance  of  this  encounter  lies  in  its   possible  to  the  other  children  that  had   to   tag
        total  misconception  of  our  role  in  model   cities   along.  We  needed   to   make   the   hospital   admin-
        that  saddled  and  hindered  us  in  all   the   weeks   istrators  aware  that   much   more   could   be   done
        we  worked.  We  felt  that   our   task   to   provide   for the people who visited the clinic * * *
        health   information   to   a   planning   agency   de-     The  National  Dairy  Council  let  us   use   for   2
        signed  to   improve   community   services   in   toto   weeks  a  6  foot  by  4  foot   electrical   cow   that
        was  an  important  one.  Given  the   scope   of   our   could  "talk".  Along  with  this   cow   came   posters
        research,  this  assignment  did  not   demand   a   40   about  proper  -nutrition;   and   the   importance   of
        hour   week,   We   spent    every    Monday    evening   drinking plenty of milk.
        and  one   Tuesday   evening   trying   to   help   the     The  cow  served  two  purposes:   the   first   thing
        Multiservice    Committee    of     Brownsville     and   that it  did  was  brighten  up  the  entire   pediatric
        East  New  York.  The  job  involved   a   great   num-   clinic  for  all   the   children.   You   should   have
        ber  of  phone  calls,  many  meetings  with  directors   seen  the  excitement  in  their   eyes   as   the   cow
        of health  facilities,  and  an  equal  number  of  re-   moved  its  head  back   and   forth   and   mooed   and
        ports for the Model  Cities  office.  It  did  not,  we   wagged   its   tail.   Many   of   the   children    had
        felt, involve  a  stranglehold  on  our  time  and  in-   never  seen  a  cow   up   close   and   couldn't   help
        terests by  a  supervisor  ill-equipped  to  direct  us   touching  the   animal.   Why   the   -   couldn't   the
        efficiently  and  an  agency   burying   itself   under   people  in  the  clinic,  the  administrators   of   the
        the  weight  of  its  own   memos.   The   net   result   clinic,  think  of  something  like  this?   In   order'
        was  a  gradual   alienation   between   us   and   our   to get the cow  free  for  2  weeks,  in  order  to  get
        supervisor,  then   the   director,   then   ultimately
        the task itself.                                          the  posters  and  handouts  for   the   people   visit-
                  I  had  written  a  rather  stinging   report   ing the clinic, all I had  to  do  was  write  a  letter
                                                                  to  the  National   Dairy   Council.   Can   you   imag-
        for  the  SHP.  it  was  written  at   a   rather   low
        point  in  a  day  in  what  had  been  a  rather   low   ine   how   much   could   be   accomplished   if    the
                                                                  head  of  the   department   of   pediatrics   or   some
        week.  I  will  quote   the   final   two   paragraphs.
          "It is our  feeling  th-at,  since  a  proposal  must   other person  in  authority  tried  to  use  his  influ-
        be   produced   by   September   lst,   the   committee   ence  -with  various  agencies'in  order  to  help   im-
        will  have  little  to  do  or  say   but   rubberstamp   prove   conditions   in   the    clinic?-D.Y.,    Medi@l
        ideas  suggested  by  the  staff.   Model   Cities   is   Student, Brooklyn.

                                                                                                                        91


                 THE       NEIGHBORHOOD        YOUTH        CORPS   terested in medicine  or  an  allied  profession.
                   A tentative program  was  developed  in  which   The other one I met before we hired  him,  and  I
                 health   science   students   and   Neighborhood   spoke with him for  a  while  and  explained  the
                 Youth Corps would  jointly  structure  a  summer   project and he  seemed  interested.  So  both  of
                 "experience." The objectives were : (a)  To  un-   these NYC's were screened. A  lot  of  the  other
                 dertake a program  which  would  give  the  NYCs   people we got were just given to us. We  had  re-
                 a  constructive  and  educational   summer   job   quested that they have  an  interest  in  medical
                 which in some  way  relates  to  health  and  to   sciences, but  in  truth,  when  people  assigned
                 medicine; (b) to enable health science  students   NYC's to us, I don't  think  they  took  anything
                 to  become  thoroughly   acquainted   with   the   like that into account.  It  was  a  real  horror
                 health needs and health  services  in  the  com-   show for a while.
                 munity; (c) to develop one-to-one  relationships     We had to  get  NYC's  f  rom  three  different
                 with  several  adolescents,  thereby  hoping  to   areas,  because  we  were  working   in   Browns-
                 have a positive influence on their  further  de-   ville, Crown  Heights,  and  Bedford  Stuyvesant,
                                                                    and we had to  get  NYC's  from  different  agen-
                 velopment  and  goal  expectations.-L.K.,  Medi-   cies within those areas. In the  beginning  there
                 cal Student, Brooklyn.                             were hangups  in  all  of  them-the  kids  didn't
                   Working  with  the  NYC's  was  both   reward-   get paid and they had to register  and  re-regis-
                 ing  and   frustrating.   They   contributed   a   ter-but after  2  or  3  weeks,  Brownsville  and
                 great deal and ran  some  of  the  projects  en-   Crown  Heights   straightened   themselves   out.
                 tirely. However, some of  them  were  too  imma-   Bedford-Stuyvesant  Youth-In-Action  has  yet  to
                 ture and didn't want to work. They  didn't  want   straighten  out.  We  were  calling   and   going
                 to walk a few blocks  when  we  were  all  going   down there and seeing  people,  and  we  got  no-
                 door-to-door  with  health   information;   they   where. And last week  we  sent  them  a  telegram
                 didn't give us suggestions when  we  asked  them   telling them, "We've  been  trying  to  get  you,
                 what  was  wrong  with  the  summer  work.  They   and the NYC's haven't  been  paid  for  6  weeks,
                 said they wanted  to  talk  to  their  age-group   and it's time  something  got  done."  Two  NYC's
                 about drug  addiction,  but  when  the  opportu-   stopped coming to the office. Last week  we  told
                 nity came they were too embarrassed to talk.       them  we  would  followup  the  telegram  and  go
                   Many times,  we  climbed  walls  in  order  to   down  there  and  sit  there  until  someone  did
                 keep them busy. I don't  think,  however,,  that   something, so  we  went  down  and  we  had,  I'd
                 our project could  have  existed  without  them.   say, about 10 or 15 people there in  that  little
                 When they were  interested  in  something,  they   crowded office, so they saw  us  and  we  got  it
                 were  creative  and  tremendously  active.-E.B.,   straightened out as well as  we  could  have  ex-
                 Medical Student, Brooklyn.                         pected@W.S.,   Student   Coordinator,   Brooklyn.
                   The big problem for most  of  the  people  -on     When  the   NYC's   were   working   they   did
                 the project who  were  working  with  the  NYC's   work comparable  to  the  work  which  was  being
                 was that they felt they  were  working  to  make   done by student fellows in the SHP.  This  is  an
                 work for the NYC'S; that  they  were  constantly   interesting  observation  and   may   shed   some
                 worried  about  what  these  kids  can  do,  and   light upon SHP's place in the community.
                 should do, and trying not to  keep  them  bored.     If  Neighborhood  Youth   Corps   workers   are
                 A couple of the  health  students  expressed  to   capable of doing  much  of  the  work  which  was
                 me that the kids  are  wasting  their  time  and   done  by  medical  students  this  summer,   then
                 could be getting a better experience  elsewhere.   why not set up  an  SHP  in  which  the  majority
                 Some of the kids worked  out  well.  In  Browns-   if not all of the student fellows  are  teenagers
                 ville we had two  kids  who  were  really  great   from the community.  I'm  sure  with  supervision
                 and they  were  interested.  We  had  known  one   from the Public Health Service  and  a  few  med-
                 of them before  this  summer  and  we  requested   ical students such a  project  would  work.  Fur-
                 him, as he had indicated to us that he  was  in-   thermore, if the funding  is  through  an  estab-

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                                                 SUMMER  1968

      lished  bureaucracy  such  as   ours   was,   there   my  efforts.  Relations  between   me   and   male
      would  be  no  financial  problems.-R.J.,   Medical   NYC's were cordial but superficial. I  cannot  re-
      Student, Brooklyn.                                    member  one  truly  frank  or  constructive   con-
         On the whole, I  found  that  working  with  the   versation  between  me  and  a   male   NYC.   The
      NYC  fellows  to  be  a  very  worthwhile   experi-   boys are mostly high  school  students  whose  in-
      ence. Although they  had  much  difficulty  as  far   terests and capabilities are varied.  I  had  more
      as receiving their  pay  checks  went,  they  still   friendly, frank discussions with  the  girls,  al-
      continued to  work  with  us  throughout  the  sum-   though these  did  'not  come  until  the  last  2
      mer. I discovered  that  these  workers  were  very   weeks of  the  project.  Boys  were  more  cynical'
      imaginative  and  as  eager  as  we  allowed   them   less interested, and less vocal; they just  didn't
      to be. That  is,  when  we  showed  enthusiasm  for   trust or like  me  and  many  other  project  mem-
      a  project,  then  the  NYC's   showed   the   same   bers, and  I  feel  they  had  good  reason.  Some
                                                            stopped coming to  work  other  than  to  pick  up
      eagerness to get  involved.  If  they  didn't  ha@?   Paychecks.
      such  a  problem  about  getting  paid,  then   i-c     Here's how we let them down, as  I  see  it.  We
      would  have  been  an  even  more  productive  sum-   have  a   kind   of   Cinderella   complex   about
      mer  for  us.  These  youngsters  know   the   com-   NYCS.  That  because  they  know   their   commun-
      munity. They helped  us  get  acquainted  with  the   ity best  we  presumed  they  have  highly  devel-
      area,  the  problems  that  the  people  had,   and   oped social interests and ideas. We did  not  tai-
      the problems that they faced  daily  in  their  own   ior  jobs  to  individuals  carefully  and,  where
      lives  in  the   ghetto.-D.Y.,   Medical   Student,   necessary,  we  did  not  provide   well   defined
      Brooklyn.                                             tasks, thus  giving  NYC's  a  feeling  of  impor-
         It  appears   that   two   factors   contributed   tance and belonging; it has  to  be  nurtured  and
      greatly  to  the  somewhat  frustrating   situation   we weren't able to do this.  I  don't  think  they
      with the  NYC'S.  First,  the  unstructured  nature   felt important  and  necessary.  We  did  not  use
      of the work in the initial stages'  the  degree  of   them as  consultants.  One  boy  failed  his  sum-
      abstract   thinking   required,   and   the    many   mer school course, and we  didn't  know  about  it
      hours  of  rather   uninteresting   but   necessary   until after he got the grade.
      busy  work.  To  do  this  busy  work  both  effec-     With  proper  direction   and   attention,   the
      tively  and  with  enthusiasm  requires  an  under-   NYC  program  could   be   productive   for   them
      standing of and  dedication  to  the  ideology.  BY   and us, but more attention must be  given  to  it.
      utilizing  a  confrontation  technique   with   the   We  must  learn  from  our  past   mistakes.-A.H.,
      NYC'S,  some  success  was  achieved  in   increas-   Medical Student, Newark.
      ing their  interest  and  participation.  Secondly,
      the  generalized  confusion  of  the  NYC   program     Neighborhood   Youth   Corps   teenagers    were
      hurt  us-many  youngsters  were  not  hired   until   essential as a direct  line  into  the  community.
      quite late and  the  payroll  mix-ups  were  numer-   They did not turn out to be secret agents at  all,
      ous.-L.K., Medical Student, Brooklyn.                 but were  frequently  direct  lines  to  the  real
         In the beginning it was  said  that  the  health   poor who need help the most.  I  did  not  develop
      students and the NYC's were to  be  equal,  but  it   as close a relation with  the  NYC's  as  I  hoped
      didn't turn  out  that  way.  The  NYC's  were  the   to, but some of the talks I did have  with  a  few
      slaves@  of  the  health  students,   because   the   of them were  mutually  b6neficial.  A  basketball
      NYC's  didn't  have  the  same  responsibility   as   game   the   health   science   students    played
      the health students. By  this  I  mean  the  hea@th   against them was a success, but it  or  a  similar
      student  did  everything  and  the  NYC   did   the   activity should have  been  held  earlier  in  the
                                                       v"   project when enthusiasm  was  still  high.  I  sug
      slave   work,   the   dirty   work.-R.P.,    N..,,,   gest intensive individual tutoring  of  the  NYC's
      Brooklyn.                                             two mornings a  week  with  as  many  health  sci-
         The NYC  program  was  nearly  a  total  fiasco,   ence  students  as  possible   participating   and
      a flop-the major failure  of  our  project  and  of   keeping daily  records  of  each  NYC's  progress.

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                                                    GREATER        NEW  YORK
                   We  never  made  operational  a  suggestion  that   ship. By the end of the first week,  the  role  of
                   instead of focusing our attention in  the  direc-   the NYC's was set  in  the  minds  of  the  glory-
                   tion of what we could find for the NYC's  to  do,   craving, great white liberals  as  kids  who  were
                   we instead charge  the  NYC's  with  the  respon-   to be  dragged  along.  These  "kids"  are  a  lot
                   sibility  of  informing  us  about   what   their   more  mature,  open,  truthful,  and   real   than
                   neighborhood and its people were  all  about  and   most middle class  health  science  students.  The
                   bringing  to  us  what  persons  they   knew   or   NYC's  are  the  most  powerful  organ   of   SHP.
                   knew of who needed  some  help.  I  feel  a  keen   They  are  the  community  and  any  student   who
                   sense  of  disappointment  that  we  didn't  make   ignores  or  exploits  them  "to   know   what   a
                   our  NYC's  experience  this  summer  nearly   as   ghetto person is like" is  ignoring  and  exploit-
                   valuable as I thought  it  should  be.  The  most   ing  the  entire  community  that  SHP   is   sup-
                   certain thing I can suggest  to  remedy  this  in   posedly  established  for.  I  myself   underrated
                   the future is that in the first week or two  when   the potential of the  NYC's  initially.  But  for-
                   enthusiasm is  still  high  (assuming  it  begins   tunately,  through  one  NYC  who   was   "showing
                   high) each NYC  is  made  to  feel  important  by   me the ropes", I  realized  their  importance  and
                   doing  something  constructive  and   meaningful,   worked much more effectively with them.
                   and  not  just  sitting  around.-N.W.,  Law  Stu-   K.S., Nursing Student, Newark.
                   dent, Newark.                                        I  feel  the  NYC's  were  the   most   important
                   The  problem  we   have   is   that   NYC's   and   people in the project,  and  with  most  of  them,
                   health science students don't relate  that  much.   especially the boys, we  failed  miserably.  First
                   The NYC's don't  have  a  sense  of  the  project   of all,  they  were  excluded  from  many  of  our
                   like the health science  students  do.  One,  the   meetings  concerning  hospital   services,   meet-
                   health  science  students  don't  have  the  same   ings  which  they  should  have  attended  as  the
                   problems, with day to day living, as  the  NYC'S,   main speakers on poor medical  care  and  bad  at-
                   so  they  don't  have  the  same  objectives.  We   titudes in the hospital.  Secondly,  many  of  the
                   have more intellectualized, idealized  objectives   health science students  went  about  their  busi-
                   of a better health service. The  NYC's  are  con-   ness  without  the  NYC'S.  They   were   regarded
                   cerned  with  summer  jobs,  keeping  busy,  get-   as little kids who had  to  tag  along  after  you
                   ting something interesting -to  do,  and  in  the   and the  biggest  question  seemed  to  be,  "What
                   winter   having   another   job,   getting   more   are  we  going  to  do  with  the  NYCS.   Nothing
                   money. Their interest in a  way  is  very  impor-   should  have  been  done  "with"  the  NYCS.  They
                   tantly, very basically, economic. They  think  of   were  all  old  enough  to   understand   why   we
                   that  more  than  we  do.  The   most   important   were there  and  what  we  were  doing,  and  they
                   thing'we're  doing  is  making   them   think-how   should not have been  treated  as  kids.  I  found
                   many of these  kids  would  otherwise  be  think-   the girl NYC's  to  be  the  most  genuine  people
                   ing  about   hospitals   and   health   problems?   on  the  project.  They  were  intelligent,  alert
                   They never would  have  thought  about  this.  If   young ladies, more aware of  the  existing  condi-
                   they have a job and they have to think  about  it   tions that  they  were  often  given  credit  for.
                   because it's their job, they're not going to stop   Had  some   of   the   health   science   students
                   thinking  when  the  job  is  over.  One  guy  is   stopped patting themselves on  the  back  and  be-
                   maybe going to get interested  and  one  guy  can   friended these boys and  girls,  they  could  have
                   change  ten  people.-D.T.,  Student  Coordinator,   learned a lot. If the NYC's had  been  treated  as
                   Newark.                                             equals they could  probably  have  proven  invalu-
                    The  most   striking   lack   of   communication   able to  the  project  goals.-A.C.,  Nursing  Stu-
                   was  between  health  science  students  and  the   dent, Newark.
                   NYC's.. It got to the point  where  one  NYC  was     This summer  the  Lower  East  Side  dental  ed-
                   assigned  to  each  health  science  student.   I   ucational   program   was   performed   by    only
                   thought this  absurd,  but  shamefully  necessary   NYC  students.  They  wrote  and  directed   their
                   in most cases, to establish this forced relation-   own  play  and  have  received  tremendous  praise

                   94


                                                   SUMMER  1968
      for  their   performances.   All   the   Head   Start    guidance.-M.H.,   Nu@sing   Student,    Lower    East
      schools  in  District   1,   daycamp   schools,   the    Side.
      Poor  People's  Campaign,   Junior   High   71,   the
      Boy's  Clubs,   Sloane   Center,   and   many   other              You  see,   one   of   the   things   about
      agencies  have  all   enjoyed   and   learned   some-    Neighborhood  Youth  Corps  is  that  it's   a   syn-
      thing  from  the  plays.  This  group  of  15   NYC's    thetic  organization  developed  for   a   particular
      have  reached  about   3,500   children   and   young    purpose.  If  you  have  two  synthetic  groups   re-
      adults this summer.  As  well  as  supplying  a  ser-    lating to each other, and the  core  of  their  expe-
      vice  to  their  own  community,  they  also  had   a    rience   is   what   happens   between   those    two
      great  time  doing  it.  I  have   personally   heard    groups,  I  think  the  community's  going   to   get
      that they are  proud  of  what  they  are  doing  and    left  off  in  the  cold   somewhere.   And   there's
      hope  to  have  an   ongoing   program   during   the    question as  to  what  extent  these  NYC's  are  re-
      school  year.  A  few  of  them  have   come   to   e    lated  to  the   community:   some   of   them   are,
                                                       T       some of them aren't;  in  fact,  the  coordinator  of
      and  expressed  their  personal  gratitude  for   the    the  whole  Youth  Corps  was  in  just  as  much  of
      summer.                                                  a  hurry  to  move  out  of  the  community   as   he
        I  am   presently   submitting   a   proposal   for    could   be.*   *   *   -S.D.,    Community    Worker,
      funds so  these  NYC's  can  continue  their  activi-    Lower East Side.
      ties during the  course  of  the  year.  We  hope  to
      coordinate  their   activities   with   an   exciting      From  my  point  of  view,  the  SHP   could   have
      program   at   NYU   Dental   School,   where    they    been  more  organized  if  the  students   had   been
      will  continue  to  perform,  to  rehearse,  to  make    more  thoughtful  in   their   decisions.   For   the
      costumes  and  scenery,  and  to  draft   new   plays    most  part,  I  think  that  the   SHP   accomplished
      after school.  They  will  perform  their  plays  for    what  was  needed   in   the   community.   I   think
      local agencies as part  of  the  dental  school  pro-    that  we  NYC's  were   very   effective   and   very
      gram. The NYC's  will  also  be  offered  a  tutorial    helpful  to  the  work  of   the   students   because
      program  to  aid  them  through   high   school   and    since  we  were  also   from   the   community,   the
      entrance to college'  They  also  will  attend   den-    people  would  be  more   attentive   to   what   was
      tal   educational   classes   where    NYU    faculty    being said.
      members  will  talk  to  them  about  oral  diseases.      The  students  I  worked   with   were,   for   the
      From  my  own   experiences   and   observations   in    most  part,  very  nice.  They  made  me   feel   ma-
      this community for  over  a  year  and  a  half,  and    ture in what I  said  and  what  I  did.  They  some-
      considering   the   recent    summary    of    dental    times  disagreed  on  what  was  decided   in   meet-
                                                               ings.,  but  I  think  this  showed  that  they   were
      needs  by  the  Public  Health  Department,  I   feel
      this group can provide a'fantastic service         to    really interested in what they were doing.
      their  community,  a   service   which   is   desper-      I feel I got  to  know  the  community  better  be-
                                                               ,ause  I  personally  went  around  to  them,   talk-
      ately    needed.-G.L.,    Dental    Student,    Lower    c
      East Side.                                               ing about the clinic. Yes, I  really  think  that  my
                                                               experiences   this   summer   may    surely    change
        We, as  students,  had  a  great  deal  of  trouble    my  plans  for  the  future  in  that  now   I   know
      adjusting  to  working  with  the   NYC'S.   We   al-    what  I  would  want  to  consider  my  life's  work.
      ternated  between  our   ignoring   their   abilities    -N.R., NYC, Lower Ectst Side.
      and their ignoring our abilities.  In  the  end,  we,      The  NYC's  in  our  office  had  not  been   hired
      the  students,  moved  into  a  cooperative,   super-    by  SHP,  but   by   LABOR.   The   ones   I   worked
      visory role,  and  it  worked  well,  Though  it  was    with  were   very   good   and   responsible.   LABOR
      hammered   into   our   heads   that   everyone   was    would  like  to  hire  them  part-time  after  school
      $'equal,"  and  that  "no  one  bosses  anyone,"   we    to  work  as  block  organizers.   My   relation   to
      finally  realized  that  the  NYC's  were  5   to   7    them  was  primarily  one   of   a   teacher-how   to
      years  younger  than  us,   much   less   experienced    get complaints in  a  building,  how  to  organize  a
      in  the  responsibilities  of  working,  and   needed    tenants' council, how to  do  a  title  search.  They

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                                                    GREATER        NEW  YORK
                were  expected  to  work  independently   and   come    In short, I am grateful  to  the  SHP  for  what  it
                to us as resources, an  excellent  relationship  for    has taught rne.-F.M., NYC, Bronx.
                those  who  were  capable  and  mature,  a  hopeless
                                                                         I hated  every  minute  of  it.  It  was  the  most
                responsibility  for  the  others.  I  felt   somehow    boring and the dirtiest  job  at  times.  This  pro-
                that NYCs should  be  treated  as  our  equals,  but    ject  was  also  very  unorganized,  confusing,  and
                they seemed  to  want  more  direction  than  I  ex-    a lot of talk as to what to do. All I really did  at
                pected.  I  think  in  a  continuing   relationship,    times this summer  was  fuck  off  in  this  project
                equality  would  emerge.  But  NYC's   really   have    because sometimes  that  was  the  only  thing  left
                to be  selected  for  the  work.  Just  hiring  any-    to  do.  SHP  did  not  do  much  work  on   housing
                body  off  the  street  and  giving  him   make-work    problems  in  the  community,  for   what   I   saw.
                is   quite    damaging.-K.B.,    Medical    Student,    Besides,  there  aren't  enough  workers  for   this
                Bronx.                                                  job  anyway.  Concerning  the   workers   I   worked
                                                                        with,  well  that  wasn't  much  of  a  problem  for
                 This   summer   found   me   working   for    LABOR
                as a screening technician. It  was  not  fun.  First    me, but for  the  medical  students,  yes,  it  was.
                of all, I don't get kicks out  of  going  from  door    They  should  have  taken  the  job  more  seriously
                to  door  asking  for  urine.  We  didn't  help  the    but  I  don't  really  blame  them   because   there
                families as far  as  housing  and  bills,  etc.  are    was  no  one  around  to  make   them   responsible.
                concerned. I  think  that  that  is  something  that    for what they were supposed to do.
                SHP should have considered.                              The  most  important  thing  I,think  I   got   out
                 As  far  the  other  NYCs  I   worked   with   were    of  this  summer  job  is  knowledge  of  the   poor
                concerned, they felt the  same  as  I  did.  We  all    conditions the hospitals are  kept  in.  They  don't
                thought it was a big  drag  and  we  all  knew  that    even  look  like  hospitals  to  me.  And  also  the
                we  weren't  doing   it   because   we   loved   o@@    poor housing  conditions  some  people  live  in.  I
                neighbors,  but  because  we   were   getting   paid    think  there  should   be   something   done   about
                $40  a  week  for  what  we  were  doing.  Being   a    this  problem,  which   some   people   don't   even
                screening  technician  didn't  give  me  an   oppor-    consider. The one thing  I  really  liked  about  my
                tunity to  get  to  know  my  community  any  better    job was that I  got  to  know  some  of  the  people
                because  I   wasn't   working   in   my   community,    in  the   community   which   I   worked   in.-R.F.,
                but I did get to meet new people.                       NYC, Bronx. .
                  My  summer   experiences   didn't   help   me   as     As  far  as  the  Bronx  project  is  concerned,  I
                far  as  the  future   is   concerned,   because   I    think that there was very little unity,  if  any  at
                wouldn't want  to  do  what  I  did  in  the  summer    all, between the older memb   ers  of  the   project
                for the future.-J.R., NYC, Bronx.                       and  the  NYC'S.  Most  of  the  young  people  felt
                                                                        as though they weren't  part  of  the  project,  but
                  To me,  this  past  summer  has  been  very  help-    more  like  an  old  shoe  that  someone  found  and
                ful  and  educational.  (I  know  I  speak  for   my    just happened to need. It is here,  I  felt,  .  a:,
                fellow  NYC's  as  well).  For  instance,  I   never    the project began to fall apart. I  think  that  the
                really knew how  bad  the  slums  are  until  I  got    .  NYC's  could  have   worked   more   harmoniously
                out  there  and  worked  in  them.  It  was   pretty    with  the   community   workers,'medical   students,
                depressing but  that's  the  only  way  of  learning    coordinators, etc, for  a  better  understanding  of
                about it. I was also blind  to  the  fact  that  in-    the community.-C.B., NYC, Bronx.
                terns  work  hard  to  become   doctors   and   when             COMMUNITY WORKERS
                they become  doctors  they  work  just  as  hard  to
                help  out  the  sick,  the  ignorant  and  the   op-      This past summer  I  was  given  a  job  that  was
                pressed.  How  do  they   do   this?   By   starting    supposed  to  be  as  community   coordinator.   The
                community  projects;  or  by  opening  public   hos-    reason I got this job was, I  believe,  because  I'm
                pitals, clinics,  etc.  Yes,  this  summer   was   a    black. I made a good salary  and  I  could  use  it,
                summer I'll never forget, for  I  learned  a  little    but I want a job not because  I  am  black  but  be-
                about a lot. Or a lot  about  a  little,  whichever.    cause I can do the job.

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                                                   SUMMER  1968
        1  may  be  a  little  old-fashioned,  but   I   take   in     SHO      community-worker      relationships.-
       pride in doing a  job  well,  and  when  I'm  given  a   J.C., Medical Student, Lower East Side.
       job to do I try  to  do  it  well.  If  I  don't  know    We   found,   unfortunately,   that   although   one
       how,  I   ask   someone   who'does   know   how,   and   of   our   community   workers   prefaced   many   of
       then I try to do the very best I can at it.              her   statements   with    "the    community    wants
        But  this  particular  job  no  one  will   ever   be   *  *  *"  we   were   actually   hearing   what   she
       able to say whether I can do well or       not,    be-   wanted.  We  found  that  she  often  had   as   much
       cause I really didn't have anything to     do.     The   difficulty   in   communicating   with   the   Puerto
       NYC's  could  have  done  most  of  what  I  did,  and   Rican  and  black  community  people  as  the  health
       this  was  not  the  fault  of  the  people  I  worked   science  students  themselves  had.  We   were   told
       with  so  much  as  the  way  the  program   was   set   by  another  community  advisor  (who   also   is   a
       up.  It  was   a   sort   of   gentlemen's   agreement   member of  the  Health  Council)  that  often,  since
       thing  -"We  must  have  these  people  in  our   pro-   the  other  community   worker   sounded   so   know-
       gram  or  we'll  look  bad,   so   keep   them   happy   ledgeable  on'  such  topics  as   city   and   state
       and   we'll   do   the   real   work."-M.W.,   Commun-   politics,  the  Health  Council  accepted  her   word
       ity Coordinator, Brooklyn.                               on faith. And we behaved  no  differently  at  first.
         As  one  of   the   community   workers,   I   found   Her  self-assurance  and  seeming   political   know-
       working   with   other    community    workers    very .  ledge  convinced  us  that  even  though   we   felt
       agreeable.  In  most  instances,  we  were   in   com-   insecure  about  going  upstate   to   do   political
       mon  agreement  as  to  how  something   was   to   be   organizing  to  get  Medicaid  back,  we   would   be
                                                                doing  the  community  disservice  by   refusing   to
       carried out. This  is  not  to  say  that  our  behav-
       iour   was   stereotyped,   but   that   a    somewhat   try.  In  effect,  she  succeeded  in   removing   us
       common  outlook  on  the  aims  of  the  project   led   from  the  community  for   the   whole   summer.   I
       to  closely   aligned   methods   of   implementation.   feel that I  was  deprived  of  a  valuable  learning
       Much of our camaradarie came about thro                  experience.   Hopefully,   however,    the    primary
                                                          ugh   o@ective of the SHP is  not  to  parasitize  off  the
       a  defense  of  the  community  and  its   legitimacy,   community   for   our   own   enlightment.    Consid-
       a  defense  provoked  by  the  subtle   attacks   made
       by   some   white   members   of   our    staff.-R.P.,   ering  that,  the  Medicaid  project   may   contrib-
       Community Coordinator, Newark.                           ute  more  of  a  long-range  "concrete  service"  to
                                                                the  community  than  those   projects   which   were
         Our   community    colleagues    were    indispensi-   more   "community    based."-J.P.,    Medical    Stu-
       ble  in  a  pr  'ect  composed   largely   of   white,   dent, Lower East Side.
                    oi
       upper   middle-class   students    who    have    very     The   community   workers   were    overall    very
       little idea  of  what  is  happening  in  the  ghetto,   helpful.    Our    community    coordinator    seemed
       what it's like to  live  there,  and  what  it's  like   less helpful than  I  hoped  and  expected.  Her  re-
       to  be  black.  Individuals  and   personalities   and   luctancib to give  advice  before  it  was  too  late
       the   abilities   and   commitment   of   the   commu-   caused   many   a   mishap.   Her   explanation    of
       nity  people  have  a  great  effect  on  the  success   community  feelings   concerning   our   difficulties
       of  any  community-wide  efforts,   but   not   neces-   was helpful,   but  I  feel   many   mistakes   could
       sarily    individual    projectg.-N.W.,    Law    Stv,   have  been  avoided  had   she   interceded   sooner.
       dent, Newark.                                            Our   other   community   worker,   though   involved
         Our  two   community   workers   were   quite   dif-   in  much  power  play,   constantly   provided   much
                                                                needed    advice    concerning    the     community's
       ferent  people,  and  the   way   they   came   across   needs and fears.
       was  remarkably  different.  I   believe   that   they     Mobilization   For   Youth   provided    us    with
       may  not  have  completely  understood   their   rela-   one of our  most  valuable  people,  the  crew  chief
       tionship   (power-wise)    to    project    decisions.   of  the  NYC'S.  He  assisted  us  in   understanding
       This  understandably  difficult  position  to   evalu-   the   NYC's   and   them   in    understanding    us.
       ate  may  have  contributed  to  a   mutual   distrust   Without  this  help,  our  project  would  have  col-

                                                                                                                   97


                                                        Liittia,l,.M.K IN.M w   I U.K.M

                 lapsed.-B.G.,   Nursing   Student,    Lower    Eagt     The  most  reactionary  and   self-seeking   mem-
                 Side.                                                 ber  of  the  Tremont  Community  Council   was   a
                   I  feel  very  funny  working  with  professional   white,  female   community   worker   assigned   to
                                                                       the SHP.  She  was  a  strong  proponent  of  "com-
                 people, perhaps  because  I  think  they're  trying   munity  relations"  (keep   the   niggers   happy),
                 to  put  something  over  on  me;  I  just   didn't   and  constantly  showed  preference  for  SHP   in-
                 want  to  work  with  them.  Then  I   reconsidered   volvements  such  as  single-shot  sex   education,
                 because of the fact  that  I  was  the  only  Span-   narcotics,   and    dental    education    programs
                 ish speaking  coordinator  in  the  whole  project.   which would reduce the envy of other co       mmun-
                 * *  *  Sometimes  I  am  asked  questions  by  the   ity organizations  for  the  concentration  of  our
                 students and I  say,  "I  don't  know  how  to  an-   services  in  the  T.C.C.  This  community   worker
                 swer you because I  have  not  consulted  the  com-   was  very  domineering,   vocal,   and   argumenta-
                 munity;"  Then  the  project  members  would   say,   tive,  and  managed   to   control   somewhat   the
                 "What  do  you   mean,   you   can't   answer   me;   range  of  action  of  two  nursing  students   who
                 you're   part   of   the   community."-H.K.,   Com-   worked with  us  on  the  project.'In  addition  to
                 munity Coordi?mtor, Lower East Side.                  being  frequently  late  or  absent  from   project
                   There  are  community  people  who'll  give   you   responsibilities, she  was  an  expert  at  ducking
                 snappy  answers.  Some  of  us  have  lived   there   her own share. At the  end  of  the  project,  when
                 long  and  worked  with  each  other  long   enough   nineteen    Bronx    SHP    students,     community
                 to  know  that  on  policy  questions,  the  snappy   workers, and NYC's signed  a  petition  to  reallo-
                 answer is not always  the  best  answer.  Like  I'm   cate  funds  from  the  extravagant  Final  Confer-
                 sure  Mrs.  K.  has   very   definite   recommenda-   ence to  the  continuation  of  the  Unwed  Mothers
                 tions on  certain  technical  things,  but  at  the   and  Head  Start  programs,  she   was   the   only
                 same  time  the  students   wanted   snap   answers   project member  who  refused  to  sign.  With  col-
                 on  things  like  broad-range  policy  to  function   leagues like  this,  who  needs  enemies?  On  sev-
                 on, to  force  someone  into  giving  them  an  an-   eral  occasions,  this   woman   openly   slandered
                 swer  and  then  say,  well  so-and-so  said  that.   two  black  community  workers  assigned   to   the
                                                                       Central  Bronx  storefront.  Her   influence   over
                 Well, we don't want  to  be  used  that  way.-S.D.,            i
                 Community Worker, Lower East Side.                    one  nursing  student  was  so  strong  that   this
                                                                       student  threatened  to  resign  from  the  project
                 In the  Bronx  we  were  fortunate  in  having  two   if  one  of  these  black  community  leaders  were
                 hardworking,  intelligent   and   congenial   women   transferred  to  her  part  of  the  project.-J.G.,
                 as  community   workers.   One,   the   mother   of   Medical Student, Bronx.
                 seven, was white  and  active  already  in  commun-     We   had   flve   community    mothers    working
                 ity affairs. She served  as  an  excellent  liaison   with us in Harlem.  We  were  told  it  was  to  be
                 between  us  and  the  Tremont  Council.  She  also
                 brought to the job  strong  ideas  about  'our  ef-   our duty  to  "train"  them  to  work  with  Public
                 forts and a willingness to do a  job.  She  related   Schools 175 and  133  health  referrals.  Three  of
                 well to the  group  and  became  an  integral,  in-   the  ladies  are  experienced  in  the   home-visit
                 terested  member  of  the  team.  The  other   com-   type of work involved, and it  was  absurd  for  us
                 munity   worker   was   Puerto   Rican.   She   was   to presume to  train  them  to  function  in  their
                 very  congenial  and,  like  her  counterpart,  be-   own  backyards,  particularly   when   there   were
                 came  a  friend  as   well   as'   fellow   worker.   20 of us  where  three  or  four  would  have  cer-
                 Through  her  we  were  able  to  understand   some   tainly been sufficient. 1,  and  I  think  many  of
                 of  the  problems  the  community  faced,  as  well   the  other  student  fellows,  overlooked  the  two
                 as her serving  as  a  link  to  the  predominantly   inexperienced  ladies  who  could  have  benefitted
                 Spanish-speaking     community.     Both      women   from  accompanying  us  on  home  visits,  to   the
                 were made  to  feel  entirely  equal  on  the.team,   hospital, and on visits with  local  oi;Ecials.  We
                 and  their  opinions  were  respected   and   often   spent the last  2  weeks  trying  to  make  up  for
                 taken  as  gospel.-V.S.,  Dental  Student,   Bronx.   our  earlier  shortcomings,  only  partially   suc-

                 98


                                               SUMMER  1968
      cessful, I am afraid. The  two  are  still  unsure   municating  to  them  whatever  cautions  are  nec-
      of themselves, partly due to our  inadequacies.  I   essary  to  prevent  them  from  proceeding  at   a
      felt  the  mothers  suffered  somewhat  from   the   pace which is unrelated to  the  sentiment  in  the
      decision to hold the orientation  and  final  con-   community.  Student  health  projects  are  an  im-
      ference far out of the city, they being  reluctant   portant   two-way   educational    program,    with
      to leave their  families.-L.B.,  Medical  Student,   communities   receiving    valuable    augmentation
      Harlem.                                              of manpower   and  students  receiving  an   indoc-
                                                           trination  and  a  sympathetic   understanding   of
        Our  community   workers   were   pretty   good;   neighborhood  problems  which   will   stand   them
      they  were  better  at  making  home  visits  than   in good stead as  professionals.  The  faculty  ad-
      the  medical  and   nursing   students.   Two   of   visor can and  should play a key  role  in  facili-
      the  five  were  working  mainly  to   get   them-   tating  this  whole  process.-J.W.,   Faculty   Ad-
      selves  out  of  the  kitchen   for   the   summer   visor, Brooklyn.
      and weren't ready to put out       . The     other
      three  were  quite  resourceful  and  critical  of     One  of  our  faculty  advisors  was   almost-to-
      things in the project or in health  facilities  in   tally  removed  from  any  contact  with  our  pro-
      Harlem  that  needed  criticizing.-R.C.,   Student   ject.  Her  main  concern  was  with  a   question-
      Coordinator, Harlem.                                 naire  which  was  given   to   postpartum   women.
                                                           If I had  had  more  contact  with  this  woman,  I
                 FACULTY ADVISORS                          could say  more.  In  summary,  her  role  was  one
        Health science students coming      to   a   new   of irrelevance.
      community from all over  the  country  for  a  10-     Our  other  faculty  advisor  served  more  as  a
      week   summer   work   experience   must    depend   hindrance to our project than as  a  boon.  He  ad-
      heavily on the advice  and  the  orientation  pro-   vised our  project  members  as  how  to  best  be-
      vided  them  by  faculty  advisors   and   precep-   come  co-opted  into  the  bureaucratic   b.s.   of
      tors  who  have  long-term   experience   in   the   which he himself is  part.  He  seemed  highly  re-
      sponsoring  institution  and   the   neighborhood.   sentful of the fact that  members  of  our  project
      The  faculty  member  must   be   able   to   work   saw fit  to  approach  the  top  of  the  Martla-nd
      equally  successfully  with  citizens,   represen-   Hospital  administration   with   suggestions   for
      tatives, and institutions  in  the  community  and   change,  which  we  saw  as   deserving   immediate
      with  the  students.  The  former   are   inclined   attention.  These  proposals  were  based  on  com-
      to be  suspicious  of  this  invasion  of  largely   munity    sentiment.-R.P.,    Community     Coordi-
      middle class  workers,  and  the  latter  are  us-   nator, Newark.
      ually  highly  idealistic  and  very  naive.   The     Our  faculty  advisor  both  expected   and   de-
      preceptors   who   have   prepared   the    ground   manded  that  we  remain  docile,   quiet   workers
      in the  neighborhood  must  be  extremely  careful   in  the  emergency   room,   and   not   make   any
      to suggest and  advise  students  without  in  any   "waves."  When  he  and  the  hospital  administra-
      way  dominating  their  project  or  making  deci-
                                                           tor learned of  our  visit  to  higher  authorities
      sions for them.  There  are  realistic  risks,  of   and  of  the   community   organization   we   were
      students   antagonizing   community   people,   or
      their  being  discriminated  against  because   of   trying  to  form,  we  were  screamed  at   accord-
                                                           ingly, threatened, and invited to  leave  the  hos-
      class, race, or  as  "carpetbaggers."  Even  their
      physical safety  ma  be  involved  at  times.  The   pital. This invitation, we learned,  wasn't  to  be
                          y                                the last.-A.C., Nursing Student, Newalrk.
      faculty  advisors  should  be  available  at   all
      times and should be capable  of  facilitating  the      Our faculty  advisors  were  virtually  nonexis-
      planning and the  carrying  out  of  student  pro-   tent.  Unfortunately,  both  are   extremely   busy
      jects,  through   a   close-working   relationship   people and  just  couldn't  put  in  much  time  at
      Particularly  with  the  student  directors.   You   project  meetings;  they  both  came   to   several
      must be able  to  relate  sympathetically  to  the   meetings at the  start  of  the  project,  but  not
      changing objectives of the  students,  while  com-   much  later.  One  advisor  taught  the  pediatrics
                                                                                                            99


                                                    GREATER       NEW  YORK

               part of  our  training  program  for  the  mothers.   was one of the parts  of  the  project  that  would
               She came to  weekly  meetings  at  our  office  for   have been nice but that it was  really  put  in  to
               that. In the future, we should  try  to  get  advi-   satisfy  Montefiore  Hospital  that  we  would   be
               sors who have more  time,  I  guess,  but  I'm  not    well   supervised."-R.C.,   Student   Coordinator,
               all that sure that  we  suffered  from  not  having   Harlem.
               faculty direction. I felt from the start that  this

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                       Part 4: OPINIONS ON THE ORGANIZATION

                   INTRODUCTION                           level, with the central  staff  being  essentially
      The  administrative  organization  of  the   1968   powerless  and  the  policy  making  council   too
    project reflected  the  spirit  of  community  con-   cumbersome  for  immediate  decision  and  action.
    trol that was  of  great  importance  to  the  pro-      GREATER NEW YORK STUDENT
    ject's student leaders and  to  many  of  the  stu-       HEALTH PROJECT STRUCTURE
    dent  participants.  The  result  was  a  structure   Bronx
    that  was  both  decentralized  and  chaotic.  Each     I felt  that  SHP  was  five  separate  projects
    of the five areas was directed  by  a  health  sci-
    ence  student  (student   area   coordinator)   as-   governed by a  sincere  but  unresponsive  leader-
    sisted  by  a  local   area   resident   (community   ship. This leadership failed  to  bring  the  pro-
    coordinator)  and  advised  by  a  faculty   member   ject together so that we  could  learn  from  each
    from the local  area  medical  school.  These  five   other before the summer ended; failed  to  act  in
    student-community-faculty     teams      determined   accordance  with  our   wishes   regarding   funds
    what  projects  students  would  work   on   during   for  continuing  programs,  supplies,   materials,
    the  summer,  who  would  work   where,   and   how   etc. (Billions for buttons but  not  a  penny  for
    day-to-day problems would be handled.                 books  seems  to  sum  up  SHP  wisdom  and  fore-
      Above  them  in  the   organizational   hierarchy   sight.) Our own  Bronx  project  split  into  sev-
    were  officers  for  the  combined  five-area  pro-   eral projects, the result of weak  leadership.  In
                                                          fact,  weak,  unresponsive  leadership  seems   to
    ject, two student codirectors, a studeit educa
                                                   I  -   be a major fault of SHP.  Policy  was  not  deter-
    tional coordinator,  and  a  faculty  director  re-
                                                          mined early enough to give direction  to  our  ef-
    presenting  the  sponsoring  agency,  Albert   Ein-   forts. Individuality is great, but we  must  real-
    stein College  of  Medicine.  Their  functions  be-
                                                          ize our limitations as individuals.
    came  deflned  as   largely   adminstrative   (pay-
                                                   I        Thus, in summary,  SHP  was  in  actuality  five
    checks,  mail  notices,  purchases   of   supplies,
                                                          SHP's  without  a  central  policy  or  theme  de-
    conference  arrangements,  etc.),  a  role  defini-
    tion  which   caused   considerable   consternation   flned enough to guide.  Central  staff  failed  to
    to  these  individuals  who  perhaps  should   have   bridge the gap  between  and  within  groups,  and
    exercised a greater role  in  project  affairs,  as   lacked both  the  leadership  and  wisdom  to  run
    well as  to  those  project  members  who  did  not   the  organization  effectively.  SHP  was  a  ship
    consider  their  administrative   functioning   be-   without a captain or a compass.
    yond  criticism.  Finally,  policy  statements   of     SHP  has  no  moral  right  to  return  to   the
    broad project  significance  had  to  be  developed   community this fall, next  spring,  or  next  sum-
                                                          mer unless it undergoes a radical  change  into  a
    and  approved  by  a  policy  making  council  con-
    sisting  of  the  student-community-faculty  repre-   student-staffed  but  commun-ity-run  and  respon-
    sentatives  from  each  of  the  five  areas,   the   sive  organization.  It  must   be   decentralized
    three student central  office  staff  members,  the   down to each local area  and  must  have  definite
    faculty director, and ex officio, the  director  of   plans  for  self-perpetuating   programs.   Other-
    Monteflore  Hospital  in  the  Bronx   and   chair-   wise, its existence is unjustified and  unaccepta-
    -na-n  of  the  department  of  community  medicine   ble.-V.S., Dental Student, Bronx.
    at Albert Einstein College of Medicine.               Lower East Side
       Given  this  administrative  structure,  project     I feel that the student health    project   this
    decisions  were  usually  made  at  the  local-area   summer tried to be all things to    all those  in-

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                                                           GREATER NEW  YORK

                volved; it cannot possibly be. It  is  foolish  to   who invented this job  before  and  had  it  clear
                think that we can be successful on all  levels  of   in their minds  as  to  what  we  could  do,  what
                involvement. In the future,  student  health  pro-   we couldn't  do,  and  where  the  mistakes  would
                jects should be  more  carefully  defined  before-   fall. None of this  really  came  out.-R.P.,  Com-
                hand so that all those involved  have  some  feel-   munity Worker, Newark.
                ing of direction and yet  at  the  same  time  the     I feel  there  was  somewhat  of  a  problem  in
                projects should be  flexible  enough  for  innova-   project  communication  which   was   mostly   the
                tions.                                               fault  of  our  student  area   coordinator,   but
                  I also feel that there  should  be  some  method   which could have  been  remedied  by  the  Central
                of screening NYC's so that  those  who  are  truly   Office. The remedy would  be  a  calendar  of  all
                interested (if this is possible) become  involved.   project  events   in   advance,   especially   the
                This is not to say that students should  not  also   weekly meetings. Meetings  or  events  subject  to
                be more carefully chosen                             change could be so  labeled,  and  we  could  con-
                  One further  suggestion:  in  the  future,  more   tact  the  area  coordinator  to  learn   of   any
                of an attempt  should  be  made  to  increase  the   changes.   This   lack   of   communication    was
                interchange of ideas  not  only  between  projects   partly  where  the  participatory   democracy   we
                within  the  city,  but  also  between  those  who   began  with   broke   down.-N.W.,   Law   Student,
                have been involved with  SHP's  in  the  past  and   Newark.
                those who  are  presently  working.  I,  for  one,
                am sorry that more of us ivere not able  to  visit     Any future project should not  try  to  consoli-
                other projects, but perhaps  this  is  unrealistic   date five separate areas  under  one  cover.  Per-
                in light of the time  factor.-L.C.,  Nursing  Stu-   haps  application  and   selection   of   students
                dent, Lower East Side.                               would  be  facilitated  by  one  mailing  address,
                Newark                                               but there should be  complete  and  absolute  com-
                                                                     munity     decentralization     (community-student
                  The  whole  program  suffered   from   lack   Of   NYCs  community   people-in   any   order).   This
                structure. People are used to  working  in  struc-   will greatly increase  the  effectiveness  of  the
                tured conditions so I think  they  would  be  most   project.-S.G. Educatz'on Director.
                effective  working  under  structured  conditions.
                I  think  it's  very  important  that  the   NYC's     SHP is leaning in the  right  direction  but  is
                work  with  health  science   students.   Somebody   not democratic  enough  (in  the  Grecian  sense).
                said to me that they don't see  a  place  for  the   The  Policy  Board  is  a  good  idea  but  should
                NYC's  unless  they  work  by  themselves.   There   function  as  a  communications  center  for   the
                has to be structure somewhere,  but  not  so  it's   benefit  of  individual  project   members.   This
                going to put out the  relationship  between  black   year  motions  were  made  and  voted  at  e  same
                and white students. I  think  the  project  should   meetings, therefore  coordinators  did  not  -dis-
                have  some  definite  goals.  White  students  and   cuss their votes with NYCs  and  fellows.  I  feel
                nonwhite   students   should   not    be    thrown   that the following  alternative  would  give  mem-
                into  a  community  and  allowed  to  spend  their   bers a  greater  sense  of  participation  without
                summer  "finding   themselves."   The   leadership   necessitating  their  presence  at  endless  meet-
                of  the  SHP,  together  with  community  workers,   ings: (a)  Any  member  can  attend  policy  board
                should have specific guidelines as to  where  Stu-   meetings;  (b)  Any  member  can  make  a   motion
                dent fellows will  work  and  what  they  will  be   at  a  policy  board  meeting;  (c)  Policy  board
                expected to accomplish.                              members have the option  only  to  second  or  not
                  I want to know what the  central  office  do-es.   second the motion; any  one  member  of  the  pol-
                  * * As  far  as  our  project  has  gone,  as  a   icy board can accept a  motion,  (d)  Motions  are
                meaningful  thing,  I  don't  think  the   central   not to be voted on by  the  policy  board  at  the
                office has had a damn  thing  to  do  with  it.  I   same meeting that they are  first  made.  Individ-
                figured that the people  who  were  going  to  run   ual coordinators should return to  the  area  pro-
                the central office were going  to  be  the  people   jects and  present  motions  to  all  members  who

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                                                 SUMMER  1968
         then   vote.   Each   coordinator   then   reports    ma- democracy.  No  generals,  no  officers.  They   now
         jority  vote  of  his  project  by  telephone  into  cen- have  officers.)-W.S.,   Medical   Student   Harlem.
         tral  @ff  who  tally  and   record   it;   (e)   Central The  structure  of  the  Greater   New   York   stu-
         staff  has  a  vote   equal   to   a   community,project. dent  health  project  this  summer  started  on   a
         -A.H., Medical Student, Newark.                         poor level. The project for  a  time  seemed  to  be
         Harlem                                                  nonexistent.  It  had  no  headquarters,  no  rules,
                                                                 no election of officers, no nothing. I met an  indi-
         The    "New    Left"    democratic     process     stinks vidual who  said  he  was  one  thing,  then  I  met
         as  a   way   of   running   an   SHP.   With   thousands another who  said  he  was  what  the  first  person
         of  dollars  of   Government   money   to   account   for had said he was.  In  my  specific  project,  I  be-
         a  contract   to   fulfill,   well-defined   bureaucratic lieve  I  encountered  four  persons  each  of  whom
         structure  is   required,   with   a   management   hier- at one time or another said he was in charge.
         archy    of    responsible    persons    selected     for Nearing   the   end   of   the   project,   however,
         leadership and managment capability'   who            can some  structure  seemed  to   have   been   in   the
         accept  the   responsibility   for   policy   and   plan- making. Directive  after  directive  began  to  flow
         ning   (as    well    as    day-to-day    decisionmaking)
         without       requiring       interminable       meetings into our  local  project.  We  read  of  the  topics
         where   everyone   has   the   right   to    speak    his discussed and passed.  *  *  *  Yes,  some  sort  Of
                                                                 structure  with  a  policy  making  body  and  vari-
         mind   no   matter   how   rapid   or   irrelevant    his ous  sanctions  finally  seemed  to  have   evolved.
         opinions.   There   is   no   guarantee   that    Grecian At  the  end  of  the  summer,  the  student  health
         democratic  vote  is  the  best   way   to   make   deci- project  had  just  been  created  -E.M.,  Law  Stu-
         sions,    especially    in    an    organization    whos.
                                                                 dent, Harle?n.
         members   generally    lack    sufficient    information,
         understanding,     and     experience     in     managing The central office staff   (personalities      ex-
         large  sums   of   money   or   supervising   people   at cluded)  served  a  dubious  role.  They   seem   to
         work.   Every   form    of    government    has    estab- have   evolved,   by   appointment    or    election
         lished  an   executive   wing   to   administer   day-to- (though -not elected by the  project  staff),  to  a
         day  matters  as  well  as   to   make   long-term   pol- position   of   policy-making   and    surveillance.
         icy    decisions.    Bureaucracy    may    have     many, Their  only  visible  activities  seemed   primarily
         many   faults    (whether    capitalistic    or    commu- to consist of  floating  from  project  to  project,
         nistic)  but  AT&T  runs   a   damned   efficient   tele- and  rapping  the  day  away.  (The  importance   is
         phone  business  and   they   don't   take   a   referen- not whether or not this is all  they  do,  but  this
         dum  every  time  a  decision  is   required.   As   long is the  impression  they  give  to  many  people  on
         as   some   checks   and   balances   exist   (such    as the project not otherwise informed.)
         open-door   policy   making)    we    need    not    fear Most   policymaking    council    decisions    were
         power placed in the hands of managers.                  reached  without  consulting  the  general   project
           Sol  next  time,  let's  establish   definite   organi- staff,  and  although  meetings  were   alleged   to
         zational   structure,   with   hire-and-fire   power   in have  included   representatives   of   the   group,
         the  hands  of  project  leadership,   and   a   definite these  meetings  were  sometimes  announced   I   or
         understanding   that    an    employee-ernployer    rela- 2  hours  beforehand,  when  it  was  impossible  to
         tionship  exists  between   the   project   fellows   and get  these  "representatives"  together.  Often   we
                                                                 were  not  told  the  purpose  of  the  meeting  and
         the   funding   agency.   Sure,    people    are    going
         to  object  to   doing   things   the   way   our   fath- could  make  no  provisions  to  attend.  The   cen-
         ers  did  them,  but  since  somebody   will   gripe   no tral office also saw fit to bless  us  with  favors-
                                                                 picnics,  educational  programs.   It   might   have
         matter   how   decisions   are   made,   or   how    much been  a  better  idea  to  consult   the   community
         structure  there  is  or  isn't,   why   not   let   them
         gripe   about   the   most   effective   and    efficient they inten ded  to  serve.-J.A.,   Medical   Student,
         method    of    managing    an    organization!     (N.B. Harlem.
         After   the   Revolution,   the   Russian    army    triedMy relationship  with  the  central  office  staff
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                                                     GREATER       NEW  YORK
                 was one of frustration and anger.  They  tried  to   structural  changes  should  be  made.   Some   of
                 pass this off as some sort of a participatory  or-   the frustration and feeling  of  being  at  "loose
                 ganization  and  then  they  would  send  out  an-   ends" and not knowing  how  to  direct  our  ener-
                 other "order". It is not  that  what  they  wanted   gies was due to the  fact  that  SHP  was  new  to
                 was  so  unreasonable,  but  rather  the  way   in   the  Lower  East  Side.  However,  much   of   the
                 which they did it. For  example,  they  asked  for   frustration  and  wasting  of  time   could   have
                 biweekly  reports  without   an   explanation   of   been avoided if the project had  been  more  care-
                 why they  wanted  or  needed  them.  In  addition,   fully  organized  before  the  summer  began.   It
                 they imposed  no  penalty  for  not  writing  one,   was  fine  to  say  wait  and  discuss   community
                 so those of us who  did  write  them  felt  rather   problems  with  people  in  the   community   such
                 foolish. To make  things  run  more  smoothly,  we   as   Neighborhood   Youth   Corps   workers    and
                 should have been able to  elect  a  representative   other  community  preceptors,   but   this   could
                 with an equal vote to sit in  on  the  policy-mak-   have  been  done  before  the  summer  began.   It
                 ing   meetings.   The   Central   Staff    members   took many of us as long as  three  weeks,  includ-
                 should not take out their  anger  on  the  student   ing orientation,  to  decide  what  we  wanted  to
                 fellows because the  response  to  something  that   do, organize material, and to  begin  doing  some-
                 the central staff is interested in was not  shared   thing. I also feel that placing  us  with  already
                 by  the  project  members.   The   black   history   existing  organizations  or  agencies  provides  a
                 classes are a  case  in  point.  Furthermore,  the   structure which  is  essential  at  least  in  the
                 central staff's penchant  for  trying  to  combine   early stages. One  must  also  consider  that  the
                 business with pleasure is  annoying  at  best.  If   Lower East Side  is  a  highly  sophisticated  and
                 and when  I  want  my  leisure  time  planned  for   well  organized  community  in  many   ways,   and
                 me, I will send a request for such a  service.  If   that  for  SHP  to  become  merely  another  sepa-
                 the  NYC's  want  a  vacation   in   upstate   New   rate organization is a poor idea.
                 York, they can have it. But  to  foist  this  upon     Many of us were  also  frustrated  by  the  lack
                 the rest of us is just not fair. If  we  have  not   of unity within the group. Perhaps it  is  unreal-
                 done our job, fire us, but to threaten not to  pay   isti'c to think that twenty students  plus  Neigh-
                 us if we do not attend  a  Final  Conference  that   borhood  Youth  Corps  teenagers  could   be   ex-
                 everyone knows  is  being  held  at  an  inconven-   pected to work together as a team. Perhaps i
                 ient place  for  many  of  us  because  the  NYC's   students were required  to  live  in  the  commun-
                 want  it,  is  just  economic  blackmail  of   the   ity and to become  involved  in  as  many  aspects
                 worst sort@F.V., Law Student, Harlem.                of community life  as  possible,  there  would  be
                 Brooklyn                                             more  community  concern  over  health   care   in
                                                                      the  broadest  sense.  By  this  I  mean  that  we
                   One of the faults with the structure of      the   should be  concerned  with  all  aspects  relating
                 SHP  was  the  lack   of   communication   between   to and influencing health care. One  of  the  most
                 the different areas of the project  (i.e.,  Brook-   valuable  experiences  I  had   was   door-to-door
                 lyn, the South  Bronx).  What  was  really  needed   work. Health care  is  a  basic  and  nonthreaten-
                 was a  newsletter  to  inform  the  people  in.the   ing subject which can serve as an  "in"  into  the
                 different  areas  of  what  was  happening.   Per-   family setting. Once into a home,  we  could  dis-
                 haps the  program  next  year  could  include  one   cuss other areas, such as  housing  or  education,
                 day in each week  in  which  each  group  went  to   with individual  families  and  try  to  help  the
                 visit  another  group  to  see  what  other  areas
                 were  doing.-D.Y.,  Medical   Student,   Brooklyn.   family  in  whatever  ways   we   could.   It   is
                                                                      more of  an  overall  understanding  of  the  many
                      LOCAL PROJECT STRUCTURE                         factors influencing health. It is for this  reason
                                                                      that I feel that  future  SHP  workers  should  at
                 Lower East Side                                      least  experience,  first-hand,  neighborhood  and
                   First of all, I feel there is a future  for  SHO   family settings.-L.C., Nursing                 "er
                 on the Lower East Side, but if it is to  continue,   East Side.

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                                                  SUMMER  1968

         There  was  no  feeling  of   an   SHP   structure   sources. Also, I think that there  should  be  two
        this summer, either  on  a  citywide  or  a  neigh-   student co-directors for  each  project  area,  so
        borhood  level.  There  was  only  the  SHP   name,   that  they  can  share  the  responsibilities  and
        and it interfered  with  our  work.  We  were  sup-   lend greater  objectivity  in  handling  all  mat-
        posed to feel allegiance to  an  organization  that   ters. Finally, I  think  more  concrete  community
        barely  existed  as  such.  The  whole  Lower  East   job  placements  should  be  made.  I  think  more
        Side SHP  met  together  once  a  week,  mainly  to   of an effort  should  be  directed  towards  work-
        criticize  each  other's  work.  These  discussions   ing  within  specific   community   organizations;
        were not very  constructive,  because  none  of  us   we  have  learned,  maybe  the  hard   way,   that
        knew  enough  about  each  other's  work  to   make   community   structure   does   exist.-L.G.,   Psy-
        meaningful   judgements   or    suggestions.    The   chology Student, Lower East Side.
        meetings became a kind  of  free-for-all  in  which   Newark
        one found oneself either  attacking  or  defending.
        The  only  goals  pronounced  by  the  Lower   East    Project  structure  was  not  deficient  in   any
        Side SHP were goals that each one  of  us,  as  in-   way that I noticed. I thought the lack  of  struc-
        dividuals,  had:  to  sensitize  ourselves  to  the   ture in our Newark  project  was  very  beneficial
        needs,  problems,  and  attitudes  of  the  commun-   as it allowed people  to  gravitate  to  or  seize
        ity,  and  to  produce  some  meaningful,   immedi-   upon  that  which  they  liked  best  and  thought
        ate   contribution    to    the    community.-M.H.,   would be most beneficial.  The  only  place  where
        Law Student, Lower East Side.                         lack of structure was really  detrimental  was  in
                                                              the  case  of  the  NYC's  who  often  sat  around
          I  think  the  Lower  East   Side   had   several   doing nothing until the last couple weeks  of  the
        problems.  First,  each  of  the  several  separate   project when,  I  suspect,  the  guys,  at  least,
        projects  seemed  isolated  from  the  others,  ex-   didn't  show  up  at   all.-N.W.,   Law   Student,
        cept for infrequent progress reports'       Second,   Newark.
        there  existed  an  atmosphere  of  tension   among
        the  student  fellows.  As  well-expressed  by  one     The local project is  basically  a  great  idea.
        student, "I don't think we really want  to  get  to   We  maintained  our  integrity  as  a  group   and
        know each other." I  feel  there  is  a  place  for   were able to  coordinte  our  efforts  in  several
        SHP  on  the  Lower  East  Side  next  summer,  but   areas. We were able  to  put  our  heads  together
        in view of  this  summer's  events,  it  should  be   nearly  every  day.  We  all  worked  out  of  our
        better  structured.  Each  student  fellow   should   UCC office  space.  It  facilitated  communication
        be made  aware,  before  being  accepted,  that  he   and  kept  morale  higher  than  it   would   have
        is taking on a full-time job,  not  a  nine-to-five   been if  we  were  separated.  When  we  met  with
        responsibility. If  a  student  has  other  obliga-   hospital personnel we had at least 15 to  20  peo-
        tions, he  must  either  adjust  them  so  they  do   ple there. The benefits of a  cohesive  group  are
        not conflict  with  SHP  activities,  or  not  work   many  when  operating  in  a  resistive   environ-
        on the project.                                       ment. I think people had  more  confidence  and  a
                                                              large fund of  ideas  and  opinions  were  availa-
          All  SHP  members  should  live  in   the   coni-
        munity  in  which  they  'will   work,   preferably   ble.  We  stimulated  each  other.-A.H.,   Medical
        nearby  or  together.  This  would   help   improve   Student, Newark.
        interpersonal  relations-we  would  get   to   know     The  structure  of  the  project   should   have
        each  other  better  and  be  more   cognizant   of   been more carefully laid out  and  adhered  to.  I
        what each  other  was  doing.  There  should  be  a   went to  Newark  expecting  to  work  as  a  nurse
        store-front which not  only  serves  as  a  meeting   in a clinic, in a  storefront,  in  the  emergency
        place for SHP, but which  offers  some  service  to   room, anyplace; I  wound  up  painting  signs  and
        the community.                                        not at all utilizing the one sure skill I have.  I
          If  people  in  the   community   want   informa-   recognize some degree of unpredictability  is  in-
        tion about health care  housing,  etc.,  we  should   evitable,  but  we  were  almost  totally  without
        be able to offer @ it or direct them to the  proper   structure  in  pursuing  the  vanishing  hope   of

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               "Improved  Medical   Care."   Several   different     As far as the leadership is concerned,  I  feel
               groups evolved, divided along racial  lines,  and   that a better system  might  have  been  the  ap-
               pursued what they thought was  the  goal  of  the   pointment of provisional  coordinators  and  Cen-
               project. This might  even  have  been  acceptable   tral Office staff, and after the groups  had  be-
               if there had been some coordination,  some  feel-   come  acquainted  with  each   other,   elections
               ing of  unity.  There  was  not  much  among  the   could  have  been  held,  giving  somewhat  of  a
               factions, just  a  sort  of  palid  coexistence.-   democratic structure  to  the  "governing"  body.
               A.M., Nursing Student, Newark.                      -i.A., Medical Student, Harlem.
               Bronx                                                 Although some of  the  nonhealth  science  stu-
                In  addition  to  problems   with   cohesiveness   dents didn't get  properly  integrated  into  the
               and  communications,  there   were   difficulties   group right away  because  the  whole  thing  was
                                                                   o unstructured, I  think  the  Harlem  group  had
               with job descriptions. This  seemed  particularly   S"
               evident in  the  Bronx  unwed  mothers'  program.   tne least group interaction problems of  all  the
               The  community  workers  seemed  the  most   con-   projects. I don't  think  the  inter-disciplinary
               fused. Since this is the first summer that  there   team  question  every  really  arose.  We  worked
               have  been  community  workers,  it   is   under-   together   as   individuals-not   "professionals"
                                                                     and  since  the  mothers  were  adults   rather
               standable that  there  was  some  confusion.  An-   -
               other reason  for  confusion  was  poor  orienta-   than NYCS, there was never  a  question  of  con-
               tion.                                               descension   between   students   and   community
                One  of  the  roles  which  I   thought   needed   People. Some of us  at  first  (myself  included)
               clearer definition was that of the  project  coor   were  condescending  toward  some  of  the   non-
               dinator. I see the project coordinator as a  per:   health science  students  because  we  felt  that
               son who spends a lot of time visiting  the  vari-   they didn't really care  enough,  but  after  the
                                                                   air was cleared on that  I  think  things  worked
               ous programs in the projects  and  setting  up  a   well.
               rapport  between   institutions   and   community
               groups.  Our  coordinator  spent  most   of   her     I think it was  especially  important  that  we
               time in the office, and I think  she  would  have   all  worked  out  of  the  same  house.  We  were
               been of  better  assistance  if  she  would  have   able  to  maintain  a  much  better  group  sense
               spent more time in the community.  She  also  be-   than  some  of  the  other  projects  that   were
               came too much of a director  instead  of  a  con-   spread  around  in  different  agencies,  and  we
               sultant. She seemed  afraid  to  delegate  respon-  were all able to keep sufficiently in touch  with
               sibility which inhibited  our  making  plans  and   what everyone was doing so  that  we  could  lend
               decisions  on  our  own.-V.V.,  Nursing  Student,   a  hand  when  necessary.  Because  people   were
               Bronx.                                              always in touch,  'we  didn't  have  the  typical
                                                                   kinds of confrontation  or  sensitivity  sessions
               Harlem                                              (that some people  think  are  essential  in  SHP
                 Concerning the structure  of  the  Harlem  pro-   projects) because things often got talked Out  in
               ject, one important  thing  was  overlooked.  The   small bull sessions  before  matters  came  to  a
               students  who  organized  it  wanted  a   loosely   head. There was  a  disadvantage  to  this,  how-
               structured  organization  with  abstract   duties   ever, in that some  things  concerning  the  phi-
               and responsibilities taken on by the  individuals   losophy  of  what  we  were  doing  and  how   we
               themselves, with no real  power  structure.  This   were going about  it  didn't  surface  until  the
               would have been  fine  if  the  organization  had   end.-W.S., Medical Student, Harlem.
               consisted only of students, but in  dealing  with
               members   of   the   community   we   were   made   Brooklyn
               aware  that  they  demanded  much   more   of   a     I feel that there were too  many  small  groups
               structure.  They   wanted   to   know   who   the   in the Brooklyn area,  and  that  in  the  future
               leaders were,'what everyone's  duties  were,  and   these small groups should  be  incorporated  into
               to whom they were responsible.                      larger  area  priority  groups  which  need  man-

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                                              SUMMER  1968
     power,  or  have  people  "float"  from  group   to   be fulfilled. It  is  good  to  sit  down  and  plan
     group as each  group  needs  extra  help  for  spe-   what we are going  to  do;  but  it  is  unrealistic
     cific  projects,  e.g.,  the  lead  poisoning  cam-   for people with  little  knowledge  of  what  it  is
     paign.  I  would  like  to  see  an  area  such  as   possible  to  accomplish  in  one  summer  to.   sit
     Brooklyn develop one  or  two  priority  goals  and   down  and  write  something  up  in  order  to   get
     spend   the   entire   summer   developing    these   funded.  What  they  write   up   may   often   have
     ideas and  then  wind  up  with  a  concrete  plan,   little  relevance  to   what   they   actually   do.
     proposal,  mass  meeting,  etc.,  so   that   these   They  then  begin  to  feel  that   they   are   not
     ideas can be carried on  by  other  than  SHP  peo-   fulfilling their jobs and  they  have  the  tendency
     ple.-S.P., Dental Student, Brooklyn.                  either to  get  upset  or  to  work  harder  towards
                                                           their  original  goals,  without  sitting  down   to
                       FUNDING                             evaluate whether or  not  their  goals  are  realis-
      The  structure  of  an  organization   can   often   tic. What I am trying to say  is  that  people  with
     make for success or lack of success of  its  activ-   comparatively  little  experience  should  not   ex-
     ities;  there  were  many  elements  of  this  sum-   pect  themselves  to   accomplish   very   much   in
     mer's SHP which I felt  limited  one's  ability  to   two  months.  When  they  write  up   some   impres-
     act effectively. By "structure" I  mean  any  deci-   sive goals they  soon  begin  to  expect  themselves
     sion  which  is  made  regarding  how  the  project   to accomplish these goals and are  not  as  flexible
     is to be run, who will run it, etc. Thus, any  lack   as they otherwise  might  have  been.  I  feel  that
     of organization Iis part of  the  structure  of  the                                          Ives    with
                                                           students should first familiarize themse
                                                           their  community  and  then  have   tasks   outlined
     SHP.
      The first bad  decision  made  was  for  the  Stu-   by  responsible  community  groups.  it  should   be
     dents  to  be  funded  by  a   Government   agency'   up to these groups to  decide  whether  or  not  the
     This put  us  in  the  position  of  another  group   students are performing effectively;  this  is  hard
     vying for funds to  "help  the  poor  people,"  and   to do if a proposal is on file  with  a  Governnxent
     immediately  set  us  apart  as  a  group  who  was   agency  that  is  paying  and  therefore  ultimately
     being paid to be in a poor  community.  It  was  at   controls  the  students  whether  they  like  it  or
     least fortunate that we  did  not  get  funds  from   -not.
     OEO,  as   we   might   then   have   been   taking     While  we're  on  the  subject  of  money,   which
     money  from   other   groups   composed   more   of   after  all  is  what  separates  rich  people   from
     grassroots  people.  Our   advantage   in   getting   poor people, I  feel  that  all  salaries  were  too
     funds  would  have  been  that   we   were   mostly   high  this  summer.  This  prevents  effective   ae-
     middle  class  people  with  a  good  idea   rather
                                                           T'lon for several reasons..  First,  community  peo-
     than  community  people  trying  to  get  money  to   ple tend to  be  suspicious  of  white  middle-class
     increase power over their own lives.                  students  who  are  paid  a  very  high  salary   to
     .  Another  problem  that  goes  along  with  writ-
     ing up a grant for  government  funds  is  that  we   enter their community. There  is  very  little  that
     become  responsible  to  the  funding  agent,   and   a  student  can  actually  do  in  two  months   and
     are no  longer  answerable  strictly  to  the  com-   this  increases  hard  feelings   towards   students
     munity.  Several  instances  have  come  up   where   who  "aren't  doing  anything."  It  is  bad  enough
                                                           when  people   ask,   "What   are   those   students
     it was necessary  to  consult  our  funding  agency   doing,  anyway?"  But  it  is  much  worse  when  it
     as to whether or not  we  could  undertake  a  spe-   is discovered what their salary is. I feel  that  it
     cific  project  recommended   by   community   con-
     sultants, or whether or  not  we  could  use  funds   was   similarly   wrong   to   pay   community   co-
     for various purposes not  outlined  in  the  grant.   directors and workers  such  a  high  salary.  R  is
     This limits the degree to  which  we  may  use  re-   commonly  known  that  one  of  the  best  ways  for
     sources given us through funding.                     bright   community   people   to-   get   ahead   is
       There is  also  a  problem  inherent  in  writing   through  one  of  the  antipoverty  agencies,  which
     up a  proposal  for  Government  approval  in  that   actively   seek   community   people   as   partici-
     we begin to think in terms  of  a  task  that  must   pants, but  not  as  administrators.  I  think  that
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                                                   GREATER       NEW  YORK
               this  system  creates  resentment  among  the  rest   NYC's  were   paid   by   a   different   organiza-
               of  the  community  which  is  "left  behind,"  and   tion, which added another voice,  at  least  poten-
               tends to separate  good  leaders  from  their  com-   tially,  as  to  what  could  be  done  during  the
               munities. I feel that all workers  on  the  Project   summer.  Also,  the  NYC's  should  be   paid   the
               should be paid  the  same  subsistence  salary.  In   same  salary  as  everyone  else.   Otherwise   our
               this way it can  be  seen  that  the  students  are   talk  about  being  colleagues  and  being  equals,
               not  in  the  community  for  the  money,  but  be-   and the  students'  not  being  the  NYCs'  bosses,
               cause  they  really  care.  And  community   people   is  nonsense.  The  argument  is  sometimes  raised
               will not be reluctant to  work  with  us  for  fear   that the  NYCs  are  younger  and  don't  have  the
               of  being  resented  by  their   fellow   community   same  educational  and  job  experience.  If   this
               members for  sticking  with  the  white  people  to   is valid, then students should be  paid  less  than
               get high pay.                                         community workers  who  are  twice  their  age.  If
                It  has  become  evident  that  with  our  present   the argument  about  education  is  valid  then  we
               personnel and structure it  is  impossible  to  ac-   are  building  inequality  into  our  project,  for
               complish  the  things  we  had  hoped  to  do.   As   many  poor  and  nonwhite  people  are   denied   a
               long as people are here for  money,  and  are  res-   chance  to  compete   with   white   middle   class
               ponsible  to  some  superstructure  which   rewards   People on  the  basis  of  not  having  had  enough
               or punishes them  for  their  actions  with  a  sa-   ducation;  furthermore,   they   are   consistently
               lary, they cannot honestly  tell  people  they  are   aenied the chance  for  a  good  education.  If  we
               here because they care  about  them.  It  seems  to   didn't learn that  this  summer,  we  may  as  well
               me  that  the  same  setup   that   denies   people   not come  back.  A  project  designed  to  overcome
               down  here  many   opportunities   (including   the   inequalities should  put  all  its  members  on  an
               opportunity for good health care)  is  the  set  up   equal basis, answerable  equally  to  one  another.
               which gives us a more  than  equal  chance  to  get   @l of us should  be  colleagues,  each  with  some-
               a  good  education,  good  pay,   become   doctors,   tnlng  different,  and   something   valuable,   to
               etc.                                                  offer  for  the  common  good.  We  must  set   one
                 If we want to correct this situation as  it  per-   standard for all of us to live up to,  so  that  we
               tains to health  care,  we  must  resent  ourselves   all finish the race at  the  same  time,  not  some
                                              p                      of  us  ahead  and   others   behind.-Student   Co-
               as  concerned  individuals   who   recognize   that   ordinator, Lower East Side.
               our advantages are the other side of  the  coin  of
               others'  disadvantages.  If  SHO  fellows  continue     One  ongoing  argument  that  we  have   had   in
               to  benefit  from  this  system  by  being  paid  a   the  Lower   East   Side   project   has   centered
               large  salary  for  "helping"  the   poor   people,   around the  money  that  we  have  been  paid  this
               they are propagating  the  very  set  of  inequali-   summer as a major factor  in  the  loose,  unstruc-
               ties they want  to  destroy.  They  therefore  must   tured,  and  often  unsuccessful  project.  In   my
               decide  to  reject  the  benefits  and  make   some   opinion, the  fact  that  we  have  been  paid for
               sort of personal sacrifice, in order to be free  to   our work  has  little  to  do  with  how  well our
               see other people's situations, and to  be  free  to   project proceeded.
               talk to them as people. I  realize  that  my  ideas     *  *  *  The  other  argument   made   about our
               are hard  to  explain  in  words,  but  I  do  feel   earning  so'  much  and  the   NYC's   earning too
               strongly that this way of conceptualizing  is  a  -   little  has  also  bothered  me.   The   NYC's are
                                                             .   p
               propriate, and  we  must  learn  to  conceptualize.   young  people,  and  when  we  were  their  age  it
               I don't want to put  across  a  sense  of  "guilt"-   was also difficult for us  to  earn.  The  fact  is
               just a recognition  of  our  position.  As  members   that we are not the equals of  the  NYC's  in  just
               of   the   SHO,   paid   $900   by   a   Government   about  every  way,  and  the  concept  of  treating
               agency,  we  are  limited  by   being   representa-   them as if they  were  our  equals  has  seemed  to
               tives of a bad  structure.  We  are  distrusted  by   be one of the greatest farces. It is one  thing  to
               the people we wish to reach.                          respect someone's  opinion  and  to  give  them  an
                 A  final  problem  in  this  area  was  that  the   equal opportunity to  express  themselves;  but  it

               108


                                              SUMMER  1968
       is  another  to  expect  the  same  maturity   and   the bogus  play  because  the  one   area   that   com-
       same    concentration    from    considerably    younger plained the  most  about  needing  their  own  stu-
       people.-P.S.,    Medical     Student,     Lower     East dents  developed  the  least  potential  for   com-
                                                              mun.ity   projects.)   A'proximately   half   of    the
       Side.                                                                    p
       My   suggestion   is   that   student   fellows   should project participants were on  the  "reserve  list".
       start  at  $60  per  week,  serve  a  probationary   pe- Applications  of  out-of-city  students  and   non-
       riod  of  five  weeks,  and  after  evaluation  by   the reserve  New  York  City.  students  were  read  by
       staff  and  community   workers,   as   well   as   area groups of our students  and  rated  highly  desira-
       coordinators,  be  given  salary  raises   computed   to ble, acceptable, and  undesirable.  The  distillate
       bring  their  total  summer's  earnings  to  the   allo- of  these  applications  (the  "highly   desirable"
       cated $900. It is a hell of a bad situation            group) was read to  the  entire  group  and  rated.
                                                not          to The  highest  scorers  were  phoned  and  asked  to
       be  able  to  control  the  miserable  rabble  who   de- come to New  York.  Not  all  of  these  applicants
       cide  that  student  health  project  is  an  easy   way accepted so  the  lower  scorers  were  called  and
       to  make  money   for   the   summer.   Before   I   be-
       came   involved   with    SHO    a    nursing    student subsequently  the  "acceptable"  group  of   appli-
                                                              cations  was  delved  into.-S.G.,   Education   Di-
       said  to   me   that   "Student   Health   is   a   good
       way  to  earn  $900  doing  nothing  I"   Every   effort rector.
       must  be  made  to   eradicate   this   idea   and   up- Interview
       root this attitude  if  the  job  is  to  be  approached Someone  told  me  the  other  day  that  the   SHO
       with  the  honesty   and   dedication   it   needs   and doesn't  rehire  the  same  students   each   year,
       deserves.   There   must   be   a   method   or   device they have some  policy  where  they  want  to  give
       for   firing    people.-B.B.,    Student    Coordinator, everyone  a  chance  to  come  and  see  what  com-
       Bronx.                                                 munity  medicine  should  involve.  That's  stupid,
       SHO    should    strive    for    joint-funding     with because the first time  the  medical  students  are
       community   agencies   such   as    LABOR    and    plan here they go through a lot of  changes,  a  lot  of
       a  project  based  on  the   twin   issues   of   health hangups, annoy a lot of people,  and  it  may  take
       and   housing.   SHP    should    also    get    funding them a long  time  to  get  straightened  out.  But
       from   foundations   to   begin   work    on    changing after they've reached  that  point,  if  you  don't
       the  institutions  that  project  fellows   come   from, bring  them  back  again,  you're  making  a   mis-
       specifically   continuing   programs   to   get   ghetto take.  The  -new  students  have  to   start   from
       residents   into   professional   schools.-K.B.,    Med- scratch all over again. If you  brought  the  expe-
       ical School, Bronx.                                    rienced ones back, they  wouldn't  have  all  these
                                                              hangups as  to  the.black-w,.ite  issue,  and  they
          STUDENT FELLOW SELECTION                            would know  what  they  could  do,  and  start  im-
        In   late   April   1968,   twelve   or   so   students mediately doing it.
       from  the  five  Greater  New   York   areas   met   and This  policy  indicates  the  student  health   or-
       read  all  of  the   goo   applications   received.   We ganization's  orientation  to  this   thing.   They
       agreed  to  accept  as  many  black   students   as   we want  students  to  learn   about   black   people-
       could,   and   accepted   all   the   applicants    from which would be for  their  benefit.  And  it  would
       Howard   and   Meharry    medical    schools'.    Ironi- make them feel good that they  had  done  a  little
       cally,  as  a  recruitment   device   for   black   stu- something to help the cause,  and  these  kids  are
       dents,  this  did  not  work  100   percent.   Two   out supposed to go back  and  stir  up  other  students
       of  seven  such  students  were  white.  We   also   ac- in their medical  school.  But  that's  a  pile  of
       cepted  all  other  people  who  indicated   that   they rubbish  because  there's  thousands   more   white
       were  black  or  Puerto   Rican.   The   students   from medical students who  haven't  got  the  least  in-
       the  five  areas  were  very  concerned   about   conti- terest in coming here. And  even  if  all  of  them
       nuity  after  the  summer,  so  they   were   asked   to had  a  chance  to  come  here  for   the   summer,
       draw  up  lists  of  students  they   wanted   to   "re- first of all they don't have to live like the  peo-
       serve".   (Subsequently   this   proved    to    be    aple live here.  They  may  be  able  to  sympathize
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                                                     GREATER        NEW  YORK
               with  these  people,  having   seen   the   conditions    I  wish  to  take  issue  with  the  composition   of
               and what  people  have  to  go  through,  but  if  you   SHP. I  sincerely  wish  to  register  a  strong  pro-
               don't come back again,  if  you  don't  stay,  it's  a   test.   Here   are   my   feelings   and   recommenda-
               waste.  All  you  do  is  understand   the   problems,   tions: I  think  project  comp.osition   should    be'as
               maybe, and  you  can  go  and  talk  to  your  friends   close to  100  percent  black  students  as  possible.
               about  them,   verbalize   the   problems,   but   you   At this  point  in  black  history  in  this  country,
               won't be able to do anything.                            black   people   need   black   leadership   to   give
                 I  would  say,  based  on   one   summer's   experi-   them   any   meaningful   stimulation    and    incen-
               ence,  that  I  don't  think  SHO  is  useful  in  the   tive. In a  situation  where  conditions  are  so  ex-
               long  run.  Take  these   white   people   that   work   treme and  time  so  short,  the  time  spent  batter-
               here  in  the  summer,   or   work   here   all   year   ing  down  the  color   barrier   between   yourselves
               round,  like  these  hospital  people;  they're   here   and  that   community   is   too   dear.-A.M.,   Nurs-
               with  this  problem  all  the  time,  and  they  still   ing Student, N&wark.
               offer  bad  medical  service.  They  haven't   learned    I   think   SHP   might   work   next    summer    if
               a damn  thing.  As  a  matter  of  fact,  they're  the   project  members  are  selected   differently.   There
               ones who're responsible for the bad service.             must  be  more  community  people  in   the   project.
                 So  you  bring  some  white  kids   in   here,   and   There  should  be  at  least   one   adult   community
               they're  going  to  see  a  few   things.   But   when   worker   to   every   health   science   student   and
               they  go  back  to  school  they're  going  to   start   NYC.   In   selecting   applicants,   students    from
               studying,  they're  going  to  fall  for  the   set-up   the   surrounding   area   should   be   given   first
               which   was   already   set   out   for   them,    and   priority so  that  SHP  can  be  a  continuing  thing-
               they're  going  to  say,  "Well,  I  had  the  experi-   Students should  not  be  selected  on  the  basis  of
               ence."  But  they  wGn't  be  able  to   do   anything   an  essay  on  "why  I  should  be  a  member  of  the
               about it.                                                project."  Every  applicant   should   have   a   per-
                 What  SHO   should   do   is   see   about   getting   sonal interview before final selection.
               programs  for  black  people  which  will   be   black     Selection  of  members  for   the   project   should
               run.  One  of  the  first  things  I  noticed  when  I   not be so final that once youtre  in,  you're  in  for
               came  in   here   was   that   we   need   some   more   good.  Members  who  do  not   want   to   work   with
               black   people   in   this   thing.-R.P.,    Community   and  for  the  project  should  be   fired   and   re-
               Coordinator, Newark.                                     placed.  It's  fine  and  dandy  if  members  want  to
                 Hiring:  Not  fair  to  ignore   rejected   applica-   do  their  "own  thing"  but  they  must  also   spend
                                                                        a major part of their ti  e with the entire p
               tions  when  first  choices  decide   on   other   em-                             m                        ro-
               ployment.   We   hired   one   student    about    one   ject on  a  United  effort  to  improve  health  care.
               month  into  the  project.  He  was  the   nephew   of   Doing   your   "own   thing"   may   help   to    make
               Dr.  Important.  This  guy  did  little,  said   noth-   small  improvements  and  give   you   personal   sat-
               ing, and was rarely seen.                                isfaction,  but  no  massive  changes  are  going   to
                 Firing: In  a  project  such  as  ours  every  free-   occur  unless  the   project   members   unite   their
               dom  should  be  given;  an   atmosphere   of   confi-   efforts.-L.D., Nursing Student, Newark.
               dence  and  optimism  is  essential   for   any   cre-     There  is  a  definite  need  for  some  changes  in
               ative  unfolding.  People  should   never   be   fired   policy  so  that  SHP  of  1969,  if   existent,   can
               for  failing,  only  not  working,   for   not   doing   function   more   effectively   with    less    wasted
               anything.   If   complaints   are   made   against   a   money  and  energy.   There   should   be   a   hiring
               member,  the  policy  council  should   consider   the   policy  that  attempts  to  accept  only   those   who
               complaints  and  vote  to  drop  the   complaint,   or   are  sincere  to  the  cause.  Interviews  would  seem
               warn  the  individual  in  question,  or  request  the   to  be  more  revealing  (than  essays)  and   perhaps
               individual  to  appear  and  explain   his   position.   interviews  with  a  member  of  the   specific   com-
               Where  or  how  someone  is  working   is   irrelevant   munity  who  is  working  on  the  project  would   be
               @nly   if   he   is   working.-A.H.,   Medical    Stu-   most productive'
               dent, Newark.                                               A firing  policy  should  also  exist  to  rid  the

               110


                                                     SUMMER  1968
        project  of  any  phony  liberals   who   are   goofing   for  some  of  them   to   realize   what's   happening
        off  or  just  there  to  exploit  the  community   for   goals.  After  all,  it  takes  over  half  the  summer
        their   own   gains.-K.S.,   Nursing   Student,    New-   for  some  of  them  to   realize   what's.   happening
        ark.                                                      in  the   community.   The   others   never   know.   I
          The  students  who  were  assigned   to   this   pro-   feel  that  only  students  having  at  least  a   full
        j ect, with  the  exception  of   a   few,   should   not year's  experiences  in  a   community   can   go   and
        have  been  included  in  a   program   of   this   na-   work   there   during   the   summer.   Students    who
                                                                  want   to   become   aware    of    community    health
        ture. Some   of   them   came   into    the    community
        only for    personal    advancement;    the     narrow-   and  needs  can  learn   initially   through   seminars
        ness of  their  motivation   limited   the   effective-   and  discussion   workshops   outside   of   the   com-
        ness of  their  work.  Two   students   in   particular   munity  in  their  schools.   Those   who   are   still
        caused  me  great   concern.   They   needed   constant   more   concerned   can   apply   for   part-time   jobs
        direction,  not  only  about  what  to  do,   but   how   during   the   summer   with   a   community    agency.
        to do it, and  at  the  end  of  ten  weeks  were  just   They   would   then   be   under   the   responsibility
        beginning   to   show   anything    that    could    be   and  authority  of   that   agency.   I   would   never
        called  initiative   and   creativity.   A   short-term   like  to  see  another  SHP   go   into   a   community
        project  suffers  when  it  is  staffed  with  liabili-   area  where  very  few  of   the   fellows   personally
        ties.                                                     know  what  the  hell  to  do  and  when  to  do   it.-
                                                                  G.L., Dental Student, Lower East Side.          .   I
          Medical  people   who   are   usually   far   removed     For  next  summer,   it   is   important   that   the
        from   grassroots   community   work   -need   to    be   SHP  attempt  to  bring  back   people   with   experi-
        sensitized  and  attuned  to  the   problems   of   the   ence  in  community  health  in  the  areas  they   are
        urban poor  areas,  but  not  at  the  expense  of  the   located.  A   single   summer   on   the   Lower   East
        community they profess to serve. A          .    10-week  Side  is  no  more  than   an   introduction   to   the
        program   cannot   sustain   the    inconvenience    Of   problems  of  health  care  in   this   community.   It
        being   burdened   with   out-of-@te    students    Wlo   is   on-the-job   training   in    community    health,
        have  to  be   taught   how   to   communicate   before   with  an  emphasis  on  the  training,   not   on   the
        they  can  operate  effectively.  Students   who   come   job.  Involving  students   in   programs   this   win-
        lacking  skills  in  contact  with   the   urban   poor   ter,  or  having  them   return   to   the   SHP   next
        should  come  in  as  volunteers  in  order  to  learn,   summer,  will  enable  students  to   use   what   they
        not  as  paid  personnel  in   order   to   experiment.   have  learned  for  the  benefit  of   the   community.
        The  experience  they  gain  is  pay  in  itself,   for
        they  certainly  get   more   out   of   the   exposure   If this  is  not  done,  the  summer  will  have  been,
        than they can possibly contribute.                        in  the  words  of  the  black  caucus,   "two   months
                                                                  in  the  sun  seeing  how  the   niggers   liVe."-4.A.,
          Next  summer  if  there  is   a   project,   students   Medical Student, Lower East Side.
        and   community   people   who    worked    effectively     The  majority  of  -the  students  chosen   for   the
        this   summer   should   be   given    priority    when   SHP  should  be   from   the   area   in   which   they
        staffing begins. A  project  of  this  sort  can  func-   will  work  in  order  to  insure  a  transition  staff
        tion  more  effectively  if  the  same   people   corn-   for   year-round    work.    Allowances    should    be
        bine their efforts to identify  the  causes  for  iaii-   made  where  necessary  to   preserve   the   interdis-
        ure  and  the  reasons  for  success  and   make   c@n-   ciplinary   approach.   New   students    should    not
        crete  plans   to   restructure   the   program,-B,j5,'   have  to  go  through  some  of  the  basic,   orienta-
        Student Coordinator, Bronx.                               tion  for  half  of  the  summer  in  the  areas  where
          From   the   experiences    and    observations    of   projects  have  already   existed.   Structured.   dis-
        this summer,  I  do  not  feel  that  there  should  be   cussions     and     seminars     with      experienced
        another   SHP   like   this   summer's.   Any    health   workers  are  suggested  to  help  prepare   them.   It
        professional  student  not  having  a  good   deal   of   is  advisable  that  the  project  be  planned  -so  as
        involvement   in    the    community    doesn't    have   not  to  require  needless  repetition   at   the   ex-
        any  business   in   the   community.   Such   students   pense  of   the   community.-L.K.,   Medical   @   Stu-
        only   hinder   and   screw   up   the   projects   and   dent, Brooklyn.


                                                  GREATER        NEW  YORK
                     INTERDISCIPLINARY TEAM                         and  two  nursing  students  were   familiar   with
                I found  that  working  with  students  from  all   the  technique  of  group  catharsis  whereby  per-
                                                                    sons who  -work  together  under  tension  can  get
              different fields  was  a  very  worthwhile  experi-   together for an hour a  week  after  work  to  dis-
              ence.   Each   of   the   fellows   had   something
              unique  to  offer  the  project.  The   interdisci-   cuss  all  their  likes  and  dislikes  about  each
              plinary  team  at  Kings  County  Hospital   worked   other and  their  work.  Properly  conducted,  such
              very well  together  and  used  the  combined  tal-     session can  act  as  a  real  help  in  reducing
              ents of the members,  with  their  individual  con-   Iriction  in  their  work.-N.W.,   Law   Stitde)zt,
              tributions,  to  a  great   extent.-D.Y.,   Medical   Newark.
              Student, Brooklyn.                                      The   interdisciplinary   team    is    a    good
                The concept of an  interdisciplinary  team  is  a   thought,  but  relatively  meaningless   once   put
              sound one  and  in  practice  is  both  stimulating   into  operation.  Personality  problems  can  occur
              and enlightening. The  availability  of  legal  ad_   anywhere  in  the  team.  Having  a   law   student
              vice was helpful on  several  occasions,  and  edu-   on hand is worthless  unless  the  student  is  al-
              cational. In the  lead  poisoning  project  and  at   ready familiar with  urban  politics  and  law.  In
              the  hospital-based  projects,   nursing,   dental,   the  case  of  the  city  of  Newark,  the   "team"
              and social  work  students,  with  their  different   loses  even  more  relevance.  People  on  the  un-
              outlooks   and   approaches,   complimented    each   dergraduate level  could  function  just  as  well.
              other.-L.K., Medical Student, Brooklyn.               They would spend  less  of  their  time  trying  to
                                                                    use  clinical  procedure;  they  wouldn't  use  the
                This aspect of the project was one       of   the   project as hustle for medical  or  dental  school.-
              most valuable factors for the success      of   the   R.P., Community Coordinator, Newark.
              project. I felt, as a sociology student   with    a
              background  in  education,   that   I   contributed     I   think   the   biggest   problem   among   the
              much towards making          y   colleagues    more   health  science  students  was  lack  of   communi-
              aware  of  the  importance  of  role  relationships   cation. Some  of  the  health  science  students  I
              and  informal  organization   in   the   hospital.-   barely saw all  summer.  I  had  vague  ideas  what
              M.H., So@logy Student, Brooklyn.                      they were doing,  but  did  not  know  how,  if  at
                                                                    all, we could  be  of  help  to  each  other.  Many
                The  medical  students   whom   I   worked   with   times  I  felt  there  were  hard  feelings   among
              were quite understanding  and  easy  to  get  along   the health science  students  and  we  were  unable
              with.  Anything  which  I  thought   would   arouse   to  communicate  these  feelings  to  each   other.
              any  difficulty,  I  directed  to  the  students  I   Many times a lot of people did  a  lot  of  talking
              worked with, and they'd  explain  it  to  me  until   and no one did any listening. I think  the  inabil-
              I was able to comprehend  and  direct  it  back  to   ity to listen on the part of  many  of  the  health
              them, They treated us as  equals  to  them,  and  I   science  students  created  the  big  communication
              grew   to   respect   them   for   it.-L.J.,   NYC,   problem.  A  weekly   sensitivity   session   might
              Brooklyn.                                             have  helped  this  problem.  By  sensitivity  ses-
                The interdisciplinary  team  was  helpful  as  it   '9ions, I  do  not  mean  a  meeting  where  people
              brought together  a  variety  of  skills  and  out-   give their philosophies of life, tell  about  their
              looks that helped in solving  or  at  least  iecog-   general  gripes  and  throw  a   bunch   of   vague
              nizing  causes  of  problems.  An  example  is  the   nonsense at each  other.  By  sensitivity,  I  mean
              highly  charged   atmosphere   of   the   emergency   the group should  sit  down  together  and  express
              room where  people  were  often  treated  as  some-   specific feelings about the  project,  individuals,
              thing less than people.  One  student  had  a  Mas-   their  work,  and  problems  they've   encountered.
              ter's degree  in  psychology  and  recognized  that   This requires  not  only  the  ability  to  express
              it was the  tension  of  their  work  which  caused   your feelings freely, but also the ability to  lis-
              many  of  the  employees  in  the  emer  ney   room   ten  to  others   express   their   feelings.-L.D.,
                                                   ,ge
              to occasionally treat people  without  dignity.  He   Nursing Student, Newairk.

              112


                                              SUMMER  1968
      My   "working"   relationship   with   our    law    It's  a  funny  thing   about   the   interdisci-
     student was not profitable. I could  not  seem  to   plinary team.  We  nurses  are-very  touchy  crea-
     fit his work in with anything I was doing.  I  en-   tures about  getting  @pped  on  by  doctors,  and
     countered a  patient  who  had  fallen  downstairs   often, since we are very  dedicated  to  the  idea
     in her apartment  building  for  the  second  time   of the "team",  get  very  up-in-arms  about  doc-
     and hurt  her  back  because  the  landlord  would   tors' attitudes. At the beginning  of  the  summer
     not fix the stairs.  I  thought  the  law  student   before we started  working,  before  we  knew  one
     might be interested in the  case,  but  he  seemed   another, the situation was very  tense,  but  once
     to think there  was  nothing  he  could  do  about   work progressed,  except  for  the  "normal"  jok-
     it.                                                  ing, we worked as one group, not  as  students  of
      I think  the  other  project  members  were  able   nursing or  students  of  medicine.  We  did  make
     to use  me  when  they  came  up  with  a  problem   one mistake; because  we  worked  as  health  sci-
     concerning   prenatal   care,   postpartem   care,   ence students I wasn't  always  cognizant  of  the
     birth control, or anything else related  to  nurs-   different  disciplines,  so  when  my  group   was
     ing.-L.D., Nursing Student, Newark.                  having some difficulties on  a  legal  matter,  we
                                                          never  thought  to  consult   the   law   students
      My contact with the three medical        students   among us. We  really  didn't  make  the  best  use
     working  on  this  project  was  constructive  and   of  our  team.-J.L.,   Nursing   Student,   LoweIr
     very enjoyable. I picked up  much  of  the  needed   East Side.
     medical  background   on   lead   poisoning   from
     them. This project was,  of  course,  particularly    The  interdisciplinary  team   really   did   not
     well suited for  interdisciplinary  work.  My  ex-   exist over  the  summer.  None  of  us  worked  in
     periences  with  our  NYCs  were   scanty,   since   any kind  of  professional  capacity.  Whatever  I
     they were almost totally utilized  for  the  medi-   did, a nursing student  or  a  law  student  could
     cal screening program. I  liked  what  I  did  see   have done.  It  was  a  good  experience  for  the
     of the high  school  students,  more  or  less  in   various  health  professional  students  to   work
     passing. In short, relationships within  the  pro-   together, though I don't  think  that  it  was  as
     ject seemed very  good,  and  I  feel  that  we've   necessary as  finding  competent  people  to  work
     gotten quite a bit done with  sufficient  interac-   on the project.
     tion  but  a  minimum  of  mutual   interference.-    * * * One fault of some  of  the  people  on  our
     A.K., Law Student, Bronx.                            project has  been  that  they  have  not  made  an
                                                          effort to work  well  with  everyone,  but  rather
      I think that  working  with  the  various  disci-   they desire and seek the  advice  of  their  close
     plines was  a  good  experience  but  one  handled   friends. It seems to me that one doesn't  have  to
     in a haphazard  way.  If  some  organized  way  Of   be best of  friends  with  Someone  to  work  well
     displaying the  "uniqueness"  of  each  discipline   with him and to respect  him.  Being  in  the  SHO
     in- alleviating health problems  and  establishing   has  always  seemed  like  being  in  a  kind   of
     total health care were  available,  I  would  have   clique, especially at NYU. I believe that the  at-
     felt elated. Nevertheless,  the  nursing  students   titudes that many  of  the  students  have  devel-
     found  out  what  makes  medical  students   tick,   oped  over  the  summer  of  not  caring  and   of
     and  vice  versa.-J.C.,  Medical  Student,   Lower   feeling left out are  derived  from  the  "in"  or
     East Side.                                           "out" feelings that are so clear on  our  project.
       I found that the  students  I  worked  with  had   -P.S., Medical Student, Lower East Side.
     a disturbingly little amount  of  initiative,  en-     Overall,  my  feeling  for  my  colleagues   was
     thusiasm, or devotion  to  accomplishment  of  our   one of high  respect.  I  have  never  been  asso-
     goal. To too many of  us,  the  project  was  just   ciated with any  project  in  which  I  personally
     a job, and that accounts  for  at  least  some  of   liked and admired  so  many  of  the  people  con-
     our failures to accomplish our goals  in  and  for   nected with it. They impressed  me  as  an  intel-
     the     community.-M.H.,     Nursing      Student,   ligent,   dedicated   group   whose   frustrations
     Lower East Side.                                     were not the  result  of  any  inner  shortcomings

                                                                                                         113


                                                    GREATER       NEW  YORK

              but rather due  to  external  factors.  (There  were   that the  work  is  reduced  to  the  lowest  common
              people  here,  however,  that  I  felt  should  have   denominator  so  that  everyone  can  do  the  work.
              been  fired,  not  only  because   they   were   not   Therefore, I don't feel that  the  project  capital-
              really doing  anything,  but  because  they  were  a   ized on  the  individual  talents  of  the  partici-
              demoralizing  influence  on  others  in   the   pro-   pants. In the long run, however,  I  think  that  it
              ject.)                                                 is difficult to overestimate the positive effect  of
                The  interdisciplinary  team  was  a   very   good   this  interdisciplinary   team   approach.   Profes-
              idea as  far  as  interaction  goes.  I  don't  know   sionals are so  impressed  with  and  caught  up  in
              what  positive  aid  this  was  to  the   community,   their  own  world  that  any  contact   with   those
              but  I  felt  that  I  personally  gained  something   outside  that  world  is  a  benefit  to  all.-F.V.,
              from being involved  in  it.  The  real  problem  is   Law Student, Harlem.

              114


                                                         Part 5: EVALUATION

                            INTRODUCTION                                          groups interested in  health  care  problems.  In
           During the summer of 1967,                    slightly   over          essence, the only common ingredient  in  the  pot
        fifty medical  health  science  students  partici-                        pourri  of  student  activities  was   health-de-
        pated  in  the  Student  Health  Project  of   the                        fined broadly enough to include  the  social  and
        South Bronx,  a  federally  financed  summer  pro-                        political interests of ghetto inhabitants.
        gram  designed  to  involve  students   in   .   e                          The major focus of this evaluation will  be  to
                                                                                  document  the  primary  sources  of  satisfaction
        health  problems  of  a  Negro  and  Puerto  Rican                        and  dissatisfaction  with  the  project   (other
        poverty  area  in  New  York  City.  Almost  every                        than  administrative  problems)  and   to   offer
        member of  the  1967  project  finished  the  sum-                        some explanations  for  the  change  from  a  to-
        mer with  a  smile-students,  faculty,  and  e!al-                        tally satisfactory  experience  in  1967  to  the
        uator.1 Thus, it was  not  surprising  that  ciur-
                                                                                  somewhat less satisfactory  experience  of  1968.
        ing the fall and winter of 1967  considerable  ei-                        Most of the following discussion  is  based  upon
        fort wa@ spent by  students  and  faculty  in  se-                        self-completed questionnaires given to  the  1968
        curing funds for a  "bigger  and  better"  student
        project for the  summer  of  1968.  These  efforts                        project  student  participants  immediately   be-
                                                                                  fore the project began in  late  June  1968,  and
        were rewarded with success, as approximatel                               then again during the final  conference  held  at
        $200,000  was   granted   by   the   Division   o,                        the  end  of  August.  Interviews  with   project
        Regional  Medical  Programs  of   the   U.S.   De-                        personnel  during  the  summer  also  contributed
        partment  of  Health,   Education,   and   Welfare                        to this evaluation report.
        for a 1968 summer project.
           The  1968  Student  Health  Project  of  Greater                       The Student Fellows
        New York consisted of  five  separate  projects  -                           Table 1 below  indicates  the  disciplines  and
        the South  Bronx,  Harlem,  the  Lower  East  Side                        backgrounds  of  the  seventy-six  (76)  students
        of     Manhattan,            the         Bedford-Stuyvesant,              who  responded  to  both  the  June  and   August
                                                                                  questionnaires      .2 Clearly, the  majority  of  stu-
        Crown-Heights,   and   Brownsville   sections   of
                                                                                  dent fellows come  from  health  science  schools
        Brooklyn,  and  the   Negro   slums   of   Newark,                        in  the  New  York  City  area,  and  from  white
        New Jersey. In  structure,  each  was  modeled  on
                                                                                  middle and u  per  class  backgrounds.  The  stu-
        the  previous  summer's  Bronx   project   pattern                                          p
                                                                                  dents  were  not,  however   without   experience
        of placing students in diverse  settings  and  al-                                                            9
        lowing them  considerable  flexibility  to  pursue                        with poor  patients  before  the  summer  program
        (or not pursue) their interests.  Thus,  the  stu-                        began, although wide variation  existed  in  this
        dents  worked'on  such  varied  programs  as  men-                        respect also. Thus, thirty-nine  percent  (399'o)
        tal retardation, narcotics addition,  illegitimacy                        -See Ronald Miller,  "The  Project  Evaluated,"  The  Student  Hedth
        and  unwed  mothers  hospital  services  and   pa-                        Project of the  South  Bronx:  SurAiner  1967,  e&.  Stan  Finh  and
                                    p                                             Jody Williams, previously pub@hed  under  a  gmnt  from  the  Office
        tient advocacy, medical services for school  chil-                        of Economic Opportunity, pp. 181-97.
        dren,  and  various  community   action   programs                         31n general, the responses of  thfte  76  students  reffeew  almost
                                                                                  perfectly the responses of the 99 who responded to  the  fint  ques-
        for  health  care  improvement.   Not   only   did                        tionnaire. Appendix I contains comparisons  of  the  rapondents  who
                                                                                  answ'e ed both and those who only  answered  the  first,  and  shows
        they work in  traditional  health  settings  (hos-                         inor  differences.  Attitudinal  and  infor=tlon  compaMsons   (not
        pitals, clinics, doctors' offices), but they  also                        shown) also Indicated similarit3r Of responses. Thus, it Is  felt'@t
                                                                                  the analysis based upon these seventy-six respondents  can  be  gen-
        worked  out  in   the   community,   with   action                        erlized to the total project membership.


                                                                           GREATER   NEW   YORK

                    had    no    experience     or     just     a     little     bit,     twen-     good    deal     or     a     great     deal     of     experience     with
                    ty-nine      percent      (29@o)      had      had       some       experi-     poor        patients        before        the        summer         program
                    ence,     and     thirty-one     percent     (317o)     had      had      a     began.
                                                                             Table         l.-Student backgrounds.
                              Discipline olo                                         Religion      @o                                Family income olo
                    Medicine            -------------    54                Protestant         ----------  17                   Under    $5,000     yr.     ----   5
                    Nursing            --------------    24                Catholic      ------------     29                   $5,000-$ 9,999            ------ 26
                    Dentistry            ------------    7                 Jewish    --------------       42                   $10,000-$14,000           ------ 29
                    Law             -----------------    9                 Other     ---------------         5                 $15,000-$19,999                    9
                    Social work,
                      Sociology           -----------    4                 None      ---------------         5                 $20,000 and over                26
                    Other            ----------------    3                 No          response --------     I                 No  response            --------   4
                      Total            -------------- 100                        Total   ------------    100                      Total           ------------- 100

                                  Race                                                   Sex                                                School
                    Caucasian           ----------- 82                     Male      ---------------     100                   New York City area              67
                    Spanish           -------------      3                 Female            ------------- 41                  Non-New York area               33
                    Negro            -------------- 12
                    Other           ---------------      3
                      Total           ------------- 100                          Total        ------------- 100                Total            --------------- 100

                      I While  percentages  may  not  add  to  100%  because of  rounding   in   these and subsequent tables. totals  are  always  reported  as  100  percent.  AU
                    1968 table percentages are based upon 76 respondents.
                    Finally,     the     students      had      different      reasons      for     divided     into     31      subareas      after      discussions      with
                    joining     the     1968     project     (table     2).     Given      this     both       faculty       and        students.        Student        fellows
                    divergence        in        student        backgrounds,         experience,     were    asked    in    late    June    and    then     again     in     Au-
                    and     expectations,     a     major     problem     of      the      pro-     gust     to     indicate     how      much      they      knew      (almost
                    ject's     student     leaders     was     to     organize     the     pro-     nothing,   a    little    bit,    some,    a    good    deal,    a    great
                    ject     to     satisfy     the     desires     and     expectations     of     deal)    about    each    of    the    items.    As    table    3     indi-
                    all student project members.                                                    cates     for     a     selected     sample     of      these      informa-
                            Table   2.-Reason   students    joined    1968    project.              tion     areas,     the     students     learned     a      great      deal
                                                                      Percent   giving   reason     during the summer.4
                              Remon joined                                 in  June  1,968            For       example,       while        only        fourteen        percent
                    To help initiate and continue
                      political    action    for    social                                          (147o)    of     the     students     said     that     they     knew     a
                      change in a poverty area                        --------------------    28    good    deal    or     a     great     deal     about     the     organiza-
                    To help poor people get better                                                  tion    of    health    services    for    the    poor    at    the     be-
                      medical  care                       --------------------------------    42    ginning       of       the        summer,        seventy-two        percent
                    To learn about the health problems of the poor                   ----     28
                    To learn about disease, health and                                              (72,7o)    said    they.knew    that     much     at     the     end     of
                      medical care during the summer                        --------------    1     the      summer.      While      similar       results       were       ob-
                    No response                        -----------------------------------    I     tained    for    most    of    the     information     areas,     a     few
                           Total                      ------------------------------------ 100      showed       almost       no        improvement        in        knowledge.
                    The        Project         as         an         Educational         Exper-     Two     of     them,     cancer      and      heart      disease      among
                    ience                                                                           the    poor,    were    the     two     major     areas     of     interest
                      The      educational      aspect      of      the       summer       pro-     to     the      Regional      Medical      Programs      Division,      the
                    ject,    the    sensitization     of     students     to     the     health     agency     which      granted      the      project      funds.
                    care     problems     of     ghetto     residents,     was     a      prime       Thus,     in     almost      every      one      of      these      areas
                                                                                                    (with     the     exceptions      noted)      a      definite      increase
                    consideration      in      the      development      of      the       pro-
                    ject.   The    project    was    viewed,    in    effect    as    a    con-     in      student      knowledge       was       evident.       Table       4
                    tinuation      of       the       student's       professional       educa-     I The  other  areas  which  are  not  shown  but  generally  also  Indicate
                    tion,       although       qualitatively       different       in       the     increased  knowledge  are   malnutrition,   sex   education   among   teen-
                                                                                                    agers, lead poisoning,  prenatal  care,  p@iatric  -care,  geriatric  care,
                    process     of     learning.     In     order     to      measure      this     dental  care,  educational   problems,   family-domestic   problems,   folk
                    learning        experience,        the        potential         educational     medicine,  Medicare  and  Medicaid,  org  nization  and  problems  of  city
                                                                                                                                           a]
                                                                                                    hospitals,  new  innovations  In  health  care,  and  new  health   careers
                    content     of     a     course     in     community      medicine      was     for non-professionals,

                    116


                                                                           SUMMER  1968

           summarizes  this  increase  in   knowledge   by   the                                 Table 4.-Information index June and August, 1968.
           students as it combines all  31  areas  into  an  in-                                 Infor?nation @ex Score                   Junel968        August    1968
           formation    index.5                                                             Low      information          ------------------   44               12
              Table  3.-Student  learning  experience  during   the   summer.               Medium information                 --------------  46               51
                                                          Percent  saying   they   know     High information               -----------------   10               37
                                                              a good or great  deal                 Total     ---------------------             100          100
              Area of Knowledge About the Poor                 about   each   area
                                                          June 1968     August     1968     Additionally,  the  information  level  of  the  stu-
           Organization of health services                ---- 14            72
           Quantity of health care received               ---- 22            76             dents  was  directly  related  to  their   membership
           Quality of health care received             ------ 30             74             (or  nonmembership)  in  the   Student   Health   Or-
           What  professional   practice   is   like                                        ganization   (SHO),   a   loose    amalgamation    of
              for poor           ------------------------     12             41
           Narcotics and drug problems                ------- 33             61             medical  and   health   science   student   organiza-
           Birth  control        ---------------------        29             54             tions  which  are  especially  concerned   with   the
           Illegitimacy and unwed mothers                 ---- 29            47             health  problems  of  the  poor  (as.well   as   with
           Welfare    services          -------------------   26             50             political-social  issues  such  as   community   con-
           Rat bites       ---------------        ----------  16             25
           Housing conditions - - - -.  @           --------- 47             80             trol  and  black  admissions  to  medical   schools).
           Job problems             ----------------------    37             61             SHO  was  largely  responsible  for  the  genesis  of
           Community   attitudes    toward    health                                        these  student  projects,  and  much  confusion   has
              problems             -----------------------    17             66             existed for the  past  two  summers  over  the  rela-
           Community    groups    concerned     with
              health  problems  - -                           17             65             tionship  of  the  student  health  organization  and
                                         ---  ----------
           Mental illness        --------------       -----   20             25             the  student  health  project.   SHO   membbrs   (see
           Mental retardation         --------------      @--10              17             table   5)   had   higher   information   scores   in
           Cancer             ---------------------------       8                7
           Heart Disease         --------------------            9               9          June,  1968   than   did   non-members,   and   main-
              ' The information  index  was  constructed  by  giving  arbitrary  scores     tained this differential  at  the  end  of  the  sum-
           of  1,2,3,4,5  to  the  five  information   response   response   categories     mer.    While    nonmembers     became     sensitized
           noted  in  the  text.  The  total  score  for  each  respondent  on  the  31
           items  was  then  classified  as  either  low  (scores  under  80),   medium     during  the   summer,   organization   members   also
           (80-99), or high  (scores  over  100).  No  responses  were  counted  as  3;     increased   their   knowledge   about   the    health
           if  there  were  more  than   two   no   responses,   the   respondent   was
           classified as  no  response.                                                     problems of the poor.

                                   Table 5.-Information index scores and membership in the student health organization.
                  information                                                         Member   Junel968     Not   a                 Member August 1968       Nota
                   index scare                                                        Of SHO               member                of    SHO                  member
              Low        information             -------------------------------          34                    59                       4                   25
              Medium information                    -------------------------    ----     53                    35                      55                   45
              High       information              -------------------------------         13                      7                    40                    31
                       Total     ------------------------------------                    100                   100                    100                   100
                                                                                      (N m 47)           (N   = 29)            (N   = 29)             (N - 47)
           Besides this        objective  data  on   the   educational                      New  York.  In  1968,  however,  one  must  ask,  "Is
           value  of  the  summer  project,  the  students  also                            education enough?"
           felt  subjectively  that  the  summer  had   contrib-
           uted to  their  professional  education.  In  August,                       .    A Clash of Perspectives
           seventy-four   percent   (747o)   said   the   summer                               The  educational  aspect   of   the   summer   pro-
           contributed a good  deal  or  a  great  deal,  seven-                            ject-the  sensitization  of  students  to  the  vari-
           teen  percent  (172'o)  said  some,  and  eight  per-                            ous  health  care  problems  of   the   urban   poor-
           cent  (87o)  said   the   summer   contributed   only                            was  seen  by  the  faculty   members   from   Monte-
           little bit or something  to  their  professional  ed-                            fiore  Hospital  and  the  Albert  Einstein   College
           ucation.                                                                         of   Medicine   (through   which   the   grant    was
              Thus,   educational    gains    should    certainly                           submitted  and  funded),  and  most  of  the  faculty
           have  contributed  to  the  satisfactory  nature   of                            members  concerned   with   the   project,   as   the
           the  Student  Summer  Health   Project   of   Greater                            prime  reason  for  the  project.  To  them,  educa'-

                                                                                                                                                                 117


                                                                 GREATER           NEW   YORK

                  tion   was    of    greatest    importance.    To    the    "edu-     especially      community      control,      made       education
                  cationalists,"    radical    political     action     for     re-     a     secondary     (although     still     important)     aspect
                  form   of   health   care   services    was    an    alien    and     of the project.
                  threatening        concept-and        widespread        impro.ve-     Community Control and'Political
                  ment    of    current    health    care    services    was    im-     Radicalism
                  plicitly   discounted   as   unrealistic.    In    fact,    early       The     controversial     issue     of      community      con-
                  in    the    spring    of    1968    (during    the     project's     +.rol-community      control       of       education,       com-
                  formative    stage)    a    direct    confrontation    of     the
                  education    and    political     action     perspectives     re-     munity     control     of     welfare     services,     community
                  sulted    in    the    two    then    student    leaders    !both     control       of       medical       services-dominated       the
                  highly    politically    oriented)    resigning     their     po-     ideological   interests    of    the    students    during    the
                  sitions   as   they   felt   the   faculty   sponsor   was   res-     summer,    especially    the    leaders    and    the     (vocal)
                  tricting   their    actions    and    redirecting    the    focus     politically     radical      student      fellows.      Education
                  of    the    project.    As    the    faculty    sponsor    later     was    not    their     primary     goal;     the     improvement
                  noted    in    his    reaction    to    a    student    manifesto     of   health   services   for   the   poor    via    control    by
                  about      the      political      action      necessary      for     the   poor   was   their   slogan.   This   is   not   meant   to
                                                                                        imply,   however,   that    all    of    the    health    science
                  improving    health     care,     "With     regard     to     the
                  manifesto    I    noted    that    in    the    preamble    there     fellows     favored     community     control.      In      fact,
                  was   no   mention   of   education   and    as    far    as    I     wide disparity existed on        . this    issue    during    the
                                                                                 ty     summer,    and    was    a    major    source     of     conflict
                  was concerned it was an educational program.                          and    internal    project     debate.
                    The    two    new     student     codirectors     felt     com-       Since    the     issue     of     community     control     was
                  pelled    to    "give    in"    and    accepted    the     educa-     clearly    important    to    the    student    leaders    during
                  tional     philosophy     formally.     They     noted,     "Stu-     the     spring,     several      questions      on      community
                  dent placements will be on the basis o                   e    po-     control    were    included     in     the     June     question-
                  tentiaI   educational   value   of    the    exper.    ence    to     naire.    The    students    were    asked     what     relation-
                  the    student."    However,    the    students    also     main-     hip    community    people     should     have     with     medi-
                  tained   their    interest    in    the    reform    of    health     s
                                                                                        ,al   personnel    in    making    decisions    at    a    neigh-
                  services   as   they   noted   that    the    dual    goals    of
                  the   project   were    the    education    of    the    students     borhood      medical      care      center;      they       could
                  and   the   reform    of    health    care    services.    Infor-     strongly   agree,   agree,    disagree,    or    strongly    dis-
                  mally,   however,   the   student    leaders    and    the    po-     agree   with   each   of   the    nine    possibilities    listed
                  litically     radical     (and     vocal)     student     fellows     in table 6.
                  stressed    over    and    over    during    the    summer    the       Table 6.-Student attitudes toward community control of
                  need    for    radical    political     change     to     achieve                                  medicine.
                  health         care         reform-especially,          community                                            Percent strongly agree, or
                                                                                                                               agree ivith each statement
                  participation,        community        control,        community,         Community people should             June  1968  August   1968
                  community,     community!     Witness     some      of      their     Advise medical personnel on
                  statements   at   the   end   of    the    summer    which    ne-       budget decisions           ---------------- 76        72
                  gated    the    value    of     the     project's     educational     Advise medical personnel on
                                                                                          decisions about the scope and
                  goals:                                                                  practices of the center          ---------- 78        79
                       The community should be served, not the students. .              A di,, on the hiring and firing
                       The  project  is  educational,  but   does   this   validate       of medical personnel           ------------ 57        67
                       using ghetto residents?                                          Have  an  equal  vote   with   medical
                       I  don't  think  it  should  be  the  purpose  of  SHP   the
                       student health project to sensitize. I     .don't     approve      personnel   on   budget    decisions   ---- 67        63
                       of  parasitizing  off  the  community  for  our   enlighten-     Have  an  equal  vote   with   medical
                       ment.                                                              personnel on decisions about the
                     Thus,      -while      educational       achievement       may       scope  and  practices  of  the  center  .  71         74
                                                                                        Have  an  equal  vote  on  the  hiring
                  have   been   an   accepted   goal   in   and   of   itself    in       and  firing   of   medical   personnel   --52         64
                  1967,   it   was   not   so   accepted    in    1968!    Emphasis     Have the final controlling vote
                  upon    political    action    for    health     care     reform,       on budget decisions   @        ------------ 26        36

                  118


                                                                      SUMMER  1968

                                                      Percent  strongly  agree,  or              by Columbia University students was
                                                      agree  with  each   statement
              Community people should                 Junel968      August     1968              justified by their cause and ideals;
          Have the final controlling      'vote   on                                       (3)   The   burning   of    draft    cards    by    oppo-
            scope  and  practices   decisions         ---- 29            45                      nents   of   the    Vietnam    war    is    morally
          Have the final controlling vote  on                                                    justified;
            the hiring and firing  of  medical
            personnel           ----------------------     20            37                 (4)  The    seizure    of    factories     by     French
                                                                                                 workers   and    the    French    general    strike
          While  the  majority  of  students   felt   in   June   that                           should   be   emulated   in   the   USA   by   poor
          community   people   should   either    advise    or    have
          an    equal    vote    with     medical     personnel     on                           people; and,
          budget,    scope-practice,    and    hiring-firing     deci-                     (5)   Black   militants   are    right    in    excluding
          sions,  less   than   one-fifth   of   the   students   felt                           white    newspapermen    from     press     confer-
          that   community    people    should    have    the    final                           ences.
          controlling   vote   on   these   issues.    Therefore,    a                  Student    responses    became    more    radical     (that
                                                                                                                             I                   ch    state-
          community    control    index     was     constructed     by                  is, the percentage agreeing with' ea
          combining   answers   on   these   three   final    control-                  ment   increased)   from   June   to   August.   This    is
          lining  vote  questions.6  As  show  in  table  7,   fifteen                  clearly    shown    in     the     Political     Radicalism
          percent   (157o)   of    the    students    were    communi-                  Index,  (table   8)   which   shows   the   same   radical-
          ty  control  radicals   in   June,   while   another   nine-                  izatio-n  as  on  the  issue  of   community   control.   7
          teen    percent    (199'o)    were     community     control                                Table 8.-Political radicalism index.
                                                                                              Cl"oiftcation                         June 1968     August    1968
          moderates.                                                                                                                                   51
                                                                                        Political radical         ------------------    87
                        Table 7.-Community control index.                               Political moderate           ----------------   40             25
              Community Control Scare                 Junel968      August     1968     Political conservative         --------------   21             16
          Community control radicals             --------  15            36             No response          -----------------------      3            8
          Community control moderates               ------ 19            16
          Community   control   conservatives         ---- 65            45                      Total   ---------------------          100            100
          No response           ----------------------       1             4              The debate over community control                            created
                  Total          ---------------------     100          100             serious  problems   for   the   project.   Not   only   did
            By   the   end    of    the    summer,    however,    many                  the   call   for   community   by   some    students    op-
          more    students    had    become    advocates    of    com-                  pose the views of others:
          mu-nity   control,   based   on   their   experiences   dur-                       The  community   people   are   more   important,   in-
                                                                                             telligent  and  trustworthy  than  the  health  science
          ing   the   summer   and    the    proselytizing    behavior
                                                                                             students; versus.
          of    the     pre-summer     community     control     advo-                       The "community" is  a  myth  used,  by  those  who  are
          cates.    Thus,     community     people     were     always                       afraid to make real changes,  to  stifle  action.
          given  a  larger   role   in   hiring   and   firing   deci-                  but,   the   radicals   resented   the    project's    less
          sions   (either   in   terms   of   advising,    an    equal                  than   total   commitment   to   the   theme    of    'com-
          vote,   or   a   final   vote);   and,   community    people                  munity control:
          were  seen  as  competent  to   have   a   final   vote   on                       It was sdt up, of, by and for students, not  io  really
          all   decisions   by   an   increased   number    of    stu-                       help the community. It  took  more  than  it  gave.
                                                                                             It was too tied  into  the  medical  establishment  and
          dents.
             This   view   of   increased    radicalism    among    the                      not to the community'        SHO  lacked  a   real   commun-
                                                                                             ity philosophy and failed to  be  militant  enough  for
          students  as   a   result   of   the   summer   project   is                       the community or to listen to it effectively.
          reinforced    by     data     on     political     attitudes                   I Each  respondent  was  scored  1,  2,  3,'  or  4  on  each  question
          which   was   also   incorporated   into   the   two   ques-                  corresponding to strongly agreed, agreed, disagrftd, or        strongly
          tio-nnaires.    Students    were    asked     to     express                  disagreed on the three final vote questions. Scores then  classified  as
                                                                                        radical  (1-6),  moderate  (7-8),  or  conservative  (9  or  more).   No
          their  opinions   on   five   issues   of   current   impor-                  responses counted  as  2.5;  no  response  to  more  than  one  question
          taiice to political radicals:                                                 resulted in the respondent  being  classified  as  no  response.
             (1)   Violence   and   rioting   by   Negroes   in   slum                     Respondents  were  given  scores  of  1-6   corresponding   to   very
                                                                                        strongly agree,  strongly  agree.  agree,  disagree,  stmngly  disagree.
                    areas  are  justified  if   they   result   in   so-                very strongly disagree with each  itenL  Added  scores  then  classified
                    cial change;                                                        gts radical (14 or less), moderate  (16-19)  and  conservative  (20  and
                                                                                        over). No response counted as  6.5;  If  there  was  more  than  one  no
             (2) The seizure            of     administrative      buildings            response, the respondent was cassified as no response.

                                                                                                                                                           119


                                                             GREATER         NEW        YORK
                    SHO         is a  liberal,  white  service  organization.    Table  10.-Student  attitudes   toward   recommending   that
                    As sueb, I don't think it  should  be  in  a  black  com-              a roommate or friend apply for project
                    munity at this point.                                                          the  following  summer.
                                                                                 would student reeom7nend
                 As  such,   the   ideological   involvement   of   some   of     room?nate-friend apply?                1961,       1968
                 the   students   in   political    radicalism    and    COM-    Definitely  yes      -------------------- 79        33
                 mu nity   control   contributed    to    the    undercurrent    Probably   yes ----------------------   17          20
                                                                                 1
                 of   tension   which   permeated    the    Student    Health    Not sure      --------------------------- 2         22
                                                                                 Probably    no -----------------------     -          9
                 Project   of   Greater    New    York,    and    contributed    Definitely  no ----------------------     -         14
                 to   the   feelings    of    discontent,    dissatisfaction,    No    response ----------------------     2           1
                 dismay    and     disappointment     which     many     pro-          Total  --------------       ------- 100       100
                 ject   members   felt   at   the   end   of   the    summer.    fifty-three   percent   (537o)   said    they    would    do
                 Satisfaction: An Overall Evaluation                             so after this summer's project.
                                                                                 Finally,   one   must    assume    that    a    satisfactory
                   As   noted   in   the   introduction,   almost   all    of    project   would   have    resulted    in    more    students
                 the   student   and   faculty   members   left   the    1967    wanting   to   work   in   poverty    areas    (when    they
                 summer    project    with    smiles    on    their    faces.    become     full-fledged     professionals)     after     the
                 Faculty    members    were    enthusiastic     about     the    summer   than   had    wanted    to    work    in    poverty
                 gains.   of    the    summer,    and    worked    diligently    areas    before    the    summer.    However,    this    did
                 with   the   students   during   the   winter   to   prepare    not   occur   in   the   1968   student   health    project;
                 for   the   next   summer's   project.   The    same    can-    no   gain   in    the    percentage    of    students    who
                 not  be   said   now.   In   fact,   thoughts   of   another    wanted   to   practice   their   profession   in   a    pov-
                                                                                 erty  area   occurred.   In   fact,   there   was   a   very
                 summer    project    are    presently    far    from     the    slight    negative    shift     from     the     seventy-two
                 minds    of    the    Einstein    faculty    members     who    Ik'4727o)   who   wanted   to   work   in   poverty    areas
                 supported   the   1967   and    1968    projects.    Student    in  June   to   the   sixty-eight   percent   (689'o)   with
                 reactions  to  the   two   projects   followed   this   pat-    the  same  desire   in   August,   1968.   In   brief,   the
                 tern.   As   table   9   indicates,    the    1968    summer    1968    Student    Health    Project    of    Greater    New
                 was    a    disappointing     experience     for     project    York   cannot   be   considered    an    unqualified    suc-
                 members,     when     compared     to      the      previous    cess.
                 year's project.                                                   The  reasons   for   this   less   than   totally   satis-
                  Table 9.-Student satisfaction  with  the  summer  projects.    factory   experience   have   been   alluded   to    before,
                       Project was                 August 1967   Augwt     1968  '&jut   can   be   placed   in   proper   perspective   now.
                 Highly satisf actory     ---------------- 83        43          First,   the   positive   aspects   of    the    educational
                 Slightly satisfactory      --------------4          28          gains   of   the    summer    were    minimized    by    the
                 Slightly unsatisfactory      ------------6            5         conflict   over   considering   education    as    a    pri-
                 Highly unsatisfactory         -----------4          18          mary   project   goal.   Since    the    "education-lis'ts,"
                 No response        ----------------------4            5         both   student   and   faculty,    were    constantly    as-
                       Total        ---------------------- 100       100         sailed   by   the   vocal    politically    oriented    stu-
                 This   shift   in   attitudes   toward   the   summer   pro-    dents,   this   tension   no   doubt   lessened   the   stu-
                 ject  from   1967   to   1968   is   clearly   shown,   once    dent's   satisfaction   with   the   knowledge   gains    of
                 again,  in   the   percentage   of   students   who   ]would    the   summer   project.   And,   it   resulted    in    many
                 recommend   that   a   roommate   or   close    friend    at    faculty    members    feeling    that    the     educational
                                                                                  ains just were       not       worth       the'aggravation.
                 school  apply   to   a   similar   project   the   following    9
                 summer.    (Table    10).    While    ninety-six     percent    Second,   the   students   were   dissatisfied   with    the
                 (96@o)    said    they    would    recommend     a     room-    limited   nature   of   those   changes   that   were    ac-
                 mate-friend   apply   after   the   1967    project,    only    complished     during     the     summer.     While     more
                                                                                 students   reported   that   they    had    achieved    some
                  I The number of cases  upon  which  percentages  are  based  for  the change   in   the   community    in    1968    as    opposed
                 1967 project is fifty-three (53) ; as usual, the  base  for  the  1968
                 project is seventy-six (76).                                    to    1967    (67    percent    said    they    accomplished

                 120


                                                      STJMMER  1968
      hange in 1968 compared to 58 percent  in                        C.  Family   income
      967), almost all of these changes were either                       Under    $5,000 ----------    5                 6
      ndividualistic   as   they    helped    one    patient    or        $5,000-9,999   ---------      26                25
                                                                          $10,000-14,999          ------- 29              27
      ne  family,   or   they   were   temporary   and   of   lit-        $1510oa-19,999          -------9                10
      le    significance.    Broad,    widespread    change    was        $20,000 and over         ------ 26              27
      Lot   accomplished.   In   1967   this   was    permissible;        No     response ----------    4                 4
      n  1968   it   was   not.   As   several   students   noted,               Total  --------        l@o 0           100
      'There    should    be    no    summer    projects.     They     D. Race
      ihould be all year  or  not  at  all."                              Caucasian     ------------    82                79
      Third,    the    controversy     over     community     con-        Spanish-speaking         ------3                3
                                                                          Negro  ----------------       12                15
      ;rol   (and   political    radicalism) and    its    relation-      Other  ----------------       3                 2
      ;hip   to   the   reorganization    of medical        services      No     response -----------                     I
      @or   the   poor    served    to    supply    the    tension               Total  -----------     100             @oo
      needed   to   minimize   the   positive   aspects   of   the     E. Sex
      summer    program.    The    Spring     confrontation     of        Male   -----------------      59                61
      education-oriented     faculty     and     political     ac-        Female          --------------- 41              39
                                                                                 Total  ---------       l@O 0             100
      tion-oriented    student    leaders     foreshadowed     the     F. School attended
      summer's    conflict    over    community    control,    po-        - -New York area         ------ 67              66
      litical    radicalism,    educational     exploration     of        -Non-New York area            --- 33            33
      the      ghetto,      and      "meaningless"       piecemeal        No     response ----------                      I
      change     "with     the      system."                                         Total       --------- 100            0
       What   had   been   a   highly   successful   project    in     'The umber f respondents  to  the  first  questionnaire  was  ninety-
      1967   had    become    a    much    less    successful-even     nine (99), while the number responding  to  both  questionnaires  was
      unsuccessful-project    in    1968.    Why?     The     rea-     seventy-six. (76). The percentages given in this appendix  are  based
                                                                       on these numbers. The main text of the report using the  data  abased
      sons   given   above   are   part   of   the    explanation;     upon the rsponses of the 76 who  responded  to  both  questionnaires.
      but,  they  are  only  part.  Perhaps  it   was   the   stu-
      dents,  the   faculty,   the   radicals   Or,   perhaps   it
      was   America   in   1968    as    compared    to    America     THE       STUDENT       HEALTH       PROJECT       AS        A
      in  1967.  Perhaps   it   was   not   the   Student   Health               LEARNING                        EXPERIENCE
      Project   of   Greater   New   York,   at    all.    Perhaps        Those   of   us   who   worked   to    develop    a    1968
      it     was     Vietnam,     Lyndon      Johnson,      Hubert     Student   Health   Project    in    New    York    City    saw
      Humphrey,    Richard     Nixon,     and     Mayor     Daley.     the   1967   California   project   as   a    partial    model
       Appendix  /.-Student  backgrounds:  Comparison   of   those     and tried to incorporate as m          uch   of   it   as   we
             who  answered  both  questionnaires  and   those          could   into   the   planning.   A   tacit    assumption    we
                 who answered the first questionnaire.                 all   made   was   that   students   would   be   brought   to
                                       First    First  and  second     New   York    City    to    work    in    "medically    disad-
      A.   Discipline          questionnaire         questionnaire     vantaged     areas,"     for      example,      black      and
           Medicine            ------------- 54             58
           Nursing            -------------- 24             24         Puerto   Rican   ghettos.   In   this   way    the    students
           Dentistry            ------------7               6          would:
           Law             -----------------9               8
           Sociology,  social  work  -  -  4                4             (1)    Learn     about     these     communities,     their
           Other' - - - - @        -----------3             3                    sights,   sounds   and   smells;   but   more    im-
                  Total           ---------- 100          100                    portantly,    the    students     would     realize,
      B.   Religion                                                              from     first-hand     experience,     how      the
           Protestant           ------------ 17             22                   community      environment      determined       the
           Catholic            ------------- 29             27                   people's   life-style   and   their   pereetion   of
           Jewish           ---------------- 42             39                   all     things,     especially     health.      This
           Other            ----------------5               5                    proved  to  be  one  of   the   most   invalid   as-
           None            -----------------5               5
           No response           -----------1               1                    sumptions   one   could   make.   I   realize    now
                  Total            --------- 710-0          100                  that  it   is   grossly   unfair   to   bring   two-
                                                                                                                                  121


                                                             GREATER  NEW     YORK

                       month    "summer    trippers",    most     of          NYC  program  was  having  its  difficulties
                       whom  do  not  live  in  the  community,  and          (as  witnessed  by  the   constant   turmoil
                       view  their  summer  as  nine  to  five   job          and  'investigations,  but  trying  to  deal
                       exposures  to  poor  people,  into  someone's          with  the   confusion,   inefficiency,   and
                       home  and  expect  the  people  to   unburden          lack  of  understanding   made   it   almost
                       themselves to  the  student,  relate  to  the          impossible  to  have   NYC   youngsters   in
                       student in  any  other  than  a  short  term,          the  Bronx  and  Brooklyn   projects.   Many
                       ad  hoc  manner  and  it  is  most  reenforc-          health  students  were  interested  in   the
                       ing to  the  student's  subtle  feeling  that          NYC'S,  but  could  not  treat  the   young-
                       he can act in this  role  with  poor  people,          sters as equals on the  job.  Maybe  it  was
                       but  would  never  dare  go  into   his   own          that the  students  received  $900  for  the
                       community  and  ask  what  he  asks,  or  as-          summer   and   the   NYC's   received   $320
                       sume  the  role  he  answers  in  poor   com-          but probably it was  that  the  health  sci-
                       munities..                                             ence students  could  not  accept  the  idea
                     (2) Help the community   get   better    health          that   their   summer   problems    required
                       care.  This   goal   was   our   number   one          creativity in setting  up  tasks  compatible
                       goal, but attached to it is the  subtle  idea          with  the  community's  needs,   the   NYC's
                       that it is all right for a  student,  to  act          capabilities, and their own  abilities.  The
                       as  a  "patient  advocate"   and   take   the          best   relationships   between   NYC's   and
                       community  person   to   the   hospital   and          students  were  in  Brooklyn  where   soriie
                       use his  own  knowledge  of  the  systems  to          students  encouraged  the  NYC's   to   take
                       help   the   community    person.    Students          an active.  role,  and  the  NYC's  accepted
                       were  also  supposed  to   work   with   some          this  involvement  and  functioned   beauti-
                       community       organizations,         either          fully.
                       through  them   (using   their   office   and    Unfortunately,  much   of   what   I   have   said
                       phones to contact  people)  or  to  become  a  thus far, places pivotal  emphasis   on   the   per-
                       summer   apprentice    to    the    community  sonality of the student,  NYC,     and     community
                       grciup  and  offer   specialized   assistance  person. Our  project  was  set  up  this  way  under
                       where   possible-and   where    decided    by  the guise of  "creativity"  and  "flexibility,"  but
                       the  organization.  I   am   happiest   about  for these assumptions  to  hold,  the  parties  con-
                       the last type  of  task,  where  the  student  cerned  must  have  some  knowledge   of   what   is
                       works   with   a   community    organization,  expected of them.  One  of  the  glaring  faults  of
                       because it  is  the  least  condescending  to  this  summer's  program  was  poor  project   devel-
                       the   community   people,   and   makes   the  opment.  The  project  descriptions  were   reassur-
                       most efficient use of the  student's  special  ing,  but  what  backed  them  up?  In  Harlem   and
                       knowledge  of  the  system  or  of   uniquely  in  Brooklyn,  most  of  the   problems   and   pre-
                       medical   matters   (for   example,    dental  ceptorial contacts were valid and  existed.  In  the
                       hygiene, birth control).                       other  three  areas  (especially  the   Lower   East
                 (3)   Work  with  a   member   of   the   Neighbor-  Side),  the  students   were   constantly   confused
                       hood   Youth   Corps   (NYC),    making    it  and  frustrated  by  a  lack  of  direction  and   a
                       easier to  come  into  a  community,  finding  paucity  of  personal  contact  who  understood  the
                       out   about   a   ghetto    youngster,    and  Student Health Project  or  what  they,  as  precep-
                       maybe  interesting  the  teenager  in  a  ca-  tors, were supposed to do.  I  can,  however,  offer
                       reer in on  of  the  bioscience's,  but  cer-  a theory as  to  why  this  happened.  We  were  not
                       tainly  helping  the  youngster   with   high  sure of  our  funding  until  two  weeks  into  May,
                       school  subjects.  This  was  the  most  dis-  after students  had  been  accepted  and  plans  for
                       appointing  aspect  of  my   summer.   -Work-  Orientation  set  into  motion.  Being   unsure   of
                       ing  with  the  NYC  organization   was   im-  the status of our  venture,  or  if  we  would  have
                       possible.  I  know   that   New   York   City  an SHP at all, students  probably  found  it  diffl-

              122


                                              SUMMER  1968
      cult to  make  firm  commitments.  When  the  con-   ple bullshit  and  she  was  unhappy  with  their
      tract was finally agreed to, I'm  sure  that  stu-   deception (she gave me no  particulars).  On  the
      dent  coordinators  in  all  the  areas   had   to   whole,  Orientation  had.  given  the   group   a
      tighten up  loose  arrangements,  but  in  Newark,   needed esprit de  corps,  and  a  very  low-keyed
      The  Bronx,  and  the  Lower  East  Side  the  ar-   introduction to the  community  health  scene  in
      rangements  never  jelled  and  remained   amorph-   New York City. This  was  not  a  radical  Orien-
      ous for the better part of  the  summer.  Through-   tation, merely an easing into the summer       PS
      out  the  summer  new  preceptorial   arrangements   problems. Some people resented the  site  of  our
      were   constantly   being   made.   This   was   a   Orientation   and   Final   Conference   sessions
      drastic  mistake.  If  the  supporting   structure   (both were  held  at  resort  hotels  outside  of
      had existed, and if the  project  staff  from  the   New  York  City).  The   problems   inherent   in
      top down had felt more secure  in  our  roles  and   finding a place to feed, provide meeting  facili-
      was clearer about direction, much of the  conf  u-   ties for, and house participants  (which  is  not
      sion  and  frustration  could  have  been  avoided   necessary, but we felt  this  would  be  optimal)
      and more would have been accomplished.               at a reasonable price in the New  York  Area  are
       As  for  the  educational  function  I  was  sup-   HUGE. This was  one  of  the  greatest  stumbling
      posed to direct, this  started  with  Orientation,   blocks all summer. We  were  a  large  group  and
      which  was  in  two  parts.  From  June  28-26  we   needed large facilities. Bader's Hotel was  ideal
                                                           (even though it was not  in  the  community)  be-
      met at  Bader's  Hotel  in  Spring  Valley,  N.Y.;
      the remainder of the week was  to  be  spent  ori-   cause we were the only group  in  the  hotel  for
      entingIthe  five   student   groups   (with   NYCs   the three days it was the hotel's off-season  and
      where  possible)  to  the  five  communities.   In   the price was right.
      general I thought  the  project  Orientation  ses-    The  educational  programs  per'se  during   the
      sion W.Q.S adequate  and  accomplished  my  inten-   summer never really achieved  my  goals.  I  fast
      tions. The first full day was devoted to an  over-   realized that the project participants  were  re-
      all view  of  the  communities  SHP  would  be  in   luctant to travel very far to hear a speaker  and
      during  the  summer.  Films,   speakers,   discus-   were not really bristling with  ideas  as  to'the
      sions, and lots of free time  were  used  to  help   kinds  of  speakers  that  would  interest  them.
      the  students  obtain  an  overview  of  community   There were  two  lecture  series,  on  black  and
      feelings  and  problems   in   the   Greater   New   Puerto Rican history, given  by  Mr.  S.  L.  and
      York Area. One  full  afternoon  was  spent  talk-   Miss C. M. Mr. L.  presented  the  problem  of  a
      ing  about  NYCs  (the  twenty  or  so  NYCs   who   self-appointed black historian. His treatment  of
      attended the Orientation  spoke  to  the  students   black history was interesting but  not  extremely
      in a wonderful  two-ho-ur  open  discussion).  The   substantive. He certainly knows quite a  bit  but
      second  day  brought  health   professionals   who   his digressions confused  matters  and  took  the
      had  some  notion  about  community  health.   The   group away from  the  factual  matters.  Miss  M.
      students  and  community  people  asked  many  re-   was  excellent.  She  not  only   knew   a   vast
      vealing questions and  I  think  received  a  rea-   amount  about  Puerto  Rican  History  and   Cul-
      so-nable superficial exposure to some of the  cur-   ture, but she was  an  eloquent  example  of  the
      rent  thinking  in  Community  Health   (none   of   second generation  Puerto  Rican  in  the  United
      it  was  radical,  however).  The  third   morning   States. In  Newark,  R.  P.  (the  Community  Co-
      was taken  up  by  a  great  discussion  of  "Com-   ordinator)  arranged  a  discussion  group   with
      munity  Control  of   Health   Care   Facilities";   his NYC'S. These groups  met  twice  a  week  and
      this seemed to be the logical culmination  of  the   discussed Before the Mayflower, a  black  history
      previous Orientation topics.  However,  this  last   text by  Lerone  Bennett  Jr.,  and  Bluk  P&wer,
      discussion was all rhetoric. In fact, one  of  the   by  Carmichael  and  Hamilton.  These  were   far
      community  people  spoke  to  me   during   August   from militant  discussions,  but  merely  an  at-
      and  said  that  some'of  the  promises  made   at   tempt  to  help  the  NYC's  become  more  verbal
      Bader's by  the  health  professionals  were  sim-   and less afraid of expressing their ideas.  These

                                                                                                        @@123


                                                      I         GREATER NEW  YORK

                  books  were  chosen  because  they  deal   with   the   ways  of  a  bureaucratic  system,  and  our  lack  of
                  one  inescapable  attribute   felt   by   all   black   assurance  as  to  which  decisions  we   could   make
                  people  in  America-blackness,   its   origins,   and   and   which   decisions   required   a    policymaking
                  its consequences.                                       council  vote,  this  kept  us  in  a  very  confusing
                    The  Bronx  project   attempted   weekly   tutorial   and confused  state  of  affairs  until  we  were  al-
                  sessions.  For  health  science  students  there  was   most   through   with   the    project    (maybe    we
                  instruction  in  Spanish,   and   for   NYC's   there   never got out of it).
                  was  instruction   in   science,   mathematics,   and      The   Final   Conference   relied   almost   exclu-
                  music.  However,  many  of  the  students   did   not   sively  on  health  science   students   and   commun-
                  have time  for  these  afternoon  sessions,  and  the   ity  people  to  lead  discussions,  present   working
                  NYC's  could  not  always  attend  because  of  their   papers,  and  determine  the  focus  of  the   Confer-
                  responsibilities.                                       ence.  Much  of   the   discontent   and   frustration
                    I am convinced that  each  area  has  to  have  its   was  vented  at  this  Conference,  as  well  as   the
                  own  educational  coordinator  who  is  in   constant   crystallization of  the  issue  that  had  been  crop-
                  contact  with  the  area  people   and   is   acutely   ping   up   throughout   the    summer:    Reform?'Sts
                  aware  of  their  desires.  I  attended  area   meet-   vs.  Revolutiona?ies  in  the   health   care   field.
                  ings once a week  but  received  little  feedback  as   That  is,  should  the  SHP  and  SHO   try   to   re-
                  to the type of programs the people wanted.              form  a   bad,   though   not   unsalvagable,   system
                    The  Final   Conference   was   steeped   in   dis-   or  should  the  thrust  be  to  work  with  any   and
                  agreement,   good   intentions,   and   subjectivity.   all allies to totally  revamp  this  system.  This  is
                  Many students  did  not  care  to  attend  the  final   the  major  decision  of  any   activist-minded   per-
                  conference  (August  26-28)   because   they   needed   son  and  was  coupled  with  a  crisis  in   choosing
                  a rest before starting school in the  fall  and  they   allies  for  health  students.  We  asked  each  other
                  wanted  that  week  for  part  of   their   vacation;   should  students  work  in   communities   or   should
                  many  people   felt   the   conference   should   not   they  only  serve  as  advisors   to   community   or-
                  have  been  held   at   the   Sha-Wan-Ga   Lodge   in   ganizations   (someone   suggested   that   our   name
                  upstate  New   York;   indeed,   many   people   felt   should    be    Community    Health     Organization).
                  very  strongly  that  the  final  conference   should   The  fallacy  of  the  first   assumption   enumerated
                  have been held in  New  York  City,  in  one  of  the   at  the  beginning  of   this   report   was   exposed
                  five   communities   SHP   was   working    in.    In   and  much  introspection  and  soul   searching   fol-
                  choosing a site for  the  final  conference  we  were   lowed.  The  Final   Conference   was   not   orderly,
                  faced  with  many  more  problems  than   with   ori-   people  complained  about  "to  much  talk,"  no   di-
                  entation.  We  felt  that  if  people  were  to  com-   rection,   and    no    continuation    of    projects
                  mute  each   day   to   the   Final   Conference   we   throughout  the  year  (however,   three   area   pro-
                  would  be  ending  the  sessions  early  and   begin-   jects  have   been   funded   through   the   winter).
                  -ning  late  in  the  morning-the   logistics   would   This  was  not   unexpected   and   merely   reflected
                  be  much  simpler  if  everybody  was  in   one'place   the clashing  of  ideals,  none  'of  which  have  ab-
                  for  the  entire   three   days.   Sha-Wan-Ga   Lodge   solute worth and all of which might be tried.
                  was far from the  ideal  location,  but  it  was  the     We  ran  into  a  problem  in  our  project  because
                  best we could find in  terms  of  space,  facilities,     e      areas and the participan        s     e  a
                  food,  convenience,  and  price.  If  I  seem  to  be   times to be  less  important  than  the  unified  Stu-
                  harping on  seemingly  trivial  issues,  it  is  only   dent  Health   Project.   We   talked   about   auton-
                  because   much   of   my   time   this   summer   was   omy  and  creativity,   but   were   faced   by   poor
                  spent worrying  about  just  such  details  and  pre-   support  on  the  local  level,  many   willing   stu-
                  cious little time  was  spent  in  a  nonbureaucratic   dents  but  some  not  willing  at  all,  much  money,
                  bag.  Much  of  the  "central   staff's"   time   was   and  a  bureaucratic  structure  second  to  none  be-
                  spent  patching  up  situations  that  arose  because   hind  the  project   (Montefiore   Hospital   runs   a
                  of  poorly  functioning  area  leadership,  and  sim-   very  efficient  bureaucracy,  and  their  staff   was
                  ple  confusion  caused  by  poor  planning   on   our   invaluable)  which   often   did   not   function   as
                  part.  Coupled  with  a  student  ignorance  of   the   responsively  as  we  would  have  liked.   The   ten-

                  124


                                                 SUMMER  1968

      sion was  between  the  five  individual  areas  and   everything   without   benefitting   from   anyone's
      what  each  thought  was   important,   what   could   specific   knowledge.   By   defining   roles   some
      be allowed  to  permit  proper  functioning  of  the   needless  overlapping  can  be  eliminated.A   clear
      project,  and   what   Montifiore   and   Washington   definition of a role does not  limit  initiative  or
      were   willing   to   allow.   These   three   power   creativity. It should enhance  it.  If  the  commun-
      groups were never  at  direct  odds,  but  the  com-   ity  worker  knows  how   the   welfare   department
      munication  between   the   three   was   not   good   functions, this in no way  stifles  his  ability  to
      and this lead  to  much  ill  will.-S.G.,  Education   work with welfare clients.
      Coordinator.                                             * *  *  It  seems  that  if  students  were  given
        If SHO  does  continue,  which  I  hope  they  do,   a specific orientation, a definition of their  role,
      they should  do  some  serious  thinking  about  the   and started the  summer  by  defining  their  focus'
      summer's   experiences.   Unfortunately,   many   of   then the  level  of  frustration  would  be  lowered
      the  comments  I  have  to  make  this  summer   are   and  the  feeling  of  accomplishing   higher.-V.V.,
      the same ones I made last summer.                      Nursing Student, Bronx.
        First of all,  Orientation  should  be  more  spe-     My  reaction  (to   orientation)   was   negative.
      cific. For  example,  those  working  in  the  Bronx   Most students  who  go  to  work  in  projects  like
      need  to  know   about   the   Bronx,   Mimeographed   this  already  have   some   awareness   of   ghetto
      sheets  of  all  community  groups,  health  facili-   problems.  The  resource  people  do   little   more
      ties and service  agencies  should  be  made  avail-   than tell us  in  more  vivid  detail  what  we  al-
      able  to  each  project  member  at  the   beginning   ready  know  in  general.  Specific  names  of  pro-
      of  the  summer.  This   summer,   halfway   through   grams and people are  lost  on  me,  as  I  have  no
      the project  one  list  of  medical  facilities  and   way to connect them with their environment.
      community  organizations  was   available   in   our     The  Orientation  seemed  to  be  trying  to  give
      office. This list should also  include  such  things   us a feel for the  ghetto  in  a  resort  hotel  at-
      as clinic  hours,  how  to  register,  and  who  the   mosphere.  It  should  have  concentrated   on   the
      heads of each department are.                          organization  of  the  power  structure  ,  and  the
        It is  also  important  to  know  basic  functions   poverty organizations, and  left  the  ghetto  feel-
      of  the  community   groups.   Last   summer   there   ing to  a  time  when  we  could  experience  it.  I
      was  an  excuse  for  not  having  this  information   want  to  become  "sensitized,"  too,  but  not   at
      available  because  it  was  the  first  summer  for   Bader's Hotel.  It  was  like  going  to  France  to
      SHP. This  year  it  was  not  excusable,  and  next   learn   German.-R.H.,   Law    Student,    BrookZyn.
      year  we  should  not  attempt  a  project   without     To  me  the  orientation   was   unnecessary   be-
      having this information  readily  available.  It  is   cause I now how it is to live  in  a  ghetto  and  I
      rather  astounding  to  find  out  that  -a  student   need no one to tell me how  it'is.  The  only  thing
      working  one  block  from  the  N.M.C.D.,   can   go   the  orientation  did  for  me  was  to  give  me  a
      half  way   through   the   summer   without   know-   chance  to  know  the  people  I  would  be  working
      ing of its existence.  Equally  astounding  is  that   with. Also to  find  out  what  their  personalities
      a  community  worker  in  the  last  week   of   the   were  like  so  I  would  know  how,   to   approach
      project  can  admit  to  not  knowing   about   Wel-   them.-W.F., NYC, Brooklin.
      fare minimum standards forms.
                                                               My only criticism of  the  project  was  the  pre-
        Orientation  should  also  include  a   discussion   and   postsummer   meetings.    They    seemed    to
      of   roles.   For   example',   community    workers   have  too  much  of  the  "party   atmostphere."   I
      should be told that they are  to  be  involved  with   am certainly  not  one  to  dislike  parties,  quite
      welfare  and  housing  problems.   Part   of   their   the  contrary.  But  I  prefer  my  parties  to   be
      introduction  to  their  new  role  should   include   paid for  by  me  and  not  out  of  funds  allotted
      specific  information  about  welfare.   They   need   for   the   urban    communities'    problems.-B.W.,
      to know  the  lines  of  authority,  the  rights  of
      the clients, the procedures of  the  different  cen-   Medical Student, IVewark.
      ters, etc. This summer everyone  did  a  little  'of     In   improving   SHP   for   next   summer,    the

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                 most apt suggestion I can make is  that  the  stu-   munity  people  as   health   workers   can   work.
                 dents in each specific project  familiarize  them-   "Sensitization"  of  student  fellows  had  a   low
                 selves with the  community  and  the  project  be-   priority.-R.C.,   Student   Coordinator,    Hartem.
                 fore the summer  so  that  when  June  comes  they     I feel that we  were  also  severely  limited  in
                 can   start   work   immediately   without   first   designating  ourselves  as  a  project  to  "teach"
                 spending a  great  deal  of  time  learning  about   other  students  about  poor   communities.   While
                 the problems of the area.  This  of  course  would
                 necessitate much  time  during  the  school  year,   this is  an  admirable  and  necessary  task,  many
                 something medical students  may  not  be  able  to   of  the  more  experienced  of  the  students  were
                 do.                                                  not  capable  of  structuring   a   project   which
                   I believe  the  orientation  session  at  Baders   could  provide  useful  service  to  the  community
                 was  most  useful   and   should   be   continued;   while  giving  uninitiated  students  first   expo-
                 though much  of  what  was  said  there  was  per-   sure. This is because  most  of  the  students  who
                 haps  not  necessary  (for  example,  what  is   a   set up the project  didn't  have  very  much  expe-
                 ghetto?). There  were  two  films  shown,  one  of   rience themselves. I don't think that-  in  several
                 SHP in California and  one  on  the  South  Bronx,   weeks or a month or  even  a  year  a  health  sci-
                 both of which gave us  an  idea  of  ghetto  life,   ence  student  can  be  knowledgeable   enough   or
                 and,  perhaps  more   important,   explained.@tti-   accepted  enough  by  the  people  he  is   working
                 tudes  we  might  face  while  working  in   these   with to take it upon himself to  bring  other  stu-
                 areas.-D.K., Medical Student, Brooklyn.              dents in to get a feel for what  is  going  on.  In
                                                                      my  opinion,  all  projects  which  are   beginning
                  The   orientation   program   at   Bader's    may   for the first time should be composed on    ly   of
                 have been costly to  SHO  and  boring  or  useless   local students  with  some  experience,  who  share
                 to  old  SHO  members  but  to  anyone  newly  ac-   some attitudes about  "health  care  as  a  right,"
                 quainted with  the  organization,  it  held  three   the economics  of  poverty,  the  poor  educational
                 opportunities: to  learn  a  bit  about  SHO,  its   system, etc. Their goal should  be:  (1)  To  prov-
                 goals, philosophy, etc.; to learn the exact  plans   ide themselves  as  consultants  to  the  community
                 and expectations of  the  various  projects  (with   on    whatever    projects    are     underway-they
                 chances to reconsider  choices!);  and  to  get  a   should  not  start  their  own  projects;  (2)   to
                 feel of some attitudes the next  ten  weeks  might   meet   people   in   the   community   and   become
                 support or struggle against.                         knowledgeable  about  the  special   problems   and
                  Local  area  orientation,  on  the  other   hand,   resources  of  that  community;  (3)  to   discuss,
                 might have been a  little  more  diligently  done.   say at  the  end  of  the  summer,  with  the  com-
                 In the future, such  proceedings  could  serve  as   munity  people  they   have   worked   with,   ways
                 a guiding push into the  summer's  activities  and   in  which  more  students  and   community   people
                 save the  student  fellow  from  wasting  precious   may work together in the fall.
                 time  learning  what  old  project  members  could    I do not think  that  students  -new  to  an  area
                 easily pass on. Admittedly, some things  will  re-   should  identify  themselves  as  SHO  or  SHP   or
                 quire a certain amount of time  for  each  student   anything  else;  this   marks   them   as   another
                 to  get  on  his   own.-A.G.,   Nursinq   Student,   group  with  something  to  do.  Their  'Only  task
                 Harlem.                                              during the first  summer  should  be  to  help  out
                  We found that   our  goals  were  somewhat   dif-   existing  community  groups.  If  this   were   the
                 ferent from those  of  the  citywide'SHP.  In  the   case there would not be  a  city-wide  SHO  as  far
                 introductory  remarks  and  the  comments  on  the   as  community  work  goes.  There  might  be   some
                 1967 California SHP film the first night  of  ori-   central  staff  to  arrange  seminars,   confronta-
                 entation, it  became  evident  that  much  of  the   tions, etc., but it should not  be  concerned  with
                 purpose  of  the  New  York  SHP  was  "sensitiza-   individual  projects,  which  at  least  at   first
                 tion."  Our  primary  goal  was  to  improve   the   would  be  directed  strictly  by  the   individual
                 school health program  in  Harlem  public  schools   community. I think  that  the  central  staff  this
                 by  demonstrating  that  a  model  for'using  com-   summer  was  very  ambivalent   about   its   role-

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                                                 SUMMER  1968
      supervisor-director   or    facilitator-but    this    one has never spoken. Yet  I  feel  frustrated  be-
      would  be  eliminated  if  they  did   not   decide    cause  I  know  that  sympathy  on  my  part   does
      things for the individual projects.                    nothing for those people.  I  feel  frustrated  be-
        I should state here that  the  idea  of  bringing    cause I see  that  the  problems  are  so  enormous
      out-of-state students  to  various  project  sites,    that I can do almost nothing.  I  also  feel  frus-
      which  goes  along  with  the  idea  of   educating    trated because  many  of  the  limited  goals  that
      students and  creating  other  SHOS,  is  overambi-    we have  established  will  not  be  achieved.  But
      tious  and  hampers  activities.  Aside  from   the    then I think about  how  I  felt  after  the  first
      difficulty of getting  a  group  with  such  diver-    time I sat  with  a  group  of  Neighborhood  Youth
      gent views together to do something, it  is  diffi-    Corps teenagers, trying  to  make  boys  and  girls
      cult to think in terms  of  ongoing  projects  when    confront each  other  about  their  ideas  on  male
      75 percent of the project staff  leaves  almost  as    and female anatomy in  a  sex  education  class.  I
      soon as it arrives. This  also  rubs  in  the  fact    felt very good because  I  say  that  these  young-
      that students  can  and  will  leave  the  -commun-    sters  could  respond  to  me  and  that  we  could
      ity, but residents are  stuck  there.  Along  these    work  together;  that  I  could   bring   Something
      lines we might also say  that  students  should  be    new   to   their   lives.-P.S.,   Medical    St@nt,
      required  to  live  in  the  communities  in  which    LowerOast Side.
      they   work.-S.D.,   Student   Coordinator,   Lower      After  2  years  of  working  as  a  student   in
      East Side.                                             Metropolitan  Hospital  I  really  cannot   say   I
        The first few weeks  on  the  project  have  been    learned  anything  new  about   the   delivery   of
      so full of,different kinds of  experience  that  it    health  care.  I  spent  the  summer   in   another
      would  take  me  many  pages  to  relate  all  that    area  of  New  York  City   where   most   of   the
      has happened. .  .  .  One  moment  I  feel  as  if    problems were basically the same,  but  I  did  ex-
      there is real purpose to  our  work  and  then  the    perience more about the  delivery  of  health  care
      next hour I feel as  if  the  entire  effort  is  a    and  hear  more  of  the  actual  feelings  of  the
      futile one. There is very little  structure  to  my    people. What I  had  learned  before  was  learned,
      project other  than  that  which  I  make.  Nothing    dressed in white, as part of  the  hospital  struc-
      in my  educational  or  work  experience  has  been    ture;  what  I  experienced  this  summer  was  ex-
      this way. The past  year  at  medical  school,  es-    perienced  as  part  of  a  community  organization
      pecially, convinced  me  that  it  was  unnecessary    (NENA)  fighting  health  rights  issues   on   its
      to have to  think  and  to  be  creative  in  on6's    own grounds. I  found  this  completely  invaluable
                                                             to my understanding. When  a  person  is  sick  and
      work,  but  this  summer  has  been  as  much   the
      opposite of last year as  possible.  Every  day  is    must go  to  a  hospital,  he  comes  to  you  (the
      different and is only  as  meaningful  as  the  ef-    nurse,  the  doctor)  on  your  grounds:.  you  are
      fort which I put in. In some ways  this  is  irooi,    the controlling  factor  in  the  relationship;  he
      I am learning how  to  work  in  a  loosely  struc-    has no voice  and  does  not  say  what  he  feels.
      tured job and how  to  create  something  of  value    When  you  go  to  him  and   meet   him   on   his
      in the summer's work.                                  grounds, you are  a  guest  in  his  home;  he  has
                                                             more authority and  can  meet  you  on  a  o-ne-to-
        I wonder,  however,  if  we  are  actually  going    one  basis.-M.L.,  Nursing  Student,   L.ower    East
      somewhere  as  an  organization   of   professional    -Side.
      students who really  do  have  talents  and  Imowl-
      edge to offer the community. I  feel  as  if  I  am      You fight  a  deadline  because  you  don't  want
      going  to  come  away  from  a  meaningful  experi-    to  disappoint  the  community,   and   then   they
      ence with  a  much  greater  understanding  of  the    don't  showup;  you  can  understand  it,  but   it
      problems of  the  poor  and  a  feeling  of  sympa-    doesn't  help  your  feeling  of  that  big   come-
      thy for the people,  a  feeling  acquired  only  by    down.  Now  you  know  how  the   people   of   the
      walking the  streets,  by  smelling  the  air  that    community  must  feel  when   they   get   promised
      people  breathe,  by  seeing  the  homes  in  which    things and don't get  anything.  I  was  too  naive
      they live, and  by  talking  to  people  with  whom    going into it; I  didn't  expect  any  hitches;  we

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                 kept  our  end  great  and  this  guy  had  promised   on the wording of the question  as  it  was  to  con-
                 he  would  get  the  kids  for  the  physical  exams   centrate   on   the   way   it   was   asked.   These
                 and I took him  on  his  promise.  I  now  know  you   mothers  are  not  stupid.   They   can   tell   when
                 can't do that. If we  were  to  do  this  again,  we   someone  is   sincere   and   when   someone   really
                 would  arrange  for  the  kids  to  come  ourselves,   cares about  the  well  being  and  safety  of  their
                 and leave  nothing  to  anyone  else.  That  is  one   children.-D.Y., Medical Student, Brooklyn.
                 thing I  have  learned  this  summer;  I've  learned     The   huge   Brookdale    medical    complex    was
                 to rely on  other  people  a  lot  less.-W.S.,  Stu,   considered  not  worth  a  damn  and   all   I   knew
                 dent Coordinator, Brooklyn.                            about it was  what  I  heard  and  all  I  heard  was
                   I  have  heard  our  SHP  advisor  say  more  than   bad.  Validity  is  not  inherent   in   universality
                 once that it is difficult and almost  impossible  to   and  because  all  of   the   gung-ho   people   from
                 assess  the  effects  of  any   community   service.   both   SHP   and   the    community    had    climbed
                 Bearing  this  in  mind,  I  think  that  the  major   aboard   the   "Bury    Brookdale"    bandwagon,    I
                 accomplishment   of   my   summer's   efforts    has
                 been my own education.                                 didn't believe any of it.
                   This  education   began   in   family   counseling     When   the    opportunity    was    presented    to
                 where  I  learned  about   welfare,   housing,   and   work  at   Brookdale   with   complete   freedom,   I
                 mental  health  problems  that  affect  some  ghetto   secured  the  position.  Seven  weeks'   of   examin-
                 residents.  I  also  saw  how  these  problems   are   ing  programs,  speaking  ta  patients,  and  quietly
                 interrelated  and  how  they  affect  ghetto   resi-   observing  the  procedures  and   handling   of   pa-
                 dents' health  and  well-being.  In  the  VD  educa-   tients'  convinced  me  that   the   blowhards   I'd-
                 tion  program,  I  learned  about  venereal  disease   heard  at  the  summer's  beginning  did   not   know
                 and also how  little  is  known  about  it  and  its   firsthand  what   they   were   talking   about.   In
                 cure  in  the  community.  It  also  became  evident   fact, they had  fallen  prey  to  exactly  what  they
                 that  even  though  people   had   many   misconcep-   so  staunchly   warned   against:   the   blind   ac-
                 tions  about  VD,  they  were  well  aware  of   the   ceptance of stories which,  as  I  later  found  out,
                 social  stigma  involved  with   having   contracted   should  have  been  either   buried   long   ago   or
                 syphilis  or   gonorrhea.-E.C.,   Medical   Student,   never    even    begun.-J.G.,     Dental     Student,
                 Brooklyn.                                              Brooklyn.
                   There   had   been   many   arguments   concerning   . * * *  I  spent  most  of  the  time  talking  with
                 the wording  used  in  our  questionnaire.  For  ex-   the  three  boys,  about  my   age,   who   work   as
                 ample,  we  wanted  to  know  if  the   person   was   guards in the office. I  quickly  learned  that  they
                                                                        were  quite  as  complex  as  I.  I  was   interested
                 living with his or  her  spouse.  One  could  simply
                 ask:  "Are  you  living  with  your   husband?"   We   and surprised  to  learn  that  the  reality  of  the
                 did not want to do  this.  These  people  have  been   ghetto,  with   its   junk,   crime,   and   imminent
                 picked  on  too  often.'They  have  been  constantly   death frightens them  as  much  as  it  would  me  if
                 questioned,  often  with  too   little   compassion,   I lived  there.  And  these  boys  are  by  no  means
                 about their personal  lives;  questioned  by  people   powder-puffs-one  is  an  ex-addict,  and   all   are
                                                                        fully  in  the  midst  of   the   Bedford-Stuyve'sant
                 who  have  different  value  systems  and  different   discene." I  was  very  discouraged  by  their  bland
                                         ife really is like. By  ask-
                 concepts about what I'
                 ing  the  number  of  children  in  the  house   and   acceptance   of   everything   that   occurs   around
                 the number  of  relatives,  etc.,  we  would  figure   them;  the  universal  gambling,  dope,  and   steal-
                                                                        ing  from  one  another  is  a   depressing   reality
                 out  by  a  person's  response   to   the   question
                 about the total  number  of  people  living  in  the   that  is  acknowledged   fully   but   left   unchal-
                 house whether she did  indeed  live  with  her  hus-   lenged  in  their  thought   or   conversation.-J.T.,
                 band.                                                  Medical Student, Brooklyn.
                   One of my  first  lessons  learned  was  that  all     For people  on  the  outside  there  is  a  feeling
                 this  beating  around  the  bush  was  quite  unnec-   that  the  black  community   in   Newark   is   dan-
                 essary.  It  wasn't  as  important  to   concentrate   gerously  unified  and  ready  for  complete  revolu-

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                                               SUMMER  1968
     tion. When  I  walked  into  Newark  this  summer,    become   somewhat   prejudiced    against    white
     I was afraid.  My  orientation  had  never  before    people, I meet one I really like.  From  past  ex-
     been  that  of  a  revolutionary;  I  had   always    perience, however, I try not to forget that  I  am
     been a reformer. I didn't believe in  violence  as    black and he or she is  white.  The  other  day  I
     a solution to any problem. I didn't like the  idea    was walking down  125th  Street  with  one  of  my
     of "black  power"  because  all  it  meant  to  me    coworkers.  I  noticed  that  some   people   were
     was separation.  I  believ'ed that everyone  had  to  staring at us; then it hit  me:  "I'm  black-she's
     get  together  to  solve  racial  problems.  After    white." I  had  forgotten.  Ivs  much  easier  and
     about 2  weeks  in  Newark,  I  changed  my  opin-    more comfortable to forget. I'll  have  to  do  it
     ions  and  my  orientation.-K.F.,   Medical   Stu-    more   often.-C.R.,   Medical   Student,   Harlem.
     dent, Newark.                                          The people  who  came  to  work  in  the  project
       Although  I  have  lived  just  outside  of  Ne-    should have  already  had  a  meaningful  attitude
     wark  for  most  of  my  life,  I   found   myself    toward  the  people  they  would  be  in   contact
     spending the first  few  weeks  of  the  SHP  pro-    with, for  example,  the  community,  before  they
     gram  getting  familiar   with   the   city-objec-    went into the  community.  And  if  some  students
     tively and subjectively.  There  were  streets  to    didn't have these attitudes,  or  there  was  some
     know, bus  lines  to  learn,  names  to  memorize,    doubt that they  did,  then  the  students  should
     landmarks to note,  people  to  meet,  etc.  There    have been screened out. This is not the  place  to
     were also attitudes to  recognize  and  to  under-    develop attitudes. This is the place to  work  for
     stand-mine,  as  well  as  those   of   the   com-    the community as a  result  of  these  attitudes.-
     munity  in  which  I  was   to   work.   My   pre-    C.R., Community Worker, Bronx.
     vious life in the suburbs had not  exposed  me  to
     the real working of Newark-, initially  I  was  in     WHAT NEXT?   SUGGESTIONS' FOR
     a  state  of  overwhelming  ignorance.  But  as  I                    THE FUTURE
     came to  know  more  about  Newark  and  its  peo-      I think there may be  a  place  in  ghettos  for
     ple, I was able to participate  in  the  SHP  task    white  liberal  medical   and   nursing   students
     of improving  the  medical  care  offered  to  the    next summer but it is a rather specific  and  con-
     people  of  this  community.-B.W.,  Medical   Stv-    ditional one. I  think  students  should  only  go
     dent, Newark.                                         into a community  at  the  request  of  a  commun-
                                                           ity group. I think the students should  see  their
       The problems  of  health  care  delivery  change    role as primarily that of support for  groups  al-
     quickly revealed themselves to  me  to  rest  more    ready working on health,  or  who  are  trying  to
     with the medical  establishment  of  the  hospital    build an  awareness  of  health  issues  in  their
     and New  York  City  health  department,  than  in    communities.
     community  apathy,  lack  of  sufficient  informa-     I would  personally  suggest  that  there  be  no
     tion about health services in  the  community,  or    more SHPs like  the  ones  we  have  had  for  the
     lack  of  parental  concern  and  cooperation.  (I    last 2 years in New York. It is  just  too  expen-
     was surprised and pleased  to  discover  how  well    sive and too exploitative  of  the  community  (we
     ghetto mothers do take care  of  their  children's    learn more from them  than  we  provide)  to  jus-
     health needs, within their  limited  means,.  even    tify taking government funds.  If  we  could  fund
     though not up  to  middle  class  white  America's    a large number of community people, as        they
     standards.)-W.S., Medical Student, Harlem.            did  in  New  Haven,  that  might  be  better.  On
        I really didn't  expect  to  re.ceive  too   much  the other hand, I think  it  would  be  better  if
     $(sensitization"  as  far  as  the  community  was    SHO  concentrated  on  what  it  could  do   year-
     concerned,  since  I  was  born  in   Harlem   and    round to raise significant  issues  in  health  in
     have  spent  several   summers   there   recently.    the  community  where  the  medical  schools  are.
     However, I was surprised to  find  that  my  rela-    SHO  should   concentrate   on   providing   human
     tionship  with  white  people  was   greatly   im-    medical care that is responsive to  the  needs  of
     proved. It seems  that  every  time  I  manage  to    the  community  and  at  the  same   time   should

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               turn other medical students  on  to  the  concept    small group which  may  serve  as  the  "cutting
               of medical care as  a  right,  not  a  privilege.    edge"  to  anything   SHP   can   becoTne.-R.C.,
               SHO should develop the attitude  of  standing  on    Student Coordimtor, Hat-le-m.
               the side of the consumer of care and  criticizing      I now believe that the  best  thing  SHPs  (or
               the facilities from that point of view, not  from    more   appropriately   year-round   active   SHO
               the point of view of  the  professional  deciding    campus groups) can do is to  focus  all  availa-
               what is best for  a  community  without  consult-    ble manpower on  a  single  significant  ground-
               ing them.                                          . floor objective (as determined by the  needs  of
                 The last thing I want to  say  relates  to  the    the specific  community  through  prior  discus-
               people I  have  seen  on  the  SHP  this  summer,    sion with people in the  community)-be  it  ser-
               These remarks fall  into  the  "I  love  humanity    vice-oriented (for example, a health rights  and
               but I can't stand people" category,  I  guess.  I    resources  community  education   campaign)   or
               think that SHP is in a dilemma;  it  was  started    activist-oriented (such as assisting  some  spe-
               by a group of people  who  were  much  more  rad-    cific community group  in  forming  a  community
               ical (in the sense that they were willing to  ad-    health advisory council). Otherwise, we  can  do
               dress themselves to  "root"  problems)  than  the    the most good working within  the  medical  care
               people  who  have  climbed  on  the  summer  pro-    delivery institutions of which we are a part  to
               ject bandwagon. For example, we've tal               effect changes in practices and policies.
               about alternative structures that seem to get  at      Medical    student     activities     (whether
               the problem of community  control,  but  most  of    SHO/SHP  or  not)  should  be  directed   toward
               the  SHP  medical  students  are  suspicious   of    two important and  closely  related  objectives:
               community  control.  We've   talked   about   the
               "politics of health" but most of the students  in      Communication:  We  can  work  to   facilitate
               the summer projects are  essentially  apolitical;    communication  between  health  service   estab-
               to wit, the Detroit SHO  convention  declined  to    lishment,  professionals  and  community  people
               take a stand on  the  war  in  Vietnam.  So  what    (and vice versa), example, liaison  with  hospi-
               we have is a liberal service organization,           tal  administrators   where   community   people
               the most part, that tries to  sound  radical  for    co idn't get a foot in the door, or  working  to
                                                            b @t    deuvelop formal hospital  "community  relations"
               that has no  real  sophistication  or  under@nct-    programs so that the  "real"  public  (not  just
               i-ng of root causes.                                 the  news  media  reporters)   can   know   what
                  I think that there will probably be  more  SHP    good and bad things  are  going  on  inside  our
               summer  projects,  simply  because  there  are  a    ivory towers.  At  present,  as  clearly  demon-
               lot of liberal medical students  who  would  like    strated in Harlem,  rumors  about  the  hospital
               a chance  to  prove  something  by  "doing  their    are allowed to  run  rampant  in  the  community
               thing" in the  ghetto.  Dealing  with  realities,    and  rumors  about  the  community  run  rampant
               then, we have to decide  how  to  make  the  ser-    in the hospital.
               vice projects as good as possible  while  leaving      Responsiveness-  We  can  work   to   convince
               the smaller group of more political  students  to    health professionals of the pressing need to re-
               deal  with  the  issues  of  decentralization  to    spond to  community  requests  for  information,
               neighborhood  clinics,   community   control   of    cooperation, suggestions for services or modifi-
               health facilities, redesigning health  care  sys-    cations of  existin.g  services,  etc.  (How  long
               tems in ghettos so that they  take  into  account    must  the  community  keep  asking  for  evening
               the life styles of the poor, and  the  fact  that    clinic hours before someone listens'?)
               even  if  the  New  York  City   hospita   system    We  also  can   work   to   increase   community
               were run efficiently (an impossibility in  a  bu-    awareness of the facilities and services availa-
               reaucracy  wracked  with  union   and   personnel    ble (community education  programs)  or  oppo-r-
               problems)  it  couldn't  provide  decent  medical    tunities they should  not  let  pass  (available
               care because  the  budget  allocation  isn't  big    jobs or positions on advisory committees, etc.).
               enough. All these issues we have to leave to  the      Specific SHP service projects should  only  be

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     initiated at the  request  of  some  responsible  ele-   entry  into  health   professions   and   over   health
     Tnent  in  the  community  which  has   existed   long   care delivery.
     enough to  have  some  real  feelin,,z  for  the  com-     Future   SHPS,   therefore,   should   develop    au-
     munity's   needs   and    desires    (PTA's,    health   tonomous   organizations   to   attack   the   problems
     councils' etc.).                                         in  each  borough.   Borough   leadership   should   be
      Dropping   twenty   or   so   health   science   stu-   shared  equally  by  one  militant  student   and   one
     dents   (and   some   unmotivated   NYC's   or    com-   experienced    community-leader.     Funding     should
     munity  workers)  into  as  complex  a  situation   as   be  entirely  independent  of   either   Federal   Gov-
     exists in urban  areas  like  those  in  New  York  to   ernment  or  medical   schools.   The   ultimate   pur-
     tackle  whatever  problems  can  be   found   in   ten   pose   of   such   an   arrangement   would   be    the
     weeks just  can't  go  on.  The  idea  of  sensitizing   ouster  of  the  health  science  student  leader   and
     health  science   students   to   the   urban   health   the   assumption   of   complete   control   by    com-
     care  problem  in  this  manner  is  too  selfish   an   munity  spokesmen.  This  is  the   strange   political
     objective  to   justify   spending   several   hundred   dialectic  that   white   health   professionals   will
     thousand  dollars.  It's  immoral  to  use  the   com-   have  to  learn  to  accept:  Success   means   getting
     munity  for  our  own   educational   purposes   with-   kicked out.-J.G., Medical Student, Bronx.
     out  providing   it   with   something   enduring   of     I  suggest  that  SHO  ought  seriously   to   consi-
     significant benefit.                                     der  making  the  relation  between  itself   and   the
      'I  don't  see  how  we  can  continue  bringing   in   community   more   explicit   and   formal   so    that
     a  new  group  of  students  each  summer  to   sensi-   the  team  of  community   worker   and   health   stu-
     tize   them,   each   summer   attacking   the    same   dent  could  be  developed  more  easily.   For   exam-
     problems  tci  no  avail,   repeating   the   previous   ple,  SHO  could  try  to   form   an   alliance   with
     year's  mistakes,  alienating  the   same   establish-   LABOR   for   joi-nt-funding   next    summer;    hous-
     ment  functionaries  (who  soon  come   to   view   us   ing  and  health  problems   go   naturally   together.
     as  a  joke),  and  leaving  behind  the   same   com-   The  basic  idea  would   be   that   health   advocacy
     munity   disillusionment   with   student    projects.   is  a  good  way  to  build  up  the  number  of   ser-
     Not  to  mention  the  health  professional  at   Har-   vices  LABOR   can   provide,   and   that   LABOR   is
     lem  Hospital  who  commented  that   we   should   be   a  good  entree  for  working  in  the   community   as
     paid  no  mind  because  we're  just   another   bunch   health  advocates.  The  idea  seems  to  me  to   have
     of mixed  up  kids  having  an  identity  crisis,  who   advantages   over   the   present   funding   and   or-
     all are in the bottom third of our class!                ganizational structure:
       In  the  first  place,  most  of  the  students  se-
                                                                 (1)  SHO  would   be   clearly   allied   with   the
     lected  for   SHP's   are   already   somewhat   aware           community   and   not   with   the   Establish-
     or  they  wouldn't  be   here,   and   a   summer   of           ment.  From  what  I've   seen   this   summer,
     foul-ups  and   frustrations   doesn't   really   have           the   SHP    funding    agency    and    policy
     sensitization value for them anyway. As          .  for          making    committee    haven't     made     any
     the  others,  who  do  need  such   exposure:   is   a           contribution  to  the  project.  If   anything,
     10-week  SHP  the  right  time   and   place   to   do           they     forced     unnecessary     compromises
     it?   I    agree    with    the    Harlem    community           on us in  the  planning  stages.  A  clear  al-
     worker  who  told  me   that   future   SHP's   should           liance   with   the   community   would    give
     consist  of  five  committed   students   and   twenty           us a  sound  and  practical  basis  for  learn-
     mothers,  rather  than   the   twenty   students   and           ing  what  community  health   will   have   to
     five  mothers   that   we   had.-W.S.,   Medied   Stu-           mean  in  the  future,  and  for  working   out
     dent, Harlem.                                                    that meaning.
       The  only  SHP  organization   relevant   to   these       (2) An    alliance    with    LABOR    based     on
     distinctive   problems   is   one   which    minimizes           joint-funding  would   give   project   fellows
     city-wide  student  and  faculty  political   infight-           a  larger  role  in  defining  how  they   will
     ing  and  which  maximizes  local   student   involve-           work   out   of    LABOR.    The    ambigui@'of
     ment  in  the  issues  of   community   control   over           the   present   relationship   created    prob-

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                                                         GREATER NEW  YORK

                      lems this summer; joint  planning  of  the   small  ones  all  over.-J.W.,   Nursing   Student,
                      project  and  joint  training  of  project   Bronx.
                      members  would  give  us   a   chance   to      I'd suggest that skeleton  ideas  for  projects
                      work out conflicts on  a  realistic  basis   be  worked  out  long  before  summer,  and   that
                      and  strengthen  our   relationship   with
                                                                   project fellows be asked to apply  for  particular
                      LABOR.                                       projects and, as part of their  application,  give
                  (3) LABOR    employees  could  provide  better   some idea of how  they  think  the  project  might
                      continuity after the summer is over.         be organized and implemented.  In  this  way,  the
                  (4) Joint-f unding with  a  community  organi-   Orientation session could get  down  to  decisions
                      zation would  give  SHO  a  good  opportu-   as to how each  group  of  eight  or  ten  student
                      nity  to  get  LABOR  involved  in  health   fellows was to  operate,  and  discussion  of  un-
                      issues and  aware  of  the  problems  that   derlying  philosophy  would  take  place  in   the
                      must be solved. This  opportunity  to  ex-   most useful context of real alternatives  and  the
                      pose and develop  our  thinking  shouldn't   effects they would  have.  I  suspect  one  reason
                      be lost. We simply cannot  go  on  educat-   why the lead poisoning  project  will  leave  con-
                      ing  ourselves,  believing  that  when  we   crete results, aside from the nature of  the  pro-
                      are  the  medical   establishment,   we'll   ject, was that project  fellows  formulated  goals
                      make  the  needed  changes.  Nor  can   we   and  thought  about  methods  before  the   summer
                      continue to  try  to  dream  up  community   work began.-A.K., Law Student, Bronx.
                      groups (i.e., by  calling  meetings)  that
                      we can  then  manipulate  to  support  our      I don't think  that  there  should  be  an  SHP
                      positions on health care.  We  must  begin   next summer, in the  form  it  took  this  summer.
                      working on a  mature,  realistic  alliance   Rather, SHP  should  be  a  kind  of  liaison,  or
                      with  community   groups,   with   sharing   coordinating body, to  place  health  professional
                      of    power.-K.B.,    Medical     Student,   students  and  perhaps  NYCs   in   various   com-
                      Bronx.                                       munity   organizations   throughout   a   specific
                                                                   area of the city. I do not believe  that  SHP  can
                  There is definitely a  place  for  SHP  in  my   accomplish  anything  worthwhile  (in   terms   of
               community.  However,  there  would  have  to   be   immediate  contributions  to  the  community)   if
               major changes  made  in  many  of  the  organiza-   it tries to function  as  an  autonomous  body  in
               tion's basic ideals. First, the program  must  be   the  community.  Students  simply  do   not   have
               organized  well   in   advance.   The   community   the experience,  the  know-how,  or  the  time  to
               should give SHP certain ideas  for  the  project,   produce  something  in  a   10-week   period.   We
               but SHP should  also  have  its  own  ideas.  And   can become more  aware  of  the  needs  and  prob-
               be  ready to act on  them.  The  leaders  of  the   lems  of  poverty-stricken  people,  and   benefit
               project should be able to tell the  student  fel-   them  more,  by  offering  our  manpower  services
               lows and other workers  exactly  what  they  will   to  organizations  which  the  people   themselves
               be doing. This was one  of  the  main  drawbacks.   have  created  out  of  awareness  of  their   own
               I.spent most of the month  of  July  looking  for   needs. Perhaps  that  way  we  can  also  convince
               the things to do, then when I finally really  got   them that we are  not  flighty,  well-meaning  but
               started  August  was  half  over.  Secondly,  SHP   do-nothing  kids,  who  have  come  slumming   for
               must have  strong  leadership.  With  an  organi-   the  summer.-M.H.,   Law   Student,   Lower   East
               zation as large and spread  out  as  the  Greater   Side.
               New York  Project,  you  must  have  leaders  who   A  place  for  SHO  in  our  community?   I   look
               are able to make  a  decision  without  taking  a   around  Grown  Heights  and  I  say  yes.  Perhaps
               poll of all the workers.  I  would  also  suggest   a  coordinating  employment  project  for  biomed-
               that -instead of spreading the project  all  over   ical  careers  and  paramedical  professions.  Why
               the city, SHP  should  concentrate  on  one  area   not  extend  the  patient  advocate  position   to
               and try to have large successes there instead  of   other  hospitals   and   other   communities.   We

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                                                SUMMER  1968

      could establish  some  liaison  with  hospitals  in   round  program  is   community   trust   and   sup-
      the   area    and     ask .  them     for     their   port.  To  merit  community  trust  and  support  a
      opinions.                                             program cannot pull  out  at  the  'end  of  a  10-
        As lead poisoning  cases  in  the  area  continue   week period.  To  effect  changes  in  health  care
      to rise, we could make a  project  of  checking  on   an  organization  must  have   community   support.
      apartments  that  are  serious  enough  to  warrant   Although  part  of  the  Newark  project  is   con-
      immediate  emergency  attention  by  the  city  and   tinuing in the form of  planning  a  health  advis-
      try to get loose paint and plaster  on  the  city's   ory council, made  up  of  community  people,  this
      list of emergency conditions  that  must  be  taken   is not  enough.  Although  the  students  must  re-
      -care  of  immediately.-M.H.,  Sociology   Student,   turn  to  their  respective   schools,   communica-
      Brookl,yn.                                            tions and activities  could  be  continued  through
        Thus  far  the  student  health   project   func-   the  work  of   the   NYC'S,   community   workers,
      tions  only  during   the   summer   months.   This   and  faculty   advisor,   and   possibly   previous
      means  that  every  summer   a   new   relationship   health  science   students   who   have   completed
      has to be fostered all  over  again  and  that  the   their   education.-K.S.,   Nursing   Student,   Ne-
      new students have  to  learn  all  over  again  how   wark.
      to cope with the problems and  the  people  of  the     I believe any  future  projects  should  seek  to
      community;  while  the  people  of  the   community   make  themselves  available  to   assist   directly
      have to  learn  how  to  trust  the  new  students.   any  already  existing  organizations  in  need  of
      Wii@ll this type of  short-term  relationship,  the   help.  This  would  provide  us  with  the   needed
      only ones who are  benefitting  are  the  students.   background   information   to   avoid   trial   and
      So far, nothing  concrete  has  been  left  in  the   error learning which we had  little  time  for.  It
      community.  Why  can't  student   health   projects   also would serve as a lever  to  get  us  into  the
      be run on a year-long basis so that there  will  be   community  quicker,  and  in  an  already  respect-
      continuity  of   care,   personnel,   and   trust?-   able way.
      M.,J., Nursing Stttdent, Bronx.                         It was  my  feeling,  in  the  beginning  of  the
        My  most   immediate   suggestion   in   continu-   summer,  that  I  would  be  living  right  in  the
      ance  of  the  program  throughout  the  year.  The   area. It was a mistake  not  to  do  so.  Though  a
                                                            few individuals did, I think  future  project  fel-
      success  of  this  project  has  been  in  becoming
      aware  of  the  health  needs  of  an  impoverished   lows should try living  in  close  proximity,  man-
      community  and  in  becoming   so   involved   with   aging the affairs  of  a  home  and  job  together.
      poor  people  and  their  unceasing  problems  that   'All money should be pooled  to  go  for  rent  and
                                                            food. Any leftovers would  be  divided  up  at  the
      one's   commitment   to   community   medicine   is
                                                            end among the workers as  salary.  I  believe  this
      strengthened.  However,  these  successes  do   not   would really lead  us  to  experience,  first-hand,
      begin to initiate  the  radical  reforms  that  are   what it means to  exist  on  a  restricted  budget.
      urgently   needed   in   the   administration    of   Granted, this is  an  idealistic  view,  but  maybe
      health care to the  indigent.  Reforms  will  @come   some of the  ideas  can  be  modified  and  put  in
      only  with  constant  pressure  on   the   existing
                                                            working  order.-J.M.,   Nurss'ng   Student,   Lower
      system  of  health  care.  This  point  was  illus-   East Side.
      trated  vividly  in  the  Newark  Project  by   ad-
      ministrators  of  Martland  Medical   Center,   the            Perhaps  one  person  could  be   specifi-
      established center of health  care  for  the  indi-   cally  in  charge  of  NYC  activity  for  two   to
      ,gent of Newark, constantly  --iving  evasive  res-   three  weeks.  This  person   might   arrange   for
      ponses to suggestions for better  health  care  de-   one  or  two  NYCs  to  work  alongside  some  per-
      livery, knowing they  would  only  have  to  listen   son in the community  whose  job  they  are  inter-
      to  these  suggestions  for  a  limited  period  of   ested in learning or  aspire  to:  surgeons,  anes-
      time.                                                 thetists,  X-ray  technicians,  attorneys,  police,
        I Another factor illustrating the limitation  @of   firemen,  etc.  Another  suggestion  to  ponder  is
      a  ten-week  program  and  the  need  for  a  year-   whether  two  community  workers  would   be   bet-


                                                             GREATER NEW  YORK

                 ter  than  one  because  some   competition   might          ual community  since  factors  such  as  de-
                 develop between  them  to  see  who  could  do  the          gree of organization and  level  of  politi-
                 better job. Or  at  least  each  might,  out  of  a          cal sophistication  had  to  be  considered.
                 sense of pride, strive  to  accomplish  a  body  of     (4)  There  were  some   complaints   that   some
                 acts  which  they  can  point  to.-N.W.,  Law  Stu-          students    become     impatient     working
                 dent, Newark.                                                with  lay  people  and  would  revert   back
                            RECOMMENDATIONS                                   to a reliance  on  other  professionals  de-
                                                                              spite the talk of equality.
                 Recommendations From Community                          (5)  It   was   unanimous   that   the    project
                 Worker Workshop                                              should  take  responsibility  to   send   to
                   (1)  Questioning of the concept  in  practice  of          every  project  staff  member   in   advance
                        the patient advocacy  role:  (a)  A  feeling          of  the  program  a  list  of  what  project
                        that  the  outsider  (usually  middle  class          funds can and cannot be used for.
                        white)  is  further   deepening   the   psy-     (6)  Everyone  should   have   job   descriptions
                        chologically  debilitating  dependency   po-          before starting the work.
                        sition of the  person  being  helped.  Doing     (7)  Finally,  community  staff  want,   psychol-
                        everything for, and failing  in  the  teach-          ogically,  to  know  that   students   cared
                        ing function which  will  enable  people  to          and really are  with  us.  "Even  a  student
                        advocate  for  themselves;  (b)   The   con-          who  goes  back  to  California  could  send
                        cept of confidentiality is  frequently  vio-          a  card  to  say  'I  was   thinking   about
                        lated. Isn't this a reflection of an  uncon-          you'.20
                        scious racism?                                 Recommendations for Community
                   (2)  On  the  selection  of   community   workers   Control
                        and  coordinators:   Selection   should   be     At  this  morning's  workshop  on  the  role   of
                        done  by   a   community   screening   group   the  white  medical  student  in   black   communi-
                        who  reflect  the  highest  aspirations   of   ties, an important  question  was  raised  but  not
                        that   community.   Priority    should    be   resolved.  It  was  mentioned  that  the  only  way
                        given  to  those   community   workers   who   the health care  delivery  in  ghetto  areas  could
                        have  worked   with   the   project   before   be  significantly  improved  would   be   for   the
                        and demonstrated their value.                  community to take  control  of  the  hospitals  and
                   (3)  On  the   question   of   whether   students   health facilities and  run  them.  A  medical  stu-
                        have  anything  significant  to  offer,   or   dent  suggested   that   that   was   impossible-it
                        whether their presence  is  irrelevant,  the   takes ten or  twelve  years  to  become  a  doctor,
                        group was split. For  those  who  felt  stu-   how  can  community  people  do  the  things   that
                        dents  had  no  place,   reasons   were:   1   doctors  do?  This  completely  missed  the  point,
                        Their  presence   is   a   perpetuation   of   we  think,  and  we  would  like  to  set  out  our
                        white  power;  (2)  they  are   not   needed   views  on  what  community   control   means,   how
                        because  when  they  leave   the   community   it  could  be  accomplished,  and  how  SHP   could
                        is in the  same  bag.  For  those  who  felt   relate  to  the  movement  toward  community   con-
                        they had a  place,  it  was  believed  that:   trol that is taking place in so  many  areas  these
                        (1)  Students  could  open  up  doors;   (2)   days.
                        students   did   provide   services    where     The  philosophical  basis   of   community   con-
                        none  previously  existed.  But  this  group   trol has its roots in this country at least as  far
                        still felt  the  issue  was  community  con-   back  as  Thomas  Jefferson.  The  classic  liberal
                        trol,  and  believed  that  the  proportions   ideal of Jefferson, the  faith  in  the  individual
                        between   community   staff   and   students   and  the  commitment  to  participation  in   self-
                        must   be   reversed.   Following    further   government,  is  one  of  the  foundations  of  our
                        discussion, it was agreed  that  this  ques-   political  system.  What  we  have  seen   in   the
                        tion was  best  answered  by  each  individ-   United States is the  rise  of  institutions  which

                 134


                                                        SUMMER         1968

       were   immune   from   the   political   system   and               more   important   for   the   community   than   more
       were  unaccountable  to  the  people  who  were   af-               glamorous   things   like   open-heart   surgery    or
       fected  by  them;  hospitals  in  ghetto  areas  with               sophisticated research'
       boards of  trustees  who  didn't  live  in  the  com-                 B.  Hiring  and  firing  of  medical  and  ancillary
                                                                           staff-the community  group  should  be  able  to  con-
       munity  are  a  good   example   of   this,   because               trol the hiring of medical personnel after  they  have
       they  so  often  become  unresponsive  to  the  needs               been  screened  for  professional  competence  by  the
       of the people they  serve.  The  two  chief  benefits               medical  board  or  director  and  ancillary   person-
       we  see  from  community  control  of  health  facil-               nel on the basis of interviews.  In  both  cases,  the
       ities,  then  are  that  they  would  be  made   res-               community  groups  could  concern  itself  with   such
                                                                           things  as  the  attitudes  of  the  employees  toward
       ponsive to  the  needs  of  the  community  and  that               the community from  which  the  patients  come,  their
       by  having  elected   health   councils   or   boards               sensitivity to people, and their  dependability.  Fir-
       they  would  be  accountable  to  the   people   they               ing could be done on the basis of  staff  and  patient
       serve.                                                              complaints.
         We  suggest  the  following  ways   to   set'up   a                 C. Control of the finances of  the  health  facility
       community  health  council  or  board  for  either  a               -we contend  that  community  control  implies  fiscal
                                                                           control. Administration of the  finance  could  be  in
       neighborhood   health   center   or    a    community               the  hands  of  a  comptroller  or  manager   employed
       hospital -                                                          by the clinic or hospital, but decisions as to w  iere
              1.  Make  contact  with  a  few  active   individuals        the money wil be spent should be in the hands of
            in  the  community  who  are  concerned  about   health        the community group.
            and want to  do  something  to  improve  the  delivery.     We  feel   that   community   control   is   where
            system.                                                   @@ings  are  headed  these  days  and  decentraliza-
              2. Set a date for  a  mass  meeting  to  discuss  the   -cion of health facilities  in  neighborhood  health
            health situation and  what  can  be  done  about  1+@.,
            disseminate   information   about   the   meeting    as   clinics is one of the  most  significant  trends  in
            widely as  possible,  using  radio,  newspapers,  leaf-   medicine.  SHP  might   involve   itself   precisely
            lets,  and   contact   with   community   groups.   The   where these  two  trends  meet;  it  might  set  it-
            community  people  could   make   the   personal   con-   self up  as  a  resource  to  community  people  who
            tacts  and  the  initiating  group  could  provide  the   want  to  develop  health  institutions   that   are
            funds and produce the leaflets.
              3.  At   the   mass   meeting,   suggest   mechanisms   responsive  to  community  needs  or  who  want   to
            for electing  a  board  or  council  and  let  the  as-   assume   control    of    existing    institutions.    Stu-
            sembled  group  decide  which  method  to   use.   Pos-   dents might be able  to  research  other  facilities
            sible  mechanisms   would   be   representatives   from   that  have  been  set  up  under  control  and  find
            all  community,  organizations  in  the  area,  a  one-   out  if  they   are   working;   they   could   help   with
            third  community,  one-third  professional,   one-third
            organization  representation,  an   election   from   a   the  organization  of   the   first   meeting;   and   they
            slate of all people  who  had  submitted  petitions  of   could  know  enough  to  get  out  when   they   are
            support, etc.                                             not  needed  or  when  they  are  getting   in   the
            4.  While  the  board  was  being  elected,  assign   a   way. Indeed, if SHP is  to  have  any  relevance  to
            group  to  explore  means  of  funding  the  clinic  or   what's happening, and not be  just  a  liberal  ser-
            cooperating with the hospital system.                     vice   organization   where   future   doctors   and
          We   suggest   the   following   powers   for   the         nurses get sensitized,  then  it  must  embrace  and
       community  council  or   board;   the   obvious   as-
                                                                      relate to the concept of community control.
       sumption is that community people do not nee
       to  be  doctors  to  control  non-medical   decisions          From Workshop on the White Student
       about the health facilities:                                   in the Ghetto
              A.   Control   setting   of    priorities-the    com-       1. Black   people   have   depended   on   whites
            munity  groups  should  be  the  one  to   assess   the
            needs of  the  community  and  set  the  priorities  of          too   long.   Any   program   has   to   create    a
            care provided by the facility  in  orderto  meet  those          black   economic   structure   in    a    "together"
            needs. For example, if there  is  a  serious  narcotics          community.   Blacks   don't   want   to   be    used
            problem  in  the  community,   the   community   groups          any  longer,  to  be  studied,  or  to   be   filmed
            should be able  to  put  narcotics  treatment  high  on          Especially to their own disadvantage.
            the list of priorities; also facilities  for  premature       2. White   students   can   do   more   by   going   to
            babies,  or  screening  for  lead  poisoning   may   be


                                                   SUMMER         1968
              effective  means  of  approaching   the   goal         residents who  are  interested  in  health  is-
              (depending  on  project  site,  previous  his-         sues.  The  students  would  use  their  exper-
              tory of successes and failures, etc.)                  tise to get  a  grant  and  would  support  the
          4.' Necessary   sensitization   should   be   pri-         project  by  doing  research  on  issues   that
              marily  in  winter  programs  and  only   sec-         the    community    workers    raise.     There
              ondary  in   the   summer   projects.   Summer         should   be   more   community   people    than
              should  be   for   doing   work   and   accom-         students in such projects.
              plishing project goals.                            4.  SHP   fund-raising   and   research.-The    as-
          5.  A  special  point  in   the   winter   program         sumption  is  that  SHP  should  try   to   get
              should  be  the  recruiting   of   black   and         funding  from   private   or   local   sources.
              Puerto Rican  high  school  and  college  stu-         Students   or   community   groups   who    are
              dents  who  show  inclination   towards   med-         working  on  improving   health   services   or
              ical and paramedical professions.                      raising  political  issues  in   health   would
          Two  types   of   project   actions   are   recom-         apply  for  funds  for  their   projects.   SHP
       mended:                                                       might  work  with   law   students   or   civil
          A.  Working     with     independent      agencies         liberties groups  to  research  legal  implica-
              doing  whatever   they   want   (i.e.,   foot-         tions of the projects.
              work, research, etc.)                              5.  A  Live-in  Project.-Students  would  live   in
          B.  Setting up  projects  whose  aims  are  to  be         a  community,  at  the  request  of   a   local
              continued  by  a  community  group.  The   na-         group  and   do   direct   community   organiz-
              ture  of  the  project  to  be   decided   and         ing   around   health,   organizing   neighbor-
              structured during the winter months.                   hood  health  councils,  bringing  direct   ac-
          Summer projects:                                           tion  against  hospitals,  etc.  The  prototype
          1.  Structured      service       projects.-Summer         for this is the Cleveland SHP.
              projects  that  are  specific  in  design  and     6.  A   Work-in   Project.-Students    would    get
              are  staffed  by  highly   selected   students         jobs  in  hospitals  or  summer  research  sti-
              with  similar  ideological   views.   Students         pends  (in  community   medicine,   if   possi-
              could  work  in  hospitals  or  with   commun-         ble)  and  would  raise  issues  of  inadequate
              ity  groups  where  significant   preparations         health  care.   They   would   seek   alliances
              have   already   been   made.   This   would..         with  community  groups   that   could   mobil-
              avoid  th.e  period  of  picking  out  a  course       ize   support   for   improvement   in   health
              of  action  and  working  out  of  group   dy-         care   provision.   Year-round   projects    at
              namics  problems   which   past   SHP's   have         schools:
              had to go through.                                 We feel  that  any  projects  should  aim  qt  edu-
          Affiliation  with   a   community   organization.-   cating  fellow  students   about   the   inadequacies
              Projects  which  could   be   funded   jointly   of  health  care  provision,  especially  in  low-in-
              with  a   community   organization   so   that   come areas, and  should  try  to  correct  injustices
              the  health   students   are   putting   them-   that  exist  in  their  own  medical  centers.   Pro-
              selves at the  direct  disposal  of  the  com-   jects could  include  courses  in  the  "Politics  of
              munity. The  project  would  have  to  be  de-   Health"  or  the  "Crisis  in  Medical  Care,"  hold-
              signed  by  students  and   community   organ-  .  ing  workshops  for  community  people   to   build
              izations together from the start.                an awareness of  health  as  a  right,  and  devising
          3.     Funding     co?nmunity     people.-Projects   means of  direct  political  action  to  bring  about
              would  be  made   up   mostly   of   community   change in the local health facilities.

                                                                                                                 137


                                                  GREATER         NEW       YORK
                      their  own   white   communities.   If   they         tion  to  the  community  before  working   in
                      want to be  involved  in  the  black  commun-         it.
                      ity there have  to  be  safeguards  to  guar-         2. Working  relationships weren't       estab-
                      antee  sincerity  and  loyalty  to  the  com-         lished  because  of   health   student   atti-
                      munity.                                               tudes of  superiority  and  lack  of  interest
                 3.   White  students  are  interfering  with   ex-         in the NYCS.
                      isting    community    structures.     People         3. NYC's feel that if they are  to  be  consider-
                      don't  want  whites  there   all   the   time         ed  equal  as  stated  at  Orientation,   they
                      (especially  on   a   summer   basis)   doing         should  be  given  the  same  wages   as   the
                      what blacks should do for themselves.                 students.  Opposition  to  this   means   that
                 4.   SHP  has  initiated  actions  which  can   be         orientation  statement  was   idealistic   and
                                                                            not worth a bag of beans.
                      pursued   by   the   community-legal   suits,         4. Late    wages    discouraged    NYC's     from
                      advocacy,   patterns   of    reforming    the         working.
                      structure.
                 5.   The  pattern  of  action  may  be   reformist         5. Equalization  of  work   between   the   NYC's
                                                                            and  health   students:   Students   shouldn't
                      or revolutionary.     The      revolutionaries        ask  NYC's  to  do  anything   they   wouldn't
                      among  us  regard  advocacy   as   patchwork.         do,  e.g.,  Bronx   lead   poisoning   project
                      There are health councils  galore  in  a  lot         where  NYC's  had  to  collect  urine   speci-
                      of  communities,  but  what  is  -needed  are         mens   from   house-to-house;   the   students
                      law  suits,  picketing.   Medical,   nursing,         collected a few  times  but  not  to  the  ex-
                      and  law  students  may  disseminate   infor-         tent that they made the NYC's collect.
                      mation,  but  the   community   should   take         6. Lack  of  constructive  work   initiated   for
                      over the hospitals.                                   either  NYC's  or  health  students   discour-
                 6.   Perhaps   the   Student   Health    Organiza-         aged NYCS.
                      tion  should  be   retitled   the   Community         7. Some  NYC's  feel  that  the   students   took
                      Health   Organization,   run   for   and   by         advantage of them as individuals.
                      black students. It is  suggested  that  black         8. NYC's   would   like   to    have    practical
                      communities  select  the  professionals   who         health education, such as first  aid,  artifi-
                      will  be  trusted,  using  a  greater  number         cial respiration,  what  to  do  in  emergency
                      of  community  people'rather   than   risking         situations like strokes, heart  ittacks,  etc.
                      getting  insincere  health  students.  It  is         9. NYC's  feel  they   would   appreciate   tuto-
                      unfair to the  community  to  send.in  'fresh         rial  programs  involving  their   needs   and
                      troops' each year just so they  can  be  sen-         interests, done on a constructive basis.
                      sitized, and then leave, returning  to  their         10. NYC's  would  like  to   have   representation
                      schools (to a white 'structure)   where,   in         within    meetings    and    have    something
                      fact, they will be coopted.                           done to  abolish  their  dislikes.  They  want
                  7.  Health  professionals  are   needed   because         spokesmen   to    make    project    directors
                      there   aren't    enough    black    doctors,         aware of their gripes and take action.
                      lawyers,   nurses.    In    certain    -ewes,         Recommendations for Future Student
                      organizations   employ   professionals   they         Health Organization Projects
                      themselves   respect.   Health   professional
                                                                            1. Summer  SHP's  must  be  a   direct   continu-
                      students  know  what  good  health  care   is         ation of SHO activities that  .exist    during
                      and  can  point  the'injustices  out  to  the         the year.
                      community,  who,  in  turn,  can   do   what-
                      ever they want to do to correct them.                 2. The  main  SHO  objective  should  not  be  to
                                                                            sensitize  or  educate  students  or   commun-
               Recommendations from NYCs                                    ity,  but  rather  to  basically  change   the
                  1. Students  need  more  experience  as  to  com-         structure of health care and delivery.
                      munity  happenings,  i.e.,  better   orienta-         3. Attack  should  be  whatever   is   the   most


                        Appendix A:- LISTING OF PARTICIPANTS

                                        CENTRAL OFFICE STAFF
                Project Director:
                    Marylyn Gore-Albert Einstein College of Medicine.
                Student Co-directors:
                    Nivia Nives-Bronx Community College School of Nursing.
                    Peter Bryson-Downstate Medical Center.
                Educational Coordinator:
                    Simeon Grater-Albert Einstein College of Medicine.
                Faculty Sponsor:
                    Martin Cherkasky, M.D.-Director, Montefiore Hospital and Chairman, Depart-
                         ment of Community Medicine-Albert Einstein College of Medicine.
                                             SOUTH BRONX
                Student Area Coordinator:
                    Bernice Baker-Bronx Community College School of Nursing.
                Community Coordinator:
                    Marie Gallishaw
                Faculty  Ad@or:
                    Harry Becker-Albert Einstein College of Medicine.
                Medicine:
                    Nora J. Avins-Woman's Medical College.
                    Karen E. Benker-University of Southern California.
                    Ingrid Buhler-Albert Einstein College of Medicine.
                    Robert Cohen-Albert Einstein College of Medicine.
                    Peter Cummings-Case Western Reserve University.
                    Robert Ferrell-New York Medical College.
                    Christopher Frantz-Albert Einstein College of Medicine.
                    John Graves-Albert Einstein College of Medicine.
                    Michael Pawel-Albert Einstein College of Medicine.
                Nursing:
                    Iris Arroyo-Bronx Community College.
                    Patricia Benson-Syracuse University.
                    Harriet Hair-Bronx Community College.
                    Madeline Jervis-Bronx Community College.
                    Anna Lopez-Bronx Community College.
                    Vicki Vernig-San Jose State College.
                    Jean Whelan-Hunter College.
                Law
                    Arthur Kaplan-Harvard University.
                Dentistry
                    Victor Sternberg-Tufts University.
                Community Workers
                    Miriam Feliciano
                    Elizabeth Prole
                    Mercedes Hunter
                    Carmello Rodriguez
                Program   Ad@or
                    Fannie May
                                               BROOKLYN
                Student Area Coordinator
                    Warren Sweberg-Downstate Medical Center.
                Coinmunity Coordinator

                                                                                                  139


                                                      GREATER NEW YORK

                               Marian Williams.
                           Faculty Advisors
                               June Finer, M. D.-Columbia    University.
                               Jeff  Weiner-Downstate   Medical'Center.
                           Medicine:
                               William Basta-Downstate Medical Center.
                               Richard Berkowitz-Downstate Medical Center.
                               Ernest Braasch-Downstate Medical Center.
                               Eric Cameron-Downstate Medical Center.
                               Benjamin Fass-Downstate Medical Center.
                               Robert Johnson-Downstate Medical Center.
                               Daniel Koblentz-Downstate Medical Center.
                               Leslie Kriegman-Downstate Medical Center.
                               Margo   Mazur-New   York   University.
                               Joseph Ryan-Downstate Medical Center.
                               Jules Tanenbaum-Downstate Medical Center.
                               Richardo Wilson-Downstate Medical Center.
                               Daniel Yellon-Downstate Medical Center.
                           Nurss'ng
                               Leslie Clarke-Boston University.
                               Ellen Pindus-Molloy College for Women.
                           Law
                               Roger Haines-University of California at Berkeley.
                           De-ntigtry
                               Jan Wade Gilbert-Meharry Medical College.
                               Steven Parnes-Meharry Medical College.
                           Sociology
                               Marian Hyler-Tufts University.
                                                                 HARLEM
                           Student Area Coordinator
                               Richard   Clapp-Columbia   University.
                           Community Coordinator:
                               Mary Smalls.
                           Faculty Ad@ors:
                               Ezra  Davidson,  M.D.-Harlem   Hospital.
                               Doris Wethers, M.D-Knickerbocker Hospital.
                           Medicine:
                               Joan Adler-University  of  Cincinnati.
                               Louis  Bartoshesky-Cornell   University.
                               Ken Cousen@Columbia University.
                               James Cowan-Meharry Medical College.
                               Stephen Gluckman-Columbia University.
                               Barry   Goozner-Columbia   University.
                               John Hibbert-Howard University.
                               John   Obedzinsky-Columbia   University.
                               Colin Romero-Howard University.
                               William M. Smith-Columbia University.
                               Carter  Willsey-Columbia   University.
                           Nursing
                               Angela Gaetano-Hunter College.
                               Patricia Jone&-Bronx Community College.
                               Barbara McFadden-Bronx Community College.
                           Law
                               Ellsworth   Martin-Howard    University.
                               Francis Vergata-University of Chicago.
                           Psychology
                               Marla Isaam-Columbia University.
                           International Affairs:
                               Janet    Barre@olumbia     University.

               140


                                                              GREATER  NEW  YU.KM
                                            Ctii%ics                            scwuud dave                                        Ext.
                                   *Endocrine & Obesity       ------ Wednesday  -----------------     I:oo-Soo       pin.  715,717
                                   *HematologY, --------------     Wednesday    -----------------     9:00-11:00      am.  715,717
                                   *Neurology ---------------      ist and Srd Mondays         -------- 9:00-11:00     a.m. 715,717
                                   *Pediatric Follow-UP      ....... Monday, Tuesday and                    2:00     noon  715,717
                                                                   Thursday     ----------------      11:00-1
                                   *Pediatric General       -------- Monday     through      Friday ---- 8:00-4:00       pm. 715,717
                                   *Physical Handicapped        ---- 2nd    Tuesday ----------------  9:00-41:00     a.m.  715,717
                                                                             sday -----------------   1:00-3:00       pm.  715,717
                                   *Premature ---------------      Wedne                      --------- 9:00-11:00      am. 715,717
                                   *Respiratory Follow-UP       ---- Tuesday    ----------                            am.  715,717
                                   *Seizare ------------------     Thursday     ------------------    9:00-11:00
                                   *Surgical Follow-Up       ------- Wednesday  -----------------     1:    3@3:30    pm.  715,717
                                   *Urology -----------------      Tuesday      -------------------   9:00-11:00      am.  715,717

                                   Surgery:
                                   *Breast  -------------------    Wednesday    -----------------     1:30-8:00       pm.         414
                                   Child    ------------------     Monday,     Wednesday      and
                                                                           Friday ------------------- 9:00-11:00      am.         580
                                   Diagnostic         -------------- Monday and Tuesday        -------- 1:00-3:00       pm.       580
                                                                   Thursday     ------------------
                                   Female   ------------------     Thursday and Friday         -------- 9:00-11:00      am.       490
                                   Ponowup    ---------------      Thursday     ------------------    1:00--B:00      PM.         580
                                   Hand     -------------------    Wednesday    -----------------     9:00-11:00      am.         580
                                   Male     -------------------    Monday, Tuesday, Thursday
                                                                    and    Friday        --------------- 9:0041:00     a-In-      689
                                   *Plastic ---------                                                                             580
                                                           --------- Monday     --------------------  1:00-3:00  pra.   -
                                                                   Thursday     ------------------    9:00-11:00      am.         414
                                   *Podiatry ----------------      Tuesday      ---------7     --------- 9:00-11:00      am.      408
                                                                   Wednesday    ------------    ----  1:00-3:00 P.M. -            408
                                   *Proctology ---------------     Monday and Friday          --------- 9:00-11:00      am.       580
                                   *Thoracic -----------------     Monday and Thursday          ------ 1:00-3:00 P.M. -  -  -     418
                                   *Tumor, Head, & Neck         ---- Wednesday  -----------------     9:00-11:00  am..  -  -      490
                                   *Urology-Adult      ------------- Tuesday      and      Thursday ----- 9:00-11:00   am.    --  580
                                   Infertility (Male)       -------- Wednesday  -----------------     5:0@8:00       pni.         580
                                   *Vascular -----------------     Tuesday and Friday         --------- 1:00-8:00       pm.       418
                                   Ear, Nose and Throat         ---- Monday, Tuesday,
                                                                    Thursday      and      Friday ----- 1:00-3:oo       PM.       -490
                                   Eye      ---------------------  Monday, Tuesday,
                                                                    Thursday, Friday          --------- 1:00-8:00      P.M.
                                   Oral Surgery          ----------- Monday     through      Friday ---- 8:00-4:00      p.m.      657
                                   Others:
                                   Blood chemistry       ----------- Monday, Tuesday and
                                                                         Thursday      ----------------- 7:00-9:00       am.      408
                                   Mental Hygiene-
                                            (Adult and Child)    ---- Monday     through      Friday ----- 9:0":OO         pm.    567
                                        Adult ----------------     Tuesday,     Wednesday     and
                                                                                                                                  567
                                                                         Thursday       ---------------- 6:80-9:00       pm.
                                   Rehabilitation    Medicine    @--Monday     through     Friday ----- 8:00-11:80      am.       584
                                   Employees    Health    Service    -Monday    through    Friday ----- 8:00-4:00       pm.       417
                                   *Appointment clinics
                                                                   Central, Harlem Destrict Health Center
                                                            2238 Fifth Avenue (137th Street) AU 3-1900
                                    1. Dental clinic
                                            1.  The patient must come from a public school within the health district
                                              School  189,  136,  175,  183,  197,  120),-  but  they  do  not  have  to  be   referred
                                              through the @ool@if a child attends one of the                schools a p
                                              bring him to the clinic.

                 146


                                          SUMMER 1968

                Community Workers:
                    Charlie Mae Jones.
                    Nettie Knox.
                    Maxine Livingston.
                    Altamese Maxwell.
                                         LOWER EAST SIDE
                Student Area Coordinator:
                    Steven Dubovsky-New York University.
                Community Coordinator:
                    Helena King.
                Faculty Advisor:
                    Alice Miller-New York University.
                medicine:
                    Jerome Aronowitz-University of Maryland.
                    Edward Charney-New York University.
                    Joseph Colletti-Howard University.
                    Kenneth Ducker-New York University.
                    Judith Pleasure-New York University.
                    Diana Post-New York University.
                    Sharon Ruskin-Marquette University.
                    Peter Sheckman-New York University.
                    David Sternber@Tufts University.
                    Joseph Willner-New York University.
                Nursing:
                    Beryl Gifford-Hunter College.
                    Marilyn Levine-Hunter College.
                    Judith Levy-Hunter College.
                    Joan Musaro-Hunter College.
                Law:
                    Martha Halpin-Yale University-
                    Jonathan Marsh-New York University.
                    Bettina Plevan-Boston University.
                Dentistry:
                    Gerald Low-New York University.
                Ps,yeh@gy -
                    Linda Gunsber@Yeshiva University.
                Coinmunity Worker -
                    Sharon Diaz.
                                               NEWARK
                Student Area Coordinator
                    Daniel Tartaglia-New Jersey College of Medicine.
                Community:
                    Reginald Peniston
                Faculty Ad@or
                    John Seebode, M.DNew Jersey College of Medicine.
                Medicine
                    Richard DeBlasi-New Jersey College of Medicine.
                    James Davis-Howard University.
                    Peter Dorsen-New Jersey College of Medicine.
                    Karen Filkins-New Jersey College of Medicine.
                    Andrew Hurayt-University of Rome.
                    Dennis Massler-New Jersey College of Medicine.
                    Bruce Wermuth-Stanford University.
                    Walter Wiechetek-University of Maryland
                Nursing:
                    Andra Cross-St. Mary's College.
                    Laura Doner-O'Connor School of Nursing.
                    Ann Maroney-Syracuse University.
                    Joyce Quock-O'Connor Sc'nool of Nursing.
                    Kathleen Sherdian-St. Joseph's College.
                                                                                                141


                             Law:
                                 Neal Wiener-Loyola University of Los Angeles.
                             Co-?nmunity Workers:
                                 James David Branch
                                 Katherine Cunningham
                                                      NEIGHBORHOOD YOUTH CORPS
                             George Acosta                  Walter Fletcher                 Gwendolyn Page
                             'tl@-rna Alvarez               Nellie Garcia                   Carlos Perez
                             Louis Aquino                   Maria Gomez                     Raymond Perez
                             Cathie Baker                   Mirella Gomez                   David Ravenell
                             Alan Benton                    Jeffrey Goodson                 Tom Reynolds
                             Shirley Beechem                Elaine Hale                     David Rhabb
                             Gail Bristol                   Walter Hall                     Jack Rivera
                             Eugene Brown                   Nurseal Hill                    Naomi Robinson
                             Alfred Burt                    Dwight Jackson                  Nilda Rodriquez
                             James Canty                    Agnes Jacobs                    Leroy Rozus
                             Joanne Challenger              Alzrina Johnson                 Rodney Shepard
                             Pat Carswell                   Gloria Jones                    Laverne Singleton
                             Roscoe Carthen                 Lilly Jones                     Cassandra Smith
                             Victor Castro                  Leonard Knox                    Joan Smith
                             'Nelson Cintron                Eric Livsey                     Leon Terry
                             '-Nlicbael Colden              Michael McClamb                 Randolph Tomlin
                             Earl Collins                   Frank Morales                   Mamie Towns
                             Kevin Collins                  Josephine Morales               Gabriel Vasquez
                             Gregory Dabney                 Arthur Murphy                   Julio Vasquez
                             Gregory Darby                  Mason Napir                     John Watson
                             Bradley Davis                  Julio Nieves                    Norm Whitlow
                             Vashti Davis                   Elizabeth Norwick               Phyllis Whittiker
                             Alvin Duggins                  Terry Ormand                    Marilyn Whittfield
                             Rafael Figuera                 Doris Ortiz   .                 Marilyn Wilder
                             LaVell Finerson                Martha Pacheco                  Denise Wills
                             Will,ard Finerson              Gladys Padilla                  Nina Yung
                             Sociologist Evaluator:
                                 Ronald Miller-New York University.
                             Administrative Assistant:
                                 Jody Williams-Albert Einstein College of Medicine.
                             Project Secretary:
                                 *Richard Perez.

                142


             Appendix B: HEALTH RESOURCES IN THE HARLEM AREA
                                   HARLEM HOSPITAL OUT PATIENT DEPARTMENT
                                            Lenox Ave. and 137th St. AU 6-3300
                          People in charge                                 Service
                    Dr.       Wesley --------------- Director ambulatory care
                    Dr.      Russell -------------- Director social services
                    Mr.      Watldns -------------- See for clinic problems
                    Mr.     Giddings ------------- Surgery clinics
                    Miss      Mebane ------------- TB clinic
                    Mrs.     Johnson ------------- Emergency room coordinator
                    Mrs.       Place ---------------- Pediatric clinic coordinator
                    Dr.         Kahn ---------------- Director Pediatrics
                    Miss Richardson      ---------- R.N. pediatric clinic
                    Mrs.    Williams    ------------ Clerk, pediatric clinic
                    Clinic procedure:
                       I.  New patient (never been to H.H. before)
                             1.    Start at the initial screening desk
                             2.    Screening area
                                   a. examination for the type of medical problem
                                   b. clinic card number is assigned
                                   c. medicaid application can be made
                                   d. blod and urine tests are ordered
                                   e. X-ray (required by state law)
                                   f. sent to a specific clinic window for the medical problem
                             S. Specified clinic window
                                   a. medical records are completed and sent to be kept in the file room
                                   b. Now the patient -may be:
                                   (1) given an appointment for the correct clinic for his problem or
                                   (2) sent directly to the correct clinic when immediate service  is  possible
                                       or
                                   (3) sent to  the  emergency  room  if  immediate  treatment  is  needed  but
                                       the clinic for his problem is dosed
                             4. When a patient goes to a specific clinic for his problem
                                   A. drop the clinic card into the box or hand it to the clerk
                                   b. clerk then either fills out medicaid form or makes out a bill for the patient
                                   c. patient then sits and waits to be called for treatment
                        11.  Old patient (been to H.H. for that problem before)
                             1. If the clinic that the patient goes to is an appointment  clinic,  the  patient
                                   goes straight there on the day of the appointment and drops the  appointment
                                   card in the box or hands it to the clerk. The patienVs records will  already
                                   be there.
                       Ill.  Old patient with a new problem
                             1.    Patient must.first go to the screening desk for an examination for the  type
                                   of medical problem
                             2.    Then the patient may
                                   a. go directly to his specific clinic if it is a non-appointment clinic or
                                   b. get an appointment for his specific clinic if that clinic requires appoint-
                                   ments or
                                   c. go to the emergency room if immediate treatment is needed but the  clinic
                                   !or his problem is closed
                       IV.  Obstetrical-Gynecological Clinic (Ob-Gyn)
                             1. It is on the 8rd floor of the K building
                             2. It requires a double  registration@nce  on  the  ground  floor  at  the  clinic
                                   registration desk, and then again on the Ob-Gyn floor (3rd).
                                                                                                                        143


                                                       GREATER  NEW   IL)nm

                                   3. Ob-Gyn does its own screening and keeps its own records
                                V. Emergency Room
                                   1. Ambulance service is by police call only
                                   2. All patients must be registered and screened  at  the  emergency  room  registra-
                                         tion deslc.
                               VI. Pediatric Clinics
                                   1.    They are on the 3rd floor of  the  pediatric  building-patient  goes  directly
                                         there to register
                                   2.    These clinics see infants and children up to about 11-12 years of age.
                                   3.    Procedure
                                         a. Patient goes directly to the pediatric clinic
                                         b. New patients go to the clerk to register and to fill out a  medicaid  applica-
                                         tion:
                                         Old patients go to the clerk and give her the clinic  card  and  the  medicaid
                                         card (if they get medicaid).
                                         c. Now sit and wait to be called for treatment
                                         d. Note: to save time-if the child has a clinic card  (any  child  who  has  been
                                         to H.H. before or  was  born  there  has  one)  the  parent  can  call  a  day
                                         ahead so then his child's hospital records will already be at the  clinic  and
                                         will not have to be sent for when he comes.
                                         e. If there is any trouble ask for Mrs. Place. She is in  charge  of  the  clinic
                                         and is there to take care of a patient's problems
                              VII. Oral Surgery Clinic
                                   1.    This is the only place in the Harlem area that one can go to get teeth  pulled
                                         (except to a private dentist).
                                   2.    Must get there at 8:00 A.M. to have a general examination.  This  is  required
                                         before they will give a patient the general anesthetic (gas).
                                   3.    Parent must accompany child the first time to register  him,  then  the  child
                                         can cozne with anyone the next time.
                             VIII. Opthamology Clinic
                                   1. Very poor clinic at H.H. Go someplace else like to MIA.
                               XI. Psychiatric Clinic
                                   1. All of the psychiatric facilities available to the  Harlem.  area  are  described
                                         on pages 14-18.
                            Additional Remarks about Harlem Hospital:
                                 1. The specialty clinics have  anywhere  from  3  weeks  to  2  months  waiting  list.
                                 2. A playroom will be opened in the pediatrics clinic  at  the  end  of  the  surmner.
                                    It will be staffed by a full time paid worker from the  Domestic  Peace  Corps.  It
                                    is there for the children who come to the clinic so that the waiting will  be  more
                                    bearable both for them and for the parents who bring them.
                                 3. Payi-ng:
                                    a.   The fees at H.H. are determined on a sliding scale; this means that  a  person
                                         pays an amount that is based on the income of his family.
                                    b.   Patients do not have to Pay when they get the treatment;  they  can  ask  that
                                         the hospital send them a bill.
                                    c.   The bills usually do not come for many months.
                                    d.   If a person has medicaid, he only has to brinx the bill back to  the  hospital
                                         along with his medicaid card. That takes care of the bill.
                                    e.   A patient should not worry about  any  billing  problems.  Treatment  must  be
                                         given for all, regardless of financial status.
                                 4.     If a patient has any difficulty in one of the clinics, he. should ask to see  Mr.
                                    Watkins.

                             *Appointment clinics
                                         cli@8                      Scheduled days                    Time
                                Gynecology
                                 *Cytology ----------------- Monday --------------------- 1:00-3:00 pin.            680
                             *Dysmenorrhea      ------------ Thursday ------------------  9:00-11:00 am. '--        630

               144


                                                        SUMMER    1968
                                        Clinice                  Scheduled days                       Titr&e      Eze.
                       *Endocervicitis  ------------   Wednesday -----------------      9:00-11:00    a.m.        630
                       *Endocrine       ---------------- Wednesday    and    Thursday --- 1:00-3:00      pm.      630
                                                       Wednesday -----------------      9:00-11:00    a.m.        630
                       *Gynecology General        ------ Tuesday -------------------    12:30-3:00    p.m.        630
                       Gynecology General         ------ Monday, Tuesday
                                                       Thursday, Friday         --------- 9:00-11:00    a.m.      630
                       *Infertility     --------------- Wednesday, Thursday       ------- 1:00-3:00     P.M.      630
                       *Menopausal      -------------- Thursday  ------------------     9:00-11:00    a.m.        630
                       *Tumor Follow Up         -------- Monday  --------------------   1:00-3:00     P.M.        630
                       Maternal    Health       --------- Saturday -------------------  9:00-12:00    noon        628
                       *I.U.D           - ------------------- Tuesday    and     Wednesday ----- 9:00-11:00    a.m. 628
                       *Oral Contraception       ------- Wednesday    and    Thursday ---- 12:30-4:00    p.m.     628

                       MEDICAL CLINICS:
                       *Allergy         ------------------ Wednesday     and     Friday ------ 9:00-11:00    a.m. 408
                       *Cardiac         ----------------
                                                       Monday, Wednesday        ---------
                                                       Thursday and Friday       -------- 9:00-11:00    a.m.      639
                       *Chest   &   T.B.C -      --------- Monday, Wednesday,
                                        Adult ------------- Thursday     and      Friday ----- 9:00-11  :00  a.m. 418
                                        Children ----------- Tuesday ------------------- 9:00-11:00    a.m.       418
                       Dermatology      -------------  Monday    through     Friday ---- 1:00-3:00     p.m.       639
                       *Diabetes        ----------------- Tuesday and Friday      --------- 1:00-3:00     p.m.    668
                       Diabetic Supply and
                       Instruction      -------------- Monday    through     Friday ----- 9:00-11:30     am.      408
                       *Gastroenterology       --------- Consultations,     Wednesday    --- 1:00-3:00     P.M.   637
                       Hematology       -------------- Wednesday  -----------------     1:004:00      P.M.        580
                       *Medical         ------------------ Monday    through     Friday ----- 9:004:00       pm.     637,668
                       Medical Reception        -------- Monday    through     Friday ----- 9:00-4:00      pm.    540
                       *Neurology       --------------- Tuesday  -------------------    1:00-3:00     p.m.        580
                       *Thyroid         ----------------- Tuesday -------------------   9:00-11:00     am.        639
                       Venereal Disease-
                                        Male G.C -    ----------- Monday    through     Friday ----- 9:00-11:00     am. 639
                                        Syphillis ------------- Monday    through     Friday ----- 1:00-3:00     p.m. 639

                       OBSTETRICAL
                       Antepartum   (new    cases)    --Monday    through    Friday ----- 9:00-11:00    a.m.      681,
                       *Antepartum (reviE;its)         ---- Monday    through     Friday ----- 1:00-3:00     p.m. 631
                       *Antepartum            Adolescent --- Friday --------------------- 1:0@   :00    P.M.      631
                       Family  Planning   General   -   -Tuesday,   Wednesday   and     5:30-7:30      pm.        631
                                                                                            -3:00     p.m.        631
                                                           Thursday      ---------------- 1:00
                       Post        partum ------------- Tuesday  -------------------    1:00-3:00     P.M.        631
                       Orthopaedic     and     fracture:

                       *Fracture-
                                        Adult --------------- Tuesday, and Friday -------- 1:00-3:00      pm.     414
                                        Child ---------------- Friday --------------------- 9:30-11:30    a.m.    592
                       *Fracture-End             Results
                          (Long   term    follow-up)    --Thursday ------------------   1:00-3:00     p.m.        414
                       *Orthopaedic-Adult              Monday    --------------------   1:00-3:00     p.m.        592
                                    Child ------------------ Friday --------------------- 9:30-11:30     am.      414

                       Pediateric:
                       *Allergy         ------------------ Wednesday     and     Friday ------ 9:00-11:30     am.   715,717
                       *Cardiac         ------------------ Thursday ------------------  1:00-3:00      pm.        - 721
                                        -----------                                                            '715,717
                       *Dermatology                    --- Tuesday ------------------   @9:00-11:00    am.
                       *Development     -------------  Monday    ------        ---------- 1:00-3:00     P.M.    715,717
                       *Deabetes
                                        ---------------- lst Tuesday     ---------------- 9:00-11:00    a.m.    715,717
                       *Appointment clinie-s
                                                                                                                                 145


                                                             GREATER  NEW  YORK
                                              Clitties                          Schauted days                      !rime         Ezt.
                                   *Endocrine &  Obesity     ------ Wednesday   -----------------    1:00-3:00      p.m.   715,717
                                   *Hematology --------------    Wednesday      -----------------    9:00-li:00     a.m.   715,717
                                   *Neurology ---------------    Ist   and    3rd    Mondays ---- --9:00-11:00       a.m.  715,717
                                   *Pediatric Follow-up .......  Monday,     Tuesday     and
                                                                         Thursday ----------------   11:00-12:00    noon   715,717
                                   *Pediatric General     -------- Monday      through      Friday ----
                                                                                                     8:00-4-00      p.m.   715,717
                                   *Physical Handicapped      ---- 2nd      Tuesday ---------------- 9:00-11:00     a.m.   715,717
                                   *Premature ---------------    Wednesday      -----------------    1:00-3:00      p.m.   715,717
                                   *Respiratory Follow-Up     ---- Tuesday      -------------------  9:00-11:00     a.m.   715,717
                                   *Seizure   ------------------ Thursday       ------------------   9:00-11:00     a.m.   716,    717
                                   *Surgical Follow-Up -------   Wednesday      -----------------    1:30-3:30       pm.   716,717
                                   *Urology   -----------------  Tuesday        -------------------  9:00-11:00      am.   715,717

                                   Surgery:
                                   *Breast    ------------------- Wednesday     -----------------    1:30-3:00       pm.         414
                                   Child      ------------------ Monday,      Wednesday      and
                                                                           Friday ------------------- 9:00-11:00      am.        580
                                   Diagnostic       -------------- Monday     and      Tuesday -------- 1:00-3:00       pm.      580
                                                                 Thursday       ------------------
                                   Female     ------------------ Thursday     and     Friday -------- 9:00-11:00      am.        490
                                   Followup   ---------------    Thursday       ------------------   1:00-3:00      P.M.         580
                                   Hand       ------------------- Wednesday     -----------------    9:00-11:00      am.         580.
                                   Male       ------------------- Monday, Tuesday, Thursday
                                                                   and     Friday ---------------    9:00-11:00      am.         589
                                   *Plastic   ------------------ Monday         -------------------- 1:00-3:00  P.M.   -         580
                                                                 Thursday       ------------------   9:00-11:00      am.         414
                                   *Podiatry  -----------------  Tuesday        -------------------  9:00-11:00      am.         408
                                                                 Wednesday      -----------------    1:00-3:00   P.M.    ---     408
                                   *Proctology ---------------   Monday and Friday         --------- 9:00-11:00      am.         580
                                   *Thoracic  -----------------  Monday     and     Thursday   ------ 1: 00-3 - 00 P.M. -        418
                                   *Tumor, Head, & Neck       ---- Wednesday    -----------------    9:00-11:00      am.         490
                                   *urology-Adult      ------------ Tuesday      and       Thursday ----- 9:00-11:00      am.    580
                                   Infertility (Male)  --------  Wednesday      -----------------    5:00-8:00    pm.    ---     580
                                   *Vascular  -----------------  Tuesday     and      Friday --------- 1:00-3:00   p.m.    ---   418
                                   Ear, Nose and Throat       ---- Monday, Tuesday,
                                                                   Thursday      and      Friday ----- 1:00-3:00   P.M.    ---   490
                                   Eye        --------------------- Monday, Tuesday,
                                                                   Thursday, Friday        ......... 1:00-3:00      P.M.
                                   Oral Surgery        ----------- Monday      through      Friday   8:00-4:00      P.M. ---     657

                                   Others:
                                   Blood chemistry     ----------- Monday,     Tuesday     and
                                                                         Thursday ----------------   7:00-9:00      a.m.         408
                                   Mental Hygiene
                                              (Adult and Child)    ---- Monday      through      Friday ----- 9:00-5:00       pm. 567
                                          Adult ---------------- Tuesday,     Wednesday      and
                                                                         Thursday ----------------   6:30-9:00      P.M.         567
                                   Rehabilitation Medicine     --- Monday      through      Friday ----- 8:00-11:30      am.     584
                                   Employees   Health    Service    -Monday    through    Friday ----- 8-00-4:00       pm.       417
                                   *Appointment  clinics
                                                              Central, Harlem Destrict Health Center
                                                           2238 Fifth Avenue (137th Street) AU 3-1900
                                   1. Dental clinic
                                              1. The patient must come from  a  public  school  within  the  health  district  (Public
                                              School  189,  136,  175,  133,  197,  120),  but  they  do  not  have  to  be   referred
                                              through  the  school-"if  a  child  attends  one   of   the   schools   a   parent   may
                                              bring him to the clinic.

                146


                                                       SUMMER 1968

                             2. To be eligible the child must be between the  fifth  grade  through  junior  high
                                 school.
                             3. Parent must accompany child only on the first visit, when history  and  financial
                                 information are given and a consent  form  is  signed.  No  treatment  is  given
                                 on the first visit; appointment will be made  for  a  later  date.  Registration
                                 times are  9-11  a.m.,  1-4  pm.  Monday  through  Friday.
                                 a.  Treatment  appointments  can  be  for  the   morning   or   the   afternoon;
                                      parent need not be with the child  on  these  visits.
                             4. Paying: Depends upon family income. If income is too high  one  is  not  eligible
                                 for the services, if the patient is eligible the services are free.
                             5. The dental clinic does everything  but  tooth  extractions  (must  go  to  Harlem
                                 Hospital oral surgery or private dentist).
                             6. School dental chairs
                               a. A number of schools have dental chairs. These  are  merely  extensions  of  the
                                    dental  clinic,  and  therefore  function  similarly  and  provide  the  same
                                    services.
                               b. Locations:  Public School 24-22 East 128th Street LE 4-2866.
                                              Public School 68-127 West 127th Street MO 2-1410.
                                              Public School 144-134 West 132 Street MO 2-3460.
                                              Public School 156-2960 Eighth Avenue AU 1-4847.
                                              Public School 194-242 West 144 Street WA 6-0580.
                                              Public School 13@2121 Fifth Avenue AU 3-3056.
                       II. Social hygiene clinic
                             1. Dr. Bloom is in charge.
                             2. Person may receive free  venereal  disease  examinations  and  treatment  without
                                 appointment.
                             3. Hours:   Monday        9-11.
                                         Tuesday       1-5
                                         Wednesday     9-11.
                                         Thursday      1-7
                                         Friday        9-11.
                      III. Maternal and Child Health Station
                             1. Services:
                               a. This facility is for well babies; One should not take a sick child here.
                               b. Periodic physical examinations.
                               C. Immunizations for DPT,  polio,  smallpox,  and  measles.  (Monday  and  Friday,
                                    9-11 a.m. come early).
                               d. Parent can come ask a doctor or nurse advice, etc.
                               e. When child enters school the records that are kept here will  be  sent  to  the
                                    school.
                             2. Children from birth to school age are eligible
                             3. Walkin (with parent) will  be  accepted  th;  first  time,  but  afterwards  must
                                 have  an   appointment.
                             4. Hours: Monday and Thursday AM and PM.
                                        Tuesday, Wednesday and Friday AM only.
                             5. Additional Locations:
                                    Morningside Health Center, 264 West 118th Street MO 3-3822.
                                    Upper Harlem Child Health Center,.231 West 151 Street TO 2-2640.
                                    Mt.  Morris  Park  Child  Health  Center,  122  Street  and  Madison   Avenue
                                      LE 4-4612.
                                 St. Nicholas Child Health Center, 281 West 127th Street UN 5-1300.
                                    Stephen.Foster Child Health Center, 50 Lenox Avenue EN 9-4610.
                       IV. Chest clinic
                             1. Only location is  the  Morningside  Health  Center,  264  West  118th  Street  MO
                                 3-3822.
                             2. At this clinic chest X-rays and other tests are given to  find out if person  has
                                 tuberculosis or other diseases of the chest. If disease  is found, treatment  is
                                 given.
                             3. Call for an appointment.

                                                                                                                           147


                                                        GREATER NEW YORK

                                V. Eye Clinic
                                 1. Persons up  to  21  years  of  age  are  eligible  for  the  eye  examinations  and
                                       prescriptions for glasses.
                                 2. 'Patient is usually referred through a school  nurse  or  through  a  child  health
                                       station, but parent may call for an appointment.
                                 3. There is an additional location at the Morningside Health Center.
                            VI.  Health  Education   Services
                                 1. Dr. Monrose is the health education officer for the  district.  He  is  located  in
                                       room 212.
                                 2. Consultation services are offered in the planning of  health  committee  activities
                                       and health programs for  church  groups,  PTA's  and  other  clubs  and  settle-
                                       ment houses.
                                 3. Films  and  pamphlets  on  a  wide  variety  of  health  topics  are  available.  A
                                       minimum of three weeks  notice  is  essential  in  booking  films,  although  by
                                       special arrangement one  may  pick  up  the  films  at  the  NYC  Department  of
                                       Education Film Library at 305 Fifth Avenue, room 11D, within 34
                                       of ordering.
                                       a. The order  must  be  placed  with  the  district  officer.  No  more  than  4
                                            films may be ordered at once.
                                 4. Speakers are also available with 4-5 weeks notice.
                            VII. Other Agencies in  Central  Harlem  District  Health  Center  building.
                                 1.   Visiting Nurse Service of New York, room 215 AU 6-7210.
                                 2.   Family and Child Welfare Student Unit, room B36.
                                 3.   Pediatric Social Service, room 211.
                                 4.   Alcohol Unit, rooms 307, 308,  311.
                                 5.   Community organization for Social  Service,  room  318.
                                 6.   Rehabilitation Medicine, rooms 334, 335.
                                                          Summary and Time Schedule of
                                           SERVICE   IN   CENTRAL   HARLEM   HEALTH   CENTER    DISTRICT
                                                                  (February 1968)
                              Legend: A=9-12 a.m.         P = 1-4 p.m.    E = 4-7 p.m.      *=First  and  third   Tues-
                                                                                                 day  of   month
                            Central  Harlem  District  Health  Center  Build-
                            ing, 2238  Fifth  Avenue,  NYC.  10037  283-1900.     m         T      w       T       E
                                 Dental       ----------------------------------  AP        AP     AP      AP      AP
                                 Social Hygiene      ---------------------------  AP        p      A       PE      A
                                 Maternal  and  Child  Health    ---------------- AP        A      A       AP      A
                                 Eye  -------------------------------------       AP                       p       A
                            Morningside  Health  Center,  264  West   118
                            Street,  NYC.  10026  MO   34822.
                                 Dental       ----------------------------------  AP        AP     AP      AP      AP
                                 Maternal  and  Child  Health    ---------------- A         A      A       AP      A
                                 Eye  -------------------------------------       p         A      A       A       A
                                 Chest -----------------------------------        AP   A*PE*       A       AP      AP
                                 Prenathan and Family Planning        ----------  P         p
                            Upper Harlem Child Health Center         -----------  A         A      A
                            231  West  151  Street,  NYC.  10039  AU  3-1970.
                            Mt. Morris Park Child Health Station       ---------
                            122 Street and Madison Avenue, NYC. 10035             A         A              A       A
                            LE   4-4612.                                                                   p
                                 Prenatal and Family Planning       ------------  A         A      A       A       A
                            St. Nicholas Child Health Station      -------------
                            281  West  127  Street,  NYC.  10027  UN  5-1800.     A         A      A       A       A
                            Stephen Foster Child Health Station       ----------
                            50 Lenox Avenue, NYC. 10026 --N 9-4610.               A                AP              A
                            Alexander  Hamilton  Child   Health   Station  ------
                            2690 Eighth Avenue, NYC. 10030 862-8002.
                            Dental Clinics in the Schools (See page 8)      ----  A         A      A       A@      A

              148


                                                        SUMMER 1968
                                           MINISTERIAL INTERFAITH ASSOCIATION (MIA)
                                                110 East 125th Street Suite  204  427-5700

                               Clinics:
                          Monday      ------------ internal medicine      --------------- 10-42 noon'
                                                   Dermatology        ------------------- 1-2:30 P.M.
                          Tuesday     -----------  Ear, nose and throat      ------------ 9 a.m@2 m.p.
                                                   Gynecology       --------------------- 2-4 p.m.
                                                   Allergy       ------------------------ 10 a.m.-12:30 P.M.
                                                   ophthamology        ------------------ 10 a.m-l P.M.
                          Wednesday       ---------                                 ..... 10:30 a.m-1:30 p.m.
                          Thursday    ----------   Pediatrics  -----------------
                          Friday      ------------- Internal medicine     ------------- -- 10a.m.-I:SOP.M-
                                                   Ear, nose and throat      ------------ 9 a.m@l P-m- .
                          Saturday    -----------  optometrist       -------------------- 1-30 p.m.-4 pm.
                        1.          MIA.is a very pleasant place-it does not look like a clinic. The staff is courteous
                                      and thorough, and the wait tends to be the shortest of any clinic in the Harlem
                                      area.
                        2. It is best to call and make an appointment for one of the clinics in advance.
                        3.  Get  there  early-30-45  minutes  before  clinic  starting  tim@or  the  shortest  wait.
                        4.  Paying:  patient  must  pay  from  8-10  dollars  per  visit.  They   accept   medicaid.
                                      They will not send a bill as Harlem Hospital Clinics do.
                        5. For  eye  problems,  go  to  the  optometrist  first.  He  will  refer  patients  to  the
                                      opthalmologist if it is necessary.
                        6. If there are any difficulties see Dr. Farkas, the  director.

                                           MANHATTAN EYE AND EAR HOSPITAL
                                                    210  East  64th  Street  TE  8-9200

                                  Cl@s:
                           Eye  clinic-First  floor.
                           Ear, nose, and throat clinic-Second floor.
                                      Allergy clinic-Second floor.
                                      Hearing and speech clinic.
                           Laboratories-Second floor.
                                      Pharmacy-basement.
                          1. A modern, well-equipped facility.
                          2.          Mrs. Benoit is the Outpatient  Department  Supervisor.
                          3.          Mrs. Fernandez is the Registrar.
                          4.          First visit is for registration and screening only; a parent  must  accompany  a
                                      child.
                          5.          Second visit is for a speciality clinic for which the patient has been given an A.M.
                                      or P.M. appointment (always on the same day  of  the  same  week  as  the  first
                                      clinic visit).
                          6.          For a foster child the BCW number and the case number are required.
                          7.          Procedure for a new patient
                                      a. No appointment-arrive by 8:30 a.m.  on  any  weekday.
                                      b. Patient gets number at the information desk and sits to wait for  an  interview.
                                      c. At interview the patient receives a clinic card and a chart number. '
                                      d. Patient then gets in line and pays in advance  for  treatment  (see  Paying  be-
                                      low).
                                      e. After paying the patient receives his chart and goes  to  the  screening  clinic
                                      where he gives the chart to the nurse and waits to be called.
                                      f. Doctor screens the patient and recommends  either  returning  to  the  screening
                                      clinic or to a speciality clinic at a later date.
                                      g. Patient takes white slip to appointment window  and  there  receives  an  ap-
                                      pointment slip which he mu8t not lose.
                           8. Paying:
                                      a. The first visit costs $5.
                                      b. All subsequentnsits cost $4.50.
                                                                                                                                 149


                                                            GREATER NEW YORK

                                       c. X-rays, laboratory work, etc. all cost extra.
                                       d. Special fees may be reduced at the  discretion  of  the  payment  desk,  but  pa-
                                        tient must always  pay  something  unless  Medicaid  or  insurance  covers  fees.
                                       e. There is no  billing  procedure-patient  must  pay  (or  present  Medicaid  card)
                                        on the spot.

                                                          KNICKERBOCKER HOSPITAL
                                                            70 Convent Avenue, AU 1-4100
                                  1.   Pediatric clinic only.
                                  2.   A.M. on Monday and Friday.
                                       P.M. on Tuesday, Wednesday, and Thursday.
                                  3.   No screening is required; appointments can be made by phone.
                                  4.   Paying:
                                       a. The first visit costs $3.
                                       b. All subsequent visits cost $2.
                                       c. Patient does not have to pay at the time of treatment; the clinic will  send  a
                                         bill.
                                       d. Medicaid is accepted in full.
                                                     ADDICT REHABILITATION CENTER
                                                                253 West 123d Street
                                  1.   A half-way house for individuals desiring to be cured of heroin addiction.
                                  2.   Persons desiring to enter must send a letter or call Mr. James Allen, the director.
                                       A personal interview follows this letter.
                                  3.   Has both inpatient and outpatient services. As of  now  women  are  only  seen  on
                                       an outpatient basis.
                                  4. This is a realistically oriented facility which is run by a staff of ex-addicts.
                                  5.   Mr. Allen or one of his staff is also available to give illustrated talks on  drug
                                       addiction.
                                  6.   One of their most important functions is the finding of jobs for the patients stay-
                                       at the center. One of their most important goals for a patient is the  achievement
                                       of economic self-sufficiency and stability.
                                               CHILD PSYCHIATRIC SERVICES AVAILABLE
                                                            IN THE HARLEM AREA
                                  Because of the increasing awareness of the need  for  child  psychiatric  treatment  in
                             the Harlem area and because of the difficulty in attaining  such  treatment,  these  facili-
                             ties have been compiled separately.

                                                              HARLEM HOSPITAL
                                             2238 Fifth Avenue, District: 116th. Street to 155th. Street
                                  Inpatient service: there is no  inpatient  service.  Outpatient  service:  handles  ap-
                             proximately 500 patients a year.
                               A. Staff: 3 full-time psychiatrists
                                          3 part-time psychiatrists
                                          I psychologist
                               B. Diagnosis: waiting period is from three days  to  a  month;  diagnosis  is  done  in  a
                                       conference with a psychiatrist, a social worker, and a psychologist.
                               C. Treatment: children  are  referred  to  Bellevue,  social  agencies,  special  schools,
                                       Rockland  State  Hosp.,  and  the  Bureau  of  Child  Welfare  for  placement   in
                                       special  homes.  Treatment  at  Harlem  Hospital  seldom  exceeds   one   appoint-
                                       ment  a  week  with  a  psychiatrist;  occasionally,  children  are  reate  by   a
                                       social worker.
                               D. Special facilities: Harlem Hospital runs a  special  school  for  children  aged  9  to
                                       13. There are now 15 children in it and there are plans to expand it.
                                                            ST. LUKE'S HOSPITAL
                                          421 West 113th. Street, District: 86th. Street, to 125th. Street,
                                                             Morningside to the river
                                  Inpatient service: no inpatient  service.  Outpatient  service:  handles  approximately
                            500 patients a year.

               150


                                                          SUMMER 1968

                         A. Staff: rotating staff  of  residents.
                         B. Diagnosis: waiting  period  is  about  a  month;  the  child  does  see  a  psychiatrist
                                after he has gone through the pediatrics clinic.
                         C.  Treatment: waiting period is about 6 months;
                                all treatment is by psychiatrists-appointments are seldom more frequent           an
                                one per week per child.
                                                    PRESBYTERIAN HOSPITAL
                               West 168th. Street and Broadway, District: 155th. Street to 181st. Street
                            Inpatient service: there are  16  inpatient  beds  (in  the  New  Psychiatric  Hospital)
                       which are  used  for  teaching  and  research  as  well  as  treatment.  Outpatient  service:
                       handles approximately 800 cases a year and  accepts  about  15-20  per  cent  for  treatment.
                         A. Diagnosis: waiting period  is  one  to  3  months  and  all  children  must  go  through
                                the pediatrics clinic before child psychiatry.
                         B.  Treatment:  varies  depending  on  the  needs  of  the   family-may   be   appointments
                                with psychiatrist,  family  conuseling,  or  group  therapy;  may  be  as  often  as
                                three times a week. Referrals are drawn from all sources.

                                                    METROPOLITAN HOSPITAL
                                                1901 First Avenue, District: 42nd. Street
                            Inpatient service: there is no inpatient service. Outpatient  service:
                            Out-patient service:
                         A.  Staff:  7  full-time  psychiatrists.
                                      5 part-time psychiatrists.
                         B. Diagnosis: a child can  be  referred  from  all  sources  to  an  intake  social  worker
                                  for initial screening; there is a one-week  to  2  month  wait  for  diagnosis  by
                                  a psychiatrist.
                         C.  Treatment: there it a 2 month wait for treatment.

                                                        MT. SINAI HOSPITAL
                                                144 Madison Avenue, District: unlimited
                            Inpatient service: there  are  15  inpatient  beds  which  are  used  for  teaching  and
                       research  as  well  as  treatment;  the  service  has  7  psychiatrists  part-time  and   pa-
                       tients are usually not accepted for more than three months.
                            Outpatient service:
                         A.  Staff:  8   psychiatrists-part,-time
                                    2     psychologists-full-time
                         B. Diagnosis: children are  referred  from  al  Isources  and  are  screened  in  the  sum-
                                mer; a doctor sees the child and a social  worker  sees  the  family.  In  September
                                25-30 cases are  accepted  for  the  year-no  more  are  accepted.
                         C. Treatment: here again, patients  are  accepted  who  will  be  good  teaching  material;
                                children seldom see the therapist more than once a week.
                         D. Special facilities: there  is  a  NIFAST  clinic  (Non-intensive,  Flexible,  Adaptable,
                                Short-term clinic) for "crisis intervention"; this clinic  meets  once  a  week  and
                                accepted 350 cases last year; it is staffed by 6  residents,  3  attending  psychia-
                                trists, I social worker,  one  assitant,  and  one  community  worker;  it  accepted
                                all but neurological or brain-damage problems.
                       Other & hospitals outside the Harlem area:
                            Hospital  for  Joint  Diseases-1919  Madison  Avenue,  Psychiatric  Clinic,  TR   6-7000
                            Belluvue Hospital-lst.  Avenue  and  30th.  Street  Mental  Hygiene  Clinic,  OR  9-5000
                            Roosevelt Hospital-428 West 59th Street Psychiatric Division, 544-7000
                            Jewish Memorial Hospital-Broadway & 196th. Street, LO 9-4700
                            New  York  Infirmary-321  East  15th.  Street  Psychiatry  Clinic  (No
                              district, but no emergency or inpatient facilities).
                                                                                                        CA    8-8000
                            New  York  Medical  College-106th.  Street  &  Madison  Avenue   Dept.
                              of Psychiatry.
                       Clinics in  the  Harlem  area:
                                      NORTHSIDE CENTER FOR CHILD DEVELOPMENT
                                                    31 West 110th. Street EN 6-6464
                         -waiting list for treatment is over a year.

                                                                                                                              151


                                                    GREATER NEW YORK

                                -the center does not take brain-damaged or handicapped children.
                                A.  Staff: therapists, psychiatrists, psychologists, social workers.
                                B. Fees: sliding scale.
                                       JAMES WELDON JOHNSON COMMUNITY CENTER
                                2089 3rd, Avenue TR 6-3533 District: 96th. Street to 125th. Street from 5th. to the
                                                              East River
                         James Weldon Johnson Community Center-2089 3rd, Ave. TR 6-3533
                                District: 96th. St. to 125th St. from 5th. to the East River
                                A.  Staff: psychiatrists, psychologists, social workers.
                                B. Diagnosis: there is a waiting list of about six families for screening and the
                                 clinic will not accept retarded or brain-damaged children.
                                C. Treatment: the waiting period for treatment is  about  15  families  or  three
                                 months; appointments can be made as often as twice a week; no fees.
                                                     KAREN HORNEY CLINIC
                                                   329 East 62nd. Street TE 8-4333
                                A. Staff: psychiatrists, psychiatric social workers.
                                B. Diagnosis: there is no waiting period for diagnosis or treatment.
                                C. Treatment: usually "family-oriented" with appointments  once  a  week  with  a
                                 psychiatric social worker; fees are adjusted but are not Medicaid eligible.
                        Other clinic8 outside the Harlem area:
                                Payne Whitney Psychiatric Clinic-525 East 168th Street, TR  9-9000,  District:
                                34th. Street to 96th. Street, east of 5th. Avenue.
                                Postgraduate Center for Mental Health-124 E. 28th. Street, MU 9-7700 all types
                                of therapy; no Medicaid.
                                New York Clinic for Mental Health-150 5th. Avenue, CH 2-3778.
                                Catholic Charities Guidance Institute-122 East 22nd. Street open intake; I month
                                wait, Staff: 1 psychiatrist, I psychologist; 4 social workers.
                                Alfred Adler Mental Hygiene Clinic-333 Central Park West
                                American Foundation of Religious & Psychiatry-3 West  29th.  Street,  MU-6138,
                                Staff: ministers, priests, or rabbis in psychiatric training.
                                Girls & Boys Service League-138 East 19th. Street GR 3-4300.
                                Henry Street Settlement-265 Henry treet, OR 4-1100.
                                Hudson Guild Counselling-436 West 27th. Street, 2@1400.
                                Institute for Crippled & Disabled-400 First, Avenue, OR 9-0100. special groups
                                for obese and neurologically damaged, no geographic limit.

                                                            MEDICAID
                               1. Centers:
                                1. Main Center: 330 West 34th Street.
                                2. Local Centers: 451 Lenox Avenue (133rd Street).  Harlem  Hospital  (Women's
                                  Pavilion Rm 103).
                                207 W. 151st Steret.
                                2384 7th Avenue (139th Street).
                                254 St. Nicholas Avenue, (123rd Street).
                                75 Lenox Avenue (114th Street).
                              11. To Apply You Need to Bring:
                                1. Social security number.
                                2. Lasteightwagestubsor,earningstatementfromemployer.
                                3. Name of bank and amount of savings.
                                4. Amount of @@ and bonds.
                                5. Health insurance: name of company, policy number, amount of premiums.
                                6. Life insurance policies.
                                7. Veteran's serial number, veteran's administration claim number.
                                8. Medicare card (if over 65).
                                9. List of any medical expenses for current year.
                       111.  Medicaid Complaints:
                                1. Send letter to the mayor and.a copy to Mr. Hamp Coley, 330 West 34th Street,
                                New Work, N.Y.
                                2. For a complaint about a drug store:
                                a. Immediately call Elihu A. Gorelik, 790-3757.

           52


                                                               SUMMER 1968
                            b.  Send  letter  to  Mr.  Alex  Green,  Room  367,   senior   pharmacist,   Bureau   of
                                  Health Care Service 330 West 34th Street, New York, N.Y.
                               -the  complaint   should   state:
                                  (1) the name, address and phone number of the pharmacy.
                                  (2) the name, address and phone number of the patient.
                                  (3) the item (prescription) in question.
                      IV.  List of Medicaid Drug Stores in the Harlem Area:
                      America    Pharmacy,    1645     Lexington --------------------------------------   876-9981
                      Ascione Pharmacy, 2268 Ist               ------------------------------------------- AT  9-0811
                      Asbell   Pharmacy,   1600   St.   Nicholas ------------------------------------     WA  1-5994
                      Atwater     Pharmacy,     1404     Madison -------------------------------------    AT  9-0400
                      Beta Pharmacy, 1960 7th                  -------------------------------------------- MO  3-5567
                      Bishop    Pharmacy,    273    W.     125th ------------------------------------------ 864-0151
                      Black Rexall, 1882 3rd 5               ---------------------------------------------- EN  9-1350
                      Broadmoor    Pharmacy,    2675    Broadway ---------------------------------        AC  2-2914
                      Brown's Pharmacy, 159-06 Harlem River Dr     -           ---------------------------- AU  1-7242
                      Callipo, J., 2146 2nd  --------------------------------------             ----------- 534-9455
                      Cardinal   Drug   Store   II,   2338   2nd --------------------------------------   SA  2-0805
                      Cardinal  Drug  Store  I,  935   Amsterdam -----------------------------------      666-7039
                      Claremont    Chemists,    3181    Broadway ----------------------------------       MO 2-0220
                      Clunie      Pharmacy,      21      Convent ------------------------------------------- RI 9-6970
                      Cohen's   Drug   Store,   2101   Amsterdam ----------------------------------       LO 8-3763
                      Cohler's  Block  Drug  Store,   1938   3rd -----------------------------------      EN 9-8533
                      Cohn, David, 1990 2nd --------------------               ---------------------------- TR 6-2451
                      Cohn,      Nathan,      1596       Madison ------------------------------------------ LE 4-0151
                      Columbia    Chemists,    1121    Amsterdam ----------------------------------       UN 4-3773
                      Co-op    Drug    Co.,    376     Manhattan ---------------------------------------- AC 2-0668
                      D&S    Farmacia    Central,    2040    2nd ---------------------------------------- 722-7100
                      Delane      Pharmacy,      586       Lenox ------------------------------------------ PO  8-3777
                      Delcina      Pharmacy,      1741      Park ----------------------------------------- EN  9-6540
                      Dorris    Pharmacy,     1450     Lexington ---------------------------------------- 289-8012
                      Drug   Mart   Pharmacy,   326   W.   125th -----          ------------------------------ RI  9-0313
                      Dumbar Drugs, 2802 8th               ------------------------------------------------ 283-9055
                      Eighth    Ave.     Drugs,     2512     8th --------------------------------------------- 283-9636
                      Eldorado     Drugs,     2647      Broadway --------------------------------------   MO  2-6030
                      Embassy      Pharmacy,      2457       7th ---------------------------------------- AD  4-1800
                      Eureka      Pharmacy,       2500       7th ------------------------------------------- WA  6-5546
                      Farmacia   San   Martin,   3340   Broadway -------------------------------------    286-5853
                      Famous      Pharmacy,       1837       7th ----------------------------------------- MO  2-2070
                      Fein's     Ethical,     3586      Broadway --------         --------------------------------- 286-4344
                      Finldestein, L., 1863 2nd            ------------------------------------------------ 722-9388
                      Forman Drugs, 2630 8th               ------------------------------------------------ 281-1400
                                                                                                               -4703
                      Friedlands     Pharmacy,     574     Lenox -------------------------------------    WA 6
                      Globe     Pharmacy,     3361      Broadway --------------------------------------   WA 6-8900
                      George's   Gothic   Pharmacy,   2180   5th ------------------------------------     FO 8-0600
                      Ganbarg      Drug,      2810      Broadway ----------------------------------------- UN 4-0700
                      Godettes    Pharmacy,    2000    Amsterdam           --------------------------------- WA 7-9571
                      Gubins, J., 100 E. Ilith            ------------------------------------------------- 534-9876
                      Harlem  Cut  Rate  Drugs,  68   W.   116th --------------------------     ----------- 369-9766
                      Hart     Pharmacy,     1661      Amsterdam --------------------------------------   FO  8-8867
                      Hartly    Chemists,     1219     Amsterdam -------------------------------------    RI  9-8480
                      Heights   Pharmacy,   701   St.   Nicholas --------------------------------------   234-9803
                      Idell    Pharmacy,    302     E.     100th -------------------------------------------- 348-9880
                      Jaystone    Drug    Co.,     104     Lenox ---------------------------------------- EN  9-3636
                      Jomel       Pharmacy,       2069       2nd --------------r        ----------------------------- TR  6-8071
                      Kenwood-Peters Pharmacy, 144 W. 125th               --------------------------------- 865-1052
                      Kirschemer     Pharmacy,     1711      3rd ---------------------------------------- 831-3786
                      Langer      Drug,      3399       Broadway ------------------------------------------ AU  1-0500
                      Lasalle      Drug,      3143      Broadway ---------------7- - - - - - - - - - - - - - - - - -  -  -  -  -  -  -  -MO  2-6908
                                                                                                                              153


                           Lax Drug, 360 Lenox          ------------------------------------------------- EN 9-0365
                           Las Marias Pharmacy, 6138 Lexington          --------------------------------- SA 2-4627
                           Lato Drug Co., 2243 2nd         ---------------------------------------------- AT 9-0030
                           Lenox Terrace  Drugs,  20  W.  135th -------------------------------------   AU 6-2120
                           Lenox   Pharmacy,   145   E.   125th ---------------------------------------- SA 2-9305
                           i,inchon Pharmacy, 2310 8th         ------------------------------------------ MO 2-6915
                           Litvin Pharmacy, 2423 2nd         -------------------------------------------- SA 2-2053
                           Majestic  Pharmacy,  356  W.   145th --------------------------------------  AU 6-6780
                           Malach Pharmacy, 2185 8th        --------------------------------------------- 864-8114
                           Mills   Pharmacy,    2032    Madison ---------------------------------------- SA 2-3128
                           Mishkin, 1961 Amsterdam          --------------------------------------------- U 6-0
                           Morningside Hts. Pharmacy, 1302 Amsterdam          --------------------------- MO 6-4337
                           Morton   Pharmacy,   1693    Madison --------------------------------------- 722-9527
                           Mt.  Carmel   Pharmacy,   2325   lat --------------------------------------- TE 1-9876
                           Mt. Morris, 1931 Madison         --------------------------------------------- TR 6-4041
                           Pacific  Pharmacy,  1821   Amsterdam        ------------------------------------ AU 6-0960
                           Palmer   Theresa,   2395    Broadway --------------------------------------- SC 4-4800
                           Pharmacraft, 3645 Broadway         ------------------------------------------- AD 4-4528
                           Physicians Prescriptions Service, 2340 7th      ------------------------------ AU84052
                           Pleasant  Pharmacy,   363   Pleasant --------------------------------------  AT 9-5677
                           116 East Drug Corp.,  116  E.  125th       ------------------------------------ TE 1-1151
                           Raysol  Pharmacy,   1870   Lexington --------------------------------------- 348-2117
                           Rexall  Drug  Store,  1350   Madison --------------------------------------  TE 1-2354
                           Rio    Pharmacy,    3839    Broadway ---------------------------------------- LO 8-2880
                           Rico   Pharmacy,    170    Manhattan ------------------------------------------ 749-8317
                           St. Nicholas Pharmacy, 840 St. Nicholas      --------------------------------- AU 1-1700
                           S-0 Cutrate Drug Co., 1486 Lexington          -------------------------------- AT  94120
                           Santos   Pharmacy,   3419   Broadway ---------------------------------------- 9624298
                           Schaaf Pharmacy, 2149 8th           ------------------------------------------ MO 2-6019
                           Schreier's Pharmacy, 1878 Lexington         ---------------------------------- EN  94760
                           Sharff Inc., 350 W. 125th        --------------------------------------------- UN 4-6300
                           Shirnat   Rexall,   3559    Broadway --------------------------------------- AU 6-5790
                           Siegel's Drug Store,  111  E.  115th -------------------------------------   EN  94030
                           60 E. 125th Drug Corp., 60 E.  125th     -------------------------------------- 427-6610
                           Snow & Yeoman's Pharmacy, 3661 Broadway            --------------------------- AU 6-2940
                           Swan   Pharmacy,    3645    Broadway ----------------------------------------- 281-9990
                           Taft   Pharmacy,   1080    Amsterdam --------------------------------------  UN 4-8600
                           Terry Drugs, 3481 Broadway         ------------------------------------------ WA 6-6910
                           Theresa    Pharmacy,    104    Lenox ------------------------------------------ 369-9850
                           Theresa  Pharmacy,   3901   Broadway        ------------------------------------ WA 3-7617
                           Thomas,    John,    2601    Broadway ---------------------------------------- UN 4-6600
                           Tosan Drug, 3419 Broadway           ------------------------------------------ AU 3-6628
                           Trau Pharmacy, 2123 3rd          --------------------------------------------- EN  94013
                           Unity  Drug   Co.,   2621   Broadway ---------------------------------------- AC 2-4100
                           V&J Pharmacy, 2247 Ist       ------------------------------------------------- 348-2548
                           Vim Drug, 3817 Broadway            ------------------------------------------- WA 7-0220
                           Webster    Drug,    2509    Broadway ----------------------------------------- RI 9-3063
                           West  Side  Drugs,   3524   Broadway ---------------------------------------- 926-5500
                           Whelan, 145th & Broadway           ------------------------------------------- WA 6-3250
                           Whelan, 2802 Sth        ------------------------------------------------------ AU 6--3590
                           Whitehouse Pharmacy, Amsterdam & 122nd            ---------------------------- MO 6-7989
                           Williams Pharmacy, 2155 7th        ----------------------------------------- MO 2-2876

                                  ADDITIONAL      IMPORTANT      RESOURCES      OF      THE      COMMUNITY
                           Department of Health:
                               Dr. Harris-Commissioner in charge of child and maternal health.
                                      Dr. Pitkin-Director of School Health (566-7082)
                                      Dr. Frederickson-Director  of  Harlem  Health  Center  (AU  3-1900)
                                      Miss Ambrose-Central Harlem Director of Nursing

              154


                                                SUMMER  1968

                Harlem Consulner Education:
                    2325 7th Ave. (926-5300)
                Harlem Self Help:
                    179 W. 137th St. Rm 12A
                    1. Qualifications: 17-21 years of age fill out application.
                    2. Functions: 21 weeks of basic education in math, science, and english.
                HARYOU ACT:
                    Local Boards:
                                  No. 1 207 West 151st Street   368-7000.
                                  No. 2 2386 7th Avenue     862-3500.
                                  No. 3 451 Lenox Avenue     862-1166.
                                  No. 4 254 Saint Nicholas Avenue    666-6920.
                                  No. 5 Lenox Avenue      666-3935.
                Legal Aid Society:
                    It is not used very much because results depend very much on the lawyer one gets,
                    and because they will not handle any controversial cases.
                United Block Asso@tion  '-
                                       68 East 131st Street (281-6000, 234-3822)
                                       Mrs. Addie Patterson-Problem Broker
                                       Mrs. Testamark-Schools (20 West 128th Street 281-6307)
                                       Miss Brabham-Operator (6th floor)
                           Urban League:
                                       204 West 136th Street (AU 6-8000)
                                       Mr. Wingate-Director
                           City,wid@ Coordinating Committee For Welfare Rights
                                       514 West 126th Street (Amst. + Bdwy.) 3rd Floor
                                       Local: 2325 7th Avenue (131st St.) 926-5300
                                       2430 7th Avenue (141-2nd) 286-9399
                        FOR EMERGENCY PHYSICIAN IN MANHATTAN CALL 879-1000

                                                                 *U.S. GOVERNMENT PRINTING OFFICE,. 1969 0-355-232


                       U.S. DEPARTMENT OF HEALTH EDUCATION, AND WELFARE
                                                  I
                                         Public Health Service